1200-P: Diabetes. Predictors of glycaemic and weight gain response to empagliflozin treatment: The ABCD Nationwide Empagliflozin Audit. (2019)

Type of publication:
Poster presentation

Author(s):
Thong K, Chung-wah-Cheong J, Yadagiri M, Cull ML, Bickerton A, Phillips SM, Evans A, Sennik DK, Rohilla A, Reid H, *Morris DS, Atkin M, Robinson AM, Williams DM, Stephens JW, Adamson K, Gallen IW, Ryder RE.

Citation:
Diabetes 2019 Jun; 68 (Supplement 1)

Abstract:
Introduction: We investigated clinical parameters that are potentially associated with improved empagliflozin treatment response.

Methods: We obtained data from a large-scale audit of empagliflozin use in the UK. We analyzed the association between patients’ baseline age, HbA1c, weight, diabetes duration, alanine aminotransferase (ALT), sex, chronic kidney disease (CKD) stage, empagliflozin dose (25 vs. 10mg), use of GLP-1RAs and use of insulin with HbA1c and weight changes at 26 weeks of treatment.

Results: Among 1436 patients, HbA1c reduced by, mean[95% CI], 1.35%[1.27,1.42] (p<0.0001) from a baseline of, mean±SD, 9.41±1.41%. Among 1381 patients, weight reduced by 3.6 kg[3.3,3.9] (p<0.0001) from a baseline of 100.2±20.7 kg. Results of univariate analyses are shown in Table 1. In multivariate analysis, higher baseline HbA1c (p<0.0001), lower CKD stage (p=0.002) and higher ALT (log transformed)(p=0.02) were associated with greater HbA1c reduction. Higher baseline weight (p<0.001) and non-insulin use (p<0.0001) were associated with greater weight reduction.

Conclusion: As expected, HbA1c reduction was associated with baseline HbA1c and background renal function, while weight reduction was associated with baseline weight. The interactions between HbA1c reduction and ALT levels, and weight reduction with insulin treatment status warrant further investigations.

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1201-P: Characteristics and Treatment Outcomes of Patients Treated with Empagliflozin in the ABCD Nationwide Empagliflozin Audit (2019)

Type of publication:
Poster presentation

Author(s):
Thong K, Chung-wah-Cheong J, Yadagiri M, Cull ML, Bickerton A, Phillips SM, Evans A, Sennik DK, Rohilla A, Reid H, *Morris DS, Atkin M, Robinson AM, Williams DM, Stephens JW, Adamson K, Gallen IW, Ryder RE.

Citation:
Diabetes 2019 Jun; 68 (Supplement 1)

Abstract:

Introduction: We investigated characteristics and treatment outcomes of patients treated with empagliflozin in a large-scale audit of routine clinical practice in the UK.

Methods: Data was obtained from the Association of British Clinical Diabetologists Nationwide Empagliflozin Audit. Between December 2014 to September 2018, multiple sites submitted data through 10 major centers on 1947 patients with at least one follow-up visit after empagliflozin initiation.

Results: Baseline characteristics of patients were, mean±SD, age 59.9±9.9 years, diabetes duration 6.4±5.4 years, HbA1c 9.41±1.43%, weight 99.6±20.8 years, BMI 33.6±9.1 kg/m2and 62.1% were male. Proportion of use of empagliflozin 25mg (vs. 10mg), GLP-1 receptor agonist, and insulin were 63.7%, 13.7% and 20.1%, respectively. There were 44.9%, 49.9%, 5.1% and 0.1% of patients with eGFR>90, 60-89, 45-59 and <45 ml/min/1.73m2, respectively. By 26 weeks, treatment with empagliflozin was associated with, mean±SD, HbA1c reduction of 1.35±1.49% (p<0.0001), weight reduction of 3.6±5.1 kg (p<0.0001) and systolic blood pressure reduction of 5±14 mmHg (p<0.0001).

Conclusions: An audit of empagliflozin use in the UK revealed poorly controlled diabetes being frequently encountered in practice in contrast to randomized clinical trials. There was a preponderance of empagliflozin 25mg dose use, disproportionate prescribing to men rather than women, and frequent co-prescription with GLP-1 receptor agonists and insulin. The audit showed excellent adherence to prescribing guidelines in relation to avoiding empagliflozin use in patients with eGFR<45 ml/min/1.73m2. There was similar treatment efficacy with empaglilfozin as was seen in clinical trials.

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Inhaled corticosteroids and pneumonia in COPD at primary care level (2018)

Type of publication:
Conference abstract

Author(s):
*Ibrahim J.; *Ali A.; *Zeb M.; *Crawford E.; *Makan A.; *Srinivasan K.; *Moudgil H.; *Ahmad N.

Citation:
Thorax 2018;73(Suppl 4):A114

Abstract:
Background Association between inhaled corticosteroids and pneumonia in COPD population is well known.1 And the risk of pneumonia is greatest with the use of high dose inhaled corticosteroids (HD-ICS).2 Hence, further work to reduce the prescription of HD-ICS should be informed by local practices. Aim We aimed to assess the incidence of pneumonia in COPD patients based at primary practices in our region according to their HD-ICS prescriptions. And thereby develop methods to safely wean off HD-ICS in this population. Methods Data was obtained on all hospital admissions for pneumonia between April-September 2017 with a secondary diagnosis code of J44 indicating COPD, from the head of information at our clinical commissioning group. We divided this data at a general practice level. We also obtained data on prescription of HD-ICS at each of the general practices till September 2017 from openprescribing.net. Statistical results were obtained from MS Excel and Vassar Stats. Results There are 14 general practices in the region. There were 123 pneumonia admissions to hospital with a secondary diagnosis of COPD. This included 50% males (n=62) with a mean age (SD) of 75 (9.7) years. There were 5 practices with >10 pneumonia admissions during this period and when compared with those with <10 pneumonia admissions, the median (IQR) COPD population was 107 patients (103-126) v 47 patients (32-69) [p<0.05] with a median (IQR) use of HDICS prescriptions 239 (170-290) v 108 (86-172) [p<0.05]. Conclusion Our data show an association between HD-ICS prescriptions and pneumonia in COPD population at a primary care level in our region. Having looked at the data including GP practices with higher prescriptions of HD-ICS, we have developed an algorithm (figure 1) to wean patients off HD-ICS while at the same time promoting awareness through local interest group meetings. (Figure Presented) .

