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Lupus Ups Atherosclerosis Risk, But Disease Remission Helps
TOPLINE:
Patients with systemic lupus erythematosus (SLE) face more than double the risk for atherosclerotic plaque progression than healthy control individuals without the condition, but management of traditional cardiovascular risk factors and prolonged clinical remission can successfully mitigate it.
METHODOLOGY:
- Researchers performed a prospective study to assess the progression of subclinical atherosclerosis plaques and the development of cardiovascular events in patients with SLE over a 10-year follow-up period.
- They included 111 patients with SLE (mean age, 43 years; 91% women) and 94 matched healthy control individuals without prior atherosclerotic cardiovascular disease (CVD), active malignancy, pregnancy, or diabetes mellitus who underwent carotid ultrasound measurements.
- A total of 738 carotid measurements were analyzed from baseline to 3-, 7-, and 10-year follow-up periods for assessing new carotid plaque development; incident CVD events were also analyzed during follow-up.
- Disease remission was evaluated based on the Definition of Remission in SLE criteria.
- Target for management of cardiovascular risk factors was based on standard recommendations.
TAKEAWAY:
- During the 10-year follow-up, patients with SLE showed a 2.3-fold higher risk for plaque progression than healthy control participants (adjusted incidence rate ratio [aIRR], 2.26; P = .002).
- Achieving risk reduction target for each standard cardiovascular risk factor (blood pressure, lipids, smoking, body weight, and physical activity) was associated with a 32% reduction in the risk for plaque progression (aIRR, 0.68; P = .004).
- Staying in remission for ≥ 75% of the follow-up period was significantly associated with a 43% reduction in the risk for plaque progression (aIRR, 0.57; P = .033).
- Patients with SLE also had a higher incidence of CVD events than healthy control participants (permutation-based log-rank P = .036).
IN PRACTICE:
“These findings support the importance of prioritizing sustained remission rather than a low disease activity state for the prevention of atherosclerosis development and progression in SLE,” the authors wrote.
SOURCE:
The study was led by Nikolaos Papazoglou, MD, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens in Greece. It was published online on December 25, 2024, in Arthritis & Rheumatology.
LIMITATIONS:
The study had limited statistical power to perform a multivariate analysis of incident CVD events due to low event rates. The cohort consisted solely of White Europeans, possibly limiting the generalizability of the findings to more ethnically diverse populations. Because antiphospholipid antibodies are known to be associated with CVD events in the general population, the lack of testing for antiphospholipid antibody positivity in healthy control participants could be another limitation.
DISCLOSURES:
The study did not receive any funding from public, commercial, or not-for-profit sectors. The authors reported no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Patients with systemic lupus erythematosus (SLE) face more than double the risk for atherosclerotic plaque progression than healthy control individuals without the condition, but management of traditional cardiovascular risk factors and prolonged clinical remission can successfully mitigate it.
METHODOLOGY:
- Researchers performed a prospective study to assess the progression of subclinical atherosclerosis plaques and the development of cardiovascular events in patients with SLE over a 10-year follow-up period.
- They included 111 patients with SLE (mean age, 43 years; 91% women) and 94 matched healthy control individuals without prior atherosclerotic cardiovascular disease (CVD), active malignancy, pregnancy, or diabetes mellitus who underwent carotid ultrasound measurements.
- A total of 738 carotid measurements were analyzed from baseline to 3-, 7-, and 10-year follow-up periods for assessing new carotid plaque development; incident CVD events were also analyzed during follow-up.
- Disease remission was evaluated based on the Definition of Remission in SLE criteria.
- Target for management of cardiovascular risk factors was based on standard recommendations.
TAKEAWAY:
- During the 10-year follow-up, patients with SLE showed a 2.3-fold higher risk for plaque progression than healthy control participants (adjusted incidence rate ratio [aIRR], 2.26; P = .002).
- Achieving risk reduction target for each standard cardiovascular risk factor (blood pressure, lipids, smoking, body weight, and physical activity) was associated with a 32% reduction in the risk for plaque progression (aIRR, 0.68; P = .004).
- Staying in remission for ≥ 75% of the follow-up period was significantly associated with a 43% reduction in the risk for plaque progression (aIRR, 0.57; P = .033).
- Patients with SLE also had a higher incidence of CVD events than healthy control participants (permutation-based log-rank P = .036).
IN PRACTICE:
“These findings support the importance of prioritizing sustained remission rather than a low disease activity state for the prevention of atherosclerosis development and progression in SLE,” the authors wrote.
SOURCE:
The study was led by Nikolaos Papazoglou, MD, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens in Greece. It was published online on December 25, 2024, in Arthritis & Rheumatology.
LIMITATIONS:
The study had limited statistical power to perform a multivariate analysis of incident CVD events due to low event rates. The cohort consisted solely of White Europeans, possibly limiting the generalizability of the findings to more ethnically diverse populations. Because antiphospholipid antibodies are known to be associated with CVD events in the general population, the lack of testing for antiphospholipid antibody positivity in healthy control participants could be another limitation.
DISCLOSURES:
The study did not receive any funding from public, commercial, or not-for-profit sectors. The authors reported no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Patients with systemic lupus erythematosus (SLE) face more than double the risk for atherosclerotic plaque progression than healthy control individuals without the condition, but management of traditional cardiovascular risk factors and prolonged clinical remission can successfully mitigate it.
METHODOLOGY:
- Researchers performed a prospective study to assess the progression of subclinical atherosclerosis plaques and the development of cardiovascular events in patients with SLE over a 10-year follow-up period.
- They included 111 patients with SLE (mean age, 43 years; 91% women) and 94 matched healthy control individuals without prior atherosclerotic cardiovascular disease (CVD), active malignancy, pregnancy, or diabetes mellitus who underwent carotid ultrasound measurements.
- A total of 738 carotid measurements were analyzed from baseline to 3-, 7-, and 10-year follow-up periods for assessing new carotid plaque development; incident CVD events were also analyzed during follow-up.
