15. 美国医疗保险受益人与 2017 年更新的 IDSA 指南相关的艰难梭菌感染 (CDI) 治疗利用和临床结果的真实世界变化,Open Forum Infectious Diseases

当前位置： X-MOL 学术 › Open Forum Infect. Dis. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

15. 美国医疗保险受益人与 2017 年更新的 IDSA 指南相关的艰难梭菌感染 (CDI) 治疗利用和临床结果的真实世界变化
Open Forum Infectious Diseases ( IF 3.8 ) Pub Date : 2021-12-05 , DOI: 10.1093/ofid/ofab466.015
Erik R Dubberke ₁ , Justin T Puckett ₂ , Engels N Obi ₃ , Sachin Kamal-Bahl ₂ , Kaushal Desai ₄ , Bruce Stuart ₅ , Jalpa A Doshi ₆

Affiliation

背景 2017 年 IDSA CDI 指南更新逐步淘汰甲硝唑 (MTZ)，并推荐万古霉素 (VAN) 或非达霉素 (FDX) 用于一线使用。本研究检查了指南更新前后 CDI 受益人的 CDI 抗生素使用和临床结果的变化。方法本回顾性理赔分析使用 2016-2018 年国家医疗保险理赔数据。这两个研究样本包括年龄≥66 岁且有新的 CDI 诊断并在期前 (04/01/2017-09/30/2017) 和期后补充抗生素的持续符合条件的按服务收费的医疗保险受益人（04/01/2018-09/30/2018），分别。结果包括接受的 CDI 抗生素类型；持续反应和 CDI 复发。多变量回归比较 pre- vs. 在控制社会人口学和临床因素的同时进行后期结果。结果前期 (N=7,389) 和后期 (N=7,746) 样本具有相似的特征（59% > 75 岁，32% 为男性）。指南更新后，MTZ 的绝对使用率下降了 27.7%（相对变化 [RC] -34.1%，p<0.001），VAN 的使用增加了 26.9%（RC +150.2%，p<0.001）（图 1）。虽然 FDX 使用量增加了 0.8%（RC +87.8%，p<0.001），但总体使用量仍然很低（1.63%）。令人惊讶的是，临床结果在前期和后期之间没有改善（表 1）。即使在调整后，总体持续反应率下降（优势比 [OR]：0.93，p=0.0197）并且总体 CDI 复发率在后期与前期略有增加（OR：1.13，p=0.0018）。按抗生素类型进行的其他分析表明，VAN（55.0% 和 35. 1%）的结果与 MTZ（54.2% 和 33.0%）相似，而 FDX（71.4% 和 20.9%）分别具有更高的持续反应和更低的 CDI 复发率（图 2）。图 1. CDI 医疗保险受益人指南更新前后 CDI 治疗的一线使用情况表 1. CDI 医疗保险受益人指南更新前后临床结果图 2.具有 CDI 的医疗保险受益人中按指数 CDI 治疗类型划分的临床结果* 注意在指数前和指数后期间接受每种指数 CDI 治疗的患者的汇总率。结论 2017 年 IDSA 指南更新与 VAN 使用的大幅增加和 MTZ 使用的减少有关。FDX 使用率仍然很低（< 2%）。尽管转向指南指示的 VAN，但总体 CDI 结果并未改善指南更新后的结果。这可能是因为相对于 MTZ，VAN 与显着改善的结果无关。然而，与 VAN 和 MTZ 相比，FDX 的结果有所改善，这表明其在医疗保险患者中的更多使用具有潜在的益处。Erik R. Dubberke, MD, MSPH, Ferring (Grant/Research Support)Merck (Consultant)Pfizer (Consultant, Grant/Research Support) Seres (Consultant)Summit (Consultant) Justin T. Puckett, BA, COVIA Health Solutions (Employee) ) Engels N. Obi, PhD, Merck & Co. (员工, 股东) Sachin Kamal-Bahl, PhD, AbbVie (顾问)Arena Pharmaceuticals, Inc. (顾问)COVIA Health Solutions (雇员)Janssen, Inc. (顾问)Merck （顾问，股东）诺华（顾问）辉瑞公司（顾问，股东）PhRMA（顾问）Kaushal Desai, PhD, AstraZeneca Pharmaceuticals（股东）Merck & Co. Inc.

