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Malozowski S. Letter to the Editor From Malozowski: "Weekly Lonapegsomatropin in Treatment-naïve Children with Growth Hormone Deficiency: the Phase 3 heiGHt Trial". J Clin Endocrinol Metab 2022; 107:e2206-e2207. [PMID: 34918085 PMCID: PMC9016435 DOI: 10.1210/clinem/dgab878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Saul Malozowski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892-5460, USA
- Correspondence: Saul Malozowski, MD, National Institutes of Health, Bethesda, MD 20896-5460, USA.
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Thornton PS, Maniatis AK, Aghajanova E, Chertok E, Vlachopapadopoulou E, Lin Z, Song W, Christoffersen ED, Breinholt VM, Kovalenko T, Giorgadze E, Korpal-Szczyrska M, Hofman PL, Karpf DB, Shu AD, Beckert M. Weekly Lonapegsomatropin in Treatment-Naïve Children With Growth Hormone Deficiency: The Phase 3 heiGHt Trial. J Clin Endocrinol Metab 2021; 106:3184-3195. [PMID: 34272849 PMCID: PMC8530727 DOI: 10.1210/clinem/dgab529] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 11/22/2022]
Abstract
CONTEXT For children with growth hormone deficiency (GHD), treatment burden with daily somatropin injections [human growth hormone (hGH)] is high, which may lead to poor adherence and suboptimal overall treatment outcomes. Lonapegsomatropin (TransCon hGH) is an investigational long-acting, once-weekly prodrug for the treatment of GHD. OBJECTIVE The objective of this study was to evaluate the efficacy and safety of once-weekly lonapegsomatropin vs daily somatropin. DESIGN The heiGHt trial was a randomized, open-label, active-controlled, 52-week Phase 3 trial (NCT02781727). SETTING This trial took place at 73 sites across 15 countries. PATIENTS This trial enrolled and dosed 161 treatment-naïve, prepubertal patients with GHD. INTERVENTIONS Patients were randomized 2:1 to receive lonapegsomatropin 0.24 mg hGH/kg/week or an equivalent weekly dose of somatropin delivered daily. MAIN OUTCOME MEASURE The primary end point was annualized height velocity (AHV) at week 52. Secondary efficacy end points included change from baseline in height SD scores (SDS). RESULTS Least squares (LS) mean (SE) AHV at 52 weeks was 11.2 (0.2) cm/year for lonapegsomatropin vs 10.3 (0.3) cm/year for daily somatropin (P = 0.009), with lonapegsomatropin demonstrating both noninferiority and superiority over daily somatropin. LS mean (SE) height SDS increased from baseline to week 52 by 1.10 (0.04) vs 0.96 (0.05) in the weekly lonapegsomatropin vs daily somatropin groups (P = 0.01). Bone age/chronological age ratio, adverse events, tolerability, and immunogenicity were similar between groups. CONCLUSIONS The trial met its primary objective of noninferiority in AHV and further showed superiority of lonapegsomatropin compared to daily somatropin, with similar safety, in treatment-naïve children with GHD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tatiana Kovalenko
- Republican Children’s Clinical Hospital of the Ministry of Health of the Udmurt Republic, Izhevsk, Russia
| | | | | | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Aimee D Shu
- Ascendis Pharma, Inc, Palo Alto, CA, USA
- Correspondence: Aimee D. Shu, MD, 500 Emerson St. Palo Alto, CA 94301, USA.
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The Effect of Space Travel on Bone Metabolism: Considerations on Today's Major Challenges and Advances in Pharmacology. Int J Mol Sci 2021; 22:ijms22094585. [PMID: 33925533 PMCID: PMC8123809 DOI: 10.3390/ijms22094585] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/14/2022] Open
Abstract
Microgravity-induced bone loss is currently a significant and unresolved health risk for space travelers, as it raises the likelihood for irreversible changes that weaken skeletal integrity and the incremental onset of fracture injuries and renal stone formation. Another issue related to bone tissue homeostasis in microgravity is its capacity to regenerate following fractures due to weakening of the tissue and accidental events during the accomplishment of particularly dangerous tasks. Today, several pharmacological and non-pharmacological countermeasures to this problem have been proposed, including physical exercise, diet supplements and administration of antiresorptive or anabolic drugs. However, each class of pharmacological agents presents several limitations as their prolonged and repeated employment is not exempt from the onset of serious side effects, which limit their use within a well-defined range of time. In this review, we will focus on the various countermeasures currently in place or proposed to address bone loss in conditions of microgravity, analyzing in detail the advantages and disadvantages of each option from a pharmacological point of view. Finally, we take stock of the situation in the currently available literature concerning bone loss and fracture healing processes. We try to understand which are the critical points and challenges that need to be addressed to reach innovative and targeted therapies to be used both in space missions and on Earth.
