Correlates of substance use in a large naturalistic cohort of young people with early and emerging psychosis

BACKGROUND

Substance use remains a barrier to recovery for young people accessing early intervention services for psychosis. While correlates of use have been explored in populations experiencing a first episode of psychosis (FEP), sample sizes have been small and less research assesses cohorts at ultrahigh risk of psychosis (UHR).

METHODS

This study uses data from a naturalistic cohort including UHR and FEP participants (N = 1252) to elucidate clinical correlates of use in the past 3 months of any illicit substance, amphetamine-type stimulants (ATS), cannabis, and tobacco. Moreover, network analysis based on use of these substances and additionally alcohol, cocaine, hallucinogens, sedatives, inhalants, and opioids was completed.

RESULTS

Young people with FEP used substances at significantly higher rates than those at UHR. High concurrence of use was seen between substances. In the FEP group, participants who had used any illicit substance, ATS, and/or tobacco had increased positive symptoms and decreased negative symptoms. Young people with FEP who used cannabis had increased positive symptoms. In the UHR group, participants who had used any illicit substance, ATS, and/or cannabis in the past 3 months showed decreased negative symptoms compared to those who had not.

CONCLUSION

A distinct clinical picture of more florid positive symptoms and alleviated negative symptoms seen in those who use substances in the FEP group appears muted in the UHR cohort. Treating young people at UHR in early intervention services represents the earliest opportunity to address substance use early to improve outcomes.

Isolated functional tricuspid regurgitation: how to define patients at risk for event?

AIMS

Functional tricuspid regurgitation (TR) is a turning point in cardiac diseases. Symptoms typically appear late. The optimal timing for proposing a valve repair remains a challenge. We sought to analyse the characteristics of right heart remodelling in patients with significant functional TR to identify the parameters that could be used in a simple prognostic model predicting clinical events.

METHODS AND RESULTS

We designed a prospective observational French multicentre study including 160 patients with significant functional TR (effective regurgitant orifice area > 30 mm² ) and left ventricular ejection fraction > 40%. Clinical, echocardiographic, and electrocardiogram data were collected at baseline and at the 1 and 2 year follow-up. The primary outcome was all-cause death or hospitalization for heart failure. At 2 years, 56 patients (35%) achieved the primary outcome. The subset with events showed more advanced right heart remodelling at baseline, but similar TR severity. Right atrial volume index (RAVI) and the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP) ratio, reflecting right ventricular-pulmonary arterial coupling, were 73 mL/m² and 0.40 vs. 64.7 mL/m² and 0.50 in the event vs. event-free groups, respectively (both P < 0.05). None among all the clinical and imaging parameters tested had a significant group × time interaction. The multivariable analysis leads to a model including TAPSE/sPAP ratio > 0.4 (odds ratio = 0.41, 95% confidence limit 0.2 to 0.82) and RAVI > 60 mL/m² (odds ratio = 2.13, 95% confidence limit 0.96 to 4.75), providing a clinically valid prognostic evaluation.

CONCLUSIONS

RAVI and TAPSE/sPAP are relevant for predicting the risk for event at 2 year follow-up in patients with an isolated functional TR.

Isolated functional tricuspid regurgitation, how define patient at-risk for event?

Introduction

Functional tricuspid regurgitation (TR) is a turning point in cardiac diseases. Symptoms typically appear late, and the optimal timing for proposing a valve repair remains a challenge. We sought to analyse the characteristics of right heart remodelling in patients with significant functional TR to identify the parameters that could be used in an easily achievable and fair prognostic model predicting clinical events.

Methods

We designed a prospective observational French multicentre study including 160 patients with significant functional TR (effective regurgitant orifice area &gt;30mm2) and LVEF &gt;40%. Clinical, echocardiographic, and ECG data were collected at baseline, and at the 1- and 2-year follow-up. The primary outcome was all-cause death or hospitalization for heart failure.

