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She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

A recent literature review is calling attention to evidence gaps in 

 epidemiology across select Asian Pacific countries.

 and highlighted a lack of incidence, mortality, treatment pattern, and humanistic burden data in certain countries across the Asia-Pacific region.

“While geographic variations of IgAN have been studied previously, few recent studies have focused on regional disease burden differences and treatment patterns among IgAN patients across Asian countries/regions and Australia,” Kristin Pareja, PharmD, MPH, director of global market access at Otsuka Pharmaceutical US, and colleagues wrote.

IgAN is the most common form of primary glomerulonephritis worldwide and is one of the leading causes of chronic kidney disease and end-stage renal disease (ESRD). Its exact cause is not known, but certain genetic and environmental factors are suspected to play a role. IgAN prevalence is thought to be greater across Asia and Europe, but regional disease burden differences and treatment patterns are not well understood across many countries.

Investigators sought to review and summarize evidence on IgAN prevalence, treatment patterns, and humanistic and economic burden in mainland China, Taiwan, South Korea, Japan, and Australia. The targeted literature review originally included relevant literature published from January 2010 to December 2021 but was later expanded to include studies from 2001.

Medline and Embase were the primary databases for publications in English, but other regional databases were searched for publications in local languages. Observational studies, reviews, and registry studies were included in the search. Publications that reported prevalence, incidence, mortality, treatment patterns, guidelines, economic, and humanistic burden were included for data extraction.

Studies that did not include outcomes of interest were excluded, as were studies with a sample size < 25. Investigators noted Strict predefined population, intervention, comparators, outcomes, and study design (PICOS) selection criteria and a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram were not used in this study.

In total, 69 publications and 3 clinical guidelines were included in the review. Of these, 38 were from mainland China, 15 were from Japan, 10 were from South Korea, 3 were from Taiwan, and 3 were from Australia. The majority (83%) of studies were retrospective in their design.

Evidence on IgAN incidence was available in 6 studies and ranged from 0 to 10.7 per 100,000 people per year in Australia, Japan, and Taiwan. Of note, the studies reported incidence across different patient populations. Among patients who underwent renal biopsy in mainland China, incidence ranged from 6.3% to 24.70%.

Prevalence across the general population was not reported in any of the included publications, except for one cross-sectional study that reported an IgAN prevalence rate of 0.03% among the general pediatric population.

In contrast, 35 publications detailed IgAN diagnosis rates. However, these figures varied greatly across studies and by country, ranging from 0 to 72.1% across mainland China, South Korea, Taiwan, Japan, and Australia.

Among the included studies, all-cause mortality was primarily reported as deaths due to ESRD, including 7 publications from mainland China, 7 from Korea, 4 from Japan, and 1 from Taiwan. However, investigators pointed out these studies varied in the definition of the endpoint, patient characteristics, and follow-up duration, making comparison difficult.

Treatment patterns were reported in 20 publications and 3 clinical guidelines. The top 3 commonly used therapies were angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (0.9-99.6%), corticosteroids (3.5-100%), and immunosuppressants (1.6-85.5%) in Japan, mainland China, and South Korea.

Quality of life was reported in 4 publications from China and was not available for any other country included in the review. Among these studies, quality of life was measured by the 36-Item Short Form Health Survey, Daily Living Ability Rating Scale, and quality of life scale combined with Self-Rating Anxiety Scale and Self-Rating Depression Scale.

Although no publications reported indirect costs, 3 retrospective studies reported hospitalization costs for patients with IgAN in China. Results showed hospitalization costs ranged from $1284.73 to $2252.12.

Investigators outlined several potential limitations to these findings, including the varying sample sizes of the included publications, the potential for biases due to data not being weighed, and the single-center design of multiple included studies.

“The prevalence of IgA nephropathy among the general population in select Asian Pacific countries/regions is not commonly available, despite evidence from studies and clinical guidelines. In addition, it is observed across geographic regions that heterogeneity exists in prevalence rates, and large variations exist in treatment patterns,” investigators concluded.

 “Future studies are needed to fill in these gaps to understand the contributing factors behind the differences through population-based, multi-center, and real-world studies.”

Zaidi O, Du F, Tang Z, Bhattacharjee S, Pareja K. Review on epidemiology, disease burden, and treatment patterns of IgA nephropathy in select APAC countries. 

