Pub Date : 2024-09-06DOI: 10.1007/s12325-024-02947-1
Uma Borate, Karen Seiter, Ravi Potluri, Debasish Mazumder, Manoj Chevli, Thomas Prebet, Lona Gaugler, Maria Strocchia, Alberto Vasconcelos, Jan Sieluk
Introduction
The substantial economic burden of acute myeloid leukemia (AML) could be reduced with post-remission maintenance therapies that delay relapse. Real-world healthcare resource utilization (HCRU) data and costs among patients with AML receiving oral azacitidine (Oral-AZA) maintenance therapy or no maintenance are not well understood. We characterize HCRU and costs among these patients in clinical practice in the USA.
Methods
Data from IQVIA PharMetrics® Plus (January 1, 2016–June 30, 2022) were used. Patients ≥ 18 years who were newly diagnosed with AML, received first-line systemic induction therapy, and attained disease remission were eligible. Patients receiving Oral-AZA maintenance and those receiving no maintenance (“watch and wait” [W&W]) were matched 1:3 on baseline characteristics using propensity score matching (PSM) and followed until hematopoietic stem cell transplantation or end of continuous insurance enrollment, whichever occurred first. Outcomes included treatment patterns, inpatient and outpatient visits, and costs.
Results
After PSM, the Oral-AZA cohort included 43 patients and the W&W cohort 129. Of the 43 patients receiving Oral-AZA, 88.4% started at the recommended dose of 300 mg and 11.6% at 200 mg. The Oral-AZA cohort had significantly (p = 0.0025) longer median (95% CI) time to relapse from the index maintenance date (median not reached [NR; 9.0 months–NR] vs 3.3 months [0.8 months–NR]), and fewer per person per month (PPPM) hospitalizations (0.23 vs 0.61; p = 0.0005) and overall outpatient visits (5.77 vs 7.58; p = 0.0391) than the W&W cohort. Despite higher AML drug costs PPPM in the Oral-AZA cohort ($16,401 vs $10,651 for W&W), total healthcare costs PPPM were lower ($25,786 vs $38,530 for W&W; p < 0.0001).
Conclusions
Patients with newly diagnosed AML treated with Oral-AZA maintenance in clinical practice had prolonged remission and lower HCRU and costs than patients receiving no maintenance therapy. These findings underscore the clinical and economic value of Oral-AZA in clinical practice.
{"title":"Healthcare Utilization and Costs Among Patients with Acute Myeloid Leukemia Receiving Oral Azacitidine Maintenance Therapy Versus No Maintenance: A US Claims Database Study","authors":"Uma Borate, Karen Seiter, Ravi Potluri, Debasish Mazumder, Manoj Chevli, Thomas Prebet, Lona Gaugler, Maria Strocchia, Alberto Vasconcelos, Jan Sieluk","doi":"10.1007/s12325-024-02947-1","DOIUrl":"10.1007/s12325-024-02947-1","url":null,"abstract":"<div><h3>Introduction</h3><p>The substantial economic burden of acute myeloid leukemia (AML) could be reduced with post-remission maintenance therapies that delay relapse. Real-world healthcare resource utilization (HCRU) data and costs among patients with AML receiving oral azacitidine (Oral-AZA) maintenance therapy or no maintenance are not well understood. We characterize HCRU and costs among these patients in clinical practice in the USA.</p><h3>Methods</h3><p>Data from IQVIA PharMetrics® Plus (January 1, 2016–June 30, 2022) were used. Patients ≥ 18 years who were newly diagnosed with AML, received first-line systemic induction therapy, and attained disease remission were eligible. Patients receiving Oral-AZA maintenance and those receiving no maintenance (“watch and wait” [W&W]) were matched 1:3 on baseline characteristics using propensity score matching (PSM) and followed until hematopoietic stem cell transplantation or end of continuous insurance enrollment, whichever occurred first. Outcomes included treatment patterns, inpatient and outpatient visits, and costs.</p><h3>Results</h3><p>After PSM, the Oral-AZA cohort included 43 patients and the W&W cohort 129. Of the 43 patients receiving Oral-AZA, 88.4% started at the recommended dose of 300 mg and 11.6% at 200 mg. The Oral-AZA cohort had significantly (<i>p</i> = 0.0025) longer median (95% CI) time to relapse from the index maintenance date (median not reached [NR; 9.0 months–NR] vs 3.3 months [0.8 months–NR]), and fewer per person per month (PPPM) hospitalizations (0.23 vs 0.61; <i>p</i> = 0.0005) and overall outpatient visits (5.77 vs 7.58; <i>p</i> = 0.0391) than the W&W cohort. Despite higher AML drug costs PPPM in the Oral-AZA cohort ($16,401 vs $10,651 for W&W), total healthcare costs PPPM were lower ($25,786 vs $38,530 for W&W; <i>p</i> < 0.0001).</p><h3>Conclusions</h3><p>Patients with newly diagnosed AML treated with Oral-AZA maintenance in clinical practice had prolonged remission and lower HCRU and costs than patients receiving no maintenance therapy. These findings underscore the clinical and economic value of Oral-AZA in clinical practice.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12325-024-02947-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1007/s12325-024-02965-z
Ying Cheng, Zhanyu Pan, Lin Wu, Bo Zhu, Yan Yu, Kai Zang, Wu Zhuang, Lianke Liu, Kangsheng Gu, Juanwen Lian, Rixin Chen, Tao Bian, Dang Lin, Shenghua Sun, Wei Li, Xiaosheng Hang, Ou Jiang, Fukuan Zhong, Rui Wang, Hui Luo, Huaqiu Shi, Zonghui Wei, Li Zhao, Shaoshui Chen, Hongmei Sun, Xingya Li, Debin Sun, Tiejun Ren, Kaijian Lei, Miao He, Gaofeng Li, Hailong Liu, Runpu Li, Chunhong Hu, Li Kong, Meili Sun, Liangzhi Xie, Wenlin Gai, Weiqiu Chen, Zhe Huang, Wenwen Ren, Huo Su
Introduction
SCT510 is a biosimilar to bevacizumab (Avastin) reference product (RP) that is approved for various metastatic cancers. In this study, we aimed to demonstrate the equivalence of SCT510 and bevacizumab in terms of efficacy, safety, immunogenicity and pharmacokinetics (PK) in patients with advanced non-squamous non-small cell lung cancer (NSCLC).
