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Background Second‐line treatment for immune thrombocytopenia (ITP) is not well reported for patients treated in real‐world clinical settings. Objective The purpose of this study was to compare outcomes of four second‐line treatments for ITP. Patients/methods Included adult patients had at least two medical records containing ITP diagnoses and second‐line eltrombopag, romiplostim, rituximab, or splenectomy. Date of treatment initiation or splenectomy was set as index date, between July 1, 2008, and March 31, 2017. Patients had first‐line corticosteroid or intravenous immune globulin treatment and continuous database activity from 6 months before to 12 months after index. Patient characteristics, treatment patterns, platelet counts, bleeding‐related episodes (BREs), and thrombotic events (TEs) were compared by second‐line treatment cohort. Results The sample included 3332 patients (mean age, 60.5 years; 52.3% female): eltrombopag (5.8%), romiplostim (9.9%), rituximab (73.3%), and splenectomy (11.0%). Patients having splenectomy were younger, more likely female and commercially insured, and less likely to require a third line of treatment than medical regimen cohorts. Proportions of patients having treatment‐free (≥180 days with no second‐line index or rescue agent) periods varied significantly (P = .01) by regimen: 33% for eltrombopag, 23% for romiplostim, 26% for rituximab, and 17% for splenectomy. All regimens significantly improved platelet counts, while TE and BRE rates differed significantly (P = .03 and P = .01, respectively) when all treatment groups were compared. Conclusions Over an average 7‐year follow‐up, all second‐line regimens improved platelet counts, but eltrombopag yielded the highest proportion of patients with completely treatment‐free periods of at least 180 days.

Background Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19. Methods This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression. Findings Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620–1·763; Black: 1·810, 1·743–1·880; Asian: 1·503, 1·381–1·636) and during follow-up (Hispanic: 1·700, 1·638–1·764; Black: 1·578, 1·526–1·633; Asian: 1·391, 1·288–1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809–0·959) but higher for Asian patients (1·205, 1·000–1·452). Interpretation Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19–related care, further analyses of disaggregated population-level COVID-19 data are needed. Funding None.

Este estudo objetivou verificar a prevalência de cefaleia em adolescentes e sua associação com o uso excessivo de computador e jogos eletrônicos. A amostra foi composta por 954 adolescentes (14 a 19 anos), de ambos os sexos, que responderam ao questionário sobre uso de computadores e jogos eletrônicos, presença de cefaleia e atividade física. Foi utilizada a regressão logística binária e multinomial, com nível de significância de 5%. Evidenciou-se alta prevalência de cefaleia (80,6%) e elevado tempo de uso de dispositivos eletrônicos. O uso excessivo dos dispositivos eletrônicos mostrou-se fator de risco para cefaleia. Os sujeitos com idade entre 14 e 16 anos apresentaram menor chance de relatar a cefaleia. Em relação ao tipo, 17,9% apresentaram cefaleia do tipo tensional, 19,3% migrânea e 43,4% outros tipos de cefaleia. Os adolescentes com idade entre 14 e 16 anos apresentam menor chance de relatar a cefaleia do tipo tensional e de outros. Estar cursando o terceiro ano e usar excessivamente equipamentos digitais mostraram-se fatores de risco para cefaleia migrânea. Os resultados permitem concluir que o uso excessivo de dispositivos eletrônicos está associado à presença de cefaleia, principalmente do tipo migrânea. The aim of this study was to determine the prevalence of headache in adolescents and its association with excessive use of electronic devices and games. The sample comprised 954 adolescents of both sexes (14 to 19 years) who answered a questionnaire about use of computers and electronic games, presence of headache and physical activity. The binary and multinomial logistic regression, with significance level of 5% was used for inferential analysis. The prevalence of headache was 80.6%. The excessive use of electronics devices proved to be a risk factor (OR = 1.21) for headache. Subjects aged between 14 and 16 years were less likely to report headache (OR = 0.64). Regarding classification, 17.9% of adolescents had tension-type headache, 19.3% had migraine and 43.4% other types of headache. The adolescents aged form 14 to 16 years had lower chance (OR ≤ 0.68) to report the tension-type headache and other types of headache. The excessive use of digital equipment, electronic games and attending the third year of high school proved to be risk factors for migraine-type development (OR ≥ 1.84). There was a high prevalence of headache in adolescents and high-time use of electronic devices. We observed an association between excessive use of electronic devices and the presence of headache, and this habit is considered a risk factor, especially for the development of migraine-type.

