In adult patients with mechanical ventilation, more frequent ventilator circuit tubing replacement may increase the odds of ventilator-associated pneumonia, but the findings are imprecise.
In pediatric patients with mechanical ventilation, more frequent and less frequent intervals of ventilator circuit tubing replacement may result in a similar risk of ventilator-associated pneumonia, all-cause mortality, and ventilator-associated pneumonia mortality, and similar durations of mechanical ventilation and hospital stay.
For preterm neonates, children, and adult patients, it is recommended to replace the ventilator circuit tubing if it is visibly soiled, not functioning properly, or as recommended in the manufacturer's instructions.
We did not find any guidelines about fixed versus nonfixed ventilator circuit tubing replacement.
{"title":"Timing of Ventilator Circuit Tubing Replacement","authors":"Zahra Jafari, Melissa Severn","doi":"10.51731/cjht.2023.730","DOIUrl":"https://doi.org/10.51731/cjht.2023.730","url":null,"abstract":"
 In adult patients with mechanical ventilation, more frequent ventilator circuit tubing replacement may increase the odds of ventilator-associated pneumonia, but the findings are imprecise.
 In pediatric patients with mechanical ventilation, more frequent and less frequent intervals of ventilator circuit tubing replacement may result in a similar risk of ventilator-associated pneumonia, all-cause mortality, and ventilator-associated pneumonia mortality, and similar durations of mechanical ventilation and hospital stay.
 For preterm neonates, children, and adult patients, it is recommended to replace the ventilator circuit tubing if it is visibly soiled, not functioning properly, or as recommended in the manufacturer's instructions.
 We did not find any guidelines about fixed versus nonfixed ventilator circuit tubing replacement.
","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135047840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Telephone triage programs (e.g., provincial and territorial 811 programs) provide timely access to trained health care professionals who perform virtual assessments of patients’ health status and symptoms and offer self-care advice and referrals to health care services and resources.
This Environmental Scan aimed to describe telephone triage programs in Canada, including what services they provide, their number and types of staff, who administers the programs, and how much they cost. It also aimed to provide a summary of some important considerations related to health equity, as well as insights into the future of telephone triage programs, including how they may incorporate emerging technologies like artificial intelligence and wearable health devices into their operations. This scan was informed through a limited literature search and a survey completed by targeted jurisdictional contacts across Canada.
All 13 provinces and territories in Canada provide residents with access to jurisdiction-wide telephone triage programs. While most of these programs have been in operation for many years, the programs in the Northwest Territories and Nunavut were established within the past 2 years.
Our findings suggest that telephone triage programs in Canada vary in the types of services they offer, as well as their characteristics and features, administrative structures, and associated costs. While all programs offer telephone triage and advice services, certain programs offer additional services, such as mental health crisis lines, assistance for quitting smoking or tobacco use, and consultation with a variety of health care professionals like pharmacists, dieticians, and physicians. Most programs are primarily staffed by registered nurses, but some telephone triage teams also include nonclinical intake agents, administrative personnel, physicians, nurse practitioners, and other health and social care providers.
{"title":"Telephone Triage Services in Canada","authors":"Calvin Young, Melissa Walter, Francesca Brundisini","doi":"10.51731/cjht.2023.731","DOIUrl":"https://doi.org/10.51731/cjht.2023.731","url":null,"abstract":"
 Telephone triage programs (e.g., provincial and territorial 811 programs) provide timely access to trained health care professionals who perform virtual assessments of patients’ health status and symptoms and offer self-care advice and referrals to health care services and resources.
 This Environmental Scan aimed to describe telephone triage programs in Canada, including what services they provide, their number and types of staff, who administers the programs, and how much they cost. It also aimed to provide a summary of some important considerations related to health equity, as well as insights into the future of telephone triage programs, including how they may incorporate emerging technologies like artificial intelligence and wearable health devices into their operations. This scan was informed through a limited literature search and a survey completed by targeted jurisdictional contacts across Canada.
 All 13 provinces and territories in Canada provide residents with access to jurisdiction-wide telephone triage programs. While most of these programs have been in operation for many years, the programs in the Northwest Territories and Nunavut were established within the past 2 years.
