Contact lenses may help diagnose glaucoma, claims study

Glaucoma effects around 70 million people worldwide and can cause irreversible loss of vision if not treated-but around half of those living with the condition are not aware of it.

Usually developing slowly over time, many cases of glaucoma are only picked up during routine eye tests, by which time lasting damage may already have been caused.

But this could change in future as academics from the UK and Türkiye have developed a contact lens which can detect changes in eye pressure which signal possible glaucoma.

Glaucoma occurs when the optic nerve, which connects the eye to the brain, becomes damaged, usually by a build-up of fluid in the front part of the eye which increases pressure inside the eye-known as intra-ocular pressure (IOP).

The new contact lenses contain micro-sensors which monitor changes in IOP over a period of several hours, sending the data collected wirelessly so it can be analysed by an ophthalmologist and a diagnosis given.

The research has been carried out by Professor Hamdi Torun, of Northumbria University; and Professors Günhan Dündar and Arda D. Yalcinkaya, of Boğaziçi University, in Istanbul, and has been published in Contact Lens and Anterior Eye, the official Journal of the British Contact Lens Association.

Their paper, entitled A first-in-human pilot study of a novel electrically-passive metamaterial-inspired resonator-based ocular sensor embedded contact lens monitoring intraocular pressure fluctuations, sets out the findings from their initial pilot study of six participants.

Having determined that the technology works successfully, they now plan to carry out a further study with a larger group of participants, which will take place over the next year. The lenses will then be made commercially available through their spin-off company GlakoLens.

One of the benefits of using the GlakoLens contact lenses to diagnose glaucoma instead of carrying out a traditional examination is that measurements can be taken more easily over a longer period of time, giving a more accurate diagnosis.

As Professor Torun explains: “Intra-ocular pressure, or IOP, can vary greatly over a 24-hour period, so it is important to monitor the patient either at intervals or ideally continuously for a whole day to get the best insight into the health of their eyes.

“Traditional methods for measuring IOP involve initially going to a clinic for a single measurement in a day, the result of which can be misleading due to the natural variation of IOP.

“If a variation is detected, further investigation is then needed which requires hospitalisation for a whole day, during which repeated measurements are taken using a technique called Goldmann applanation tonometry, which involves numbing the eye with drops and then using a small cone to touch the cornea to measure the pressure.

“However, studies have shown that waking patients up at night to carry out measurements can make the results less accurate, in addition to obvious discomfort to the patients and the economic cost to the healthcare system.

“The benefit of the contact lenses we have developed is that once placed in the eye, the patient can then go about their day as normal while their IOP measurements are recorded and sent to a doctor for analysis once the 24-hour period of testing is complete.”

The new system has been tested with six healthy volunteers, during which time they were asked to drink 1.5 litres of water and lie flat to intentionally increase their IOP levels.

While this is not the first time contact lenses have been developed to measure IOP, previous products have used an electrically active silicon chip, which results in a thicker, less comfortable lens. The chip also makes the lens less flexible and can restrict vision, making it more difficult to carry out daily activities.

The GlakoLens contact lenses use an electrically passive sensor embedded in a disposable soft contact lens, and a wearable electronic readout system to collect, store and process the data-making the lens more comfortable and allowing the patient to go about their day as normal.

As well as diagnosing glaucoma, there is also potential for the lenses to be used to detect other health conditions by measuring glucose, lactic acid and other molecules present in eye.

As Professor Torun adds: “We believe this technology has huge potential and could not only save the sight of patients in the early stages of glaucoma but also provide early diagnosis of other diseases in future.”

Reference:

Ozgur Kaya, M. Akif Aydin, Morteza Teymoori, Hamdi Torun, Gunhan Dundar, Arda D. Yalcinkaya, A first-in-human pilot study of a novel electrically-passive metamaterial-inspired resonator-based ocular sensor embedded contact lens monitoring intraocular pressure fluctuations, Contact Lens and Anterior Eye https://doi.org/10.1016/j.clae.2023.102102.

Powered by WPeMatico

Combination therapy lowers blood pressure in patients receiving ibrutinib, reveals study

Combination treatments with two or more blood pressure drugs can significantly reduce blood pressure in patients taking ibrutinib, according to a new study published in Blood Advances.

