Background: Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias. Objectives: This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias. Methods: This is a retrospective analysis of 100% of 2010-2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities. Results: Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65-0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63-0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57-0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67-0.99). Discussion: The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias. Conclusions: Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's dis- ease and related dementia care.

The development of heat-induced antigen retrieval technologies with Tris-EDTA buffer has dramatically improved immunostaining of specific antigens for routine immunohistochemical detection (Krenacs et al., 2010) [1]. However, little evidence exists on whether heat-Induced antigen retrieval utilizing Tris-EDTA buffer can strip western blot (WB) membranes and allow sequential reprobing. Here, we serendipitously discover that-95 degrees C Tris-EDTA buffer with 0.01% Tween 20 could repeatedly strip the Nitrocellulose membranes (NC). After electroblotting, NC blots were soaked into Tris-EDTA stripping buffer (-95 degrees C, 10-25min) and we could perform at least five rounds (the following antibodies used: Vinculin, Atg7, Caspase-3, UBA5, JNK and ERK1/2) stripping in sequential chemiluminescent detections. The NC membranes also show clear western signals and background without losing transferred proteins during the reprobing process of WB. Hence, this study report additional new roles of the heat-Induced antigen retrieval Tris-EDTA buffer with 0.01% Tween 20. The method is simpler, more affordable and harmless for the nitrocellulose paper, which will be helpful for effective reprobing in western blotting applications.

For western blot analysis, a housekeeping protein, such as β-actin or glyceraldehyde-3-phosphate dehydrogenase, is used as loading control with the assumption that these proteins are stable. In practice, these internal loading control proteins vary with different cell states and tissue types. These internal standards are not appropriate for use with serum, extracellular secretion, cerebrospinal fluid analysis or for protein purification. We investigated total protein measurement using Congo red staining and found it to be a superior alternative to routine loading controls. Advantages include lower cost, technical simplicity and improved linear regression. We propose using Congo red staining for total protein immunoblotting to evaluate protein loading in western blots.

This work focused on studying the enzymatic and electrochemical properties of cellulase immobilized on carboxylated MWCNTs (cellulase/c-MWCNTs). The morphology and attachment of impurities, enzymatic and electrochemical properties of c-MWCNTs and cellulase/c-MWCNTs were studied. Results of morphology and attachment of impurities by FESEM and FTIR showed that the cMWCNTs were prepared in bundles structure with porous and smooth surface but after cellulase immobilization by entrapment inside c-MWCNTs matrix, the prepared cellulase/c-MWCNTs displayed the rougher surface with more saturated pores. These results of FTIR evidenced to form N– H and O–H stretching vibrations of cellulase, and presence of nitriles, amide group and aliphatic amide bond in cellulase/c-MWCNTs structure that confirmed to successfully immobilization of cellulase enzyme on the c-MWCNTs side walls. Study of enzymatic properties showed that the optimum condition for electrochemical study of the cellulase/c-MWCNTs was concentration of 4 mg/ml, pH 4 and temperature of 35°C. Electrochemical study of cellulase/c-MWCNTs for detection catechol showed linear range and detection limit were obtained 10 to 160 μM and 0.004 μM, respectively. The comparison of sensing properties of cellulase/c-MWCNTs and other reported catechol sensors indicated the comparable electrochemical properties. Low detection limit for determination of catechol on the cellulase/c-MWCNTs can be due to formation of fast electron transfer pathways between the cellulase/c-MWCNTs electrode and the electrolyte.

Nogo-A protein consists of two main extracellular domains: Nogo-66 (rat amino acid [aa] 1019–1083) and Nogo-A-Δ20 (extracellular, active 180 amino acid Nogo-A region), which serve as strong inhibitors of axon regeneration in the adult CNS (Central Nervous System). Although receptors S1PR2 and HSPGs have been identified as Nogo-A-Δ20 binding proteins, it remains at present elusive whether other receptors directly interacting with Nogo-A-Δ20 exist, and decrease cell death. On the other hand, the key roles of EphA4 in the regulation of glioblastoma, axon regeneration and NSCs (Neural Stem Cells) proliferation or differentiation are well understood, but little is known the relationship between EphA4 and Nogo-A-Δ20 in NSCs apoptosis. Thus, we aim to determine whether Nogo-A-Δ20 can bind to EphA4 and affect survival of NSCs. Here, we discover that EphA4, belonging to a member of erythropoietin-producing hepatocellular (Eph) receptors family, could be acting as a high affinity ligand for Nogo-A-Δ20. Trans-membrane protein of EphA4 is needed for Nogo-A-Δ20-triggered inhibition of NSCs apoptosis, which are mediated by balancing p38 inactivation and JNK MAPK pathway activation. Finally, we predict at the atomic level that essential residues Lys-205, Ile-190, Pro-194 in Nogo-A-Δ20 and EphA4 residues Gln-390, Asn-425, Pro-426 might play critical roles in Nogo-A-Δ20/EphA4 binding via molecular docking.

