1
|
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.
Collapse
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
| |
Collapse
|
2
|
Sultana J, Camilleri N, Crisafulli S, Borg JJ, Spagnol S, Tillati S, Borg J. The pharmacological treatment of granulomatosis with polyangiitis: a review of clinical trials registered in clinicaltrials.gov and the International Clinical Trials Registry Platform. Ther Adv Rare Dis 2023; 4:26330040231213888. [PMID: 38116207 PMCID: PMC10729619 DOI: 10.1177/26330040231213888] [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] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/23/2023] [Indexed: 12/21/2023]
Abstract
To date, there is no published overview of the drug pipeline in granulomatosis with polyangiitis (GPA), a rare disease. The aim of this study was to identify clinical trials from two study repositories. A review of clinical trials was conducted using publicly available data. Clinicaltrials.gov and International Clinical Trials Registry Platform were searched from inception until 25 September 2022. Only GPA-specific studies were included; these were described in detail. A total of 137 studies were identified in the trial repositories, of which 108 (79%) studies were found to concern GPA. Of these 108 studies, 67 enrolled GPA patients to investigate pharmacotherapy in this disease (62%). Most studies included all severity types (n = 51; 76%); the scope of almost half of the studies was remission induction (n = 33; 49%). The drug class which was by the most widely investigated in trials was the non-corticosteroid immunosuppressant drug class (46; 68.7%), monoclonal antibodies (32; 47.8%), and corticosteroids (31; 46.3%). There is a need for more GPA trials to generate evidence on effectiveness in terms of severity-specificity and maintenance of remission.
Collapse
Affiliation(s)
- Janet Sultana
- Exeter College of Medicine and Health, St. Luke’s Campus, Exeter, EX4 4QJ, UK
- Quality Improvement, Pharmacy Department, Mater Dei Hospital, Msida, Malta
- Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Medical School, Msida, Malta
| | - Nikita Camilleri
- Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Medical School, Msida, Malta
| | | | - John Joseph Borg
- Post-licensing Department, Malta Medicines Authority, Msida, Malta
| | - Silvan Spagnol
- Quality Improvement, Pharmacy Department, Mater Dei Hospital, Msida, Malta
| | - Silvia Tillati
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Joseph Borg
- Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Medical School, Msida, Malta
| |
Collapse
|
3
|
Tillati S, Pati I, Delle Donne M, Meneghel A, Londero D, De Angelis V. Horiba Micros ES 60 Blood Cell Analyzer in Blood Donor Eligibility: A Validation Study. Diagnostics (Basel) 2022; 12:diagnostics12112586. [PMID: 36359430 PMCID: PMC9689173 DOI: 10.3390/diagnostics12112586] [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: 09/15/2022] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Eligibility criteria for blood donation require hemoglobin levels of ≥12.5 g/dL for women and ≥13.5 g/dL for men, and a platelet count of ≥180 × 109/L. Screening methods before donation should ensure high accuracy, precision, and ease in operation. We assessed the performance, precision, and repeatability of the Horiba Micros ES 60 (Horiba) compared to the Beckman Coulter DXH 800. Methods: Performance was compared by testing samples for each of the 11 devices across 6 sites in the Transfusion Service of Friuli Venezia Giulia Region, Italy. We measured precision by calculating the coefficient of variation (CV), concordance with ρ-Pearson’s correlation coefficient, and accuracy with F-tests. The intra-assay agreement was examined in the 11 devices, and repeatability was performed by using CV and the Kruskal−Wallis test. Results: The precision of Horiba was acceptable. Overall, ρ-Pearson’s coefficients indicated a strong correlation and positive relationship between all variables. The Bland−Altman plots showed that most of the differences lay within the limits of agreement. All CV were below the reference threshold for all the parameters. Finally, the Kruskal−Wallis test reported non-significant statistical differences for all parameters, except platelet count (p < 0.000). Conclusions: Horiba is adequate for routine pre-donation screening. The intra-assay agreement further demonstrates the accuracy of the device.
