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Indolfi G, Easterbrook P, Giometto S, Malik F, Chou R, Lucenteforte E. Efficacy and safety of DAA in children and adolescents with chronic HCV infection: A systematic review and meta-analysis. Liver Int 2024; 44:663-681. [PMID: 38293756 DOI: 10.1111/liv.15827] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND AIMS We evaluated the effectiveness and safety of pan-genotypic regimens, glecaprevir/pibrentasvir (GLE/PIB), sofosbuvir/velpatasvir (SOF/VEL), and sofosbuvir/daclatasvir (SOF/DCV) and other direct-acting antivirals (DAA) regimens for the treatment of hepatitis C virus (HCV)-infected adolescents (12-18 years), older children (6-11 years), and young children (3-5 years). The purpose of this systematic review and meta-analysis was to inform the World Health Organization (WHO) guidelines. METHODS We included clinical trials and observational studies published up to August 11, 2021, that evaluated DAA regimens in HCV-infected adolescents, older children, and young children. We searched MEDLINE, EMBASE, and CENTRAL databases and key conference abstracts. Sustained virological response 12 weeks after the end of treatment (SVR12), adverse events (AEs), and treatment discontinuation were the outcomes evaluated. Risk of bias was assessed using a modified version of the ROBINS-I tool. Data were pooled using random-effects models, and certainty of the evidence was assessed using the GRADE approach. RESULTS A total of 49 studies including 1882 adolescents, 436 older children, and 166 young children were considered. The SVR12 was 100% (95% Confidence Interval: 96-100), 96% (90-100), and 96% (83-100) for GLE/PIB in adolescents, older, and young children, respectively; 95% (90-99), 93% (86-98), and 83% (70-93), for SOF/VEL, respectively; and 100% (97-100) and 100% (94-100) for SOF/DCV in adolescent and older children, respectively. There was a clear trend towards a higher rate of any reported AE from adolescents (50%), older children (53%), to young children (72%). Serious AEs and treatment discontinuations were uncommon in adolescents and older children (<1%) but slightly higher in young children (3%). CONCLUSIONS All three pan-genotypic DAA regimens were highly effective and well-tolerated and are now recommended by the WHO for use in adults, adolescents, and children down to 3 years, which will simplify procurement and supply chain management. The evidence was based largely on single-arm non-randomized controlled studies. Moreover, there were also missing data regarding key variables such as route of HCV acquisition, presence or absence of cirrhosis, or HIV co-infection that precluded evaluation of the impact of these factors on outcomes. PROSPERO RECORD CRD42020146752.
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Affiliation(s)
- Giuseppe Indolfi
- Department Neurofarba, University of Florence, Florence, Italy
- Paediatric and Liver Unit, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Philippa Easterbrook
- Global HIV, Hepatitis and STI Programmes, World Health Organization Headquarters, Geneva, Switzerland
| | - Sabrina Giometto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Farihah Malik
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Roger Chou
- Departments of Medicine, and Medical Informatics & Clinical Epidemiology, Oregon Health Sciences University, Portland, Oregon, USA
| | - Ersilia Lucenteforte
- Department of Statistics, Computer Science and Applications «G. Parenti», University of Florence, Florence, Italy
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Giometto S, Finocchietti M, Paoletti O, Lombardi N, Celani MG, Sciancalepore F, Lucenteforte E, Kirchmayer U. Adherence to riluzole therapy in patients with amyotrophic lateral sclerosis in three Italian regions-The CAESAR study. Pharmacoepidemiol Drug Saf 2024; 33:e5736. [PMID: 38014926 DOI: 10.1002/pds.5736] [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: 06/12/2023] [Revised: 09/12/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease. Riluzole may increase survival and delay the need for mechanical ventilation. The CAESAR project ('Comparative evaluation of the efficacy and safety of drugs used in rare neuromuscular and neurodegenerative diseases', FV AIFA project 2012-2013-2014) involves evaluating prescribing patterns, and analysing effectiveness and comparative safety of drugs, in patients with neurodegenerative diseases. The aim of this study is to evaluate adherence to riluzole in patients with ALS during the first year of use, identifying adherence clusters. METHODS A retrospective cohort study was conducted using administrative data from Latium, Tuscany, and Umbria. We identified subjects with a new diagnosis of ALS between 2014 and 2019, with the first dispensation of riluzole within 180 days of diagnosis. We considered a two-year look-back period for the characterization of patients, and we followed them from the date of first dispensing of riluzole for 1 year. We calculated 12 monthly adherence measures, through a modified version of the Medication Possession Ratio, estimating drug coverage with Defined Daily Dose. Adherence trajectories were identified using a three-step method: (1) calculation of statistical measures; (2) principal component analysis; (3) cluster analysis. Patient characteristics at baseline and during follow-up were described and compared between adherence groups identified. RESULTS We included 264 ALS patients as new users of riluzole in Latium, 344 in Tuscany, and 63 in Umbria. We observed a higher frequency of males (56.2%) and a mean age of 67.4 (standard deviation, SD, 10.4) in the overall population. We identified two clusters in all regions: one more numerous, including adherent patients (60%, 74%, 88%, respectively), and another one including patients who discontinued therapy (40%, 26%, 12%, respectively). In Tuscany patients discontinuing riluzole more frequently died (28.6% vs. 15.4%, p-value <0.01). Additionally, low-adherers had a higher frequency of central nervous system disorders (69.0% vs. 52.5%, p-value 0.01), and a greater use of non-pharmacological treatments (p-values ≤0.01 for invasive ventilation and tracheostomy). We did not observe any differences in Lazio, whereas in Umbria we observed a higher use of drugs for dementia-related psychiatric problems among low-adherers (57.1% vs. 7.8%, respectively, p-value <0.01), although with small numbers. CONCLUSION Most ALS patients who start riluzole adhere to therapy during the first year. Patients who discontinue therapy early show greater fragility and mortality.
