Linda Ibatá - Academia.edu (original) (raw)
Papers by Linda Ibatá
Clinical Rheumatology, Dec 19, 2023
JCO global oncology, Feb 1, 2024
Biomedicines, Mar 1, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Annals of the Rheumatic Diseases, May 19, 2021
patients, was used to determine methotrexate (MTX) intolerance prevalence in RA patients. The MIS... more patients, was used to determine methotrexate (MTX) intolerance prevalence in RA patients. The MISS consisted of four domains: abdominal pain, nausea, vomiting, and behavioral symptoms, occurring before (anticipatory), after, and when thinking of MTX (associative). MTX intolerance was defined as six or more points on the MISS. Our statistical analysis was based on a descriptive study and logistic regression with SPSS20. Results: We included 102 RA patients with a mean age of 51.60 ± 14.33 years, Women were predominant (93.1%). The mean disease duration was 14.86 ± 9.78 years, with a mean methotrexate use duration of 7.42 ± 6.44 years. The mean dose of methotrexate was 12.13 ± 9.06 mg per week. The prevalence of methotrexate intolerance was 55.9%, and seventy-six patients (74.5 %) experienced at least one gastrointestinal symptom during MTX treatment. After MTX administration, the most prevalent gastrointestinal symptom was nausea (93% of the intolerant patient), whereas abdominal pain occurred in 73.7% and vomiting in 57.9%. These symptoms were also prevalent before and when thinking of MTX. Anticipatory nausea was reported in 45.6% and associative nausea in 54.5% of the cases, abdominal pain occurred anticipatory in 22.8% and associative in 42.1 %, anticipatory vomiting was the least prevalent, affecting 8.8 %. Behavioral symptoms affected 87.7% of intolerant patients, with restlessness being the most prominent symptom in 71.9% of them. Among the intolerant patients, 45 patients (79%) took parenteral MTX, and 12 (21.1%) took methotrexate orally. In comparison, young patients (49.11 ± 14.95 years) were more intolerant to MTX than old (54.76 ± 13 years, p = 0.048) ones. However, in univariate logistic regression analysis, we did not find any significant association between methotrexate administration route, dose, duration, and digestive intolerance. Conclusion: Methotrexate intolerance was highly prevalent in our RA population. These results strengthen the idea that early detection of MTX intolerance may avoid effective treatment discontinuation, especially in younger patients. REFERENCES: [1] Bulatović M, Heijstek MW, Verkaaik M, van Dijkhuizen EH, Armbrust W, Hoppenreijs EP et al. High prevalence of methotrexate intolerance in juvenile idiopathic arthritis: development and validation of a methotrexate intolerance severity score.
Annals of the Rheumatic Diseases, May 19, 2021
Background: A personalized approach to prescribing targeted drugs implies the availability of dat... more Background: A personalized approach to prescribing targeted drugs implies the availability of data that can be used to suggest that a particular drug is better suited for a given patient than others. Retention on the treatment can be considered as an integral indicator of the acceptability of the drug in real practice. For the purposes of treatment personalization, the indicators that are associated with better retention on some drugs and with worse retention, or that do not have a clear association with retention on others, are of particular interest. Objectives: to identify predictors those are differently associated with retention on different targeted drugs for the treatment of rheumatoid arthritis. Methods: Data of the patients with rheumatoid arthritis (RA) from the Moscow Unified Register of Arthritis (MUAR) were used. The analysis includes episodes of treatment with biological or synthetic targeted drugs (tDMARDs) that continue or end during the patient's follow-up in the registry. Within the framework of the Cox proportional risk regression model, significant independent predictors of tDMARDs cancellation were identified. These indicators were later considered as confounders. Further, in the generated linear regression risk model, all available indicators were tested for the presence of a statistically significant interaction with the factor of used tDMARD. Results: The study included 944 episodes of tDMARDs treatment (Table 1.) in 832 patients. The average age is 55.3 + 12.4 years. There were 131 males (16.1%). The average duration of the disease is 13.1 + 9.4 years. Smoking, family history of RA, and the nature of RA onset (acute or gradual) were identified as reliable mutually independent predictors of retention on tDMARDs treatment. As a result of the search for indicators that reliably interact with used tDMARD, patient's reports of the association of the onset of arthritis 1) with symptoms of intestinal dyspepsia (p < 0.001), 2) with genital inflammatory disease (p = 0.002) were revealed. Most strongly associated with factor 1) was retention on abatacept (ABA), rituximab (RIT), and tofacitinib (TOFA). The second indicator was most strongly associated with retention on ABA, adalimumab (ADA) and TOFA (Picture 1).
