The temporal association between hospital admissions, biological therapy usage and direct health care costs in rheumatoid arthritis patients

The temporal association between adverse drug reactions and antirheumatic drugs utilisation in Western Australia: a retrospective study from real-world data (1995-2015)

BACKGROUND/OBJECTIVES

Adverse drug reactions (ADRs) can result in morbidity, mortality, and higher healthcare costs. Given the limited information available on ADRs associated with antirheumatic medications, this study aims to analyse and compare ADR reporting for these drugs in the pharmacovigilance datasets of Western Australia (WA) and the United States (US).

METHODS

Therapeutic Goods Administration provided WA pharmacovigilance data of selected antirheumatic drugs to from 1995 to 2015. The proportional reporting ratio (PRR) for WA case reports was compared to corresponding USA pharmacovigilance data by assessing the disproportionality of each ADR. clinically significant or true ADRs were determined using the Evans 2001 criteria (n > 2, chi-square > 4, PRR > 2).

RESULTS

A total of 232 reports were found in WA, mostly on sixty-nine women aged 45 to 69. Methotrexate, leflunomide, azathioprine, sulfasalazine, and infliximab had the highest reported ADRs, related to gastrointestinal disorders. Patients who used biological agents in WA had 2.7 times the likelihood of reporting true ADRs compared to conventional antirheumatic drugs. The ADR rates in the two datasets were comparable over the study period.

CONCLUSIONS

The PRR values of ADRs were consistent between WA and US databases. Methotrexate and infliximab use were commonly associated with ADR reports in WA females, with incidence rates comparable to the US; while patients using biological agents were more likely to report true ADRs than those on conventional antirheumatic drugs in WA.

Anti-prostate cancer mechanism of black ginseng during the "nine steaming and nine sun-drying" process based on HPLC analysis combined with vector space network pharmacology

HPLC analysis determined six small-molecule organic acids, maltol, 5-hydroxymethylfurfural (5-HMF), 17 ginsenosides, four oligosaccharides, and 20 amino acids in black ginseng samples with different processing times. Based on the content determination results, the differential ingredients in the processing of black ginseng were screened by multivariate statistical analysis. Network pharmacological methods obtained the core targets and pathways of the above ingredients against prostate cancer. Finally, the entropy weight method was used to assign values to the above ingredients, targets, and pathways, and the vector space network pharmacology method was established to study the anti-prostate cancer mechanism of black ginseng in the process of "nine steaming and nine sun-drying". Based on principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA), fructose, glucose, dencichin, glutamate, ginsenoside 20 (S)-Rg3, 20 (R)-Rg3, 20 (S)-Rh2, Rg1, Re, and Rc were the main differential ingredients in various steaming and sun-drying cycle periods of black ginseng. The results of vector space network pharmacology showed that the main reason for the change in the anti-prostate cancer pathway of black ginseng with the number of steaming and sun-drying was the different regulatory ability of black ginseng on the PI3K-Akt signaling pathway and chemical carcinogenesis-receptor activation pathway. It gave researchers a fresh perspective for exploring the anti-prostate cancer active components of black ginseng and the change in the mechanism of the effect of traditional Chinese medicine in processing.

Geospatial analysis of the hospitalisation rate of patients with rheumatoid arthritis in Hunan: a cross-sectional Chinese study

OBJECTIVE

Little is known about spatial variability of hospitalisation rate (HR) of patients with rheumatoid arthritis (RA) worldwide, especially in China.

METHODS

A cross-sectional study was conducted among patients with RA admitted to hospitals in Hunan Province. Global Moran's I and local indicators of spatial association were used to explore the geospatial pattern of the HR of patients with RA. Generalised estimating equation analysis and geographically weighted regression were used to identify the potential influencing factors of the HR of patients with RA.

RESULTS

There were a total of 11 599 admissions, and the average HR was 1.57 per 10 000 population in Hunan. We detected different cluster patterns of the HR among patients with RA by local indicators of spatial association. Age, ethnicity, average temperature, average temperature range, average rainfall, regions, gross domestic product per capita, and doctors and hospitals per 10 000 people were risk factors for the HR. However, only average temperature, gross domestic product per capita and hospitals per 10 000 people showed different regression coefficients on the HR in different counties. The increase in hospitals increased the probability of HR from east to west in Hunan with a positive coefficient, while temperature decreases increased the risk of HR from south to north negatively. Similarly, the growth of gross domestic product per capita decreased the probability of HR from southwest to northeast.

