Jongwha Chang

Quetiapine misuse and abuse: Is it an atypical paradigm of drug seeking behavior?

Recent case reports in medical literatures suggest that more and more second-generation atypical antipsychotics (AAs) have been prescribed for off-label use; quetiapine (Brand name: Seroquel®) showed increase in its trend for off-label use. Little is known about the reasons behind this trend, although historical sedative and hypnotic prescription patterns suggest that despite relatively superior safety profiles of quetiapine (especially for movement disorders), it may be used for treating substance abuse disorder. In addition, recent studies have shown a strong potential for misuse and abuse (MUA) of quetiapine beyond Food and Drug Administration-approved indications. This includes drug-seeking behaviors, such as feigning symptoms, motivated by quetiapine and use of quetiapine in conjunction with alcohol. Quetiapine appears to be the most documented AA with street values bartered illicitly on the street. A recent report from the Drug Abuse Warning Network has shown a high prevalence of quetiapine-related emergency department visits involving MUA. Several other case studies have found that quetiapine causes seeking behaviors observed in substance use disorder. In fact, the majority of quetiapine MUA involved patients diagnosed with substance use disorder. In the absence of a definitive mechanism of action of quetiapines reinforcing properties, it is imperative to gather robust evidence to support or refute increasing off-label use of AAs.

Cardiovascular Mortality of Oral Antidiabetic Drugs Approved Before and After the 2008 US FDA Guidance for Industry: A Systemic Review and Meta-Analysis

BackgroundBoth diabetes and antidiabetic drugs (ADDs) increase the risk for cardiovascular (CV) diseases. Due to the increasing concern about CV safety associated with ADDs, the US FDA revised regulatory guidelines in 2008 to include CV safety as an endpoint.ObjectiveThe objective of the current study was to conduct a systematic review with meta-analysis to compare CV mortality of oral ADDs approved before and after the FDA’s 2008 guidance.MethodsThree electronic databases (PubMed, Scopus, and the Clinical Trial Registry) were searched to retrieve studies published up to 24 February 2017. Randomized clinical trials were included in this study if they (1) were published in the English language; (2) included adults with type 2 diabetes mellitus with or without CV risk factors, who were taking at least one oral antidiabetic drug; and (3) had at least one study outcome as CV mortality. Meta-analysis was performed using a random-effects model. Small-study effects were accessed using funnel plot symmetry. The primary outcome was CV mortality.ResultsWe found that there was no significant increase in CV mortality for drugs approved before and after 2008. The overall odds ratio (OR) and the upper bound of the two-sided 95% confidence interval (CI) for all drugs approved after 2008 (OR 0.74, 95% CI 0.52–1.07) were lower than the overall OR for all drugs approved before 2008 (OR 1.03, 95% CI 0.89–1.19). In addition, the upper bounds of the two-sided 95% CI for both groups of drugs before and after 2008 were below 1.3. Empagliflozin, which was approved after the guidance, was significantly associated with a reduction in CV mortality.ConclusionThe 2008 FDA guidance appears to have a positive impact on CV risk assessment of recently marketed drugs for the management of diabetes.

Prescription Drug Price Paradox: Cost Analysis of Canadian Online Pharmacies versus US Medicare Beneficiaries for the Top 100 Drugs

Background and objectivesDespite the introduction of Medicare Part D (MPD) and 2012 Affordable Care Act (ACA), patients have a cost burden due to increases in drug prices. To overcome cost barriers, some patients purchase their medications from Canadian online pharmacies as Canadian prescription drug prices are believed to be lower than US prescription drug prices. The objective of this study was to determine which top 100 Medicare drugs can be imported to the USA legally, and to determine which type of prescription drug would be more beneficial to be purchased from Canadian online pharmacies. Moreover, we also deemed it important to compare MPD beneficiary annual expenses with expenses patients would have when obtaining their prescriptions from Canadian online pharmacies.MethodsWe conducted a cost analysis from a patient perspective. A list of the top 100 Medicare drugs was compiled and information on drug prices was collected from three Canadian online pharmacies and four MPD plans in Virginia. The annual cost of each Medicare drug and percent change between Canadian online pharmacies and MPD were compared.ResultsA total of 78 drugs from the top 100 Medicare drugs were included in the final analysis. Seventy-six prescription drugs (97.4%) that could be purchased from Canadian online pharmacies showed a significantly lower average drug price percent change of −72.71% (P < 0.0001). The heart health/blood pressure subgroup had the highest number of drugs that could be purchased from Canadian online pharmacies.ConclusionThe majority of prescription drugs can be purchased at lower prices from Canadian online pharmacies when compared to Medicare beneficiaries’ potential expenses. Purchasing medications from Canadian online pharmacies may be a viable option to address cost barriers.