 Our findings suggest that telephone triage programs in Canada vary in the types of services they offer, as well as their characteristics and features, administrative structures, and associated costs. While all programs offer telephone triage and advice services, certain programs offer additional services, such as mental health crisis lines, assistance for quitting smoking or tobacco use, and consultation with a variety of health care professionals like pharmacists, dieticians, and physicians. Most programs are primarily staffed by registered nurses, but some telephone triage teams also include nonclinical intake agents, administrative personnel, physicians, nurse practitioners, and other health and social care providers.
","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135048076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH recommends that Zoryve be reimbursed by public drug plans for the treatment of plaque psoriasis, including treatment of psoriasis in the intertriginous areas, in patients 12 years of age and older if certain conditions are met. Zoryve should only be covered to treat patients who have a clinical diagnosis of plaque psoriasis with an Investigator Global Assessment (IGA) score of at least 2 (mild) and an area of plaque psoriasis appropriate for topical treatment covering a body surface area of 2% to 20% (inclusive). Zoryve should be discontinued if a response has not been demonstrated by 8 weeks. A response to treatment is defined as at least a 2-grade improvement from baseline in IGA score or an IGA score of “clear” or “almost clear” (0 or 1). The cost of Zoryve should not exceed the drug program cost of treatment with the least costly topical therapy reimbursed for the treatment of plaque psoriasis.
{"title":"Roflumilast (Zoryve)","authors":"Cadth","doi":"10.51731/cjht.2023.729","DOIUrl":"https://doi.org/10.51731/cjht.2023.729","url":null,"abstract":"\u0000CADTH recommends that Zoryve be reimbursed by public drug plans for the treatment of plaque psoriasis, including treatment of psoriasis in the intertriginous areas, in patients 12 years of age and older if certain conditions are met. \u0000Zoryve should only be covered to treat patients who have a clinical diagnosis of plaque psoriasis with an Investigator Global Assessment (IGA) score of at least 2 (mild) and an area of plaque psoriasis appropriate for topical treatment covering a body surface area of 2% to 20% (inclusive). \u0000Zoryve should be discontinued if a response has not been demonstrated by 8 weeks. A response to treatment is defined as at least a 2-grade improvement from baseline in IGA score or an IGA score of “clear” or “almost clear” (0 or 1). The cost of Zoryve should not exceed the drug program cost of treatment with the least costly topical therapy reimbursed for the treatment of plaque psoriasis. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"131 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82474338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec.
This review assesses atogepant (Qulipta), 10 mg, 30 mg, and 60 mg, oral tablets.
Indication: The prevention of episodic migraine (< 15 migraine days per month) in adults.
{"title":"Atogepant (Qulipta)","authors":"None CADTH","doi":"10.51731/cjht.2023.727","DOIUrl":"https://doi.org/10.51731/cjht.2023.727","url":null,"abstract":"
 CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
 The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec.
 This review assesses atogepant (Qulipta), 10 mg, 30 mg, and 60 mg, oral tablets.
 Indication: The prevention of episodic migraine (< 15 migraine days per month) in adults.
","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136144422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec.
This review assesses vericiguat (Verquvo), 2.5 mg, 5 mg, 10 mg, orally administered, film-coated tablets.
Indication: For the treatment of symptomatic chronic heart failure in adult patients with reduced ejection fraction who are stabilized after a recent heart failure decompensation event requiring hospitalization and/or IV diuretic therapy. Verquvo should be used in combination with standard-of-care therapy for heart failure.
{"title":"Vericiguat (Verquvo)","authors":"None CADTH","doi":"10.51731/cjht.2023.726","DOIUrl":"https://doi.org/10.51731/cjht.2023.726","url":null,"abstract":"
 CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
 The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec.
 This review assesses vericiguat (Verquvo), 2.5 mg, 5 mg, 10 mg, orally administered, film-coated tablets.
 Indication: For the treatment of symptomatic chronic heart failure in adult patients with reduced ejection fraction who are stabilized after a recent heart failure decompensation event requiring hospitalization and/or IV diuretic therapy. Verquvo should be used in combination with standard-of-care therapy for heart failure.
","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136144421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec.
This review assesses upadacitinib (Rinvoq), 15 mg and 30 mg extended-release tablets, oral.