Methods
Patients with non-squamous NSCLC were randomized equally to the SCT510 group (comprising SCT510, paclitaxel, and carboplatin) and the bevacizumab group (comprising bevacizumab, paclitaxel, and carboplatin) for 4–6 cycles, followed by maintenance monotherapy with SCT510. The primary endpoint was the objective response rate (ORR) at week 12. Secondary endpoints included 18-week ORR, disease control rate (DCR), duration of response (DoR), progression-free survival (PFS), overall survival (OS), and 1-year survival rate, as well as assessments of safety, immunogenicity, and multi-dose PK analysis.
Results
Between March 29, 2019, and April 27, 2021, 989 patients were screened and 567 eligible patients were randomly assigned to the SCT510 group (285 patients) and the bevacizumab group (282 patients). The ORR at week 12 was 52.6% [95% confidence interval (CI) 46.66–58.55%] in the SCT510 group and 52.5% (95% CI 46.47–58.47%) in the bevacizumab group. The ORR at week 18 was 55.4% (95% CI 49.46–61.30%) for SCT510 and 55.7% (95% CI 49.68–61.62%) for bevacizumab. The ORR risk ratio (RR) at weeks 12 and 18 was 0.99 (90% CI 0.873–1.133) and 0.99 (90% CI 0.872–1.114), respectively, both within the pre-specified equivalence margin of 0.75–1.33. There were no differences between the two groups in relation to other secondary endpoints, specifically DCR, DOR, PFS, OS, and 1-year survival rate. The overall safety findings were similar between the two treatment groups, and both SCT510 and bevacizumab RP exhibited low immunogenicity.
Conclusions
SCT510 is similar to bevacizumab in clinical efficacy, safety, immunogenicity, and PK in patients with advanced non-squamous NSCLC. The totality of the evidence supports the clinical equivalence of SCT510 and bevacizumab.
Trial Registration
NCT03792074.
简介SCT510 是贝伐珠单抗(安维汀)的生物类似药,已被批准用于多种转移性癌症。在这项研究中,我们旨在证明 SCT510 和贝伐珠单抗在晚期非鳞状非小细胞肺癌(NSCLC)患者中的疗效、安全性、免疫原性和药代动力学(PK)方面的等效性:将非鳞状NSCLC患者随机平均分为SCT510组(包括SCT510、紫杉醇和卡铂)和贝伐珠单抗组(包括贝伐珠单抗、紫杉醇和卡铂),各治疗4-6个周期,然后用SCT510维持单药治疗。主要终点是第12周的客观反应率(ORR)。次要终点包括18周ORR、疾病控制率(DCR)、反应持续时间(DoR)、无进展生存期(PFS)、总生存期(OS)和1年生存率,以及安全性、免疫原性和多剂量PK分析评估:2019年3月29日至2021年4月27日期间,共筛选出989名患者,567名符合条件的患者被随机分配到SCT510组(285名患者)和贝伐珠单抗组(282名患者)。第12周时,SCT510组的ORR为52.6%[95%置信区间(CI)46.66-58.55%],贝伐单抗组为52.5%(95% CI 46.47-58.47%)。第18周时,SCT510的ORR为55.4%(95% CI 49.46-61.30%),贝伐珠单抗为55.7%(95% CI 49.68-61.62%)。第12周和第18周的ORR风险比(RR)分别为0.99(90% CI 0.873-1.133)和0.99(90% CI 0.872-1.114),均在预先指定的0.75-1.33等效范围内。两组在其他次要终点,特别是DCR、DOR、PFS、OS和1年生存率方面没有差异。两组治疗的总体安全性结果相似,SCT510和贝伐珠单抗RP都表现出较低的免疫原性:结论:在晚期非鳞癌NSCLC患者中,SCT510与贝伐珠单抗在临床疗效、安全性、免疫原性和PK方面相似。所有证据都支持SCT510与贝伐珠单抗具有临床等效性:试验注册:NCT03792074。
{"title":"Efficacy and Safety of Biosimilar SCT510 Compared with Bevacizumab for the First-Line Treatment of Advanced Non-Squamous Non-Small Cell Lung Cancer: A Randomized, Double-Blind, Phase III Study","authors":"Ying Cheng, Zhanyu Pan, Lin Wu, Bo Zhu, Yan Yu, Kai Zang, Wu Zhuang, Lianke Liu, Kangsheng Gu, Juanwen Lian, Rixin Chen, Tao Bian, Dang Lin, Shenghua Sun, Wei Li, Xiaosheng Hang, Ou Jiang, Fukuan Zhong, Rui Wang, Hui Luo, Huaqiu Shi, Zonghui Wei, Li Zhao, Shaoshui Chen, Hongmei Sun, Xingya Li, Debin Sun, Tiejun Ren, Kaijian Lei, Miao He, Gaofeng Li, Hailong Liu, Runpu Li, Chunhong Hu, Li Kong, Meili Sun, Liangzhi Xie, Wenlin Gai, Weiqiu Chen, Zhe Huang, Wenwen Ren, Huo Su","doi":"10.1007/s12325-024-02965-z","DOIUrl":"10.1007/s12325-024-02965-z","url":null,"abstract":"<div><h3>Introduction</h3><p>SCT510 is a biosimilar to bevacizumab (Avastin) reference product (RP) that is approved for various metastatic cancers. In this study, we aimed to demonstrate the equivalence of SCT510 and bevacizumab in terms of efficacy, safety, immunogenicity and pharmacokinetics (PK) in patients with advanced non-squamous non-small cell lung cancer (NSCLC).</p><h3>Methods</h3><p>Patients with non-squamous NSCLC were randomized equally to the SCT510 group (comprising SCT510, paclitaxel, and carboplatin) and the bevacizumab group (comprising bevacizumab, paclitaxel, and carboplatin) for 4–6 cycles, followed by maintenance monotherapy with SCT510. The primary endpoint was the objective response rate (ORR) at week 12. Secondary endpoints included 18-week ORR, disease control rate (DCR), duration of response (DoR), progression-free survival (PFS), overall survival (OS), and 1-year survival rate, as well as assessments of safety, immunogenicity, and multi-dose PK analysis.</p><h3>Results</h3><p>Between March 29, 2019, and April 27, 2021, 989 patients were screened and 567 eligible patients were randomly assigned to the SCT510 group (285 patients) and the bevacizumab group (282 patients). The ORR at week 12 was 52.6% [95% confidence interval (CI) 46.66–58.55%] in the SCT510 group and 52.5% (95% CI 46.47–58.47%) in the bevacizumab group. The ORR at week 18 was 55.4% (95% CI 49.46–61.30%) for SCT510 and 55.7% (95% CI 49.68–61.62%) for bevacizumab. The ORR risk ratio (RR) at weeks 12 and 18 was 0.99 (90% CI 0.873–1.133) and 0.99 (90% CI 0.872–1.114), respectively, both within the pre-specified equivalence margin of 0.75–1.33. There were no differences between the two groups in relation to other secondary endpoints, specifically DCR, DOR, PFS, OS, and 1-year survival rate. The overall safety findings were similar between the two treatment groups, and both SCT510 and bevacizumab RP exhibited low immunogenicity.</p><h3>Conclusions</h3><p>SCT510 is similar to bevacizumab in clinical efficacy, safety, immunogenicity, and PK in patients with advanced non-squamous NSCLC. The totality of the evidence supports the clinical equivalence of SCT510 and bevacizumab.</p><h3>Trial Registration</h3><p>NCT03792074.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124540","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}
Pub Date : 2024-08-31DOI: 10.1007/s12325-024-02967-x
Riyad Omar Al-Lehebi, Mona Al Ahmad, Venkata Nagarjuna Maturu, Alejandra Galeano Mesa, Bassam Mahboub, Elizabeth Garcia, Patricia Fernandez, Claudia Soares, Gabriela Abreu, Debora dos Santos, Juliana Queiroz, Alejandro Raimondi, Maria Laucho-Contreras, Saeed Noibi, Gur Levy, Sevim Bavbek
Introduction
The Nucala Effectiveness Study (NEST) assessed the effectiveness of mepolizumab in patients with severe asthma (SA) in countries previously underrepresented in real-world studies.
