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Hurley E, Geisler BP, Lupattelli A, Poblador-Plou B, Lassalle R, Jové J, Bernard MA, Sakr D, Sanfélix-Gimeno G, Sánchez-Saez F, Rodríguez-Bernal CL, Sabaté M, Ballarín E, Aguilera C, Jordan S, Thayer D, Farr I, Ahmed S, Bartolini C, Limoncella G, Paoletti O, Gini R, Maglanoc LA, Dudukina E, Ehrenstein V, Alsina E, Vaz TA, Riera-Arnau J, Sturkenboom MCJM, Nordeng HME. COVID-19 and pregnancy: A European study on pre- and post-infection medication use. Eur J Clin Pharmacol 2024; 80:707-716. [PMID: 38347228 PMCID: PMC11001745 DOI: 10.1007/s00228-024-03639-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The COVID-19 pandemic has impacted medication needs and prescribing practices, including those affecting pregnant women. Our goal was to investigate patterns of medication use among pregnant women with COVID-19, focusing on variations by trimester of infection and location. METHODS We conducted an observational study using six electronic healthcare databases from six European regions (Aragon/Spain; France; Norway; Tuscany, Italy; Valencia/Spain; and Wales/UK). The prevalence of primary care prescribing or dispensing was compared in the 30-day periods before and after a positive COVID-19 test or diagnosis. RESULTS The study included 294,126 pregnant women, of whom 8943 (3.0%) tested positive for, or were diagnosed with, COVID-19 during their pregnancy. A significantly higher use of antithrombotic medications was observed particularly after COVID-19 infection in the second and third trimesters. The highest increase was observed in the Valencia region where use of antithrombotic medications in the third trimester increased from 3.8% before COVID-19 to 61.9% after the infection. Increases in other countries were lower; for example, in Norway, the prevalence of antithrombotic medication use changed from around 1-2% before to around 6% after COVID-19 in the third trimester. Smaller and less consistent increases were observed in the use of other drug classes, such as antimicrobials and systemic corticosteroids. CONCLUSION Our findings highlight the substantial impact of COVID-19 on primary care medication use among pregnant women, with a marked increase in the use of antithrombotic medications post-COVID-19. These results underscore the need for further research to understand the broader implications of these patterns on maternal and neonatal/fetal health outcomes.
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Affiliation(s)
- Eimir Hurley
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Benjamin P Geisler
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute, Miguel Servet University Hospital, Saragossa, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion, Research Network on Health Services in Chronic Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Régis Lassalle
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Jérémy Jové
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Marie-Agnes Bernard
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Dunia Sakr
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Gabriel Sanfélix-Gimeno
- Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Francisco Sánchez-Saez
- Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Clara L Rodríguez-Bernal
- Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Mònica Sabaté
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Elena Ballarín
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Cristina Aguilera
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Daniel Thayer
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Ian Farr
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Saira Ahmed
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | | | | | - Olga Paoletti
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Luigi A Maglanoc
- IT Department, Data Management, University of Oslo, Oslo, Norway
| | - Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ema Alsina
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tiago A Vaz
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judit Riera-Arnau
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miriam C J M Sturkenboom
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hedvig M E Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.
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Angeli F, Verdecchia P, Coiro S, Santucci A, Notaristefano F, Bartolini C, Reboldi G. [Non-inferiority trials]. G Ital Cardiol (Rome) 2024; 25:262-269. [PMID: 38526362 DOI: 10.1714/4244.42207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Superiority trials are designed to test the hypothesis that a given diagnostic or therapeutic strategy is better than (i.e. "superior to") placebo or an active control. Conversely, non-inferiority trials test the hypothesis that a newer (i.e. alternative) strategy is not "unacceptably worse" than a control (i.e. "traditional", or "older") strategy. Non-inferiority trials are increasingly conducted in clinical medicine more often when a "newer" strategy is supposed to offer a relevant advantage in terms other than clinical efficacy (i.e. better tolerability, less cost, simpler regimen, etc.) versus a "gold standard" traditional strategy. The principle underlying non-inferiority trials is that the above advantage justifies the preferential use of the newer strategy in the clinical practice even if the clinical efficacy of the "new" appears to be a bit worse than that of the "old", albeit not unacceptably worse (i.e. not beyond a pre-specified value). The demonstration of non-inferiority requires that the confidence interval of the point estimate (e.g. the hazard ratio) does not cross a pre-specified limit. The definition of such pre-specified limit, the so called "non-inferiority margin", is a pivotal point when planning non-inferiority trials. It denotes the maximally tolerated worse effect of the alternative strategy, compared with the traditional one, required to conclude that an alternative strategy is non-inferior to the traditional "gold standard". The non-inferiority margin is derived from previous trials evaluating the efficacy of the traditional strategy vs placebo. We reviewed the principles and the practical aspects in the design and conduct of non-inferiority trials.
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Affiliation(s)
- Fabio Angeli
- Dipartimento di Medicina e Innovazione Tecnologica (DiMIT), Università degli Studi dell'Insubria, Varese - Dipartimento di Medicina e Riabilitazione Cardiopolmonare, Istituti Clinici e di Ricerca Maugeri - IRCCS, Tradate (VA)
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia - S.C. Cardiologia, Ospedale S. Maria della Misericordia, Perugia
| | - Stefano Coiro
- S.C. Cardiologia, Ospedale S. Maria della Misericordia, Perugia
| | - Andrea Santucci
- S.C. Cardiologia, Ospedale S. Maria della Misericordia, Perugia
| | | | | | - Gianpaolo Reboldi
- Dipartimento di Medicina e Chirurgia, Università degli Studi, Perugia - S.C. Nefrologia, Ospedale S. Maria della Misericordia, Perugia
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Angeli F, Zappa M, Bartolini C, Verdecchia P. [Gene therapy for hypertension: focus on zilebesiran]. G Ital Cardiol (Rome) 2023; 24:948-950. [PMID: 38009345 DOI: 10.1714/4139.41339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Affiliation(s)
- Fabio Angeli
- Dipartimento di Medicina e Innovazione Tecnologica (DiMIT), Università degli Studi dell'Insubria, Varese - Dipartimento di Medicina e Riabilitazione Cardiopolmonare, Istituto di Cura e Ricerca Maugeri, IRCCS, Tradate (VA)
| | - Martina Zappa
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria, Varese
| | - Claudia Bartolini
- Fondazione Umbra Cuore e Ipertensione-ONLUS e S.C. Cardiologia, Ospedale S. Maria della Misericordia, Perugia
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS e S.C. Cardiologia, Ospedale S. Maria della Misericordia, Perugia
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Ferraro S, Cappello E, Bartolini C, Convertino I, Bertani L, Lucenteforte E, Costa F, Paoletti O, Giometto S, Gini R, Tuccori M. Potential missed diagnoses of Crohn's disease in tertiary care: impact on drug utilization and healthcare facilities use. Eur J Gastroenterol Hepatol 2023; 35:1263-1269. [PMID: 37724478 DOI: 10.1097/meg.0000000000002642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND A missed diagnosis of Crohn's disease (CD) can delay treatment initiation with consequences on disease course. AIMS To measure the possible impact of missed diagnoses on drug utilization and access to healthcare facilities in a real-world cohort of CD patients. METHODS This retrospective observational study has been conducted on the regional administrative databases of Tuscany (Italy). We included patients with a first record of CD diagnosis between 06/11/2011 and 06/30/2016. Possible missed diagnosis (exposure) was defined by hospital presentation for gastrointestinal symptoms consistent with CD diagnosis that occurred in the 7-60 months preceding CD diagnosis. We compared exposed and non-exposed patients by assessing time-free from biologic drugs and from Emergency Department (ED) or hospital access. Hazard ratio (HR) was calculated using Cox models. RESULTS Among 3342 CD patients, 584 (17.5%) had a possible missed diagnosis. A risk of being treated with biologic drugs [adjusted HR (aHR): 2.17, 95% CI: 1.75-2.71] and of access to ED or hospitalization (aHR: 1.59, 95% CI: 1.44-1.75) was observed in patients with a possible missed diagnosis as compared to those without. CONCLUSION Tertiary care caregivers should be trained in the identification of early CD symptoms, to timely identify CD diagnosis and optimize pharmacological treatment and disease management.
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Affiliation(s)
- Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Claudia Bartolini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Firenze
| | - Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Lorenzo Bertani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa
| | - Francesco Costa
- Department of General Surgery and Gastroenterology, Pisa University Hospital
| | - Olga Paoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa
| | - Rosa Gini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Firenze
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
- Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
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Convertino I, Cazzato M, Tillati S, Giometto S, Gini R, Valdiserra G, Cappello E, Ferraro S, Bonaso M, Bartolini C, Paoletti O, Lorenzoni V, Trieste L, Filippi M, Turchetti G, Cristofano M, Blandizzi C, Mosca M, Lucenteforte E, Tuccori M. Assessing disease activity of rheumatoid arthritis patients and drug-utilization patterns of biologic disease-modifying antirheumatic drugs in the Tuscany region, Italy. Front Pharmacol 2023; 14:1244486. [PMID: 37818193 PMCID: PMC10561246 DOI: 10.3389/fphar.2023.1244486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction: The disease activity associated with the drug-utilization patterns of biologic Disease Modifying Anti-Rheumatic Drugs (DMARDs) is poorly investigated in real-world studies on rheumatoid arthritis (RA) patients. To investigate the relationship between biologic DMARD initiation/discontinuations in RA patients identified in the healthcare administrative databases of Tuscany and the Disease Activity Score 28 (DAS28) reported in the medical charts. Methods: This retrospective population-based study included RA's first-ever biologic DMARD users of the Pisa University Hospital from 2014 to 2016. Patients were followed up until 31 December 2019. We evaluated the DAS28 recorded before (T0) and after (T1) the biologic DMARD initiation and before (TD0) and after (TD1) discontinuations. Patients were classified as "off-target" (DAS28 > 3.2) or "in-target" (DAS28 ≤ 3.2). We described the disease activity trends at initiation and discontinuation. Results: Ninety-five users were included (73 women, mean age 59.6). Among 70 patients (74%) with at least three DAS28 measures, 28 (40.0%) were off-target at T0 and 38 (54.3%) in-target at T1. Thirty-three (47%) patients had at least one discontinuation, among those with at least three DAS28 assessments. In the disease activity trend, disease stability or improvement was observed in 28 out of 37 (75.7%) patients at initiation and in 24 out of 37 (64.9%) at discontinuation. Discussion: Biologic DMARD discontinuations identified in the healthcare administrative databasese of Tuscany are frequently observed in situations of controlled RA disease. Further studies are warranted to confirm that these events can be used in studies using healthcare administrative databases as proxies of treatment effectiveness.
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Affiliation(s)
- Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Silvia Tillati
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosa Gini
- Tuscan Regional Healthcare Agency, Florence, Italy
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | | | - Leopoldo Trieste
- Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Matteo Filippi
- Direzione Medica di Presidio, University Hospital of Pisa, Pisa, Italy
| | | | | | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Marta Mosca
- Unit of Rheumatology, University Hospital of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
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6
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Durán CE, Riera-Arnau J, Abtahi S, Pajouheshnia R, Hoxhaj V, Gamba M, Alsina E, Martin-Perez M, Garcia-Poza P, Llorente-Garcia A, Gonzalez-Bermejo D, Ibánez L, Sabaté M, Vidal X, Ballarín E, Sanfélix-Gimeno G, Rodríguez-Bernal C, Peiró S, García-Sempere A, Sanchez-Saez F, Ientile V, Ingrasciotta Y, Guarneri C, Tanaglia M, Tari M, Herings R, Houben E, Swart-Polinder K, Holthuis E, Huerta C, Gini R, Roberto G, Bartolini C, Paoletti O, Limoncella G, Girardi A, Hyeraci G, Andersen M, Kristiansen SB, Hallgreen CE, Klungel O, Sturkenboom M. Impact of the 2018 revised Pregnancy Prevention Programme by the European Medicines Agency on the use of oral retinoids in females of childbearing age in Denmark, Italy, Netherlands, and Spain: an interrupted time series analysis. Front Pharmacol 2023; 14:1207976. [PMID: 37663263 PMCID: PMC10469888 DOI: 10.3389/fphar.2023.1207976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background: In March 2018, the European pregnancy prevention programme for oral retinoids was updated as part of risk minimisation measures (RMM), emphasising their contraindication in pregnant women. Objective: To measure the impact of the 2018 revision of the RMMs in Europe by assessing the utilisation patterns of isotretinoin, alitretinoin and acitretin, contraceptive measures, pregnancy testing, discontinuation, and pregnancy occurrence concomitantly with a retinoid prescription. Methods: An interrupted time series (ITS) analysis to compare level and trend changes after the risk minimisation measures implementation was conducted on a cohort of females of childbearing age (12-55 years of age) from January 2010 to December 2020, derived from six electronic health data sources in four countries: Denmark, Netherlands, Spain, and Italy. Monthly utilisation figures (incidence rates [IR], prevalence rates [PR] and proportions) of oral retinoids were calculated, as well as discontinuation rates, contraception coverage, pregnancy testing, and rates of exposed pregnancies to oral retinoids, before and after the 2018 RMMs. Results: From 10,714,182 females of child-bearing age, 88,992 used an oral retinoid at any point during the study period (mean age 18.9-22.2 years old). We found non-significant level and trend changes in incidence or prevalence of retinoid use in females of child-bearing age after the 2018 RMMs. The reason of discontinuation was unknown in >95% of cases. Contraception use showed a significant increase trend in Spain; for other databases this information was limited. Pregnancy testing was hardly recorded thus was not possible to model ITS analyses. After the 2018 RMM, rates of pregnancy occurrence during retinoid use, and start of a retinoid during a pregnancy varied from 0.0 to 0.4, and from 0.2 to 0.8, respectively. Conclusion: This study shows a limited impact of the 2018 RMMs on oral retinoids utilisation patterns among females of child-bearing age in four European countries. Pregnancies still occur during retinoid use, and oral retinoids are still prescribed to pregnant women. Contraception and pregnancy testing information was limited in most databases. Regulators, policymakers, prescribers, and researchers must rethink implementation strategies to avoid any pregnancy becoming temporarily related to retinoid use.
