Author Correction: Utilization of peginterferon-β-1a in the real-world practice for relapsing-remitting multiple sclerosis

Correction to: European Review for Medical and Pharmacological Sciences 2024; 28 (1): 411-418. DOI: 10.26355/eurrev_202401_34930-published online on January 16, 2024. After publication, the authors have applied some corrections to the galley proof: • In the Patients and Methods section of the abstract, "National Health System" is corrected to "National Health Service". • In the Conclusions section of the abstract, "SC PEG-IFN-β-1a and IFN- β-1a" is corrected to "PEG-IFN-β-1a and SC IFN-β-1a". • In the Population section, the study period "January 1st 2015 to December 31st 2019" was not reported; therefore, this specification has been added to the text. • The legend of Figure 1 was wrongly reported as the same as Table I. The correct title of Figure 1 is "Study flow diagram". • Under Tables I, II, and III, "interferon beta 1a IFN-β-1a" is corrected to "interferon beta 1a (IFN-β-1a)". • In Table III, "CS Glatiramer acetate" is corrected to "SC Glatiramer acetate". • In the Conclusions section, "SC IFN-β-1a SC" is corrected to "SC IFN-β-1a". • The funding section has been amended as follows: "This study was sponsored by Biogen Italia (Milan, Italy)." There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/34930.

Utilization of peginterferon-β-1a in the real-world practice for relapsing-remitting multiple sclerosis

OBJECTIVE

Peginterferon β-1a (PEG-IFN-β-1a) is the most recent interferon beta formulation approved for treating relapsing-remitting multiple sclerosis (RRMS). We aim to describe the real-world utilization of PEG-IFN-β-1a in RRMS and compare it with other injectable disease-modifying therapies (DMTs).

PATIENTS AND METHODS

In this population-based study, we used 2015-2019 routinely collected healthcare data of the Campania region of Italy from National Healthcare System DMT prescriptions, inpatient and outpatient clinical records of hospitals in Campania, and the Federico II University MS clinical registry for a subset of patients. We included individuals with RRMS receiving new prescriptions of PEG-IFN-β-1a [n=281; age = 38.8±12.3 years; females=70.5%; disease duration = 8.4±8.3 years; Expanded Disability Status Scale (EDSS) at baseline=2.0 (1.0-6.5)], glatiramer acetate [n=751; age = 46.0±11.4 years; females=67.1%; disease duration = 9.8±8.2 years; EDSS=4.0 (1.5-8.5)], and subcutaneous (SC) IFN-β-1a [n=1,226; age = 39.7±11.7 years; females=66.5%; disease duration = 8.2±6.5 years; EDSS 2.5 (1.5-6.5)]. Adherence [medication possession ratio (MPR)], escalation to more effective DMTs, hospitalization rates and costs were measured. We used mixed-effect linear regression models (for adherence, hospitalization rates and costs) and Cox regression models (for escalation) to assess differences between PEG-IFN-β-1a (statistical reference), glatiramer acetate, and SC IFN-β-1a. All models included age, sex, previous treatment/untreated, year of treatment initiation, treatment duration, and adherence as covariates.

RESULTS

Adherence was lower in glatiramer acetate (MPR = 0.91±0.1; Coeff=-0.11; p<0.01), and IFN-β-1a (MPR = 0.92±0.1; Coeff=-0.08; p<0.01), compared with PEG-IFN-β-1a (MPR = 1.01±0.1). The probability of escalating to more effective DMTs was higher for glatiramer acetate (14.9%; HR=4.09; p<0.01) and IFN-β-1a (9.1%; HR=3.35; p=0.01), compared with PEG-IFN-β-1a (4.9%). No differences in annualized hospitalization rates were identified between glatiramer acetate [annualized hospitalization rates (AHR) = 0.05±0.30; Coeff=0.02; p=0.31), IFN-β-1a (AHR = 0.02±0.21; Coeff=0.01; p=0.97], and PEG-IFN-β-1a (AHR = 0.02±0.24); however, monthly costs for MS admissions were higher for glatiramer acetate (€49.45±€195.27; Coeff=-29.89; p=0.03), compared with IFN-β-1a (€29.42±€47.83; Coeff=6.79; p=0.61), and PEG-IFN-β-1a (€23.91±€43.90).

