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Suruki RY, Desai RJ, Davis KJ, Berlin JA, Gagne JJ. OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:e236-e237. [PMID: 35333307 PMCID: PMC9348766 DOI: 10.1093/rheumatology/keac157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert Y Suruki
- Correspondence to: Robert Suruki, Department of Global Epidemiology, Janssen Pharmaceutical Companies of Johnson and Johnson, 1400 McKean Rd, Spring House, PA 19477, USA. E-mail:
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
| | - Kourtney J Davis
- Department of Global Epidemiology, Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, NJ
| | - Jesse A Berlin
- Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Bala Cynwyd, PA
| | - Joshua J Gagne
- Global Epidemiology, Johnson and Johnson, Cambridge
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Engelkes M, de Ridder MA, Svensson E, Berencsi K, Prieto-Alhambra D, Lapi F, Giaquinto C, Picelli G, Boudiaf N, Albers FC, Cockle SM, Bradford ES, Suruki RY, Brusselle GG, Rijnbeek PR, Sturkenboom MC, Verhamme KM. Multinational cohort study of mortality in patients with asthma and severe asthma. Respir Med 2020; 165:105919. [PMID: 32174450 DOI: 10.1016/j.rmed.2020.105919] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma. METHODS Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma. RESULTS The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality. CONCLUSION All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.
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Affiliation(s)
| | | | | | | | - Daniel Prieto-Alhambra
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain; Musculoskeletal Pharmaco and Device Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | | | | | | | - Nada Boudiaf
- Research and Development, GlaxoSmithKline, Middlesex, UK
| | - Frank C Albers
- Global Respiratory Franchise, GlaxoSmithKline, Research Triangle Park, NC, United States
| | - Sarah M Cockle
- Research and Development, GlaxoSmithKline, Brentford, UK
| | - Eric S Bradford
- Research and Development, GlaxoSmithKline, Research Triangle Park, NC, United States
| | | | - Guy Go Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, ErasmusMC, Rotterdam, the Netherlands
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Sloan VS, Sheahan A, Stark JL, Suruki RY. Opioid Use in Patients with Ankylosing Spondylitis Is Common in the United States: Outcomes of a Retrospective Cohort Study. J Rheumatol 2019; 46:1450-1457. [PMID: 30647189 DOI: 10.3899/jrheum.180972] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the prevalence of chronic opioid use in patients with ankylosing spondylitis (AS), and to compare the characteristics of patients with and without chronic opioid use. METHODS This was a retrospective cohort study of patients with AS identified in the Truven Health MarketScan Research database between January 1, 2012, and March 31, 2017. Commercial and Medicaid claims data were examined using both specific (720.0 and M45.x) and broader (720.x and M45.x) International Classification of Diseases (ICD) coding definitions. Patients were aged ≥ 18 years on the date of first qualifying ICD code occurrence (the index date). Demographics and clinical characteristics were assessed in the 12-month period preceding the index date. The 12-month followup period was used to assess prevalence and characteristics of chronic opioid use. RESULTS Chronic opioid use was common among patients with commercial claims (23.5% of ICD 720.0 patients; 27.3% of ICD 720.x patients), and especially those with Medicaid claims (57.1% and 76.7%, respectively). The proportion of patients with claims for anti-tumor necrosis factor therapies during followup was often low, and for Medicaid patients was lower among those with chronic opioid use (29.6% of ICD 720.0 patients; 2.3% of ICD 720.x patients) than those without (47.1% and 7.1%, respectively). Among chronic opioid users in all cohorts, the cumulative supply of opioids was typically high (≥ 270 days in the followup period); most opioids prescribed were Schedule II. CONCLUSION Patients with AS receive opioids with disturbing frequency. The infrequent prescription of recommended therapies to these patients reflects a need to optimize treatment further through education of patients and healthcare professionals alike.