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Affiliation(s)
- Carlos E. Durán
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judit Riera-Arnau
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Shahab Abtahi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Vjola Hoxhaj
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Magdalena Gamba
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Ema Alsina
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mar Martin-Perez
- Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
| | | | | | | | - Luisa Ibánez
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Mònica Sabaté
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Xavier Vidal
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Ballarín
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Gabriel Sanfélix-Gimeno
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Clara Rodríguez-Bernal
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Salvador Peiró
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Aníbal García-Sempere
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Francisco Sanchez-Saez
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Ylenia Ingrasciotta
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Matilde Tanaglia
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | | | | | | | | | - Consuelo Huerta
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa Gini
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | - Giuseppe Roberto
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | | | - Olga Paoletti
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | | | - Anna Girardi
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | - Giulia Hyeraci
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Brøgger Kristiansen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christine Erikstrup Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Miriam Sturkenboom
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
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7
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Abtahi S, Pajouheshnia R, Durán CE, Riera-Arnau J, Gamba M, Alsina E, Hoxhaj V, Andersen M, Bartolini C, Kristiansen SB, Brown J, Hallgreen CE, Garcia-Poza P, Gardarsdottir H, Gini R, Girardi A, Holthuis E, Huerta C, Ibánez L, Limoncella G, Martín-Pérez M, Paoletti O, Roberto G, Souverein P, Swart KMA, Wing K, Sturkenboom M, Klungel O. Impact of 2018 EU Risk Minimisation Measures and Revised Pregnancy Prevention Programme on Utilisation and Prescribing Trends of Medicinal Products Containing Valproate: An Interrupted Time Series Study. Drug Saf 2023:10.1007/s40264-023-01314-3. [PMID: 37294532 DOI: 10.1007/s40264-023-01314-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Due to established teratogenicity of valproates, the EU risk minimisation measures (RMMs) with a pregnancy prevention programme (PPP) for valproate were updated in March 2018. OBJECTIVES To investigate the effectiveness of the 2018 EU RMMs on valproate utilisation in five European countries/regions. METHODS A multi-database, times series study of females of childbearing potential (12-55 years) was conducted using electronic medical records from five countries/regions (01.01.2010-31.12.2020): Denmark, Tuscany (Italy), Spain, the Netherlands, and the UK. Clinical and demographic information from each database was transformed to the ConcePTION Common Data Model, quality checks were conducted and a distributed analysis was performed using common scripts. Incident and prevalent use of valproate, proportion of discontinuers and switchers to alternative medicine, frequency of contraception coverage during valproate use, and occurrence of pregnancies during valproate exposure were estimated per month. Interrupted time series analyses were conducted to estimate the level or trend change in the outcome measures. RESULTS We included 69,533 valproate users from 9,699,371 females of childbearing potential from the five participating centres. A significant decline in prevalent use of valproates was observed in Tuscany, Italy (mean difference post-intervention -7.7%), Spain (-11.3%), and UK (-5.9%) and a non-significant decline in the Netherlands (-3.3%), but no decline in incident use after the 2018 RMMs compared to the period before. The monthly proportion of compliant valproate prescriptions/dispensings with a contraceptive coverage was low (<25%), with an increase after the 2018 RMMs only in the Netherlands (mean difference post-intervention 12%). There was no significant increase in switching rates from valproates to alternative medicine after the 2018 intervention in any of the countries/regions. We observed a substantial number of concurrent pregnancies during valproate exposure, but with a declining rate after the 2018 RMMs in Tuscany, Italy (0.70 per 1000 valproate users pre- and 0.27 post-intervention), Spain (0.48 and 0.13), the Netherlands (0.34 and 0.00), and an increasing rate in UK (1.13 and 5.07). CONCLUSION There was a small impact of the 2018 RMMs on valproate use in the studied European countries/regions. The substantial number of concurrent pregnancies with valproate exposure warrants a careful monitoring of implementation of the existing PPP for valproate in clinical practice in Europe, to see if there is any need for additional measures in the future.
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Affiliation(s)
- Shahab Abtahi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Carlos E Durán
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Judit Riera-Arnau
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Clinical Pharmacology Department, Hospital Universitari de la Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Magdalena Gamba
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Ema Alsina
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Vjola Hoxhaj
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Brøgger Kristiansen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeremy Brown
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Christine Erikstrup Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
- Department of Clinical Pharmacy, UMCU, Utrecht, The Netherlands
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | - Anna Girardi
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | - Emily Holthuis
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Consuelo Huerta
- Department of Public Health, Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Luisa Ibánez
- Clinical Pharmacology Department, Hospital Universitari de la Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Mar Martín-Pérez
- Agencia Espanola de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Olga Paoletti
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | | | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Kevin Wing
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
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Bartolini C, Roberto G, Girardi A, Moscatelli V, Spini A, Barchielli A, Bocchia M, Fabbri A, Donnini S, Ziche M, Monti MC, Gini R. Validity of Italian administrative healthcare data in describing the real-world utilization of infusive antineoplastic drugs: the study case of rituximab use in patients treated at the University Hospital of Siena for onco-haematological indications. Front Oncol 2023; 13:1059109. [PMID: 37324023 PMCID: PMC10264685 DOI: 10.3389/fonc.2023.1059109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/18/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Italian administrative healthcare databases are frequently used for studies on real-world drug utilization. However, there is currently a lack of evidence on the accuracy of administrative data in describing the use of infusive antineoplastics. In this study, we used rituximab as a case study to investigate the validity of the regional administrative healthcare database of Tuscany (RAD) in describing the utilization of infusive antineoplastics. Methods We identified patients aged 18 years or older who had received ≥1 rituximab administration between 2011 and 2014 in the onco-haematology ward of the University Hospital of Siena. We retrieved this information from the Hospital Pharmacy Database (HPD-UHS) and linked the person-level information to RAD. Patients who had received ≥1dispensing of rituximab, single administration episodes, and patients treated for non-Hodgkin Lymphoma (nHL) or Chronic Lymphocytic Leukemia (CLL) were identified in RAD and validated using HPD-UHS as the reference standard. We identified the indications of use using algorithms based on diagnostic codes (ICD9CM codes, nHL=200*, 202*; CLL=204.1). We tested 22 algorithms of different complexity for each indication of use and calculated sensitivity and positive predictive value (PPV), with 95% confidence intervals (95%CI), as measures of validity. Results According to HPD-UHS, 307 patients received rituximab for nHL (N=174), CLL (N=21), or other unspecified indications (N=112) in the onco-haematology ward of the University Hospital of Siena. We identified 295 rituximab users in RAD (sensitivity=96.1%), but PPV could not be assessed due to missing information in RAD on dispensing hospital wards. We identified individual rituximab administration episodes with sensitivity=78.6% [95%CI: 76.4-80.6] and PPV=87.6% [95%CI: 86.1-89.2]. Sensitivity of algorithms tested for identifying nHL and CLL ranged from 87.7% to 91.9% for nHL and from 52.4% to 82.7% for CLL. PPV ranged from 64.7% to 66.1% for nHL and from 32.4% to 37.5% for CLL. Discussion Our findings suggest that RAD is a very sensitive source of information for identifying patients who received rituximab for onco-haematological indications. Single administration episodes were identified with good-to-high accuracy. Patients receiving rituximab for nHL were identified with high sensitivity and acceptable PPV, while the validity for CLL was suboptimal.
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Affiliation(s)
- Claudia Bartolini
- Pharmaecoepidemiology Unit, Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | - Giuseppe Roberto
- Pharmaecoepidemiology Unit, Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | - Anna Girardi
- Pharmaecoepidemiology Unit, Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | | | - Andrea Spini
- Department of Life Sciences, Università Degli Studi di Siena, Siena, Italy
| | - Alessandro Barchielli
- Tuscany Cancer Registry, Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| | - Monica Bocchia
- Onco-hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alberto Fabbri
- Onco-hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sandra Donnini
- Department of Life Sciences, Università Degli Studi di Siena, Siena, Italy
| | - Marina Ziche
- Department of Life Sciences, Università Degli Studi di Siena, Siena, Italy
| | - Maria Cristina Monti
- Università di Pavia, Dipartimento di Sanità Pubblica, Medicina Sperimentale e Forense, Pavia, Italy
| | - Rosa Gini
- Pharmaecoepidemiology Unit, Agenzia Regionale di Sanità della Toscana, Firenze, Italy
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Angeli F, Reboldi G, Solano FG, Prosciutto A, Paolini A, Zappa M, Bartolini C, Santucci A, Coiro S, Verdecchia P. Interpretation of Ambulatory Blood Pressure Monitoring for Risk Stratification in Hypertensive Patients: The 'Ambulatory Does Prediction Valid (ADPV)' Approach. Diagnostics (Basel) 2023; 13:diagnostics13091601. [PMID: 37174992 PMCID: PMC10178200 DOI: 10.3390/diagnostics13091601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Several outcome-based prospective investigations have provided solid data which support the prognostic value of 24 h ambulatory blood pressure over and beyond cardiovascular traditional risk factors. Average 24 h, daytime, and nighttime blood pressures are the principal components of the ambulatory blood pressure profile that have improved cardiovascular risk stratification beyond traditional risk factors. Furthermore, several additional ambulatory blood pressure measures have been investigated. The correct interpretation in clinical practice of ambulatory blood pressure monitoring needs a standardization of methods. Several algorithms for its clinical use have been proposed. Implementation of the results of ambulatory blood pressure monitoring in the management of individual subjects with the aim of improving risk stratification is challenging. We suggest that clinicians should focus attention on ambulatory blood pressure components which have been proven to act as the main independent predictors of outcome (average 24 h, daytime, and nighttime blood pressure, pulse pressure, dipping status, BP variability).
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, 21100 Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, 06100 Perugia, Italy
- Division of Nephrology, Hospital S. Maria della Misericordia, 33100 Perugia, Italy
| | | | | | | | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Claudia Bartolini
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Andrea Santucci
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Stefano Coiro
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
- Fondazione Umbra Cuore e Ipertensione-ONLUS, 06100 Perugia, Italy
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10
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Convertino I, Lorenzoni V, Gini R, Turchetti G, Fini E, Giometto S, Bartolini C, Paoletti O, Ferraro S, Cappello E, Valdiserra G, Bonaso M, Blandizzi C, Tuccori M, Lucenteforte E. Drug-Utilization, Healthcare Facilities Accesses and Costs of the First Generation of JAK Inhibitors in Rheumatoid Arthritis. Pharmaceuticals (Basel) 2023; 16:ph16030465. [PMID: 36986565 PMCID: PMC10058541 DOI: 10.3390/ph16030465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
This study is aimed at describing tofacitinib and baricitinib users by characterizing their prescription and healthcare histories, drug and healthcare utilization patterns, and direct costs from a healthcare system perspective. This retrospective cohort study was performed using Tuscan administrative healthcare databases, which selected two groups of Janus kinase inhibitors (JAKi) incident users (index date) from 1st January 2018 to 31 December 2019 and from 1 January 2018 to 30 June 2019. We included patients ≥18 years old, at least 10 years of data, and six months of follow-up. In the first analysis, we describe mean time, standard deviation (SD), from the first-ever disease-modifying antirheumatic drug (DMARD) to the JAKi, and costs of healthcare facilities and drugs in the 5 years preceding the index date. In the second analysis, we assessed Emergency Department (ED) accesses and hospitalizations for any causes, visits, and costs in the follow-up. In the first analysis, 363 incident JAKi users were included (mean age 61.5, SD 13.6; females 80.7%, baricitinib 78.5%, tofacitinib 21.5%). The time to the first JAKi was 7.2 years (SD 3.3). The mean costs from the fifth to the second year before JAKi increased from 4325 € (0; 24,265) to 5259 € (0; 41,630) per patient/year, driven by hospitalizations. We included 221 incident JAKi users in the second analysis. We observed 109 ED accesses, 39 hospitalizations, and 64 visits. Injury and poisoning (18.3%) and skin (13.8%) caused ED accesses, and cardiovascular (69.2%) and musculoskeletal (64.1%) caused hospitalizations. The mean costs were 4819 € (607.5; 50,493) per patient, mostly due to JAKi. In conclusion, the JAKi introduction in therapy occurred in compliance with RA guidelines and the increase in costs observed could be due to a possible selective prescription.
