Gene Detection With Carbon Nanotubes

The potential of carbon nanotubes (CNTs) as nanosensors in detection of genes through a vibration analysis is investigated with molecular dynamics. The carbon nanotube based nanosensor under investigation is wrapped by a gene whose structure includes a single strand deoxyribose nucleic acid (DNA) with a certain number of distinct nucleobases. Different genes are differentiated or detected by identifying a differentiable sensitivity index that is defined to be the shifts of the resonant frequency of the nanotube. Simulation results indicate that the nanosensor is able to differentiate distinct genes, i.e., small proline-rich protein 2 A, small proline-rich protein 2B, small proline-rich protein 2D, and small proline-rich protein 2E, with a recognizable sensitivity. The research provides a rapid, effective, and practical method for detection of genes.

First observation of the M1 transition ψ(3686)→γη(c)(2S)

Using a sample of 106×10(6) ψ(3686) events collected with the BESIII detector at the BEPCII storage ring, we have made the first measurement of the M1 transition between the radially excited charmonium S-wave spin-triplet and the radially excited S-wave spin-singlet states: ψ(3686)→γη(c)(2S). Analyses of the processes ψ(3686)→γη(c)(2S) with η(c)(2S)→K(S)(0)K(±)π(∓) and K(+)K(-)π(0) give an η(c)(2S) signal with a statistical significance of greater than 10 standard deviations under a wide range of assumptions about the signal and background properties. The data are used to obtain measurements of the η(c)(2S) mass (M(η(c)(2S))=3637.6±2.9(stat)±1.6(syst) MeV/c(2)), width (Γ(η(c)(2S))=16.9±6.4(stat)±4.8(syst) MeV), and the product branching-fraction (B(ψ(3686)→γη(c)(2S))×B(η(c)(2S)→KKπ)=(1.30±0.20(stat)±0.30(syst))×10(-5)). Combining our result with a BABAR measurement of B(η(c)(2S)→KKπ), we find the branching fraction of the M1 transition to be B(ψ(3686)→γη(c)(2S))=(6.8±1.1(stat)±4.5(syst))×10(-4).

Measurements of the mass and width of the η(c) using the decay ψ(3686)→γη(c)

The mass and width of the lowest-lying S-wave spin singlet charmonium state, the η(c), are measured using a data sample of 1.06×10(8) ψ(3686) decays collected with the BESIII detector at the BEPCII storage ring. We use a model that incorporates full interference between the signal reaction, ψ(3686)→γη(c), and a nonresonant radiative background to describe the line shape of the η(c) successfully. We measure the η(c) mass to be 2984.3±0.6±0.6 MeV/c(2) and the total width to be 32.0±1.2±1.0 MeV, where the first errors are statistical and the second are systematic.

First observation of η(1405) decays into f(0)(980)π0

The decays J/ψ → γ π+ π- π0 and J/ψ → γ π0 π0 π0 are analyzed using a sample of 225×10(6) J/ψ events collected with the BESIII detector. The decay of η(1405) → f(0)(980)π0 with a large isospin violation is observed for the first time. The width of the f(0)(980) observed in the dipion mass spectra is anomalously narrower than the world average. Decay rates for three-pion decays of the η' are also measured precisely.

Spin-parity analysis of pp¯ mass threshold structure in J/ψ and ψ(3686) radiative decays

A partial wave analysis of the pp¯ mass-threshold enhancement in the reaction J/ψ→γpp¯ is used to determine its J(PC) quantum numbers to be 0(-+), its peak mass to be below threshold at M=1832(-5)(+19)(stat)(-17)(+18)(syst)±19(model) MeV/c(2), and its total width to be Γ<76 MeV/c(2) at the 90% C.L. The product of branching ratios is measured to be BR[J/ψ→γX(pp¯)]BR[X(pp¯)→pp¯]=[9.0(-1.1)(+0.4)(stat)(-5.0)(+1.5)(syst)±2.3(model)]×10(-5). A similar analysis performed on ψ(3686)→γpp¯ decays shows, for the first time, the presence of a corresponding enhancement with a production rate relative to that for J/ψ decays of R=[5.08(-0.45)(+0.71)(stat)(-3.58)(+0.67)(syst)±0.12(model)]%.