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Sluggett JK, Hopkins RE, Chen EYH, Ilomäki J, Corlis M, Van Emden J, Hogan M, Caporale T, Ooi CE, Hilmer SN, Bell JS. Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial. J Clin Med 2020; 9:E1053. [PMID: 32276360 PMCID: PMC7231224 DOI: 10.3390/jcm9041053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/02/2022] Open
Abstract
In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (-0.38, 95% confidence intervals (CI) -0.69 to -0.07) and 12 months (-0.47, 95%CI -0.84 to -0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57-5.53) or mortality (relative risk 0.81, 95%CI 0.48-1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement.
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Affiliation(s)
- Janet K. Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA 5005, Australia
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
| | - Ria E. Hopkins
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
| | - Esa YH Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia;
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia;
| | - Michelle Hogan
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia;
| | | | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
| | - Sarah N. Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, School of Medicine, University of Sydney, Sydney, NSW 2050, Australia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Carls GS, Tuttle E, Tan RD, Huynh J, Yee J, Edelman SV, Polonsky WH. Understanding the Gap Between Efficacy in Randomized Controlled Trials and Effectiveness in Real-World Use of GLP-1 RA and DPP-4 Therapies in Patients With Type 2 Diabetes. Diabetes Care 2017; 40:1469-1478. [PMID: 28801475 DOI: 10.2337/dc16-2725] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/27/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to estimate and explain the gap between clinical efficacy and real-world (RW) effectiveness of type 2 diabetes medications. RESEARCH DESIGN AND METHODS This mixed-methods quasi-experimental study used retrospective claims (Optum/Humedica) to compare the change in HbA1c of RW patients with type 2 diabetes 12 months after starting a glucagon-like peptide 1 receptor agonist (GLP-1 RA) or dipeptidyl peptidase 4 (DPP-4) inhibitor with published findings from randomized controlled trials (RCTs) evaluating these drugs. Selected RW patients were similar to RCT patients, and regression analysis was used in the RW data to adjust for differences between poorly adherent and adherent patients to explain why RCT and RW findings may differ. RESULTS RW patients initiating a GLP-1 RA (n = 221) or a DPP-4 (n = 652) experienced smaller reductions in HbA1c (GLP-1 RA: -0.52% [-6 mmol/mol], DPP-4: -0.51% [-6 mmol/mol])than reported in RCTs (-1.30% [-14 mmol/mol] from seven GLP-1 RA RCTs, n = 2,600; -0.68% [-8 mmol/mol] from four DPP-4 RCTs, n = 1,889). Baseline HbA1c, additional medications, and adherence were significant explanatory factors in the RW HbA1c change. Modeled estimates of RCT efficacy (-1.04% GLP-1 RA [-12 mmol/mol], -0.69% DPP-4 [-8 mmol/mol]) were within the RCTs' reported range (GLP-1 RA: -0.84% to -1.60% [-9 to -18 mmol/mol], DPP-4: -0.47% to -0.90% [-5 to -10 mmol/mol]). Poor medication adherence accounted for approximately three-fourths of the gap between RW and expected RCT results (gap = 0.51% [6 mmol/mol] GLP-1 RA; 0.18% [3 mmol/mol] DPP-4). CONCLUSIONS Poor medication adherence is primarily why RW effectiveness is significantly less than RCT efficacy, suggesting an urgent need to effectively address adherence among patients with type 2 diabetes.
