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LDL-C Goal Attainment with Fixed-Dose Ezetimibe and Atorvastatin Versus High-Dose Atorvastatin in Chinese Patients: Subgroup Analysis of a Randomized Trial. 固定剂量依折麦比和阿托伐他汀与高剂量阿托伐他汀在中国患者LDL-C目标达到:一项随机试验的亚组分析
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-19 DOI: 10.1007/s12325-025-03429-8
Juying Qian, Xuelian Zhang, Jiyan Chen, Chunhua Ding, Ping Yang, Li Qing, Yan Liu, Si Si Chen, Junbo Ge

Introduction: Combining ezetimibe (EZ) and statins is recommended for the treatment of elevated low-density lipoprotein-cholesterol (LDL-C). This subgroup analysis evaluated the efficacy of fixed-dose combination (FDC) therapy with EZ and atorvastatin (AS) versus AS monotherapy on attaining LDL-C goals in Chinese patients with very high risk of atherosclerotic cardiovascular disease (ASCVD) grouped by ASCVD risk, age, and sex.

Methods: Data from the phase III, randomized, double-blind study (NCT03768427) compared EZ10/AS10 mg FDC versus AS20 mg (cohort A), and EZ10/AS20 mg FDC versus AS40 mg monotherapy (cohort B) in Chinese patients with uncontrolled hypercholesterolemia. Proportions of patients attaining 2016 Chinese guideline-recommended LDL-C goals (low/medium risk [< 130 mg/dL], high risk [< 100 mg/dL], very high risk [< 70 mg/dL]) were assessed at weeks 6 and 12. Subgroup analyses by ASCVD risk, age (< 65 and ≥ 65 years), and sex were conducted.

Results: LDL-C goal attainment was significantly higher with FDCs versus AS monotherapy at week 12 (cohort A: 62.7% vs. 35.1%, P = 0.0009; cohort B: 67.5% vs. 31.0%, P < 0.0001). A greater proportion of patients with very high ASCVD risk attained LDL-C goals with FDCs versus AS monotherapy at week 12 (cohort A: 62.3% vs. 33.9%; cohort B: 69.1% vs. 29.5%). LDL-C goal attainment was higher with FDCs versus individual doses of AS at weeks 6 and 12 in both cohorts, regardless of age or sex.

Conclusion: FDCs significantly improved LDL-C goal attainment compared to AS monotherapy in patients with very high ASCVD risk. In the subgroups by age and sex, a higher proportion of patients with uncontrolled hypercholesterolemia attained their LDL-C goals.

Trial registry: Trial registration number NCT03768427.

ezetimibe (EZ)联合他汀类药物被推荐用于治疗低密度脂蛋白-胆固醇(LDL-C)升高。该亚组分析评估了EZ和阿托伐他汀(AS)固定剂量联合治疗(FDC)与AS单药治疗在中国动脉粥样硬化性心血管疾病(ASCVD)高危患者(按ASCVD风险、年龄和性别分组)达到LDL-C目标方面的疗效。方法:来自III期随机双盲研究(NCT03768427)的数据比较了EZ10/AS10 mg FDC与AS20 mg(队列A),以及EZ10/AS20 mg FDC与AS40 mg单药治疗(队列B)的中国未控制的高胆固醇血症患者。达到2016年中国指南推荐的LDL-C目标(低/中风险)的患者比例[结果:在第12周,FDCs与AS单药治疗相比,LDL-C目标的实现显著更高(队列A: 62.7% vs. 35.1%, P = 0.0009;队列B: 67.5% vs. 31.0%, P)结论:与AS单药治疗相比,FDCs显著提高了非常高ASCVD风险患者LDL-C目标的实现。在按年龄和性别划分的亚组中,未控制的高胆固醇血症患者达到LDL-C目标的比例较高。试验注册:试验注册号NCT03768427。
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引用次数: 0
Comparative Efficacy and Safety of Advanced Therapies in Maintenance Treatment of Adult Patients with Moderate-to-Severe Crohn's Disease: A Systematic Literature Review and Network Meta-Analysis. 先进疗法在成人中重度克罗恩病患者维持治疗中的比较疗效和安全性:系统文献综述和网络荟萃分析
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-19 DOI: 10.1007/s12325-025-03447-6
Stefan Schreiber, Silvio Danese, Jean-Frédéric Colombel, Tadakazu Hisamatsu, Peter M Irving, Hyunsoo Park, Dong-Hyeon Kim, Young Nam Lee, Stephen B Hanauer

Introduction: While the therapeutic options for Crohn's disease (CD) have broadened swiftly, direct comparative evidence on treatment efficacy remains limited. This study explored the relative efficacy and safety of available treatments based on current evidence.

Methods: A network meta-analysis (frequentist random-effect model) evaluated comparative efficacy of licensed advanced therapies for CD using data on efficacy of maintenance therapy from fully published, randomised, controlled phase 3/3b studies with 48-64-week follow-up periods and placebo or active comparator controls, identified through a systematic literature review (PROSPERO number CRD42023413752). Intravenous (IV) and subcutaneous (SC) infliximab, SC adalimumab, IV and SC vedolizumab, SC ustekinumab, SC risankizumab, and oral upadacitinib were included. Clinical remission and endoscopic response rates attained through maintenance regimens were assessed according to line of use (e.g., first-line and second-or-later line). Safety (serious adverse event rates) was also compared.

Results: Data from nine randomised controlled trials were analysed. SC infliximab 120 mg every 2 weeks (q.2.w.) exhibited the highest risk difference (95% confidence interval) vs. placebo in both first-line and second-or-later-line maintenance treatment for achieving clinical remission (0.38 [0.23-0.53] and 0.51 [0.19-0.83], respectively; 14 and 12 comparator arms, respectively), and endoscopic response (0.39 [0.29-0.49] and 0.35 [0.07-0.63], respectively; 5 comparator arms) compared with other treatments. Differences between therapies did not reach statistical difference. Safety was comparable among treatments in terms of rates of serious adverse events.

Conclusions: The current NMA integrating recently updated phase 3 data in CD indicated that no single treatment significantly outperformed others in achieving clinical remission and endoscopic response, although SC infliximab 120 mg q.2.w exhibited highest numerical efficacy as both a first-line and second-or-later-line maintenance treatment in adult patients with moderate-to-severe CD.