Results

At 2 years, 56 patients (35%) achieved the primary outcome. The subset with events showed more advanced right heart remodelling at baseline, but similar TR severity. Right atrial volume index (RAVI) and the TAPSE/sPAP ratio, reflecting right-ventricle-pulmonary artery coupling, were 73 mL/m2 and 0.40 versus 64.7 mL/m2 and 0.50 in the event vs event-free group, respectively (both p&lt;0.05). None among all the clinical and imaging parameters tested had a significant group × time interaction. In multivariable analysis, the model including TAPSE/sPAP ratio &gt;0.4 (OR=0.41, 95%CL 0.2 to 0.82) and RAVI &gt;60 mL/m2 (OR=2.13, 95%CL 0.96 to 4.75) permitted the fairest and most parsimonious prognostic evaluation.

Conclusion

RAVI and TAPSE/sPAP are relevant for predicting the risk for event at 2-year follow-up in patient with an isolated functional TR.

Funding Acknowledgement

Type of funding sources: None.

Functional tricuspid regurgitation: A clustering analysis and prognostic validation of three echocardiographic phenotypes in an external cohort

BACKGROUND

Functional tricuspid regurgitation (FTR) is an independent risk factor for morbidity and mortality. New pathophysiological concepts but also new therapeutic options are justifying new knowledges for characterizing FTRs and their prognoses.

AIM

To study echocardiographic criteria associated with prognosis in FTR-patients using a clustering method in two cohorts.

METHODS AND RESULTS

Two hundred forty-one patients with at least severe (≥grade 3) TR were enrolled: 92 in the retrospective cohort (mean age 77.9 ± 13 years) and 149 in the prospective validation cohort. Hierarchical clustering analysis was conducted. Four parameters explained the clustering categorization according to a multinomial regression (right ventricular (RV) end-diastolic mid-cavity diameter, RV free-wall strain, right atrial (RA) volume index, RA strain; p = 0.0039). Three clusters were identified in the retrospective cohort: Cluster 1 had better right ventricular, left ventricular, and right atrial function than Cluster 2 (reduced RV and RA strain despite similar sizes). Cluster 3 included patients with severely dilated heart chambers associated to RV and RA dysfunctions. When applying the model in the validation (external) cohort, the rate of the primary endpoint (hospitalization for heart failure and/or death from any cause) was lowest in Cluster 1 (30.8% versus 48% and 58.8% in Clusters 2 and 3, respectively; p < 0.05).

CONCLUSION

In FTR patients, different profiles of RV and RA remodeling are associated with different outcomes. Therefore, the diagnostic work-up in this clinical setting should include RV and RA characteristics. Under noninterventional management, the phenotype corresponding to preserved RV size and preserved RA and RV functions appears to have a better prognosis.

Right heart interplay with secondary tricuspid regurgitation. How can we predict clinical events?

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

TRAP

Introduction. Secondary Tricuspid Regurgitation (TR) is a turning point in cardiac diseases. Symptoms occurred too late according to the right heart reverse remodelling capabilities. The ideal timing for proposing a valve repair remains a challenge. We sought to analyse characteristics of patients with significant secondary TR, seeking for changes in parameters over time that could be related to the risk of clinical event.

Material and method. We designed a prospective observational French multicentre study of 160 patients with significant secondary TR (effective regurgitant orifice area &gt; 30 mm²) and LVEF &gt; 40%; we collected clinical, echocardiographic, and EKG data at baseline, 1- and 2-year follow-up. All echocardiographies were centrally analyzed. The primary outcome was death or hospitalization for heart failure

Results. At 2-year 95 patients (59.3%) presented the primary outcome. They had significant morphological and functional alteration of the right heart parameters. Right Atrial Volume Index (RAVI) and right ventricular free wall Strain were respectively 73mL/m² and -19.8% versus 64.7mL/m² and 22.3% in the event-free group. None of them had significant group*time interaction. In the multivariable analysis, TAPSE/sPAP ratio &gt; 0.4 (OR = 0.41 95%CL 0.2 to 0.82) associated to RAVI &gt; 60mL/m² (OR = 2.13 95%CL 0.96 to 4.75) were the two independent parameters that enable the fairest and parsimonious evaluation.

