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Anti-TNF certolizumab pegol effective in early RA
Anti-TNF drug certolizumab pegol in combination with methotrexate achieves significantly better outcomes in early active rheumatoid arthritis than does methotrexate alone, according to researchers.
They conducted a randomized, double-blind, placebo-controlled phase III trial of certolizumab pegol (CZP) in combination with dose-optimized methotrexate (MTX) versus dose-optimized methotrexate and placebo (PBO) in 879 treatment-naive patients with moderate to severe, active, progressive RA, and with poor prognostic factors.
After 1 year of treatment, 28.9% of the 660 patients who received the CZP and MTX combination had achieved sustained remission, compared with 15% of the 219 patients in the PBO+MTX group (P less than .001) (Ann Rheum Dis. 2016 May 10. doi: 10.1136/annrheumdis-2015-209057).
The study also found that 43.8% of patients in the treatment arm achieved sustained low disease activity, compared with 28.6% of the control arm (P less than .001). Adjustment for withdrawals in each arm did not significantly bias the results.
CZP with MTX has shown efficacy both in patients with established RA who have shown an insufficient response to MTX alone, and in MTX-naive individuals with early RA, which the authors said justified further study in recently-diagnosed individuals.
“These data demonstrate that CZP+MTX combination therapy results in a significantly higher proportion of patients achieving sREM [sustained remission] than those treated with PBO+MTX, even when using a ‘treat-to-tolerance’ dosing strategy for MTX,” wrote Dr. Paul Emery of Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds, England, and coauthors.
“Consequently, for patients with poor prognostic factors for severe disease progression, treating early and aggressively may represent a unique opportunity to achieve maximal clinical benefit.”
Significantly more patients treated with CZP and MTX than with PBO achieved an ACR50 response (61.8% vs. 52.6%, P = .023), signifying at least a 50% improvement in the number of tender and swollen joints, and in the patient assessments of disease status, pain, and function.
Patients in the active group also showed greater improvements in physical function, as measured by the Health Assessment Questionnaire–Disability Index, and significantly less radiographic progression. Researchers noted that patients in the active arm of the study showed less joint erosion and less joint space narrowing compared with those in the placebo arm.
“The analysis of radiographic data in C-EARLY demonstrates that CZP+MTX therapy can inhibit structural damage significantly more than MTX alone – the percentage of patients with radiographic nonprogression was significantly higher in the CZP+MTX group compared with the PBO+MTX group,” the authors reported.
The incidence of adverse events was similar in both groups, with nausea, upper respiratory tract infection, urinary tract infection, nasopharyngitis, headache, and increased levels of alanine aminotransferase the most commonly reported events in the active arm.
One death in a patient taking CZP and MTX was caused by disseminated, noncharacterized, mycobacterium infection, which the investigators considered to be related to the study medication. However, the overall rates of serious adverse events and withdrawals due to adverse events were similar between both arms of the study.
Patients given CZP began on a dose of 400 mg at baseline, week 2 and week 4, then 200 mg every 2 weeks until week 52, while the dose of oral MTX used in the study was titrated up from an initial dose of 10 mg/week by 5 mg every 2 weeks, to a maximum of 25 mg/week by week 8.
The authors suggested that the methotrexate titration was an important part of the treatment because it ensured each patient received the maximum-tolerated dose within 8 weeks.
“To our knowledge, there are no previous studies in MTX-naive or DMARD-naive patients with RA where MTX doses have been optimized per-protocol to the levels achieved in C-EARLY,” they wrote. “This optimization may have been responsible, in part, for the response observed for the PBO+MTX and CZP+MTX arms.”
The study and manuscript development was sponsored by UCB Pharma, which also signed off on the manuscript after a review. The authors declared consultancy, speaker’s fees, grants and other funding from a range of pharmaceutical companies including UCB Pharma, and five authors were employees of UCB Pharma.
Anti-TNF drug certolizumab pegol in combination with methotrexate achieves significantly better outcomes in early active rheumatoid arthritis than does methotrexate alone, according to researchers.
They conducted a randomized, double-blind, placebo-controlled phase III trial of certolizumab pegol (CZP) in combination with dose-optimized methotrexate (MTX) versus dose-optimized methotrexate and placebo (PBO) in 879 treatment-naive patients with moderate to severe, active, progressive RA, and with poor prognostic factors.
After 1 year of treatment, 28.9% of the 660 patients who received the CZP and MTX combination had achieved sustained remission, compared with 15% of the 219 patients in the PBO+MTX group (P less than .001) (Ann Rheum Dis. 2016 May 10. doi: 10.1136/annrheumdis-2015-209057).
The study also found that 43.8% of patients in the treatment arm achieved sustained low disease activity, compared with 28.6% of the control arm (P less than .001). Adjustment for withdrawals in each arm did not significantly bias the results.
CZP with MTX has shown efficacy both in patients with established RA who have shown an insufficient response to MTX alone, and in MTX-naive individuals with early RA, which the authors said justified further study in recently-diagnosed individuals.
“These data demonstrate that CZP+MTX combination therapy results in a significantly higher proportion of patients achieving sREM [sustained remission] than those treated with PBO+MTX, even when using a ‘treat-to-tolerance’ dosing strategy for MTX,” wrote Dr. Paul Emery of Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds, England, and coauthors.
“Consequently, for patients with poor prognostic factors for severe disease progression, treating early and aggressively may represent a unique opportunity to achieve maximal clinical benefit.”
Significantly more patients treated with CZP and MTX than with PBO achieved an ACR50 response (61.8% vs. 52.6%, P = .023), signifying at least a 50% improvement in the number of tender and swollen joints, and in the patient assessments of disease status, pain, and function.
Patients in the active group also showed greater improvements in physical function, as measured by the Health Assessment Questionnaire–Disability Index, and significantly less radiographic progression. Researchers noted that patients in the active arm of the study showed less joint erosion and less joint space narrowing compared with those in the placebo arm.
“The analysis of radiographic data in C-EARLY demonstrates that CZP+MTX therapy can inhibit structural damage significantly more than MTX alone – the percentage of patients with radiographic nonprogression was significantly higher in the CZP+MTX group compared with the PBO+MTX group,” the authors reported.
The incidence of adverse events was similar in both groups, with nausea, upper respiratory tract infection, urinary tract infection, nasopharyngitis, headache, and increased levels of alanine aminotransferase the most commonly reported events in the active arm.
One death in a patient taking CZP and MTX was caused by disseminated, noncharacterized, mycobacterium infection, which the investigators considered to be related to the study medication. However, the overall rates of serious adverse events and withdrawals due to adverse events were similar between both arms of the study.
Patients given CZP began on a dose of 400 mg at baseline, week 2 and week 4, then 200 mg every 2 weeks until week 52, while the dose of oral MTX used in the study was titrated up from an initial dose of 10 mg/week by 5 mg every 2 weeks, to a maximum of 25 mg/week by week 8.
The authors suggested that the methotrexate titration was an important part of the treatment because it ensured each patient received the maximum-tolerated dose within 8 weeks.
“To our knowledge, there are no previous studies in MTX-naive or DMARD-naive patients with RA where MTX doses have been optimized per-protocol to the levels achieved in C-EARLY,” they wrote. “This optimization may have been responsible, in part, for the response observed for the PBO+MTX and CZP+MTX arms.”
The study and manuscript development was sponsored by UCB Pharma, which also signed off on the manuscript after a review. The authors declared consultancy, speaker’s fees, grants and other funding from a range of pharmaceutical companies including UCB Pharma, and five authors were employees of UCB Pharma.
Anti-TNF drug certolizumab pegol in combination with methotrexate achieves significantly better outcomes in early active rheumatoid arthritis than does methotrexate alone, according to researchers.
They conducted a randomized, double-blind, placebo-controlled phase III trial of certolizumab pegol (CZP) in combination with dose-optimized methotrexate (MTX) versus dose-optimized methotrexate and placebo (PBO) in 879 treatment-naive patients with moderate to severe, active, progressive RA, and with poor prognostic factors.
After 1 year of treatment, 28.9% of the 660 patients who received the CZP and MTX combination had achieved sustained remission, compared with 15% of the 219 patients in the PBO+MTX group (P less than .001) (Ann Rheum Dis. 2016 May 10. doi: 10.1136/annrheumdis-2015-209057).
The study also found that 43.8% of patients in the treatment arm achieved sustained low disease activity, compared with 28.6% of the control arm (P less than .001). Adjustment for withdrawals in each arm did not significantly bias the results.
CZP with MTX has shown efficacy both in patients with established RA who have shown an insufficient response to MTX alone, and in MTX-naive individuals with early RA, which the authors said justified further study in recently-diagnosed individuals.
“These data demonstrate that CZP+MTX combination therapy results in a significantly higher proportion of patients achieving sREM [sustained remission] than those treated with PBO+MTX, even when using a ‘treat-to-tolerance’ dosing strategy for MTX,” wrote Dr. Paul Emery of Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds, England, and coauthors.
“Consequently, for patients with poor prognostic factors for severe disease progression, treating early and aggressively may represent a unique opportunity to achieve maximal clinical benefit.”
