Clinical outcomes among patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) who received treatment with a covalent BTK and BCL2 inhibitor in the United States: a real-world database study

This retrospective study using the nationwide de-identified Flatiron Health electronic health record-derived database was designed to evaluate clinical outcomes among patients with chronic lymphocytic leukemia (CLL) who previously received both a covalent Bruton's tyrosine kinase inhibitor (cBTKi) and B-cell lymphoma 2 inhibitor (BCL2i) in a real-world setting. Outcomes for the immediate next line of therapy following the latter of the cBTKi or BCL2i treatment included: real-world response rate of 34.4% (using methods most consistent with clinical trials); median duration of real-world response of 13.3 months; and median real-world progression-free survival of 9.2 months. Median overall survival was 25.5 months from the start of the immediate next line of therapy. There remains a need for more effective therapies after cBTKi and BCL2i therapy for patients with CLL.

Vitrectomy for Complicated Retinal Detachment Without the Use of Perfluorocarbon Liquid: A Real-World Data and Retrospective Study

Introduction

This study aimed to evaluate the effectiveness of vitrectomy without using perfluorocarbon liquid (PFCL) for the treatment of complicated retinal detachment (RD).

Methods

The utilisation of PFCL was calculated in four hospitals in 2020 and in one hospital every year from 2012 to 2020. A case series of 320 RD eyes treated with vitrectomy without the use of perfluorocarbon liquid (VWTPL) was followed up for 1–26 months. The rate of retinal reattachment (RR) and postoperative visual acuity (VA, LogMAR) was evaluated. Furthermore, factors influencing RR and VA were analysed.

Results

The overall utilisation of PFCL was 43.87% (42.74%, 45.83%, 62.39% and 4.5%). The annual utilisation was 46.94%, 20.43%, 46.73%, 47.41%, 20%, 17.24%, 7.60%, 10.67% and 4.49% from 2012 to 2020. The VA of 320 eyes improved from 1.96 ± 1.07 preoperatively to 1.43 ± 0.92 (LogMAR, p < 0.001) 1 week post-operation. In the follow-up of 1–26 months (median: 9 months), the primary and final RR was 87.37% and 95.56%, respectively. Age, uveitis, recurrent RD, the number of detached retinal quadrants, aPVR and preoperative VA were considered as the factors influencing postoperative VA. Moreover, preoperative VA and preoperative intraocular pressure were the factors influencing RR.

Conclusion

The utilisation of PFCL varies amongst hospitals with a highest percentage of 62.39%. VWTPL is safe and effective, thereby saving costs and preventing complications related to PFCL.

Trial Registration

ChiCTR-ORC-17014225.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-022-00479-x.

Emulation of the control cohort of a randomized controlled trial in pediatric kidney transplantation with Real-World Data from the CERTAIN Registry

BACKGROUND

Randomized controlled trials in pediatric kidney transplantation are hampered by low incidence and prevalence of kidney failure in children. Real-World Data from patient registries could facilitate the conduct of clinical trials by substituting a control cohort. However, the emulation of a control cohort by registry data in pediatric kidney transplantation has not been investigated so far.

METHODS

In this multicenter comparative analysis, we emulated the control cohort (n = 54) of an RCT in pediatric kidney transplant patients (CRADLE trial; ClinicalTrials.gov NCT01544491) with data derived from the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) registry, using the same inclusion and exclusion criteria (CERTAIN cohort, n = 554).

RESULTS

Most baseline patient and transplant characteristics were well comparable between both cohorts. At year 1 posttransplant, a composite efficacy failure end point comprising biopsy-proven acute rejection, graft loss or death (5.8% ± 3.3% vs. 7.5% ± 1.1%, P = 0.33), and kidney function (72.5 ± 24.9 vs. 77.3 ± 24.2 mL/min/1.73 m² P = 0.19) did not differ significantly between CRADLE and CERTAIN. Furthermore, the incidence and severity of BPAR (5.6% vs. 7.8%), the degree of proteinuria (20.2 ± 13.9 vs. 30.6 ± 58.4 g/mol, P = 0.15), and the key safety parameters such as occurrence of urinary tract infections (24.1% vs. 15.5%, P = 0.10) were well comparable.

