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Peter Lohse - One of the best experts on this subject based on the ideXlab platform.
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late onset tumor necrosis factor receptor associated periodic syndrome in multiple sclerosis patients carrying the tnfrsf1a r92q mutation
Arthritis & Rheumatism, 2007Co-Authors: Tania Kümpfel, Lisa-ann Hoffmann, Heike Rübsamen, Walter Pöllmann, Wolfgang Feneberg, Reinhard Hohlfeld, Peter LohseAbstract:Objective Tumor necrosis factor receptor–associated periodic syndrome (TRAPS) is an autosomal-dominantly inherited autoinflammatory disorder caused by mutations in the TNFRSF1A gene. It is characterized by episodes of autoinflammation usually associated with fever, abdominal pain, myalgia, exanthema, Arthralgia/arthritis, and ocular involvement. We undertook this study to investigate the prevalence of TRAPS in patients with multiple sclerosis (MS) who reported, in addition to their neurologic symptoms, at least 2 other symptoms compatible with TRAPS. Methods Twenty-five unrelated MS patients were prospectively screened for TNFRSF1A mutations. In addition, blood samples from 365 unrelated MS patients and 407 unrelated Caucasian controls were analyzed to determine the R92Q carrier frequency. Results Six of 25 adult MS patients (24%) with symptoms suggestive of TRAPS were found to carry the identical arginine-to-glutamine substitution at amino acid position 92 (R92Q or p.Arg121Gln) encoded by exon 4 of the TNFRSF1A gene. All R92Q heterozygotes had similar symptoms, including Arthralgias/arthritis, myalgias, urticarial rash, and severe fatigue, which began before the onset of MS. In 5 of the 6 patients, we could identify family members who had TRAPS symptoms and had inherited the identical mutation. The R92Q exchange was also detected in 17 of 365 unselected MS patients (4.66%) and in 12 of 407 controls (2.95%) (P = 0.112). Three patients were heterozygous carriers of MEFV variants, in 1 patient in combination with the R92Q mutation. Conclusion Autoinflammatory syndromes and especially late-onset TRAPS should be considered in MS patients who report symptoms such as Arthralgias/arthritis, myalgias, urticarial rash, and severe fatigue.
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Late-onset tumor necrosis factor receptor–associated periodic syndrome in multiple sclerosis patients carrying the TNFRSF1A R92Q mutation
Arthritis and rheumatism, 2007Co-Authors: Tania Kümpfel, Lisa-ann Hoffmann, Heike Rübsamen, Walter Pöllmann, Wolfgang Feneberg, Reinhard Hohlfeld, Peter LohseAbstract:Objective Tumor necrosis factor receptor–associated periodic syndrome (TRAPS) is an autosomal-dominantly inherited autoinflammatory disorder caused by mutations in the TNFRSF1A gene. It is characterized by episodes of autoinflammation usually associated with fever, abdominal pain, myalgia, exanthema, Arthralgia/arthritis, and ocular involvement. We undertook this study to investigate the prevalence of TRAPS in patients with multiple sclerosis (MS) who reported, in addition to their neurologic symptoms, at least 2 other symptoms compatible with TRAPS. Methods Twenty-five unrelated MS patients were prospectively screened for TNFRSF1A mutations. In addition, blood samples from 365 unrelated MS patients and 407 unrelated Caucasian controls were analyzed to determine the R92Q carrier frequency. Results Six of 25 adult MS patients (24%) with symptoms suggestive of TRAPS were found to carry the identical arginine-to-glutamine substitution at amino acid position 92 (R92Q or p.Arg121Gln) encoded by exon 4 of the TNFRSF1A gene. All R92Q heterozygotes had similar symptoms, including Arthralgias/arthritis, myalgias, urticarial rash, and severe fatigue, which began before the onset of MS. In 5 of the 6 patients, we could identify family members who had TRAPS symptoms and had inherited the identical mutation. The R92Q exchange was also detected in 17 of 365 unselected MS patients (4.66%) and in 12 of 407 controls (2.95%) (P = 0.112). Three patients were heterozygous carriers of MEFV variants, in 1 patient in combination with the R92Q mutation. Conclusion Autoinflammatory syndromes and especially late-onset TRAPS should be considered in MS patients who report symptoms such as Arthralgias/arthritis, myalgias, urticarial rash, and severe fatigue.
