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Efficacy, Safety and Economic Evaluation of Treatments for Rheumatoid Arthritis (pp.125-152) $100.00
Authors:  (Roberto Pontarolo, Astrid Wiens, Cassyano Januário Correr, Luana Lenzi, Rafael Venson, Universidade Federal do Paraná, Brazil)
Abstract:
Rheumatoid arthritis (RA) is an immune-mediated systemic inflammatory disease of unknown etiology. Patients with may develop permanent deformity of joints, functional limitation that progresses over time, and reduction of life expectancy, besides other consequences like joint destruction and bone and cartilage erosion. The prevalence is about 1% of population, mainly in people aged 40–60 years and affects more women than men. Although the etiology remains unknown, it is known that tumor necrosis factor-α (TNF-α) plays an important role in RA pathogenesis, leading to synovitis and joint destruction.There are some important parameters that have to be evaluated by choosing a therapy, which are the efficacy and safety of available drugs and also the cost of these drugs for the health system and society. When choosing one of the biologic drugs, it is important to evaluate the efficacy and safety of each one. This has been done through systematic review and meta-analysis of 21 randomized, placebo-controlled trials (eight adalimumab, seven infliximab, six etanercept). With short-term treatment (12–30 weeks), etanercept demonstrated the highest risk ratios for reaching ACR20 and ACR50 (efficacy parameters). Adalimumab demonstrated the highest risk ratio for achieving ACR70. Over a long-term treatment course (1–3 years), adalimumab demonstrated the highest risk ratio for the three parameters. No statistically significant differences were noted in the safety of any of the three drugs. Infliximab had the highest risk ratio for withdrawing from the study due to lack of efficacy and adverse events. Clinicians should be aware that each of the three drugs has different rates of efficacy and different safety considerations that must be taken into account when selecting the best treatment for an individual with rheumatoid arthritis. The cost of each therapy is also an important parameter that should to be assessed before the treatment. There is great difference in cost between the three
Rheumatoid arthritis (RA) is an immune-mediated systemic inflammatory disease of unknown etiology. Patients with may develop permanent deformity of joints, functional limitation that progresses over time, and reduction of life expectancy, besides other consequences like joint destruction and bone and cartilage erosion. The prevalence is about 1% of population, mainly in people aged 40–60 years and affects more women than men. Although the etiology remains unknown, it is known that tumor necrosis factor-α (TNF-α) plays an important role in RA pathogenesis, leading to synovitis and joint destruction.There are some important parameters that have to be evaluated by choosing a therapy, which are the efficacy and safety of available drugs and also the cost of these drugs for the health system and society. When choosing one of the biologic drugs, it is important to evaluate the efficacy and safety of each one. This has been done through systematic review and meta-analysis of 21 randomized, placebo-controlled trials (eight adalimumab, seven infliximab, six etanercept). With short-term treatment (12–30 weeks), etanercept demonstrated the highest risk ratios for reaching ACR20 and ACR50 (efficacy parameters). Adalimumab demonstrated the highest risk ratio for achieving ACR70. Over a long-term treatment course (1–3 years), adalimumab demonstrated the highest risk ratio for the three parameters. No statistically significant differences were noted in the safety of any of the three drugs. Infliximab had the highest risk ratio for withdrawing from the study due to lack of efficacy and adverse events. Clinicians should be aware that each of the three drugs has different rates of efficacy and different safety considerations that must be taken into account when selecting the best treatment for an individual with rheumatoid arthritis. The cost of each therapy is also an important parameter that should to be assessed before the treatment. There is great difference in cost between the three 


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Efficacy, Safety and Economic Evaluation of Treatments for Rheumatoid Arthritis (pp.125-152)