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The Evidence Speaks (November 2017)

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The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators.

In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Barbour S, Lo C, Espino-Hernandez G, Sajjadi S, Feehally J, Klarenbach S, Gill J. The population-level costs of immunosuppression medications for the treatment of glomerulonephritis are increasing over time due to changing patterns of practice. Nephrol Dial Transplant. 2017 Jul 2 epub ahead of print.

Glomerulonephritis, a type of kidney disease, is commonly treated with immunosuppressive (IS) therapies, however, despite their popularity, the real-world cost of these treatments is generally unknown. To approach this knowledge gap, CHÉOS Scientists Sean Barbour and Jagbir Gill analyzed administrative data for all adult patients who were diagnosed with IS-treatable glomerulonephritis between the years 2000 and 2012. The type and amount of medications dispensed where collected using PharmaNet and medications received in hospital not captured by this system were inferred using an algorithm. The cohort of eligible patients was followed until the end of 2013. Due to the utilization of newer and more expensive therapies, the per-patient cost increased from $205 in 2000 to $1394 in 2013. This rise was driven in part by the increased use of the expensive medication rituximab, the efficacy for which was demonstrated in two clinical trials published in 2010. The authors noted that the popularity of medications generally followed such publications, showing the dissemination of the literature into clinical practice. The authors stressed the importance of comprehensive cost-effectiveness analyses that incorporate patient-reported outcomes and quality of life and that anticipation of changes in clinical practice in response to the published literature is essential for cost-containment efforts.

 

Tsao NW, Lynd LD, Sadatsafavi M, Hanley G, De Vera MA. Patterns of biologics utilization and discontinuation before and during pregnancy in women with autoimmune diseases: A population-based cohort study. Arthritis Care Res. 2017 Oct 3 epub ahead of print.

Autoimmune diseases, such as rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and Crohn’s disease, may be correlated with pregnancy-related complications for both the mother and newborn. As many as half of women with autoimmune diseases require treatment during their pregnancy to prevent adverse outcomes by limiting their disease activity. However, commonly used medications for these diseases can negatively impact fetal development — a potential alternative for these women is to use biologic drugs. CHÉOS’ Dr. Larry Lynd and his team set out to identify patterns of biologic drug utilization and discontinuation during pregnancy in B.C. Using administrative data from Population Data BC and the BC Perinatal Database Registry, the team collected information on 8,341 pregnancies in women with autoimmune diseases between 2002 and 2012. Of those, prescriptions for biologics were filled in 144 pregnancies, most commonly in women with RA, IBD, and psoriatic arthritis (Ps). The use of biologics over this time period increased significantly, however, two-thirds of women discontinued their use by the third trimester. The odds of discontinuation were not related to the severity of disease during pregnancy, a finding which highlights the need for further research on the risks and benefits of discontinuing biologic treatment during pregnancy.

Rose C, Gill J, Gill JS. Association of kidney transplantation with survival in patients with long dialysis exposure. Clin J Am Soc Nephrol. 2017 Oct 26 epub ahead of print.

End-stage renal disease (ESRD) is ideally treated via kidney transplantation because it is associated with improved survival, quality of life, and cost effectiveness compared to dialysis. However, due to this preference, the waitlist for a viable kidney can be considerable, requiring patients to undergo dialysis while they wait. It is unknown whether transplantation following prolonged dialysis results in equivalent positive outcomes compared to transplantation immediately following diagnosis of ESRD. Drs. Caren Rose, Jagbir Gill, and John Gill used data from several U.S. databases to answer this question. The researchers identified 5365 transplant-eligible patients who were on dialysis for at least 10 years. Analysis showed that survival was substantially better in patients who received a transplantation rather than remaining on dialysis although the increased survival was not seen until 2 years post-transplant. The authors noted that over 80 per cent of study patients were put on the waitlist after 10 years of dialysis and thus underwent a recent clinical assessment, highlighting the need for close surveillance of potential recipients. Finally, in this population, the long-term survival benefit of transplantation using lower-quality kidneys is largely unknown and an area for future investigation.

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