Carlo Deangelis - One of the best experts on this subject based on the ideXlab platform.
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Taxane-induced Arthralgia and myalgia: A literature review.
Journal of Oncology Pharmacy Practice, 2016Co-Authors: Nicholas Chiu, Leonard Chiu, Ronald Chow, Henry Lam, Sunil Verma, Mark Pasetka, Edward Chow, Carlo DeangelisAbstract:Purpose Arthralgia and myalgia following taxane chemotherapy has been documented in the literature. However, these two toxicities associated with taxane treatment have not been closely examined in the literature, and data remain inconsistent in terms of the reported incidences of these toxicities. The purpose of this literature review was to provide a more comprehensive understanding of the incidence of taxane-induced Arthralgia and myalgia, as well as to document the risk factors and preventative and therapeutic treatments that have been investigated. Methods A literature search was conducted in Ovid Medline, OldMedline, Embase, Embase Classic, and Cochrane Central Register of Controlled Trials using relevant subject headings and keywords such as: "Arthralgia," "myalgia," "muscle pain," "joint pain," "taxane," "chemotherapy," "docetaxel," "paclitaxel." Results The reported incidences of Arthralgia and myalgia were variable. Taxane chemotherapy was found to be associated with greater incidences of Arthralgia and myalgia than non-taxane forms of chemotherapy. Moreover, docetaxel and nab-paclitaxel seem to be associated with lower incidences of Arthralgia and myalgia than paclitaxel. Finally, the literature on prevention and therapeutic treatment of taxane-induced Arthralgia and myalgia is scarce. Conclusion More studies should be done in order to more conclusively identify optimal therapeutic and preventative treatments as well as different risk factors. We recommend that a prospective study be done in order to better understand the true incidence of Arthralgia and myalgia in patients being treated with the paclitaxel, docetaxel, and nab-paclitaxel.
Jessica C. Hassel - One of the best experts on this subject based on the ideXlab platform.
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Arthralgia Induced by BRAF Inhibitor Therapy in Melanoma Patients
Cancers, 2020Co-Authors: Martin Salzmann, Kristina Buder-bakhaya, Karolina Benesova, Antonia Dimitrakopoulou-strauss, Alexander Enk, Hanns-martin Lorenz, Dimitrios Papamichail, Jessica C. HasselAbstract:Introduction: BRAF inhibitors (BRAFi), commonly used in BRAF-mutated metastatic melanoma (MM) treatment, frequently cause Arthralgia. Although this is one of the most common side effects, it has not been characterized yet. Methods: We retrospectively included all patients treated with BRAFi +/− MEK inhibitors (MEKi) for MM at the National Center for Tumor Diseases (Heidelberg) between 2010 and 2018 and reviewed patient charts for the occurrence and management of Arthralgia. The evaluation was supplemented by an analysis of frozen sera. Results: We included 154 patients (63% males); 31% (48/154) of them reported Arthralgia with a median onset of 21 days after the start of the therapy. Arthralgia mostly affected small joints (27/36, 75%) and less frequently large joints (19/36, 53%). The most commonly affected joints were in fingers (19/36, 53%), wrists (16/36, 44%), and knees (12/36, 33%). In 67% (24/36) of the patients, Arthralgia occurred with a symmetrical polyarthritis, mainly of small joints, resembling the pattern typically observed in patients affected by rheumatoid arthritis (RA), for which a role of the MAPK signaling pathway was previously described. Patients were negative for antinuclear antibodies, anti-citrullinated protein antibodies, and rheumatoid factor; arthritis was visible in 10 of 13 available PET–CT scans. The development of Arthralgia was linked to better progression-free survival and overall survival. Conclusion: Arthralgia is a common side effect in patients receiving BRAFi +/− MEKi therapy and often presents a clinical pattern similar to that observed in RA patients. Its occurrence was associated with longer-lasting tumor control.
