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Impact of VA Hematology/Oncology Clinical Pharmacy Practitioners in the Review of Community Prescriptions for Specialty Medications
The value of a hematology/oncology clinical pharmacy practitioner (CPP) has been validated in several studies documenting their positive impact on patient outcomes, supportive care management, laboratory monitoring, medication error identification, and drug expenditure.1-6 With> 200 oncology-related US Food and Drug Administration approval notifications published from 2020 to 2023, it is no surprise that national trends in oncology drug clinic expenditures increased from $39.9 billion in 2020 to $44.1 billion in 2021.7,8 With the rapidly changing treatment landscape, new drug approvals, and risk of polypharmacy, oral anticancer agents carry a high risk for medication errors.4 Additional challenges include complex dosing regimens and instructions, adherence issues, drug interactions, adjustments for organ dysfunction, and extensive adverse effect (AE) profiles.
Because of the niche and complexity of oral anticancer agents, trained CPPs havehematology/oncology education and expertise that pharmacists without specialized training lack. A survey of 243 nonspecialized community pharmacists that assessed their knowledge of oral anticancer therapies revealed that only about half of the knowledge questions were answered correctly, illustrating an education gap among these pharmacists.9 The Hematology/Oncology Pharmacist Association's suggests that best practices for managing oral oncology therapy should include comprehensive medication review by an oncology-trained pharmacist for each prescription.10
The US Department of Veterans Affairs (VA) community care network, which was established by the MISSION Act, allows covered access for eligible veterans in the local community outside of the VA network. Unfortunately, this dual-system use of health care could increase the risk of poorly coordinated care and has been associated with the risk of inappropriate prescribing.11,12 It is unclear how many private practices enrolled in the community care program have access to oncology-trained pharmacists. Specialized pharmaceutical reviews of oral anticancer medication prescriptions from these practices are vital for veteran care. This study evaluates the clinical and financial interventions of hematology/oncology CPPs review of specialty hematology/oncology prescriptions from community care health care practitioners (HCPs) at the Veterans Affairs North Texas Health Care System (VANTHCS) in Dallas.
METHODS
This study is a retrospective review of Computerized Patient Record System (CPRS) records of patients at VANTHCS from January 1, 2015, to June 30, 2023. Patients included were aged ≥ 18 years, enrolled in the VA community care program, received a specialty hematology/oncology medication that was dispensed through VA pharmacies or VA-contracted pharmacies, and had an hematology/oncology CPP medication review documented in CPRS. The primary aim of this study was to assess the number and types of clinical interventions performed. A clinical intervention was defined as a documented communication attempt with a community care HCP or direct communication with a patient to address a specific medication-related issue noted during CPP review.
Review of specialty hematology/oncology medications by a hematology/oncology CPP included evaluation of therapy indication, such as whether the prescription meets clinical guidelines, VA criteria for use, or other clinical literature as judged appropriate by the CPP. In some cases, the CPP requested that the community care HCP prescribe a more cost-effective or formulary-preferred agent. Each prescription was reviewed for dosage and formulation appropriateness, drug interactions with available medication lists, baseline laboratory test completion, and recommended supportive care medicines. At times, patient counseling is completed as part of the clinical review. When necessary, CPPs could discuss patient cases with a VA-employed oncologist for further oversight regarding appropriateness and safety. Secondary outcomes included the number of interventions accepted or denied by the prescriber provider and cost savings.
Data collected included the type of malignancy, hematology/oncology specialty medication requested, number and type of interventions sent to the community care prescriber, number of interventions accepted or denied by the community care prescriber, and whether the CPP conducted patient counseling or dispensed or denied the product. Cost savings were calculated for medications that were denied or changed to a formulary preferred or cost-effective agent using pricing data from the National Acquisition Center Contract Catalog or Federal Supply Schedule Service as of April 2024.
RESULTS
A total of 221 hematology/oncology prescriptions met inclusion criteria. Among patients receiving these prescriptions, the median age was 70 years and 91% were male. The most common malignancies included 31 instances of multiple myeloma (14%), 26 for chronic lymphocytic leukemia (12%), 24 for prostate cancer (11%), 23 for glioblastoma/brain cancer (10%), 18 for renal cell carcinoma (8%), 17 for colorectal cancer (8%), and 15 for acute myeloid leukemia (7%). Clinical interventions by the hematology/oncology CPP were completed for 82 (37%) of the 221 prescriptions. One clinical intervention was communicated directly to the patient, and attempts were made to communicate with the community care HCP for the remaining 81 prescriptions. The CPP documented 97 clinical interventions for the 82 prescriptions (Table 1). The most commonly documented clinical interventions included: 25 for managing/preventing a drug interaction (26%), 24 for dose adjustment request (25%), 13 for prescription denial (13%), and 11 for requesting the use of a preferred or more cost-effective product (11%). Of note, 16 patients (7%) received counseling from the hematology/oncology CPP. Ten patients (5%) received counseling alone with no other intervention and did not meet the definition of a clinical intervention.
The most frequent prescriptions requiring intervention included 8 for enzalutamide, 7 for venetoclax, 6 for ibrutinib, and 5 each for lenalidomide, cabozantinib, and temozolomide. Among the 97 interventions, 68 were approved (70%), 15 received no response (16%), and 14 were denied by the community care HCP (14%). Despite obtaining no response or intervention denial from the community care HCP, hematology/oncology CPPs could approve these prescriptions if clinically appropriate, and their reasoning was documented. Table 2 further describes the types of interventions that were denied or obtained no response by the community care practitioner. Among the prescriptions denied by the hematology/oncology CPP, 11 were rejected for off-label indications and/or did not have support through primary literature, national guidelines, or VA criteria for use. Only 2 prescriptions were denied for safety concerns.
These documented clinical interventions had financial implications. For drugs with available cost data, requesting the use of a preferred/cost-effective product led to estimated savings of at least $263,536 over the study period with some ongoing cost savings. Prescription denials led to further estimated savings of $186,275 per month, although this is limited by the lack of known costs of alternative therapies the community care physicians chose.
DISCUSSION
More than one-third of prescriptions required clinical interventions, and 70% of these interventions were accepted by the community care prescriber, demonstrating the CPP’s essential role. Results indicate that most CPP clinical interventions involved clarifying and correcting doses, managing pertinent drug interactions, and ensuring appropriate use of medications according to clinical and national VA guidelines. Other studies have examined the impact of CPPs on patient care and cancer treatment.5,6 The randomized, multicenter AMBORA trial found that clinical pharmacist support reduced severe AEs and medication errors related to oral anticancer agents.5 The per-patient mean number of medication errors found by pharmacist review was 1.7 (range, 0 to 9), with most medication errors noted at the prescribing stage.5 Suzuki and colleagues analyzed data from 35,062 chemotherapy regimens and found that 53.1% of the chemotherapy prescriptions were modified because of pharmacist interventions.6 The most common reason for prescription modifications was prescription error.
Most of the clinical interventions in this study were accepted by community HCPs, indicating that these prescribers are receptive to hematology/oncology CPP input. Among those with no response, most were in relation to recommendations regarding drug interactions. In most of these cases, the drug interaction was not clinically concerning enough to require a response before the CPP approved the prescription. Therefore, it is unknown whether the outside HCP implemented the clinical recommendations. The most common types of clinical interventions the community care HCP declined were dose adjustment requests or requests to switch to a more cost-effective/formulary-preferred agent. In these cases, the prescriber’s preference was documented and, if clinically appropriate, approved by the CPP.
Although the financial implications of CPP clinical interventions were only marginally evaluated in this review, results suggest that cost savings by requests to switch to a cost-effective/formulary preferred agent or prescription denials are substantial. Because of changes in prescription costs over time, it is possible that savings from CPP intervention were greater than calculations using current Federal Supply Schedule Service pricing. The total impact of CPP prescription interventions on reducing or preventing hospitalizations or AEs is not known from this review, but other data suggest that cost savings may benefit the system.13,14
Limitations
This study's retrospective design is a limitation because practice patterns at the VANTHCS involving multiple hematology/oncology CPPs review of community care prescriptions might have evolved over time. The total financial implications of CPP interventions cannot fully be elucidated. The cost of alternative therapies used for patients who received a prescription denial is not factored into this review.
Conclusions
VANTHCS CPPs played an essential role in reviewing anticancer medication prescriptions from community care prescribers. In this study, CPP clinical interventions were completed for more than one-third of the prescriptions and the community-based HCP approved most of these interventions. These changes also resulted in financial benefits.
These findings add to the body of literature emphasizing the need for hematology/oncology-trained CPPs to review anticancer prescriptions and treatment plans. Our review could be used to justify CPP involvement in community care specialty medication review at VA facilities that do not currently have CPP involvement.