CONCLUSIONS

SC PEG-IFN-β-1a and IFN-β-1a were used in relatively similar populations, while glatiramer acetate was preferred in older and more disabled patients. PEG-IFN-β-1a was associated with higher adherence and lower escalation rates toward more effective (and costly) DMTs.

A training ground Lay out improves rehabilitation after trauma surgery: A Fast Track Policy

 

Fracture patients are frail and have high mortality. We investigated whether introducing a fast-track strategy during post-surgery care and including early rehabilitation protocols may shorten the length of hospital stay (LOS) while improving the overall clinical effectiveness. A training ground was built inside the inpatient area dedicated to trauma settings. Usual postoperative care consists of immobilization during the first day, but patients may start rehabilitation earlier, 24 hours after the surgical procedure, with a fast-track strategy. In general, gait speed, step length, and self-assessment in terms of mobility improve significantly in the first six postoperative weeks in fracture patients. As delayed postoperative mobility during hospitalization was observed, the established training ground may help with this concern. The expert physiotherapist may contribute to ameliorating the indicators showing great potential in postoperative rehabilitation regardless of fracture pattern. The primary outcome was postoperative physical functioning. Secondary outcomes included the patient’s assessment of therapeutic effect (overall improvement), perceived pain intensity, health services utilization, treatment side effects, and adverse events. Data were analyzed by univariate analysis and binary logistic regression showing a reduction of LOS of almost three days. Further, the optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Adding to the schedule, some PROMPTS (Patient-reported outcome measures) could further integrate the patient empowerment perspective into the quality set of values. For this reason, ‘fast track’ may define a crucial policy able to guarantee rapid rehabilitation, becoming a key factor to achieving a good clinical effect. Fast-track rehabilitation facilitates a shortened hospital stay and cost-saving and can be used to optimize the patient’s condition before admission to a rehabilitation facility

Key messages

• Early rehabilitation protocols may shorten the length of hospital stay (LOS) while improving the overall clinical effectiveness.

• Human factors and patients empowerments may help.

Association between atherogenic index of plasma and carotid intima-media thickness in a cohort of Mediterranean women

The association between early atherosclerosis (IMT) and Atherogenic index of plasma (AIP), a marker of atherogenicity (log triglycerides/HDL Cholesterol) was evaluated in a population-based cohort study in women, aged 30-69, living in the metropolitan area of Naples, Southern Italy (Progetto ATENA). Serum cholesterol, HDL-cholesterol, LDL-cholesterol, Triglyceride, Insulin, HOMA, Apo B, hs-CPR were measured in 390 menopausal women, as a part of 5.062 participants of the cohort. Women in the second and third tertile of AIP showed an increased common carotid intima-media thickness compared with those in the first tertile: II vs I tertile (O.R. = 2.24, p = 0.007), III vs I tertile (O.R. = 2.29, p = 0.005), adjusted for age and Systolic pressure or II vs I tertile (O.R. = 2.19, p = 0.014), III vs I tertile (O.R. = 2.13, p = 0.026), adjusted for age, Systolic pressure, Body mass index and Apo B. Women in the second and third tertile of AIP compared to those in the first tertile, showed an OR of 2.14 (p = 0.016) and 1.99 (p = 0.033) respectively, of having elevates level of IMT, adjusted for traditional cardiovascular risk factor (age, Systolic Pressure, BMI, LDL Cholesterol, Diabetes diagnosis). This finding shows that in this group of menopausal women increased IMT is associated with elevated AIP independently of age and different cardiovascular risk factors. These results are in line with the hypothesis that AIP may be an useful clinical tools to give additional information in the risk assessment for atherosclerotic disease, in particular in postmenopausal women.

