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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 

Elna Saah, MD joins HCPLive to discuss the current care landscape in sickle cell disease and new advancements benefiting clinical care. 

Elna Saah, MD: Unraveling the Current Care Landscape in Sickle Cell Disease

 impacts approximately 70,000 to 1000,000 people in the United States, making it the most common form of an inherited blood disorder. The condition is marked by the production of abnormal hemoglobin from birth, with complications of the disease leading to severe pain and other health complications, including infection, acute chest syndrome, and stroke.

, Elna Saah, MD, a hematologist at the Emory University School of Medicine, described the public health concerns stemming from the condition and the importance of screening newborns to make a diagnosis immediately after birth.

“It’s a real big problem, a public health issue because it is progressive and complications continue to evolve as patients get older and older,” Saah told HCPLive. “In adults, there’s a lot of multiple organ involvement, which reduces the lifespan, causes earlier mortality and morbidity, and burdens both the patient and the healthcare system.”

Saah pointed to the variety, and potential disparity, in care resources between pediatric and adult populations with SCD. Children with SCD are typically treated by a general pediatric hematologist-oncologist, not necessarily an SCD specialist.

The care team also includes psychosocial support, including a social worker, psychologist, and teachers, to help manage trauma from the pain, as well as extensive support from advanced practice providers and nurse practitioners. As children reach adulthood, a transition is prepared for them to move from the pediatric side of care to adult providers.

However, according to Saah, the resources for SCD treatment are much more sparse and not as generous in adult care.

“We have fewer and fewer adult hematologists or hematologist oncologists who are willing and able and have the bandwidth to take on SCD patients,” Saah told 

. “We also do not have a lot of supportive resources, including social workers and psychologists or neuropsychologists, to support this progressive disease and the patients end up with chronic pain.”

Saah also touched on the care landscape from the 1970s to the modern day, from early trial data indicating the proficiency of hydroxyurea to recent US Food and Drug Administration (FDA) approvals, including L-glutamine, Crizanlizumab, and Voxelotor. Other recent FDA approvals touched on included two gene therapies for SCD, including exagamglogene autotemcel (exa-cel) and lovotibeglogene autotemcel (lovo-cel) for children aged ≥12 years.

Saah also elaborated on recent data pointing to the unintentional negative effect of the 2016 Centers for Disease Control and Prevention on opioid prescriptions in patients with SCD. The release of the guidelines inadvertently curbed opioid prescribing for patients with SCD and those patients tended to seek hospitalization more frequently for their pain.

“I think we should take these results a bit more guarded, it is difficult to broadly analyze and extrapolate these Medicaid data on any individual patient,” Saah told HCPLive. “While we have seen that to be true in other patients, it behooves us to look for alternative support for long-term opioid and non-opioid prescribing in patients with chronic pain. It is unfortunate some patients did have opioids when they needed to have been withheld from them or delayed.”

Watch the full interview with Saah in the above video.

What is sickle cell disease? Centers for Disease Control and Prevention. July 6, 2023. Accessed April 18, 2024. https://www.cdc.gov/ncbddd/sicklecell/facts.html.

Sickle cell disease. Hematology.org. Accessed April 18, 2024. https://www.hematology.org/education/patients/anemia/sickle-cell-disease.

Treatment. National Heart Lung and Blood Institute. Accessed April 18, 2024. https://www.nhlbi.nih.gov/health/sickle-cell-disease/treatment

Iapoce C. CDC opioid guidelines linked to negative consequences in sickle cell disease. HCP Live. March 12, 2024. Accessed April 18, 2024. https://www.hcplive.com/view/cdc-opioid-guidelines-linked-negative-consequences-sickle-cell-disease.

Videos

Elna Saah, MD joins HCPLive to discuss the current landscape in sickle cell disease and recent advancements benefiting clinical care.

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Hematology

Sickle Cell

Sickle Cell condition center page, resources on the topics of medical news and expert insight into sickle cell disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on sickle cell research, treatment, and drug development.

Elna Saah, MD: Unraveling the Current Landscape in Sickle Cell Disease

A recent head-to-head cross-sectional study found state-of-the-art large language models (LLMs), including ChatGPT-4, are nearing expert-level clinical knowledge and reasoning in the field of 

In the analysis, GPT-4 fared well with expert ophthalmologists and specialty trainees, achieving a pass-worthy performance on a mock ophthalmological examination. However, as top-performing doctors remained superior in the knowledge examination, LLMs might be most beneficial for eye-related advice or management suggestions.