Collapse
Affiliation(s)
- Silvia Tillati
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
| | - Ilaria Pati
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-06-4990-4953
| | - Michela Delle Donne
- Transfusion Medicine Department, Udine University Hospital, 33100 Udine, Italy
| | - Alessandra Meneghel
- Transfusion Medicine Department, Udine University Hospital, 33100 Udine, Italy
| | - Donatella Londero
- Transfusion Medicine Department, Udine University Hospital, 33100 Udine, Italy
| | - Vincenzo De Angelis
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| |
Collapse
|
4
|
Stincarelli MA, Baj A, Guidotti B, Spezia PG, Novazzi F, Lucenteforte E, Tillati S, Focosi D, Maggi F, Giannecchini S. Plasma Torquetenovirus (TTV) microRNAs and severity of COVID-19. Virol J 2022; 19:79. [PMID: 35562762 PMCID: PMC9099037 DOI: 10.1186/s12985-022-01812-3] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Torquetenovirus (TTV), a widespread anellovirus recognized as the main component of the healthy human virome, displays viremia that is highly susceptible to variations in immune competence. TTV possesses microRNA (miRNA)-coding sequences that might be involved in viral immune evasion. Among TTV-encoded miRNAs, miRNA t1a, t3b, and tth8 have been found in biological fluids. Here, the presence of TTV DNA and TTV miRNAs in the plasma of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected subjects was investigated to monitor the possible association with coronavirus disease 2019 (COVID-19) severity. Methods Detection of TTV DNA and miRNA t1a, t3b, and tth8 was investigated in plasma samples of 56 SARS-CoV-2-infected subjects with a spectrum of different COVID-19 outcomes. TTV DNA and TTV miRNAs were assessed with a universal single step real-time TaqMan PCR assay and miRNA quantitative RT-PCR miRNA assay, respectively. Results The TTV DNA prevalence was 59%, whereas at least one TTV miRNA was found in 94% of the patients tested. miRNA tth8 was detected in 91% of subjects, followed by miRNAs t3b (64%) and miRNAt1a (30%). Remarkably, although TTV DNA was unrelated to COVID-19 severity, miRNA tth8 was significantly associated with the degree of disease (adjusted incidence rate ratio (IRR) 2.04, 95% CI 1.14–3.63, for the subjects in the high severity group compared to those in the low severity group). Conclusions Our findings encourage further investigation to understand the potential role of TTV miRNAs in the different outcomes of COVID-19 at early and late stages.
Collapse
Affiliation(s)
- Maria Alfreda Stincarelli
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 48, 50134, Florence, Italy
| | - Andreina Baj
- Department of Medicine and Surgery, University of Insubria, 21100, Varese, Italy
| | - Bernardo Guidotti
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 48, 50134, Florence, Italy
| | | | - Federica Novazzi
- Department of Medicine and Surgery, University of Insubria, 21100, Varese, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, 56100, Pisa, Italy
| | - Silvia Tillati
- Department of Clinical and Experimental Medicine, University of Pisa, 56100, Pisa, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, 56124, Pisa, Italy
| | - Fabrizio Maggi
- Department of Medicine and Surgery, University of Insubria, 21100, Varese, Italy
| | - Simone Giannecchini
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 48, 50134, Florence, Italy.
| |
Collapse
|
5
|
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.
Collapse
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.)
| |
Collapse
|
6
|
Focosi D, Genoni A, Lucenteforte E, Tillati S, Tamborini A, Spezia PG, Azzi L, Baj A, Maggi F. Previous Humoral Immunity to the Endemic Seasonal Alphacoronaviruses NL63 and 229E Is Associated with Worse Clinical Outcome in COVID-19 and Suggests Original Antigenic Sin. Life (Basel) 2021; 11:298. [PMID: 33915711 PMCID: PMC8067214 DOI: 10.3390/life11040298] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 03/04/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022] Open
Abstract
Antibody-dependent enhancement (ADE) of severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) infection has been hypothesized. However, to date, there has been no in vitro or in vivo evidence supporting this. Cross-reactivity exists between SARS CoV-2 and other Coronaviridae for both cellular and humoral immunity. We show here that IgG against nucleocapsid protein of alphacoronavirus NL63 and 229E correlate with the World Health Organization's (WHO) clinical severity score ≥ 5 (incidence rate ratios was 1.87 and 1.80, respectively, and 1.94 for the combination). These laboratory findings suggest possible ADE of SARS CoV-2 infection by previous alphacoronavirus immunity.
