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Ham SD, Desai P, Wertenteil S, Levy CF. A Newborn with Blueberry Muffin Lesions. Neoreviews 2024; 25:e299-e302. [PMID: 38688891 DOI: 10.1542/neo.25-5-e299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Steven D Ham
- Department of Pediatrics, Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY
| | - Pooja Desai
- Department of Pediatrics, Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY
| | - Sara Wertenteil
- Department of Dermatology, Northwell Health, New Hyde Park, NY
| | - Carolyn Fein Levy
- Department of Pediatrics, Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY
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Rowan CG, Agiro A, Chan KA, Colman E, White K, Desai P, Dwyer JP. Hyperkalemia Recurrence Following Medical Nutrition Therapy in Patients with Stage 3-4 Chronic Kidney Disease: The REVOLUTIONIZE I Real-World Study. Adv Ther 2024:10.1007/s12325-024-02835-8. [PMID: 38687454 DOI: 10.1007/s12325-024-02835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/06/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The REVOLUTIONIZE I study aimed to characterize the relationships between medical nutrition therapy (MNT) and hyperkalemia recurrence in patients with stage 3-4 chronic kidney disease (CKD) and hyperkalemia who received MNT in real-world clinical practice. METHODS This observational cohort study used de-identified electronic health record data from patients aged ≥ 18 years with stage 3-4 CKD who received MNT between January 2019 and October 2022 and had hyperkalemia (serum potassium > 5.0 mmol/L) within 30 days before MNT. Patients were followed for 6 months or until the first censoring event (death, prescription of outpatient potassium binder, or study end). The primary outcome was the percentage of patients with ≥ 1 hyperkalemia recurrence during follow-up. Secondary outcomes included the number of hyperkalemia recurrences per patient, time to each recurrence, and hyperkalemia-related healthcare resource utilization. Exploratory outcomes included all-cause healthcare resource utilization and mortality. RESULTS The final cohort comprised 2048 patients; 1503 (73.4%) patients remained uncensored after 6 months. During the 6-month follow-up period, 56.0% of patients had ≥ 1 hyperkalemia recurrence and 37.4% had ≥ 1 recurrence within the first month. Patients with ≥ 1 hyperkalemia recurrence during follow-up had a mean ± standard deviation (SD) of 2.6 ± 2.2 recurrences. The mean ± SD time to first hyperkalemia recurrence was 45 ± 46 days; the time between recurrences decreased with subsequent episodes. Hyperkalemia-related hospitalizations and emergency department visits were recorded for 13.7% and 1.5% of patients, respectively. Sensitivity analyses showed that results were consistent across patient subgroups, including those with comorbid heart failure and patients receiving renin-angiotensin-aldosterone system inhibitor therapy at baseline. CONCLUSION Most patients with stage 3-4 CKD had hyperkalemia recurrence, and MNT alone was inadequate to prevent recurrence. These patients may require additional long-term treatment, such as novel potassium binders, to maintain normokalemia and prevent hyperkalemia recurrence following MNT. Infographic available for this article. INFOGRAPHIC.
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Affiliation(s)
- Christopher G Rowan
- Pharmacoepidemiology, COHRDATA, INC, 4030 Calle Marlena, San Clemente, CA, 92672, USA.
| | - Abiy Agiro
- US Evidence, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | | | - Ellen Colman
- US Renal, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | | | - Pooja Desai
- US Renal, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | - Jamie P Dwyer
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Dwyer JP, Agiro A, Desai P, Oluwatosin Y. Impact of Sodium Zirconium Cyclosilicate Plus Renin-Angiotensin-Aldosterone System Inhibitor Therapy on Short-Term Medical Costs in Hyperkalemia: OPTIMIZE II Real-World Study. Adv Ther 2023; 40:4777-4791. [PMID: 37606716 PMCID: PMC10567937 DOI: 10.1007/s12325-023-02631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Patients receiving cardiorenal-protective renin-angiotensin-aldosterone system inhibitors (RAASis) are at increased risk of developing hyperkalemia, which is associated with increased medical costs. The aim of this study was to evaluate the impact of adding sodium zirconium cyclosilicate (SZC) therapy on 3-month medical costs in patients who experienced hyperkalemia while receiving RAASi therapy. METHODS The retrospective OPTIMIZE II study used medical and pharmacy claims data from IQVIA PharMetrics® Plus. Patients aged ≥ 18 years who received SZC (≥ 60 day supply over 3 months' follow-up) and continued RAASi between July 2019 and December 2021 (Continue RAASi + SZC cohort) were 1:1 exact and propensity score matched with patients who discontinued RAASi after hyperkalemia diagnosis and did not receive SZC (Discontinue RAASi + no SZC cohort). The primary outcome was hyperkalemia-related medical costs to payers over 3 months; all-cause medical and pharmacy costs were also analyzed. RESULTS In the Continue RAASi + SZC (n = 467) versus Discontinue RAASi + no SZC (n = 467) cohort, there were significant reductions in mean per-patient hyperkalemia-related medical costs (reduction of $2216.07; p = 0.01) and all-cause medical costs (reduction of $6102.43; p < 0.001); mean hyperkalemia-related inpatient medical costs and all-cause inpatient and emergency department medical costs were significantly reduced. The reduction in all-cause medical cost in the Continue RAASi + SZC cohort offset an increase in the mean per-patient all-cause pharmacy cost (increase of $3117.71; p < 0.001). CONCLUSION RAASi therapy has well-established cardiorenal benefits. In OPTIMIZE II, management of RAASi-induced hyperkalemia with SZC was associated with lower hyperkalemia-related and all-cause medical costs than RAASi discontinuation without SZC, demonstrating medical cost savings with maintaining RAASi therapy with SZC.
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Affiliation(s)
- Jamie P Dwyer
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Abiy Agiro
- US Evidence, US Medical Affairs, AstraZeneca, 1800 Concord Pike, Wilmington, DE, 19850, USA.
| | - Pooja Desai
- US Renal, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
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Reading Turchioe M, Harkins S, Desai P, Kumar S, Kim J, Hermann A, Joly R, Zhang Y, Pathak J, Benda NC. Women's perspectives on the use of artificial intelligence (AI)-based technologies in mental healthcare. JAMIA Open 2023; 6:ooad048. [PMID: 37425486 PMCID: PMC10329494 DOI: 10.1093/jamiaopen/ooad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/24/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023] Open
Abstract
This study aimed to evaluate women's attitudes towards artificial intelligence (AI)-based technologies used in mental health care. We conducted a cross-sectional, online survey of U.S. adults reporting female sex at birth focused on bioethical considerations for AI-based technologies in mental healthcare, stratifying by previous pregnancy. Survey respondents (n = 258) were open to AI-based technologies in mental healthcare but concerned about medical harm and inappropriate data sharing. They held clinicians, developers, healthcare systems, and the government responsible for harm. Most reported it was "very important" for them to understand AI output. More previously pregnant respondents reported being told AI played a small role in mental healthcare was "very important" versus those not previously pregnant (P = .03). We conclude that protections against harm, transparency around data use, preservation of the patient-clinician relationship, and patient comprehension of AI predictions may facilitate trust in AI-based technologies for mental healthcare among women.
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Affiliation(s)
- Meghan Reading Turchioe
- Corresponding Author: Meghan Reading Turchioe, PhD, MPH, RN, Columbia University School of Nursing, 560 W. 168th Street, New York, NY, USA;
| | - Sarah Harkins
- Columbia University School of Nursing, New York, New York, USA
| | - Pooja Desai
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | | | - Jessica Kim
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Natalie C Benda
- Columbia University School of Nursing, New York, New York, USA
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Agiro A, Dwyer JP, Oluwatosin Y, Desai P. Medical Costs in Patients with Hyperkalemia on Long-Term Sodium Zirconium Cyclosilicate Therapy: The RECOGNIZE II Study. Clinicoecon Outcomes Res 2023; 15:691-702. [PMID: 37753303 PMCID: PMC10519215 DOI: 10.2147/ceor.s420217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose Hyperkalemia, defined as abnormally high serum potassium levels of ≥5.1 mmol/L, is associated with increased medical costs. This real-world study evaluated the impact of long-term sodium zirconium cyclosilicate (SZC) therapy on medical costs in patients with hyperkalemia. Patients and Methods This retrospective, comparative study used claims data from IQVIA PharMetrics® Plus. Patients aged ≥18 years with hyperkalemia who had outpatient SZC fills (>3-month supply over 6 months) between July 2019 and December 2021 and continuous insurance coverage 6 months before and 6 months after the first SZC fill were included. These patients (SZC cohort) were 1:1 exact- and propensity score-matched on baseline variables with patients with hyperkalemia who did not receive SZC (non-SZC cohort). The primary endpoint was hyperkalemia-related medical costs to payers over 6 months. Results Each cohort included 661 matched patients. Mean per-patient hyperkalemia-related medical costs were reduced by 49.5% ($3728.47) for the SZC versus non-SZC cohort ($3798.04 vs $7526.51; P<0.001), whereas mean all-cause medical costs were reduced by 21.0% ($5492.20; $20,722.23 vs $26,214.43; P<0.01). A 39.8% ($3621.03) increase in all-cause pharmacy costs ($12,727.20 vs $9106.17; P<0.01) was offset by the medical cost savings. Conclusion This study demonstrated that long-term (>3 months) outpatient treatment with SZC was associated with medical cost savings compared with no SZC therapy.
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Affiliation(s)
- Abiy Agiro
- US Evidence, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | - Jamie P Dwyer
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | | | - Pooja Desai
- US Renal, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
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Spindler D, Monroe KK, Malakh M, McCaffery H, Shaw R, Biary N, Foo K, Levy K, Vittorino R, Desai P, Schmidt J, Saul D, Skoczylas M, Chang YK, Osborn R, Jacobson E. Management Practices for Standard-Risk and High-Risk Patients With Bronchiolitis. Hosp Pediatr 2023; 13:833-840. [PMID: 37534416 DOI: 10.1542/hpeds.2022-006518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Management guidelines for bronchiolitis advocate for supportive care and exclude those with high-risk conditions. We aim to describe and compare the management of standard-risk and high-risk patients with bronchiolitis. METHODS This retrospective study examined patients <2 years of age admitted to the general pediatric ward with an International Classification of Diseases, 10th Revision discharge diagnosis code of bronchiolitis or viral syndrome with evidence of lower respiratory tract involvement. Patients were defined as either standard- or high-risk on the basis of previously published criteria. The frequencies of diagnostic and therapeutic interventions were compared. RESULTS We included 265 patients in this study (122 standard-risk [46.0%], 143 high-risk [54.0%]). Increased bronchodilator use was observed in the standard-risk group (any albuterol dosing, standard-risk 65.6%, high-risk 44.1%, P = .003). Increased steroid use was observed in the standard-risk group (any steroid dosing, standard-risk 19.7%, high-risk 14.7%, P = .018). Multiple logistic regression revealed >3 doses of albuterol, hypertonic saline, and chest physiotherapy use to be associated with rapid response team activation (odds ratio [OR] >3 doses albuterol: 8.36 [95% confidence interval (CI): 1.99-35.10], P = .048; OR >3 doses hypertonic saline: 13.94 [95% CI: 4.32-44.92], P = .001); OR percussion and postural drainage: 5.06 [95% CI: 1.88-13.63], P = .017). CONCLUSIONS A varied approach to the management of bronchiolitis in both standard-risk and high-risk children occurred institutionally. Bronchodilators and steroids continue to be used frequently despite practice recommendations and regardless of risk status. More research is needed on management strategies in patients at high-risk for severe disease.