- Disease remission was evaluated based on the Definition of Remission in SLE criteria.
- Target for management of cardiovascular risk factors was based on standard recommendations.
TAKEAWAY:
- During the 10-year follow-up, patients with SLE showed a 2.3-fold higher risk for plaque progression than healthy control participants (adjusted incidence rate ratio [aIRR], 2.26; P = .002).
- Achieving risk reduction target for each standard cardiovascular risk factor (blood pressure, lipids, smoking, body weight, and physical activity) was associated with a 32% reduction in the risk for plaque progression (aIRR, 0.68; P = .004).
- Staying in remission for ≥ 75% of the follow-up period was significantly associated with a 43% reduction in the risk for plaque progression (aIRR, 0.57; P = .033).
- Patients with SLE also had a higher incidence of CVD events than healthy control participants (permutation-based log-rank P = .036).
IN PRACTICE:
“These findings support the importance of prioritizing sustained remission rather than a low disease activity state for the prevention of atherosclerosis development and progression in SLE,” the authors wrote.
SOURCE:
The study was led by Nikolaos Papazoglou, MD, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens in Greece. It was published online on December 25, 2024, in Arthritis & Rheumatology.
LIMITATIONS:
The study had limited statistical power to perform a multivariate analysis of incident CVD events due to low event rates. The cohort consisted solely of White Europeans, possibly limiting the generalizability of the findings to more ethnically diverse populations. Because antiphospholipid antibodies are known to be associated with CVD events in the general population, the lack of testing for antiphospholipid antibody positivity in healthy control participants could be another limitation.
DISCLOSURES:
The study did not receive any funding from public, commercial, or not-for-profit sectors. The authors reported no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TNF Inhibitors Ward Off Fracture in Axial Spondyloarthritis
TOPLINE:
Tumor necrosis factor (TNF) inhibitors protect patients with axial spondyloarthritis (axSpA) from hip and spine fractures better than other drugs.
METHODOLOGY:
- Large US insurance claims database study comparing protective effects of TNF inhibitors vs other drugs on fractures in patients with axSpA.
- The study included 13,519 patients with axSpA aged 18-65 years, of whom 1229 had hip or spine fractures (mean age, 53 years; 38% women) and 12,290 were control participants without fractures.
- Effects of TNF inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), or no medication before the fracture were compared.
- The primary outcome was a composite hip and/or spine fracture, and the secondary outcome was a spine fracture.
TAKEAWAY:
- TNF inhibitor users had a lower risk for hip and spine fractures (adjusted odds ratio [aOR], 0.75; 95% CI, 0.62-0.91) than NSAID users, but this protective association was not seen in csDMARD users.
- Sex-stratified analysis showed similar protective effects of TNF inhibitors in both women and men.
- TNF inhibitor users showed a significantly lower risk for spine fractures than NSAID users (aOR, 0.81; 95% CI, 0.66-0.99).
- The protective effect of TNF inhibitors on hip and spine fractures was also seen in patients with a history of prior fractures; however, the effect was not statistically significant.
IN PRACTICE:
“Our findings underscore the multifaceted benefits of TNF inhibitors in axSpA,” the authors wrote.
SOURCE:
Devin Driscoll, MD, Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, led the study, published online in Arthritis & Rheumatology.
LIMITATIONS:
Identification of the axSpA cohort and fracture outcomes was based solely on diagnostic and procedure codes, which may have led to misclassification. The administrative database lacked detailed information on disease activity levels, and the high proportion of missing data for body mass index, a known strong confounder for fracture risk, may have introduced bias. There were insufficient numbers of hip fractures to conduct analyses limited solely to hip fractures.
DISCLOSURES:
The study was supported by R03 AR076495 and NIH P30 AR072571. Two authors declared receiving grants, contracts, payments, honoraria, and other affiliations with various institutions and pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Tumor necrosis factor (TNF) inhibitors protect patients with axial spondyloarthritis (axSpA) from hip and spine fractures better than other drugs.
METHODOLOGY:
- Large US insurance claims database study comparing protective effects of TNF inhibitors vs other drugs on fractures in patients with axSpA.
- The study included 13,519 patients with axSpA aged 18-65 years, of whom 1229 had hip or spine fractures (mean age, 53 years; 38% women) and 12,290 were control participants without fractures.
- Effects of TNF inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), or no medication before the fracture were compared.
- The primary outcome was a composite hip and/or spine fracture, and the secondary outcome was a spine fracture.
TAKEAWAY:
- TNF inhibitor users had a lower risk for hip and spine fractures (adjusted odds ratio [aOR], 0.75; 95% CI, 0.62-0.91) than NSAID users, but this protective association was not seen in csDMARD users.
- Sex-stratified analysis showed similar protective effects of TNF inhibitors in both women and men.
- TNF inhibitor users showed a significantly lower risk for spine fractures than NSAID users (aOR, 0.81; 95% CI, 0.66-0.99).
- The protective effect of TNF inhibitors on hip and spine fractures was also seen in patients with a history of prior fractures; however, the effect was not statistically significant.
IN PRACTICE:
“Our findings underscore the multifaceted benefits of TNF inhibitors in axSpA,” the authors wrote.
SOURCE:
Devin Driscoll, MD, Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, led the study, published online in Arthritis & Rheumatology.
LIMITATIONS:
Identification of the axSpA cohort and fracture outcomes was based solely on diagnostic and procedure codes, which may have led to misclassification. The administrative database lacked detailed information on disease activity levels, and the high proportion of missing data for body mass index, a known strong confounder for fracture risk, may have introduced bias. There were insufficient numbers of hip fractures to conduct analyses limited solely to hip fractures.
DISCLOSURES:
The study was supported by R03 AR076495 and NIH P30 AR072571. Two authors declared receiving grants, contracts, payments, honoraria, and other affiliations with various institutions and pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Tumor necrosis factor (TNF) inhibitors protect patients with axial spondyloarthritis (axSpA) from hip and spine fractures better than other drugs.