Methods
A multi-country, bi-directional, self-controlled, observational cohort study conducted in Colombia, Chile, India, Türkiye, Saudi Arabia, United Arab Emirates, Kuwait, Oman, and Qatar. Historical and/or prospective data from patients with SA were assessed 12 months pre- and post-mepolizumab initiation. Primary endpoint: incident rate ratio (IRR) of clinically significant exacerbations (CSEs). Key secondary endpoints: healthcare resource utilisation (HCRU), oral corticosteroid (OCS) use, lung function and symptom control (Asthma Control Test [ACT] scores).
Results
Overall, 525 patients with SA burden pre-initiation (geometric mean blood eosinophil count [BEC] 490.7 cells/µl; 31.4% prior biologic use; 37.3% obese) received at least one dose of mepolizumab 100 mg subcutaneously. Post-initiation, a significant reduction in CSEs was observed (76% [p < 0.001]; IRR [95% confidence interval] 0.24 [0.19–0.30]); 72.0% of patients had no CSEs. Mepolizumab treatment led to a reduction in OCS use (52.8% pre-initiation vs. 16.6% post-initiation) and a mean (standard deviation [SD]) change in OCS dose of − 18.1 (20.7) mg post-initiation; 36.1% of patients became OCS-free. Fewer patients were hospitalised post-initiation (22.5% pre-initiation vs. 6.9% post-initiation). Improvements in mean (SD) forced expiratory volume in 1 s (62.8 [20.2]% pre-initiation vs. 73.0 [22.7]% post-initiation) and ACT scores (15.0% pre-initiation vs. 64.5% of patients post-initiation with well-controlled asthma) were observed. Proportion of patients with BEC ≥ 500 cells/µl decreased from 84.4% pre-initiation to 18.1% post-initiation.
Conclusion
Mepolizumab was effective in reducing the burden of SA by significantly reducing CSEs, reducing OCS use and HCRU, and improving lung function and asthma control, which could translate to improvements in health-related quality of life in patients with SA and high OCS dependency in the countries studied. A graphical abstract is available with this article.
简介:纽卡拉疗效研究(NEST)评估了甲泼尼珠单抗对重症哮喘患者的疗效:Nucala 有效性研究(NEST)评估了美泊利珠单抗对严重哮喘(SA)患者的疗效:在哥伦比亚、智利、印度、土耳其、沙特阿拉伯、阿拉伯联合酋长国、科威特、阿曼和卡塔尔开展了一项多国、双向、自控、观察性队列研究。主要终点:临床症状明显加重(CSE)的发生率(IRR)。主要次要终点:医疗资源利用率(HCRU)、口服皮质类固醇(OCS)使用率、肺功能和症状控制率(哮喘控制测试 [ACT] 评分):总体而言,525 名启动前有 SA 负担的患者(几何平均血液嗜酸性粒细胞计数 [BEC] 490.7 cells/µl;31.4% 曾使用过生物制剂;37.3% 肥胖)接受了至少一剂 100 毫克的 mepolizumab 皮下注射。开始治疗后,观察到 CSE 明显减少(76% [p 结论:"CSE 明显减少"):在所研究的国家中,通过显著减少 CSE、减少 OCS 使用和 HCRU、改善肺功能和哮喘控制,麦泊珠单抗可有效减轻 SA 的负担,从而改善 SA 患者与健康相关的生活质量。本文附有图表摘要。
{"title":"Real-World Effectiveness of Mepolizumab in Severe Asthma: Results from the Multi-country, Self-controlled Nucala Effectiveness Study (NEST)","authors":"Riyad Omar Al-Lehebi, Mona Al Ahmad, Venkata Nagarjuna Maturu, Alejandra Galeano Mesa, Bassam Mahboub, Elizabeth Garcia, Patricia Fernandez, Claudia Soares, Gabriela Abreu, Debora dos Santos, Juliana Queiroz, Alejandro Raimondi, Maria Laucho-Contreras, Saeed Noibi, Gur Levy, Sevim Bavbek","doi":"10.1007/s12325-024-02967-x","DOIUrl":"10.1007/s12325-024-02967-x","url":null,"abstract":"<div><h3>Introduction</h3><p>The Nucala Effectiveness Study (NEST) assessed the effectiveness of mepolizumab in patients with severe asthma (SA) in countries previously underrepresented in real-world studies.</p><h3>Methods</h3><p>A multi-country, bi-directional, self-controlled, observational cohort study conducted in Colombia, Chile, India, Türkiye, Saudi Arabia, United Arab Emirates, Kuwait, Oman, and Qatar. Historical and/or prospective data from patients with SA were assessed 12 months pre- and post-mepolizumab initiation. Primary endpoint: incident rate ratio (IRR) of clinically significant exacerbations (CSEs). Key secondary endpoints: healthcare resource utilisation (HCRU), oral corticosteroid (OCS) use, lung function and symptom control (Asthma Control Test [ACT] scores).</p><h3>Results</h3><p>Overall, 525 patients with SA burden pre-initiation (geometric mean blood eosinophil count [BEC] 490.7 cells/µl; 31.4% prior biologic use; 37.3% obese) received at least one dose of mepolizumab 100 mg subcutaneously. Post-initiation, a significant reduction in CSEs was observed (76% [<i>p</i> < 0.001]; IRR [95% confidence interval] 0.24 [0.19–0.30]); 72.0% of patients had no CSEs. Mepolizumab treatment led to a reduction in OCS use (52.8% pre-initiation vs. 16.6% post-initiation) and a mean (standard deviation [SD]) change in OCS dose of − 18.1 (20.7) mg post-initiation; 36.1% of patients became OCS-free. Fewer patients were hospitalised post-initiation (22.5% pre-initiation vs. 6.9% post-initiation). Improvements in mean (SD) forced expiratory volume in 1 s (62.8 [20.2]% pre-initiation vs. 73.0 [22.7]% post-initiation) and ACT scores (15.0% pre-initiation vs. 64.5% of patients post-initiation with well-controlled asthma) were observed. Proportion of patients with BEC ≥ 500 cells/µl decreased from 84.4% pre-initiation to 18.1% post-initiation.</p><h3>Conclusion</h3><p>Mepolizumab was effective in reducing the burden of SA by significantly reducing CSEs, reducing OCS use and HCRU, and improving lung function and asthma control, which could translate to improvements in health-related quality of life in patients with SA and high OCS dependency in the countries studied. A graphical abstract is available with this article.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12325-024-02967-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.1007/s12325-024-02949-z
Di Zhang, Zihao Dai, Yong Sun, Guoyao Sun, Haifeng Luo, Xiaoyi Guo, Jiangning Gu, Zhuo Yang
Introduction
Concomitant gallbladder and common bile duct (CBD) stones, known as cholecystocholedocholithiasis, are clinically prevalent. There is currently no consensus on sequential versus simultaneous management approaches, and, if simultaneous, which approach to adopt. This meta-analysis evaluates the safety and efficacy of one-stage laparoscopic cholecystectomy (LC) with intraoperative endoscopic retrograde cholangiopancreatography (ERCP) versus two-stage ERCP followed by LC for treating concomitant gallbladder and CBD stones.
