Trending Topics in Health-System Pharmacy
Opioid use disorder medications improve outcomes after endocarditis hospitalization
A new study led by researchers at the Boston Medical Center’s Grayken Center for Addiction found that starting naltrexone or buprenorphine medication to treat opioid use disorder due to endocarditis related to injection drug use improves health outcomes.
Results of the study, published in Clinical Infectious Diseases on January 21, showed that patients who received medication within 30 days of being discharged from the hospital were less likely to overdose or be readmitted to the hospital within a year.
Because opioid use disorder is the underlying cause of many endocarditis inpatient hospitalizations, the findings highlight the importance of offering and prescribing medications to treat opioid use disorder while these patients are in the hospital, as well as connecting them to treatment after discharge.
Barocas and colleagues performed a retrospective cohort study using a large commercial health insurance database of claims from persons aged 18 years and older between July 1, 2010, and June 30, 2016. Primary outcomes included opioid-related overdoses and 1-year all-cause rehospitalization. The cohort included 768 individuals whose average age was 39 years.
The opioid-related overdose rate among those who received naltrexone or buprenorphine in the 30 days following hospitalization was lower than among those who did not (5.8 per 100 person-years vs. 7.3 per 100-person years, respectively). The rate of 1-year rehospitalization among those who received these medications was also lower than those who did not (162.0 per 100 person-years vs. 255.4 per 100 person-years, respectively).
The researchers emphasized that it is critical to treat the underlying opioid use disorder in patients with endocarditis related to injection drug use, which often leads to these serious complications and inpatient hospitalizations.
They also stress that medications to treat opioid use disorder should be part of a comprehensive treatment plan that includes linkage to outpatient care and access to harm reduction services.
Apixaban may be safer and more effective than rivaroxaban for patients with atrial fibrillation
Apixaban and rivaroxaban are the most commonly prescribed direct oral anticoagulants for adults with atrial fibrillation, but head-to-head data are lacking.
In a retrospective cohort study of a U.S. nationwide commercial health care claims database from December 28, 2012, to January 1, 2019, researchers at Brigham and Women’s Hospital and Harvard Medical School as well as Sinai Health System and the University of Toronto compared the safety and effectiveness of apixaban versus rivaroxaban for patients with nonvalvular atrial fibrillation.
The study by Fralick and colleagues, published in the March 10 Annals of Internal Medicine, compared almost 40,000 patients who were newly prescribed apixaban with the same number who were newly prescribed rivaroxaban. Patients’ mean age was 69 years, 40% were women, and mean follow-up was 288 days for new apixaban users and 291 days for new rivaroxaban users.
The results showed that the incidence rate of ischemic stroke or systemic embolism was 6.6 per 1,000 person-years for adults prescribed apixaban compared with 8.0 per 1,000 person-years for those prescribed rivaroxaban.
Adults prescribed apixaban also had a lower rate of GI bleeding or intracranial hemorrhage (12.9 per 1,000 person-years) compared with those prescribed rivaroxaban (21.9 per 1,000 person-years).
The researchers concluded that in routine care, adults with atrial fibrillation prescribed apixaban had a lower rate of both ischemic stroke or systemic embolism and bleeding compared with those prescribed rivaroxaban.
Comparing ticagrelor and clopidogrel in patients with acute coronary syndrome
Current guidelines recommend use of ticagrelor over clopidogrel for patients with acute coronary syndrome (ACS), based on randomized clinical trial data in which ticagrelor reduced major adverse coronary events (MACE) but increased bleeding and dyspnea compared with clopidogrel.
But a recent study by Turgeon and colleagues in JAMA Internal Medicine showed that use of ticagrelor compared with clopidogrel was not associated with a lower risk of MACE in patients with ACS who underwent percutaneous coronary intervention (PCI). However, use of ticagrelor was associated with an increased risk of major bleeding and dyspnea.
The researchers conducted a population-based cohort study using data from patients discharged after PCI for ACS from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry from April 1, 2012, to March 31, 2016, with follow-up to 1 year. Analysis began in April 2018.
Of 11,185 patients who underwent PCI, the median age was 61 years, and 24.7% were women. Ticagrelor users (36.4%) were generally younger and had fewer cardiac and noncardiac comorbidities than clopidogrel users.
A total of 3,328 ticagrelor users (81.6%) were adherent, versus 5,256 of clopidogrel users (73.9%). In the full cohort, adherence (defined as a medication refill adherence value of 80% or higher) was associated with a lower MACE risk.
Assessing treatment-related quality of life of patients with appendicitis
Although surgical removal of the appendix has long been a standard treatment, use of antibiotics is now considered an option for treatment of uncomplicated appendicitis.
A recent report in JAMA Surgery from Sippola and colleagues of the University of Turku in Finland studied patient satisfaction and quality of life after antibiotic therapy and appendectomy for treating uncomplicated acute appendicitis.
The researchers conducted an observational follow-up of the Appendicitis Acuta multicenter randomized clinical trial comparing appendectomy with antibiotics conducted from November 2009 to June 2012.
That study included 530 patients age 18 to 60 years with computed tomography–confirmed uncomplicated acute appendicitis who were randomized to undergo appendectomy (273 [52%]) or receive antibiotics (257 [49%]).
Long-term results support the use of antibiotics for treatment of uncomplicated acute appendicitis as an alternative to appendectomy, but treatment-related long-term patient satisfaction and quality of life had not been assessed.
Of the 530 patients enrolled in the trial 423 patients (80%) were available for phone interview at a median follow-up of 7 years; 206 patients (80%) took antibiotics and 217 (79%) underwent appendectomy. Of the 206 patients taking antibiotics, 81 (39%) had undergone a subsequent appendectomy.
The researchers concluded that long-term quality of life was similar after appendectomy and antibiotic therapy for the treatment of uncomplicated acute appendicitis.
Patients who were treated with antibiotics who later underwent appendectomy were less satisfied overall than patients with initially successful antibiotics or appendectomy.