Advances in Therapy最新文献

{"title":"Investigation of Severe Hypoglycemia Risk Among Patients with Diabetes Treated with Ultra-Rapid Lispro in Japan","authors":"Seiko Mizuno,&nbsp;Machiko Minatoya,&nbsp;Satoshi Osaga,&nbsp;Rina Chin,&nbsp;Makoto Imori","doi":"10.1007/s12325-024-03050-1","DOIUrl":"10.1007/s12325-024-03050-1","url":null,"abstract":"<div><h3>Introduction</h3><p>There is no information on the incidence of severe hypoglycemia in real-world patients with diabetes receiving ultra-rapid lispro (URLi). This post-marketing, observational, safety study assessed the incidence proportion and incidence rate of the first severe hypoglycemia event requiring a hospital visit in URLi-treated patients. It also compared the risk of severe hypoglycemia between patients treated with URLi or other rapid-acting insulin analogs (RAIAs).</p><h3>Methods</h3><p>Claims data were obtained from a nationwide hospital-based administrative database in Japan (Medical Data Vision). Adults with diabetes who initiated URLi or other RAIA on/after June 01, 2020, were followed up through May 31, 2023. Severe hypoglycemia was identified using a validated algorithm. Incidence proportion and incidence rate of the first severe hypoglycemia event requiring a hospital visit was described in URLi-treated patients (descriptive analysis). These outcomes were also compared against propensity score (PS)-matched other RAIA-treated patients (comparator; comparative analysis). Hazard ratio (HR) and 95% confidence interval (CI) was estimated with a Cox proportional hazards model.</p><h3>Results</h3><p>The descriptive analysis’ URLi-treated cohort included 17,838 patients [mean (standard deviation, SD) age 65.9 (15.7) years; 58.3% male]. The majority had type 2 diabetes (75.7%). The incidence proportion of the first severe hypoglycemia event requiring a hospital visit was 0.6% (95% CI 0.5, 0.8) and the incidence rate was 1.7 per 100 person-years (95% CI 0.7, 4.3). The comparative analysis included 10,592 URLi-treated and 52,917 comparator-treated patients. The incidence rate of severe hypoglycemia did not significantly differ between these cohorts (HR 0.8; 95% CI 0.5, 1.1; <i>p</i> = 0.132;.</p><h3>Conclusion</h3><p>This study did not show a statistically significant increase in the incidence and risk of the first severe hypoglycemia event requiring a hospital visit in real-world URLi-treated patients in Japan, compared with a PS-matched cohort of other RAIA-treated patients.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"413 - 426"},"PeriodicalIF":3.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Safety and Effectiveness of Dimethyl Fumarate in Patients with MS: Results from the ESTEEM Phase 4 and PROCLAIM Phase 3 Studies with a Focus on Older Patients","authors":"Yang Mao-Draayer,&nbsp;Amit Bar-Or,&nbsp;Konstantin Balashov,&nbsp;John Foley,&nbsp;Kyle Smoot,&nbsp;Erin E. Longbrake,&nbsp;Derrick Robertson,&nbsp;Jason P. Mendoza,&nbsp;James B. Lewin,&nbsp;Nicholas Everage,&nbsp;Ivan Božin,&nbsp;Jennifer Lyons,&nbsp;Oksana Mokliatchouk,&nbsp;Eris Bame,&nbsp;Fabrizio Giuliani","doi":"10.1007/s12325-024-03047-w","DOIUrl":"10.1007/s12325-024-03047-w","url":null,"abstract":"<div><h3>Introduction</h3><p>Real-world studies in the USA report that 41–56% of patients with multiple sclerosis (MS) are ≥ 50 years old, yet data on their response to disease-modifying therapies (DMTs) is limited. Dimethyl fumarate (DMF) is an oral DMT approved for treating relapsing MS. This analysis evaluated the safety, efficacy, and immunophenotype changes of DMF in patients ≥ 50 years compared with patients &lt; 50 years.</p><h3>Methods</h3><p>ESTEEM, a 5-year, real-world, observational phase 4 study, assessed the safety and effectiveness of DMF, including treatment-emergent serious adverse events (SAEs) and adverse events (AEs) leading to treatment discontinuation. Absolute lymphocyte counts (ALCs) were recorded from a subset of patients. The PROCLAIM study, a phase 3b interventional study, reported safety outcomes and lymphocyte subset changes in patients with relapsing–remitting MS (RRMS) treated with DMF. The study evaluated safety outcomes by analyzing the incidence of SAEs and detailed changes in CD4⁺ and CD8⁺ T cell compartments over 96 weeks of DMF treatment.</p><h3>Results</h3><p>ESTEEM included 4020 patients aged &lt; 50 years and 1069 aged ≥ 50 years. AEs leading to discontinuation were reported by 19.6% patients &lt; 50 years and 29.6% of patients ≥ 50 years, with gastrointestinal disorders being the most common. SAEs were reported by 5.2% of patients &lt; 50 years and 8.9% those ≥ 50 years. In PROCLAIM, SAEs were reported in 13% of patients &lt; 50 years and 10% of those ≥ 50 years. Median ALC decreased by 35% in patients &lt; 50 years and 50% in those ≥ 50 years in ESTEEM, with similar patterns observed in PROCLAIM.