Treatment Continuation Rate Research Articles

An Evaluation of Inpatient Treatment Continuation and Hospital Readmission Rates in Patients with Bipolar Disorder Treated with Aripiprazole or Quetiapine

The primary objective of this study was to assess patient and treatment variables that have an impact on inpatient antipsychotic treatment continuation and 30-day hospital readmission rates in patients with bipolar disorder treated with aripiprazole or quetiapine. This was a retrospective cohort study of adult patients with bipolar disorder admitted to a psychiatric hospital. Patients who were initiated on aripiprazole or quetiapine during hospitalization were included in the analysis. The two groups were compared with regards to antipsychotic treatment continuation to discharge and 30-day hospital readmission rates using logistic regression analysis. A total of 336 patients were included in the study. No difference in inpatient antipsychotic treatment continuation rates to discharge were observed, with 85.3% and 84.9% of patients in the aripiprazole and quetiapine cohorts, respectively, continuing treatment with the index antipsychotic to discharge (p = 0.92). Logistic regression analysis revealed that patients were more likely to be prescribed their index antipsychotic at discharge if they were younger than 40 years of age (OR = 2.05, 95% CI =1.08-3.89) and/or diagnosed with a bipolar depressed (OR = 3.05, 95% CI = 1.05-8.85) or mixed episode (OR = 4.14, 95% CI = 1.24-13.87) compared with a manic episode. Patients treated with divalproex (OR = 0.49, 95% CI = 0.25-0.94) or a benzodiazepine (OR = 0.37, 95% CI = 0.18-0.75) at discharge were less likely to be prescribed the index antipsychotic at discharge. Continuation of the index antipsychotic to discharge did not have an impact on readmission rates; admissions during the year before the index hospitalization were the only predictor of 30-day readmission rates (OR = 2.44, 95% CI = 1.08-5.48). No difference was observed in inpatient antipsychotic treatment continuation and 30-day hospital readmission rates in patients treated with either aripiprazole or quetiapine.

AB0338 Evaluation of tocilizumab treatment continuation rate stratified by time of start of administration

BackgroundThe utility of treating rheumatoid arthritis (RA) with a biological agent is often evaluated by the treatment continuation rate combining safety and therapeutic effect. However, there are few reports from...

Abstract TMP103: Combined Results of Two Phase 3 Studies of PA32540, an Antiplatelet Therapy of Enteric-Coated Aspirin and Immediate-Release Omeprazole, in Patients with Previous Cerebrovascular Disease

Introduction: Antiplatelet therapy with aspirin is a mainstay for secondary prevention of ischemic strokes and other vascular events. Yet, many patients do not take aspirin or discontinue it due to gastrointestinal (GI) side effects. Proton pump inhibitors are often co-prescribed to those who develop aspirin-related dyspepsia or who are at risk for GI complications. We investigated a new aspirin formulation (PA32540), which is a coordinated-delivery tablet of immediate-release (IR) omeprazole (40 mg) and enteric-coated (EC) aspirin (325 mg), in an effort to improve co-prescription compliance, reduce GI side effects, and improve overall antiplatelet therapy efficacy. Methods: Two phase 3 double-blind multicenter studies included a subset of subjects with ≥ 1 transient ischemic attack or ischemic stroke who were prescribed aspirin at 325 mg once daily for ≥ 3 months for secondary prevention of cardiovascular (CV) events. All subjects were randomly assigned to once-daily treatment with PA32540 or 325 mg EC aspirin. Use of coumadin was excluded. Endoscopic assessments for gastric or duodenal ulcers were performed at screening and at 1, 3, and 6 months. Major adverse cardiovascular events (MACE) were adjudicated by an independent blinded endpoint committee. Results: Baseline characteristics and rates of discontinuation are shown in Table 1. The rate of gastroduodenal ulcers and discontinuations due to upper GI events were significantly lower following administration of PA32540 vs EC aspirin alone over 6 months. No difference in MACE was identified. Conclusion: In patients with previous cerebrovascular disease, PA32540 was associated with a significantly lower rate of endoscopic gastroduodenal ulcers, a higher rate of treatment continuation, and no increase in the number of MACE, compared with aspirin alone. These findings support the use of a single tablet prescription of omeprazole and aspirin for improving the overall efficacy of antiplatelet therapy.