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Characterization of Arthralgia induced by PD-1 antibody treatment in patients with metastasized cutaneous malignancies
Cancer Immunology Immunotherapy, 2018Co-Authors: Kristina Buder-bakhaya, Karolina Benesova, Carsten Schulz, Hoda Anwar, Antonia Dimitrakopoulou-strauss, Tim F. Weber, Alexander Enk, Hanns-martin Lorenz, Jessica C. HasselAbstract:Background PD-1 antibodies (PD1ab) are increasingly used in metastatic melanoma and other malignancies. Arthralgia is an underestimated side effect of PD-1 antibody treatment with unknown cause. Our aim was to characterize PD1ab-induced Arthralgia. Patients and methods We retrospectively included patients with metastatic cutaneous malignancies treated with pembrolizumab or nivolumab ± ipilimumab at the National Center for Tumor Diseases (Heidelberg) between 01/2013 and 09/2016. Arthralgia was characterized by laboratory diagnostics, imaging, and if indicated, rheumatologic consultation. Results 26 of 195 patients (13.3%) developed Arthralgia. The median onset of symptoms was 100 days (7–780 days). Most frequently, Arthralgia involved large joints (shoulders, knees) in a predominantly symmetrical pattern. Only two patients were seropositive for rheumatoid factor and/or anti-citrullinated protein antibodies. Ten patients developed the clinical picture of arthritis, with seven of them showing synovitis in MRI or PET/CT. Five patients showed inflammation in joints pre-damaged by osteoarthritis. In 11 patients Arthralgia could not be specified. The majority of patients was satisfactorily treated with non-steroidal anti-inflammatory drugs (NSAIDs), 23.1% required additional low-dose corticosteroids and only 7.6% of our patients received further immunosuppressive treatment. Patients with Arthralgia showed a better treatment response and improved PFS and OS. Conclusion Arthralgia is frequent during PD1ab treatment. The clinical picture varies between synovitis of predominantly large joints, progressive osteoarthritis and Arthralgia without evident joint damage. Vast majority of cases can be satisfactorily managed by NSAID and/or low-dose corticosteroids.
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Characterization of Arthralgia induced by PD-1 antibody treatment in patients with metastasized cutaneous malignancies
Cancer immunology immunotherapy : CII, 2017Co-Authors: Kristina Buder-bakhaya, Karolina Benesova, Carsten Schulz, Hoda Anwar, Antonia Dimitrakopoulou-strauss, Tim F. Weber, Alexander Enk, Hanns-martin Lorenz, Jessica C. HasselAbstract:PD-1 antibodies (PD1ab) are increasingly used in metastatic melanoma and other malignancies. Arthralgia is an underestimated side effect of PD-1 antibody treatment with unknown cause. Our aim was to characterize PD1ab-induced Arthralgia. We retrospectively included patients with metastatic cutaneous malignancies treated with pembrolizumab or nivolumab ± ipilimumab at the National Center for Tumor Diseases (Heidelberg) between 01/2013 and 09/2016. Arthralgia was characterized by laboratory diagnostics, imaging, and if indicated, rheumatologic consultation. 26 of 195 patients (13.3%) developed Arthralgia. The median onset of symptoms was 100 days (7–780 days). Most frequently, Arthralgia involved large joints (shoulders, knees) in a predominantly symmetrical pattern. Only two patients were seropositive for rheumatoid factor and/or anti-citrullinated protein antibodies. Ten patients developed the clinical picture of arthritis, with seven of them showing synovitis in MRI or PET/CT. Five patients showed inflammation in joints pre-damaged by osteoarthritis. In 11 patients Arthralgia could not be specified. The majority of patients was satisfactorily treated with non-steroidal anti-inflammatory drugs (NSAIDs), 23.1% required additional low-dose corticosteroids and only 7.6% of our patients received further immunosuppressive treatment. Patients with Arthralgia showed a better treatment response and improved PFS and OS. Arthralgia is frequent during PD1ab treatment. The clinical picture varies between synovitis of predominantly large joints, progressive osteoarthritis and Arthralgia without evident joint damage. Vast majority of cases can be satisfactorily managed by NSAID and/or low-dose corticosteroids.
Alec H Ritchie - One of the best experts on this subject based on the ideXlab platform.