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Affiliation(s)
- Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | | | - Rosa Gini
- Tuscan Regional Healthcare Agency, 50100 Florence, Italy
| | | | - Elisabetta Fini
- Medical Specialization School of Pharmacology, University of Pisa, 56126 Pisa, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | | | - Olga Paoletti
- Tuscan Regional Healthcare Agency, 50100 Florence, Italy
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56126 Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56126 Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Willame C, Dodd C, Durán CE, Elbers RJHJ, Gini R, Bartolini C, Paoletti O, Wang L, Ehrenstein V, Kahlert J, Haug U, Schink T, Diez-Domingo J, Mira-Iglesias A, Carreras JJ, Vergara-Hernández C, Giaquinto C, Barbieri E, Stona L, Huerta C, Martín-Pérez M, García-Poza P, de Burgos A, Martínez-González M, Bryant V, Villalobos F, Pallejà-Millán M, Aragón M, Carreras JJ, Souverein P, Thurin NH, Weibel D, Klungel OH, Sturkenboom MCJM. Background rates of 41 adverse events of special interest for COVID-19 vaccines in 10 European healthcare databases - an ACCESS cohort study. Vaccine 2023; 41:251-262. [PMID: 36446653 PMCID: PMC9678835 DOI: 10.1016/j.vaccine.2022.11.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In May 2020, the ACCESS (The vACCine covid-19 monitoring readinESS) project was launched to prepare real-world monitoring of COVID-19 vaccines. Within this project, this study aimed to generate background incidence rates of 41 adverse events of special interest (AESI) to contextualize potential safety signals detected following administration of COVID-19 vaccines. METHODS A dynamic cohort study was conducted using a distributed data network of 10 healthcare databases from 7 European countries (Italy, Spain, Denmark, The Netherlands, Germany, France and United Kingdom) over the period 2017 to 2020. A common protocol (EUPAS37273), common data model, and common analytics programs were applied for syntactic, semantic and analytical harmonization. Incidence rates (IR) for each AESI and each database were calculated by age and sex by dividing the number of incident cases by the total person-time at risk. Age-standardized rates were pooled using random effect models according to the provenance of the events. FINDINGS A total number of 63,456,074 individuals were included in the study, contributing to 211.7 million person-years. A clear age pattern was observed for most AESIs, rates also varied by provenance of disease diagnosis (primary care, specialist care). Thrombosis with thrombocytopenia rates were extremely low ranging from 0.06 to 4.53/100,000 person-years for cerebral venous sinus thrombosis (CVST) with thrombocytopenia (TP) and mixed venous and arterial thrombosis with TP, respectively. INTERPRETATION Given the nature of the AESIs and the setting (general practitioners or hospital-based databases or both), background rates from databases that show the highest level of completeness (primary care and specialist care) should be preferred, others can be used for sensitivity. The study was designed to ensure representativeness to the European population and generalizability of the background incidence rates. FUNDING The project has received support from the European Medicines Agency under the Framework service contract nr EMA/2018/28/PE.
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Affiliation(s)
- C Willame
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - C Dodd
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - CE Durán
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - RJHJ Elbers
- Department of Data science & Biostatistic, Data manegement, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - R Gini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - C Bartolini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - O Paoletti
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - L Wang
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - J Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - U Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Faculty of Human and Health Sciences, University of Bremen, Germany
| | - T Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, 28359 Bremen, Germany
| | - J Diez-Domingo
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - A Mira-Iglesias
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Vergara-Hernández
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - E Barbieri
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - L Stona
- Fondazione Penta ONLUS, Corso Stati Uniti 4, 35127 Padova, Italy
| | - C Huerta
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - M Martín-Pérez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - P García-Poza
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - A de Burgos
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - M Martínez-González
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - V Bryant
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - F Villalobos
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Pallejà-Millán
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - P Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - NH Thurin
- INSERM CIC-P1401, Bordeaux PharmacoEpi, Univ. Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France
| | - D Weibel
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - OH Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - MCJM Sturkenboom
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands,Corresponding author at: Department Datascience & Biostatistics Univerisity Medical Center Utrecht, Heidelberglaan 100, The Netherlands
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Holthuis E, Smits E, Spentzouris G, Beier D, Enders D, Gini R, Bartolini C, Mazzaglia G, Penning-van Beest F, Herings R. Increased Risk of Stroke Due to Non-adherence and Non-persistence with Direct Oral Anticoagulants (DOACs): Real-World Analyses Using a Nested Case-Control Study from The Netherlands, Italy and Germany. Drugs Real World Outcomes 2022; 9:597-607. [PMID: 35790603 DOI: 10.1007/s40801-022-00317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND A high degree of adherence to direct oral anticoagulants is essential for reducing the risk of ischaemic stroke and systemic embolism in patients with atrial fibrillation, owing to the rapid decline in anticoagulation activity when doses are omitted (i.e. rebound effect). OBJECTIVE We aimed to assess the relationship between non-adherence and non-persistence with direct oral anticoagulants and the incidence of ischaemic stroke in patients with atrial fibrillation. METHODS A nested case-control study was conducted in the Netherlands, Italy and Germany among patients with atrial fibrillation starting direct oral anticoagulants between the drug approval date and the end of database availability. Patients with an ischaemic stroke during the follow-up were selected as cases and compared with matched controls (matched on age ± 5 years, sex, year of cohort entry date and CHA2DS2-VASc-score at cohort entry date). The cohort entry date was the first dispensing date. Study patients were those aged ≥ 45 years, with ≥ 1 year database history, ≥ 1 year follow-up and at least two direct oral anticoagulant dispensings after the cohort entry date. Adherence and persistence to direct oral anticoagulant treatment were defined as the proportion of days covered ≥ 80% or direct oral anticoagulant continuous use between the cohort entry date and the index date (i.e. date of ischaemic stroke), respectively. RESULTS In The Netherlands, Italy and Germany, 105 cases and 395 controls, 1580 cases and 6248 controls, and 900 cases and 3570 controls were included, respectively. Odds ratios (ORs) for stroke among current users who were non-adherent compared to adherent users were 0.43 (95% confidence interval [CI] 0.09-1.96) in The Netherlands, 1.11 (95% CI 0.98-1.26) in Italy and 1.21 (95% CI 1.01-1.45) in Germany. The risk of stroke was significantly higher among non-persistent users compared with persistent users in all three databases [OR 1.56 (95% CI 1.00-2.44), OR 1.48 (1.32-1.65) and OR 1.91 (95% CI 1.64-2.22), respectively]. In The Netherlands and Germany, the risk of stroke was higher the longer a patient had stopped using direct oral anticoagulants. CONCLUSIONS Both non-adherence (in Germany) and non-persistence increased the risk of stroke, either using a once-daily or twice-daily regime.
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Affiliation(s)
- Emily Holthuis
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands.
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| | | | - Dominik Beier
- InGef-Institute for Applied Health Research, Berlin GmbH, Berlin, Germany
| | - Dirk Enders
- InGef-Institute for Applied Health Research, Berlin GmbH, Berlin, Germany
| | - Rosa Gini
- Agenzi Regionali di Sanità della Toscana, Firenze, Italy
| | | | - Giampiero Mazzaglia
- Center for Public Health Research (CESP), University of Milan-Bicocca, Milan, Italy
| | - Fernie Penning-van Beest
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands.,Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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13
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Roberto G, Girardi A, Barone-Adesi F, Pecere A, Ientile V, Bartolini C, Da Cas R, Spila-Alegiani S, Ferrajolo C, Francesconi P, Trifirò G, Poluzzi E, Baccetti F, Gini R. Time to Treatment Intensification in Patients Receiving DPP4 Inhibitors Versus Sulfonylureas as the First Add-On to Metformin Monotherapy: A Retrospective Cohort Study. Front Pharmacol 2022; 13:871052. [PMID: 35707398 PMCID: PMC9189773 DOI: 10.3389/fphar.2022.871052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background: To verify whether, in patients on metformin (MET) monotherapy for type 2 diabetes (T2D), the add-on of a dipeptidyl peptidase inhibitor (DPP4i) compared to a sulfonylurea (SU) can delay the time to the subsequent treatment intensification (TI). Methods: Population-based administrative data banks from four Italian geographic areas were used. Patients aged ≥18 years on MET monotherapy receiving first DPP4i or SU dispensing between 2008 and 2015 (cohort entry) were followed up to the occurrence of TI (insulin dispensing or add-on of a third non-insulin hypoglicemic >180 days after cohort entry), treatment discontinuation, switch, cancer, death, TI occurrence within, end of data availability, end of study period (31 December 2016), whichever came first. Patients on MET + DPP4i were matched 1:1 with those on MET + SU by sex, age, year of cohort entry, and data bank. Hazard Ratio (HR) and 95% confidence intervals (95%CI) were estimated using multivariable Cox regression model including matching variables and potential confounders measured at baseline. Different sensitivity analyses were performed: i) matching at 180 days after cohort entry, ii) intent to treat (ITT) analysis, iii) matching by duration of MET monotherapy, iv) matching by propensity score. Results: The matched study cohort included 10,600 patients. Overall, 763 TI were observed (4.5/100 person-years; mean follow-up = 1.6 years). The primary analysis showed no difference in time to TI between the two groups (HR = 1.02; 95% CI = 0.88–1.19). Sensitivity analyses confirmed this result, except from the ITT analysis (HR = 1.27; 1.13–1.43). Conclusion: The use of a DPP4i rather than a SU as add-on to MET monotherapy was not associated with a delay in treatment intensification.
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Affiliation(s)
- Giuseppe Roberto
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
- *Correspondence: Giuseppe Roberto,
| | - Anna Girardi
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
| | - Francesco Barone-Adesi
- Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
| | - Alessandro Pecere
- Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
| | - Valentina Ientile
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università Degli Studi di Messina, Messina, Italy
| | - Claudia Bartolini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
| | - Roberto Da Cas
- Centro Nazionale per la Ricerca e la Valutazione Preclinica e Clinica Dei Farmaci, Istituto Superiore di Sanità, Roma, Italy
| | - Stefania Spila-Alegiani
- Centro Nazionale per la Ricerca e la Valutazione Preclinica e Clinica Dei Farmaci, Istituto Superiore di Sanità, Roma, Italy
| | - Carmen Ferrajolo
- Dipartimento di Medicina Sperimentale, Università Degli Studi Della Campania “L. Vanvitelli” e Centro Regionale di Farmacovigilanza, Regione Campania, Napoli, Italy
| | - Paolo Francesconi
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
| | - Gianluca Trifirò
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università Degli Studi di Messina, Messina, Italy
| | - Elisabetta Poluzzi
- Unità di Farmacologia, Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Fabio Baccetti
- Unità Operativa di Diabetologia Massa-Carrara, USL Toscana Nordovest, Massa, Italy
| | - Rosa Gini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
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14
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Sultana J, Crisafulli S, Almas M, Antonazzo IC, Baan E, Bartolini C, Bertuccio MP, Bonifazi F, Capuano A, Didio A, Ehrenstein V, Felisi M, Ferrajolo C, Fontana A, Francisca R, Fourrier-Reglat A, Fortuny J, Gini R, Hyeraci G, Hoeve C, Kontogiorgis C, Isgrò V, Lalagkas PN, L'Abbate L, Layton D, Landi A, Narduzzi S, Pereira LR, Poulentzas G, Rafaniello C, Roberto G, Scondotto G, Sportiello L, Toma M, Toussi M, Verhamme K, Volpe E, Trifirò G. Overview of the EU PAS register post-authorization studies performed in Europe from September 2010 to December 2018. Pharmacoepidemiol Drug Saf 2022; 31:689-705. [PMID: 35092329 PMCID: PMC9303697 DOI: 10.1002/pds.5413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The European post-authorisation study (EU PAS) register is a repository launched in 2010 by the European Medicines Agency (EMA). All EMA-requested PAS, commonly observational studies, must be recorded in this register. Multi-database studies (MDS) leveraging secondary data have become an important strategy to conduct PAS in recent years, as reflected by the type of studies registered in the EU PAS register. OBJECTIVES To analyse and describe PAS in the EU PAS register, with focus on MDS. METHODS Studies in the EU PAS register from inception to 31st December 2018 were described concerning transparency, regulatory obligations, scope, study type (e.g. observational study, clinical trial, survey, systematic review/meta-analysis), study design, type of data collection and target population. MDS were defined as studies conducted through secondary use of >1 data source not linked at patient-level. Data extraction was carried out independently by 14 centres with expertise in pharmacoepidemiology, using publicly available information in the EU PAS register including study protocol, whenever available, using a standardised data collection form. For validation purposes, a second revision of key fields for a 15% random sample of studies was carried out by a different centre. The inter-rater reliability (IRR) was then calculated. Finally, to identify predictors of primary data collection-based studies /vs those based on secondary use of healthcare databases) or MDS (vs. non-MDS), odds ratios (OR) and 95% confidence intervals (CI) were calculated fitting univariate logistic regression models. RESULTS Overall, 1,426 studies were identified. Clinical trials (N=30; 2%), systematic reviews/meta-analyses (N=16; 1%) and miscellaneous study designs (N=46; 3%) were much less common than observational studies (N=1,227; 86%). The protocol was available for 63% (N=360) of 572 observational studies requested by a competent authority. Overall, 36% (N=446) of observational studies were based fully or partially on primary data collection. Of 757 observational studies based on secondary use of data alone, 282 (37%) were MDS. Drug utilisation was significantly more common as a study scope in MDS compared to non-MDS studies. The overall percentage agreement among collaborating centres that collected the data concerning study variables was highest for study type (93.5%) and lowest for type of secondary data (67.8%). CONCLUSIONS Observational studies were the most common type of studies in the EU PAS register, but 30% used primary data, which is more resource-intensive. Almost half of observational studies using secondary data were MDS. Data recording in the EU PAS register may be improved further, including more widespread availability of study protocols to improve transparency.
