Cognitive function in chronic non-malignant pain patients treated with sustained-release morphine sulfate (Avinza)

textThe purpose of this study is to evaluate the association between sustained-release morphine (Avinza®), and performance on neuropsychological tests assessing short term memory, information processing, and motor skills in chronic pain patients, while controlling for stages of pain model variables and the effects of benzodiazepines. A convenience sampling procedure was utilized to enroll a sample of patients who had a trial of short-acting narcotic analgesics for their chronic non-malignant pain. Enrolled patients were treated with long-acting morphine Avinza.® Patient interviews were conducted at enrollment and one-month follow-up. A total of 129 patients were enrolled in the study. Mean pain intensity ratings at the highest, lowest, and average levels in the previous week were lower at follow-up (10.90, 4.56. 7.64) than at baseline (12.71, 6.76, 10.01) respectively. Reduction in pain levels was associated with a corresponding reduction in levels of pain unpleasantness, pain suffering, and pain behaviors. The models evaluating the associations between the stages of pain model variables, morphine dose, benzodiazepine dose, and digit span test (chi square = 147.79, p = 0.76), digit symbol test (chi square = 128.06, p = 0.5), and paced auditory serial attention test fit the data well (chi square = 160.39, p = 0.85). There was a statistically significant inverse association between frequency of pain behaviors and digit span test scores at baseline (-0.49, p = 0.01). Although the association between pain behaviors and digit symbol test scores (- 17. 0 %, p = 0.09) and paced auditory serial addition test scores (-4.0%, p = .28) at baseline were not statistically significant, a large negative effect was found. At follow-up, the association between pain behaviors and digit span test was positive and not significant. The negative association between frequency of pain behaviors and digit symbol test scores (-4.4%, p = 0.67 ) and paced auditory serial addition test scores (-2.8%, p = 0.21) at follow-up were considerably weaker. There were no significant association between opioid dose and cognitive function test scores. Opioid therapy, particularly, sustained release morphine therapy (Avinza) does not contribute to cognitive impairment in chronic pain patients.Pharmac

Hospitalization Among Pulmonary Arterial Hypertension Patients With and Without Connective Tissue Disease Comorbidities Prescribed Oral Selexipag

Abstract Introduction Patients with connective tissue disorders (CTD) and pulmonary arterial hypertension (PAH) have a poorer prognosis than those with other PAH etiologies. This study assessed the impact of CTD on healthcare outcomes among PAH patients with and without CTD comorbidities that were treated with oral selexipag. Methods The study utilized Optum’s de-identified Clinformatics® Data Mart Database (2007–2021) from January 1, 2014 to June 30, 2019, and identified patients with PAH without CTD and PAH with CTD treated with oral selexipag. Patients had ≥ 12-month baseline period with no requirement for a minimum follow-up period. Patients were followed until any of the following events: discontinuation of oral selexipag, or health plan disenrollment, or death, or presence of a diagnosis claim for CTEPH, or study end date, whichever occurred first. PAH-related hospitalizations, PAH disease progression, and healthcare utilizations and costs were assessed in the follow-up period. The Cox proportional hazards model was used to evaluate the time to hospitalization and generalized linear models were used to examine healthcare costs and utilization between the two cohorts. Results In the analysis, 237 PAH without CTD, and 80 PAH patients with CTD comorbidities prescribed oral selexipag were included. The PAH without CTD comorbidities cohort was older (65 vs. 63 years old), had proportionately less females (72 vs. 83%), and higher comorbidity burden than PAH with CTD comorbidities (mean CCI index 3 vs. 2). After adjusting for potential confounders, the risk for PAH-related hospitalization (hazard ratio (HR) 1.13, p value 0.641), all-cause hospitalization (HR 1.09, p value: 0.765), and PAH disease progression (HR 1.14, p value 0.522) between the two cohorts were similar. After adjusting for baseline demographic and clinical characteristics, PAH with CTD comorbidities incurred higher total mean all-cause PAH-related medical care costs compared to PAH without CTD comorbidities. Conclusions In this real-world study, the risk of hospitalization and PAH disease progression were similar between the two cohorts who received oral selexipag. The results from this study corroborate findings of the GRIPHON post hoc analysis of PAH-associated CTD patients and support oral selexipag use in PAH-CTD patients

Impact of selexipag use within 12 months of pulmonary arterial hypertension diagnosis on hospitalizations and medical costs: A retrospective cohort study

Abstract Background Oral selexipag, a prostacyclin pathway agent (PPA), is effective in patients with pulmonary arterial hypertension (PAH). The objective of this study is to assess the impact of initiating oral selexipag within 12 months of diagnosis on health outcomes. Methods This retrospective cohort study used data from Optum's de‐identified Clinformatics® Data Mart Database. PAH patients between 1 October 2015 and 30 September 2019 were included. Patients were also required to have received PAH medication within 12 months of their initial diagnosis. Study groups included patients who initiated selexipag within 12 months of PAH diagnosis (SEL ≤ 12) and those who did not initiate any PPA within 12 months of PAH diagnosis (No PPA ≤ 12). Inverse probability of treatment weighting was used to remove potential confounding between groups. Cox and Poisson regression models were used to compare hospitalization and disease progression. Generalized linear model with gamma distribution and log link was used to compare costs. Results SEL ≤ 12 had lower rate of all‐cause hospitalizations (rate ratio: 0.76, 95% confidence interval [CI]: 0.60, 0.96) versus no PPA ≤ 12, but no differences in PAH‐related hospitalization rate (rate ratio: 1.03, 95% CI: 0.79, 1.33) or risk of disease progression (hazard ratio: 1.01, 95% CI: 0.71, 1.44). SEL ≤ 12 incurred lower all‐cause (mean difference: −$23 623; 95$12 927; 95% CI: −19 559, −5679) versus no PPA ≤ 12. Conclusion Selexipag initiation within 12 months of PAH diagnosis demonstrated reductions in all‐cause hospitalization rate and medical costs

Cost-effectiveness of once weekly carfilzomib 70 mg/m2 plus dexamethasone in patients with relapsed and refractory multiple myeloma in the United States

Background: In the US, carfilzomib 70 mg⁄m2 once-weekly plus dexamethasone (Kd70 QW) was recently indicated for relapsed and/or refractory multiple myeloma. In current US clinical practice, most patients treated with Kd receive carfilzomib at a previously approved dose of 27 mg/m2 twice-weekly (Kd27 BIW). This analysis assessed the cost-effectiveness (CE) of Kd70 QW vs Kd27 BIW regimens which were compared in the randomized phase 3 ARROW trial. Methods: Based on clinical outcomes (overall survival and utilities) from ARROW, a partitioned survival model was developed to estimate life years (LYs) and quality-adjusted life years (QALYs). Long-term survival was extrapolated using SEER registry data matched to ARROW patients. Costs were estimated using a US healthcare payer perspective. Results: The analysis estimated that treatment with Kd70 QW vs Kd27 BIW resulted in an increase of 1.10 LYs, 0.91 QALYs, and additional lifetime costs of $74,858, yielding an incremental CE ratio (ratio of incremental costs to QALYs) of$82,257 per QALY gained. Results were robust to sensitivity and subgroup analyses. Conclusions: When compared with Kd27 BIW, Kd70 QW is the optimal dose that represents a cost-effective utilization of health care budget with incremental CE ratios well below the accepted willingness-to-pay thresholds in the US. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group