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Affiliation(s)
- Derek Spindler
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | - Kimberly K Monroe
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | - Mayya Malakh
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | | | - Rebekah Shaw
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | - Nora Biary
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | - Katrina Foo
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | - Kathryn Levy
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Pooja Desai
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | - John Schmidt
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | - D'Anna Saul
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Maria Skoczylas
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | - Y Katharine Chang
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
| | - Rachel Osborn
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Emily Jacobson
- Department of Pediatrics, Division of Pediatric Hospital Medicine, C.S. Mott Children's Hospital
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Borentain S, Desai P, Fu DJ, Nancy Chen L, Lane R, Mathews M, Canuso CM. Commentary on Cochrane review: "Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder". J Psychopharmacol 2023; 37:836-844. [PMID: 36218274 PMCID: PMC10399093 DOI: 10.1177/02698811221123046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cochrane recently published a review of esketamine and other glutamate receptor modulators in depression. AIM To address the limitations of the review, analyses of esketamine data were conducted to provide additional perspective to the reviewers' interpretation of their findings. METHODS Response rate, remission rate, and change from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) total score were determined using data from all esketamine phase 2/3 registration studies of treatment-resistant depression (TRD) and, separately, all esketamine phase 2/3 registration studies of major depressive disorder (MDD) and active suicidal ideation with intent. Outcomes were assessed at all timepoints (i.e., 24 h, 72 h (MDD with active suicidal intent only), and 1, 2, and 4 weeks). Enrollment criteria of the TRD studies were different than those of the studies of MDD and active suicidal ideation with intent, resulting in differences in patients' clinical characteristics and depression severity between the cohorts. Thus, we did not compare results between these cohorts (as was done in the Cochrane review). RESULTS/OUTCOMES In the combined TRD studies, a statistically significant between-group difference favored esketamine plus antidepressant over antidepressant plus placebo at 24 h (based on response, remission, and change in MADRS score), 1 week (change in MADRS score), 2 weeks (response and change in MADRS score), and 4 weeks (response, remission, and change in MADRS score). In the combined studies of MDD and active suicidal ideation with intent, the between-group difference was statistically different, favoring esketamine plus standard-of-care over placebo plus standard-of-care, at 24 h (response, remission, and change in MADRS score), 72 h and 1 week (change in MADRS score), 2 weeks (response), and 4 weeks (response, remission, and change in MADRS score). For both study types, the between-group difference in outcomes was not statistically significant at the other timepoints. CONCLUSIONS/INTERPRETATION Esketamine improves response, remission, and depressive symptoms as early as 24 h post-first dose among patients with TRD and among patients with MDD and active suicidal ideation with intent.
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Affiliation(s)
| | - Pooja Desai
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Dong-Jing Fu
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Li Nancy Chen
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Rosanne Lane
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Maju Mathews
- Janssen Research & Development, LLC, Titusville, NJ, USA
- Perception Neuroscience, New York, NY, USA (current employment)
| | - Carla M Canuso
- Janssen Research & Development, LLC, Titusville, NJ, USA
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Dwyer JP, Agiro A, Desai P, Cremisi H. Short-term costs in patients with chronic kidney disease treated with dapagliflozin: a retrospective cohort study. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1057-1066. [PMID: 37540162 DOI: 10.1080/14737167.2023.2237679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES This real-world study evaluated the impact of dapagliflozin on short-term medical costs in patients with stage 3 chronic kidney disease (CKD). METHODS This retrospective, observational cohort study used medical and pharmacy claims data from IQVIA PharMetrics Plus. Patients aged ≥18 years with a filled dapagliflozin prescription after stage 3 CKD diagnosis between September 2020 and December 2021 were 1:1 propensity score matched with patients with stage 3 CKD who did not receive dapagliflozin. The primary endpoint was cardiorenal medical costs to payers over 6 months; all-cause medical and pharmacy costs were also analyzed. Within the overall population, there was a new-user subgroup of patients with no sodium-glucose co-transporter-2 use during baseline. RESULTS The new-user subgroup included 503 matched patients per cohort. Mean per-patient cardiorenal medical costs were reduced by 49.0% in the dapagliflozin versus non-dapagliflozin cohort ($3172.15 vs $6219.50; P < 0.001). Mean all-cause medical costs were reduced ($8043.58 vs $12,194.87; P < 0.001) and mean all-cause pharmacy costs were increased ($9056.98 vs $7453.23; P = 0.22). Results were similar for the overall population. CONCLUSION This study showed dapagliflozin was associated with reduced cardiorenal medical costs over 6 months compared with no dapagliflozin treatment in patients with stage 3 CKD, demonstrating real-world medical cost savings.
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Affiliation(s)
- Jamie P Dwyer
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Abiy Agiro
- US Evidence, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | - Pooja Desai
- US Renal, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | - Henry Cremisi
- US Renal, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
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Agiro A, AN A, Cook EE, Mu F, Chen J, Desai P, Oluwatosin Y, Pollack CV. Real-World Modifications of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Hyperkalemia Initiating Sodium Zirconium Cyclosilicate Therapy: The OPTIMIZE I Study. Adv Ther 2023; 40:2886-2901. [PMID: 37140706 PMCID: PMC10220114 DOI: 10.1007/s12325-023-02518-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/06/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Hyperkalemia (HK) may result in disruptions of guidelines-concordant renin-angiotensin-aldosterone system inhibitors (RAASi), a standard of care in persons with chronic kidney disease (CKD). Such disruptions-dose reduction or discontinuation-diminish the benefits of RAASi, placing patients at risk of serious events and renal dysfunction. This real-world study evaluated RAASi modifications among patients who initiated sodium zirconium cyclosilicate (SZC) for HK. METHODS Adults (≥ 18 years) initiating outpatient SZC (index date) while on RAASi were identified from a large US claims database (January 2018-June 2020). RAASi optimization (maintain same or up-titration of RAASi dosage), non-optimization (down-titration of RAASi dosage or discontinuation), and persistence were descriptively summarized following index. Predictors of RAASi optimization were assessed using multivariable logistic regression models. Analyses were conducted by subgroups, including patients without end-stage kidney disease (ESKD), with CKD, and with CKD + diabetes. RESULTS A total of 589 patients initiated SZC during RAASi therapy (mean age 61.0 years, 65.2% male), and 82.7% patients (n = 487) kept RAASi after index (mean follow-up = 8.1 months). Most patients (77.4%) optimized RAASi therapy after initiating SZC; 69.6% maintained the same dosage while 7.8% had up-titrations. A similar rate of RAASi optimization was observed among subgroups without ESKD (78.4%), with CKD (78.9%), and with CKD + diabetes (78.1%). At 1-year post-index, 73.9% of all patients who optimized RAASi were still on therapy, while only 17.9% of patients who did not optimize therapy were still on a RAASi. Among all patients, predictors of RAASi optimization included fewer prior hospitalizations (odds ratio = 0.79, 95% CI [0.63-1.00]; p < 0.05) and fewer prior emergency department (ED) visits (0.78 [0.63-0.96]; p < 0.05). CONCLUSION Consistent with clinical trial findings, nearly 80% of patients who initiated SZC for HK optimized their RAASi therapy. Patients may require long-term SZC therapy to encourage continuation of RAASi therapy especially after inpatient and ED visits.
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Affiliation(s)
- Abiy Agiro
- AstraZeneca, US Medical Affairs, 1800 Concord Pike, Wilmington, DE 19850 USA
| | - Amin AN
- University of California Irvine, Irvine, CA 92697 USA
| | - Erin E. Cook
- Analysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA 02199 USA
| | - Fan Mu
- Analysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA 02199 USA
| | - Jingyi Chen
- Analysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA 02199 USA
| | - Pooja Desai
- AstraZeneca, US Medical Affairs, 1800 Concord Pike, Wilmington, DE 19850 USA
| | - Yemmie Oluwatosin
- AstraZeneca, US Medical Affairs, 1800 Concord Pike, Wilmington, DE 19850 USA
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Desai P, Awatiger MM, Angadi PP. Geometrics Morphometrics in Craniofacial Skeletal Age Estimation - A Systematic Review. J Forensic Odontostomatol 2023; 41:57-64. [PMID: 37149754 PMCID: PMC10319097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Geometric morphometrics is a novel statistical shape based technique used as an additional approach to the currently used methods in forensics for the assessment of age. Various craniofacial units are used for the estimation of age using this technique. The aim of this systematic review was to assess if Geometric Morphometrics is an accurate and reliable method in craniofacial skeletal age estimation. A literature search was conducted for cross-sectional studies on geometric morphometrics in craniofacial skeletal age estimation using various search engines such as Pubmed, Google Scholar, and Scopus using specific MESH terms. AQUA (Anatomical Quality Assessment) tool was used for the quality assessment. A total of 4 articles were included for qualitative synthesis as they met the objectives of this review. The results of all the included studies suggested that geometric morphometrics can be used for craniofacial skeletal age estimation. The centroid size calculated using digitized images or CBCT scanned images is said to be the highest predictor of age.This systematic review summarises the merits and demerits of this technique and suggests that it is rapid and accurate method for age estimation even in instances of single skeletal remains of craniofacial units and can be performed on a digitized image or a CBCT scanned images. However, further studies are needed to derive reliable data and meta-analysis can be performed effectively.
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Affiliation(s)
- P Desai
- Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences and Hospital, Constituent Unit of KLE Academy of Higher Education and Research Belgaum. Karnataka - India
| | - M M Awatiger
- Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences and Hospital, Constituent Unit of KLE Academy of Higher Education and Research Belgaum. Karnataka - India
| | - P P Angadi
- Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences and Hospital, Constituent Unit of KLE Academy of Higher Education and Research Belgaum. Karnataka - India
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Kamst O, Desai P. Evaluation of HyperArc™ using film and portal dosimetry quality assurance. Phys Eng Sci Med 2023; 46:57-66. [PMID: 36454430 DOI: 10.1007/s13246-022-01197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022]
Abstract
HyperArc™ is a stereotactic radiotherapy modality designed for targeting multiple brain metastases using a single isocenter with multiple non-coplanar arcs. This study aimed to assess the efficacy of two patient-specific quality assurance methods, film and the Varian Portal Dosimetry System with Varian's HyperArc™ technique and raise important considerations in the customisation of patient-specific quality assurance to accommodate HyperArc™ delivery. Assessment criteria included gamma analysis and mean dose at full width half maximum. The minimum metastasis size, maximum off-axis distance and suitable energy were identified and validated. Patient-specific quality assurance procedures were applied to a range of clinically relevant brain metastasis plans. Initial investigation into energy selection showed no significant differences in gamma pass rates using 6MV, 6MV FFF, or 10MV FFF for metastasis sizes greater than 15 mm diameter at the isocenter. Gamma pass rates (2%/2mm) for 15 mm metastases at the isocenter for all energies were greater than 96.0% for portal dosimetry and greater than 98.7% for film. Fields of size 15 mm placed at various distances (10-70 mm) from the isocenter resulted in a maximum mean dose difference of 1.5% between film and planned. Clinically relevant plans resulted in a maximum mean dose difference for selected metastases of 1.0% between film and plan and a maximum point dose difference of 2.9% between portal dose and plan. Portal dose image prediction was a quick and convenient quality assurance tool for metastases larger than 15 mm near the isocenter but provided diminished geometrical relevance for off-axis metastases. Film QA required exacting procedures but offered the ability to assess the accuracy of geometrical targeting for off-axis metastases and provided dosimetric accuracy for metastases to well below 15 mm diameter.