METHODOLOGY:
- Large US insurance claims database study comparing protective effects of TNF inhibitors vs other drugs on fractures in patients with axSpA.
- The study included 13,519 patients with axSpA aged 18-65 years, of whom 1229 had hip or spine fractures (mean age, 53 years; 38% women) and 12,290 were control participants without fractures.
- Effects of TNF inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), or no medication before the fracture were compared.
- The primary outcome was a composite hip and/or spine fracture, and the secondary outcome was a spine fracture.
TAKEAWAY:
- TNF inhibitor users had a lower risk for hip and spine fractures (adjusted odds ratio [aOR], 0.75; 95% CI, 0.62-0.91) than NSAID users, but this protective association was not seen in csDMARD users.
- Sex-stratified analysis showed similar protective effects of TNF inhibitors in both women and men.
- TNF inhibitor users showed a significantly lower risk for spine fractures than NSAID users (aOR, 0.81; 95% CI, 0.66-0.99).
- The protective effect of TNF inhibitors on hip and spine fractures was also seen in patients with a history of prior fractures; however, the effect was not statistically significant.
IN PRACTICE:
“Our findings underscore the multifaceted benefits of TNF inhibitors in axSpA,” the authors wrote.
SOURCE:
Devin Driscoll, MD, Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, led the study, published online in Arthritis & Rheumatology.
LIMITATIONS:
Identification of the axSpA cohort and fracture outcomes was based solely on diagnostic and procedure codes, which may have led to misclassification. The administrative database lacked detailed information on disease activity levels, and the high proportion of missing data for body mass index, a known strong confounder for fracture risk, may have introduced bias. There were insufficient numbers of hip fractures to conduct analyses limited solely to hip fractures.
DISCLOSURES:
The study was supported by R03 AR076495 and NIH P30 AR072571. Two authors declared receiving grants, contracts, payments, honoraria, and other affiliations with various institutions and pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Exposure to Dioxins May Increase Obesity Risk
TOPLINE:
Combined exposure to dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs) is significantly associated with an increased risk for obesity in adults, with 1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin (HpCDD) showing the greatest contribution.
METHODOLOGY:
- Researchers evaluated the relationship between mixed exposure to nine types of dioxins and DL-PCBs and obesity or obesity indices in 852 adults using data from the National Health and Nutrition Examination Survey from 2003 to 2004.
- They chose nine chemicals for analysis: 1,2,3,4,6,7,8-HpCDD; 1,2,3,4,6,7,8,9-octachlorodibenzo-p-dioxin (OCDD); 3,3’,4,4’,5-pentachlorodibenzofuran (PnCB); PCB28; PCB66; PCB74; PCB105; PCB118; and PCB156.
- General and abdominal obesity were present in 34% and 53.9% of participants, respectively.
- Multiple statistical approaches were employed to evaluate the association of exposures to dioxins and DL-PCBs with obesity. Mediation analysis was performed to assess the potential role of A1c in this association.
TAKEAWAY:
- Multivariable logistic regression analysis found that a single exposure to higher concentrations of 1,2,3,4,6,7,8-HpCDD; 1,2,3,4,6,7,8,9-OCDD; 3,3’,4,4’,5-PnCB; PCB74; PCB105; and PCB118 was associated with an increased risk for general and abdominal obesity (P for trend < .001 for all). A stratified analysis by sex found that except for PCB28, PCB66, PCB74, and PCB156, all chemicals were linked to increased general and abdominal obesity risk in both men and women.
- Combined exposure to dioxins and DL-PCBs was positively associated with the risk for obesity, with 1,2,3,4,6,7,8-HpCDD showing the greatest contribution.
- When considering obesity indices, 1,2,3,4,6,7,8,9-OCDD; 1,2,3,4,6,7,8-HpCDD; 3,3’,4,4’,5-PnCB; PCB74; PCB105; and PCB118 were significantly associated with body mass index and waist circumference.
- A1c levels significantly mediated the association between mixed exposure to dioxins and DL-PCBs and obesity (P < .05), with mediation proportions of 6.94% for general obesity and 5.21% for abdominal obesity.
IN PRACTICE:
“Our findings suggested that dioxins and DL-PCBs may be independent risk factors for obesity,” the authors wrote. “The hazards of dioxins on obesity should be emphasized, and additional studies are desirable to elucidate the potential mechanisms for dioxins on obesity in adults.”
SOURCE:
This study, led by Zhao-Xing Gao, Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University and Center for Big Data and Population Health of IHM, both in Hefei, China, was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The cross-sectional nature of this study prevented the establishment of causal relationships between dioxins or DL-PCBs and obesity. This study relied on a small sample. Replacing chemical concentrations below the limit of detection with fixed values may have introduced bias.
DISCLOSURES:
This study was funded by grants from the National Natural Science Foundation of China, Research Fund of Anhui Institute of Translational Medicine, and Research Fund of Center for Big Data and Population Health of IHM. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Combined exposure to dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs) is significantly associated with an increased risk for obesity in adults, with 1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin (HpCDD) showing the greatest contribution.
METHODOLOGY:
- Researchers evaluated the relationship between mixed exposure to nine types of dioxins and DL-PCBs and obesity or obesity indices in 852 adults using data from the National Health and Nutrition Examination Survey from 2003 to 2004.
- They chose nine chemicals for analysis: 1,2,3,4,6,7,8-HpCDD; 1,2,3,4,6,7,8,9-octachlorodibenzo-p-dioxin (OCDD); 3,3’,4,4’,5-pentachlorodibenzofuran (PnCB); PCB28; PCB66; PCB74; PCB105; PCB118; and PCB156.
- General and abdominal obesity were present in 34% and 53.9% of participants, respectively.