Significantly more patients treated with CZP and MTX than with PBO achieved an ACR50 response (61.8% vs. 52.6%, P = .023), signifying at least a 50% improvement in the number of tender and swollen joints, and in the patient assessments of disease status, pain, and function.
Patients in the active group also showed greater improvements in physical function, as measured by the Health Assessment Questionnaire–Disability Index, and significantly less radiographic progression. Researchers noted that patients in the active arm of the study showed less joint erosion and less joint space narrowing compared with those in the placebo arm.
“The analysis of radiographic data in C-EARLY demonstrates that CZP+MTX therapy can inhibit structural damage significantly more than MTX alone – the percentage of patients with radiographic nonprogression was significantly higher in the CZP+MTX group compared with the PBO+MTX group,” the authors reported.
The incidence of adverse events was similar in both groups, with nausea, upper respiratory tract infection, urinary tract infection, nasopharyngitis, headache, and increased levels of alanine aminotransferase the most commonly reported events in the active arm.
One death in a patient taking CZP and MTX was caused by disseminated, noncharacterized, mycobacterium infection, which the investigators considered to be related to the study medication. However, the overall rates of serious adverse events and withdrawals due to adverse events were similar between both arms of the study.
Patients given CZP began on a dose of 400 mg at baseline, week 2 and week 4, then 200 mg every 2 weeks until week 52, while the dose of oral MTX used in the study was titrated up from an initial dose of 10 mg/week by 5 mg every 2 weeks, to a maximum of 25 mg/week by week 8.
The authors suggested that the methotrexate titration was an important part of the treatment because it ensured each patient received the maximum-tolerated dose within 8 weeks.
“To our knowledge, there are no previous studies in MTX-naive or DMARD-naive patients with RA where MTX doses have been optimized per-protocol to the levels achieved in C-EARLY,” they wrote. “This optimization may have been responsible, in part, for the response observed for the PBO+MTX and CZP+MTX arms.”
The study and manuscript development was sponsored by UCB Pharma, which also signed off on the manuscript after a review. The authors declared consultancy, speaker’s fees, grants and other funding from a range of pharmaceutical companies including UCB Pharma, and five authors were employees of UCB Pharma.
FROM ANNALS OF THE RHEUMATIC DISEASES
Key clinical point: Certolizumab pegol and methotrexate is more efficacious than methotrexate alone in treatment-naive individuals with early active rheumatoid arthritis.
Major finding: After 1 year of treatment, 28.9% of the 660 patients who received the certolizumab pegol and methotrexate combination had achieved sustained remission, compared with 15% of the 219 patients in the methotrexate and placebo group.
Data source: A randomized, double-blind, placebo-controlled phase III trial of 879 treatment-naive patients with moderate to severe, active, progressive rheumatoid arthritis.
Disclosures: The study and manuscript development was sponsored by UCB Pharma, which also signed off on the manuscript after a review. The authors declared consultancy, speaker fees, grants, and other funding from a range of pharmaceutical companies including UCB Pharma, and five authors were employees of UCB Pharma.
HIV-1 antibody shows clearance of virus and infected cells
An antibody that targets and neutralizes HIV’s CD4 binding site across a broad range of viral strains could be a new treatment option for the disease, according to two papers published online May 20 in Science.
In a phase I trial, researchers saw an enhanced antibody response over 6 months in 15 viremic HIV-1 infected individuals given a single injection of the broadly neutralizing antibody 3BNC117, compared with untreated controls, suggesting the immunotherapy may enhance the immune response against HIV-1.
“The absolute change in neutralizing activity varied between viruses and individuals, ranging from small effects to dramatic increases,” wrote Dr. Till Schoofs, from the Laboratory of Molecular Immunology at Rockefeller University, New York, and coauthors.
The antibody was also given to 12 individuals on antiretroviral therapy, with no detectable or very low viremia, with the result being a significantly less pronounced increase in neutralizing activity, compared with that seen in the non–ART treated individuals (Science. 2016 May 20. doi: 10.1126/science.aaf0972).
In a second paper, the same group of researchers analyzed the abundance of the antibody and viral load decline in the treated individuals and attempted to explain why their study observations did not fit with predictions.
Their modeling suggested that not only was the antibody binding to free virus particles but was also clearing HIV-1 infected cells.
They confirmed this with a study in HIV-1 infected mice, which showed treatment with the antibody was associated with accelerated clearance of HIV-infected cells, and in cells infected with patient isolates where the antibody achieved accelerated clearance of HIV-infected CD4+ T cells (Science. 2016 May 20. doi: 10.1126/science.aaf1279).
“Our mathematical analysis of patient data, and the antibody-mediated reduction in infected cells seen in adoptive transfer experiments establish that bNAbs [broadly neutralizing antibodies] alter the half-life of infected cells,” wrote Ching-Lan Lu, from the Laboratory of Molecular Immunology at Rockefeller University, New York, and coauthors.
“The finding that antibodies can clear infected cells in vivo has significant implications for therapies aimed at HIV prevention and viral reservoir reduction or elimination.”
The first study was supported by the Bill and Melinda Gates Foundation Collaboration for AIDS Vaccine Discovery, the Robertson Foundation, NIH Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery, the University of Pennsylvania Center for AIDS Research, the National Institutes of Health, and HIVRAD.
The second study was supported by Collaboration for AIDS Vaccine Discovery, the National Center for Advancing Translational Sciences; NIH Clinical and Translational Science Award, the NIH Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery, the Bill and Melinda Gates Foundation, the Robertson Foundation, the German Research Foundation, the American Foundation for AIDS research, the Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, Harvard, and the National Institute of Allergy and Infectious Diseases.
One author from both studies is an inventor on a pending patent for 3BNC117 by Rockefeller University, New York.
An antibody that targets and neutralizes HIV’s CD4 binding site across a broad range of viral strains could be a new treatment option for the disease, according to two papers published online May 20 in Science.
In a phase I trial, researchers saw an enhanced antibody response over 6 months in 15 viremic HIV-1 infected individuals given a single injection of the broadly neutralizing antibody 3BNC117, compared with untreated controls, suggesting the immunotherapy may enhance the immune response against HIV-1.
“The absolute change in neutralizing activity varied between viruses and individuals, ranging from small effects to dramatic increases,” wrote Dr. Till Schoofs, from the Laboratory of Molecular Immunology at Rockefeller University, New York, and coauthors.
The antibody was also given to 12 individuals on antiretroviral therapy, with no detectable or very low viremia, with the result being a significantly less pronounced increase in neutralizing activity, compared with that seen in the non–ART treated individuals (Science. 2016 May 20. doi: 10.1126/science.aaf0972).
In a second paper, the same group of researchers analyzed the abundance of the antibody and viral load decline in the treated individuals and attempted to explain why their study observations did not fit with predictions.
Their modeling suggested that not only was the antibody binding to free virus particles but was also clearing HIV-1 infected cells.
They confirmed this with a study in HIV-1 infected mice, which showed treatment with the antibody was associated with accelerated clearance of HIV-infected cells, and in cells infected with patient isolates where the antibody achieved accelerated clearance of HIV-infected CD4+ T cells (Science. 2016 May 20. doi: 10.1126/science.aaf1279).
“Our mathematical analysis of patient data, and the antibody-mediated reduction in infected cells seen in adoptive transfer experiments establish that bNAbs [broadly neutralizing antibodies] alter the half-life of infected cells,” wrote Ching-Lan Lu, from the Laboratory of Molecular Immunology at Rockefeller University, New York, and coauthors.
“The finding that antibodies can clear infected cells in vivo has significant implications for therapies aimed at HIV prevention and viral reservoir reduction or elimination.”
The first study was supported by the Bill and Melinda Gates Foundation Collaboration for AIDS Vaccine Discovery, the Robertson Foundation, NIH Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery, the University of Pennsylvania Center for AIDS Research, the National Institutes of Health, and HIVRAD.
The second study was supported by Collaboration for AIDS Vaccine Discovery, the National Center for Advancing Translational Sciences; NIH Clinical and Translational Science Award, the NIH Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery, the Bill and Melinda Gates Foundation, the Robertson Foundation, the German Research Foundation, the American Foundation for AIDS research, the Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, Harvard, and the National Institute of Allergy and Infectious Diseases.
One author from both studies is an inventor on a pending patent for 3BNC117 by Rockefeller University, New York.
An antibody that targets and neutralizes HIV’s CD4 binding site across a broad range of viral strains could be a new treatment option for the disease, according to two papers published online May 20 in Science.
In a phase I trial, researchers saw an enhanced antibody response over 6 months in 15 viremic HIV-1 infected individuals given a single injection of the broadly neutralizing antibody 3BNC117, compared with untreated controls, suggesting the immunotherapy may enhance the immune response against HIV-1.
“The absolute change in neutralizing activity varied between viruses and individuals, ranging from small effects to dramatic increases,” wrote Dr. Till Schoofs, from the Laboratory of Molecular Immunology at Rockefeller University, New York, and coauthors.
The antibody was also given to 12 individuals on antiretroviral therapy, with no detectable or very low viremia, with the result being a significantly less pronounced increase in neutralizing activity, compared with that seen in the non–ART treated individuals (Science. 2016 May 20. doi: 10.1126/science.aaf0972).
