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Promising Results With CBT App in Young Adults With Anxiety
TOPLINE:
after 3 weeks, with continued improvement through week 12, a new randomized clinical trial shows.
METHODOLOGY:
- The study included 59 adults aged 18-25 years (mean age, 23 years; 78% women) with anxiety disorders (56% with generalized anxiety disorder; 41% with social anxiety disorder).
- Participants received a 6-week CBT program with a self-guided mobile application called Maya and were assigned to one of three incentive strategies to encourage engagement: Loss-framed (lose points for incomplete sessions), gain-framed (earn points for completed sessions), or gain-social support (gain points with added social support from a designated person).
- The primary end point was change in anxiety at week 6, measured with the Hamilton Anxiety Rating Scale.
- The researchers also evaluated change in anxiety at 3 and 12 weeks, change in anxiety sensitivity, social anxiety symptoms, and engagement and satisfaction with the app.
TAKEAWAY:
- Anxiety decreased significantly from baseline at week 3, 6, and 12 (mean differences, −3.20, −5.64, and −5.67, respectively; all P < .001), with similar reductions in anxiety among the three incentive conditions.
- Use of the CBT app was also associated with significant reductions in anxiety sensitivity and social anxiety symptoms over time, with moderate to large effect sizes.
- A total of 98% of participants completed the 6-week assessment and 93% the 12-week follow-up. On average, the participants completed 10.8 of 12 sessions and 64% completed all sessions.
- The participants reported high satisfaction with the app across all time points, with no significant differences based on time or incentive condition.
IN PRACTICE:
“We hear a lot about the negative impact of technology use on mental health in this age group,” senior study author Faith M. Gunning, PhD, said in a press release. “But the ubiquitous use of cell phones for information may provide a way of addressing anxiety for some people who, even if they have access to mental health providers, may not go. If the app helps reduce symptoms, they may then be able to take the next step of seeing a mental health professional when needed.”
SOURCE:
The study was led by Jennifer N. Bress, PhD, Department of Psychiatry, Weill Cornell Medicine, New York City. It was published online in JAMA Network Open.
LIMITATIONS:
This study lacked a control group, and the unbalanced allocation of participants to the three incentive groups due to the COVID-19 pandemic may have influenced the results. The study sample, which predominantly consisted of female and college-educated participants, may not have accurately represented the broader population of young adults with anxiety.
DISCLOSURES:
This study was funded by the NewYork-Presbyterian Center for Youth Mental Health, the Khoury Foundation, the Paul and Jenna Segal Family Foundation, the Saks Fifth Avenue Foundation, Mary and Jonathan Rather, Weill Cornell Medicine, the Pritzker Neuropsychiatric Disorders Research Consortium, and the National Institutes of Health. Some authors reported obtaining grants, receiving personal fees, serving on speaker’s bureaus, and having other ties with multiple pharmaceutical companies and institutions. Full disclosures are available in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
after 3 weeks, with continued improvement through week 12, a new randomized clinical trial shows.
METHODOLOGY:
- The study included 59 adults aged 18-25 years (mean age, 23 years; 78% women) with anxiety disorders (56% with generalized anxiety disorder; 41% with social anxiety disorder).
- Participants received a 6-week CBT program with a self-guided mobile application called Maya and were assigned to one of three incentive strategies to encourage engagement: Loss-framed (lose points for incomplete sessions), gain-framed (earn points for completed sessions), or gain-social support (gain points with added social support from a designated person).
- The primary end point was change in anxiety at week 6, measured with the Hamilton Anxiety Rating Scale.
- The researchers also evaluated change in anxiety at 3 and 12 weeks, change in anxiety sensitivity, social anxiety symptoms, and engagement and satisfaction with the app.
TAKEAWAY:
- Anxiety decreased significantly from baseline at week 3, 6, and 12 (mean differences, −3.20, −5.64, and −5.67, respectively; all P < .001), with similar reductions in anxiety among the three incentive conditions.
- Use of the CBT app was also associated with significant reductions in anxiety sensitivity and social anxiety symptoms over time, with moderate to large effect sizes.
- A total of 98% of participants completed the 6-week assessment and 93% the 12-week follow-up. On average, the participants completed 10.8 of 12 sessions and 64% completed all sessions.
- The participants reported high satisfaction with the app across all time points, with no significant differences based on time or incentive condition.
IN PRACTICE:
“We hear a lot about the negative impact of technology use on mental health in this age group,” senior study author Faith M. Gunning, PhD, said in a press release. “But the ubiquitous use of cell phones for information may provide a way of addressing anxiety for some people who, even if they have access to mental health providers, may not go. If the app helps reduce symptoms, they may then be able to take the next step of seeing a mental health professional when needed.”
SOURCE:
The study was led by Jennifer N. Bress, PhD, Department of Psychiatry, Weill Cornell Medicine, New York City. It was published online in JAMA Network Open.
LIMITATIONS:
This study lacked a control group, and the unbalanced allocation of participants to the three incentive groups due to the COVID-19 pandemic may have influenced the results. The study sample, which predominantly consisted of female and college-educated participants, may not have accurately represented the broader population of young adults with anxiety.
DISCLOSURES:
This study was funded by the NewYork-Presbyterian Center for Youth Mental Health, the Khoury Foundation, the Paul and Jenna Segal Family Foundation, the Saks Fifth Avenue Foundation, Mary and Jonathan Rather, Weill Cornell Medicine, the Pritzker Neuropsychiatric Disorders Research Consortium, and the National Institutes of Health. Some authors reported obtaining grants, receiving personal fees, serving on speaker’s bureaus, and having other ties with multiple pharmaceutical companies and institutions. Full disclosures are available in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
after 3 weeks, with continued improvement through week 12, a new randomized clinical trial shows.
METHODOLOGY:
- The study included 59 adults aged 18-25 years (mean age, 23 years; 78% women) with anxiety disorders (56% with generalized anxiety disorder; 41% with social anxiety disorder).
- Participants received a 6-week CBT program with a self-guided mobile application called Maya and were assigned to one of three incentive strategies to encourage engagement: Loss-framed (lose points for incomplete sessions), gain-framed (earn points for completed sessions), or gain-social support (gain points with added social support from a designated person).
- The primary end point was change in anxiety at week 6, measured with the Hamilton Anxiety Rating Scale.
- The researchers also evaluated change in anxiety at 3 and 12 weeks, change in anxiety sensitivity, social anxiety symptoms, and engagement and satisfaction with the app.
TAKEAWAY:
- Anxiety decreased significantly from baseline at week 3, 6, and 12 (mean differences, −3.20, −5.64, and −5.67, respectively; all P < .001), with similar reductions in anxiety among the three incentive conditions.
- Use of the CBT app was also associated with significant reductions in anxiety sensitivity and social anxiety symptoms over time, with moderate to large effect sizes.
- A total of 98% of participants completed the 6-week assessment and 93% the 12-week follow-up. On average, the participants completed 10.8 of 12 sessions and 64% completed all sessions.
- The participants reported high satisfaction with the app across all time points, with no significant differences based on time or incentive condition.
IN PRACTICE:
“We hear a lot about the negative impact of technology use on mental health in this age group,” senior study author Faith M. Gunning, PhD, said in a press release. “But the ubiquitous use of cell phones for information may provide a way of addressing anxiety for some people who, even if they have access to mental health providers, may not go. If the app helps reduce symptoms, they may then be able to take the next step of seeing a mental health professional when needed.”
SOURCE:
The study was led by Jennifer N. Bress, PhD, Department of Psychiatry, Weill Cornell Medicine, New York City. It was published online in JAMA Network Open.
LIMITATIONS:
This study lacked a control group, and the unbalanced allocation of participants to the three incentive groups due to the COVID-19 pandemic may have influenced the results. The study sample, which predominantly consisted of female and college-educated participants, may not have accurately represented the broader population of young adults with anxiety.
DISCLOSURES:
This study was funded by the NewYork-Presbyterian Center for Youth Mental Health, the Khoury Foundation, the Paul and Jenna Segal Family Foundation, the Saks Fifth Avenue Foundation, Mary and Jonathan Rather, Weill Cornell Medicine, the Pritzker Neuropsychiatric Disorders Research Consortium, and the National Institutes of Health. Some authors reported obtaining grants, receiving personal fees, serving on speaker’s bureaus, and having other ties with multiple pharmaceutical companies and institutions. Full disclosures are available in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
Stroke Risk from Atrial Fibrillation Rises in Presence of Rheumatoid Arthritis
TOPLINE:
Patients with both rheumatoid arthritis (RA) and atrial fibrillation (AF) have a higher risk for ischemic stroke than those with only AF. They are also less likely to receive oral anticoagulant treatment, which may contribute to this increased stroke risk.
METHODOLOGY:
- Researchers conducted a registry-based retrospective cohort study using the Norwegian Cardio-Rheuma Register to evaluate the risk for ischemic stroke following the diagnosis of AF in patients with or without RA.
- They included 163,595 patients with newly diagnosed AF between 2010 and 2017, of whom 2750 had RA. Patients had to be diagnosed with RA before the diagnosis of AF.
- They also assessed whether patients with RA were less likely to receive oral anticoagulants for stroke prevention within 3 months of AF diagnosis than those without RA.
- The median follow-up time was 2.5 years for patients with RA and 3.0 years for those without RA.
- The primary endpoint was ischemic stroke, which was identified through hospital admissions and visits.
TAKEAWAY:
- At 5 years, patients with both RA and AF showed a higher cumulative incidence of ischemic stroke than those with only AF (7.3% vs 5.0%).
- Among patients with AF, the risk of having a stroke was 25% higher in those with RA than in those without RA (adjusted hazard ratio, 1.25; 95% CI, 1.05-1.50).
- Patients with RA were also less likely to receive treatment with oral anticoagulants than those without RA, driven by concerns over potential interactions with RA medications, bleeding risk, or other factors (adjusted odds ratio, 0.88; 95% CI, 0.80-0.97).
