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Hsu YT, Wu SJ, Kao HW, Hsiao SY, Liao CK, Chen TY, Wang MC. Glofitamab as a salvage treatment for B-cell lymphomas in the real world: A multicenter study in Taiwan. Cancer 2024; 130:1972-1981. [PMID: 38306242 DOI: 10.1002/cncr.35217] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Glofitamab is a bispecific antibody with promise for treating relapsed/refractory B-cell lymphoma according to a phase 1/2 clinical trial. This study examined its real-world effectiveness. METHODS This was an investigator-initiated, multicenter retrospective study including 34 patients who had relapsed/refractory B-cell lymphomas after at least three prior lines of therapy and received glofitamab monotherapy in a compassionate use program in Taiwan between January 2021 and October 2022. RESULTS At a median follow-up of 15.9 months, 56% of patients responded to glofitamab and 23% achieved complete remission. Response to the previous line of therapy significantly correlated with response to glofitamab (p = .020). Most responses were durable; only five out of the 19 responders had documented disease recurrence at the data cutoff date. The estimated progression-free survival (PFS) was 3.2 months, and the estimated 1-year PFS was 33% for the entire cohort. PFS was better for responders than nonresponders (median PFS, 16.9 vs. 1.8 months; 1-year PFS, 60% vs. 0%). Forty-three cytokine release syndrome (CRS) events were observed, three of which were grade 3; all were manageable without glofitamab discontinuation. No immune effector cell-associated neurotoxicity was reported. Among seven hepatitis B virus (HBV) carriers (six had antiviral prophylaxis) and 14 patients with remote HBV (four had antiviral prophylaxis), no HBV reactivation was observed. CONCLUSIONS In this real-world cohort, glofitamab exhibited effectiveness comparable to trial results without excessive CRS or new safety issues. With appropriate prophylaxis, glofitamab-treated patients with chronic or remote HBV infection are unlikely to experience virus reactivation.
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Affiliation(s)
- Ya-Ting Hsu
- Division of Hematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shang-Ju Wu
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Wen Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Sheng-Yen Hsiao
- Division of Hematology-Oncology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chun-Kai Liao
- Division of Hematology-Oncology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Tsai-Yun Chen
- Division of Hematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Chung Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung-Chang Gang Memorial Hospital, Kaohsiung, Taiwan
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Schiavetti I, Signori A, Albanese A, Frau J, Cocco E, Lorefice L, di Lemme S, Fantozzi R, Centonze D, Landi D, Marfia G, Signoriello E, Lus G, Zecca C, Gobbi C, Iodice R, Malimpensa L, Cordioli C, Ferraro D, Ruscica F, Pasquali L, Repice A, Immovilli P, Ferrò MT, Bonavita S, Di Filippo M, Abbadessa G, Govone F, Sormani MP. Therapeutic choices and disease activity after 2 years of treatment with cladribine: An Italian multicenter study (CladStop). Eur J Neurol 2024; 31:e16250. [PMID: 38549186 DOI: 10.1111/ene.16250] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/12/2023] [Accepted: 02/04/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND PURPOSE Cladribine tablets, a purine analogue antimetabolite, offer a unique treatment regimen, involving short courses at the start of the first and second year, with no further treatment needed in years 3 and 4. However, comprehensive evidence regarding patient outcomes beyond the initial 24 months of cladribine treatment is limited. METHODS This retrospective, multicenter study enrolled 204 patients with multiple sclerosis who had completed the 2-year course of cladribine treatment. The primary outcomes were therapeutic choices and clinical disease activity assessed by annualized relapse rate after the 2-year treatment course. RESULTS A total of 204 patients were enrolled; most patients (75.4%) did not initiate new treatments in the 12 months postcladribine. The study found a significant reduction in annualized relapse rate at the 12-month follow-up after cladribine completion compared to the year prior to starting therapy (0.07 ± 0.25 vs. 0.82 ± 0.80, p < 0.001). Furthermore, patients with relapses during cladribine treatment were more likely to start new therapies, whereas older patients were less likely. The safety profile of cladribine was favorable, with lymphopenia being the primary registered adverse event. CONCLUSIONS This study provides insights into therapeutic choices and disease activity following cladribine treatment. It highlights cladribine's effectiveness in reducing relapse rates and disability progression, reaffirming its favorable safety profile. Real-world data, aligned with previous reports, draw attention to ocrelizumab and natalizumab as common choices after cladribine. However, larger, prospective studies for validation and a more comprehensive understanding of cladribine's long-term impact are necessary.
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Affiliation(s)
- Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Angela Albanese
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Jessica Frau
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari, Azienda Sanitaria Locale (ASL) Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari, Azienda Sanitaria Locale (ASL) Cagliari, Cagliari, Italy
- Dipartimento Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Lorena Lorefice
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari, Azienda Sanitaria Locale (ASL) Cagliari, Cagliari, Italy
| | - Sonia di Lemme
- Unit of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Roberta Fantozzi
- Unit of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Diego Centonze
- Unit of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Girolama Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Elisabetta Signoriello
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Giacomo Lus
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Chiara Zecca
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Claudio Gobbi
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Rosa Iodice
- Clinica Neurologica, DSNRO Università Federico II di Napoli, Napoli, Italy
| | - Leonardo Malimpensa
- Mediterranean Neurological Institute Neuromed, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pozzilli, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Montichiari, Italy
| | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Ruscica
- Unità operativa di Neurologia, Fondazione Istituto G.Giglio, Palermo, Italy
| | - Livia Pasquali
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Anna Repice
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - Paolo Immovilli
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Maria Teresa Ferrò
- Neurological Unit, Cerebrovascular Department, Neuroimmunology, Center for Multiple Sclerosis, ASST Crema, Crema, Italy
| | - Simona Bonavita
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Gianmarco Abbadessa
- I Division of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Flora Govone
- Centro Sclerosi Multipla-Neurologia di Mondovì, Cuneo, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Kosko M, Wang L, Santacatterina M. A fast bootstrap algorithm for causal inference with large data. Stat Med 2024. [PMID: 38738397 DOI: 10.1002/sim.10075] [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: 04/25/2023] [Revised: 11/18/2023] [Accepted: 03/22/2024] [Indexed: 05/14/2024]
Abstract
Estimating causal effects from large experimental and observational data has become increasingly prevalent in both industry and research. The bootstrap is an intuitive and powerful technique used to construct standard errors and confidence intervals of estimators. Its application however can be prohibitively demanding in settings involving large data. In addition, modern causal inference estimators based on machine learning and optimization techniques exacerbate the computational burden of the bootstrap. The bag of little bootstraps has been proposed in non-causal settings for large data but has not yet been applied to evaluate the properties of estimators of causal effects. In this article, we introduce a new bootstrap algorithm called causal bag of little bootstraps for causal inference with large data. The new algorithm significantly improves the computational efficiency of the traditional bootstrap while providing consistent estimates and desirable confidence interval coverage. We describe its properties, provide practical considerations, and evaluate the performance of the proposed algorithm in terms of bias, coverage of the true 95% confidence intervals, and computational time in a simulation study. We apply it in the evaluation of the effect of hormone therapy on the average time to coronary heart disease using a large observational data set from the Women's Health Initiative.
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Affiliation(s)
- Matthew Kosko
- Department of Statistics, George Washington University, Washington, DC
| | - Lin Wang
- Department of Statistics, Purdue University, West Lafayette, Indiana
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4
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Subhi Y, Schneider M, Hajari JN, la Cour M. Injection burden and treatment intervals of aflibercept in observe-and-plan regimen for neovascular age-related macular degeneration. Acta Ophthalmol 2024. [PMID: 38733136 DOI: 10.1111/aos.16709] [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: 01/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE The Observe-and-Plan (O&P) regimen allows for individualised treatment. In this study, we evaluated injection burden and intervals using aflibercept in an O&P regimen for eyes with neovascular age-related macular degeneration (AMD). METHODS This was a retrospective registry-based study of treatment-naïve eyes with neovascular AMD. Treatment data were compiled for 3 years after commencement of intravitreal aflibercept therapy. We evaluated clinical consequences at the first follow-up after loading dose, the proportion of patients who obtained and kept dry macula after loading dose, number of injections and intervals between injections. RESULTS Data were obtained for 1103 eyes. After loading dose, 0.4% were lost to follow-up, 7.5% discontinued, 50.9% booked for further injections and 41.3% booked for monthly observations. After loading dose, the macula remained dry in 49.2% at 3 months, 34.0% at 6 months, 23.7% at 12 months and 15.2% at 24 months. For the entire population, median cumulative total number of injections was 7, 12 and 15, after 1, 2 and 3 years, respectively. After the 3rd year, the proportion of eyes in the short 4-6 weeks treatment interval was 51.1%, 8 weeks interval was kept in 14.4% and the extended treatment intervals of 10 and 12 weeks was possible in 34.4%. CONCLUSION After loading dose, one in two eyes required further injections. A large proportion required therapy with shorter intervals than the label-recommended 8 weeks. The large majority of those who obtained a dry macula after loading dose turned exudative again, mostly within the first 3 months.
