A comparison of leflunomide and subcutaneous methotrexate in the treatment of rheumatoid arthritis: an approximation based on the number needed to treat
Comparación de leflunomida y metrotrexato subcutáneo en el tratamiento de la artritis reumatoide: una aproximación basada en el número de pacientes que es necesario tratar
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Nolla" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Dolors" "apellidos" => "Martínez-Aguilà" ] 1 => array:2 [ "nombre" => "Carmen" "apellidos" => "Gómez-Vaquero" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Narváez" ] 3 => array:2 [ "nombre" => "Montserrat" "apellidos" => "Romera" ] 4 => array:2 [ "nombre" => "Antoni" "apellidos" => "Rozadilla" ] 5 => array:2 [ "nombre" => "Joan M." "apellidos" => "Nolla" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574309700929?idApp=UINPBA00004M" "url" => "/21735743/0000000500000002/v1_201305061553/S2173574309700929/v1_201305061553/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "A comparison of leflunomide and subcutaneous methotrexate in the treatment of rheumatoid arthritis: an approximation based on the number needed to treat" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "66" "paginaFinal" => "70" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonio J. Garcia Ruiz, Ana C. Montesinos Galvez, Lucia Perez Costillas, Pablo Rebollo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Antonio J." "apellidos" => "Garcia Ruiz" "email" => array:1 [ 0 => "ajgr@uma.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana C." "apellidos" => "Montesinos Galvez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Lucia" "apellidos" => "Perez Costillas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Pablo" "apellidos" => "Rebollo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unit of Pharmacoeconomics and Health Results Research, Universidad de Málaga, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "BAP Health Outcomes, Oviedo, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comparación de leflunomida y metrotrexato subcutáneo en el tratamiento de la artritis reumatoide: una aproximación basada en el número de pacientes que es necesario tratar" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-04-02" "fechaAceptado" => "2008-11-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec112029" "palabras" => array:5 [ 0 => "Rheumatoid arthritis" 1 => "Treatment" 2 => "Cost" 3 => "NNT" 4 => "Pharmacoeconomics" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec112028" "palabras" => array:5 [ 0 => "Artritis reumatoide" 1 => "Tratamiento" 2 => "Costes" 3 => "NNT" 4 => "Farmacoeconomía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To compare, in the Spanish setting, 2 drugs for adults with rheumatoid artritis (RA): leflunomide and subcutaneous methotrexate (SC). The high price of methotrexate SC compared with traditional presentations of methotrexate justifies conducting an economic evaluation comparing it with leflunomide.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The analysis considered the annual costs of the drugs and their effectiveness, measured with a number needed to treat (NNT) approach, considering both the ACR20 and ACR50 criteria for effectiveness. Data about efficacy and dosage were derived from the clinical trial US310, a randomized, doble-blinded controlled trial, which compared efficacy and safety of leflunomide (20<span class="elsevierStyleHsp" style=""></span>mg/daily) versus placebo versus methotrexate (7.5–15<span class="elsevierStyleHsp" style=""></span>mg/weekly) in 482 patients with active RA. Data about use of medical resources for drug monitoring (visits to rheumatologists and diagnostic procedures) were derived from the manufacturers¿ summary of product characteristics. Direct costs (drugs and monitoring) were obtained from 2 Spanish databases. The analysis has been performed under the Spanish National Health System perspective.