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Anglin P, Elia-Pacitti J, Eberg M, Muratov S, Kukaswadia A, Sharma A, Ewara EM. Estimating the Associated Burden of Illness and Healthcare Utilization of Newly Diagnosed Patients Aged ≥65 with Mantle Cell Lymphoma (MCL) in Ontario, Canada. Curr Oncol 2023; 30:5529-5545. [PMID: 37366901 DOI: 10.3390/curroncol30060418] [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: 03/07/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND With the emergence of therapies for mantle cell lymphoma (MCL), understanding the treatment patterns and burden of illness among older patients with MCL in Canada is essential to inform decision making. METHODS A retrospective study using administrative data matched individuals aged ≥65 who were newly diagnosed with MCL between 1 January 2013 and 31 December 2016 with general population controls. Cases were followed for up to 3 years in order to assess healthcare resource utilization (HCRU), healthcare costs, time to next treatment or death (TTNTD), and overall survival (OS); all were stratified according to first-line treatment. RESULTS This study matched 159 MCL patients to 636 controls. Direct healthcare costs were highest among MCL patients in the first year following diagnosis (Y1: CAD 77,555 ± 40,789), decreased subsequently (Y2: CAD 40,093 ± 28,720; Y3: CAD 36,059 ± 36,303), and were consistently higher than the costs for controls. The 3-year OS after MCL diagnosis was 68.6%, with patients receiving bendamustine + rituximab (BR) experiencing a significantly higher OS compared to patients treated with other regimens (72.4% vs. 55.6%, p = 0.041). Approximately 40.9% of MCL patients initiated a second-line therapy or died within 3 years. CONCLUSION Newly diagnosed MCL presents a substantial burden to the healthcare system, with almost half of all patients progressing to a second-line therapy or death within 3 years.
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Affiliation(s)
- Peter Anglin
- Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, ON L3Y 2P9, Canada
- Bayshore HealthCare, 2101 Hadwen Rd., Mississauga, ON L5K 2L3, Canada
| | - Julia Elia-Pacitti
- Janssen Canada Inc., 19 Green Belt Drive, North York, ON M3C 1L9, Canada
| | - Maria Eberg
- Real World Solutions, IQVIA, 16720 Rte Transcanadienne, Kirkland, QC H9H 5M3, Canada
| | - Sergey Muratov
- Real World Solutions, IQVIA, 402-1875 Buckhorn Gate, Mississauga, ON L4W 5N9, Canada
| | - Atif Kukaswadia
- Real World Solutions, IQVIA, 402-1875 Buckhorn Gate, Mississauga, ON L4W 5N9, Canada
| | - Arushi Sharma
- Real World Solutions, IQVIA, 301-300 March Rd., Kanata, ON K2K 2E2, Canada
| | - Emmanuel M Ewara
- Janssen Canada Inc., 19 Green Belt Drive, North York, ON M3C 1L9, Canada
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Kuruvilla J, Ewara EM, Elia-Pacitti J, Ng R, Eberg M, Kukaswadia A, Sharma A. Estimating the Burden of Illness of Relapsed Follicular Lymphoma and Marginal Zone Lymphoma in Ontario, Canada. Curr Oncol 2023; 30:4663-4676. [PMID: 37232810 DOI: 10.3390/curroncol30050352] [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: 03/14/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Many patients with advanced follicular lymphoma (FL) and marginal zone lymphoma (MZL) relapse after first-line chemotherapy. OBJECTIVE To examine healthcare resource utilization (HCRU) and cost, treatment patterns, progression, and survival of patients with FL and MZL who relapse after first-line treatment, in Ontario, Canada. METHODS A retrospective, administrative data study identified patients with relapsed FL and MZL (1 January 2005-31 December 2018). Patients were followed for up to three years post relapse to assess HCRU, healthcare costs, time to next treatment (TTNT), and overall survival (OS), stratified by first- and second-line treatment. RESULTS The study identified 285 FL and 68 MZL cases who relapsed after first-line treatment. Average duration of first-line treatment was 12.4 and 13.4 months for FL and MZL patients, respectively. Drug (35.9%) and cancer clinic costs (28.1%) were major contributors to higher costs in year 1. Three-year OS was 83.9% after FL and 74.2% after MZL relapse. No statistically significant differences were observed in TTNT and OS between patients with FL who received R-CHOP/R-CVP/BR in the first line only versus both the first- and second- line. A total of 31% of FL and 34% of MZL patients progressed to third-line treatment within three years of initial relapse. CONCLUSION Relapsing and remitting nature of FL and MZL in a subset of patients results in substantial burden to patients and the healthcare system.
