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Gouverneur A, Favary C, Jové J, Rouyer M, Bignon E, Salvo F, Tchalla A, Paillaud E, Aparicio T, Noize P. Impact of Cardiovascular Comorbidities on the Effectiveness and Safety of Bevacizumab in Older Patients with Metastatic Colorectal Cancer. Target Oncol 2023; 18:717-726. [PMID: 37682504 DOI: 10.1007/s11523-023-00986-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Cardiovascular comorbidities are not contraindications of bevacizumab for metastatic colorectal cancer. OBJECTIVE We aimed to evaluate the impact of cardiovascular comorbidities before bevacizumab treatment on overall survival and cardiovascular safety in older patients with metastatic colorectal cancer. METHODS A 2009-2015 cohort of patients with metastatic colorectal cancer aged ≥ 65 years administered first-line bevacizumab was extracted from the French healthcare reimbursement claims database. Baseline heart failure, hypertension, and venous/arterial thromboembolic events were identified. The 36-month overall survival rate was evaluated using the Kaplan-Meier method, and the impact of cardiovascular comorbidities on the 36-month overall survival using a time-dependent, multivariable, Cox proportional hazards model. The 36-month cumulative incidence of cardiovascular events, and the impact of cardiovascular comorbidities on the likelihood of cardiovascular events were evaluated using the Fine and Gray model, with death as a competing risk. RESULTS We included 9222 patients (56.4% male; median age 73 years). Two-thirds (66.7%) had baseline cardiovascular comorbidities. The median 36-month overall survival was 20.4 [95% confidence interval (CI) 19.9-21.0] and 21.8 [95% CI 21.1-22.6] months in patients with and without cardiovascular comorbidities, respectively. Age ≥ 75 years, dependency in activities of daily living, radiotherapy, and another targeted therapy were identified as death risk factors, but not cardiovascular comorbidities. At 36 months, cardiovascular events had occurred in 60.2% [95% CI 58.9-61.4] and 44.1% [95% CI 42.3-45.9] of patients with and without cardiovascular comorbidities. Baseline venous thrombosis, female, three or more cardiovascular medications, another targeted therapy, and more than six bevacizumab injections were identified as risk factors for cardiovascular events. CONCLUSIONS In clinical practice, cardiovascular comorbidities before administering bevacizumab to older patients with metastatic colorectal cancer impacted the cardiovascular safety, but not overall survival. Unless they limit functional independency, older patients with cardiovascular comorbidities should be treated with bevacizumab under close monitoring.
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Affiliation(s)
- Amandine Gouverneur
- Univ. Bordeaux, INSERM, BPH, U1219, Team AHeaD; CHU de Bordeaux, Pôle de santé publique, Service de pharmacologie médicale, 33000, Bordeaux, France
| | - Clélia Favary
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 33000, Bordeaux, France
| | - Jérémy Jové
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 33000, Bordeaux, France
| | - Magali Rouyer
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 33000, Bordeaux, France
| | - Emmanuelle Bignon
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 33000, Bordeaux, France
| | - Francesco Salvo
- Univ. Bordeaux, INSERM, BPH, U1219, Team AHeaD; CHU de Bordeaux, Pôle de santé publique, Service de pharmacologie médicale, 33000, Bordeaux, France
| | - Achille Tchalla
- Université de Limoges, Institut OMEGA HEALTH, Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé); CHU de Limoges, Pôle HU de gérontologie clinique, Service de médecine gériatrique, 87042, Limoges, France
| | - Elena Paillaud
- Université de Paris Cité, Paris Cancer Institute CARPEM; Hôpital Européen Georges Pompidou, APHP, Service de gériatrie, 75015, Paris, France
| | - Thomas Aparicio
- Université de Paris; Hôpital Saint-Louis, APHP, Service de gastroentérologie, 75010, Paris, France
| | - Pernelle Noize
- Univ. Bordeaux, INSERM, BPH, U1219, Team AHeaD; CHU de Bordeaux, Pôle de santé publique, Service de pharmacologie médicale, 33000, Bordeaux, France.
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Garg A, Limaye K, Shaban A, Leira EC, Adams HP. Risk of Ischemic Stroke after an Inpatient Hospitalization for Transient Ischemic Attack in the United States. Neuroepidemiology 2020; 55:40-46. [PMID: 33260176 DOI: 10.1159/000511829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION A diagnosis of transient ischemic attack (TIA) must be followed by prompt investigation and rapid initiation of measures to prevent stroke. Prior studies evaluating the risk of stroke after TIA were conducted in the emergency room or clinic settings. Experience of patients admitted to the hospital after a TIA is not well known. We sought to assess the early risk of ischemic stroke after inpatient hospitalization for TIA. METHODS We used the 2010-2015 Nationwide Readmissions Database to identify all hospitalizations with the primary discharge diagnosis of TIA and investigated the incidence of ischemic stroke readmissions within 90 days of discharge from the index hospitalization. RESULTS Of 639,569 index TIA admissions discharged alive (mean ± SD age 70.4 ± 14.4 years, 58.7% female), 9,131 (1.4%) were readmitted due to ischemic stroke within 90 days. Male sex, head/neck vessel atherosclerosis, hypertension, diabetes, atrial flutter/fibrillation, previous history of TIA/stroke, illicit drug use, and higher Charlson Comorbidity Index score were independently associated with readmissions due to ischemic stroke. Ischemic stroke readmissions were associated with excess mortality, discharge disposition other than to home, and elevated cost. CONCLUSIONS Patients hospitalized for TIA have a lower risk of ischemic stroke compared to that reported in the studies based on the emergency room and/or outpatient clinic evaluation. Among these patients, those with cardiovascular comorbidities remain at a higher risk of readmission due to ischemic stroke despite undergoing an inpatient evaluation and should therefore be the target for future preventive strategies.