1. Shah NN, Casella E, Capozzi D, et al. Improving the safety of oral chemotherapy at an academic medical center. J Oncol Pract. 2016;12(1):e71-e76. doi:10.1200/JOP.2015.007260
2. Gatwood J, Gatwood K, Gabre E, Alexander M. Impact of clinical pharmacists in outpatient oncology practices: a review. Am J Health Syst Pharm. 2017;74(19):1549-1557. doi:10.2146/ajhp160475
3. Lankford C, Dura J, Tran A, et al. Effect of clinical pharmacist interventions on cost in an integrated health system specialty pharmacy. J Manag Care Spec Pharm. 2021;27(3):379-384. doi:10.18553/jmcp.2021.27.3.379
4. Schlichtig K, Dürr P, Dörje F, Fromm MF. Medication errors during treatment with new oral anticancer agents: consequences for clinical practice based on the AMBORA Study. Clin Pharmacol Ther. 2021;110(4):1075-1086. doi:10.1002/cpt.2338
5. Dürr P, Schlichtig K, Kelz C, et al. The randomized AMBORA Trial: impact of pharmacological/pharmaceutical care on medication safety and patient-reported outcomes during treatment with new oral anticancer agents. J Clin Oncol. 2021;39(18):1983-1994. doi:10.1200/JCO.20.03088
6. Suzuki S, Chan A, Nomura H, Johnson PE, Endo K, Saito S. Chemotherapy regimen checks performed by pharmacists contribute to safe administration of chemotherapy. J Oncol Pharm Pract. 2017;23(1):18-25. doi:10.1177/1078155215614998
7. Tichy EM, Hoffman JM, Suda KJ, et al. National trends in prescription drug expenditures and projections for 2022. Am J Health Syst Pharm. 2022;79(14):1158-1172. doi:10.1093/ajhp/zxac102
8. US Food and Drug Administration. Oncology (cancer)/hematologic malignancies approval notifications. 2023.
9. O’Bryant CL, Crandell BC. Community pharmacists’ knowledge of and attitudes toward oral chemotherapy. J Am Pharm Assoc (2003). 2008;48(5):632-639. doi:10.1331/JAPhA.2008.07082
10. Mackler E, Segal EM, Muluneh B, Jeffers K, Carmichael J. 2018 hematology/oncology pharmacist association best practices for the management of oral oncolytic therapy: pharmacy practice standard. J Oncol Pract. 2019;15(4):e346-e355. doi:10.1200/JOP.18.00581
11. Thorpe JM, Thorpe CT, Schleiden L, et al. Association between dual use of Department of Veterans Affairs and Medicare part D drug benefits and potentially unsafe prescribing. JAMA Intern Med. 2019;179(11):1584-1586. doi:10.1001/jamainternmed.2019.2788
12. Thorpe JM, Thorpe CT, Gellad WF, et al. Dual health care system use and high-risk prescribing in patients with dementia: a national cohort study. Ann Intern Med. 2017;166(3):157-163. doi:10.7326/M16-0551
13. Chen P-Z, Wu C-C, Huang C-F. Clinical and economic impact of clinical pharmacist intervention in a hematology unit. J Oncol Pharm Pract. 2020;26(4):866-872. doi:10.1177/1078155219875806
14. Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37-46. doi:10.2147/IPRP.S108047
The value of a hematology/oncology clinical pharmacy practitioner (CPP) has been validated in several studies documenting their positive impact on patient outcomes, supportive care management, laboratory monitoring, medication error identification, and drug expenditure.1-6 With> 200 oncology-related US Food and Drug Administration approval notifications published from 2020 to 2023, it is no surprise that national trends in oncology drug clinic expenditures increased from $39.9 billion in 2020 to $44.1 billion in 2021.7,8 With the rapidly changing treatment landscape, new drug approvals, and risk of polypharmacy, oral anticancer agents carry a high risk for medication errors.4 Additional challenges include complex dosing regimens and instructions, adherence issues, drug interactions, adjustments for organ dysfunction, and extensive adverse effect (AE) profiles.
Because of the niche and complexity of oral anticancer agents, trained CPPs havehematology/oncology education and expertise that pharmacists without specialized training lack. A survey of 243 nonspecialized community pharmacists that assessed their knowledge of oral anticancer therapies revealed that only about half of the knowledge questions were answered correctly, illustrating an education gap among these pharmacists.9 The Hematology/Oncology Pharmacist Association's suggests that best practices for managing oral oncology therapy should include comprehensive medication review by an oncology-trained pharmacist for each prescription.10
The US Department of Veterans Affairs (VA) community care network, which was established by the MISSION Act, allows covered access for eligible veterans in the local community outside of the VA network. Unfortunately, this dual-system use of health care could increase the risk of poorly coordinated care and has been associated with the risk of inappropriate prescribing.11,12 It is unclear how many private practices enrolled in the community care program have access to oncology-trained pharmacists. Specialized pharmaceutical reviews of oral anticancer medication prescriptions from these practices are vital for veteran care. This study evaluates the clinical and financial interventions of hematology/oncology CPPs review of specialty hematology/oncology prescriptions from community care health care practitioners (HCPs) at the Veterans Affairs North Texas Health Care System (VANTHCS) in Dallas.
METHODS
This study is a retrospective review of Computerized Patient Record System (CPRS) records of patients at VANTHCS from January 1, 2015, to June 30, 2023. Patients included were aged ≥ 18 years, enrolled in the VA community care program, received a specialty hematology/oncology medication that was dispensed through VA pharmacies or VA-contracted pharmacies, and had an hematology/oncology CPP medication review documented in CPRS. The primary aim of this study was to assess the number and types of clinical interventions performed. A clinical intervention was defined as a documented communication attempt with a community care HCP or direct communication with a patient to address a specific medication-related issue noted during CPP review.
Review of specialty hematology/oncology medications by a hematology/oncology CPP included evaluation of therapy indication, such as whether the prescription meets clinical guidelines, VA criteria for use, or other clinical literature as judged appropriate by the CPP. In some cases, the CPP requested that the community care HCP prescribe a more cost-effective or formulary-preferred agent. Each prescription was reviewed for dosage and formulation appropriateness, drug interactions with available medication lists, baseline laboratory test completion, and recommended supportive care medicines. At times, patient counseling is completed as part of the clinical review. When necessary, CPPs could discuss patient cases with a VA-employed oncologist for further oversight regarding appropriateness and safety. Secondary outcomes included the number of interventions accepted or denied by the prescriber provider and cost savings.
Data collected included the type of malignancy, hematology/oncology specialty medication requested, number and type of interventions sent to the community care prescriber, number of interventions accepted or denied by the community care prescriber, and whether the CPP conducted patient counseling or dispensed or denied the product. Cost savings were calculated for medications that were denied or changed to a formulary preferred or cost-effective agent using pricing data from the National Acquisition Center Contract Catalog or Federal Supply Schedule Service as of April 2024.
RESULTS
A total of 221 hematology/oncology prescriptions met inclusion criteria. Among patients receiving these prescriptions, the median age was 70 years and 91% were male. The most common malignancies included 31 instances of multiple myeloma (14%), 26 for chronic lymphocytic leukemia (12%), 24 for prostate cancer (11%), 23 for glioblastoma/brain cancer (10%), 18 for renal cell carcinoma (8%), 17 for colorectal cancer (8%), and 15 for acute myeloid leukemia (7%). Clinical interventions by the hematology/oncology CPP were completed for 82 (37%) of the 221 prescriptions. One clinical intervention was communicated directly to the patient, and attempts were made to communicate with the community care HCP for the remaining 81 prescriptions. The CPP documented 97 clinical interventions for the 82 prescriptions (Table 1). The most commonly documented clinical interventions included: 25 for managing/preventing a drug interaction (26%), 24 for dose adjustment request (25%), 13 for prescription denial (13%), and 11 for requesting the use of a preferred or more cost-effective product (11%). Of note, 16 patients (7%) received counseling from the hematology/oncology CPP. Ten patients (5%) received counseling alone with no other intervention and did not meet the definition of a clinical intervention.
The most frequent prescriptions requiring intervention included 8 for enzalutamide, 7 for venetoclax, 6 for ibrutinib, and 5 each for lenalidomide, cabozantinib, and temozolomide. Among the 97 interventions, 68 were approved (70%), 15 received no response (16%), and 14 were denied by the community care HCP (14%). Despite obtaining no response or intervention denial from the community care HCP, hematology/oncology CPPs could approve these prescriptions if clinically appropriate, and their reasoning was documented. Table 2 further describes the types of interventions that were denied or obtained no response by the community care practitioner. Among the prescriptions denied by the hematology/oncology CPP, 11 were rejected for off-label indications and/or did not have support through primary literature, national guidelines, or VA criteria for use. Only 2 prescriptions were denied for safety concerns.