Indication: For the treatment of adults with active ankylosing spondylitis who have had an inadequate response to a biologic disease-modifying antirheumatic drug or when use of those therapies is inadvisable; may be used as monotherapy or in combination with nonsteroidal anti-inflammatory drugs.
{"title":"Upadacitinib (Rinvoq)","authors":"None CADTH","doi":"10.51731/cjht.2023.724","DOIUrl":"https://doi.org/10.51731/cjht.2023.724","url":null,"abstract":"
 CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
 The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec.
 This review assesses upadacitinib (Rinvoq), 15 mg and 30 mg extended-release tablets, oral.
 Indication: For the treatment of adults with active ankylosing spondylitis who have had an inadequate response to a biologic disease-modifying antirheumatic drug or when use of those therapies is inadvisable; may be used as monotherapy or in combination with nonsteroidal anti-inflammatory drugs.
","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"1955 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136349280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH recommends that Tavneos not be reimbursed by public drug plans as adjunctive treatment for adults with severe active antineutrophil cytoplasmic autoantibody-associated vasculitis (ANCA-AV) (granulomatosis with polyangiitis [GPA] and microscopic polyangiitis [MPA]). One clinical trial demonstrated that Tavneos in combination with ANCA-AV background therapy (including glucocorticoids and drugs that reduce immune system function) was as good as oral prednisone (60 mg dose reduced over 20 weeks) in combination with ANCA-AV background therapy for showing a reduction in disease symptoms at week 26 and was better than oral prednisone for maintaining symptom improvement at week 52. However, it was unclear if Tavneos offered a meaningful clinical benefit over other treatments used for ANCA-AV mainly because rituximab was not used as maintenance therapy in the trial, as is currently recommended by Canadian guidelines, and there is uncertainty around the clinical meaningfulness of the differences between the treatment groups for outcomes that assessed renal function, relapse, and Short Form [36] Health Survey version 2 (SF-36v2). There was not enough evidence to conclude that Tavneos met patients’ needs for a treatment that reduces or eliminates the use of glucocorticoids and their side effects as well as improves their health-related quality of life (HRQoL).
{"title":"Avacopan (Tavneos)","authors":"Cadth","doi":"10.51731/cjht.2023.723","DOIUrl":"https://doi.org/10.51731/cjht.2023.723","url":null,"abstract":"\u0000CADTH recommends that Tavneos not be reimbursed by public drug plans as adjunctive treatment for adults with severe active antineutrophil cytoplasmic autoantibody-associated vasculitis (ANCA-AV) (granulomatosis with polyangiitis [GPA] and microscopic polyangiitis [MPA]). \u0000One clinical trial demonstrated that Tavneos in combination with ANCA-AV background therapy (including glucocorticoids and drugs that reduce immune system function) was as good as oral prednisone (60 mg dose reduced over 20 weeks) in combination with ANCA-AV background therapy for showing a reduction in disease symptoms at week 26 and was better than oral prednisone for maintaining symptom improvement at week 52. However, it was unclear if Tavneos offered a meaningful clinical benefit over other treatments used for ANCA-AV mainly because rituximab was not used as maintenance therapy in the trial, as is currently recommended by Canadian guidelines, and there is uncertainty around the clinical meaningfulness of the differences between the treatment groups for outcomes that assessed renal function, relapse, and Short Form [36] Health Survey version 2 (SF-36v2). \u0000There was not enough evidence to conclude that Tavneos met patients’ needs for a treatment that reduces or eliminates the use of glucocorticoids and their side effects as well as improves their health-related quality of life (HRQoL). \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86181208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
What Is the Issue? Shortage events, the phenomena when demand exceeds supply, can affect both medical care and medical devices. The COVID-19 pandemic caused a global shortage event, the consequences of which are still being experienced beyond the peak of the pandemic (e.g., the lack of pediatric pain medication available in fall 2022). Children are vulnerable to shortage events as they represent a small proportion of the overall population, have distinct needs, and the pediatric medical device market has historically offered a lack of options. What Are the Technologies? Technologies such as artificial intelligence (AI)-enabled devices, point of care testing, and virtual care options could contribute to alleviating shortages in pediatric care. Technologies such as 3D printing, alternative interventions such as tracheostomy during shortages of mechanical ventilators, and the reprocessing of single use devices such as ventilator tubes have been suggested in times of pediatric medical device shortages. Solutions to shortage events can take the form of novel devices, interventions, or policies; however, due to the complexity of this problem, a multipronged approach is likely needed. What Is the Potential Impact? Shortages can cause delayed intervention, which has health and financial costs. When cancer diagnoses and treatments are delayed, overall survival rates decrease. High-quality early intervention can change a child’s developmental trajectory and improve outcomes for children, families, and communities. Finding solutions to shortages, particularly for children as they are already at risk for health inequities, is crucial to ensure good health care outcomes in the long-term. What Else Should We Know? During a shortage event, alternative interventions may have different safety profiles or require different training than default practices. Equity should be a consideration when implementing technologies, interventions, and policies to address shortage events so that these solutions do not end up replicating or exacerbating existing inequities.