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Affiliation(s)
- Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Javad Nouri Hajari
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Brush JE, Lu Y, Liu Y, Asher JR, Li SX, Sawano M, Young P, Schulz WL, Anderson M, Burrows JS, Krumholz HM. Hypertension Trends and Disparities Over 12 Years in a Large Health System: Leveraging the Electronic Health Records. J Am Heart Assoc 2024; 13:e033253. [PMID: 38686864 DOI: 10.1161/jaha.123.033253] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/29/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The digital transformation of medical data enables health systems to leverage real-world data from electronic health records to gain actionable insights for improving hypertension care. METHODS AND RESULTS We performed a serial cross-sectional analysis of outpatients of a large regional health system from 2010 to 2021. Hypertension was defined by systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or recorded treatment with antihypertension medications. We evaluated 4 methods of using blood pressure measurements in the electronic health record to define hypertension. The primary outcomes were age-adjusted prevalence rates and age-adjusted control rates. Hypertension prevalence varied depending on the definition used, ranging from 36.5% to 50.9% initially and increasing over time by ≈5%, regardless of the definition used. Control rates ranged from 61.2% to 71.3% initially, increased during 2018 to 2019, and decreased during 2020 to 2021. The proportion of patients with a hypertension diagnosis ranged from 45.5% to 60.2% initially and improved during the study period. Non-Hispanic Black patients represented 25% of our regional population and consistently had higher prevalence rates, higher mean systolic and diastolic blood pressure, and lower control rates compared with other racial and ethnic groups. CONCLUSIONS In a large regional health system, we leveraged the electronic health record to provide real-world insights. The findings largely reflected national trends but showed distinctive regional demographics and findings, with prevalence increasing, one-quarter of the patients not controlled, and marked disparities. This approach could be emulated by regional health systems seeking to improve hypertension care.
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Affiliation(s)
- John E Brush
- Sentara Health Norfolk VA
- Eastern Virginia Medical School Norfolk VA
| | - Yuan Lu
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Yuntian Liu
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | | | - Shu-Xia Li
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Mitsuaki Sawano
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Patrick Young
- Department of Laboratory Medicine Yale School of Medicine New Haven CT
| | - Wade L Schulz
- Department of Laboratory Medicine Yale School of Medicine New Haven CT
| | | | | | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
- Department of Health Policy and Management Yale School of Public Health New Haven CT
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Gray C, Ralphs E, Fox MP, Lash TL, Liu G, Kou TD, Rivera DR, Bosco J, Braun KVN, Grimson F, Layton D. Use of quantitative bias analysis to evaluate single-arm trials with real-world data external controls. Pharmacoepidemiol Drug Saf 2024; 33:e5796. [PMID: 38680093 DOI: 10.1002/pds.5796] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Use of real-world data (RWD) for external controls added to single-arm trials (SAT) is increasingly prevalent in regulatory submissions. Due to inherent differences in the data-generating mechanisms, biases can arise. This paper aims to illustrate how to use quantitative bias analysis (QBA). METHODS Advanced non-small cell lung cancer (NSCLC) serves as an example, where many small subsets of patients with molecular tumor subtypes exist. First, some sources of bias that may occur in oncology when comparing RWD to SAT are described. Second, using a hypothetical immunotherapy agent, a dataset is simulated based on expert input for survival analysis of advanced NSCLC. Finally, we illustrate the impact of three biases: missing confounder, misclassification of exposure, and outcome evaluation. RESULTS For each simulated scenario, bias was induced by removing or adding data; hazard ratios (HRs) were estimated applying conventional analyses. Estimating the bias-adjusted treatment effect and uncertainty required carefully selecting the bias model and bias factors. Although the magnitude of each biased and bias-adjusted HR appeared moderate in all three hypothetical scenarios, the direction of bias was variable. CONCLUSION These findings suggest that QBA can provide an intuitive framework for bias analysis, providing a key means of challenging assumptions about the evidence. However, the accuracy of bias analysis is itself dependent on correct specification of the bias model and bias factors. Ultimately, study design should reduce bias, but QBA allows us to evaluate the impact of unavoidable bias to assess the quality of the evidence.
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Affiliation(s)
- Christen Gray
- Real World Data Science, Biopharmaceuticals Medical Evidence, AstraZeneca, Cambridge, UK
- Methods and Evidence Generation, Real World Solutions, IQVIA, London, UK
- Health Data Science, London School of Hygiene and Tropical Medicine, London, UK
| | - Eleanor Ralphs
- Methods and Evidence Generation, Real World Solutions, IQVIA, London, UK
| | - Matthew P Fox
- Department of Epidemiology, Department of Global Health, Boston University, Boston, Massachusetts, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Universal Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Applied Molecular Profiling Pharmacogenomic Epidemiologic Laboratory, Princess Margaret Cancer Centre, Universal Health Network, Toronto, Ontario, Canada
| | - Tzuyung Doug Kou
- Global Patient Safety, BeiGene, Ridgefield Park, New Jersey, USA
| | - Donna R Rivera
- Oncology Center of Excellence, United States Food & Drug Administration, Silver Spring, Maryland, USA
| | - Jaclyn Bosco
- Epidemiology and Database Studies, Real World Solutions, IQVIA, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Kim Van Naarden Braun
- Translational Epidemiology, Informatics and Predictive Sciences, BMS, Summit, New Jersey, USA
| | - Fiona Grimson
- Health Data Science, London School of Hygiene and Tropical Medicine, London, UK
- Biometrics and Quantitative Sciences, UCB Pharma, Slough, UK
| | - Deborah Layton
- PEPI Consultancy Limited, Southampton, UK
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
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Ferri Grazzi E, Blenkiron T, Hawes C, Camp C, O'Hara J, Burke T, O'Brien G. Anxiety and depression among adults with haemophilia A: Patient and physician reported symptoms from the real-world European CHESS II study. Haemophilia 2024; 30:743-751. [PMID: 38507035 DOI: 10.1111/hae.14989] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION The physical pain and disability affecting many people with haemophilia A (PwHA) are known detractors from psychological wellbeing. While psychosocial support is considered a core tenet of the haemophilia comprehensive care structure, the extent to which mental health challenges are detected and monitored by the individuals treating haematologist remains relatively unexplored. AIM To describe prevalence of anxiety and depression in a real-world cohort of adult PwHA and evaluate the congruence in reporting of anxiety or depression (A/D) between PwHA and their treating physicians. METHODS Data for PwHA without inhibitors was drawn from the European 'Cost of Haemophilia: A Socioeconomic Survey II' (CHESS II) study. Haematologist-indicated comorbidities of anxiety and depression were unified into a single A/D indicator. The EQ-5D-5L health status measure was used to characterise self-reported A/D, with individuals stratified into two non-mutually exclusive subgroups based on level of A/D reported (Subgroup A: 'some' or above; Subgroup B: 'moderate' or above). RESULT Of 381 PwHA with evaluable EQ-5D-5L responses, 54% (n = 206) self-reported at least some A/D (Subgroup A) and 17% (n = 66) reported at least moderate A/D (Subgroup B). Patient-physician congruence in A/D reporting was 53% and 76% for Subgroups A and B, respectively. Descriptive analysis suggested that individuals with physician- and/or self-reported A/D experienced worse clinical outcomes (bleeding events, joint disease, chronic pain). CONCLUSION While adverse clinical outcomes appear to correlate with A/D, self-reports of moderate-severe symptoms occasionally lacked formal recognition from treating physicians. Cross-disciplinary surveillance of mental health issues could improve both psychological and clinical outcomes among PwHA.
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Affiliation(s)
| | - Thomas Blenkiron
- Health Economics and Outcomes Research, HCD Economics, Knutsford, UK
| | | | | | - Jamie O'Hara
- Health Economics and Outcomes Research, HCD Economics, Knutsford, UK
- Department of Health and Social Care, University of Chester, Chester, UK
| | - Tom Burke
- Health Economics and Outcomes Research, HCD Economics, Knutsford, UK
- Department of Health and Social Care, University of Chester, Chester, UK
| | - Gráinne O'Brien
- Department of Clinical Psychology, Royal Infirmary of Edinburgh, Edinburgh, UK
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Mishriky BM, Cummings DM, Fu Y, Halladay JR, Jones S, Boan AD, Jones S, Patil SP, Powell JR, Adams A, Irish W. Comparative analysis of hospitalization risk for incident heart failure in non-Hispanic Black versus non-Hispanic White individuals with type 2 diabetes on empagliflozin (Empa-AA): Insights from real-world data. Diabetes Obes Metab 2024; 26:1830-1836. [PMID: 38361455 DOI: 10.1111/dom.15499] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
AIM There are limited data to evaluate hospitalization for heart failure (hHF) in non-Hispanic Black (hereafter Black) or non-Hispanic White (hereafter White) individuals without previous hHF. Our goal was to evaluate the risk of hHF among Black versus White patients with type 2 diabetes (T2DM) who were initially prescribed empagliflozin using real-world data. METHODS This multicentre retrospective cohort study included participants aged ≥18 years who had T2DM, were either Black or White, had no previous hHF, and were prescribed empagliflozin between August 2014 and December 2019. Our primary outcome was time to first hHF after the initial prescription of empagliflozin. A propensity-score (PS)-weighted analysis was performed to balance characteristics by race. The inverse probability treatment weighting method based on PS was used to make treatment comparisons. To compare Black with White, a PS-weighted Cox's cause-specific hazards model was used. RESULTS In total, 8789 participants were eligible for inclusion (Black = 3216 vs. White = 5573). The Black cohort was significantly younger, had a higher proportion of females, and had a higher prevalence of chronic kidney disease, hypertension and diabetic retinopathy, while the White cohort had a higher prevalence of coronary artery disease. After adjustment for confounding factors such as age, gender, coronary artery disease, hypertension and diabetic retinopathy, the hazard ratio for first-time hHF was not significantly different between the two racial groups [hazard ratio (95% confidence interval) = 1.09 (0.84-1.42), p = .52]. CONCLUSION This study showed no significant difference in incident hHF among Black versus White individuals with T2DM following a prescription for empagliflozin.