IN PRACTICE:
“Our study prompts preventive measures such as meticulous cardiovascular risk factor control among patients with RA and AF and raises the question whether the presence of RA should be taken into account when considering OAC [oral anticoagulant] treatment for AF patients,” the authors wrote.
SOURCE:
This study was led by Anne M. Kerola, MD, PhD, Helsinki University Hospital and University of Helsinki in Finland. It was published online in Rheumatology.
LIMITATIONS:
This study lacked data on smoking, blood pressure measurements, alcohol use, and obesity, which may have affected the comprehensiveness of the findings. The study population was limited to Norway and may not be generalizable to other populations.
DISCLOSURES:
This study was supported by the Olav Thon Foundation, the Research Council of Norway, and the Foundation for Research in Rheumatology. Some authors received speaker fees, participated in advisory boards, served as consultants, or had other ties with some pharmaceutical companies and institutions.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Patients with both rheumatoid arthritis (RA) and atrial fibrillation (AF) have a higher risk for ischemic stroke than those with only AF. They are also less likely to receive oral anticoagulant treatment, which may contribute to this increased stroke risk.
METHODOLOGY:
- Researchers conducted a registry-based retrospective cohort study using the Norwegian Cardio-Rheuma Register to evaluate the risk for ischemic stroke following the diagnosis of AF in patients with or without RA.
- They included 163,595 patients with newly diagnosed AF between 2010 and 2017, of whom 2750 had RA. Patients had to be diagnosed with RA before the diagnosis of AF.
- They also assessed whether patients with RA were less likely to receive oral anticoagulants for stroke prevention within 3 months of AF diagnosis than those without RA.
- The median follow-up time was 2.5 years for patients with RA and 3.0 years for those without RA.
- The primary endpoint was ischemic stroke, which was identified through hospital admissions and visits.
TAKEAWAY:
- At 5 years, patients with both RA and AF showed a higher cumulative incidence of ischemic stroke than those with only AF (7.3% vs 5.0%).
- Among patients with AF, the risk of having a stroke was 25% higher in those with RA than in those without RA (adjusted hazard ratio, 1.25; 95% CI, 1.05-1.50).
- Patients with RA were also less likely to receive treatment with oral anticoagulants than those without RA, driven by concerns over potential interactions with RA medications, bleeding risk, or other factors (adjusted odds ratio, 0.88; 95% CI, 0.80-0.97).
IN PRACTICE:
“Our study prompts preventive measures such as meticulous cardiovascular risk factor control among patients with RA and AF and raises the question whether the presence of RA should be taken into account when considering OAC [oral anticoagulant] treatment for AF patients,” the authors wrote.
SOURCE:
This study was led by Anne M. Kerola, MD, PhD, Helsinki University Hospital and University of Helsinki in Finland. It was published online in Rheumatology.
LIMITATIONS:
This study lacked data on smoking, blood pressure measurements, alcohol use, and obesity, which may have affected the comprehensiveness of the findings. The study population was limited to Norway and may not be generalizable to other populations.
DISCLOSURES:
This study was supported by the Olav Thon Foundation, the Research Council of Norway, and the Foundation for Research in Rheumatology. Some authors received speaker fees, participated in advisory boards, served as consultants, or had other ties with some pharmaceutical companies and institutions.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Patients with both rheumatoid arthritis (RA) and atrial fibrillation (AF) have a higher risk for ischemic stroke than those with only AF. They are also less likely to receive oral anticoagulant treatment, which may contribute to this increased stroke risk.
METHODOLOGY:
- Researchers conducted a registry-based retrospective cohort study using the Norwegian Cardio-Rheuma Register to evaluate the risk for ischemic stroke following the diagnosis of AF in patients with or without RA.
- They included 163,595 patients with newly diagnosed AF between 2010 and 2017, of whom 2750 had RA. Patients had to be diagnosed with RA before the diagnosis of AF.
- They also assessed whether patients with RA were less likely to receive oral anticoagulants for stroke prevention within 3 months of AF diagnosis than those without RA.
- The median follow-up time was 2.5 years for patients with RA and 3.0 years for those without RA.
- The primary endpoint was ischemic stroke, which was identified through hospital admissions and visits.
TAKEAWAY:
- At 5 years, patients with both RA and AF showed a higher cumulative incidence of ischemic stroke than those with only AF (7.3% vs 5.0%).
- Among patients with AF, the risk of having a stroke was 25% higher in those with RA than in those without RA (adjusted hazard ratio, 1.25; 95% CI, 1.05-1.50).
- Patients with RA were also less likely to receive treatment with oral anticoagulants than those without RA, driven by concerns over potential interactions with RA medications, bleeding risk, or other factors (adjusted odds ratio, 0.88; 95% CI, 0.80-0.97).
IN PRACTICE:
“Our study prompts preventive measures such as meticulous cardiovascular risk factor control among patients with RA and AF and raises the question whether the presence of RA should be taken into account when considering OAC [oral anticoagulant] treatment for AF patients,” the authors wrote.
SOURCE:
This study was led by Anne M. Kerola, MD, PhD, Helsinki University Hospital and University of Helsinki in Finland. It was published online in Rheumatology.
LIMITATIONS:
This study lacked data on smoking, blood pressure measurements, alcohol use, and obesity, which may have affected the comprehensiveness of the findings. The study population was limited to Norway and may not be generalizable to other populations.
DISCLOSURES:
This study was supported by the Olav Thon Foundation, the Research Council of Norway, and the Foundation for Research in Rheumatology. Some authors received speaker fees, participated in advisory boards, served as consultants, or had other ties with some pharmaceutical companies and institutions.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
In-Hospital e-Alerts: A Step Toward Better Kidney Health?
TOPLINE:
METHODOLOGY:
- AKI is a common complication in hospitalized patients, leading to increased comorbidities, healthcare costs, and short- and long-term mortality, but the impact of early detection through electronic health care record systems (e-alerts) is unclear.
- Researchers conducted an updated systematic review and meta-analysis to assess the association of e-alerts for AKI with patient outcomes and clinical practice patterns.
- Overall, 13 studies involving 41,837 patients with AKI were included, comparing e-alerts for AKI with standard care or no e-alerts.
- The primary outcomes were mortality, AKI progression, dialysis events, and kidney recovery, and secondary outcomes were nephrologist consultations, post-AKI exposure to NSAIDs and other medications, and hospital length of stay and costs.
- The investigators assessed bias, the certainty of evidence, and whether the primary outcome conclusions of the meta-analysis were premature.
TAKEAWAY:
- The use of e-alerts for AKI was not associated with reduced mortality outcomes compared with no e-alerts (risk ratio [RR], 0.96; 95% CI, 0.89-1.03; 12 studies).
- E-alerts were associated with a reduced risk for AKI progression (RR, 0.91; 95% CI, 0.84-0.99; five studies); however, the results were found to be heterogeneous and possibly premature.
- E-alerts for AKI were also linked to increased nephrologist consultations (RR, 1.45; 95% CI, 1.04-2.02; 11 studies), reduced post-AKI NSAID exposure (RR, 0.75; 95% CI, 0.59-0.95; four studies), and improved AKI documentation (RR, 1.28; 95% CI, 1.04-1.58; eight studies).
- The use of e-alerts for AKI was associated with increased dialysis events (RR, 1.16; 95% CI, 1.05-1.28).
IN PRACTICE:
“We recommend that each hospital establish its own AKI e-alert system and individualized AKI management protocol tailored to its specific needs,” wrote the authors who also suggested the system be “integrated with earlier risk stratification methods, such as the renal angina index, artificial intelligence–based continuous AKI prediction, and care bundle implementation within a clinical decision support system to enhance early diagnosis and management, potentially improving outcomes.”
SOURCE:
This study was led by Jia-Jin Chen, MD, from the Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan. It was published online in JAMA Network Open.
LIMITATIONS:
The limitations included the scarcity of randomized clinical trials in the meta-analysis. Few studies examined the impact of these e-alerts on the hospital length of stay, healthcare costs, AKI stage progression, and post-AKI kidney recovery, which limited the ability to draw conclusive statements on these aspects. Major adverse kidney events at 28 and 90 days were not reported in any of the enrolled studies, so the impact of AKI e-alerts and increased dialysis events on long-term outcomes remained uncertain.
DISCLOSURES:
The study was supported by grants from the Taiwanese Ministry of Health and Welfare and Linkou Chang Gung Memorial Hospital. The authors declared no conflicts of interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
METHODOLOGY:
- AKI is a common complication in hospitalized patients, leading to increased comorbidities, healthcare costs, and short- and long-term mortality, but the impact of early detection through electronic health care record systems (e-alerts) is unclear.
- Researchers conducted an updated systematic review and meta-analysis to assess the association of e-alerts for AKI with patient outcomes and clinical practice patterns.
- Overall, 13 studies involving 41,837 patients with AKI were included, comparing e-alerts for AKI with standard care or no e-alerts.
- The primary outcomes were mortality, AKI progression, dialysis events, and kidney recovery, and secondary outcomes were nephrologist consultations, post-AKI exposure to NSAIDs and other medications, and hospital length of stay and costs.
- The investigators assessed bias, the certainty of evidence, and whether the primary outcome conclusions of the meta-analysis were premature.
TAKEAWAY:
- The use of e-alerts for AKI was not associated with reduced mortality outcomes compared with no e-alerts (risk ratio [RR], 0.96; 95% CI, 0.89-1.03; 12 studies).
- E-alerts were associated with a reduced risk for AKI progression (RR, 0.91; 95% CI, 0.84-0.99; five studies); however, the results were found to be heterogeneous and possibly premature.
- E-alerts for AKI were also linked to increased nephrologist consultations (RR, 1.45; 95% CI, 1.04-2.02; 11 studies), reduced post-AKI NSAID exposure (RR, 0.75; 95% CI, 0.59-0.95; four studies), and improved AKI documentation (RR, 1.28; 95% CI, 1.04-1.58; eight studies).
- The use of e-alerts for AKI was associated with increased dialysis events (RR, 1.16; 95% CI, 1.05-1.28).