“We could realistically deploy AI in triaging patients with eye issues to decide which cases are emergencies that need to be seen by a specialist immediately, which can be seen by a general practitioner, and which don’t need treatment,” lead study author Arun J Thirunavukarasu, MB BChir, University of Cambridge school of clinical medicine, explained in a statement.

 “The models could follow clear algorithms already in use, and we’ve found GPT-4 is as good as expert clinicians at processing eye symptoms and signs to answer more complicated questions.”

LLMs have proven revolutionary in natural language processing and their introduction into medicine is the center of a significant discussion around its utility and ethical concerns. In eye care, ChatGPT showed superiority on eye-related questions in an examination for general practitioners and achieved significant improvement over time on ophthalmic knowledge assessments after GPT-3.5 was succeeded by GPT-4.

However, Thirunavukarasu and colleagues suggested these analyses are impacted by the potential for “contamination,” or an inflated performance related to previously recalled text, rather than clinical reasoning.

 In addition, the examination performance does little to indicate the potential of LLMs to improve clinical practice as a medical assistance tool.

For this analysis, investigators used the United Kingdom’s FRCOphth Part 2 examination to evaluate the capability of state-of-the-art LLMs, with fully qualified and current training ophthalmologists serving as a robust clinical benchmark, rather than raw examination scores. As these questions were not fully available online, the risk of contamination was minimized.

Each eligible question was inputted into ChatGPT (GPT-3.5 and GPT-4 versions) between April and May 2023. If the LLM did not provide a definitive answer, the question was re-trialed up to three times and regarded as “null” if no answer was provided. After their release, the PaLM 2 and LLaMA models were trialed on the 90-question examination between June and July 2023.

To evaluate the performance and accuracy of the LLM outputs, five expert ophthalmologists who had passed the examination, three trainees currently in residency, and two unspecialized junior doctors answered the 90-question mock examination, independently, without reference to textbooks, the internet, or the LLMs’ recorded answers.

Ultimately, 347 of 360 questions from the textbook were used for analysis, including 87 of the 90 questions from the mock examination chapter. Overall performance across the 347 questions was significantly higher for GPT-4 than for GPT-3.5 (61.7% vs. 48.41%; 

Performance in the mock examination revealed GPT-4 compared well with other LLMs, junior and trainee doctors, and ophthalmology experts. GPT-4 was the top-scoring model (69%), compared with GPT, performing higher than GPT-23.5 (48%) and LLaMA (32%), but statistically similar to PaLM 2 (56%), despite a superior score.

Moreover, the performance of GPT-4 was statistically similar to the mean score achieved by expert ophthalmologists (

 = .28). Overall, GPT-4 performed favorably to expert ophthalmologists (median, 76%; range, 64–90%), ophthalmology trainees (median, 59%; range, 57–63%), and unspecialized junior doctors (median, 43%; range, 41–44%).

Low agreement between LLMs and doctors indicated idiosyncratic differences in knowledge and reasoning with consistency across subjects and type (

 >.05). LLM knowledge and reasoning ability may be general across ophthalmology, rather than strong for a particular subspecialty or question type.

The LLM examination performance translated to subjective preference, as all ophthalmologists preferred responses from GPT-4. In particular, they rated the accuracy and relevance of GPT-4 higher than GPT-3.5 (

Thirunavukarasu and colleagues noted the remarkable performance of GPT-4 in ophthalmology may provide its usefulness in clinical contexts, particularly in areas without access to ophthalmologists. Its ophthalmic knowledge and reasoning ability are likely superior to non-specialist doctors and could assist clinicians in their day-to-day work.

“Even taking the future use of AI into account, I think doctors will continue to be in charge of patient care,” Thirunavukarasu said.

 “The most important thing is to empower patients to decide whether they want computer systems to be involved or not. That will be an individual decision for each patient to make.”

Thirunavukarasu AJ, Mahmood S, Malem A, et al. Large language models approach expert-level clinical knowledge and reasoning in ophthalmology: A head-to-head cross-sectional study. PLOS Digital Health. April 17, 2024. Accessed April 17, 2024. https://journals.plos.org/digitalhealth/article?id=10.1371%2Fjournal.pdig.0000341

Cambridge_Uni. Artificial intelligence beats doctors in accurately assessing eye problems. EurekAlert! April 17, 2024. Accessed April 17, 2024. https://www.eurekalert.org/news-releases/1040936.