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Affiliation(s)
- Sabrina Giometto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Niccolò Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Francesco Sciancalepore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Ferraro S, Cappello E, Bartolini C, Convertino I, Bertani L, Lucenteforte E, Costa F, Paoletti O, Giometto S, Gini R, Tuccori M. Potential missed diagnoses of Crohn's disease in tertiary care: impact on drug utilization and healthcare facilities use. Eur J Gastroenterol Hepatol 2023; 35:1263-1269. [PMID: 37724478 DOI: 10.1097/meg.0000000000002642] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND A missed diagnosis of Crohn's disease (CD) can delay treatment initiation with consequences on disease course. AIMS To measure the possible impact of missed diagnoses on drug utilization and access to healthcare facilities in a real-world cohort of CD patients. METHODS This retrospective observational study has been conducted on the regional administrative databases of Tuscany (Italy). We included patients with a first record of CD diagnosis between 06/11/2011 and 06/30/2016. Possible missed diagnosis (exposure) was defined by hospital presentation for gastrointestinal symptoms consistent with CD diagnosis that occurred in the 7-60 months preceding CD diagnosis. We compared exposed and non-exposed patients by assessing time-free from biologic drugs and from Emergency Department (ED) or hospital access. Hazard ratio (HR) was calculated using Cox models. RESULTS Among 3342 CD patients, 584 (17.5%) had a possible missed diagnosis. A risk of being treated with biologic drugs [adjusted HR (aHR): 2.17, 95% CI: 1.75-2.71] and of access to ED or hospitalization (aHR: 1.59, 95% CI: 1.44-1.75) was observed in patients with a possible missed diagnosis as compared to those without. CONCLUSION Tertiary care caregivers should be trained in the identification of early CD symptoms, to timely identify CD diagnosis and optimize pharmacological treatment and disease management.
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Affiliation(s)
- Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Claudia Bartolini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Firenze
| | - Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Lorenzo Bertani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa
| | - Francesco Costa
- Department of General Surgery and Gastroenterology, Pisa University Hospital
| | - Olga Paoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa
| | - Rosa Gini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Firenze
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
- Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
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Convertino I, Cazzato M, Tillati S, Giometto S, Gini R, Valdiserra G, Cappello E, Ferraro S, Bonaso M, Bartolini C, Paoletti O, Lorenzoni V, Trieste L, Filippi M, Turchetti G, Cristofano M, Blandizzi C, Mosca M, Lucenteforte E, Tuccori M. Assessing disease activity of rheumatoid arthritis patients and drug-utilization patterns of biologic disease-modifying antirheumatic drugs in the Tuscany region, Italy. Front Pharmacol 2023; 14:1244486. [PMID: 37818193 PMCID: PMC10561246 DOI: 10.3389/fphar.2023.1244486] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction: The disease activity associated with the drug-utilization patterns of biologic Disease Modifying Anti-Rheumatic Drugs (DMARDs) is poorly investigated in real-world studies on rheumatoid arthritis (RA) patients. To investigate the relationship between biologic DMARD initiation/discontinuations in RA patients identified in the healthcare administrative databases of Tuscany and the Disease Activity Score 28 (DAS28) reported in the medical charts. Methods: This retrospective population-based study included RA's first-ever biologic DMARD users of the Pisa University Hospital from 2014 to 2016. Patients were followed up until 31 December 2019. We evaluated the DAS28 recorded before (T0) and after (T1) the biologic DMARD initiation and before (TD0) and after (TD1) discontinuations. Patients were classified as "off-target" (DAS28 > 3.2) or "in-target" (DAS28 ≤ 3.2). We described the disease activity trends at initiation and discontinuation. Results: Ninety-five users were included (73 women, mean age 59.6). Among 70 patients (74%) with at least three DAS28 measures, 28 (40.0%) were off-target at T0 and 38 (54.3%) in-target at T1. Thirty-three (47%) patients had at least one discontinuation, among those with at least three DAS28 assessments. In the disease activity trend, disease stability or improvement was observed in 28 out of 37 (75.7%) patients at initiation and in 24 out of 37 (64.9%) at discontinuation. Discussion: Biologic DMARD discontinuations identified in the healthcare administrative databasese of Tuscany are frequently observed in situations of controlled RA disease. Further studies are warranted to confirm that these events can be used in studies using healthcare administrative databases as proxies of treatment effectiveness.