虽然克罗恩病(CD)的治疗选择已经迅速扩大,但关于治疗效果的直接比较证据仍然有限。本研究在现有证据的基础上探讨了现有治疗方法的相对有效性和安全性。方法:通过系统文献综述(PROSPERO编号CRD42023413752),网络荟萃分析(frequentist随机效应模型)评估了获得许可的先进疗法治疗CD的比较疗效,使用的数据来自完全发表的、随机的、对照的3/3b期研究,随访期为48-64周,对照组为安慰剂或主动对照。包括静脉注射(IV)和皮下注射(SC)英夫利昔单抗,SC阿达木单抗,静脉注射和SC维多利单抗,SC ustekinumab, SC risankizumab和口服upadacitinib。通过维持方案获得的临床缓解和内镜反应率根据使用线(例如,一线和二线或二线)进行评估。安全性(严重不良事件发生率)也进行了比较。结果:分析了9项随机对照试验的数据。与其他治疗相比,SC英夫利昔单抗120mg / 2周(q.2.w.)与安慰剂相比,在一线和二线或二线维持治疗中获得临床缓解的风险差异最高(95%置信区间)(分别为0.38[0.23-0.53]和0.51[0.19-0.83],分别为14和12个比较组),内窥镜反应(分别为0.39[0.29-0.49]和0.35[0.07-0.63],分别为5个比较组)。治疗组间差异无统计学意义。在严重不良事件发生率方面,两种治疗的安全性相当。结论:目前的NMA整合了最近更新的CD的3期数据表明,尽管SC英夫利昔单抗120mg q2,但在实现临床缓解和内窥镜反应方面,没有单一治疗明显优于其他治疗。w在成年中重度CD患者中作为一线和二线或二线维持治疗均表现出最高的数值疗效。
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引用次数: 0
FF/UMEC/VI and BUD/GLY/FORM in Patients with COPD Stepping Up from Dual Therapy Stratified by Exacerbations and Prior Dual Therapy: A Subgroup Analysis of a Comparative Effectiveness Study. 慢性阻塞性肺病患者的FF/UMEC/VI和BUD/GLY/FORM在加重和既往双重治疗后加重:一项比较疗效研究的亚组分析
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-19 DOI: 10.1007/s12325-025-03470-7
Jadwiga A Wedzicha, Stephen G Noorduyn, Valentina Di Boscio, Olivier Le Rouzic, Anurita Majumdar, Rosirene Paczkowski, Stephen Weng, Guillaume Germain, François Laliberté, David Mannino

Introduction: Three previous publications have reported real-world comparative effectiveness of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) and budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FORM) in patients with chronic obstructive pulmonary disease (COPD) in the USA. This subgroup analysis assessed treatment with FF/UMEC/VI and BUG/GLY/FORM in patients with COPD who stepped up from dual therapy, stratified by number of prior exacerbations and class of prior dual therapy.

Methods: Propensity score (PS)-weighted patients identified within healthcare claims from the Komodo Research database were used to compare annualized rates and time to first moderate-severe COPD exacerbation between FF/UMEC/VI and BUD/GLY/FORM initiators stepping up from dual therapy, stratified by the type of dual therapy (long-acting muscarinic antagonist plus long-acting β2-agonist [LAMA/LABA] or inhaled corticosteroid [ICS] plus LABA) and by prior (none or ≥ 1) COPD exacerbation. Results are presented as events per patient year (PPY) and rate ratio (RR) with 95% confidence intervals (CIs).

Results: Approximately 14,000 patients contributed to this analysis, 10,093 FF/UMEC/VI and 3926 BUD/GLY/FORM initiators. Baseline characteristics were well balanced following PS weighting. Step-up to FF/UMEC/VI was associated with a statistically significant reduction in moderate-severe exacerbations compared with step-up to BUD/GLY/FORM irrespective of exacerbation history: no prior exacerbation, n = 7235, 0.48 vs 0.56 PPY, RR [95% CI] 0.86 [0.77, 0.95], P = 0.003; ≥ 1 prior exacerbation, n = 6784, 1.14 vs 1.41 PPY, RR [95% CI] 0.81 [0.74, 0.87], P < 0.001. Step-up to FF/UMEC/VI was also associated with a statistically significant reduction in moderate-severe exacerbations compared with step-up to BUD/GLY/FORM across both subgroups of prior dual therapy: LAMA/LABA, n = 5717, 0.71 vs 0.95 PPY; RR [95% CI] 0.75 [0.67, 0.83], P < 0.001; ICS/LABA, n = 8302, 0.85 vs 0.99 PPY; RR [95% CI] 0.86 [0.79, 0.93], P < 0.001.

Conclusion: Patients newly initiating FF/UMEC/VI following prior treatment with ICS/LABA or LAMA/LABA experienced a significantly lower rate of moderate-severe COPD exacerbations than those newly initiating BUD/GLY/FORM irrespective of number of prior exacerbations or prior dual therapy class.

在美国,已有三篇先前的出版物报道了糠酸氟替卡松/乌莫利维尼/维兰特罗(FF/UMEC/VI)和布地奈德/甘罗罗酸/富马酸福莫特罗(BUD/GLY/FORM)在慢性阻塞性肺疾病(COPD)患者中的实际疗效比较。该亚组分析评估了FF/UMEC/VI和BUG/GLY/FORM对双重治疗后加重的COPD患者的治疗效果,并按既往加重次数和既往双重治疗类别进行分层。方法:使用来自Komodo研究数据库的医疗保健声明中确定的倾向评分(PS)加权患者,比较FF/UMEC/VI和BUD/GLY/FORM启动者从双重治疗中逐步加重的年化率和首次中重度COPD加重时间,按双重治疗类型(长效毒蕈碱拮抗剂加长效β2激动剂[LAMA/LABA]或吸入皮质类固醇[ICS]加LABA)分层,并按先前(无或≥1)COPD加重。结果显示为每患者年事件数(PPY)和95%置信区间(ci)的发生率比(RR)。结果:大约14000名患者参与了这项分析,10093名FF/UMEC/VI和3926名BUD/GLY/FORM启动者。PS加权后,基线特征得到很好的平衡。与加重史无关,升级到FF/UMEC/VI与升级到BUD/GLY/FORM相比,中重度加重的减少具有统计学意义:无加重,n = 7235, 0.48 vs 0.56 PPY, RR [95% CI] 0.86 [0.77, 0.95], P = 0.003;≥1次既往加重,n = 6784, 1.14 vs 1.41 PPY, RR [95% CI] 0.81 [0.74, 0.87], P结论:与既往使用ICS/LABA或LAMA/LABA治疗后新启动FF/UMEC/VI的患者相比,新启动BUD/GLY/FORM的患者,无论既往加重次数或既往双重治疗类别如何,其中重度COPD加重率均显著降低。
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引用次数: 0
Prescribing Patterns and Perceptions of Pancreatic Enzyme Replacement Therapy among Healthcare Providers: A Prospective United States Healthcare Providers Survey. 处方模式和感知胰腺酶替代治疗的医疗保健提供者:一项前瞻性的美国医疗保健提供者调查。
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-12 DOI: 10.1007/s12325-025-03454-7
Motaz Ashkar, Jennifer Geremia, Zach Baldwin, Marie Louise Edwards, Yuehan Zhang, Viviana Garcia-Horton, Min Yang, Eric Shen, Douglas E Dylla, Yuri Sanchez Gonzalez, Jodie A Barkin

