scholarly journals Experience With the Use of Baricitinib and Tocilizumab Monotherapy or Combined, in Patients With Interstitial Pneumonia Secondary to Coronavirus COVID19: A Real-World Study

2020 ◽  
Author(s):  
José Rosas ◽  
Francisco Pasquau Liaño ◽  
Mónica Llombart Cantó ◽  
José María Carrasco Barea ◽  
Amparo Raga Beser ◽  
...  
Keyword(s):  
Interstitial Pneumonia ◽  
Real World ◽  
Tocilizumab Monotherapy

scholarly journals The sequence of disease-modifying anti-rheumatic drugs: pathways to and predictors of tocilizumab monotherapy

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Daniel H. Solomon ◽  
Chang Xu ◽  
Jamie Collins ◽  
Seoyoung C. Kim ◽  
Elena Losina ◽  
...  
Keyword(s):  
Real World ◽  
Large Scale ◽  
Disease Duration ◽  
Learning Algorithm ◽  
Supervised Machine Learning ◽  
Tnf Inhibitor ◽  
Discrete State ◽  
Prior Use ◽  
Disease Modifying ◽  
Tocilizumab Monotherapy

Abstract Background There are numerous non-biologic and biologic disease-modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA). Typical sequences of bDMARDs are not clear. Future treatment policies and trials should be informed by quantitative estimates of current treatment practice. Methods We used data from Corrona, a large real-world RA registry, to develop a method for quantifying sequential patterns in treatment with bDMARDs. As a proof of concept, we study patients who eventually use tocilizumab monotherapy (TCZm), an IL-6 antagonist with similar benefits used as monotherapy or in combination. Patients starting a bDMARD were included and were followed using a discrete-state Markov model, observing changes in treatments every 6 months and determining whether they used TCZm. A supervised machine learning algorithm was then employed to determine longitudinal patient factors associated with TCZm use. Results 7300 patients starting a bDMARD were followed for up to 5 years. Their median age was 58 years, 78% were female, median disease duration was 5 years, and 57% were seropositive. During follow-up, 287 (3.9%) reported use of TCZm with median time until use of 25.6 (11.5, 56.0) months. Eighty-two percent of TCZm use began within 3 years of starting any bDMARD. Ninety-three percent of TCZm users switched from TCZ combination, a TNF inhibitor, or another bDMARD. Very few patients are given TCZm as their first DMARD (0.6%). Variables associated with the use of TCZm included prior use of TCZ combination therapy, older age, longer disease duration, seronegative, higher disease activity, and no prior use of a TNF inhibitor. Conclusions Improved understanding of treatment sequences in RA may help personalize care. These methods may help optimize treatment decisions using large-scale real-world data.

scholarly journals The Sequence of Disease Modifying Anti-Rheumatic Drugs: Pathways to and Predictors of Tocilizumab Monotherapy

2021 ◽  
Author(s):  
Daniel Solomon ◽  
Chang Xu ◽  
Jamie Collins ◽  
Seoyoung C. Kim ◽  
Elena Losina ◽  
...  
Keyword(s):  
Real World ◽  
Large Scale ◽  
Disease Duration ◽  
Learning Algorithm ◽  
Supervised Machine Learning ◽  
Tnf Inhibitor ◽  
Discrete State ◽  
Prior Use ◽  
Disease Modifying ◽  
Tocilizumab Monotherapy

Abstract Background: There are numerous non-biologic and biologic disease modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA). Typical sequences of bDMARDs are not clear. Future treatment policies and trials should be informed by quantitative estimates of current treatment practice. Methods: We used data from Corrona, a large real-world RA registry, to develop a method for quantifying sequential patterns in treatment with bDMARDs. As a proof of concept, we study patients who eventually use tocilizumab monotherapy (TCZm), an IL-6 antagonist with similar benefits used as monotherapy or in combination. Patients starting a bDMARD were included and were followed using a discrete-state Markov model, observing changes in treatments every six-months and determining whether they used TCZm. A supervised machine learning algorithm was then employed to determine longitudinal patient factors associated with TCZm use.Results: 7,300 patients starting a bDMARD were followed for up to 5 years. Their median age was 58 years, 78% were female, median disease duration was 5 years, and 57% were seropositive. During follow-up, 287 (3.9%) reported use of TCZm with median time until use of 25.6 (11.5, 56.0) months. 82% of TCZm use began within three years of starting any bDMARD. 93% of TCZm users switched from TCZ combination, a TNF inhibitor, or another bDMARD. Very few patients are given TCZm as their first DMARD (0.6%). Variables associated with use of TCZm included: prior use of TCZ combination therapy, older age, longer disease duration, seronegative, higher disease activity, and no prior use of a TNF inhibitor.Conclusions: Improved understanding of treatment sequences in RA may help personalize care. These methods may help optimize treatment decisions using large-scale real-world data.

scholarly journals The Application of Transbronchial Lung Cryobiopsy and Uniportal and Tubeless Video-Assisted Thoracic Surgery in the Multidisciplinary Diagnosis of Interstitial Lung disease—A Real-World Prospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Qian Han ◽  
Xiaobo Chen ◽  
Xin Xu ◽  
Weiping Qian ◽  
Gui Zhao ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Thoracic Surgery ◽  
Prospective Study ◽  
Lung Disease ◽  
Interstitial Pneumonia ◽  
Real World ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Transbronchial Lung Cryobiopsy ◽  
Biopsy Methods

