Systematic review and analysis of evidences on clinical efficacy and cost-effectiveness of biological drugs for the treatment of Ankylosing Spondylitis

Technology: Infliximab and comparator biological such as adalimumab, etanercept, golimumab. Conditions: Ankylosing spondylitis (AS) Issue: Infliximab is registered to be used in patients with AS. The aim of the Report is to evaluate the clinical efficacy and safety of infliximab and comparator biologicals for the treatment of adult AS. Methods: Systematic literature review and analysis as well as meta-analysis (direct and indirect comparison) of published randomised controlled clinical trials (RCT) were performed, all relevant health economics literature were identified ad analysed. Results: Clinical efficacy of biological therapies is based on good clinical evidences regarding to all clinical efficacy endpoints (ASAS20, ASAS40, ASAS 5/6, and BASDAI 50% response). Altogether, 22 trials are included in our meta-analysis, 12 infliximab, 3 adalimumab studies, 6 etanercept and 1 golimumab. Efficacy of biological treatments for the treatment of AS has been established by clinical scientific evidences, significant improvement at all outcomes considered was confirmed. According to the results of indirect comparison, there were no significant difference between biological treatments and placebo in terms of safety and tolerability endpoints. We found no significant difference between the clinical efficacy and safety of infliximab, adalimumab, etanercept and golimumab therapies. Cost-utility analysis of adalimumab and/or infliximab, etanercept and golimumab treatment for AS were performed in the UK, Canada, The Netherlands, Germany, Spain and France. There are no cost-utility studies from Eastern Central Europe. Implications for decision making: Efficacy of infliximab and comparator biologicals for the treatment of Ankylosing Spondylitis (AS) was proved by clinical evidence, significant improvement at all outcomes considered was confirmed. We found no significant differences in efficacy and safety of different biological treatments. Health economics results suggest that biological therapies are cost-effective alternatives for the treatment of AS in group of developed high income countries. There is a lack of health economics results in Central-Eastern European countries however these data are more and more required by governments and funders as part of the company economic dossiers.

Comparative analysis of the relationship between phenological phenomena and meteorological indicators based on insect and plant monitoring

Climate change is one of the biggest environmental problems of the 21st century. The most sensitive indicators of the effects of the climatic changes are phenological processes of the biota. The effects of climate change which were observed the earliest are the remarkable changes in the phenology (i.e. the timing of the phenophases) of the plants and animals, which have been systematically monitored later. In our research we searched for the answer: which meteorological factors show the strongest statistical relationships with phenological phenomena based on some chosen plant and insect species (in case of which large phenological databases are available). Our study was based on two large databases: one of them is the Lepidoptera database of the Hungarian Plant Protection and Forestry Light Trap Network, the other one is the Geophytes Phenology Database of the Botanical Garden of Eötvös Loránd University. In the case of butterflies, statistically defined phenological dates were determined based on the daily collection data, while in the case of plants, observation data on blooming were available. The same meteorological indicators were applied for both groups in our study. On the basis of the data series, analyses of correlation were carried out and a new indicator, the so-called G index was introduced, summing up the number of correlations which were found to be significant on the different levels of significance. In our present study we compare the significant meteorological factors and analyse the differences based on the correlation data on plants and butterflies. Data on butterflies are much more varied regarding the effectiveness of the meteorological factors.