Injectable Medications Research Articles

Pain associated with prostaglandin E1-containing intracavernosal injection medication is associated with poor erectile function recovery after radical prostatectomy.

Intracavernosal injection therapy is often used as second-line therapy for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase-5 inhibitors has failed, but prostaglandin E1-containing vasoactive agents are associated with penile pain in some men. To define the incidence of pain with prostaglandin E1-containing intracavernosal injectionmixtures for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase-5 inhibitors has failed, and whether painwasa predictor of erectile function recovery. Men who underwent radical prostatectomy andwerecommencedonintracavernosal injection within 12 months of radical prostatectomy were included. A pain visual analog scale (0-10) was used to assess the degree of pain. Erectile function recovery was defined asthe International Index of Erectile Function domain score ≥24using phosphodiesterase-5 inhibitors at 24months. The study included 566 patients, mean age was 58±14 (42-74) years. Duration post-radical prostatectomy at intracavernosal injection training was 3.5±3.5m. Nerve sparing status: bilateral 76%, unilateral 13%, and non-nerve sparing 11%. Incidence of pain with intracavernosal injection per nerve sparing status: bilateral 10% of patients, unilateral 32%, non-nerve sparing 92% (p<0.001). Median visual analog scale in those experiencing pain: bilateral 4 (interquartile range 3, 5), unilateral 5.5 (interquartile range 3, 6), non-nerve sparing 7 (interquartile range 3, 9) (p<0.001). Phosphodiesterase-5 inhibitors success at 24months (no pain vs. pain): bilateral 70%vs. 40% (p<0.001), unilateral 50%vs. 28% (p<0.001), non-nerve sparing 10%vs. 0% (p<0.001). On multivariate analysis, predictors of failure to respond to phosphodiesterase-5 inhibitors at 24months post-radical prostatectomy included baseline erectile function, increasing age, incomplete nerve-sparing surgery, and presence of pain. The presence of penile pain with intracavernosal injection is associated with poorer erectile function recovery post-radical prostatectomy. Incidence of pain is high in men with non-nerve sparing radical prostatectomy; older patient age, poorer nerve sparing, poor baseline erectile function, and the presence of penile pain with prostaglandin E1-containing intracavernosal injection medication, were predictive of poor erectile function recovery using phosphodiesterase-5 inhibitors at 24months.

Clinical, Quality of Life, and Health Care Utilization Outcomes of Switching the Administration Route of Antipsychotic Medications Among People With Schizophrenia Spectrum Disorder: A Systematic Review and Meta-Analysis.

Using long-acting injectable (LAI) antipsychotic medications can improve the outcomes of patients with schizophrenia, such as reducing symptom severity and hospitalization risk. However, the outcomes of switching from oral to LAI antipsychotic medications are unclear. The purpose of this review is to provide a summary of the clinical, quality of life, and health care utilization outcomes of switching from oral to LAI antipsychotics among patients with Schizophrenia Spectrum Disorder. We thoroughly searched the PubMed, Scopus, PsycInfo, and CINAHL databases. To conduct the meta-analysis, we used the Comprehensive Meta-Analysis Program. Forty-one articles met our inclusion criteria. After switching to LAIs, symptom severity, the number of rehospitalizations, emergency department visits, and overall health care costs were reduced. Also, social functioning significantly improved. However, no differences were observed in the frequency of outpatient visits. Pharmacy costs were increased between pre- and post-LAI initiation. Our findings support evidence that changing the route of administration of antipsychotic medications from oral to long-acting intramuscular injections can improve the clinical, quality of life, and health care utilization outcomes in people with schizophrenia. Health care practitioners might consider encouraging LAI use earlier during treatment for schizophrenia for better clinical outcomes and to reduce health care utilization associated with treatment.

Multi-level barriers and facilitators to implementing evidence-based antipsychotics in the treatment of early-phase schizophrenia.

