Hepatic decompensation in patients with HIV/Hepatitis B Virus (HBV)/Hepatitis C Virus (HCV) triple infection versus HIV/HCV coinfection and the effect of anti-HBV nucleos(t)ide therapy

Onur Başer (MEF Author)The incidence rate of hepatic decompensation was higher in patients with human immunodeficiency virus (HIV)/hepatitis B virus (HBV)/hepatitis C virus (HCV) triple infection than in those with HIV/HCV coinfection (24.1 vs 10.8 events per 1000 person-years; hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.12–3.18). Compared with HIV/HCVinfected patients, the rate of decompensation was increased among HIV/HBV/HCV-infected patients receiving no anti-HBV therapy (HR, 2.48; 95% CI, 1.37–4.49) but not among those who did receive such therapy (HR, 1.09; 95% CI, .40–2.97)WOS:000343411900019Scopus - Affiliation ID: 60105072PMID: 24944235Science Citation Index ExpandedQ1Editorial MaterialUluslararası işbirliği ile yapılan - EVETEkim2014YÖK - 2014-1

Patient-reported barriers to osteoporosis therapy

SUMMARY: We investigated reasons for non-treatment of osteoporosis and discontinuation of osteoporosis therapy. Barriers to treatment include patients’ preference for alternative treatments and a fear of possible side effects. Side effects are a common reason for treatment discontinuation, and they may be associated with a lack of willingness to restart treatment. PURPOSE/INTRODUCTION: Osteoporosis patients commonly cite treatment-related side effects, or the fear thereof, as a reason for discontinuing or not initiating anti-osteoporosis medications. The purpose of this study was to investigate, from the patient’s perspective, reasons for (i) non-treatment of osteoporosis and (ii) discontinuation of osteoporosis therapy. METHODS: This was an internet-based survey of postmenopausal women in the USA who self-reported having been diagnosed with osteoporosis. Respondents were recruited from consumer research panels and received nominal compensation. RESULTS: Within the surveyed population (N = 1407), 581 patients were currently being treated, 503 had never been treated, and 323 had previously been treated. Among patients never treated for osteoporosis, the highest ranking reasons for non-treatment were the use of alternative treatments such as over-the-counter vitamins/supplements (57.5 % of respondents) and fear of side effects (43.9 %). Among previously treated patients, frequent reasons for discontinuation included the direction of the physician (41.2 % of respondents), concerns about long-term safety (30.3 %), and the experience of side effects (29.8 %). When asked about their willingness to restart their osteoporosis medication, previously treated patients who were not willing (N = 104) to restart had a higher frequency of experiencing side effects (44.2 versus 20.5 % of those willing; P < 0.001). CONCLUSIONS: From the osteoporosis patient’s perspective, barriers to prescription treatment include a preference for alternative, non-prescription treatments and a fear of possible side effects. Side effects are one of the most common reasons for discontinuing osteoporosis medications, and they appear to be associated with a lack of willingness to restart treatment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11657-016-0272-5) contains supplementary material, which is available to authorized users

Food Frequency Questionnaires and Overnight Urines Are Valid Indicators of Daidzein and Genistein Intake in U.S. Women Relative to Multiple 24-h Urine Samples

Data regarding convenient, valid methods for measuring U.S. isoflavone intake are limited. We evaluated a soy food questionnaire (SFQ), the Willett food frequency questionnaire (FFQ), and overnight urine samples relative to excretion in 24-h urine samples. We also described intake among women in a high-risk program for breast or ovarian cancer. Between April 2002 and June 2003, 451 women aged 30 to 50 yr with a family history of breast or ovarian cancer completed the SFQ and FFQ. Of them, 27 provided four 24-h and overnight urine specimens. In these women, 24-h sample measures were correlated with SFQ estimates of daidzein (Spearman r = .48) and genistein (r = .54) intake, moderately correlated with the Willett FFQ (daidzein r = .38, genistein r = .33), and strongly correlated with overnight urine excretion (daidzein r = .84, genistein r = 0.93). Among all 451 SFQ respondents, mean (median) daidzein and genistein intakes were 2.8 (0.24) and 3.9 (0.30) mg/day. Primary sources of both were soymilk, soy nuts, and tofu.We conclude that targeted soy food questionnaires, comprehensive FFQs, and multiple overnight urines are all reasonable options for assessing isoflavone intake in epidemiologic studies

Adolescent Lifestyle Factors and Adult Breast Density in U.S. Chinese Immigrant Women