In Silico Preliminary evaluation of Cx601 as new therapeutic approach in hospital clinical paths

 

Crohn's disease is a chronic inflammatory bowel disease characterized by transmural inflammation and fistula formation. Perianal fistulas are a common complication of Crohn's disease and are estimated to affect up to 28% of patients in the first two decades after diagnosis, particularly those with colonic disease and rectal involvement. Complex perianal fistulas in Crohn's disease are challenging to treat, severely impair patients' quality of life and cause substantial morbidity. Allogeneic, expanded, adipose-derived stem cells (Cx601) are a promising new therapeutic approach, although their high cost is often discouraging. We aimed at assessing the safety and efficacy of this treatment in patients with complex perianal fistulas in patients with Crohn's disease. Therefore, we conducted a meta-analysis in order to evaluate this new therapeutic approach before introducing it as standard of care. We examined 8 studies published in the last 10 years, 5 of which were selected for the final analysis. The primary outcome assessed was the combined fistula remission (clinical + imaging) assessed through the clinical examination and MRI, the control being the traditional medical strategies (ie, antibiotics, immunomodulators and anti-tumour necrosis factor agents). We registered a total of 128 events (lack of remission) in the control group vs 94 in the experimental one (Confidence Interval for OR of 0,12-0,31, P &lt; 0,001). Our “in silico” assessment is reliable, being the introduction of (Cx601) an innovative and effective treatment. Further insights will be provided by the INSPIRE registry, a multinational post-marketing study whose main objective is the evaluation of the real-world clinical effectiveness and safety of (Cx601) in patients affected by Crohn's disease with complex perianal fistulas for a duration of 36 months, to which our University “Federico II” is actively taking part.

Key messages

Disability reduction is an important goal in cronh therapeutic path of care. Our “in silico” assessment may support the introduction of (Cx601) an innovative and effective treatment.

Liquid biopsy in lung cancer: tertiary prevention potential

Background

In the era of personalized therapy liquid biopsy is considered an important diagnostic tool in the clinical management of cancer patients. Tissue specimen represents “gold standard” for molecular evaluation of specific gene targets alterations that lead cancer patients to benefit of a “tailed therapy” based on molecular features of the tumor. This innovative source of nucleic acids was introduced in clinical setting only for NSCLC patients to test Epidermal Grow Factor Receptor (EGFR) mutations when tissue is not available or to monitor acquired resistance mutation after a first line of treatment. The study aimed at assessing the diagnostic potential of liquid biopsy in balanced tertiary screening modeling.

Methods

The cases relating to 5 years of activity regarding to molecular diagnostics performed on liquid biopsy specimens in the Predictive Diagnostic laboratory of AOU Federico II were reviewed. Laboratory data were collected in SPSS. Non parametric analysis were performed in order to test the differences between patients WILD TYPE or not. A multivariate logistic model was performed in order to assess the effect of mutation, age and sex, on the tumor progression. The results of the revision concern 515 total cases (almost of all plasma or peripheral blood) allowed to evaluate the liquid biopsies for women and men. The average age of the Patients is 66.3 years, and the 25 percentile is 59 years.

Results

The cases are 221 basal and 294 by progression. The cases with mutation, as expected, have an OR 4,15 compared to the basal to have a tumor progression (95% IC: 2,7 - 6,3) regardless of sex and age. The mutations detected were 131 from different types of pulmonary carcinomas.

Conclusions

Working on case data, specifying the characteristics of the Patients with mutations will drive a further estimate in tertiary prevention screening designs.

Key messages

In the last five years, the liquid biopsy has been used for different purposes in oncology. To specify the characteristics of the Patients with mutations will drive a further estimate in tertiary prevention screening designs.

From 'to cure' to 'to care' in Oncology Toward shared Evidence based practice

Aims

Oncological disease need a system of care involving hospital staff and informal caregivers. Care-givers are subjected to stressful factors (burden) with repercussions on psycho-physical balance. The project, carried out together with the ONLUS Travel Companions Association and the Multidisciplinary Oncological Groups (GOM) of Brain and Breast Cancers, intends to offer supportive training experiences for care-givers and health workers, offering emotional and practical preparation for the treatments that they will find themselves providing the cancer relative by helping to improve the quality of care and the relationship between the subjects. The professionals participating in the project (doctors, nurses) take part in a training held by professionals from the Association. The care givers, divided into groups, carry out a CBI test (Caregiver Burden Inventory) and training meetings on medical, psychological and social assistance issues. After 3 months from the end of the course, the care-giver carries out the interview with the psychologist and recompiles the CBI. Furthermore, on 30 selected patients of Breast Cancers, GOM, an emotional evaluation questionnaire of their life experience was administered with respect to the stages of the disease pathway.

