Association between TriptanUse and Cardiac Contraindications in an Insured Migraine Population

Background Safety concerns exist when using triptansto treat patients with cardiac contraindications. –Triptans cause vasoconstriction, a safety concern for migraineurswith cardiovascular (CV) disease or other cardiac risk factors. –All triptans contain contraindications in their package inserts to avoid use in patients with cardiac conditions. •Previous research indicates that clinicians are less likely to prescribe triptansin patients with CV disease or CV risk factors. Limited research has examined the proportion of migraine patients with cardiovascular disease or those individuals who were concurrently treated with triptans

Spatial and Socio-Classification of Traffic Pollutant Emissions and Associated Mortality Rates in High-Density Hong Kong via Improved Data Analytic Approaches

Excessive traffic pollutant emissions in high-density cities result in thermal discomfort and are associated with devastating health impacts. In this study, an improved data analytic framework that combines geo-processing techniques, social habits of local citizens like traffic patterns and working schedule and district-wise building morphologies was established to retrieve street-level traffic NOx and PM2.5 emissions in all 18 districts of Hong Kong. The identification of possible human activity regions further visualizes the intersection between emission sources and human mobility. The updated spatial distribution of traffic emission could serve as good indicators for better air quality management, as well as the planning of social infrastructures in the neighborhood environment. Further, geo-processed traffic emission figures can systematically be distributed to respective districts via mathematical means, while the correlations of NOx and mortality within different case studies range from 0.371 to 0.783, while varying from 0.509 to 0.754 for PM2.5, with some assumptions imposed in our study. Outlying districts and good practices of maintaining an environmentally friendly transportation network were also identified and analyzed via statistical means. This newly developed data-driven framework of allocating and quantifying traffic emission could possibly be extended to other dense and heavily polluted cities, with the aim of enhancing health monitoring campaigns and relevant policy implementations

Hospitalization outcomes in patients with schizophrenia after switching to lurasidone or quetiapine: a US claims database analysis

Abstract Background This study compared hospital admission rates among adult patients with schizophrenia who switched to antipsychotic monotherapy with lurasidone or quetiapine. Methods This retrospective cohort study used U.S.-based Truven Health MarketScan® Medicaid Multi-State Database (April 2010 through December 2012) and MarketScan® Commercial Claims and Encounters Database (April 2010 through October 2013). Continuous enrollment for 6-months before and after medication initiation was required. Treatment episodes ended after 6-months post lurasidone or quetiapine initiation, a 60-day treatment gap, or initiation of another antipsychotic. Length of treatment episodes (i.e., treatment duration) was compared using a t-test. All-cause, mental-health, and schizophrenia-related hospitalization rates, as well as costs, were compared between lurasidone- and quetiapine-treated patients using multivariable generalized linear models that adjusted for background characteristics. Results Quetiapine (n = 435) compared to lurasidone (n = 238) treatment was associated with increased all-cause (21% vs 13%, p < 0.05) and mental health-related hospitalizations (20% vs 12%, p < 0.05), but similar rates of schizophrenia-related hospitalizations (14% vs. 10%, p = 0.14). After adjusting for baseline covariates, quetiapine had 64% higher likelihood of all-cause hospitalizations (OR [odds ratio] = 1.64, 95% confidence interval [CI] 1.05–2.57, p = 0.03), 74% higher likelihood of mental health-related hospitalizations (OR = 1.74, 95% CI 1.11–2.75, p = 0.02), and a similar likelihood of schizophrenia-related hospitalization (OR = 1.35, 95% CI 0.82–2.22, p = 0.24). For those with hospital admissions, adjusted all-cause admission costs were higher for quetiapine when compared with lurasidone in both the Medicaid ($22,036 vs.$15,424, p = 0.17) and commercial populations ($23,490 vs.$20,049, p = 0.61). These differences were not significant. The length of treatment episodes was significantly shorter for quetiapine than lurasidone (115.4 vs 123.1 days, p < 0.05). Conclusions In this retrospective claims database study, patients with schizophrenia who were switched to lurasidone had significantly fewer all-cause and mental health-related hospitalizations and similar rates of schizophrenia-related hospitalization compared with those switched to quetiapine. Patients switching to lurasidone had a significantly longer treatment duration rate than those switching to quetiapine. These results may reflect differences in efficacy or tolerability between lurasidone and quetiapine

Long-term health-related quality of life improvements among patients treated with lurasidone: results from the open-label extension of a switch trial in schizophrenia

