Use Of Pharmacotherapy Research Articles

Analytical review of the inf l uence of socio-economic factors on the state of pharmaceutical care for patients with cardiovascular diseases.

Aim: To investigate the influence of socio-economic factors on the state of pharmaceutical provision of patients with cardiovascular diseases. Materials and Methods: To achieve the goal of the research, scientific publications posted in Ukrainian information and scientific databases (NRAT, OUCI) and scientometric databases Scopus, Web of Science, PubMed, MedLine, BMJ, Embase were used. The analysis of international and domestic legal documents was carried out, the sites of global international organizations, the sites of cardiology societies and Ukrainian statistical data bases were researched. The methods of content analysis, synthesis, systematization, and generalization were used. Conclusions: As a result of the study, socio-economic factors that af f ect the state of pharmaceutical provision of patients with CVD (in particular, CAD) were determined. In this study, among the specif i ed socio-economic factors, the need to update the regulatory and legal security of the pharmaceutical care process attracts the most of attention. The positive impact of the use of modern drug pharmacotherapy for coronary artery disease on the budget of the health care system in clinical practice proposed by the ESC was determined.

Maladaptive Eating Behaviours, Generalised Anxiety Disorder and Depression Severity: A Comparative Study between Adult Women with Overweight, Obesity, and Normal Body Mass Index Range.

(1) Background: Causes of obesity are multifactorial and include genetic predisposition as well as behavioural, psychological, social, and hormonal influences. We aimed to compare adult women with normal weight, overweight, and obesity, with a focus on maladaptive eating behaviours, the presence of generalised anxiety disorder, and the severity of depression. Additionally, we explored the context of anti-obesity pharmacotherapy and the status of bariatric surgery. (2) Methods: The sample was composed of 1105 adult women. The following measures, through the Computer-Assisted Web Interview (CAWI), were used in the present study: the Three Factor Eating Questionnaire (TFEQ-R18), the 7-item Generalised Anxiety Disorders Scale (GAD-7), and the 9-item Patient Health Questionnaire (PHQ-9). (3) Results: All domains of the TFEQ-R18 had correlations with Body Mass Index (BMI). There was a weak negative association between BMI and Cognitive Restraint (r = -0.172, p < 0.001) and a weak positive relationship between BMI and Uncontrolled as well as Emotional Eating (r = 0.165, p < 0.001; r = 0.191, p < 0.001, respectively). Women who screened positive for anxiety scored lower in the Cognitive Restraint domain (10.11 ± 3.58, p = 0.042) and higher in the Uncontrolled Eating (12.69 ± 6.04, p < 0.001) and Emotional Eating (5.29 ± 2.75, p < 0.001) domains. Similarly, women screening positive for depression had lower scores in Cognitive Restraint (9.88 ± 3.61, p < 0.001) and higher scores in Uncontrolled Eating (12.64 ± 6.09, p < 0.001) and Emotional Eating (5.31 ± 2.71, p < 0.001). A significant association between liraglutide and semaglutide administration and Cognitive Restraint was observed. (4) Conclusions: Individualised treatment for obesity should consider the existing and confirmed association between maladaptive eating behaviours and generalised anxiety disorder, as well as the severity of depression influencing the BMI altogether. The use of anti-obesity pharmacotherapy needs further exploration because the evidence for the use of liraglutide and semaglutide in terms of positive associations with eating behaviours is encouraging.

Anti-obesity Medication Use for Adolescent Metabolic and Bariatric Surgery Patients: A Systematic Literature Review.

Bariatric surgery, in combination with pharmacotherapy, has been proven to be successful incombatting weight regain in adults; however, the useof anti-obesity medications to augment weight loss in adolescents before and after bariatric surgery is not well studied.In adolescent obese patients, the efficacy of anti-obesity pharmacotherapy before and after bariatric surgery on weight loss compared to no interventions in various studies was investigated. A PubMed literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed to identifystudies related to the pharmacologic treatment of obesity in adolescents with a history of bariatric surgery. Inclusion criteria consisted of clinical trials, case reports, case series, chart reviews, systematic reviews, and meta-analyses written in English and published between 2005 and 2022 using our search criteria. Exclusion criteria were studies that investigated adults, did not include pharmacotherapy, and were not relevant to the outcome of interest. The initial search yielded 1275 results, which was reduced to 879 after removal of duplicates. After applying exclusion criteria, the number of articles was reduced to 63.Full articles were examined and 44 were excluded due to relevance. Nineteen articles were included in the qualitative analysis. A total of 2471 adolescents were treated with various types of pharmacotherapy, 65 of whom had a history of bariatric surgery. The results showed varied effects of pharmacotherapy with the different medications studied. However, the 65 patients were included in cohorts of patients with no history of bariatric surgery. These studies did not include data specific to adolescent bariatric surgery patients. There is a wealth of evidence highlighting the efficacy of pharmacotherapy in assisting with weight loss in adolescents with obesity; however, our literature search showed a lack of studies focusing on the use of pharmacotherapy in the adolescent bariatric surgery population. Potential limitations include missing studies in our literature search, the variability in methods between studies, and the lack of standardized quality assessment. Additionally, studies involving our objective of choice regardingbariatric surgery with anti-obesity medication were limited. Clinical trials to determine the efficacy of medications as an adjunct to bariatric surgery in preventing weight regain and leading to optimal weight loss in this population are of utmost importance.

