Escalation Rate Research Articles

P0721 Anti-TNFs have similar safety profile to vedolizumab and ustekinumab as first line biologic treatment in elderly patients with Crohn’s disease

Abstract Background The prevalence of Crohn’s disease (CD) in elderly patients is rising and is associated with aging-related challenges. Data on effectiveness and safety of first line biologic treatment (FLBT) in the elderly, are scarce. Our aim was to compare the safety, effectiveness, and drug persistence to FLBT in elderly patients with CD. Methods A retrospective, single tertiary center study, including all patients with CD who initiated their FLBT at age≥60 years, between 1/1/2010 to 31/12/2023. Clinical and demographic data were extracted and adverse events (AEs), treatment response and drug persistence were collected. Results A total of 214 patients with CD ≥60 years of age started FLBT, data were available for 168 (78.5%) patients. Anti-TNFs were initiated in 85 (50.6%) patients, and non anti-TNFs in 83 (49.4%) patients (71-vedolizumab, 12-ustekinumab). Patients starting anti-TNF were younger (67.3±6.1 vs 72.0±7.0 years, p<0.001), with lower Charlson comorbidity index (CCI: 3.6±1.7 vs 4.9±2.2, p<0.001), had higher rates of penetrating (31.8% vs 9.6%, p=0.002) and perianal (40.0% vs 18.1%, p=0.002) disease phenotype, and previous GI resections (37.6% vs 22.9%, p=0.038). Endoscopic disease severity was comparable [Table 1]. Drug persistence was calculated from 2014 (time of vedolizumabs’ approval for clinical use) and was similar between the groups (60 patients on anti-TNF: median 82.0 weeks [IQR 27.5-175.3] vs. 83 patients on non-anti-TNF median 89.7 weeks [IQR 41.0-183.9], p=0.765). Use of corticosteroids (CS) and immunomodulators (IMM) during 14-weeks of induction and 52-weeks of maintenance was comparable (p=NS). At 52-weeks, no difference was observed in clinical response and remission rates, nor in dose escalation and drug discontinuation rates (p=NS). Eighty-three AEs were recorded at 52-weeks: 50 (58.8%) in anti TNF vs. 33 (39.8%) in non-anti-TNF group. Serious infections: 7 (8.2%) patients in the anti-TNF group (3 hospitalized for sepsis: 1 urinary and 2 respiratory, 1 cellulitis, 1 pharyngitis, 1 systemic CMV and 1 clostridium difficile infection (CDI) vs 7 (8.2%) in the non-anti-TNF group (2 intra-abdominal abscess, 1 herpes zoster infection, 1 CDI, 1 cellulitis and 2 bronchitis, p=1). Hospitalization and surgery rates were 25.8% and 12.9% in anti-TNF vs 22.9% and 8.4% in non-anti-TNF groups respectively, (p=NS) [Table 2]. In a multivariate logistic regression analysis adjusted to type of FLBT, age, gender, CCI, dose escalation, and treatment with CS and IMM, no variable was significantly associated with the development of AEs (p=NS). Conclusion Anti-TNFs and vedolizumab/ustekinumab have similar safety and drug persistence as FLBT among elderly patients with CD. Larger prospective studies are needed to fortify our findings.

P0772 Efficacy and consumption of golimumab is similar with European and American dosing regimens in Ulcerative Colitis: Results of a prospective study

Abstract Background Golimumab is a subcutaneous TNF-alpha inhibitor approved for ulcerative colitis in European Union (EU) and United States of America (US). Interestingly, maintenance dose for patients weighing ≤80 kg is different in EU and US. In EU, golimumab maintenance dose in 50 mg every 4 weeks with an option of reactive dose escalation to 100 mg every 4 weeks in case of inappropriate response. In US, maintenance dose is 100 mg every 4 weeks for all patients, irrespective of body weight and response to induction. Here we compared efficacy, safety and drug consumption of EU and US maintenance dosing of golimumab in patients weighing ≤80 kg. Methods In this investigator initiated prospective study (ClinicalTrials.gov ID: NCT04156984) we recruited 29 patients with active ulcerative colitis. After common induction (golimumab 200 mg at baseline and 100 mg at week 2) all patients received 1 year of maintenance treatment. First 15 patients received US maintenance regimen with 100 mg golimumab monthly and next 14 patients received EU maintenance regimen with 50 mg golimumab monthly. Those in EU regimen with inadequate response to induction or loss of response during maintenance phase (rectal bleeding score (RBS) > 0 or endoscopic Mayo score (eMayo) ≥ 2) increased dose of golimumab from 50 mg to 100 mg. Co-primary endpoints were endoscopic improvement (eMayo ≤ 1) at weeks 14 and 50 and clinical remission (RBS = 0 and stool frequency score (SFS) < 2) at weeks 14, 26, 38, and 50. Statistical analysis included Chi-square and Mann-Whitney tests. Results Patient demographic data are shown in Table 1. Endoscopic improvement and clinical remission rates were similar with EU and US maintenance regimens (Figure 1). 8/14 (57%) of patients in EU regimen needed dose escalation to 100 mg due to inadequate response after a median of 8.6 weeks (interquartile range 6 to 14 weeks). Drug persistence and drug consumption was similar in both maintenance regimens (Figure 1). In the US regimen 3 potentially drug-related side effects occurred (one case each: one-dermatome herpes zoster, labial herpes, skin small vessel vasculitis), but none in the EU regimen. Conclusion In this prospective study, EU and US golimumab maintenance regimens resulted in similar endoscopic improvement and clinical remission rates during the first year of treatment with golimumab in patients with ulcerative colitis weighing ≤80 kg. Due to high dose escalation rates in EU regimen dose consumption was similar in both maintenance regimens.

