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Azzam AY, Nassar M, Zomia ASA, Elswedy A, Morsy MM, Mohamed AA, Elamin O, Elsayed OS, Azab MA, Essibayi MA, Wu J, Dmytirw AA, Altschul DJ. Safety and Efficacy of Metformin for Idiopathic Intracranial Hypertension. A U.S-Based Real-World Data Retrospective Multicenter Cohort Study. ASIDE INTERNAL MEDICINE 2024; 1:12-19. [PMID: 39816946 PMCID: PMC11734492 DOI: 10.71079/2024001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2025]
Abstract
Introduction Managing idiopathic intracranial hypertension (IIH) is challenging due to limited treatment options. This study evaluates metformin as a potential therapy for IIH, examining its impact on disease outcomes and safety. Methods We performed a retrospective cohort study using the TriNetX database, covering data from 2009 to August 2024. The study included IIH patients, excluding those with other causes of raised intracranial pressure or pre-existing diabetes. Propensity score matching adjusted for age, sex, race, ethnicity, Hemoglobin A1C, and baseline BMI at metformin initiation. We assessed outcomes up to 24 months. Results Initially, 1,268 patients received metformin and 49,262 served as controls, showing disparities in various parameters. After matching, both groups consisted of 1,267 patients each. Metformin users had significantly lower risks of papilledema, headache, and refractory IIH at all follow-ups (p<0.0001). They also had fewer spinal punctures and reduced acetazolamide use. BMI reductions were more significant in the metformin group from 6 months onward (p<0.0001), with benefits persisting regardless of BMI changes. Metformin's safety profile was comparable to the control group. Conclusions The study indicates metformin's potential as a disease-modifying treatment in IIH, with improvements across multiple outcomes independent of weight loss. This suggests complex mechanisms at play, supporting further research through prospective clinical trials to confirm metformin's role in IIH management and its mechanisms of action.
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Affiliation(s)
- Ahmed Y. Azzam
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mahmoud Nassar
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA
| | | | - Adam Elswedy
- Faculty of Medicine, October 6 University, Giza, Egypt
| | | | | | - Osman Elamin
- Department of Neurosurgery, Jordan Hospital, Amman, Jordan
| | | | - Mohammed A. Azab
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Muhammed Amir Essibayi
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jin Wu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam A. Dmytirw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - David J. Altschul
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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102
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Siddeeque N, Hussein MH, Abdelmaksoud A, Bishop J, Attia AS, Elshazli RM, Fawzy MS, Toraih EA. Neuroprotective effects of GLP-1 receptor agonists in neurodegenerative Disorders: A Large-Scale Propensity-Matched cohort study. Int Immunopharmacol 2024; 143:113537. [PMID: 39486172 DOI: 10.1016/j.intimp.2024.113537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 10/27/2024] [Accepted: 10/28/2024] [Indexed: 11/04/2024]
Abstract
BACKGROUND GLP-1 receptor agonists, traditionally used for treating type 2 diabetes mellitus and obesity, have demonstrated anti-inflammatory properties. However, their potential neuroprotective effects in neurodegenerative disorders remain unclear. OBJECTIVE To evaluate the impact of GLP-1 receptor agonists on the risk of developing various neurodegenerative conditions in obese patients. METHODS This comprehensive retrospective cohort study analyzed data from 5,307,845 obese adult patients across 73 healthcare organizations in 17 countries. Propensity score matching was performed, resulting in 102,935 patients in each cohort. We compared the risk of developing neurodegenerative disorders between obese patients receiving GLP-1 receptor agonist therapy and those who were not. RESULTS Obese patients treated with GLP-1 receptor agonists showed significantly lower risks of developing Alzheimer's disease (RR = 0.627, 95 %CI = 0.481-0.817), Lewy body dementia (RR = 0.590, 95 %CI = 0.462-0.753), and vascular dementia (RR = 0.438, 95 %CI = 0.327-0.588). The risk reduction for Parkinson's disease was not statistically significant overall (RR = 0.784, 95 %CI = 0.580-1.058) but was significant for semaglutide users (RR = 0.574, 95 %CI = 0.369-0.893). Semaglutide consistently showed the most pronounced protective effects across all disorders. Additionally, a significant reduction in all-cause mortality was observed (HR = 0.525, 95 %CI = 0.493-0.558). CONCLUSION This study provides evidence that the effects of GLP-1 receptor agonists may extend beyond their known metabolic and cardioprotective benefits to include neuroprotection, associated with a decreased risk of developing various neurodegenerative disorders. These findings suggest the potential for expanding the therapeutic applications of GLP-1 receptor agonists to improve neurocognitive outcomes. Further research is warranted to elucidate the mechanisms underlying these neuroprotective effects and to explore their clinical applications in neurodegenerative disease prevention and treatment.
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Affiliation(s)
| | | | - Ahmed Abdelmaksoud
- Department of Internal Medicine, University of California, Riverside, CA 92521, USA
| | - Julia Bishop
- Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Abdallah S Attia
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Rami M Elshazli
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA; Biochemistry and Molecular Genetic Unit, Department of Basic Sciences, Faculty of Physical Therapy, Horus University - Egypt, New Damietta 34517, Egypt; Department of Biological Sciences, Faculty of Science, New Mansoura University, New Mansoura City 35742, Egypt
| | - Manal S Fawzy
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar 91431, Saudi Arabia; Center for Health Research, Northern Border University, Arar 1321, Saudi Arabia
| | - Eman A Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA; Medical Genetics Unit, Department of Histology and Cell Biology, Suez Canal University, Ismailia 41522, Egypt.
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103
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Rezaeianzadeh R, Sadatsafavi M. Beyond glycaemic control: reduced pneumonia and sepsis risk with GLP-1 RAs and SGLT2 inhibitors in patients with type 2 diabetes. Thorax 2024; 80:5-6. [PMID: 39645258 DOI: 10.1136/thorax-2024-222540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2024] [Indexed: 12/09/2024]
Affiliation(s)
- Ramin Rezaeianzadeh
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
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Henney AE, Riley DR, Hydes TJ, Anson M, Ibarburu GH, Frost F, Alam U, Cuthbertson DJ. Comparative estimate of glucose-lowering therapies on risk of incident pneumonia and severe sepsis: an analysis of real-world cohort data. Thorax 2024; 80:32-41. [PMID: 39645259 PMCID: PMC11671942 DOI: 10.1136/thorax-2024-221906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 10/03/2024] [Indexed: 12/09/2024]
Abstract
BACKGROUND Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are treatments for type 2 diabetes (T2D). Beyond glucose-lowering and cardiorenal protection, these drugs may protect against pneumonia and sepsis. AIMS This study assesses the impact of SGLT2i and GLP-1 RAs on the risk of incident pneumonia and severe sepsis. METHODS A retrospective cohort study was conducted using anonymised electronic medical records from TriNetX, a global federated database. Two intention-to-treat analyses were performed, each with two cohorts of adult T2D patients. The first analysis compared individuals prescribed SGLT2i, and the second individuals prescribed GLP-1 RAs, with those prescribed dipeptidyl peptidase-4 inhibitors (DPP-4i). An active comparator new user design was used, with outcomes defined as time-to-incident pneumonia and severe sepsis. Propensity score matching (1:1) was applied to control for potential confounders, and patients were followed for 12 months. Secondary analyses compared SGLT2i and GLP-1 RAs against other glucose-lowering therapies. RESULTS After propensity score matching, 352 687 patients were included in the SGLT2i versus DPP-4i comparison. SGLT2i treatment was associated with a risk reduction in incident pneumonia (HR 0.75 (95% CI 0.73, 0.78)) and severe sepsis (0.75 (0.73, 0.77)). In the GLP-1 RA versus DPP-4i comparison, 331 863 patients were included. GLP-1 RA treatment was associated with a risk reduction in incident pneumonia (0.60 (0.58, 0.62)) and severe sepsis (0.61 (0.59, 0.63)). CONCLUSION SGLT2i and GLP-1 RAs are associated with a reduced risk of incident pneumonia and severe sepsis in patients with T2D. Further research and focused randomised controlled trials are warranted to explore the broader clinical implications of these treatments.
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Affiliation(s)
- Alex E Henney
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - David R Riley
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Theresa J Hydes
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Anson
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Frederick Frost
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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105
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Biondi BE, Munroe S, Lavarin C, Curtis MR, Buzzee B, Lodi S, Epstein RL. Racial and Ethnic Disparities in Hepatitis C Care in Reproductive-Aged Women With Opioid Use Disorder. Clin Infect Dis 2024; 79:1428-1436. [PMID: 39356149 PMCID: PMC11650893 DOI: 10.1093/cid/ciae426] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND In the United States, hepatitis C virus (HCV) diagnoses among reproductive-aged women are increasing amidst the ongoing opioid and drug overdose epidemic. While previous studies document racial and ethnic disparities in HCV testing and treatment in largely male populations, to our knowledge no national studies analyze these outcomes in reproductive-aged women with opioid use disorder (OUD). METHODS We analyzed data from a cohort of reproductive-aged women (aged 15-44 years) with diagnosed OUD captured in the TriNetX Research Network, a network of electronic health records from across the United States. Using a log-binomial model, we assessed differences in achieving HCV cascade of care stages (HCV antibody testing, HCV infection [positive HCV RNA test result], linkage to care, and HCV treatment) by race and ethnicity. RESULTS From 2014 to 2022, 44.6% of the cohort were tested for HCV antibody. Asian and black/African American individuals had a lower probability of having an HCV antibody test than white individuals (risk ratio, 0.77 [95% confidence interval, .62-.96] and 0.76 [.63-.92], respectively). Among those with HCV infection, only 9.1% were treated with direct-acting antivirals. Hispanic/Latinx individuals had a higher probability of treatment than non-Hispanic/Latinx individuals (risk ratio, 1.63 [95% confidence interval, 1.01-2.61]). CONCLUSIONS Few reproductive-aged women with OUD are tested or treated for HCV. Disparities by race and ethnicity in HCV testing further exacerbate the risk of perinatal transmission and disease progression among minoritized communities. Interventions are needed to improve overall rates of and equity in HCV screening and treatment for reproductive-aged women.
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Affiliation(s)
- Breanne E Biondi
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sarah Munroe
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Claudine Lavarin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Megan R Curtis
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin Buzzee
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Rachel L Epstein
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
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Desai A, Farraye FA, Caldera F. Letter: Enhancing the Rigor of Research on Herpes Zoster Risk in IBD Patients Post-SARS-CoV2: Recommendations for Global and Detailed Analyses-Authors' Reply. Inflamm Bowel Dis 2024; 30:2528. [PMID: 39361968 DOI: 10.1093/ibd/izae223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Affiliation(s)
- Aakash Desai
- Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
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Glickman D, Dalessio S, Raup-Konsavage WM, Vrana KE, Coates MD. Response to the Letter to the Editor, "Refining the Understanding of Cannabis Impact on Inflammatory Bowel Disease Outcomes: Recommendations for Enhanced Research and Healthcare Practices". Inflamm Bowel Dis 2024; 30:2531-2532. [PMID: 39361966 PMCID: PMC11630245 DOI: 10.1093/ibd/izae228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Affiliation(s)
| | - Shannon Dalessio
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | | | - Kent E Vrana
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Matthew D Coates
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
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Alsoudi AF, Wai KM, Koo E, McConnell RA, Pham NH, Do BK, Ludwig CA, Kossler AL, Mruthyunjaya P, Rahimy E. Risk of Intestinal Complications, Extraintestinal Morbidity, and Mortality in Patients with Crohn's Disease and Ocular Involvement. Ocul Immunol Inflamm 2024; 32:2486-2493. [PMID: 39401331 DOI: 10.1080/09273948.2024.2413895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 09/29/2024] [Accepted: 10/01/2024] [Indexed: 10/23/2024]
Abstract
PURPOSE Patients with Crohn's disease (CD) and subsequent ocular manifestations may have worse outcomes when compared to matched patients with CD without ocular disease. METHODS In this retrospective cohort study, an aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with CD stratified by the presence or absence of ocular involvement with at least 1 year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities. RESULTS Patients with CD with ocular disease showed a greater risk of undergoing bowel resections (RR: 2.06, 95% CI: 1.48-2.85, p < 0.001), developing other CD-related gastrointestinal complications (RR: 1.31, CI: 1.15-1.49, p < 0.001), or acquiring Clostridioides difficile infections (RR: 2.19, CI: 1.89-2.54, p < 0.001). Further, patients with CD with ocular sequelae had a greater risk of developing NASH (RR: 1.43, CI: 1.31-1.56, p < 0.001), CD-related nutrient deficiencies (RR: 1.38, CI: 1.29-1.49, p < 0.001), iron deficiency anemia (RR: 1.41, CI: 1.33-1.50, p < 0.001), CD-related dermatological disease (RR: 1.84, CI: 1.65-2.05, p < 0.001), osteoporosis (RR: 1.49, CI: 1.37-1.64, p < 0.001) and primary sclerosing cholangitis (RR: 1.63, CI: 1.11-2.38, p = 0.011). Among patients with CD with ocular involvement, there was an elevated risk of MI (RR: 1.36, CI: 1.14-1.63, p < 0.001), stroke (RR: 1.42, CI: 1.18-1.70, p < 0.001), VTE (RR: 1.37, CI: 1.22-1.54, p < 0.001), and sepsis (RR: 1.53, CI: 1.37-1.71, p < 0.001). CONCLUSIONS Patients who have CD and subsequent ocular involvement have an increased risk of local intestinal complications, extraintestinal morbidity, and cardiovascular complications when compared to patients with CD without ocular involvement.
