Medication Categories Research Articles

Validation and meaningful within-patient change in work productivity and activity impairment questionnaire (WPAI) for episodic or chronic migraine

BackgroundNo available studies demonstrate validity and meaningful change thresholds of Work Productivity and Activity Impairment (WPAI) questionnaire in patients with migraine. In this post-hoc analysis, we assessed reliability, validity, responsiveness, and meaningful within-patient change from baseline to Month 3 for Work Productivity and Activity Impairment (WPAI) domain scores in patients with episodic migraine (EM) or chronic migraine (CM).MethodThe Phase 3, multicenter, randomized, double-blind, placebo-controlled CONQUER study (NCT03559257, N = 462) enrolled patients with EM or CM who failed two to four categories of prior preventive medication in past ten years. The analyses were performed for WPAI domain scores (absenteeism, presenteeism, overall work productivity, and non-work-related activity impairment). Migraine Specific Quality of Life Questionnaire version 2.1 (MSQv2.1) domain scores (Role Function-Restrictive [RFR] and Role Function-Preventive [RFP]), and monthly migraine headache days were used as anchors. Responder criteria were changes from baseline to Month 3 for each of these anchors and were defined as: increase in MSQ-RFR by ≥ 25.71 points and MSQ-RFP by ≥ 20.00 points and a 50% reduction in monthly migraine headache days. Assessments were performed for overall population, and patients with EM or CM. The meaningful change threshold was determined based on Youden index, Phi coefficient and sensitivity.ResultsOf 462 randomized patients, 444 who completed WPAI questionnaire were included in post-hoc analysis. Test–retest reliability over 3 months in a stable subgroup revealed moderate correlations for non-work-related Activity Impairment (ICC = 0.446) presenteeism (ICC = 0.438) and a fair correlation for overall work productivity loss (ICC = 0.360). At baseline, all correlations between WPAI domain scores and continuous anchor variables exceeded recommended threshold of ≥ 0.30, except for WPAI domain scores with number of monthly migraine headache days. Patients achieving pre-specified responsiveness thresholds for monthly migraine headache days, and MSQ-RFP, MSQ-RFR from baseline to Month 3 (responders) showed significant improvements in WPAI domain scores compared with non-responders (P < 0.001). The meaningful change thresholds of -20 (% unit) were identified for WPAI domain scores.ConclusionIn conclusion, WPAI has sufficient validity, reliability, responsiveness, and appropriate interpretation standards to assess the impact of EM or CM on presenteeism and overall work productivity loss and non-work-related activity impairment.Trial registrationNCT number of CONQUER study, NCT03559257.

Twenty-three medication-taking traits and stroke: A comprehensive Mendelian randomization study.

Certain medication categories may increase the risk of stroke. Nonetheless, the evidence regarding the causal relationship of medication-taking in promoting stroke and subtypes is deficient. We evaluated the causal effect of a genetic predisposition for certain medication categories on stroke and subtypes (ischemic and hemorrhagic categories) by a two-sample Mendelian randomization (MR) analysis. Data for 23 medication categories were gathered from a genome-wide association study (GWAS) involving 318,177 patients. The Medical Research Council Integrative Epidemiology Unit Open GWAS database and the FinnGen consortium were used to gather GWAS data for stroke and subtypes. Inverse variance weighted, MR-Egger, and weighted median were used for the estimation of causal effects. Cochran's Q test, MR-Egger intercept test, and leave-one-out analysis were used for sensitivity analyses. Ten medication categories were linked to a high stroke risk. Nine categories were linked to a high-risk ischemic stroke. Five categories were associated with small vessel ischemic stroke. Nine categories were positively associated with large artery atherosclerotic ischemic stroke. Three categories causally increased the possibility of cardioembolic ischemic stroke. Four categories were associated with intracerebral hemorrhage. Four categories were associated with nontraumatic intracranial hemorrhage. Three categories were causally associated with subarachnoid hemorrhage (SAH). Four categories were associated with the combination of SAH, unruptured cerebral aneurysm, and aneurysm operations SAH. This study confirms that some medication categories lead to a greater risk of strokes. Meanwhile, it has an implication for stroke screening as well as direct clinical significance in the design of conduction of future randomized controlled trials.

