Direct costs in patients with chronic inflammatory arthropathies on biological therapy: a real-world data study.

OBJECTIVES: The aim of the study was to assess the direct costs for the Spanish Health System of patients with chronic inflammatory arthropathies treated with biological therapies in daily clinical practice and to establish possible factors associated with lower costs. METHODS: A descriptive, observational and retrospective study was conducted. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biological therapy between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic status, disease and biological therapy were included. The annual cost of biological treatment and other direct medical costs were calculated for each disease. The analysis of costs was based on the National Health Service perspective. The time horizon comprised the 8-year long study period. RESULTS: A total of 422 biological therapy lines were analysed. The annual biological therapy cost per patient was €12,494±3,865 for rheumatoid arthritis, €11,248±2,763 for ankylosing spondylitis and €12,263±35,155 for psoriatic arthritis (p=0.008). The cost of biological therapies entailed about 80% of the total cost of these diseases. Hospital admission was a factor which contributed to an increasing cost in all these conditions. A longer duration of the biological therapy was associated with lower cost in all the diseases. CONCLUSIONS: The cost of ankylosing spondylitis is lower than that of rheumatoid arthritis and psoriatic arthritis. The biological therapy is the factor with the highest impact on the overall cost of these diseases. Preventing hospital admissions and a higher persistence to the biological therapy can contribute to lower costs for the system.

Medication persistence on biological therapies prescribed for the treatment of chronic inflammatory arthropathies: a real-world data study.

OBJECTIVES: Medication persistence, defined as the duration of time from its initiation to its discontinuation, is a surrogate for treatment effectiveness. The aim of the study was to evaluate persistence and causes of biological therapy (BT) suspension in patients with chronic inflammatory arthropathies: rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS: Single institution, descriptive, retrospective cohort study. Adult patients with chronic inflammatory arthropathies on BT between January 2009 and December 2016 were included. Persistence to BT was compared considering the type of pathology and treatment. The Kaplan-Meier test was used to analyse medication persistanence and factors associated with it. An analysis of reasons for therapy discontinuation was performed. RESULTS: Three hundred and sixty-two patients were included in the study, which comprised 478 BT lines. For all patients, the 12-month persistence rate was 71.3% (341 out of 478). At the end of the study, 45.2% of the patients continued on their initial BT. Median treatment persistence was 1489 days (CI 95% 1195 to 1783). Longer BT persistence was associated with naïve BT patients: 1945 days (95% CI 1523 to 2367; P<0.001) and ankylosing spondylitis diagnosis: 2402 days (95% CI 1604 to 3200; P=0.014). The most frequent causes of treatment discontinuation were therapeutic failure (47.6%) and adverse drug events (28.2%). CONCLUSIONS: We found good long-term persistence in patients with chronic inflammatory arthropathies treated with BT. Patients with rheumatoid arthritis had significantly shorter persistence compared with those with ankylosing spondylitis and psoriatic arthritis. Naïve BT was associated with longer persistence. Therapeutic failure was the main cause of BT withdrawal.

Biological therapy safety in chronic inflammatory arthropathy patients.

OBJECTIVE: The marketing of biological therapies transformed the treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. But there is still concern about patient safety and management in daily clinical practice. The aim of this study was to estimate risk factors of the adverse effects in a cohort of Spanish patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS: A single institution, descriptive, retrospective, cohort study was developed from January 2009 to December 2016. Patients diagnosed with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis on biological therapies were included. Undesirable events affecting patients during biological therapy, their clinical implications and the use of health resources related to adverse effects were collected. RESULTS: Three hundred and sixty-two patients corresponding to 478 biological therapy lines were analysed. It implied 1192 years of monitoring. There were 57 adverse effects per 100 biological patient-years and 4.8 serious adverse effects per 100 biological patient-years. The only significant factor for a likely serious adverse effect was having a Charlson Index ≥10, OR of 6.2 (CI 95%: 3.4-11.1, p<0.001). Around 15 % of patients with adverse effects were admitted to hospital and 25% received attention at the Emergency Department. CONCLUSION: Over half of the patients with arthropathies on biological therapy can suffer adverse effect during treatment but only 8.5% of these effects are serious. Special vigilance must be paid to patients with a higher number of comorbidities because they are more likely to experience serious adverse effects.

