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Avalos-Salgado FA, Gonzalez-Lopez L, Gonzalez-Vazquez S, Ponce-Guarneros JM, Santiago-Garcia AP, Amaya-Cabrera EL, Arellano-Cervantes R, Gutiérrez-Aceves JA, Alcaraz-Lopez MF, Nava-Valdivia CA, Gonzalez-Ponce F, Rodriguez-Jimenez NA, Macias-Islas MA, Valdivia-Tangarife ER, Saldaña-Cruz AM, Cardona-Muñoz EG, Gamez-Nava JI. Risk Factors Associated with Adverse Events Leading to Methotrexate Withdrawal in Elderly Rheumatoid Arthritis Patients: A Retrospective Cohort Study. J Clin Med 2024; 13:1863. [PMID: 38610627 PMCID: PMC11012848 DOI: 10.3390/jcm13071863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Rheumatoid arthritis (RA) in elderly population represents a challenge for physicians in terms of therapeutic management. Methotrexate (MTX) is the first-line treatment among conventional synthetic-disease-modifying anti-rheumatic drugs (cs-DMARDs); however, it is often associated with adverse events (AEs). Therefore, the objective of this study was to identify the incidence and risk factors of MTX discontinuation due to AEs in elderly patients with RA in a long-term retrospective cohort study. Methods: Clinical sheets from elderly RA patients taking MTX from an outpatient rheumatology consult in a university centre were reviewed. To assess MTX persistence, we used Kaplan-Meir curves and Cox regression models to identify the risk of withdrawing MTX due to adverse events. Results: In total, 198 elderly RA patients who reported using MTX were included. Of them, the rates of definitive suspension of MTX due to AEs were 23.0% at 5 years, 35.6% at 10 years and 51.7% at 15 years. The main organs and system involved were gastrointestinal (15.7%) and mucocutaneous (3.0%). Factors associated with withdrawing MTX due to AEs were MTX dose ≥ 15 mg/wk (adjusted HR: 2.46, 95% CI: 1.22-4.96, p = 0.012); instead, the folic acid supplementation was protective for withdrawal (adjusted HR: 0.28, 95% CI: 0.16-0.49, p < 0.001). Conclusions: Higher doses of MTX increase the risk of withdrawals in elderly RA, while folic acid supplementation reduces the risk. Therefore, physicians working in therapeutic management for elderly patients using MTX must focus on using lower MTX doses together with the concomitant prescription of folic acid.
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Affiliation(s)
- Felipe Alexis Avalos-Salgado
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
| | - Laura Gonzalez-Lopez
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Programa de Maestria Salud Publica, Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Sergio Gonzalez-Vazquez
- Hospital General Regional 110, Instituto Mexicano del Seguro Social, Guadalajara 44716, Mexico
| | - Juan Manuel Ponce-Guarneros
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 97, Magdalena 46474, Mexico
| | - Aline Priscilla Santiago-Garcia
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
| | | | - Reynaldo Arellano-Cervantes
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - J. Ahuixotl Gutiérrez-Aceves
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
| | - Miriam Fabiola Alcaraz-Lopez
- Departamento de Medicina Interna-Reumatología, Hospital General Regional Núm. 46, Instituto Mexicano del Seguro Social, Guadalajara 44910, Mexico
| | - Cesar Arturo Nava-Valdivia
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Fabiola Gonzalez-Ponce
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
| | - Norma Alejandra Rodriguez-Jimenez
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Miguel Angel Macias-Islas
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (M.A.M.-I.)
| | - Edgar Ricardo Valdivia-Tangarife
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (M.A.M.-I.)
| | - Ana Miriam Saldaña-Cruz
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Ernesto German Cardona-Muñoz
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Jorge Ivan Gamez-Nava
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Programa de Maestria Salud Publica, Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
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Wang C, Torisu-Itakura H, Hanada T, Matsuo T, Cai Z, Osaga S, Aranishi T. Treatment persistence of interleukin-17 inhibitor class drugs among patients with psoriasis in Japan: a retrospective database study. J DERMATOL TREAT 2023; 34:2229465. [PMID: 37403477 DOI: 10.1080/09546634.2023.2229465] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Real-world evidence on persistence of interleukin-17 inhibitors (IL-17i) as a drug class among Japanese patients with psoriasis is lacking. Hence, we aimed to describe persistence rates of IL-17is among patients with psoriasis including psoriasis vulgaris (PsO), psoriatic arthritis (PsA), and generalized pustular psoriasis (GPP) or erythrodermic psoriasis (EP) in Japan. METHODS We analyzed claims data from the Medical Data Vision database. Patients ≥15 years old with a psoriasis diagnosis and an IL-17i prescription between November 2016 and August 2020 were included and followed through August 2021. Persistence rates of the IL-17i class among patients with psoriasis and its subtypes (PsO, PsA, and GPP or EP), and persistence rates of ixekizumab, secukinumab, or brodalumab among patients with PsO or PsA were analyzed using Kaplan-Meier method. Analyses were conducted in the bio-naïve and bio-experienced subgroups. RESULTS The IL-17i class had >50% persistence rates up to 36 months among patients with psoriasis and its subtypes (PsO, PsA, and GPP or EP). 36-Month persistence rates for ixekizumab, secukinumab, and brodalumab were 46.2% to 57.7% in patients with PsO and 43.0% to 48.4% in patients with PsA. Across analyses, bio-naïve patients demonstrated similar or greater persistence rates than bio-experienced patients. CONCLUSION IL-17is' persistence rates over 36 months were >50% among patients with psoriasis and its subtypes (PsO, PsA, and GPP or EP) in Japan.
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Cerna K, Duricova D, Lukas M, Kolar M, Machkova N, Hruba V, Mitrova K, Kubickova K, Kostrejova M, Jirsa J, Kastylova K, Peterka S, Vojtechova G, Lukas M. Subcutaneous Infliximab in Refractory Crohn's Disease Patients: A Possible Biobetter? Crohns Colitis 360 2023; 5:otad040. [PMID: 38028954 PMCID: PMC10640858 DOI: 10.1093/crocol/otad040] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background A subcutaneous formulation of infliximab (IFX-SC) approved to treat patients with inflammatory bowel disease may offer improved efficacy versus intravenous infliximab. Methods Patients with refractory Crohn's disease (CD, n = 32) previously treated unsuccessfully with at least 2 biologics were treated with IFX-SC and followed from baseline at Week 0 (W0) to Week 30 (W30). The study's primary endpoint was the treatment's persistence at W30, while secondary goals included the analysis of serum infliximab trough levels (TL IFX), dynamics of anti-IFX antibodies (ATIs), and clinical, serum and fecal markers of CD activity during IFX-SC treatment. Results Midterm treatment persistence with the continuation of treatment after W30 was 53%. TL IFX median values showed rapid, significant upward dynamics and exceeded 15.5 μg/mL at W30, whereas median ATI levels significantly declined. Among ATI-negative patients at W0 (n = 15), only one showed IFX immunogenicity with newly developed ATIs at W30. Among ATI-positive patients at W0, ATI seroconversion from ATI-positive to ATI-negative status was observed in 10 of 17 patients (58.8%). Patients who had continued IFX-SC treatment at W30 showed significant decreases in C-reactive protein (P = .0341), fecal calprotectin (P = .0002), and Harvey-Bradshaw index (P = .0029) since W0. Conclusions Patients with refractory CD previously treated with at least 2 biologics exhibited clinically relevant improvement with IFX-SC, which showed less immunogenic potential than IFX-IV and highly stable TL IFX.
