Safety and immunogenicity of the NVX-CoV2373 vaccine as a booster in adults previously vaccinated with the BBIBP-CorV vaccine

This phase 3 observer-blind, randomized, controlled study was conducted in adults ≥18 years of age to assess the safety and immunogenicity of NVX-CoV2373 as a heterologous booster compared to BBIBP-CorV when utilized as a homologous booster. Approximately 1000 participants were randomly assigned in a 1:1 ratio to receive a single dose of NVX-CoV2373 or BBIBP-CorV after prior vaccination with 2 or 3 doses of BBIBP-CorV. Solicited adverse events (AEs) were collected for 7 days after vaccination. Unsolicited AEs were collected for 28 days following the booster dose and serious adverse and adverse events of special interest (AESI) were collected throughout the study. Anti-spike IgG and neutralizing antibodies against SARS-CoV-2 were measured at baseline, day 14, day 28, and day 180. The study achieved its primary non-inferiority endpoint and also demonstrated statistically higher neutralization responses when NVX-CoV2373 was utilized as a heterologous booster compared with BBIBP-CorV as a homologous booster. Both vaccines had an acceptably low reactogenicity profile, and no new safety concerns were found. Heterologous boosting with NVX-CoV2373 was a highly immunogenic and safe vaccine regimen in those previously vaccinated with BBIBP-CorV.

The Novavax Heterologous COVID Booster Demonstrates Lower Reactogenicity Than mRNA: A Targeted Review

COVID-19 continues to be a global health concern and booster doses are necessary for maintaining vaccine-mediated protection, limiting the spread of SARS-CoV-2. Despite multiple COVID vaccine options, global booster uptake remains low. Reactogenicity, the occurrence of adverse local/systemic side effects, plays a crucial role in vaccine uptake and acceptance, particularly for booster doses. We conducted a targeted review of the reactogenicity of authorized/approved mRNA and protein-based vaccines demonstrated by clinical trials and real-world evidence. It was found that mRNA-based boosters show a higher incidence and an increased severity of reactogenicity compared with the Novavax protein-based COVID vaccine, NVX-CoV2373. In a recent NIAID study, the incidence of pain/tenderness, swelling, erythema, fatigue/malaise, headache, muscle pain, or fever was higher in individuals boosted with BNT162b2 (0.4 to 41.6% absolute increase) or mRNA-1273 (5.5 to 55.0% absolute increase) compared with NVX-CoV2373. Evidence suggests that NVX-CoV2373, when utilized as a heterologous booster, demonstrates less reactogenicity compared with mRNA vaccines, which, if communicated to hesitant individuals, may strengthen booster uptake rates worldwide.

Understanding compliance issues for daily self-injectable treatment in ambulatory care settings

BACKGROUND

The challenge of understanding factors influencing compliance with injectable treatments is critical as injectable biologics/medications become more common.

OBJECTIVE

Understanding compliance issues for long term self-injectable treatments, using a chronic condition (osteoporosis) as a model.

RESEARCH DESIGN

A qualitative study to generate hypotheses regarding compliance issues for self-injectable treatments. Semi-structured interview guides were developed and data collected from patients and clinical experts. Findings were analyzed for common themes and a conceptual model of the compliance impact of self-injectable treatments generated.

SUBJECTS

Six physicians (Rheumatology, Internal Medicine, and Endocrinology) and 22 patients (14% never began treatment, 23% had filled at least one prescription but discontinued treatment, and 63% were currently on treatment) were interviewed.

RESULTS

Physician and patient factors influenced the compliance process at four distinct time-points: pre-treatment, time treatment recommended, short-term, and long-term. Physician factors that influenced patients' persistence were knowledge about treatment, patient-training resources, and clinical profile/efficacy evaluations. For patients, motivation level, physician message, and clinical profile were key. Logistical issues, minor side effects and injection site issues influenced adherence but not persistence.

CONCLUSIONS

Compliance is a multifactorial, dynamic process. Both physician and patient factors influence compliance at different points in the process.

Actual versus predicted first-year utilization patterns of teriparatide in patients with employer-sponsored health insurance

OBJECTIVE

To characterize first-year utilization patterns of teriparatide derived from a claims database analysis versus predictions from an economic model.

RESEARCH DESIGN AND METHODS

Claims data for actual teriparatide utilization were obtained from an integrated administrative database of approximately 3.4 million beneficiaries. A control group included patients with osteoporosis but without the use of teriparatide. An economic model, which relied on first-year market share projections, predicted the utilization of teriparatide from the demographic characteristics of the plan. Predictions were compared to actual utilization for eight health plans within the database.

MAIN OUTCOME MEASURES

Demographic and clinical characteristics, number of teriparatide patients, and days of teriparatide therapy.

RESULTS

Less than 1% of patients diagnosed with osteoporosis received teriparatide. Teriparatide-treated patients, compared to other patients with osteoporosis, were older and more likely to have experienced a previous fracture or to have received previous osteoporosis pharmacotherapy. For the combined 505 300 lives in the eight plans used for the comparative analysis, there were 134 teriparatide patients; the model predicted 131. For individual plans, the predictions varied in their accuracy. The greatest under-prediction for one plan was 17 patients (40 predicted vs. 57 actual), while the greatest over-prediction was 18 patients (34 predicted vs. 16 actual). For the other 6 plans, the predictions were within four patients of the actual number of teriparatide users. A similar pattern of differences was observed by comparing actual versus predicted days of teriparatide therapy across the eight plans.

LIMITATIONS

Some clinical details of the actual patient cohorts, such as bone mineral density results, were not available in the database. The comparisons made between the teriparatide model predictions and actual utilization were based on analyses of a single model and do not speak to the broader issue of the accuracy of predictive economic models in general.

