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Abstract Background Few data are available regarding the epidemiology of invasive aspergillosis (IA) in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs) among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. Methods Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008). Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6) who received initial antifungal therapy (AF) in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS) were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. Results From 6,424 aspergillosis patients in the database, 412 (6.4%) ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%), acute respiratory failure (76%) and acute renal failure (41%). In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once). Mean length of stay (LOS) was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p Conclusions Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.

Objective: The aim of this study was to identify factors that influence treatment adjustments and adoption of a treat-to-target (T2T) strategy in patients with rheumatoid arthritis (RA) in European practices., Methods: Cross-sectional data were drawn from the Adelphi 2014 RA Disease Specific Programme. Treatment patterns and clinical characteristics were investigated in patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) vs non-bDMARDs. For the T2T analysis, patients were subdivided into two subsets (RA diagnosis <2 or ≥2 years) and compared according to the approach used (no target = no T2T approach; pragmatic = target different from remission; and aspirational = target set as remission)., Results: Data from 2,536 patients were analyzed (mean age: 52.76 years and mean time since RA diagnosis: 6.05 years). Of the 1,438 patients eligible to receive bDMARDs, 55% did not receive them. Initiation of bDMARDs in a bDMARD-naïve patient was prompted by worsening of the disease. In the RA diagnosis <2 years subset, a T2T approach was not adopted in 58% of the patients, whereas 8% and 34% adopted a pragmatic and aspirational approach, respectively. In the RA diagnosis ≥2 years subset, 45%, 19%, and 36% of the patients adopted a no target, pragmatic, and aspirational approach, respectively. Physician satisfaction with RA control was lower in the RA diagnosis <2 years subset than in the RA diagnosis ≥2 years subset (65% vs 77% satisfied, respectively; P <0.0001)., Conclusion: This analysis shows that the use of bDMARDs remains suboptimal and that a T2T strategy is not universally adopted., Competing Interests: Disclosure PCT has received fees from AbbVie, Bristol-Myers Squibb, Janssen, Lilly, Merck, Pfizer, Sandoz, Biogen, and UCB Pharma. RA has received fees from AbbVie, Bristol-Myers Squibb, Janssen, Lilly, Merck, Pfizer, Sandoz, Biogen, and UCB Pharma. JJGR has received fees from AbbVie, Biogen, Bristol-Myers Squibb, Hospira, Janssen, Merck, Pfizer, Regeneron, and UCB Pharma. RC has received fees from AbbVie, MSD, Pfizer, Roche, and UCB Pharma. PB has received fees from MSD, Pfizer, Reckitt Benckiser, and Roche. ES, RW, and JP are employees of Adelphi Real World and were contracted by Pfizer to provide data, input into design of data collection, and statistical support for the development of this study. This study was spon sored by Pfizer. Adelphi Real World was contracted by Pfizer to conduct the survey and provide data, input into design of data collection, and statistical support for the development of this study. Preliminary data from this study were presented as posters at the British Society for Rheumatology (BSR) Annual Meeting, April 26–28, 2016, Glasgow, Scotland, and at the Annual Scientific Meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP); November 6–11, 2015; San Francisco, CA, USA. The authors report no other conflicts of interest in this work.

Objectives: Optimising therapy to minimise disease activity is the goal for treating rheumatoid arthritis (RA) today. In refractory disease requiring biologics, the ability to modify therapy may be limited. In the case of the most widely used biologics, the TNF inhibitors (TNFi), dose escalation consisting of increasing the dose and/or shortening the interval between doses is often reported., Methods: We systematically searched PubMed, EMBASE, Cochrane and Centre of Disseminated Reviews for reports of dose escalation of TNFi in RA and the economic effects of such a practice., Results: Of 41 publications, 36 reported dose escalation and a weighted proportion of dose escalators was calculated for each drug. The proportion of dose escalators varied widely (adalimumab 7.5% to 36%, etanercept 0% to 22%, and infliximab 0% to 80%) due to a variety of methods for defining dose escalation. Based on 33 studies, the weighted proportion of dose escalators was adalimumab 14.9%, etanercept 4.9% and infliximab 41.7%. Six studies reported economic data comparing dose escalators with non-dose escalators. Adalimumab drug costs increased 27% to 43%, with total costs increasing 28% to 34%; infliximab drug costs increased 14% to 71%, RA-related costs increased 25% to 54% and total costs increased 14% to 34% and etanercept drug costs increased 3.2% to 19%, RA-related costs increased 4.5% and total costs increased 2.2% to 15%., Conclusions: Escalating the dose of TNFi in inadequate responders in RA is widespread, occurring most frequently with infliximab and least with etanercept. This practice not only increases drug costs, but also RA-related and total costs.

Objectives: The present paper aims to investigate the effect of psoriatic arthritis (PsA) disease duration on the outcome of treatment with etanercept (ETN) in patients with PsA who also have moderate-to-severe psoriasis., Methods: Patients from the PRESTA trial who received ≥1 ETN 50 mg once weekly (QW) dose and had ≥1 post-baseline value were evaluated. Baseline and after-treatment changes were compared between patients with PsA ≤2 years versus PsA >2 years in efficacy measures (physician global assessment [PGA] arthritis, swollen joint count and Psoriasis Area and Severity Index [PASI]) and patient reported outcomes (PROs; joint pain, arthritis activity, Euro-Qol [EQ-5D] utility and visual analogue score [VAS]) using linear regression analysis., Results: Baseline efficacy measures were similar between the PsA ≤2 years (n=103) and PsA >2 years (n=269) groups, with the exception of PGA arthritis (p=0.006). At week 24, improvements in efficacy measures were observed in both groups but were significantly greater for PGA arthritis in the PsA ≤2 years group (p=0.03). Quality of life (QoL), measured using PROs, was generally lower at baseline in patients with PsA >2 years. Clinically meaningful improvements were seen in QoL with ETN treatment in both groups, but the change from baseline scores at week 24 were significantly higher in PsA ≤2 years group for joint pain (p=0.007), arthritis activity (p=0.01), EQ-5D utility (p=0.046) and EQ-5D VAS (p=0.04) responses., Conclusions: PsA patients responded to ETN 50 mg QW treatment irrespective of disease duration; however, patients with shorter PsA duration had greater improvements in arthritis scores and several PRO measures.