Effectiveness of risk minimisation measures for valproate: a drug utilisation study in Europe, analysis of data from Spain

INTRODUCTION

Risk minimisation measures for valproate were implemented in Spain in 2015.

OBJECTIVE

The objective of this study is to assess the effectiveness of valproate risk minimisation measures in Spain intended to decrease the use of valproate as a first-line therapy, and to evaluate the prescribing patterns of valproate in women, including women of childbearing potential, in the pre- and post-implementation risk minimisation measures periods.

MATERIALS AND METHODS

The prescribing patterns of valproate in females and women of childbearing potential before and after risk minimisation measures implementation were examined using the longitudinal patient data database, which includes patient information from two panels: primary care physicians and neurologists/psychiatrists. Primary endpoint was the proportion of initial valproate prescriptions with at least one medication related to the valproate indications before the valproate initiation date.

RESULTS

The proportion of incident valproate prescriptions with previous use of medication related to valproate indications was 78.0% (95% CI, 73.9%; 81.5%), and 78.2% (74.5%; 81.4%) in the main pre-and post-implementation periods in the primary care physician panel. The corresponding figures for women of childbearing potential were 79.6% (73.6%; 84.5%) and 75.5% (69.7%; 80.6%), respectively. The incidence rate of pregnancies exposed to valproate (per 1,000 person-years) in women of childbearing potential decreased from 17.4 the entire pre-implementation to 8.5 in the entire post-implementation periods.

CONCLUSION

After the implementation of risk minimisation measures for valproate in Spain, no meaningful change in prescribing was observed regarding the proportion of valproate initiations preceded by prior medication related to valproate indications. The preventative measures recommended for use of valproate in women of childbearing potential should be considered.

Projecting the long-term benefits of single pill combination therapy for patients with hypertension in five countries

Background

It is well established that single pill combination (SPC) therapies have the potential to improve patient adherence versus multi-pill regimens, thereby improving blood pressure control and clinical outcomes in populations with hypertension.

Purpose

To develop a microsimulation model, capturing different treatment pathways, to project the impact on clinical outcomes of using single pill combination therapies for the management of hypertension in five countries (Italy, Russia, China, South Korea and Mexico).

Methods

The model was designed to project health outcomes between 2020 and 2030 for populations with hypertension managed according to four different treatment pathways: current treatment practices [CTP], single drug with dosage titration first then sequential addition of other agents [start low and go slow, SLGS], free choice combination with multiple pills [FCC] and combination therapy in the form of a single pill [SPC]. Model inputs were derived from Global Burden of Disease 2017 dataset, including demographics, health status/risk factors, transition probabilities and treatment attributes/healthcare utilization, and the model incorporated real-world challenges to healthcare delivery such as access to care, SBP measurement error, adherence and therapeutic inertia. Simulated outcomes of mortality, incidence of chronic kidney disease (CKD), stroke and ischemic heart disease (IHD), and disability-adjusted life years (DALYs) due to these conditions were estimated for population of 1,000,000 simulated patients for each treatment pathway and country.

Results

SPC therapy was projected to improve health outcomes over SLGS, FCC and CTP over 10 years in all five countries. SPC was forecast to reduce mortality by 5.4% (Italy), 4.9% (Russia), 4.5% (China), 2.3% (South Korea) and 3.6% (Mexico) versus CTP and showed greater projected reductions in mortality than SLGS and FCC. DALYs were projected to be reduced with SPC therapy by between 5.7% (Italy) and 2.2% (South Korea) compared with CTP and reductions in the incidence of clinical events were also projected with SPC therapy, with decreases in the range of 11.5% (Italy) to 4.9% (South Korea) versus CTP.

