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Objective: To evaluate treatment patterns, healthcare resource utilization (HRU) and costs among peripheral T-cell lymphoma (PTCL) patients in the USA. Methods: A retrospective cohort study, using the IQVIA PharMetrics® Plus claims database from 1 April 2011 to 30 November 2021, identified PTCL patients receiving systemic treatments. Three mutually exclusive subcohorts were created based on line of therapy (LOT): 1LOT, 2LOT and ≥3LOT. Common treatment regimens, median time on treatment, all-cause and PTCL-related HRU and costs were estimated. Results: Among 189 PTCL patients identified, 61.9% had 1LOT, 21.7% had 2LOT and 16.4% had ≥3LOT. The most common treatment regimens in the 1LOT were CHOP/CHOP-like, CHOEP/CHOEP-like and brentuximab vedotin; monotherapies were most common in the 2LOT and ≥3LOT. All-cause and PTCL-related hospitalizations and prescriptions PPPM increased with increasing LOT. Nearly 70% of total treatment costs were PTCL related. Conclusion: Higher utilization of combination therapies in the 1LOT and monotherapies in subsequent LOTs were observed, alongside high PTCL-related costs. Peripheral T-cell lymphomas (PTCL) are a rare and fast-growing form of blood cancer. About 8000–12,000 people in the USA are diagnosed with PTCL every year. As it is a rare disease and has many types, and there is a limited understanding of the patients who have PTCL and the treatments they receive in the real world. The purpose of this study was to evaluate how these patients are treated, what are they treated with and what are the costs of these treatments in the USA. The data collected on these patients was divided into three groups based upon the number of lines of treatment/therapy (LOT) they received: 1LOT, 2LOT and ≥3LOT. This study researched different treatments and their duration in each line of therapy. Among 189 PTCL patients included in the study, the average age of patients was 55 years and 62% were male. Among these patients, 62% had 1LOT, 22% had 2LOT and 16% had ≥3LOT. The most common treatments in the 1LOT were traditional chemotherapy regimens followed by targeted therapies: CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) or CHOP-like, CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide and prednisone) or CHOEP-like, and brentuximab vedotin. Treatment regimens with only one drug were most common in the 2LOT and ≥3LOT. The total cost of PTCL treatment in the USA is very high; 70% of this cost is related to their treatment with various drugs. More research is needed to better understand the treatment and cost of this rare cancer. Treatment patterns and costs in peripheral T-cell lymphoma. [ABSTRACT FROM AUTHOR]

Aim: Elderly acute myeloid leukemia (AML) patients are often not treated with antileukemic therapy due to their poor overall health condition, leaving supportive care as the sole treatment option. Objective: To evaluate patient characteristics, treatment patterns and outcomes of elderly patients with AML who are treated with supportive care only. Methods: A retrospective analysis of elderly AML patients included in the Surveillance, Epidemiology and End Results-Medicare database from 2008 to 2015. Results: Of elderly patients with AML (n = 7665), 3209 (41.9%) received supportive care only. Their mean age was 79 years, 50.5% were males; 48.2% died during the first 3 months and 67.3% died during the first 6 months. 82.2% died within the first year; only 13.2% survived >12 months. 77.9% patients died due to leukemia. Conclusion: In elderly AML patients treated with supportive care only, older age, concurrent hypertension, chronic obstructive pulmonary disease, chronic kidney disease and acute myocardial infarction were identified as prognostic factors associated with decreased likelihood of survival. Ideally, these patients should be treated with antileukemic therapy in addition to supportive care, as most of them die from disease progression. This study analyzed data on elderly patients with acute myeloid leukemia (AML) who were only treated with supportive care. The source of this data was the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Of the 7665 patients diagnosed with AML during 2008–2015, 3209 (41.9%) received supportive care only. Their mean age at index date was 79 years; slightly more than half of these were males (50.5%). Almost half of these