Background: Progressive supranuclear palsy is a rare neurodegenerative movement disorder and little is known about its epidemiology.Objective: Estimate age-adjusted prevalence of progressive supranuclear palsy and describe antecedent diagnoses and progressive supranuclear palsy patient features in the 5 years before first diagnostic code.Methods: In a nested case-control study in the IBM MarketScan Commercial and Medicare Supplemental Databases, a large set of US insurance databases containing medical service and prescription drug claims from employer-based commercial and Medicare supplemental health insurance plans, progressive supranuclear palsy cases (identified via International Statistical Classification of Diseases 9th/10th revision codes) and controls were included if enrollment was ≥1 month in the study period (October 1, 2015–October 31, 2017). Two controls with no diagnosis codes for PSP were matched to cases on birth year, sex, enrollment time in the database, and pharmacy benefit eligibility. Controls were assigned a randomly selected index date from their eligibility period. Prevalence of progressive supranuclear palsy was estimated in 2016 among patients with ≥1 month of continuous enrollment in that year. Prevalence ratios for comorbidities (claim/diagnosis codes) were examined in the ≤ 5 years before index date (first progressive supranuclear palsy claim date).Results: Age-adjusted progressive supranuclear palsy prevalence was 2.95/100,000 in 2016. The most common diagnosis codes in cases vs. controls in the 5 years pre-index were gait abnormalities (79.3 vs. 21.8%), pain in joint (54.9 vs. 36.0%), Parkinson's disease (54.6 vs. 1.0%), fatigue (49.8 vs. 21.6%), and cerebrovascular disease (45.6 vs. 16.4%).Conclusions: In this large database analysis, based on preliminary analyses, the prevalence of diagnosed progressive supranuclear palsy was 2.95/100,000, which is lower than many prior studies. Typical symptoms suggestive of progressive supranuclear palsy were present before index date, indicating a potential delay in time to diagnosis. The identification of diagnostic codes for clinical features of progressive supranuclear palsy that occurred before index date may be used to develop predictive models to identify potential progressive supranuclear palsy patients earlier in their disease course.

Introduction The extent that cognitive measures are documented in electronic health records (EHR) is important for quality care and addressing disparities in timely diagnosis of dementia or Alzheimer's disease (AD). Methods Analysis of U.S. EHR data to describe the frequency and factors associated with cognitive measures prior to diagnosis of dementia (N = 111,125) or AD (N = 30,203). Results Only 11% of dementia patients and 24% of AD patients had a cognitive measure documented in the 5 years prior to diagnosis. Black race, older age, non‐commercial health insurance, lower mean neighborhood income, greater in‐patient stays, and fewer out‐patient visits were associated with lacking cognitive measures. Discussion Extensive missing cognitive data and differences in the availability of cognitive measures by race, age, and socioeconomic factors hinder patient care and limit utility of EHR for dementia research. Structured fields and prompts for cognitive data inputs at the point of care may help address these gaps.

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Background Treatment paradigms for rheumatoid arthritis (RA) continue to evolve with the generation of further efficacy and safety evidence and the launch of new biologics and novel oral treatments. Population-based studies can help assess which strategies are being used in “real-world” practice for the complete spectrum of clinical RA. This approach can also relate therapy to the consumption of other health-care resources such as RA-related surgery or hospitalization which are fundamental for RA economic models. Objectives To describe biologics use in RA patients newly diagnosed in 2009 followed for two years. Methods A retrospective cohort analysis of adults (age ≥20) with complete medical and pharmacy insurance claims from 1 January 2008 to 31 December 2011 was deployed. “Incident RA” required a primary diagnosis at two separate visits 30 days apart in 2009 and no prior claims for RA. Databases used were the Marketscan Commercial Claims and Encounters (CCAE) and Medicare Supplemental and Coordination of Benefits (MSCB) databases from Truven Health Analytics. Information on demographics, co-morbidities and treatments including conventional (cDMARD) and biologic (bDMARD) therapy and sequencing thereof was obtained for the entire follow-up period. Time to discontinuation and Medication Possession Ratios (MPR), were calculated; a cut-point of 80% was considered to be good adherence. Results This analysis is based on 8,507 incident cases arising from 8.02 million persons who met study criteria. In the first 60 days after diagnosis, 42% of patients received no DMARD therapy; 7.6% initiated a biologic and the remainder a cDMARD; median time to first prescription overall was 7 days. Over the first 12 months, 26% of patients received no DMARD therapy; 64.2% initiated cDMARDs, and 9.7% initiated bDMARDs either as monotherapy (4.3%) or in combination with cDMARDs (5.4%). More than 90% of the latter two groups involved TNF-inhibitors; abatacept was the most common other biologic. By the end of follow-up, 23% of patients had been prescribed at least one biologic and switching to a second occurred in 22% of starters. However, 10% of patients prescribed a biologic filled only one prescription and, within six months, 26% had discontinued therapy; after that, the rate of discontinuation slowed such that by 24 months, 64% were under active treatment. In those receiving biologics, the proportion with MPRs >80% was 72% in year 1 and 77% in year 2, and was consistent across specific drugs. Conclusions A quarter of newly diagnosed patients did not receive any DMARD over two years. Of those that did, the majority began with cDMARD but, by the end of follow-up, the most commonly used drugs were MTX and TNF-inhibitors, and over one-fifth of patients had been prescribed biologics. After steep initial reductions, biologic use was stable as reflected in the time to discontinuation. bDMARD choices were limited for this cohort compared with later cohorts as in 2009 golimumab and certolizumab pegol had just been launched in the US,...