Thirunavukarasu AJ, Hassan R, Mahmood S, et al. Trialling a Large Language Model (ChatGPT) in General Practice With the Applied Knowledge Test: Observational Study Demonstrating Opportunities and Limitations in Primary Care. 

. 2023;9:e46599. Published 2023 Apr 21. doi:10.2196/46599

Mihalache A, Popovic MM, Muni RH. Performance of an Artificial Intelligence Chatbot in Ophthalmic Knowledge Assessment. 

 2023;141(6):589–597. doi:10.1001/jamaophthalmol.2023.1144

Articles

Modern large language models perform strongly on ophthalmic knowledge assessments and approach or exceed the scores of fully qualified and trainee ophthalmologists.

Ophthalmology

Ophthalmology page, resources on the topics of medical news and expert insight into ophthalmic disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on eye disease research, treatment, and drug development.

GPT-4 Nears "Expert-Level" Performance in Ophthalmology Examination

Patrick Campbell is the managing editor of HCPLive. Formerly the editorial lead of Endocrinology Network, Practical Cardiology, and Rheumatology Network, Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. He now helps to lead coverage in each of these respective areas for HCPLive. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter with the Pocono Record in Stroudsburg, PA, and Star News Group in Manasquan, NJ. He also touts experience in multimedia, having spent time as a multimedia specialist with NJ Advance Media and multimedia coordinator at the Pocono Record. Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

Use of icosapent ethyl (Vascepa) was associated with regardless of baseline

, according to a new analysis of the REDUCE-IT trial.

American College of Cardiology 2024 (ACC.24) Annual Scientific Session

, results of the analysis underline the benefit of icosapent ethyl across the spectrum of LDL-C levels within the trial, including those in lower ranges.

“Among adults with increased CV risk and elevated [triglycerides], icosapent ethyl reduced the rate of [cardiovascular] outcomes irrespective of baseline LDL-C,” wrote investigators.

The pivotal trial supporting icosapent ethyl’s expanded approval for reducing cardiovaacular risk in 2019, REDUCE-IT was a multicenter, randomized, double-blind, placebo-controlled trial of 8179 patients randomized to 2 grams of icosapent ethyltwice daily or matching placebo with a primary composite endpoint of ardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina. Results of the trial demonstrated use of icosapent ethyl was associated with a 25% reduction in risk of a primary outcome event relative to placebo therapy (Hazard Ratio [HR], 0.75; 95% Confidence Interval [CI], 0.68 to 0.83; 

Since it was initially published, the trial has been the subject of dozens of subsequent analyses assessing the benefits and safety profile across a multitude of patient subgroups, including an 

 examining effects on risk among patients according to baseline lipoprotein(a) levels. In that analysis, icosapent ethyl provided cardiovascular event reductions across the range of lipoprotein(a) levels (

for interaction >.10), with reductions in risk observed for those with concentrations less than 50 mg/dL (HR, 0.75; 95% CI, 0.66 to 0.84) and those with concentrations greater than or equal to 50 mg/dL (HR, 0.79; 95% CI, 0.64-0.97).

Presented by Rahul Aggarwal, MD, a cardiology fellow at Brigham and Women's Hospital, Harvard Medical School, the current analysis stratified patients in the trial based on whether or not their baseline LDL-C levels were less than 55 mg/dL. Of the 8179 patients included in the REDUCE-IT trial, 1058 (n=12.9%) had an LDL-C less than 55 mg/dL. The primary outcome of interest for the analysis was a composite of death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina, with differences assessed using Cox proportional hazards models.

Analysis of those with an LDL-C less than 55 mg/dL at baseline suggested a primary outcome event occurred among 16.2% of those receiving icosapent ethyl and 22.8% of the placebo group (HR, 0.66; 95% CI, 0.50 to 0.87; 

 = .003), with a number needed to treat of 15. Among those with an LDL-C of 55 mg/dL or greater, a primary outcome event was observed among 17.4% of those receiving icosapent ethyl and 21.9% of those receiving placebo therapy (HR, 0.76; 95% CI, 0.69 to 0.85; 

 < .0001), with a number needed to treat of 22. Further analysis indicated there was no signification interaction based on baseline LDL-C (

“As we know, LDL-C is a well-established major [cardiovascular] risk factor. These data are important and show that among adults with increased [cardiovascular] risk and elevated [triglycerides], icosapent ethyl clearly reduced the rate of [cardiovascular] outcomes irrespective of baseline LDL-C, including in those with very well controlled LDL-C <55 mg/dL,” said principal investigator the REUDCE-IT trial Deepak L. Bhatt, MD, MPH, MBA, director of Mount Sinai Fuster Heart Hospital.

