Drug Adherence and Persistence of Patients with Moderate to Severe Psoriasis Treated with Biologic Medications in a US Commercially Insured Population

Dermatology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Chang Xu ◽  
Amanda Teeple ◽  
Bingcao Wu ◽  
Timothy Fitzgerald ◽  
Steven R. Feldman
Keyword(s):  
Index Date ◽  
Certolizumab Pegol ◽  
Severe Psoriasis ◽  
Drug Adherence ◽  
Medical Claim ◽  
Biologic Treatment ◽  
The Usa ◽  
Study Population ◽  
Biologic Medication

<b><i>Background:</i></b> Adalimumab (ADA), certolizumab pegol (CER), etanercept (ETA), guselkumab (GUS), ixekizumab (IXE), secukinumab (SEC), and ustekinumab (UST) are biologic medications approved in the USA for the treatment of moderate to severe psoriasis. We examined drug adherence and persistence of patients with moderate to severe psoriasis who initiated these seven biologic medications. <b><i>Methods:</i></b> Adult patients with ≥1 pharmacy/medical claim for any of the seven psoriasis medications and ≥1 diagnosis of psoriasis in the previous 6 months between July 1, 2014 and June 30, 2019 were selected from the IBM MarketScan® Commercial Claims and Encounters Database. The index date was defined as the date of the first prescription fill. Patients were required to have continuous health plan enrollment during the 6 months prior to their index date and ≥9 months after. Patients were grouped into seven study cohorts based upon their index biologic medication. Adherence was measured using the proportion of days covered (PDC) and defined by a PDC ≥80%. Adherence and persistence with index biologic medications were examined during fixed follow-up periods of 3, 6, and 9 months, with a subpopulation analysis carried out among patients with 12 months of follow-up. <b><i>Results:</i></b> Among psoriasis patients with ≥9 months of continuous enrollment included in the study population, the number of those who initiated each biologic medication was 10,324 for ADA, 431 for CER, 3,092 for ETA, 821 for GUS, 1,766 for IXE, 4,132 for SEC, and 5,441 for UST. The mean age at the time of initiating biologic treatment was 46.9 years. During the 9-month follow-up period, the proportions of adherent patients (i.e., PDC ≥80%) were numerically higher among those treated with UST (59.9%) and GUS (56.9%), followed by those treated with SEC (46.1%), IXE (45.5%), ADA (44.7%), ETA (33.9%), and CER (22.0%). The proportions of patients who were persistent with their index biologic medication during the 9-month follow-up period were numerically higher among those treated with UST (70.1%) and GUS (67.8%), followed by those treated with IXE (47.3%), SEC (46.9%), ADA (28.7%), CER (14.8%), and ETA (10.7%). <b><i>Conclusions:</i></b> In this large healthcare claims database analysis of psoriasis patients treated with seven different biologic medications, adherence was numerically higher among those treated with UST or GUS. UST and GUS were also associated with numerically greater persistence.

Real-world antiemetic utilization in patients undergoing carboplatin chemotherapy.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 10-10
Author(s):  
Michael Polson ◽  
Brooke Harrow
Keyword(s):  
Index Date ◽  
Nausea And Vomiting ◽  
Administrative Claims ◽  
Target Area ◽  
Minimal Risk ◽  
Medical Claim ◽  
Time Curve ◽  
Study Population ◽  
Ed Visits ◽  
Carboplatin Auc

10 Background: More than 70% of patients receiving chemotherapy will experience chemotherapy-induced nausea and vomiting (CINV). Chemotherapeutic regimens (regimens) are classified as highly emetogenic, moderately emetogenic, low potential, or minimal risk for emesis. The NCCN has recently reclassified carboplatin emetogenicity according to the AUC (target area under the concentration versus time curve) with a carboplatin AUC ≥4 classified as highly emetogenic and carboplatin AUC < 4 as moderately emetogenic - but highly emetogenic in certain patients. This study assessed use of anti-emetic agents in carboplatin based regimens. Methods: This study consisted of a retrospective analysis of administrative claims data from multiple commercial health plans. Claims from 1/1/2010-10/31/2017 were analyzed. Index date for each patient was the first medical claim of the regimen of interest. Included patients had ≥1 medical claim for the selected regimen and were eligible for both medical and pharmacy benefits for ≥6 months prior to, and 12 months post index date. CINV-related hospitalizations and ER cost and utilization were assessed for patients treated with carboplatin based regimens. Results: In total, 4,430 mostly female (74%) patients met criteria for treatment with a carboplatin-based index regimen. Between 2010 and 2017, the following trends were noted in the study population: Adherence to NCCN recommended 3 drug CINV prophylaxis (triplet therapy) ranged from about 23% to 35%. The rate of CINV related emergency department (ED) visits was 5.3% and the overall rate of CINV related inpatient visits was 0.11%. The average cost for CINV related hospitalization for a carboplatin patient was $8,562 (SD 6,207) with an average LOS of 3.1 days. ED visits that were CINV related cost $2,463 on average (SD 3,054). Conclusions: Guidelines recommend use of up to three agents in the prevention of chemotherapy induced nausea and vomiting. Use of a triplet therapy for CINV prophylaxis in carboplatin based highly emetogenic regimens has increased over time in the plans analyzed and may offer an opportunity to reduce rate of CINV related hospitalizations and ED visits, as well as associated costs.