Methods
A comprehensive literature search was conducted in five databases, PubMed, Embase, Web of Science, VIP, and Wanfang, for all randomized controlled trials (RCTs), cohort and retrospective studies published up to February 2024. Data extraction was performed independently by two reviewers. The primary outcomes were CBD stone clearance rate and postoperative complications morbidity. Secondary outcomes included conversion to other procedures and length of hospital stay. Statistical analyses were performed using R (v.4.3.2) with weighted mean differences and odds ratios (ORs) calculated for continuous and dichotomous variables, respectively, with 95% confidence intervals (CIs).
Results
A total of 17 studies involving 2120 patients have been included, with 898 patients receiving single-stage and 1222 patients undergoing two-stage treatment. Of these studies, 9 were RCTs and 8 were retrospective cohort study. The one-stage group demonstrated superior outcomes in terms of CBD stone clearance (OR = 2.07, p = 0.0004), overall morbidity (OR = 0.35, p < 0.0001), post-operative pancreatitis (OR = 0.49, p = 0.006), conversion to other procedures (OR = 0.38, p = 0.0006), and length of hospital stay (MD = – 2.6456, 95% CI – 3.5776; – 1.7136, p < 0.0001). No significant differences were observed in post-operative cholangitis (OR = 0.44, p = 0.12), post-operative bleeding (OR = 0.76, p = 0.47), or bile leakage (OR = 1.28, p = 0.54).
Conclusion
For patients with concomitant gallbladder and CBD stones, the one-stage approach combining ERCP and LC appears safer and more effective, with advantages including higher stone clearance rates, reduced postoperative complications (particularly pancreatitis), shorter hospital stays, fewer residual stones, and decreased need for additional procedures. However, additional high-quality clinical trials are needed to establish the optimal treatment approach for various patient scenarios.
{"title":"One-Stage Intraoperative ERCP combined with Laparoscopic Cholecystectomy Versus Two-Stage Preoperative ERCP Followed by Laparoscopic Cholecystectomy in the Management of Gallbladder with Common Bile Duct Stones: A Meta-analysis","authors":"Di Zhang, Zihao Dai, Yong Sun, Guoyao Sun, Haifeng Luo, Xiaoyi Guo, Jiangning Gu, Zhuo Yang","doi":"10.1007/s12325-024-02949-z","DOIUrl":"10.1007/s12325-024-02949-z","url":null,"abstract":"<div><h3>Introduction</h3><p>Concomitant gallbladder and common bile duct (CBD) stones, known as cholecystocholedocholithiasis, are clinically prevalent. There is currently no consensus on sequential versus simultaneous management approaches, and, if simultaneous, which approach to adopt. This meta-analysis evaluates the safety and efficacy of one-stage laparoscopic cholecystectomy (LC) with intraoperative endoscopic retrograde cholangiopancreatography (ERCP) versus two-stage ERCP followed by LC for treating concomitant gallbladder and CBD stones.</p><h3>Methods</h3><p>A comprehensive literature search was conducted in five databases, PubMed, Embase, Web of Science, VIP, and Wanfang, for all randomized controlled trials (RCTs), cohort and retrospective studies published up to February 2024. Data extraction was performed independently by two reviewers. The primary outcomes were CBD stone clearance rate and postoperative complications morbidity. Secondary outcomes included conversion to other procedures and length of hospital stay. Statistical analyses were performed using R (v.4.3.2) with weighted mean differences and odds ratios (ORs) calculated for continuous and dichotomous variables, respectively, with 95% confidence intervals (CIs).</p><h3>Results</h3><p>A total of 17 studies involving 2120 patients have been included, with 898 patients receiving single-stage and 1222 patients undergoing two-stage treatment. Of these studies, 9 were RCTs and 8 were retrospective cohort study. The one-stage group demonstrated superior outcomes in terms of CBD stone clearance (OR = 2.07, <i>p</i> = 0.0004), overall morbidity (OR = 0.35, <i>p</i> < 0.0001), post-operative pancreatitis (OR = 0.49, <i>p</i> = 0.006), conversion to other procedures (OR = 0.38, <i>p</i> = 0.0006), and length of hospital stay (MD = – 2.6456, 95% CI – 3.5776; – 1.7136, <i>p</i> < 0.0001). No significant differences were observed in post-operative cholangitis (OR = 0.44, <i>p</i> = 0.12), post-operative bleeding (OR = 0.76, <i>p</i> = 0.47), or bile leakage (OR = 1.28, <i>p</i> = 0.54).</p><h3>Conclusion</h3><p>For patients with concomitant gallbladder and CBD stones, the one-stage approach combining ERCP and LC appears safer and more effective, with advantages including higher stone clearance rates, reduced postoperative complications (particularly pancreatitis), shorter hospital stays, fewer residual stones, and decreased need for additional procedures. However, additional high-quality clinical trials are needed to establish the optimal treatment approach for various patient scenarios.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103429","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}
Pub Date : 2024-08-29DOI: 10.1007/s12325-024-02952-4
Martina Kojanova, Barbora Turkova, Spyridon Gkalpakiotis, Petra Cetkovska, Jorga Fialova, Tomas Dolezal, Alena Machovcova, Eydna Didriksen Apol
Introduction
The aim of this observational, multicenter study was to assess the real-world use of brodalumab for the treatment of moderate-to-severe plaque psoriasis in patients in the Czech Republic, using data from the BIOREP registry.