Gambaran Evaluasi Discharge Planning Pada Pasien Hemodialisa

Fluid management adherence is a majority problem for hemodialysis patients. Nurse discharge planning is expected to solve this problem. This study aims to describe the evaluation of discharge planning in hemodialysis patients at Panembahan Senopati Hospital, Yogyakarta. This research is a quantitative descriptive study. The population in this study was 261 people. The purposive sampling was used in the 38 chronic renal failure patients who underwent hemodialysis at Panembahan Senopati Hospital, Bantul. The univariate analysis was performed to obtain the frequency distribution on gender, age, marital status, education, employment status, and length of time undergoing hemodialysis. Participants were completed with evaluation sheets and structured interviews. The characteristics of the respondents were male and female (50% each), aged 26-35 years old (36.8%), (79%) did not work, underwent hemodialysis 1-3 years (57.8 %), and half of the respondents (47.1%) had senior high school education. The implementation of nurse discharge planning included the good category of medication (10.5%), treatment (39.5%), health promotion (26.3%), and diet (47.4%). But the finding that discharge education was performed either the patient asks or if there are abnormal clinical/laboratory results only. It concluded that the implementation of discharge planning is deficient. Additional participation and performing further research related to hemodialysis patients confidence and adherence in supporting discharge planning was strongly recommended.

Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019

BackgroundThe number of medications prescribed during pregnancy has increased over the past few decades. Few studies have described the prevalence of multiple medication use among pregnant women. This study aims to describe the overall prevalence over the last two decades among all pregnant women and those with multimorbidity and to identify risk factors for polypharmacy in pregnancy.MethodsA retrospective cohort study was conducted between 2000 and 2019 using the Clinical Practice Research Datalink (CPRD) pregnancy register.Prescription records for 577 medication categories were obtained. Prevalence estimates for polypharmacy (ranging from 2+ to 11+ medications) were presented along with the medications commonly prescribed individually and in pairs during the first trimester and the entire pregnancy period.Logistic regression models were performed to identify risk factors for polypharmacy.ResultsDuring the first trimester (812,354 pregnancies), the prevalence of polypharmacy ranged from 24.6% (2+ medications) to 0.1% (11+ medications). During the entire pregnancy period (774,247 pregnancies), the prevalence ranged from 58.7 to 1.4%.Broad-spectrum penicillin (6.6%), compound analgesics (4.5%) and treatment of candidiasis (4.3%) were commonly prescribed. Pairs of medication prescribed to manage different long-term conditions commonly included selective beta 2 agonists or selective serotonin re-uptake inhibitors (SSRIs).Risk factors for being prescribed 2+ medications during the first trimester of pregnancy include being overweight or obese [aOR: 1.16 (1.14–1.18) and 1.55 (1.53–1.57)], belonging to an ethnic minority group [aOR: 2.40 (2.33–2.47), 1.71 (1.65–1.76), 1.41 (1.35–1.47) and 1.39 (1.30–1.49) among women from South Asian, Black, other and mixed ethnicities compared to white women] and smoking or previously smoking [aOR: 1.19 (1.18–1.20) and 1.05 (1.03–1.06)]. Higher and lower age, higher gravidity, increasing number of comorbidities and increasing level of deprivation were also associated with increased odds of polypharmacy.ConclusionsThe prevalence of polypharmacy during pregnancy has increased over the past two decades and is particularly high in younger and older women; women with high BMI, smokers and ex-smokers; and women with multimorbidity, higher gravidity and higher levels of deprivation. Well-conducted pharmaco-epidemiological research is needed to understand the effects of multiple medication use on the developing foetus.

FDA approves new treatment for Alzheimer's disease

The U.S. Food and Drug Administration (FDA) approved Leqembi (lecanemab‐irmb) via its accelerated approval pathway for the treatment of Alzheimer's disease, the agency announced in a news release on Jan. 6. Leqembi is the second of a new category of medications approved for Alzheimer's disease that target the fundamental pathophysiology of the disease. These medications represent an important advancement in the ongoing fight to effectively treat Alzheimer's disease.

Review of Anti-inflammatory and Immunosuppressive Drugs Used in COVID-19 Epidemic

Introduction Immunosuppressive drugs are classified into different groups depending on the mechanism of action and are used in the control of acute and chronic inflammatory disorders. Considering the possibility of severe inflammatory complications such as acute respiratory failure and cytokine storm in the patients with COVID-19, there is a need to review the updated data on the effectiveness and side effects of administering these drugs in patients. In the present article, along with the brief introduction of different categories of immunosuppressive medications, positive and negative effects of using these drugs in corona patients have been discussed.&#x0D; Conclusion: Taken together, it seems that the administration of immunosuppressive drugs has positive effects on COVID-19 patients. Reduced need for mechanical ventilation, decreased admission to the intensive care unit, promotion of acute symptoms, and decreased mortality rate, especially in critically ill patients are some of these advantages. However, the possibility of treatment prolongation and increased risk of bacterial and fungal infections should be kept in mind. Maintaining a balance in the doses and duration of immunosuppressant drugs might diminish their adverse effects.

