Uptake of HPV vaccination among boys after the introduction of gender-neutral HPV vaccination in Germany before and during the COVID-19 pandemic.

BACKGROUND: HPV vaccination has been recommended and reimbursed for girls in Germany since 2007. In June 2018 the German Standing Committee on Vaccination (STIKO) recommended the gender-neutral vaccination of adolescents aged 9 to 14 years with catch-up through age 17. Objectives of this study were to describe the uptake of vaccination in boys before and during the COVID-19 pandemic. METHODS: The study used data from a proprietary electronic medical record database and a database with information on nationally dispensed vaccine doses. The monthly number of first doses of HPV vaccinations in boys and girls aged 9-17 years in the period from 01/2018 to 12/2021 was determined. In addition, for boys the cumulative vaccination rates were calculated for initiated and completed vaccination series. RESULTS: Four months after the introduction of mandatory reimbursement for boys, the monthly numbers of first doses were comparable to that of girls. Compared to the same month in 2019, the number of first doses declined by up to 49% (girls) in 2020 and 71% (boys) in 2021. At the end of 2021, the vaccination rate for 15-year-old boys (2006 birth cohort) reached 44.4% for initiated and 26.4% for completed series. CONCLUSION: After an initial dynamic increase in HPV vaccinations in boys, the impact of COVID-19 was particularly strong in the second year of the pandemic. At the end of 2021 vaccination rates were still low. Efforts are needed to catch-up on adolescents that missed doses during the pandemic and to increase uptake.

Investigation of the representativeness of the German IQVIA Vaccine Analyzer database.

PURPOSE: The aim of this study was to investigate the representativeness of the German IQVIA Vaccine Analyzer (VA) database with respect to vaccination rates in Germany. MATERIALS AND METHODS: Descriptive statistics for the demographic characteristics of the patients like gender and age distribution and vaccination rates of various types of vaccinations in children, adolescents, and adults were calculated and compared to official data sources in Germany. The vaccination rates were calculated as the ratio between extrapolated vaccinated patient numbers from the database and official population counts from the Federal Statistical Office. RESULTS: The sex distribution for patients attending general practitioners (GPs) and those attending pediatricians was similar to the German population. The age distribution of the adult German population was comparable to that of the GP and gynecologist patients included in our study. There was good agreement between vaccination rates for diphtheria, tetanus, pertussis, and poliomyelitis in this study (79%) and the rates for the general population according to official sources (78%). HPV vaccination rates in boys in 2018/2019 (1.9%) were also close to the German national rate of 1.3% of all boys reported at the end of 2018. This study found slightly higher vaccination rates for influenza in adults aged over 60 (46%) than the national rate (39%). CONCLUSION: The study indicates good accordance between the VA and official reference data for different vaccination rates, especially for children, and indicates that the VA database is suitable for epidemiological studies on vaccines.

Association Between Psoriasis and Dementia: A Retrospective Cohort Study.

Background: To date, no large study has examined the relationship between psoriasis and dementia in Germany. Objective: The aim of this study was to assess the association between psoriasis and the risk of all-cause dementia in patients followed in general practices in Germany. Methods: This retrospective cohort study is based on longitudinal data from the IQVIATM Disease Analyzer database and included patients with an initial diagnosis of psoriasis between January 1995 and December 2014 in 1,173 general practices in Germany. Patients without psoriasis were matched individually (1:1) to psoriasis patients using propensity scores. The main outcome of the study was the cumulative incidence of dementia diagnoses within up to 15 years of the index date. Univariate Cox proportional regression models were used to assess the relationship between psoriasis or psoriatic arthritis and dementia. Results: The present study included 10,583 patients with a diagnosis of psoriasis and 10,583 controls without psoriasis. After 15 years of follow-up, 22.0% of the psoriasis patients and 19.1% (p < 0.001) of the non-psoriasis patients developed dementia. The incidence rate of dementia in 1,000 person-years was 15.0 in psoriasis patients and 11.9 in the non-psoriasis cohort. Psoriasis was significantly associated with a dementia risk (HR: 1.24; 95% CI: (1.14-1.35); p < 0.001). The association was stronger in patients with PsA (HR: 1.35; 95% CI: (0.98-1.86)) but this was not significant (p = 0.070). Conclusion: The present study found a positive association between psoriasis and all-cause dementia in patients in general practices in Germany.

Incidence of Newly-Diagnosed Dementia After COVID-19 Infection versus Acute Upper Respiratory Infection: A Retrospective Cohort Study.