PIN87 Hepatitis C Treatment Continuation Rates in Treatment-Naïve Genotype 1 Patients in the Brazilian Public Health Care System

Determine real-life treatment continuation rates of chronic Hepatitis C (HCV) treatment from a database of medicine dispensation in the Brazilian public healthcare system. Monthly data from a public database of medicine dispensation was analyzed for a period of 17 months. The patient cohort was defined as all new HCV (CID10 B18.2) patients initiating treatment between January and December 2009. To identify HCV genotype 1 (G1) patients, it was assumed G1 patients initiated treatment with the pegylated forms of the interferons (pegIFN), as defined by the Brazillian national guidelines for HCV. Between January and December 2009, 10,992 patients began treatment for HCV. Around 58% of these patients were male with a median age of 49.7 years. Of these, 82% of patients (9,019) were considered G1 as they began treatment with pegIFN and/or ribavirin. Almost all patients (97%) began treatment with the treatment combination pegIFN and ribavirin, with an equal split among both brands of pegIFN. For all HCV patients treatment mean/median was 38,3/40 weeks compared to 40.2/44.0 weeks for G1 patients. At week 48, 63% of all HCV patients had discontinued treatment compared to 58% of G1 patients. At week 24, around 19% of all HCV patients had discontinued treatment compared to 18% of G1 patients. The maximum observed treatment duration was 85 weeks in both all HCV and G1 patients. Discontinuation rates before week 24 were similar between all HCV and G1 patients. Although 48 weeks of treatment is the established duration for G1 patients, the majority of patients discontinue treatment earlier. These data, however, do not guarantee patients actually receive treatment, as it follows medicine dispensation.

Hepatitis C Treatment Completion in Individuals With Psychiatric Comorbidity and Depression

Hepatitis C virus is a common bloodborne pathogen. Patient, provider, and health care system factors combine to constrain access to treatment and have led to low rates of treatment initiation and continuation among medically eligible individuals. Behavioral health comorbidity, which is common in the patient population, has historically been an exclusion criterion and is one such barrier to care. We implemented an interdisciplinary nurse-managed primary care-based hepatitis C evaluation and treatment program to address behavioral health needs concurrently in an effort to increase treatment initiation and continuation rates among comorbid individuals. We found no association between having a psychiatric or substance use history and treatment discontinuation in our patient cohort. Likewise, there was no association in our cohort between becoming depressed or anxious while undergoing treatment and treatment discontinuation. The results of our study concur with others that have shown that addressing behavioral health comorbidities concurrently with hepatitis C evaluation and treatment may improve treatment continuation rates among comorbid patients, thereby helping to remove barriers to treatment of chronic hepatitis C.

Safety profile of tacrolimus in patients with rheumatoid arthritis

We assessed the safety of tacrolimus therapy for rheumatoid arthritis. Forty-two patients who started tacrolimus therapy between April 2005 and July 2006 were investigated retrospectively using data from their medical records up to June 2007. The cumulative treatment continuation rate was assessed by the Kaplan-Meier method. Fisher's exact test was used to compare gastrointestinal symptoms between different tacrolimus doses and between the presence and absence of each concomitant medication. The mean (+/-SD) observation period was 288 +/- 238 days. The cumulative treatment continuation rate was, respectively, 59.5% and 38.1% at 6 months and 1 year after the patients started treatment. Tacrolimus was discontinued in 28 patients, and was discontinued because of adverse reactions in 21 patients. Gastrointestinal symptoms were the most common adverse reactions (45.2% = 19/42 patients), followed by infections and hyperglycemia. Tacrolimus was discontinued in 9/19 patients with gastrointestinal symptoms, and was discontinued within 60 days of starting treatment in seven of them. Nausea and vomiting led to discontinuation in seven patients (within 60 days of starting treatment in six of them). The incidence of gastrointestinal symptoms was higher in patients receiving a daily dose >or=2 mg than in those receiving <2 mg/day. During treatment of rheumatoid arthritis by oral tacrolimus therapy, gastrointestinal symptoms were common, early, and dose-dependent. However, these symptoms were not severe and did not cause any serious safety problems.

Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia

Objective To evaluate the efficacy, acceptability, and possible side effects of a levonorgestrel-releasing intrauterine system for menorrhagia. Methods Sixty-three women with menorrhagia but without uterine enlargement, endometrial hyperplasia with atypia, or endometrial carcinoma were enrolled in this prospective, open, nonrandomized clinical trial. An intrauterine system releasing 20 μg/day of levonorgestrel (LNG-IUS; Mirena, Shering, Finland) was inserted in the postmenstrual phase. Menstrual pattern, number of bleeding days, and subjective and objective estimation of menstrual blood loss using a pictorial blood loss assessment chart (PBAC) were recorded before insertion and at specific intervals for 4 years. Hemoglobin levels and endometrial thickness were evaluated at baseline and at 12 months. Treatment continuation and hysterectomy rates were noted as well as side effects. Results The device was expelled spontaneously in 6 patients (9.52%) and removed prematurely in 9 patients (14.3%); 3 patients (4.8%) were lost to follow-up; and 45 patients (71.4%) continued with the LNG-IUS. Menorrhagia was cured in 35 (77.7%) of these 45 patients at 3 months and in all patients at 36 months. There was a significant decrease in the mean number of bleeding days ( P = 0.01) and PBAC score ( P = 0.00) at 1 month, and the decrease continued with treatment duration. The subjective blood loss reduction was considerable as well, and at 12 months the mean ± SD rise in hemoglobin concentration was 1.06 ± 1.7 g/dL ( P = 0.000). Endometrial thickness was decreased by 3.4 ± 3.53 mm ( P = 0.0001) at 12 months. The most common side effect was intermenstrual spotting during the first 6 months, and 18 patients (28.57%) developed amenorrhea. Conclusion Using the LNG-IUS is an effective and well-accepted option overall for the medical management of menorrhagia.

Long-Acting Formulations of Atypical Antipsychotics

The current availability of a long-acting injectable formulation of risperidone and the potential future availability of long-acting formulations of other atypical antipsychotics (such as paliperidone) should prompt a reconsideration of at what stage in the treatment of schizophrenia such long-acting agents should be introduced. At present, long-acting formulations, particularly of conventional antipsychotics (depots), are usually reserved for patients with chronic schizophrenia who are at high-risk of noncompliance. Recent and increasing data from other patient groups, such as those with first-episode psychosis, suggest that long-acting risperidone is associated with good efficacy and tolerability leading to high patient acceptance, and treatment continuation rates that are greater than with oral antipsychotics. The benefits of an atypical antipsychotic coupled with the assurance of medication delivery in the form of a long-acting injection imply that these novel formulations should be considered in first-episode patients, for whom optimal outcome is frequently compromised by early treatment discontinuation and poor adherence.

Patient Limit Keeping Many From Buprenorphine Treatment

Patient Limit Keeping Many From Buprenorphine Treatment

Preventing Osteoporosis-Related Fractures: An Overview

Osteoporosis is a skeletal disorder characterized by compromised bone strength, which predisposes a person to increased risk of fracture. In the United States, 26% of women aged ≥65 years and >50% of women aged ≥85 years have osteoporosis. Over 1.5 million fractures per year are attributable to osteoporosis; these fractures result in 500,000 hospitalizations, 800,000 emergency room visits, 2.6 million physician visits, 180,000 nursing home placements, and $12 billion to $18 billion in direct healthcare costs each year. Fracture also results in loss of function and has a negative impact on psychological status. In recognition of the importance of bone health, the US Surgeon General has, for the first time, issued a comprehensive report on bone health and treatment. The report recommends a pyramidal approach to osteoporosis treatment that includes calcium and vitamin D supplementation, physical activity, and fall prevention as the first line in fracture prevention. The second level consists of treating secondary causes of osteoporosis; the third and top level consists of pharmacotherapy. Pharmacotherapeutic interventions (e.g., bisphosphonates, selective estrogen receptor modulators, calcitonin, and teriparatide) in women with postmenopausal osteoporosis provide substantial reduction in fracture risk over and above risk reduction with calcium and vitamin D supplementation alone. Despite the effectiveness of therapy, most patients who receive treatment do not remain on treatment for >1 year. An important approach to reducing the rate of fractures is first to target our treatments to patients at high risk for fracture and then to develop strategies to improve treatment continuation rates.

Hormone therapy use among postmenopausal French women before the publication of the Women’s Health Initiative Study: duration of use and factors associated with discontinuation

Compliance with recent recommendations concerning hormone therapy (HT) requires that we understand the reasons why women receiving HT continue or stop their treatment. Our aim was to estimate the duration of HT use and analyze factors associated with its discontinuation during the period before the publication of articles challenging the safety of HT. With data from 3 mail questionnaires--at inclusion (in 1990), 3 years, and 6 years--we estimated the cumulative treatment continuation rate by the actuarial method and used the Cox model to analyze the factors associated with discontinuation. French women participating in the GAZEL cohort of employees of the French national power and electricity company (Electricité de France-Gaz de France). One thousand eighty-three postmenopausal women who were ever-HT users. None. Discontinuation of HT. A total of 91.6% of women consulted gynecologists, and 88% continued treatment 5 years after they had begun it. Those reporting hot flashes as a reason for taking HT and those younger than 45 years old at menopause were less likely to stop HT, as were women reporting alcohol use. Our results demonstrate the importance of providing information to physicians, primarily gynecologists, to ensure appropriate treatment of symptoms for menopausal women, especially those younger than 45 years old, while bearing their long-term health in mind.