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bupropion induced serum sickness like reaction
Annals of Pharmacotherapy, 2000Co-Authors: Robert A Mccollom, Dean Elbe, Alec H RitchieAbstract:OBJECTIVE:To report three cases of serum sickness–like reaction (SSLR) associated with bupropion ingestion.CASE SUMMARY:A 27-year-old woman, a 46-year-old man, and a 43-year-old woman presented to our emergency department within a three-week period with symptoms consistent with SSLR. Symptoms consisted of pruritic skin rash, tongue swelling, and Arthralgias. All three patients had initiated bupropion therapy within two to three weeks prior to arrival.DISCUSSION:This is the second published case describing SSLRs associated with bupropion. Reports of urticaria and rash with bupropion use are numerous and the incidence has been estimated at between 1% and 4%. Arthralgia and arthropathy with bupropion use are reported much less commonly. The onset of symptoms of SSLRs typically begins six to 21 days after administration of the causative agent. SSLRs are usually self-limiting, lasting four to 14 days.CONCLUSIONS:SSLRs following bupropion ingestion appear to be rare. However, the fact that this cluster of patie...
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Bupropion-Induced Serum Sickness–Like Reaction
The Annals of pharmacotherapy, 2000Co-Authors: Robert A Mccollom, Dean Elbe, Alec H RitchieAbstract:OBJECTIVE:To report three cases of serum sickness–like reaction (SSLR) associated with bupropion ingestion.CASE SUMMARY:A 27-year-old woman, a 46-year-old man, and a 43-year-old woman presented to our emergency department within a three-week period with symptoms consistent with SSLR. Symptoms consisted of pruritic skin rash, tongue swelling, and Arthralgias. All three patients had initiated bupropion therapy within two to three weeks prior to arrival.DISCUSSION:This is the second published case describing SSLRs associated with bupropion. Reports of urticaria and rash with bupropion use are numerous and the incidence has been estimated at between 1% and 4%. Arthralgia and arthropathy with bupropion use are reported much less commonly. The onset of symptoms of SSLRs typically begins six to 21 days after administration of the causative agent. SSLRs are usually self-limiting, lasting four to 14 days.CONCLUSIONS:SSLRs following bupropion ingestion appear to be rare. However, the fact that this cluster of patie...
Ww Bolten - One of the best experts on this subject based on the ideXlab platform.
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compliance and Arthralgia in clinical therapy the compact trial assessing the incidence of Arthralgia and compliance within the first year of adjuvant anastrozole therapy
Annals of Oncology, 2014Co-Authors: P. Hadji, Ww Bolten, Maria Blettner, H. J. Hindenburg, C. Jackisch, P. Klein, K König, Winfried Rief, R Kreienberg, D WallwienerAbstract:5 Office-based Professional Association Gynecologic Oncologists e.V. in Germany (BNGO e.V.), Berlin; 6 Background: This prospective study evaluated the relationship between Arthralgia and compliance during the first year of adjuvant anastrozole therapy in postmenopausal women with hormone receptor-positive early breast cancer. Patients and methods: COMPliance and Arthralgia in Clinical Therapy (COMPACT) was an open-label, multicenter, noninterventional study conducted in Germany. Patients had started adjuvant anastrozole 3-6 months before the study start. The primary end points were Arthralgia, compliance, and the relationship between compliance and Arthralgia, assessed at specific time points. Results: Overall, 1916 patients received upfront anastrozole. Mean Arthralgia scores were increased from baseline at each visit up to 9 months. Compliance with anastrozole therapy gradually decreased over time from baseline to 9 months (P 95% of patients were compliant versus patient reports of <70%. There was a significant association between Arthralgia mean scores and noncompliance at 6 months (P < 0.0001), 9 months (P < 0.0001), and overall (P< 0.0001). Over time, new events or impairment of existing Arthralgias were reported in 14% (3 months), 11% (6 months), and 9% (9 months) of patients. Conclusion: Arthralgia is important in the clinical management of women with early breast cancer and may contribute to noncompliance and clinical outcomes. ClinicalTrials.gov identifier: NCT00857012.
