Global Epidemiology

Cardiff, United Kingdom

Global Epidemiology

Cardiff, United Kingdom
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News Article | May 1, 2017
Site: marketersmedia.com

— Global Huntington’s disease Epidemiology Market Forecast To 2023 provides an overview of the epidemiology trends of Huntington’s disease in seven major markets (US, France, Germany, Italy, Spain, UK and Japan). It includes 10 years epidemiology historical and forecasted data of Huntington’s disease prevalent or incident cases segmented by age, sex and subpopulations. Global Huntington’s disease Epidemiology Market Forecast To 2023 report also discusses the prevailing risk factors, disease burden with special emphasis on the unmet medical need associated with the Huntington’s disease. The report is built using data and information sourced from proprietary databases, primary and secondary research and in-house Forecast model analysis by team of industry experts. The Report includes the prevalent population and how will it change over the next eight years. Prevalent or incident cases segmented by age and sex. Coverage of key Huntington’s disease subpopulations and its prevalent or incident cases The key differences in epidemiology patterns across the seven market segments The report will help in developing business strategies by understanding the trends shaping and driving the global Huntington’s disease market. Identifying prevalent patient populations as well as risk factors in the global Huntington’s disease market will help to improve product design, pricing, and launch plans. Organize sales and marketing efforts by identifying the best opportunities for Huntington’s disease therapeutics in each of the markets covered. • Huntington’s disease Global Epidemiology, (2013-2023) • Prevalent Cases of Huntington’s disease (Ages =XX Years), (2013-2023) • Prevalent Cases of Huntington’s disease By Sex (Males & Females) (2013-2023) • Prevalent Cases By Huntington’s disease Sub-population (2013-2023) • Huntington’s disease Epidemiology of United States-2023 • Huntington’s disease Epidemiology of United Kingdom-2023 • Huntington’s disease Epidemiology of Germany-2023 • Huntington’s disease Epidemiology of France-2023 • Huntington’s disease Epidemiology of Spain-2023 • Huntington’s disease Epidemiology of Italy-2023 • Huntington’s disease Epidemiology of Japan-2023 About Us: Reportsnreports.com is an online database of market research reports offer in-depth analysis of over 5000 market segments. The library has syndicated reports by leading market research publishers across the globe and also offer customized market research reports for multiple industries. For more information, please visit http://www.reportsnreports.com/reports/810743-huntingtons-disease-epidemiology-forecast-to-2023.html