Long-acting injectable (LAI) antipsychotic medications and clozapine are effective yet underutilized medical therapies in early intervention services. The purpose of this study was to conduct a pre-implementation evaluation of contextual determinants of early intervention programs to implement innovations optimizing LAI antipsychotic and clozapine use within a shared decision-making model. Semi-structured interviews explored barriers and facilitators to implementing LAI antipsychotics and clozapine in early intervention services. Participants were: prescribers (n = 2), non-prescribing clinicians (n = 5), administrators (n = 3), clients (n = 3), and caregivers (n = 3). Interviews were structured and analyzed using the Consolidated Framework for Implementation Research (CFIR 2.0). Participants were supportive of using LAI antipsychotics, despite barriers (e.g., transportation, insurance coverage), while most were unfamiliar with clozapine (Innovation). Critical incidents (e.g., COVID-19) did not interfere with implementation, while barriers included lack of performance measures; stigma affecting willingness to take medication; and clozapine considered to be a "last resort" (Outer Setting). Treatment culture was described as client-centered and collaborative, and most participants indicated LAI antipsychotic use was compatible with clinic workflows, but some were in need of resources (e.g., individuals trained to administer LAI antipsychotics; Inner Setting). Participants on the healthcare team expressed confidence in their roles. Family education and collaborative decision-making were recommended to improve client/family engagement (Individuals). Participants related the importance of tracking medication compliance, addressing client concerns, and providing prescribers with updated guidelines on evidence-based treatment (Implementation Process). Results may guide implementation strategy selection for future programs seeking to optimize the use of LAI antipsychotics and clozapine for early-phase schizophrenia, when appropriate.

A discrete choice experiment to understand preferences of patients with type 2 diabetes about the attributes of GLP1 receptor agonists in Spain

Objective To determine the preferences regarding injection, medication frequency and complexity of GLP1 receptor agonists among patients with type 2 diabetes, treatment-naïve for such drugs in Spain. Additionally, patients’ willingness to pay according to these attributes was evaluated. Methods A discrete-choice experiment survey designed to evaluate patients’ preferences over three attributes discriminating by age, sex and patients experience with previous injectable treatment was fulfilled by patients. The resulting model was analyzed using a conditional (fixed-effects) logistic regression. Results A total of 180 patients (63.35 ± 11.49 years, 63.28% men, 48.41% with previous cardiovascular disease, 54.69% with a time of evolution of diabetes >10 years) recruited from 5 health care centers in Spain completed the survey. Patients viewed positively weekly injections (vs daily injections), but rated negatively a complex preparation of the dose (vs simple preparation). Whereas naïve patients for injectable medications did not consider administration timing of importance, no naïve patients considered it relevant. No relevant differences were observed according to age or gender. Patients were willing to pay 83.25€for a “no preparation required” dose. No naïve and naïve patients were willing to pay 34.61€ and 14.35€; p = 0.000, to change daily injection for a weekly injection. Conclusions Patients highly valued the avoidance of injections, with weekly dosing clearly preferred over daily dosing, as well as reducing the treatment complexity. These findings may provide a better understanding of what patients prefer and value in their treatment and provide guidance for clinicians making therapeutic decisions regarding treatments of patients with type 2 diabetes.

Treatment Adherence in Pediatric Atopic Dermatitis: A Systematic Review.

Adherence to pediatric atopic dermatitis (AD) treatment regimens can be complex and a major challenge to optimizing treatment outcome. We aimed to review factors associated with nonadherence in pediatric AD and propose interventions to improve adherence. PubMed and EMBASE databases were systematically searched for articles from 2000 to February 2023 related to AD and adherence, with an additional update in December 2023. Non-human studies, reviews, commentaries, and meta-analyses were excluded. Articles were sorted into pediatric versus adult study population based on volume. Herein, we examine the results of papers discussing adherence factors related to pediatric patients. A total of 62 studies met inclusion criteria. Thirty-six studies surveyed patients and caregivers (N = 10,268) to identify barriers to treatment adherence. None of the included studies were specific to systemic medications. Barriers includedpoor caregiver quality of life, inadequate AD-related education, topical corticosteroid (TCS) phobia, unclear therapy-related instructions, and dissatisfaction with physician interaction. Five studies solely measured adherence using medication electronic monitoring systems, Morisky medication adherence scale, or self-reported adherence to measure adherencetotopical medications. Twenty-one studies described interventions involving nurse-led or web-based education programs, text message or email reminders, and TCS education. Adherence was improved with caregiver education programs, daily text-message reminders, eczema action plans, TCS potency "traffic light" color system, and frequent follow-up visits. Adherence to pediatric AD treatment poses a multifactorial challenge for caregivers and patients. This study provides an index of strategies to optimize adherence, as it is essential for prevention of long-term sequela associated with AD in children. As the AD treatment landscape rapidly expands, further studies are vital to assess pediatric adherence to new topical, oral, and injectable medications. PROSPERO: CRD42023488557.

