Félix de Carlos Villafranca

Universidad de Oviedo

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Juan Cobo

Universidad de Oviedo

José A. Vega

Universidad de Oviedo

Juan Cobo Plana

Universidad de Oviedo

Antonino Germanà

University of Messina

Teresa Cobo

Universidad de Oviedo

Emilio Macías Escalada

Universidad de Deusto

Emilio Macías

Universidad de Oviedo

Nuria García‐Carrillo

Universidad de Murcia

E. Ciriaco

University of Messina

José Luís Calvo‐Guirado

Universidad de Murcia

Cooperative Institutions

Universidad de Oviedo

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

Marqués de Valdecilla University Hospital

Instituto de Salud Carlos III

Central University Hospital of Asturias

Centro de Investigación Biomédica en Red

Instituto de Investigación Sanitaria del Principado de Asturias

Universidad de Murcia

University of Messina

University of the Basque Country

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FRI0175 Indirect Treatment Comparisons and Network Meta-Analysis among Biological Agents for Rheumatoid Arthritis: A Systematic Review of Published Literature

Annals of the Rheumatic Diseases (2014)

Félix de Carlos Villafranca Alfredo Aguirre María Paula Naranjo C. Villaverde Gutiérrez J. Marruecos Querol

Background

Rheumatoid arthritis (RA) is associated with significant morbidity, functional impairment, loss of quality of life, premature mortality, and substantial economic burden.¹ Biological disease-modifying antirheumatic drugs (bDMARD) are key in the RA treatment pathway. Indirect treatment comparisons (ITC) and network meta-analysis (NMA) allow inferences in the absence of head-to-head comparisons.²

Objectives

To perform a systematic review of publications of ITC and NMA among bDMARD in RA.

Methods

A search in PubMED/Medline and Google Scholar was conducted. Inclusion criteria included full-text access and publication in English or Spanish during a 2009–2013 timeframe. Studies that pooled TNF-α inhibitors and those focused on economic evaluations were excluded. Competing alternatives (either as monotherapy or in combination) were infliximab, etanercept (ETN), adalimumab, certolizumab pegol (CZP), golimumab, abatacept, tocilizumab (TOC), rituximab, and anakinra. Relevant characteristics regarding target population and study design (eg. prior drugs failed and if bDMARD were given as monotherapy or in combination besides its duration) of the selected clinical trials were registered. Trial quality assessment (eg. Jadad scale) and type of statistical approach (frequentist or Bayesian) used when performing ITC or NMA were also recorded. American College of Rheumatology (ACR) 20, 50, and 70 response criteria and withdrawal rates analysed throughout ITC or NMA comprised the outcomes of interest for the present review.

Results

Sixty-five references were retrieved, of which 10 achieved inclusion criteria for ITC and NMA.^3–12 The number of clinical trials analyzed in each publication varied from 10⁵ to 44.¹⁰ Among the 3 studies that conducted frequentist analyses,^3–5 CZP ranked highest for efficacy in 4 out of 7 efficacy ranking reports, followed by ETN (2) and TOC (1). CZP received the highest efficacy rank in 10 out of 13 ranking reports among the 7 studies with Bayesian approaches,^6–12 while ETN ranked highest in the other 3. ETN was associated with the lowest rates of withdrawal due to adverse events (AEs),^3,10 whereas CZP showed the lowest rates of withdrawal due to lack of efficacy.¹⁰ Overall, CZP had the lowest rates of all-causes of withdrawal.¹⁰

Conclusions

Current review indicated that published ITC and NMA show that CZP has the highest treatment effect compared to other bDMARD used in RA. In terms of withdrawal rates, ETN had the lowest rates due to AEs, and CZP was associated with the lowest all-cause withdrawal rates.

References

Russell A. Pharmacoeconomics 2008;26(10):831-846. Ades et al. Rheumatology (Oxford) 2011;50 Suppl 4:iv5-9. Singh et al. CMAJ 2009;181(11):787-796. Mandema et al. Clin Pharmacol Ther 2011;90(6):828-835. Gallego-Galisteo et al. J Clin Pharm Ther 2012;37(3):301-307. Devine et al. Pharmacotherapy 2011;31(1):39-51. Launois et al. J Rheumatol 2011;38(5):835-845. Turkstra et al. Curr Med Res Opin 2011;27(10):1885-1897. Guyot et al. J Rheumatol 2012;39(6):1198-1206. Desai et al. Ann Pharmacother 2012;46(11):1491-1505. Schmitz et al. BMC Med Res Methodol 2012;12:167. Orme et al. Biologics 2012;6:429-464.

Acknowledgements

The authors acknowledge Costello Medical Consulting for editorial assistance which was funded by UCB Pharma.

