Uncovering the unseen and unspoken signs of eosinophilic esophagitis

Eosinophilic Esophagitis: The Challenging Journey to Diagnosis

The study shows a reduction in hemoglobin and a reduced risk of hypoglycemia in participants.

Research Shows New FRC Treatment Could Benefit Patients with Type 2 Diabetes

Researchers push for transparency between health care professionals and patients with diabetes about the safety and efficacy of the influenza vaccine

New Study Seeks to Increase Vaccination Rate in Patients with Type 2 Diabetes

Armand Butera is the assistant editor for 

. He attended Fairleigh Dickinson University and graduated with a degree in communications with a concentration in journalism. Prior to graduating, Armand worked as the editor-in-chief of his college newspaper and a radio host for WFDU. He went on to work as a copywriter, freelancer, and human resources assistant before joining 

. In his spare time, he enjoys reading, writing, traveling with his companion and spinning vinyl records. Email him at 

Mutations in cancer have always presented a challenge for doctors and patients alike. Lung cancer has several known mutations that have been extensively studied, with an ever-evolving list of inhibitors and therapies that followed suit.

In the newest episode of Lungcast, Andrea Mazzocchi, PhD, co-founder and chief executive officer of Known Medicine, and adjunct professor at Wake Forest University, sat down with host and American Lung Association (ALA) chief medical officer Al Rizzo, MD, to talk about the known mutations regarding lung cancer, the methods for treating these mutations, and immunotherapy and checkpoint inhibitors that can be used to determine cancer in patients.

Of the mutations mentioned, Dr. Mazzocchi noted that the EGFR mutation remained the most known. Approximately 10% of non-small cell lung cancer patients develop an EGFR mutation, which also affects approximately 50% of non-smokers as well, something that Mazzocchi said intrigued researchers.

Several treatments are available for EGFR positive patients, such as the therapy drug erlotnib.

During the discussion, Mazzocchi spoke of the importance of genetic testing, which could lead to more appropriate cancer treatment for patients.

“There’s a lot of opportunities to start using this genetic testing to start matching the patients with (the stages of cancer progression) as well as the mutations, and to what treatment would work best for them,” Mazzocchi said.

While there are a variety of treatments for EGFR mutations, KRAZ mutation treatments remain more elusive. There are considerably less treatments for KRAZ mutations, but that is subject to change in the intervening years.

“Unfortunately, lung cancer affects so many patients, especially in comparison to other cancers, that there’s a lot of development around EGFR and KRAS mutations,” Mazzocchi said “A lot of these can be dictated or driven by these genetic tests and are a great option for patients who have been identified with mutations.”

Additional mutations were discussed in the episode, with potential off-label treatments referenced as well. Mazzocchi suggested that many of the therapies referenced would be treated in parallel with chemotherapies and immunotherapies.

Later in the discussion, Dr. Rizzo and Dr. Mazzocchi discussed the future of immunotherapy in cancer treatment.

Mazzocchi spoke of the “huge promise” that the current 5 immunotherapies presented. She noted that cancer cells tend to disrupt the immune cells with additional receptors that make it harder for immune cells to identify the threat. Luckily, the inhibitors used in immunotherapies can help properly identifying and attacking the cancer cells.

“That’s why these (immunotherapies) are so exciting,” Mazzochi said. “You’re really turning on your immune system.”

While the differences in safety between the PDR1 and CTL4 immunotherapies were noted, she added that there had been an “amazing response” by patients that include reductions in tumor size and quick recovery rates.

“I think there’s a huge amount of promise and a lot of development still to be had, but these treatments are hugely helpful for the population receiving them,” Mazzocchi said.

To learn more about genetic testing, immunotherapies, and microbiomes of cancer referenced in the interview, watch the video above.

To hear all of Dr. Rizzo’s engaging conversation with Dr. Mazzochi, listen to Lungcast below.

Articles

Dr. Mazzocchi discusses the limits and benefits of immunotherapies, as well as the importance of genetic testing in determining cancer diagnosis and treatment in patients.

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The Promising Future of Immunotherapies in Cancer Research

. Prior to joining MJH Life Sciences in 2019, he worked as a digital reporter covering nanotechnology, life sciences, material science and more with 

. He graduated with a degree in journalism from Temple University in 2008 and began his career as a local reporter for a chain of weekly newspapers based on the Jersey shore. When not working, he enjoys going to the beach and enjoying the shore in the summer and watching North Carolina Tar Heel basketball in the winter.

The US Food and Drug Administration (FDA) has approved exenatide extended-release (Bydureon BCise) for the treatment of 

The once-weekly injectable suspension is aimed at improving glycemic control in pediatric patients as an adjunct to diet and exercise.