Background With modern antiretroviral (ARV) regimens, HIV infection has evolved into a manageable chronic condition. The ultimate goal of treatment is to maximize the virologic suppression of HIV virus while minimizing intolerability, toxicity, drug-to-drug interactions, and noncompliance. The objectives of this study were to describe clinical characteristics and treatment history of currently treated HIV-1 patients in commercial and Medicare Advantage health plans in the United States. Methods A retrospective cohort study of adults (≥18 years) with ≥1 ARV pharmacy claim from January 1, 2012 to March 31, 2017 and ≥1 HIV-1 diagnosis code in the Optum Research Database. A claims-based algorithm was used to identify lines of therapy (LOT), including the most recent LOT (LOT0) and previous LOTs dating back to January 1, 2007. Subjects were continuously enrolled 12 months prior to the start of LOT0 (baseline) and comorbidities assessed. Treatment-naïve subjects were defined as having LOT0 only during baseline, while subjects with >1 LOT were defined as treatment-experienced. Study variables were summarized descriptively and results were stratified by treatment status, insurance type, and age groups. Results There were 18,699 eligible subjects, of whom 27% were treatment naïve. Average age was 47 years (±12), 84% were male, 51% Caucasian, and 82% had commercial insurance. Common baseline comorbidities among subjects were hyperlipidemia (41%), cardiovascular disease (41%), hypertension (34%), and depression (17%). Most comorbidities increased with age except for depression and anxiety, which were mostly constant across age groups. Among all subjects, the average cumulative proportion of days covered with an ARV was 85%. Average total pills per day, ARV and non-ARV, increased with age corresponding with Medicare subjects having 9.2 and commercial subjects having 3.7 pills per day. Conclusion As ARV regimens have improved the life expectancy for patients with HIV, management of comorbidities and overall medication burden has become increasingly complex. HIV treatment guidelines suggest streamlined ARV regimens may be considered as patient complexity evolves over time to decrease disease burden taking into account co-morbidities, drug–drug interactions and total pill burden. Disclosures J. Priest, ViiV Healthcare: Employee, Salary. T. Burton, Optum: Consultant and Employee, Salary. AstraZeneca: Research Contractor, Consulting fee. C. Blauer-Peterson, Optum: Employee, Salary. ViiV: Research Contractor, Consulting fee. K. Andrade, Optum: Employee, Salary. Viiv: Research Contractor, Consulting fee. A. Oglesby, ViiV Healthcare: Employee and Shareholder, Salary.

INTRODUCTION:Cancer treatment-related thrombocytopenia is a serious problem in patients treated for cancer. Literature indicates the incidence of chemotherapy and radiation induced thrombocytopenia can be as high as 50%, based on underlying cancer type and treatment. This study describes patients treated with eltrombopag, a thrombopoietin receptor agonist, for cancer treatment -related thrombocytopenia. METHODS: Patients, who initiated treatment with eltrombopag and met all inclusion criteria, were identified from the Optum EHR database between 1st Jan 2009 to 31st Mar 2018. The earliest order date for eltrombopag was considered the index date. Inclusion criteria were: 18 years of age and older; male or female; diagnosis of solid or lymphoid malignancy prior to the index date; receipt of systemic chemotherapy 4 months prior or 1 month after the index date; platelets 100,000/mm3 pre index date; no evidence of prior use of eltrombopag; no evidence of therapy with rituximab; and, active in the database for at least 4 months prior to and at least 14 days following index date. Outcomes evaluated were (1) pre-index date minimum and mean platelet values, (2) post index date maximum and mean platelet values during the index chemotherapy cycle of eltrombopag treatment and line of therapy (LOT) time periods. RESULTS: The study cohort consisted of 107 patients, with mean age of 63.7 years (SD: 17.9), 59.8% male, 40.2% female, and 32.7% had commercial insurance. The mean Charlson Comorbidity index (CCI) score was 4.0 (SD: 2.6). Top cancer diagnoses were malignant neoplasms of lymphoid and histiocytic tissue (14.0%), malignant neoplasm of female breast (9.4%), and malignant neoplasm of trachea, bronchus and lung (5.6%). Top chemotherapy regimens used in the cohort were: decitabine (9.4%); azacitidine (8.5%); lenalidomide (6.6%); ruxolitinib (3.8%), and carboplatin plus gemcitabine, daunorubin plus cytarabine, hydroxyurea, and radiation (2.8% for each regimen). The mean index cycle duration was 2.3 months (SD: 2.4 months) and median was 1.2 months, while the mean index LOT duration was 3.3 months (SD: 2.6 months) and median was 3 months. The pre and post mean platelet values, shown in the figure, indicated an increase in the mean platelet values post treatment in the mean and maximum values from the mean and minimum pre-index values, within both the index cycle and the LOT treatment period. CONCLUSIONS:The results of this retrospective analysis of patients with cancer treatment-related thrombocytopenia treated with eltrombopag are consistent with eltrombopag's known profile in improving platelet counts, as evidenced for other approved indications. Further studies are needed to determine the specific patient population who will benefit most from eltrombopag in this type of secondary thrombocytopenia. Figure1: Pre and Post Index Cycle and LOT Mean Platelet Values Disclosures Pawar: Novartis: Consultancy. Velcheti:AstraZeneca: Consultancy; Foundation Medicine: Consultancy; Merck: Consultancy; Boston Scientific: Consultancy; BMS: Consultancy; Novartis: Consultancy; Reddy Labs: Consultancy; Alkermes: Consultancy; Genentech: Consultancy. Lal:Optum: Employment. Le:Optum: Employment. Andrade:Optum: Employment. Desai:Precision Xtract: Employment. Patwardhan:Novartis Pharmaceuticals: Employment. OffLabel Disclosure: Eltrombopag for chemotherapy or radiation induced thrombocytopenia

