Adjusted comparison of daratumumab monotherapy versus real-world historical control data from the Czech Republic in heavily pretreated and highly refractory multiple myeloma patients.

OBJECTIVES: We conducted an adjusted comparison of progression-free survival (PFS) and overall survival (OS) for daratumumab monotherapy versus standard of care, as observed in a real-world historical cohort of heavily pretreated multiple myeloma patients from Czech Republic. METHODS: Using longitudinal chart data from the Registry of Monoclonal Gammopathies (RMG) of the Czech Myeloma Group, patient-level data from the RMG was pooled with pivotal daratumumab monotherapy studies (GEN501 and SIRIUS; 16 mg/kg). RESULTS: From the RMG database, we identified 972 treatment lines in 463 patients previously treated with both a proteasome inhibitor and an immunomodulatory drug. Treatment initiation dates for RMG patients were between March 2006 and March 2015. The most frequently used treatment regimens were lenalidomide-based regimens (33.4%), chemotherapy (18.1%), bortezomib-based regimens (13.6%), thalidomide-based regimens (8.0%), and bortezomib plus thalidomide (5.3%). Few patients were treated with carfilzomib-based regimens (2.5%) and pomalidomide-based regimens (2.4%). Median observed PFS for daratumumab and the RMG cohort was 4.0 and 5.8 months (unadjusted hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.94-1.39), respectively, and unadjusted median OS was 20.1 and 11.9 months (unadjusted HR, 0.61; 95% CI, 0.48-0.78), respectively. Statistical adjustments for differences in baseline characteristics were made using patient-level data. The adjusted HRs (95% CI) for PFS and OS for daratumumab versus the RMG cohort were 0.79 (0.56-1.12; p = .192) and 0.33 (0.21-0.52; p < .001), respectively. CONCLUSIONS: Adjusted comparisons between trial data and historical cohorts can provide useful insights to clinicians and reimbursement decision makers on relative treatment efficacies in the absence of head-to-head comparison studies for daratumumab monotherapy.

De novo cost-utility analysis of oral paliperidone in the treatment of schizoaffective disorder.

OBJECTIVES: The aim of this analysis is to compare costs and effectiveness of paliperidone ER vs. placebo in the treatment of schizoaffective disorder (SAD) in the Czech Republic based on pooled clinical trial data. METHODS: A de novo micro-simulation model was developed to assess the cost-utility analysis of paliperidone vs. placebo as there is lack of clinical data comparing paliperidone to other interventions. There are no studies primarily evaluating the efficacy of treatment of SAD with other antipsychotics. The model estimated effectiveness and costs of patients with SAD every week during 24-week time horizon. The effectiveness was defined as improvement of a patient's PANSS score where utilities were assigned to each modelled PANSS score. Based on the patient level data a linear mixed-effects model was used to estimate the regression equations of percentage decrease of PANSS score from the baseline. Utilities were computed using a regression function of patients' age, sex and PANSS score, which was adapted from a clinical study of patients with schizophrenia as there are no QoL data on SAD patients. Among relevant costs, reflecting the payer's perspective, costs of pharmacotherapy, concomitant medications and outpatient care were considered. RESULTS: The average ICER of paliperidone compared to placebo reached 28,935 EUR/QALY. The probability of paliperidone being cost-effective compared to placebo was 99.5%. CONCLUSIONS: Treatment of SAD with paliperidone results in acceptable ICER and high probability of being cost-effective compared to placebo. Thus, it can be considered as a cost-effective treatment of patients with SAD in the Czech Republic.

Economic and clinical comparison of atypical depot antipsychotic drugs for treatment of chronic schizophrenia in the Czech Republic.

PURPOSE: The Czech Republic is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. A pharmacoeconomic analysis was conducted to determine the cost-effectiveness of atypical depots. METHODS: An existing 1-year decision-analytic framework was adapted to model drug use in this healthcare system. The average direct costs to the General Insurance Company of the Czech Republic of using paliperidone palmitate (Xeplion®), risperidone (Risperdal Consta®), and olanzapine pamoate (Zypadhera®) were determined. Literature-derived clinical rates populated the model, with costs adjusted to 2012 Euros using the consumer price index. Outcomes included quality-adjusted life-years (QALYs), days in remission, and proportions hospitalized or visiting emergency rooms. One-way sensitivity analyses were calculated for all important inputs. A multivariate probability analysis was used to examine the stability of results using 10,000 iterations of simulated input over reasonable ranges of all included variables. RESULTS: Expected average costs/per patient treated were €5377 for PP-LAI, €6118 for RIS-LAI, and €6537 for OLZ-LAI. Respective QALYs were 0.817, 0.809, and 0.811; ER visits were 0.127, 0.134, and 0.141; hospitalizations were 0.252, 0.298, and 0.289. Results were generally robust in sensitivity analyses. PP-LAI dominated RIS-LAI and OLZ-LAI in 90.2% and 92.1% of simulations, respectively. Results were insensitive to drug prices but sensitive to adherence and hospitalization rates. CONCLUSIONS: PP-LAI dominated the other two drugs, as it had a lower overall cost and superior clinical outcomes, making it the preferred choice. Using PP-LAI in place of RIS-LAI for chronic relapsing schizophrenia would reduce the overall costs of care for the healthcare system.

