Treatment patterns and outcomes of patients with advanced malignant pleural mesothelioma in a community practice setting.

Aim: To assess real-world treatment patterns and outcomes among patients with advanced malignant pleural mesothelioma. Patients & methods: Retrospective database analysis. Results: In all, 469 patients received first-line systemic anticancer therapy (SACT) at community centers. Median follow-up from diagnosis was 11.6 months. Pemetrexed + platinum was the most common first-line SACT; similar proportions of patients received cisplatin or carboplatin with pemetrexed. Only a small proportion of patients received second- and third-line therapies. Median overall survival for first-line SACT was 12.0 months (95% CI: 10.7-14.2). Results were similar with pemetrexed + cisplatin and pemetrexed + carboplatin. Median overall survival with second-line SACT was 6.4 months (95% CI: 5.1-7.6). Conclusion: There is a need for more effective SACTs for advanced malignant pleural mesothelioma.

Lay abstract Real-world data on treatment patterns and outcomes among patients with advanced malignant pleural mesothelioma (MPM), largely a cancer of the lining surrounding the lungs, are limited. In this analysis based on patients treated in the USA, pemetrexed + cisplatin or pemetrexed + carboplatin was shown to be the most common treatment received by patients when first diagnosed with advanced MPM. Only a few patients received any subsequent treatments. Survival among patients receiving treatment was poor, with a median of approximately 12 months. Immunotherapy regimens are currently being investigated, with nivolumab + ipilimumab being the first immunotherapy regimen approved in October 2020 for the treatment of advanced MPM.

Evaluating patient adherence to antidepressant therapy among uninsured working adults diagnosed with major depression: results of the Texas Demonstration to Maintain Independence and Employment study.

This study examined antidepressant adherence and persistence among uninsured working adults diagnosed with major depression enrolled in the Texas Demonstration to Maintain Independence and Employment (DMIE) program. Antidepressant adherence was measured between intervention and control cohorts using proportion of days covered (PDC) during a 365-day observation period. Persistence examined duration of time from drug initiation to discontinuation based on a ≥35-day refill supply gap. Older, non-minority patients with higher education were more adherent or persistent to antidepressant therapy. Adjusting for covariates, results showed no significant difference in PDC at the end of 12-months between intervention and control participants (b = .07, P = .054, semi-partial η (2) = .02). Exploratory analysis found subgroup differences in PDC among the study recruitment cohorts. No significant difference between intervention and control groups was found in persistence between the groups. Follow-up investigation is planned to assess the longer term impact of the DMIE program on antidepressant adherence and persistence.

Examining the heterogeneity of treatment patterns in attention deficit hyperactivity disorder among children and adolescents in the Texas Medicaid population: modeling suboptimal treatment response.

Objectives: To examine suboptimal responses (SR) in attention deficit hyperactivity disorder (ADHD) among pediatric patients in the Texas Medicaid program receiving osmotic-release oral system methylphenidate (OROS-MPH) or lisdexamfetamine (LDX) and apply an SR prediction model to identify patients most likely to experience an SR to either OROS-MPH or LDX therapies. Methods: A retrospective cohort study was conducted using Texas Medicaid claims data of ADHD children and adolescents (6-17 years of age) initiating OROS-MPH or LDX. Primary SR endpoints were drug discontinuation, switching, and augmentation 12-months post-ADHD drug initiation. Logistic regression models were developed to predict SR to OROS-MPH and LDX in 1:1 matched groups of children and adolescent cohorts. Results: A total of 3,633 children and 1,611 adolescents were matched for each cohort. SR was observed among more children (76.4% vs 72.3%; p < 0.001) and adolescents (82.7% vs 78.2%; p = 0.002) initiating OROS-MPH compared to LDX. Patient sub-groups with the highest predicted risk of OROS-MPH SR experienced significantly lower observed SR rates (p < 0.05) when initiating LDX (children: 80.6% for OROS-MPH vs 75.8% for LDX; OR = 0.75, 95% CI = 0.60-0.94; adolescents: 87.2% for OROS-MPH vs 80.6% for LDX; OR = 0.61, 95% CI = 0.41-0.89). For patients with highest predicted SR rates to LDX, observed SR rates were not significantly different between patients initiating LDX or OROS-MPH. Conclusions: This study demonstrated how a personalized medicine approach using administrative claims data can be used to identify sub-groups of child and adolescent ADHD patients with different risks for suboptimal response with OROS-MPH or LDX in a Medicaid population.