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Affiliation(s)
- Onno Kamst
- ICON Cancer Care, Gold Coast University Hospital, Southport, Australia.
| | - P Desai
- ICON Cancer Care, Gold Coast University Hospital, Southport, Australia
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12
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Marhamati S, Qu L, Kangotra I, Desai P, Klein J, Bagla S, Singh I. Does prostate artery embolization prior to Aquablation® reduce peri-operative morbidity and increase the likelihood of same day discharge? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00076-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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13
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Lin CC, Kim T, Desai P, Lee K, Feng YH, Ngamphaiboon N, Kim SB, Yang MH, Muzaffar J, Chmielowski B, Swiecicki P, Bowyer S, Brahmer J, Chisamore M, Goyal R, Nasrah N, Ho W, Cho B. 187P Phase I/II study of the oral CCR4 antagonist, FLX475, as monotherapy and in combination with pembrolizumab in advanced cancer. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Cho S, Ensari I, Elhadad N, Weng C, Radin JM, Bent B, Desai P, Natarajan K. An interactive fitness-for-use data completeness tool to assess activity tracker data. J Am Med Inform Assoc 2022; 29:2032-2040. [PMID: 36173371 PMCID: PMC9667174 DOI: 10.1093/jamia/ocac166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/29/2022] [Accepted: 09/16/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To design and evaluate an interactive data quality (DQ) characterization tool focused on fitness-for-use completeness measures to support researchers' assessment of a dataset. MATERIALS AND METHODS Design requirements were identified through a conceptual framework on DQ, literature review, and interviews. The prototype of the tool was developed based on the requirements gathered and was further refined by domain experts. The Fitness-for-Use Tool was evaluated through a within-subjects controlled experiment comparing it with a baseline tool that provides information on missing data based on intrinsic DQ measures. The tools were evaluated on task performance and perceived usability. RESULTS The Fitness-for-Use Tool allows users to define data completeness by customizing the measures and its thresholds to fit their research task and provides a data summary based on the customized definition. Using the Fitness-for-Use Tool, study participants were able to accurately complete fitness-for-use assessment in less time than when using the Intrinsic DQ Tool. The study participants perceived that the Fitness-for-Use Tool was more useful in determining the fitness-for-use of a dataset than the Intrinsic DQ Tool. DISCUSSION Incorporating fitness-for-use measures in a DQ characterization tool could provide data summary that meets researchers needs. The design features identified in this study has potential to be applied to other biomedical data types. CONCLUSION A tool that summarizes a dataset in terms of fitness-for-use dimensions and measures specific to a research question supports dataset assessment better than a tool that only presents information on intrinsic DQ measures.
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Affiliation(s)
- Sylvia Cho
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Ipek Ensari
- Department of Artificial Intelligence and Human Health, Icahn School of Medicine, New York, New York, USA
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Data Science Institute, Columbia University, New York, New York, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Data Science Institute, Columbia University, New York, New York, USA
| | - Jennifer M Radin
- Scripps Research Translational Institute, La Jolla, California, USA
| | - Brinnae Bent
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Pooja Desai
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Data Science Institute, Columbia University, New York, New York, USA
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15
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Chung Y, Carr T, Ambrose C, Lindsley A, Collacott H, Schulz A, Desai P, Rane P, Williams M. PATIENT AND CLINICIAN PREFERENCES WITH BIOLOGIC TREATMENTS FOR SEVERE ASTHMA: A DISCRETE CHOICE EXPERIMENT. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Silver LJ, Desai P, Shah S, Krystal J, Taylor M, Murphy K. New pediatric leukemia/lymphoma diagnoses during the COVID-19 pandemic: A New York perspective. Pediatr Blood Cancer 2022; 70:e29879. [PMID: 35870156 PMCID: PMC9349903 DOI: 10.1002/pbc.29879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Layne J. Silver
- Division of Pediatric Critical Care MedicineCohen Children's Medical CenterDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthNew Hyde ParkNew YorkUSA
| | - Pooja Desai
- Division of Pediatric Hematology and OncologyCohen Children's Medical CenterDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthNew Hyde ParkNew YorkUSA
| | - Sareen Shah
- Division of Pediatric Critical Care MedicineCohen Children's Medical CenterDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthNew Hyde ParkNew YorkUSA
| | - Julie Krystal
- Division of Pediatric Hematology and OncologyCohen Children's Medical CenterDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthNew Hyde ParkNew YorkUSA
| | - Matthew Taylor
- Division of Pediatric Critical Care MedicineCohen Children's Medical CenterDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthNew Hyde ParkNew YorkUSA
| | - Kristina Murphy
- Division of Pediatric Critical Care MedicineCohen Children's Medical CenterDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthNew Hyde ParkNew YorkUSA
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17
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Husni ME, Chang E, Broder MS, Paydar C, Bognar K, Desai P, Klyachkin Y, Khilfeh I. Biologic Initiation Rate in Systemic-Naïve Psoriatic Arthritis Patients Starting Treatment with Apremilast vs Methotrexate: 1-Year Retrospective Analysis of a US Claims Database. Open Access Rheumatol 2022; 14:123-132. [PMID: 35734243 PMCID: PMC9207121 DOI: 10.2147/oarrr.s342123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the rate of biologic initiation after commencing treatment with apremilast (APR) vs methotrexate (MTX), in systemic-naïve patients with psoriatic arthritis (PsA). Patients and Methods Systemic-naïve patients with PsA who started treatment with either APR or MTX between 01/01/2015 and 12/31/2018 were analyzed using claims data from the IBM® MarketScan® Commercial and Medicare Supplemental databases (2014-2019). PsA patients were identified via diagnosis codes; the first prescription date for APR or MTX was the index date. Patient demographics, clinical characteristics, healthcare utilization during the year pre-index (baseline) and the year post-index (follow-up), and median time to biologic initiation were reported descriptively. The rates and risk of biologic initiation during follow-up were compared between APR and MTX users by logistic and Cox regressions, respectively. Models were adjusted for demographics, clinical and utilization measures during the baseline period. Results A total of 2116 patients with PsA newly treated with APR (n = 534) or MTX (n = 1582) were identified. Mean age was similar (50.5 vs 50.4; P = 0.938), and proportion of females was higher for APR vs MTX users (59.4% vs 54.0%; P = 0.031). Mean time to biologic initiation among patients who initiated during follow-up was 194.1 vs 138.7 days between APR vs MTX users (P < 0.001). After adjusting for confounders, the likelihood of biologic initiation was 58% lower (OR, 0.42 [95% CI, 0.32-0.54]; P < 0.001) with APR, with a significantly lower predicted rate of biologic initiation among APR users when compared to MTX users during follow-up (20.0% [95% CI, 16.6-23.9%] vs 37.5% [95% CI, 35.0-40.1%]). Additionally, APR users had a lower risk of biologic initiation than MTX users (HR, 0.46 [95% CI, 0.37-0.57]; P < 0.001) during the 1-year follow-up. Conclusion Systemic-naïve patients with PsA have a lower rate of, and longer time to, biologic initiation over one-year following APR initiation, compared to those initiating MTX.
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Affiliation(s)
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Caleb Paydar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Katalin Bognar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
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18
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Danese MD, Fox KM, Duryea JL, Desai P, Rubin RJ. The rate, cost and outcomes of parathyroidectomy in the united states dialysis population from 2016-2018. BMC Nephrol 2022; 23:220. [PMID: 35729513 PMCID: PMC9215010 DOI: 10.1186/s12882-022-02848-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background In end-stage kidney disease, patients may undergo parathyroidectomy if secondary hyperparathyroidism cannot be managed medically. This study was designed to estimate the parathyroidectomy rate in the United States (US) and to quantify changes in costs and other outcomes after parathyroidectomy. Methods This was a retrospective observational cohort study using US Renal Data System data for 2015–2018. Parathyroidectomy rates were estimated for adult hemodialysis and peritoneal dialysis patients alive at the beginning of 2016, 2017, and 2018 who were followed for a year or until parathyroidectomy, death, or transplant. Incremental differences in economic and clinical outcomes were compared before and after parathyroidectomy in adult hemodialysis and peritoneal dialysis patients who received a parathyroidectomy in 2016 and 2017. Results The rate of parathyroidectomy per 1,000
person-years decreased from 6.5 (95% CI 6.2-6.8) in 2016 to 5.3 (95% CI
5.0-5.6) in 2018. The incremental
increase in 12-month cost after versus before parathyroidectomy was $25,314
(95% CI $23,777-$27,078). By the second
month after parathyroidectomy, 58% of patients had a corrected calcium level
< 8.5 mg/dL. In the year after
parathyroidectomy (versus before), hospitalizations increased by 1.4 per
person-year (95% CI 1.3-1.5), hospital days increased by 12.1 per person-year
(95% CI 11.2-13.0), dialysis visits decreased by 5.2 per person-year (95% CI
4.4-5.9), and office visits declined by 1.3 per person-year (95% CI
1.0-1.5). The incremental rate per 1,000
person years for hematoma/bleed was 224.4 (95% CI 152.5-303.1), for vocal cord
paralysis was 124.6 (95% CI 59.1-232.1), and for seroma was 27.4 (95% CI
0.4-59.0). Conclusions Parathyroidectomy was a relatively uncommon event in the hemodialysis and peritoneal dialysis populations. The incremental cost of parathyroidectomy was mostly attributable to the cost of the parathyroidectomy hospitalization. Hypocalcemia occurred in over half of patients, and calcium and phosphate levels were reduced. Clinicians, payers, and patients should understand the potential clinical and economic outcomes when considering parathyroidectomy. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02848-x.
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Affiliation(s)
- Mark D Danese
- Outcomes Insights, Inc., 30200 Agoura Road, Suite 230, Agoura Hills, CA, 91301, USA.
| | - Kathleen M Fox
- Global Health Economics, Amgen, Inc., Thousand Oaks, CA, USA
| | - Jennifer L Duryea
- Outcomes Insights, Inc., 30200 Agoura Road, Suite 230, Agoura Hills, CA, 91301, USA
| | | | - Robert J Rubin
- Division of Nephrology and Hypertension, Georgetown University, Washington, DC, USA
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19
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Tan L, Reibman J, Ambrose C, Chung Y, Desai P, Llanos JP, Moynihan M, Tkacz J. Clinical and economic burden of uncontrolled severe noneosinophilic asthma. Am J Manag Care 2022; 28:e212-e220. [PMID: 35738228 DOI: 10.37765/ajmc.2022.89159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To quantify the clinical and economic burden of patients with severe asthma with low blood eosinophil counts (BECs) untreated with biologics. STUDY DESIGN Retrospective cohort study in IBM MarketScan claims database. METHODS Patients 12 years and older with severe asthma with BEC data were selected between January 1, 2013, and June 30, 2018 (date of the most recent BEC was used as the index date). Inclusion criteria were (1) presence of BEC laboratory test result, (2) continuous enrollment for 12 months preceding and following the index date, (3) meeting the Healthcare Effectiveness Data and Information Set definition of persistent asthma, (4) meeting the Global Initiative for Asthma definition of severe asthma, and (5) an absence of biologic treatment, other respiratory diagnoses, and malignancies 12 months preceding and following the index date. Asthma exacerbations, levels of disease control, and all-cause and asthma-related health care costs were reported during the 12-month postindex period for patients with a BEC less than 300 cells/mcL. RESULTS The sample included 8073 patients with severe asthma; 78% (n = 6260) presented with a BEC less than 300 cells/mcL. Mean (SD) age of the sample was 54.8 (14.2) years; 64% were female. Eighteen percent of patients had an asthma exacerbation; 19% had either uncontrolled or suboptimally controlled asthma based on the frequency of asthma-related hospital admissions, emergency department visits, or corticosteroid prescription fills. One-year all-cause and asthma-related total health care costs were $25,845 and $2802, respectively. Patients with suboptimally controlled and uncontrolled asthma spent $1471 and $3872 more, respectively, on asthma-related claims compared with patients with controlled asthma. CONCLUSIONS Among patients with severe asthma with low eosinophils untreated with biologics, there is a high burden of disease among those who have suboptimal disease control, highlighting an unmet need in severe asthma treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Joseph Tkacz
- IBM Watson Health, 75 Binney St, Cambridge, MA 02142.
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20
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Kaplan D, Husni E, Chang E, S Broder M, Paydar C, Bognar K, Yan J, Richter S, Desai P, Khilfeh I. Biologic initiation rates in systemic-naive psoriasis patients after first-line apremilast versus methotrexate use. J Comp Eff Res 2022; 11:575-582. [PMID: 35514324 DOI: 10.2217/cer-2021-0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare rates of biologic initiation after commencing treatment with apremilast (APR) versus methotrexate (MTX) in systemic-naive patients with psoriasis (PsO). Methods: This was a retrospective cohort study of systemic-naive patients with PsO who initiated treatment with APR or MTX between 1 January 2015 and 31 March 2018. Outcomes: Adjusted rates of biologic initiation during follow-up were compared by logistic and Cox regressions. Results: APR initiators had 58% lower likelihood of biologic initiation (odds ratio: 0.42; 95% CI: 0.37-0.48; p < 0.001), lower adjusted biologic initiation rate (14.4% [95% CI: 13.2-15.7%] vs 28.6% [95% CI: 26.8-30.5%]), lower risk of biologic initiation (hazard ratio: 0.45; 95% CI: 0.40-0.51; p < 0.001) compared with MTX initiators. Conclusion: Systemic-naive patients with PsO have a lower rate of biologic initiation over 1 year following APR initiation.