The approval, awarded to AstraZeneca, is the first regulatory approval for a once-weekly glucagon-like peptide-1 receptor agonist (GLP-1 RA) for pediatric patients with type 2 diabetes.

In the BCB114 phase 3 study, the treatment added to standard of care, resulted in a significant improvement of glycemic control compared to placebo for pediatric patients.

In the randomized, double-blind, placebo-controlled trial, the researchers met the primary efficacy endpoint of the change in glycated hemoglobin A1c (HbA1c) from baseline to week 24.

The team found patients in the treatment arm had a significantly greater mean change in HbA1c from baseline compared to the placebo group (-0.25%; n = 58; baseline A1c, 8.13% vs +0.45%; n = 24; baseline A1c, 8.28%, respectively; 

For safety, adverse events in the pediatric population was consistent with what was previous found in adults.

“This decision is an important milestone for the care of this younger patient population by providing a convenient, once-weekly treatment option,” Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, said in a 

. “The Phase III data that supported this approval demonstrated the safety and tolerability of exenatide extended-release in younger patients was similar to the proven safety profile of this medicine in adults.”

Exenatide extended-release was first approved in the US in 2017 as a once-weekly single-dose autoinjector device for adults with type 2 diabetes and uncontrolled blood sugar on 1 or more oral medicines.

Exenatide extended-release represents the first regulatory approval for a once-weekly glucagon-like peptide-1 receptor agonist (GLP-1 RA) for pediatric patients with type 2 diabetes.

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FDA Approves Treatment for Pediatric Type 2 Diabetes Patients

Jonathan Alicea is an assistant editor for 

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A study from France characterized patients with 

 who attended therapeutic patient education programs, noting that moderate-to-severe disease was common among attending patients.

However, overall attendance was low despite the expansion of such programs across the country.

The observational, cross-sectional study was conducted by Sébastien Barbarot, MD, PhD, of Nantes University Hospital, and colleagues, where they circulated a survey to parents of children (6 – 17 years) and adults 18 and older.

The aim of the study was to elucidate the type of patients and parents who attended therapeutic education sessions by describing sociodemographic and clinical characteristics.

“A better understanding of such characteristics may help to reach categories of patients who do not usually make use of them,” Barbarot and colleagues wrote.

The team collected data from 1063 children and parents. Relevant data included program attendance, sex, age, and area of origin. For either or both parents, the investigators inquired about presence of atopic dermatitis, professional level, and feelings of guilt or of neglecting siblings.

Clinical severity of children was assessed by parents using a proxy version of the Patient-Oriented Eczema Measure (POEM), which asked about frequency of itch, sleep, bleeding, weeping, cracking, flaking off, and dryness during the previous week.

Total scores for each category were added together and severity was ascertained from the overall combined score. Furthermore, parents were explicitly asked to evaluate their child’s disease severity as mild, moderate, or severe.

The overall attendance rate among the entire population was 12.3% (n = 131), and the majority of attendees went for 2-5 sessions.

“In the group attending therapeutic patient education, there were 85 boys (64.9%), and severity evaluated by POEM was mild in 29.8%, moderate in 52.7% and severe in 17.6% of patients,” the investigators reported.

While there were no associations between distance to program centers and attendance, the team observed that urban regions with high numbers of inhabitants like Paris and Normandy had high rates of attendance.

Furthermore, therapeutic patient education sessions had higher rates of attendance among parents who were young, employed, had atopic dermatitis or a history of atopic dermatitis, and had feelings of guilt or of neglecting their other children.

“Concerning clinical characteristics of atopic dermatitis,” the investigators wrote, “the prevalence of parents/children attending therapeutic patient education sessions was higher when the disease was more severe, and when children had a consultation with a dermatologist or a pediatrician.”

A logistic regression model supported strong associations between attendance and the sex of the child as well as the aforementioned clinical characteristics.

Several limitations acknowledged by Barbarot and his team were lack of details on sessions as well as barriers to attendance. They noted that it is possible that some patients/parents may never have been offered the option among those who never attended a therapeutic patient education session.

“Further research should focus on determinants and barriers of therapeutic patient education programs access in patients with AD in order to improve attendance,’ they opined. “In particular, therapeutic patient education should be more integrated in primary care system in France instead of being restricted to tertiary hospitals.”

Characteristics of children and adolescents with atopic dermatitis who attended therapeutic patient education

The Journal of The European Academy of Dermatology and Venereology.

Males and patients with higher disease severity were more likely to attend program sessions. 