</p><h3>Conclusions</h3><p>ESTEEM found no unexpected safety signals in older patients and annualized relapse rates (ARRs) were significantly reduced in both age groups. Both studies indicated that DMF is efficacious and has a favorable safety profile in patients with RRMS aged ≥ 50 years.</p><h3>Clinical Trial Registration</h3><p>ESTEEM (NCT02047097), PROCLAIM (NCT02525874).</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"395 - 412"},"PeriodicalIF":3.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Response to: Letter to the Editor Regarding “Comparing Cardiovascular Outcomes and Costs of Perindopril-, Enalapril- or Losartan-Based Antihypertensive Regimens in South Africa: Real-World Medical Claims Database Analysis”","authors":"Jacques R. Snyman,&nbsp;Freedom Gumedze,&nbsp;Erika S. W. Jones,&nbsp;Olufunke A. Alaba,&nbsp;Nqoba Tsabedze,&nbsp;Alykhan Vira,&nbsp;Ntobeko A. B. Ntusi","doi":"10.1007/s12325-024-03045-y","DOIUrl":"10.1007/s12325-024-03045-y","url":null,"abstract":"","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"552 - 555"},"PeriodicalIF":3.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Corticosteroid-Related Healthcare Resource Utilization and Associated Costs in Patients with COPD","authors":"Gary Tse,&nbsp;Cono Ariti,&nbsp;Mona Bafadhel,&nbsp;Alberto Papi,&nbsp;Victoria Carter,&nbsp;Jiandong Zhou,&nbsp;Derek Skinner,&nbsp;Xiao Xu,&nbsp;Hana Müllerová,&nbsp;Benjamin Emmanuel,&nbsp;David Price","doi":"10.1007/s12325-024-03024-3","DOIUrl":"10.1007/s12325-024-03024-3","url":null,"abstract":"<div><h3>Introduction</h3><p>Oral corticosteroids (OCS) are used to manage chronic obstructive pulmonary disease (COPD) exacerbations but are associated with adverse outcomes that may increase healthcare resource utilization and costs. We compared attendance/costs associated with OCS-related adverse outcomes in patients who ever used OCS versus those who never used OCS and examined associations between cumulative OCS exposure and attendance/costs.</p><h3>Methods</h3><p>This direct matched observational cohort study used the UK Clinical Practice Research Datalink GOLD database (data range 1987–2019). Patients with a COPD diagnosis on/after April 1, 2003, and Hospital Episode Statistics linkage were included. Emergency room, specialist or primary care outpatient, and inpatient attendance were analyzed. Costs, estimated using Health and Social Care 2019 and National Health Service Reference Costs 2019–2020 reports, were adjusted for sex, age, exacerbation number, and inhaler type used in the 12 months before index date.</p><h3>Results</h3><p>The OCS cohort had higher annualized disease-specific (excluding respiratory) total attendance/costs versus the non-OCS cohort (adjusted incidence rate ratio [aIRR] with 95% confidence intervals [CIs]) ranging from 37% (1.37 [1.31, 1.43]) for emergency room attendances to 149% (2.49 [2.36, 2.63]) for specialist consultations. Disease-specific (excluding respiratory) attendance/costs increased in a positive dose–response relationship for most attendance categories versus the &lt; 0.5 g reference dose. For the 0.5 to &lt; 1.0 g cumulative dose category, the greatest increases in disease-specific (excluding respiratory) attendance/costs occurred for primary care consultations (aIRR [95% CI] 1.38 [1.32, 1.44]). For the ≥ 10 g cumulative dose category, the greatest increases were observed for primary care consultations (aIRR [95% CI] 2.83 [2.66, 3.00]), non-elective long stays (≥ 2 days; 2.54 [2.15, 2.99]), and non-elective short stays (≤ 1 day; 2.51 [2.12, 2.98]). Similar findings were observed for all-cause attendance/costs.</p><h3>Conclusion</h3><p>Among patients with COPD, OCS-related adverse outcomes were associated with higher attendance and costs, with a positive dose–response relationship.</p><p>A graphical abstract is available with this article.</p><h3>Graphical Abstract</h3><div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"375 - 394"},"PeriodicalIF":3.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding “Comparing Cardiovascular Outcomes and Costs of Perindopril-, Enalapril- or Losartan-Based Antihypertensive Regimens in South Africa: Real-World Medical Claims Database Analysis”","authors":"Trudy D. Leong,&nbsp;Sumayyah Ebrahim,&nbsp;Tamara Kredo","doi":"10.1007/s12325-024-03025-2","DOIUrl":"10.1007/s12325-024-03025-2","url":null,"abstract":"","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"548 - 551"},"PeriodicalIF":3.