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Affiliation(s)
- David Kaplan
- Adult & Pediatric Dermatology, Overland Park, KS 66211, USA
| | - Elaine Husni
- Cleveland Clinic Department of Rheumatic and Immunologic Diseases, Cleveland, OH 44195, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, USA
| | - Caleb Paydar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, USA
| | - Kata Bognar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, USA
| | - Jessie Yan
- Roche, South San Francisco, CA 94080, USA
| | | | - Pooja Desai
- Janssen Pharmaceuticals, Titusville, NJ 08560, USA
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21
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Mamdouhi T, Desai P, Goodman HJ, Amodio JB, Edelman MC, Rich BS, Glick RD, Lipton JM, Levy CF. Comment on: Discrepancies between F-18-FDG PET/CT findings and conventional imaging in Langerhans cell histiocytosis. Pediatr Blood Cancer 2022; 69:e29504. [PMID: 34913590 DOI: 10.1002/pbc.29504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Tania Mamdouhi
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Pooja Desai
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Pediatrics, Division of Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Howard J Goodman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Orthopedics, Division of Orthopedic Oncology, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - John B Amodio
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Radiology, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Morris C Edelman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Pediatrics, Division of Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Barrie S Rich
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Richard D Glick
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Jeffrey M Lipton
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Pediatrics, Division of Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Carolyn Fein Levy
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Pediatrics, Division of Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, New York, USA
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22
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Karaboyas A, Muenz D, Hwang Y, Goodman W, Cheng S, Desai P, Fox KM, Robinson BM, Pisoni RL. Etelcalcetide Versus Cinacalcet in Hemodialysis Patients in the United States: A Facility Calcimimetic Approach to Assess Real-World Effectiveness. Kidney Med 2022; 4:100475. [PMID: 35637925 PMCID: PMC9142674 DOI: 10.1016/j.xkme.2022.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Rationale & Objective Some US hemodialysis (HD) facilities switched from oral cinacalcet to intravenous etelcalcetide as the primary calcimimetic therapy to control parathyroid hormone (PTH) levels after the introduction of etelcalcetide in 2017. Although clinical trials have demonstrated the superior efficacy of etelcalcetide versus cinacalcet, evidence comparing real-world effectiveness is lacking. Study Design Prospective cohort. Setting & Participants Patients receiving HD enrolled in US Dialysis Outcomes and Practice Patterns Study facilities. Exposure We classified HD facilities on the basis of whether >75% of calcimimetic users were prescribed etelcalcetide (“etelcalcetide-first”) or cinacalcet (“cinacalcet-first”) from March-August 2019. Outcomes PTH, calcium, and phosphorus levels among calcimimetic users, all averaged in the 6 months after the exposure assessment period. Analytical Approach We used adjusted linear regression to compare outcomes using 2 approaches: (1) cross-sectional comparison of etelcalcetide-first and cinacalcet-first HD facilities; (2) pre-post comparison of HD facilities that switched from cinacalcet-first to etelcalcetide-first using facilities that remained cinacalcet-first as a comparison group. Results We identified 45 etelcalcetide-first and 67 cinacalcet-first HD facilities; etelcalcetide-first (vs cinacalcet-first) facilities were more likely to be from small or independent dialysis organizations (86% vs 22%) and had higher total calcimimetic use (43% vs 29%) and lower active vitamin D use (66% vs 82%). In the cross-sectional analysis comparing etelcalcetide-first and cinacalcet-first HD facilities, the adjusted mean difference in PTH levels was −115 pg/mL (95% CI, −196 to −34) and the prevalence of a PTH level of >600 pg/mL was lower (prevalence difference, −11.4%; 95% CI, −19.3% to −3.5%). Among facilities that switched to etelcalcetide-first, the mean PTH level decreased from 671 to 484 pg/mL and the prevalence of a PTH level of >600 pg/mL decreased from 39% to 21%. Among facilities that remained cinacalcet-first, the mean PTH level increased from 632 to 698 pg/mL and the prevalence of a PTH level of >600 pg/mL increased from 37% to 43%. The adjusted difference-in-difference between the switch to etelcalcetide-first and the continuation of cinacalcet-first was −169 pg/mL (−249 to −90 pg/mL) for the mean PTH and −14.4% (−22.0% to −6.8%) for a PTH level of >600 pg/mL. We also observed slightly lower serum calcium levels and minimal differences in serum phosphorus levels between the etelcalcetide-first and the cinacalcet-first facilities. Limitations Residual confounding. Conclusions We observed better PTH control in HD facilities that switched from using cinacalcet to etelcalcetide as the primary calcimimetic therapy. Further research is needed to investigate how the greater real-world effectiveness of intravenous etelcalcetide (vs oral cinacalcet) may affect clinical outcomes.
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23
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Kilpatrick K, Jo H, Desai P, Llanos Ackert JP, Rane P, Ambrose C, Chung Y, Oppenheimer J, Goldstein S. Clinical and Economic Burden of Patients With Severe Asthma Untreated With a Biologic in the United States, Overall and by Blood Eosinophil and Level of Asthma Control. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Carr W, Jain N, Ambrose C, Clarke N, Martin N, Kmita K, Desai P, Llanos-Ackert JP, Ponnarambil S. Tezepelumab Treatment Reduced Asthma Symptomatic Days in Adults and Adolescents with Severe, Uncontrolled Asthma in the Phase 3 NAVIGATOR Study. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Chalakh S, Desai P. Assessment of PAM (Pesticide Awareness Module) as Community Teaching Tool. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i60b35096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: The ability of students to understand and support the needs of the community is at the heart of community-based education. Because India is a developing country with a large proportion of the population living in villages, the medical education system must guarantee that learners who serve as health care providers acquire the necessary skills and venture out into the community as needed. In today’s scenario pesticide poisoning in farmer's communities is an issue of high concern with this aim PAM (pesticide awareness module) is designed and is assessed as a community teaching tool. The pesticide Awareness module (PAM) was prepared as per the need of the community. The pretest of the student was conducted. Module was implemented by the student in the community with Flex, Charts, and Video. After implementation of the module post-test of students was conducted after one month. With the help of a Checklist, students were assessed for community teaching. Students’ perception of community teaching was obtained using a feedback questionnaire. The average Pre-test score was 23.35% and in Post-test it was increased to 86.85%. This indicates students gain desired level of knowledge for a longer period & Students also get benefitted by acquiring self-confidence, behavioral and attitudinal skill. The intervention of PAM as a community teaching tool was highly effective for the student in gaining knowledge & different skills.
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Lipton JM, Molmenti CLS, Desai P, Lipton A, Ellis SR, Vlachos A. Early Onset Colorectal Cancer: An Emerging Cancer Risk in Patients with Diamond Blackfan Anemia. Genes (Basel) 2021; 13:56. [PMID: 35052397 PMCID: PMC8774389 DOI: 10.3390/genes13010056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
Diamond Blackfan anemia (DBA) is a rare inherited bone marrow failure syndrome, the founding member of a class of disorders known as ribosomopathies. Most cases result from loss of function mutations or deletions in 1 of 23 genes encoding either a small or large subunit-associated ribosomal protein (RP), resulting in RP haploinsufficiency. DBA is characterized by red cell hypoplasia or aplasia, poor linear growth and congenital anomalies. Small case series and case reports demonstrate DBA to be a cancer predisposition syndrome. Recent analyses from the Diamond Blackfan Anemia Registry of North America (DBAR) have quantified the cancer risk in DBA. These studies reveal the most prevalent solid tumor, presenting in young adults and in children and adolescents, to be colorectal cancer (CRC) and osteogenic sarcoma, respectively. Of concern is that these cancers are typically detected at an advanced stage in patients who, because of their constitutional bone marrow failure, may not tolerate full-dose chemotherapy. Thus, the inability to provide optimal therapy contributes to poor outcomes. CRC screening in individuals over the age of 50 years, and now 45 years, has led to early detection and significant improvements in outcomes for non-DBA patients with CRC. These screening and surveillance strategies have been adapted to detect familial early onset CRC. With the recognition of DBA as a moderately penetrant cancer risk syndrome a rational screening and surveillance strategy will be implemented. The downstream molecular events, resulting from RP haploinsufficiency and leading to cancer, are the subject of significant scientific inquiry.
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Affiliation(s)
- Jeffrey M. Lipton
- Division of Hematology/Oncology and Cellular Therapy, Cohen Children’s Medical Center, New Hyde Park, NY 11040, USA; (P.D.); (A.V.)
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; (C.L.S.M.); (A.L.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Christine L. S. Molmenti
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; (C.L.S.M.); (A.L.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Division of Epidemiology, Department of Occupational Medicine, Epidemiology and Prevention, Great Neck, NY 11021, USA
| | - Pooja Desai
- Division of Hematology/Oncology and Cellular Therapy, Cohen Children’s Medical Center, New Hyde Park, NY 11040, USA; (P.D.); (A.V.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Alexander Lipton
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; (C.L.S.M.); (A.L.)
| | - Steven R. Ellis
- Department of Biochemistry and Molecular Biology, University of Louisville, Louisville, KY 40202, USA;
| | - Adrianna Vlachos
- Division of Hematology/Oncology and Cellular Therapy, Cohen Children’s Medical Center, New Hyde Park, NY 11040, USA; (P.D.); (A.V.)
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; (C.L.S.M.); (A.L.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
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Stephens JM, Fox KM, Desai P, Cheng S, Goodman WG, Kendrick JB. Calcimimetic use in US hemodialysis facilities in first 2 years after the launch of etelcalcetide: A descriptive analysis of real-world clinical practice and outcomes. Hemodial Int 2021; 26:243-254. [PMID: 34931443 DOI: 10.1111/hdi.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study described control of parathyroid hormone (PTH), phosphorus, and corrected calcium in adults initiating calcimimetics in small dialysis organizations after the introduction of etelcalcetide. METHODS This retrospective study using Visonex Clarity electronic health records between October 1, 2017, and December 31, 2019, identified adults ≥ 18 years of age receiving in-center hemodialysis as either a cinacalcet or etelcalcetide initiator based on their first calcimimetic use in 2018 (index date) with no prior calcimimetic use in the 3 months preindex date. Patients were stratified by PTH at index date and were followed for 15 months. Subcohorts of patients who were persistent on a single calcimimetic for 15 months and of patients who had their calcimimetic changed from cinacalcet to etelcalcetide were also analyzed. FINDINGS A total of 677 patients initiated cinacalcet and 711 initiated etelcalcetide. Mean PTH (pg/ml), phosphorus, and corrected calcium (mg/dl) at baseline were 864, 5.9, and 9.3 for cinacalcet and 804, 5.9, and 9.4 for etelcalcetide, respectively. During follow-up, the proportion of initiators considered in-target (monthly average PTH < 600) increased from 48% to 62% with cinacalcet and from 56% to 86% with etelcalcetide in the baseline PTH 600 to < 800 subgroup; increased from 30% to 64% with cinacalcet and 31% to 59% with etelcalcetide among those with baseline PTH 800 to < 1000; and increased from 14% to 41% with cinacalcet and 12% to 58% with etelcalcetide among those with baseline PTH ≥1000. A similar pattern was observed for persistent users (n = 646). For patients changed from cinacalcet to etelcalcetide (n = 183), the proportion of patients considered in-target increased from 22% in the month prior to the treatment change to 51% in Month 6 postchange. DISCUSSION Patients initiating calcimimetics at lower baseline PTH had better biochemical control than patients starting at higher PTH. Patients changed from cinacalcet to etelcalcetide had improvements in PTH control postchange.
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Sanyaolu A, Dzando G, Okorie C, Jaferi U, Marinkovic A, Prakash S, Patidar R, Desai P, Younis K. Anemia prevalence in mothers with children under five years of age in Dodi Papase, Volta region of Ghana and preventive practices. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Sociodemographic factors influence the prevalence of anemia in endemic areas. The purpose of this study is to establish the prevalence and causes of anemia and to determine anemia preventive practices carried out by mothers with children under five years of age in the Kadjebi District of the Volta region of Ghana.