High-fat diet (HFD) has been associated with neuroinflammation and apoptosis in distinct brain regions. To explore the effect of short-term (7, 14 and 21 days) high-fat overfeeding on apoptosis, inflammatory signaling proteins, APP changes and glial cell activities in cerebral cortex and cerebellum. Mice were fed with HFD for different lengths (up to 21 days) and after each time body weights of mice was tested, then the apoptotic proteins, IL-1β, APP, BACE1and MAPKs, Akt and NF-κB signaling activity were evaluated by western blots. Results demonstrate that short period of high-fat overnutrition significantly promotes apoptosis, APP expression at day 21 of cerebral cortex and at day 7 of cerebellum compared to chow diet. In addition, increased GFAP+astrocytes, Iba-1+microglia and IL-1β 30 were observed in cerebral cortex after 21 days HFD, but no changes for 7 days overfeeding of cerebellum. Serendipitously, ERK1/2 pathway was activated both in cerebral cortex and cerebellum for different time course of HFD. Furthermore, increased phospho-p38 MAPK level was observed in cerebellum only. In consistent with in vivo results, SH-SY5Y cells treatment with cholesterol (50 μM, 100 μM) for 48 h culture in vitro demonstrated that pro-apoptotic proteins were enhanced as well. In brief, short-term HFD consumption increases sensitivity to apoptosis, APP and IL-1β production as well as gliosis in cerebral cortex and cerebellum, which may be related to enhancement of ERK1/2 and p38 MAPK activation.

High-fat diet (HFD) has been associated with neuroinflammation and apoptosis in distinct brain regions. To explore the effect of short-term (7, 14 and 21 days) high-fat overfeeding on apoptosis, inflammatory signaling proteins, APP changes and glial cell activities in cerebral cortex and cerebellum. Mice were fed with HFD for different lengths (up to 21 days) and after each time body weights of mice was tested, then the apoptotic proteins, IL-1β, APP, BACE1and MAPKs, Akt and NF-κB signaling activity were evaluated by western blots. Results demonstrate that short period of high-fat overnutrition significantly promotes apoptosis, APP expression at day 21 of cerebral cortex and at day 7 of cerebellum compared to chow diet. In addition, increased GFAP+astrocytes, Iba-1+microglia and IL-1β 30 were observed in cerebral cortex after 21 days HFD, but no changes for 7 days overfeeding of cerebellum. Serendipitously, ERK1/2 pathway was activated both in cerebral cortex and cerebellum for different time course of HFD. Furthermore, increased phospho-p38 MAPK level was observed in cerebellum only. In consistent with in vivo results, SH-SY5Y cells treatment with cholesterol (50 μM, 100 μM) for 48 h culture in vitro demonstrated that pro-apoptotic proteins were enhanced as well. In brief, short-term HFD consumption increases sensitivity to apoptosis, APP and IL-1β production as well as gliosis in cerebral cortex and cerebellum, which may be related to enhancement of ERK1/2 and p38 MAPK activation.

Protein lysine crotonylation is a newly discovered protein post-translational modification (PTM), which has been associated with cellular metabolism, cell cycle, gene transcription, DNA damage response. However, its potential roles related to human central nervous system diseases remain largely unknown. In the present study, we observed a significant elevated lysine crotonylation in a screening of nine lysine acylations in cortex tissues of HFD-fed mice after short-term overfeeding. On the base of previous reports and molecular weight of proteins, we also speculate that actin, ERK2 or GAPDH and CDK1 might be modified by lysine crotonylation (KCr). Taken together, our findings highlight a potential role of protein lysine crotonylation in HFD-induced brain disorders and as possible therapeutic candidates in the future.