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Affiliation(s)
- Victor S Sloan
- From UCB Pharma, Raleigh, North Carolina; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; UCB Pharma, Smyrna, Georgia, USA. .,V.S. Sloan, MD, FACP, FACR, Vice President and Development Strategy Lead (Immunology), UCB Pharma, Raleigh, and Clinical Associate Professor of Medicine, Rutgers-Robert Wood Johnson Medical School; A. Sheahan, PhD, Real World Evidence Lead Scientist (Immunology), UCB Pharma, Raleigh; J.L. Stark, MD, Head of Medical Affairs (Rheumatology), UCB Pharma, Smyrna; R.Y. Suruki, ScD, Real World Evidence Strategy Lead (Immunology), UCB Pharma, Raleigh.
| | - Anna Sheahan
- From UCB Pharma, Raleigh, North Carolina; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; UCB Pharma, Smyrna, Georgia, USA.,V.S. Sloan, MD, FACP, FACR, Vice President and Development Strategy Lead (Immunology), UCB Pharma, Raleigh, and Clinical Associate Professor of Medicine, Rutgers-Robert Wood Johnson Medical School; A. Sheahan, PhD, Real World Evidence Lead Scientist (Immunology), UCB Pharma, Raleigh; J.L. Stark, MD, Head of Medical Affairs (Rheumatology), UCB Pharma, Smyrna; R.Y. Suruki, ScD, Real World Evidence Strategy Lead (Immunology), UCB Pharma, Raleigh
| | - Jeffrey L Stark
- From UCB Pharma, Raleigh, North Carolina; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; UCB Pharma, Smyrna, Georgia, USA.,V.S. Sloan, MD, FACP, FACR, Vice President and Development Strategy Lead (Immunology), UCB Pharma, Raleigh, and Clinical Associate Professor of Medicine, Rutgers-Robert Wood Johnson Medical School; A. Sheahan, PhD, Real World Evidence Lead Scientist (Immunology), UCB Pharma, Raleigh; J.L. Stark, MD, Head of Medical Affairs (Rheumatology), UCB Pharma, Smyrna; R.Y. Suruki, ScD, Real World Evidence Strategy Lead (Immunology), UCB Pharma, Raleigh
| | - Robert Y Suruki
- From UCB Pharma, Raleigh, North Carolina; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; UCB Pharma, Smyrna, Georgia, USA.,V.S. Sloan, MD, FACP, FACR, Vice President and Development Strategy Lead (Immunology), UCB Pharma, Raleigh, and Clinical Associate Professor of Medicine, Rutgers-Robert Wood Johnson Medical School; A. Sheahan, PhD, Real World Evidence Lead Scientist (Immunology), UCB Pharma, Raleigh; J.L. Stark, MD, Head of Medical Affairs (Rheumatology), UCB Pharma, Smyrna; R.Y. Suruki, ScD, Real World Evidence Strategy Lead (Immunology), UCB Pharma, Raleigh
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Albers FC, Müllerová H, Gunsoy NB, Shin JY, Nelsen LM, Bradford ES, Cockle SM, Suruki RY. Biologic treatment eligibility for real-world patients with severe asthma: The IDEAL study. J Asthma 2017. [PMID: 28622052 DOI: 10.1080/02770903.2017.1322611] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Severe asthma comprises several distinct phenotypes. Consequently, patients with severe asthma can be eligible for more than one biologic treatment targeting Th2 inflammation, such as anti-interleukin (IL)-5 and anti-immunoglobulin (Ig) E. The objective of this study was to describe treatment eligibility and overlap in treatment eligibility for mepolizumab (anti-IL-5), omalizumab (anti-IgE) and reslizumab (anti-IL-5) in patients with severe asthma, who were recruited from clinical practice. METHODS This cross-sectional, single-visit, observational study in six countries enrolled patients with severe asthma (defined by American Thoracic Society/European Respiratory Society guidelines). Assessable patients were analysed as a total cohort and a sub-cohort, who were not currently receiving omalizumab. Treatment eligibility was defined according to the local prescribing information or protocol-defined inclusion/exclusion criteria. Patients currently receiving omalizumab were automatically categorised as omalizumab-eligible. RESULTS The total cohort comprised 670 patients who met the analysis criteria, of whom 20% were eligible for mepolizumab, 31-41% were eligible for omalizumab (depending on eligibility criteria used), and 5% were eligible for reslizumab. In patients not currently receiving omalizumab (n = 502), proportions eligible for each biologic were similar (mepolizumab: 20%, reslizumab 6%) or lower (omalizumab 7-21%) than those for the total cohort. Overlap in treatment eligibility varied; in mepolizumab-eligible patients not currently receiving omalizumab (n = 101), 27-37% were omalizumab-eligible and 18% were reslizumab-eligible. CONCLUSIONS Treatment eligibility for mepolizumab and omalizumab was higher than that for reslizumab. Although there was some overlap in treatment eligibility, the patient groups eligible for treatment with anti-IL-5 or anti-IgE therapies were often distinct, emphasising the different phenotypes and endotypes in severe asthma.
