Use of gabapentinoid medications among US adults with cancer, 2005-2015

Tramadol use in U.S. Adults With Commercial Health Insurance, 2005-2021

INTRODUCTION

Tramadol has been associated with chronic opioid use and emergency room (ER) visits. However, little is known about trends in prescription tramadol use in the U.S.

METHODS

Optum's de-identified Clinformatics® Data Mart Database was used to assess trends in monthly incident and prevalent tramadol use from 2005 to 2021, stratified by sex and age (18-64 vs. ≥65 years). State-specific trends following scheduling of tramadol as Class IV controlled substance in August 2014 were analyzed with random effects regression models. Demographics, comorbidities, initiation setting, dose, and co-dispensing with other opioids and central nervous system (CNS) agents were assessed in people initiating tramadol, stratified by age and initiation year (2005-2010, 2011-2015, 2016-2021). Analyses were performed in 2023 and 2024.

RESULTS

During 2005-2021, the mean percentage using tramadol in a given month was 0.88% of younger females, 0.55% of younger males, 1.97% of older females, and 1.14% of older males; 5,729,652 initiations were identified. Since 2014, estimated relative yearly decrease was 4% (95% CI 3%; 5%) in use and 5% (95% CI 4%; 5%) in initiation, with variation across states. Primary care percentage of tramadol initiations declined from 49.2% in 2005-2010 to 37.2% in 2016-2021. During 2016-2021, co-dispensing with other CNS agents occurred in 37.8% of younger and 32.1% of older adults initiating tramadol.

CONCLUSIONS

Tramadol use was higher in females and older adults, exhibited heterogeneous trends across states, and shifted from primary care to ER and specialist settings over time. Co-dispensing with other CNS agents was common and warrants further monitoring.

Comparative study on the anti-tumor effect of steroids derived from different organisms in H22 tumor-bearing mice and analysis of their mechanisms

This study aimed to comparatively investigate the anti-tumor mechanisms of steroids including ergosterol, β-sitosterol, cholesterol, and fucosterol. The model of H22 tumor-bearing mice was constructed based on histopathological data and biochemical parameters, while serums were subjected to metabolomics analysis to study the potential anti-tumor mechanisms. The results indicated that the four steroids exhibited different degrees of anti-tumor effects on H22 mice. The tumor inhibition rates were 63.25% for ergosterol, 56.41% for β-sitosterol, 61.54% for cholesterol, and 72.65% for fucosterol. Metabolomic analyses revealed that 87, 71, and 129 differential metabolites were identified in ergosterol, cholesterol, and fucosterol treatment groups, respectively. The fucosterol treatment group had the highest number of differential metabolites. At the same time, it mainly inhibited purine and amino acid metabolism to exert anti-tumor effects. Ergosterol enhanced immunity and affected pyruvate metabolism, and cholesterol inhibited purine metabolism. The chemical structure difference among ergosterol, cholesterol, and fucosterol is mainly at the number and position of sterol double bonds and the number and length of side chain carbons. Therefore, there is a structure-activity relationship between the structure of steroid compounds and their efficacy. This study provides a key foundation for the exploitation of the anti-tumor effects of steroids derived from different organisms.

Deciphering key regulators of Inonotus hispidus petroleum ether extract involved in anti-tumor through whole transcriptome and proteome analysis in H22 tumor-bearing mice model

ETHNOPHARMACOLOGICAL RELEVANCE

The mushroom Inonotus hispidus is traditional Chinese medicine, which has been used to treat tumor illness for a long history in China. Our previous research found that I. hispidus petroleum ether extract (IPE) has significant anti-tumor activity. However, the potential anti-tumor regulatory pathways and targets of I. hispidus remain unclear.

OBJECTIVE

The present study was envisaged to explore the key regulators responsible for anti-tumor of IPE using whole transcriptome and proteome analysis in H22 tumor-bearing mice model.