A modified, sensitive and reversible method for protein staining on nitrocellulose (NC) and polyvinylidine fluoride (PVDF) membranes was developed in Western blotting. The method employed Congo red staining to visualize proteins on different blot membranes. Staining of proteins with Congo red dye is more faster procedures. According to the experimental results, approximate 20 ng proteins could be detected in 3 min in room temperature. The staining on the proteins is easily reversible with Congo red destaining solution for NC and PVDF membranes, so that the blot membranes can be reused for Western blotting. In addition, we confirmed that the staining method is fully compatible with Western blot detection. NC and PVDF membranes treatment with Congo red staining does not interfere with conventional chemiluminescent substrates of peroxidase. As compared to MemCode reversible protein stain kits from Pirece Biotechnology, the staining technique is more sensitive, lower of cost, convenient and not adversely affecting subsequent Western blotting results. On the other hand, the stain is more sensitive than the Ponceau S staining. Therefore, Congo red staining is a promising and ideal alternative for current protein stain. Besides, the binding modes of Congo red or Ponceau S stain were investigated using various 2D and 3D molecular docking and demonstrated potential molecular basis for sensitivity of Congo red staining are higher than Ponceau S.

Astrocytes can serve multiple functions in maintaining cellular homeostasis of the central nervous system (CNS), and normal functions for autophagy in astrocytes is considered to have very vital roles in the pathogenesis of aging and neurodegenerative diseases. Autophagy is a major intracellular lysosomal (or its yeast analog, vacuolar) clearance pathways involved in the degradation and recycling of long-lived proteins, oxidatively damaged proteins and dysfunctional organelles by lysosomes. Current evidence has shown that autophagy might influence inflammation, oxidative stress, aging and function of astrocytes. Although the interrelation between autophagy and inflammation, oxidative stress, aging or neurological disorders have been addressed in detail, the influence of astrocytes mediated-autophagy in aging and neurodegenerative disorders has yet to be fully reviewed. In this review, we will summarize the most up-to-date findings and highlight the role of autophagy in astrocytes and link autophagy of astrocytes to aging and neurodegenerative diseases. Due to the prominent roles of astrocytic autophagy in age-related neurodegenerative diseases, we believe that we can provide new suggestions for the treatment of these disorders.

BACKGROUND: Because of increasing safety concerns related to erythropoiesis-stimulating agents (ESAs), the Centers for Medicare & Medicaid Services issued a Medicare reimbursement policy change regarding these medications in cancer patients. However, the policy established an absolute hemoglobin or hematocrit threshold to qualify for reasonable use but did not take the effect of gender and racial/ethnic differences in hemoglobin levels into consideration. OBJECTIVE: To examine disparities in the use of ESAs and blood transfusions after the Medicare policy change. METHODS: This study was an exploratory treatment effectiveness study and used the SEER-Medicare linked database. The treatment group was composed of cancer patients, whereas the control group was composed of chronic kidney disease patients. An interrupted time series design was used to examine the effect of the Medicare policy change on the use of ESAs and blood transfusions in different gender and racial/ethnic groups. RESULTS: The Medicare reimbursement policy change had an immediate effect on reducing the use of ESAs by 50% and increasing the use of blood transfusions by 10%. The immediate effect of the policy change on the monthly utilization of ESAs was 2 times greater in females (60% reduction) than males (30% reduction). Females had a 10% immediate increase in the monthly utilization of blood transfusions after the policy change. The policy change had the same immediate effect of a 50% reduction on the use of ESAs for Whites, African Americans/Blacks, and Latinos. African Americans/Blacks had a 50% immediate increase in the monthly utilization of blood transfusions after the policy change. CONCLUSIONS: Gender and racial/ethnic disparities were associated with the Medicare reimbursement policy change in the use of ESAs and blood transfusions. Thus, future policy considerations should keep biologic differences across gender and racial/ethnic groups in mind.

In case of a large or medium LOCA accident of marine nuclear power plant, the loop pressure drops rapidly. In case of power failure of the whole ship at this time, the active safety injection system will lose its function because the safety injection pump needs AC power, and the core is at risk of melting. A passive marine safety injection system based on high-pressure compressed gas is designed for the superposition of large and medium LOCA accidents and the whole ship's power failure accidents, including the safety injection subsystem of medium and low pressure and the safety injection subsystem of recirculation. The energy required for safety injection is provided by the potential energy of compressed gas, the pressure head is provided by the technology of gas-liquid booster pump, and the collection signals and valves are controlled by the technology of intelligent fluid control unit with small power consumption. The power supply used in the system is provided by DC 24 V battery. The mathematical and physical models of accumulator, gas storage tank, gas-liquid booster pump, reactor body and its pipeline are established for the designed passive safety injection system. The operation and safety characteristics of medium pressure safety injection, low pressure safety injection and recycling safety injection under LOCA accident conditions are simulated. The safety injection time and flow rate of three safety injection pressures are simulated by medium pressure safety injection, the safety injection time and peak temperature are simulated by low pressure safety injection, and the pressure and system temperature are simulated by recirculation safety injection. The simulation results show that the marine passive safety injection system designed under LOCA accident conditions can meet the requirements of core cooling. (C) 2020 Elsevier Ltd. All rights reserved.