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Affiliation(s)
- Karin Cerna
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
- GENNET, Prague, Czech Republic
| | - Dana Duricova
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Pharmacology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Lukas
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Libechov, Czech Republic
- Department of Surgery, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Martin Kolar
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Libechov, Czech Republic
| | - Nadezda Machkova
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Veronika Hruba
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katarina Mitrova
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Pediatrics, University Hospital Motol and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kristyna Kubickova
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marta Kostrejova
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, Hospital of the Sisters of Mercy of St. Charles Borromeo, Prague, Czech Republic
| | - Jakub Jirsa
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kristyna Kastylova
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stepan Peterka
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, Hospital Jindrichuv Hradec, Jindrichuv Hradec, Czech Republic
| | - Gabriela Vojtechova
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
- ResTrial GastroEndo, Prague, Czech Republic
| | - Milan Lukas
- Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Savarese G, Kishi T, Vardeny O, Adamsson Eryd S, Bodegård J, Lund LH, Thuresson M, Bozkurt B. Heart Failure Drug Treatment-Inertia, Titration, and Discontinuation: A Multinational Observational Study (EVOLUTION HF). JACC Heart Fail 2023; 11:1-14. [PMID: 36202739 DOI: 10.1016/j.jchf.2022.08.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Guidelines recommend early initiation of multiple guideline-directed medical therapies (GDMTs) to reduce mortality/rehospitalization in patients with heart failure and reduced ejection fraction. Understanding GDMT use is critical to improving clinical practice. OBJECTIVES This study sought to describe GDMT use in Japan, Sweden, and the United States in contemporary real-world settings. METHODS EVOLUTION HF (Utilization of Dapagliflozin and Other Guideline Directed Medical Therapies in Heart Failure Patients: A Multinational Observational Study Based on Secondary Data) is an observational cohort study using routine-care databases. Patients initiating any GDMT within 12 months of a hospitalization for heart failure (hHF) discharge were included. Dapagliflozin (the only sodium-glucose cotransporter-2 inhibitor approved at study onset), sacubitril/valsartan, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) were considered separately. Doses and discontinuation were assessed in the 12 months following initiation. Target dose was defined as ≥100% of the guideline-recommended dose. RESULTS Overall, 266,589 patients were included. Mean times from hHF to GDMT initiation were longer for novel GDMTs (dapagliflozin or sacubitril/valsartan) than for other GDMTs: 39 and 44 vs 12 to 13 days (Japan), 44 and 33 vs 22 to 31 days (Sweden), and 33 and 19 vs 18 to 24 days (United States). Pooled across countries, proportions of patients who discontinued therapy (not including switches from ACE inhibitor or ARB to sacubitril/valsartan) within 12 months were 23.5% (dapagliflozin), 26.4% (sacubitril/valsartan), 38.4% (ACE inhibitors), 33.4% (ARBs), 25.2% (beta-blockers), and 42.2% (MRAs). Corresponding target dose achievements were 75.7%, 28.2%, 20.1%, 6.7%, 7.2%, and 5.1%, respectively. CONCLUSIONS Initiation of novel GDMTs is delayed compared with other GDMTs. Few patients received target doses of GDMTs requiring uptitration. Persistence was higher for dapagliflozin than other GDMTs.
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Affiliation(s)
- Gianluigi Savarese
- Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
| | - Takuya Kishi
- Department of Graduate School of Medicine (Cardiology), International University of Health and Welfare, Okawa, Japan
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Johan Bodegård
- CVRM Evidence, BioPharmaceuticals Medical, AstraZeneca, Oslo, Norway
| | - Lars H Lund
- Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Lin L, Liu C, Cheng W, Song Q, Zeng Y, Li X, Deng D, Liu D, Chen Y, Cai S, Chen P. Comparison of treatment persistence, adherence, and risk of exacerbation in patients with COPD treated with single-inhaler versus multiple-inhaler triple therapy: A prospective observational study in China. Front Pharmacol 2023; 14:1147985. [PMID: 37025493 PMCID: PMC10072324 DOI: 10.3389/fphar.2023.1147985] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Aim: This study sought to compare treatment persistence, adherence, and risk of exacerbation among patients with COPD treated with single-inhaler triple therapy (SITT) and multiple-inhaler triple therapy (MITT) in the Chinese population. Methods: This was a multicenter, prospective observational study. Patients with COPD from ten hospitals in Hunan and Guangxi provinces in China were recruited from 1 January 2020 to 31 November 2021 for the study and were followed up for one year. Treatment persistence, adherence, and exacerbation rates during the 12-month follow-up were analyzed in COPD patients treated with SITT and MITT. Results: A total of 1,328 patients were enrolled for final analysis, including 535 (40.3%) patients treated with SITT and 793 (59.7%) treated with MITT. Of these patients, the mean age was 64.9 years and most patients were men. The mean CAT score was 15.2 ± 7.1, and the median (IQR) FEV1% was 54.4 (31.2). The SITT group had a higher mean CAT score, more patients with mMRC >1, and lower mean FEV1% and FEV1/FVC than the MITT patients. Moreover, the proportion of patients with ≥1 exacerbation in the previous year was higher in the SITT cohort. SITT patients had, compared to MITT patients, a higher proportion of adherence (proportion of days covered, PDC) ≥0.8 (86.5% vs. 79.8%; p = 0.006), higher treatment persistence [HR: 1.676 (1.356-2.071), p < 0.001], lower risk of moderate-to-severe exacerbation [HR: 0.729 (0.593-0.898), p = 0.003], and severe exacerbation [HR: 0.675 (0.515-0.875), p = 0.003], as well as reduced all-cause mortality risk [HR: 0.475 (0.237-0.952), p = 0.036] during the 12-month follow-up. Persistence was related to fewer future exacerbations and mortality than non-persistence in the SITT and MITT groups. Conclusion: Patients with COPD treated with SITT showed improved treatment persistence and adherence, as well as a reduction in the risk of moderate-to-severe exacerbation, severe exacerbation, and mortality compared to patients treated with MITT in the Chinese population. Clinical Trial Registration: https://www.chictr.org.cn/, identifier ChiCTR-POC-17010431.
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Affiliation(s)
- Ling Lin
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Cong Liu
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Wei Cheng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Qing Song
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yuqin Zeng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Xin Li
- Division 4 of Occupational Diseases, Hunan Prevention and Treatment Institute for Occupational Diseases, Changsha, China
| | - Dingding Deng
- Department of Respiratory Medicine, The First Affiliated People’s Hospital, Shaoyang College, Shaoyang, China
| | - Dan Liu
- Department of Respiratory, The Eighth Hospital in Changsha, Hunan, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Shan Cai
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
- *Correspondence: Ping Chen,
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Barbieri MA, Viola A, Cicala G, Spina E, Fries W. Effectiveness and Safety Profiles of Biological Therapies in Inflammatory Bowel Disease: Real Life Data from an Active Pharmacovigilance Project. Biomedicines 2022; 10:biomedicines10123280. [PMID: 36552036 PMCID: PMC9775949 DOI: 10.3390/biomedicines10123280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Post-marketing surveillance is essential to evaluate the risk/benefit profile of drugs; however, pharmacovigilance studies comparing persistence and safety of biologic therapies in patients with inflammatory bowel disease (IBD) are scant. The aim of this study was to prospectively investigate persistence together with safety profiles of biologics in a cohort of patients diagnosed with Crohn's Disease (CD) or ulcerative colitis (UC) followed by the IBD unit of Messina and treated with infliximab (IFX), adalimumab (ADA), golimumab (GOL), vedolizumab (VED), and ustekinumab (UST) from 2017 through 2021. Descriptive and treatment persistence analyses with predictors for discontinuation and occurrence of adverse drug reactions (ADRs) were performed. A total of 675 IBD patients were enrolled. A higher persistence rate was noted for UST and ADA in the first year (83.8% and 83.1%, respectively) and for IFX in the fifth year of treatment (58.1%). GOL, VED, and UST-all used as second/third-line therapies-seemed to have a higher risk of non-persistence than IFX (in order HR: 2.19; CI 95%: 1.33-3.61, 1.45; 1.04-2.04, 2.25; 1.25-4.07) as well as switchers and those who had at least one ADR (18.1; 13.22-24.68 and 1.55; 1.20-1.99, respectively). The reported ADRs, which were generally mild-moderate, were largely known. However, real-world data should be implemented to further study undetected safety concerns, including risk of malignancy.
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Gómez-Castañeda E, Hopcroft LEM, Rogers S, Munje C, Bittencourt-Silvestre J, Copland M, Vetrie D, Holyoake T, Jørgensen HG. Tyrosine Kinase Inhibitor Independent Gene Expression Signature in CML Offers New Targets for LSPC Eradication Therapy. Cancers (Basel) 2022; 14:5253. [PMID: 36358672 PMCID: PMC9655972 DOI: 10.3390/cancers14215253] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022] Open
Abstract
Tyrosine kinase inhibitors (TKI) have revolutionised the treatment of CML. However, TKI do not eliminate the leukaemia stem cells (LSC), which can re-initiate the disease. Thus, finding new therapeutic targets in CML LSC is key to finding a curative treatment. Using microarray datasets, we defined a list of 227 genes that were differentially expressed in CML LSC compared to the healthy controls but were not affected by TKI in vitro. Two of them, CD33 and PPIF, are targeted by gemtuzumab-ozogamicin and cyclosporin A, respectively. We treated CML and the control CD34+ cells with either drug with or without imatinib to investigate the therapeutic potential of the TKI-independent gene expression programme. Cyclosporine A, in combination with imatinib, reduced the number of CML CFC compared with non-CML controls, but only at supra-therapeutic concentrations. Gemtuzumab-ozogamicin showed an EC50 of 146 ng/mL, below the plasma peak concentration of 630 ng/mL observed in the AML patients and below the EC50 of 3247 ng/mL observed in the non-CML cells. Interestingly, gemtuzumab-ozogamicin seems to promote cell cycle progression in CML CD34+ cells and demonstrated activation of the RUNX1 pathway in an RNAseq experiment. This suggests that targeting the TKI-independent genes in CML LSC could be exploited for the development of new therapies in CML.