Two decades of SVT ablation in Denmark: a trend towards higher age, more comorbidity, and less prior use of antiarrhythmic and rate-limiting pharmacotherapy—a nationwide registry-based Danish study

Background and aimsTrends in patient selection and use of pharmacotherapy prior to catheter ablation (CA) for supraventricular tachycardia (SVT) are not well described. This study examined temporal trends in patients undergoing first-time CA for regular SVT, including atrioventricular nodal re-entry tachycardia (AVNRT), accessory pathways (APs), and ectopic atrial tachycardia (EAT) on a nationwide scale in Denmark in the period 2001–2018.Methods and resultsUsing Danish Nationwide registers, 9959 patients treated with first-time CA for SVT between 2001 and 2018 were identified, of which 6023 (61%) received CA for AVNRT, 2829 (28%) for AP, and 1107 (11%) for EAT. Median age was 55, 42, and 55 in the AVNRT, APs, and EAT group, respectively. The number of patients receiving CA increased from 1195 between 2001 and 2003 to 1914 between 2016 and 2018. The percentage of patients with a CHA2DS2-VASc score ≥ 2 increased in all patient groups. The number of patients who underwent CA with no prior use of antiarrhythmic- or rate limiting medicine increased significantly, though prior use of beta-blockers increased for AVNRT patients. Use of verapamil decreased in all three SVT groups (P < 0.05). Use of amiodarone and class 1C antiarrhythmics remained low, with the highest usage among EAT patients.ConclusionBetween 2001 and 2018, CA was increasingly performed in patients with SVT, primarily AVNRT- and EAT patients. The burden of comorbidities increased. Patients undergoing CA without prior antiarrhythmic- or rate-limiting drug therapy increased significantly. Use of beta-blockers increased and remained the most widely used drug.Graphical

Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders

BackgroundAppetite suppression and weight loss are established potential side effects of most medications for attention deficit/hyperactivity disorder (ADHD). These side effects may be especially problematic when using stimulants to treat ADHD in the context of a restrictive eating disorder, such as avoidant restrictive food intake disorder (ARFID), although these diagnoses are often comorbid in children. This paper presents a combined approach to treating ADHD comorbid with ARFID using stimulant medication and behavior management within a partial hospitalization program (PHP) and intensive outpatient program (IOP)for eating disorders. The aim of this paper is to determine if the continued or new use of stimulant medication allows for adequate weight restoration by reviewing a series of cases receiving the combined treatment.Case presentationsConsecutive patients with a historical or new diagnosis of ADHD when presenting for treatment for ARFID were included in this case series. This series included 10 patients (8 male, 2 female) who received pharmacotherapy using stimulants and behavior management interventions involving structured mealtimes and contingency management. All treatment occurred within the context of a PHP/IOP for childhood eating disorders. All youth were able to effectively continue on stimulant medication, show clinical benefit in core ADHD symptoms, and able to gradually restore weight. In all cases, stimulant medications were not discontinued, but in some cases, doses were optimized (increased or decreased), switched to a different stimulant, or augmented with non-ADHD medication, such as mirtazapine, to support the management of ADHD while concurrently assisting in weight gain as necessary for the treatment of ARFID. Only one patient was newly started on a stimulant medication; as this was near the end of her treatment stay, limited conclusions can be drawn from this case.ConclusionsThese findings support the use of pharmacotherapy, including continuing stimulant medication, when combined with behavior management strategies as a potentially effective treatment approach for ADHD in youth with ARFID in the PHP/IOP setting. Future studies using more rigorous methodology, longer follow-up times, and within other treatment settings are needed.

