A scoping review from the Stanford School of Medicine found 3 issues in data sets that were used to develop and test clinical artificial intelligence (AI) algorithms for 

The issues pertained to the sparsity of data set characterization and a lack of transparency, nonstandard and unverified disease labels, and inability to fully assess patient diversity used for algorithm development and testing.

The study was led by Roxana Daneshjou, MD, PhD, Stanford Department of Dermatology.

Daneshjou and investigators noted the potential of clinical AI to improve clinical care, but added that generalizable algorithms depended on clinical care that they are tested and trained on.

Over a 5-year period of data, the team performed the scoping review that assessed data set availability and data set descriptions such as labeling and patient diversity in order to better understand the characteristics of data sets used for developing AI algorithms and assess potential problems in dermatology AI sets.

Daneshjou and investigators initially searched PubMed for peer-reviewed articles published between January 1, 2015, and November 1, 2020.

Articles that defined a clinically relevant task and developed a deep learning algorithm or that tested an existing deep learning algorithm using clinical or dermoscopic images of skin disease were included in the study.

Of these studies, 57 developed a new deep learning algorithm and 13 tested an existing algorithm on an additional data set.

A majority of the studies were published in the past 2 years.

Data set audit criteria were determined by consensus of all au- thors after reviewing existing literature to highlight data set transparency and sources of bias, and data set descriptions were based on how data were presented in the study.

The team identified 70 studies that met their criteria.

Among those studies, 57 trained and tested a new algorithm, and only 14 had test data that were from a different source than the training set or an additional external validation.

Additionally, 56 studies included at least 1 cutaneous malignant neoplasm in their task, and 36 (64.3%) met gold standard criteria for histopathological diagnosis. This suggested that a substantial number of studies were trained and/or tested on noisy annotations, which could affect diagnostic accuracy.

Among all studies, only 14 of 70 (20.0%) described any information on the ethnicity or race of patients in at least 1 data set and only 7 of 70 (10.0%) included any information on the Fitzpatrick skin types of images used in at least 1 data set.

Investigators noted that data on the prevalence of Fitzpatrick skin types in the US population were inadequate.

They also recorded a lack of clear labeling in many studies. They estimated that of a total 1,065,291 images, only 257,372 (24.2%) were publicly available or available on request, whereas 807,919 (75.8%) were private.

Most of the AI literature addressing skin conditions was developed from private data sets used once to generate a single study, with no ability for replication, which greatly limited their effect and generalizability.

Across all the studies, models were generally not accessible, with only 21 of the 70 studies (30.0%) stating that the model was available via request or through a commercial product.

Based off their findings, investigators had 3 recommendations improving transparency and reducing the potential for bias in developed clinical algorithms, the first of which dealt with the sharing of data sets and/or models at the time of publication.

The second recommendation suggested a clear description of important data set characteristics, which include patient populations, skin tones represented, and the image labeling process, if data could not be shared. Lastly, a clear description of how data sets were used for training, validation, testing, or additional external validation was also suggested.

“Developing clinically applicable deep learning models in medicine is predicated on the creation of robust models developed from data sets that are either publicly available for scrutiny or well described,” the team wrote. “Clinical AI must be held to a high standard owing to the potential for significant medical harm from errors and bias.”

“Lack of Transparency and Potential Bias

in Artificial Intelligence Data Sets and Algorithms A Scoping Review,”

 was published online in JAMA Dermatology.

Articles

Acknowledging the potential medical harm from errors and bias, investigators believe clinical AI needs to be held to a higher standard.

Lack of Data, Potential Bias Reported in AI Algorithms for Skin Disease

The US Food and Drug Administration (FDA) has approved evolocumab (Repatha) injection as an add-on therapy with diet or other treatment for patients aged ≥10 years with 

heterozygous familial hypercholesterolemia (HeFH) and homozygous FH (HoFH).

The new approval expands the indicated use of evolocumab, which was previously approved as an add-on therapy for reducing LDL-C in adults with HeFH and patients with HoFH.

