Influence of treatment of vulvovaginal atrophy with intravaginal prasterone on the male partner.

OBJECTIVE: The aim was to analyze the opinion of the male partner of women treated for vulvovaginal atrophy (VVA) with intravaginal 0.50% DHEA (prasterone), thus providing information on both members of the couple. METHODS: On a voluntary basis, in a prospective, randomized, double-blind and placebo-controlled phase-III clinical trial, the male partner filled a questionnaire at baseline and at 12 weeks stating his observations related to his penis and intercourse before and after VVA treatment. RESULTS: Sixty-six men having a partner treated with intravaginal DHEA and 34 others having a partner treated with placebo answered the questionnaires. Concerning the feeling of vaginal dryness of their female partner, the severity score following DHEA treatment improved by 81% (0.76 units) over placebo (p = 0.0347). Thirty-six percent of men having a partner treated with DHEA did not feel the vaginal dryness of the partner at the end of treatment compared to 7.8% in the placebo group. When analyzing the situation at 12 weeks compared to baseline, an improved score of 1.09 units was the difference found for the DHEA group compared to 0.76 for the placebo group (p = 0.05 vs. placebo). In the DHEA group, 38% of men scored very improved compared to 18% in the placebo group. No adverse event has been reported. CONCLUSION: The male partner had a very positive evaluation of the treatment received by his female partner.

Population-based risk factors and resource utilization for HCC: US perspective.

OBJECTIVE: Hepatocellular carcinoma (HCC) is a deadly cancer with limited treatment options. HCC cases in the United States (US) were identified from a claims database to analyze the risk factors, the health care provider referral patterns, and treatment options in actual (real-world) clinical settings. METHODS: MarketScan, a health care claims database from Thomas Reuters covering 18 million lives yearly and all US census regions from 2002 to 2008, was used to identify HCC patients and obtain data on patient characteristics, health care providers, and treatment utilization (i.e., medications, interventions). RESULTS: HCC cases (n = 4406) were identified with an annual incidence of 0.4 per 1000 covered lives (i.e., those currently enrolled in a health care plan) from 2002 to 2008. Nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) was the most common underlying etiologic risk factor (59%), followed by diabetes (36%) and hepatitis C virus infection (22%). Primary care/internal medicine providers managed the majority of cases (55%); a minority were seen by an oncologist (24%). Only 22% of cases known to have cirrhosis were undergoing HCC screening prior to diagnosis. Type of provider did not change significantly after the diagnosis was made. Systemic chemotherapy was the most commonly used treatment (32.8%); however, only 6% received sorafenib, the only approved drug for HCC. Limitations include lack of patient records and potential for physician coding variances. CONCLUSION: The incidence of HCC in the database was 0.4 per 1000 persons. NAFLD/NASH and type 2 diabetes mellitus, along with hepatitis C virus infection, were the major etiologic risk factors associated with HCC. This claims database analysis suggests a gap exists between screening and treatment guidelines and practice patterns, implying a need for greater health care provider awareness and education.