News Article | November 16, 2016
Site: www.newsmaker.com.au

The Short Bowel Syndrome - Market Insights, Epidemiology and Market Forecast-2020 report provides an overview of the disease, epidemiology and global market trends for the seven major markets ie: United States, EU5 (France, Germany, Italy, Spain, UK) and rest of the world. According to DelveInsight, the forecasted patient population of SBS will increase at a CAGR of 1.73% from 2015 to 2020 and the worldwide SBS market is estimated to be 2.69 billion by 2020. The treatment options are complex and varied. The specific treatment plan may be highly individualized and can include Total Parental Nutrition (TPN) support, which involves use of oral rehydration solutions, parenteral nutrition and enteral nutrition. Gattex (Teduglutide) is currently the first non-surgical treatment for short bowel syndrome (SBS), which is predicted to improve the daily, lives of the patients and is the third approved therapy by USFDA Key Coverage and Benefits:  •  • The report will help in developing business strategies by understanding the trends shaping and driving the global Short Bowel Syndrome  • Identifying patient populations in the global Short Bowel Syndrome market to improve product design, pricing, and launch plans.  • Organize sales and marketing efforts by identifying the best opportunities for Short Bowel Syndrome therapeutics in each of the markets covered.  • To understand the future market competition in the global Short Bowel Syndrome therapeutics market and Insightful review of the key market drivers and barriers.  Scope of the Report:  • Report covers the disease overview including etiology, pathophysiology, symptoms, diagnosis, disease management, and current treatment options.  • Marketed information including available prescription drugs, its patent and exclusivity details followed by drug sales till 2018.  • The Report also covers the detailed global historical and forecasted epidemiological data covering United States, EU5, Middle Eastern Countries and rest of the word from 2010-2020.  • It also provides Market size of Short Bowel Syndrome for United States, EU5, Middle Eastern Countries from 2010 and forecasted Market size to 2020 Short Bowel syndrome  Disease overview:  Pathophysiology:  Symptoms of disease:  Etiology of disease  Diagnosis of disease  Treatment of disease  Overview of Marketed drugs  Zorbtive Description  Mechanism of Action  Pharmacokinetics Properties  Marketed Details  United States  Patent Information  Patents Details  NutreStore Description  Mechanism of Action  Pharmacodynamic Properties  Pharmacokinetics Properties  Marketed Details  United States  Gattex Description  Mechanism of Action  Pharmacodynamics Properties  Pharmacokinetics Properties  Marketed Details  United States  Europe  Patent Information  Patent Exclusivity Expiry Assessment United States (US)  Patents Details  Historical and Forecasted sales of marketed molecules in the Global Short Bowel Syndrome Market  Global Epidemiology of Short Bowel Syndrome Forecasted to 2020  Global Market size (2011-2014)  Global Forecasted Market size (2015-2020)  Global Market Size by Geography  Market size of US (2011-2014)  Forecasted Market size of US (2015-2020)  Market size of Europe  Market size of Germany (2011-2014)  Forecasted Market size of Germany (2015-2020)  Market size of United Kingdom (2011-2014)  Forecasted Market size of United Kingdom (2015-2020)  Market size of France (2011-2014)  Forecasted Market size of France (2015-2020)  Market size of Italy (2011-2014)  Forecasted Market size of Italy (2015-2020)  Market size of Spain (2011-2014)  Forecasted Market size of Spain (2015-2020)  Market size of Japan (2011-2014)  Forecasted Market Size of Japan (2015-2020)  Market size of ROW (2011-2014)  Forecasted Market size of ROW (2015-2020)  Appendix  Report Methodology  Consulting Services  Disclaimer  Report Purchase Options  About DelveInsight Table 1: Zorbtive, Description  