Targeted drugs such as ibrutinib have improved outcomes for patients with cancers of the lymphatic system, but patients treated with ibrutinib and other drugs in its class often develop new or worsening high blood pressure (or hypertension or HTN). Few studies have examined how best to treat this potentially serious side effect, nor do any formal guidelines exist to steer doctors toward the most effective treatments.

“To our knowledge, this is the first and only study to examine how to optimally treat high blood pressure in patients receiving ibrutinib,” said Mazyar Shadman, MD, MPH, of Fred Hutchinson Cancer Center and the University of Washington School of Medicine, and the study’s senior author. “Our findings strongly suggest that aggressive treatment with certain combinations of antihypertensive medications can achieve significantly reduced blood pressures in this patient population.”

The researchers found that different drug combinations may be more effective depending on whether patients had high blood pressure before starting treatment with ibrutinib or developed high blood pressure while taking the drug.

Ibrutinib, which has been on the market since 2013, was the first drug in its class, known as Bruton tyrosine kinase inhibitors (BTKis), to receive U.S. Food and Drug Administration (FDA) approval to treat patients with mantle cell lymphoma, chronic lymphocytic leukemia, and certain other lymphoid cancers. “Several studies have shown that BTKis can cause patients to develop new or worsening high blood pressure,” said Laura Samples, MD, also of Fred Hutchinson Cancer Center and the University of Washington School of Medicine, and the study’s first author.

“One study found this to be the case in over 78% of patients treated with ibrutinib over a median of 30 months,” Dr. Samples said. “Uncontrolled high blood pressure, or hypertension, can lead to major adverse cardiovascular events, such as heart attack, heart failure, and stroke.”

For this study, Drs. Samples, Shadman, and their colleagues examined the medical records of 196 patients who were concurrently treated with a BTKi and one or more antihypertensive medication for at least three months between 2014 and 2018 at one of 14 medical centers in the United States. Nearly 93% of the study’s participants identified as Caucasian, with an average age of 67 years. Approximately 71% were male, while 29% were female. The patients were separated into two groups: those who were taking at least one antihypertensive medication before starting treatment with a BTKi (the prior-HTN group; 118 patients) and those who began taking one or more antihypertensive medications while being treated with a BTKi (the group that developed new onset high blood pressure after starting treatment; 78 patients).

The researchers categorized antihypertensive medications into four groups: ACE inhibitors and angiotensin receptor blockers (ARBs), beta blockers, calcium channel blockers, and hydrochlorothiazide. The study’s primary outcome was the effectiveness of antihypertensive treatment as assessed by the average reduction in mean arterial pressure (MAP), the average pressure in a patient’s arteries during one heartbeat cycle.

Results showed that patients in the prior-HTN group who took beta blockers along with hydrochlorothiazide achieved statistically significant average reductions in MAP of about five mmHg (unit of measurement for blood pressure). Patients in the de novo HTN group who took ACE inhibitors or ARBs along with hydrochlorothiazide achieved similar reductions in MAP. Approximately 15% of patients in both groups taking beta blockers and hydrochlorothiazide reached what researchers classified as a normal blood pressure range (120/80 or lower).

“Our results reinforce that – in this patient population as in patients with hypertension in general – you need to treat with multiple drugs to achieve successful blood pressure control,” said Dr. Samples.

The study findings do not shed any light on why certain combination regimens were more effective than others or why different combination regimens were most effective in patients with pre-existing and new-onset hypertension, Dr. Shadman added. “But we now have some data that other researchers can analyze to perhaps find answers to these questions,” he said.

A limitation of the study is that it is retrospective – that is, it looked back at patients’ medical records to determine how they were treated and what the outcomes were. “Large prospective studies are needed to develop formal guidelines on the most effective antihypertensive regimens in patients taking BTKis,” Dr. Samples said.

Secondly, patients’ blood pressure was measured only during clinic visits. Studies have shown that blood pressure measurements taken in doctors’ offices or other clinical settings can produce varying results. “Future studies should, if possible, measure patients’ blood pressure using wearable devices that measure blood pressure over a 24-hour period,” Dr. Shadman said.