. 2024;25(1):136. doi:10.1186/s12882-024-03555-5

National Institute of Health. IgA Nephropathy. Kidney Disease. September 2022. Accessed May 3, 2024. 

https://www.niddk.nih.gov/health-information/kidney-disease/iga-nephropathy#morelikely

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Results showed the prevalence and treatment patterns for IgAN in select Asian Pacific countries and regions were not commonly available. 

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Study Highlights Evidence Gaps in IgA Nephropathy Disease Burden, Treatment Patterns

McIntyre explains why GLP-1/GIP receptor agonists like semaglutide may alter cognitive and psychiatric care similar to cardiometabolic disease.

Roger S. McIntyre, MD: GLP-1 Agonists for Psychiatry?

GLP-1 / GIP receptor agonists including semaglutide (Ozempic) and investigative retatrutide are representative of a seismic shift in cardiometabolic and comorbidity treatment. Over the last decade, the emerging drug class has been robustly evidenced to effectively treat type 2 diabetes, as well as persistent comorbidities including cardiovascular events, chronic kidney disease, fatty liver disease and clinical obesity—among other outcomes.

To perhaps little surprise, they may have a role to play in 

American Psychiatric Association (APA) 2024 Annual Meeting

 in New York, NY, this week, Roger S. McIntyre, MD, professor of psychiatry and pharmacology at the University of Toronto, discussed his presentation topic evaluating the prospect of GLP-1 receptor agonists in the treatment of psychiatric disorders.

As McIntyre explained, the potential benefit with the dynamic drug class would be three-fold.

“We now have reasons to believe that mechanistic steps that lead to symptom relief in many mental disorders includes activating molecular and cellular systems in the brain relevant to neuroplasticity, neuroprotection, and so-called anti-apoptosis—keeping cells alive. This is a mechanism shared by antidepressants, shared by neurostimulation—like transcranial magnetic stimulation—as well as by psychotherapy,” McIntyre said. “What's interesting about GLPs and GIPs, is similar to what I just described, they also activate molecular and cellular systems relevant to neuroplasticity, neuroprotection, anti-apoptosis.”

GLP-1 and GIP receptor agonists may provide some targeted, preventive effects in psychiatry akin to their effect in various chronic conditions, McIntyre said. The potential would be to address patient’s conditions with “mechanistically informed” therapy.

“We would prefer treatments that are able to target key mechanisms that are responsible for these syndromes that we have in the DSM,” he said. “We also would like to have treatments that are not simply suppressing symptoms, but hopefully are modifying the disease. It may be modifying the illness trajectory.”

McIntyre identified neurocognitive disorders including Parkinson and Alzheimer disease as viable clinical targets for the drug class; in the former condition, investigators have found evidence suggesting it may “slow down some of the progression of the motor problems so cardinal to that illness.” He additionally believes there may be opportunity to treat conditions including alcohol use disorder, among other substance issues.

“The prevailing view in obesity research today is that a key mechanism mediating the decrease in food consumption with obesity is modulating what we call reward salience. There's too much exaggerated reward for a cue in the environment,” McIntyre said. “So, people are looking at this very opportunity being GLP-1s to treat these types of other addictive disorders.”

Other opportune conditions for GLP-1 / GIP receptor agonists may include traumatic brain injury, stroke-related illness and depressive disorders, McIntyre said.

Lastly, McIntyre discussed the well-regarded clinical efficacy of the drug class on weight loss—an outcome that may be particularly promising to resolve the common antipsychotic treatment effect of uncontrolled weight gain.

“And we now have the beginning of an evidence base showing that GLP-1s could be extremely effective in helping not only weight gain that's been imparted by the underlying drugs, but also weight gain as part of the illness—helping not just weight but helping metabolic (conditions) and also helping blood pressure,” McIntyre said.

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Devanand reviews lecanemab and the advent of blood biomarkers for dementia and Alzheimer's management at APA 2024.