Aggarwal R, Bhatt DL, Steg PG, et al. EFFICACY OF ICOSAPENT ETHYL FOR REDUCING CARDIOVASCULAR OUTCOMES BY BASELINE LOW DENSITY LIPOPROTEIN CHOLESTEROL LEVEL. Presented at: American College of Cardiology (ACC.24) Annual Scientific Session. April 6 – 8, 2024. Atlanta, GA.

Office of the Commissioner. FDA approves use of drug to reduce risk of cardiovascular events in certain adult patient groups. U.S. Food and Drug Administration. December 13, 2019. Accessed April 18, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-use-drug-reduce-risk-cardiovascular-events-certain-adult-patient-groups.

Bhatt DL, Steg PG, Miller M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. 

. 2019;380(1):11-22. doi:10.1056/NEJMoa1812792

Campbell P. Reduce-it lp(a) analysis details icosapent ethyl effect on Mace across LP(a) range. HCP Live. March 27, 2024. Accessed April 18, 2024. https://www.hcplive.com/view/reduce-it-lp-a-analysis-details-icosapent-ethyl-effect-on-mace-across-lp-a-range.

New reduce-IT® analyses show VASCEPA®/VAZKEPA® (icosapent ethyl) benefit in high-risk cardiovascular disease patient subgroups: Amarin Global. New REDUCE-IT® Analyses Show VASCEPA®/VAZKEPA® (Icosapent Ethyl) Benefit in High-Risk Cardiovascular Disease Patient Subgroups | Amarin Global. April 6, 2024. Accessed April 18, 2024. https://amarincorp.com/news-and-media/new-reduce-itr-analyses-show-vasceparvazkepar-icosapent-ethyl.

A new analysis of the REDUCE-IT trial reveals the benefits of icosapent ethyl in reducing cardiovascular outcomes regardless of LDL-C levels.

Dyslipidemia

REDUCE-IT Analysis Outlines Benefit of Icosapent Ethyl Across Range of LDL-C Levels

Daily 16 mg oral targeted-release budesonide capsule (Nefecon) provided more preserved kidney function without worse impact to quality of life (QoL) compared to placebo in patients with 

 over 2 years, according to findings from a pair of late-stage trials.

Data from the phase 3 NeflgArd trial, presented this week at the ISN World Congress of Nephrology 2024 in Buenos Aires, Argentina, showed the novel therapy was associated with no clinically significant changes in any QoL domains per 36-Item Short Form Health Survey (SF-36) results compared to placebo. Combined with findings from NeflgArd that which also showed a reduced estimated glomerular filtration rate (eGFR) change among patients receiving budesonide versus placebo over 2 years following a 9-months regimen, the data depict a promising benefit-risk profile associated with Calliditas Therapeutics’ investigative drug.

The findings were additionally accompanied by data from the World Congress showing benefit in kidney health for patients with IgA nephropathy regardless of low urine protein creatinine ratio (UPCR) levels at baseline and White or Asian patient background—a series of data from NeflgArd that depicts a more comprehensive clinical profile of budesonide over 2 years.

“We were pleased to share additional analyses from the 2-year phase 3 NeflgArd trial of Nefecon in IgAN at this year’s World Congress of Nephrology,” Richard Philipson, Chief Medical Officer of Calliditas, said in an accompanying statement. “These additional data further reinforce the impact of Nefecon across the entire study population, irrespective of baseline UPCR levels or patient’s racial and ethnic backgrounds.”

Led by Richard Lafayette, MD, professor of medicine at Stanford University, investigators conducted an assessment of 2-year outcomes for composite endpoint of time to confirmed 30% eGFR reduction or kidney failure among patients in the NeflgArd trial. Original eligibility in the trial included patients aged ≥18 years old with biopsy-confirmed primary IgA nephropathy; eGFR 35 – 90 mL/min per 1.73 m2; and UPCR ≥0.8 g/g or proteinuria ≥1 g per 24 hours, despite inhibition of RAS.