Conclusions

Ten-year projections of clinical outcomes associated with different anti-hypertensive treatment pathways in five countries indicated that both combination therapies (FCC and SPC) are likely to reduce the disease burden of hypertension compared with conventional management approaches, with SPC showing the greatest overall benefits due to improved adherence.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Sanofi, Gentilly, France

THU0212 FIRST LINE TREATMENT WITH CONVENTIONAL SYNTHETIC DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN RHEUMATOID ARTHRITIS: A MULTINATIONAL POPULATION-BASED COHORT FROM 14 REAL WORLD HEALTHCARE DATABASES AND 9 COUNTRIES - REALITY VERSUS GUIDELINES

Background:

Treatment guidelines recommend early initiation of csDMARDs following diagnosis of rheumatoid arthritis (RA), with methotrexate (MTX) as first-line therapy. Scarce evidence exists on adherence to this guidance

Objectives:

To characterize first-line csDMARD treatment during the first year following an RA diagnosis.

Methods:

14 real world databases (3 Primary care, 6 primary/secondary care records, 5 claims) from 9 countries were included, all mapped to the OMOP common data model.

Patients were included on the earliest event of: 1st diagnosis of RA or 1st DMARD prescription with an RA diagnosis within 30 days. Patients were >18 years-old, required 1+ year pre-index data, and at least 1-year follow-up. Study period covered 2000-2018. Previous users of DMARDs or non-RA inflammatory arthritis history were excluded. Only MTX, Hydroxychloroquine (HCQ), Sulfasalazine (SSZ) and Leflunomide (LEF) were available in all databases.

Results:

We identified 323,547 eligible participants. Large variation was observed internationally (Figure 1). MTX as first-line monotherapy ranged from 33.3% to 74.5%, and in combination with HCQ from 2.1% to 6.7%. Three additional csDMARDs were used as first-line: HCQ in 10.1% to 30.2%, SSZ in 0.9% to 28.7%, and LEF in 1.8% to 15.2%.

Figure 1.

First line csDMARD treatment during 1yr from first observed RA diagnosis

Conclusion:

We report wide heterogeneity of first-line csDMARDs regimens internationally. Despite recommendations for MTX to be first line therapy, data suggest that a large proportion of patients receive alternative csDMARD.

Disclosure of Interests: :

Anthony G Sena Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Full-time employment salary from Janssen, Employee of: Janssen employee, Paid instructor for: Janssen employee, Speakers bureau: Janssen employee, Denis Granados: None declared, Nigel Hughes Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen employee, Paid instructor for: Janssen employee, Speakers bureau: Janssen employee, WALID FAKHOURI Shareholder of: E Lilly Shares, Employee of: Eli Lilly and Company, Antje Hottgenroth Shareholder of: Eli Lilly shares, Employee of: Lilly Deutschland GmbH, Raivo Kolde: None declared, Sulev Reisberg: None declared, Carmen Olga Torre: None declared, Talita Duarte-Salles: None declared, Yesika Díaz: None declared, Jose Felipe Golib-Dzib Grant/research support from: Full-time employment salary from Janssen, Employee of: Yes, Janssen employee, Paid instructor for: Janssen Employee, Speakers bureau: Janssen Employee, Emily S. Brouwer Shareholder of: J&J shares, Takeda shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen employee, Paid instructor for: Janssen Employee, Speakers bureau: Janssen Employee, Edward Burn: None declared, Jennifer Lane: None declared, David Vizcaya Employee of: Bayer, Sara Bruce Wirta Employee of: Janssen-Cilag Sweden AB, Marcel de Wilde: None declared, Katia Verhamme: None declared, Peter Rijnbeek: None declared, Elke Theander Employee of: Janssen-Cilag Sweden AB, Katerina Chatzidionysiou Consultant of: AbbVie, Pfizer, Lilly., Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen, Patrick Ryan: None declared

Electrical and geometrical tuning of MoS2 field effect transistors via direct nanopatterning