Cardioprotective pharmacotherapy in patients with type 2 diabetes across the Middle East and Africa: the PACT-MEA study

Abstract Background There is limited information about the management of cardiovascular (CV) risk in patients with type 2 diabetes (T2D) in the Middle East and Africa. For patients with T2D and established atherosclerotic cardiovascular disease (eASCVD) or those at risk for ASCVD, global guidelines recommend the use of antidiabetic medications with proven cardiovascular and kidney benefit (glucagon-like peptide-1 receptor agonists [GLP-1 RAs] and sodium-glucose cotransporter-2 inhibitors [SGLT2is]), in addition to lipid lowering, blood pressure lowering, and antiplatelet therapy, independent of baseline HbA1c or metformin use. Purpose To determine the use of pharmacotherapy among a population of patients with T2D and eASCVD or high/very high ASCVD risk in seven countries across the Middle East and Africa. Methods Adult patients with T2D were enrolled in a cross-sectional, observational study in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa, and United Arab Emirates. Pharmacotherapy data extracted from the medical charts of patients during a routine scheduled clinic visit in 2022 were analysed. Descriptive statistics were used to characterize patients with T2D and their glucose-lowering pharmacotherapy use by age, diabetes duration, body mass index, HbA1c, microvascular complications, estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio (UACR). Results Of the 3726 patients in the overall study sample (mean age, 58 ± 12; male, 53%), one in five had eASCVD (21%) and nearly all were classified as being at high (69%)/very high risk (30%, includes eASCVD), according to European Society of Cardiology (ESC) 2021 guidelines. About one-third (36%) of patients were taking SGLT2is (Table 1, range across countries: 20%-64%). Use of SGLT2is was similar across age and BMI but more patients with T2D for ≥10 years (40%) received these medications than those with T2D for &amp;lt;10 years (31%). More males than females were on SGLT2is (40% vs 32%). Use of SGLT2is was also higher among patients with HbA1c ≥7% (42% vs 33%, Table 2). SGLT2i use was similar by eGFR and UACR levels. Few (13%) of the overall sample of patients with T2D received GLP-1 RAs (Table 1, range across countries: 3%-25%), the use of which declined with age. More females than males were taking GLP1-RAs (16% vs 11%). More patients with obesity (BMI ≥30 kg/m2) received GLP-1 RAs than those without obesity (18% vs 8%); use was also higher among patients with eGFR ≥60 (14% vs 9%, Table 2). Conclusions Despite availability of cardio-renal therapy in each of the seven participating countries in the Middle East and Africa, few patients with T2D who had eASCVD or were at high/very high risk for ASCVD received SGLT2is or GLP-1 RAs, as recommended by guidelines. Active prioritization of cardio-renal protective therapies based on CV risk and renal target organ damage should be addressed given the high burden of disease and complications in the region.Table 1Table 2

Opioid and Non-Opioid Pharmacotherapy Use for Pain Management Among Privately Insured Pediatric Patients With Cancer in the United States.

This study examined the trends and patterns of opioid and non-opioid pharmacotherapy use among a large national sample of privately insured pediatric patients with cancer in the United States. We identified pediatric (aged < 21) patients diagnosed with central nervous system (CNS), lymphoma, gonadal, leukemia, or bone cancer from MarketScan data 2005-2019. We examined the proportion of patients who filled a prescription for the following 5 types of pharmacotherapy: opioid, anticonvulsant, non-steroidal anti-inflammatory drug (NSAID), antidepressant, and muscle relaxant during active cancer treatment. We assessed the trends and patterns in pharmacotherapy using multivariable logistic regressions. Among 4174 patients included, 2979 (71%) had an opioid prescription; 746 (18%), 384 (9%), 202 (5%), and 169 (4%) had anticonvulsant, NSAID, antidepressant and muscle relaxant prescriptions, respectively. Multivariable logistic regression showed a nonlinear trend in the use of opioids among pediatric patients with cancer over time such that use slightly increased until 2012 (OR of 1.40 [95% CI, 1.12-1.73] for 2012 vs. 2006) but then decreased thereafter (OR of 0.51 [0.37-0.68] for 2018 vs. 2012). The use of anticonvulsants, NSAIDs, and muscle relaxants increased significantly linearly over time (all P < .005). There has been a downward trend in the use of opioids in recent years among pediatric patients with cancer and an upward trend in the use of non-opioid pharmacotherapy for pain management potentially as an alternative to opioids.

