Showing papers in "Current Medical Research and Opinion in 2018"
TL;DR: Identifying patients progressing to APD and suitable for device-aided therapies will enable general neurologists to assess the need for referral to movement disorder specialists and improve the quality of care and patient outcomes.
Abstract: Background: Lack of a global consensus on the definition of advanced Parkinson’s disease (APD) and considerations for timing of device-aided therapies may result in heterogeneity in care.Objectives...
127 citations
TL;DR: Examples of TM presented in this article support the argument for the formation of more TM networks on the local and regional levels and require further study to identify the economic and social impact of TM.
Abstract: Introduction: Patients with complex medical and surgical problems often travel great distances to prestigious university medical centers in search of solutions and in some cases for nothing more th
101 citations
TL;DR: A systematic literature review was conducted comparing different approaches estimating persistence and adherence in chronic diseases with polypharmacy of oral and subcutaneous treatments, recommending proportion of days covered (PDC) as a gold standard calculation method for long-term treatments.
Abstract: Objectives: A systematic literature review was conducted comparing different approaches estimating persistence and adherence in chronic diseases with polypharmacy of oral and subcutaneous treatments.Methods: This work followed published guidance on performing systematic reviews. Twelve electronic databases and grey literature sources were used to identify studies and guidelines for persistence and adherence of oral and subcutaneous therapies in hypercholesterolemia, type 2 diabetes, hypertension, osteoporosis and rheumatoid arthritis. Outcomes of interest of each persistence and adherence data collection and calculation method included pros: accurate, easy to use, inexpensive; and cons: inaccurate, difficult to use, expensive.Results: A total of 4158 records were retrieved up to March 2017. We included 16 observational studies, 5 systematic reviews and 7 guidelines, in patients with hypercholesterolemia (n = 8), type 2 diabetes (n = 4), hypertension (n = 2), rheumatoid arthritis (n = 1) and mixed ...
78 citations
TL;DR: The widespread cellular and physiological effects of iron deficiency highlight the need for early detection and treatment ofIron deficiency, both to ameliorate these non-erythropoietic effects, and to avoid progression to iron deficiency anemia.
Abstract: Objective: To consider the key implications of iron deficiency for biochemical and physiological functions beyond erythropoiesis.Methods: PubMed was searched for relevant journal articles published up to August 2017.Results: Anemia is the most well-recognized consequence of persisting iron deficiency, but various other unfavorable consequences can develop either before or concurrently with anemia. Mitochondrial function can be profoundly disturbed since iron is a cofactor for heme-containing enzymes and non-heme iron-containing enzymes in the mitochondrial electron transport chain. Biosynthesis of heme and iron-sulfur clusters in the mitochondria is inhibited, disrupting synthesis of compounds such as hemoglobin, myoglobin, cytochromes and nitric oxide synthase. The physiological consequences include fatigue, lethargy, and dyspnea; conversely, iron repletion in iron-deficient individuals has been shown to improve exercise capacity. The myocardium, with its high energy demands, is particularly at r...
74 citations
TL;DR: Despite the availability of approved asthma treatments, this literature analysis confirms that SUA poses a substantial epidemiologic, clinical, humanistic, and economic burden.
Abstract: Objective: This study sought to characterize the epidemiologic, clinical, humanistic, and economic burden of patients with asthma uncontrolled by GINA Steps 4 or 5 treatment (severe, uncontrolled a...
60 citations
TL;DR: This commentary critically analyze the evidence regarding the use of QIs in acute POPM based upon the experience of pain specialists from Europe and the USA who are members of the Change Pain Advisory Board.
Abstract: Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient pain assessments and sub-optimal treatment. Effective monitoring of POPM is essential to enable policy makers and healthcare providers to improve the quality of care. Quality indicators (QIs) are quantitative measures of clinical practice that can monitor, evaluate and guide the quality of care provided to patients. QIs can be used to assess various aspects relating to the care process and they have proven useful in improving health outcomes in diseases such as myocardial infarction. In this commentary we critically analyze the evidence regarding the use of QIs in acute POPM based upon the experience of pain specialists from Europe and the USA who are members of the Change Pain Advisory Board. We also undertook a literature review to see what has been published on QIs in acute pain with the goal of assessing which QIs have been developed and used, and which ones have been successful/unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly trained, multidisciplinary team and it is at this level that major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving clinical outcomes. Changes in structure and processes to deliver high-level quality care need to be regularly audited to ensure translation into better outcomes. QIs can help drive this process by providing an indicator of current levels of performance. In addition, outcomes QIs can be used to benchmark levels of performance between different healthcare providers.