IN PRACTICE:
“We recommend that each hospital establish its own AKI e-alert system and individualized AKI management protocol tailored to its specific needs,” wrote the authors who also suggested the system be “integrated with earlier risk stratification methods, such as the renal angina index, artificial intelligence–based continuous AKI prediction, and care bundle implementation within a clinical decision support system to enhance early diagnosis and management, potentially improving outcomes.”
SOURCE:
This study was led by Jia-Jin Chen, MD, from the Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan. It was published online in JAMA Network Open.
LIMITATIONS:
The limitations included the scarcity of randomized clinical trials in the meta-analysis. Few studies examined the impact of these e-alerts on the hospital length of stay, healthcare costs, AKI stage progression, and post-AKI kidney recovery, which limited the ability to draw conclusive statements on these aspects. Major adverse kidney events at 28 and 90 days were not reported in any of the enrolled studies, so the impact of AKI e-alerts and increased dialysis events on long-term outcomes remained uncertain.
DISCLOSURES:
The study was supported by grants from the Taiwanese Ministry of Health and Welfare and Linkou Chang Gung Memorial Hospital. The authors declared no conflicts of interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
METHODOLOGY:
- AKI is a common complication in hospitalized patients, leading to increased comorbidities, healthcare costs, and short- and long-term mortality, but the impact of early detection through electronic health care record systems (e-alerts) is unclear.
- Researchers conducted an updated systematic review and meta-analysis to assess the association of e-alerts for AKI with patient outcomes and clinical practice patterns.
- Overall, 13 studies involving 41,837 patients with AKI were included, comparing e-alerts for AKI with standard care or no e-alerts.
- The primary outcomes were mortality, AKI progression, dialysis events, and kidney recovery, and secondary outcomes were nephrologist consultations, post-AKI exposure to NSAIDs and other medications, and hospital length of stay and costs.
- The investigators assessed bias, the certainty of evidence, and whether the primary outcome conclusions of the meta-analysis were premature.
TAKEAWAY:
- The use of e-alerts for AKI was not associated with reduced mortality outcomes compared with no e-alerts (risk ratio [RR], 0.96; 95% CI, 0.89-1.03; 12 studies).
- E-alerts were associated with a reduced risk for AKI progression (RR, 0.91; 95% CI, 0.84-0.99; five studies); however, the results were found to be heterogeneous and possibly premature.
- E-alerts for AKI were also linked to increased nephrologist consultations (RR, 1.45; 95% CI, 1.04-2.02; 11 studies), reduced post-AKI NSAID exposure (RR, 0.75; 95% CI, 0.59-0.95; four studies), and improved AKI documentation (RR, 1.28; 95% CI, 1.04-1.58; eight studies).
- The use of e-alerts for AKI was associated with increased dialysis events (RR, 1.16; 95% CI, 1.05-1.28).
IN PRACTICE:
“We recommend that each hospital establish its own AKI e-alert system and individualized AKI management protocol tailored to its specific needs,” wrote the authors who also suggested the system be “integrated with earlier risk stratification methods, such as the renal angina index, artificial intelligence–based continuous AKI prediction, and care bundle implementation within a clinical decision support system to enhance early diagnosis and management, potentially improving outcomes.”
SOURCE:
This study was led by Jia-Jin Chen, MD, from the Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan. It was published online in JAMA Network Open.
LIMITATIONS:
The limitations included the scarcity of randomized clinical trials in the meta-analysis. Few studies examined the impact of these e-alerts on the hospital length of stay, healthcare costs, AKI stage progression, and post-AKI kidney recovery, which limited the ability to draw conclusive statements on these aspects. Major adverse kidney events at 28 and 90 days were not reported in any of the enrolled studies, so the impact of AKI e-alerts and increased dialysis events on long-term outcomes remained uncertain.
DISCLOSURES:
The study was supported by grants from the Taiwanese Ministry of Health and Welfare and Linkou Chang Gung Memorial Hospital. The authors declared no conflicts of interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Diet Rich in Processed Foods Linked to Elevated Risk for Colorectal Cancer
TOPLINE:
METHODOLOGY:
- To date, no known studies have investigated how a dietary pattern (rather than just individual foods or nutrients) specifically directed at CRC-related microbes may contribute to an increased CRC risk.
- Using stool metagenomes and dietary information from 307 men and 212 women, researchers identified and then validated a dietary pattern specifically linked to an established CRC-related gut microbial signature, which they termed the CRC Microbial Dietary Score (CMDS).
- They then investigated the association between CMDS and the risk for CRC in 259,200 participants (50,637 men and 208,563 women) from three large US cohorts where health professionals provided detailed information on various lifestyle factors over long follow-up periods.
- Researchers also analyzed the risk for CRC on the basis of the presence of gut bacteria, such as F nucleatum, pks+ E coli, and ETBF, in the tumor tissues of the participants who underwent surgical resection for CRC.
TAKEAWAY:
- The CMDS was characterized by high intake of processed foods and low intake of fiber-rich foods.
- Over 6,467,378 person-years assessed in the three US cohorts, 3854 cases of incident CRC were documented, with 1172, 1096, and 1119 cases measured for F nucleatum, pks+ E coli, and ETBF, respectively.
- A higher CMDS was associated with an increased risk for CRC after adjusting for putative CRC risk factors (adjusted hazard ratio [HR], 1.25; Ptrend < .001).
- The association between CMDS and the risk for CRC was stronger for tumors with detectable levels of F nucleatum (HR, 2.51; Ptrend < .001), pks+ E coli (HR, 1.68; Ptrend = .005), and ETBF (HR, 2.06; Ptrend = .016).
IN PRACTICE:
“A dietary pattern with a low consumption of processed foods may help prevent colorectal cancer through modulation of the gut microbiome. The dietary pattern modulating the colorectal cancer–related gut microbial signature may particularly help prevent tumoral microbial positive colorectal cancer, which tends to have a worse prognosis,” the authors wrote.
SOURCE:
This study, led by Kai Wang and Chun-Han Lo, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, was published online in Gastroenterology.
LIMITATIONS:
The study’s observational design may have limited the ability to establish causality between dietary patterns and the risk for CRC. The inclusion of participants who were all health professionals from a predominantly White US population may have limited the generalizability of the findings to other populations. The reliance on self-reported dietary data may have introduced recall bias and affected the accuracy of the dietary pattern assessed.
DISCLOSURES:
This work was supported by various sources, including the National Institutes of Health and the Cancer Research UK Grand Challenge Award. One author served as a consultant for some pharmaceutical companies, and another received funding from various sources, both unrelated to this study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
METHODOLOGY:
- To date, no known studies have investigated how a dietary pattern (rather than just individual foods or nutrients) specifically directed at CRC-related microbes may contribute to an increased CRC risk.
- Using stool metagenomes and dietary information from 307 men and 212 women, researchers identified and then validated a dietary pattern specifically linked to an established CRC-related gut microbial signature, which they termed the CRC Microbial Dietary Score (CMDS).
- They then investigated the association between CMDS and the risk for CRC in 259,200 participants (50,637 men and 208,563 women) from three large US cohorts where health professionals provided detailed information on various lifestyle factors over long follow-up periods.
- Researchers also analyzed the risk for CRC on the basis of the presence of gut bacteria, such as F nucleatum, pks+ E coli, and ETBF, in the tumor tissues of the participants who underwent surgical resection for CRC.
TAKEAWAY:
- The CMDS was characterized by high intake of processed foods and low intake of fiber-rich foods.
- Over 6,467,378 person-years assessed in the three US cohorts, 3854 cases of incident CRC were documented, with 1172, 1096, and 1119 cases measured for F nucleatum, pks+ E coli, and ETBF, respectively.
- A higher CMDS was associated with an increased risk for CRC after adjusting for putative CRC risk factors (adjusted hazard ratio [HR], 1.25; Ptrend < .001).
- The association between CMDS and the risk for CRC was stronger for tumors with detectable levels of F nucleatum (HR, 2.51; Ptrend < .001), pks+ E coli (HR, 1.68; Ptrend = .005), and ETBF (HR, 2.06; Ptrend = .016).
IN PRACTICE:
“A dietary pattern with a low consumption of processed foods may help prevent colorectal cancer through modulation of the gut microbiome. The dietary pattern modulating the colorectal cancer–related gut microbial signature may particularly help prevent tumoral microbial positive colorectal cancer, which tends to have a worse prognosis,” the authors wrote.
SOURCE:
This study, led by Kai Wang and Chun-Han Lo, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, was published online in Gastroenterology.
LIMITATIONS:
The study’s observational design may have limited the ability to establish causality between dietary patterns and the risk for CRC. The inclusion of participants who were all health professionals from a predominantly White US population may have limited the generalizability of the findings to other populations. The reliance on self-reported dietary data may have introduced recall bias and affected the accuracy of the dietary pattern assessed.
DISCLOSURES:
This work was supported by various sources, including the National Institutes of Health and the Cancer Research UK Grand Challenge Award. One author served as a consultant for some pharmaceutical companies, and another received funding from various sources, both unrelated to this study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
METHODOLOGY:
- To date, no known studies have investigated how a dietary pattern (rather than just individual foods or nutrients) specifically directed at CRC-related microbes may contribute to an increased CRC risk.
- Using stool metagenomes and dietary information from 307 men and 212 women, researchers identified and then validated a dietary pattern specifically linked to an established CRC-related gut microbial signature, which they termed the CRC Microbial Dietary Score (CMDS).
- They then investigated the association between CMDS and the risk for CRC in 259,200 participants (50,637 men and 208,563 women) from three large US cohorts where health professionals provided detailed information on various lifestyle factors over long follow-up periods.
- Researchers also analyzed the risk for CRC on the basis of the presence of gut bacteria, such as F nucleatum, pks+ E coli, and ETBF, in the tumor tissues of the participants who underwent surgical resection for CRC.
TAKEAWAY:
- The CMDS was characterized by high intake of processed foods and low intake of fiber-rich foods.