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Dermatology

Atopic Dermatitis Study Characterizes Therapeutic Patient Education Attendance

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 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 2020 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline of management of patients with 

 has been updated following the results of both randomized clinical trials and regulatory approval of transcatheter aortic valve implantation technology (TAVI) in patients with aortic stenosis.

The team, led by Thoralf M. Sundt, MD, Massachusetts General Hospital, Harvard Medical School, observed how the emphasis on recommendations for surgical aortic valve replacement (SAVR) or TAVI shifted from risk strata to more of a focus on patient age and life expectancy.

They noted the emphasis on engagement of the heart team, as well as the process of shared decision-making.

Data show the results of multiple RCTs have established TAVI as an alternative to SAVR in treatment of aortic stenosis in all risk groups.

The decision in choice of TAVI or SAVR is dependent on patient-specific factors, noted the investigators, as well as the decision between mechanical and biological prostheses.

Some of the factors included technical, procedure-specific contraindications and the balance between estimated life expectancy and anticipated prosthesis durability.

Due to this, SAVR is recommended for the majority of patients ≤65 years, while mechanical valves are favored in patients ≤50 years.

Patients who are >65 years, the guideline noted the perioperative risks of mortality and stroke are lower with transfemoral TAVI compared with SAVR.

However, the risks of paravalvular leak, pacemaker requirement and vascular complications have a higher risk.

Further, TAVI has demonstrated a lower risk of stroke and perioperative death, less major bleeding and shorter length of hospital stay in a meta-analysis of RCTs.

“Data from RCTs and observational studies have demonstrated clearly that TAVI is superior to medical therapy for severe symptomatic aortic stenosis among patients with inoperable cases or at extreme risk,” investigators wrote.

Sundt and colleagues noted the use of TAVI has appeal for older patients with calcific aortic stenosis with a trileaflet valve.

They noted the transcatherter aortic valve implantation has benefit in patients with a heavily calcified ascending aorta and patients with comorbidities including severe lung, liver, or kidney dysfunction.

However, there is inadequate data in recommending TAVI to patients ≤65 years or patients with aortic stenosis secondary to bicuspid aortic valve or rheumatic valve disease.

Further, risks may also be exacerbated by anatomic factors including large or small valve annulus, subaortic calcification, or hypertrophy requiring myectomy or aortic dilatation.

In addition, concomitant conditions such as clinically significant primary mitral regurgitation or coronary artery disease (CAD) are not recommended for TAVI treatment.

The team noted the greatest benefit of TAVI is obtained with the transfemoral approach, so inadequate femoral vascular access is in favor of SAVR.

The team concluded that long-term durability of TAVI will better define its potential in younger patients, as well as showing the long-term outcomes in patients with bicuspid aortic valves.

“Finally, the implications of need for future surgical intervention following TAVI because of patient prosthesis mismatch, structural valve deterioration, infection, or other indications are yet to be defined,” investigators wrote.

Guideline Update on Indications for Transcatheter Aortic Valve Implantation Based on the 2020 American College of Cardiology/American Heart Association Guidelines for Management of Valvular Heart Disease

JAMA Cardiology Clinical Guidelines Synopsis

New guidelines on aortic valve implantation in risk groups with aortic stenosis shifted from risk strata to a focus on patient age and life expectancy.

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Updated Indication for Transcatheter Aortic Valve Implantation Include Focus on Age

Investigators from Texas Tech University Health Sciences Center in El Paso found a high prevalence of 

. The findings come with several complications, such as increased in risk of higher body mass index (BMI) and a promising association with increasing age.

It was the most comprehensive meta-analysis on the prevalence of OSA in the rheumatic disease population, according to the investigators involved in the study.

Early in the study, investigators, led by Bhaskar Thakur, PhD, touched on the significant public health issue that OSA presented in recent years.

Obstructive sleep apnea is characterized by recurring apneas or hypopneas during sleep, the latter of which was defined as a 30% reduction in airflow for at least 10 seconds accompanied by a 4% reduction in oxygen saturation.

Although OSA has been associated with an increased risk of cardiovascular disease as well as increasing age, obesity or larger BMI, and larger neck circumference, there remained a substantial deficit in published research prior to the new study.

With their research, Thakur and colleagues focused their attention on patients with rheumatoid arthritis to recognize the prevalence and risk factors of OSA in that population.

A systematic literature search involving PubMed, Scopus, and EMBASE was conducted until October 30, 2020. In addition to that, up to 10 pages of the Google Scholar database were reviewed to obtain relevant studies that may have been overlooked.

The investigators identified 94 records from 136 searched documents found in the electronic databases and pulled a total of 8 unique studies from around the world. Of all the available studies, 3 were conducted in the US, with the remaining studies coming from Japan, Saudi Arabia, Taiwan, Egypt, and Brazil.