Patients had been randomized to a 9-month regimen of either daily 16 mg budesonide (n = 182) or placebo (n = 182), then observed off-drug for 15 months afterward. Lafayette and colleagues noted only 21 (12%) of patients treated with budesonide reached the primary endpoint of 30% reduced eGFR from baseline or kidney failure at 2 years, compared with 39 (21%) patients receiving placebo—indicating a 55% reduced risk of outcome with treatment (hazard ratio [HR], 0.45; 95% CI, 0.26 – 0.75).

Another 32 (18%) patients on budesonide required rescue therapy, versus 56 (31%) of patients on placebo (HR, 0.51; 95% CI, 0.33 – 0.79). Investigators noted that the treatment effect of budesonide was notable regardless of patient rescue medication and baseline UPCR levels. The team additionally wrote that tolerability and safety profiles for the therapy were consistent with known locally-acting oral budesonide use.

“The time from randomization to confirmed 30% eGFR reduction or kidney failure was significantly delayed with Nefecon versus placebo,” Lafayette and colleagues wrote. “These findings strongly indicate that Nefecon preserved kidney function and provide support for Nefecon as a disease-modifying therapy in patients with IgAN.”

In the QoL assessment, a team of investigators led by Jonathan Barratt, PhD, of the College of Medicine Biological Sciences and Psychology at University of Leicester, sought to interpret change in SF-36 assessment scores among the 2 arms of the NeflgArd trial at 9 and 24 months versus baseline.

The 36-item questionnaire assessed 8 subscales of QoL, including: physical function; role limitations due to physical health; bodily pain; general health perceptions; vitality; social functioning; role limitations due to emotional problems; and mental health. Scores from each subscale ranged from 0 – 100 points, with greater scores indicating better QoL.

Investigators observed that SF-36 scores were similar between the budesonide and placebo arms across all the QoL subscales at baseline. Thereafter, they observed neither clinically meaningful worsening nor improvement of SF-36 scores at the end of the treatment period (9 months) as well as the end of the 2-year observation period (24 months).

“These findings further support the benefit/risk profile of Nefecon, demonstrating that 9 months of treatment with Nefecon 16 mg/day did not result in changes in QoL at any measure, while providing significant benefit in preserving kidney function,” they concluded.

Lafayette R, Kristensen J, Stone A, Floege J, et al. eGFR decline in patients with IgAN treated with Nefecon or placebo: Results from the 2-year NefIgArd Phase 3 trial. Poster presented at: ISN World Congress of Nephrology 2024. Buenos Aires, Argentina. April 13 – 16, 2024.

Barratt J, Kristensen J, Stone A, Floege J, et al. Nefecon effect on quality of life in patients with IgAN: SF-36 results from the Phase 3 NefIgArd trial. Poster presented at: ISN World Congress of Nephrology 2024. Buenos Aires, Argentina. April 13 – 16, 2024.

Kunzmann K. Investigative Oral Targeted Budesonide Significantly Improves Berger Disease Over 9 Months. 

. Published August 17, 2023. https://www.hcplive.com/view/investigative-oral-targeted-budenoside-significantly-improves-berger-disease-9-months

Calliditas Therapeutics. Calliditas Therapeutics Presents Additional Data Analyses from the Phase 3 NeflgArd trial of Nefecon in Primary IgA Nephropathy at the ISN World Congress of Nephrology 2024. Press release. Published April 18, 2024. https://news.cision.com/calliditas-therapeutics/r/calliditas-therapeutics-presents-additional-data-analyses-from-the-phase-3-neflgard-trial-of-nefecon,c3963340

New phase 3 findings show daily oral budesonide reduces eGFR decline while maintaining patient quality of life over 2 years.

IgA Nephropathy

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Budesonide Maintains IgA Nephropathy Kidney Failure Reduction, Quality of Life at 2 Years

Natalie McCormick, PhD
Credit: American College of Rheumatology

An analysis of data from a population-level database of type 2 diabetes patients from British Columbia, Canada offers further insight into the benefits of SGLT2 inhibition on 

With evidence supporting the urate lowering effect of SGLT2 inhibitors in patients with type 2 diabetes, the study builds on previous research from the investigatory team, which was led by Natalie McCormick, PhD, an epidemiologist at Massachusetts General Hospital and Harvard Medical School.

