Juliana de Oliveira Costa

Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis

To evaluate the safety of regimens containing calcineurin inhibitors (CNI), proliferation signal inhibitors (TOR-I) and antimetabolites, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies. A total of 4,960 citations were identified in our electronic search and 14 additional articles were identified through hand searching. Forty-eight articles (11,432 participants) from 42 studies (38 RCTs and four cohorts) met the inclusion criteria. Meta-analysis results revealed the following: (i) tacrolimus was associated with an increased risk for diabetes and lower risk of dyslipidemia, compared to cyclosporine; (ii) mycophenolate mofetil (MMF) was associated with increased risk for total infections, abdominal pain, diarrhea and vomiting, compared with azathioprine; (iii) sirolimus was associated with higher risk of anemia, diabetes, dyslipidemia, lymphoceles and withdrawal compared to tacrolimus or cyclosporine, and cyclosporine was associated with an increased risk of CMV infection; (iv) the combination of CNI with antimetabolites was associated with more adverse events than CNI alone; (v) TOR-I was related to more adverse events than MMF. The data observed in this meta-analysis are similar to those describe by others authors; thus, the choice of treatment must be made by the clinical staff based on specific patient characteristics.

Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia

ABSTRACT Background: In Zambia, antibiotics are categorized as prescription-only medicines. Antibiotics dispensed without a prescription pose a public health threat, which is a concern. Consequently, the aim is to ascertain the extent of non-prescription sales and dispensing of antibiotics in community pharmacies in Zambia. Methods: The practice of non-prescription sale and dispensing were assessed in 73 randomly selected community retail pharmacies, using a structured interviewer-administered questionnaire with simulated case scenarios. Results: Majority (97%) stated that clients frequently requested non-prescribed antibiotics. Interviewees usually asked clients’ indications (94%), counselled on dosing (96%) and suggested changes to antibiotic choices (97%). All (100%) dispensed non-prescribed antibiotics. Commonly dispensed antibiotics included amoxicillin (52%), cotrimoxazole (25%) and metronidazole (23%). Non-prescription sale and dispensing of antibiotics was significantly associated with interviewees’ professional qualification in four out of five simulations. Conclusion: Non-prescription sale and dispensing of antibiotics is widespread in Zambia. Concerted public and professional interventions are needed coupled with stronger regulatory enforcement to reduce this.

Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil

OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation. METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results. RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R

Implementation of clinical guidelines in Brazil: should academic detailing be used?

78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R

Tratamento da artrite reumatoide no Sistema Unico de Saude, Brasil: gastos com infliximabe em comparacao com medicamentos modificadores do curso da doenca sinteticos, 2003 a 2006

61,350.44. CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. However, regimens containing cyclosporine were more cost-effective.

Adalimumab in rheumatoid arthritis treatment: a systematic review and meta-analysis of randomized clinical trials

The Brazilian National Health System provides high cost medicines through the Specialized Component of Pharmaceutical Assistance in accordance with the adherence to agreed Clinical Guidelines. However, physician compliance to these Guidelines, as well as the barriers and facilitators related to them and the influence on the subsequent quality of care provided is unknown. Consequently, the objectives of this article are to undertake a review of international experiences and scientific publications of a strategy to disseminate and communicate guidelines to physicians through Academic Detailing. Subsequently, use the findings to develop and conduct a pilot Academic Detailing Programme in Brazil targeting specialists who prescribe medicines for patients with Alzheimers disease, which are part of the Specialized Component of Pharmaceutical Assistance.

Initiatives across countries to reduce antibiotic utilization and resistance patterns: impact and implications

This study aimed to characterize the profile of users and related expenses with infliximab and synthetic disease-modifying anti-rheumatic drugs (DMARD) for rheumatoid arthritis treatment in the Brazilian Unified National Health System (SUS). We constructed a cohort from 2003 to 2006 drawing on databases of the SUS Outpatient Information System. Analyses were stratified by clinical and socio-demographic characteristics. We calculated average monthly expenditure per individual follow-up year and the factors that influenced it. The cohort consisted of 26,228 patients, mostly female, between 40 and 59 years of age, living in the Southeast of Brazil, and diagnosed with Feltys syndrome. Medicines for rheumatoid arthritis totalized BRL 74,306,087.18, of which infliximab accounted for 70%. Median monthly per capita expenditure was BRL 3,466.03 for patients receiving infliximab compared to BRL 143.85 for patients treated with synthetic DMARD. Drug treatment for rheumatoid arthritis was the main expense in SUS, with high economic impact from infliximab. Sex, diagnosis, age, and region of residence were factors that influenced expenditures.Este trabajo caracterizo el perfil de los usuarios y los gastos con infliximab y farmacos modificadores de la enfermedad (FARME) sinteticos para tratamiento de la artritis reumatoide en el Sistema Unico de Salud (SUS), Brasil. Se construyo una cohorte de 2003-2006 a partir de bases de datos del Sistema de Informacion Ambulatorio de SUS y los analisis fueron estratificados por caracteristicas clinicas y sociodemograficas. Se calculo el promedio de gasto per capita mensual por ano de seguimiento y los factores que influyeron en el. Fueron incluidos 26.228 pacientes, la mayoria mujeres, entre 40-59 anos que vivian en Sudeste y con diagnostico del sindrome de Felty. Se gastaron R

Rituximab for rheumatoid arthrits treatment: a systematic review

74.306.087,18 con medicamentos para la artritis reumatoide. El gasto medio mensual per capita fue de R

Ten-year kidney transplant survival of cyclosporine- or tacrolimus-treated patients in Brazil

3.466,03 en pacientes que utilizaran infliximab frente a R

Infliximabe, metotrexato e sua combinação no tratamento da artrite reumatoide: revisão sistemática e metanálise

143,85 para los que usaron FARME sinteticos. El tratamiento farmacologico de la artritis reumatoide fue el principal gasto en el SUS, con alto impacto economico debido al infliximab. El sexo, diagnostico, edad y region de residencia fueron factores que influyeron en el gasto.