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Influenza Vaccine Clinical Performance: A Podcast","authors":"Nihar R. Desai,&nbsp;Pier L. Lopalco","doi":"10.1007/s12325-024-03021-6","DOIUrl":"10.1007/s12325-024-03021-6","url":null,"abstract":"<div><p>Despite well-established vaccination programs, seasonal influenza is still causing substantial clinical, economic and societal burdens. As part of strategies to continually improve influenza vaccine clinical performance, several new approaches are being examined, including high-dose vaccines, adjuvanted vaccines, egg-free vaccines, nasal spray vaccines and mRNA vaccines. Given this range of influenza vaccines, coupled with various vaccine hesitancy concerns, healthcare professionals’ understanding and confidence in the clinical performance of influenza vaccines remain key. In this podcast, we discuss the challenges for healthcare professionals in understanding the clinical performance of influenza vaccines and the importance of education in this area, particularly to address perceptions of influenza vaccine failure. We also explore several elements that should be considered in the assessment of influenza vaccine clinical performance: (1) assessing relevant clinical outcomes, such as hospitalization data, (2) utilizing robust methodology in influenza vaccine trials to ensure high quality evidence and (3) approaches used when considering the full body of evidence.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"1 - 9"},"PeriodicalIF":3.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Asthma Exacerbations Using Machine Learning Models","authors":"Gianluca Turcatel,&nbsp;Yi Xiao,&nbsp;Scott Caveney,&nbsp;Gilles Gnacadja,&nbsp;Julie Kim,&nbsp;Nestor A. Molfino","doi":"10.1007/s12325-024-03053-y","DOIUrl":"10.1007/s12325-024-03053-y","url":null,"abstract":"<div><h3>Introduction</h3><p>Although clinical, functional, and biomarker data predict asthma exacerbations, newer approaches providing high accuracy of prognosis are needed for real-world decision-making in asthma. Machine learning (ML) leverages mathematical and statistical methods to detect patterns for future disease events across large datasets from electronic health records (EHR). This study conducted training and fine-tuning of ML algorithms for the real-world prediction of asthma exacerbations in patients with physician-diagnosed asthma.</p><h3>Methods</h3><p>Adults with ≥ 2 ICD9/10 asthma codes within 1 year and at least 30 days apart were identified from the Optum Panther EHR database between 2016 and 2023. An emergency department (ED), urgent care, or inpatient visit for asthma, while on systemic administration of corticosteroids, was considered an exacerbation. To predict factors associated with exacerbations in a 6-month study period, clinical information from patients was retrieved in the preceding 6-month baseline period. Clinical information included demographics, lab results, diagnoses, medications, immunizations, and allergies. Three models built using Extreme Gradient Boosting (XGBoost), Long Short-Term Memory (LSTM), and Transformers algorithms were trained and tested on independent datasets. Predictions were explained using the SHAP (SHapley Additive exPlanations) library.</p><h3>Results</h3><p>Of 1,331,934 patients with asthma, 16,279 (1.2%) experienced ≥ 1 exacerbation. XGBoost was the best predictive algorithm (area under the curve [AUC] = 0.964). Factors associated with exacerbations included a prior history of exacerbation, prednisone usage, high-dose albuterol usage, and elevated troponin I. Reduced probability of exacerbations was associated with receiving inhaled albuterol, vitamins, aspirin, statins, furosemide, and influenza vaccination.</p><h3>Conclusion</h3><p>This ML-based study on asthma in the real world confirmed previously known features associated with increased exacerbation risk for asthma, while uncovering not entirely understood features associated with reduced risk of asthma exacerbations. These findings are hypothesis-generating and should contribute to ongoing discussion of the strengths and limitations of ML and other supervised learning models in patient risk stratification.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"362 - 374"},"PeriodicalIF":3.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug Survival, Retention, and Persistence of Dupilumab in Adults and Adolescents with Atopic Dermatitis: A Narrative Literature Review","authors":"Mariateresa Rossi,&nbsp;Silvia M. Ferrucci,&nbsp;Piergiacomo Calzavara-Pinton,&nbsp;Angelo V. Marzano,&nbsp;Ketty Peris,&nbsp;Elena Nicoli,&nbsp;Devis Moretti,&nbsp;Andrea Chiricozzi","doi":"10.1007/s12325-024-03052-z","DOIUrl":"10.1007/s12325-024-03052-z","url":null,"abstract":"<div><p>Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition that can have a negative impact on a patient’s quality of life. Long-term effectiveness is required to manage the symptoms of AD (skin inflammation, eczematous lesions, and itching). Because some