scholarly journals Long-term trends in the prescription of antidiabetic drugs: real-world evidence from the Diabetes Registry Tyrol 2012–2018

2020 ◽  
Vol 8 (1) ◽  
pp. e001279
Author(s):  
Clemens Engler ◽  
Marco Leo ◽  
Bernhard Pfeifer ◽  
Martin Juchum ◽  
Di Chen-Koenig ◽  
...  
Keyword(s):  
Real World ◽  
Age Groups ◽  
Quality Parameters ◽  
Antidiabetic Drugs ◽  
National Guidelines ◽  
Prescription Patterns ◽  
Diabetes Registry ◽  
Cardiovascular Outcome Trials ◽  
Glucagon Like Peptide 1

IntroductionPrescription patterns of antidiabetic drugs in the period from 2012 to 2018 were investigated based on the Diabetes Registry Tyrol. To validate the findings, we compared the numbers with trends of different national registries conducted in a comparable period of time.Research design and methodsMedication data, prescription patterns, age groups, antidiabetic therapies and quality parameters (hemoglobin A1c, body mass index, complications) of 10 875 patients with type 2 diabetes from 2012 to 2018 were retrospectively assessed and descriptively analyzed. The changes were assessed using a time series analysis with linear regression and prescription trends were plotted over time.ResultsSodium/glucose cotransporter 2 inhibitors (SGLT-2i) showed a significant increase in prescription from 2012 to 2018 (p<0.001), as well as metformin (p=0.002), gliptins (p=0.013) and glucagon-like peptide-1 agonists (GLP-1a) (p=0.017). Significant reduction in sulfonylurea prescriptions (p<0.001) was observed. Metformin was the most frequently prescribed antidiabetic drug (51.3%), followed by insulin/analogs (34.6%), gliptins (28.2%), SGLT-2i (11.7%), sulfonylurea (9.1%), glitazones (3.7%), GLP-1a (2.8%) and glucosidase inhibitors (0.4%).ConclusionsIn this long-term, real-world study on prescription changes in the Diabetes Registry Tyrol, we observed significant increase in SGLT-2i, metformin, gliptins and GLP-1a prescriptions. In contrast prescriptions for sulfonylureas declined significantly. Changes were consistent over the years 2012–2018. Changes in prescription patterns occurred even before the publication of international and national guidelines. Thus, physicians change their prescription practice not only based on published guidelines, but even earlier on publication of cardiovascular outcome trials.

Abstract 6017: Long-Term TAXUS Paclitaxel-Eluting Stent Outcomes in the Elderly Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Daniel E Forman ◽  
Jeanne Y Wei ◽  
Mark I Friedman ◽  
Keith D Dawkins ◽  
Donald S Baim
Keyword(s):  
High Risk ◽  
Elderly Patients ◽  
Real World ◽  
Patient Population ◽  
Death Rate ◽  
Age Groups ◽  
High Risk Patient ◽  
Safety And Efficacy ◽  
The Impact

Although percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is widely used for treating elderly patients (pts), there are limited data regarding PCI outcomes in this high-risk patient population. To determine the impact of age on long-term safety and efficacy following implantation of the TAXUS Express 2 paclitaxel-eluting stent, we analyzed the TAXUS and ARRIVE studies. The 2,797 pts in TAXUS I, II SR, IV and V randomized trials and 7,492 pts in ARRIVE 1 and 2 “real world” registries were divided into three groups based on age: <60, 60 –70 and >70 years. Safety and efficacy outcomes were compared among these age groups. Results: While the 5-year death rate increased with age in the TAXUS trials, the rates of target lesion revascularization (TLR) and myocardial infarction (MI) were comparable, and the rate of stent thrombosis (ST) decreased with age. Moreover, the bare metal stent pts >70 (not shown) had similar rates of death and MI and a higher rate of TLR and ST than the corresponding TAXUS cohort. In “real world” higher risk ARRIVE pts, the 2-year death rate and cardiac death rate also increased with age while the rates of TLR, MI, and ST actually decreased with age. Elderly pts (age >70) treated with the TAXUS Express 2 stent had higher long-term death rates, but comparable TLR and MI rates and reduced ST rates compared to their younger counterparts. Collectively, these results indicate that despite the high-risk clinical and angiographic characteristics commonly observed in elderly pts, this patient population derives similar safety and efficacy from TAXUS stent treatment and such treatment should not be withheld on the basis of age alone when clinically and anatomically appropriate.

