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Abigail Brooks is an assistant editor for 

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.

Findings from a recent study are providing clinicians with an overview of the role of vitamin D deficiency in viral hepatitis, underscoring its significant immunomodulatory role in hepatitis B virus (HBV) but not 

 and showed vitamin D affected CD8, CD4, HBV DNA, and CD19 in the natural progression of chronic HBV infection, further revealing a negative relationship between vitamin D and complement C3.

A vaccine-preventable liver infection, HBV is often a short-term illness but in some cases can become a long-term, chronic infection leading to serious health issues like liver disease or liver cancer. The risk for chronic infection varies based on age at infection and is greatest among young children.

Suppressing virus replication and restoring host immune response are both significant in HBV therapy strategies, and recent research has alluded to the potential role of vitamin D concentration in these processes.

“It is speculated that reduced hepatic vitamin D receptor expression diminishes the ability of vitamin D to support the immune defense system, consequently weakening its effect on inhibiting viral replication,” Osman Evliyaoglu, of the Institute for Clinical Chemistry at the University of Heidelberg and colleagues wrote.

 “However, this cycle can be disrupted by effective antiviral therapy, leading to improved vitamin D levels.”

Investigators sought to study the relationship of vitamin D with innate and adaptive immune response parameters in patients with chronic HBV and HCV. To do so, they enrolled inpatients from University Hospital Mannheim registered in the hospital information system with vitamin D, complement, serological tests, or fluorescence-activated cell sorting parameters from January 2013 to April 2023. Investigators identified patients with chronic viral hepatitis based on ICD codes and extracted laboratory data for those with HBV (n = 302) and HCV (n = 32), additionally including health patients (n = 256) in a separate control group for comparison.

Results showed the percentage of CD4-positive T lymphocytes and the CD4-positive/CD8-positive ratio significantly decreased (

 <.05) in patients with chronic HBV and HCV, but the percentage of CD8-positive increased (

 <.05) compared to the control group. Of note, patients with HBV had significantly lower serum vitamin D concentration compared to the control group and this decrease became significant over time (

 <.001), but the decreased level of vitamin D in patients with HCV was not significant. Additionally, vitamin D showed a moderate negative influence on the CD8 cell count in patients with HBV.

Investigators further stratified the study groups based on their vitamin D status, categorized as sufficient (≥31 ng/mL), insufficient (21–30 ng/mL), deficient (11–20 ng/mL), and severely deficient (1–10 ng/mL), regardless of viral infection. Upon analysis, the vitamin D deficient group showed significantly lower antibody production compared to the normal group and exhibited significantly decreased CD4 numbers and increased CD8 numbers (

 <.001, respectively), while the CD4/CD8 ratio was also significantly decreased in the insufficiency group (P <.001). Investigators noted this imbalance of helper T cells (CD4-positive T cells) and cytotoxic T cells (CD8-positive T cells) indicates immune system dysfunction.

Investigators noted complement C3 levels were not associated with CD4 and CD8 but had an inverse relation with vitamin D, suggesting the complement system does not exert a direct influence on cellular immune regulation. However, they noted the association between vitamin D and the complement system shows the anti-inflammatory properties of vitamin D. Additionally, investigators observed a significant association between vitamin D levels and complement C3, CD8+, CD4+, CD19+ cells, and HBV DNA levels.

Investigators outlined several potential limitations to these findings, including their reliance on data mining, inability to account for comorbidities and certain parameters across HBV subgroups, and variability in the types of testing parameters included in the study.

“This study supports the theoretical basis of the relationship between Vitamin D and the immune system in a big cohort and provides a novel reference for further studies,” investigators concluded.