- Over 6,467,378 person-years assessed in the three US cohorts, 3854 cases of incident CRC were documented, with 1172, 1096, and 1119 cases measured for F nucleatum, pks+ E coli, and ETBF, respectively.
- A higher CMDS was associated with an increased risk for CRC after adjusting for putative CRC risk factors (adjusted hazard ratio [HR], 1.25; Ptrend < .001).
- The association between CMDS and the risk for CRC was stronger for tumors with detectable levels of F nucleatum (HR, 2.51; Ptrend < .001), pks+ E coli (HR, 1.68; Ptrend = .005), and ETBF (HR, 2.06; Ptrend = .016).
IN PRACTICE:
“A dietary pattern with a low consumption of processed foods may help prevent colorectal cancer through modulation of the gut microbiome. The dietary pattern modulating the colorectal cancer–related gut microbial signature may particularly help prevent tumoral microbial positive colorectal cancer, which tends to have a worse prognosis,” the authors wrote.
SOURCE:
This study, led by Kai Wang and Chun-Han Lo, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, was published online in Gastroenterology.
LIMITATIONS:
The study’s observational design may have limited the ability to establish causality between dietary patterns and the risk for CRC. The inclusion of participants who were all health professionals from a predominantly White US population may have limited the generalizability of the findings to other populations. The reliance on self-reported dietary data may have introduced recall bias and affected the accuracy of the dietary pattern assessed.
DISCLOSURES:
This work was supported by various sources, including the National Institutes of Health and the Cancer Research UK Grand Challenge Award. One author served as a consultant for some pharmaceutical companies, and another received funding from various sources, both unrelated to this study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Semaglutide Coverage Could Raise Medicare Costs by Billions
TOPLINE:
after Medicare allowed Part D plans to cover the drug for patients with a BMI ≥ 27 and a history of cardiovascular disease (CVD), regardless of their diabetes status.
METHODOLOGY:
- In March 2024, Medicare approved the coverage of semaglutide by Part D plans for patients with a high BMI and existing CVD, irrespective of their diabetes status. This decision follows the SELECT trial results, showing that semaglutide lowered the risk for cardiovascular events in some patients without diabetes.
- This study aimed to describe the Medicare beneficiaries most likely to be newly eligible for semaglutide treatment and estimated maximum costs to Medicare Part D.
- The researchers included 5111 individuals aged ≥ 65 years with self-reported Medicare enrollment in the National Health and Nutrition Examination Survey between 2011 and 2020, all of whom had a BMI ≥ 27 and were likely to benefit from semaglutide treatment.
- They evaluated the following potential definitions of established CVD that could be considered by the Part D plan: physician-provided diagnosis of myocardial infarction, stroke, coronary artery disease, or angina; a 10-year risk for atherosclerotic CVD between 7.5% and < 20.0%; a 10-year risk for atherosclerotic CVD of ≥ 20%; or fulfillment of any of the previous three criteria.
- Data on interview responses, medication use, clinical examinations, laboratory results, and diabetes diagnoses were obtained from the participants.
TAKEAWAY:
- This study found that 3.6 million individuals (14.2%) were deemed highly likely to qualify for semaglutide treatment for the first time, and broadening the criteria for established CVD could increase this number to 15.2 million individuals (60.9%).
- If all newly eligible beneficiaries were to receive semaglutide treatment, Medicare spending could increase by $34-$145 billion annually.
- Even with more conservative definitions of CVD and a significant portion of individuals not maintaining long-term adherence to semaglutide treatment, costs could still increase by $10 billion annually.
- Younger, generally healthier, female Medicare beneficiaries were still likely to remain ineligible for semaglutide treatment according to the coverage provided by Part D Medicare plans.
IN PRACTICE:
“Although approximately one in seven Medicare beneficiaries with elevated BMI is likely to be newly eligible for semaglutide, the majority will remain ineligible if a narrow definition of established CVD is used by Part D plans. Weight control has benefits for patients with elevated BMI, so the definition of established CVD used by Part D plans for coverage of semaglutide could have outsized public health implications,” the authors wrote.
SOURCE:
The study was led by Alexander Chaitoff, MD, MPH, Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital, Boston. It was published online in Annals of Internal Medicine.
LIMITATIONS:
This analysis relied on self-reported cases of CVD. The study was also limited to only community-dwelling adults. It estimated maximum budgetary impacts but did not account for payment reforms introduced by the Inflation Reduction Act or for absolute contraindications to semaglutide.
DISCLOSURES:
This study did not disclose any sources of funding. Some authors declared receiving grants, serving as consultants, and having other ties with some institutions.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
after Medicare allowed Part D plans to cover the drug for patients with a BMI ≥ 27 and a history of cardiovascular disease (CVD), regardless of their diabetes status.
METHODOLOGY:
- In March 2024, Medicare approved the coverage of semaglutide by Part D plans for patients with a high BMI and existing CVD, irrespective of their diabetes status. This decision follows the SELECT trial results, showing that semaglutide lowered the risk for cardiovascular events in some patients without diabetes.
- This study aimed to describe the Medicare beneficiaries most likely to be newly eligible for semaglutide treatment and estimated maximum costs to Medicare Part D.
- The researchers included 5111 individuals aged ≥ 65 years with self-reported Medicare enrollment in the National Health and Nutrition Examination Survey between 2011 and 2020, all of whom had a BMI ≥ 27 and were likely to benefit from semaglutide treatment.
- They evaluated the following potential definitions of established CVD that could be considered by the Part D plan: physician-provided diagnosis of myocardial infarction, stroke, coronary artery disease, or angina; a 10-year risk for atherosclerotic CVD between 7.5% and < 20.0%; a 10-year risk for atherosclerotic CVD of ≥ 20%; or fulfillment of any of the previous three criteria.
- Data on interview responses, medication use, clinical examinations, laboratory results, and diabetes diagnoses were obtained from the participants.
TAKEAWAY:
- This study found that 3.6 million individuals (14.2%) were deemed highly likely to qualify for semaglutide treatment for the first time, and broadening the criteria for established CVD could increase this number to 15.2 million individuals (60.9%).
- If all newly eligible beneficiaries were to receive semaglutide treatment, Medicare spending could increase by $34-$145 billion annually.
- Even with more conservative definitions of CVD and a significant portion of individuals not maintaining long-term adherence to semaglutide treatment, costs could still increase by $10 billion annually.
- Younger, generally healthier, female Medicare beneficiaries were still likely to remain ineligible for semaglutide treatment according to the coverage provided by Part D Medicare plans.
IN PRACTICE:
“Although approximately one in seven Medicare beneficiaries with elevated BMI is likely to be newly eligible for semaglutide, the majority will remain ineligible if a narrow definition of established CVD is used by Part D plans. Weight control has benefits for patients with elevated BMI, so the definition of established CVD used by Part D plans for coverage of semaglutide could have outsized public health implications,” the authors wrote.
SOURCE:
The study was led by Alexander Chaitoff, MD, MPH, Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital, Boston. It was published online in Annals of Internal Medicine.
LIMITATIONS:
This analysis relied on self-reported cases of CVD. The study was also limited to only community-dwelling adults. It estimated maximum budgetary impacts but did not account for payment reforms introduced by the Inflation Reduction Act or for absolute contraindications to semaglutide.
DISCLOSURES:
This study did not disclose any sources of funding. Some authors declared receiving grants, serving as consultants, and having other ties with some institutions.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
after Medicare allowed Part D plans to cover the drug for patients with a BMI ≥ 27 and a history of cardiovascular disease (CVD), regardless of their diabetes status.
METHODOLOGY:
- In March 2024, Medicare approved the coverage of semaglutide by Part D plans for patients with a high BMI and existing CVD, irrespective of their diabetes status. This decision follows the SELECT trial results, showing that semaglutide lowered the risk for cardiovascular events in some patients without diabetes.
- This study aimed to describe the Medicare beneficiaries most likely to be newly eligible for semaglutide treatment and estimated maximum costs to Medicare Part D.
- The researchers included 5111 individuals aged ≥ 65 years with self-reported Medicare enrollment in the National Health and Nutrition Examination Survey between 2011 and 2020, all of whom had a BMI ≥ 27 and were likely to benefit from semaglutide treatment.
- They evaluated the following potential definitions of established CVD that could be considered by the Part D plan: physician-provided diagnosis of myocardial infarction, stroke, coronary artery disease, or angina; a 10-year risk for atherosclerotic CVD between 7.5% and < 20.0%; a 10-year risk for atherosclerotic CVD of ≥ 20%; or fulfillment of any of the previous three criteria.
- Data on interview responses, medication use, clinical examinations, laboratory results, and diabetes diagnoses were obtained from the participants.
TAKEAWAY:
- This study found that 3.6 million individuals (14.2%) were deemed highly likely to qualify for semaglutide treatment for the first time, and broadening the criteria for established CVD could increase this number to 15.2 million individuals (60.9%).
- If all newly eligible beneficiaries were to receive semaglutide treatment, Medicare spending could increase by $34-$145 billion annually.
- Even with more conservative definitions of CVD and a significant portion of individuals not maintaining long-term adherence to semaglutide treatment, costs could still increase by $10 billion annually.
- Younger, generally healthier, female Medicare beneficiaries were still likely to remain ineligible for semaglutide treatment according to the coverage provided by Part D Medicare plans.
IN PRACTICE:
“Although approximately one in seven Medicare beneficiaries with elevated BMI is likely to be newly eligible for semaglutide, the majority will remain ineligible if a narrow definition of established CVD is used by Part D plans. Weight control has benefits for patients with elevated BMI, so the definition of established CVD used by Part D plans for coverage of semaglutide could have outsized public health implications,” the authors wrote.
SOURCE:
The study was led by Alexander Chaitoff, MD, MPH, Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital, Boston. It was published online in Annals of Internal Medicine.
LIMITATIONS:
This analysis relied on self-reported cases of CVD. The study was also limited to only community-dwelling adults. It estimated maximum budgetary impacts but did not account for payment reforms introduced by the Inflation Reduction Act or for absolute contraindications to semaglutide.