Understanding total cost of care in advanced non-small cell lung cancer pre- and postapproval of immuno-oncology therapies.

This study assesses resource utilization and total direct medical cost among patients in the United States starting systemic antineoplastic therapy (ST) pre- and postapproval of immuno-oncology (IO) agents for advanced non-small cell lung cancer. Adults diagnosed with lung cancer initiating first-line ST within 6 months of diagnosis during either the pre- (March 2013-March 2014) or post-IO (March 2015-December 2016) approval period were identified in a US-based multipayer administrative claims database. Excluded were patients with small cell lung cancer, secondary malignancies, less than 1 month follow-up, and those in clinical trials. Total cost (TC) was calculated from the date of initiation of treatment until the last follow-up. Propensity score matching was adjusted for differences in patient cohorts, including follow-up time. Binary multiple logistic regression assessed predictors of high TC (above mean) pre- and post IO. Mean TC per patient was higher pre-IO versus post IO in both unmatched ($165,548 vs $95,715) and matched analyses($129,977 vs $113,177). Hospitalization and emergency department (ED) visit rates were higher pre-IO versus postapproval. Predictors of high TC pre-IO included use of first-line combination therapy, radiation, targeted therapy, maintenance therapy, biomarker testing, more comorbidities, longer follow-up, first-line hospitalization, first-line cost above mean, and age 65 years and older. In the post-IO period, additional predictors of higher TC included use of IO, having mild liver disease or hemiplegia, and longer time to ST initiation. Early data show lower ED visit and hospitalization rates and associated lower TC in the post-IO era.

Influences of attitudes on family physicians' willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain.

BACKGROUND: The treatment of moderate to severe chronic nonmalignant pain (CNMP) is a challenge for both the patient and health care provider. Conflicting information exists regarding the appropriate use of long-acting (ie, controlled-release [CR]) opioid analgesics for CNMP, and physicians may be reluctant to prescribe them even when medically appropriate. OBJECTIVE: This study examined physicians' willingness and attitudes toward prescribing long-acting opioids to patients with moderate to severe CNMP METHODS: As part of a larger survey sent to 2750 family physicians, one question was used to assess physicians' willingness to prescribe, and 20 Likert-type questions were used to measure physicians' attitudes toward prescribing CR opioids. RESULTS: Of the 267 usable responses (10% response rate), two thirds of physicians indicated that they were "somewhat willing" to "extremely willing" to prescribe long-acting opioids to their patients with CNMP Physicians indicated an overall slightly favorable attitude (mean [SD], +2.96 [17.75] [possible range, -90 to +90]) toward prescribing long-acting opioids for CNMP Physicians who were unwilling to prescribe had an overall unfavorable attitude (mean [SD], -7.87 [17.43]) compared with willing physicians (mean [SD], +9.56 [14.81]). Approximately 80% of physicians believed that long-acting opioids would be effective in controlling pain and would improve overall quality of life in patients with CNMP. However, 78% indicated that they were "somewhat likely" to "extremely likely" to encounter regulatory scrutiny if they prescribed long-acting opioids for CNMP, and about half (51%) of the respondents believed prescribing them would lead to patient addiction. Unwilling physicians held stronger beliefs that prescribing opioids would lead to patient abuse, addiction, and regulatory scrutiny compared with willing physicians. CONCLUSIONS: About two thirds of physician respondents were willing to prescribe long-acting opioids for patients with CNMP, and physician attitudes were marginally favorable. Further study should investigate how physicians' attitudes and willingness translate into actual prescribing behavior.

Pharmacoepidemiology education in US colleges and schools of pharmacy.

OBJECTIVE: To examine the type and extent of pharmacoepidemiology education offered by US colleges and schools of pharmacy. METHODS: An electronic Web-survey was sent to all 89 US colleges and schools of pharmacy between October 2005 and January 2006 to examine the type and extent of pharmacoepidemiology education offered to professional (PharmD) and graduate (MS/PhD) students. RESULTS: The response rate was 100%. Of the 89 schools surveyed, 69 (78%) provided pharmacoepidemiology education to their professional students. A mean of 119 (+/-60) PharmD students per college/school per year received some pharmacoepidemiology education (range 1-60 classroom hours; median 10 hours). Thirty-five schools (39%) provided education to a mean of 6 (+/-5) graduate students (range 2-135 classroom hours; median 15 hours). CONCLUSIONS: A majority of US colleges and schools of pharmacy offer some pharmacoepidemiology education in their curriculum. However, the topics offered by each school and number of classroom hours varied at both the professional and graduate level.