Methods/Case Report
This homogenous sampling study involved women of reproductive age with children less than five years of age from Saint Mary Theresa Hospital. Interview guides were administered, and the data collected were analyzed using the Statistical Package for Social Sciences (SPSS) version 21.
Results (if a Case Study enter NA)
A total of 150 participants were studied. 52.7% of the mothers indicated that their children had never been diagnosed with anemia; however, Hb levels recorded for these children showed that 73.3% were anemic, even though 93.8% of the mothers had been given iron supplements during their pregnancy. Furthermore, anemia prevention practices comprised of whether the child had been given any anti-malaria prophylaxis (98.4% denied / 1.6% confirmed) if the child had been dewormed in the last three months (89.9% denied / 10.1% confirmed), whether the child was given iron supplements in the last three months (59.7% denied / 40.3% confirmed), if the child had been given vitamin supplements in the last three months (24.0% denied / 76.0% confirmed).
Conclusion
Nutritional deficiencies, worm infestation, and malaria were identified as the major causes of anemia among the children. Mothers were educated about the possible causes and prevention methods of anemia.
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Affiliation(s)
- A Sanyaolu
- Communicable Diseases, AMOOF Healthcare Consulting, Calgary, Alberta, CANADA
| | - G Dzando
- University of Cape Coast, Cape Coast, GHANA
| | - C Okorie
- Union County College, Plainfield Campus, New Jersey, UNITED STATES
| | - U Jaferi
- All Saints University School of Medicine, Roseau, DOMINICA
| | - A Marinkovic
- Saint James School of Medicine, The Quarter, ANGUILLA
| | - S Prakash
- Saint James School of Medicine, The Quarter, ANGUILLA
| | - R Patidar
- Saint James School of Medicine, The Quarter, ANGUILLA
| | - P Desai
- American University of Saint Vincent School of Medicine, Leeward Hwy, SAINT VINCENT AND THE GRENADINES
| | - K Younis
- Mount Royal University, Calgary, Alberta, CANADA
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Krez A, Lane J, Heilbronner A, Park-Min KH, Kaneko K, Pannellini T, Mintz D, Hansen D, McMahon DJ, Kirou KA, Roboz G, Desai P, Bockman RS, Stein EM. Risk factors for multi-joint disease in patients with glucocorticoid-induced osteonecrosis. Osteoporos Int 2021; 32:2095-2103. [PMID: 33877383 PMCID: PMC8056829 DOI: 10.1007/s00198-021-05947-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/01/2021] [Indexed: 12/24/2022]
Abstract
UNLABELLED This study investigated risk factors for osteonecrosis involving multiple joints (MJON) among glucocorticoid-treated patients. The best predictor of MJON was cumulative oral glucocorticoid dose. Risk of MJON was 12-fold higher in patients who had a second risk factor for osteonecrosis. Further research is needed into strategies for prevention of MJON. INTRODUCTION Osteonecrosis (ON) is a debilitating musculoskeletal condition in which bone cell death can lead to mechanical failure. When multiple joints are affected, pain and disability are compounded. Glucocorticoid treatment is one of the most common predisposing factors for ON. This study investigated risk factors for ON involving multiple joints (MJON) among glucocorticoid-treated patients. METHODS Fifty-five adults with glucocorticoid-induced ON were prospectively enrolled. MJON was defined as ON in ≥ three joints. Route, dose, duration, and timing of glucocorticoid treatment were assessed. RESULTS Mean age of enrolled subjects was 44 years, 58% were women. Half had underlying conditions associated with increased ON risk: systemic lupus erythematosus (29%), acute lymphoblastic leukemia (11%), HIV (9%), and alcohol use (4%). Mean daily oral dose of glucocorticoids was 29 mg. Average cumulative oral dose was 30 g over 5 years. The best predictor of MJON was cumulative oral glucocorticoid dose. For each increase of 1,000 mg, risk of MJON increased by 3.2% (95% CI 1.03, 1.67). Glucocorticoid exposure in the first 6 months of therapy, peak dose (oral or IV), and mean daily dose did not independently increase risk of MJON. The risk of MJON was 12-fold in patients who had a second risk factor (95% CI 3.2, 44.4). CONCLUSIONS Among patients with glucocorticoid-induced ON, cumulative oral dose was the best predictor of multi-joint disease; initial doses of IV and oral glucocorticoids did not independently increase risk. Further research is needed to better define optimal strategies for prevention and treatment of MJON.
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Affiliation(s)
- A Krez
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - J Lane
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - A Heilbronner
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - K-H Park-Min
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomic Research Center, Hospital for Special Surgery, New York, NY, USA
| | - K Kaneko
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomic Research Center, Hospital for Special Surgery, New York, NY, USA
| | - T Pannellini
- Research Division, Hospital for Special Surgery, New York, NY, USA
| | - D Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - D Hansen
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - D J McMahon
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - K A Kirou
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - G Roboz
- Department of Hematology and Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - P Desai
- Department of Hematology and Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - R S Bockman
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - E M Stein
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA.
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Holdsworth EA, Donaghy B, Fox KM, Desai P, Collier DH, Furst DE. Biologic and Targeted Synthetic DMARD Utilization in the United States: Adelphi Real World Disease Specific Programme for Rheumatoid Arthritis. Rheumatol Ther 2021; 8:1637-1649. [PMID: 34487340 PMCID: PMC8572299 DOI: 10.1007/s40744-021-00357-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/03/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction In patients with inadequate response or intolerance to first biologic disease-modifying antirheumatic drug (bDMARD), guidelines recommend switching to an agent of different mechanism of action or to another bDMARD. However, the reasons behind switching between bDMARD/targeted synthetic (ts)DMARD are not well documented in many studies. The objective of this study was to assess the rheumatologists’ perceptions and behaviors towards choice of initial b/tsDMARD treatment and reasons for switching between bDMARDs/tsDMARDs, in the context of present treatment patterns. Methods This was a retrospective analysis of data collected from the 12th Adelphi Real World Disease Specific Programme for rheumatoid arthritis (RA). Qualified rheumatologists involved in treatment decision-making for ≥ 10 patients a month completed patient record forms (PRFs). Patients aged ≥ 18 years with RA diagnosis and receiving bDMARD/tsDMARD were included. The outcomes assessed were proportion of patients receiving bDMARD/tsDMARD at molecule and class levels; rheumatologist-reported reasons for choice of therapy; proportion of patients who switched bDMARDs/tsDMARDs; and rheumatologist-reported reasons for switching therapies. Results Eighty-six rheumatologists completed PRFs for 1027 patients. Of these, 621 were receiving bDMARD/tsDMARD at data collection. The majority (73%) of patients received first-line bDMARD/tsDMARD, and at first-line, 68% received a tumor necrosis factor inhibitor (TNFi) and 21% received a Janus kinase inhibitor (JAKi). The response option of strong overall efficacy was the primary reason for selecting first-line and second-line bDMARD/tsDMARD. A total of 163 patients had switched from first-line b/tsDMARD to second-line b/tsDMARD therapy. Of these, 44, 28, and 17% had switched from TNFi to another TNFi, TNFi to non-TNF biologic, and TNFi to JAKi, respectively. Lack of efficacy and worsening disease were the most frequent reasons for switching therapies. Conclusions TNFis remain the most prescribed b/tsDMARD for first-line and second-line treatments. Strong overall efficacy was the primary reason for selecting therapy and loss of efficacy was the primary reason for switching therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00357-1.
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Affiliation(s)
| | | | | | | | | | - Daniel E Furst
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,University of Washington, Seattle, WA, USA.,University of Florence, Florence, Italy
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Tehrani DM, Wang X, Rafique AM, Hayek SS, Herrmann J, Neilan TG, Desai P, Morgans A, Lopez-Mattei J, Parikh RV, Yang EH. Impact of cancer and cardiovascular disease on in-hospital outcomes of COVID-19 patients: results from the american heart association COVID-19 cardiovascular disease registry. Cardiooncology 2021; 7:28. [PMID: 34372948 PMCID: PMC8352751 DOI: 10.1186/s40959-021-00113-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022]
Abstract
Background While pre-existing cardiovascular disease (CVD) appears to be associated with poor outcomes in patients with Coronavirus Disease 2019 (COVID-19), data on patients with CVD and concomitant cancer is limited. The purpose of this study is to evaluate the effect of underlying CVD and CVD risk factors with cancer history on in-hospital mortality in those with COVID-19. Methods Data from symptomatic adults hospitalized with COVID-19 at 86 hospitals in the US enrolled in the American Heart Association’s COVID-19 CVD Registry was analyzed. The primary exposure was cancer history. The primary outcome was in-hospital death. Multivariable logistic regression models were adjusted for demographics, CVD risk factors, and CVD. Interaction between history of cancer with concomitant CVD and CVD risk factors were tested. Results Among 8222 patients, 892 (10.8%) had a history of cancer and 1501 (18.3%) died. Cancer history had significant interaction with CVD risk factors of age, body mass index (BMI), and smoking history, but not underlying CVD itself. History of cancer was significantly associated with increased in-hospital death (among average age and BMI patients, adjusted odds ratio [aOR] = 3.60, 95% confidence interval [CI]: 2.07–6.24; p < 0.0001 in those with a smoking history and aOR = 1.33, 95%CI: 1.01—1.76; p = 0.04 in non-smokers). Among the cancer subgroup, prior use of chemotherapy within 2 weeks of admission was associated with in-hospital death (aOR = 1.72, 95%CI: 1.05–2.80; p = 0.03). Underlying CVD demonstrated a numerical but statistically nonsignificant trend toward increased mortality (aOR = 1.18, 95% CI: 0.99—1.41; p = 0.07). Conclusion Among hospitalized COVID-19 patients, cancer history was a predictor of in-hospital mortality. Notably, among cancer patients, recent use of chemotherapy, but not underlying CVD itself, was associated with worse survival. These findings have important implications in cancer therapy considerations and vaccine distribution in cancer patients with and without underlying CVD and CVD risk factors.
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Affiliation(s)
- David M Tehrani
- Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Xiaoyan Wang
- Division of General Internal Medicine and Health Service Research, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Asim M Rafique
- Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Tomas G Neilan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Pooja Desai
- Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Alicia Morgans
- Division of Hematology and Oncology, Department of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Juan Lopez-Mattei
- Division of Cardiology, Department of Medicine, Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rushi V Parikh
- Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA. .,UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA.
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Lipton JM, Molmenti CLS, Hussain M, Desai P, Florento M, Atsidaftos E, Vlachos A. Colorectal cancer screening and surveillance strategy for patients with Diamond Blackfan anemia: Preliminary recommendations from the Diamond Blackfan Anemia Registry. Pediatr Blood Cancer 2021; 68:e28984. [PMID: 34089224 DOI: 10.1002/pbc.28984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/12/2022]
Abstract
Diamond Blackfan anemia (DBA) is a rare inherited bone marrow failure syndrome characterized by red cell failure, congenital anomalies, poor linear growth, and cancer predisposition. Two previous analyses from the Diamond Blackfan Anemia Registry have quantified DBA as a cancer predisposition syndrome of moderate cancer penetrance. Patients with DBA have a 4.8-fold higher relative risk of developing cancer with an overall cumulative incidence of 13.7% by age 45 years. The two most prevalent solid tumors are colorectal cancer (CRC) and osteogenic sarcoma. Current and evolving data support the institution of cancer screening and surveillance strategies for CRC in DBA.
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Affiliation(s)
- Jeffrey M Lipton
- Cohen Children's Medical Center, Hematology/Oncology and Cellular Therapy, New Hyde Park, New York, USA.,Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Christine L S Molmenti
- Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Division of Epidemiology, Department of Occupational Medicine, Epidemiology and Prevention, Hempstead, New York, USA
| | - Maryam Hussain
- Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Pooja Desai
- Cohen Children's Medical Center, Hematology/Oncology and Cellular Therapy, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Maria Florento
- Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Eva Atsidaftos
- Cohen Children's Medical Center, Hematology/Oncology and Cellular Therapy, New Hyde Park, New York, USA.,Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Adrianna Vlachos
- Cohen Children's Medical Center, Hematology/Oncology and Cellular Therapy, New Hyde Park, New York, USA.,Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Chalakh S, Desai P, Rajput D. Impact of Pesticide Awareness module (PAM) in Improving the knowledge of Farmers Community about Pesticide Poisoning: A Pre- and Post- Intervention Study in Wardha District in Maharashtra, India. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i38b32111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background:Pesticide poisoning is a major concern in developing countries like India due to a lack of knowledge about its hazardous effect. It can be minimised by creating awareness among the farmers .This study was conducted to assess the impact of pesticide awareness module in improving the awareness among the farmers' community about pesticide poisoning.
