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Randomized Versus Real-World Evidence on the Efficacy and Toxicity of Checkpoint Inhibitors in Cancer in Patients with Advanced Non-small Cell Lung Cancer or Melanoma: A Meta-analysis. Target Oncol 2022; 17:507-515. [PMID: 35913645 PMCID: PMC9512877 DOI: 10.1007/s11523-022-00901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/22/2022]
Abstract
Background Both randomized controlled trials (RCTs) and real-world evidence (RWE) studies provide results regarding the efficacy and toxicity of checkpoint inhibitors in cancer patients. The results from these two sources are considered complementary but whether they are comparable remains unknown. Objective The aim of this study was to compare the efficacy and toxicity of checkpoint inhibitors between RCTs and RWE studies in patients with advanced non-small cell lung cancer (NSCLC) or melanoma. Patients and Methods Two electronic databases were searched to identify eligible studies, either RCTs or RWE studies, investigating the efficacy or toxicity of checkpoint inhibitors given for indications that were approved by the European Medicines Agency (EMA) at the date of the last search. A meta-analysis was performed and the pooled estimates of objective response rates (ORR), progression-free survival (PFS), overall survival (OS), and toxicity and treatment discontinuation between RCTs and RWE studies were compared. Results In total, 43 RWE studies and 15 RCTs were eligible, with adequate data for pooled estimates for immunotherapy indications regarding NSCLC and melanoma. No statistically significant or clinically meaningful differences in terms of pooled PFS, OS, or rates of treatment discontinuation due to toxicity between RCTs and RWE studies were observed. In some indications, a higher rate of response rates and lower rate of toxicity in favor of RWE was observed. Conclusion In patients with melanoma or NSCLC, the clinical value of checkpoint inhibitors is evident in both RCTs and real-world settings. Some differences in response or toxicity rates in favor of RWE mainly reflects the inherent difficulties in evaluating these outcomes in RWE studies. Supplementary Information The online version contains supplementary material available at 10.1007/s11523-022-00901-1.
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Real world data of anticoagulant treatment in non-valvular atrial fibrillation across renal function status. Sci Rep 2022; 12:6123. [PMID: 35414001 PMCID: PMC9005546 DOI: 10.1038/s41598-022-10164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/22/2022] [Indexed: 11/09/2022] Open
Abstract
The objective is to assess the impact of anticoagulant treatment in non-valvular atrial fibrillation (AF) and different categories of renal dysfunction in real world. Electronic Health recordings of patients with diagnosis of AF and renal function collected throughout 5 years and classified according to KDIGO categories. Stroke, transitory ischemic attack (TIA), intracranial hemorrhage and all-cause mortality were identified. Anticoagulant treatments during the study period were classified in untreated (never received therapy), VKA, NOAC and Aspirin. The risk of events was calculated by Cox-proportional hazard models adjusted by confounders. A total of 65,734 patients with AF, mean age 73.3 ± 10.49 years old and 47% females and follow-up of 3.2 years were included. KDIGO classification were: G1 33,903 (51.6%), G2 17,456 (26.6%), G3 8024 (12.2%) and G4 6351 (9.7%). There were 8592 cases of stroke and TIA, 437 intracranial hemorrhage, and 9603 all-cause deaths (incidence 36, 2 and 38 per 103 person/year, respectively). 4.1% of patients with CHA2DS2-VASc Score 2 or higher did not receive anticoagulant therapy. Risk of stroke, TIA, and all-cause mortality increased from G1 to G4 groups. Anticoagulant treatments reduced the risk of events in the four categories, but NOAC seemed to offer significantly better protection. Renal dysfunction increases the risk of events in AF and anticoagulant treatments reduced the risk of stroke and all-cause mortality, although NOAC were better than VKA. Efforts should be done to reduce the variability in the use of anticoagulants even in this high risk group.