MATERIALS AND METHODS

The model of H22 tumor-bearing mice was constructed according to the histopathological data and biochemical parameters. The isolated tumor tissues of different treatment groups were subjected to transcriptomic and proteomic analysis. An integrated approach of RNA-Seq, proteomics, and system biology analysis was used to identify key regulators involved in antitumor pathways. The analyzed differential expression patterns were supported by gene and protein expression studies.

RESULTS

These results indicated that 957 differentially expressed genes and 405 proteins were identified in the tumor tissue of different treatment groups through RNA-Seq and liquid chromatography with tandem mass spectrometry-based proteomic analysis, respectively. The combined omics analysis revealed five critical genes/proteins, including Lilrb4a, Nrp1, Gzma, Gstt1, and Pdk4 that could play a role in antitumor pathways. Furthermore, Lilrb4a, Nrp1, Gzma, Gstt1 and Pdk4 genes/proteins, as key regulators of the anti-tumor effect of IPE, were verified by qRT-PCR and western blotting methods, respectively.

CONCLUSION

Our study provides new ideas for analyzing the antitumor mechanism of IPE from the point of view of gene and protein expression and will encourage further development of the I. hispidus pharmaceutical industry.

Anti-tumor effect of Inonotus hispidus petroleum ether extract in H22 tumor-bearing mice and analysis its mechanism by untargeted metabonomic

ETHNOPHARMACOLOGICAL RELEVANCE

The mushroom Inonotus hispidus is traditional Chinese medicine, which has been used to treat tumor illness for many years in China. However, the potential anti-tumor mechanisms of I. hispidus remain unclear.

OBJECTIVE

This study aimed to reveal the anti-tumor mechanism of I. hispidus petroleum ether extract (IPE) on H22 tumor-bearing mice from the point of view of metabonomics.

MATERIALS AND METHODS

The model of H22 tumor-bearing mice was constructed according to the histopathological data and biochemical parameters, while the serum metabolomics was analyzed by non-targeted ultra-high performance liquid chromatography and high-resolution mass spectrometry (UPLC-MS/MS) to study the potential anti-tumor mechanisms of IPE.

RESULTS

These results indicated that IPE has significant anti-tumor effect on H22 tumor-bearing mice and no obvious adverse reactions were observed. After the intervention of IPE, the biosynthesis of cortisol and corticosterone as the metabolics in the downstream of steroid biosynthesis pathway and the biosynthesis of succinate, fumarate and malate as the metabolics in the downstream of tricarboxylic acid cycle pathway were inhibited; but the metabolic pathways of the amino acids as tryptophan, lysine degradation, alanine, aspartate and glutamate and other amino acid were activated.

CONCLUSION

IPE has significant anti-tumor effect in H22 tumor-bearing mice, and the anti-tumor activity of IPE is main through the regulation of energy, amino acids, and steroid hormone biosynthesis pathways expression.

Temporal Trends in Opioid Prescribing Patterns Among Oncologists in the Medicare Population

BACKGROUND

In the wake of the US opioid epidemic, there have been efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patients often require opioids for symptom management. We investigated temporal patterns in opioid prescribing for Medicare beneficiaries among oncologists and nononcologists.

METHODS

We queried the Centers for Medicare and Medicaid Services Part D prescriber dataset for all physicians between January 1, 2013, and December 31, 2017. We used population-averaged multivariable negative binomial regression to estimate the association between time and per-provider opioid and gabapentinoid prescribing rate, defined as the annual number of drug claims (original prescriptions and refills) per beneficiary, among oncologists and nononcologists on a national and state level.

RESULTS

From 2013 to 2017, the national opioid-prescribing rate declined by 20.7% (P < .001) among oncologists and 22.8% (P < .001) among non oncologists. During this time frame, prescribing of gabapentin increased by 5.9% (P < .001) and 23.1% (P < .001) among oncologists and nononcologists, respectively. Among palliative care providers, opioid prescribe increased by 15.3% (P < .001). During the 5-year period, 43 states experienced a decrease (P < .05) in opioid prescribing among oncologists, and in 5 states, opioid prescribing decreased more among oncologists than nononcologists (P < .05).