Methodology: This was a pre and Post-intervention study in six villages in the Wardha district in Maharashtra. Forty farmers from six villages were interviewed regarding the knowledge, about pesticide poisoning before and after the sensitization with pesticide awareness module with the predesigned questionnaire.
Result: Statistically high significant difference is detected in pre and post-test. It was found that average Pre-test score was 1.84 (out of 10) which was increased in post-test score to 6.52(out of 10). The observed change was 46.79%.
Conclusion: The intervention of PAM was highly effective in knowledge gaining of farmer community
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Trevor J, Lugogo N, Carr W, Moore WC, Soong W, Panettieri RA, Desai P, Trudo F, Ambrose CS. Exacerbations in US Severe Asthma: Incidence, Characteristics, Predictors, and Effects of Biologic Treatments. Ann Allergy Asthma Immunol 2021; 127:579-587.e1. [PMID: 34273485 DOI: 10.1016/j.anai.2021.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with severe asthma (SA) have a heightened risk of exacerbations, including hospitalization. The real-world, specialist-verified incidence and characteristics of exacerbations among patients with SA in the United States (US) have not been described. OBJECTIVE To describe the real-world incidence, characteristics, and predictors of exacerbations among patients with SA in the US. METHODS CHRONICLE is an ongoing observational study of specialist-treated US adults with SA receiving biologic treatment or maintenance systemic corticosteroids (SCS), or uncontrolled by high-dosage inhaled corticosteroids with additional controllers. For patients enrolled February 2018 to February 2020, annualized rates and characteristics of exacerbation-related events were summarized by treatment category for 12 months before enrollment and after enrollment through the latest data collection. Results were further analyzed for subgroups of interest. RESULTS Among 1884 enrolled patients, 53.5% and 12.3% experienced an exacerbation and asthma hospitalization, respectively (0.81 and 0.14 per person-year). Of all exacerbations, 36%, 9%, and 15% required an unscheduled healthcare provider visit, emergency department visit without hospitalization, and hospitalization, respectively. Among patients not receiving biologics or SCS, higher blood eosinophil count, higher fractional exhaled nitric oxide, and lower total immunoglobulin E level were associated with higher exacerbation rates. Exacerbation rates decreased after starting or switching biologics (n = 1299). Multivariate analyses of enrolled patients showed prior-year exacerbations/hospitalizations, lack of asthma control, and geographic region also predicted event risk. CONCLUSION In this real-world cohort of specialist-treated US adults with SA, there was a substantial burden of exacerbations and associated healthcare resource utilization. Patients receiving biologics had a lower exacerbation burden.
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Affiliation(s)
| | | | - Warner Carr
- Allergy & Asthma Associates of Southern California, Mission Viejo, California
| | - Wendy C Moore
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Weily Soong
- University of Alabama at Birmingham, Birmingham, Alabama
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Karaboyas A, Muenz D, Fuller DS, Desai P, Lin TC, Robinson BM, Rossetti S, Pisoni RL. Etelcalcetide Utilization, Dosing Titration, and Chronic Kidney Disease-Mineral and Bone Disease (CKD-MBD) Marker Responses in US Hemodialysis Patients. Am J Kidney Dis 2021; 79:362-373. [PMID: 34273436 DOI: 10.1053/j.ajkd.2021.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 05/23/2021] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVE Clinical trial data have demonstrated the efficacy of etelcalcetide for reducing parathyroid hormone (PTH) levels in hemodialysis (HD) patients. We provide a real-world summary of etelcalcetide utilization, dosing, effectiveness, and discontinuation since its US introduction in April 2017. STUDY DESIGN New-user design within prospective cohort. SETTING PARTICIPANTS 2596 new users of etelcalcetide from April 2017 through August 2019 in a national sample of adult, chronic HD patients in the US Dialysis Outcomes and Practice Patterns Study (DOPPS). PREDICTORS Baseline PTH, prior cinacalcet use, initial etelcalcetide dose. OUTCOME(S) Trajectories of etelcalcetide dose, use of mineral bone disorder (MBD) medications, and levels of PTH, serum calcium, and phosphorus in the 12 months following etelcalcetide initiation. ANALYTICAL APPROACH Cumulative incidence methods for etelcalcetide discontinuation and linear generalized estimating equations for trajectory analyses. RESULTS By August 2019 etelcalcetide prescriptions increased to 6% of HD patients from their first use in April 2017. Starting etelcalcetide dose was 15 mg/week in 70% of patients and 7.5 mg/week in 27% of patients; 49% of new users were prescribed cinacalcet in the prior 3 months. Etelcalcetide discontinuation was 9%, 17%, and 27% by 3, 6, and 12 months post-initiation. One year after etelcalcetide initiation, mean PTH levels declined by 40%, from 948 to 566 pg/mL, and the proportion of patients with PTH within target (150-599 pg/mL) increased from 33% to 64% overall, from 0% to 60% among patients with baseline PTH ≥600 pg/mL, and from 30% to 63% among patients with prior cinacalcet use. The proportion of patients with serum phosphorus >5.5 mg/dL decreased from 55% to 45%, while the prevalence of albumin-corrected serum calcium <7.5 mg/dL remained at 1%-2%. Use of active vitamin D (from 77% to 87%) and Ca-based phosphate binders (from 41% to 50%) increased in the 12 months following etelcalcetide initiation. LIMITATIONS Data unavailable for provider dosing protocols, dose holds, or reasons for discontinuation. CONCLUSIONS In the 12 months following etelcalcetide initiation, patients had large and sustained reductions in PTH levels. These results support the utility of etelcalcetide as an effective therapy to achieve the KDIGO recommended guidelines for CKD-MBD markers in HD patients.
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Affiliation(s)
| | - Daniel Muenz
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
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Vasudeva R, Bhatt P, Lilje C, Desai P, Amponsah J, Umscheid J, Parmar N, Bhatt N, Adupa R, Pagad S, Agrawal P, Donda K, Dapaah-Siakwan F, Yagnik P. Trends in Acute Myocarditis Related Pediatric Hospitalizations in the United States, 2007-2016. Am J Cardiol 2021; 149:95-102. [PMID: 33757784 DOI: 10.1016/j.amjcard.2021.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/07/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
There has been little exploration of acute myocarditis trends in children despite notable advancements in care over the past decade. We explored trends in pediatric hospitalizations for acute myocarditis from 2007 to 2016 in the United States (US). This was a retrospective, serial cross-sectional study of the National Inpatient Sample database from 2007 to 2016, identifying patients ≤18 years hospitalized with acute myocarditis. Patient demographics and incidence trends were examined. Other relevant clinical and resource utilization outcomes were also explored. Out of 60,390,000 weighted pediatric hospitalizations, 6371 were related to myocarditis. The incidence of myocarditis increased from 0.7 to 0.9 per 100,000 children (p <0.0001) over the study period. The mortality decreased from 7.5% to 6.1% (p = 0.02). A significant inflation-adjusted increase by $4,574 in the median hospitalization cost was noted (p = 0.02) while length of stay remained stable (median 6.1 days). Tachyarrhythmias were identified as the most common type of associated arrhythmia. The occurrence of congestive heart failure remained steady at 27%. In conclusion, in-hospital mortality associated with pediatric acute myocarditis has decreased in the United States over years 2007 to 2016 with a concurrent rise in incidence. Despite steady length of stay, hospitalization costs have increased. Future studies investigating long-term outcomes relating to acute myocarditis are warranted.
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Tehrani D, Wang X, Rafique AM, Hayek SS, Herrmann J, Neilan TG, Desai P, Morgans A, Lopez-mattei J, Parikh RV, Yang EH. Impact of Cancer and Cardiovascular Disease on In-Hospital Outcomes of COVID-19 Patients: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry.. [PMID: 34127966 PMCID: PMC8202433 DOI: 10.21203/rs.3.rs-600795/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: While pre-existing cardiovascular disease (CVD) appears to be associated with poor outcomes in patients with Coronavirus Disease 2019 (COVID-19), data on patients with CVD and concomitant cancer is limited. Evaluate the effect of underlying CVD and CVD risk factors with cancer history on in-hospital mortality in those with COVID-19. Methods: Data from symptomatic adults hospitalized with COVID-19 at 86 hospitals in the US enrolled in the American Heart Association’s COVID-19 CVD Registry was analyzed. The primary exposure was cancer history. The primary outcome was in-hospital death. Multivariable logistic regression models were adjusted for demographics, CVD risk factors, and CVD. Interaction between history of cancer with concomitant CVD and CVD risk factors were tested. Results: Among 8222 patients, 892 (10.8%) had a history of cancer and 1501 (18.3%) died. Cancer history had significant interaction with CVD risk factors of age, body mass index (BMI), and smoking history, but not underlying CVD itself. History of cancer was significantly associated with increased in-hospital death (among average age and BMI patients, adjusted odds ratio [aOR]=3.60, 95% confidence interval [CI]: 2.07–6.24; p<0.0001 in those with a smoking history and aOR=1.33, 95%CI: 1.01 – 1.76; p=0.04 in non-smokers). Among the cancer subgroup, prior use of chemotherapy within 2 weeks of admission was associated with in-hospital death (aOR=1.72, 95%CI: 1.05–2.80; p=0.03). Underlying CVD demonstrated a numerical but statistically nonsignificant trend toward increased mortality (aOR=1.18, 95% CI: 0.99 – 1.41; p=0.07). Conclusion: Among hospitalized COVID-19 patients, cancer history was a predictor of in-hospital mortality. Notably, among cancer patients, recent use of chemotherapy, but not underlying CVD itself, was associated with worse survival. These findings have important implications in cancer therapy considerations and vaccine distribution in cancer patients with and without underlying CVD and CVD risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Juan Lopez-Mattei
- MD Anderson Division of Radiation Oncology: The University of Texas MD Anderson Cancer Center Division of Radiation Oncology
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Henner DE, Drambarean B, Gerbeling TM, Kendrick JB, Kendrick WT, Koester Wiedemann L, Nickolas T, Rastogi A, Rauf AA, Dyson B, Singer MC, Desai P, Fox K, Cheng S, Goodman W. MO571PRACTICE PATTERNS ON THE MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM IN THE UNITED STATES: RESULTS FROM A MODIFIED DELPHI PANEL. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab086.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
The 2017 Kidney Disease Improving Global Outcomes (KDIGO) Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) guidelines inform clinical practice for the management of secondary hyperparathyroidism (SHPT) internationally; however, many recommendations lacked high or moderate clinical evidence as defined by KDIGO. An expert panel was convened to establish clinical consensus for the current management of SHPT in the United States (US).
Method
The panel comprised 10 US healthcare providers (HCPs; [6 nephrologists, 1 surgeon, 1 nurse practitioner, 1 pharmacist, 1 dietician]) and 1 patient. HCP panelists participated in a modified Delphi process over 3 phases, addressing 126 questions based on a review of the literature and published guidelines. The threshold for consensus was 66%. In phases 1 and 2, panelists anonymously completed electronic surveys considering a ‘typical’ patient with SHPT unless otherwise specified. In phase 1, panelists answered 126 questions based on their own knowledge and experiences. In phase 2, panelists were reminded of their answers to closed-ended questions that did not achieve consensus in phase 1 and were asked if they would change their responses in light of the most common response. For open-ended questions, they were asked if they agreed with summary statements that captured the most common answers. Phase 3 was an unblinded virtual meeting where panelists reviewed the consensus reached in phases 1 and 2, and through active discussion, resolved those questions that had not reached consensus. The patient completed a separate electronic survey, which complemented key points in the HCP survey, and provided perspective during the virtual meeting.