The 8 studies offered up 585 patients with OSA among a total of 37,285 patients with rheumatoid arthritis. Most of the patients were women (78%), and the age range of all participants fell between 40-67 years old.

The reported range of disease duration was 6-23 years.

Finally, a sensitivity analyses was performed based on the publication period and diagnostic criteria of the studies collected.

In 1 study alone, the sensitivity analyses found that OSA prevalence was 79.3% of the study population. However, the study focused primarily on patients with rheumatoid arthritis and occipitocervical lesions, which the investigators believed may have significantly contributed to the observed heterogeneity.

Once the Japan study was excluded, the OSA prevalence in patients with rheumatoid arthritis was reduced to 23.9%.

There was no reduction in the heterogeneity measure in the study.

Overall, Thakur and investigators observed that OSA was prevalent in 29.8% of patients with rheumatoid arthritis, although previous data claimed the prevalence was 50%.

Several studies linked a high prevalence of OSA to occipitocervical lesions or occipitocervical disease. Additionally, previous evidence of rheumatoid arthritis causing damage to the upper cervical spine was referenced in the study, as the investigators believed it to be a causal factor for both OSA and central sleep apnea.

An increased BMI was also associated with OSA in the rheumatoid arthritis population, although a lack of evidence was noted.

While the investigators did show a high level of heterogeneity in the prevelance of OSA in patients with rheumatoid arthritis, they also recommended ways in which it could be managed by patients and health care professionals.

“Referral to a dedicated sleep clinic for further diagnostic assessment and therapy as required would be appropriate,” the team said. “Treatment for co-existing OSA in patients with RA may prove beneficial in terms of future cardiovascular and respiratory morbidity, as well as potentially improving measures of inflammation, pain, and fatigue.” 

“Prevalence of obstructive sleep apnea among patients with rheumatoid arthritis and its association with age and body mass index: A systematic review and meta-analysis,”

 was published online in the International Journal of Rheumatic Diseases

Researchers from Texas determined the global prevalence of OSA using 8 unique studies involving patients with rheumatoid arthritis from around the world.

Rheumatoid Arthritis

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Rheumatology condition center page is a comprehensive resource for clinical news and insights on rheumatologic disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for arthritis, gout, nr-AxSpA, and more.

Sleep

Study Cites Prevalence of OSA in Patients with Rheumatoid Arthritis

Data show while women with GDM wanted to be responsible for their own health, an annual reminder and combined appointments would help to screen for T2D. 

Endocrinology

Clinical

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Patients Stress Flexibility in Scheduling Diabetes Test After Gestational Diabetes 

Videos

On this episode of Coping After COVID, Dr. Craig Chepke discusses the challenges for schizophrenia patients.

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Coping After COVID: A Troubling Time for Schizophrenia Patients

Orphaned children experience greater risk of abuse and health complications, prompting a call to action for greater research and management of COVID-19 in ailing countries.

Global Orphan Rates Significantly Increased Due to COVID-19

The rare liver disease can often lead to liver failure. 

Rare Disease Report®

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FDA Approves Odevixibat for PFIC

A study notes that irradiation did not impact transfusion requirements or relevant laboratory values among patients receiving chronic blood transfusions. 

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Universal Red Blood Cell Irradiation Appears Safe for Sickle Cell Patients

A leading author of a recent Oxford study speaks of azithromycin, its limitations in treating patients with COVID-19, and the importance of properly utilizing the antibiotic.

Hospital Medicine

Dr. Timothy Hinks, MD: Azithromycin Does Not Work on Patients with COVID-19

Data show no significant difference in survival rates in the canukinumab group (88.8%) compared to placebo (85.7%). 

No Link Between Canakinumab, Higher Survival Rates without IMV in COVID-19 Patients

Data show postoperative initiation of factor XI inhibition was effective method for reducing the risk of VTE following total knee arthroplasty. 

Venous Thromboembolism

Abelacimab Effective in Prevention of VTE, Including Low Bleeding Risk

The issuance comes within a week of the planned PDUFA date for the drug's possible indication as an adult CKD therapy.

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FDA Issues Letter to Ardelyx for Submission of Tenapanor for Chronic Kidney Disease

The researchers found sero-protection rate at 12-month was significantly higher in the ID arm compared to the IM cohort.


Latest News

The Promising Future of Immunotherapies in Cancer Research

FDA Approves Treatment for Pediatric Type 2 Diabetes Patients

Atopic Dermatitis Study Characterizes Therapeutic Patient Education Attendance

Updated Indication for Transcatheter Aortic Valve Implantation Include Focus on Age

Study Cites Prevalence of OSA in Patients with Rheumatoid Arthritis