scholarly journals Safety and Efficacy of Cryoballoon Ablation of Atrial Fibrillation in relation to the Patients’ Age: Results from a Large Real-World Multicenter Observational Project

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Luigi Sciarra ◽  
Saverio Iacopino ◽  
Giuseppe Arena ◽  
Claudio Tondo ◽  
Paolo Pieragnoli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real World ◽  
Age Groups ◽  
Cryoballoon Ablation ◽  
Efficacy And Safety ◽  
Long Term Follow Up ◽  
High Degree ◽  
Af Recurrence

Background. The real-world efficacy and safety of atrial fibrillation (AF) ablation in particularly young and elderly patients are still under debate. The aim of the analysis was to investigate the effect of age on the efficacy and safety of cryoballoon ablation (CBA). Methods. 2,534 patients underwent pulmonary vein isolation (PVI) by way of CBA for paroxysmal or persistent drug-resistant and symptomatic AF. The population was divided into age quartiles for evaluation, including (1) <53 years, (2) ≥53 and <61 years, (3) ≥61 and <67 years, and (4) ≥67 years. Furthermore, outcomes were analyzed in patients <41 years, ≥41 and ≤74, and >74 years old. Procedural data and complications were collected, and atrial fibrillation recurrences were evaluated during follow-up. Results. Procedural-related complications (4.1%) were similar in the four subgroups according to age. At the 12-month follow-up, freedom from AF recurrence was 79.2%, 77.4%, 76.8%, and 75.2% ( p = 0.21 ), respectively (with increasing age). At 24-month follow-up, similar incidences of AF recurrence were observed in the four subgroups. When the sample was arbitrarily divided into the three age groups, a higher rate of recurrence was observed in older patients with regard to long-term follow-up (freedom from AF recurrence was 71.8% and 40.9%, respectively, at 12 and 24-month follow-up). In the univariate and multivariate analysis, age did not result in a significant predictor of AF recurrence during follow-up; however, a trend toward higher AF recurrences rates in patients ≥67 years was observed. Conclusion. The data demonstrated a high degree of safety during CBA across all patient ages. Procedural performance and complications were similar between different ages; AF recurrences seem to be more frequent in patients over 74 years.

scholarly journals Benefits and Limitations of Long-Term Eculizumab Treatment for Paroxysmal Nocturnal Hemoglobinuria (PNH): Real-World Data from Large Cohort Study in Russia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2589-2589 ◽  
Author(s):  
Aleksandr Kulagin ◽  
Olesya Klimova ◽  
Tatiana Rudakova ◽  
Irina Golubovskaya ◽  
Maria Ivanova ◽  
...  
Keyword(s):  
Overall Survival ◽  
Real World ◽  
Cumulative Incidence ◽  
Bone Marrow Failure ◽  
Large Cohort ◽  
National Guidelines ◽  
Allogeneic Hsct ◽  
Ckd Stage ◽  
Prospective Phase

