Roy Altman, MD, was a father, a husband, a teacher, a physician, an editor, and a mentor. He died November 30 as a result of complications related to Parkinson’s disease.

Altman was an editorial advisory board member for MDedge Rheumatology/Rheumatology News since the publications’ start in 2002. He also treated patients and taught students at the University of Miami and the University of California, Los Angeles. A father of four adult children and a grandfather to nine grandchildren, Altman was also a husband to Linda, “his lifelong partner.”

“[He] had this tremendous editorial expertise to be able to manage different journals at the same time without conflict,” said Marc Hochberg, MD, MPH, a professor of medicine, epidemiology, and public health and head of the division of rheumatology and clinical immunology at the University of Maryland School of Medicine, Baltimore. “This was done in the days before electronic publishing, in the days before everything was being done on the computer.”

Publications where Altman served as editor include Osteoarthritis and Cartilage and Seminars in Arthritis and Rheumatism.

In addition to editing articles, Altman also had an active patient panel, while lecturing and traveling internationally, Hochberg said. Altman accomplished this “while maintaining a very active family life,” remembers Hochberg, who learned from Altman about ways to achieve work-life balance.

“That’s important when you’re a junior faculty member – and you’re trying to develop your academic career – that you prioritize what you need to do to be successful in the world of academic medicine, especially rheumatology,” said Hochberg, who described Altman as a “very close friend.”

Teacher, physician, and mentor

John FitzGerald, MD, PhD, MBA, chief of clinical rheumatology at the University of California, Los Angeles, looks back on the more than 15 years that Altman drove 1 hour each way to teach fellows about topics including osteoarthritis. “He really valued teaching. ... that was a lot of his focus,” said FitzGerald, who adds that Altman also enjoyed his relationships with patients.

Altman joined the University of California, Los Angeles, faculty as a professor of medicine in the division of rheumatology and immunology in 2003. Before arriving at UCLA, he was chief of rheumatology and immunology at the University of Miami for many years.

“His patients loved him because he was providing treatments and services that they really had trouble finding elsewhere,” FitzGerald said. Altman entrusted FitzGerald with giving him injections between patients or during lunch for the arthritis that increasingly bothered him.

“He was very appreciative of having the care provided to him. ... he was also sort of playful and teasing,” FitzGerald said.

Altman also took on the role of teacher at home, according to his daughter, Evie. “My dad loved to diagnose; he enjoyed piecing together the disparate physical and radiologic clues to determine the cause of disease or pain. When I was much younger, he taught me how to spot someone with Paget’s Disease from the other end of the room.”

“He loved teaching, imparting his knowledge to others,” she added, remembering the slide sessions Altman presented to his students at their family home. “We loved [the slide sessions] because we could get pizza for dinner, and we got really good at spotting the biological markers of rheumatoid arthritis.”

Aaron Altman said his father was “impassioned by bringing people alleviation of their pain and suffering. It drove him to his very core.”

Researcher and family man

Evie Altman said in an interview that many people don’t know her father was one of the first practitioners of arthroscopy. “He would bring the then-rigid scopes into our elementary school class for ‘show and tell.’ Also, he traveled to the Bolivian jungles in the late 1970s to gather specific red ants whose venom locals had reported as an arthritic treatment,” she said.

Ultimately, Altman isolated the venom’s active ingredient, said Evie, who remembers that her father studied the effect of the treatment for many years. “This eventually led to his research with capsaicin peppers, which was developed into a cream used widely today.”

“Growing up, our garage freezer always had serum and patient urine in one section, away from the ice cream,” Evie added.

In 2011, Sally Koch Kubetin reported for Rheumatology News on Altman’s habit of donning his wife’s handpainted ties. His motivation? It was “born of the sensible desire to be recognizable in a busy world,” she wrote.

Evie said that her mother started painting ties for her father early in his career. Two of his favorite ties, she said, are the “Lady and the Tramp” tie featuring the two dogs eating spaghetti from the same bowl and the Winnie the Pooh tie. “Mostly, he loved the ties because my mom made them,” she said.

Student and military doctor

Altman received his medical degree from the University of Miami School of Medicine after earning an undergraduate degree from Michigan State University, East Lansing, Kubetin reported. The University of Miami School of Medicine was also where he did his internship, residency, and fellowship in rheumatology.

Kubetin reported that Altman’s military service interrupted his training. During his service as a lieutenant in the U.S. Navy active duty reserve, he was a general medical officer and cared for sailors and officers at Naval Air Station Point Mugu in Oxnard, Calif.

Altman had a second academic appointment as a professor of orthopedics when he was in Miami, according to the Rheumatology News profile. In addition, he was the clinical director of the geriatric research, education, and clinical center, and chief of the arthritis section in the division of medicine at the Miami Veterans Affairs Medical Center.

“Persistence, stubbornness, and all around stick-to-it-iveness defined him in our eyes,” said his daughter, Sarah. His daughter, Ruth, credits her father’s kindness and patience with informing how she practices veterinary medicine. “When I went to rounds with dad on Saturdays, he went to a nearby flower place downtown to get mom flowers almost every week if he could,” she said.

Altman announced at the family’s annual summer reunion in 2021 that he would stop seeing patients, said his daughter, Evie. He continued to present slide sessions and grand rounds to medical students at UCLA until early this year. Altman continued to edit journals and review articles until he died from complications of Parkinson’s disease.

He published articles in medical journals that number in the thousands, according to a website established by Altman’s family that honors his life. Altman was born in Astoria, N.Y., on May 16, 1937, and moved to Miami Beach with his parents when he was young.

Roy Altman, MD, was a father, a husband, a teacher, a physician, an editor, and a mentor. He died November 30 as a result of complications related to Parkinson’s disease.

Altman was an editorial advisory board member for MDedge Rheumatology/Rheumatology News since the publications’ start in 2002. He also treated patients and taught students at the University of Miami and the University of California, Los Angeles. A father of four adult children and a grandfather to nine grandchildren, Altman was also a husband to Linda, “his lifelong partner.”

“[He] had this tremendous editorial expertise to be able to manage different journals at the same time without conflict,” said Marc Hochberg, MD, MPH, a professor of medicine, epidemiology, and public health and head of the division of rheumatology and clinical immunology at the University of Maryland School of Medicine, Baltimore. “This was done in the days before electronic publishing, in the days before everything was being done on the computer.”

Publications where Altman served as editor include Osteoarthritis and Cartilage and Seminars in Arthritis and Rheumatism.

In addition to editing articles, Altman also had an active patient panel, while lecturing and traveling internationally, Hochberg said. Altman accomplished this “while maintaining a very active family life,” remembers Hochberg, who learned from Altman about ways to achieve work-life balance.

“That’s important when you’re a junior faculty member – and you’re trying to develop your academic career – that you prioritize what you need to do to be successful in the world of academic medicine, especially rheumatology,” said Hochberg, who described Altman as a “very close friend.”

Teacher, physician, and mentor

John FitzGerald, MD, PhD, MBA, chief of clinical rheumatology at the University of California, Los Angeles, looks back on the more than 15 years that Altman drove 1 hour each way to teach fellows about topics including osteoarthritis. “He really valued teaching. ... that was a lot of his focus,” said FitzGerald, who adds that Altman also enjoyed his relationships with patients.

Altman joined the University of California, Los Angeles, faculty as a professor of medicine in the division of rheumatology and immunology in 2003. Before arriving at UCLA, he was chief of rheumatology and immunology at the University of Miami for many years.

“His patients loved him because he was providing treatments and services that they really had trouble finding elsewhere,” FitzGerald said. Altman entrusted FitzGerald with giving him injections between patients or during lunch for the arthritis that increasingly bothered him.

“He was very appreciative of having the care provided to him. ... he was also sort of playful and teasing,” FitzGerald said.

Altman also took on the role of teacher at home, according to his daughter, Evie. “My dad loved to diagnose; he enjoyed piecing together the disparate physical and radiologic clues to determine the cause of disease or pain. When I was much younger, he taught me how to spot someone with Paget’s Disease from the other end of the room.”

