RESUMEN
BACKGROUND: Since its approval, the use of alteplase had been limited to patients aged ≤80 years. AIMS: TESPI trial had been designed to evaluate whether alteplase treatment within 3 h in patients with acute ischemic stroke aged >80 years resulted in favorable benefit/risk ratio compared with standard care. The meta-analysis of randomized controlled trials was updated to put findings in the context of all available evidence. METHODS: TESPI was a multicenter, open-label with blinded outcome evaluation, randomized, controlled trial. Main clinical endpoints were 90-day favorable functional outcome (mRS score 0-2) and mortality and symptomatic intracerebral hemorrhage. The trial was prematurely terminated for ethical reasons after publication of IST-3 trial which provided evidence of treatment benefit in elderly. RESULTS: Of the planned 600 patients, 191 (88 assigned to alteplase) were enrolled. Overall, 24/83 (28.9%) alteplase patients had a favorable outcome compared to 22/95 (23.2%) controls (non-significant absolute difference of 5.7% for alteplase; OR 1.35, 95% CI 0.69-2.64, P = 0.381). Rates of death were non-significantly lower in the alteplase patients (18.1% vs. 26.5%); rates of symptomatic intracerebral hemorrhage were similar between the two groups (5.9% vs. 5.1%). The updated meta-analysis showed consistent results with prior estimates and add weights. CONCLUSIONS: The effects of alteplase observed in this interrupted trial did not reach statistical significance, probably for the small numbers, but are consistent with and add weight to the sum total of the randomized evidence demonstrating that alteplase is beneficial in patients with acute ischemic stroke aged over 80 years, particularly if given within 3 h.
Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Anciano , Isquemia Encefálica/complicaciones , Isquemia Encefálica/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Humanos , Italia , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Psoriasis arthritis will develop during cutaneous psoriasis in a significant percentage. The aim of this study was to improve assistance to patients and to provide the most individualized care possible. METHODS: Patients: all consecutive subjects with psoriasis accessing the outpatients facilities of five dermatologic centers of excellence in the Tuscany region of Italy between December 2014 and February 2015. All subjects were screened for the presence of a previous diagnosis of arthritis and symptoms affecting the articular system, using some questions chosen and shared by dermatologists in charge of the centers. RESULTS: In the chosen three months period, 134 patients affected with psoriasis had been observed, 32 (24%) of which answered "yes" to the question "Have you ever been diagnosed with arthritis?". There have been differences in the characteristics of patients in the two groups, with and without arthritis. In particular, in the arthritis patients a statistically significant higher mean age, more ungueal psoriasis, less body surface cutaneous psoriasis extension, and a statistically significant higher percentage of patients treated with biological drugs (57% vs. 24.5%) have been observed. CONCLUSIONS: The results were consistent with the scientific literature in the field. The experience seems to confirm the opportunity of screening programs on arthropathy in cutaneous psoriasis patients. About a quarter of psoriasis patients had relevant arthropathic features, and more than half of these required challenging therapies like biologics.