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Affiliation(s)
- Amer F Alsoudi
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Karen M Wai
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Euna Koo
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ryan A McConnell
- Department of Gastroenterology, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Nathan H Pham
- Department of Gastroenterology, University of Washington Seattle, Seattle, Washington, USA
| | - Brian K Do
- Department of Ophthalmology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- The Retina Group of Washington, Chevy Chase, Maryland, USA
| | - Cassie A Ludwig
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andrea L Kossler
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Prithvi Mruthyunjaya
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ehsan Rahimy
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, California, USA
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Lin BY, Lessard C, Li Y, Gong L, Ling R, Jyotsana P, Steinle J, Borodovsky JT, Nascimento FA, Xu KY. Cannabidiol prescribing in the United States: An analysis of real-world data. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 13:100303. [PMID: 39679130 PMCID: PMC11638645 DOI: 10.1016/j.dadr.2024.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 11/18/2024] [Accepted: 11/19/2024] [Indexed: 12/17/2024]
Abstract
Background Off-label prescribing of Epidiolex® (pharmaceutical cannabidiol) comes with both potential benefits and risks for patients. The aims of this study were to: (1) identify the percentage of people prescribed Epidiolex® who do not have diagnostic indications for Epidiolex® (Lennox Gastaut Syndrome [LGS], Dravet Syndrome [DS], and Tuberous Sclerosis Complex [TSC]) and (2) examine potential co-prescribing of medications that may interact with Epidiolex®. Method Using TriNetX analytics, a web-based database of de-identified electronic health records spanning >110 million people in the United States, we analyzed 4214 people receiving Epidiolex® in 2022. We computed the number of people prescribed Epidiolex® who did not have diagnoses for LGS, DS, or TSC. We evaluated the prevalence of co-occurring prescriptions that are known to interact with cannabidiol following each individual's first Epidiolex® prescription. Results Among individuals receiving Epidiolex®, 40 % did not have FDA-approved diagnostic indications (LGS/DS/TSC) in the medical record. In the overall sample, co-occurring psychotropic prescribing was prevalent, including medications with known interactions with cannabidiol (Clobazam=47.2 %; Diazepam=47.4 %; Clonazepam=40.7 %). Among individuals without LGS/DS/TSC who received Epidiolex®, the most common diagnoses received following the index prescription were unspecified epileptic syndromes (53.8 %), sleep disorders (25.7 %), anxiety disorders (25.9 %), mood disorders (18.6 %) and autism spectrum disorders (10.8 %). Conclusion Off-label prescribing and co-prescription of medications with known interactions with cannabidiol is prevalent. Further research is needed to elucidate longitudinal outcomes associated with off-label Epidiolex® prescribing.
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Affiliation(s)
- Binx Yezhe Lin
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
- Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Chloe Lessard
- Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Yifan Li
- Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Lisa Gong
- Division of Addiction Science, Prevention & Treatment, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Ruth Ling
- Division of Addiction Science, Prevention & Treatment, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Pallawi Jyotsana
- Department of Psychiatry, SIU School of Medicine, Springfield, IL, United States
| | - Jacob Steinle
- Division of Addiction Science, Prevention & Treatment, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Jacob T. Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, NH, United States
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, NH, United States
| | - Fábio A. Nascimento
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Kevin Y. Xu
- Division of Addiction Science, Prevention & Treatment, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Center for the Study of Race, Ethnicity & Equity and Institute for Public Health, Washington University School of Medicine, St. Louis, MO, United States
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Contreras GA, Golovko G. Prevalence of Trypanosoma cruzi Infection in Solid Organ Transplant Recipients: A Neglected Disease in America. Open Forum Infect Dis 2024; 11:ofae650. [PMID: 39605974 PMCID: PMC11600953 DOI: 10.1093/ofid/ofae650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 11/06/2024] [Indexed: 11/29/2024] Open
Abstract
This study investigates the prevalence of Trypanosoma cruzi infection among solid organ transplant recipients in the United States from 2019 to 2023 before transplantation. Utilizing data from a large multicenter network, we identified a rising seroprevalence of 4.8% from 1523 solid organ transplant recipients at the time of the evaluation for transplantation, particularly among lung and heart transplant recipients. The findings highlight the need for improved screening protocols to address this neglected tropical disease in transplant populations.
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Affiliation(s)
- German A Contreras
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - George Golovko
- Department of Pharmacology & Toxicology, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Imbroane MR, Akesson C, Kim H, Richards EG. Marfan syndrome is associated with increased risk for gynecologic disorders and maternal complications. J Assist Reprod Genet 2024; 41:3371-3377. [PMID: 39470919 PMCID: PMC11706806 DOI: 10.1007/s10815-024-03297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 10/14/2024] [Indexed: 11/01/2024] Open
Abstract
PURPOSE To determine whether patients with Marfan syndrome are at an increased risk for reproductive disorders. METHODS This retrospective cohort study was conducted using the US collaborative network on the TriNetX research network of health care organizations. We included female patients aged 18-44 and identified a cohort of 4347 patients with Marfan syndrome (ICD-10 Q87.4). Our control cohort consisted of 16,424,990 patients without a diagnosis of Marfan syndrome or Ehlers-Danlos syndrome (ICD-10 Q79.6). The primary outcomes included gynecologic diagnoses such as dysmenorrhea and endometriosis, and our secondary outcomes included urogynecologic, fertility, and obstetric outcomes, all identified by ICD-10 codes. We conducted a relative risk analysis with a p-value of <0.05 considered significant. RESULTS Patients with Marfan syndrome were at an increased risk for pelvic and perineal pain, dysmenorrhea, abnormal uterine bleeding, endometriosis (all p <0.0001), dyspareunia (p =0.0009), leiomyoma (p =0.0076), polyp of female genital tract (p =0.016), urinary incontinence (p <0.0001), female genital prolapse (p =0.0006), fertility testing (p =0.0075), cesarean delivery (p =0.0003), gestational hypertension (p =0.0012), and pre-eclampsia (p =0.0024) compared to the control group following an adjusted, matched comparison. CONCLUSIONS Patients with Marfan syndrome have an increased risk of numerous reproductive disorders and obstetric complications compared to patients without this diagnosis.
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Affiliation(s)
- Marisa R Imbroane
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Cydni Akesson
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Hanna Kim
- Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Cleveland, OH, USA
| | - Elliott G Richards
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
- Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Cleveland, OH, USA.
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Alobaida M, Harrison SL, Lane DA, Rowe F, Austin P, Abdul‐Rahim AH, Lip GYH. Impact of bridging thrombolysis versus endovascular thrombectomy alone on outcomes in anticoagulated patients with atrial fibrillation and acute ischaemic stroke. Eur J Neurol 2024; 31:e16453. [PMID: 39177017 PMCID: PMC11554861 DOI: 10.1111/ene.16453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND AND PURPOSE The impact of bridging thrombolysis prior to endovascular thrombectomy (EVT) compared to EVT alone on intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), and death in anticoagulated atrial fibrillation (AF) patients with acute ischaemic stroke (AIS) is not well defined. METHODS A retrospective study was conducted using data from a federated research network (TriNetX) including 114 health care organisations in the United States. Anticoagulated AF patients with AIS who received either bridging thrombolysis (BT) or EVT alone from September 2018 to November 2023 were included. Following propensity score matching, Cox regression analyses examined the risk of ICH, SAH, and death within 30 and 90 days, comparing anticoagulated AF patients receiving BT versus EVT only. RESULTS A total of 3156 patients with AIS were treated with BT or EVT alone. Following 1:1 propensity score matching, the cohort included 766 patients in each group. ICH occurred within 30 and 90 days in 6.9% and 8.0% in the BT group compared with 7.4% and 7.7% in the EVT-only group (hazard ratios [HR] = 0.92, 95% confidence interval [CI] = 0.63-1.33 and HR = 1.01, 95% CI = 0.71-1.45, respectively). SAH occurred within 30 and 90 days in 4.2% and 4.4% of patients in the BT compared to 3.0% and 3.4% in the EVT-only group (HR = 1.38, 95% CI = 0.81-2.38 and HR = 1.29, 95% CI = 0.77-2.14, respectively). Death occurred within 30 and 90 days in 17.8% and 19.8% of patients in the BT compared to 22.2% and 27.3% in the EVT-only group (HR = 0.77, 95% CI = 0.62-0.97 and HR = 0.65, 95% CI = 0.56-0.86, respectively). CONCLUSIONS In anticoagulated AF patients with AIS, BT was associated with a significantly lower risk of death, with no difference in ICH or SAH risk within 30 and 90 days compared to EVT only.
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Affiliation(s)
- Muath Alobaida
- Liverpool Centre for Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical SciencesUniversity of LiverpoolLiverpoolUK
- Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical ServicesKing Saud UniversityRiyadhSaudi Arabia
| | - Stephanie L. Harrison
- Liverpool Centre for Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical SciencesUniversity of LiverpoolLiverpoolUK
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideAustralia
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical SciencesUniversity of LiverpoolLiverpoolUK
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Fiona Rowe
- Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | | | - Azmil H. Abdul‐Rahim
- Liverpool Centre for Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical SciencesUniversity of LiverpoolLiverpoolUK
- Stroke Division, Department of Medicine for Older People, Whiston HospitalMersey and West Lancashire Teaching Hospitals NHS TrustRainhillUK
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical SciencesUniversity of LiverpoolLiverpoolUK
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
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France-Ratcliffe M, Harrison SL, Verma LA, Abdul-Rahim AH, McCallum L, Young CA, McDowell G, Buckley BJ. Vitamin D and cardiovascular outcomes in multiple sclerosis. Mult Scler Relat Disord 2024; 92:106155. [PMID: 39522463 DOI: 10.1016/j.msard.2024.106155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 11/02/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Vitamin D (25(OH)D) deficiency is linked to increased cardiovascular disease (CVD) risk in the general population, but its implications for people with multiple sclerosis (pwMS) remain unexplored. This study aimed to evaluate the association of 25(OH)D with long-term CVD outcomes in pwMS and the impact of vitamin D supplementation. METHODS This observational cohort study analysed anonymised medical records from 70 healthcare organisations following pwMS for 5-years (2019-2024). PwMS and deficient or inadequate 25(OH)D levels were 1:1 propensity-score matched with pwMS and adequate 25(OH)D levels, for demographics, comorbidities, and cardiovascular care. Cox proportional hazard models analysed the incidence of all-cause mortality, stroke, acute myocardial infarction, heart failure, angina, atrial fibrillation/flutter, and a composite measure of major adverse cardiovascular events (MACE). Propensity-matched pwMS who had deficient or inadequate 25(OH)D levels taking cholecalciferol were compared to pwMS and adequate 25(OH)D levels (not taking supplementation). RESULTS Amongst 74,372 pwMS, 9 % had deficient 25(OH)D levels, 18 % inadequate, and 73 % adequate. Deficient, or inadequate 25(OH)D levels were associated with an increased rate of MACE (HR, 1.32 [95 % CI: 1.19, 1.46], HR, 1.29 [95 % CI: 1.20, 1.40], respectively) compared to those with adequate levels. Cholecalciferol supplementation in pwMS and deficient or inadequate 25(OH)D levels did not alleviate the higher CVD rate (HR, 1.39 [95 % CI: 1.21,1.60], HR, 1.31 [95 % CI: 1.17, 1.47], respectively) in comparison to those with adequate 25(OH)D levels taking no vitamin D supplementation. CONCLUSIONS Deficient or inadequate 25(OH)D levels in pwMS were associated with an increased rate of MACE, which may not be mitigated by vitamin D supplementation.
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Affiliation(s)
- Madeleine France-Ratcliffe
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom.
| | - Stephanie L Harrison
- Registry of Senior Australians, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Leona A Verma
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Liverpool John Moores University, School of Pharmacy and Biomolecular Sciences, Liverpool, L3 3AF, United Kingdom; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Azmil H Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Stroke Division, Department of Medicine for Older People, Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
| | - Linsay McCallum
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Carolyn A Young
- Molecular and Integrative Biology, Institute of Systems, University of Liverpool, Liverpool, United Kingdom; Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Garry McDowell
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Liverpool John Moores University, School of Pharmacy and Biomolecular Sciences, Liverpool, L3 3AF, United Kingdom
| | - Benjamin Jr Buckley
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
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Gallagher TJ, Chung RS, Lin ME, Kim I, Kokot NC. Cannabis Use and Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:1068-1075. [PMID: 39115834 PMCID: PMC11310842 DOI: 10.1001/jamaoto.2024.2419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/17/2024] [Indexed: 08/11/2024]
Abstract
Importance Cannabis is the most commonly used illicit substance worldwide. Whether cannabis use is associated with head and neck cancer (HNC) is unclear. Objective To assess the clinical association between cannabis use and HNC. Design, Setting, and Participants This large multicenter cohort study used clinical records from a database that included 20 years of data (through April 2024) from 64 health care organizations. A database was searched for medical records for US adults with and without cannabis-related disorder who had recorded outpatient hospital clinic visits and no prior history of HNC. Propensity score matching was performed for demographic characteristics, alcohol-related disorders, and tobacco use. Subsequently, relative risks (RRs) were calculated to explore risk of HNC, including HNC subsites. This analysis was repeated among those younger than 60 years and 60 years or older. Exposure Cannabis-related disorder. Main Outcomes and Measures Diagnosis of HNC and any HNC subsite. Results The cannabis-related disorder cohort included 116 076 individuals (51 646 women [44.5%]) with a mean (SD) age of 46.4 (16.8) years. The non-cannabis-related disorder cohort included 3 985 286 individuals (2 173 684 women [54.5%]) with a mean (SD) age of 60.8 (20.6) years. The rate of new HNC diagnosis in all sites was higher in the cannabis-related disorder cohort. After matching (n = 115 865 per group), patients with cannabis-related disorder had a higher risk of any HNC (RR, 3.49; 95% CI, 2.78-4.39) than those without HNC. A site-specific analysis yielded that those with cannabis-related disorder had a higher risk of oral (RR, 2.51; 95% CI, 1.81-3.47), oropharyngeal (RR, 4.90; 95% CI, 2.99-8.02), and laryngeal (RR, 8.39; 95% CI, 4.72-14.90) cancer. Results were consistent when stratifying by older and younger age group. Conclusions and Relevance This cohort study highlights an association between cannabis-related disorder and the development of HNC in adult patients. Given the limitations of the database, future research should examine the mechanism of this association and analyze dose response with strong controls to further support evidence of cannabis use as a risk factor for HNCs.