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Affiliation(s)
| | | | | | | | - John Yee
- Intarcia Therapeutics, Boston, MA
| | - Steven V Edelman
- Division of Endocrinology and Metabolism, School of Medicine, University of California, San Diego, San Diego, CA.,Taking Control of Your Diabetes, Del Mar, CA.,Veterans Affairs Medical Center, San Diego, CA
| | - William H Polonsky
- Department of Psychiatry, University of California, San Diego, San Diego, CA.,Behavioral Diabetes Institute, San Diego, CA
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Fautrel B, Balsa A, Van Riel P, Casillas M, Capron JP, Cueille C, de la Torre I. Influence of route of administration/drug formulation and other factors on adherence to treatment in rheumatoid arthritis (pain related) and dyslipidemia (non-pain related). Curr Med Res Opin 2017; 33:1231-1246. [PMID: 28358217 DOI: 10.1080/03007995.2017.1313209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES A comprehensive review was performed to investigate the effect of route of administration on medication adherence and persistence in rheumatoid arthritis (RA) and to compare adherence/persistence with oral medications between RA and a non-painful disease (dyslipidemia). RESEARCH DESIGN AND METHODS Comprehensive database searches were performed to identify studies investigating medication adherence and/or persistence in adults with RA receiving conventional synthetic or biologic agents. Similar searches were performed for studies of patients with dyslipidemia receiving statins. Studies had to be published after 1998 in English and involve ≥6 months' follow up. MAIN OUTCOME MEASURES Adherence and persistence were compared between the different routes of drug administration in RA, and between the two diseases for oral medications. RESULTS A total of 35 and 28 papers underwent data extraction for RA and dyslipidemia, respectively. Within the constraints of the analysis, adherence and persistence rates appeared broadly similar for the different routes of drug administration in RA. Adherence to oral medications was also broadly similar across the two diseases, but persistence was lower in dyslipidemia. Poor adherence has clinical consequences in both diseases: greater disease activity and risk of flare in RA, and increased serum cholesterol levels and risk of heart and cerebrovascular disease in dyslipidemia. Over 1-3 years, poor adherence to biologic RA medications led to increased resource use and medical costs but lower total direct costs due to reduced biologic drug costs. Conversely, poor adherence to dyslipidemia medications resulted in increased total direct costs. In both diseases, adherence improved with patient education/support. CONCLUSIONS The route of drug administration and the symptomatic (pain) nature of the disease do not appear to be dominant factors for drug adherence or persistence in RA. LIMITATION The wide range of adherence and persistence values and definitions across studies made comparisons between drug formulations and diseases difficult.
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Affiliation(s)
- Bruno Fautrel
- a Pierre et Marie Curie University, Sorbonne Universités ; and Rheumatology Department, Pitié Salpêtrière Hospital , Paris , France
| | - Alejandro Balsa
- b Rheumatology Department and Health Research Institute (Idipaz) , Hospital Universitario de La Paz , Madrid , Spain
| | - Piet Van Riel
- c Scientific Institute for Quality of Healthcare, Radboud University Medical Center , Nijmegen , and Department of Rheumatology , Bernhoven, Uden , The Netherlands
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Amin A, Marrs JC. Direct Oral Anticoagulants for the Management of Thromboembolic Disorders. Clin Appl Thromb Hemost 2016; 22:605-16. [DOI: 10.1177/1076029615601492] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Anticoagulation therapy is central to the management of thromboembolic disorders, and the use of direct oral anticoagulants offers several advantages over standard therapy with parenteral heparins and vitamin K antagonists. In phase III clinical trials, the direct oral anticoagulants (given once or twice daily) all demonstrated favorable benefit–risk profiles compared with conventional standard therapy for the treatment and secondary prevention of venous thromboembolism and for stroke prevention in patients with nonvalvular atrial fibrillation. In clinical practice, many factors may influence overall clinical outcomes in patients receiving anticoagulant therapy, including adherence and persistence to the prescribed therapy, which becomes particularly important during long-term therapy. When choosing an anticoagulant for an individual patient, the pharmacological and clinical profile of the anticoagulant, its dosing regimen, and the patient’s clinical characteristics (eg, renal function and comorbidities) and preferences should be considered. This review examines the rationale for and clinical evidence of the selected dosing regimens of the direct oral anticoagulants for the treatment of venous thromboembolism and stroke prevention in nonvalvular atrial fibrillation. The potential influence of dosing strategies (eg, once- or twice-daily dosing) and other factors on patient adherence and therapy persistence are also discussed.
