A retrospective database analysis on persistence with inhaled corticosteroid therapy: comparison of two dry powder inhalers during asthma treatment in Germany.

BACKGROUND: Asthma is one of the most common chronic diseases worldwide. Patient persistence with treatment is essential to achieve sufficient outcomes, in particular to avoid exacerbations. OBJECTIVE: To investigate inhaled corticosteroid (ICS) therapy with two different inhalers (Novolizer® and Turbuhaler®) by comparing persistence, concomitant use of additional asthma medication and occurrence of exacerbations in real life. STUDY DESIGN: A retrospective analysis of prescription data from outpatient treatment was performed using the IMS Disease Analyzer. It provides longitudinal anonymized patient data from ~ 3,000 office-based physicians in Germany. Treatment persistence of asthma patients (ICD 10 code: J45) using 200 µg budesonide either via Novopulmon®/Budecort® (Novolizer group = NOV) or Pulmicort® (Turbuhaler group = TUR) was compared. Eligible patients hadthe first prescription of ICS medication (index day) between June 2001 and September 2007 and a data history available for at least twelve months before and after the index day. RESULTS: Analysis of 1,780 NOV and 664 TUR patients revealed that 1 year after index day, 89% NOV patients remained on their ICS compared to 85% TUR patients. NOV patients changed significantly less often and later to another ICS (p = 0.0108; log-rank test). Significantly fewer NOV patients switched temporarily or permanently to another ICS during the observation time (NOV group: 14.7%; TUR group: 20.8%; p = 0.0002, log-rank test). On average, NOV and TUR patients received comparable prescriptions of short acting medication (NOV more SABA, TUR more formoterol). There was a trend towards fewer prescriptions of systemic corticosteroids in NOV patients. CONCLUSIONS: Our results suggest better therapy persistence with NOV compared to TUR during asthma treatment in Germany. This can be a marker of better compliance and may contribute to prevent exacerbations. However, the number of exacerbations per patient year in the NOV group (0.12) compared to the TUR group (0.18) was not statically significantly lower (p = 0.4096).

Effects of selected antidiabetics on weight loss--a retrospective database analysis.

AIMS: In published studies metformin was often associated with weight loss in type 2 diabetes patients. Until now, no epidemiological studies have directly compared the effects of DPP-4 and GLP-1 versus metformin on weight loss. Our study is a comparison of sulfonylurea, DPP-4 and GLP-1 with metformin regarding body weight in type 2 diabetes patients. METHODS: Data from 2641 patients initiated therapy with either metformin, sulfonylurea, DPP-inhibitors or GLP-1 with baseline BMI >30 were retrospectively analyzed (Disease Analyzer Germany: 11/2008-10/2012). Comparison was performed for the weight change after 1 year of therapy compared with the last value prior to therapy. Differences between SU, DPP-4, GLP-1 versus metformin were estimated using regression model adjusted for age, gender, health insurance status, defined co-diagnoses and body weight at baseline. RESULTS: In absolute values, metformin patients lost an average of 2.6 kg, subjects treated with SU gained 0.3 kg, body weight in the DPP-4 group decreased by 1.8 kg and GLP-1 patients lost 3.3 kg in body weight after 1 year. After adjustment for other variables, comparisons with metformin revealed the following results: SU +3.4 kg (p < 0.001), DPP-4 +1.0 kg (p = 0.003) and GLP-1 -0.4 kg (p = 0.589). CONCLUSION: Our study showed that GLP-1 treatment was comparable to metformin regarding the weight reduction, while sulfonylurea and DPP-4 are inferior in this regard.

Which adverse effects influence the dropout rate in selective serotonin reuptake inhibitor (SSRI) treatment? Results for 50,824 patients.

BACKGROUND: Nowadays, selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants due to their superior clinical efficacy, effectiveness, tolerability, and safety as compared to tricyclic antidepressants or monoamino oxidase inhibitors. However, despite these advantages SSRIs are still associated with a number of adverse drug reactions, especially in the early stages of treatment, which may lead to premature discontinuation of therapy in some cases. The aim of the present study was to assess the most common adverse drug reactions of SSRIs as well as their impact on dropout rate in a large study population. PATIENTS AND METHODS: Data for 50,824 patients treated for major depressive disorder with SSRIs for the first time was accessed via the Disease Analyzer database (IMS Health, Germany), providing information on SSRI adverse drug reactions and their influence on premature treatment discontinuation calculated by regression analysis. The presence of certain co-morbidities was also registered. RESULTS: The mean age was 54.5 ± 19 years, two-thirds of the study population being female. The adverse effects mentioned most frequently were: "discomfort" of the digestive system (10%), sleep disorders (8.6%), and heart rhythm disorders (4%); however, these were of tolerable severity as they did not significantly influence the dropout rate. Contrary to that, somnolence and younger age (≤50 years) in particular increased the chance of premature treatment discontinuation, while patients suffering from cardiovascular risk factors or osteoporosis tended to adhere to the therapy. CONCLUSIONS: Overall, there is high tolerability for early SSRI treatment, whereas the occurrence of somnolence leads to discontinuation.

Risk of psychiatric and neurological diseases in patients with workplace mobbing experience in Germany: a retrospective database analysis.

INTRODUCTION: The number of mobbing experiences recorded has increased during recent years and it has now been established as global phenomenon among the working population. The goal of our study was to analyze the incidence of certain neurologic and psychiatric diseases as a consequence of mobbing as compared with a control group and to examine the possible influence of previous diseases that occurred within one year before the first mobbing documentation on the incidence of mobbing. MATERIAL & METHODS: We used a large database (IMS® Disease Analyzer, Germany) to collect data from general practitioners in Germany from 01/2003 until 12/2012. Based on age, gender, and health insurance, patients with experience of mobbing were matched with a control group of patients who had not reported workplace mobbing and who were being treated by the same physicians. At first, diseases that occurred within one year before the bullying experience took place ("index date") were noted and compared to a control group of similar composition in terms of gender, age, and health insurance. Subsequently, the prevalence of depression, anxiety, somatoform disorders, and sleep disorders following experiences of mobbing were determined. After adjustment to take into account the odds of bullying, the ratios of these diseases were assessed using a logistic regression model. RESULTS: The study population consisted of n=2,625 patients and n=2,625 controls, of which 33% were men. The number of cases of bullying documented rose continuously from 2003 to 2011 and remained high in 2012. Those who would later become victims of mobbing demonstrated a considerably higher prevalence of diseases in general - these diseases were not confined to the neurologic-psychiatric spectrum. Following experiences of bullying, depression, anxiety, somatoform disorders, and sleep disorders were significantly more prevalent than in the control group (for all, p<0.05). Similarly, odds ratios (OR) representing the risk of suffering from diseases were higher in affected patients, with the highest value (4.28) for depression and the lowest value for sleep disorders (OR=2.4). CONCLUSION: Those who will later become the victims of bullying are more prone to suffer from diseases in general, even before this experience of mobbing has occurred, which underlines the importance of supporting (chronically) ill patients to protect them against bullying. Sequelae of mobbing include, in particular, diseases from the neurologic-psychiatric spectrum.