The approval granted to Amgen was based on findings from a pair of pediatric clinical trials. The first, involving patients aged 10-17 years with HeFH, assessed 420 mg monthly subcutaneous injection for 24 weeks; patients reported a mean 38% reduction in LDL-C versus placebo.

In the second trial, patients aged 11-17 years old with HoFH received the same evolocumab dose regimen for 80 weeks, and reported a mean 14% reduction in LDL-C compared to baseline.

Evolocumab previously received orphan drug designation from the FDA in 2013 to treat HoFH. It is not indicated for use in patients with serious hypersensitivity, either by clinical diagnosis or emerging signs or symptoms.

Approximately 1 in 250,000 individuals are diagnosed with HoFH, while HeFH is prevalent in 1 in every 250 individuals. The conditions are rare and life-threatening, characterized by gene mutations that influence the body’s clearance of cholesterol including LDL-C.

The approval is based on 24- and 80-week findings showing significant benefit in LDL-C reduction with the subcutaneous injection drug.

FDA Approves Evolocumab for Pediatric Familial Hypercholesterolemia Indications

Although recent Phase 3 study data have assessed the efficacy of sotagliflozin in patients with 

, the entirety of outcome data has not been systematically reviewed, leading to a new review and meta-analysis on efficacy and safety of sotagliflozin in this patient population.

The team of investigators, led by Ioannis Avgerinos, MD, Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, observed a reduction in blood glucose, body weight, and systolic blood pressure with sotagliflozin use, showing overall benefit on heart failure and myocardial infarction.

Within the study parameters, investigators searched Medline, Embase, and the Cochrane Library until August 2021.

Inclusion criteria included randomized controlled trials (RCTs) with an ≥8 week treatment duration that compared sotagliflozin to placebo or other antidiabetes agent in the patient population with T2D.

In all outcomes, investigators extracted data for once-daily sotagliflozin 200 mg and 400mg. The primary efficacy outcome consisted of the change in HbA1c from baseline, while secondary efficacy outcomes included change in body weight, systolic blood pressure, and diastolic blood pressure.

They observed 15 safety outcomes, including serious adverse events, all-cause mortality, heart failure, and stroke.

In the meta-analysis, the team synthesized efficacy outcomes through weighted mean differences (WMD) and 95% confidence intervals (CI), as well as odds ratios in safety outcomes.

Avgerinos and colleagues noted that efficacy outcomes utilized data from RCTs with treatment duration of ≥12 weeks, while safety outcome data came from trials with duration of ≥8 weeks.

The systematic review included 11 trials with 16,411 patients. Data show patients had a mean HbA1c at baseline of 8.2%, mean systolic blood pressure of 135.6 mmHg, and mean age of 62.9 years.

In the analysis, sotagliflozin reduced HbA1c by 0.42% (95% CI, -0.56 to -0.29) in comparison to placebo. They found no difference in comparison to other antidiabetic agents, including empagliflozin and glimepiride.

Further, in a dose-dependent subgroup analysis, investigators observed both 200mg and 400mg of sotagliflozin reduced HbA1c level in comparison to placebo.

This was noted regardless of trial duration (WMD -0.48%; 95% CI, -0.72 to -0.25, 5 studies <52 weeks; WMD -0.35%, -0.53% to -0.17, 4 studies <52 weeks).

In terms of secondary efficacy, data show treatment with sotagliflozin reduced body weight by 1.33 kg (95% CI, 1.57 - 1.09). Compared to placebo, sotagliflozin reduced systolic blood pressure by 2.44 mmHg (95% CI, 2.18 - 2.07) and diastolic blood pressure by 0.81 mmHg (95% CI, 0.56 - 1.06).

Further, investigators observed sotagliflozin reduced incidence of heart failure by 32% (OR 0.68, 95% CI, 0.58 - 0.79) and myocardial infarction by 28% (OR 0.72, 95% CI 0.54 - 0.97), but neutral effect on all-cause mortality, cardiovascular mortality, and stroke.

They noted sotagliflozin treatment was safe regarding adverse events (OR versus placebo, 0.90, 95% CI, 0.83 - 0.97).

