Last Updated : June 7, 2024
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Key Message
What Is the Issue?
- Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are the most common toxicities secondary to T-cell engager or chimeric antigen receptor (CAR) T-cell therapy.
- The US FDA and Health Canada approved tocilizumab, an anti-interleukin-6 receptor antagonist, for the management of severe or life-threatening cases of CRS.
- Corticosteroids also play an important role in CRS management and are the mainstay of ICANS management.
- Decision-makers are interested in understanding the use of anticytokine drugs (i.e., tocilizumab, anakinra, siltuximab) and/or corticosteroids in the management of CRS and ICANS following T-cell engager or CAR T-cell therapy.
What Did We Do?
- We identified and summarized the literature comparing the clinical effectiveness and safety of anticytokine therapy and/or corticosteroids with alternative care or treatment as usual for treating and preventing of CRS and ICANS. We also searched for evidence-based recommendations for the use of anticytokine therapy and/or corticosteroids to treat and prevent CRS and ICANS.
- A research information specialist conducted a literature search of peer-reviewed and grey literature sources published between January 1, 2019 and February 26, 2024 for CRS; and between January 1, 2019 and March 4, 2024 for ICANS. One reviewer screened citations for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings.
What Did We Find?
- This report presents evidence-based findings on 3 retrospective chart review studies, 2 prospective cohort studies, and 4 consensus guidelines.
- Limited and low-quality clinical evidence from studies with a high risk of bias suggested that early use of tocilizumab or corticosteroids, or prophylactic use of tocilizumab or anakinra may reduce the risk of a high-grade CRS without a negative impact on neurotoxicity or immunotherapy treatment outcomes.
- The included guidelines recommend the use of tocilizumab for treatment of higher-grade CRS, or for treatment of grade 1 CRS if symptoms persist for 3 days or more. Corticosteroids could be added in conjunction if there is no improvement or persistent symptoms after tocilizumab therapy.
- For the management of ICANS in the absence of concurrent CRS, supportive care is the preferred treatment option for grade 1 ICANS, while corticosteroids are recommended for the management of grade 2 to 4 ICANS. In the presence of concurrent CRS, guidelines recommend tocilizumab therapy as per management of CRS, and corticosteroids should be continued until improvement to grade 1.
- We did not identify any clinical evidence regarding the clinical efficacy and safety of anticytokine therapy and/or corticosteroids for treatment of CRS and ICANS compared with alternative treatment or treatment as usual.
- We also did not identify any guidelines for the use of prophylactic anticytokine therapy, corticosteroids, or both for the prevention of CRS and ICANS.
What Does This Mean?
- Despite limited and low-quality evidence, the findings suggest some potential benefits of prophylactic or early use of anticytokine therapy and corticosteroids for the management of immunotherapy-related toxicities. Guidelines offer guidance on the management of CRS, ICANS and other less common toxicities related to immunotherapy based on the available low-quality evidence.
- When using the clinical evidence and recommendations summarized in this report to inform decisions, decision-makers should consider that the evidence is limited and of low quality.
- To improve the certainty of findings, there is a need for more robust prospective clinical trials with larger sample sizes, and lower risk of bias.
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Basket trials are an increasingly common approach to estimating the clinical efficacy of treatments with biomolecular targets. These treatments are typically efficacious in diseases that can affect more than 1 organ system (e.g., a gene mutation that is present in different types of cancer). Bayesian hierarchical models (BHMs) allow for information to be pooled from these basket trials. This paper summarizes the methodological approach to conducting BHMs, and their application to health economic evaluations.
Last Updated : May 31, 2024
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This report is linked to Drug Shortages in Canada — Expert Panel. The 2 key objectives of this Environmental Scan are to identify scoring systems that were developed to evaluate the importance of drugs based on clinical criteria and to identify a single scoring system and adapt it to rank the clinical importance of drugs and inform a drug shortage risk prediction model in Canada.
Last Updated : July 31, 2024
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Given the rapid growth in the prevalence of diabetes during pregnancy and the evolution of recommendations for treatments, contemporary data are needed on the use of antidiabetic drugs during pregnancy in Canada. As one in a series of Sentinel Common Data Model (CDM) demonstration projects, the purpose of this study was to demonstrate the feasibility of replicating the Sentinel CDM-based analysis in Canada, extending the accrual period over a more contemporary time horizon using the most recent Canadian data available transformed into the Sentinel CDM.
