Real-World Treatment Patterns, Outcomes, and Healthcare Resource Utilization in Relapsed or Refractory Multiple Myeloma: Evidence from a Medical Record Review in France

Background. Limited data are available from real-world practices in Europe describing prevailing treatment patterns and outcomes in relapsed/refractory multiple myeloma (RRMM), particularly by cytogenetic risk. Methods. A retrospective medical record review was conducted in 200 RRMM patients in France. From first relapse, patients were assessed on second-/third-line treatments, progression-free survival (PFS), overall survival (OS), and healthcare utilization. Results. Fifty-five high risk and 113 standard risk patients were identified. Overall, 192 patients (96%) received second-line therapy after relapse. Lenalidomide-based regimens were most common (>50%) in second line. Hospitalization incidence in high risk patients was approximately twice that of standard risk patients. From Kaplan-Meier estimation, median (95% CI) second-line PFS was 21.4 (17.5, 25.0) months (by high versus standard risk: 10.6 [6.4, 17.0] versus 28.7 [22.1, 37.3] months). Among second-line recipients, 47.4% were deceased at data collection. Median second-line OS was 59.4 (38.8, NE) months (by high versus standard risk: 36.5 [17.4, 50.6] versus 73.6 [66.5, NE] months). Conclusions. The prognostic importance of cytogenetic risk in RRMM was apparent, whereby high (versus standard) risk patients had decidedly shorter PFS and OS. Frequent hospitalizations indicated potentially high costs associated with RRMM, particularly for high risk patients. These findings may inform economic evaluations of RRMM therapies

Predictors of selective laser trabeculoplasty success in open angle glaucoma or ocular hypertension:Does baseline tonography have a predictive role?

BACKGROUND: The determinants of success of selective laser trabeculoplasty (SLT) in treatment-naïve patients with open angle glaucoma (OAG) and ocular hypertension (OHT) have not been understood fully. Therefore, we have conducted this study to explore the predictors of success. METHODS: This is a retrospective review of a pre-existing database of patients who had received primary SLT at St Thomas' Hospital, London, UK. Patients with OAG and OHT who had received primary 360° SLT treatment and had reliable baseline tonographic outflow facility (TOF) with minimum of 1 year of follow-up were included. Univariate and multivariate analyses were performed to find the determinants of success. RESULTS: One hundred and seventy-four patients between August 2006 and February 2010 had received primary 360° SLT treatment and had baseline TOF measurement. Of these, 72 subjects fulfilled the eligibility criteria. In multivariate regression analysis, the only variable associated with success was baseline intraocular pressure (IOP) (R^{2}=0.32, beta=-0.51, p<0.001, 95% CI -2.02 to -0.74). CONCLUSION: To our knowledge, this is the only study investigating the pretreatment TOF (measured with electronic Shiøtz tonography) and IOP as determinants of success 12 month's post-360° SLT in treatment-naïve patients with OAG and OHT. This study demonstrated that pretreatment IOP (and not TOF) is the only determinant of success after primary SLT therapy

Treatment Patterns and Survival among Adult Patients with Advanced Soft Tissue Sarcoma: A Retrospective Medical Record Review in the United Kingdom, Spain, Germany, and France

Objective. To describe real-world treatment patterns and outcomes for patients with advanced soft tissue sarcoma (STS) not amenable to surgery or radiotherapy in the United Kingdom, Spain, Germany, and France. Methods. Physicians completed a web-based medical record abstraction for adult patients with advanced STS (other than Kaposi’s sarcoma or gastrointestinal stromal tumor) who received ≥1 line of systemic therapy. Clinical characteristics, treatments, tumor responses, and mortality data were recorded. Results. A total of 130 physicians provided data for 807 patients. Patients’ mean age at advanced STS diagnosis was 57.1 (±12.3) years; 59% were male. The most commonly identified histologic categories were leiomyosarcoma (28%), liposarcoma (13%), and rhabdomyosarcoma (11%). Overall, 57% of patients received only 1 line of therapy, 32% received 2 lines of therapy, and 11% received ≥3 lines of therapy. The most common first-line regimens were doxorubicin alone (41%), doxorubicin plus ifosfamide (19%), docetaxel plus gemcitabine (9%), paclitaxel alone (4%), and ifosfamide (4%). Median overall survival from start of treatment was estimated to be 17.6 months (95% confidence interval, 15.6–19.0 months). Conclusions. In real-world clinical practice, advanced STS is most commonly treated with older therapies in the United Kingdom, Spain, Germany, and France. New therapies that improve overall survival in advanced STS are needed

Herpes Zoster Incidence and Burden in Adults with Type 2 Diabetes Mellitus in the United States: A Retrospective Database Analysis

   Objective Data on real-world burden of herpes zoster (HZ) in adults with type 2 diabetes mellitus (T2D) in the U.S. are limited. We assessed HZ in patients with and without T2D and measured the impact of HZ on healthcare resource use (HCRU) and costs. Research design and methods A retrospective cohort analysis using U.S. commercial claims data (sourced from claims incurred between January 1, 2012 and July 31, 2018). HZ incidence rates/1,000 person-years [PY] were calculated in patients with/without T2D; HZ risk was evaluated using Poisson regression to generate adjusted incidence rate ratios (aIRRs).  T2D patients with HZ were propensity score matched to patients with T2D only, and to patients with HZ without T2D. HCRU and costs were compared across cohorts during a 1-year follow-up period. Cox proportional hazards analyses evaluated factors associated with HZ-related complications.  Results Crude HZ incidence rates in patients with and without T2D were 9.8/1,000 PY and 2.6/1,000 PY respectively. T2D patients were almost twice as likely to be diagnosed with HZ (aIRR, 1.84 [95% CI: 1.82–1.85]). HZ was associated with increased HCRU and healthcare costs. At 12-months, unadjusted incremental all-cause healthcare costs for T2D patients with HZ versus T2D patients without HZ were $5,216; unadjusted incremental HZ-related healthcare costs for T2D patients with HZ versus patients with HZ without T2D were$2,726. Age was the most important predictor for HZ-related complications. Conclusions Given the increased risk of HZ and HCRU and cost burden in T2D patients, HZ prevention in T2D patients may be beneficial. </p