Introduction: Pancreatic enzyme replacement therapy (PERT) is the central management strategy for symptomatic and confirmed exocrine pancreatic insufficiency (EPI). PERT products composed of pancrelipase (under the brand names Creon, Zenpep, Pancreaze, Viokace, Pertzye) differ in formulation-specific attributes and access/coverage considerations. Multiple factors impact healthcare providers' (HCPs) decision-making when selecting an appropriate PERT. The current study's primary objective is to assess real-world EPI management practice and HCP perceptions of PERT products in the United States.

Methods: An online survey was carried out with HCPs who had treated patients with EPI for ≥ 3 years and prescribed PERT products to ≥ 10 patients over a 12-month period. The survey collected de-identified data on HCP characteristics, prescribing patterns, and perceptions of PERT products across the domains of efficacy, convenience, and access. Descriptive statistics were calculated, and HCPs' perceptions were compared across PERT products.

Results: A total of 250 HCPs were surveyed comprising 124 specialists, 95 generalists, and 31 advanced practice providers. HCPs managed a median of 30 patients with EPI on PERT in the 12 months preceding the survey. The most commonly prescribed PERT products were Creon (84.0%), Zenpep (60.4%), and Pancreaze (59.2%), with fewer HCPs prescribing Viokace (27.2%) and Pertzye (16.0%). Specific factors considered in prescribing decisions included improvement in abdominal and bowel symptoms (83.6%), affordability (72.4%), and formulary/insurance coverage (72.0%). A significantly higher proportion of HCPs reported favorable perceptions of Creon over other PERT products. Perceptions of formulary/insurance coverage across PERT products varied, with 8.0-56.0% of HCPs agreeing or strongly agreeing that a prescribed product had good coverage. These findings were generally consistent across different provider types.

Conclusions: HCPs consider multiple factors when prescribing PERT for patients with EPI. HCP perceptions varied across PERT products, and Creon was favorably perceived more often compared to the other therapeutic options. Various factors may contribute to barriers to treatment and should be addressed to improve access.

简介:胰酶替代疗法(PERT)是症状性和确诊的外分泌性胰腺功能不全(EPI)的中心管理策略。由胰酶组成的PERT产品(品牌名称为Creon, Zenpep, Pancreaze, Viokace, Pertzye)在配方特定属性和访问/覆盖考虑方面有所不同。在选择合适的PERT时,多种因素会影响医疗保健提供者(HCPs)的决策。当前研究的主要目的是评估美国实际的EPI管理实践和HCP对PERT产品的看法。方法:对治疗EPI患者≥3年并在12个月内给≥10例患者开PERT产品的HCPs进行在线调查。该调查收集了关于HCP特征、处方模式和PERT产品在功效、便利性和可及性方面的看法的去识别数据。计算描述性统计数据,并比较不同PERT产品的HCPs的感知。结果:共调查了250名HCPs,包括124名专科医生,95名全科医生和31名高级执业医师。在调查前的12个月,HCPs管理了中位数为30例使用PERT治疗EPI的患者。最常使用的PERT产品是Creon(84.0%)、Zenpep(60.4%)和pancreatic aze(59.2%),较少的HCPs使用Viokace(27.2%)和Pertzye(16.0%)。处方决定中考虑的具体因素包括腹部和肠道症状的改善(83.6%)、可负担性(72.4%)和处方/保险覆盖率(72.0%)。与其他PERT产品相比,HCPs报告的Creon好感度明显更高。对PERT产品的处方/保险覆盖范围的看法各不相同,8.0-56.0%的hcp同意或强烈同意处方产品具有良好的覆盖范围。这些发现在不同的提供者类型中是一致的。结论:HCPs在给EPI患者开PERT处方时会考虑多种因素。不同PERT产品对HCP的看法各不相同,与其他治疗方案相比,Creon更常被认为是有利的。各种因素可能造成治疗障碍,应加以解决,以改善获得治疗的机会。
{"title":"Prescribing Patterns and Perceptions of Pancreatic Enzyme Replacement Therapy among Healthcare Providers: A Prospective United States Healthcare Providers Survey.","authors":"Motaz Ashkar, Jennifer Geremia, Zach Baldwin, Marie Louise Edwards, Yuehan Zhang, Viviana Garcia-Horton, Min Yang, Eric Shen, Douglas E Dylla, Yuri Sanchez Gonzalez, Jodie A Barkin","doi":"10.1007/s12325-025-03454-7","DOIUrl":"https://doi.org/10.1007/s12325-025-03454-7","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic enzyme replacement therapy (PERT) is the central management strategy for symptomatic and confirmed exocrine pancreatic insufficiency (EPI). PERT products composed of pancrelipase (under the brand names Creon, Zenpep, Pancreaze, Viokace, Pertzye) differ in formulation-specific attributes and access/coverage considerations. Multiple factors impact healthcare providers' (HCPs) decision-making when selecting an appropriate PERT. The current study's primary objective is to assess real-world EPI management practice and HCP perceptions of PERT products in the United States.</p><p><strong>Methods: </strong>An online survey was carried out with HCPs who had treated patients with EPI for ≥ 3 years and prescribed PERT products to ≥ 10 patients over a 12-month period. The survey collected de-identified data on HCP characteristics, prescribing patterns, and perceptions of PERT products across the domains of efficacy, convenience, and access. Descriptive statistics were calculated, and HCPs' perceptions were compared across PERT products.</p><p><strong>Results: </strong>A total of 250 HCPs were surveyed comprising 124 specialists, 95 generalists, and 31 advanced practice providers. HCPs managed a median of 30 patients with EPI on PERT in the 12 months preceding the survey. The most commonly prescribed PERT products were Creon (84.0%), Zenpep (60.4%), and Pancreaze (59.2%), with fewer HCPs prescribing Viokace (27.2%) and Pertzye (16.0%). Specific factors considered in prescribing decisions included improvement in abdominal and bowel symptoms (83.6%), affordability (72.4%), and formulary/insurance coverage (72.0%). A significantly higher proportion of HCPs reported favorable perceptions of Creon over other PERT products. Perceptions of formulary/insurance coverage across PERT products varied, with 8.0-56.0% of HCPs agreeing or strongly agreeing that a prescribed product had good coverage. These findings were generally consistent across different provider types.</p><p><strong>Conclusions: </strong>HCPs consider multiple factors when prescribing PERT for patients with EPI. HCP perceptions varied across PERT products, and Creon was favorably perceived more often compared to the other therapeutic options. Various factors may contribute to barriers to treatment and should be addressed to improve access.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Role of Income and Health Insurance on Migraine Care: Results of the OVERCOME (US) Study. 收入和健康保险在偏头痛治疗中的作用:美国研究的结果。
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-12 DOI: 10.1007/s12325-025-03428-9
Richard B Lipton, Betzaida Martinez, Dawn C Buse, Ali Sheikhi Mehrabadi, Anthony J Zagar, Fred Cohen, Robert E Shapiro, Margaret Hoyt, Sait Ashina, Robert A Nicholson, E Jolanda Muenzel