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Affiliation(s)
- Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Malta.,Exeter College of Medicine and Health, Exeter
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Mariana Almas
- Real World Solutions Department, IQVIA, Lisbon, Portugal
| | - Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Esme Baan
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Maria Paola Bertuccio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Fedele Bonifazi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Antonella Didio
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mariagrazia Felisi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,CVBF Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - Carmen Ferrajolo
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Remy Francisca
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Annie Fourrier-Reglat
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team of Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | | | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Giulia Hyeraci
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Christel Hoeve
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Valentina Isgrò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Luca L'Abbate
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Deborah Layton
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Annalisa Landi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Silvia Narduzzi
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Leonardo Roque Pereira
- University Medical Center Utrecht, Department of Datascience & Biostatistics, Utrecht, the Netherlands
| | | | - Concetta Rafaniello
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | | | - Giulia Scondotto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Maddalena Toma
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Massoud Toussi
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Katia Verhamme
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Elisabetta Volpe
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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15
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Convertino I, Giometto S, Gini R, Cazzato M, Fornili M, Valdiserra G, Cappello E, Ferraro S, Bartolini C, Paoletti O, Tillati S, Baglietto L, Turchetti G, Trieste L, Lorenzoni V, Blandizzi C, Mosca M, Tuccori M, Lucenteforte E. Trajectories of Adherence to Biologic Disease-Modifying Anti-Rheumatic Drugs in Tuscan Administrative Databases: The Pathfinder Study. J Clin Med 2021; 10:5743. [PMID: 34945038 PMCID: PMC8708974 DOI: 10.3390/jcm10245743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
Scanty information on clustering longitudinal real-world data is available in the medical literature about the adherence implementation phase in rheumatoid arthritis (RA). To identify and characterize trajectories by analyzing the implementation phase of adherence to biologic Disease-Modifying Anti-Rheumatic Drugs (DMARDs), we conducted a retrospective cohort drug-utilization study using Tuscan administrative databases. RA patients were identified by a validated algorithm, including the first biologic DMARD supply from 2010 to 2015, RA specialist visit in the year before or after the first supply date and RA diagnosis in the five years before or in the year after the first supply date. We observed users for three years or until death, neoplasia, or pregnancy. We evaluated adherence quarterly through the Medication Possession Ratio. Firstly, we identified adherence trajectories and described the baseline characteristics; then, we focused on the trajectory most populated to distinguish the related sub-trajectories. We identified 952 first ever-biologic DMARD users in RA (712 females, mean age 52.7 years old, standard deviation 18.8). The biologic DMARD mostly supplied was etanercept (387 users) followed by adalimumab (233). Among 935 users with at least 3 adherence values, we identified 49 fully-adherent users, 829 continuous users, and 57 early-discontinuing users. Significant differences were observed among the index drugs. After focusing on the continuous users, three sub-trajectories were identified: continuous-steady users (556), continuous-alternate users (207), and continuous-declining users (66). No relevant differences emerged at the baseline. The majority of first ever-biologic DMARD users showed a continuous adherence behavior in RA. The role of adherence potential predictors and the association with effectiveness and safety outcomes should be explored by further studies.
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Affiliation(s)
- Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
| | - Rosa Gini
- Unit of Pharmacoepidemiology, Tuscan Regional Healthcare Agency, 50100 Florence, Italy; (R.G.); (C.B.); (O.P.)
| | - Massimiliano Cazzato
- Unit of Rheumatology, University Hospital of Pisa, 56100 Pisa, Italy; (M.C.); (M.M.)
| | - Marco Fornili
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
| | - Claudia Bartolini
- Unit of Pharmacoepidemiology, Tuscan Regional Healthcare Agency, 50100 Florence, Italy; (R.G.); (C.B.); (O.P.)
| | - Olga Paoletti
- Unit of Pharmacoepidemiology, Tuscan Regional Healthcare Agency, 50100 Florence, Italy; (R.G.); (C.B.); (O.P.)
| | - Silvia Tillati
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
| | - Laura Baglietto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
| | - Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (G.T.); (L.T.); (V.L.)
| | - Leopoldo Trieste
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (G.T.); (L.T.); (V.L.)
| | - Valentina Lorenzoni
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (G.T.); (L.T.); (V.L.)
| | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56100 Pisa, Italy
| | - Marta Mosca
- Unit of Rheumatology, University Hospital of Pisa, 56100 Pisa, Italy; (M.C.); (M.M.)
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56100 Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
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16
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Thurin NH, Pajouheshnia R, Roberto G, Dodd C, Hyeraci G, Bartolini C, Paoletti O, Nordeng H, Wallach-Kildemoes H, Ehrenstein V, Dudukina E, MacDonald T, De Paoli G, Loane M, Damase-Michel C, Beau AB, Droz-Perroteau C, Lassalle R, Bergman J, Swart K, Schink T, Cavero-Carbonell C, Barrachina-Bonet L, Gomez-Lumbreras A, Giner-Soriano M, Aragón M, Neville AJ, Puccini A, Pierini A, Ientile V, Trifirò G, Rissmann A, Leinonen MK, Martikainen V, Jordan S, Thayer D, Scanlon I, Georgiou ME, Cunnington M, Swertz M, Sturkenboom M, Gini R. From Inception to ConcePTION: Genesis of a Network to Support Better Monitoring and Communication of Medication Safety During Pregnancy and Breastfeeding. Clin Pharmacol Ther 2021; 111:321-331. [PMID: 34826340 PMCID: PMC9299060 DOI: 10.1002/cpt.2476] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/24/2021] [Indexed: 02/01/2023]
Abstract
In 2019, the Innovative Medicines Initiative (IMI) funded the ConcePTION project-Building an ecosystem for better monitoring and communicating safety of medicines use in pregnancy and breastfeeding: validated and regulatory endorsed workflows for fast, optimised evidence generation-with the vision that there is a societal obligation to rapidly reduce uncertainty about the safety of medication use in pregnancy and breastfeeding. The present paper introduces the set of concepts used to describe the European data sources involved in the ConcePTION project and illustrates the ConcePTION Common Data Model (CDM), which serves as the keystone of the federated ConcePTION network. Based on data availability and content analysis of 21 European data sources, the ConcePTION CDM has been structured with six tables designed to capture data from routine healthcare, three tables for data from public health surveillance activities, three curated tables for derived data on population (e.g., observation time and mother-child linkage), plus four metadata tables. By its first anniversary, the ConcePTION CDM has enabled 13 data sources to run common scripts to contribute to major European projects, demonstrating its capacity to facilitate effective and transparent deployment of distributed analytics, and its potential to address questions about utilization, effectiveness, and safety of medicines in special populations, including during pregnancy and breastfeeding, and, more broadly, in the general population.
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Affiliation(s)
- Nicolas H Thurin
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Univ. Bordeaux, Bordeaux, France
| | - Romin Pajouheshnia
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Caitlin Dodd
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Giulia Hyeraci
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | | | - Olga Paoletti
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Helle Wallach-Kildemoes
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Thomas MacDonald
- MEMO Research, School of Medicine, University of Dundee, Dundee, UK
| | - Giorgia De Paoli
- MEMO Research, School of Medicine, University of Dundee, Dundee, UK
| | - Maria Loane
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | | | - Anna-Belle Beau
- INSERM, CERPOP: SPHERE, CIC 1436, Université de Toulouse, Toulouse, France
| | | | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Univ. Bordeaux, Bordeaux, France
| | - Jorieke Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Clara Cavero-Carbonell
- Fundació per al Foment de la Investigació Sanitaria i Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Laia Barrachina-Bonet
- Fundació per al Foment de la Investigació Sanitaria i Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Ainhoa Gomez-Lumbreras
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María Aragón
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Amanda J Neville
- IMER Registry (Emila Romagna Registry of Birth Defects), Center of Epidemiology for Clinical Research, University of Ferrara, Ferrara, Italy
| | - Aurora Puccini
- Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy
| | - Anna Pierini
- Epidemiology of Rare Diseases and Congenital Anomalies Unit, National Research Council-Institute of Clinical Physiology (CNR-IFC), Pisa, Italy
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | | | | | - Sue Jordan
- Faculty of Health and Life Science, Swansea University, Swansea, UK
| | - Daniel Thayer
- Faculty of Health and Life Science, Swansea University, Swansea, UK
| | - Ieuan Scanlon
- Faculty of Health and Life Science, Swansea University, Swansea, UK
| | | | | | - Morris Swertz
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miriam Sturkenboom
- Department Datascience and Biostatistics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Florence, Italy
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17
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Fornari C, Antonazzo IC, Paoletti O, Cei E, Bartolini C, Conti S, Ferrara P, Mantovani LG, Gini R, Mazzaglia G. Use of antidepressants during COVID19 outbreak: a real-world drug-utilization study. Eur J Public Health 2021. [PMCID: PMC8574249 DOI: 10.1093/eurpub/ckab165.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Lockdown measures implementation (LMI) to prevent COVID19 disease diffusion was associated to increased depression and anxiety cases. The main aim was to evaluate whether LMI affected prevalence and incidence of antidepressants (ADs) use, and ADs treatment interruption (TI) in the general population. Methods Adults (≥18 years) with at least 1 dispensing of ADs between 01/01/2019-26/09/2020 were selected from a regional Italian healthcare administrative database. Patients presenting an AD dispensing in the year preceding the first observation were considered as prevalent otherwise as incident users. We divided the studied period into 3 parts: pre-lockdown (01/01/2019-08/03/2020), lockdown (09/03/2020-14/06/2020) and post-lockdown (15/06/2020-27/09/2020). The weekly prevalence (WP) and incidence (WI) per 10,000 inhabitants were compared among periods. Incidence of TI (no dispensing refill within 30 days of the end of its validity) was computed among prevalent AD users. Results The WP (mean of 552.3 per 10,000 pre-lockdown vs 505.5 lockdown phase; relative change: -9%) and WI (5.2 vs 3.7; -29%) of ADs use decreased after LMI. During the post-lockdown phase WP (505.5 vs 495.9; -2%) decreased whereas the WI (3.7 vs 4.3; 16%) slightly increased in relation to the lockdown period, although differences were not statistically significant. Conversely, the incidence of TI increased during lockdown (344.7 vs 384.3; 12%) and post-lockdown (384.3 vs 394.2; 3%) periods, even not always statistically significant. Conclusions Our analysis showed a reduction of ADs use during the early phase of lockdown. Several factors might have impacted on the observed phenomenon (i.e, patient reluctance to start new AD treatment). Considering the mutation of the virus and the potential waves that might occur in the next months, a continuous monitoring of the impact of COVID19 on mental diseases onset and treatment adherence are suggested. Key messages In Italy, the implementation of lockdown measures was followed by a reduction in antidepressants use, even though evidences are that diagnoses of psychiatric disorders increased. Future studies should monitor if these phenomena led to an increase in adverse events potentially correlated with inappropriate treatment of depression.
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Affiliation(s)
- C Fornari
- Center for Public Health Research, University of Milano- Bicocca, Monza, Italy
| | - IC Antonazzo
- Center for Public Health Research, University of Milano- Bicocca, Monza, Italy
| | - O Paoletti
- Pharmacoepidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - E Cei
- Center for Public Health Research, University of Milano- Bicocca, Monza, Italy
| | - C Bartolini
- Pharmacoepidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - S Conti
- Center for Public Health Research, University of Milano- Bicocca, Monza, Italy
- Value-based Healthcare Unit, IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - P Ferrara
- Center for Public Health Research, University of Milano- Bicocca, Monza, Italy
- Value-based Healthcare Unit, IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - LG Mantovani
- Center for Public Health Research, University of Milano- Bicocca, Monza, Italy
- Value-based Healthcare Unit, IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - R Gini
- Pharmacoepidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - G Mazzaglia
- Center for Public Health Research, University of Milano- Bicocca, Monza, Italy
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18
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Massari M, Spila-Alegiani S, Fabiani M, Belleudi V, Trifirò G, Kirchmayer U, Poggi FR, Mancuso P, Menniti-Ippolito F, Gini R, Bartolini C, Leoni O, Ercolanoni M, Da-Re F, Guzzinati S, Luxi N, Riccardo F, Giorgi-Rossi P. Association of Influenza Vaccination and Prognosis in Patients Testing Positive to SARS-CoV-2 Swab Test: A Large-Scale Italian Multi-Database Cohort Study. Vaccines (Basel) 2021; 9:716. [PMID: 34358133 PMCID: PMC8310185 DOI: 10.3390/vaccines9070716] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022] Open
Abstract
To investigate the association of the 2019-2020 influenza vaccine with prognosis of patients positive for SARS-CoV-2A, a large multi-database cohort study was conducted in four Italian regions (i.e., Lazio, Lombardy, Veneto, and Tuscany) and the Reggio Emilia province (Emilia-Romagna). More than 21 million adults were residing in the study area (42% of the population). We included 115,945 COVID-19 cases diagnosed during the first wave of the pandemic (February-May, 2020); 34.6% of these had been vaccinated against influenza. Three outcomes were considered: hospitalization, death, and intensive care unit (ICU) admission/death. The adjusted relative risk (RR) of being hospitalized in the vaccinated group when compared with the non-vaccinated group was 0.87 (95% CI: 0.86-0.88). This reduction in risk was not confirmed for death (RR = 1.04; 95% CI: 1.01-1.06), or for the combined outcome of ICU admission or death. In conclusion, our study, conducted on the vast majority of the population during the first wave of the pandemic in Italy, showed a 13% statistically significant reduction in the risk of hospitalization in some geographical areas and in the younger population. No impact of seasonal influenza vaccination on COVID-19 prognosis in terms of death and death or ICU admission was estimated.
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Affiliation(s)
- Marco Massari
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation (CNRVF), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (M.M.); (F.M.-I.)
| | - Stefania Spila-Alegiani
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation (CNRVF), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (M.M.); (F.M.-I.)
| | - Massimo Fabiani
- Department of Infectious Diseases (DMI), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (M.F.); (F.R.)
| | - Valeria Belleudi
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy; (V.B.); (U.K.); (F.R.P.)
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 3, 37134 Verona, Italy;
- Italian Society of Pharmacology, Via Giovanni Pascoli 3, 20129 Milan, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy; (V.B.); (U.K.); (F.R.P.)
| | - Francesca Romana Poggi
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy; (V.B.); (U.K.); (F.R.P.)
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122 Reggio Emilia, Italy; (P.M.); (P.G.-R.)
| | - Francesca Menniti-Ippolito
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation (CNRVF), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (M.M.); (F.M.-I.)