Methods
The study included 273 patients aged ≥ 18 years with moderate-to-severe psoriasis who received brodalumab. Endpoints were drug survival (time from treatment initiation to discontinuation), effectiveness [Psoriasis Area and Severity Index (PASI)], and health-related quality-of-life [Dermatology Life Quality Index (DLQI)].
Results
Predicted drug survival probability was 92.4% [95% confidence interval (CI): 89.1, 95.7%] at 6 months and 84.2% (95% CI 79.5, 89.1%) at 12 months; this was maintained at 24 months [80.4% (95% CI 74.5, 86.8%)]. Younger age, higher body mass index, and no previous biologic treatment were significantly associated with longer drug survival. Absolute PASI ≤ 3 after 3 months was achieved by 89.8% of patients; 92.4%, 77.8%, and 59.1% reached PASI 75, PASI 90, and PASI 100, respectively. After 12 months, 96.5% of 141 patients had an absolute PASI ≤ 3. The proportion of patients achieving DLQI 0/1 was 87.3% at 12 months.
Conclusion
This study demonstrated high and sustained drug survival with high rates of skin clearance and improved quality of life in patients with relatively severe disease treated with brodalumab. Improvements were observed as early as 3 months post-treatment initiation and were sustained for up to 24 months in a real-life setting.
简介:这项多中心观察性研究旨在利用 BIOREP 登记处的数据,评估捷克共和国中重度斑块状银屑病患者使用布达鲁单抗治疗的实际情况:研究纳入了273名年龄≥18岁、接受过布达鲁单抗治疗的中重度银屑病患者。终点是药物存活率(从开始治疗到停药的时间)、疗效[银屑病面积和严重程度指数(PASI)]和健康相关生活质量[皮肤科生活质量指数(DLQI)]:6 个月时的预测药物存活率为 92.4% [95% 置信区间 (CI):89.1, 95.7%],12 个月时为 84.2% (95% CI 79.5, 89.1%);24 个月时仍为 80.4% (95% CI 74.5, 86.8%) [80.4%(95% CI 74.5, 86.8%)]。年龄越小、体重指数越高以及既往未接受过生物治疗与药物存活期越长有显著相关性。89.8% 的患者在 3 个月后 PASI 绝对值≤3;分别有 92.4%、77.8% 和 59.1% 的患者达到 PASI 75、PASI 90 和 PASI 100。12 个月后,141 名患者中有 96.5% 的患者 PASI 绝对值≤ 3。12个月后,达到DLQI 0/1的患者比例为87.3%:这项研究表明,使用布达鲁单抗治疗病情相对较重的患者,药物存活率高且持续时间长,皮肤清除率高,生活质量得到改善。在实际生活中,早在治疗开始后 3 个月就能观察到改善,并可持续长达 24 个月。
{"title":"Real-World Data on Brodalumab Treatment in Patients with Moderate-to-Severe Plaque Psoriasis: An Observational Study from the Czech Republic BIOREP Registry","authors":"Martina Kojanova, Barbora Turkova, Spyridon Gkalpakiotis, Petra Cetkovska, Jorga Fialova, Tomas Dolezal, Alena Machovcova, Eydna Didriksen Apol","doi":"10.1007/s12325-024-02952-4","DOIUrl":"10.1007/s12325-024-02952-4","url":null,"abstract":"<div><h3>Introduction</h3><p>The aim of this observational, multicenter study was to assess the real-world use of brodalumab for the treatment of moderate-to-severe plaque psoriasis in patients in the Czech Republic, using data from the BIOREP registry.</p><h3>Methods</h3><p>The study included 273 patients aged ≥ 18 years with moderate-to-severe psoriasis who received brodalumab. Endpoints were drug survival (time from treatment initiation to discontinuation), effectiveness [Psoriasis Area and Severity Index (PASI)], and health-related quality-of-life [Dermatology Life Quality Index (DLQI)].</p><h3>Results</h3><p>Predicted drug survival probability was 92.4% [95% confidence interval (CI): 89.1, 95.7%] at 6 months and 84.2% (95% CI 79.5, 89.1%) at 12 months; this was maintained at 24 months [80.4% (95% CI 74.5, 86.8%)]. Younger age, higher body mass index, and no previous biologic treatment were significantly associated with longer drug survival. Absolute PASI ≤ 3 after 3 months was achieved by 89.8% of patients; 92.4%, 77.8%, and 59.1% reached PASI 75, PASI 90, and PASI 100, respectively. After 12 months, 96.5% of 141 patients had an absolute PASI ≤ 3. The proportion of patients achieving DLQI 0/1 was 87.3% at 12 months.</p><h3>Conclusion</h3><p>This study demonstrated high and sustained drug survival with high rates of skin clearance and improved quality of life in patients with relatively severe disease treated with brodalumab. Improvements were observed as early as 3 months post-treatment initiation and were sustained for up to 24 months in a real-life setting.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1007/s12325-024-02968-w
Luca Potestio, Nello Tommasino, Giuseppe Lauletta, Antonia Salsano, Gioacchino Lucagnano, Luca Menna, Gianluca Esposito, Fabrizio Martora, Matteo Megna
Several studies have described increased risk ratios of certain types of malignancies in patients with severe psoriasis. Among these, the lymphoproliferative disorders, including non-Hodgkin’s lymphoma, cutaneous T-cell lymphoma and non-melanoma skin cancer, have been described most frequently. In addition to traditional cancer risk factors, some psoriasis treatments may also be implicated as potential carcinogens. The aim of this study was to perform a review of current literature on the association between psoriasis, the therapies against this disease and skin cancer, focusing on both epidemiology and the potential mechanism involved. Some psoriasis treatments, such as psoralen and ultraviolet A (PUVA) therapy and cyclosporine, have been associated with increased risk of skin cancer. Variable data have been reported for anti-tumour necrosis factor (TNF) drugs, whereas other class of biologics, like anti-IL17 and IL23, as well as ustekinumab, seem not to be related to skin cancer risk, such as the case of currently available small molecules.
