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Purpose The purpose is to describe management of adverse events of special interest across tyrosine kinase inhibitors approved for metastatic renal cell carcinoma. Methods We conducted a retrospective chart review in metastatic renal cell carcinoma patients initiating tyrosine kinase inhibitor monotherapy between 15 November 2010 and 15 November 2013, and experiencing ≥ 1 adverse events of special interest (diarrhea, fatigue, hand-foot syndrome, hypertension, or stomatitis/mucositis) within 3 months of initiation. Demographics, medical history, treatment regimens, and adverse events of special interest management data for 3.5 months postonset were collected. Results In 220 charts from 27 centers, tyrosine kinase inhibitors prescribed included sunitinib (55%), pazopanib (27%), axitinib (9%), and sorafenib (8%). During the study period, patients experienced 376 adverse events of special interest (13% serious). Fatigue was most common (62% of patients), followed by hypertension (37%), diarrhea (30%), stomatitis/mucositis (29%), and hand-foot syndrome (12%). Over half (56%) the adverse events of special interest were resolved or resolving. Treatment discontinuation due to adverse events of special interest occurred in 15% of patients. Prophylaxis was rarely provided (8%), whereas 59% of patients received adverse events of special interest treatment (pharmacologic (55%) and/or nonpharmacologic (7%)), 27% received tyrosine kinase inhibitor dose management, 23% received both adverse events of special interest treatment and dose management, and 31% received neither. Hypertension was the most treated (72% of all events), and fatigue was the least treated (9%); only 4% of patients received pharmacologic treatment for fatigue. Conclusions Most adverse events of special interest were nonserious and more than half of the patients received pharmacologic and/or nonpharmacologic treatment. Fatigue was the most common yet least frequently treated adverse event of special interest, and few patients received prophylaxis or nonpharmacologic treatment. More emphasis on treatment and prophylaxis options for bothersome adverse events is warranted. [ABSTRACT FROM AUTHOR]

This retrospective study compared adverse-event rates in patients with chronic lymphocytic leukemia (CLL) or non-Hodgkin lymphoma (NHL), with and without renal impairment, receiving bendamustine alone or with rituximab. Patients ( n = 940) were stratified into a renally impaired group (creatinine clearance [CrCL] < 40 mL/min) and two comparator groups (CrCL ≥ 40 mL/min and CrCL ≥ 60 mL/min). Renally impaired patients with NHL had a significantly greater incidence of grade 3-4 thrombocytopenia compared with the CrCL ≥ 60 mL/min group (hazard ratio [HR], 2.57; p = 0.025). For CLL and NHL together, grade 3-4 increased blood urea nitrogen was significantly higher in the renally impaired group than in the CrCL ≥ 40 mL/min (HR, 2.36; p = 0.02) and CrCL ≥ 60 mL/min (HR, 4.46; p = 0.001) groups. Based on these results, monitoring blood counts (including platelets) and renal function would be prudent in the management of patients with renal dysfunction and NHL or CLL who receive bendamustine-based regimens. [ABSTRACT FROM AUTHOR]

Introduction: US administrative claims data provide the opportunity to study large, generalizable, real-world populations. Our objective was to study the epidemiology of CAD and PAD, and characterize cohorts of patients with either incident CAD, incident PAD, or both (CAD/PAD) Methods: The Optum Clinformatics® database includes medical and pharmacy claims for > 56 million individuals and is representative of the insured US population by age, gender, race, and region. CAD/PAD was considered incident if not diagnosed in prior 1.5 yr period. Annual prevalence and incidence rate (IR) of CAD/PAD were estimated for patients ≥18 yrs between 2008 - 2016. We described baseline characteristics, treatments, and event rates during follow-up for 2 cohorts of patients ≥18 yrs with no prior atrial fibrillation, VTE, or cancer: 1. Incident CAD/PAD, and 2. Hospitalized with incident CAD/PAD. Results: The CAD/PAD cohort comprised 910,946 patients, mean age 67.1 yrs (SD 13.40), 51% female. Hypertension was the most common comorbidity (74%), followed by hyperlipidemia (68%), and diabetes (36%). P2Y12 inhibitors were dispensed for 22% of patients during baseline or follow-up. The hospitalized CAD/PAD cohort comprised 164,720 patients, mean age 68.9 yrs (12.66) and only 42.6% female. The proportion of most baseline comorbidities and previous treatment with beta blockers, diuretics, or lipid lowering agents were similar. The prevalence of CAD/PAD generally increased from 4.9% in 2009 to 5.9% in 2016; the IR ranged between 16.7 - 18.7 per 1,000 person yrs (PY). Hospitalized CAD/PAD prevalence was stable at 1.2%; IR was 3.6-4.0. IR per 1,000 PY during follow-up (mean 961 days) in the CAD/PAD cohort were 213.3 for all-cause hospitalizations, 24.9 CV hospitalizations, 44.5 MI, 35.0 GI bleeding, 8.8 intracerebral hemorrhage, 21.5 limb ischemia, and 6.2 amputation. IR (post discharge) in the hospitalized cohort was markedly higher for MI (220.1), and 50%-60% higher for all-cause and CV hospitalizations. Risk of events was substantially higher in the first year of follow-up compared to following years in both cohorts. Conclusions: The incidence of CAD or PAD is associated with a high rate of hospitalizations and morbidities, especially in the first year post-diagnosis. [ABSTRACT FROM AUTHOR]

Inappropriate antibiotic prescribing is common, and the consequences are severe. Prescribing guidelines are intended to reduce inappropriate prescribing. Guidelines, though, give empirical antibiotic treatment recommendations that are general and not tailored to local prevalence patterns. A computerized decision support system for empirical antibiotic prescribing that considers the likely infectious organism, antibiotic susceptibility, and patient characteristics, should decrease inappropriate antibiotic prescribing. We describe the design of such a system and the setting for its evaluation.