Changes In Medication Usage Research Articles

Medication use before and after bariatric surgery: 5-year results from a randomised controlled trial of banded Roux-en-Y gastric bypass versus sleeve gastrectomy in patients with obesity and type 2 diabetes.

Bariatric surgery is an effective tool for weight loss and for improving weight related co-morbidities. Changes in medication usage after a silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) are unknown. This was a single-centre, double-blind, randomised controlled trial. Patients were randomised to either SR-LRYGB or LSG. A medication history was obtained at regular follow-up intervals, and mean numbers of prescribed medications were analysed over 5 years. Poisson regression and generalised estimating equations were used to test for statistically significant changes in usage. After eight patients were lost to follow-up, data from 52 patients in each group were available for analysis. There was no difference between the SR-LRYGB or LSG groups in the number of medications prescribed, with the exception of oral glucose-lowering medications, where there was a greater decrease after SR-LRYGB compared to LSG (79% vs 55% respectively) from baseline to 5 years. At 5 years, total medication prescribed was down 10% from pre-operative levels. Prescribed insulin decreased by 72%, and cardiovascular medication decreased by 56% compared to baseline. Prescriptions for analgesia increased by 50%, psychiatric medications by 133% and proton-pump inhibitors by 81%. Both SR-LRYGB and LSG reduced requirement for diabetic and cardiovascular medications, but increased requirement for nutritional supplementation, analgesia and psychiatric medications. There was a greater reduction in oral anti-diabetic medication prescriptions following SR-LRYGB compared to LSG, but no other difference in medication usage between surgical groups was found.

Longitudinal low density lipoprotein cholesterol goal achievement and cardiovascular outcomes among adult patients with familial hypercholesterolemia: The CASCADE FH registry

Background and aimsThere are limited data from the US on outcomes of patients in specialty care for familial hypercholesterolemia (FH). MethodsCASCADE FH Registry data were analyzed to assess longitudinal changes in medication usage, in low density lipoprotein cholesterol (LDL-C) levels, and the rate of major adverse cardiovascular events (MACE (myocardial infarction, coronary revascularization, stroke or transient ischemic attack) in adults with FH followed in US specialty clinics. ResultsThe cohort consisted of 1900 individuals (61% women, 87% Caucasian), with mean age of 56 ± 15 years, 37% prevalence of ASCVD at enrollment, mean pretreatment LDL-C 249 ± 68 mg/dl, mean enrollment LDL-C 145 mg/dl and 93% taking lipid lowering therapy. Over follow up of 20 ± 11 months, lipid lowering therapy use increased (mean decrease in LDL-C of 32 mg/dl (p < 0.001)). Only 48% of participants achieved LDL-C < 100 mg/dl and 22% achieved LDL-C < 70 mg/dl; ASCVD at enrollment was associated with greater likelihood of goal achievement. MACE event rates were almost 6 times higher among patients with prior ASCVD compared to those without (4.6 vs 0.8/100 patient years). Also associated with incident MACE were markers of FH severity and conventional ASCVD risk factors. ConclusionsWith care in FH specialized clinics, LDL-C decreased, but LDL-C persisted >100 mg/dl in 52% of patients. High ASCVD event rates suggest that adults with FH warrant designation as having an ASCVD risk equivalent. Earlier and more aggressive therapy of FH is needed to prevent ASCVD events.

Medical Therapy Versus Balloon Sinus Dilation in Adults With Chronic Rhinosinusitis (MERLOT): 12-Month Follow-up.