In a second paper, the same group of researchers analyzed the abundance of the antibody and viral load decline in the treated individuals and attempted to explain why their study observations did not fit with predictions.
Their modeling suggested that not only was the antibody binding to free virus particles but was also clearing HIV-1 infected cells.
They confirmed this with a study in HIV-1 infected mice, which showed treatment with the antibody was associated with accelerated clearance of HIV-infected cells, and in cells infected with patient isolates where the antibody achieved accelerated clearance of HIV-infected CD4+ T cells (Science. 2016 May 20. doi: 10.1126/science.aaf1279).
“Our mathematical analysis of patient data, and the antibody-mediated reduction in infected cells seen in adoptive transfer experiments establish that bNAbs [broadly neutralizing antibodies] alter the half-life of infected cells,” wrote Ching-Lan Lu, from the Laboratory of Molecular Immunology at Rockefeller University, New York, and coauthors.
“The finding that antibodies can clear infected cells in vivo has significant implications for therapies aimed at HIV prevention and viral reservoir reduction or elimination.”
The first study was supported by the Bill and Melinda Gates Foundation Collaboration for AIDS Vaccine Discovery, the Robertson Foundation, NIH Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery, the University of Pennsylvania Center for AIDS Research, the National Institutes of Health, and HIVRAD.
The second study was supported by Collaboration for AIDS Vaccine Discovery, the National Center for Advancing Translational Sciences; NIH Clinical and Translational Science Award, the NIH Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery, the Bill and Melinda Gates Foundation, the Robertson Foundation, the German Research Foundation, the American Foundation for AIDS research, the Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, Harvard, and the National Institute of Allergy and Infectious Diseases.
One author from both studies is an inventor on a pending patent for 3BNC117 by Rockefeller University, New York.
FROM SCIENCE
Key clinical point: A broadly neutralizing antibody against HIV-1 could accelerate clearance of both free virus and infected cells.
Major finding: A single injection of a broadly neutralizing antibody against HIV-1 led to a significant antibody response over 6 months in HIV-1 infected individuals with viremia.
Data source: A phase I controlled trial in 15 HIV-1 infected individuals with viremia.
Disclosures: The first study was supported by the Bill and Melinda Gates Foundation Collaboration for AIDS Vaccine Discovery, the Robertson Foundation, NIH Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery, the University of Pennsylvania Center for AIDS Research, the National Institutes of Health, and HIVRAD. The second study was supported by Collaboration for AIDS Vaccine Discovery, the National Center for Advancing Translational Sciences; NIH Clinical and Translational Science Award, the NIH Center for HIV/AIDS Vaccine Immunology and Immunogen Discover, the Bill and Melinda Gates Foundation, the Robertson Foundation, the German Research Foundation, the American Foundation for AIDS research, the Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, Harvard, and the National Institute of Allergy and Infectious Diseases. One author from both studies is an inventor on a pending patent for 3BNC117 by Rockefeller University, New York.
Chronic HCV boosts hospitalization risk, not just for liver
People with chronic hepatitis C infection were nearly four times more likely than other health system patients to be hospitalized, and not only with liver-related problems.
An observational cohort study of 10,131 patients with chronic hepatitis C infection (the Chronic Hepatitis Cohort Study) and 20,262 health system patients showed the overall hospitalization rate was 3.7 times higher in patients with chronic hepatitis C.
The study, published online May 15 in the Journal of Viral Hepatitis, found patients with chronic hepatitis C experienced an average of 3.5 hospitalizations over a mean of 5.5 years follow-up, compared with 1.9 hospitalizations in other patients over an average of 4.8 years. Investigators excluded HCV patients with HIV or hepatitis B coinfection, or who had received a liver transplant.
Hospitalization rates in both groups were significantly higher among patients who were older than 65 years, black, or who had a household income less than $15,000 per year (J Viral Hepat. 2016 May 15. doi: 10.1111/jvh.12548).
Patients with chronic hepatitis C had a nearly 25-fold greater risk of being hospitalized with liver-related conditions, compared with other health system patients.
“Liver-related conditions are the third leading cause of nonsurgical hospitalizations of chronic HCV patients after cardiovascular diseases and infections,” wrote Dr. E. H. Teshale, from the division of viral hepatitis at the Centers for Disease Control and Prevention, Atlanta, and coauthors.
However liver-related complications only accounted for 9.1% of all hospitalizations in this group, compared with 1.3% of hospitalizations in the control group.
The analysis also revealed a sixfold greater risk of hospitalization for infection, a sevenfold greater risk for dermatologic and hematologic problems, a 10-fold greater risk of hospitalization for substance abuse, and a nearly threefold greater risk of being hospitalized for cardiovascular disease, compared with other health system patients.
Hospitalizations were significantly lower among patients receiving treatment for hepatitis C and who had achieved a sustained virologic response, the authors noted.
“Initiation of treatment prior to progression to advanced liver disease can reduce the cost of hospitalization, which in many cases may include repeated hospitalizations and other costly interventions,” the investigators reported. “Some studies have found a significant health care cost alleviation following HCV therapy, which [was] primarily due to costs associated with hospitalizations for non-HCV–related comorbidities.”
The Chronic Hepatitis Cohort Study was funded by the CDC Foundation, which receives grants from a range of pharmaceutical companies. No other conflicts of interest were declared.
People with chronic hepatitis C infection were nearly four times more likely than other health system patients to be hospitalized, and not only with liver-related problems.
An observational cohort study of 10,131 patients with chronic hepatitis C infection (the Chronic Hepatitis Cohort Study) and 20,262 health system patients showed the overall hospitalization rate was 3.7 times higher in patients with chronic hepatitis C.
The study, published online May 15 in the Journal of Viral Hepatitis, found patients with chronic hepatitis C experienced an average of 3.5 hospitalizations over a mean of 5.5 years follow-up, compared with 1.9 hospitalizations in other patients over an average of 4.8 years. Investigators excluded HCV patients with HIV or hepatitis B coinfection, or who had received a liver transplant.
Hospitalization rates in both groups were significantly higher among patients who were older than 65 years, black, or who had a household income less than $15,000 per year (J Viral Hepat. 2016 May 15. doi: 10.1111/jvh.12548).
Patients with chronic hepatitis C had a nearly 25-fold greater risk of being hospitalized with liver-related conditions, compared with other health system patients.
“Liver-related conditions are the third leading cause of nonsurgical hospitalizations of chronic HCV patients after cardiovascular diseases and infections,” wrote Dr. E. H. Teshale, from the division of viral hepatitis at the Centers for Disease Control and Prevention, Atlanta, and coauthors.
However liver-related complications only accounted for 9.1% of all hospitalizations in this group, compared with 1.3% of hospitalizations in the control group.
The analysis also revealed a sixfold greater risk of hospitalization for infection, a sevenfold greater risk for dermatologic and hematologic problems, a 10-fold greater risk of hospitalization for substance abuse, and a nearly threefold greater risk of being hospitalized for cardiovascular disease, compared with other health system patients.
Hospitalizations were significantly lower among patients receiving treatment for hepatitis C and who had achieved a sustained virologic response, the authors noted.
“Initiation of treatment prior to progression to advanced liver disease can reduce the cost of hospitalization, which in many cases may include repeated hospitalizations and other costly interventions,” the investigators reported. “Some studies have found a significant health care cost alleviation following HCV therapy, which [was] primarily due to costs associated with hospitalizations for non-HCV–related comorbidities.”
The Chronic Hepatitis Cohort Study was funded by the CDC Foundation, which receives grants from a range of pharmaceutical companies. No other conflicts of interest were declared.
People with chronic hepatitis C infection were nearly four times more likely than other health system patients to be hospitalized, and not only with liver-related problems.
An observational cohort study of 10,131 patients with chronic hepatitis C infection (the Chronic Hepatitis Cohort Study) and 20,262 health system patients showed the overall hospitalization rate was 3.7 times higher in patients with chronic hepatitis C.
The study, published online May 15 in the Journal of Viral Hepatitis, found patients with chronic hepatitis C experienced an average of 3.5 hospitalizations over a mean of 5.5 years follow-up, compared with 1.9 hospitalizations in other patients over an average of 4.8 years. Investigators excluded HCV patients with HIV or hepatitis B coinfection, or who had received a liver transplant.
Hospitalization rates in both groups were significantly higher among patients who were older than 65 years, black, or who had a household income less than $15,000 per year (J Viral Hepat. 2016 May 15. doi: 10.1111/jvh.12548).
Patients with chronic hepatitis C had a nearly 25-fold greater risk of being hospitalized with liver-related conditions, compared with other health system patients.
“Liver-related conditions are the third leading cause of nonsurgical hospitalizations of chronic HCV patients after cardiovascular diseases and infections,” wrote Dr. E. H. Teshale, from the division of viral hepatitis at the Centers for Disease Control and Prevention, Atlanta, and coauthors.
However liver-related complications only accounted for 9.1% of all hospitalizations in this group, compared with 1.3% of hospitalizations in the control group.
The analysis also revealed a sixfold greater risk of hospitalization for infection, a sevenfold greater risk for dermatologic and hematologic problems, a 10-fold greater risk of hospitalization for substance abuse, and a nearly threefold greater risk of being hospitalized for cardiovascular disease, compared with other health system patients.
