BackgroundMalignant pleural mesothelioma (MPM) is rare and aggressive neoplasia, with a poor prognosis; furthermore, the monetary cost of its treatment represents a major challenge for many patients. The economic burden this malignancy imposes is underscored by the fact that asbestos exposure, which is the most frequent risk factor, is much more prevalent in the lower socioeconomic population of developing countries. The aims of the present study were to evaluate the efficacy, safety, and cost of continuous infusion of low-dose Gemcitabine plus Cisplatin (CIGC) as a treatment strategy for patients with unresectable MPM.MethodsWe performed a prospective cohort study to determine efficacy and safety of continuous infusion gemcitabine at a dose of 250 mg/m2 in a 6-h continuous infusion plus cisplatin 35 mg/m2 on days 1 and 8 of a 21-day cycle in patients with unresectable MPM. We also performed a cost-minimization analysis to determine if this chemotherapy regimen is less expensive than other currently used regimens.ResultsThe median number of chemotherapy cycles was six (range 1–11 cycles); objective response rate was documented in 46.2%, and disease control rate was seen in 81.2%. Median PFS was 8.05 months (CI 95% 6.97–9.13); median OS was 16.16 months (CI 95% 12.5–19.9). The cost minimization analysis revealed savings of 66.4, 61.9, and 97.7% comparing CIGC with short-infusion gemcitabine plus cisplatin (SIGC), cisplatin plus pemetrexed (CP), and cisplatin plus pemetrexed and bevacizumab (CPB), respectively. Furthermore, this chemotherapy regimen proved to be safe at the administered dosage.ConclusionCIGC is an effective and safe treatment option for patients with unresectable MPM; besides, this combination is a cost-saving option when compared with other frequently used chemotherapy schemes. Therefore, this treatment scheme should be strongly considered for patients with unresectable MPM and limited economic resources.

The purpose of the study was to evaluate the efficacy and safety of cladribine tablets compared with all oral therapies used in patients with relapsing-remitting multiple sclerosis (RRMS). A systematic review of the literature was conducted to identify published clinical trials about RRMS and a network meta-analysis was performed to determine the efficacy and safety of available treatments. We identified seven relevant studies, which were selected based on three criteria that allowed us to construct comparisons of efficacy and safety. Regarding the annualized relapse rate (ARR), there were no significant differences with respect to the decrease of this between cladribine tablets, dimethyl fumarate and fingolimod; although teriflunomide and cladribine tablets showed a significant difference. In relation to the mean number of gadolinium-enhanced T1 lesions, dimethyl fumarate showed a lower number of lesions (−0.85 [−1.21; −0.48]), as did cladribine tablets versus placebo. No statistically significant differences were identified between cladribine tablets and fingolimod (−0.08 [−0.35; 0.19]) and cladribine versus teriflunomide (−0.28 [−0.64; 0.08]). While comparing adverse events that caused discontinuation, cladribine tablets showed an adequate safety profile, which was quantitatively similar to the compared drugs. Cladribine tablets demonstrated efficacy in terms of decrease of ARR and gadolinium-enhanced T1 lesions; although there is no significant difference between cladribine tablets, fingolimod and teriflunomide, the ARR is a stronger measure of efficacy compared to the number of T1 lesions made in contrast with long-term RRMS. Cladribine also demonstrated an adequate safety and tolerability profile promoting therapeutic adherence.

USD, representing the 0.02536% of the budget of the NHS. The deterministic sensitivity analysis confirm that the results were robust. ConCluSionS: According to the results of the BIA, the inclusion of bosentan to the NHS of Mexico is displayed as an affordable option for the treatment of pediatric patients (2-12 years) with HAP.

Objectives: Patients with rheumatoid arthritis (RA) have higher rates of mortality. Previous research indicates that treatment with statin therapy may play a role in reducing the mortality rate of patients with RA but literature is scarce and limited.