itunes 9.0.3 64 bit download

Name: itunes 9.0.3 64 bit download
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Published: kunfatipo1976
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Promonitor 9.1 downloads.
Abstract Number: 598.
Economic Impact of Decreasing Adalimumab and Etanercept Doses and Drug Monitoring in Patients with Rheumatoid Arthritis in Clinical Remission: Preliminary Study from a Local Biologics Unit.
José Rosas 1 , Francisca Llinares-Tello 2 , José Miguel Senabre 1 , Gregorio Santos-Soler 1 , Esteban Salas-Heredia 1 , Xabier Barber 3 , Ana Pons 4 , Catalina Cano 4 , Marisa Lorente 5 and Juan Molina 6 , 1 Rheumatology, Hospital Marina Baixa, Villajoyosa, Spain, 2 Clinical Analysis, Hospital Marina Baixa, Clinical Analysis, Villajoyosa, Spain, 3 Centro de Investigación Operativa, Miguel Hernández University, Elche, Spain, 4 Hospital Marina Baixa, Nursing, Villajoyosa, Spain, 5 Marina Baixa Hospital, Nursing, Villajoyosa, Spain, 6 Hospital Marina Baixa, Clinical Analysis, Villajoyosa, Spain.
Date of first publication: September 29, 2015.
Session Information.
Session Type: ACR Poster Session A.
Session Time: 9:00AM-11:00AM.
Background/Purpose: To evaluate the economic impact of adalimumab (ADL) and etanercept (ETN) dose reduction (by decreasing treatment frequency) and drug monitoring in patients with rheumatoid arthritis (RA) in clinical remission.
Methods: ADL, ETN and anti-drug antibody levels were measured using Promonitor-ADL, Promonitor-ETN, Promonitor-Anti-ADL and Promonitor-Anti-ETN ELISA kits (Progenika, Grifols, Spain), respectively, during 2013-2014. Cut-points for ADL and ETN levels were 0.024 and 0.035 mg/L, respectively, and for Anti-ADL and Anti-ETN antibodies 3.5 and 132 AU/mL, respectively. Sera were drawn immediately before each injection. Clinical remission was defined as sustained DAS28-ESR≤2.6 during 6 consecutive months. The following was collected: RA progress, time on biologic treatment, reason for drug withdrawal or for resuming the conventional frequency, ultrasound activity index (Doppler) in 12 joints, and basal (ADL every 14 days; ETN every 7 days) and decreased (ADL every 18-21-28 days; ETN every 10-14 days) frequencies. Annual doses avoided were calculated for the modified frequency of ADL (every 18 days: 5.8 doses; every 21 days: 8.7 doses and every 28 days: 13 doses) and ETN (every 10 days: 15.5 doses and every 14 days: 26 doses). Savings during the two years, and the theoretical number of patients that could have been treated with costs saved were calculated (ADL and ETN dose prices were 500€ and 250€, respectively).
Results: Drug and anti-drug antibody levels were measured in 45 RA patients accounting for a total of 94 tests. 87% of patients were women, average age of 60.5±18 years. Average disease duration was 15±9.8 years and average ADL and ETN treatment durations were 5.2±1.3 and 5.1±1.8 years, respectively. Average time of decreased treatment frequency for both drugs was 1.2±0.7 years. ADL and ETN was the first line biological drug in 73% and 37% of patients, respectively. Synthetic DMARDS were given in 100% and 78% of patients on ADL and ETN, respectively. 87% of patients with a modified dosing frequency maintained clinical remission. Two ADL patients (7%, those treated every 18 days) resumed the conventional frequency and 4 ETN patients (22%, 3/75% treated every 10 days and 1/25% treated every 14 days: average of 6 months on modified frequency). Anti-drug antibodies were not detected in any patient after 1 year follow up. Table 1 summarizes clinical, drug monitoring and impact of savings data. During 2013 and 2014 22 RA patients started biologic therapy. Cost savings consequence of optimization allowed treatment of 22 new patients during 1 year.
Conclusion: Decreasing ADL and ETN dosing frequency with sustained clinical activity is possible in RA patients in remission by monitoring disease activity and serum drug levels. Dose optimization enables significant savings. Antibodies are not detected in patients with a decreased treatment frequency. It is likely that patients with a long term remission require less drug level.

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