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Affiliation(s)
- Eduardo Gómez-Castañeda
- Paul O’Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 21 Shelley Road, Glasgow G12 0ZD, UK
| | - Lisa E. M. Hopcroft
- Paul O’Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 21 Shelley Road, Glasgow G12 0ZD, UK
| | - Simon Rogers
- School of Computing Science, College of Science and Engineering, University of Glasgow, 18 Lilybank Gardens, Glasgow G12 8RZ, UK
| | - Chinmay Munje
- Paul O’Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 21 Shelley Road, Glasgow G12 0ZD, UK
| | - Joana Bittencourt-Silvestre
- Paul O’Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 21 Shelley Road, Glasgow G12 0ZD, UK
| | - Mhairi Copland
- Paul O’Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 21 Shelley Road, Glasgow G12 0ZD, UK
| | - David Vetrie
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Science, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1QH, UK
| | - Tessa Holyoake
- Paul O’Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 21 Shelley Road, Glasgow G12 0ZD, UK
| | - Heather G. Jørgensen
- Paul O’Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 21 Shelley Road, Glasgow G12 0ZD, UK
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Cheung WY, LaForty C, Liovas A, McKechnie H, Loree JM. A Real-World Observational Study of the Use and Associated Costs of Treating Neuroendocrine Tumors With Somatostatin Analogs in Canada. Pancreas 2022; 51:1146-1152. [PMID: 37078938 PMCID: PMC10144276 DOI: 10.1097/mpa.0000000000002144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 10/17/2022] [Indexed: 04/21/2023]
Abstract
OBJECTIVES Somatostatin analogs (SSAs; lanreotide autogel and octreotide long-acting release) are used to treat neuroendocrine tumors; however, factors that influence SSA use are unclear. METHODS This real-world, observational study collected data from private/public pharmacy claims for patients using SSAs in Canada. Data relating to dosing regimens, injection burden, treatment persistence, and costs were retrospectively analyzed for treatment-naive patients. RESULTS Overall, 1545 patients were included in the analysis of dosing regimens, 908 for injection burden, 453 for treatment persistence, and 903 for treatment-associated costs. Compared with lanreotide, treatment with octreotide long-acting release was more likely associated with treatment above the maximum recommended dose (odds ratio, 16.2; 95% confidence interval, 4.3-136.2; P < 0.0001), higher weighted average long-acting SSA injection burden (13.4 vs 12.5, P < 0.0001), and a higher number of rescue medication claims per patient (0.22 vs 0.03, P < 0.0001). Treatment with lanreotide autogel was associated with greater treatment persistence (hazard ratio, 0.58; 95% confidence interval, 0.42-0.80; P = 0.001) and lower mean annual costs of treatment than octreotide long-acting release (Canadian dollars $27,829.35 vs $31,255.49; P < 0.0001). CONCLUSIONS These findings provide valuable insight into SSA use in clinical settings and may inform treatment selection.
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Affiliation(s)
| | | | - Anna Liovas
- Ipsen Biopharmaceuticals Canada, Mississauga
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9
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Ylisaukko-Oja T, Puttonen M, Jokelainen J, Koivusalo M, Tamminen K, Torvinen S, Voutilainen M. Dose-escalation of adalimumab, golimumab or ustekinumab in inflammatory bowel diseases: characterization and implications in real-life clinical practice. Scand J Gastroenterol 2022; 57:415-423. [PMID: 34927504 DOI: 10.1080/00365521.2021.2014950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Dose-escalation is a common practice to optimize treatment with subcutaneously administered biologicals in Crohn's disease (CD) and ulcerative colitis (UC). However, limited data is available on the extent of dose-escalation in real-life. Here, we analyzed treatment persistence, dose-escalation, concomitant corticosteroid use, and costs of adalimumab, golimumab, and ustekinumab in inflammatory bowel diseases (IBD). METHODS This was a nationwide, retrospective, non-interventional registry study. All adult patients who were diagnosed with CD or UC and had purchased adalimumab, golimumab, or ustekinumab from Finnish pharmacies between 2008 and 2018 were included in the study and followed up for 24 months after treatment initiation. RESULTS A total of 2884 patients were included in the analyses. For adalimumab, treatment persistence was higher for CD patients compared to UC patients both at months 12 (46.2% versus 37.1%; p < .0001) and 24 (26.1% versus 19.7%; p < 0.0001). For golimumab (UC), treatment persistence was 48.3% at month 12 and 28.1% at month 24. The 12-month treatment persistence rate for patients on ustekinumab (CD) was 47.1%. Cumulative doses exceeding the regular dosing according to the summary of product characteristics (SPC), was observed for adalimumab in CD during the first 6 months of treatment (62.9% of the treatment periods), golimumab in the later stages of the UC treatment (52-54% of treatment periods at months 7-24), and ustekinumab during the first 6 months (70.7%). CONCLUSIONS Based on this study, dose-escalation of subcutaneously administered biologicals is a common clinical practice in IBD. This has implications for treatment costs, use of concomitant medications, and treatment outcomes.
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Affiliation(s)
- Tero Ylisaukko-Oja
- MedEngine Oy, Helsinki, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Minna Puttonen
- Takeda Oy, Helsinki, Finland.,Division of Pharmaceutical Technology and Chemistry, Industrial Pharmacy, University of Helsinki, Helsinki, Finland
| | - Jari Jokelainen
- MedEngine Oy, Helsinki, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | | | | | | | - Markku Voutilainen
- Division of Medicine, Turku University Hospital, Turku, Finland.,Department of Medicine, University of Turku, Turku, Finland
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10
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Blauvelt A, Shi N, Somani N, Burge R, Zhu B, Ridenour TL, Lew CR, Zimmerman NM, Atiya B, Murage MJ. Comparison of two-year treatment adherence, persistence, discontinuation, reinitiation, and switching between psoriasis patients treated with ixekizumab or secukinumab in real-world settings. J Am Acad Dermatol 2021:S0190-9622(21)02079-X. [PMID: 34252464 DOI: 10.1016/j.jaad.2021.06.878] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Real-world data on long-term treatment patterns associated with interleukin-17A inhibitors in plaque psoriasis are lacking. OBJECTIVE To compare ixekizumab or secukinumab treatment patterns over a 24-month period among plaque psoriasis patients. METHODS Adult patients with psoriasis who had 1 or more claims for ixekizumab or secukinumab between March 1, 2016, and October 31, 2019, and with 24 months of follow-up after starting treatment were identified from IBM MarketScan claims databases. Inverse probability of treatment weighting and multivariable models were employed to balance cohorts and estimate the risks of nonpersistence, discontinuation, and switching and odds of highly adherent treatment (proportion of days covered ≥ 80%). RESULTS A total of 471 ixekizumab and 990 secukinumab users were included. Compared to secukinumab, ixekizumab use was associated with a 20% lower risk of nonpersistence (hazard ratio, 0.80; 95% CI, 0.70-0.92), a 17% lower risk of discontinuation (hazard ratio, 0.83; 95% CI, 0.72-0.96), and a 42% higher odds of being highly adherent to treatment (odds ratio, 1.42; 95% CI, 1.12-1.80). No difference in risk of switching was observed (hazard ratio, 0.83; 95% CI, 0.68-1.01). LIMITATIONS Disease severity and clinical outcomes were unavailable. CONCLUSION Over 24 months, ixekizumab users exhibited better persistence and adherence, and a lower risk of discontinuation than secukinumab users in real-world settings.
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11
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Mahlich J, May M, Feig C, Straub V, Schmelz R. Persistence With Biologic Therapy and Associated Costs of Patients With Inflammatory Bowel Disease: A German Retrospective Claims Data Analysis. Crohns Colitis 360 2021; 3:otab011. [PMID: 36778945 PMCID: PMC9802337 DOI: 10.1093/crocol/otab011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background In recent years, biologic agents became a relevant and promising treatment option for inflammatory bowel diseases (IBDs). However, high treatment costs and moderate remission rates lead to a high interest in treatment persistence and corresponding economic consequences. Methods A retrospective health claims data analysis was conducted including biologic naive patients diagnosed with IBD between 2013 and 2018. Observation points were at 12 and 18 months of follow-up, starting from the first biologic prescription. Nonpersistence was defined as either no further prescription or prescription of another biologic agent within the days of supply per original prescription. Biologic agents included were Adalimumab, Golimumab, Infliximab, Ustekinumab, and Vedolizumab. Results In total, 1444 patients with IBD were included in this analysis, mostly treated with Adalimumab (46.9%) and Infliximab (39.9%) as their first biologic treatment. After 12 months, 72.2% of patients were still persistent with their initial biologic treatment with the highest shares for Infliximab (74%) and Vedolizumab (72.4%). 27.8% of patients were nonpersistent, mostly due to a switch of biologic agent (75.8%). Cox regression identified female, hospitalizations, and simultaneous prescriptions of corticosteroids and immunomodulators as risk factors for nonpersistence. Treatment costs per year were approximately 3000€ higher for nonpersistent patients (27,146€) than for persistent patients (23,839€), mostly due to inpatient treatment costs. Conclusions The persistence of biologic therapy in this study was rather high at 72% after 12 months, while nonpersistence was mostly due to switches to other biologic agents. Lack of persistence is associated with increased cost, mostly due to nonbiologic medication and inpatient treatment.
