Citations

This study uses genetic and pharmacologic approaches to demonstrate novel roles of eosinophils in the progression of atherosclerosis and arterial thrombosis.

Background:The treatment paradigm for multiple myeloma (MM) has evolved rapidly following new drug approvals and combinations. These improvements have the potential to improve outcomes for patients, but only if specialists in hematology/oncology (hem/oncs) have up‐to‐date knowledge on selection of treatments, prevention and management of adverse events (AEs), and comfort with emerging clinical trial data.Aims:We sought to determine if a curriculum of online continuing medical education (CME) activities could improve hem/onc knowledge and competence in treating patients with MM.MethodsThis analysis included hem/onc data from a MM curriculum spanning over 4 years, with 54 activities. For each year of the curriculum, an expert panel identified knowledge/competence gaps to be addressed through CME. Within the analysis, assessment questions were grouped into learning topics and the average for pre and post‐education was calculated for 2016‐2018 of the curriculum for each topic. The analysis elucidated the impact of the curriculum on narrowing gaps in knowledge/competence using a pre/post design. Statistical significance was assessed using a chi‐square statistic (P < .05 level).Results:As of December 2018, the curriculum had reached 33,699 US hem/onc learners and 2144 participated in the outcomes assessment. Treatment Selection: The curriculum significantly improved hem/onc knowledge/competence over time for selecting treatment for patients with relapsed/refractory (R/R) MM (pre/post: 2016, 41%/51%, P < .001; 2018, 48%/64%, P < .001). Managing AEs: The curriculum led to sustained knowledge gains for hem/oncs over time related to managing treatment‐related AEs in patients with MM (pre/post: 2016, 39%/53%, P < .001; 2018, 80%/84%, P = .427). Knowledge of Clinical Trial Data: Activities within the curriculum also significantly improved hem/onc knowledge of clinical trial data for consolidation and maintenance therapy (pre/post: 2016, 63%/76%, P < .001; 2017, 68%/74%, P < .05; 2018, 62%/76%, P < .001). Potential Patient Impact: The reach of Medscape Oncology CME has a large impact on how US hem/oncs treat patients with MM. Of all hem/onc specialists with MM diagnostic encounters, 64% are members of Medscape. Additionally, 70% of all high decile (deciles 7‐10) hem/onc specialists with MM diagnostic encounters are members of Medscape. Based on the number of learners for the curriculum and the average number of patient encounters, this education has the potential to impact 33,894 MM patient encounters.[IQVIA Data]Summary/Conclusion:This analysis shows that online CME, as part of a sustained educational curriculum, using various formats (video, text, panel discussion, case‐based) can significantly improve the knowledge and competence of hem/oncs in multiple areas related to MM. Statistically significant gains in knowledge and competence selecting treatment for R/R MM were seen even with the introduction of new clinical evidence in this area. The analysis also shows the potential impact on patients and the large reach that is achievable with online education. As new therapies and combinations of treatments continue to change practice, additional education is needed to aid hem/oncs in staying abreast of new data, managing AEs, and tailoring therapy selection for individual patients with MM.

AbstractPurposeHistorical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2019 in nonfederal hospitals, clinics, and overall (all sectors).MethodsDrug expenditure data through calendar year 2018 were obtained from the IQVIA National Sales Perspectives database and analyzed. New drug approvals, patent expirations, and other factors that may influence drug spending in hospitals and clinics in 2019 were also reviewed. Expenditure projections for 2019 for nonfederal hospitals, clinics, and overall (all sectors) were made through a combination of quantitative analyses and expert opinion.ResultsU.S. prescription sales in calendar year 2018 totaled $476.2 billion, a 5.5% increase from 2017 spending. The top 3 drugs by expenditures were adalimumab ($19.1 billion), insulin glargine ($9.3 billion), and etanercept ($8.0 billion). Prescription expenditures in nonfederal hospitals totaled $35.8 billion, a 4.8% increase from 2017. Expenditures in clinics in 2018 increased by 13.0% to $80.5 billion. The increase in spending in nonfederal hospitals was largely driven by new products and increased utilization of existing products. The list of the top 25 drugs by expenditures in nonfederal hospitals and clinics was dominated by specialty drugs.ConclusionWe predict continued moderate growth of 4–6% in overall drug expenditures (across the entire U.S. market). We expect the clinic sector to continue to experience high (11–13%) growth in drug spending in 2019. Finally, for nonfederal hospitals we anticipate growth in the range of 3–5%. These estimates are at the national level. Health-system pharmacy leaders should carefully examine local drug utilization patterns to determine their own organization’s anticipated spending in 2019.