Epidemiology and mortality of metastatic castration-resistant prostate cancer (mCRPC) in a managed care population in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13592-e13592 ◽  
Author(s):  
Katrine Wallace ◽  
Adrienne Landsteiner ◽  
Scott Bunner ◽  
Nicole Engel-Nitz ◽  
Amy Luckenbaugh
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Index Date ◽  
The United States ◽  
Baseline Period ◽  
Mortality Data ◽  
Administrative Claims ◽  
Claims Database ◽  
Study Population

e13592 Background: To date, there has been a paucity of information in the literature describing the epidemiology of mCRPC within the prostate cancer population. We present a real-world data study describing characteristics and mortality of patients with mCRPC within an administrative claims database of an insured population within the United States. Methods: In an administrative claims database of ≈18,000,000 covered lives, adult male patients were included if they had ≥1 claim for prostate cancer (ICD-9: 185 or 233.4; ICD-10: C61 or D075), underwent pharmacologic or surgical castration, and had a code for metastatic disease during the identification period (January 1, 2008–March 31, 2018). The index date was the first metastatic claim; 6 months of continuous enrollment (CE) prior to (baseline period) and after (follow-up period) the index date was required. Patients with metastatic claims in the baseline period were excluded. Patients were followed until the earliest of: death (unless prior to the 6-month CE), end of study period, or disenrollment. A claims-based algorithm was employed to identify locally advanced and distant mCRPC patients in the prostate cancer study population. Mortality data were sourced from the Social Security Administration Medicare data, and a claims algorithm. Results: 343,089 patients were identified with a claim for prostate cancer; of those, 3690 mCRPC cases (1.1%) were identified using the claims-based algorithm and met the study inclusion criteria. Median age was 75 years. Insurance type included commercial plans (27%) and Medicare (73%). Castration type included pharmacologic (99%) and surgical (1%). First claims for metastases were most commonly in the bone (65%) or lymph nodes (15%), with 20% in other sites. The study population averaged a Charlson comorbidity index score of 3.05 at baseline, with 16% of patients receiving a score of ≥5. The most common baseline comorbidities were hypertension (67%), urinary disease (58%), dyslipidemia (52%), and cardiac disease (45%). Median follow-up time among the mCRPC group was 538 days, during which 1834 deaths occurred; 50% of the population experienced mortality during the study period. Conclusions: This study provides valuable insights into the epidemiology, clinical characteristics, prevalence rate, and mortality of patients with mCRPC. Given the high mortality proportion of this disease, the development of novel therapies to prolong life in patients with mCRPC is warranted.

The Language of New Terrorism: Differences in Psychological Dimensions of Communication in Dabiq and Inspire

2017 ◽  
Author(s):  
Matteo Vergani ◽  
Ana-Maria Bliuc
Keyword(s):  
Experimental Study ◽  
English Language ◽  
Terrorist Attacks ◽  
Al Qaeda ◽  
Positive Attitudes ◽  
Terrorist Groups ◽  
The Usa ◽  
Psychological Dimensions ◽  
New Terrorism

We investigate differences in the psychological aspects underpinning Western mobilisation of two terrorist groups by analysing their English-language propaganda. Based on a computerized analysis of the language used in two English-language online magazines circulated by ISIS and al-Qaeda (i.e., Dabiq and Inspire), we found significant differences in their language - the ISIS’ language being higher in authoritarianism and its level of religiousness. In a follow-up experimental study, we found that being high in religiousness and authoritarianism predicts more positive attitudes towards the language used by ISIS, but not towards the language used by al-Qaeda. The results suggest that ISIS’ propaganda may be more effective in mobilising individuals who are more authoritarian and more focused on religion than that of al-Qaeda. These findings are consistent with the behaviour observed in recent homegrown terrorist attacks in the USA and Europe.