Biological therapy safety in chronic inflammatory arthropathy patients.

OBJECTIVE: The marketing of biological therapies transformed the treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. But there is still concern about patient safety and management in daily clinical practice. The aim of this study was to estimate risk factors of the adverse effects in a cohort of Spanish patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS: A single institution, descriptive, retrospective, cohort study was developed from January 2009 to December 2016. Patients diagnosed with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis on biological therapies were included. Undesirable events affecting patients during biological therapy, their clinical implications and the use of health resources related to adverse effects were collected. RESULTS: Three hundred and sixty-two patients corresponding to 478 biological therapy lines were analysed. It implied 1192 years of monitoring. There were 57 adverse effects per 100 biological patient- years and 4.8 serious adverse effects per 100 biological patient-years. The only significant factor for a likely serious adverse effect was having a Charlson Index ≥10, OR of 6.2 (CI 95%: 3.4-11.1, p<0.001). Around 15 % of patients with adverse effects were admitted to hospital and 25% received attention at the Emergency Department. CONCLUSION: Over half of the patients with arthropathies on biological therapy can suffer adverse effect during treatment but only 8.5% of these effects are serious. Special vigilance must be paid to patients with a higher number of comorbidities because they are more likely to experience serious adverse effects.

Content analysis of Twitter in relation to biological treatments for chronic inflammatory arthropathies: an exploratory study.

OBJECTIVE: To analyse the volume and content of tweets in relation to biological treatments for chronic inflammatory arthropathies. METHODS: A Twitter analysis was carried out during one month using the following keywords: 'rheumatoid arthritis', 'ankylosing spondylitis', 'psoriatic arthritis' and their biological therapies: 'abatacept', 'adalimumab', 'certolizumab', 'etanercept', 'golimumab', 'infliximab' and 'tocilizumab'. Tweets were hand-coded and filtered for content. RESULTS: 25 441 tweets contained at least one of the keywords. After filtering, 2480 tweets were included in the analysis. Regarding the 983 tweets about therapies, the most frequently mentioned biologics were 'adalimumab' (n=359), 'infliximab' (n= 278) and 'etanercept' (n= 205). In the 1497 tweets about diseases, the term 'rheumatoid arthritis' (n= 1109) was used more frequently than 'psoriatic arthritis' (n= 233) and 'ankylosing spondylitis' (n= 155). The most commonly addressed subjects in the tweets in relation to biological therapies were related to safety/adverse events (136 of 983 (13.8%)) and to administration, particularly drug infusion (60 of 983 (6.1%)) and self-administration (57 of 983 (5.8%)). Regarding diseases, the most commonly addressed subjects were non-pharmacological recommendations such as alternative therapies (145 of 1497 (9.7%)), nutrition (128 of 1497 (8.5%)) and exercise (91 of 1497 (6.1%)). CONCLUSIONS: Twitter is widely used to search for information about biological treatments for chronic athropathies. Learning more about the subjects dealt with in the tweets will enable us to improve our understanding of the areas of greater interest and concern among patients. This could help hospital pharmacists establish patient-focused strategies addressing the needs of the patients.

Adherencia a las terapias biológicas en pacientes con artropatías inflamatorias crónicas / Adherence to biological therapies in patients with chronic inflammatory arthropathies