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Affiliation(s)
- Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Silvia Tillati
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosa Gini
- Tuscan Regional Healthcare Agency, Florence, Italy
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | | | - Leopoldo Trieste
- Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Matteo Filippi
- Direzione Medica di Presidio, University Hospital of Pisa, Pisa, Italy
| | | | | | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Marta Mosca
- Unit of Rheumatology, University Hospital of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
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Spini A, Giometto S, Donnini S, Posarelli M, Dotta F, Ziche M, Tosi GM, Girardi A, Lucenteforte E, Gini R, Etminan M, Virgili G. Risk of Intraocular Pressure Increase With Intravitreal Injections of Vascular Endothelial Growth Factor Inhibitors: A Cohort Study. Am J Ophthalmol 2023; 248:45-50. [PMID: 36410468 DOI: 10.1016/j.ajo.2022.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/04/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Intraocular pressure increase (IOPi) after intravitreal injections of vascular endothelial growth factor inhibitors (VEGFis) might be different among different VEGFis (bevacizumab, aflibercept, ranibizumab). The purpose of this study was to evaluate the risk of IOPi among new users of bevacizumab, ranibizumab, and aflibercept in nondiabetic patients in Tuscany, Italy. DESIGN Retrospective cohort study. METHODS Tuscan regional administrative database was used to identify subjects with a first VEGFi intravitreal injection between 2011 and 2020, followed to first incidence of IOPi. Diabetic subjects, those with pre-existing IOPi, or previous use of dexamethasone implants were excluded. Multivariable Cox regression analyses (intention-to-treat and as treated) were conducted to evaluate risk of IOPi among aflibercept, bevacizumab, and ranibizumab, adjusting for potential confounding variables. IOPi was defined as the first record of International Classification of Diseases, Ninth Revision (ICD-9-CM) code 365 or use of 2 glaucoma drugs dispensations within 180 days of each other. RESULTS We identified 6585 new users of VEGFis: 1749 aflibercept, 1112 bevacizumab, and 3724 ranibizumab. Women made up 60% of the cohort, with a mean age of 73.6 years. In the intention-to-treat analysis, the adjusted hazard ratio (HR) for incident IOPi, compared with aflibercept, was higher for bevacizumab (HR = 2.20, 95% CI = 1.64-2.95) and ranibizumab users (HR = 1.88, 95% CI = 1.46-2.42), respectively. The HRs remained robust after exclusion of patients with proxy of retinal vascular occlusion. As treated analysis confirmed such results (bevacizumab: HR = 3.76, 95% CI = 2.30-6.17; ranibizumab: HR = 2.49, 95% CI = 1.62-3.82). CONCLUSIONS This study found an increased risk of IOPi among nondiabetic patients with ranibizumab and bevacizumab compared with aflibercept. Future studies are needed to validate these findings.
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Affiliation(s)
- Andrea Spini
- From the Department of Medicine, Surgery and Neuroscience (A.S., F.D., M.Z., G.M.T.), University of Siena, Siena, Italy; Azienda Ospedaliera Universitaria Senese (A.S., M.P., F.D., G.M.T.), Siena, Italy
| | - Sabrina Giometto
- Department of Clinical and Experimental Medicine (S.G., E.L.), University of Pisa, Pisa, Italy
| | - Sandra Donnini
- Department of Life Sciences (S.D.), University of Siena, Siena, Italy
| | - Matteo Posarelli
- Azienda Ospedaliera Universitaria Senese (A.S., M.P., F.D., G.M.T.), Siena, Italy
| | - Francesco Dotta
- From the Department of Medicine, Surgery and Neuroscience (A.S., F.D., M.Z., G.M.T.), University of Siena, Siena, Italy; Azienda Ospedaliera Universitaria Senese (A.S., M.P., F.D., G.M.T.), Siena, Italy
| | - Marina Ziche
- From the Department of Medicine, Surgery and Neuroscience (A.S., F.D., M.Z., G.M.T.), University of Siena, Siena, Italy; Azienda Ospedaliera Universitaria Senese (A.S., M.P., F.D., G.M.T.), Siena, Italy
| | - Gian Marco Tosi
- From the Department of Medicine, Surgery and Neuroscience (A.S., F.D., M.Z., G.M.T.), University of Siena, Siena, Italy
| | - Anna Girardi
- Agenzia Regionale di Sanità della Toscana (A.G., R.G.), Firenze, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine (S.G., E.L.), University of Pisa, Pisa, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana (A.G., R.G.), Firenze, Italy
| | - Mahyar Etminan
- Departments of Ophthalmology and Visual Sciences and Medicine (M.E.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Gianni Virgili
- Centre for Public Health (G.V.), Queen's University, Belfast, UK; Department NEUROFARBA (G.V.), University of Florence, Florence Italy.