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Affiliation(s)
- Tyler J. Gallagher
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Ryan S. Chung
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Matthew E. Lin
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Ian Kim
- Department of Pediatrics and Department of Disease Prevention, Stanford University, Palo Alto, California
| | - Niels C. Kokot
- Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles
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Bleecker E, Blaiss M, Jacob-Nara J, Huynh L, Duh MS, Guo T, Ye M, Stanford RH, Wang Z, Soler X, Nag A, Nair R, Borsos K. Comparative effectiveness of dupilumab and omalizumab on asthma exacerbations and systemic corticosteroid prescriptions: Real-world US ADVANTAGE study. J Allergy Clin Immunol 2024; 154:1500-1510. [PMID: 39186985 DOI: 10.1016/j.jaci.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND In the United States, dupilumab is approved for moderate-to-severe eosinophilic or oral corticosteroid-dependent asthma, and omalizumab is approved for managing moderate-to-severe allergic asthma uncontrolled by inhaled corticosteroids. However, limited comparative effectiveness data exist for these biologics due to differing patient characteristics and treatment histories. OBJECTIVE This study assessed the real-world effectiveness of dupilumab and omalizumab for asthma in patients in the United States. METHODS In this retrospective observational study, TriNetX Dataworks electronic medical record data were used to identify patients with asthma age ≥12 years who initiated (index) dupilumab or omalizumab between November 2018 and September 2020 and who had at least 12 months of pre- and post-index clinical information. Inverse probability of treatment weighting was applied to balance potential confounding in treatment groups. Asthma exacerbation rates and systemic corticosteroid (SCS) prescriptions were compared using a doubly robust negative binomial regression model, adjusting for baseline exacerbation/SCS rates and patient characteristics with ≥10% standardized differences after inverse probability of treatment weighting. RESULTS All inclusion and exclusion criteria were met by 2138 dupilumab patients and 1313 omalizumab patients. After weighting, the majority of baseline characteristics were balanced (standard difference <10%) between the 2 groups. Dupilumab was associated with a 44% lower asthma exacerbation rate (P < .0001) versus omalizumab. Additionally, dupilumab treatment significantly (P < .05) reduced SCS prescriptions by 28% during the follow-up period compared with omalizumab treatment. CONCLUSIONS The US ADVANTAGE real-world study demonstrated a significant reduction in severe asthma exacerbations and SCS prescriptions for patients prescribed dupilumab compared with patients prescribed omalizumab during 12 months of follow-up.
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Affiliation(s)
| | - Michael Blaiss
- Medical College of Georgia at Augusta University, Augusta, Ga
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Patel N, Shetty NS, Pampana A, Gaonkar M, Vekariya N, Li P, Owens AT, Semsarian C, Arora G, Arora P. Sex-Associated Differences in Clinical Outcomes After Septal Reduction Therapies in Hypertrophic Cardiomyopathy. Mayo Clin Proc 2024; 99:1933-1944. [PMID: 39530964 PMCID: PMC11727816 DOI: 10.1016/j.mayocp.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/10/2024] [Accepted: 05/21/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVE To evaluate sex-associated differences in the short- and long-term outcomes of patients with hypertrophic cardiomyopathy (HCM) undergoing septal myectomy and alcohol septal ablation. METHODS This retrospective cohort study used electronic health record data from the TriNetX research database. International Classification of Diseases, Ninth Revision and Tenth Revision diagnosis and procedure codes were used to identify patients with HCM who underwent septal myectomy and alcohol septal ablation in the United States between January 2002 and March 2023. The outcomes were long-term mortality and postprocedural complications (<30 days), including death, stroke, major bleeding, and renal failure. Multivariable adjusted Cox models were used to assess the association of outcomes by sex, taking female patients as reference. RESULTS Of 11,680 adults (32.0% female; median age, 63 [interquartile range, 54 to 71] years), 1916 (16.4%) and 9764 (83.6%) underwent septal myectomy and alcohol septal ablation, respectively. For those who underwent septal myectomy, sex was not associated with short-term (adjusted hazard ratio [HRadj], 1.57 [0.64 to 3.87]) and long-term (HRadj, 1.05 [0.87 to 1.26]) mortality. Male patients had a higher risk of acute renal failure compared with female patients after septal myectomy (HRadj, 1.69 [1.33 to 2.15]). Of those who underwent alcohol septal ablation, male patients (HRadj, 1.07 [0.99 to 1.16]) had a similar risk of long-term mortality to that of female patients. Compared with female patients, the risk of acute renal failure was higher in male patients (HRadj, 1.23 [1.02 to 1.48]) after alcohol septal ablation. CONCLUSION This nationwide study found that the risk of short- and long-term mortality was similar for male and female patients undergoing septal myectomy and alcohol septal ablation for HCM. The sex-based differences in the clinical presentation should not prevent consideration of septal reduction therapies.
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Affiliation(s)
- Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Naman S Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Akhil Pampana
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Mokshad Gaonkar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Nehal Vekariya
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Anjali T Owens
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL.
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Koi AN, Johnson JC, Engebretsen TL, Mujtaba MA, Lea AS, Stevenson HL, Kueht ML. Precision in Immune Management: Balancing Steroid Exposure, Rejection Risk, and Infectious Outcomes in Adult Kidney Transplant Recipients. J Pers Med 2024; 14:1106. [PMID: 39590598 PMCID: PMC11595447 DOI: 10.3390/jpm14111106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 11/09/2024] [Accepted: 11/12/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES With kidney transplant immunosuppression, physicians must balance preventing rejection with minimizing infection and malignancy risks. Steroids have been a mainstay of these immunosuppression regimens since the early days of kidney transplantation, yet their risks remain debated. Our study looks at the clinical outcomes of patients undergoing early steroid withdrawal (ESW) vs. steroid continuous (SCI) maintenance immunosuppression in adult kidney transplant recipients. METHODS A retrospective case-control study, utilizing propensity score-matching, was performed using the US Collaborative Network Database within TriNetX to evaluate renal transplant outcomes at one year in first-time kidney transplant adult patients (>18 years old) who were prescribed an ESW regimen (no steroids after post-transplant day 7 with maintenance tacrolimus [tac] + mycophenolic acid [MMP]/mycophenolate mofetil [MMF]) vs. SCI (tac + MMF/MMP + prednisone). Cohorts were matched on demographics, comorbidities, previously described risk factors for rejection, and induction immunosuppression. Primary outcomes included viral infections, pyelonephritis, and sepsis. Secondary outcomes included renal transplant rejection, death-censored allograft failure (eGFR < 15 mL/min), patient mortality, delayed graft function, and diabetes mellitus. RESULTS A total of 2056 patients were in each cohort after matching (mean age: 50.7-51 years, 17.9-20.0% African American, 60-60.6% male.) The SCI cohort had a significantly higher cumulative incidence of composite viremia (18 vs. 28.1%, ESW vs. SCI, p < 0.01) driven by CMV, EBV, and BK virus. Post-transplant diabetes mellitus was significantly higher in the SCI cohort (3.21% vs. 5.49%, ESW vs. SCI, p < 0.01). Delayed graft function was also higher in the SCI cohort (19.55% vs. 22.79%, ESW vs. SCI, p < 0.01). Pyelonephritis (2.3 vs. 4.91%, ESW vs. SCI, p < 0.01) and sepsis (2.15 vs. 5.95%, ESW vs. SCI, p < 0.01) were higher in the SCI cohort. Rejection rates were similar between ESW and SCI (29 vs. 31%, ESW vs. SCI, p = 0.41). There were significantly higher incidences of graft failure (4.9 vs. 9.9%, ESW vs. SCI, p < 0.01) and mortality (0.8 vs. 2.1%, ESW vs. SCI, p < 0.01) in the SCI cohort. CONCLUSIONS This well-matched case-control study suggests that ESW is associated with lower infectious outcomes, mortality, and graft failure without increasing rejection risk, supporting the potential benefits of ESW in kidney transplant patients.
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Affiliation(s)
- Avery N. Koi
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX 77555-0609, USA
| | - John C. Johnson
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX 77555-0609, USA
| | - Trine L. Engebretsen
- Department of Surgery, Division of Multiorgan Transplant and Hepatobiliary Surgery, The University of Texas Medical Branch, Galveston, TX 77555-0609, USA
| | - Muhammad A. Mujtaba
- Department of Medicine, Division of Transplant Nephrology, The University of Texas Medical Branch, Galveston, TX 77555-0609, USA
| | - Alfred Scott Lea
- Department of Medicine, Division of Infectious Disease, The University of Texas Medical Branch, Galveston, TX 77555-0609, USA
| | - Heather L. Stevenson
- Department of Pathology, Division of Transplant Pathology, The University of Texas Medical Branch, Galveston, TX 77555-0609, USA
| | - Michael L. Kueht
- Department of Surgery, Division of Multiorgan Transplant and Hepatobiliary Surgery, The University of Texas Medical Branch, Galveston, TX 77555-0609, USA
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Azzam AY, Essibayi MA, Farkas N, Azab MA, Morsy MM, Elamin O, Elswedy A, Zomia ASA, Alotaibi HA, Alamoud A, Atallah O, Abukhadijah HJ, Dmytriw AA, Baker A, Khatri D, Haranhalli N, Altschul DJ. Efficacy of Tirzepatide Dual GIP/GLP-1 Receptor Agonist In Patients with Idiopathic Intracranial Hypertension. A Real-World Propensity Score-Matched Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.11.12.24317193. [PMID: 39677436 PMCID: PMC11643283 DOI: 10.1101/2024.11.12.24317193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
Introduction Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure, predominantly affecting obese women of reproductive age. While GLP-1 receptor agonists have shown promise in IIH management, the potential of dual GIP/GLP-1 receptor activation through tirzepatide remains unexplored. This study aimed to evaluate tirzepatide's efficacy as an adjunctive therapy in IIH management. Methods We conducted a retrospective cohort analysis using the TriNetX Global Health Research Network, analyzing data through November 2024. Through propensity score matching, we compared 193 tirzepatide-exposed IIH patients with 193 controls receiving standard care. Primary outcomes included papilledema severity, visual function, headache frequency, and treatment resistance, monitored at multiple follow-up timepoints. Results Our analysis revealed significant improvements across all measured outcomes in the tirzepatide group. At 24 months, we observed a 68% reduction in papilledema risk (RR 0.320, 95% CI 0.189-0.542, p<0.001), a 73.9% reduction in visual disturbance and blindness risk (RR 0.261, 95% CI 0.143-0.477, p<0.001), and a 19.7% reduction in headache risk (RR 0.803, 95% CI 0.668-0.966, p=0.019). The tirzepatide group demonstrated significant body-mass index reductions, reaching -1.147 kg/m² (95% CI [-1.415, -0.879], p<0.001) at 24 months compared to controls. Conclusions Our results demonstrate that tirzepatide, when used as an adjunctive therapy, provides significant therapeutic benefits in IIH management, particularly in improving papilledema and visual outcomes. Our findings suggest that dual GIP/GLP-1 receptor activation may offer advantages over traditional single-receptor therapies, potentially through enhanced metabolic regulation and direct effects on intracranial pressure dynamics.
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Affiliation(s)
- Ahmed Y. Azzam
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Muhammed Amir Essibayi
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nathan Farkas
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohammed A. Azab
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mahmoud M. Morsy
- October 6 University Hospital, October 6 University, 6 of October City, Giza, Egypt
| | - Osman Elamin
- Department of Neurosurgery, Jordan Hospital, Amman, Jordan
| | - Adam Elswedy
- Biomedicinskt Centrum BMC, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | | | - Hammam A. Alotaibi
- Ophthalmology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alamoud
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | - Adam A. Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Amanda Baker
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Deepak Khatri
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neil Haranhalli
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David J. Altschul
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Azzam AY, Essibayi MA, Vaishnav D, Azab MA, Morsy MM, Elamin O, Zomia ASA, Alotaibi HA, Alamoud A, Mohamed AA, Ahmed OS, Elswedy A, Atallah O, Abukhadijah HJ, Dmytriw AA, Altschul DJ. Semaglutide as an Adjunctive Therapy to Standard Management for Idiopathic Intracranial Hypertension: A Real-World Data-Based Retrospective Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.11.12.24317197. [PMID: 39677446 PMCID: PMC11643286 DOI: 10.1101/2024.11.12.24317197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
Background Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure, predominantly affecting young women with obesity. This study evaluates the effectiveness of semaglutide as an adjunctive therapy to standard IIH management using real-world data. Methods We conducted a retrospective cohort analysis comparing IIH patients receiving semaglutide plus standard therapy versus standard therapy alone. After propensity score matching, we analyzed 635 patients in each cohort. Primary outcomes included papilledema, headache manifestations, visual disturbances, and refractory disease status at 3-months, 6-months, 12-months, and 24-months. Secondary outcomes included BMI changes. Results Semaglutide demonstrated significant improvements across all outcomes. At three months, the treatment group showed reduced risks of visual disturbances (RR 0.28, 95% CI 0.179-0.440, p=0.0001), papilledema (RR 0.366, 95% CI 0.260-0.515, p=0.0001), and headache (RR 0.578, 95% CI 0.502-0.665, p=0.0001). These benefits persisted through 24 months. Refractory disease risk was reduced by 40% at three months (RR 0.6, 95% CI 0.520-0.692, p=0.0001). The semaglutide group showed progressive BMI reduction, with a baseline-adjusted difference of -1.38 kg/m2 (95% CI [-1.671, -1.089], p<0.0001) at 24 months. Conclusions Semaglutide as an adjunctive therapy demonstrates significant and sustained improvements in IIH-related outcomes, including visual disturbances, papilledema, and headache symptoms. These findings suggest semaglutide may be a valuable addition to standard IIH management protocols, particularly for patients with refractory disease.
