Adherence to Antihypertensive Medications andCardiovascular Morbidity Among Newly DiagnosedHypertensive Patients

Background—Nonadherence to antihypertensive treatment is a common problem in cardiovascular prevention and may influence prognosis. We explored predictors of adherence to antihypertensive treatment and the association of adherence with acute cardiovascular events. Methods and Results—Using data obtained from 400 Italian primary care physicians providing information to the Health Search/Thales Database, we selected 18 806 newly diagnosed hypertensive patients 35 years of age during the years 2000 to 2001. Subjects included were newly treated for hypertension and initially free of cardiovascular diseases. Patient adherence was subdivided a priori into 3 categories— high (proportion of days covered, 80%), intermediate (proportion of days covered, 40% to 79%), and low (proportion of days covered, 40%)—and compared with the long-term occurrence of acute cardiovascular events through the use of multivariable models adjusted for demographic factors, comorbidities, and concomitant drug use. At baseline (ie, 6 months after index diagnosis), 8.1%, 40.5%, and 51.4% of patients were classified as having high, intermediate, and low adherence levels, respectively. Multiple drug treatment (odds ratio, 1.62; 95% CI, 1.43 to 1.83), dyslipidemia (odds ratio, 1.52; 95% CI, 1.24 to 1.87), diabetes mellitus (odds ratio, 1.40; 95% CI, 1.15 to 1.71), obesity (odds ratio, 1.50; 95% CI, 1.26 to 1.78), and antihypertensive combination therapy (odds ratio, 1.29; 95% CI, 1.15 to 1.45) were significantly (P0.001) associated with high adherence to antihypertensive treatment. Compared with their low-adherence counterparts, only high adherers reported a significantly decreased risk of acute cardiovascular events (hazard ratio, 0.62; 95% CI, 0.40 to 0.96; P0.032). Conclusions—The long-term reduction of acute cardiovascular events associated with high adherence to antihypertensive treatment underscores its importance in assessments of the beneficial effects of evidence-based therapies in the population. An effort focused on early antihypertensive treatment initiation and adherence is likely to provide major benefits

Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in patients with severe asthma eligible for both.

BACKGROUND: Patients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life. METHODS: This was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term-oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance, and hospital admissions. RESULTS: In the matched analysis (n = 350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p < 0.001) and experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs. 20.55% reduction; p = 0.023). There was some evidence to suggest that patients treated with anti-IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43). CONCLUSIONS: In real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes; however, anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use

Russian Point of View on German Rossievedenie

This review deals with the chapter about modern Russian Studies in Germany in the collective monograph “Izuchenie Rossii sovremennymi istorikami Zapada i Vostoka”, recently published under the editorship of N. V. Trubnikova. Its authors, the Tomsk historians V. V. Ageeva and M. A. Shtanko, have set a promising goal for their research: to approach the German rossievedenie in their overview covering the period from 1975 until 2014 with theoretical-methodological criteria instead of the more common in such cases political ones. In order to realize this project, they proposed to divide modern German historiography into three periods, with the latter one which covers the years 2005–2014 being a no less important innovation. However, it fell short of the reader’s expectations. Unfortunately, the chapter “Sovremennoe nemetskoe rossievedenie: spetsifika diskursa, tematicheskie polia i protsess institucionalizacii” is a mere compilation of superficially adapted facts, conclusions and ideas mostly taken from other works. V. V. Ageeva and M. A. Shtanko do not seem to have paid attention to the fact that some of the data they draw on have already lost its actuality. Statistical material serves largely to confirm their own postulates, and most references to German historians and their studies are inaccurate and misspelled, which does not enhance comprehension. Overall, the reader gets the impression that the authors were due to finish their work under some time pressure. This probably would explain why they chose “to take the easy way out” — in the end, the welcoming innovative theses expressed at the beginning of the chapter are abandoned, whereas outdated clichés — confirmed.This article was prepared within the framework of the state project of the Ministry of Science and Higher Education of the Russian Federation “Regional Identity of Russia: Comparative Historical and Philological Studies” (Laboratory for the Study of Primary Sources, Ural Federal University) No. FEUZ- 2020-0056

Characterization of patients in the International Severe Asthma Registry with high steroid exposure who did or did not initiate biologic therapy

Peer reviewedPostprin

Global variability in administrative approval prescription criteria for biologic therapy in severe asthma