CONCLUSIONS

In conclusion, usage of Real-World Data from patient registries such as CERTAIN to emulate the control cohort of an RCT is feasible and could facilitate the conduct of clinical trials in pediatric kidney transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.

What, Where, and How to Collect Real-World Data and Generate Real-World Evidence to Support Drug Reimbursement Decision-Making in Asia: A reflection Into the Past and A Way Forward

BACKGROUND

Globally, there is increasing interest in the use of real-world data (RWD) and real-world evidence (RWE) to inform health technology assessment (HTA) and reimbursement decision-making. Using current practices and case studies shared by eleven health systems in Asia, a non-binding guidance that seeks to align practices for generating and using RWD/RWE for decision-making in Asia was developed by the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) Working Group, addressing a current gap and needs among HTA users and generators.

METHODS

The guidance document was developed over two face-to-face workshops, in addition to an online survey, a face-to-face interview and pragmatic search of literature. The specific focus was on what, where and how to collect RWD/ RWE.

RESULTS

All 11 REALISE member jurisdictions participated in the online survey and the first in-person workshop, 10 participated in the second in-person workshop, and 8 participated in the in-depth face-to-face interviews. The guidance document was iteratively reviewed by all working group members and the International Advisory Panel. There was substantial variation in: (a) sources and types of RWD being used in HTA, and (b) the relative importance and prioritization of RWE being used for policy-making. A list of national-level databases and other sources of RWD available in each country was compiled. A list of useful guidance on data collection, quality assurance and study design were also compiled.

CONCLUSION

The REALISE guidance document serves to align the collection of better quality RWD and generation of reliable RWE to ultimately inform HTA in Asia.

Integrating Evidence to Guide Use of Biologics and Small Molecules for Inflammatory Bowel Diseases

Advances in science have led to the development of multiple biologics and small molecules for the treatment of inflammatory bowel diseases (IBDs). This growth in advanced medical therapies has been accompanied by an increase in methodological innovation to study and compare therapies. Guidelines provide an evidence-based approach to integrating therapies into routine practice, but they are often unable to provide timely recommendations as new therapies come to market, and they have limited incorporation of real-world evidence when making recommendations. This limits the scope and usability of guidelines, and a gap remains in defining how best to position and integrate advanced medical therapies for IBD. In this review, we provide a framework for clinicians and researchers to understand key differences in sources of evidence, how different methodologies are applied to study the comparative effectiveness of advanced medical therapies in IBD, and considerations for how these sources of evidence can be used to better integrate current guideline recommendations. Over time, we anticipate this framework will allow for a transition to living guidelines and/or practice recommendations.

An evaluation of a five-year program for newborn congenital heart disease screening in Jiangsu Province, 2019-2023

BACKGROUND

Since 2019, Jiangsu province has implemented newborn screening for congenital heart disease (CHD). As of 2023, 591 hospitals (584 public or private midwifery institutions, 7 specialized hospitals for children) in Jiangsu province conduct CHD screening, including 132 with diagnostic capabilities and 21 with treatment facilities, ensuring comprehensive coverage of 13 prefecture-level cities, 95 counties (19 counties, 21 county-level cities, 55 districts) in Jiangsu Province. This study aims to examine the implementation of the newborn CHD screening program within Jiangsu Province's healthcare systems using real-world clinical data and to assess its effectiveness in patient care systematically. Additionally, we seek to offer data-driven recommendations for advancing the development of patient risk screening tools.

METHODS

Our study analyzed dataset from live births at midwifery institutions across Jiangsu province from 2019 to 2023. All newborns aged 6-72 h were screened by trained medical staff using the dual-index method. Newborns diagnosed without CHD or screened negative were tracked through the Child Health Management program, a basic public health service for children under 7 years of age in China. Newborns testing positive were referred to a diagnostic institution for echocardiographic assessment, and those with confirmed CHDs were directed to a treatment facility for further evaluation and treatment.

RESULTS

During the study period, 2,512,635 out of 2,648,298 infants (94.88%) were screened within 72 h of birth. Of these, 71,041 (2.83%) tested positive for screening, and 23,150 (32.59%) of those positive were diagnosed with CHD. From 2018 to 2023, there was approximately a twofold decrease in the infant mortality rate (IMR) due to CHD, from 0.37‰ to 0.14‰ (APC= -17.33, P < 0.001), and a reduction in the under-five mortality rate (U5MR) due to CHD, from 0.45‰ to 0.17‰ (APC= -16.79, P < 0.001).