OBJECTIVES:To compare viewpoints of nationally certified and noncertified technicians and explore the perceived value of technician certification in the job performance domains of medication safety, skills and abilities, experience, engagement and satisfaction, and productivity. METHODS:A cross-sectional survey of pharmacy technicians, from 6 states representing 4 regions of the United States, was conducted. Technician mailing lists were purchased from Boards of Pharmacy, and randomly selected technicians were sent survey invitations. Surveys were completed via Qualtrics and analyzed with the use of SAS. RESULTS:Six hundred seventy-six technicians (547 certified, 103 noncertified, and 26 previously certified) responded to the survey (9.4% response rate). Certified technicians reported significantly higher confidence rating for desire to take on new responsibilities (P < 0.01; Cohen d 0.45) and plans to remain in the pharmacy field (P = 0.01, Cohen d 0.35), lower rating for leaving the job in the next 12 months (P < 0.01; Cohen d 0.35), and perceived lower rate of medication errors (P < 0.01; Cohen d 0.35) compared with other technicians in the work setting. The majority of respondents stated confidence in performing the "final check" on another technician's preparation of a new or refill medication if allowed. Both certified and noncertified technicians noted dissatisfaction with pay. The majority of respondents reported that they spent none of or less than 10% of their workday assisting pharmacists with medication therapy management (MTM) sessions, immunizations, or point-of-care tests; however, 71 respondents specifically described how they assist pharmacists with MTM. CONCLUSION:Results from our survey sample indicate that certified technicians have a stronger organizational and career commitment and desire to take on new roles. A majority of respondents noted dissatisfaction with pay but feel a sense of pride in their work. Both groups were confident in their abilities needed for tech-check-tech product verification.

Certain sub-populations (e.g., those living in poverty, racial/ethnic minorities, sexual minorities, and people with mental health conditions) experience profound tobacco-related health disparities. Ongoing surveillance of use of various combustible tobacco products by priority populations of cigarette smokers is needed, particularly in the changing U.S. tobacco regulatory landscape. In 2018 the FDA announced their consideration of a tobacco product standard that would limit the level of nicotine in combustible cigarettes, and such regulations should consider potential effects on tobacco-related disparities. If certain subgroups of cigarette smokers are also using other combustible products, they may be particularly likely to continue dual use or switch to exclusive use of those products if a nicotine reduction standard only applies to cigarettes. Accordingly, this study provided recent U.S. nationally representative data on use of other combustible tobacco products among current cigarette smokers by sociodemographic characteristics. Data were drawn from current cigarette smokers (n = 2559) in 2016 and 2017 U.S. nationally representative surveys. Associations between sociodemographic variables (poverty status, education, race/ethnicity, sexual orientation, and mental health status) with use of little cigars and cigarillos (LCCs), traditional cigars, and hookah were examined. Among current cigarette smokers, those living in poverty, racial/ethnic minorities, and those with mental health conditions were particularly likely to use LCCs. Racial/ethnic minority smokers were more likely to smoke traditional cigars. Non-heterosexual smokers, Hispanic smokers, and smokers with mental health conditions were particularly likely to use hookah. These findings have important implications for tobacco regulatory policy and other efforts to combat tobacco-related disparities.

BACKGROUNDAmyloid-β (Aβ) accumulation plays a critical role in the pathogenesis of Alzheimer's disease (AD) lesions. Deficiency of Serotonin signaling recently has been linked to the increased Aβ level in transgenic mice and humans. In addition, tryptophan hydroxylase-2 (Tph2), a second tryptophan hydroxylase isoform, controls brain serotonin synthesis. However, it remains to be determined that whether Tph2 deficient APP/PS1mice affect the formation of Aβ plaques in vivo.METHODSBoth quantitative and qualitative immunochemistry methods, as well as Congo red staining were used to evaluate the Aβ load and astrogliosis in these animals.RESULTSwe studied alterations of cortex and hippocampus in astrocytes and senile plaques by Tph2 conditional knockout (Tph2 CKO) AD mice from 6-10 months of age. Using Congo red staining and immunostained with Aβ antibody, we showed that plaques load or plaques numbers significantly increased in Tph2 CKO experimental groups at 8 to 10 months old, compared to wild type (WT) group, respectively. Using GFAP+ astrocytes immunofluorescence method, we found that the density of GFAP+ astrocytes markedly enhanced in Tph2 CKO at 10 months. We showed Aβ plaques co-localized autophagic markers LC3 and p62. Nevertheless, we did not observe any co-localization between GFAP+ astrocytes and autophagic markers, but detected the co-localization between βIII-tubulin+ neurons and autophagic markers.CONCLUSIONOverall, our work provides the preliminary evidence in vivo that Tph2 plays a role in amyloid plaques generation.