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Convertino I, Lorenzoni V, Gini R, Turchetti G, Fini E, Giometto S, Bartolini C, Paoletti O, Ferraro S, Cappello E, Valdiserra G, Bonaso M, Blandizzi C, Tuccori M, Lucenteforte E. Drug-Utilization, Healthcare Facilities Accesses and Costs of the First Generation of JAK Inhibitors in Rheumatoid Arthritis. Pharmaceuticals (Basel) 2023; 16:ph16030465. [PMID: 36986565 PMCID: PMC10058541 DOI: 10.3390/ph16030465] [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: 02/23/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
This study is aimed at describing tofacitinib and baricitinib users by characterizing their prescription and healthcare histories, drug and healthcare utilization patterns, and direct costs from a healthcare system perspective. This retrospective cohort study was performed using Tuscan administrative healthcare databases, which selected two groups of Janus kinase inhibitors (JAKi) incident users (index date) from 1st January 2018 to 31 December 2019 and from 1 January 2018 to 30 June 2019. We included patients ≥18 years old, at least 10 years of data, and six months of follow-up. In the first analysis, we describe mean time, standard deviation (SD), from the first-ever disease-modifying antirheumatic drug (DMARD) to the JAKi, and costs of healthcare facilities and drugs in the 5 years preceding the index date. In the second analysis, we assessed Emergency Department (ED) accesses and hospitalizations for any causes, visits, and costs in the follow-up. In the first analysis, 363 incident JAKi users were included (mean age 61.5, SD 13.6; females 80.7%, baricitinib 78.5%, tofacitinib 21.5%). The time to the first JAKi was 7.2 years (SD 3.3). The mean costs from the fifth to the second year before JAKi increased from 4325 € (0; 24,265) to 5259 € (0; 41,630) per patient/year, driven by hospitalizations. We included 221 incident JAKi users in the second analysis. We observed 109 ED accesses, 39 hospitalizations, and 64 visits. Injury and poisoning (18.3%) and skin (13.8%) caused ED accesses, and cardiovascular (69.2%) and musculoskeletal (64.1%) caused hospitalizations. The mean costs were 4819 € (607.5; 50,493) per patient, mostly due to JAKi. In conclusion, the JAKi introduction in therapy occurred in compliance with RA guidelines and the increase in costs observed could be due to a possible selective prescription.
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Affiliation(s)
- Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | | | - Rosa Gini
- Tuscan Regional Healthcare Agency, 50100 Florence, Italy
| | | | - Elisabetta Fini
- Medical Specialization School of Pharmacology, University of Pisa, 56126 Pisa, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | | | - Olga Paoletti
- Tuscan Regional Healthcare Agency, 50100 Florence, Italy
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56126 Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56126 Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Balestrini S, Doccini V, Giometto S, Lucenteforte E, De Masi S, Giarola E, Brambilla I, Pieroni F, Perulli M, Battaglia D, Specchio N, Ragona F, Granata T, Pellacani S, Ferrari A, Marini C, Matricardi S, Cesaroni E, Giordano L, Accorsi P, Sciruicchio V, Tinuper P, Messana T, Russo A, Pruna D, Nosadini M, De Giorgis V, Caputo D, Pellegrin S, Lo Barco T, Darra F, Dalla Bernardina B, Guerrini R. A registry for Dravet syndrome: the Italian experience. Epilepsia Open 2023. [PMID: 36938796 DOI: 10.1002/epi4.12730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/15/2022] [Accepted: 03/11/2023] [Indexed: 03/21/2023] Open
Abstract
OBJECTIVES We describe the Residras registry, dedicated to Dravet syndrome (DS) and to other phenotypes related to SCN1A mutations, as a paradigm of registry for rare and complex epilepsies. Our primary objectives are to present the tools and framework of the integrative platform, the main characteristics emerging from the patient cohort included in the registry, with emphasis on demographic, clinical outcome, and mortality. METHODS Standardised data of enrolled paediatric and adult patients were collected in 24 Italian expert centres, and regularly updated at least on a yearly basis. Patients were prospectively enrolled, at registry starting, but historical retrospective data were also included. RESULTS At present, 281 individuals with DS and a confirmed SCN1A mutation are included. Most patients have data available on epilepsy (n=263) and their overall neurological condition (n=255), based on at least one follow-up update. Median age at first clinical assessment was 2 years (IQR 0-9) whilst at last follow-up was 11 years (IQR 5-18.5). During the seven year-activity of the registry, five patients died resulting in a mortality rate of 1.84 per 1000-person-years. When analysing clinical changes over the first 5-year follow-up, we observed a significant difference in cognitive function (P< 0.001), an increased prevalence of behavioural disorders including attention deficit (P< 0.001), a significant worsening of language (P= 0.001) and intellectual disability (P< 0.001). SIGNIFICANCE The Residras registry represents a large collection of standardised national data for the DS population. The registry platform relies on a shareable and interoperable framework which promotes multicentre high-quality data collection. In the future such integrated platform may represent an invaluable asset for easing access to cohorts of patients that may benefit from clinical trials with emerging novel therapies, for drug safety monitoring, and for delineating natural history. Its framework makes it improvable based on growing experience with its use and easily adaptable to other rare and complex epilepsy syndromes.