As a takeaway, sotagliflozin treatment showed improvement in glycemic control, body weight and blood pressure in patients with T2D, without serious adverse events. Moreover, sotagliflozin reduced CV events, including heart failure and myocardial infarction.

“Future trials should further explore its comparative effectiveness against other antidiabetic drugs, and verify its long-term beneficial effect on cardiovascular outcomes, given the early stop of the dedicated cardiovascular outcomes trials,” investigators wrote.

Sotagliflozin for patients with type 2 diabetes: a systematic review and meta- analysis

Sotagliflozin reduced HbA1c by 0.42% and heart failure by 32% in comparison to placebo. 

Sotagliflozin Improved Glycemic Control, Reduced CV Events in Patients with T2D

In the September 2021 episode of Lungcast, Al Rizzo, MD, Chief Medical Officer of the American Lung Association (ALA), touched on the future of 

Castro is the Chief of Pulmonary, Critical Care and Sleep Medicine; Vice-Chair for Clinical and Translational Research; and Director of Rainbow Clinical and Translational Science Unit, Frontiers at the University of Kansas School of Medicine.

He noted that it was an “exciting time” for the future of asthma therapy, as clinicians continue to find agents that will modify the disease process for affected patients.

We have some good drugs now, so I think that what we're really studying now (is) whether or not they're truly disease modifying,” Castro said. “None of these therapies have that indication approved by the FDA, but we might have some candidates; these biologic therapies, as I mentioned, they're achieving control, they're improving lung function, and we think that they might have a chance of disease modification.”

For Castro, disease modification would entail improving a patient’s lung function and normalizing their disease to the extent that they do not have progressive disability.

“My goal is not to take away (or) cure the disease, I think that's an unrealistic expectation at this point with the current therapies that we have available,” Castro said. “But, if I can modify that disease to the point that their lung function is preserved, long-term...so they don't ever reach the point of disability from reduced lung function then that, to me, is a disease modifier.”

He added that he is often asked of early introductions of disease modification in children, with an example being the change of progression of chronic obstructive lung disease from childhood to adulthood.

Though he is optimistic about those possibilities, Castro mentioned that the best way to aim for those results is through increased, safe studies on biologics and the 

Rizzo and Castro briefly discussed the implications of the

Though recent CDC data suggested the virus posed no increased risk to patients with asthma, Castro mentioned that patients who received the vaccine experienced very mild disease in comparison to unvaccinated people.

“I truly believe that the vaccine is effective and my patients with asthma, and certainly encourage them (to get vaccinated),” Castro said.

Lungcast is a monthly respiratory health podcast series from the ALA, produced by 

Subscribe or listen to Lungcast on your favorite platforms:

https://open.spotify.com/show/1F3u1hKrwxi9snSQ0q3nti

https://podcasts.apple.com/us/podcast/lungcast/id1524712350

Videos

Dr. Castro considers it to be a fruitful and exciting time in the study of asthma-modifying therapy, with some biologic therapies achieving control in patients with severe asthma.

Mario Castro, MD, MPH: The Future of Asthma-Modifying Therapy

 (CDI) genotypes are more prevalent in hospital-acquired infections than others, information that could help identify hypervirulent strains earlier.

A team, led by Elena Novakova, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, analyzed the phenotypic and genotypic patterns of C difficile isolates of patients with CDI.

While representing the most common nosocomial pathogen and antibiotic-related cause of diarrhea in health care facilities, the rates of C difficile infections have still increased in recent years in Slovakia.

The study included data from patients with CDI from July to August 2016 from hospitals in the Horne Povazie region of northern Slovakia. The investigators also identified hypervirulent strains such as the presence of RT027 or RT176.

“The accurate and fast diagnosis of CDI is essential for optimal patient care and preventing the spread of infection,” the authors wrote. “Diagnostic methods for the identification of different targets determine the presence of free toxins or toxigenic strains in the diarrheal feces.”

The team collected biological samples of suspected CDI using glutamate dehydrogenase enzyme

(GDH), anaerobic culture, enzyme immunoassay on toxins A/B, multiplex “real-time” polymerase chain reaction (PCR), and PCR capillary-based electrophoresis ribotyping, and by MALDI TOF MS.