Table 2: Zorbtive, Marketed Details United States (US)  Table 3: Zorbtive, Patent Number Specific Patent Expiry in US (Year), 2015  Table 4: Zorbtive, Patent Details for US  Table 5: NutreStore, Description  Table 6: NutreStore, Marketed Details United States (US)  Table 7: Gattex, Description  Table 8: Gattex, Marketed Details United States (US)  Table 9: Gattex, Marketed Details Europe (EU)  Figure 10: Gattex, Patent Number Specific Patent Expiry (Year), 2015  Table 11: Gattex, Patent Number Specific Patent Expiry in US (Year), 2015  Table 12: Gattex, Patent Exclusivity Expiry (Year), 2015  Table 13: Gattex, Patent (US5789379 A) Details for US  Table 14: Gattex, Patent (US 7056886 B2) Details for US  Table 15: Gattex, Patent (US 7847061 B2) Details for US  Table 16: Short Bowel Syndrome Gattex Drug Sales (USD Millions), (2014-2020)  Table 17: Global Epidemiology of Short Bowel Syndrome (2011-2020)  Table 18: Short Bowel Syndrome Global Market Size (USD Millions), (2011-2014)  Table 19: Short Bowel Syndrome Global Market Size (USD Millions), (2015-2020)  Table 20: Short Bowel Syndrome US Market Size (USD Millions), (2011-2014)  Table 21: Short Bowel Syndrome US Market Size (USD Millions), (2015-2020)  Table 22: Short Bowel Syndrome United Kingdom Market Size (USD Millions), (2011-2014)  Table 23: Short Bowel Syndrome Germany Market Size (USD Millions), (2015-2020)  Table 24: Short Bowel Syndrome United Kingdom Market Size (USD Millions), (2011-2014)  Table 25: Short Bowel Syndrome United Kingdom Market Size (USD Millions), (2015-2020)  Table 26: Short Bowel Syndrome France Market Size (USD Millions), (2011-2014)  Table 27: Short Bowel Syndrome France Market Size (USD Millions), (2015-2020)  Table 28: Short Bowel Syndrome Italy Market Size (USD Millions), (2011-2014)  Table 29: Short Bowel Syndrome Italy Market Size (USD Millions), (2015-2020)  Table 30: Short Bowel Syndrome Spain Market Size (USD Millions), (2011-2014)  Table 31: Short Bowel Syndrome Spain Market Size (USD Millions), (2015-2020)  Table 32: Short Bowel Syndrome Japan Market Size (USD Millions), (2011-2014)  Table 33: Short Bowel Syndrome Japan Market Size (USD Millions), (2015-2020)  Table 34: Short Bowel Syndrome ROW Market Size (USD Millions), (2011-2014)  Table 35: Short Bowel Syndrome ROW Market Size (USD Millions), (2015-2020)  List of Figures Figure 1: Short Bowel Syndrome Gattex Drug Sales (USD Millions), (2011-2014)  Figure 2: Global Epidemiology of Short Bowel Syndrome (2011-2020)  Figure 3: Short Bowel Syndrome Global Market Size (USD Millions), (2011-2014)  Figure 4: Short Bowel Syndrome Global Market Size (USD Millions), (2015-2020)  Figure 5: Short Bowel Syndrome US Market Size (USD Millions), (2011-2014)  Figure 6: Short Bowel Syndrome US Market Size (USD Millions), (2015-2020)  Figure 7: Short Bowel Syndrome Germany Market Size (USD Millions), (2011-2014)  Figure 8: Short Bowel Syndrome Germany Market Size (USD Millions), (2015-2020)  Figure 9: Short Bowel Syndrome United Kingdom Market Size (USD Millions), (2011-2014)  Figure 10: Short Bowel Syndrome United Kingdom Market Size (USD Millions), (2015-2020)  Figure 11: Short Bowel Syndrome France Market Size (USD Millions), (2011-2014)  Figure 12: Short Bowel Syndrome France Market Size (USD Millions), (2015-2020)  Figure 13: Short Bowel Syndrome Italy Market Size (USD Millions), (2011-2014)  Figure 14: Short Bowel Syndrome Italy Market Size (USD Millions), (2015-2020)  Figure 15: Short Bowel Syndrome Spain Market Size (USD Millions), (2011-2014)  Figure 16: Short Bowel Syndrome Spain Market Size (USD Millions), (2015-2020)  Figure 17: Short Bowel Syndrome Japan Market Size (USD Millions), (2011-2014)  Figure 18: Short Bowel Syndrome Japan Market Size (USD Millions), (2015-2020)  Figure 19: Short Bowel Syndrome ROW Market Size (USD Millions), (2011-2014)  Figure 20: Short Bowel Syndrome ROW Market Size (USD Millions), (2015-2020) For more information or any query mail at [email protected]


