The annual relative contribution to the 9,082 bisphosphonate initiators identified over the entire period of interest (2003–2012).

<p>The dotted line represents the total number of patients aged 10 to 45 years in the study database.</p

Potential indications for initiating bisphosphonate treatment.

<p>Potential indications for initiating bisphosphonate treatment.</p

Characteristics of 9,082 patients in the year prior to initiating a bisphosphonate.

<p>^a Includes Paget’s disease of bone, osteogenesis imperfecta, and osteomalacia.</p><p>HRT = hormone replacement therapy</p><p>Characteristics of 9,082 patients in the year prior to initiating a bisphosphonate.</p

Human Papillomavirus Vaccine Uptake among Individuals with Systemic Inflammatory Diseases

<div><p>Objectives</p><p>The human papillomavirus (HPV) vaccine is safe and efficacious in patients with systemic inflammatory diseases (SID) who have higher rates of persistent HPV infection. We compared HPV vaccine uptake among SID and non-SID patients.</p><p>Methods</p><p>Using a U.S. insurance claims database (2006–2012), we identified individuals 9–26 years with ≥2 SID diagnosis codes ≥7 days apart with ≥12 months of continuous enrollment prior to the second code (index date). We matched SID patients by age, sex and index date to randomly selected non-SID subjects and selected those with ≥24 months of post-index date continuous follow-up. We also identified a non-SID subcohort with ≥1 diagnosis code for asthma. We defined initiation as ≥1 HPV vaccination claim after 2007, and completion as 3 claims. We used multivariable logistic regression to assess uptake in females 11–26 years comparing SID, non-SID and asthma cohorts, adjusting for demographics, region, comorbidities, and healthcare utilization.</p><p>Results</p><p>We identified 5,642 patients 9–26 years with SID and 20,643 without. The mean age was 18.1 years (SD 4.9). We identified 1,083 patients with asthma; the mean age was 17.2 (SD 5.1). Among females, 20.6% with SID, 23.1% without SID and 22.9% with asthma, received ≥1 HPV vaccine. In our adjusted models, the odds of receipt of ≥1 vaccine was 0.87 times lower in SID (95% CI 0.77–0.98) compared to non-SID and did not differ for 3 vaccines (OR 1.03, 95% CI 0.83–1.26). The odds of initiation and completion were not statistically different between SID and non-SID asthma cohorts.</p><p>Conclusions</p><p>In this nationwide cohort, HPV vaccine uptake was extremely low. Despite the heightened risk of persistent HPV infection among those with SID, no increase in HPV vaccine uptake was observed. Public health efforts to promote HPV vaccination overall are needed, and may be particularly beneficial for those at higher risk.</p></div

HPV vaccine uptake among females with systemic inflammatory diseases (SID, A), without SID (B), and without SID with asthma (C).

<p>HPV vaccine uptake among females with systemic inflammatory diseases (SID, A), without SID (B), and without SID with asthma (C).</p

Number and percentage of female HPV vaccine initiators (≥1) and completers (3) by systemic inflammatory disease (SID) status and length of continuous follow-up after the index date.

<p>Number and percentage of female HPV vaccine initiators (≥1) and completers (3) by systemic inflammatory disease (SID) status and length of continuous follow-up after the index date.</p

Overview of Study Design.

<p>Among subjects with ≥12 months of continuous enrollment, we identified those with ≥2 diagnosis codes for SID during this time period. The index date was defined as the date of the second diagnosis code (SID) or visit date (non-SID). SID and non-SID subjects were matched by age, sex and index date (1:4 ratio). In SID and non-SID matched subjects, we assessed HPV vaccine uptake beginning in 2007 among those with ≥24 months of continuous follow-up.</p

Disease distribution and HPV vaccine uptake by disease in systemic inflammatory disease (SID) cohort.

<p>*Other includes dermatomyositis, systemic sclerosis, ankylosing spondylitis, sarcoidosis and Goodpasture’s syndrome.</p><p>Disease distribution and HPV vaccine uptake by disease in systemic inflammatory disease (SID) cohort.</p

Baseline characteristics of the systemic inflammatory diseases (SID) cohort, the non-SID cohort, and the non-SID asthma subcohort

<p>*All p-values comparing SID and non-SID cohort characteristics <0.05, excluding age, South and West. All p-values comparing SID and non-SID asthma cohort characteristics <0.05 excluding sex, sexually transmitted diseases, primary care visits, obstetrics/gynecology visits, Northeast and South.</p><p>+Systemic Inflammatory Diseases (SID include: juvenile idiopathic arthritis, rheumatoid arthritis, systemic lupus erythematosus, psoriasis, psoriatic arthritis, inflammatory bowel disease, vasculitis, multiple sclerosis, juvenile dermatomyositis, systemic sclerosis, ankylosing spondylitis, Goodpasture’s syndrome, and sarcoidosis</p><p>Baseline characteristics of the systemic inflammatory diseases (SID) cohort, the non-SID cohort, and the non-SID asthma subcohort</p

Meta-Analysis of Atrial Fibrillation Associated with Use of Bisphosphonates.

<p>* Abbreviations: CI, confidence interval; EPIC, Early Postmenopausal Intervention Cohort study; FIT, Fracture Intervention Trial; FOSIT, Fosamax International Trial; HORIZON-PFT, the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly Pivotal Fracture Trial; HORIZON-RFT, the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly Recurrent Fracture Trial; M-H, Mantel Haenszel; OR, odds ratio. * Lewiecki (2010) et al. included data from 4 trials of ibandronate. Karam (2007) et al. included data from 6 trials of risedronate. Individual study data were not available.</p