Objetivo: Los objetivos del estudio fueron cuantificar la adherencia, determinar los factores predictivos y conocer las consecuencias de una menor adherencia, en la práctica clínica diaria, en pacientes con artropatías inflamatorias crónicas tratados con terapias biológicas. Método: Estudio descriptivo, observacional y retrospectivo. Se incluyeron pacientes con artritis reumatoide, espondilitis anquilosante y artritis psoriásica que iniciaron una terapia biológica entre el 1 de enero de 2009 y el 31 de diciembre de 2016. Se recogieron variables sociodemográficas, relacionadas con la enfermedad, sobre las terapias biológicas y los recursos hospitalarios. La adherencia se calculó mediante la ratio media de posesión. Resultados: Se incluyeron 362 pacientes y 423 líneas de terapia biológica. La media de edad ± desviación estándar fue de 50,3 ± 13,9 años; 228 (53,9%) fueron mujeres. El porcentaje de adherentes fue de 187 de 216 (87%) en artritis reumatoide, 91 de 107 (85%) en espondilitis anquilosante y 84 de 100 (84%) en artritis psoriásica. La adherencia se relacionó con acudir con más frecuencia a la consulta del servicio de farmacia (odds ratio de 1,2; intervalo de confianza 95%: 1,1-1,3 [p < 0,001]) e inversamente con no acudir a las consultas de reumatología en la fecha prevista (odds ratio de 0,2; intervalo de confianza 95%: 0,1-0,9 [p = 0,030]) No hubo diferencias en el número de recursos hospitalarios utilizados por pacientes adherentes y no adherentes. Conclusiones: La adherencia a las terapias biológicas entre las artropatías inflamatorias crónicas es similar. Dicha adherencia se correlaciona con la frecuentación a consultas externas, pero no implica un aumento del consumo de recursos

Introduction: The aims of the study were to quantify adherence, determine the factors that can predict adherence and identify the consequences of poorer adherence in patients with chronic inflammatory arthropathies treated with biological therapies in daily clinical practice. Method: A descriptive, observational and retrospective study was carried out. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biologic therapy between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic status, the disease, the biological therapy and hospital resources were included. Adherence was calculated by using the medication possession ratio. Results: Three hundred and sixty-two patients and 423 lines of biological therapy were included. Mean age ± standard deviation was 50.3 ± 13.9 years, and 228 (53.9%) were women. The percentage of adherent patients was 187 out of 216 (87%) in rheumatoid arthritis, 91 out of 107 (85%) in ankylosing spondylitis and 84 out of 100 (84%) in psoriatic arthritis. Greater adherence was associated with more frequent visits to the pharmacy service (odds ratio 1.2, 95% confidence interval: 1.1-1.3 [p < 0.001]) and poorer adherence with a failure to attend scheduled appointments at the rheumatology clinic (odds ratio 0.2, 95% confidence interval: 0.1-0.9 [p = 0.030]). There were no differences between adherent and non-adherent patients in terms of the number of hospital resources used. Conclusions: There are no differences in adherence to biological therapies among patients with chronic inflammatory arthropathies. Adherence correlates with attendance at outpatient appointments, but this does not imply an increase in the use of hospital resources

Adherence to biological therapies in patients with chronic inflammatory arthropathies.

INTRODUCTION: The aims of the study were to quantify adherence, determine the factors that can  predict adherence and identify the consequences of poorer adherence in patients with chronic  inflammatory arthropathies treated with biological therapies in daily clinical practice. METHOD: A descriptive, observational and retrospective study was carried out. Patients with  rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biologic therapy  between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic  status, the disease, the biological therapy and hospital resources were included. Adherence was  calculated by using the medication possession ratio. RESULTS: Three hundred and sixty-two patients and 423 lines of biological therapy were included.  Mean age ± standard deviation was 50.3 ± 13.9 years, and 228 (53.9%) were women. The  percentage of adherent patients was 187 out of 216 (87%) in rheumatoid arthritis, 91 out of 107  (85%) in ankylosing spondylitis and 84 out of 100 (84%) in psoriatic arthritis. Greater adherence was  associated with more frequent visits to the pharmacy service (odds ratio 1.2, 95% confidence  interval: 1.1-1.3 [p = 0.001]) and poorer adherence with a failure to attend scheduled appointments  at the rheumatology clinic (odds ratio 0.2, 95% confidence interval: 0.1-0.9 [p = 0.030]). There were  no differences between  adherent and non-adherent patients in terms of the number of hospital resources used. CONCLUSIONS: There are no differences in adherence to biological therapies among patients with  chronic inflammatory arthropathies. Adherence correlates with attendance at outpatient  appointments, but this does not imply an increase in the use of hospital resources.