DISCLOSURES:
This study did not disclose any sources of funding. Some authors declared receiving grants, serving as consultants, and having other ties with some institutions.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
The Battle Against Recurrent UTIs in Welsh Women
TOPLINE:
The prevalence of recurrent urinary tract infections (rUTIs) and the use of antibiotics for prevention are substantial among women in Wales, particularly among those over the age of 57 years. A high level of resistance to two recommended antibiotics was observed, suggesting that more frequent urine cultures could better guide antibiotic selection for treatment and prophylaxis.
METHODOLOGY:
- The researchers conducted a retrospective cross-sectional study using a large databank of patients in Wales to describe the characteristics and urine profiles of women with rUTIs between 2010 and 2022.
- They created two cohorts: One with 92,213 women (median age, 60 years) who experienced rUTIs, defined as two or more acute episodes within 6 months or three or more acute episodes within 12 months.
- Another cohort comprised of 26,862 women (median age, 71 years) were prescribed prophylactic antibiotics, which was defined as receiving three or more consecutive prescriptions of the same UTI-specific antibiotic (trimethoprim, nitrofurantoin, or cefalexin), with intervals of 21-56 days between prescriptions.
- Urine culture results in the 12 months before a rUTI diagnosis and 18 months before prophylactic antibiotic initiation and all urine culture results within 7 days of an acute UTI were analyzed to assess antibiotic resistance patterns.
TAKEAWAY:
- Overall, 6% of women had rUTIs, 1.7% of which were prescribed prophylactic antibiotics with proportions increasing sharply after age 57.
- Nearly half of the women (49%) who were prescribed a prophylactic antibiotic qualified as having rUTIs in the 18 months before initiation.
- This study showed that 80.8% of women with rUTIs had a urine culture result documented in the 12 months preceding the diagnosis.
- More than half (64%) of the women taking prophylactic antibiotics had a urine culture result documented before starting treatment, and 18% of those prescribed trimethoprim had resistance to the antibiotic.
IN PRACTICE:
“More frequent urine cultures in the workup of rUTI diagnosis and prophylactic antibiotic initiation could better inform antibiotic choice,” the authors wrote.
SOURCE:
The study was led by Leigh Sanyaolu, BSc (Hons), MRCS, MRCGP, PGDip, a general practitioner from the Division of Population Medicine and PRIME Centre Wales at Cardiff University in Cardiff, and was published online in the British Journal of General Practice.
LIMITATIONS:
The study’s reliance on electronic health records may have led to coding errors and missing data. The diagnosis of UTIs may have been difficult in older women with increased frailty as they can have fewer specific symptoms and asymptomatic bacteriuria, which can be misdiagnosed as a UTI.
DISCLOSURES:
This work was supported by Health and Care Research Wales. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
The prevalence of recurrent urinary tract infections (rUTIs) and the use of antibiotics for prevention are substantial among women in Wales, particularly among those over the age of 57 years. A high level of resistance to two recommended antibiotics was observed, suggesting that more frequent urine cultures could better guide antibiotic selection for treatment and prophylaxis.
METHODOLOGY:
- The researchers conducted a retrospective cross-sectional study using a large databank of patients in Wales to describe the characteristics and urine profiles of women with rUTIs between 2010 and 2022.
- They created two cohorts: One with 92,213 women (median age, 60 years) who experienced rUTIs, defined as two or more acute episodes within 6 months or three or more acute episodes within 12 months.
- Another cohort comprised of 26,862 women (median age, 71 years) were prescribed prophylactic antibiotics, which was defined as receiving three or more consecutive prescriptions of the same UTI-specific antibiotic (trimethoprim, nitrofurantoin, or cefalexin), with intervals of 21-56 days between prescriptions.
- Urine culture results in the 12 months before a rUTI diagnosis and 18 months before prophylactic antibiotic initiation and all urine culture results within 7 days of an acute UTI were analyzed to assess antibiotic resistance patterns.
TAKEAWAY:
- Overall, 6% of women had rUTIs, 1.7% of which were prescribed prophylactic antibiotics with proportions increasing sharply after age 57.
- Nearly half of the women (49%) who were prescribed a prophylactic antibiotic qualified as having rUTIs in the 18 months before initiation.
- This study showed that 80.8% of women with rUTIs had a urine culture result documented in the 12 months preceding the diagnosis.
- More than half (64%) of the women taking prophylactic antibiotics had a urine culture result documented before starting treatment, and 18% of those prescribed trimethoprim had resistance to the antibiotic.
IN PRACTICE:
“More frequent urine cultures in the workup of rUTI diagnosis and prophylactic antibiotic initiation could better inform antibiotic choice,” the authors wrote.
SOURCE:
The study was led by Leigh Sanyaolu, BSc (Hons), MRCS, MRCGP, PGDip, a general practitioner from the Division of Population Medicine and PRIME Centre Wales at Cardiff University in Cardiff, and was published online in the British Journal of General Practice.
LIMITATIONS:
The study’s reliance on electronic health records may have led to coding errors and missing data. The diagnosis of UTIs may have been difficult in older women with increased frailty as they can have fewer specific symptoms and asymptomatic bacteriuria, which can be misdiagnosed as a UTI.
DISCLOSURES:
This work was supported by Health and Care Research Wales. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
The prevalence of recurrent urinary tract infections (rUTIs) and the use of antibiotics for prevention are substantial among women in Wales, particularly among those over the age of 57 years. A high level of resistance to two recommended antibiotics was observed, suggesting that more frequent urine cultures could better guide antibiotic selection for treatment and prophylaxis.
METHODOLOGY:
- The researchers conducted a retrospective cross-sectional study using a large databank of patients in Wales to describe the characteristics and urine profiles of women with rUTIs between 2010 and 2022.
- They created two cohorts: One with 92,213 women (median age, 60 years) who experienced rUTIs, defined as two or more acute episodes within 6 months or three or more acute episodes within 12 months.
- Another cohort comprised of 26,862 women (median age, 71 years) were prescribed prophylactic antibiotics, which was defined as receiving three or more consecutive prescriptions of the same UTI-specific antibiotic (trimethoprim, nitrofurantoin, or cefalexin), with intervals of 21-56 days between prescriptions.
- Urine culture results in the 12 months before a rUTI diagnosis and 18 months before prophylactic antibiotic initiation and all urine culture results within 7 days of an acute UTI were analyzed to assess antibiotic resistance patterns.
TAKEAWAY:
- Overall, 6% of women had rUTIs, 1.7% of which were prescribed prophylactic antibiotics with proportions increasing sharply after age 57.
- Nearly half of the women (49%) who were prescribed a prophylactic antibiotic qualified as having rUTIs in the 18 months before initiation.
- This study showed that 80.8% of women with rUTIs had a urine culture result documented in the 12 months preceding the diagnosis.
- More than half (64%) of the women taking prophylactic antibiotics had a urine culture result documented before starting treatment, and 18% of those prescribed trimethoprim had resistance to the antibiotic.
IN PRACTICE:
“More frequent urine cultures in the workup of rUTI diagnosis and prophylactic antibiotic initiation could better inform antibiotic choice,” the authors wrote.
SOURCE:
The study was led by Leigh Sanyaolu, BSc (Hons), MRCS, MRCGP, PGDip, a general practitioner from the Division of Population Medicine and PRIME Centre Wales at Cardiff University in Cardiff, and was published online in the British Journal of General Practice.
LIMITATIONS:
The study’s reliance on electronic health records may have led to coding errors and missing data. The diagnosis of UTIs may have been difficult in older women with increased frailty as they can have fewer specific symptoms and asymptomatic bacteriuria, which can be misdiagnosed as a UTI.
DISCLOSURES:
This work was supported by Health and Care Research Wales. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Untreated Hypertension Tied to Alzheimer’s Disease Risk
TOPLINE:
Older adults with untreated hypertension have a 36% increased risk for Alzheimer’s disease (AD) compared with those without hypertension and a 42% increased risk for AD compared with those with treated hypertension.
METHODOLOGY:
- In this meta-analysis, researchers analyzed the data of 31,250 participants aged 60 years or older (mean age, 72.1 years; 41% men) from 14 community-based studies across 14 countries.
- Mean follow-up was 4.2 years, and blood pressure measurements, hypertension diagnosis, and antihypertensive medication use were recorded.
- Overall, 35.9% had no history of hypertension or antihypertensive medication use, 50.7% had a history of hypertension with antihypertensive medication use, and 9.4% had a history of hypertension without antihypertensive medication use.
- The main outcomes were AD and non-AD dementia.
TAKEAWAY:
- In total, 1415 participants developed AD, and 681 developed non-AD dementia.
- Participants with untreated hypertension had a 36% increased risk for AD compared with healthy controls (hazard ratio [HR], 1.36; P = .041) and a 42% increased risk for AD (HR, 1.42; P = .013) compared with those with treated hypertension.
- Compared with healthy controls, patients with treated hypertension did not show an elevated risk for AD (HR, 0.961; P = .6644).
- Patients with both treated (HR, 1.285; P = .027) and untreated (HR, 1.693; P = .003) hypertension had an increased risk for non-AD dementia compared with healthy controls. Patients with treated and untreated hypertension had a similar risk for non-AD dementia.
IN PRACTICE:
“These results suggest that treating high blood pressure as a person ages continues to be a crucial factor in reducing their risk of Alzheimer’s disease,” the lead author Matthew J. Lennon, MD, PhD, said in a press release.
SOURCE:
This study was led by Matthew J. Lennon, MD, PhD, School of Clinical Medicine, UNSW Sydney, Sydney, Australia. It was published online in Neurology.
LIMITATIONS:
Varied definitions for hypertension across different locations might have led to discrepancies in diagnosis. Additionally, the study did not account for potential confounders such as stroke, transient ischemic attack, and heart disease, which may act as mediators rather than covariates. Furthermore, the study did not report mortality data, which may have affected the interpretation of dementia risk.