Background Regulatory bodies have approved five biologics for severe asthma. However, regional differences in accessibility may limit the global potential for personalized medicine. Objective To compare global differences in ease of access to biologics. Methods In April 2021, national prescription criteria for omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab were reviewed by severe asthma experts collaborating in the International Severe Asthma Registry. Outcomes (per country, per biologic) were (1) country-specific prescription criteria and (2) development of the Biologic Accessibility Score (BACS). The BACS composite score incorporates 10 prescription criteria, each with a maximum score of 10 points. Referenced to European Medicines Agency marketing authorization specifications, a higher score reflects easier access. Results Biologic prescription criteria differed substantially across 28 countries from five continents. Blood eosinophil count thresholds (usually ≥300 cells/μL) and exacerbations were key requirements for anti-IgE/anti–IL-5/5R prescriptions in around 80% of licensed countries. Most countries (40% for dupilumab to 54% for mepolizumab) require two or more moderate or severe exacerbations, whereas numbers ranged from none to four. Moreover, 0% (for reslizumab) to 21% (for omalizumab) of countries required long-term oral corticosteroid use. The BACS highlighted marked between-country differences in ease of access. For omalizumab, mepolizumab, benralizumab, and dupilumab, only two, one, four, and seven countries, respectively, scored equal or higher than the European Medicines Agency reference BACS. For reslizumab, all countries scored lower. Conclusions Although some differences were expected in country-specific biologic prescription criteria and ease of access, the substantial differences found in the current study present a challenge to implementing precision medicine across the world

Misdiagnosed Hypomanic Symptoms in Patients with Treatment-Resistant Major Depressive Disorder in Italy: Results from the Improve Study

Background: Undiagnosed and therefore inadequately treated hypomanic symptoms may be a leading cause of drug resistance in depression diagnosed as unipolar (major depressive disorder, MDD). The purpose of the IMPROVE study was to identify the rate of misdiagnoses in patients with treatment-resistant MDD by screening for the presence of previous hypomanic episodes, and to study the characteristics of those patients with a positive history of hypomania. Methods: Patients attending 29 psychiatric units throughout Italy with a diagnosis of MDD who were resistant to antidepressant treatment were included in this multicentre, observational single visit study. The Hypomania Checklist 32 (HCL-32) was administered to detect underlying bipolarity. Results: Among the 466 enrolled patients, 256 (57.40%) were positive at screening for a previous hypomanic episode (HCL-32 ≥12), therefore suggesting a misdiagnosis. These patients scored higher than those with a negative history in both the "active/elated hypomania" (11.27±3.11 vs 3.57±3.05; P<0.0001) and "irritable/risk-taking hypomania" (2.87±2.03 vs 2.06±1.73; P<0.001) HCL-32 sub-scales. Patients with a positive history of hypomania were younger, had a higher number of previous depressive episodes and a higher frequency of comorbid conditions compared to those with a negative history. Conclusions: This study suggests that screening for hypomania in MDD-resistant patients facilitates identification of a notable proportion of undiagnosed cases of bipolar spectrum disorder. Patients with a positive history of hypomania at screening had a demographic/clinical bipolar-like profile that included young age, higher number of previous depressive episodes and higher frequency of comorbid conditions. They also had both higher active and irritable hypomania symptom scores

Statins for the primary prevention of cardiovascular events in elderly patients: a picture from clinical practice without strong evidence from clinical trials

Statins have been demonstrated to be beneficial for secondary prevention of cardiovascular (CV) events also in the elderly. However, a great debate is ongoing about the actual effectiveness in the primary prevention in this patient group. Notwithstanding the lack of strong evidence for primary prevention of CV events in the elderly, statins might be prescribed to elderly in general practice, thus contributing to increase the economic burden of this drug type on the Italian National Health System expenditure. We have conducted an analysis using the general practice database of Caserta-1 Local Health Unit. We selected subjects that received at least one statin prescriptions during the years 2004-2005. We stratified statin users according to CV primary and secondary prevention. The data show that 17.3% of statin users are aged 75 and older (median 78). Prevalence of statin use in elderly patients is 10.0%. Primary prevention of CV events represents the most frequent indication of use of statins in this age group (62.7%). In particular, 30.6% of elderly people receiving statins for primary prevention are new users. Almost 40% of statin users aged 75 and older received only one to five statin prescriptions within the study period. Our data show a wide use of statins in patients aged 75 and older, particularly for primary prevention of CV events. These results should be interpreted also in relation to economics. Alternatively the risk of statin-related adverse events increases with age because of polytherapy and reduced hepatic and renal function. Economic impact and a benefit risk ratio assessment of statin therapy for primary prevention of CV events in elderly people should be taken into account