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Via Pietro Dazzi 1, 50141 Florence, Italy; (R.G.); (C.B.)
| | - Claudia Bartolini
- Agenzia Regionale di Sanità della Toscana, Via Pietro Dazzi 1, 50141 Florence, Italy; (R.G.); (C.B.)
| | - Olivia Leoni
- Department of Health of Lombardy Region, Epidemiology Observatory, Piazza Città di Lombardia 1, 20124 Milan, Italy; (O.L.); (M.E.)
| | - Michele Ercolanoni
- Department of Health of Lombardy Region, Epidemiology Observatory, Piazza Città di Lombardia 1, 20124 Milan, Italy; (O.L.); (M.E.)
| | - Filippo Da-Re
- Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, Rio Novo-Dorsoduro 3493, 30123 Venice, Italy;
| | - Stefano Guzzinati
- Azienda Zero, Regione del Veneto, Passaggio Luigi Gaudenzio, 1, 35131 Padova, Italy;
| | - Nicoletta Luxi
- Department BIOMORF, University of Messina, Piazza Pugliatti 1, 98122 Messina, Italy;
| | - Flavia Riccardo
- Department of Infectious Diseases (DMI), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (M.F.); (F.R.)
| | - Paolo Giorgi-Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122 Reggio Emilia, Italy; (P.M.); (P.G.-R.)
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19
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Antonazzo IC, Fornari C, Paoletti O, Bartolini C, Conti S, Cortesi PA, Mantovani LG, Gini R, Mazzaglia G. COVID-19 Outbreak Impact on Anticoagulants Utilization: An Interrupted Time-Series Analysis Using Health Care Administrative Databases. Thromb Haemost 2021; 121:1115-1118. [PMID: 34100278 DOI: 10.1055/a-1523-7658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Olga Paoletti
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Claudia Bartolini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.,Value-based Healthcare Unit, IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.,Value-based Healthcare Unit, IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.,Value-based Healthcare Unit, IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - Rosa Gini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
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20
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Bollaerts K, de Smedt T, McGee C, Emborg HD, Villa M, Alexandridou M, Duarte-Salles T, Gini R, Bartolini C, de Lusignan S, Tin Tin Htar M, Titievsky L, Sturkenboom M, Bauchau V. ADVANCE: Towards near real-time monitoring of vaccination coverage, benefits and risks using European electronic health record databases. Vaccine 2020; 38 Suppl 2:B76-B83. [DOI: 10.1016/j.vaccine.2019.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 12/15/2022]
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21
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Peltrini R, D'Ambra M, Bartolini C, Lionetti R, Bracale U, Corcione F. Laparoscopic right hemicolectomy for cT4b caecal adenocarcinoma involving the bladder - a video vignette. Colorectal Dis 2020; 22:1771-1772. [PMID: 32473044 DOI: 10.1111/codi.15162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 02/08/2023]
Affiliation(s)
- R Peltrini
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M D'Ambra
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - C Bartolini
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - R Lionetti
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - U Bracale
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - F Corcione
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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22
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Peltrini R, Pontecorvi E, Silvestri V, Bartolini C, D'Ambra M, Bracale U, Corcione F. Laparoscopic sigmoid colectomy with preservation of the inferior mesenteric artery for diverticular disease - a video vignette. Colorectal Dis 2020; 22:1205-1206. [PMID: 32248599 DOI: 10.1111/codi.15053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/17/2020] [Indexed: 02/08/2023]
Affiliation(s)
- R Peltrini
- Department of Public Health, School of Medicine, University of Naples Federico II - Minimally Invasive General and Oncological Surgery Unit, Napoli, Italy
| | - E Pontecorvi
- Department of Public Health, School of Medicine, University of Naples Federico II - Minimally Invasive General and Oncological Surgery Unit, Napoli, Italy
| | - V Silvestri
- Department of Public Health, School of Medicine, University of Naples Federico II - Minimally Invasive General and Oncological Surgery Unit, Napoli, Italy
| | - C Bartolini
- Department of Public Health, School of Medicine, University of Naples Federico II - Minimally Invasive General and Oncological Surgery Unit, Napoli, Italy
| | - M D'Ambra
- Department of Public Health, School of Medicine, University of Naples Federico II - Minimally Invasive General and Oncological Surgery Unit, Napoli, Italy
| | - U Bracale
- Department of Public Health, School of Medicine, University of Naples Federico II - Minimally Invasive General and Oncological Surgery Unit, Napoli, Italy
| | - F Corcione
- Department of Public Health, School of Medicine, University of Naples Federico II - Minimally Invasive General and Oncological Surgery Unit, Napoli, Italy
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23
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Hyeraci G, Spini A, Roberto G, Gini R, Bartolini C, Lucenteforte E, Corrao G, Rea F. A Systematic Review of Case-Identification Algorithms Based on Italian Healthcare Administrative Databases for Three Relevant Diseases of the Cardiovascular System: Acute Myocardial Infarction, Ischemic Heart Disease, and Stroke. Epidemiol Prev 2020; 43:37-50. [PMID: 31650805 DOI: 10.19191/ep19.4.s2.p037.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND acute myocardial infarction (AMI), ischemic heart diseases (IHDs) and stroke are serious cardiovascular diseases (CVDs) which may lead to hospitalizations, require periodical medical monitoring and life-long drugs use, thus having a high impact on public health and Healthcare Service expenditure. In this contest, Italian Healthcare Administrative Databases (HADs), which routinely collect patientlevel information on healthcare services reimbursed by the National Healthcare service, are increasingly used for identification of these CVDs. OBJECTIVES to identify and describe all AMI, IHDs and stroke case-identification algorithms by means of Italian HADs, through the review of papers published in the past 10 years. METHODS this study is part of a project that systematically reviewed case-identification algorithms for 18 acute and chronic conditions by means of HADs in Italy. PubMed was searched for original articles, published between 2007 and 2017, in Italian or English. The search string consisted of a combination of free text and MeSH terms with a common part that focused on HADs and a disease-specific part. All identified papers were screened by two independent reviewers. Pertinent papers were classified according to the objective for which the algorithm had been used, and only articles that used algorithms for primary objectives (I disease occurrence; II population/cohort selection; III outcome identification) were considered for algorithm extraction. The HADs used (hospital discharge records, drug prescriptions, etc.), ICD-9 and ICD-10 codes, ATC classification of drugs, follow-back periods, and age ranges applied by the algorithms have been reported. Further information on specific objective(s), accuracy measures, sensitivity analyses and the contribution of each HAD, have also been recorded. RESULTS the search strategy has led to the identification of 611 papers for AMI,801 for IHDs and 791 for stroke. Among these,45,12 and 31 papers for AMI, IHDs and stroke respectively, were considered pertinent for inclusion in the systematic review. The majority of the works was published during 2014-2017. The setting of the studies was mainly regional for AMI and stroke, while the majority of IHD's papers was based on a national multicenter context. By screening full texts, a total of 17,5 and 28 original algorithms for AMI, IHDs and stroke respectively, intended for the above-mentioned objectives, were found. Moreover, 3 original algorithms for STEMI, 3 for NSTEMI, 8 for ischemic stroke and 3 for hemorrhagic stroke were identified. The hospital discharge diagnosis database (HDD) was used in all algorithms. In only a few cases the co-payment exemption registry, drug prescription database, and mortality registry database were used as additional algorithm components. For the same event, there was always a difference of >=1 code. External validation was performed in only one case for AMI and stroke identification. CONCLUSION a remarkable heterogeneity, in terms of both data sources and codes used, was observed for algorithms aimed to identify AMI, IHDs and stroke in HADs. This was likely due to the paucity of validation studies. Administrative data sources other than HDD remain underutilized.
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Affiliation(s)
- Giulia Hyeraci
- Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence (Italy);
| | - Andrea Spini
- Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence (Italy).,Department of Medicine, Surgery and Neuroscience, University of Siena, Siena (Italy)
| | - Giuseppe Roberto
- Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence (Italy)
| | - Rosa Gini
- Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence (Italy)
| | - Claudia Bartolini
- Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence (Italy)
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, (Italy)
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan (Italy).,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan (Italy)
| | - Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan (Italy).,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan (Italy)
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24
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Roberto G, Spini A, Bartolini C, Moscatelli V, Barchielli A, Paoletti D, Giorgi S, Fabbri A, Bocchia M, Donnini S, Gini R, Ziche M. Real word evidence on rituximab utilization: Combining administrative and hospital-pharmacy data. PLoS One 2020; 15:e0229973. [PMID: 32163477 PMCID: PMC7067445 DOI: 10.1371/journal.pone.0229973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/17/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To describe patterns of utilization, survival and infectious events in patients treated with rituximab at the University Hospital of Siena (UHS) to explore the feasibility of combining routinely collected administrative and hospital-pharmacy data for examining the real-world use of intravenous antineoplastic drugs. METHODS A retrospective, longitudinal cohort study was conducted using data from the Hospital Pharmacy of Siena (HPS) and the Regional Administrative Database of Tuscany (RAD). Patients aged ≥18 years with ≥1 rituximab administration recorded between January 2012 and June 2016 were identified in the HPS database. Anonymized patient-level data were linked to RAD. Rituximab utilization during the first year of treatment was described using HPS. Hospital diagnoses of adverse infectious events that occurred during the first year of follow-up and four-year survival were observed using RAD. RESULTS A total of 311 new users of rituximab were identified: 264 patients received rituximab for non-Hodgkin's lymphoma (NHL) and 47 were treated for chronic lymphocytic leukemia (CLL). Among new users with one complete year of follow-up (n = 203) over 95% received rituximab as the first-line treatment, and approximately 70% of them received 5-8 doses. No patient in the CLL group received >8 administrations. Four-year survival was approximately 70% in both CLL and NHL patients. Sepsis was the most frequent infectious event observed (5.1%). CONCLUSION HPS and RAD provided complementary information on rituximab utilization, demonstrating their potential for future pharmacoepidemiological studies on antineoplastic medications administered in the Italian hospital setting. Overall, this general description of the real-world utilization of rituximab in patients treated for NHL and CLL at UHS was in line with treatment guidelines and current knowledge on the rituximab safety profile.
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MESH Headings
- Administration, Intravenous
- Administrative Claims, Healthcare/statistics & numerical data
- Adolescent
- Adult
- Aged
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Databases, Factual/statistics & numerical data
- Drug Utilization/statistics & numerical data
- Female
- Follow-Up Studies
- Humans
- Infections/chemically induced
- Infections/epidemiology
- Infections/immunology
- Italy/epidemiology
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Longitudinal Studies
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/mortality
- Male
- Middle Aged
- Pharmacy Service, Hospital/statistics & numerical data
- Retrospective Studies
- Rituximab/administration & dosage
- Rituximab/adverse effects
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
| | - Andrea Spini
- Department of Medical Science, Surgery and Neuroscience, University of Siena, and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | | | - Davide Paoletti
- Farmacia Oncologica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Silvano Giorgi
- Farmacia Oncologica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Monica Bocchia
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Sandra Donnini
- Department of Life sciences, University of Siena, Siena, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | - Marina Ziche
- Department of Medical Science, Surgery and Neuroscience, University of Siena, and Azienda Ospedaliera Universitaria Senese, Siena, Italy
- * E-mail:
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25
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Gini R, Dodd CN, Bollaerts K, Bartolini C, Roberto G, Huerta-Alvarez C, Martín-Merino E, Duarte-Salles T, Picelli G, Tramontan L, Danieli G, Correa A, McGee C, Becker BFH, Switzer C, Gandhi-Banga S, Bauwens J, van der Maas NAT, Spiteri G, Sdona E, Weibel D, Sturkenboom M. Quantifying outcome misclassification in multi-database studies: The case study of pertussis in the ADVANCE project. Vaccine 2019; 38 Suppl 2:B56-B64. [PMID: 31677950 DOI: 10.1016/j.vaccine.2019.07.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/28/2019] [Accepted: 07/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Accelerated Development of VAccine beNefit-risk Collaboration in Europe (ADVANCE) is a public-private collaboration aiming to develop and test a system for rapid benefit-risk (B/R) monitoring of vaccines using European healthcare databases. Event misclassification can result in biased estimates. Using different algorithms for identifying cases of Bordetella pertussis (BorPer) infection as a test case, we aimed to describe a strategy to quantify event misclassification, when manual chart review is not feasible. METHODS Four participating databases retrieved data from primary care (PC) setting: BIFAP: (Spain), THIN and RCGP RSC (UK) and PEDIANET (Italy); SIDIAP (Spain) retrieved data from both PC and hospital settings. BorPer algorithms were defined by healthcare setting, data domain (diagnoses, drugs, or laboratory tests) and concept sets (specific or unspecified pertussis). Algorithm- and database-specific BorPer incidence rates (IRs) were estimated in children aged 0-14 years enrolled in 2012 and 2014 and followed up until the end of each calendar year and compared with IRs of confirmed pertussis from the ECDC surveillance system (TESSy). Novel formulas were used to approximate validity indices, based on a small set of assumptions. They were applied to approximately estimate positive predictive value (PPV) and sensitivity in SIDIAP. RESULTS The number of cases and the estimated BorPer IRs per 100,000 person-years in PC, using data representing 3,173,268 person-years, were 0 (IR = 0.0), 21 (IR = 4.3), 21 (IR = 5.1), 79 (IR = 5.7), and 2 (IR = 2.3) in BIFAP, SIDIAP, THIN, RCGP RSC and PEDIANET respectively. The IRs for combined specific/unspecified pertussis were higher than TESSy, suggesting that some false positives had been included. In SIDIAP the estimated IR was 45.0 when discharge diagnoses were included. The sensitivity and PPV of combined PC specific and unspecific diagnoses for BorPer cases in SIDIAP were approximately 85% and 72%, respectively. CONCLUSION Retrieving BorPer cases using only specific concepts has low sensitivity in PC databases, while including cases retrieved by unspecified concepts introduces false positives, which were approximately estimated to be 28% in one database. The share of cases that cannot be retrieved from a PC database because they are only seen in hospital was approximately estimated to be 15% in one database. This study demonstrated that quantifying the impact of different event-finding algorithms across databases and benchmarking with disease surveillance data can provide approximate estimates of algorithm validity.
