Immune checkpoint inhibitors (CPIs) have expanded treatment options for patients with solid tumors. Systemic corticosteroids (CSs) have an indispensable role in cancer care, but CS-related immunosuppression may counteract the CPI-driven antitumor immune response. This retrospective study investigated the association between baseline CS use (bCS; ≤14 days before, ≤30 days after CPI initiation) and clinical outcomes in patients with advanced non-small cell lung cancer (aNSCLC), melanoma (aMel), or urothelial carcinoma (aUC). We analyzed data from the Flatiron Health electronic health record–derived de-identified database for adults diagnosed with aNSCLC, aMel, or aUC between January 2011 and June 2017 who received ≥1 CPI monotherapy in any treatment line. Associations of bCS use with overall survival (OS) and time to next treatment (TTNT) were estimated using multivariable Cox proportional hazards models adjusting for demographic and clinical characteristics (i.e., ECOG performance status, site of metastases). In total, 2,213 patients were diagnosed with aNSCLC (n = 862), aMel (n = 742), or aUC (n = 609) and received ≥1 CPI administration. Most patients (67%-95%) received CSs, many during the baseline period (19%-30%). Patients with bCS use had shorter median OS than those with no bCS use for aNSCLC (6.6 vs 10.6 months; P = .00018), aMel (16.4 vs 21.5; P = .095), and aUC (4.1 vs 7.7; P = .0012). bCS use was associated with shorter OS (not significant for aMel) and TTNT in adjusted multivariable analyses, and clinical outcomes were not explained by prior CS use or other measured confounders. These findings suggest a potential association between bCS use and decreased CPI effectiveness, warranting further investigation.

Dieting, unhealthy weight control and muscle-enhancing behaviors are common among adolescents: friends are a probable source of influence on these behaviors. The present study uses data provided by nominated friends to examine associations between friends' disordered eating and muscle-enhancing behaviors and participants' own behaviors in a diverse sample of American youth. Male and female adolescents (mean age = 14.4) completed surveys and identified their friends from a class roster; friends' survey data were then linked to each participant. Participants (N = 2126) who had at least one nominated friend were included in the analytic sample. Independent variables were created using the same weight control and muscle-enhancing behaviors reported by nominated friends, and were used in logistic regression models to test associations between participants' and their friends' behaviors, stratified by gender. Results indicated that dieting, disordered eating and muscle-enhancing behaviors were common in this sample, and selected friends' behaviors were associated with the same behaviors in participants. For example, girls whose friends reported extreme weight control behaviors had significantly greater odds of using these behaviors than girls whose friends did not report these same behaviors (OR = 2.39). This research suggests that friends' weight- and shape-related behaviors are a feature of social relationships, and is the first report demonstrating these associations for muscle-enhancing behaviors. Capitalizing on the social element may be important to the development of increasingly effective intervention and prevention programs.

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The research reported in this manuscript was supported by AbbVie through consulting fees paid to Precision Health Economics (PHE). AbbVie and PHE collaborated to develop the study design and protocol. AbbVie and PHE participated in the interpretation of data, review, and approval of the manuscript. Shafrin and Shim are employed by PHE. Ganguli and Sanchez Gonzalez are employed by AbbVie. Seabury reports consulting fees from PHE. The results from this study were presented in poster form at the Academy of Managed Care Pharmacy's 2015 Annual Meeting and Expo; April 7-10, 2015; San Diego, California, and at the Academy of Managed Care Pharmacy's 2016 Annual Meeting and Expo; April 19-22, 2016; San Francisco, California. Study concept and design were contributed primarily by Shafrin, along with Ganguli and Seabury. Shafrin and Shim took the lead in data collection, and data interpretation was performed by Ganguli, Sanchez Gonzalez, Seabury, and Shafrin. The manuscript was written primarily by Shafrin, along with Shim and Seabury, and revised primarily by Ganguli, along with Sanchez Gonzalez and Seabury.

Purpose: Since 2004, concerns about the safety of erythropoiesis-stimulating agents (ESAs) have resulted in label changes and restrictions on their use. We examined changes in ESA use and blood transfusions over time. Methods Conclusion:Our study demonstrated a rapid decline in the percentage of patients treated with ESAs after changes to reimbursement policy, but not after warnings about use. Reimbursement restrictions of other overused or off-label drugs may help reduce health care expenditures.