scholarly journals Treatment with compounded fluticasone suspension improves the clinical, endoscopic, and histologic features of eosinophilic esophagitis

2020 ◽  
Author(s):  
Corey J Ketchem ◽  
Craig C Reed ◽  
Zoe Stefanadis ◽  
Evan S Dellon
Keyword(s):  
Eosinophilic Esophagitis ◽  
Medical Records ◽  
Clinical Care ◽  
The United States ◽  
Food Impaction ◽  
Histologic Response ◽  
Off Label ◽  
Endoscopic Findings ◽  
Loss Of Response ◽  
Routine Clinical Care

Summary No approved medication exists for the treatment of eosinophilic esophagitis (EoE) in the United States, which forces patients to utilize off-label drugs and/or create their own formulations. We assessed the efficacy of a standardized compounded fluticasone suspension. To do this, we performed a retrospective cohort study identifying all EoE patients treated with compounded fluticasone. Compounded fluticasone was prescribed during routine clinical care and dispensed by a specialty compounding pharmacy. Clinical data were extracted from medical records. Outcomes (symptomatic, endoscopic, and histologic) were assessed after the initial and last compounded fluticasone treatment in our system. There were 27 included patients (mean age 34.2; 67% male; 96% white) treated for a mean length of 5.4 ± 4.4 months. The majority (89%) previously utilized dietary elimination or topical corticosteroids, and many (75%) had primary non-response or secondary loss of response to these treatments. After starting compounded fluticasone, symptoms and endoscopic findings improved [dysphagia (89 vs. 56%, P = 0.005), food impaction (59 vs. 4%, P = 0.003), heartburn (26 vs. 4%, P = 0.01), chest pain (26 vs. 8%, P = 0.05), white plaques (63 vs. 32%; P = 0.005), furrows (81 vs. 60%; P = 0.06), and edema (15 vs. 4%; P = 0.16)]. The median of the peak eosinophil counts decreased from 52 to 37 eos/hpf (P = 0.10) and 35% of patients achieved <15 eos/hpf. In conclusion, compounded fluticasone provided a significant improvement in symptoms and endoscopic findings, with more than a third achieving histologic response in a treatment refractory EoE population. Compounded fluticasone should be considered as an EoE management option.

scholarly journals Economic burden of elderly patients with acute myeloid leukemia treated in routine clinical care in the United States

2018 ◽  
Vol 71 ◽  
pp. 27-33 ◽  
Author(s):  
Jill A. Bell ◽  
Aaron Galaznik ◽  
Eileen Farrelly ◽  
Marlo Blazer ◽  
Sharanya Murty ◽  
...  
Keyword(s):  
United States ◽  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Economic Burden ◽  
Myeloid Leukemia ◽  
Clinical Care ◽  
The United States ◽  
Routine Clinical Care ◽  
Acute Myeloid

PROVE—Phase IV Study of Perampanel in Real-World Clinical Care of Patients with Epilepsy: Interim Analysis in Pediatric Patients

2022 ◽  
pp. 088307382110476
Author(s):  
Eric Segal ◽  
Katherine Moretz ◽  
James Wheless ◽  
Patricia Penovich ◽  
Marcelo Lancman ◽  
...  
Keyword(s):  
Medical Records ◽  
Interim Analysis ◽  
Pediatric Patients ◽  
Clinical Care ◽  
Retention Rates ◽  
Routine Clinical Care ◽  
Adolescent Patients ◽  
Patients With Epilepsy ◽  
Oral Doses ◽  
Phase Iv

PROVE is a retrospective, phase IV study assessing retention, dosing, efficacy, and safety of perampanel when administered to patients during routine clinical care. We report an interim analysis of preadolescent (1 to <12 years) and adolescent (12 to <18 years) patients. Data were obtained from medical records of patients with epilepsy initiating perampanel after January 1, 2014; cut-off date for this analysis was October 10, 2018. Overall, 151 preadolescent and 183 adolescent patients were included. Retention rates following 24 months on perampanel were 42.5% (preadolescent subgroup; n = 31/73) and 55.7% (adolescent subgroup; n = 54/97). Treatment-emergent adverse events occurred in 53 (35.1%) preadolescent (most common: aggression, irritability, and somnolence) and 78 (42.6%) adolescent patients (most common: somnolence, aggression, and dizziness). These data indicate that daily oral doses of perampanel are generally well tolerated during routine clinical care, with favorable retention rates for ≤2 years, in patients aged 1 to <18 years.

scholarly journals Economic Burden of Patients Treated for Higher-Risk Myelodysplastic Syndromes (HR-MDS) in Routine Clinical Care in the United States