58 citations
TL;DR: An estimated 3.7 million US adults had hyperkalemia in 2014, and this prevalence rate has increased since 2010, with higher rates observed in patients with chronic kidney disease, heart failure, diabetes and hypertension.
Abstract: Objective: The retrospective study aimed to estimate prevalence of hyperkalemia using a large US commercial claims database.Methods: Adults with serum potassium lab data (2010 to 2014) and ≥1 calendar year of data were included from a large US commercial claims database. Hyperkalemia was defined as ≥2 serum potassium measurements >5.0 mEq/L or one hyperkalemia diagnosis code (ICD-9-CM, 276.7) or one sodium polystyrene sulfonate fill. Hyperkalemia prevalence was estimated for the overall population and subgroups with hyperkalemia-related comorbidities by calendar year. Hyperkalemia prevalence was also standardized to the US population to estimate the number of US adults with hyperkalemia.Results: The analysis included 2,270,635 patients (2010–2014). The annual prevalence of hyperkalemia in the overall population was 1.57% in 2014, with higher rates observed in patients with chronic kidney disease (CKD), heart failure, diabetes and hypertension. Among patients with CKD and/or heart failure, the 2014...
57 citations
TL;DR: Cl cladribine tablets are a comparatively effective and safe alternative to other DMTs in both active RRMS and HRA + DAT populations, and overall adverse event risk for cladribin tablets did not differ significantly from that of placebo and most alternative D MTs.
Abstract: Objective: To assess the comparative efficacy and safety of cladribine tablets versus alternative disease modifying treatments (DMTs) in patients with active relapsing–remitting multiple sclerosis (RRMS), and in a subgroup with high disease activity (HRA + DAT), using systematic literature review (SLR) and network meta-analysis (NMA).Methods: MEDLINE, Embase, MEDLINE In-Process and CENTRAL databases were systematically searched to identify English-language publications of relevant studies of approved DMTs for RRMS. Searches were conducted from database inception to January 2017. Conference websites and trial registries were also searched. NMA considered the effects of DMTs on annualized relapse rate (ARR), confirmed disease progression (CDP), no evidence of disease activity (NEDA) and safety.Results: Of 10,825 articles retrieved and screened, 44 studies assessing 12 DMTs contributed to the NMA. In patients with active RRMS, cladribine tablets were associated with a significant 58% reduction in ARR...
53 citations
TL;DR: Early intervention plays an important role in preventing pain chronification and, as key influencers in the management of patients with acute pain, it is critical that primary care physicians are equipped with the necessary awareness, education and skills to manage pain patients appropriately.
Abstract: Objective: Pain is one of the most common reasons for an individual to consult their primary care physician, with most chronic pain being treated in the primary care setting. However, many primary ...
48 citations
TL;DR: Ovulation day varies considerably for any given menstrual cycle length, thus it is not possible for calendar/app methods that use cycle-length information alone to accurately predict the day of ovulation.
Abstract: Objective: The accuracy of prediction of ovulation by cycle apps and published calendar methods was determined by comparing to true probability of ovulation.Methods: A total of 949 voluntee...
46 citations
TL;DR: VAT was more strongly associated with insulin resistance than SAT in Chinese subjects with pre-diabetes, and that of SAT was lost in multiple regression analysis.
Abstract: Aims: To investigate the value of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in a cohort of a community’s residents who were diagnosed as pre-diabetes, and to evaluate the association of VAT and SAT with insulin resistance.Methods: This study was based on cross-sectional analysis of data from 107 adults. VAT and SAT were assessed by computed tomography. Insulin resistance was defined by homeostasis model assessment of insulin resistance >2.69. The relationship of VAT and SAT with insulin resistance were examined by linear regression. Logistic regression was used to analyze the association of VAT and SAT with insulin resistance.Results: A total of 87 subjects had VAT ≥100 cm2. Thirty-six out of 107 (33.6%) subjects were detected to have insulin resistance, 71 were normal (66.4%), and all had insulin resistance with VAT ≥100 cm2. VAT (r = 0.378, p < .001) and SAT (r = 0.357, p < .001) were significantly and positively correlated with insulin resistance. In multiple regressio...
TL;DR: Dulaglutide was associated with a significant decrease in HbA1c levels 6 months after treatment initiation, and patients who adhered to or persisted with dulagLutide therapy, or were naïve to GLP-1 RA use, experienced greater decreases in HBA1C levels.
Abstract: Objectives: To assess glycemic effectiveness, adherence and persistence within 6 months of treatment initiation with dulaglutide, a once weekly GLP-1 receptor agonist, in a US real-world setting.Me...
