Disparities in Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors prescription and dispensing in the Israeli population – a retrospective cohort study.

Objective: To describe disparities in prescribing and dispensing Sodium-glucose Cotransporter-2 Inhibitors (SGLT2i) in Israel.Research Design and Methods: A population-based retrospective cohort study of adults with type 2 diabetes mellitus eligible for SGLT2i treatment from 2017 to 2023. The primary outcome was time between initial eligibility and first prescription of SGLT2i. Results: Among 32,742 eligible patients, only 53% were prescribed SGLT2i. Multivariable analyses, adjusting for death as competing risk, revealed delays in prescription associated with older age, Arab or Bedouin ethnicity, neoplasms, acute kidney failure, falls, previous hospitalization, urinary tract infections and dementia. Factors associated with shorter time intervals to prescription were gender (men), medium/high socioeconomic status and residing in an intermediate or central area of Israel.Conclusions: Disparities in drug prescription exist even in a country with universal health coverage. Addressing these disparities requires improvements in healthcare systems, education and alert systems to overcome barriers to evidence-based interventions. </p

Treatment of Anemia in Inflammatory Bowel Disease– Systematic Review and Meta-Analysis

<div><p>Background</p><p>Anemia is considered the most common systemic complication of inflammatory bowel disease (IBD). We aimed to provide all available evidence regarding the safety and efficacy of therapy existing today to correct anemia in IBD.</p><p>Methods</p><p>Systematic review and meta-analysis of randomized controlled trials that compared any treatment for anemia in patients with IBD. We searched electronic databases, conference proceedings and clinical trials registries. Two reviewers independently extracted data from included trials. The primary outcome was the effect of treatment for anemia in IBD on the hemoglobin (Hb) response, defined as rate of patients who achieved an increase of 2 g/dl in Hb concentration at the end of the follow-up. Secondary outcomes included disease severity scores, iron indices, Hb levels, inflammatory markers, adverse effects, and mortality. Dichotomous data were analysed by calculating the relative risk (RR) for each trial with the uncertainty in each result being expressed using 95% confidence intervals (CI). A fixed effect model was used, except in the event of significant heterogeneity between the trials (P<0.10, I²>40%), in which we used a random effects model.</p><p>Results</p><p>Nine trials fulfilled the inclusion criteria, to a total of 973 patients. We were able to perform meta-analysis for intravenous (IV) versus oral iron and for ESAs versus placebo. IV iron was associated with a higher rate of achieving Hb response in comparison to oral iron; RR 1.25 (95% CI 1.04–1.51, I² = 2%, 4 trials), CRP levels and disease activity indexes were not significantly affected by IV iron. IV iron was associated with a decrease in adverse events that required discontinuation of intervention and without an increase in serious adverse.</p><p>Discussion</p><p>Treatment for anemia in IBD should include IV iron and not oral iron replacement, due to improved Hb response, no added toxicity and no negative effect on disease activity.</p></div

Outcomes according to filling of the Padua score.

BackgroundVenous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis.AimTo evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates.MethodsRetrospective Study was performed in Israel during the years 2014–2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed.Results18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49–1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97–1.31) and OR 1.22 (95% CI 0.79–1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups.ConclusionsPadua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure.</div

Patients’ characteristics according to physician’s compliance with filling the Padua score.

Patients’ characteristics according to physician’s compliance with filling the Padua score.</p

Administration of VTE prophylaxis according to fulfillment of Padua score.

Administration of VTE prophylaxis according to fulfillment of Padua score.</p

Multiregression analysis for VTE.

BackgroundVenous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis.AimTo evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates.MethodsRetrospective Study was performed in Israel during the years 2014–2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed.Results18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49–1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97–1.31) and OR 1.22 (95% CI 0.79–1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups.ConclusionsPadua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure.</div

Risk of bias assessment.

<p>Risk of bias assessment.</p

Trials protocols & data summary.

<p>Trials protocols & data summary.</p

Multiregression analysis for mortality.

BackgroundVenous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis.AimTo evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates.MethodsRetrospective Study was performed in Israel during the years 2014–2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed.Results18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49–1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97–1.31) and OR 1.22 (95% CI 0.79–1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups.ConclusionsPadua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure.</div

Trial selection.

<p>Trial selection.</p