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Affiliation(s)
- Frank C Albers
- a Respiratory Medical Franchise, GSK , Research Triangle Park , NC , USA
| | - Hana Müllerová
- b Real World Evidence, GSK , Stockley Park, Uxbridge , Middlesex , UK
| | - Necdet B Gunsoy
- c Clinical Statistics, GSK , Stockley Park, Uxbridge , Middlesex , UK
| | | | - Linda M Nelsen
- e Value Evidence and Outcomes, GSK , Collegeville , PA , USA
| | - Eric S Bradford
- a Respiratory Medical Franchise, GSK , Research Triangle Park , NC , USA
| | - Sarah M Cockle
- f Value Evidence and Outcomes, GSK House , Brentford , Middlesex , UK
| | - Robert Y Suruki
- g Worldwide Epidemiology, GSK , Research Triangle Park , NC , USA.,h Department of Epidemiology, UCB Biosciences , Research Triangle Park , NC , USA
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Suruki RY, Daugherty JB, Boudiaf N, Albers FC. The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA. BMC Pulm Med 2017; 17:74. [PMID: 28449686 PMCID: PMC5406966 DOI: 10.1186/s12890-017-0409-3] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 04/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma exacerbations are frequent in patients with severe disease. This report describes results from two retrospective cohort studies describing exacerbation frequency and risk, emergency department (ED)/hospital re-admissions, and asthma-related costs by asthma severity in the US and UK. METHODS Patients with asthma in the US-based Clinformatics™ DataMart Multiplan IMPACT (2010-2011; WEUSKOP7048) and the UK-based Clinical Practice Research Datalink (2009-2011; WEUSKOP7092) databases were categorized by disease severity (Global Initiative for Asthma [GINA]; Step and exacerbation history) during the 12 months pre-asthma medical code (index date). Outcomes included: frequency of exacerbations (asthma-related ED visit, hospitalization, or oral corticosteroid use with an asthma medical code recorded within ±2 weeks) 12 months post-index, asthma-related ED visits/hospitalization, and asthma-related costs 30 days post-index. Risk of a subsequent exacerbation was determined by proportional hazard model. RESULTS Of the 222,817 and 211,807 patients with asthma included from the US and UK databases, respectively, 12.5 and 8.4% experienced ≥1 exacerbation during the follow-up period. Exacerbation frequency increased with disease severity. Among the 5,167 and 2,904 patients with an asthma-related ED visit/hospitalization in the US and UK databases, respectively, 9.2 and 4.7% had asthma-related re-admissions within 30 days. Asthma-related re-admission rates and costs increased with disease severity, approximately doubling between GINA Step 1 and 5 and in patients with ≥2 versus <2 exacerbations in the previous year. Risk of a subsequent exacerbation increased 32-35% for an exacerbation requiring ED visit/hospitalization versus oral corticosteroids. CONCLUSION Increased disease severity was associated with higher exacerbation frequency, ED/hospitalization re-admission, costs and risk of subsequent exacerbation, indicating that these patients require high-intensity post-exacerbation management.
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Affiliation(s)
- Robert Y Suruki
- Worldwide Epidemiology, GSK, Research Triangle Park, Durham, NC, USA.,Present Address: UCB Biosciences, Epidemiology, Research Triangle Park, Durham, NC, USA
| | - Jonas B Daugherty
- Value Outcomes and Epidemiology, PAREXEL International, Research Triangle Park, Durham, NC, USA.,Present Address: Department of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Nada Boudiaf
- Worldwide Epidemiology, GSK, Stockley Park, Uxbridge, UK.,Present Address: Chiltern International Ltd, Slough, Berkshire, UK
| | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, 5 Moore Drive, PO Box 13398, Durham, NC, 27709, USA.
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Zeiger RS, Schatz M, Dalal AA, Chen W, Sadikova E, Suruki RY, Kawatkar AA, Qian L. Blood Eosinophil Count and Outcomes in Severe Uncontrolled Asthma: A Prospective Study. J Allergy Clin Immunol Pract 2016; 5:144-153.e8. [PMID: 27665383 DOI: 10.1016/j.jaip.2016.07.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Severe uncontrolled asthma (SUA) is associated with increased asthma exacerbations. Whether high blood eosinophil counts are related to this burden is uncertain. OBJECTIVES To determine the relationship of blood eosinophil counts to asthma exacerbations, utilization, and cost in patients with SUA. METHODS Patients with persistent asthma (age ≥ 12 years) were identified administratively with SUA in phase I by evidencing (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Of the 541 patients with SUA invited to participate in the prospective phase II follow-up study, 261 (48.2%) had blood tests (index date) to determine eosinophil count and other atopic biomarkers. The relationship of blood eosinophil cutoff points to asthma exacerbations and direct costs 1 year after the index date were determined by multivariable regression. RESULTS A blood eosinophil cutoff point of greater than or equal to 400 cells/mm3 compared with less than 400 cells/mm3, but not 150 cells/mm3 or 300 cells/mm3, was a risk factor in the outcome year in adjusted analyses for 2 or more asthma exacerbations (risk ratio, 1.55; 95% CI, 1.02-2.35; P =.04) and any asthma emergency department visit or hospitalization (risk ratio, 2.29; 95% CI, 1.16-4.55; P =.02), but not for rate of asthma exacerbations or incremental total direct asthma costs per patient ($202; 95% CI, -286 to 691). CONCLUSIONS A high blood eosinophil count was an independent risk factor for 2 or more asthma exacerbations or any asthma emergency department visit or hospitalization, but not direct costs in patients with SUA, possibly constrained by limited power.
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Affiliation(s)
- Robert S Zeiger
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif.
| | - Michael Schatz
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | | | - Wansu Chen
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | - Ekaterina Sadikova
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | | | - Aniket A Kawatkar
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | - Lei Qian
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
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Suruki RY, Boudiaf N, Ortega HG. Retrospective cohort analysis of healthcare claims in the United States characterising asthma exacerbations in paediatric patients. World Allergy Organ J 2016; 9:18. [PMID: 27298711 PMCID: PMC4893900 DOI: 10.1186/s40413-016-0109-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/18/2016] [Indexed: 11/17/2022] Open
Abstract
Background Asthma is the most common chronic disease in childhood and places a significant burden on public and private health systems. This retrospective cohort analysis utilised administrative healthcare claims data (US Clinformatics™ Multiplan database; compliant with the US Department of Health & Human Services Health Insurance Portability and Accountability Act) to characterise asthma exacerbations requiring intervention in a US paediatric patient population. Methods Patients aged > 1–17 years with a recorded asthma diagnosis and receiving treatment were identified in the US Clinformatics™ Multiplan database over a 9-year period (2004–2012). Both incident and prevalent cases of asthma were included, with the most recently recorded asthma diagnosis designated as the index date. The 12-month period following the index date was analysed for asthma exacerbations, defined as an event requiring treatment with systemic corticosteroid or resulting in an asthma-related hospitalisation or emergency department visit. Results Data from 734,114 children with asthma (41.5 % females, 58.5 % males) were analysed, of this cohort 34.4 % experienced ≥ 1 exacerbation during the follow-up period. The proportion who experienced ≥ 1 exacerbation increased from 28.9 % in 2004 to 36.3 % in 2012, based on the reported index date. Their mean annual exacerbation frequency was 1.4; 85.8 % of exacerbations were defined by systemic corticosteroids use. A consistent trend of increased exacerbation incidence in the fall and early winter was observed, in particular exacerbations defined by systemic corticosteroid use. A greater proportion of asthma-related hospitalisations were associated with younger age. Conclusions Approximately one-third of children experienced ≥ 1 exacerbation in real-world clinical practice. A targeted treatment approach with a focus on those with a history of recurrent exacerbations is recommended to improve asthma control. This targeted approach could also minimise the frequent systemic corticosteroid exposure particularly at an early age when side effects of systemic corticosteroids are more pronounced.
