Low-Dose Aspirin may increase Risk of Anaemia in Older Adults: Study

Low-Dose Aspirin may increase Risk of Anaemia in Older Adults suggests a study published in the European Heart Journal.

A study was done to assess the risk of anaemia among low-dose aspirin (LDA) exposure in Danish older individuals in a real-world setting. Population based-cohort study conducted using Danish registers. The study population included older individuals (≥65 years) exposed to LDA between 2008 and 2013 for primary or secondary prevention of cardiovascular events. Over a five-year follow-up, outcomes included anaemia incidence based on haemoglobin values and hematinic deficiency incidence based on antianemic prescriptions.

Results: Among the 313 508 individuals included in the study population, those exposed to LDA (n = 59 869, 19.1%) had an incidence of hematinic deficiency determined by the use of antianemic treatment of 9.6%, with an incidence rate ratio of 9.11 (95% Confidence Interval, CI: 8.81-9.41) when compared to non-users of LDA (n = 253 639, 80.9%), who had an incidence of 3.7%. Anaemia determined by haemoglobin value measurements was observed in 5.9% of those exposed to LDA, with an incidence rate ratio of 7.89 (95% CI: 7.58-8.21) when compared to non-users of LDA. Approximately one in five individuals (n = 2 422, 21.5%) who experienced anaemia also experienced bleeding. Severe anaemia was observed in 1.3% of those exposed to LDA compared to 0.6% of those not exposed. Among the exposed, the reduction in haemoglobin and ferritin levels was associated with the severity of anaemia. These findings indicate that in a real-world setting, anaemia with LDA can occur in 6 to 10 older individuals out of every 100 LDA users during the first 5 years of treatment.

Reference:

Maria Antonietta Barbieri, Dilsad Simay Peker, Mohsen Gamal Saad Askar, Vera Battini, Andrea Abate, Carla Carnovale, Emilio Clementi, Richard Ofori-Asenso, Edoardo Spina, Manan Pareek, Kristian Kragholm, Christian Torp-Pedersen, Maurizio Sessa, Low-Dose Aspirin and Risk of Anaemia in Older Adults: Insights from a Danish Register-based Cohort Study, European Heart Journal – Quality of Care and Clinical Outcomes, 2024;, qcae089, https://doi.org/10.1093/ehjqcco/qcae089

Keywords:

Low-Dose, Aspirin, increase, Risk, Anaemia, Older, Adults, Study, Maria Antonietta Barbieri, Dilsad Simay Peker, Mohsen Gamal Saad Askar, Vera Battini, Andrea Abate, Carla Carnovale, Emilio Clementi, Richard Ofori-Asenso, Edoardo Spina, Manan Pareek, Kristian Kragholm

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First-line thioguanine therapy effective in patients with thiopurine-naïve IBD: Study

A recent study published in the journal of Inflammatory Bowel Diseases showed that first-line thioguanine treatment was clinically beneficial at 12 months with an acceptable safety profile in 53% of patients with thiopurine-naïve inflammatory bowel disease.

2 well-known maintenance medications for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC) are azathioprine and mercaptopurine. Even though they work well to keep patients in remission, up to 40% of patients must stop their treatment because of unfavorable side effects. Thioguanine has a less complex metabolism than azathioprine and mercaptopurine. It is directly transformed into the pharmacologically active 6-thioguaninucleotides (6-TGNs) by HGPRT (hypoxanthine-guanine phosphoribosyltransferase) without the production of potentially harmful metabolites like 6-MMP (6-methylmercaptopurine).

As of now, thioguanine is only utilized to treat inflammatory bowel disease in cases where azathioprine and/or mercaptopurine have failed. This research was to evaluate the safety, efficacy, and 12-month drug survival of thioguanine in patients with inflammatory bowel disease who had never taken thiopurine.