Abstract Background: Anticomplement C5 therapy with eculizumab is the standard of treatment of patients (pts) with active hemolytic PNH. However, there are few data on long-term complement inhibition efficacy and current PNH prognosis from real-world clinical practice. Objectives: The aim of this study was to evaluate long-term eculizumab efficacy and PNH outcomes in the large cohort in Russia. Methods: As of August 1, 2018, a total of 354 pts with hemolytic PNH were observed in the I.P. Pavlov First St. Petersburg State Medical University in cooperation with the local hematological service in 75 regions of Russia (n=344), as well as in Belarus, Kazakhstan, Kyrgyzstan, Ukraine, Tajikistan (n=10) (Table 1). The analysis was conducted in the whole cohort and separately in the prospective phase after November 2011 with the eculizumab availability in Russia. We analyzed indications and access to anticomplement C5 therapy according to National guidelines (2014), frequency and causes of discontinuation of therapy, cumulative incidence of independence from transfusions with allo-HSCT as competing risk, frequency of breakthrough hemolysis (BTH) and intensive extravascular hemolysis, overall survival (OS) and causes of mortality. Results: According to the current National guidelines (2014), 323 pts had at least one indication for therapy with eculizumab: thrombosis (n=89, 25 %), transfusion-dependent hemolytic anemia (n=261, 74 %), acute kidney injury (AKI, n=69, 19 %), chronic kidney disease (CKD, n=244/304, 80 %) including CKD stage ≥ 2 (n=66/304, 22 %), pulmonary hypertension (n=66/265, 25 %) and pregnancy (n=22). Due to differences in regional support for rare diseases, only 204 (63%) pts had access to therapy with eculizumab. In addition, 19 pts received novel anti-C5 agent in clinical trial and were excluded from analysis. Allogeneic HSCT was performed in 24 pts, including 2 cases of MDS/AML evolved from AA/PNH and 17 cases of severe AA/PNH with eculizumab bridging in the prospective phase. With the median duration of eculizumab therapy of 3.4 years (0.2-6.1) the independence from RBC transfusions (TI) was achieved in 109 of 154 initially transfused pts (71 %) with a cumulative incidence of 61 % (95 % CI, 52-68) and 69 % (95 % CI, 60-76) after 12 and 24 months of therapy respectively. The median hemoglobin level at last follow-up were 6.6 (4.0-9.7), 10.5 (range, 7.1-15.4) and 12.1 g/dl (8.9-14.0) in patients who did not reach the TI, who reached the TI and were never transfused, respectively (p =0.0001). BTH was documented in 36 of 184 evaluated pts (20 %), including 16 and 20 cases with and without obvious triggers respectively. Intensive extravascular hemolysis with bilirubin level > 2xULN persisted in 31 % pts. Temporary or permanent discontinuation of eculizumab treatment occurred in 58 pts due to death (n=11), allogeneic BMT (n=17), spontaneous clone reduction (n = 4), absence of new indications 6 months after delivery (n=4), and terminating access to treatment (n=22). All pts of the latter group developed a relapse of intensive intravascular hemolysis, which in 3 cases was complicated by AKI (n=1), stroke (n=1) and myocardial infarction (n=1). OS was assessed in the prospective phase after 2011. A total of 24/203 (12 %) pts died which resulted in 5-year OS of 87% (CI 95 %, 81-92). Treatment with eculizumab significantly improved OS (Fig.1). The 5-year OS rate was 91% (CI 95 %, 85-98) in pts treated with eculizumab and 74 % (CI 95 %, 63-85) in never-treated pts (p=0.0003). There were significant differences in the causes of death between pts receiving and not receiving eculizumab: related to thrombosis 1/7 (14 %) vs 9/17 (53 %), AA and MDS 4/7 (57%) vs 5/17 (29 %). Conclusions: The results of the study show both the high efficacy and limitations of treatment with eculizumab for PNH in real-world practice. Prospectively confirmed significant improvement of the overall survival on eculizumab stress the need for faster and wider access to costly therapy. Nevertherless, a number of limitations, including BTH and extravascular hemolysis, lack of control of bone marrow failure and further clonal evolution, determine the relevance of next-generation complement inhibitors and risk-adjusted allogeneic HSCT as a curative option. Disclosures Kulagin: Alexion Pharmaceuticals, Inc: Consultancy, Honoraria.

878-P: Real-World Data from U.S. Patients Using a Long-Term Implantable Continuous Glucose Monitoring (CGM) System: Age Effect on Glycemic Control

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 878-P
Author(s):  
KATHERINE TWEDEN ◽  
SAMANWOY GHOSH-DASTIDAR ◽  
ANDREW D. DEHENNIS ◽  
FRANCINE KAUFMAN
Keyword(s):  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Real World ◽  
Glucose Monitoring ◽  
Age Effect ◽  
Real World Data ◽  
World Data

COVID - 19 AND THE PROBLEM OF PERSONALITY

2020 ◽  
pp. 31-35
Author(s):  
Mazaeva N.A. ◽  
Golovina A.G.
Keyword(s):  
General Population ◽  
Age Groups ◽  
Personal Transformation ◽  
Personality Changes ◽  
Age Dependent

In order to determine possible trends in the dynamics and characterological structure of personality in the General population caused by the COVID-19 pandemic, which is a long-term strong stressful effect and clinically and psychopathologically comparable to chronic personality changes after experiencing a disaster, the conditions predisposing to personal transformation, including clinical and prognostic patterns, are analyzed. The age-dependent nature of these changes is shown, and a number of features identified for different age groups are discussed.