"点击查看英文标题和摘要"

15. Real-World Changes in Clostridioides difficile infection (CDI) Treatment Utilization and Clinical Outcomes Associated with Updated 2017 IDSA Guidelines among Medicare Beneficiaries in the U.S

Background The 2017 IDSA CDI guideline update phased out metronidazole (MTZ) and recommended vancomycin (VAN) or fidaxomicin (FDX) for first-line use. This study examined changes in CDI antibiotic use and clinical outcomes among Medicare beneficiaries with CDI pre- vs. post- the guideline update. Methods This retrospective claims analysis used 2016-2018 national Medicare claims data. The two study samples included continuously eligible fee-for-service Medicare beneficiaries aged ≥66 years with a new CDI diagnosis followed by an antibiotic fill in the pre-period (04/01/2017-09/30/2017) and post-period (04/01/2018-09/30/2018), respectively. Outcomes included type of CDI antibiotic received; sustained response and CDI recurrence. Multivariable regressions compared pre- vs. post-period outcomes while controlling for sociodemographic and clinical factors. Results The pre-period (N=7,389) and post-period (N=7,746) samples had similar characteristics (59% > 75 years, 32% male). Post-guideline update, absolute rates of MTZ use declined 27.7% (relative change [RC] -34.1%, p< 0.001) and VAN use increased 26.9% (RC +150.2%, p< 0.001) (Figure 1). While FDX use increased 0.8% (RC +87.8%, p< 0.001), overall use remained low (1.63%). Surprisingly, clinical outcomes did not improve between the pre- and post-period (Table 1). Even after adjustment, overall sustained response rates decreased (Odds Ratio [OR]: 0.93, p=0.0197) and overall CDI recurrence rates increased (OR: 1.13, p=0.0018) slightly in the post- vs. pre-period. Additional analyses by type of antibiotic showed that VAN (55.0% and 35.1%) was similar in outcomes to MTZ (54.2% and 33.0%), whereas FDX (71.4% and 20.9%) had higher sustained response and lower CDI recurrence rates, respectively (Figure 2). Figure 1. First-line use of CDI treatments, pre- vs. post- the guideline update, among Medicare beneficiaries with CDI Table 1. Clinical outcomes, pre- vs. post- the guideline update, among Medicare beneficiaries with CDI Figure 2. Clinical outcomes* by type of index CDI treatment among Medicare beneficiaries with CDI Note Pooled rates among patients on each index CDI treatment across the pre- and post-index periods. Conclusion The 2017 IDSA guideline update was associated with a substantial increase in VAN use and decrease in MTZ use. FDX use rates remained low (< 2%). Overall CDI outcomes did not improve post guideline update despite the shift to guideline-indicated VAN. This may be because VAN was not associated with meaningfully improved outcomes relative to MTZ. However, improved outcomes seen with FDX relative to VAN and MTZ suggest potential benefits from its greater use in Medicare patients. Disclosures Erik R. Dubberke, MD, MSPH, Ferring (Grant/Research Support)Merck (Consultant)Pfizer (Consultant, Grant/Research Support)Seres (Consultant)Summit (Consultant) Justin T. Puckett, BA, COVIA Health Solutions (Employee) Engels N. Obi, PhD, Merck & Co. (Employee, Shareholder) Sachin Kamal-Bahl, PhD, AbbVie (Consultant)Arena Pharmaceuticals, Inc. (Consultant)COVIA Health Solutions (Employee)Janssen, Inc. (Consultant)Merck (Consultant, Shareholder)Novartis (Consultant)Pfizer, Inc. (Consultant, Shareholder)PhRMA (Consultant) Kaushal Desai, PhD, AstraZeneca Pharmaceuticals (Shareholder)Merck & Co. Inc. (Employee) Bruce Stuart, PhD, COVIA Health Solutions (Consultant) Jalpa A. Doshi, PhD, Acadia (Consultant, Advisor or Review Panel member)Allergan (Advisor or Review Panel member)Biogen (Grant/Research Support)Boehringer Ingelheim (Other Financial or Material Support, Scientific lecture)Catabasis (Consultant)Humana (Grant/Research Support)Janssen, Inc. (Consultant, Grant/Research Support)MeiraGTX (Consultant)Merck (Grant/Research Support, Advisor or Review Panel member)Novartis (Grant/Research Support)Otsuka (Advisor or Review Panel member)Regeneron (Grant/Research Support)SAGE Therapeutics (Consultant)Sanofi (Grant/Research Support)Shire (Advisor or Review Panel member)The Medicines Company (Advisor or Review Panel member)

更新日期：2021-12-05

点击分享查看原文

点击收藏

公开下载

阅读更多本刊新发论文本刊介绍/投稿指南