These documented clinical interventions had financial implications. For drugs with available cost data, requesting the use of a preferred/cost-effective product led to estimated savings of at least $263,536 over the study period with some ongoing cost savings. Prescription denials led to further estimated savings of $186,275 per month, although this is limited by the lack of known costs of alternative therapies the community care physicians chose.
DISCUSSION
More than one-third of prescriptions required clinical interventions, and 70% of these interventions were accepted by the community care prescriber, demonstrating the CPP’s essential role. Results indicate that most CPP clinical interventions involved clarifying and correcting doses, managing pertinent drug interactions, and ensuring appropriate use of medications according to clinical and national VA guidelines. Other studies have examined the impact of CPPs on patient care and cancer treatment.5,6 The randomized, multicenter AMBORA trial found that clinical pharmacist support reduced severe AEs and medication errors related to oral anticancer agents.5 The per-patient mean number of medication errors found by pharmacist review was 1.7 (range, 0 to 9), with most medication errors noted at the prescribing stage.5 Suzuki and colleagues analyzed data from 35,062 chemotherapy regimens and found that 53.1% of the chemotherapy prescriptions were modified because of pharmacist interventions.6 The most common reason for prescription modifications was prescription error.
Most of the clinical interventions in this study were accepted by community HCPs, indicating that these prescribers are receptive to hematology/oncology CPP input. Among those with no response, most were in relation to recommendations regarding drug interactions. In most of these cases, the drug interaction was not clinically concerning enough to require a response before the CPP approved the prescription. Therefore, it is unknown whether the outside HCP implemented the clinical recommendations. The most common types of clinical interventions the community care HCP declined were dose adjustment requests or requests to switch to a more cost-effective/formulary-preferred agent. In these cases, the prescriber’s preference was documented and, if clinically appropriate, approved by the CPP.
Although the financial implications of CPP clinical interventions were only marginally evaluated in this review, results suggest that cost savings by requests to switch to a cost-effective/formulary preferred agent or prescription denials are substantial. Because of changes in prescription costs over time, it is possible that savings from CPP intervention were greater than calculations using current Federal Supply Schedule Service pricing. The total impact of CPP prescription interventions on reducing or preventing hospitalizations or AEs is not known from this review, but other data suggest that cost savings may benefit the system.13,14
Limitations
This study's retrospective design is a limitation because practice patterns at the VANTHCS involving multiple hematology/oncology CPPs review of community care prescriptions might have evolved over time. The total financial implications of CPP interventions cannot fully be elucidated. The cost of alternative therapies used for patients who received a prescription denial is not factored into this review.
Conclusions
VANTHCS CPPs played an essential role in reviewing anticancer medication prescriptions from community care prescribers. In this study, CPP clinical interventions were completed for more than one-third of the prescriptions and the community-based HCP approved most of these interventions. These changes also resulted in financial benefits.
These findings add to the body of literature emphasizing the need for hematology/oncology-trained CPPs to review anticancer prescriptions and treatment plans. Our review could be used to justify CPP involvement in community care specialty medication review at VA facilities that do not currently have CPP involvement.
The value of a hematology/oncology clinical pharmacy practitioner (CPP) has been validated in several studies documenting their positive impact on patient outcomes, supportive care management, laboratory monitoring, medication error identification, and drug expenditure.1-6 With> 200 oncology-related US Food and Drug Administration approval notifications published from 2020 to 2023, it is no surprise that national trends in oncology drug clinic expenditures increased from $39.9 billion in 2020 to $44.1 billion in 2021.7,8 With the rapidly changing treatment landscape, new drug approvals, and risk of polypharmacy, oral anticancer agents carry a high risk for medication errors.4 Additional challenges include complex dosing regimens and instructions, adherence issues, drug interactions, adjustments for organ dysfunction, and extensive adverse effect (AE) profiles.
Because of the niche and complexity of oral anticancer agents, trained CPPs havehematology/oncology education and expertise that pharmacists without specialized training lack. A survey of 243 nonspecialized community pharmacists that assessed their knowledge of oral anticancer therapies revealed that only about half of the knowledge questions were answered correctly, illustrating an education gap among these pharmacists.9 The Hematology/Oncology Pharmacist Association's suggests that best practices for managing oral oncology therapy should include comprehensive medication review by an oncology-trained pharmacist for each prescription.10
The US Department of Veterans Affairs (VA) community care network, which was established by the MISSION Act, allows covered access for eligible veterans in the local community outside of the VA network. Unfortunately, this dual-system use of health care could increase the risk of poorly coordinated care and has been associated with the risk of inappropriate prescribing.11,12 It is unclear how many private practices enrolled in the community care program have access to oncology-trained pharmacists. Specialized pharmaceutical reviews of oral anticancer medication prescriptions from these practices are vital for veteran care. This study evaluates the clinical and financial interventions of hematology/oncology CPPs review of specialty hematology/oncology prescriptions from community care health care practitioners (HCPs) at the Veterans Affairs North Texas Health Care System (VANTHCS) in Dallas.
METHODS
This study is a retrospective review of Computerized Patient Record System (CPRS) records of patients at VANTHCS from January 1, 2015, to June 30, 2023. Patients included were aged ≥ 18 years, enrolled in the VA community care program, received a specialty hematology/oncology medication that was dispensed through VA pharmacies or VA-contracted pharmacies, and had an hematology/oncology CPP medication review documented in CPRS. The primary aim of this study was to assess the number and types of clinical interventions performed. A clinical intervention was defined as a documented communication attempt with a community care HCP or direct communication with a patient to address a specific medication-related issue noted during CPP review.
Review of specialty hematology/oncology medications by a hematology/oncology CPP included evaluation of therapy indication, such as whether the prescription meets clinical guidelines, VA criteria for use, or other clinical literature as judged appropriate by the CPP. In some cases, the CPP requested that the community care HCP prescribe a more cost-effective or formulary-preferred agent. Each prescription was reviewed for dosage and formulation appropriateness, drug interactions with available medication lists, baseline laboratory test completion, and recommended supportive care medicines. At times, patient counseling is completed as part of the clinical review. When necessary, CPPs could discuss patient cases with a VA-employed oncologist for further oversight regarding appropriateness and safety. Secondary outcomes included the number of interventions accepted or denied by the prescriber provider and cost savings.
Data collected included the type of malignancy, hematology/oncology specialty medication requested, number and type of interventions sent to the community care prescriber, number of interventions accepted or denied by the community care prescriber, and whether the CPP conducted patient counseling or dispensed or denied the product. Cost savings were calculated for medications that were denied or changed to a formulary preferred or cost-effective agent using pricing data from the National Acquisition Center Contract Catalog or Federal Supply Schedule Service as of April 2024.
RESULTS
A total of 221 hematology/oncology prescriptions met inclusion criteria. Among patients receiving these prescriptions, the median age was 70 years and 91% were male. The most common malignancies included 31 instances of multiple myeloma (14%), 26 for chronic lymphocytic leukemia (12%), 24 for prostate cancer (11%), 23 for glioblastoma/brain cancer (10%), 18 for renal cell carcinoma (8%), 17 for colorectal cancer (8%), and 15 for acute myeloid leukemia (7%). Clinical interventions by the hematology/oncology CPP were completed for 82 (37%) of the 221 prescriptions. One clinical intervention was communicated directly to the patient, and attempts were made to communicate with the community care HCP for the remaining 81 prescriptions. The CPP documented 97 clinical interventions for the 82 prescriptions (Table 1). The most commonly documented clinical interventions included: 25 for managing/preventing a drug interaction (26%), 24 for dose adjustment request (25%), 13 for prescription denial (13%), and 11 for requesting the use of a preferred or more cost-effective product (11%). Of note, 16 patients (7%) received counseling from the hematology/oncology CPP. Ten patients (5%) received counseling alone with no other intervention and did not meet the definition of a clinical intervention.
The most frequent prescriptions requiring intervention included 8 for enzalutamide, 7 for venetoclax, 6 for ibrutinib, and 5 each for lenalidomide, cabozantinib, and temozolomide. Among the 97 interventions, 68 were approved (70%), 15 received no response (16%), and 14 were denied by the community care HCP (14%). Despite obtaining no response or intervention denial from the community care HCP, hematology/oncology CPPs could approve these prescriptions if clinically appropriate, and their reasoning was documented. Table 2 further describes the types of interventions that were denied or obtained no response by the community care practitioner. Among the prescriptions denied by the hematology/oncology CPP, 11 were rejected for off-label indications and/or did not have support through primary literature, national guidelines, or VA criteria for use. Only 2 prescriptions were denied for safety concerns.