CONCLUSIONS AND RELEVANCE

The current study provides encouraging evidence that the screening program has effectively advanced the diagnosis of CHD in children and reduced infant mortality, thereby supporting health rights and benefiting children with CHD throughout the province. Furthermore, our analysis demonstrates that the newborn CHD screening program has been effectively implemented across Jiangsu province's healthcare systems.

Effectiveness of Adjuvant Capecitabine in Triple-Negative Breast Cancer Patients With Residual Disease After Neoadjuvant Treatment: A Real-World Evidence Study in Korea

BACKGROUND

Residual disease after neoadjuvant chemotherapy (NAC) has important role in triple negative breast cancer (TNBC). The CREATE-X study demonstrated a survival benefit from adjuvant capecitabine (adjC) in breast cancer patients, especially for TNBC populations. Because the landscape of early TNBC treatment has been changing rapidly, an optimal adjuvant strategy for real-world practice is needed. We evaluated the effectiveness of adjC in TNBC patients with residual disease after NAC.

METHOD

We used de-identified, anonymous data from an institutional clinical data warehouse to retrospectively analyze 934 TNBC patients who received NAC between 2017 and 2023. Among them, 405 patients received at least 1 cycle of adjC, and 77 received no adjuvant treatment. The primary outcomes of the study were distant-disease free survival (DDFS) rate and overall survival (OS) rate at 3 years. The secondary outcomes were subgroup analyses and Cox regression analyses of survival outcomes.

RESULT

The median follow up period was 34.3 months (range 1.8-71.5). The DDFS rate at 3 years was higher in the capecitabine group: 86.3% of the capecitabine group and 74.4% of the no adjuvant group (P = .019). The OS rates at 3 years were 93.3% and 83.8%, respectively (P = .032). Subgroup analyses indicated a greater benefit from adjC in patients aged 50 years or older and those who received platinum-based NAC, both in terms of DDFS and OS.

CONCLUSION

Our study showed that adjC was more effective than no adjuvant treatment for TNBC patients with residual disease in terms of DDFS and OS.

A Standards-Based Approach for Quality Assessment in Data Collection for Retrospective Clinical Studies

Relying on our experience on the development and configuration of tools for the collection, validation and integration of Real-World Data for clinical studies, we designed a knowledge-based approach to facilitate quality assessment during registration of clinical and biological data for multi-center, retrospective studies.

Electronic medical records-based comparison of glycemic control efficacy between sulfonylureas and dipeptidyl peptidase-4 inhibitors added on to metformin monotherapy in patients with type 2 diabetes

Sulfonylurea (SU) and dipeptidyl peptidase-4 (DPP-4) inhibitors are most common secondary agents that are added to metformin monotherapy. Real-world studies have become increasingly important in providing evidence of treatment effectiveness in clinical practice and real-world data could help appropriate therapeutic information. Therefore, this study aims to compare the glycemic effectiveness of SU and DPP-4 inhibitors, which are added to metformin monotherapy in real clinical practice using electronic medical record (EMR) data. EMR data of type 2 diabetes patients treated at Seoul National University Hospital from December 2002 to December 2012 were retrieved and analyzed. The patients were divided into three groups: patients who maintained metformin monotherapy (M), and patients who added SU (MS) or DPP-4 inhibitors (MD) to metformin monotherapy. The mean change in HbA1c level, the proportion of patients achieving the HbA1c target < 7.0%, proportion of patients with treatment failure, and probability of treatment failure occurrence and changes in prescription were evaluated to compare glycemic control efficacy between SU and DPP-4 inhibitors. The MS showed significantly greater reduction in the Hb1Ac level than MD. The proportion of patients achieving HbA1c < 7.0% is higher in MD, whereas the proportion of patients with treatment failure was greater in MS. The probability of the treatment failure and probability of changes in the prescription were lower in MD than MS with hazard ratio of 0.499 and 0.579, respectively. In conclusion, this real-world study suggested that DPP-4 inhibitors are expected to show more durable glycemic control efficacy than SU in long-term use.