Outcomes of patients with cancer cared for in a multisite home hospital program.

394 Background: Home hospital provides hospital-level care for acutely ill patients in their homes as a substitute for care in brick-and-mortar hospitals. Since the Centers for Medicare and Medicaid Services’ acute hospital care at home waiver in November 2020, 330 hospitals have received approval to launch home hospital programs. Prior research has shown that patients cared for in home hospital have improved physical activity, and lower mortality and readmission rates. However, many of these programs exclude patients with cancer, and data describing outcomes of patients with cancer cared for in home hospital programs are limited. Methods: We identified patients admitted to a multisite home hospital program affiliated with an urban health system between February 1, 2020 and May 1, 2024 who had a diagnosis of cancer (ICD-10: C00-C96) or myelodysplastic syndrome (ICD-10: D46) managed by an oncologist within the health system. For each admission we conducted chart reviews to determine whether the malignancy was active at the time of admission, defined by ongoing antineoplastic treatment or an admission directly related to the malignancy. We also captured the patient’s cancer diagnosis, the admission diagnosis, total length of stay, and length of time in home hospital. We identified readmissions within 30 days of discharge and escalations of care, defined as a return to a brick-and-mortar hospital for additional care spanning at least one midnight, and calculated rates of these outcomes. Results: There were 141 home hospital admissions among 128 patients with cancer diagnoses (mean age: 77, 36% female). The most common oncologic diagnoses were lymphoma (16%, N = 22), chronic leukemias and MDS (14%, N = 20), and lung cancer (13%, N = 18). Seventy-one patients (50%) had active cancer at the time of admission. The leading admission diagnoses were pneumonia (N = 28, 16%), heart failure exacerbations (N = 19, 13%), complicated urinary tract infections (N = 12, 9%) and soft tissue infections (N = 10, 7%). The mean total length of stay was 7.9 days (SD 5.6) and patients were admitted to home hospital for a mean of 4.9 days (SD: 3.5). Escalation rates and 30-day readmission rates were 7% (N = 10) and 13% (N = 19), respectively, among all patients, and 5% (N = 4) and 14% (N = 10) among patients with active malignancies. Conclusions: These data describe a cohort of patients with cancer cared for in a multisite home hospital program. They show low rates of transfer back to brick-and-mortar hospitals and low 30-day readmission rates, and they demonstrate that patients with cancer can be safely cared for in a home hospital. As home hospital programs build new capabilities, a larger proportion of oncology patients will be eligible for home hospital. More work is needed to estimate risk-adjusted outcomes among these populations and to understand the patient and caregiver experience with oncology home hospital.

An Institutional Febrile Neutropenia Protocol Improved the Antibacterial Treatment and Encouraged the Development of a Computerized Clinical Decision Support System.

We investigated the influence of a local guideline on the quality of febrile neutropenia (FN) management and the applicability of a computerized decision support system (CDSS) using real-life data. The study included 227 FN patients between April 2016 and January 2019. The primary outcome measure was the achievement of a 20% increase in the rate of appropriate empirical treatment of FN in bacteremic patients. The compatibility of the CDSS (the development of which was completed in November 2021) with local protocols was tested using standard patient scenarios and empirical antibiotic recommendations for bacteremic FN patients. In total, 91 patients were evaluated before (P1: between April 2016 and May 2017) and 136 after (P2: between May 2017 and January 2019) the guideline's release (May 2017). The demographic characteristics were similar. Appropriate empirical antibacterial treatment was achieved in 58.3% of P1 and 88.1% of P2 patients (p = 0.006). The need for escalation of antibacterial treatment was significantly lower in P2 (49.5% vs. 35.3%; p = 0.03). In P2, the performance of the CDSS and consulting physicians was similar (CDSS 88.8% vs. physician 88.83%; p = 1) regarding appropriate empirical antibacterial treatment. The introduction of the local guideline improved the appropriateness of initial empirical treatment and reduced escalation rates in FN patients. The high rate of compliance of the CDSS with the local guideline-based decisions in P2 highlights the usefulness of the CDSS for these patients.

