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Panagiota Mitrou

Bio: Panagiota Mitrou is an academic researcher. The author has contributed to research in topics: Population & Mortality rate. The author has an hindex of 1, co-authored 2 publications receiving 2 citations.

Papers
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Journal ArticleDOI
01 Nov 2021-RMD Open
TL;DR: In this article, the authors compared current all-cause mortality rates in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) versus general population.
Abstract: Objectives To compare current all-cause mortality rates in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) versus general population. Methods In this population-based, retrospective cohort study, anonymised data on 11 186 586 citizens, including all patients with RA (42 735, 79% female), AS (9707, 43% female), PsA (13 779, 55% female), SLE (10 440, 89% female) and SSc (2277, 88% female), (median age of 64/47/54/53/59 years at study entry, respectively), under prescribed treatment between 2015 and 2019, were extracted from the electronic database covering nearly 99% of the Greek population. Results After 1:5 (patients:general population) matching for gender/age, we found that survival was worse in SSc, followed by SLE and inflammatory arthritis. Compared with the general population HRs for death increased from the first 3 years to 5 years of observation possibly due to increases in disease duration: RA (from 0.63 to 1.13 (95% CI: 1.05 to 1.22), AS (from 0.62 to 1.01, (95% CI: 0.76 to 1.33)), PsA (from 0.68 to 1.06, (95% CI: 0.88 to 1.28)), SLE (from 1.52 to 1.98, (95% CI: 1.67 to 2.33)) and SSc (from 2.27 to 4.24, (95% CI: 3.19 to 5.63)). In both SLE and SSc mortality was increased in men than women and in patients younger than 50 years. Conclusions Survival rates over 5 years in inflammatory arthritis under treatment are currently becoming comparable (AS/PsA) or slightly higher (RA) than those of the general population. However, all-cause mortality is almost twofold and fourfold higher in SLE and SSc, respectively, being even higher for male and younger patients.

20 citations

Journal ArticleDOI
01 Sep 2020-RMD Open
TL;DR: In real-world settings, both introduction and switching of bDMARDs in patients with IRDs were associated with the presence of mood disorders and the impact of depression and anxiety should always be considered by physicians facing the decision to introduce or switch b DMARDs.
Abstract: Objectives Depression and anxiety are linked bi-directionally with inflammatory rheumatic diseases (IRDs) activity, which in turn, depends on subjective patient reported outcomes that can be distorted by comorbid mood disorders. We tested the hypothesis that introduction and/or switching of biologic agents for IRDs are associated with treatment for depression and/or anxiety, by analysing real-world data. Methods Using a country-wide electronic prescription database (10 012 604 registered, 99% population coverage), we captured almost all patients with rheumatoid arthritis (n=12 002), psoriatic arthritis (n=5465) and ankylosing spondylitis (n=6423) who received biologic disease modifying anti-rheumatic drugs (bDMARDs) during a 2-year period (8/2016–7/2018). Concomitant antidepressant/anxiolytic medication use was documented in patients who started or switched bDMARDs and compared with those who remained on conventional synthetic (cs)DMARDs or the same bDMARD, respectively, by multivariate regression analysis. Results Two-year data analysis on 42 815 patients revealed that bDMARD introduction was associated with both antidepressant [OR: 1.248, 95% CI 1.153 to 1.350, p Conclusion In real-world settings, both introduction and switching of bDMARDs in patients with IRDs were associated with the presence of mood disorders. Although a causal relationship is uncertain, the impact of depression and anxiety should always be considered by physicians facing the decision to introduce or switch bDMARDs in patients with active IRDs.

