Persistence and Compliance of Deferoxamine Versus Deferasirox in Medicaid Patients with Sickle-Cell Disease.
Bibliographic record
Abstract
Abstract Abstract 1982 Poster Board I-1004 Background: Patients with sickle-cell disease (SCD) receiving chronic transfusions of red blood cells are at risk of developing serious adverse effects. Iron chelating therapies (ICTs) help eliminate iron surplus by binding with plasma iron to form a non-toxic conjugate that can be safely excreted from the body. Two iron chelating agents are currently available in the US: deferoxamine (DFO) is an injectable formulation and deferasirox (Exjade®) is an oral suspension. This study compared the frequency of hospitalizations, persistence, and compliance of SCD patients from Medicaid programs treated with DFO versus deferasirox. Methods: An analysis of patients' electronic claims records from the Florida (1998-2007), Missouri (1993-2008), and New Jersey (1996-2008) Medicaid programs was conducted. Patients with continuous enrollment for at least six months prior to ICT initiation and ≥1 SCD diagnosis were included in the analysis. Patients were divided into four cohorts: patients treated with DFO (any DFO group) and patients treated with deferasirox (any deferasirox group); the latter was further divided into patients initiated on DFO and then switched to deferasirox (deferasirox switchers), and patients treated with deferasirox only (deferasirox only group). Frequency of hospitalization as well as length of stay pre- and post-ICT treatment initiation were assessed. Persistence was defined as time to drug discontinuation with at least one Rx gap, using Kaplan-Meier approach. Compliance was estimated using a medication possession ratio (MPR), calculated as the total days of supply divided by the number of days between the first and last dispensing plus the days of supply of the last dispensing. Results: A total of 217 (mean age=19.4), 275 (20.1), 105 (19.4), and 166 (20.4) patients were included in the any DFO, any deferasirox, deferasirox switchers, and deferasirox only groups, respectively. Exposure period, defined as the time from the date of the first dispensing to the end of the days supply of the last dispensing, was approximately two times longer in the DFO group than in the deferasirox groups (days, DFO: 783, any deferasirox: 353, deferasirox switchers: 416, deferasirox only groups: 317). After ICT initiation, both DFO and deferasirox groups experienced significant reduction in the frequency of hospitalizations relative to pre-treatment (DFO: from 0.92 to 0.64 hospitalizations per patient per month, P=.0010; any deferasirox: from 1.22 to 0.4, P<.0001). Median length of hospitalization stay remained similar after ICT initiation relative to pre-treatment in both the DFO group (pre- and post-ICT initiation: 3 days) and the any deferasirox group (from 3 days pre-ICT to 4 days post-ICT initiation). The Kaplan-Meier rates of medication persistence during the first year of ICT were significantly greater for all three deferasirox cohorts compared to the DFO cohort (see Table 1). Patients treated with deferasirox were significantly more compliant compared to the DFO group (see Table 2). Conclusions: Based on a Medicaid population, deferasirox patients were more compliant and persistent to their treatment than those treated with DFO. Frequency of hospitalizations was significantly reduced in the observation period for all ICT treated patients, although the length of hospitalization stay remained similar. Prospective studies are warranted to validate these results. Disclosures: Jordan: Analysis Group, Inc.: Consultancy. Vekeman:Analysis Group, Inc.: Employment; Novartis Pharmaceuticals Corporation: Research Funding. Sengupta:Analysis Group, Inc.: Employment; Novartis Pharmaceuticals Corporation: Research Funding. Corral:Novartis Pharmaceuticals Corporation: Employment. Guo:Novartis Pharmaceuticals Corporation: Employment. Duh:Novartis Pharmaceuticals Corporation: Research Funding; Analysis Group, Inc.: Employment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".