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Affiliation(s)
- Robert Y Suruki
- UCB Biosciences Inc., 8010 Arco Corporate Drive, Raleigh, NC 27617 USA
| | - Nada Boudiaf
- GSK, Worldwide Epidemiology, Stockley Park West, Uxbridge, Middlesex UK
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Suruki RY, Gunsoy N, Shin JY, Daugherty J, Nelsen L, Bradford E, Albers FC. The Identification and Description of Severe Asthma Patients in a Cross-Sectional Study —the Ideal Study. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Suruki RY, Daugherty JB, Boudiaf N, Albers FC. P221 Evaluation of exacerbation frequency and re-hospitalisation, and risk for subsequent exacerbations in asthma patients in a UK primary care setting. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.357] [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: 11/03/2022]
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Zeiger RS, Schatz M, Dalal AA, Qian L, Chen W, Ngor EW, Suruki RY, Kawatkar AA. Utilization and Costs of Severe Uncontrolled Asthma in a Managed-Care Setting. J Allergy Clin Immunol Pract 2015; 4:120-9.e3. [PMID: 26439182 DOI: 10.1016/j.jaip.2015.08.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 07/30/2015] [Accepted: 08/11/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinical and economic burden of patients with severe uncontrolled asthma (SUA) in a real-world managed-care setting required further documentation. OBJECTIVE The objective of this study was to determine the characteristics, clinical, and economic burden of SUA in a managed-care setting. METHODS This observational study identified patients with persistent asthma aged 12 years or more (N = 25,935) using the International Classification of Diseases, 9th Revision asthma codes and Healthcare Effectiveness Data and Information Set administrative criteria. An SUA subgroup was identified when all of the following 3 criteria were met in 2012: (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Health care utilization and direct costs (all-cause and asthma-related) in 2013 were compared between SUA and non-SUA subgroups using multivariable regression. RESULTS Compared with the non-SUA subgroup (N = 25,350, 97.7%), the SUA subgroup (N = 585, 2.3%) at baseline was significantly older and had more comorbidities, asthma specialist care, controller medication dispensed, and asthma exacerbations. During follow-up, patients with SUA exhibited significantly more asthma exacerbations and short-acting β2-agonist use, and higher all-cause and asthma-related costs than patients with non-SUA. The adjusted asthma-related average direct cost per patient at follow-up was significantly higher for SUA (mean ± SE) ($2325 ± $75) than non-SUA ($1261 ± $9) with an incremental cost of $1056 (95% CI, $907-$1205). Asthma drugs accounted for the major difference (incremental cost of $848/patient; 95% CI, $737-$959). CONCLUSION Increases and disparities in health care utilization and direct cost by SUA status suggest that patients with SUA require more intensive therapy, greater attention to adherence and comorbidities, more specialist care, and, possibly, personalized treatment approaches including novel biologic treatments.
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Affiliation(s)
- Robert S Zeiger
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif.