Abstract 14287: Real-World Healthcare Resource Utilization Among Patients With Hypertension or Congestive Heart Failure and Comorbid Alcohol Use Disorder

Introduction: Excessive alcohol consumption has been associated with increased risk of cardiovascular (CV) disease. Hypertension (HTN) is a known risk factor for CV disease, in general, including congestive heart failure (CHF). Healthcare resource utilization (HRU) and costs associated with comorbid alcohol use disorder (AUD) among patients with HTN or CHF were evaluated. Methods: This retrospective cohort study identified adults with moderate-to-severe AUD from patients with ≥1 inpatient, or ≥2 outpatient claims on separate days, for HTN or CHF (MarketScan® and Medicare [1/1/2016-12/31/2020], Medicaid [1/1/2016-12/31/2019] databases), and ≥1 year of continuous healthcare enrollment prior to diagnosis (baseline) and 3 months after. Monthly HRU and costs were compared between propensity-score matched patients based on AUD presence using rate ratios in generalized linear models. Results: Of 4,015,785 patients with HTN, 1% were diagnosed with AUD. Use of HTN pharmacotherapy was similar for all patients, except for less frequent use of angiotensin receptor blockers (ARBs) in those with AUD. HTN patients with comorbid AUD had a higher risk of inpatient visits (89%), ED visits (39%), longer inpatient stays (98%), and outpatient visits (9%) relative to non-AUD patients. Of 294,892 patients with CHF, 2% had comorbid AUD. CHF pharmacotherapy use was similar for all patients, except for less frequent ARB use in those with AUD. CHF with comorbid AUD had a higher risk of inpatient visits (31%), ED visits (25%), and longer inpatient stays (34%) relative to non-AUD patients. Outpatient visits were 5% lower in CHF patients with AUD. AUD was associated with higher acute care costs, fewer pharmacy claims, and lower pharmacy costs in both HTN and CHF cohorts. Patients with AUD in both cohorts were more likely to be younger, male, enrolled in Medicaid, with a higher comorbidity burden. Conclusion: In this real-world study, the presence of AUD in patients with either HTN or CHF was associated with greater comorbidity burden, higher acute care utilization and costs, and lower outpatient pharmacy utilization relative to patients without AUD. These findings suggest that AUD impacts care for both HTN and CHF, which could be an opportunity for improved screening and treatment.

Abstract 11760: Prevalence of Atherosclerosis, Heart Failure, and Chronic Kidney Disease Among Patients With Type 2 Diabetes and Management With Diabetes Pharmacotherapy

Introduction: Individuals with type 2 diabetes (T2D) are at increased risk for cardiovascular disease (CVD), the leading cause of mortality in these patients, and chronic kidney disease (CKD). Recent clinical guidelines recommend the use of diabetes pharmacotherapy with cardiovascular or renal benefits in patients with T2D and CVD or CKD. Aims: The aims of this study were to 1) assess the prevalence of established CVD, including atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF), and CKD, and 2) determine the proportion of patients prescribed CVD/CKD-protective diabetes pharmacotherapy (SGLT-2i and GLP1-RA) among individuals with T2D receiving primary care in the US. Data: Data for this retrospective, cross-sectional study were obtained from Optum Labs Data Warehouse, which contains de-identified administrative claims and electronic health record data representing a diversity of age, race, and ethnicity across the US. Eligible individuals were aged ≥18 years, had established T2D and were required to have ≥1 outpatient visit with a primary care provider in 2019. Results: This study included 843,119 individuals with T2D receiving care in 2019. Among these patients, the prevalence of CVD was 44.1%, with 41.5% having evidence of ASCVD and 14.4% having evidence of HF, and the prevalence of CKD was 34.6%. The prevalence of these comorbidities increased with age. For individuals who had T2D and ASCVD, HF, or CKD, 14.0%, 11.7% and 15.1%, respectively, were prescribed SGLT-2i or GLP1-RA, relative to 16.8% of patients with T2D without these comorbidities. Additionally, compared with younger patients, comorbid patients older than 65 years were prescribed these therapies at much lower rates. Conclusions: Among patients with T2D and established CVD, 9 of 10 patients had ASCVD: a 3-fold higher prevalence than HF. Less than 17% of individuals with T2D were prescribed a guideline-recommended glucose-lowering treatment with cardiovascular and renal benefits. The data from this study suggest that patients with T2D and CVD/CKD were prescribed less SGLT-2i or GLP1-RA compared to patients with T2D without these comorbidities. This trend was concerning among older patients, who had both higher rates of these comorbidities and lower prescribing trends.

