1
|
Morciano C, Spila Alegiani S, Menniti Ippolito F, Belleudi V, Trifirò G, Zanoni G, Puccini A, Sapigni E, Mores N, Leoni O, Monaco G, Clagnan E, Zappetti C, Bovo E, Cutillo M, Da Cas R, Massari M. Post-marketing active surveillance of Guillain Barré Syndrome following COVID-19 vaccination in persons aged ≥12 years in Italy: A multi-database self-controlled case series study. PLoS One 2024; 19:e0290879. [PMID: 38241309 PMCID: PMC10798452 DOI: 10.1371/journal.pone.0290879] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/17/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Recently published studies have reported association of COVID-19 vaccine ChAdOx1-S (Vaxzevria) with Guillain Barré Syndrome (GBS). Less is known about the safety of other COVID-19 vaccines with respect to GBS outcome. This study investigated the association of COVID-19 vaccines with GBS in more than 15 million persons aged ≥12 years in Italy. METHODS Study population was all individuals aged ≥12 years who received at least one dose of COVID-19 vaccines, admitted to emergency care/hospital for GBS from 27 December 2020-30 September 2021 in Italy. Identification of GBS cases and receipt of at least one dose of mRNA-1273 (Elasomeran), BNT162b2 (Tozinameran), ChAdOx1-S (Vaxzevria) and Ad26.COV2.S (Janssen) through record linkage between regional health care and vaccination registries. Relative Incidence (RI) was estimated Self-controlled case series method adapted to event-dependent exposure using in the 42-day exposure risk period after each dose compared with other observation periods. RESULTS Increased risk of GBS was found after first (RI = 6.83; 95% CI 2.14-21.85) and second dose (RI = 7.41; 2.35-23.38) of mRNA-1273 and first dose of ChAdOx1-S (RI = 6.52; 2.88-14.77). Analysis by age found an increased risk among those aged≥60 years after first (RI = 8.03; 2.08-31.03) and second dose (RI = 7.71; 2.38-24.97) of mRNA-1273. The first dose of ChAdOx1-S was associated with GBS in those aged 40-59 (RI = 4.50; 1.37-14.79) and in those aged ≥ 60 years (RI = 6.84; 2.56-18.28). CONCLUSIONS mRNA-1273 and ChAdOx1-S vaccines were associated with an increased risk of GBS however this risk resulted in a small number of excess cases. Limitations were loss of GBS outpatient cases and imprecision of the estimates in the subgroup analysis due to a low number of events.
Collapse
Affiliation(s)
- Cristina Morciano
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Stefania Spila Alegiani
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Francesca Menniti Ippolito
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Rome, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Aurora Puccini
- Hospital Assistance Service, General Directorate for Personal Care, Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Ester Sapigni
- Hospital Assistance Service, General Directorate for Personal Care, Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Nadia Mores
- Institute of Pharmacology, Pharmacovigilance, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy
| | - Olivia Leoni
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | - Giuseppe Monaco
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | - Elena Clagnan
- Regional Health Authority, Friuli Venezia Giulia Region, Udine, Italy
| | - Cristina Zappetti
- Central Directorate for Health, Social Policies, Friuli Venezia Giulia Region, Trieste, Italy
| | | | - Maria Cutillo
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Marco Massari
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| |
Collapse
|
2
|
De Angelis S, Medda E, Rotondi D, Masocco M, Minardi V, Contoli B, Possenti V, Sorbo A, D’Amato M, Turco AC, Pastorelli AA, Stacchini P, Cas RD, Bagnasco M, Bonofiglio D, Gasperi M, Meringolo D, Mian C, Moleti M, Vermiglio F, Puxeddu E, Taccaliti A, Tonacchera M, Ulisse S, Dimida A, Rago T, Nazzari E, Schiavo M, Bossert I, Sturniolo G, Corbetta C, Cereda C, Cappelletti L, Camilot M, Teofoli F, Ciatti R, Tarsi E, Perrotti N, Marasco O, Scozzafava G, Righetti F, Andò S, Catalano S, Cristofaro M, Sorrenti G, Censi S, Morelli S, Baldini E, Plutino G, Copparoni R, Alonzo E, Giacomozzi C, Silano M, Olivieri A. Fifteen Years of Iodine Prophylaxis in Italy: Results of a Nationwide Surveillance (Period 2015-2019). J Clin Endocrinol Metab 2024; 109:e495-e507. [PMID: 37820735 PMCID: PMC10795908 DOI: 10.1210/clinem/dgad593] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
CONTEXT In 2005, a nationwide program of iodine prophylaxis on a voluntary basis was implemented in Italy by law. However, recent data on iodine status are lacking. OBJECTIVE The aim of this study was to evaluate efficiency, effectiveness, and possible adverse effects (increased occurrence of thyroid autoimmunity and hyperthyroidism) of the Italian iodine prophylaxis program. METHODS From 2015 to 2019, a nationwide survey was performed. The use of iodized salt was evaluated in a sample of 164 593 adults and in 998 school canteens. A sample of 4233 schoolchildren (aged 11-13 years) was recruited to assess urinary iodine concentration, prevalence of goiter, and thyroid hypoechogenicity on ultrasound, with the latter being an indirect indicator of thyroid autoimmunity. Neonatal TSH values of 197 677 infants screened in regions representative of Northern, Central, and Southern Italy were analyzed to investigate the percentage of TSH values >5.0 mIU/L. Data on methimazole prescriptions were analyzed as indirect indicators of new cases of hyperthyroidism. RESULTS The prevalence of the use of iodized salt was 71.5% in adult population and 78% in school canteens. A median urinary iodine concentration of 124 μg/L, a prevalence of goiter of 2.2%, and a prevalence of thyroid hypoechogenicity of 5.7% were observed in schoolchildren. The percentage of neonatal TSH values >5.0 mIU/L resulted still higher (5.1%) than the World Health Organization threshold of 3.0%, whereas the prescriptions of methimazole showed a reduction of 13.5%. CONCLUSION Fifteen years of iodine prophylaxis have led to iodine sufficiency in Italy, although there still is concern about iodine nutritional status during pregnancy.
Collapse
Affiliation(s)
- Simona De Angelis
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome 00161, Italy
| | - Emanuela Medda
- Reference Center for Behavioral Sciences and Mental Health, Italian National Institute of Health, Rome 00161, Italy
| | - Daniela Rotondi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome 00161, Italy
| | - Maria Masocco
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome 00161, Italy
| | - Valentina Minardi
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome 00161, Italy
| | - Benedetta Contoli
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome 00161, Italy
| | - Valentina Possenti
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome 00161, Italy
| | - Angela Sorbo
- Department of Food Safety, Nutrition and Veterinary Public Health, Italian National Institute of Health, Rome 00161, Italy
| | - Marilena D’Amato
- Department of Food Safety, Nutrition and Veterinary Public Health, Italian National Institute of Health, Rome 00161, Italy
| | - Anna Chiara Turco
- Department of Food Safety, Nutrition and Veterinary Public Health, Italian National Institute of Health, Rome 00161, Italy
| | - Alberto Augusto Pastorelli
- Department of Food Safety, Nutrition and Veterinary Public Health, Italian National Institute of Health, Rome 00161, Italy
| | - Paolo Stacchini
- Department of Food Safety, Nutrition and Veterinary Public Health, Italian National Institute of Health, Rome 00161, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome 00161, Italy
| | - Marcello Bagnasco
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa 16132, Italy
| | - Daniela Bonofiglio
- Department of Pharmacy, Health and Nutritional Sciences, Centro Sanitario, University of Calabria, Cosenza 87036, Italy
| | - Maurizio Gasperi
- Department of Medicine and Health Sciences “V. Tiberio,” University of Molise, Campobasso 86100, Italy
| | | | - Caterina Mian
- Department of Medicine, University of Padua, Padua 35128, Italy
| | - Mariacarla Moleti
- Department of Clinical and Experimental Medicine, University of Messina, Messina 98125, Italy
| | - Francesco Vermiglio
- Department of Clinical and Experimental Medicine, University of Messina, Messina 98125, Italy
| | - Efisio Puxeddu
- Department of Medicine and Surgery, University of Perugia, Perugia 06132, Italy
| | - Augusto Taccaliti
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona 60126, Italy
| | - Massimo Tonacchera
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56124, Italy
| | - Salvatore Ulisse
- Department of Surgery, “Sapienza” University of Rome, Rome 00185, Italy
| | - Antonio Dimida
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56124, Italy
| | - Teresa Rago
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56124, Italy
| | - Elena Nazzari
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa 16132, Italy
| | - Mara Schiavo
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa 16132, Italy
| | - Irene Bossert
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa 16132, Italy
| | - Giacomo Sturniolo
- Department of Clinical and Experimental Medicine, University of Messina, Messina 98125, Italy
| | - Carlo Corbetta
- Department of Woman, Mother and Neonate, “Vittore Buzzi” Children's Hospital, Milan 20154, Italy
| | - Cristina Cereda
- Department of Pediatrics, “Vittore Buzzi” Children's Hospital, Milan 20154, Italy
| | - Laura Cappelletti
- Department of Pediatrics, “Vittore Buzzi” Children's Hospital, Milan 20154, Italy
| | - Marta Camilot
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona 37134, Italy
| | - Francesca Teofoli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona 37134, Italy
| | - Renzo Ciatti
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Ospedaliero Santa Croce, Fano 61032, Italy
| | - Elisabetta Tarsi
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Ospedaliero Santa Croce, Fano 61032, Italy
| | - Nicola Perrotti
- Department of Health Sciences, University Magna Graecia, Catanzaro 88100, Italy
| | - Onorina Marasco
- Regional Neonatal Screening Laboratory, Azienda Ospedaliera Mater Domini, Catanzaro 88100, Italy
| | - Giovanna Scozzafava
- Regional Neonatal Screening Laboratory, Azienda Ospedaliera Mater Domini, Catanzaro 88100, Italy
| | - Francesca Righetti
- Regional Laboratory for Neonatal Screening and Endocrine-Metabolic Diseases, IRCCS University Sant'Orsola Hospital, Bologna 40138, Italy
| | - Sebastiano Andò
- Department of Pharmacy, Health and Nutritional Sciences, Centro Sanitario, University of Calabria, Cosenza 87036, Italy
| | - Stefania Catalano
- Department of Pharmacy, Health and Nutritional Sciences, Centro Sanitario, University of Calabria, Cosenza 87036, Italy
- Annunziata Hospital, Cosenza 87100, Italy
| | | | | | - Simona Censi
- Department of Medicine, University of Padua, Padua 35128, Italy
| | - Silvia Morelli
- Department of Medicine and Surgery, University of Perugia, Perugia 06132, Italy
| | - Enke Baldini
- Department of Surgery, “Sapienza” University of Rome, Rome 00185, Italy
| | - Giuseppe Plutino
- General Direction of Food Safety and Nutrition, Italian Ministry of Health, Rome 00144, Italy
| | - Roberto Copparoni
- General Direction of Food Safety and Nutrition, Italian Ministry of Health, Rome 00144, Italy
| | - Elena Alonzo
- Food Hygiene and Nutrition Service–SIAN, Local Health Authority of Catania, Catania 95027, Italy
| | - Claudia Giacomozzi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome 00161, Italy
| | - Marco Silano
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome 00161, Italy
| | - Antonella Olivieri
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome 00161, Italy
| |
Collapse
|
3
|
Menniti-Ippolito F, Mele A, Da Cas R, De Masi S, Chiarotti F, Fabiani M, Baglio G, Traversa G, Colavita F, Castilletti C, Salomone M, Zoccali C, Messa P. Correction to: Safety and efficacy of COVID-19 vaccines in patients on dialysis: a multicentre cohort study in Italy. J Nephrol 2024; 37:259-260. [PMID: 38114883 DOI: 10.1007/s40620-023-01864-w] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
| | - Alfonso Mele
- Italian National Institute of Health, Rome, Italy
| | | | | | | | | | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | | | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Concetta Castilletti
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Mario Salomone
- Unit of Nephrology and Dialysis, Chieri and Moncalieri Hospitals, Turin, Italy
| | - Carmine Zoccali
- Renal Research Institute, New York, USA
- Istituto di Biologia e Genetica Molecolare (BIOGEM), Ariano Irpino, Italy
- Associazione Ipertensione, Nefrologia e Trapianto Renale (IPNET) c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Piergiorgio Messa
- Unit of Nephrology, Dialysis, and Renal Transplant, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
4
|
Guerrizio MA, Zito S, Mammarella F, Frulio R, Trotta MP, Da Cas R, Maestri E, Trotta F. Effectiveness of different local actions to control vitamin D prescription in Italy. Ann Ist Super Sanita 2023; 59:271-279. [PMID: 38088394 DOI: 10.4415/ann_23_04_06] [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: 12/18/2023]
Abstract
INTRODUCTION In the last decade, the significant expenditure and consumption increase of vitamin D in Italy led some regions to adopt strategies to improve prescribing appropriateness and contain expenditure. MATERIALS AND METHODS Using the statistical analysis method of interrupted time series for consumption and expenditure of cholecalciferol, different types of interventions adopted in four Italian regions and their efficacy were evaluated. RESULTS Molise achieved the best results by adopting a health professionals' education program in addition to a prescriber-sanction system. Emilia-Romagna also opted for a medical education strategy, but the results were less relevant due to the lack of penalties. Lazio obtained a slowdown in consumption growth by targeting on the utilization of lower-cost per defined daily dose (DDD) packs and adopting a therapeutic plan. Sardinia showed a decrease in expenditure by adopting a target threshold of lower-cost formulation. CONCLUSION The reimbursement of the lowest-cost packs within the National Health Service (NHS) undoubtedly influences spending trend, but it does not solve prescriptive inappropriateness.
Collapse
Affiliation(s)
| | | | - Federica Mammarella
- Dipartimento di Geriatria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Roberto Da Cas
- Centro Nazionale per la Ricerca e la Valutazione Preclinica e Clinica dei Farmaci, Istituto Superiore di Sanità, Rome, Italy
| | - Emilio Maestri
- Azienda USL - IRCCS di Reggio Emilia, Governo Clinico, Reggio Emilia, Italy
| | | |
Collapse
|
5
|
Menniti-Ippolito F, Mele A, Da Cas R, De Masi S, Chiarotti F, Fabiani M, Baglio G, Traversa G, Colavita F, Castilletti C, Salomone M, Zoccali C, Messa P. Safety and efficacy of COVID-19 vaccines in patients on dialysis: a multicentre cohort study in Italy. J Nephrol 2023; 36:2013-2022. [PMID: 37490271 DOI: 10.1007/s40620-023-01708-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/09/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and safety of COVID-19 vaccines in patients undergoing haemodialysis in Italy compared to the general population. METHODS In this cohort study, 118 dialysis centres from 18 Italian Regions participated. Individuals older than 16 years on dialysis treatment for at least 3 months, who provided informed consent were included. We collected demographic and clinical information, as well as data on vaccination status, hospitalisations, access to intensive care units and adverse events. We calculated the incidence, hospitalisation, mortality, and fatality rates in the vaccinated dialysis cohort, adjusted for several covariates. The incidence rates of infection in the dialysis cohort and the general population were compared through Standardised Incidence Rate Ratio. RESULTS The study included 6555 patients vaccinated against SARS-CoV-2 infection according to the schedule recommended in Italy. Between March 2021 and May 2022, there were 1096 cases of SARS-CoV-2 infection, with an incidence rate after completion of the three-dose vaccination cycle of 37.7 cases per 100 person-years. Compared to the general population, we observed a 14% reduction in the risk of infection for patients who received three vaccine doses (Standardised Incidence Rate Ratio: 0.86; 95% Confidence Interval: 0.81-0.91), whereas no statistically significant differences were found for COVID-19-related hospitalisations, intensive care unit admissions or death. No safety signals emerged from the reported adverse events. CONCLUSIONS The vaccination program against SARS-CoV-2 in the haemodialysis population showed an effectiveness and safety profile comparable to that seen in the general population.
