Current medical research and opinion
-
Background: Mantle cell lymphoma (MCL), a rare and aggressive disease, accounts for approximately 5% of all B-cell non-Hodgkin's lymphomas. Evidence on the burden of this disease, for patients and healthcare providers, is scarce. Methods: Four systematic literature reviews were developed to identify epidemiological, real-world clinical, economic and humanistic burden data on patients with MCL. ⋯ Conclusions: We identified significant data gaps for many G20 countries for epidemiology, real-world clinical, economic and humanistic burden. These literature reviews demonstrate the ongoing unmet need for MCL patients globally. Future research to further understand the real-world impact of MCL is needed along with new therapeutic options to improve patient outcomes.
-
Objective: To evaluate the risk of death from Alzheimer's disease among cancer survivors in a population-based setting. Methods: Within Surveillance, Epidemiology and End Results (SEER)-9 registries, cancer patients who were diagnosed between 1975 and 2016 have been reviewed. Observed/expected ratios for the risk of death from Alzheimer's disease were calculated for the overall group as well as for clinically defined subgroups. "Observed" is the number of observed deaths from Alzheimer's disease in the studied group, while "Expected" is the number of deaths from Alzheimer's disease in a demographically similar group within the US and within the same period. ⋯ Death from Alzheimer's disease seems to be particularly associated with older age at time of cancer diagnosis (O/E for patients ≥70 years: 1.29 [95% CI: 1.26-1.31] versus O/E for patients <70 years: 1.01 [95% CI: 0.98-1.03]), American Indian race (O/E for American Indian patients: 1.94 [95% CI: 1.30-2.78] versus O/E for White patients: 1.12 [95% CI: 1.10-1.14]), localized tumor stage (O/E for patients with localized disease stage: 1.13 [95% CI: 1.11-1.15] versus O/E for patients with distant disease stage: 1.04 [95% CI: 0.93-1.15]) and brain tumors (O/E for brain tumors: 2.54 [95% CI: 1.42-4.19]). Conclusion: Long-term cancer survivors (≥10 years) are more likely to die from Alzheimer's disease compared to the US general population. This risk seems to be higher among patients with older age at the time of cancer diagnosis, American Indian race and those with brain tumors.
-
Retraction Of Publication Retracted Publication
Modulation of sensitization processes in the management of pain and the importance of descending pathways: a role for tapentadol?
Objective: This paper presents and discusses recent evidence on the pathophysiological mechanisms of pain. The role of tapentadol - an analgesic molecule characterized by an innovative mechanism of action (i.e. µ-opioid receptor [MOR] agonism and inhibition of noradrenaline [NA] reuptake [NRI]) - in the modulation of pain, and the most recent pharmacological evidence on this molecule (e.g. the µ-load concept) are also presented and commented upon. Methods: Narrative review. ⋯ The synergistic interaction of these two mechanisms allows a strong analgesic effect by acting on both ascending and descending pathways. Of note, the reduced µ-load of tapentadol has two important consequences: first, it limits the risk of opioid-related adverse events, as well as the risk of dependence; second, the NA component becomes predominant at least in some types of pain with consequent specific clinical efficacy in the treatment of neuropathic and chronic pain. Conclusions: According to these characteristics, tapentadol appears suitable in the treatment of chronic pain conditions characterized by both a nociceptive and a neuropathic component, such as osteoarthritis or back pain.
-
Objective: Endometriosis affects up to 10% of women of reproductive age, and the main goal of treatment is to relieve symptoms. Progestins have been the mainstay of endometriosis suppression, of which dienogest has become an important option in many parts of the world. This is an expert literature review, with recommendations on the use of dienogest in the context of various clinical considerations when treating endometriosis. ⋯ Counseling women on potential bleeding risks before starting treatment may be helpful, and evidence suggests that few women discontinue treatment for this reason, with the benefits of treatment outweighing any impact of bleeding irregularities. Conclusions: Overall, the evidence demonstrates that dienogest offers an effective and tolerable alternative or adjunct to surgery and provides many advantages over combined hormonal contraceptives for the treatment of endometriosis. It is important that treatment guidelines are followed and care is tailored to the woman's individual needs and desires.
-
Objective: To assess the real-world use of home health services (HHS) among patients with major depressive disorder (MDD) with and without treatment-resistant depression (TRD). Methods: Adults (18-64 years) from a commercial claims database (07/2009 to 03/2015) were categorized into three cohorts: "TRD"(N = 6411), "non-TRD MDD"(N = 33,068), "non-MDD"(N = 149,884) stratified based on use of HHS (HHS vs. no-HHS). Healthcare resource utilization (HRU) and costs were evaluated up to two years following the first antidepressant pharmacy claim using descriptive statistics. ⋯ Patients without MDD who used HHS had annual healthcare costs of $22,340 while non-MDD patients who did not use HHS had healthcare costs of $3479 PPPY. However, among HHS users, HHS costs represented a relatively small proportion of total healthcare costs. Conclusions: The high proportion of TRD patients using HHS suggests it is a utilized healthcare delivery pathway by TRD patients.