Cohort Builder: A Software Pipeline for Generating Patient Cohorts with Predetermined Baseline Characteristics from Medical Records and Raw Ophthalmic Imaging Data

In clinical research, the analysis of patient cohorts is a widely employed method for investigating relevant healthcare questions. The ability to automatically extract large-scale patient cohorts from hospital systems is vital in order to unlock the potential of real-world clinical data, and answer pivotal medical questions through retrospective research studies. However, existing medical data is often dispersed across various systems and databases, preventing a systematic approach to access and interoperability. Even when the data are readily accessible, clinical researchers need to sift through Electronic Medical Records, confirm ethical approval, verify status of patient consent, check the availability of imaging data, and filter the data based on disease-specific image biomarkers. We present Cohort Builder, a software pipeline designed to facilitate the creation of patient cohorts with predefined baseline characteristics from real-world ophthalmic imaging data and electronic medical records. The applicability of our approach extends beyond ophthalmology to other medical domains with similar requirements such as neurology, cardiology and orthopedics.

Disparities in Initial Antihypertensive Intensity by Sex, Race and Ethnicity in Newly-Treated Patients with Hypertension

BACKGROUND

Sex, race, and ethnicity disparities in hypertension (HTN) treatment intensity have been previously described. It remains unclear if these disparities occur at treatment onset and whether they can be explained by differences in clinical factors.

METHODS

We conducted a retrospective cross-sectional study of adults with newly-treated HTN using linked EHR+claims data from OneFlorida+ Consortium. We included Florida Medicaid & Medicare-recipients diagnosed with HTN and prescribed ≥1 first-line antihypertensive during 2013-2020. We used generalized linear models to estimate differences in total therapeutic intensity score (TTIS)-a patient's total daily dose (TDD) divided by recommended maximum TDD for a drug, summed across entire regimen-by sex, race, and ethnicity. We then modeled the same, controlling for demographics, blood pressure, and relevant comorbidities.

RESULTS

In total 4,094 patients (mean age 58 ± 16; female 57.6%; White 56.7%) were included. We observed variations in the initiation of antihypertensive classes by sex, race and ethnicity. In univariate analyses, men averaged 7.6% (95%CI:3.9%-11.3%) greater TTIS versus women and Black individuals averaged 10.5% (95%CI:6.6%-14.3%) greater TTIS versus White individuals, whereas no disparities were observed by ethnicity. After adjusting for clinical factors, these disparities persisted: men had 7.6% (95%CI:3.9%-11.4%) greater TTIS versus women, and Black individuals had 17.9% (95%CI:13.8%-21.9%) greater TTIS versus White individuals.

CONCLUSION

We observed disparities in treatment intensity by sex and race that were not explained by differences in clinical factors. There was sex-based variation in practice patterns, and Black individuals received more intensive initial antihypertensive therapy than White individuals.

Data Quality in Medical Real-World Data - An Oncological Use Case

Data quality deficiencies significantly limit the applicability of real-world data in data-driven medical research. In this study, using an oncological use case, we report and discuss common quality deficiencies in real-world medical datasets, such as missing data, class imbalances, and timeliness issues. We compiled a multi-departmental real-world dataset comprising 13861 cancer cases diagnosed at University Hospital Cologne and examined data quality throughout the data integration process.

Stimulating solidarity to improve knowledge on medications used during pregnancy : A contribution from the ConcePTION project

BACKGROUND

Pregnant people have been overlooked or excluded from clinical research, resulting in a lack of scientific knowledge on medication safety and efficacy during pregnancy. Thus far, both the opportunities to generate evidence-based knowledge beyond clinical trials and the role of pregnant people in changing their status quo have not been discussed. Some scholars have argued that for rare disease patients, for whom, just like pregnant people, a poor evidence base exists regarding treatments, solidarity has played an important role in addressing the evidence gap. This paper explores whether and how the enactment of solidarity among pregnant people can be stimulated to help address the poor evidence base on medications used during pregnancy.

METHOD

We use the concept of solidarity formulated by Prainsack and Buyx and enrich their concept by providing an account for stimulating the enactment of solidarity. Then we apply this account to the case of pregnant people who use medication.

RESULTS

Solidarity means enacted commitment on the part of an individual to assisting others with whom the person recognizes a similarity in a relevant respect. Although solidarity cannot be imposed, we argue that the empowerment of people is a crucial concept in understanding how solidarity can be stimulated. Empowerment in the context of pregnant people means creating awareness about their status quo, explaining how scientific research can help close the knowledge gap, and how pregnant people can themselves contribute. In particular, how pregnant people can contribute to the collection of health data to strengthen the evidence base for medications used during pregnancy.

