Comparative efficacy and safety of biosimilar infliximab and other biological treatments in ankylosing spondylitis: systematic literature review and meta-analysis.

OBJECTIVES: To compare the efficacy and safety of infliximab-biosimilar with other biological drugs for the treatment of active ankylosing spondylitis (AS). METHODS: Systematic literature review for randomized controlled trials (RCTs) with adalimumab, etanercept, golimumab, infliximab and infliximab-biosimilar in AS was performed and indirect meta-analysis (Bayesian mixed treatment comparison) was carried out. The proportion of patients reaching 20 % improvement by the assessment of Spondyloarthritis International Society response criteria (ASAS20) at weeks 12 and 24 was used as efficacy endpoints, and the occurrence of serious adverse events at week 24 was applied to compare the safety of the biologicals. RESULTS: Altogether, 13 RCTs, identified by the systematic literature search, were included in the analysis. Results on the ASAS20 efficacy endpoint were reported for week 12 in 12 RCTs involving 2,395 patients, and for week 24 in 5 RCTs comprising 1,337 patients. All the five biological agents proved to be significantly superior to placebo. Infliximab showed the highest odds ratio (OR) of 7.2 (95 % CI 3.68-13.19) compared to placebo, followed by infliximab-biosimilar with OR 6.25 (95 % CI 2.55-13.14), both assessed at week 24. No significant difference was found between infliximab-biosimilar and other biological treatments regarding their efficacy and safety. CONCLUSIONS: This is the first study which includes a biosimilar drug in the meta-analysis of biological treatments in AS. The results have proven the similar efficacy and safety profile of infliximab-biosimilar treatment compared to other biologicals.

Efficacy and safety of infliximab-biosimilar compared to other biological drugs in rheumatoid arthritis: a mixed treatment comparison.

OBJECTIVE: The aim of this meta-analysis was to compare the efficacy and safety of infliximab-biosimilar and other available biologicals for the treatment of rheumatoid arthritis (RA), namely abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab and tocilizumab. METHODS: A systematic literature review of MEDLINE database until August 2013 was carried out to identify relevant randomized controlled trials (RCTs). Bayesian mixed treatment comparison method was applied for the pairwise comparison of treatments. Improvement rates by the American College of Rheumatology criteria (ACR20 and ACR50) at week 24 were used as efficacy endpoints, and the occurrence of serious adverse events was considered to assess the safety of the biologicals. RESULTS: Thirty-six RCTs were included in the meta-analysis. All the biological agents proved to be superior to placebo. For ACR20 response, certolizumab pegol showed the highest odds ratio (OR) compared to placebo, OR 7.69 [95 % CI 3.69-14.26], followed by abatacept OR 3.7 [95 % CI 2.17-6.06], tocilizumab OR 3.69 [95 % CI 1.87-6.62] and infliximab-biosimilar OR 3.47 [95 % CI 0.85-9.7]. For ACR50 response, certolizumab pegol showed the highest OR compared to placebo OR 8.46 [3.74-16.82], followed by tocilizumab OR 5.57 [95 % CI 2.77-10.09], and infliximab-biosimilar OR 4.06 [95 % CI 1.01-11.54]. Regarding the occurrence of serious adverse events, the results show no statistically significant difference between infliximab-biosimilar and placebo, OR 1.87 [95 % CI 0.74-3.84]. No significant difference regarding efficacy and safety was found between infliximab-biosimilar and the other biological treatments. CONCLUSION: This is the first indirect meta-analysis in RA that compares the efficacy and safety of biosimilar-infliximab to the other biologicals indicated in RA. We found no significant difference between infliximab-biosimilar and other biological agents in terms of clinical efficacy and safety.

Az egyéni teljesítményértékelési rendszer működésének tapasztalatai a magyar közigazgatásban (Operating experiences of the individual performance appraisal system in the Hungarian public sector)

A tanulmány – egy 2005 végén lefolytatott, országosan reprezentatív kérdőíves felmérés empirikus bázisán – a magyar közigazgatási dolgozók körében 2002-től bevezetett egyéni teljesítményértékelési rendszert vizsgálja. A rendszer egészét tekintve a vizsgálat végkövetkeztetései nem túl rózsásak: az eredmények arra utalnak, hogy a rendszer mint egész nem képes kitűzött fő célját, a munkateljesítmények javítását elérni. Az egyes részrendszerek, szervezettípusok szintjén differenciáltabb eredményeket kapunk, míg a minisztériumokban a rendszer egésze a szándékolttól alapvetően különböző célokat látszik szolgálni, addig a többi szervezettípusnál inkább „csak” a rendszer tökéletlen működéséről beszélhetünk. ____ On the basis of a questionnaire survey of a nationally representative sample of Hungarian civil servants, the study attempts to give a preliminary evaluation of the individual performance assessment system introduced in 2002 throughout the Hungarian civil service. The general conclusion of the analysis is that the performance assessment system is unlikely to reach its goals: its central element, the performance related pay incentives are overly dispersed and, on the average, insignificant in size, meanwhile the objectivity of performance assessments is also questionable. Moreover, comparative analysis of responses from different administrative branches reveals an interesting idiosyncrasy characteristic for central government ministries. Here, the main function of the incentive system seems to be ensuring the labor market competitiveness of the ministries as employers by enabling them to pay higher-than-usual salaries for employees having certain types of expertise.

Tíz év az Európai Unióban - az új tagországok agrárteljesítményei = A decade in the EU: the agricultural performances of the new member-states

Több mint tíz év telt el az Európai Unió 2004. évi kibővülése óta. A tízéves évforduló jó lehetőséget kínált a mérlegkészítésre, annak vizsgálatára, hogy a legfrissebb elérhető adatok tükrében milyen fejlődési pályát tudhatnak maguk mögött az új tagországok mezőgazdasági szektorai. Írásunk célja a tíz kelet- európai EU-tagállam agrárteljesítményének értékelése, illetve ez alapján a csatlakozás nyerteseinek, illetve veszteseinek azonosítása. A rendelkezésre álló adatokat a többdimenziós faktoranalízis módszerével feldolgozva arra az eredményre jutottunk, hogy Lengyelország, Észtország és Litvánia hármasa tekinthető az agrárcsatlakozás abszolút nyertesének, míg a többi új tagállam nem volt képes teljes mértékben kihasználni a csatlakozás adta lehetőségeket. Az eredményekből az is látható, hogy a magas hozzáadott értékű termékekre való szakosodás jó stratégiának bizonyult, mert gyorsabb fejlődést biztosított, mint a mezőgazdasági alaptermékekre való koncentrálás. ____ The period of over ten years since the 2004 round of EU accessions provides a good opportunity to assess and take stock of agricultural developments in the new member- States, in light of the latest available data. The paper sets out to assess their agricultural performances and to identify the winners and losers by accession in this regard. Ranking individual country performances using Parallel Factor Analysis (PARAFAC) suggests that Poland, Estonia and Lithuania can be considered as winners, whereas the other countries failed to use the potentials of membership to the full. The results also suggest that focusing on agri-food products with a high added value proved a good development strategy for the sector. Countries that concentrated on producing agri-food raw materials lagged behind.