Collapse
Affiliation(s)
- Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, 56124 Pisa, Italy
| | - Angelo Genoni
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (A.G.); (L.A.); (A.B.); (F.M.)
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, 56100 Pisa, Italy; (E.L.); (S.T.)
| | - Silvia Tillati
- Department of Clinical and Experimental Medicine, University of Pisa, 56100 Pisa, Italy; (E.L.); (S.T.)
| | | | | | - Lorenzo Azzi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (A.G.); (L.A.); (A.B.); (F.M.)
- Unit of Oral Medicine and Pathology, ASST Sette Laghi, 21100 Varese, Italy
| | - Andreina Baj
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (A.G.); (L.A.); (A.B.); (F.M.)
- Laboratory of Microbiology, ASST Sette Laghi, 21100 Varese, Italy;
| | - Fabrizio Maggi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (A.G.); (L.A.); (A.B.); (F.M.)
- Laboratory of Microbiology, ASST Sette Laghi, 21100 Varese, Italy;
| |
Collapse
|
7
|
Sultana J, Fontana A, Giorgianni F, Tillati S, Cricelli C, Pasqua A, Patorno E, Ballard C, Sturkenboom M, Trifirò G. Measuring the Effectiveness of Safety Warnings on the Risk of Stroke in Older Antipsychotic Users: A Nationwide Cohort Study in Two Large Electronic Medical Records Databases in the United Kingdom and Italy. Drug Saf 2020; 42:1471-1485. [PMID: 31556019 DOI: 10.1007/s40264-019-00860-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Safety warnings relating to antipsychotic-associated stroke among older persons in the UK and Italy were issued. However, the impact of these safety warnings on stroke risk has not been measured to date. OBJECTIVE The aim of this study was to measure the change in stroke incidence after two safety warnings in both the UK and Italy. METHOD A cohort study was conducted using electronic medical records representative of the UK (The Health Improvement Network) and Italy (Health Search-IQVIA Health LPD), containing data on 11 million and 1 million patients, respectively. After each drug safety warning, elderly antipsychotic new initiators were propensity-score matched 1:1:1 on antipsychotic initiators before any safety warning. Stroke incidence within 6 months of antipsychotic initiation, using an intention-to-treat approach, was the main outcome. RESULTS In the UK and Italy, 6342 and 7587 elderly antipsychotic initiators were identified, respectively. A 42% stroke incidence reduction was seen in the UK after the first safety warning [42.3 (95% confidence interval (CI) 35.2-50.8) vs. 24.4 [95% CI 19.0-31.2] events per 1000 person-years (PYs)], while there was a 60% stroke incidence reduction after the second warning (16.9 [95% CI 12.2-23.4] events per 1000 PYs) compared to before the first warning. There was no significant reduction in stroke incidence in Italy. CONCLUSION Antipsychotic safety warnings were followed by a reduction in stroke incidence among older antipsychotic users in the UK, but not Italy.