Data-driven based financial analysis of concentrated solar power integrating biomass and thermal energy storage: A profitability perspective

This study utilizes decision tree algorithms to estimate the financial feasibility of concentrated solar power (CSP). The main focus of CSP is on solar tower (ST) technology combined with two backup systems, such as biomass boilers and thermal energy storage (TES). The main goal is to develop three decision tree algorithms to predict the power plant's profitability factor (PF) for each of the following three operational scenarios: solar tower-base case-no biomass (ST-BC-NB), solar tower-operation strategy 1-medium biomass (ST-OS1-MB), and solar tower-operation strategy 2-full biomass (ST-OS2-FB). PF was predicted according to main input parameters, including direct capital costs, biomass cost, annual escalation rate, hourly electricity price, annual escalation rate, and peaks and troughs for daily electricity prices. Thermal energy storage was in five different capacities: no-thermal energy storage (No-TES), 5 h, 10 h, 15 h, and 20 h. The decision tree models demonstrated accurate predictions with low errors, high confidence levels, and most data falling within the 95% confidence interval for the "No-TES" case. Solar power plants with biomass backup had a 30% reduction in generation costs compared to conventional plants. The configurations without thermal energy storage had the highest profitability, with a maximum PF of −0.014 USD/kWh and a 25% chance of achieving profitability.

High Rates of Organ Preservation in Rectal Cancer with Papillon Contact X-ray Radiotherapy: Results from a Swiss Cohort.

Rectal cancer typically necessitates a combination of radiotherapy (RT), chemotherapy, and surgery. The associated functional disorders and reduction in quality of life have led to an increasing interest in organ preservation strategies. Response strongly correlates with RT dose, but dose escalation with external beam remains limited even with modern external beam RT techniques because of toxicity of the surrounding tissues. This study reports on the use of Papillon, an endocavitary Radiotherapy device, in the treatment of rectal cancer. The device delivers low energy X-rays, allowing for safe dose escalation and better complete response rate. Between January 2015 and February 2024, 24 rectal cancer patients were treated with the addition of a boost delivered by Papillon to standard RT, with or without chemotherapy, in an upfront organ preservation strategy. After a median follow-up (FU) of 43 months, the organ preservation rate was 96% (23/24), and the local relapse rate was 8% (2/24). None of our patients developed grade 3 or more toxicities. Our results demonstrate that the addition of Papillon contact RT provides a high rate of local remission with sustained long-term organ preservation, offering a promising alternative to traditional surgical approaches in patients with rectal cancer.

Tool Development for Life Cycle Cost (LCC) of Wooden Building Envelope

The main goal of this study is to provide a platform for LCC calculation rules for timber buildings that comply with the Standards EN 16627:2015 and EN 15643-4, by employing a refined technical service life estimation. The database includes economic data for the building envelope and structural elements at the product level. In addition, the use phase of the building is included as maintenance, and the relevant economic data related to design failure, user preferences, and technical defects due to moisture. This model is under development as part of the WoodLCC project, with partners from Germany, Sweden, Norway, Estonia, Slovenia, and Austria, aiming to implement advanced methods to calculate accurate technical service life estimations and give the users the opportunity to evaluate the differences in building and maintenance costs based on different parameters. In this study, a data structure is created based on the necessary indicators and parameters for LCC calculation. An Excel model is developed, which will be used as a base for a software development in the WoodLCC project. Only wooden material is being considered for building envelope and bearing system. All material price data and installation times for each element is taken from a Norwegian dataset. This data is then modified for the selected European country using country specific labour cost- and material cost-indexes, convertible to the inquired currency. Inflation and escalation rates are considered for calculating the maintenance or repair that will occur in future. Material prices for different species and modification are included. Improved service life input data will enable more precise LCC for wood-based products, resulting in improved economic impact. LCC finds common acceptance only if reliable input data are available and complemented with knowledge about user expectations. We will evaluate the possibility of future improvements of such models.

Start low, go slow: A systematic review and meta-analysis of upfront tailored treatment dosing in older adults with advanced cancer.