Open Access Rheumatology : Research and Reviews, Nov 1, 2022
Rheumatoid arthritis is a prevalent worldwide disease, associated with an increased risk of multi... more Rheumatoid arthritis is a prevalent worldwide disease, associated with an increased risk of multiple metabolic abnormalities that generate a higher disease burden. Objective: To gather the available evidence on the epidemiology, pathophysiology, current perspectives, clinical implications and prognosis of metabolic abnormalities in patients with rheumatoid arthritis. Methods: This is a narrative literature review. Search was conducted in PubMed, OVID, and Taylor & Francis databases, using the following MeSH terms: "Arthritis Rheumatoid", "Metabolic Diseases", and "Metabolic Syndrome". Results: This study describes the main metabolic manifestations of rheumatoid arthritis. Research has recognized that rheumatoid arthritis and metabolic abnormalities share pathophysiological mechanisms with an additive effect that increases cardiovascular risk. In that context, appropriate antirheumatic treatment can also impact on cardiovascular risk. Conclusion: There are metabolic abnormalities in rheumatoid arthritis patients that increase cardiovascular risk. Therefore, it is crucial to evaluate cardiovascular risk to provide appropriate comprehensive management to reduce morbidity and mortality in patients with this disease.
Annals of Oncology, Sep 1, 2021
Open Access Rheumatology: Research and Reviews
To describe clinical characteristics and effectiveness of health care in patients with rheumatoid... more To describe clinical characteristics and effectiveness of health care in patients with rheumatoid arthritis (RA) as part of a multidisciplinary care model (MCM) in a specialized rheumatology center, compared with the results of a national registry of RA (NARRA) as evidence of real-world management. Patients and Methods: We conducted a real-world study (July 1, 2018 to June 30, 2019) based on an analysis of electronic health records of a cohort of RA patients managed with the "Treat-to-Target" strategy in a specialized rheumatology center in Colombia with an MCM, compared with the NARRA that includes different models of usual care. Results: We have analyzed 7053 subjects with RA treated at a specialized rheumatology center and 81,492 patients from the NARRA. Cohorts were similar in their baseline characteristics, with women in predominance and diagnosis age close to 50 years. At the time of diagnosis, a higher proportion of clinical diagnostic test use and rheumatology consultation access was observed in the specialized rheumatology center than in the national registry (4-6 per year versus three or less). In addition, higher proportions of patients in remission and low disease activity were reported for the specialized rheumatology center, with a >40% amount of data lost in the national registry. Pharmacological management was similar regarding the analgesic use. In the specialized center, Certolizumab was more frequently used than in the NARRA registry; also, there were significant differences in methotrexate, leflunomide, and sulfasalazine use, being higher in the specialized rheumatology center. Conclusion: The MCM of a specialized center in RA can guarantee comprehensive care, with better access to all the services required to manage the disease. It ensures specialist management and evidence-based care that facilitates the achievement of therapeutic objectives. In addition, better patient records and follow-ups are available to evaluate health outcomes.
Revista Colombiana de Reumatología
Frontiers in drug safety and regulation, Jan 9, 2023
Introduction: The antimalarials chloroquine and hydroxychloroquine have been used for several dec... more Introduction: The antimalarials chloroquine and hydroxychloroquine have been used for several decades in treating malaria and some autoimmune diseases-mainly rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)-with excellent efficacy and safety. Due to the massive use of antimalarials worldwide for managing SARS-CoV-2/COVID-19 infection during the last 2 years and the consequent increase in cardiac arrhythmia, fear has risen about the safety of using antimalarials, especially for patients with increased cardiovascular risk. Objective: To describe a real-life experience about the safety of antimalarials in the setting of a single rheumatological center in Colombia. Methods: This is a cross sectional study that includes patients diagnosed with RA and treated with antimalarials between 2020 and 2021. Clinical follow-up information was gathered from the medical records, and all reported adverse events were described. Results: A total of 957 patients were included, primarily women (79.2%). The most frequent comorbidities were hypertension and osteoporosis. Chloroquine use was more frequent than hydroxychloroquine (86.4% vs. 13.6%). During the observation period, 243 (25.4%) patients presented at least one adverse event, 72 (29.6%) had retinal toxicity, 85 (35%) dermatological events, and 81 (33.3%) gastrointestinal intolerance. Other adverse events reported less frequently (15.2%) included headache, dizziness, lipothymia, and elevated transaminases. There were no reports of cardiovascular events from the period of antimalarial use to the date of data collection despite the high frequency of previous metabolic or cardiovascular disease in this cohort. Conclusion: This study reasserts the evidence of antimalarials safety profile for patients with rheumatological conditions such as RA. RA patients that were treated with antimalarials at doses recommended by the guidelines had no cardiovascular events.