Background Chronic rhinosinusitis (CRS) is a devastating disease affecting nearly 30 million people in the United States. An interim analysis of data from the present study suggested that, in patients who had previously failed medical therapy, balloon sinus dilation (BSD) plus medical management (MM) provides a significant improvement in the quality of life (QOL) at 24 weeks postprocedure compared to MM alone. Objective The primary objective of this final analysis was to evaluate the durability of treatment effects through the 52-week follow-up. Methods Adults aged 19 and older with CRS who had failed MM elected either BSD plus MM or continued MM. Patients were evaluated at 2 (BSD arm only), 12, 24, and 52 weeks posttreatment. Balloon dilations were performed either as an office-based procedure under local anesthesia or in the operating room per physicians' and patients' discretion. The primary end point was change in patient-reported QOL as measured by Chronic Sinusitis Survey (CSS) total score from baseline to the 24-week follow-up. Secondary outcomes including changes in CSS, Rhinosinusitis Disability Index (RSDI), and Sino-Nasal Outcome Test (SNOT) total and subscores, sinus medication usage, missed days of work/school, number of medical care visits, and sinus infections from baseline to the 52-week follow-up are reported here within. Results BSD led to sustained greater improvements in self-reported QOL using the CSS and RSDI total scores with a trend toward improvement in the SNOT-20 total score from baseline to the 52-week follow-up compared to continued MM. There were no changes in medication usage apart from nasal steroid usage for which the MM cohort had an increase in usage. There were no device-related serious adverse events. Conclusion The current analysis highlights the safety, effectiveness, and durability of BSD in CRS patients aged 19 and older who had previously failed MM.

Comparative effectiveness of coronary CT angiography vs stress cardiac imaging in patients following hospital admission for chest pain work-up: The Prospective First Evaluation in Chest Pain (PERFECT) Trial

BackgroundBecause the frequency of cardiac event rates is low among chest pain patients following either performance of coronary CT angiography (CCTA) or stress testing, there is a need to better assess how these tests influence the central management decisions that follow from cardiac testing. The present study was performed to assess the relative impact of CCTA vs stress testing on medical therapies and downstream resource utilization among patients admitted for the work-up of chest pain. MethodsThe admitted patients were randomized in a 1:1 ratio to either cardiac imaging stress test or CCTA. Primary outcomes were time to discharge, change in medication usage, and frequency of downstream testing, cardiac interventions, and cardiovascular re-hospitalizations. We randomized 411 patients, 205 to stress testing, and 206 to CCTA. ResultsThere were no differences in time to discharge or initiation of new cardiac medications at discharge. At 1 year follow-up, there was no difference in the number of patients who underwent cardiovascular downstream tests in the CCTA vs stress test patients (21% vs 15%, P = .1) or cardiovascular hospitalizations (14% vs 16%, P = .5). However, there was a higher frequency of invasive angiography in the CCTA group (11% vs 2%, P = .001) and percutaneous coronary interventions (6% vs 0%, P < .001). ConclusionsRandomization of hospitalized patients admitted for chest pain work-up to either CCTA or to stress testing resulted in similar discharge times, change in medical therapies at discharge, frequency of downstream noninvasive testing, and repeat hospitalizations. However, a higher frequency of invasive coronary angiography and revascularization procedures were performed in the CCTA arm. (ClinicalTrials.gov number, NCT01604655.)

OP.7D.03] RENAL DENERVATION IN HYPERTENSIVE PATIENTS NOT ON BLOOD PRESSURE LOWERING DRUGS

Objective: Studies on the blood pressure lowering effect of renal denervation (RDN) in resistant hypertensive patients have produced conflicting results. Change in medication usage during the studies may be responsible for this inconsistency. To eliminate the effect of medication usage on blood pressure we focused on unmedicated hypertensive patients who underwent RDN. Design and method: Our study reports on a cohort of patients who were not on blood pressure lowering drugs at baseline and during follow-up from eight tertiary centers. Data of patients were used when they were treated with RDN and had a baseline office systolic blood pressure (SBP) of at least 140 mmHg and/or 24-hour ambulatory SBP of at least 130 mmHg. Our primary outcome was defined as change in office and 24-hour SBP at 12 months after RDN, compared to baseline. Results: Fifty-three patients were included. There were three different reasons for not using blood pressure lowering drugs: 1) documented intolerance or allergic reaction (57%); 2) temporary cessation of medication for study purposes (28%); and 3) reluctance to take antihypertensive drugs (15%). Mean change in 24-hour SBP was −5.7 mmHg (95% confidence interval [CI] −11.0 to −0.4; P = 0.04). Mean change in office SBP was −13.1 mmHg (95% CI −20.4 to −5.7; P = 0.001). Figure 1 represents individual changes in blood pressure after RDN. No changes were observed in other variables, such as eGFR, body–mass-index and urinary sodium excretion. Conclusions: This explorative study in hypertensive patients, who were not on blood pressure lowering medication, suggests that at least in some patients RDN lowers blood pressure.