Conclusion. We demonstrated that short analysis using RAVI and TAPSE/sPAP almost reached us to an easier patient assessment by limiting the number of involved parameters. These parameters are now to be for defining the best timing and response to interventions. Abstract Figure. LAVI and TAPSE/sPAP according to events

COVID-19 infection in first trimester of pregnancy marked by a liver cytolysis in a woman previously treated by hydroxychloroquine for repeated implantation failure: a case report

BACKGROUND

In December 2019, a new disease (COVID-19) caused by a novel coronavirus called SARS-CoV-2 emerged in China and spread to many other countries. There is only limited data about the clinical features of COVID-19 during pregnancy, especially in first trimester.

CASE PRESENTATION

We report a COVID-19 infection in a 35 years-old patient in first trimester of pregnancy and its consequent medical care. At 7 weeks of pregnancy, the patient, who did not have any pregestational comorbidities, complained of intense nausea and asthenia. An important liver cytolysis was discovered with biological perturbations of transaminases levels. No respiratory symptoms were recorded. Classical viral aetiologies and drug-related toxicity were discarded. Because of the aggravation of the symptoms and the occurrence of the breathlessness, the patient was tested for the COVID-19 in a nasopharyngeal swab. The RTq-PCR assay indicated the presence of SARS-CoV-2 RNA. In the absence of severe symptoms, the patient was monitored at home according to the French government guidelines. After a few days, the symptoms resolved without any complications. The pregnancy is still ongoing without any visible sequelae on the foetus so far.

CONCLUSIONS

This first case illustrated the difficulty of COVID-19 diagnosis in patients with isolated digestive symptoms in first trimester of pregnancy that could be confused with gravida hyperemesis. Monitoring of pregnancy after an episode of COVID-19 should be strengthened with bimonthly foetal growth ultrasounds and doppler assessments because of the risks for intrauterine growth restriction. Comprehensive data on larger numbers of first trimester gravid women with COVID-19 are required to better understanding the overall impact of SARS-CoV-2 on maternal and birth outcomes.

P1277 Cardiac remodeling in secondary tricuspid regurgitation: should we just look at the tricuspid annulus diameter?

Funding Acknowledgements

Financial support: French society of cardiovascular imaging.

Background

The respective strength of the different mechanisms that could lead to significant secondary TR occurrence remains debated.

Purpose

The main objective of our study was to characterize the determinants of tricuspid regurgitation (TR) severity in stable patients with preserved left ventricle ejection fractionand without significant left valvular heart disease. Patients were classified into 5 groups according to echocardiographic TR severity assessment: mild / moderate / severe / massive / torrential. Secondary objectives were to describe the evolution of the dimensions of the right cavities and the right ventricle (RV) function parameters according to the severity of the TR.

Methods

This is a prospective observational and multicentric study. Criteria for inclusion were: age ≥ 18 years; at least moderate TR; euvolemic status. We excluded patients with organic TR. All patients underwent standard trans-thoracic echocardiographyat distance from initial diagnosis and after stable optimized medical treatment. All exams were analysed in a Core Laboratory.

Results

100 patients (12 presented mild TR, 31 moderate, 18 severe, 17 massive and 22 torrential) were enrolled and we used effective regurgitant orifice area (EROA) to quantify the severity of TR. To explain TR severity in multivariate analysis, right atrium (RA) indexed volume and tethering area were statistically significant (p &lt; 0.001). For an increase of 10 mL/m2of RA volume, EROA increases by 4.2 mm2and for an increase of 0.1 cm2of tethering area, EROA increases by 2.2 mm2. The right heart dilation and the degree of restriction of tricuspid apparatus change significantly according to the severity of the TR (p &lt; 0.001). RV function parameters did not differ significantly according to the degree of TR.