Journal of Translational Autoimmunity
Biologics: Targets and Therapy
Tofacitinib is recommended for treatment of rheumatoid arthritis (RA) in patients with moderate t... more Tofacitinib is recommended for treatment of rheumatoid arthritis (RA) in patients with moderate to severe disease activity, but there is not enough evidence on its effectiveness after conventional DMARDs vs its use after biologics. The aim was evaluating the effectiveness of tofacitinib in RA as first-line treatment (after conventional DMARDs) in a real-life setting in Colombian (Latin-American) patients. Patients and Methods: Retrospective cohort study conducted at a specialized center for RA management. A complete statistical analysis was performed to compare the values of the change in the DAS28 at months 3, 6, and 12 in both treatment groups. Results: A total of 152 RA patients who received tofacitinib: first-line 85 patients (55.9%) after failure on conventional DMARDs or second-line 67 patients (44.1%) after failure on biologic DMARDs. Comparative analysis of response to treatment showed a reduction in DAS28 at 3, 6, and 12 months in both study groups without statistical differences, but a higher proportion of firstline patients achieved remission (45% vs 23%). Nonresponse at three months were associated with no response at six months of follow-up. Baseline DAS28 was significantly associated with response at 12 months (OR: 1.87, 95%CI: 1.06-3.30, p-value 0.028). In second-line patients, response to tofacitinib was not related to number of biologic DMARDs previously used. Conclusion: Tofacitinib is an effective treatment option for patients with RA, maybe better after conventional DMARDs than after biologic therapy failure. Further studies are required to determine the role of tofacitinib in different lines of RA treatment and in other groups of patients.
Biomédica
Introducción. La detección del virus del papiloma humano mediante la combinación de la prueba de ... more Introducción. La detección del virus del papiloma humano mediante la combinación de la prueba de HPV y otras técnicas como la citología, ha demostrado su eficacia en el diagnóstico y tratamiento oportuno de lesiones asociadas con el cáncer de cuello uterino.Objetivo. Estimar el impacto presupuestal de la estrategia de detección temprana del HPV mediante la prueba de genotipificación combinada con la citología en comparación con la citología convencional, en mujeres de 30 a 65 años participantes en el programa de tamizaje de cáncer de cuello uterino en una Entidad Administradora del Plan de Beneficios en salud (EAPB) en Colombia.Materiales y métodos. Utilizando un árbol de decisiones y un modelo de Markov, se estimaron las implicaciones clínicas y los costos directos anuales de dos ciclos de tamizaje, diagnóstico y tratamiento, en una cohorte de mujeres. Las prevalencias de los resultados clínicos y los costos se tomaron de la base de datos de una EAPB y la información de la progresi...
Archivos en Medicina Familiar, Nov 28, 2018
El dolor lumbar es una causa frecuente de consulta en los servicios de salud donde es insuficient... more El dolor lumbar es una causa frecuente de consulta en los servicios de salud donde es insuficientemente reconocido y tratado. Esta patología genera costos importantes derivados de la atención médica directa y de la pérdida de productividad secundaria a la incapacidad asociada. El propósito de este documento es brindar una orientación basada en la eficacia, efectividad y seguridad de las alternativas disponibles, para el tratamiento farmacológico y no farmacológico del dolor lumbar en contextos no especializados. Las recomendaciones recopiladas provienen de guías de manejo publicadas por organizaciones reconocidas a nivel mundial como la American College of Physicians and the American Pain Society, National Institute for Health and Care Excellence (NICE), National Guideline Clearing House y de otras fuentes consideradas de interés. Las indicaciones mundiales han sido revisadas y ajustadas a la realidad de la práctica colombiana, pueden no aplicar para todos los pacientes o todas las situaciones clínicas y no pretenden reemplazar el criterio médico sobre la evaluación individual de casos. Las recomendaciones recopiladas aquí brindan una directriz acerca del diagnóstico, tratamiento farmacológico y no farmacológico, seguimiento y remisión del paciente con dolor lumbar. El conocimiento basado en la evidencia se configura como la piedra angular de un tratamiento integral, impactando tanto en la calidad de vida y disminución de la discapacidad, como en la reducción de los gastos al sistema de salud asociados con la atención y manejo de esta condición.
Biomedicines, 2022
Background: Novel combination therapies have been shown to improve the outcomes of treatment-naiv... more Background: Novel combination therapies have been shown to improve the outcomes of treatment-naive patients with locally advanced or metastatic renal cell carcinoma (aRCC). However, the optimal systemic therapy for aRCC of favorable risk has yet to be clarified. We aimed to evaluate the efficacy and safety of different immunotherapy (IO) combinations, either with another IO (IO–IO) or with an antiangiogenic (IO–TKI), versus sunitinib in the first-line setting in aRCC patients with favorable IMDC risk. Methods: We conducted a systematic search for evidence in PubMed, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials published up to February 2021. The GRADE approach was used to assess the quality of evidence. Survival hazard ratios were extracted for analysis in the favorable-risk aRCC subgroup (IMDC). A sensitivity analysis was performed excluding trials of combination therapy without TKI. Results: Five randomized controlled phase III trials with a total of...
