ObjectiveTo investigate the trends in antiseizure medications (ASM) use following ischaemic stroke and to examine factors associated with use of newer‐ and older‐generation ASMs.MethodsA retrospective cohort study was conducted using state‐wide linked health datasets. Patients who were hospitalised with a first‐ever ischaemic stroke between 2013‐2017 and were dispensed ASM within 12 months from discharge were included. Logistic regression was used to examine the predictors of receiving newer‐generation ASMs. Generalised linear modelling was used to identify factors associated with ASM use after ischaemic stroke.ResultsOf 19,601 people hospitalized with a first‐ever ischaemic stroke, 989 were dispensed an ASM within 12 months from discharge. The most prevalent first ASMs were levetiracetam (38.0%), valproate (25.8%) and carbamazepine (10.3%). Most people were dispensed ASM monotherapy (86.9%). There was a shift towards the use of newer‐generation ASMs between 2013‐2017 (Odds Ratio [OR] 2.82, 95% confidence interval [CI] 1.92‐4.16). Metropolitan residents were more likely to be dispensed newer‐generation ASMs as a first‐line treatment (OR 1.79, 95% CI 1.31‐2.45). People over 85 years (OR 0.38, 95% CI 0.23‐0.64), with dementia (OR 0.35, 95% CI 0.19‐0.63) and psychotic comorbidities (OR 0.29, 95% CI 0.09‐0.96) were less likely to be dispensed newer‐generation ASMs. Older age (coefficient [β] 0.23, p=0.030), history of beta blocker use (β 0.17, p=0.029), multiple ASMs (β 0.78, p<0.001) and newer‐generation ASM (β 0.23, p=0.001) were associated with higher defined daily dose (DDD) of ASM whereas female sex and being married were associated with lower DDD.SignificanceThere has been a shift toward newer‐generation ASMs for post‐stroke seizures and epilepsy. Concerningly, vulnerable patient groups were more likely to be dispensed older‐generation ASMs. This may lead to unnecessary exposure to adverse events and drug‐drug interactions. Further research is needed to evaluate comparative effectiveness and safety of newer‐ and older‐generation ASMs in post‐stroke populations.
Background
The association between obesity and response to neoadjuvant chemotherapy in breast cancer patients is not clear. We evaluated the impact of obesity on response to neoadjuvant chemotherapy in patients with operable breast cancer.
Methods
From May 2008 to December 2010, 104 patients were diagnosed with invasive breast cancer at Korea University Anam Hospital and received neoadjuvant chemotherapy before surgery. Patients were classified into those of normal (BMI of 18.5 to <25kg/m2), overweight (BMI of 25 to <30kg/m2), or Obese (BMI≥30kg/m2). The association between body mass index and pathologic response (pathologic complete response(pCR) and pathologic partial response(pPR)) to neoadjuvant chemotherapy was examined using logistic regression.
Results
Median age was 45 years. Mean BMI was 24.8 kg/m2; 53.8% had a normal BMI, 35.6% overweight, and 10.6% of patients was obese. BMI did not show a significant association with ER status, PR status, HER-2 status, lymph node involvement and neoadjuvant chemotherapy regimen. In univariate analysis, overweight and obese patients were significantly less likely to have a pCR compared with normal weight patients (odds ratio [OR] = 0.300; 95% CI, 0.115 to 0.784; p = 0.010). In multivariate analysis, ER negativity was significantly associated with a pCR and pPR to neoadjuvant chemotherapy (OR = 2.987; 95% CI, 1.128 to 7.907; p = 0.028), And there was significant difference in pCR for overweight and obese compared with normal weight patients (OR = 0.304;95% CI, 0.115 to 0.803; p = 0.016).
Conclusion
This study suggests that higher BMI should be considered to be a factor of worse response to neoadjuvant chemotherapy in patients with operable breast cancer.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-22.
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