Hospitalizations were significantly lower among patients receiving treatment for hepatitis C and who had achieved a sustained virologic response, the authors noted.
“Initiation of treatment prior to progression to advanced liver disease can reduce the cost of hospitalization, which in many cases may include repeated hospitalizations and other costly interventions,” the investigators reported. “Some studies have found a significant health care cost alleviation following HCV therapy, which [was] primarily due to costs associated with hospitalizations for non-HCV–related comorbidities.”
The Chronic Hepatitis Cohort Study was funded by the CDC Foundation, which receives grants from a range of pharmaceutical companies. No other conflicts of interest were declared.
FROM THE JOURNAL OF VIRAL HEPATITIS
Key clinical point: Individuals with chronic hepatitis C infection have significantly greater risk of hospitalization for a range of health issues than other health system patients.
Major finding: The risk of hospitalization was 3.7 times greater in individuals with chronic hepatitis C infection, compared with general health system patients.
Data source: An observational cohort study in 10,131 patients with chronic hepatitis C infection (the Chronic Hepatitis Cohort Study) and 20,262 other health system patients.
Disclosures: The Chronic Hepatitis Cohort Study was funded by the CDC Foundation, which receives grants from a range of pharmaceutical companies. No other conflicts of interest were declared.
Youth Concussion Symptoms Vary Across Competition Levels
High school football athletes have more concussion-related symptoms than either college or youth football athletes, and have the highest proportion of concussions for which athletes are kept from play for at least 30 days, according to injury surveillance data published online May 2 in JAMA Pediatrics.
Researchers analyzed data on 1,429 sports-related concussions, collected by three injury surveillance programs, finding that high school football players with concussions showed the highest mean number of reported symptoms (5.60), followed by college athletes (5.56) and youth (4.76).
“Our findings suggest an association between level of competition and these outcomes, and highlight the need for future research to continue exploring how the epidemiology of sports-related concussion varies across the lifespan,” wrote Zachary Y. Kerr, Ph.D., of the Datalys Center for Sports Injury Research and Prevention, Indianapolis, and his coauthors.
Overall, 15.5% of concussions resulted in the athlete being returned to play after at least 30 days, and 3.1% of athletes with concussion returned to play less than 24 hours after the concussion.
“In youth football, 1 in10 athletes with concussions returned to play less than 24 hours after injury,” the authors reported. “Such findings may be the result of athletes presenting with delayed concussion symptoms, disagreement between athletic trainers and physicians, or difficulty of youth in reporting symptoms.”
The odds of return to play at least 30 days after injury were significantly higher in high school athletes (odd ratio, 2.89) and youth athletes (OR, 2.75), compared with college athletes (JAMA Pediatrics. 2016 May 2. doi: 10.1001/jamapediatrics.2016.0073).
The mean number of concussion symptoms reported was 5.48, with the most common symptoms being headache (94.3%), dizziness (75.0%), and difficulty concentrating (60.5%). The authors noted that very few concussions in any level of play resulted in loss of consciousness, pointing out that this further highlighted the limited utility of that symptom in diagnosis.
Neurocognitive symptoms such as difficulty concentrating and excess drowsiness were more common in high school than in youth athletes, while both high school and college athletes reported a higher mean number of sleep symptoms than did youth athletes.
“These data provide the most common symptoms across levels of play, providing clinicians some guidance as to which symptoms should be minimally included in an assessment,” the authors wrote.
The study was supported by USA Football, the National Athletic Trainers’ Association Research and Education Foundation, BioCrossroads in partnership with the Central Indiana Corporate Partnership Foundation, and the National Collegiate Athletic Association. No financial conflicts of interest were reported.
High school football athletes have more concussion-related symptoms than either college or youth football athletes, and have the highest proportion of concussions for which athletes are kept from play for at least 30 days, according to injury surveillance data published online May 2 in JAMA Pediatrics.
Researchers analyzed data on 1,429 sports-related concussions, collected by three injury surveillance programs, finding that high school football players with concussions showed the highest mean number of reported symptoms (5.60), followed by college athletes (5.56) and youth (4.76).
“Our findings suggest an association between level of competition and these outcomes, and highlight the need for future research to continue exploring how the epidemiology of sports-related concussion varies across the lifespan,” wrote Zachary Y. Kerr, Ph.D., of the Datalys Center for Sports Injury Research and Prevention, Indianapolis, and his coauthors.
Overall, 15.5% of concussions resulted in the athlete being returned to play after at least 30 days, and 3.1% of athletes with concussion returned to play less than 24 hours after the concussion.
“In youth football, 1 in10 athletes with concussions returned to play less than 24 hours after injury,” the authors reported. “Such findings may be the result of athletes presenting with delayed concussion symptoms, disagreement between athletic trainers and physicians, or difficulty of youth in reporting symptoms.”
The odds of return to play at least 30 days after injury were significantly higher in high school athletes (odd ratio, 2.89) and youth athletes (OR, 2.75), compared with college athletes (JAMA Pediatrics. 2016 May 2. doi: 10.1001/jamapediatrics.2016.0073).
The mean number of concussion symptoms reported was 5.48, with the most common symptoms being headache (94.3%), dizziness (75.0%), and difficulty concentrating (60.5%). The authors noted that very few concussions in any level of play resulted in loss of consciousness, pointing out that this further highlighted the limited utility of that symptom in diagnosis.
Neurocognitive symptoms such as difficulty concentrating and excess drowsiness were more common in high school than in youth athletes, while both high school and college athletes reported a higher mean number of sleep symptoms than did youth athletes.
“These data provide the most common symptoms across levels of play, providing clinicians some guidance as to which symptoms should be minimally included in an assessment,” the authors wrote.
The study was supported by USA Football, the National Athletic Trainers’ Association Research and Education Foundation, BioCrossroads in partnership with the Central Indiana Corporate Partnership Foundation, and the National Collegiate Athletic Association. No financial conflicts of interest were reported.
High school football athletes have more concussion-related symptoms than either college or youth football athletes, and have the highest proportion of concussions for which athletes are kept from play for at least 30 days, according to injury surveillance data published online May 2 in JAMA Pediatrics.
Researchers analyzed data on 1,429 sports-related concussions, collected by three injury surveillance programs, finding that high school football players with concussions showed the highest mean number of reported symptoms (5.60), followed by college athletes (5.56) and youth (4.76).
“Our findings suggest an association between level of competition and these outcomes, and highlight the need for future research to continue exploring how the epidemiology of sports-related concussion varies across the lifespan,” wrote Zachary Y. Kerr, Ph.D., of the Datalys Center for Sports Injury Research and Prevention, Indianapolis, and his coauthors.
Overall, 15.5% of concussions resulted in the athlete being returned to play after at least 30 days, and 3.1% of athletes with concussion returned to play less than 24 hours after the concussion.
“In youth football, 1 in10 athletes with concussions returned to play less than 24 hours after injury,” the authors reported. “Such findings may be the result of athletes presenting with delayed concussion symptoms, disagreement between athletic trainers and physicians, or difficulty of youth in reporting symptoms.”
The odds of return to play at least 30 days after injury were significantly higher in high school athletes (odd ratio, 2.89) and youth athletes (OR, 2.75), compared with college athletes (JAMA Pediatrics. 2016 May 2. doi: 10.1001/jamapediatrics.2016.0073).
The mean number of concussion symptoms reported was 5.48, with the most common symptoms being headache (94.3%), dizziness (75.0%), and difficulty concentrating (60.5%). The authors noted that very few concussions in any level of play resulted in loss of consciousness, pointing out that this further highlighted the limited utility of that symptom in diagnosis.
Neurocognitive symptoms such as difficulty concentrating and excess drowsiness were more common in high school than in youth athletes, while both high school and college athletes reported a higher mean number of sleep symptoms than did youth athletes.
“These data provide the most common symptoms across levels of play, providing clinicians some guidance as to which symptoms should be minimally included in an assessment,” the authors wrote.
The study was supported by USA Football, the National Athletic Trainers’ Association Research and Education Foundation, BioCrossroads in partnership with the Central Indiana Corporate Partnership Foundation, and the National Collegiate Athletic Association. No financial conflicts of interest were reported.
FROM JAMA PEDIATRICS
Youth concussion symptoms vary across competition levels
High school football athletes have more concussion-related symptoms than either college or youth football athletes, and have the highest proportion of concussions for which athletes are kept from play for at least 30 days, according to injury surveillance data published online May 2 in JAMA Pediatrics.
Researchers analyzed data on 1,429 sports-related concussions, collected by three injury surveillance programs, finding that high school football players with concussions showed the highest mean number of reported symptoms (5.60), followed by college athletes (5.56) and youth (4.76).
“Our findings suggest an association between level of competition and these outcomes, and highlight the need for future research to continue exploring how the epidemiology of sports-related concussion varies across the lifespan,” wrote Zachary Y. Kerr, Ph.D., of the Datalys Center for Sports Injury Research and Prevention, Indianapolis, and his coauthors.