1625 Background: Older adults aged ≥65 with advanced cancer are underrepresented in treatment trials. This gap limits informed decision-making regarding the dose and tolerability of proposed therapies. Standard chemotherapy is associated with >50% serious adverse event rate among older adults, with frequent dose reduction and early treatment discontinuation. A "start low, go slow" (SLGS) approach begins systemic therapy at lower-than-standard doses and increases the dose if well-tolerated. This alternative dosing strategy has shown value in minimizing adverse events and functional decline without compromising the overall effectiveness of treatments. We conducted the first systematic review and meta-analysis of SLGS effectiveness among older adults across advanced cancers. Methods: This review, was registered with PROSPERO and adhered to PRISMA criteria, covering PubMed, Journal of Geriatric Oncology and EMBASE from January 2000 until December 15, 2024. Eligible study designs were randomized controlled trials, retrospective trials, and non-randomized clinical trials with patients with advanced cancers who underwent systemic therapy. We reported all studies that studied the SLGS approach. Our studied outcomes were overall survival (OS), progression-free survival (PFS), treatment discontinuation, and toxicity. Data extraction included author, patient, cancer type, treatment, and survival outcomes. A meta-analysis using fixed effects and risk ratios (RR) was performed when sufficient data was available; significant outcomes had α<0.05. Results: Our search identified 13 studies testing SLGS strategies in oncology, including 3,508 patients, with a median age 63-78 years. The -represented cancers included colorectal (6 studies, 3059 patients total), lung (2 studies, 113 pts), chronic myeloid leukemia (2 studies, 127 pts), non-Hodgkin lymphoma (1 study, 45 pts), and prostate (2 studies, 164 pts) cancers. Ten (77%) studies assessed OS and PFS. Five studies (39%) compared SLGS against standard doses, finding no significant differences in PFS and OS across all trials. Dose escalation rates for SLGS ranged from 5% to 60%. The ability to complete planned cycles was higher with SLGS compared to standard dose (1 study, 43% vs 26%, p=0.04). Treatment discontinuation was not different for SLGL vs. standard dose (5 studies, meta-analysis RR 1.07, 95% CI 0.90-1.27, p=0.42). Toxicity ranged from 5% to 89% across studies; SLGS had lower grade ≥3 adverse events compared to standard dose (4 studies, meta-analysis RR 0.88, 95% CI 0.80-0.94, p < 0.001). Conclusions: This is the first systematic review and meta-analysis analyzing the SLGS approach to systemic therapy dosing in older adults with advanced cancer. Compared to standard-dose systemic therapy, older adults pursuing a SLGS strategy had greater completion of planned cycles, reduced toxicity, and similar survival.

Escalating hot-dry extremes in Southwest China Karst

Study regionSouthwestern China of Hubei, Hunan, Guangxi, Guangdong, Yunnan, Guizhou, Sichuan, and Chongqing. Study focusCompound hot-dry extreme events (CHDEs) are escalating disproportionately worldwide, posing significant challenges across various sectors. Yet, their driving mechanisms and characteristics at a regional scale remain largely uncertain. This study used a copula-based approach to construct the daily Standardized Compound Hot-Dry Index (SCHDI) to discern the intensifying trends of hot-dry extremes from 1963 to 2022, especially under different karst landscapes in Southwestern China. New hydrological insights for the regionSCHDI variations show an escalation of hot-dry conditions across most areas, with a notable increase in extreme hot, dry, and hot-dry events. There was a consistent increase in the frequency, duration, severity, and intensity of CHDEs, with larger magnitudes observed in non-karst areas. However, karst regions exhibited a higher escalation rate in intensity, especially over the most recent three decades. Land areas affected by less severe CHDEs (e.g., abnormal: −0.31%/year) show decreasing trends over 1993–2022, while the most extreme category (e.g., extreme: 0.34%/year) has increased. The areas affected by CHDEs showed a greater increase in trend slope compared to hot or dry events alone. Additionally, these trends are further influenced by large-scale circulation patterns. Our study highlights the role of karst landscapes in escalating hot-dry extremes in Southwestern China Karst.

Development of a national maternity early warning score: centile based score development and Delphi informed escalation pathways

ObjectiveTo derive a new maternity early warning score (MEWS) from prospectively collected data on maternity vital signs and to design clinical response pathways with a Delphi consensus exercise.DesignCentile based score...

Altered reward processing following sucrose bingeing in male and female mice

ABSTRACT Objectives: Binge eating disorder (BED) is the most prevalent eating disorder associated with multiple adverse health effects, especially mental health issues, including substance use disorders and mood and anxiety disorders. Given these high comorbidities, the objective of our study was to examine whether bingeing behavior would lead to altered perception of reinforcing properties of EtOH and changes in well-being. Methods: We used a sucrose bingeing model based on an intermittent access paradigm with a two-bottle choice, without fasting, in male and female mice. We examined the effect of 2-week sucrose paradigm on ethanol-reinforcing properties using a conditioned place preference test (CPP). Well-being, anxiety- and depressive-like behavioral tests were performed to assess emotional state following 2 and 8-week sucrose bingeing paradigm. Results: Mice with intermittent access to sucrose developed a binge-like behavior assessed by higher sucrose intake and escalation rate during the 1st hour of access, in comparison with mice with a continuous sucrose access. We show for the first time that sucrose bingeing in mice modifies positive reinforcing effect of EtOH in a CPP paradigm without marked alteration of emotional state. Interestingly, prolonging sucrose access for 8 weeks revealed an exacerbated bingeing behavior in female mice, and some signs of emotional state alterations in female with continuous access. Discussion : In sum, our findings broaden the understanding of behavioral alterations associated with bingeing, highlighting the need to investigate addictive-like properties of palatable food both in male and female mice.

