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  1. Article ; Online: Comparative Effectiveness of a Second Tumor Necrosis Factor Inhibitor Versus a Non-Tumor Necrosis Factor Biologic in the Treatment of Patients With Polyarticular-Course Juvenile Idiopathic Arthritis.

    Mannion, Melissa L / Amin, Shahla / Balevic, Stephen / Chang, Min-Lee / Correll, Colleen K / Kearsley-Fleet, Lianne / Hyrich, Kimme L / Beukelman, Timothy

    Arthritis care & research

    2024  

    Abstract: Objective: The objective of this study was to compare the effectiveness of a second tumor necrosis factor inhibitor (TNFi) versus a non-TNFi biologic following discontinuation of a TNFi for patients with polyarticular-course juvenile idiopathic ... ...

    Abstract Objective: The objective of this study was to compare the effectiveness of a second tumor necrosis factor inhibitor (TNFi) versus a non-TNFi biologic following discontinuation of a TNFi for patients with polyarticular-course juvenile idiopathic arthritis (pJIA).
    Methods: Using the Childhood Arthritis and Rheumatology Research Alliance Registry, patients with pJIA who started receiving a second biologic following a first TNFi were identified. Patients were required to have no active uveitis on the index date and a visit six months after the index date. Outcome measures included Clinical Juvenile Arthritis Disease Activity Score with a maximum of 10 active joints (cJADAS10), cJADAS10 inactive disease (ID; ≤2.5) and cJADAS10 minimal disease activity (MiDA; ≤5). Multiple imputation was used to account for missing data. Adjusted odds ratios (aORs) were calculated using propensity score quintiles to compare outcomes at six months following second biologic initiation.
    Results: There were 216 patients included, 84% initially received etanercept, and most patients stopped receiving it because of its ineffectiveness (74%). A total of 183 (85%) started receiving a second TNFi, and 33 (15%) started receiving a non-TNFi. Adalimumab was the most common second biologic received (71% overall, 84% of second TNFi), and tocilizumab was the most common non-TNFi second biologic received (9% overall, 58% of non-TNFi). There was no difference between receiving TNFi versus non-TNFi in cJADAS10 ID (29% vs 25%; aOR 1.23, 95% confidence interval [CI] 0.47-3.20) or at least MiDA (43% vs 39%; aOR 1.11, 95% CI 0.47-2.62) at six months.
    Conclusion: Most patients with pJIA started receiving TNFi rather than non-TNFi as their second biologic, and there were no differences in disease activity at six months.
    Language English
    Publishing date 2024-03-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.25339
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2446: Show issues Location:
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  2. Article ; Online: Rapid Growth Of Antipsychotic Prescriptions For Children Who Are Publicly Insured Has Ceased, But Concerns Remain.

    Crystal, Stephen / Mackie, Thomas / Fenton, Miriam C / Amin, Shahla / Neese-Todd, Sheree / Olfson, Mark / Bilder, Scott

    Health affairs (Project Hope)

    2016  Volume 35, Issue 6, Page(s) 974–982

    Abstract: The rapid growth of antipsychotic medication use among publicly insured children in the early and mid-2000s spurred new state efforts to monitor and improve prescription behavior. A starting point for many oversight initiatives was the foster care system, ...

    Abstract The rapid growth of antipsychotic medication use among publicly insured children in the early and mid-2000s spurred new state efforts to monitor and improve prescription behavior. A starting point for many oversight initiatives was the foster care system, where most of the children are insured publicly through Medicaid. To understand the context and the effects of these initiatives, we analyzed patterns and trends in antipsychotic treatment of Medicaid-insured children in foster care and those in Medicaid but not in foster care. We found that the trend of rapidly increasing use of antipsychotics appears to have ceased since 2008. Children in foster care treated with antipsychotic medications are now more likely than other Medicaid-insured children to receive psychosocial interventions and metabolic monitoring for the side effects of the medications. However, challenges persist in increasing safety monitoring and access to psychosocial treatment. Development of specialized managed care plans for children in foster care represents a promising policy opportunity. New national quality measures for safe and judicious antipsychotic medication use are also now available to guide improvement. Oversight policies developed for foster care appear to have potential for adaptation to the broader population of Medicaid-covered children.
    Language English
    Publishing date 2016-06-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632712-6
    ISSN 1544-5208 ; 0278-2715
    ISSN (online) 1544-5208
    ISSN 0278-2715
    DOI 10.1377/hlthaff.2016.0064
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Serious mental illness and risk of new HIV/AIDS diagnoses: an analysis of Medicaid beneficiaries in eight states.

    Prince, Jonathan D / Walkup, James / Akincigil, Ayse / Amin, Shahla / Crystal, Stephen

    Psychiatric services (Washington, D.C.)

    2012  Volume 63, Issue 10, Page(s) 1032–1038

    Abstract: Objective: A longitudinal analysis was used to explore the relationship between diagnosis of serious mental illness and subsequent new diagnoses of HIV.: Methods: Logistic regression was used to predict HIV/AIDS diagnoses in 2002–2004 among Medicaid ... ...