Overall, 15.5% of concussions resulted in the athlete being returned to play after at least 30 days, and 3.1% of athletes with concussion returned to play less than 24 hours after the concussion.
“In youth football, 1 in10 athletes with concussions returned to play less than 24 hours after injury,” the authors reported. “Such findings may be the result of athletes presenting with delayed concussion symptoms, disagreement between athletic trainers and physicians, or difficulty of youth in reporting symptoms.”
The odds of return to play at least 30 days after injury were significantly higher in high school athletes (odd ratio, 2.89) and youth athletes (OR, 2.75), compared with college athletes (JAMA Pediatrics. 2016 May 2. doi: 10.1001/jamapediatrics.2016.0073).
The mean number of concussion symptoms reported was 5.48, with the most common symptoms being headache (94.3%), dizziness (75.0%), and difficulty concentrating (60.5%). The authors noted that very few concussions in any level of play resulted in loss of consciousness, pointing out that this further highlighted the limited utility of that symptom in diagnosis.
Neurocognitive symptoms such as difficulty concentrating and excess drowsiness were more common in high school than in youth athletes, while both high school and college athletes reported a higher mean number of sleep symptoms than did youth athletes.
“These data provide the most common symptoms across levels of play, providing clinicians some guidance as to which symptoms should be minimally included in an assessment,” the authors wrote.
The study was supported by USA Football, the National Athletic Trainers’ Association Research and Education Foundation, BioCrossroads in partnership with the Central Indiana Corporate Partnership Foundation, and the National Collegiate Athletic Association. No financial conflicts of interest were reported.
High school football athletes have more concussion-related symptoms than either college or youth football athletes, and have the highest proportion of concussions for which athletes are kept from play for at least 30 days, according to injury surveillance data published online May 2 in JAMA Pediatrics.
Researchers analyzed data on 1,429 sports-related concussions, collected by three injury surveillance programs, finding that high school football players with concussions showed the highest mean number of reported symptoms (5.60), followed by college athletes (5.56) and youth (4.76).
“Our findings suggest an association between level of competition and these outcomes, and highlight the need for future research to continue exploring how the epidemiology of sports-related concussion varies across the lifespan,” wrote Zachary Y. Kerr, Ph.D., of the Datalys Center for Sports Injury Research and Prevention, Indianapolis, and his coauthors.
Overall, 15.5% of concussions resulted in the athlete being returned to play after at least 30 days, and 3.1% of athletes with concussion returned to play less than 24 hours after the concussion.
“In youth football, 1 in10 athletes with concussions returned to play less than 24 hours after injury,” the authors reported. “Such findings may be the result of athletes presenting with delayed concussion symptoms, disagreement between athletic trainers and physicians, or difficulty of youth in reporting symptoms.”
The odds of return to play at least 30 days after injury were significantly higher in high school athletes (odd ratio, 2.89) and youth athletes (OR, 2.75), compared with college athletes (JAMA Pediatrics. 2016 May 2. doi: 10.1001/jamapediatrics.2016.0073).
The mean number of concussion symptoms reported was 5.48, with the most common symptoms being headache (94.3%), dizziness (75.0%), and difficulty concentrating (60.5%). The authors noted that very few concussions in any level of play resulted in loss of consciousness, pointing out that this further highlighted the limited utility of that symptom in diagnosis.
Neurocognitive symptoms such as difficulty concentrating and excess drowsiness were more common in high school than in youth athletes, while both high school and college athletes reported a higher mean number of sleep symptoms than did youth athletes.
“These data provide the most common symptoms across levels of play, providing clinicians some guidance as to which symptoms should be minimally included in an assessment,” the authors wrote.
The study was supported by USA Football, the National Athletic Trainers’ Association Research and Education Foundation, BioCrossroads in partnership with the Central Indiana Corporate Partnership Foundation, and the National Collegiate Athletic Association. No financial conflicts of interest were reported.
High school football athletes have more concussion-related symptoms than either college or youth football athletes, and have the highest proportion of concussions for which athletes are kept from play for at least 30 days, according to injury surveillance data published online May 2 in JAMA Pediatrics.
Researchers analyzed data on 1,429 sports-related concussions, collected by three injury surveillance programs, finding that high school football players with concussions showed the highest mean number of reported symptoms (5.60), followed by college athletes (5.56) and youth (4.76).
“Our findings suggest an association between level of competition and these outcomes, and highlight the need for future research to continue exploring how the epidemiology of sports-related concussion varies across the lifespan,” wrote Zachary Y. Kerr, Ph.D., of the Datalys Center for Sports Injury Research and Prevention, Indianapolis, and his coauthors.
Overall, 15.5% of concussions resulted in the athlete being returned to play after at least 30 days, and 3.1% of athletes with concussion returned to play less than 24 hours after the concussion.
“In youth football, 1 in10 athletes with concussions returned to play less than 24 hours after injury,” the authors reported. “Such findings may be the result of athletes presenting with delayed concussion symptoms, disagreement between athletic trainers and physicians, or difficulty of youth in reporting symptoms.”
The odds of return to play at least 30 days after injury were significantly higher in high school athletes (odd ratio, 2.89) and youth athletes (OR, 2.75), compared with college athletes (JAMA Pediatrics. 2016 May 2. doi: 10.1001/jamapediatrics.2016.0073).
The mean number of concussion symptoms reported was 5.48, with the most common symptoms being headache (94.3%), dizziness (75.0%), and difficulty concentrating (60.5%). The authors noted that very few concussions in any level of play resulted in loss of consciousness, pointing out that this further highlighted the limited utility of that symptom in diagnosis.
Neurocognitive symptoms such as difficulty concentrating and excess drowsiness were more common in high school than in youth athletes, while both high school and college athletes reported a higher mean number of sleep symptoms than did youth athletes.
“These data provide the most common symptoms across levels of play, providing clinicians some guidance as to which symptoms should be minimally included in an assessment,” the authors wrote.
The study was supported by USA Football, the National Athletic Trainers’ Association Research and Education Foundation, BioCrossroads in partnership with the Central Indiana Corporate Partnership Foundation, and the National Collegiate Athletic Association. No financial conflicts of interest were reported.
FROM JAMA PEDIATRICS
Key clinical point: High school football athletes have more concussion-related symptoms than either college or youth football athletes.
Major finding: High school football athletes with concussion have a mean of 5.6 symptoms, compared with 4.76 symptoms in youth athletes.
Data source: An analysis of injury surveillance data for 1,429 sports-related concussions in youth, high school, and college football athletes.
Disclosures: The study was supported by USA Football, the National Athletic Trainers’ Association Research and Education Foundation, BioCrossroads in partnership with the Central Indiana Corporate Partnership Foundation, and the National Collegiate Athletic Association. No financial conflicts of interest were reported.
Study of Twins Quantifies Diabetes, Obesity Link With Psoriasis
The statistically significant association between psoriasis and both obesity and type 2 diabetes comes down to genetics, according to a large population-based study of twins.
Across the entire cohort of 33,588 Danish twins, researchers found the prevalence of psoriasis was 53% higher in individuals with type 2 diabetes, while the prevalence of psoriasis was 81% higher in individuals with a body mass index of at least 35, after adjustment for confounders such as sex, age, and smoking (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2015.6262).
Among the 449 twin pairs discordant for psoriasis, the risk for obesity was more than double in the twin with psoriasis compared to the unaffected twin, although this was significant only among dizygotic pairs, not monozygotic pairs.
The twin analysis also found that the risk of type 2 diabetes was the same between twins with and without psoriasis.
“Increased plasma levels of tumor necrosis factor, tumor necrosis factor receptors, and interleukin 6, which have important roles in the pathogenesis of psoriasis, have been found to be linked with obesity,” wrote Dr. Ann Sophie Lønnberg of the department of dermato-allergology, Gentofte Hospital, University of Copenhagen, and her associates.
“The association between type 2 diabetes mellitus and psoriasis also might be owing to increased tumor necrosis factor production from psoriatic inflammation and low-grade obesity inflammation, because it contributes to insulin resistance,” they wrote.
While obesity and type 2 diabetes are known comorbidities of psoriasis, Dr. Lønnberg and colleagues said this was the first study, to their knowledge, to explore the contribution of genetic and environmental factors to this interaction, and they suggested that future studies could look for genes and epigenetic factors that might underlie these associations.
Their analysis showed the genetic correlation between psoriasis and type 2 diabetes was 0.13, while the environmental correlation was 0.10. Similarly, the genetic correlation between psoriasis and BMI was 0.12, while environmental correlation was –0.05.
No conflicts of interest were declared.
Given the association of psoriasis – particularly more severe disease – and increases in BMI, most of our patients would be recommended for diabetes screening based on standard recommendations.
|
Dr. Joel M. Gelfand |
Therefore, dermatologists have the opportunity to educate patients with psoriasis and initiate appropriate screenings (or refer them to primary care physicians), which can result in better health outcomes through evidence-based interventions.
Dr. Joel M. Gelfand is from the department of dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. He made this comments in an accompanying editorial (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2016.0670). Dr. Gelfand declared consultancies for Abbvie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant, and Pfizer; research grant support from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer (to the trustees of the University of Pennsylvania); and having received payment for continuing medical education work related to psoriasis. He is is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma.
