Improved Outcomes With High-dose Isoniazid in Multidrug-resistant Tuberculosis Treatment in Haiti

We report outcomes for a cohort of patients with multidrug-resistant tuberculosis who received high-dose isoniazid in Haiti. Patients who received high-dose isoniazid had a faster time to culture conversion and higher odds of successful outcome, despite high-level isoniazid resistance. This suggests high-dose isoniazid may have effectiveness even with phenotypic resistance.

Can social media data lead to earlier detection of drug-related adverse events?

Purpose

To compare the patient characteristics and the inter‐temporal reporting patterns of adverse events (AEs) for atorvastatin (Lipitor^®) and sibutramine (Meridia^®) in social media (AskaPatient.com) versus the FDA Adverse Event Reporting System (FAERS).

Methods

We identified clinically important AEs associated with atorvastatin (muscle pain) and sibutramine (cardiovascular AEs), compared their patterns in social media postings versus FAERS and used Granger causality tests to assess whether social media postings were useful in forecasting FAERS reports.

Results

We analyzed 998 and 270 social media postings between 2001 and 2014, 69 003 and 7383 FAERS reports between 1997 and 2014 for atorvastatin and sibutramine, respectively. Social media reporters were younger (atorvastatin: 53.9 vs. 64.0 years, p < 0.001; sibutramine: 36.8 vs. 43.8 years, p < 0.001). Social media reviews contained fewer serious AEs (atorvastatin, pain: 2.5% vs. 38.2%; sibutramine, cardiovascular issues: 7.9% vs. 63.0%; p < 0.001 for both) and concentrated on fewer types of AEs (proportion comprising the top 20 AEs: atorvastatin, 88.7% vs. 55.4%; sibutramine, 86.3% vs. 65.4%) compared with FAERS. While social media sibutramine reviews mentioning cardiac issues helped predict those in FAERS 11 months later (p < 0.001), social media atorvastatin reviews did not help predict FAERS reports.

Conclusions

Social media AE reporters were younger and focused on less‐serious and fewer types of AEs than FAERS reporters. The potential for social media to provide earlier indications of AEs compared with FAERS is uncertain. Our findings highlight some of the promises and limitations of online social media versus conventional pharmacovigilance sources and the need for careful interpretation of the results. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

A Second Look at the Association between Gender and Mortality on Antiretroviral Therapy

Objective

We assessed the association between gender and mortality on antiretroviral therapy (ART) using identical models with and without sex-specific categories for weight and hemoglobin.

Design

Cohort study of adult patients on ART.

Setting

GHESKIO Clinic in Port-au-Prince, Haiti.

Participants

4,717 ART-naïve adult patients consecutively enrolled on ART at GHESKIO from 2003 to 2008.

Main Outcome Measure

Mortality on ART; multivariable analyses were conducted with and without sex-specific categories for weight and hemoglobin.

Results

In Haiti, male gender was associated with mortality (OR 1.61; 95% CI: 1.30–2.00) in multivariable analyses with hemoglobin and weight included as control variables, but not when sex-specific interactions with hemoglobin and weight were used.

Conclusions

If sex-specific categories are omitted, multivariable analyses indicate a higher risk of mortality for males vs. females of the same weight and hemoglobin. However, because males have higher normal values for weight and hemoglobin, the males in this comparison would generally have poorer health status than the females. This may explain why gender differences in mortality are sometimes observed after controlling for differences in baseline variables when gender-specific interactions with weight and hemoglobin are omitted.

Gap Between Evidence and Patient Access: Policy Implications for Bariatric and Metabolic Surgery in the Treatment of Obesity and its Complications

Despite consistently supportive evidence of clinical effectiveness and economic advantages compared with currently available non-surgical obesity treatments, patient access to bariatric and metabolic surgery (BMS) is impeded. To address this gap and better understand the relationship between value and access, the objectives of this study were twofold: (i) identify the multidimensional barriers to adoption of BMS created by clinical guidelines, public policies, and health technology assessments; and, most importantly, (ii) develop recommendations for stakeholders to improve patient access to BMS. Updated public policies focused on treatment and clinical guidelines that reflect the demonstrated advantages of BMS, patient education on safety and effectiveness, updated reimbursement policies, and additional data on long-term BMS effectiveness are needed to improve patient access.

Medical costs associated with imatinib (IM) non-compliance in chronic myeloid leukemia (CML) patients (pts)