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Affiliation(s)
- Alpesh Amin
- Anticoagulation Services, Department of Medicine, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Joel C. Marrs
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
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Remondi FA, Cabrera MAS, Souza RKTD. [Non-adherence to continuous treatment and associated factors: prevalence and determinants in adults 40 years and older]. CAD SAUDE PUBLICA 2014; 30:126-36. [PMID: 24627020 DOI: 10.1590/0102-311x00092613] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 08/06/2013] [Indexed: 12/29/2022] Open
Abstract
This study investigates factors associated with non-adherence to continuous drug therapy in individuals 40 years and older. A population-based survey was conducted in Cambé, Paraná State, Brazil. Treatment adherence was assessed with the four-item Morisky et al. medication adherence scale. The study also assessed socio-demographic variables and health services access and use of medication. Among 1,180 interviewees, 78% reported use of medication, with continuous use in 55%. The study analyzed 639 individuals, the majority female, ranging from 40 to 59 years of age, with low schooling, and from socioeconomic stratum C (on a scale from A to E). Prevalence of non-adherence was 63.5%. Mean therapeutic complexity was 8.1. After adjusted analysis, the following factors remained associated with non-adherence: not being assisted by community health workers, discontinuous access to medication, and high frequency of medication throughout the day. The results indicate high prevalence of non-adherence, with potentially negative impacts for individuals and society.
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Abstract
The word 'adherence' refers to the provision of consistent support (eg. for a political party or religion) or the act of holding particular elements together (eg. in constructing a building). In the medical context, adherence refers to the extent to which patients take their medications as prescribed. While the terminology related to medical adherence has changed significantly over the past two millennia, the core issue has not. Most recently, the term 'adherence' has replaced the term 'compliance', although it still jostles with 'concordance' in a growing literature which focuses now, as always, on one key question: why do so many people seek treatment for illness but then decide not to take their prescribed medication? This is an important question, both in terms of public health and societal cost: in the US, up to 50% of patients do not take their prescribed medications, resulting in additional healthcare costs of $290 billion per year. The greatest cost of non-adherence, however, relates to prolonged illness, increased rates of relapse and reduced wellness.
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Waimann CA, Marengo MF, de Achaval S, Cox VL, Garcia-Gonzalez A, Reveille JD, Richardson MN, Suarez-Almazor ME. Electronic monitoring of oral therapies in ethnically diverse and economically disadvantaged patients with rheumatoid arthritis: consequences of low adherence. ACTA ACUST UNITED AC 2013; 65:1421-9. [PMID: 23728826 DOI: 10.1002/art.37917] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 02/21/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To quantify adherence to oral therapies in ethnically diverse and economically disadvantaged patients with rheumatoid arthritis (RA), using electronic medication monitoring, and to evaluate the clinical consequences of low adherence. METHODS A total of 107 patients with RA enrolled in a 2-year prospective cohort study agreed to have their oral RA drug therapy intake electronically monitored using the Medication Event Monitoring System. Adherence to disease-modifying antirheumatic drugs (DMARDs) and prednisone was determined as the percentage of days (or weeks for methotrexate) on which the patient took the correct dose as prescribed by the physician. Patient outcomes were assessed, including function measured by the modified Health Assessment Questionnaire, disease activity measured by the Disease Activity Score in 28 joints (DAS28), health-related quality of life, and radiographic damage measured using the modified Sharp/van der Heijde scoring method. RESULTS Adherence to the treatment regimen as determined by the percentage of correct doses was 64% for DMARDs and 70% for prednisone. Patients who had better mental health were statistically more likely to be adherent. Only 23 of the patients (21%) had an average adherence to DMARDs ≥80%. These patients showed significantly better mean DAS28 values across 2 years of followup than those who were less adherent (3.28 versus 4.09; P = 0.02). Radiographic scores were also worse in nonadherent patients at baseline and at 12 months. CONCLUSION Only one-fifth of RA patients had an overall adherence to DMARDs of at least 80%. Less than two-thirds of the prescribed DMARD doses were correctly taken. Adherent patients had lower disease activity across the 2 years of followup.