Results
All 11 panelists completed the entire modified Delphi process. Sixty-three out of 126 (50%) and 116/126 (92.1%) questions reached consensus or addressed practice-specific information not requiring consensus by the end of phase 1 and 2, respectively; all questions reached consensus by the end of phase 3, including modification of 2 questions and the addition of 1 question. The panel unanimously agreed that SHPT treatment is often started too late and suggested additional markers for early identification of patients requiring treatment are needed. Serum levels of calcium, phosphate, and parathyroid hormone (PTH) should be monitored starting at CKD stage G3a at intervals of every 6 months, 3–6 months for CKD G3b, and at least every 3 months at CKD G4 and above. Thresholds for interventions could not be defined in absolute terms for all patients due to patient-and practice-specific factors. However, in patients on dialysis, serum levels of phosphate > 5.5 mg/dL (1.8 mmol/L) and calcium > 9.5 mg/dL (2.4 mmol/L), warrant increased monitoring and consideration of therapeutic interventions. Serum intact PTH > 300 pg/mL (32 pmol/L) typically indicates a need for SHPT treatment, with a consensus preferred target of 150–300 pg/mL (16–32 pmol/L); patients on dialysis were considered out of PTH target at ≥ 8 times the upper limit of normal (> 520 pg/mL [55 pmol/L] intact PTH). HCPs were concerned about vascular calcification in all patients with CKD 3a–G5D. The panel reached consensus on the use of several SHPT interventions, including a consensus preference for the intravenous calcimimetic etelcalcetide over the oral calcimimetic cinacalcet in appropriate in-center dialysis patients requiring PTH-lowering therapy; cinacalcet was agreed to be first-line therapy in appropriate patients on home dialysis (Table 1). Factors such as formularies and dialysis center protocols were recognized to influence therapeutic choices.
Conclusion
Ten US HCPs reached consensus on many aspects of SHPT management, further defining therapeutic strategies and highlighting the need to be proactive. While the panel expressed evidenced-based preferences for certain therapies, factors such as cost and dialysis center protocols may affect decision making.
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Affiliation(s)
- David E Henner
- Berkshire Medical Center, Division of Nephrology, Pittsfield, Massachusetts, United States of America
| | - Beatrice Drambarean
- University of Illinois Hospital & Health Sciences System, Chicago, Illinois, United States of America
| | | | - Jessica B Kendrick
- University of Colorado, Division of Renal Diseases and Hypertension, Aurora, Colorado, United States of America
| | - William T Kendrick
- Eastern Nephrology Associates, Greenville, North Carolina, United States of America
| | - Lisa Koester Wiedemann
- Washington University School of Medicine, Division of Nephrology, St. Louis, Missouri, United States of America
| | - Thomas Nickolas
- Columbia University Irving Medical Center, Division of Nephrology, New York, New York, United States of America
| | - Anjay Rastogi
- UCLA School of Medicine, Division of Nephrology, Los Angeles, California, United States of America
| | - Anis A Rauf
- Nephrology Associates of Northern Illinois, Oakbrook, Illinois, United States of America
| | | | - Michael C Singer
- Henry Ford Hospital, Department of Otolaryngology–Head and Neck Surgery, Detroit, Michigan, United States of America
| | - Pooja Desai
- Amgen, Inc., Thousand Oaks, California, United States of America
| | - Kathleen Fox
- Amgen, Inc., Thousand Oaks, California, United States of America
| | - Sunfa Cheng
- Amgen, Inc., Thousand Oaks, California, United States of America
| | - William Goodman
- Amgen, Inc., Thousand Oaks, California, United States of America
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Karaboyas A, Muenz D, Hwang Y, Goodman W, Cheng S, Desai P, Fox K, Robinson B, Pisoni R. FC 078REAL-WORLD EFFECTIVENESS OF ETELCALCETIDE VS. CINACALCET IN US HEMODIALYSIS PATIENTS: A FACILITY CALCIMIMETIC PREFERENCE APPROACH. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab123.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Calcimimetic therapy, including oral cinacalcet and intravenous (IV) etelcalcetide, is often used to control parathyroid hormone (PTH) levels in hemodialysis (HD) patients. In a head-to-head clinical trial, etelcalcetide was superior to cinacalcet on PTH reduction. Given that oral administration of cinacalcet is susceptible to challenges of self-management and adherence, etelcalcetide may be even more effective in the real-world setting. To limit confounding by indication, we used a facility calcimimetic preference approach to investigate the comparative effectiveness of etelcalcetide vs. cinacalcet by estimating effects on PTH and other mineral and bone disorder (MBD) markers in a cohort of US HD patients.
Method
We used data from the US Dialysis Outcomes and Practice Patterns Study (US-DOPPS), a prospective cohort study of in-center HD patients. During a 6-month run-in period from March to August 2019, we evaluated facility calcimimetic preference by calculating the proportion of calcimimetic users in each facility who were prescribed etelcalcetide (vs. cinacalcet). Among patients with any prescription for a calcimimetic during the 6-month run-in period, we evaluated MBD marker outcomes (PTH, albumin-corrected serum calcium [Ca], serum phosphorus [P]), averaged over the subsequent 6 months, from September 2019 to February 2020. We compared HD facilities that treated >75% of calcimimetic users with etelcalcetide (“Etel-first”) vs. those that treated >75% of calcimimetic users with cinacalcet (“Cina-first”). Linear regression was used to model each continuous outcome. Modified Poisson regression was used to estimate the prevalence ratio (PR) of each MBD marker being out of target (PTH >600 pg/mL, Ca <8.4 mg/dL, P >5.5 mg/dL). All models were adjusted for patient-level and facility-level confounders and accounted for facility clustering using GEE.
Results
We excluded 38 HD facilities with little-to-no calcimimetic use (<10% use or <5 total users) because calcimimetic preference could not be reliably defined, and 44 HD facilities with no clear calcimimetic preference (25-75% etelcalcetide use among calcimimetic users). The analysis included 2156 calcimimetic users: 969 patients from 45 Etel-first facilities and 1187 patients from 67 Cina-first facilities. In Etel-first (vs. Cina-first) HD facilities, the mean difference in PTH levels (primary outcome) was -99 pg/mL (95% CI: -179, -19) and the prevalence of PTH >600 was lower (PR=0.75; 95% CI: 0.60, 0.94) in adjusted models. The adjusted mean levels of serum Ca and serum P (secondary outcomes) were slightly lower in Etel-first (vs. Cina-first) facilities [Table 1].
Conclusion
To our knowledge, this is the first large-scale comparison of IV etelcalcetide with oral cinacalcet in the real-world setting. Our unique approach resembles a natural experiment by leveraging practice variation across the US and isolating HD facilities with a clear preference for one calcimimetic. Thus, the prescribed calcimimetic type for included patients was more likely determined by facility preference than biased by patient indication. Our results indicate better PTH control (mean levels ∼100 pg/mL lower) in US HD facilities using etelcalcetide (vs. cinacalcet) as the primary calcimimetic therapy. Further research is needed to investigate the degree to which the greater real-world effectiveness of IV etelcalcetide (vs. oral cinacalcet) may be driven by adherence to the prescribed therapy, and how clinical outcomes may be affected.
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Affiliation(s)
- Angelo Karaboyas
- Arbor Research Collaborative for Health, Ann Arbor, United States of America
| | - Daniel Muenz
- Arbor Research Collaborative for Health, Ann Arbor, United States of America
| | - Yunji Hwang
- Amgen, Inc., Thousand Oaks, United States of America
| | | | - Sunfa Cheng
- Amgen, Inc., Thousand Oaks, United States of America
| | - Pooja Desai
- Amgen, Inc., Thousand Oaks, United States of America
| | - Kathleen Fox
- Amgen, Inc., Thousand Oaks, United States of America
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, United States of America
- University of Michigan, Department of Internal Medicine, Ann Arbor, United States of America
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, United States of America
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Tehrani D, Rafique A, Wang X, Desai P, Morgans A, Herrmann J, Lopez-Mattei J, Neilan T, Hayek S, Parikh R, Yang E. IN-HOSPITAL OUTCOMES AMONG COVID-19 PATIENTS WITH CANCER AND CARDIOVASCULAR DISEASE. J Am Coll Cardiol 2021. [PMCID: PMC8091257 DOI: 10.1016/s0735-1097(21)04419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reibman J, Tan L, Ambrose C, Chung Y, Desai P, Llanos JP, Moynihan M, Tkacz J. Clinical and economic burden of severe asthma among US patients treated with biologic therapies. Ann Allergy Asthma Immunol 2021; 127:318-325.e2. [PMID: 33775904 DOI: 10.1016/j.anai.2021.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with severe asthma may remain uncontrolled despite biologic therapy in addition to standard therapy, but this disease burden has not been quantified. OBJECTIVE To estimate the clinical and economic burden in a US national sample. METHODS Patients who have severe asthma with indicated biologic treatment (earliest use = index date) were selected from the MarketScan database between January 1, 2013, and June 30, 2018. Inclusion criteria were continuous enrollment for 12 months postindex with a minimum of 2 biologic fills, greater than or equal to 12 years of age, evidence of medium- to high-dose inhaled corticosteroids and long-acting β-agonist combination before the index, and absence of other respiratory diagnoses and malignancies. Disease exacerbations (used to classify asthma control), health care costs, and treatment characteristics were reported during the 12-month postindex period. RESULTS The sample included 3262 biologic patients; 88% with anti-immunoglobulin E therapy (omalizumab) and 12% non-anti-immunoglobulin E (reslizumab, mepolizumab, benralizumab). The mean age was 49 (±15) years; 64% were women. Prescriptions included inhaled corticosteroids and long-acting β-agonist (82%), systemic corticosteroids (76%), and leukotriene receptor antagonists (68%). Notably, 63% of patients presented greater than or equal to 1 asthma exacerbation (mean 1.3 per patient/year). Furthermore, 35% of patients were categorized as having controlled asthma, whereas 28% were suboptimally controlled and 29% were uncontrolled. Patients with uncontrolled disease had higher all-cause and asthma-related costs ($69,206 and $45,693, respectively) than patients with suboptimally controlled ($59,407 and $40,793, respectively) or controlled disease ($53,083 and $38,393, respectively). Furthermore, 62% of newly treated patients were persistent with their index biologic. CONCLUSION Biologic therapies are effective in reducing exacerbations, but a substantial proportion of patients with severe asthma treated with current biologics continue to experience uncontrolled disease, highlighting a remaining unmet need for patients with severe uncontrolled asthma.
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Affiliation(s)
- Joan Reibman
- Department of Medicine, NYU Langone Health, New York, New York.
| | - Laren Tan
- Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Chris Ambrose
- Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | - Yen Chung
- Payer Evidence, AstraZeneca, Gaithersburg, Maryland
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Chirenda J, Nhlema Simwaka B, Sandy C, Bodnar K, Corbin S, Desai P, Mapako T, Shamu S, Timire C, Antonio E, Makone A, Birikorang A, Mapuranga T, Ngwenya M, Masunda T, Dube M, Wandwalo E, Morrison L, Kaplan R. A feasibility study using time-driven activity-based costing as a management tool for provider cost estimation: lessons from the national TB control program in Zimbabwe in 2018. BMC Health Serv Res 2021; 21:242. [PMID: 33736629 PMCID: PMC7977596 DOI: 10.1186/s12913-021-06212-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Insufficient cost data and limited capacity constrains the understanding of the actual resources required for effective TB control. This study used process maps and time-driven activity-based costing to document TB service delivery processes. The analysis identified the resources required to sustain TB services in Zimbabwe, as well as several opportunities for more effective and efficient use of available resources. Methods A multi-disciplinary team applied time-driven activity-based costing (TDABC) to develop process maps and measure the cost of clinical pathways used for Drug Susceptible TB (DS-TB) at urban polyclinics, rural district and provincial hospitals, and community based targeted screening for TB (Tas4TB). The team performed interviews and observations to collect data on the time taken by health care worker-patient pairs at every stage of the treatment pathway. The personnel’s practical capacity and capacity cost rates were calculated on five cost domains. An MS Excel model calculated diagnostic and treatment costs. Findings Twenty-five stages were identified in the TB care pathway across all health facilities except for community targeted screening for TB. Considerable variations were observed among the facilities in how health care professionals performed client registration, taking of vital signs, treatment follow-up, dispensing medicines and processing samples. The average cost per patient for the entire DS-TB care was USD324 with diagnosis costing USD69 and treatment costing USD255. The average cost for diagnosis and treatment was higher in clinics than in hospitals (USD392 versus USD256). Nurses in clinics were 1.6 time more expensive than in hospitals. The main cost components were personnel (USD130) and laboratory (USD119). Diagnostic cost in Tas4TB was twice that of health facility setting (USD153 vs USD69), with major cost drivers being demand creation (USD89) and sputum specimen transportation (USD5 vs USD3). Conclusion TDABC is a feasible and effective costing and management tool in low-resource settings. The TDABC process maps and treatment costs revealed several opportunities for innovative improvements in the NTP under public health programme settings. Re-engineering laboratory testing processes and synchronising TB treatment follow-up with antiretroviral treatments could produce better and more uniform TB treatments at significantly lower cost in Zimbabwe.