CONCLUSIONS

We conclude that acting in solidarity can help change the status quo for pregnant people. Furthermore, we argue that the empowerment of pregnant people and other relevant stakeholders is a way to stimulate the enactment of solidarity. The process of empowerment starts by raising awareness about the lack of evidence on medications used during prengnacy and by explaining to pregnant people how they can contribute to changing the way knowledge is being generated by, for example, sharing data on the health effects of medications.

Dark Data in Real-World Evidence: Challenges, Implications, and the Imperative of Data Literacy in Medical Research

Randomized controlled trials (RCTs) and real-world evidence (RWE) studies are crucial and complementary in generating clinical evidence. RCTs provide controlled settings to validate the clinical effect of specific drugs or medical devices, while RWE integrates extrinsic factors, encompassing external influences affecting real-world scenarios, thus challenging RCT results in practical applications. In this study, we explore the impact of extrinsic factors on RWE outcomes, focusing on "dark data," which refers to data collected but not used or excluded from the analyses. Dark data can arise in many ways during research process, from selecting study samples to data collection and analysis. However, even unused or unanalyzed dark data hold potential insights, providing a comprehensive view of clinical contexts. Extrinsic factors lead to divergent RWE outcomes that could differ from RCTs beyond statistical correction's scope. Two main types of dark data exist: "known-unknown" and "unknown-unknown." The distinction between these dark data types highlights RWE's complexity. The transformation of unknown into known depends on data literacy-powerful utilization capabilities that can be interpreted based on medical expertise. Shifting the focus to excluded subjects or unused data in real-world contexts reveals unexplored potential. Understanding the significance of dark data is vital in reflecting the complexity of clinical settings. Connecting RCTs and RWEs requires medical data literacy, enabling clinicians to decipher meaningful insights. In the big data and artificial intelligence era, medical staff must navigate data complexities while promoting the core role of medicine. Prepared clinicians will lead this transformative journey, ensuring data value shapes the medical landscape.

Oral and long-acting injectable antipsychotic discontinuation and relationship to side effects in people with first episode psychosis: a longitudinal analysis of electronic health record data

Background

Discontinuation of treatment in people with first episode psychosis (FEP) is common, but the extent to which this is related to specific adverse effects of antipsychotic medications is unclear.

Objectives

To investigate whether antipsychotic discontinuation is associated with the prescription of particular antipsychotics and particular adverse effects.

Design

Retrospective cohort study.

Methods

We assembled de-identified electronic health record (EHR) data from 2309 adults with FEP who received care from the South London and Maudsley NHS Foundation Trust between 1st April 2008 and 31st March 2019. Associations between antipsychotic medications, clinician-recorded side effects and treatment discontinuation were investigated across a mean follow-up period of 34.2 months using Cox regression.

Results

The mean age of patients was 26.7 years and 1492 (64.6%) were male. Among first prescribed antipsychotic medications, discontinuation occurred earlier with haloperidol [hazard ratio (HR) = 2.78, 95% CI = 1.69-4.60] and quetiapine (HR = 1.43, 95% CI = 1.16-1.80) than with olanzapine. Discontinuation occurred sooner when there was evidence of extrapyramidal symptoms (HR = 1.33, 95% CI = 1.08-1.64) or sexual dysfunction (HR = 1.59, 95% CI = 1.03-2.46). Among antipsychotics prescribed at any point during treatment, lurasidone (HR = 1.40, 95% CI = 1.10-1.78) and aripiprazole (HR = 1.09, 95% CI = 1.01-1.19) were associated with earlier discontinuation than olanzapine. Conversely, clozapine (HR = 0.55, 95% CI = 0.41-0.73) and paliperidone 1-monthly (PP1M) long-acting injectable (HR = 0.80, 95% CI = 0.68-0.94) were associated with later discontinuation. Unexpectedly, for antipsychotics prescribed at any stage of treatment, sedation (HR = 0.89, 95% CI = 0.81-0.97), weight gain (HR = 0.73, 95% CI = 0.64-0.83), and multiple side effects (HR = 0.83, 95% CI = 0.76-0.90) were associated with later discontinuation.