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Affiliation(s)
- Basem M Mishriky
- Department of Internal Medicine, Duke University Health System, Raleigh, North Carolina, USA
| | - Doyle M Cummings
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Yuanyuan Fu
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Jacqueline R Halladay
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Schuyler Jones
- Department of Internal Medicine - Cardiology, Duke University Health System, Durham, North Carolina, USA
| | - Andrea D Boan
- Department of Clinical Sciences, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sara Jones
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Shivajirao P Patil
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - James R Powell
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Alyssa Adams
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - William Irish
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Vasiliadou I, Grose D, Wilson C, Thapa A, Donnelly O, Lee E, Leslie I, Karim M, Hartley A, Partridge S, Medlow K, De Boisanger J, Metcalf R, Williamson A, Haridass A, Noble D, Mactier K, Walter H, Ma N, De Winton E, Cohen J, Rayner L, Geropantas K, Jankowska P, Mason J, Moleron R, Laws K, Ulahannan D, Nallathambi C, Michaelidou A, Nallamilli S, Raouf S, Palmer K, Bienz M, Karet T, Khalique S, Paterson C, Harrington K, Bhide S, Kong A. The use of pembrolizumab monotherapy for the management of head and neck squamous cell carcinoma (HNSCC) in the UK. Int J Cancer 2024. [PMID: 38685816 DOI: 10.1002/ijc.34963] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 05/02/2024]
Abstract
Pembrolizumab has received approval in the UK as first-line monotherapy for recurrent and/or metastatic HNSCC (R/M HNSCC) following the results of the KEYNOTE-048 trial, which demonstrated a longer overall survival (OS) in comparison to the EXTREME chemotherapy regimen in patients with a combined positive score (CPS) ≥1. In this article, we provide retrospective real-world data on the role of pembrolizumab monotherapy as first-line systemic therapy for HNSCC across 18 centers in the UK from March 20, 2020 to May 31, 2021. 211 patients were included, and in the efficacy analysis, the objective response rate (ORR) was 24.7%, the median progression-free survival (PFS) was 4.8 months (95% confidence interval [CI]: 3.6-6.1), and the median OS was 10.8 months (95% CI 9.0-12.5). Pembrolizumab monotherapy was well tolerated, with 18 patients having to stop treatment owing to immune-related adverse events (irAEs). 53 patients proceeded to second-line treatment with a median PFS2 of 10.2 months (95% CI: 8.8-11.5). Moreover, patients with documented irAEs had a statistically significant longer median PFS (11.3 vs. 3.3 months; log-rank p value = <.001) and median OS (18.8 vs. 8.9 months; log-rank p value <.001). The efficacy and safety of pembrolizumab first-line monotherapy for HNSCC has been validated using real-world data.
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Affiliation(s)
- Ifigenia Vasiliadou
- Guy's and St. Thomas NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Derek Grose
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Alekh Thapa
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Olly Donnelly
- Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, UK
| | - Elsa Lee
- Guy's and St. Thomas NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Isla Leslie
- Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Sarah Partridge
- Imperial College Healthcare NHS Trust-Charing Cross Hospital, London, UK
| | - Katharine Medlow
- Imperial College Healthcare NHS Trust-Charing Cross Hospital, London, UK
| | - James De Boisanger
- Imperial College Healthcare NHS Trust-Charing Cross Hospital, London, UK
| | | | | | | | | | | | | | - Ning Ma
- University Hospitals of Leicester, Leicester, UK
| | - Emma De Winton
- Royal United Hospitals Bath-NHS Foundation trust, Bath, UK
| | - Jennifer Cohen
- Royal United Hospitals Bath-NHS Foundation trust, Bath, UK
| | - Lindsay Rayner
- Royal United Hospitals Bath-NHS Foundation trust, Bath, UK
| | | | - Petra Jankowska
- Musgrove Park Hospital-Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Jessica Mason
- Musgrove Park Hospital-Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | - Kirsten Laws
- Aberdeen Royal Infirmary-NHS Grampian, Aberdeen, UK
| | | | | | | | - Susanna Nallamilli
- Maidstone Hospital-Tunbridge Wells Hospital-NHS Trust, Tunbridge Wells, UK
| | - Sherif Raouf
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Kieran Palmer
- King's College London, London, UK
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | | | | | | | | | - Kevin Harrington
- Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Shreerang Bhide
- Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Anthony Kong
- Guy's and St. Thomas NHS Foundation Trust, London, UK
- King's College London, London, UK
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10
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von Stebut J, Heiland M, Preissner R, Rendenbach C, Preissner S. Association of Herpes simplex infection with significantly increased risk of head and neck cancer: real-world evidence of about 500,000 patients. Int J Dermatol 2024. [PMID: 38643367 DOI: 10.1111/ijd.17196] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/26/2024] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND The role of viral agents in the development of head and neck cancers has remained controversial. While markers of viral origin have been isolated from oral cancer tissues, a causative relationship has yet to be shown. The aim of this study was to evaluate the relationship between head and neck cancers and Herpes simplex virus, one of the most common viral infections of the oral orifice. METHODS Here, we conducted a retrospective analysis of two age- and gender-matched cohorts extracted from the real-world database TriNetX on March 10th, 2023, each consisting of 249,272 patients with and without Herpes simplex infections (ICD-10: B00). The diagnoses C00-C14 were analyzed, and risk analysis and Kaplan-Meier survival statics were computed. RESULTS The strongest association was found for lip cancer (ICD-10: C00) with a hazard ratio [HR (CI 95% low-high)] of 3.08 (1.77-5.35). A significant association with HR of 1.17 (1.02-1.34) was found for the entire group of head and neck cancers. Confounders like smoking and alcohol dependence were considered using propensity score matching. CONCLUSION The surprisingly strong correlation with lip, oral cavity, and pharynx neoplasms sheds new light on supposedly harmless herpes simplex infections, suggesting them as a possible new factor for risk stratification.
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Affiliation(s)
- Jennifer von Stebut
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Preissner
- Structural Bioinformatics Group, Science-IT and Institute for Physiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Saskia Preissner
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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11
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Li S, Yi J, Tuo Y, Nie G, Wang J, Wang Y, Sun D, Liu Z. Population pharmacokinetics and dosing optimization of perampanel in children with epilepsy: A real-world study. Epilepsia 2024. [PMID: 38572689 DOI: 10.1111/epi.17954] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The purposes of this study were to explore the pharmacokinetics of perampanel (PER) in children with epilepsy, identify factors that contribute to pharmacokinetic variations among subjects, evaluate the connection between PER exposure and clinical outcome, and establish an evidence-based approach for tailoring individualized antiepileptic treatment in this specific population. METHODS In this prospective study, PER plasma concentrations and genetic information on metabolic enzymes were obtained from 194 patients younger than 18 years. The disposition kinetics of PER in pediatric patients following oral dosing were characterized using nonlinear mixed effect models. The effective range for the plasma concentration of PER was determined by assessing the efficacy and safety of PER treatment and analyzing the relationship between drug exposure and clinical response. Monte Carlo simulations were then performed to evaluate and optimize the current dosing regimens. RESULTS The pharmacokinetic profile of PER was adequately described by a one-compartment model with first-order absorption and elimination. Body weight, total bilirubin level, and concomitant oxcarbazepine were found to have significant influences on PER pharmacokinetics. Model estimates of apparent clearance and volume of distribution were .016 ± .009 L/h/kg and 1.47 ± .78 L/kg, respectively. The effective range predicted from plasma concentration data in responders was 215-862 μg/L. Dosing scenarios stratified according to essential covariates were proposed through simulation analysis. SIGNIFICANCE In this study, we captured the pharmacokinetic/pharmacodynamic characteristics of PER in pediatric epilepsy patients through analysis of real-world data and adopted a pharmacometric approach to support an individualized dosing strategy for PER in this specific population.
