FACTORS ASSOCIATED WITH NON-ADHERENCE TO HEPATITIS B VIRUS ANTIVIRAL THERAPY

Objective: To assess the adherence to antivirals in Hepatitis B Virus (HBV) infected patients and to determine various social and demographic factors which can have an impact on it. Study Design: Cross- sectional study. Place and Duration of Study: Department of Gastroenterology, Pak Emirates Military Hospital Rawalpindi, from Jan to Mar 2019. Methodology: Patients on oral anti-viral agents for hepatitis B virus infection were enrolled from outdoor clinics using consecutive sampling technique. Medication adherence was assessed using the 4-item Modified Morisky Score Questionnaire. Data was also collected about different variables that could potentially affect compliance, such as age, gender, education, residence, total number of pills prescribed for each day, travelling time to hospital, attendant’s company, adverse effects of treatment, presence of co-morbid conditions, patients’ knowledge regarding importance of adherence and whether they followed any particular routine in taking medicines. Results: There were 127 patients having mean age of 47.80 ± 14.54 years. Out of these, 20 (15.75%) were not adherent to treatment. Patients not following a fixed drug-dosing schedule, patients not aware of the significance of good drug compliance and residents of urban areas were more likely to have lesser compliance to treatment. Conclusion: Majority of our patients were compliant to treatment for chronic hepatitis B infection. This was more likely to be the case amongst those following a fixed drug-dosing schedule, having an awareness of significance of adherence to medication and residents of rural areas.

Assessing Blood-Based Biomarkers to Define a Therapeutic Window for Natalizumab

Natalizumab is a monoclonal antibody that binds CD49d. Although it is one of the most effective treatments for Relapsing-Remitting Multiple Sclerosis (RRMS), a dosing regimen has not been optimized for safety and efficacy in individual patients. We aimed to identify biomarkers to monitor Natalizumab treatment and to establish a personalized dose utilizing an ongoing longitudinal study in 29 RRMS patients under Natalizumab with standard interval dose (SD) of 300 mg/4wks or extended interval dose (EID) of 300 mg/6wks. Blood samples were analyzed by flow cytometry to determine CD49d saturation and expression in several T and B lymphocytes subpopulations. Each patient was analyzed at two different timepoints separated by 3 Natalizumab administrations. Natalizumab and sVCAM-1 levels in serum were also analyzed using ELISA. To determine the reproducibility of various markers, two different timepoints were compared and no significant differences were observed for CD49d expression nor for saturation; SD patients had higher saturation levels (~80%) than EID patients (~60%). A positive correlation exists between CD49d saturation and Natalizumab serum levels. CD49d expression and saturation are stable parameters that could be used as biomarkers in the immunomonitoring of Natalizumab treatment. Moreover, Natalizumab and sVCAM-1 serum levels could be used to optimize an individual’s dosing schedule.

ROLE OF OCTREOTIDE IN ENTERO-CUTANEAOUS FISTULA- A PROSPECTIVE STUDY

Octreotide is a octapeptide that mimics natural somatostatin pharmacologically. It exerts Inhibitory effects on gastrointestinal secretion and motility thus considered, useful in management of gastrointestinal stula. The half life of octerotide is 113 minutes which allow intermittent (three times daily) subcutaneous dosing schedule for the treatment of stula. The main focus of this review is to know the use of octreotide in management of enterocutaneous stula.

897 Infusion episode-related benefits of pembrolizumab Q6W dosing schedule for patients with melanoma treated in the adjuvant and metastatic settings in the United States (US)