Comparative efficacy, tolerability, and acceptability of pharmacological interventions for the treatment of children, adolescents, and young adults with Tourette's syndrome: a systematic review and network meta-analysis

In clinical practice guidelines there is no consensus about the medications that should be initially offered to children and young people with Tourette's syndrome. To provide a rigorous evidence base that could help guide decision making and guideline development, we aimed to compare the efficacy, tolerability, and acceptability of pharmacological interventions for Tourette's syndrome. For this systematic review and network meta-analysis, we searched the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, PubMed, Web of Science, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov, for published and unpublished studies from database inception to Nov 19, 2021. We included double-blind randomised controlled trials of any medication administered as a monotherapy for at least 1 week against another medication or placebo in children and adolescents (aged ≥4 years and ≤18 years), adults (>18 years), or both, diagnosed with Tourette's syndrome according to standardised criteria. We excluded studies that exclusively recruited participants with comorbid attention-deficit hyperactivity disorder or obsessive-compulsive disorder. The primary outcome was change in severity of tic symptoms (efficacy). Secondary outcomes were treatment discontinuations due to adverse events (tolerability) and for any reason (acceptability). Pharmacological interventions were examined considering medication categories and medications individually in separate analyses. Summary data were extracted and pooled with a random-effects network meta-analysis to calculate standardised mean differences for efficacy and odds ratios for tolerability and acceptability, with 95% CIs. The Confidence in Network Meta-Analysis (CINeMA) framework was used to assess the certainty of evidence. The protocol was pre-registered in PROSPERO (CRD42022296975). Of the 12 088 records identified through the database search, 88 records representing 39 randomised controlled trials were included in the network meta-analysis; these 39 randomised controlled trials comprised 4578 participants (mean age 11·8 [SD 4·5] years; 3676 [80·8%] male participants) and evaluated 23 individual medications distributed across six medication categories. When considering medication categories, first-generation (standardised mean difference [SMD] -0·65 [95% CI -0·79 to -0·51]; low certainty of evidence) and second-generation (-0·71 [-0·88 to -0·54]; moderate certainty of evidence) antipsychotic drugs, as well as α-2 agonists (-0·21 [-0·39 to -0·03]; moderate certainty of evidence), were more efficacious than placebo. First-generation and second-generation antipsychotic drugs did not differ from each other (SMD 0·06 [95% CI -0·14 to 0·25]; low certainty of evidence). However, both first-generation (SMD 0·44 [95% CI 0·21 to 0·66]) and second-generation (0·49 [0·25 to 0·74]) antipsychotic drugs outperformed α-2 agonists, with moderate certainty of evidence. Similar findings were observed when individual medications were considered: aripiprazole (SMD -0·60 [95% CI -0·83 to -0·38]), haloperidol (-0·51 [-0·88 to -0·14]), olanzapine (-0·83 [-1·49 to -0·18]), pimozide (-0·48 [-0·84 to -0·12]), risperidone (-0·66 [-0·98 to -0·34]), and clonidine (-0·20 [-0·37 to -0·02]) all outperformed placebo, with moderate certainty of evidence. Antipsychotic medications did not differ from each other, but there was low to very low certainty of evidence for these comparisons. However, aripiprazole (SMD -0·40 [95% CI -0·69 to -0·12]) and risperidone (-0·46 [-0·82 to -0·11]) outperformed clonidine, with moderate certainty of evidence. Heterogeneity or inconsistency only emerged for a few comparisons. In terms of tolerability and acceptability, there were no relevant findings for any of the efficacious medication categories or individual medications against each other or placebo, but there was low to very low certainty of evidence associated with these comparisons. Our analyses show that antipsychotic drugs are the most efficacious intervention for Tourette's syndrome, while α-2 agonists are also more efficacious than placebo and could be chosen by those who elect not to take antipsychotic drugs. Shared decision making about the degree of tic-related severity and distress or impairment, the trade-offs of efficacy and safety between antipsychotic drugs and α-2 agonists, and other highly relevant individual factors that could not be addressed in the present analysis, should guide the choice of medication for children and young people with Tourette's syndrome. None.

The role of the clinical pharmacist in the prevention of drug-induced acute kidney injury in the intensive care unit.