Finally, nearly 90% of patients in the study were taking ibrutinib. The rest were treated with acalabrutinib or other, newer BTKi’s such as zanubrutinib, which received its initial FDA approval in 2019. Data for the study came from a period when ibrutinib was still more common than its second-generation counterparts. “Studies suggest that patients taking these newer agents still face an increased risk of major adverse cardiovascular events, although the risk may be lower than that of ibrutinib,” Dr. Samples said.

“Given that increased blood pressure is a “class effect” of treatment with BTKis, both doctors and patients need to be aware of this risk and patients’ blood pressure should be monitored regularly so that treatment can begin immediately when an increase is detected,” Dr. Samples said.     

Powered by WPeMatico

qSOFA score may predict prognosis in ICU patients with sepsis across socioeconomic levels: Study

Recent research paper investigates the association between Sequential Organ Failure Assessment (qSOFA) and 28-day mortality in intensive care unit (ICU) patients admitted for sepsis, focusing on different income settings. The study included 4980 patients from 343 ICUs and 22 countries, analyzing the association of qSOFA with early (3-day), medium (28-day), and late (90-day) mortality in low, lower middle, upper middle, and high-income countries/regions. The study found that higher qSOFA was associated with increasing 28-day and 90-day mortality in low and lower middle income countries, and only with early mortality in high-income countries. Multivariate analysis showed that qSOFA remained associated with 28-day mortality even after adjustments for confounders. The study also compared the predictive performance of qSOFA with APACHE II, SIRS, and SOFA, and explored the impact of lactate measurement on qSOFA sepsis mortality prediction. Additionally, the study described the characteristics and outcomes of different clinical sepsis phenotypes in patients meeting Sepsis-3 SOFA, SIRS, and qSOFA criteria. The findings suggest that qSOFA was independently associated with 28-day mortality in ICU patients admitted for sepsis, and its predictive performance varied across different income settings. The study also highlighted the clinical utility and limitations of qSOFA in prognosticating sepsis mortality, providing valuable insights for clinicians and researchers.

Reference –

Li, A., Ling, L., Qin, H. et al. Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings. Crit Care 28, 30 (2024). https://doi.org/10.1186/s13054-024-04804-7.

Powered by WPeMatico

Migraines and persistent vasomotor symptoms jointly associated with greater risk for CVD, stroke: Study

USA: A recent study published in Menopause has revealed a joint association of migraines and persistent vasomotor symptoms (VMS) with a greater risk of stroke and cardiovascular diseases, although the risk attenuates with adjustment for traditional CVD risk factors.

Catherine Kim, Departments of Medicine, Obstetrics and Gynecology, and Epidemiology, University of Michigan, Ann Arbor, MI, and colleagues conducted the study to examine whether vasomotor symptoms and migraine headaches, hypothesized to be vasoactive conditions, are associated with greater risk for cardiovascular disease events including strokes.

For this purpose, the researchers performed a secondary data analysis of a subset of women (n = 1,954) in a population-based cohort, the CARDIA study, which began data collection at 18 to 30 y of age. They examined whether migraine headaches and VMS trajectories (characterized as minimal, increasing, and persistent) at CARDIA year 15 examination were linked with a higher risk of stroke (both ischemic and hemorrhagic) and CVD events using Cox proportional hazards regression models and adjustment for traditional CVD risk factors (cigarette use, age, and levels of systolic and diastolic blood pressure, high- and low-density cholesterol, fasting glucose, and triglycerides) and reproductive factors.

Based on the study, the researchers reported the following findings:

  • Among women with minimal VMS (n = 835), increasing VMS (n = 521), and persistent VMS (n = 598), there were 81 incident CVD events, including 42 strokes.
  • Women with histories of migraine and persistent VMS had a greater risk of CVD (hazard ratio [HR], 2.25) after adjustment for age, race, estrogen use, oophorectomy, and hysterectomy compared with women without migraine histories and with minimal/increasing VMS.
  • After adjustment for CVD risk factors, these associations were attenuated (HR, 1.51).
  • Women with histories of migraine and persistent VMS had a greater risk of stroke (HR, 3.15), but these associations were attenuated after adjustment for CVD risk factors (HR, 1.70).

“Migraines and persistent vasomotor symptoms jointly associate with a greater risk for cardiovascular disease and stroke, although the risk is attenuated with adjustment for traditional CVD risk factors,” the researchers wrote.