“He loved teaching, imparting his knowledge to others,” she added, remembering the slide sessions Altman presented to his students at their family home. “We loved [the slide sessions] because we could get pizza for dinner, and we got really good at spotting the biological markers of rheumatoid arthritis.”

Aaron Altman said his father was “impassioned by bringing people alleviation of their pain and suffering. It drove him to his very core.”

Researcher and family man

Evie Altman said in an interview that many people don’t know her father was one of the first practitioners of arthroscopy. “He would bring the then-rigid scopes into our elementary school class for ‘show and tell.’ Also, he traveled to the Bolivian jungles in the late 1970s to gather specific red ants whose venom locals had reported as an arthritic treatment,” she said.

Ultimately, Altman isolated the venom’s active ingredient, said Evie, who remembers that her father studied the effect of the treatment for many years. “This eventually led to his research with capsaicin peppers, which was developed into a cream used widely today.”

“Growing up, our garage freezer always had serum and patient urine in one section, away from the ice cream,” Evie added.

In 2011, Sally Koch Kubetin reported for Rheumatology News on Altman’s habit of donning his wife’s handpainted ties. His motivation? It was “born of the sensible desire to be recognizable in a busy world,” she wrote.

Evie said that her mother started painting ties for her father early in his career. Two of his favorite ties, she said, are the “Lady and the Tramp” tie featuring the two dogs eating spaghetti from the same bowl and the Winnie the Pooh tie. “Mostly, he loved the ties because my mom made them,” she said.

Student and military doctor

Altman received his medical degree from the University of Miami School of Medicine after earning an undergraduate degree from Michigan State University, East Lansing, Kubetin reported. The University of Miami School of Medicine was also where he did his internship, residency, and fellowship in rheumatology.

Kubetin reported that Altman’s military service interrupted his training. During his service as a lieutenant in the U.S. Navy active duty reserve, he was a general medical officer and cared for sailors and officers at Naval Air Station Point Mugu in Oxnard, Calif.

Altman had a second academic appointment as a professor of orthopedics when he was in Miami, according to the Rheumatology News profile. In addition, he was the clinical director of the geriatric research, education, and clinical center, and chief of the arthritis section in the division of medicine at the Miami Veterans Affairs Medical Center.

“Persistence, stubbornness, and all around stick-to-it-iveness defined him in our eyes,” said his daughter, Sarah. His daughter, Ruth, credits her father’s kindness and patience with informing how she practices veterinary medicine. “When I went to rounds with dad on Saturdays, he went to a nearby flower place downtown to get mom flowers almost every week if he could,” she said.

Altman announced at the family’s annual summer reunion in 2021 that he would stop seeing patients, said his daughter, Evie. He continued to present slide sessions and grand rounds to medical students at UCLA until early this year. Altman continued to edit journals and review articles until he died from complications of Parkinson’s disease.

He published articles in medical journals that number in the thousands, according to a website established by Altman’s family that honors his life. Altman was born in Astoria, N.Y., on May 16, 1937, and moved to Miami Beach with his parents when he was young.

Roy Altman, MD, was a father, a husband, a teacher, a physician, an editor, and a mentor. He died November 30 as a result of complications related to Parkinson’s disease.

Altman was an editorial advisory board member for MDedge Rheumatology/Rheumatology News since the publications’ start in 2002. He also treated patients and taught students at the University of Miami and the University of California, Los Angeles. A father of four adult children and a grandfather to nine grandchildren, Altman was also a husband to Linda, “his lifelong partner.”

“[He] had this tremendous editorial expertise to be able to manage different journals at the same time without conflict,” said Marc Hochberg, MD, MPH, a professor of medicine, epidemiology, and public health and head of the division of rheumatology and clinical immunology at the University of Maryland School of Medicine, Baltimore. “This was done in the days before electronic publishing, in the days before everything was being done on the computer.”

Publications where Altman served as editor include Osteoarthritis and Cartilage and Seminars in Arthritis and Rheumatism.

In addition to editing articles, Altman also had an active patient panel, while lecturing and traveling internationally, Hochberg said. Altman accomplished this “while maintaining a very active family life,” remembers Hochberg, who learned from Altman about ways to achieve work-life balance.

“That’s important when you’re a junior faculty member – and you’re trying to develop your academic career – that you prioritize what you need to do to be successful in the world of academic medicine, especially rheumatology,” said Hochberg, who described Altman as a “very close friend.”

Teacher, physician, and mentor

John FitzGerald, MD, PhD, MBA, chief of clinical rheumatology at the University of California, Los Angeles, looks back on the more than 15 years that Altman drove 1 hour each way to teach fellows about topics including osteoarthritis. “He really valued teaching. ... that was a lot of his focus,” said FitzGerald, who adds that Altman also enjoyed his relationships with patients.

Altman joined the University of California, Los Angeles, faculty as a professor of medicine in the division of rheumatology and immunology in 2003. Before arriving at UCLA, he was chief of rheumatology and immunology at the University of Miami for many years.

“His patients loved him because he was providing treatments and services that they really had trouble finding elsewhere,” FitzGerald said. Altman entrusted FitzGerald with giving him injections between patients or during lunch for the arthritis that increasingly bothered him.

“He was very appreciative of having the care provided to him. ... he was also sort of playful and teasing,” FitzGerald said.

Altman also took on the role of teacher at home, according to his daughter, Evie. “My dad loved to diagnose; he enjoyed piecing together the disparate physical and radiologic clues to determine the cause of disease or pain. When I was much younger, he taught me how to spot someone with Paget’s Disease from the other end of the room.”

“He loved teaching, imparting his knowledge to others,” she added, remembering the slide sessions Altman presented to his students at their family home. “We loved [the slide sessions] because we could get pizza for dinner, and we got really good at spotting the biological markers of rheumatoid arthritis.”

Aaron Altman said his father was “impassioned by bringing people alleviation of their pain and suffering. It drove him to his very core.”

Researcher and family man

Evie Altman said in an interview that many people don’t know her father was one of the first practitioners of arthroscopy. “He would bring the then-rigid scopes into our elementary school class for ‘show and tell.’ Also, he traveled to the Bolivian jungles in the late 1970s to gather specific red ants whose venom locals had reported as an arthritic treatment,” she said.

Ultimately, Altman isolated the venom’s active ingredient, said Evie, who remembers that her father studied the effect of the treatment for many years. “This eventually led to his research with capsaicin peppers, which was developed into a cream used widely today.”

“Growing up, our garage freezer always had serum and patient urine in one section, away from the ice cream,” Evie added.

In 2011, Sally Koch Kubetin reported for Rheumatology News on Altman’s habit of donning his wife’s handpainted ties. His motivation? It was “born of the sensible desire to be recognizable in a busy world,” she wrote.

Evie said that her mother started painting ties for her father early in his career. Two of his favorite ties, she said, are the “Lady and the Tramp” tie featuring the two dogs eating spaghetti from the same bowl and the Winnie the Pooh tie. “Mostly, he loved the ties because my mom made them,” she said.

Student and military doctor

Altman received his medical degree from the University of Miami School of Medicine after earning an undergraduate degree from Michigan State University, East Lansing, Kubetin reported. The University of Miami School of Medicine was also where he did his internship, residency, and fellowship in rheumatology.

Kubetin reported that Altman’s military service interrupted his training. During his service as a lieutenant in the U.S. Navy active duty reserve, he was a general medical officer and cared for sailors and officers at Naval Air Station Point Mugu in Oxnard, Calif.

Altman had a second academic appointment as a professor of orthopedics when he was in Miami, according to the Rheumatology News profile. In addition, he was the clinical director of the geriatric research, education, and clinical center, and chief of the arthritis section in the division of medicine at the Miami Veterans Affairs Medical Center.

“Persistence, stubbornness, and all around stick-to-it-iveness defined him in our eyes,” said his daughter, Sarah. His daughter, Ruth, credits her father’s kindness and patience with informing how she practices veterinary medicine. “When I went to rounds with dad on Saturdays, he went to a nearby flower place downtown to get mom flowers almost every week if he could,” she said.

Altman announced at the family’s annual summer reunion in 2021 that he would stop seeing patients, said his daughter, Evie. He continued to present slide sessions and grand rounds to medical students at UCLA until early this year. Altman continued to edit journals and review articles until he died from complications of Parkinson’s disease.

