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The study was to compare the effectiveness of different epidermal growth factor receptor—tyrosine kinase inhibitors (EGFR‐TKIs) in patients with advanced non‐small‐cell lung cancer (NSCLC) and received EGFR‐TKIs as first‐line therapy. This retrospective cohort study was conducted using data from real‐world settings. Patients with stage IIIB and IV NSCLC and first received gefitinib, erlotinib, or afatinib between 2011 and 2015 were included. The date of the first claim for EGFR‐TKIs was set as the index date. Study endpoints were all‐cause death and treatment failure that was defined when patients added on or switched to chemotherapy or terminal care. A total of 5,940 patients, including 3,982 (67.0%) receiving gefitinib, 1,207 (20.3%) receiving erlotinib, and 751 (12.7%) receiving afatinib, were eligible for this study. The 1‐year overall survival (OS) rates for gefitinib, erlotinib, and afatinib groups were 74% (95% confidence interval [CI]: 72–75%), 75% (95% CI: 73–77%), and 80% (95% CI: 77–83%), respectively. Compared to gefitinib, afatinib was associated with a lower risk of all‐cause death (adjusted hazard ratio [aHR] = 0.82, 95% CI: 0.72–0.93) but not erlotinib (aHR = 0.95, 95% CI: 0.86–1.05). Similar results were also found regarding the effectiveness of treatment. All the three EGFR‐TKIs showed no differences for both outcomes among patients with an Eastern Cooperative Oncology Group Performance Score of 2. The real‐world data exhibited afatinib was more likely to be used for younger patients in a better condition than other EGFR inhibitors, and observed prolonged OS and treatment effectiveness compared to gefitinib after performing a multivariate Cox regression analysis.

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Consistent with Western countries, vision impairment is associated with significantly increased health care costs in Taiwan. The excess costs seem to increase with severity of vision impairment and decrease in the second year.

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OBJECTIVES:To estimate the incidences of hospitalizations for statin-related adverse events (AEs) and further evaluate the influence of the concomitant use of fibrates or cytochrome P450 (CYP) 3A4 inhibitors on the risks of AEs in patients initiating statin treatments. METHODS: A retrospective cohort study design was employed with analyses from the Taiwan National Health Insurance Research Database between January 1, 2000 and December 31, 2007. The study cohort comprised patients initially treated with statins, and was followed to observe the occurrence of hospitalizations for statin-associated AEs, including myopathy, renal adverse events, hepatotoxic events and acute pancreatitis. Use of statins was further categorized into three groups to examine the effect of concomitant use of the interacting drugs: statin-fibrate combination, statin-CYP3A4 inhibitor combination, and statin monotherapy. Poisson regressions were used to estimate the individual incidences and incidence rate ratios (IRRs) of hospitalization events for the combined therapies versus statin monotherapy. RESULTS: A total of 53,594 statin initiators were identified as the study cohort, with atorvastatin and lovastatin being observed as the most commonly prescribed statins. The proportion of statin initiators concomitantly treated with fibrates and CYP3A4 inhibitors was 7.1% and 14.3%, respectively. Overall, the highest incidence occurred in renal adverse events (36.8/10,000 person-years), followed by hepatotoxic events, acute pancreatitis, and myopathy. A similar ranking order of the incidences was observed across the three groups. Compared to statin monotherapy, combination therapy of statins with the interacting medications increased the risks of overall AEs (statin-fibrate combination: adjusted IRR, 2.01; 95% CI, 1.21-3.32; statin-CYP3A4 inhibitor combination: adjusted IRR, 2.29; 95% CI, 1.73-3.02). CONCLUSIONS: Renal toxicity is found to be the most frequently occurring AE during statin treatments. Concomitant use of statins with fibrates or CYP3A4 inhibitors increases the risks of statin-associated AEs, which warrants caution for close monitoring of adverse symptoms when statins are used concurrently with the potential interacting drugs.