The patients with inflammatory bowel disease who had not taken thiopurine before and were receiving thioguanine as their first thiopurine derivative participated in this retrospective cohort study. The maintenance of thioguanine without the (re)initiation of concomitant biological treatment, systemic corticosteroids, or surgery was considered clinically successful. The Common Terminology Criteria for Adverse Events were used to categorize each adverse event.

A total of 114 patients participated with a median therapy duration of 25 months and a median thioguanine dose of 20 mg/d. 53% of patients showed clinical efficacy at 12 months, and 78% of these responding patients continued to show improvement until the conclusion of the follow-up period.

Over the course of the follow-up period, 26 patients were defined as initial non-responders, 8 experienced a subsequent loss of response and 11 patients were deemed non-responders because they were unable to stop using systemic corticosteroids within 6 months. 86% of the patients were still using thioguanine a year later.

9 patients (8%) stopped their medication as a result of adverse events, and 50 (44%) patients experienced grade 1 or 2 adverse events. 3 people were infected, although none of them required hospitalization, and 2 other patients had pancytopenia. No evidence of portal hypertension or nodular regenerative hyperplasia was seen.

Overall, first-line thioguanine treatment had clinical efficacy rates comparable to normal azathioprine/mercaptopurine therapy at 12 months. Future studies in a more prospective and controlled setting should investigate the prospective function of thioguanine as first-line treatment for IBD.

Reference:

Crouwel, F., Bayoumy, A. B., Mulder, C. J. J., Peters, J. H. C., Boekema, P. J., Derijks, L. J. J., de Boer, S. Y., van de Meeberg, P. C., Ahmad, I., Buiter, H. J. C., & de Boer, N. K. (2023). The Effectiveness and Safety of First-Line Thioguanine in Thiopurine-Naïve Inflammatory Bowel Disease Patients. In Inflammatory Bowel Diseases (Vol. 30, Issue 9, pp. 1492–1499). Oxford University Press (OUP). https://doi.org/10.1093/ibd/izad197

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Vitamin C Boosts Placental Health in Pregnant Smokers, Offering Hope for Offspring Development: Study

USA: Recent research has revealed that vitamin C supplementation can significantly improve placental function and alter gene expression in pregnant smokers, potentially benefiting the health of their offspring. The study, published in Scientific Reports, highlights the important role of vitamin C in addressing the adverse effects of smoking during pregnancy, which is known to compromise fetal development and increase the risk of various health issues.

Researchers utilized RNA sequencing to analyze the impact of vitamin C on placental tissue from pregnant smokers. The results indicated that supplementation led to notable changes in the expression of messenger RNA (mRNA) in genes that are crucial for vascular and cardiac development.

“These findings suggest a promising mechanism by which vitamin C may mitigate some of the detrimental effects of maternal smoking on placental function and, by extension, fetal health,” the researchers wrote.

Smoking during pregnancy has long been linked to reduced blood flow to the placenta, resulting in insufficient nutrient and oxygen delivery to the developing fetus. This can lead to complications such as low birth weight, preterm birth, and lasting developmental issues, including reduced pulmonary function in offspring due to nicotine crossing the placenta. However, vitamin C supplementation during pregnancy has shown promise in preventing some of these adverse effects. Previous research in animal models exposed to prenatal nicotine suggests that vitamin C can enhance placental function, potentially mitigating the negative impacts of maternal smoking.

Against the above background, Eliot R. Spindel, Oregon Health & Science University, Beaverton, OR, USA, and colleagues aimed to determine whether vitamin C supplementation can mitigate the effects of MSDP on placental structure, function, and gene expression in pregnant women who smoke.

For this purpose, the researchers conducted Doppler ultrasound assessments on a subset of 55 pregnant smokers involved in the “Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function” (VCSIP) randomized clinical trial, as well as on 33 pregnant nonsmokers.

The researchers found that Doppler ultrasound measurements indicated a reduction in umbilical vein Doppler velocity (Vmax) among smokers receiving placebo. However, those smokers who were given vitamin C showed a significant improvement, with their Vmax levels returning to those similar to nonsmokers.

