Metabolic outcomes of matched patient populations initiating exenatide BID vs. insulin glargine in an ambulatory care setting

AIM

This observational study evaluated the clinical effectiveness of exenatide BID (exenatide) vs. insulin glargine (glargine) in patients with type 2 diabetes mellitus in ambulatory clinical practice.

METHODS

Retrospective analyses were conducted using an electronic medical record (EMR) database among adult patients with type 2 diabetes mellitus initiating exenatide or glargine between 1 November 2006 and 30 April 2009. The cohorts were propensity-score matched to control baseline demographics, clinical measures, health status and medication use. The changes from baseline to a 12-month follow-up period for A1C (primary outcome), weight, body mass index (BMI), blood pressure and lipid levels were compared between the matched cohorts using paired tests.

RESULTS

Propensity-score matching between the exenatide (n = 4494) and glargine (n = 5424) cohorts led to 2683 matched pairs with comparable characteristics, including age, gender and baseline clinical values. The exenatide cohort achieved a greater mean reduction in A1C (-0.6% vs. -0.4%, p < 0.01), weight (-2.6 kg vs. -0.2 kg, p < 0.01), BMI (-0.8 kg/m(2) vs. -0.04 kg/m(2) , p < 0.01) and systolic blood pressure (SBP) (-1.8 mmHg vs. -0.1 mmHg, p < 0.01) in the follow-up period. The changes in diastolic blood pressure and lipid levels were not significantly different between cohorts.

CONCLUSIONS

Compared to glargine, exenatide-treated patients experienced significant reductions in A1C, weight, BMI and SBP. Acknowledging the limitations of observational research, exenatide showed greater clinical effectiveness than glargine from a large EMR database in the ambulatory care setting.

The clinical and economic costs associated with regional disparities in varicella vaccine coverage in Italy over 50 years (2020-2070)

Italy implemented two-dose universal varicella vaccination (UVV) regionally from 2003 to 2013 and nationally from 2017 onwards. Our objective was to analyze regional disparities in varicella outcomes resulting from disparities in vaccine coverage rates (VCRs) projected over a 50-year time-horizon (2020-2070). A previously published dynamic transmission model was updated to quantify the potential public health impact of the UVV program in Italy at the national and regional levels. Four 2-dose vaccine strategies utilizing monovalent (V) and quadrivalent (MMRV) vaccines were evaluated for each region: (A) MMRV-MSD/MMRV-MSD, (B) MMRV-GSK/MMRV-GSK, (C) V-MSD/MMRV-MSD, and (D) V-GSK/MMRV-GSK. Costs were reported in 2022 Euros. Costs and quality-adjusted life-years (QALYs) were discounted 3% annually. Under strategy A, the three regions with the lowest first-dose VCR reported increased varicella cases (+ 34.3%), hospitalizations (+ 20.0%), QALYs lost (+ 5.9%), payer costs (+ 22.2%), and societal costs (+ 14.6%) over the 50-year time-horizon compared to the three regions with highest first-dose VCR. Regions with low first-dose VCR were more sensitive to changes in VCR than high first-dose VCR regions. Results with respect to second-dose VCR were qualitatively similar, although smaller in magnitude. Results were similar across all vaccine strategies.

Abstract P3-07-08: Recent trends in the characteristics of patients with distant stage breast cancer in the United States Surveillance, Epidemiology and End Stage Disease (SEER) program

Objectives. Even though advances in screening and contemporary diagnostic techniques have led to earlier detection, a proportion of breast cancer patients are still diagnosed with distant stage disease. The objective of this research was to describe the changing demographic and clinical characteristics of patients with distant stage breast cancer.

Methods. We identified women aged 20 years or older who were diagnosed with distant stage primary breast cancer between 1995 and 2009 with non-missing hormone receptor (HR) status in the SEER 18 Registry (1973–2009) database. As staging systems changed across the years of the study, we opted to use the SEER historic stage in our analyses. Trends in demographic and clinical characteristics were evaluated by time period of diagnosis (1995–1999, 2000–2004, 2005–2009) and HR status (HR+ includes ER+/PR+, ER+/PR- and ER−/PR+; HR− includes ER−/PR− only). Statistically significant changes were examined using the Cochran Armitage test.

Results. A total of 30,161 women with distant stage breast cancer were identified. Over the 15 years, the incidence rate (IR) of distant stage disease was stable (10.6 to 10.9 per 100,000 pys), as well as the proportion of HR+ cases (68%).

Age did not vary significantly over time; 55% of the HR+ cases and 45% of the HR- cases were 60 years or older. The proportion of Black and Hispanic patients increased significantly over time (18 to 24% for HR+; 24 to 33% for HR−) -as did the proportion of patients diagnosed with grades I and II cancers (44 to 54% for HR+; and 16 to 20% for HR−). The proportion of ductal histologic diagnoses was stable over time, at 77% among HR+ cases and 93% among HR- cases in 2005–2009. Cancer-directed surgeries (from 63 to 47% for HR+; 72 to 56% for HR−) and radiation therapies (43 to 37% for HR+; 42 to 38% for HR−) became less common over the time. Information on chemotherapy/systemic therapies is unavailable in this dataset.

Conclusions. Although, incidence rate of distant stage breast cancer was stable over a time, there was a higher proportion of diagnosis of grade I/II stage cancer cases potentially due to earlier cancer detections by screening programs. The growing proportion of minorities suggested that screening programs be adjusted to the changing demographics in the United States.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-07-08.