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Affiliation(s)
- Sichan Li
- Department of Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqin Yi
- Department of Neurology, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center of Neurodevelopmental Disabilities in Children in Hubei Province, Wuhan, China
| | - YaLi Tuo
- Department of Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Nie
- Department of Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Wang
- Department of Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Wang
- Drug Clinical Trial Institution, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Sun
- Department of Neurology, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center of Neurodevelopmental Disabilities in Children in Hubei Province, Wuhan, China
| | - Zhisheng Liu
- Department of Neurology, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center of Neurodevelopmental Disabilities in Children in Hubei Province, Wuhan, China
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12
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Uekusa R, Yokoi A, Watanabe E, Yoshida K, Yoshihara M, Tamauchi S, Shimizu Y, Ikeda Y, Yoshikawa N, Niimi K, Suzuki S, Kajiyama H. Real-world data of poly (ADP-ribose) polymerase inhibitor response in Japanese patients with ovarian cancer. Cancer Med 2024; 13:e7149. [PMID: 38572951 PMCID: PMC10993710 DOI: 10.1002/cam4.7149] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/21/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Poly (ADP-ribose) polymerase (PARP) inhibitors have been increasingly used in the treatment of ovarian cancer, with BRCA positivity and homologous recombination deficiency (HRD) being common biomarkers used for predicting their efficacy. However, given the limitations of these biomarkers, new ones need to be explored. METHODS This retrospective study included 181 ovarian cancer patients who received olaparib or niraparib at two independent hospitals in Japan between May 2018 and December 2022. Clinical information and blood sampling data were collected. Patient characteristics, treatment history, and predictability of treatment duration based on blood data before treatment initiation were examined. RESULTS High-grade serous carcinoma, BRCA positivity, HRD, and maintenance therapy after recurrence treatment were observed more frequently in the olaparib group than in the niraparib group. The most common reasons for treatment interruption were anemia, fatigue, and nausea in the olaparib group and thrombocytopenia in the niraparib group. Regarding response to olaparib treatment, complete response to the most recent treatment, maintenance therapy after the first chemotherapy, high-grade serous carcinoma, and germline BRCA positivity were observed significantly more frequently among responders than among non-responders. Furthermore, neutrophil counts were significantly higher among responders than among non-responders. CONCLUSIONS Inflammation-related blood data, such as neutrophil count, obtained at the initial pre-treatment visit might serve as potential predictors for prolonged olaparib treatment. While this study offers valuable insights into potential indicators for prolonged olaparib treatment, it underscores the need for more expansive research to strengthen our understanding of PARP inhibitors and optimize treatment strategies in ovarian cancer.
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Affiliation(s)
- Ryosuke Uekusa
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Akira Yokoi
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
- Institute for Advanced ResearchNagoya UniversityNagoyaJapan
| | - Eri Watanabe
- Department of Gynecologic OncologyAichi Cancer Center HospitalNagoyaJapan
| | - Kosuke Yoshida
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
- Institute for Advanced ResearchNagoya UniversityNagoyaJapan
| | - Masato Yoshihara
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Satoshi Tamauchi
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Yusuke Shimizu
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Yoshiki Ikeda
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Kaoru Niimi
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Shiro Suzuki
- Department of Gynecologic OncologyAichi Cancer Center HospitalNagoyaJapan
| | - Hiroaki Kajiyama
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
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Mori Y, Okawara M, Shibao K, Kohi S, Tamura T, Sato N, Fujino Y, Fushimi K, Matsuda S, Hirata K. Short-term outcomes of pancreatoduodenectomy in older individuals over a 9-year period using real-world data: A multilevel analysis based on a nationwide administrative database in Japan. J Hepatobiliary Pancreat Sci 2024; 31:262-272. [PMID: 38031900 DOI: 10.1002/jhbp.1396] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND We aimed to evaluate the short-term outcomes of pancreatoduodenectomy (PD) in older individuals. METHODS Data from the Japanese Diagnosis Procedure Combination database on 62 275 patients who underwent PD from 1 April 2012 to 31 March 2020 were analyzed. Patients were divided into five age groups: <70, 70-74, 75-79, 80-84, and ≥85 years. The associations between postoperative outcomes and age were investigated using multilevel analysis. The mean differences in length of hospital stay and cost were also compared. RESULTS The rate of PD in older individuals increased annually. Compared with the youngest age group (< 70 years), the incidence rate ratios for in-hospital mortality were 1.52 (95% confidence interval [CI]: 1.30-1.76), 2.07 (1.82-2.37), 2.29 (1.94-2.71), and 2.92 (2.20-3.87) in the 70-74, 75-79, 80-84, and ≥ 85-year-old age groups, respectively (all p < .001). Postoperative complications, length of postoperative hospital stay, and cost increased significantly with increasing age. CONCLUSIONS These real-world data emphasize the higher levels of morbidity, mortality, and cost in older patients. Careful attention should be paid when considering the indication for PD in older individuals.
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Affiliation(s)
- Yasuhisa Mori
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Makoto Okawara
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazunori Shibao
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shiro Kohi
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshihisa Tamura
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Norihiro Sato
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Keiji Hirata
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Uttervall K, Tätting L, Lemonakis K, Majd M, Crafoord J, Olsson M, Mellqvist U, Hansson M, Nahi H. Effectiveness and infectious complications of BCMA T-cell engagers in treating multiple myeloma: Real-world evidence from Sweden. Cancer Med 2024; 13:e7048. [PMID: 38651177 PMCID: PMC11036077 DOI: 10.1002/cam4.7048] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM), an incurable disease characterized by frequent relapses and a need for multiple treatments, often progresses to a relapse/refractory status resistant to all available drugs and drug classes. Bispecific antibodies, specifically BCMA T-cell engagers, have emerged as effective treatments for MM, demonstrating impressive efficacy. However, these treatments can adversely affect the immune system, increasing vulnerability to infections. METHODS/RESULTS This study evaluated the efficacy and safety of BCMA T-cell engagers in 58 Swedish patients with poor MM prognosis. The patients exhibited a 69% overall response rate, with 69% survival and 60% progression-free survival at 15 months. CONCLUSIONS Despite the risk of infectious complications, the prognosis of MM patients can be significantly improved with vigilant monitoring and proactive management of infections. This real-world data highlight the potential of BCMA T-cell engagers in treating MM, emphasizing the need for careful patient monitoring to mitigate infection risks.
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Affiliation(s)
- Katarina Uttervall
- Center for Hematology and Regenerative Medicine, Department of Medicine, HuddingeKarolinska InstitutetStockholmSweden
| | - Love Tätting
- Department of Haematology in Linköping, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | | | - Mousa Majd
- Center for Hematology and Regenerative Medicine, Department of Medicine, HuddingeKarolinska InstitutetStockholmSweden
| | - Jacob Crafoord
- Department of MedicineOrebro University HospitalOrebroSweden
| | - Mikael Olsson
- Section of Hematology Department of Internal MedicineHallands Sjukhus VarbergVarbergSweden
| | - Ulf‐Henrik Mellqvist
- Section of Hematology and Coagulation, Department of MedicineSahlgrenska University HospitalGothenburgSweden
| | - Markus Hansson
- Section of Hematology and Coagulation, Department of MedicineSahlgrenska University HospitalGothenburgSweden
| | - Hareth Nahi
- Center for Hematology and Regenerative Medicine, Department of Medicine, HuddingeKarolinska InstitutetStockholmSweden
- Department of Haematology in Linköping, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
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15
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Boys EL, Gao B, Grimison P, Sutherland S, MacKenzie KL, Reddel RR, Liu J. Retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in Australia. Cancer Med 2024; 13:e7052. [PMID: 38523552 PMCID: PMC10961596 DOI: 10.1002/cam4.7052] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Carcinoma of unknown primary (CUP) remains an important tumor entity and a disproportionate cause of cancer mortality. Little is known about the contemporary clinical characteristics, treatment patterns, and outcomes of CUP patients based on updated international classification guidelines. We evaluated a contemporary CUP cohort to provide insight into current clinical practice and the impact of tissue of origin assignment, site-specific and empirical therapy in a real-world setting. METHODS We conducted a retrospective cohort study of CUP patients, as defined by the updated European Society of Medical Oncology (ESMO) 2023 guidelines, across three tertiary referral centers in Australia between 2015 and 2022. We analyzed clinical characteristics, treatment patterns, and survival outcomes using the Kaplan-Meier method and Cox regression proportional hazard model between favorable and unfavorable risk groups. RESULTS We identified a total of 123 CUP patients (n = 86 unfavorable, n = 37 favorable risk as per the 2023 ESMO guidelines). Sixty-four patients (52%) were assigned a tissue of origin by the treating clinician. Median progression free survival (PFS) was 6.8 (95% confidence interval (CI) 5.1-12.1) months and overall survival (OS) 10.2 (95% CI 6.0-18.5) months. Unfavorable risk (hazard ratio [HR] 2.9, p = 0.006), poor performance status (HR 2.8, p < 0.001), and non-squamous histology (HR 2.5, p < 0.05) were associated with poor survival outcome. A total of 70 patients (57%) proceeded to systemic therapy. In patients with non-squamous histology and unfavorable risk, site-specific therapy compared to empirical chemotherapy did not improve outcome (median OS 8.2 vs. 11.8 months, p = 0.7). CONCLUSIONS In this real-world cohort, CUP presentations were heterogenous. Overall survival and rates of systemic treatment were poor. Poor performance status and unfavorable risk were associated with worse survival. For most patients, site-specific therapy did not improve survival outcome. Improved and timely access to diagnostic tests and therapeutics for this group of patients is urgently required.