Abstract Background Long-term improvement of health-related quality of life (HRQoL) in schizophrenia may improve adherence and reduce relapse and rehospitalization. This analysis examines long-term changes in HRQoL among patients with schizophrenia switched to lurasidone from other antipsychotics. Methods Patients who completed an open-label 6-week switch study continued on lurasidone for an additional 24-weeks. HRQoL was measured using the self-reported Personal Evaluation of Transitions in Treatment (PETiT) scale and Short-Form 12 (SF-12) questionnaire. The PETiT assessed HRQoL via total and domain scores (adherence-related attitude and psychosocial functioning). The SF-12 assessed patients’ mental and physical component summary scores (MCS and PCS). Mean changes from the initial baseline were calculated at extension baseline and extension endpoint using analysis of covariance models. Analyses were further stratified by prior antipsychotic medication and responder status; responders were defined as having a ≥20 % improvement in Positive and Negative Syndrome Scale during the first 6-weeks of treatment. Results The analysis included 144 patients with PETIT or SF-12 data who received ≥1 dose of lurasidone. Mean (standard deviation) PETiT total score improved significantly from 34.9 (9.3) at baseline to 39.5 (8.9) at extension baseline and 39.1 (9.0) at extension endpoint, representing improvements of 4.5 (7.9) and 5.1 (7.2) points, respectively (both p < 0.001). Significant improvements in adherence-related attitude and psychosocial functioning were observed at extension baseline and extension endpoint (all p < 0.001). Improvement in SF-12 MCS score was observed at extension baseline and endpoint, and PCS score at extension endpoint (all p < 0.01). Patients who switched from quetiapine and aripiprazole showed significant improvement of PETiT total score and adherence-related attitude at extension baseline and extension endpoint. In addition, patients who switched from quetiapine, risperidone, aripiprazole, or ziprasidone showed significant improvement in MCS scores from baseline to extension endpoint. Responders to lurasidone demonstrated greater improvement in PETiT total, psychosocial functioning, and MCS scores at extension baseline than nonresponders. Conclusions After switching to lurasidone, patients with schizophrenia experienced HRQoL improvements that were sustained for an additional 24 weeks of treatment. Further study is warranted to understand the implications of these improvements in terms of employment, adherence, relapse, and rehospitalization. Trial registration Clinical trials.gov identifier NCT01143090 (June 10th, 2010)

Additional file 2: of Hospitalization outcomes in patients with schizophrenia after switching to lurasidone or quetiapine: a US claims database analysis

Multivariate Model Results. Table S1. Multivariate results for all-cause hospital admission in combined Medicaid and commercial insurance. Table S2. Multivariate results for mental-health hospital admission in combined Medicaid and commercial insurance. Table S3. Multivariate results for schizophrenia-related hospital admission in combined Medicaid and commercial insurance. Table S4. Multivariate results for all-cause hospital costs in commercial insurance among treatment episodes with an admission. Table S5. Multivariate results for all-cause hospital costs in Medicaid among treatment episodes with an admission. (DOCX 76 kb

EQ-5D™-derived utility values for different levels of migraine severity from a UK sample of migraineurs

<p>Abstract</p> <p>Background</p> <p>To estimate utility values for different levels of migraine pain severity from a United Kingdom (UK) sample of migraineurs.</p> <p>Methods</p> <p>One hundred and six migraineurs completed the EQ-5D to evaluate their health status for mild, moderate and severe levels of migraine pain severity for a recent migraine attack, and for current health defined as health status within seven days post-migraine attack. Statistical tests were used to evaluate differences in mean utility scores by migraine severity.</p> <p>Results</p> <p>Utility scores for each health state were significantly different from 1.0 (no problems on any EQ-5D dimension) (p < 0.0001) and one another (p < 0.0001). The lowest mean utility, − 0.20 (95% confidence interval [CI]: -0.27 – -0.13), was for severe migraine pain. The smallest difference in mean utility was between mild and moderate migraine pain (0.13) and the largest difference in mean utility was between current health (without migraine) and severe migraine pain (1.07).</p> <p>Conclusions</p> <p>Results indicate that all levels of migraine pain are associated with significantly reduced utility values. As severity worsened, utility decreased and severe migraine pain was considered a health state worse than death. Results can be used in cost-utility models examining the relative economic value of therapeutic strategies for migraine in the UK.</p

MOESM1 of Weight changes before and after lurasidone treatment: a real-world analysis using electronic health records

Additional file 1. Analysis examining potential overestimation of weight change by linear model