Conclusion

Earlier treatment discontinuation associated with sexual or extrapyramidal side effects could be related to their rapid onset and poor tolerability. Later treatment discontinuation associated with clozapine and PP1M could be related to the relative efficacy of these treatments. These findings merit consideration when selecting antipsychotic therapy for people with FEP.

A Framework to Support the Standardized Management of Real-World Data

Relying on our experience on the development of data registration and management systems for clinical and biological data coming from patients with hematological malignancies, as well as on the design of strategies for data collection and analysis to support multi-center, clinical association studies, we designed a framework for the standardized collection and transformation of clinically relevant real-world data into evidence, to meet the challenges of gathering biomedical data collected during daily clinical practice in order to promote basic and clinical research.

On the Judicialization of Health and Access to Medicines in Latin America

In a context of rapid technological innovation and expensive new products, the paper calls for the generation of real-world data to inform decision-making and an international discussion on the affordability of new medicines, particularly for low- and middle-income countries. Without these, the challenges of health judicialization will continue to grow.

Smart FOX - Enabling Citizen-Based Donation of EHR-Standardised Data for Clinical Research in Austria

Access to healthcare data for secondary use in clinical research is often restricted due to privacy concerns or business interests, hindering comprehensive analysis across patient pathways. The Smart FOX project seeks to address this challenge by developing concepts, methods, and tools to facilitate citizen/patient-driven donations of health data for clinical research. Leveraging the groundwork, laid by the national Electronic Health Record implementation in Austria (called ELGA), Smart FOX aims to harness structured datasets from ELGA for research purposes through an opt-in approach. With funding secured from the Austrian Research Promotion Agency, the project embarks on innovative solutions encompassing governance frameworks, community engagement, and technical infrastructure. The Smart FOX consortium, comprising key stakeholders across various healthcare-associated domains, will evaluate these efforts through demonstrators focusing on clinical registries, patient-generated data, and recruitment services. The project targets to accompany the development of future data donation infrastructure while ultimately advancing clinical research efficiency and bolstering Austria's preparedness for the European Health Data Space. This paper presents the first systematic evaluation of the technical concept and proposal for the federated system architecture of the Austrian Health Data Donation Space, which is the socio-technical goal of Smart FOX.

Real-world data on efficacy and safety of 1256 consecutive ultrasound-guided percutaneous carpal tunnel release

PURPOSE

Carpal tunnel syndrome (CTS) is a prevalent condition requiring effective and safe treatment options. This study evaluated the efficacy and safety of ultrasound-guided carpal tunnel release (UCTR) in routine clinical practice. Furthermore, we assessed UCTR outcomes in terms of symptom resolution, patient satisfaction, and complication rates using real-world data extracted via a natural language processing model.

METHODS

A retrospective analysis was performed on 926 patients who underwent 1256 UCTR procedures between November 2018 and May 2024. Primary outcomes included the resolution of paresthesia and pain, and secondary outcomes involved strength restoration and patient satisfaction. Complication rates were assessed to evaluate safety. Data accuracy and precision were validated through standardized methods.

RESULTS

Post-UCTR, significant symptom improvement was observed, with paresthesia rates decreasing from 99% (620/626) to 8.5% (79/926) and pain rates from 96% (654/926) to 9% (83/926). Strength restoration was noted, and 95.8% (628/926) of patients reported positive results with the procedure. Safety was demonstrated by a low complication rate of 0.7% (10/1256). Validation demonstrated data accuracy of 96.3% and precision of 100%.

CONCLUSION

UCTR is a highly effective and safe intervention for CTS that delivers substantial symptom relief, high patient satisfaction, and minimal risk. These findings support the adoption of UCTR in clinical practice. Further prospective studies are recommended to confirm these results and investigate long-term outcomes.

Use of Real-World Data to Support Adverse Drug Reactions Prevention During ePrescription

Adverse Drug Reactions (ADRs) are a crucial public health issue due to the significant health and monetary burden that they can impose. Real-World Data (RWD), e.g., Electronic Health Records, claims data, etc., can support the identification of potentially unknown ADRs and thus, they could provide raw data to mine ADR prevention rules. The PrescIT project aims to create a Clinical Decision Support System (CDSS) for ADR prevention during ePrescription and uses OMOP-CDM as the main data model to mine ADR prevention rules, based on the software stack provided by the OHDSI initiative. This paper presents the deployment of OMOP-CDM infrastructure using the MIMIC-III as a testbed.

