RODRIGO MARTINS ABREU
Projetos de Pesquisa
Unidades Organizacionais
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
3 resultados
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- Cost-effectiveness analysis of paricalcitol versus calcitriol for the treatment of SHPT in dialytic patients from the SUS perspective(2016) MENEZES, Fabiana Gatti de; ABREU, Rodrigo Martins; ITRIA, AlexanderAbstract Introduction: Secondary hyperparathyroidism (SHPT) is a consequence of chronic kidney disease. The treatment at the Brazilian Unified Heath System (SUS) is performed with calcitriol, a drug which favors hypercalcemia and/or hyperphosphatemia, hindering the control of SHPT. Another option is paricalcitol, which causes parathormone (PTH) suppression faster than calcitriol, with minor changes in calcium-phosphorus product and calcium and phosphorus serum levels. Objective: This study aims to develop a cost-effectiveness analysis of paricalcitol versus calcitriol for patients in dialytic treatment with SHPT, from the SUS perspective. Methods: A Markov decision model was developed for patients ≥ 50 years old with end stage renal disease in dialytic treatment and SHPT. Quarterly cycles and a lifetime time horizon were considered. Life years (LY) gained were assessed as clinical outcome. Clinical and economic inputs were obtained from systematic literature review and official databases. Costs are presented in Brazilian real (BRL), for the year 2014. Results: In the base case: paricalcitol generated a clinical benefit of 16.28 LY gained versus 14.11 LY gained with calcitriol, total costs of BRL 131,064 and BRL 114,262, respectively, determining an incremental cost-effectiveness ratio of BRL 7,740 per LY gained. The data robustness was confirmed by the sensitivity analysis. Conclusions: According to cost-effectiveness threshold recommended by the World Health Organization for 2013, the treatment of SHPT in patients on dialysis with paricalcitol is cost-effective when compared to calcitriol, from the public healthcare system perspective, in Brazil.
- Assessment of Adherence to Prescribed Therapy in Patients with Chronic Hepatitis B(2016) ABREU, Rodrigo Martins; FERREIRA, Camila da Silva; FERREIRA, Aline Siqueira; REMOR, Eduardo; NASSER, Paulo Dominguez; CARRILHO, Flair Jose; ONO, Suzane KiokoEvidence shows that treatment for hepatitis B virus (HBV) can suppress viral load. Among the factors directly linked to therapeutic success is adherence to the treatment. Several instruments to assess adherence are available, but they are not validated for use in chronic hepatitis B. The purpose of this paper was to adapt and validate the ""Assessment of Adherence to Antiretroviral Therapy Questionnaire-HIV"" (CEAT-VIH) for patients with chronic hepatitis B (referred to herein as CEAT-HBV). The validity of the adapted questionnaire evidence was established through concurrent, criterion, and construct validities. We found negative and significant correlation between the domain ""degree of compliance to antiviral therapy"" assessed by CEAT-HBV and the Morisky test (r = -0.62, P < 0.001) and between the domain ""barriers to adherence"" and HBV viral load (r = -0.42, P < 0.001). In terms of the construct's discriminative capacity, scores greater than or equal to 80 detected antiviral therapy success, which are necessary for the prediction of an undetectable HBV viral load. Thus, a cutoff value of 80.5 was set with a value of 81% for sensitivity and 67% for specificity. The CEAT-HBV identified 43% (n = 79) non-adherent patients and was shown to be a useful tool in clinical practice.
- Pegylated interferon alfa for chronic hepatitis B: systematic review and meta-analysis(2016) KIM, V.; ABREU, R. M.; NAKAGAWA, D. M.; BALDASSARE, R. M.; CARRILHO, F. J.; ONO, S. K.Conventional interferon alfa and nucleos(t)ide analogues, such as lamivudine, are frequently used for chronic hepatitis B (CHB) treatment, but are associated with adverse effects and viral resistance. Here we performed a systematic review and meta-analysis evaluating all studies of pegylated interferon alfa (PEG-IFN) treatment in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with CHB. We searched electronic databases - PubMed, EMBASE, Cochrane Library and LILACS - for randomized controlled trials evaluating PEG-IFN therapy between 1999 and September 2014. Virological response was the primary outcome. We identified 14 studies involving 2829 patients. Our analysis revealed that PEG-IFN+lamivudine combination therapy produced better virological and biochemical responses than PEG-IFN monotherapy in HBeAg-positive and HBeAg-negative patients at the end of treatment. PEG-IFN+adefovir dipivoxil achieved better seroconversion rate than PEG-IFN in HBeAg-positive patients at the end of treatment. The present findings demonstrated a beneficial response rate following PEG-IFN combination therapy with nucelos(t)ides among HBeAg-positive and HBeAg-negative patients with CHB. Further trials are needed to investigate simultaneous and sequential therapy strategies.