Emergence of Canine Distemper Virus Strains With Modified Molecular Signature and Enhanced Neuronal Tropism Leading to High Mortality in Wild Carnivores

An ongoing canine distemper epidemic was first detected in Switzerland in the spring of 2009. Compared to previous local canine distemper outbreaks, it was characterized by unusually high morbidity and mortality, rapid spread over the country, and susceptibility of several wild carnivore species. Here, the authors describe the associated pathologic changes and phylogenetic and biological features of a multiple highly virulent canine distemper virus (CDV) strain detected in and/or isolated from red foxes ( Vulpes vulpes), Eurasian badgers ( Meles meles), stone ( Martes foina) and pine ( Martes martes) martens, from a Eurasian lynx ( Lynx lynx), and a domestic dog. The main lesions included interstitial to bronchointerstitial pneumonia and meningopolioencephalitis, whereas demyelination—the classic presentation of CDV infection—was observed in few cases only. In the brain lesions, viral inclusions were mainly in the nuclei of the neurons. Some significant differences in brain and lung lesions were observed between foxes and mustelids. Swiss CDV isolates shared together with a Hungarian CDV strain detected in 2004. In vitro analysis of the hemagglutinin protein from one of the Swiss CDV strains revealed functional and structural differences from that of the reference strain A75/17, with the Swiss strain showing increased surface expression and binding efficiency to the signaling lymphocyte activation molecule (SLAM). These features might be part of a novel molecular signature, which might have contributed to an increase in virus pathogenicity, partially explaining the high morbidity and mortality, the rapid spread, and the large host spectrum observed in this outbreak.

Metformin induces apoptosis of lung cancer cells through activating JNK/p38 MAPK pathway and GADD153

There are epidemiological and experimental evidences that metformin, an insulin-sensitizer agent widely used for diabetes treatment, has inhibitory effects on the growth of various human cancers. However, the underlying molecular mechanisms for its anti-neoplastic activity has not been yet clarified and the effect of metformin on human lung cancer remains unknown. In this study we revealed for the first time that metformin treatment led to increased apoptosis in human lung cancer cell lines A549 and NCI-H1299 and significantly inhibited the cells proliferation in a dose- and time-dependent manner, which was further demonstrated by the data obtained from A549 tumor xenografts in nude mice. We also found that metformin treatment can activate AMP-activated protein kinase, JNK/p38 MAPK signaling pathway and caspases, as well as upregulate the expression of growth arrest and DNA damage inducible gene 153 (GADD153). Either blockade of JNK/p38 MAPK pathway or knockdown of GADD153 gene abrogated the apoptosis-inducing effect of metformin. Taken together, our data suggest that metformin inhibits the growth of lung cancer cells and induces apoptosis through activating JNK/p38 MAPK pathway and GADD153.

ηπ+ π- resonant structure around 1.8 GeV/c(2) and η(1405) in J/ψ → ωηπ+ π-

We present results of a study of the decay J/ψ → ωηπ+ π- using a sample of (225.2 ± 2.8) × 10(6) J/ψ events collected by the BESIII detector, and report the observation of a new process J/ψ → ωX(1870) with a statistical significance of 7.2σ, in which X(1870) decays to a(0)(±)(980)π±. Fitting to ηπ+ π- mass spectrum yields a mass M = 1877.3 ± 6.3(stat)(-7.4)(+3.4)(syst) MeV/c(2), a width Γ = 57 ± 12(stat)(-4)(+19)(syst) MeV/c(2), and a product branching fraction B(J/ψ → ωX) × B(X→a(0)(±)(980)π±) × B(a(0) (±)(980) → ηπ±) = [1.50 ± 0.26(stat)(-0.36)(+0.72) (syst)] × 10(-4). Signals for J/ψ → ωf(1)(1285) and J/ψ → ω η(1405) are also clearly observed and measured.

Observation of χ(c1) decays into vector meson pairs φφ, ωω, and ωφ

Using (106±4)×10⁻⁶ ψ(3686) events accumulated with the BESIII detector at the BEPCII e⁺e⁻ collider, we present the first measurement of decays of χ(c1) to vector meson pairs φφ, ωω, and ωφ. The branching fractions are measured to be (4.4±0.3±0.5)×10⁻⁴, (6.0±0.3±0.7)×10⁻⁴, and (2.2±0.6±0.2)×10⁻⁵, for χ(c1)→φφ, ωω, and ωφ, respectively, which indicates that the hadron helicity selection rule is significantly violated in χ(cJ) decays. In addition, the measurement of χ(cJ)→ωφ provides the first indication of the rate of doubly OZI-suppressed χ(cJ) decay. Finally, we present improved measurements for the branching fractions of χ(c0) and χ(c2) to vector meson pairs.