Collapse
Affiliation(s)
- Janet Sultana
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 1, Consolare Valeria Street, 98125, Messina, Italy.,Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Andrea Fontana
- Fondazione IRCCS Casa Sollievo della Sofferenza, Unit of Biostatistics, Viale Cappuccini, 2, 71013, San Giovanni Rotondo, FG, Italy
| | - Francesco Giorgianni
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 1, Consolare Valeria Street, 98125, Messina, Italy
| | - Silvia Tillati
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 1, Consolare Valeria Street, 98125, Messina, Italy
| | - Claudio Cricelli
- Health Search, Italian College of General Practitioners, Sestese Street, 61, 50141, Florence, Italy
| | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners, Sestese Street, 61, 50141, Florence, Italy
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA
| | - Clive Ballard
- University of Exeter Medical School, Medical School Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Miriam Sturkenboom
- Julius Centre for Global Health, Utrecht University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 1, Consolare Valeria Street, 98125, Messina, Italy. .,Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| |
Collapse
|
8
|
Valent F, Tillati S, Zanier L. Prevalence and comorbidities of known diabetes in northeastern Italy. J Diabetes Investig 2013; 4:355-60. [PMID: 24843679 PMCID: PMC4020229 DOI: 10.1111/jdi.12043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/03/2012] [Accepted: 12/03/2012] [Indexed: 12/19/2022] Open
Abstract
AIMS/INTRODUCTION We aimed at estimating the prevalence and at identifying the frequent comorbidities of diabetes mellitus in a region of northeastern Italy from administrative health data. MATERIALS AND METHODS The prevalence was estimated according to two disease definitions, based on administrative health data. Association rule mining was used to detect comorbid diagnoses that coexisted with a diagnosis of diabetes among patients admitted to the regional hospitals. RESULTS The prevalence of known diabetes in 2010 was 6.0-8.1%, with great variations by age class (from approximately 2% <60 years to more than 20% in some elderly age groups). Of 155,494 patients admitted to the hospital in 2011, 9,358 had a diagnosis of diabetes. A total of 12 rules satisfied our criteria for support (>0.5%) and confidence (>5%), and identified nine frequent isolated comorbidities and three pairs of comorbid diagnoses. The rule with the highest support (2.4%) and confidence (39.5%) identified the combination of diabetes and essential hypertension. CONCLUSIONS Association rule mining was useful, because it showed the complexity of diabetic patients. Clinical management of those patients cannot neglect comorbidities.
Collapse
Affiliation(s)
- Francesca Valent
- Epidemiological ServiceRegional Health DirectorateFriuli Venezia Giulia RegionUdineItaly
| | - Silvia Tillati
- Epidemiological ServiceRegional Health DirectorateFriuli Venezia Giulia RegionUdineItaly
| | - Loris Zanier
- Epidemiological ServiceRegional Health DirectorateFriuli Venezia Giulia RegionUdineItaly
| |
Collapse
|
9
|
Struzzo P, Fumato R, Tillati S, Cacitti A, Gangi F, Stefani A, Torcutti A, Crapesi L, Tubaro G, Balestrieri M. Individual empowerment in overweight and obese patients: a study protocol. BMJ Open 2013; 3:bmjopen-2013-002669. [PMID: 23676799 PMCID: PMC3657655 DOI: 10.1136/bmjopen-2013-002669] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Obesity is a growing health problem in Europe and it causes many diseases. Many weight-reducing methods are reported in medical literature, but none of them proved to be effective in maintaining the results achieved over time. Self-empowerment can be an important innovative method, but an effectiveness study is necessary. In order to standardise the procedures for a randomised controlled study, a pilot study will be run to observe, measure and evaluate the effects of a period of self-empowerment group treatment on overweight/obese patients. METHODS and analysis Non-controlled, experimental, pilot study. A selected group of patients with body mass index >25, with no severe psychiatric disorders, with no aesthetic or therapeutic motivation will be included in the study. A set of quantitative and qualitative measures will be utilised to evaluate the effects of a self-empowerment course in a 12 month time. Group therapy and medical examinations will also complete this observational phase. At the end of this pilot study, a set of appropriate measures and procedures to determine the effectiveness of individual empowerment will be identified and agreed among the different professional figures. Results will be recorded and analysed to start a randomised controlled trial to evaluate the effectiveness of the proposed methodology. ETHICS AND DISSEMINATION This protocol was approved by the local Ethics Committee of Udine in March 2012. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and public events involving the local administrations of the towns where the trial participants are resident. TRIAL REGISTRATION http://www.clinicalstrials.gov identifier NCT01644708.