- Multiple statistical approaches were employed to evaluate the association of exposures to dioxins and DL-PCBs with obesity. Mediation analysis was performed to assess the potential role of A1c in this association.
TAKEAWAY:
- Multivariable logistic regression analysis found that a single exposure to higher concentrations of 1,2,3,4,6,7,8-HpCDD; 1,2,3,4,6,7,8,9-OCDD; 3,3’,4,4’,5-PnCB; PCB74; PCB105; and PCB118 was associated with an increased risk for general and abdominal obesity (P for trend < .001 for all). A stratified analysis by sex found that except for PCB28, PCB66, PCB74, and PCB156, all chemicals were linked to increased general and abdominal obesity risk in both men and women.
- Combined exposure to dioxins and DL-PCBs was positively associated with the risk for obesity, with 1,2,3,4,6,7,8-HpCDD showing the greatest contribution.
- When considering obesity indices, 1,2,3,4,6,7,8,9-OCDD; 1,2,3,4,6,7,8-HpCDD; 3,3’,4,4’,5-PnCB; PCB74; PCB105; and PCB118 were significantly associated with body mass index and waist circumference.
- A1c levels significantly mediated the association between mixed exposure to dioxins and DL-PCBs and obesity (P < .05), with mediation proportions of 6.94% for general obesity and 5.21% for abdominal obesity.
IN PRACTICE:
“Our findings suggested that dioxins and DL-PCBs may be independent risk factors for obesity,” the authors wrote. “The hazards of dioxins on obesity should be emphasized, and additional studies are desirable to elucidate the potential mechanisms for dioxins on obesity in adults.”
SOURCE:
This study, led by Zhao-Xing Gao, Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University and Center for Big Data and Population Health of IHM, both in Hefei, China, was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The cross-sectional nature of this study prevented the establishment of causal relationships between dioxins or DL-PCBs and obesity. This study relied on a small sample. Replacing chemical concentrations below the limit of detection with fixed values may have introduced bias.
DISCLOSURES:
This study was funded by grants from the National Natural Science Foundation of China, Research Fund of Anhui Institute of Translational Medicine, and Research Fund of Center for Big Data and Population Health of IHM. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Combined exposure to dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs) is significantly associated with an increased risk for obesity in adults, with 1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin (HpCDD) showing the greatest contribution.
METHODOLOGY:
- Researchers evaluated the relationship between mixed exposure to nine types of dioxins and DL-PCBs and obesity or obesity indices in 852 adults using data from the National Health and Nutrition Examination Survey from 2003 to 2004.
- They chose nine chemicals for analysis: 1,2,3,4,6,7,8-HpCDD; 1,2,3,4,6,7,8,9-octachlorodibenzo-p-dioxin (OCDD); 3,3’,4,4’,5-pentachlorodibenzofuran (PnCB); PCB28; PCB66; PCB74; PCB105; PCB118; and PCB156.
- General and abdominal obesity were present in 34% and 53.9% of participants, respectively.
- Multiple statistical approaches were employed to evaluate the association of exposures to dioxins and DL-PCBs with obesity. Mediation analysis was performed to assess the potential role of A1c in this association.
TAKEAWAY:
- Multivariable logistic regression analysis found that a single exposure to higher concentrations of 1,2,3,4,6,7,8-HpCDD; 1,2,3,4,6,7,8,9-OCDD; 3,3’,4,4’,5-PnCB; PCB74; PCB105; and PCB118 was associated with an increased risk for general and abdominal obesity (P for trend < .001 for all). A stratified analysis by sex found that except for PCB28, PCB66, PCB74, and PCB156, all chemicals were linked to increased general and abdominal obesity risk in both men and women.
- Combined exposure to dioxins and DL-PCBs was positively associated with the risk for obesity, with 1,2,3,4,6,7,8-HpCDD showing the greatest contribution.
- When considering obesity indices, 1,2,3,4,6,7,8,9-OCDD; 1,2,3,4,6,7,8-HpCDD; 3,3’,4,4’,5-PnCB; PCB74; PCB105; and PCB118 were significantly associated with body mass index and waist circumference.
- A1c levels significantly mediated the association between mixed exposure to dioxins and DL-PCBs and obesity (P < .05), with mediation proportions of 6.94% for general obesity and 5.21% for abdominal obesity.
IN PRACTICE:
“Our findings suggested that dioxins and DL-PCBs may be independent risk factors for obesity,” the authors wrote. “The hazards of dioxins on obesity should be emphasized, and additional studies are desirable to elucidate the potential mechanisms for dioxins on obesity in adults.”
SOURCE:
This study, led by Zhao-Xing Gao, Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University and Center for Big Data and Population Health of IHM, both in Hefei, China, was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The cross-sectional nature of this study prevented the establishment of causal relationships between dioxins or DL-PCBs and obesity. This study relied on a small sample. Replacing chemical concentrations below the limit of detection with fixed values may have introduced bias.
DISCLOSURES:
This study was funded by grants from the National Natural Science Foundation of China, Research Fund of Anhui Institute of Translational Medicine, and Research Fund of Center for Big Data and Population Health of IHM. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
Disc Degeneration in Chronic Low Back Pain: Can Stem Cells Help?
TOPLINE:
Allogeneic bone marrow–derived mesenchymal stromal cells (BM-MSCs) are safe but do not show efficacy in treating intervertebral disc degeneration (IDD) in patients with chronic low back pain.
METHODOLOGY:
- The RESPINE trial assessed the efficacy and safety of a single intradiscal injection of allogeneic BM-MSCs in the treatment of chronic low back pain caused by single-level IDD.
- Overall, 114 patients (mean age, 40.9 years; 35% women) with IDD-associated chronic low back pain that was persistent for 3 months or more despite conventional medical therapy and without previous surgery, were recruited across four European countries from April 2018 to April 2021 and randomly assigned to receive either intradiscal injections of allogeneic BM-MSCs (n = 58) or sham injections (n = 56).
