Legal status
In February 2021, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a conditional marketing authorization for the medicinal product Jemperli, intended for the treatment of certain types of recurrent or advanced endometrial cancer. The applicant for this medicinal product is GSK (Ireland) Limited. Dostarlimab was approved for medical use in the European Union in April 2021. Economics
In the United States, dostarlimab is an expensive medication, costing around US$11,000 per dose.For patients with endometrial cancer it is estimated cost of dostarlimab is $104,000 in the first 6 months. This only includes the cost of accessing the medication and not the doctors fee or infusion cost or imaging. Thus those who are uninsured will most likely have trouble getting treatment with Dostarlimab. Among those who are insured, those who have Medicaid insurance are less likely to receive full care for gynecologic cancer. Those insured through private insurance still experience economical hardships while getting treatment. Uninsured patients do not tend to get screened regularly, which results in late diagnosis of the disease. References
External links
"Dostarlimab". Drug Information Portal. U.S. National Library of Medicine. Clinical trial number NCT02715284 for "Study of TSR-042, an Anti-programmed Cell Death-1 Receptor (PD-1) Monoclonal Antibody, in Participants With Advanced Solid Tumors (GARNET)" at ClinicalTrials.gov
This may be due to strain and inflammation of the ligaments supporting the navicular bone, reduced blood flow and increased pressure within the hoof, damage to the navicular bursa or DDF tendon, or from cartilage erosion. Affected horses display a "tiptoe" gait - trying to walk on the toes due to heel pain. They may stumble frequently. The lameness may switch from one leg to another, and may not be consistent. Lameness usually occurs in both front feet, although one foot may be more sore than the other. Lameness is usually mild (1–2 on a scale of 5). It can be made worse when the horse is worked on a hard surface or on a circle. After several months of pain, the feet may begin to change shape, especially the foot that has been experiencing the most pain, which tends to become more upright and narrow. Treatment and prognosis
No single treatment works for all cases, probably because there is no single cause for all cases. The degenerative changes are usually quite advanced by the time the horse is consistently lame, and these changes are believed to be non-reversible. At this time, it is best to manage the condition and focus on alleviating pain and slowing the degeneration. Trimming
Putting the foot into proper neurological and biomechanical balance is crucial. Often navicular horses have long toes and underrun heels with very little inner wall depth or strength. Exposing the horse to proper stimulus to improve hoof form and structure is also vital.