The application of transbronchial lung cryobiopsy (TBLC) and uniportal and tubeless video-assisted thoracic surgery (UT-VATS) in the multidisciplinary diagnosis of interstitial lung disease (ILD) has not been demonstrated in real-world clinical practice. This prospective study included 137 patients with no definitive diagnosis who were the subject of two multidisciplinary discussion (MDD) sessions. As indicated in the first MDD, 67 patients underwent UT-VATS and 70 underwent TBLC. The specificity of biopsy information and its contribution to final MDD diagnosis were evaluated in the second MDD. The post-operative complications and hospitalization costs associated with the two biopsy methods were compared. UT-VATS was favored for patients initially diagnosed with idiopathic pulmonary fibrosis (IPF), bronchiolitis-associated interstitial lung disease (RB-ILD)/desquamative interstitial pneumonia (DIP) and undefined idiopathic interstitial pneumonia (UIIP), while TBLC was preferred for pulmonary lymphangioleiomyomatosis (PLAM) and pulmonary alveolar proteinosis (PAP). The spirometry parameters were better in patients who underwent UT-VATS than those who underwent TBLC. UT-VATS provided more specific pathological results than TBLC (85.7 vs 73.7%, p = 0.06). In patients initially diagnosed with UIIP, pathological information from UT-VATS was more clinically useful than that obtained from TBLC, although both tests contributed similarly to cases initially diagnosed as interstitial pneumonia with auto-immune features (IPAF)/connective tissue disease-related ILD (CTD-ILD). The safety of UT-VATS was comparable with TBLC although TBLC was cheaper during hospitalization (US$4,855.7 vs US$3,590.9, p < 0.001). multidisciplinary discussion decisions about biopsies were driven by current knowledge of sampling and diagnosis capacity as well as potential risks of different biopsy methods. The current MDD considered UT-VATS more informative than TBLC in cases initially diagnosed as UIIP although they were equally valuable in patients initially diagnosed with IPAF/CTD-ILD.

scholarly journals The Sequence of Disease Modifying Anti-Rheumatic Drugs: Pathways to and Predictors of Tocilizumab Monotherapy

2020 ◽  
Author(s):  
Daniel Solomon ◽  
Chang Xu ◽  
Jamie Collins ◽  
Seoyoung C. Kim ◽  
Elena Losina ◽  
...  
Keyword(s):  
Real World ◽  
Large Scale ◽  
Disease Duration ◽  
Learning Algorithm ◽  
Supervised Machine Learning ◽  
Tnf Inhibitor ◽  
Discrete State ◽  
Prior Use ◽  
Disease Modifying ◽  
Tocilizumab Monotherapy

Abstract Background: There are numerous non-biologic and biologic disease modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA). Typical sequences of bDMARDs are not clear. Future treatment policies and trials should be informed by quantitative estimates of current treatment practice. Methods: We used data from Corrona, a large real-world RA registry, to develop a method for quantifying sequential patterns in treatment with bDMARDs. As a proof of concept, we study patients who eventually use tocilizumab monotherapy (TCZm), an IL-6 antagonist with similar benefits used as monotherapy or in combination. Patients starting a bDMARD were included and were followed using a discrete-state Markov model, observing changes in treatments every six-months and determining whether they used TCZm. A supervised machine learning algorithm was then employed to determine longitudinal patient factors associated with TCZm use. Results: 7,300 patients starting a bDMARD were followed for up to 5 years. Their median age was 58 years, 78% were female, median disease duration was 5 years, and 57% were seropositive. During follow-up, 287 (3.9%) reported use of TCZm with median time until use of 25.6 (11.5, 56.0) months. 82% of TCZm use began within three years of starting any bDMARD. 93% of TCZm users switched from TCZ combination, a TNF inhibitor, or another bDMARD. Very few patients are given TCZm as their first DMARD (0.6%). Variables associated with use of TCZm included: prior use of TCZ combination therapy, older age, longer disease duration, seronegative, higher disease activity, and no prior use of a TNF inhibitor. Conclusions: Improved understanding of treatment sequences in RA may help personalize care. These methods may help optimize treatment decisions using large-scale real-world data.

Replications can cause distorted belief in scientific progress

2018 ◽  
Vol 41 ◽  
Author(s):  
Michał Białek
Keyword(s):  
Real World ◽  
Scientific Progress ◽  
The Public ◽  
Psychological Science

AbstractIf we want psychological science to have a meaningful real-world impact, it has to be trusted by the public. Scientific progress is noisy; accordingly, replications sometimes fail even for true findings. We need to communicate the acceptability of uncertainty to the public and our peers, to prevent psychology from being perceived as having nothing to say about reality.

Current Issues: Evidence-Based Practice for the Real World: Thoughts on Clinical Education in Communication Disorders

2010 ◽  
Vol 20 (3) ◽  
pp. 100-105 ◽  
Author(s):  
Anne K. Bothe
Keyword(s):  
Clinical Education ◽  
Real World ◽  
Evidence Based Practice ◽  
Communication Disorders ◽  
University Faculty ◽  
Evidence Based ◽  
Speech Language Pathology ◽  
Basic Principles ◽  
The Real ◽  
Language Pathology

This article presents some streamlined and intentionally oversimplified ideas about educating future communication disorders professionals to use some of the most basic principles of evidence-based practice. Working from a popular five-step approach, modifications are suggested that may make the ideas more accessible, and therefore more useful, for university faculty, other supervisors, and future professionals in speech-language pathology, audiology, and related fields.

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