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Fan JG, Li Y, Yu Z, Luo XX, Zheng P, Hao X, Wang ZY, Gao F, Zhang GQ, Feng WY. Effectiveness and Economic Evaluation of Polyene Phosphatidyl Choline in Patients With Liver Diseases Based on Real-World Research. Front Pharmacol 2022; 13:806787. [PMID: 35330831 PMCID: PMC8940240 DOI: 10.3389/fphar.2022.806787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/24/2022] [Indexed: 01/07/2023] Open
Abstract
Aims: Liver disease has high prevalence, number, and disease burden in China, and polyene phosphatidyl choline (PPC) is a widely used liver protective drug. We aim to explore the effectiveness and economy of PPC in patients with liver diseases based on real-world research and compare with other hepatoprotective drugs. Methods: This is a “three-phase” study from three medical centers, including descriptive study of patients using PPC injection, self-control case study of patients using PPC injection, and specific-disease cohort study of patients using PPC injection or control drugs. The major measurements of liver function for effectiveness analysis were the alanine transaminase (ALT) level changes and recovery rate. The main statistical methods were Wilcoxon signed rank test, χ2 test, and Mann–Whitney U test. Propensity score matching was applied to reduce bias. Cost-effectiveness analysis, cost minimization analysis, and sensitivity analysis were used for economic evaluation. Results: PPC alone or in combination with glutathione and magnesium isoglycyrrhizinate shows less total hospitalization cost (p < 0.05) and smaller cost-effectiveness ratio and was effective in protecting liver function, especially in patients with liver transplantation or postoperation of nontumor liver disease (ALT decreased significantly after PPC treatment; p < 0.05). Glutathione and magnesium isoglycyrrhizinate combined with PPC could enhance the protective function of liver. Conclusion: PPC was an effective and economic liver protective drug in patients with specific liver diseases, and PPC could enhance the liver protective function of glutathione and magnesium isoglycyrrhizinate.
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Affiliation(s)
- Jian-Gao Fan
- Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Li
- Department of Pharmacy, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Ze Yu
- Beijing Medicinovo Technology Co. Ltd., Beijing, China
| | - Xing-Xian Luo
- School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China
| | - Ping Zheng
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Hao
- Dalian Medicinovo Technology Co. Ltd., Dalian, China
| | - Ze-Yuan Wang
- Beijing Medicinovo Technology Co. Ltd., Beijing, China
| | - Fei Gao
- Beijing Medicinovo Technology Co. Ltd., Beijing, China
| | - Guo-Qing Zhang
- Department of Pharmacy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wan-Yu Feng
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
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Calderon JM, Martinez F, Diaz J, Fernandez A, Sauri I, Uso R, Trillo JL, Vela S, Bea C, Redon J, Forner MJ. Real-World Data of Anticoagulant Treatment in Non-valvular Atrial Fibrillation. Front Cardiovasc Med 2022; 8:733300. [PMID: 35127843 PMCID: PMC8814520 DOI: 10.3389/fcvm.2021.733300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
AimsTo assess the impact of anticoagulant treatment on risk for stroke and all-cause mortality of patients with atrial fibrillation using real-world data (RWD).MethodsPatients with prevalent or incident atrial fibrillation were selected throughout a study period of 5 years. Stroke, transitory ischemic attack, hemorrhagic stroke, and all-cause mortality were identified in the claims of the electronic health records (EHRs). Subjects were classified according to the anticoagulant treatment in four groups: untreated, vitamin K antagonists (VKAs), New Oral Anticoagulants (NOACs), and antiplatelet (AP). Risk of events and protection with anticoagulant therapy were calculated by Cox proportional hazard models adjusted by potential confounders.ResultsFrom a total population of 3,799,884 patients older than 18,123,227 patients with incident or prevalent atrial fibrillation (AF) were identified (mean age 75.2 ± 11.5 years old; 51.9% women). In a follow-up average of 3.2 years, 17,113 patients suffered from an ischemic stroke and transitory ischemic attack (TIA), 780 hemorrhagic stroke, and 42,558 all-cause death (incidence of 46, 8, 2, and 120 per 1,000 patients/year, respectively). Among CHA2DS2, VASc Score equal or >2, 11.7% of patients did not receive any anticoagulant therapy, and a large proportion of patients, 47%, shifted from one treatment to another. Although all kinds of anticoagulant treatments were significantly protective against the events and mortality, NOAC treatment offered significantly better protection compared to the other groups.ConclusionIn the real world, the use of anticoagulant treatments is far from guidelines recommendations and is characterized by variability in their use. NOACs offered better protection compared with VKAs.