Reference:

Kim, Catherine MD, MPH1; Schreiner, Pamela J. PhD2; Yin, Zhe MS3; Whitney, Rachael PhD4; Sidney, Stephen MD, MPH5; Ebong, Imo MD6; Levine, Deborah A. MD, MPH4. Migraines, vasomotor symptoms, and cardiovascular disease in the Coronary Artery Risk Development in Young Adults study. Menopause ():10.1097/GME.0000000000002311, February 13, 2024. | DOI: 10.1097/GME.0000000000002311

Powered by WPeMatico

Intravenous Tirofiban Reduces Neurological Deterioration in Acute Noncardioembolic Stroke: JAMA

Researchers have found that intravenous tirofiban, administered within 24 hours of stroke onset, decreases the risk of early neurological deterioration in patients with acute noncardioembolic stroke compared to oral aspirin. The study’s findings suggest that tirofiban may be an effective alternative to traditional antiplatelet therapy without increasing the risk of symptomatic intracerebral hemorrhage. This study was published in JAMA Neurology. The study was conducted by Wenbo Zhao and colleagues.

Acute ischemic stroke remains a significant health challenge globally, and antiplatelet therapy is a cornerstone of its management. However, patients continue to experience neurological deterioration despite recommended treatment, which can lead to poor clinical outcomes. Investigators aimed to evaluate whether intravenous tirofiban could prevent early neurological deterioration in patients with acute noncardioembolic stroke compared to oral aspirin.

This multicenter, open-label, randomized clinical trial enrolled 425 patients aged 18 to 80 years with acute noncardioembolic stroke within 24 hours of onset. Patients were assigned randomly to receive either intravenous tirofiban (n = 213) or oral aspirin (n = 212) for 72 hours. All patients received oral aspirin afterward. The primary efficacy outcome was early neurological deterioration (increase in National Institutes of Health Stroke Scale [NIHSS] score ≥4 points) within 72 hours after randomization. The primary safety outcome was symptomatic intracerebral hemorrhage within the same timeframe.

The key findings of the study were:

  • Early neurological deterioration occurred in 4.2% of patients in the tirofiban group compared to 13.2% in the aspirin group (adjusted relative risk [RR], 0.32; 95% CI, 0.16-0.65; P = .002).

  • No patients in the tirofiban group experienced symptomatic intracerebral hemorrhage.

  • At 90-day follow-up, mortality rates were similar in both groups (1.3% in the tirofiban group and 1.5% in the aspirin group).

  • Median modified Rankin scale scores at 90 days were comparable between the groups (1.0 for both groups).

The study demonstrates that intravenous tirofiban may provide a significant benefit in reducing early neurological deterioration in patients with acute noncardioembolic stroke. The lack of increased risk for symptomatic intracerebral hemorrhage suggests that tirofiban is a safe option for early stroke intervention.

In patients with noncardioembolic stroke seen within 24 hours of symptom onset, intravenous tirofiban decreases the risk of early neurological deterioration without increasing the risk of symptomatic intracerebral hemorrhage or systematic bleeding. This treatment may offer an alternative to the current antiplatelet regimen for acute ischemic stroke management.

Reference:

Zhao, W., Li, S., Li, C., Wu, C., Wang, J., Xing, L., Wan, Y., Qin, J., Xu, Y., Wang, R., Wen, C., Wang, A., Liu, L., Wang, J., Song, H., Feng, W., Ma, Q., Ji, X., Ding, J., … TREND Investigators. (2024). Effects of tirofiban on neurological deterioration in patients with acute ischemic stroke: A randomized clinical trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2024.0868

Powered by WPeMatico

Finasteride or Minoxidil, what is better for hair regrowth in female pattern hair loss?

Canada: A first-of-its-kind network meta-analysis (NMA) published in the Journal of Cosmetic Dermatology has shed light on the relative effect of monotherapy with 5-alpha reductase inhibitors and minoxidil for female pattern hair loss (PHL). For both agents, the efficacy appeared to be considerably dose-dependent.

“Our findings can improve clinical guidelines and help dermatologists manage female pattern hair loss more optimally with the available options,” Mesbah Talukder, School of Pharmacy, BRAC University, Dhaka, Bangladesh, and colleagues wrote in their study.

