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The latest update of the EULAR recommendations for the treatment of RA maintain csDMARD (conventional systemic DMARDs) as the first line treatment, with methotrexate (MTX) still identified as the anchor drug, to which it is possible to add, in failure patients with negative prognostic factors, a biological drug or a tsDMARD (target synthetic DMARD), i.e JAK inhibitors.

Economic impact of biosimilar drugs in Italy: past, present and future of infliximab and etanerceptPurposeThe objective of this study is to estimate the impact of the Anti-TNF monoclonal antibodies that are currently approved in Italy (etanercept ed infliximab) on healthcare expenditure between 2014 and 2020.MethodsThe prediction model was developed considering the standard unit consumption and equivalent patients from IMS database. Drug costs were calculated using official hospital reimbursement prices reported by the Italian Pharmaceutical Agency. By analysing the number of treated patients between 2014 and 2016, clinical experts develop three alternative scenarios and provide estimating the number of patients that they expect to treat during the next 4 years with biosimilars or originator in Italy.ResultsConsidering the number of standard units dispensed each year, the model estimated a total number of 28.000 patient/year that are treated with infliximab or etanercept (28% for AR, 17% for psoriasis, 26% for psoriatic arthritis, 18% for IBD and 11% for other indications). In 2020, drugs expenditure is expected to decline between €42 and €90 billion as compared to 2014, (12% and 26% of total spending in 2014 respectively). Overall, the cumulative savings are estimated between €132 and €296 billions.ConclusionsThe estimated savings may constitute an economic resource that could be re-invested for achieving improvements within the healthcare system.

Il Prof. Antonio Zoppini è venuto a mancare nell’estate di quest’anno, dopo una lunga e dolorosa malattia. Il triste evento è stato vissuto in forma strettamente privata, ma è giusto ricordare il Prof. Zoppini a tutti coloro che Lo hanno conosciuto ed apprezzato all’interno del mondo accademico e ancor più ampiamente in ambito professionale, nell’arco della sua lunga carriera....

Background: Tumor necrosis factor-α (TNF-a) inhibitors are associated with an increased risk of reactivation of latent tuberculosis infection (LTBI); thus, the guidelines recommends TB screening for all patients before starting anti-TNF-α therapy.The use of tuberculin skin test (TST) is controversial because of the immunosuppressive treatment may lead to false-negative TST results and previous BCG-vaccination produces false-positive. The introduction in clinical practice of the interferon-gamma release assays (IGRAs) has opened new perspectives for diagnosis of LTBI.The aim of the study was to investigate the performance of QuantiFERON-TB Gold In Tube assay (QFT-GIT) for the diagnosis of LTBI in patients with an immune-mediated inflammatory diseases candidates for anti-TNF-α therapy. Methods:We enrolled 195 patients with rheumatoid arthritis (n=72), psoriatic arthritis (n=40), psoriasis (n=41), ankylosing spondylitis (n=10), Crohn’s disease (n=18), and Behcet’s disease (n=8). Screening included: clinical evaluation, chest X-ray,TST and QFT-GIT. Results: Of the 195 patients, 32 (16.4%), 137 (70.2%) and 26 (13.3%) tested positive, negative and indeterminate with QFT-GIT test, respectively. The level of agreement between two tests was 81.6 % (k=0.55). Among the screened patients, 38 (19%) were considered to have LTBI and received isoniazid treatment, while 31 patients (16%) showed discordant results between two tests. Univariate analysis showed an association between BCG vaccination and discordant TST-positive/QFT-GIT-negative results (OR=6; 95%CI: 2.3-37.1; p