Journal of Clinical Oncology, 2020
374 Background: In order to improve long term results for high-risk prostate cancer, several clin... more 374 Background: In order to improve long term results for high-risk prostate cancer, several clinical trials have tested the addition of docetaxel chemotherapy. The outcomes of this trials have not led to clear conclusions. We conducted a meta-analysis of randomized phase 3 trials testing the efficacy of docetaxel after radiotherapy in high risk prostate cancer patients. Methods: A systematic review of PubMed (Medline), Embase and the Cochrane Library was conducted. We followed the PRISMA guidelines, three investigators independently selected the articles and verified inclusion criteria. We compared the overall survival and disease-free survival between the intervention group (adjuvant chemotherapy with docetaxel) and the control group (without adjuvant chemotherapy) by calculating the hazard ratio (HR) with 95% confidence intervals (CIs). Pooled effects were calculated using random-effects or fixed-effects models based on the heterogeneity of included studies. Results: 382 publicat...
Indian Journal of Urology, 2019
Introduction: Sentinel lymph node biopsy (SLNB) was designed as a minimally invasive method for e... more Introduction: Sentinel lymph node biopsy (SLNB) was designed as a minimally invasive method for evaluation of nodal involvement in patients with penile cancer and nonpalpable lymph nodes. Nevertheless, SLNB is not used in a regular basis due to the lack of studies that adequately characterize the performance of this procedure. The purpose of this study was to evaluate the diagnostic performance of SLNB in patients with infiltrative penile carcinoma without palpable inguinal lymph nodes in a Colombian population. Materials and Methods: This is a retrospective observational study of 89 patients diagnosed with infiltrative penile squamous cell carcinoma with nonpalpable inguinal lymph nodes. These patients underwent partial or complete penectomy, along with SLNB, between 2008 and 2017. Those individuals with a positive SLNB underwent inguinal lymphadenectomy, while those with a negative SLNB were followed on a quarterly basis with a physical examination and imaging to assess relapse. Statistical analysis was done using the STATA 14 software. A contingency table was made to calculate sensitivity, specificity, positive predictive value, negative predictive value, and exactitude, each one with its own confidence interval (CI) of 95%. Results: There was an average follow-up of 31.4 months, and all 89 patients were evaluated; most primary tumors were T2 (55%), followed by T1 (37%), all of which were subclassified as T1b and T3 (8%). Tumours were most frequently located in the glans (43%). All patients were classified as cN0 and underwent SLNB. Sixty-one patients (69%) tested negative in the SLNB, four of whom (6%) presented with lymph node relapse. On the other hand, 28 patients (31%) tested positive in the SLNB and consequently underwent inguinal lymphadenectomy, seven of whom had negative lymph nodeinvolvement (25% false positives). According to the results, the sensitivity was 84% (95% CI, 65.3–93.6) and the specificity was 89% (95% CI, 79.4–94.7), with a false-negative rate of 6.5%. Conclusions: The SLNB using radiotracer can be a useful method for lymph node staging in patients with penile cancer and nonpalpable lymph nodes when performed in experienced centers.
,celular 3103200354. RESUMEN Objetivo General: Establecer la frecuencia de Carcinoma de Seno Basa... more ,celular 3103200354. RESUMEN Objetivo General: Establecer la frecuencia de Carcinoma de Seno Basal Like en pacientes femeninas con Carcinoma Ductal Infiltrante de fenotipo triple negativo del 2008 al 2012, con la expresión de Factor de Crecimiento Epidérmico y Citoqueratina 5/6 en el Hospital Militar Central. Metodología: Estudio descriptivo de corte transversal. Del total de pacientes diagnosticadas con Carcinoma Ductal infiltrante en el Hospital militar central del 2008 al 2012, se seleccionaron las pacientes que presentaban fenotipo triple negativo (Receptores de Estrógenos, Receptores de y Herb 2 negativos). Posteriormente, estos casos fueron revisados para determinar el bloque representativo de tumor y se realizaron nuevos marcadores de inmunohistoquímica Factor de Crecimiento Epidérmico y Citoqueratina 5/6 en el laboratorio de patología del Hospital Militar Central, con personal entrenado y equipos específicos para dicha actividad. Resultados: De 117 pacientes con diagnóstico de Carcinoma Ductal Infiltrante, 25 casos correspondientes al 21.4% fueron triple negativos, de estos 18 casos cumplieron con todos los criterios de inclusión para el presente trabajo. A estos 18 casos se les realizó un nuevo panel de inmunohistoquímica con Citoqueratina 5/6 y Factor de Crecimiento Epidérmico. Diez de los 18 casos correspondientes al 55.5% de los casos incluidos, fueron simultáneamente positivos para Citoqueratina 5/6 y Factor de Crecimiento Epidérmico, permitiendo así clasificarlos como Carcinoma Basal Like. El promedio de edad de las pacientes con carcinoma basal Like fue de 56 años con un rango entre 31 y 81, 9 de las 10 pacientes tenían entre 51 y 81 años y 1 de ellas tenía 31 años. Conclusiones: La frecuencia de Carcinoma Basal Like corresponde al 8,55% de la población estudiada encontrándose dentro del rango reportado en la literatura internacional.