BACKGROUND: There is emerging evidence that coronavirus disease 2019 (COVID-19) is giving rise to seemingly unrelated clinical conditions long after the infection has resolved. OBJECTIVE: The aim of this study is to examine whether COVID-19 is associated with an increased risk of dementia including Alzheimer's disease. METHODS: This retrospective cohort study is based on longitudinal data from the IQVIATM Disease Analyzer database and included patients aged≥65 with an initial diagnosis of COVID-19 or acute upper respiratory infection (AURI) from 1,293 general practitioner practices between January 2020 and November 2021. AURI patients were matched 1 : 1 with COVID-19 patients using propensity scores based on sex, age, index quarter, health insurance type, the number of doctor visits, and comorbidities associated with dementia risk. Incidence rates of newly-diagnosed dementia were calculated using the person-years method. Poisson regression models were used to compute the incidence rate ratios (IRR). RESULTS: The present study included 8,129 matched pairs (mean age 75.1 years, 58.9% females). After 12 months of follow-up, 1.84% of the COVID-19 patients and 1.78% of the AURI patients had been diagnosed with dementia. The Poisson regression model resulted in an IRR of 1.05 (95% CI: 0.85-1.29). CONCLUSION: This study did not find any association between COVID-19 infection and one-year dementia incidence after controlling for all common risk factors for dementia. Because dementia is a progressive disease, which can be difficult to diagnose, a longer follow-up period might offer a better insight into a possible association between COVID-19 infection and an increased incidence of dementia cases in the future.

Dosing Patterns of Dulaglutide and Semaglutide in Patients with Type 2 Diabetes in the United Kingdom and Germany: A Retrospective Cohort Study.

INTRODUCTION: As new glucagon-like peptide 1 receptor agonist (GLP-1 RA) formulations are available, the aim of this study was to understand dulaglutide and subcutaneous (s.c.) semaglutide dosing patterns in people with type 2 diabetes mellitus (T2DM) in the UK and Germany as well as oral semaglutide in the UK. METHODS: Adults with evidence of T2DM and a prescription of dulaglutide or semaglutide between August 2020 and December 2021 were identified using the IQVIA Longitudinal Prescription Data (LRx). Patients were divided into cohort 1 (incident users) and cohort 2 (prevalent users) based on previous exposure to GLP-1 RAs and were followed up to 12 months post-index. RESULTS: During the patient selection window in Germany and the UK, 368,320 and 123,548 patients respectively received at least one prescription of a study GLP-1 RA. Among dulaglutide users in Germany at 12 months post-index, the 1.5-mg dosage formulation was the most common for both cohort 1 (65.6%) and 2 (71.2%). Among s.c. semaglutide users at 12 months post-index, 39.2% and 58.4% of cohort 1 received 0.5 mg and 1.0 mg, respectively. In the UK, at 12 months post-index, the most common dulaglutide dosage formulation was 1.5 mg (71.7% cohort 1 and 80.9% cohort 2). Among s.c. semaglutide users at 12 months post-index, 0.5- and 1.0-mg formulations were the most common for both cohort 1 (38.9% and 56.0%, respectively) and cohort 2 (29.5% and 67.1%, respectively). Prescribing of the more recently introduced 3.0- and 4.5-mg formulations for dulaglutide and oral semaglutide was also reported in the study. CONCLUSION: Dosing patterns of GLP-1 RAs, although similar between the UK and Germany, were heterogeneous over time. Given that the higher dulaglutide doses and oral semaglutide were recently introduced to the market, additional real-world evidence studies which include clinical outcomes is required.

Epidemiology and treatment of children with hereditary angioedema in Germany: A retrospective database study.

BACKGROUND: Hereditary angioedema (HAE) is a potentially life-threatening inherited disease that causes recurrent, serious, and debilitating episodes of swelling. While evidence has improved in adult patients, data on the epidemiology and treatment of pediatric patients with HAE remain very limited. The aim of this study was to determine the incidence and prevalence of pediatric patients with HAE aged <12 years, as well as treatment patterns, co-medication, and specialties involved. METHODS: In this retrospective study (2016-2021), the German IQVIATM pharmacy claims (LRx) database was used to analyze prescriptions of HAE-specific treatments and co-medications. RESULTS: We found an HAE prevalence in pediatric patients aged <12 years of 2.51:100,000 and a 12-month prevalence of up to 1.02:100,000 between 2016 and 2021. Most HAE treatments were prescribed by outpatient clinics and pediatricians, with an increasing proportion of icatibant as an on-demand treatment and low rates of long-term prophylaxis (LTP). The prescription rate of analgesics as the most common co-medication decreased notably after HAE diagnosis. CONCLUSION: Our findings provide insights into the epidemiology and current pediatric HAE treatment landscape in Germany. The obtained HAE prevalence in pediatric patients aged <12 years was even higher than the previously reported average of overall cohorts, whereas the LTP rate was low, which might indicate an unmet need for newer LTP treatment options in pediatric patients.

Metabolic syndrome in primary care: A latent variable analysis of electronic medical records.