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Affiliation(s)
- John Kuruvilla
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2C1, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 3H7, Canada
| | - Emmanuel M Ewara
- Market Access, Janssen Canada Inc., 19 Green Belt Drive, North York, ON M3C 1L9, Canada
| | - Julia Elia-Pacitti
- Medical Affairs, Janssen Canada Inc., 19 Green Belt Drive, North York, ON M3C 1L9, Canada
| | - Ryan Ng
- Real World Solutions, IQVIA, 16720 Rte Transcanadienne, Kirkland, QC H9H 5M3, Canada
| | - Maria Eberg
- Real World Solutions, IQVIA, 16720 Rte Transcanadienne, Kirkland, QC H9H 5M3, Canada
| | - Atif Kukaswadia
- Real World Solutions, IQVIA, 300-6700 Century Avenue, Mississauga, ON L5N 6A4, Canada
| | - Arushi Sharma
- Real World Solutions, IQVIA, 535 Legget Drive, Tower C, 7th Floor, Ottawa, ON K2K 3B8, Canada
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Rahman P, Arendse R, Khraishi M, Sholter D, Sheriff M, Rampakakis E, Lehman AJ, Nantel F. Long-term effectiveness and safety of infliximab, golimumab and ustekinumab in patients with psoriatic arthritis from a Canadian prospective observational registry. BMJ Open 2020; 10:e036245. [PMID: 32792436 PMCID: PMC7430557 DOI: 10.1136/bmjopen-2019-036245] [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] [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
OBJECTIVES The objectives of this study were to describe the demographic profile and baseline disease characteristics of patients with psoriatic arthritis (PsA) treated with either infliximab (IFX), subcutaneous golimumab (GLM) or ustekinumab (UST) treatment in Canadian routine care setting along with assessing long-term effectiveness and safety. METHODS Patients with PsA were enrolled into the Biologic Treatment Registry Across Canada registry (ClinicalTrials.gov Identifier: NCT00741793) from 2005 to 2017. The study visits occurred at study enrolment (baseline) and every 6 months thereafter. Effectiveness was assessed by changes in disease parameters (joint counts, Psoriasis Area Severity Index (PASI), Health Assessment Questionnaire, patient/physician global, minimal disease activity, enthesitis, dactylitis, erythrocyte sedimentation rate, C reactive protein). Improvements from baseline were explored with the paired t-test and the McNemar's test. Safety was evaluated by assessing the incidence of adverse events (AEs) and drug survival rates. RESULTS A total of 111 IFX-treated, 281 GLM-treated and 70 UST-treated patients were enrolled. Most baseline disease parameters remained similar over time in all three cohorts. UST-treated patients had lower mean baseline Disease Activity Score in 28 joints CRP, swollen joint based on 28 joints and higher PASI compared with patients treated with GLM. Treatment with IFX, GLM and UST was associated with significant improvements in all disease parameters over time (p<0.001) from baseline up to 84, 84 and 40 months, respectively.AEs were reported for 74.8%, 69.8% and 52.9% (138, 114 and 115 events/100 patient-years (PYs)) covering 325, 567 and 87 years of exposure for IFX-treated, GLM-treated and UST-treated patients, respectively. Severe AEs were reported in 19.8%, 8.5% and 5.7% (8.8, 7.2 and 8.0 events/100 PYs) in IFX-treated, GLM-treated and UST-treated patients, respectively. The proportion of patients who discontinued treatment were 63.1%, 50.9% and 50.0%, respectively. CONCLUSIONS IFX, GLM and UST treatment significantly reduced disease activity and improved functionality in patients with PsA followed by routine clinical practice and had a safety profile similar to that previously reported in the literature. TRIAL REGISTRATION NUMBER NCT00741793.