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Affiliation(s)
- Joerg Mahlich
- Health Economics and Outcomes Research, Janssen-Cilag GmbH, Neuss, Germany,Düsseldorf Institute for Competition Economics (DICE), DICE, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany,Address correspondence to: Joerg Mahlich, PhD, Janssen-Cilag, Johnson & Johnson Platz 1, 41470 Neuss, Germany ()
| | - Melanie May
- Health Economics, HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - Chiara Feig
- Health Economics, HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - Vincent Straub
- Health Economics, HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - Renate Schmelz
- Medical Department, Universitätsklinikum Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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12
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Tuka V, Linhart A. Why we still dont achieve blood pressure targets. Vnitr Lek 2021; 67:368-371. [PMID: 35459381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Arterial hypertension is one of the main modifiable risk factors for atherosclerotic cardiovascular disease. The prevalence of hypertension remains high, and its compensation is still unsatisfactory. In most patients, we should try to achieve office blood pressure values below 140/90 mm Hg, and in those who tolerate treatment well, values around 130/80 mm Hg, as soon as possible, ideally within three months of diagnosis. While lifestyle interventions are essential and should not be overlooked, most hypertensive patients cannot avoid pharmacotherapy, primarily using a combination of two or more antihypertensives. Achieving blood pressure targets, which determine the patients prognosis, is still not ideal. Factors on both the physicians side and the patients side contribute to achieving blood pressure targets. The review article offers various approaches to achieving blood pressure targets, such as using fixed combinations.
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Arikawa M, Ota K, Azekawa T, Ohashi S, Funaoka Y, Yoshiie H, Koshi H, Takaishi Y, Nakao S. The Use of the Japanese Public Financial Support Has Positive Impact on Persistence with Outpatient Treatments for Schizophrenia: Single-center Retrospective Cohort Study in Japan. Patient Prefer Adherence 2021; 15:169-175. [PMID: 33564227 PMCID: PMC7866921 DOI: 10.2147/ppa.s282958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/04/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE One of the challenges of treating schizophrenia is how to improve persistence with outpatient treatments. Lengthening community life by improving persistence and preventing relapse and rehospitalization can have positive influence on the patients' personal recovery and well-being. In Japan, there is "Medical Expenses for Services and Supports for Persons with Disabilities" ("Jiritsu-shien-iryo-hi" in Japanese) which is the public financial support system for psychiatric outpatient treatments. However, it is not clear how this financial support affects persistence with outpatient treatments for patients with schizophrenia. The purpose of the study is to investigate how the financial support affects persistence with outpatient treatments for schizophrenia. PATIENTS AND METHODS Data of outpatients who visited the clinic between October 1, 2006 and September 30, 2016 was collected. The variables for the analysis were continuation and discontinuation of treatment of those who used the financial support (user) and those who did not (nonuser). The covariates were sex, age, time from onset of the disease to first visit to the clinic, number of hospitalizations in the past, use of psychiatric day care, and use of psychiatric home nursing care. Kaplan-Meier analysis was performed using propensity score matching. The observation period was five years from the first visit to the clinic. RESULTS Among 1155 patients who were diagnosed with schizophrenia, 718 were excluded, based on the exclusion criteria. The propensity score matching was performed for 437 patients, and the subjects for the final analysis were 278. Average survival period was 1.09 (SD ±1.66) years for nonuser, 3.02 (SD ±1.77) years for users, and users exhibited a significantly longer number of years of outpatient treatments (P<0.001). CONCLUSION The results indicated that use of the financial support can contribute to persistence with outpatient treatments.
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Affiliation(s)
- Masatoshi Arikawa
- Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan
- Correspondence: Masatoshi Arikawa Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan Email
| | - Kazumi Ota
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Takaharu Azekawa
- Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan
| | - Shizuko Ohashi
- Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan
| | - Yoichi Funaoka
- Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan
| | - Hiroshi Yoshiie
- Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan
| | - Haruka Koshi
- Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan
| | - Yohei Takaishi
- Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan
| | - Saeka Nakao
- Department of Psychiatry, Shioiri Mental Clinic, Yokosuka, Kanagawa, Japan
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Abstract
Objective: The aim of the study was to identify factors for treatment non-persistence in patients with ADHD. Method: Data for 100 patients with ADHD aged 5 to 16 who completed the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K) and Korean Wechsler Intelligence Scale for Children (K-WISC) were obtained between 2008 and 2013. Patients were classified as treatment-persistent and treatment-non-persistent based on 6-month follow-up. Sociodemographic data, comorbidities, intelligence quotient (IQ), severity, and social/school functioning were compared. Results: Adolescence and poor parental spousal relationships significantly predicted treatment non-persistence. Although comorbid major depressive disorder and absence of transient tic disorder were associated with treatment non-persistence, there was no difference in overall psychiatric comorbidity. No differences existed for IQ, Clinical Global Impressions-Severity (CGI-S) score, peer relationships, and academic achievement. Conclusion: Lower treatment persistence was associated with adolescence, comorbid depression, absence of tics, and poor parental spousal relationships, but not with symptom severity or impairment of the disorder.
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Affiliation(s)
- Jiung Park
- Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Bongseog Kim
- Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
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15
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Park JA, Lee MY, Nam JH, Shin JY, Wood R, Holbrook T, Kwon SH. Real-world treatment persistence of non-tumor necrosis factor inhibitors versus tumor necrosis factor inhibitors among patients with rheumatoid arthritis in South Korea. Curr Med Res Opin 2020; 36:343-351. [PMID: 31670976 DOI: 10.1080/03007995.2019.1688271] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aims: We aimed to assess treatment persistence of tumor necrosis factor (TNF) inhibitors and non-TNF inhibitors in two groups of rheumatoid arthritis (RA) patients: biologic disease-modifying antirheumatic drug (bDMARD) initiators and switchers.Patients and methods: This retrospective cohort study utilized a national health insurance claims database. Patients aged ≥18 years initiating/switching bDMARD between 1 December 2013 and 31 December 2014, the index period, were followed for 12 months. Initiators who began treatment with a bDMARD during the index period were defined as having no bDMARD prescriptions for the previous year. Switchers who changed treatment from the previous bDMARD to the index bDMARD were defined as having different bDMARDs during the index period. Treatment persistence rates during the follow-up period were measured, and factors associated with non-persistence were assessed with the Cox proportional hazard model.Results: Of 2684 patients, treatment persistence rates were the highest for abatacept in initiators (69.3%) and tocilizumab in switchers (77.0%), while adalimumab showed the lowest persistence rates for both initiators and switchers (48.2%, 28.8%), followed by etanercept (51.3%, 41.0%). Adalimumab and etanercept were significantly more likely to show non-persistence (HR 1.58, 95% CI 1.27-1.96; HR 1.42, 95% CI 1.14-1.76) compared to infliximab for initiators, while tocilizumab was significantly more likely to show persistence (HR 0.411, 95% CI 0.206-0.819) in switchers.Conclusions: Non-TNF inhibitors showed higher persistence rates than TNF inhibitors in South Korean RA patients, and tocilizumab especially was associated with higher persistence in patients with inadequate response to TNF inhibitors. Good persistence with non-TNF inhibitors indicates the potential for long-term efficacy as first-line treatment.