He published articles in medical journals that number in the thousands, according to a website established by Altman’s family that honors his life. Altman was born in Astoria, N.Y., on May 16, 1937, and moved to Miami Beach with his parents when he was young.

In September 2022, the US Preventive Services Task Force (USPSTF) released 2 sets of draft recommendations on screening for 3 mental health conditions in adults: ­anxiety, depression, and suicide risk.^1,2 These draft recommendations are summarized in TABLE 1^1-4 along with finalized recommendations on the same topics for children and adolescents, published in October 2022.^3,4

The recommendations on depression and suicide risk screening in adults are updates of previous recommendations (2016 for depression and 2014 for suicide risk) with no major changes. Screening for anxiety is a topic addressed for the first time this year for adults and for children and adolescents.^1,3

The recommendations are fairly consistent between age groups. A “B” recommendation supports screening for major depression in all patients starting at age 12 years, including during pregnancy and the postpartum period. (See TABLE 1 for grade definitions.) For all age groups, evidence was insufficient to recommend screening for suicide risk. A “B” recommendation was also assigned to screening for anxiety in those ages 8 to 64 years. The USPSTF believes the evidence is insufficient to make a recommendation on screening for anxiety among adults ≥ 65 years of age.

The anxiety disorders common to both children and adults included in the USPSTF recommendations are generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder, phobias, selective mutism, and anxiety type not specified. For adults, the USPSTF also includes substance/medication-induced anxiety and anxiety due to other medical conditions.

Adults with anxiety often present with generalized complaints such as sleep disturbance, pain, and other somatic disorders that can remain undiagnosed for years. The ­USPSTF cites a lifetime prevalence of anxiety disorders of 26.4% for men and 40.4% for women, although the data used are 10 years old.⁵ The cited rate of generalized anxiety in pregnancy is 8.5% to 10.5%, and in the postpartum period, 4.4% to 10.8%.⁶

The data on direct benefits and harms of screening for anxiety in adults through age 64 are sparse. Nevertheless, the USPSTF deemed that screening tests for anxiety have adequate accuracy and that psychological interventions for anxiety result in moderate reduction of anxiety symptoms. Pharmacologic interventions produce a small benefit, although there is a lack of evidence for pharmacotherapy in pregnant and postpartum women. There is even less evidence of benefit for treatment in adults ≥ 65 years of age.¹

How anxiety screening tests compare

Screening tests for anxiety in adults reviewed by the USPSTF included the Generalized Anxiety Disorder (GAD) scale and the Edinburgh Postnatal Depression Scale (EPDS) anxiety subscale.¹ The most studied tools are the ­GAD-2 and GAD-7.

Continue to: The sensitivity and specificity...

The sensitivity and specificity of each test depends on the cutoff used. With the GAD-2, a cutoff of 2 or more resulted in a sensitivity of 94% and a specificity of 68% for detecting generalized anxiety.⁷ A cutoff of 3 or more resulted in a sensitivity of 81% and a specificity of 86%.⁷ The GAD-7, using 10 as a cutoff, achieves a sensitivity of 79% and a specificity of 89%.⁷ Given the similar performance of the 2 options, the GAD-2 (TABLE 2^8,9) is probably preferable for use in primary care because of its ease of administration.

The tests evaluated by the USPSTF for anxiety screening in children and adolescents ≥ 8 years of age included the Screen for Child Anxiety Related Disorders (SCARED) and the Patient Health Questionnaire–Adolescent (PHQ-A).³ These tools ask more questions than the adult screening tools do: 41 for the SCARED and 13 for the PHQ-A. The sensitivity of SCARED for generalized anxiety disorder was 64% and the specificity was 63%.¹⁰ The sensitivity of the PHQ-A was 50% and the specificity was 98%.¹⁰

Various versions of all of these screening tools can be easily located on the internet. Search for them using the acronyms.

Screening for major depression

The depression screening tests the USPSTF examined were various versions of the Patient Health Questionnaire (PHQ), the Center for Epidemiologic Studies Depression Scale ­(CES-D), the Geriatric Depression Scale (GDS) in older adults, and the EPDS in postpartum and pregnant persons.⁷

A 2-question version of the PHQ was found to have a sensitivity of 91% with a specificity of 67%. The 9-question PHQ was found to have a similar sensitivity (88%) but better specificity (85%).⁷TABLE 3¹¹ lists the 2 questions in the PHQ-2 and explains how to score the results.

Continue to: The most commonly...

The most commonly studied screening tool for adolescents is the PHQ-A. Its sensitivity is 73% and specificity is 94%.¹²

The GAD-2 and PHQ-2 have the same possible answers and scores and can be combined into a 4-question screening tool to assess for anxiety and depression. If an initial screen for anxiety or depression (or both) is positive, further diagnostic testing and follow-up are needed.

Frequency of screening

The USPSTF recognized that limited information on the frequency of screening for both anxiety and depression does not support any recommendation on this matter. It suggested screening everyone once and then basing the need for subsequent screening tests on clinical judgment after considering risk factors and life events, with periodic rescreening of those at high risk. Finally, USPSTF recognized the many challenges to implementing screening tests for mental health conditions in primary care practice, but offered little practical advice on how to do this.

Suicide risk screening

As for the evidence on benefits and harms of screening for suicide risk in all age groups, the USPSTF still regards it as insufficient to make a recommendation. The lack of evidence applies to all aspects of screening, including the accuracy of the various screening tools and the potential benefits and harms of preventive interventions.^2,7

Next steps

The recommendations on screening for depression, suicide risk, and anxiety in adults have been published as a draft, and the public comment period will be over by the time of this publication. The USPSTF generally takes 6 to 9 months to consider all the public comments and to publish final recommendations. The final recommendations on these topics for children and adolescents have been published since drafts were made available last April. There were no major changes between the draft and final versions.

In September 2022, the US Preventive Services Task Force (USPSTF) released 2 sets of draft recommendations on screening for 3 mental health conditions in adults: ­anxiety, depression, and suicide risk.^1,2 These draft recommendations are summarized in TABLE 1^1-4 along with finalized recommendations on the same topics for children and adolescents, published in October 2022.^3,4

The recommendations on depression and suicide risk screening in adults are updates of previous recommendations (2016 for depression and 2014 for suicide risk) with no major changes. Screening for anxiety is a topic addressed for the first time this year for adults and for children and adolescents.^1,3

The recommendations are fairly consistent between age groups. A “B” recommendation supports screening for major depression in all patients starting at age 12 years, including during pregnancy and the postpartum period. (See TABLE 1 for grade definitions.) For all age groups, evidence was insufficient to recommend screening for suicide risk. A “B” recommendation was also assigned to screening for anxiety in those ages 8 to 64 years. The USPSTF believes the evidence is insufficient to make a recommendation on screening for anxiety among adults ≥ 65 years of age.

The anxiety disorders common to both children and adults included in the USPSTF recommendations are generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder, phobias, selective mutism, and anxiety type not specified. For adults, the USPSTF also includes substance/medication-induced anxiety and anxiety due to other medical conditions.

Adults with anxiety often present with generalized complaints such as sleep disturbance, pain, and other somatic disorders that can remain undiagnosed for years. The ­USPSTF cites a lifetime prevalence of anxiety disorders of 26.4% for men and 40.4% for women, although the data used are 10 years old.⁵ The cited rate of generalized anxiety in pregnancy is 8.5% to 10.5%, and in the postpartum period, 4.4% to 10.8%.⁶

The data on direct benefits and harms of screening for anxiety in adults through age 64 are sparse. Nevertheless, the USPSTF deemed that screening tests for anxiety have adequate accuracy and that psychological interventions for anxiety result in moderate reduction of anxiety symptoms. Pharmacologic interventions produce a small benefit, although there is a lack of evidence for pharmacotherapy in pregnant and postpartum women. There is even less evidence of benefit for treatment in adults ≥ 65 years of age.¹

How anxiety screening tests compare

Screening tests for anxiety in adults reviewed by the USPSTF included the Generalized Anxiety Disorder (GAD) scale and the Edinburgh Postnatal Depression Scale (EPDS) anxiety subscale.¹ The most studied tools are the ­GAD-2 and GAD-7.

