BackgroundChronic hepatitis C (HCV) disease can be complicated with comorbid conditions that may impact treatment eligibility and outcomes. The aim of the study was to systematically review comorbidities and symptoms in an HCV infected population, specifically assessing comorbidities associated with HCV anti-viral treatment and disease, as well as comparing comorbidities between an HCV infected and uninfected control population.MethodsThis was a retrospective cohort study within a United States medical claims database among patients with chronic HCV designed to estimate the two-year period prevalence of comorbidities. Patients with two HCV diagnosis codes, 24 months of continuous health insurance coverage, and full medical and pharmacy benefits were included.ResultsAmong a chronic HCV cohort of 7411 patients, at least one comorbid condition was seen in almost all patients (> 99%) during the study period. HCV-infected patients reported almost double the number of comorbidities compared to uninfected controls. Of the 25 most common comorbidities, the majority of the comorbidities (n = 22) were known to be associated with either HCV antiviral treatment or disease. The five most frequent comorbidities were liver disease [other] (37.5%), connective tissue disease (37.5%), abdominal pain (36.1%), upper respiratory infections (35.6%), and lower respiratory disease (33.7%). Three notable comorbidities not known to be associated with antiviral treatment or disease were benign neoplasms (24.3%), genitourinary symptoms & ill-defined conditions (14.8%), and viral infections (13.8%).ConclusionsThis US medically insured HCV population is highly comorbid. Effective strategies to manage these comorbidities are necessary to allow wider access to HCV treatment and reduce the future burden of HCV disease and its manifestations.

IntroductionThis study aimed to characterize patients with chronic obstructive pulmonary disease (COPD) newly prescribed a long-acting bronchodilator (LABD), and to assess changes in medication over 24 months.MethodsA cohort of patients with COPD aged ≥40 years newly prescribed an LABD between January 1, 2007 and December 31, 2009 were identified from the Truven Marketscan® Commercial Database (Truven Health Analytics, Ann Arbor, MI, USA) and followed for 24 months. Inclusion criteria included no prior prescription for an LABD or inhaled corticosteroids for 12 months prior to the LABD index date (baseline). Patient characteristics were examined. As LABDs were mainly long-acting muscarinic antagonists (LAMAs), additions, switches, discontinuation, adherence to (medication possession ratio), and persistence (proportion of days covered) with LAMA monotherapy were assessed for 24 months following the index date. Adherence and persistence with long-acting β2-agonists (LABAs) were also assessed.ResultsA cohort of 3,268 patients aged 40–65 years was identified (mean age 55.8 years, 48% male). LAMA monotherapy was prescribed to 93% of patients who received an LABD. During the 24-month follow-up, 16% of these patients added COPD medication, 10% switched to an inhaled corticosteroid-containing medication, and 25% discontinued after one LAMA prescription at baseline. Over 12 and 24 months, adherence to LAMA was 40% and 33%, respectively, and adherence to LABA was 29% and 24%, respectively. Over the same time periods, persistence with LAMA monotherapy was 19% and 15%, respectively, and persistence with LABA was 9% and 7%, respectively.ConclusionAdherence to newly initiated LAMA monotherapy was low, with one in four patients adding to or switching from LAMA and many patients discontinuing therapy. Adherence to LABA was also low. These results suggest that additional medication to a single LABD may be required in some patients with COPD to achieve optimal disease control.

Thrombocytopenia is a clinically relevant outcome in HIV. However, the epidemiology of this condition, including frequency, severity, and duration, has not been well-characterized in the era of highly active antiretroviral therapy (HAART). In this study, we describe the epidemiology of thrombocytopenia using two methods. We conducted a systematic review of the literature published between 1997 and 2009 to characterize the frequency of thrombocytopenia in different populations in the HAART era. Secondly, we examined the frequency, severity, and duration of thrombocytopenia among HIV patients in the Collaborations in HIV Outcomes Research/US (CHORUS) Cohort from 1997 to 2006 and among HIV patients participating in GlaxoSmithKline HIV Clinical Trials between 1996 and 2004. Prevalence estimates of thrombocytopenia (<150 000 platelets/µl) in the literature varied greatly but were generally above 10%. The thrombocytopenia prevalence estimates in the CHORUS Cohort and the HIV Clinical Trials were both 14%. In the CHORUS Cohort, the platelet count was ≤50 000/µl among 3.1% and ≤30 000/µl among 1.7%; in the HIV clinical trials database, the platelet count was ≤50 000/µl among 1.3% and ≤30 000/µl among 0.67%. Duration of severe thrombocytopenia varied greatly, with the medium duration to ≥75 000 platelets/µl taking 147 days in the CHORUS Cohort and 33 days in the HIV clinical trials database. Among 111 patients with severe thrombocytopenia in the CHORUS Cohort, 23% never achieved a higher platelet count over follow-up. In conclusion, while the prevalence of severe thrombocytopenia was low, it occurred at levels associated with bleeding and was persistent among a small proportion of patients despite receipt of HAART.