These documented clinical interventions had financial implications. For drugs with available cost data, requesting the use of a preferred/cost-effective product led to estimated savings of at least $263,536 over the study period with some ongoing cost savings. Prescription denials led to further estimated savings of $186,275 per month, although this is limited by the lack of known costs of alternative therapies the community care physicians chose.
DISCUSSION
More than one-third of prescriptions required clinical interventions, and 70% of these interventions were accepted by the community care prescriber, demonstrating the CPP’s essential role. Results indicate that most CPP clinical interventions involved clarifying and correcting doses, managing pertinent drug interactions, and ensuring appropriate use of medications according to clinical and national VA guidelines. Other studies have examined the impact of CPPs on patient care and cancer treatment.5,6 The randomized, multicenter AMBORA trial found that clinical pharmacist support reduced severe AEs and medication errors related to oral anticancer agents.5 The per-patient mean number of medication errors found by pharmacist review was 1.7 (range, 0 to 9), with most medication errors noted at the prescribing stage.5 Suzuki and colleagues analyzed data from 35,062 chemotherapy regimens and found that 53.1% of the chemotherapy prescriptions were modified because of pharmacist interventions.6 The most common reason for prescription modifications was prescription error.
Most of the clinical interventions in this study were accepted by community HCPs, indicating that these prescribers are receptive to hematology/oncology CPP input. Among those with no response, most were in relation to recommendations regarding drug interactions. In most of these cases, the drug interaction was not clinically concerning enough to require a response before the CPP approved the prescription. Therefore, it is unknown whether the outside HCP implemented the clinical recommendations. The most common types of clinical interventions the community care HCP declined were dose adjustment requests or requests to switch to a more cost-effective/formulary-preferred agent. In these cases, the prescriber’s preference was documented and, if clinically appropriate, approved by the CPP.
Although the financial implications of CPP clinical interventions were only marginally evaluated in this review, results suggest that cost savings by requests to switch to a cost-effective/formulary preferred agent or prescription denials are substantial. Because of changes in prescription costs over time, it is possible that savings from CPP intervention were greater than calculations using current Federal Supply Schedule Service pricing. The total impact of CPP prescription interventions on reducing or preventing hospitalizations or AEs is not known from this review, but other data suggest that cost savings may benefit the system.13,14
Limitations
This study's retrospective design is a limitation because practice patterns at the VANTHCS involving multiple hematology/oncology CPPs review of community care prescriptions might have evolved over time. The total financial implications of CPP interventions cannot fully be elucidated. The cost of alternative therapies used for patients who received a prescription denial is not factored into this review.
Conclusions
VANTHCS CPPs played an essential role in reviewing anticancer medication prescriptions from community care prescribers. In this study, CPP clinical interventions were completed for more than one-third of the prescriptions and the community-based HCP approved most of these interventions. These changes also resulted in financial benefits.
These findings add to the body of literature emphasizing the need for hematology/oncology-trained CPPs to review anticancer prescriptions and treatment plans. Our review could be used to justify CPP involvement in community care specialty medication review at VA facilities that do not currently have CPP involvement.
1. Shah NN, Casella E, Capozzi D, et al. Improving the safety of oral chemotherapy at an academic medical center. J Oncol Pract. 2016;12(1):e71-e76. doi:10.1200/JOP.2015.007260
2. Gatwood J, Gatwood K, Gabre E, Alexander M. Impact of clinical pharmacists in outpatient oncology practices: a review. Am J Health Syst Pharm. 2017;74(19):1549-1557. doi:10.2146/ajhp160475
3. Lankford C, Dura J, Tran A, et al. Effect of clinical pharmacist interventions on cost in an integrated health system specialty pharmacy. J Manag Care Spec Pharm. 2021;27(3):379-384. doi:10.18553/jmcp.2021.27.3.379
4. Schlichtig K, Dürr P, Dörje F, Fromm MF. Medication errors during treatment with new oral anticancer agents: consequences for clinical practice based on the AMBORA Study. Clin Pharmacol Ther. 2021;110(4):1075-1086. doi:10.1002/cpt.2338
5. Dürr P, Schlichtig K, Kelz C, et al. The randomized AMBORA Trial: impact of pharmacological/pharmaceutical care on medication safety and patient-reported outcomes during treatment with new oral anticancer agents. J Clin Oncol. 2021;39(18):1983-1994. doi:10.1200/JCO.20.03088
6. Suzuki S, Chan A, Nomura H, Johnson PE, Endo K, Saito S. Chemotherapy regimen checks performed by pharmacists contribute to safe administration of chemotherapy. J Oncol Pharm Pract. 2017;23(1):18-25. doi:10.1177/1078155215614998
7. Tichy EM, Hoffman JM, Suda KJ, et al. National trends in prescription drug expenditures and projections for 2022. Am J Health Syst Pharm. 2022;79(14):1158-1172. doi:10.1093/ajhp/zxac102
8. US Food and Drug Administration. Oncology (cancer)/hematologic malignancies approval notifications. 2023.
9. O’Bryant CL, Crandell BC. Community pharmacists’ knowledge of and attitudes toward oral chemotherapy. J Am Pharm Assoc (2003). 2008;48(5):632-639. doi:10.1331/JAPhA.2008.07082
10. Mackler E, Segal EM, Muluneh B, Jeffers K, Carmichael J. 2018 hematology/oncology pharmacist association best practices for the management of oral oncolytic therapy: pharmacy practice standard. J Oncol Pract. 2019;15(4):e346-e355. doi:10.1200/JOP.18.00581
11. Thorpe JM, Thorpe CT, Schleiden L, et al. Association between dual use of Department of Veterans Affairs and Medicare part D drug benefits and potentially unsafe prescribing. JAMA Intern Med. 2019;179(11):1584-1586. doi:10.1001/jamainternmed.2019.2788
12. Thorpe JM, Thorpe CT, Gellad WF, et al. Dual health care system use and high-risk prescribing in patients with dementia: a national cohort study. Ann Intern Med. 2017;166(3):157-163. doi:10.7326/M16-0551
13. Chen P-Z, Wu C-C, Huang C-F. Clinical and economic impact of clinical pharmacist intervention in a hematology unit. J Oncol Pharm Pract. 2020;26(4):866-872. doi:10.1177/1078155219875806
14. Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37-46. doi:10.2147/IPRP.S108047
1. Shah NN, Casella E, Capozzi D, et al. Improving the safety of oral chemotherapy at an academic medical center. J Oncol Pract. 2016;12(1):e71-e76. doi:10.1200/JOP.2015.007260
2. Gatwood J, Gatwood K, Gabre E, Alexander M. Impact of clinical pharmacists in outpatient oncology practices: a review. Am J Health Syst Pharm. 2017;74(19):1549-1557. doi:10.2146/ajhp160475
3. Lankford C, Dura J, Tran A, et al. Effect of clinical pharmacist interventions on cost in an integrated health system specialty pharmacy. J Manag Care Spec Pharm. 2021;27(3):379-384. doi:10.18553/jmcp.2021.27.3.379
4. Schlichtig K, Dürr P, Dörje F, Fromm MF. Medication errors during treatment with new oral anticancer agents: consequences for clinical practice based on the AMBORA Study. Clin Pharmacol Ther. 2021;110(4):1075-1086. doi:10.1002/cpt.2338
5. Dürr P, Schlichtig K, Kelz C, et al. The randomized AMBORA Trial: impact of pharmacological/pharmaceutical care on medication safety and patient-reported outcomes during treatment with new oral anticancer agents. J Clin Oncol. 2021;39(18):1983-1994. doi:10.1200/JCO.20.03088
6. Suzuki S, Chan A, Nomura H, Johnson PE, Endo K, Saito S. Chemotherapy regimen checks performed by pharmacists contribute to safe administration of chemotherapy. J Oncol Pharm Pract. 2017;23(1):18-25. doi:10.1177/1078155215614998
7. Tichy EM, Hoffman JM, Suda KJ, et al. National trends in prescription drug expenditures and projections for 2022. Am J Health Syst Pharm. 2022;79(14):1158-1172. doi:10.1093/ajhp/zxac102