Collapse
Affiliation(s)
| | - Alfonso Mele
- Italian National Institute of Health, Rome, Italy
| | | | | | | | | | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | | | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Concetta Castilletti
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Mario Salomone
- Unit of Nephrology and Dialysis, Chieri and Moncalieri Hospitals, Turin, Italy
| | - Carmine Zoccali
- Renal Research Institute, New York, USA
- Istituto di Biologia e Genetica Molecolare (BIOGEM), Ariano Irpino, Italy
- Associazione Ipertensione, Nefrologia e Trapianto Renale (IPNET) c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Piergiorgio Messa
- Unit of Nephrology, Dialysis, and Renal Transplant, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
6
|
Spila Alegiani S, Morciano C, Menniti-Ippolito F, Da Cas R, Felicetti P, Marchione P, Petronzelli F, Marra AR, Massari M. Postmarketing observational study on the safety of 2021/2022 and 2022/2023 influenza vaccination campaigns in Italy: TheShinISS-Vax|Flu study protocol. BMJ Open 2023; 13:e069858. [PMID: 37550029 PMCID: PMC10407352 DOI: 10.1136/bmjopen-2022-069858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION The purpose of TheShinISS-Vax|Flu study is to examine the association between influenza vaccines and adverse events requiring hospital admission or emergency care during the influenza vaccination campaigns 2021/2022 and 2022/2023 in Italy. METHODS AND ANALYSIS This is a Self-Controlled Case Series multiregional study using linked routinely collected data from regional healthcare databases of the participating regions. Study participants will be persons aged ≥6 months, unvaccinated or who have received influenza vaccine during the influenza vaccination campaigns in the seasons 2021/2022 and 2022/2023 in Italy and who have experienced the outcome of interest for the first time during the study period (1 September 2021-30 June 2022 and 1 September 2022-30 June 2023 for the first and second vaccination campaigns, respectively). Risk periods will be specifically defined for each outcome and further subdivided into periods of 7 days. The exposures will be the first or second dose of the influenza vaccines administered during the two vaccination campaigns. Statistical analysis will be conducted separately for the data of the two campaigns. Exposure risk period will be compared with baseline risk period defined as any time of observation out of the risk periods. The modified SCCS method will be applied to handle event-dependent exposure and mortality and fitted using unbiased estimating equations to estimate relative incidences and excess of cases per 100 000 vaccinated by dose, age, sex and type of vaccine. Calendar period will be included as time-varying confounder in the model, where appropriate. ETHICS AND DISSEMINATION The study received the approval from the National ethics committee for clinical trials of public research bodies and other national public institutions (PRE BIO CE n.0036723, 23/09/2022). Results will be published in peer-reviewed journals and reports in accordance with the publication policies of the Italian National Institute of Health and of the Italian Medicines Agency.
Collapse
Affiliation(s)
- Stefania Spila Alegiani
- National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Cristina Morciano
- National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | | | - Roberto Da Cas
- National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Patrizia Felicetti
- Department of Post-Marketing Surveillance, Italian Medicines Agency, Roma, Italy
| | - Pasquale Marchione
- Department of Post-Marketing Surveillance, Italian Medicines Agency, Roma, Italy
| | - Fiorella Petronzelli
- Department of Post-Marketing Surveillance, Italian Medicines Agency, Roma, Italy
| | - Anna Rosa Marra
- Department of Post-Marketing Surveillance, Italian Medicines Agency, Roma, Italy
| | - Marco Massari
- National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| |
Collapse
|
7
|
Maggini V, Crescioli G, Ippoliti I, Gallo E, Menniti-Ippolito F, Chiaravalloti A, Mascherini V, Da Cas R, Potenza S, Gritti G, Galiulo MT, Sottosanti L, Vannacci A, Lombardi N, Firenzuoli F. Safety Profile of Vitamin D in Italy: An Analysis of Spontaneous Reports of Adverse Reactions Related to Drugs and Food Supplements. J Clin Med 2023; 12:4726. [PMID: 37510843 PMCID: PMC10381134 DOI: 10.3390/jcm12144726] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Vitamin D (VitD) is largely used in Italy, often inappropriately; thus, an evaluation of its safety is a crucial issue. This study analyses the adverse reactions (ARs) associated with the use of products containing VitD (VitDps) reported to the Italian National Pharmacovigilance and Phytovigilance networks. From March 2002 to August 2022, a total of 643 and 127 reports concerning 903 and 215 ARs were retrieved from Pharmacovigilance and Phytovigilance networks, respectively. Overall, 332 (29.6%) ARs were classified as serious, and the most described ones were hypercalcaemia, renal failure and tachycardia. Serious AR risk was significantly higher for subjects using more than four concomitant products (OR 2.44 [95% CI 1.30-4.60]) and VitD doses higher than 1000 IU/day (OR 2.70 [95% CI 1.30-5.64]). In Italy, there was a modest decrease in AR reporting, despite the slightly increased use of VitD during the COVID-19 pandemic. To the best of our knowledge, this is the first study describing all VitDps-related ARs observed in the Italian general population. Since underreporting is the main limitation of the safety reporting systems, the necessity to continue ARs monitoring, also using real-world data on VitDps prescription, use and outcome patterns is highlighted.
Collapse
Affiliation(s)
- Valentina Maggini
- Research and Innovation Center in Phytotherapy and Integrated Medicine-CERFIT, Referring Center for Phytotherapy of Tuscany Region, Careggi University Hospital, 50141 Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50141 Florence, Italy
| | - Ilaria Ippoliti
- National Centre for Drug Research and Evaluation, National Institute of Health, 00161 Rome, Italy
| | - Eugenia Gallo
- Research and Innovation Center in Phytotherapy and Integrated Medicine-CERFIT, Referring Center for Phytotherapy of Tuscany Region, Careggi University Hospital, 50141 Florence, Italy
| | | | - Adelaide Chiaravalloti
- Research and Innovation Center in Phytotherapy and Integrated Medicine-CERFIT, Referring Center for Phytotherapy of Tuscany Region, Careggi University Hospital, 50141 Florence, Italy
- General and Clinical Phytotherapy, Department of Experimental and Clinical Medicine, University of Florence, 50141 Florence, Italy
| | - Vittorio Mascherini
- Research and Innovation Center in Phytotherapy and Integrated Medicine-CERFIT, Referring Center for Phytotherapy of Tuscany Region, Careggi University Hospital, 50141 Florence, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, National Institute of Health, 00161 Rome, Italy
| | | | | | | | | | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50141 Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50141 Florence, Italy
| | - Fabio Firenzuoli
- Research and Innovation Center in Phytotherapy and Integrated Medicine-CERFIT, Referring Center for Phytotherapy of Tuscany Region, Careggi University Hospital, 50141 Florence, Italy
| |
Collapse
|
8
|
Fortinguerra F, Belleudi V, Poggi FR, Perna S, Bortolus R, Donati S, D’Aloja P, Da Cas R, Clavenna A, Locatelli A, Addis A, Davoli M, Trotta F. Monitoring medicine prescriptions before, during and after pregnancy in Italy. PLoS One 2023; 18:e0287111. [PMID: 37319236 PMCID: PMC10270638 DOI: 10.1371/journal.pone.0287111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/29/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The use of medications during pregnancy is a common event worldwide. Monitoring medicine prescriptions in clinical practice is a necessary step in assessing the impact of therapeutic choices in pregnant women as well as the adherence to clinical guidelines. The aim of this study was to provide prevalence data on medication use before, during and after pregnancy in the Italian population. METHODS A retrospective prevalence study using administrative healthcare databases was conducted. A cohort of 449,012 pregnant women (15-49 years) residing in eight Italian regions (59% of national population), who delivered in 2016-2018, were enrolled. The prevalence of medication use was estimated as the proportion (%) of pregnant women with any prescription. RESULTS About 73.1% of enrolled women received at least one drug prescription during pregnancy, 57.1% in pre-pregnancy and 59.3% in postpartum period. The prevalence of drug prescriptions increased with maternal age, especially during the 1st trimester of pregnancy. The most prescribed medicine was folic acid (34.6%), followed by progesterone (19%), both concentrated in 1st trimester of pregnancy (29.2% and 14.8%, respectively). Eight of the top 30 most prescribed medications were antibiotics, whose prevalence was higher during 2nd trimester of pregnancy in women ≥ 40 years (21.6%). An increase in prescriptions of anti-hypertensives, antidiabetics, thyroid hormone and heparin preparations was observed during pregnancy; on the contrary, a decrease was found for chronic therapies, such as anti-epileptics or lipid-modifying agents. CONCLUSIONS This study represents the largest and most representative population-based study illustrating the medication prescription patterns before, during and after pregnancy in Italy. The observed prescriptive trends were comparable to those reported in other European countries. Given the limited information on medication use in Italian pregnant women, the performed analyses provide an updated overview of drug prescribing in this population, which can help to identify critical aspects in clinical practice and to improve the medical care of pregnant and childbearing women in Italy.
Collapse
Affiliation(s)
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | | | - Renata Bortolus
- Directorate General for Preventive Health–Office 9, Ministry of Health, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità –Italian National Institute of Health, Rome, Italy
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità –Italian National Institute of Health, Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità –Italian National Institute of Health, Rome, Italy
| | - Antonio Clavenna
- Laboratory for Pharmacoepidemiology, Department of Public Health, IRCCS–Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | | |
Collapse
|
9
|
Marano G, Da Cas R, Zito S, Ippoliti I, Cangini A, Pierantozzi A, Menniti-Ippolito F, Trotta F, Fortinguerra F. [Parole chiave. Appropriatezza prescrittiva, consumi farmaceutici, emofilia, fattori della coagulazione, malattia di von Willebrand, malattie emorragiche congenite.]. Recenti Prog Med 2023; 114:258-267. [PMID: 37114607 DOI: 10.1701/4032.40074] [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: 04/29/2023]
Abstract
Therapeutic strategies for the treatment of congenital bleeding disorders. Congenital hemorrhagic diseases (CHDs) are a group of rare disorders caused by quantitative or qualitative deficiency of one or more coagulation factors. Haemophilia A, Haemophilia B, and von Willebrand disease are the most common congenital bleeding disorders. Over the past decades, the evolution of CHDs treatments has resulted in an increase in the average life expectancy of patients and in an improvement in their quality of life; it has also enabled the prevention of bleeding complications much more effectively than in the past. This has been possible, especially for haemophilia, mainly because of earlier diagnosis, introduction of recombinant factors, especially long-acting factors, and availability of new non-substitutive therapies. In 2021, there was an increase in the overall expenditure and consumption of coagulation factors in Italy; the increase concerned especially the long-acting recombinant factors used in the treatment of Haemophilia A and B and the monoclonal antibody emicizumab. Waiting for innovative therapies that can enable individually tailored therapies, special attention must be paid to prescriptive appropriateness and to identify the best diagnostic and therapeutic care pathways for patients.
Collapse
Affiliation(s)
- Giuseppe Marano
- Centro nazionale per la ricerca e la valutazione preclinica e clinica dei farmaci, Istituto superiore di sanità, Roma
| | - Roberto Da Cas
- Centro nazionale per la ricerca e la valutazione preclinica e clinica dei farmaci, Istituto superiore di sanità, Roma
| | | | - Ilaria Ippoliti
- Centro nazionale per la ricerca e la valutazione preclinica e clinica dei farmaci, Istituto superiore di sanità, Roma
| | | | | | - Francesca Menniti-Ippolito
- Centro nazionale per la ricerca e la valutazione preclinica e clinica dei farmaci, Istituto superiore di sanità, Roma
| | | | | |
Collapse
|
10
|
Marano G, Da Cas R, Zito S, Ippoliti I, Fortinguerra F, Pierantozzi A, Menniti-Ippolito F, Trotta F, Cangini A. [Pharmacotherapy of Hemophilia A: expenditure and consumption for the year 2022 and future expenditure scenarios.]. Recenti Prog Med 2023; 114:268-276. [PMID: 37114608 DOI: 10.1701/4032.40075] [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: 04/29/2023]
Abstract
In 2021, the national expenditure for blood coagulation factors was 541.4 million, growing steadily over the past decade. Hemophilia A is the congenital hemorrhagic disease with the highest drug consumption and expenditure. It has also the highest annual increase. Data from the OsMed report showed an increased use of long-acting recombinant factors and a concomitant reduction in consumption of short-acting ones and also an increasing trend of emicizumab. Based on these findings, two possible expenditure scenarios were described: 1) assuming a 25% of reduction in consumption of short-acting recombinant factors with proportional redistribution to the consumption observed in 2022 for long-acting recombinant factors; 2) assuming that all new patients with a moderate and severe form of the disease will start prophylaxis with emicizumab and also calculating different switch percentages (20%, 30%, 50% or 70%). The first hypothesis showed a potential increase in expenditure of 3.3% (approximately 10 million euros) switching from short- to long-acting factors. In the second one, based on estimated number of patients with Hemophilia A on treatment, a total expenditure of about 457.6 million euros was estimated. Based on these findings, different expenditure outlooks were hypothesized and that there should be a switch from the recombinant factors to emicizumab. Specifically, an expenditure increase of 8% in the case of 20% switch and 28.1% in the case of 70% switch were estimated.
Collapse
Affiliation(s)
- Giuseppe Marano
- Centro nazionale per la ricerca e la valutazione preclinica e clinica dei farmaci, Istituto superiore di sanità, Roma
| | - Roberto Da Cas
- Centro nazionale per la ricerca e la valutazione preclinica e clinica dei farmaci, Istituto superiore di sanità, Roma
| | | | - Ilaria Ippoliti
- Centro nazionale per la ricerca e la valutazione preclinica e clinica dei farmaci, Istituto superiore di sanità, Roma
| | | | | | - Francesca Menniti-Ippolito
- Centro nazionale per la ricerca e la valutazione preclinica e clinica dei farmaci, Istituto superiore di sanità, Roma
| | | | | |
Collapse
|
11
|
Marano G, Da Cas R, Pierantozzi A, Ippoliti I, Cangini A, Menniti-Ippolito F, Trotta F. A preliminary analysis of luspatercept use and expenditure in Italy in the first semester of 2022. Letter. Ann Ist Super Sanita 2023; 59:99-100. [PMID: 37337983 DOI: 10.4415/ann_23_02_01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Affiliation(s)
- Giuseppe Marano
- Centro Nazionale per la Ricerca e la Valutazione dei Farmaci, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Da Cas
- Centro Nazionale per la Ricerca e la Valutazione dei Farmaci, Istituto Superiore di Sanità, Rome, Italy
| | | | - Ilaria Ippoliti
- Centro Nazionale per la Ricerca e la Valutazione dei Farmaci, Istituto Superiore di Sanità, Rome, Italy
| | | | | | | |
Collapse
|
12
|
Marengoni A, Cangini A, Pierantozzi A, Onder G, Da Cas R, Ippoliti I, Zito S, Trotta F. Reply to the Letter "Paracetamol: should we hide it within the NSAID category to dismiss its real infodemiology analysis?". Aging Clin Exp Res 2023; 35:905. [PMID: 36897557 PMCID: PMC9999065 DOI: 10.1007/s40520-023-02379-x] [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] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | | | | | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Ilaria Ippoliti
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | | | | | | |
Collapse
|
13
|
Floridia M, Giuliano M, Monaco M, Palmieri L, Lo Noce C, Palamara AT, Pantosti A, Brusaferro S, Onder G, Palmieri L, Agazio E, Barbariol P, Bella A, Benelli E, Bertinato L, Bocci M, Boros S, Bressi M, Calcagnini G, Canevelli M, Censi F, Ciervo A, Colaizzo E, Da Cas R, Del Manso M, Di Benedetto C, Donfrancesco C, Fabiani M, Facchiano F, Floridia M, Galati F, Giuliano M, Grisetti T, Guastadisegni C, Lega I, Lo Noce C, Maiozzi P, Manno V, Martini M, Massari M, Urdiales AM, Mattei E, Meduri C, Meli P, Menniti Ippolito F, Minelli G, Onder G, Petrone D, Pezzotti P, Pricci F, Punzo O, Quarata F, Raparelli V, Riccardo F, Rocchetto S, Sacco C, Salerno P, Sarti G, Serra D, Spila Alegiani S, Spuri M, Tallon M, Tamburo De Bella M, Tiple D, Toccaceli Blasi M, Trentin F, Unim B, Vaianella L, Vanacore N, Vescio MF, Villani ER, Weimer LE, Brusaferro S. Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020–2021. Antimicrob Resist Infect Control 2022; 11:74. [PMID: 35598032 PMCID: PMC9123740 DOI: 10.1186/s13756-022-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19.