- The first co-primary endpoint was the rate of response to BM-MSC injections at 12 months after treatment, defined as improvement of at least 20% or 20 mm in the Visual Analog Scale for pain or improvement of at least 20% in the Oswestry Disability Index for functional status.
- The secondary co-primary endpoint was structural efficacy, based on disc fluid content measured by quantitative T2 MRI between baseline and month 12.
TAKEAWAY:
- At 12 months post-intervention, 74% of patients in the BM-MSC group were classified as responders compared with 68.8% in the placebo group. However, the difference between the groups was not statistically significant.
- The probability of being a responder was higher in the BM-MSC group than in the sham group; however, the findings did not reach statistical significance.
- The average change in disc fluid content, indicative of disc regeneration, from baseline to 12 months was 37.9% in the BM-MSC group and 41.7% in the placebo group, with no significant difference between the groups.
- The incidence of adverse events and serious adverse events was not significantly different between the treatment groups.
IN PRACTICE:
“BM-MSC represents a promising opportunity for the biological treatment of IDD, but only high-quality randomized controlled trials, comparing it to standard care, can determine whether it is a truly effective alternative to spine fusion or disc replacement,” the authors wrote.
SOURCE:
The study was led by Yves-Marie Pers, MD, PhD, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, CHRU Lapeyronie, Montpellier, France. It was published online on October 11, 2024, in Annals of the Rheumatic Diseases.
LIMITATIONS:
MRI results were collected from only 55 patients across both trial arms, which may have affected the statistical power of the findings. Although patients were monitored for up to 24 months, the long-term efficacy and safety of BM-MSC therapy for IDD may not have been fully captured. Selection bias could not be excluded because of the difficulty in accurately identifying patients with chronic low back pain caused by single-level IDD.
DISCLOSURES:
The study was funded by the European Union’s Horizon 2020 Research and Innovation Programme. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Allogeneic bone marrow–derived mesenchymal stromal cells (BM-MSCs) are safe but do not show efficacy in treating intervertebral disc degeneration (IDD) in patients with chronic low back pain.
METHODOLOGY:
- The RESPINE trial assessed the efficacy and safety of a single intradiscal injection of allogeneic BM-MSCs in the treatment of chronic low back pain caused by single-level IDD.
- Overall, 114 patients (mean age, 40.9 years; 35% women) with IDD-associated chronic low back pain that was persistent for 3 months or more despite conventional medical therapy and without previous surgery, were recruited across four European countries from April 2018 to April 2021 and randomly assigned to receive either intradiscal injections of allogeneic BM-MSCs (n = 58) or sham injections (n = 56).
- The first co-primary endpoint was the rate of response to BM-MSC injections at 12 months after treatment, defined as improvement of at least 20% or 20 mm in the Visual Analog Scale for pain or improvement of at least 20% in the Oswestry Disability Index for functional status.
- The secondary co-primary endpoint was structural efficacy, based on disc fluid content measured by quantitative T2 MRI between baseline and month 12.
TAKEAWAY:
- At 12 months post-intervention, 74% of patients in the BM-MSC group were classified as responders compared with 68.8% in the placebo group. However, the difference between the groups was not statistically significant.
- The probability of being a responder was higher in the BM-MSC group than in the sham group; however, the findings did not reach statistical significance.
- The average change in disc fluid content, indicative of disc regeneration, from baseline to 12 months was 37.9% in the BM-MSC group and 41.7% in the placebo group, with no significant difference between the groups.
- The incidence of adverse events and serious adverse events was not significantly different between the treatment groups.
IN PRACTICE:
“BM-MSC represents a promising opportunity for the biological treatment of IDD, but only high-quality randomized controlled trials, comparing it to standard care, can determine whether it is a truly effective alternative to spine fusion or disc replacement,” the authors wrote.
SOURCE:
The study was led by Yves-Marie Pers, MD, PhD, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, CHRU Lapeyronie, Montpellier, France. It was published online on October 11, 2024, in Annals of the Rheumatic Diseases.
LIMITATIONS:
MRI results were collected from only 55 patients across both trial arms, which may have affected the statistical power of the findings. Although patients were monitored for up to 24 months, the long-term efficacy and safety of BM-MSC therapy for IDD may not have been fully captured. Selection bias could not be excluded because of the difficulty in accurately identifying patients with chronic low back pain caused by single-level IDD.
DISCLOSURES:
The study was funded by the European Union’s Horizon 2020 Research and Innovation Programme. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Allogeneic bone marrow–derived mesenchymal stromal cells (BM-MSCs) are safe but do not show efficacy in treating intervertebral disc degeneration (IDD) in patients with chronic low back pain.
METHODOLOGY:
- The RESPINE trial assessed the efficacy and safety of a single intradiscal injection of allogeneic BM-MSCs in the treatment of chronic low back pain caused by single-level IDD.
- Overall, 114 patients (mean age, 40.9 years; 35% women) with IDD-associated chronic low back pain that was persistent for 3 months or more despite conventional medical therapy and without previous surgery, were recruited across four European countries from April 2018 to April 2021 and randomly assigned to receive either intradiscal injections of allogeneic BM-MSCs (n = 58) or sham injections (n = 56).
- The first co-primary endpoint was the rate of response to BM-MSC injections at 12 months after treatment, defined as improvement of at least 20% or 20 mm in the Visual Analog Scale for pain or improvement of at least 20% in the Oswestry Disability Index for functional status.
- The secondary co-primary endpoint was structural efficacy, based on disc fluid content measured by quantitative T2 MRI between baseline and month 12.
TAKEAWAY:
- At 12 months post-intervention, 74% of patients in the BM-MSC group were classified as responders compared with 68.8% in the placebo group. However, the difference between the groups was not statistically significant.
- The probability of being a responder was higher in the BM-MSC group than in the sham group; however, the findings did not reach statistical significance.
- The average change in disc fluid content, indicative of disc regeneration, from baseline to 12 months was 37.9% in the BM-MSC group and 41.7% in the placebo group, with no significant difference between the groups.