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Affiliation(s)
- Jose Miguel Calderon
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Fernando Martinez
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
- Internal Medicine Hospital Clínico de Valencia, Valencia, Spain
| | - Javier Diaz
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Antonio Fernandez
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Inmaculada Sauri
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Ruth Uso
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Jose Luis Trillo
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Sara Vela
- Internal Medicine Hospital Clínico de Valencia, Valencia, Spain
| | - Carlos Bea
- Internal Medicine Hospital Clínico de Valencia, Valencia, Spain
| | - Josep Redon
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
- Internal Medicine Hospital Clínico de Valencia, Valencia, Spain
- CIBERObn Carlos III Institute, Madrid, Spain
- *Correspondence: Josep Redon
| | - Maria Jose Forner
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
- Internal Medicine Hospital Clínico de Valencia, Valencia, Spain
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Lai Y, Wang R, Li W, Zhu H, Fei S, Shi H, Lu N, Ung COL, Hu H, Han S. Clinical and economic analysis of Gastrodin injection for dizziness or vertigo: a retrospective cohort study based on electronic health records in China. Chin Med 2022; 17:6. [PMID: 34983603 PMCID: PMC8725493 DOI: 10.1186/s13020-021-00561-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/25/2021] [Indexed: 12/30/2022] Open
Abstract
Background Dizziness and vertigo are common clinical symptoms. Gastrodin injection has shown clinical effects on dizziness or vertigo. However, little is known about the effectiveness and costs of combining Gastrodin injection with conventional treatment on dizziness or vertigo in daily practice. This study aimed to analyze the clinical and economic effects of Gastrodin injection for patients with dizziness or vertigo in comparison to Extract of Ginkgo Biloba Leaves injection in real-world practice. Methods Data was collected from the Hospital Information System of 131 hospitals across China from January to December 2018. Patients whose primary discharge diagnosis was dizziness or vertigo according to ICD-10 diagnostic coding were included and divided into two samples: sample of dizziness or vertigo; sample of dizziness or vertigo, with the complication of cerebral infarction. Comparative analysis of the medical cost per hospitalization, hospitalization duration, effective rates, and cure rates between the group of Gastrodin injection and the group of Extract of Ginkgo Biloba Leaves injection was conducted. Propensity Score Matching was used to control potential confounding factors. Results In the sample of dizziness or vertigo, although there was no significant differences on hospitalization duration (P = 0.080), the group of Gastrodin injection was significantly better than the group of Extract of Ginkgo Biloba Leaves injection (P < 0.001) in terms of treatment effect and the per capita hospitalization cost. In the sample of dizziness or vertigo, with the complication of cerebral infarction, there was no significant difference (P = 0.371) in terms of hospitalization duration, but the group of Gastrodin injection was significantly better than the group of Extract of Ginkgo Biloba Leaves injection (P = 0.009) in terms of treatment effect, and significant difference regarding the per capita hospitalization cost (P < 0.001). Conclusions Gastrodin injection showed advantages for inpatients with dizziness or vertigo compared with Extract of Ginkgo Biloba Leaves injection. Future studies using prospective pragmatic controlled trials can test and explore more about the effects of Gastrodin injections on dizziness or vertigo. Supplementary Information The online version contains supplementary material available at 10.1186/s13020-021-00561-9.
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Affiliation(s)
- Yunfeng Lai
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.,State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Ruoning Wang
- Department of Continuing Medical Education, Peking University Health Science Center, Beijing, China
| | - Wei Li
- Department of Real-World Evidence and Pharmacoeconomics, International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - He Zhu
- Department of Real-World Evidence and Pharmacoeconomics, International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Shuyang Fei
- Department of Vasculocardiology, AnZhen Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Honghao Shi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Nan Lu
- Inchuan Medlinker Internet Hospital, Yinchuan, NingXia Hui Autonomous Region, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China.
| | - Sheng Han
- Department of Real-World Evidence and Pharmacoeconomics, International Research Center for Medicinal Administration, Peking University, Beijing, China.
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