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Background: Not adhering to treatment (tx) may lead to suboptimal outcomes. This study examined associations between medical costs and IM compliance in CML pts. Methods: CML pts under age 65 were identified with ICD-9 diagnosis code (205.1X) using MarketScan Commercial Claims data between 1/1/02–12/31/05. Pts were required to be continuously enrolled in the 4 months prior to (baseline) and the 6 months following (study period) IM initiation. CML severity was categorized into 3 groups by diagnosis of CML and related comorbidities. Compliance was defined by medication possession ratio (MPR=total days of IM supply in the study period divided by 180), and stratified into 3 groups (low: <65%, medium: 65–95%, high: 95–100%). Tx interruption was defined as tx gap of 30 or more consecutive days in the study period. Costs for inpatient (IP), ER, outpatient (OP) services and OP drugs during the study period were adjusted to 2005 dollars. Costs, the number of IP admissions and hospital days were compared across different levels of tx compliance using Wilcoxon tests. A generalized linear model (GLM) was also used to compare costs controlling for age, sex, CML severity, Charlson comorbidity index, year of IM start, etc. Results: The study sample consisted of 404 pts. Compared to the high MPR group, pts in the low MPR group incurred 1.6 times the average total health care costs (p <.001), 5.9 times the IP costs (p<.001), 2.6 times the OP costs (p=.722), 2.1 times the non-IM drug costs (p<.001), and 0.39 times the IM drug costs (p<.001). Compared to the high MPR pts, low MPR pts had on average 3.8 times the IP admissions (p<.001), and 7.3 times the IP days (p<.001). Comparing costs of pts interrupting tx versus those who did not showed similar trends. GLM regression showed that 6-month total health care costs per patient in the low MPR group were 1.4 times (p<.01) those of the high MPR group. Pts who had tx interruption had 1.3 times the total health care costs (p<.01) compared to those who did not. Conclusions: This study shows that better IM compliance was associated with significantly lower health care costs in CML pts, especially for IP costs. Further analyses will be conducted to confirm whether lower compliance leads to more hospitalizations.

No significant financial relationships to disclose.

The value of antihypertensive drugs: a perspective on medical innovation

Using national survey data and risk equations from the Framingham Heart Study, we quantify the impact of antihypertensive therapy changes on blood pressures and the number and cost of heart attacks, strokes, and deaths. Antihypertensive therapy has had a major impact on health. Without it, 1999-2000 average blood pressures (at age 40+) would have been 10-13 percent higher, and 86,000 excess premature deaths from cardiovascular disease would have occurred in 2001. Treatment has generated a benefit-to-cost ratio of at least 6:1, but much more can be achieved. More effective use of antihypertensive medication would have an impact on mortality akin to eliminating all deaths from medical errors or accidents.

Dose conversion and cost effectiveness of erythropoietic therapies in chemotherapy-related anemia: a Canadian application

OBJECTIVE

To determine the dose-conversion ratio (DCR) between epoetin alfa and darb-epoetin alfa in cancer patients and compare the treatment costs of both agents at the estimated DCRs.

METHODS

A comprehensive search of the literature was carried out on clinical trials evaluating patients with chemotherapy-related anemia treated with epoetin alfa or darbepoetin alfa. A multivariate meta-analysis regression was conducted to determine the relative doses of these two agents at which they were equally effective. The effectiveness measure used was the area under the hemoglobin change curve. Using the estimated DCR for each dosing regimen, the relative cost of epoetin alfa and darbepoetin alfa treatments in Canada was evaluated.

RESULTS

Twenty-nine study arms, evaluating 12,923 patients (10,582 treated with epoetin alfa and 2341 treated with darbepoetin alfa), were eligible for this study. Results comparing specific dosing regimens indicated that the DCRs were systematically lower than 200:1. The cost premium associated with darbepoetin alfa weekly drug cost was between 37 and 44% above epoetin alfa for the same level of effectiveness.

CONCLUSION

Based on the evidence from this meta-analysis, epoetin alfa appeared to be more cost-effective compared to darbepoetin alfa in Canada for cancer patients.

Relationship Between Hemoglobin Levels and Quality of Life During Radiation Therapy Plus Concomitant or Sequential Chemotherapy in Patients With Cancer and Anemia Treated With Epoetin Alfa

This study in patients with cancer and anemia, who were receiving chemoradiation and were treated with epoetin alfa, examined the relationship between hemoglobin level and quality of life (QOL), change in hemoglobin and change in QOL, and incremental (1 g/dL) increase in hemoglobin and related incremental improvement in QOL. Data from a multicenter, open-label, prospective study of once-weekly epoetin alfa therapy in anemic cancer patients receiving chemoradiation were used to retrospectively evaluate the relationship between hemoglobin changes and QOL changes via correlation and longitudinal analyses. A sample selection correction method was used to ensure unbiased results. QOL (energy, activity, overall QOL) was measured using the Linear Analog Scale Assessment. An incremental analysis determined the greatest incremental increase in QOL associated with a 1 g/dL increase in hemoglobin level. Of the 777 patients enrolled, 464 met chemotherapy and radiotherapy eligibility criteria. Of these, 359 (77%) underwent two QOL assessments and were eligible for analysis. A nonlinear and statistically significant positive correlation was found between hemoglobin levels and Linear Analog Scale Assessment QOL scores (r = 0.32 [energy], 0.33 [activity], and 0.29 [overall QOL]; P < .0001). An incremental analysis used regression methods to characterize the changes in hemoglobin levels and QOL scores. Hemoglobin change was found to be a statistically significant determinant of QOL changes (P < .05). The greatest incremental QOL gain associated with a 1-g/dL change in hemoglobin occurred around hemoglobin 12 g/dL (range, 11–13 g/dL). A direct relationship exists between hemoglobin increases and corresponding QOL increases. Maximal incremental gain in QOL occurred when hemoglobin was approximately 12 g/dL (range, 11–13 g/dL).