A Discrete-Choice Experiment Assessing the Patient Preferences and Real-World Experiences of Patients with Migraine in Japan.

Migraine is a debilitating headache disorder with a high prevalence in Japan that imposes significant societal burden. Although the Japanese Clinical Practice Guideline for Headache Disorders 2021 recommends both acute and preventive migraine treatments, the usage of preventive treatments is still limited. Therefore, it is crucial to understand the treatment preferences of patients with migraine pertaining to both acute and preventive treatments. A mixed-methods study including a discrete choice experiment (DCE) was conducted with Japanese patients with migraine (10 for the qualitative interviews, and 400 for the DCE) who were recruited from the Rakuten Insight panel. The DCE presented hypothetical treatment options including oral acute, oral preventive, and injectable preventive medications. Six attributes (method of delivery, reduction of pain, impact of headaches on daily routines, dosage adjustability, and temporary and persistent side effects) each with three levels were included in the survey. A hierarchical Bayesian model was used to estimate relative attribute importance scores (RAI) for all attributes. For the 400 participants in the DCE, the most common age bracket was 40-49years old, and the majority were female (66.75%). RAI estimates indicated that "method of delivery" was the most important attribute for patients (RAI 51.92, SD = 10.20), followed by "reduction of pain when experiencing a headache" (RAI 17.00, SD = 7.74). Oral preventive treatments were preferred over injectable preventive treatments. The qualitative interviews showed that patients prefer oral medications to injectable treatments, and a lack of awareness regarding preventive treatments. This study found that the "method of delivery" was the most important driver of treatment preferences of patients with migraine in Japan, with oral acute medications being preferred. Oral preventive treatments were found to be preferred over injectable treatments. These results may indicate the need for increased education regarding preventive treatments, as well as the need for further development of these treatments.

Relation between Self-Efficacy and Compliance to Treatment with Injectable Medication for Type 2 Diabetes

Relation between Self-Efficacy and Compliance to Treatment with Injectable Medication for Type 2 Diabetes

Long-Acting Injectable Antipsychotic Medication Use in Youth: A Systematic Review of the Literature Along with MedWatch Safety Data and Prescriber Attitudes.

Objectives: Long-acting injectable (LAI) antipsychotic medications are being prescribed to children and adolescents along a broad age range from 2 to 17 years old. However, there is no U.S. Food and Drug Administration (FDA) approved indication for the use of any LAI in a pediatric population. The goal of this article is to perform a systematic literature review regarding the use of LAIs in a pediatric population, to obtain pediatric LAI safety data, and to survey prescriber attitudes regarding LAI use in youth. Methods: A search for relevant articles between June 1986 and June 2021 was conducted. Safety data were obtained from FDA MedWatch postmarketing adverse event reports regarding LAI use in children and adolescents. A survey of practicing Child and Adolescent Psychiatrists in Wisconsin was done regarding the use of LAIs in youth. Results: The predominant reasons for LAI use in youth were illness severity and treatment noncompliance. Twenty-six of 30 identified studies and reports favored LAI use in youth, but were of low to very low quality. Overall, 587 FDA MedWatch reports between June 1986 and June 2021 were identified. Most adverse events occurred in modest numbers. Extrapyramidal symptoms accounted for 18% of all MedWatch reports, neuroleptic malignant syndrome accounted for 3% of all reports, and deaths accounted for 2% of all reports. The concern for safety was reflected in prescriber survey results along with a recognition that LAIs can be helpful to target severe psychiatric symptoms and address treatment noncompliance. Conclusions: No randomized controlled studies were found. Identified published studies and reports were of low to very low quality. However, it appeared reasonable that the use of LAIs in a select group of pediatric patients can be helpful to target severe psychiatric symptoms and to enhance treatment compliance.

Underutilization of Injectable Parkinson's Disease Medication: An Analysis of Neurologist and Patient Perspectives.

We hypothesized that many neurologists underestimate patients' willingness to self-administer injectable Parkinson's disease (PD) medication. To evaluate patient and physician perceptions contributing to underutilization of PD medications for acute OFF episodes. Data were collected using an online survey including n = 4063 PD patients experiencing OFF episodes and n = 200 neurologists. 89% of patients were willing to self-inject rescue therapies to treat acute OFF episodes. After reviewing patient survey data, 54% of general neurologists and 37% of movement disorder specialist (MDS) demonstrated a change in perceptions about patients' willingness to use self-injected therapies (P < 0.05). 37% of general neurologists and 21% of MDS indicated a greater likelihood of prescribing these treatments (P < 0.05). Most patients suffering from OFF episodes would be willing to self-inject to abort their symptoms. Neurologists underestimate this patient acceptance. Understanding patient attitudes and further education about rescue therapies is likely to increase use of these therapies.

PIONEER REAL UK: A Multi-Centre, Prospective, Real-World Study of Once-Daily Oral Semaglutide Use in Adults with Type 2 Diabetes.

Oral semaglutide provides an alternative to injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) for treatment of type 2 diabetes (T2D). The PIONEER REAL studies evaluate clinical outcomes of oral semaglutide treatment of T2D in a real-world setting. PIONEER REAL UK focused on adults living with T2D in the UK. The multi-centre, prospective and non-interventional single-arm study enrolled 333 participants and followed them for 34-44 weeks. Participants were treated as part of routine clinical practice and had not been previously treated with injectable glucose-lowering medication. The primary endpoint was change in glycated haemoglobin (HbA1C) from baseline to end of study (EOS). Secondary endpoints included change in body weight, proportion of participants with HbA1C < 7% (53 mmol/mol) at EOS and proportion of participants with ≥ 1%-point HbA1C reduction and body weight reduction of ≥ 3% or ≥ 5% at EOS. Treatment satisfaction was assessed by Diabetes Treatment Satisfaction Questionnaire (DTSQ) status and change. Of 333 participants, 299 completed the study and 227 were on treatment at EOS. People treated with oral semaglutide experienced significantly reduced HbA1C by an estimated change of - 1.1%-points (95% CI - 1.27 to - 0.96; P < 0.0001) or - 12.2 mmol/mol (CI - 13.87 to - 10.47; P < 0.0001). Estimated change in body weight was - 4.8 kg (CI - 5.47 to - 4.12; P < 0.0001). At EOS, an HbA1C level < 7% (53 mmol/mol) was recorded in 46.3% of participants. A ≥ 1%-point reduction in HbA1C combined with a ≥ 3% reduction in body weight was observed in 36.4% of participants, and 27.1% had a ≥ 1%-point reduction in HbA1C and a ≥ 5% body weight reduction. Treatment satisfaction improved significantly during the study. No new safety concerns or cases of severe hypoglycaemia were reported. People living with T2D in the UK experienced a meaningful decrease in HbA1C and body weight after initiation of oral semaglutide treatment. No new safety issues were observed. ClinicalTrials.gov: NCT04862923. Graphical plain language summary available for this article.

Stated preferences for long-acting injectable ART among mobile men living with HIV in Malawi: a qualitative study

Background: Long-acting injectable (LAI) antiretroviral medications are as effective as daily oral antiretroviral therapy (ART) and offer discreet, less frequent dosing. LAIs may be ideal treatment options for people who experience challenges with adherence to daily oral ART, including mobile men living with HIV (MLHIV). Methods: We conducted a qualitative sub-study within two trials (ENGAGE and IDEaL) in 24 health facilities in Malawi that enrolled MLHIV &gt;15 years not on ART. We conducted in-depth interviews with a stratified random sample of participants who had taken oral ART and self-reported mobility (travel) during the 6-month study (&gt;1 trip of &gt;3 nights). Interviews described cabotegravir/rilpivirine and asked about clients’ stated preferences for LAI vs. oral ART and their reasoning. Interviews were translated, transcribed, coded in Atlas.ti, and analyzed using framework analysis. Results: We interviewed 29 mobile MLHIV from 1 July to 30 August 2022, median age 36 (IQR:31-41), mean 28 nights away in last six months (SD: 40). Nearly all participants (26/29) expressed a preference for LAI over daily oral ART because LAI would reduce the risks of forgetting to take pills and unwanted disclosure. Three men preferred oral ART primarily due to fear of side effects from a new medication. A few men reported they would change their preference if injection site reactions prevented them from working. Conclusion: Mobile MLHIV in Malawi with previous ART adherence challenges expressed strong stated preferences for LAI over daily oral ART. Further research is needed to understand implementation challenges and potential effectiveness of LAI among harder-to-reach populations.

COMPARATIVE ANALYSIS OF INSULIN VARIETIES IN THE MANAGEMENT OF OBESITY: A COMPREHENSIVE SYSTEMATIC REVIEW

Obesity remains a critical global health issue, closely intertwined with metabolic conditions such as type 2 diabetes. The prevalence of obesity continues to surge, and the need for effective strategies to manage both obesity and its associated comorbidities has become increasingly pressing. Traditionally, insulin therapy has been associated with weight gain, posing additional challenges for obese individuals with diabetes. However, recent advancements in insulin formulations, particularly GLP-1 receptor agonists and amylin agonists, have opened new pathways for dual managing obesity and glycemic control. This systematic review examines the relationship between insulin formulations and obesity control, focusing on injectable medications such as Victoza®, Saxenda®, Ozempic®, and Mounjaro®. These drugs belong to the GLP-1 receptor agonist class and have shown significant promise in promoting weight loss, enhancing glycemic control, and managing obesity-related comorbidities. Additionally, the overall effectiveness of these treatments is incorporated in a meta-analysis of relevant clinical trials in the management of obesity.

Validity assessment of self-reported medication use in a pharmacoepidemiologic study by comparison with prescription record review

Objectives Although self-reported questionnaires are widely used to collect information on medication use in epidemiological studies, their validity for studies involving older adults has not been sufficiently assessed. This study evaluated the validity of self-reported medication use using questionnaires in comparison with drug notebooks.Methods The study enrolled 370 older community dwellers who participated in an aging sub-study survey of the Tsuruoka Metabolomics Cohort Study between April 2019 and March 2021. Medication use was assessed by comparing self-reported questionnaire data with drug notebook records. We analyzed medications used for hypertension, dyslipidemia, myocardial infarction, angina, diabetes, rheumatism, osteoporosis/metabolic bone disease, constipation, anxiety/depression, dementia, asthma, allergy, thrombosis, and thyroid disease. Moreover, gastrointestinal (GI) medications, steroids, and antipyretic analgesics were assessed, and data on injectable medications for osteoporosis/metabolic bone disease was collected. Using drug notebook records, we identified regular medication users by assessing whether they had received oral medication prescriptions covering over 28 days and took the medication within the 90 days preceding the day of their survey. To define medication categories, we used Anatomical Therapeutic Chemical (ATC) classification codes. Sensitivity, specificity, and kappa statistics were calculated for each medication using drug notebooks as standards. Those who did not bring their drug notebooks on the day of the survey were defined as non-medication users.Results The mean age (standard deviation) of the 370 participants (146 men and 224 women) was 73.3 (4.0) years. The sensitivity and specificity for each medication were as follows: hypertension (0.97, 0.97), dyslipidemia (0.93, 0.98), myocardial infarction (0.24, 0.99), diabetes (0.94, 1.00), rheumatism (1.00, 1.00), osteoporosis/metabolic bone disease (0.82, 0.99), constipation (0.71, 0.98), GI conditions (0.63, 0.97), anxiety/depression (0.36, 1.00), dementia (0.67, 1.00), asthma (0.67, 0.98), allergy (0.57, 0.99), thrombosis (0.88, 0.98), steroids (0.80, 0.99), thyroid disease (1.00, 1.00) and antipyretic analgesics (0.75, 0.96).Conclusions Although sensitivity and specificity differed by medication categories, the results of our population-based cohort study suggested that self-reported questionnaires on medication use among older adults are valid, especially for medications with high sensitivity (≥ 0.8).

Sodium ampicillin release from biocompatible hydrogel with enhanced antibacterial characteristics

The goal of this research is to develop an intelligent carrier that can control the release of medications in response to particular triggers. A novel carrier was created by combining different amounts of chitosan and polyvinylalcohal along with specific amount of cinnamon extract to enhance the antibacterial response of the prepared hydrogels. A non-hazardous crosslinker 3-Aminopropyl(diethoxy)methylsilane (3-APDEMS) was used to study its effect on the physical and chemical properties of the produced injectable hydrogels as well as the controlled drug release behaviour. The hydrogels swelling behaviour was assessed in a range of solvent environments and the results indicated that the swelling ratio decreased as the concentration of 3-APDEMS rose. The hydrogels showed the most swelling at acidic pH values and the least swelling at basic and neutral pH values. They are appropriate for use in injectable controlled medication delivery systems due to their unique pH-sensitive characteristic at pH 7.To evaluate its release profile in this particular setting, ampicillin sodium salt was effectively added to the best hydrogel formulation (which contained 100 μL cinnamon extract and 150 μL 3-APDEMS).The results showed that the release of ampicillin sodium (AMS) was regulated in PBS (7.4), reached up to 98.236 % release over 90 min.The utilisation of these hydrogels as a cutting-edge material for physiological pH-controlled injectable medication delivery and other biological applications is supported by these results.

Switching from injectable to other Disease Modifying Therapies may improve sexual dysfunction in people with Multiple Sclerosis

BackgroundMultiple Sclerosis (MS) a central nervous system autoimmune disorder, mainly affecting young adults and more prevalent among women, can lead to sexual dysfunction (SD) among both males and females with MS. Female sexual dysfunction can be defined as dyspareunia, a lack of sexual desire, disorders in the arousal and orgasm phases, and sexual pain disorders. The purpose of this study is to investigate the changes in sexual function among females with MS whose treatment was switched from first-line injectable medications to other agents after a six-month duration. And assess the changes in all three domains of SD.MethodsIn this longitudinal study females diagnosed with MS, aged between 18 and 50 years old, and were candidates for switching their treatment from interferon beta-1a (intra-muscular and subcutaneous), and Glatiramer Acetate (GA), to Fingolimod, Dimethyl Fumarate (DMF), or Natalizumab (NTZ) due to patients’ convenience and tolerability and adverse events were included. “Multiple Sclerosis Intimacy and Sexuality Questionnaire-19” was used to evaluate the SD changes before and six months after the new treatment initiation. Statistical analysis was conducted using SPSS V.24 software. Histograms and the Shapiro-Wilk test were used to assess the normality of the variables; due to the non-normal distribution of quantitative variables (except for age), the Wilcoxon signed-rank test was used to compare the scores, before and six months after the medication change. The level of significance was considered less than 0.05.ResultsOut of 107 female participants (average age: 35.09 ± 5.61), The mean of overall MSISQ-19 scores, before and six months after the medication change were not significant (p-value = 0.091). However, considering the subdomains, the medication changes only affected the tertiary subdomain of MSISQ-19 (p-value = 0.017). Still, the scores of other subdomains did not change significantly (p-value = 0.761 for primary SD and 0.479 for secondary SD). Also, there wasn’t any significant difference between EDSS before and after the medication change (p-value = 0.461).ConclusionsTo our knowledge, this was the first study, assessing the effect of MS medication change on the improvement of SD among patients. According to the results of the presented cross-sectional study, we found that during a six-month period, the tertiary subdomain of MSISQ-19 symptoms improved significantly, while the changes in other SD domains were not significant.

No Difference in Short-Term Surgical Outcomes from Semaglutide Treatment for Type 2 Diabetes Mellitus after Cervical Decompression and Fusion: A Propensity Score-Matched Analysis.

Retrospective cohort. To evaluate the impact of semaglutide treatment for Type 2 Diabetes Mellitus (T2DM) on the risk of short-term (<6 months) postoperative complications in patients undergoing primary cervical spine decompression and fusion (CSDF). Semaglutide, a GLP-1 receptor agonist, is gaining popularity as a weekly injectable medication for the treatment of T2DM and obesity. Existing research indicates that higher levels of HbA1c and obesity are linked to fewer positive results after undergoing spine surgery, particularly cervical decompression and fusion. Nevertheless, there is a scarcity of publications evaluating the influence of semaglutide therapy on surgical complications, including surgical site infection, wound complications, and reoperation within 6 months, which were aggregated into a composite measure. The PearlDiver Database was queried from January 2010 to December 2021 for patients with a primary diagnosis of T2DM who underwent CSDF for degenerative pathology. Patients with semaglutide treatment within 6 months before index surgery were propensity score-matched to patients without the treatment, employing age, gender, and Charlson comorbidity index (CCI) as matching covariates. A multivariate regression model was used to investigate the impact of semaglutide treatment on postoperative surgical complications. The propensity score-matched cohort included 596 patients (semaglutide cohort: 298, control cohort: 298). There were no statistically significant differences between cohorts in the composite measure of postoperative surgical complications following index CSDF (OR 1.26, 95% CI 0.83-1.93, P=0.331). Similarly, both 30-day (OR 0.83, 95% CI 0.49-1.42, P=0.589) and 90-day readmission rate (OR 0.89, 95% CI 0.56-1.42, P=0.724) were similar between both cohorts. This study suggests that in patients with T2DM, semaglutide treatment is not associated with higher rates of short-term adverse events after CSDF. The effect of semaglutide use on long-term outcomes remains unknown.

Antipsychotic use in a large community sample of patients with delusional disorder

BackgroundTo examine clinical and sociodemographic differences between patients with delusional disorder; with and without diagnoses of an additional severe mental disorder (SMD) or cognitive impairment. MethodsPopulation-based study including all individuals diagnosed with DD between 2005 and 2021 from a large catchment area in Madrid, Spain. Sociodemographic and clinical characteristics and the antipsychotic prescription patterns of the study population was described. Patients were divided into (i) patients with DD and no additional diagnosis of SMD or cognitive impairment (DD group), (ii) patients with DD and a diagnosis of an additional SMD (DD-SMD group), and (iii) patients with DD and cognitive impairment (DD-CI group). ResultsOf 1109 patients with a DD diagnosis (62.5 % female), 131 (11.8 %) patients were diagnosed with an additional SMD, and 69 (6.2 %) were diagnosed with cognitive impairment. DD-SMD patients were on average 10 years younger and had longer time between first mental healthcare contact and DD disorder than DD patients. DD-CI patients were on average 10 years older and had a higher proportion of females. Paliperidone (21.9 %) and aripiprazole (20.6 %) were the modal antipsychotic drugs chosen overall. DD-SMD patients were more likely to receive paliperidone and to be prescribed long-acting injectable medication; DD-CI were more likely to receive risperidone or quetiapine; and DD patients were more likely to receive olanzapine. ConclusionsSociodemographic and clinical characteristics and choice of antipsychotic drug and delivery method for individuals with DD vary based on its comorbidity.

P-581 Optimizing efficiency and enhancing patient convenience in DuoStim cycles: A study exploring the continuous application of corifollitropin alpha