Conclusion

Early TA enlargement is present in secondary isolated TR. Then, increase in tethering area and RA indexed volume are associated with increase in TR severity. All right heart cavities dilate progressively without clear impact on RV-function parameters when TR increase.

Factor determining increase in EROA coefficient SD p value RA volume (mL/m2) 0.42 0.09 &lt; 0.001 Tethering area (cm2) 22.1 3.9 &lt; 0.001 Multivariate linear regression model. EROA: Effective Regurgitant Orifice Area; SD: Standard Deviation; RA: Right Atrium.

Abstract P1277 Figure. RV-EDA: probability of TR class severity

Pain and gastrointestinal dysfunction are significant associations with psychiatric disorders in patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders: a retrospective study

In this retrospective study, we investigate the frequency and types of psychiatric disorders and their relationship to systemic manifestations in a cohort of 391 Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorder (HSD) patients based on the current 2017 International Classification of EDS diagnostic criteria. A detailed, systematic retrospective chart review was undertaken for patients assessed for HSD or EDS at two Canadian health centres. Patients were diagnosed according to the Villefranche criteria and reclassified for this study according to the 2017 International Classification of EDS. Data validation and statistical analyses were conducted. Psychiatric disorders were very common, with 49.4% of the total cohort affected; 28.9% reported multiple psychiatric diagnoses. Mood (34.5%) and somatoform (28.6%) disorders were most common. Interestingly, attention-deficit/hyperactivity disorder (ADHD) was significantly enriched in the HSD, but not EDS cohort (p = 0.0002, 95% CI 3.48-9.00) compared to the general population. There were no differences in the systemic associations with having psychiatric manifestations in the HSD compared to the EDS subsets. Muscle/body pain (OR 1.99) and gastrointestinal dysfunction (OR 2.07) were significantly associated with having mood disorders, and gastrointestinal dysfunction (OR 2.61) and nerve-related pain (OR 3.27) were associated with having somatoform disorders across the cohort. The common systemic associations with the presence of psychiatric manifestations in both HSD and EDS reaffirm that the conditions should be treated as a spectrum rather than as wholly separate entities, particularly with respect to psychiatric management. EDS and HSD patients share common psychiatric presentations, though ADHD is more common with HSD.

Abstract P6-18-38: Treatment patterns and sequences among pre-menopausal women with HR+/HER2- metastatic breast cancer: A chart review study

Background: Recently, a novel class of treatments, CDK4/6 inhibitors, has been approved, and is now recommended for pre-menopausal women with HR+/HER2- metastatic breast cancer (mBC). This study examined prevailing treatment patterns and sequencing among premenopausal women with mBC treated in clinical practice.

Methods: Patient-level data were collected from patient charts in May 2018 from 30 oncologists, mostly from community practice, in the US. Treatment sequences and patterns were assessed for pre-menopausal women diagnosed with HR+/HER2- mBC between January 2015 and January 2017 (with a minimum of 1 year of follow-up).

Results: Data were collected on 201 pre-menopausal women with HR+/HER2- mBC. In first-line therapy for mBC, 52.7% of the patients received a CDK4/6 inhibitor-based regimen, 23.4% received endocrine monotherapy, 20.9% received a chemotherapy-based regimen, and the remaining 3.0% received an everolimus-based regimen. The majority of patients who received a CDK4/6 inhibitor received it in combination with an AI (73.6%), fulvestrant (11.3%), or tamoxifen (6.6%). Approximately half of all patients (51.2%) received an ovarian suppression agent during first-line therapy. Overall, median time on treatment from Kaplan Meier (KM) analysis for first-line therapy was 16.1 months. Most common reason for discontinuing first line was disease progression or suboptimal response (79.0% of patients who discontinued); another common reason was the completion of the planned duration of therapy (12.6%).

Among the 106 patients who received a CDK4/6 inhibitor in the first line, median time on treatment from KM analysis was 26.8 months. Main reason for CDK4/6 inhibitor discontinuation was disease progression or suboptimal response (90.2% of patients who discontinued).

