Simon Greaves

Adverse events resulting in withdrawal of biologic therapy for psoriasis in real-world clinical practice: A Canadian multicenter retrospective study

BACKGROUNDnSafety profiles of biologics for treatment of psoriasis are limited to data from randomized controlled trials. There is a need for comparative safety reports of biologics based on data from clinical practice.nnnOBJECTIVEnWe sought to estimate and compare the incidence of adverse events (AEs) leading to withdrawal of biologics (etanercept, infliximab, adalimumab, and ustekinumab) in the treatment of psoriasis.nnnMETHODSnWe conducted a multicenter retrospective chart review from September 2005 to September 2014. Incidence proportion and rate of AEs leading to withdrawal by biologic agent and AE were calculated.nnnRESULTSnFor 545 treatments administered in 398 patients, 22 (4.04%) AEs were associated with withdrawal, for a rate of 1.97/100 patient-years (95% confidence interval [CI] 1.32-2.94). Common AEs were injection-/infusion-site reactions (0.55%, 0.92%, 0%, and 0% for etanercept, infliximab, adalimumab, and ustekinumab, respectively); infections (0%, 0.18%, 0.55%, 0.18%); and malignancies (0.18%, 0.18%, 0%, 0.37%).nnnLIMITATIONSnPossible incompleteness of chart details and small study population limit the conclusiveness of findings.nnnCONCLUSIONnBiologic agents for treatment of psoriasis are safe; AEs associated with withdrawal occurred in 4% of all administered biologic therapies. It does not appear that real-world patients encounter more AEs with biologics than patients in clinical trials.

Survival rates of biological therapies for psoriasis treatment in real-world clinical practice: A Canadian multicentre retrospective study

Data on biologic drug survival in real‐world psoriasis treatment are limited. There is a need to evaluate long‐term trends of biologic use outside the realm of clinical trials.

Changes in the dispensing of opioid medications in Canada following the introduction of a tamper-deterrent formulation of long-acting oxycodone: A time series analysis

BACKGROUNDnIn February 2012, a reformulated tamper-deterrent form of long-acting oxycodone, OxyNeo, was introduced in Canada. We investigated the impact of the introduction of OxyNeo on patterns of opioid prescribing.nnnMETHODSnWe conducted population-based, cross-sectional analyses of opioid dispensing in Canada between 2008 and 2016. We estimated monthly community pharmacy dispensing of oral formulations of codeine, morphine, hydromorphone and oxycodone, and a transdermal formulation of fentanyl, and converted quantities to milligrams of morphine equivalents (MMEs) per 1000 population. We used time series analysis to evaluate the effect of the introduction of OxyNeo on these trends.nnnRESULTSnNational dispensing of long-acting opioids fell by 14.9% between February 2012 and April 2016, from 36u202f098 MMEs to 30u202f716 MMEs per 1000 population (p < 0.01). This effect varied across Canada and was largest in Ontario (reduction of 22.8%) (p = 0.01) and British Columbia (reduction of 30.0%) (p = 0.01). The national rate of oxycodone dispensing fell by 46.4% after the introduction of OxyNeo (p < 0.001); this was partially offset by an increase of 47.8% in hydromorphone dispensing (p < 0.001). Although dispensing of immediate-release opioids was a substantial contributor to overall population opioid exposure across Canada, it was unaffected by the introduction of OxyNeo (p > 0.05 in all provinces).nnnINTERPRETATIONnThe findings suggest that the introduction of a tamper-deterrent formulation of long-acting oxycodone in Canada, against a background of changing public drug benefits, was associated with sustained changes in selection of long-acting opioids but only small changes in the quantity of long-acting opioids dispensed. This illustrates the limited effect a tamper-deterrent formulation and associated coverage policy can have when other, non-tamper-deterrent alternatives are readily available.

Catastrophic drug coverage: utilization insights from the Ontario Trillium Drug Program

BACKGROUNDnCatastrophic drug coverage programs help those with high drug-costs to reduce the burden of out-of-pocket expenses. We set out to measure changes in utilization, spending and demographic profiles of people accessing Ontarios catastrophic drug program, the Trillium Drug Program.nnnMETHODSnWe conducted a cross-sectional time-series analysis examining quarterly utilization and spending trends among medications reimbursed by the Trillium Drug Program in Ontario, Canada from Jan. 1, 2000, to Dec. 31, 2016. In each of 2000, 2005, 2010 and 2015, we described the population of beneficiaries, including demographic information, health care utilization and medication utilization.nnnRESULTSnOver our study period, use of the Trillium Drug Program increased threefold from 3.6 beneficiaries per 1000 to 10.9 beneficiaries per 1000 Ontarians, and total government spending on the program increased by over 700%, reaching

