Introduction Hyperkalemia is a common and clinically relevant condition in patients with chronic kidney disease (CKD)
and heart failure (HF), often limiting optimal use of renin–angiotensin–aldosterone system inhibitors (RAASi).
Methods This real-world study evaluated adherence, clinical outcomes, and healthcare costs among Italian patients initiating
patiromer, sodium zirconium cyclosilicate (SZC), or sodium polystyrene sulfonate (SPS) between January 2022 and
June 2024.
Results Administrative data covering about 10% of the Italian population identified 1953 patients: 249 on patiromer, 387 on
SZC, and 1317 on SPS. After full matching, 67.5% of patiromer patients were adherent at 6 months, compared with 20.4%
for SZC and 0.5% for SPS (p < 0.001). Over the total follow-up, adherence remained higher with patiromer (42.5% vs 13.4% and 0.5%). During the first 6 months, HF-related hospitalization rates were lower with patiromer versus SZC (5.4 vs 12.8 events per 100 person-years; p = 0.079), becoming significant over overall follow-up (5.3 vs 15.7; p = 0.003). Composite HF outcomes at 6 months were also lower with patiromer compared with SZC (5.3 vs 17.4; p = 0.012) and SPS (3.4 vs 24.8; p = 0.005). At 12 months, total healthcare costs were significantly lower with patiromer than with SZC and SPS (€5645 vs €8500 and €4736 vs €6234; p < 0.001). Overall, patiromer use was associated with better adherence, fewer HF-related events, and reduced healthcare expenditure. Conclusions These findings suggest a patiromer potential role for sustained potassium binder therapy in supporting RAASi optimization and improving clinical management in routine practice, but confirmation through direct comparative prospective randomized trials is needed

Background/Objectives: Psoriasis is a chronic inflammatory skin disease leading to substantial
psycho-physical and social burden and reduced quality of life. Biologic agents
have transformed its therapeutic landscape. This real-world Italian study described the
pattern of treatment with biologic drugs in patients with psoriasis. Methods: A retrospective
observational study was conducted using administrative databases from Italian
Local Health Units, covering nearly 12 million individuals. The study included adults
with psoriasis identified from January 2015 to March 2025 by hospitalization, co-payment
exemption code, or topical anti-psoriatic prescriptions. Patients initiating a biologic drug
(anti-TNFα, anti-IL12/23, anti-IL17, and anti-IL23) were selected and further analyzed
in terms of treatment switching, drug survival, and healthcare resource utilization and
related costs within the first year after biologic initiation, and compared. Results: A total
of 10,270 biologic-naïve adult patients was included in the analysis (anti-TNFα N = 5078;
anti-IL12/23 N = 767; anti-IL17 N = 2574; anti-IL23 N = 1851). Most patients (95.0%) starting
an anti-IL23 agent did not switch. Compared with anti-TNFα, initiating an anti-IL23
inhibitor was associated with a significant reduced risk of switching (HR = 0.186; 95%CI:
0.144–0.240; p < 0.001). According to the cost analysis stratified by switching status, remaining on the index biologic was associated with a lower economic burden. Although differences between switchers vs. non-switchers among anti-IL23 users did not reach statistical significance (€12,052 vs. €11,406, respectively, p = 0.132), data support the economic advantage associated with greater treatment stability. Conclusions: Anti-IL23 agents showed effective, durable first-line use with potential long-term clinical and economic benefits in moderate-to-severe psoriasis.