- The incidence of adverse events and serious adverse events was not significantly different between the treatment groups.
IN PRACTICE:
“BM-MSC represents a promising opportunity for the biological treatment of IDD, but only high-quality randomized controlled trials, comparing it to standard care, can determine whether it is a truly effective alternative to spine fusion or disc replacement,” the authors wrote.
SOURCE:
The study was led by Yves-Marie Pers, MD, PhD, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, CHRU Lapeyronie, Montpellier, France. It was published online on October 11, 2024, in Annals of the Rheumatic Diseases.
LIMITATIONS:
MRI results were collected from only 55 patients across both trial arms, which may have affected the statistical power of the findings. Although patients were monitored for up to 24 months, the long-term efficacy and safety of BM-MSC therapy for IDD may not have been fully captured. Selection bias could not be excluded because of the difficulty in accurately identifying patients with chronic low back pain caused by single-level IDD.
DISCLOSURES:
The study was funded by the European Union’s Horizon 2020 Research and Innovation Programme. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
Controlling Six Risk Factors Can Combat CKD in Obesity
TOPLINE:
Optimal management of blood pressure, A1c levels, low-density lipoprotein cholesterol (LDL-C), albuminuria, smoking, and physical activity may reduce the excess risk for chronic kidney disease (CKD) typically linked to obesity. The protective effect is more pronounced in men, in those with lower healthy food scores, and in users of diabetes medication.
METHODOLOGY:
- Obesity is a significant risk factor for CKD, but it is unknown if managing multiple other obesity-related CKD risk factors can mitigate the excess CKD risk.
- Researchers assessed CKD risk factor control in 97,538 participants with obesity from the UK Biobank and compared them with an equal number of age- and sex-matched control participants with normal body weight and no CKD at baseline.
- Participants with obesity were assessed for six modifiable risk factors: Blood pressure, A1c levels, LDL-C, albuminuria, smoking, and physical activity.
- Overall, 2487, 12,720, 32,388, 36,988, and 15,381 participants with obesity had at most two, three, four, five, and six risk factors under combined control, respectively, with the two or fewer group serving as the reference.
- The primary outcome was incident CKD and the degree of combined risk factor control in persons. The CKD risk and risk factor control in participants with obesity were also compared with CKD incidence in matched normal weight participants.
TAKEAWAY:
- During a median follow-up period of 10.8 years, 3954 cases of incident CKD were reported in participants with obesity and 1498 cases in matched persons of normal body mass index (BMI).
- In a stepwise pattern, optimal control of each additional risk factor was associated with 11% (adjusted hazard ratio [aHR], 0.89; 95% CI, 0.86-0.91) reduction in the incidence of CKD events, down to a 49% reduction in CKD incidence (aHR, 0.51; 95% CI, 0.43-0.61) for combined control of all six risk factors in participants with obesity.
- The protective effect of combined control of risk factors was more pronounced in men vs women, in those with lower vs higher healthy diet scores, and in users vs nonusers of diabetes medication.
- A similar stepwise pattern emerged between the number of risk factors controlled and CKD risk in participants with obesity compared with matched individuals of normal BMI, with the excess CKD risk eliminated in participants with obesity with six risk factors under control.
IN PRACTICE:
“Comprehensive control of risk factors might effectively neutralize the excessive CKD risk associated with obesity, emphasizing the potential of a joint management approach in the prevention of CKD in this population,” the authors wrote.
SOURCE:
The study was led by Rui Tang, MS, Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana. It was published online in Diabetes, Obesity and Metabolism.
LIMITATIONS:
The evaluated risk factors for CKD were arbitrarily selected, which may not represent the ideal group. The study did not consider the time-varying effect of joint risk factor control owing to the lack of some variables such as A1c. The generalizability of the findings was limited because over 90% of the UK Biobank cohort is composed of White people and individuals with healthier behaviors compared with the overall UK population.
DISCLOSURES:
The study was supported by grants from the US National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Optimal management of blood pressure, A1c levels, low-density lipoprotein cholesterol (LDL-C), albuminuria, smoking, and physical activity may reduce the excess risk for chronic kidney disease (CKD) typically linked to obesity. The protective effect is more pronounced in men, in those with lower healthy food scores, and in users of diabetes medication.
METHODOLOGY:
- Obesity is a significant risk factor for CKD, but it is unknown if managing multiple other obesity-related CKD risk factors can mitigate the excess CKD risk.
- Researchers assessed CKD risk factor control in 97,538 participants with obesity from the UK Biobank and compared them with an equal number of age- and sex-matched control participants with normal body weight and no CKD at baseline.
- Participants with obesity were assessed for six modifiable risk factors: Blood pressure, A1c levels, LDL-C, albuminuria, smoking, and physical activity.
- Overall, 2487, 12,720, 32,388, 36,988, and 15,381 participants with obesity had at most two, three, four, five, and six risk factors under combined control, respectively, with the two or fewer group serving as the reference.
- The primary outcome was incident CKD and the degree of combined risk factor control in persons. The CKD risk and risk factor control in participants with obesity were also compared with CKD incidence in matched normal weight participants.
TAKEAWAY:
- During a median follow-up period of 10.8 years, 3954 cases of incident CKD were reported in participants with obesity and 1498 cases in matched persons of normal body mass index (BMI).
- In a stepwise pattern, optimal control of each additional risk factor was associated with 11% (adjusted hazard ratio [aHR], 0.89; 95% CI, 0.86-0.91) reduction in the incidence of CKD events, down to a 49% reduction in CKD incidence (aHR, 0.51; 95% CI, 0.43-0.61) for combined control of all six risk factors in participants with obesity.
- The protective effect of combined control of risk factors was more pronounced in men vs women, in those with lower vs higher healthy diet scores, and in users vs nonusers of diabetes medication.