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Affiliation(s)
- Ahmed Y. Azzam
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Muhammed Amir Essibayi
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dhrumil Vaishnav
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohammed A. Azab
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mahmoud M. Morsy
- October 6 University Hospital, October 6 University, 6 of October City, Giza, Egypt
| | - Osman Elamin
- Department of Neurosurgery, Jordan Hospital, Amman, Jordan
| | | | - Hammam A. Alotaibi
- Ophthalmology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alamoud
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Omar S. Ahmed
- October 6 University Hospital, October 6 University, 6 of October City, Giza, Egypt
| | - Adam Elswedy
- Biomedicinskt Centrum BMC, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | - Adam A. Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - David J. Altschul
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Azzam AY, Essibayi MA, Vaishnav D, Morsy MM, Elamin O, Zomia ASA, Alotaibi HA, Alamoud A, Mohamed AA, Ahmed OS, Elswedy A, Abukhadijah HJ, Atallah O, Dmytriw AA, Altschul DJ. Cardiometabolic Outcomes in Idiopathic Intracranial Hypertension: An International Matched-Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.11.12.24317203. [PMID: 39677466 PMCID: PMC11643231 DOI: 10.1101/2024.11.12.24317203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
Introduction Idiopathic intracranial hypertension (IIH) has been traditionally viewed as a neuro-ophthalmic disorder, yet emerging evidence suggests broader systemic implications. Our study investigates the cardiometabolic outcomes associated with IIH through a comprehensive matched-cohort analysis. Methods We conducted a retrospective analysis of electronic health records from 2009 to 2024. We compared IIH patients with matched controls using propensity score matching based on age, sex, race, ethnicity, and baseline BMI. Cardiovascular and metabolic outcomes were assessed over a ten-year follow-up period, with additional stratified analyses comparing obese and non-obese subgroups. Results IIH patients demonstrated significantly increased risks of ischemic stroke/TIA (RR 2.515, 95% CI 2.250-2.812) and non-traumatic hemorrhagic stroke (RR 7.744, 95% CI 6.118-9.801). Notable metabolic findings included elevated risks of insulin resistance (RR 1.470, 95% CI 1.258-1.717) and type 2 diabetes mellitus (RR 1.210, 95% CI 1.171-1.250). These associations persisted in non-obese IIH patients, suggesting pathogenic mechanisms independent of adiposity. Additionally, IIH patients showed increased prevalence of polycystic ovarian syndrome (RR 1.470, 95% CI 1.258-1.717) and metabolic syndrome (RR 1.125, 95% CI 1.045-1.205). Conclusions Our findings highlight IIH as a complex multisystem disorder with significant cardiometabolic implications beyond its traditional neuro-ophthalmic presentation. The findings suggest the need for comprehensive cardiovascular and metabolic screening in IIH patients, regardless of BMI status, and indicate potential novel therapeutic targets for investigation.
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Affiliation(s)
- Ahmed Y. Azzam
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Muhammed Amir Essibayi
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dhrumil Vaishnav
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mahmoud M. Morsy
- October 6 University Hospital, October 6 University, 6 of October City, Giza, Egypt
| | - Osman Elamin
- Department of Neurosurgery, Jordan Hospital, Amman, Jordan
| | | | - Hammam A. Alotaibi
- Ophthalmology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alamoud
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Omar S. Ahmed
- October 6 University Hospital, October 6 University, 6 of October City, Giza, Egypt
| | - Adam Elswedy
- Biomedicinskt Centrum BMC, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | | | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Adam A. Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - David J. Altschul
- Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Peng CY, Chang YC, Gong C, Chang Y, Chi KY, Hsiao CL, Chiang CH, Chiang CH. Association between Glucagon-like Peptide-1 Receptor Agonists and Aspiration Pneumonia during Endoscopic Procedures. Anesthesiology 2024; 141:1009-1012. [PMID: 39240542 DOI: 10.1097/aln.0000000000005174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Affiliation(s)
| | | | | | | | | | | | | | - Cho-Han Chiang
- Harvard Medical School, Cambridge, Massachusetts (C.-H.C.).
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Lorenz FJ, Schopper HK, Lighthall JG. Chemodenervation is Associated With Reduced Mental Health Disorders in Patients With Synkinesis. Otolaryngol Head Neck Surg 2024; 171:1355-1361. [PMID: 39148288 DOI: 10.1002/ohn.936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/03/2024] [Accepted: 06/18/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To compare the prevalence of mental health disorders in individuals with facial synkinesis, facial paralysis alone, and the general population. STUDY DESIGN Retrospective cohort. SETTING Eighty-two health care organizations across the United States. METHODS The TriNetX Research Network was queried from 2011 to 2021 for patients with facial paralysis without synkinesis, facial paralysis and documented synkinesis, and controls, matched for age, sex, race, and ethnicity. Cases included infectious, iatrogenic, or idiopathic facial paralysis. Patients with pre-existing depression or anxiety were excluded. Two-year rates of newly diagnosed depression, anxiety, and mental health prescriptions were compared. RESULTS Among 127,573 patients with facial paralysis, 92.5% (n = 117,976) had facial paralysis alone, and 7.5% (n = 9597) also had documented synkinesis. Compared to controls, patients with facial paralysis alone had increased risks of new depression (8.9% vs 7.3%, P < .001) and anxiety (10.1% vs 9.6%, P < .001), with higher mental health medication rates (16.6% vs 13.1%, P < .001). Patients with documented synkinesis, in comparison to controls, had the highest risks of depression (19.8% vs 8.6%, P < .001), anxiety (20.5% vs 10.5%, P < .001), and prescriptions (28.1% vs 15.8%, P < .001). The 27.8% (n = 2669) of synkinetic patients treated with chemodenervation had lower rates of depression (8.5% vs 23.5%, P < .001), anxiety (9.0% vs 23.8%, P < .001), and prescriptions (21.6% vs 30.0%, P < .001) compared to synkinetic patients who were not. CONCLUSION Facial paralysis, particularly synkinesis, is linked to increased mental health disorders. Integrating mental health screening and treatment into a comprehensive approach is crucial. Chemodenervation is associated with decreased mental health disorders in synkinesis, highlighting its therapeutic potential.
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Affiliation(s)
- Fred Jeffrey Lorenz
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Heather K Schopper
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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Shiau BW, Hsu WH, Tsai YW, Wu JY, Liu TH, Huang PY, Chuang MH, Lai CC, Jang LW. Effectiveness of recently-approved oral antiviral medications on the outcome of patients with mild-to-moderate COVID-19 and pre-existing chronic obstructive pulmonary diseases. Expert Rev Anti Infect Ther 2024; 22:977-985. [PMID: 38702925 DOI: 10.1080/14787210.2024.2351571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/16/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES This study assessed the effectiveness of the oral antiviral agents nirmatrelvir - ritonavir (NMV-r) and molnupiravir (MOV) for treating mild-to-moderate coronavirus disease 2019 (COVID-19) in patients with COPD. METHODS This retrospective cohort study extracted data from the TriNetX platform and examined 94,984 COVID-19 patients with preexisting COPD from 1 January 2022, to 1 October 2023. Patients receiving NMV-r or MOV (study group) were compared with those not receiving oral antiviral agents (control group) after propensity score matching (PSM). RESULTS After PSM, 7,944 patients were classified into the study and control groups. The primary composite outcome of all-cause hospitalization, or death in 30 days was reported in 458 (5.7%) patients in the study group and 566 (7.1%) patients in the control cohort, yielding a hazard ratio [HR] of 0.79 (95% confidence interval [CI]: 0.70-0.89; Table 2). Compared with the control group, the study group had a significantly lower risk of all-cause hospitalization (HR, 0.87; 95% CI: 0.76-0.99) and death (HR: 0.21, 95% CI: 0.13-0.35). CONCLUSIONS This study revealed that oral antivirals - NMV-r or MOV might improve clinical outcomes in patients with preexisting COPD and COVID-19. However, only a small proportion of preexisting COPD patients with COVID-19 received oral antiviral treatment.
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Affiliation(s)
- Bo-Wen Shiau
- Division of General Medicine, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Wan-Hsuan Hsu
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ya-Wen Tsai
- Center for Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ting-Hui Liu
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Lih-Wen Jang
- Department of Emergency, Chi-Mei Medical Center, Tainan, Taiwan
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Henney AE, Riley DR, Hydes TJ, Anson M, Ibarburu GH, Zhao SS, Cuthbertson DJ, Alam U. Metabolic syndrome traits differentially and cumulatively influence micro- and macrovascular disease risk in patients with MASLD. Liver Int 2024; 44:3031-3049. [PMID: 39221811 DOI: 10.1111/liv.16086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/13/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The cumulative impact of metabolic syndrome (MetS) components on micro- and macrovascular disease in metabolic dysfunction-associated steatotic liver disease (MASLD) is unclear. We aimed to determine whether the number of the MetS components increases the risk of micro- and macrovascular disease in patients with MASLD. METHODS We performed a retrospective cohort study of electronic medical records using the TriNetX network, a global federated database. The exposure arm was patients with hepatic steatosis (defined via International Classification of Diseases, 10th Revision coding, or modified hepatic steatosis index), and ≥1 MetS components (obesity/central adiposity, insulin resistance, hypertension, or dyslipidaemia), compared with a reference arm of adults without any MetS components or hepatic steatosis. Our propensity score matched (1:1) for confounders with 5 years of follow-up. Primary outcomes included microvascular (peripheral neuropathy, retinopathy, and nephropathy) and macrovascular (cardiovascular events, cerebrovascular accidents, and peripheral vascular disease) disease. Secondary analyses assessed the impact of additional MetS components on these outcomes, as well as the impact of sex. RESULTS MASLD, defined by hepatic steatosis and insulin resistance (n = 15 937), carried the highest risk of microvascular disease (HR 13.93 (95% CI 8.55-22.68)), whilst MASLD, defined by hepatic steatosis and hypertension (n = 53 028), carried the highest risk of macrovascular disease (7.23 (6.45-8.13)). MASLD with all MetS components carried greatest risk of both micro- (31.20 (28.88-33.70) (n = 462 789)) and macrovascular (8.04 (7.33-8.82) (n = 336 010)) disease. CONCLUSION We demonstrate a differential effect of MetS components on micro- and macrovascular disease risk in patients with MASLD, with a cumulative impact of multiple MetS on overall risk. The impact of MetS components was most pronounced in women. Aggressive metabolic risk factor management is critical for prevention of micro- and macrovascular complications.
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Affiliation(s)
- Alex E Henney
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - David R Riley
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Theresa J Hydes
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Anson
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Gema H Ibarburu
- The institution/company is TriNetX LLC, Cambridge, Massachusetts, USA
| | - Sizheng S Zhao
- Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Kukhareva PV, Facelli JC, O'Brien MJ, Gouripeddi R, Kawamoto K, Zhang Y, Reddy D, Malone DC. Racial and Ethnic Disparities in Prescribing of GLP-1 Receptor Agonists in the United States: A Retrospective Cohort Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.10.28.24316312. [PMID: 39574878 PMCID: PMC11581057 DOI: 10.1101/2024.10.28.24316312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2024]
Abstract
Background Type 2 diabetes (T2D) represents a major public health burden in the United States, with racial disparities in medication use potentially exacerbating inequities in health outcomes. This study examined racial/ethnic differences in the prescription of high-efficacy glucose-lowering medications for T2D using a large EHR network (TriNetX). Methods A retrospective cohort study included adults with uncomplicated T2D (ICD-10: E11.9), categorized as Hispanic or Latino (Hispanic) or non-Hispanic American Indian/Alaska Native (AI/AN), Asian, Black, Native Hawaiian/Pacific Islander (NH/PI), and White. Adjusted odds ratios for GLP-1 receptor agonist medications (tirzepatide, semaglutide, and dulaglutide) prescriptions in 2022-2023 were calculated by race/ethnicity, controlling for age, sex, and Charlson Comorbidity Index. Findings Among 57,320 patients included in the analysis, we observed significant racial disparities in the prescribing of GLP-1 medications. Compared to White patients, for tirzepatide, adjusted odds ratios prescriptions were 0.6 (95% CI: 0.4-0.9) for AI/AN, 0.3 (95% CI: 0.3-0.4) for Asian, 0.7 (95% CI: 0.6-0.9) for Black, 0.4 (95% CI: 0.3-0.5) for Hispanic, and 0.4 (95% CI: 0.3-0.6) for NH/PI. For semaglutide, adjusted odds ratios were 0.8 (95% CI: 0.7-0.9) for AI/AN, 0.5 (95% CI: 0.5-0.6) for Asian, 0.8 (95% CI: 0.7-0.9) for Black, 0.6 (95% CI: 0.6-0.7) for Hispanic, and 0.6 (95% CI: 0.5-0.8) for NH/PI. For dulaglutide, adjusted odds ratios were 1.2 (95% CI: 1.0-1.4) for AI/AN, 0.5 (95% CI: 0.4-0.5) for Asian, 1.0 (95% CI: 0.9-1.1) for Black, 0.9 (95% CI: 0.8-1.0) for Hispanic, and 0.5 (95% CI: 0.4-0.6) for NH/PI. Interpretation Racial disparities in high-efficacy diabetes medication prescriptions may contribute to unequal health outcomes in T2D, highlighting the need for targeted research and interventions for equitable diabetes care.
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Tsai SHL, Yang CY, Huo AP, Wei JCC. Interleukin 23 versus interleukin 12/23 inhibitors on preventing incidental psoriatic arthritis in patients with psoriasis? A real-world comparison from the TriNetX Global Collaborative Network. J Am Acad Dermatol 2024; 91:889-895. [PMID: 39079603 DOI: 10.1016/j.jaad.2024.07.1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 08/30/2024]
Abstract
BACKGROUND Managing psoriasis (PsO) and its comorbidities, particularly psoriatic arthritis, often involves using interleukin (IL)-23 and IL-12/23 inhibitors. However, the comparative risk of these treatments still needs to be explored. OBJECTIVE This study evaluates the risk of developing psoriatic arthritis in patients treated with IL-23 inhibitors compared to IL-12/23 inhibitors. METHODS This retrospective cohort study utilized data from the TriNetX, including adult patients diagnosed with PsO. Patients with IL-23 or IL-12/23 inhibitors treatment were included and propensity score matched. The primary outcome was the incidence of psoriatic arthritis (PsA), analyzed using a Cox regression hazard model and Kaplan-Meier estimates. RESULTS The study included matched cohorts of patients treated with IL-23 inhibitors (n = 2273) and IL-12/23 inhibitors (n = 2995). Cox regression analysis revealed no significant difference in the cumulative incidence of PsA between the IL-23i and IL-12/23i cohorts (P = .812). Kaplan-Meier estimates confirmed similar cumulative incidences of arthropathic PsO in both cohorts over the study period. LIMITATION Long-term follow-up studies are required to understand more of the effects of these interleukin inhibitors. CONCLUSION No significant difference but a numerically lower risk of psoriatic arthritis in PsO patients treated with IL-23 inhibitors than with IL-12/23 inhibitors was found, underscoring their comparable efficacy in PsO management and follow-up.
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Affiliation(s)
- Sung Huang Laurent Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center, and Chang Gung University, Keelung, Taiwan; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chi-Ya Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
| | - An-Ping Huo
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical Hospital, Tongji Shanxi Hospital, Taiyuan, China; Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Office of Research and Development, Asia University, Taichung, Taiwan.