Mechanically exfoliated van der Waals materials can be used to prepare proof-of-concept electronic devices. Their optoelectronic properties strongly depend on the geometry and number of layers present in the exfoliated flake. Once the device fabrication steps have been completed, tuning the device response is complex, since the geometry and number of layers cannot be easily modified. In this work, we employ Pulsed Focused Electron Beam Induced Etching (PFEBIE) to tailor the geometry and electronic properties of field effect transistors based on mechanically exfoliated Molybdenum Disulfide (MoS₂) flakes. First, MoS₂ field effect transistors are fabricated via optical lithography and conventional methods. Then, the geometry of the MoS₂ source-drain conduction channel is modified employing a Xenon difluoride (XeF₂) gas injection nozzle combined with a pulsed electron beam pattern-generation system. Electrical characterization of devices carried out before and after the nanopatterning step via PFEBIE reveals a shift in the doping from N-type towards P-type. We attribute this change to sulfur vacancies induced during the direct nanopatterning step. This is confirmed by micro-Raman and micro-Photoluminescence spectroscopy experiments. The direct nanopatterning method allows us to fine-tune the geometry and thus the electronic properties of the devices, once the conventional fabrication steps have been completed. The success rate of our tailoring method exceeds 85% when tuning the geometry of the flake into a 250 nm wide and straight conduction channel between source and drain.

Topologically protected superconducting ratchet effect generated by spin-ice nanomagnets

We have designed, fabricated and tested a robust superconducting ratchet device based on topologically frustrated spin ice nanomagnets. The device is made of a magnetic Co honeycomb array embedded in a superconducting Nb film. This device is based on three simple mechanisms: (i) the topology of the Co honeycomb array frustrates in-plane magnetic configurations in the array yielding a distribution of magnetic charges which can be ordered or disordered with in-plane magnetic fields, following spin ice rules; (ii) the local vertex magnetization, which consists of a magnetic half vortex with two charged magnetic Néel walls; (iii) the interaction between superconducting vortices and the asymmetric potentials provided by the Néel walls. The combination of these elements leads to a superconducting ratchet effect. Thus, superconducting vortices driven by alternating forces and moving on magnetic half vortices generate a unidirectional net vortex flow. This ratchet effect is independent of the distribution of magnetic charges in the array.

Encapsulating Chemically Doped Graphene via Atomic Layer Deposition

Controlling graphene's doping will be critically important for its incorporation into future electronic and optoelectronic devices. Noncovalent functionalization through adsorption of organic molecules on graphene's surface has proved to be a promising route for achieving p- or n-type doping. However, due to the poor adhesion of the molecules, these tend to desorb over time under standard environmental conditions or in the presence of certain solvents. The resulting reversal in the achieved chemical doping is a major obstacle to using organic molecules as noncovalent graphene dopants. In this work, we present a simple method for achieving long-term p- and n-doping of graphene devices through vapor phase evaporation of organic molecules, followed by encapsulation under an inert Al₂O₃ film. This film, grown via an optimized atomic layer deposition process, ensures long-term doping stability, as confirmed by electrical transport and Raman spectroscopy measurements. The doping is maintained even after storing the devices for six weeks in ambient conditions and immersing them in a dopant removing solvent, demonstrating that the film is as an effective barrier against environmental degradation of the doped devices.

Tunable nanocrystalline CoFe2O4 isotropic powders obtained by co-precipitation and ultrafast ball milling for permanent magnet applications

Synthesis of nanocrystalline Co-ferrite powders with tunable magnetic properties is demonstrated by using co-precipitation and a novel ultrafast milling route.

Superconducting/magnetic Three-state Nanodevice for Memory and Reading Applications

We present a simple nanodevice that can operate in two modes: i) non-volatile three-state memory and ii) reading device. The nanodevice can retain three well defined states −1, 0 and +1 and can operate in a second mode as a sensor for external magnetic fields. The nanodevice is fabricated with an array of ordered triangular-shaped nanomagnets embedded in a superconducting thin film gown on Si substrates. The device runs based on the combination of superconducting vortex ratchet effect (superconducting film) with the out of plane magnetization (nanomagnets). The input signals are ac currents and the output signal are dc voltages. The memory mode is realized without applying a magnetic field and the nanomagnet stray magnetic fields govern the effect. In the sensor mode an external magnetic field is applied. The main characteristic of this mode is that the output signal is null for a precise value of the external magnetic field that only depends on the fabrication characteristics of the nanodevice.