The Respiratory Syncytial Virus Infections- Market Insights, Epidemiology and Market Forecast-2020 report provides an overview of the disease, epidemiology and global market trends for the seven major markets ie: United States, EU5 (France, Germany, Italy, Spain, UK) and middle east countries (Jordan, Saudi Arabia, Kuwait, Oman, UAE, Tunisia, Turkey, Egypt, Lebanon and Qatar). According to DelveInsight, the market for preventive therapies to treat RSV Infections will experience modest annual growth over the 2010-2020 forecast period, as market size increase from $148.9 million to 777.49 million in European five countries. Respiratory syncytial virus (RSV) is a virus that causes infections of the lungs and respiratory tract. It's so common that most children have been infected with the virus by age 2.RSV can cause upper respiratory infections (such as cold, fever and otitis media) and lower respiratory tract infections (such as pneumonia, bronchiolitis, tracheobronchitis). RSV also affects adults and can also become serious in older adult with heart and lung diseases, or anyone with a very weak immune system (immune compromised). Key Coverage and Benefits:  • The report will help in developing business strategies by understanding the trends shaping and driving the global Respiratory Syncytial Virus Infections  • Identifying patient populations in the global Respiratory Syncytial Virus Infections market to improve product design, pricing, and launch plans.  • Organize sales and marketing efforts by identifying the best opportunities for Respiratory Syncytial Virus Infections therapeutics in each of the markets covered.  • To understand the future market competition in the global Respiratory Syncytial Virus Infections therapeutics market and Insightful review of the key market drivers and barriers. Scope of the Report:  • Report covers the disease overview including etiology, pathophysiology, symptoms, diagnosis, disease management, and current treatment options.  • Marketed information including available prescription drugs, its patent and exclusivity details followed by drug sales till 2018.  • The Report also covers the detailed global historical and forecasted epidemiological data covering United States, EU5, Middle Eastern Countries and rest of the word from 2010-2020.  • It also provides Market size of Respiratory syncytial virus (RSV) for United States, EU5, Middle Eastern Countries from 2010 and forecasted Market size to 2020 Respiratory Syncytial Virus Infection  Disease overview:  Pathophysiology:  Symptoms of disease:  Etiology of disease  Diagnosis of disease  Treatment of disease  Overview of Marketed drugs  Synagis Description  Mechanism of Action  Pharmacokinetics Properties  Marketed Details  United States  Europe  Patent Information  Patents Details  Historical and Forecasted sales of marketed molecules in the Global Respiratory Syncytial Virus (RSV) Infections Market  Global Epidemiology of Respiratory Syncytial Virus (RSV) Infections Forecasted to 2020  Global Historical & Forecasted Market size (2010-2020)  Global Market size of United States (US) (2010-2020)  Global Market size of Europe (EU5) (2010-2020)  Global Market Size by Geography in Europe  Market size of Germany (2010-2020)  Market size of United Kingdom (2010-2020)  Market size of France (2010-2020)  Market size of Italy (2010-2020)  Market size of Spain (2010-2020)  Global Market Size in Middle Eastern Countries  Global Market Size in Middle Eastern Countries by Geography  Market size of Jordan (2010-2020)  Market size of Saudi Arabia (2010-2020)  Market size of Kuwait (2010-2020)  Market size of Oman (2010-2020)  Market size of UAE (2010-2020)  Market size of Tunisia (2010-2020)  Market size of Turkey (2010-2020)  Market size of Egypt (2010-2020)  Market size of Lebanon (2010-2020)  Market size of Qatar (2010-2020)  Appendix  Report Methodology  Consulting Services  Disclaimer  Report Purchase Options  About DelveInsight Table 1:Synagis, Description  Table 2: Synagis, Marketed Details for United States (US)  Table 3: Synagis, Marketed Details for Europe  Table 4: Synagis, Patent Number Specific Patent Expiry in US (Year), 2015  Table 5: Synagis, Patent 1 Details for US  Table 6: Synagis, Patent 2 Details for US  Table 7: Synagis, Patent 3 Details for US  Table 8: Synagis, Patent 4 Details for US  Table 9: Synagis, Patent 5 Details for US  Table 10: Synagis, Patent 6 Details for US  Table 11: Synagis, Patent 7 Details for US  Table 12: Synagis, Patent 8 Details for US  Table 13: Respiratory Syncytial Virus (RSV) Infections Synagis Drug Sales (USD Millions), (2014-2020)  Table 14: Global Epidemiology of Respiratory Syncytial Virus (RSV) Infections (2012-2020)  Table 15: Respiratory Syncytial Virus (RSV) Infections United States Market Size (USD Millions), (2010-2020)  Table 15: Respiratory Syncytial Virus (RSV) Infections Germany Market Size (USD Millions), (2010-2020)  Table 16: Respiratory Syncytial Virus (RSV) Infections United Kingdom Market Size (USD Millions), (2010-2020)  Table 17: Respiratory Syncytial Virus (RSV) Infections France Market Size (USD Millions), (2010-2020)  Table 18: Respiratory Syncytial Virus (RSV) Infections Italy Market Size (USD Millions), (2010-2020)  Table 19: Respiratory Syncytial Virus (RSV) Infections Spain Market Size (USD Millions), (2010-2020)  Table 20: Respiratory Syncytial Virus (RSV) Infections Jordan Market Size (USD Millions), (2010-2020)  Table 21: Respiratory Syncytial Virus (RSV) Infections Saudi Arabia Market Size (USD Millions), (2010-2020)  Table 22: Respiratory Syncytial Virus (RSV) Infections Kuwait Market Size (USD Millions), (2010-2020)  Table 23: Respiratory Syncytial Virus (RSV) Infections Oman Market Size (USD Millions), (2010-2020)  Table 24: Respiratory Syncytial Virus (RSV) Infections UAE Market Size (USD Millions), (2010-2020)  Table 25: Respiratory Syncytial Virus (RSV) Infections Tunisia Market Size (USD Millions), (2010-2020)  Table 26: Respiratory Syncytial Virus (RSV) Infections Turkey Market Size (USD Millions), (2010-2020)  Table 27: Respiratory Syncytial Virus (RSV) Infections Egypt Market Size (USD Millions), (2010-2020)  Table 28: Respiratory Syncytial Virus (RSV) Infections Lebanon Market Size (USD Millions), (2010-2020)  Table 29: Respiratory Syncytial Virus (RSV) Infections Qatar Market Size (USD Millions), (2010-2020) For more information or any query mail at [email protected]