patients (48.2%) died within the first 3 months and approximately two-thirds (67.3%) died within the first 6 months. Only a small proportion (13%) of these patients were alive after 1 year. These patients who were alive after one were likely to be in remission (there was decrease in the signs and symptoms of AML). The results of this study showed that elderly AML patients who only received supportive care were more likely to die early if they also had chronic kidney disease, chronic obstructive pulmonary disease, history of acute myocardial infarction or hypertension. As elderly AML patients may be in poor general health and have other diseases (comorbidities), this could be the reason why they may not be treated with antileukemic therapy. Instead of treatment with supportive care only, these patients should ideally receive antileukemic therapy in addition to supportive care. More research should be done to find alternate treatments for these elderly AML patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: After erythropoiesis‐stimulating agent (ESA) failure, lenalidomide and hypomethylating agents are the only remaining treatment options for most patients with lower‐risk myelodysplastic syndromes (LR‐MDS). Optimal choice of these agents as front‐line therapy in non‐del(5q) LR‐MDS is unclear. Because azacitidine clinical data mainly describe experience in higher‐risk MDS, we performed a meta‐analysis of patient‐level data to evaluate azacitidine in patients with red blood cell (RBC) transfusion‐dependent LR‐MDS. Materials and Methods: We searched English‐language articles for prospective phase II and III azacitidine clinical trials and patient registries published between 2000 and 2015, and Embase abstracts from 2015 conferences. Patient‐level data from identified relevant studies were provided by investigators. Meta‐analyses followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Efficacy endpoints were RBC transfusion independence (TI) and Clinical Benefit (RBC‐TI, erythroid response, and complete or partial remission, per International Working Group 2006 criteria for MDS). Results: Data for 233 patients from 6 clinical studies and 1 registry study met criteria for inclusion in analyses. Overall, 90.3% of patients had non‐del(5q) LR‐MDS. Pooled estimates from random‐effects models of RBC‐TI and Clinical Benefit were 38.9% and 81.1%, respectively; for the ESA‐refractory subgroup, they were 40.5% and 77.3%; and for patients with isolated anemia, they were 41.9% and 82.5%. In multivariate analyses, planned use of ≥6 azacitidine treatment cycles was significantly predictive of response. Conclusion: Azacitidine effects in these patients, most with non‐del(5q) LR‐MDS, were promising and generally similar to those reported for lenalidomide in similar patients. The choice of initial therapy is important because most patients eventually stop responding to front‐line therapy and alternatives are limited. Implications for Practice: Lower‐risk myelodysplastic syndromes (LR‐MDS) are primarily characterized by anemia. After erythropoiesis‐stimulating agent (ESA) failure, lenalidomide and hypomethylating agents are the only remaining treatment options for most patients. This meta‐analysis of 233 azacitidine‐treated red blood cell (RBC) transfusion‐dependent patients with LR‐MDS (92.3% non‐del[5q]) from 7 studies showed 38.9% became RBC transfusion‐independent. There is no clear guidance regarding the optimal choice of lenalidomide or hypomethylating agents for patients with non‐del(5q) LR‐MDS following ESA failure. Clinical presentation (e.g., number of cytopenias) and potential outcomes after hypomethylating agent failure are factors to consider when making initial treatment decisions for LR‐MDS patients. [ABSTRACT FROM AUTHOR]

Epidemiological studies have shown that maternal infection can increase the risk for mental illness in the offspring. In a mouse model of maternal respiratory infection with influenza virus, the adult offspring display striking behavioral, pharmacological and histological abnormalities. Although influenza primarily infects the respiratory system, there are reports of viral mRNA and protein in the fetus of infected pregnant animals. To determine the extent of viral spread following maternal respiratory infection, we used RT–PCR to assay various maternal and fetal tissues for influenza A mRNAs coding for neuraminidase, non-structural protein 2, nuclear protein and matrix protein. While infected maternal lungs exhibit uniformly very strong signals, placentae are only rarely positive, and viral RNAs are not detectable in fetal brains from infected mothers. Thus, the effects of maternal infection on fetal brain development are likely to be indirect, probably involving the maternal inflammatory response. [Copyright &y& Elsevier]