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Using the ACR20 criteria, the NNT with leflunomide and methotrexate are 4 (95% CI, 2.56–7.71) and 5 (95% CI, 3.03–14.3) respectively. Using the ACR50 criteria, NNT are 4 (95% CI, 2.72-6.54) and 7 (95% CI, 4.03–19.3). In the case of leflunomide, annual treatment costs per patient-year equals €1793.30; in the case of methotrexate total treatment costs amounts to €2149.20</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Combining these results the cost of a controlled patient according to ACR20 would amount €7173 for leflunomide and €10 746 for methotrexate SC. Results considering ACR50 are €7173 and €15 044 for leflunomide and methotrexate respectively.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparar 2 farmacos para la artritis reumatoide (AR): leflunomida y metotrexato subcutaneo (s.c.) (jeringas precargadas), considerando tanto costes anuales de tratamiento como la efectividad medida a traves del numero de pacientes que es necesario tratar (NNT).</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los datos de eficacia y dosis fueron extraidos del ensayo clinico US310, ensayo aleatorizado y doble ciego, que tuvo por objetivo comparar la eficacia y la seguridad del tratamiento a 12 meses con leflunomida (20<span class="elsevierStyleHsp" style=""></span>mg/dia) frente a placebo y metotrexato (7,5–15<span class="elsevierStyleHsp" style=""></span>mg/semana) en 482 pacientes con AR activa. La informacion sobre los actos medicos para los seguimientos de control se obtuvo de la ficha tecnica del producto. El estudio de costes se ha realizado con la perspectiva del Sistema Nacional de Salud espanol.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Considerando el criterio de ACR20, el NNT de leflunomida es 4 (intervalo de confianza [IC] del 95%, 2,56-7,71) y el de metotrexato s.c., 5 (IC del 95%, 3,03–14,3); para el criterio de ACR50, el NNT de leflunomida es 4 (IC del 95%, 2,72–6,54) y el de metotrexato s.c., 7 (IC del 95%, 4,03–19,3). El coste anual del farmaco fue 1.112,52 euros para la leflunomida y 1.438,91 euros para el metotrexato s.c. Los costes anuales de monitorizacion fueron 680,76 euros para la leflunomida y 710,26 euros para el metotrexato s.c.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Combinando la informacion, el coste de un paciente respondedor segun ACR20 seria de 7.173 euros con leflunomida y 10.746 euros con metotrexato s.c.; los resultados considerando ACR50 oscilarian entre los 7.173 euros para la leflunomida y 15.044 euros para el metotrexato s.c.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 12 | 17 |
| 2024 October | 42 | 47 | 89 |
| 2024 September | 47 | 18 | 65 |
| 2024 August | 63 | 35 | 98 |
| 2024 July | 44 | 36 | 80 |
| 2024 June | 53 | 38 | 91 |
| 2024 May | 51 | 19 | 70 |
| 2024 April | 42 | 27 | 69 |
| 2024 March | 50 | 39 | 89 |
| 2024 February | 29 | 35 | 64 |
| 2024 January | 19 | 34 | 53 |
| 2023 December | 25 | 27 | 52 |
| 2023 November | 21 | 21 | 42 |
| 2023 October | 22 | 30 | 52 |
| 2023 September | 46 | 40 | 86 |
| 2023 August | 27 | 10 | 37 |
| 2023 July | 28 | 21 | 49 |
| 2023 June | 26 | 23 | 49 |
| 2023 May | 37 | 11 | 48 |
| 2023 April | 29 | 12 | 41 |
| 2023 March | 29 | 34 | 63 |
| 2023 February | 26 | 26 | 52 |
| 2023 January | 20 | 20 | 40 |
| 2022 December | 27 | 33 | 60 |
| 2022 November | 27 | 34 | 61 |
| 2022 October | 23 | 32 | 55 |
| 2022 September | 26 | 39 | 65 |
| 2022 August | 51 | 44 | 95 |
| 2022 July | 49 | 45 | 94 |
| 2022 June | 60 | 43 | 103 |
| 2022 May | 55 | 58 | 113 |
| 2022 April | 41 | 59 | 100 |
| 2022 March | 45 | 50 | 95 |
