notas clínicas0 síndrome de May-thurner, diagnóstico y tratamiento: a propósito de un caso May-Thurner syndrome, diagnosis and treatment: a case report

BackgroundTreatments for ulcerative colitis (UC) and Crohn’s disease (CD) include conventional agents and tumour necrosis factor-alpha inhibitors (anti-TNFα). A substantial proportion of patients do not respond, are intolerant to both therapies or these drugs are contraindicated. Vedolizumab, a monoclonal antibody directed against α4β7-integrin that inhibits lymphocyte recruitment to the gastrointestinal tract, provides another therapeutic option.PurposeTo assess the efficacy, safety and economic impact of vedolizumab treatment in UC and CD patients in clinical practice.Material and methodsRetrospective, observational study of patients treated with intravenous vedolizumab from September 2015 to September 2017. Variables: age, sex, diagnosis, previous anti-TNFα therapy, duration, dose variation and analytical parameters: haemoglobin (Hb), C-reactive protein (CRP) and faecal calprotectine (FCP). Clinical response was measured by haemoglobin and CRP variation during induction and maintenance, and FCP reduction. Safety was assessed by reported treatment-emergent adverse events, and economic impact by drug patient-year cost.ResultsForty-one patients, 63% men, mean age 46.6 years (19–76), were included. Indications: 16 patients (39%) UC and 19 (61%) CD. Most of the patients had previously been treated with anti-TNFα therapies (85%), mostly infliximab (88%), while 15% had never had biotherapy. Mean duration was 10.4 (1–30) months. Fourteen patients (34%) required a maintenance dose modification every 4 to 6 weeks instead of every 8 weeks. Mean Hb and CRP levels before vedolizumab administration were 13.3 mg/dl and 18.5 mg/L respectively, improving at the end of the induction in 0.2 mg/dl and 6.4 mg/L, and 0.3 mg/dl and 7.7 mg/L in the maintenance phase. Average FCP reduction was 22.4% from baseline levels to values at the end of the study. With regard to adverse events, 16 patients (39%) reported gastrointestinal events and seven (17%) arthralgias. Treatment was discontinued in two patients due to lack of efficacy. Estimated patient-year cost in our hospital was €18 259 the first year, and €14 202 the following year.ConclusionVedolizumab provides an additional therapy for patients with an inadequate response or were intolerant to anti-TNFα. Effectiveness outcomes in our clinical setting were within the percentages presented in clinical trials either in induction or maintenance, showing a similar safety profile to other biological treatments and to that described in clinical trials.References and/or AcknowledgementsVedolizumab: EPAR-Summary for the public. EMA.No conflict of interest

BackgroundComplementary and alternative medicine (CAM) use has grown considerably, although there is little research about its prevalence in cancer patients in Europe.PurposeThe main objective of this study was to determine the prevalence of CAM use in adult patients on antineoplastic treatment in a referral cancer centre. The study focused on the use of oral CAM, as pharmacokinetic interactions have been described with chemotherapy.Material and methodsResearchers went to the ambulatory treatment unit of a hospital for 2 weeks. Patients were invited to complete a questionnaire regarding CAM use and sociodemographic variables (age, gender, marital status, educational level). Clinical data were extracted from medical databases (primary tumour, stage of cancer, number of treatments received). Descriptive statistics were calculated and differences between CAM and non-CAM users were assessed using the χ2 test, with the SPSS program. This was an observational, cross sectional study.Results316 adult cancer patients were included. 32.3% of patients on antineoplastic treatment reported CAM use. 89% of these patients were ingesting products. Herbs were the most commonly used (66%), followed by natural products (39%, regardless of dietary supplements), vitamins/minerals (35%) and homeopathy (18%). 81% of patients started to use CAM after diagnosis. The main source of information about CAM was family/friends (69%); healthcare professionals did not reach 8%. 65% of patients seemed to have benefits from using CAM, especially improvements in both their physical and psychological well being (29%). Only 2% found CAM of benefit to fight cancer. Independent predictors of CAM use were female sex (p = 0.027), age ≤55 years (p = 0.000), both equal to what other reports showed, and secondary education (p = 0.003). No differences were found in the frequency of CAM use with regard to type and stage of cancer, unlike other studies.ConclusionA considerable proportion of patients use CAM at the same time as antineoplastic therapy. These practices are mainly initiated after diagnosis and consist of product intake.  Precisely, this type of CAM is the one at risk of interacting with chemotherapy. The findings of this study can serve as a guide to identify potential patients who may require advice on CAM in medical and pharmacist consultations.References and/or AcknowledgementsOncology Department, CHN.No conflict of interest.