BUDGET IMPACT OF MIRIKIZUMAB-MRKZ IN THE TREATMENT OF ADULT PATIENTS WITH MODERATELY-TO-SEVERELY ACTIVE ULCERATIVE COLITIS IN THE UNITED STATES

Abstract BACKGROUND Mirikizumab (miri), an IL-23p19 antagonist, is undergoing US FDA review for treatment of moderately-to-severely active ulcerative colitis (UC) in adults. However, the budget impact of its addition to payer formularies is unknown. METHODS A de novo budget impact model was developed to estimate the cost of introducing miri to the formulary of a hypothetical one-million-member health insurance plan. Epidemiological inputs drew primarily from published sources, while market research informed the current and future market share of advanced therapies. The model accounted for drug acquisition, drug administration, treatment monitoring, and adverse event management, derived from US prescribing information, trial results, and published sources. Discontinuation and dose escalation rates were based on the literature, applying assumptions where data gaps existed. In the base case, the model assumed that half of miri’s market share would be accrued from ustekinumab (an IL-12/IL-23 antagonist). The base-case analysis adopted a US commercial payer perspective over a 3-year period. Deterministic sensitivity analyses (DSA) assessed the implications of uncertainty in model inputs, while scenario analyses estimated budget impact under alternative assumptions about the origin of miri’s market share, and about the patient population under consideration. RESULTS In the base-case, 445, 480, and 515 patients were predicted eligible for advanced therapies for UC in Year1, Year2, and Year3, respectively with total UC drug management expenditures of $137.4 million over three years. Introducing miri to formulary for moderately-to-severely active UC yielded cumulative incremental costs of $1.3 million (relative impact=0.93%), equivalent to $0.04 per member per month (PMPM) or $0.43 per member per year (PMPY). Among patients who had already failed an advanced therapy, miri yielded lower cumulative incremental costs of $0.8 million (relative impact=1.1%), equivalent to $0.02 PMPM/$0.28 PMPY, consistent with the more narrowly defined eligible patient population (219, 252, and 284 patients in Year1, Year2, and Year3, respectively). In the scenario in which miri’s market share derived only from ustekinumab, the model predicted total cost savings of $2.6 million over three years (relative impact=-1.9%), as well as PMPM savings of $0.07 and PMPY savings of $0.85, due to higher estimated average drug costs associated with ustekinumab. DSA results suggested that base-case results were robust to uncertainty in the value of key model parameters. CONCLUSION Introducing miri to formulary for moderately-to-severely active UC may offer patients and clinicians an additional therapeutic option to manage this challenging and debilitating condition at minimal added cost to payers. The addition of miri to formulary could be relatively budget neutral or cost saving in some contexts.

Design, Installation, and Performance Monitoring of a 105 kWp Rooftop Solar PV System

Rooftop Solar PV systems are gaining growing attention on the path toward carbon neutrality. Hence, a great effort must be exerted to ensure smooth and efficient penetration of such systems into the existing utility grids. In the current work, a 105 kWp rooftop solar system is designed and installed to fulfil part of the electric demand of the faculty of Engineering, Zagazig University, Egypt. The performance parameters of this grid-connected solar PV system are optimized for the least-cost of electricity supply through using industry-standard software NREL SAM. For the current rooftop system, fixed orientation of an optimized tilt angle of 23 degrees is preferred over sun-tracking systems due to the reduced operating and maintenance costs. The annual energy production of the system is 175,700 kWh with a capacity factor of 19.1%. Through using parametric optimization and inter-connected financial analysis algorithms, it was possible to define the least cost for the electricity supplied to the grid to be 0.55 EGP/kWh, which achieves grid parity in Egypt. The project is finically profitable without any subsidy, with a discounted payback period of 7.9 years, and IRR (on equity) of 20.1 % and saves 1882-ton CO2 over its lifetime. Sensitivity analysis showed that the electricity escalation rate greatly enhances the project finances. In the first year of operation, the system performed fairly well compared with the theoretical design, provided that the system is frequently cleaned (at least once a week) and continuously connected.

Utilization of peginterferon-β-1a in the real-world practice for relapsing-remitting multiple sclerosis.