Background: Increasing evidence links elevated serum uric acid levels to adverse cardiorenal outcomes. To date,
limited data exist on whether the benefits of urate-lowering therapies (ULTs) depend on timely treatment
initiation and sustained adherence in patients at high cardiovascular risk.
Methods: An economic evaluation was conducted, based on a simulation model populated by Italian real-world
patient-level data from the Uric Acid Right for Heart Health (URRAH) cohort to evaluate long-term cardiovascular,
renal, and economic outcomes associated with timely allopurinol use. 10,000 patients with hyperuricemia
(serum uric acid >5.6 mg/dL) and elevated cardiovascular risk were simulated over a 20-year time horizon.
Timely initiation of allopurinol (before the first gout flare) was compared with treatment initiated only after
symptomatic disease onset. Scenarios reflecting current and improved adherence to ULTs were assessed. Outcomes
included major adverse cardiovascular events, end-stage renal disease onset, and economic outcomes from
the payer’s perspective.
Results: According to our model, timely initiation of allopurinol was associated with modest but consistent health
gain (0.04 quality adjusted life years) including reductions in gout flares, cardiovascular- and renal endpoints.
Timely allopurinol initiation was cost-saving and, from a health economic perspective, dominant over current
practice. Improved ULT adherence amplified these benefits.
Conclusion: Our hypothesis-generating research suggests that, in hyperuricemic patients at high cardiovascular
risk, the potential benefits of allopurinol also depend on timely initiation and sustained adherence. While these
findings do not constitute evidence of causal clinical benefit, they support a broader cardiorenal clinical
approach to hyperuricemia management that extends beyond gout prevention

Background Migraine is a leading cause of disability worldwide, impairing quality of life and productivity. Preventive
therapies aim to reduce attack frequency, severity and the need for acute medications. Oral atogepant (60 mg), a
calcitonin gene-related peptide (CGRP) receptor antagonist, has recently expanded migraine prevention options. This
study evaluated changes in triptan use after atogepant initiation using real-world data.
Methods This retrospective observational study used administrative healthcare databases from the Local Health Unit
of Modena (Italy). Adults with chronic or high-frequency episodic migraine initiating atogepant between November
2023 and December 2024 were identified. Triptan use and related costs were assessed in the 6 months before and
after treatment initiation (index date), measured as dispensed dosage units.
Results Among 95 patients (86% female; mean age 53.5 years), 55 triptan users were included in the analysis. Triptan
use decreased in 45 patients (82%), with ≥ 60% reduction in 27 (49%) and complete discontinuation in 10. Median
consumption decreased from 76 to 24 dosage units, and mean consumption from 88.1 to 45.2. This reduction was
statistically significant (Wilcoxon signed-rank test, p < 0.001). This reduction corresponded to a decrease of €2,591 in triptan-related pharmaceutical expenditure within the study cohort. Conclusion Atogepant preventive treatment may substantially reduce acute migraine medication use in real-world practice, with potential clinical and economic benefits. Keywords CGRP, Gepants, Headache, Medication-overuse headache, Pain

Background: Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries, mainly affecting older
people. Targeted agents have reshaped first-line (1L) strategies, making real-world evidence important to complement clinical trials.
Objective: To estimate the incidence of Italian patients initiating first-line CLL therapy (2019–2022) and describe demographics/
clinical profile, treatment patterns, adherence, outcomes (overall survival [OS], time to next treatment [TTNT]), and healthcare costs
from the perspective of the Italian National Health System (NHS).
Methods: A retrospective observational study using administrative healthcare databases (~9 million residents) was conducted on CLL
patients starting 1L therapy (index-date) for CLL. Baseline characteristics were assessed in the 12 months pre-index; follow-up was
≥12 months. Drug use, adherence (medication possession ratio), dose adjustments, OS, TTNT, and direct costs were analyzed with
descriptive and multivariable methods.
Results: A total of 1479 patients initiated 1L therapy: 63.9% chemotherapy (CHT), 23.2% ibrutinib, 3.2% acalabrutinib, and 9.7%
other regimens. CHT remained common, especially among older and more comorbid patients. Ibrutinib showed lower mortality versus
CHT (HR 0.663; p=0.002) and longer TTNT (median not reached). Dose adjustments were frequent; extended refill intervals did not
appear to reduce drug survival. Mean annual cost per patient was €38,573, mainly driven by drug acquisition; ibrutinib users had lower
hospitalization and outpatient costs than other 1L groups.
Conclusion: In Italian practice, ibrutinib was the main targeted 1L option and was associated with improved survival and delayed
progression versus CHT. Despite higher drug costs, reduced hospital-based resource use suggests favourable overall clinical and
economic impact.
Keywords: chronic lymphocytic leukemia, first-line treatment, healthcare costs, ibrutinib, real-world evidence, targeted therapy