For the 109 patients for whom we observed a second-line therapy, treatment sequences are presented in Table 1. Median time on treatment for second and third line therapy was 9.6 and 7.8 months, respectively.

Conclusion: Following the introduction of novel CDK4/6 inhibitor treatments in the mBC setting, we observed that approximately half of pre-menopausal patients received a CDK4/6-based regimen in the first line of therapy.

Top 5 treatment sequences in pre-menopausal HR+/HER2- mBC patients (n=109)Treatment SequenceN(%)CDK4/6 - ET -&gt; Everolimus - ET21(19.3%)Chemo -&gt; Chemo16(14.7%)CDK4/6 - ET -&gt; Chemo13(11.9%)ET -&gt; CDK4/6 - ET13(11.9%)Chemo -&gt; CDK4/6 - ET10(9.2%)ET: endocrine therapy; Chemo: chemotherapy; -&gt; indicates a change to the next line of therapy. Percentages calculated among patients with at least 2 lines of therapy

Citation Format: Dalal AA, Goldschmidt D, Romdhani H, Kelkar S, Guerin A, Wang H, Caria N, Sawhney A, O'Shaughnessy J. Treatment patterns and sequences among pre-menopausal women with HR+/HER2- metastatic breast cancer: A chart review study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-38.

Introduction of pharmacy technicians onto a busy oncology ward as part of the nursing team

A project was planned to explore the practicality of using pharmacy technicians to support the workload of nursing teams on a busy haematology oncology ward of 28 beds in a university acute care children's hospital of 300 beds. The question asked was, could pharmacy technicians be part of the nursing team to undertake what has traditionally been considered a nursing role? Three pharmacy technicians were trained and participated in the study. Assisting in the preparation and administration of 509 intravenous injections out of a possible 1123 (45%) of all intravenous injections prepared on the ward during the study period. The results indicated a reduction in adverse events of 1-2 a day during the study period, a reduction in work-related stress by nursing staff associated with preparing complex medication and releasing a nurse, 4 hours a day to enable them additional time to care for patients.

Abstract P5-20-15: Dosing patterns and economic burden of drug wastage among postmenopausal women with HR+/HER2- metastatic breast cancer receiving palbociclib

Background: Dose modification related to adverse event is common in the treatment of metastatic breast cancer (mBC). Based on the dosage form and strengths available, dose modification may lead to drug wastage when the dose cannot be split or saved for later use. This study aimed to describe dosing patterns and to estimate the economic burden of drug wastage associated with dose modifications in postmenopausal women with HR+/HER2- mBC receiving palbociclib.

Methods: Postmenopausal adult women diagnosed with HR+/HER2- mBC were identified from the Truven administrative claims database (2006Q1–2015Q4). Regimens received following mBC diagnosis were identified – patients who received a palbociclib-based regimen during one of their first three lines of therapy for mBC were included in the study. Palbociclib starting daily dose, average daily dose, and dosing patterns (dosing modifications and sequences) were reported. A dose modification was defined as a change (decrease/increase) of ≥25mg daily compared to the preceding dose. The economic burden of drug wastage was estimated by multiplying the number of days with drug wastage (i.e., days with overlapping palbociclib prescriptions due to dosage change) by the average cost reimbursed by payers for one unit of palbociclib. Descriptive analyses were conducted separately by line of therapy for mBC.

Results: A total of 473 patients received palbociclib in first (214), second (157), or third (120) line of therapy for mBC. Patients were observed to receive palbociclib for an average of 4.3 months in first line and 4.1 months in second and third line of therapy. The majority of patients started palbociclib on the recommended 125 mg dose and remained on that dose until the end of observation. Dosing patterns and sequences are summarized in Table 1. Among the 214 patients who used palbociclib in first line, 38 (17.8%) had a dose modification – among these, 6 (15.8%) patients had an overlap in prescription fills (average overlap of 9.2 days). This potential drug wastage resulted in an average cost of $4,376 per patient over a period of approximately 4 months following treatment initiation. Results were consistent in second and third lines of therapy, with higher proportions of patients with drug wastage in later lines of therapy.