| | - Michael Schatz
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | | | - Lei Qian
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | - Wansu Chen
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | - Eunice W Ngor
- Kaiser Permanente Northern California Region, Oakland, Calif
| | | | - Aniket A Kawatkar
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
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Ortega H, Prazma C, Suruki RY, Li H, Anderson WH. Association of CHI3L1 in African-Americans with prior history of asthma exacerbations and stress. J Asthma 2012. [PMID: 23190377 DOI: 10.3109/02770903.2012.733991] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
RATIONALE Asthma exacerbations are influenced by multiple factors including environmental exposures, psychosocial interactions, and genetic variations. AIM To better understand the correlation between clinical, physiologic, genetic, and psychological dimensions in asthma phenotypes and exacerbations. METHODS Supervised cluster analysis of a previously conducted clinical trial of asthma was used to identify subpopulations with differing exacerbation rates in an African-American study population (n = 475). The clusters were characterized by their clinical characteristics and genetic variations. The genetic analysis (n = 322) compared subgroups across 40 different polymorphisms of 10 genes associated with asthma exacerbations. RESULTS Four clusters were identified with varying annualized rates of exacerbations. Cluster 1 (n = 272) was represented by subjects with a mean age of 25 years and 52% females. In contrast, cluster 4, most divergent from cluster 1, was represented by subjects with the highest rate of asthma exacerbations (1.18 events per year), was mostly female (>80%), with a mean body mass index of 34, and was distinguished by the report of stress and emotions as the cause for prior exacerbations. Lower lung function and increased rescue medication use was also reported in cluster 4. Additionally, genetic analysis revealed a significant difference in distribution of genotypes among the four clusters for rs4950928, a single nucleotide polymorphism (SNP) located in the promoter region of the CHI3L1, the chitinase 3-like 1 gene encoding YKL-40. CONCLUSIONS African-Americans who reported stress and emotions as a primary historical cause of exacerbations had the highest annualized rate of exacerbation. Further, a significant correlation with the genotypes in CHI3L1/YKL-40 was observed in the context of stress and asthma severity.
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Affiliation(s)
- Hector Ortega
- Respiratory Medcines Development Center, GlaxoSmithKline, Research Triangle Park, NC 27709, USA.
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Abstract
OBJECTIVES We examined the potential association between prior chronic obstructive pulmonary disease (COPD) and edentulism, and whether the association varied by COPD severity using data from the Dental Atherosclerosis Risk in Communities Study. DESIGN Cross-sectional. SETTING Community dwelling subjects from four US communities. PARTICIPANTS AND MEASUREMENTS Cases were identified as edentulous (without teeth) and subjects with one or more natural teeth were identified as dentate. COPD cases were defined by spirometry measurements that showed the ratio of forced expiratory volume (1 s) to vital capacity to be less than 0.7. The severity of COPD cases was also determined using a modified Global Initiative for Chronic Obstructive Lung Disease classification criteria (GOLD stage I-IV). Multiple logistic regression was used to examine the association between COPD and edentulism, while adjusting for age, gender, centre/race, ethnicity, education level, income, diabetes, hypertension, coronary heart disease and congestive heart failure, body mass index, smoking, smokeless tobacco use and alcohol consumption. RESULTS 13 465 participants were included in this analysis (2087 edentulous; 11 378 dentate). Approximately 28.3% of edentulous participants had prior COPD compared with 19.6% among dentate participants (p<0.0001). After adjustment for potential confounders, we observed a 1.3 (1.08 to 1.62) and 2.5 (1.68 to 3.63) fold increased risk of edentulism among GOLD II and GOLD III/IV COPD, respectively, as compared with the non-COPD/dentate referent. Given the short period of time between the measurements of COPD (visit 2) and dentate status (visit 4) relative to the natural history of both diseases, neither temporality nor insight as to the directionality of the association can be ascertained. CONCLUSIONS We found a statistically significant association between prior COPD and edentulism, with evidence of a positive incremental effect seen with increasing GOLD classification.
