PubMed:22823909 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PubMed/sourceid/22823909","sourcedb":"PubMed","sourceid":"22823909","source_url":"http://www.ncbi.nlm.nih.gov/pubmed/22823909","text":"Impact of 5-HT3 receptor antagonists on chemotherapy-induced nausea and vomiting: a retrospective cohort study.\nBACKGROUND: 1st generation 5-hydroxytryptamine receptor antagonists (5-HT3 RAs), and palonosetron, a 2nd generation 5-HT3 RA, are indicated for the prevention of chemotherapy (CT)-induced nausea and vomiting (CINV) associated with moderately (MEC) and highly emetogenic CT agents (HEC). This study explores the impact of step therapy policies requiring use of an older 5-HT3 RA before palonosetron on risk of CINV associated with hospital or emergency department (ED) admissions.\nMETHODS: Patients who received cyclophosphamide post breast cancer (BC) surgery or who were diagnosed with lung cancer on carboplatin (LC-carboplatin) or cisplatin (LC-cisplatin) were selected from PharMetrics' (IMS LifeLink) claims dataset (2005-2008). Patients were followed for 6 months from initial CT administration for CINV events identified through ICD-9-CM codes. Patients were grouped into those initiated with older, generic 5-HT3 RAs (ondansetron, granisetron, and dolasetron) and those initiated and maintained on palonosetron throughout study follow-up. CINV events and CINV days were analyzed using multivariate regressions controlling for demographic and clinical variables.\nRESULTS: Eligible patients numbered 3,606 in BC, 4,497 in LC-carboplatin and 1,154 in LC-cisplatin cohorts, with 52%, 40%, and 34% in the palonosetron group, respectively. There was no significant difference between the two 5-HT3 RA groups in age or Charlson Comorbidity Index among the two MEC cohorts (BC and LC-carboplatin). Among the LC-cisplatin cohort, palonosetron users were older with more males than the older 5-HT3 RA group (age: 60.1 vs. 61.3; males, 66.9% vs. 56.9%). Compared to the older 5-HT3 RAs, the palonosetron groups incurred 22%-51% fewer 5-HT3 RA pharmacy claims, had fewer patients with CINV events (3.5% vs. 5.5% in BC, 9.5% vs. 12.8% in LC-carboplatin, 16.4% vs. 21.7% in LC-cisplatin), and had lower risk for CINV events (odds ratios 0.62, 0.71, or 0.71, respectively; p\u003c0.05). The BC and LC-carboplatin palonosetron groups experienced 50% and 30% fewer CINV days than the generic 5-HT3 RA group (p\u003c0.05).\nCONCLUSIONS: Patients with breast or lung cancer initiated and maintained on palonosetron were at significantly lower risk for potentially costly CINV versus those on older 5-HT3 RAs. Further studies on impact of step therapy policy are warranted in order to minimize the clinical and economic burden of CINV.","tracks":[{"project":"Allie","denotations":[{"id":"SS1_22823909_2_0","span":{"begin":139,"end":179},"obj":"expanded"},{"id":"SS2_22823909_2_0","span":{"begin":181,"end":190},"obj":"abbr"},{"id":"SS1_22823909_2_1","span":{"begin":274,"end":286},"obj":"expanded"},{"id":"SS2_22823909_2_1","span":{"begin":288,"end":290},"obj":"abbr"},{"id":"SS1_22823909_2_2","span":{"begin":364,"end":391},"obj":"expanded"},{"id":"SS2_22823909_2_2","span":{"begin":393,"end":396},"obj":"abbr"},{"id":"SS1_22823909_3_0","span":{"begin":554,"end":574},"obj":"expanded"},{"id":"SS2_22823909_3_0","span":{"begin":576,"end":578},"obj":"abbr"},{"id":"SS1_22823909_5_0","span":{"begin":645,"end":658},"obj":"expanded"},{"id":"SS2_22823909_5_0","span":{"begin":660,"end":662},"obj":"abbr"},{"id":"SS1_22823909_5_1","span":{"begin":699,"end":725},"obj":"expanded"},{"id":"SS2_22823909_5_1","span":{"begin":727,"end":741},"obj":"abbr"}],"relations":[{"id":"AE1_22823909_2_0","pred":"abbreviatedTo","subj":"SS1_22823909_2_0","obj":"SS2_22823909_2_0"},{"id":"AE1_22823909_2_1","pred":"abbreviatedTo","subj":"SS1_22823909_2_1","obj":"SS2_22823909_2_1"},{"id":"AE1_22823909_2_2","pred":"abbreviatedTo","subj":"SS1_22823909_2_2","obj":"SS2_22823909_2_2"},{"id":"AE1_22823909_3_0","pred":"abbreviatedTo","subj":"SS1_22823909_3_0","obj":"SS2_22823909_3_0"},{"id":"AE1_22823909_5_0","pred":"abbreviatedTo","subj":"SS1_22823909_5_0","obj":"SS2_22823909_5_0"},{"id":"AE1_22823909_5_1","pred":"abbreviatedTo","subj":"SS1_22823909_5_1","obj":"SS2_22823909_5_1"}],"attributes":[{"subj":"SS1_22823909_2_0","pred":"source","obj":"Allie"},{"subj":"SS2_22823909_2_0","pred":"source","obj":"Allie"},{"subj":"SS1_22823909_2_1","pred":"source","obj":"Allie"},{"subj":"SS2_22823909_2_1","pred":"source","obj":"Allie"},{"subj":"SS1_22823909_2_2","pred":"source","obj":"Allie"},{"subj":"SS2_22823909_2_2","pred":"source","obj":"Allie"},{"subj":"SS1_22823909_3_0","pred":"source","obj":"Allie"},{"subj":"SS2_22823909_3_0","pred":"source","obj":"Allie"},{"subj":"SS1_22823909_5_0","pred":"source","obj":"Allie"},{"subj":"SS2_22823909_5_0","pred":"source","obj":"Allie"},{"subj":"SS1_22823909_5_1","pred":"source","obj":"Allie"},{"subj":"SS2_22823909_5_1","pred":"source","obj":"Allie"}]},{"project":"PubmedHPO","denotations":[{"id":"T1","span":{"begin":300,"end":306},"obj":"HP_0002018"},{"id":"T2","span":{"begin":311,"end":319},"obj":"HP_0002013"}],"attributes":[{"subj":"T1","pred":"source","obj":"PubmedHPO"},{"subj":"T2","pred":"source","obj":"PubmedHPO"}]},{"project":"PubMed_Structured_Abstracts","denotations":[{"id":"T1","span":{"begin":124,"end":591},"obj":"BACKGROUND"},{"id":"T2","span":{"begin":601,"end":1281},"obj":"METHODS"},{"id":"T3","span":{"begin":1291,"end":2214},"obj":"RESULTS"},{"id":"T4","span":{"begin":2228,"end":2524},"obj":"CONCLUSIONS"}],"attributes":[{"subj":"T1","pred":"source","obj":"PubMed_Structured_Abstracts"},{"subj":"T2","pred":"source","obj":"PubMed_Structured_Abstracts"},{"subj":"T3","pred":"source","obj":"PubMed_Structured_Abstracts"},{"subj":"T4","pred":"source","obj":"PubMed_Structured_Abstracts"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"Allie","color":"#ec93a1","default":true},{"id":"PubmedHPO","color":"#93bbec"},{"id":"PubMed_Structured_Abstracts","color":"#d5ec93"}]}]}}