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Srivastava K, Arora A, Kataria A, Cappelleri JC, Sadosky A, Peterson AM. Impact of reducing dosing frequency on adherence to oral therapies: a literature review and meta-analysis. Patient Prefer Adherence 2013; 7:419-34. [PMID: 23737662 PMCID: PMC3669002 DOI: 10.2147/ppa.s44646] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To assess the impact of reduced frequency of oral therapies from multiple-dosing schedules to a once-daily (OD) dosing schedule on adherence, compliance, persistence, and associated economic impact. METHODS A meta-analysis was performed based on relevant articles identified from a comprehensive literature review using MEDLINE® and Embase®. The review included studies assessing adherence with OD, twice-daily (BID), thrice-daily (TID), and four-times daily (QID) dosing schedules and costs associated with optimal/suboptimal adherence among patients with acute and chronic diseases. Effect estimates across studies were pooled and analyzed using the DerSimonian and Laird random-effect model. RESULTS Forty-three studies met inclusion criteria, and meta-analyzable data were available from 13 studies. The overall results indicated that OD schedules were associated with higher adherence rates (odds ratio [OR] 3.07, 95% confidence interval [CI] 1.80-5.23; P < 0.001 for OD versus > OD dosing) and compliance rates (OR 3.50, 95% CI 1.73-7.08; P < 0.001 for OD versus > OD dosing); persistence rates showed the same direction but were not statistically significant (OR 1.43, 95% CI 0.62-3.29; P = 0.405 for OD versus BID dosing). Results for each of the conditions were consistent with those observed overall with respect to showing the benefits of less frequent dosing. From a health economic perspective, higher adherence rates with OD relative to multiple dosing in a number of conditions were consistently associated with corresponding lower costs of health care resources utilization. CONCLUSION Current meta-analyses suggested that across acute and chronic disease states, reducing dosage frequency from multiple dosing to OD dosing may improve adherence to therapies among patients. Improving adherence may result in subsequent decreases in health care costs.
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Affiliation(s)
| | | | | | | | - Alesia Sadosky
- Pfizer Inc Global Health Economics and Outcomes Research, New York, NY, USA
| | - Andrew M Peterson
- Mayes College of Healthcare Business and Policy, University of the Sciences, Philadelphia, PA, USA
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Tonia T, Mettler A, Robert N, Schwarzer G, Seidenfeld J, Weingart O, Hyde C, Engert A, Bohlius J. Erythropoietin or darbepoetin for patients with cancer. Cochrane Database Syst Rev 2012; 12:CD003407. [PMID: 23235597 PMCID: PMC8145276 DOI: 10.1002/14651858.cd003407.pub5] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Anaemia associated with cancer and cancer therapy is an important clinical factor in the treatment of malignant diseases. Therapeutic alternatives are recombinant human erythropoiesis stimulating agents (ESAs) and red blood cell transfusions. OBJECTIVES To assess the effects of ESAs to either prevent or treat anaemia in cancer patients. SEARCH METHODS This is an update of a Cochrane review first published in 2004. We searched the Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE and other databases. Searches were done for the periods 01/1985 to 12/2001 for the first review, 1/2002 to 04/2005 for the first update and to November 2011 for the current update. We also contacted experts in the field and pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials on managing anaemia in cancer patients receiving or not receiving anti-cancer therapy that compared the use of ESAs (plus transfusion if needed). DATA COLLECTION AND ANALYSIS Several review authors assessed trial quality and extracted data. One review author assessed quality assessment and extracted data, a second review author checked for correctness. MAIN RESULTS This update of the systematic review includes a total of 91 trials with 20,102 participants. Use of ESAs significantly reduced the relative risk of red blood cell transfusions (risk ratio (RR) 0.65; 95% confidence interval (CI) 0.62 to 0.68, 70 trials, N = 16,093). On average, participants in the ESAs group received one unit of blood less than the control group (mean difference (MD) -0.98; 95% CI -1.17 to -0.78, 19 trials, N = 4,715). Haematological response was observed more often in participants receiving ESAs (RR 3.93; 95% CI 3.10 to 3.71, 31 trials, N = 6,413). There was suggestive evidence that ESAs may improve Quality of Life (QoL). There was strong evidence that ESAs increase mortality during active study period (hazard ratio (HR) 1.17; 95% CI 1.06 to 1.29, 70 trials, N = 15,935) and some evidence that ESAs decrease overall survival (HR 1.05; 95% CI 1.00 to 1.11, 78 trials, N = 19,003). The risk ratio for thromboembolic complications was increased in patients receiving ESAs compared to controls (RR 1.52, 95% CI 1.34 to 1.74; 57 trials, N = 15,498). ESAs may also increase the risk for hypertension (fixed-effect model: RR 1.30; 95% CI 1.08 to 1.56; random-effects model: RR 1.12; 95% CI 0.94 to 1.33, 31 trials, N = 7,228) and thrombocytopenia/haemorrhage (RR 1.21; 95% CI 1.04 to 1.42; 21 trials, N = 4,507). There was insufficient evidence to support an effect of ESA on tumour response (fixed-effect RR 1.02; 95% CI 0.98 to 1.06, 15 trials, N = 5,012). AUTHORS' CONCLUSIONS ESAs reduce the need for red blood cell transfusions but increase the risk for thromboembolic events and deaths. There is suggestive evidence that ESAs may improve QoL. Whether and how ESAs affects tumour control remains uncertain. The increased risk of death and thromboembolic events should be balanced against the potential benefits of ESA treatment taking into account each patient's clinical circumstances and preferences. More data are needed for the effect of these drugs on quality of life and tumour progression. Further research is needed to clarify cellular and molecular mechanisms and pathways of the effects of ESAs on thrombogenesis and their potential effects on tumour growth.