Introduction: Using data from the OVERCOME study, we examined the influence of household income on access to specialty care and use of recommended acute and preventive treatments for migraine in a large population-based study.

Methods: This analysis from the OVERCOME study, a multicohort, web-based survey (2018-2020) among adults with migraine in the US, examined the influence of annual household income on (1) care-seeking, (2) the highest level of care received (emergency department/urgent care, primary care, specialty care), and (3) use of acute or preventive treatments recommended by the American Headache Society. We used standardized mean differences and logistic regression (LR) models to estimate the magnitude of differences in health care behavior as a function of household income and insurance status.

Results: Among OVERCOME (US) respondents with migraine who provided demographic information (n = 56,667), a higher proportion of people in the lowest income group (< $25,000) received their highest level of migraine care in the emergency department/urgent care setting versus the proportion in the highest income group [≥ $100,000: 12.3% vs 6.5%, standardized mean difference (SMD) = 0.20], and a greater proportion in the highest income group received care in a specialty headache care setting (48.6% vs 36.6% in the lowest income group, SMD = 0.24). The highest income group was more likely to receive a recommended acute treatment [odds ratio (OR) = 1.3, 95% confidence interval (CI) = (1.2, 1.4)] and a recommended preventive treatment [OR = 1.3, 95% CI = (1.2, 1.4)]. Those with health insurance were more likely to receive specialized care [OR = 2.6, 95% CI = (2.4, 2.8)] and recommended acute [OR = 1.9, 95% CI = (1.8, 2.0)] and preventive treatment [OR = 2.1, 95% CI = (1.9, 2.3)]. The effect of insurance was greatest in low-income strata and was not significant in the highest household income group.

Conclusion: Disparities in annual household income may be a barrier to appropriate migraine care, but having health insurance mitigates the effect.

引言:利用来自OVERCOME研究的数据,我们在一项基于人群的大型研究中检查了家庭收入对获得专业护理和使用推荐的偏头痛急性和预防性治疗的影响。方法:该研究是一项基于网络的多队列调查(2018-2020),研究了家庭年收入对以下因素的影响:(1)求诊,(2)接受最高水平的护理(急诊科/紧急护理、初级保健、专科护理),以及(3)使用美国头痛协会推荐的急性或预防性治疗。我们使用标准化平均差异和逻辑回归(LR)模型来估计医疗保健行为差异的大小作为家庭收入和保险状况的函数。结果:在美国提供人口统计信息的偏头痛患者(n = 56,667)中,最低收入群体的比例较高(结论:家庭年收入的差异可能是适当偏头痛治疗的障碍,但拥有健康保险可以减轻这种影响。
{"title":"The Role of Income and Health Insurance on Migraine Care: Results of the OVERCOME (US) Study.","authors":"Richard B Lipton, Betzaida Martinez, Dawn C Buse, Ali Sheikhi Mehrabadi, Anthony J Zagar, Fred Cohen, Robert E Shapiro, Margaret Hoyt, Sait Ashina, Robert A Nicholson, E Jolanda Muenzel","doi":"10.1007/s12325-025-03428-9","DOIUrl":"https://doi.org/10.1007/s12325-025-03428-9","url":null,"abstract":"<p><strong>Introduction: </strong>Using data from the OVERCOME study, we examined the influence of household income on access to specialty care and use of recommended acute and preventive treatments for migraine in a large population-based study.</p><p><strong>Methods: </strong>This analysis from the OVERCOME study, a multicohort, web-based survey (2018-2020) among adults with migraine in the US, examined the influence of annual household income on (1) care-seeking, (2) the highest level of care received (emergency department/urgent care, primary care, specialty care), and (3) use of acute or preventive treatments recommended by the American Headache Society. We used standardized mean differences and logistic regression (LR) models to estimate the magnitude of differences in health care behavior as a function of household income and insurance status.</p><p><strong>Results: </strong>Among OVERCOME (US) respondents with migraine who provided demographic information (n = 56,667), a higher proportion of people in the lowest income group (< $25,000) received their highest level of migraine care in the emergency department/urgent care setting versus the proportion in the highest income group [≥ $100,000: 12.3% vs 6.5%, standardized mean difference (SMD) = 0.20], and a greater proportion in the highest income group received care in a specialty headache care setting (48.6% vs 36.6% in the lowest income group, SMD = 0.24). The highest income group was more likely to receive a recommended acute treatment [odds ratio (OR) = 1.3, 95% confidence interval (CI) = (1.2, 1.4)] and a recommended preventive treatment [OR = 1.3, 95% CI = (1.2, 1.4)]. Those with health insurance were more likely to receive specialized care [OR = 2.6, 95% CI = (2.4, 2.8)] and recommended acute [OR = 1.9, 95% CI = (1.8, 2.0)] and preventive treatment [OR = 2.1, 95% CI = (1.9, 2.3)]. The effect of insurance was greatest in low-income strata and was not significant in the highest household income group.</p><p><strong>Conclusion: </strong>Disparities in annual household income may be a barrier to appropriate migraine care, but having health insurance mitigates the effect.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Integrating IVF and Surgical Management in Endometriosis-Associated Infertility: A Review. 结合IVF和手术治疗子宫内膜异位症相关不孕症:综述。
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-12 DOI: 10.1007/s12325-025-03489-w
Giorgia Elisabeth Colombo, Noemi Salmeri, Mathew Leonardi