5 citations


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01 Jan 2011
TL;DR: In this paper, a meta-analysis of the association between depression and medication adherence among patients with chronic diseases was conducted, finding evidence that depression is associated with poor adherence to medication across a range of chronic diseases, and a new potential effect of adherence measurement type on this relationship.
Abstract: ObjectiveTo conduct a meta-analysis of the association between depression and medication adherence among patients with chronic diseases. Poor medication adherence may result in worse outcomes and higher costs than if patients fully adhere to their medication regimens.Data SourcesWe searched the PubMed and PsycINFO databases, conducted forward searches for articles that cited major review articles, and examined the reference lists of relevant articles.Study Eligibility Criteria, Participants, and InterventionsWe included studies on adults in the United States that reported bivariate relationships between depression and medication adherence. We excluded studies on special populations (e.g., substance abusers) that were not representative of the general adult population with chronic diseases, studies on certain diseases (e.g., HIV) that required special adherence protocols, and studies on interventions for medication adherence.Study Appraisal and Synthesis MethodsData abstracted included the study population, the protocol, measures of depression and adherence, and the quantitative association between depression and medication adherence. Synthesis of the data followed established statistical procedures for meta-analysis.ResultsThe estimated odds of a depressed patient being non-adherent are 1.76 times the odds of a non-depressed patient, across 31 studies and 18,245 participants. The association was similar across disease types but was not as strong among studies that used pharmacy records compared to self-report and electronic cap measures.LimitationsThe meta-analysis results are correlations limiting causal inferences, and there is some heterogeneity among the studies in participant characteristics, diseases studied, and methods used.ConclusionsThis analysis provides evidence that depression is associated with poor adherence to medication across a range of chronic diseases, and we find a new potential effect of adherence measurement type on this relationship. Although this study cannot assess causality, it supports the importance that must be placed on depression in studies that assess adherence and attempt to improve it.

31 citations

Journal ArticleDOI
TL;DR: In this article , a large body of additional knowledge has accumulated regarding various aspects of anti-TNF-α therapy, whereas new indications have been added, and the current implementation of the "treat-to-target" approach and treatment de-escalation strategies of IMIDs were based on anti-tNFs.
Abstract: Since the late 1990s, tumor necrosis factor alpha (TNF-α) inhibitors (anti-TNFs) have revolutionized the therapy of immune-mediated inflammatory diseases (IMIDs) affecting the gut, joints, skin and eyes. Although the therapeutic armamentarium in IMIDs is being constantly expanded, anti-TNFs remain the cornerstone of their treatment. During the second decade of their application in clinical practice, a large body of additional knowledge has accumulated regarding various aspects of anti-TNF-α therapy, whereas new indications have been added. Recent experimental studies have shown that anti-TNFs exert their beneficial effects not only by restoring aberrant TNF-mediated immune mechanisms, but also by de-activating pathogenic fibroblast-like mesenchymal cells. Real-world data on millions of patients further confirmed the remarkable efficacy of anti-TNFs. It is now clear that anti-TNFs alter the physical course of inflammatory arthritis and inflammatory bowel disease, leading to inhibition of local and systemic bone loss and to a decline in the number of surgeries for disease-related complications, while anti-TNFs improve morbidity and mortality, acting beneficially also on cardiovascular comorbidities. On the other hand, no new safety signals emerged, whereas anti-TNF-α safety in pregnancy and amid the COVID-19 pandemic was confirmed. The use of biosimilars was associated with cost reductions making anti-TNFs more widely available. Moreover, the current implementation of the “treat-to-target” approach and treatment de-escalation strategies of IMIDs were based on anti-TNFs. An intensive search to discover biomarkers to optimize response to anti-TNF-α treatment is currently ongoing. Finally, selective targeting of TNF-α receptors, new forms of anti-TNFs and combinations with other agents, are being tested in clinical trials and will probably expand the spectrum of TNF-α inhibition as a therapeutic strategy for IMIDs.

