Effectiveness of postoperative radiotherapy after radical cystectomy for locally advanced bladder cancer

BACKGROUND: Local-regional failure (LF) for locally advanced bladder cancer (LABC) after radical cystectomy (RC) is common even with chemotherapy and is associated with high morbidity/mortality. Postoperative radiotherapy (PORT) can reduce LF and may enhance overall survival (OS) but has no defined role. We hypothesized that the addition of PORT would improve OS in LABC in a large nationwide oncology database. METHODS: We identified ≥ pT3pN0-3M0 LABC patients in the National Cancer Database diagnosed 2004-2014 who underwent RC ± PORT. OS was calculated using Kaplan-Meier and Cox proportional hazards regression modeling was used to identify predictors of OS. Propensity matching was performed to match RC patients who received PORT vs those who did not. RESULTS: 15,124 RC patients were identified with 512 (3.3%) receiving PORT. Median OS was 20.0 months (95% CI, 18.2-21.8) for PORT vs 20.8 months (95% CI, 20.3-21.3) for no PORT (P = 0.178). In multivariable analysis, PORT was independently associated with improved OS: hazard ratio 0.87 (95% CI, 0.78-0.97); P = 0.008. A one-to-three propensity match yielded 1,858 patients (24.9% receiving PORT and 75.1% without). In the propensity-matched cohort, median OS was 19.8 months (95% CI, 18.0-21.6) for PORT vs 16.9 months (95% CI, 15.6-18.1) for no PORT (P = 0.030). In the propensity-matched cohort of urothelial carcinoma patients (N = 1,460), PORT was associated with improved OS for pT4, pN+, and positive margins (P \u3c 0.01 all). CONCLUSION: In this observational cohort, PORT was associated with improved OS in LABC. While the data should be interpreted cautiously, these results lend support to the use of PORT in selected patients with LABC, regardless of histology. Prospective trials of PORT are warranted

Factors Predicting Development of Opioid use Disorders among Individuals Who Receive an Initial Opioid Prescription: Mathematical Modeling Using a Database of Commercially-insured Individuals

Background Prescription drug abuse in the United States and elsewhere in the world is increasing at an alarming rate with non-medical opioid use, in particular, increasing to epidemic proportions over the past two decades. It is imperative to identify individuals most likely to develop opioid abuse or dependence to inform large-scale, targeted prevention efforts. Methods The present investigation utilized a large commercial insurance claims database to identify demographic, mental health, physical health, and healthcare service utilization variables that differentiate persons who receive an opioid abuse or dependence diagnosis within two years of filling an opioid prescription (OUDs) from those who do not receive such a diagnosis within the same time frame (non-OUDs). Results When compared to non-OUDs, OUDs were more likely to: (1) be male (59.9% vs. 44.2% for non-OUDs) and younger (M = 37.9 vs. 47.7); (2) have a prescription history of more opioids (1.7 vs. 1.2), and more days supply of opioids (M = 272.5, vs. M = 33.2; (3) have prescriptions filled at more pharmacies (M = 3.3 per year vs. M = 1.3); (4) have greater rates of psychiatric disorders; (5) utilize more medical and psychiatric services; and (6) be prescribed more concomitant medications. A predictive model incorporating these findings was 79.5% concordant with actual OUDs in the data set. Conclusions Understanding correlates of OUD development can help to predict risk and inform prevention efforts

The effect of regulatory controls on the quality of psychoactive drug prescribing.

The effect of regulatory controls on the quality of psychoactive drug prescribing

Survey of Nonprescription Medication and Antibiotic Use in Patients with Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, and Overlap Syndrome

Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and overlap syndrome (SJS-TEN) are rare, serious skin and mucosa break-down conditions frequently associated with antibiotic use. The role of nonprescription medications alone, or in combination with antibiotics in triggering SJS/TEN, is largely unknown. This study summarized data collected from patient surveys about nonprescription and antibiotic use prior to a SJS/TEN diagnosis. The survey was administered online to members of the U.S. SJS Foundation who had been diagnosed with SJS/TEN or were the parent of a child who had been diagnosed with SJS/TEN. Respondents were asked about nonprescription medications taken within the year before diagnosis, and the approximate point in time before diagnosis that they had taken them. They were also asked about specific prescription medications, including antibiotics, that they took before diagnosis. An estimated 4500 patients received an invitation to complete the survey. 251 patients completed it, resulting in a response rate of 5.6%. The mean age of respondents was 43 years (SD (standard deviation) = 17.3) and 70% were female. 32.3% of respondents indicated that a prescription antibiotic triggered their reaction. 14.1% indicated a nonprescription medication had triggered their SJS/TEN, and 18.1% said a nonprescription medication may have triggered their SJS/TEN. 85.5% of respondents said they took a nonprescription medication within three months of their SJS/TEN diagnosis. Of those respondents who reported that an antibiotic triggered their SJS/TEN, 35.2% reported taking a nonprescription medication within the three months prior to their diagnosis. This survey captured valuable information about nonprescription and antibiotic use in SJS/TEN patients. It is important for future studies to estimate the impact of antibiotics on SJS/TEN, and account for nonprescription medication use in that relationship

