Real-world adherence and persistence of dual antiplatelet therapy over two years in patients with coronary artery diseases
Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA)/clopidogrel showed a statistically significant better persistence vs ASA/ticagrelor and ASA/prasugrel. However, no statistically significant differences were seen in adherence to ASA/clopidogrel fixed dose combination (FDC) vs the use of two different pills.

<h2>Main Takeaway</h2>
<ul>
 <li>In this first study evaluating the difference in adherence between FDC vs each component taken as a separate pill, in patients with coronary artery disease treated with DAPT (at two years): 
 <ul>
 <li>No statistically significant difference was found between FDC of ASA/clopidogrel and the combination of the two ASA and clopidogrel pills taken separately (P = 0.0752).</li>
 <li>Adherence data were optimal for all types of DAPT analyzed (absolute value of adherence = 0.96).</li>
 </ul></li>
 <li>In this real-life analysis, persistence to therapy was observed to be better in the ASA/clopidogrel group vs the ASA/prasugrel and the ASA/ticagrelor groups (at two years). 
 <ul>
 <li>ASA/clopidogrel and ASA/clopidogrel (FDC) curves showed a statistically significant better persistence than ASA/prasugrel and ASA/ticagrelor curves (P &lt;0.001).</li>
 <li>However, the persistence data showed low adherence to the guidelines.</li>
 </ul></li>
</ul>

<h2>Why This Matters</h2>
<ul>
 <li>There is a lack of consensus regarding the optimal duration of DAPT for patients with coronary artery disease.</li>
 <li>Additionally, long-term adherence to DAPT remains a challenge in the management of patients with cardiovascular diseases in real-life, due to various factors like need for prolonged therapy, lack of proper prescription in the context of primary care, and the instructions provided at hospital discharge.</li>
 <li>This real-world study therefore, evaluated adherence and persistence over two years in patients receiving DAPT.</li>
</ul>

<h2>Study Design</h2>
<ul>
 <li>This non-interventional, retrospective study included all patients treated with DAPT in the Hospital of Pescara (Italy) utilizing data from the Hospital reimbursement database.</li>
 <li>The study population consisted of prevalent users of clopidogrel, ASA, prasugrel, and ticagrelor (administered as first-line therapy).</li>
</ul>

<h2>Key Results</h2>
<ul>
 <li>Overall, 519 patients treated with DAPT were included in the analysis (male = 83%; median age = 63; ASA/clopidogrel, n = 277; ASA/prasugrel, n = 77; ASA/ticagrelor, n = 57, and ASA/clopidogrel FDC, n = 108).</li>
 <li>Persistence (at two years): Persistence to therapy was observed to be better in the ASA/clopidogrel group vs the ASA/prasugrel and the ASA/ticagrelor groups 
 <ul>
 <li>ASA/clopidogrel and ASA/clopidogrel (FDC) curves showed a statistically significant better persistence than ASA/prasugrel and ASA/ticagrelor curves (P &lt;0.001).</li>
 <li>In total, 34 patients remained on ASA/clopidogrel and 18 patients remained on ASA/clopidogrel (FDC); while 1 patient each remained on ASA/prasugrel and ASA/ticagrelor therapies.</li>
 <li>Overall persistence data showed low adherence to the guidelines.</li>
 </ul></li>
 <li>Adherence (at two years): Adherence to therapy was optimal for all types of DAPT analyzed and remained stable over the study period 
 <ul>
 <li>Absolute value of adherence at two years was 0.96 and adherence ≥ 0.8 was observed in 94% of the patients</li>
 <li>ASA/prasugrel group had better adherence vs the other groups: Absolute value of adherence was 0.98; and adherence value ≥ 0.8 was seen in 97% of the patients</li>
 <li>FDC ASA/clopidogrel group had poor adherence vs the other groups: Absolute value of adherence was 0.94; and adherence value ≥ 0.8 was seen in 88% of the patients</li>
 <li>No statistically significant difference was found between FDC of ASA/clopidogrel and the combination of the two ASA and clopidogrel pills taken separately (P = 0.0752).</li>
 </ul></li>
</ul>

<h2>Limitations</h2>
<ul>
 <li>The reasons for non-persistence of therapy were not evaluated as the analysis was based on data from an administrative database.</li>
</ul>

Reference

Adherence and persistence analysis in patients treated with DAPT

THROMBOSIS

CARDIOLOGY

Unveil the complexities of Advent Atopic Dermatitis Pathophysiology:&nbsp;Breaking Down the Barrier! Explore the intricate mechanisms behind skin barrier dysfunction, the latest insights into immune system involvement, and innovative therapeutic approaches.
This essential read will enhance your understanding and management of atopic dermatitis, empowering you to provide better care for your patients.

References

ATOPIC-DERMATITIS

DERMATOLOGY

Atopic Dermatitis Pathophysiology: Breaking Down the Barrier

ASTHMA

RESPIRATORY

When do you discuss Biologic treatment with your Asthma patients?

A Biologic option in severe Asthma

What is your experience with Dupixent in your practice?

Dupixent Asthma KOL Expert Series Video - DUPIXENT in Your Practice.

Severe Asthma Biomarker's

What is the clinical utility of monitoring changes in eosinophils, IgE, and fractional exhaled nitric oxide (FeNO) to assess the effectiveness of biologic treatments?
Eosinophils and FeNO - these clinical measurements can help us predict exacerbation risk and make wise decision on biological options.1&nbsp;What is the clinical utility of monitoring changes in eosinophils, IgE, and fractional exhaled nitric oxide (FeNO) to assess the effectiveness of biologic treatments?