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Affiliation(s)
- Steven Offenbacher
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - James D Beck
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Silvana P Barros
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert Y Suruki
- GlaxoSmithKline R&D, Worldwide Epidemiology, Research Triangle Park, North Carolina, USA
| | - Zvi G Loewy
- Department of Pharmaceutical and Biomedical Sciences, Touro College of Pharmacy, New York, New York, USA
- Department of Biochemistry & Molecular Biology, New York Medical College, Valhalla, New York, USA
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Suruki RY, Mueller N, Hayashi K, Harn D, DeGruttola V, Raker CA, Tsubouchi H, Stuver SO. Host immune status and incidence of hepatocellular carcinoma among subjects infected with hepatitis C virus: a nested case-control study in Japan. Cancer Epidemiol Biomarkers Prev 2007; 15:2521-5. [PMID: 17164379 DOI: 10.1158/1055-9965.epi-06-0485] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A nested case-control study was conducted to examine the association between host immune status, as characterized by serum immune marker levels, and the development of hepatocellular carcinoma (HCC) up to 8 years later in persons with chronic hepatitis C virus (HCV) infection. Cases (n = 39) and matched controls (n = 117) were selected from participants of the Town C HCV Study in Japan between 1996 and 2004 and matched on age at first available sample (+/-1 year), gender, and length of follow-up. Separate analyses were done for each of three serum immune markers: soluble tumor necrosis factor-receptor II (sTNF-R2) and soluble intercellular adhesion molecule-1 (sICAM-1), as indicators of type 1, cell-mediated immune response, and soluble CD30 (sCD30), as an indicator of type 2, humoral immune response. The median concentrations of sTNF-R2, sICAM-1, and sCD30 among controls were 3,170 pg/mL, 305 ng/mL, and 3.0 units/mL, respectively, and were higher among cases (3,870 pg/mL, 372 ng/mL, and 3.3 units/mL, respectively). The risk of developing HCC among subjects with immune marker concentrations above the median levels of the controls was >2-fold greater than among subjects with lower concentrations for all three markers [sTNF-R2: odds ratio (OR), 6.9; 95% confidence interval (95% CI), 2.4-20.5; sICAM-1: OR, 2.0; 95% CI, 0.9-4.1; and sCD30: OR, 2.1; 95% CI, 1.0-4.7]. Simultaneous adjustment for all three markers revealed only sTNF-R2 to be associated with HCC risk (OR, 6.4; 95% CI, 2.0-20.6). Adjustment for alcohol consumption and HCV serotype did not materially alter these associations. Results from this prospective, community-based study suggest that a dysregulation in both type 1-related and type 2-related host immunity contributes to the development of HCV-associated HCC.
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Affiliation(s)
- Robert Y Suruki
- Department of Epidemiology, Harvard School of Public Health, USA.
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Papatheofanis FJ, McKenzie RS, Mody SH, Suruki RY, Piech CT. Dosing patterns, hematologic outcomes, and costs of erythropoietic agents in predialysis chronic kidney disease patients with anemia. Curr Med Res Opin 2006; 22:837-42. [PMID: 16709305 DOI: 10.1185/030079906x100113] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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: 11/23/2022]
Abstract
OBJECTIVE Few observational studies have evaluated the use of epoetin alfa (EPO) and darbepoetin alfa (DARB) in chronic kidney disease (CKD) patients with anemia. The objective of this study was to investigate dosing patterns, hematologic outcomes, and intervention costs with EPO and DARB in anemic CKD patients treated in an ambulatory care setting. METHODS This was a multicenter, retrospective, chart review of predialysis CKD patients with anemia treated with EPO or DARB. Charts were sequentially selected from 435 EPO and 432 DARB patients naive to erythropoietic therapy and treated for > or = 24 weeks. Hemoglobin (Hb) levels, dates, and EPO/DARB doses were recorded. Drug costs using 2005 wholesale acquisition costs (WAC) and Federal Supply Schedule (FSS) pricing were based on the mean cumulative drug dose over the 24-week study period. RESULTS A total of 393 EPO and 396 DARB charts met all criteria with predominantly male subjects (EPO: 94%; DARB: 96%). Mean baseline GFR and Hb levels were similar. Once-weekly and extended dosing (> or = Q2W) was common in both groups. At Weeks 4, 8, and 12 following initiation of therapy, a greater proportion of EPO than DARB patients reached target Hb levels (> or = 11 g/dL) (p < 0.0001); at Week 24, all patients reached target Hb levels. Mean 24-week cumulative doses were EPO 279 336 +/- 68 302 units and DARB 1084 +/- 246 microg. Drug cost was higher for DARB independent of pricing utilized (WAC: EPO = 3400 US dollars, DARB = 4726 US dollars; FSS: EPO = 1528 US dollars, DARB = 2379 US dollars). CONCLUSIONS Extended dosing (Q2W) was common in EPO- and DARB-treated patients with CKD-related anemia, with EPO-treated patients experiencing a significantly greater hematologic response (at Weeks 4, 8, and 12). In addition, drug cost was 39-56% higher in the DARB group. The male predominance may limit generalizability, warranting further research in other populations.
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