{"title":"Shortages of Care and Medical Devices Affecting the Pediatric Patient Population","authors":"Sarah Jones, M. Walter","doi":"10.51731/cjht.2023.719","DOIUrl":"https://doi.org/10.51731/cjht.2023.719","url":null,"abstract":"What Is the Issue?\u0000\u0000Shortage events, the phenomena when demand exceeds supply, can affect both medical care and medical devices. The COVID-19 pandemic caused a global shortage event, the consequences of which are still being experienced beyond the peak of the pandemic (e.g., the lack of pediatric pain medication available in fall 2022).\u0000Children are vulnerable to shortage events as they represent a small proportion of the overall population, have distinct needs, and the pediatric medical device market has historically offered a lack of options.\u0000\u0000What Are the Technologies?\u0000\u0000Technologies such as artificial intelligence (AI)-enabled devices, point of care testing, and virtual care options could contribute to alleviating shortages in pediatric care.\u0000Technologies such as 3D printing, alternative interventions such as tracheostomy during shortages of mechanical ventilators, and the reprocessing of single use devices such as ventilator tubes have been suggested in times of pediatric medical device shortages.\u0000Solutions to shortage events can take the form of novel devices, interventions, or policies; however, due to the complexity of this problem, a multipronged approach is likely needed.\u0000\u0000What Is the Potential Impact?\u0000\u0000Shortages can cause delayed intervention, which has health and financial costs. When cancer diagnoses and treatments are delayed, overall survival rates decrease. High-quality early intervention can change a child’s developmental trajectory and improve outcomes for children, families, and communities.\u0000Finding solutions to shortages, particularly for children as they are already at risk for health inequities, is crucial to ensure good health care outcomes in the long-term.\u0000\u0000What Else Should We Know?\u0000\u0000During a shortage event, alternative interventions may have different safety profiles or require different training than default practices.\u0000Equity should be a consideration when implementing technologies, interventions, and policies to address shortage events so that these solutions do not end up replicating or exacerbating existing inequities.\u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82393929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH recommends that Ultomiris should not be reimbursed by public drug plans for the treatment of adult patients with anti-acetylcholine receptor (AChR) antibody–positive generalized myasthenia gravis (gMG).
Although evidence from a clinical trial (CHAMPION) suggested that Ultomiris contributed to improvement in activities of daily living and gMG disease severity after 26 weeks, it is uncertain if immunosuppressive therapy (IST) was optimized at the time of study enrolment. Patients in both Ultomiris and placebo groups of the CHAMPION trial received stable doses of IST; however, it was unclear if IST was optimized in both groups. The eligibility criteria for duration of IST treatment and duration of stable IST dosing in the CHAMPION trial were below the estimated range of time to maximal response according to the clinical experts consulted by CADTH. Although some evidence (mean time frame since MG diagnosis, mean corticosteroid treatment durations) was available, without dose information, it is unclear if corticosteroid was optimized for patients at the time of study enrolment.
Feedback from patient and clinician groups identified an unmet need for patients with gMG who have symptoms but are not considered refractory to IST. There is an unmet need for effective therapy for patients with refractory gMG, but the CHAMPION trial did not require patients to be refractory. Therefore, it is unknown how many patients in the CHAMPION trial were refractory and if the results observed in the trial would be the same in these patients. As a result, the ability of Ultomiris to fill the unmet need for patients who are refractory to IST is limited by the CHAMPION trial design, which used Ultomiris earlier in the treatment paradigm for gMG and did not require participants to be refractory to IST.