Therapeutic value and long-term safety of pulsed estrogen therapy

Objectives: To demonstrate equivalent efficacy for menopausal symptoms between Aerodiol® nasal spray and reference oral estradiol therapy, and to investigate the endometrial safety and tolerability of Aerodiol in the long term. Methods: The efficacy of Aerodiol 300 μg, once daily, was compared with oral estradiol 2 mg/day in a randomized, double-blind trial. A statistical test of noninferiority was performed on the mean absolute Kupperman index (KI) obtained after 14 and 23 weeks of the two treatments. Long-term safety was assessed in a 1-year open-label study. The initial Aerodiol dose was 300 μg/day, and was adjusted if required. Endometrial biopsies were obtained at inclusion and at the end of the trial and examined independently by two pathologists. Results: In the equivalence trial, the KI improved similarly in the Aerodiol group ( n=317) and the oral estradiol group ( n=342). Aerodiol was shown statistically to be at least as effective as oral therapy ( P<0.001), but the incidences of mastalgia and withdrawal bleeding were significantly lower in the Aerodiol group (P<0.01 and P<0.001, respectively). In the long-term safety trial ( n=408), the rate of Aerodiol treatment continuation at 12 months was 85%, and there was no incidence of endometrial hyperplasia or cancer. Aerodiol dose adaptation was performed by 29% of women. Conclusions: Aerodiol was shown to have equivalent efficacy to reference oral estradiol therapy, but with better gynaecological acceptability. The endometrial safety of Aerodiol was confirmed in the long term, and the ability to adjust the dosage easily was of benefit to a substantial proportion of women.

Endometrial safety and tolerability of AERODIOL® (intranasal estradiol) for 1 year

Objective: the purpose of this study was to assess the endometrial safety and patient acceptability of a pulsed estrogen therapy provided by S21400 (intranasal 17 β-estradiol) in the treatment of postmenopausal symptoms. Design: postmenopausal women ( n=408) entered an open-label, community based, multicentre trial. Patients received S21400 plus sequential (>90% of patients) or continuous progestogen. Treatment was initiated with a standard daily dose of 300 μg but dose adaptation was possible every 3 months from 150 to 600 μg daily. Endometrial biopsies were performed at entry and at 12 months, and bleeding patterns were recorded at 3-monthly intervals throughout the trial. Results: 71% of patients received 300 μg per day S21400 throughout the study, 3% had their dose decreased, 19% had their dose increased and 7% had their dose both decreased and increased. Three hundred and eleven biopsies were obtained after 12 months of treatment, there were no cases of endometrial hyperplasia. The 95% confidence interval [CI] for the rate of incidence was 0–1.2%. Cyclical bleeding occurred in 82% of sequential treatment cycles. Unexpected bleeding occurred in 5% of the treatment cycles. Presence of unexpected bleeding varied according to the treatment regimen, 15 and 4% of the cycles with combined continuous and sequential regimen, respectively. Unexpected bleeding was mostly spotting. Nasal treatment was well accepted. Nasal symptoms (itching sensation, rhinorrhea and sneezing) were mostly mild in intensity and they led to treatment withdrawal in approximately 3% of patients. The rate of treatment continuation was 85% at 1 year. Conclusions: S21400, in combination with continuous or sequential progestogen, exhibits good endometrial safety and patient acceptability in postmenopausal women.

Discontinuation from Long-Term Individual Psychodynamic Psychotherapy

This study compared commonly reported rates of treatment discontinuation to rates found in a postgraduate training setting that delivers longterm psychodynamic treatment. It related patient and therapist variables to discontinuation during three time periods. A 28% rate of treatment continuation for one year or more was found in this setting over a 5-year period (N = 399). Demographic characteristics of patients and therapists were unrelated to discontinuation in a subsample of discontinuers (n = 73) studied during one year. Presenting complaint of depression, therapists' reports of patients' reasons for discontinuation and dynamic issues in treatment were related to discontinuation rate in the three time periods. Implications for treatment and training are discussed.