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Affiliation(s)
- Thomy Tonia
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
| | - Annette Mettler
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
| | - Nadège Robert
- Kantonsspitalapotheke WinterthurPharmacyBrauerstrasse 15WinterthurSwitzerlandCH‐8400
| | - Guido Schwarzer
- Institute of Medical Biometry and Medical Informatics, University Medical Center FreiburgGerman Cochrane CentreStefan‐Meier‐Str. 26FreiburgGermanyD‐79104
| | - Jerome Seidenfeld
- American Society of Clinical OncologyDepartment of Quality and Guidelines1900 Duke Street, Suite 200AlexandriaVAUSA22314
| | | | - Chris Hyde
- University of Exeter Medical School, University of ExeterPeninsula Technology Assessment Group (PenTAG)Veysey BuildingSalmon Pool LaneExeterUKEX2 4SG
| | - Andreas Engert
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Julia Bohlius
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
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Boye KS, Matza LS, Walter KN, Van Brunt K, Palsgrove AC, Tynan A. Utilities and disutilities for attributes of injectable treatments for type 2 diabetes. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:219-30. [PMID: 20224930 DOI: 10.1007/s10198-010-0224-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 02/09/2010] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Although cost-utility models are frequently used to estimate treatment outcomes for type 2 diabetes, utilities are not available for key attributes of injectable treatments. The purpose of this study was to identify the utility or disutility of three injection-related attributes (dose frequency, dose flexibility, injection site reaction) that may influence patient preference. METHODS Patients with type 2 diabetes in Scotland completed standard gamble (SG) interviews to assess the utility of hypothetical health states and their own current health state. The EQ-5D, PGWB, IWQOL-Lite, and QIDS were also administered. Construct validity and differences among health states were examined. RESULTS A total of 151 patients completed interviews. Of the three injection-related attributes, dose frequency was the only attribute with a statistically significant impact on utility (in a multiple regression model, p = 0.01). Weekly injections were associated with an average added utility of 0.023 in comparison to everyday injections. Flexible dosing and injection site reactions resulted in somewhat smaller utility shifts that were in the expected directions (+0.006 and -0.011, respectively). SG utility of current health (mean = 0.897) demonstrated construct validity through statistically significant correlations with patient-reported outcome measures. DISCUSSION The three injection attributes were associated with small utility shifts in the expected directions. Dose frequency appears to be the most important of the three attributes from the patients' perspective. The vignette-based SG approach was feasible and useful for assessing added utility or disutility of injection-related attributes associated with treatments for type 2 diabetes.