Female pattern hair loss is a distressing condition affecting millions of women worldwide. While it shares similarities with male pattern hair loss (MPHL), its underlying mechanisms and treatment responses differ. Among the various therapeutic options, monotherapy with 5-alpha reductase inhibitors (5-ARIs) and minoxidil is widely used, however, evidence on the relative effectiveness of these drugs is far less for women than for men.

To fill this knowledge gap, the researchers performed an age-adjusted NMA to determine the comparative efficacy of monotherapy with the three agents—in any dosage and administrative route—on PHL in adult women.

For this purpose, the researchers systematically reviewed the peer-reviewed literature to obtain data for the NMA. The outcome measure for the NMA was a “change in total hair density.” The regimen was referred to as an “agent and its dosage;” Bayesian NMA estimated regimens’ surface under the cumulative ranking curve (SUCRA) values and pairwise relative effects.

The NMA used data from 13 trials—across which the following ten regimens were identified (in decreasing order of SUCRA): 5 mg/day finasteride for 24 weeks (SUCRA = 95.7%), 5% topical minoxidil solution twice daily for 24 weeks (SUCRA = 89.5%), 1 mg/day minoxidil for 24 weeks (SUCRA = 78.1%), 5% topical minoxidil foam 1 half capful/day for 24 weeks (SUCRA = 66.5%), 3% topical minoxidil solution 1 mL twice daily for 24 weeks (SUCRA = 45.1%), 2% topical minoxidil solution 1 mL twice daily for 24 weeks (SUCRA = 44.6%), 5% topical minoxidil solution 1 mL/day for 24 weeks (SUCRA = 41.7%), 0.25 mg/day minoxidil for 24 weeks (SUCRA = 35.5%), 1.25 mg/day finasteride for 24 weeks (SUCRA = 24.8%) and 1 mg/day finasteride for 24 weeks (SUCRA = 4.3%).

“To our knowledge, this is the first report of an NMA in female androgenetic alopecia (AGA) comparing the relative efficacies of oral minoxidil (1, 0.25 mg/day), oral finasteride (5, 1.25, 1 mg/day), and topical minoxidil (5% and 2% each applied twice daily) in total hair regrowth. The efficacy demonstrated a possible dose-dependent effect for oral finasteride and topical and oral minoxidil,” the researchers concluded.

Reference:

Gupta, A. K., Wang, T., Bamimore, M. A., & Talukder, M. (2023). The relative effect of monotherapy with 5-alpha reductase inhibitors and minoxidil for female pattern hair loss: A network meta-analysis study. Journal of Cosmetic Dermatology, 23(1), 154-160. https://doi.org/10.1111/jocd.15910

Powered by WPeMatico

Oral Antibiotics Effective in Treating Uncomplicated Appendicitis: JAMA

Recent findings from the Appendicitis Acuta II (APPAC II) trial indicated that treating uncomplicated acute appendicitis with just oral antibiotics may not be inferior to a combined regimen of intravenous and oral antibiotics. This study published in the Journal of American Medical Association offers critical look at the potential of antibiotic monotherapy to replace more traditional treatments that involved surgery.

This research was conducted across nine university and central hospitals in Finland and involved a substantial cohort of 599 patients. This secondary analysis evaluate the effectiveness of oral antibiotic monotherapy against a combined approach of intravenous and oral antibiotics in the patients with computed tomography (CT)-confirmed uncomplicated acute appendicitis. The participants included in the trial were between 18 to 60 years and were administered either oral moxifloxacin or a combination of IV ertapenem followed by oral levofloxacin and metronidazole.

Over a three-year follow-up period, the primary measure of success was defined by the resolution of appendicitis symptoms, discharge without the need for surgical intervention and the absence of recurrence. At the year 3 mark, the data revealed a slight difference in treatment success rates of 63.4% for the oral monotherapy group and 65.2% for the individuals who received combined therapy.

The noninferiority margin was not definitively exceeded, as the difference in treatment success rates between the two groups was marginal at -1.8 percentage points. Based on the individual patient scenarios and healthcare provider discretion, this indicates that oral antibiotics alone might still be a potential alternative to more invasive methods, despite being slightly less effective.

The study observed no significant differences in secondary outcomes such as late appendicitis recurrence, treatment-related adverse events, quality of life, hospital stay duration or length of sick leave. These findings suggest that both treatment protocols are similarly safe and tolerable for patients.