“Consistent with their known urate-lowering effects, [SGLT2 inhibitors] may reduce gout risk for those who need a second-line agent after metformin and provide an attractive option to simultaneously address the high burden of gout and cardiometabolic sequelae in patients with diabetes,” wrote investigators.

McCormick has led a number of studies examining the effects of SGLT2 inhibitors in patients with gout, including a 

 assessing risk of recurrent gout flares among people with type 2 diabetes using SGLT2 inhibitors from. In this study, rate of gout flares was lower with SGLT2 inhibitor initiation (52.4 events per 1000 person-years) than with DPP-4 initiation (79.7 events per 1000 person-years), which correlates to a rate ratio (RR) of 0.66 (95% confidence interval [CI], 0.57 to 0.75) and a rate difference (RD) of —27.4 (95% CI, —36.0 to —18.7).

The current research endeavor from McCormick and colleagues was designed to further illustrate the effect of SGLT2 inhibitors in patients with type 2 diabetes by examining effects of use within a sequential, propensity score-matched, new-user comparative effectiveness study leveraging data from a Canadian general population database and using target trial emulation framework. The database used by investigators was the Population Data BC database, which is a series of linked administrative databases of all provincially funded emergency department and outpatient medical visits and hospital discharges as well as all dispensed prescriptions in British Columbia, Canada.

The primary outcome of interest for the study was incident gout, which was defined as an emergency department visit or hospitalization with a primary discharge diagnosis or an ICD-9/10 code of gout during an outpatient encounter with intra-articular or oral corticosteroids, colchicine, or NSAIDs dispensed within 7 days. Investigators planned to perform Cox proportional hazards and Poisson regressions with 1:1 propensity score matching for their primary analysis, with overlap weighting used as part of the study’s sensitivity analysis.

For inclusion in the trial, patients were required to be at least 18 years or older with type 2 diabetes whose first-ever dispensing for SGLT2 inhibitors or sulfonylurea occurred from January 2014 through June 2022. investigators required patients to have a current prescription for metformin at the time of dispensing no prior dispensing of other glucose-lowering medications. Investigator pointed out this analysis excluded patients with a gout diagnosis or dispensing of a gout-specific medication, such as allopurinol, febuxostat, probenecid, or colchicine, unlike their analysis of recurrent gout flares, which included patients with existing gout at baseline.

Overall, 34,604 propensity score-matched adults initiating SGLT2 inhibitors or sulfonylurea were identified for inclusion in the study. This cohort had a mean age of 60 (Standard Deviation [SD], 12.4) years, 60% were male, and the mean follow-up was 1.38 years.

During the follow-up, there were 105 incident gout cases among the SGLT2 inhibitor cohort (4.27 per 1000 person-years), compared with 159 cases among the 17,302 propensity score-matched patients who initiated sulfonylurea (6.91 per 1000 person-years; This corresponded to an adjusted Hazard Ratio (aHR) of 0.62 (95% CI, 0.48 to 0.80) and RD of −2.6 (95% CI, −4.0 to −1.3) per 1000 person-years. In their sensitivity analysis, application of overlap weighting in place of 1:1 propensity-score matching resulted in an aHR of 0.68 (95% CI, 0.54 to 0.85) and an RD of −2.0 (95% CI, −3.6 to −0.5).

Investigators called attention to an analysis of cardiovascular outcomes in their study. These results suggested use was associated with reduced risk of major adverse cardiovascular events (HR, 0.87; 95% CI, 0.77 to 0.98; and RD, −3.58; 95% CI, −6.19 to −0.96) as well as a reduced risk of heart failure.

Investigators highlighted multiple limitations in their study to consider before overinterpretation of results. These included the observational nature of the study, inability to access measures for HbA2c, uric acid, or kidney function tests, and lack of data related to race and ethnicity of patients included.

“The gout and cardiovascular benefits associated with [SGLT2 inhibitors] in these target trial emulations may guide selection of glucose-lowering therapy in patients with [type 2 diabetes] who are at risk for (or already have) gout needing a second-line agent after metformin,” investigators wrote.

McCormick N, Yokose C, Lu N, et al. Sodium-Glucose Cotransporter-2 Inhibitors vs Sulfonylureas for Gout Prevention Among Patients With Type 2 Diabetes Receiving Metformin. 