Improved glycemic control with insulin treatment is generally associated with weight gain. Two open-label randomized trials were conducted to compare the effect of inhaled Technosphere®/Insulin (T/I) with that of subcutaneous insulin aspart (Asp) on glycemic control and weight. Diabetic patients receiving glargine as basal insulin were randomized to receive T/I or Asp, with glargine as basal insulin in two separate trials; a 12-week study of 110 patients with type 1 DM and a 24-week study with a 22-week follow-up period of 309 patients with type 2 DM. Type 1 diabetic patients receiving T/I experienced a mean weight loss of 0.45 kg over 12 weeks, versus a mean gain of 0.80 kg in the Asp group (P=-.0017). In the 24-week treatment period, type 2 diabetic patients receiving T/I experienced a weight loss of 0.78 kg (P=-.0016) compared with a mean gain of 0.23 kg in the Asp group. When type 1 and type 2 patients were combined for analysis, the T/I patients experienced a mean loss of 0.69 kg (P=.0001) at Week 12. Type 2 diabetic patients who participated in the 22-week follow-resumed conventional therapy. Patients initially randomized to receive Asp had a mean weight gain of 0.81 kg during follow-up. Patients originally in the T/I group similarly gained a mean 0.74 kg following resumption of conventional therapy (P=.8125). In addition to treatment, baseline BMI, categorized into three groups (<27, 27-29, >29) was found to be a significant factor in weight change at 24 weeks (weight gain, no weight gain) based on multivariate logistics regression model for subjects with type 2 diabetes. Subjects with BMI 27-29 are 3.09 (95% CI: 1.285-7.420) times more likely to have weight loss or no weight gain than those with BMI<27. T/I and Asp produced similar improvement in glycemic control as prandial insulin together with a basal insulin. There was a weight increase in the group receiving Asp, while there was no increase in weight during T/I treatment; when returning to conventional therapy, these patients gained weight. We conclude that in contrast to Asp, T/I offers the advantage of similar glycemic control without associated weight gain. [ABSTRACT FROM AUTHOR]

Limited data exist concerning risk factors for cardiovascular (CV) hospitalization in patients with atrial fibrillation (AF) or atrial flutter (AFL). The aim of this retrospective cohort evaluation was to assess whether patient characteristics and risk factors, including CHADS2 (congestive heart failure, hypertension, age ≥75 years, type 2 diabetes, and previous stroke or transient ischemic attack [doubled]) and CHA2DS2-VASc (congestive heart failure; hypertension; age ≥75 years [doubled]; type 2 diabetes; previous stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65 to 75 years; and sex category) scores, identified patients with AF or AFL at risk for CV hospitalization. Claims data (January 2003 to June 2009) were evaluated to identify patients aged ≥40 years with ≥1 inpatient or ≥2 (within 30 days of each other) outpatient diagnoses of AF or AFL and an absence of diagnosis codes related to cardiac surgery within 30 days of AF or AFL diagnosis. Risk factors for first CV hospitalization in the 2-year period after diagnosis were assessed using univariate and multivariate analyses. Overall, 377,808 patients (mean age 73.9 ± 12.1 years) were identified, of whom 128,048 had CV hospitalizations. CHADS2 and CHA2DS2-VASc scores were the top 2 predictors of first CV hospitalization after AF or AFL diagnosis. Hospitalization risk was increased 2.3- to 2.7-fold in patients with CHADS2 scores of 6 and approximately 3.0-fold in patients with CHA2DS2-VASc scores of 9 compared to patients with a score of 0. These increases were maintained essentially unchanged throughout the 2-year follow-up period. In conclusion, CHADS2 and CHA2DS2-VASc scores were predictive of first CV hospitalization in patients with AF or AFL and may be helpful in identifying “at-risk” patients and guiding therapy. [Copyright &y& Elsevier]