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Huang YN, Liao WL, Huang JY, Lin YJ, Yang SF, Huang CC, Wang CH, Su PH. Long-term safety and efficacy of glucagon-like peptide-1 receptor agonists in individuals with obesity and without type 2 diabetes: A global retrospective cohort study. Diabetes Obes Metab 2024; 26:5222-5232. [PMID: 39171569 DOI: 10.1111/dom.15869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/24/2024] [Accepted: 07/28/2024] [Indexed: 08/23/2024]
Abstract
AIM We aimed to investigate the long-term impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on thyroid function, cardiovascular health, renal outcomes and adverse events in individuals with obesity and without type 2 diabetes (T2D). MATERIALS AND METHODS In this observational cohort study, we used propensity score matching to construct comparable cohorts of individuals with obesity and without T2D who were new to GLP-1 RA treatment and those who did not receive glucose-lowering medications. In total, 3,729,925 individuals with obesity were selected from the TriNetX Global Network, with an index event between 1 January 2016 and 31 March 2024. The primary outcomes were safety, cardiovascular, thyroid and clinical biochemical profile outcomes occurring within 5 years following the index event. RESULTS After propensity score matching, the study included 12,123 individuals in each group. GLP-1 RA treatment was associated with a significantly lower risk of all-cause mortality (hazard ratio 0.23; 95% confidence interval 0.15-0.34) and several cardiovascular complications, including ischaemic heart disease, heart failure, arrhythmias, hypertension, stroke and atrial fibrillation (all p < 0.05). GLP-1 RAs were also associated with a lower risk of acute kidney injury and allergic reactions. These protective effects were consistent across various subgroups and regions. CONCLUSIONS In this large observational study, GLP-1 RAs showed long-term protective effects on cardiovascular health, renal outcomes and adverse events in individuals with obesity and without T2D. Our findings suggest that GLP-1 RAs may offer a comprehensive approach to managing obesity and its related comorbidities, potentially improving overall health and survival in this population.
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Affiliation(s)
- Yu-Nan Huang
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Center for Personalized Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jing-Yang Huang
- Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Jung Lin
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Post-Baccalaureate Chinese Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chieh-Chen Huang
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Chung-Hsing Wang
- Division of Genetics and Metabolism, Children's Hospital of China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Pen-Hua Su
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Henson J, Ibarburu GH, Drebert Z, Slater T, Hall AP, Khunti K, Sargeant JA, Zaccardi F, Davies MJ, Yates T. Sleep disorders in younger and middle-older age adults with newly diagnosed type 2 diabetes mellitus: A retrospective cohort study in >1million individuals. Diabetes Res Clin Pract 2024; 217:111887. [PMID: 39419118 DOI: 10.1016/j.diabres.2024.111887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 10/07/2024] [Accepted: 10/08/2024] [Indexed: 10/19/2024]
Abstract
AIMS To explore the 5-year incidence and relative rates of sleep disorders in younger (16-≤40 years) and middle-older (=>40 years) age adults with and without newly diagnosed type 2 diabetes. METHODS This retrospective, observational cohort study utilised data from the US Collaborative Network within the TriNetX database. We compared 5-year cumulative incidence of sleep disorders in younger (n = 110,088) and middle-older populations (n = 1,185,961). RESULTS The absolute risk of developing any type of sleep disorder was greater in individuals with type 2 diabetes vs. those without. Over the 5-year follow-up period, 14.2 % of younger adults and 18.5 % of middle-older age adults with newly diagnosed type 2 diabetes developed any form of sleep disorder, compared to 4.5 % and 7.9 % propensity matched individuals without diabetes. We observed a more pronounced relative rate across the observed sleep disorders in younger adults. CONCLUSIONS The 5-year risk of sleep disorders is higher in those with newly diagnosed type 2 diabetes vs. those without. A higher absolute risk was seen in middle-older adults, but relative rates were consistently higher in younger adults with type 2 diabetes. Sleep should be regularly discussed as part of a holistic approach to diabetes care, particularly in those aged ≤40.
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Affiliation(s)
- Joseph Henson
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK.
| | | | | | - Tommy Slater
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK
| | - Andrew P Hall
- Hanning Sleep Laboratory, Leicester General Hospital, University Hospitals of Leicester NHS Trust, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; NIHR Applied Health Research Collaboration - East Midlands (NIHR ARC-EM), Leicester Diabetes Centre, Leicester, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, UK
| | - Jack A Sargeant
- NIHR Leicester Biomedical Research Centre, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, UK
| | - Francesco Zaccardi
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK
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Fakhry B, Attaway A, Kim HJ, Yaqoob Z, Al-Kindi SG, Chedraoui C, Sleiman J, Zein JG. Polycystic ovary syndrome and the risk of asthma in reproductive-age women: Insights from 2 real-world large cohorts. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:3132-3134. [PMID: 39127100 PMCID: PMC11560732 DOI: 10.1016/j.jaip.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Battoul Fakhry
- Lerner Research Institute and Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amy Attaway
- Lerner Research Institute and Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hyun Jo Kim
- Department of Systems Biology and Bioinformatics, Case Western Reserve University, Cleveland, Ohio
| | - Zaid Yaqoob
- Department of Pulmonary and Critical Care, Trinity Health, Oakland, Mich
| | - Sadeer G Al-Kindi
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | - Joelle Sleiman
- Department of Medicine, Staten Island University Hospital, Staten Island, N. Y
| | - Joe G Zein
- Department of Medicine, Mayo Clinic, Scottsdale, Ariz.
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Thomas HA, Goudman L, DiMarzio M, Barron G, Pilitsis JG. Prevalence of pain phenotypes and co-morbidities of chronic pain in Parkinson's Disease. Clin Neurol Neurosurg 2024; 246:108563. [PMID: 39299006 DOI: 10.1016/j.clineuro.2024.108563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/10/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE The prevalence of chronic pain in Parkinson's disease (PD) in neurology practices ranges from 24 % to 83 %. To determine whether this prevalence is accurate across patients with PD, we leveraged data from electronic medical records in 80 inpatient and outpatient general practice settings. METHODS We explored the prevalence of chronic pain in patients with PD relative to age and sex-matched controls in a large international database with electronic medical records from over 250 million patients (TriNetX Cambridge, MA, USA). We described demographics, co-morbid conditions and medication differences between patients with PD and without PD who have chronic pain. RESULTS Extracted data included 4510 patients with PD and 4,214,982 age-matched control patients without Parkinson's Disease. A chronic pain diagnosis was identified in 19.3 % of males and 22.8 % of females with PD. This differed significantly from age-matched patients without PD who had a significantly lower prevalence of chronic pain 3.78 % and 4.76 %. Significantly more PD patients (both male and females) had received tramadol, oxycodone, and neuropathic agents (p<0.001) than patients without PD. Females with PD more often received anti-depressants than males with PD (p<0.05), corresponding with a significantly higher prevalence of depression. CONCLUSION Chronic pain in patients with PD is five times as common as in age-matched controls in general practice settings. Patients with PD have a greater prevalence of comorbid conditions that affect development of chronic pain. Whether the pain or the PD is causative to those conditions remains to be elucidated.
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Affiliation(s)
- Hannah A Thomas
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Lisa Goudman
- STIMULUS Research Group (Research and TeachIng NeuroModULation Uz Brussel), Vrije Universiteit Brussel, Brussels, Belgium; Florida Atlantic University, Boca Raton, FL, USA
| | - Marisa DiMarzio
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Grace Barron
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA.
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Zirpel H, Ständer S, Frączek A, Olbrich H, Ludwig RJ, Thaçi D. Atopic dermatitis is associated with an increased risk of cardiovascular diseases: a large-scale, propensity-score matched US-based retrospective study. Clin Exp Dermatol 2024; 49:1405-1412. [PMID: 38703379 DOI: 10.1093/ced/llae164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/15/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease characterized by intense itch, and impacting heavily on patients' and caregivers' quality of life. Its clinical presentation is accompanied by a variety of comorbidities associated with type 2 inflammation, such as asthma, hay fever and food allergies. However, current data on cardiovascular comorbidities are inconsistent. OBJECTIVES To identify the risk of cardiovascular diseases (CVDs) in patients with AD. METHODS Data from electronic health records of 1 070 965 patients with AD and equally distributed propensity-score matched controls were retrieved from the US Collaborative Network, part of the federated TriNetX network. Hazard ratios (HRs) for the risk of onset of CVDs with a prevalence of ≥ 1% in both cohorts within 20 years after diagnosis were determined. RESULTS In total, 55 CVDs belonging to 8 major cardiovascular groups were identified. Of those, 53 diagnoses displayed a significantly increased risk in patients with AD. Different diagnoses of heart failure and heart disease were found most often, followed by valve insufficiencies, arrhythmia, tachycardia, atrial fibrillation and flutter, but also major adverse cardiovascular events and venous thromboembolism. The highest HRs were displayed by the individual diagnoses of venous insufficiency, atherosclerosis of native arteries of the extremities, and unspecified diastolic (congestive) heart failure. CONCLUSIONS AD is associated with an increased risk for multiple CVDs.
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Affiliation(s)
- Henner Zirpel
- Institute and Comprehensive Centre for Inflammation Medicine, University Hospital Schleswig Holstein (UKSH), Campus Lübeck, Lübeck, Germany
| | - Sascha Ständer
- Institute and Comprehensive Centre for Inflammation Medicine, University Hospital Schleswig Holstein (UKSH), Campus Lübeck, Lübeck, Germany
- Department of Dermatology, Allergology and Venerology, Section for Inflammatory Medicine, UKSH, Campus Lübeck, Lübeck, Germany
| | - Alicja Frączek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, University Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | - Henning Olbrich
- Department of Dermatology, Allergology and Venerology, Section for Inflammatory Medicine, UKSH, Campus Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Department of Dermatology, Allergology and Venerology, Section for Inflammatory Medicine, UKSH, Campus Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Centre for Inflammation Medicine, University Hospital Schleswig Holstein (UKSH), Campus Lübeck, Lübeck, Germany
- Department of Dermatology, Allergology and Venerology, Section for Inflammatory Medicine, UKSH, Campus Lübeck, Lübeck, Germany
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Kerem L, Stokar J. Risk of Suicidal Ideation or Attempts in Adolescents With Obesity Treated With GLP1 Receptor Agonists. JAMA Pediatr 2024:2824895. [PMID: 39401009 PMCID: PMC11581746 DOI: 10.1001/jamapediatrics.2024.3812] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 07/04/2024] [Indexed: 10/15/2024]
Abstract
Importance Glucagon-like peptide 1 receptor agonists (GLP1R) are increasingly being used for the treatment of obesity in adolescents. It is currently unknown whether GLP1R treatment is associated with suicidal ideation or attempts in this population. Objective To investigate the association between GLP1R initiation and suicidal ideation or attempts in adolescents with obesity. Design, Setting, and Participants Retrospective propensity score-matched cohort study using electronic health records from the TriNetX global federated network between December 2019 and June 2024. The analysis included data from 120 health care organizations, mainly from the USA. Participants were adolescents aged 12 to 18 years with a diagnosis of obesity and evidence of an antiobesity GLP1R prescription or lifestyle intervention without GLP1R within the following year. Cohorts were balanced for baseline demographic characteristics, psychiatric medications and comorbidities, and diagnoses associated with socioeconomic status and health care access using propensity score matching. Exposure Initial prescription of GLP1R (study cohort) or lifestyle intervention without GLP1R (control cohort). Main Outcomes and Measures Incidence of suicidal ideation or attempts based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes recorded in patient electronic health records during 12 months of follow-up. Diagnoses of upper respiratory tract infections (URTI) were used as negative control outcomes, and gastrointestinal symptoms (GI) were used as positive control outcomes. Results A total of 4052 adolescents with obesity and a concomitant antiobesity intervention were identified for the GLP1R cohort and 50 112 were identified for the control cohort. Propensity score matching resulted in 3456 participants in each balanced cohort. Prescription of GLP1R was associated with a 33% reduced risk for suicidal ideation or attempts over 12 months of follow-up (1.45% vs 2.26%; hazard ratio [HR], 0.67; 95% CI, 0.47-0.95; P = .02) and a higher rate of GI symptoms (6.9% vs 5.4%; HR, 1.41; 95% CI, 1.12-1.78; P = .003) but no difference in rates of URTI diagnoses. Conclusions and Relevance In this study, adolescents with obesity prescribed a GLP1R had a lower incidence of suicidal ideation or attempts compared with matched patients not prescribed GLP1R who were treated with lifestyle intervention. These results suggest a favorable psychiatric safety profile of GLP1R in adolescents. The detected reduction in HRs for suicidal ideation among adolescents with obesity prescribed GLP1R suggests potential avenues for future research.
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Affiliation(s)
- Liya Kerem
- Division of Pediatric Endocrinology, Department of Pediatrics, Hadassah University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua Stokar
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Internal Medicine, Department of Endocrinology, Hadassah University Medical Center, Jerusalem, Israel
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Azzam AY, Nassar M, Al Zomia AS, Elswedy A, Morsy MM, Mohamed AA, Elamin O, Elsayed OS, Azab MA, Essibayi MA, Wu J, Dmytirw AA, Altschul DJ. Safety and Efficacy of Metformin for Idiopathic Intracranial Hypertension. A U.S-Based Real-World Data Retrospective Multicenter Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.01.24312907. [PMID: 39410963 PMCID: PMC11475866 DOI: 10.1101/2024.09.01.24312907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
INTRODUCTION Idiopathic intracranial hypertension (IIH) remains a challenging condition to manage, with limited therapeutic options. This study investigated the potential of metformin as a novel treatment for IIH, exploring its effects on disease outcomes and safety profile. METHODS We conducted a retrospective cohort study using the TriNetX database, analyzing data from 2009 to August 2024. Patients diagnosed with IIH were included, with exclusions for other causes of elevated intracranial pressure and pre-existing diabetes. Propensity score matching was employed to balance cohorts according to age, sex, race, ethnicity, Hemoglobin A1C, and baseline body mass index (BMI) at the time of metformin initiation. Outcomes were assessed at various follow-up points up to 24 months. RESULTS Our study initially comprised 1,268 patients in the metformin group and 49,262 in the control group, with notable disparities in several parameters. Post-matching, both cohorts were refined to 1,267 patients each after matching with metformin group. Metformin-treated patients showed significantly lower risks of papilledema, headache, and refractory IIH status at all follow-up points (p<0.0001). The metformin group also had reduced rates of therapeutic spinal punctures and acetazolamide continuation. BMI reductions were more pronounced in the metformin group, with significant differences observed from 6 months onward (p<0.0001). Notably, metformin's beneficial effects persisted independently of BMI changes. The safety profile of metformin was favorable, with no significant differences in adverse events compared to the control group which did not receive metformin during the study timeframe. CONCLUSIONS Our study provides evidence for metformin's potential as a disease-modifying therapeutic approach in IIH, demonstrating improvements across multiple outcomes. The benefits appear to extend beyond weight loss, suggesting complex mechanisms of action. These findings warrant further investigation through prospective clinical trials to establish metformin's role in IIH management and explore its underlying therapeutic mechanisms.