8. US Food and Drug Administration. Oncology (cancer)/hematologic malignancies approval notifications. 2023.
9. O’Bryant CL, Crandell BC. Community pharmacists’ knowledge of and attitudes toward oral chemotherapy. J Am Pharm Assoc (2003). 2008;48(5):632-639. doi:10.1331/JAPhA.2008.07082
10. Mackler E, Segal EM, Muluneh B, Jeffers K, Carmichael J. 2018 hematology/oncology pharmacist association best practices for the management of oral oncolytic therapy: pharmacy practice standard. J Oncol Pract. 2019;15(4):e346-e355. doi:10.1200/JOP.18.00581
11. Thorpe JM, Thorpe CT, Schleiden L, et al. Association between dual use of Department of Veterans Affairs and Medicare part D drug benefits and potentially unsafe prescribing. JAMA Intern Med. 2019;179(11):1584-1586. doi:10.1001/jamainternmed.2019.2788
12. Thorpe JM, Thorpe CT, Gellad WF, et al. Dual health care system use and high-risk prescribing in patients with dementia: a national cohort study. Ann Intern Med. 2017;166(3):157-163. doi:10.7326/M16-0551
13. Chen P-Z, Wu C-C, Huang C-F. Clinical and economic impact of clinical pharmacist intervention in a hematology unit. J Oncol Pharm Pract. 2020;26(4):866-872. doi:10.1177/1078155219875806
14. Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37-46. doi:10.2147/IPRP.S108047
Study Identifies Plasma Proteins Linked to Increased PsA Risk
Key clinical point: Levels of certain proteins found in the blood plasma affected the risk for development of psoriatic arthritis (PsA) and could serve as potential therapeutic targets for the condition.
Major finding: Apolipoprotein F increased the risk for PsA by 60% (odds ratio [OR] 1.69; PFDR < .001), whereas interleukin-10 reduced the risk for PsA by 40% (OR 0.60; PFDR = .034). Other proteins associated with an increased risk for PsA included tumor necrosis factor, V-type proton ATPase subunit G 2, receptor-type tyrosine protein phosphatase F, and septin-8.
Study details: This two-sample Mendelian randomization analysis included the data of 3537 patients with PsA and 262,844 control individuals without PsA from the FinnGen study and the data of 1837 unique plasma proteins from a genome-wide association study within the UK Biobank Pharma Proteomics Project.
Disclosures: This study was supported by the Natural Science Foundation of Guangxi Province and the National Natural Science Foundation of China. The authors declared no conflicts of interest.
Source: Zhao H, Zhou Y, Wang Z, Zhang X, Chen L, Hong Z. Plasma proteins and psoriatic arthritis: A proteome-wide Mendelian randomization study. Front Immunol. 15:1417564 (July 3). Doi: 10.3389/fimmu.2024.1417564 Source
Key clinical point: Levels of certain proteins found in the blood plasma affected the risk for development of psoriatic arthritis (PsA) and could serve as potential therapeutic targets for the condition.
Major finding: Apolipoprotein F increased the risk for PsA by 60% (odds ratio [OR] 1.69; PFDR < .001), whereas interleukin-10 reduced the risk for PsA by 40% (OR 0.60; PFDR = .034). Other proteins associated with an increased risk for PsA included tumor necrosis factor, V-type proton ATPase subunit G 2, receptor-type tyrosine protein phosphatase F, and septin-8.
Study details: This two-sample Mendelian randomization analysis included the data of 3537 patients with PsA and 262,844 control individuals without PsA from the FinnGen study and the data of 1837 unique plasma proteins from a genome-wide association study within the UK Biobank Pharma Proteomics Project.
Disclosures: This study was supported by the Natural Science Foundation of Guangxi Province and the National Natural Science Foundation of China. The authors declared no conflicts of interest.
Source: Zhao H, Zhou Y, Wang Z, Zhang X, Chen L, Hong Z. Plasma proteins and psoriatic arthritis: A proteome-wide Mendelian randomization study. Front Immunol. 15:1417564 (July 3). Doi: 10.3389/fimmu.2024.1417564 Source
Key clinical point: Levels of certain proteins found in the blood plasma affected the risk for development of psoriatic arthritis (PsA) and could serve as potential therapeutic targets for the condition.
Major finding: Apolipoprotein F increased the risk for PsA by 60% (odds ratio [OR] 1.69; PFDR < .001), whereas interleukin-10 reduced the risk for PsA by 40% (OR 0.60; PFDR = .034). Other proteins associated with an increased risk for PsA included tumor necrosis factor, V-type proton ATPase subunit G 2, receptor-type tyrosine protein phosphatase F, and septin-8.
Study details: This two-sample Mendelian randomization analysis included the data of 3537 patients with PsA and 262,844 control individuals without PsA from the FinnGen study and the data of 1837 unique plasma proteins from a genome-wide association study within the UK Biobank Pharma Proteomics Project.
Disclosures: This study was supported by the Natural Science Foundation of Guangxi Province and the National Natural Science Foundation of China. The authors declared no conflicts of interest.
Source: Zhao H, Zhou Y, Wang Z, Zhang X, Chen L, Hong Z. Plasma proteins and psoriatic arthritis: A proteome-wide Mendelian randomization study. Front Immunol. 15:1417564 (July 3). Doi: 10.3389/fimmu.2024.1417564 Source
Impact of Smoking and Diabetes on PsA Risk in Psoriasis Patients
Key clinical point: The presence of type 2 diabetes (T2D) and smoking history increased the risk for psoriatic arthritis (PsA) in patients with psoriasis; however, T2D seemed to have a greater impact than smoking history in increasing incidence rate of PsA.
Major finding: The risk for PsA was significantly higher in patients with psoriasis who did vs did not have T2D (hazard ratio [HR] 1.11; 95% CI 1.03-1.20) and in those with vs without smoking history (HR 1.11; 95% CI 1.06-1.17). However, the risk was not significant in patients with psoriasis and T2D with vs without smoking history (HR 1.05; 95% CI 0.92-1.20).
Study details: This retrospective cohort study included patients with psoriasis with or without T2D (n = 42,315 each), those with or without smoking history (n = 74,046 each), and those with T2D with or without smoking history (n = 13,065 each).
Disclosures: This study was funded by the Chung Shan Medical University Hospital research project. The authors declared no conflicts of interest.
Source: Huo A-P, Liao P-L, Leong P-Y, Wei JC-C. From psoriasis to psoriatic arthritis: Epidemiological insights from a retrospective cohort study of 74,046 patients. Front Med. 2024;11:1419722 (June 26). Doi: 10.3389/fmed.2024.1419722 Source
Key clinical point: The presence of type 2 diabetes (T2D) and smoking history increased the risk for psoriatic arthritis (PsA) in patients with psoriasis; however, T2D seemed to have a greater impact than smoking history in increasing incidence rate of PsA.
Major finding: The risk for PsA was significantly higher in patients with psoriasis who did vs did not have T2D (hazard ratio [HR] 1.11; 95% CI 1.03-1.20) and in those with vs without smoking history (HR 1.11; 95% CI 1.06-1.17). However, the risk was not significant in patients with psoriasis and T2D with vs without smoking history (HR 1.05; 95% CI 0.92-1.20).
Study details: This retrospective cohort study included patients with psoriasis with or without T2D (n = 42,315 each), those with or without smoking history (n = 74,046 each), and those with T2D with or without smoking history (n = 13,065 each).
Disclosures: This study was funded by the Chung Shan Medical University Hospital research project. The authors declared no conflicts of interest.
Source: Huo A-P, Liao P-L, Leong P-Y, Wei JC-C. From psoriasis to psoriatic arthritis: Epidemiological insights from a retrospective cohort study of 74,046 patients. Front Med. 2024;11:1419722 (June 26). Doi: 10.3389/fmed.2024.1419722 Source
Key clinical point: The presence of type 2 diabetes (T2D) and smoking history increased the risk for psoriatic arthritis (PsA) in patients with psoriasis; however, T2D seemed to have a greater impact than smoking history in increasing incidence rate of PsA.
Major finding: The risk for PsA was significantly higher in patients with psoriasis who did vs did not have T2D (hazard ratio [HR] 1.11; 95% CI 1.03-1.20) and in those with vs without smoking history (HR 1.11; 95% CI 1.06-1.17). However, the risk was not significant in patients with psoriasis and T2D with vs without smoking history (HR 1.05; 95% CI 0.92-1.20).
Study details: This retrospective cohort study included patients with psoriasis with or without T2D (n = 42,315 each), those with or without smoking history (n = 74,046 each), and those with T2D with or without smoking history (n = 13,065 each).
Disclosures: This study was funded by the Chung Shan Medical University Hospital research project. The authors declared no conflicts of interest.