Pharmacotherapy before and after bariatric surgery.

Diabetes is a chronic disease that affects a vast number of individuals globally, and without optimal treatment, can lead to significant health complications. Moreover, obesity is another chronic disease with several complications, which includes type 2 diabetes. Bariatric surgery is a viable long-term choice for managing diseases such as obesity and type 2 diabetes. However, the impact of pharmacotherapy before and after surgery remains unclear. In this review, we assessed the use of pharmacotherapy in patients with obesity with or without diabetes before and after bariatric surgery, focusing on weight loss, glycemic control, and the risk of postoperative complications. We showed that anti-obesity medication has become increasingly important in managing obesity and type 2 diabetes, both before and after bariatric surgery. The use of preoperative pharmacotherapy can optimize patients for surgery and reduce perioperative complications. Meanwhile, postoperative pharmacotherapy can maximize weight loss, improve metabolic outcomes, and lower the risk of weight regain. Medications such as sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and combination therapies, are now very effective for treating obesity and type 2 diabetes mellitus. However, optimal timing, duration, and which combinations of pharmacotherapy to use with bariatric surgery remain unclear. Additionally, the long-term safety and efficacy of these treatments should be assessed. Integrating pharmacotherapy with bariatric surgery is a promising approach to managing obesity and type 2 diabetes, providing patients with additional options for achieving sustainable weight loss and improving their metabolic health.

Outcomes at one year in women with peripartum cardiomyopathy: Findings from the ESC EORP PPCM Registry.

There are few prospective reports of 1-year outcomes for women with peripartum cardiomyopathy (PPCM). We report findings from the European Society of Cardiology EURObservational Research Programme PPCM Registry. The registry enrolled women from 51 countries from 2012 to 2018. Eligibility included: (i) a peripartum state, (ii) signs or symptoms of heart failure, (iii) left ventricular (LV) ejection fraction ≤45%, (iv) exclusion of alternative causes of heart failure. We report mortality, thromboembolism, stroke, rehospitalization, LV recovery and remodelling at 1 year. Differences between regions were compared. One-year mortality data were available in 535 (71%) women and follow-up differed across regions. At 1 year, death from any cause occurred in 8.4% of women, with regional variation (Europe 4.9%, Africa 6.5%, Asia-Pacific 9.2%, Middle East 18.9%; p < 0.001). The frequencies of thromboembolism and stroke were 6.3% and 2.5%, respectively, and were similar across regions. A total of 14.0% of women had at least one rehospitalization and 3.5% had recurrent rehospitalizations (i.e. two or more). Overall, 66.1% of women had recovery of LV function (22% between 6 months and 1 year), with a mean LV ejection fraction increase from baseline of 21.2% (±13.6). Recovery occurred most frequently in Asia-Pacific (77.5%) and least frequently in the Middle East (32.7%). There were significant regional differences in the use of heart failure pharmacotherapies. Approximately 1 in 12 women with PPCM had died by 1 year and thromboembolism and stroke occurred in 6.3% and 2.5%, respectively. Around 1 in 7 women had been rehospitalized and, in 1 in 3, LV recovery had not occurred. PPCM is associated with substantial mortality and morbidity globally.

IMMUNE SYSTEM SUSCEPTIBILITY OF DEPRESSED PATIENTS TO DENGUE VIRUS INFECTION: CASE REPORT

Introduction – Depression is a health problem that causes mortality and morbidity. The incidence of depression aged ≥ 15 years is as much as 6.1%. Another health problem is dengue hemorrhagic fever (DHF), where 71,700 confirmed cases of DHF have been reported in Indonesia as of July 2020. The study at Mayo Hospital Lahore explained that there is a correlation between DHF infection and depression. There is no study to describe susceptibility of the immune system of depressed patients to dengue virus infection in Indonesia. Methods – Presented the case of patient, female, 19 years old with initial diagnosis and management of DHF from internal medicine departement. We use a Hamilton Depression Rating Scale (HDRS) questionnaire to evaluated status mental patient. Results – The results of the patient's HDRS questionnaire showed that the patient had moderate depression. The results of the psychiatric examination showed depressive affect, anhedonia, anenergy and feeling useless with an onset 1 month before suffering from DHF. The patient was given pharmacotherapy and psychotherapy from psychiatry. Discuss – Late diagnosis and treatment of depression causes prolonged stress in the body. This condition triggers HPA axis and sympathetic nervous system which will increase levels cortisol, and increased secretion of anti-inflammatory cytokines can reduce inflammatory response to incoming pathogens, so that body will be susceptible to dengue virus infection. Management of depression at a young age with psychotherapy and pharmacotherapy use SSRI and benzodiazepines for reduce the risk of suicide. Conclusion – Late diagnosis and treatment of depression makes immune system vulnerable to pathogens or infections. Interdisciplinary collaboration is needed so that the enforcement of psychiatric cases in hospitalization becomes more accurate and for further research to be carried out on the correlation of depression with the incidence of dengue hemorrhagic fever with a different research design. Keywords: depression, DHF, HPA axis, proinflammatory cytokines, cortisol.