The median age of the patient population was 77 years. Samples were taken from patients in internal medicine (n = 29), long-term care (n = 26), and surgery (n = 1), as well as from 4 non-hospitalized patients.

Patients in the study were also hospitalized for a number of comorbid conditions, including cardiovascular (29%), gastro-intestinal (24%), pulmonary (11%), renal (5%) and oncological diseases (1%), as well as other chronic diseases.

Current recommendations for diagnosing CDI include multi-step diagnostic algorithms combining GDH and toxin EIA with PCR, which can be very sensitive to the disease, but do not distinguish between symptomatic CDI and asymptomatic colonization.

 isolates included in the studied samples were tested for the presence of toxin genes by multiplex real-time PCR assay.

A total of 44 C difficile isolates were identified using PCR ribotyping, with 5 prominent ribotypes—RT001, RT011, RT017, RT081, and RT176.

However, the presence of hypervirulent RT027 was not identified.

RT001, RT011, RT081, and RT176 were deemed susceptible to metronidazole and vancomycin, while RT017 had reduced susceptibility to vancomycin.

There was also not a statistically significant difference between RT001 and RT176, the most prevalent PCR ribotype from both inpatient and outpatient individuals, regarding various variables, including albumin, CRP, creatinine, the length of hospitalizations (

“The results of PCR capillary-based electrophoresis ribotyping in the studied samples showed a high prevalence of RT176 and 001,” the authors wrote. “Accurate and fast diagnostics of CDI are essential for optimal patient care and preventing the spread of infection. Laboratory diagnosis involving a high-sensitivity screening assay, followed by a high specificity assay, is important for the treatment and diagnosis of the disease.”

Diagnostic Methods of Clostridioides difficile Infection and Clostridioides difficile Ribotypes in Studied Sample

RT001 and RT176 were the most prevalent C difficile ribotypes found from C difficile isolates using PCR testing. 

Investigators Identify Prevalent C Difficile Genotypes in Slovakia

, most studies on associations between high low-density lipoprotein cholesterol (LDL-C) levels and CVD are only measured at one time point in life, leaving a lack of data on long-term exposure to LDL-C.

In a recent cohort study, investigators, led by Yiyi Zhang, PhD, Division of General Medicine, Columbia University Medical Center, looked to evaluate the association of cumulative exposure to LDL-C, time-weighted average (TWA) LDL-C, and the LDL-C slope change during young adulthood and middle age, with incident CVD in later life.

Results from the study showed cumulative LDL-C and TWA LDL-C during these time periods were associated with the risk of incident CVD, regardless of LDL-C level at midlife.

The study conducted an analysis of 4 large, community-based prospective cohort studies in the United states, including the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Framingham Heart Study Offspring Cohort, and Multi-Ethnic Study of Atherosclerosis.

For inclusion criteria, participants were included with ≥2 LDL-C measures that were at least 2 years apart between ages 18 - 60 years, with 1 of the LDL-measures taking place in middle age (40 - 60 years).

The team defined the index visit as the last visit during the middle-age period with an observed LDL-C measurement.

Further, the defined primary exposures of interest as cumulative exposure to LDL-C, TWA LDL-C, and LDL-C scope from ages 18 - 60 years. Then, primary outcomes of interest for the present analysis were incident Exposure to LDL-C in Young Adults Linked to Risk of Incident Coronary Heart Disease (CHD), ischemic stroke, and heart failure (HF).

Additionally, investigators used cox proportional hazards regression models to examine associations between LDL-C exposure and incident CVD events.

Out of the 4 cohort studies, a total of 18,288 participants were included. They had a mean age of 56.4 years at index visit, including 10,309 women (56.4%) and 7979 men (43.6%). 

Through a median follow-up of 16 years, investigators observed a total of 1165 incident CHD, 599 ischemic stroke, and 1145 HF events. 

Further, the team used the multivariable Cox proportional hazards regression model that adjusted for most recent LDL-C levels measured during middle age and other CVD risk factors.