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Affiliation(s)
- Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | - Caitlin N Dodd
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands; Julius Global Health, University Medical Center, Utrecht, Heidelberglaan 100, the Netherlands
| | - Kaatje Bollaerts
- P95 Epidemiology and Pharmacovigilance, Koning Leopold III laan 1, 3001 Heverlee, Belgium.
| | - Claudia Bartolini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | | | - Elisa Martín-Merino
- BIFAP Database, Spanish Agency of Medicines and Medical Devices, Madrid, Spain.
| | - Talita Duarte-Salles
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Gino Picelli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy.
| | - Lara Tramontan
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy.
| | - Giorgia Danieli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy
| | - Ana Correa
- University of Surrey, Guildford, Surrey GU2 7XH, UK.
| | - Chris McGee
- University of Surrey, Guildford, Surrey GU2 7XH, UK; Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London NW1 2FB, UK.
| | - Benedikt F H Becker
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands.
| | | | | | - Jorgen Bauwens
- University Children's Hospital, Basel, Switzerland; University of Basel, Switzerland; Brighton Collaboration Foundation, Switzerland.
| | | | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control, Gustav III's Boulevard 40, 16973 Solna, Sweden.
| | - Emmanouela Sdona
- European Centre for Disease Prevention and Control, Gustav III's Boulevard 40, 16973 Solna, Sweden
| | - Daniel Weibel
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands.
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center, Utrecht, Heidelberglaan 100, the Netherlands; P95 Epidemiology and Pharmacovigilance, Koning Leopold III laan 1, 3001 Heverlee, Belgium; VACCINE.GRID Foundation, Spitalstrasse 33, Basel, Switzerland.
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Spini A, Roberto G, Gini R, Bartolini C, Bazzani L, Donnini S, Crispino S, Ziche M. Evidence of β-blockers drug repurposing for the treatment of triple negative breast cancer: A systematic review. Neoplasma 2019; 66:963-970. [PMID: 31607128 DOI: 10.4149/neo_2019_190110n34] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/28/2019] [Indexed: 11/08/2022]
Abstract
Triple negative breast cancer (TNBC) is a particularly aggressive subtype of breast cancer (BC) for which limited therapeutic options are available. Recently, β-blockers (BBs) have been suggested to have favorable effects in the treatment of BC. The aim of this systematic review was to collect evidence from preclinical and clinical studies concerning the scientific evidence for the repurposing of BBs in TNBC treatment. PubMed database was searched to retrieve studies of interest published up to 30/01/2018. All preclinical studies using TNBC in vitro and in vivo models and assessing the effect of any molecule with sympatholytic or sympathomimetic activity on adrenergic receptors were included. Clinical studies concerning BBs were considered eligible. The Newcastle-Ottawa scale was used for the quality assessment of clinical studies. A total of 614 study references were retrieved. Forty-six preclinical studies were included. In in vitro studies, propranolol, a non-selective BB, significantly decreased proliferation, migration and invasion of TNBC cells. Consistently, in in vivo studies, propranolol inhibited metastasis, angiogenesis and tumor growth. Clinical studies, reporting evidence from a total of four distinct retrospective observational cohort studies, showed a beneficial effect of BBs in TNBC treatment. The overall quality of the clinical evidence collected was low. Preclinical evidence collected in this systematic review are in line with the results reported in the clinical studies retrieved, pointing towards a beneficial effect of BB in the treatment of TNBC. However, given the overall low quality of available evidence, no definite conclusion may be drawn.
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Affiliation(s)
- A Spini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - G Roberto
- Agenzia Regionale di Sanita toscana, Florence, Italy
| | - R Gini
- Agenzia Regionale di Sanita toscana, Florence, Italy
| | - C Bartolini
- Agenzia Regionale di Sanita toscana, Florence, Italy
| | - L Bazzani
- Department of Life Sciences, University of Siena, Siena, Italy
| | - S Donnini
- Department of Life Sciences, University of Siena, Siena, Italy
| | - S Crispino
- ASSO, Siena, Italy.,Anticancer fund, Strombeek Bever, Belgium
| | - M Ziche
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Verdecchia P, D'Onofrio A, Russo V, Fedele F, Adamo F, Benedetti G, Ferrante F, Lodigiani C, Paciullo F, Aita A, Bartolini C, Molini MG, Di Lenarda A, Mazzone C, Scotti L, Lanati EP, Iorio A. Persistence on apixaban in atrial fibrillation patients: a retrospective multicentre study. J Cardiovasc Med (Hagerstown) 2019; 20:66-73. [PMID: 30540644 DOI: 10.2459/jcm.0000000000000744] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Real-world data on treatment persistence, safety and effectiveness of non-Vitamin K antagonist oral anticoagulants (NOACs) play an important role in the assessment of risks and benefits of these drugs. Our aim was to evaluate persistence on treatment, incidence of major bleeding and incidence of a composite endpoint of major events, including all-cause death, myocardial infarction, stroke and systemic thromboembolism, during treatment with apixaban in a cohort of patients with nonvalvular atrial fibrillation (NVAF). METHODS In this multicentre retrospective observational study, we retrieved data from medical records of five Italian hospitals on patients with a diagnosis of NVAF who initiated apixaban between 1 January 2014 and 31 March 2016 and had a first subsequent visit at the same hospital. RESULTS We studied 766 patients with mean age of 74.2 (standard deviation 11.1) years and median CHADS2 and CHA2DS2VASc scores of 2.0 and 4.0, respectively. Over a median follow-up period of 339 days, persistence on treatment was 83.5% [95% confidence interval (95% CI) 75.5-89.1%]. The rate of major bleeding (per 100 person-years) was 1.15 (95% CI 0.39-1.90 per 100 person-years), while the cumulative incidence was 4.4% (95% CI 1.6-12.0). The rate of major events was 1.97 (95% CI 1.08-2.86) per 100 patient-years, with a cumulative incidence over the entire follow-up period of 7.7% (95% CI 4.6-12.8). CONCLUSION In real-life conditions, NVAF patients treated with apixaban show rates of treatment discontinuation and major bleedings, which are comparable to those found in the ARISTOTLE pivotal study, thus supporting its external validity.
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Affiliation(s)
- Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS, Hospital S. Maria della Misericordia, Cardiology, Perugia
| | | | - Vincenzo Russo
- Cardiology Department, Ospedale Monaldi, Naples.,Division of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia
| | - Francesco Fedele
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome
| | - Francesco Adamo
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome
| | - Giulia Benedetti
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome
| | - Fabio Ferrante
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome
| | | | - Francesco Paciullo
- Fondazione Umbra Cuore e Ipertensione-ONLUS, Hospital S. Maria della Misericordia, Cardiology, Perugia
| | - Adolfo Aita
- Fondazione Umbra Cuore e Ipertensione-ONLUS, Hospital S. Maria della Misericordia, Cardiology, Perugia
| | - Claudia Bartolini
- Fondazione Umbra Cuore e Ipertensione-ONLUS, Hospital S. Maria della Misericordia, Cardiology, Perugia
| | - Maria Gabriella Molini
- Fondazione Umbra Cuore e Ipertensione-ONLUS, Hospital S. Maria della Misericordia, Cardiology, Perugia
| | - Andrea Di Lenarda
- Cardiovascular Centre, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Carmine Mazzone
- Cardiovascular Centre, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Lorenza Scotti
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca
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Spini A, Roberto G, Gini R, Bartolini C, Bazzani L, Donnini S, Crispino S, Ziche M. Abstract P3-14-08: Preclinical and clinical evidence about the use of betablockers for the treatment of triple negative breast cancer: A systematic review. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-14-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Triple negative breast cancer (TNBC) is a particularly aggressive subtype of breast cancer (BC) for which very limited therapeutic options are available. Recently, beta-blockers (BB) have been suggested to have favorable effects on the treatment of BC both in preclinical and clinical studies.
Objective
The aim of this systematic review was to collect evidence from preclinical and clinical studies concerning the scientific evidence for the repurposing of BBs in TNBC treatment.
Methods
PubMed database was searched for retrieving studies of interest published up to 30/01/2018. All preclinical studies using BC in vitro and in vivo models and assessing the effect of any molecule with sympatholytic or sympathomimetic activity on adrenoceptors were included. Clinical studies concerning BB were considered eligible. Two authors independently reviewed and screened title and abstract of retrieved references. Potentially relevant studies were further assessed through full-texts examination. One author extracted information from preclinical and clinical studies respectively. A second author subsequently reviewed the extracted data. The Newcastle-Ottawa scale was used for the quality assessment of clinical studies.
Results
A total of 616 study references were initially retrieved. Six additional records were retrieved through snowball search. A total of 62 preclinical studieswere included, of which 46 concerned in vitro and in vivo models of TNBC, i.e. cell cultures and/or animal studies (20 in vitro, 9 in vivo, and 17 in vivo/vitro). In vitro studies showed a high expression of β2 adrenoreceptors in TNBC cell lines. Propranolol, a non-selective β1/β2 antagonist, was reported to significantly decrease proliferation, migration and invasion of TNBC cells. Similar effects were also reported for carvedilol, a selective β2 antagonist and α1 antagonist. In vivo studies reported a reduction of metastasis, angiogenesis and tumor growth in animals exposed to propranolol..Clinical studies, reporting evidence from a total of four distinct retrospective observational cohort studies, showed a beneficial effect of BB in TNBC treatment: e.g. study#1: Overall Survival Hazard Ratio (HR)=0.35 (95%CI 0.12-1.00); study#2: metastasis HR=0.32 (95%CI 0.12–0.90); study3# Progression Free Survival: HR=0.52 (95%CI 0.34–0.79); study #4 Relapse Free Survival: HR=0.69 (95%CI 0.35–1.34). The overall quality of the clinical evidence collected was low.
Conclusion:
Preclinical evidence collected in this systematic review are in line with the results reported in the four clinical studies retrieved, pointing towards a beneficial effect of BB in the treatment of TNBC. However, given the overall low quality of available evidence, no definite conclusion may be drawn. The execution of large scale interventional clinical studies are warranted to shed light on the efficacy/effectiveness of BB in TNBC treatment.
Aknowledgment:
This study was supported by Fondazione decima regio “Olga e Raimondo Curri”
Citation Format: Spini A, Roberto G, Gini R, Bartolini C, Bazzani L, Donnini S, Crispino S, Ziche M. Preclinical and clinical evidence about the use of betablockers for the treatment of triple negative breast cancer: A systematic review [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-14-08.
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Affiliation(s)
- A Spini
- University of Siena, Siena, Italy; Agenzia Regionale di Sanità Toscana, Florence, Italy; ASSO, Siena, Italy; Anticancer Fund Brussels, Brussel, Belgium
| | - G Roberto
- University of Siena, Siena, Italy; Agenzia Regionale di Sanità Toscana, Florence, Italy; ASSO, Siena, Italy; Anticancer Fund Brussels, Brussel, Belgium
| | - R Gini
- University of Siena, Siena, Italy; Agenzia Regionale di Sanità Toscana, Florence, Italy; ASSO, Siena, Italy; Anticancer Fund Brussels, Brussel, Belgium
| | - C Bartolini
- University of Siena, Siena, Italy; Agenzia Regionale di Sanità Toscana, Florence, Italy; ASSO, Siena, Italy; Anticancer Fund Brussels, Brussel, Belgium
| | - L Bazzani
- University of Siena, Siena, Italy; Agenzia Regionale di Sanità Toscana, Florence, Italy; ASSO, Siena, Italy; Anticancer Fund Brussels, Brussel, Belgium
| | - S Donnini
- University of Siena, Siena, Italy; Agenzia Regionale di Sanità Toscana, Florence, Italy; ASSO, Siena, Italy; Anticancer Fund Brussels, Brussel, Belgium
| | - S Crispino
- University of Siena, Siena, Italy; Agenzia Regionale di Sanità Toscana, Florence, Italy; ASSO, Siena, Italy; Anticancer Fund Brussels, Brussel, Belgium
| | - M Ziche
- University of Siena, Siena, Italy; Agenzia Regionale di Sanità Toscana, Florence, Italy; ASSO, Siena, Italy; Anticancer Fund Brussels, Brussel, Belgium
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Roberto G, Barone-Adesi F, Giorgianni F, Pizzimenti V, Ferrajolo C, Tari M, Bartolini C, Da Cas R, Maggini M, Spila-Alegiani S, Francesconi P, Trifirò G, Poluzzi E, Baccetti F, Gini R. Patterns and trends of utilization of incretin-based medicines between 2008 and 2014 in three Italian geographic areas. BMC Endocr Disord 2019; 19:18. [PMID: 30732592 PMCID: PMC6367760 DOI: 10.1186/s12902-019-0334-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The incretin-based medicines GLP1 analogues (GLP1a) and dipeptidyl peptidase-4 inhibitors (DPP4i) are hypoglycaemic agents licensed for the treatment of type 2 diabetes mellitus (T2DM). Although these drugs possess comparable efficacy and low risk of hypoglycaemia, differences in terms of route of administration (subcutaneous versus oral), effect on body weight and gastrointestinal tolerabily can impact their actual use in clinical practice. This study aimed to describe the real-world utilization of incretin-based medicines in the Italian clinical practice. METHODS A multi-database, population-based, descriptive, cohort study was performed using administrative data collected between 2008 and 2014 from three Italian geographic areas. Subjects aged ≥18 were selected. New users were defined as those with ≥1 dispensing of GLP1a or DPP4i during the year of interest and none in the past. Trends of cumulative annual incidence of use in the general adult population were observed. New users of GLP1a or DPP4i were respectively described in terms of demographic characteristics and use of antidiabetic drugs during 1 year before and after the first incretin dispensing. RESULTS The overall study population included 4,943,952 subjects. A total of 7357 new users of GLP1a and 41,907 of DPP4i were identified during the study period. Incidence of use increased between 2008 (0.2‰ for both GLP1a and DPP4i) and 2011 (GLP1a = 0.6‰; DPP4i = 2.5‰) and slightly decreased thereafter. In 2014, 61% of new GLP1a users received once-daily liraglutide while 52% of new DPP4i users received metformin/DPP4i in fixed-dose. The percentage of new DPP4i users older than 65 years of age increased from 30.9 to 62.6% during the study period. Around 12% of new users had not received any antidiabetic before starting an incretin. CONCLUSIONS During the study period, DPP4i rapidly became the most prescribed incretin-based medicine, particularly among older new user. The choice of the specific incretin-based medicine at first prescription appeared to be directed towards those with higher convenience of use (e.g. oral DPP4i rather than subcutaneous GLP1a, once-daily liraglutide rather than twice-daily exenatide). The non-negligibile use of incretin-based medicines as first-line pharmacotherapy for T2DM warrants further effectiveness and safety evaluations to better define their place in therapy.
