Sandipan Bhattacharjee

Antidepressant use and new‐onset diabetes: a systematic review and meta‐analysis

Antidepressant use has been linked to new‐onset diabetes. However, the existing literature on this relationship has yielded inconsistent findings. The primary objective of this study was to systematically synthesize the literature on the relationship between antidepressant use and new‐onset diabetes using meta‐analysis.

Use of antidepressants and statins and short-term risk of new-onset diabetes among high risk adults

AIMS We evaluated the association of combined use of antidepressants and statins and the risk of new-onset diabetes among high-risk adults. METHODS We used a retrospective, observational, longitudinal design among adults (age ≥ 22 years) who were diabetes free at baseline and had reported hypertension or hyperlipidemia or heart disease. We used data were from 2004 to 2009 Medical Expenditure Panel Survey and identified from self-reported diabetes or insulin use. We categorized antidepressants and statins use into four groups: antidepressants only, statins only, combined use of antidepressants and statins (antidepressants-statins), and neither antidepressant nor statins. We conducted chi-square and multivariable logistic regressions to examine the association between use of antidepressants-statins and new-onset diabetes after controlling for demographic and economic characteristics, health-status, access to care, presence of depression, and lifestyle risk factors. RESULTS In our study sample, 9.3% used antidepressants only, 10.7% used statins only and 2.4% adults reported use of antidepressants-statins. Nearly 2% of the study sample reported new-onset diabetes. In unadjusted analyses, significantly higher proportion of adults using antidepressants-statins (3.2%) reported new-onset diabetes compared to those using neither antidepressants nor statins (1.1%). However, after controlling for all other variables in multivariable regression we did not observe a statistically significant association between use of antidepressants-statins and new-onset diabetes. CONCLUSIONS Our study results do not suggest that use of antidepressants-statins may increase the risk of new-onset diabetes. Future research needs to examine this relationship with specific combinations of these drug classes and using longer follow up periods.

Perception of cancer recurrence risk: more information is better.

OBJECTIVE Breast cancer is the most common cancer among women worldwide. Given the advances in extending survival, the number of recently diagnosed breast cancer patients and longer-term breast cancer survivors is growing. The goals of this study were to better understand (1) perceptions of provider cancer recurrence risk communication, (2) perceived risk of breast cancer recurrence in cancer patients and survivors, and (3) accuracy of perceived risk. METHODS A survey was conducted on women with a prior breast cancer (n=141). RESULTS Approximately 40% of women perceived that providers had not talked about their breast cancer recurrence risk; although only 1 person reported not wanting a physician to talk to her about her risk. Women were largely inaccurate in their assessments of risk. Greater worry, living in a rural area, and longer time since diagnosis were associated with greater inaccuracy. Women tended to think about distal recurrence of cancer as often of local recurrence. CONCLUSIONS Perceived risk of breast cancer recurrence was inaccurate, and patients desired more communication about recurrence risk. PRACTICE IMPLICATIONS Consistent with findings from other studies, greater efforts are needed to improve the communication of cancer recurrence risk to patients. Attention should be paid to those from rural areas and to distal cancer recurrence in women with a previous history of breast cancer.

Co-occurring chronic conditions and healthcare expenditures associated with Parkinson's disease: A propensity score matched analysis

BACKGROUND The objective of this study was to ascertain co-occurring chronic conditions and expenditures associated with Parkinsons disease among elderly individuals (age ≥ 65 years). METHODS A retrospective, cross-sectional matched case-control design with data from Medical Expenditure Panel Survey (MEPS), a nationally representative survey of households in the United States was used. Elderly with Parkinsons disease (N = 350) were compared to a matched control group (N = 1050) based on propensity scores. Ordinary Least Squares regressions on logged dollars were performed to understand the association between Parkinsons disease and expenditures. All analyses accounted for the complex survey design of the MEPS and were conducted in SAS 9.3. RESULTS Among elderly, the average total expenditures were