Methods
We reviewed the hospital charts of a sample of patients deceased with COVID-19 from the Italian National COVID-19 Surveillance, who had laboratory-confirmed bacterial or fungal bloodstream infections (BSI) or lower respiratory tract infections (LRTI), evaluating the pathogens responsible for the infections and their antimicrobial susceptibility.
Results
Among 157 patients with infections hospitalised from February 2020 to April 2021, 28 (17.8%) had co-infections (≤ 48 h from admission) and 138 (87.9%) had secondary infections (> 48 h). Most infections were bacterial; LRTI were more frequent than BSI. The most common co-infection was pneumococcal LRTI. In secondary infections, Enterococci were the most frequently recovered pathogens in BSI (21.7% of patients), followed by Enterobacterales, mainly K. pneumoniae, while LRTI were mostly associated with Gram-negative bacteria, firstly Enterobacterales (27.4% of patients, K. pneumoniae 15.3%), followed by A. baumannii (19.1%). Fungal infections, both BSI and LRTI, were mostly due to C. albicans. Antibiotic resistance rates were extremely high in Gram-negative bacteria, with almost all A. baumannii isolates resistant to carbapenems (95.5%), and K. pneumoniae and P. aeruginosa showing carbapenem resistance rates of 59.5% and 34.6%, respectively.
Conclusions
In hospitalised patients with severe COVID-19, secondary infections are considerably more common than co-infections, and are mostly due to Gram-negative bacterial pathogens showing a very high rate of antibiotic resistance.
Collapse
|
14
|
Perna S, Cangini A, Marini R, Guerrizio MA, Da Cas R, Traversa G, Trotta F. Dynamics of price competition in Italian pharmaceutical off-patent market. Front Med (Lausanne) 2022; 9:1045374. [DOI: 10.3389/fmed.2022.1045374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022] Open
Abstract
IntroductionThe aim of the study was to evaluate, in a regulated generics market, the effect of the number of manufacturers of generic drugs on the amplitude of off-patent products price reduction and the price evolution of originators and generics after the patent expiry of pharmaceuticals dispensed by community pharmacies and reimbursed by the Italian National Health Service (INHS).MethodsThe AIFA “transparency list” was utilized to select unbranded and branded off-patent drug dispensed by community pharmacies and reimbursed by the Italian National Health Service between 2012 and 2018. The unbranded drug entry in the transparency list database was considered as a proxy of its patent expiry.ResultsA total of 42 different active ingredients were included in the analysis. The relative price per dose at time t of unbranded and branded drugs, considering as common denominator the price per dose a year before the patent expiry, (t-1) decreased with the increase of unbranded manufacturers. At the time of the patent expiry, the price of unbranded drugs was almost 50% less than that of branded drugs at t-1 and the price of branded drugs started to decrease before the first unbranded entry.ConclusionAn inverse relation between the number of generic drug entrants and the price of generics and originators was detected. The patent expiry determines a price decline, more concentrated in the first year of patent expiry.
Collapse
|
15
|
Massari M, Spila Alegiani S, Morciano C, Spuri M, Marchione P, Felicetti P, Belleudi V, Poggi FR, Lazzeretti M, Ercolanoni M, Clagnan E, Bovo E, Trifirò G, Moretti U, Monaco G, Leoni O, Da Cas R, Petronzelli F, Tartaglia L, Mores N, Zanoni G, Rossi P, Samez S, Zappetti C, Marra AR, Menniti Ippolito F. Postmarketing active surveillance of myocarditis and pericarditis following vaccination with COVID-19 mRNA vaccines in persons aged 12 to 39 years in Italy: A multi-database, self-controlled case series study. PLoS Med 2022; 19:e1004056. [PMID: 35900992 PMCID: PMC9333264 DOI: 10.1371/journal.pmed.1004056] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/22/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Myocarditis and pericarditis following the Coronavirus Disease 2019 (COVID-19) mRNA vaccines administration have been reported, but their frequency is still uncertain in the younger population. This study investigated the association between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mRNA vaccines, BNT162b2, and mRNA-1273 and myocarditis/pericarditis in the population of vaccinated persons aged 12 to 39 years in Italy. METHODS AND FINDINGS We conducted a self-controlled case series study (SCCS) using national data on COVID-19 vaccination linked to emergency care/hospital discharge databases. The outcome was the first diagnosis of myocarditis/pericarditis between 27 December 2020 and 30 September 2021. Exposure risk period (0 to 21 days from the vaccination day, subdivided in 3 equal intervals) for first and second dose was compared with baseline period. The SCCS model, adapted to event-dependent exposures, was fitted using unbiased estimating equations to estimate relative incidences (RIs) and excess of cases (EC) per 100,000 vaccinated by dose, age, sex, and vaccine product. Calendar period was included as time-varying confounder in the model. During the study period 2,861,809 persons aged 12 to 39 years received mRNA vaccines (2,405,759 BNT162b2; 456,050 mRNA-1273); 441 participants developed myocarditis/pericarditis (346 BNT162b2; 95 mRNA-1273). Within the 21-day risk interval, 114 myocarditis/pericarditis events occurred, the RI was 1.99 (1.30 to 3.05) after second dose of BNT162b2 and 2.22 (1.00 to 4.91) and 2.63 (1.21 to 5.71) after first and second dose of mRNA-1273. During the [0 to 7) days risk period, an increased risk of myocarditis/pericarditis was observed after first dose of mRNA-1273, with RI of 6.55 (2.73 to 15.72), and after second dose of BNT162b2 and mRNA-1273, with RIs of 3.39 (2.02 to 5.68) and 7.59 (3.26 to 17.65). The number of EC for second dose of mRNA-1273 was 5.5 per 100,000 vaccinated (3.0 to 7.9). The highest risk was observed in males, at [0 to 7) days after first and second dose of mRNA-1273 with RI of 12.28 (4.09 to 36.83) and RI of 11.91 (3.88 to 36.53); the number of EC after the second dose of mRNA-1273 was 8.8 (4.9 to 12.9). Among those aged 12 to 17 years, the RI was of 5.74 (1.52 to 21.72) after second dose of BNT162b2; for this age group, the number of events was insufficient for estimating RIs after mRNA-1273. Among those aged 18 to 29 years, the RIs were 7.58 (2.62 to 21.94) after first dose of mRNA-1273 and 4.02 (1.81 to 8.91) and 9.58 (3.32 to 27.58) after second dose of BNT162b2 and mRNA-1273; the numbers of EC were 3.4 (1.1 to 6.0) and 8.6 (4.4 to 12.6) after first and second dose of mRNA-1273. The main study limitations were that the outcome was not validated through review of clinical records, and there was an absence of information on the length of hospitalization and, thus, the severity of the outcome. CONCLUSIONS This population-based study of about 3 millions of residents in Italy suggested that mRNA vaccines were associated with myocarditis/pericarditis in the population younger than 40 years. According to our results, increased risk of myocarditis/pericarditis was associated with the second dose of BNT162b2 and both doses of mRNA-1273. The highest risks were observed in males of 12 to 39 years and in males and females 18 to 29 years vaccinated with mRNA-1273. The public health implication of these findings should be considered in the light of the proven mRNA vaccine effectiveness in preventing serious COVID-19 disease and death.
Collapse
Affiliation(s)
- Marco Massari
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Stefania Spila Alegiani
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Cristina Morciano
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
- * E-mail:
| | - Matteo Spuri
- Department of Infectious Diseases, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Pasquale Marchione
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Patrizia Felicetti
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Rome, Italy
| | | | - Marco Lazzeretti
- Business Intelligence, Data Science e Data Analysis, ARIA S.p.A., Milan, Italy
| | - Michele Ercolanoni
- Business Intelligence, Data Science e Data Analysis, ARIA S.p.A., Milan, Italy
| | - Elena Clagnan
- ARCS–Azienda Regionale di Coordinamento per la Salute, Udine, Italy
| | | | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ugo Moretti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giuseppe Monaco
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | - Olivia Leoni
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Fiorella Petronzelli
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Loriana Tartaglia
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Nadia Mores
- Institute of Pharmacology, Pharmacovigilance, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy
| | | | - Paola Rossi
- Direzione centrale salute, politiche sociali e disabilità, Friuli Venezia Giulia Region, Trieste, Italy
| | - Sarah Samez
- Centro Regionale di Farmacovigilanza, Friuli Venezia Giulia Region, Trieste, Italy
| | - Cristina Zappetti
- Direzione centrale salute, politiche sociali e disabilità, Friuli Venezia Giulia Region, Trieste, Italy
| | - Anna Rosa Marra
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Francesca Menniti Ippolito
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | | |
Collapse
|
16
|
Fabiani M, Puopolo M, Filia A, Sacco C, Mateo-Urdiales A, Spila Alegiani S, Del Manso M, D’Ancona F, Vescio F, Bressi M, Petrone D, Spuri M, Rota MC, Massari M, Da Cas R, Morciano C, Stefanelli P, Bella A, Tallon M, Proietti V, Siddu A, Battilomo S, Palamara AT, Popoli P, Brusaferro S, Rezza G, Riccardo F, Menniti Ippolito F, Pezzotti P. Effectiveness of an mRNA vaccine booster dose against SARS-CoV-2 infection and severe COVID-19 in persons aged ≥60 years and other high-risk groups during predominant circulation of the delta variant in Italy, 19 July to 12 December 2021. Expert Rev Vaccines 2022; 21:975-982. [PMID: 35389748 PMCID: PMC9115794 DOI: 10.1080/14760584.2022.2064280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/06/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Consolidated information on the effectiveness of COVID-19 booster vaccination in Europe are scarce. RESEARCH DESIGN AND METHODS We assessed the effectiveness of a booster dose of an mRNA vaccine against any SARS-CoV-2 infection (symptomatic or asymptomatic) and severe COVID-19 (hospitalization or death) after over two months from administration among priority target groups (n = 18,524,568) during predominant circulation of the Delta variant in Italy (July-December 2021). RESULTS Vaccine effectiveness (VE) against SARS-CoV-2 infection and, to a lesser extent, against severe COVID-19, among people ≥60 years and other high-risk groups (i.e. healthcare workers, residents in long-term-care facilities, and persons with comorbidities or immunocompromised), peaked in the time-interval 3-13 weeks (VE against infection = 67.2%, 95% confidence interval (CI): 62.5-71.3; VE against severe disease = 89.5%, 95% CI: 86.1-92.0) and then declined, waning 26 weeks after full primary vaccination (VE against infection = 12.2%, 95% CI: -4.7-26.4; VE against severe disease = 65.3%, 95% CI: 50.3-75.8). After 3-10 weeks from the administration of a booster dose, VE against infection and severe disease increased to 76.1% (95% CI: 70.4-80.7) and 93.0% (95% CI: 90.2-95.0), respectively. CONCLUSIONS These results support the ongoing vaccination campaign in Italy, where the administration of a booster dose four months after completion of primary vaccination is recommended.
Collapse
Affiliation(s)
- Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Puopolo
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Sacco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Martina Del Manso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fortunato D’Ancona
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fenicia Vescio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Bressi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Daniele Petrone
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Matteo Spuri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Massari
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Cristina Morciano
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Tallon
- Department of Informatics, Istituto Superiore di Sanità, Rome, Italy
| | - Valeria Proietti
- Directorate of Digitalisation, Health Information System and Statistics, Italian Ministry of Health, Rome, Italy
| | - Andrea Siddu
- General Directorate of Health Prevention, Italian Ministry of Health, Rome, Italy
| | - Serena Battilomo
- Directorate of Digitalisation, Health Information System and Statistics, Italian Ministry of Health, Rome, Italy
| | | | - Patrizia Popoli
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giovanni Rezza
- General Directorate of Health Prevention, Italian Ministry of Health, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
D’Aloja P, Da Cas R, Belleudi V, Fortinguerra F, Poggi FR, Perna S, Trotta F, Donati S. Drug Prescriptions among Italian and Immigrant Pregnant Women Resident in Italy: A Cross-Sectional Population-Based Study. Int J Environ Res Public Health 2022; 19:ijerph19074186. [PMID: 35409869 PMCID: PMC8998753 DOI: 10.3390/ijerph19074186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023]
Abstract
Ensuring drug safety for pregnant women through prescription drug monitoring is essential. The aim of this study was to describe the prescription pattern of medicines among pregnant immigrant women from countries with high migratory pressure (HMPCs) compared to pregnant Italian women. The prevalence of drug prescriptions among the two study populations was analysed through record linkage procedures applied to the administrative databases of eight Italian regions, from 2016 to 2018. The overall prevalence of drug prescription was calculated considering all women who received at least one prescription during the study period. Immigrants had a lower prevalence of drug prescriptions before (51.0% vs. 58.6%) and after pregnancy (55.1% vs. 60. 3%). Conversely, during pregnancy, they obtained a slightly higher number of prescriptions (74.9% vs. 72.8%). The most prescribed class of drugs was the blood and haematopoietic organs category (category ATC B) (56.4% vs. 45.9%, immigrants compared to Italians), followed by antimicrobials (31.3% vs. 33.7%). Most prescriptions were appropriate, while folic acid administration 3 months before conception was low for both study groups (3.9% immigrants and 6.2% Italians). Progesterone seemingly was prescribed against early pregnancy loss, more frequently among Italians (16.5% vs. 8.1% immigrants). Few inappropriate medications were prescribed among antihypertensives, statins and anti-inflammatory drugs in both study groups.
Collapse
Affiliation(s)
- Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità (National Institute of Health), 00161 Rome, Italy;
- Correspondence:
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), 00161 Rome, Italy;
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, 00145 Rome, Italy; (V.B.); (F.R.P.)
| | - Filomena Fortinguerra
- HTA & Pharmaceutical Economy Division, Italian Medicines Agency (AIFA), 00187 Rome, Italy; (F.F.); (S.P.); (F.T.)
| | - Francesca Romana Poggi
- Department of Epidemiology, Lazio Regional Health Service, 00145 Rome, Italy; (V.B.); (F.R.P.)
| | - Serena Perna
- HTA & Pharmaceutical Economy Division, Italian Medicines Agency (AIFA), 00187 Rome, Italy; (F.F.); (S.P.); (F.T.)
| | - Francesco Trotta
- HTA & Pharmaceutical Economy Division, Italian Medicines Agency (AIFA), 00187 Rome, Italy; (F.F.); (S.P.); (F.T.)