Basel, December 16, 2016 - Novartis announced today that it has entered into a definitive agreement for the acquisition of Ziarco Group Limited, a privately held company focused on the development of novel treatments in dermatology. This acquisition would add a once-daily oral H receptor antagonist in development for atopic dermatitis (AD), commonly known as eczema, to complement the growing Novartis dermatology portfolio and pipeline. The transaction is subject to customary closing conditions, including regulatory approval. The financial details of this transaction are not disclosed. Ziarco's lead investigational product, ZPL389, is a potential first-in-class oral treatment for moderate-to-severe eczema. Eczema is a chronic, itchy, inflammatory skin condition found in millions of children and adults worldwide[1]. In addition, it is associated with sleep loss and a significant reduction in quality of life[2]. Currently, no safe, effective, and well-tolerated oral treatments are available for the moderate-to-severe form of this condition. "There is an unmet need for innovative, effective and safe oral treatment options for people living with eczema," said Vasant Narasimhan, Global Head, Drug Development and Chief Medical Officer, Novartis. "We are proud of our dermatology capabilities shown by the recent successful launches of Cosentyx and Xolair. Now we're excited about a potential new medicine for people with eczema through the acquisition of Ziarco and the addition of a first-in-class oral H receptor antagonist to our growing pipeline." In a proof of concept study, ZPL389 showed a clinically and statistically significant reduction of eczema. After eight weeks of treatment, the compound reduced the Eczema Area and Severity Index (EASI) score by 50% (placebo: 27%, (p=0.01)) in a study of 98 patients. In addition, there was a statistically significant improvement in SCORing Atopic Dermatitis (SCORAD) and body surface area (BSA) scores affected by eczema for ZPL389. The study also showed a decrease in itching, which was numerically greater in the active treatment arm. Both the EASI and SCORAD sub-scores related to itching showed positive results and there was a statistically significant decrease in sleep loss for the active comparator. Itch is a major cause for sleep loss in eczema patients[2]. In clinical studies conducted to date, ZPL389 has a favorable safety profile. Eczema poses a significant burden on health-care resources and patients' quality of life with recent data showing that its prevalence is still increasing[3]. Eczema affects up to 10% of the population in the US alone[4],[5], with approximately 15% of children and 70% of adults having the moderate-to-severe form of the disease[6]. Treatment does not cure eczema but can control symptoms and potentially improve quality of life[7]. About the Novartis dermatology portfolio Novartis is committed to addressing the unmet medical needs of patients living with dermatological conditions and improving their overall quality of life by providing innovative medicines. The Novartis Dermatology portfolio includes Cosentyx (secukinumab) for the treatment of moderate-to-severe psoriasis and Xolair (omalizumab) for the treatment of chronic spontaneous urticaria. Disclaimer The foregoing release contains forward-looking statements that can be identified by words such as "to add," "to treat," "pipeline," "investigational," "agreement for the acquisition," "would," "subject to customary closing conditions," "potential," "excited," "committed" or similar terms, or by express or implied discussions regarding potential completion of the announced acquisition of Ziarco Group Limited, or regarding potential marketing approvals for ZPL389, or regarding potential future revenues from ZPL389 and the other products in the Novartis dermatology portfolio. You should not place undue reliance on these statements. Such forward-looking statements are based on the current beliefs and expectations of management regarding future events, and are subject to significant known and unknown risks and uncertainties. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those set forth in the forward-looking statements. There can be no guarantee that the proposed acquisition will be completed in the expected form or within the expected time frame or at all. Nor can there be any guarantee that Novartis will be able to realize any of the potential strategic benefits, synergies or opportunities as a result of the acquisition. Neither can there be any ZPL389 will be submitted or approved for sale in any market, or at any particular time. Nor can there be any guarantee that ZPL389 or the other compound in the Novartis dermatology portfolio will be commercially successful in the future. In particular, management's expectations regarding ZPL389 could be affected by, among other things, unexpected regulatory actions or delays or government regulation generally, including an unexpected failure to obtain necessary government approvals for the acquisition of Ziarco Group Limited, or unexpected delays in obtaining such approvals; the potential that any other closing conditions for acquisition of Ziarco Group Limited might not be met; the potential that the strategic benefits, synergies or opportunities expected from the acquisition of Ziarcro Group Limited may not be realized or may take longer to realize than expected;  the uncertainties inherent in research and development, including unexpected clinical trial results and additional analysis of existing clinical data; the company's ability to obtain or maintain proprietary intellectual property protection; general economic and industry conditions; competition in general; global trends toward health care cost containment, including ongoing pricing pressures; unexpected safety, quality or manufacturing issues, and other risks and factors referred to in Novartis AG's current Form 20-F on file with the US Securities and Exchange Commission. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise. About Novartis Novartis provides innovative healthcare solutions that address the evolving needs of patients and societies. Headquartered in Basel, Switzerland, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, eye care and cost-saving generic pharmaceuticals. Novartis is the only global company with leading positions in these areas. In 2015, the Group achieved net sales of USD 49.4 billion, while R&D throughout the Group amounted to approximately USD 8.9 billion (USD 8.7 billion excluding impairment and amortization charges). Novartis Group companies employ approximately 118,000 full-time-equivalent associates. Novartis products are available in more than 180 countries around the world. For more information, please visit http://www.novartis.com. Novartis is on Twitter. Sign up to follow @Novartis at http://twitter.com/novartis For Novartis multimedia content, please visit www.novartis.com/news/media-library For questions about the site or required registration, please contact media.relations@novartis.com References [1] Bieber T. Atopic Dermatitis. N Engl J Med. 2008;358:1483-1494 [2] Patel T. et al. Nocturnal Itch: Why do we itch at night? Acta Derm Venereol. 2007;87:295-298 [3] Nutten S. Atopic Dermatitis: Global Epidemiology and Risk Factors. Ann Nutr Metab. 2015;66(suppl 1):8-16 [4] Silverberg et al. Adult eczema prevalence and associations with asthma and other health and demographic factors: A US population-based study. J Allergy Clin Immunol. 2013; 132 (5): 1132-1138. [5] Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema Prevalence in the United States: Data from the 2003 National Survey of Children's Health. J. Invest. Dermatol. 2001; 131:67-73. [6] Hanifin JM, Reed ML. A population-based survey of eczema in the United States. Dermatitis. 2007;18(2):82-91. [7] American Academy of Dermatology (AAD) website. Atopic Dermatitis. Available at: https://www.aad.org/public/diseases/eczema/atopic-dermatitis#treatment. Last accessed December 2016