Background: The treatment of heart failure with reduced ejection fraction has been the subject of numerous randomized controlled trials involving medications and cardiac implantable electronic device therapies. As newer effective pharmacological therapies suggest significant reductions in all-cause mortality, the role of additional device therapy in heart failure with reduced ejection fraction deserves further scrutiny. Methods: A systematic review and network meta-analysis on the effect of medication and device therapies in heart failure with reduced ejection fraction on all-cause mortality was performed. Randomized controlled trials published between January 1980 and July 2017 were identified using Medline, EMBASE, and Cochrane Controlled Register of Trials databases. Pcnetmeta package in R was used to calculate treatment arm–based estimated rates, rate ratios, and probability ranks with 95% credible intervals. Results: Combination therapy of ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) with β-blockers (BBs) alone or in addition to implantable cardiac defibrillators or cardiac resynchronization therapy with defibrillators demonstrated a significant reduction of all-cause mortality when compared with placebo. By probability rank, implantable cardiac defibrillator+ACE inhibitor or ARB+BB+mineralocorticoid receptor antagonist, implantable cardiac defibrillator+ACE inhibitor or ARB+BB, and angiotensin receptor-neprilysin inhibitor+BB+mineralocorticoid receptor antagonist combination therapies have the highest probability of being ranked the best treatment. There was no significant difference in the rate of mortality when comparing angiotensin receptor-neprilysin inhibitor+BB+mineralocorticoid receptor antagonist to implantable cardiac defibrillator+optimal pharmacological combination therapy. Conclusions: BB and renin-angiotensin system blockers alone or in combination with defibrillator device therapy have robust evidence for a reduction in mortality compared with placebo. The comparative efficacy of pharmacological therapy with angiotensin receptor-neprilysin inhibitors and device therapy deserves further investigation.

Abstract Background High mammographic breast density is the primary reason for missed cancers or delayed detection on mammography, and is associated with a higher rate of advanced and interval cancers which increase breast cancer mortality. Digital breast tomosynthesis (DBT) has been shown to reduce false positive findings relative to 2D mammography but does not eliminate the potential for tumor masking in dense breasts due to the similar x-ray attenuation characteristics of tumors and normal fibroglandular tissue. Molecular Breast Imaging (MBI) performed with a dedicated gamma camera to detect functional uptake of a radiotracer, Tc-99m sestamibi, has been shown to reveal breast cancers obscured by density on mammography. In single-institution studies, adding MBI to 2D mammography in women with dense breasts detected an additional 5 to10 invasive cancers per 1000 screened, with modest increases in recall rate (6 to 8%) at a lower cost-per-cancer detected than mammography alone. Despite this promising evidence, the lack of multicenter trial data has limited wider acceptance. Also, MBI has yet to be compared to DBT, which in some centers has replaced 2D mammography screening. We present interim results from a multicenter trial comparing cancer detection rate of DBT and MBI in screening of women with mammographically dense breasts. Methods In this ongoing, prospective, multicenter clinical trial, asymptomatic women aged 40-75 years with dense breasts on prior mammogram and no prior history of supplemental screening are invited to undergo two annual rounds of concurrent DBT and MBI. MBI is performed with injection of 300 MBq Tc-99m sestamibi with a dual-head semiconductor-based gamma camera. Screening tests are interpreted independently. Here, preliminary cancer detection rates (cancers per 1000 women screened), recall rates, and biopsy rates of DBT and MBI for initial screening are reported. Results In 537 women out of a planned 3000 who have completed the first round of screening, 7 cancers were detected: one by DBT only and 6 by MBI only, giving cancer detection rates of 1.9 for DBT vs. 11.2 for MBI and incremental cancer detection rate of 9.3 for MBI. The one DBT-only cancer was a node-negative 0.8 cm invasive lobular carcinoma. All 6 cancers detected by MBI were invasive; 5 of 6 were node negative (median size 1.0 cm; range 0.6 to 2.6 cm). Recall rate was 11% (60/537) for DBT alone; 16% (84/537) for MBI alone, and 21% (115/537) for the combination. Biopsy was prompted by DBT in 13 patients (PPV 8% [1/13]); by MBI in 23 patients (PPV 26% [6/23]); and by the combination of modalities in 33 (PPV 21% [7/33]). Conclusion These preliminary results demonstrate that MBI detects invasive breast cancers occult on DBT in dense breasts. Data from a second screening round will allow calculation of sensitivity and specificity, and determination of the impact of screening MBI in reducing advanced (&gt; 2 cm) and interval cancers. Additional planned analyses will evaluate a denoising algorithm for further reduction in MBI radiation dose to match that of DBT. Citation Format: Rhodes D, Hunt K, Conners A, Zingula S, Whaley D, Ellis R, Gasal Spilde J, Mehta R, Polley M-Y, O'Connor M, Hruska C. Molecular breast imaging and tomosynthesis to eliminate the reservoir of undetected cancer in dense breasts: The Density MATTERS trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD4-05.