Carer perspective on treatment, comorbidities and diagnosis of Paediatric ADHD in France

Objectives

To examine treatment, comorbidity status and diagnosis among the French sample of the Caregiver Perspective of Pediatric ADHD (CAPPA) survey.

Methods

Carers in 10 EU countries, including France, completed an Internet survey regarding ADHD diagnosis, treatment and comorbidities. Descriptive statistics were calculated for categorical [n (%)] and continuous variables [mean, standard deviation (SD), median, range].

Results

EU carers representing 3688 children/adolescents (6–17 years) with ADHD completed the survey; 486 were from France (median age 10 years, 84% male). Most (77%) French children/adolescents were currently receiving pharmacological treatment(s): 74% stimulant, 15% non-stimulant and 22% antipsychotic. Across countries, stimulant use ranged from 60% (Italy) to 93% (Germany/Netherlands), non-stimulant use from 1% (Germany) to 18% (Sweden) and antipsychotic use from 8% (Germany) to 46% (Italy). Many French children/adolescents received behaviour therapy (BT) after ADHD diagnosis (59%). Among those receiving BT, 52% began prior to starting medication. BT was often discontinued within 6 months (44%) or 6–12 (30%) months. 52% of carers reported ≥ 1 comorbidity; they reported the highest rates of conduct (24%), sleep (11%), eating (6%) and motor-coordination (6%) disorders, and the second-highest rates of anxiety (22%), learning difficulties (15%), oppositional defiant disorder (5%), bipolar disorder (4%) and epilepsy (2%). Time to diagnosis from first doctor's visit averaged 7 months (SD 11, median 3). 81% received a specialist referral. French carers reported the highest perceived difficulty (‘great deal’/’a lot’ of difficulty) obtaining a diagnosis (43%) and a specialist referral (53%).

Conclusions

This sample of French children/adolescents with ADHD had higher non-stimulant and antipsychotic use than most other countries and higher reports of certain comorbid conditions. Carers perceived greater difficulty in obtaining a diagnosis and seeing a specialist, although time to diagnosis was lower compared with a number of other countries.

Qualitative validation of the FACIT-Fatigue scale in systemic lupus erythematosus

Objective

Fatigue in systemic lupus erythematosus (SLE) is burdensome and must be assessed using validated scales. Although the psychometric properties of the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue) scale in SLE have been evaluated previously, its content validity in this disease remains to be evaluated. The study objective was, therefore, to evaluate content validity of the FACIT-Fatigue in SLE.

Methods

Three SLE focus groups ( n = 21) in the United States were conducted using semi-structured interviews. Participant comments were categorized by response type, and relative response strength was qualitatively assessed.

Results

Participants were mostly female (90%; n = 19), white (57%; n = 12) with a mean age of 43.7 years (range = 28–70). Most scale items were considered relevant with the exception of four items for which participant interpretations varied . Consistent with the scale’s measurement model, “listless” on item 3 (“ I feel listless (‘ washed out’)”) was interpreted as physical or mental impairment. Participant responses to item 8 (“ I am able to do my usual activities”) sometimes included influence of other health conditions, which is acceptable because it is difficult to separate disease-specific and general fatigue. Some participants found item 7 (“ I have energy”) irrelevant and most could not relate to item 10 (“ I am too tired to eat”). However, both items were intended to capture the extreme ends of fatigue (item 7, ceiling; item 10, floor).

Conclusions

From a content perspective, items of the FACIT-Fatigue scale were relevant for measuring fatigue in SLE.

Resource utilization and direct medical costs in adult systemic lupus erythematosus patients from a commercially insured population

OBJECTIVE

Our aim was to estimate annual health care resource use and medical costs associated with systemic lupus erythematosus (SLE) in a large US managed care health plan.

METHODS

Subjects at least 18 years of age and with claims-based evidence of SLE (ICD-9-CM 710.0x) were identified from a health plan database. Subjects were matched on the basis of demographic and clinical characteristics to unaffected controls. Resource use and costs were determined during a fixed 12-month period. A generalized linear model (GLM) was used to adjust costs for demographic and clinical characteristics.

RESULTS

In total, 1278 newly diagnosed SLE subjects were matched to 3834 controls, and 10,152 subjects with existing SLE were matched to 30,456 controls. Health care resource use was significantly higher among SLE subjects than matched controls, including average annual numbers of ambulatory visits, specialist visits, and inpatient hospital stays (all p < 0.001). SLE subjects had significantly higher overall mean annual medical costs than matched controls (newly diagnosed: $19,178 vs. $4909; existing: $15,487 vs. $5156; both p < 0.001). Evidence of specific organ involvement including renal failure and central nervous system complications, were each associated with increased costs (both p < 0.001).

CONCLUSIONS

Subjects with SLE have high resource use and medical costs relative to controls.

Abatacept improves both the physical and mental health of patients with rheumatoid arthritis who have inadequate response to methotrexate treatment

OBJECTIVE

To examine the impact of added abatacept treatment on health related quality of life (HRQoL) in patients with rheumatoid arthritis (RA) who have inadequate response to methotrexate (MTX).

METHODS

The impact of abatacept treatment on HRQoL was examined in a longitudinal, randomised double blind, placebo controlled clinical trial. Effects of treatment on HRQoL were examined using repeated measures analysis of covariance and comparing rates of change in HRQoL across treatment groups. The relationship between American College of Rheumatology (ACR) clinical markers and disease duration with changes in HRQoL indicators was also examined. Finally, a responder analysis was used to examine the percentage of patients who improved by 0.5 SD in 12 months or who reached the normative levels seen in the US general population.

RESULTS

Statistically significant improvements in the abatacept group relative to controls were observed across a range of HRQoL measures, including physical function, fatigue, all eight domains of the SF-36, and the physical and mental component summaries (PCS and MCS). Improvements were seen as early as day 29 for fatigue and for five out of eight SF-36 domains. By day 169, all HRQoL measures were significantly better with abatacept than with placebo. HRQoL gains were associated with greater ACR clinical improvement, and the effects were consistent for patients with different disease duration. A significantly greater percentage of patients treated with abatacept reached normative levels of PCS, MCS, physical functioning, and fatigue compared with patients treated with MTX alone.

CONCLUSION

Combined abatacept and MTX treatment produces significant improvements across a wide range of HRQoL domains in patients with RA.