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Affiliation(s)
- Jae-A Park
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | | | - Jin Hyun Nam
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Robert Wood
- Real-World Evidence Generation, Adelphi Real World, Bollington, UK
| | - Tim Holbrook
- Real-World Evidence Generation, Adelphi Real World, Bollington, UK
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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Reenaers C, Cremer A, Dewit O, De Vroey B, Van Moerkercke W, Bossuyt P, Muls V, Imschoot J, Block S, Hantson A, Van Hootegem P. Effectiveness and persistence of Vedolizumab in patients with inflammatory bowel disease : results from the Belgian REal-LIfe study with VEdolizumab (Be-RELIVE). Acta Gastroenterol Belg 2020; 83:15-23. [PMID: 32233267] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND STUDY AIMS Vedolizumab (VDZ) is a gutselective integrin inhibitor used to treat Crohn's disease (CD) and ulcerative colitis (UC). This retrospective study assessed effectiveness and treatment persistence of VDZ in a Belgian reallife cohort of CD and UC patients. PATIENTS AND METHODS CD and UC patients from 15 Belgian centers, who started VDZ between 01/09/2015 and 31/06/2016 and attended ≥1 visit after the first VDZ infusion, were included. Data were collected before first infusion, at week (W)10, W14 (CD patients only), month (M)6 and last follow-up. Treatment response and remission rates (changes in disease activity scores) and treatment persistence (Kaplan-Meier analysis) were assessed. RESULTS Of the 348 patients receiving at least one dose of VDZ, 325 (202 CD, 45 biologic-naïve; and 123 UC, 42 biologic-naïve) patients were included in data analyses. At M6, 87.6% (176/201) of CD and 86.1% (105/122) of UC patients were still on VDZ treatment, 75.6% (34/45) and 83.9% (26/31) achieved clinical response, and 66.7% (44/66) and 42.9% (15/35) were in remission. At M6 remission rates was significantly higher while response rates tended to be higher among biologic-naïve versus biologic-failure CD patients. CONCLUSIONS VDZ offers an effective treatment option in real-life settings and treatment effectiveness appears higher in biologic-naïve versus biologic-failure CD patients. (Acta gastroenterol. belg., 2020, 83, 15-23).
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Affiliation(s)
- C Reenaers
- Centre Hospitalier Universitaire de Liège, Avenue de l'Hôpital 1, 4000 Liège, Belgium
| | - A Cremer
- Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - O Dewit
- Clinique Universitaire Saint-Luc, Brussels, Belgium
| | - B De Vroey
- Clinique Universitaire Saint-Luc, Brussels, Belgium
- Centre Hospitalier Jolimont, Haine-Saint-Paul, Belgium
| | | | - P Bossuyt
- Imelda GI Clinical Research Centre, Bonheiden, Belgium
| | - V Muls
- Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | | | - S Block
- Takeda Belgium, Zaventem, Belgium
| | | | - P Van Hootegem
- Algemeen Ziekenhuis Sint-Lucas Brugge vzw, Brugge, Belgium
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17
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Clunie G, McInnes IB, Barkham N, Marzo-Ortega H, Patel Y, Gough A, Packham J, Kyle S, Kirkham B, Sheeran T, Coope H, Bishop-Bailey A, McHugh N. Long-term effectiveness of tumour necrosis factor-α inhibitor treatment for psoriatic arthritis in the UK: a multicentre retrospective study. Rheumatol Adv Pract 2019; 2:rky042. [PMID: 31431979 PMCID: PMC6649900 DOI: 10.1093/rap/rky042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/26/2018] [Indexed: 12/31/2022] Open
Abstract
Objective Real-world evidence of the long-term effectiveness of TNF-α inhibitor (TNFi) therapy in patients with PsA is limited. This study was conducted to describe patterns of TNFi therapy and treatment responses in patients with PsA treated in UK clinical practice. Methods A multicentre, retrospective, observational cohort study of consenting patients treated with TNFi for PsA with ≥3 years follow-up from first TNFi initiation (observation period) was carried out in 11 UK National Health Service hospitals. Data were collected concerning baseline patient characteristics, PsA-related treatment pathways and TNFi treatment responses (PsA response criteria components: swollen/tender joint counts, physician and patient global assessments). Results The mean age of patients (n = 141) was 50.3 (s.d.: 12.1) years (50% male). During a median observation period of 4.5 (range: 3.4–5.5) years, patients received a median of one (range: one to five) TNFi. Twelve-week response rates for first TNFi (where available) were as follows: 80% (n = 64/80) for swollen joint counts, 79% (n = 63/79) for tender joint counts, 79% (n = 37/47) for physician global assessments, 69% (n = 41/59) for patient global assessments and 79% (n = 37/47) for PsA response criteria. At the end of the observation period, the proportions of patients remaining on first, second, third and fourth/fifth TNFi were 56, 15, 5 and 3%, respectively; 21% of patients permanently discontinued TNFi therapy. Conclusion Long-term TNFi therapy is generally well tolerated and may be effective; however, after initial TNFi failure, there appears to be progressively less benefit and more adverse effects with successive TNFi switches. Strategies are needed for effective therapy for PsA beyond the first TNFi failure.
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Affiliation(s)
| | | | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust Leeds, Leeds.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | | | - Andrew Gough
- Rheumatology, Harrogate District Hospital, Harrogate
| | - Jon Packham
- Rheumatology, Haywood Hospital, Stoke-on-Trent
| | - Stuart Kyle
- Rheumatology, North Devon Hospital, Barnstaple
| | - Bruce Kirkham
- Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London
| | - Tom Sheeran
- Rheumatology, Cannock Chase Hospital, Cannock
| | - Helen Coope
- Immunology & Dermatology, Novartis Pharmaceuticals UK Limited, Frimley
| | | | - Neil McHugh
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
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Chen C, Hartzema AG, Xiao H, Wei YJ, Chaudhry N, Ewelukwa O, Glover SC, Zimmermann EM. Real-world Pattern of Biologic Use in Patients With Inflammatory Bowel Disease: Treatment Persistence, Switching, and Importance of Concurrent Immunosuppressive Therapy. Inflamm Bowel Dis 2019; 25:1417-1427. [PMID: 30839057 DOI: 10.1093/ibd/izz001] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Medication persistence, defined as the time from drug initiation to discontinuation of therapy, has been suggested as a proxy for real-world therapeutic benefit and safety. This study seeks to compare the persistence of biologic drugs among patients with inflammatory bowel disease (IBD). METHODS Patients with newly diagnosed IBD were included in a retrospective study using Truven MarketScan database. Treatment persistence and switching was compared among biologic medications including infliximab, adalimumab, certolizumab, golimumab, and vedolizumab. Predictors for discontinuation and switching were evaluated using time-dependent proportional hazard regression. RESULTS In total, 5612 patients with Crohn's disease (CD) and 3533 patients with ulcerative colitis (UC) were included in this analysis. Less than half of the patients continued using their initial biologic treatment after 1 year (48.48% in CD cohort; 44.78% in UC cohort). In the first year, adalimumab had the highest persistence and lowest switching rates for both CD (median survival time: 1.04 years) and UC (median survival time: 0.84 years). In subsequent years, infliximab users were more likely to persist in the use of biologic. Combination therapy with immunomodulators significantly decreased the risk of discontinuation, especially when immunomodulator therapy was started more than 30 days before the biologic (hazard ratio [HR], 0.22; CI, 0.16, 0.32). The major predictors for noncompliance included infection and hospitalization. CONCLUSION Overall, the persistence profiles of biologics suggest a high rate of dissatisfaction or adverse disease outcomes resulting in discontinuation and switching to a different agent. Early initiation of immunomodulators will substantially increase the persistence of biologic treatment.
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Affiliation(s)
- Chao Chen
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Abraham G Hartzema
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Hong Xiao
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Yu-Jung Wei
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Naueen Chaudhry
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Ofor Ewelukwa
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Sarah C Glover
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Ellen M Zimmermann
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
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Luttropp K, Dozier M, Justo N, Cornillie F, Kachroo S, Govoni M, Salomonsson S, Black CM, Khalifa A. Real-world treatment persistence of golimumab in the management of immune-mediated rheumatic diseases in Europe: a systematic literature review. BMJ Open 2019; 9:e027456. [PMID: 31142529 PMCID: PMC6549706 DOI: 10.1136/bmjopen-2018-027456] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Received: 10/23/2018] [Revised: 02/14/2019] [Accepted: 03/25/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To summarise real-world data from studies reporting golimumab persistence in European immune-mediated rheumatic disease (IMRD) populations and to report pooled estimates. DESIGN Systematic literature review. DATA SOURCES Relevant literature was identified through searching Medline and Embase via Ovid as well as the conference databases of European League Against Rheumatism and American College of Rheumatology-Association of Rheumatology Health Professionals. ELIGIBILITY CRITERIA We screened records using predefined patients, interventions, comparators, outcomes and study design criteria. Eligible studies included reports of persistence among adult IMRD patients in Europe receiving treatment with subcutaneous golimumab. Clinical trials, randomised controlled trials, literature reviews, editorials, guidelines and studies with <20 patients receiving golimumab were excluded. DATA EXTRACTION AND SYNTHESIS Following double screening by two independent reviewers, 27 studies out of 578 identified records were selected for inclusion and subsequent data extraction. Persistence was most commonly reported at 12and 24 months; hence, pooled persistence estimates were calculated for these two time points and reported according to indication. RESULTS Persistence ranged between 58.1% (psoriatic arthritis (PsA) patients regardless of treatment line) and 75.7% (biological-naïve rheumatoid arthritis patients) at 12 months; at 24 months, the range was 43% (axial spondyloarthritis (AxSpA) patients regardless of treatment line) and 69.6% (biological-naïve PsA patients). On the basis of data from 12 studies, persistence with golimumab treatment was either significantly higher or not significantly different from other tumour necrosis factor inhibitors (TNFi). CONCLUSIONS Golimumab persistence at 24 months approximates 50%, with a lower persistence among AxSpA (43%) patients. However, as the number of studies in these populations was low, they warrant further research. In 12 studies comparing various TNFi treatments, golimumab was shown to have significantly better or equal persistence to its comparators.