Disclosure of Interest

F. Carlos Consultant for: Roche, MSD, Eli Lilly, UCB Pharma, A. Aguirre Employee of: UCB Pharma, M. Naranjo Employee of: UCB Pharma, C. Gutiérrez Employee of: UCB Pharma, J. Querol Employee of: UCB Pharma

DOI

10.1136/annrheumdis-2014-eular.2512

Tocilizumab

Abatacept

Golimumab

Certolizumab pegol

10.1136/annrheumdis-2014-eular.2512

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Ronchopathie chronique et syndrome de l'apnée-hypopnée obstructive du sommeil chez l'enfant

L Orthodontie Française (2003)

Félix de Carlos Villafranca Juan Cobo Plana Belen Díaz-Esnal P. FERNANDEZ-MONDRAGON Emilio Macías Escalada

The problems children have in sleeping are manifold; the gamut of disorders that have been described ranges from simple, occasional snoring with no accompanying complications, through the syndrome of increased blockage of the upper airways to the obstructive sleep apnea-hypopnea syndrome (OSAHS) where respiratory difficulties accompanied by hypoxemia, hypercapnia and structural sleep difficulties. Mouth breathing and chronic snoring occur frequently in children, with the incidence of snoring, identical for both sexes, varying between 3.2 and 27%. Difficulties in sleeping begin between the ages of the 3 and 9, peaking between 3 and 6. These results demonstrate, in a general way, the disparity between growth of the adenoids and tonsils, and upper airway growth. A differential diagnosis between the various pathological possibilities is based on the observed clinical signs and symptoms, analysis of cephalometric radiographs, polysomnography, a nocturnal cardio-respiratory polygraph and a video film taken during sleep. Snoring is the most characteristic sign of OSAHS in children. We do not yet have available any synthetic study that would sum up results of studies of sleep disorders in children. Nevertheless, we can define obstructive sleep apnea in children as the partial or total cessation of nose and mouth breathing for a period double that of the normal respiratory cycle. Classical treatment of children who suffer from severe respiratory difficulties during sleep, after identification of the etiology of the problem, consists of surgical removal of the adenoids or tonsils and, in certain, continuous positive pressure to assist breathing. The authors of this article have worked with 137 patients between the ages of 6 and 9, 77 of whom were chronic snorers with an average age of 7 years 6 months. The average age of the control group of 60 children was 7 years 2 months. We collected clinical data, medical histories, and distributed a questionnaire to determine individual sleep and vigilance behavior of each child in the sample. To complete our evaluation, we made a cephalometric analysis of facial type, antero-postero skeletal pattern, upper airways, and hyoid bone position. The symptom that we encountered most frequently in young chronic snorers was agitated and uneasy sleep, sometimes accompanied by bed-wetting and cervical hyperextension. We often found daytime symptoms of hyperactivity and personality or behavioral problems. Hypertrophy of the adenoids, the adenoidal fascia, and the tonsils were also frequent clinical signs. The cephalometric analyses often showed the patients to be of the dolichocephalic facial type, often with the mandible rotated posteriorly. The children were as likely to be classified as Class II owing to retrognathic mandibles as to be Class III owing to maxillary deficiencies or mandibular excess. At the level of the upper airways, it appears that the development of snoring can be explained by a reduction in the dimensions of the upper pharynges accompanied by an increase in the dimensions of the middle and lower pharynges.

Hypopnea

Mouth breathing

Etiology

10.1051/orthodfr/200374431

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Mandibular Advancement Device (MAD®) to Treat Sleet Apnoea-Hypopnoea Syndrome and Chronic Snoring

IFMBE proceedings (2009)

Juan Manuel Dieste Cobo Félix de Carlos Villafranca Adrián Suárez

Sleep

10.1007/978-3-642-01697-4_121

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Experimental evidence of pharmacological management of anchorage in Orthodontics: A systematic review

Figshare (2022)

Felipe J. Fernández-González Aránzazu Cañigral Felipe Balbontín-Ayala José M. Gonzalo‐Orden Félix de Carlos Villafranca

Introduction: Orthodontic anchorage is one of the most challenging aspects of Orthodontics. Preventing undesired movement of teeth could result in safer and less complicated orthodontic treatment. Recently, several reviews have been published about the effects of different molecules on bone physiology and the clinical side effects in Orthodontics. However, the effects of local application of these substances on the rate of orthodontic tooth movement have not been assessed.Objectives: The aim of this research was to analyze the scientific evidence published in the literature about the effects of different molecules on orthodontic anchorage.Methods: The literature was systematically reviewed using PubMed/Medline, Scopus and Cochrane databases from 2000 up to July 31st, 2014. Articles were independently selected by two different researchers based on previously established inclusion and exclusion criteria, with a concordance Kappa index of 0.86. The methodological quality of the reviewed papers was performed.Results: Search strategy identified 270 articles. Twenty-five of them were selected after application of inclusion/exclusion criteria, and only 11 qualified for final analysis. Molecules involved in orthodontic anchorage were divided into three main groups: osteoprotegerin (OPG), bisphosphonates (BPs) and other molecules (OMs).Conclusions: Different drugs are able to alter the bone remodeling cycle, influencing osteoclast function and, therefore, tooth movement. Thus, they could be used in order to provide maximal anchorage while preventing undesired movements. OPG was found the most effective molecule in blocking the action of osteoclasts, thereby reducing undesired movements.

