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Introduction: Some patients with rheumatoid arthritis (RA) using tumor necrosis factor inhibitors (TNFi) experience inefficacy or lack of tolerability and hence switch to another TNFi (cycling) or to a therapy with another mode of action (switching). This study examined patient characteristics, prescribing patterns and treatment practice for RA in the United States. Methods: Data were from the Adelphi Disease Specific Programme (Q2-Q3 2016). Rheumatologists completed a survey and patient record forms for adult patients with RA who had

Introduction Tumor necrosis factor inhibitors (TNFi) are commonly used as first-line therapy (biologic disease-modifying antirheumatic drug [bDMARD] and targeted synthetic DMARD [tsDMARD]: defined as targeted therapy) for patients with moderate-to-severe rheumatoid arthritis (RA), usually combined with conventional synthetic DMARDs (csDMARDs) but sometimes as monotherapy. If treatment fails, patients cycle to another TNFi (cycling) or switch to a targeted therapy with a different mode of action (MOA; switching). The study aimed to examine prescribing patterns and reasons for current RA treatment practice in Europe (EU5: France, Germany, Italy, Spain, UK) and Japan. Methods Data were collected from the Adelphi Disease Specific Programme™ (DSP; Q1–Q2 2017). Rheumatologists seeing ≥ 10 (EU5) and ≥ 5 (Japan) patients with RA a month completed Patient Record Forms. Patients ≥ 18 years old, with RA diagnosis and complete RA-targeted therapy history were included. Patients were grouped based on first-line targeted therapy class, and on whether first-line targeted therapy was monotherapy (targeted therapy alone) or combination therapy (targeted therapy and csDMARD). Those patients receiving TNFi at first-line and with ≥ 1 targeted therapy were classified as TNFi cyclers or MOA switchers. Univariate analysis compared factors across groups. Patient demographics and characteristics compared across groups; physician reasoning for targeted therapy change; and time to discontinuation of targeted therapy. Results In EU5 and Japan, respectively, 1741 and 147 patients were included; at first-line, 80.8% and 64.6% received TNFi and 76.0% and 77.6% received combination therapy. Overall in EU5, more combination therapy than monotherapy patients reached maximum csDMARD dose before first-line targeted therapy ( P < 0.05); disease severity was higher in patients initiating TNFi versus non-TNFi ( P < 0.05). In Japan, trends were similar but not significant. The most common reason physicians gave for changing therapy following first-line targeted therapy was ‘secondary lack of efficacy’ (EU5: 46.2%; Japan: 53.8%). In EU5 and Japan, respectively, of 365 and 22 patients who received second-line targeted therapy, 52.1% and 54.5% were MOA switchers. In EU5, TNFi cyclers had longer time from diagnosis to second-line targeted therapy initiation than MOA switchers ( P = 0.04). Conclusions TNFis were the most commonly prescribed targeted therapy at first-line. Between 10 and 20% of patients prescribed a TNFi as first-line targeted therapy did so without concomitant csDMARD. Almost half of patients cycled to another TNFi at second-line. Electronic Supplementary Material The online version of this article (10.1007/s40744-020-00211-w) contains supplementary material, which is available to authorized users.

Background Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), affects an estimated 1.6 million US adults, and results in humanistic and economic burden even amongst mild patients, which grows with increasing disease activity. Methods Gastroenterologists and their IBD patients provided real-world data via US IBD Disease Specific Programmes™ 2014–2018. Patients with physician- and patient-reported data completing a Work Productivity and Activity Impairment questionnaire were categorized by disease activity, defined using Crohn’s Disease Activity Index (CD) and partial Mayo scores (UC) respectively. Associations of disease activity with patient-reported productivity and indirect costs were assessed. Results The analyses included 281 patients with CD and 282 patients with UC. Mean ages were 40.0 years and 40.5 years, and mean disease durations 7.1 years and 5.4 years, for CD and UC, respectively. In CD, absenteeism (0.95–14.6%), presenteeism (11.7–44.9%), and overall work impairment (12.4–51.0%) increased with increasing disease activity (all p&lt;0.0001). In UC, absenteeism (0.6–11.9%), presenteeism (7.1–37.1%), and overall work impairment (7.5–41.9%) increased with increasing disease activity (all p&lt;0.0001). Annual indirect costs due to total work impairment increased with increasing disease activity (all p&lt;0.0001), from $7,169/patient/year (remission) to $29,524/patient/year (moderately-to-severely active disease) in CD and $4,348/patient/year (remission) to $24,283/patient/year (moderately-to-severely active disease) in UC. Conclusions CD and UC patients experienced increased absenteeism, presenteeism, and overall work impairment with increasing disease activity, resulting in higher indirect costs. Treatments significantly reducing IBD disease activity could provide meaningful improvements in work productivity and associated costs.

Mercuric chloride solutions have been used in operations for over 30 years in attempts to kill cancer cells implanted on healthy tissue. Three applications have emerged. The most common is the use of 1/500 and 1/1000 solutions to wash out the bowel lumen during operations for colorectal carcinona. '-3