Clinical Rheumatology, Dec 19, 2023
JCO global oncology, Feb 1, 2024
Biomedicines, Mar 1, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Annals of the Rheumatic Diseases, May 19, 2021
patients, was used to determine methotrexate (MTX) intolerance prevalence in RA patients. The MIS... more patients, was used to determine methotrexate (MTX) intolerance prevalence in RA patients. The MISS consisted of four domains: abdominal pain, nausea, vomiting, and behavioral symptoms, occurring before (anticipatory), after, and when thinking of MTX (associative). MTX intolerance was defined as six or more points on the MISS. Our statistical analysis was based on a descriptive study and logistic regression with SPSS20. Results: We included 102 RA patients with a mean age of 51.60 ± 14.33 years, Women were predominant (93.1%). The mean disease duration was 14.86 ± 9.78 years, with a mean methotrexate use duration of 7.42 ± 6.44 years. The mean dose of methotrexate was 12.13 ± 9.06 mg per week. The prevalence of methotrexate intolerance was 55.9%, and seventy-six patients (74.5 %) experienced at least one gastrointestinal symptom during MTX treatment. After MTX administration, the most prevalent gastrointestinal symptom was nausea (93% of the intolerant patient), whereas abdominal pain occurred in 73.7% and vomiting in 57.9%. These symptoms were also prevalent before and when thinking of MTX. Anticipatory nausea was reported in 45.6% and associative nausea in 54.5% of the cases, abdominal pain occurred anticipatory in 22.8% and associative in 42.1 %, anticipatory vomiting was the least prevalent, affecting 8.8 %. Behavioral symptoms affected 87.7% of intolerant patients, with restlessness being the most prominent symptom in 71.9% of them. Among the intolerant patients, 45 patients (79%) took parenteral MTX, and 12 (21.1%) took methotrexate orally. In comparison, young patients (49.11 ± 14.95 years) were more intolerant to MTX than old (54.76 ± 13 years, p = 0.048) ones. However, in univariate logistic regression analysis, we did not find any significant association between methotrexate administration route, dose, duration, and digestive intolerance. Conclusion: Methotrexate intolerance was highly prevalent in our RA population. These results strengthen the idea that early detection of MTX intolerance may avoid effective treatment discontinuation, especially in younger patients. REFERENCES: [1] Bulatović M, Heijstek MW, Verkaaik M, van Dijkhuizen EH, Armbrust W, Hoppenreijs EP et al. High prevalence of methotrexate intolerance in juvenile idiopathic arthritis: development and validation of a methotrexate intolerance severity score.
Annals of the Rheumatic Diseases, May 19, 2021
Background: A personalized approach to prescribing targeted drugs implies the availability of dat... more Background: A personalized approach to prescribing targeted drugs implies the availability of data that can be used to suggest that a particular drug is better suited for a given patient than others. Retention on the treatment can be considered as an integral indicator of the acceptability of the drug in real practice. For the purposes of treatment personalization, the indicators that are associated with better retention on some drugs and with worse retention, or that do not have a clear association with retention on others, are of particular interest. Objectives: to identify predictors those are differently associated with retention on different targeted drugs for the treatment of rheumatoid arthritis. Methods: Data of the patients with rheumatoid arthritis (RA) from the Moscow Unified Register of Arthritis (MUAR) were used. The analysis includes episodes of treatment with biological or synthetic targeted drugs (tDMARDs) that continue or end during the patient's follow-up in the registry. Within the framework of the Cox proportional risk regression model, significant independent predictors of tDMARDs cancellation were identified. These indicators were later considered as confounders. Further, in the generated linear regression risk model, all available indicators were tested for the presence of a statistically significant interaction with the factor of used tDMARD. Results: The study included 944 episodes of tDMARDs treatment (Table 1.) in 832 patients. The average age is 55.3 + 12.4 years. There were 131 males (16.1%). The average duration of the disease is 13.1 + 9.4 years. Smoking, family history of RA, and the nature of RA onset (acute or gradual) were identified as reliable mutually independent predictors of retention on tDMARDs treatment. As a result of the search for indicators that reliably interact with used tDMARD, patient's reports of the association of the onset of arthritis 1) with symptoms of intestinal dyspepsia (p < 0.001), 2) with genital inflammatory disease (p = 0.002) were revealed. Most strongly associated with factor 1) was retention on abatacept (ABA), rituximab (RIT), and tofacitinib (TOFA). The second indicator was most strongly associated with retention on ABA, adalimumab (ADA) and TOFA (Picture 1).