A systematic review and meta-analysis of the efficacy and safety of the interleukin (IL)-12/23 and IL-17 inhibitors ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab and tildrakizumab for the treatment of moderate to severe plaque psoriasis

15,404 for those with Parkinsons disease and

Prevalence, Patterns, and Predictors of Depression Treatment among Community-Dwelling Elderly Individuals with Dementia in the United States

13,333 for those without Parkinsons disease. Results from regressions revealed that elderly with Parkinsons disease had 109% greater total expenditure compared to those without Parkinsons disease, when only demographic and socioeconomic variables were entered in the model. When co-occurring chronic conditions were additionally included in the model, those with Parkinsons disease had 84% greater expenditures compared to those without Parkinsons disease. CONCLUSIONS Excess expenditures associated with Parkinsons disease are partially driven by co-occurring conditions among individuals with Parkinsons disease.

Prevalence, Patterns and Predictors of Psychotropic Polypharmacy Among Elderly Individuals with Parkinson's Disease In Long Term Care Settings In The United States

Abstract Objective: To systematically analyze the efficacy and safety of interleukin (IL)-12/23, IL-17, and selective IL-23 inhibitors in moderate to severe plaque psoriasis. Methods and results: Twenty-four randomized placebo-controlled trials were included. Compared to placebo, risk ratios (RR) of achieving PASI-75 and PGA/IGA 0/1 respectively were 20.20 (95% CI 13.82–29.54, p < .00001) and 14.55 (10.42–20.31, p < .00001) for ustekinumab 90 mg, 13.75 (8.49–22.28, p < .00001) and 9.81 (5.70–16.89, p < .00001) for ustekinumab 45 mg, 17.65 (12.38–25.17, p < .00001) and 26.13 (16.05–42.53, p < .00001) for secukinumab 300 mg, 15.36 (10.76–21.94, p < .00001) and 20.91 (12.82–34.13, p < .00001) for secukinumab 150 mg, 18.22 (10.63–31.23, p < .000001) and 18.82 (10.36–34.16, p < .00001) for ixekizumab 80 mg every 4 weeks, 19.83 (11.07–35.52, p < .00001) and 20.41 (11.01–37.81, p < .00001) for ixekizumab 80 mg every 2 weeks, 14.79 (9.86–22.16, p < .00001) and 21.93 (15.52–31.01, p < .00001) for brodalumab 210 mg, 11.55 (7.77–17.18, p < .00001) and 16.59 (11.72–23.49, p < .00001) for brodalumab 140 mg, 12.40 (8.87–17.34, p < .00001) and 10.84 (7.91–14.85, p < .00001) for guselkumab 100 mg, 11.45 (7.45–17.58, p < .00001) and 10.97 (6.44–18.69, p < .00001) for tildrakizumab 200 mg, 11.02 (7.17–16.93, p < .00001) and 10.03 (6.45–15.59, p < .00001) for tildrakizumab 100 mg. Similar outcomes were seen for PASI-90. Safety was satisfactory for each therapy at any dose, but a slightly increased risk of withdrawal due to toxicity was observed in individuals receiving ixekizumab compared to placebo. Conclusion: Ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and tildrakizumab were highly efficacious and generally well-tolerated when used as treatments for moderate to severe plaque psoriasis.

Patterns and Predictors of Depression Treatment among Stroke Survivors with Depression in Ambulatory Settings in the United States