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Affiliation(s)
- Emma L. Boys
- ProCan®, Children's Medical Research InstituteWestmeadNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Medical OncologyCrown Princess Mary Cancer CentreWestmeadNew South WalesAustralia
- Blacktown Cancer and Haematology Centre, Blacktown HospitalBlacktownNew South WalesAustralia
| | - Bo Gao
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Medical OncologyCrown Princess Mary Cancer CentreWestmeadNew South WalesAustralia
- Blacktown Cancer and Haematology Centre, Blacktown HospitalBlacktownNew South WalesAustralia
| | - Peter Grimison
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Chris O'Brien LifehouseSydneyNew South WalesAustralia
| | - Sarah Sutherland
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Chris O'Brien LifehouseSydneyNew South WalesAustralia
| | - Karen L. MacKenzie
- ProCan®, Children's Medical Research InstituteWestmeadNew South WalesAustralia
- School of Medical Science, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Roger R. Reddel
- ProCan®, Children's Medical Research InstituteWestmeadNew South WalesAustralia
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Jia Liu
- ProCan®, Children's Medical Research InstituteWestmeadNew South WalesAustralia
- The Kinghorn Cancer Centre, St Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of Clinical Medicine, St Vincent's CampusUniversity of New South WalesSydneyNew South WalesAustralia
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Bayani DB, Lin YC, Ooi MG, Tso ACY, Wee HL. Real-world utilization and healthcare costs for multiple myeloma: A retrospective analysis of patients in Singapore. EJHaem 2023; 4:1013-1018. [PMID: 38024607 PMCID: PMC10660121 DOI: 10.1002/jha2.798] [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] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 12/01/2023]
Abstract
Multiple myeloma, a hematological malignancy, imposes a significant financial burden on healthcare systems. Health technology assessments (HTA) and economic evaluations play vital roles in reimbursement decisions and cost containment. This study aimed to explore healthcare utilization patterns and costs among myeloma patients in Singapore through a retrospective analysis of 605 patients treated at two cancer centers. Data encompassing demographics, treatment utilization, and billing were extracted from electronic records, and a cost analysis was performed from the perspective of the Singapore healthcare system. The results revealed common usage of immunomodulatory agents (52%) and proteasome inhibitors (37%), with bortezomib being the most frequently used targeted treatment. Treatment costs increased with disease progression, displaying variations depending on the therapeutic agent used. Notably, hospitalization costs due to adverse events were substantial, with pneumonia as the leading cause. This study highlights the high cost of myeloma therapy in Singapore, posing a financial burden for households. Findings may inform economic evaluations, evidence generation, reimbursement, and subsidy decisions. Leveraging real-world data from electronic records provides valuable insights into local healthcare utilization patterns. Future studies may explore integrating billing databases with clinical repositories for a more comprehensive analysis, and consider limitations such as incomplete clinical information and potential selection bias.
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Affiliation(s)
| | | | - Melissa G. Ooi
- Department of Haematology‐OncologyNational University Cancer InstituteSingapore
| | | | - Hwee Lin Wee
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
- Department of PharmacyNational University of SingaporeSingapore
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17
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Morland K, Gerges C, Elwing J, Visovatti SH, Weatherald J, Gillmeyer KR, Sahay S, Mathai SC, Boucly A, Williams PG, Harikrishnan S, Minty EP, Hobohm L, Jose A, Badagliacca R, Lau EMT, Jing Z, Vanderpool RR, Fauvel C, Leonidas Alves J, Strange G, Pulido T, Qian J, Li M, Mercurio V, Zelt JGE, Moles VM, Cirulis MM, Nikkho SM, Benza RL, Elliott CG. Real-world evidence to advance knowledge in pulmonary hypertension: Status, challenges, and opportunities. A consensus statement from the Pulmonary Vascular Research Institute's Innovative Drug Development Initiative's Real-world Evidence Working Group. Pulm Circ 2023; 13:e12317. [PMID: 38144948 PMCID: PMC10739115 DOI: 10.1002/pul2.12317] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/26/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
This manuscript on real-world evidence (RWE) in pulmonary hypertension (PH) incorporates the broad experience of members of the Pulmonary Vascular Research Institute's Innovative Drug Development Initiative Real-World Evidence Working Group. We aim to strengthen the research community's understanding of RWE in PH to facilitate clinical research advances and ultimately improve patient care. Herein, we review real-world data (RWD) sources, discuss challenges and opportunities when using RWD sources to study PH populations, and identify resources needed to support the generation of meaningful RWE for the global PH community.
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Affiliation(s)
- Kellie Morland
- Global Medical AffairsUnited Therapeutics CorporationResearch Triangle ParkNorth CarolinaUSA
| | - Christian Gerges
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaViennaAustria
| | - Jean Elwing
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of CincinnatiCincinnatiOhioUSA
| | - Scott H. Visovatti
- Division of Cardiovascular MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Jason Weatherald
- Department of Medicine, Division of Pulmonary MedicineUniversity of AlbertaEdmontonCanada
| | - Kari R. Gillmeyer
- The Pulmonary CenterBoston University Chobian & Avedisian School of MedicineBostonMassachusettsUSA
- Center for Healthcare Organization & Implementation ResearchVA Bedford Healthcare System and VA Boston Healthcare SystemBedfordMassachusettsUSA
| | - Sandeep Sahay
- Division of Pulmonary, Critical Care & Sleep MedicineHouston Methodist HospitalHoustonTexasUSA
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Athénaïs Boucly
- Faculté de MédecineUniversité Paris‐SaclayLe Kremlin‐BicêtreFrance
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital BicêtreAssistance Publique Hôpitaux de ParisLe Kremlin BicêtreFrance
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Paul G. Williams
- Center of Chest Diseases & Critical CareMilpark HospitalJohannesburgSouth Africa
| | | | - Evan P. Minty
- Department of Medicine & O'Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada
| | - Lukas Hobohm
- Department of CardiologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
- Center for Thrombosis and Hemostasis (CTH)University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Arun Jose
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of CincinnatiCincinnatiOhioUSA
| | - Roberto Badagliacca
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of RomePoliclinico Umberto IRomeItaly
| | - Edmund M. T. Lau
- Department of Respiratory Medicine, Royal Prince Alfred HospitalUniversity of SydneyCamperdownNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Zhi‐Cheng Jing
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | | | - Charles Fauvel
- Service de Cardiologie, Centre de Compétence en Hypertension Pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, INSERM EnVI U1096Université de RouenRouenFrance
| | - Jose Leonidas Alves
- Pulmonary Division, Heart InstituteUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - Geoff Strange
- School of MedicineThe University of Notre Dame AustraliaPerthWestern AustraliaAustralia
| | - Tomas Pulido
- Ignacio Chávez National Heart InstituteMéxico CityMexico
| | - Junyan Qian
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC‐DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical ImmunologyMinistry of EducationBeijingChina
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC‐DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical ImmunologyMinistry of EducationBeijingChina
| | - Valentina Mercurio
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | - Jason G. E. Zelt
- Department of Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Victor M. Moles
- Division of Cardiovascular MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Meghan M. Cirulis
- Division of Pulmonary and Critical Care MedicineUniversity of UtahSalt Lake CityUtahUSA
- Department of Pulmonary and Critical Care MedicineIntermountain Medical Center MurraySalt Lake CityUtahUSA
| | | | - Raymond L. Benza
- Mount Sinai HeartIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - C. Gregory Elliott
- Division of Pulmonary and Critical Care MedicineUniversity of UtahSalt Lake CityUtahUSA
- Department of Pulmonary and Critical Care MedicineIntermountain Medical Center MurraySalt Lake CityUtahUSA
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18
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Ebben KC, de Kroon CD, Schmeink CE, van der Hel OL, van Vegchel T, Moncada‐Torres A, de Hingh IH, van der Werf J. A novel method for continuous measurements of clinical practice guideline adherence. Learn Health Syst 2023; 7:e10384. [PMID: 37860062 PMCID: PMC10582230 DOI: 10.1002/lrh2.10384] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Clinical practice guidelines (hereafter 'guidelines') are crucial in providing evidence-based recommendations for physicians and multidisciplinary teams to make informed decisions regarding diagnostics and treatment in various diseases, including cancer. While guideline implementation has been shown to reduce (unwanted) variability and improve outcome of care, monitoring of adherence to guidelines remains challenging. Real-world data collected from cancer registries can provide a continuous source for monitoring adherence levels. In this work, we describe a novel structured approach to guideline evaluation using real-world data that enables continuous monitoring. This method was applied to endometrial cancer patients in the Netherlands and implemented through a prototype web-based dashboard that enables interactive usage and supports various analyses. Method The guideline under study was parsed into clinical decision trees (CDTs) and an information standard was drawn up. A dataset from the Netherlands Cancer Registry (NCR) was used and data items from both instruments were mapped. By comparing guideline recommendations with real-world data an adherence classification was determined. The developed prototype can be used to identify and prioritize potential topics for guideline updates. Results CDTs revealed 68 data items for recording in an information standard. Thirty-two data items from the NCR were mapped onto information standard data items. Four CDTs could sufficiently be populated with NCR data. Conclusion The developed methodology can evaluate a guideline to identify potential improvements in recommendations and the success of the implementation strategy. In addition, it is able to identify patient and disease characteristics that influence decision-making in clinical practice. The method supports a cyclical process of developing, implementing and evaluating guidelines and can be scaled to other diseases and settings. It contributes to a learning healthcare cycle that integrates real-world data with external knowledge.