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e22535 Background: Synovial sarcoma (SS) is a rare and aggressive soft tissue sarcoma which primarily affects the extremities of the arms and legs, and can also occur in the head and neck, lungs and pleura, and the trunk. The disease burden of SS is generally extrapolated from overall soft tissue sarcoma (STS) with SS accounting for 4.5% of all STS (587 cases estimated in 2018 in the US) (Noone, 2018; Siegel, 2018). The objective of this study was to provide disease burden estimates specific to SS in the US. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) 18 Registries, Nov. 2017 (2000-2015) were analyzed using SEER*Stat software (v8.3.5). The incidence and prevalence of SS was estimated by utilizing SS-specific International Classification of Diseases for Oncology, V.3 (ICD-O-3) and histology codes. Data from 2011-2015 were used to project incidence rates (age-specific and age-adjusted), 5-year limited duration prevalence, number of incidence and prevalent cases, and the age distribution of synovial sarcoma for 2018. Results: In the US, the age-adjusted incidence rate of SS was 0.177 per 100,000 (estimated 580 incident cases) in 2018. SS is more frequently manifested in patients aged 20-49 years, with the highest occurrence of new cases in patients between 45-49 years (incidence rate 0.26 per 100,000). The prevalence rate of SS across all ages was 0.65 per 100,000 (estimated 2129 prevalent cases) as of January 1, 2018. Conclusions: We described incidence and prevalence rates of SS, including age-specific and age-standardized rates, and characterized the age distribution of SS. This approach provided more precise estimates that are specific to SS without extrapolation from STS, and which are not available in the literature. References: Noone AM, et al. (ed). SEER CSR, 1975-2015, https://seer.cancer.gov/csr/1975_2015/ . Siegel RL, et al. Cancer statistics, 2018. CA Cancer J Clin 2018;68:7–30.

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e13600 Background: Adenoid cystic carcinoma (ACC) is a rare malignancy of the secretory glands, accounting for approximately 1% of head and neck cancers and 10% of salivary gland neoplasms. ACC primarily occurs in the major and minor salivary glands; however, it is found in other sites of the head and neck, breast, female genital tract, prostate and skin. There is limited scientific literature on the epidemiology of ACC and no published incidence or prevalence estimates across all anatomic sites. Methods: Using data from the Surveillance, Epidemiology, and End Results (SEER) 18 registries, ACC cases were identified by International Classification of Diseases for Oncology 3rd Edition histology codes. Data from 2012-2016 were used to estimate age-adjusted incidence rates (IR) and 5-year limited duration prevalence (LDP). Data from 2000-2016 were used to approximate 16-year LDP. IR and LDP were estimated overall and by age, sex and race. IR was calculated for each anatomic site. Total incident and prevalent cases were projected using the 2020 US Census population. Analyses were conducted in SEER*Stat (v8.3.6) and SAS 9.4. Results: In the US, ACC age-adjusted IR was 0.35 per 100,000 and 5- and 16-year LDP were 1.48 and 3.24 per 100,000, respectively (Table). ACC IR and LDP (per 100,000) were highest in those aged 75-79 years (IR 1.45; 5-year LDP 5.82; 16-year LDP 14.25) and in females, and lowest among Native Americans/Alaska Natives. ACC IR (per 100,000) were highest in the oral cavity and pharynx (IR 0.19), salivary glands (IR 0.12), respiratory system (IR 0.07) and breast (IR 0.05). As of January 1, 2020, 10,777 patients were living with ACC in the US who had been diagnosed 2000-2016. Conclusions: This study describes the US epidemiology of ACC across all anatomic sites and provides incidence and prevalence estimates not currently published in the literature. Improving understanding of the epidemiology of this rare cancer has important implications for the development of effective clinical and public health interventions. [Table: see text]

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