Journal of general internal medicine
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Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) are a recent class of medication approved for the treatment of type 2 diabetes (T2D). Previous meta-analyses have quantified the benefits and harms of SGLT2Is; however, these analyses have been limited to specific outcomes and comparisons and included trials of short duration. We comprehensively reviewed the longer-term benefits and harms of SGLT2Is compared to placebo or other anti-hyperglycemic medications. ⋯ We found that SGLT2Is led to durable reductions in cardiovascular risk factors compared to both placebo and other anti-hyperglycemic medications. Reductions in macrovascular complications and mortality were only observed in comparisons with placebo, although trials comparing SGLT2Is vs. other anti-hyperglycemic medications were not designed to assess longer-term outcomes.
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The average length of buprenorphine treatment for opioid use disorder is less than 6 months. ⋯ This review was registered with PROSPERO (#CRD42019120336) in March 2019.
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Meta Analysis
Empirical Comparisons of 12 Meta-analysis Methods for Synthesizing Proportions of Binary Outcomes.
Meta-analysis is increasingly used to synthesize proportions (e.g., disease prevalence). It can be implemented with widely used two-step methods or one-step methods, such as generalized linear mixed models (GLMMs). Existing simulation studies have shown that GLMMs outperform the two-step methods in some settings. It is, however, unclear whether these simulation settings are common in the real world. We aim to compare the real-world performance of various meta-analysis methods for synthesizing proportions. ⋯ Although different methods produced similar overall proportion estimates in most datasets, one-step methods should be considered in the presence of small total event counts or sample sizes and very low or high event rates.
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Observational Study
Association Between Cost-Saving Prescription Policy Changes and Adherence to Chronic Disease Medications: an Observational Study.
Pharmacy benefit design is one tool for improving access and adherence to medications for the management of chronic disease. ⋯ In this cohort of commercially insured adults on medications for chronic disease, a change in PBM accompanied by a prescription out-of-pocket maximum and change to 90 days' supply was associated with short-term disruptions in adherence followed by return to pre-intervention trends. A small improvement in adherence over the year of follow-up may not be clinically significant. These findings have important implications for employers, insurers, or health systems wishing to utilize pharmacy benefit design to improve management of chronic disease.
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Chronic non-cancer pain (CNCP) is highly prevalent in older adults and long-term opioid therapy (LTOT) has been used to manage chronic pain. However, the safety of LTOT among older adults with CNCP is not well-established and there is a need to identify therapy-related risk factors of opioid-related adverse events among older adults. ⋯ Older adults receiving medically prescribed opioids at higher doses and those using LA and combination of LA and SA opioids are at increased risks for opioid-related adverse events, highlighting the need for close patient supervision.