Objetivo: Los objetivos del estudio fueron cuantificar la adherencia, determinar los factores  predictivos y conocer las consecuencias de una menor adherencia, en la práctica clínica diaria, en  pacientes con artropatías inflamatorias crónicas tratados con terapias biológicas. Método: Estudio descriptivo, observacional y retrospectivo. Se incluyeron pacientes con artritis  reumatoide, espondilitis anquilosante y artritis psoriásica que iniciaron una terapia biológica entre el 1  de enero de 2009 y el 31 de diciembre de 2016. Se recogieron variables sociodemográficas, relacionadas con la enfermedad, sobre las terapias biológicas y los recursos  hospitalarios. La adherencia se calculó mediante la ratio media de posesión.Resultados: Se incluyeron 362 pacientes y 423 líneas de terapia biológica. La media de edad ±  desviación estándar fue de 50,3 ± 13,9 años; 228 (53,9%) fueron mujeres. El porcentaje de  adherentes fue de 187 de 216 (87%) en artritis reumatoide, 91 de 107 (85%) en espondilitis  anquilosante y 84 de 100 (84%) en artritis psoriásica. La adherencia se relacionó con acudir con más  frecuencia a la consulta del servicio de farmacia(odds ratio de 1,2; intervalo de confianza 95%: 1,1- 1,3 [p = 0,001]) e inversamente con no acudir a las consultas de reumatología en la fecha prevista (odds ratio de 0,2; intervalo de confianza 95%: 0,1-0,9 [p = 0,030]). No hubo diferencias en  el número de recursos hospitalarios utilizados por pacientes adherentes y no adherentes.Conclusiones: La adherencia a las terapias biológicas entre las artropatías inflamatorias crónicas es  similar. Dicha adherencia se correlaciona con la frecuentación a consultas externas, pero no implica  un aumento del consumo de recursos.

Factors associated with patient satisfaction in an outpatient hospital pharmacy.

OBJECTIVE: To analyse the factors leading to greater satisfaction among patients attending the outpatient hospital pharmacy (OPh). METHODS: A cross-sectional study was conducted of patients attending the OPh of a 1250-bed university hospital. A self-administered questionnaire for measuring outpatients' satisfaction was developed. Global satisfaction was measured on a scale of 1 to 10. Indices of perceived quality for accessibility, interpersonal professional-patient relationship and the convenience of the process were modelled through a principal component analysis using varimax rotation. The relationship between the principal components and overall satisfaction was evaluated using regression analysis. RESULTS: A questionnaire-based survey was conducted between May and June 2015. A total of 509 valid responses (86.9% response rate) were collected from the OPh. The overall satisfaction score was 7.81 (95% CI 7.59 to 8.04). The principal component analysis produced two components that explained 62.1% of the variance. The first component (CP1) contained questions related to the adequacy of the resources and services. The second component (CP2) contained questions about interpersonal professional-patient relationship. An additional unit in the CP2 was associated with a 3.23 increased risk of having higher satisfaction scores, while an increase of an additional unit in CP1 was associated with a 1.93 increased risk of having higher satisfaction scores. CONCLUSIONS: Our study shows that the factor which predicts the satisfaction of patients who come to the OPh is the quality of care provided by pharmacists-in particular, information provided, resolution of doubts, personal attention and time devoted to the patient.

Truncating FLNC Mutations Are Associated With High-Risk Dilated and Arrhythmogenic Cardiomyopathies.