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità (National Institute of Health), 00161 Rome, Italy;
| | | |
Collapse
|
19
|
Zazzara MB, Cangini A, Da Cas R, Ippoliti I, Marengoni A, Pierantozzi A, Poluzzi E, Zito S, Onder G. Medication Use and Costs Among Older Adults Aged 90 Years and Older in Italy. Front Pharmacol 2022; 13:818875. [PMID: 35370651 PMCID: PMC8971522 DOI: 10.3389/fphar.2022.818875] [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: 11/20/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Older adults are often affected by multiple chronic conditions and experience geriatric syndromes that may affect the risk/benefit profile of medications. Little is known about the use of such medications in the older population. This article describes medication use and costs in Italian adults aged ≥90 years. Data from the 2019 Pharmaceutical Prescriptions database, concerning data on medications reimbursed by the Italian National Health Service, were analyzed in terms of prevalence and amount of use expressed as defined daily dose/1,000 users (DDD/1,000 users/day), accounting for different age-groups and sex. All individuals aged ≥90 years used at least one medication, with a mean number of 3128 DDD/1,000 users/day corresponding to an annual cost of 683 euros per user. Both use and costs linearly decreased with increasing age, with men accounting for a higher amount of DDD/1,000 users and costs than women across all age-groups. Antihypertensives (1330 DDD/1,000 inhabitants), antiplatelet agents (337 DDD/1,000 inhabitants), medications for peptic ulcer and gastroesophageal reflux (328 DDD/1,000 inhabitants), and lipid-lowering agents (166 DDD/1,000 inhabitants) were the most frequently used medications. We observed a progressive decrease in the usage of the majority of medications with increasing age, with the exception of antibiotics and antipsychotics. Individuals aged ≥90 years used a lower DDD/1,000 users, with an associated decrease in annual costs. The persistent use of preventive medications highlights the potential lack of awareness regarding medication rationalization and guidance for optimizing prescriptions. Our findings highlight the need for further initiatives to improve medications’ appropriateness in these older age-groups.
Collapse
Affiliation(s)
- Maria Beatrice Zazzara
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- *Correspondence: Maria Beatrice Zazzara,
| | | | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Ippoliti
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, Università Degli Studi di Brescia, Brescia, Italy
| | | | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Graziano Onder
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
20
|
Fabiani M, Puopolo M, Morciano C, Spuri M, Spila Alegiani S, Filia A, D'Ancona F, Del Manso M, Riccardo F, Tallon M, Proietti V, Sacco C, Massari M, Da Cas R, Mateo-Urdiales A, Siddu A, Battilomo S, Bella A, Palamara AT, Popoli P, Brusaferro S, Rezza G, Menniti Ippolito F, Pezzotti P. Effectiveness of mRNA vaccines and waning of protection against SARS-CoV-2 infection and severe covid-19 during predominant circulation of the delta variant in Italy: retrospective cohort study. BMJ 2022; 376:e069052. [PMID: 35144968 PMCID: PMC8829820 DOI: 10.1136/bmj-2021-069052] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To estimate the effectiveness of mRNA vaccines against SARS-CoV-2 infection and severe covid-19 at different time after vaccination. DESIGN Retrospective cohort study. SETTING Italy, 27 December 2020 to 7 November 2021. PARTICIPANTS 33 250 344 people aged ≥16 years who received a first dose of BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine and did not have a previous diagnosis of SARS-CoV-2 infection. MAIN OUTCOME MEASURES SARS-CoV-2 infection and severe covid-19 (admission to hospital or death). Data were divided by weekly time intervals after vaccination. Incidence rate ratios at different time intervals were estimated by multilevel negative binomial models with robust variance estimator. Sex, age group, brand of vaccine, priority risk category, and regional weekly incidence in the general population were included as covariates. Geographic region was included as a random effect. Adjusted vaccine effectiveness was calculated as (1-IRR)×100, where IRR=incidence rate ratio, with the time interval 0-14 days after the first dose of vaccine as the reference. RESULTS During the epidemic phase when the delta variant was the predominant strain of the SARS-CoV-2 virus, vaccine effectiveness against SARS-CoV-2 infection significantly decreased (P<0.001) from 82% (95% confidence interval 80% to 84%) at 3-4 weeks after the second dose of vaccine to 33% (27% to 39%) at 27-30 weeks after the second dose. In the same time intervals, vaccine effectiveness against severe covid-19 also decreased (P<0.001), although to a lesser extent, from 96% (95% to 97%) to 80% (76% to 83%). High risk people (vaccine effectiveness -6%, -28% to 12%), those aged ≥80 years (11%, -15% to 31%), and those aged 60-79 years (2%, -11% to 14%) did not seem to be protected against infection at 27-30 weeks after the second dose of vaccine. CONCLUSIONS The results support the vaccination campaigns targeting high risk people, those aged ≥60 years, and healthcare workers to receive a booster dose of vaccine six months after the primary vaccination cycle. The results also suggest that timing the booster dose earlier than six months after the primary vaccination cycle and extending the offer of the booster dose to the wider eligible population might be warranted.
Collapse
Affiliation(s)
| | - Maria Puopolo
- Italian National Institute of Health (ISS), Rome, Italy
| | | | - Matteo Spuri
- Italian National Institute of Health (ISS), Rome, Italy
| | | | | | | | | | | | - Marco Tallon
- Italian National Institute of Health (ISS), Rome, Italy
| | | | - Chiara Sacco
- Italian National Institute of Health (ISS), Rome, Italy
| | - Marco Massari
- Italian National Institute of Health (ISS), Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
De Angelis S, Rotondi D, Gilardi E, Stacchini P, Pastorelli AA, Sorbo A, D’Amato M, Turco AC, Medda E, Da Cas R, Andò S, Bonofiglio D, Bagnasco M, Gasperi M, Meringolo D, Mian C, Puxeddu E, Regalbuto C, Moleti M, Taccaliti A, Ulisse S, Tonacchera M, Tanda ML, Boi F, Ruggiero V, Mariotti S, Corbetta C, Ciatti R, Tarsi E, Stoppioni V, Perrotti N, Marasco O, Scozzafava G, Camilot M, Teofoli F, Righetti F, Dimida A, Plutino G, Carrano E, Copparoni R, Gabbianelli M, Vitti P, Olivieri A. Aggiornamento sulla nutrizione iodica in Italia: i risultati della seconda sorveglianza dell’Osservatorio per il Monitoraggio della Iodoprofilassi in Italia-OSNAMI (2015-2019). L'Endocrinologo 2022. [PMCID: PMC8790550 DOI: 10.1007/s40619-022-01018-3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Simona De Angelis
- Dipartimento di Malattie Cardiovascolari, Endocrino-Metaboliche e Invecchiamento, Istituto Superiore di Sanità, Roma, Italia
| | - Daniela Rotondi
- Dipartimento di Malattie Cardiovascolari, Endocrino-Metaboliche e Invecchiamento, Istituto Superiore di Sanità, Roma, Italia
| | - Enzo Gilardi
- Dipartimento di Malattie Cardiovascolari, Endocrino-Metaboliche e Invecchiamento, Istituto Superiore di Sanità, Roma, Italia
| | - Paolo Stacchini
- Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare, Istituto Superiore di Sanità, Roma, Italia
| | - Augusto Alberto Pastorelli
- Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare, Istituto Superiore di Sanità, Roma, Italia
| | - Angela Sorbo
- Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare, Istituto Superiore di Sanità, Roma, Italia
| | - Marilena D’Amato
- Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare, Istituto Superiore di Sanità, Roma, Italia
| | - Anna Chiara Turco
- Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare, Istituto Superiore di Sanità, Roma, Italia
| | - Emanuela Medda
- Centro di Riferimento per le Scienze Comportamentali e la Salute Mentale, Istituto Superiore di Sanità, Roma, Italia
| | - Roberto Da Cas
- Centro Nazionale Ricerca e Valutazione Preclinica e Clinica dei Farmaci, Istituto Superiore di Sanità, Roma, Italia
| | - Sebastiano Andò
- Centro Sanitario, Dipartimento di Farmacia e Scienze della Salute e della Nutrizione, Università della Calabria, Cosenza, Italia
| | - Daniela Bonofiglio
- Centro Sanitario, Dipartimento di Farmacia e Scienze della Salute e della Nutrizione, Università della Calabria, Cosenza, Italia
| | - Marcello Bagnasco
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, IRCCS Ospedale Policlinico S. Martino, Genova, Italia
| | - Maurizio Gasperi
- Dipartimento di Medicina e Scienze per la Salute, Università degli Studi del Molise, Campobasso, Italia
| | | | - Caterina Mian
- Dipartimento di Medicina, Azienda Ospedaliera di Padova, Padova, Italia
| | - Efisio Puxeddu
- Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italia
| | - Concetto Regalbuto
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Catania, Italia
| | - Mariacarla Moleti
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italia
| | - Augusto Taccaliti
- Clinica di Endocrinologia e Malattie del Metabolismo, Università Politecnica delle Marche, Ancona, Italia
| | - Salvatore Ulisse
- Dipartimento di Scienze Chirurgiche, “Sapienza” Università di Roma, Roma, Italia
| | - Massimo Tonacchera
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italia
| | - Maria Laura Tanda
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, ASST-Settelaghi, Varese, Italia
| | - Francesco Boi
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italia
| | - Valeria Ruggiero
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italia
| | - Stefano Mariotti
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italia
| | - Carlo Corbetta
- Laboratorio di Riferimento Regionale per lo Screening Neonatale, Ospedale V. Buzzi, Milano, Italia
| | - Renzo Ciatti
- Centro Screening Neonatale Regione Marche, UOC di Neuropsichiatria Infantile, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Ospedaliero Santa Croce, Fano, Italia
| | - Elisabetta Tarsi
- Centro Screening Neonatale Regione Marche, UOC di Neuropsichiatria Infantile, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Ospedaliero Santa Croce, Fano, Italia
| | - Vera Stoppioni
- Centro Screening Neonatale Regione Marche, UOC di Neuropsichiatria Infantile, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Ospedaliero Santa Croce, Fano, Italia
| | - Nicola Perrotti
- Dipartimento Scienze della Salute, Università Magna Graecia, Catanzaro, Italia
| | - Onorina Marasco
- Laboratorio Regionale di Screening Neonatale, Azienda Ospedaliera Mater Domini, Catanzaro, Italia
| | - Giovanna Scozzafava
- Laboratorio Regionale di Screening Neonatale, Azienda Ospedaliera Mater Domini, Catanzaro, Italia
| | - Marta Camilot
- Laboratorio Regionale di Screening Neonatale, Azienda Ospedaliera Universitaria Integrata di Verona, Ospedale Borgo Roma, Verona, Italia
| | - Francesca Teofoli
- Laboratorio Regionale di Screening Neonatale, Azienda Ospedaliera Universitaria Integrata di Verona, Ospedale Borgo Roma, Verona, Italia
| | - Francesca Righetti
- Centro Laboratoristico Regionale di Riferimento per lo Screening Neonatale e Malattie Endocrino-Metaboliche, Azienda Ospedaliero-Universitaria Policlinico Sant’Orsola-Malpighi, Bologna, Italia
| | - Antonio Dimida
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italia
| | - Giuseppe Plutino
- Direzione Generale per l’Igiene e la Sicurezza degli Alimenti e la Nutrizione, Ministero della Salute, Roma, Italia
| | - Elena Carrano
- Direzione Generale per l’Igiene e la Sicurezza degli Alimenti e la Nutrizione, Ministero della Salute, Roma, Italia
| | - Roberto Copparoni
- Direzione Generale per l’Igiene e la Sicurezza degli Alimenti e la Nutrizione, Ministero della Salute, Roma, Italia
| | - Marco Gabbianelli
- Dipartimento di Malattie Cardiovascolari, Endocrino-Metaboliche e Invecchiamento, Istituto Superiore di Sanità, Roma, Italia
| | - Paolo Vitti
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italia
| | - Antonella Olivieri
- Dipartimento di Malattie Cardiovascolari, Endocrino-Metaboliche e Invecchiamento, Istituto Superiore di Sanità, Roma, Italia
| |
Collapse
|
22
|
Zito S, Fortinguerra F, Pierantozzi A, Ambrosino F, Traversa G, Trotta F, Da Cas R, Cangini A. [Medicines use in Italy. 2020 OsMed National Report.]. Recenti Prog Med 2021; 112:659-667. [PMID: 34647536 DOI: 10.1701/3679.36657] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The 2020 National Report "Medicines use in Italy", produced by the National Observatory on the Use of Medicines (OsMed) of the Italian Medicines Agency (AIFA), describes the Italian pharmaceutical assistance through different available information flows that allow to recompose pharmaceutical territorial and hospital assistance, concerning both the national health service and private citizens. In the Report the results of numerous analyzes, both general and focused on specific therapeutic categories and classes, relating to pharmaceutical expenditure and consumption, are reported, but it is also present an in-depth analysis about monitoring registries and conditional reimbursement agreements, and a comparison between the most relevant Italian data and those of nine other European countries.
Collapse
|
23
|
Ippoliti I, Ancidoni A, Vanacore N, Da Cas R, Pierantozzi A, Trotta F. Anti-dementia drugs: A descriptive study of prescription pattern in Italy. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119045] [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: 11/17/2022]
|
24
|
Mateo-Urdiales A, Spila Alegiani S, Fabiani M, Pezzotti P, Filia A, Massari M, Riccardo F, Tallon M, Proietti V, Del Manso M, Puopolo M, Spuri M, Morciano C, D'Ancona FP, Da Cas R, Battilomo S, Bella A, Menniti-Ippolito F. Risk of SARS-CoV-2 infection and subsequent hospital admission and death at different time intervals since first dose of COVID-19 vaccine administration, Italy, 27 December 2020 to mid-April 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34169819 PMCID: PMC8229378 DOI: 10.2807/1560-7917.es.2021.26.25.2100507] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 12/20/2022]
Abstract
To assess the real-world impact of vaccines on COVID-19 related outcomes, we analysed data from over 7 million recipients of at least one COVID-19 vaccine dose in Italy. Taking 0–14 days post-first dose as reference, the SARS-CoV-2 infection risk subsequently decreased, reaching a reduction by 78% (incidence rate ratios (IRR): 0.22; 95% CI: 0.21–0.24) 43–49 days post-first dose. Similarly, hospitalisation and death risks decreased, with 89% (IRR: 0.11; 95% CI: 0.09–0.15) and 93% (IRR: 0.07; 95% CI: 0.04–0.11) reductions 36–42 days post-first dose. Our results support ongoing vaccination campaigns.