CONCLUSIONS

Overall, first-year teriparatide utilization was relatively limited, consistent with model predictions. Predictions for individual plans varied in their accuracy.

Assessing the economic impact of chronic conditions in postmenopausal women

The ageing of the US population and the recognised importance of preventative care has led to a growing body of research regarding the morbidity and mortality associated with chronic diseases in postmenopausal women. According to the National Institute of Health, postmenopausal women have a significant increase in risk for a number of debilitating diseases, including osteoporosis, breast cancer and cardiovascular disease. In addition, recently published studies prompted patients, clinicians and payers to re-examine the risks and benefits of a well-accepted therapy to treat postmenopausal symptoms. The objective of this paper is to provide a framework for assessing the economic impact of disorders affecting postmenopausal women, with a particular focus on osteoporosis, breast cancer and cardiovascular disease. This framework considers the prevalence of these conditions, the profiles of women suffering from each of them and prevailing patterns of treatment for these disorders. Taken together, these factors are used to analyse the overall economic impact of postmenopausal disorders and to provide an expert opinion in this context.

Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI

CONTEXT

Issues of cost and quality are gaining importance in the delivery of medical care, and whether quality of care is better in teaching vs nonteaching hospitals is an essential question in this current national debate.

OBJECTIVE

To examine the association of hospital teaching status with quality of care and mortality for fee-for-service Medicare patients with acute myocardial infarction (AMI).

DESIGN, SETTING, AND PATIENTS

Analysis of Cooperative Cardiovascular Project data for 114,411 Medicare patients from 4361 hospitals (22,354 patients from 439 major teaching hospitals, 22,493 patients from 455 minor teaching hospitals, and 69,564 patients from 3467 nonteaching hospitals) who had AMI between February 1994 and July 1995.

MAIN OUTCOME MEASURES

Administration of reperfusion therapy on admission, aspirin during hospitalization, and beta-blockers and angiotensin-converting enzyme inhibitors at discharge for patients meeting strict inclusion criteria; mortality at 30, 60, and 90 days and 2 years after admission.

RESULTS

Among major teaching, minor teaching, and nonteaching hospitals, respectively, administration rates for aspirin were 91.2%, 86.4%, and 81.4% (P<.001); for angiotensin-converting enzyme inhibitors, 63. 7%, 60.0%, and 58.0% (P<.001); for beta-blockers, 48.8%, 40.3%, and 36.4% (P<.001); and for reperfusion therapy, 55.5%, 58.9%, and 55.2% (P =.29). Differences in unadjusted 30-day, 60-day, 90-day, and 2-year mortality among hospitals were significant at P<.001 for all time periods, with a gradient of increasing mortality from major teaching to minor teaching to nonteaching hospitals. Mortality differences were attenuated by adjustment for patient characteristics and were almost eliminated by additional adjustment for receipt of therapy.

CONCLUSIONS

In this study of elderly patients with AMI, admission to a teaching hospital was associated with better quality of care based on 3 of 4 quality indicators and lower mortality. JAMA. 2000;284:1256-1262

The epidemiology of fire-related deaths in Alabama, 1992-1997

The state of Alabama has one of the highest fire-related fatality rates in the nation. The goal of this study was to present the epidemiology of fire-related deaths in the state of Alabama. Fatality reports for all fire-related deaths in the state of Alabama from 1992 to 1997 were obtained from the State Fire Marshall's Office. Fatality rates were calculated and compared according to age, sex, and race. Descriptive statistics were generated for population and fire characteristics. Fatality rates were higher among black people, men, children, and older people. Approximately half (48.8%) of the deaths occurred between the months of November and March; July had the lowest proportion of deaths (5.0%). Residential fires accounted for the largest proportion of deaths. Fatality rates were higher for mobile home residents. Overall, smoke detectors were present in only 32.5% of the residential fires. The presence of smoke detectors was more common with deaths in urban locations (41.8%) than with deaths in rural locations (20.8%). The most frequently reported cause of fatal fires was misuse of cigarettes. More than half of the victims aged 18 years and older tested positive for alcohol. Fire prevention efforts should focus on smoke detectors, fire-safe cigarettes, and alcohol. Mobile home residents should also be targeted for fire prevention initiatives.

Fire fatalities in older people

OBJECTIVE

To compare the epidemiology of fire-related fatalities among older, middle-aged, and young people.

DESIGN

Retrospective case series.

SETTING

Alabama, 1992-1997.

PARTICIPANTS

All persons fatally injured in fire-related incidents in the state of Alabama from 1992 to 1997.

MEASUREMENTS

The State Fire Marshal's Office provided both demographic and autopsy information about the victim. In addition, information regarding the nature and circumstances of the fire was also obtained.

RESULTS

Between 1992 and 1997, there were 674 fire-related deaths in the state of Alabama. The fire-related fatality rate was highest among older persons. The fatality rate was particularly high among older black people. The rate of fatal fires caused by heating devices was higher (15.0%) among older people compared with their young and middle-aged counterparts (6.3% and 4.5%, respectively). Fatalities among older people were least likely (26.0%) to occur if smoke detectors were present, compared with deaths among young and middle-aged persons (38.3% and 33.5%, respectively). There were fewer smoke detectors present in the fatal fires of older rural black adults and white adults (0.0% and 29.0%, respectively) compared with their urban counterparts (25.0% and 47.0%, respectively). Alcohol was not a factor in fatal fires involving older adults (29.0%) compared with those involving the young (52.0%) and middle-aged adults (73.9%).

CONCLUSIONS

With the growth of the percentage of older people in the population, the problem of fire-related deaths in this age group is likely to increase. Interventions focused on this age group are necessary for the state of Alabama to meet the National Health Objectives for the year 2000.