BACKGROUND: Filamin C (encoded by the FLNC gene) is essential for sarcomere attachment to the plasmatic membrane. FLNC mutations have been associated with myofibrillar myopathies, and cardiac involvement has been reported in some carriers. Accordingly, since 2012, the authors have included FLNC in the genetic screening of patients with inherited cardiomyopathies and sudden death. OBJECTIVES: The aim of this study was to demonstrate the association between truncating mutations in FLNC and the development of high-risk dilated and arrhythmogenic cardiomyopathies. METHODS: FLNC was studied using next-generation sequencing in 2,877 patients with inherited cardiovascular diseases. A characteristic phenotype was identified in probands with truncating mutations in FLNC. Clinical and genetic evaluation of 28 affected families was performed. Localization of filamin C in cardiac tissue was analyzed in patients with truncating FLNC mutations using immunohistochemistry. RESULTS: Twenty-three truncating mutations were identified in 28 probands previously diagnosed with dilated, arrhythmogenic, or restrictive cardiomyopathies. Truncating FLNC mutations were absent in patients with other phenotypes, including 1,078 patients with hypertrophic cardiomyopathy. Fifty-four mutation carriers were identified among 121 screened relatives. The phenotype consisted of left ventricular dilation (68%), systolic dysfunction (46%), and myocardial fibrosis (67%); inferolateral negative T waves and low QRS voltages on electrocardiography (33%); ventricular arrhythmias (82%); and frequent sudden cardiac death (40 cases in 21 of 28 families). Clinical skeletal myopathy was not observed. Penetrance was >97% in carriers older than 40 years. Truncating mutations in FLNC cosegregated with this phenotype with a dominant inheritance pattern (combined logarithm of the odds score: 9.5). Immunohistochemical staining of myocardial tissue showed no abnormal filamin C aggregates in patients with truncating FLNC mutations. CONCLUSIONS: Truncating mutations in FLNC caused an overlapping phenotype of dilated and left-dominant arrhythmogenic cardiomyopathies complicated by frequent premature sudden death. Prompt implantation of a cardiac defibrillator should be considered in affected patients harboring truncating mutations in FLNC.

Multidisciplinary teams involved: detection of drug-related problems through continuity of care / Equipos multidisciplinares comprometidos: detección de problemas relacionados con los medicamentos a través de la continuidad asistencial

Objective: To quantify Drug-Related problems (DRPs) by establishing a Strategic Continuity of Care Program (e-Conecta-Concilia Program; e-CC) focused on the drug therapy of patients within an Integrated Management Structure, in order to guarantee the therapeutical efficiency, safety and traceability of patients. Method: A prospective study at 8 months. The project included 22 Hospital Pharmacists and 12 Primary Care Pharmacists. Electronic clinical records were used, which can be accessed by all healthcare levels. Those interventions required in order to create a Standard Operating Procedure (SOP) were carried out (creation of working groups, computing, meeting points), for coordination among pharmacists in different care levels through a common communication system. The working groups formed by pharmacists of both care levels established the following inclusion criteria: patients with chronic diseases and polymedicated, patients for whom drug-related problems (DRP) had been detected, detection of any off-label use in Primary Care, or discrepancies in the standardization of medical prescriptions. Results: In the setting of the e-CC program, interventions were unified and discrepancies were identified. During this project, 245 drug-related problems were detected; the majority regarding inadequate dosing, regimen, or duration (24%), and involving Group B medications (33%), according to the ATC classification. Conclusions: The implementation of a Continuity of Care SOP between pharmacists allowed to detect and solve DRPs and discrepancies in patient pharmacotherapy, with a high rate of acceptance (84.1%) of interventions (AU)

Objetivo: Cuantificar los problemas relacionados con los medicamentos (PRMs) mediante el establecimiento de un Programa Estratégico de Continuidad Asistencial (Programa e-Conecta-Concilia; e-CC) enfocado a la farmacoterapia de los pacientes pertenecientes a una Estructura Organizativa de Gestión Integrada, para garantizar la eficiencia, seguridad y trazabilidad terapéutica del paciente. Método: Estudio prospectivo de 8 meses de duración. Participaron en el proyecto 22 farmacéuticos de hospital y 12 de Atención Primaria. Se utilizó la historia clínica electrónica accesible a todos los niveles. Se llevaron a cabo las actuaciones necesarias para la creación de un procedimiento normalizado de trabajo (PNT) (creación de los grupos de trabajo, informática, puntos de encuentro) de coordinación entre farmacéuticos de diferentes niveles asistenciales con un sistema de comunicación común. Los grupos de trabajo constituidos por farmacéuticos de ambos niveles asistenciales establecieron los siguientes criterios de inclusión: pacientes con enfermedades crónicas y polimedicados, pacientes en los que se detectaba algún PRM, detección en Atención Primaria de un uso fuera de ficha técnica o discrepancias en la homologación de recetas sanitarias. Resultados: En el seno del Programa e-CC se unificaron las intervenciones y se identificaron discrepancias. Durante este proyecto se detectaron 245 problemas relacionados con los medicamentos, siendo los mayoritarios los de dosis, pauta o duración no adecuada (24%) y los que afectaban a los medicamentos del grupo B (33%), según la clasificación ATC. Conclusiones: La implantación de un PNT de Continuidad Asistencial entre farmacéuticos permitió detectar y resolver PRMs y discrepancias en la farmacoterapia de los pacientes, con un alto porcentaje de aceptación (84,1%) de las intervenciones (AU)