Results

The answers were then analyzed by the word cloud method and summarized in a synthetic map for each question. The most used words to describe the mood during the illness are 'anger, pain, anguish and worry'; while waiting before the visit they are 'long, exhausting, anxious'; towards the doctor 'availability, humanity, kindness, friendliness, professionalism'; with regard to 'excellent, availability' assistance; about social life during the 'unchanged, serene' illness; towards the return home 'joy'.

Conclusions

The project is a starting point towards a continuous and progressive humanization of the integrated pathways from 'to cure' to 'to care' in oncology.

Key messages

Patients are positively affected from shared initiatives. Word cloud may resume patients moods and thei main issues concerninthe path.

Share your rare with care: a patient corner for the European Reference Networks on Rare Disease

Background

The European Reference Network on Rare Disease (ERN) is focused on providing more equitable care across Europe and creates a network of both medical specialists and patient experts. One relevant objective of the activities planned into the ERNs is to address the economic dimensions of rare diseases in order to develop strategies to improve research and patients' access to orphan drugs (ODs) and highly specialized health technologies. The themes built in these preliminary years were directed toward guidelines and policies concerning reimbursement of ODs and direct provision by the healthcare system.

Methods

to proceed further in humanization of care we establish involvement of patients' associations in decision making and implementation of clinical practice guidelines. We built in Federico II University Hospital where 12 ERN were aligned a front office corner shared between patients association and hospital direction in order to face the patient difficulties along the pathway. The corner is open three times a week on the morning, with a dedicated phone number.

Results

Main issues regarded the understanding of the disease and the diagnosis (ie, lack of familiarity with the rare disease, disease heterogeneity, lack of established diagnostic criteria, misdiagnosis,) the development of effective treatments and the need for efficacy along the path way of care (ie, geographical limitations, disease coding systems, ethical and privacy issues). Fewer concerns were about the equity of access and other social pressures. Conclusions In general, in ERN context, few people declared to work in human and social issues, including research on patient's quality of life, patient's awareness, or methods for social support. Our findings demonstrated that Patients were positively affected from the corner initiative: this may ameliorate the use of infrastructures offering services, also that rarely known as national and international biobanking platforms, registries and networks.

Key messages

Humanization of care issues and strategies are nowadays mandatory in rare diseases. Patients are positively affected from shared initiatives.

Prognostic and Predictive biomarkers in a Mediterranean cohort (Review from Atena Project)

Background

Atena project involved 5,062 women aged 30 to 69 years living in the area of Naples. The purpose of this study is to investigate the causes of those chronic diseases that have a major impact on the female population. As a part of the design (scheduled in 2002-2004). After 10 years, in 228 women, some biochemical measurements were performed.

Methods

This systematic review and meta-analysis biomarkers were evaluated in studies nested into the Atena cohort. Studies were searched using MEDLINE/PubMed. The search was performed by entering individually or in combination: Atena, Mediterranean woman, biomarkers. The preferred reporting of systematic reviews and meta-analysis (PRISMA) guidelines were used for the review. Studies selected for this review are conducted in the Atena project Cohort and reported the study of biomarkers. Disagreements on data extractions between the two investigators were solved by consensus. The extracted data were entered and analyzed using REVMAN software. The original articles were described using forest plot and table. Heterogeneity was computed by Cochran’s Q test.

Results

The search strategy retrieved 13 potential articles, 11 were screened as full text articles and 6 were included in the pooled estimates. Among the articles included, biomarkers chosen as predictors were Lipids, Hcrp, as prognostic where predictive of IMT; and cycle length and LPa as predictive of an augmented LDL cholesterol mean. According to the comparability of data presented, for the first comparison we selected 3 of the 5 studies that assed IMT, for the second we selected 2 of the three studies that analyzed for LDL mean. Results were shown into forrest plots. The pooled estimates verified the potential of biomarkers as predictor of IMT, the significance seemed lower for prediction of LDL cholesterol.

Conclusions

Both results, consistent with the multifactor profile of the CV risk, identify the impact of secondary prevention according to biochemical profiles.