Sandwich technique, peripheral nerve stimulation, peripheral field stimulation and hybrid stimulation for inguinal region and genital pain

Objective: Ilioinguinal neuralgia (IG) and genitofemoral (GF) neuralgia following inguinal hernia repair is a chronic and debilitating neuropathic condition. Recently, peripheral nerve stimulation has become an effective and minimally invasive option for the treatment of refractory pain. Here we present a retrospective case series of six patients who underwent placement of peripheral nerve stimulation electrodes using various techniques for treatment of refractory post-intervention inguinal region pain.Methods: Six patients with post-intervention inguinal, femoral or GF neuropathic pain were evaluated for surgery. Either octopolar percutaneous electrodes or combination of paddle and percutaneous electrodes were implanted in the area of their pain. Pain visual analog scores (VAS), surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of satisfaction with this therapy was assessed.Results: All six patients had an average improvement of 62% in the immediate post-operative follow-up. Four patients underwent stimulation for IG, one for femoral neuralgia, and another for GF neuralgia. Peripheral nerve stimulation provided at least 50% pain relief in all the six patients with post-intervention inguinal region pain. 85% of patients indicated they were completely satisfied with the therapy overall. There was one treatment failure with an acceptable complication rate.Conclusion: Peripheral nerve or field stimulation for post-intervention inguinal region pain is a safe and effective treatment for this refractory and complex problem for patients who have exhausted other management options.

Renal denervation in hypertensive patients not on blood pressure lowering drugs.

IntroductionStudies on the blood pressure lowering effect of renal denervation (RDN) in resistant hypertensive patients have produced conflicting results. Change in medication usage during the studies may be responsible for this inconsistency. To eliminate the effect of medication usage on blood pressure we focused on unmedicated hypertensive patients who underwent RDN.Methods and resultsOur study reports on a cohort of patients, who were not on blood pressure lowering drugs at baseline and during follow-up, from eight tertiary centers. Data of patients were used when they were treated with RDN and had a baseline office systolic blood pressure (SBP) ≥140 mmHg and/or 24-h ambulatory SBP ≥130 mmHg. Our primary outcome was defined as change in office and 24-h SBP at 12 months after RDN, compared to baseline. Fifty-three patients were included. There were three different reasons for not using blood pressure lowering drugs: (1) documented intolerance or allergic reaction (57 %); (2) temporary cessation of medication for study purposes (28 %); and (3) reluctance to take antihypertensive drugs (15 %). Mean change in 24-h SBP was −5.7 mmHg [95 % confidence interval (CI) −11.0 to −0.4; p = 0.04]. Mean change in office SBP was −13.1 mmHg (95 % CI −20.4 to −5.7; p = 0.001). No changes were observed in other variables, such as eGFR, body–mass-index and urinary sodium excretion.ConclusionThis explorative study in hypertensive patients, who are not on blood pressure lowering drugs, suggests that at least in some patients RDN lowers blood pressure.Electronic supplementary materialThe online version of this article (doi:10.1007/s00392-016-0984-y) contains supplementary material, which is available to authorized users.

Decreased physical activity and cardiorespiratory fitness in adults with ankylosing spondylitis: a cross-sectional controlled study.