Peginterferon β-1a (PEG-IFN-β-1a) is the most recent interferon beta formulation approved for treating relapsing-remitting multiple sclerosis (RRMS). We aim to describe the real-world utilization of PEG-IFN-β-1a in RRMS and compare it with other injectable disease-modifying therapies (DMTs). In this population-based study, we used 2015-2019 routinely collected healthcare data of the Campania region of Italy from National Healthcare System DMT prescriptions, inpatient and outpatient clinical records of hospitals in Campania, and the Federico II University MS clinical registry for a subset of patients. We included individuals with RRMS receiving new prescriptions of PEG-IFN-β-1a [n=281; age = 38.8±12.3 years; females=70.5%; disease duration = 8.4±8.3 years; Expanded Disability Status Scale (EDSS) at baseline=2.0 (1.0-6.5)], glatiramer acetate [n=751; age = 46.0±11.4 years; females=67.1%; disease duration = 9.8±8.2 years; EDSS=4.0 (1.5-8.5)], and subcutaneous (SC) IFN-β-1a [n=1,226; age = 39.7±11.7 years; females=66.5%; disease duration = 8.2±6.5 years; EDSS 2.5 (1.5-6.5)]. Adherence [medication possession ratio (MPR)], escalation to more effective DMTs, hospitalization rates and costs were measured. We used mixed-effect linear regression models (for adherence, hospitalization rates and costs) and Cox regression models (for escalation) to assess differences between PEG-IFN-β-1a (statistical reference), glatiramer acetate, and SC IFN-β-1a. All models included age, sex, previous treatment/untreated, year of treatment initiation, treatment duration, and adherence as covariates. Adherence was lower in glatiramer acetate (MPR = 0.91±0.1; Coeff=-0.11; p<0.01), and IFN-β-1a (MPR = 0.92±0.1; Coeff=-0.08; p<0.01), compared with PEG-IFN-β-1a (MPR = 1.01±0.1). The probability of escalating to more effective DMTs was higher for glatiramer acetate (14.9%; HR=4.09; p<0.01) and IFN-β-1a (9.1%; HR=3.35; p=0.01), compared with PEG-IFN-β-1a (4.9%). No differences in annualized hospitalization rates were identified between glatiramer acetate [annualized hospitalization rates (AHR) = 0.05±0.30; Coeff=0.02; p=0.31), IFN-β-1a (AHR = 0.02±0.21; Coeff=0.01; p=0.97], and PEG-IFN-β-1a (AHR = 0.02±0.24); however, monthly costs for MS admissions were higher for glatiramer acetate (€49.45±€195.27; Coeff=-29.89; p=0.03), compared with IFN-β-1a (€29.42±€47.83; Coeff=6.79; p=0.61), and PEG-IFN-β-1a (€23.91±€43.90). SC PEG-IFN-β-1a and IFN-β-1a were used in relatively similar populations, while glatiramer acetate was preferred in older and more disabled patients. PEG-IFN-β-1a was associated with higher adherence and lower escalation rates toward more effective (and costly) DMTs.

Home Hospital Outcomes for Acute Decompensated Heart Failure and Factors Associated With Escalation of Care.

Overall outcomes and the escalation rate for home hospital admissions for heart failure (HF) are not known. We report overall outcomes, predict escalation, and describe care provided after escalation among patients admitted to home hospital for HF. Our retrospective analysis included all patients admitted for HF to 2 home hospital programs in Massachusetts between February 2020 and October 2022. Escalation of care was defined as transfer to an inpatient hospital setting (emergency department, inpatient medical unit) for at least 1 overnight stay. Unexpected mortality was defined as mortality excluding those who desired to pass away at home on admission or transitioned to hospice. We performed the least absolute shrinkage and selection operator logistic regression to predict escalation. We included 437 hospitalizations; patients had a median age of 80 (interquartile range, 69-89) years, 58.1% were women, and 64.8% were White. Of the cohort, 29.2% had reduced ejection fraction, 50.9% had chronic kidney disease, and 60.6% had atrial fibrillation. Median admission Get With The Guidelines HF score was 39 (interquartile range, 35-45; 1%-5% predicted inpatient mortality). Escalation occurred in 10.3% of hospitalizations. Thirty-day readmission occurred in 15.1%, 90-day readmission occurred in 33.8%, and 6-month mortality occurred in 11.5%. There was no unexpected mortality during home hospitalization. Patients who experienced escalation had significantly longer median length of stays (19 versus 7.5 days, P<0.001). The most common reason for escalation was progressive renal dysfunction (36.2%). A low mean arterial pressure at the time of admission to home hospital was the most significant predictor of escalation in the least absolute shrinkage and selection operator regression. About 1 in 10 home hospital patients with HF required escalation; none had unexpected mortality. Patients requiring escalation had longer length of stays. A low mean arterial pressure at the time of admission to home hospital was the most important predictor of escalation of care in the least absolute shrinkage and selection operator logistic regression model.

