Real-world effectiveness of dupilumab versus benralizumab and mepolizumab.

INTRODUCTION: In the United States, this real-world study compared the effectiveness of dupilumab, benralizumab, andmepolizumab in reducing exacerbations and systemic corticosteroid (SCS) prescriptions among patients with asthma. METHODS: Patients (12 years old) who initiated dupilumab, benralizumab, or mepolizumab (index) between November 2018 and September 2020 were identified by using electronic medical record data. Subjects were included if they had greater than or equal to 12 months of data before and after the index date and two or more severe asthma-related exacerbations before the index date. Differences in baseline characteristics were addressed by using inverse probability treatment weighting (IPTW). Pairwisecomparisons between dupilumab and benralizumab, or mepolizumab were conducted by using negative binomial regression, adjusting for baseline rates and unbalance characteristics (greater than or equal to 10% standardized differences) after IPTW. RESULTS: Overall, a total of 1737 subjects met all criteria: 825 dupilumab, 461 benralizumab, and 451 mepolizumab initiators.In the postindex period, dupilumab was associated with a 24% and 28% significant reduction in the risk of severe asthmaexacerbations versus benralizumab (incidence rate ratio [IRR] 0.76 [95% confidence interval {CI}, 0.67-0.86)] and mepolizumab(IRR 0.72 [95% CI, 0.63-0.82]), respectively. In addition, dupilumab treatment significantly reduced SCS prescriptionsby 16% and 25% versus benralizumab and mepolizumab, respectively (p < 0.05). CONCLUSION: This study represents one of the largest real-world comparisons of biologics (dupilumab, benralizumab, and mepolizumab) for asthma in the United States to date. This analysis shows that the use of dupilumab was associated with a significantly greater reduction in both severe asthma exacerbations and SCS prescriptions compared with benralizumab and mepolizumab.

Real-world effectiveness of dupilumab in patients with asthma: Findings from the US ADVANTAGE study.

BACKGROUND: Dupilumab is approved as an add-on maintenance therapy for patients (≥6 years) with moderate-to-severe asthma. Better understanding of real-world effectiveness is needed. OBJECTIVE: To characterize the real-world effectiveness of dupilumab in asthma management. METHODS: This retrospective study included patients (≥12 years of age) diagnosed with asthma, initiating dupilumab between November 2018 and September 2020. The study used a US electronic medical record database (TriNetX Dataworks, Cambridge, Massachusetts). Asthma exacerbation rates before and after the initiation of dupilumab were analyzed using generalized estimating equations models with Poisson probabilistic link to estimate incidence rate ratios (IRRs). Sensitivity analyses were conducted based on previous exacerbation data, eosinophil levels, history of atopic dermatitis or chronic rhinosinusitis with nasal polyps, previous use of biologics, and presence of SARS-CoV-2 (COVID-19). RESULTS: A total of 2400 patients initiating dupilumab met all study criteria. After initiation of dupilumab, risk of asthma exacerbation was reduced by 44% (IRR, 0.56; 95% CI, 0.47-0.57; P = <0.0001) and systemic corticosteroid prescriptions by 48% (IRR, 0.52; 95% CI, 0.48, 0.56; P = <0.0001) compared with those before initiation of dupilumab. Adjustment for COVID-19 showed a greater reduction in asthma exacerbations (IRR, 0.50; 95% CI, 0.45-0.55; P = <0.0001). CONCLUSION: Current real-world efficacy evidence indicates that dupilumab reduces asthma exacerbations and total systemic corticosteroid prescriptions in clinical practice. The effectiveness of dupilumab was observed independent of exacerbation history, eosinophil levels, or COVID-19 impact.

[Costs of treatment in patients with schizophrenia switched to amisulpride--one-year follow-up]. / Az amisulpridre történô átállítás hatása a szkizofréniával kapcsolatos költségekre egyéves követés során.

OBJECTIVES: In our present research we have studied the costs associated with switching schizophrenia patients to amisulpride as well as the efficacy of amisulpride treatment. We wanted to explore whether the relatively higher costs of amisulpride can be recovered under the current Hungarian economic and financing conditions. METHODS: From 2002, we analysed clinical improvement with a 6 months follow-up measured by CGI and also compared the costs that were incurred before and after switching in 76 patients suffering from schizophrenia who received amisulpride instead of their previous treatment with typical or atypical antipsychotics. In a second, retrospective phase of the study which lasted for 6 months, we studied the willingness of investigators and patients to continue amisulpride treatment. During this period of treatment both the investigators and the patients were unaware of the fact that the circumstances of treatment would be investigated later; thus, we could determine the number of investigators and patients who decided on the continuation of amisulpride in this phase, and how costs changed later on. In our analysis we followed the cost evaluation methodology introduced earlier by Agnes Rupp. RESULTS: 68 patients were available for the second phase of the study, 65 continued the treatment with amisulpride. Amisulpride has demonstrated cost neutrality in both phases of the study. Higher costs of this medicine have been compensated by an increase in productivity and the resulting cost reduction. Amisulpride treatment was associated with a significant improvement of CGI-measures. CONCLUSIONS: In an open, non-controlled study, modelling a field study in its second phase, amisulpride has been shown to be an effective antipsychotic which is readily accepted by patients and clinicians and which can be prescribed without increasing costs.

[Costs related to change to amisulpride in patients suffering from schizophrenia]. / Az amisulpridre történõ átállítás hatása a szkizofréniával kapcsolatos költségekre.

OBJECTIVES: The present research studied the cost effects of converting patients suffering from schizophrenia to the use of amisulpride, in order to learn whether the relatively higher medicine costs were compensated for under the Hungarian economic and financing conditions. METHODS: We analysed and compared costs having occurred before and after conversion in the case of 76 patients suffering from schizophrenia who got amisulpride instead of other typical or atypical antipsychotics in hospital. The analysis adhered to the methodology introduced by Agnes Rupp. RESULTS: In conformity with earlier investigations in Hungary performed with atypical antipsychotics, amisulpride has also proved its cost neutrality under local economic and financing conditions. Namely, higher disbursements for medicaments are compensated for by productivity increase, indicative of amisulpride's effectiveness, implying decreased economic (and other) burdens to family members. Te remarkable cost ratio improvement in case of patients defined as therapy resistant has played an important role in cost neutrality. CONCLUSIONS: Amisulpride is an effective antipsychotic which can be prescribed without increasing costs, and in case of therapy resistant patients, it appears to have significant cost sparing effects.