Continue to: The sensitivity and specificity...

The sensitivity and specificity of each test depends on the cutoff used. With the GAD-2, a cutoff of 2 or more resulted in a sensitivity of 94% and a specificity of 68% for detecting generalized anxiety.⁷ A cutoff of 3 or more resulted in a sensitivity of 81% and a specificity of 86%.⁷ The GAD-7, using 10 as a cutoff, achieves a sensitivity of 79% and a specificity of 89%.⁷ Given the similar performance of the 2 options, the GAD-2 (TABLE 2^8,9) is probably preferable for use in primary care because of its ease of administration.

The tests evaluated by the USPSTF for anxiety screening in children and adolescents ≥ 8 years of age included the Screen for Child Anxiety Related Disorders (SCARED) and the Patient Health Questionnaire–Adolescent (PHQ-A).³ These tools ask more questions than the adult screening tools do: 41 for the SCARED and 13 for the PHQ-A. The sensitivity of SCARED for generalized anxiety disorder was 64% and the specificity was 63%.¹⁰ The sensitivity of the PHQ-A was 50% and the specificity was 98%.¹⁰

Various versions of all of these screening tools can be easily located on the internet. Search for them using the acronyms.

Screening for major depression

The depression screening tests the USPSTF examined were various versions of the Patient Health Questionnaire (PHQ), the Center for Epidemiologic Studies Depression Scale ­(CES-D), the Geriatric Depression Scale (GDS) in older adults, and the EPDS in postpartum and pregnant persons.⁷

A 2-question version of the PHQ was found to have a sensitivity of 91% with a specificity of 67%. The 9-question PHQ was found to have a similar sensitivity (88%) but better specificity (85%).⁷TABLE 3¹¹ lists the 2 questions in the PHQ-2 and explains how to score the results.

Continue to: The most commonly...

The most commonly studied screening tool for adolescents is the PHQ-A. Its sensitivity is 73% and specificity is 94%.¹²

The GAD-2 and PHQ-2 have the same possible answers and scores and can be combined into a 4-question screening tool to assess for anxiety and depression. If an initial screen for anxiety or depression (or both) is positive, further diagnostic testing and follow-up are needed.

Frequency of screening

The USPSTF recognized that limited information on the frequency of screening for both anxiety and depression does not support any recommendation on this matter. It suggested screening everyone once and then basing the need for subsequent screening tests on clinical judgment after considering risk factors and life events, with periodic rescreening of those at high risk. Finally, USPSTF recognized the many challenges to implementing screening tests for mental health conditions in primary care practice, but offered little practical advice on how to do this.

Suicide risk screening

As for the evidence on benefits and harms of screening for suicide risk in all age groups, the USPSTF still regards it as insufficient to make a recommendation. The lack of evidence applies to all aspects of screening, including the accuracy of the various screening tools and the potential benefits and harms of preventive interventions.^2,7

Next steps

The recommendations on screening for depression, suicide risk, and anxiety in adults have been published as a draft, and the public comment period will be over by the time of this publication. The USPSTF generally takes 6 to 9 months to consider all the public comments and to publish final recommendations. The final recommendations on these topics for children and adolescents have been published since drafts were made available last April. There were no major changes between the draft and final versions.

In September 2022, the US Preventive Services Task Force (USPSTF) released 2 sets of draft recommendations on screening for 3 mental health conditions in adults: ­anxiety, depression, and suicide risk.^1,2 These draft recommendations are summarized in TABLE 1^1-4 along with finalized recommendations on the same topics for children and adolescents, published in October 2022.^3,4

The recommendations on depression and suicide risk screening in adults are updates of previous recommendations (2016 for depression and 2014 for suicide risk) with no major changes. Screening for anxiety is a topic addressed for the first time this year for adults and for children and adolescents.^1,3

The recommendations are fairly consistent between age groups. A “B” recommendation supports screening for major depression in all patients starting at age 12 years, including during pregnancy and the postpartum period. (See TABLE 1 for grade definitions.) For all age groups, evidence was insufficient to recommend screening for suicide risk. A “B” recommendation was also assigned to screening for anxiety in those ages 8 to 64 years. The USPSTF believes the evidence is insufficient to make a recommendation on screening for anxiety among adults ≥ 65 years of age.

The anxiety disorders common to both children and adults included in the USPSTF recommendations are generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder, phobias, selective mutism, and anxiety type not specified. For adults, the USPSTF also includes substance/medication-induced anxiety and anxiety due to other medical conditions.

Adults with anxiety often present with generalized complaints such as sleep disturbance, pain, and other somatic disorders that can remain undiagnosed for years. The ­USPSTF cites a lifetime prevalence of anxiety disorders of 26.4% for men and 40.4% for women, although the data used are 10 years old.⁵ The cited rate of generalized anxiety in pregnancy is 8.5% to 10.5%, and in the postpartum period, 4.4% to 10.8%.⁶

The data on direct benefits and harms of screening for anxiety in adults through age 64 are sparse. Nevertheless, the USPSTF deemed that screening tests for anxiety have adequate accuracy and that psychological interventions for anxiety result in moderate reduction of anxiety symptoms. Pharmacologic interventions produce a small benefit, although there is a lack of evidence for pharmacotherapy in pregnant and postpartum women. There is even less evidence of benefit for treatment in adults ≥ 65 years of age.¹

How anxiety screening tests compare

Screening tests for anxiety in adults reviewed by the USPSTF included the Generalized Anxiety Disorder (GAD) scale and the Edinburgh Postnatal Depression Scale (EPDS) anxiety subscale.¹ The most studied tools are the ­GAD-2 and GAD-7.

Continue to: The sensitivity and specificity...

The sensitivity and specificity of each test depends on the cutoff used. With the GAD-2, a cutoff of 2 or more resulted in a sensitivity of 94% and a specificity of 68% for detecting generalized anxiety.⁷ A cutoff of 3 or more resulted in a sensitivity of 81% and a specificity of 86%.⁷ The GAD-7, using 10 as a cutoff, achieves a sensitivity of 79% and a specificity of 89%.⁷ Given the similar performance of the 2 options, the GAD-2 (TABLE 2^8,9) is probably preferable for use in primary care because of its ease of administration.

The tests evaluated by the USPSTF for anxiety screening in children and adolescents ≥ 8 years of age included the Screen for Child Anxiety Related Disorders (SCARED) and the Patient Health Questionnaire–Adolescent (PHQ-A).³ These tools ask more questions than the adult screening tools do: 41 for the SCARED and 13 for the PHQ-A. The sensitivity of SCARED for generalized anxiety disorder was 64% and the specificity was 63%.¹⁰ The sensitivity of the PHQ-A was 50% and the specificity was 98%.¹⁰

Various versions of all of these screening tools can be easily located on the internet. Search for them using the acronyms.

Screening for major depression

The depression screening tests the USPSTF examined were various versions of the Patient Health Questionnaire (PHQ), the Center for Epidemiologic Studies Depression Scale ­(CES-D), the Geriatric Depression Scale (GDS) in older adults, and the EPDS in postpartum and pregnant persons.⁷

A 2-question version of the PHQ was found to have a sensitivity of 91% with a specificity of 67%. The 9-question PHQ was found to have a similar sensitivity (88%) but better specificity (85%).⁷TABLE 3¹¹ lists the 2 questions in the PHQ-2 and explains how to score the results.

Continue to: The most commonly...

The most commonly studied screening tool for adolescents is the PHQ-A. Its sensitivity is 73% and specificity is 94%.¹²

The GAD-2 and PHQ-2 have the same possible answers and scores and can be combined into a 4-question screening tool to assess for anxiety and depression. If an initial screen for anxiety or depression (or both) is positive, further diagnostic testing and follow-up are needed.

Frequency of screening

The USPSTF recognized that limited information on the frequency of screening for both anxiety and depression does not support any recommendation on this matter. It suggested screening everyone once and then basing the need for subsequent screening tests on clinical judgment after considering risk factors and life events, with periodic rescreening of those at high risk. Finally, USPSTF recognized the many challenges to implementing screening tests for mental health conditions in primary care practice, but offered little practical advice on how to do this.