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Affiliation(s)
- Giuseppe Roberto
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
| | | | - Francesco Giorgianni
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Valeria Pizzimenti
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Carmen Ferrajolo
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Experimental medicine, Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania, University of Campania, Naples, Italy
| | | | - Claudia Bartolini
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, National Institute of Health, Rome, Italy
| | - Marina Maggini
- National Centre for Drug Research and Evaluation, National Institute of Health, Rome, Italy
| | | | - Paolo Francesconi
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Science, University of Bologna, Unit of Pharmacology, Bologna, Italy
| | - Fabio Baccetti
- Unit of DiabetologyLocal, Health Authority of North-West Tuscany, Massa, Italy
| | - Rosa Gini
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
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Roberto G, Bartolini C, Rea F, Onder G, Vitale C, Trifirò G, Kirchmayer U, Chinellato A, Lucenteforte E, Corrao G, Mugelli A, Lapi F, Gini R. NSAIDs utilization for musculoskeletal indications in elderly patients with cerebro/cardiovascular disease. Eur J Clin Pharmacol 2018; 74:637-643. [PMID: 29383397 PMCID: PMC5893698 DOI: 10.1007/s00228-018-2411-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/03/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe NSAID utilization for musculoskeletal conditions in a large cohort of Italian elderly with cerebro/cardiovascular disease, a population in which NSAIDs should be generally avoided due to the prothrombotic potential. METHODS Administrative data from five Italian geographic areas were analyzed. Patients aged ≥ 65 with a cerebro/cardiovascular event recorded between 2008 and 2011 (cohort entry) were selected. Prescription NSAIDs reimbursed for musculoskeletal conditions and dispensed during 1 year follow-up were retrieved to describe (i) prevalence of use, (ii) average amount of defined daily doses of NSAIDs claimed by users per day of follow-up, and (iii) distribution of the received daily dose (RDD) among patients with ≥ 2 dispensings. Among new users, i.e., patients without NSAID dispensings during 2 years before cohort entry, the first dispensed NSAID molecule was observed. RESULTS Overall, 511,989 patients were selected. Across the five geographic areas, prevalence of use ranged from 48 to 21% and average consumption ranged between 30 and 67 DDD/1000 users/day. Around 10% of patients in the overall cohort had a RDD > 1. Nimesulide (9.6%) and diclofenac (7.5%) had the highest prevalence of use. The most consumed NSAIDs were nimesulide and coxibs with 10.6 and 7.5 DDD/1000 users/day, respectively. Among new users recruited in 2011, 30% had diclofenac or a coxibs as the first prescription. CONCLUSIONS NSAID use was common in the study cohort, particularly in central-southern areas. In contrast with current recommendations, coxibs and diclofenac were among the most prescribed active principles, even in new users. Interventions to promote appropriateness of use are warranted.
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Affiliation(s)
- Giuseppe Roberto
- Agenzia Regionale di Sanità della Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy.
| | - Claudia Bartolini
- Agenzia Regionale di Sanità della Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
| | - Federico Rea
- Università degli studi di Milano-Bicocca, Milan, Italy
| | | | | | | | | | | | | | | | | | - Francesco Lapi
- Agenzia Regionale di Sanità della Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
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Verdecchia P, Angeli F, Mazzotta G, Bartolini C, Garofoli M, Aita A, Poltronieri C, Pinzagli MG, Valecchi F, Martone S, Ramundo E, Turturiello D, Reboldi G. Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension. J Am Heart Assoc 2017; 6:JAHA.117.005948. [PMID: 28539381 PMCID: PMC5669190 DOI: 10.1161/jaha.117.005948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The different geometric patterns of the left ventricle may or may not coexist with chamber dilatation. The prognostic impact of such a combination is unclear. METHODS AND RESULTS We studied a cohort of 2635 initially untreated patients with hypertension, mean age 50 years. At entry, 24-hour ambulatory blood pressure progressively increased across the patterns of normal geometry, concentric left ventricular (LV) remodeling, eccentric nondilated LV hypertrophy (LVH), eccentric dilated LVH, concentric nondilated LVH, and concentric dilated LVH. During a mean follow-up of 9.7 years, 360 patients developed a first major cardiovascular event at a rate (×100 patient-years) of 1.41. The event rate was 0.93 in the group with normal LV geometry, 1.10 in the group with LV concentric remodeling, 1.40 in the group with nondilated eccentric LVH, 2.10 in the group with eccentric dilated LVH, 2.34 in the group with nondilated concentric LVH, and 4.67 in the group with dilated concentric LVH (log-rank test: P<0.001). In a Cox model, after adjustment for several independent covariables (age, sex, diabetes mellitus, current smoking, total cholesterol, estimated glomerular filtration rate, and average 24-hour systolic blood pressure), concentric dilated LVH was associated with a 98% excess risk of cardiovascular events (P=0.0037). However, LV geometric pattern lost statistical significance when LV mass was entered into the model. CONCLUSIONS In initially untreated patients with hypertension, LV dilatation adds an adverse prognostic burden to the patterns of eccentric and concentric LVH. This phenomenon is explained by the greater LV mass associated with LV chamber dilatation.
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Affiliation(s)
| | - Fabio Angeli
- Cardiology and Cardiovascular Pathophysiology, Hospital and University of Perugia, Italy
| | | | | | | | - Adolfo Aita
- Department of Medicine, Hospital of Assisi, Italy
| | | | | | | | | | | | - Dario Turturiello
- Cardiology and Cardiovascular Pathophysiology, Hospital and University of Perugia, Italy
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Bonaccorsi G, Santomauro F, Donzellini M, Baldi P, Bartolini C, Lorini C. Health literacy among paid caregivers of elderly people: preliminary Resultsof a Tuscan study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw166.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Verdecchia P, Angeli F, Aita A, Bartolini C, Garofoli M, Reboldi G. [Blood pressure: the lower the better? Maybe yes]. G Ital Cardiol (Rome) 2016; 17:335-8. [PMID: 27310905 DOI: 10.1714/2252.24254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The SPRINT study tested the hypothesis that hypertensive patients randomized to a more intensive treatment, aimed at lowering systolic blood pressure (BP) below 120 mmHg have a lower incidence of major cardiovascular events when compared to patients randomized to a less intensive treatment (systolic BP reduction below 140 mmHg). Overall, 9361 patients were randomized to the more intensive (n=4678) or less intensive (n=4683) antihypertensive treatment. The study was prematurely interrupted because of an excess benefit in the more intensive arm. Indeed, the group randomized to the more intensive arm showed, when compared to the group randomized to the less intensive arm, a 25% reduction in the primary endpoint (1.65 vs 2.19% per year; p<0.001), a 43% reduction in cardiovascular death (0.25 vs 0.43%; p=0.005), a 27% reduction in all-cause death (1.03% vs 1.40%; p=0.003) and a 38% reduction in hospitalizations for heart failure (0.41 vs 0.67%; p<0.002). Unexpectedly, there was no significant reduction in the risk of stroke (not significant 11% reduction). The SPRINT study unequivocally shows that, in hypertensive patients with systolic BP ≥130 mmHg and no history of diabetes, previous stroke and polycystic renal disease, we should try to lower systolic BP to levels below 120 mmHg with the objective to lower the incidence of heart failure in addition to all-cause and cardiovascular death. Future guidelines on the management of patients with hypertension should implement the results of the SPRINT study.
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Affiliation(s)
| | - Fabio Angeli
- Dipartimento di Cardiologia, Ospedale Santa Maria della Misericordia, Perugia
| | - Adolfo Aita
- S.C. Medicina, Ospedale di Assisi, Assisi (PG)
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Abstract
Several patients with non-valvular atrial fibrillation treated with warfarin or other vitamin-K antagonists (VKA) might benefit from switching to an oral non vitamin-K antagonist anticoagulant (NOAC). In the absence of randomised comparative trials of switching to NOACs versus maintaining VKA treatment, several considerations argue in favour of a switching strategy. First, there is conclusive evidence that haemorrhagic strokes and intracranial bleedings are much fewer in number with NOACs than with warfarin. The risk of intracranial bleeding is 52 % lower with NOACS than with warfarin, with extremes ranging from 33 to 70 %. Such benefit is applicable to different NOACs, and independent of the time-in-therapeutic range under warfarin. Patients at increased risk for intra-cranial bleeding (renal dysfunction, or prior stroke or intra-cranial bleeding) should benefit most from switching to NOACs. Patients with labile International Normalized Ratio are also considered good candidates for switching because of their increased risk of stroke, and the lack of interactions between the effects of NOACs versus warfarin and the time-in-therapeutic range. Furthermore, some NOACs proved to be superior to warfarin in reducing the risk of thromboembolic complications even in intention-to-treat analyses. As further advantage, NOACs show fewer drug-drug and drug-food interactions when compared with warfarin. Last, but not least, NOACs do not need frequent blood drawings except in patients with moderate renal dysfunction, in whom periodic controls of serum creatinine are generally advised. The higher cost remains a barrier to a wider use of NOACs, especially in low-income settings.
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Affiliation(s)
- Paolo Verdecchia
- Struttura Complessa di Medicina, Ospedale di Assisi, Via Valentin Müller, 1, 06081, Assisi, Italy.
| | - Fabio Angeli
- Dipartimento di Cardiologia, Ospedale 'Santa Maria della Misericordia', Perugia, Italy
| | - Adolfo Aita
- Struttura Complessa di Medicina, Ospedale di Assisi, Via Valentin Müller, 1, 06081, Assisi, Italy
| | - Claudia Bartolini
- Struttura Complessa di Medicina, Ospedale di Assisi, Via Valentin Müller, 1, 06081, Assisi, Italy
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Angeli F, Reboldi G, Poltronieri C, Aita A, Bartolini C, Verdecchia P. Detrimental Effects of Hyperglycemia in Acute Coronary Syndromes: from Pathophysiological Mechanisms to Therapeutic Strategies. Mini Rev Med Chem 2015. [DOI: 10.2174/1389557515666150722111341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Angeli F, Reboldi G, Poltronieri C, Angeli E, De Filippo V, Crocetti A, Bartolini C, D'Ambrosio C, Verdecchia P. Efficacy and safety profile of aliskiren: practical implications for clinicians. Curr Drug Saf 2015; 9:106-17. [PMID: 24517108 DOI: 10.2174/1389450115666140211113040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/30/2014] [Accepted: 02/11/2014] [Indexed: 11/22/2022]
Abstract
Renin-angiotensin-system (RAS) is an enzymatic cascade that plays a pivotal role in the development of arterial hypertension, kidney disease and cardiovascular disease. Inhibition of the RAS with angiotensin converting enzyme (ACE) inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) has proved to be a successful strategy for the treatment of hypertension and related cardiovascular disorders. However, by reducing feedback inhibition of renin release, the effects of ACE-Is and ARBs lead to an increase in plasma renin concentration (PRC) and activity (PRA), limiting a complete inhibition of the RAS. Consequently the effects of a different pharmacological strategy that completely blocks the RAS upstream has been assessed in the last years. In this context, aliskiren is the first representative of a new class of non-peptide orally active renin inhibitor that blocks the RAS at its rate-limiting step and induces a net reduction in PRA, angiotensin II and aldosterone levels. Aliskiren effectively reduces blood pressure as a monotherapy as well in combination therapy. In addition, aliskiren has a placebo-like tolerability profile at the licensed doses of 150 mg and 300 mg. Aliskiren also exhibits additive effects on blood pressure reduction when combined with drugs that lead to a reactive increase in the PRA, such as diuretics, ACE-Is or ARBs. In previous studies, aliskiren showed beneficial effects in patients with arterial hypertension and associated clinical conditions. However, later trials indicated that the use of aliskiren should be avoided in patients with renal failure or receiving ACE-Is or ARBs. The main aim of this review is to summarize the available data on its efficacy and safety profile, highlighting clinical implications from recent trials.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Paolo Verdecchia
- Division of Cardiology and Cardiovascular Pathophysiology, University Hospital "S.M. della Misericordia", Perugia, Italy.
