Recenti progressi in medicina
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Multicenter Study Comparative Study Observational Study
Safety and effectiveness of direct oral anticoagulants versus vitamin K antagonists: results from 3 Italian regions.
In Italy, direct oral anticoagulant drugs (DOACs) were authorized for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) in 2013. There is conflicting evidence on their benefit-risk profile under real world conditions. ⋯ The present study confirms findings from previous research regarding bleeding events, whereas we did not find a reduced risk of mortality in DOAC users. Further research on single active agents and specific populations is warranted.
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Checkpoint inhibitors immunotherapy was a breakthrough in anti-tumor treatments. Anti-PD-1 monoclonal antibodies are now a standard of treatment for advanced melanoma patients, with a 3-year overall survival of over 50% and a low rate (<20%) of severe toxicities in the phase 3 studies. The aim of this review was to report the most important updates on anti-PD-1 drug pembrolizumab from ASCO (American Society of Clinical Oncology) and ESMO (European Society for Medical Oncology) 2017 Annual Meetings.
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Immune checkpoint inhibitors led to major advances in melanoma therapy, and pembrolizumab (anti-PD-1 monoclonal antibody) is now a new standard of treatment for advanced melanoma. The aim of this work was to discuss, on the basis of planned or ongoing clinical trials, future perspectives to improve the efficacy of pembrolizumab, such as combination regimens with other immunotherapies or targeted therapies.
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Following the development of a unifying and transparent approach to grading the certainty of evidence and strength or recommendations, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group has refined its process of moving from Evidence to Decisions. The purpose of its new Evidence to Decision (EtD) frameworks is to help people use evidence in a structured and transparent way to inform decisions in the context of clinical recommendations, coverage decisions, and health system or public health recommendations and decisions. EtD frameworks inform users about the judgments that were made and the evidence supporting those judgments by making the basis for decisions transparent to target audiences. EtD frameworks also facilitate dissemination of recommendations and enable decision makers in other jurisdictions to adopt recommendations or decisions, or adapt them to their context.