Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use.

Background and AimsVedolizumab, a humanised monoclonal antibody for the treatment of inflammatory bowel disease, selectively blocks gut lymphocyte trafficking. This may reduce the risk of respiratory tract infections [RTIs] compared with systemic immunosuppressive therapies. To assess this possibility, we evaluated the rates of RTIs in clinical trials of vedolizumab.MethodsPatient-level data from Phase 3 randomised controlled trials [RCTs] of vedolizumab in ulcerative colitis [UC; GEMINI 1] and Crohn’s disease [CD; GEMINI 2], and a long-term safety study [UC and CD] were pooled. Cox proportional hazards models were used to estimate the incidence of upper RTIs [URTIs] and lower RTIs [LRTIs] with adjustment for significant covariates.ResultsIn the RCTs [n = 1731 patients], the incidence of URTIs was numerically higher in patients receiving vedolizumab compared with those receiving placebo, although this difference was not statistically significant (38.7 vs 33.0 patients per 100 patient-years; hazard ratio [HR] 1.12; 95% confidence interval [CI]: 0.83–1.51; p = 0.463). The rate of LRTIs, including pneumonia, was numerically lower in the vedolizumab versus the placebo group: this difference was not statistically significant (7.7 vs 8.5 per 100 patient-years [HR 0.85; 95% CI: 0.48–1.52; p = 0.585]). Both URTIs and LRTIs were more frequent in patients with CD compared with UC. Most RTIs in patients receiving vedolizumab were not serious and did not require treatment discontinuation.ConclusionsVedolizumab therapy was not associated with an increased incidence of respiratory tract infection compared with placebo.

IntroductionWhile opioids have become a standard treatment option for those experiencing moderate to severe chronic pain, side effects of constipation and related symptoms have interfered with their usage in as many as 40–50% of treated patients. Prior research has elucidated the range of these symptoms, but no study has determined which of these symptoms patients most desire improving or whether improving constipation itself by as little as one more bowel movement per week is deemed an important change.MethodsWe conducted an online patient survey of 513 participants residing in one of six countries who reported having chronic pain, were taking opioids, and experiencing opioid-induced constipation (OIC) to address these questions.ResultsRespondents rank ordered their preferences and the following eight symptoms generated >80% endorsement as important to improve: improvement in having bowel movements without rectal pain, soft stools that are not loose or watery, regular bowel movements, a reduction in rectal straining, relief from feeling bloated, feeling less fear about having OIC when following their opioid medication regime, a desire to worry less overall about having a bowel movement, and with less ‘stomach’ area pain. When asked ‘how important is it you to have 1 more bowel movement per week”, over 90% endorsed it was ‘somewhat’, ‘very’, or ‘extremely important’ with nearly 70% (n = 354) endorsing the ‘extremely’ or ‘very important’ response options. In multivariate models, being in more overall pain or reporting fewer than 3 bowel movements per week were found to be independent predictors of the importance.ConclusionsThese results highlight the notable range of OIC symptoms most desired by patients to improve and demonstrate that bowel movements of only one more per week were important to register a meaningful improvement. The latter is particularly helpful for those assessing the minimal clinically important difference in treating this condition.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0169-x) contains supplementary material, which is available to authorized users.

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition with broad economic impacts. It presents a major opportunity for healthcare cost reduction and improved functional status. This study measures the gaps between current treatment practices and recently issued guidelines, and identifies the primary opportunities for COPD disease management. COPD patients (n 5 1,036) were initially identified using pharmacy claims data on outpatient respiratory medication use. Through a health assessment survey, they confirmed their diagnosis and reported on their medical resource use, vaccinations, smoking, and healthrelated quality of life (QOL). Drug utilization was measured using a 12-month retrospective review of prescription claims. Patients were stratified by severity level based on QOL scores. A large subset of patients (25.7%) did not use inhaled bronchodilators, the preferred first-line therapy in COPD guidelines; instead, these patients used oral bronchodilators (8.1%) or no bronchodilator at all (17.6%). Inhaled corticosteroids (ICSs) were used by 54.8% of patients. Many patients had not received an influenza vaccination during the previous year (20.7%) or a pneumococcal vaccination during their lifetime (28.3%). Some patients continue to smoke on a regular basis (11.8%). A majority of patients reported that they do not feel knowledgeable about their disease (52.2%) or therapy (53.2%). In summary, significant gaps exist between COPD treatment guidelines and clinical practice, including underuse of inhaled bronchodilators, extensive use of ICSs, and underuse of vaccinations. To reduce the condition's clinical and economic impacts, COPD disease management programs need to target four key areas: pharmacotherapy, vaccination rates, smoking cessation, and patient education. 143

Postmenopausal females treatment-naïve to aromatase inhibitor therapy who also received treatment with a prescription antiarthralgia medication did not have significantly higher persistence with aromatase inhibitor therapy. Further research should focus on other possible causes of poor persistence in patients using aromatase inhibitor therapy.