    Abstract Objective: A longitudinal analysis was used to explore the relationship between diagnosis of serious mental illness and subsequent new diagnoses of HIV.
    Methods: Logistic regression was used to predict HIV/AIDS diagnoses in 2002–2004 among Medicaid beneficiaries in eight states (N=6,417,676) who were without HIV in 2001. Results for beneficiaries with and without serious mental illness, a substance use disorder, and psychiatric comorbidities in 2001 were compared.
    Results: After controlling for substance abuse or dependence and other factors, the analyses indicated that the odds of new HIV/AIDS diagnoses among beneficiaries with or without serious mental illness did not differ significantly. Compared with beneficiaries without a substance use disorder or serious mental illness, individuals with a substance use disorder but without serious mental illness were 3.1 times (OR=3.13, p<.001) more likely, and those with both substance abuse or dependence and serious mental illness were 2.1 times (OR=2.09, p<.001) more likely, to receive a new HIV diagnosis in 2002–2004. However, people with serious mental illness but without a substance use disorder in 2001 were 23% less likely (OR=.77, p<.001) than people without serious mental illness or a substance use disorder in 2001 to receive a new HIV diagnosis.
    Conclusions: After substance abuse or dependence was controlled for longitudinally, little independent association between serious mental illness and the risk of new HIV diagnoses was found. HIV-prevention services for low-income individuals should be delivered to all persons with serious mental illness, but especially those with comorbid substance use disorders.
    MeSH term(s) Acquired Immunodeficiency Syndrome/epidemiology ; Adolescent ; Adult ; Bipolar Disorder/epidemiology ; Comorbidity ; Depressive Disorder, Major/epidemiology ; Female ; HIV Infections/epidemiology ; Humans ; Logistic Models ; Longitudinal Studies ; Male ; Medicaid ; Middle Aged ; Odds Ratio ; Risk Factors ; Schizophrenia/epidemiology ; Substance-Related Disorders/epidemiology ; United States/epidemiology ; Young Adult
    Language English
    Publishing date 2012-10
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1220173-x
    ISSN 1557-9700 ; 1075-2730
    ISSN (online) 1557-9700
    ISSN 1075-2730
    DOI 10.1176/appi.ps.201100342
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 416: Show issues Location:
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  4. Article: Use of Medicaid data to explore community characteristics associated with HIV prevalence among beneficiaries with schizophrenia.

    Walkup, James / Akincigil, Ayse / Hoover, Donald R / Siegel, Michele J / Amin, Shahla / Crystal, Stephen

    Public health reports (Washington, D.C. : 1974)

    2010  Volume 126 Suppl 3, Page(s) 89–101

    Abstract: Objectives: People with severe mental illness (SMI) may be at increased risk for several adverse health conditions, including HIV/AIDS. This disproportionate disease burden has been studied primarily at the individual rather than community level, in ... ...

    Abstract Objectives: People with severe mental illness (SMI) may be at increased risk for several adverse health conditions, including HIV/AIDS. This disproportionate disease burden has been studied primarily at the individual rather than community level, in part due to the rarity of data sources linking individual information on medical and mental health characteristics with community-level data. We demonstrated the potential of Medicaid data to address this gap.
    Methods: We analyzed data on Medicaid beneficiaries with schizophrenia from eight states that account for 66% of cumulative AIDS cases nationally.
    Results: Across 44 metropolitan statistical areas (MSAs), the treated prevalence of HIV among adult Medicaid beneficiaries diagnosed with schizophrenia was 1.56% (standard deviation = 1.31%). To explore possible causes of variation, we linked claims files with a range of MSA social and contextual variables including local AIDS prevalence rates, area-based economic measures, crime rates, substance abuse treatment resources, and estimates of injection drug users (IDUs) and HIV infection among IDUs, which strongly predicted community infection rates among people with schizophrenia.
    Conclusions: Effective strategies for HIV prevention among people with SMI may include targeting prevention efforts to areas where risk is greatest; examining social network links between IDU and SMI groups; and implementing harm reduction, drug treatment, and other interventions to reduce HIV spread among IDUs. Our findings also suggest the need for research on HIV among people with SMI that examines geographical variation and demonstrates the potential use of health-care claims data to provide epidemiologic insights into small-area variations and trends in physical health among those with SMI.
    MeSH term(s) Crime/statistics & numerical data ; HIV Infections/complications ; HIV Infections/epidemiology ; Humans ; Medicaid/statistics & numerical data ; Prevalence ; Schizophrenia/complications ; Schizophrenia/epidemiology ; Socioeconomic Factors ; Sociology, Medical/statistics & numerical data ; Substance Abuse, Intravenous/complications ; United States/epidemiology
    Language English
    Publishing date 2010-09-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 120953-x
    ISSN 1468-2877 ; 0033-3549
    ISSN (online) 1468-2877
    ISSN 0033-3549
    DOI 10.1177/00333549111260S314
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Prevalence of diagnosed HIV disease among medicaid beneficiaries with schizophrenia in U.S. metropolitan areas.

