Capacity to work is impacted by psoriatic arthritis (PsA). Our objective was to describe the course of work productivity and leisure activity in patients with PsA treated with biologic (b) and ...targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs).
A systematic literature review identified all trials and observational studies published January 1, 2010-October 22, 2021, reporting work productivity using the Work Productivity and Activity Impairment Questionnaire (WPAI) in patients with PsA treated with b/tsDMARDs. Outcomes for WPAI domains (absenteeism, presenteeism, total work productivity, and activity impairment) were collected at baseline and time point closest to 24 weeks of treatment. A random effects meta-analysis of single means was conducted to calculate an overall absolute mean change from baseline for each WPAI domain.
Twelve studies (ten randomized controlled and two observational) assessing patients treated with adalimumab, bimekizumab, guselkumab, ixekizumab, risankizumab, secukinumab, or upadacitinib were analysed. Among 3741 employed patients, overall mean baseline scores were 11.4%, 38.7%, 42.7%, and 48.9% for absenteeism, presenteeism, total work productivity impairment, and activity impairment, respectively. Estimated absolute mean improvements (95% confidence interval) to week 24 were 2.4 percentage points (%p) (0.6, 4.1), 17.8%p (16.2,19.3), 17.6%p (15.9,19.4), and 19.3%p (17.6, 21.0) respectively, leading to a mean relative improvement of 41% for total work productivity. The change in work outcomes in the b/tsDMARDs appeared similar.
This systematic literature review and meta-analysis confirmed that patients with active PsA have a substantially reduced capacity to work and participate in leisure activities. Substantial improvements across various WPAI domains were noted after 24 weeks of b/tsDMARD treatment, especially in presenteeism, total work productivity, and activity impairment. These findings may be useful for reimbursement purposes and in the context of shared decision-making. This systematic literature review (SLR) of randomized clinical trials and observational studies of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs b/tsDMARDs in patients with PsA found that at treatment introduction, patients presented with a 42.7% mean productivity loss per week as assessed by the Work Productivity and Activity Impairment (WPAI) Questionnaire. Through a meta-analysis comparing before/after values without adjustment for placebo response, we found that after 24 weeks of treatment with b/tsDMARDs, there was a mean absolute improvement of 17.6 percentage points and a mean relative improvement of 41% in total work productivity, with similar magnitudes of improvement in time spent at work and regular activities outside of work. These results provide clinical-, regulatory- and reimbursement decision-makers with data on the potential societal and socio-economic benefits of b/tsDMARDs in PsA.
PurposesThe relationship between body mass index (BMI) and frailty in older Mexican Americans has not been previously studied. The objective of this study was to examine the relationship between BMI ...and frailty among non-frail older Mexican Americans at baseline over 18 years of follow up.MethodsLongitudinal population-based study of 1,648 non-institutionalized Mexican Americans aged ≥ 67 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/96-2012/13). Frailty phenotype was defined as meeting three or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, low physical activity, and slow walking speed. BMI (kg/m2) was classified as underweight (<18.5), normal weight (18.5-<25), overweight (25-< 30), obesity category I (30-<35), and obesity category II/morbid obesity (≥35). Covariates included socio-demographics, comorbidities, cognitive function, and depressive symptoms. Generalized Estimating Equation models were performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of frailty as a function of BMI category.ResultsParticipants with underweight or obesity category II/ morbid obesity had greater odds of frailty over time compared to those with normal weight (OR = 2.39, 95% CI = 1.29-4.44 and OR = 1.62, 95% CI = 1.07-2.44, respectively) after controlling for all covariates. Participants with BMIs in the overweight or category I obesity were at lower odds of frailty over time.ConclusionsMexican American older adults with BMIs in the underweight or obesity category II/morbid obesity were at higher odds of frailty over time. This indicates that maintaining a healthy weight in this population may prevent future frailty.
The relationship between body mass index (BMI) and frailty in older Mexican Americans has not been previously studied. The objective of this study was to examine the relationship between BMI and ...frailty among non-frail older Mexican Americans at baseline over 18 years of follow up.
Longitudinal population-based study of 1,648 non-institutionalized Mexican Americans aged ≥ 67 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/96-2012/13). Frailty phenotype was defined as meeting three or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, low physical activity, and slow walking speed. BMI (kg/m2) was classified as underweight (<18.5), normal weight (18.5-<25), overweight (25-< 30), obesity category I (30-<35), and obesity category II/morbid obesity (≥35). Covariates included socio-demographics, comorbidities, cognitive function, and depressive symptoms. Generalized Estimating Equation models were performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of frailty as a function of BMI category.
Participants with underweight or obesity category II/ morbid obesity had greater odds of frailty over time compared to those with normal weight (OR = 2.39, 95% CI = 1.29-4.44 and OR = 1.62, 95% CI = 1.07-2.44, respectively) after controlling for all covariates. Participants with BMIs in the overweight or category I obesity were at lower odds of frailty over time.