有几项研究表明,严重银屑病患者罹患某些类型恶性肿瘤的风险比率增加。其中,淋巴组织增生性疾病,包括非霍奇金淋巴瘤、皮肤 T 细胞淋巴瘤和非黑色素瘤皮肤癌的描述最为常见。除了传统的癌症风险因素外,一些银屑病治疗方法也可能是潜在的致癌物质。本研究的目的是对目前有关银屑病、银屑病疗法和皮肤癌之间关系的文献进行综述,重点关注流行病学和潜在的相关机制。一些银屑病治疗方法,如补骨脂素和紫外线 A(PUVA)疗法和环孢素,与皮肤癌风险增加有关。抗肿瘤坏死因子(TNF)药物的数据不一,而其他生物制剂,如抗IL17和IL23,以及乌司替尼(ustekinumab),似乎与皮肤癌风险无关,如目前可用的小分子药物。
{"title":"The Impact of Psoriasis Treatments on the Risk of Skin Cancer: A Narrative Review","authors":"Luca Potestio, Nello Tommasino, Giuseppe Lauletta, Antonia Salsano, Gioacchino Lucagnano, Luca Menna, Gianluca Esposito, Fabrizio Martora, Matteo Megna","doi":"10.1007/s12325-024-02968-w","DOIUrl":"10.1007/s12325-024-02968-w","url":null,"abstract":"<div><p>Several studies have described increased risk ratios of certain types of malignancies in patients with severe psoriasis. Among these, the lymphoproliferative disorders, including non-Hodgkin’s lymphoma, cutaneous T-cell lymphoma and non-melanoma skin cancer, have been described most frequently. In addition to traditional cancer risk factors, some psoriasis treatments may also be implicated as potential carcinogens. The aim of this study was to perform a review of current literature on the association between psoriasis, the therapies against this disease and skin cancer, focusing on both epidemiology and the potential mechanism involved. Some psoriasis treatments, such as psoralen and ultraviolet A (PUVA) therapy and cyclosporine, have been associated with increased risk of skin cancer. Variable data have been reported for anti-tumour necrosis factor (TNF) drugs, whereas other class of biologics, like anti-IL17 and IL23, as well as ustekinumab, seem not to be related to skin cancer risk, such as the case of currently available small molecules.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142078855","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}
Pub Date : 2024-08-21DOI: 10.1007/s12325-024-02955-1
Brett Hauber, Agnes Hong, Elke Hunsche, Martine C. Maculaitis, Sean P. Collins
Introduction
Medical androgen deprivation therapy (ADT) options have expanded for patients with advanced prostate cancer (PC). Historically, ADT was primarily available in long-acting injectable formulations. In 2020, the first oral formulation was US Food and Drug Administration-approved for adults with advanced PC. This study’s aim was to assess patient preferences for attributes of medical ADT, including mode of administration, side effects, impact on sexual interest, and out-of-pocket (OOP) costs, and to segment respondents into distinct groups based on their treatment choice patterns.
Methods
A cross-sectional survey was conducted among US residents aged > 40 years with PC, employing a discrete choice experiment to assess preferences for ADT attributes. For each choice task, respondents were asked to select the hypothetical treatment profile that they preferred out of two presented. Latent class analysis (LCA) was conducted to estimate attribute-level preference weights and calculate attribute relative importance for groups of respondents with similar treatment preferences.
Results
A total of 304 respondents completed the survey (mean age 64.4 years). LCA identified four preference groups, named according to the attribute each group considered most important: Sexual interest, Cost-sensitive, Favors daily pill, and Favors injection. Most respondents in the Sexual interest group were < 65 years, while the Cost-sensitive group was mostly ≥ 65 years. Favors daily pill had the highest proportion of ADT-naïve individuals. On average, respondents in these groups preferred an oral medication. Favors injection, which had the highest proportion of ADT-experienced individuals, preferred infrequent intramuscular injections, lower chance of post-ADT testosterone recovery, and lower OOP cost.
Conclusion
Respondents differed in their preferences regarding ADT attributes, highlighting the need for patient involvement in their treatment decisions. Effective communication between healthcare providers and patients about the benefits and risks of available therapies should be encouraged to ensure that patients receive the PC treatment that best meets their needs.
简介:晚期前列腺癌(PC)患者的雄激素剥夺疗法(ADT)选择越来越多。一直以来,ADT 主要采用长效注射制剂。2020 年,首个口服制剂获得美国食品和药物管理局批准,可用于晚期 PC 成人患者。本研究旨在评估患者对医用 ADT 特性的偏好,包括给药方式、副作用、对性兴趣的影响以及自付(OOP)费用,并根据受访者的治疗选择模式将其划分为不同的群体:方法:对年龄大于 40 岁、患有 PC 的美国居民进行了一项横断面调查,采用离散选择实验来评估 ADT 属性的偏好。在每个选择任务中,受访者被要求从两个假定的治疗方案中选择他们更喜欢的方案。对具有相似治疗偏好的受访者群体进行潜类分析(LCA),以估计属性级偏好权重并计算属性相对重要性:共有 304 名受访者完成了调查(平均年龄为 64.4 岁)。LCA 确定了四个偏好群体,根据每个群体认为最重要的属性进行命名:性兴趣、成本敏感、偏好每日服药和偏好注射。性兴趣组中的大多数受访者是结论派:受访者对 ADT 特性的偏好各不相同,这说明患者需要参与治疗决策。应鼓励医疗服务提供者与患者就现有疗法的益处和风险进行有效沟通,以确保患者接受最符合其需求的 PC 治疗。
{"title":"Patient Preferences for Attributes of Androgen Deprivation Therapies in Prostate Cancer: A Discrete Choice Experiment with Latent Class Analysis","authors":"Brett Hauber, Agnes Hong, Elke Hunsche, Martine C. Maculaitis, Sean P. Collins","doi":"10.1007/s12325-024-02955-1","DOIUrl":"10.1007/s12325-024-02955-1","url":null,"abstract":"<div><h3>Introduction</h3><p>Medical androgen deprivation therapy (ADT) options have expanded for patients with advanced prostate cancer (PC). Historically, ADT was primarily available in long-acting injectable formulations. In 2020, the first oral formulation was US Food and Drug Administration-approved for adults with advanced PC. This study’s aim was to assess patient preferences for attributes of medical ADT, including mode of administration, side effects, impact on sexual interest, and out-of-pocket (OOP) costs, and to segment respondents into distinct groups based on their treatment choice patterns.</p><h3>Methods</h3><p>A cross-sectional survey was conducted among US residents aged > 40 years with PC, employing a discrete choice experiment to assess preferences for ADT attributes. For each choice task, respondents were asked to select the hypothetical treatment profile that they preferred out of two presented. Latent class analysis (LCA) was conducted to estimate attribute-level preference weights and calculate attribute relative importance for groups of respondents with similar treatment preferences.</p><h3>Results</h3><p>A total of 304 respondents completed the survey (mean age 64.4 years). LCA identified four preference groups, named according to the attribute each group considered most important: Sexual interest, Cost-sensitive, Favors daily pill, and Favors injection. Most respondents in the Sexual interest group were < 65 years, while the Cost-sensitive group was mostly ≥ 65 years. Favors daily pill had the highest proportion of ADT-naïve individuals. On average, respondents in these groups preferred an oral medication. Favors injection, which had the highest proportion of ADT-experienced individuals, preferred infrequent intramuscular injections, lower chance of post-ADT testosterone recovery, and lower OOP cost.</p><h3>Conclusion</h3><p>Respondents differed in their preferences regarding ADT attributes, highlighting the need for patient involvement in their treatment decisions. Effective communication between healthcare providers and patients about the benefits and risks of available therapies should be encouraged to ensure that patients receive the PC treatment that best meets their needs.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1007/s12325-024-02951-5
