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Boulder City, CO, United States

Purpose/Aim of the Study: Trials of dimethyl fumarate (DMF) and teriflunomide, two new oral therapies for relapsing-remitting multiple sclerosis (RRMS) were recently published [1, 2, 3]. A comparison of their safety against glatiramer acetate-a prevalent injectable treatment-is relevant to inform therapy-switching decisions. The study objective was to conduct a systematic review and mixed treatment comparison of total AEs in RCTs of dimethyl fumarate 240 mg bid (DMF2) or tid (DMF3), glatiramer acetate 20 mg injectable daily (GA), and teriflunomide 7 mg (TERI7) or 14 mg (TERI14) daily in RRMS patients. Materials and Methods: Articles were selected following Cochrane guidelines. A network meta-analysis was used to compare the odds of patients experiencing at least one AE between drugs, using placebo as baseline. Drugs were compared using the odds ratio (OR), credible interval (CrI), and confidence in OR ≥1 (PrOR). The mean rank (best = 1) and corresponding Surface-Under-Cumulative-Ranking (SUCRA) (best = 100%) were reported. Results: 3737 patients from three RCTs were included for analysis. Patients receiving GA exhibited the lowest AEs (DMF2 [OR = 2.67, PrOR = 98.7%], DMF3 [OR = 1.92, PrOR = 95.3%], Teri7 [OR = 2.74, PrOR = 95.2%], Teri14 [OR = 3.03, PrOR = 96.4%]), and equivalent to PB (OR = 1.60; PrOR = 94.3%). No other significant differences were found. GA also ranked with the lowest AEs (rank = 1.2, SUCRA = 96.0%), whereas DMF2 and Teri14 ranked highest (rank = 4.8). Conclusions: RRMS patients treated with glatiramer have the lowest odds of experiencing AEs, while patients taking DMF or teriflunomide have similar, higher odds of developing AEs, suggesting that patients treated with glatiramer may have higher QoL than patients under DMF or teriflunomide. © 2014 Taylor and Francis. Source

Groenendaal H.,EpiX Analytics | Zagmutt F.J.,EpiX Analytics | Patton E.A.,Trade and Consumer Protection | Wells S.J.,University of Minnesota
Journal of Dairy Science | Year: 2015

Johne's disease (JD), or paratuberculosis, is a chronic enteric disease of ruminants, caused by infection with Mycobacterium avium ssp. paratuberculosis (MAP). Johne's disease causes considerable economic losses to the US dairy industry, estimated to be over $200 million annually. Available control strategies include management measures to improve calf hygiene, test-and-cull strategies, and vaccination. Although the first 2 strategies have shown to reduce the prevalence of MAP, they require dedicated and long-term efforts from dairy producers, with often relatively slow progress. As a result, uptake of both strategies has not been as wide as expected given the economic benefits especially of improved hygiene. Vaccination has also been found to reduce the prevalence and economic losses of JD, but most economic estimates have been based on simulation of hypothetical vaccines. In addition, if an animal is vaccinated, cross-reactivity between MAP antibodies and bovine tuberculosis (BTB) antigens may occur, decreasing the specificity of BTB tests. Therefore, MAP vaccination would cause additional indirect costs to the BTB surveillance and control program. The objective of the present study was to use data from a MAP vaccine trial together with an epidemiologic and economic model to estimate the direct on-farm benefits of MAP vaccination and to estimate the indirect costs of MAP vaccination due to the cross-reactivity with BTB tests. Direct economic benefits of MAP vaccination were estimated at $8.03 (90% predictive interval: -$25.97 to $41.36) per adult animal per year, all accruing to the dairy producers. This estimate is likely an underestimation of the true direct benefits of MAP vaccination. In addition, indirect economic costs due to cross-reactivity were $2.14 per adult animal per year, making MAP vaccination economically attractive. Only in regions or states with a high frequency of BTB testing (because of, for example, Mycobacterium bovis outbreaks in a wild deer population) and areas where typically small groups of animals are BTB tested would MAP vaccination not be economically attractive. © 2015 American Dairy Science Association. Source

Zagmutt F.J.,EpiX Analytics | Sempier S.H.,Mississippi Alabama Sea Grant Consortium | Hanson T.R.,03 Swingle Hall
Risk Analysis | Year: 2013

Emerging diseases (ED) can have devastating effects on agriculture. Consequently, agricultural insurance for ED can develop if basic insurability criteria are met, including the capability to estimate the severity of ED outbreaks with associated uncertainty. The U.S. farm-raised channel catfish (Ictalurus punctatus) industry was used to evaluate the feasibility of using a disease spread simulation modeling framework to estimate the potential losses from new ED for agricultural insurance purposes. Two stochastic models were used to simulate the spread of ED between and within channel catfish ponds in Mississippi (MS) under high, medium, and low disease impact scenarios. The mean (95% prediction interval (PI)) proportion of ponds infected within disease-impacted farms was 7.6% (3.8%, 22.8%), 24.5% (3.8%, 72.0%), and 45.6% (4.0%, 92.3%), and the mean (95% PI) proportion of fish mortalities in ponds affected by the disease was 9.8% (1.4%, 26.7%), 49.2% (4.7%, 60.7%), and 88.3% (85.9%, 90.5%) for the low, medium, and high impact scenarios, respectively. The farm-level mortality losses from an ED were up to 40.3% of the total farm inventory and can be used for insurance premium rate development. Disease spread modeling provides a systematic way to organize the current knowledge on the ED perils and, ultimately, use this information to help develop actuarially sound agricultural insurance policies and premiums. However, the estimates obtained will include a large amount of uncertainty driven by the stochastic nature of disease outbreaks, by the uncertainty in the frequency of future ED occurrences, and by the often sparse data available from past outbreaks. © 2013 Society for Risk Analysis. Source

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