Disparities in hepatitis C virus infection screening among Baby Boomers in the United States

Background: The study objective was to identify potential sociodemographic disparities in hepatitis C virus (HCV) infection screening among Baby Boomers in the United States. Methods: We analyzed cross‐sectional data from the 2013‐2016 National Health Interview Survey. The outcome was whether a person had an HCV infection screening (yes/no). Key independent variables were race/ethnicity, geographic region, poverty level, education level, and health insurance status. Multivariate logistic regression was performed to examine the factors associated with the receipt of HCV screening. Results: The study sample included a total of 41,914 United States Baby Boomers, who represented a population size of 69,554,339. In 2016, the HCV screening rate among Baby Boomers was 13.9%. In the multivariate logistic regression, we found that Asians had 27% lower odds of receiving an HCV screening compared to Blacks (odds ratio [OR] = 0.74, P = .02). People who lived in the Northeast, South, and West had a higher likelihood of having an HCV screening than those who lived in the Midwest (OR = 1.33, 1.39, and 1.69, respectively; all P values <.001). Additionally, people with less education, lower income, and private health insurance were significantly less likely to have an HCV screening. Conclusion: Future studies or interventions are needed to target these disadvantaged populations to improve HCV screening in Baby Boomers.

Spatial and temporal variations of screening for breast and colorectal cancer in the United States, 2008 to 2012

AbstractCancer screening tests are important tools to combat cancer-related morbidity and mortality. There is limited up-to-date research on spatial and temporal variations of colorectal and breast cancer screening in the United States.County-level data of cancer screening adherence rates were generated from 2008 to 2012 Behavioral Risk Factor Surveillance System. We performed the univariate local indicators for spatial analyses (LISA) for the geographic differences of screening adherence rate and the differential LISA for the change of screening adherence rate from 2008 to 2012.In the univariate LISA, low-to-low clusters were consistently identified in counties of New Mexico, Wyoming, and Mississippi (Pu200a<u200a0.05) for both screenings. In the differential LISA, we found low-to-low clusters in Indiana counties (Pu200a<u200a0.05) for mammography screening, which implied that counties with a below-average difference in mammography adherence were surrounded by counties of below-average difference in adherence rates. A high-to-high cluster was also identified in the southern Appalachian counties for mammography screening (Pu200a<u200a0.05). No obvious spatial pattern was found for the colorectal cancer screening adherence rate across the United States.We found low-to-low clusters over time in adherence to screening guidelines for both cancer types in New Mexico, Wyoming, and Mississippi, and clusters of potential decrease in adherence to mammography screening guideline in counties of Indiana. The study also showed improvement on mammography screening clustered in southern Appalachia. The methodology adopted in this study identified areas with clusters of consistent low adherence to screening and a decrease in adherence, which implies that further research and intervention is warranted.

PIH41 PATIENT SATISFACTION AND PERCIEVED CARE IN OBSTETRICIANS AND GYNECOLOGISTS COMPARED TO OTHER SPECIALTIES: ANALYSIS OF US SELF-REPORTED SURVEY DATA

s A169 38 states. Using the data-analysis software SAS Enterprise Guide, the data were analyzed for signifi cant variables by comparing a treatment and control group through frequencies, densities, summary statistics, logistic regression, and linear regression models. RESULTS: Initial analyses reveal the majority of infants diagnosed with perinatal infection are male. There is a higher occurrence of the disease in hispanic and black infants and lower occurrence in whites. The disease is life-threatening and is linked to a longer length of stay and higher total charges. Regression models showed that there are inversely and directly proportional relationships between disease presence and a variety of diagnoses and procedures, some of which can signifi cantly increase a patient’s length of stay and total charges. CONCLUSIONS: Patient descriptors such as race and gender can affect the presence of perinatal infection, and certain common additional diagnoses and procedures associated with the disease can signifi cantly prolong a patient’s length of stay and increase total charges. Applying these results to perinatal infection research, there should be more focus on these factors in order to improve the effi ciency and quality of perinatal infection treatment and management. PIH39 ASSOCIATION BETWEEN SEXUAL DRIVE CHANGE AND PREMENSTRUAL SYMPTOMS Yang M, Hammond GC, Yarlas AS, Gricar JA QualityMetric Incorporated, Lincoln, RI, USA, Independent Health Care Consultant, New