TL;DR: Cancer nanomedicine emerged as an alternative treatment option that uses specific drug-delivery systems, improves efficacy of drugs and reduces detrimental side effects to normal tissues in the last decade.
Abstract: Purpose: Cancer remains a significant cause of morbidity and mortality across the globe. A recent report suggests around 14.1 million new cases and 8.2 million cancer-related deaths, which are expe...
TL;DR: DOACs were associated with lower or similar risk of major bleeding compared with warfarin in NVAF patients, and Apixaban was associated with a significantly lower risk ofmajor bleeding than other DOACs.
Abstract: Objective: To conduct a systematic literature review (SLR) and network meta-analysis (NMA) of real-world studies comparing major bleeding risk among patients with non-valvular atrial fibrillation (NVAF) on direct oral anticoagulants (DOACs) or warfarin.Methods: Systematic searches were conducted in MEDLINE and Embase for full-text articles published between January 1, 2003 and March 18, 2017. Eligible studies compared at least two of the following in a real-world setting: warfarin, apixaban, dabigatran, rivaroxaban, or edoxaban. A Bayesian NMA was conducted to estimate hazard ratios (HRs) for major bleeding using a random-effects model.Results: Eleven studies were included in the NMA. Nine studies included DOACs vs Warfarin comparisons, and four studies included DOACs vs DOACs comparisons (two studies included both comparisons). Median follow-up duration ranged from 2.6–31.2 months. No evidence was identified for edoxaban. Apixaban was associated with a significantly lower risk of major bleeding c...
TL;DR: Adjunctive brexpiprazole 2−3 mg/day improved symptoms of depression compared with adjunctive placebo in patients with MDD and an inadequate response to ADTs, and was well tolerated with no unexpected side effects.
Abstract: Objective: To assess the efficacy, safety, and tolerability of brexpiprazole as adjunctive treatment in adults with major depressive disorder (MDD) and an inadequate response to prior antidepressant treatment (ADT).Methods: Patients with a current major depressive episode after prior treatment with 1−3 ADTs entered an 8- or 10-week prospective treatment phase in which they received double-blind placebo adjunct to open-label ADT. Inadequate responders were randomized (2:2:1) to brexpiprazole 2−3 mg/day, placebo, or quetiapine extended-release (XR) 150−300 mg/day, adjunct to the same ADT, for 6 weeks. The primary efficacy endpoint was the change from baseline (randomization) to week 6 in Montgomery−Asberg Depression Rating Scale (MADRS) total score. The key secondary efficacy endpoint was the change in Sheehan Disability Scale (SDS) mean score.Results: Adjunctive brexpiprazole showed a greater improvement in MADRS total score than adjunctive placebo (least squares mean difference [95% confidence int...
TL;DR: Adherence to NOACs for both 6 months and prolonged use (up to 12 months) was associated with a reduction in IS and DVTPE risk, but did not substantially increase risk of MB.
Abstract: Objectives: Our study examined the impact of adherence to novel oral anticoagulants [NOACs - dabigatran and rivaroxaban] on ischemic-stroke (IS), major-bleeding (MB), deep-vein-thrombosis and pulmo...
Nanjing University1, Sun Yat-sen University2, Nanjing Medical University3, Tianjin Medical University4, Southeast University5, Peking University6, Southern Medical University7, Central South University8, Peking Union Medical College9, Xiamen University10, Shanghai Jiao Tong University11, Fudan University12
TL;DR: High prevalence of total VC in Chinese CKD patients will supplement current knowledge, which is mostly limited, contributing in creating awareness and optimizing VC management.
Abstract: Objective: With limited data available on calcification prevalence in chronic kidney disease (CKD) patients on dialysis, the China Dialysis Calcification Study (CDCS) determined the prevalence of v...
TL;DR: The results emphasize the impact of atopic dermatitis, especially mild atopic skinitis, on patient lives and finances, including education of clinicians, payers, and patients regarding benefits associated with treatment adherence.
Abstract: Objective: To present a systematic review of studies conducted to evaluate patient impact and economic burden of mild-to-moderate atopic dermatitis.Methods: A MEDLINE (via PubMed), Excerpta...
TL;DR: The results of this large population-based study suggested an improvement in OS among patients with a GBM diagnosis in 2010–2012 compared to 2006–2008, indicating a possible benefit of bevacizumab in this population.