Given the association of psoriasis – particularly more severe disease – and increases in BMI, most of our patients would be recommended for diabetes screening based on standard recommendations.
|
|
Dr. Joel M. Gelfand |
Therefore, dermatologists have the opportunity to educate patients with psoriasis and initiate appropriate screenings (or refer them to primary care physicians), which can result in better health outcomes through evidence-based interventions.
Dr. Joel M. Gelfand is from the department of dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. He made this comments in an accompanying editorial (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2016.0670). Dr. Gelfand declared consultancies for Abbvie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant, and Pfizer; research grant support from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer (to the trustees of the University of Pennsylvania); and having received payment for continuing medical education work related to psoriasis. He is is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma.
Given the association of psoriasis – particularly more severe disease – and increases in BMI, most of our patients would be recommended for diabetes screening based on standard recommendations.
|
|
Dr. Joel M. Gelfand |
Therefore, dermatologists have the opportunity to educate patients with psoriasis and initiate appropriate screenings (or refer them to primary care physicians), which can result in better health outcomes through evidence-based interventions.
Dr. Joel M. Gelfand is from the department of dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. He made this comments in an accompanying editorial (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2016.0670). Dr. Gelfand declared consultancies for Abbvie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant, and Pfizer; research grant support from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer (to the trustees of the University of Pennsylvania); and having received payment for continuing medical education work related to psoriasis. He is is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma.
The statistically significant association between psoriasis and both obesity and type 2 diabetes comes down to genetics, according to a large population-based study of twins.
Across the entire cohort of 33,588 Danish twins, researchers found the prevalence of psoriasis was 53% higher in individuals with type 2 diabetes, while the prevalence of psoriasis was 81% higher in individuals with a body mass index of at least 35, after adjustment for confounders such as sex, age, and smoking (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2015.6262).
Among the 449 twin pairs discordant for psoriasis, the risk for obesity was more than double in the twin with psoriasis compared to the unaffected twin, although this was significant only among dizygotic pairs, not monozygotic pairs.
The twin analysis also found that the risk of type 2 diabetes was the same between twins with and without psoriasis.
“Increased plasma levels of tumor necrosis factor, tumor necrosis factor receptors, and interleukin 6, which have important roles in the pathogenesis of psoriasis, have been found to be linked with obesity,” wrote Dr. Ann Sophie Lønnberg of the department of dermato-allergology, Gentofte Hospital, University of Copenhagen, and her associates.
“The association between type 2 diabetes mellitus and psoriasis also might be owing to increased tumor necrosis factor production from psoriatic inflammation and low-grade obesity inflammation, because it contributes to insulin resistance,” they wrote.
While obesity and type 2 diabetes are known comorbidities of psoriasis, Dr. Lønnberg and colleagues said this was the first study, to their knowledge, to explore the contribution of genetic and environmental factors to this interaction, and they suggested that future studies could look for genes and epigenetic factors that might underlie these associations.
Their analysis showed the genetic correlation between psoriasis and type 2 diabetes was 0.13, while the environmental correlation was 0.10. Similarly, the genetic correlation between psoriasis and BMI was 0.12, while environmental correlation was –0.05.
No conflicts of interest were declared.
The statistically significant association between psoriasis and both obesity and type 2 diabetes comes down to genetics, according to a large population-based study of twins.
Across the entire cohort of 33,588 Danish twins, researchers found the prevalence of psoriasis was 53% higher in individuals with type 2 diabetes, while the prevalence of psoriasis was 81% higher in individuals with a body mass index of at least 35, after adjustment for confounders such as sex, age, and smoking (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2015.6262).
Among the 449 twin pairs discordant for psoriasis, the risk for obesity was more than double in the twin with psoriasis compared to the unaffected twin, although this was significant only among dizygotic pairs, not monozygotic pairs.
The twin analysis also found that the risk of type 2 diabetes was the same between twins with and without psoriasis.
“Increased plasma levels of tumor necrosis factor, tumor necrosis factor receptors, and interleukin 6, which have important roles in the pathogenesis of psoriasis, have been found to be linked with obesity,” wrote Dr. Ann Sophie Lønnberg of the department of dermato-allergology, Gentofte Hospital, University of Copenhagen, and her associates.
“The association between type 2 diabetes mellitus and psoriasis also might be owing to increased tumor necrosis factor production from psoriatic inflammation and low-grade obesity inflammation, because it contributes to insulin resistance,” they wrote.
While obesity and type 2 diabetes are known comorbidities of psoriasis, Dr. Lønnberg and colleagues said this was the first study, to their knowledge, to explore the contribution of genetic and environmental factors to this interaction, and they suggested that future studies could look for genes and epigenetic factors that might underlie these associations.
Their analysis showed the genetic correlation between psoriasis and type 2 diabetes was 0.13, while the environmental correlation was 0.10. Similarly, the genetic correlation between psoriasis and BMI was 0.12, while environmental correlation was –0.05.
No conflicts of interest were declared.
FROM JAMA DERMATOLOGY
Study of twins quantifies diabetes, obesity link with psoriasis
The statistically significant association between psoriasis and both obesity and type 2 diabetes comes down to genetics, according to a large population-based study of twins.
Across the entire cohort of 33,588 Danish twins, researchers found the prevalence of psoriasis was 53% higher in individuals with type 2 diabetes, while the prevalence of psoriasis was 81% higher in individuals with a body mass index of at least 35, after adjustment for confounders such as sex, age, and smoking (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2015.6262).
Among the 449 twin pairs discordant for psoriasis, the risk for obesity was more than double in the twin with psoriasis compared to the unaffected twin, although this was significant only among dizygotic pairs, not monozygotic pairs.
The twin analysis also found that the risk of type 2 diabetes was the same between twins with and without psoriasis.
“Increased plasma levels of tumor necrosis factor, tumor necrosis factor receptors, and interleukin 6, which have important roles in the pathogenesis of psoriasis, have been found to be linked with obesity,” wrote Dr. Ann Sophie Lønnberg of the department of dermato-allergology, Gentofte Hospital, University of Copenhagen, and her associates.
“The association between type 2 diabetes mellitus and psoriasis also might be owing to increased tumor necrosis factor production from psoriatic inflammation and low-grade obesity inflammation, because it contributes to insulin resistance,” they wrote.
While obesity and type 2 diabetes are known comorbidities of psoriasis, Dr. Lønnberg and colleagues said this was the first study, to their knowledge, to explore the contribution of genetic and environmental factors to this interaction, and they suggested that future studies could look for genes and epigenetic factors that might underlie these associations.
Their analysis showed the genetic correlation between psoriasis and type 2 diabetes was 0.13, while the environmental correlation was 0.10. Similarly, the genetic correlation between psoriasis and BMI was 0.12, while environmental correlation was –0.05.
No conflicts of interest were declared.
Given the association of psoriasis – particularly more severe disease – and increases in BMI, most of our patients would be recommended for diabetes screening based on standard recommendations.
|
|
Dr. Joel M. Gelfand |
Therefore, dermatologists have the opportunity to educate patients with psoriasis and initiate appropriate screenings (or refer them to primary care physicians), which can result in better health outcomes through evidence-based interventions.
Dr. Joel M. Gelfand is from the department of dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. He made this comments in an accompanying editorial (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2016.0670). Dr. Gelfand declared consultancies for Abbvie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant, and Pfizer; research grant support from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer (to the trustees of the University of Pennsylvania); and having received payment for continuing medical education work related to psoriasis. He is is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma.
Given the association of psoriasis – particularly more severe disease – and increases in BMI, most of our patients would be recommended for diabetes screening based on standard recommendations.
|
|
Dr. Joel M. Gelfand |
Therefore, dermatologists have the opportunity to educate patients with psoriasis and initiate appropriate screenings (or refer them to primary care physicians), which can result in better health outcomes through evidence-based interventions.
Dr. Joel M. Gelfand is from the department of dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. He made this comments in an accompanying editorial (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2016.0670). Dr. Gelfand declared consultancies for Abbvie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant, and Pfizer; research grant support from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer (to the trustees of the University of Pennsylvania); and having received payment for continuing medical education work related to psoriasis. He is is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma.
Given the association of psoriasis – particularly more severe disease – and increases in BMI, most of our patients would be recommended for diabetes screening based on standard recommendations.
|
|
Dr. Joel M. Gelfand |
Therefore, dermatologists have the opportunity to educate patients with psoriasis and initiate appropriate screenings (or refer them to primary care physicians), which can result in better health outcomes through evidence-based interventions.
Dr. Joel M. Gelfand is from the department of dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. He made this comments in an accompanying editorial (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2016.0670). Dr. Gelfand declared consultancies for Abbvie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant, and Pfizer; research grant support from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer (to the trustees of the University of Pennsylvania); and having received payment for continuing medical education work related to psoriasis. He is is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma.
The statistically significant association between psoriasis and both obesity and type 2 diabetes comes down to genetics, according to a large population-based study of twins.
Across the entire cohort of 33,588 Danish twins, researchers found the prevalence of psoriasis was 53% higher in individuals with type 2 diabetes, while the prevalence of psoriasis was 81% higher in individuals with a body mass index of at least 35, after adjustment for confounders such as sex, age, and smoking (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2015.6262).