Acute kidney injury (AKI) is a disorder that is commonly seen in patients in the intensive care unit (ICU) and has a detrimental impact on the patients' clinical prognosis. Although a variety of factors contribute to the development of AKI in patients, drug-induced AKI is a common occurrence in the ICU. With the widespread availability of clinical pharmacy services, the clinical pharmacist's consultation service to the healthcare team aids in the resolution of drug-related issues and the enhancement of therapeutic outcomes. The involvement of a clinical pharmacist in the ICU team is expected to minimize the incidence of drug-induced AKI and enhance therapeutic results. Therefore, the goal of our study was to demonstrate the impact of having a clinical pharmacist on the occurrence, stages, and treatment of AKI. The study included two patient groups: intervention (n=75) (IG) and control (n=75) (CG) groups. The clinical pharmacist has made recommendations to the ICU team regarding the treatment of IG patients on drug selection, drug administration routes, drug dose adjustment, drug-drug interactions, drug-food or nutritional solution interactions, drug side effect management, and drug incompatibility. No interventions were provided by the clinical pharmacist in the CG patients. The clinical pharmacist visited patients regularly and noted the laboratory findings and pharmacological treatments of patients in the study groups on the patient follow-up forms. The obtained data of IG and CG were compared and statistical methods were used to assess them. According to our findings, AKI was found to be more common in CG than in IG (p < 0.05). Stage 1 was shown to be the most common AKI stage in the patients (p > 0.05). The gap between the patients' highest Cr and basal sCr values was less in IG (p < 0.05). When the association between reasons for ICU admission and AKI was investigated, pulmonary edema and acute respiratory failure were found to have a significant and positive relationship with AKI (p < 0.05). Furthermore, it was shown that patients with diabetes and cancer comorbidities were the most vulnerable to developing AKI (p < 0.05). Antibiotics, anaesthetics, and cardiovascular system medication categories were found to have a significant and positive correlation with AKI in patients (p < 0.05). Also, it was revealed that the usage of vancomycin, colistin, ampicillin-sulbactam, clarithromycin, ceftriaxone, midazolam, and dexketoprofen caused AKI (p < 0.05). Our findings demonstrate that if a clinical pharmacist is included in the ICU team and provides consultation services to the ICU team regarding patient treatment by performing regular patient follow-up, the incidence of AKI in patients can be minimized and therapeutic outcomes can be improved.

EPID-08. AGE-STRATIFIED SURVIVAL ANALYSES OF PHARMACOLOGICAL TREATMENTS IN PATIENTS WITH GLIOBLASTOMA

Abstract Glioblastoma is the most common primary malignant brain tumor in adults. Age is a prognostic factor for grade IV glioma (GIV) survival, where older adults 65 and older, tend to have quicker mortality compared to adults 18-64. This may be due to intrinsic aspects of the aged host, including age-dependent changes to the brain and immune systems. We studied pharmacologic management of GIV patients treated with medications affecting the brain, immune, and other systems for associations with age and survival. Electronic records for 1,208 GIV patients were collected at a single institution from 1/1/2000 to 9/8/2021 and used to construct a multivariable time-dependent cox model that examined intra-cohort hazards associated with 14 different categories of outpatient medications. Date of diagnosis was identified as the start-time and subject death was used to define the event-time. Patients who were alive or lost to follow-up were censored to last recorded date. Survival time was calculated as the difference between diagnosis date and event time or censorship. For positive control, we confirmed that younger and older patients experienced an improved hazard with temozolomide. Strikingly, younger, but not older patients, experienced increased hazard with a steroid prescription (1.46 [1.12,1.90], **). In contrast, older, but not younger patients experienced improvements in hazard with prescription of neurological medications including benzodiazepines (0.47 [0.27, 0.80] **) and anti-convulsants (0.28 [0.08, 0.90] *), in addition to heart failure treatments including angiotensin II inhibitors (0.48 [0.27, 0.85] *) and diuretics (0.30 [0.15, 0.87] *). Patients prescribed antidepressants didn’t show improved hazard across younger and older GIV patients, which consistent with our previously published work. These data indicate novel associative benefits due to prescription of select pharmacologic agents that vary with patient age. This work may be used to better understand therapeutic approaches that selectively benefit younger vs. older adults with GIV.

Deficiency Citations on Inappropriate Psychotropics Use Related to Care for Behavioral Symptoms of Dementia.

The Centers for Medicare and Medicaid (CMS) initiated the National Partnership to Improve Dementia Care in Nursing Homes in 2012, which helped decrease antipsychotics use. However, inappropriate use of antipsychotics and other psychotropic medications to control behavioral symptoms associated with dementia persists. Nursing homes (NHs) can be flagged for inappropriate psychotropics use as a deficiency of care citation (F-758 tag). The purpose of this study was to comprehensively explore inappropriate psychotropic medication use deficiency, F-758 citations, in caring for NH residents with dementia. A mixed-methods study was performed. During the first quarter of 2018 (January-March), 3526 NHs were surveyed, of which 642 received F-758 tags. Of the 642, the sample was confined to the 444 NHs that received the citation for the care of residents with dementia. Information on deficiencies was obtained from 2018 Certification and Survey Provider Enhanced Reporting data. Inspection reports for deficiencies were obtained from Centers for Medicare and Medicaid Nursing Home Compare and ProPublica. Quantitative analysis was used to examine the frequency of involved psychotropic medications, scope/severity of F-758 deficiency citations, and reasons for the citations. Reasons for F-758 citations by psychotropic medication categories and scope/severity of the citations were also examined using χ² tests. Qualitative data analysis was conducted using content analysis with an inductive coding approach to summarize the inspection reports. Antipsychotics were the most involved drug category for F-758 tag citations. The 3 most common reasons for F-758 citations included failure to identify and/or monitor behavioral symptoms (178 NHs), attempt gradual drug reduction (131 NHs), and maintain 14-day limitations on Pro Re Nata (PRN) psychotropic orders (121 NHs). Compared with those with no involvement of antipsychotic drugs, facilities with antipsychotics-related F-758 tags had higher rates of failure to identify/monitor behavioral symptoms (P&lt;.001), attempt gradual drug reduction (P &lt; .001), and provide adequate indications for psychotropics use (P &lt; .001). NHs with F-758 tags related to inappropriate antianxiety medication use had a higher prevalence of failure to maintain 14-day limitation on PRN orders (P &lt; .001) and provide nonpharmacologic interventions (P &lt; .001). This study suggests areas for improvement that could potentially reduce inappropriate psychotropics use. Supporting quality of dementia care workforce and improving cooperation within healthcare staff and professionals are recommended to ensure proper nonpharmacologic and pharmacologic interventions.