Daphnia intoxicated by nerve agent tabun can be treated using human antidotes.

Application of human antidotes against nerve agent intoxications to microcrustacean Daphnia magna (Crustacea, Cladocera) intoxicated by a nerve agent tabun (O-ethyl-N,N-dimethylphosphoramidocyanidate) and their efficacy was investigated. It was found that antidotes can be successfully applied to intoxicated daphnids. Three different treatment regimens were tested: the combination of atropine and acetylcholinesterase reactivator (trimedoxime was chosen), atropine only and trimedoxime alone, too. The most efficient was the combination of atropine and trimedoxime followed by treatment with atropine only. The proportion of recovered animals increased with time not only in treated groups but also in the control as well. This can be explained by a spontaneous reactivation of tabun-inhibited cholinesterase in daphnids probably indicating a difference between mammalian and crustacean cholinesterases.

Efficacy and dosing of antidotes applied to Daphnia intoxicated by nerve agent tabun.

A new assay with Daphnia, which can be used as a time, cost, and human effort-saving tool in the development of effective antidotes against organophosphate intoxications, is presented. Five concentrations of atropine (antimuscarinic anticholinergics) as well as a reactivator (trimedoxime) were tested to define the optimal dosage. Various reactivators (trimedoxime, obidoxime) were used to examine difference in effectivity of treatments. The most effective dose of trimedoxime corresponded to the 75% of its EC(50)(24) value, i.e. 77.85mgl(-1). The most effective dose of atropine corresponded to the 25% of its EC(50)(24) value, i.e. 104.70mgl(-1). The most effective treatment was a combined atropine-obidoxime treatment, followed by the combined atropine-trimedoxime treatment, the atropine only and the obidoxime only treatments. The efficacy of the trimedoxime only treatment was doubtful. The surprisingly high efficacy of obidoxime in the obidoxime only treatment indicates that some oximes might act in daphnids not just as reactivators but also by some other mechanisms.

Tests with Daphnia magna: a new approach to prescreen toxicity of newly synthesized acetylcholinesterase reactivators.

Reactivators of phosphorylated acetylcholinesterase (oximes) are substances used as a human antidotal therapy for organophosphate poisoning. The objective of our study was to examine if juveniles of freshwater microcrustacean Daphnia magna could be employed as test animals in early screen toxicity tests of those substances as a first step for further experiments with daphnids intoxicated by organophosphates. For this purpose, seven different oximes were investigated. It was found that toxicity of all tested oximes increased with time. Mono-quaternary oximes were approximately ten fold (EC50, 14.9 mg.l(-1)) more toxic in 24 hour tests and five fold (EC50 was 79.46 mg.l(-1)) more toxic in 48 hour tests than bis-quaternary oximes. Tests with daphnids were shown to be easy to carry out at low cost and provided valuable results which could be used as a starting point for further research.

Plasticity in filtering screens of Daphnia cucullata×galeata hybrids and parental species at two food concentrations.

The coexistence of Daphnia cucullata × galeata hybrids with the parental species D. galeata and D. cucullata was investigated by measuring areas and mesh sizes of filtering structures of these herbivorous zooplankton taxa cultivated at low and high food concentrations. The clearance rates and somatic growth rates were also determined. When reared at low food concentration, all taxa had larger filtering areas. Larger filtering areas also resulted in higher clearance rates. Differences between taxa in both filtering area and clearance rate were caused mainly by interspecific size differences. Hybrids had the largest absolute mesh sizes, and the parental species had smaller mesh sizes. Hybrids also showed heterosis in somatic growth rate at high food concentration. The observed taxon-specific differences in mesh size and somatic growth rate contribute to resource partitioning between the taxa and thus to their successful coexistence in lakes.