As a result, the hazard ratios for CHD included 1.57 (95% CI, 1.10 - 2.23, 

 = .01), for cumulative LDL-C level, 1.69 (95% CI, 1.23 - 2.31, 

 <.001) for TWA LDL-C level, and 0.88 (95% CI, 0.69 - 1.12, 

Investigators noted a lack of association between any LDL-C variables and ischemic stroke or heart failure.

They found that associations were similar in women (HR 1.82; 95% CI, 1.07 - 3.10) and in men (HR 1.67; 95% CI, 1.06 - 2.64).

In participants who never used lipid-lowering medication (n = 15,626), data show TWA LDL-C level remained significantly associated with incident CHD (HR 1.54; 95% CI, 1.08 - 2.18).

As a result, greater exposure to LDL-C and TWA-C at young adulthood and middle age were associated with an increased risk of CHD, which remained after adjustment for the most recent LDL-C level during middle age.

“These findings suggest that previous levels of LDL-C may inform strategies for primary prevention of CHD and that maintaining optimal LDL-C levels throughout young adulthood and middle age may reduce the lifetime risk of developing atherosclerotic CVD,” investigators wrote.

Association Between Cumulative Low-Density Lipoprotein Cholesterol Exposure During Young Adulthood and Middle Age and Risk of Cardiovascular Events

Hazard ratios for CHD included 1.57 for cumulative LDL-C level, 1.69 for TWA LDL-C level, and 0.88 for LDL-C slope. 

Exposure to LDL-C in Young Adults Linked to Risk of Incident Coronary Heart Disease

To establish a correlation between persistent cough and 

 and severity, investigators from Cleveland found that patients with persistent cough tended to have a more severe asthmatic presentation.

This was especially prevalent in patients with a positive immunoglobulin E (IgE) allergy class test to cat and dog dander, house dust, or lamb’s quarter.

Michael S. Benninger, MD, Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine, Head and Neck Institute, led a team of investigators in establishing the correlation. They suspected cough to be a potential risk factor for severe asthma based on their previous study, ““The phenotypes of allergic asthma: Does in-vitro allergy testing help to predict poor responsiveness?”.

However, this was not included in the original study, which prompted them to conduct a separate, independent review which aided them in identifying patients with a potentially more challenging disease. 

With asthma being cited as a common etiology for chronic cough in adult nonsmokers (24%-29%), Benninger and colleagues hypothesized that asthmatic patients who had or have persistent cough would have poorly responsive asthma.

The team conducted a retrospective review on 701 patients who had positive IgE allergy in vitro blood testing between 2014 and 2018 and asthma diagnosis.

The data they collected included age, sex, diagnosis and age of diagnosis of asthma, IgE allergy test results, asthma treatment, smoking status and respiratory comorbidities such as cancer, and inflammatory diseases such as chronic obstructive pulmonary disease, as well as other systemic illness treated with steroids.

Treatment classes were also established, and included short-acting beta-2 agonists, long-acting beta-2 agonists, inhaled corticosteroids, anticholinergics, leukotriene modifiers, oral methylxanthines, cromolyn, immunomodulators, anti-IgE and oral corticosteroids, or a combination of these medications.

A myriad of primary IgE tests were included. Each IgE class response was evaluated using the median and interquartile range (IQR).

Benninger and colleagues evaluated 5 different outcome measures, namely 1) number of clinic visits due to asthma measured as an average clinic visits < or >4 per year for asthma care, 2) emergency department (ED) visits due to asthma measured as < or >1 a year due to asthma, 3) hospital admissions due to asthma measured as yes/no; 4) asthma treatment measured as < or >2 medica- tions needed to control asthma excluding rescue inhalers, and 5) use of corticosteroids measured as yes/no.

Lastly, persistent cough was identified by a description of cough lasting >8 weeks in one visit for adults or >4 weeks in pediatric patients or 2 or more diagnosis of cough from the same episode separated >8 weeks for adults or >4 weeks for pediatric patients.

The data from the study suggested that patients with persistent cough and a positive IgE allergy class test noted earlier could have a more severe asthma presentation.