Background: With the evolving roles of pharmacy technicians in the United States, the profession has attempted to define a national standard. Community pharmacy employers to-date have preferred on-the-job training to formal, accredited training programs or credentialing, however, limited evidence exists on the perceived needs of pharmacy technicians in the United States compared to those of community pharmacy employers. Objectives: The aims of this study were to explore: 1) community pharmacy employer perceptions of associated benefits and perceived value of pharmacy technician certification and 2) needs of employers related to pharmacy technician attitudes and knowledge, skills and abilities (KSAs). Methods: Using a semi-structured interview guide, researchers interviewed 7 community pharmacy employers within top management teams in a variety of community pharmacy settings. The data were analyzed for themes using the human capital vs. signal theory. Results: Employers and managers generally saw both attitude and KSAs as vital to success. However, given a choice between experience and attitude, attitude was preferred. There was general agreement that certified technicians offered more value to their organization, however gaps in certified technician KSAs were noted (i.e., lack of day-to-day practical skills, vaccination screening, motivating patients to change behaviors, patient communication and workflow management). Conclusions: New emerging directions for certification now exist due to the rapidly shifting pharmacy landscape, which is revolves around new and expanded clinical patient care services. This shifting landscape has exposed gaps, reinforced strengths, and uncovered potential new opportunities and needs related to technician certification.

Curcumin is an orange-yellow colored, lipophilic polyphenol substance derived from the rhizome of Curcuma longa that is widely used in many countries. Curcumin has many reported functions, including antioxidant and anti-inflammatory effects. Autophagy removes damaged organelles and protein aggregates in the cell. However, whether curcumin mediates its effects on neural stem cell (NSC) differentiation, cell cycle and apoptosis through autophagy is unknown. In the present study, the effects of curcumin and 3-methyladenine (3MA; an autophagy inhibitor, as a positive control) on the autophagy, differentiation, cell cycle progression and apoptosis of NSCs in different culture states were examined. In order to confirm the role of autophagy in these processes of NSC behavioral change, the protein expression level changes of markers of autophagy, such as autophagy-related protein 7 (Atg7), light chain (LC)3 and p62, were assessed. When NSCs were in an adherent state, 10 mu M curcumin inhibited their differentiation into GFAP(+) astrocytes or DCX+ immature neurons, while Atg7 and p62 protein expression were also reduced compared with the untreated control group. When NSCs were in a suspended state, 10 mu M curcumin inhibited the cell cycle progression and apoptosis of NSCs as determined by western blotting, which was associated with a decreased autophagic flux and Atg7 expression. In addition, the curcumin-treated group trended in a similar direction to the 3MA-treated group. Thus, the data suggest that curcumin can inhibit differentiation, promote cell survival and inhibit cell cycle progression from G(1) to S in NSCs, and that these effects are mediated through the regulation of Atg7 and p62.