CONCLUSIONS

Between 2013 and 2017, the opioid-prescribing rate statistically significantly decreased nationwide among oncologists and nononcologists, respectively. Given similar declines in opioid prescribing among oncologists and nononcologists, there is concern that opioid-prescribing guidelines intended for the noncancer population are being applied inappropriately to patients with cancer and cancer survivors.

Strategies for Rotation between Gabapentinoids in the Inpatient Setting

Guidance and evidence to support best practices in rotating between gabapentinoids is lacking. This retrospective cohort study was performed to describe and evaluate strategies for rotation. Patients rotated while admitted from June 1st, 2014 to April 25th, 2020 at a large, academic medical center were included. The primary outcome was the proportion of rotations using a direct switch strategy compared to a cross-taper strategy. Secondary outcomes were successful rotation, defined as stable or improved pain scores pre- to post-rotation, dose ratios, and adverse effects. A total of 67 patients were included. Median age was 50 years (35 - 59) and 58% (38) were male. The majority used a direct switch strategy (87%). Ninety-five percent of patients using the direct switch strategy and 78% of patients using the cross-taper strategy were successful. There was no difference in strategies between those who were successful and those who were not. Post hoc analysis of patients with normal renal function (eGFR ≥ 50 mL/min/1.73 m²) found that those who were successful were more likely to have used a direct switch strategy (p = 0.048). There were no differences in adverse effects. These findings suggest that either strategy is reasonable for gabapentinoid rotation in the inpatient setting.

Current Evidence on Abuse and Misuse of Gabapentinoids

This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Pharmacovigilance studies, register-based studies, surveys, clinical toxicology studies, and forensic toxicology studies were identified and scrutinized with the goal to define the problem, identify risk factors, and discuss possible methods to reduce the potential for abuse and misuse. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored.

Patient-reported outcomes collected in ambulatory oncology practices: Feasibility, patterns, and correlates

OBJECTIVE

To examine the feasibility of soliciting outcomes from adults who received chemotherapy treatment for cancer and describe the patterns and correlates of patient-reported toxicities.

DATA SOURCES

Patient survey data from 29 Michigan ambulatory oncology practices collected in 2017.

STUDY DESIGN

Secondary analysis of patient survey data. Descriptive statistics were generated at the patient and practice levels. Thematic analysis of open-text comments identified clusters of frequently reported toxicities.

DATA COLLECTION METHODS

Patients completed 11 items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. Using a 5-point Likert scale, patients rated the frequency of nausea, vomiting, diarrhea, and pain; the severity of nausea, vomiting, constipation, numbness/tingling, and pain; and how much numbness/tingling and pain interfered with usual or daily activities. Patients could also report two toxicities in open-text comments. Finally, patients reported unplanned health care service for toxicity or side effect management.

PRINCIPAL FINDINGS

Of 3565 eligible patients, 2245 participated (63%) and 457 (20%) rated at least one toxicity as severe/very severe. Across practices, the proportion of patients who reported at least one severe/very severe toxicity ranged from 8% to 50%. Troubling toxicities included pain frequency (mean 2.3, SD 1.3), pain severity (2.1, 1.1), and diarrhea frequency (1.9, 1.0). From completed assessments, 1653 (74%) reported at least one toxicity in open-text comments; fatigue (n = 182), stomach discomfort (n = 53), and skin/nail changes (n = 41) were most frequently reported. Regarding consequences, 156 patients (7%) reported unplanned health care service use: 41 (26%) visited an emergency department and 32 (21%) were admitted to a hospital.

CONCLUSIONS

Querying patients on chemotherapy treatment experiences and toxicities was feasible. Toxicity rates varied across practices, which informed quality improvement. Toxicity severity and service use incidence exceed previously published trial data, particularly for pain, fatigue, and gastrointestinal issues. Open-text questions enabled exploration with newer treatment regimens.