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Objectives: Tyrosine kinase inhibitors (TKIs) account for the vast majority of healthcare expenditure on patients with chronic myeloid leukemia (CML), and it has been demonstrated that TKI discontinuation in patients in long-term deep molecular remission (DMR) is safe and improves quality of life. Our objective was to estimate the budget impact of TKI discontinuation in CML patients in long-term DMR from the perspective of the French healthcare system.Methods: This analysis was conducted over a 5-year time horizon using a Markov model with cycles of 6 months. Transition probabilities were estimated through systematic reviews and meta-analyses. Costs were estimated from the French National Claims Database. Monte Carlo simulations were performed to take into account the uncertainty surrounding model parameters. Sensitivity analyses were carried out by varying the size of the target population and the cost of TKIs.Results: Over a 5-year period and for a target population of 100 patients each year eligible and agreeing to stop TKI, the TKI discontinuation strategy would save €25.5 million (95% confidence interval -39.3 to 70.0). In this model, the probability that TKI discontinuation would be more expensive than TKI continuation was 12.0%. In sensitivity analyses, mean savings ranged from €14.9 million to €62.9 million.Conclusions: This study provides transparent, reproducible, and interpretable results for healthcare professionals and policy makers. Our results clearly show that innovative healthcare strategies can benefit both the healthcare system and patients. Savings from generalizing TKI discontinuation in CML patients in sustained DMR should yield health gains for other patients. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to determine the similarities and differences of type 2 diabetes mellitus (T2DM) treatment patterns in daily practice in 5 European countries and whether these reflect differences in guidelines. Methods Prescriptions for drugs used in diabetes treatment during a 5-year study period were obtained from electronic databases. Patients initiating T2DM treatment during the study period were included. An SAS analysis tool was developed to create episodes of use of drug classes, which resulted in treatment patterns. Findings A total of 253,530 patients initiating T2DM treatment during the study period were included; 52% to 55% were male, and the mean age ranged from 62 to 67 years. Metformin was the most common initial treatment in all countries. After initial therapy, most patients in the Netherlands, Spain, and the United Kingdom switched to a combination of metformin + a sulfonylurea derivative (SU). In Italy, metformin in combination with an SU was outnumbered by “other treatment,” mainly because of repaglinide use. In France, treatments including dipeptidyl peptidase-4 inhibitors were most frequent as second- and fourth-line treatment. Metformin monotherapy was again most commonly observed as the third line of treatment in all countries. Fourth treatment was a combination of metformin + an SU in the Netherlands and Spain; in the United Kingdom and France, dipeptidyl peptidase-4 inhibitors were the most frequently used fourth line of treatment. Implications This study provides a comprehensive overview of T2DM treatment patterns among patients initiating T2DM treatment in 5 European countries. There were differences, especially regarding the uptake of newer incretin-based treatments, which are usually prescribed as a second and/or third treatment in agreement with local guidelines. These variations reflect the differences between the national guidelines of these countries. [ABSTRACT FROM AUTHOR]

Background Imatinib has dramatically improved the prognosis of advanced gastrointestinal stromal tumours (GISTs). Clinical trial data showed that patients with trough imatinib plasma concentrations (Cmin) below 1100 ng/ml (quartile 1) had shorter time to progression, but no threshold has been defined. The main objective of this study was to investigate in advanced GIST whether a Cmin threshold value associated with a longer progression-free survival (PFS) could be specified. This would be the first step leading to therapeutic drug monitoring of imatinib in GIST. Patients and methods Advanced GIST patients (n = 96) treated with imatinib 400 mg/d (41 stomach, 34 small bowel, and 21 other primary site localisations) were prospectively included in this real-life setting study. Routine plasma level testing imatinib (Cmin) and clinical data of were recorded prospectively. Results Small bowel localisation was associated with an increased relative risk of progression of 3.09 versus stomach localisation (p = 0.0255). Mean Cmin (±standard deviation) was 868 (±536) ng/ml with 75% inter-individual and 26% intra-patient variability. A Cmin threshold of 760 ng/ml defined by log-rank test was associated with longer PFS for the whole population (p = 0.0256) and for both stomach (p = 0.043) and small bowel (p = 0.049) localisations when analysed separately. Multivariate Cox regression analysis found that Cmin above 760 ng/ml was associated with 65% reduction risk of progression (p = 0.0271) in the whole population independently of the anatomical localisation. Conclusion Concentration of imatinib significantly influences duration of tumour control treatment in GIST patients with a Cmin threshold of 760 ng/ml associated with prolonged PFS in real-life setting. [ABSTRACT FROM AUTHOR]

Abstract: Aim of the study: Hydro-alcoholic extracts of Centaurium erythraea Rafn (CE), Gentianaceae and Artemisia herba-alba Asso (AHA), Asteraceae, medicinal plants used in traditional treatment of diabetes in north-eastern Algeria, were tested in established type 2 diabetes induced with a standardized high fat diet (HFD) in mice. Materials and methods: After confirmation of diabetes (17th week), plant extracts were administered orally by gavage at a dose of 2g/kg daily for 18 weeks to male C57BL/6J mice fed HFD. Animals were weighed, food intake and plasma glucose measured weekly, insulin and lipid profile at study end. Results: At 35 weeks, groups treated with AHA or CE vs. HFD control had a significant reduction in mean (±SD) fasting blood glucose concentrations (143.8±23.9 and 139.5±14.2 vs. 229.0±20.8mg/dL, p <0.05, respectively), triglyceride (18.9±11.1 and 16.0±6.5 vs. 62.8±18.3mg/dL, p <0.05), total cholesterol (1.2±0.1 and 1.2±0.3 vs. 1.8±1.1g/L, p <0.05) and serum insulin concentrations (1.7±0.7 and 0.9±0.7 vs. 3.3±14.3ng/mL, p <0.05). Plant extracts also markedly reduced insulin resistance as compared to HFD controls (AHA: 15.6±9.1, CE: 9.0±7.7 vs. HFD control 38.5±30.3, p <0.05). The plant extracts decreased calorie intake and had little effect on body weight or HDL-cholesterol. Conclusion: AHA has already been shown to have a antihyperglycaemic and antihyperlipidemic effect but this is the first demonstration of an effect of AHA and CE on established HFD-induced diabetes. [Copyright &y& Elsevier]