Efficacy and safety of once daily liraglutide versus twice daily exenatide in type 2 diabetic patients in Qatar: an observational study.

Objective: Compare efficacy and safety of liraglutide (1.8 mg subcutaneous once daily) and exenatide (10 mcg subcutaneous twice daily) in uncontrolled type 2 diabetes at 26 and 52 weeks. Method: A retrospective observation study of uncontrolled type 2 diabetes patients who took liraglutide or exenatide in addition to their anti-diabetic medications. This study was conducted at Hamad Medical Corporation, the predominant public healthcare organization in Qatar. The primary outcome was the change in haemoglobin A1C (HbA1C) after 26 and 52 weeks. Key finding: Two hundred and two patients were included in this study (liraglutide 98, exenatide 114). There was no significant HbA1C change observed between two groups at either 26 or 52 weeks (P = 0.23 and 0.40 respectively). However, more patients in the liraglutide group achieved HbA1C ≤7% at week 26. Liraglutide reduced the mean Fasting blood glucose (FBG) more than exenatide at week 26 and 52. Although both medications were associated with some benefits in other studied variables at a certain point (e.g. weight losses, blood pressure), neither of them were able to show a significant change from baseline. No patients in either group reported drug-related side effects (e.g. nausea and vomiting) or episodes of hypoglycaemia during the treatment period. Conclusions; Exenatide and liraglutide resulted in similar glycaemic effects (HbA1C and fasting plasma glucose changes) in patients with type 2 diabetes who were sub-optimally controlled with other anti-diabetic therapy. However, this study supports the effectiveness of both medications for weight reduction at both endpoints. A prospective large-scale study is recommended to overcome the study limitations

Bridging vs Non-Bridging with Warfarin Peri-Procedural Management: Cost and Cost-Effectiveness Analyses

The warfarin peri-procedural management in Qatar is predominantly based on bridging (63%), compared to non-bridging. This study sought to perform a first-time cost analysis of current warfarin peri-procedural management practices, including a cost-effectiveness analysis (CEA) of predominant bridging vs predominant non-bridging practices. From the hospital perspective, a one-year decision-analytic model followed the cost and success consequences of the peri-procedural warfarin in a hypothetical cohort of 10,000 atrial fibrillation patients. Success was defined as survival with no adverse events. Outcome measures were the cost and success consequences of the 63% bridging (vs not-bridging) practice in the study setting, ie, Hamad Medical Corporation, Qatar, and the incremental cost-effectiveness ratio (ICER, cost/success) of the warfarin therapy when predominantly bridging based vs when predominantly non-bridging based. The model was based on Monte Carlo simulation, and sensitivity analyses were performed to confirm the robustness of the study conclusions. As per 63% bridging practices, the mean overall cost of peri-procedural warfarin management per patient was USD 3,260 (QAR 11,900), associated with an overall success rate of 0.752. Based on the CEA, predominant bridging was dominant (lower cost, higher effect) over the predominant non-bridging practice in 62.2% of simulated cases, with a cost-saving of up to USD 2,001 (QAR 7,303) at an average of USD 272 (QAR 993) and was cost-effective in 36.9% of cases. Being between cost-saving and cost-effective, compared to predominant non-bridging practices, the predominant use of bridging with warfarin seems to be a favorable strategy in atrial fibrillation patients

Behavioral determinants potentially influencing COVID-19 vaccine acceptance among pharmacy professionals in Qatar: a nationwide survey using the Theoretical Domains Framework

Background: There is a paucity of robust, theory-based research investigating vaccination behavior. 1 Using Theoretical Domains Framework (TDF), the study aimed to explore the key behavioral determinants influencing vaccine behavior among pharmacy professionals in Qatar. Methods: A cross-sectional online survey of pharmacy professionals was conducted in April 2021. Survey items included questions related to demographics, vaccination behavior, and behavioral ‘determinants’ influencing vaccination (Likert statements, TDF items). The draft questionnaire was reviewed for face and content validity with experts and piloted among 80 participants. The sample size was calculated (n = 353) using the Raosoft online calculator. Data were analyzed using descriptive and inferential statistics and Principal component analysis (PCA) of TDF items. 2,3 Results: The response rate was 37.40% (1,065/2,400). The majority expressed willingness to receive the COVID-19 vaccines. Participants who refused the influenza vaccine in the past were more likely to refuse the COVID-19 vaccines too (χ2(1) = 12.6, chi-square; p < 0.001). The mean (SD) overall percentage score of behavioral determinants influencing vaccine acceptance and advocacy were 31.2 ± 19.6 and 36.5 ± 28.2 (on a scale from -100 to 100). Vaccine acceptance was lower among those who refused any vaccines in the past (33.2 ± 18.9 vs 28.7 ± 20.1; p < 0.001) (Table 1). The main barriers to vaccine acceptance were safety, speed of development, and cultural influences. PCA identified ‘belief of consequence and emotions (fear and anxiety) as more negative determinant (-1.4 ± 42.1) potentially influencing vaccine acceptance behavior (Table 2). Although most participants considered it as their professional duty to advocate the use of vaccines, they were unsure if patients will accept their recommendations. Conclusion: Most participants expressed an interest to receive the COVID-19 vaccines and considered it as their professional duty to recommend the use of the vaccine. However, they were unsure if patients would accept their advice. Study findings will assist to develop behavior change interventions targeting individuals.qscienc