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3. Sex-specific risk of heart failure and acute myocardial infarction associated with osimertinib in older patients with non-small cell lung cancer.

Author

Byun, Joo-Young, Han, Sola, Liu, Yan, and Park, Chanhyun

Abstract

Background: The cardiovascular risk associated with the newer epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), osimertinib, in non-small cell lung cancer (NSCLC) is being reported. While more than half of patients with NSCLC are aged 65 or older, whether the cardiovascular risk increases in older patients treated with osimertinib compared to traditional EGFR-TKIs has not been clearly identified. Objectives: We aimed to identify the risk of major adverse cardiovascular events (MACEs) in older patients treated with osimertinib and traditional EGFR-TKIs, stratifying by sex, age, and race/ethnicity. Design: A retrospective cohort study. Methods: Using the 2006–2019 Surveillance, Epidemiology, and End Results (SEER)-Medicare, older patients with advanced NSCLC prescribed EGFR-TKIs were included. Hazard ratio (HR) and 95% confidence interval (CI) of incident MACEs were calculated using Cox proportional hazard model. Results: Osimertinib had a significantly higher risk of heart failure (HF) [HR, 1.20 (95% CI, 1.01–1.42)] and a lower risk of angina [HR, 0.36 (95% CI, 0.20–0.64)] than first/second-generation EGFR-TKI. The risk of HF and acute myocardial infarction (AMI) was significantly elevated in female [HR, 1.40 (95% CI, 1.13–1.73)] and male [HR, 1.98 (95% CI, 1.13–3.48)] subgroups, respectively, when used osimertinib than first/second-generation EGFR-TKIs. Within osimertinib users, the risk of HF was higher in patients aged ⩾75 (versus aged 65–74) [HR, 1.71 (95% CI, 1.07–2.71)], White patients (versus Asian/Pacific Islanders patients) [HR, 1.80 (95% CI, 1.04–3.12)]. The risk of AMI within osimertinib users was higher in White [HR, 3.23 (95% CI, 1.34–7.80)] and Black [HR, 5.63 (95% CI, 1.23–25.87)] than Asian/Pacific Islanders patients. Conclusion: Increased risk of HF was observed in patients who are female, White, and aged ⩾75 while male patients had a higher risk of AMI when treated with osimertinib than first/second-generation EGFR-TKIs. The in-depth examination of osimertinib-induced cardiotoxicity provides evidence for individualized cardiotoxicity surveillance, prevention, and treatment for osimertinib users. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Long QT syndrome after using EGFR-TKIs in older patients with advanced non-small cell lung cancer

Author

Byun, Joo-Young, Han, Sola, Qdaisat, Aiham, and Park, Chanhyun

Abstract

ABSTRACTBackgroundLong QT syndrome (LQTS) has been reported in older patients with advanced non-small cell lung cancer (NSCLC) following the use of osimertinib, the third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). However, there have not been analytic epidemiology studies on this topic. We aimed to compare the risk of LQTS between osimertinib and first/second-generation EGFR-TKIs in older patients with advanced NSCLC.Research design and methodsThis retrospective observational study used the 2006–2019 Surveillance, Epidemiology, and End Results (SEER)-Medicare data and included older patients with advanced NSCLC who were treated with either osimertinib or first/second-generation EGFR-TKIs during 2007–2017. Inverse probability of treatment weighting (IPTW) was used to balance the two groups with propensity scores estimated based on the patients’ socioeconomic and clinical characteristics. Crude incidence rate (IR) and adjusted hazard ratio (HR) of the primary outcome, incident LQTS, were estimated.ResultsA total of 545 and 1,135 patients were included in the osimertinib and first/second-generation EGFR-TKI groups, which increased to 1,614 and 1,659, respectively, after IPTW. The osimertinib group had a higher IR of LQTS (2.62 per 100 person-years, 95% CI 2.03–3.38) compared to the first/second-generation EGFR-TKI group (1.33 per 100 person-years, 95% CI 0.92–1.92). After adjusting for covariates, the osimertinib group had a higher risk of LQTS than the first/second-generation EGFR-TKI group, with an HR of 1.94 (95% CI 1.23–3.08). The increased LQTS risk in the osimertinib group was even higher in females, whites and patients aged ≥ 75.ConclusionsGiven the elevated risk of LQTS associated with osimertinib user, close monitoring for cardiac rhythm irregularities of high-risk patients following initiation of EGFR-TKI is recommended.

Published
2024
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9. A Systematic Review of Economic Evaluations of Active Tuberculosis Treatments

Author

Byun, Joo-Young, Kim, Hye-Lin, Lee, Eui-Kyung, and Kwon, Sun-Hong

Subjects
Pharmacology, economic evaluation, tuberculosis, systematic review, cost-effectiveness analysis, cost-utility analysis, Pharmacology (medical), Therapeutics. Pharmacology, RM1-950
Abstract

Background: The disease burden of active tuberculosis (TB) is considerable, but systematic reviews of economic evaluations of active TB treatments are scarce.Methods: PubMed, EMBASE, and the Cochrane Library databases were used to search for articles on cost-effectiveness analysis or cost-utility analysis that economically evaluated active TB treatments, which were then systematically reviewed by two independent reviewers. We extracted vital components of the included studies, such as country, population, intervention/comparator, primary outcome, values of outcomes, thresholds, model type, time horizon, and health states included in the model.Results: Seventeen studies were included in this systematic review. Thirteen dealt with interventions of medications, and the remaining four compared care strategies. The Markov model was the most commonly used tool to compare medications, whereas studies on care plans mainly used decision trees. The most commonly used primary outcome was disability-adjusted life years, followed by quality-adjusted life years. For treatment-naïve TB, the 4-month regimen was more cost-effective than the 6-month regimen mainly in low- and middle-income countries. For multidrug-resistant TB, a bedaquiline-based regimen was cost-effective. For multidrug-resistant TB, decentralized care that employed the use of home or mobile devices was more cost-effective than hospital-based centralized care in low- and middle-income countries.Conclusion: New treatment strategies to improve therapeutic outcomes by enhancing treatment adherence, such as regimens with shorter durations (2 or 4 months) and decentralized care, or new anti-TB agents (e.g., bedaquiline) have been suggested as cost-effective interventions for active TB. This review provides information on the economic evaluation of active TB from good-quality studies, thus aiding the future economic evaluation of active TB.

Published
2021

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