Collapse
Affiliation(s)
- Alberto Mateo-Urdiales
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Massari
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Tallon
- Department of Informatics, Istituto Superiore di Sanità, Rome, Italy
| | | | - Martina Del Manso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Maria Puopolo
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Matteo Spuri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cristina Morciano
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | | | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | | | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | -
- The members have been listed at the end of this article
| | -
- The members have been listed at the end of this article
| |
Collapse
|
25
|
Piccinni C, Addesi A, Pedrini A, Esposito I, Rampazzo R, Mezzalira L, Trentin L, Font M, Trotta F, Pierantozzi A, Di Filippo A, Altamura G, Da Cas R, Martini N. [Therapeutic drug plans: how many and which ones? Overview of a prescriptive and care appropriateness tool.]. Recenti Prog Med 2021; 112:243-249. [PMID: 33877085 DOI: 10.1701/3584.35683] [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: 11/05/2022]
Abstract
Therapeutic plans (TPs) were introduced in Italy in 2004 in order to ensure the continuity in the prescription of new drugs between specialist physicians and general practitioners (GPs). Over the years this prescription tool was updated several times: starting from a paper form without any template ("paper TP") to a template defined by AIFA to collect specific clinical information, up to a web-based form to collect all information into a database. Over time-critical issues concerning its usefulness have been raised, especially when AIFA established several extensions for TP validity to ensure the social distancing required by the covid-19 pandemic. Therefore, after several years from their establishment, pending adoption of necessary implementing of Ministerial Decree of 25th March 2020, a check of the actual impact of TPs is required, in order to plan their review. This study provide a detailed overview of all TPs active in Italy at the 11th May 2020. From Farmadati database, all drugs reimbursed by the National Health Service (class A drugs) and requiring TP were selected. The consumption of these drugs has been derived from OsMed Reports that make available data of medicines consumption and expenditure in the general population in Italy. The analysis showed that TP is required for the prescription of 935 medicinal products (9.6% of class-A drugs) and 147 different active substances (belonging to 34 different Therapeutic Groups and 66 subgroups). Out of these, 67 (46%) required a paper TP without any template, 72 (49%) a paper TP on AIFA template, and 8 (5%) a web-based TP. The Therapeutic Group with the largest number of active ingredients with TP were antidiabetics (19.7%), followed by immunomodulating and immunosuppressants (9.5%) and medications for asthma and COPD (6.8%). Consumption analysis of drugs with TP showed that this prescription tool covers 943,899,598 DDD per year, equal to 2,586,026 DDD/day. This means that TPs have a very high impact in terms of the prevalence of patients treated on the entire care process. Of all annual DDDs prescribed on TP, 46.8% concerned drugs with TP on template AIFA, 34.5% drugs with web-based TP, while the remaining 18.7% drugs with paper TP without a template. This analysis may provide the basis for an analytical case-by-case review of TP maintenance needs, trying to maximize the benefits of this tool and to reduce its possible adverse effects. This review could be helpful to ensure the appropriateness in the drug uses, to enhance the role of general medicine, and to simplify the pathways of millions of patients ensuring the continuity of their care.
Collapse
|
26
|
Fulgenzio C, Massari M, Traversa G, Da Cas R, Ferrante G, Aschbacher R, Moser V, Pagani E, Vestri AR, Massidda O, Kurotschka PK. Impact of Prior Antibiotic Use in Primary Care on Escherichia coli Resistance to Third Generation Cephalosporins: A Case-Control Study. Antibiotics (Basel) 2021; 10:antibiotics10040451. [PMID: 33923682 PMCID: PMC8073604 DOI: 10.3390/antibiotics10040451] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/05/2022] Open
Abstract
Research is lacking on the reversibility of antimicrobial resistance (AMR). Thus, we aimed to determine the influence of previous antibiotic use on the development and decay over time of third generation cephalosporin (3GC)-resistance of E. coli. Using the database of hospital laboratories of the Autonomous Province of Bolzano/Bozen (Italy), anonymously linked to the database of outpatient pharmaceutical prescriptions and the hospital discharge record database, this matched case-control study was conducted including as cases all those who have had a positive culture from any site for 3GC resistant E. coli (3GCREC) during a 2016 hospital stay. Data were analyzed by conditional logistic regression. 244 cases were matched to 1553 controls by the date of the first isolate. Male sex (OR 1.49, 95% CI 1.10–2.01), older age (OR 1.11, 95% CI 1.02–1.21), the number of different antibiotics taken in the previous five years (OR 1.20, 95% CI 1.08–1.33), at least one antibiotic prescription in the previous year (OR 1.92, 95% CI 1.36–2.71), and the diagnosis of diabetes (OR 1.57, 95% CI 1.08–2.30) were independent risk factors for 3GCREC colonization/infection. Patients who last received an antibiotic prescription two years or three to five years before hospitalization showed non-significant differences with controls (OR 0.97, 95% CI 0.68–1.38 and OR 0.85, 95% CI 0.59–1.24), compared to an OR of 1.92 (95% CI 1.36–2.71) in those receiving antibiotics in the year preceding hospitalization. The effect of previous antibiotic use on 3GC-resistance of E. coli is highest after greater cumulative exposure to any antibiotic as well as to 3GCs and in the first 12 months after antibiotics are taken and then decreases progressively.
Collapse
Affiliation(s)
- Chiara Fulgenzio
- Department of Public Health and Infectious Diseases, Postgraduate School of Medical Statistics and Biometry, University of Rome “La Sapienza”, 00185 Rome, Italy; (C.F.); (A.R.V.)
| | - Marco Massari
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.M.); (G.T.); (R.D.C.)
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.M.); (G.T.); (R.D.C.)
- Agenzia Italiana del Farmaco, 00187 Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.M.); (G.T.); (R.D.C.)
| | - Gianluigi Ferrante
- Azienda Ospedaliera, Universitaria Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Richard Aschbacher
- Health Service of Bolzano/Bozen Province, 39100 Bolzano/Bozen, Italy; (R.A.); (V.M.); (E.P.)
| | - Verena Moser
- Health Service of Bolzano/Bozen Province, 39100 Bolzano/Bozen, Italy; (R.A.); (V.M.); (E.P.)
| | - Elisabetta Pagani
- Health Service of Bolzano/Bozen Province, 39100 Bolzano/Bozen, Italy; (R.A.); (V.M.); (E.P.)
| | - Anna Rita Vestri
- Department of Public Health and Infectious Diseases, Postgraduate School of Medical Statistics and Biometry, University of Rome “La Sapienza”, 00185 Rome, Italy; (C.F.); (A.R.V.)
| | - Orietta Massidda
- Department of Cellular, Computational and Integrative Biology, University of Trento, 38123 Povo, Italy;
| | - Peter Konstantin Kurotschka
- Department of Medical Sciences and Public Health, Faculty of Medicine and Surgery, University of Cagliari, 09124 Cagliari, Italy
- Correspondence:
| |
Collapse
|
27
|
Unim B, Minelli G, Da Cas R, Manno V, Trotta F, Palmieri L, Galluzzo L, Maggi S, Onder G. Trends in hip and distal femoral fracture rates in Italy from 2007 to 2017. Bone 2021; 142:115752. [PMID: 33188958 DOI: 10.1016/j.bone.2020.115752] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/29/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
Osteoporosis-related fractures are a growing public health concern worldwide due to high societal and economic burden. The study aims to assess trends in incidence rates of hip and distal femoral fractures and in the use of anti-osteoporosis drugs in Italy between 2007 and 2017. Patients with hip and distal femoral fractures (ICD-9-CM codes 820.x and 821.x) were identified in the Italian National Hospital Discharge Database while anti-osteoporosis medication data were retrieved from the National Observatory on the Use of Medicines Database. A joinpoint regression analysis was performed to identify the years where the trends in incidence rates of hip and distal femoral fractures changed significantly; the average annual percentage change for the period of observation was estimated. Hospitalizations for femoral fractures were 991,059, of which 91.4% were hip fractures and 76.5% occurred in women. Age-standardized hip fractures rate per 100,000 person-years decreased both in women (-8.7%; from 789.9 in 2007 to 721.5 in 2017) and in men (-4.3%; from 423.9 to 405.6), while the rate of distal femoral fractures increased by 23.9% in women (from 67.78 to 83.95) and 22.7% in men (from 27.76 to 34.06). These changes were associated with an increment in the use of anti-osteoporosis drugs from 2007 to 2011 (from 9.1 to 12.4 DDD/1000 inhabitants/day), followed by a plateau in the period 2012-2017. The use of bisphosphonates increased progressively from 2007 to 2010 (from 8.2 to 10.5 DDD/1000 inhabitants/day), followed by a plateau and then decreased from 2015 onwards. The decreasing trend of hip fractures could be related to a major intake of anti-osteoporosis medications while the increment of distal femoral fractures might be due to population aging and to the use of bisphosphonates and denosumab. Further research is needed to identify and implement interventions to prevent hip and distal femoral fractures.
Collapse
Affiliation(s)
- Brigid Unim
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
| | - Giada Minelli
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Valerio Manno
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | | | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Galluzzo
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
28
|
Maestri E, Formoso G, Da Cas R, Mammarella F, Guerrizio MA, Trotta F. [Vitamin D and coronavirus: a new field of use?]. Recenti Prog Med 2020; 111:253-256. [PMID: 32319447 DOI: 10.1701/3347.33188] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Given the succession of communications in scientific and popular circuits, tending to take for granted a role for vitamin D in the control of the coronavirus pandemic, the authors conducted an analysis of the literature currently available in order to recognize what is supported by opinions personal and what evidence of effectiveness. At the end of the bibliographic survey there is the current absence of evidence of efficacy in favor of vitamin D in the treatment of coronavirus infection in its various expressions. The diffusion of personal opinions as if they were evidence can be a disturbing factor for adequate assistance and for correct research.
Collapse
Affiliation(s)
- Emilio Maestri
- Azienda USL - IRCCS di Reggio Emilia, Ambulatorio di Endocrinologia, Guastalla (Reggio Emilia)
| | - Giulio Formoso
- Azienda USL - IRCCS di Reggio Emilia, Ambulatorio di Endocrinologia, Guastalla (Reggio Emilia)
| | | | | | | | | |
Collapse
|
29
|
Cangini A, Fortinguerra F, Di Filippo A, Pierantozzi A, Da Cas R, Villa F, Trotta F, Moro ML, Gagliotti C. Monitoring the community use of antibiotics in Italy within the National Action Plan on antimicrobial resistance. Br J Clin Pharmacol 2020; 87:1033-1042. [PMID: 32643167 DOI: 10.1111/bcp.14461] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/21/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In Italy both the consumption of antibiotics and the prevalence of bacterial resistance are higher than in other European countries. In 2017, the first National Action Plan on Antimicrobial Resistance (PNCAR) was adopted in Italy. In response to the PNCAR two national reports on antibiotic use in the human setting have been published. This article's aim is to describe the pattern of antibiotic consumption in the community setting in Italy from 2013 to 2018. METHODS To analyse the consumption for reimbursed antibiotics dispensed by community pharmacies different data sources were used. Consumption was measured in terms of defined daily dose (DDD), prescriptions or prevalence of use. RESULTS In 2018, the consumption of antibiotics in Italy amounted to 16.1 DDD per 1000 inhabitants per day. The rates of consumption by geographical area were: 12.7 DDD in the north, 16.9 in the centre and 20.4 in the south. The use was greater in the extreme age groups than in the population aged from 20 to 64 years. The consumption was higher in winter season, with high peaks in the incidence of flu syndromes. In the paediatric population, a utilization rate of 1010 prescriptions per 1000 children, with a prevalence of use of 40.8%, was found. CONCLUSION The study provides useful information on the geographical variability of antibiotic use in Italy to guide decision makers in the introduction of tailored interventions, as suggested by PNCAR, aimed at promoting a more rational use of antibiotics for humans and reducing antimicrobial resistance.
Collapse
Affiliation(s)
| | | | | | | | | | - Federico Villa
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Maria Luisa Moro
- Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Bologna, Italy
| | - Carlo Gagliotti
- Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Bologna, Italy
| |
Collapse
|
30
|
Kurotschka PK, Serafini A, Massari M, Da Cas R, Figueiras A, Forte V, Moro MF, Massidda M, Contu F, Minerba L, Marcias M, Nardelli M, Perra A, Carta MG, Spila Alegiani S. Broad Spectrum project: factors determining the quality of antibiotic use in primary care: an observational study protocol from Italy. BMJ Open 2020; 10:e038843. [PMID: 32636291 PMCID: PMC7342852 DOI: 10.1136/bmjopen-2020-038843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The overuse of antibiotics is causing worldwide spread of antimicrobial resistance (AMR). Compared with other countries, Italy has both high antibiotic consumption rates and high rates of AMR. Due to the fact that around 90% of antibiotics are prescribed by general practitioners (GPs), this study aims to measure the impact of knowledge, attitudes and sociodemographic and workplace-related factors on the quality of antibiotic prescriptions filled by GPs in the Italian Region of Sardinia. METHODS AND ANALYSIS Knowledge, attitude, sociodemographic and workplace-related factors deemed to influence physicians prescribing behaviour will be evaluated in a cross-sectional study conducted among all GPs of the Italian Region of Sardinia (n=1200). A knowledge and attitudes questionnaire (Knowledge and Attitudes on Antibiotics and Resistance - Italian version: ITA-KAAR) accompanied by a sociodemographic form will be linked to drug prescription data reimbursed by the National Health System. European Surveillance of Antibiotic Consumption quality indicators for outpatient antibiotic use will be calculated from drug prescription records. Every GP will be deemed to have demonstrated an adequate quality of prescriptions of antibiotics if half of the indicator score plus one is better than the median of the region. A multivariate Poisson regression model with robust variance estimation will be used to evaluate the impact of the determinants of antibiotic prescriptions on the actual prescribing quality of each physician. ETHICS AND DISSEMINATION The project has been approved by the ethics committee of the Regional Health Trust of Sardinia (176/2019/CE, 24 September 2019). The results will be useful to inform evidence-based interventions to tackle irrational antibiotic use in the community.
Collapse
Affiliation(s)
- Peter Konstantin Kurotschka
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
- General Practitioner in Training, Primary Care Department, Regional Health Trust of Sardinia, Cagliari, Italy
| | - Alice Serafini
- General Practitioner in Training, Primary Care Department, Local Health Trust Modena, Modena, Italy
| | - Marco Massari
- National Centre for Pre-Clinical and Clinical Drug Research and Surveillance (CNRVF), Istituto Superiore di Sanita, Rome, Italy
| | - Roberto Da Cas
- National Centre for Pre-Clinical and Clinical Drug Research and Surveillance (CNRVF), Istituto Superiore di Sanita, Rome, Italy
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Viviana Forte
- General Practitioner, Primary Care Department, Regional Health Trust, Cagliari, Italy
| | | | - Matteo Massidda
- General Practitioner in Training, Primary Care Department, Regional Health Trust of Sardinia, Cagliari, Italy
| | - Federico Contu
- General Practitioner in Training, Primary Care Department, Regional Health Trust of Sardinia, Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Maurizio Marcias
- Health Technology Assessment Unit, Regional Health Trust of Sardinia, Cagliari, Italy
| | - Marco Nardelli
- Brayford Square Surgery, Tower Hamlets Primary Care Trust, London, UK
| | - Alessandra Perra
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Stefania Spila Alegiani
- National Centre for Pre-Clinical and Clinical Drug Research and Surveillance (CNRVF), Istituto Superiore di Sanita, Rome, Italy
| |
Collapse
|
31
|
Cangini A, Gagliotti C, Fortinguerra F, Da Cas R, Villa F, Trotta MP, Moro ML, Trotta F. [Prescribing appropriateness, use and consumption of antibiotics in Italy. An extract from the National Report 2018.]. Recenti Prog Med 2020; 111:13-29. [PMID: 31992901 DOI: 10.1701/3294.32650] [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: 11/05/2022]
Abstract
INTRODUCTION Antimicrobial resistance is a major global public health concern. In Italy, in 2017, the National Plan to Fight Antimicrobial Resistance (PNCAR 2017-2020) was approved, in line with the Global One Health Action Plan. Despite the decreasing trend, the consumption of antibiotics in Italy continues to be higher than the European average, with a great variability between regions. In the European investigation on the distribution of resistant bacteria in Europe, Italy holds together with Greece the record for the spread of resistant germs. OBJECTIVE The present study, dedicated to antibiotics for human use, allows to monitor the trend of consumption and expenditure in Italy and at the same time to identify areas of potential inappropriateness of use. METHODS The analyses presented concern the use of antibiotics in the community setting, with a focus on consumption in the paediatric population and on the prescription of fluoroquinolones in specific population subgroups. In addition, the analysis on the use of antibiotics in hospital settings, the analysis on the private purchase of reimbursed antibiotics and the evaluation of indicators of appropriateness of antibiotic prescribing were also included. The analyses are based on the reading and integration of the data collected through different administrative healthcare databases: OsMed, Purchase by public health facilities, Direct distribution, Hospital consumption, Monitoring of pharmaceutical prescriptions, Private purchase by citizens, Hospital Discharge Records (Schede di Dimissione Ospedaliera, SDO), InfluNet surveillance. RESULTS The consumption of antibiotics in Italy in 2018 stood at 21.4 DDD/1000 ab. die and, despite the downward trend, is still above the European average. In terms of consumption within the territory (community setting), there is a considerable regional variety - ranging from 8.9 of the provincial government of Bolzano to 23.4 DDD/1000 ab. die of Campania (national average 16.1 DDD) - with higher values in the South and the Islands and lower in the North. The differences in drug use concern not only the number of prescriptions but also the type of antibiotics prescribed (type of molecules; broad spectrum vs. narrow spectrum). The association amoxicillin/clavulanic acid is the most widely used antibiotic both in the community and in hospitals. In the paediatric population (0-13 years) there is a peak prevalence of use of 50% in the first year of life of the child, with no differences between males and females. The consumption of antibiotics in hospitals is increasing in the three-year period 2016-2018 and presents a wide variability between different geographical areas.