Morgan C.L.,Global Epidemiology | Mukherjee J.,Bristol Myers Squibb | Jenkins-Jones S.,Global Epidemiology | Holden S.E.,Global Epidemiology | And 3 more authors.
Diabetes, Obesity and Metabolism | Year: 2014

Aims: To evaluate the risk of all-cause mortality and major adverse cardiovascular events (MACE) for patients exposed to first-line monotherapy with sulphonylurea or metformin. Methods: Data were from the Clinical Practice Research Datalink (CPRD). Patients with type 2 diabetes were selected if initiated with metformin or sulphonylurea monotherapy as their first-line glucose-lowering regimen 2000-2012. The primary endpoint was all-cause mortality; the secondary endpoint was MACE (myocardial infarction or stroke). Times to endpoints were compared using Cox proportional hazards models. Additional analyses were performed on subsets matched directly on key characteristics and by propensity score. Results: In the main analysis, 76 811 patients were prescribed metformin monotherapy (mean follow-up 2.9 years) and 15 687 sulphonylurea monotherapy (mean follow-up 3.1 years). A total of 2604 patients were included in each arm of the directly matched cohorts and 8836 in the propensity-matched. With respect to all-cause mortality, using all three analytical approaches the hazard ratio (HR) was significantly increased for sulphonylurea compared with metformin: adjusted HR=1.580 (95% CI 1.483-1.684) for the main analysis, 1.902 (1.733-2.088) for those matched on propensity score, and 1.272 (1.021-1.584) for the directly matched cohort analysis. For MACE, the respective HRs were 1.196 (1.090-1.313), 1.202 (1.001-1.442) and 0.814 (0.578-1.148), respectively. Conclusions: All-cause mortality was significantly increased in patients prescribed sulphonylurea compared with metformin monotherapy. Whilst residual confounding and confounding by indication may remain, this study indicates that first-line treatment with sulphonylurea monotherapy should be reconsidered. © 2014 John Wiley & Sons Ltd.