The results did not robustly demonstrate the noninferiority of oral antibiotic monotherapy when compared to the combined therapy approach. This calls for further investigations to solidify the role of oral antibiotics in treating uncomplicated appendicitis with the potential benefits of avoiding surgery and its associated risks. These findings imply that the need for surgical interventions in uncomplicated appendicitis cases potentially reduced and shifting the treatment towards a less invasive approach.

Source:

Selänne, L., Haijanen, J., Sippola, S., Hurme, S., Rautio, T., Nordström, P., Rantanen, T., Pinta, T., Ilves, I., Mattila, A., Rintala, J., Marttila, H., Meriläinen, S., Laukkarinen, J., Sävelä, E.-L., Paajanen, H., Grönroos, J., & Salminen, P. (2024). Three-Year Outcomes of Oral Antibiotics vs Intravenous and Oral Antibiotics for Uncomplicated Acute Appendicitis. In JAMA Surgery. American Medical Association (AMA). https://doi.org/10.1001/jamasurg.2023.5947

Powered by WPeMatico

Hormone replacement therapy tied to decreased utilization of sinus surgery in older women with chronic rhinosinusitis: Study

USA: A recent study published in The Laryngoscope has shed light on the effect of hormone replacement therapy (HRT) on chronic rhinosinusitis (CRS) management.

Analyzing data from over 65,000 women aged 55 or older, the study found that those undergoing HRT were significantly less likely to require endoscopic sinus surgery (ESS) for chronic rhinosinusitis treatment versus those not on HRT (OR: 0.28). This effect was particularly pronounced in patients with nasal polyps. However, hormone replacement therapy was associated with higher antibiotic utilization.

Chronic rhinosinusitis is a disease that represents a significant health burden, estimated to affect 1.0–12.1% globally. CRS patients have been found to have worse quality-of-life scores versus those with chronic obstructive pulmonary disease and congestive heart failure. Kevin Hur, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA, and colleagues aimed to investigate whether hormone replacement therapy impacts healthcare resource utilization in the management of chronic rhinosinusitis in older women.

The study included women 55 years or older with a diagnosis of CRS using the TriNetX US health record database and followed for three years. The cohort was stratified into two groups: women who received HRT at the beginning of the study were compared to women who did not receive HRT.

The groups were matched by race, age, history of asthma, ethnicity, and history of nasal polyps. Outcomes included whether the patient underwent endoscopic sinus surgery and the frequency of antibiotic use. Kaplan–Meier analysis, measures of association, and cohort descriptive statistics were calculated.

The researchers reported the following findings:

  • Of the 65,400 women included, the mean age was 66.9 years. 27.0% and 3.6% of patients had a history of asthma or nasal polyps, respectively.
  • 2.0% of CRS patients underwent ESS, with the HRT group less likely to undergo ESS [OR: 0.28] versus patients who did not receive HRT.
  • When stratified by polyp status, HRT patients with nasal polyps had a greater decrease in ESS rates compared to control than HRT patients without nasal polyps.
  • The HRT group had a higher mean number of antibiotic prescriptions compared to the non-HRT group.

In conclusion, postmenopausal CRS patients concurrently receiving hormone replacement therapy are less likely to undergo endoscopic sinus surgery but receive more antibiotic prescriptions.

CRSwNP-HRT patients when stratified by polyp status have a greater decrease in ESS rate versus patients with CRSsNP-HRT.

“There is a need for further research investigating potential immunologic mechanisms behind this effect and how menopause itself may affect disease burden to improve care within this population,” the researchers wrote.

Reference:

Herrera, K., Parikh, M., Vemula, S., & Hur, K. Effect of Hormone Replacement Therapy on Chronic Rhinosinusitis Management. The Laryngoscope. https://doi.org/10.1002/lary.31433

Powered by WPeMatico

Prenatal opioid exposure increase long-term impact on immunity in pediatric population: JAMA

A recent retrospective study published in the Journal of American Medical Association unveiled a concerning association between prenatal opioid exposure (POE) and the alterations in the fetal immune system that potentially affect the long-term health of exposed children. This study encompassing health records of a vast cohort of 401,462 children born between 2003 and 2018 in the Western Australia, sheds light on the impacts of opioid exposure during pregnancy.