Development of a novel monoclonal antibody to B7-H4: characterization and biological activity

Objective

B7-H4, a member of the B7 family of immunoregulatory receptors, may participate in the negative regulation of cell-mediated immunity. Aberrant B7-H4 expression is detected in some tumors and it plays a role in the occurrence and development of tumors. The aim of this study was to elucidate the functional and structural properties of B7-H4.

Methods

We developed a monoclonal antibody (mAb) against the extracellular domain of B7-H4 through immunization of Balb/c mice with 3T3-mB7-H4 cells which expressed extrinsic B7-H4. A stable hybridoma cell line was established. Then, we analysised the characterization of the mAb through Enzyme linked immunosorbent assay (ELISA), Immunoprecipitation (IP), western blotting, Immunohistochemical (IHC), and tested the biological activity of the mAb.

Results

ELISA, IP, and western blotting analyses indicated that the mAb specifically recognized B7-H4. In addition, flow cytometry demonstrated that the mAb exhibits excellent reactivity when applied to leukemic cells. IHC staining revealed that the mAb stained in a predominantly diffuse plasmalemmal or cytoplasmic pattern when applied to certain tumor tissues. The preliminary results of the mAb's biological activity showed that the mAb could effectively inhibit the function of B7-H4 in the inhibition of T cell, while promotingg the growth of T cells and the secretion of Interleukin-2 (lL-2), Interleukin-4 (IL-4), Interleukin10 (IL-10) and Interferon-γ (IFN-γ).

Conclusion

This mAb will be a valuable tool for the further investigation of B7-H4 function.

Average daily dose, medication adherence, and healthcare costs among commercially-insured patients with fibromyalgia treated with duloxetine

OBJECTIVE

What is the relationship between average daily dose (ADD) of duloxetine, adherence to therapy, and healthcare costs among patients with fibromyalgia?

METHODS

Employing a retrospective cohort design, this study assessed administrative claims data for commercially-insured fibromyalgia patients who initiated duloxetine in 2006. Initiation was defined as a 90-day clean period without access to duloxetine. Five study cohorts were constructed based on the ADD of duloxetine, calculated from all prescriptions dispensed over the 12-month follow-up period: <30 mg, 30 mg, 31-59 mg, 60 mg, and >60 mg (duloxetine starting dose: 30 mg/day; target dose: 60 mg/day). Medication possession ration (MPR) was used to assess duloxetine adherence, with MPR ≥0.8 as 'high' adherence. Multivariate regressions were applied to examine the association between ADD, duloxetine adherence, and healthcare costs (total, inpatient, outpatient, and pharmacy), adjusting for differences in demographic and clinical characteristics between cohorts.

RESULTS

Of the 4869 patients with fibromyalgia, 3% had an ADD of <30 mg, 12% had 30 mg, 21% had 31-59 mg, 46% had 60 mg, and 18% had >60 mg. High adherence to duloxetine ranged from 16% to 41% across cohorts. Controlling for demographic and clinical characteristics, patients with an ADD of 31-59 mg or >60 mg were more likely to adhere to duloxetine therapy than those in the 60 mg cohort, while patients in the <30 mg cohort were less likely to adhere to duloxetine (all p < 0.05). Total costs were significantly higher for individuals in the 31-59 mg or >60 mg ADD cohorts ($1834 and $5766) than those maintaining an ADD of 60 mg, as were outpatient ($1167 and $2275) and pharmacy costs ($502 and $2983) (all p < 0.05). Patients with an ADD of 30 mg had significantly lower total (-$1770), inpatient (-$1524), and pharmacy (-$827) costs (all p < 0.05) than those with an ADD of 60 mg.

LIMITATIONS

This study is subject to selection bias because some confounders might be unobserved in the administrative claims database. Indirect costs or over-the-counter medication costs were also not available.

CONCLUSIONS

Fibromyalgia patients with an ADD of 60 mg of duloxetine had better adherence than patients with an ADD ≤30 mg. Duloxetine patients with an ADD of 30 mg (31-59 or >60 mg) had significantly lower (higher) healthcare costs than those maintaining an ADD of 60 mg.