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Affiliation(s)
- Simona Balestrini
- Neuroscience Department, Meyer Children's Hospital IRCSS-University of Florence, Full Member of European Reference Network EpiCARE, Florence, Italy.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Buckinghamshire, UK
| | - Viola Doccini
- Neuroscience Department, Meyer Children's Hospital IRCSS-University of Florence, Full Member of European Reference Network EpiCARE, Florence, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126, Pisa, Italy
| | | | - Elisa Giarola
- Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy.,Dravet Italia Onlus, Italy; Rare Epilepsies Alliance, Italy; ERN EpiCare (Epag), Italy
| | - Isabella Brambilla
- Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy.,Dravet Italia Onlus, Italy; Rare Epilepsies Alliance, Italy; ERN EpiCare (Epag), Italy
| | | | - Marco Perulli
- Pediatric Neuropsychiatry, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenica Battaglia
- Pediatric Neuropsychiatry, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Specchio
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Full Member of European Reference Network EpiCARE, Milan, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Full Member of European Reference Network EpiCARE, Milan, Italy
| | - Simona Pellacani
- Neuroscience Department, Meyer Children's Hospital IRCSS-University of Florence, Full Member of European Reference Network EpiCARE, Florence, Italy
| | - Annarita Ferrari
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128, Pisa, Italy
| | - Carla Marini
- Department of Child Neuropsychiatry, Children's Hospital, Ancona, Italy
| | - Sara Matricardi
- Department of Child Neuropsychiatry, Children's Hospital, Ancona, Italy
| | | | - Lucio Giordano
- Paediatric Neurology and Psychiatry Unit, Spedali Civili Children's Hospital, University of Brescia, Brescia, Italy
| | - Patrizia Accorsi
- Paediatric Neurology and Psychiatry Unit, Spedali Civili Children's Hospital, University of Brescia, Brescia, Italy
| | | | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età pediatrica, Bologna, Italy
| | - Tullio Messana
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età pediatrica, Bologna, Italy
| | - Angelo Russo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età pediatrica, Bologna, Italy
| | - Dario Pruna
- Child Neurology and Epileptology Unit, Paediatric Department, ARNAS Brotzu, Cagliari, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy
| | - Davide Caputo
- Epilepsy Center, ASST Santi Paolo Carlo, Health Sciences Department University of Milan, Italy
| | - Serena Pellegrin
- Department of Pediatric Neurology, Bolzano Hospital, Bolzano, Italy
| | - Tommaso Lo Barco
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Francesca Darra
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Bernardo Dalla Bernardina
- Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy.,Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital IRCSS-University of Florence, Full Member of European Reference Network EpiCARE, Florence, Italy
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8
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Venturini E, Giometto S, Tamborino A, Becciolini L, Bosis S, Corsello G, Del Barba P, Garazzino S, Lo Vecchio A, Pugi A, Signa S, Stera G, Trapani S, Castelli Gattinara G, Lucenteforte E, Galli L. Sensitivity of three commercial tests for SARS-CoV-2 serology in children: an Italian multicentre prospective study. Ital J Pediatr 2022; 48:192. [PMID: 36461032 PMCID: PMC9716520 DOI: 10.1186/s13052-022-01381-9] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND US Food and Drug Administration has issued Emergency Use Authorizations for hundreds of serological assays to support Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) diagnosis. The aim of this study is to evaluate, for the first time in children, the performance of three widely utilized SARS-CoV-2 serology commercial assays, Diesse Diagnostics (IgG, IgA, IgM) and Roche Diagnostics, both Roche Nucleocapsid (N) IgG and Roche Spike (S) IgG assays. METHODS Sensitivity and 95% confidence intervals (CIs) were estimated for each of the three different serological tests and mixed and direct comparison were performed. Univariate and multivariate Poisson regression models were fitted to calculate incidence rate ratios and 95% CIs as estimate of the effects of age, gender, time on the serology title. A p-value < 0.05 indicated statistical significance. RESULTS Overall, 149 children were enrolled in the study. A low sensitivity was found for Diesse IgA, IgM and IgG. Compare to Diesse, Roche S had a higher sensitivity at 15-28 days from infection (0.94, 95%CI: 0.73-1.0) and Roche N at 28-84 days (0.78, 95%CI: 0.58-0.91). When a direct comparison of IgG tests sensitivity was feasible for patients with pairwise information, Roche S and Roche N showed a statistically significant higher sensitivity compared to Diesse in all the study periods, whereas there was no difference between the two Roche tests. CONCLUSION Roche S and Roche N serology tests seem to better perform in children. Large prospective studies are needed to better define the characteristics of those tests.