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Affiliation(s)
- Karin Luttropp
- Real World Evidence Strategy & Analytics, ICON Clinical Research, Stockholm, Sweden
| | - Mary Dozier
- Real World Evidence Strategy & Analytics, ICON Clinical Research, Boston, Massachusetts, USA
| | - Nahila Justo
- Real World Evidence Strategy & Analytics, ICON Clinical Research, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | - Freddy Cornillie
- Medical Affairs Immunology, MSD Switzerland, Lucerne, Switzerland
| | - Sumesh Kachroo
- Center for Observational and Real-world Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Stina Salomonsson
- Center for Observational and Real-world Evidence (CORE), MSD Sweden, Stockholm, Sweden
| | - Christopher M Black
- Center for Observational and Real-world Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Ahmed Khalifa
- Medical Affairs Immunology, MSD Switzerland, Lucerne, Switzerland
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Cummings F, Gaya DR, Levison S, Subramanian S, Owen G, Rathmell A, Glen F, Demuth D, Meadowcroft S, Irving PM. A retrospective observational study of early experiences of vedolizumab treatment for inflammatory bowel disease in the UK: The REVIVE study. Medicine (Baltimore) 2019; 98:e14681. [PMID: 30817598 PMCID: PMC6831399 DOI: 10.1097/md.0000000000014681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 12/31/2022] Open
Abstract
Results from clinical trials show that vedolizumab is an efficacious treatment for inflammatory bowel disease, namely Crohn's disease (CD) and ulcerative colitis (UC). However, there is limited evidence from real-world clinical practice, especially on early clinical experiences in the UK.To describe real-world early experiences of vedolizumab to treat CD and UC in the UK.A retrospective, chart review study of patients with CD or UC treated with vedolizumab across 5 UK hospitals. All eligible adults (≥18 years at initiation) with a diagnosis of CD and ≥14 weeks of data or UC and ≥10 weeks of data available following vedolizumab initiation were included.Data were analyzed for 112 patients (CD: 66; UC: 46). Patients with CD had a median of 7.4 (interquartile range 5.7-9.4) months follow-up and patients with UC had a median of 7.4 (5.6-10.2) months follow-up post-vedolizumab initiation. Most patients, 80% (53/66) with CD and 89% (41/46) with UC, remained on vedolizumab treatment at the time of data collection. No new safety signals were identified during the study.These results add to the body of evidence supporting vedolizumab as an effective and well-tolerated treatment for CD and UC in real-world clinical practice.
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Affiliation(s)
- Fraser Cummings
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton
| | - Daniel R. Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow
| | - Scott Levison
- Department of Gastroenterology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester
| | - Sreedhar Subramanian
- Department of Gastroenterology, Royal Liverpool University Hospital, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool
| | - Glynn Owen
- Takeda UK Ltd, High Wycombe, UK. Current address: Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Anna Rathmell
- Takeda UK Ltd, High Wycombe, UK. Current address: Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | - Dirk Demuth
- Evidence and Value Generation, Takeda Development Centre Europe Ltd
| | - Simon Meadowcroft
- Takeda UK Ltd, High Wycombe, UK. Current address: Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Peter M. Irving
- IBD Unit, St Thomas’ Hospital, Guys and St Thomas’ NHS Foundation Trust, London, UK
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Acar M, Juneja P, Handel M. Treatment persistence of subcutaneous TNF inhibitors among Australian patients with immune-mediated rheumatic disease (IMRD). Open Access Rheumatol 2018; 10:151-160. [PMID: 30568519 PMCID: PMC6267492 DOI: 10.2147/oarrr.s179704] [Citation(s) in RCA: 6] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction To describe the persistence of treatment with subcutaneous tumor necrosis factor inhibitors (TNFi) adalimumab, etanercept, and golimumab in immune-mediated rheumatic disease (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) by treatment sequence (first-line treatment, second-line or further lines of treatment). Methods A retrospective cohort analysis was conducted using the Australian Commonwealth Department of Human Services Pharmaceutical Benefits Scheme 10% sample data from January 1, 2010, to June 30, 2016. Pharmaceutical Benefits Scheme indications were used to identify patient prescriptions for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. A patient was considered persistent until a 3-month gap period where a prescription was not dispensed. The 3-month gap interval was chosen because only 1% of all discontinuations occurred beyond this 3-month period. Results Data from 2,612 first-line patients were included. Treatment discontinuation among first-line patients treated with etanercept or adalimumab was not significantly different from those treated with golimumab (HR 1.10, 95% CI 0.95–1.28, P=0.22; HR 1.06, 95% CI 0.93–1.22, P=0.39; respectively). Among the 1,276 patients in the second-line cohort (etanercept=41%, adalimumab=41%, golimumab=18%) discontinuation was significantly higher for patients on etanercept compared with golimumab (HR 1.24, 95% CI 1.03–1.50, P=0.03); but not for adalimumab compared with golimumab (HR 1.11, 95% CI 0.91–1.34, P=0.31). In the third-line setting, treatment persistence with etanercept was longer than golimumab (HR 0.75, 95% CI 0.59–0.96, P=0.02), but there was no difference between golimumab and adalimumab. Similar findings occurred in the propensity score matched population. Conclusion Our study shows there is variance in real-world persistence to TNFi in patients with immune-mediated rheumatic disease by line of therapy, with the time on therapy decreasing by line. Australian persistence has been reported at lower overall rates than international evidence.
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Bonafede MMK, McMorrow D, Proudfoot C, Shinde S, Kuznik A, Chen CI. Treatment Persistence and Healthcare Costs Among Patients with Rheumatoid Arthritis After a Change in Targeted Therapy. Am Health Drug Benefits 2018; 11:192-202. [PMID: 30464787 PMCID: PMC6207310] [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] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/12/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Targeted disease-modifying antirheumatic drug (DMARD) options for rheumatoid arthritis (RA) include tumor necrosis factor (TNF) inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab) or alternative mechanisms of action (MOAs), such as a T-cell co-stimulation modulator (abatacept), Janus kinase inhibitor (tofacitinib), or interleukin-6 inhibitor (tocilizumab). OBJECTIVE To examine treatment persistence and healthcare costs in patients with RA who changed therapy by cycling therapy (ie, switching within the same drug class), or switching between, the TNF inhibitors and alternative MOA medication classes. METHODS We analyzed medical and pharmacy claims for commercially insured patients who cycled or switched between targeted DMARD agents between January 1, 2010, and September 30, 2014 (ie, the index date), to determine treatment patterns (ie, treatment switching, discontinuation, restarting after a gap ≥60 days, or persistence) and costs (plan- and patient-paid) for 1 year postindex. The cost per persistent patient was the total healthcare cost divided by the number of treatment-persistent patients. RESULTS The analysis included 6203 patients who cycled between TNF inhibitors, 2640 patients who switched from TNF inhibitors to alternative MOA agents, 699 patients who cycled between alternative MOA agents, and 687 patients who switched from alternative MOA agents to TNF inhibitors. The 1-year treatment persistence rates (with P values vs TNF inhibitor cyclers) were 45.2% for TNF inhibitor cyclers, 50.3% for TNF inhibitor-alternative MOA switchers (P <.001), 51.4% for alternative MOA agent cyclers (P = .002), and 46.1% for alternative MOA-TNF inhibitor switchers (P = .63). Compared with TNF inhibitor cyclers, the cost per persistent patient was lower for TNF inhibitor-alternative MOA switchers (-$16,853 RA-related; -$19,280 targeted DMARDs), alternative MOA agent cyclers (-$21,662 RA-related; -$25,153 targeted DMARDs), and alternative MOA-TNF inhibitor cyclers (-$7206 RA-related; -$7919 targeted DMARDs). CONCLUSION Among patients with RA, patients who switched from a TNF inhibitor to an alternative MOA agent and those who cycled between alternative MOA agents had significantly higher treatment persistence rates and a substantially lower cost per persistent patient than those who cycled between TNF inhibitors. These findings support the evaluation of switching medication classes for patients with RA when a targeted therapy fails.