This study highlights the potential benefits of vitamin C supplementation for pregnant smokers, specifically in improving placental blood flow. Enhanced umbilical venous flow is crucial for delivering oxygen and nutrients to the fetus, suggesting that vitamin C could mitigate some harmful effects of maternal smoking.

The researchers propose that vitamin C may counteract changes in vascular structure caused by nicotine, thus improving placental function and benefiting offspring’s pulmonary development. RNA sequencing analysis indicates that vitamin C could activate key growth factor signaling pathways and promote blood vessel formation, reinforcing previous research linking placental DNA methylation to infant lung health.

“While these findings are promising, further clinical studies are needed to understand the practical implications of vitamin C supplementation in obstetric care. It remains unclear how these improvements in placental function may influence overall fetal development and obstetric outcomes,” the researchers concluded.

“Notably, while vitamin C supplementation may help address some fetal health issues, it does not counteract all the negative effects of smoking, such as risks of prematurity and neural development challenges. Therefore, smoking cessation continues to be crucial for optimal fetal development in pregnancies where avoiding nicotine is not feasible.”

Reference:

E., L., McEvoy, C. T., M., S., Milner, K., Vuylsteke, B., Tepper, R. S., Morgan, T. K., Roberts, V. H., Lo, J. O., Frias, A. E., Haas, D. M., Park, B., Gao, L., Vu, A., Morris, C. D., & Spindel, E. R. (2024). Vitamin C supplementation improves placental function and alters placental gene expression in smokers. Scientific Reports, 14(1), 1-13. https://doi.org/10.1038/s41598-024-73005-7

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Mepivacaine can reduce pain during IUD placement in Nulliparous Women, reveals research

A groundbreaking study revealed that intrauterine
mepivacaine can significantly reduce pain during intrauterine device placement
in nulliparous women who are at high risk of unintended pregnancy as per a
trial that was published in the American Journal of Obstetrics & Gynecology.

Providing access to successful and effective contraceptive
methods is necessary for comprehensive family planning among women in the reproductive
age group. Long-acting reversible contraception (LARC), such as intrauterine
devices (IUDs) and subdermal implants are the most effective reversible
contraceptive options available and recommended as per international
guidelines. However, fear of pain and discomfort during the IUD placement is a
major barrier to the uptake of IUDs among nulliparous women. Hence, researchers
conducted a trial to assess whether the instillation of intrauterine
mepivacaine before IUD placement alleviates pain more effectively than a
placebo.

a multicenter, double-blind, randomized, placebo-controlled
trial was carried out involving nulliparous women who were ready for IUD
placement. A hydrosonography catheter was used for the intrauterine
instillation of 10 mL of 20 mg/mL mepivacaine or 0.9 mg/mL sodium chloride and
administrated 2 minutes before IUD placement. A 100 mm visual analog scale
(VAS) was used to assess pain at prespecified time points. The primary outcome
was to assess the difference in VAS pain scores between the intervention group
and the placebo group during IUD placement. Secondary outcomes included VAS
pain scores at instillation and 10 minutes after placement, tolerability of the
placement pain, as well as acceptability of the analgesia method.

Findings:

About 151 participants were enrolled, with 76 randomized to
the mepivacaine group and 75 to the placebo group.

The mean VAS pain score during IUD placement showed a
difference of 13.3 mm.

The mepivacaine group had a mean of 53.9 mm, while the
placebo group had a mean of 67.2 mm suggesting that mepivacaine was effective
in reducing the pain.

A statistically significant difference between the pain
scores was seen after adjusting for each individual provider’s impact.

A greater proportion of women in the intervention group
reported tolerable pain during placement with 70/75 participants (93.3%)
compared to 53/66 participants (80.3%) in the placebo group.