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Affiliation(s)
- Elisabetta Venturini
- grid.413181.e0000 0004 1757 8562Infectious Disease Unit, Meyer Children’s Hospital, Florence, Italy
| | - Sabrina Giometto
- grid.5395.a0000 0004 1757 3729Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agnese Tamborino
- grid.413181.e0000 0004 1757 8562Infectious Disease Unit, Meyer Children’s Hospital, Florence, Italy
| | - Laura Becciolini
- grid.413181.e0000 0004 1757 8562Clinical Chemistry and Microbiology Laboratory, Meyer Children’s Hospital, Florence, Italy
| | - Samantha Bosis
- grid.414818.00000 0004 1757 8749Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Corsello
- grid.10776.370000 0004 1762 5517Unit of Pediatrics and Neonatal Intensive Therapy, Department of Promotion of Maternal and Infantile and Internal Medicine Health, and Specialist Excellence “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Paolo Del Barba
- grid.18887.3e0000000417581884Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Garazzino
- grid.7605.40000 0001 2336 6580Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | - Andrea Lo Vecchio
- grid.4691.a0000 0001 0790 385XSection of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandra Pugi
- grid.413181.e0000 0004 1757 8562Clinical Trial Office, Meyer Children’s Hospital, Florence, Italy
| | - Sara Signa
- grid.419504.d0000 0004 1760 0109Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giacomo Stera
- grid.6292.f0000 0004 1757 1758Postgraduate School of Pediatrics, University of Bologna, Bologna, Italy
| | - Sandra Trapani
- grid.8404.80000 0004 1757 2304Department of Health Sciences, University of Florence, Florence, Italy
| | - Guido Castelli Gattinara
- grid.414603.4Vaccination Unit, University Hospital Paediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ersilia Lucenteforte
- grid.5395.a0000 0004 1757 3729Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luisa Galli
- grid.413181.e0000 0004 1757 8562Infectious Disease Unit, Meyer Children’s Hospital, Florence, Italy ,grid.8404.80000 0004 1757 2304Department of Health Sciences, University of Florence, Florence, Italy
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9
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Barba C, Giometto S, Lucenteforte E, Pellacani S, Matta G, Bettiol A, Minghetti S, Falorni L, Melani F, Di Giacomo G, Giordano F, De Masi S, Guerrini R. Seizure Outcome of Temporal Lobe Epilepsy Surgery in Adults and Children: A Systematic Review and Meta-Analysis. Neurosurgery 2022; 91:676-683. [PMID: 35960753 DOI: 10.1227/neu.0000000000002094] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Temporal lobe epilepsy (TLE) surgery is associated with the best seizure outcome in adults, although its long-term results remain suboptimal. Retrospective pediatric studies suggest better figures whose determinants are poorly understood. OBJECTIVE To conduct a systematic review and meta-analysis of studies on the efficacy of TLE surgery in children (age younger than 18 years) and adults. METHODS We searched MEDLINE, Embase, and Cochrane Library for TLE surgery original research from January 1, 1990, until May 12, 2020. The outcome measures were seizure freedom since surgery and seizure freedom either at last or longest follow-up. We meta-analyzed the proportion of children and adults achieving either Engel I/International League Against Epilepsy (ILAE) 1 or Engel IA/ILAE 1A outcome by follow-up duration, type of surgery, histopathology, neuroimaging, quality of the studies, and publication period. We used a random effects model with Freeman-Tukey double arcsine transformation of proportions. RESULTS From 40 409 records identified, we included 277 studies (30 848 patients). The proportions of patients achieving Engel I/ILAE 1 and Engel IA/ILAE 1A outcomes were 0.74 (95% CI, 0.69-0.78) and 0.61 (0.48-0.74) for children and 0.69 (0.67-0.71) and 0.56 (0.52-0.60) for adults. Histopathology significantly influenced Engel I/ILAE 1 outcome in adults but not in children (P < .0001), while the type of surgery significantly influenced Engel I/ILAE 1 outcome in children but not in adults. CONCLUSION The proportion of seizure freedom after TLE surgery was higher in children, although not significantly. Histopathology and the surgical approach can influence seizure outcome, with age-related variability.