Effect of antibiotic exposure on Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

BackgroundAntibiotics are commonly implicated in Stevens-Johnson syndrome (SJS), overlap syndrome (SJS-TEN), and Toxic Epidermal Necrolysis (TEN), rare disorders of skin and mucosal membranes, often the result of adverse drug reactions. The objective of this study is to examine associations between SJS, SJS-TEN, and TEN and antibiotic exposure overlapping diagnosis, and 3, 6, and 12 months before diagnosis.MethodsA case-control study was conducted using PharMetrics LifeLink® Health Plan Claims Database (2001-2013). Cases had ≥1 diagnoses of SJS/TEN identified using ICD-9 codes, and ≥1 year of continuous health plan enrollment before earliest diagnosis. Controls were randomly selected from patients with no diagnoses of SJS/TEN, and matched to cases 4:1 on age, gender, and amount of continuous health plan enrollment. Multivariate logistic regression was used to estimate odds ratios for varying antibiotic exposures.Results192 cases and 768 controls were included. Odds of an antibiotic fill overlapping diagnosis was ten times higher for cases than controls (OR=10.4; 95% CI 5.1, 21.1). Most common antibiotics overlapping diagnosis were aminopenicillins and cephalosporins, however associations between specific antibiotics and SJS/TEN were not significant (OR=1.03; 95% CI 0.6, 1.9). Unadjusted ORs for 3 (OR=1.05; 95% CI 1.03-1.07), 6 (OR=1.03; 95% CI 1.02, 1.04), and 12 months (OR=1.02; 95% CI 1.01, 1.02) before diagnosis show lower associations further in the past between antibiotics and reaction.ConclusionsA significant association was found between overlapping antibiotic exposure and SJS/TEN. Likely due to small sample sizes, associations between specific antibiotic classes and SJS/TEN were not significant; further studies should be pursued to examine specific antibiotics

Effect of antibiotic exposure on Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

BackgroundAntibiotics are commonly implicated in Stevens-Johnson syndrome (SJS), overlap syndrome (SJS-TEN), and Toxic Epidermal Necrolysis (TEN), rare disorders of skin and mucosal membranes, often the result of adverse drug reactions. The objective of this study is to examine associations between SJS, SJS-TEN, and TEN and antibiotic exposure overlapping diagnosis, and 3, 6, and 12 months before diagnosis.MethodsA case-control study was conducted using PharMetrics LifeLink® Health Plan Claims Database (2001-2013). Cases had ≥1 diagnoses of SJS/TEN identified using ICD-9 codes, and ≥1 year of continuous health plan enrollment before earliest diagnosis. Controls were randomly selected from patients with no diagnoses of SJS/TEN, and matched to cases 4:1 on age, gender, and amount of continuous health plan enrollment. Multivariate logistic regression was used to estimate odds ratios for varying antibiotic exposures.Results192 cases and 768 controls were included. Odds of an antibiotic fill overlapping diagnosis was ten times higher for cases than controls (OR=10.4; 95% CI 5.1, 21.1). Most common antibiotics overlapping diagnosis were aminopenicillins and cephalosporins, however associations between specific antibiotics and SJS/TEN were not significant (OR=1.03; 95% CI 0.6, 1.9). Unadjusted ORs for 3 (OR=1.05; 95% CI 1.03-1.07), 6 (OR=1.03; 95% CI 1.02, 1.04), and 12 months (OR=1.02; 95% CI 1.01, 1.02) before diagnosis show lower associations further in the past between antibiotics and reaction.ConclusionsA significant association was found between overlapping antibiotic exposure and SJS/TEN. Likely due to small sample sizes, associations between specific antibiotic classes and SJS/TEN were not significant; further studies should be pursued to examine specific antibiotics