BACKGROUND: The best definition of the metabolic syndrome (MetSyn) remains controversial. The aim was to develop a latent variable measurement model for the MetSyn using primary care data. METHODS: This retrospective case-control study was based on the data from the IQVIA Disease Analyzer (DA) database including a representative panel of general and internal medicine practices in Germany. 23,020 adult patients, who were newly diagnosed with ≥1 component of the MetSyn (cases; median age [IQR]: 60 [50-72] years; 54 % males) between January 2016 to December 2019, and 2,144 patients without any MetSyn component (controls; 48 [38-61] years; 45 % males) were included. MetSyn was modeled by ICD-10 codes (E66: obesity, I10: hypertension, E11: type 2 diabetes, E78: lipid disorders) and physiological measures (BMI, HbA1c, blood pressure, HDL-cholesterol, LDL-cholesterol, triglycerides). RESULTS: The covariance structure of the ICD codes and physiological measures could not be accounted for by a single MetSyn factor (root mean square error of approximation, RMSEA=0.085). Enrichment by another factor "Likelihood to Diagnose" significantly increased model fit with the observed data (RMSEA=0.054). "Likelihood to Diagnose" hardly correlated with MetSyn (r = 0.06), and was differentially associated with male sex, older age, and corresponding cardio- and cerebrovascular diseases. MetSyn showed the highest loading on four subordinate factors "hyperlipidemia" (0.70), "obesity" (0.66), "type 2 diabetes" (0.60), followed by "hypertension" (0.42). The ICD codes E66 and E78 were less indicative of these factors relative to BMI and triglycerides/HDL-cholesterol, respectively, whereas E11 and I10 were similarly indicative as their corresponding physiological measures. CONCLUSIONS: MetSyn was best indicated by BMI, triglycerides (an indirect marker of insulin sensitivity), HbA1c, and ICD-10 diagnosis E11 (type 2 diabetes). The factor "Likelihood to diagnose" probably constitutes a method factor of differential diagnosis systematically contributing to the common consistency of the MetSyn diagnosis in primary care.

Association Between Inflammatory Bowel Disease and Dementia: A Retrospective Cohort Study.

BACKGROUND: The critical role of inflammatory processes in the pathogenesis of dementia has recently been established. OBJECTIVE: The aim of this study was to investigate the association between inflammatory bowel disease (IBD) and dementia risk in patients followed in general practices in Germany. METHODS: This study included patients aged over 60 with an initial diagnosis of IBD (Crohn's Disease (CD), ulcerative colitis (UC)) who were followed in 1,159 German general practices between January 1995 and December 2014. IBD patients were matched to healthy patients using propensity scores based on age, gender, index year, insurance type and comorbidities. Kaplan-Meier curves were used to study the development of dementia in patients with or without IBD within up to 15 years of the index date. Cox proportional hazard regression models were used to estimate the relationship between IBD and dementia. RESULTS: The study included 3,850 patients with and 3,850 patients without IBD and revealed a higher cumulative incidence of dementia in IBD patients than in non-IBD patients after the follow-up period. The cumulative incidence of dementia differed within IBD subtypes; it was significantly higher in UC patients than in CD patients. Cox proportional hazard models showed that IBD is associated with a 1.22-fold increase in the risk (95% CI: 1,07-1,39) of developing dementia. UC patients had a 1.25-fold higher risk of developing dementia (95% CI: 1.07-1.46). CD is not significantly associated with an increased risk of dementia (HR: 1.17, 95% CI: 0.93-1.47). CONCLUSION: A positive association between IBD and dementia was found in patients followed in general practices in Germany.

Association Between Low-Density Lipoprotein Cholesterol Levels, Statin Use, and Dementia in Patients followed in German General Practices.

BACKGROUND: No studies have been conducted to date on the association between low-density lipoprotein cholesterol (LDL-C), statin use classified into low, medium, and high statin dosages, and dementia in German general practices. OBJECTIVE: The goal of this retrospective case-control study was to investigate the relationship between elevated LDL-C, statins, and dementia in elderly persons followed in general practices in Germany. METHODS: This study included patients aged 65 or older with an initial dementia diagnosis between January 2015 and December 2019 and at least one documented LDL-C value within the year prior to the dementia diagnosis. These patients were treated in one of 963 general practices which document LDL-C in Germany. Dementia cases were matched to non-dementia controls using propensity scores based on age, sex, and comorbidities. Logistic regression models were conducted to assess a possible association between accelerated LDL-C, statins, and dementia. RESULTS: The study included 12,236 patients with dementia and 12,236 non-dementia controls. In total, 2,528 of the dementia patients were diagnosed with vascular dementia. The use of all dosages of statin use was negatively associated with all-cause dementia (OR: 0.80 for low dose, OR: 0.92 for medium dose, and OR: 0.85 for high dose) and with vascular dementia (OR: 0.61 for low dose, OR: 0.77 for medium dose, and OR: 0.74 for high dose). There was no clinically relevant association between elevated LDL-C and dementia. CONCLUSION: A negative association was found between all dosage use of statin therapy and all-cause dementia and vascular dementia in elderly patients in general practices in Germany.