scholarly journals THE RELATIONSHIP BETWEEN INFLAMMATORY DIETARY PATTERN AND INCIDENCE OF PERIODONTITIS

2021 ◽  
pp. 1-36
Author(s):  
Ahmed A. Alhassani ◽  
Frank B. Hu ◽  
Bernard A. Rosner ◽  
Fred K. Tabung ◽  
Walter C. Willett ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Periodontal Disease ◽  
Secondary Analysis ◽  
Hazard Ratio ◽  
Reduced Rank Regression ◽  
Rank Regression ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Study Population

ABSTRACT The long-term inflammatory impact of diet could potentially elevate the risk of periodontal disease through modification of systemic inflammation. The aim of the present study was to prospectively investigate the associations between a food based, reduced rank regression (RRR) derived, empirical dietary inflammatory pattern (EDIP) and incidence of periodontitis. The study population was composed of 34,940 men from the Health Professionals Follow-Up Study, who were free of periodontal disease and major illnesses at baseline (1986). Participants provided medical and dental history through mailed questionnaires every 2 years, and dietary data through validated semi-quantitative food frequency questionnaires every 4 years. We used Cox proportional hazard models to examine the associations between EDIP scores and validated self-reported incidence of periodontal disease over a 24-year follow-up period. No overall association between EDIP and the risk of periodontitis was observed; the hazard ratio comparing the highest EDIP quintile (most proinflammatory diet) to the lowest quintile was 0.99 (95% confidence interval: 0.89 -1.10, p-value for trend = 0.97). A secondary analysis showed that among obese non-smokers (i.e. never and former smokers at baseline), the hazard ratio for periodontitis comparing the highest EDIP quintile to the lowest was 1.39 (95% confidence interval: 0.98 -1.96, p-value for trend = 0.03). In conclusion, no overall association was detected between EDIP and incidence of self-reported periodontitis in the study population. From the subgroups evaluated EDIP was significantly associated with increased risk of periodontitis only among nonsmokers who were obese. Hence, this association must be interpreted with caution.

scholarly journals Analysis of risk scores and duration of hospital stay in prognosis of STEMI patients after pPCI

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
SR Thangasami ◽  
JS Prajapati ◽  
GL Dubey ◽  
VR Pandey ◽  
PM Shaniswara ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Early Discharge ◽  
Risk Scores ◽  
Timi Score ◽  
Study Population ◽  
Event Rates ◽  
Grace Score

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Advances in the immediate management of ST elevation myocardial infarction (STEMI) have led to a dramatic decline in mortality and reduction in hospital length of stay (LOS). We analysed the prognostic value of selected risk models in STEMI treated with primary percutaneous coronary intervention (PPCI) and to identify additional parameters to strengthen risk scores in categorizing patients for safe early discharge and to identify parameters prolonging hospital stay. Purpose To assess parameters and risk scores to categorize patients for safe early discharge following STEMI and to assess the composite of death, MI, unstable angina (UA), stroke, unplanned hospitalization at the end of 30 days, 6 months and at 1year follow up. Methods The study included 222 patients, who were diagnosed as STEMI, treated with successful pPCI. The risk scores like TIMI score, GRACE score, ZWOLLE score, CADILLAC score were calculated for all patients from the baseline clinical data collected on admission. Routine blood investigations along with Brain natri-uretic peptide (BNP) were done for all patients. The entire cohort was divided into three groups on the basis of length of stay: ≤3 days (n = 150), 4–5 days (n = 47), and &gt;5 days (n = 25). All-cause mortality and major cardiovascular events (MACEs) were assessed up to 1 year. Results The mean age group (yrs) of the study population was 53.92 ± 12.9. Patients in LOS &lt;3 days had a mean age (yrs) of 52.41 ± 11.74, patients in LOS 4-5 days group had 54.19 ±13.59 and patient with LOS &gt;5 days had 62.52 ± 15.32. The most important parameters that predicted hospital stay in our study are BNP levels OR: 1.003, 95% CI: 1.002-1.004, P &lt; 0.001, GRACE score OR: 1.02 ,95% CI: 1.01-1.03, P &lt; 0.001, TIMI score OR: 1.35, 95% CI: 1.18-1.55, P = 0.007, ZWOLLE score OR: 1.26, 95% CI: 1.16-1.37, P &lt; 0.001, CADILLAC score OR: 1.24, 95% CI; 1.15-1.3: P &lt; 0.001. 32 (14.4%) patients expired in the study population. 36% patients of LOS &gt;5 days expired in 1year follow up with maximum mortality in the first 6 months. 56% of the patients in LOS &gt; 5 days had an adverse cardiac event in 1 year follow up. Patients in LOS &gt;5 days had increased event rates in 30 days,6 months and in 1 year follow up. Patients with LOS 4-5 days (30%) had increased event rates than patients in LOS &lt; 3 days (19%).Unadjusted Kaplan Meir survival curves for 1 year mortality among hospital survivors showed a significant increase in mortality at 6 months in length of stay&gt; 5 days group. (P value &lt; 0.001). CONCLUSION Long hospital stay after PCI among patients with STEMI was associated with increased long-term all-cause mortality. Addition of BNP to this risk scores can better predict the course of hospital stay and adverse clinical outcomes in follow up. Long hospital stay may be used as a marker to identify patients at higher risk for long-term mortality. Abstract Figure. Kaplan meir survival curve