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Affiliation(s)
- Kees C.W.J. Ebben
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Cornelis D. de Kroon
- Department of Obstetrics and GynecologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Olga L. van der Hel
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Thijs van Vegchel
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Arturo Moncada‐Torres
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Ignace H.J.T. de Hingh
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
- Department of Surgical OncologyCatharina HospitalEindhovenThe Netherlands
| | - Jurrian van der Werf
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
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19
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Peltier E, de Salvo R, Ehret A, Trapp S, Lakomsky D, El Shazly MA. Evaluation of a 5% dexpanthenol-containing ointment for the treatment of infant irritant diaper dermatitis through the lens of the caregiver-A real-world data observational study. Health Sci Rep 2023; 6:e1033. [PMID: 36620516 PMCID: PMC9817493 DOI: 10.1002/hsr2.1033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
Background and Aims Irritant diaper dermatitis (IDD) is very common in infants and usually managed by the caregiver. Dexpanthenol-containing ointment (DCO) is a decades-long established product that has demonstrated efficacy and tolerability in the treatment and prevention of infant IDD in controlled clinical settings. The aim of this study was to evaluate the effectiveness of DCO in the treatment of infant IDD from the perspective of the caregiver by collecting data not explored in clinical trials, such as infant quality of life and the speed of action. Methods A retrospective observational real-world data (RWD) study was conducted with French adult caregivers who had used a DCO to treat IDD in their infants within the past 6 months and consented to participate to the study completed a web-based survey answering questions regarding the severity of their infants' symptoms (intensity/extent of redness and discomfort, rated using Likert scales) before and after DCO application. The speed of onset of symptom relief and product acceptability were also collected. Results A total of 500 caregivers of 564 infants completed the survey. Of these, 80% reported that DCO visibly treats IDD. In terms of speed of action, 83% declared that the first signs of symptom relief appeared after 1 day of application and 78% reported full symptom resolution within 2 days of application. Additionally, ≥77% of caregivers agreed that DCO provided overnight relief from the discomfort caused by IDD and reduced sleep disturbance in their children. Finally, 85% of caregivers declared being satisfied with the product overall and considered the product pleasant to use. Conclusion This evidence from caregivers' experience confirms that DCO can be considered an adequate medication to self-manage IDD episode as it provides rapid relief of the signs and symptoms of inflammation, while by being pleasant to be use.
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20
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McCurdy A, Louzada M, Venner CP, Visram A, Masih‐Khan E, Kardjadj M, Jimenez‐Zepeda VH, LeBlanc R, Sebag M, Song K, White D, Mian H, Stakiw J, Reiman A, Aslam M, Kotb R, Gul E, Reece D. Carfilzomib usage patterns and outcomes in patients with relapsed multiple myeloma: A multi-institutional report from the Canadian Myeloma Research Group (CMRG) Database. EJHaem 2022; 3:1252-1261. [PMID: 36467802 PMCID: PMC9713064 DOI: 10.1002/jha2.559] [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] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/22/2022] [Accepted: 08/16/2022] [Indexed: 06/17/2023]
Abstract
Carfilzomib is an active and commonly used treatment in patients with multiple myeloma (MM). Using the Canadian Myeloma Research Group Database, we performed a retrospective observational study of patients treated with carfilzomib for relapse of MM in a real-world setting in Canada between years 2007 and 2020. A total of 445 patients were included in this study: the doublet (Kd/p, n = 218) and triplets (KCd, n = 88; KRd, n = 99; KPd/p, n = 40). One hundred and twenty-two (27%) received carfilzomib-based treatment in line 2, 133 (30%) in line 3, 90 (20%) in line 4, and 100 (23%) in line 5 or higher. Carfilzomib was dosed weekly in 40% of patients and twice weekly in 60%. The overall response rate of the entire cohort was 57.7%, with 33.6% of patients achieving very good partial response or better. Median progression-free survival for the overall cohort was 6.3 months with overall survival 19.7 months. This study provides a benchmark for carfilzomib-based regimens in the real world, demonstrating that these regimens are effective in treating patients with relapsed MM.
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Affiliation(s)
| | | | | | | | - Esther Masih‐Khan
- Princess Margaret Cancer CentreTorontoOntarioCanada
- Canadian Myeloma Research GroupVaughanOntarioCanada
| | | | | | - Richard LeBlanc
- Maisonneuve‐Rosemont Hospital Research CentreUniversity of MontrealMontrealQuebecCanada
| | | | - Kevin Song
- BC Cancer AgencyVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Darrell White
- Queen Elizabeth II Health Sciences CentreDalhousie UniversityHalifaxNova ScotiaCanada
| | - Hira Mian
- Juravinski Cancer CenterHamiltonOntarioCanada
| | - Julie Stakiw
- Saskatoon Cancer CentreUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Anthony Reiman
- Saint John Regional HospitalSaint JohnNew BrunswickCanada
| | | | - Rami Kotb
- Cancer Care ManitobaWinnipegManitobaCanada
| | - Engin Gul
- Canadian Myeloma Research GroupVaughanOntarioCanada
| | - Donna Reece
- Princess Margaret Cancer CentreTorontoOntarioCanada
- Canadian Myeloma Research GroupVaughanOntarioCanada
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21
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Bastarache L, Brown JS, Cimino JJ, Dorr DA, Embi PJ, Payne PR, Wilcox AB, Weiner MG. Developing real-world evidence from real-world data: Transforming raw data into analytical datasets. Learn Health Syst 2022; 6:e10293. [PMID: 35036557 PMCID: PMC8753316 DOI: 10.1002/lrh2.10293] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/30/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
Development of evidence-based practice requires practice-based evidence, which can be acquired through analysis of real-world data from electronic health records (EHRs). The EHR contains volumes of information about patients-physical measurements, diagnoses, exposures, and markers of health behavior-that can be used to create algorithms for risk stratification or to gain insight into associations between exposures, interventions, and outcomes. But to transform real-world data into reliable real-world evidence, one must not only choose the correct analytical methods but also have an understanding of the quality, detail, provenance, and organization of the underlying source data and address the differences in these characteristics across sites when conducting analyses that span institutions. This manuscript explores the idiosyncrasies inherent in the capture, formatting, and standardization of EHR data and discusses the clinical domain and informatics competencies required to transform the raw clinical, real-world data into high-quality, fit-for-purpose analytical data sets used to generate real-world evidence.
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Affiliation(s)
- Lisa Bastarache
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jeffrey S. Brown
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMassachusettsUSA
| | - James J. Cimino
- Informatics Institute, University of Alabama at BirminghamBirminghamAlabamaUSA
| | - David A. Dorr
- Department of Medical Informatics and Clinical EpidemiologyOregon Health Sciences UniversityPortlandOregonUSA
| | - Peter J. Embi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
| | - Philip R.O. Payne
- Institute for Informatics, Washington University in St. LouisSt. LouisMissouriUSA
| | - Adam B. Wilcox
- Institute for InformaticsWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | - Mark G. Weiner
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNew YorkUSA
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22
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Standaert DG, Aldred J, Anca-Herschkovitsch M, Bourgeois P, Cubo E, Davis TL, Iansek R, Kovács N, Pontieri FE, Siddiqui MS, Simu M, Bergmann L, Kukreja P, Robieson WZ, Chaudhuri KR. DUOGLOBE: One-Year Outcomes in a Real-World Study of Levodopa Carbidopa Intestinal Gel for Parkinson's Disease. Mov Disord Clin Pract 2021; 8:1061-1074. [PMID: 34631942 PMCID: PMC8485588 DOI: 10.1002/mdc3.13239] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/05/2021] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 11/09/2022] Open
Abstract
Background Levodopa-carbidopa intestinal gel (LCIG) is an established treatment for improving motor and some non-motor symptoms (NMS) in patients with advanced Parkinson's disease (PD). Prospective long-term data in routine clinical practice are limited. Objective Assess LCIG effectiveness and safety in patients with advanced PD after 12 months during real-world routine clinical practice. Methods Duodopa/Duopa in patients with advanced Parkinson's disease-a global observational study evaluating long-term effectiveness (DUOGLOBE) (NCT02611713) is an ongoing, prospective, multinational, observational study of LCIG-naïve patients treated as part of routine clinical practice; 3 years of follow-up are planned. The primary outcome is the change in patient-reported off time. Other assessments include the Unified Dyskinesia Rating Scale (UDysRS), Non-Motor Symptoms Scale (NMSS), Parkinson's Disease Sleep scale (PDSS-2), Epworth Sleepiness Scale (ESS), health-related quality of life (HR-QoL), caregiver burden, and serious adverse events (SAEs). Outcomes from baseline to month (M) 12 are presented. Results In this 12-month follow-up, patients (N = 195) had baseline characteristics similar to other LCIG studies. Significant improvements (mean change to M12) were observed in off time (-3.9 ± 3.6 hr/day, P < 0.001), dyskinesia assessed using the UDysRS (-9.6 ± 22.5, P < 0.001), NMSS (-23.1 ± 41.4, P < 0.001), sleep and sleepiness symptoms on the PDSS-2 (-6.5 ± 12.2, P < 0.001) and ESS (-1.0 ± 5.7, P < 0.05), HR-QoL (-9.0 ± 21.6, P < 0.001), and caregiver burden (-1.9 ± 6.7, P = 0.008). Overall, 40.5% (n = 79) of patients experienced SAEs; fall (n = 6; 3.1%) and urinary tract infection (n = 6; 3.1%) were SAEs reported in ≥3% of patients. Conclusions These 12-month outcome data show sustained, long-term improvements and support the real-world effectiveness of LCIG in patients with advanced PD. Safety was consistent with previous studies.