Source: Huo A-P, Liao P-L, Leong P-Y, Wei JC-C. From psoriasis to psoriatic arthritis: Epidemiological insights from a retrospective cohort study of 74,046 patients. Front Med. 2024;11:1419722 (June 26). Doi: 10.3389/fmed.2024.1419722 Source
Periodontitis Impacts Oral Health-Related Quality of Life in PsA
Key clinical point: In individuals with vs without psoriatic arthritis (PsA), periodontitis was highly prevalent and negatively affected oral Health-Related Quality of Life (HRQOL).
Major finding: Individuals with vs without PsA were 2.67 times more likely to develop periodontitis (prevalence 57.0% vs 33.1%; odds ratio 2.67; P < .001), which was significantly associated with worsened oral HRQOL (odds ratio 1.92; P < .001). The mean Oral Impacts on Daily Performance scores, indicative of oral HRQOL, were also higher in individuals with vs without PsA (P < .001).
Study details: This case-control study included 86 individuals with PsA, 210 individuals with psoriasis, and 359 control individuals without psoriasis, all age 35-65 years and having ≥ 14 teeth.
Disclosures: This study was supported by the National Council for Scientific and Technological Development - CNPq, Brazil. The authors declared no conflicts of interest.
Source: Costa AA, Cota LOM, Esteves Lima RP, et al. The association between periodontitis and the impact of oral health on the quality of life of individuals with psoriasis and psoriatic arthritis. PLoS One. 2024;19(6):e0301158 (June 25). Doi: 10.1371/journal.pone.0301158 Source
Key clinical point: In individuals with vs without psoriatic arthritis (PsA), periodontitis was highly prevalent and negatively affected oral Health-Related Quality of Life (HRQOL).
Major finding: Individuals with vs without PsA were 2.67 times more likely to develop periodontitis (prevalence 57.0% vs 33.1%; odds ratio 2.67; P < .001), which was significantly associated with worsened oral HRQOL (odds ratio 1.92; P < .001). The mean Oral Impacts on Daily Performance scores, indicative of oral HRQOL, were also higher in individuals with vs without PsA (P < .001).
Study details: This case-control study included 86 individuals with PsA, 210 individuals with psoriasis, and 359 control individuals without psoriasis, all age 35-65 years and having ≥ 14 teeth.
Disclosures: This study was supported by the National Council for Scientific and Technological Development - CNPq, Brazil. The authors declared no conflicts of interest.
Source: Costa AA, Cota LOM, Esteves Lima RP, et al. The association between periodontitis and the impact of oral health on the quality of life of individuals with psoriasis and psoriatic arthritis. PLoS One. 2024;19(6):e0301158 (June 25). Doi: 10.1371/journal.pone.0301158 Source
Key clinical point: In individuals with vs without psoriatic arthritis (PsA), periodontitis was highly prevalent and negatively affected oral Health-Related Quality of Life (HRQOL).
Major finding: Individuals with vs without PsA were 2.67 times more likely to develop periodontitis (prevalence 57.0% vs 33.1%; odds ratio 2.67; P < .001), which was significantly associated with worsened oral HRQOL (odds ratio 1.92; P < .001). The mean Oral Impacts on Daily Performance scores, indicative of oral HRQOL, were also higher in individuals with vs without PsA (P < .001).
Study details: This case-control study included 86 individuals with PsA, 210 individuals with psoriasis, and 359 control individuals without psoriasis, all age 35-65 years and having ≥ 14 teeth.
Disclosures: This study was supported by the National Council for Scientific and Technological Development - CNPq, Brazil. The authors declared no conflicts of interest.
Source: Costa AA, Cota LOM, Esteves Lima RP, et al. The association between periodontitis and the impact of oral health on the quality of life of individuals with psoriasis and psoriatic arthritis. PLoS One. 2024;19(6):e0301158 (June 25). Doi: 10.1371/journal.pone.0301158 Source
Sedentary Lifestyle Linked to Increased Disease Burden in PsA
Key clinical point: Around 25% patients with psoriatic arthritis (PsA) had a sedentary lifestyle (< 90 min of physical activity per week), with lack of physical activity associated with pain, worsened clinical activity, functionality, and disease impact.
Major finding: Overall, 25.9% of patients had a sedentary lifestyle. Patients with a sedentary vs non-sedentary lifestyle had more enthesitis, fatigue, higher disease activity, greater disease impact, and lower functionality (all P < .05). Sedentary lifestyle was also associated with increased risk for pain (odds ratio 1.5; P < .001).
Study details: This cross-sectional study included 232 patients with PsA aged 18-69 years with no radiographic damage or respiratory or cardiac diseases that limit physical activity.
Disclosures: This study did not receive any financial support. The authors declared no conflicts of interest. During the review, the reviewer declared a shared affiliation, with no collaboration, of the lead author to the handling editor.
Source: Toledano E, Chacón CC, Compán O, et al. Analysis of physical activity in psoriatic arthritis: Relationship with clinical and analytical parameters and comorbidity—description of the sedentary patient. Front Med. 2024;11:1385842 (June 23). Doi: 10.3389/fmed.2024.1385842 Source
Key clinical point: Around 25% patients with psoriatic arthritis (PsA) had a sedentary lifestyle (< 90 min of physical activity per week), with lack of physical activity associated with pain, worsened clinical activity, functionality, and disease impact.
Major finding: Overall, 25.9% of patients had a sedentary lifestyle. Patients with a sedentary vs non-sedentary lifestyle had more enthesitis, fatigue, higher disease activity, greater disease impact, and lower functionality (all P < .05). Sedentary lifestyle was also associated with increased risk for pain (odds ratio 1.5; P < .001).
Study details: This cross-sectional study included 232 patients with PsA aged 18-69 years with no radiographic damage or respiratory or cardiac diseases that limit physical activity.
Disclosures: This study did not receive any financial support. The authors declared no conflicts of interest. During the review, the reviewer declared a shared affiliation, with no collaboration, of the lead author to the handling editor.
Source: Toledano E, Chacón CC, Compán O, et al. Analysis of physical activity in psoriatic arthritis: Relationship with clinical and analytical parameters and comorbidity—description of the sedentary patient. Front Med. 2024;11:1385842 (June 23). Doi: 10.3389/fmed.2024.1385842 Source
Key clinical point: Around 25% patients with psoriatic arthritis (PsA) had a sedentary lifestyle (< 90 min of physical activity per week), with lack of physical activity associated with pain, worsened clinical activity, functionality, and disease impact.
Major finding: Overall, 25.9% of patients had a sedentary lifestyle. Patients with a sedentary vs non-sedentary lifestyle had more enthesitis, fatigue, higher disease activity, greater disease impact, and lower functionality (all P < .05). Sedentary lifestyle was also associated with increased risk for pain (odds ratio 1.5; P < .001).
Study details: This cross-sectional study included 232 patients with PsA aged 18-69 years with no radiographic damage or respiratory or cardiac diseases that limit physical activity.
Disclosures: This study did not receive any financial support. The authors declared no conflicts of interest. During the review, the reviewer declared a shared affiliation, with no collaboration, of the lead author to the handling editor.
Source: Toledano E, Chacón CC, Compán O, et al. Analysis of physical activity in psoriatic arthritis: Relationship with clinical and analytical parameters and comorbidity—description of the sedentary patient. Front Med. 2024;11:1385842 (June 23). Doi: 10.3389/fmed.2024.1385842 Source
Genetically Mimicked IL-13 Inhibition Raises PsA Risk
Key clinical point: A genetic variant of the IL-13 gene that was designed to mimic the therapeutic effects of interleukin-13 (IL-13) inhibition was associated with an increased risk for psoriatic arthritis (PsA).
Major finding: IL-13 inhibition, genetically mimicked using an IL-13 gene variant was associated with an increased risk for PsA (odds ratio 37.39; P = 1.64×10-9).
Study details: This two-sample Mendelian randomization study analyzed the data of 563,946 individuals with exposure to IL-13 inhibition while the genetic outcomes were assessed in 3609 patients with PsA and 9192 control individuals without PsA.
Disclosures: This study was supported by the National Institute for Health Research Manchester Biomedical Research Centre, UK. Three authors declared receiving grants, consulting fees, speaker fees, honoraria, or travel support from various sources unrelated to this study. Other authors declared no conflicts of interest.
Source: Zhao SS, Hyrich K, Yiu Z, et al. Genetically proxied IL-13 inhibition is associated with risk of psoriatic disease: Mendelian randomization study. Arthritis Rheumatol. 2024 (July 8). Doi: 10.1002/art.42942 Source
Key clinical point: A genetic variant of the IL-13 gene that was designed to mimic the therapeutic effects of interleukin-13 (IL-13) inhibition was associated with an increased risk for psoriatic arthritis (PsA).