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Affiliation(s)
- Carmen Barba
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy.,University of Florence, Florence, Italy
| | - Sabrina Giometto
- Unit of Medical Statistic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Pellacani
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Giulia Matta
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Minghetti
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Lavinia Falorni
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Federico Melani
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | | | - Flavio Giordano
- University of Florence, Florence, Italy.,Neurosurgery Department, Meyer Children's Hospital, Florence, Italy
| | | | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy.,University of Florence, Florence, Italy
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10
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Giugni C, Cecchi C, Santucci C, Giometto S, Lucenteforte E, Ricci Z. Why is corneal donation so rare in children's hospices? A survey of multidisciplinary team members attitudes, knowledge, practice, and experience. Pediatr Transplant 2022; 26:e14217. [PMID: 34994059 DOI: 10.1111/petr.14217] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Corneal donation is a rare event among pediatric patients dying in children's hospices in Italy. Previous research suggests that lack of knowledge and negative attitude of Health Care Professionals (HCPs) are the most relevant factors for low donation rates in hospice, rather than patient ineligibility or public refusal. We conducted a national survey to explore children's hospice staff's knowledge and attitude toward corneal donation, to survey HCPs confidence in discussing the subject with patients and families, to investigate whether staff members receive specific training about corneal donation and its potential impact on the willingness to raise the topic with patients and families. METHODS An anonymous web-based survey with multiple-choice responses was delivered to the team members of seven Italian children's hospices to test their knowledge and attitude about corneal donation. RESULTS Of the seven children's hospices approached, four agreed to participate with a response rate of 48.5%. Among respondents, 70% declared that they had not received specific training about corneal donation. Results of statistical analysis showed that there were no significant differences in responses between trained and non-trained staff and among the different professionals (nurses, doctors, psychologists, AND social workers) regarding confidence in discussing the subject with patients and families. CONCLUSIONS In our sample of HCPs working in Italian children's hospices, there was no difference in self-reported trust between professionals who reported receiving specific cornea donation training and those who did not. It is remarkable that training on corneal donation was endorsed by a minority of the sample.
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Affiliation(s)
- Cristina Giugni
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Costanza Cecchi
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Claudia Santucci
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Zaccaria Ricci
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy.,Anesthesiology and Critical Care medicine, Department of Health Science, University of Florence, Florence, Italy
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11
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Convertino I, Giometto S, Gini R, Cazzato M, Fornili M, Valdiserra G, Cappello E, Ferraro S, Bartolini C, Paoletti O, Tillati S, Baglietto L, Turchetti G, Trieste L, Lorenzoni V, Blandizzi C, Mosca M, Tuccori M, Lucenteforte E. Trajectories of Adherence to Biologic Disease-Modifying Anti-Rheumatic Drugs in Tuscan Administrative Databases: The Pathfinder Study. J Clin Med 2021; 10:5743. [PMID: 34945038 PMCID: PMC8708974 DOI: 10.3390/jcm10245743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/12/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
Scanty information on clustering longitudinal real-world data is available in the medical literature about the adherence implementation phase in rheumatoid arthritis (RA). To identify and characterize trajectories by analyzing the implementation phase of adherence to biologic Disease-Modifying Anti-Rheumatic Drugs (DMARDs), we conducted a retrospective cohort drug-utilization study using Tuscan administrative databases. RA patients were identified by a validated algorithm, including the first biologic DMARD supply from 2010 to 2015, RA specialist visit in the year before or after the first supply date and RA diagnosis in the five years before or in the year after the first supply date. We observed users for three years or until death, neoplasia, or pregnancy. We evaluated adherence quarterly through the Medication Possession Ratio. Firstly, we identified adherence trajectories and described the baseline characteristics; then, we focused on the trajectory most populated to distinguish the related sub-trajectories. We identified 952 first ever-biologic DMARD users in RA (712 females, mean age 52.7 years old, standard deviation 18.8). The biologic DMARD mostly supplied was etanercept (387 users) followed by adalimumab (233). Among 935 users with at least 3 adherence values, we identified 49 fully-adherent users, 829 continuous users, and 57 early-discontinuing users. Significant differences were observed among the index drugs. After focusing on the continuous users, three sub-trajectories were identified: continuous-steady users (556), continuous-alternate users (207), and continuous-declining users (66). No relevant differences emerged at the baseline. The majority of first ever-biologic DMARD users showed a continuous adherence behavior in RA. The role of adherence potential predictors and the association with effectiveness and safety outcomes should be explored by further studies.