Collapse
Affiliation(s)
- Agnese Cangini
- Ufficio Monitoraggio della Spesa Farmaceutica e Rapporti con le Regioni, Agenzia Italiana del Farmaco
| | - Carlo Gagliotti
- Agenzia Sanitaria e Sociale Regionale Regione Emilia-Romagna
| | - Filomena Fortinguerra
- Ufficio Monitoraggio della Spesa Farmaceutica e Rapporti con le Regioni, Agenzia Italiana del Farmaco
| | - Roberto Da Cas
- Centro Nazionale Ricerca e la Valutazione preclinica e clinica dei Farmaci (CNRVF), Istituto Superiore di Sanità
| | - Federico Villa
- Ufficio Monitoraggio della Spesa Farmaceutica e Rapporti con le Regioni, Agenzia Italiana del Farmaco
| | - Maria Paola Trotta
- Ufficio Monitoraggio della Spesa Farmaceutica e Rapporti con le Regioni, Agenzia Italiana del Farmaco
| | | | - Francesco Trotta
- Ufficio Monitoraggio della Spesa Farmaceutica e Rapporti con le Regioni, Agenzia Italiana del Farmaco
| |
Collapse
|
32
|
Crescioli G, Lombardi N, Bettiol A, Menniti‐Ippolito F, Da Cas R, Parrilli M, Del Lungo M, Gallo E, Mugelli A, Maggini V, Firenzuoli F, Vannacci A. Adverse events following cannabis for medical use in Tuscany: An analysis of the Italian Phytovigilance database. Br J Clin Pharmacol 2020; 86:106-120. [PMID: 31656045 PMCID: PMC6983517 DOI: 10.1111/bcp.14140] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS Despite a significant increase in using cannabis for medical purposes, current evidence on its safety in real-world clinical practice is still poorly characterised. By a case-by-case analysis of spontaneous reports of suspected adverse events (AEs) collected in Tuscany within the Italian Phytovigilance database, the aim of the present study was to describe AEs occurred in patients exposed to medical cannabis. METHODS We evaluated all reports of cannabis-related suspected AEs collected within the Phytovigilance database up to December 2018. Information regarding cannabis therapy, patient's demographic and clinical characteristics, concomitant medications, AE description according to the Medical Dictionary for Regulatory Activities (MedDRA) classification, AE seriousness and AE outcome, were collected. The causality assessment was performed following World Health Organisation-Uppsala Monitoring Centre criteria. RESULTS Fifty-three cannabis-related AE reports were analysed. The majority of patients were females (77.3%), with a mean age of 61.9 years. Thirty-nine (73.6%) cases were defined as nonserious and the majority of them (86.9%) showed a complete resolution or improvement. Forty-six (86.8%) cases were judged as probably related to cannabis consumption. The most frequently reported system organ class was psychiatric and nervous system disorders, and a potential drug-drug interaction was present in 16 cases. CONCLUSION Cannabis was generally well tolerated and the majority of AEs were mild and transient. Our analysis highlighted important safety issues for clinical practice, in particular the need for an accurate prescription monitoring during the titration phase, particularly in the presence of concomitant medications.
Collapse
Affiliation(s)
- Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly
| | - Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly
| | | | - Roberto Da Cas
- National Centre for Drug Research and EvaluationNational Institute of HealthRomeItaly
| | - Maria Parrilli
- Regional Centre for PharmacovigilanceAzienda USL Toscana CentroFlorenceItaly
| | - Martina Del Lungo
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly
- Regional Centre for PharmacovigilanceAzienda USL Toscana CentroFlorenceItaly
| | - Eugenia Gallo
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Research and Innovation Center in Phytotherapy and Integrated Medicine – CERFIT, Referring Center for Phytotherapy of Tuscany Region, CareggiUniversity HospitalFlorenceItaly
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly
| | - Valentina Maggini
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Research and Innovation Center in Phytotherapy and Integrated Medicine – CERFIT, Referring Center for Phytotherapy of Tuscany Region, CareggiUniversity HospitalFlorenceItaly
| | - Fabio Firenzuoli
- Research and Innovation Center in Phytotherapy and Integrated Medicine – CERFIT, Referring Center for Phytotherapy of Tuscany Region, CareggiUniversity HospitalFlorenceItaly
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly
| |
Collapse
|
33
|
Trotta F, Mayer F, Barone-Adesi F, Esposito I, Punreddy R, Da Cas R, Traversa G, Perrone F, Martini N, Gyawali B, Addis A. Anticancer drug prices and clinical outcomes: a cross-sectional study in Italy. BMJ Open 2019; 9:e033728. [PMID: 31826897 PMCID: PMC6924817 DOI: 10.1136/bmjopen-2019-033728] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate whether the prices of new anticancer drugs correlated with their relative benefit despite negotiation. DESIGN Retrospective cross-sectional study correlating new anticancer drugs prices with clinical outcomes. SETTING We did a retrospective cross-sectional study including all new anticancer drugs approved by the European Medicines Agency (EMA) (2010-2016) and reimbursed in Italy. MAIN OUTCOMES AND MEASURES Information on clinical outcomes-in terms of median overall survival (OS), median progression-free survival (PFS) and objective response rate (ORR)-was extracted from pivotal trials as reported in the European Public Assessment Reports available on the EMA website. Cost of a full course treatment was estimated on negotiated official and discounted prices. Regression coefficients β, their levels of significance p and the coefficients of determination R2 were estimated adjusting by tumour type. RESULTS Overall, 30 new anticancer drugs (with 35 indications) were available for analysis. Where data on OS were available, we observed no correlation between the improvement in median OS (in weeks) and negotiated price (R2=0.067, n=16 drugs for 17 indications). When the clinical outcomes were expressed as improvements in the median PFS or ORR, 25 drugs (29 indications) were available for the analysis, and again, there was no correlation with prices (R2=0.004 and 0.006, respectively). CONCLUSIONS AND RELEVANCE Our results suggest that the prices of anticancer drugs in Italy do not reflect their therapeutic benefit. Drug price negotiations, which is mandatory by law in Italy, do not seem to ensure that prices correlate with clinical benefits provided by the cancer drugs. These results call for further efforts to establish the standard determinants of drug prices available at the time of negotiation. These findings need to be confirmed in other countries where price negotiations are in place. Moreover, further investigations may verify whether outcome data obtained after drug marketing would improve the correlation between prices and therapeutic benefit.
Collapse
Affiliation(s)
- Francesco Trotta
- Department of Epidemiology of the Regional Health Service Lazio, Rome, Italy
| | - Flavia Mayer
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Italy
| | | | | | | | - Roberto Da Cas
- National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Giuseppe Traversa
- National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Francesco Perrone
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | | | - Antonio Addis
- Department of Epidemiology of the Regional Health Service Lazio, Rome, Italy
| |
Collapse
|
34
|
Spila-Alegiani S, Trotta F, Da Cas R, Rossi M, Venegoni M, Traversa G. Comparative Effectiveness of Two Tiotropium Formulations: A Retrospective Cohort Study. COPD 2019; 15:418-423. [PMID: 30822243 DOI: 10.1080/15412555.2018.1554032] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The effectiveness of the tiotropium Respimat® formulation in routine clinical practice is still an open issue due to concern about the generalizability of the Tiotropium Safety and Performance in Respimat® (TIOSPIR) trial findings. Our aim was to compare the incidence of acute respiratory events between new users of tiotropium Respimat® and HandiHaler®. The study population comprised patients aged ≥45 years resident in two Italian regions who received a first tiotropium prescription (HandiHaler® or Respimat®) between 1 July 2011 and 30 November 2013. The cohort was identified within the database of drug prescriptions reimbursed by the Italian National Health Service. Clinical outcomes were obtained from hospital records. The primary outcome was the first hospitalization for respiratory events, including chronic obstructive pulmonary disease (COPD) exacerbation, respiratory failure, hypoxemia/hyperventilation and pneumonia, during the exposure period. The hazard ratios were estimated for the propensity score matched groups with Cox regression. After matching, 31,334 patients with incident tiotropium prescriptions were included. Similar incidence rates of the primary outcome between the Respimat® and HandiHaler® users were identified (adjusted hazard ratio 0.95, 95% CI 0.84-1.07). No differences emerged in the subgroup analyses conducted according to the baseline characteristics of the tiotropium users. This study confirms the findings observed in the TIOSPIR trial in a more heterogeneous population that included patient subgroups with severe respiratory disease and unstable COPD.
Collapse
Affiliation(s)
- Stefania Spila-Alegiani
- a Pharmacoepidemiology Unit, National Center for Drug Research and Evaluation , National Institute of Health (ISS) , Rome , Italy
| | | | - Roberto Da Cas
- a Pharmacoepidemiology Unit, National Center for Drug Research and Evaluation , National Institute of Health (ISS) , Rome , Italy
| | - Mariangela Rossi
- c Unit for Pharmaceutical Governance , General Directorate for Health , Perugia , Italy
| | - Mauro Venegoni
- d Pharmacology Institute, University of Verona , Verona , Italy
| | - Giuseppe Traversa
- a Pharmacoepidemiology Unit, National Center for Drug Research and Evaluation , National Institute of Health (ISS) , Rome , Italy
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Trotta F, Spila-Alegiani S, Da Cas R, Rajevic M, Conti V, Venegoni M, Rossi M, Traversa G. Cardiovascular safety of tiotropium Respimat vs HandiHaler in the routine clinical practice: A population-based cohort study. PLoS One 2017; 12:e0176276. [PMID: 28430820 PMCID: PMC5400270 DOI: 10.1371/journal.pone.0176276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/07/2017] [Indexed: 01/08/2023] Open
Abstract
The cardiovascular safety of tiotropium Respimat formulation in the routine clinical practice is still an open issue. Our aim was to compare the risk of acute myocardial infarction and heart rhythm disorders in incident users of either tiotropium Respimat or HandiHaler. The study population comprises patients aged ≥45 years, resident in two Italian regions with a first prescription of tiotropium (HandiHaler or Respimat) between 01/07/2011-30/11/2013. The cohort was identified through the database of prescriptions reimbursed by the Italian National Health Service. Comorbidities and clinical outcomes were obtained from hospital records. The primary outcome was the first hospitalization for acute myocardial infarction and/or for heart rhythm disorders during the exposure period. Hazard ratios were estimated in the propensity score-matched groups through Cox regression. After matching, 31,334 patients with incident prescription of tiotropium were included. The two groups were balanced with regard to baseline characteristics. Similar incidence rates of the primary outcome between Respimat and HandiHaler users were identified (adjusted hazard ratio 1.02, 95% CI 0.82–1.28). No risk difference between Respimat and HandiHaler emerged when considering clinical events separately. This large cohort study showed a comparable acute cardiovascular safety profile of the two tiotropium formulations.
Collapse
Affiliation(s)
- Francesco Trotta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Stefania Spila-Alegiani
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Rome, Italy
- * E-mail:
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Rome, Italy
| | - Maja Rajevic
- PhD Course, Pharmaceutical Sciences, Drug Chemistry and Technologies Department, “La Sapienza” University of Rome, Rome, Italy
| | - Valentino Conti
- Regional Center for Pharmacovigilance, General Directorate for Health, The Lombardy Region, Milan, Italy
| | - Mauro Venegoni
- Regional Center for Pharmacovigilance, General Directorate for Health, The Lombardy Region, Milan, Italy
| | - Mariangela Rossi
- Unit for Pharmaceutical Governance, General Directorate for Health, Umbria Region, Perugia, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Rome, Italy
| |
Collapse
|
37
|
Mazzanti G, Moro PA, Raschi E, Da Cas R, Menniti‐Ippolito F. Adverse reactions to dietary supplements containing red yeast rice: assessment of cases from the Italian surveillance system. Br J Clin Pharmacol 2017; 83:894-908. [PMID: 28093797 PMCID: PMC5346868 DOI: 10.1111/bcp.13171] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 10/11/2016] [Accepted: 10/23/2016] [Indexed: 01/02/2023] Open
Abstract
AIMS Red yeast rice (RYR) is contained in dietary supplements for patients with dyslipidemia. RYR supplements contain monacolin K, which is chemically identical to lovastatin, a licensed drug with a well-known risk profile. We aim to describe the safety profile of RYR by analysing spontaneous reports of suspected adverse reactions (ARs). METHODS Within the Italian Surveillance System of Natural Health Products, suspected ARs were collected and evaluated by a multidisciplinary group of experts to assess causality using the WHO-UMC system or the CIOMS/RUCAM score, for hepatic reactions. The public version of the WHO-Vigibase was also queried. RESULTS From April 2002 to September 2015, out of 1261 total reports, 52 reports concerning 55 ARs to RYR dietary supplements were collected. ARs consisted in myalgia and/or increase in creatine phosphokinase (19), rhabdomyolysis (1), liver injury (10), gastrointestinal reactions (12), cutaneous reactions (9) and other reactions (4). Women were involved in 70% of cases. In 13 cases, the reaction required hospitalization, and 28 patients were taking other medications. Dechallenge was positive in 40 reactions (73%), rechallenge was positive in 7. Causality resulted as certain (1), probable (31, 56%), possible (18, 34%), unlikely (3) or unassessable (2). Similar distribution emerged from the WHO-Vigibase. CONCLUSIONS The potential safety signals of myopathies and liver injury raise the hypothesis that the safety profile of RYR is similar to that of statins. Continuous monitoring of dietary supplements should be promoted to finally characterize their risk profile, thus supporting regulatory bodies for appropriate actions.