Management of antithrombotic therapy in patients with AF undergoing PCI

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Risk factor profile and outcomes of young patients suffering their first acute myocardial infarction: Results from Gulf Coast
Findings from this first prospective cohort study evaluating Gulf-Arabs without prior cardiovascular disease presenting with first acute myocardial infarction (AMI) highlight important age-related care gaps in this patient population.
<h2>Main Takeaway</h2>
<ul>
 <li>This&nbsp;Gulf-Coast study in adults without established atherosclerotic cardiovascular disease (ASCVD)&nbsp;presenting with first AMI highlights significant differences in the clinical presentation, treatment patterns, and age-related care gaps between young ( 50 years of age) and older (&gt;50 years of age) patients with first AMI. 
 <ul>
 <li>Young patients with first AMI had a high burden of modifiable ASCVD risk factors, and were more prone to be obese, smokers, and have a family history of premature coronary artery disease (CAD).</li>
 <li>This study noted a crucial treatment paradox: Older patients with AMI were less likely to receive potentially lifesaving interventions vs younger patients.</li>
 <li>Young patients had significantly lower odds of any major adverse cardiovascular events (MACE: adjusted odds ratio [aOR] = 0.53; P = 0.006) and had significantly lower odds of cumulative death up to 12-months post-discharge (aOR = 0.34; P &lt;0.001).</li>
 </ul></li>
</ul>

<h2>Why This Matters</h2>
<ul>
 <li>The incidence of AMI in young adults is on the rise, yet the modifiable ASCVD risk factors accounting for the majority of AMI risk&nbsp;may remain undiagnosed or undertreated until the time of first AMI.</li>
 <li>Alarmingly high rates of&nbsp;cardiovascular risk factors were seen in the younger population in the Middle Eastern Gulf region;&nbsp;however, limited information is available regarding the risk profile of young patients with AMI in this region.</li>
</ul>
<h2>Study Design</h2>
<ul>
 <li>This study analyzed a subset of patients enrolled in the&nbsp;Gulf COAST registry&nbsp;(from January 2012 to January 2013): 
 <ul>
 <li>Key inclusion criteria: Individuals with no prior history of clinical ASCVD who presented with acute coronary syndrome and carried the diagnosis of AMI as their admission event</li>
 <li>Key exclusion criteria: Prior percutaneous coronary interventions, coronary artery bypass surgery, prior history of transient ischemic attack or stroke, renal dysfunction requiring dialysis, or patients presenting with concomitant stroke or severe bleeding, chronic obstructive pulmonary disease exacerbation, or pneumonia</li>
 <li>ASCVD risk factors: Modifiable (hypertension, dyslipidemia, diabetes, smoking, obesity and central adiposity) and non-modifiable risk factors (sex or family history of premature CAD) were obtained</li>
 <li>Study outcomes: Associations between age group and in-hospital MACE (re-infarction, heart failure, cardiogenic shock, cardiac arrest, stroke, and in-hospital death) and post-discharge mortality</li>
 </ul></li>
</ul>
<h2>Key Results</h2>
<ul>
 <li>95.5% of matched patients used aspirin with ticagrelor or clopidogrel among the 31,290 propensity-matched pairs 
 <ul>
 <li>Of note, 59% of the young patients had 2 modifiable ASCVD risk factors.</li>
 <li>At the time of AMI, young patients were more likely to present with typical ischemic symptoms, and less signs of heart failure on presentation.</li>
 <li>Treatment patterns (guideline-proven therapies in young vs older patients): -blockers = 83.0% vs 74.4% (P &lt;0.001); clopidogrel = 82.3% vs 76.0% (P = 0.009); and primary reperfusion therapy = 85.6% vs 75.6% (P = 0.003)</li>
 <li>Young patients had significantly lower odds of any MACE (aOR = 0.53 [95% CI: 0.34–0.83]; P = 0.006) vs older patients.</li>
 <li>Young patients had lower likelihood of cumulative death (including in-hospital death) at 12-month post-discharge. 
 <ul>
 <li>In-hospital death: aOR = 0.37 (95% CI: 0.16–0.86; P = 0.021)</li>
 <li>Cumulative death at 12 months: aOR = 0.34 (95% CI: 0.19-0.59; P &lt;0.001)</li>
 </ul></li>
 </ul></li>
</ul>
<h2>Limitations</h2>
<ul>
 <li>This study only included patients presenting to the hospital with suspected acute coronary syndrome.</li>
 <li>The sensitivities in detecting elevated troponin levels may have varied across the different centers (data for the type of troponin assay used in each enrolling center was not collected).</li>
 <li>The success rate of primary reperfusion therapy was not documented.</li>
</ul>

In hospital outcomes in young patients with AMI: Results from Gulf Coast

Spirometry&nbsp;is the gold standard to assess lung function2.
Lung function assessment&nbsp;can1:
<ul>
 <li>Diagnose pulmonary disease</li>
 <li>Monitor disease progression</li>
 <li>Monitor treatment response</li>
</ul>

Lung Function Decline and Exacerbation in Asthma

Impact of reduced lung function2
<ul>
 <li>Shortness of breath</li>
 <li>Increased exacerbation risk</li>
 <li>Reduced exercise tolerance</li>
 <li>Impaired gas exchange resulting&nbsp; in hypoxemia and hypercapnia</li>
</ul>

Why is it important to look for Type 2 inflammation in patients with Asthma?

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