Morgan C.L.,Global Epidemiology | Mukherjee J.,Bristol Myers Squibb | Jenkins-Jones S.,Global Epidemiology | Holden S.E.,Global Epidemiology | And 3 more authors.
Diabetes, Obesity and Metabolism | Year: 2014

Aims: To compare the risk of major adverse cardiovascular events (MACE) and mortality for combination therapies with metformin and either sulphonylurea (SU) or dipeptidyl peptidase-4 inhibitor (DPP-4i). Methods: Data were from the UK Clinical Practice Research Datalink (CPRD). Patients with type 2 diabetes were selected if initiated with combination therapies comprising metformin plus SU or DPP-4i 2007-2012. The co-primary endpoints were all-cause mortality and MACE (myocardial infarction or stroke). Times to endpoints were compared using Cox proportional hazards models. Additional analyses were performed on subsets matched directly on key characteristics and by propensity score. Results: A total of 33 983 patients were prescribed SU and 7864 DPP-4i, and 5447 patients in each cohort could be matched directly and 6901 by propensity score. In the main analysis, there were 716 MACE events and 1217 deaths. Crude event rates for MACE were 11.3 events per 1000 person-years (pkpy) for SU, versus 5.3 pkpy for DPP-4i. For all-cause mortality, rates were 16.9 versus 7.3 pkpy, respectively. Following adjustment, there was a significant increase in the adjusted hazard ratio (aHR) for all-cause mortality in those exposed to SU across all analytical models: aHR=1.357 (95% CI 1.076-1.710) for all subjects, 1.850 (1.245-2.749) directly matched and 1.497 (1.092-2.052) propensity-matched. For MACE, aHR was 1.710 (1.280-2.285) for all subjects, 1.323 (0.832-2.105) directly matched and 1.547 (1.076-2.225) propensity-matched. Conclusions: There was a reduction in all-cause mortality for patients treated with metformin combined with DPP-4i versus metformin plus SU, and a similar trend for MACE. © 2014 John Wiley & Sons Ltd.


Holden S.E.,University of Cardiff | Gale E.A.M.,University of Bristol | Jenkins-Jones S.,Global Epidemiology | Currie C.J.,University of Cardiff
Diabetes, Obesity and Metabolism | Year: 2014

Aims: We set out to estimate the prevalence rate of insulin use in the UK population, the total number of people in the UK who use insulin, the proportion of users with type 1 and type 2 diabetes and changes between 1991 and 2010. Methods: Patients receiving prescriptions for insulin were identified in the Clinical Practice Research Datalink and attributed a diagnosis of type 1 or type 2 diabetes. The annual prevalence of insulin use was calculated and applied to population data. Results: The crude prevalence rate of insulin use increased from 2.43 (95% CI 2.38-2.49) per 1000 population in 1991 to 6.71 (6.64-6.77) per 1000 in 2010. The largest change was an increase in the prevalence of insulin users with a diagnosis of type 2 diabetes from 0.67 (0.64-0.70) to 4.34 (4.29-4.39) per 1000 population. The absolute number using insulin increased from 137000 people (121000-155000) in 1991 to 421000 (400000-444000) in 2010. The proportion taking insulin alone (as against combination with oral agents) decreased from 97% in the first decade to 37% in the second. Conclusion: The number of people using insulin trebled between 1991 and 2010, largely due to a considerable increase in the number of people with type 2 diabetes using insulin. © 2014 John Wiley & Sons Ltd.


Currie C.J.,University of Cardiff | Poole C.D.,Global Epidemiology | Jenkins-Jones S.,Global Epidemiology | Gale E.A.M.,University of Bristol | And 2 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - Type 2 diabetes is associated with an increased risk of several types of cancer and with reduced survival after cancer diagnosis. We examined the hypotheses that survival after a diagnosis of solid-tumor cancer is reduced in those with diabetes when compared with those without diabetes, and that treatment with metformin influences survival after cancer diagnosis. RESEARCH DESIGN ANDMETHODS - Data were obtained from >350 U.K. primary care practices in a retrospective cohort study. All individuals with or without diabetes who developed a first tumor after January 1990 were identified and records were followed to December 2009. Diabetes was further stratified by treatment regimen. Cox proportional hazards models were used to compare all-cause mortality from all cancers and from specific cancers. RESULTS - Of 112,408 eligible individuals, 8,392 (7.5%) had type 2 diabetes. Cancer mortality was increased in those with diabetes, compared with those without (hazard ratio 1.09 [95% CI 1.06-1.13]). Mortality was increased in those with breast (1.32 [1.17-1.49]) and prostate cancer (1.19 [1.08-1.31]) but decreased in lung cancer (0.84 [0.77-0.92]). When analyzed by diabetes therapy, mortality was increased relative to nondiabetes in those on monotherapy with sulfonylureas (1.13 [1.05-1.21]) or insulin (1.13 [1.01-1.27]) but reduced in those on metformin monotherapy (0.85 [0.78-0.93]). CONCLUSIONS - This study confirmed that type 2 diabetes was associated with poorer prognosis after incident cancer, but that the association varied according to diabetes therapy and cancer site. Metformin was associated with survival benefit both in comparison with other treatments for diabetes and in comparison with a nondiabetic population. © 2012 by the American Diabetes Association.