Suicide risk screening

As for the evidence on benefits and harms of screening for suicide risk in all age groups, the USPSTF still regards it as insufficient to make a recommendation. The lack of evidence applies to all aspects of screening, including the accuracy of the various screening tools and the potential benefits and harms of preventive interventions.^2,7

Next steps

The recommendations on screening for depression, suicide risk, and anxiety in adults have been published as a draft, and the public comment period will be over by the time of this publication. The USPSTF generally takes 6 to 9 months to consider all the public comments and to publish final recommendations. The final recommendations on these topics for children and adolescents have been published since drafts were made available last April. There were no major changes between the draft and final versions.

Key clinical point: Patients with moderate-to-severe atopic dermatitis (AD) had the highest incidence rate (IR) per 1000 person-years for major adverse cardiovascular events (MACE), followed by venous thrombotic events (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE).

Major finding: The IR per 1000 person-years for MACE, VTE, DVT, and PE were 2.6 (95% CI 2.1-3.2), 2.0 (95% CI 1.5-2.5), 1.6 (95% CI 1.2-2.1), and 0.7 (95% CI 0.5-1.0), respectively.

Study details: This retrospective cohort study included 8197 patients aged ≥12 years with moderate-to-severe AD.

Disclosures: This study was funded by Pfizer, Inc. Some authors declared receiving grant funding from Pfizer. Two authors declared being current or former employees and shareholders of Pfizer.

Source: Hedderson MM et al. Rates of cardiovascular events among patients with moderate-to-severe atopic dermatitis in an integrated health care system: A retrospective cohort study. PLoS One. 2022;17(11):e0277469 (Nov 17). Doi: 10.1371/journal.pone.0277469

Key clinical point: Patients with moderate-to-severe atopic dermatitis (AD) had the highest incidence rate (IR) per 1000 person-years for major adverse cardiovascular events (MACE), followed by venous thrombotic events (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE).

Major finding: The IR per 1000 person-years for MACE, VTE, DVT, and PE were 2.6 (95% CI 2.1-3.2), 2.0 (95% CI 1.5-2.5), 1.6 (95% CI 1.2-2.1), and 0.7 (95% CI 0.5-1.0), respectively.

Study details: This retrospective cohort study included 8197 patients aged ≥12 years with moderate-to-severe AD.

Disclosures: This study was funded by Pfizer, Inc. Some authors declared receiving grant funding from Pfizer. Two authors declared being current or former employees and shareholders of Pfizer.

Source: Hedderson MM et al. Rates of cardiovascular events among patients with moderate-to-severe atopic dermatitis in an integrated health care system: A retrospective cohort study. PLoS One. 2022;17(11):e0277469 (Nov 17). Doi: 10.1371/journal.pone.0277469

Key clinical point: Patients with moderate-to-severe atopic dermatitis (AD) had the highest incidence rate (IR) per 1000 person-years for major adverse cardiovascular events (MACE), followed by venous thrombotic events (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE).

Major finding: The IR per 1000 person-years for MACE, VTE, DVT, and PE were 2.6 (95% CI 2.1-3.2), 2.0 (95% CI 1.5-2.5), 1.6 (95% CI 1.2-2.1), and 0.7 (95% CI 0.5-1.0), respectively.

Study details: This retrospective cohort study included 8197 patients aged ≥12 years with moderate-to-severe AD.

Disclosures: This study was funded by Pfizer, Inc. Some authors declared receiving grant funding from Pfizer. Two authors declared being current or former employees and shareholders of Pfizer.

Source: Hedderson MM et al. Rates of cardiovascular events among patients with moderate-to-severe atopic dermatitis in an integrated health care system: A retrospective cohort study. PLoS One. 2022;17(11):e0277469 (Nov 17). Doi: 10.1371/journal.pone.0277469

Key clinical point: Baricitinib could serve as an effective treatment option for patients with difficult-to-treat moderate-to-severe atopic dermatitis (AD), including those unresponsive to dupilumab treatment; however, a high discontinuation rate indicates its rather heterogenous efficacy.

Major finding: At week 16, the mean Eczema Area and Severity Index score and numerical rating scale-pruritis significantly decreased from 18.3 to 11.1 (P < .0001) and from 6.6 to 5.3 (P < .0001), respectively. The most frequent adverse events (AE) were nausea (11.8%), urinary tract infection (9.8%), and herpes simplex infections (7.8%). Baricitinib treatment was discontinued by 43.2% of patients due to ineffectiveness or AE.

Study details: This multicenter prospective observational study included 51 adult patients with moderate-to-severe AD from the BioDay registry who received baricitinib over 16 weeks.

Disclosures: This study did not report a source of funding. Some authors declared serving as speakers, consultants, advisory board members, or investigators for various organizations.

Source: Boesjes CM et al. Daily practice experience of baricitinib treatment for patients with difficult-to-treat atopic dermatitis: Results from the BioDay registry. Acta Derm Venereol. 2022;102:adv00820 (Nov 24). Doi: 10.2340/actadv.v102.3978

Key clinical point: Baricitinib could serve as an effective treatment option for patients with difficult-to-treat moderate-to-severe atopic dermatitis (AD), including those unresponsive to dupilumab treatment; however, a high discontinuation rate indicates its rather heterogenous efficacy.

Major finding: At week 16, the mean Eczema Area and Severity Index score and numerical rating scale-pruritis significantly decreased from 18.3 to 11.1 (P < .0001) and from 6.6 to 5.3 (P < .0001), respectively. The most frequent adverse events (AE) were nausea (11.8%), urinary tract infection (9.8%), and herpes simplex infections (7.8%). Baricitinib treatment was discontinued by 43.2% of patients due to ineffectiveness or AE.

Study details: This multicenter prospective observational study included 51 adult patients with moderate-to-severe AD from the BioDay registry who received baricitinib over 16 weeks.

Disclosures: This study did not report a source of funding. Some authors declared serving as speakers, consultants, advisory board members, or investigators for various organizations.

Source: Boesjes CM et al. Daily practice experience of baricitinib treatment for patients with difficult-to-treat atopic dermatitis: Results from the BioDay registry. Acta Derm Venereol. 2022;102:adv00820 (Nov 24). Doi: 10.2340/actadv.v102.3978

Key clinical point: Baricitinib could serve as an effective treatment option for patients with difficult-to-treat moderate-to-severe atopic dermatitis (AD), including those unresponsive to dupilumab treatment; however, a high discontinuation rate indicates its rather heterogenous efficacy.

Major finding: At week 16, the mean Eczema Area and Severity Index score and numerical rating scale-pruritis significantly decreased from 18.3 to 11.1 (P < .0001) and from 6.6 to 5.3 (P < .0001), respectively. The most frequent adverse events (AE) were nausea (11.8%), urinary tract infection (9.8%), and herpes simplex infections (7.8%). Baricitinib treatment was discontinued by 43.2% of patients due to ineffectiveness or AE.

Study details: This multicenter prospective observational study included 51 adult patients with moderate-to-severe AD from the BioDay registry who received baricitinib over 16 weeks.

Disclosures: This study did not report a source of funding. Some authors declared serving as speakers, consultants, advisory board members, or investigators for various organizations.

Source: Boesjes CM et al. Daily practice experience of baricitinib treatment for patients with difficult-to-treat atopic dermatitis: Results from the BioDay registry. Acta Derm Venereol. 2022;102:adv00820 (Nov 24). Doi: 10.2340/actadv.v102.3978

This patient was given a diagnosis of cutaneous mastocytosis. The condition was previously known as urticaria pigmentosa, but in 2016 the World Health Organization reclassified the disease to better suit its pathophysiology as a myeloid cell disorder.¹

As the name suggests, this condition—which involves lesions in a sporadic, truncal distribution—involves overactivation of mastocytes at the tissue level from various stimuli, resulting in histocyte degranulation and hyperpigmentation. The exact cause is unknown. What is known is that it is often associated with other allergic or immunologic conditions and is thought to be related to mutations in the gene for CD-117’s receptor for tyrosine kinase.¹ Incidence is similar to that of asthma, in that it occurs more often in younger patients; a majority of affected individuals will grow out of the disease by adolescence.¹

Although most patients do not experience severe symptomatology, it is still important to differentiate cutaneous vs systemic mastocytosis. If a patient presents with inexplicable systemic symptoms of malaise, vague abdominal pain, heartburn, or flushing, the physician should consider systemic mastocytosis, idiopathic anaphylaxis, or hereditary alpha-tryptasemia.²

The test of choice is a serum tryptase test; levels will be elevated with systemic mastocytosis. Consider obtaining a skin biopsy if lesions are ambiguous or nondistinct.