The investigators founf that for patients with asthma and persistet, positivity to lamb’s quarter 2.92 (95% CI 1.63, 5.22; P < .001) showed a higher likelihood of ED visits. However, allergens had no influence on ED visits for patients without persistent cough.

In the analysis of hospitalizations for patients with persistent cough, positivity to cat dander 2.09 (95% CI 1.03, 4.59; P < .05), lamb’s quarter 2.96 (95% CI 1.50, 5.79; P < .002), dog dander 3.37 (95% CI 1.54, 8.45; P < .004) showed a higher likelihood of hospitalizations.

For patients without persistent cough, positivity to cat dander 2.62 (95% CI 1.12, 6.88; P < .035) and dog dander 3.15 (95% CI 1.30, 8.81; P < .017) showed higher odds of hospitalization.

Benninger and colleagues believed these data could have potential long-term benefits in asthma prevention.

“This can help physicians identify high-risk groups and have more tailored treatments to prevent exacerbations and disease burden from one of the most bothersome symptoms for patients, cough,” the team wrote.

“Persistent Cough as a Predictor of Poor Responsiveness in Asthma Patients,”

 was published online in The Laryngoscope.

Investigators believe these findings can help identify high-risk groups and prevent exacerbations through tailored treatments.

Patients with Persistent Cough Prone to Severe Asthma Presentation

New research did not show a statistically significant association between different malignant disorders and 

A team, led by Chetana Vaishnavi, PhD, Postgraduate Institute Of Medical Education And Research, quantified the link between C difficile infections in patients with different kinds of malignancies.

While there are several diseases that are known risk factors for C difficile infections, there is little known about the association between malignancy and CDI.

In the study, the investigators identified 496 patients with specific malignancies, including adenocarcinoma, hematological malignancies, multiple myeloma, and pediatric solid tumor. The patients were compared to 526 control group participants.

The investigators reviewed laboratory data on demographics, antibiotic exposure, clinical symptoms, and fecal Clostridioides difficile toxin assay for all 1022 participants.

In addition, 805 patients received antibiotics.

Clostridioides difficile toxin was positive for 28% (n = 7) of patients with pediatric solid tumor, 25% (n = 24) of patients with adenocarcinoma, 21.4% (n = 71) of patients with hematological malignancies, and 7% (n = 3) of patients with multiple myeloma.

The investigators did find a correlation between different malignant conditions and different demographics. For example, males with adenocarcinoma (

= 0.039) and hematological malignancies (

= 0.003), antibiotic exposure in multiple myeloma (

<0.001) and fever in pediatric solid tumor and hematological malignancies subgroups were deemed significant (

“No significant association of [Clostridioides difficile toxin] was seen in malignant patients compared to the controls, though patients in [pediatric solid tumors] and [adenocarcinoma] subgroups were more prone to CDI,” the authors wrote.

Earlier this year, investigators found a new orally administered adsorbent could prevent antibiotic disruption of intestinal flora against 

 in patients with hematologic malignancies.

An investigational formulation of an adsorbent to protect against antibiotic disruption of intestinal microbiota and colonization of 

 will be evaluated in a phase 3 clinical trial in patients with hematologic malignancies who require antibiotics for severe infections while receiving intensive chemotherapy.

DAV132 is an orally administered formulation that releases 5gm of activated charcoal from a 7.5 gm dosage into, or after passage through the ileum.

 described by the manufacturer, 7.5gm of DAV132 administered 3 times daily to elderly patients receiving oral or intravenous fluoroquinolone antibiotics demonstrated protection against antibiotic-induced disruption of intestinal microbiota.

According to the manufacturer's summary of the trial results, the adsorbent product significantly reduced free fecal concentrations of fluoroquinolones without affecting their plasma levels, and therefore without affecting their efficacy in treating the patients' infections.

The delayed release of the activated charcoal ingredient was also found in a phase 1 study to avoid the potential interaction with concurrently administered drugs. That study was conducted with healthy volunteers receiving a 7.5gm dose of DAV132 concurrently with either 5mg of the anticoagulant warfarin, or 1mg of the antiepileptic clonazepam.