Conclusion: Over a short observation period, dose modifications, mostly dose reductions, were relatively frequent, and potential resulting drug wastage was associated with a substantial economic burden.

Table 1: Palbociclib dosing patterns and sequences First lineSecond lineThird lineStarting dose (mg daily), N (%)   757 (3.3)3 (1.9)3 (2.5)10015 (7.0)17 (10.8)4 (3.3)125 - recommended dose192 (89.7)137 (87.3)113 (94.2)Average dose on treatment, mean±SD [median]119.52±11.27 [125]115.95±13.61 [125]116.85±13.30 [125]Dose sequencing (mg daily), N (%)   125163 (76.2)96 (61.1)74 (61.7)125→10021 (9.8)29 (18.5)26 (21.7)125→100→756 (2.8)8 (5.1)7 (5.8)125→100→1250 (0.0)1 (0.6)1 (0.8)125→752 (0.9)3 (1.9)4 (3.3)125→75→1000 (0.0)0 (0.0)1 (0.8)10010 (4.7)9 (5.7)1 (0.8)100→752 (0.9)7 (4.5)3 (2.5)100→1253 (1.4)0 (0.0)0 (0.0)100→75→1000 (0.0)1 (0.6)0 (0.0)753 (1.4)3 (1.9)3 (2.5)75→1002 (0.9)0 (0.0)0 (0.0)75→100→1251 (0.5)0 (0.0)0 (0.0)75→1251 (0.5)0 (0.0)0 (0.0)

Citation Format: Dalal AA, Gagnon-Sanschagrin P, Burne R, Guerin A, Gauthier G, Small T, Niravath P. Dosing patterns and economic burden of drug wastage among postmenopausal women with HR+/HER2- metastatic breast cancer receiving palbociclib [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-15.

Abstract P4-14-04: A chart review of patient characteristics, treatment patterns and response in metastatic breast cancer patients treated with ado-trastuzumab emtansine in first-line therapy and beyond

Background: Ado-trastuzumab emtansine (T-DM1) approved for HER2+ unresectable locally advanced metastatic breast cancer (mBC) has been shown to significantly improve progression-free and overall survival in patients (pts) previously treated with trastuzumab and a taxane. However, little is known about real-world patterns and outcomes of T-DM1.

Method: Pt-level data was collected from 90 US oncologists using an online chart extraction tool. Oncologists randomly selected eligible adult mBC pts started on T-DM1 on or after February 22nd 2013. Pts demographics, clinical information, and T-DM1 patterns and responses were described. Among pts whose T-DM1 response was assessed, univariate logistic regression models were used to assess the association between each factor and the probability of achieving complete response (CR).

Results: Among the 303 pts, median follow-up after T-DM1 initiation was 5.1 months; 58.4% started T-DM1 in the 2nd half of 2014. Median age was 58 years, most pts were Caucasian (62.0%), median number of metastatic sites was 2, and 65.3% of pts had a mBC diagnosis (dx) within 1 year of the BC dx. Most common metastatic sites were liver (51.5%), lung/pleura (42.6%), and bone/bone marrow (41.6%). Median time from mBC dx to T-DM1 initiation was 7.1 months. 34.0% of pts started T-DM1 in 1st line for mBC, 55.4% in 2nd line, and 10.6% in later lines after mBC dx; most common prior treatments were trastuzumab, pertuzumab, and taxane. Best response achieved while on T-DM1 was CR in 17.5% of pts, partial response (PR) in 46.2%, stable disease in 11.2%, recurrence/progression in 3.6%, and the response was unknown in 21.5% of pts. CR/PR was achieved within a median of 5 months of T-DM1 initiation. At the end of follow-up, 80.2% were still on T-DM1, 3.3% had switched, 12.9% had discontinued without switching, and 3.6% were deceased. 44.9% of pts discontinued/switched after CR/PR and 32.7% after progression. When physicians were surveyed about their practice, 30.0% reported intention to interrupt T-DM1 after CR and 7.8% after an a priori determined number of cycles. Among pts whose response on T-DM1 was assessed (78.5%), race (Asian), initiation of T-DM1 shortly after mBC dx or in 1st line for mBC, ≤ 2 metastatic lesions, single metastatic site, and estrogen (ER)+ /progesterone (PR)+ at T-DM1 initiation were found to be significant predictors of CR, while pts who progressed between mBC dx and T-DM1 were less likely to achieve CR.