Open Access Rheumatology : Research and Reviews, Nov 1, 2022
Rheumatoid arthritis is a prevalent worldwide disease, associated with an increased risk of multi... more Rheumatoid arthritis is a prevalent worldwide disease, associated with an increased risk of multiple metabolic abnormalities that generate a higher disease burden. Objective: To gather the available evidence on the epidemiology, pathophysiology, current perspectives, clinical implications and prognosis of metabolic abnormalities in patients with rheumatoid arthritis. Methods: This is a narrative literature review. Search was conducted in PubMed, OVID, and Taylor & Francis databases, using the following MeSH terms: "Arthritis Rheumatoid", "Metabolic Diseases", and "Metabolic Syndrome". Results: This study describes the main metabolic manifestations of rheumatoid arthritis. Research has recognized that rheumatoid arthritis and metabolic abnormalities share pathophysiological mechanisms with an additive effect that increases cardiovascular risk. In that context, appropriate antirheumatic treatment can also impact on cardiovascular risk. Conclusion: There are metabolic abnormalities in rheumatoid arthritis patients that increase cardiovascular risk. Therefore, it is crucial to evaluate cardiovascular risk to provide appropriate comprehensive management to reduce morbidity and mortality in patients with this disease.
Annals of Oncology, Sep 1, 2021
Open Access Rheumatology: Research and Reviews
To describe clinical characteristics and effectiveness of health care in patients with rheumatoid... more To describe clinical characteristics and effectiveness of health care in patients with rheumatoid arthritis (RA) as part of a multidisciplinary care model (MCM) in a specialized rheumatology center, compared with the results of a national registry of RA (NARRA) as evidence of real-world management. Patients and Methods: We conducted a real-world study (July 1, 2018 to June 30, 2019) based on an analysis of electronic health records of a cohort of RA patients managed with the "Treat-to-Target" strategy in a specialized rheumatology center in Colombia with an MCM, compared with the NARRA that includes different models of usual care. Results: We have analyzed 7053 subjects with RA treated at a specialized rheumatology center and 81,492 patients from the NARRA. Cohorts were similar in their baseline characteristics, with women in predominance and diagnosis age close to 50 years. At the time of diagnosis, a higher proportion of clinical diagnostic test use and rheumatology consultation access was observed in the specialized rheumatology center than in the national registry (4-6 per year versus three or less). In addition, higher proportions of patients in remission and low disease activity were reported for the specialized rheumatology center, with a >40% amount of data lost in the national registry. Pharmacological management was similar regarding the analgesic use. In the specialized center, Certolizumab was more frequently used than in the NARRA registry; also, there were significant differences in methotrexate, leflunomide, and sulfasalazine use, being higher in the specialized rheumatology center. Conclusion: The MCM of a specialized center in RA can guarantee comprehensive care, with better access to all the services required to manage the disease. It ensures specialist management and evidence-based care that facilitates the achievement of therapeutic objectives. In addition, better patient records and follow-ups are available to evaluate health outcomes.
Revista Colombiana de Reumatología
Frontiers in drug safety and regulation, Jan 9, 2023
Introduction: The antimalarials chloroquine and hydroxychloroquine have been used for several dec... more Introduction: The antimalarials chloroquine and hydroxychloroquine have been used for several decades in treating malaria and some autoimmune diseases-mainly rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)-with excellent efficacy and safety. Due to the massive use of antimalarials worldwide for managing SARS-CoV-2/COVID-19 infection during the last 2 years and the consequent increase in cardiac arrhythmia, fear has risen about the safety of using antimalarials, especially for patients with increased cardiovascular risk. Objective: To describe a real-life experience about the safety of antimalarials in the setting of a single rheumatological center in Colombia. Methods: This is a cross sectional study that includes patients diagnosed with RA and treated with antimalarials between 2020 and 2021. Clinical follow-up information was gathered from the medical records, and all reported adverse events were described. Results: A total of 957 patients were included, primarily women (79.2%). The most frequent comorbidities were hypertension and osteoporosis. Chloroquine use was more frequent than hydroxychloroquine (86.4% vs. 13.6%). During the observation period, 243 (25.4%) patients presented at least one adverse event, 72 (29.6%) had retinal toxicity, 85 (35%) dermatological events, and 81 (33.3%) gastrointestinal intolerance. Other adverse events reported less frequently (15.2%) included headache, dizziness, lipothymia, and elevated transaminases. There were no reports of cardiovascular events from the period of antimalarial use to the date of data collection despite the high frequency of previous metabolic or cardiovascular disease in this cohort. Conclusion: This study reasserts the evidence of antimalarials safety profile for patients with rheumatological conditions such as RA. RA patients that were treated with antimalarials at doses recommended by the guidelines had no cardiovascular events.