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Al-Aqeel S, Al-Sabhan J. Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy. Cochrane Database Syst Rev 2011:CD008312. [PMID: 21249705 DOI: 10.1002/14651858.cd008312.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Poor adherence to antiepileptic medications is associated with increased mortality and morbidity. In this review we focus on interventions designed to assist patients with adherence to antiepileptic medications. OBJECTIVES To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medications in adults and children with epilepsy. SEARCH STRATEGY We searched the Epilepsy Group's Specialised Register (24 June 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2) and electronic databases: MEDLINE (OVID) (1950 to June 2010); EMBASE (OVID) (1980 to 2010 Week 24); CINAHL (1982 to June 2010) and PsycINFO (22 June 2010), and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of adherence-enhancing interventions aimed at patients with clinical diagnosis of epilepsy (as defined in individual studies), of any age and of either gender, treated with antiepileptic drugs in a primary care, outpatient or other community setting. DATA COLLECTION AND ANALYSIS We screened titles and abstracts for eligibility. Two review authors independently extracted data and assessed each study according to the Cochrane criteria. The studies differed widely according to intervention and measures of adherence, therefore combining data was not appropriate. MAIN RESULTS Six trials met our inclusion criteria: five targeted adult epileptic patients with a combined patient number of 222 and one targeted parents of children with epilepsy (n = 51). Follow-up time was generally short: from one to six months. Two main types of intervention were examined: educational and behavioural modification. Each study compared treatment with no intervention 'usual care'. None compared one intervention with another. Due to heterogeneity between studies in terms of interventions and the methods used to measure adherence, we did not pool the results. Education and counselling of patients with epilepsy have shown mixed success. Behavioural interventions such as the use of intensive reminders and 'implementation intention' interventions provided more positive effects on adherence. AUTHORS' CONCLUSIONS Intensive reminders and 'implementation intention' interventions appear promising in enhancing adherence to antiepileptic mediations, however we need more reliable evidence on their efficacy from carefully designed randomised controlled trials before a firm conclusion can be reached.
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Affiliation(s)
- Sinaa Al-Aqeel
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
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de Achaval S, Suarez-Almazor ME. Treatment adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and systemic lupus erythematosus. INTERNATIONAL JOURNAL OF CLINICAL RHEUMATOLOGY 2010; 5:313-326. [PMID: 20676388 PMCID: PMC2910438 DOI: 10.2217/ijr.10.15] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Treatment adherence is critical in the management of rheumatic diseases. Recent advances in therapy for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are promising, although the impact on quality of life may be limited due to nonadherence. Databases including Ovid Medline, Scopus and the Epub-ahead-of-print subset of PubMed were searched for the period of the last 10 years using combined keywords patient compliance, medication adherence, disease modifying antirheumatic drug (DMARD), rheumatoid arthritis and systemic lupus erythematosus. Additional references from retrieved papers were considered. Inclusion criteria were the following: identification of a quantitative measure of adherence to medications including DMARDs and biologics; inclusion of well-defined measures of adherence; and patients with RA or SLE. Studies in RA and SLE patients demonstrated overall inadequate treatment adherence. Adherence was measured using multiple methods including pharmacy records, electronic monitoring, self-report and physician report. The evidence for interventions to improve treatment adherence was limited and demonstrated various results. Future research should further explore determinants of nonadherence and continue to examine the efficacy of implementing various strategies to improve medication management in this patient population.
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Affiliation(s)
- Sofia de Achaval