Last Updated : April 4, 2025
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Renal cell carcinoma (RCC) is the most common type of kidney cancer and is often diagnosed at a later stage, which makes it difficult to treat. Recent advancements in systemic therapies, such as dual immunotherapy and combinations of immune checkpoint inhibitors with vascular endothelial growth factor (VEGF) inhibitors, have shown promising results. However, real-world data on the use and duration of these treatments is limited.
Last Updated : May 1, 2025
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Congenital cytomegalovirus (cCMV) infection is a leading cause of childhood hearing loss. This brief provides a summary about newborn screening for cCMV in Canada, including whether screening is available for cCMV in each province and territory, and if so, whether screening is universal or targeted, using publicly available information.
Last Updated : May 22, 2024
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Question(s)
- What is the clinical utility of universal NBS versus targeted or no newborn screening for cCMV?
- What is the cost-effectiveness of universal NBS versus targeted or no newborn screening for cCMV?
- What are the evidence-based guidelines regarding NBS for cCMV?
Key Message
What Is the Issue?
- Congenital cytomegalovirus (cCMV) is estimated to affect between 0.2% and 2.4% of newborns worldwide, and may cause long-term effects, including hearing loss and neurodevelopmental disability.
- Newborn screening for cCMV can identify affected neonates and provide an opportunity for early treatment, which may reduce any long-term effects from infection.
- We wanted to know if universal newborn screening is a clinically effective and cost-effective intervention for identifying and managing cCMV.
What Did We Do?
- We identified and summarized published literature comparing the clinical effectiveness and cost-effectiveness of universal newborn screening with either targeted newborn screening or no screening for congenital cytomegalovirus in neonates. We also identified and summarized published, evidence-based guidelines that make recommendations concerning the use of newborn screening for congenital cytomegalovirus to help inform decisions considering the use of this intervention.
- An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2014, and March 19, 2024. The search was limited to English-language documents. One reviewer screened articles for eligibility based on predefined criteria, critically appraised the included studies, and narratively summarized the findings.
What Did We Find?
- Evidence from 1 prospective cohort study in the US found that, compared to universal newborn screening for cCMV, targeted newborn screening failed to identify a significant proportion of neonates who developed hearing loss associated with infection.
- Three cost-effectiveness evaluations concluded that universal newborn screening for cCMV was cost-effective when compared to targeted newborn screening or no screening. None of these analyses were specific to the Canadian context.
- While 1 of 3 evidence-based guidelines identified by this review makes a recommendation favouring universal newborn screening for cCMV, 2 evidence-based guidelines recommend against the implementation of universal newborn screening for cCMV (including 1 from the Canadian context), generally citing a lack of sufficient clinical evidence.
What Does This Mean?
- The included cost-effectiveness studies and evidence-based guidelines in this report emphasize that limited clinical evidence is currently available to inform decision-making concerning newborn screening for cCMV.
Jurisdictions where universal newborn screening for cCMV has been implemented provide an opportunity for clinical research to support and inform future decision-making.
The current limitation of available clinical data describing newborn screening for cCMV will require decision-makers to draw from a broader set of inputs and sources than those available from empirical studies.
Last Updated : May 17, 2024
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Glucagon-like peptide-1 (GLP-1) receptor agonists are used to treat type 2 diabetes. Some of these drugs are also used for weight management. Recently, there have been reports of suicide or self-harm in patients treated with these drugs. This report critically appraised published observational studies evaluating suicidality and self-harm behaviours among patients with type 2 diabetes, and patients with obesity who do not have diabetes, treated with GLP-1 receptor agonists.
Last Updated : May 16, 2024
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Question(s)
The objective of this report is to provide information on the number and cost of MRI and CT exams conducted during the 2021 to 2022 and 2022 to 2023 fiscal years in Canadian privately owned imaging facilities. This report summarizes the results of a survey distributed to private imaging facilities in Canada that offer MRI and/or CT exams.
Key Message
- The private, for-profit imaging landscape is expanding and is anticipated to continue expanding due to changes in some provincial government policies aimed at reducing wait lists.
- The collection of data on private imaging can help to build a complete and comprehensive picture of overall procedural capacity across the country.
- Estimates on the number of publicly funded exams conducted in private facilities can inform the extent to which wait times have been impacted by the shift in some provincial government policies.
- The number of MRI and CT exams conducted at private facilities has increased over the past 4 fiscal years, with the exception of the first year of the COVID-19 pandemic (2020 to 2021).
- Payment through private insurance and out-of-pocket payments were the main funding sources for MRI scans in 2021 to 2023 in the private setting. Provincial health care insurance was the main funding source for CT scans conducted at private facilities.
Last Updated : May 7, 2024