268 AUDIT: GENERIC PRESCRIBING COMPLIANCE IN AN ACUTE HOSPITAL

Abstract Background Generic prescribing is cost-effective, and evidence suggests that clinical outcomes compared with brand name products are largely equivalent. Hospital guidelines recommend that medications should be prescribed using the approved generic name, not the brand name. There are some exceptions to this. Anecdotal evidence suggests that medication reconciliation for patients on admission to hospital are charted by brand name rather than the generic title. To investigate this we conducted a four-day audit of the prescribing of medications on patients admitted to medical wards in an acute hospital. Methods This audit took place over a four-day period. The Kardex of each patient admitted to the three medical wards was reviewed. Patients admitted under cardiology, haematology and oncology were excluded. All medications including whether they were prescribed using the generic or brand name were collected. Statistical analysis was carried out using Microsoft Excel. Results A total of 33 kardexes were collected. Two hundred and fifty-seven prescribed medications were reviewed. Ninety-five were charted as brand names and 63% (n=162) were prescribed using the generic name. One hundred and eighteen different categories of medications were prescribed. Enoxaparin was prescribed using the brand name ten times and the generic title three times. The antibiotic Piperacillin/tazobactam was prescribed three times using the brand name and one time using the generic title. Of the eight times atorvastatin was prescribed, it was charted using the generic name seven times (88%). Conclusion Almost two-thirds of medications for patients admitted to medical wards are prescribed using generic titles. However, there is room for improvement. Of note, commonly prescribed medications such as enoxaparin and certain antimicrobials were prescribed using the brand name. Opportunities e.g., induction, grand rounds and Non-Consultant Hospital Doctor (NCHD) teaching sessions should be utilised to provide education on the importance of generic prescribing to all NCHDs admitting patients.

A Review of Vatika Shiroroga and its Ayurvedic Management

The modern man must cope with the variety of difficulties such as stresses, and anxieties. One or more psychosomatic disorders have been linked to etiopathogenic mental elements such as excessive crying, anguish, fear, and terror. Regular and unnatural eating habits, repressing natural urges, less time of relaxation and a lack of proper sleep are inseparable components of our routine, that drain the body's energy and eventually result in disease. Most psychosomatic disorders are caused by a combination of these physical elements and persistently stressful psychological states. One such psycho-somatic is tension headache that is comparable to Vatika Shiroroga is mentioned in Ayurvedic texts. The Vataja-Shiroroga is a violent headache attack that has no apparent explanation, gets worse at night, and is eased by applying pressure, a bandage, or fomentation to the head. This attack is thought to be caused by the derranged Vayu. Its management requires thorough understanding of the condition, application of Nasya, Shirodhara, Dhumpaan, and correct aahaar-vihaar in addition to the ayurvedic medications that fall under the category of medhaya medications.

Development of a Semiautomated Database for Patients With Adult Congenital Heart Disease.

Databases for Congenital Heart Disease (CHD) are effective in delivering accessible datasets ready for statistical inference. Data collection hitherto has, however, been labour and time intensive and has required substantial financial support to ensure sustainability. We propose here creation and piloting of a semiautomated technique for data extraction from clinic letters to populate a clinical database. PDF formatted clinic letters stored in a local folder, through a series of algorithms, underwent data extraction, preprocessing, and analysis. Specific patient information (diagnoses, diagnostic complexity, interventions, arrhythmia, medications, and demographic data) was processed into text files and structured data tables, used to populate a database. A specific data validation schema was predefined to verify and accommodate the information populating the database. Unsupervised learning in the form of a dimensionality reduction technique was used to project data into 2 dimensions and visualize their intrinsic structure in relation to the diagnosis, medication, intervention, and European Society of Cardiology classification lists of disease complexity. Ninety-three randomly selected letters were reviewed manually for accuracy. There were 1409 consecutive outpatient clinic letters used to populate the Scottish Adult Congenital Cardiac Database. Mean patient age was 35.4 years; 47.6% female; with 698 (49.5%) having moderately complex, 369 (26.1%) greatly complex, and 284 (20.1%) mildly complex lesions. Individual diagnoses were successfully extracted in 96.95%, and demographic data were extracted in 100% of letters. Data extraction, database upload, data analysis and visualization took 571 seconds (9.51 minutes). Manual data extraction in the categories of diagnoses, intervention, and medications yielded accuracy of the computer algorithm in 94%, 93%, and 93%, respectively. Semiautomated data extraction from clinic letters into a database can be achieved successfully with a high degree of accuracy and efficiency.