Major finding: IL-13 inhibition, genetically mimicked using an IL-13 gene variant was associated with an increased risk for PsA (odds ratio 37.39; P = 1.64×10-9).
Study details: This two-sample Mendelian randomization study analyzed the data of 563,946 individuals with exposure to IL-13 inhibition while the genetic outcomes were assessed in 3609 patients with PsA and 9192 control individuals without PsA.
Disclosures: This study was supported by the National Institute for Health Research Manchester Biomedical Research Centre, UK. Three authors declared receiving grants, consulting fees, speaker fees, honoraria, or travel support from various sources unrelated to this study. Other authors declared no conflicts of interest.
Source: Zhao SS, Hyrich K, Yiu Z, et al. Genetically proxied IL-13 inhibition is associated with risk of psoriatic disease: Mendelian randomization study. Arthritis Rheumatol. 2024 (July 8). Doi: 10.1002/art.42942 Source
Key clinical point: A genetic variant of the IL-13 gene that was designed to mimic the therapeutic effects of interleukin-13 (IL-13) inhibition was associated with an increased risk for psoriatic arthritis (PsA).
Major finding: IL-13 inhibition, genetically mimicked using an IL-13 gene variant was associated with an increased risk for PsA (odds ratio 37.39; P = 1.64×10-9).
Study details: This two-sample Mendelian randomization study analyzed the data of 563,946 individuals with exposure to IL-13 inhibition while the genetic outcomes were assessed in 3609 patients with PsA and 9192 control individuals without PsA.
Disclosures: This study was supported by the National Institute for Health Research Manchester Biomedical Research Centre, UK. Three authors declared receiving grants, consulting fees, speaker fees, honoraria, or travel support from various sources unrelated to this study. Other authors declared no conflicts of interest.
Source: Zhao SS, Hyrich K, Yiu Z, et al. Genetically proxied IL-13 inhibition is associated with risk of psoriatic disease: Mendelian randomization study. Arthritis Rheumatol. 2024 (July 8). Doi: 10.1002/art.42942 Source
Multimorbidity Worsens Quality of Life in Patients With PsA
Key clinical point: Multimorbidity was present in nearly 50% of patients with psoriatic arthritis (PsA) and significantly affected the physical aspects of their quality of life.
Major finding: Multimorbidity was observed in 50.2% patients, with cardiovascular diseases being the most prevalent comorbidity. Patients with vs without multimorbidity had worsened scores for various 36-Item Short Form Health Survey domains, including bodily pain (34.7 vs 47.5; P < .01), physical functioning (52.1 vs 63.1; P < .01), and ability to perform roles due to physical health problems (28.5 vs 42.8; P < .01).
Study details: This cross-sectional observational study included 267 patients with PsA, age > 18 years.
Disclosures: This study was supported by a grant from the National Centre for Research and Development, Warsaw, Poland. The authors declared no conflicts of interest.
Source: Biedroń G, Wilk M, Nowakowski J, et al. Impact of comorbidities on patient-reported outcomes in psoriatic arthritis: A single centre cohort study. Rheumatol Int. Published online 2024;44:1435-1443. Doi: 10.1007/s00296-024-05632-2 Source
Key clinical point: Multimorbidity was present in nearly 50% of patients with psoriatic arthritis (PsA) and significantly affected the physical aspects of their quality of life.
Major finding: Multimorbidity was observed in 50.2% patients, with cardiovascular diseases being the most prevalent comorbidity. Patients with vs without multimorbidity had worsened scores for various 36-Item Short Form Health Survey domains, including bodily pain (34.7 vs 47.5; P < .01), physical functioning (52.1 vs 63.1; P < .01), and ability to perform roles due to physical health problems (28.5 vs 42.8; P < .01).
Study details: This cross-sectional observational study included 267 patients with PsA, age > 18 years.
Disclosures: This study was supported by a grant from the National Centre for Research and Development, Warsaw, Poland. The authors declared no conflicts of interest.
Source: Biedroń G, Wilk M, Nowakowski J, et al. Impact of comorbidities on patient-reported outcomes in psoriatic arthritis: A single centre cohort study. Rheumatol Int. Published online 2024;44:1435-1443. Doi: 10.1007/s00296-024-05632-2 Source
Key clinical point: Multimorbidity was present in nearly 50% of patients with psoriatic arthritis (PsA) and significantly affected the physical aspects of their quality of life.
Major finding: Multimorbidity was observed in 50.2% patients, with cardiovascular diseases being the most prevalent comorbidity. Patients with vs without multimorbidity had worsened scores for various 36-Item Short Form Health Survey domains, including bodily pain (34.7 vs 47.5; P < .01), physical functioning (52.1 vs 63.1; P < .01), and ability to perform roles due to physical health problems (28.5 vs 42.8; P < .01).
Study details: This cross-sectional observational study included 267 patients with PsA, age > 18 years.
Disclosures: This study was supported by a grant from the National Centre for Research and Development, Warsaw, Poland. The authors declared no conflicts of interest.
Source: Biedroń G, Wilk M, Nowakowski J, et al. Impact of comorbidities on patient-reported outcomes in psoriatic arthritis: A single centre cohort study. Rheumatol Int. Published online 2024;44:1435-1443. Doi: 10.1007/s00296-024-05632-2 Source
Biologics Better Than Methotrexate for Preventing PsA in Psoriasis
Key clinical point: The onset rate of psoriatic arthritis (PsA) in patients with psoriasis was lower with biologics than with methotrexate, with topical therapy being associated with the lowest rate.
Major finding: Treatment with biologics vs methotrexate significantly reduced the risk of developing PsA (adjusted hazard ratio [aHR] 0.46; 95% CI 0.35-0.62); however, biologics were associated with an increased risk of developing PsA when compared to topical therapy (aHR 2.16; 95% CI 1.44-3.24). Prior exposure to at least two biologics (odds ratio [OR] 6.09; P < .001) or methotrexate (OR 1.88; P = .026) was tied to increased PsA risk.
Study details: This retrospective cohort study included 58,671 patients with psoriasis treated with biologics, methotrexate, phototherapy, or topical therapy; patients who received phototherapy or topical therapy did not undergo any prior systemic treatment.
Disclosures: This study was supported by an educational grant from Janssen Pharmaceuticals. Alen Zabotti declared being an editorial board member of Rheumatology and Therapy. The other authors declared no conflicts of interest.
Source: Watad A, Zabotti A, Patt YS, et al. From psoriasis to psoriatic arthritis: Decoding the impact of treatment modalities on the prevention of psoriatic arthritis. Rheumatol Ther. 2024;11:963-976 (June 7). Doi: 10.1007/s40744-024-00680-3 Source
Key clinical point: The onset rate of psoriatic arthritis (PsA) in patients with psoriasis was lower with biologics than with methotrexate, with topical therapy being associated with the lowest rate.
Major finding: Treatment with biologics vs methotrexate significantly reduced the risk of developing PsA (adjusted hazard ratio [aHR] 0.46; 95% CI 0.35-0.62); however, biologics were associated with an increased risk of developing PsA when compared to topical therapy (aHR 2.16; 95% CI 1.44-3.24). Prior exposure to at least two biologics (odds ratio [OR] 6.09; P < .001) or methotrexate (OR 1.88; P = .026) was tied to increased PsA risk.
Study details: This retrospective cohort study included 58,671 patients with psoriasis treated with biologics, methotrexate, phototherapy, or topical therapy; patients who received phototherapy or topical therapy did not undergo any prior systemic treatment.
Disclosures: This study was supported by an educational grant from Janssen Pharmaceuticals. Alen Zabotti declared being an editorial board member of Rheumatology and Therapy. The other authors declared no conflicts of interest.
Source: Watad A, Zabotti A, Patt YS, et al. From psoriasis to psoriatic arthritis: Decoding the impact of treatment modalities on the prevention of psoriatic arthritis. Rheumatol Ther. 2024;11:963-976 (June 7). Doi: 10.1007/s40744-024-00680-3 Source
Key clinical point: The onset rate of psoriatic arthritis (PsA) in patients with psoriasis was lower with biologics than with methotrexate, with topical therapy being associated with the lowest rate.
Major finding: Treatment with biologics vs methotrexate significantly reduced the risk of developing PsA (adjusted hazard ratio [aHR] 0.46; 95% CI 0.35-0.62); however, biologics were associated with an increased risk of developing PsA when compared to topical therapy (aHR 2.16; 95% CI 1.44-3.24). Prior exposure to at least two biologics (odds ratio [OR] 6.09; P < .001) or methotrexate (OR 1.88; P = .026) was tied to increased PsA risk.