The health benefits of physical activity (PA) in the general population are numerous; however, few studies have measured PA among adults with ankylosing spondylitis (AS). The aims of this study were to: (1) objectively measure the PA levels and cardiorespiratory fitness of adults with AS and compare these to population controls, and (2) examine the relationships between PA, cardiorespiratory function and condition-specific outcomes. This cross-sectional study included participants (>18 years) meeting the modified New York criteria for AS, and matched population controls. Exclusion criteria were the presence of comorbidities limiting PA, or recent changes in medication usage. Participants completed clinical questionnaires assessing disease activity, physical function and quality of life. Tri-axial accelerometers recorded habitual PA over 1 week. Cardiorespiratory fitness was assessed by submaximal treadmill test with breath-by-breath gas analysis and heart rate monitoring. Thirty-nine adults with AS and 39 controls were recruited. The AS group spent significantly less time performing vigorous-intensity PA than controls [mean difference (95 % CI) 1.8 min/day (1.2-2.7)] and performed significantly fewer bouts of health-enhancing PA [1.7 min/day (1.1-2.5)]. The AS group had significantly lower predicted VO(2MAX) than controls [6.0 mL kg(-1) min(-1) (1.8-10.1)]. PA was associated with aerobic capacity. Sedentary time was associated with disease activity and physical function. Adults with AS participate in less health-enhancing PA than population controls. Fewer than half meet PA recommendations, despite exercise being a key component of AS management. Explorations of PA behaviour and strategies to increase PA participation are needed.

Recent trends in medication usage for the treatment of juvenile idiopathic arthritis and the influence of tumor necrosis factor inhibitors.

Using administrative data from a large commercial US health insurer, we investigated temporal trends in medication use among children diagnosed with juvenile idiopathic arthritis (JIA). Children with ≥ 1 physician diagnosis code for JIA in the calendar years 2005 through 2012 were included. Use of tumor necrosis factor inhibitors (TNFi), methotrexate (MTX), nonsteroidal antiinflammatory drugs (NSAID), and oral glucocorticoids (GC) was determined. Temporal changes in medication usage were evaluated with the Cochran-Armitage test for trend. We used paired t-tests to evaluate the use of NSAID and GC in the 6 months before and after new TNFi use. We identified 4261 unique individuals with JIA. The proportion of patients receiving TNFi increased from 8.7% in 2005 to 22.4% in 2012 (p < 0.0001). MTX use increased from 18.4% to 23.2% (p = 0.02). NSAID use decreased from 49% to 40% (p = 0.02). GC use was relatively unchanged. Following new TNFi use, the mean number of NSAID prescriptions (among prevalent users) decreased from 2.8 to 2.0 (p < 0.0001), and the mean daily GC dose (among prevalent users) decreased from 7.3 mg/day to 3.9 mg/day (p < 0.0001). Many new TNFi users (57%) had not used MTX in the previous 6 months, and only 37% had any concurrent MTX use in the 6 months following new TNFi use. TNFi use in the treatment of JIA increased 2- to 3-fold over the last 8 years. New TNFi use was associated with decreased NSAID and GC use. TNFi may be replacing, rather than complementing, MTX in the treatment of many patients.

OP0281 Recent Trends in Medication Usage for the Treatment of Juvenile Idiopathic Arthritis in the United States and the Influence of Tnf Inhibitors

BackgroundThe pharmacologic management of JIA has changed dramatically over the last decade with the advent of tumor necrosis factor inhibitors (TNFi), but the impact of TNFi on medication usage in...