Journal of Translational Autoimmunity
Biologics: Targets and Therapy
Tofacitinib is recommended for treatment of rheumatoid arthritis (RA) in patients with moderate t... more Tofacitinib is recommended for treatment of rheumatoid arthritis (RA) in patients with moderate to severe disease activity, but there is not enough evidence on its effectiveness after conventional DMARDs vs its use after biologics. The aim was evaluating the effectiveness of tofacitinib in RA as first-line treatment (after conventional DMARDs) in a real-life setting in Colombian (Latin-American) patients. Patients and Methods: Retrospective cohort study conducted at a specialized center for RA management. A complete statistical analysis was performed to compare the values of the change in the DAS28 at months 3, 6, and 12 in both treatment groups. Results: A total of 152 RA patients who received tofacitinib: first-line 85 patients (55.9%) after failure on conventional DMARDs or second-line 67 patients (44.1%) after failure on biologic DMARDs. Comparative analysis of response to treatment showed a reduction in DAS28 at 3, 6, and 12 months in both study groups without statistical differences, but a higher proportion of firstline patients achieved remission (45% vs 23%). Nonresponse at three months were associated with no response at six months of follow-up. Baseline DAS28 was significantly associated with response at 12 months (OR: 1.87, 95%CI: 1.06-3.30, p-value 0.028). In second-line patients, response to tofacitinib was not related to number of biologic DMARDs previously used. Conclusion: Tofacitinib is an effective treatment option for patients with RA, maybe better after conventional DMARDs than after biologic therapy failure. Further studies are required to determine the role of tofacitinib in different lines of RA treatment and in other groups of patients.
Biomédica
Introducción. La detección del virus del papiloma humano mediante la combinación de la prueba de ... more Introducción. La detección del virus del papiloma humano mediante la combinación de la prueba de HPV y otras técnicas como la citología, ha demostrado su eficacia en el diagnóstico y tratamiento oportuno de lesiones asociadas con el cáncer de cuello uterino.Objetivo. Estimar el impacto presupuestal de la estrategia de detección temprana del HPV mediante la prueba de genotipificación combinada con la citología en comparación con la citología convencional, en mujeres de 30 a 65 años participantes en el programa de tamizaje de cáncer de cuello uterino en una Entidad Administradora del Plan de Beneficios en salud (EAPB) en Colombia.Materiales y métodos. Utilizando un árbol de decisiones y un modelo de Markov, se estimaron las implicaciones clínicas y los costos directos anuales de dos ciclos de tamizaje, diagnóstico y tratamiento, en una cohorte de mujeres. Las prevalencias de los resultados clínicos y los costos se tomaron de la base de datos de una EAPB y la información de la progresi...
Archivos en Medicina Familiar, Nov 28, 2018
El dolor lumbar es una causa frecuente de consulta en los servicios de salud donde es insuficient... more El dolor lumbar es una causa frecuente de consulta en los servicios de salud donde es insuficientemente reconocido y tratado. Esta patología genera costos importantes derivados de la atención médica directa y de la pérdida de productividad secundaria a la incapacidad asociada. El propósito de este documento es brindar una orientación basada en la eficacia, efectividad y seguridad de las alternativas disponibles, para el tratamiento farmacológico y no farmacológico del dolor lumbar en contextos no especializados. Las recomendaciones recopiladas provienen de guías de manejo publicadas por organizaciones reconocidas a nivel mundial como la American College of Physicians and the American Pain Society, National Institute for Health and Care Excellence (NICE), National Guideline Clearing House y de otras fuentes consideradas de interés. Las indicaciones mundiales han sido revisadas y ajustadas a la realidad de la práctica colombiana, pueden no aplicar para todos los pacientes o todas las situaciones clínicas y no pretenden reemplazar el criterio médico sobre la evaluación individual de casos. Las recomendaciones recopiladas aquí brindan una directriz acerca del diagnóstico, tratamiento farmacológico y no farmacológico, seguimiento y remisión del paciente con dolor lumbar. El conocimiento basado en la evidencia se configura como la piedra angular de un tratamiento integral, impactando tanto en la calidad de vida y disminución de la discapacidad, como en la reducción de los gastos al sistema de salud asociados con la atención y manejo de esta condición.
Biomedicines, 2022
Background: Novel combination therapies have been shown to improve the outcomes of treatment-naiv... more Background: Novel combination therapies have been shown to improve the outcomes of treatment-naive patients with locally advanced or metastatic renal cell carcinoma (aRCC). However, the optimal systemic therapy for aRCC of favorable risk has yet to be clarified. We aimed to evaluate the efficacy and safety of different immunotherapy (IO) combinations, either with another IO (IO–IO) or with an antiangiogenic (IO–TKI), versus sunitinib in the first-line setting in aRCC patients with favorable IMDC risk. Methods: We conducted a systematic search for evidence in PubMed, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials published up to February 2021. The GRADE approach was used to assess the quality of evidence. Survival hazard ratios were extracted for analysis in the favorable-risk aRCC subgroup (IMDC). A sensitivity analysis was performed excluding trials of combination therapy without TKI. Results: Five randomized controlled phase III trials with a total of...