Background Treatment guidelines recommend low dose corticosteroids (steroids) as an effective short-term (<3 months) therapy among rheumatoid arthritis (RA) patients to "bridge" patients until benefits of disease modifying anti-rheumatic drugs (DMARDs) are observed and in flare management.1 Physician quality reporting system (PQRS) measures in the US require a documented management plan for patients on steroids >10 mg/day and this may be a prompt to advance RA therapy. Understanding steroid treatment patterns and associated burden prior to biologic DMARD initiation can inform clinical and policy decision-makers on the appropriate use of these two drug classes in RA management. Objectives To examine effects of steroid treatment patterns on initiation of biologic DMARDs and adverse effects of steroid utilization before biologic DMARD initiation among patients with RA. Methods A retrospective analysis was conducted of adult RA patients (18 and older) in the US MarketScan Database (2011- 2015). The earliest date a patient was diagnosed with RA was the index date. The following patterns of oral and injectable steroid utilization were analyzed: whether steroids were used; duration of steroid use (short/long duration defined as < or ≥3 months); and steroid dosage (low as <2.5 mg/day, medium as 2.5-<7.5 and high as ≥7.5 mg/day). Kaplan-Meier survival analysis was used to compare time to initiation of first biologic DMARD across groups of steroid utilization. The effects of steroid use on initiation of biologic DMARDs were examined using Cox proportional hazards models. Likelihood and number of adverse events were examined using logistic and negative binomial regression models. Independent variables in all models included patient demographics and health characteristics. Results A total of 25,537 patients were included (40.82% used steroids). Based on Kaplan-Meier survival analysis, steroid users (Figure 1), those with longer duration, and in lower dosage categories had delayed time to initiation of a biologic DMARD than their counterparts (nonusers, those with shorter duration and higher dosages, respectively) (P<0.001). According to Cox proportional hazards model, lower hazard of biologic DMARD initiation was associated with steroid use ([HR]=0.89, 95% Confidence Interval [CI]=0.83–0.96, compared to nonusers), longer steroid duration (HR=0.73, 95% CI=0.60–0.89 compared to short duration) and lower dosages (HR=1.10, 95% CI=0.99–1.23 for medium dose and HR=1.93, 95% CI=1.59–2.34 for high dose compared to low dose). Higher likelihood of adverse events was associated with steroid use (Odds Ratio [OR]=1.13, 95% CI=1.06–1.20), and longer duration (OR=1.75, 95% CI=1.47–2.09) than their counterparts. Likelihood of adverse events did not significantly differ across dosages. Similar effects of steroid utilization were found on the number of adverse events. Conclusions The findings indicate that RA patients who use steroids, those with longer duration and lower dosages have delayed initiation of biologic DMARDS than their counterparts. RA patients who use steroids and those with longer duration have higher likelihood/number of adverse events prior to initiating biologic DMARDS. References Singh JA, et al. doi: 10.1002/acr.22783. Disclosure of Interest C. Spivey Grant/research support from: AbbVie, J. Griffith Shareholder of: AbbVie, Employee of: AbbVie, C. Kaplan Grant/research support from: AbbVie, A. Postlethwaite Grant/research support from: AbbVie, A. Ganguli Shareholder of: AbbVie, Employee of: AbbVie, J. Wang Grant/research support from: AbbVie

BACKGROUND:Increasingly, third-party payers are requiring patients with multiple sclerosis (MS) to participate in specialty pharmacy management programs to improve their adherence to their prescribed medications. The effects of specialty pharmacy care on MS clinical outcomes have not yet been comprehensively examined in the literature.OBJECTIVE:To compare the effectiveness of specialty pharmacy care and usual community pharmacy care MS outcomes.METHODS:Inpatient, outpatient, and pharmacy claims for patients with MS were extracted from a major national pharmacy benefit management company's databases for this retrospective cohort study. Enrollees with continuous medical and pharmacy benefits were followed for 3 years. MS relapse status was defined by a specific algorithm and was compared in patients who had specialty pharmacy care and those with usual community pharmacy care. The outcome measures included time to the first and second disease relapses and the number of relapses. Kaplan-Meier method and Cox proportional hazards regression analyses were performed on the time to first and second relapses, and generalized linear regression models were performed on the number of disease relapses.RESULTS:The study cohort included 1731 eligible patients with MS, of whom 1427 received specialty pharmacy care. During the study period, between 2006 and 2009, 1634 relapses were identified, with a mean annual relapse rate of 0.3 among the specialty pharmacy care group versus 0.4 among the usual pharmacy care group. Specialty pharmacy care was associated with a lower risk for disease relapse, with a hazard ratio (HR) of 0.73 (95% confidence interval [CI], 0.607-0.871) for the first relapse and HR of 0.78 (95% CI, 0.610-1.002) for the second relapse. When controlling for demographics, comorbidities, and index medications, specialty pharmacy care was associated with a lower risk for disease relapse with HR of 0.82 (95% CI, 0.680-0.985) for first relapse versus usual pharmacy care. The time to second relapse was not significantly different between the 2 groups in the unadjusted and adjusted Cox regression models. In addition, a generalized linear regression model showed that specialty pharmacy care, index age, geographic North region, 3-year Chronic Disease Score, and Elixhauser comorbidity measure were significantly associated with the number of disease relapses.CONCLUSION:These results show that specialty pharmacy care is associated with a significantly lower risk for disease relapse in patients with MS (specifically the first relapse) and fewer relapses compared with usual community pharmacy care.