Bannister C.A.,University of Cardiff | Poole C.D.,University of Cardiff | Jenkins-Jones S.,Global Epidemiology | Ll. Morgan C.,University of Cardiff | And 3 more authors.
Diabetes Care | Year: 2014

OBJECTIVE To evaluate the performance of the UK Prospective Diabetes Study Risk Engine (UKPDS-RE) for predicting the 10-year risk of cardiovascular disease end points in an independent cohort of U.K. patients newly diagnosed with type 2 diabetes. RESEARCH DESIGN AND METHODS This was a retrospective cohort study using routine health care data collected between April 1998 and October 2011 from ~350 U.K. primary care practicescontributing to the Clinical Practice Research Datalink (CPRD). Participants comprised 79,966 patients aged between 35 and 85 years (388,269 person-years) with 4,984 cardiovascular events. Four outcomes were evaluated: first diagnosis of coronary heart disease (CHD), stroke, fatal CHD, and fatal stroke. RESULTS Accounting for censoring, the observed versus predicted 10-year event rates were as follows: CHD 6.1 vs. 16.5%, fatal CHD 1.9 vs. 10.1%, stroke 7.0 vs. 10.1%, and fatal stroke 1.7 vs. 1.6%, respectively. The UKPDS-RE showed moderate discrimination for all four outcomes, with the concordance index values ranging from 0.65 to 0.78. CONCLUSIONS The UKPDS stroke equations showed calibration ranging from poor to moderate; however, the CHD equations showed poor calibration and considerably overestimated CHD risk. There is a need for revised risk equations in type 2 diabetes. © 2014 by the American Diabetes Association.


Holden S.E.,University of Cardiff | Jenkins-Jones S.,Global Epidemiology | Morgan C.L.,Global Epidemiology | Schernthaner G.,Rudolfstiftung Hospital Vienna | Currie C.J.,University of Cardiff
Diabetes, Obesity and Metabolism | Year: 2015

Aims: To evaluate the association between insulin exposure and all-cause mortality, incident major adverse cardiovascular events (MACE) and incident cancer in people with type 2 diabetes treated with insulin monotherapy. Methods: For this retrospective study, people with type 2 diabetes who progressed to insulin monotherapy from the year 2000 were identified from the UK Clinical Practice Research Datalink. The risks of progression to serious adverse outcomes were compared using Cox proportional hazards models. In the main analysis, insulin exposure was introduced into the model as prescribed international units per kilogram per day, as a cumulative, continuous, annually updated, time-dependent covariable. Results: A total of 6484 subjects with type 2 diabetes who progressed to treatment with insulin monotherapy from the year 2000 onwards were followed for a mean of 3.3years. The event numbers were as follows: deaths, n=1110; incident MACE, n=342; incident cancers, n=382. Unadjusted event rates were 61.3 deaths per 1000person-years, 26.4 incident MACE per 1000person-years and 24.6 incident cancers per 1000person-years. The adjusted hazard ratios in relation to 1-unit increases in insulin dose were 1.54 [95% confidence interval (CI) 1.32-1.78] for all-cause mortality, 1.37 (95% CI 1.05-1.81) for MACE and 1.35 (95% CI 1.04-1.75) for cancer. Conclusions: There was an association between increasing exogenous insulin dose and increased risk of all-cause mortality, MACE and cancer in people with type 2 diabetes. The limitations of observational studies mean that this should be further investigated using an interventional study design. © 2014 John Wiley & Sons Ltd.

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