Among the 449 twin pairs discordant for psoriasis, the risk for obesity was more than double in the twin with psoriasis compared to the unaffected twin, although this was significant only among dizygotic pairs, not monozygotic pairs.
The twin analysis also found that the risk of type 2 diabetes was the same between twins with and without psoriasis.
“Increased plasma levels of tumor necrosis factor, tumor necrosis factor receptors, and interleukin 6, which have important roles in the pathogenesis of psoriasis, have been found to be linked with obesity,” wrote Dr. Ann Sophie Lønnberg of the department of dermato-allergology, Gentofte Hospital, University of Copenhagen, and her associates.
“The association between type 2 diabetes mellitus and psoriasis also might be owing to increased tumor necrosis factor production from psoriatic inflammation and low-grade obesity inflammation, because it contributes to insulin resistance,” they wrote.
While obesity and type 2 diabetes are known comorbidities of psoriasis, Dr. Lønnberg and colleagues said this was the first study, to their knowledge, to explore the contribution of genetic and environmental factors to this interaction, and they suggested that future studies could look for genes and epigenetic factors that might underlie these associations.
Their analysis showed the genetic correlation between psoriasis and type 2 diabetes was 0.13, while the environmental correlation was 0.10. Similarly, the genetic correlation between psoriasis and BMI was 0.12, while environmental correlation was –0.05.
No conflicts of interest were declared.
The statistically significant association between psoriasis and both obesity and type 2 diabetes comes down to genetics, according to a large population-based study of twins.
Across the entire cohort of 33,588 Danish twins, researchers found the prevalence of psoriasis was 53% higher in individuals with type 2 diabetes, while the prevalence of psoriasis was 81% higher in individuals with a body mass index of at least 35, after adjustment for confounders such as sex, age, and smoking (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2015.6262).
Among the 449 twin pairs discordant for psoriasis, the risk for obesity was more than double in the twin with psoriasis compared to the unaffected twin, although this was significant only among dizygotic pairs, not monozygotic pairs.
The twin analysis also found that the risk of type 2 diabetes was the same between twins with and without psoriasis.
“Increased plasma levels of tumor necrosis factor, tumor necrosis factor receptors, and interleukin 6, which have important roles in the pathogenesis of psoriasis, have been found to be linked with obesity,” wrote Dr. Ann Sophie Lønnberg of the department of dermato-allergology, Gentofte Hospital, University of Copenhagen, and her associates.
“The association between type 2 diabetes mellitus and psoriasis also might be owing to increased tumor necrosis factor production from psoriatic inflammation and low-grade obesity inflammation, because it contributes to insulin resistance,” they wrote.
While obesity and type 2 diabetes are known comorbidities of psoriasis, Dr. Lønnberg and colleagues said this was the first study, to their knowledge, to explore the contribution of genetic and environmental factors to this interaction, and they suggested that future studies could look for genes and epigenetic factors that might underlie these associations.
Their analysis showed the genetic correlation between psoriasis and type 2 diabetes was 0.13, while the environmental correlation was 0.10. Similarly, the genetic correlation between psoriasis and BMI was 0.12, while environmental correlation was –0.05.
No conflicts of interest were declared.
FROM JAMA DERMATOLOGY
Key clinical point: The prevalence of both type 2 diabetes and psoriasis is significantly higher in individuals with psoriasis.
Major finding: The risk of obesity is twofold higher in a twin with psoriasis compared to the co-twin without psoriasis.
Data source: Cross-sectional, population-based study of 33,588 Danish twins, including 449 pairs discordant for psoriasis.
Disclosures: No conflicts of interest were declared.
Patient-controlled epidural analgesia similar to intravenous
Patient-controlled epidural analgesia achieves pain control similar to that of patient-controlled intravenous analgesia after spinal fusion surgery, but is associated with a higher incidence of pruritus and paresthesia, a meta-analysis published in BMC Musculoskeletal Disorders has found.
The analysis of eight randomized controlled trials involving 482 patients found that patient-controlled epidural analgesia was associated with significantly better analgesic effects on day 1 and 2 after surgery (mean difference in visual analog scale scores of −0.47 and −0.66, respectively), but this difference was no longer statistically significant on day 3.
The study, conducted by Dr. Peng Tian of Tianjin (China) Hospital and colleagues showed that patient-controlled epidural analgesia was associated with a significant 53% higher incidence of pruritus and a threefold increase in paresthesia, compared with patient-controlled intravenous analgesia, although there were no significant differences in the rates of nausea or vomiting (BMC Musculoskeletal Disorders 2015 Dec 15. doi: 10.1186/s12891-015-0849-y).
Researchers noted that patient-controlled epidural analgesia achieves a faster analgesic effect than does patient-controlled intravenous analgesia because it acts directly on the near-operative region, but the analgesic effect of the intravenous administration lasts longer.
“The most important findings of the present meta-analysis are that the application of PCEA [patient-controlled epidural analgesia] does not more effectively relieve” pain in 3 postoperative days compared with patient-controlled intravenous analgesia, “meanwhile increasing the incidence of some complications such as pruritus and paresthesia,” wrote the investigators.
The National Natural Science Foundation of China supported the study. No conflicts of interest were declared.
Patient-controlled epidural analgesia achieves pain control similar to that of patient-controlled intravenous analgesia after spinal fusion surgery, but is associated with a higher incidence of pruritus and paresthesia, a meta-analysis published in BMC Musculoskeletal Disorders has found.
The analysis of eight randomized controlled trials involving 482 patients found that patient-controlled epidural analgesia was associated with significantly better analgesic effects on day 1 and 2 after surgery (mean difference in visual analog scale scores of −0.47 and −0.66, respectively), but this difference was no longer statistically significant on day 3.
The study, conducted by Dr. Peng Tian of Tianjin (China) Hospital and colleagues showed that patient-controlled epidural analgesia was associated with a significant 53% higher incidence of pruritus and a threefold increase in paresthesia, compared with patient-controlled intravenous analgesia, although there were no significant differences in the rates of nausea or vomiting (BMC Musculoskeletal Disorders 2015 Dec 15. doi: 10.1186/s12891-015-0849-y).
Researchers noted that patient-controlled epidural analgesia achieves a faster analgesic effect than does patient-controlled intravenous analgesia because it acts directly on the near-operative region, but the analgesic effect of the intravenous administration lasts longer.
“The most important findings of the present meta-analysis are that the application of PCEA [patient-controlled epidural analgesia] does not more effectively relieve” pain in 3 postoperative days compared with patient-controlled intravenous analgesia, “meanwhile increasing the incidence of some complications such as pruritus and paresthesia,” wrote the investigators.
The National Natural Science Foundation of China supported the study. No conflicts of interest were declared.
Patient-controlled epidural analgesia achieves pain control similar to that of patient-controlled intravenous analgesia after spinal fusion surgery, but is associated with a higher incidence of pruritus and paresthesia, a meta-analysis published in BMC Musculoskeletal Disorders has found.
The analysis of eight randomized controlled trials involving 482 patients found that patient-controlled epidural analgesia was associated with significantly better analgesic effects on day 1 and 2 after surgery (mean difference in visual analog scale scores of −0.47 and −0.66, respectively), but this difference was no longer statistically significant on day 3.
The study, conducted by Dr. Peng Tian of Tianjin (China) Hospital and colleagues showed that patient-controlled epidural analgesia was associated with a significant 53% higher incidence of pruritus and a threefold increase in paresthesia, compared with patient-controlled intravenous analgesia, although there were no significant differences in the rates of nausea or vomiting (BMC Musculoskeletal Disorders 2015 Dec 15. doi: 10.1186/s12891-015-0849-y).
Researchers noted that patient-controlled epidural analgesia achieves a faster analgesic effect than does patient-controlled intravenous analgesia because it acts directly on the near-operative region, but the analgesic effect of the intravenous administration lasts longer.
“The most important findings of the present meta-analysis are that the application of PCEA [patient-controlled epidural analgesia] does not more effectively relieve” pain in 3 postoperative days compared with patient-controlled intravenous analgesia, “meanwhile increasing the incidence of some complications such as pruritus and paresthesia,” wrote the investigators.
The National Natural Science Foundation of China supported the study. No conflicts of interest were declared.
FROM BMC MUSCULOSKELETAL DISORDERS
Key clinical point: Patient-controlled epidural analgesia achieves pain control similar to that of patient-controlled intravenous analgesia after spinal fusion surgery, but with more pruritus and paresthesia.
Major finding: Patient-controlled epidural analgesia achieved greater analgesic effects on day 1 and 2 after surgery but these differences were no longer significant by day 3.
Data source: A meta-analysis of eight randomized controlled trials in 482 patients undergoing spinal fusion surgery.
Disclosures: The National Natural Science Foundation of China supported the study. No conflicts of interest were declared.
Intracranial calcification, hypomyelination seen with Zika virus congenital microcephaly
A CT imaging study in 23 infants with Zika virus–linked congenital microcephaly has revealed severe brain anomalies, in particular intracranial calcifications mainly in the frontal and parietal lobes that were mostly punctate, often with a bandlike distribution.