Thus, the study concluded that intrauterine instillation of
mepivacaine results in a statistically significant reduction in pain scores
among nulliparous women during IUD placement. The researchers concluded that
there was a reported high acceptance of the IUD after mepivacaine due to
tolerable pain levels reported by women.

Thus, intrauterine mepivacaine installation has better
clinical relevance during IUD placement in reducing pain in nulliparous women
who are at high risk of unintended pregnancy.

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Higher hs-CRP to HDL-C ratio associated with adverse outcomes in ischaemic stroke patients, finds study

A new study published in the journal of BMC Neurology showed that an elevated high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) ratio (hs-CRP/HDL-C ratio) considerably raised the risk of bad outcomes in individuals who had an acute ischemic stroke (AIS), where each unit increase was associated with a 2.4% higher chance of adverse outcomes.

According to recent Global Burden of Disease (GBD) data, stroke mortality, incidence, and disability-adjusted life years (DALYs) decreased between 1999 and 202. It is currently unknown if blood high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) ratios are associated with outcomes in individuals with acute ischemic stroke. 

Data from a prospective cohort study including 1559 AIS patients who were enrolled at a South Korean hospital between January 2010 and December 2016 were used in this secondary analysis. To investigate the relationship between the hs-CRP/HDL-C ratio and adverse outcomes in AIS patients, this study built a binary logistic regression model. To clarify possible nonlinear interactions, a generalized additive model (GAM) with smooth curve fitting was attempted. Also, binary logistic regression models were created for either side of the inflection points, which were found using a recursive technique. The best model for elucidating the relationship between the hs-CRP/HDL-C ratio and adverse outcomes in patients with AIS was ultimately determined using a log-likelihood ratio test.

The outcomes suggested that the median hs-CRP/HDL-C ratio was 3.64, and the incidence of adverse events was 24.5%. A statistically significant positive correlation between the hs-CRP/HDL-C ratio and the probability of poor outcomes in AIS patients was found using the binary logistic regression model after controlling for other variables. With the hs-CRP/HDL-C ratio’s initial inflection point at 42.74, a nonlinear connection was noted. A 2.4% higher chance of adverse outcomes was linked to every unit rise in the hs-CRP/HDL-C ratio.

Overall, the hs-CRP/HDL-C ratio and 3-month adverse outcomes in AIS patients were shown to be positively and nonlinearly correlated in this study. A substantial positive correlation between rising ratios and worse outcomes in AIS patients was identified when the hs-CRP/HDL-C ratio was ≤42.74. Thus, the hs-CRP/HDL-C ratio may be a practical and affordable predictive biomarker that predicts negative results in AIS patients.

Source:

Luwen, H., Lei, X., Qing-Rong, O., Linlin, L., & Ming, Y. (2024). Association between hs-CRP/HDL-C ratio and three-month unfavorable outcomes in patients with acute ischemic stroke: a second analysis based on a prospective cohort study. In BMC Neurology (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12883-024-03929-0

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Breast cancer drug shows potential for treatment of rare appendix cancer, suggests study

Researchers at University of California San Diego School of Medicine found an FDA-approved drug used to treat breast cancer has the potential to be an effective therapeutic for a specific type of appendix cancer.

The clinical trial results, publishing in the October 16, 2024 online edition of the Journal of Clinical Oncology, showed the oral medication, known as palbociclib, stabilized tumor growth and reduced blood tumor marker levels in patients with peritoneal mucinous carcinomatosis (PMC). This form of cancer originates in the appendix and is often resistant to standard chemotherapy.

“Finding that a breast cancer drug is successful in treating a subset of appendix cancer — where treatment options are currently limited — marks a significant advancement in our fight against this disease,” said co-senior author Andrew Lowy, MD, professor in the Department of Surgery and chief of the Division of Surgical Oncology at UC San Diego School of Medicine and clinical director for cancer surgery at Moores Cancer Center at UC San Diego Health. “This breakthrough introduces the first targeted therapy for this rare cancer.”