Endometriosis is a chronic, debilitating condition characterized by heterogenous clinical manifestations. It has a prevalence of 5-10% in women of reproductive age, and 30-50% of individuals with endometriosis are affected by infertility. There are multiple mechanisms through which endometriosis can lead to infertility: reduced ovarian reserve, distorted pelvic anatomy, chronic inflammation, altered immunity, dyspareunia, and/or altered hormonal and cell-mediated endometrial function. The revised American Society for Reproductive Medicine (rASRM) classification was one of the initial methods to stage disease severity. The Endometriosis Fertility Index (EFI) score, based upon the rASRM score and other factors, can help guide management. Medical treatment for endometriosis is predominantly contraceptive; therefore, surgery and medical reproduction techniques are the mainstay of management for endometriosis-related infertility. The evidence regarding the benefit of surgery for endometriosis-related infertility is conflicting; however, ablative techniques for endometriomas may enhance conception spontaneously and via assisted reproduction techniques (ART). Medically-assisted reproduction techniques include intra-uterine insemination and ovarian stimulation, as well as ART such as in vitro fertilization or intracytoplasmic sperm injection. ART has similar outcomes in individuals with rASRM stage I to II endometriosis as it does in individuals without endometriosis; however, live birth rate, mean number of oocytes retrieved, and clinical pregnancy rate are reduced in individuals with rASRM stages III-IV. Ultimately, endometriosis-related infertility treatment plans should be patient-centered, individualized, and holistic, considering alternative factors which may influence which treatment option can be offered.

子宫内膜异位症是一种慢性衰弱性疾病,其临床表现具有异质性。它在育龄妇女中的患病率为5-10%,30-50%的子宫内膜异位症患者患有不孕症。子宫内膜异位症可导致不孕症的机制有多种:卵巢储备减少、骨盆解剖扭曲、慢性炎症、免疫改变、性交困难和/或激素和细胞介导的子宫内膜功能改变。修订后的美国生殖医学学会(rASRM)分类是划分疾病严重程度的最初方法之一。基于rASRM评分和其他因素的子宫内膜异位症生育指数(EFI)评分可以帮助指导治疗。子宫内膜异位症的治疗主要是避孕;因此,手术和医学生殖技术是治疗子宫内膜异位症相关不孕症的主要方法。关于手术治疗子宫内膜异位症相关不孕症的益处的证据是相互矛盾的;然而,子宫内膜异位瘤的消融技术可以通过辅助生殖技术(ART)自然增强受孕。医学辅助生殖技术包括子宫内人工授精和卵巢刺激,以及诸如体外受精或胞浆内单精子注射等抗逆转录病毒技术。抗逆转录病毒疗法在rASRM I期至II期子宫内膜异位症患者中的疗效与非子宫内膜异位症患者相似;然而,在rASRM III-IV期个体中,活产率、平均卵母细胞数量和临床妊娠率降低。最终,子宫内膜异位症相关不孕症的治疗方案应以患者为中心,个体化和整体性,考虑可能影响治疗方案的其他因素。
{"title":"Integrating IVF and Surgical Management in Endometriosis-Associated Infertility: A Review.","authors":"Giorgia Elisabeth Colombo, Noemi Salmeri, Mathew Leonardi","doi":"10.1007/s12325-025-03489-w","DOIUrl":"https://doi.org/10.1007/s12325-025-03489-w","url":null,"abstract":"<p><p>Endometriosis is a chronic, debilitating condition characterized by heterogenous clinical manifestations. It has a prevalence of 5-10% in women of reproductive age, and 30-50% of individuals with endometriosis are affected by infertility. There are multiple mechanisms through which endometriosis can lead to infertility: reduced ovarian reserve, distorted pelvic anatomy, chronic inflammation, altered immunity, dyspareunia, and/or altered hormonal and cell-mediated endometrial function. The revised American Society for Reproductive Medicine (rASRM) classification was one of the initial methods to stage disease severity. The Endometriosis Fertility Index (EFI) score, based upon the rASRM score and other factors, can help guide management. Medical treatment for endometriosis is predominantly contraceptive; therefore, surgery and medical reproduction techniques are the mainstay of management for endometriosis-related infertility. The evidence regarding the benefit of surgery for endometriosis-related infertility is conflicting; however, ablative techniques for endometriomas may enhance conception spontaneously and via assisted reproduction techniques (ART). Medically-assisted reproduction techniques include intra-uterine insemination and ovarian stimulation, as well as ART such as in vitro fertilization or intracytoplasmic sperm injection. ART has similar outcomes in individuals with rASRM stage I to II endometriosis as it does in individuals without endometriosis; however, live birth rate, mean number of oocytes retrieved, and clinical pregnancy rate are reduced in individuals with rASRM stages III-IV. Ultimately, endometriosis-related infertility treatment plans should be patient-centered, individualized, and holistic, considering alternative factors which may influence which treatment option can be offered.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hepatic Response Dynamics in Newly Diagnosed Patients with Light-chain Amyloidosis: A Retrospective Cohort Study. 新诊断的轻链淀粉样变性患者的肝脏反应动力学:一项回顾性队列研究。
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-12 DOI: 10.1007/s12325-025-03474-3
Chengyang Xu, Ai Guan, Lu Zhang, Zhuang Tian, Daobin Zhou, Kai Sun, Kaini Shen, Jian Li

Introduction: Hematologic response is well established in systemic light chain (AL) amyloidosis treatment, but hepatic response patterns remain unclear. This study explored hepatic response dynamics in hepatic-involved patients with AL amyloidosis who achieved hematologic partial response within 24 months post-treatment.

