Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis

Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumonia (IP) caused by leflunomide (LEF) were reported, but many of them were considered as the victims of opportunistic infection currently. In this paper, efficacy and safety of low-dose LEF classified by body weight (BW) were studied. Methods: Fifty-nine RA patients were started to administrate LEF from July 2007 to July 2009. Among them, 25 patients were excluded because of the combination with tacrolimus, and medication modification within 3 months before LEF. Remaining 34 RA patients administered 20 to 50 mg/week of LEF were followed up for 1 year and enrolled in this study. Dose of LEF was classified by BW (50 mg/week for over 50 kg, 40 mg/week for 40 to 50 kg and 20 to 30 mg/week for under 40 kg). The average age and RA duration of enrolled patients were 55.5 years old and 10.2 years. Prednisolone (PSL), methotrexate (MTX) and etanercept were used in 23, 28 and 2 patients, respectively. In case of insufficient response or adverse effect, dosage change or discontinuance of LEF were considered. Failure was defined as dosages up of PSL and MTX, or dosages down or discontinuance of LEF. Last observation carried forward method was used for the evaluation of failed patients at 1 year. Results: At 1 year after LEF start, good/ moderate/ no response assessed by the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score, including a 28-joint count (DAS28)-C reactive protein (CRP) were showed in 14/ 10/ 10 patients, respectively. The dosage changes of LEF at 1 year were dosage up: 10, same dosage: 5, dosage down: 8 and discontinuance: 11 patients. The survival rate of patients in this study was 23.5% (24 patients failed) but actual LEF continuous rate was 67.6% (11 patients discontinued) at 1 year. The major reason of failure was liver dysfunction, and pneumocystis pneumonia was occurred in 1 patient resulted in full recovery. One patient died of sepsis caused by decubitus ulcer infection. DAS28-CRP score was decreased from 3.9 to 2.7 significantly. Although CRP was decreased from 1.50 to 0.93 mg/dl, it wasn't significant. Matrix metalloproteinase (MMP)-3 was decreased from 220.0 to 174.2 ng/ml significantly. Glutamate pyruvate transaminase (GPT) was increased from 19 to 35 U/l and number of leukocyte was decreased from 7832 to 6271 significantly. DAS28-CRP, CRP, and MMP-3 were improved significantly with MTX, although they weren't without MTX. Increase of GPT and leukopenia were seen significantly with MTX, although they weren't without MTX. Conclusions: It was reported that the risks of IP caused by LEF in Japanese RA patients were past IP history, loading dose administration and low BW. Addition of low-dose LEF is a potent safe alternative for the patients showing unsatisfactory response to current medicines, but need to pay attention for liver function and infection caused by leukopenia, especially with MTX. Disclosure statement: The authors have declared no conflicts of interes

Public Procurement Regulation in Africa

Please help populate SUNScholar with the full text of SU research output. Also - should you need this item urgently, please snd us the details and we will try to get hold of the full text as quick possible. E-mail to [email protected]. Thank you.RegsgeleerdheidPubliekre

The Reform and Regulation of Public Procurement in Nigeria

RegsgeleerdheidPubliekregPlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Defining “Talent”: Insights from Management and Migration Literatures for Policy Design

Taking the case of defining “talent,” a term that has been widely used but its definitions differ by discipline, organization, policy sector, as well as over time, we demonstrate how the basic definition of a policy subject may affect policy design and the assessment of policy outcomes. We review how “talent” is defined in two sets of literature, talent management and migration studies, and find that definitions fall under one of two categories: binary (“talent” as qualities) or composite (“talent” as a relational concept). The implications of our findings are epistemological and ontological; the findings point to diverse epistemological effects of definitions through developments of indicators, as expected, and they also reveal the policy designers’ ontological starting points. Ontological perspectives are significant because they ultimately determine whether the policy assessments carried out differ in degrees or in kind. In the case of defining “talent,” this means determining which objectives the designers would set (e.g., recruiting vs. cultivating vs. introducing competition), the policy instrumentation for achieving the goals (migration measures vs. education vs. lifelong learning vs. human resource policy), and the type of assessment for measuring policy outcomes (single vs. multiple indicators, qualitative vs. quantitative).Accepted versio