&lt;b&gt;Measuring Clinical Outcomes of Animal-Assisted Therapy: Impact on Resident Medication Usage&lt;/b&gt;

To measure changes in medication usage of as-needed, psychoactive medications and other select as-needed medication usage as a result of a therapy dog residing in the rehabilitation facility. Additional measures are participants' thoughts and feelings on quality-of-life factors. One group, pretest, post-test. Residential rehabilitation facility. Convenience sample, N = 58 residents living at the facility. A certified, trained therapy dog. Changes in as-needed medication usage for the following categories: analgesics, psychoactive medications, and laxatives, as well as changes in vital sign measurements of blood pressure, pulse, respiration rate, and body weight. Additionally, changes in the residents' perception of quality-of-life factors. One of the three monitored drug classes, analgesia, revealed a decrease in medication usage (mean = 2.6, standard deviation [SD] +/- 6.90, P = 0.017), and one of four monitored vital signs, pulse, showed a decrease (mean = 5.8, SD +/-7.39, P = 0.000) in study participants exposed to the therapy dog. Positive changes were reported in study participants' quality of life. The benefits to human welfare as a result of the presence of a therapy dog have the potential to decrease medication usage for certain conditions in long-term care patients as well as decrease costs. Pharmacist involvement in animal-assisted therapy has the potential to make unique and measurable improvements to best patient care.

Changes in medication use from age 26 to 32 in a representative birth cohort

To date, longitudinal studies of medications have been confined to older adults or clinical samples, with no data from prospective studies of younger adults. The aim of the study was to examine changes in medication usage between ages 26 and 32 in a prospective study of a representative birth cohort. Medication use during the previous 2 weeks was investigated among 960 individuals at ages 26 and 32. Nearly two-thirds took at least one medication at each age, with medication prevalence higher among women than among men. Three-quarters of those taking at least one at age 26 were doing so at 32. Over-the-counter medication prevalence increased from 35 to 43% between 26 and 32 years of age. Although the prevalence of prescribed medications decreased (from just under half to just over one-third, and from two-thirds to below half among women), there was no significant difference between the ages once hormonal contraceptives were accounted for. By 32, reduced usage of hormonal contraceptives was apparent, with one-third of age-26 users still taking these at 32. Other categories showing major changes were analgesics (increased), anti-asthma drugs (decreased), antidepressants (increased) and antiulcer drugs (increased). At 32, 82% of those taking analgesics, 85% of those taking nutrient supplements, 71% of those taking antihistamines and 33% of those taking antiulcer drugs had self-prescribed them. A considerable proportion of the sample used medications by age 32, and there was considerable change between 26 and 32. The changes are likely to have been due to a mix of ageing and period effects.

Reduction in Prescription Medication Costs after Laparoscopic Gastric Bypass

Morbidly obese patients undergoing bariatric surgery commonly have multiple obesity-related comorbidities, including hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HLP), and gastroesophageal reflux (GERD). Medical management of these conditions can be costly. The aim of this study was to determine changes in the monthly prescription medication costs in morbidly obese patients who underwent laparoscopic gastric bypass. We examined the data on 77 morbidly obese patients receiving medications prescribed for GERD, DM, HTN, and/or HLP before and after laparoscopic gastric bypass. Changes in medication usage were recorded at 3-month intervals. The retail cost for these medications was obtained from drugstore.com. There were 55 women with a mean age of 45 +/- 11 years. The mean body mass index was 47 +/- 6. The mean excess body weight loss was 67 +/- 14 per cent at 1 year. The mean number of prescription medication per patient was reduced from 2.4 preoperatively to 0.2 at 12 months after surgery. The mean monthly medication cost decreased from dollars 196 preoperatively to dollars 54 one month after surgery, representing a 72 per cent cost savings. One month postoperatively, medication cost saving for GERD was 81 per cent; for DM was 69 per cent; for HLP was 53 per cent; and for HTN was 43 per cent. The mean monthly medication cost savings for the first year after surgery was dollars 168, with a yearly savings of dollars 2016 per patient. Improvement of GERD, DM, HLP, and HTN occur as early as 1 month after laparoscopic gastric bypass results in substantial monthly medication cost savings.