Methods: Using two- and four-level hepatic response criteria (two-level: hepatic organ response [hepatic OR], hepatic no response [hepatic NR]; four-level: hepatic complete response [hepaCR], hepatic very good partial response [hepaVGPR], hepatic partial response [hepaPR], hepatic no response [hepaNR]), responses were assessed at 3, 6, 12, and 24 months.

Results: Among 137 patients (median follow-up: 55.0 months), hepatic OR and ≥ hepaPR plateaued at 24 months, with hepatic OR achieved in 75.6% (65/86), hepaCR in 10.5% (9/86), hepaVGPR in 16.3% (14/86), and hepaPR in 38.4% (33/86). The two-level hepatic response better predicted overall survival than the four-level criteria. Patients achieving hepatic OR within 24 months had significantly better prognosis than non-responders (log-rank p = 0.008; HR, 2.782; 95% CI, 1.260-6.141), with no impact from response speed. Hematologic complete response (CRH) at 3 months predicted higher likelihood of 24-month hepatic OR (OR 2.571, 95% CI, 1.387-4.767, p = 0.003).

Conclusion: The study highlights the importance of monitoring hepatic response dynamics, identifying 3-month CRH and 24-month hepatic OR as key treatment milestones. A graphical abstract is also available with this article.

在系统性轻链(AL)淀粉样变性治疗中,血液学反应已经建立,但肝脏反应模式尚不清楚。本研究探讨了肝受累的AL淀粉样变性患者在治疗后24个月内获得血液学部分缓解的肝脏反应动力学。方法:采用二级和四级肝脏反应标准(二级:肝器官反应[liver OR],肝脏无反应[liver NR];四级:肝脏完全反应[hepaCR],肝脏极好部分反应[hepaVGPR],肝脏部分反应[hepaPR],肝脏无反应[hepaNR]),在3、6、12和24个月时评估肝脏反应。结果:137例患者(中位随访时间为55.0个月)中,肝脏OR和≥hepaPR在24个月时达到稳定,其中肝脏OR达到75.6% (65/86),hepaCR达到10.5% (9/86),hepaVGPR达到16.3% (14/86),hepaPR达到38.4%(33/86)。二级肝脏反应比四级标准更能预测总生存期。24个月内实现肝OR的患者预后明显好于无应答者(log-rank p = 0.008; HR, 2.782; 95% CI, 1.260-6.141),且不受应答速度的影响。3个月的血液学完全缓解(CRH)预测24个月肝脏OR的可能性更高(OR 2.571, 95% CI, 1.387-4.767, p = 0.003)。结论:该研究强调了监测肝脏反应动态的重要性,确定3个月的CRH和24个月的肝脏OR是关键的治疗里程碑。本文还提供了图形摘要。
{"title":"Hepatic Response Dynamics in Newly Diagnosed Patients with Light-chain Amyloidosis: A Retrospective Cohort Study.","authors":"Chengyang Xu, Ai Guan, Lu Zhang, Zhuang Tian, Daobin Zhou, Kai Sun, Kaini Shen, Jian Li","doi":"10.1007/s12325-025-03474-3","DOIUrl":"https://doi.org/10.1007/s12325-025-03474-3","url":null,"abstract":"<p><strong>Introduction: </strong>Hematologic response is well established in systemic light chain (AL) amyloidosis treatment, but hepatic response patterns remain unclear. This study explored hepatic response dynamics in hepatic-involved patients with AL amyloidosis who achieved hematologic partial response within 24 months post-treatment.</p><p><strong>Methods: </strong>Using two- and four-level hepatic response criteria (two-level: hepatic organ response [hepatic OR], hepatic no response [hepatic NR]; four-level: hepatic complete response [hepaCR], hepatic very good partial response [hepaVGPR], hepatic partial response [hepaPR], hepatic no response [hepaNR]), responses were assessed at 3, 6, 12, and 24 months.</p><p><strong>Results: </strong>Among 137 patients (median follow-up: 55.0 months), hepatic OR and ≥ hepaPR plateaued at 24 months, with hepatic OR achieved in 75.6% (65/86), hepaCR in 10.5% (9/86), hepaVGPR in 16.3% (14/86), and hepaPR in 38.4% (33/86). The two-level hepatic response better predicted overall survival than the four-level criteria. Patients achieving hepatic OR within 24 months had significantly better prognosis than non-responders (log-rank p = 0.008; HR, 2.782; 95% CI, 1.260-6.141), with no impact from response speed. Hematologic complete response (CR<sub>H</sub>) at 3 months predicted higher likelihood of 24-month hepatic OR (OR 2.571, 95% CI, 1.387-4.767, p = 0.003).</p><p><strong>Conclusion: </strong>The study highlights the importance of monitoring hepatic response dynamics, identifying 3-month CR<sub>H</sub> and 24-month hepatic OR as key treatment milestones. A graphical abstract is also available with this article.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A REtrospective Study to Describe the Real-World Treatment Landscape in Patients with Metastatic Castration-Resistant PROstate Cancer: REMPRO. 一项描述转移性去势抵抗性前列腺癌患者真实世界治疗情况的回顾性研究:REMPRO。
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-12 DOI: 10.1007/s12325-025-03472-5
Ray Manneh, Tarek Hashem, Joung Jae Young, Amit Joshi, Sahin Bahadir, Ayman Omar, Salem Eid, Ayman Elsayes, Francisco Gonzalez, Mohamed Elsayed, Pushpalatha Kantharaju

Introduction: Metastatic castration-resistant prostate cancer (mCRPC) presents significant treatment challenges. Although androgen deprivation therapy (ADT) has been the standard treatment for metastatic prostate cancer for over 80 years, its efficacy is often limited to the initial treatment phase for most patients. Recent clinical trials have investigated various therapeutic options for mCRPC; however, real-world evidence is essential for a comprehensive understanding of the current treatment landscape and to identify unmet clinical needs.

Methods: A multi-country, retrospective, non-interventional study was conducted across 31 centres in Latin America, the Middle East and Asia. Adults diagnosed with mCRPC between January 2016 and December 2018 were enrolled as the study subjects. Treatment patterns were thoroughly analysed, including those used when patients were at the metastatic castration-sensitive prostate cancer (mCSPC) and non-metastatic castration-resistant prostate cancer (nmCRPC) settings.