Association of Clostridioides difficile infection with specific malignant conditions

Journal of Microbiology and Infectious Diseases

Patients with pediatric solid tumors and hematological malignancies were more prone to C difficile infections. 

No Correlation Found in Association Between Malignancies and C Difficile Infections

4:05 - What is the multidisciplinary approach?

If the crisis point is the moment where a crisis will worsen or begins to get better, the question remains: Where are we now?

, a comprehensive look at the public health crises affecting the United States today, with global implications tomorrow. 

 of the series took on the scope of the obesity crisis and the larger framework of the disease space.

This episode goes beyond that - to the actual structure of care that clinicians in this medical space deal with on a daily basis.

We discuss the multidisciplinary approach, bariatric surgical options, and body mass index (BMI), with a lens focusing on the clinical burdens that these clinicians face in the pursuit of care.

Once again, we are joined by the experts and advocates in the obesity care space who share their expertise and knowledge on the subject.

Hans Schmidt, MD, Division Chief, Bariatric Surgery, Hackensack University Medical Center

Jun Tashiro, MD, Pediatric Surgeon, Hassenfeld Children’s Hospital, NYU Langone Health

Jose Aleman, MD, Assistant Professor, NYU Langone Health

Louis Aronne, MD, Chief Medical Officer of Intellihealth and Medical Director, Comprehensive Weight Control Center, Weill Cornell Medical Center.

Next week’s episode will tackle the regional differences found in obesity care, from location and demographics to food options and nutritional ability.

Thanks for watching and stay tuned for more from 

Episode 2 of HCPLive Crisis Point tackles the clinical aspects and potential burdens clinicians face in the pursuit of obesity care. 

Burdens of Clinical Care in the Obesity Crisis 

A myriad of different devices, molecules, and combinations had been offered to patients with 

 to aid in the management of their condition. Over the past decade, similar advancements and opportunities have been cited in the realm of biologics.

In the September 2021 episode of Lungcast, Al Rizzo, MD, Chief Medical Officer of the American Lung Association (ALA), discusses several potential biologic therapies with Mario Castro, MD, MPH, Chief of Pulmonary, Critical Care and Sleep Medicine; Vice-Chair for Clinical and Translational Research; and Director of Rainbow Clinical and Translational Science Unit, Frontiers at the University of Kansas School of Medicine.

In their discussion, Castro categorized the biologic therapies that are currently available into 3 broad categories, which were anti-IgE, anti-IL-4 and anti-IL-5 receptors.

Omalizumab, and anti-IgE receptor, has been available for nearly 2 decades, and was approved for urticaria and nasal polyposis. The biologic can also be used to aid pediatric patients with underlying allergic asthma as they are re-enter schools and other communities.

“If they have underlying allergic asthma (and) you use omalizumab, you kind of dampen those triggers during the fall and keep them under much better control so they don't have to require steroids,” Castro said.

Castro also noted that there were more options regarding anti-IL-5 biologics, such as mepolizumab, reslizumab, and benralizumab. Currently, mepolizumab is the only biologic referenced in this category that is approved for patients aged 6 years old.

“When I think about those biologics, I think about several factors,” Castro said. “One is the level of blood eosinophil levels, I think about (a patient’s) underlying comorbidities, and I think about their age, as well, and what their preferences in terms of administration.”

Lastly, the anti-IL-4 category featured 1 biologic, dupilumab, which has been indicated for asthma, as well as atopic dermatitis and rhinosinusitis with nasal polyposis. He urged clinicians to be mindful of any comorbidities when recommending agents like dupilumab to help treat a wide variety of conditions while helping patients with an respiratory complications.

Ultimately, the intention of biologic therapy, Castro noted, was to maintain treatment and potential decrease the number of treatments a patient is on.

“My goal always is to eliminate their systemic steroid exposure first, then minimize their inhaled steroids to the lowest dose possible,” Castro said. “Also, just to decrease the amount of medications (patients) are on.”

Dr. Castro talks of the available biologic therapies that can be used to treat asthma and other respiratory disorders.

All News