DISCLOSURES:
This research was supported by the National Institute on Aging of the National Institutes of Health. Some authors reported ties with several institutions and pharmaceutical companies outside this work. Full disclosures are available in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Older adults with untreated hypertension have a 36% increased risk for Alzheimer’s disease (AD) compared with those without hypertension and a 42% increased risk for AD compared with those with treated hypertension.
METHODOLOGY:
- In this meta-analysis, researchers analyzed the data of 31,250 participants aged 60 years or older (mean age, 72.1 years; 41% men) from 14 community-based studies across 14 countries.
- Mean follow-up was 4.2 years, and blood pressure measurements, hypertension diagnosis, and antihypertensive medication use were recorded.
- Overall, 35.9% had no history of hypertension or antihypertensive medication use, 50.7% had a history of hypertension with antihypertensive medication use, and 9.4% had a history of hypertension without antihypertensive medication use.
- The main outcomes were AD and non-AD dementia.
TAKEAWAY:
- In total, 1415 participants developed AD, and 681 developed non-AD dementia.
- Participants with untreated hypertension had a 36% increased risk for AD compared with healthy controls (hazard ratio [HR], 1.36; P = .041) and a 42% increased risk for AD (HR, 1.42; P = .013) compared with those with treated hypertension.
- Compared with healthy controls, patients with treated hypertension did not show an elevated risk for AD (HR, 0.961; P = .6644).
- Patients with both treated (HR, 1.285; P = .027) and untreated (HR, 1.693; P = .003) hypertension had an increased risk for non-AD dementia compared with healthy controls. Patients with treated and untreated hypertension had a similar risk for non-AD dementia.
IN PRACTICE:
“These results suggest that treating high blood pressure as a person ages continues to be a crucial factor in reducing their risk of Alzheimer’s disease,” the lead author Matthew J. Lennon, MD, PhD, said in a press release.
SOURCE:
This study was led by Matthew J. Lennon, MD, PhD, School of Clinical Medicine, UNSW Sydney, Sydney, Australia. It was published online in Neurology.
LIMITATIONS:
Varied definitions for hypertension across different locations might have led to discrepancies in diagnosis. Additionally, the study did not account for potential confounders such as stroke, transient ischemic attack, and heart disease, which may act as mediators rather than covariates. Furthermore, the study did not report mortality data, which may have affected the interpretation of dementia risk.
DISCLOSURES:
This research was supported by the National Institute on Aging of the National Institutes of Health. Some authors reported ties with several institutions and pharmaceutical companies outside this work. Full disclosures are available in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Older adults with untreated hypertension have a 36% increased risk for Alzheimer’s disease (AD) compared with those without hypertension and a 42% increased risk for AD compared with those with treated hypertension.
METHODOLOGY:
- In this meta-analysis, researchers analyzed the data of 31,250 participants aged 60 years or older (mean age, 72.1 years; 41% men) from 14 community-based studies across 14 countries.
- Mean follow-up was 4.2 years, and blood pressure measurements, hypertension diagnosis, and antihypertensive medication use were recorded.
- Overall, 35.9% had no history of hypertension or antihypertensive medication use, 50.7% had a history of hypertension with antihypertensive medication use, and 9.4% had a history of hypertension without antihypertensive medication use.
- The main outcomes were AD and non-AD dementia.
TAKEAWAY:
- In total, 1415 participants developed AD, and 681 developed non-AD dementia.
- Participants with untreated hypertension had a 36% increased risk for AD compared with healthy controls (hazard ratio [HR], 1.36; P = .041) and a 42% increased risk for AD (HR, 1.42; P = .013) compared with those with treated hypertension.
- Compared with healthy controls, patients with treated hypertension did not show an elevated risk for AD (HR, 0.961; P = .6644).
- Patients with both treated (HR, 1.285; P = .027) and untreated (HR, 1.693; P = .003) hypertension had an increased risk for non-AD dementia compared with healthy controls. Patients with treated and untreated hypertension had a similar risk for non-AD dementia.
IN PRACTICE:
“These results suggest that treating high blood pressure as a person ages continues to be a crucial factor in reducing their risk of Alzheimer’s disease,” the lead author Matthew J. Lennon, MD, PhD, said in a press release.
SOURCE:
This study was led by Matthew J. Lennon, MD, PhD, School of Clinical Medicine, UNSW Sydney, Sydney, Australia. It was published online in Neurology.
LIMITATIONS:
Varied definitions for hypertension across different locations might have led to discrepancies in diagnosis. Additionally, the study did not account for potential confounders such as stroke, transient ischemic attack, and heart disease, which may act as mediators rather than covariates. Furthermore, the study did not report mortality data, which may have affected the interpretation of dementia risk.
DISCLOSURES:
This research was supported by the National Institute on Aging of the National Institutes of Health. Some authors reported ties with several institutions and pharmaceutical companies outside this work. Full disclosures are available in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
After Remission Failure in Early RA, Adding Etanercept No Better Than Adding Leflunomide
TOPLINE:
Treatment with etanercept led to faster disease control initially in patients with early rheumatoid arthritis (RA) who had an insufficient early response to methotrexate and bridging glucocorticoids therapy, but more patients achieved disease control with leflunomide at 104 weeks.
METHODOLOGY:
- Researchers conducted CareRA2020, a randomized controlled trial including 276 patients with early RA who were initially treated with oral methotrexate 15 mg/wk and a step-down prednisone scheme, with early insufficient responders (n = 110) randomized to add etanercept 50 mg/wk or leflunomide 10 mg/d for 24 weeks.
- Patients were classified as early insufficient responders if they did not achieve a 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) < 3.2 between weeks 8 and 32 or < 2.6 at week 32, despite an increase in methotrexate dose to 20 mg/wk.
- The primary outcome was the longitudinal disease activity measured by DAS28-CRP over 104 weeks.
- The secondary outcomes included disease control at 28 weeks post randomization and the use of biologic or targeted synthetic disease-modifying antirheumatic drugs at week 104.
TAKEAWAY:
- Early introduction of etanercept in patients with RA did not show long-term superiority over leflunomide in disease control over 2 years (P = .157).
- At 28 weeks post randomization, the percentage of patients who achieved a DAS28-CRP < 2.6 was higher in the etanercept group than in the leflunomide group (59% vs 44%).
- After stopping etanercept, disease activity scores worsened, and a lower proportion of patients achieved DAS28-CRP < 2.6 in the etanercept group than in the leflunomide group (55% vs 69%) at week 104.
- Even after treatment with etanercept or leflunomide, the 110 early insufficient responders never reached the same level of disease control as the 142 patients who responded to methotrexate and bridging glucocorticoids within weeks 8-32.
IN PRACTICE:
“The CareRA2020 trial did not completely solve the unmet need of patients responding insufficiently to conventional initial therapy for early RA, but it provides opportunities to further optimize the treatment approach in this population, for instance, by focusing on the identification of potential subgroups with different disease activity trajectories within the early insufficient responder group,” wrote the authors.
SOURCE:
The study was led by Delphine Bertrand of the Skeletal Biology and Engineering Research Center in the Department of Development and Regeneration at KU Leuven in Belgium, and was published online on August 7, 2024, in RMD Open.
LIMITATIONS:
The open-label design of the study may have introduced bias, as patients and investigators were aware of the treatment. The temporary administration of etanercept may not have reflected its long-term effects. The study was conducted in Belgium, which limited the generalizability of the findings to other populations.
DISCLOSURES:
The study was supported by the Belgian Health Care Knowledge Centre. Some authors reported serving as speakers or receiving grants, consulting fees, honoraria, or meeting or travel support from financial ties with Novartis, Pfizer, Amgen, and other pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Treatment with etanercept led to faster disease control initially in patients with early rheumatoid arthritis (RA) who had an insufficient early response to methotrexate and bridging glucocorticoids therapy, but more patients achieved disease control with leflunomide at 104 weeks.
METHODOLOGY:
- Researchers conducted CareRA2020, a randomized controlled trial including 276 patients with early RA who were initially treated with oral methotrexate 15 mg/wk and a step-down prednisone scheme, with early insufficient responders (n = 110) randomized to add etanercept 50 mg/wk or leflunomide 10 mg/d for 24 weeks.
- Patients were classified as early insufficient responders if they did not achieve a 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) < 3.2 between weeks 8 and 32 or < 2.6 at week 32, despite an increase in methotrexate dose to 20 mg/wk.
- The primary outcome was the longitudinal disease activity measured by DAS28-CRP over 104 weeks.
- The secondary outcomes included disease control at 28 weeks post randomization and the use of biologic or targeted synthetic disease-modifying antirheumatic drugs at week 104.
TAKEAWAY:
- Early introduction of etanercept in patients with RA did not show long-term superiority over leflunomide in disease control over 2 years (P = .157).
- At 28 weeks post randomization, the percentage of patients who achieved a DAS28-CRP < 2.6 was higher in the etanercept group than in the leflunomide group (59% vs 44%).
- After stopping etanercept, disease activity scores worsened, and a lower proportion of patients achieved DAS28-CRP < 2.6 in the etanercept group than in the leflunomide group (55% vs 69%) at week 104.
- Even after treatment with etanercept or leflunomide, the 110 early insufficient responders never reached the same level of disease control as the 142 patients who responded to methotrexate and bridging glucocorticoids within weeks 8-32.
IN PRACTICE:
“The CareRA2020 trial did not completely solve the unmet need of patients responding insufficiently to conventional initial therapy for early RA, but it provides opportunities to further optimize the treatment approach in this population, for instance, by focusing on the identification of potential subgroups with different disease activity trajectories within the early insufficient responder group,” wrote the authors.
SOURCE:
The study was led by Delphine Bertrand of the Skeletal Biology and Engineering Research Center in the Department of Development and Regeneration at KU Leuven in Belgium, and was published online on August 7, 2024, in RMD Open.
LIMITATIONS:
The open-label design of the study may have introduced bias, as patients and investigators were aware of the treatment. The temporary administration of etanercept may not have reflected its long-term effects. The study was conducted in Belgium, which limited the generalizability of the findings to other populations.