Confirmation of the X(1835) and observation of the resonances X(2120) and X(2370) in J/ψ→γπ+π-η'

With a sample of (225.2±2.8)×10(6) J/ψ events registered in the BESIII detector, J/ψ→γπ(+)π(-)η(') is studied using two η(') decay modes: η(')→π(+)π(-)η and η(')→γρ(0). The X(1835), which was previously observed by BESII, is confirmed with a statistical significance that is larger than 20σ. In addition, in the π(+)π(-)η(') invariant-mass spectrum, the X(2120) and the X(2370), are observed with statistical significances larger than 7.2σ and 6.4σ, respectively. For the X(1835), the angular distribution of the radiative photon is consistent with expectations for a pseudoscalar.

Economic impact of using inhaled corticosteroids without prior exacerbation among elderly patients with chronic obstructive pulmonary disorder

OBJECTIVE

To assess the economic impact of initiating inhaled corticosteroids (ICS) without evidence of prior exacerbation among elderly patients with chronic obstructive pulmonary disease (COPD) in the US.

METHODS

This retrospective study used administrative claims to identify newly diagnosed COPD patients between 1/1/2005 and 6/30/2006 who were dispensed ICS. The dispense date of the first ICS was set as the index date. Patients with prior diagnoses for asthma, cystic fibrosis, or lung cancer were excluded. Cohorts were constructed based on whether ICS therapy was concordant with recommended guidelines of having prior COPD exacerbation. Each COPD patient with prior exacerbation was matched to four patients without exacerbation based on age, gender, Charlson Comorbidity Index, and whether COPD diagnosis code was not elsewhere specified (i.e., 496). Multivariate regressions were estimated to assess the association between use of ICS therapy without prior exacerbation and total healthcare costs, controlling for demographics and clinical characteristics.

RESULTS

The study included 3650 patients: 730 with prior exacerbation and 2920 without prior exacerbation. Patients were 76 years of age and 54% were male. Those with prior exacerbation were more likely to have inpatient stays both prior to (74.4 vs. 44.1%, p<0.05) and following (37.0 vs. 33.1%, p<0.05) the index date. Controlling for patient characteristics, patients who were dispensed ICS without prior exacerbation had $1859 higher in total costs (p<0.05) compared to patients with prior exacerbation during the 12 months following ICS initiation.

LIMITATIONS

The retrospective design of this study limits the interpretation of findings as association and not causality. This study is subject to selection bias due to unobservable confounders.

CONCLUSIONS

Among COPD patients, initiation of ICS without prior exacerbation appears to be associated with increased healthcare costs. These findings suggest that ICS initiation without evidence of exacerbation as consistent with guidelines is associated with adverse economic consequences.

Surgical procedures and their cost estimates among women with newly diagnosed endometriosis: a US database study

OBJECTIVE

This descriptive study assessed the rate and costs of surgical procedures among newly diagnosed endometriosis patients.

METHODS

Utilizing the Medstat MarketScan database, commercially insured women aged 18-45 with endometriosis newly diagnosed during 2006-2007 were identified. Each endometriosis patient was matched to four women without endometriosis (population controls) based on age and region of residence. Surgical procedures received during the 12 months post-diagnosis were assessed. Costs of surgical procedures were the amount paid by the insurance companies.

RESULTS

This study identified 15,891 women with newly diagnosed endometriosis and 63,564 population controls. More than 65% of endometriosis patients received an endometriosis-related surgical procedure within 1 year of the initial diagnosis. The most common procedure was therapeutic laparoscopy (31.6%), followed by abdominal hysterectomy (22.1%) and vaginal hysterectomy (6.8%). Prevalence and type of surgery performed varied by patient age, including a hysterectomy rate of approximately 16% in patients younger than 35 and 37% among patients aged 35-45 years. Average costs ranged from $4,289 (standard deviation [SD]: $3,313) for diagnostic laparoscopy to $11,397 (SD: $8,749) for abdominal hysterectomy.

LIMITATIONS

Diagnosis of endometriosis cannot be validated against medical records, and information on the severity of endometriosis-related symptoms is not available in administrative claims data.

CONCLUSIONS

Over 65% of patients had endometriosis-related surgical procedures, including hysterectomy, within 1 year of being diagnosed with endometriosis. The cost of surgical procedures related to endometriosis places a significant financial burden on the healthcare system.

