Cost per responder analysis of guselkumab versus targeted therapies in the treatment of moderate to severe plaque psoriasis in Germany.

BACKGROUND: The fully human monoclonal antibody guselkumab is an effective treatment option for patients with moderate to severe psoriasis. OBJECTIVE: The objective of this study was to examine the cost per responder of guselkumab compared with other targeted therapies for the treatment of moderate to severe plaque psoriasis in Germany. METHODS: A one-year cost per responder model was developed based on efficacy and safety data from a published network meta-analysis. Drug, treatment administration, resource use, and adverse event costs were included in the analysis. The primary analysis assessed the cost per Psoriasis Area and Severity Index (PASI) 90 responder at week 16. Additional analyses were conducted at year 1. In the year 1 analyses, treatment response was assessed at the end of the induction period (week 16) to determine which patients continued onto maintenance therapy (responders) and which patients moved onto a subsequent adalimumab or secukinumab therapy (non-responders). RESULTS: At week 16, the cost per PASI 90 responder was lower for guselkumab than all comparators except adalimumab and brodalumab. Similarly, in the year 1 analyses, guselkumab had a lower cost per PASI 90 responder than all comparators except brodalumab. CONCLUSIONS: Guselkumab is a cost-effective therapy option in Germany.

Importance of assessing and adjusting for cross-study heterogeneity in network meta-analysis: a case study of psoriasis.

AIM: The importance of adjusting for cross-study heterogeneity when conducting network meta-analyses (NMAs) was demonstrated using a case study of biologic therapies for moderate-to-severe plaque psoriasis. METHODS: Bayesian NMAs were conducted for Psoriasis Area and Severity Index 90 response. Several covariates were considered to account for cross-trial differences: baseline risk (i.e., placebo response), prior biologic use, body weight, psoriasis duration, age, race and baseline Psoriasis Area and Severity Index score. Model fit was evaluated. RESULTS: The baseline risk-adjusted NMA, which adjusts for multiple observed and unobserved effect modifiers, was associated with the best model fit. Lack of adjustment for cross-trial differences led to different clinical interpretations of findings. CONCLUSION: Failure to adjust for cross-trial differences in NMA can have important implications for clinical interpretations when studying the comparative efficacy of healthcare interventions.

Comprehensive Review on Magnetic Resonance Imaging in Alzheimer's Disease.

Alzheimer's disease (AD) is the most common cause of dementia in the elderly. However, definitive diagnosis of AD is only achievable postmortem and currently relies on clinical neurological evaluation. Magnetic resonance imaging (MRI) can evaluate brain changes typical of AD, including brain atrophy, presence of amyloid ß (Aß) plaques, and functional and biochemical abnormalities. Structural MRI (sMRI) has historically been used to assess the inherent brain atrophy present in AD. However, new techniques have recently emerged that have refined sMRI into a more precise tool to quantify the thickness and volume of AD-sensitive cerebral structures. Aß plaques, a defining pathology of AD, are widely believed to contribute to the progressive cognitive decline in AD, but accurate assessment is only possible on autopsy. In vivo MRI of plaques, although currently limited to mouse models of AD, is a very promising technique. Measuring changes in activation and connectivity in AD-specific regions of the brain can be performed with functional MRI (fMRI). To help distinguish AD from diseases with similar symptoms, magnetic resonance spectroscopy (MRS) can be used to look for differing metabolite concentrations in vivo. Together, these MR techniques, evaluating various brain changes typical of AD, may help to provide a more definitive diagnosis and ease the assessment of the disease over time, noninvasively.

Accumulation of bone strontium measured by in vivo XRF in rats supplemented with strontium citrate and strontium ranelate.

Strontium ranelate is an approved pharmacotherapy for osteoporosis in Europe and Australia, but not in Canada or the United States. Strontium citrate, an alternative strontium salt, however, is available for purchase over-the-counter as a nutritional supplement. The effects of strontium citrate on bone are largely unknown. The study's objectives were 1) to quantify bone strontium accumulation in female Sprague Dawley rats administered strontium citrate (N=7) and compare these levels to rats administered strontium ranelate (N=6) and vehicle (N=6) over 8 weeks, and 2) to verify an in vivo X-ray fluorescence spectroscopy (XRF) system for measurement of bone strontium in the rat. Daily doses of strontium citrate and strontium ranelate were determined with the intention to achieve equivalent amounts of elemental strontium. However, post-hoc analyses of each strontium compound conducted using energy dispersive spectrometry microanalysis revealed a higher elemental strontium concentration in strontium citrate than strontium ranelate. Bone strontium levels were measured at baseline and 8 weeks follow-up using a unique in vivo XRF technique previously used in humans. XRF measurements were validated against ex vivo measurements of bone strontium using inductively coupled plasma mass spectrometry. Weight gain in rats in all three groups was equivalent over the study duration. A two-way ANOVA was conducted to compare bone strontium levels amongst the three groups. Bone strontium levels in rats administered strontium citrate were significantly greater (p<0.05) than rats administered strontium ranelate and vehicle. ANCOVA analyses were performed with Sr dose as a covariate to account for differences in strontium dosing. The ANCOVA revealed differences in bone strontium levels between the strontium groups were not significant, but that bone strontium levels were still very significantly greater than vehicle.