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Affiliation(s)
- Ahmed Y. Azzam
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mahmoud Nassar
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA
| | | | - Adam Elswedy
- Faculty of Medicine, October 6 University, Giza, Egypt
| | | | | | - Osman Elamin
- Department of Neurosurgery, Jordan Hospital, Amman, Jordan
| | | | - Mohammed A. Azab
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Muhammed Amir Essibayi
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jin Wu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam A. Dmytirw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - David J. Altschul
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Mbizvo GK, Bucci T, Lip GYH, Marson AG. Morbidity and mortality risks associated with valproate withdrawal in young adults with epilepsy. Brain 2024; 147:3426-3441. [PMID: 38657115 PMCID: PMC11449131 DOI: 10.1093/brain/awae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 04/26/2024] Open
Abstract
Valproate is the most effective treatment for idiopathic generalized epilepsy. Current guidance precludes its use in females of childbearing potential, unless other treatments are ineffective or not tolerated, because of high teratogenicity. This risk was recently extended to males. New guidance will limit use both in males and females aged <55 years, resulting in withdrawal of valproate from males already taking it, as occurs for females. Whether there are risks of personal harm (including injury or death) associated with valproate withdrawal has not yet been quantified for males or females ON valproate, meaning clinicians cannot reliably counsel either sex when discussing valproate withdrawal with them, despite that this concern may be at the forefront of patients' and clinicians' minds. We assessed whether there are any morbidity or mortality risks associated with valproate withdrawal in young males and females. We performed a retrospective cohort study of internationally derived electronic health data within the TriNetX Global Collaborative Network. Included were males and females aged 16-54 years with ≥1 epilepsy disease or symptom code between 1 December 2017 and 1 December 2018, and ≥2 valproate prescriptions over the preceding 2 years (1 January 2015-30 November 2017). Five-year propensity-matched risks of mortality and a range of morbidity outcomes were compared between those remaining ON versus withdrawn from valproate during the 1 December 2017-1 December 2018 recruitment period, regardless of whether switched to another antiseizure medication. Survival analysis was undertaken using Cox-proportional hazard models, generating hazard ratios (HRs) with 95% confidence intervals (CIs). In total, 8991 males and 5243 females taking valproate were recruited. Twenty-eight per cent of males and 36% of females were subsequently withdrawn from valproate. Valproate withdrawal was associated with significantly increased risks of emergency department attendance [HRs overall: 1.236 (CI 1.159-1.319), males: 1.181 (CI 1.083-1.288), females: 1.242 (CI 1.125-1.371)], hospital admission [HRs overall: 1.160 (CI 1.081-1.246), males: 1.132 (CI 1.027-1.249), females: 1.147 (CI 1.033-1.274)], falls [HRs overall: 1.179 (CI 1.041-1.336), males: 1.298 (CI 1.090-1.546)], injuries [HRs overall: 1.095 (CI 1.021-1.174), males: 1.129 (CI 1.029-1.239)], burns [HRs overall: 1.592 (CI 1.084-2.337)] and new-onset depression [HRs overall 1.323 (CI 1.119-1.565), females: 1.359 (CI 1.074-1.720)]. The risk of these outcomes occurring was 1%-7% higher in those withdrawn from valproate than in those remaining ON valproate. Overall, valproate withdrawal was not associated with increased mortality. These results may help patients and clinicians have a more informed discussion about personal safety when considering valproate withdrawal.
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Affiliation(s)
- Gashirai K Mbizvo
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, L69 7TX, UK
- Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7BE, UK
- Neurology Service, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, L69 7TX, UK
- Department of General and Specialized Surgery, Sapienza University of Rome, Rome, 00185, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, L69 7TX, UK
- Department of Clinical Medicine, Danish Centre for Health Services Research, Aalborg University, Aalborg, 9220, Denmark
| | - Anthony G Marson
- Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7BE, UK
- Neurology Service, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
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Mora N, Mehall M, Lennox LA, Pincus HA, Charron D, Morrato EH. A national unmet needs assessment for CTSA-affiliated electronic health record data networks: A customer discovery approach. J Clin Transl Sci 2024; 8:e137. [PMID: 39478788 PMCID: PMC11523010 DOI: 10.1017/cts.2024.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 11/02/2024] Open
Abstract
Introduction The expansion of electronic health record (EHR) data networks over the last two decades has significantly improved the accessibility and processes around data sharing. However, there lies a gap in meeting the needs of Clinical and Translational Science Award (CTSA) hubs, particularly related to real-world data (RWD) and real-world evidence (RWE). Methods We adopted a mixed-methods approach to construct a comprehensive needs assessment that included: (1) A Landscape Context analysis to understand the competitive environment; and (2) Customer Discovery to identify stakeholders and the value proposition related to EHR data networks. Methods included surveys, interviews, and a focus group. Results Thirty-two CTSA institutions contributed data for analysis. Fifty-four interviews and one focus group were conducted. The synthesis of our findings pivots around five emergent themes: (1) CTSA segmentation needs vary according to resources; (2) Team science is key for success; (3) Quality of data generates trust in the network; (4) Capacity building is defined differently by researcher career stage and CTSA existing resources; and (5) Researchers' unmet needs. Conclusions Based on the results, EHR data networks like ENACT that would like to meet the expectations of academic research centers within the CTSA consortium need to consider filling the gaps identified by our study: foster team science, improve workforce capacity, achieve data governance trust and efficiency of operation, and aid Learning Health Systems with validating, applying, and scaling the evidence to support quality improvement and high-value care. These findings align with the NIH NCATS Strategic Plan for Data Science.
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Affiliation(s)
- Nallely Mora
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA
- Institute for Translational Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Madeline Mehall
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA
- Institute for Translational Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Lindsay A. Lennox
- Colorado Clinical and Translational Sciences Institute, Aurora, CO, USA
| | - Harold A. Pincus
- Irving Institute for Clinical and Translational Research, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - David Charron
- Haas School of Business, NSF and NIH I-Corps Programs, University of California, Berkeley, CA, USA
| | - Elaine H. Morrato
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA
- Institute for Translational Medicine, Loyola University Chicago, Chicago, IL, USA
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Lavu MS, Porto JR, Hecht CJ, Kaelber DC, Sculco PK, Heckmann ND, Kamath AF. The Five-Year Incidence of Progression to Osteoarthritis and Total Joint Arthroplasty in Patients Prescribed Glucagon-Like Peptide 1 Receptor Agonists. J Arthroplasty 2024; 39:2433-2439.e1. [PMID: 38857711 DOI: 10.1016/j.arth.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Research has suggested that glucagon-like peptide-1 receptor agonists (GLP-1-RAs) may have therapeutic effects on osteoarthritis of the hip and knee, in addition to managing diabetes and obesity. However, there is a lack of understanding regarding the association between GLP-1-RA use and the diagnosis of osteoarthritis (OA) of the hip and knee. METHODS A collaborative network analytics platform was queried for obese diabetic (n = 1,094,198), obese nondiabetic (n = 916,235), and nonobese diabetic (n = 157,305) patients who had an index visit between 2015 and 2017. Patients who had pre-existing hip and/or knee OA were excluded. A 1:1 propensity score matching was used to balance GLP-1-RA use in stratified cohorts for age, sex, race, body mass index, and hemoglobin A1c. The primary outcomes were rates of progression to hip OA, knee OA, major joint injections, total hip arthroplasty, and total knee arthroplasty. Cox proportional hazards models determined hazard ratios (HRs) between cohorts prescribed and not prescribed GLP-1-RAs. RESULTS All patients had a five-year follow-up. Rates of progression to hip and knee OA were higher among the GLP-1-RA users in both obese diabetic (hip HR: 1.63, 95% confidence interval [CI]: 1.46 to 1.82; knee HR: 1.52, CI: 1.41 to 1.64) and nonobese diabetic (hip HR: 1.78, CI: 1.50 to 2.10; knee HR: 1.58, CI: 1.39 to 1.80) cohorts. These diabetic cohorts received higher rates of major joint injections, though there was no difference in rates of total hip arthroplasty or total knee arthroplasty. No differences in five-year outcomes were seen when comparing obese, nondiabetic patients who were prescribed GLP-1-RAs with obese, nondiabetic patients not exposed to GLP-1-RAs. CONCLUSIONS This five-year analysis found a greater risk of progression to hip and knee OA among obese and non-obese diabetic GLP-1-RA users. Further studies should explore GLP-1-RA effects upon glucose management, weight loss, and lower extremity arthritis development. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Monish S Lavu
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Joshua R Porto
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christian J Hecht
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio; The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Peter K Sculco
- Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Trager RJ, Burton WM, Loewenthal JV, Perez JA, Lisi AJ, Kowalski MH, Wayne PM. Chiropractic Spinal Manipulation and Fall Risk in Older Adults With Spinal Pain: Observational Findings From a Matched Retrospective Cohort Study. Cureus 2024; 16:e72330. [PMID: 39583476 PMCID: PMC11585376 DOI: 10.7759/cureus.72330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2024] [Indexed: 11/26/2024] Open
Abstract
INTRODUCTION Limited research suggests that spinal manipulative therapy (SMT) might positively influence balance, yet its association with falls remains underexplored. We hypothesized that older adults receiving chiropractic SMT for spinal pain would have a reduced fall risk during 13 months of follow-up compared to matched controls. METHODS We searched >116 million patient records from TriNetX (2013-2023; Cambridge, MA, US) to identify adults aged ≥65 years with spinal pain. After excluding those with major fall risk factors, we formed SMT and non-SMT cohorts, using propensity score matching to control for confounders (e.g., age, sex, comorbidities). Risk ratios (RR) with 95% CIs and p-values were calculated for primary (fall) and secondary (limb fracture) outcomes over 13 months. We explored the cumulative incidence of falls and fractures and negative control outcomes (colonoscopy, vital signs, diabetes, nicotine/tobacco screening). RESULTS After matching, each cohort had 1,666 patients (mean age 72 years). The SMT cohort had a lower fall rate than the non-SMT cohort (3.8% vs. 5.4%), yielding an RR (95% CI) of 0.71 ((0.52, 0.97); p=0.0319). Cumulative incidences revealed a brief lag in SMT cohort fall incidence. There was no meaningful difference in limb fractures (RR of 1.16 (0.87, 1.54); p=0.3153). Negative control outcomes were similar between cohorts. CONCLUSIONS This study suggests that older adults receiving SMT for spinal pain may have a reduced risk of falls. However, given the observational nature of the study and the lack of significant differences in limb fracture incidence, the clinical significance of these findings remains uncertain. Further research, including randomized controlled trials, is needed to explore injurious falls, care utilization, pain, and costs.
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Affiliation(s)
- Robert J Trager
- Department of Chiropractic Medicine, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, USA
| | - Wren M Burton
- Osher Center for Integrative Health, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
- Division of Preventive Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Julia V Loewenthal
- Division of Aging, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Anthony J Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven, USA
- Section of Biomedical Informatics and Data Science, School of Medicine, Yale University, New Haven, USA
| | - Matthew H Kowalski
- Osher Center for Integrative Health, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Peter M Wayne
- Osher Center for Integrative Health, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
- Division of Preventive Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
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Wilson JL, Betensky M, Udassi S, Ellison PR, Lilienthal R, Stahl LR, Palchuk MB, Zia A, Town DA, Kimble W, Goldenberg NA, Morizono H. Leveraging a global, federated, real-world data network to optimize investigator-initiated pediatric clinical trials: the TriNetX Pediatric Collaboratory Network. JAMIA Open 2024; 7:ooae077. [PMID: 39224867 PMCID: PMC11368118 DOI: 10.1093/jamiaopen/ooae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/29/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024] Open
Abstract
Objective Clinical research networks facilitate collaborative research, but data sharing remains a common barrier. Materials and Methods The TriNetX platform provides real-time access to electronic health record (EHR)-derived, anonymized data from 173 healthcare organizations (HCOs) and tools for queries and analysis. In 2022, 4 pediatric HCOs worked with TriNetX leadership to found the Pediatric Collaboratory Network (PCN), facilitated via a multi-institutional data-use agreement (DUA). The DUA enables collaborative study design and execution, with institutional review board-approved transfer of complete datasets for further analyses on a per-protocol basis. Results and Discussion Of the 41.2 million children with TriNetX records, the PCN represents nearly 10%. The PCN assisted several early-career investigators to bring study concepts from conception to an international scientific meeting presentation and journal submission. Conclusion The PCN facilitates EHR vendor-agnostic multicenter pediatric research on the global TriNetX platform. Continued growth of the PCN will advance knowledge in pediatric health.