Collapse
Affiliation(s)
- Gabriela Mazzanti
- Department of Physiology and Pharmacology ‘Vittorio Erspamer’Sapienza University of RomePiazzale Aldo Moro 500185RomeItaly
| | - Paola Angela Moro
- Poison Control CenterNiguarda Ca' Grande HospitalPiazza Ospedale Maggiore 320162MilanItaly
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical SciencesUniversity of BolognaVia Irnerio 4840126BolognaItaly
| | - Roberto Da Cas
- Centre for EpidemiologyNational Institute of HealthViale Regina Elena 29900161RomeItaly
| | | |
Collapse
|
38
|
D'Amore C, Trotta F, Da Cas R, Zocchetti C, Cocci A, Traversa G. Antihypertensive drug use during pregnancy: a population based study. Ann Ist Super Sanita 2017; 51:236-43. [PMID: 26428049 DOI: 10.4415/ann_15_03_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The study aimed at assessing if the European guideline on the use of antihypertensive drugs (AD) in pregnancy are followed in clinical practice. We also evaluated the association between the use of non-recommended drugs and individual characteristics. METHODS This study analyzed a cohort of 86 171 singleton deliveries occurring between 2009-2010 in the Lombardy region, Italy. Women with first prescription of AD during pregnancy were considered as incident users. Methyldopa, labetalol and nifedipine were considered as "recommended drugs"; all other AD were considered as "non-recommended". Odds Ratio and 95% confidence intervals were estimated. RESULTS Among the 1009 patients (1.2%) exposed to AD during pregnancy, 675 (66.9%) were incident users. Among the incident users, 31% received non-recommended drugs; this proportion decreased to 18% among women who started treatment in the third trimester. Women with at least four concomitant diseases had an elevated risk of receiving non-recommended drugs in pregnancy (OR 2.68; 95% CI 1.10-6.73). CONCLUSIONS Exposure to recommended antihypertensives increased during pregnancy. Nevertheless, a fraction of users that continued or began treatment with non-recommended medications was still present.
Collapse
Affiliation(s)
- Carmen D'Amore
- Reparto di Farmacoepidemiologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Trotta
- Ufficio di Farmacovigilanza, Agenzia Italiana del Farmaco, Rome, Italy
| | - Roberto Da Cas
- Reparto di Farmacoepidemiologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Zocchetti
- Unità di Programmazione Sanitaria, Direzione Generale Salute, Regione Lombardia, Milan, Italy
| | - Alfredo Cocci
- Centro Regionale di Farmacovigilanza, Regione Lombardia, Milan, Italy
| | - Giuseppe Traversa
- Reparto di Farmacoepidemiologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
39
|
Marcianò I, Ingrasciotta Y, Giorgianni F, Bolcato J, Chinellato A, Pirolo R, Di Giorgio A, Manna S, Ientile V, Gini R, Santarpia M, Genazzani AA, Uomo I, Pastorello M, Pollina Addario SW, Scondotto S, Cananzi P, Da Cas R, Traversa G, Rossi M, Sottosanti L, Caputi AP, Trifirò G. How did the Introduction of Biosimilar Filgrastim Influence the Prescribing Pattern of Granulocyte Colony-Stimulating Factors? Results from a Multicentre, Population-Based Study, from Five Italian Centres in the Years 2009-2014. BioDrugs 2017; 30:295-306. [PMID: 27138636 DOI: 10.1007/s40259-016-0175-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Granulocyte colony-stimulating factors (G-CSFs) are biological products for which the main indication of use is chemotherapy-induced neutropenia. Biosimilars of G-CSFs have been available in Europe since 2007. OBJECTIVE The objective of this study was to investigate the prescribing pattern of G-CSFs in five Italian centres using different healthcare policy interventions to promote the use of biosimilars in routine care. METHODS This retrospective, population-based drug utilization study was conducted during the years 2009-2014 using the administrative databases of the Caserta, Treviso and Palermo Local Health Units (LHUs) and the Tuscany and Umbria regions. G-CSF users were characterized and the prevalence of use, proportion of biosimilar users and switching pattern of different G-CSFs were evaluated over time and across centres. RESULTS Overall, 30,247 patients were treated with G-CSFs in the years 2009-2014, of which 29,083 (96.2 %) were naïve users. The overall prevalence of G-CSF use increased from 0.8 per 1000 inhabitants in 2009 to 1.1 per 1000 in 2014. An increase in the proportion of the use of the biosimilar filgrastim by the total G-CSF users was observed in all centres: from 0.2 % (2009) to 66.2 % (2014). However, heterogeneity across different centres was reported, with the largest increase in Treviso LHU (from 0 to 89.1 % from 2009 to 2014). During the first year of treatment, switching between different G-CSFs was frequent (20.3 %). CONCLUSIONS Heterogeneity in the use of G-CSF and, in particular, biosimilar filgrastim across different Italian centres was observed, probably due to different regional healthcare policy interventions. During the first year of treatment, switching between different G-CSFs was frequent. Considering the impact of biological drugs on pharmaceutical expenses, it is necessary to harmonize healthcare policies promoting the use of biological drugs with the lowest cost.
Collapse
Affiliation(s)
- Ilaria Marcianò
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Ylenia Ingrasciotta
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
| | | | - Jenny Bolcato
- Pharmaceutical Service, Local Health Authority (ULSS9), Treviso, Italy
| | | | - Roberta Pirolo
- Pharmaceutical Service, Local Health Authority (ULSS9), Treviso, Italy
| | | | - Sonia Manna
- Caserta-1 Local Health Service, Caserta, Italy
| | - Valentina Ientile
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | | | - Armando A Genazzani
- Department of Pharmaceutical Sciences, "A. Avogadro" University, Novara, Italy
| | - Ilaria Uomo
- Department of Pharmacy, Palermo Local Health Unit, Palermo, Italy
| | | | | | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Pasquale Cananzi
- Sicilian Regional Centre of Pharmacovigilance, Servizio 7-Farmaceutica, Health Department of Sicily, Palermo, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Mariangela Rossi
- Health-Unit for Pharmaceutical Governance, Umbria Region, Perugia, Italy
| | | | - Achille P Caputi
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy. .,Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands.
| |
Collapse
|
40
|
Abstract
Background The acceptability of switching between reference drugs and their biosimilars is often disputed. It is unclear whether this concern is specific to the use of biosimilars or is relevant to the practice of switching between any biological drugs. Objective The objective of this study was to quantify the occurrence of switching between different erythropoiesis-stimulating agents. Methods A retrospective drug utilization study was conducted in the Umbria region (Italy). The study population included all residents who received their first epoetin prescription between 1 July 2011 and 31 December 2014. The Umbria drug prescription database and the regional archive of residents were used to gather information. Switching was defined as any transition between different epoetins (different substances and/or different products of the same substance) in a series of two prescriptions. The probability of switching was described in relationship to the duration of treatment in a survival analysis. Results Overall, 3258 subjects received prescriptions of epoetins. Among the 2896 patients with at least two prescriptions, 354 (12.2 %) experienced one or more switches. The probability of switching depended on the duration of treatment: approximately 15 % of users switched within 12 months of observation and 25 % switched within 2 years. Switching was not limited to reference and biosimilar epoetins and it affected patent and off-patent epoetins equally. Conclusions Switching between different epoetins was related to the duration of use and most episodes of switching involved epoetins that have never been contrasted in a comparability exercise. The present level of switching may provide reassurance to physicians when taken together with other sources of comparative evidence. Electronic supplementary material The online version of this article (doi:10.1007/s40259-015-0155-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Carmen D'Amore
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Mariangela Rossi
- Unit for Pharmaceutical Governance, General Directorate for Health, Umbria Region, Perugia, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy.
| |
Collapse
|
41
|
Trotta F, Da Cas R, Bella A, Santuccio C, Salmaso S. Intussusception hospitalizations incidence in the pediatric population in Italy: a nationwide cross-sectional study. Ital J Pediatr 2016; 42:89. [PMID: 27677340 PMCID: PMC5039877 DOI: 10.1186/s13052-016-0298-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Received: 07/26/2016] [Accepted: 09/21/2016] [Indexed: 11/30/2022] Open
Abstract
Background Study to investigate the intussusception incidence background in the pediatric population and its temporal trend in Italy. Methods A cross-sectional study was conducted on the pediatric population aged 0 to 15 years, in the period 1 January 2002 to 31 December 2012. Intussusception cases were identified using the national hospital discharge database. The annual intussusception incidence, the incidence rate ratios (IRRs) and the related 95 % confidence Intervals (CI) were calculated. Results The overall intussusception incidence rate was 21 per 100,000 children aged ≤15 years, and was higher among boys than girls. The highest intussusception incidence rate occurred in infants <1 year of age (39 per 100,000 infants). Among infants, incidence varied with the geographical area, with higher rates in the central Italy (50 per 100,000 infants). The annual incidence rates in infants were stable since 2004 and up to 2012, ranging from 40.1 and 33.0 per 100,000 infants. Similar stable patterns were observed when conducting the analysis on children over 1 year of age. Conclusions This study provided the intussusception incidence background in Italy in different pediatric ages, including infants, over an 11-year period. This information is essential in post-marketing safety surveillance, to continuously monitor the benefit/risk profile of rotavirus vaccinations. Electronic supplementary material The online version of this article (doi:10.1186/s13052-016-0298-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Francesco Trotta
- Pharmacovigilance Office, Italian Medicines Agency (AIFA), Via del Tritone 181, Rome, 00187, Italy. .,National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy.
| | - Roberto Da Cas
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
| | - Antonino Bella
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
| | - Carmela Santuccio
- Pharmacovigilance Office, Italian Medicines Agency (AIFA), Via del Tritone 181, Rome, 00187, Italy
| | - Stefania Salmaso
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
| |
Collapse
|
42
|
Da Dalt L, Zerbinati C, Strafella MS, Renna S, Riceputi L, Di Pietro P, Barabino P, Scanferla S, Raucci U, Mores N, Compagnone A, Da Cas R, Menniti-Ippolito F. Henoch-Schönlein purpura and drug and vaccine use in childhood: a case-control study. Ital J Pediatr 2016; 42:60. [PMID: 27316345 PMCID: PMC4912703 DOI: 10.1186/s13052-016-0267-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Received: 02/11/2016] [Accepted: 05/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Henoch-Schönlein purpura (HSP) is the most common vasculitis in childhood; nevertheless, its etiology and pathogenesis remain unknown despite the fact that a variety of factors, mainly infectious agents, drugs and vaccines have been suggested as triggers for the disease. The aim of this study was to estimate the association of HSP with drug and vaccine administration in a pediatric population. METHODS An active surveillance on drug and vaccine safety in children is ongoing in 11 clinical centers in Italy. All children hospitalized through the local Paediatric Emergency Department for selected acute clinical conditions of interest were enrolled in the study. Data on drug and vaccine use in children before the onset of symptoms leading to hospitalization were collected by parents interview. A case-control design was applied for risk estimates: exposure in children with HSP, included as cases, was compared with similar exposure in children with gastroduodenal lesions, enrolled as controls. HSP cases were validated according to EULAR/PRINTO/PRES criteria. Validation was conducted retrieving data from individual patient clinical record. RESULTS During the study period (November 1999-April 2013), 288 cases and 617 controls were included. No increased risk of HSP was estimated for any drug. Among vaccines, measles-mumps-rubella (MMR) vaccine showed an increased risk of HSP (OR 3.4; 95 % CI 1.2-10.0). CONCLUSIONS This study provides further evidence on the possible role of MMR vaccine in HSP occurrence.
Collapse
Affiliation(s)
- Liviana Da Dalt
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | | | | | | | | | | | | | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nadia Mores
- Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy
| | - Adele Compagnone
- Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy
| | - Roberto Da Cas
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy
| | - Francesca Menniti-Ippolito
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy.
| | | |
Collapse
|
43
|
Abstract
OBJECTIVES The study aims at investigating the influence of several factors on the probability of receiving one of the two tiotropium formulations (Respimat or Handihaler). DESIGN Drug utilisation study. SETTING All residents in the Region Umbria, Italy, aged ≥45 years, who received prescriptions of tiotropium during 2011-2012. PARTICIPANTS Two groups of patients were studied: (1) incident users of the two tiotropium formulations (ie, without tiotropium prescriptions in the previous 6 months); (2) switchers from Handihaler to Respimat. Users of the two formulations were compared with regard to baseline characteristics and medical history. The adjusted OR of receiving Respimat was estimated for several factors. RESULTS Incident users of the two formulations (4390 participants) had similar characteristics. They were older and with more comorbidities than patients included in randomised control trials (RCTs). Among prevalent users of Handihaler, the probability of switching to Respimat was greater in patients with severe respiratory disease (users of ≥4 respiratory drugs: adjusted OR=4.62; 95% CI 2.46 to 8.69) and among β-blocker users (adjusted OR=1.76; 95% CI 1.13 to 2.75). Age above 75 years and lipid-lowering drug use reduced the probability of switching. A positive association was also found between neurological conditions and the use of Respimat. CONCLUSIONS When starting tiotropium treatment, the choice between the two formulations is weakly affected by comorbidities and chronic obstructive pulmonary disease severity. Instead, these characteristics influence the likelihood of switching from Handihaler to Respimat. Since tiotropium users in clinical practice are more severe than those included in RCTs, further aetiological studies are needed to compare the safety profile of the two formulations in routine care.
Collapse
Affiliation(s)
- Francesco Trotta
- Pharmacovigilance Office, Italian Medicines Agency, Rome, Italy
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Maja Rajevic
- Pharmaceutical Sciences, Drug Chemistry and Technologies Department, “La Sapienza” University, Rome, Italy
| | - Mariangela Rossi
- Unit for Pharmaceutical Governance, General Directorate for Health, Umbria Region, Perugia, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| |
Collapse
|
44
|
Da Cas R, Nigro A, Terrazzino S, Sances G, Viana M, Tassorelli C, Nappi G, Cargnin S, Pisterna A, Traversa G, Genazzani AA. Triptan use in Italy: Insights from administrative databases. Cephalalgia 2014; 35:619-26. [DOI: 10.1177/0333102414550419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/17/2014] [Indexed: 01/03/2023]
Abstract
Introduction In this drug utilization study, we aimed at assessing the pattern of triptan use in Italy by means of the drug prescription databases of two local health authorities, accounting for approximately 1 million citizens. Methods The study population included all residents aged 18 to 84 years in the Vercelli province (about 175,000 inhabitants) and in the Umbria region (about 885,000 inhabitants), who had at least one dispensation for triptans in 2012. A frequent user, who might be at risk of medication-overuse headache (MOH), was defined as a patient being dispensed at least 10 defined daily doses (DDD) of triptans every month for at least three consecutive months. Results Triptans were used by 0.7%–1% of the population. While most patients were dispensed fewer than 60 DDDs per year, about 10% of all triptan users were classified as frequent users. In both areas, patients below the age of 29 were less likely to be frequent users while the 40- to 49-year-old population was the most affected, with no sex difference. About two-thirds of frequent users persisted in this behavior for an additional three-month period in the following six months. Conclusions Our data indicate that approximately 10% of all triptan users in the Italian population are potentially at risk for MOH. An approach based on drug prescription databases could be useful to identify patients at risk for MOH.