During the study period from August 30, 2022 to February 27, 2023, the study investigated the link between POE and subsequent risks of hospitalization and emergency department visits for immune-related conditions. The outcomes indicated that neonates with POE, constituting 0.4% of the cohort, exhibited a higher likelihood of preterm birth, low birth weight, and co-exposure to cigarette smoke.

Perinatal opioid exposure was associated with a 62% increased risk of perinatal infection and an astonishing 11.91 times higher risk of eczema and dermatitis compared to non-exposed neonates. Neonatal abstinence syndrome resulting from opioid withdrawal in newborns was linked to a nearly threefold increase in the risk of both perinatal infection and eczema/dermatitis.

Prenatal opioid exposure was also found to be linked to a 44% increased risk of childhood asthma. But, no significant associations were observed with allergies, anaphylaxis or autoimmune conditions. By differentiating between opioids prescribed for pain and those used to treat opioid use disorder (OUD), the study observed that while POE from pain-related opioids to increase the risk of infection, OUD-related opioids were linked with a higher risk of childhood eczema and dermatitis.

These findings underscore the need for further research into the impact of opioid-induced changes on the immune system during pregnancy. Understanding the mechanisms behind opioid-induced immune dysregulation could be important to develop interventions to reduce the long-term health risks in children exposed to opioids in utero.

Reference:

Kelty, E., Rae, K., Jantzie, L. L., Wyrwoll, C. S., & Preen, D. B. (2024). Prenatal opioid exposure and immune-related conditions in children. JAMA Network Open, 7(1), e2351933. https://doi.org/10.1001/jamanetworkopen.2023.51933

Powered by WPeMatico

Secukinumab may significantly alleviate symptoms of psoriatic arthritis, finds research

Researchers have found that a dose of 300 mg of secukinumab can significantly alleviate symptoms of psoriatic arthritis (PsA) compared to placebo, according to a new study published in Rheumatology and Therapy. The study demonstrates that secukinumab provides better clinical outcomes for patients with PsA. This study was condiucted by Alan J. Kivitz, MD, from the Altoona Center for Clinical Research/Altoona Arthritis and Osteoporosis Center and colleagues.

Psoriatic arthritis is a chronic autoimmune disease linked to reduced quality of life, physical function, and work productivity. Prior research has indicated that secukinumab, a selective inhibitor of interleukin 17A, improves PsA symptoms and has a favorable safety profile. This study aimed to compare the efficacy and safety of secukinumab versus placebo in US patients with challenging-to-treat PsA.

The study pooled data from phase 3 FUTURE 2-5 trials, excluding FUTURE 1 due to its use of an intravenous loading dose not approved by regulatory agencies. A total of 2,147 patients were randomized in the trials, but the current analysis focused on 279 US patients who had harder-to-treat PsA. Participants received secukinumab 300 mg, secukinumab 150 mg with or without a loading dose, or placebo.

The key findings of the study were as follows:

  • Patients on secukinumab 300 mg showed significantly greater ACR20 response rates (59.7%; P < .0001) at week 16 compared to placebo.

  • Secukinumab 150 mg with a loading dose also demonstrated higher response rates (43.4%; P < .0001).

  • Patients receiving secukinumab 300 mg experienced greater improvements in PASI75/90/100 scores, indicating a reduction in psoriasis severity.

  • The safety profile of secukinumab was comparable to placebo, with similar rates of treatment-emergent adverse events across all groups.

  • Patients on all doses of secukinumab showed significant improvement in health-related quality of life and reduced nail disease.

The study found that secukinumab, particularly at a dose of 300 mg, is effective in rapidly improving disease activity and quality of life for patients with PsA. The loading-dose regimen for secukinumab 150 mg also appears to be beneficial. Researchers emphasized the importance of optimal dosing to achieve the best outcomes in PsA treatment. The researchers acknowledged limitations such as not adjusting for logistic regression analyses, nominal P values, and variability in baseline scores. Further studies may be needed to address these limitations.

Reference:

Kivitz AJ, Kremer JM, Legerton CW 3rd, Pricop L, Singhal A. Efficacy and Safety of Secukinumab in US Patients with Psoriatic Arthritis: A Subgroup Analysis of the Phase 3 FUTURE Studies. Rheumatol Ther. Published online April 16, 2024. doi:10.1007/s40744-024-00666-1

Powered by WPeMatico