Treatment of Intermediate Uveitis-associated Retinal Vasoproliferative Tumors: A Case Series.

To report the use of combination intravitreal pharmacotherapy using anti-vascular endothelial growth factor (VEGF) and short and long-term corticosteroid implants for the treatment of retinal vasoproliferative tumors (VPT) associated with intermediate uveitis. Retrospective chart review of patients with VPT secondary to idiopathic intermediate uveitis that underwent combination intravitreal pharmacotherapy at a single center was performed. Multimodal imaging including ultrawide field color fundus photography, ultrawide field fluorescein angiography, and optical coherence tomography obtained before and after treatment were reviewed. Four eyes of 4 patients were treated with multiple injections of a combination of aflibercept, dexamethasone, and fluocinolone acetonide implants for VPT associated with intermediate uveitis. All 4 patients had improvement in visual acuity, intraocular inflammation, central macular thickness, and retinal vascular leakage, as well as regression of the VPT and reduction in lesion leakage on follow-up. Combination intravitreal anti-VEGF and corticosteroid implants may be a useful approach for the treatment of intermediate uveitis-associated VPTs and can lead to both functional and structural improvement.

Abstract PO-058: Piloting a novel strategy to rapidly implement smoking cessation treatment for newly-diagnosed head and neck cancer patients

Abstract Purpose The purpose of this study is to evaluate a novel, bimodal strategy to implement smoking cessation treatment prior to oncologic therapy in newly-diagnosed head and neck cancer (HNC) patients. Background Among the 65,000 people who develop HNC in the United States (US) annually, 20-30% smoke cigarettes and 50-80% will continue smoking throughout survivorship. Quitting smoking before oncologic therapy correlates with improved health outcomes. However, the window of opportunity to quit smoking is narrow since cancer treatment often begins 4-5 weeks after the first oncology visit. The failure to rapidly implement evidence-based smoking cessation treatment is a major cause of this problem. Offering both behavioral therapy and pharmacotherapy increases abstinence rates by 2-3-fold. Despite this, only 4-17% of cancer patients receive both therapies at any time. Methods We conducted a pragmatic, quasi-experimental, pilot study using a pre-post design to evaluate a strategy to rapidly implement behavioral therapy and pharmacotherapy. The pre-test period was from 1/21-3/22 and the strategy was deployed from 4/22-10/22. The population included newly-diagnosed patients with mucosal HNC or salivary gland cancer. The setting was an academic medical center with an established tobacco treatment program (TTP). The implementation strategy involved bimodal administration of the evidence-based Ask, Advise, Connect (AAC) approach before and at the first surgical oncology visit. First, a dedicated medical assistant (MA) used an electronic health record (EHR)-based tool to identify, ask, advise, and connect (i.e. refer) smokers to the TTP at the time of clinic referral, or ~1-2 weeks before the first surgical oncology visit. Second, the AAC strategy was delivered by the triage MA and nurse at the time of the first surgical oncology visit. Some surgeons opportunistically offered patients pharmacotherapy. Results Among the 383 eligible, newly-diagnosed HNC patients, and 48 (12.5%) were current smokers. Twelve smokers were diagnosed between 4/22-10/22 and were eligible for the bimodal AAC strategy. However, only six of 12 patients received the AAC strategy before the first oncology visit. Among the 48 smokers, 75% were male, the median age was 65.5-years, and cancer treatment was started a median 34 days after the first oncology visit. Within 30 days of the first surgical oncology visit, 67% were advised to quit, 25% were referred to the TTP, 6% completed a comprehensive TTP visit, 21% had pharmacotherapy ordered, and 17% received both behavioral therapy and pharmacotherapy. While there were otherwise no differences in outcomes between pre- and post-strategy groups, more bimodal AAC strategy-eligible patients received pharmacotherapy (42%) compared to pre-strategy patients (14%, p=0.040). Conclusions Our bimodal AAC strategy correlated with increased use of pharmacotherapy, despite suboptimal fidelity to the approach. Additional strategies to improve delivery of timely behavioral therapy and pharmacotherapy for smoking cessation are needed. Citation Format: Sahajveer Mann, Julia Casazza, Dalia Mitchell, Quynh-Chi Dang, Dequan Weston, Brette Harding, Baran D. Sumer, Brittny Tillman, Heather Kitzman, George Jackson, Robert Schnoll, Amit Singal, Andrew T. Day. Piloting a novel strategy to rapidly implement smoking cessation treatment for newly-diagnosed head and neck cancer patients [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Innovating through Basic, Clinical, and Translational Research; 2023 Jul 7-8; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2023;29(18_Suppl):Abstract nr PO-058.