scholarly journals Nasal symptoms increase the risk of snoring and snoring increases the risk of nasal symptoms. A longitudinal population study

2021 ◽  
Author(s):  
Maria Värendh ◽  
Christer Janson ◽  
Caroline Bengtsson ◽  
Johan Hellgren ◽  
Mathias Holm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Health ◽  
Smoking Status ◽  
Northern Europe ◽  
Nasal Breathing ◽  
Nasal Symptoms ◽  
Increased Risk ◽  
Study Population ◽  
Independent Risk Factors

Abstract Purpose Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms. Methods In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112). Results Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47). Conclusion Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.

scholarly journals Design of a prospective follow-up study on early parenthood and smoking behaviour during pregnancy in Finnish primary healthcare

2021 ◽  
pp. 140349482110224
Author(s):  
Mikael O. Ekblad ◽  
Hanna P. Wallin ◽  
Marjukka Pajulo ◽  
Päivi E. Korhonen
Keyword(s):  
Pregnant Women ◽  
Study Design ◽  
Primary Healthcare ◽  
Routine Data ◽  
Smoking Behaviour ◽  
Self Report ◽  
Health Clinic ◽  
Follow Up Study ◽  
Study Population

Aims: The primary aim of the study is to explore different factors affecting parents’ smoking behaviour, and especially how smoking may be connected with individual differences in the psychological process of becoming a parent. In the current paper, we present the study design together with basic information on the study population. Methods: The Central Satakunta Maternity and Child Health Clinic (KESALATU) Study is an ongoing prospective follow-up study in primary healthcare of the Satakunta region of southwest Finland. Families were recruited during their first maternity clinic visit between 1 September 2016 and 31 December 2019, and participation will continue until the child is 1.5 years of age. The study combines different sources and types of data: e.g. routine data obtained from primary healthcare clinic records, specific parental self-report data and data from a new exhaled carbon monoxide meter indicating maternal smoking. The data are collected using frequently repeated assessments both during pregnancy and postnatally. The methods cover the following areas of interest: family background factors (including smoking and alcohol use), self-reported parental–foetal/infant attachment and mentalization, self-reported stress, depression and quality of life. Results: 589 pregnant women and their partners were asked to participate in the study during the collection time period. The final study population consisted of 248 (42.1%) pregnant women and 160 (27.1%) partners. Conclusions: The new methods and study design have the potential to increase our understanding about the link between early parenting psychology, prenatal psychosocial risk factors and parental health behaviour.

Maternal age at birth and daughter’s fecundability

2021 ◽  
Author(s):  
Olga Basso ◽  
Sydney K Willis ◽  
Elizabeth E Hatch ◽  
Ellen M Mikkelsen ◽  
Kenneth J Rothman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Maternal Age ◽  
Limited Information ◽  
Loss To Follow Up ◽  
Older Mothers ◽  
Registration Number ◽  
The Usa ◽  
Competing Interest