INTRODUCTION: Immune Thrombocytopenia (ITP) is a disease of immune-mediated destruction of platelets and suppression of platelet production. ITP has been historically treated with corticosteroids and/or immune globulins as first-line agents. There are several second-line treatments available, should patients fail to respond to initial treatment or relapse after it is tapered. This study utilizes a national electronic health record (EHR) database to understand clinical outcomes with use of second-line treatments including: thrombopoietin receptor agonists (specifically, eltrombopag and romiplostim), rituximab, and splenectomy. METHODS: Utilizing the Optum EHR database, we identified patients who initiated a second-line treatment from Jan. 1, 2009 to Sep. 30, 2016 for primary or unspecified ITP. Additionally, patients included in the analysis had the following characteristics: 18 years or older; previous treatment with corticosteroids or immune globulin products; and active in the database for at least 6 months prior to and 12 months post initiation of a second-line treatment. Evaluated outcomes included: (1) platelet counts; (2) bleeding related episodes (BREs); and (3) thrombotic events (TEs), including stroke, transient ischemic attack, myocardial infarction, deep vein thrombosis, and pulmonary embolism. All outcomes were evaluated over the 12-month period following the initiation of second-line treatment. BREs and TEs were defined using ICD codes, collapsed to first three characters, indicating a form of bleeding or thrombotic events. Chi-square test and t-test were used to evaluate differences among the four treatment cohorts (eltrombopag, romiplostim, rituximab, and splenectomy). RESULTS: 2,047 patients met the inclusion criteria and used the second-line treatments as follows: eltrombopag, N=110 (5.4%); romiplostim, N=189 (9.2%); rituximab, N=1,488 (72.7%); splenectomy, N=260 (12.7%). The mean age was 60.8 years (standard deviation [SD]: 17.4), with 52.4% female and mean Charlson comorbidity score of 2.1 (SD: 2.1). Compared with platelet counts at the initiation of second-line treatments (collected within +/- 14 days of initiation of second-line treatments), mean platelet counts achieved during the 12 months post initiation of a second-line treatment increased in all treatment cohorts, ranging from an increase of 63,000/μL for rituximab to an increase of 157,000/μL for splenectomy. Mean platelet counts achieved during the 12 months post initiation of a second-line treatment differed significantly across treatment cohorts, ranging from 102,000/μL for eltrombopag to 240,000/μL for splenectomy (p CONCLUSIONS: This retrospective real world evidence study compares mean platelet response and burden of both BREs and TEs in ITP patients treated with different second-line treatments. Although there were significant differences in mean platelet counts achieved with the second-line treatments, TEs were observed with similar incidence across all treatments. Patients who received splenectomy had the highest mean platelet counts and also the highest proportion of patients who experienced TEs, though differences in TEs did not reach statistical significance. Incidence proportion of patients with BREs was lower in patients treated with eltrombopag than in patients treated with other second-line treatments. Such differences in outcomes may be useful when selecting treatment in the second-line setting. Disclosures Said: Novartis Pharmaceuticals Corporation: Employment. Lal:Optum: Employment. Andrade:Optum: Employment. Nezami:Novartis Pharmaceuticals: Employment. Graves:Novartis: Employment. Roy:Novartis: Employment. Cuker:Kedrion: Membership on an entity's Board of Directors or advisory committees; Synergy: Consultancy; Genzyme: Consultancy; Spark Therapeutics: Research Funding.