Key messages

Biomarkers studied in nested cohort stufies have predictive potential. pooled estimates may identify the impact of secondary prevention according to biochemical profiles.

Show your rare, handle with care: a knowledge brokers network to handle rare disease patients

Background

In Rare diseases patients. difficult in diagnosis can produce inappropriate pathways of care. A correct diagnosis took almost 5 years in Europe and 7.3-7.6 y in US. The directive 2011/24/EU provides a legal regulatory asset for the European Reference Networks (ERNs). ERNs are designed to connect health care providers and centers of expertise for gaining appropriate pathways of high-quality care and to support sponsorship in order to make healthcare closer to the patients. Federico II University actually has 9 confirmed ERNs.

Methods

We connected the patient related activities inside the ERNs and we planned a project-based network that creates harmonization of diagnostic tools and widespread diffusion of screening activity able to drive diagnostic enrichment. The Hospital Chief Office together with the Public Health Department acts as “Knowledge brokers” (KB) defined as connectors who may crisscross the hierarchical boundaries. We scheduled interventions into the ERNs and future improvements. Interventions areas have been represented in a conceptual map.

Results

Brokers into the network are attended to allow better merged innovation rate and sharing data. Improvements could be directed toward: 1) sharing data and communication, 2) diagnostic enrichment 3) hospital services networking into the path. Including this model in the regional pathways may build a common platform to support appropriate care in disease-endemic regions.

The designed model finally aimed at define how humanization and networking of care can be measured as gain in efficiency along the overall path.

Conclusions

Network potential may overload a simply specific hub focused approach. The “criss cross” knowledge brokering (could be a strategy able to support clinical and diagnostic activities. To proceed over, in orphan disease handling, we may progress from approaches centered on florid cases toward a balanced screening design, able to guarantee a diagnostic enrichment for a rare condition.

Key messages

Implicit and formal Networking cam help rare disease handling. Sharing data and diagnostic enrichment are the main issues.

Menstrual cycle length, serum lipids and lipoproteins in a cohort of Italian Mediterranean women: findings from Progetto ATENA

BACKGROUND AND AIMS

Clinical studies suggest that menstrual irregularities are associated with metabolic and hormonal abnormalities, insulin resistance and a hyperestrogenic/hyperandrogenic imbalance, that may influence the risk of cardiovascular disease.

METHODS AND RESULTS

The association of these abnormalities with the metabolic syndrome suggests that information on lipid patterns at different menstrual cycle length may be of interest in identifying women at higher cardiovascular risk. The association of lipid patterns with menstrual cycle length was evaluated in a cohort of 5062 women participating in the Progetto ATENA Study. Questions were administered to the participants about their cycle lengths at different periods of time over their reproductive life. The period between 20 and 50 years was investigated: normal cycle length was defined as short (<or=26 days), medium (between 27 and 29 days) or long (>30 days). Perimenopausal women were excluded and variables adjusted for age, BMI and menopausal status. In 4434 participants serum triglycerides were found to increase with an increased number of days in the menstrual cycle: 106 mg/dl in the short cycle pattern (21-26 days); 113 mg/dl in the medium cycle pattern (27-29 days); and 116 mg/dl in the long cycle pattern (30-31 days), whereas total and LDL cholesterol were found to be higher and HDL was lower in women with longer cycles, but the difference was not statistically significant. The results were very similar when the same adjusted analysis was restricted to a subgroup of 3823 women with a stable cycle length over the fourth and the fifth decade of life.

CONCLUSIONS

These results suggest that cycle length may be a marker of higher cardiovascular risk due to associated metabolic and hormonal patterns.

[CUA analysis in new drug evaluation: a review of available tools]

Cost utility analysis (CUA) is a peculiar kind of efficacy evaluation. The outcome is the quality adjusted years of life derived by comparing an intervention versus a comparator. We review literature analyzing some criticism emerging from Cost Utility evaluation as selection bias or eventual methodological inconsistency. We applied this model to a new drug--Macugen--assessing an incremental cost of 7258.68 euro for a two years treatment schedule. Our analysis suggest that CUA is potential informative especially in certain context as prevention, but efficacy assessment and robust outcomes measuring is crucial.