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Bohlius J, Schmidlin K, Brillant C, Schwarzer G, Trelle S, Seidenfeld J, Zwahlen M, Clarke MJ, Weingart O, Kluge S, Piper M, Napoli M, Rades D, Steensma D, Djulbegovic B, Fey MF, Ray‐Coquard I, Moebus V, Thomas G, Untch M, Schumacher M, Egger M, Engert A. Erythropoietin or Darbepoetin for patients with cancer--meta-analysis based on individual patient data. Cochrane Database Syst Rev 2009; 2009:CD007303. [PMID: 19588423 PMCID: PMC7208183 DOI: 10.1002/14651858.cd007303.pub2] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Erythropoiesis-stimulating agents (ESAs) reduce anemia in cancer patients and may improve quality of life, but there are concerns that ESAs might increase mortality. OBJECTIVES Our objectives were to examine the effect of ESAs and identify factors that modify the effects of ESAs on overall survival, progression free survival, thromboembolic and cardiovascular events as well as need for transfusions and other important safety and efficacy outcomes in cancer patients. SEARCH STRATEGY We searched the Cochrane Library, Medline, Embase and conference proceedings for eligible trials. Manufacturers of ESAs were contacted to identify additional trials. SELECTION CRITERIA We included randomized controlled trials comparing epoetin or darbepoetin plus red blood cell transfusions (as necessary) versus red blood cell transfusions (as necessary) alone, to prevent or treat anemia in adult or pediatric cancer patients with or without concurrent antineoplastic therapy. DATA COLLECTION AND ANALYSIS We performed a meta-analysis of randomized controlled trials comparing epoetin alpha, epoetin beta or darbepoetin alpha plus red blood cell transfusions versus transfusion alone, for prophylaxis or therapy of anemia while or after receiving anti-cancer treatment. Patient-level data were obtained and analyzed by independent statisticians at two academic departments, using fixed-effects and random-effects meta-analysis. Analyses were according to the intention-to-treat principle. Primary endpoints were on study mortality and overall survival during the longest available follow-up, regardless of anticancer treatment, and in patients receiving chemotherapy. Tests for interactions were used to identify differences in effects of ESAs on mortality across pre-specified subgroups. The present review reports only the results for the primary endpoint. MAIN RESULTS A total of 13933 cancer patients from 53 trials were analyzed, 1530 patients died on-study and 4993 overall. ESAs increased on study mortality (combined hazard ratio [cHR] 1.17; 95% CI 1.06-1.30) and worsened overall survival (cHR 1.06; 95% CI 1.00-1.12), with little heterogeneity between trials (I(2) 0%, p=0.87 and I(2) 7.1%, p=0.33, respectively). Thirty-eight trials enrolled 10441 patients receiving chemotherapy. The cHR for on study mortality was 1.10 (95% CI 0.98-1.24) and 1.04; 95% CI 0.97-1.11) for overall survival. There was little evidence for a difference between trials of patients receiving different cancer treatments (P for interaction=0.42). AUTHORS' CONCLUSIONS ESA treatment in cancer patients increased on study mortality and worsened overall survival. For patients undergoing chemotherapy the increase was less pronounced, but an adverse effect could not be excluded.
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Affiliation(s)
- Julia Bohlius
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
| | - Kurt Schmidlin
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
| | - Corinne Brillant
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Guido Schwarzer
- Insitute of Medical Biometry and Medical InformaticsGerman Cochrane CentreUniversity Medical Center FreiburgStefan‐Meier‐Str. 26FreiburgGermanyD‐79104
| | - Sven Trelle
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
| | - Jerome Seidenfeld
- American Society of Clinical OncologyDepartment of Cancer Policy and Clinical Affairs1900 Duke Street, Suite 200AlexandriaVAUSA22314
| | - Marcel Zwahlen
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
| | - Mike J Clarke
- UK Cochrane CentreNational Institute for Health ResearchSummertown Pavilion, Middle WayOxfordUKOX2 7LG
| | - Olaf Weingart
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Sabine Kluge
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Margaret Piper
- Blue Cross and Blue Shield AssociationTechnology Evaluation Center225 N Michigan AvenueChicagoILUSA60501
| | - Maryann Napoli
- Center for Medical Consumers130 Macdougal StreetNew YorkUSA10012
| | - Dirk Rades
- University HospitalDepartment of Radiation OncologyLübeckGermany
| | | | - Benjamin Djulbegovic
- Center for Evidence Based Medicine and Health Outcomes Research, University of South FloridaProfessor of Medicine and Oncology, H. Lee Moffitt Cancer CenterUSF Health Clinical Research,12901 Bruce B. Downs Boulevard, MDC02TampaFloridaUSA33612
| | - Martin F Fey
- University and Inselspital BernDepartment of Medical OncologyEffingerstraße 102BernSwitzerland3010
| | | | - Volker Moebus
- Academic Hospital Frankfurt am Main HöchstDepartment of GynecologyGotenstraße 6‐8Frankfurt a.M.Germany65929
| | - Gillian Thomas
- University of TorontoOdette Sunnybrook Cancer CentreRoxborough Street WTorontoOntarioCanadaM5R 1V1
| | - Michael Untch
- Helios Hospital Berlin‐BuchClinic for GynaecologySchwanebecker Chaussee 50BerlinGermany13125
| | - Martin Schumacher
- Institute of Medical Biometry and Medical Informatics, University Medical Center FreiburgGerman Cochrane CenterFreiburgGermany
| | - Matthias Egger
- Institute of Social and Preventive MedicineInstitute of Social MedicineFinkenhubelweg 11BernSwitzerland3012
| | - Andreas Engert
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
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Kikano G. Safety and Efficacy of Extended-Release Guaifenesin/Pseudoephedrine Hydrochloride for Adjunctive Symptom Relief of Acute Respiratory Infections. Postgrad Med 2009; 121:173-5. [DOI: 10.3810/pgm.2009.05.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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