Effects of Substance Abuse Consumption and Socio-Economic Development in Kontagora Local Government Area, Niger State

Substance abuse and its effects on socio economic development, a study of Kontagora Local Government area of Niger State is the topic of the study. The study rise some questions on some of the effects of substance abuse on socio economic development, how do the abusers access the substance both local and industrialized substance, why do people engaged in substance abuse, what are the challenges face by law enforcement agents in tackling the menace of substance abuse in Kontagora local government area of Niger state. The study aimed at finding out whether or not substance abuse has effects on socio economic development in Kontagora. The study examine and investigates ways, methods and manners on how do people abuse local and industrialized substance. The study adopted Merton’s Structural Strain Theory as the study theoretical framework, and the method used in data collections was documentary. The following are some findings of the study, substance abusers do not face much challenges in accessing the substance of both local and industrialized substance as far as they have the means (Money) to buy the substance, furthermore, the study revealed that some of the factors that contributes to the escalation rate of the substance abusers are broken home, peer group influence, unemployment, nurture, and inadequate parental care, etc. Finally, the study recommends Establishment of Counseling Centers for Substance Control, Designing Curriculum on Substance education in our schools, Establishment of Substance Awareness Units in all our political wards across the country, and frequent Campaign against Substance abuse by law enforcement agencies.

Advanced care at home at scale in an integrated health care system.

To assess the feasibility of scaling advanced care at home (ACAH) (otherwise known as hospital at home) within an integrated health care delivery system. Retrospective cohort study of patients qualified for hospital-level care who were admitted to either ACAH or a traditional hospital. From April 29, 2020, to November 14, 2021, patients requiring hospital-level care received Kaiser Permanente at Home or traditional hospital care. In a subgroup of patients, we compared outcomes for Kaiser Permanente at Home vs traditional hospital care using regression models. A total of 1005 patients were admitted to Kaiser Permanente at Home. Average daily census (ADC) was intentionally increased over time in stages, from 7.2 to 8.8, then to 12.7. The maximum daily census was 22, with a peak ADC of 16, representing 9% of the total hospital inpatient medicine service census. During this time, there were numeric decreases in Kaiser Permanente at Home escalation rates (17.5% to 10.8%), median length of stay (7.43 days to 5.46 days), and readmission rates (9.79% to 9.24%). A subgroup of Kaiser Permanente at Home patients contributed to the comparative analyses, which showed that patients admitted to Kaiser Permanente at Home were 64% less likely to experience delirium than patients admitted for traditional hospital care (OR, 0.36; 95% CI, 0.15-0.88; P = .026). Comparisons of quality metrics across stages of implementation (readmissions, escalations, length of stay) were inconclusive. In an integrated delivery system, ACAH care can be scaled and can create hospital capacity. However, our data were inconclusive regarding quality throughout scaling due to the small effective sample size, necessitating replication in a larger prospective study with adequate power/precision.

Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn's Disease Initiating Biologics With 3 Years of Follow-Up.

Background: There is limited real-world evidence on treatment patterns of patients with Crohn's disease (CD) initiating biologics with an extensive follow-up period. This study describes persistence and dose titration among CD patients with 3 years of follow-up. Methods: This retrospective observational study was conducted using the STATinMED RWD Insights all-payer medical and pharmacy data. Adult patients with at least 1 CD medical claim and at least 1 medical/pharmacy claim for a biologic (adalimumab [ADA], certolizumab pegol (CZP), infliximab [IFX] and its biosimilar products [IFX-BS], ustekinumab [UST], and vedolizumab [VDZ]) between September 2016 and October 2018 were identified. Commercially insured patients with continuous capture for at least 12 months before and at least 36 months after biologics initiation were selected. Confirmed CD patients were included in the final cohort. Baseline patient characteristics and treatment patterns over the 3-year follow-up period were evaluated. Results were summarized using means and SD or counts and percentages. Results: A total of 2309 confirmed patients with CD were identified (847 [36.7%] IFX, 534 [23.1%] ADA, 486 [21.1%] VDZ, 394 [17.1%] UST, 85 [3.7%] CZP, and 72 [3.1%] IFX-BS). CZP and IFX-BS were excluded due to small sample sizes. Approximately half of CD patients were between ages 35 and 54. Patients on UST had a higher Charlson Comorbidity Index score. Common comorbidities (>10%) included anemia, anxiety, depression, and hypertension. Persistence over 3 years' follow-up was highest for UST (61.4%) patients, followed by VDZ (58.0% ), ADA (52.1% , and IFX (48.1%). The discontinuation rate without switch or restart was highest for ADA (37.3%), followed by UST (30.7%), IFX (28.1%), and VDZ (25.3%). Over the 3 years of follow-up, the dose titration rate was highest for IFX (76.5%) and lowest for UST (50.8%). In particular, UST had the lowest dose escalation rate (35.5%) and highest dose-reduction rate (16.5%). Conclusions: Patients with CD on UST had the highest persistence and lowest dose escalation across different biologic users over the 3-year follow-up period, possibly suggesting a better clinical response of UST. Future studies with longer follow-up adjusting for confounders are needed to better understand treatment patterns among biologics users.

