scholarly journals Biologic Drug Survival in Psoriasis: A Systematic Review & Comparative Meta-Analysis

2020 ◽  
Author(s):  
Ahmed I Mourad ◽  
Robert Gniadecki
Keyword(s):  
Real World ◽  
Survival Data ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Survival Rates ◽  
Clinical Decision ◽  
Drug Discontinuation ◽  
Large Variability ◽  
Drug Survival ◽  
Biologic Drug

Background: Drug survival studies have been utilized to evaluate the real-world effectiveness of biologics used in psoriasis. However, the increasing volume of drug survival data suffers from large variability due to regional differences in drug availability, patient selection and biologic reimbursement. Objectives: To conduct a meta-analysis of biologic drug survival to determine comparative effectiveness of the biologics in a real-world setting. Methods: Studies reporting drug survival for biologic therapy in psoriasis were identified by a systematic literature search. Hazard ratio data for drug discontinuation were estimated directly from published Kaplan-Meier estimator curves at year 1, 2 and 5 of treatment and compared pairwise for the following biologics: ustekinumab, adalimumab, etanercept, infliximab, secukinumab and ixekizumab. This pooled hazard ratios were used to estimate 2- and 5- year overall drug survival rates. Results: Ustekinumab had the longest persistence at 2 years and 5 years among all biologics included in this meta-analysis. Adalimumab was superior to etanercept and infliximab at 5 years. Pooled 5-year drug survival rates for adalimumab, etanercept, and infliximab were 46.3%, 35.9% and 34.7%, respectively. 2- and 5-year data were not available for anti-IL-17 drugs, but at 1-year ustekinumab outperformed secukinumab, the latter being equal to anti-TNFs. Conclusions: Ustekinumab is characterized by longer drug survival than TNF inhibitors and IL-17 inhibitors. Estimated pooled 2- and 5- year drug survival rates may serve as a useful tool for patient communication and clinical decision-making.

scholarly journals Biologic Drug Survival in Psoriasis: A Systematic Review & Comparative Meta-Analysis

2021 ◽  
Vol 7 ◽  
Author(s):  
Ahmed I. Mourad ◽  
Robert Gniadecki
Keyword(s):  
Real World ◽  
Survival Data ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Survival Rates ◽  
Clinical Decision ◽  
Drug Discontinuation ◽  
Large Variability ◽  
Drug Survival ◽  
Biologic Drug

Drug survival studies have been utilized to evaluate the real-world effectiveness of biologics used in psoriasis. However, the increasing volume of drug survival data suffers from large variability due to regional differences in drug availability, patient selection and biologic reimbursement. The objective of this study was to conduct a meta-analysis of biologic drug survival to determine comparative effectiveness of the biologics in a real-world setting. Studies reporting drug survival for biologic therapy in psoriasis were identified by a systematic literature search. Hazard ratio data for drug discontinuation were estimated directly from published Kaplan-Meier estimator curves at year 1, 2, and 5 of treatment and compared pairwise for the following biologics: ustekinumab, adalimumab, etanercept, infliximab, secukinumab, and ixekizumab. This pooled hazard ratios were used to estimate 2- and 5-year overall drug survival rates. Ustekinumab had the longest persistence at 2 and 5 years among all biologics included in this meta-analysis. Adalimumab was superior to etanercept and infliximab at 5 years. Pooled 5-year drug survival rates for adalimumab, etanercept, and infliximab were 46.3, 35.9, and 34.7%, respectively. Two- and five-year data were not available for anti-IL-17 drugs, but at 1-year ustekinumab outperformed secukinumab, the latter being equal to anti-TNFs. In conclusion, ustekinumab is characterized by longer drug survival than TNF inhibitors and IL-17 inhibitors. Estimated pooled 2- and 5-year drug survival rates may serve as a useful tool for patient communication and clinical decision-making.