Switching away from smoking at 12 months among adult JUUL users varying in recent history of quit attempts made with and without smoking cessation medication.

Some smokers switch away from smoking using e-cigarettes, but guidelines recommend trying approved medications first. We analyzed switching in adult smokers using JUUL by their recent history of quit attempts and use of smoking cessation medications. Participants were 8511 adult (21+) established smokers (at baseline), in which 50.3% are daily smokers, in a longitudinal observational study who completed a survey 12 months after first purchasing a JUUL Starter Kit. At baseline, participants reported attempts to quit smoking in the prior year and use of pharmacotherapy (nicotine replacement therapy [NRT] or prescription medication) in their most recent attempt. The outcomes were switching (self-reported no past-30-day smoking) and 50%+ reductions in cigarette consumption. Multivariable analyses were adjusted for baseline covariates. Two thirds of the participants had made a quit attempt in the year before purchasing JUUL. Overall, 59% [58%, 60%] had switched at 12 months. Switching was more likely in those who had used NRT and who attempted quitting without medication versus those who used prescription medications or made no quit attempt. In adjusted multivariable analyses, only making a past-year quit attempt (vs. not) was associated with higher odds of switching (OR =1.15 [1.04, 1.28]). Over 60% of dual users reduced cigarette consumption by ≥50%. These associations were largely similar in daily smokers. Twelve months after purchasing JUUL, almost all smokers reported either switching or reducing their smoking by 50%+, including those who had recently failed to quit smoking with approved pharmacotherapies. E-cigarettes provide an alternative route to abstinence from smoking for smokers with a history of cessation and cessation treatment failure.

Guideline-Directed Medical Therapies for Heart Failure with a Reduced Ejection Fraction in Older Adults: A Narrative Review on Efficacy, Safety and Timeliness.

Heart failure is a prevalent syndrome among older adults, with a major impact on morbidity and mortality. Higher age is correlated with underuse of guideline-directed medical therapies which, in turn, has been linked to worse clinical outcomes. Importantly, most evidence so far has been collected in adults who were younger, less multi-morbid and polymedicated compared with those who are commonly treated in daily clinical practice. Hence, we aimed to assess and describe the evidence base for pharmacotherapy in older adults with heart failure with a reduced ejection. First, a narrative review was undertaken using Medline, from inception to January 2023. Four foundational therapies were selected based on the latest European Society of Cardiology clinical practice guideline: angiotensin-converting enzyme inhibitors/angiotensin receptor neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors. Post hoc analyses from landmark heart failure drug trials were searched and included if they contained data on the impact of age on efficacy, safety and/or timeliness of therapies in the management of heart failure with a reduced ejection fraction. Second, a proposal was developed to support and promote the use of evidence-based heart failure pharmacotherapy in complex, older adults. In total, 11 articles were selected: 4 meta-analyses, 6 post hoc analyses and 1 review paper. No attenuation of efficacy for any of the foundational agents was found in older adults. Regarding safety, dedicated analyses showed that beta blockers, mineraloid receptor antagonists, sacubitril-valsartan, dapagliflozin and empagliflozin retained their overall benefit-risk profile regardless of age. Time to benefit was short and occurred generally within 1 month. Consensus was achieved on a five-step proposal to manage complex medication regimens in older adults suffering from heart failure. In conclusion, older adults suffering from heart failure with a reduced ejection fraction should not be denied treatment based on their age.