An experimental approach to studying the effectiveness and safety of meglumine antimoniate formulations

Among the problems associated to leishmaniasis, the two most outstanding ones are the lack of a vaccine and the adverse effects caused by drugs use for its control. Meglumine antimoniate compounds are the first-line drugs in the treatment for cutaneous leishmaniasis (the most prevalent form of the disease in Colombia); nevertheless, they are far from being ideal drugs due to their toxicity (not to mention the emergence of drug-resistant parasites), all of which has prompted current search for new strategies to improve their safety. This work assesses the effectiveness and safety (toxicity including new aspects related with immunotoxicity not reported previously) of two different meglumine antimoniate formulations using an in vitro and in vivo murine model. The results evidence that although both injectable formulations induce an equally efficient (clearance of intracellular parasites), both give rise to adverse effects, including a preferential immunomodulation on Balb/c mice and in a lesser proportion on ICR mice. These results are comparable to human trials reporting variable reactions when following the same treatment regimen. The model presented herein is proposed as a tool for evaluating the effectiveness and safety of meglumine antimoniate-based antileishmanial formulations.

Emission polarization control in semiconductor quantum dots coupled to a photonic crystal microcavity

We study the optical emission of single semiconductor quantum dots weakly coupled to a photonic-crystal micro-cavity. The linearly polarized emission of a selected quantum dot changes continuously its polarization angle, from nearly perpendicular to the cavity mode polarization at large detuning, to parallel at zero detuning, and reversing sign for negative detuning. The linear polarization rotation is qualitatively interpreted in terms of the detuning dependent mixing of the quantum dot and cavity states. The present result is relevant to achieve continuous control of the linear polarization in single photon emitters.

Oscillatory persistent currents in self-assembled quantum rings

We report the direct measurement of the persistent current carried by a single electron by means of magnetization experiments on self-assembled InAs/GaAs quantum rings. We measured the first Aharonov-Bohm oscillation at a field of 14 T, in perfect agreement with our model based on the structural properties determined by cross-sectional scanning tunneling microscopy measurements. The observed oscillation magnitude of the magnetic moment per electron is remarkably large for the topology of our nanostructures, which are singly connected and exhibit a pronounced shape asymmetry.

[Disability-adjusted life years: an instrument for defining public health priorities?]

BACKGROUND

The objective of this paper is the study of a health indicator allowing surveillance and evaluation of the overall health of the Paris population, and providing information to help prioritize possible choices among preventive and curative actions. Moreover, comparison between results obtained for Paris with a global health indicator, "Disability-adjusted life years" (DALYs) and available bibliographical data will enable clarifying some points about summary measures of health.

METHODS

The method used is that of the Global Burden of Disease. It allows a ranking of diseases using an indicator called DALYs. This indicator integrates mortality and morbidity components by summing expected years of life lost due to premature mortality and calculated years of healthy life lost. DALYs were calculated using local mortality data and published regional disabilities tables from the World Health Organisation (WHO).

RESULTS

There were a total of 242 061 DALYs for Paris for the year 1999. The six leading specific causes are: alcoholic psychosis and dependence (accounting for 6.5% of the total), lung cancers (5.7%), ischaemic hearth disease (4.8%), depression (4.4%), dementias (4.2%), and arthritis (3.9%). Men contributed the majority of DALYs for the first three. For four of the six leading causes, the majority of DALYs came from years lived with disability, rather than mortality. Only for lung cancer and ischaemic hearth disease was the majority of DALYs from years of life lost by mortality.

CONCLUSION

The results for Paris are used to illustrate how DALYs can illuminate debates about public health priorities. Such data can inform the population about health condition and provide decision makers with global health indicators. The next step will be to estimate the DALYs from local morbidity data when available, and compare these results to those based on the World Health Organisation tables, which are not sensitive to local results other than those due to mortality. Future steps include further evaluation and development of this method for surveillance, assessment and evaluation of public health actions. However, some of the results obtained with this indicator underline the limits of this kind of analysis.