Gerhards C, Teufel A, Gerigk M, et al. Potential role of Vitamin D in immune response in patients with viral hepatitis. Nutrition. Published online March 30, 2024. doi:10.1016/j.nut.2024.112447

US Centers for Disease Control and Prevention. Hepatitis B Information. Viral Hepatitis. March 9, 2023. Accessed May 6, 2024. 

https://www.cdc.gov/hepatitis/hbv/index.htm

Articles

Vitamin D concentration was significant in chronic hepatitis B virus but not hepatitis C virus infection, suggesting its potential impact on immune response.

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Hepatitis C

Hepatitis C page, resources on the topics of medical news and expert insight into HCV can be found. Content includes articles, interviews, videos, podcasts, and breaking news on hepatitis C virus research, treatment, and drug development.

Hepatology

Vitamin D May Modulate Immune Function in Chronic HBV Infection

The panel emphasizes the importance of early identification of patients based on subgroups.

Patient Subgroups With a Higher Prevalence of Hypercortisolism

Videos

The panel emphasizes the importance of early identification of patients based on subgroups, such as those with difficult-to-control diabetes, hypertension, and bone issues, highlighting that the inability to lower a patient's insulin dosage is a significant risk factor for hypercortisolism.

Type 1 Diabetes

Type 2 Diabetes

Peer Exchange

HCPLive® Peer Exchange panel discussions feature authoritative insights, opinions, and perspectives on important issues facing today's care professionals.

Christopher Lucci, MD, reviews the current diagnostic tests for hypercortisolism. 

Testing for Hypercortisolism

Christopher Lucci, MD, reviews the current diagnostic tests for hypercortisolism, which include the Dexamethasone Suppression Test, DHEA level tests, and ACTH assessments.

Ryan McLaughlin, PhD: Challenges Studying Cannabis to Treat Psychiatric Illness

In the past few years, research has expanded on studying cannabis as a treatment option for 

 reported the Biden administration will soon announce an interim role reclassifying cannabis for the first time since 1971, when the Controlled Substances Act began.

The Drug Enforcement Administration has proposed to reclassify marijuana from Schedule I—the classification of the drugs heroin, methamphetamines, and LSD—to Schedule III. The proposal acknowledges the substance’s potential medical benefits. With cannabis currently being classified as Schedule I, the substance is not accepted for medical use, unlike Schedule III substances such as Tylenol, steroids, and testosterone.

It will take time before Cannabis switches to the Schedule III classification as the proposal needs to first be published in the Federal Register, followed by a 60-day public comment period. After that, an administrative law judge can hold a hearing before the rule is approved.

, Ryan McLaughlin, MD, assistant professor of integrative physiology and neuroscience at Washington State University, described how the distribution of CB1 and CB2 receptors which bind to cannabis molecules influence physiological processes. He explained the receptors target areas such as movement, motor control, memory, appetite, immune regulation, and inflammation.

Even though the government is making moves on changing the classification of cannabis to allow for medical use, research on treating psychiatric illness with cannabis presents ethical challenges. McLaughlin discussed said challenges.

“We would want to ideally design a study where you have a randomized placebo controlled double blind study: this is the gold standard in human research,” McLaughlin said. “When you're trying to evaluate the efficacy of a novel drug, but with cannabis, it's ethically impractical to actually dichotomize groups or split people randomly.”

He explained how investigators cannot just randomly select 1 participant to be a cannabis user and another to not be a cannabis user to follow over time.

“It's difficult,” he said. “We have to really rely on quasi experimental and correlational studies to try and gain insight into how cannabis is affecting all these sorts of things.”

He added another challenge of researching cannabis includes the fact “no real patenting of plants to that degree” exists.

“There's less of an impetus from drug companies to push very expensive and lengthy clinical trials for whole plant cannabis products,” McLaughlin said. “They would much rather use drugs that are in early development that kind of target the same system, but don't actually have intoxicating effects the same way that cannabis does. So we just aren't quite there yet with the field.”

McLaughlin, R. Talking With (and Listening to) Your Patients About Cannabis. Session presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 5, 2024.