Results: Among 795 enrolled patients with mCRPC (most aged ≥ 65 years), significant attrition was observed between treatment lines: approximately 50% of patients on first-line (1L) therapy advanced to second line (2L) but only 23.5% proceeded to third line (3L). New hormonal agent (NHA)-based therapies were the most prevalent choice for 1L and 2L, with post-chemotherapy NHA being the most common 1L-2L sequence. Disease progression, the primary reason for discontinuation across all regimens, occurred in > 60% of patients during mCRPC treatment. Generally, median real-world progression-free survival (rwPFS) decreased with each subsequent line of therapy. This study also highlights the inadequacy of prostate cancer screening in these regions.

Conclusion: This study offers valuable insights into the current treatment landscape of patients with mCRPC in non-US and non-European settings within a real-world context.

Clinicaltrials:

Gov id: NCT04801186.

转移性去势抵抗性前列腺癌(mCRPC)提出了重大的治疗挑战。尽管雄激素剥夺疗法(ADT)作为转移性前列腺癌的标准治疗已有80多年的历史,但对大多数患者而言,其疗效往往局限于初始治疗阶段。最近的临床试验研究了mCRPC的各种治疗方案;然而,真实世界的证据对于全面了解当前的治疗情况和确定未满足的临床需求至关重要。方法:在拉丁美洲、中东和亚洲的31个中心进行了一项多国、回顾性、非介入性研究。2016年1月至2018年12月期间诊断为mCRPC的成年人被招募为研究对象。研究人员对治疗模式进行了全面分析,包括转移性去势敏感前列腺癌(mCSPC)和非转移性去势抵抗前列腺癌(nmCRPC)患者的治疗模式。结果:在795名入组的mCRPC患者(大多数年龄≥65岁)中,在治疗线之间观察到显著的消耗:大约50%的一线(1L)治疗的患者进展到二线(2L),但只有23.5%的患者进展到三线(3L)。以新激素制剂(NHA)为基础的治疗是1L和2L最普遍的选择,化疗后NHA是最常见的1L-2L序列。在所有方案中,疾病进展是停药的主要原因,在mCRPC治疗期间,有60%的患者出现疾病进展。一般来说,真实世界无进展生存期(rwPFS)的中位数随着后续治疗线的增加而下降。这项研究也强调了这些地区前列腺癌筛查的不足。结论:本研究为非美国和非欧洲地区mCRPC患者的治疗现状提供了有价值的见解。临床试验:政府编号:NCT04801186。
{"title":"A REtrospective Study to Describe the Real-World Treatment Landscape in Patients with Metastatic Castration-Resistant PROstate Cancer: REMPRO.","authors":"Ray Manneh, Tarek Hashem, Joung Jae Young, Amit Joshi, Sahin Bahadir, Ayman Omar, Salem Eid, Ayman Elsayes, Francisco Gonzalez, Mohamed Elsayed, Pushpalatha Kantharaju","doi":"10.1007/s12325-025-03472-5","DOIUrl":"https://doi.org/10.1007/s12325-025-03472-5","url":null,"abstract":"<p><strong>Introduction: </strong>Metastatic castration-resistant prostate cancer (mCRPC) presents significant treatment challenges. Although androgen deprivation therapy (ADT) has been the standard treatment for metastatic prostate cancer for over 80 years, its efficacy is often limited to the initial treatment phase for most patients. Recent clinical trials have investigated various therapeutic options for mCRPC; however, real-world evidence is essential for a comprehensive understanding of the current treatment landscape and to identify unmet clinical needs.</p><p><strong>Methods: </strong>A multi-country, retrospective, non-interventional study was conducted across 31 centres in Latin America, the Middle East and Asia. Adults diagnosed with mCRPC between January 2016 and December 2018 were enrolled as the study subjects. Treatment patterns were thoroughly analysed, including those used when patients were at the metastatic castration-sensitive prostate cancer (mCSPC) and non-metastatic castration-resistant prostate cancer (nmCRPC) settings.</p><p><strong>Results: </strong>Among 795 enrolled patients with mCRPC (most aged ≥ 65 years), significant attrition was observed between treatment lines: approximately 50% of patients on first-line (1L) therapy advanced to second line (2L) but only 23.5% proceeded to third line (3L). New hormonal agent (NHA)-based therapies were the most prevalent choice for 1L and 2L, with post-chemotherapy NHA being the most common 1L-2L sequence. Disease progression, the primary reason for discontinuation across all regimens, occurred in > 60% of patients during mCRPC treatment. Generally, median real-world progression-free survival (rwPFS) decreased with each subsequent line of therapy. This study also highlights the inadequacy of prostate cancer screening in these regions.</p><p><strong>Conclusion: </strong>This study offers valuable insights into the current treatment landscape of patients with mCRPC in non-US and non-European settings within a real-world context.</p><p><strong>Clinicaltrials: </strong></p><p><strong>Gov id: </strong>NCT04801186.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Virtualizing Alcohol Use Disorder Therapy: A Systematic Scoping Review. 虚拟化酒精使用障碍治疗:一项系统范围综述。
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-07 DOI: 10.1007/s12325-025-03449-4
Alexander Bazhanov, Gerrit Meixner

Background: Virtual reality (VR) technology has become more mature and accessible in recent years. In the context of alcohol use disorder (AUD), it can be used for various therapeutic contexts, such as exposure therapy, diagnostics, and improved interactivity. Although promising, the data regarding its effectiveness vary; therefore, caution is warranted when it is introduced. This review aims to illustrate the current state of research on virtual reality in alcohol use disorder therapy.

Methods: In accordance with the PRISMA and Cochrane guidelines, publications focusing on implementing virtual reality to treat alcohol use disorder, published since 2015, were investigated. These included trials, prototype presentations, and expert interviews.

Results: Thirty-two publications were identified, 19 of which were trials, with 653 participants. The results indicate that VR has been researched in various therapeutic contexts. In virtual cue-exposure therapy (CET), trials suggest that virtual reality can effectively increase craving and anxiety after one-time use and reduce craving after multiple uses. In diagnostics, trials demonstrate that it is possible to distinguish between heavy and light consumers based on the choices made in virtual reality, leading to a more standardized approach. In virtual approach-avoidance therapy (AAT), trials indicate increased effectiveness in the use of VR compared to the usual two-dimensional approach regarding craving. Non-trial publications focus on the inclusion of specific technologies, such as biofeedback, design choices, and ethical considerations.

