The peer-reviewed literature is remarkably consistent: CF-associated growth impairment and airway abnormalities are reported at birth, and disease progression is reported in infancy and throughout childhood. Earlier access to routine CF management is associated with improved subsequent health status.

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Acute myeloid leukemia (AML) is a life-threatening malignancy that is more prevalent in the elderly. Because the patient population is heterogenous and advanced in age, choosing the optimal therapy can be challenging. There is strong evidence supporting antileukemic therapy, including standard intensive induction chemotherapy (IC) and non-intensive chemotherapy (NIC), for older patients with AML, and guidelines recommend treatment selection based on a patient’s individual and disease characteristics as opposed to age alone. Nonetheless, historic evidence indicates that a high proportion of patients who may be candidates for NIC receive no active antileukemic treatment (NAAT), instead receiving only best supportive care (BSC). We conducted a focused literature review to assess current real-world patterns of undertreatment in AML. From a total of 25 identified studies reporting the proportion of patients with AML receiving NAAT, the proportion of patients treated with NAAT varied widely, ranging from 10 to 61.4% in the US and 24.1 to 35% in Europe. Characteristics associated with receipt of NAAT included clinical factors such as age, poor performance status, comorbidities, and uncontrolled concomitant conditions, as well as sociodemographic factors such as female sex, unmarried status, and lower income. Survival was diminished among patients receiving NAAT, with reported median overall survival values ranging from 1.2 to 4.8 months compared to 5 to 14.4 months with NIC. These findings suggest a proportion of patients who are candidates for NIC receive NAAT, potentially forfeiting the survival benefit of active antileukemic treatment.

SUMMARYWhat is known and objective: Since 2005, a mounting base of evidence has identified that conventional antipsychotic medications are associated with an increased risk of mortality among elderly patients when compared to atypical antipsychotics. This study sought to explore the feasibility of using the EmiliaRomagna Region (RER) database for comparative safety analyses by replicating and refining risk estimates of this well-known drug safety example through meta-analysis. Methods: We identified a cohort of 23 681 Italian RER patients (aged ≥65) who initiated treatment with a conventional or atypical antipsychotic between 1 July 2009 and 30 June 2011. We compared 180-day mortality using Cox proportional hazards models adjusted for risk factors for death, use of other medications and measures of health services utilization intensity, all measured before antipsychotic initiation. We conducted a metaanalysis of studies with similar methods against which to compare our results. Results: Among 14 462 and 9219 patients prescribed conventional and atypical antipsychotics, respectively, we observed 2402 (16Á6%) and 821 (8Á9%) deaths during follow-up. Conventional antipsychotic initiators were older and generally had higher prevalence of outcome risk factors and higher baseline health service use intensity. The crude hazard ratio (HR) was 1Á95 [95% confidence interval (CI), 1Á80-2Á11], which decreased to 1Á47 (95% CI, 1Á35-1Á60) after full adjustment. We identified seven published studies that examined this association using similar methods. The pooled HR from these studies was 1Á34 (95% CI, 1Á28-1Á39). Including our study, the meta-analysis yielded a summary estimate of 1Á35 (95% CI, 1Á31-1Á40) and did not introduce any heterogeneity (I 2 = 0%; P = 0Á455). What is new and conclusions: Our results support the use of the RER database for pharmacoepidemiological studies and provide an up-to-date and pooled estimate of the magnitude of the association between mortality and conventional vs. atypical antipsychotics. WHAT IS KNOWN AND OBJECTIVEIn April 2005, the US Food and Drug Administration issued a public health advisory highlighting an association between atypical antipsychotic medications and increased mortality in elderly patients.1 In the wake of this advisory, subsequent studies found an even greater risk of mortality associated with the use of conventional antipsychotics as compared to atypical antipsychotics (Wang et al.,2 Schneeweiss et al. 3), and since then, the FDA, EMA and other regulatory and health agencies have expanded this alert to include conventional antipsychotics.1,4,5 Most of the studies on which these regulatory actions were based were conducted in large, population-based electronic healthcare databases comprising administrative claims from multiple sources, including pharmacies, hospitals, and outpatient physicians.Electronic healthcare databases from many countries have been used for a number of research purposes including to evaluate physician prescribing, drug utilization, drug adverse effects...