Collapse
Affiliation(s)
- Pierluigi Struzzo
- Region Friuli Venezia Giuia, Regional Centre for the Training in Primary care, Monfalcone, Italy
| | - Raffaella Fumato
- Department of Mental Health, Local Health Unit ‘Medio Friuli’, Udine, Italy
| | - Silvia Tillati
- Department of Economic and Statistical Sciences, Università degli Studi di Udine, Udine, Italy
| | - Anita Cacitti
- Department of Mental Health, Local Health Unit ‘Medio Friuli’, Udine, Italy
| | - Fabrizio Gangi
- Region Friuli Venezia Giuia, Regional Centre for the Training in Primary care, Monfalcone, Italy
| | - Alessia Stefani
- Region Friuli Venezia Giuia, Regional Centre for the Training in Primary care, Monfalcone, Italy
| | - Alessia Torcutti
- Region Friuli Venezia Giuia, Regional Centre for the Training in Primary care, Monfalcone, Italy
| | - Lucia Crapesi
- Region Friuli Venezia Giuia, Regional Centre for the Training in Primary care, Monfalcone, Italy
| | - Gianni Tubaro
- Region Friuli Venezia Giuia, Regional Centre for the Training in Primary care, Monfalcone, Italy
| | - Matteo Balestrieri
- Department of Psychiatry, Teaching Hospital of Udine and DISM, University of Udine, Udine, Italy
| |
Collapse
|
10
|
Valent F, Tillati S, Zanier L. [Gender bias in the management and outcome of cardiovascular patients in Friuli Venezia Giulia (Northern Italy)]. Epidemiol Prev 2013; 37:115-123. [PMID: 23851240] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE to assess whether there are any differences depending on the patient's gender in the acute management of patients with symptoms compatible with coronary disease or admitted to the hospital with a diagnosis or coronary disease in the Friuli Venezia Giulia Region (Northern Italy). DESIGN retrospective analysis of the Emergency Room (ER) and Hospitalization databases of the regional health information system. SETTING AND PARTICIPANTS the study included all the patients who arrived at one of the 18 regional ERs because of chest pain, and all the patients admitted to one of the regional hospitals with a diagnosis of coronary disease in 2010. MAIN OUTCOME MEASURES for both genders,waiting times from triage to the physician's visit, electrocardiogram (ECG) frequency in the ER among patients with chest pain and frequency of coronary angioplasty, and intrahospital mortality among patients admitted with a diagnosis of coronary disease were evaluated. RESULTS women arriving at an ER with chest pain waited on average 3 minutes more than men before being visited by a physician (24.9 vs. 21.9 minutes); however, the likelihood of undergoing ECG was similar in the two genders (54.4%vs. 55.0%; OR: 0.96, 95%CI 0.89-1.03). Women admitted to the hospital because of coronary disease undergo coronary angioplasty less frequently than men (29.1%vs. 43.5%; OR: 0.67, 95%CI 0.57- 0.78). Intrahospital mortality was 7.6%in men and 4.3%in women, however, it was similar after adjustment for confounders. Among patients <65 years it was 3 times higher for women than for men. CONCLUSION some gender differences in the management of patients were observed. Further research is warranted to assess whether those differences reflect appropriate care or whether they indicate the existence of a gender bias affecting the decisions of healthcare professionals.
Collapse
Affiliation(s)
- Francesca Valent
- Servizio di epidemiologia, Direzione centrale salute, integrazione sociosanitaria e politiche sociali, Regione autonoma Friuli Venezia Giulia,Udine.
