11 research outputs found
An evaluation of exact matching and propensity score methods as applied in a comparative effectiveness study of inhaled corticosteroids in asthma
Peer reviewedPublisher PD
Prevalence of anal fistulas in Europe: Systematic literature reviews and population-based database analysis
Introduction: Despite the fact that perianal
fistulas are associated with significant morbidity
and impaired quality of life, their prevalence in
Europe is unknown. The aim of this study was
to estimate the prevalence of perianal fistulas in
Europe, overall and according to etiology.
Methods: Two independent literature reviews
were performed using different search strategies
to maximize the identification of potentially
relevant studies. Data from relevant articles
were used to estimate the prevalence of perianal
fistulas in Europe. The robustness of the estimate
was evaluated using data from a large
population-based database from the UK.
Results: A total of 26 studies provided epidemiological
data on perianal fistulas, of which
16 provided suitable data to estimate the
prevalence. Estimations using these data yielded
a total prevalence of 1.69 per 10,000 population.
Cryptoglandular infection and Crohn’s
disease (CD) were the predominant etiologies,
with prevalence rates at 0.86 and 0.76 per
10,000 population, respectively. Comparison of
prevalence data from the UK population-based
database with the European population resulted
in a standardized prevalence estimate of all
perianal fistulas of 1.83 per 10,000 population,
confirming the robustness of the literaturebased
estimate.
Conclusion: Although in terms of incidence
cryptoglandular fistulas were clearly predominant,
the prevalence of fistulas in CD and
cryptoglandular infection appeared more balanced.
This is due to the longer duration and
higher frequency of relapses of fistulas in CD.
The estimated prevalence implies that perianal
fistulas meet the criteria to be considered as a
rare condition in Europe (prevalence less than 5
per 10,000 population).This study was funded by Takeda Pharmaceutical U.S.A., Inc. and TiGenix SA
Exacerbations and healthcare resource utilization among COPD patients in a Swedish registry-based nation-wide study
Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are an important measure of disease severity in terms of impaired disease progression, increased recovery time, healthcare resource utilization, overall morbidity and mortality. We aimed to quantify exacerbation and healthcare resource utilization rates among COPD patients in Sweden with respect to baseline treatments, exacerbation history, and comorbidities. Methods: Patients with a COPD or chronic bronchitis (CB) diagnosis in secondary care at age of >= 40 years on 1.7. 2009 were identified and followed until 1.7.2010 or death. Severe exacerbations were defined as hospitalizations due to respiratory disease, and healthcare resource utilization was measured by all-cause hospitalizations and secondary care visits. Poisson regression was used adjusting for age, gender, time since COPD/CB diagnosis, and Charlson comorbidity index. Results: In 88,548 patients (54% females, mean age 72 years), previous respiratory hospitalizations and current high use of COPD medication (double or triple therapy) predicted an 8.3-fold increase in severe exacerbation rates and 1. 8-fold increase in healthcare resource utilization rates in the following year, compared to patients without combination treatment and/or history of severe exacerbations. Conclusions: COPD/CB patients with history of severe exacerbations and high use of COPD medication experienced a significantly increased rate of severe exacerbations and healthcare resource utilization during the one-year follow-up
Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids
Purpose Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). Methods: This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. Results: Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. Conclusions: In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS