Main Reason For Discontinuation Research Articles

Real-World Clinical Outcomes of Patients with Myelofibrosis Treated with Ruxolitinib: Evidence from a Multinational Medical Record Review

Real-World Clinical Outcomes of Patients with Myelofibrosis Treated with Ruxolitinib: Evidence from a Multinational Medical Record Review

Perceptions of Acne and Its Treatments Among Chinese College Students: A Cross-Sectional Survey

Objective: This cross-sectional survey aimed to explore Chinese college students’ perceptions regarding acne and its topical medications, and to evaluate whether these perceptions affect their motivation to seek and adhere to treatments. Methods: A cross section survey was performed using a 14-item questionnaire was administered via WeChat. among Chinese college students at Jiangsu University aged 18–24 years. Results: One thousand and four hundred and fifteen responses were received. The prevalence of self-diagnosed acne was 34.1%. The factors associated with a greater likelihood of seeking treatment were being female, having acne for a longer duration, and having severe acne. Nearly two-thirds of the respondents had discontinued topical medication use within 1 month, with only 4.8% continuing for over 6 months. The main reason for discontinuation was slow onset of action. Patients who considered acne a long-term condition were more likely to seek treatment and use medication for longer periods than those who considered it a short-term condition. Lack of knowledge about medication features, proper usage, and prevention of adverse effects may lead to early discontinuation. Furthermore, 93.8% of the respondents hoped to obtain the above information from doctors. Conclusion: Detailed explanations of acne and medication guidance are necessary to help patients understand the necessity of continuous treatment and the expected efficacy.

Treatment patterns of advanced or recurrent endometrial cancer following platinum-based therapy in the U.S. real-world setting.

274 Background: Patient (pt) prognosis is poor following disease progression on or after primary (1L) platinum-based therapy (PBT) for advanced/recurrent (A/R) endometrial cancer (EC), and no consensus on standard second-line (2L) therapy exists. This retrospective analysis aimed to understand real-world (RW) treatment patterns of pts with A/R mismatch repair deficient/microsatellite instability-high (dMMR/MSI-H) EC who progressed after 1L PBT. Methods: Physicians in Cardinal Health’s Oncology Provider Extended Network submitted retrospective data by abstracting outpatient electronic medical records of pts who received systemic treatment for A/R EC following PBT from 2016 to 2018. Demographics, clinical characteristics, treatments, and outcomes were summarized descriptively. Results: This study included 84 pts with A/R dMMR/MSI-H EC (table). The majority of participating physicians were hematologists/medical oncologists (80%) and practiced in the community setting (70%). Median duration of therapy (mDOT) in 1L was 4.9 months (95% CI, 4.47–5.57); 64% of pts discontinued treatment due to completion and 35% due to disease progression. In contrast, mDOT in 2L was 6.2 months (95% CI, 5.40–6.37); 37% of pts discontinued treatment due to completion and 44% due to disease progression. The most common MMR/MSI testing modalities were next-generation sequencing (NGS) only, immunohistochemistry (IHC) only, and polymerase chain reaction (PCR) only (table). Conclusions: RW treatment patterns in pts with A/R dMMR/MSI-H EC show that most will undergo PBT retreatment. However, progression is the main reason for discontinuation during retreatment. An urgent need exists for durable therapies that improve prognosis. Opportunities to improve timely testing of MMR/MSI exist. Funding: GlaxoSmithKline, Waltham, MA, USA. [Table: see text]

Biological therapy and international travel: A questionnaire survey among Danish patients with rheumatic disease.

To describe travel activities, preparations, and health problems encountered by patients with arthritis receiving biological therapy. A travel survey was conducted in a Danish rheumatology outpatient clinic by distribution of a semistructured questionnaire to 300 consecutive patients with arthritis. Among the 273 (91%) patients returning the questionnaire, a history of traveling outside Denmark was reported by 203 (74%) respondents and outside Europe by 92 (34%). In 81% of the patients, travel activities had not decreased after the initiation of biological treatment. However, 24% reported that they had become more cautious regarding the choice of travel destination. Pre-travel advice was sought by less than one-third of the patients, whereas travel insurance was taken out by 86%, but only half of them had disclosed information about the biological treatment. Treatment was discontinued temporarily while traveling in 26% of patients on subcutaneous biologics. The main reason for discontinuation was concern about transport and storage of medicine. Only 6% of the travelers had experienced health problems, which were of only minor importance. Treatment with biologics seems not to have any major influence on international travel activity among Danish patients with arthritis. Health problems when traveling were of minor importance. However, pre-travel advice issues, including treatment compliance, transport of medicine, and insurance coverage, need to be addressed proactively by the outpatient clinic staff as part of patient consultation.

Twelve-month Continuation of the Etonogestrel Implant in Adolescents With Polycystic Ovary Syndrome.

To identify why adolescents with polycystic ovary syndrome (PCOS) chose the etonogestrel (ENG) contraceptive implant, to determine the 12-month continuation rate, and to characterize factors related to discontinuation. Retrospective chart review of adolescents seen at a tertiary care children's hospital between July 1, 2008, and August 30, 2019, with PCOS diagnosis confirmed per National Institutes of Health criteria and ≥12-month ENG follow-up. Demographic characteristics, reasons for ENG insertion and removal, and information on other hormonal/contraceptive therapies were collected. Patients were categorized as ENG continuers (use ≥12months) or discontinuers (removal at <12months), and groups were compared. A total of 96 patients met inclusion criteria (age 17.7±2.2years, body mass index 34.8±8kg/m2). Reasons for ENG were documented in 74% (51% contraception, 32% ease of use, 15% other, 13% estrogen avoidance). In all, 27% had never been sexually active, and 67% had had prior sexual activity. Treatments prior to ENG placement included 74% combined hormonal contraception, 20% medroxyprogesterone acetate withdrawal, and 17% depot medroxyprogesterone. A total of 77% continued ENG at 12months. The main reasons for discontinuation were bleeding (41%), concern about weight gain (23%), and mood changes (18%). No preimplantation characteristics were independently predictive of continuation, although 100% of patients with type 2 diabetes (n=11) continued. Patients who sought additional care, including telephone calls (41% vs 12%, P=.006) and clinic visits (64% vs 20%, P<.001) were more likely to discontinue. The ENG implant was well tolerated in adolescents with PCOS and similar to published 12-month continuation rates.

CML-277: Efficacy of Bosutinib in Imatinib-Resistant vs Dasatinib/Nilotinib-Resistant Chronic Phase Chronic Myeloid Leukemia: Results from the Phase 4 BYOND Study

Context Bosutinib is approved for patients with Philadelphia chromosome (Ph)+ chronic myeloid leukemia (CML) resistant/intolerant to prior therapy and newly diagnosed patients in chronic phase (CP). Objective To evaluate the efficacy of bosutinib in patients with Ph+ CP CML according to subgroups of resistance (imatinib vs. dasatinib/nilotinib) or intolerance to prior tyrosine kinase inhibitors (TKIs). Design BYOND ( NCT02228382 ) is an ongoing, phase 4, single-arm, open-label study. Data are reported at ≥1 year after last enrolled patient; 85% of patients had a minimum follow-up of 2 years. Setting Multicenter study in Europe and North America. Patients Patients with CML resistant/intolerant to prior TKIs. Interventions Bosutinib 500 mg QD (starting dose). Main outcome measures Cumulative response rates. Results Of 156 patients with Ph+ CP CML who received bosutinib, 52 had resistance only to imatinib, 31 had resistance to dasatinib and/or nilotinib, and 73 were intolerant to all prior TKIs. Corresponding median treatment duration was 24.1, 8.9, and 25.3 months, and median dose intensity was 360, 431, and 292 mg/day. At the data cut-off, 69.2%, 41.9%, and 53.4% of imatinib-resistant, dasatinib/nilotinib-resistant, and TKI-intolerant patients, respectively, were still receiving treatment. The main reason for discontinuation was adverse events: 19.2%, 25.8%, and 28.8% of imatinib-resistant, dasatinib/nilotinib-resistant, and TKI-intolerant patients, respectively. Corresponding discontinuations due to insufficient response occurred in 3.8%, 16.1%, and 1.4% of patients. No patient experienced on-treatment transformation to advanced phase CML. In patients without baseline complete cytogenetic response (CCyR), CCyR rates by 1 year were 65.0%, 50.0%, and 72.2% in imatinib-resistant, dasatinib/nilotinib-resistant, and TKI-intolerant patients, respectively. In patients without baseline major molecular response (MMR), cumulative MMR rates by 1 year were 55.6%, 28.6%, and 80.6% in imatinib-resistant, dasatinib/nilotinib-resistant, and TKI-intolerant patients, respectively. Deaths occurred in 3, 3, and 4 imatinib-resistant, dasatinib/nilotinib-resistant, and TKI-intolerant patients, respectively. Conclusions Response rates were similar between imatinib-resistant and TKI-intolerant patients. Despite the fact that dasatinib/nilotinib-resistant patients were more heavily pretreated and had a shorter treatment duration, responses were also seen in patients with resistance to these second-generation TKIs. These results further support bosutinib use for patients with Ph+ CP CML and resistance/intolerance to prior TKIs. Study Sponsor Pfizer.

First-ever treatment in multiple sclerosis

The current treated MS population is very different from that of patients in randomized clinical trials. To study the long-term efficacy and tolerance of fingolimod (FTY) and dimethyl fumarate (DMF), both available as first-line treatment in early-treated treatment-naïve MS patients. Retrospective analysis of 75 patients from our prospective MS registry fulfilling the inclusion criteria: FTY or DMF as first-line treatment, treatment initiation within 36months of disease onset and treatment duration>12months. Demographics and MRI characteristics at baseline were similar in both groups (FTY 55 patients, DMF 20), but patients on FTY had higher pretreatment clinical activity (P=0.008). Twenty-two percent of patients in the FTY group and 15% in the DMF group had highly active disease. At last follow-up (mean: 44.2, SD: 17.3months), the majority of the patients were still on treatment while 54.5% of FTY and 65% of DMF patients reached NEDA 3 status (P=0.444). Both treatments significantly decreased relapses and occurrence of new T1 Gd-enhancing lesions (P<0.001). The main reason for discontinuation was disease activity without severe side effects on either treatment. Our findings support efficacy and tolerance of both drugs in early-treated treatment-naive MS patients, arguing in favour of efficient early immunomodulation in MS patients. Both drugs significantly reduced the incidence of new relapses and Gd-enhancing lesions on treatment with FTY being more frequently prescribed than DMF, especially in patients with evidence of higher clinical disease activity.

Exenatide Once Weekly: Effectiveness, Tolerability, and Discontinuation Predictors in a Real-world Setting

PurposeThe goal of this study was to evaluate the effectiveness and safety of exenatide once weekly (EOW) and to determine predictors of treatment response and drug discontinuation in patients with type 2 diabetes mellitus (T2DM) followed up for 18 months in a real-world setting. MethodsThis retrospective cohort study included patients with T2DM who initiated EOW 2 mg between 2014 and 2019 in an outpatient diabetes clinic in Italy. Data were collected at baseline and at follow-up visits (6, 12, and 18 months after EOW). We estimated glycosylated hemoglobin (HbA1c) and body weight mean changes from baseline to follow-up visits and assessed the proportion of patients reaching HbA1c target ≤7% and a 5% weight loss after 12 months of treatment. We then attempted to establish predictors of glycemic and weight response, and compared patient characteristics between subjects who persisted on treatment versus those who discontinued EOW. FindingsOne-hundred eighty-six patients (46.2% male) were included in the study. The mean (SD) age and diabetes duration were 63.2 (8.9) years and 10.7 years (18.3), respectively. Significant reductions in HbA1c values (−0.9%; 95% CI, −1.1 to −0.8) and body weight (−2.8 kg; 95% CI, −3.4 to −2.2) were observed after 6 months. Sixty-one percent of patients (87 of 143) achieved target HbA1c values ≤ 7% after 12 months, and 34% (45 of 134) exhibited a weight loss of at least 5% of baseline body weight. Blood glucose and weight reductions were maintained after an 18-month follow-up. Predictors of adequate glycemic and weight response were shorter diabetes duration and nonuse of a different GLP-1RA, respectively. Patients on sulfonylureas failed to reach metabolic and body weight targets. The most common adverse events were gastrointestinal side effects (7.5%) and injection site reactions (6.4%), followed by headache (1.1%) and allergic reactions (1.1%). Forty-three percent of patients (79 of 186) discontinued EOW. The main reasons for discontinuation were insufficient HbA1c improvement and/or limited weight reduction (19.9%), side effects (16.1%), or patient decision (6.5%). Predictors of discontinuation were higher HbA1c levels at baseline and use of basal insulin therapy before EOW treatment. ImplicationsEOW treatment, in a real-world setting, offers sustained and effective glycemic control and weight loss over 18 months in patients with T2DM. Diabetes duration and basal insulin therapy, however, may affect the outcome of EOW treatment, suggesting that early initiation of EOW could improve glycemic control and reduce the risk of treatment discontinuation.

Factors associated with early long-acting reversible contraceptives discontinuation in Ethiopia: evidence from the 2016 Ethiopian demographic and health survey

BackgroundEthiopia is struggling to achieve the 2020 family planning target. But the current contraceptive prevalence uptake is low and dominated by short-acting methods. Contraceptive discontinuation rate is also high. This analysis was done to identify the reasons and factors associated with long-acting and reversible contraceptives (LARC) discontinuation in Ethiopia.MethodsThe unit of analysis was LARC-use episodes in the 5 years preceding the survey, generated from the 2016 Ethiopian Demographic and Health Survey data. A total of 1385 LARC episodes were included. Data analysis was done using STATA 15. The event file generated from the contraceptive calendar was merged to the original data set to identify factors associated with LARC discontinuation. Univariate, bivariate and inferential analyses were done for 12 months LARC discontinuation.ResultApproximately 82% of LARC episodes were implants. About 45% of intrauterine device (IUD) and 61% of implant episodes were discontinued by 36 months. Side effects and the desire to become pregnant were the main reasons for discontinuation. Women aged 25–34 (HR = 0.26; 95% CI: 0.20–0.35) and those aged 35–49 (HR = 0.17; 95%CI: 0.11–0.26), women who participated in decision-making partially (HR = 0.53; 95%CI: 0.37–0.78), or fully (HR = 0.55; 95%CI: 0.40–0.74) and primiparous women (HR = 0.53, 95%CI: 0.33–0.86) had a lower hazard of discontinuing LARCs. On the other hand, women who had only primary education (HR = 1.32; 95%CI: 1.02–1.72) and women who were not sure about their fertility intention (HR = 2.11; 95%C: 1.28–3.46) had a higher likelihood of discontinuing these methods.ConclusionMajority of LARC episodes were discontinued early, mainly due to the desire for pregnancy or experience of side effects. Older women, particularly those involved in household decision-making, and primipara were less likely to discontinue LARC. Women with only primary education and those uncertain about their fertility intention had a higher likelihood of discontinuation. Family planning service providers should focus on fertility intention and side effects when counseling women for contraceptive choice. Improving women’s participation in household decision-making may decrease LARC discontinuation in Ethiopia.

A new desensitization protocol, overcoming hypersensitivity reactions to chemotherapy.

e15523 Background: Despite the progress for cancer treatment, some drugs remain a cornerstone for an optimal approach. Hypersensitivity reactions to chemotherapy may render these essential chemotherapeutic agents useless and for some types of cancer continuing the therapeutic scheme could be crucial. Various regimens for desensitization to allow chemotherapy administration through the time were conceived, with different dilutions, time and settings of administration. Methods: A prospective study of patients with systemic treatment for histopathologically confirmed cancer in our Oncological Institute „Prof. Ion Chiricuta” Cluj-Napoca, with an allergic reaction during treatment being the keys inclusion criteria in the analysis. Patients were administered a three days desensitization regimen from the following cycle of treatment with blood samples that were taken to observe the predictive value of biological markers. Results: Eighty-two patients were the initial pool, with a median age of 56 years. Platin derivates containing regiments were responsible for an allergic reaction for 75 out of 82 patients. Four of them were known with a previous allergic reaction for chemotherapy in their personal medical history, and 56 of them had more than one chemotherapy line in their treatment. More than 688 desensitization cycles were administrated during our study with a rate of failure of 1.3 %. The main reason for discontinuation was disease progression or adjuvant character (limited duration) of the chemotherapy administration. Conclusions: Allergic reaction does not impede the administration of the responsible drug. A 3-day inpatient regimen could be a valuable option with a successful rate of administration without the need for ICU monitoring.

Treatment patterns of advanced or recurrent endometrial cancer following platinum-based therapy in the US real-world setting.

e18036 Background: Following disease progression on or after primary (1L) platinum-based therapy (PBT) for advanced/recurrent (A/R) endometrial cancer (EC), patient (pt) prognosis is poor and no consensus on standard second-line therapy exists. This retrospective analysis aimed to understand real-world (RW) treatment patterns of pts with A/R mismatch repair deficient/microsatellite instability-high (dMMR/MSI-H) EC who progressed after 1L PBT. Methods: Physicians in Cardinal Health’s Oncology Provider Extended Network submitted retrospective data by abstracting outpatient electronic medical records of pts who received systemic treatment for A/R EC following PBT from 2016 to 2018. Demographics, clinical characteristics, treatments received, and outcomes were summarized descriptively. Results: This study included 84 pts with A/R dMMR/MSI-H EC (table). The majority of participating physicians were hematologists/medical oncologists (80%) and practiced in the community setting (70%). Median duration of therapy (mDOT) in 1L was 4.9 months (95% CI, 4.47–5.57); 64% of pts discontinued treatment due to therapy completion and 35% due to disease progression. In contrast, mDOT in 2L was 6.2 months (95% CI, 5.40–6.37); 37% of pts discontinued treatment due to therapy completion and 44% due to disease progression. The most common MMR/MSI testing modalities were next-generation sequencing (NGS) only, immunohistochemistry (IHC) only, and polymerase chain reaction (PCR) only (table). Conclusions: RW treatment patterns in pts with A/R dMMR/MSI-H EC show that most will undergo PBT retreatment. However, progression is the main reason for discontinuation during retreatment. An urgent need exists for durable therapies that improve prognosis. Opportunities to improve timely testing of MMR/MSI exist. [Table: see text]

Effect of Baseline Characteristics on Cabazitaxel Treatment Duration in Patients with Metastatic Castration-Resistant Prostate Cancer: A Post Hoc Analysis of the Compassionate Use/Expanded Access Programs and CAPRISTANA Registry.

We examined factors that may impact cabazitaxel treatment duration in a real-life setting in a compassionate use program, expanded access program, and prospective observational study in metastatic castration-resistant prostate cancer (mCRPC). Patients with mCRPC previously treated with docetaxel (N = 1621) received cabazitaxel 25 mg/m2 intravenously every 3 weeks until disease progression, death, unacceptable toxicity or physician/patient decision. The median number of cabazitaxel cycles was six (range, 1–49); 708 patients (43.7%) received >6 cycles. Patients receiving >6 cycles tended to have a better Eastern Cooperative Oncology Group performance status of 0–1 (p = 0.0017 for ≤6 vs. >6 cycles). Overall, 348 patients (21.5%) were ≥75 years of age; 139 (39.9%) received >6 cycles. The main reason for discontinuation was disease progression; however, in patients receiving 1–2 cycles, the main reason for discontinuation was adverse events. Only 52 patients (3.2%) progressed during cycles 1–2. Cabazitaxel was well tolerated in these studies, which included some elderly and frail patients, offering clinicians an important treatment option in the management of mCRPC. Proactive management of adverse events may allow patients to receive a higher number of cabazitaxel cycles and derive greater benefit.