Journal of Clinical Oncology, 2020
374 Background: In order to improve long term results for high-risk prostate cancer, several clin... more 374 Background: In order to improve long term results for high-risk prostate cancer, several clinical trials have tested the addition of docetaxel chemotherapy. The outcomes of this trials have not led to clear conclusions. We conducted a meta-analysis of randomized phase 3 trials testing the efficacy of docetaxel after radiotherapy in high risk prostate cancer patients. Methods: A systematic review of PubMed (Medline), Embase and the Cochrane Library was conducted. We followed the PRISMA guidelines, three investigators independently selected the articles and verified inclusion criteria. We compared the overall survival and disease-free survival between the intervention group (adjuvant chemotherapy with docetaxel) and the control group (without adjuvant chemotherapy) by calculating the hazard ratio (HR) with 95% confidence intervals (CIs). Pooled effects were calculated using random-effects or fixed-effects models based on the heterogeneity of included studies. Results: 382 publicat...
Indian Journal of Urology, 2019
Introduction: Sentinel lymph node biopsy (SLNB) was designed as a minimally invasive method for e... more Introduction: Sentinel lymph node biopsy (SLNB) was designed as a minimally invasive method for evaluation of nodal involvement in patients with penile cancer and nonpalpable lymph nodes. Nevertheless, SLNB is not used in a regular basis due to the lack of studies that adequately characterize the performance of this procedure. The purpose of this study was to evaluate the diagnostic performance of SLNB in patients with infiltrative penile carcinoma without palpable inguinal lymph nodes in a Colombian population. Materials and Methods: This is a retrospective observational study of 89 patients diagnosed with infiltrative penile squamous cell carcinoma with nonpalpable inguinal lymph nodes. These patients underwent partial or complete penectomy, along with SLNB, between 2008 and 2017. Those individuals with a positive SLNB underwent inguinal lymphadenectomy, while those with a negative SLNB were followed on a quarterly basis with a physical examination and imaging to assess relapse. Statistical analysis was done using the STATA 14 software. A contingency table was made to calculate sensitivity, specificity, positive predictive value, negative predictive value, and exactitude, each one with its own confidence interval (CI) of 95%. Results: There was an average follow-up of 31.4 months, and all 89 patients were evaluated; most primary tumors were T2 (55%), followed by T1 (37%), all of which were subclassified as T1b and T3 (8%). Tumours were most frequently located in the glans (43%). All patients were classified as cN0 and underwent SLNB. Sixty-one patients (69%) tested negative in the SLNB, four of whom (6%) presented with lymph node relapse. On the other hand, 28 patients (31%) tested positive in the SLNB and consequently underwent inguinal lymphadenectomy, seven of whom had negative lymph nodeinvolvement (25% false positives). According to the results, the sensitivity was 84% (95% CI, 65.3–93.6) and the specificity was 89% (95% CI, 79.4–94.7), with a false-negative rate of 6.5%. Conclusions: The SLNB using radiotracer can be a useful method for lymph node staging in patients with penile cancer and nonpalpable lymph nodes when performed in experienced centers.
,celular 3103200354. RESUMEN Objetivo General: Establecer la frecuencia de Carcinoma de Seno Basa... more ,celular 3103200354. RESUMEN Objetivo General: Establecer la frecuencia de Carcinoma de Seno Basal Like en pacientes femeninas con Carcinoma Ductal Infiltrante de fenotipo triple negativo del 2008 al 2012, con la expresión de Factor de Crecimiento Epidérmico y Citoqueratina 5/6 en el Hospital Militar Central. Metodología: Estudio descriptivo de corte transversal. Del total de pacientes diagnosticadas con Carcinoma Ductal infiltrante en el Hospital militar central del 2008 al 2012, se seleccionaron las pacientes que presentaban fenotipo triple negativo (Receptores de Estrógenos, Receptores de y Herb 2 negativos). Posteriormente, estos casos fueron revisados para determinar el bloque representativo de tumor y se realizaron nuevos marcadores de inmunohistoquímica Factor de Crecimiento Epidérmico y Citoqueratina 5/6 en el laboratorio de patología del Hospital Militar Central, con personal entrenado y equipos específicos para dicha actividad. Resultados: De 117 pacientes con diagnóstico de Carcinoma Ductal Infiltrante, 25 casos correspondientes al 21.4% fueron triple negativos, de estos 18 casos cumplieron con todos los criterios de inclusión para el presente trabajo. A estos 18 casos se les realizó un nuevo panel de inmunohistoquímica con Citoqueratina 5/6 y Factor de Crecimiento Epidérmico. Diez de los 18 casos correspondientes al 55.5% de los casos incluidos, fueron simultáneamente positivos para Citoqueratina 5/6 y Factor de Crecimiento Epidérmico, permitiendo así clasificarlos como Carcinoma Basal Like. El promedio de edad de las pacientes con carcinoma basal Like fue de 56 años con un rango entre 31 y 81, 9 de las 10 pacientes tenían entre 51 y 81 años y 1 de ellas tenía 31 años. Conclusiones: La frecuencia de Carcinoma Basal Like corresponde al 8,55% de la población estudiada encontrándose dentro del rango reportado en la literatura internacional.