Abstract: Objective: Glioblastoma (GBM) is an aggressive disease with limited therapeutic options. While bevacizumab was approved in 2009 for the treatment of patients with progressive GBM, its impact on overall survival (OS) remains unclear. Using US population-based cancer registry data (SEER), this study compared OS of patients diagnosed with GBM before and after bevacizumab approval.Methods: Adult patients from SEER with a GBM diagnosis were divided into two cohorts: patients diagnosed in 2006–2008 (pre-bevacizumab cohort, n = 6,120) and patients diagnosed in 2010–2012 (post-bevacizumab cohort, n = 6,753). Patients were included irrespective of the treatments received. OS post-diagnosis was compared between the study cohorts utilizing Kaplan-Meier analyses and multivariate Cox proportional hazards regression.Results: Among 12,873 patients with GBM, the median age was 62 years, 41% were women, 31% underwent gross total resection, and 75% received radiation therapy. Survival was stable within the 2006–200...
TL;DR: Estimating the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T1DM using basal-bolus insulin found the burden associated with SHO is not negligible and reducing SHO events can help decrease the burden related to SHO among patients withT1DM.
Abstract: Aims: Approximately 1.25 million people in the US have type 1 diabetes mellitus (T1DM), a chronic metabolic disease that develops from the body’s inability to produce insulin, and requires life-long insulin therapy. Poor insulin adherence may cause severe hypoglycemia (SHO), leading to hospitalization and long-term complications; these, in turn, drive up costs of SHO and T1DM overall. This study’s objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T1DM using basal-bolus insulin.Methods: Using Truven MarketScan claims, we identified adult T1DM patients using basal-bolus insulin regimens who were hospitalized for SHO (inpatient SHO patients) during 2010–2015. Two comparison groups were defined: those with outpatient SHO-related encounters only, including emergency department (ED) visits without hospitalization (outpatient SHO patients), and those with no SHO- or acute hyperglycemia-related events (comparison pa...
TL;DR: Although not sufficient by themselves to prevent prescription opioid abuse and misuse, opioid ADFs are an important component of a healthcare provider’s comprehensive opioid risk management plan.
Abstract: Objective: Abuse and misuse of prescription opioids is a significant public health concern. This review examines the strategies used to confer abuse-deterrent properties on opioid abuse-deterrent formulations (ADFs), the characteristics and supporting data for each of the available ADFs, and the role of opioid ADFs as part of a comprehensive opioid risk management plan.Methods: A PubMed search was performed for articles published within the last 10 years using the search terms “abuse deterrent opioids”. Articles were limited to clinical studies and reviews focusing on United States (US) Food and Drug Administration (FDA)-approved opioid ADFs in the US.Results: There are currently nine extended-release and one immediate-release opioid pain medications with US FDA-approved ADF labelling. All use either physical and chemical barriers or agonist/antagonist combinations to deter manipulation and abuse. Evidence is mounting that introduction of opioid ADFs has been associated with decreased rates of abu...
TL;DR: Lebanese pharmacists have the required knowledge and positive attitude to start reporting ADRs, were aware of ADRs occurring with various medicines post-marketing, yet were currently not able to disseminate this information widely or to record it centrally, emphasizing the importance of establishing a national ADR reporting system.
Abstract: Background: The effectiveness of a national post-marketing surveillance program depends directly on the active participation of all health professionals. There is no current comprehensive and activ...
TL;DR: This survey of data provided by first-responder and community-based organizations indicated that NNS was successful at reversing the effects of opioid overdose in most reported cases.
Abstract: Objective: Naloxone hydrochloride, an opioid antagonist, has been approved as a concentrated 4 mg dose intranasal formulation for the emergency treatment of known or suspected opioid overdose This new formulation is easier to use and contains a higher dose of naloxone compared with earlier, unapproved kits A survey of first responders and community-based organizations was conducted to understand initial real-world experiences with this new formulation for opioid overdose reversalMethods: In August 2016, 152 US organizations known to have received units of the approved 4 mg dose/unit naloxone nasal spray (Narcan®1 nasal spray 4 mg; NNS) were surveyed regarding experiences using this formulation and availability of recorded data on these cases Descriptive statistics were calculated based on the number of responses received for each itemResults: Eight first-responder or community-based organizations provided case report data on 261 attempted overdose reversals using NNS, with survival reported f
TL;DR: Development of AKI is associated with increased odds of various post-operative complications and long-term renal insufficiency and mortality, and age and pre-operative hematocrit <30% were independent predictors of progression to CKD.
Abstract: Objective: To identify factors associated with acute kidney injury (AKI) and its progression to chronic kidney disease (CKD) in a non-cardiac/non-vascular surgery setting.Methods: This study examin...