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Affiliation(s)
- Machaon M K Bonafede
- Senior Director of Outcomes Research, Truven Health Analytics, an IBM Company, Cambridge, MA
| | | | | | - Shraddha Shinde
- Research Analyst, Health Economics and Outcomes Research, Sanofi
| | - Andreas Kuznik
- Senior Director, Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY
| | - Chieh-I Chen
- Director, Health Economics and Outcomes Research, Regeneron Pharmaceuticals
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Xing P, Dong H, Liu Q, Yao F, Xu Y, Chen B, Zheng X, Wu Y, Jin F, Li J. Impact of persistence on survival of patients with breast cancer treated with endocrine therapy in Northeast China: a prospective study. Oncotarget 2017; 8:102499-510. [PMID: 29254265 DOI: 10.18632/oncotarget.18454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/22/2017] [Indexed: 11/25/2022] Open
Abstract
The purpose of this prospective study is to investigate the impact of endocrine treatment persistence on the survival of patients with estrogen receptor-positive breast cancer treated with endocrine therapy and identify the risk factors influencing the treatment persistence. We enrolled 1085 patients from Northeast China who were diagnosed as stage I–III, estrogen receptor-positive breast cancer between January 2007 and December 2010. The prognostic factors for disease-free survival (DFS) and overall survival (OS) of patients were identified using univariate and multivariate Cox proportional hazards regression models. Multiple logistic regression analysis was done to determine the possible risk factors for non-endocrine treatment and treatment discontinuation. Among the patients enrolled, 598 (55.1%) underwent 5 years of endocrine therapy, 278 (25.6%) less than 5 years, and 209 (19.3%) non-endocrine therapy. OS rates in the continuation, discontinuation, and non-endocrine treatment groups were 97.8%, 92.6% and 74.3%, and DFS 97.5%, 86.2% and 69.9%, respectively. After adjusting for pathological and socioeconomic factors, non-endocrine therapy and discontinuation were independent predictors for DFS and OS. Elderly patients (≥ 65 years), those living in suburban and rural areas, locally advanced patients, and receiving no radiotherapy and/or chemotherapy were more likely to receive non-endocrine therapy and discontinue endocrine treatment. In conclusion, the prospective study demonstrate that the persistence of endocrine treatment is low in estrogen receptor-positive breast cancer patients in Northeast China. Non-endocrine treatment and early discontinuation serve as independent prognostic factors for both DFS and OS of breast cancer patients treated with endocrine therapy.
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Wabe N, Wojciechowski J, Wechalekar MD, Cleland LG, McWilliams L, Lee A, Proudman S, Wiese MD. Disease activity trajectories in early rheumatoid arthritis following intensive DMARD therapy over 3 years: association with persistence to therapy. Int J Rheum Dis 2017; 20:1447-1456. [PMID: 28952204 DOI: 10.1111/1756-185x.13184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify the disease activity trajectories during intensive triple disease modifying anti-rheumatic drug (DMARD) therapy over 3 years in rheumatoid arthritis (RA) patients and to evaluate the association with treatment persistence. METHODS Disease Activity Score in 28 joints, baseline risk factors and medication usage were obtained from a longitudinal observational cohort of early RA patients, most of whom were treated with combination DMARD therapy consisting of methotrexate, sulfasalazine and hydroxychloroquine. Persistence of each DMARD was defined as the duration of time from initiation to cessation. A group-based trajectory modelling technique was used to identify disease activity trajectories. RESULT Three disease activity trajectories (good [43.8%], moderate [39.7%] and poor [16.5%]) were identified in a cohort of 297 patients. Most baseline risk factors, medication usage, the rate of treatment persistence and the effect of persistence on disease activity differed among patients in each of the three trajectories. Although the rate of persistence was higher in the trajectory with a good outcome, the association with persistence was more pronounced among patients who were in the poor outcome trajectory. Persistence with at least two or all three baseline DMARDs was associated with a decrease in disease activity to a broadly similar degree in all trajectories. CONCLUSION After correction for other baseline prognostic factors, persistence with initial DMARDs contributes to heterogeneity in disease activity trajectory and there was an association between persistence with initial DMARD therapy and lower long-term disease activity.
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Affiliation(s)
- Nasir Wabe
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, Adelaide, South Australia, Australia
| | - Jessica Wojciechowski
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, Adelaide, South Australia, Australia.,Australian Centre for Pharmacometrics, University of South Australia, Adelaide, South Australia, Australia
| | - Mihir D Wechalekar
- Rheumatology Unit, Repatriation General Hospital, Adelaide, South Australia, Australia
| | - Leslie G Cleland
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Leah McWilliams
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Anita Lee
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael D Wiese
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, Adelaide, South Australia, Australia
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Spelman T, Frisell T, Piehl F, Hillert J. Comparative effectiveness of rituximab relative to IFN-β or glatiramer acetate in relapsing-remitting MS from the Swedish MS registry. Mult Scler 2017. [PMID: 28649912 DOI: 10.1177/1352458517713668] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare treatment effectiveness and persistence in relapsing-remitting multiple sclerosis patients who initiated rituximab versus glatiramer acetate (GA) or interferon-beta (IFN-β). METHODS A total of 461 patients from the Swedish MS registry in the rituximab arm were propensity score matched on a 1:2 basis with 922 patients from the IFN-β/GA comparator, between April 2005 and November 2015. Annualised relapse rate (ARR) was compared using the Poisson method. A marginal Cox model was used to analyse time to first relapse, 3-month confirmed disability progression and treatment discontinuation in the matched sample. A signed-rank test was used to compare Expanded Disability Status Scale (EDSS) change from baseline. RESULTS Rituximab was associated with a reduction in ARR (0.003; 95% confidence interval (CI) = 0.001, 0.009) relative to IFN-β/GA (0.026; 95% CI = 0.020, 0.033) ( p < 0.001). Rituximab was associated with an 87% reduction in the relapse rate (hazard ratio (HR) = 0.13; 95% CI = 0.04, 0.41) and an 85% reduction in the discontinuation rate (HR = 0.15; 95% CI = 0.11, 0.20) relative to IFN-β/GA. EDSS regression from baseline was greater in the rituximab group at 12 and 24 months. CONCLUSION Rituximab appears to be superior to first-generation disease-modifying treatments (DMTs) with respect to relapse control and tolerability, whereas superiority on disability outcomes is less clear.
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Affiliation(s)
- Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Thomas Frisell
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Bohlken J, Jacob L, Kostev K. Association between Anti-Dementia Treatment Persistence and Daily Dosage of the First Prescription: A Retrospective Analysis in Neuropsychiatric Practices in Germany. J Alzheimers Dis 2017; 58:37-44. [PMID: 28372337 DOI: 10.3233/jad-170091] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND High adherence and persistence are important for the efficacy of anti-dementia treatments. OBJECTIVE The goal of this study was to analyze the association between anti-dementia treatment persistence and daily dosage of the first prescription in patients treated in neuropsychiatric practices in Germany. METHODS This study included patients aged 60 years or over who were diagnosed with Alzheimer's disease and received anti-dementia prescriptions (galantamine, donepezil, memantine, and rivastigmine) for the first time between 2005 and 2014. The main outcome measure was the treatment persistence rate within 12 months after the index date as a function of the first dose. Cox proportional hazards regression models were used to estimate the relation between persistence and daily dosages after adjusting for age, gender, and residence in nursing homes. RESULTS In this study, 2,442, 5,669, 4,416, 642, and 2,334 patients received galantamine, donepezil, memantine, oral rivastigmine, and patch rivastigmine, respectively. After 12 months of follow-up, continuation rates were similar for individuals using different doses of galantamine, donepezil, oral rivastigmine, and patch rivastigmine, but were significantly different for those taking memantine. Patients using 20 mg of memantine were less likely to discontinue their treatment than patients using 10 mg (HR = 0.88, 95% CI: 0.80-0.96). There was no significant association between daily dosages and persistence for the other drugs (HRs ranging from 0.86 to 1.15). CONCLUSIONS There was no significant association between treatment persistence and daily dosages in patients with Alzheimer's disease in Germany who were treated with galantamine, donepezil, or rivastigmine.
