AIM:To investigate the efficacy,safety,and cost of treatment of direct acting antivirals(DAAs) with and without peg interferon alfa2a(P),and/or ribavirin(R) in treating hepatitis C virus(HCV) genotype 1 patients.METHO...AIM:To investigate the efficacy,safety,and cost of treatment of direct acting antivirals(DAAs) with and without peg interferon alfa2a(P),and/or ribavirin(R) in treating hepatitis C virus(HCV) genotype 1 patients.METHODS:MEDLINE was searched for randomized controlled trials(RCT) using DAAs for HCV treatment.Phase 1 trials and studies with investigational drugs on genotype 2 or 3,and on human immunodeficiency virus patients were excluded.Data were pooled for sustained virologic response(SVR),serious adverse effects,and drug discontinuation rate on various treatment arms in trials:P + R;1st generation DAA(telaprevir or boceprevir) + P + R;2nd generation DAA(sofosbuvir or simeprevir) + P + R;2nd generation DAA + R;two 2nd generation DAA + R;and two 2nd gen DAA.Data were analyzed separately for each arm for treatment naive and non-responders(NR) to previous treatment.The cost of treatment with each regimen for achieving one SVR was also compared.RESULTS:Twenty three RCTs(n = 9354,62% male,11% cirrhosis) were analyzed.All oral(P free) regimens with combination of 2 DAA achieved SVR above 95%.The cost of treatment to achieve an SVR with DAA based regimens was lower for NR compared to P+R regimen.However,the cost per SVR remained higher for treatment naive patients.CONCLUSION:Second generation and emerging DAAs are promising agents in HCV treatment,with a very high level of safety and efficacy.An important drawback is their high cost.However,the present meta-analysis shows that the cost per SVR for non responders(but not for naive patients) was lower compared to P + R.This finding together with the superior safety profile and better compliance makes these drugs highly attractive.It is possible that further reduction in treatment duration may make them even more cost effective.展开更多
Tumors arising from the anal canal are usually of epithelial origin and are mostly squamous cell carcinoma or basal cell carcinoma. We present a case of benign anal adenomas arising from the anus, an extremely rare di...Tumors arising from the anal canal are usually of epithelial origin and are mostly squamous cell carcinoma or basal cell carcinoma. We present a case of benign anal adenomas arising from the anus, an extremely rare diagnosis. A 78-year-old white man presented with rectal bleeding of several months duration. Examination revealed a 4 cm friable mass attached to the anus by a stalk. At surgery, the mass was grasped with a Babcock forceps and was resected using electrocautery. Microscopic examination revealed a tubulovillus adenoma with no areas of high grade dysplasia or malignant transformation. The squamocolumnar junction was visible at the edges of the lesion confirming the anal origin of the tumor. We believe the tubulovillus adenoma arose from either an anal gland or its duct that opens into the anus. Although seen rarely, it is important to recognize and treat these tumors at an early stage because of their potential to transform into adenocarcinoma.展开更多
文摘AIM:To investigate the efficacy,safety,and cost of treatment of direct acting antivirals(DAAs) with and without peg interferon alfa2a(P),and/or ribavirin(R) in treating hepatitis C virus(HCV) genotype 1 patients.METHODS:MEDLINE was searched for randomized controlled trials(RCT) using DAAs for HCV treatment.Phase 1 trials and studies with investigational drugs on genotype 2 or 3,and on human immunodeficiency virus patients were excluded.Data were pooled for sustained virologic response(SVR),serious adverse effects,and drug discontinuation rate on various treatment arms in trials:P + R;1st generation DAA(telaprevir or boceprevir) + P + R;2nd generation DAA(sofosbuvir or simeprevir) + P + R;2nd generation DAA + R;two 2nd generation DAA + R;and two 2nd gen DAA.Data were analyzed separately for each arm for treatment naive and non-responders(NR) to previous treatment.The cost of treatment with each regimen for achieving one SVR was also compared.RESULTS:Twenty three RCTs(n = 9354,62% male,11% cirrhosis) were analyzed.All oral(P free) regimens with combination of 2 DAA achieved SVR above 95%.The cost of treatment to achieve an SVR with DAA based regimens was lower for NR compared to P+R regimen.However,the cost per SVR remained higher for treatment naive patients.CONCLUSION:Second generation and emerging DAAs are promising agents in HCV treatment,with a very high level of safety and efficacy.An important drawback is their high cost.However,the present meta-analysis shows that the cost per SVR for non responders(but not for naive patients) was lower compared to P + R.This finding together with the superior safety profile and better compliance makes these drugs highly attractive.It is possible that further reduction in treatment duration may make them even more cost effective.
文摘Tumors arising from the anal canal are usually of epithelial origin and are mostly squamous cell carcinoma or basal cell carcinoma. We present a case of benign anal adenomas arising from the anus, an extremely rare diagnosis. A 78-year-old white man presented with rectal bleeding of several months duration. Examination revealed a 4 cm friable mass attached to the anus by a stalk. At surgery, the mass was grasped with a Babcock forceps and was resected using electrocautery. Microscopic examination revealed a tubulovillus adenoma with no areas of high grade dysplasia or malignant transformation. The squamocolumnar junction was visible at the edges of the lesion confirming the anal origin of the tumor. We believe the tubulovillus adenoma arose from either an anal gland or its duct that opens into the anus. Although seen rarely, it is important to recognize and treat these tumors at an early stage because of their potential to transform into adenocarcinoma.