TL;DR: Once-weekly semaglutide treatment is significantly better compared to SGLT-2is in achieving adequate glycemic control in T2D patients inadequately controlled with metformin monotherapy.
Abstract: Objective: Treatment intensification with additional anti-diabetic agents is recommended in type 2 diabetes (T2D) for patients inadequately controlled on metformin monotherapy. The present ...
TL;DR: The NNT and incremental cost per responder are meaningful ways to assess comparative effectiveness and cost effectiveness among psoriasis treatments.
Abstract: Background: The clinical benefits of biologic therapies for moderate-to-severe psoriasis are well established, but wide variations exist in patient response.Objectives: To determine the number need...
TL;DR: The results of the studies suggest that a prandial GLP-1 RA as an add-on to basal insulin may be a safe and effective treatment intensification option (vs basal-plus or basal-bolus insulin).
Abstract: Background: Diabetes mellitus is a serious and increasingly prevalent condition in Canada and around the world. Treatment strategies have become increasingly complex, with a widening array of pharmacological agents available for glycemic management in type 2 diabetes mellitus (T2DM). New therapies that act in concert with available basal insulins may represent alternatives to basal insulin intensification with prandial or pre-mixed insulin. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have recently shown promise as useful additions to basal insulin, with significant reductions in glycated hemoglobin and potentially beneficial effects on body weight. This review will focus on pivotal clinical trials to assess the potential benefits of adding prandial GLP-1 RAs to basal insulin in patients with T2DM.Methods: Clinical studies combining prandial GLP-1 RAs and basal insulin (published between 2011 and July 2017) were identified and reviewed in PubMed, the Cochrane Central Register of Clinical ...
TL;DR: The many variations in programming that need to be further tested to establish the benefits of PIEB delivery compared with traditional CEI with PCEA are emphasized.
Abstract: Background and objectives: Programmed intermittent epidural bolus (PIEB) is a delivery mode associated with decreased local analgesia dosing, motor block, and physician-administered top-ups (PATUs) during labor analgesia. We hypothesized that PIEB delivery at different settings will result in fewer PATUs for labor analgesia than the same hourly volume of a continuous epidural infusion (CEI).Methods: “Before and after” study design of combined spinal–epidural (CSE) for labor, with bupivacaine 0.0625%–fentanyl 2 mcg/ml and patient-controlled epidural analgesia (PCEA; 5 ml bolus with 10 min lock-out). The “before” group (N = 120) received a CEI at 10 ml/hour. PIEB groups received a programmed bolus of 10 ml: every 60 min (PIEB60, N = 120), every 45 min (PIEB45, N = 140), or every 45 min with high flow (500 ml/hour) (PIEB45HF, N = 25).Main outcome measures: Number of women requesting a PATU, time intervals from CSE to PATU and to delivery, and obstetric outcomes.Results: There was no difference in the...
TL;DR: It is indicated that MACE rates observed in real-world studies are substantially higher than those reported in RCTs, suggesting that the secondary MACE burden and potential benefits of effective CVD management in ASCVD patients may be underestimated if real- world data are not taken into consideration.
Abstract: Objective: Based on randomized controlled trials (RCTs), non-fatal myocardial infarction (MI) rates range between 9 and 15 events per 1000 person-years, ischemic stroke between 4 and 6 per 1000 per...
TL;DR: A meta-analysis of randomized controlled trials found that tyrosine kinase inhibitors significantly improved PFS and RR in patients with advanced or metastatic DTC or MTC and recommends thoroughly evaluating patients’ health status and cautiously using TKIs to maximize their benefits and minimize their toxicity.
Abstract: Background and aims: Radioiodine-refractory advanced or metastatic thyroid cancer has poor prognosis. We conducted a meta-analysis of randomized controlled trials to evaluate the effectiveness and safety of tyrosine kinase inhibitors (TKIs) for advanced or metastatic thyroid cancer treatment.Methods: Studies published up to April 2017 were selected. The pooled effect size was calculated through meta-analysis by using random effects models. Outcomes were overall survival (OS), progression-free survival (PFS), objective response rate (RR), and adverse events (AEs).Results: Six studies examining 1615 patients were included. TKI treatment significantly improved PFS in patients with differentiated thyroid cancer (DTC; hazard ratio [HR] = 0.43; 95% confidence interval [CI], 0.23–0.82) and those with medullary thyroid cancer (MTC; HR = 0.36; 95% CI, 0.22–0.58). TKI treatment significantly prolonged OS in patients with DTC (HR = 0.74; 95% CI, 0.58–0.95). The TKI treatment group exhibited a significantly i...