Appendix cancer is extremely uncommon, accounting for less than 1% of all gastrointestinal cancers, with the American Cancer Society estimating fewer than 2,000 cases diagnosed in the U.S. each year.

The study cohort involved 16 participants diagnosed with PMC, most of whom had previously received other treatments without success. Researchers analyzed the genetic mutations present within these cancers and found that tumors with mutations in one specific gene, GNAS, responded well to the drug. In these patients, blood markers associated with cancer activity were reduced in more than 80% of patients.

Laboratory results also showed that the drug slowed or stopped the multiplication of cancer cells, offering a well-tolerated alternative to chemotherapy, which is often associated with severe side effects.

“This medication can be implemented immediately without the need to wait for a new drug to be developed or for FDA approval,” said co-senior author Shumei Kato, MD, associate professor of medicine at UC San Diego School of Medicine and medical oncologist at UC San Diego Health.

Kato, who is also a UC San Diego Moores Cancer Center member, adds that the study underscores the advanced use of existing cancer treatments.

“The findings signal a promising new era for the treatment of appendix cancer and potentially other rare cancers with similar genetic mutations.”

Next steps include investigating how combining this drug with both traditional chemotherapies and newer targeted therapies could further enhance its effectiveness.

“This groundbreaking study validates our unique position as the only National Cancer Institute (NCI)-designated Comprehensive Center in the region and our commitment to discovering and offering the most leading-edge treatment options,” said Diane Simeone, MD, director of Moores Cancer Center at UC San Diego Health. “As an academic medical center, our clinical researchers are leading trials that are identifying promising new treatments and providing hope for patients who previously had few options.”

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Trans-sinus implants suitable option for rehabilitation of atrophic edentulous jaws, finds study

A new study published in the Journal of Prosthetic Dentistry showed that although trans-sinus implant could be a good choice for treating an atrophic maxilla. When there is not enough bone height in the upper jaw, dental implants can be placed via a surgical technique called trans-sinus implant surgery. Using this technique, the implant is positioned to pass into the sinus cavity and become partially embedded in the sinus floor, providing stability and support for the dental prosthesis. There are not enough systematic evaluations to assess how well trans-sinus dental implants work for oral rehabilitation in individuals with atrophic maxilla. To ascertain the efficacy of trans-sinus dental implants placed in patients with an atrophic maxilla, Pedro Henrique and his team carried out this systematic research.

According to predetermined inclusion and exclusion criteria and the question if trans-sinus implants can be an appropriate choice for the rehabilitation of the atrophic maxilla, five databases including the nonpeer-reviewed literature up until March 2024. Using a 95% confidence interval, the Revman software tool was employed for the meta-analysis of the variables implant loss and marginal bone loss. The ROBINS I technique was used to assess the studies’ risk of bias.

4 of the 1884 articles that were initially discovered in the databases under investigation were included in this systematic evaluation. One was a randomized clinical study, while the other 3 were observational studies. With a 97.2% efficacy rate, a total of 144 patients with 658 implants (207 of which were trans-sinus) were assessed. When comparing trans-sinus implants to conventional implants, there was no statistically significant difference in efficacy, and there was no statistically significant difference in the marginal bone loss of the groups. A low risk of bias was not found in any of the examined research.

Overall, a viable and highly successful approach for the rehabilitation of atrophic edentulous jaws is the use of trans-sinus implants. The limited amount of controlled research on the topic and the significant chance of bias, however, are crucial aspects that need to be taken into account before selecting this treatment.

Reference:

Sales, P. H. da H., Diniz, D. A., Silva, P. G. de B., Carvalho, A. de A. T., Vescovi, P., Meleti, M., & Leão, J. C. (2024). Effectiveness of trans-sinus dental implants in the complete arch rehabilitation of the edentulous maxilla: A systematic review and meta-analysis. In The Journal of Prosthetic Dentistry. Elsevier BV. https://doi.org/10.1016/j.prosdent.2024.08.003

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Total Hip Surgery more effective than Resistance Training in Hip Osteoarthritis: Study

A recent study found that total
hip surgery substantially reduced hip pain and clinically relevant improvement
in hip function than resistance training. This observation was seen in
individuals aged 50 years and older suffering from hip osteoarthritis as
published in The New England Journal of Medicine.