Head CT images were taken between 3 days and 5 months after birth (mean age, 36 days) revealing ventriculomegaly in all infants, which was severe in more than half, according to a letter published online April 6 in the New England Journal of Medicine.
Researchers also observed global hypogyration in the cerebral cortex in all the infants (severe in 78%) and cerebellar hypoplasia in 74%, as well as an abnormally low density of white matter in all cases (N Engl J Med. 2016 April 6. doi: 10.1056/NEJMc1603617).
“The global presence of cortical hypogyration and white-matter hypomyelination or dysmyelination in all the infants, and cerebellar hypoplasia in the majority of them, suggest that ZIKV [Zika virus] is associated with a disruption in brain development rather than a destruction of brain,” wrote Dr. Adriano N. Hazin of the Instituto di Medicina Integral Professor Fernando Figueira, Recife, Brazil, and coauthors who reported the findings for the Microcephaly Epidemic Research Group.
Two authors declared grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico. No other conflicts of interest were declared.
A CT imaging study in 23 infants with Zika virus–linked congenital microcephaly has revealed severe brain anomalies, in particular intracranial calcifications mainly in the frontal and parietal lobes that were mostly punctate, often with a bandlike distribution.
Head CT images were taken between 3 days and 5 months after birth (mean age, 36 days) revealing ventriculomegaly in all infants, which was severe in more than half, according to a letter published online April 6 in the New England Journal of Medicine.
Researchers also observed global hypogyration in the cerebral cortex in all the infants (severe in 78%) and cerebellar hypoplasia in 74%, as well as an abnormally low density of white matter in all cases (N Engl J Med. 2016 April 6. doi: 10.1056/NEJMc1603617).
“The global presence of cortical hypogyration and white-matter hypomyelination or dysmyelination in all the infants, and cerebellar hypoplasia in the majority of them, suggest that ZIKV [Zika virus] is associated with a disruption in brain development rather than a destruction of brain,” wrote Dr. Adriano N. Hazin of the Instituto di Medicina Integral Professor Fernando Figueira, Recife, Brazil, and coauthors who reported the findings for the Microcephaly Epidemic Research Group.
Two authors declared grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico. No other conflicts of interest were declared.
A CT imaging study in 23 infants with Zika virus–linked congenital microcephaly has revealed severe brain anomalies, in particular intracranial calcifications mainly in the frontal and parietal lobes that were mostly punctate, often with a bandlike distribution.
Head CT images were taken between 3 days and 5 months after birth (mean age, 36 days) revealing ventriculomegaly in all infants, which was severe in more than half, according to a letter published online April 6 in the New England Journal of Medicine.
Researchers also observed global hypogyration in the cerebral cortex in all the infants (severe in 78%) and cerebellar hypoplasia in 74%, as well as an abnormally low density of white matter in all cases (N Engl J Med. 2016 April 6. doi: 10.1056/NEJMc1603617).
“The global presence of cortical hypogyration and white-matter hypomyelination or dysmyelination in all the infants, and cerebellar hypoplasia in the majority of them, suggest that ZIKV [Zika virus] is associated with a disruption in brain development rather than a destruction of brain,” wrote Dr. Adriano N. Hazin of the Instituto di Medicina Integral Professor Fernando Figueira, Recife, Brazil, and coauthors who reported the findings for the Microcephaly Epidemic Research Group.
Two authors declared grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico. No other conflicts of interest were declared.
FROM NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point: Zika virus–linked congenital microcephaly is characterized by severe brain anomalies including intracranial calcifications, ventriculomegaly, and hypomyelination.
Major finding: Hypomyelination and ventriculomegaly were present in all infants with Zika virus–associated congenital microcephaly.
Data source: A CT imaging study in 23 infants with Zika virus–associated congenital microcephaly.
Disclosures: Two authors declared grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico. No other conflicts of interest were declared.
Subclinical hyperthyroidism disease tied to higher mortality in elderly
Subclinical hyperthyroidism and hypothyroidism are both linked to higher mortality in the elderly, with the greatest mortality increases found in those with thyroid-stimulating hormone (TSH) values above 6.38 mIU/L, according to a retrospective cohort study.
Researchers analyzed medical records from 538 individuals with subclinical hyperthyroidism, 1,956 with subclinical hypothyroidism and 14,946 with normal thyroid-stimulating hormone levels, and found subclinical hyperthyroidism (TSH less than 0.35 mIU/L) was associated with an 80% greater risk of mortality over 10 years of follow-up, compared with normal TSH levels.
The study showed subclinical hypothyroidism (TSH greater than 4.2 mIU/L) was associated with a 68% greater mortality risk, even after adjustment for potential confounders such as age, sex, chronic kidney or lung disease, smoking, and hypertension.
The analysis also showed that when TSH values were stratified into quintiles for both subclinical hyperthyroidism and hypothyroidism, individuals with TSH levels above 6.38 mIU/L had the greatest excess of mortality, compared with other individuals with hypothyroidism, while there were no significant mortality differences between the quintiles in subclinical hyperthyroidism.
“Whether this should lead to less-restricted thyroid hormone replacement in elderly individuals with subclinical hypothyroidism is unclear, but these results certainly serve as preliminary evidence for the requirement for thyroid hormone replacement in the elderly with subclinical hypothyroidism, possibly with a higher thyroid-stimulating hormone threshold value,” wrote Dr. Alon Grossman from the Rabin Medical Center, Petah Tikva, Israel, and coauthors (Am J Med. 2016 Apr;129[4]:423-30).
No conflicts of interest were declared.
Subclinical hyperthyroidism and hypothyroidism are both linked to higher mortality in the elderly, with the greatest mortality increases found in those with thyroid-stimulating hormone (TSH) values above 6.38 mIU/L, according to a retrospective cohort study.
Researchers analyzed medical records from 538 individuals with subclinical hyperthyroidism, 1,956 with subclinical hypothyroidism and 14,946 with normal thyroid-stimulating hormone levels, and found subclinical hyperthyroidism (TSH less than 0.35 mIU/L) was associated with an 80% greater risk of mortality over 10 years of follow-up, compared with normal TSH levels.
The study showed subclinical hypothyroidism (TSH greater than 4.2 mIU/L) was associated with a 68% greater mortality risk, even after adjustment for potential confounders such as age, sex, chronic kidney or lung disease, smoking, and hypertension.
The analysis also showed that when TSH values were stratified into quintiles for both subclinical hyperthyroidism and hypothyroidism, individuals with TSH levels above 6.38 mIU/L had the greatest excess of mortality, compared with other individuals with hypothyroidism, while there were no significant mortality differences between the quintiles in subclinical hyperthyroidism.
“Whether this should lead to less-restricted thyroid hormone replacement in elderly individuals with subclinical hypothyroidism is unclear, but these results certainly serve as preliminary evidence for the requirement for thyroid hormone replacement in the elderly with subclinical hypothyroidism, possibly with a higher thyroid-stimulating hormone threshold value,” wrote Dr. Alon Grossman from the Rabin Medical Center, Petah Tikva, Israel, and coauthors (Am J Med. 2016 Apr;129[4]:423-30).
No conflicts of interest were declared.
Subclinical hyperthyroidism and hypothyroidism are both linked to higher mortality in the elderly, with the greatest mortality increases found in those with thyroid-stimulating hormone (TSH) values above 6.38 mIU/L, according to a retrospective cohort study.
Researchers analyzed medical records from 538 individuals with subclinical hyperthyroidism, 1,956 with subclinical hypothyroidism and 14,946 with normal thyroid-stimulating hormone levels, and found subclinical hyperthyroidism (TSH less than 0.35 mIU/L) was associated with an 80% greater risk of mortality over 10 years of follow-up, compared with normal TSH levels.
The study showed subclinical hypothyroidism (TSH greater than 4.2 mIU/L) was associated with a 68% greater mortality risk, even after adjustment for potential confounders such as age, sex, chronic kidney or lung disease, smoking, and hypertension.
The analysis also showed that when TSH values were stratified into quintiles for both subclinical hyperthyroidism and hypothyroidism, individuals with TSH levels above 6.38 mIU/L had the greatest excess of mortality, compared with other individuals with hypothyroidism, while there were no significant mortality differences between the quintiles in subclinical hyperthyroidism.
“Whether this should lead to less-restricted thyroid hormone replacement in elderly individuals with subclinical hypothyroidism is unclear, but these results certainly serve as preliminary evidence for the requirement for thyroid hormone replacement in the elderly with subclinical hypothyroidism, possibly with a higher thyroid-stimulating hormone threshold value,” wrote Dr. Alon Grossman from the Rabin Medical Center, Petah Tikva, Israel, and coauthors (Am J Med. 2016 Apr;129[4]:423-30).
No conflicts of interest were declared.
FROM THE AMERICAN JOURNAL OF MEDICINE
Key clinical point: Subclinical hyperthyroidism and hypothyroidism are both associated with increased mortality in the elderly.
Major finding: The greatest mortality was in individuals with thyroid-stimulating hormone levels above 6.38 mIU/L.
Data source: Retrospective cohort study in 17,440 individuals.
Disclosures: No conflicts of interest were declared.