Real-World Utilization and Predictors of Neurohormonal Inhibitors Use in Young and Middle-Aged Breast Cancer Patients, Initiating Anthracycline-Based Treatments
Author(s)
Udim Damachi, MS1, Susan Dosreis, PhD1, Eberechukwu Onukwugha, MSc, PhD1, Manu M. Mysore, MD2, Mathangi Gopalakrishnan, MS, PhD1, Wendy Camelo Castillo, MD, MSc, PhD1;
1University of Maryland Baltimore, School of Pharmacy, Baltimore, MD, USA, 2University of Maryland Baltimore, School of Medicine, Baltimore, MD, USA
1University of Maryland Baltimore, School of Pharmacy, Baltimore, MD, USA, 2University of Maryland Baltimore, School of Medicine, Baltimore, MD, USA
OBJECTIVES: Neurohormonal inhibitors (NHI), i.e., beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers, may mitigate the risk of anthracycline-induced cardiotoxicity in breast cancer patients. It is unknown whether individuals with low-medium cardiovascular disease (CVD) risk who could potentially benefit from treatment receive NHI. We aim to examine NHI patterns and predictors of use among breast cancer patients with low-medium CVD risk who initiate adjuvant anthracycline-based treatment.
METHODS: A retrospective cohort was derived from 2006-2022 IQVIA PharMetrics® Plus for Academics US health plan claims data using a 25% random sample. We identified women 18-64 years old with a claim for breast cancer diagnosis and breast cancer surgery in the nine months before anthracycline treatment initiation (index date). Low-medium risk CVD was defined by evidence of risk factors (i.e. hypertension, hyperlipidemia) without evidence of cardiovascular outcomes (i.e. stroke, myocardial infarction) in the nine-month baseline before the index date. New NHI users were identified 12 months after the index date. Logistic regression analyses assessed significant associations with demographics, medical history, prior medication use, and NHI use.
RESULTS: Among 2595 breast cancer patients initiating anthracycline treatment, 7.0% received NHI. The median (interquartile range) time to the start of NHI was 162 (151) days. A higher proportion of NHI users had hypertension, received breast-conservation surgery, and received HER2 inhibitors relative to non-NH users. Significant predictors of NHI use included hypertension (OR:13.5, 95% CI: 5.4-33.7); prior use of HER2 inhibitors (OR:15.2, 95% CI: 3.4-67.7); and alkylating agent (OR:5.9, 95% CI: 1.2-28.0).
CONCLUSIONS: Among women with breast cancer and low-medium CVD risk who initiate cardiotoxic anthracycline treatment, less than 1 in 10 receive NHI treatment. Future research exploring the role of blood pressure control may improve understanding of NHI utilization in this population.
METHODS: A retrospective cohort was derived from 2006-2022 IQVIA PharMetrics® Plus for Academics US health plan claims data using a 25% random sample. We identified women 18-64 years old with a claim for breast cancer diagnosis and breast cancer surgery in the nine months before anthracycline treatment initiation (index date). Low-medium risk CVD was defined by evidence of risk factors (i.e. hypertension, hyperlipidemia) without evidence of cardiovascular outcomes (i.e. stroke, myocardial infarction) in the nine-month baseline before the index date. New NHI users were identified 12 months after the index date. Logistic regression analyses assessed significant associations with demographics, medical history, prior medication use, and NHI use.
RESULTS: Among 2595 breast cancer patients initiating anthracycline treatment, 7.0% received NHI. The median (interquartile range) time to the start of NHI was 162 (151) days. A higher proportion of NHI users had hypertension, received breast-conservation surgery, and received HER2 inhibitors relative to non-NH users. Significant predictors of NHI use included hypertension (OR:13.5, 95% CI: 5.4-33.7); prior use of HER2 inhibitors (OR:15.2, 95% CI: 3.4-67.7); and alkylating agent (OR:5.9, 95% CI: 1.2-28.0).
CONCLUSIONS: Among women with breast cancer and low-medium CVD risk who initiate cardiotoxic anthracycline treatment, less than 1 in 10 receive NHI treatment. Future research exploring the role of blood pressure control may improve understanding of NHI utilization in this population.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD169
Topic
Real World Data & Information Systems
Disease
SDC: Oncology