Susana Marcos-Peña, Beatriz Fernández-Pernia, Drew Provan, Tomás José González-López
Thrombopoietin receptor agonists (TPO-Ras; romiplostim/eltrombopag/avatrombopag) have demonstrated high efficacy rates (59–88%) and a good safety profile in clinical trials with adult patients with immune thrombocytopenia (ITP). Similar efficacy and safety results have been observed with romiplostim and eltrombopag in paediatric cohorts. Continuous treatment with TPO-RAs has shown durable responses with long-term use, up to 3 years. The effect of TPO-RAs was generally considered transient, as platelet counts tended to drop to baseline values after a short period of time (about 2 weeks), unless treatment was maintained. Several groups have reported successful discontinuation of TPO-RAs without the need for concomitant treatments. This is referred to as sustained remission off treatment (SROT). Both short- and medium-term treatment with TPO-RAs may reduce costs to our healthcare systems and, more importantly, may reduce the potential side effects that may be associated with continuous TPO-RA treatment. The issue of tapering and discontinuation of TPO-RAs in paediatric patients with ITP has received little attention to date. Given that paediatric ITP has much higher rates of spontaneous remission than ITP in adults, we consider that the possibility of SROT of TPO-RAs in paediatric patients with ITP is a neglected but very relevant issue in this subtype of the disease.
{"title":"Tapering and Sustained Remission of Thrombopoietin Receptor Agonists (TPO-RAs): Is it Time for Paediatric ITP?","authors":"Susana Marcos-Peña, Beatriz Fernández-Pernia, Drew Provan, Tomás José González-López","doi":"10.1007/s12325-024-02951-5","DOIUrl":"10.1007/s12325-024-02951-5","url":null,"abstract":"<div><p>Thrombopoietin receptor agonists (TPO-Ras; romiplostim/eltrombopag/avatrombopag) have demonstrated high efficacy rates (59–88%) and a good safety profile in clinical trials with adult patients with immune thrombocytopenia (ITP). Similar efficacy and safety results have been observed with romiplostim and eltrombopag in paediatric cohorts. Continuous treatment with TPO-RAs has shown durable responses with long-term use, up to 3 years. The effect of TPO-RAs was generally considered transient, as platelet counts tended to drop to baseline values after a short period of time (about 2 weeks), unless treatment was maintained. Several groups have reported successful discontinuation of TPO-RAs without the need for concomitant treatments. This is referred to as sustained remission off treatment (SROT). Both short- and medium-term treatment with TPO-RAs may reduce costs to our healthcare systems and, more importantly, may reduce the potential side effects that may be associated with continuous TPO-RA treatment. The issue of tapering and discontinuation of TPO-RAs in paediatric patients with ITP has received little attention to date. Given that paediatric ITP has much higher rates of spontaneous remission than ITP in adults, we consider that the possibility of SROT of TPO-RAs in paediatric patients with ITP is a neglected but very relevant issue in this subtype of the disease.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003341","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}
Pub Date : 2024-08-20DOI: 10.1007/s12325-024-02863-4
Lise Retat, Dunming Xiao, Laura Webber, Alexander Martin, Joshua Card-Gowers, Jiaqi Yao, Yuzheng Zhang, Chalet Zhang, Juan Jose Garcia Sanchez, Claudia Cabrera, Susan Grandy, Naveen Rao, Yiqing Wu, Zuo Li, Jianwei Xuan
Introduction
Anemia is a common comorbidity of chronic kidney disease (CKD) that has been associated with increased risk of complications, healthcare expenditure, and reduced quality of life. In China, the treatment of anemia of CKD has been reported to be suboptimal in part because of a lack of awareness of the condition and its management. It is therefore important to raise awareness of the condition by estimating the future health and economic burden of anemia of CKD and also to understand how it may be addressed through proactive policies. This study aims to project the health and economic burden of anemia of CKD, in China, from 2023 to 2027 and to estimate the impact of a hypothetical intervention on related clinical and cost outcomes.
Methods
A virtual Chinese population was simulated using demographic, clinical, and economic statistics within a validated CKD microsimulation model. Each individual was assigned a CKD stage, anemia stage, comorbidity status (type 2 diabetes, hypertension), complication status (stroke, heart failure, and/or myocardial infarction), and a probability of receiving treatments and therapies. Annual direct healthcare costs were assigned and based on these factors. The hypothetical intervention reduced the prevalence of moderate and severe anemia by 5% annually. This hypothetical scenario was chosen to highlight the impact of implementing policies that could reduce anemia of CKD, and is aligned with the Healthy China 2030 policy, which aims to reduce mortality from noncommunicable diseases by 30%. Interventions could consist of early screening and intervention to reduce the escalation of anemia from mild to moderate or severe. Results were compared with a baseline “no change” scenario which reflects current trends.
Results
The number of patients with moderate/severe anemia of CKD was projected to increase from 3.0 to 3.2 million patients, with associated costs increasing from ¥22.0 billion (B) to ¥24.4B between 2023 and 2027, respectively. Compared with the no change scenario, the hypothetical intervention reduced the prevalence of moderate and severe anemia of CKD, saving ¥3.9B in healthcare costs in 2027 (¥24.4B vs ¥20.6B, respectively).
Conclusions
Consistent with trends in CKD burden in China, the prevalence of anemia of CKD is projected to increase, leading to greater related healthcare costs. The introduction of healthcare interventions designed to screen for and treat anemia more effectively could therefore reduce its future burden and related costs.