Tsirkin, J and Alba, M. Biden Administration Plans to Reclassify Marijuana, Easing Restrictions Nationwide. 

https://www.nbcnews.com/politics/joe-biden/biden-administration-plans-reclassify-marijuana-easing-restrictions-na-rcna149424

In an interview, Ryan McLaughlin discussed the ethical concerns regarding treating psychiatric illness with cannabis.

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

Lana Pine is the editor of HCPLive Rheumatology. She is an experienced editor and technical writer with a demonstrated history of working in the banking and publishing industries. In her free time, she enjoys cooking, yoga, listening to podcasts, and drawing. She can be reached via email at LPine@mjhlifesciences.com.

 treated with upadacitinib, an oral Janus kinase (JAK) inhibitor, reported higher rates of serious infection, lymphopenia, nonmelanoma skin cancer (NMSC), and herpes zoster, according to findings from an integrated analysis of the phase 2/3 and phase 3 SELECT trials published in 

These treatment-emergent adverse events (TEAEs) were also slightly elevated among patients with PsA receiving upadacitinib compared with patients with 

 treated with the drug. Despite these results, upadacitinib 15 mg was well tolerated and showed a generally consistent safety profile with no new safety signals were reported. 

“Advances in understanding the pathogenesis of SpA have led to a new therapeutic option with targeted, small-molecule JAK inhibitors, which have also been assessed for treating different immune-mediated inflammatory diseases (IMIDs),” wrote a group of investigators led by Gerd R. Burmester, MD, professor of medicine in the Department of Rheumatology and Clinical Immunology at the Charité University Hospital in Berlin, Germany.

Patients with IMIDs are more likely to develop infections and other adverse events due to both their health conditions and the use of immunomodulatory therapies, including JAKs. For example, the ORAL Surveillance study revealed treatment with tofacitinib, another JAK inhibitor, was linked to increased cardiovascular risks in patients with 

, leading to questions about the safety of this class of drug for patients with rheumatic diseases.

Investigators evaluated the safety profile of upadacitinib 15 mg for up to 5 years of exposure among patients with PsA, non-radiographic axSpA (nr-axSpA), and ankylosing spondylitis (AS) using safety data from 5 trials (2 in PsA [SELECT-PsA 1 and SELECT-PsA 2]; 2 in AS [SELECT-AXIS 1 and SELECT-AXIS 2]; and 1 in nr-axSpA [SELECT-AXIS2]). One of the PsA studies used adalimumab as an active comparator.

TEAEs, adverse events of special interest (AESI), and laboratory values were evaluated. TEAEs were collected and summarized for all studies and reported as exposure-adjusted event rates per 100 patient-years (E/100 PY).

In total, the studies included 1789 patients who received ≥ 1 dose of upadacitinib for 3689 PY of exposure or adalimumab (n = 429) for 1147 PY of exposure. Of these patients, 907 had a PsA diagnosis, 596 had AS, and 286 had nr-axSpA. Patients in the PsA group reported the highest maximum duration of treatment (5.0 years, median 2.9 years), while the nr-axSpA cohort had the shortest duration (2.2 years, median 1.0 years).

The rates of TEAEs raged from 183.9 E/100 PY in the AS cohort to 232.9 E/100 PY in the PsA group. Both overall TEAEs and serious TEAEs were higher in patients with PsA and were numerically higher in those receiving upadacitinib compared with adalimumab. However, rates were similar among the AS and nr-axSpA populations.

TEAEs that led to discontinuation were comparable across groups, although there was a numerically lower rate among the AS cohort. The most common adverse events were respiratory tract infection, COVID-19 infection, and nasopharyngitis.

Patients with PsA treated with upadacitinib had higher rates of herpes zoster, serious infection, lymphopenia, and NMSC compared with the adalimumab cohort. However, the rates of malignancy (besides NMSC), adjudicated venous thromboembolic events, and adjudicated major adverse cardiovascular events were comparable across treatment groups in PsA and similar across diseases.