Evaluation of Treatment Patterns and Maintenance Dose Titration Among Patients With Crohn’s Disease Initiating Biologics With 3 Years of Follow-Up

Background: There is limited real-world evidence on treatment patterns of patients with Crohn’s disease (CD) initiating biologics with an extensive follow-up period. This study describes persistence and dose titration among CD patients with 3 years of follow-up. Methods: This retrospective observational study was conducted using the STATinMED RWD Insights all-payer medical and pharmacy data. Adult patients with at least 1 CD medical claim and at least 1 medical/pharmacy claim for a biologic (adalimumab [ADA], certolizumab pegol (CZP), infliximab [IFX] and its biosimilar products [IFX-BS], ustekinumab [UST], and vedolizumab [VDZ]) between September 2016 and October 2018 were identified. Commercially insured patients with continuous capture for at least 12 months before and at least 36 months after biologics initiation were selected. Confirmed CD patients were included in the final cohort. Baseline patient characteristics and treatment patterns over the 3-year follow-up period were evaluated. Results were summarized using means and SD or counts and percentages. Results: A total of 2309 confirmed patients with CD were identified (847 [36.7%] IFX, 534 [23.1%] ADA, 486 [21.1%] VDZ, 394 [17.1%] UST, 85 [3.7%] CZP, and 72 [3.1%] IFX-BS). CZP and IFX-BS were excluded due to small sample sizes. Approximately half of CD patients were between ages 35 and 54. Patients on UST had a higher Charlson Comorbidity Index score. Common comorbidities (&gt;10%) included anemia, anxiety, depression, and hypertension. Persistence over 3 years’ follow-up was highest for UST (61.4%) patients, followed by VDZ (58.0% ), ADA (52.1% , and IFX (48.1%). The discontinuation rate without switch or restart was highest for ADA (37.3%), followed by UST (30.7%), IFX (28.1%), and VDZ (25.3%). Over the 3 years of follow-up, the dose titration rate was highest for IFX (76.5%) and lowest for UST (50.8%). In particular, UST had the lowest dose escalation rate (35.5%) and highest dose-reduction rate (16.5%). Conclusions: Patients with CD on UST had the highest persistence and lowest dose escalation across different biologic users over the 3-year follow-up period, possibly suggesting a better clinical response of UST. Future studies with longer follow-up adjusting for confounders are needed to better understand treatment patterns among biologics users.

OGC P25 Impact of minimally-invasive oesophagectomy on post-operative analgesia and surrogate outcomes

Abstract Background Minimally invasive oesophagectomy (MIO) via either two (MIO2) or three phases (MIO3) has been proposed to reduce post-operative pain and correspondingly improve patient recovery compared to open Ivor-lewis (ILO), Left thoracoabdominal oesophagectomy (LTA) or hybrid-ILO (lap abdomen, open thoracotomy). The primary aim of this study was to audit analgesia outcomes according to surgical approach via maximum daily pain score, daily and total post-operative opiate usage. Secondary outcomes included return of GI function, mobility, and rates of post-operative pneumonia, escalation in ward care or re-intubation due to respiratory failure. Methods Retrospective review of records from consecutive patients undergoing oesophagectomy at a single tertiary centre between January 2015 and December 2022. Post-operative analgesia consisted of thoracic epidural and patient controlled analgesia (PCA) for patients undergoing thoracotomy and PCA+/- paravertebral analgesia for those undergoing MIO. Patients remaining ventilated due to early post-operative complications were excluded from analysis. Opioid usage was converted to oral morphine equivalents for comparison. Patient mobility was prospectively recorded by a physiotherapist using the Manchester Mobility Score (MMS). Pneumonia was defined as either rising inflammatory makers or fever and any new respiratory symptom, oxygen requirement or pulmonary imaging changes. Results Of a total 328 eligible patients, 225 underwent open oesophagectomy, 80 MIO, and 23 hybrid-ILO. Pain scores were similar on post-operative day 0-5 across approaches. MIO was associated with a significantly lower median total opioid usage (MIO2-624mg, MIO3-720mg) compared to open (ILO-1608mg, LTA-1984mg ) and hybrid-ILO-1977mg (P&amp;lt;0.001). There was no significant difference in pneumonia, escalation or reintubation rates between the different approaches. MIO was associated with an earlier return of bowel function (P&amp;lt;0.001) and patients undergoing MIO achieved the maximum MMS score earlier than those undergoing thoracotomy (P&amp;lt;0.001). Conclusions Equivalent post-operative analgesia can be achieved between open and minimally invasive oesophagectomy when multimodal approaches including epidural anaesthesia are employed. MIO is however, associated with an approximately threefold reduction in opiate use with corresponding earlier return of gut function, and improved post-operative mobility compared to ILO, LTA or hybrid-ILO. Where feasible and can safely be employed, suitable patients may benefit from a minimally invasive oesophagectomy over open or hybrid approaches as part of an enhanced recovery pathway supported by a multidisciplinary team.