- A similar stepwise pattern emerged between the number of risk factors controlled and CKD risk in participants with obesity compared with matched individuals of normal BMI, with the excess CKD risk eliminated in participants with obesity with six risk factors under control.
IN PRACTICE:
“Comprehensive control of risk factors might effectively neutralize the excessive CKD risk associated with obesity, emphasizing the potential of a joint management approach in the prevention of CKD in this population,” the authors wrote.
SOURCE:
The study was led by Rui Tang, MS, Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana. It was published online in Diabetes, Obesity and Metabolism.
LIMITATIONS:
The evaluated risk factors for CKD were arbitrarily selected, which may not represent the ideal group. The study did not consider the time-varying effect of joint risk factor control owing to the lack of some variables such as A1c. The generalizability of the findings was limited because over 90% of the UK Biobank cohort is composed of White people and individuals with healthier behaviors compared with the overall UK population.
DISCLOSURES:
The study was supported by grants from the US National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Optimal management of blood pressure, A1c levels, low-density lipoprotein cholesterol (LDL-C), albuminuria, smoking, and physical activity may reduce the excess risk for chronic kidney disease (CKD) typically linked to obesity. The protective effect is more pronounced in men, in those with lower healthy food scores, and in users of diabetes medication.
METHODOLOGY:
- Obesity is a significant risk factor for CKD, but it is unknown if managing multiple other obesity-related CKD risk factors can mitigate the excess CKD risk.
- Researchers assessed CKD risk factor control in 97,538 participants with obesity from the UK Biobank and compared them with an equal number of age- and sex-matched control participants with normal body weight and no CKD at baseline.
- Participants with obesity were assessed for six modifiable risk factors: Blood pressure, A1c levels, LDL-C, albuminuria, smoking, and physical activity.
- Overall, 2487, 12,720, 32,388, 36,988, and 15,381 participants with obesity had at most two, three, four, five, and six risk factors under combined control, respectively, with the two or fewer group serving as the reference.
- The primary outcome was incident CKD and the degree of combined risk factor control in persons. The CKD risk and risk factor control in participants with obesity were also compared with CKD incidence in matched normal weight participants.
TAKEAWAY:
- During a median follow-up period of 10.8 years, 3954 cases of incident CKD were reported in participants with obesity and 1498 cases in matched persons of normal body mass index (BMI).
- In a stepwise pattern, optimal control of each additional risk factor was associated with 11% (adjusted hazard ratio [aHR], 0.89; 95% CI, 0.86-0.91) reduction in the incidence of CKD events, down to a 49% reduction in CKD incidence (aHR, 0.51; 95% CI, 0.43-0.61) for combined control of all six risk factors in participants with obesity.
- The protective effect of combined control of risk factors was more pronounced in men vs women, in those with lower vs higher healthy diet scores, and in users vs nonusers of diabetes medication.
- A similar stepwise pattern emerged between the number of risk factors controlled and CKD risk in participants with obesity compared with matched individuals of normal BMI, with the excess CKD risk eliminated in participants with obesity with six risk factors under control.
IN PRACTICE:
“Comprehensive control of risk factors might effectively neutralize the excessive CKD risk associated with obesity, emphasizing the potential of a joint management approach in the prevention of CKD in this population,” the authors wrote.
SOURCE:
The study was led by Rui Tang, MS, Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana. It was published online in Diabetes, Obesity and Metabolism.
LIMITATIONS:
The evaluated risk factors for CKD were arbitrarily selected, which may not represent the ideal group. The study did not consider the time-varying effect of joint risk factor control owing to the lack of some variables such as A1c. The generalizability of the findings was limited because over 90% of the UK Biobank cohort is composed of White people and individuals with healthier behaviors compared with the overall UK population.
DISCLOSURES:
The study was supported by grants from the US National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Current Hydroxychloroquine Use in Lupus May Provide Protection Against Cardiovascular Events
TOPLINE:
Current use of hydroxychloroquine is associated with a lower risk for myocardial infarction (MI), stroke, and other thromboembolic events in patients with systemic lupus erythematosus (SLE). This protective effect diminishes after discontinuation of hydroxychloroquine treatment.
METHODOLOGY:
- Researchers used a nested case-control design to evaluate the association between exposure to hydroxychloroquine and the risk for cardiovascular events in patients with SLE.
- They included 52,883 adults with SLE (mean age, 44.23 years; 86.6% women) identified from the National System of Health Databases, which includes 99% of the French population.
- Among these, 1981 individuals with composite cardiovascular conditions were matched with 16,892 control individuals without cardiovascular conditions.
- Patients were categorized on the basis of hydroxychloroquine exposure into current users (last exposure within 90 days before a cardiovascular event), remote users (91-365 days before), and nonusers (no exposure within 365 days).
- The study outcomes included a composite of cardiovascular events, including MI, stroke (including transient ischemic attack), and other thromboembolic events such as phlebitis, thrombophlebitis, venous thrombosis, venous thromboembolism, and pulmonary embolism.
TAKEAWAY:
- Current hydroxychloroquine users had lower odds of experiencing a composite cardiovascular outcome than nonusers (adjusted odds ratio [aOR], 0.63; 95% CI, 0.57-0.70).
- The odds of MI (aOR, 0.72; 95% CI, 0.60-0.87), stroke (aOR, 0.71; 95% CI, 0.61-0.83), and other thromboembolic events (aOR, 0.58; 95% CI, 0.48-0.69) were also lower among current users than among nonusers.
- No significant association was found for remote hydroxychloroquine exposure and the risk for composite cardiovascular events, MI, stroke, and other thromboembolic events.
IN PRACTICE:
“These findings support the protective association of hydroxychloroquine against CV [cardiovascular] events and underscore the importance of continuous hydroxychloroquine therapy for patients diagnosed with SLE,” the authors wrote.