Hip osteoarthritis is a common disability
disorder in old age causing pain, functional impairment, and reduced quality of
life. Total hip replacement surgery is a routine procedure for individuals with
hip osteoarthritis. Non-surgical procedures like resistance training are one of
the common procedures prescribed. However, there is uncertainty in the previous
literature on the effectiveness of total hip surgery over resistance training.
Hence, researchers from Denmark conducted a trial to evaluate whether total hip
replacement would provide superior results regarding alleviation of
patient-reported hip pain and improved patient-reported function as compared
with resistance training.

Also Read: Findings Call for Caution: Broad-Spectrum Antibiotics Raise ADE Risks in Outpatient Pneumonia Patients

A multicenter, randomized,
controlled, superiority trial was carried out by randomly (1:1) assigning the
individuals to undergo total hip replacement or to participate in a supervised
resistance training program using a computer-generated randomization sequence. Individuals
aged 50 years or older who had severe hip osteoarthritis and an
indication for total hip replacement based on hip pain, clinical presentation,
and radiographic imaging were included in the trial. The total hip surgery
included a standard fast-track surgical program while the resistance
training included 1-hour, individual, supervised sessions twice weekly for 12
weeks. After the initiation of the trial, follow-ups were carried out at 3,
6, 12, and 24 months. The primary outcome was the change in patient-reported
hip pain and function from baseline to 6 months as assessed using the Oxford
Hip Score. Secondary outcomes included
changes from baseline to 6 months in patient-reported domains of pain,
symptoms, function in activities of daily living, hip-related quality of life,
and function in sports and recreation.

Findings:

  • A total of 109 patients (mean age, 67.6 years)
    were randomly assigned to total hip replacement (53 patients) or resistance
    training (56 patients).
  • An improvement (mean increase) was seen in the
    Oxford hip score by 15.9 points in total hip replacement and 4.5 points in the
    resistance training group in the intention-to-treat analysis.
  • The total hip replacement group has shown a
    significant improvement over the resistance training group in the intent-to-treat
    analysis.
  • From baseline to 6 months, 5 patients (9%) who
    had been assigned to total hip replacement had not undergone surgery, and 12
    patients (21%) who had been assigned to resistance training had undergone total
    hip replacement.
  • The incidence of serious adverse events at 6
    months was similar in the two groups; the majority of such events were known
    complications of total hip replacement.
Also Read: Ferric derisomaltose plus tranexamic acid may reduce blood transfusion risk by 50% in hip surgery

Thus, the study concluded that total
hip replacement resulted in a clinically important, superior reduction in hip
pain and improved hip function in individuals aged 50 years and older with hip
osteoarthritis.

Further reading: Frydendal T,
Christensen R, Mechlenburg I, et al. Total Hip Replacement or Resistance
Training for Severe Hip Osteoarthritis. N Engl J Med.
2024;391(17):1610-1620. doi:10.1056/NEJMoa2400141

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Women with PCOS may have higher emotional and uncontrolled eating scores, reveals research

Women with PCOS may have higher emotional and uncontrolled eating scores, reveals research published in the Fertility and Sterility.