PD62-01 A FIRST STEP TOWARDS A GLOBAL NOMOGRAM TO PREDICT DISEASE PROGRESSION FOR MEN ON ACTIVE SURVEILLANCE

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD62)1 Apr 2020PD62-01 A FIRST STEP TOWARDS A GLOBAL NOMOGRAM TO PREDICT DISEASE PROGRESSION FOR MEN ON ACTIVE SURVEILLANCE Mieke Van Hemelrijck, Xinge Ji, Jozien Helleman, Monique Roobol*, Daan Nieboer, Chris Bangma, Mark Frydenberg, Antti Rannikko, Lui Shiong Lee, Vincent Gnanapragasam, Mike Kattan, and GAP3 Movember Foundation's Active Surveillance Database Mieke Van HemelrijckMieke Van Hemelrijck More articles by this author , Xinge JiXinge Ji More articles by this author , Jozien HellemanJozien Helleman More articles by this author , Monique Roobol*Monique Roobol* More articles by this author , Daan NieboerDaan Nieboer More articles by this author , Chris BangmaChris Bangma More articles by this author , Mark FrydenbergMark Frydenberg More articles by this author , Antti RannikkoAntti Rannikko More articles by this author , Lui Shiong LeeLui Shiong Lee More articles by this author , Vincent GnanapragasamVincent Gnanapragasam More articles by this author , Mike KattanMike Kattan More articles by this author , and GAP3 Movember Foundation's Active Surveillance Database GAP3 Movember Foundation's Active Surveillance Database More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000979.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Using data from Movembers’ GAP3 Consortium we have shown that after 5 yrs of follow-up, 57% of men who started on active surveillance (AS) were still on AS. Signs of disease progression (28%) and conversion to active treatment without evidence of disease progression (13%) were the main reasons for discontinuation. We aimed to develop a nomogram to be used as a prediction tool for outcomes in men with localised prostate cancer (PCa) on AS. METHODS: As a first step in the development of a nomogram, we assessed heterogeneity between centres in terms of discontinuation due to disease progression. We started with the assessment of the baseline hazards for disease progression based on grouping of GAP3 centres according to similarities in follow-up protocols [high: yearly; intermediate: ∼2 yearly; and low: at year 1, 4 & 7 (i.e. PRIAS)]. We conducted cause-specific Cox proportional hazards regression to estimate the risk of disease progression by centre in each group. We then evaluated heterogeneity of prevalence of clinical factors and their relationship to disease progression with univariate and multivariate hazard ratios by centre. RESULTS: 14,380 men were included. Heterogeneity analysis for the risk of disease progression showed large differences in risk of upgrading between centres (median HR: 2.5). Next, we assessed how clinical factors such as age (</≥70 years), year of diagnosis (</≥2010), Gleason grade group (</≥2), number of positive cores (</≥2), and PSA (</≥7 ng/mL) were predictors of disease progression for each centre. After adjustment for these clinical factors, the heterogeneity in risk of disease progression remained between the centres (Figure 1). CONCLUSIONS: When combining worldwide cohorts of men on AS, we noted unexplained differences in baseline hazards of disease progression. However, the relative effects of patient characteristics on risk of disease progression were fairly stable between centres. This indicates that it is possible to develop a global nomogram in future, provided that local adjustments for differences in risk of disease progression and competing risks (e.g. watchful waiting, conversion to active treatment, or death) are taken into account for these observed differences in baseline hazards or reasons for these differences are examined further. Source of Funding: Movember Foundation. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1285-e1285 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mieke Van Hemelrijck More articles by this author Xinge Ji More articles by this author Jozien Helleman More articles by this author Monique Roobol* More articles by this author Daan Nieboer More articles by this author Chris Bangma More articles by this author Mark Frydenberg More articles by this author Antti Rannikko More articles by this author Lui Shiong Lee More articles by this author Vincent Gnanapragasam More articles by this author Mike Kattan More articles by this author GAP3 Movember Foundation's Active Surveillance Database More articles by this author Expand All Advertisement PDF downloadLoading ...

Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

Background: Acute diarrheal diseases remain a leading cause of global morbidity and mortality in young children. The effective implementation of provision of zinc in addition to low osmolarity ORS remains very poor.Methods: A prospective observational study was done to determine compliance with zinc therapy on 103 children aged between two months to five years with acute gastroenteritis. They were started on WHO ORS and zinc in the form of syrup (20 mg/day in those &gt;6 months of age and 10mg/day in those &lt;6 months of age) and advised to continue for 14 days. Further episodes of diarrhea was considered as the primary outcome variable. Number of days zinc taken was considered as the primary explanatory variable. p-value &lt;0.05 was considered statistically significant.Results: The mean age was 19.49±14.41 months. The compliance to complete 14-day zinc therapy was 62.14%. The mean number of days zinc was taken was 11.28±3.81 days. In 11.65% of participants, there was further episodes of diarrhea. The main reasons for discontinuation were diarrhea stopped (45%), Ignorance (37.5%), URI (12.5%).Conclusions: Findings indicate that the syrup formulation is acceptable, but further efforts are required to enhance adherence. These findings also highlight the importance of guiding in ensuring adherence to zinc duration while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

Exploring reasons for discontinuing use of immediate post-partum intrauterine device in Nepal: a qualitative study

BackgroundPostpartum intrauterine device (PPIUD) use remains very low in Nepal despite high levels of unmet need for postpartum family planning and the national government’s efforts to promote its use. This study investigates reasons for continuing or discontinuing PPIUD use among Nepali women.MethodsWe conducted in-depth interviews (IDIs) with 13 women who had discontinued PPIUD use and 12 women who were continuing to use the method 9 months or longer following the insertion. All interviews were audio recorded, transcribed, translated into English, and analyzed using a thematic approach.ResultsWomen discontinued PPIUD for several reasons: 1) side effects such as excessive bleeding during menstruation, nausea, back and abdominal pain; 2) poor quality of counselling and, relatedly, mismatched expectations in terms of device use; and 3) lack of family support from husbands and in-laws. In contrast, women who were continuing to use the method at the time of the study stated that they had not experienced side-effects, had received appropriate information during counselling sessions, and had the backing of their family members in terms of using PPIUD.ConclusionExperiencing side-effects or complications following PPIUD insertion and poor quality of family planning counselling were the two main reasons for discontinuation. Family members appeared to play a major role in influencing a woman’s decision to continue or discontinue PPIUD suggesting that counseling may need to be expanded to them as well. Improving quality of counselling by providing complete and balanced information of family planning methods as well as ensuring sufficient time for counselling and extending PPIUD service availability at lower level clinics/health posts will potentially increase the uptake and continued use of postpartum family planning, including PPIUD, in Nepal.

Uptake and Discontinuation of Integrase Inhibitors (INSTIs) in a Large Cohort Setting.