We examined recalled measures of adolescent diet, physical activity, and body size in relation to adult breast density in 201 U.S. Chinese immigrant women recruited in January 2002 to May 2003 from Philadelphia region screening programs. Mammographic images were classified into 1 of 4 categories ranging from “entirely fatty” to “extremely dense.” Questionnaires assessed diet and physical activity between ages 12–17, relative weight and height at age 10, and weight at age 18. To estimate odds ratios (ORs), we conducted logistic regression analyses using proportional odds models for polychotomous outcomes. Higher adult breast density was significantly associated with adolescent red meat intake (adjusted 3rd vs. 1st tertile OR= 3.0, 95% confidence interval (CI) 1.5–6.4, trend P=0.003) but not with other adolescent factors. For the association of adult acculturation with breast density, adjustment for adolescent red meat intake attenuated the OR for the highest vs. lowest level of acculturation from 2.5 (95% CI 1.2–5.3) to 1.9 (95% CI 0.9–4.0). Greater adolescent red meat intake may have increased adult breast density and partly accounted for the strong association between acculturation and breast density in this sample of immigrant Chinese women. If confirmed by further study, dietary prevention efforts for breast cancer should be considered earlier in life

Real World Treatment Patterns, Adverse Events and Healthcare Resource Utilization and Costs Among Chronic Lymphocytic Leukemia (CLL) Patients in the United States

Abstract Background: CLL is one of the most common types of leukemia among adults. Treatment options for CLL have expanded in recent years, but few studies provide contemporary real-world data on treatment patterns, treatment-related adverse events (AEs) and the economic burden associated with these agents. This study aimed to evaluate treatment-related AEs and the healthcare resource utilization (HCRU) and cost associated with the current treatment for chronic lymphocytic leukemia (CLL). Methods: This retrospective study used medical and pharmacy claims from the Optum Research Database, a large national US database, to identify adults (≥ 18 years old) commercially insured and Medicare Advantage (MA) enrollees. The study included patients with CLL (≥ 2 medical claims at least 7 days apart between July 1, 2012, through May 30, 2017), at least 1 claim for systemic CLL-directed therapy and continuous enrollment for 12 months prior to (baseline period) and ≥ 1 month after the first observed CLL-directed therapy (index date). Patients with systemic CLL-directed therapy during the baseline period or undergoing stem cell transplantation during the entire study period were excluded from analysis. Up to 3 line of therapy (LOT) periods were captured based on timing and receipt of systemic CLL-directed therapy. Cohorts based on the most common regimens received, regardless of LOT sequence, were created. Potential treatment-related AEs (prevalent and incident conditions) during regimen cohorts were identified by ICD-9 and ICD-10 diagnosis codes in position 1 or 2 on claims. All-cause and AE-related healthcare resource utilization and costs (per patient per month (PPPM)) were examined. All analyses were descriptive. Results: A total of 3292 patients with CLL met all study criteria; 65% were MA enrollees and 35% were commercially insured. Mean age (standard deviation, [SD]) was 71 years (SD 11) with a baseline Charlson comorbidity index score of 3.5 (SD 1.9). During the study period, 31% of patients had ≥ 2 LOTs and 10% had ≥ 3 LOTs. The most common regimens (excluding rituximab maintenance therapy) observed by LOT were; bendamustine + rituximab (23%) during LOT1, ibrutinib (22%) during LOT2 and ibrutinib (17%) during LOT3. Among the study patients, 4,509 LOT periods (LOT1-LOT3) were observed. Of these periods, 3177 accounted for the 5 most common treatment regimens observed: rituximab (excluding maintenance therapy) (30%); bendamustine + rituximab (28%); ibrutinib (20%); obinutuzumab ± chlorambucil (14%); and cyclophosphamide + fludarabine + rituximab (8%). The most common AEs associated with these treatment regimens are reported in the Table. Conclusions: The most common regimen during LOT1 was bendamustine + rituximab, and was ibrutinib during LOT2 and LOT3.This study provides evidence that occurrence of AEs among patients with CLL receiving systemic anti-cancer therapy in the real-world setting is substantial and associated with significant health care cost. The economic burden associated with increased AEs underscores the need for treatments with fewer AEs. Figure. Figure. Disclosures Kabadi: AstraZeneca: Employment. Le:Optum: Employment; Optum/United Health Group: Equity Ownership. Dacosta Byfield:Optum/United Health Group: Equity Ownership; Optum: Employment. Olufade:AstraZeneca: Employment; AstraZeneca: Equity Ownership. </jats:sec