Background and Objective. Skeletal-related events (SREs) are common in men with bone metastases and have negative consequences for patients with castration-resistant prostate cancer (CRPC), including pain, reduced quality of life, and increased mortality. We estimated incidence rates of first SREs in a cohort of men with CRPC in the Surveillance, Epidemiology, and End Results-Medicare database. Methods. We included men aged ≥ 65 years with a prostate cancer diagnosis in 2000-2011 if they had no prior malignancy (other than nonmelanoma skin cancer) and had surgical or medical castration with subsequent second-line systemic therapy, which was used to infer castration resistance. The first occurrence of an SRE (fracture, bone surgery, radiation therapy, or spinal cord compression) in Medicare claims was identified. Incidence rates of SREs were estimated in all eligible person-time and, in secondary analyses, stratified by any use of bone-targeted agents (BTAs) and history of SRE. Results. Of 2,234 men with CRPC (84% white, mean age = 76.6 years), 896 (40%) had an SRE during follow-up, with 74% occurring within a year after cohort entry. Overall, the incidence rate of SREs was 3.78 (95% CI, 3.53-4.03) per 100 person-months. The incidence rate of SREs before any BTA use was 4.16 (95% CI, 3.71-4.65) per 100 person-months, and after any BTA use was 3.60 (95% CI, 3.32-3.91) per 100 person-months. The incidence rate in patients with no history of SRE was 3.33 (95% CI 3.01-3.68) per 100 person-months, and in patients who had such a history, it was 4.20 (95% CI 3.84-4.58) per 100 person-months. Conclusions. In this large cohort of elderly men with CRPC in the US, SREs were common. A decrease in incidence of SREs after starting BTA is suggested, but the magnitude of the effect may be confounded by indication and other factors such as age and prior SRE.

Background As people with HIV infections age, comorbidities and complications have increased and could affect antiretroviral therapy (ART) adherence. Purpose To determine the comorbidities of patients with HIV infection, as well as to evaluate their contribution to ART adherence. Materials and methods A twelve-month retrospective observational study (from January 2012 to December 2012) was conducted in HIV-infected patients who were being treated with ART. ART adherence was the dependent variable. We collected the following independent variables: sex, age, HCV coinfection, transmission risk, CD4+ T-cell count, HIV viral load, ART-naive, type of ART and comorbidities. We defined polypathological patients as patients with two or more chronic conditions. Adherence was determined through dispensing pharmacy records (Total number of units dispensed/Total number of units needed×100) and the simplified medicines adherence questionnaire (SMAQ). Patients who took at least 90% of their prescribed ART were classified as good adherers. We performed a univariate logistic regression to determine the relationship between the comorbidities and ART adherence. Results We included 536 patients in the study (80.2% men, mean age 47 ± 7.1 years) of whom 49.2% were HIV-HCV co-infected. Injected drug use was the main mode of HIV transmission. The median CD4+ was 574.5 cells/mm3 (IQR: 353.8–776.3) and viral suppression (<20 copies/ml) was noted in 73.5% of the whole study population. 82.5% were ART-naive overall, antiretroviral regimens were mainly NNRTI-based (40.3%), and 31.5% were receiving a PI-based regimen. We identified 51.9% polypathological patients. The most common comorbidities were: dyslipidaemia (19.4%), neuropsychiatric disorders (14.7%), hypertension (13.2%), diabetes (5.6%) and cardiovascular disease (5.2%). The percentage of adherent patients was 86.2%. The variable polypathological patients (OR = 0.44; CI[0.26–.74]; p = 0.002) showed statistically significant relationships with ART adherence. Conclusions There is an important number of polypathological HIV-infected patients. Despite ART adherence being high, the presence of these comorbidities significantly reduces adherence. No conflict of interest.

188 Background: Skeletal-related events (SREs) are common in men with bone metastases and have negative consequences for patients with castration-resistant prostate cancer (CRPC), including pain, reduced quality of life, and increased risk of death. Published data on background rates of SREs in men with CPRC in real-world practice are sparse. Methods: We included men aged ≥ 65 years in the SEER-Medicare database with a prostate cancer diagnosis in 2000-2011 if they had no prior malignancy, had surgical or medical castration, and met protocol-defined criteria for castration resistance. Castration resistance was inferred from subsequent treatment with any of these systemic therapies: abiraterone, cabazitaxel, docetaxel, enzalutamide, mitoxantrone, or sipuleucel-T. The first occurrence of an SRE was identified in Medicare claims using diagnosis or procedure codes for fracture, bone surgery, radiation therapy, or spinal cord compression. We estimated incidence rates (IRs) of SREs in all eligible person-time and stratified by person-time before and after any use of the following bone-targeted agents (BTAs): alendronate, denosumab, ibandronate, pamidronate, risedronate, or zoledronic acid. Results: Of 2,234 men with CRPC (84% white, mean age 76.6 years), 896 (40%) had an SRE during follow-up, with 74% occurring within a year after cohort entry. Overall, the IR of SREs was 3.78 (95% CI, 3.53-4.03) per 100 person-months. The IR of SREs before any BTA use was 4.16 (95% CI, 3.71-4.65) per 100 person-months, and after any use was 3.60 (95% CI, 3.32-3.91) per 100 person-months. Conclusions: In this large cohort of elderly men with CRPC in a real-world setting in the U.S., SREs were common, with most occurring within a year after cohort entry. Although a direct causal interpretation of the difference in rates before and after BTA use is not possible (since confounding by indication and other factors cannot be excluded), further analysis may address at least some potential confounders.

Background Potentially inappropriate medicines (PIM) use in older adults has been associated with increased medicines-related problems and morbidity. Investigating the prevalence of this problem is important for the initiation of intervention programmes in order to prevent its occurrence. Purpose To estimate the prevalence of PIM use in older adults and determine the drugs involved. Materials and methods Prospective study carried out in a third level hospital over 8 months (from January to August 2013). All patients older than 65 years were included who were taking ≥5 medicines and were admitted to the hospital’s internal medicine service. Each patient’s home medicines profile was revised after admission. The frequency of PIM use was analysed according to the Beers criteria 2012. The criteria reviewed covered 2 types of statements: medicines that should generally be avoided in persons 65 years or older and medicines that should not be used in older persons known to have specific medical conditions (drug-disease interaction). Results A total of 216 patients were evaluated in this study. The average age was 78.8 ± 8.8. A total of 193 PIM were detected in 79(36.6%) patients. Frequency of PIM was: long acting benzodiazepines 35(16.2%), digoxin > 0.125 mg/d 38(17.6%), amiodarone 4(1.8%), amitriptyline 6(2.7%), first-generation antihistamines 12(5.5%), doxazosin 11(5.1%), nifedipine immediate release 2(0.9%), aspirin > 325 mg/d 2(0.9%), non–COX-selective NSAIDs 16(7.4%). Frequency of drug-disease interaction was: heart failure-diltiazem 12(5.5%), dementia and cognitive impairment-benzodiazepines 28(13.0%), Parkinson’s disease- metoclopramide 5(2.3%), history of gastric or duodenal ulcers- NSAIDs 8(3.7%), serotonin-norepinephrine reuptake inhibitors-hyponatraemia 4(1.8%), stress or mixed urinary incontinence-doxazosin 10(4.6%). Conclusions The results of this study showed a high prevalence of PIM use in older adults. Inappropriate chronic use of potentially unsafe medicines must be a key issue in medical and pharmaceutical care. Interventions for decreasing drug-related problems should be planned in order to minimise drug-related costs. No conflict of interest.

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