The CHAMPION trial did not provide evidence on the efficacy or harms of Ultomiris compared with other therapies used in clinical practice, such as rituximab, IV immunoglobulin, and plasma exchange. Therefore, the potential therapeutic benefit is unknown compared to what is used in clinical practice.
{"title":"Ravulizumab (Ultomiris)","authors":"None CADTH","doi":"10.51731/cjht.2023.721","DOIUrl":"https://doi.org/10.51731/cjht.2023.721","url":null,"abstract":"
 CADTH recommends that Ultomiris should not be reimbursed by public drug plans for the treatment of adult patients with anti-acetylcholine receptor (AChR) antibody–positive generalized myasthenia gravis (gMG).
 Although evidence from a clinical trial (CHAMPION) suggested that Ultomiris contributed to improvement in activities of daily living and gMG disease severity after 26 weeks, it is uncertain if immunosuppressive therapy (IST) was optimized at the time of study enrolment. Patients in both Ultomiris and placebo groups of the CHAMPION trial received stable doses of IST; however, it was unclear if IST was optimized in both groups. The eligibility criteria for duration of IST treatment and duration of stable IST dosing in the CHAMPION trial were below the estimated range of time to maximal response according to the clinical experts consulted by CADTH. Although some evidence (mean time frame since MG diagnosis, mean corticosteroid treatment durations) was available, without dose information, it is unclear if corticosteroid was optimized for patients at the time of study enrolment.
 Feedback from patient and clinician groups identified an unmet need for patients with gMG who have symptoms but are not considered refractory to IST. There is an unmet need for effective therapy for patients with refractory gMG, but the CHAMPION trial did not require patients to be refractory. Therefore, it is unknown how many patients in the CHAMPION trial were refractory and if the results observed in the trial would be the same in these patients. As a result, the ability of Ultomiris to fill the unmet need for patients who are refractory to IST is limited by the CHAMPION trial design, which used Ultomiris earlier in the treatment paradigm for gMG and did not require participants to be refractory to IST.
 The CHAMPION trial did not provide evidence on the efficacy or harms of Ultomiris compared with other therapies used in clinical practice, such as rituximab, IV immunoglobulin, and plasma exchange. Therefore, the potential therapeutic benefit is unknown compared to what is used in clinical practice.
","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135464917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH recommends that Sotyktu not be reimbursed by public drug plans for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. The evidence from 2 clinical trials was insufficient to determine that Sotyktu offered treatment benefits over the currently available advanced treatments in Canada for the treatment of moderate to severe plaque psoriasis in adults. No evidence was found that directly compared Sotyktu to newer interleukin (IL)-17 and IL-23 biologics, and the indirect evidence suggested that Sotyktu was less effective at improving skin plaques than several biologics (including IL-17 and IL-23 biologics) that are available and reimbursed in Canada. CADTH concluded that there was not enough evidence to show that Sotyktu met the needs of patients with moderate to severe plaque psoriasis not already addressed by other available treatments.
{"title":"Deucravacitinib (Sotyktu)","authors":"Deucravacitinib Sotyktu","doi":"10.51731/cjht.2023.720","DOIUrl":"https://doi.org/10.51731/cjht.2023.720","url":null,"abstract":"\u0000CADTH recommends that Sotyktu not be reimbursed by public drug plans for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. \u0000The evidence from 2 clinical trials was insufficient to determine that Sotyktu offered treatment benefits over the currently available advanced treatments in Canada for the treatment of moderate to severe plaque psoriasis in adults. \u0000No evidence was found that directly compared Sotyktu to newer interleukin (IL)-17 and IL-23 biologics, and the indirect evidence suggested that Sotyktu was less effective at improving skin plaques than several biologics (including IL-17 and IL-23 biologics) that are available and reimbursed in Canada. \u0000CADTH concluded that there was not enough evidence to show that Sotyktu met the needs of patients with moderate to severe plaque psoriasis not already addressed by other available treatments. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84761244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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