CONCLUSION

A non-random spatial distribution of the HR of patients with RA was demonstrated in Hunan, and average temperature, gross domestic product per capita and hospitals per 10 000 people showed different regression coefficients on the HR in different counties. Our study indicated that spatial and geostatistics may be useful approaches for further study among patients with RA.

Mortality Trends Among Patients with Rheumatoid Arthritis in Western Australia

INTRODUCTION

With scarce comparative data on mortality in Australian patients with rheumatoid arthritis (RA), we investigated temporal changes in standardized mortality rates for patients with RA using longitudinal linked population-wide health data in Western Australia (WA) over the period 1980 to 2015.

METHODS

The study included 17,125 patients with a first-time hospital contact for RA (ICD-10-AM M05.00-M06.99 and ICD-9-AM 714.00-714.99) in the study period. Standardized mortality rate ratios (SMRRs) for the RA cohort versus the WA general population was estimated using direct age standardization. We analyzed temporal trends over with dates and causes provided by the WA Death Registry.

RESULTS

During 356,069 patient-years of follow-up, a total of 8955 (52%) deaths occurred in the RA cohort. The SMRR was 2.24 (95% CI 2.15-2.34) in males and 3.09 (95% CI 3.00-3.19) in females over the study period. SMRR decreased since 2000 to 1.59 (95% CI 1.39-1.81) for the period 2011-2015. Median survival was 26.80 years (95% CI 26.30-27.30), where age and comorbidity independently increased the risk of death. The leading causes of deaths were cardiovascular diseases (26.60%), cancer (16.80%), rheumatic diseases (5.80%), chronic pulmonary disease 491 (5.50%), dementia (3.00%), and diabetes 235 (2.6%).

CONCLUSIONS

The mortality rate in patients with RA in WA has decreased but remains 1.59-times higher than in community counterparts, suggesting that there is room for further improvement. Comorbidity is the main modifiable risk factor to further reduce mortality in patients with RA.

The prevalence of rheumatoid arthritis in Western Australia

BACKGROUND

Rheumatoid arthritis (RA) is the most common form of autoimmune arthritis, but the prevalence in Australia is unknown. We estimated RA period prevalence and identified factors associated with frequent RA hospitalisations, using linked administrative health and state-specific Australian Pharmaceutical Benefits Scheme (PBS) datasets in Western Australia (WA) from 1995 to 2014.

METHODS

This was a longitudinal population-based cohort study using two independent datasets to identify prevalent RA patients. RA prevalence was calculated per 1000 hospital separations and biological therapy users. RA patients were identified in the WA linked health dataset using ICD codes 714.0-714.9 and M05.00-M06.99. Dispensing data on biological therapy for RA were obtained from PBS records and converted to defined daily doses /1000 population/day. Multivariable logistic regression was used to analyse factors associated with frequent RA hospitalisations (> 2/year), controlling for sex, age, and geographic locations. Potential interactions were assessed using logistic regression in a stepwise approach.

RESULTS

A total of 17,125 RA patients had 50,353 hospital separations between 1995 and 2014, averaging three hospitalisations per patient over 20 years. The RA period prevalence was 3.4 per 1000 separations (0.34%; 95% CI 0.33-0.34), while the RA period prevalence based on biological therapy use was 0.36% (95% CI 0.35-0.37). The corrected RA prevalence based on biological therapy usage was 0.36% (95% CI 0.35-0.37) for the 2005-2009 and increased to 0.72% (95% CI 0.70-0.74) in 2010-2014 period. Associated factors for frequent RA hospitalisations were being female [1.21 (95% CI 1.15-1.26)], aged 60-69 years [4.45 (95% CI 3.74-5.30)], living in rural areas [1.12 (95% CI 1.02-1.24)]. The odd ratio of interaction between these associated factors was 1.34 (95% CI 1.16-1.55).

CONCLUSION

The minimal prevalence of RA in Western Australia is 0.34-0.36%, which falls within the literature range. Older female RA patients in rural were more likely to be hospitalised, suggesting unmet primary care for needs.