BACKGROUND AND OBJECTIVES: The use of electronic devices as entertainment and recreation means has directly affected adolescents’ lives; however their excessive use may bring consequences. This study aimed at observing the prevalence of primary headaches and their possible association with excessive use of computers among adolescents. METHODS: Participated in the study 262 teenagers aged between 14 and 19 years, students of a public school, who have answered a questionnaire to evaluate socio-demographic variables, data on computer use, presence of headache symptoms and level of physical activity. Multiple models of binary and multinomial logistic regression were used to evaluate the association among variables. Significance level was 5%. RESULTS: Prevalence of headache was 87.8%. There has been no significant difference in the prevalence of headache between genders, but among classification types, tension headache was more prevalent among females (35.4%). Females aged between 12 and 15 years and excessive computer use had higher chances of reporting headache. Females have 15.61 times more chance of reporting tension headache. Adolescents reporting excessive computer use had 2.54 times more chance of reporting migraine. CONCLUSION: Results have shown high prevalence of primary headache among adolescents, being migraine the most prevalent type. Abusive computer use were considered risk factors for the development of headache.

BACKGROUND AND OBJECTIVES: The use of electronic devices has reconfigured the daily life of adolescents; however, their excessive use may be associated to health problems. This study aimed at observing the prevalence of musculoskeletal pain among adolescents and its association with the use of computers and videogames. METHODS: Sample was made up of 265 adolescents of both genders (14 to 19 years old), students of a public school, who have answered a questionnaire about the use of electronic devices, musculoskeletal pain, physical activity and demographics. Values of absolute and relative frequency, confidence intervals and mean and standard deviation were expressed for descriptive analysis. Independent t and Chi-square tests were used for comparison between genders, and multiple logistic regression model was used for association test. All tests had significance level of 5%. RESULTS: The prevalence of musculoskeletal pain was 72.1%, being significantly higher for females. There has been no association between musculoskeletal pain and the use of electronic devices; however it was identified that females had 10.66 times more probability of reporting this type of pain. Cervical and thoraco-lumbar pains were associated to females (OR=1.80), and individuals attending the 2nd and 3rd year were associated to cervical pain (OR≥2.26). CONCLUSION: There has been high prevalence of musculoskeletal pain among adolescents, especially females. Although not observing association between pain and use of electronic devices, it was noted that those attending the last years of high school and of the female gender had higher risk to develop musculoskeletal pain. RESUMO JUSTIFICATIVA E OBJETIVOS: O uso de dispositivos eletrônicos reconfigurou o cotidiano dos adolescentes, porém a utilização excessiva pode estar associada a problemas de saúde. O objetivo deste estudo foi verificar a prevalência de dor musculoesquelética em adolescentes e sua associação com o uso de computador e jogos eletrônicos. MÉTODOS: A amostra foi composta por 265 adolescentes de ambos os gêneros (14 a 19 anos), estudantes de uma escola pública, que responderam um questionário sobre uso de dispositivos eletrônicos, dor musculoesquelética, atividade física e dados sócio-demográficos. Para análise descritiva, foram expressos valores de frequência absoluta, relativa, intervalos de confiança e média e desvio padrão. Foram utilizados o teste t independente e Qui-quadrado para comparação entre gêneros, e modelo de regressão logística múltipla para teste de associação. Todos os testes tiveram nível de significância de 5%. RESULTADOS: A prevalência de dor musculoesquelética foi de 72,1%, sendo significativamente maior no gênero feminino. Não foi encontrada associação entre dor musculoesquelética e uso de dispositivos eletrônicos. Porém, foi identificado que o gênero feminino apresenta 10,66 mais probabilidades de referir esse tipo de dor. As dores cervicais e toracolombares tiveram associação com gênero feminino (OR=1,80) e os indivíduos que cursam o 2º e 3º ano tiveram associação com dor cervical (OR≥2,26). CONCLUSÃO: Evidenciou-se alta prevalência de dor musculoesquelética nos adolescentes, principalmente do gênero feminino. Embora não se tenha observado associação entre dor e uso de dispositivos eletrônicos, notou-se que aqueles que cursam os últimos anos do ensino médio e do gênero feminino apresentam maior risco de desenvolver dores musculoesqueléticas.