There is no definitive cure for systemic or cutaneous mastocytosis, so treatment is directed at symptoms. Start by advising patients to avoid triggers and to refrain from scratching the affected areas. Topical antihistamines and oral nonsedating antihistamines can be helpful. If symptoms are more severe, refer the patient to an allergist/immunologist or to a hematologist for further medical management.²

The patient in this case had no systemic symptoms, so she was advised to continue taking oral loratadine 10 mg/d, which had been helpful, and to avoid rubbing her skin.

‌

Image courtesy of Daniel Stulberg, MD. Text courtesy of Murtaza Rizvi, MD, and Daniel Stulberg, MD, FAAFP, Professor and Chair, Department of Family and Community Medicine, Western Michigan University Homer Stryker, MD School of Medicine, Kalamazoo.

This patient was given a diagnosis of cutaneous mastocytosis. The condition was previously known as urticaria pigmentosa, but in 2016 the World Health Organization reclassified the disease to better suit its pathophysiology as a myeloid cell disorder.¹

As the name suggests, this condition—which involves lesions in a sporadic, truncal distribution—involves overactivation of mastocytes at the tissue level from various stimuli, resulting in histocyte degranulation and hyperpigmentation. The exact cause is unknown. What is known is that it is often associated with other allergic or immunologic conditions and is thought to be related to mutations in the gene for CD-117’s receptor for tyrosine kinase.¹ Incidence is similar to that of asthma, in that it occurs more often in younger patients; a majority of affected individuals will grow out of the disease by adolescence.¹

Although most patients do not experience severe symptomatology, it is still important to differentiate cutaneous vs systemic mastocytosis. If a patient presents with inexplicable systemic symptoms of malaise, vague abdominal pain, heartburn, or flushing, the physician should consider systemic mastocytosis, idiopathic anaphylaxis, or hereditary alpha-tryptasemia.²

The test of choice is a serum tryptase test; levels will be elevated with systemic mastocytosis. Consider obtaining a skin biopsy if lesions are ambiguous or nondistinct.

There is no definitive cure for systemic or cutaneous mastocytosis, so treatment is directed at symptoms. Start by advising patients to avoid triggers and to refrain from scratching the affected areas. Topical antihistamines and oral nonsedating antihistamines can be helpful. If symptoms are more severe, refer the patient to an allergist/immunologist or to a hematologist for further medical management.²

The patient in this case had no systemic symptoms, so she was advised to continue taking oral loratadine 10 mg/d, which had been helpful, and to avoid rubbing her skin.

‌

Image courtesy of Daniel Stulberg, MD. Text courtesy of Murtaza Rizvi, MD, and Daniel Stulberg, MD, FAAFP, Professor and Chair, Department of Family and Community Medicine, Western Michigan University Homer Stryker, MD School of Medicine, Kalamazoo.

This patient was given a diagnosis of cutaneous mastocytosis. The condition was previously known as urticaria pigmentosa, but in 2016 the World Health Organization reclassified the disease to better suit its pathophysiology as a myeloid cell disorder.¹

As the name suggests, this condition—which involves lesions in a sporadic, truncal distribution—involves overactivation of mastocytes at the tissue level from various stimuli, resulting in histocyte degranulation and hyperpigmentation. The exact cause is unknown. What is known is that it is often associated with other allergic or immunologic conditions and is thought to be related to mutations in the gene for CD-117’s receptor for tyrosine kinase.¹ Incidence is similar to that of asthma, in that it occurs more often in younger patients; a majority of affected individuals will grow out of the disease by adolescence.¹

Although most patients do not experience severe symptomatology, it is still important to differentiate cutaneous vs systemic mastocytosis. If a patient presents with inexplicable systemic symptoms of malaise, vague abdominal pain, heartburn, or flushing, the physician should consider systemic mastocytosis, idiopathic anaphylaxis, or hereditary alpha-tryptasemia.²

The test of choice is a serum tryptase test; levels will be elevated with systemic mastocytosis. Consider obtaining a skin biopsy if lesions are ambiguous or nondistinct.

There is no definitive cure for systemic or cutaneous mastocytosis, so treatment is directed at symptoms. Start by advising patients to avoid triggers and to refrain from scratching the affected areas. Topical antihistamines and oral nonsedating antihistamines can be helpful. If symptoms are more severe, refer the patient to an allergist/immunologist or to a hematologist for further medical management.²

The patient in this case had no systemic symptoms, so she was advised to continue taking oral loratadine 10 mg/d, which had been helpful, and to avoid rubbing her skin.

‌

Image courtesy of Daniel Stulberg, MD. Text courtesy of Murtaza Rizvi, MD, and Daniel Stulberg, MD, FAAFP, Professor and Chair, Department of Family and Community Medicine, Western Michigan University Homer Stryker, MD School of Medicine, Kalamazoo.

Key clinical point: The first exposure of pediatric individuals to general anesthesia (GA) is not associated with an increased or decreased risk of developing atopic dermatitis (AD).

Major finding: Multivariate analysis revealed that individuals who were exposed vs not exposed to GA did not have an increased or decreased risk of developing AD (adjusted hazard ratio 1.03; P  =  .701).

Study details: This retrospective cohort study included pediatric individuals aged ≤18 years who were (n = 7,681) or were not (n = 38,405; control individuals) exposed to GA.

Disclosures: This study was funded by a 2020 Amorepacific (South Korea) grant. The authors declared no  conflicts of interest.

Source: Kim DC et al. No association between first exposure to general anaesthesia and atopic dermatitis in the paediatric population. Acta Derm Venereol. 2022;102:adv00813 (Nov 14). Doi: 10.2340/actadv.v102.2738

Key clinical point: The first exposure of pediatric individuals to general anesthesia (GA) is not associated with an increased or decreased risk of developing atopic dermatitis (AD).

Major finding: Multivariate analysis revealed that individuals who were exposed vs not exposed to GA did not have an increased or decreased risk of developing AD (adjusted hazard ratio 1.03; P  =  .701).

Study details: This retrospective cohort study included pediatric individuals aged ≤18 years who were (n = 7,681) or were not (n = 38,405; control individuals) exposed to GA.

Disclosures: This study was funded by a 2020 Amorepacific (South Korea) grant. The authors declared no  conflicts of interest.

Source: Kim DC et al. No association between first exposure to general anaesthesia and atopic dermatitis in the paediatric population. Acta Derm Venereol. 2022;102:adv00813 (Nov 14). Doi: 10.2340/actadv.v102.2738

Key clinical point: The first exposure of pediatric individuals to general anesthesia (GA) is not associated with an increased or decreased risk of developing atopic dermatitis (AD).

Major finding: Multivariate analysis revealed that individuals who were exposed vs not exposed to GA did not have an increased or decreased risk of developing AD (adjusted hazard ratio 1.03; P  =  .701).

Study details: This retrospective cohort study included pediatric individuals aged ≤18 years who were (n = 7,681) or were not (n = 38,405; control individuals) exposed to GA.

Disclosures: This study was funded by a 2020 Amorepacific (South Korea) grant. The authors declared no  conflicts of interest.

Source: Kim DC et al. No association between first exposure to general anaesthesia and atopic dermatitis in the paediatric population. Acta Derm Venereol. 2022;102:adv00813 (Nov 14). Doi: 10.2340/actadv.v102.2738

Key clinical point: Downtitrated baricitinib treatment was efficacious in most patients with moderate-to-severe atopic dermatitis (AD) through 16 weeks; clinically relevant efficacy was observed in most patients who were readministered the original dose due to downtitration or treatment withdrawal-related efficacy loss.