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Affiliation(s)
- J Chirenda
- College of Health Sciences, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - B Nhlema Simwaka
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland.
| | - C Sandy
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - K Bodnar
- Harvard Business School, Boston, MA, USA
| | - S Corbin
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - P Desai
- Harvard Business School, Boston, MA, USA
| | - T Mapako
- College of Health Sciences, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.,National Blood Service, Harare, Zimbabwe
| | - S Shamu
- College of Health Sciences, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - C Timire
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - E Antonio
- Price Waterhouse Coopers (PWC), Harare, Zimbabwe
| | - A Makone
- Price Waterhouse Coopers (PWC), Harare, Zimbabwe
| | - A Birikorang
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - T Mapuranga
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - M Ngwenya
- World Health Organisation, Harare, Zimbabwe
| | - T Masunda
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - M Dube
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - E Wandwalo
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - L Morrison
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - R Kaplan
- Harvard Business School, Boston, MA, USA
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Tan L, Reibman J, Ambrose C, Chung Y, Desai P, Llanos Ackert JP, Moynihan M, Tkacz J. Clinical and Economic Burden of Patients with Uncontrolled Severe Asthma with Low Blood Eosinophil Levels in the United States. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gooding M, Desai P, Owens H, Petrilla AA, Kambhampati M, Levine Z, Young J, Fagan J, Rubin R. Calcimimetic Use in Dialysis-Dependent Medicare Fee-for-Service Beneficiaries and Implications for Bundled Payment. Kidney360 2020; 1:1091-1098. [PMID: 35368776 PMCID: PMC8815481 DOI: 10.34067/kid.0003042020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/21/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patients who are dialysis dependent and have secondary hyperparathyroidism (SHPT) may require calcimimetics to reduce parathyroid hormone levels to treatment goals. Medicare currently uses the Transitional Drug Add-on Payment Adjustment (TDAPA) designation under the ESKD Prospective Payment System ("bundled payment") to pay for calcimimetics (the first products eligible for the adjustment); this payment designation for calcimimetics is expected to conclude after 2020. This study explores variability in calcimimetic use across key patient characteristics and its potential effect on policy options for incorporating calcimimetics permanently into the bundle. METHODS This descriptive analysis used the 100% sample of Medicare FFS Part B (outpatient) 2018 claims to describe national-, regional-, and patient-level variation (including race, dual eligibility, and dialysis vintage) in calcimimetic use among beneficiaries who are dialysis dependent. RESULTS A total of 373,874 beneficiaries were analyzed, 28% had ≥90 days of calcimimetic use during 2018. At the national level, the proportion of patients on dialysis using calcimimetics was roughly 80% higher in Black versus non-Black patients on dialysis, 30% higher in patients on dialysis who were dual eligible versus non-dual eligible, and three times higher in patients with a dialysis vintage ≥3 years versus <3 years (all results unadjusted). Calcimimetic use was similar across census regions, however, substantial variation in calcimimetic use was observed at the facility level. Medicare spending for calcimimetic therapies as a proportion of total Medicare dialysis spending was >10% in approximately 20% of dialysis facilities. CONCLUSIONS Although less than a third of beneficiaries use calcimimetics, certain patient-level characteristics are associated with higher rates of maintenance calcimimetic use. Due to the financial pressure many dialysis facilities face, how calcimimetics are incorporated into the bundle may have a direct effect on facility reimbursement for, and patient access to, therapy. Careful consideration will be required to ensure patients who are vulnerable and require treatment for SHPT do not face barriers to appropriate care.
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Affiliation(s)
| | - Pooja Desai
- Global Health Economics, Amgen, Inc., Thousand Oaks, California
| | - Holly Owens
- US Government Affairs and Policy, Amgen, Inc., Washington, DC
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Quinton A, Chung J, Desai P, Dube J, Ambrose C. TARGETED LITERATURE REVIEW: BURDEN OF DISEASE ASSOCIATED WITH SEVERE, UNCONTROLLED ASTHMA IN THE USA. Chest 2020. [DOI: 10.1016/j.chest.2020.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Danese MD, Lubeck D, Belozeroff V, Lin TC, Desai P, Gleeson M, Martin K, Chonchol M. Real World Use and Effects of Calcimimetics in Treating Mineral and Bone Disorder in Hemodialysis Patients. Am J Nephrol 2020; 51:815-822. [PMID: 32966995 DOI: 10.1159/000510360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Calcimimetics are used to treat mineral and bone disorder by reducing parathyroid hormone (PTH), calcium (Ca), and phosphorus (Phos). The study objectives were to assess the control of PTH, Ca, and Phos over time in patients receiving cinacalcet or etelcalcetide as well as dosing and time to discontinuation for etelcalcetide. METHODS This was a retrospective cohort study using electronic medical records from small and independent dialysis centers. Adults ≥18 years of age were identified as cinacalcet or etelcalcetide users based on the first calcimimetic received in 2018 (index date). Patients were followed from the index date until parathyroidectomy, kidney transplant, death, or end of data (December 31, 2018). Analyses of mean PTH, Ca, and Phos, as well as target achievement of PTH, Ca, and Phos were conducted over a 9-month period. Discontinuation with etelcalcetide was measured with the Kaplan-Meier estimator. RESULTS There were 1,346 cinacalcet patients (mean age 60.5 years, 43.5% female, and 47.1% Black) and 1,255 etelcalcetide patients (mean age 63.4 years, 46.6% female, and 38.5% Black). At baseline, the proportions in target were similar for etelcalcetide versus cinacalcet: 36 versus 38% for PTH, 79 versus 80% for Ca, and 43 versus 44% for Phos. Overall, 40-47% of cinacalcet users and 48-62% of etelcalcetide users were observed to be in target for PTH over 9 months. The proportion in target for Phos ranged from 41 to 46% for cinacalcet and 46-51% for etelcalcetide. The proportion in target for Ca ranged from 74 to 78% for cinacalcet and 60-73% for etelcalcetide. Etelcalcetide 12-month discontinuation was 37.4%. CONCLUSION Both calcimimetics were effective in keeping PTH, Ca, and Phos levels within target. Patients receiving etelcalcetide tended to have lower laboratory values for PTH, Ca, and Phos over time, while patients receiving cinacalcet tended to be more likely to be in target for Ca over time.
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Affiliation(s)
- Mark D Danese
- Outcomes Insights, Inc., Agoura Hills, California, USA,
| | | | | | | | | | | | - Kevin Martin
- Division of Nephrology and Hypertension, Saint Louis University, St. Louis, Missouri, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado, USA
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Maheshwari R, Qadri SY, Rakhul LR, Chaturvedi S, Desai P, Grover R, Chhabra G, Khullar D, Kumar A. Prospective Nonrandomized Comparison Between Open and Robot-Assisted Kidney Transplantation: Analysis of Midterm Functional Outcomes. J Endourol 2020; 34:939-945. [PMID: 32600060 DOI: 10.1089/end.2020.0213] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: To compare short- and midterm outcomes of the first 55 patients undergoing robot-assisted kidney transplant (RAKT) with patients undergoing open kidney transplant (OKT) during the same period in a tertiary care hospital. Materials and Methods: Data of all end-stage renal disease patients undergoing renal transplant were prospectively maintained. All graft kidneys were harvested laparoscopically. Both RAKT and OKT were performed using standardized techniques, and all RAKTs were performed by a single experienced robotic surgeon. Chi-square test/Fisher exact test was done for categorical data, and Mann-Whitney U test was done for continuous data. Discrete variables were expressed in absolute numbers and percentages. For all tests, p < 0.05 was considered significant. All results were expressed as mean ± standard deviation or median with range. Results: Between April 2016 and September 2018, 55 patients underwent RAKT. The same was compared with 152 patients who underwent OKT. The two groups were comparable in terms of age, gender, and body mass index. Duration on hemodialysis was significantly higher in the RAKT group, and hemoglobin and donor kidney glomerular filtration rate was significantly better in the RAKT group. Requirement of perioperative analgesia was significantly less in the RAKT group. Rewarm ischemia time was significantly longer in the RAKT group. The fall in serum creatinine was slower in RAKT group till 3 months. The serum creatinine levels were statistically similar in the two cohorts at 3 months (p = 0.082), which was maintained at median 29 months of follow-up (p = 0.067). Tacrolimus levels on postoperative day 2 were found to be significantly higher in RAKT cohort (17.98 ± 14.41) vs OKT cohort (11.38 ± 6.93). Surgical-site infections were rare in the RAKT group. Conclusions: RAKT confers advantage of decreased wound morbidity with similar functional outcomes compared with OKT in midterm. It looks promising; however, long-term follow-up of larger numbers of patients is needed.
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Affiliation(s)
- R Maheshwari
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - S Y Qadri
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - L R Rakhul
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - S Chaturvedi
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - P Desai
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - R Grover
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - G Chhabra
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - D Khullar
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - A Kumar
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
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Maheshwari R, Chaturvedi S, Desai P, Panwar P, Singh V, Bansal D, Bansal A, Kumar A. Comparison of outcomes between open and robot assisted kidney transplant in paediatric population - initial results. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
INTRODUCTION Migraine management is characterized by the poor use of preventive therapy and the overuse of acute medications. An analysis of current treatment patterns in migraineurs is needed to improve care in this patient population. The aim of this study was to describe treatment patterns and healthcare utilization of newly diagnosed migraine patients. METHODS This was a retrospective observation study of newly diagnosed migraine patients (no indication of migraine in the past year) identified in the IBM MarketScan Commercial Claims and Encounters database from 1 January 2010 to 30 June 2014. The final study population comprised persons aged 18-64 years at index (new diagnosis of migraine) with 12 months of continuous enrollment in an insurance plan with medical and pharmacy benefits pre-index and post-index. Treatment patterns and healthcare resource utilization were assessed during the post-index period (at least 12-months). RESULTS Of the 1,588,666 migraine patients identified in the database as potentially eligible to participate in the study, 284,719 (17.9%) met the final inclusion criteria. Patients generally used acute and preventive therapies to manage migraine attacks, with most patients using preventive therapy (59.1%). However, 67.9% of those using preventive therapy discontinued the current therapy, with a median time to discontinuation of 5 months. Most of the patients who discontinued preventative therapy also used an acute treatment to manage migraine attacks after discontinuation (77.6%), generally in the year following discontinuation (68.4%). Patients on acute therapies were found to use triptans excessively (1.6%) and other non-migraine-specific acute medications for treatment (7.1%). Acute patients were also at risk of opioid dependence (12.0%) and commonly received opioids or barbiturates as first-line therapy (34.1%). CONCLUSION Newly diagnosed migraine patients are not being properly treated, as indicated by their excessive use of acute therapies and short time on preventive treatment before discontinuation of that treatment. Further study of the reasons why patients discontinue preventive therapy (adverse events, no response, etc.) and continue to excessively use acute treatments once their treatment regimen has been established is needed.
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Duzyj CM, Desai P, Patrick HS, Rosen TJ, Wang B. 136: Characterization of decidual natural killer cell populations and abnormal trophoblast invasion in late human pregnancy. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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