DISCLOSURES:
The study was supported by the Belgian Health Care Knowledge Centre. Some authors reported serving as speakers or receiving grants, consulting fees, honoraria, or meeting or travel support from financial ties with Novartis, Pfizer, Amgen, and other pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Treatment with etanercept led to faster disease control initially in patients with early rheumatoid arthritis (RA) who had an insufficient early response to methotrexate and bridging glucocorticoids therapy, but more patients achieved disease control with leflunomide at 104 weeks.
METHODOLOGY:
- Researchers conducted CareRA2020, a randomized controlled trial including 276 patients with early RA who were initially treated with oral methotrexate 15 mg/wk and a step-down prednisone scheme, with early insufficient responders (n = 110) randomized to add etanercept 50 mg/wk or leflunomide 10 mg/d for 24 weeks.
- Patients were classified as early insufficient responders if they did not achieve a 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) < 3.2 between weeks 8 and 32 or < 2.6 at week 32, despite an increase in methotrexate dose to 20 mg/wk.
- The primary outcome was the longitudinal disease activity measured by DAS28-CRP over 104 weeks.
- The secondary outcomes included disease control at 28 weeks post randomization and the use of biologic or targeted synthetic disease-modifying antirheumatic drugs at week 104.
TAKEAWAY:
- Early introduction of etanercept in patients with RA did not show long-term superiority over leflunomide in disease control over 2 years (P = .157).
- At 28 weeks post randomization, the percentage of patients who achieved a DAS28-CRP < 2.6 was higher in the etanercept group than in the leflunomide group (59% vs 44%).
- After stopping etanercept, disease activity scores worsened, and a lower proportion of patients achieved DAS28-CRP < 2.6 in the etanercept group than in the leflunomide group (55% vs 69%) at week 104.
- Even after treatment with etanercept or leflunomide, the 110 early insufficient responders never reached the same level of disease control as the 142 patients who responded to methotrexate and bridging glucocorticoids within weeks 8-32.
IN PRACTICE:
“The CareRA2020 trial did not completely solve the unmet need of patients responding insufficiently to conventional initial therapy for early RA, but it provides opportunities to further optimize the treatment approach in this population, for instance, by focusing on the identification of potential subgroups with different disease activity trajectories within the early insufficient responder group,” wrote the authors.
SOURCE:
The study was led by Delphine Bertrand of the Skeletal Biology and Engineering Research Center in the Department of Development and Regeneration at KU Leuven in Belgium, and was published online on August 7, 2024, in RMD Open.
LIMITATIONS:
The open-label design of the study may have introduced bias, as patients and investigators were aware of the treatment. The temporary administration of etanercept may not have reflected its long-term effects. The study was conducted in Belgium, which limited the generalizability of the findings to other populations.
DISCLOSURES:
The study was supported by the Belgian Health Care Knowledge Centre. Some authors reported serving as speakers or receiving grants, consulting fees, honoraria, or meeting or travel support from financial ties with Novartis, Pfizer, Amgen, and other pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
Patients With Immune-Mediated Inflammatory Diseases, Type 2 Diabetes Reap GLP-1 Receptor Agonist Benefits, Too
TOPLINE:
Compared with dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are associated with a lower risk for all-cause mortality and major adverse cardiovascular events (MACE) in patients with immune-mediated inflammatory diseases (IMIDs) and type 2 diabetes (T2D).
METHODOLOGY:
- GLP-1 RAs reduce the risk for all-cause mortality, cardiovascular mortality, and stroke in patients with diabetes. However, previous trials have excluded those with IMIDs, leaving a gap in understanding the cardioprotective effects of GLP-1 RAs in this population.
- Researchers conducted a population-based cohort study to assess if patients with an IMID derive greater benefits from GLP-1 RAs than DPP-4 inhibitors.
- They used administrative health data from British Columbia, Canada, to include 10,855 patients with IMIDs (rheumatoid arthritis, psoriatic disease, ankylosing spondylitis, inflammatory bowel disease, or systemic autoimmune rheumatic disease) and T2D who initiated either GLP-1 RA (n = 3570) or DPP-4 inhibitor (n = 7285).
- The mean follow-up was 1.46 and 1.88 years in the GLP-1 RA and DPP-4 inhibitor cohorts, respectively.
- The primary outcome was all-cause mortality, and the secondary outcome was MACE, including cardiovascular death, myocardial infarction, and ischemic stroke.
TAKEAWAY:
- The risk for all-cause mortality was 52% lower in patients who initiated GLP-1 RAs than in those who initiated DPP-4 inhibitors (weighted hazard ratio [HR], 0.48; 95% CI, 0.31-0.75).
- Additionally, patients initiating DPP-4 inhibitors.
- In the subgroup of patients with GLP-1 RAs had a significantly lower risk for MACE (weighted HR, 0.66; 95% CI, 0.50-0.88), particularly myocardial infarction (weighted HR, 0.62; 95% CI, 0.40-0.96), than those initiating rheumatoid arthritis and T2D, those who initiated GLP-1 RAs had a 55% lower risk for all-cause mortality and 61% lower risk for MACE than those who initiated DPP-4 inhibitors.
IN PRACTICE:
“This corresponds to nine fewer deaths and 11 fewer MACE per 1000 person-years, respectively, supporting the hypothesis that these agents have a cardioprotective effect in this high-risk population,” the authors wrote.
SOURCE:
This study was led by Derin Karacabeyli, MD, Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada, and was published online on August 8, 2024, in PLOS ONE.
LIMITATIONS:
The study’s dependence on administrative health data might have resulted in incomplete capture of comorbidities, particularly obesity. The mean follow-up period was relatively short, which might have limited the long-term applicability of these findings. The accuracy of the case definitions for IMIDs and T2D, according to International Classification of Diseases codes, could not be fully ascertained.
DISCLOSURES:
The study was supported by grants from the Canadian Institutes of Health Research. Two authors declared receiving research support, consulting fees, or participating in advisory boards outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Compared with dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are associated with a lower risk for all-cause mortality and major adverse cardiovascular events (MACE) in patients with immune-mediated inflammatory diseases (IMIDs) and type 2 diabetes (T2D).
METHODOLOGY:
- GLP-1 RAs reduce the risk for all-cause mortality, cardiovascular mortality, and stroke in patients with diabetes. However, previous trials have excluded those with IMIDs, leaving a gap in understanding the cardioprotective effects of GLP-1 RAs in this population.
- Researchers conducted a population-based cohort study to assess if patients with an IMID derive greater benefits from GLP-1 RAs than DPP-4 inhibitors.
- They used administrative health data from British Columbia, Canada, to include 10,855 patients with IMIDs (rheumatoid arthritis, psoriatic disease, ankylosing spondylitis, inflammatory bowel disease, or systemic autoimmune rheumatic disease) and T2D who initiated either GLP-1 RA (n = 3570) or DPP-4 inhibitor (n = 7285).
- The mean follow-up was 1.46 and 1.88 years in the GLP-1 RA and DPP-4 inhibitor cohorts, respectively.
- The primary outcome was all-cause mortality, and the secondary outcome was MACE, including cardiovascular death, myocardial infarction, and ischemic stroke.
TAKEAWAY:
- The risk for all-cause mortality was 52% lower in patients who initiated GLP-1 RAs than in those who initiated DPP-4 inhibitors (weighted hazard ratio [HR], 0.48; 95% CI, 0.31-0.75).
- Additionally, patients initiating DPP-4 inhibitors.
- In the subgroup of patients with GLP-1 RAs had a significantly lower risk for MACE (weighted HR, 0.66; 95% CI, 0.50-0.88), particularly myocardial infarction (weighted HR, 0.62; 95% CI, 0.40-0.96), than those initiating rheumatoid arthritis and T2D, those who initiated GLP-1 RAs had a 55% lower risk for all-cause mortality and 61% lower risk for MACE than those who initiated DPP-4 inhibitors.
IN PRACTICE:
“This corresponds to nine fewer deaths and 11 fewer MACE per 1000 person-years, respectively, supporting the hypothesis that these agents have a cardioprotective effect in this high-risk population,” the authors wrote.
SOURCE:
This study was led by Derin Karacabeyli, MD, Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada, and was published online on August 8, 2024, in PLOS ONE.
LIMITATIONS:
The study’s dependence on administrative health data might have resulted in incomplete capture of comorbidities, particularly obesity. The mean follow-up period was relatively short, which might have limited the long-term applicability of these findings. The accuracy of the case definitions for IMIDs and T2D, according to International Classification of Diseases codes, could not be fully ascertained.
DISCLOSURES:
The study was supported by grants from the Canadian Institutes of Health Research. Two authors declared receiving research support, consulting fees, or participating in advisory boards outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Compared with dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are associated with a lower risk for all-cause mortality and major adverse cardiovascular events (MACE) in patients with immune-mediated inflammatory diseases (IMIDs) and type 2 diabetes (T2D).
METHODOLOGY:
- GLP-1 RAs reduce the risk for all-cause mortality, cardiovascular mortality, and stroke in patients with diabetes. However, previous trials have excluded those with IMIDs, leaving a gap in understanding the cardioprotective effects of GLP-1 RAs in this population.
- Researchers conducted a population-based cohort study to assess if patients with an IMID derive greater benefits from GLP-1 RAs than DPP-4 inhibitors.
- They used administrative health data from British Columbia, Canada, to include 10,855 patients with IMIDs (rheumatoid arthritis, psoriatic disease, ankylosing spondylitis, inflammatory bowel disease, or systemic autoimmune rheumatic disease) and T2D who initiated either GLP-1 RA (n = 3570) or DPP-4 inhibitor (n = 7285).
- The mean follow-up was 1.46 and 1.88 years in the GLP-1 RA and DPP-4 inhibitor cohorts, respectively.
- The primary outcome was all-cause mortality, and the secondary outcome was MACE, including cardiovascular death, myocardial infarction, and ischemic stroke.
