Impact of Hypomethylating Agent Use on Hospital and Emergency Room Visits, and Predictors of Early Discontinuation in Patients With Higher-Risk Myelodysplastic Syndromes.
Impact of Hypomethylating Agent Use on Hospital and Emergency Room Visits, and Predictors of Early Discontinuation in Patients With Higher-Risk Myelodysplastic Syndromes.
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低甲基化剂的使用对医院和急诊室就诊的影响以及高危骨髓增生异常综合征患者早期停药的预测因素。
DOI：
10.1016/j.clml.2022.04.016
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
R. Epstein
中科院分区：
文献类型：
--
作者：
A. Zeidan;N. Joshi;Hrishikesh P. Kale;Wei;S. Corman;T. Salimi;R. Epstein
背景以前使用SEER-医疗保险数据库的分析报告了高风险骨髓增生异常综合征（MDS）患者中低甲基化药物（HMA）的大量使用不足，以及HMA持续性差与高经济负担之间的相关性。我们的目的是比较根据使用或不使用HMA治疗的高风险MDS患者的住院率和急诊室（ER）就诊率，并探讨与HMA治疗早期中止相关的因素。患者和方法我们使用2010-2016年SEER-Medicare数据库来识别年龄≥66岁的新诊断为难治性贫血伴原始细胞过多的患者。（RAEB;高风险MDS的替代品）。确定MDS诊断后12个月内的新住院和ER访视。治疗中止被定义为停止HMA治疗前4 cycles.ResultsOverall，664（55.8%）患者HMA用户和526（44.2%）非用户。与HMA使用者相比，非使用者每月有更多的住院（平均0.47 vs.0.30，P <0.001）和急诊就诊（平均0.69 vs.0.41，P = 0.005）。在HMA使用者中，193人（29.1%）在4个周期前停止HMA治疗，其中91人（47.2%）在1个周期后停止HMA治疗。年龄较大和性能状态不佳与HMA discontinuation.ConclusionAn增加的住院率和ER访问发生在HMA非用户与HMA用户的风险较高。大约三分之一的患者早期停止HMA治疗。停药的预测因素包括年龄较大和体能状态不佳。需要新的方法来提高HMA治疗的利用率和持久性以及相关的结果，特别是在这些高危人群中。
BackgroundPrevious analyses using the SEER-Medicare database have reported substantial underutilization of hypomethylating agents (HMAs) among patients with higher-risk myelodysplastic syndromes (MDS), and an association between poor HMA persistence and high economic burden. We aimed to compare rates of hospitalizations and emergency room (ER) visits among patients with higher-risk MDS according to use or non-use of HMA therapy, and to explore factors associated with early discontinuation of HMA therapy.Patients and MethodsWe used the 2010–2016 SEER-Medicare database to identify patients aged ≥66 years with a new diagnosis of refractory anemia with excess blasts (RAEB; a surrogate for higher-risk MDS) between 2011 and 2015. New hospitalizations and ER visits during the 12 months following MDS diagnosis were determined. Treatment discontinuation was defined as stopping HMA therapy before 4 cycles.ResultsOverall, 664 (55.8%) patients were HMA users and 526 (44.2%) non-users. Non-users had more hospitalizations (mean 0.47 vs. 0.30,P< .001) and ER visits (mean 0.69 vs. 0.41,P= .005) per month than HMA users. Among HMA users, 193 (29.1%) discontinued HMA therapy before 4 cycles, and 91 (47.2%) of these after 1 cycle. Older age and poor performance status were associated with higher risk of HMA discontinuation.ConclusionAn increased rate of hospitalizations and ER visits occurred in HMA non-users vs. HMA users. Approximately one-third of patients discontinued HMA therapy early. Predictors of discontinuation included older age and poor performance status. Novel approaches are needed to improve utilization and persistence with HMA therapy and associated outcomes, particularly among these higher-risk groups.
与常规护理方案相比，阿扎西丁氨酸的疗效在治疗高风险的髓质发育异常综合征中：一项随机，开放标签的III期研究。
影响因子：
51.1
作者：
Fenaux, Pierre;Mufti, Ghulam J.;Hellstrom-Lindberg, Eva;Santini, Valeria;Finelli, Carlo;Giagounidis, Aristoteles;Schoch, Robert;Gattermann, Norbert;Sanz, Guillermo;List, Alan;Gore, Steven D.;Seymour, John F.;Bennett, John M.;Byrd, John;Backstrom, Jay;Zimmerman, Linda;McKenzie, David;Beach, C. L.;Silverman, Lewis R.
通讯作者：
Silverman, Lewis R.
影响因子：
45.3
作者：
Silverman, LR;Demakos, EP;Holland, JF
通讯作者：
Holland, JF