Impact of Timing of Methadone Initiation on Perinatal Outcomes Following Delivery Among Pregnant Women on Methadone Maintenance Therapy in Ontario

487 million in 2016. Between 2000 and 2015, there was an increase in the number of beneficiaries who were under the age of 35 years (19.6% to 25.3%; p < 0.0001), did not have a hospital admission (68.3% to 80.5%; p < 0.0001) and had medium to high deductibles (2.3% to 8.0%; p < 0.0001). Further, there was a large increase in the percentage of users with drug claims greater than

Efficacies Of Biologic Therapies at week 12 in patients with Plaque Psoriasis in Real World Academic Clinical Practice: A Canadian Multicentre Retrospective Study.

1000 (3.4% to 10.4%; p < 0.0001) and those dispensed a high-cost biologic drug (1.6% to 5.5%; p < 0.0001).nnnINTERPRETATIONnIncreasing use of Ontarios catastrophic drug program highlights the growing burden of high drug prices for Canadians. With a growing number of expensive drugs being approved in Canada, we anticipate that spending and use of the catastrophic drug program will continue to expand.

Effectiveness of sequential use of biologics in the treatment of moderate to severe psoriasis in real world Canadian academic clinical practice: A cohort study

BACKGROUND AND AIMSnMethadone maintenance therapy (MMT) is associated with improved outcomes for children exposed to maternal opioid dependence in utero. We examined Ontarios population of pregnant women on MMT and determined the impact of timing of MMT initiation on perinatal outcomes.nnnDESIGNnCohort study.nnnSETTINGnOntario, Canada.nnnPARTICIPANTSnWomen eligible for public drug benefits and on MMT during pregnancy between 2005 and 2015.nnnMEASUREMENTSnWe stratified women based on their timing of MMT initiation: (1) stabilized prior to conception, (2) newly initiated prior to conception, (3) initiation in trimester 1, (4) initiation in trimester 2 or (5) initiation in trimester 3. The primary outcomes in the multivariable logistic regression analysis were key perinatal health indicators: small for gestational age, preterm birth, congenital anomalies, severe maternal morbidity, caesarean section and induced labor. Secondary outcomes were specific to maternal opioid dependence: neonatal abstinence syndrome (NAS), admission to a neonatal intensive care unit (NICU), NAS treatment, removal from mothers custody at hospital discharge and neonatal death.nnnFINDINGSnAmong 1842 women on MMT during pregnancy, 87.6% (nxa0=xa01614) initiated MMT before conception. Almost a quarter of their infants (22.2%; nxa0=xa0408) were born small for gestational age, 17.5% (nxa0=xa0323) were preterm and 5.9% (nxa0=xa0109) were born with a congenital anomaly. The odds of primary outcomes occurring did not differ based on timing of methadone initiation; however, infants of mothers who initiated methadone during pregnancy had up to a fourfold increase in the odds of social services removal at the hospital [adjusted odds ratio (aOR) rangexa0=xa03.70-4.19] compared with those whose mothers were stabilized on MMT prior to conception.nnnCONCLUSIONSnLater initiation of methadone maintenance therapy among pregnant women in Ontario, Canada has not been found to be clearly related to most key perinatal adverse health outcomes.

Behind the prescriptions: a snapshot of opioid use across all Ontarians

Psoriasis is a chronic inflammatory condition for which biologic therapies have been proven as effective therapies.1 However, considerable variation in the real world efficacy of these agents is observed in clinical practice.2 Given the treatment choices available, it is vital that dermatologists have access to the necessary information for optimal treatment selection in daily clinical practice. In this large, multi-centre study, we examine the real world effectiveness of, etanercept (ETN), adalimumab (ADA), ustekinumab (UST), infliximab (IFX) and validated assessment tools of response to these treatments. n nThis article is protected by copyright. All rights reserved.

Latest trends in opioid-related deaths in Ontario

2. Coloe J, Morrell DS. Could higher doses of isotretinoin reduce the frequency of treatment failure in acne patients? J Am Acad Dermatol. 2011;65(2):422-423. 3. Blasiak RC, Stamey CR, Burkhart CN, et al. High-dose isotretinoin treatment and rate of retrial, relapse, and adverse effects in patients with acne vulgaris. JAMA Dermatol. 2013;149(12): 1392-1398. 4. Absorica (isotretinoin) [ prescribing information]. Jacksonville, FL: Ranbaxy Laboratories Inc; 2014. 5. Gerhardstein PC, Hsu S, Liu A, et al. Relapse of acne following isotretinoin treatment: a retrospective study of 405 patients. J Drugs Dermatol. 2008;7(10):963.