Davangere Devanand, MD: The State of Dementia Drug Development

There’s a growing sense of optimism in the prospects to treat dementia and 

—some informed by regulatory breakthroughs, and more inspired by what’s still to come in drug development. Primary to one expert in the field is that a refined treatment blueprint is taking shape.

 in New York, NY, this week, Davangere P. Devanand, MD, director of geriatric psychiatry at Columbia University Medical Center, discussed the evolution of dementia and Alzheimer’s treatment strategy based on the introduction of new blood and plasma biomarkers—innovations in diagnostics that may trickle from specialist prescribing, down to primary care intervention.

While lifestyle and behavior modifications including exercise and cognitive training has been previously advocated for early-stage and at-risk patients, Devanand said it’s now better understood to have only a small effect. And the anti-amyloid lecanemab—the first drug approved to treat Alzheimer’s disease by the US Food and Drug Administration (FDA) in decades—is now well understood to provide little more than disease-modifying properties.

“While it doesn't improve patients, it changes the trajectory so instead of going downhill at a steep slope, they go at a moderate slope,” Devanand said. “So in terms of diagnosis, understanding the pathophysiology and management, there have been improvements in all these areas, although we are a long way from curing the disease.”

Relative to previously established dementia drugs like cholinesterase inhibitors and memantine—which may be associated with short-term improvement of cognitive symptoms—lecanemab’s most significant value seems to be a delay in disease progression. Untreated dementia may take another 2 - 3 more years to progress significantly in patients, giving them a maintained quality of life not previously afforded.

All the same, the primary treatment outcome when assessing lecanemab, cholinesterase inhibitors, or other treatments to come remains cognitive performance. But the outcome may be relative to patients based on their condition severity, their symptoms, and their response to treatment.

“For example, if a patient feels better—is less depressed or anxious, feels calmer—that may not be captured by the main outcomes for these cognitive enhancers,” Devanand said. “Or, the patient may feel better, even though on the paper-and-pencil cognitive test, we don't see much change. And function is very important.”

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Marmar explains what anticipated blood and molecular profiling of PTSD may provide psychiatrists treating patients.

Charles R. Marmar, MD: Blood Biomarkers for PTSD

There is a great, yet increasingly feasible, ambition to define well-evidenced blood and plasma biomarkers for the diagnosis of 

. To many psychiatry experts, it’s a pursuit that’s been long in the making—but still faces hurdles in the coming years.

 in New York, NY, this weekend, Charles R. Marmar, MD, director of the NYU Langone department of psychiatry, discussed the history of progress in diagnosis PTSD—a practice that has been documented to as far back as Assyria, 3400 years ago.

“It was a single-case study published by the physician to the king of Assyria,” Marmar said. “And he had a patient who was a war veteran, and the war veteran was talking about having horrible experiences in which they would wake up in the middle of the night and imagine they were back on the battlefield. And the the theory of the doctor at that time was the reason the patients suffering from flashbacks to war, is that he's guilty about the enemies he's killed in battle, and the spirit of the dead enemies is coming back to haunt him.”

These symptoms, Marmar explained, correlate with the very core standard of diagnostic questions clinicians use today: “Are they having nightmares? Flashbacks? Are they jumpy and easily startled? Are they having thoughts, images, and memories that interfere with their ability to concentrate and function? Are they having difficulty falling asleep, staying asleep? And are they woken up by disturbing dreams of the traumatic event?”

Despite knowing these symptoms for thousands of years, the field is still burdened by a stigma from patients to admit their condition, Marmar said.

This issue may be eventually resolved by the advent of blood and brain imaging tests, among other biological assays under development for PTSD. Such a development may also provide psychiatrists with the first opportunity to subtype PTSD diagnoses—a finer disease definition based not only on symptoms, but molecular profiles.

From there, the opportunity may come to establish precision based medicine in PTSD.

“We want to eventually catch up with cancer and heart disease treatment,” Marmar said. “If a woman presents with breast cancer, we have precise genomic molecular features we can study and determine—based on the profile of estrogen receptors, progesterone receptors, HER-2 receptors and others—we can begin to say, 'It's this subtype of breast cancer, not that type, and therefore we would treat it with a specific monoclonal antibody.' We want to know what the molecular pathways are in PTSD that respond better to one treatment rather than another.”

PTSD

Kane explains why newer long-acting injectables and clozapine may be under-utilized still in the management of schizophrenia.