Mexican American older adults with BMIs in the underweight or obesity category II/morbid obesity were at higher odds of frailty over time. This indicates that maintaining a healthy weight in this population may prevent future frailty.
The authors examined the relationship of comorbid non-substance use psychiatric disorders to preadmission problem status and treatment outcomes in 278 methadone maintenance patients. Recent ...admissions were assigned DSM-III-R Axis I and II diagnoses according to structured diagnostic interviews. The Addiction Severity Index was administered at admission to assess past and current substance use and psychosocial problems and again 7 months later. Treatment retention and month 7 drug urinalysis results were also obtained. Across substance use and psychosocial domains, participants showed significant and comparable levels of improvement regardless of comorbidity. Comorbid participants received more concurrent psychiatric treatment which may have accounted for the lack of differential improvement among groups. Nevertheless, psychiatric comorbidity was associated with poorer psychosocial and medical status at admission and follow-up and participants with the combination of Axis I and II comorbidity had the most severe problems. Admission and month 7 substance use were, for the most part, not related to psychiatric comorbidity, although there was a trend indicating more treatment attrition for participants with personality disorders.
Pulmonary neuroendocrine tumors represent a spectrum of disease ranging from typical carcinoid tumors to small cell lung cancers. The incidence of low-grade pulmonary NETs has been increasing, ...leading to improved awareness and the need for more treatment options for this rare cancer. Somatostatin analogs continue to be the backbone of therapy and may be followed or accompanied by targeted therapy, chemotherapy, and immune therapy. The recent addition of peptide receptor radionuclide therapy (PRRT) to the treatment armamentarium of NETs has led to the development of targeted alpha therapy to overcome PRRT resistance and minimize off-target adverse effects. Herein, we aim to highlight current treatment options for patients with advanced low grade pulmonary NETs along with emerging therapies, sequencing of therapies, upcoming clinical trials, and the importance of a multidisciplinary team to improve patient outcomes.
The latent structure of Davis's 28-item Interpersonal Reactivity Index (IRI) measure of empathy was examined in 241 methadone maintenance (MM) patients using factor analytic procedures and the ...divergent and convergent reliability of the derived structure was determined. Contrary to the four-factor structure determined for the IRI previously, three factors, comprised of 18 items, were found to best represent the construct of empathy in MM patients--an Empathy factor (nine items) combining the Empathic Concern and Perspective Taking factors originally described by Davis, and Fantasy (four items) and Personal Distress (five) factors. Canonical correlation analysis undertaken to determine concurrent validity of the IRI's revealed latent structure supported the validity of the derived Empathy factor as a measure of empathy, but indicated that Personal Distress appeared to be associated with neuroticism. These findings are consistent with more recent factor analytic and validity findings for the IRI.PUBLICATION ABSTRACT
There is a paucity of head-to-head data for R/R CP-CML treated with tyrosine kinase inhibitors (TKIs) in later-line therapy. We analyzed clinical responses in pts treated with a TKI after ...second-generation TKI failure and in those with T315I based on published studies and determined anticipated costs for payers.
Estimate the NNT and CpR to obtain 1 complete cytogenic response (CCyR), a validated endpoint correlated to long-term survival.
A systematic literature review (2006–2021) was conducted to identify studies reporting CCyR with >15-mo follow-up (f/u) for R/R CP-CML pts after second-generation TKI failure; pts with T315I had 12-mo f/u. NNT was calculated for each TKI using unadjusted pooled probabilities of CCyR estimated by a Bayesian meta-analysis. Wholesale acquisition drug costs were used to estimate the cost to obtain 1 CCyR.
Of 3680 identified publications, 8, 2, and 4 studies were eligible for PON, ASC, and BOS, respectively. The crude analysis of CCyR was highest for PON (0.56) versus ASC (0.45) and BOS (0.27), despite a higher percentage of TKI-resistant pts in the PON group than the ASC group. The NNT to achieve 1 CCyR was lowest for PON (1.8 pts) and highest for BOS (3.7 pts). Estimated 15-mo CpR was lowest for PON ($508,634) and highest for BOS ($980,535), which was similar to the trend observed for estimated 12-mo CpR (PON, $406,907; ASC, $484,079; BOS, $784,428). For pts with T315I, NNT was 1.5 (95% credible interval CrI: 1.3–1.8) pts for PON and 2.3 (95% CrI: 1.6–4.0) pts for ASC. Estimated 12-mo CpR was $351,517 (95% CrI: 308,452–408,942) for PON and $2,485,315 (95% CrI: 1,706,030–4,411,298) for ASC. BOS was excluded as it is not active or indicated in pts with T315I.
In later-line CP-CML therapy, PON demonstrated favorable CCyR and NNT in difficult-to-treat pts over 15-mo f/u, leading to lower CpRs versus ASC and BOS. In a subanalysis of 12-mo data, CpR was substantially lower for PON versus ASC in pts with T315I because of the lower response rate and higher dose required for ASC.