SOURCE:
The study was led by Lamiae Grimaldi-Bensouda, PharmD, PhD, Department of Pharmacology, Hospital Group Paris-Saclay, Assistance Publique-Hôpitaux de Paris, France. It was published online on August 30, 2024, in JAMA Network Open.
LIMITATIONS:
The observational nature of the study may have introduced confounding. Current hydroxychloroquine users were younger than nonusers, with an average age difference of almost 5 years. Current hydroxychloroquine users had a twofold longer duration of onset of SLE and had a higher prevalence of chronic kidney disease compared with nonusers.
DISCLOSURES:
This study was funded by the Banque pour l’Investissement, Deeptech. Some authors declared having financial ties with various institutions and companies outside of the current study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Current use of hydroxychloroquine is associated with a lower risk for myocardial infarction (MI), stroke, and other thromboembolic events in patients with systemic lupus erythematosus (SLE). This protective effect diminishes after discontinuation of hydroxychloroquine treatment.
METHODOLOGY:
- Researchers used a nested case-control design to evaluate the association between exposure to hydroxychloroquine and the risk for cardiovascular events in patients with SLE.
- They included 52,883 adults with SLE (mean age, 44.23 years; 86.6% women) identified from the National System of Health Databases, which includes 99% of the French population.
- Among these, 1981 individuals with composite cardiovascular conditions were matched with 16,892 control individuals without cardiovascular conditions.
- Patients were categorized on the basis of hydroxychloroquine exposure into current users (last exposure within 90 days before a cardiovascular event), remote users (91-365 days before), and nonusers (no exposure within 365 days).
- The study outcomes included a composite of cardiovascular events, including MI, stroke (including transient ischemic attack), and other thromboembolic events such as phlebitis, thrombophlebitis, venous thrombosis, venous thromboembolism, and pulmonary embolism.
TAKEAWAY:
- Current hydroxychloroquine users had lower odds of experiencing a composite cardiovascular outcome than nonusers (adjusted odds ratio [aOR], 0.63; 95% CI, 0.57-0.70).
- The odds of MI (aOR, 0.72; 95% CI, 0.60-0.87), stroke (aOR, 0.71; 95% CI, 0.61-0.83), and other thromboembolic events (aOR, 0.58; 95% CI, 0.48-0.69) were also lower among current users than among nonusers.
- No significant association was found for remote hydroxychloroquine exposure and the risk for composite cardiovascular events, MI, stroke, and other thromboembolic events.
IN PRACTICE:
“These findings support the protective association of hydroxychloroquine against CV [cardiovascular] events and underscore the importance of continuous hydroxychloroquine therapy for patients diagnosed with SLE,” the authors wrote.
SOURCE:
The study was led by Lamiae Grimaldi-Bensouda, PharmD, PhD, Department of Pharmacology, Hospital Group Paris-Saclay, Assistance Publique-Hôpitaux de Paris, France. It was published online on August 30, 2024, in JAMA Network Open.
LIMITATIONS:
The observational nature of the study may have introduced confounding. Current hydroxychloroquine users were younger than nonusers, with an average age difference of almost 5 years. Current hydroxychloroquine users had a twofold longer duration of onset of SLE and had a higher prevalence of chronic kidney disease compared with nonusers.
DISCLOSURES:
This study was funded by the Banque pour l’Investissement, Deeptech. Some authors declared having financial ties with various institutions and companies outside of the current study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Current use of hydroxychloroquine is associated with a lower risk for myocardial infarction (MI), stroke, and other thromboembolic events in patients with systemic lupus erythematosus (SLE). This protective effect diminishes after discontinuation of hydroxychloroquine treatment.
METHODOLOGY:
- Researchers used a nested case-control design to evaluate the association between exposure to hydroxychloroquine and the risk for cardiovascular events in patients with SLE.
- They included 52,883 adults with SLE (mean age, 44.23 years; 86.6% women) identified from the National System of Health Databases, which includes 99% of the French population.
- Among these, 1981 individuals with composite cardiovascular conditions were matched with 16,892 control individuals without cardiovascular conditions.
- Patients were categorized on the basis of hydroxychloroquine exposure into current users (last exposure within 90 days before a cardiovascular event), remote users (91-365 days before), and nonusers (no exposure within 365 days).
- The study outcomes included a composite of cardiovascular events, including MI, stroke (including transient ischemic attack), and other thromboembolic events such as phlebitis, thrombophlebitis, venous thrombosis, venous thromboembolism, and pulmonary embolism.
TAKEAWAY:
- Current hydroxychloroquine users had lower odds of experiencing a composite cardiovascular outcome than nonusers (adjusted odds ratio [aOR], 0.63; 95% CI, 0.57-0.70).
- The odds of MI (aOR, 0.72; 95% CI, 0.60-0.87), stroke (aOR, 0.71; 95% CI, 0.61-0.83), and other thromboembolic events (aOR, 0.58; 95% CI, 0.48-0.69) were also lower among current users than among nonusers.
- No significant association was found for remote hydroxychloroquine exposure and the risk for composite cardiovascular events, MI, stroke, and other thromboembolic events.
IN PRACTICE:
“These findings support the protective association of hydroxychloroquine against CV [cardiovascular] events and underscore the importance of continuous hydroxychloroquine therapy for patients diagnosed with SLE,” the authors wrote.
SOURCE:
The study was led by Lamiae Grimaldi-Bensouda, PharmD, PhD, Department of Pharmacology, Hospital Group Paris-Saclay, Assistance Publique-Hôpitaux de Paris, France. It was published online on August 30, 2024, in JAMA Network Open.
LIMITATIONS:
The observational nature of the study may have introduced confounding. Current hydroxychloroquine users were younger than nonusers, with an average age difference of almost 5 years. Current hydroxychloroquine users had a twofold longer duration of onset of SLE and had a higher prevalence of chronic kidney disease compared with nonusers.
DISCLOSURES:
This study was funded by the Banque pour l’Investissement, Deeptech. Some authors declared having financial ties with various institutions and companies outside of the current study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.