Factors associated with pain medication selection among patients diagnosed with diabetic peripheral neuropathic pain: a retrospective study

OBJECTIVE

To assess the demographic and clinical characteristics associated with initiation of duloxetine therapy compared with other pharmacologic therapies for treatment of diabetic peripheral neuropathic pain (DPNP).

METHODS

This study used administrative claims databases for commercially-insured individuals aged 18-64 years to examine factors associated with treatment among DPNP patients who initiated duloxetine versus tricyclic antidepressants (TCAs), venlafaxine, gabapentin, pregabalin, or opioids between 7/1/2005 and 12/31/2007. Treatment initiation was defined as no pill coverage of the same medication over the previous 90 days. Multiple logistic regression models were estimated to assess factors associated with initiating duloxetine versus each of the other DPNP therapies.

RESULTS

The study included 11,060 DPNP patients with average age of 55 years old. Cardiovascular disease (63-70%), cerebrovascular/peripheral vascular disease (26-33%), low back pain (24-39%), and osteoarthritis (17-26%) were the most common diabetes- and pain-related comorbidities. Controlling for demographic and clinical characteristics, patients who received duloxetine or pregabalin in the prior 12-month period were more likely to initiate duloxetine. Patients from other DPNP treatment cohorts, except for those in the pregabalin cohort, were more likely to re-initiate the same prior therapy than begin treatment with duloxetine (all p<0.05). A history of anxiety disorder was significantly associated with initiation of all DPNP treatments other than duloxetine (all p<0.05), except for TCAs. Patients with low back pain were more likely to initiate duloxetine than TCAs or venlafaxine, but less likely to initiate duloxetine than pregabalin or opioids. Patients with infections related to diabetes were less likely to initiate duloxetine than venlafaxine, gabapentin, or opioids.

LIMITATIONS

Because a retrospective administrative claims database was used, this study is subject to selection bias due to unobservable confounders, inability to measure prescriber preferences or characteristics or disease severity.

CONCLUSIONS

Among commercially-insured DPNP patients, those with prior use of duloxetine or pregabalin were more likely to initiate duloxetine than other treatments. The presence of select comorbidities was also associated with specific medication initiation.

Evidence for ψ' decays into γπ0 and γη

The decays ψ'→γπ(0), γη and γη' are studied using data collected with the BESIII detector at the BEPCII e(+)e(-) collider. The processes ψ'→γπ(0) and ψ'→γη are observed for the first time with signal significances of 4.6σ and 4.3σ, respectively. The branching fractions are determined to be B(ψ'→γπ(0))=(1.58±0.40±0.13)×10(-6), B(ψ'→γη)=(1.38±0.48±0.09)×10(-6), and B(ψ'→γη')=(126±3±8)×10(-6), where the first errors are statistical and the second ones systematic.

Opioid use and healthcare costs among patients with DPNP initiating duloxetine versus other treatments

OBJECTIVE

To compare opioid utilization and healthcare costs over a 1-year period following the initiation with duloxetine versus other standard of care (SOC) treatments among patients with diabetic peripheral neuropathic pain (DPNP).

METHODS

This retrospective cohort study assessed commercially-insured DPNP patients between 18 and 64 years old who initiated duloxetine or other SOC treatments (tricyclic antidepressants, venlafaxine, gabapentin, pregabalin) between 3/1/2005 and 12/31/2005. Initiation was defined as a 90-day period without available study medication. The first dispense date of the study medication was denoted as the index date. Selected patients had no opioid pill coverage during the 90 days prior to initiation. Duloxetine and SOC patients were matched via propensity scoring (1:1 ratio), controlling for demographics, comorbidities, prior healthcare utilization and costs, and prior medication history. Opioid utilization and healthcare costs over the 12-month post-index period were compared between study cohorts.

RESULTS

The matched sample included 117 patients in each of the duloxetine and SOC cohorts. Compared with SOC-treated patients, duloxetine-treated patients were less likely to use any opioids (52.1 vs. 84.6%, p < 0.05) over the 12-month post-index period. Duloxetine-treated patients, on average, had two fewer opioid prescriptions dispensed, 27 fewer days on opioids, 121 days greater delay in subsequent opioid use, and 1815 mg lower morphine equivalent dosage than SOC-treated patients (all p < 0.05). Also, duloxetine-treated patients had significantly lower total ($18,623 vs. 30,602, p < 0.05) and outpatient costs ($7371 vs. 15,343, p < 0.05). Due to the use of a retrospective administrative claims database, limitations of this study include the potential for selection bias between study cohorts, and inability to measure unobservable confounding and disease severity and/or duration.