11 citations

Journal ArticleDOI
TL;DR: The role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities is reviewed and a consensus-based decision algorithm for when a CMR study could be considered in patientsWith ARDs is presented, together with a standardized study protocol.
Abstract: Autoimmune rheumatic diseases (ARDs) involve multiple organs including the heart and vasculature. Despite novel treatments, patients with ARDs still experience a reduced life expectancy, partly caused by the higher prevalence of cardiovascular disease (CVD). This includes CV inflammation, rhythm disturbances, perfusion abnormalities (ischaemia/infarction), dysregulation of vasoreactivity, myocardial fibrosis, coagulation abnormalities, pulmonary hypertension, valvular disease, and side-effects of immunomodulatory therapy. Currently, the evaluation of CV involvement in patients with ARDs is based on the assessment of cardiac symptoms, coupled with electrocardiography, blood testing, and echocardiography. However, CVD may not become overt until late in the course of the disease, thus potentially limiting the therapeutic window for intervention. More recently, cardiovascular magnetic resonance (CMR) has allowed for the early identification of pathophysiologic structural/functional alterations that take place before the onset of clinically overt CVD. CMR allows for detailed evaluation of biventricular function together with tissue characterization of vessels/myocardium in the same examination, yielding a reliable assessment of disease activity that might not be mirrored by blood biomarkers and other imaging modalities. Therefore, CMR provides diagnostic information that enables timely clinical decision-making and facilitates the tailoring of treatment to individual patients. Here we review the role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities. Furthermore, we present a consensus-based decision algorithm for when a CMR study could be considered in patients with ARDs, together with a standardized study protocol. Lastly, we discuss the clinical implications of findings from a CMR examination.

9 citations

Journal ArticleDOI
31 Mar 2022
TL;DR: In this paper , a growing number of health insurance data analyses show an increase in the prevalence of rheumatoid arthritis (RA) in Germany in recent years compared to earlier periods.
Abstract: A growing number of health insurance data analyses show an increase in the prevalence of rheumatoid arthritis (RA) in Germany. The studies refer to the claims diagnosis of RA, which is more frequent in recent years compared to earlier periods. Depending on the case definition, the numbers vary between 0.6% and 1.4% of the adult population. In this paper, the different studies are reviewed with regard to their data sources, the case definitions of RA and the frequency of the diagnosis. Due to the lack of clinical validation, the prevalence cannot be precisely determined from claims data.Immer mehr Auswertungen von Krankenkassendaten zeigen einen Anstieg der Prävalenz der rheumatoiden Arthritis (RA) in Deutschland. Die Studien beziehen sich auf die Abrechnungsdiagnose einer RA, die in Krankenkassendaten in den letzten Jahren im Vergleich zu früheren Zeiträumen häufiger zu finden ist. Je nach Falldefinition variieren die Zahlen zwischen 0,6% und 1,4% der erwachsenen Bevölkerung. In dieser Arbeit werden die verschiedenen Studien hinsichtlich der Datenquellen, der Falldefinitionen einer RA und der Diagnosehäufigkeit beleuchtet. Aufgrund der fehlenden klinischen Validierung lässt sich die Prävalenz anhand von Abrechnungsdaten nicht präzise bestimmen.

8 citations

Journal ArticleDOI
31 Mar 2022
TL;DR: In this article , a growing number of health insurance data analyses show an increase in the prevalence of rheumatoid arthritis (RA) in Germany in recent years compared to earlier periods.
Abstract: A growing number of health insurance data analyses show an increase in the prevalence of rheumatoid arthritis (RA) in Germany. The studies refer to the claims diagnosis of RA, which is more frequent in recent years compared to earlier periods. Depending on the case definition, the numbers vary between 0.6% and 1.4% of the adult population. In this paper, the different studies are reviewed with regard to their data sources, the case definitions of RA and the frequency of the diagnosis. Due to the lack of clinical validation, the prevalence cannot be precisely determined from claims data.Immer mehr Auswertungen von Krankenkassendaten zeigen einen Anstieg der Prävalenz der rheumatoiden Arthritis (RA) in Deutschland. Die Studien beziehen sich auf die Abrechnungsdiagnose einer RA, die in Krankenkassendaten in den letzten Jahren im Vergleich zu früheren Zeiträumen häufiger zu finden ist. Je nach Falldefinition variieren die Zahlen zwischen 0,6% und 1,4% der erwachsenen Bevölkerung. In dieser Arbeit werden die verschiedenen Studien hinsichtlich der Datenquellen, der Falldefinitionen einer RA und der Diagnosehäufigkeit beleuchtet. Aufgrund der fehlenden klinischen Validierung lässt sich die Prävalenz anhand von Abrechnungsdaten nicht präzise bestimmen.

7 citations