{"title":"Inside ANEMIA of CKD: Projecting the Future Burden of Anemia of Chronic Kidney Disease and Benefits of Proactive Management: A Microsimulation Model of the Chinese Population","authors":"Lise Retat, Dunming Xiao, Laura Webber, Alexander Martin, Joshua Card-Gowers, Jiaqi Yao, Yuzheng Zhang, Chalet Zhang, Juan Jose Garcia Sanchez, Claudia Cabrera, Susan Grandy, Naveen Rao, Yiqing Wu, Zuo Li, Jianwei Xuan","doi":"10.1007/s12325-024-02863-4","DOIUrl":"10.1007/s12325-024-02863-4","url":null,"abstract":"<div><h3>Introduction</h3><p>Anemia is a common comorbidity of chronic kidney disease (CKD) that has been associated with increased risk of complications, healthcare expenditure, and reduced quality of life. In China, the treatment of anemia of CKD has been reported to be suboptimal in part because of a lack of awareness of the condition and its management. It is therefore important to raise awareness of the condition by estimating the future health and economic burden of anemia of CKD and also to understand how it may be addressed through proactive policies. This study aims to project the health and economic burden of anemia of CKD, in China, from 2023 to 2027 and to estimate the impact of a hypothetical intervention on related clinical and cost outcomes.</p><h3>Methods</h3><p>A virtual Chinese population was simulated using demographic, clinical, and economic statistics within a validated CKD microsimulation model. Each individual was assigned a CKD stage, anemia stage, comorbidity status (type 2 diabetes, hypertension), complication status (stroke, heart failure, and/or myocardial infarction), and a probability of receiving treatments and therapies. Annual direct healthcare costs were assigned and based on these factors. The hypothetical intervention reduced the prevalence of moderate and severe anemia by 5% annually. This hypothetical scenario was chosen to highlight the impact of implementing policies that could reduce anemia of CKD, and is aligned with the Healthy China 2030 policy, which aims to reduce mortality from noncommunicable diseases by 30%. Interventions could consist of early screening and intervention to reduce the escalation of anemia from mild to moderate or severe. Results were compared with a baseline “no change” scenario which reflects current trends.</p><h3>Results</h3><p>The number of patients with moderate/severe anemia of CKD was projected to increase from 3.0 to 3.2 million patients, with associated costs increasing from ¥22.0 billion (B) to ¥24.4B between 2023 and 2027, respectively. Compared with the no change scenario, the hypothetical intervention reduced the prevalence of moderate and severe anemia of CKD, saving ¥3.9B in healthcare costs in 2027 (¥24.4B vs ¥20.6B, respectively).</p><h3>Conclusions</h3><p>Consistent with trends in CKD burden in China, the prevalence of anemia of CKD is projected to increase, leading to greater related healthcare costs. The introduction of healthcare interventions designed to screen for and treat anemia more effectively could therefore reduce its future burden and related costs.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1007/s12325-024-02957-z
Pamela Kushner, Kamlesh Khunti, Ana Cebrián, Gary Deed
Early-stage (stage 1–3) chronic kidney disease (CKD) has an asymptomatic presentation such that most people with CKD are unaware of their disease status and remain undiagnosed. CKD is associated with multiple long-term conditions (MLTC), or multimorbidity, the most common of these being cardiovascular disease, hypertension, and type 2 diabetes. Primary care practitioners (PCPs) are crucial in the early identification and management of patients with CKD. For individuals at high risk of CKD, measurements of estimated glomerular filtration rate, urine albumin–creatinine ratio, and blood pressure should be obtained regularly and recorded in a timely manner. The importance of lifestyle changes in the prevention and management of CKD should also be highlighted. A recent addition to the treatment of CKD in people with and without type 2 diabetes has been the recommendation by clinical practice guidelines of a sodium–glucose co-transporter 2 (SGLT2) inhibitor alongside a renin–angiotensin–aldosterone system inhibitor as foundational therapy. SGLT2 inhibitors prevent CKD progression and reduce fatal and non-fatal kidney and cardiovascular events, hospitalization for heart failure, and all-cause mortality, and they have a favorable safety and tolerability profile. However, uptake has been slow, particularly in people with CKD without type 2 diabetes. A multifaceted approach is required to ensure that people with CKD receive optimal kidney protection. Measures to raise awareness of the importance of early identification and intervention include local/national campaigns via social media and practice-based education; clinical education programs; integration of clinical decision support tools into electronic health records; detection programs built around electronic health records; and good interdisciplinary communication. PCPs at the forefront of multidisciplinary care are best placed to implement the evidence-based clinical practice CKD guidelines for lifestyle modification and guideline-directed medical therapy.
{"title":"Early Identification and Management of Chronic Kidney Disease: A Narrative Review of the Crucial Role of Primary Care Practitioners","authors":"Pamela Kushner, Kamlesh Khunti, Ana Cebrián, Gary Deed","doi":"10.1007/s12325-024-02957-z","DOIUrl":"10.1007/s12325-024-02957-z","url":null,"abstract":"<div><p>Early-stage (stage 1–3) chronic kidney disease (CKD) has an asymptomatic presentation such that most people with CKD are unaware of their disease status and remain undiagnosed. CKD is associated with multiple long-term conditions (MLTC), or multimorbidity, the most common of these being cardiovascular disease, hypertension, and type 2 diabetes. Primary care practitioners (PCPs) are crucial in the early identification and management of patients with CKD. For individuals at high risk of CKD, measurements of estimated glomerular filtration rate, urine albumin–creatinine ratio, and blood pressure should be obtained regularly and recorded in a timely manner. The importance of lifestyle changes in the prevention and management of CKD should also be highlighted. A recent addition to the treatment of CKD in people with and without type 2 diabetes has been the recommendation by clinical practice guidelines of a sodium–glucose co-transporter 2 (SGLT2) inhibitor alongside a renin–angiotensin–aldosterone system inhibitor as foundational therapy. SGLT2 inhibitors prevent CKD progression and reduce fatal and non-fatal kidney and cardiovascular events, hospitalization for heart failure, and all-cause mortality, and they have a favorable safety and tolerability profile. However, uptake has been slow, particularly in people with CKD without type 2 diabetes. A multifaceted approach is required to ensure that people with CKD receive optimal kidney protection. Measures to raise awareness of the importance of early identification and intervention include local/national campaigns via social media and practice-based education; clinical education programs; integration of clinical decision support tools into electronic health records; detection programs built around electronic health records; and good interdisciplinary communication. PCPs at the forefront of multidisciplinary care are best placed to implement the evidence-based clinical practice CKD guidelines for lifestyle modification and guideline-directed medical therapy.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}