OBJECTIVES Co-occurring dementia and depression exerts a substantial burden on the elderly. This study utilizes data from a nationally representative cohort of community-dwelling individuals 65 years and older to examine the prevalence, patterns, and predictors of depression treatment among elderly individuals with co-occurring dementia and depression. DESIGN Retrospective, cross-sectional study. SETTING Multiple years of Medical Expenditure Panel Survey (2002, 2004, 2006, 2008, 2010, and 2012) data. PARTICIPANTS The study sample consisted of elderly (age ≥65 years) individuals who 1) had dementia, 2) were alive during the calendar year, and 3) had co-occurring depression. MEASUREMENTS The dependent variable of this study was depression treatment, identified by antidepressant medication with or without psychotherapy use. Individual level factors associated with depression treatment among elderly individuals with dementia and co-occurring depression were evaluated by conducting multinomial logistic regression. RESULTS Co-occurring depression prevalence among community-dwelling elderly individuals with dementia was approximately 22%. An overwhelming majority (nearly 88%) of the study sample reported receipt of depression treatment. Antidepressants only and combination therapy (antidepressant with psychotherapy) was reported by 75% and 13%, respectively, of the study sample. Age, race/ethnicity, marital status, limitations of instrumental activities of daily living, perceived mental health status, and pain were significantly associated with the reporting of receipt of depression treatment. CONCLUSIONS An overwhelming majority of the study sample received depression treatment and several subgroup differences (such as in terms of age) existed in terms of reporting the use of depression treatment was observed.

Parkinson’s Disease and Home Healthcare Use and Expenditures among Elderly Medicare Beneficiaries

BACKGROUND Elderly individuals with Parkinsons disease (PD) generally suffer from more than one psychiatric comorbidity, which necessitates the use of concurrent psychotropic medications. To the best of the authors knowledge there are no nationally representative estimates of psychotropic polypharmacy among elderly individuals with PD in the United States (US). OBJECTIVE Therefore, the primary objective of this study was to examine the prevalence, patterns and predictors of psychotropic polypharmacy among elderly individuals with PD in the (US). METHODS A retrospective, cross-sectional study design with 2004 National Nursing Home Survey (NNHS) and 2007 National Home and Hospice Care Survey (NHHCS) data was used. The analytic sample included elderly (age ≥65 years) individuals with PD. Antidepressants, antipsychotics, sedative/hypnotics, and anti-anxiety medications constituted the psychotropic medication classes. Concurrent use of two or more psychotropic medications was classified as psychotropic polypharmacy. RESULTS Approximately 93,648 and 37,439 elderly individuals with PD resided in nursing homes and home health settings respectively. Among elderly nursing home residents with PD, the nationally representative prevalence of psychotropic polypharmacy was 26.28%, whereas, it was 21.36% in the home health setting. Use of antidepressant medications constituted the majority of the psychotropic medication use among both nursing home (48.91%) and home health (40.98%) residents with PD. Multiple logistic regression analyses revealed that specific comorbidities were significantly associated with psychotropic polypharmacy among elderly nursing home residents with PD. CONCLUSIONS These findings underscore the importance of evidence-based prescribing when psychotropic medications are used in elderly individuals with PD to reduce unnecessary polypharmacy.

Medication prior authorization from the providers perspective: A prospective observational study

GOAL Despite the importance of treating depression, little is known regarding the current practice pattern of depression treatment among older adults with stroke and depression. We used national survey data from ambulatory settings to examine the depression treatment patterns and predictors among stroke survivors in the United States (US). MATERIALS AND METHODS We used a cross-sectional study design by pooling multiple-year data (2005-2011) from the National Ambulatory Medical Care Survey and the outpatient department of the National Hospital Ambulatory Medical Care Survey. Older adults (age ≥50 years) with stroke and depression constituted the final study sample. Depression treatment defined as antidepressant use with or without psychotherapy was the dependent variable in this study. All analyses adjusted for the complex survey design of the datasets to obtain nationally representative estimates. FINDINGS The overall depression treatment was observed in 47.32% of the study sample, mainly driven by antidepressant use alone. An overwhelming majority used selective serotonin reuptake inhibitors (77% of overall antidepressant use), and sertraline was the most prescribed antidepressant (30.5% of overall antidepressant use). Gender, race or ethnicity, region of residence, number of medications recorded at the sampled visit, and number of chronic conditions were significantly associated with depression treatment. CONCLUSION According to this nationally representative sample, approximately 1 in 2 stroke survivors with depression received depression treatment in ambulatory care settings in the US. Appropriate interventions should be developed to optimize depression treatment.