    Walkup, James T / Akincigil, Ayse / Amin, Shahla / Hoover, Donald / Siegel, Michele / Crystal, Stephen

    The Journal of nervous and mental disease

    2010  Volume 198, Issue 9, Page(s) 682–686

    Abstract: Numerous reports suggest HIV may be elevated among those with severe mental illnesses such as schizophrenia or bipolar illness, but this has been studied in only a limited number of sites. Medicaid claim's files from 2002 to 2003 were examined for ... ...

    Abstract Numerous reports suggest HIV may be elevated among those with severe mental illnesses such as schizophrenia or bipolar illness, but this has been studied in only a limited number of sites. Medicaid claim's files from 2002 to 2003 were examined for metropolitan statistical areas (MSAs) in 8 states, focusing on schizophrenia. Across 102 MSAs, 1.81% of beneficiaries with schizophrenia had received diagnoses of HIV/AIDS. MSA rates ranged widely, from 5.2% in Newark, NJ, to no cases in 16 of the MSAs.
    MeSH term(s) Comorbidity ; HIV Infections/epidemiology ; Humans ; Medicaid/statistics & numerical data ; Prevalence ; Schizophrenia/epidemiology ; United States ; Urban Population
    Language English
    Publishing date 2010-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 3020-x
    ISSN 1539-736X ; 0022-3018
    ISSN (online) 1539-736X
    ISSN 0022-3018
    DOI 10.1097/NMD.0b013e3181ef21a2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Bipolar medication use and adherence to antiretroviral therapy among patients with HIV-AIDS and bipolar disorder.

    Walkup, James T / Akincigil, Ayse / Chakravarty, Sujoy / Olfson, Mark / Bilder, Scott / Amin, Shahla / Siegel, Michele J / Crystal, Stephen

    Psychiatric services (Washington, D.C.)

    2011  Volume 62, Issue 3, Page(s) 313–316

    Abstract: Objective: The study examined relationships between adherence to bipolar medication and to antiretroviral therapy, measured by medication fills, among patients with diagnoses of bipolar disorder and HIV infection.: Methods: A retrospective study was ... ...

    Abstract Objective: The study examined relationships between adherence to bipolar medication and to antiretroviral therapy, measured by medication fills, among patients with diagnoses of bipolar disorder and HIV infection.
    Methods: A retrospective study was conducted of Medicaid claims data (2001-2004) from eight states, focusing on antiretroviral adherence. The unit of analysis was person-month (N=53,971). The average observation period for the 1,687 patients was 32 months. Analyses controlled for several patient characteristics.
    Results: Patients possessed antiretroviral drugs in 72% of the person-months. When a bipolar medication prescription was filled in the prior month, the rate of antiretroviral possession in the subsequent month was 78%, compared with 65% when bipolar medication was not filled in the prior month (p<.001). Odds of antiretroviral possession were 66% higher in months when patients had a prior-month supply of bipolar medication.
    Conclusions: Bipolar medication adherence may improve antiretroviral adherence among patients with bipolar disorder and HIV infection.
    MeSH term(s) Adolescent ; Adult ; Anti-Retroviral Agents/therapeutic use ; Bipolar Disorder/drug therapy ; Female ; HIV Infections/drug therapy ; Humans ; Insurance Claim Review ; Male ; Medicaid ; Middle Aged ; Patient Compliance ; Retrospective Studies ; United States ; Young Adult
    Chemical Substances Anti-Retroviral Agents
    Language English
    Publishing date 2011-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1220173-x
    ISSN 1557-9700 ; 1075-2730
    ISSN (online) 1557-9700
    ISSN 1075-2730
    DOI 10.1176/ps.62.3.pss6203_0313
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005.

    Akincigil, Ayse / Olfson, Mark / Walkup, James T / Siegel, Michele J / Kalay, Ece / Amin, Shahla / Zurlo, Karen A / Crystal, Stephen

    Journal of the American Geriatrics Society

    2011  Volume 59, Issue 6, Page(s) 1042–1051

    Abstract: Objective: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants.: Design: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally ... ...

    Abstract Objective: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants.
    Design: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005.
    Setting: Community, usual care.
    Participants: Older Medicare fee-for-service beneficiaries.
    Measurements: Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers.
    Results: The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan-area residents, and 55% greater for nonmetropolitan-area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses.
    Conclusion: Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more-prominent and psychotherapy a less-prominent role. These shifts are most pronounced in groups with less-severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear.
    MeSH term(s) Aged ; Aged, 80 and over ; Antidepressive Agents/adverse effects ; Antidepressive Agents/classification ; Antidepressive Agents/therapeutic use ; Combined Modality Therapy ; Cross-Sectional Studies ; Depressive Disorder/diagnosis ; Depressive Disorder/drug therapy ; Depressive Disorder/epidemiology ; Depressive Disorder, Major/diagnosis ; Depressive Disorder, Major/drug therapy ; Depressive Disorder, Major/epidemiology ; Drug Utilization/statistics & numerical data ; Female ; Health Surveys ; Humans ; Independent Living ; Male ; Medicare/statistics & numerical data ; Psychotherapy/statistics & numerical data ; Social Environment ; Treatment Outcome ; United States
    Chemical Substances Antidepressive Agents
    Language English
    Publishing date 2011-06
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/j.1532-5415.2011.03447.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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