Peripheral Stimulation for Treatment of Trigeminal Postherpetic Neuralgia and Trigeminal Posttraumatic Neuropathic Pain: A Pilot Study

Trigeminal neuropathic pain (TNP) after facial trauma or herpes zoster infection is often refractory to treatment. Peripheral nerve stimulation has been used to treat occipital neuralgia; however, efficacy in controlling facial TNP or postherpetic neuralgia is unknown. A retrospective case series of patients who underwent subcutaneous placement of stimulating electrodes for treatment of V(1) or V(2) TNP secondary to herpetic infection or facial trauma is presented. Ten patients received implanted subcutaneous pulse generators and quadripolar electrodes for peripheral stimulation of the trigeminal nerve supraorbital or infraorbital branches. Long-term treatment results were determined by retrospective review of medical records (1998-2003) and by independent observers interviewing patients using a standard questionnaire. Surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of therapy satisfaction were assessed. Mean follow-up was 26.6 +/- 4.7 months. Peripheral nerve stimulation provided at least 50% pain relief in 70% of patients with TNP or postherpetic neuralgia. Medication use declined in 70% of patients, and 80% indicated that they were mostly or completely satisfied with treatment overall. There were no treatment failures (<50% pain relief and a lack of decrease in medication use) in the posttraumatic group, and two failures (50%) occurred in the postherpetic group. The complication rate requiring reoperation was 30%. Peripheral nerve stimulation of the supraorbital or infraorbital branches of the trigeminal nerve is an effective method for relief of TNP after facial trauma or herpetic infection. A prospective trial using this novel approach to treat these disorders is thus warranted.

Methods to assess respiratory effects of complex mixtures.

This paper evaluates the influence of exposures on acute and chronic airway obstruction. Clinical, physiological, and immunological aspects are important in evaluating the effects of the pollutant exposures. Aspects of the exposure-response relationships important enough to record are those factors interactive with the pollutants (e.g., smoking and other personal/behavioral factors) and precursor conditions. To determine baseline status and study chronic effects, one uses standardized and modified health questionnaires and standardized pulmonary function. Confirmatory studies of responsive airways, potentially assessed first by diurnal peak flow, can be done using post-bronchodilator maximum expiratory flow volume curves and methacholine challenges. Immunoglobulin determinations for immunological status (a predisposing/susceptibility factor), allergy skin tests (for immediate hypersensitivity status), and blood counts (mostly for eosinophils) are also important. Other tests that could be performed include expired carbon monoxide and/or carboxyhemoglobin and methemoglobin (for smoking and combustion exposures). Measures of acute effects are symptomatic responses (by questionnaires and diaries), responses of the airways (as measured by spirometry and peak flows), and changes in medication usage or associated medical care (in diaries). Methodologies should also include discussions of protocols and analysis.

Methods to Assess Respiratory Effects of Complex Mixtures

This paper evaluates the influence of exposures on acute and chronic airway obstruction. Clinical, physiological, and immunological aspects are important in evaluating the effects of the pollutant exposures. Aspects of the exposure-response relationships important enough to record are those factors interactive with the pollutants (e.g., smoking and other personal/behavioral factors) and precursor conditions. To determine baseline status and study chronic effects, one uses standardized and modified health questionnaires and standardized pulmonary function. Confirmatory studies of responsive airways, potentially assessed first by diurnal peak flow, can be done using post-bronchodilator maximum expiratory flow volume curves and methacholine challenges. Immunoglobulin determinations for immunological status (a predisposing/susceptibility factor), allergy skin tests (for immediate hypersensitivity status), and blood counts (mostly for eosinophils) are also important. Other tests that could be performed include expired carbon monoxide and/or carboxyhemoglobin and methemoglobin (for smoking and combustion exposures). Measures of acute effects are symptomatic responses (by questionnaires and diaries), responses of the airways (as measured by spirometry and peak flows), and changes in medication usage or associated medical care (in diaries). Methodologies should also include discussions of protocols and analysis.