| 2022 February | 21 | 45 | 66 |
| 2022 January | 25 | 49 | 74 |
| 2021 December | 25 | 49 | 74 |
| 2021 November | 27 | 58 | 85 |
| 2021 October | 78 | 61 | 139 |
| 2021 September | 23 | 38 | 61 |
| 2021 August | 32 | 53 | 85 |
| 2021 July | 26 | 33 | 59 |
| 2021 June | 24 | 48 | 72 |
| 2021 May | 46 | 33 | 79 |
| 2021 April | 55 | 69 | 124 |
| 2021 March | 63 | 27 | 90 |
| 2021 February | 39 | 20 | 59 |
| 2021 January | 28 | 18 | 46 |
| 2020 December | 23 | 23 | 46 |
| 2020 November | 25 | 16 | 41 |
| 2020 October | 9 | 11 | 20 |
| 2020 September | 28 | 23 | 51 |
| 2020 August | 14 | 13 | 27 |
| 2020 July | 20 | 18 | 38 |
| 2020 June | 51 | 24 | 75 |
| 2020 May | 37 | 16 | 53 |
| 2020 April | 48 | 32 | 80 |
| 2020 March | 22 | 12 | 34 |
| 2020 February | 5 | 0 | 5 |
| 2020 January | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 1 | 0 | 1 |
| 2019 June | 2 | 0 | 2 |
| 2019 March | 4 | 0 | 4 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 1 | 0 | 1 |
| 2018 May | 7 | 1 | 8 |
| 2018 April | 48 | 16 | 64 |
| 2018 March | 38 | 12 | 50 |
| 2018 February | 20 | 5 | 25 |
| 2018 January | 22 | 5 | 27 |
| 2017 December | 24 | 10 | 34 |
| 2017 November | 26 | 11 | 37 |
| 2017 October | 20 | 9 | 29 |
| 2017 September | 26 | 4 | 30 |
| 2017 August | 20 | 10 | 30 |
| 2017 July | 33 | 6 | 39 |
| 2017 June | 46 | 23 | 69 |
| 2017 May | 40 | 11 | 51 |
| 2017 April | 32 | 6 | 38 |
| 2017 March | 21 | 8 | 29 |
| 2017 February | 13 | 1 | 14 |
| 2017 January | 27 | 10 | 37 |
| 2016 December | 99 | 15 | 114 |
| 2016 November | 61 | 6 | 67 |
| 2016 October | 89 | 12 | 101 |
| 2016 September | 81 | 8 | 89 |
| 2016 August | 42 | 4 | 46 |
| 2016 July | 30 | 11 | 41 |
| 2016 April | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 4 | 0 | 4 |
| 2015 July | 6 | 7 | 13 |
| 2015 June | 18 | 6 | 24 |
| 2015 May | 32 | 17 | 49 |
| 2015 April | 24 | 19 | 43 |
| 2015 March | 12 | 17 | 29 |
| 2015 February | 18 | 12 | 30 |
| 2015 January | 18 | 21 | 39 |
| 2014 December | 19 | 20 | 39 |
| 2014 November | 13 | 12 | 25 |
| 2014 October | 19 | 19 | 38 |
| 2014 September | 15 | 13 | 28 |
| 2014 August | 19 | 21 | 40 |
| 2014 July | 22 | 18 | 40 |
| 2014 June | 20 | 21 | 41 |
| 2014 May | 30 | 25 | 55 |
| 2014 April | 25 | 7 | 32 |
| 2014 March | 32 | 21 | 53 |
| 2014 February | 20 | 22 | 42 |
| 2014 January | 18 | 24 | 42 |
| 2013 December | 21 | 25 | 46 |
| 2013 November | 12 | 16 | 28 |
| 2013 October | 41 | 11 | 52 |
| 2013 September | 33 | 14 | 47 |
| 2013 August | 19 | 16 | 35 |
| 2013 July | 25 | 7 | 32 |
| 2013 June | 18 | 10 | 28 |
| 2013 May | 12 | 13 | 25 |
| 2013 April | 28 | 17 | 45 |
| 2013 March | 25 | 13 | 38 |
| 2013 February | 6 | 11 | 17 |
| 2013 January | 14 | 12 | 26 |
| 2012 December | 19 | 15 | 34 |
| 2012 November | 4 | 16 | 20 |
| 2012 October | 5 | 6 | 11 |
| 2012 September | 6 | 2 | 8 |
| 2012 June | 4 | 0 | 4 |
| 2012 May | 3 | 0 | 3 |
| 2012 April | 3 | 0 | 3 |
| 2012 March | 6 | 0 | 6 |
| 2012 February | 2 | 0 | 2 |
| 2012 January | 4 | 0 | 4 |
| 2011 December | 2 | 0 | 2 |
| 2011 November | 7 | 0 | 7 |
| 2011 October | 1 | 0 | 1 |
| 2011 September | 2 | 0 | 2 |
| 2011 August | 1 | 0 | 1 |
| 2011 June | 3 | 0 | 3 |
| 2011 April | 1 | 0 | 1 |
| 2011 March | 12 | 0 | 12 |
| 2011 February | 3 | 0 | 3 |
| 2011 January | 2 | 0 | 2 |
| 2010 December | 6 | 0 | 6 |
| 2010 November | 2 | 0 | 2 |
| 2010 October | 3 | 0 | 3 |
| 2010 September | 6 | 0 | 6 |
| 2010 August | 1 | 0 | 1 |
| 2010 July | 1 | 0 | 1 |
| 2010 June | 3 | 0 | 3 |
| 2010 May | 8 | 0 | 8 |
| 2010 April | 13 | 0 | 13 |
| 2010 March | 13 | 0 | 13 |
| 2010 January | 4 | 0 | 4 |
| 2009 December | 9 | 0 | 9 |
| 2009 November | 31 | 0 | 31 |
| 2009 October | 16 | 0 | 16 |
| 2009 September | 21 | 0 | 21 |
| 2009 August | 22 | 0 | 22 |
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