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Affiliation(s)
- Proton Rahman
- Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada
| | - Regan Arendse
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Majed Khraishi
- Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada
| | - Dalton Sholter
- Faculty of Medicine & Dentistry - Medicine Dept, University of Alberta, Edmonton, Alberta, Canada
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Rahman P, Zummer M, Bessette L, Baer P, Haraoui B, Chow A, Kelsall J, Kapur S, Rampakakis E, Psaradellis E, Lehman AJ, Nantel F, Osborne B, Tkaczyk C. Real-world validation of the minimal disease activity index in psoriatic arthritis: an analysis from a prospective, observational, biological treatment registry. BMJ Open 2017; 7:e016619. [PMID: 28855200 PMCID: PMC5629663 DOI: 10.1136/bmjopen-2017-016619] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 12/31/2022] Open
Abstract
OBJECTIVE To describe the minimal disease activity (MDA) rate over time in patients with psoriatic arthritis (PsA) receiving antitumour necrosis factor agents, evaluate prognostic factors of MDA achievement and identify the most common unmet criteria among MDA achievers. DESIGN Biologic Treatment Registry Across Canada (BioTRAC): ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis, ankylosing spondylitis or PsA with infliximab (IFX), golimumab (GLM) or ustekinumab. SETTING 46 primary-care Canadian rheumatology practices. PARTICIPANTS 223 patients with PsA receiving IFX (enrolled since 2005) and GLM (enrolled since 2010) with available MDA information at baseline, 6 months and/or 12 months. PRIMARY AND SECONDARY OUTCOME MEASURES MDA was defined as ≥5 of the following criteria: 28-item tender joint count (TJC28) ≤1, 28-item swollen joint count (SJC28) ≤1, Psoriasis Area and Severity Index (PASI) ≤1 or body surface area≤3, Pain Visual Analogue Scale (VAS) ≤15 mm, patient's global assessment (PtGA) (VAS) ≤20 mm, Health Assessment Questionnaire (HAQ) ≤0.5, tender entheseal points ≤1. Independent prognostic factors of MDA achievement were assessed with multivariate logistic regression. RESULTS MDA was achieved by 11.7% of patients at baseline, 43.5% at 6 months, 44.8% at 12 months and 48.8% at either 6 or 12 months. Among MDA achievers at 6 months, 75.7% had sustained MDA at 12 months. Lower baseline HAQ (OR=0.210; 95% CI: 0.099 to 0.447) and lower TJC28 (OR=0.880; 95% CI: 0.804 to 0.964), were significant prognostic factors of MDA achievement over 12 months of treatment. The most commonly unmet MDA criteria among MDA achievers was patient reported pain (25%), PtGA (15%) and PASI (12%). CONCLUSIONS Almost 50% of patients treated with IFX or GLM in routine clinical care achieved MDA within the first year of treatment. Lower baseline HAQ and lower TJC28, were identified as significant prognostic factors of MDA achievement. The most commonly unmet criteria in patients who achieved MDA were pain, PtGA and PASI. TRIAL REGISTRATION NUMBER BioTRAC (NCT00741793).
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Affiliation(s)
- Proton Rahman
- Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland, Canada
| | - Michel Zummer
- Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Louis Bessette
- Infectious and immune diseases, Centre Hospitalier de l'Université Laval, Quebec City, Quebec, Canada
| | - Philip Baer
- Rheumatology, Ontario Medical Association, Toronto, Ontario, Canada
| | - Boulos Haraoui
- Rheumatology, Centre Hospitalier de l’ Université de Montréal, Montreal, Quebec, Canada
| | - Andrew Chow
- Rheumatology, Credit Valley Rheumatology, Mississauga, Ontario, Canada
| | - John Kelsall
- Rheumatology, Saint Paul's Hospital, Vancouver, British Columbia, Canada
| | - Suneil Kapur
- Rheumatology, University of Ottawa, Ottawa, Ontario, Canada
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