CONCLUSIONS

Among commercially-insured DPNP patients, duloxetine-treated patients had delayed and reduced opioid use and lower healthcare costs than SOC-treated patients.

Simian virus 40 inhibits differentiation and maturation of rhesus macaque DC-SIGN(+) dendritic cells

Dendritic cells (DC) are the initiators and modulators of the immune responses. Some species of pathogenic microorganisms have developed immune evasion strategies by controlling antigen presentation function of DC. Simian virus 40 (SV40) is a DNA tumor virus of rhesus monkey origin. It can induce cell transformation and tumorigenesis in many vertebrate species, but often causes no visible effects and persists as a latent infection in rhesus monkeys under natural conditions. To investigate the interaction between SV40 and rhesus monkey DC, rhesus monkey peripheral blood monocyte-derived DC were induced using recombinant human Interleukin-4 (rhIL-4) and infective SV40, the phenotype and function of DC-specific intracellular adhesion molecule-3 grabbing nonintegrin (DC-SIGN)(+) DC were analyzed by flow cytometry (FCM) and mixed lymphocyte reaction (MLR). Results showed that SV40 can down-regulate the expression of CD83 and CD86 on DC and impair DC-induced activation of T cell proliferation. These findings suggest that SV40 might also cause immune suppression by influencing differentiation and maturation of DC.

Changes in opioid use and healthcare costs among U.S. patients with diabetic peripheral neuropathic pain treated with duloxetine compared with other therapies

OBJECTIVE

To examine changes in opioid use and healthcare costs among commercially insured patients with diabetic peripheral neuropathic pain (DPNP) who initiated duloxetine versus other standard of care (SOC) medications (tricyclic antidepressants, venlafaxine, gabapentin, pregabalin).

RESEARCH DESIGN AND METHODS

Using an administrative claims database, patients with DPNP aged 18-64 who initiated duloxetine or SOC between March 1, 2005 and December 31, 2005 were identified. Initiation was defined as a 90-day clean period without the available study medication. Selected patients had 12 months of continuous enrollment before and after the index date, and at least one opioid dispensed in the prior 90 days. Duloxetine and SOC patients were further classified into continuous and non-continuous users based on whether the medication possession ratio was > or =0.8. Total opioid days, number of opioid prescriptions dispensed, and cumulative morphine equivalents were examined over the 12-month pre- and post-index periods. Multivariate regressions were applied to assess the changes (pre-index minus post-index) in opioid use (total, short-acting vs. long-acting) and healthcare costs, controlling for demographic and clinical characteristics.

RESULTS

The study sample included 1281 patients: 98 duloxetine continuous, 243 duloxetine non-continuous, 195 SOC continuous, and 745 SOC non-continuous users. Controlling for demographic and clinical characteristics, duloxetine non-continuous and SOC (continuous and non-continuous) patients had significantly less reduction in total opioid days (-24.4, -23.7, -18.5, respectively, all p < 0.05) from the 12-month pre-index to the post-index period than duloxetine continuous patients. Compared with duloxetine non-continuous, SOC continuous, and SOC non-continuous users, duloxetine continuous users had a greater reduction in short-acting hydrocodone use (difference between the 12 month pre-index and post-index periods) in terms of the total number of prescriptions dispensed (adjusted differences: 1.5, 1.7, 1.7, respectively, all p < 0.05), total supply days (adjusted differences: 28.1, 27.3, 29.7, respectively, all p < 0.05), and morphine equivalent dosage (adjusted differences: 1290 mg, 1132 mg, 1127 mg, respectively, all p < 0.05). Duloxetine non-continuous patients had significantly higher adjusted total ($12,729, p < 0.05) and inpatient costs ($14,993, p < 0.05) than duloxetine continuous patients.

LIMITATIONS

Due to the use of a retrospective administrative claims database, this study is subject to selection bias between study cohorts, misidentification of DPNP and/or other comorbidities, and an inability to confirm adherence to therapy or assess indirect costs and costs of over-the-counter medications.

CONCLUSIONS

Among commercially insured patients with DPNP, continuous treatment with duloxetine was associated with a reduction in opioid use between the 12-month pre- and post-index periods compared with treatment with SOC or non-continuous treatment with duloxetine. Duloxetine continuous patients also incurred lower subsequent healthcare costs than non-continuous duloxetine patients.