of the systemic immunosuppressants used to treat AD have been associated with serious adverse events (AEs), other safer, more effective options, including dupilumab, have been proven effective long-term for treatment of adult and adolescent patients with moderate-to-severe AD. The long-term safety and effectiveness of a drug are usually confirmed in real-world studies by evaluating its performance over time. Measures such as drug survival, drug retention, drug persistence, or retention rates reflect whether treatment may be considered as satisfactory by both patients and physicians, meeting key clinical needs. This review aimed to describe the survival, retention, or persistence of dupilumab therapy in adults and adolescents with moderate-to-severe AD by conducting a PubMed search in March 2023 and screening for relevant publications. Globally, real-world studies with dupilumab have regularly reported high drug survival rates after 1, 2, and 3 years of observation, being consistently at 80–90%, with low rates of treatment discontinuation due to lack of efficacy or AEs. These findings are notably higher than 1- and 2-year drug survival rates of systemic immunosuppressants (including cyclosporine [37% and 20%, respectively] and methotrexate [41% and 33%, respectively]). Overall, real-world data on drug survival have confirmed that dupilumab provides long-term sustained efficacy and acceptable safety in patients with moderate-to-severe AD.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"94 - 105"},"PeriodicalIF":3.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Inside ANEMIA of CKD: Projecting the Future Burden of Anemia of Chronic Kidney Disease and Benefits of Proactive Management: A Microsimulation Model of the Chinese Population","authors":"Lise Retat,&nbsp;Dunming Xiao,&nbsp;Laura Webber,&nbsp;Alexander Martin,&nbsp;Joshua Card-Gowers,&nbsp;Jiaqi Yao,&nbsp;Yuzheng Zhang,&nbsp;Chalet Zhang,&nbsp;Juan Jose Garcia Sanchez,&nbsp;Claudia Cabrera,&nbsp;Susan Grandy,&nbsp;Naveen Rao,&nbsp;Yiqing Wu,&nbsp;Zuo Li,&nbsp;Jianwei Xuan","doi":"10.1007/s12325-024-03012-7","DOIUrl":"10.1007/s12325-024-03012-7","url":null,"abstract":"","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"556 - 558"},"PeriodicalIF":3.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Chronic Kidney Disease as a Model Framework to Estimate Healthcare-Related Environmental Impact","authors":"Juan Jose Garcia Sanchez,&nbsp;Katherine A. Barraclough,&nbsp;Aleix Cases,&nbsp;Roberto Pecoits-Filho,&nbsp;Celine Germond-Duret,&nbsp;Carmine Zoccali,&nbsp;Nina Embleton,&nbsp;Antony Wright,&nbsp;Luke Hubbert,&nbsp;Lindsay Nicholson,&nbsp;Salvatore Barone,&nbsp;Nigel Budgen,&nbsp;Claudia Cabrera,&nbsp;Viknesh Selvarajah,&nbsp;Matthew J. Eckelman","doi":"10.1007/s12325-024-03039-w","DOIUrl":"10.1007/s12325-024-03039-w","url":null,"abstract":"<div><h3>Introduction</h3><p>While the economic and clinical burden of chronic diseases are well documented, their environmental impact remains poorly understood. We developed a framework to estimate the environmental impact of a disease care pathway using chronic kidney disease (CKD) as an example.</p><h3>Methods</h3><p>A life cycle assessment framework was developed for the CKD care pathway and validated by experts. Life cycle stages were characterised for resource utilisation based on a literature review and ecoinvent database inputs, in ten countries. The ReCiPe impact assessment method was used to calculate impacts across multiple environmental dimensions.</p><h3>Results</h3><p>At CKD stage 5, kidney replacement therapies (KRT) have highest impact; emissions ranged between 3.5 and 43.9 kg carbon dioxide equivalents (CO₂e) per session depending on dialysis modality, and 336–2022 kg CO₂e for kidney transplant surgery, depending on donor type. Hospitalisations have a substantial environmental impact: a 1-day intensive care stay had highest impact (66.4–143.6 kg CO₂e), followed by a 1-day hospital stay (28.8–63.9 kg CO₂e) and an 8-h emergency room visit (14.4–27.5  kg CO₂e). Patient transport to and from healthcare sites was a key driver of environmental impact for all life cycle stages, representing up to 99.5% of total CO₂e emissions.</p><h3>Conclusion</h3><p>Full care pathways should be analysed alongside specific healthcare processes. Application of this framework enables quantification of the environmental benefits of preventative medicine and effective management of chronic diseases. For CKD, early diagnosis, and proactive management to reduce the need for KRT and hospitalisations could improve patient outcomes and reduce environmental burden.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 1","pages":"348 - 361"},"PeriodicalIF":3.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}