Psychotropic Medication Usage in Individuals with Fetal Alcohol Spectrum Disorders (FASD) and Psychiatric Co-morbidities in Canada

Background and objective Individuals with Fetal Alcohol Spectrum Disorder (FASD) tend to be prescribed a high number of psycho-tropic medications to treat high rates of comorbid psychiatric disorders. A lack of guidance regarding best practices for prescribing psychotropic medications to individuals with FASD probably accounts for this reliance on polypharmacy. The objective of this study is to describe the types of medications prescribed to individuals with prenatal alcohol exposure, comparing rates between individuals diagnosed with FASD and individuals without FASD as well as how medications are prescribed based on age, sex, and comorbid psychiatric disorders. Material and methods Data were drawn from Canada's national FASD database. This database includes information collected during an FASD assessment related to diagnostic outcomes, secondary challenges, and medical and mental health information. Descriptive statistics were calculated for four diagnostic groups (FASD with sentinel facial features [FASD + SFF], FASD without sentinel facial features [FASD - SFF], at risk for FASD [“at risk”], and no FASD). Group demographics were compared using Chi-Square, Fisher's Exact Test, and ANOVA, as appropriate. Differences in the proportion of individuals between these four diagnostic groups were calculated using each of the following six classes of psychotropic medications—antipsychotics, antidepressants/anxiolytic, anticonvulsants/mood stabilizers, stimulants, melatonin, and others—using ANOVA. Considering just the individuals with FASD by combining the FASD + SFF and FASD - SFF groups, independent sample tests were used to compare differences in the proportion of males and females prescribed different medications. Chi-Square and Fisher's Exact Test were used to compare the proportion of individuals using psychotropic medications, according to category, within the FASD group based on the presence or absence of 13 comorbid psychiatric disorders. Results The overall sample included 2349 participants (mean value = 18.1 years, SD = 10.3). The sample included 1453 participants with an FASD diagnosis (n = 218, FASD + SFF, mean = 23.7 years, SD = 15.8, and n = 1235, FASD - SFF, mean = 19.5 years, SD = 10.0 years) and 896 participants who were assessed but did not receive an FASD diagnosis (n = 653, no FASD, mean = 16.1 years and n = 261, “at risk” for FASD, mean = 12.2 years). The FASD groups had a significantly higher rates of anxiety disorders, depressive disorders, and the presence of at least one comorbid psychiatric disorder compared to the no FASD and the “at risk” groups. Both FASD groups had a higher proportion of individuals taking antipsychotic and antidepressant/anxiolytic medications compared to the no FASD and “at risk” groups. Females with FASD were more often prescribed antidepressants/anxiolytics compared to males with FASD, while males with FASD were more often prescribed stimulants than females with FASD. The prevalence of antidepressants/anxiolytics, stimulants, and melatonin use by individuals with FASD differed across the lifespan. The prevalence of the prescription of six medication categories was found to differ according to psychiatric disorder. Conclusion Compared to individuals assessed as not fulfilling criteria for FASD, those with FASD had higher rates of psychiatric disorders and were prescribed significantly more antidepressants/anxiolytics and antipsychotics. The class and rate of prescriptions may support efforts in devising treatment guidelines for a complex disorder with known high comorbidity such as FASD.

Trajectories of neuropsychological symptom burden in postmenopausal women prescribed anastrozole for early-stage breast cancer.