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Angeli F, Reboldi G, Poltronieri C, Lazzari L, Sordi M, Garofoli M, Bartolini C, Verdecchia P. Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications. Ther Adv Cardiovasc Dis 2015; 9:412-24. [PMID: 26194489 DOI: 10.1177/1753944715594528] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Hyperglycemia is a frequent condition in patients with acute coronary syndromes (ACS). Hyperglycemia during ACS is caused by an inflammatory and adrenergic response to ischemic stress, when catecholamines are released and glycogenolysis induced. Although the involved pathophysiological mechanisms have not yet been fully elucidated, it is believed that hyperglycemia is associated with an increase in free fat acids (which induce cardiac arrhythmias), insulin resistance, chemical inactivation of nitric oxide and the production of oxygen reactive species (with consequent microvascular and endothelial dysfunction), a prothrombotic state, and vascular inflammation. It is also related to myocardial metabolic disorders, leading to thrombosis, extension of the damaged area, reduced collateral circulation, and ischemic preconditioning. In the last few years, several observational studies demonstrated that hyperglycemia in ACS is a powerful predictor of survival, increasing the risk of immediate and long-term complications in patients both with and without previously known diabetes mellitus. Glucose management strategies in ACS may improve outcomes in patients with hyperglycemia, perhaps by reducing inflammatory and clotting mediators, by improving endothelial function and fibrinolysis and by reducing infarct size. Recent clinical trials of insulin in ACS have resulted in varying levels of benefit, but the clinical benefit of an aggressive treatment with insulin is yet unproved.
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Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology, Hospital S.M. della Misericordia, Perugia, Italy
| | - Gianpaolo Reboldi
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | | | - Ludovico Lazzari
- Department of Cardiology, University Hospital of Terni, Terni, Italy
| | - Martina Sordi
- Department of Cardiology, University Hospital of Terni, Terni, Italy
| | - Marta Garofoli
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
| | | | - Paolo Verdecchia
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
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Verdecchia P, Molini G, Bartolini C, Filippo V, Valecchi F, Martone S, Aita A, Giacomo L, Angeli F, Reboldi G. Safety of Dabigatran in an Elderly Population: Single Center Experience in Italy. Curr Drug Saf 2015; 10:165-9. [DOI: 10.2174/1574886309666141111102344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/02/2014] [Accepted: 11/05/2014] [Indexed: 11/22/2022]
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Verdecchia P, Angeli F, Bartolini C, De Filippo V, Aita A, Di Giacomo L, Poltronieri C, Lip GYH, Reboldi G. Safety and efficacy of non-vitamin K oral anticoagulants in non-valvular atrial fibrillation: a Bayesian meta-analysis approach. Expert Opin Drug Saf 2014; 14:7-20. [PMID: 25311731 DOI: 10.1517/14740338.2014.971009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Choosing between different non-vitamin K antagonist oral anticoagulants (NOACs) in non-valvular atrial fibrillation (NVAF) is difficult due to the absence of head to head comparative studies. We performed a Bayesian meta-analysis to explore similarities and differences between different NOACs and to rank treatments overall for safety and efficacy outcomes. AREAS COVERED Through a systematic literature search we identified randomized controlled Phase III trials of dabigatran, rivaroxaban, apixaban, and edoxaban versus adjusted-dose warfarin in patients with NVAF. EXPERT OPINION Warfarin ranked worst for all-cause mortality and intracranial bleedings and had a nil probability of ranking first for any outcome. The risk of major bleeding versus warfarin was lower with apixaban, dabigatran 110 mg, and both doses of edoxaban. All agents reduced the risk of intracranial bleeding versus warfarin. Edoxaban 30 mg was the best among the treatments being compared for major and gastrointestinal bleeding. Dabigatran 150 mg was the best for stroke and systemic embolism. This study suggests that NOACs are generally preferable to warfarin in patients with NVAF. However, safety and efficacy differences do exist among NOACs, which might drive their use in specific subsets of AF patients, allowing prescribers to tailor treatment to distinct patient profiles.
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Affiliation(s)
- Paolo Verdecchia
- Hospital of Assisi, Department of Medicine , Via Valentin Müller 1, 06081 Assisi , Italy +075 8139301 ;
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Angeli F, Verdecchia P, Poltronieri C, Bartolini C, de Filippo V, D'Ambrosio C, Reboldi G. Ambulatory blood pressure monitoring in the elderly: features and perspectives. Nutr Metab Cardiovasc Dis 2014; 24:1052-1056. [PMID: 24932538 DOI: 10.1016/j.numecd.2014.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/30/2014] [Accepted: 04/07/2014] [Indexed: 11/22/2022]
Abstract
Aging leads to a multitude of changes in the cardiovascular system that include a rise in blood pressure. Age-related changes in blood pressure are mainly attributable to an increase in systolic blood pressure, generally associated with a slight decrease diastolic blood pressure. This leads to a widening in pulse pressure. Ambulatory blood pressure monitoring is a useful tool to understand these processes and to refine cardiovascular risk assessment. In the light of emerging data in this area, we reviewed the main features of ambulatory blood pressure in elderly and discussed the evidence showing that ambulatory blood pressure is superior to clinic blood pressure to reflect the true pattern of blood pressure over time. Furthermore, we discussed the role of weight control obtained by fitness programs to prevent an excessive rise in blood pressure with age. A thorough understanding of these concepts is of paramount importance and has therapeutic implications in the growing population of elderly subjects with increased blood pressure.
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Affiliation(s)
- F Angeli
- Division of Cardiology and Cardiovascular Pathophysiology, University Hospital of Perugia, Perugia, Italy.
| | - P Verdecchia
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
| | - C Poltronieri
- Division of Cardiology and Cardiovascular Pathophysiology, University Hospital of Perugia, Perugia, Italy
| | - C Bartolini
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
| | - V de Filippo
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
| | - C D'Ambrosio
- Department of Internal Medicine, Hospital of Città della Pieve, Italy
| | - G Reboldi
- Department of Internal Medicine, University of Perugia, Italy
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Murdolo G, Angeli F, Reboldi G, Di Giacomo L, Aita A, Bartolini C, Vedecchia P. Left Ventricular Hypertrophy and Obesity: Only a Matter of Fat? High Blood Press Cardiovasc Prev 2014; 22:29-41. [DOI: 10.1007/s40292-014-0068-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/04/2014] [Indexed: 12/11/2022] Open
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Angeli F, Reboldi G, Poltronieri C, Bartolini C, D'Ambrosio C, de Filippo V, Verdecchia P. Clinical utility of ambulatory blood pressure monitoring in the management of hypertension. Expert Rev Cardiovasc Ther 2014; 12:623-34. [PMID: 24678697 DOI: 10.1586/14779072.2014.903155] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Accurate blood pressure (BP) measurement is essential for the diagnosis, monitoring and management of hypertension. However, conventional office-based BP readings have several limitations that include a low reproducibility, the white-coat effect and the existence of masked hypertension. These limitations can be addressed through the use of ambulatory BP monitoring. Because ambulatory monitoring provides measurements at specific time intervals throughout a 24-hour period, this technique represents a better picture of the normal fluctuations in BP levels associated with daily activities and sleep. In addition, end-organ damage associated with hypertension is more closely related to ambulatory BP than office BP measurements and ambulatory BP profile give better prediction of clinical outcome than conventional BP measurements.
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Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology, University Hospital "S.M. della Misericordia", Perugia, Italy
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Petruzzelli A, Amagliani G, Foglini M, Bartolini C, Agnetti F, Magistrali C, Omiccioli E, Brandi G, Tonucci F. IDENTIFICATION OF E. COLI O157 IN A BOVINE MILK FARM BY MULTIPLEX REAL-TIME PCR. Ital J Food Saf 2012. [DOI: 10.4081/ijfs.2012.4.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Greco G, Rosa R, Beskin G, Karpov S, Romano L, Guarnieri A, Bartolini C, Bedogni R. Evidence of deterministic components in the apparent randomness of GRBs: clues of a chaotic dynamic. Sci Rep 2012; 1:91. [PMID: 22355609 PMCID: PMC3216577 DOI: 10.1038/srep00091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/01/2011] [Indexed: 11/13/2022] Open
Abstract
Prompt γ-ray emissions from gamma-ray bursts (GRBs) exhibit a vast range of extremely complex temporal structures with a typical variability time-scale significantly short – as fast as milliseconds. This work aims to investigate the apparent randomness of the GRB time profiles making extensive use of nonlinear techniques combining the advanced spectral method of the Singular Spectrum Analysis (SSA) with the classical tools provided by the Chaos Theory. Despite their morphological complexity, we detect evidence of a non stochastic short-term variability during the overall burst duration – seemingly consistent with a chaotic behavior. The phase space portrait of such variability shows the existence of a well-defined strange attractor underlying the erratic prompt emission structures. This scenario can shed new light on the ultra-relativistic processes believed to take place in GRB explosions and usually associated with the birth of a fast-spinning magnetar or accretion of matter onto a newly formed black hole.
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Affiliation(s)
- G Greco
- INAF-Astronomical Observatory of Bologna, Italy.
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Graef C, Hauber S, Bartolini C, Lévy F, Waller C. Demandes de groupages sanguins en excès aux hôpitaux universitaires de Strasbourg. Transfus Clin Biol 2010. [DOI: 10.1016/j.tracli.2010.09.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Graef C, Hauber S, Bartolini C, Lévy F, Waller C. À propos d’une erreur d’attribution de produits sanguins labiles aux hôpitaux universitaires de Strasbourg. Transfus Clin Biol 2010. [DOI: 10.1016/j.tracli.2010.09.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Graef C, Hauber S, Bartolini C, Lévy F, Waller C. Quand le contrôle ultime au lit du malade devient un élément perturbateur pré-transfusionnel aux hôpitaux universitaires de Strasbourg. Transfus Clin Biol 2010. [DOI: 10.1016/j.tracli.2010.09.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Exaggerated pressor responses to mental stress in patients with coronary artery disease (CAD) are associated with increased risk for subsequent cardiovascular events. The integrated baroreflex gain and its mechanical and neural component were estimated and then related to the blood pressure and heart rate responses to simulated real-life stressors: mental arithmetic and public speaking. Eighteen healthy individuals (aged 61 +/- 8 yr) and 29 individuals with documented CAD but no other comorbidities (aged 59 +/- 8 yr) were studied. Heart rate and blood pressures were continuously assessed before, during preparation for, and during performance of a math task and a speech task. The assessment of beat-to-beat carotid diameters during baroreflex engagement was used to estimate the integrated baroreflex gain and its mechanical and neural component. The CAD subjects demonstrated significantly greater increases in heart rate and blood pressures for the performance of the speech task. However, there were no group differences in integrated cardiovagal baroreflex gain or either mechanical or neural baroreflex component. These findings indicate that the augmented pressor responses in CAD do not result from a generalized arterial baroreflex deficit.
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Affiliation(s)
- Gaelle Deley
- Dept. of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02114, USA
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Racusin JL, Karpov SV, Sokolowski M, Granot J, Wu XF, Pal’shin V, Covino S, van der Horst AJ, Oates SR, Schady P, Smith RJ, Cummings J, Starling RLC, Piotrowski LW, Zhang B, Evans PA, Holland ST, Malek K, Page MT, Vetere L, Margutti R, Guidorzi C, Kamble AP, Curran PA, Beardmore A, Kouveliotou C, Mankiewicz L, Melandri A, O’Brien PT, Page KL, Piran T, Tanvir NR, Wrochna G, Aptekar RL, Barthelmy S, Bartolini C, Beskin GM, Bondar S, Bremer M, Campana S, Castro-Tirado A, Cucchiara A, Cwiok M, D’Avanzo P, D’Elia V, Valle MD, de Ugarte Postigo A, Dominik W, Falcone A, Fiore F, Fox DB, Frederiks DD, Fruchter AS, Fugazza D, Garrett MA, Gehrels N, Golenetskii S, Gomboc A, Gorosabel J, Greco G, Guarnieri A, Immler S, Jelinek M, Kasprowicz G, La Parola V, Levan AJ, Mangano V, Mazets EP, Molinari E, Moretti A, Nawrocki K, Oleynik PP, Osborne JP, Pagani C, Pandey SB, Paragi Z, Perri M, Piccioni A, Ramirez-Ruiz E, Roming PWA, Steele IA, Strom RG, Testa V, Tosti G, Ulanov MV, Wiersema K, Wijers RAMJ, Winters JM, Zarnecki AF, Zerbi F, Mészáros P, Chincarini G, Burrows DN. Broadband observations of the naked-eye γ-ray burst GRB 080319B. Nature 2008; 455:183-8. [DOI: 10.1038/nature07270] [Citation(s) in RCA: 376] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 07/11/2008] [Indexed: 11/09/2022]
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Bentivoglio M, Bergamini E, Fabbri M, Andreoli C, Bartolini C, Cosmi D, Capasso V, Bottini P, Ambrosio G. [Obstructive sleep apnea syndrome and cardiovascular diseases]. G Ital Cardiol (Rome) 2008; 9:472-481. [PMID: 18678213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Obstructive sleep apnea (OSA) syndrome is one of the most common respiratory disorders in humans. There is emerging evidence linking OSA to vascular disease, particularly hypertension. The underlying pathophysiological mechanisms that link OSA to cardiovascular diseases such as hypertension, congestive heart failure and atrial fibrillation are not entirely understood, although they certainly include mechanical events, increased sympathetic activity and oxidative stress. This review will examine the evidence and mechanisms linking OSA syndrome to cardiovascular disease.
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Affiliation(s)
- Maurizio Bentivoglio
- Cardiologia e Fisiopatologia Cardiovascolare, Università e Azienda Ospedaliera di Perugia
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