Drug survival rates and reasons for drug discontinuation in patients with atopic dermatitis: a retrospective study of adult outpatients

2021 ◽  
Vol 31 (2) ◽  
pp. 233-238
Author(s):  
Jehane Pino Lopez ◽  
Christian Kromer ◽  
Raphael Herr ◽  
Astrid Schmieder ◽  
Christiane Bayerl ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Retrospective Study ◽  
Survival Rates ◽  
Drug Discontinuation ◽  
Drug Survival

Abstract P111: Comparative Efficacy Of Bisoprolol Compared To Other Selective Beta-1 Blockers In Patients With Hypertension - A Systematic Review And Meta-analysis Of Observational Studies

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Uday M Jadhav ◽  
Tiny Nair ◽  
SANDEEP BANSAL ◽  
Saumitra Ray
Keyword(s):  
Lipid Profile ◽  
Observational Studies ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Hdl Cholesterol ◽  
Clinical Decision ◽  
Cochrane Library ◽  
Favourable Effect ◽  
Pooled Data ◽  
Cholesterol Levels

Introduction: Selective beta-1 blockers (s-BBs) are used in the management of hypertension (HT) in specific subsets. Studies comparing the potency of blood pressure (BP) lowering with different s-BBs are sparse. The objective of this meta-analysis was to evaluate the efficacy of bisoprolol compared to other s-BBs (Atenolol, Betaxolol, Esmolol, Acebutolol, Metoprolol, Nebivolol) in HT patients by examining their effect on BP, heart rate (HR) and metabolic derangements, by examining the evidences reported in observational studies. Methods: Electronic databases like PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov, Surveillance, Epidemiology and End Results Program and 12 PV databases were systematically searched from inception to October 2019. Observational studies that compared bisoprolol with other s-BBs in patients with HT were evaluated in accordance with the PRISMA guidelines. Pooled data were calculated using random-effects model for meta-analysis in terms of mean difference (MD) and 95% confidence interval (95% CI) for each outcome. Outcomes of interest were BP, HR and lipid profile. Results: Four observational studies which compared bisoprolol with other s-BBs (nebivolol and atenolol) were included in this meta-analysis. Significant reduction was observed in office diastolic BP [MD: -1.70; 95% CI: -2.68,-0.72; P <0.01] among arterial HT patients treated with bisoprolol for 26 weeks (w) compared to those treated with other s-BBs. HT patients treated with bisoprolol for 26 w showed significant reduction in HR [MD: -2.20; 95% CI: -3.57,-0.65; P <0.01] and office HR [MD: -2.55; 95% CI: -3.57,-1.53; P <0.01] than other s-BBs. HDL cholesterol levels increased significantly in essential HT patients treated with bisoprolol at 26 w [MD: 7.17; 95% CI: 1.90,12.45; P <0.01], 78 w [MD: 11.70; 95% CI: 4.49,18.91; P <0.01] and 104 w [MD: 10.20, 95% CI: 4.49,18.91; P <0.01] compared to other s-BBs. Conclusion: Our results suggests that bisoprolol is superior to other s-BBs in reducing BP and HR. Bisoprolol also had a favourable effect on lipid profile shown by increase in HDL cholesterol. This meta-analysis emphasizes the efficacy of bisoprolol over other s-BBs, which aids clinical decision making in treatment of patients with HT.

A meta-analysis of confidence and judgment accuracy in clinical decision making.

2015 ◽  
Vol 62 (4) ◽  
pp. 553-567 ◽  
Author(s):  
Deborah J. Miller ◽  
Elliot S. Spengler ◽  
Paul M. Spengler
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Judgment Accuracy

scholarly journals Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Body ◽  
Representative Sampling ◽  
Real World Evidence ◽  
Wide Range

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

scholarly journals Ondansetron use is associated with lower COVID-19 mortality in a Real-World Data network-based analysis

2021 ◽  
Author(s):  
Gregory M Miller ◽  
Austin J Ellis ◽  
Rangaprasad Sarangarajan ◽  
Amay Parikh ◽  
Leonardo O Rodrigues ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Real World ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Long Term Effects ◽  
Real World Data ◽  
World Data ◽  
Antiemetic Agent ◽  
Future Loss ◽  
Selection Operator