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Affiliation(s)
| | | | | | | | - Esther Cubo
- Neurology Department Hospital Universitario Burgos Burgos Spain
| | - Thomas L Davis
- Vanderbilt University Medical Center Nashville Tennessee USA
| | - Robert Iansek
- Kingston Centre, Monash Health Melbourne Victoria Australia
| | | | | | | | - Mihaela Simu
- Victor Babes University of Medicine and Pharmacy Timisoara Romania
| | | | | | | | - K Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital, and King's College Institute of Psychiatry, Psychology & Neuroscience London United Kingdom
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23
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Thomsen RW, Knudsen JS, Kahlert J, Baggesen LM, Lajer M, Holmgaard PH, Vedin O, Ustyugova A, Sørensen HT. Cardiovascular Events, Acute Hospitalizations, and Mortality in Patients With Type 2 Diabetes Mellitus Who Initiate Empagliflozin Versus Liraglutide: A Comparative Effectiveness Study. J Am Heart Assoc 2021; 10:e019356. [PMID: 34032121 PMCID: PMC8483550 DOI: 10.1161/jaha.120.019356] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background In cardiovascular outcome trials, the sodium glucose cotransporter 2 inhibitor empagliflozin and glucagon‐like peptide‐1 (GLP‐1) receptor agonist liraglutide caused similar reductions in major adverse cardiac events (MACE). We compared clinical outcomes in routine clinical care. Methods and Results EMPLACE (Cardiovascular and Renal Outcomes, and Mortality in Danish Patients with Type 2 Diabetes Who Initiate Empagliflozin Versus GLP‐1RA: A Danish Nationwide Comparative Effectiveness Study) is an ongoing nationwide population‐based comparative effectiveness cohort study in Denmark. For the present study, we included 14 498 new users of empagliflozin and 12 706 new users of liraglutide, 2015 to 2018. Co‐primary outcomes were expanded major adverse cardiac events (stroke, myocardial infarction, unstable angina, coronary revascularization, hospitalization for heart failure [HHF], or all‐cause death); HHF or all‐cause death; and first HHF or first initiation of loop‐diuretic therapy. Secondary outcomes included all‐cause hospitalization or death. We applied propensity score balancing and Cox regression to compute adjusted hazard ratios (aHRs) in on‐treatment (OT) and intention‐to‐treat (ITT) analyses. Cohorts were well balanced at baseline (median age 61 years, 59% men, diabetes mellitus duration 6.6 years, 30% with preexisting cardiovascular disease). During mean follow‐up of 1.1 years in OT and 1.5 years in ITT analyses, empagliflozin versus liraglutide was associated with a similar rate of expanded major adverse cardiac events (OT aHR, 1.02; 95% CI, 0.91–1.14; ITT aHR, 1.06; 95% CI, 0.96–1.17), and HHF or all‐cause death (OT aHR, 0.97; 95% CI, 0.85–1.11; ITT aHR, 1.02; 95% CI, 0.91–1.14); and a decreased rate of a first incident HHF or loop‐diuretic initiation (OT aHR, 0.80; 95% CI, 0.68–0.94; ITT aHR, 0.87; 95% CI, 0.76–1.00), and of all‐cause hospitalization or death (OT aHR, 0.93; 95% CI, 0.89–0.98; ITT aHR, 0.93; 95% CI, 0.90–0.97). Conclusions Empagliflozin and liraglutide initiators had comparable rates of expanded major adverse cardiac events, and HHF or all‐cause death, whereas empagliflozin initiators had a lower rate of a first HHF or loop‐diuretic initiation.
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Affiliation(s)
- Reimar W Thomsen
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | - Jakob S Knudsen
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | - Lisbeth M Baggesen
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | | | | | - Ola Vedin
- Boehringer Ingelheim AB Stockholm Sweden
| | | | - Henrik T Sørensen
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
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24
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Dhruva SS, Parzynski CS, Gamble GM, Curtis JP, Desai NR, Yeh RW, Masoudi FA, Kuntz R, Shaw RE, Marinac-Dabic D, Sedrakyan A, Normand SLT, Krumholz HM, Ross JS. Attribution of Adverse Events Following Coronary Stent Placement Identified Using Administrative Claims Data. J Am Heart Assoc 2020; 9:e013606. [PMID: 32063087 PMCID: PMC7070203 DOI: 10.1161/jaha.119.013606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/22/2022]
Abstract
Background More than 600 000 coronary stents are implanted during percutaneous coronary interventions (PCIs) annually in the United States. Because no real‐world surveillance system exists to monitor their long‐term safety, claims data are often used for this purpose. The extent to which adverse events identified with claims data can be reasonably attributed to a specific medical device is uncertain. Methods and Results We used deterministic matching to link the NCDR (National Cardiovascular Data Registry) CathPCI Registry to Medicare fee‐for‐service claims for patients aged ≥65 years who underwent PCI with drug‐eluting stents (DESs) between July 1, 2009 and December 31, 2013. We identified subsequent PCIs within 1 year of the index procedure in Medicare claims as potential safety events. We linked these subsequent PCIs back to the NCDR CathPCI Registry to ascertain how often the revascularization could be reasonably attributed to the same coronary artery as the index PCI (ie, target vessel revascularization). Of 415 306 DES placements in 368 194 patients, 33 174 repeat PCIs were identified in Medicare claims within 1 year. Of these, 28 632 (86.3%) could be linked back to the NCDR CathPCI Registry; 16 942 (51.1% of repeat PCIs) were target vessel revascularizations. Of these, 8544 (50.4%) were within a previously placed DES: 7652 for in‐stent restenosis and 1341 for stent thrombosis. Of 16 176 patients with a claim for acute myocardial infarction in the follow‐up period, 4446 (27.5%) were attributed to the same coronary artery in which the DES was implanted during the index PCI (ie, target vessel myocardial infarction). Of 24 288 patients whose death was identified in claims data, 278 (1.1%) were attributed to the same coronary artery in which the DES was implanted during the index PCI. Conclusions Most repeat PCIs following DES stent implantation identified in longitudinal claims data could be linked to real‐world registry data, but only half could be reasonably attributed to the same coronary artery as the index procedure. Attribution among those with acute myocardial infarction or who died was even less frequent. Safety signals identified using claims data alone will require more in‐depth examination to accurately assess stent safety.