| | | | | |
Collapse
|
11
|
Trifirò G, Tillati S, Spina E, Ferrajolo C, Alacqua M, Aguglia E, Rizzi L, Caputi AP, Cricelli C, Samani F. A nationwide prospective study on prescribing pattern of antidepressant drugs in Italian primary care. Eur J Clin Pharmacol 2012; 69:227-36. [PMID: 22706616 DOI: 10.1007/s00228-012-1319-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 05/20/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Our purpose was to explore antidepressant drug (AD) prescribing patterns in Italian primary care. METHODS Overall, 276 Italian general practitioners (GPs) participated in this prospective study, recruiting patients >18 years who started AD therapy during the enrolment period (January 2007 to June 2008). During visits at baseline and 3, 6, and 12 months, data about patients' characteristics and AD treatments were collected by the GPs. Discontinuation rate among new users of AD classes [i.e., selective serotonin reuptake inhibitors (SSRI); tricyclics (TCAs); other ADs) were compared. Logistic regression analyses were performed to identify predictors of AD discontinuation. RESULTS SSRIs were the most frequently prescribed ADs (N = 1,037; 75.3 %), especially paroxetine and escitalopram. SSRIs were more likely to be prescribed because of depressive disorders (80 %), and by GPs (51.1 %) rather than psychiatrists (31.8 %). Overall, 27.5 % (N = 378) of AD users discontinued therapy during the first year, mostly in the first 3 months (N = 242; 17.6 %), whereas 185 (13.4 %) were lost to follow-up. SSRI users showed the highest discontinuation rate (29 %). In patients with depressive disorders, younger age, psychiatrist-based diagnosis, and treatment started by GPs were independent predictors of SSRI discontinuation. CONCLUSIONS In Italy, ADs-especially SSRIs-are widely prescribed by GPs because of depressive/anxiety disorders. Active monitoring of AD users in general practice might reduce the AD discontinuation rate.
Collapse
Affiliation(s)
- Gianluca Trifirò
- Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Via Consolare Valeria Gazzi, 98125 Messina, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Di Bartolomeo S, Tillati S, Valent F, Zanier L, Barbone F. ISS mapped from ICD-9-CM by a novel freeware versus traditional coding: a comparative study. Scand J Trauma Resusc Emerg Med 2010; 18:17. [PMID: 20356359 PMCID: PMC2852374 DOI: 10.1186/1757-7241-18-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Accepted: 03/31/2010] [Indexed: 12/03/2022] Open
Abstract
Background Injury severity measures are based either on the Abbreviated Injury Scale (AIS) or the International Classification of diseases (ICD). The latter is more convenient because routinely collected by clinicians for administrative reasons. To exploit this advantage, a proprietary program that maps ICD-9-CM into AIS codes has been used for many years. Recently, a program called ICDPIC trauma and developed in the USA has become available free of charge for registered STATA® users. We compared the ICDPIC calculated Injury Severity Score (ISS) with the one from direct, prospective AIS coding by expert trauma registrars (dAIS). Methods The administrative records of the 289 major trauma cases admitted to the hospital of Udine-Italy from 1 July 2004 to 30 June 2005 and enrolled in the Italian Trauma Registry were retrieved and ICDPIC-ISS was calculated. The agreement between ICDPIC-ISS and dAIS-ISS was assessed by Cohen's Kappa and Bland-Altman charts. We then plotted the differences between the 2 scores against the ratio between the number of traumatic ICD-9-CM codes and the number of dAIS codes for each patient (DIARATIO). We also compared the absolute differences in ISS among 3 groups identified by DIARATIO. The discriminative power for survival of both scores was finally calculated by ROC curves. Results The scores matched in 33/272 patients (12.1%, k 0.07) and, when categorized, in 80/272 (22.4%, k 0.09). The Bland-Altman average difference was 6.36 (limits: minus 22.0 to plus 34.7). ICDPIC-ISS of 75 was particularly unreliable. The differences increased (p < 0.01) as DIARATIO increased indicating incomplete administrative coding as a cause of the differences. The area under the curve of ICDPIC-ISS was lower (0.63 vs. 0.76, p = 0.02). Conclusions Despite its great potential convenience, ICPIC-ISS agreed poorly with its conventionally calculated counterpart. Its discriminative power for survival was also significantly lower. Incomplete ICD-9-CM coding was a main cause of these findings. Because this quality of coding is standard in Italy and probably in other European countries, its effects on the performances of other trauma scores based on ICD administrative data deserve further research. Mapping ICD-9-CM code 862.8 to AIS of 6 is an overestimation.
Collapse
|