Comparative effectiveness of treatments for rheumatoid arthritis in clinical practice: A systematic review

OBJECTIVE

To assess real-world comparative effectiveness studies of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) in adults with rheumatoid arthritis (RA) through a systematic review.

METHODS

We searched Medline for journal articles (2001-2021) and Embase® for abstracts presented at the European Alliance of Associations for Rheumatology and American College of Rheumatology (ACR) 2020 and 2021 annual meetings on non-randomized studies comparing the effectiveness of b/tsDMARDs using ACR-recommended disease activity measures, measures of functional status, and patient-reported outcomes (HAQ, PROMIS PF, patient pain, Patient and Physician Global Assessment of disease activity). Methodological heterogeneity between studies precluded meta-analyses. Risk of bias was assessed using the Cochrane Risk Of Bias In Non-randomized Studies of Interventions-I tool.

RESULTS

Of 1283 records screened, 68 were selected for data extraction, of which 1 was excluded due to critical risk of bias. Most studies were multicenter observational cohort/registry studies (n = 60) and were published between 2011 and 2021 (n = 60). Mean or median reported RA duration was between 6 and 15 years. Disease Activity Score in 28 joints (46 studies), Clinical Disease Activity Index (37 studies), and Health Assessment Questionnaire-Disability Index (32 studies) were the most common outcomes used in clinical practice, with regional differences identified. The most common comparison was between tumor necrosis factor inhibitors (TNFis) and non-TNFi bDMARDs (35 studies). There were no evident differences between b/tsDMARDs in clinical effectiveness.

CONCLUSION

This systematic review summarizing real-world evidence from a very large number of global studies found there are many effective options for the treatment of RA, but relatively less evidence to support the use of any one b/tsDMARD or drug class over another. Treatment for patients with RA should be tailored to suit individual clinical profiles. Further research is needed to identify whether specific patient subgroups may benefit from specific drug classes.

An Overview of Real-World Data Infrastructure for Cancer Research

AIMS

There is increasing interest in the opportunities offered by Real World Data (RWD) to provide evidence where clinical trial data does not exist, but access to appropriate data sources is frequently cited as a barrier to RWD research. This paper discusses current RWD resources and how they can be accessed for cancer research.

MATERIALS AND METHODS

There has been significant progress on facilitating RWD access in the last few years across a range of scales, from local hospital research databases, through regional care records and national repositories, to the impact of federated learning approaches on internationally collaborative studies. We use a series of case studies, principally from the UK, to illustrate how RWD can be accessed for research and healthcare improvement at each of these scales.

RESULTS

For each example we discuss infrastructure and governance requirements with the aim of encouraging further work in this space that will help to fill evidence gaps in oncology.

CONCLUSION

There are challenges, but real-world data research across a range of scales is already a reality. Taking advantage of the current generation of data sources requires researchers to carefully define their research question and the scale at which it would be best addressed.

Central nervous system relapse after allogeneic HCT in FLT3-mutated AML

Central nervous system (CNS) relapse in acute myeloid leukemia (AML) is rare, but prognostically extremely unfavorable and associated with very high mortality rates. Aim of our single-center study was to define risk factors for CNS relapse in patients with FLT3-mutated AML after allogeneic hematopoietic cell transplantation (HCT) and to determine the impact of pre-emptive or salvage therapy with FLT3-inhibitors (FLT3i) on occurrence of CNS relapse and overall prognosis. We analyzed 39 FLT3-mutated AML patients who were treated with intensive induction therapy and consecutively underwent HCT at our institution. We observed that the remission status before HCT was strongly associated with relapse probability. Notably, FLT3-mutated AML showed a high propensity for CNS relapse with a cumulative incidence of 50% (95% confidence interval [CI], 16-77) at 2 years in non-responders pre-HCT compared to 0% in responders (cause-specific hazard ratio, 24.5, 95% CI, 2.9-206.2; p = 0.003). This was not abrogated by pre-emptive or salvage therapy with FLT3i in first relapse. Targeted therapies prior to transplant, use of intrathecal chemoprophylaxis or closer monitoring may be considered in patients with FLT3-mutated AML with active disease prior to HCT in order to prevent CNS relapse.