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Affiliation(s)
- Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
| | - Rosa Gini
- Unit of Pharmacoepidemiology, Tuscan Regional Healthcare Agency, 50100 Florence, Italy; (R.G.); (C.B.); (O.P.)
| | - Massimiliano Cazzato
- Unit of Rheumatology, University Hospital of Pisa, 56100 Pisa, Italy; (M.C.); (M.M.)
| | - Marco Fornili
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
| | - Claudia Bartolini
- Unit of Pharmacoepidemiology, Tuscan Regional Healthcare Agency, 50100 Florence, Italy; (R.G.); (C.B.); (O.P.)
| | - Olga Paoletti
- Unit of Pharmacoepidemiology, Tuscan Regional Healthcare Agency, 50100 Florence, Italy; (R.G.); (C.B.); (O.P.)
| | - Silvia Tillati
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
| | - Laura Baglietto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
| | - Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (G.T.); (L.T.); (V.L.)
| | - Leopoldo Trieste
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (G.T.); (L.T.); (V.L.)
| | - Valentina Lorenzoni
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (G.T.); (L.T.); (V.L.)
| | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56100 Pisa, Italy
| | - Marta Mosca
- Unit of Rheumatology, University Hospital of Pisa, 56100 Pisa, Italy; (M.C.); (M.M.)
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (I.C.); (G.V.); (E.C.); (S.F.); (C.B.); (M.T.)
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56100 Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (M.F.); (S.T.); (L.B.)
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12
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Giometto S, Baglietto L, Conte M, Vannacci A, Tuccori M, Mugelli A, Gini R, Lucenteforte E. Use of antiseizure medications and safety of branded versus generic formulations: A comparative study on Tuscan administrative databases. Epilepsy Behav 2021; 117:107876. [PMID: 33714929 DOI: 10.1016/j.yebeh.2021.107876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 12/21/2020] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess patterns of use of antiseizure medications (ASMs) and to compare the safety of generic versus branded formulations in terms of admission to hospital or to emergency department (ED). METHODS We conducted a drug utilization study with a propensity score-matched design using the administrative databases of the Italian Tuscany region. New users of ASMs during 2015 with no history of neoplasia were considered and their first prescription was classified as: available only as branded (only-B-ASM); branded with generic available (B-ASM); and generic (G-ASM). Patients with G-ASM first prescription were matched with four patients with B-ASM prescription. Participants were followed up for one year or until the date of death or diagnosis of neoplasia. Cox regression models were fitted to estimate the risk of admission to hospital or ED. RESULTS We identified 36,601 ASM new-users, including 2094 (6.4%) with only-B-ASM as first prescription, 24,588 (74.9%) with B-ASM, and 5788 (17.6%) with G-ASM. We found no differences in the risk of admission to hospital or ED (Hazard Ratio (HR), 0.92; 95% Confidence Interval (CI), 0.85-1.02) among users of generic ASMs compared to those using branded ASMs. CONCLUSIONS In our study population, generic ASMs were used less than branded ones. The similarity in the safety of branded and generic formulations suggests that generic ASMs could be the preferred formulation in current clinical practice resulting in a substantial decrease in the cost of treatment.
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Affiliation(s)
- Sabrina Giometto
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Marco Conte
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Florence, Italy.
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
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13
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Indolfi G, Giometto S, Serranti D, Bettiol A, Bigagli E, De Masi S, Lucenteforte E. Systematic review with meta-analysis: the efficacy and safety of direct-acting antivirals in children and adolescents with chronic hepatitis C virus infection. Aliment Pharmacol Ther 2020; 52:1125-1133. [PMID: 32809230 DOI: 10.1111/apt.16037] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/27/2020] [Accepted: 07/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effect of direct-acting anti-virals (DAAs) in children and adolescents with chronic hepatitis C virus (HCV) infection is difficult to determine, since few, aged between 3 and 18 years, have been enrolled in clinical trials, and some data come from observational studies. AIM To summarise the evidence on efficacy and safety of DAAs in children and adolescents with chronic HCV infection. METHODS We performed a systematic review and meta-analysis of prospective studies on the efficacy and safety of DAAs in subjects <18 years of age. We considered the sustained virological response at post-treatment week 12 as efficacy outcome and adverse events as safety outcome. We considered intervention effect for each study arm by calculating the proportion of sustained virologic response at post-treatment week 12 in subjects receiving all doses of treatment and proportion of adverse events in subjects receiving at least one dose of treatment. Pooled proportions were calculated using the Freeman-Tukey double arcsine transformation. Random effects model was used for all analyses. RESULTS Among 39 included studies (1796 subjects), the pooled proportion among those receiving all doses of treatment and reaching sustained virologic response at post-treatment week 12 was 100% (95% confidence interval: 100-100). Considering subjects receiving at least one dose of treatment, lowest estimates were reported among children with cirrhosis (83%). Headache and fatigue were the most common adverse events. Serious adverse events were uncommon. CONCLUSIONS Children and adolescents with chronic HCV infection can be safely treated with DAAs with similar efficacy as reported in adults.
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Affiliation(s)
- Giuseppe Indolfi
- Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze, Italy.,Department NEUROFARBA, University of Florence, Florence, Italy
| | - Sabrina Giometto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniele Serranti
- Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze, Italy
| | | | | | - Salvatore De Masi
- Clinical Trial Office, Meyer's Children University Hospital of Florence, Firenze, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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