Facilitating human papillomavirus vaccination pathways by extending vaccination competencies to community pharmacists: A cross-sectional survey on the acceptability and expectations among healthcare professionals and parents.

Background: Human papillomavirus (HPV) vaccination coverage rate (VCR) remains low in France (37.4% in girls in 2021). The French health authority recommended in 2022 to extend vaccination competencies to additional healthcare providers (HCPs), including community pharmacists (CPs). Objectives: To understand the acceptability by general practitioners (GPs), CPs and parents of adolescents of extending vaccination competencies and to identify benefits and barriers of new vaccination pathways. Methods: This cross-sectional research used a qualitative and quantitative approach. For the quantitative survey, GPs, CPs and parents of adolescents eligible to HPV vaccination completed an online questionnaire. Participants were asked to imagine themselves in different pathways and evaluate them. Results: A total of 200 GPs, 201 CPs and 800 parents were included. The level of acceptability of extending vaccination competencies to other HCPs was high in CPs (86% rated ≥7/10), but low in GPs (35%) and intermediate in parents (61%). Parents ranked first (44%) a pathway where GPs prescribed while CPs vaccinated because GPs inspire confidence as vaccine prescribers (80%) and parents prefer to be informed on vaccination by them (80%). CPs ranked first (42%) a scenario where they vaccinated after invitation of adolescents from the French National Health Insurance Fund (NHIS). They emphasized the simplicity of this scenario (94%) and the potential increase of VCR (91%), but asked to be more informed on HPV vaccination (77%) and favored television (83%) for communication campaigns. Conclusions: GPs and parents, in contrast with community pharmacists, were only moderately supportive of the extension the vaccination competencies. Confidence in the HCP remains the primary factor for adherence to a vaccination pathway beyond the simplicity of the pathway. Training of CPs, traceability tool, support from authorities and communication campaigns are levers that will support CPs in their new role and contribute to increase parents' acceptability toward CPs.

Presence of anti-cyclic citrullinated peptide antibodies is associated with better treatment response to abatacept but not to TNF inhibitors in patients with rheumatoid arthritis: a meta-analysis.

OBJECTIVES: The objective of this study was to investigate whether anti-cyclic citrullinated peptide antibody (ACPA) status is associated with clinical responses to abatacept or TNF-α-inhibitors (TNF-α-i) in RA patients. METHODS: A systematic literature review (SLR) was performed in January 2018 to identify published studies and conference abstracts evaluating biologic DMARD response according to ACPA status. Mantel-Haenszel meta-analysis methods were used to pool risk ratios (RRs). In the base-case, treatment response was assessed using EULAR measure, while a scenario analysis assessed response by combining ACR20, DAS28 and EULAR measures. Subgroup analyses were performed for duration of study follow-up. RESULTS: Eighteen of the 30 SLR studies were included in the meta-analysis. The base-case showed a statistically significant positive association between ACPA positivity and EULAR response for patients treated with abatacept (RR: 1.13 [95% CI: 1.00, 1.26]), while ACPA positivity was associated with lower EULAR responses to TNF-α-i (RR: 0.91 [95% CI: 0.84, 0.98]). For the scenario analysis, results were consistent with the base-case for abatacept (RR 1.18 [95% CI 1.03, 1.35]), while for TNFα-i, no significant difference by ACPA status was observed (RR 0.97 [95% CI 0.86, 1.10]). Subgroups analyses showed results similar to the base-case for both abatacept and TNF-α-i. CONCLUSIONS: This meta-analysis confirms that ACPA-positive RA patients are marginally more likely to achieve EULAR and ACR20 response to abatacept compared to ACPA-negative patients. Additionally, the analysis demonstrates that there is no association between ACPA status and response to TNF-α-i, consistent with findings of previously published studies.

Botulinum Toxins Type A (Bont-A) in the Management of Lower Limb Spasticity in Children: A Systematic Literature Review and Bayesian Network Meta-analysis.

BACKGROUND: Botulinum neurotoxins type A (BoNT-As) are used in pediatric lower limb spasticity, which affects more than 2.5 million children worldwide. Botulinum neurotoxins type-A improve active function and delay musculoskeletal complications. The objective of this analysis was to evaluate the efficacy and safety of abobotulinumtoxinA versus other botulinum neurotoxins type A in pediatric spasticity, in the absence of head-to-head evidence. METHODS: A systematic literature review was conducted to identify relevant randomized controlled trials. The evidence base was synthesized with Bayesian network meta-analyses. Outcomes analyzed included Modified Ashworth Scale, Tardieu Scale (TS) spasticity grade, and Goal Attainment Scale (standard mean difference only) at 12 weeks postinjection, and adverse events occurring during study periods. RESULTS: Thirty-eight studies were identified, 10 of which met inclusion criteria for quantitative synthesis. On Modified Ashworth Scale, abobotulinumtoxinA 15 U/kg/leg was significantly more efficacious than onabotulinumtoxinA 4 U/kg/leg (-0.99 [-1.34, -0.64]) and onabotulinumtoxinA 4 U/kg/leg+casting (-0.81 [-1.16, -0.46]) and numerically better than onabotulinumtoxinA 8 U/kg (-0.40 [-0.67, -0.14]). AbobotulinumtoxinA 10 U/kg/leg was significantly more efficacious than onabotulinumtoxinA 4 U/kg/leg (±casting). On Goal Attainment Scale, abobotulinumtoxinA 15 U/kg/leg and 10 U/kg/leg were significantly more efficacious than onabotulinumtoxinA 12 U/kg/leg. On Tardieu Scale spasticity grade, abobotulinumtoxinA was comparable to other treatments. AbobotulinumtoxinA demonstrated adverse event rates comparable to all doses of onabotulinumtoxinA. CONCLUSIONS: In pediatric lower limb spasticity, abobotulinumtoxinA offered significant or numerical efficacy advantages on tone (Modified Ashworth Scale) and functional outcomes (Goal Attainment Scale), and comparable efficacy on Tardieu Scale spasticity grade. AbobotulinumtoxinA was comparable to onabotulinumtoxinA on tolerability. Results should be interpreted in the context of heterogeneity and sparsity of the evidence base.