Characterizing Health Outcomes in Idiopathic Pulmonary Fibrosis using US Health Claims Data.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a life-threatening interstitial lung disease (ILD). Characterizing health outcomes of IPF patients is challenging due to disease rarity. OBJECTIVE: This study aimed to identify the burden of disease in patients newly diagnosed with IPF. METHODS: Patients with ≥1 claim with an IPF diagnosis were identified from a United States healthcare insurer's database (2000-2013). Patients with other known causes of ILD or aged <40 years were excluded. Subgroups were compared based on the 2011 change in International Classification of Diseases, 9th Revision (ICD-9) definition of IPF and occurrence of IPF testing. The prevalence and incidence of preselected health conditions of clinical interest were estimated. RESULTS: Median age of newly diagnosed patients (n = 7,298) was 62 years (54.0% male). Restricting to patients with IPF diagnostic testing did not substantially affect cohort characteristics, nor did ICD-9 IPF coding change. Mean follow-up was 1.7 years; 16.8% of patients died; and a substantial proportion of patients were censored due to end of health plan enrollment (50.7%) and other causes of ILD (19.6%). The incidence of pulmonary hypertension, lung cancer, and claims-based algorithm proxy for acute respiratory worsening of unknown cause was 22.5, 17.6, and 12.6 per 1,000 person-years, respectively. CONCLUSIONS: Patients with IPF had a high disease burden with a variety of health outcomes observed, including a high rate of mortality. Database censoring due to changes in enrollment or other ILD diagnoses limited follow-up. Altering cohort entry definitions, including IPF testing or ICD-9 IPF coding change, had little impact on cohort baseline characteristics.

Eficacia de los ácidos grasos omega-3 como tratamiento suplementario en la esquizofrenia / Efficacy of Omega-3 Fatty Acids as a Supplementary Treatment in Schizophrenia

La teoría de la membrana fosfolípidica en torno a la etiopatogenia de la esquizofrenia sostiene que una deficiencia en la composición de ácidos grasos poliinsaturados (PUFA) de los lípidos en la membrana neuronal es un factor relevante en la fisiopatología de este trastorno. Diversos ensayos clínicos evalúan el papel terapéutico de la suplementación con PUFA omega-3 en la esquizofrenia. Una revisión sistemática de la literatura publicada identificó siete ensayos clínicos realizados en condiciones de doble ciego y control con placebo que evaluaron la eficacia de dicha suplementación. Los resultados de estos estudios son heterogéneos. Parte de los datos indica una eficacia moderada de la suplementación con ácido eicosapentaenoico en dosis de 2 g/día en pacientes con esquizofrenia establecida. Dos estudios se centraron en psicosis incipiente, con resultados alentadores a corto plazo. Sin embargo, los estudios que reclutaron mayor número de pacientes no advirtieron diferencias respecto a placebo (AU)

The phospholipid membrane theory about the aetiopathogenesis of schizophrenia supports the idea that a deficiency in the polyunsaturated fatty acids (PUFA) of the lipids in the neuronal membrane is a significant factor in the pathophysiology of this disorder. Various clinical trials have evaluated the therapeutic role of omega-3 PUFA supplements in schizophrenia. A systematic review of the published literature was performed, identifying 7 double-blind, placebo controlled clinical trials that evaluated the efficacy of these supplements. The study results are heterogeneous. The data suggest that there is a moderate effect with supplements containing eicosapentaenoic acid in a dose of 2 g/day in patients with established schizophrenia. Two studies focused on incipient psychosis, with encouraging results in the short term. However, the studies that recruited a larger number of patients did not observe any differences compared to the placebo (AU)

An open-label study of amisulpride in the treatment of mania.

BACKGROUND: Amisulpride is a selective D(2)-D(3) antagonist that has been reported to be effective in the treatment of schizophrenia and major depressive disorder. However, no prospective study to date has assessed the effectiveness and tolerability of this compound in mania. METHOD: Twenty DSM-IV-defined acutely ill manic bipolar patients with a Young Mania Rating Scale (YMRS) score of 20 or more entered this open, prospective, 6-week study. Assessments included the YMRS, the Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions Scale for Bipolar Disorder, Modified (CGI-BP-M), and the systematic report of adverse events. Amisulpride was added to other medications, but other antipsychotics were not allowed. RESULTS: Fourteen patients (70%) completed the study. Using last-observation-carried-forward (LOCF) analyses, amisulpride produced significant improvements on the YMRS (p = .0001), the HAM-D (p < .0141), and the overall (p = .0003), mania (p = .0001), and depression (p = .0268) subscales of the CGI-BP-M. The most common side effect was sedation (N = 5, 25%), but there were also some extrapyramidal symptoms, galactorrhea, insomnia, and agitation. The mean amisulpride dose was 680 mg/day (LOCF) and 786 mg/day in completers. CONCLUSIONS: This first prospective study on amisulpride in the treatment of mania suggests that, despite the limitations of the open, observational design and small sample size, amisulpride may be effective and reasonably safe in the treatment of bipolar mania. D(2) and D(3) antagonism may be involved in the mechanisms of the therapeutic response to antipsychotics in mania.