10.6084/m9.figshare.20043784

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Les élastiques intermaxillaires des classes II et III exercent-ils une action sur les A.T.M ? Étude par la méthode des éléments finis

Revue d Orthopédie Dento-Faciale (2002)

Félix de Carlos Villafranca Juan Manuel Dieste Cobo Emilio Macías Escalada Javier Canut

L'implication possible du traitement orthodontique, et tout particulierement de l'utilisation des elastiques intermaxillaires, dans la genese des dysfonctions des articulations temporo-mandibulaires, est un des themes de debat classiques en orthodontie contemporaine. Dans cette etude, nous voulons donner une vue d'ensemble de la distribution des tensions exercees sur les articulations temporo-mandibulaires, lors de l'application d'elastiques intermaxillaires. Pour cela, nous avons realise un modele bidimensionnel de simulation par la methode des elements finis. D'apres nos resultats, les elastiques intermaxillaires de classe III provoquent peu de tensions sur les articulations temporo-mandibulaires. Au contraire, les elastiques de classe II entrainent des tensions plus importantes sur la zone articulaire et pourraient ainsi avoir un role dans la genese de certains desordres articulaires.

10.1051/odf/2002030

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Resolución de la enuresis nocturna de 3 pacientes en tratamiento ortodóncico con aparatos de avance mandibular

Anales de Pediatría (2000)

Juan Cobo Plana Bibiana Villa Félix de Carlos Villafranca L. Díaz Esnal

10.1016/s1695-4033(00)77322-x

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Ortodoncia y vías aéreas superiores

RCOE (2002)

Juan Cobo Plana Belén Díaz Esnal Félix de Carlos Villafranca Ma Pilar Fernández Mondragón

Entre los objetivos generales del tratamiento en ortodoncia y los combinados de ortodoncia y cirugia ortognatica, estan lograr una buena oclusion y una mejoria estetica, sobre todo en el caso de deformidades dentoesqueleticas severas. Sin embargo, en muchas ocaciones no se tienen en cuenta los parametros de la via aerea superior a la hora de realizar los objetivos del tratamiento convencional. Los pacientes con alteraciones obstructivas durante el sueno, representan para los odontologos y estomatologo un tipo de paciente diferente al normal, en los que el tratamiento, va dirigido a mejorar la saturacion de oxigeno. Aqui, las consideraciones funcionales se imponen a las puramente esteticas. Es conveniente a la hora de realizar un diagnostico ortodoncico, quirurgico o mixto de un paciente, tener en cuenta las connotaciones inherentes a la via aerea superior (VAS) que el tratamiento pueda a acarrear. No podemos pretender conseguir una buena estetica a expensas de generar pacientes mas propensos a los trastornos estenosantes de la VAS. Palabras clave: Via aerea superior, Ortodoncia, Cirugia ortognatica, Patologia del sueno.

10.4321/s1138-123x2002000500007

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Citations (2)

Posttraumatic impaction of both maxillary central incisors

American Journal of Orthodontics and Dentofacial Orthopedics (2003)

Emilio Macías Félix de Carlos Villafranca Juan Cobo

Impaction

10.1016/s0889-5406(03)00305-6

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Citations (19)

Absence of Meissner corpuscles in the digital pads of mice lacking functional TrkB

Brain Research (2004)

Tatiana González-Martı x nez Germana P. Germanà Diego F. Monjil Inmaculada Silos‐Santiago Félix de Carlos Villafranca

Trigeminal ganglion

Mechanoreceptor

Dorsal root ganglion

Sensory receptor

10.1016/j.brainres.2004.01.003

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Caracterización de biomateriales pre y post aplicación en un modelo in vivo mediante uso de tomografía computerizada

Labor dental clínica: Avances clínicos en odontoestomatología (2021)