TAKEAWAY:
- The risk for all-cause mortality was 52% lower in patients who initiated GLP-1 RAs than in those who initiated DPP-4 inhibitors (weighted hazard ratio [HR], 0.48; 95% CI, 0.31-0.75).
- Additionally, patients initiating DPP-4 inhibitors.
- In the subgroup of patients with GLP-1 RAs had a significantly lower risk for MACE (weighted HR, 0.66; 95% CI, 0.50-0.88), particularly myocardial infarction (weighted HR, 0.62; 95% CI, 0.40-0.96), than those initiating rheumatoid arthritis and T2D, those who initiated GLP-1 RAs had a 55% lower risk for all-cause mortality and 61% lower risk for MACE than those who initiated DPP-4 inhibitors.
IN PRACTICE:
“This corresponds to nine fewer deaths and 11 fewer MACE per 1000 person-years, respectively, supporting the hypothesis that these agents have a cardioprotective effect in this high-risk population,” the authors wrote.
SOURCE:
This study was led by Derin Karacabeyli, MD, Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada, and was published online on August 8, 2024, in PLOS ONE.
LIMITATIONS:
The study’s dependence on administrative health data might have resulted in incomplete capture of comorbidities, particularly obesity. The mean follow-up period was relatively short, which might have limited the long-term applicability of these findings. The accuracy of the case definitions for IMIDs and T2D, according to International Classification of Diseases codes, could not be fully ascertained.
DISCLOSURES:
The study was supported by grants from the Canadian Institutes of Health Research. Two authors declared receiving research support, consulting fees, or participating in advisory boards outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Mobile App Shows Promise in Managing Fibromyalgia Symptoms
TOPLINE:
A smartphone app that delivers acceptance and commitment therapy (ACT), a type of cognitive behavioral therapy, improves overall well-being and reduces the severity of pain, fatigue, sleep issues, and depression to a greater extent than daily symptom tracking in patients with fibromyalgia.
METHODOLOGY:
- Researchers conducted the phase 3 PROSPER-FM trial at 25 community sites in the United States to assess the efficacy and safety of digital ACT for patients with fibromyalgia.
- A total of 275 adult patients aged 22-75 years with fibromyalgia were randomly assigned to either the digital ACT group (n = 140) or the active control group (n = 135) for 12 weeks.
- Patients in the digital ACT group received a self-guided, smartphone-delivered program in which they learned and practiced the core ACT skills of acceptance, values, mindfulness, defusion, self as context, and willingness and committed action to build psychological flexibility, while the control group underwent daily symptom tracking and received educational materials.
- The primary endpoint was the response rate on the Patient Global Impression of Change (PGIC) at week 12, which is an indicator of patient well-being.
- The secondary endpoints included changes in the Revised Fibromyalgia Impact Questionnaire (FIQ-R) total score and pain intensity, pain interference, and sleep interference scores.
TAKEAWAY:
- At week 12, 71% of the patients in the digital ACT group responded with a minimally improved or better change in the PGIC response, compared with only 22% of the patients in the control group (P < .0001).
- The digital ACT group showed a significant reduction in the impact of fibromyalgia, with a between-group effect size of d = 0.65 (P < .0001) at week 12. The FIQ-R total score significantly improved within 3 weeks of using the self-guided digital ACT app.
- The use of digital ACT also demonstrated positive effects on the levels of weekly pain intensity (P = .001) and depression (P < .0001), compared with the control group.
- No serious adverse effects related to the app were reported, and both groups demonstrated high rates of adherence, with most (72%) participants in the digital ACT group completing at least 42 sessions.
IN PRACTICE:
“The results found in the study are essential for professionals who care for patients with fibromyalgia as they present a new viable treatment alternative,” Guilherme Torres Vilarino, PhD, Santa Catarina State University, Florianópolis, Brazil, wrote in an accompanying editorial.
SOURCE:
This study was led by R. Michael Gendreau, MD, PhD, Gendreau Consulting, Poway, California. It was published online in The Lancet.
LIMITATIONS:
The study population predominantly consisted of women and White individuals, which may limit the generalizability of the findings to more diverse populations. Additionally, the study was conducted in the United States, and the results may thus not be applicable to other countries with different racial, ethnic, educational, and economic characteristics. The study duration was 12 weeks, and the long-term benefits of digital ACT have not yet been shown.
DISCLOSURES:
This study was funded by Swing Therapeutics. Seven authors declared having stock options and/or receiving salary from Swing Therapeutics. Other authors reported having many ties with several sources, including Swing Therapeutics.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
A smartphone app that delivers acceptance and commitment therapy (ACT), a type of cognitive behavioral therapy, improves overall well-being and reduces the severity of pain, fatigue, sleep issues, and depression to a greater extent than daily symptom tracking in patients with fibromyalgia.
METHODOLOGY:
- Researchers conducted the phase 3 PROSPER-FM trial at 25 community sites in the United States to assess the efficacy and safety of digital ACT for patients with fibromyalgia.
- A total of 275 adult patients aged 22-75 years with fibromyalgia were randomly assigned to either the digital ACT group (n = 140) or the active control group (n = 135) for 12 weeks.
- Patients in the digital ACT group received a self-guided, smartphone-delivered program in which they learned and practiced the core ACT skills of acceptance, values, mindfulness, defusion, self as context, and willingness and committed action to build psychological flexibility, while the control group underwent daily symptom tracking and received educational materials.
- The primary endpoint was the response rate on the Patient Global Impression of Change (PGIC) at week 12, which is an indicator of patient well-being.
- The secondary endpoints included changes in the Revised Fibromyalgia Impact Questionnaire (FIQ-R) total score and pain intensity, pain interference, and sleep interference scores.
TAKEAWAY:
- At week 12, 71% of the patients in the digital ACT group responded with a minimally improved or better change in the PGIC response, compared with only 22% of the patients in the control group (P < .0001).
- The digital ACT group showed a significant reduction in the impact of fibromyalgia, with a between-group effect size of d = 0.65 (P < .0001) at week 12. The FIQ-R total score significantly improved within 3 weeks of using the self-guided digital ACT app.
- The use of digital ACT also demonstrated positive effects on the levels of weekly pain intensity (P = .001) and depression (P < .0001), compared with the control group.
- No serious adverse effects related to the app were reported, and both groups demonstrated high rates of adherence, with most (72%) participants in the digital ACT group completing at least 42 sessions.
IN PRACTICE:
“The results found in the study are essential for professionals who care for patients with fibromyalgia as they present a new viable treatment alternative,” Guilherme Torres Vilarino, PhD, Santa Catarina State University, Florianópolis, Brazil, wrote in an accompanying editorial.
SOURCE:
This study was led by R. Michael Gendreau, MD, PhD, Gendreau Consulting, Poway, California. It was published online in The Lancet.
LIMITATIONS:
The study population predominantly consisted of women and White individuals, which may limit the generalizability of the findings to more diverse populations. Additionally, the study was conducted in the United States, and the results may thus not be applicable to other countries with different racial, ethnic, educational, and economic characteristics. The study duration was 12 weeks, and the long-term benefits of digital ACT have not yet been shown.
DISCLOSURES:
This study was funded by Swing Therapeutics. Seven authors declared having stock options and/or receiving salary from Swing Therapeutics. Other authors reported having many ties with several sources, including Swing Therapeutics.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
A smartphone app that delivers acceptance and commitment therapy (ACT), a type of cognitive behavioral therapy, improves overall well-being and reduces the severity of pain, fatigue, sleep issues, and depression to a greater extent than daily symptom tracking in patients with fibromyalgia.
METHODOLOGY:
- Researchers conducted the phase 3 PROSPER-FM trial at 25 community sites in the United States to assess the efficacy and safety of digital ACT for patients with fibromyalgia.
- A total of 275 adult patients aged 22-75 years with fibromyalgia were randomly assigned to either the digital ACT group (n = 140) or the active control group (n = 135) for 12 weeks.
- Patients in the digital ACT group received a self-guided, smartphone-delivered program in which they learned and practiced the core ACT skills of acceptance, values, mindfulness, defusion, self as context, and willingness and committed action to build psychological flexibility, while the control group underwent daily symptom tracking and received educational materials.
- The primary endpoint was the response rate on the Patient Global Impression of Change (PGIC) at week 12, which is an indicator of patient well-being.
- The secondary endpoints included changes in the Revised Fibromyalgia Impact Questionnaire (FIQ-R) total score and pain intensity, pain interference, and sleep interference scores.
TAKEAWAY:
- At week 12, 71% of the patients in the digital ACT group responded with a minimally improved or better change in the PGIC response, compared with only 22% of the patients in the control group (P < .0001).
- The digital ACT group showed a significant reduction in the impact of fibromyalgia, with a between-group effect size of d = 0.65 (P < .0001) at week 12. The FIQ-R total score significantly improved within 3 weeks of using the self-guided digital ACT app.
- The use of digital ACT also demonstrated positive effects on the levels of weekly pain intensity (P = .001) and depression (P < .0001), compared with the control group.
- No serious adverse effects related to the app were reported, and both groups demonstrated high rates of adherence, with most (72%) participants in the digital ACT group completing at least 42 sessions.
IN PRACTICE:
“The results found in the study are essential for professionals who care for patients with fibromyalgia as they present a new viable treatment alternative,” Guilherme Torres Vilarino, PhD, Santa Catarina State University, Florianópolis, Brazil, wrote in an accompanying editorial.
SOURCE:
This study was led by R. Michael Gendreau, MD, PhD, Gendreau Consulting, Poway, California. It was published online in The Lancet.
LIMITATIONS:
The study population predominantly consisted of women and White individuals, which may limit the generalizability of the findings to more diverse populations. Additionally, the study was conducted in the United States, and the results may thus not be applicable to other countries with different racial, ethnic, educational, and economic characteristics. The study duration was 12 weeks, and the long-term benefits of digital ACT have not yet been shown.
DISCLOSURES:
This study was funded by Swing Therapeutics. Seven authors declared having stock options and/or receiving salary from Swing Therapeutics. Other authors reported having many ties with several sources, including Swing Therapeutics.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.