John Kane, MD: Shifts in Antipsychotics for Schizophrenia

While many advances in clinical research have catalyzed psychiatry’s understanding of 

, the practical application of those lessons learned have lagged behind.

 in New York, NY, this weekend, John Kane, MD, co-director and professor at the Institute of Behavioral Science at Feinstein Institutes for Medical Research, discussed his planned presentation topic regarding the progression of antipsychotic therapies for schizophrenia.

As Kane explained, research and therapeutic development has been promising of late in schizophrenia—including the anticipated US Food and Drug Administration (FDA) decision for Karuna Therapeutics’ xanomeline-trospium (KarXT) for the treatment of adults with schizophrenia.

 But he also perceives a difficulty in implementing new clinical evidence and drug indications into care strategies in a timely fashion.

A pair of examples that speak to that struggle, Kane said, is the implementation of proven long-acting injectables (LAIs) and clozapine.

“A substantial proportion of patients do not respond adequately to the first or second medication that they receive,” Kane said. “The long-acting injectable medications have been shown to facilitate adherence and reduce the risk of relapse and re-hospitalization, as well as discontinuation of medication. So, unfortunately, they are also underutilized particularly in early-phase patients.”

With the development of later-generation antipsychotics, Kane has observed a notable improvement in safety profiles—only clozapine stands out for particular treatment efficacy, being the lone FDA-approved therapy indicated for treatment-resistant depression. However, that trend may change with the development of up-and-coming antipsychotic medications: muscarinic agonists that differentiate from the common dopamine D2 receptor-targeting drugs that constitute the traditional early classes of schizophrenia drugs.

“We will wait to see if those drugs are more effective, or more efficacious than the medicines that we currently have available,” Kane said. “But they do seem to work, and they do seem to be working via a different mechanism. So that's very exciting.”

One avenue by which schizophrenia care has improved in practice, Kane noted, is the addition of multidisciplinary care team members earlier into a patient’s diagnosis. Facets of disease management—including psychosocial care, family-based education, supportive employment and education—have become better embedded into the initiation of schizophrenia treatment at institutions like his own.

“And we believe that the combination of these modalities and these professionals is really necessary to bring about the best chance of recovery for someone in the early phase of schizophrenia, and we've seen the growth of programs across the US and around the world that are delivering this type of treatment,” Kane said. “I think we still have a long way to go. But that's been a very positive development, as well.“

Armstrong A. After long journey, Karuna's schizophrenia drug gets FDA decision date. Fierce Biotech. Published November 29, 2023. https://www.fiercebiotech.com/biotech/after-long-journey-karunas-schizophrenia-drug-gets-fda-decision-date

Foster DJ, Bryant ZK, Conn PJ. Targeting muscarinic receptors to treat schizophrenia. 

. 2021;405:113201. doi:10.1016/j.bbr.2021.113201

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Physical Fitness Linked to All Gait Parameters for Women with Fibromyalgia

Results showed 46.45 and 72.74% increases in the global incidences of acute infection and HCV-related cirrhosis, respectively, in reproductive-age women.

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Payal Kohli, MD, discusses how recent advancements have changed conversations surrounding modifiable cardiovascular risk and what it means for practitioners. 

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A nutritional supplement significantly improved the signs and symptoms of dry eye, including tear production and reduced ocular surface damage.

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Daily Nutritional Supplement Achieves Improvement in Dry Eye Symptoms

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This analysis indicates that quantitative interstitial abnormalities may indicate alterations in lung tissue processes that can result in short- and long-term consequences as far as symptoms.

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Smokers with Lung Abnormalities More Likely to Report Severe Acute Respiratory Disease Events

A new study highlights the importance of daily antioxidant intake for endometriosis-related RA.

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Compositive Dietary Antioxidant Index Linked to endometriosis-related RA

Findings showed the light microscopy pattern of glomerular injury and the intensity of mesangial C3 deposition may refine the histological assessment of IgAN.

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Study Highlights Evidence Gaps in IgA Nephropathy Disease Burden, Treatment Patterns

Roger S. McIntyre, MD: GLP-1 Agonists for Psychiatry?

Davangere Devanand, MD: The State of Dementia Drug Development

Charles R. Marmar, MD: Blood Biomarkers for PTSD

John Kane, MD: Shifts in Antipsychotics for Schizophrenia