Major finding: In the 4-mg and 2-mg cohorts, 61% and 71% of patients maintained a validated Investigator’s Global Assessment for AD (vIGA-AD) score of 0/1/2 at downtitration week 16 and 80%/85%/88% and 90%/56%/86% of patients who switched to original dose in the continuous dosing/downtitration/treatment withdrawal group re-achieved vIGA-AD 0/1/2, respectively.

Study details: This BREEZE-AD3 trial substudy included 526 patients with moderate-to-severe AD treated with 4/2 mg baricitinib at trial entry who achieved vIGA-AD 0/1/2 at week 52, with each cohort being re-assigned to continuous dosing, downtitration, or treatment withdrawal.

Disclosures: This study was sponsored by Eli Lilly and Company under license from Incyte Corporation. Some authors reported ties with various sources, including Eli Lilly and Incyte. Three authors declared being current or former employees and shareholders of Eli Lilly.

Source: Reich K et al. Efficacy of downtitration or treatment withdrawal compared to continuous dosing after successful treatment with baricitinib in patients with moderate-to-severe atopic dermatitis in a randomised substudy from the long-term extension study, BREEZE-AD3. Br J Dermatol. 2022 (Nov 17). Doi: 10.1093/bjd/ljac057

Key clinical point: Downtitrated baricitinib treatment was efficacious in most patients with moderate-to-severe atopic dermatitis (AD) through 16 weeks; clinically relevant efficacy was observed in most patients who were readministered the original dose due to downtitration or treatment withdrawal-related efficacy loss.

Major finding: In the 4-mg and 2-mg cohorts, 61% and 71% of patients maintained a validated Investigator’s Global Assessment for AD (vIGA-AD) score of 0/1/2 at downtitration week 16 and 80%/85%/88% and 90%/56%/86% of patients who switched to original dose in the continuous dosing/downtitration/treatment withdrawal group re-achieved vIGA-AD 0/1/2, respectively.

Study details: This BREEZE-AD3 trial substudy included 526 patients with moderate-to-severe AD treated with 4/2 mg baricitinib at trial entry who achieved vIGA-AD 0/1/2 at week 52, with each cohort being re-assigned to continuous dosing, downtitration, or treatment withdrawal.

Disclosures: This study was sponsored by Eli Lilly and Company under license from Incyte Corporation. Some authors reported ties with various sources, including Eli Lilly and Incyte. Three authors declared being current or former employees and shareholders of Eli Lilly.

Source: Reich K et al. Efficacy of downtitration or treatment withdrawal compared to continuous dosing after successful treatment with baricitinib in patients with moderate-to-severe atopic dermatitis in a randomised substudy from the long-term extension study, BREEZE-AD3. Br J Dermatol. 2022 (Nov 17). Doi: 10.1093/bjd/ljac057

Key clinical point: Downtitrated baricitinib treatment was efficacious in most patients with moderate-to-severe atopic dermatitis (AD) through 16 weeks; clinically relevant efficacy was observed in most patients who were readministered the original dose due to downtitration or treatment withdrawal-related efficacy loss.

Major finding: In the 4-mg and 2-mg cohorts, 61% and 71% of patients maintained a validated Investigator’s Global Assessment for AD (vIGA-AD) score of 0/1/2 at downtitration week 16 and 80%/85%/88% and 90%/56%/86% of patients who switched to original dose in the continuous dosing/downtitration/treatment withdrawal group re-achieved vIGA-AD 0/1/2, respectively.

Study details: This BREEZE-AD3 trial substudy included 526 patients with moderate-to-severe AD treated with 4/2 mg baricitinib at trial entry who achieved vIGA-AD 0/1/2 at week 52, with each cohort being re-assigned to continuous dosing, downtitration, or treatment withdrawal.

Disclosures: This study was sponsored by Eli Lilly and Company under license from Incyte Corporation. Some authors reported ties with various sources, including Eli Lilly and Incyte. Three authors declared being current or former employees and shareholders of Eli Lilly.

Source: Reich K et al. Efficacy of downtitration or treatment withdrawal compared to continuous dosing after successful treatment with baricitinib in patients with moderate-to-severe atopic dermatitis in a randomised substudy from the long-term extension study, BREEZE-AD3. Br J Dermatol. 2022 (Nov 17). Doi: 10.1093/bjd/ljac057

Key clinical point: Dupilumab decreases disease severity, disease-associated symptoms, and severity-associated serum biomarker levels in pediatric patients with atopic dermatitis (AD) in daily practice.

Major finding: At week 28, 49.2% of patients achieved Eczema Area and Severity Index-75; 84.7%, 45.3%, and 77.4% achieved a ≥4-point improvement in the Patient-Oriented Eczema Measure, Numeric Rating Scale (NRS)-pruritus, and NRS-pain scores, respectively; 36.1% scored clear or almost clear on the Investigator’s Global Assessment. The levels of severity-associated markers soluble IL-2-receptor alpha (P < .05), periostin (P < .05), thymus- and activation-regulated chemokine (P < .005), and pulmonary- and activation-regulated chemokine (P < .005) were significantly reduced at week 4. Conjunctivitis (16.4%) and headache (6.6%) were the most common side effects.

Study details: This multicenter prospective observational study included 61 patients (children ≥6 to <12 years; adolescents ≥12 to <18 years) from the BioDay registry with moderate-to-severe AD who received dupilumab for 28 weeks.

Disclosures: The BioDay registry is sponsored by Sanofi/Regeneron and others. Some authors reported ties with various sources, including Sanofi.

Source: Kamphuis E, Boesjes CM et al. Dupilumab in daily practice for the treatment of pediatric atopic dermatitis: 28-week clinical and biomarker results from the BioDay registry. Pediatr Allergy Immunol. 2022;13(12):e13887 (Dec 5). Doi: 10.1111/pai.13887

Key clinical point: Dupilumab decreases disease severity, disease-associated symptoms, and severity-associated serum biomarker levels in pediatric patients with atopic dermatitis (AD) in daily practice.

Major finding: At week 28, 49.2% of patients achieved Eczema Area and Severity Index-75; 84.7%, 45.3%, and 77.4% achieved a ≥4-point improvement in the Patient-Oriented Eczema Measure, Numeric Rating Scale (NRS)-pruritus, and NRS-pain scores, respectively; 36.1% scored clear or almost clear on the Investigator’s Global Assessment. The levels of severity-associated markers soluble IL-2-receptor alpha (P < .05), periostin (P < .05), thymus- and activation-regulated chemokine (P < .005), and pulmonary- and activation-regulated chemokine (P < .005) were significantly reduced at week 4. Conjunctivitis (16.4%) and headache (6.6%) were the most common side effects.

Study details: This multicenter prospective observational study included 61 patients (children ≥6 to <12 years; adolescents ≥12 to <18 years) from the BioDay registry with moderate-to-severe AD who received dupilumab for 28 weeks.

Disclosures: The BioDay registry is sponsored by Sanofi/Regeneron and others. Some authors reported ties with various sources, including Sanofi.

Source: Kamphuis E, Boesjes CM et al. Dupilumab in daily practice for the treatment of pediatric atopic dermatitis: 28-week clinical and biomarker results from the BioDay registry. Pediatr Allergy Immunol. 2022;13(12):e13887 (Dec 5). Doi: 10.1111/pai.13887

Key clinical point: Dupilumab decreases disease severity, disease-associated symptoms, and severity-associated serum biomarker levels in pediatric patients with atopic dermatitis (AD) in daily practice.

Major finding: At week 28, 49.2% of patients achieved Eczema Area and Severity Index-75; 84.7%, 45.3%, and 77.4% achieved a ≥4-point improvement in the Patient-Oriented Eczema Measure, Numeric Rating Scale (NRS)-pruritus, and NRS-pain scores, respectively; 36.1% scored clear or almost clear on the Investigator’s Global Assessment. The levels of severity-associated markers soluble IL-2-receptor alpha (P < .05), periostin (P < .05), thymus- and activation-regulated chemokine (P < .005), and pulmonary- and activation-regulated chemokine (P < .005) were significantly reduced at week 4. Conjunctivitis (16.4%) and headache (6.6%) were the most common side effects.