Table 1. Factors Associated with CR Odds Ratio and 95% Confidence IntervalsAsian (vs non-Asian)2.9 (1.2 - 7.4)T-DM1 ≤ 1 year after mBC dx (vs &gt; 1)3.2 (1.4 - 7.6)T-DM1 in 1st line after mBC dx (vs later lines)3.8 (2.0 - 7.2)≤ 2 metastases (vs&gt;2)3.8 (1.9 - 7.6)1 metastatic site (vs &gt;1)4.4 (2.3 - 8.4)ER+/PR+ (vs other status)4.9 (2.5 - 9.7)Progression between mBC dx and T-DM1 (vs no progression)0.2 (0.1 - 0.4)

Conclusions: Most pts started T-DM1 as 1st or 2nd line therapy for mBC and were still treated with T-DM1 at the end of follow-up. CR/PR, assessed by treating oncologists, was achieved in &gt;50% of pts within 5 months of T-DM1 initiation.

Citation Format: Gauthier G, Guerin A, Zhdanava M, Wu E, Masaquel A, Barnett B. A chart review of patient characteristics, treatment patterns and response in metastatic breast cancer patients treated with ado-trastuzumab emtansine in first-line therapy and beyond. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-04.

Abstract P4-14-03: What are the real-world treatment patterns and medical costs in patients with metastatic breast cancer treated with ado-trastuzumab emtansine?

Background: Ado-trastuzumab emtansine (T-DM1) was approved by the FDA (02/2013) for the treatment of HER2+ metastatic breast cancer (mBC). This study assessed the real-world treatment (tx) patterns and medical costs in patients (pts) receiving T-DM1 or other targeted therapy [TT] or chemotherapy [CHT] for the tx of HER2+ mBC in the US.

Methods: Adult women with mBC initiated on T-DM1 (index date) covered by their health plan ≥365 days before and ≥30 days after the index date were selected in a large US commercial claims database (Q2 2009–Q2 2014). Pts were observed from the index date to the end of health plan enrollment (study period). Patient characteristics at T-DM1 initiation were reported and tx patterns, including T-DM1 tx duration, discontinuation (no T-DM1 claim for ≥60 days) and switch to a new TT or CHT (among pts who discontinued T-DM1), were analyzed using Kaplan Meier (KM) analyses.

In addition, T-DM1 pts were exactly matched to pts treated with another TT or CHT with similar profiles (same line of therapy and metastatic sites) on a 1:1 ratio. Tx change, defined as the initiation of or a switch to a new TT or CHT, and medical costs, measured up to 6 months after index date, were compared between pts receiving T-DM1 vs. other TT or CHT using multivariate Cox and GLM regression models, respectively.

Results: A total of 240 T-DM1 pts were selected. Mean age was 54 years and pts had on average 2.9 distinct metastatic sites. Most prevalent sites were bone/bone marrow (69.6%), liver (47.1%), and lung/pleura (40.4%). Median time from mBC diagnosis to index date was 25.0 months. Pts were observed for a median of 5.6 months after index date. 8.3% of pts were initiated on T-DM1 in 1st line therapy, 30.4% in 2nd line, 15.4% in 3rd line, 17.5% in 4th line, and 28.3% in later lines. 9.2% of pts were initiated on T-DM1 concomitantly with hormonal therapy. Pts received a mean of 6.2 doses (median: 5.0) of T-DM1 over the study period. KM median T-DM1 tx duration estimate was 7.4 months. KM rates of T-DM1 discontinuation and switch at 6 months were 18.6% and 23.1%, respectively.