Aromatase inhibitors (AIs) prolong survival for postmenopausal women with hormone receptor-positive breast cancer (HR + BC) but also burden patients with symptoms, a major reason for suboptimal AI adherence. This study characterizes inter-relationships among symptom measures; describes neuropsychological symptom burden trajectories; and identifies trajectory group membership predictors for postmenopausal women prescribed anastrozole for HR + BC. This study utilized prospectively collected data from a cohort study. Relationships among various self-reported symptom measures were examined followed by a factor analysis to reduce data redundancy before trajectory analysis. Four neuropsychological scales/subscales were rescaled (range 0-100) and averaged into a neuropsychological symptom burden (NSB) score, where higher scores indicated greater symptom burden. Group-based trajectory modeling characterized NSB trajectories. Trajectory group membership predictors were identified using multinomial logistic regression. Women (N = 360) averaged 61years old, were mostly White, and diagnosed with stage I HR + BC. Several measures were correlated temporally but four neuropsychological measures had strong correlations and dimensional loadings. These four measures, combined for the composite NSB, averaged (mean ± standard deviation) 17.4 ± 12.9, 18.0 ± 12.7, 19.5 ± 12.8, and 19.8 ± 13.0 at pre-anastrozole, 6, 12, and 18months post-initiation, respectively. However, the analysis revealed five NSB trajectories-low-stable, low-increasing, moderate-stable, high-stable, and high-increasing. Younger age and baseline medication categories (pre-anastrozole), including anti-depressants, analgesics, anti-anxiety, and no calcium/vitamin D, predicted the higher NSB trajectories. This study found relationships among neuropsychological symptom measures and distinct trajectories of self-reported NSB with pre-anastrozole predictors. Identifying symptom trajectories and their predictors at pre-anastrozole may inform supportive care strategies via symptom management interventions to optimize adherence for women with HR + BC.

Chronic Prescription Medication Is Associated With A History Of Exercise Associated Muscle Cramps In Runners

INTRODUCTION: The prevalence of chronic prescription medication (CPM) use in recreational distance runners is 12.5%. CPM use in endurance athletes is associated with a history of exercise associated muscle cramps (hEAMC), but which main categories of CPM are associated with hEAMC has not been explored. PURPOSE: To determine the association between the use of main categories of CPM and a hEAMC. METHODS: 76654 consenting entrants (71.8% of all entrants) in two annual races (21.1 km & 56 km) were studied from 2012-2015. CPM use and type of medication in 8 main categories were self-reported as part of an online pre-race medical screening questionnaire at race entry. Entrants reported demographics (age, sex, and race distance), CPM use in 8 categories (blood pressure-lowering, asthma, cholesterol-lowering, anxiety/depression, allergy, any diabetes, any heart, other medication) and hEAMC. The prevalence (%; 95%CI) and prevalence ratio’s (PR; 95%CI) of main categories of CPM use in runners with (E group) and without hEAMC (C group) are reported, using a multinominal logistic regression model (adjusted for age, gender, and race distance). RESULTS: CPM use was significantly higher in the E vs. C group for main categories of medication use (prevalence in %; PR in decreasing order; 95%CIs): allergy (E: 1.5; 1.2-1.8 vs C: 0.8; 0.7-0.9, PR = 2.1; 1.7-2.6; p < 0.0001); asthma (E: 3.9; 3.5-4.3 vs C: 2.4; 2.3-2.5, PR = 1.8; 1.6-2.0; p < 0.0001); anxiety/depression (E: 3.0; 2.6-3.4 vs C: 2.1; 2.0-2.2, PR = 1.6; 1.4-1.8; p < 0.0001); any diabetes (E: 0.9; 0.7-1.1 vs C: 0.6; 0.6-0.7, PR = 1.5; 1.2-2.0; p < 0.01); blood pressure-lowering (E: 3.8;3.4-4.2 vs C: 3.0;2.8-3.2, PR = 1.4;1.3-1.6; p < 0.0001); cholesterol-lowering (E: 3.6; 3.2-4.0 vs C: 2.9; 2.7-3.0, PR = 1.4; 1.2-1.6; p < 0.0001). CONCLUSIONS: CPM use is associated with hEAMC in endurance athletes and may contribute to EAMC. Specific main categories of medication associated with >1.5X risk of hEAMC are allergy medication, asthma medication, medication to treat anxiety/depression, and any diabetes medication.

32929 Dupilumab decreases concomitant therapy use in adults with atopic dermatitis (AD): Long-term data from the RELIEVE-AD study

Introduction: Dupilumab is a fully human anti-IL-4Rα monoclonal antibody approved in the US for patients aged ≥6 years with moderate-to-severe AD inadequately controlled by topical therapies. This analysis evaluated the long-term use of concomitant therapy among adult patients treated with dupilumab from RELIEVE-AD, a prospective, longitudinal patient survey conducted in the US. Methods: Adults with moderate-to-severe AD who were prescribed dupilumab but had not yet initiated treatment were recruited to the RELIEVE-AD study from the dupilumab patient support program. Based on a 4-week recall, surveys assessed concomitant AD therapy use, including oral/ injectable steroids, immunosuppressants, and topical medications (steroids, calcineurin inhibitors, crisaborole), at baseline, throughout 1 year after treatment initiation, and at 30-36 months. Results: Of 698 patients completing the baseline survey, 425 (61.0%) responded at Month 30-36. A significant reduction in concomitant AD medication use from baseline was reported across all medication categories assessed: topical use significantly decreased from 81.2% (baseline) to 57.7% (Month 1) and 44.5% (Month 30-36) (both P < .001). Oral steroid use decreased from 30.1% (baseline) to 6.2% (Month 1) and 4.0% (Month 30-36) (both P < .001). Steroid injection treatment decreased from 8.7% (baseline) to 1.7% (Month 1) and 0.9% (Month 30-36) (both P < .001). The proportion of patients reporting no concomitant treatment use significantly increased from 12.8% (baseline) to 39.6% (Month 1) and 54.4% (Month 30-36) (both P < .001). Conclusions: Dupilumab treatment led to a rapid reduction in concomitant medication use that was sustained through 30–36-month follow-up among adults with moderate-to-severe AD.