 Published online April 15, 2024. doi:10.1001/jamainternmed.2024.0376

Campbell P. SGLT2 inhibitors could lower risk of recurrent gout flares in people with diabetes. HCP Live. June 4, 2023. Accessed April 18, 2024. https://www.hcplive.com/view/sglt2-inhibitors-could-lower-risk-of-recurrent-gout-flares-in-people-with-diabetes.

A propensity score-matched, new-user analysis suggests SGLT2 inhibitors may reduce gout risk in type 2 diabetes patients relative to other second-line therapies.

Gout

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

SGLT2 Inhibitors Reduce Risk of New Gout Diagnoses in T2D Relative to Sulfonylurea

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.

Results of the SELECT-GCA study demonstrated approximately half of patients with giant cell arteritis treated with upadacitinib plus a steroid tapering regimen were able to achieve sustained remission through week 52.

Rheumatoid Arthritis

The HCPLive rheumatoid arthritis page is a comprehensive resource for clinical news and insights on arthritis. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for RA, and more.

Phase 3 Upadacitinib Study Achieves Positive Results for the Treatment of Giant Cell Arteritis 

A new study found an intervention targeting proton pump inhibitor overuse was linked to an absolute reduction of 7.3%.

Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

Pharmacy-Based Intervention Linked to Reduced Proton Pump Inhibitor Overuse

Meta-analysis of 11 phase 3 trials shows SGLT2 inhibitors reduce cardiovascular event risk by 9% across diverse patient populations.

Type 2 Diabetes

Chronic Kidney Disease

Heart Failure

The HCPLive heart failure page is a resource for medical news and expert insights on HF. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for heart disease, reduced and preserved ejection fraction, and more.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

SMART-C Meta-Analysis: SGLT2 Inhibitors Reduce Cardiovascular Events

Experts discuss the management of dry eye in the presence of concurrent ocular conditions, as well as managing dry eye before undergoing cataract and refractive surgery.

Treating Dry Eye in The Presence of Ocular Comorbidities

Almost 50% of fibromyalgia patients use cannabis for symptom relief, according to new study. Experts suggest results underline need for clinician awareness, further research.

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.

Survey Finds Many Fibromyalgia Patients Finding Symptom Relief with Medical Cannabis

A recent study found Black individuals had a sharp increase in midlife deaths from suicide, drug overdose, and alcoholic liver disease after 2015.

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.

Addiction

Addiction medicine condition center page, resources on the topics of medical news and expert insight into clinical addiction can be found. Content includes articles, interviews, videos, podcasts, and breaking news on addiction therapy research, treatment, and drug development.

2022 Spike in “Deaths of Despair” Among Black Population Surpasses White People

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.

The modified difference-in-differences analysis found notable increases in DAA use after state Medicaid programs relaxed certain coverage restrictions.

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

DAA Use Increased After State Medicaid Programs Eased HCV Treatment Restrictions

NSAID use decreased the odds of a cardiovascular event by 12% in patients with gout.

NSAIDs Decrease the Odds of Adverse Cardiovascular Events in Gout

Patient-led urate monitoring supports adherence to urate-lowering therapy and helps attain target concentrations among individuals with gout.

Self-Monitoring of Urate Concentration Could Benefit Gout Management 

Podcasts

In this episode, hosts discuss the STEP HFpEF DM trial and the need for fair allocation of incretin-based therapies with ongoing shortages and overwhelming demand.

Obesity Management

Obesity Management condition center page, resources on the topics of medical news and expert insight into clinical weight management can be found. Content includes articles, interviews, videos, podcasts, and breaking news on obesity research, treatment, and drug development.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives is a monthly podcast hosted by Diana Isaacs, PharmD, and Natalie Bellini, DNP, aimed at providing a regular roundup of the latest clinically applicable insights across diabetes and metabolic diseases, with a focus on leveraging technology to improve care.

podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, Rare Disease Report, and Heart Trials.

Latest News

Elna Saah, MD: Unraveling the Current Landscape in Sickle Cell Disease

GPT-4 Nears "Expert-Level" Performance in Ophthalmology Examination

REDUCE-IT Analysis Outlines Benefit of Icosapent Ethyl Across Range of LDL-C Levels

Budesonide Maintains IgA Nephropathy Kidney Failure Reduction, Quality of Life at 2 Years

SGLT2 Inhibitors Reduce Risk of New Gout Diagnoses in T2D Relative to Sulfonylurea