Investigators mentioned the lack of placebo control arms, as well as having no active comparator in the AS and nr-axSpA groups, as limitations of the study. Further, as these were long-term extension trials, only the patients who met the previous eligibility criteria were included in the analysis.

“The safety of upadacitinib will continue to be monitored in the ongoing clinical trial program and post-marketing reports,” investigators concluded.

Burmester GR, Stigler J, Rubbert-Roth A, et al. Safety Profile of Upadacitinib up to 5 Years in Psoriatic Arthritis, Ankylosing Spondylitis, and Non-radiographic Axial Spondyloarthritis: An Integrated Analysis of Clinical Trials. 

. Published online April 29, 2024. doi:10.1007/s40744-024-00671-4

Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, Landewe RBM, Van den Bosch FE, Boteva B, Bremander A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82:19–34.

Both overall TEAEs and serious TEAEs were numerically higher in those receiving upadacitinib compared with adalimumab. 

Psoriatic Arthritis

On the HCPLive psoriatic arthritis page, resources on the topics of medical news and expert insight into PsA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on arthritis, and more.

Non-radiographic Axial Spondyloarthritis

On the HCPLive non-radiographic axial spondyloarthritis page, resources on the topics of medical news and expert insight into nr-axSpA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on rheumatic disease, and more.

Spondyloarthritis

The HCPLive spondyloarthritis page is a resource for medical news and expert insights on spondylitis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for autoimmune disease, and more.

Ankylosing Spondylitis

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Upadacitinib Demonstrates Higher Rates of Adverse Events Compared with Adalimumab in PsA

Connor Iapoce is an associate editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

The phase 2 trial failed to show improvement of ≥2-DRSS levels with the vorolanib intravitreal insert in patients with non-proliferative diabetic retinopathy.

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PAVIA: Duravyu Misses Primary Phase 2 Endpoint in Diabetic Retinopathy

The final in our 3-part quiz series based on the NLA's 2024 update to their 2019 scientific statement on use of lipoprotein(a) in clinical practice focuses on treatment considerations and therapeutic options for elevated Lp(a).

Dyslipidemia

Clinical Quiz: Lp(a) Treatments and Therapeutics Considerations

BI 764524 was well tolerated following intravitreal administration of single and multiple doses in the phase 1/2a trial, with signs pointing to early efficacy.

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HORNBILL: BI 764524 Meets Safety Endpoints in Diabetic Macular Ischemia

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

In this interview, Browning discusses his team’s trial data and the implications of the FDA’s decision to accept the supplemental new drug application for tapinarof as an eczema treatment.

Atopic Dermatitis

Atopic Dermatitis condition center page, resources on the topics of medical news and expert insight into eczema can be found. Content includes articles, interviews, videos, podcasts, and breaking news on dermatitis research, treatment, and drug development.

Discussing the Potential Approval of Tapinarof for Atopic Dermatitis with John Browning, MD

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

IgA Nephropathy

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Nephrology

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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.

Cardiology

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

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

Geriatrics

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Davangere Devanand, MD: The State of Dementia Drug Development

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

PTSD

Charles R. Marmar, MD: Blood Biomarkers for PTSD

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

Schizophrenia

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John Kane, MD: Shifts in Antipsychotics for Schizophrenia

Treatment-resistant depression with intranasal esketamine was linked to improvements in major depressive disorder (MDD) symptoms and fibromyalgia pain in a 40-year-old female.

Fibromyalgia

On the HCPLive fibromyalgia page, resources on the topics of medical news and expert insight into fibrositis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on fibromyalgia, and more.

Latest News

Vitamin D May Modulate Immune Function in Chronic HBV Infection

Patient Subgroups With a Higher Prevalence of Hypercortisolism

Testing for Hypercortisolism

Ryan McLaughlin, PhD: Challenges Studying Cannabis to Treat Psychiatric Illness

Upadacitinib Demonstrates Higher Rates of Adverse Events Compared with Adalimumab in PsA