2018 ◽  
Vol 3 (2) ◽  
pp. 237-245 ◽  
Author(s):  
Jill A. Bell ◽  
Aaron Galaznik ◽  
Marlo Blazer ◽  
Huai-Che Shih ◽  
Eileen Farrelly ◽  
...  
Keyword(s):  
United States ◽  
Myelodysplastic Syndromes ◽  
Economic Burden ◽  
Clinical Care ◽  
The United States ◽  
Routine Clinical Care

scholarly journals The Risk of Esophageal Food Impaction In Eosinophilic Esophagitis Patients; The Role of Clinical And Socioeconomic Factors

2022 ◽  
Author(s):  
Tarik Alhmoud ◽  
Sami Ghazaleh ◽  
Marcel Ghanim ◽  
Roberta Redfern
Keyword(s):  
Socioeconomic Status ◽  
Eosinophilic Esophagitis ◽  
Medical Records ◽  
Significant Proportion ◽  
Erosive Esophagitis ◽  
Food Impaction ◽  
Esophageal Food Impaction ◽  
Life Threatening ◽  
Zip Code

Abstract Background: Eosinophilic esophagitis (EoE) patients present with dysphagia and often suffer from esophageal food impaction (EFI). EFI can lead to life-threatening perforation, and requires emergent endoscopic intervention. The aim of this study is to evaluate the risk factors for EFI in EoE patients.Methods: This is a retrospective study performed at a tertiary health care system. Medical records and endoscopy images of EoE cases were reviewed. Clinical characteristics and outcomes including EFIs were documented. We used Zip-code median household income as a surrogate for patients’ socioeconomic status.Results: 291 EoE cases were included, mean age was 42 years. Most patients (65%) had classic EoE endoscopic findings including linear furrows and/or concentric rings, however, a significant proportion (47%) had findings suggestive of gastroesophageal reflux disease (GERD), such as the presence of erosive-esophagitis, a hiatal hernia or Schatzki’s ring. 48 patients (16%) developed one or more esophageal food impaction (EFI). The risk of EFI was less likely in the absence of furrows and/or rings; odds ratio (OR) = .28, 95%CI (0.11, 0.72) [P = .008]. Females had less EFI risk; OR = 0.42, 95%CI (0.19, 0.95) [P = .04]. The type of medical insurance and socioeconomic status was not associated with EFI risk.Conclusion: EFI risk is higher in EoE patients with esophageal furrows and/or rings and in men. Aggressive treatment might be required in this population. GERD and EoE can coexist in many patients. Further studies are required to examine the role of the socioeconomic status in EoE complications.

Treatment of painful bone metastases in prostate and breast cancer patients with the therapeutic radiopharmaceutical rhenium-188-HEDP

2016 ◽  
Vol 55 (05) ◽  
pp. 188-195 ◽  
Author(s):  
Floor Overbeek ◽  
John de Klerk ◽  
Pieternel Pasker-de Jong ◽  
Alexandra van den Berk ◽  
Rob ter Heine ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Clinical Benefit ◽  
Response Rate ◽  
Clinical Care ◽  
Pain Response ◽  
Pain Palliation ◽  
Breast Cancer Patients ◽  
Routine Clinical Care ◽  
Painful Bone Metastases

Summary Aim: Rhenium-188-HEDP (188Re-HEDP) is an effective radiopharmaceutical for the palliative treatment of osteoblastic bone metastases. However, only limited data on its routine use are available and its effect on quality of life (QoL) has not been studied. Therefore, we evaluated the clinical benefit of 188Re-HEDP in routine clinical care. Patients and methods: Prostate or breast cancer patients with painful bone metastases receiving 188Re-HEDP as a routine clinical procedure were eligible for evaluation. Clinical benefit was assessed in terms of efficacy and toxicity. Pain palliation and QoL were monitored using the visual analogue scale (VAS), corrected for opioid intake, and the EORTC QLQ-C30 Global health status/QoL-scale. Thrombocyte and leukocyte nadirs were used to assess haematological toxicity. Results: 45 and 47 patients were evaluable for pain palliation and QoL, respectively. After a single injection of 188Re-HEDP, the overall pain response rate was 69% and mean VAS-scores decreased relevantly and significantly (p < 0.05). Repeated treatment resulted in similar pain response. The overall QoL response rate was 68% and mean Global health status/QoL-scores increased relevantly and significantly. Haematological side effects were mild and transient. Conclusion: The clinically relevant response on pain and quality of life and the limited adverse events prove clinical benefit of treatment with 188Re-HEDP and support its use in routine clinical care. Its effectiveness appears comparable to that of external beam radiotherapy.

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