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Affiliation(s)
- Jurran L Wilson
- Center for Translational Research, Children’s National Hospital, Washington, DC 20010, United States
| | - Marisol Betensky
- Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
- Johns Hopkins All Children’s Institute for Clinical and Translational Research, St Peterburg, FL 33701, United States
| | - Sharda Udassi
- Department of Pediatrics, WVU Medicine Children’s Hospital, Morgantown, WV 26505, United States
| | - Pavithra R Ellison
- Department of Anesthesiology, WVU Medicine Children’s Hospital, Morgantown, WV 26505, United States
| | | | | | | | - Ayesha Zia
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Deborah A Town
- Research, Children’s Health, Dallas, TX 75235, United States
| | - Wes Kimble
- West Virginia Clinical and Translational Science Institute, Morgantown, WV 26506, United States
| | - Neil A Goldenberg
- Johns Hopkins All Children’s Institute for Clinical and Translational Research, St Peterburg, FL 33701, United States
- Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Hiroki Morizono
- Center for Genetic Medicine Research, Children’s National Hospital, Washington, DC 20010, United States
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Dobbins NJ, Morris M, Sadhu E, MacFadden D, Nazaire MD, Simons W, Weber G, Murphy S, Visweswaran S. Towards cross-application model-agnostic federated cohort discovery. J Am Med Inform Assoc 2024; 31:2202-2209. [PMID: 39110920 PMCID: PMC11413448 DOI: 10.1093/jamia/ocae211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/16/2024] [Accepted: 07/25/2024] [Indexed: 08/22/2024] Open
Abstract
OBJECTIVES To demonstrate that 2 popular cohort discovery tools, Leaf and the Shared Health Research Information Network (SHRINE), are readily interoperable. Specifically, we adapted Leaf to interoperate and function as a node in a federated data network that uses SHRINE and dynamically generate queries for heterogeneous data models. MATERIALS AND METHODS SHRINE queries are designed to run on the Informatics for Integrating Biology & the Bedside (i2b2) data model. We created functionality in Leaf to interoperate with a SHRINE data network and dynamically translate SHRINE queries to other data models. We randomly selected 500 past queries from the SHRINE-based national Evolve to Next-Gen Accrual to Clinical Trials (ENACT) network for evaluation, and an additional 100 queries to refine and debug Leaf's translation functionality. We created a script for Leaf to convert the terms in the SHRINE queries into equivalent structured query language (SQL) concepts, which were then executed on 2 other data models. RESULTS AND DISCUSSION 91.1% of the generated queries for non-i2b2 models returned counts within 5% (or ±5 patients for counts under 100) of i2b2, with 91.3% recall. Of the 8.9% of queries that exceeded the 5% margin, 77 of 89 (86.5%) were due to errors introduced by the Python script or the extract-transform-load process, which are easily fixed in a production deployment. The remaining errors were due to Leaf's translation function, which was later fixed. CONCLUSION Our results support that cohort discovery applications such as Leaf and SHRINE can interoperate in federated data networks with heterogeneous data models.
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Affiliation(s)
- Nicholas J Dobbins
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA 98195, United States
- Biomedical Informatics & Data Science, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, United States
| | - Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Eugene Sadhu
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Douglas MacFadden
- Department of Biomedical Informatics, Harvard University, Boston, MA 02138, United States
| | - Marc-Danie Nazaire
- Department of Biomedical Informatics, Harvard University, Boston, MA 02138, United States
| | - William Simons
- Department of Biomedical Informatics, Harvard University, Boston, MA 02138, United States
| | - Griffin Weber
- Department of Biomedical Informatics, Harvard University, Boston, MA 02138, United States
| | - Shawn Murphy
- Department of Biomedical Informatics, Harvard University, Boston, MA 02138, United States
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15260, United States
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140
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Miller MG, Terebuh P, Kaelber DC, Xu R, Davis PB. SARS-CoV-2 Infection and New-Onset Type 2 Diabetes Among Pediatric Patients, 2020 to 2022. JAMA Netw Open 2024; 7:e2439444. [PMID: 39401034 PMCID: PMC11581647 DOI: 10.1001/jamanetworkopen.2024.39444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/22/2024] [Indexed: 10/15/2024] Open
Abstract
Importance In adults, diagnoses of new-onset type 2 diabetes (T2D) have increased following diagnosis with COVID-19, but whether this occurs in children is unclear. Objective To determine whether risk of incident T2D diagnosis is increased during the 6 months after SARS-CoV-2 infection among children. Design, Setting, and Participants This retrospective cohort study used electronic health records from the TriNetX analytics platforms between January 1, 2020, and December 31, 2022. Pediatric patients aged 10 to 19 years without preexisting diabetes were eligible for inclusion. Data were analyzed from August 15 to September 15, 2023, with supplemental analyses January 20 and August 8 to 13, 2024. Exposures Diagnosis of COVID-19 or a non-COVID-19 respiratory infection. Main Outcomes and Measures New diagnosis of T2D compared by risk ratios (RRs) and 95% CIs at 1, 3, and 6 months after index infection. Results The main study population included 613 602 patients, consisting of 306 801 with COVID-19 (mean [SD] age at index, 14.9 [2.9] years; 52.8% female) and 306 801 with other respiratory infections (ORIs) but no documented COVID-19 (mean [SD] age at index, 14.9 [2.9] years; 52.6% female) after propensity score matching. Risk of a new diagnosis of T2D was significantly increased from day of infection to 1, 3, and 6 months after COVID-19 diagnosis compared with the matched cohort with ORIs (RR at 1 month, 1.55 [95% CI, 1.28-1.89]; RR at 3 months: 1.48 [95% CI, 1.24-1.76]; RR at 6 months: 1.58 [95% CI, 1.35-1.85]). Similar results were found in the subpopulation classified as having overweight or obesity (RR at 1 month: 2.07 [95% CI, 1.12-3.83]; RR at 3 months: 2.00 [95% CI, 1.15-3.47]; RR at 6 months: 2.27 [95% CI, 1.38-3.75]) and the hospitalized subpopulation (RR at 1 month: 3.10 [95% CI, 2.04-4.71]; RR at 3 months: 2.74 [95% CI, 1.90-3.96]; RR at 6 months: 2.62 [95% CI, 1.87-3.66]). Similar elevation in risk was found at 3 and 6 months when excluding patients diagnosed during the interval from the index date to 1 month after infection. Conclusions and Relevance In this retrospective cohort study of children and adolescents aged 10 to 19 years, the risk of an incident diagnosis of T2D was greater following a COVID-19 diagnosis than in children diagnosed with ORIs. Further study is required to determine whether diabetes persists or reverses later in life.
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Affiliation(s)
- Margaret G. Miller
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pauline Terebuh
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David C. Kaelber
- Center for Clinical Informatics Research and Education, The MetroHealth System and Departments of Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pamela B. Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Ashruf OS, Ashruf Z, Luyckx V, Kaelber DC, Sethi SK, Raina R. Sociodemographic Disparities in 1-Year Outcomes of Children With Community-Acquired Acute Kidney Injury. JAMA Netw Open 2024; 7:e2440988. [PMID: 39470639 PMCID: PMC11522937 DOI: 10.1001/jamanetworkopen.2024.40988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 08/27/2024] [Indexed: 10/30/2024] Open
Abstract
Importance Racial disparities have been identified in pediatric community-acquired acute kidney injury (CA-AKI), and they are associated with increased risk of child mortality, morbidity, and progression of kidney disease. Objective To assess clinical outcomes at 1 year among children with CA-AKI, stratified by age, race, and ethnicity. Design, Setting, and Participants This retrospective cohort study is a population-based analysis of deidentified, aggregated electronic health record data collected by 61 large health care organizations from 2003 to 2023 and accessed through the TriNetX platform. Outcomes were assessed at 1 year after a CA-AKI episode. Participants included pediatric patients (aged <18 years) with AKI. Data were accessed in January 2024. Exposure A diagnosis of CA-AKI and sociodemographic factors such as race, ethnicity, and age, as reported in electronic health records. Main Outcomes and Measures The primary end point of this study was to assess differences in clinical outcomes within 1 year of an episode of CA-AKI, including all-cause emergency department (ED) visits, intensive care unit (ICU) admissions, mechanical intubation and ventilation, and mortality. Risk was compared between White children and Asian (including Asian, Native Hawaiian, and Other Pacific Islander), Black, and Hispanic children, stratified by age group. Measures of association, Cox proportional hazard analyses, and Kaplan-Meier survival curves were performed within the TriNetX Advanced Analytics Platform between racial and ethnic groups for each analysis. Results From the total sample of 18 152 children, those with hospital-acquired AKI, chronic kidney disease, end-stage kidney failure, or dialysis dependence were excluded, leaving a final cohort of 17 125 children (mean [SD] age, 11.2 [5.2] years; 9424 male [55.3%]). Eligible patients were divided into racial and ethnic groups as follows: non-Hispanic Asian, 1169 children (6.5%); non-Hispanic Black, 4636 children (27.3%); Hispanic, 1786 children (10.2%); and non-Hispanic White, 9534 children (55.9%). Patients were further subdivided into groups aged 0 to 9 years (546 Asian children, 1675 Black children, 689 Hispanic children, and 3340 White children) and 10 to 18 years (623 Asian children, 2961 Black children, 1091 Hispanic children, and 6104 White children). Within 1 year of CA-AKI diagnosis, compared with White children, Black children experienced greater rates of ED visits (hazard ratio [HR], 1.53; 95% CI, 1.40-1.67), ICU admissions (HR, 1.31; 95% CI, 1.16-1.47), mechanical ventilation (HR, 1.33; 95% CI, 1.13-1.56), and all-cause mortality (HR, 1.27; 95% CI, 1.09-1.48), as well as the greatest risk for composite outcomes (HR, 1.43; 95% CI, 1.33-1.53). Hispanic children experienced greater rates of ED visits (HR, 1.40; 95% CI, 1.21-1.62) and the greatest risk of all-cause mortality (HR, 1.66; 95% CI, 1.31-2.09), whereas Asian children experienced greater rates of mechanical ventilation (HR, 1.69; 95% CI, 1.26-2.27), compared with White children. Black and Hispanic children aged 0 to 9 years were at greatest risk of experiencing poor clinical outcomes. Black children had a 11.41% lower survival probability and Hispanic children had a 7.14% lower survival probability compared with White children after an initial ED encounter. Conclusions and Relevance Among children with an identified episode of CA-AKI diagnosed in an ED, within 1 year, Black and Hispanic children had a poorer survival probability compared with White children. Future studies are needed to understand these disparities and improve awareness and follow-up after emergency care.
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Affiliation(s)
- Omer S. Ashruf
- Department of Internal Medicine, Northeast Ohio Medical University, Rootstown
| | - Zaid Ashruf
- Department of Nephrology, Akron Nephrology Associates, Cleveland Clinic Akron General Medical Center, Akron, Ohio
| | - Valerie Luyckx
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - David C. Kaelber
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
- Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Sidharth K. Sethi
- Pediatric Nephrology, Kidney Institute and Pediatric Intensive Care, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | - Rupesh Raina
- Department of Nephrology, Akron Nephrology Associates, Cleveland Clinic Akron General Medical Center, Akron, Ohio
- Department of Nephrology, Akron Children’s Hospital, Akron, Ohio
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Chiang CH, Xu X, Song J, Xanthavanij N, Chi KY, Chang YC, Chang Y, Hsiao CL, Chiang CH, Lin S. The association between pembrolizumab and risk of venous thromboembolism in patients with breast cancer. Thromb Res 2024; 242:109119. [PMID: 39167941 DOI: 10.1016/j.thromres.2024.109119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Cho-Han Chiang
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
| | - Xiaocao Xu
- Division of Hematology and Oncology, Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Junmin Song
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nutchapon Xanthavanij
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Kuan-Yu Chi
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yu-Cheng Chang
- Department of Medicine, Danbury Hospital, Danbury, CT, USA
| | - Yu Chang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Lien Hsiao
- School of International and Public Affairs, Columbia University, New York, NY, USA
| | - Cho-Hung Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuwen Lin
- Department of Oncology, Montefiore Einstein Comprehensive Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Henney AE, Riley DR, Heague M, Hydes TJ, Anson M, Alam U, Cuthbertson DJ. Sodium-glucose cotransporter 2 inhibitors reduce the risk of incident type 2 diabetes in people with heart failure without diabetes: An analysis of real-world, cohort data. Diabetes Obes Metab 2024; 26:4665-4673. [PMID: 39109451 DOI: 10.1111/dom.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 09/19/2024]
Abstract
AIM Sodium-glucose cotransporter 2 inhibitors (SGLT2is), used as a glucose-lowering therapy in people with type 2 diabetes (T2D), have significant cardiorenal benefits, reducing hospitalization for heart failure (HF) and cardiovascular mortality in patients with and without T2D. Recent clinical trial evidence suggests their potential utility in preventing incident T2D among the high-risk HF populations. Therefore, we aimed to assess whether this finding was reproducible in a real-world setting. METHODS We performed a retrospective cohort analysis of 484 643 patients with HF, without baseline diabetes, prescribed either angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers with/without SGLT2is (treatment, n = 42 018; reference, n = 442 625) across 95 global health care organizations, using a large real-world ecosystem. Propensity score matching balanced arms 1:1 for confounders (n = 39 168 each arm). Subgroup analysis further evaluated the impact on patients with prediabetes and the efficacy of dapagliflozin/empagliflozin, specifically, on incident T2D and secondary outcomes, including all-cause mortality, acute pulmonary oedema and hospitalization. RESULTS Treatment with SGLT2is significantly reduced incident T2D {hazard ratio (HR) 0.71 [95% confidence interval (CI) 0.63, 0.75]} in patients with HF. The analysis of patients with prediabetes found that SGLT2is further reduced incident T2D [HR 0.62 (95% CI 0.45, 0.80)]. The magnitude of reduction in incident T2D was higher in patients prescribed dapagliflozin [HR 0.47 (95% CI 0.39, 0.56)] versus empagliflozin [HR 0.81 (95% CI 0.70, 0.93)]. CONCLUSION Treatment with SGLT2is in patients with HF was associated with a reduced risk of incident T2D, most strikingly in people with prediabetes.
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Affiliation(s)
- Alex E Henney
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - David R Riley
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Megan Heague
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Theresa J Hydes
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Anson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Desai RJ, Marsolo K, Smith J, Carrell D, Penfold R, Pillai HS, Lii J, Ngan K, Winter R, Adgent M, Ramaprasan A, Driscoll MR, Scarnecchia D, Kiernan D, Draper C, Lyons JG, Khurshid A, Maro JC, Zimmerman R, Brown J, Bright P, Hernández-Muñoz JJ, Matheny ME, Schneeweiss S. The FDA Sentinel Real World Evidence Data Enterprise (RWE-DE). Pharmacoepidemiol Drug Saf 2024; 33:e70028. [PMID: 39385712 DOI: 10.1002/pds.70028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 09/16/2024] [Indexed: 10/12/2024]
Abstract
PURPOSE The US Food and Drug Administration's Sentinel Innovation Center aimed to establish a query-ready, quality-checked distributed data network containing electronic health records (EHRs) linked with insurance claims data for at least 10 million individuals to expand the utility of real-world data for regulatory decision-making. METHODS In this report, we describe the resulting network, the Real-World Evidence Data Enterprise (RWE-DE), including data from two commercial EHR-claims linked assets collectively termed the Commercial Network covering 21 million lives, and four academic partner institutions collectively termed the Development Network covering 4.5 million lives. RESULTS We discuss provenance and completeness of the data converted in the Sentinel Common Data Model (SCDM), describe patient populations, and report on EHR-claims linkage characterization for all contributing data sources. Further, we introduce a standardized process to store free-text notes in the Development Network for efficient retrieval as needed. CONCLUSIONS Finally, we outline typical use cases for the RWE-DE where it can broaden the reach of the types of questions that can be addressed by the Sentinel system.