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COMPliance and Arthralgia in Clinical Therapy: the COMPACT trial, assessing the incidence of Arthralgia, and compliance within the first year of adjuvant anastrozole therapy
Annals of oncology : official journal of the European Society for Medical Oncology, 2013Co-Authors: P. Hadji, Ww Bolten, Maria Blettner, H. J. Hindenburg, C. Jackisch, P. Klein, K König, Winfried Rief, R Kreienberg, D WallwienerAbstract:5 Office-based Professional Association Gynecologic Oncologists e.V. in Germany (BNGO e.V.), Berlin; 6 Background: This prospective study evaluated the relationship between Arthralgia and compliance during the first year of adjuvant anastrozole therapy in postmenopausal women with hormone receptor-positive early breast cancer. Patients and methods: COMPliance and Arthralgia in Clinical Therapy (COMPACT) was an open-label, multicenter, noninterventional study conducted in Germany. Patients had started adjuvant anastrozole 3-6 months before the study start. The primary end points were Arthralgia, compliance, and the relationship between compliance and Arthralgia, assessed at specific time points. Results: Overall, 1916 patients received upfront anastrozole. Mean Arthralgia scores were increased from baseline at each visit up to 9 months. Compliance with anastrozole therapy gradually decreased over time from baseline to 9 months (P 95% of patients were compliant versus patient reports of
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AB1394 Compliance and Arthralgias in clinical therapy (compact): Assessment of the incidence of Arthralgia, therapy costs and compliance within the first year of anastrozole therapy
Annals of the Rheumatic Diseases, 2013Co-Authors: Ww Bolten, Maria Blettner, Nadia Harbeck, H. J. Hindenburg, C. Jackisch, P. Klein, K König, Winfried Rief, Diethelm Wallwiener, S ZaunAbstract:Background Aromatase inhibitors (AI) are well established as adjuvant endocrine treatment for postmenopausal women with hormone receptor-positive (HR+) early breast cancer (EBC). Drug-induced myalgia or Arthralgia is among the most frequently reported adverse drug reactions to AIs. Objectives Little is known about the pathomechanism by which AIs cause muscle and joint injury. The literature on skeletal muscle complaints with AIs is confusing, in part because of a lack of clear definitions. Myalgia/Arthralgia is defined as muscle/joint pain and is likely to affect patients’ quality of life and compliance with AI medication . We designed a prospective trial to collect real world data on the effects of AI-associated myalgia or Arthralgia on patient compliance, patient outcomes as well as treatment costs of myalgia or Arthralgia. Methods COMPACT is an open, prospective, non-interventional study (NCT00857012) assessing the incidence of Arthralgia, therapy costs, and compliance within the first year of adjuvant anastrozole therapy in postmenopausal patients with HR+ EBC. The study is sponsored by AstraZeneca and supported by German health insurance funds. Patients on adjuvant AI anastrozole for 3-6 months were enrolled and stratified by initial adjuvant anastrozole or switch from tamoxifen. All patients receive regular standardized information about breast cancer from baseline to week 20 after study start to support treatment compliance. Data on demographics, Arthralgias, therapy of Arthralgia and quality of life are collected at baseline, 3, 6 and 9 months. Primary endpoints are scaled data on Arthralgia and compliance within the first year of AI therapy. Secondary endpoints include the incidence of Arthralgias, therapy costs, reasons for non-compliance, and influence of Arthralgias on clinical outcome. For a subgroup of patients data on Arthralgia therapy and compliance will be validated with corresponding accounting data of participating health insurance funds. Results From April 2009 to March 2011, 2313 patients were recruited, 2007 receiving upfront anastrozole and 306 patients on switch therapy. Mean age was 64.5 years, mean BMI 27.7. 41.5% of patients had concomitant symptoms relating to skeleton or musculature, and 11.9% stated Arthralgias existing prior to AI-treatment. 13.1% reported a worsening of preexisting Arthralgias or new Arthralgia after starting AI. All patients will be followed for Arthralgia, Arthralgia treatment, and compliance to therapy. Conclusions COMPACT aims to provide valid data on AI-associated Arthralgias, treatment, therapy compliance and treatment costs. This may help to better inform patients and health care providers about these clinically important issues with the aim to improve adherence to AI-treatment, breast cancer outcomes, and therapy costs. Disclosure of Interest W. Bolten Consultant for: AstraZeneca, M. Blettner: None Declared, N. Harbeck Consultant for: member of study steering committee, H.-J. Hindenburg: None Declared, C. Jackisch: None Declared, P. Klein: None Declared, K. Konig: None Declared, W. Rief: None Declared, D. Wallwiener: None Declared, S. Zaun: None Declared, R. Kreienberg: None Declared, P. Hadji Consultant for: AstraZeneca