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Affiliation(s)
- Jens Bohlken
- Praxis für Neurologie und Psychiatrie, Berlin, Germany
| | - Louis Jacob
- Faculty of medicine, University of Paris 5, Paris, France
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Lin J, Lingohr-Smith M, Fan T. Real-world medication persistence and outcomes associated with basal insulin and glucagon-like peptide 1 receptor agonist free-dose combination therapy in patients with type 2 diabetes in the US. Clinicoecon Outcomes Res 2016; 9:19-29. [PMID: 28053550 PMCID: PMC5192057 DOI: 10.2147/ceor.s117200] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Free-dose combination treatment with basal insulin and short-acting glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduces hyperglycemia via complementary targeting of fasting and postprandial blood glucose levels, however, in the real world, due to injection burden and clinical inertia, the full efficacy may not be able to translate into clinical and economic benefits. Objective The aim of the study was to evaluate treatment persistence and associated outcomes in patients with type 2 diabetes (T2D) treated with a GLP-1 RA in free-dose combination with basal insulin. Methods Claims data were extracted on US adults with T2D with ≥1 prescription claim for both a GLP-1 RA and a basal insulin from July 1, 2008 to June 30, 2013, and continuous health plan coverage for 6 months prior to (baseline) and 12 months after the index date (follow-up period). Outcomes analyzed for patients stratified by treatment persistence included glycemic control, hypoglycemia, and health care costs and resource utilization. Multivariate analyses were used to examine factors associated with persistence or hypoglycemia. Results The analysis included 7,320 patients, of whom 16.9% were persistent with free-dose combination treatment. The median time to treatment discontinuation was 133 days. Compared with nonpersistent patients, persistent patients had greater glycated hemoglobin A1c (A1C) reductions (−0.80% vs −0.42%; P=0.032), were more likely to achieve A1C <7.0% (39% vs 22%; P<0.001), and were less likely to experience hypoglycemia (9.5% vs 6.8%; P=0.002). Persistent patients also had significantly fewer hospitalizations and shorter hospital stays. While prescription costs were significantly higher (all-cause: $14,691 vs $10,791; P<0.001; diabetes-related: $8,142 vs $5,124; P<0.001), total medical charges were significantly lower (all-cause: $28,405 vs $40,292; P=0.001; diabetes-related: $11,114 vs $15,203; P=0.003) for persistent patients compared with nonpersistent patients. Conclusion This retrospective claims study of US patients with T2D showed that, although persistence with concurrent GLP-1 RA and basal insulin treatment is low, improved treatment persistence is associated with greater A1C reductions and lower total medical charges.
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Affiliation(s)
- Jay Lin
- Health Economics and Outcomes Research, Novosys Health, Green Brook, NJ, USA
| | | | - Tao Fan
- North America Medical Affairs, Sanofi US, Inc., Bridgewater, NJ, USA
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Bonafede MM, Shi N, Bower AG, Barron RL, Grauer A, Chandler DB. Teriparatide treatment patterns in osteoporosis and subsequent fracture events: a US claims analysis. Osteoporos Int 2015; 26:1203-12. [PMID: 25567774 PMCID: PMC4331607 DOI: 10.1007/s00198-014-2971-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 03/26/2014] [Accepted: 11/16/2014] [Indexed: 01/30/2023]
Abstract
UNLABELLED The objective of this study was to describe the risk of fragility-related fractures in the 2 years following teriparatide initiation. In an administrative claims analysis of over 11,407 patients, approximately one in eight patients had a new or recurrent fragility-related fracture in the 2 years following teriparatide initiation. INTRODUCTION The objective of this study was to describe the risk of fragility-related fractures in the 2 years following the initiation of teriparatide in a real-world setting. METHODS This retrospective study used data from the 2002 to 2011 MarketScan® Commercial and Medicare Supplemental Databases to identify patients 50 years and older with a diagnosis of osteoporosis (ICD-9-CM code 733.0x) who were initiating teriparatide. Patients were required to have continuous medical and pharmacy benefit coverage for the 12 months prior to and 24 months following teriparatide initiation (index event). Teriparatide treatment patterns (persistence and adherence) were described, as was the use of antiresorptive therapy. The primary study outcome was the presence of a new or recurring fragility fracture following the initiation of teriparatide. RESULTS A total of 11,407 patients met the study criteria (mean age = 69.5, standard deviation = 10.6 years; 92.0% female). One in four (25.6%) patients had fragility fracture claims in the year prior to teriparatide initiation, of which 64.0% were on existing antiresorptive therapy. Overall, 13.4% (n = 1527) of patients had a new or recurrent fracture during the 2-year follow-up period. Forty-eight percent of patients on teriparatide treatment were considered persistent; fragility fractures were more common among patients nonpersistent with teriparatide (15.2%) than among those persistent with teriparatide (11.4%). A higher fracture rate (35.7%) was observed in the cohort with previous fragility fracture then those without pre-index fractures (24%). CONCLUSION More than 13.4% of patients had new or recurrent fragility-related fractures during the 2 years following the initiation of teriparatide; these fractures were more in common in patients with pre-existing fractures and the patients who were nonpersistent with teriparatide.
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Affiliation(s)
- M M Bonafede
- Life Sciences, Truven Health Analytics, 150 Cambridge Park Dr., Cambridge, MA, 02140, USA,
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Baser O, Tangirala K, Wei W, Xie L. Real-world outcomes of initiating insulin glargine-based treatment versus premixed analog insulins among US patients with type 2 diabetes failing oral antidiabetic drugs. Clinicoecon Outcomes Res 2013; 5:497-505. [PMID: 24124384 PMCID: PMC3794873 DOI: 10.2147/ceor.s49279] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background In patients with type 2 diabetes mellitus, basal-bolus strategies can improve treatment by offering dosing flexibility, and improved satisfaction, adherence, and clinical outcomes. The purpose of this study was to compare real-world outcomes between US patients initiating analog insulin therapy with insulin glargine and those initiating with a premixed analog insulin (PMX). Methods This was a retrospective study of data from patients (≥18 years) with type 2 diabetes mellitus in the IMPACT® database who initiated insulin treatment with insulin glargine (GLA) or a PMX. Clinical and economic outcomes were measured over one year, including persistence and adherence, consumption of insulin, glycemic outcomes, incident hypoglycemia, and health care resource utilization and cost. Results Data from 2,502 patients were included in the analyses (n = 834 for PMX, n = 1,668 for GLA). Compared with PMX, persistence was higher and consumption of insulin was lower for GLA (both P < 0.0001). Adherence, glycemic outcomes, and hypoglycemia-related events were similar between groups, as were health care utilization and total health care costs. Diabetes-related drug and supply costs were lower for GLA than for PMX (P < 0.0001 and P = 0.046, respectively). Conclusion In US patients with type 2 diabetes mellitus, initiating insulin with once-daily GLA, rather than a PMX, is associated with increased treatment persistence and similar clinical and hypoglycemic outcomes, but lower diabetes pharmacy and supply costs. GLA may be a more flexible option than PMX. However, these results also show suboptimal glycemic control in the real-world setting despite change in treatment regimens and call for optimization in management of patients with type 2 diabetes mellitus.
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Affiliation(s)
- Onur Baser
- STATinMED Research Inc, Ann Arbor, MI, NJ, USA ; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, NJ, USA
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Miao R, Wei W, Baser O, Xie L. Real world outcomes of adding rapid-acting insulin versus switching to analog premix insulin among US patients with type 2 diabetes treated with insulin glargine. Patient Prefer Adherence 2013; 7:951-60. [PMID: 24086105 PMCID: PMC3786817 DOI: 10.2147/ppa.s49287] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Patients with type 2 diabetes mellitus (T2DM) often require intensification of basal insulin therapy. This retrospective, observational study compared real-world outcomes in US patients with T2DM treated with insulin glargine who added a rapid-acting insulin (RAI) (basal-bolus approach) with those who switched to premixed insulin (PMX). METHODS The national US IMPACT® database was used to identify data from adult patients (≥18 years of age) with T2DM who added bolus RAI to insulin glargine (GLA + RAI) or who switched from GLA to PMX between 2001 and 2009. A stringent 1:1 propensity score-matching method was used to address the selection bias by matching GLA + RAI patients and PMX patients. Clinical and economic outcomes were determined for 1 year after the initial pharmacy claim for RAI or for PMX. Outcomes included treatment persistence and adherence, average insulin doses, glycated hemoglobin (A1C) levels, the prevalence and incidence of hypoglycemia, and health care costs/utilization. Analysis was carried out using an intent-to-treat approach. RESULTS The study included data from 746 propensity-matched patients (n = 373 in each cohort). Treatment persistence and adherence were higher in the GLA + RAI cohort. There was no significant difference in A1C reduction from baseline and the number of patients achieving target A1C levels of <7% in each cohort. The incidence of hypoglycemic events was also similar in both groups. However, during follow-up, many patients (48.8%) who initially switched from insulin glargine to PMX crossed back over to use GLA and/or RAI as part of their regimen. Health care costs and utilization levels were not significantly different. CONCLUSION Clinical and economic outcomes were similar in T2DM patients who added RAI to GLA and in those who switched to PMX, but a basal-bolus strategy appears to be associated with better treatment persistence and adherence.
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Affiliation(s)
- Raymond Miao
- Sanofi US, Bridgewater, NJ, USA
- Correspondence: Raymond Miao, Sanofi US, 55 Corporate Drive, Bridgewater, NJ 08807, USA, Tel +1 908 981 6049, Email
| | | | - Onur Baser
- STATinMeD Research, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lin Xie
- STATinMeD Research, Ann Arbor, MI, USA
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