Collapse
Affiliation(s)
- Roberto Da Cas
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Italy
| | | | | | - Grazia Sances
- Headache Science Center – C. Mondino National Neurological Institute, Italy
| | - Michele Viana
- Headache Science Center – C. Mondino National Neurological Institute, Italy
| | | | - Giuseppe Nappi
- Headache Science Center – C. Mondino National Neurological Institute, Italy
| | - Sarah Cargnin
- Department of Pharmaceutical Sciences, ‘‘A. Avogadro’’ University, Italy
| | | | - Giuseppe Traversa
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Italy
| | | |
Collapse
|
45
|
Menniti-Ippolito F, Da Cas R, Traversa G, Santuccio C, Felicetti P, Tartaglia L, Trotta F, Di Pietro P, Barabino P, Renna S, Riceputi L, Tovo PA, Gabiano C, Urbino A, Baroero L, Le Serre D, Virano S, Perilongo G, Daverio M, Gnoato E, Maretti M, Galeazzo B, Rubin G, Scanferla S, Da Dalt L, Stefani C, Zerbinati C, Chiappini E, Sollai S, De Martino M, Mannelli F, Becciani S, Giacalone M, Montano S, Remaschi G, Stival A, Furbetta M, Abate P, Leonardi I, Pirozzi N, Raucci U, Reale A, Rossi R, Russo C, Mancinelli L, Manuela O, Carlo C, Mores N, Romagnoli C, Chiaretti A, Compagnone A, Riccardi R, Delogu G, Sali M, Prete V, Tipo V, Dinardo M, Auricchio F, Polimeno T, Sodano G, Maccariello A, Rafaniello C, Fucà F, Di Rosa E, Altavilla D, Mecchio A, Arrigo T. Vaccine effectiveness against severe laboratory-confirmed influenza in children: results of two consecutive seasons in Italy. Vaccine 2014; 32:4466-4470. [PMID: 24962760 DOI: 10.1016/j.vaccine.2014.06.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 12/04/2013] [Revised: 03/20/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of seasonal influenza vaccine in preventing Emergency Department (ED) visits and hospitalisations for influenza like illness (ILI) in children. METHODS We conducted a test negative case-control study during the 2011-2012 and 2012-2013 influenza seasons. Eleven paediatric hospital/wards in seven Italian regions participated in the study. Consecutive children visiting the ED with an ILI, as diagnosed by the doctor according to the European Centre for Disease Control case definition, were eligible for the study. Data were collected from trained pharmacists/physicians by interviewing parents during the ED visit (or hospital admission) of their children. An influenza microbiological test (RT-PCR) was carried out in all children. RESULTS Seven-hundred and four children, from 6 months to 16 years of age, were enrolled: 262 children tested positive for one of the influenza viruses (cases) and 442 tested negative (controls). Cases were older than controls (median age 46 vs. 29 months), though with a similar prevalence of chronic conditions. Only 25 children (4%) were vaccinated in the study period. The overall age-adjusted vaccine effectiveness (VE) was 38% (95% confidence interval -52% to 75%). A higher VE was estimated for hospitalised children (53%; 95% confidence interval -45% to 85%). DISCUSSION This study supports the effectiveness of the seasonal influenza vaccine in preventing visits to the EDs and hospitalisations for ILI in children, although the estimates were not statistically significant and with wide confidence intervals. Future systematic reviews of available data will provide more robust evidence for recommending influenza vaccination in children.
Collapse
Affiliation(s)
| | - Roberto Da Cas
- National Centre of Epidemiology, National Institute of Health, Roma, Italy
| | - Giuseppe Traversa
- National Centre of Epidemiology, National Institute of Health, Roma, Italy
| | | | | | | | | | | | | | | | | | | | - Clara Gabiano
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Luca Baroero
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Silvia Virano
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Marco Daverio
- Department of Paediatrics, University of Padova, Italy
| | - Elisa Gnoato
- Department of Paediatrics, University of Padova, Italy
| | | | | | - Giulia Rubin
- Department of Paediatrics, University of Padova, Italy
| | | | | | - Chiara Stefani
- Department of Paediatrics, Treviso Hospital, Treviso, Italy
| | | | | | - Sara Sollai
- Anna Meyer Children's University Hospital, Firenze, Italy
| | | | | | | | | | - Simona Montano
- Anna Meyer Children's University Hospital, Firenze, Italy
| | | | - Alessia Stival
- Anna Meyer Children's University Hospital, Firenze, Italy
| | - Mario Furbetta
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Piera Abate
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Ilaria Leonardi
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Nicola Pirozzi
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Umberto Raucci
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Antonino Reale
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Rossella Rossi
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Cristina Russo
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Livia Mancinelli
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Onori Manuela
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Concato Carlo
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Nadia Mores
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Costantino Romagnoli
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Antonio Chiaretti
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Adele Compagnone
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Riccardo Riccardi
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Giovanni Delogu
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Michela Sali
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Valentina Prete
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Vincenzo Tipo
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Michele Dinardo
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Fabiana Auricchio
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Teodoro Polimeno
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Giuseppe Sodano
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | | | | | - Fortunata Fucà
- Giovanni Di Cristina Paediatric Hospital, Palermo, Italy
| | | | - Domenica Altavilla
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
| | - Anna Mecchio
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
| | - Teresa Arrigo
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
| | | |
Collapse
|
46
|
Abstract
OBJECTIVE To assess the risk of maternal, fetal, and neonatal outcomes associated with the administration of an MF59 adjuvanted A/H1N1 vaccine during pregnancy. DESIGN Historical cohort study. SETTING Singleton pregnancies of the resident population of the Lombardy region of Italy. PARTICIPANTS All deliveries between 1 October 2009 and 30 September 2010. Data on exposure to A/H1N1 pandemic vaccine, pregnancy, and birth outcomes were retrieved from regional databases. Vaccinated and non-vaccinated women were compared in a propensity score matched analysis to estimate risks of adverse outcomes. MAIN OUTCOME MEASURES Main maternal outcomes included type of delivery, admission to intensive care unit, eclampsia, and gestational diabetes; fetal and neonatal outcomes included perinatal deaths, small for gestational age births, and congenital malformations. RESULTS Among the 86,171 eligible pregnancies, 6246 women were vaccinated (3615 (57.9%) in the third trimester and 2557 (40.9%) in the second trimester). No difference was observed in terms of spontaneous deliveries (adjusted odds ratio 1.02, 95% confidence interval 0.96 to 1.08) or admissions to intensive care units (0.95, 0.47 to 1.88), whereas a limited increase in the prevalence of gestational diabetes (1.26, 1.04 to 1.53) and eclampsia (1.19, 1.04 to 1.39) was seen in vaccinated women. Rates of fetal and neonatal outcomes were similar in vaccinated and non-vaccinated women. A slight increase in congenital malformations, although not statistically significant, was present in the exposed cohort (1.14, 0.99 to 1.31). CONCLUSIONS Our findings add relevant information about the safety of the MF59 adjuvanted A/H1N1 vaccine in pregnancy. Residual confounding may partly explain the increased risk of some maternal outcomes. Meta-analysis of published studies should be conducted to further clarify the risk of infrequent outcomes, such as specific congenital malformations.
Collapse
Affiliation(s)
- Francesco Trotta
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy Pharmacovigilance Unit, Italian Medicines Agency (AIFA), 00187 Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Stefania Spila Alegiani
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Maria Gramegna
- Unit for Preventive Medicine, General Directorate for Health, The Lombardy Region, 20124 Milan, Italy
| | - Mauro Venegoni
- Regional Centre for Pharmacovigilance, General Directorate for Health, The Lombardy Region, 20124 Milan, Italy
| | - Carlo Zocchetti
- Unit for Local Health Service Governance, General Directorate for Health, The Lombardy Region, 20124 Milan, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| |
Collapse
|
47
|
Damiani G, Federico B, Anselmi A, Bianchi CBNA, Silvestrini G, Iodice L, Navarra P, Da Cas R, Raschetti R, Ricciardi W. The impact of regional co-payment and national reimbursement criteria on statins use in Italy: an interrupted time-series analysis. BMC Health Serv Res 2014; 14:6. [PMID: 24393340 PMCID: PMC3893493 DOI: 10.1186/1472-6963-14-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/02/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Statins are among the most commonly prescribed drugs worldwide in the prevention of cardiovascular diseases and their effectiveness is largely acknowledged. The consumption of statins increased four-fold during the 2000-2010 decade in Italy and national and regional control policies were developed. Restrictions to reimbursement were fixed at the national level, whereas co-payment was introduced in some, but not all, regions. The aim of the present study is to assess the impact of such policies on the consumption of statins in Italy between 2001-2007 among outpatients. METHODS The statin use was measured in terms of defined daily doses per 1,000 inhabitants per day (DDD/1000 inh. day) from May 2001 to December 2007. The study was conducted in 17 out of 21 regions, nine of which had implemented a co-payment policy. Time trends in consumption before and after the introduction of co-payment policies and reimbursement criteria were examined using segmented regression analysis of interrupted time-series, adjusting for seasonal components. RESULTS The consumption of statins increased by 22.9 DDD/1000 inh. day in May 2001 to 54.7 DDD/1000 inh. day in December 2007. On average, there was a 1.7% increase in statin use each month before the national guideline changed while the increase was about 0.5% afterwards. The revision of the reimbursement criteria was associated with a significant decrease in level (coefficient = -2.80, 95% CI -3.70 to -1.90 p-value <0.001) and trend (coefficient = -0.33, 95% CI -0.37 to -0.29 p-value <0.001). The introduction of co-payment was associated with a significant change in trend of consumption so that the overall use of the drug increased by 0.04 (95% CI 0.02 to 0.07, p-value < 0.001) DDD/1000 inh. day per month in the post-intervention period, but there was no evidence of a change in level of consumption (p-value = 0.163). CONCLUSIONS Consumption of statins in Italy increased almost three-fold during the study period. The restriction to reimbursement Interventions was associated with an immediate drop and a decrease in trend of statin use, while the regional copayment was associated with a small increase in trend of statin use.
Collapse
Affiliation(s)
- Gianfranco Damiani
- Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Bruno Federico
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Angela Anselmi
- Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Giulia Silvestrini
- Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Lanfranco Iodice
- Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Pierluigi Navarra
- Department of Pharmacology, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Walter Ricciardi
- Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
48
|
Trotta F, Da Cas R, Maggini M, Rossi M, Traversa G. Generic substitution of antidiabetic drugs in the elderly does not affect adherence. Ann Ist Super Sanita 2014; 50:333-340. [PMID: 25522073 DOI: 10.4415/ann_14_04_07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The possibility that variation in packaging and pill appearance may reduce adherence is a reason for concern, especially for chronic diseases. The objectives of the study were to quantify the extent of switches between generic antidiabetics and to verify whether switching between different products of the same substance affects adherence. MATERIALS AND METHODS All elderly residents of the Umbria Region who received at least 2 prescriptions of antidiabetics in 2010 and 2011 were included in the study. Switching was defined as the dispensing of two different products of the same substance in a series of two prescriptions. Single and multiple switchers were identified according to the number of switches during 2011. Switching relevant to the three off-patent substances with generic use ≥ 5% (metformin, gliclazide and repaglinide) was quantified. The effect of switching on adherence, defined as the proportion of days in 2011 covered by prescriptions (Medication Possession Ratio, MPR), was estimated. RESULTS Among the 15 964 patients receiving antidiabetics (14.4% of the elderly population) 9211 were prescribed at least one of the generic substances. Of these patients, 23.3% experienced a single switch and 15.7% were multiple switchers (61.0% never switched). The proportion of multiple switchers increased with the number of prescriptions, reaching 26% among patients with ≥ 11 prescriptions. MPR was 62%, 62% and 72%, respectively among non-switchers, single and multiple switchers. CONCLUSIONS In elderly patients treated with antidiabetics, the substitution between branded and unbranded products (as well as between generics) of the same substance, did not negatively affect adherence.
Collapse
|
49
|
Donati S, Satolli R, Colombo C, Senatore S, Cotichini R, Da Cas R, Spila Alegiani S, Mosconi P. Informing women on menopause and hormone therapy: Know The Menopause a multidisciplinary project involving local healthcare system. PLoS One 2013; 8:e85121. [PMID: 24391988 PMCID: PMC3877328 DOI: 10.1371/journal.pone.0085121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 11/22/2013] [Indexed: 11/21/2022] Open
Abstract
Background Hormone therapy (HT) in the menopause is still a tricky question among healthcare providers, women and mass media. Informingwomenabouthormonereplacementtherapy was a Consensus Conference (CC) organized in 2008: the project KnowtheMenopause has been launched to shift out the results to women and healthcare providers and to assess the impact of the cc’s statement. Methods And Findings: The project, aimed at women aged 45-60 years, was developed in four Italian Regions: Lombardy, Tuscany, Lazio, Sicily, each with one Local Health Unit (LHU) as “intervention” and one as “control”. Activities performed were: survey on the press; training courses for health professionals; educational materials for target populations; survey aimed at women, general practitioners (GPs), and gynaecologists; data analysis on HT drugs’ prescription. Local activities were: training courses; public meetings; dissemination on mass media. About 3,700 health professionals were contacted and 1,800 participated in the project. About 146,500 printed leaflets on menopause were distributed to facilitate the dialogue among women and health care professionals. Training courses and educational cascade-process activities: participation ranged 25- 72% of GPs, 17-71% of gynaecologists, 14-78% of pharmacists, 34-85% of midwives. Survey: 1,281 women interviewed. More than 90% believed menopause was a normal phase in life. More than half did not receive information about menopause and therapies. HT prescription analysis: prevalence fell from 6% to 4% in five years. No differences in time trends before-after the intervention. Major limitations are: organizational difficulties met by LHU, too short time for some local activities. Conclusions A huge amount of information was spread through health professionals and women. The issue of menopause was also used to discuss women’s wellbeing. This project offered an opportunity to launch a multidisciplinary, multimodal approach to menopause looking not only at pharmacological aspects, but also at quality of life and information.
Collapse
Affiliation(s)
- Serena Donati
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italia
| | | | - Cinzia Colombo
- Laboratory for medical research and consumers involvement, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italia
| | - Sabrina Senatore
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italia
| | - Rodolfo Cotichini
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italia
| | - Roberto Da Cas
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italia
| | - Stefania Spila Alegiani
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italia
| | - Paola Mosconi
- Laboratory for medical research and consumers involvement, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italia
- * E-mail:
| |
Collapse
|
50
|
Raucci U, Rossi R, Da Cas R, Rafaniello C, Mores N, Bersani G, Reale A, Pirozzi N, Menniti-Ippolito F, Traversa G, in Drug and Children IMSGFVS. Stevens-johnson syndrome associated with drugs and vaccines in children: a case-control study. PLoS One 2013; 8:e68231. [PMID: 23874553 PMCID: PMC3712963 DOI: 10.1371/journal.pone.0068231] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/28/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Stevens-Johnson Syndrome (SJS) is one of the most severe muco-cutaneous diseases and its occurrence is often attributed to drug use. The aim of the present study is to quantify the risk of SJS in association with drug and vaccine use in children. METHODS A multicenter surveillance of children hospitalized through the emergency departments for acute conditions of interest is currently ongoing in Italy. Cases with a diagnosis of SJS were retrieved from all admissions. Parents were interviewed on child's use of drugs and vaccines preceding the onset of symptoms that led to the hospitalization. We compared the use of drugs and vaccines in cases with the corresponding use in a control group of children hospitalized for acute neurological conditions. RESULTS Twenty-nine children with a diagnosis of SJS and 1,362 with neurological disorders were hospitalized between 1(st) November 1999 and 31(st) October 2012. Cases were more frequently exposed to drugs (79% vs 58% in the control group; adjusted OR 2.4; 95% CI 1.0-6.1). Anticonvulsants presented the highest adjusted OR: 26.8 (95% CI 8.4-86.0). Significantly elevated risks were also estimated for antibiotics use (adjusted OR 3.3; 95% CI 1.5-7.2), corticosteroids (adjusted OR 4.2; 95% CI 1.8-9.9) and paracetamol (adjusted OR 3.2; 95% CI 1.5-6.9). No increased risk was estimated for vaccines (adjusted OR: 0.9; 95% CI 0.3-2.8). DISCUSSION Our study provides additional evidence on the etiologic role of drugs and vaccines in the occurrence of SJS in children.
Collapse
Affiliation(s)
- Umberto Raucci
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Rossella Rossi
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Roberto Da Cas
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | - Concita Rafaniello
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, Second University of Napoli, Napoli, Italy
| | - Nadia Mores
- Pharmacology and Paediatrics, Università Cattolica S. Cuore, Roma, Italy
| | - Giulia Bersani
- Pharmacology and Paediatrics, Università Cattolica S. Cuore, Roma, Italy
| | - Antonino Reale
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Nicola Pirozzi
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Francesca Menniti-Ippolito
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | - Giuseppe Traversa
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
- * E-mail:
| | | |
Collapse
|