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Abstract P6-09-08: COMPliance and Arthralgia in Clinical Therapy: The COMPACT trial, assessing the incidence of Arthralgia, therapy costs and compliance within the first year of adjuvant anastrozole therapy
Poster Session Abstracts, 2012Co-Authors: Nadia Harbeck, Ww Bolten, Maria Blettner, H. J. Hindenburg, C. Jackisch, P. Klein, K König, Winfried Rief, R Kreienberg, Diethelm WallwienerAbstract:Background: Aromatase Inhibitors (AI) are well established as adjuvant treatment for postmenopausal (PMP) women with hormone receptor positive (HR+) early breast cancer (EBC). However, phase III clinical trials have reported higher rates of Arthralgia associated with AI than tamoxifen. This study aims to collect real world data on the effects of AI-associated Arthralgia on patient compliance, patient outcomes and on treatment of Arthralgia. Methods: COMPACT is an open, prospective, non-interventional, non-randomized study (NCT00857012) run in Germany. PMP women with HR+ EBC who had been on adjuvant anastrozole (ANA) for 3–6 months were enrolled and stratified by initial adjuvant ANA or switch from tamoxifen. All patients received regular standardized information about breast cancer from baseline to week 20 to support treatment compliance. Data on demographics, Arthralgia, related therapies, other side effects and QoL were collected at baseline, 3, 6 and 9 months. Primary endpoints are scaled data on Arthralgia and compliance within the first year of ANA therapy. Secondary endpoints include incidence of Arthralgia, therapy costs, reasons for non-compliance, and influence of Arthralgia on clinical outcome. Results: Between Apr 2009 and Mar 2011, 2313 patients were enrolled, 2007 on upfront ANA and 306 on switch from tamoxifen. The mean age at baseline was 64.5 years, mean BMI 27.7. Only 17.0% of patients had received HRT prior to their EBC. At baseline, 41.9% reported symptoms relating to skeleton or musculature. 12.0% reported Arthralgia existing prior to ANA treatment and 13.2% stated a worsening of pre-existing Arthralgia or new Arthralgia after starting ANA. Predictors for non-adherence to AI therapy were former non-adherence, general symptom load on the side effect scale GASE, and low benefit expectation at treatment start. Risk of Arthralgia was related to BMI (lowest for patients with BMI ≤24.1 kg/m2, highest with BMI >30.5 kg/m2 at all time points; OR>1) and upfront therapy (switch patients had a reduced risk of 68% at 6 and 61% at 9 months compared to patients with ANA upfront, p = 0.002). Patients with prior chemotherapy had lower rates of Arthralgia before start of ANA (10.4% vs 13.3%, p = 0.036) but higher rates after the start of ANA and before study start (27.0% vs 22.5%, p = 0.013). Patients with Arthralgia showed higher compliance rates at all time points (p Conclusion: COMPACT identified Arthralgia and musculoskeletal symptoms as common complaints in PMP women with EBC. ANA treatment both increased the number of women with such symptoms and aggravated these in some patients. Higher BMI and upfront AI predicted for risk of AI associated Arthralgia. However, COMPACT also showed that AI-associated Arthralgia did not lead to non-compliance in most patients. This data may help to better understand compliance issues with adjuvant AI treatment. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-09-08.
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Compliance and Arthralgias in clinical therapy (COMPACT): Assessment of the incidence of Arthralgia, therapy costs, and compliance in the first year of adjuvant anastrozole.
Journal of Clinical Oncology, 2012Co-Authors: Peyman Hadji, Ww Bolten, Maria Blettner, Nadia Harbeck, H. J. Hindenburg, C. Jackisch, P. Klein, K König, Winfried Rief, Diethelm WallwienerAbstract:e11040^ Background: Aromatase Inhibitors (AI) are well established as adjuvant endocrine treatment for postmenopausal women with HR+ early breast cancer (EBC). However, clinical trial data show higher frequently of Arthralgia with AI than tamoxifen. As Arthralgia may be greatly influencing compliance to adjuvant therapy, we designed a prospective trial to collect real world data on the effects of AI-associated Arthralgia on patient compliance, patient outcomes and treatment costs of Arthralgia. Methods: COMPACT is an open, prospective non-interventional study (NCT00857012) assessing the incidence of Arthralgia, therapy costs, and compliance within the first year of adjuvant anastrozole (ANA) therapy in postmenopausal patients with HR+ EBC. Patients on adjuvant ANA for 3-6 months were enrolled and stratified by initial adjuvant ANA or switch from tamoxifen. All patients receive regular standardized information about breast cancer from baseline to week 20 to support treatment compliance. Data on demographic...
