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Marie Fournier,1 Chieh-I Chen,2 Andreas Kuznik,2 Clare Proudfoot,3 Usha G Mallya,4 Kaleb Michaud5,6 1Health Economics & Value Assessment, Sanofi France, Chilly-Mazarin, France; 2Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA; 3Sanofi, Guildford, UK; 4Sanofi, Bridgewater, NJ, USA; 5University of Nebraska Medical Center, Omaha, NE, USA; 6The National Databank for Rheumatic Diseases, Wichita, KS, USA Purpose: Treatment outcomes and direct medical costs were examined, from a US health payer perspective, of monotherapy with sarilumab 200 mg subcutaneous (SC) every 2 weeks (Q2W) vs adalimumab 40 mg SC Q2W/QW in adult patients with moderately to severely active rheumatoid arthritis who are intolerant of, inadequate responders to, or considered inappropriate candidates for continued methotrexate treatment.Patients and methods: Short-term analysis was based on 24-week wholesale acquisition costs of drugs and treatment response observed in the MONARCH Phase III trial (NCT02332590) per American College of Rheumatology (ACR) 20/50 criteria and European League Against Rheumatism (EULAR) Moderate/Good Disease Activity Score 28-joint count erythrocyte sedimentation rate. Long-term analysis, which also considered drug administration and routine care costs, was conducted via a 6-month decision tree and a 1- to 10-year Markov model with microsimulation of patient profiles from the MOBILITY Phase III trial (NCT01061736). Utilities and quality-adjusted life-years (QALYs) were estimated by mapping 6-month ACR levels to a relative change in Health Assessment Questionnaire – Disability Index score and via published algorithms.Results: For sarilumab and adalimumab, respectively, 24-week drug costs were $18,954 and $29,232, and costs per responder were $26,435 vs $50,055 on ACR20; $41,475 vs $98,425 on ACR50; and $22,511 vs $41,230 on EULAR Moderate/Good. Base case results at 10 years for total costs and QALYs were $176,977 and 2.75 for sarilumab and $212,136 and 2.61 for adalimumab, respectively. Sarilumab was consistently the more effective and cost-saving treatment across all short-term and long-term incremental analyses.Conclusion: Sarilumab monotherapy was the economically dominant treatment on incremental cost per responder and incremental cost per QALY compared with adalimumab monotherapy. These results were maintained within the sensitivity analyses. Keywords: treatment costs, disease-modifying anti-rheumatic drug, IL-6 inhibitor, rheumatoid arthritis, cost per responser

Cheryl P Ferrufino,1 Julie Munakata,1 Wenhui Wei,2 Clare Proudfoot,3 Andreas Kuznik,4 Susan H Boklage,4 Chieh-I Chen4 1IQVIA, Fairfax, VA, USA; 2Sanofi, Bridgewater, NJ, USA; 3Sanofi, Guildford, UK; 4Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA Objective: To estimate the 5-year budget impact (BI) on a US health plan of introducing sarilumab – a human immunoglobulin G1 anti-IL-6 receptor α monoclonal antibody – as combination treatment with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or monotherapy in patients with moderate-to-severe rheumatoid arthritis (RA).Methods: BI analysis was conducted from a commercial payer perspective. Treatment-eligible populations included adult patients with moderate-to-severe RA and inadequate response (IR) to csDMARDs or tumor necrosis factor (TNF)-α inhibitors-IR. All licensed biologic treatments recommended by the American College of Rheumatology guidelines were included.Results: For a hypothetical plan of one million members, 409 csDMARD-IR and 345 TNF-IR patients were annually eligible for combination therapy and 226 csDMARD and TNF-IR patients for monotherapy with sarilumab. Based on 2018 US direct treatment costs, the introduction of sarilumab was estimated to save $526,424, $322,637 and $264,306 over 5 years for csDMARD-IR combination therapy patients, TNF-IR combination therapy patients, and csDMARD-IR/TNF-IR monotherapy patients, respectively. As sarilumab absorbed a greater market share over the horizon, annual savings increased from years 1 to 5, $28,610 (–0.14%) to $194,646 (–0.83%) in csDMARD-IR, $16,986 (–0.11%) to $120,893 (–0.67%) in TNF-IR, and $14,256 (–0.13%) to $98,040 (–0.79%) in monotherapy. One-way sensitivity analyses revealed that the model was most sensitive to variations in sarilumab adherence.Conclusion: Total cost savings of introducing sarilumab to a health-care plan accrued from years 1 to 5, attributable to the lower treatment cost, stable dosing paradigm, and price parity for the two available doses (150 and 200 mg every 2 weeks) compared with alternative biologic DMARDs that have substantial variability in dose titration/schedules. Keywords: treatment costs, disease-modifying anti-rheumatic drug, IL-6 inhibitor

Ferrufino CP, Munakata J, Wei W, et al. Clinicoecon Outcomes Res. 2018;10: 805—819. On page 810, Table 4, Drug costs column, Methotrexate, the Unit WAC was listed as $1 however it should have been $2.36. On page 817, Table S2, the monitoring costs for (A) csDMARD-IR and (B) TNF-IR were changed. Read the original article

The article provides information about the best practice on training patients with anaphylaxis and improving the nurse's ability in guiding them. It explains the importance of allergy management in training and updating patients in anaphylaxis prevention and treatment. Also cited are the information about anaphylaxis that patients must know, including causes, prevention and emergency strategies, and safety issues. Anaphylaxis management plans usually cover the patient's medications and when they should be used.

Celia Proudfoot describes the setting up of a tuberculosis screening programme for homeless people and staff working with them. [ABSTRACT FROM AUTHOR]

Aim: To identify the incidence of children who have local reactions to amethocaine and whether site and age are important factors in the occurrence of local reactions.Design: A within group (paired) comparison study. Children attending an outpatient department for venepuncture as part of their normal treatment had amethocaine applied to the elbow and the dorsum of the hand.Results: Seventy-seven children took part in the study of whom 42 (55 per cent) had an urticarial reaction. All 42 children with an urticarial reaction experienced the reaction at the elbow, four of these children also had a reaction at the dorsum of the hand. There was an association between age and reaction with the frequency of reaction greater in younger children (p=0.0002).Conclusion: There is an increased frequency of urticarial reaction when amethocaine is used at the elbow compared with the dorsum of the hand. Younger children are at an increased risk of experiencing a reaction. [ABSTRACT FROM AUTHOR]

The article focuses on the study which investigates the generation of induced pluripotent stem cells (iPSCs) from equine keratinocytes using cell-based therapies.

An abstract of the study "Nonmeiotic Introgression of Quantitative Trait Nucleotides and Correction of Congenital Mutations in Livestock With Transcription Activator-Like Effector Nucleases," by S. C. Fahrenkrug and colleagues is presented.