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Efficacy of methotrexate in reducing the risk of bone erosion in patients with rheumatoid arthritis: a systematic review of randomized controlled trials

Destiani DP, Naja S, Dewi S, Rahmadi AR, Sulaiman SAS, Abdulah R

Osteoporos Int, 2021 May;32(5):805-816.
PMID: 33210179 DOI: 10.1007/s00198-020-05743-z

Even though new drugs for the treatment of rheumatoid arthritis (RA) have been developed, methotrexate (MTX) remains a commonly used drug for RA management. In addition to monitoring disease activity during RA treatment, bone erosion should be closely assessed throughout long-term RA management. In this review article, we present a systematic review of MTX effectiveness in reducing the risk of bone erosion. We reviewed randomized controlled trial studies that involved MTX monotherapy or MTX in combination with placebo. Evaluation of the progression of bone erosion was examined by radiographic assessment such as total Sharp score (TSS) or van der Heijde score (SvdH or vdH TSS), joint space narrowing (JSN), erosion score (ERO), and proportion of radiographic nonprogressors. Several key factors were found to influence the response to MTX treatment, such as gene polymorphism. The exact mechanism of the prevention of bone erosion by MTX remains unclear, which warrants future investigations. The variability of RA disease activity in study subjects resulted in variations in the results reported by individual studies. Collective analysis suggests that MTX could slow down the progression of bone erosion based on a radiographic score of less than 0.5-1/year.
Fulltext Cost-Effectiveness Analysis of Spending on Research and Development to Address the Needs for Innovative Therapeutic Products in Indonesia

Suwantika AA, Kautsar AP, Zakiyah N, Abdulah R, Boersma C, Postma MJ

Ther Clin Risk Manag, 2020;16:969-977.
PMID: 33116546 DOI: 10.2147/TCRM.S260377

Background: The annual gross domestic expenditure on research and development (GERD) per capita of Indonesia ($24) remains relatively lower than the annual GERD per capita of neighboring countries, such as Vietnam ($36), Singapore ($1804), Malaysia ($361), and Thailand ($111).
Objective: The aim of this study was to conduct a cost-effectiveness analysis of spending on healthcare R&D to address the needs of developing innovative therapeutic products in Indonesia.
Methods: A decision tree model was developed by taking into account four stages of R&D: stage 1 from raw concept to feasibility, stage 2 from feasibility to development, stage 3 from development to early commercialization, and stage 4 from early to full commercialization. Considering a 3-year time horizon, a stage-dependent success rate was applied and analyses were conducted from a business perspective. Two scenarios were compared by assuming the government of Indonesia would increase GERD in health and medical sciences up to 2- and 3-times higher than the baseline (current situation) for the first and second scenario, respectively. Cost per number of innovative products in health and medical sciences was considered as the incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis was conducted to investigate the effects of different input parameters on the ICER.
Results: There was a statistically significant association (P-value<0.05) between countries' GERD in medical and health sciences with the number of innovative products. We estimated the ICER would be $8.50 million and $2.04 million per innovative product for the first and second scenario, respectively. The sensitivity analysis showed that the success rates in all stages and total GERD were the most influential parameters impacting the ICER.
Conclusion: The result showed that there was an association between GERD in medical and health sciences with the number of innovative products. In addition, the second scenario would be more cost-effective than the first scenario.
Biomonitoring of Exposures to Solvents and Metals in Electronics Manufacturing Facilities in Batam, Indonesia

Lee JH, Gatera VA, Smith T, Panimbang F, Gonzalez A, Abdulah R, et al.

New Solut, 2024 Feb;33(4):220-235.
PMID: 38112404 DOI: 10.1177/10482911231218478

Concerns about chemical exposure in the electronics manufacturing industry have long been recognized, but data are lacking in Southeast Asia. We conducted a study in Batam, Indonesia, to evaluate chemical exposures in electronics facilities, using participatory research and biological monitoring approaches. A convenience sample of 36 workers (28 exposed, 8 controls) was recruited, and urine samples were collected before and after shifts. Five solvents (acetone, methyl ethyl ketone, toluene, benzene, and xylenes) were found in 46%-97% of samples, and seven metals (arsenic, cadmium, cobalt, tin, antimony, lead, and vanadium) were detected in 60%-100% of samples. Biological monitoring and participatory research appeared to be useful in assessing workers' exposure when workplace air monitoring is not feasible due to a lack of cooperation from the employer. Several logistical challenges need to be addressed in future biomonitoring studies of electronics workers in Asia in factories where employers are reluctant to track workers' exposure and health.
Fulltext Traditional medicine users in a treated chronic disease population: a cross-sectional study in Indonesia

Pradipta IS, Aprilio K, Febriyanti RM, Ningsih YF, Pratama MAA, Indradi RB, et al.

BMC Complement Med Ther, 2023 Apr 14;23(1):120.
PMID: 37060056 DOI: 10.1186/s12906-023-03947-4

BACKGROUND: Traditional medicine (TM) is commonly used as a treatment in Indonesia. This raises the need for an analysis of its potential development and irrational use. Therefore, we analyze the proportion of TM users among chronic disease patients and its associated characteristics to optimize the use of TM in Indonesia.
METHODS: A cross-sectional study of treated adult chronic disease patients was conducted using the fifth Indonesian Family Life Survey (IFLS-5) database. Descriptive analysis was used to identify the proportion of TM users, while a multivariate logistic regression was used to analyze their characteristics.
RESULTS: This study included 4901 subjects and identified 27.1% as TM users. The highest TM use was in subjects with cancer (43.9%), liver issues (38.3%), cholesterol issues (34.3%), diabetes (33.6%), and stroke (31.7%). Characteristics associated with TM users were a perception of one's current health as unhealthy (OR 2.59, 95% CI 1.76-3.81), low medication adherence (OR 2.49, 95% CI 2.17-2.85), age above 65 years (OR 2.17, 95% CI 1.63-2.90), having higher education (OR 1.64, 95% CI 1.17-2.29), and residence outside of Java (OR 1.27, 95% CI 1.11-1.45).
CONCLUSIONS: Low medication adherence among TM users highlights the potentially irrational use of treatment in chronic diseases. Nevertheless, the longstanding use of TM users indicates the potential for its development. Further studies and interventions are needed to optimize TM use in Indonesia.
Correction: Traditional medicine users in a treated chronic disease population: a cross-sectional study in Indonesia

Pradipta IS, Aprilio K, Febriyanti RM, Ningsih YF, Pratama MAA, Indradi RB, et al.

BMC Complement Med Ther, 2023 Dec 06;23(1):443.
PMID: 38057887 DOI: 10.1186/s12906-023-04276-2