Among the matched sample (n=228 in each cohort), T-DM1 pts had a lower risk of tx change (hazard ratio (HR) [95% CI]: 0.61 [0.40; 0.94]) compared to pts treated with other TT or CHT. Among T-DM1 pts, those receiving T-DM1 in 1st or 2nd lines of therapy had a lower risk of tx change than those receiving T-DM1 in later lines (HR [95% CI]: 0.34 [0.14; 0.80]). Once adjusted for potential confounding factors, T-DM1 pts had lower medical costs (adjusted, $1,630 per pt per month [pppm]) compared to pts treated with other TT or CHT (unadjusted, $5,075 vs. $6,204; p&lt;.05). The medical cost difference was mainly driven by the outpatient cost difference (adjusted, $1,002 pppm; p&lt;.05). Incremental cost associated with adverse events accounted for 25% (adjusted, $255 pppm) of the outpatient cost difference.

Conclusions: In this real-world study of mBC pts treated with T-DM1 shortly after its approval, most pts were initiated on T-DM1 in 2nd and later lines of therapy. When compared to pts with similar profiles initiated on other TT or CHT, T-DM1 pts had a lower risk of tx change and lower medical costs.

Citation Format: Cloutier M, Guerin A, Heroux J, Emond B, Wu EQ, Masaquel A, Barnett B. What are the real-world treatment patterns and medical costs in patients with metastatic breast cancer treated with ado-trastuzumab emtansine?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-03.

Atherosclerosis versus arterial stiffness in advanced renal failure

Epidemiological as well as clinical studies have shown that regardless of the severity of renal impairment the cardiovascular mortality in renal disease patients is very high compared to the general population. In uremia, cardiovascular disease is a combination of atherosclerosis, characterized by the presence of highly calcified plaques, and arteriosclerosis, an arterial wall alteration in response to both hemodynamic changes and humoral modifications such as inflammation or calcium-phosphate imbalance. Vascular endothelium, recognized as a large and complex endocrine organ strategically located between the wall of the blood vessel and the blood stream, could be the link between these two processes evolving during the same course.

[MIRA study: epidemiology of microalbuminuria in type 2 diabetes patients and associated comorbidities]

This is an observational survey screening for microalbuminuria in diabetes patients type 2. This survey takes place during the general practioner (GP) consultation in Rhône-Alpes area. It is preliminary survey. Five hundred and sixty three patients were included, consecutively, during the same week, by 185 GP. They were aged from 18 to 80 years and previously research for microalbuminuria was carried out at least one year ago. A questionnaire collecting data concerning age, weight, height, diabetic vintage and HbA1c, arterial pressure, renal function, associated risk factors as (lipids, tabacco, cardiovascular history personal and family, antihypertensive diabetic and lipid treatments. Microalbuminuria as well as urine creatinine was detected with a dipstick to calculate albumin-creatinine ratio. Patients aged 64.66 +/- 11.23, 55% were male; 51% had a microalbumuniria between 30 mL/L and 300 mL/L, but if one consider the albumin-creatinine ratio 59% had a microalbuminuria. In these patients, the diabetes history is longer and body mass index >30 is more frequent 35 vs 27%. HbA1c is similar in the two groups of patients, but patients with microalbuminuria had more often two treatments. Regarding hypertension, there are no difference between the two groups in term of blood pressure control and there is no correlation between blood pressure and albuminuria level. Nevertheless 68% of the patients were uncontrolled for blood pressure. Renal impairment (creatinine clearance <60 mL/min) was present in 26% of the whole group but more frequent in microalbuminuria patients 30 vs 23%.

IN CONCLUSION

prevalence of microalbuminuria seems to be higher in this population compared to data previously reported and linked to the vintage of the diabetes mellitus. Comorbidities as well as risk factors were more frequent in patients with microalbuminuria.