Multidisciplinary teams involved: detection of drug-related problems through continuity of care.

OBJECTIVE: To quantify Drug-Related problems (DRPs) by establishing a Strategic Continuity of Care Program (e-Conecta- Concilia Program; e-CC) focused on the drug therapy of patients within an Integrated Management Structure, in order to guarantee the therapeutical efficiency, safety and traceability of patients. METHOD: A prospective study at 8 months. The project included 22 Hospital Pharmacists and 12 Primary Care Pharmacists. Electronic clinical records were used, which can be accessed by all healthcare levels. Those interventions required in order to create a Standard Operating Procedure (SOP) were carried out (creation of working groups, computing, meeting points), for coordination among pharmacists in different care levels through a common communication system. The working groups formed by pharmacists of both care levels established the following inclusion criteria: patients with chronic diseases and polymedicated, patients for whom drug-related problems (DRP) had been detected, detection of any off-label use in Primary Care, or discrepancies in the standardization of medical prescriptions. RESULTS: In the setting of the e-CC program, interventions were unified and discrepancies were identified. During this project, 245 drug-related problems were detected; the majority regarding inadequate dosing, regimen, or duration (24%), and involving Group B medications (33%), according to the ATC classification. CONCLUSIONS: The implementation of a Continuity of Care SOP between pharmacists allowed to detect and solve DRPs and discrepancies in patient pharmacotherapy, with a high rate of acceptance (84.1%) of interventions.

Objetivo: Cuantificar los problemas relacionados con los medicamentos (PRMs) mediante el establecimiento de un Programa Estratégico de Continuidad Asistencial (Programa e-Conecta-Concilia; e-CC) enfocado a la farmacoterapia de los pacientes pertenecientes a una Estructura Organizativa de Gestión Integrada, para garantizar la eficiencia, seguridad y trazabilidad terapéutica del paciente. Método: Estudio prospectivo de 8 meses de duración. Participaron en el proyecto 22 farmacéuticos de hospital y 12 de Atención Primaria. Se utilizó la historia clínica electrónica accesible a todos los niveles. Se llevaron a cabo las actuaciones necesarias para la creación de un procedimiento normalizado de trabajo (PNT) (creación de los grupos de trabajo, informática, puntos de encuentro) de coordinación entre farmacéuticos de diferentes niveles asistenciales con un sistema de comunicación común. Los grupos de trabajo constituidos por farmacéuticos de ambos niveles asistenciales establecieron los siguientes criterios de inclusión: pacientes con enfermedades crónicas y polimedicados, pacientes en los que se detectaba algún PRM, detección en Atención Primaria de un uso fuera de ficha técnica o discrepancias en la homologación de recetas sanitarias. Resultados: En el seno del Programa e-CC se unificaron las intervenciones y se identificaron discrepancias. Durante este proyecto se detectaron 245 problemas relacionados con los medicamentos, siendo los mayoritarios los de dosis, pauta o duración no adecuada (24%) y los que afectaban a los medicamentos del grupo B (33%), según la clasificación ATC. Conclusiones: La implantación de un PNT de Continuidad Asistencial entre farmacéuticos permitió detectar y resolver PRMs y discrepancias en la farmacoterapia de los pacientes, con un alto porcentaje de aceptación (84,1%) de las intervenciones.