Worldwide epidemiological studies provide estimates of migraine prevalence. The International Headache Society (IHS) diagnostic criteria have permitted more reliable and generalizable study estimates. In this review, recent population-based reports of IHS-defined migraine are discussed to update the current epidemiological literature, to highlight methodological challenges, and to encourage greater public awareness of this frequently undiagnosed disabling disorder.

Objective: To compare temporal trends in clinical and health care resource utilization (HRU) outcomes in people with refractory and nonrefractory generalized myasthenia gravis (gMG). Methods: A retrospective analysis of data from adults with gMG in the Myasthenia Gravis Foundation of America Patient Registry. gMG status (ever-refractory or always nonrefractory) and clinical (Myasthenia Gravis—Activities of Daily Living [MG-ADL] scores, exacerbations) and HRU outcomes were determined from questionnaires self-completed 6-monthly for up to 4 years. The probability of each outcome was compared for the 2 groups over time. Results: The mean MG-ADL score and the probability of experiencing each outcome were significantly greater in the ever-refractory versus nonrefractory groups during each year of follow-up. Between-group differences in time trends were statistically significant for intensive care and feeding-tube use. Conclusions: People who have ever had refractory gMG may have worse functional status, more exacerbations, and higher HRU than people with consistently nonrefractory disease.

The authors examined how differences in SSRI utilization affect the risk of hospitalization among persons with depression. In particular, they decompose how different types of drug therapy affect hospitalization and how that effect varies with the usage pattern of the drug. Using retrospective medical and pharmacy claims from a Midwestern health maintenance organization, they employed multiple logistic regression analyses of patients newly treated for depression. Their findings were that (a) paroxetine may be a significant risk factor for early discontinuation compared with fluoxetine; and (b) sertraline initiation among stable-use patients may lower the risk of hospitalization. However, initiation on paroxetine or sertraline rather than fluoxetine may increase the risk of hospitalization among patients not exhibiting a stable usage pattern.

Objective: To summarize pharmacy database studies of persistence with ocular hypotensives and review the literature of adherence with 2 additional classes of medication—antihypertensives and antihyperlipidemics—comparing methods used to analyze adherence in the 3 treatment areas. Data Sources: A search of MEDLINE (1990–2004) was conducted, using search terms designed to identify English-language articles describing adherence or persistence with any of the 3 drug classes of interest. Study Selection and Data Extraction: All articles identified through MEDLINE were reviewed and screened for use of an automated pharmacy database as an information source, quantitative results provided, and follow-up duration of at least 90 days. Details of methods used to estimate adherence or persistence and estimates of persistence with ocular hypotensive therapy, antihypertensives, and lipid-lowering agents were extracted. Data Synthesis: All studies describing the use of ocular hypotensives, and the majority of studies in the other treatment areas, identified inception cohorts of drug initiators. Use of survival analysis techniques to analyze adherence to medication therapy was less common in the hypertension and hyperlipidemia treatment adherence literature than in literature about glaucoma. In the treatment of hypertension, use of angiotensin II receptor antagonists or angiotensin-converting enzyme inhibitors was associated with higher levels of adherence. Statins in treatment of hyperlipidemia and topical prostaglandins as ocular hypotensive medications were also associated with higher levels of adherence. Conclusions: Findings regarding the relative superiority of specific drug classes were consistent within each therapeutic area, with less consistency in identifying other predictors of adherence. Increased use of survival analysis in future studies of persistence might improve comparability of results across studies.