INTRAUTERINE GROWTH RETARDATION - A REVIEW ARTICLE

2018 ◽  
pp. 184-195
Author(s):  
Minh Son Pham ◽  
Vu Quoc Huy Nguyen ◽  
Dinh Vinh Tran
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Growth Potential ◽  
National Guidelines ◽  
Intrauterine Growth ◽  
No Gold Standard

Small for gestational age (SGA) and fetal growth restriction (FGR) is difficult to define exactly. In this pregnancy condition, the fetus does not reach its biological growth potential as a consequence of impaired placental function, which may be because of a variety of factors. Fetuses with FGR are at risk for perinatal morbidity and mortality, and poor long-term health outcomes, such as impaired neurological and cognitive development, and cardiovascular and endocrine diseases in adulthood. At present no gold standard for the diagnosis of SGA/FGR exists. The first aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines. Another aim to summary a number of interventions which are being developed or coming through to clinical trial in an attempt to improve fetal growth in placental insufficiency. Key words: fetal growth restriction (FGR), Small for gestational age (SGA)

СОХРАНЕНИЕ ПРИВЕРЖЕННОСТИ К ТЕРАПИИ КАК ГАРАНТИЯ ЭФФЕКТИВНОСТИ СЛИТ

2019 ◽  
Author(s):  
K.S. Pavlova ◽  
D.S. Mdinaradze
Keyword(s):  
Allergic Diseases ◽  
Atopic Asthma ◽  
National Guidelines ◽  
Allergen Specific Immunotherapy ◽  
Dose Dependent ◽  
Methods Of Treatment ◽  
Choice Of Therapy ◽  
Dose Dependent Effect ◽  
Reduced Adherence

По данным ВОЗ, рекомендации врача выполняют не более 50 пациентов. В конечном итоге это приводит к снижению или отсутствию эффекта от назначаемого лечения. В связи с этим во всех последних международных и национальных руководствах говорится о необходимости учета предпочтений пациента при выборе терапии. Аллерген-специфическая иммунотерапия (АСИТ) является одним из основных методов лечения аллергических заболеваний, таких как аллергический ринит, конъюнктивит и атопическая бронхиальная астма, обладает болезнь-модифицирующими свойствами и долгосрочным эффектом после окончания лечения. АСИТ относится к профилактическому и продолжительному методу (рекомендовано на протяжении не менее 3 лет), что часто является причиной снижения приверженности к терапии. В различных исследованиях подтвержден зависимый от дозы аллергена эффект АСИТ, а следовательно, изменение режимов или сокращение сроков терапии могут влиять на конечный результат. При недостаточной эффективности АСИТ необходимо в первую очередь рассматривать вероятность низкого комплаенса. Сублингвальная АСИТ (СЛИТ) требует от пациента высокой вовлеченности в процесс лечения. Задачей врача в данном случае становится повышение терапевтического сотрудничества как одного из важнейших факторов обеспечения эффективности СЛИТ. Основными способами в данном случае являются улучшение понимания пациентом цели терапии и регулярный контроль со стороны врача.According to WHO at last 50 of the patient dont follow doctors recommendations. Ultimately, this leads to a decrease or absence of the treatment effect. In this regard, all the latest international and national guidelines mention the need to take into account the patients preferences in the choice of therapy. Allergen-specific immunotherapy (AIT) is one of the main methods of treatment of allergic diseases such as allergic rhinitis, allergic conjunctivitis and atopic asthma, and has disease modifying properties and the long-term efficacy after stop treatment. AIT refers to a preventive and long-term method (recommended for at least 3 years), that is often the cause of reduced adherence to therapy. Various studies have confirmed the dose-dependent effect of AIT, and, consequently, changes in regimens or shortening of therapy may affect the end result. In case of insufficient effectiveness of AIT, the probability of low compliance should be considered first of all. Sublingual AIT (SLIT) requires the patient to be highly involved in the treatment process. The task of the doctor in this case is increasing therapeutic cooperation, as one of the most important factors to ensure the effectiveness of SLIT. The main methods in this case are to improve the patients understanding of the purpose of the therapy and regular monitoring by the doctor.

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