Abstract Study question Corifollitropin alfa in DuoStim cycles: is weekly continuous dosing a viable alternative to daily FSH administration for comparable oocyte yield? Summary answer Employing corifollitropin alfa on a weekly basis throughout a DuoStim cycle achieves comparable oocyte numbers to daily FSH while significantly reducing the number of injections. What is known already The DuoStim protocol is frequently employed in patients with poor response or low ovarian reserve. However, its utilization has recently been proposed in patients who require elective oocyte/embryo freezing with the aim of maximizing the number of gametes/embryos obtained in a menstrual cycle. While its popularity is growing, the prolonged stimulation period involves the administration of a high number of injectable medications adding to the treatment burden. Study design, size, duration A non-inferiority, paired-matched study was planned with a minimum sample size of 13 patients per group, based on a tolerated difference of ± 1 oocyte, SD: 1, 80% power and type 1 error: 5%. Study group (n = 30): patients undergoing DuoStim from November 2022–December 2023. The control group (n = 30) was selected from patients undergoing DuoStim in years 2021-2022 following a standard daily-FSH administration. Controls were 1-to-1 matched based on AMH (±0.4 pmol/l) and age. Participants/materials, setting, methods The study group received consecutive injections of 150µg corifollitropin alfa every eight days, along with uninterrupted oral administration of natural progesterone 200 mg/day (LH surge prevention) throughout the follicular and luteal phases. The control group employed a daily-FSH/flexible GnRH-antagonist protocol. GnRH-agonist trigger was used in the follicular phase, whereas either hCGr and/or GnRH-agonist triggering was allowed in the luteal phase. Main results and the role of chance Baseline characteristics: age (years), AMH (pmol/l), and BMI (Kg/m2) were comparable between control vs study group (39.7vs40.3, 6.1vs6.1, 24.4vs23.9; p0.05, p0.5 and p0.9, respectively). In terms of the primary objective: total COCs and MII yield (follicular + luteal phase); the standard daily-FSH protocol vs study group achieved a similar total oocyte and MII yield (10.9±5.5 vs 10.4±7.0, p0.6 and 8.7±4.8 vs 7.8±5.6, p0.4, respectively). Additionally, all secondary outcomes (fertilisation rates, number of blastocysts, days of stimulation and gonadotrophin cost) showed no significant differences between the groups. Notably, the study group experienced a remarkable reduction in the number of injections needed to complete a DuoStim cycle [3.8±1.1 vs 30.9±12.9, p &amp;lt; 0.001; MD -27.1±12.5, (95%CI, -49 to -8)]. Limitations, reasons for caution The secondary outcomes revealed comparable fertilisation rates and blastocyst numbers between the two groups. Nevertheless, it is important to interpret the laboratory results beyond oocyte collection cautiously, considering the smaller sample size (n = 23/group). Larger participant cohorts are necessary to validate these findings and mitigate the risk of type II errors. Wider implications of the findings This protocol involving long-acting FSH in combination with natural progesterone offers a viable alternative for patients undergoing DuoStim. It enables comparable results in terms of egg retrieval while minimizing the need for injectables, without increasing the treatment duration or costs. Consequently, it alleviates emotional and therapeutic burdens experienced by patients. Trial registration number NCT05815719

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches.

Spasticity is a very common sign in the neurological field. It can be defined as "a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes" associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life". The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients' performance and outcomes. The combined strategies might rise the toxin's effect, lowering its dosages of botulinum and reducing side effects and costs.

145-OR: Assessing the Current State of Diabetes Care in Long-Term Facilities Using Continuous Glucose Monitoring

Introduction: Recommendations for diabetes care in long term care facilities (LTCF) focuses on avoidance of hypoglycemia and symptomatic hyperglycemia. Using continuous glucose monitoring (CGM), we evaluated the current state of glycemia in LTCF residents with multiple comorbidities. Methods: We conducted a cross-sectional study using CGM in 8 LTC facilities in the United States. A masked Dexcom G6 pro CGM was placed for 10 days on residents with diagnosis of diabetes mellitus (DM) who were on any oral or injectable hypoglycemic medications. Clincial and demographic information were collected from medical records. Results: We evaluated 65 residents (mean age 65 years, 50% female). Fourteen percent of the cohort was on sulfonylurea medications and 68% were on insulin. CGM data showed 26% of the cohort with &amp;gt;1% time spent in hypoglycemia (time &amp;lt;70 mg/dL). A larger burden of hyperglycemia was seen with 54% of the cohort spending &amp;gt;10% time &amp;gt;250mg/dL, 37% spending &amp;gt;25% time &amp;gt;250 mg/dL, and 14% spending &amp;gt;90% time &amp;gt;250 mg/dL. Only 44% of the cohort had &amp;gt;50% Time-in-Range (70-180 mg/dL). The latest A1C was &amp;lt;7% in 45% of the cohort, 7-8% in 27%, 8.1-9% in 12%, and &amp;gt;9% in 16%. Fingerstick reading frequency was 2 or fewer times/day in 74% of the cohort, 3 times/day in 13%, and 4 or more times/day in 13%. On average, this cohort had 13 comorbidities, with 85% having functional disabilities. There was 14% with dementia and 42% with obesity (BMI&amp;gt;30). All 100% of the participants had polypharmacy(≥5 medications/day). Conclusions: In this multi-morbid cohort of residents with diabetes living in LTCF, we identified a high burden of both hypoglycemia and severe hyperglycemia, despite fair control of A1C. More consistent use of CGM could help identify glycemic excursions to improve therapeutic decision-making. Disclosure C. Slyne: None. K. Roberts: None. C.D. Conery: None. H. Brabant: None. N. Krakoff: None. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi. M. Munshi: Consultant; Sanofi. Funding Supported by an investigator initiated grant from Dexcom