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Affiliation(s)
- Aayushi Garg
- Departments of Neurology, University of Iowa, Iowa City, Iowa, USA,
| | - Kaustubh Limaye
- Departments of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Amir Shaban
- Departments of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Enrique C Leira
- Departments of Neurology, University of Iowa, Iowa City, Iowa, USA.,Departments of Neurosurgery, University of Iowa, Iowa City, Iowa, USA.,Departments of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Harold P Adams
- Departments of Neurology, University of Iowa, Iowa City, Iowa, USA.,Departments of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
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Quillet A, Colin O, Bourgeois N, Favrelière S, Ferru A, Boinot L, Lafay-Chebassier C, Perault-Pochat MC. Detection of adverse drug reactions: evaluation of an automatic data processing applied in oncology performed in the French Diagnosis Related Groups database. Fundam Clin Pharmacol 2017; 32:227-233. [DOI: 10.1111/fcp.12333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/03/2017] [Accepted: 11/09/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Alexandre Quillet
- Service de Pharmacologie Clinique et Vigilances; CHU de Poitiers; 2 rue de la milétrie, 86021 Poitiers France
| | - Olivier Colin
- Service de Neurologie; CHU de Poitiers; 2 rue de la milétrie, 86021 Poitiers France
| | - Nicolas Bourgeois
- Service de Pharmacologie Clinique et Vigilances; CHU de Poitiers; 2 rue de la milétrie, 86021 Poitiers France
| | - Sylvie Favrelière
- Service de Pharmacologie Clinique et Vigilances; CHU de Poitiers; 2 rue de la milétrie, 86021 Poitiers France
| | - Aurélie Ferru
- Service d'Oncologie Médicale; CHU de Poitiers; 2 rue de la milétrie, 86021 Poitiers France
| | - Laurence Boinot
- Service d'Information Médicale; CHU de Poitiers; 2 rue de la milétrie, 86021 Poitiers France
| | - Claire Lafay-Chebassier
- Service de Pharmacologie Clinique et Vigilances; CHU de Poitiers; 2 rue de la milétrie, 86021 Poitiers France
| | - Marie-Christine Perault-Pochat
- Service de Pharmacologie Clinique et Vigilances; CHU de Poitiers; 2 rue de la milétrie, 86021 Poitiers France
- INSERM, CIC 1402; CHU de Poitiers; 2 rue de la milétrie, 86021 Poitiers France
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Bezin J, Duong M, Lassalle R, Droz C, Pariente A, Blin P, Moore N. The national healthcare system claims databases in France, SNIIRAM and EGB: Powerful tools for pharmacoepidemiology. Pharmacoepidemiol Drug Saf 2017; 26:954-962. [PMID: 28544284 DOI: 10.1002/pds.4233] [Citation(s) in RCA: 348] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/30/2017] [Accepted: 04/23/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Julien Bezin
- Department of Medical Pharmacology, CHU de Bordeaux; Université de Bordeaux; 33076 Bordeaux France
- INSERM U1219; 33076 Bordeaux France
| | - Mai Duong
- INSERM U1219; 33076 Bordeaux France
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Régis Lassalle
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Cécile Droz
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Antoine Pariente
- Department of Medical Pharmacology, CHU de Bordeaux; Université de Bordeaux; 33076 Bordeaux France
- INSERM U1219; 33076 Bordeaux France
| | - Patrick Blin
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Nicholas Moore
- Department of Medical Pharmacology, CHU de Bordeaux; Université de Bordeaux; 33076 Bordeaux France
- INSERM U1219; 33076 Bordeaux France
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
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Stroke severity may predict causes of readmission within one year in patients with first ischemic stroke event. J Neurol Sci 2016; 372:21-27. [PMID: 28017214 DOI: 10.1016/j.jns.2016.11.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 10/25/2016] [Accepted: 11/13/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Readmissions after stroke are costly. Risk assessment using information available upon admission could identify high-risk patients for potential interventions to reduce readmissions. Baseline stroke severity has been suspected to be a factor in readmission; however, the exact nature of the impact has not been adequately understood. METHODS Hospitalized adult patients with first-ever ischemic stroke were identified from a nationwide administrative database. Stroke severity was assessed using a validated claims-based stroke severity index. Cox proportional hazards models were used to investigate the relationship between stroke severity and first readmission within one year. RESULTS Of the 10,877 patients, 4295 (39.5%) were readmitted in one year. The cumulative risk of readmission was 34.1%, 44.7%, and 62.9% in patients with mild, moderate, and severe stroke, respectively. Patients with greater stroke severity had a significantly higher adjusted risk of first readmission for infection, metabolic disorders, neurological sequelae, and pulmonary diseases, whereas those with lesser stroke severity were prone to first readmission due to accidents. Stroke severity did not affect the risk of first readmission for recurrent stroke/transient ischemic attack, other cardiovascular events, malignancy, ulcers/upper gastrointestinal bleeding, kidney diseases, and others. CONCLUSIONS Stroke severity in patients with first-ever ischemic stroke not only predicts readmission but also relates to the cause of readmission. Our results might provide important information for tailoring discharge planning to prevent readmissions.
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