ObjectivesThe 30‐day clinical outcomes with prasugrel or ticagrelor were compared using a US payer database in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).BackgroundPrasugrel and ticagrelor demonstrated superior efficacy with increased non‐coronary artery bypass graft major bleeding compared with clopidogrel in randomized clinical trials. No direct randomized or observational studies have compared clinical outcomes between prasugrel and ticagrelor.MethodsPatients hospitalized for ACS‐PCI between August 1, 2011 and April 30, 2013 and prescribed prasugrel or ticagrelor were selected. Drug treatment cohorts were propensity matched based upon demographic and clinical characteristics. The primary objective compared 30‐day net adverse clinical events (NACE) in prasugrel‐ and ticagrelor‐treated patients using a prespecified 20% noninferiority margin. Secondary objectives included comparisons of major adverse cardiovascular events (MACE) and major bleeding.ResultsData were available for 16,098 patients (prasugrel, n = 13,134; ticagrelor, n = 2,964). In unmatched cohorts, prasugrel‐treated patients were younger with fewer comorbidities than ticagrelor‐treated patients, and 30‐day NACE rates were 5.6 and 9.3%, respectively (P < 0.001). Following propensity matching, NACE was noninferior (P < 0.001) and 22% lower in prasugrel‐treated than in ticagrelor‐treated patients (RR, 0.78; 95% CI, 0.64–0.94). A 30‐day adjusted MACE (RR, 0.80; 95% CI, 0.64–0.98) and major bleeding (RR, 0.65; 95% CI, 0.45–0.95) were also lower in prasugrel‐treated patients compared with ticagrelor‐treated patients.ConclusionsIn this “real‐world,” retrospective, observational study, physicians appear to preferentially use prasugrel in younger patients with lower risk of bleeding or comorbidities compared with ticagrelor. Following adjustment, clinical outcomes associated with prasugrel use appear as good, if not better, than those associated with ticagrelor in ACS‐PCI patients. © 2015 Wiley Periodicals, Inc.

Patient-reported outcomes (PROs) associated with insulin therapy are potentially important determinants of adherence to diabetes management programs. This article reviews published evidence of PROs over the past 3 decades in patients with type 1 diabetes (T1D) and/or type 2 diabetes (T2D) who used vial and syringe for insulin delivery compared to those who used insulin pens. Based on predetermined selection criteria, articles were identified through a search of primary sources published from January 1980 to February 2008. Two independent reviewers determined study eligibility and performed a detailed evaluation of the articles that met the selection criteria. Of the 124 articles screened, 41 met selection criteria. Approximately 75% of the selected articles were published between 1990 and 2008, and a majority (78%) of the research studies was conducted outside the United States. Most (>75%) of the studies evaluated male and female patients with T1D and/or T2D and mean ages around 45 years. Studies used varied comparative study designs with follow-up periods ranging from 2 weeks to 5 years. The PROs assessed in these articles included preference, acceptability, treatment satisfaction, ease of use, convenience, injection pain, handling, and dosing. Most articles (n = 36) showed more favorable PROs for insulin pen users compared to vial and syringe users. These findings have potential clinical and policy implications for patients, diabetes care providers, and/or payers to make evidence-based decisions regarding ways to facilitate initiation and management of insulin therapy.

Aim: To describe treatment patterns and outcomes for advanced/metastatic non-small-cell lung cancer (aNSCLC) treated with single-agent or combination ramucirumab (ramucirumab-based) and/or immune checkpoint inhibitor (ICI-based) therapy. Materials & methods: Retrospective study of aNSCLC patients (n = 4054) identified in the Flatiron Health database, who received at least two treatment lines including ramucirumab- and/or ICI-based regimens between December 2014 and May 2017. Results: Median overall survival (95% CI) from aNSCLC diagnosis was 29.3 (25.5–33.0) months for patients receiving sequential ramucirumab- and ICI-based therapy (n = 245), 15.1 (12.6–18.2) months for patients receiving sequences including ramucirumab- without ICI-based therapy (n = 112), and 23.1 (21.9–24.2) months for patients receiving ICI-based therapy without ramucirumab-based therapy in sequence (n = 3697). Conclusion: Results provide real-world survival estimates for aNSCLC treated with sequences including ramucirumab- and/or ICI-based therapies.

Although adherence to prasugrel was generally high, the duration of therapy was frequently below recommendations. An awareness of risk factors for low adherence or early discontinuation can point to appropriate targets for intervention.

This study was funded by Eli Lilly and Company. Molife, Brown, Tawney, and Cuyun Carter are equity holders and employees of Eli Lilly and Company. Bly, Cinfio, and Klein are employees of Medical Decision Modeling, which received funding from Eli Lilly and Company to conduct this research and prepare this manuscript.