Study details: This retrospective cohort study included 58,671 patients with psoriasis treated with biologics, methotrexate, phototherapy, or topical therapy; patients who received phototherapy or topical therapy did not undergo any prior systemic treatment.
Disclosures: This study was supported by an educational grant from Janssen Pharmaceuticals. Alen Zabotti declared being an editorial board member of Rheumatology and Therapy. The other authors declared no conflicts of interest.
Source: Watad A, Zabotti A, Patt YS, et al. From psoriasis to psoriatic arthritis: Decoding the impact of treatment modalities on the prevention of psoriatic arthritis. Rheumatol Ther. 2024;11:963-976 (June 7). Doi: 10.1007/s40744-024-00680-3 Source
Achilles Tendon Pain Severely Impairs Function in PsA
Key clinical point: Patients with psoriatic arthritis (PsA) who did vs did not have Achilles tendon (AT) pain reported severe functional impairment and disability.
Major finding: Patients with PsA with vs without AT pain had significantly greater AT-related morning stiffness (90.9% vs 9.1%; P < .001), impaired AT function (median heel raise repetition rate 0.72 vs 1.24; P = .005), worse Psoriatic Arthritis Impact of Disease questionnaire score (mean 5.52 vs 3.38; P = .018), and pain on passive dorsiflexion (36.4% vs 0%; P = .011) and resisted plantarflexion (45.5% vs 0%; P = .003).
Study details: This cross-sectional, observational study included 22 patients with PsA with (n = 11) and without (n = 11) self-reported AT pain and 11 healthy individuals without PsA or AT pain.
Disclosures: This study was funded by a Glasgow (UK) Caledonian University-funded PhD studentship. The authors declared no conflicts of interest.
Source: Patience A, Steultjens M, Siebert S, Hendry G. Significant functional impairment and disability in individuals with psoriatic arthritis and Achilles tendon pain: A cross-sectional observational study. Rheumatol Int. 2024;44:1469-1479 (June 8). Doi: 10.1007/s00296-024-05629-x Source
Key clinical point: Patients with psoriatic arthritis (PsA) who did vs did not have Achilles tendon (AT) pain reported severe functional impairment and disability.
Major finding: Patients with PsA with vs without AT pain had significantly greater AT-related morning stiffness (90.9% vs 9.1%; P < .001), impaired AT function (median heel raise repetition rate 0.72 vs 1.24; P = .005), worse Psoriatic Arthritis Impact of Disease questionnaire score (mean 5.52 vs 3.38; P = .018), and pain on passive dorsiflexion (36.4% vs 0%; P = .011) and resisted plantarflexion (45.5% vs 0%; P = .003).
Study details: This cross-sectional, observational study included 22 patients with PsA with (n = 11) and without (n = 11) self-reported AT pain and 11 healthy individuals without PsA or AT pain.
Disclosures: This study was funded by a Glasgow (UK) Caledonian University-funded PhD studentship. The authors declared no conflicts of interest.
Source: Patience A, Steultjens M, Siebert S, Hendry G. Significant functional impairment and disability in individuals with psoriatic arthritis and Achilles tendon pain: A cross-sectional observational study. Rheumatol Int. 2024;44:1469-1479 (June 8). Doi: 10.1007/s00296-024-05629-x Source
Key clinical point: Patients with psoriatic arthritis (PsA) who did vs did not have Achilles tendon (AT) pain reported severe functional impairment and disability.
Major finding: Patients with PsA with vs without AT pain had significantly greater AT-related morning stiffness (90.9% vs 9.1%; P < .001), impaired AT function (median heel raise repetition rate 0.72 vs 1.24; P = .005), worse Psoriatic Arthritis Impact of Disease questionnaire score (mean 5.52 vs 3.38; P = .018), and pain on passive dorsiflexion (36.4% vs 0%; P = .011) and resisted plantarflexion (45.5% vs 0%; P = .003).
Study details: This cross-sectional, observational study included 22 patients with PsA with (n = 11) and without (n = 11) self-reported AT pain and 11 healthy individuals without PsA or AT pain.
Disclosures: This study was funded by a Glasgow (UK) Caledonian University-funded PhD studentship. The authors declared no conflicts of interest.
Source: Patience A, Steultjens M, Siebert S, Hendry G. Significant functional impairment and disability in individuals with psoriatic arthritis and Achilles tendon pain: A cross-sectional observational study. Rheumatol Int. 2024;44:1469-1479 (June 8). Doi: 10.1007/s00296-024-05629-x Source
Varied Psoriasis Manifestations Pose Differential Risk for Psoriatic Arthritis
Key clinical point: The risk of developing psoriatic arthritis (PsA) varied across different manifestations of psoriasis, with psoriasis vulgaris posing the highest risk.
Major finding: Compared with control individuals without psoriasis, patients with psoriasis vulgaris had the highest risk for incident PsA (hazard ratio [HR] 87.7; P < .0001), followed by those with generalized pustular psoriasis (HR 26.8; P < .0001) and pustulosis palmoplantaris (HR 15.3; P < .0001). The risk for PsA was marginally elevated in female vs male patients with psoriasis vulgaris (HR 1.1; P = .002).
Study details: This population-based retrospective cohort study included patients with psoriasis vulgaris (n = 35,281), pustulosis palmoplantaris (n = 9639), or generalized pustular psoriasis (n = 2281) who were propensity-score matched with an equal number of control individuals without psoriasis.
Disclosures: This study was funded by the Cluster of Excellence "Precision Medicine in Chronic Inflammation" (Deutsche Forschungsgemeinschaft) and other sources. Some authors declared having ties with various sources or serving as editorial board members for Frontiers.
Source: Gershater B, Bieber K, Vorobyev A, et al. Differential risks of psoriatic arthritis development in patients with varied psoriasis manifestations: A sex- and ethnicity-specific analysis. Front Med. 2024;11:1385491 (June 20). Doi: 10.3389/fmed.2024.1385491 Source
Key clinical point: The risk of developing psoriatic arthritis (PsA) varied across different manifestations of psoriasis, with psoriasis vulgaris posing the highest risk.
Major finding: Compared with control individuals without psoriasis, patients with psoriasis vulgaris had the highest risk for incident PsA (hazard ratio [HR] 87.7; P < .0001), followed by those with generalized pustular psoriasis (HR 26.8; P < .0001) and pustulosis palmoplantaris (HR 15.3; P < .0001). The risk for PsA was marginally elevated in female vs male patients with psoriasis vulgaris (HR 1.1; P = .002).
Study details: This population-based retrospective cohort study included patients with psoriasis vulgaris (n = 35,281), pustulosis palmoplantaris (n = 9639), or generalized pustular psoriasis (n = 2281) who were propensity-score matched with an equal number of control individuals without psoriasis.
Disclosures: This study was funded by the Cluster of Excellence "Precision Medicine in Chronic Inflammation" (Deutsche Forschungsgemeinschaft) and other sources. Some authors declared having ties with various sources or serving as editorial board members for Frontiers.
Source: Gershater B, Bieber K, Vorobyev A, et al. Differential risks of psoriatic arthritis development in patients with varied psoriasis manifestations: A sex- and ethnicity-specific analysis. Front Med. 2024;11:1385491 (June 20). Doi: 10.3389/fmed.2024.1385491 Source
Key clinical point: The risk of developing psoriatic arthritis (PsA) varied across different manifestations of psoriasis, with psoriasis vulgaris posing the highest risk.
Major finding: Compared with control individuals without psoriasis, patients with psoriasis vulgaris had the highest risk for incident PsA (hazard ratio [HR] 87.7; P < .0001), followed by those with generalized pustular psoriasis (HR 26.8; P < .0001) and pustulosis palmoplantaris (HR 15.3; P < .0001). The risk for PsA was marginally elevated in female vs male patients with psoriasis vulgaris (HR 1.1; P = .002).
Study details: This population-based retrospective cohort study included patients with psoriasis vulgaris (n = 35,281), pustulosis palmoplantaris (n = 9639), or generalized pustular psoriasis (n = 2281) who were propensity-score matched with an equal number of control individuals without psoriasis.
Disclosures: This study was funded by the Cluster of Excellence "Precision Medicine in Chronic Inflammation" (Deutsche Forschungsgemeinschaft) and other sources. Some authors declared having ties with various sources or serving as editorial board members for Frontiers.
Source: Gershater B, Bieber K, Vorobyev A, et al. Differential risks of psoriatic arthritis development in patients with varied psoriasis manifestations: A sex- and ethnicity-specific analysis. Front Med. 2024;11:1385491 (June 20). Doi: 10.3389/fmed.2024.1385491 Source