Despite increased integrase strand transfer inhibitor (INSTI) use, limited large-scale, real-life data exists on INSTI uptake and discontinuation. International multicohort collaboration. RESPOND participants starting dolutegravir (DTG), elvitegravir (EVG), or raltegravir (RAL) after January 1, 2012 were included. Predictors of INSTI used were assessed using multinomial logistic regression. Kaplan-Meier and Cox proportional hazards models describe time to and factors associated with discontinuation. Overall, 9702 persons were included; 5051 (52.1%) starting DTG, 1933 (19.9%) EVG, and 2718 (28.0%) RAL. The likelihood of starting RAL or EVG vs DTG decreased over time and was higher in Eastern and Southern Europe compared with Western Europe. At 6 months after initiation, 8.9% (95% confidence interval: 8.3% to 9.5%) had discontinued the INSTI (6.4% DTG, 7.4% EVG, and 14.0% RAL). The main reason for discontinuation was toxicity (44.2% DTG, 42.5% EVG, 17.3% RAL). Nervous system toxicity accounted for a higher proportion of toxicity discontinuations on DTG (31.8% DTG, 23.4% EVG, 6.6% RAL). Overall, treatment simplification was highest on RAL (2.7% DTG, 1.6% EVG, and 19.8% RAL). Factors associated with a higher discontinuation risk included increasing year of INSTI initiation, female gender, hepatitis C coinfection, and previous non-AIDS-defining malignancies. Individuals in Southern and Eastern Europe were less likely to discontinue. Similar results were seen for discontinuations after 6 months. Uptake of DTG vs EVG or RAL increased over time. Discontinuation within 6 months was mainly due to toxicity; nervous system toxicity was highest on DTG. Discontinuation was highest on RAL, mainly because of treatment simplification.

Systemic delivery of peptides by the oral route: Formulation and medicinal chemistry approaches.

In its 33 years, ADDR has published regularly on the po5tential of oral delivery of biologics especially peptides and proteins. In the intervening period, analysis of the preclinical and clinical trial failures of many purported platform technologies has led to reflection on the true status of the field and reigning in of expectations. Oral formulations of semaglutide, octreotide, and salmon calcitonin have completed Phase III trials, with oral semaglutide being approved by the FDA in 2019. The progress made with oral peptide formulations based on traditional permeation enhancers is against a background of low and variable oral bioavailability values of ~1%, leading to a current perception that only potent peptides with a viable cost of synthesis can be realistically considered. Desirable features of candidates should include a large therapeutic index, some stability in the GI tract, a long elimination half-life, and a relatively low clearance rate. Administration in nanoparticle formats have largely disappointed, with few prototypes reaching clinical trials: insufficient particle loading, lack of controlled release, low epithelial particle uptake, and lack of scalable synthesis being the main reasons for discontinuation. Disruptive technologies based on engineered devices promise improvements, but scale-up and toxicology aspects are issues to address. In parallel, medicinal chemists are synthesizing stable hydrophobic macrocyclic candidate peptides of lower molecular weight and with potential for greater oral bioavailability than linear peptides, but perhaps without the same requirement for elaborate drug delivery systems. In summary, while there have been advances in understanding the limitations of peptides for oral delivery, low membrane permeability, metabolism, and high clearance rates continue to hamper progress.

Immune Checkpoint Inhibitor Therapy for Acute Myeloid Leukemia and Higher-Risk Myelodysplastic Syndromes: A Single-Center Experience

Immune Checkpoint Inhibitor Therapy for Acute Myeloid Leukemia and Higher-Risk Myelodysplastic Syndromes: A Single-Center Experience

Toxicities and Outcomes of Acalabrutinib-Treated Patients with Chronic Lymphocytic Leukemia: A Retrospective Analysis of Real World Patients

Toxicities and Outcomes of Acalabrutinib-Treated Patients with Chronic Lymphocytic Leukemia: A Retrospective Analysis of Real World Patients

Efficacy of Bosutinib in Imatinib-Resistant Vs Dasatinib/Nilotinib-Resistant Chronic Phase Chronic Myeloid Leukemia: Results from the Phase 4 BYOND Study

Efficacy of Bosutinib in Imatinib-Resistant Vs Dasatinib/Nilotinib-Resistant Chronic Phase Chronic Myeloid Leukemia: Results from the Phase 4 BYOND Study