Abstract STUDY QUESTION Do daughters of older mothers have lower fecundability? SUMMARY ANSWER In this cohort study of North American pregnancy planners, there was virtually no association between maternal age ≥35 years and daughters’ fecundability. WHAT IS KNOWN ALREADY Despite suggestive evidence that daughters of older mothers may have lower fertility, only three retrospective studies have examined the association between maternal age and daughter’s fecundability. STUDY DESIGN, SIZE, DURATION Prospective cohort study of 6689 pregnancy planners enrolled between March 2016 and January 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnancy Study Online (PRESTO) is an ongoing pre-conception cohort study of pregnancy planners (age, 21-45 years) from the USA and Canada. We estimated fecundability ratios (FR) for maternal age at the participant’s birth using multivariable proportional probabilities regression models. MAIN RESULTS AND THE ROLE OF CHANCE Daughters of mothers ≥30 years were less likely to have previous pregnancies (or pregnancy attempts) or risk factors for infertility, although they were more likely to report that their mother had experienced problems conceiving. The proportion of participants with prior unplanned pregnancies, a birth before age 21, ≥3 cycles of attempt at study entry or no follow-up was greater among daughters of mothers &lt;25 years. Compared with maternal age 25–29 years, FRs (95% CI) for maternal age &lt;20, 20–24, 30–34, and ≥35 were 0.72 (0.61, 0.84), 0.92 (0.85, 1.00), 1.08 (1.00, 1.17), and 1.00 (0.89, 1.12), respectively. LIMITATIONS, REASONS FOR CAUTION Although the examined covariates did not meaningfully affect the associations, we had limited information on the participants’ mother. Differences by maternal age in reproductive history, infertility risk factors and loss to follow-up suggest that selection bias may partly explain our results. WIDER IMPLICATIONS OF THE FINDINGS Our finding that maternal age 35 years or older was not associated with daughter’s fecundability is reassuring, considering the trend towards delayed childbirth. However, having been born to a young mother may be a marker of low fecundability among pregnancy planners. STUDY FUNDING/COMPETING INTEREST(S) PRESTO was funded by NICHD Grants (R21-HD072326 and R01-HD086742) and has received in-kind donations from Swiss Precision Diagnostics, FertilityFriend.com, Kindara.com, and Sandstone Diagnostics. Dr Wise is a fibroid consultant for AbbVie, Inc. TRIAL REGISTRATION NUMBER n/a

scholarly journals Caring for Overweight Children and Adolescents at a Reference Clinic in Nutrology: Habits and Attendance

2021 ◽  
Vol 14 (01) ◽  
pp. 006-010
Author(s):  
Valeria Moro ◽  
Luiz Antonio Del Ciampo
Keyword(s):  
Physical Activity ◽  
Children And Adolescents ◽  
Soft Drinks ◽  
Overweight And Obesity ◽  
Dropout Rates ◽  
Overweight Children ◽  
Obesity Epidemic ◽  
Study Population ◽  
Municipal Health

Abstract Introduction The global obesity epidemic has mobilized health services to offer care at all levels, with reference outpatient clinics playing a prominent role in cases of greater complexity. Objectives The present study aimed to identify soft drinks consumption and physical activity habits among children and adolescents diagnosed with overweight and obesity during the first visit at a secondary level nutrology outpatient clinic, and to verify attendance at follow-up visits in a 2-year period from the first visit. Materials and Methods This is a retrospective, descriptive study based on data collection from medical records of overweighted or obese patients receiving first care at the Nutrology Clinic of the Municipal Health Secretariat from Ribeirão Preto, São Paulo, Brazil. The study population included children and adolescents aged between 2 and 18 years old cared for from January 2, 2013 to December 30, 2017. Age, weight, height, soft drinks consumption, physical activity, and attendance in scheduled follow-up visits during a 2-year period were analyzed. Results During the study period, 316 patients were registered, including 302 (95.5%) diagnosed with obesity. Of these, 112 (35.4%) were children and 204 (64.6%) were adolescents. Only 2.0% of the children and adolescents did not consume soft drinks, while 23.5 and 26.2% of the children and adolescents, respectively, consumed them daily. Physical inactivity was reported by 31.8% of the children and by 35.8% of the adolescents. Among those who practiced some type of physical activity, 81.3% of the children and 78.2% of the adolescents did not meet the recommendation of moderate to vigorous activity for 60 minutes per day. Dropout rates within the 1st year were of 41.9% for children and of 34.3% for adolescents, increasing to 76.9% and 73.8%, respectively, within the 2nd year. Conclusion There was a high consumption of soft drinks and low adherence to physical activity among patients who started outpatient follow-up. A small adherence to the follow-up program was also identified, with high dropout rates within the 2-year period following the first visit.

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