2024年 · 第47卷第09期

Grow in spring and grow in summer, harvest in autumn and store in winter. In this golden autumn season when the summer heat has still not dissipated, this magazine has met with your readers in the 9th issue of 2024.

Background:Symptomatic malignant pleural effusion (MPE) can be alleviated by thoracic catheter drainage (IPC) or pleurodesis, which requires high medical services and medical costs, but there are not many cost-effectiveness related studies related to these management measures. The study aimed to compare the use of medical services and the cost of home care services after IPC versus hospitalization after pleurodesis in patients with MPE 12 months after IPC or pleurodesis. Methods: Adult MPEs patients who underwent IPC or pleurodesis between January 1, 2015 and December 31, 2019 in a provincial health management database were retrospectively analyzed. Patients were followed up from the day of the operation, and the follow-up endpoint was patient death or 12 months after the operation. Adjusting for confounders of baseline characteristics using inverse probability weighting (IPTW); Weighted regression was used to analyze differences in length of stay, readmission, emergency department visits, home care visits, and medical costs.Results:Of the 5 752 patients included, 4 432 (77%) underwent IPC and 1 320 (23%) underwent pleurodesis. Patients who underwent IPC had fewer days in hospital compared to those who underwent pleurodesis: 12.4 dvs.16.0 d, the standard mean difference (SMD) was 0.229, but the proportion of readmissions was higher: 2.7%vs.1.1%（P=0.000 2）。 Longer time in home care for patients receiving IPC: 41.0 hvs.21.1 h with an SMD of 0.671, but the overall mean healthcare cost was lower than that of patients undergoing pleurodesis: $40 179/casevs.$46,640/case with an SMD of 0.177.Conclusion:For MPE patients, IPC under home care reduces healthcare resource use compared to pleurodesis; Given the similar efficacy of these two treatments, the study recommends IPC for the management of MPE patients.

Background:The incidence and mortality of arterial pulmonary hypertension (PAH) remain high. Activation of platelet-derived growth factor receptor, colony stimulating factor 1 receptor, and mast cell or stem cell growth factor receptor kinase stimulates inflammatory, proliferative, and fibrotic pathways that drive pulmonary vascular remodeling in PAH. Seralutinib is an inhaled kinase inhibitor that targets these pathways. The aim of this study was to evaluate the efficacy and safety of seratinib in patients with PAH receiving standard background therapy. Methods: The TORREY trial was a phase 2, randomized, multicenter, transnational, double-blind, placebo-controlled study. Patients with PAH from 40 hospitals and community sites were randomly assigned to receive seraglutinib (60 mg twice/d for 2 weeks, then increased to 90 mg twice/d depending on tolerability) by interactive response technique in a 1:1 ratio, or placebo twice daily via a dry powder inhaler for 24 weeks. Based on baseline pulmonary vascular resistance (PVR<800 dyn s^-1• cm^-5and ≥800 dyn·s^-1• cm^-5) Stratification of randomized groups. If the patient is classified as WHO Group 1 PH (PAH), WHO Functional Class II or III and has a PVR of 400 dyn·s^-1• cm^-5Or above, with a 6-min walking distance between 150 and 550 m, patients were eligible for enrollment. The primary endpoint was the change in PVR from baseline to 24 weeks. Endpoint efficacy analyses were performed in randomly assigned patients (intent-to-treat population). The safety analysis included all patients receiving study drug. TORREY has completed registration with ClinicalTrials.gov (NCT04456998).Results:A total of 151 patients were screened between Nov. 12, 2020 and Apr. 20, 2022, and 86 adults receiving background therapy for PAH were randomly assigned to either seraglutinib (44, of which 4 males and 40 females) or placebo (42, of which 4 males and 38 females). The least squares mean change in PVR from baseline to week 24 was 21.2 dyn s in the placebo group^-1• cm^-5（95%CI: -37.4 to 79.8) and-74.9 dyn·s in the serutinib group^-1• cm^-5（95%CI：-139.7~-10.2）。 The least squares mean difference in PVR change between the seraglutinib and placebo groups was-96.1 dyn s^-1• cm^-5（95%CI：-183.5~-8.8；P=0.03）。 The most common treatment-emergent adverse event in both treatment groups was cough: cough occurred in 16 of 42 patients in the placebo group (38%); 19 of 44 patients (43%) in the celatinib group.Conclusion:Patients in the seralutinib-treated group had a significantly reduced change in PVR at 24 weeks compared with the placebo group, reaching the primary endpoint of the study. In addition, the Seralutinib treatment group also showed certain advantages in other efficacy endpoints, such as improved 6-min walking distance and WHO functional grading. In terms of safety, the incidence of adverse events was similar in the seralutinib-treated and placebo groups.