Effect of Galcanezumab on Total Pain Burden in Patients Who Had Previously Not Benefited from Migraine Preventive Medication (CONQUER Trial): A PostHoc Analysis.

IntroductionIn evaluating therapies for migraine prevention, emphasis is placed on frequency and less attention is paid to duration or severity. Total pain burden (TPB) combines frequency, duration, and severity of migraine headache, and has the potential to further characterize the benefit of preventive treatment using a single composite measure. TPB was previously used to characterize response to galcanezumab (GMB) in patients with migraine. In this post hoc analysis we assessed the impact of GMB in lowering TPB in patients who had previously not benefited from two to four categories of migraine preventive medication.MethodsCONQUER trial patients (N = 462), 18–75 years old who had previously not benefited from two to four categories of migraine preventive medication, were randomized (1:1) to monthly placebo or GMB 120 mg with 240 mg loading dose. For each patient, monthly TPB in severity-weighted hours was calculated by multiplying migraine headache duration (hours) by maximum severity for each migraine headache day, then summing these daily scores over the month for the monthly score. Changes from baseline in monthly TPB across months 1–3 were analyzed. Spearman correlations between TPB and scores on the Migraine-Specific Quality-of-Life Questionnaire (MSQ) total and Migraine Disability Assessment Scale (MIDAS) were assessed at baseline.ResultsMean (SD) baseline monthly TPB was 192.1 (158.3) and 188.2 (197.4) severity-weighted hours for GMB-treated and placebo-treated patients, respectively. Across the 3-month double-blind period, GMB-treated patients experienced significantly greater mean reductions from baseline in monthly TPB compared with placebo-treated patients, both for mean change (GMB − 82.7, placebo − 15.8, p < 0.001) and percentage change (GMB − 38.6%, placebo 9.4%, p < 0.001). Furthermore, baseline TPB correlated with MSQ score (r = − 0.39) and MIDAS score (r = 0.40), suggesting good association of TPB with functional and disability outcomes.ConclusionGMB reduced mean TPB in patients who had previously not benefited from two to four categories of migraine preventive medication.Trial RegistrationNCT03559257.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02233-y.

Fingerstick glucose monitoring by cognitive impairment status in Veterans Affairs nursing home residents with diabetes.

Guidelines recommend nursing home (NH) residents with cognitive impairment receive less intensive glycemic treatment and less frequent fingerstick monitoring. Our objective was to determine whether current practice aligns with guideline recommendations by examining fingerstick frequency in Veterans Affairs (VA) NH residents with diabetes across cognitive impairment levels. We identified VA NH residents with diabetes aged ≥65 residing in VA NHs for >30 days between 2016 and 2019. Residents were grouped by cognitive impairment status based on the Cognitive Function Scale: cognitively intact, mild impairment, moderate impairment, and severe impairment. We also categorized residents into mutually exclusive glucose-lowering medication (GLM) categories: (1) no GLMs, (2) metformin only, (3) sulfonylureas/other GLMs (+/- metformin but no insulin), (4) long-acting insulin (+/- oral/other GLMs but no short-acting insulin), and (5) any short-acting insulin. Our outcome was mean daily fingersticks on day 31 of NH admission. Among 13,637 NH residents, mean age was 75 years and mean hemoglobin A1c was 7.0%. The percentage of NH residents on short-acting insulin varied by cognitive status from 22.7% in residents with severe cognitive impairment to 33.9% in residents who were cognitively intact. Mean daily fingersticks overall on day 31 was 1.50 (standard deviation=1.73). There was a greater range in mean fingersticks across GLM categories compared to cognitive status. Fingersticks ranged widely across GLM categories from 0.39 per day (no GLMs) to 3.08 (short-acting insulin), while fingersticks ranged slightly across levels of cognitive impairment from 1.11 (severe cognitive impairment) to 1.59 (cognitively intact). NH residents receive frequent fingersticks regardless of level of cognitive impairment, suggesting that cognitive status is a minor consideration in monitoring decisions. Future studies should determine whether decreasing fingersticks in NH residents with moderate/severe cognitive impairment can reduce burdens without compromising safety.

National estimates of emergency department visits for medication-related self-harm: United States, 2016–2019

BackgroundMedication poisoning is a common form of self-harm injury, and increases in injuries due to self-harm, including suicide attempts, have been reported over the last two decades.MethodsCross-sectional (2016–2019) data from...