Substance Use, Pharmacotherapy and Impact of Pharmacotherapy for Renal System: A Review

Increase of the substance abuse, especially narcotic drugs and psychotropic substances, is a major challenge faced by entire region of the world. The use of narcotic drugs and psychotropic substances without medical supervision is associated with significant health risks to the individual who depend on drugs. Therefore, providing of proper treatment services and interventions is important and it must be based on scientific evidence, and match the specific needs of individual patients at a particular phase or severity of their disorder. As a part of that medications can be very helpful in managing and/or treating a variety of drug use disorders and health conditions due to drug use, such as acute intoxication and overdose, withdrawal syndromes, as well as a variety of comorbid disorders. Pharmacological interventions should be administered, when appropriate, alongside psychosocial interventions. Majority of these abusive drugs, medications or their metabolites are excreted through the kidneys. Therefore renal complications including wide range of glomerular, interstitial and vascular diseases leading to acute or chronic renal failure of these drugs are very common. The present review discusses the possible renal complications associated with pharmacotherapy

Pharmacotherapy and gambling disorder: a narrative review

Background Gambling disorder (GD) is a psychiatric disorder classified in the DSM-5 as a non-substance-related and addictive disorder with extensive health and socioeconomic impacts. Its chronic and high-relapsing nature makes it essential to find treatment strategies that improve functioning and reduce impairment associated with it. The purpose of this narrative review is to evaluate and summarize the available evidence on the effectiveness and safety of pharmacotherapy in GD. Methods An electronic literature search of Medline, Embase, and Cochrane Central was conducted to identify systematic reviews, meta-analyses, and reviews on pharmacological interventions in patients with gambling disorder. A similar search of these databases and of Prospero, Clinicaltrials.gov, and Epistemonikos was conducted to identify clinical trials that were published since 2019. Results The initial search identified 1925 articles. After screening and duplicate removal, 18 articles were included in the review (11 studies were systematic reviews and meta-analyses, 6 were reviews, and 1 was an open-label trial). Eight pharmacological agents (naltrexone, nalmefene, paroxetine, fluvoxamine, citalopram, escitalopram, lithium, and topiramate) that were studied in randomized controlled trials and open-label trials showed small to moderate effect sizes in reducing GD symptoms in some studies during post-hoc analyses. Conclusion The overall sum of evidence in the literature on the use of pharmacotherapy in GD is conflicting and inconclusive. Some studies have shown that pharmacotherapy’s role in GD is promising, especially when the choice of the agent is guided by comorbid psychiatric disorders. However, significant limitations exist in the study designs, which need to be addressed in future research on the topic. Conducting future and more rigorous trials that address the limitations in the existing literature is necessary to establish more accurate efficacy data on the use of pharmacotherapy in this population.

Exploring Approved Medications and the Promise of Phase 3 Clinical Trials: Anti-Obesity Drugs in the Sky and on the Horizon.

Obesity is a prevalent global health issue affecting approximately half of the world's population. Extensive scientific research highlights the urgent need for effective obesity management to mitigate health risks and prevent complications. While bariatric surgery has proven to be highly effective, providing substantial short-term and long-term weight loss and resolution of obesity-related comorbidities, it is important to recognize its limitations and associated risks. Given the global obesity epidemic and the limitations of surgical interventions, there is high demand for effective and safe anti-obesity medications (AOMs). In Korea, the Korean Society for the Study of Obesity strongly advocates for the use of pharmacotherapy in Korean adults with a body mass index of 25 kg/m2 or higher who have not achieved weight reduction through non-pharmacological treatments. Currently, five AOMs have been approved for long-term weight management: orlistat, naltrexone/bupropion, phentermine/topiramate, liraglutide, and semaglutide. Tirzepatide is awaiting approval, and compounds such as CagriSema (Novo Nordisk) and oral semaglutide are currently undergoing rigorous evaluation in phase 3 clinical trials. Furthermore, other promising drugs, including orforglipron, BI 456906, and retartrutide, are progressing to phase 3 studies, expanding the therapeutic options for obesity management. In personalized patient care, physicians play a crucial role in accurately identifying individuals who genuinely require pharmacotherapy and selecting appropriate AOMs based on individual patient characteristics. By integrating evidence-based interventions and considering the unique needs of patients, healthcare professionals significantly contribute to the success of obesity management strategies.

CO141 Utilization Trends of Pharmacotherapies Among Patients with Heart Failure with Preserved Ejection Fraction

Half of patients with heart failure have preserved ejection fraction (HFpEF). Over the years, guidelines have recommended (e.g., angiotensin receptor blockers (ARBs)) or advised against (e.g., nitrates) various therapies for HFpEF management. However, there is limited evidence on the trends in utilization of HFpEF medications. We examined the trends in use of pharmacotherapies among patients with HFpEF from 2008 through 2020.