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Affiliation(s)
- Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Keith Marsolo
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Joshua Smith
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Carrell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington State, USA
| | - Robert Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington State, USA
| | - Haritha S Pillai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joyce Lii
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry Ngan
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Winter
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Margaret Adgent
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arvind Ramaprasan
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington State, USA
| | - Meighan Rogers Driscoll
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Scarnecchia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Kiernan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Draper
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer G Lyons
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Anjum Khurshid
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Judith C Maro
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Patricia Bright
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA
| | - José J Hernández-Muñoz
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA
| | - Michael E Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatrics Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville, Tennessee, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Gallagher TJ, Parikh M, Herrera K, Lin ME, Hur K. Association of COVID-19 Vaccination With Changes in Smell and Taste. Otolaryngol Head Neck Surg 2024; 171:1240-1244. [PMID: 38822762 DOI: 10.1002/ohn.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
Since the introduction of vaccines for severe acute respiratory syndrome coronavirus 2 in the United States, there has been significant vaccine hesitancy, in part due to fear of adverse effects. We sought to investigate the rates of smell and taste changes after COVID-19 vaccination compared to other common vaccines. Our study cohort included individuals identified by Current Procedural Terminology code in the TriNetX database receiving the COVID-19 first series, COVID-19 booster, influenza, tetanus, diphtheria, pertussis (TDAP), or pneumococcal vaccines between December 15, 2020, and August 15, 2023. After 1:1 propensity score matching, postvaccination incidence of disturbance of smell and taste was significantly less likely after COVID-19 first series vaccine compared to influenza (odds ratios, OR: 0.27 [95% confidence interval, CI: 0.20-0.36]), TDAP (OR: 0.35 [95% CI: 0.26-0.47]), and pneumococcal vaccines (OR: 0.17 [95% CI: 0.09-0.32]). Similarly, incidence of disturbance of smell and taste was significantly less likely after COVID-19 booster vaccine compared to the influenza (OR: 0.60 [95% CI: 0.48-0.76]), TDAP (OR: 0.63 [95% CI: 0.47-0.85]), and pneumococcal vaccines (OR: 0.44 [95% CI: 0.28-0.68]). This study builds upon the literature demonstrating the safety of COVID-19 vaccination.
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Affiliation(s)
- Tyler J Gallagher
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Miti Parikh
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Kevin Herrera
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Matthew E Lin
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kevin Hur
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Welbeck A, Torres-Izquierdo B, Mittal MM, Momtaz D, Gonuguntla R, Guisse N, Hu J, Pereira DE, Hosseinzadeh P. Epidemiology of Pediatric Firearm Injuries in the United States: The Progression of Gunshot Injury Rates Through the Coronavirus Disease 2019 Pandemic. J Pediatr Orthop 2024; 44:545-554. [PMID: 38853750 DOI: 10.1097/bpo.0000000000002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
OBJECTIVES Ballistic injuries among pediatric populations have become a public health crisis in the United States. The surge in firearm injuries among children has outpaced other causes of death. This study aims to assess the trend in pediatric gunshot injuries (GSIs) over the last decade and investigate the impact, if any, of the pandemic on GSIs statistics. METHODS A comprehensive retrospective analysis was conducted using a federated, real-time national database. A total of 15,267,921 children without GSIs and 6261 children with GSIs between 2017 and 2023 were identified. The study evaluated the incidence and annual proportions of GSIs among different demographics. In addition, the incidence proportions per 100,000 for accidental, nonaccidental, fracture-related, and fatal GSIs were analyzed. RESULTS The incidence proportions per 100,000 for GSIs, accidental GSIs, nonaccidental GSIs, fatal GSIs, wheelchair-bound cases, and fracture-related GSIs increased significantly from 2017 to 2023, going from 9.7 to 22.8 (Relative Risk: 2.342, 95% CI: 2.041, 2.687 , P < 0.001). The overall increase was mostly a result of accidental GSI when compared with nonaccidental (incidence proportion 25.8 vs 2.1; P < 0.001) in 2021 at the height of the pandemic. In patients with an accidental GSI, the incidence proportion per 100k between 2017 and 2023 increased from 8.81 to 21.11 (Relative Risk: 2.397, 95% CI: 2.076, 2.768, P < 0.001). CONCLUSION The study supports the shift in the leading cause of death among children from motor vehicle accidents to GSIs, with the continued rise in rates despite the coronavirus disease 2019 pandemic. Accidental injuries constituted the majority of GSIs, indicating the need for enhanced gun safety measures, including requirements for gun storage, keeping firearms locked and unloaded, requiring child supervision in homes with guns, and enforcing stricter punishments as penalties. Comprehensive efforts are required to address this public health crisis. Pediatricians play a vital role in counseling and educating families on firearm safety. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Arakua Welbeck
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
| | | | - Mehul M Mittal
- Department of Orthopaedics, UT Southwestern Medical Center, Dallas, TX
| | - David Momtaz
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Rishi Gonuguntla
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Ndéye Guisse
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
| | - Jesse Hu
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
| | - Daniel E Pereira
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
| | - Pooya Hosseinzadeh
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
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147
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Chiang CH, Xu XH, Song J, Xanthavanij N, Chi KY, Chang YC, Chang Y, Hsiao CL, Hsia YP, Chiang CH, Lin S. The incidence and risk of cardiovascular events associated with pembrolizumab in patients with breast cancer. Cancer Lett 2024; 611:217277. [PMID: 39332590 DOI: 10.1016/j.canlet.2024.217277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/21/2024] [Accepted: 09/23/2024] [Indexed: 09/29/2024]
Affiliation(s)
- Cho-Han Chiang
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
| | - Xiaocao Haze Xu
- Division of Hematology and Oncology, Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Junmin Song
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nutchapon Xanthavanij
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Kuan-Yu Chi
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yu-Cheng Chang
- Department of Medicine, Danbury Hospital, Danbury, CT, USA
| | - Yu Chang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Lien Hsiao
- School of International and Public Affairs, Columbia University, New York, NY, USA
| | - Yuan Ping Hsia
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Cho-Hung Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Shuwen Lin
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA
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148
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Davis HA, Hoberg AA, Jacobus LS, Nepple K, Seaman AT, Sorensen J, Weiner GJ, Gilbertson-White S. Leveraging oncology collaborative networks and biomedical informatics data resources to rapidly recruit and enroll rural residents into oncology quality of life clinical trials. J Clin Transl Sci 2024; 8:e135. [PMID: 39345703 PMCID: PMC11428118 DOI: 10.1017/cts.2024.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 10/01/2024] Open
Abstract
Purpose This study assesses the feasibility of biomedical informatics resources for efficient recruitment of rural residents with cancer to a clinical trial of a quality-of-life (QOL) mobile app. These resources have the potential to reduce costly, time-consuming, in-person recruitment methods. Methods A cohort was identified from the electronic health record data repository and cross-referenced with patients who consented to additional research contact. Rural-urban commuting area codes were computed to identify rurality. Potential participants were emailed study details, screening questions, and an e-consent link via REDCap. Consented individuals received baseline questionnaires automatically. A sample minimum of n = 80 [n = 40 care as usual (CAU) n = 40 mobile app intervention] was needed. Results N = 1298 potential participants (n = 365 CAU; n = 833 intervention) were screened for eligibility. For CAU, 68 consented, 67 completed baseline questionnaires, and 54 completed follow-up questionnaires. For intervention, 100 consented, 97 completed baseline questionnaires, and 58 completed follow-up questionnaires. The CAU/intervention reached 82.5%/122.5% of the enrollment target within 2 days. Recruitment and retention rates were 15.3% and 57.5%, respectively. The mean age was 59.5 ± 13.5 years. The sample was 65% women, 20% racial/ethnic minority, and 35% resided in rural areas. Conclusion These results demonstrate that biomedical informatics resources can be highly effective in recruiting for cancer QOL research. Precisely identifying individuals likely to meet inclusion criteria who previously indicated interest in research participation expedited recruitment. Participants completed the consent and baseline questionnaires with zero follow-up contacts from the research team. This low-touch, repeatable process may be highly effective for multisite clinical trials research seeking to include rural residents.
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Affiliation(s)
- Heath A. Davis
- Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA, USA
- Carver College of Medicine IT, University of Iowa, Iowa City, IA, USA
| | - Asher A. Hoberg
- Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA, USA
- Carver College of Medicine IT, University of Iowa, Iowa City, IA, USA
| | - Laura S. Jacobus
- Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA, USA
- Vanderbilt Institute for Clinical & Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth Nepple
- Urology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Aaron T. Seaman
- Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Jamie Sorensen
- Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - George J. Weiner
- Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Stephanie Gilbertson-White
- Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Community & Primary Care, College of Nursing, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
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149
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Wu YC, Chen HH, Chao WC. Association between red blood cell distribution width and 30-day mortality in critically ill septic patients: a propensity score-matched study. J Intensive Care 2024; 12:34. [PMID: 39294760 PMCID: PMC11409593 DOI: 10.1186/s40560-024-00747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 08/28/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Sepsis is the leading cause of death worldwide, and a number of biomarkers have been developed for early mortality risk stratification. Red blood cell distribution width (RDW) is a routinely available hematological data and has been found to be associated with mortality in a number of diseases; therefore, we aim to address the association between RDW and mortality in critically ill patients with sepsis. METHODS We analyzed data of critically ill adult patients with sepsis on the TriNetX platform, excluding those with hematologic malignancies, thalassemia, and iron deficiency anemia. Propensity score-matching (PSM) (1:1) was used to mitigate confounding effects, and hazard ratio (HR) with 95% confidence (CI) was calculated to determine the association between RDW and 30-day mortality. We further conducted sensitivity analyses through using distinct cut-points of RDW and severities of sepsis. RESULTS A total of 256,387 critically ill septic patients were included in the analysis, and 40.0% of them had RDW equal to or higher than 16%. After PSM, we found that high RDW was associated with an increased 30-day mortality rate (HR: 1.887, 95% CI 1.847-1.928). The associations were consistent using distinct cut-points of RDW, with the strength of association using cut-points of 12%, 14%, 16%, 18% and 20% were 2.098, 2.204, 1.887, 1.809 and 1.932, respectively. Furthermore, we found consistent associations among critically ill septic patients with distinct severities, with the association among those with shock, receiving mechanical ventilation, bacteremia and requirement of hemodialysis being 1.731, 1.735, 2.380 and 1.979, respectively. CONCLUSION We found that RDW was associated with 30-day mortality in critically ill septic patients, underscoring the potential as a prognostic marker in sepsis. More studies are needed to explore the underlying mechanisms.
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Affiliation(s)
- Yu-Cheng Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- Doctoral Program in Translational Medicine, National Chung Hsing University, Taichung City, Taiwan
| | - Hsin-Hua Chen
- Division of Clinical Informatics, Center of Quality Management, Taichung Veterans General Hospital, Taichung City, Taiwan
- Department of post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung City, Taiwan
- Big Data Center, National Chung Hsing University, Taichung City, Taiwan
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan.
- Department of post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung City, Taiwan.
- Big Data Center, National Chung Hsing University, Taichung City, Taiwan.
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150
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Wang CA, Lin LC, Chen JY, Wang WJ, Wu VC. Exploring the mortality and cardiovascular outcomes with SGLT-2 inhibitors in patients with T2DM at dialysis commencement: a health global federated network analysis. Cardiovasc Diabetol 2024; 23:327. [PMID: 39227933 PMCID: PMC11373240 DOI: 10.1186/s12933-024-02424-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) have demonstrated associations with lowering cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). However, the impact of SGLT-2is on individuals at dialysis commencement remains unclear. The aim of this real-world study is to study the association between SGLT-2is and outcomes in patients with T2DM at dialysis commencement. METHODS This is a retrospective cohort study of electronic health records (EHRs) of patients with T2DM from TriNetX Research Network database between January 1, 2012, and January 1, 2024. New-users using intention to treatment design was employed and propensity score matching was utilized to select the cohort. Clinical outcomes included major adverse cardiac events (MACE) and all-cause mortality. Safety outcomes using ICD-10 codes, ketoacidosis, urinary tract infection (UTI) or genital infection, dehydration, bone fracture, below-knee amputation, hypoglycemia, and achieving dialysis-free status at 90 days and 90-day readmission. RESULTS Of 49,762 patients with T2DM who initiated dialysis for evaluation, a mere 1.57% of patients utilized SGLT-2is within 3 months after dialysis. 771 SGLT-2i users (age 63.3 ± 12.3 years, male 65.1%) were matched with 771 non-users (age 63.1 ± 12.9 years, male 65.8%). After a median follow-up of 2.0 (IQR 0.3-3.9) years, SGLT-2i users were associated with a lower risk of MACE (adjusted Hazard Ratio [aHR] = 0.52, p value < 0.001), all-cause mortality (aHR = 0.49, p < 0.001). SGLT-2i users were more likely to become dialysis-free 90 days after the index date (aHR = 0.49, p < 0.001). No significant differences were observed in the incidence of ketoacidosis, UTI or genital infection, hypoglycemia, dehydration, bone fractures, below-knee amputations, or 90-day readmissions. CONCLUSIONS Our findings indicated a lower incidence of all-cause mortality and MACE after long-term follow-up, along with a higher likelihood of achieving dialysis-free status at 90 days in SGLT-2i users. Importantly, they underscored the potential cardiovascular protection and safety of SGLT-2is use in T2DM patients at the onset of dialysis.
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Affiliation(s)
- Chung-An Wang
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Wei-Jie Wang
- Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Healthy and Welfare, Taoyuan, Taiwan
- Department of Biomedical Engineering, Chung Yuan Christian University, Chungli, Taiwan
| | - Vin-Cent Wu
- Primary Aldosteronism Center of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- National Taiwan University Hospital Study Group of Acute Renal Failure (NSARF), Consortium for Acute Kidney Injury and Renal Diseases, Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, Room 1555, B4, Clinical Research Building, 7 Chung-Shan South Road, Taipei, 100, Taiwan.
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