Adrián Hurtado Bermúdez Nuria García‐Carrillo Miguel Garcés Villalá Félix de Carlos Villafranca F. Martínez

espanolObjetivo Establecer un metodo que nos permita la caracteri zacion de biomateriales pre y post aplicacion, basan dose en la informacion proporcionada por la micro tomografia computerizada (micro-TC) y densidad osea medida en Unidades Hounsfield (UH). Metodologia Como biomaterial se trabajo con 48 dientes de pe rro (Premolares P2, P3, P4 y el primero molar M1) que se fueron triturados con Smart Dentin Grinder, 24 de ellos fueron enviados al analisis de micro-TC y 24 muestras posteriormente fueron im plantados en los alveolos de 6 perros Beagle. Tres meses despues de la implantacion se tomaron las biopsias y se analizaron con el MicroCT. La me todologia empleada se baso en una estadistica des criptiva de los valores de densidad osea medidos en UH obtenidos a partir de la creacion de volumenes de interes (VOIs) e isocontornos 3D predefinidos a partir de las imagenes obtenidas tras realizar mi cro-TC de las biopsias del diente triturado (dentin grinder) y su posterior analisis con el examinador de datos de imagenes medicas AMIDE. Resultados El micro-TC permite establecer las caracteristicas de los biomateriales mediante el estudio de las HU. Existe una marcada predominancia de densidad tipo hueso D3 (350-850 HU) en la muestra con una media de porcentaje de los tres valores obtenidos de 96,14%. Existe una ausencia de densidad tipo hueso D2 y D1 en 2 de las regiones estudiadas pre sentando su maximo valor en 805,86 HU y 802,67 HU respectivamente, con un minimo porcentaje de densidad tipo hueso D2 en la region de interes comprendida en el elipsoide 1 (0,08%). Lo mismo hemos encontrado en las biopsias donde redomina la presencia de densidad tipo hueso D3 (350-850 HU) en el analisis del volumen total de la region de interes seleccionada comprendida en el cilindro de dimen siones de 180x180x180 mm en un 61%. Conclusiones La micro-TC podria ser considerada una tecnica de gran valor en la caracterizacion en base a las UH de biomateriales, tanto pre como post implantacion en un modelo in vivo. El metodo descrito nos per mite evaluar la densidad radiologica tanto del bio material como de las biopsias, siendo necesario el analisis de varios parametros de la microarquitectu ra del tejido mas alla de las UH para establecer un ANALISIS fiable de la calidad del tejido a evaluar. Los resultados del analisis del micro-TC mostraron densidades en UH, similares, tanto en las muestras pre-implantacion como en las biopsias post implan tacion, similar al hueso de densidad D2-D3 EnglishObjective To establish a method that allows us to characterize pre and post application biomaterials, based on the information provided by micro-computed tomo graphy (micro-CT) and bone density measured in Hounsfield Units (HU). Methodology As a biomaterial, 48 dog teeth were used (Premolars P2, P3, P4 and the first molar M1) that were crus hed with Smart Dentin Grinder, 24 of them were sent for micro-CT analysis and 24 samples were la ter implanted. in the alveoli of 6 Beagle dogs. Biop sies were taken three months after implantation and analyzed with the MicroCT. The methodology used was based on a descriptive statistic of the bone density values measured in HU obtained from the creation of volumes of interest (VOIs) and predefi ned 3D iso-contours from the images obtained after performing micro-CT of the biopsies of the crushed tooth (dentin grinder) and its subsequent analysis with the medical imaging data examiner AMIDE. 1 Graduado en Odontologia. Universidad Catolica de Murcia. Murcia 2 Veterinaria. Universidad de Murcia. Murcia 3 Doctor en Odontologia. Investigador Fundacion Corazon de Jesus. San Juan Argentina. 4 Profesor Titular de Ortodoncia. Facultad de Medicina . Universidad de Oviedo. Oviedo 5 Servicio de Ortopedia y Traumatologia. Hospital Universitario Virgen de la Arrixaca. Murcia 6 Profesora cirugia bucal. Universidad Catolica de Murcia Results The micro-CT allows to establish the characteristics of the biomaterials by studying the HU. There is a marked predominance of bone type D3 density (350-850 HU) in the sample with a mean percenta ge of the three values obtained of 96.14%. There is an absence of bone-type density D2 and D1 in 2 of the regions studied, presenting its maximum value at 805.86 HU and 802.67 HU respectively, with a minimum percentage of bone-type density D2 in the region of interest comprised in the ellipsoid 1 (0.08%). We have found the same in biopsies where the presence of D3 bone density (350-850 HU) is prominent in the analysis of the total volume of the selected region of interest comprised in the cylinder with dimensions of 180x180x180 mm by 61%. Conclusions Micro-CT could be considered a technique of great value in the characterization based on the HU of biomaterials, both before and after implantation in an in vivo model. The described method allows us to evaluate the radiological density of both the bioma terial and the biopsies, being necessary the analysis of several parameters of the tissue microarchitecture beyond the HU to establish a reliable ANALYSIS of the quality of the tissue to be evaluated. The results of the micro-CT analysis showed similar densities in UH, both in the pre-implantation samples and in the post-implantation biopsies, similar to bone density D2-D3

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