BackgroundA new dosing schedule for pembrolizumab (400 mg every six weeks (Q6W)) received accelerated FDA approval in 2020 across all approved adult indications. The Q6W dosing schedule provides an opportunity to reduce the number of infusions required over the treatment course, thereby decreasing time and costs for health care providers, patients and their caregivers. This study quantified the potential infusion episode-related benefits of pembrolizumab Q6W regimen for the treatment of patients with melanoma in the adjuvant and metastatic settings in the US.MethodsAn Excel-based tool was developed to quantify the infusion episode-related time and cost of using pembrolizumab Q6W compared to available nivolumab dosing regimens (Q4W/Q2W) to treat patients with melanoma in the adjuvant and metastatic settings from the patient, caregiver, provider, and payer perspectives. The number of infusion visits, time and costs were estimated considering a hypothetical infusion center. Time-related inputs were based on a survey of patients, physicians and nurses; cost-related inputs were obtained from published sources. Sensitivity analyses were performed to assess the robustness of results. Additional analyses assessed the impact of using alternative regimens with different frequencies of administration.ResultsBased on the tool, pembrolizumab Q6W reduced the number of infusion visits (31%), time at the infusion center (41%) and chair time (31%) in total, over one year, versus nivolumab Q4W. Because fewer visits are needed, travel time is estimated to decrease by 31%. The infusion-related direct and indirect costs borne by patients and caregivers are projected to decrease by $1,095 and $2,272, respectively over a treatment course. For a typical US infusion center treating 169 melanoma patients per week over a 1-year period, using pembrolizumab Q6W rather than nivolumab Q4W is estimated to reduce the number of infusions by 2,729 (31% reduction) for a total of 3,802 fewer hours of infusion chair time, allowing the infusion center to increase patient capacity by up to 45% using currently available resources. Time and cost savings are more prominent when comparing with nivolumab Q2W: 5,757 fewer infusion events (66% reduction) and 8,062 less hours of chair time, which would increase the patient capacity by 2.9 times.ConclusionsUtilizing pembrolizumab Q6W to treat patients with melanoma in the US is expected to substantially reduce the number of infusion visits and associated chair time required over the duration of treatment, reducing the time and monetary burden for patients and their caregivers. Additionally, it may also improve system capacity.

Daratumumab utilization and cost analysis among patients with multiple myeloma in a US community oncology setting

Background: The introduction of daratumumab into the treatment of multiple myeloma has improved outcomes in patients; however, community oncologists often dose more frequently than the US FDA-approved label. Materials and methods: Integra analyzed its database to elucidate daratumumab treatment patterns and the impact of increased utilization on the cost of care for multiple myeloma. Results: Following week 24, 671 (65%) of 1037 patients remained on daratumumab-containing regimens, with 330 patients continuing more frequent treatments than the expected once-every-4-weeks dosing described in the standard dosing schedule. Patients received an average of 14% more daratumumab doses than the FDA-approved label indicates, increasing the 1-year daratumumab costs by an estimated US$31,353. Conclusion: Daratumumab is utilized more frequently than the FDA-recommended dosing, leading to higher multiple myeloma treatment costs.

The impact of equity factors on receipt of timely appropriate care for children with suspected malaria in eastern Uganda

Introduction Malaria accounts for more than one-tenth of sub-Saharan Africa’s 2.8 million annual childhood deaths, and remains a leading cause of post-neonatal child mortality in Uganda. Despite increased community-based treatment in Uganda, children continue to die because services fail to reach those most at risk. This study explores the influence of two key equity factors, socioeconomic position and rurality, on whether children with fever in eastern Uganda receive timely access to appropriate treatment for suspected malaria. Methods This was a cross-sectional study in which data were collected from 1094 caregivers of children aged 6–59 months on: illness and care-seeking during the previous two weeks, treatment received, and treatment dosing schedule. Additional data on rurality and household socioeconomic position were extracted from the Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) database. A child was considered to have received prompt and appropriate care for symptoms of malaria if they received the recommended drug in the recommended dosing schedule on the day of symptom onset or the next day. Unadjusted and adjusted logistic regression models were developed to explore associations of the two equity factors with the outcome. The STROBE checklist for observational studies guided reporting. Results Seventy-four percent of children had symptoms of illness in the preceding two weeks, of which fever was the most common. Children from rural households were statistically more likely to receive prompt and appropriate treatment with artemisinin-combination therapy than their semi-urban counterparts (OR 2.32, CI 1.17–4.59, p = 0.016). This association remained significant following application of an adjusted regression model that included the age of the child, caregiver relationship, and household wealth index (OR 2.4, p = 0.036). Wealth index in its own right did not exert a significant effect for children with reported fever (OR for wealthiest quintile = 1.02, CI 0.48–2.15, p = 0.958). Conclusions The findings from this study help to identify the role and importance of two key equity determinants on care seeking and treatment receipt for fever in children. Whilst results should be interpreted within the limitations of data and context, further studies have the potential to assist policy makers to target inequitable social and spatial variations in health outcomes as a key strategy in ending preventable child morbidity and mortality.