Study details: This multicenter prospective observational study included 61 patients (children ≥6 to <12 years; adolescents ≥12 to <18 years) from the BioDay registry with moderate-to-severe AD who received dupilumab for 28 weeks.

Disclosures: The BioDay registry is sponsored by Sanofi/Regeneron and others. Some authors reported ties with various sources, including Sanofi.

Source: Kamphuis E, Boesjes CM et al. Dupilumab in daily practice for the treatment of pediatric atopic dermatitis: 28-week clinical and biomarker results from the BioDay registry. Pediatr Allergy Immunol. 2022;13(12):e13887 (Dec 5). Doi: 10.1111/pai.13887

Key clinical point: Early application of emollients can effectively prevent atopic dermatitis (AD) in infants, with emollient emulsion seeming an optimal treatment option in infancy compared with creams or mixed emollients.

Major finding: The incidence of AD was significantly lower in high-risk infants receiving early emollients vs standard care (risk ratio 0.64; 95% CI 0.47-0.88), with surface under the cumulative ranking curve analysis revealing emollient emulsion (82.6%) as the optimal treatment for AD prevention in infants, followed by mixed emollient (77.4%) and emollient cream (21.9%).

Study details: This was a systematic review and network meta-analysis of 11 randomized controlled trials including 3483 infants without AD who received either prophylactic emollients (cream, emulsion, or mixed types) or standard care.

Disclosures: This study was supported by the Key Research and Development Project of Xinjiang Uygur Autonomous Region, China. The authors declared no  conflicts of interest.

Source: Liang J, Hu F et al. Systematic review and network meta‐analysis of different types of emollient for the prevention of atopic dermatitis in infants. J Eur Acad Dermatol Venereol. 2022 (Nov 23). Doi: 10.1111/jdv.18688

Key clinical point: Early application of emollients can effectively prevent atopic dermatitis (AD) in infants, with emollient emulsion seeming an optimal treatment option in infancy compared with creams or mixed emollients.

Major finding: The incidence of AD was significantly lower in high-risk infants receiving early emollients vs standard care (risk ratio 0.64; 95% CI 0.47-0.88), with surface under the cumulative ranking curve analysis revealing emollient emulsion (82.6%) as the optimal treatment for AD prevention in infants, followed by mixed emollient (77.4%) and emollient cream (21.9%).

Study details: This was a systematic review and network meta-analysis of 11 randomized controlled trials including 3483 infants without AD who received either prophylactic emollients (cream, emulsion, or mixed types) or standard care.

Disclosures: This study was supported by the Key Research and Development Project of Xinjiang Uygur Autonomous Region, China. The authors declared no  conflicts of interest.

Source: Liang J, Hu F et al. Systematic review and network meta‐analysis of different types of emollient for the prevention of atopic dermatitis in infants. J Eur Acad Dermatol Venereol. 2022 (Nov 23). Doi: 10.1111/jdv.18688

Key clinical point: Early application of emollients can effectively prevent atopic dermatitis (AD) in infants, with emollient emulsion seeming an optimal treatment option in infancy compared with creams or mixed emollients.

Major finding: The incidence of AD was significantly lower in high-risk infants receiving early emollients vs standard care (risk ratio 0.64; 95% CI 0.47-0.88), with surface under the cumulative ranking curve analysis revealing emollient emulsion (82.6%) as the optimal treatment for AD prevention in infants, followed by mixed emollient (77.4%) and emollient cream (21.9%).

Study details: This was a systematic review and network meta-analysis of 11 randomized controlled trials including 3483 infants without AD who received either prophylactic emollients (cream, emulsion, or mixed types) or standard care.

Disclosures: This study was supported by the Key Research and Development Project of Xinjiang Uygur Autonomous Region, China. The authors declared no  conflicts of interest.

Source: Liang J, Hu F et al. Systematic review and network meta‐analysis of different types of emollient for the prevention of atopic dermatitis in infants. J Eur Acad Dermatol Venereol. 2022 (Nov 23). Doi: 10.1111/jdv.18688

Key clinical point: Ruxolitinib cream demonstrated effective disease control and was well tolerated in patients with atopic dermatitis (AD) during 44 weeks of as-needed treatment.

Major finding: At week 52, 74.1%-77.8% of patients had an Investigator’s Global Assessment score of 0/1, with the mean affected body surface area being 1.4%-1.8%. Treatment-related adverse events were reported in 8.7%/7.4% of patients on 0.75%/1.5% ruxolitinib and in 2.0%/6.1% of those who switched from vehicle to 0.75%/1.5% ruxolitinib, respectively.

Study details: This study analyzed pooled data from two phase 3 studies, TRuE-AD1 and TRuE-AD2, including 1249 patients aged ≥12 years with AD who were randomly assigned to receive 0.75% or 1.5% ruxolitinib cream or vehicle for 8 weeks; thereafter, the vehicle group patients were re-assigned to receive either strength ruxolitinib cream for 44 weeks.

Disclosures: This study was funded by Incyte Corporation, U.S. Some authors reported ties with various sources, including Incyte. Four authors declared being current or former employees and shareholders of Incyte.

Source: Papp K et al. Long-term safety and disease control with ruxolitinib cream in atopic dermatitis: Results from two phase 3 studies. J Am Acad Dermatol. 2022 (Nov 25). Doi: 10.1016/j.jaad.2022.09.060

Key clinical point: Ruxolitinib cream demonstrated effective disease control and was well tolerated in patients with atopic dermatitis (AD) during 44 weeks of as-needed treatment.

Major finding: At week 52, 74.1%-77.8% of patients had an Investigator’s Global Assessment score of 0/1, with the mean affected body surface area being 1.4%-1.8%. Treatment-related adverse events were reported in 8.7%/7.4% of patients on 0.75%/1.5% ruxolitinib and in 2.0%/6.1% of those who switched from vehicle to 0.75%/1.5% ruxolitinib, respectively.

Study details: This study analyzed pooled data from two phase 3 studies, TRuE-AD1 and TRuE-AD2, including 1249 patients aged ≥12 years with AD who were randomly assigned to receive 0.75% or 1.5% ruxolitinib cream or vehicle for 8 weeks; thereafter, the vehicle group patients were re-assigned to receive either strength ruxolitinib cream for 44 weeks.

Disclosures: This study was funded by Incyte Corporation, U.S. Some authors reported ties with various sources, including Incyte. Four authors declared being current or former employees and shareholders of Incyte.

Source: Papp K et al. Long-term safety and disease control with ruxolitinib cream in atopic dermatitis: Results from two phase 3 studies. J Am Acad Dermatol. 2022 (Nov 25). Doi: 10.1016/j.jaad.2022.09.060

Key clinical point: Ruxolitinib cream demonstrated effective disease control and was well tolerated in patients with atopic dermatitis (AD) during 44 weeks of as-needed treatment.

Major finding: At week 52, 74.1%-77.8% of patients had an Investigator’s Global Assessment score of 0/1, with the mean affected body surface area being 1.4%-1.8%. Treatment-related adverse events were reported in 8.7%/7.4% of patients on 0.75%/1.5% ruxolitinib and in 2.0%/6.1% of those who switched from vehicle to 0.75%/1.5% ruxolitinib, respectively.

Study details: This study analyzed pooled data from two phase 3 studies, TRuE-AD1 and TRuE-AD2, including 1249 patients aged ≥12 years with AD who were randomly assigned to receive 0.75% or 1.5% ruxolitinib cream or vehicle for 8 weeks; thereafter, the vehicle group patients were re-assigned to receive either strength ruxolitinib cream for 44 weeks.

Disclosures: This study was funded by Incyte Corporation, U.S. Some authors reported ties with various sources, including Incyte. Four authors declared being current or former employees and shareholders of Incyte.

Source: Papp K et al. Long-term safety and disease control with ruxolitinib cream in atopic dermatitis: Results from two phase 3 studies. J Am Acad Dermatol. 2022 (Nov 25). Doi: 10.1016/j.jaad.2022.09.060