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Affiliation(s)
- Sanket S Dhruva
- University of California, San Francisco, School of Medicine and San Francisco Veterans Affairs Healthcare System San Francisco CA.,National Clinician Scholars Program Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Craig S Parzynski
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Ginger M Gamble
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Medicine, and National Clinician Scholars Program Yale School of Medicine New Haven CT
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Medicine, and National Clinician Scholars Program Yale School of Medicine New Haven CT
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Boston MA.,Division of Cardiovascular Medicine Beth Israel Deaconess Medical Center Boston MA.,Harvard Medical School Boston MA.,Baim Institute for Clinical Research Boston MA
| | - Frederick A Masoudi
- Division of Cardiology Department of Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | | | - Richard E Shaw
- Department of Clinical Informatics California Pacific Medical Center San Francisco CA
| | - Danica Marinac-Dabic
- Office of Clinical Evidence and Analysis Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD
| | - Art Sedrakyan
- Department of Health Policy and Research Weill Cornell Medicine New York Presbyterian Hospital New York NY
| | - Sharon-Lise T Normand
- Department of Health Care Policy Harvard Medical School Boston MA.,Department of Biostatistics Harvard T.H. Chan School of Public Health Harvard University Boston MA
| | - Harlan M Krumholz
- National Clinician Scholars Program Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Medicine, and National Clinician Scholars Program Yale School of Medicine New Haven CT.,Department of Health Policy and Management Yale School of Public Health New Haven CT
| | - Joseph S Ross
- National Clinician Scholars Program Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Department of Health Policy and Management Yale School of Public Health New Haven CT.,Section of General Medicine Department of Medicine, and National Clinician Scholars Program Yale School of Medicine New Haven CT
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25
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Patorno E, Najafzadeh M, Pawar A, Franklin JM, Déruaz‐Luyet A, Brodovicz KG, Santiago Ortiz AJ, Bessette LG, Kulldorff M, Schneeweiss S. The EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study programme: Design and exposure accrual for an evaluation of empagliflozin in routine clinical care. Endocrinol Diabetes Metab 2020; 3:e00103. [PMID: 31922030 PMCID: PMC6947693 DOI: 10.1002/edm2.103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 08/02/2019] [Revised: 10/09/2019] [Accepted: 11/03/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The EMPA-REG OUTCOME trial showed that empagliflozin reduced the risk of cardiovascular death and hospitalization for heart failure (HHF) in diabetic patients with cardiovascular disease. EMPRISE is a study programme on the effectiveness, safety and healthcare utilization of empagliflozin in routine care, leveraging real-world data from two commercial and one federal US data sources from 2014 to 2019. OBJECTIVES To describe rationale and design of EMPRISE, assess ability to minimize confounding and evaluate the time to reach sufficient statistical power for a key study outcome, HHF, using baseline information from the first year of EMPRISE. METHODS In 3 claims data sets, we identified a 1:1 propensity score (PS)-matched cohort of diabetic patients ≥18 years initiating empagliflozin or a dipeptidyl peptidase-4 inhibitor (DPP4i), resulting in 6643 total pairs. The PS model included >140 baseline covariates. We measured covariate balance via standardized differences (SD) and postmatching c-statistic. We computed the incidence rate (IR) of HHF, predicted exposure accrual over time and calculated expected power. RESULTS After PS matching, patient characteristics were balanced with SD <0.1 and c-statistic between 0.54 and 0.59. The population IR of HHF was 4.4 per 1000 person-years using a specific HHF definition and 14.8 using a broader HHF definition. In our projection, 80%-powered analyses would require a minimum of 169 HHF events, expected to accumulate by year 3 (specific definition) or year 2 (broader definition). CONCLUSION Baseline information from EMPRISE provided evidence of solid confounding control and adequate exposure accrual with expected powered analyses for the primary outcomes.
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Affiliation(s)
- Elisabetta Patorno
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Mehdi Najafzadeh
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Ajinkya Pawar
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Jessica M. Franklin
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | | | | | - Adrian J. Santiago Ortiz
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Lily G. Bessette
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Martin Kulldorff
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
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Lee H, Park JH, Floyd JS, Park S, Kim HC. Combined Effect of Income and Medication Adherence on Mortality in Newly Treated Hypertension: Nationwide Study of 16 Million Person-Years. J Am Heart Assoc 2019; 8:e013148. [PMID: 31422733 PMCID: PMC6759906 DOI: 10.1161/jaha.119.013148] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/29/2022]
Abstract
Background Low socioeconomic status and poor medication adherence are known to be associated with increased morbidity and mortality among patients with hypertension, but their combined effects have not been studied. We therefore evaluated the joint association of household income and medication adherence with death and cardiovascular disease in patients newly treated for hypertension. Methods and Results This was a nationwide cohort study using the Korean National Health Insurance database. We included 1 651 564 individuals, aged 30 to 80 years, with newly treated hypertension and no prior cardiovascular disease and followed them for 10 years. Main exposures were household income in quintiles and adherence to antihypertensive medication, estimated by medication possession ratio: good (≥0.8), moderate (0.5 to <0.8), or poor (<0.5). The primary outcomes were all-cause and cardiovascular deaths. Higher mortality risk was observed in patients with low income (adjusted hazard ratio=1.50, 99% CI=1.46-1.53; lowest versus highest quintile) and poor medication adherence (adjusted hazard ratio=1.66, 99% CI=1.63-1.68; poor versus good adherence). When compared with the highest-income and good-adherence group, adjusted hazard ratio (99% CI) of death was 1.56 (1.52-1.61) for highest-income poor-adherers, 1.46 (1.41-1.51) for lowest-income good-adherers, and 2.46 (2.38-2.54) for lowest-income poor-adherers (P for interaction <0.001). Conclusions Low socioeconomic status and poor adherence to antihypertensive medication are associated with increased mortality and cardiovascular disease risks, but patients with low income are subject to larger excess risks by nonadherence. This highlights the potential importance of promoting medication adherence for risk reduction, especially in low-income patients with hypertension.
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Affiliation(s)
- Hokyou Lee
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea.,Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.,Graduate School Yonsei University College of Medicine Seoul Korea
| | - Jong Heon Park
- Big Data Steering Department National Health Insurance Service Wonju Korea
| | - James S Floyd
- Department of Medicine University of Washington Seattle WA.,Department of Epidemiology University of Washington Seattle WA
| | - Sungha Park
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.,Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea.,Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.,Big Data Steering Department National Health Insurance Service Wonju Korea
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Berger ML, Sox H, Willke RJ, Brixner DL, Eichler HG, Goettsch W, Madigan D, Makady A, Schneeweiss S, Tarricone R, Wang SV, Watkins J, Mullins CD. Good Practices for Real-World Data Studies of Treatment and/or Comparative Effectiveness: Recommendations from the Joint ISPOR-ISPE Special Task Force on Real-World Evidence in Health Care Decision Making. Value Health 2017; 20:1003-1008. [PMID: 28964430 DOI: 10.1016/j.jval.2017.08.3019] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Real-world evidence (RWE) includes data from retrospective or prospective observational studies and observational registries and provides insights beyond those addressed by randomized controlled trials. RWE studies aim to improve health care decision making. METHODS The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) created a task force to make recommendations regarding good procedural practices that would enhance decision makers' confidence in evidence derived from RWD studies. Peer review by ISPOR/ISPE members and task force participants provided a consensus-building iterative process for the topics and framing of recommendations. RESULTS The ISPOR/ISPE Task Force recommendations cover seven topics such as study registration, replicability, and stakeholder involvement in RWE studies. These recommendations, in concert with earlier recommendations about study methodology, provide a trustworthy foundation for the expanded use of RWE in health care decision making. CONCLUSION The focus of these recommendations is good procedural practices for studies that test a specific hypothesis in a specific population. We recognize that some of the recommendations in this report may not be widely adopted without appropriate incentives from decision makers, journal editors, and other key stakeholders.
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Affiliation(s)
| | - Harold Sox
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Richard J Willke
- International Society for Pharmacoeconomics and Outcomes Research, Lawrenceville, NJ, USA
| | | | | | - Wim Goettsch
- Zorginstituut Nederland and University of Utrecht, Utrecht, The Netherlands
| | | | - Amr Makady
- Zorginstituut Nederland and University of Utrecht, Utrecht, The Netherlands
| | | | | | - Shirley V Wang
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Zhang S, Manne S, Lin J, Yang J. Characteristics of patients potentially eligible for pharmacotherapy for weight loss in primary care practice in the United States. Obes Sci Pract 2016; 2:104-114. [PMID: 27840686 PMCID: PMC5089644 DOI: 10.1002/osp4.46] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 01/07/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 12/20/2022] Open
Abstract
Objective To describe the characteristics of real‐world patients potentially eligible for adjunctive pharmacotherapy for weight loss. Methods Patients from the GE Centricity electronic medical record database were selected if they had body mass index (BMI) ≥30 or ≥27 to <30 kg m−2 with ≥1 obesity‐associated comorbidity (hypertension, dyslipidemia, or type 2 diabetes) from 2002–2011; were aged ≥18 years and had ≥12 months of continuous enrollment before and after the date of first eligible BMI recorded (index date). Descriptive statistics and logistic regression were used for analysis. Results Of the 1,835,541 patients with overweight or obesity included, comorbidities were common (hypertension [55.4%], dyslipidemia [36.1%] and type 2 diabetes [13.4%]). The percentage of patients who received pharmacotherapy for weight loss was 0.7% within 12 months after the index date. Patients who received pharmacotherapy had higher BMI (median, 33.6 vs. 31.3 kg m−2), were younger (median, 42 vs. 52 years), primarily women (84.3 vs. 58.2%), commercially insured (70.1 vs. 50.4%) and had more frequent use of antidepressants (30.8 vs. 14.1%) and non‐steroidal anti‐inflammatory drugs (21.7 vs. 12.0%) than those who did not at baseline (all P values < 0.0001). Conclusions Few eligible patients received pharmacotherapy for weight loss. Patients who received pharmacotherapy tended to be heavier, younger, female, commercially insured, and used more antidepressants and non‐steroidal anti‐inflammatory drugs.
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Affiliation(s)
- Shumin Zhang
- Epidemiology Takeda Development Center Americas, Inc. Deerfield IL USA
| | - Sudhakar Manne
- Safety Statistics Takeda Development Center Americas, Inc. Deerfield IL USA
| | - Jennifer Lin
- Safety Statistics Takeda Development Center Americas, Inc. Deerfield IL USA
| | - Jiao Yang
- Safety Statistics Takeda Development Center Americas, Inc. Deerfield IL USA
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