Objective: The COVID-19 pandemic generated a massive amount of clinical data, which potentially holds yet undiscovered answers related to COVID-19 morbidity, mortality, long term effects, and therapeutic solutions. The objective of this study was to generate insights on COVID-19 mortality-associated factors and identify potential new therapeutic options for COVID-19 patients by employing artificial intelligence analytics on real-world data. Materials and Methods: A Bayesian statistics-based artificial intelligence data analytics tool (bAIcis®) within Interrogative Biology® platform was used for network learning, inference causality and hypothesis generation to analyze 16,277 PCR positive patients from a database of 279,281 inpatients and outpatients tested for SARS-CoV-2 infection by antigen, antibody, or PCR methods during the first pandemic year in Central Florida. This approach generated causal networks that enabled unbiased identification of significant predictors of mortality for specific COVID-19 patient populations. These findings were validated by logistic regression, regression by least absolute shrinkage and selection operator, and bootstrapping. Results: We found that in the SARS-CoV-2 PCR positive patient cohort, early use of the antiemetic agent ondansetron was associated with increased survival in mechanically ventilated patients. Conclusions: The results demonstrate how real world COVID-19 focused data analysis using artificial intelligence can generate valid insights that could possibly support clinical decision-making and minimize the future loss of lives and resources.

P1858Meta-analysis of performance of risks scores for predicting outcomes after percutaneous Mitraclip implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T K M Wang ◽  
M T M Wang
Keyword(s):  
Confidence Interval ◽  
Risk Stratification ◽  
Clinical Decision Making ◽  
Operative Mortality ◽  
Data Extraction ◽  
Meta Analysis ◽  
Critical Role ◽  
Clinical Decision ◽  
Risk Scores ◽  
Sts Score

Abstract Background The Mitraclip is the most established percutaneous mitral valve intervention indicated for severe mitral regurgitation at high or prohibitive surgical risk. Risk stratification plays a critical role in selecting the appropriate treatment modality in high risk valve disease patients but have been rarely studied in this setting. We compared the performance of risk scores at predicting mortality after Mitraclip in this meta-analysis. Methods MEDLINE, Embase and Cochrane databases from 1 January 1980 to 31 December 2018 were searched. Two authors reviewed studies which reported c-statistics of risk models to predict mortality after Mitraclip for inclusion, followed by data extraction and pooled analyses. Results Amongst 494 articles searched, 47 full-text articles were evaluated, and 4 studies totalling 879 Mitraclip cases were included for analyses. Operative mortality was reported at 3.3–7.4% in three studies, and 1-year mortality 11.2%-13.5% in two studies. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.66 (0.57–0.75), EuroSCORE II 0.72 (0.60–0.85) and STS Score 0.64 (0.56–0.73). Respective Peto's odds ratios (95% confidence interval) to assess calibration were EuroSCORE 0.21 (0.14–0.31), EuroSCORE II 0.43 (0.24–0.76) and STS Score 0.36 (0.21–0.61). C-statistics (95% confidence interval) for 1-year mortality were EuroSCORE II 0.64 (0.57–0.70) and STS Score (0.58–0.64). Conclusion All scores over-estimated operative mortality, and EuroSCORE II had the best moderate discrimination while the other two scores were only modestly prognostic. Development of Mitraclip-specific scores may improve accuracy of risk stratification for this procedure to guide clinical decision-making.

Creating Public Health Policy

2014 ◽  
pp. 210-223
Author(s):  
Bruce F. Chorpita ◽  
Jeanne Miranda ◽  
Adam Bernstein
Keyword(s):  
Mental Health ◽  
Health Policy ◽  
Real World ◽  
Clinical Decision Making ◽  
Mental Health Policy ◽  
Clinical Decision ◽  
Quality Practices ◽  
Mental Health Treatments ◽  
And Training ◽  
The Way

In recent years, clinical psychology has made significant contributions to mental health policy through its increasing focus on the notion of evidence-based practice and an empirical approach to clinical decision-making. These developments have not been without challenges, however. Most notable are issues with the acceptability of treatment design among practitioners and the difficulty of implementing and sustaining high-quality practices in real-world contexts. Two specific barriers central to these challenges are discussed, namely, the highly specialized architecture of most research-based mental health treatments and the unavailability of a dedicated supervisory and training infrastructure. Solutions are proposed that suggest the need to rethink both the way treatments are packaged and the way they are supported in real-world practice.

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