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Breast Reconstruction Affects Coping Mechanisms in Breast Cancer Survivors (2019)

Type of publication:
Journal article

Author(s):
*Lake, Blossom; Fuller, Heidi R; *Rastall, Sarah; *Usman, Tamoor

Citation:
Indian Journal of Surgery; Feb 2019; vol. 81 (no. 1); p. 43-50

Abstract:
Coping strategies used by women with breast cancer are vital for adjustment to their disease. Whilst it is clear that factors such as age at diagnosis, social support and ethnicity can influence coping mechanisms, there is currently no information about whether breast reconstruction changes mechanisms of coping for such patients. The aims of this study, therefore, were to determine how women who have had immediate breast reconstruction and mastectomy cope, compared to those who have mastectomy alone, and whether there are differences in coping mechanisms due to breast reconstruction surgery. This was a retrospective cohort study, using a standardised questionnaire called the Brief Cope Scale. Inclusion criteria was the following: all women
who had immediate breast reconstruction and mastectomy in Shropshire from 2003 to 2014 for ductal carcinoma in situ or node-negative invasive breast cancer. Each patient was matched for year of diagnosis, adjuvant therapy and age to one woman who had mastectomy alone. Two hundred thirty-four questionnaires were sent with a 58% response rate. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.66, P value 0.04) compared to those in the mastectomy alone cohort. In contrast, significantly more patients in the mastectomy alone cohort coped by active venting compared to the reconstruction cohort (T value 1.71, P value 0.04). This study indicates for the first time that breast reconstruction may alter coping mechanisms in breast cancer survivors. Awareness of these coping mechanisms will enable clinicians to provide appropriate, individualised support.

Community-acquired pneumonia: what community nurses should know. (2019)

Type of publication:
Journal article

Author(s):
*Pickstock, Shirley

Citation:
Journal of Community Nursing; Apr 2019; vol. 33 (no. 2); p. 50-54

Abstract:
Pneumonia has a huge impact upon the healthcare system in the UK and is not only associated with higher rates of hospital admissions than any other respiratory disease, but also carries a high risk of mortality. This article offers an overview of community-acquired pneumonia in adult patients, including the pathophysiology, common aetiologies, at-risk groups and pharmacological management. There is also a brief discussion on differential diagnoses and potential strategies to support clinical decision-making in the community.

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Real-world Effectiveness and Safety of Pazopanib in Patients With Intermediate Prognostic Risk Advanced Renal Cell (2018)

Type of publication:
Conference abstract

Author(s):
Procopio G.; Bamias A.; Schmidinger M.; Hawkins R.; Sanchez A.R.; Estevez S.V.; *Srihari N.; Kalofonos H.; Bono P.; Pisal C.B.; Hirschberg Y.; Dezzani L.; Ahmad Q.; Rodriguez C.S.; Jonasch E.

Citation:
Annals of Oncology (2018) 29 (suppl_8): p.313

Abstract:
Introduction: The objective of this study was to determine the effectiveness and safety of pazopanib in patients with intermediate-risk advanced/metastatic renal cell carcinoma in the PRINCIPAL study (NCT01649778). Patients and Methods: Patients had clear-cell advanced/metastatic renal cell carcinoma and met intermediaterisk International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Assessments included progression-free survival, overall survival, objective response rate, and safety. We also evaluated effectiveness based on number of risk factors, age, and performance status (PS), as well as safety in older and younger patients.
Result(s): Three hundred forty-three and 363 intermediate-risk MSKCC and IMDC patients were included, respectively. The median progression-free survival was 13.8 months (95% confidence interval [CI], 10.7-18.1 months) and 7.4 months (95% CI, 6.2-10.3 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 13.1 months (95% CI, 10.7-18.1 months) and 8.1 months (95% CI, 6.4-10.7 months) for patients with 1 and 2 IMDC risk factors, respectively. The median overall survival was not reached and was 15.2 months (95% CI, 12.3-26.5 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 33.9 months (95% CI, 33.9 months to not estimable) and 19.4 months (95% CI, 14.3 months to not estimable) with 1 and 2 IMDC risk factors, respectively. A lower overall response rate was observed with Eastern Cooperative Oncology Group PS >= 2 (vs. PS < 2). All-grade treatment-related adverse events occurred in approximately 63% of patients, and the safety profile among older and younger patients was similar.
Conclusion(s): Outcomes with pazopanib in intermediate-risk patients suggest that patients can be further stratified by number of risk factors (1 vs. 2) and Eastern Cooperative Oncology Group PS (< 2 vs. >= 2) to more accurately predict outcomes. Patients with intermediate-risk advanced renal cell carcinoma are a heterogeneous population, having either 1 or 2 risk factors. It is unclear whether all patients in this risk category should be treated similarly. A secondary analysis of the PRINCIPAL study of pazopanib found that patients can be stratified by number of risk factors and Eastern Cooperative Oncology Group performance status to more accurately predict outcomes.