Conclusions: Despite promising results, current research is limited. From a therapeutic perspective, the limitations are the variety of approaches to development and use, the heterogeneous designs, inconsistent trial results, and the lack of long-term data on abstinence, effectiveness, and potential risks for patients. Technologically, the adaptation of virtual environments and the inclusion of biofeedback devices require more research. Methodically, the interdependence of scientific disciplines increases the complexity. Since virtual reality has been used in other types of therapy with success (e.g., phobia and anxiety treatment) and a growing body of literature presents promising findings, there is a strong incentive to continue research on using virtual reality in treating alcohol use disorder.

背景:近年来,虚拟现实(VR)技术变得越来越成熟和普及。在酒精使用障碍(AUD)的情况下,它可以用于各种治疗环境,如暴露治疗、诊断和改善互动性。虽然很有希望,但关于其有效性的数据各不相同;因此,在引入时要谨慎。本文综述了虚拟现实技术在酒精使用障碍治疗中的研究现状。方法:根据PRISMA和Cochrane指南,对2015年以来发表的关于实施虚拟现实治疗酒精使用障碍的出版物进行调查。其中包括试验、原型演示和专家访谈。结果:确定了32篇出版物,其中19篇是试验,有653名参与者。结果表明,VR已经在各种治疗背景下进行了研究。在虚拟提示暴露疗法(CET)中,试验表明虚拟现实可以有效地增加一次性使用后的渴望和焦虑,减少多次使用后的渴望。在诊断方面,试验表明,根据虚拟现实做出的选择,可以区分重度和轻度消费者,从而形成一种更加标准化的方法。在虚拟逃避疗法(AAT)中,试验表明,与通常的二维方法相比,使用VR治疗渴望的效果更高。非试验出版物侧重于特定技术的纳入,如生物反馈、设计选择和伦理考虑。结论:尽管有很好的结果,目前的研究是有限的。从治疗的角度来看,局限性在于开发和使用方法的多样性、异质设计、不一致的试验结果,以及缺乏关于患者戒断、有效性和潜在风险的长期数据。在技术上,虚拟环境的适应和生物反馈装置的包含需要更多的研究。有条不紊地,科学学科之间的相互依赖增加了复杂性。由于虚拟现实已成功地用于其他类型的治疗(例如,恐惧症和焦虑症的治疗),并且越来越多的文献提出了有希望的发现,因此有强烈的动机继续研究使用虚拟现实治疗酒精使用障碍。
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引用次数: 0
Community-Based Models for Type 2 Diabetes Care: A Review of Effectiveness, Implementation, and Health System Integration. 基于社区的2型糖尿病护理模式:有效性、实施和卫生系统整合的综述。
IF 4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-01-07 DOI: 10.1007/s12325-025-03462-7
Vandana Esht, Madhur Verma, Shazia Malik, Marim Ali M Slimani, Gunjeet Kaur, Jaya Prasad Tripathy, Gursimer Jeet, Sanjay Kalra

Introduction: Type 2 diabetes mellitus (T2DM) presents a major challenge in low- and middle-income countries (LMICs) due to workforce shortages, limited primary-care capacity, and fragmented chronic-care delivery. Community-based diabetes care models have emerged as scalable approaches to strengthen self-management and extend service reach. With this background, we aimed to synthesize global evidence on community-based diabetes care models, classify major intervention typologies, examine their alignment with the diabetes care continuum, and assess their effectiveness and implementation characteristics.

Methods: A narrative review was conducted using a structured search of PubMed, Scopus, Web of Science, and Embase for studies published between January 2010 and March 2025. Eligible studies focused on community-based T2DM interventions delivered by community health workers (CHWs), peer educators, or digital-community hybrids. Interventions were categorized and mapped across the diabetes care continuum, and evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as complementary integration models.

Results: Eleven studies were included, in which peer-led models were common in high-income countries, while CHW-led and hybrid models were predominant in LMICs. Interventions demonstrated clinically significant improvements in glycated hemoglobin (HbA1c), BMI, and self-efficacy. Successful models embedded within existing public health systems or culturally rooted community platforms showed higher adoption and long-term maintenance. Digital interventions enhanced reach, but faced challenges with sustained engagement and infrastructure support. The RE-AIM analysis revealed strong effectiveness and reach; however, long-term maintenance and adoption varied based on the level of contextual integration and supervision structures.

Conclusion: Community-based T2DM care models offer scalable, sustainable strategies to improve disease control. Integration into national health platforms, supportive supervision, and digital augmentation enhance implementation success. Challenges persist in follow-up, cost-effectiveness, and equity design; scale-up should prioritize integration, financing, and CHW capacity.

2型糖尿病(T2DM)是低收入和中等收入国家(LMICs)面临的一个主要挑战,原因是劳动力短缺、初级保健能力有限以及慢性保健服务不完整。以社区为基础的糖尿病护理模式已成为加强自我管理和扩大服务范围的可扩展方法。在此背景下,我们旨在综合基于社区的糖尿病护理模式的全球证据,对主要干预类型进行分类,检查其与糖尿病护理连续体的一致性,并评估其有效性和实施特征。方法:使用PubMed、Scopus、Web of Science和Embase对2010年1月至2025年3月间发表的研究进行结构化搜索,进行叙述性综述。符合条件的研究侧重于社区卫生工作者(chw)、同伴教育者或数字社区混合体提供的基于社区的2型糖尿病干预措施。对糖尿病护理连续体的干预措施进行分类和映射,并使用RE-AIM(覆盖范围、有效性、采用、实施和维护)框架以及互补整合模型进行评估。结果:纳入了11项研究,其中同伴主导模式在高收入国家很常见,而chw主导和混合模式在中低收入国家占主导地位。干预显示糖化血红蛋白(HbA1c)、BMI和自我效能有临床意义的改善。嵌入现有公共卫生系统或根植于文化的社区平台的成功模式显示出更高的采用率和长期维护。数字干预措施扩大了覆盖范围,但在持续参与和基础设施支持方面面临挑战。RE-AIM分析显示了较强的有效性和可及性;然而,长期的维护和采用根据上下文整合和监督结构的水平而变化。结论:以社区为基础的2型糖尿病护理模式为改善疾病控制提供了可扩展的、可持续的策略。与国家卫生平台的整合、支持性监督和数字化增强促进了实施的成功。在后续、成本效益和公平性设计方面仍然存在挑战;扩大规模应优先考虑整合、融资和CHW能力。
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引用次数: 0
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