Search

Long 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. This 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. A 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. Given 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. Long QT syndrome (LQTS) indicates a disorder of heart beats with prolonged QT intervals. There have been reports of LQTS in older patients with advanced non-small cell lung cancer (NSCLC) who were treated with osimertinib, a third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). We conducted a retrospective study using Surveillance, Epidemiology, and End Results (SEER)-Medicare database, including older patients aged ≥ 65 with advanced NSCLC who were treated with EGFR-TKIs. Our results show higher incidence of LQTS after using osimertinib than first/second-generation EGFR-TKIs. After adjusting for patients' characteristics that might have affected the incidence of LQTS, the risk of LQTS was significantly higher in osimertinib users than in earlier generation EGFR-TKI users. Females, whites, and patients aged ≥ 75 had an even higher risk of LQTS when treated with osimertinib. Close monitoring for cardiac rhythm irregularities in high-risk patients after osimertinib initiation is recommended. [ABSTRACT FROM AUTHOR]

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]

To describe the clinical profile of nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH) patients in a Texas integrated delivery network (IDN) and elucidate the local relationship between patient factors and the risk of advanced fibrosis. This observational, retrospective, cross-sectional study utilized existing data from the electronic health record at a large Texas IDN. Data was collected during the study period from 1 January 2019, to 1 March 2023. Patient characteristics, comorbidities, labs, and medication orders were collected from the most recent encounter in which a Fibrosis-4 (FIB-4) score could be calculated. Chi square tests and analysis of variance (ANOVA) tests were conducted to evaluate differences among the three fibrosis risk categories. Ordinal logistic regression was utilized to assess associations between select variables and a higher risk of advanced fibrosis. A total of 56,253 patients were included in the study. 34,839 (61.9%) were Low-Risk 15,578 (27.7%) were Intermediate-Risk, and 5,836 (10.4%) were High-Risk of advanced fibrosis. Results showed that up to 70.4% of patients within a risk group were obese. Only 49.5% of patients in the High-Risk group had at least one gastroenterologist or hepatologist visit. Males, Medicare patients, former smokers, and those with hypertension, type 2 diabetes, and chronic kidney disease were associated with a higher risk of advanced fibrosis. This study highlights the need for early screening and proactive management of metabolic risk factors for patients with NAFLD/NASH. The findings indicate a notable prevalence of obesity in the study population, a need for specialist referral for those at High-Risk of advanced fibrosis, and the importance of routine labs to evaluate metabolic factors. Primary care providers may be ideal providers to target these interventions and address this care need. [ABSTRACT FROM AUTHOR]