Chien-Yu Tseng

Background: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory disease characterized by widespread pustular eruptions and systemic inflammation. Objective: To evaluate the clinical characteristics and disease burden of patients with GPP in Taiwan using a national claims database. Methods: Patients with GPP and no prior diagnosis of psoriasis vulgaris (PV) who experienced an incident flare between January 1, 2017, and September 30, 2020, were identified from Taiwan’s National Health Insurance Database. Clinical characteristics, comorbidities, and treatment patterns were described. Recurrent flare frequency, healthcare resource utilization (HCRU) and costs were compared with those of a propensity score–matched PV cohort at a ratio of up to 1:4. Outpatient-managed flares were classified as moderate, whereas hospitalized flares were classified as severe. Results: A total of 245 patients with GPP were included (mean age 51.3 years; 49.8% male). During follow-up, 1,156 moderate-to-severe flares were identified. Compared with matched patients with PV, patients with GPP had a higher recurrent flare rate (rate ratio 1.14; 95% CI 1.06– 1.23). Patients with GPP also had greater HCRU, including more outpatient visits (incidence rate ratio [IRR] 1.03 [95% CI 1.01– 1.05]), emergency room visits (IRR 1.33, 95% CI 1.19– 1.49), and hospital admissions (IRR 1.69 [1.50– 1.91]). Median monthly healthcare costs were approximately twice as high among patients with GPP as among matched patients with PV. Conclusion: Patients with GPP experienced recurrent flares, greater healthcare utilization, and higher healthcare costs than matched patients with PV, underscoring the substantial real-world clinical and economic burden of GPP.

Aims: Predetermined treatment duration limits (PTDLs) are often used by Taiwan's National Health Insurance Administration to contain healthcare costs, but they may compromise patient outcomes. Therefore, we studied Taiwan's 2017 extension of the bevacizumab PTDL from 24 to 36 weeks in metastatic colorectal cancer (mCRC) to evaluate whether prolonged treatment duration improves clinical outcomes, specifically treatment continuity, therapy duration and survival. Methods: We identified two cohorts based on initial bevacizumab prescription dates from the Taiwan Health and Welfare Database: PTDL‐24 weeks (1 April 2013–31 March 2016; n = 2051) and PTDL‐36 weeks (1 April 2017–31 March 2020; n = 2484). We assessed overall survival (OS), progression‐free survival (PFS) and time on treatment (ToT) for first‐line therapy over 2 years. A doubly robust approach was applied, including inverse probability of treatment weighting (IPTW) to balance covariates and Cox proportional hazards models adjusted for calendar year. A two‐stage residual inclusion (2‐SRI) model estimated the impact of the policy on bevacizumab duration and subsequent survival outcomes. Results: After IPTW adjustment, baseline characteristics were well‐balanced. The 36‐week PTDL policy was associated with improved PFS (adjusted hazard ratio: 0.814 [95% confidence interval: 0.691–0.959]) and ToT (0.821 [0.703–0.959]), but not OS (0.926 [0.751–1.142]). The 2‐SRI analysis showed the policy extended bevacizumab treatment by approximately 8 weeks and was associated with improvements in OS (0.912 [0.89–0.934]), PFS (0.941 [0.923–0.959]) and ToT (0.966 [0.95–0.984]). Conclusions: Relaxing the PTDL can extend bevacizumab treatment exposure, improving PFS and ToT.

Purpose Comorbid insomnia and sleep apnea (COMISA) is a prevalent clinical syndrome. We characterized differences in characteristics and medication use patterns between participants with COMISA and those with sleep apnea alone. Methods Data used came from 2018 Health and Retirement Study, a nationally representative cohort study of U.S. middle-aged and older adults. Participants were asked if “a doctor had ever told them they have a sleep disorder” and which disorder. They also reported frequency of insomnia symptoms (i.e., “falling asleep,” “waking during the night,” “waking too early,”) and how often they “felt rested in the morning.” We tested differences in demographic and clinical characteristics as well as medication use between participants with COMISA vs. those with sleep apnea alone by using logistic regression. Results Out of N = 1,776 with sleep apnea, 47% had COMISA. Compared to those with sleep apnea alone, participants with COMISA were more likely to be female (p = 0.032), have lower education (p < 0.001), and report lung disease, stroke, psychiatric problems, and dementia/cognitive impairment (all p’s < 0.001). They reported difficulty in functioning (i.e., activities of daily living), and greater depressive symptomatology (all p’s < 0.001). Finally, they were more likely to report the use of opioids (p = 0.037), stomach (p = 0.028), and sleep medications (p < 0.001). Conclusions Compared to those with sleep apnea alone, COMISA participants had a more medically complex health profile and medication use that may exacerbate sleep apnea (e.g., opioids and sleep medications). Future research should focus on managing COMISA in medically complex patients for improved health outcomes.