A study was done to investigate eating behavior domains—emotional, uncontrolled, and cognitive restraint eating—in women with polycystic ovary syndrome (PCOS) with different PCOS phenotypes and women without PCOS at midlife. A prospective cohort study. Eating behavior domains were assessed at age of 46 years. Predictors of eating behaviors were evaluated using variables collected at ages of 31 and 46 years. Women identified as having PCOS (n = 251) at age of 31 years using the updated Rotterdam criteria were compared with women without any PCOS criteria (n = 935). The PCOS population comprised women with the classic A+B-phenotype (hyperandrogenism and oligomenorrhea, with or without elevated antimüllerian hormone, n = 60), C-phenotype (hyperandrogenism and elevated antimüllerian hormone, n = 84), and D-phenotype (oligomenorrhea and elevated antimüllerian hormone, n = 86). Result(s): Compared with women without PCOS, women with PCOS exhibited higher scores for emotional (33.1 ± 27.8 vs. 39.0 ± 29.9) and uncontrolled eating (26.7 ± 18.2 vs. 30.7 ± 19.4) but no difference in cognitive restraint (46.6 ± 18.6 vs. 45.9 ± 18.5) at age of 46 years. Emotional and uncontrolled eating scores were higher in the A+B-phenotype compared with women without PCOS, whereas uncontrolled eating scores in the C-phenotype were higher than in women without PCOS and the D-phenotype. At age of 46 years, the perception of overweight was an independent predictor of emotional eating among women with PCOS (B = 11.96 [95% confidence interval {CI}: 2.81–20.29]), whereas a history of weight loss attempts was a predictor of uncontrolled eating (B = 6.06 [95% CI: 1.05–10.83]). Among women with PCOS, higher psychological distress at age of 31 years was a significant risk factor for scoring in the highest quartile of emotional (adjusted odds ratio [aOR]: 2.85 [95% CI: 1.19–6.85]) and uncontrolled eating (aOR: 4.37 [95% CI: 1.77–10.80]) at age of 46 years. Women with PCOS at midlife showed a high tendency for unfavorable eating behaviors. Our findings emphasize the need for sensitivity in weight management counseling and addressing psychological distress to prevent unfavorable eating in this population.

Reference:

Women with polycystic ovary syndrome are at risk of emotional and uncontrolled eating at midlife: a population-based cohort study. Pesonen, Emilia et al. Fertility and Sterility, Volume 0, Issue 0

Keywords:

Women, PCOS, higher, emotional, uncontrolled, eating, scores, reveals, research, Fertility and Sterility, Pesonen, Emilia, PCOS, eating behavior, disordered eating, TFEQ-18

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Exposure to TNF Inhibitors Associated with Increased Risk of Inflammatory CNS Diseases: Study

A recent meta-analysis published in JAMA Neurology has revealed that tumor necrosis factor (TNF) inhibitors, widely used in treating autoimmune diseases, may increase the risk of inflammatory central nervous system (CNS) diseases. The study, analyzing data from 18 observational studies involving over 1.1 million patients, provides important insights into this rare but serious side effect.

The research found that patients receiving TNF inhibitors had a 36% higher risk of developing inflammatory CNS diseases compared to those on conventional treatments. This increased risk was primarily associated with demyelinating conditions, rather than non-demyelinating diseases. The findings remained consistent across different types of autoimmune conditions and various TNF inhibitors.

The study encompassed data from more than 258,897 patients who received TNF inhibitors, with new-onset inflammatory CNS events occurring at rates between 2.0 to 13.4 per 10,000 person-years. The analysis covered both rheumatic diseases and inflammatory bowel disease, finding no significant difference in risk between these conditions.

When comparing different TNF inhibitors, the researchers found similar risk levels among most medications, though certolizumab pegol showed a slightly higher risk. However, researchers caution that this finding needs further investigation due to limited data.

Several mechanisms might explain this increased risk, including restricted entry due to the blood-brain barrier, increased autoreactive T cells, and alterations in cytokine responses. Interestingly, classical risk factors for multiple sclerosis are not typically observed in TNF inhibitor-related cases, suggesting unique underlying mechanisms.

The study had some limitations. As an analysis of observational studies, it couldn’t completely rule out confounding factors such as disease severity. Additionally, most studies relied on diagnostic codes rather than detailed neurological examinations, which could have led to some misclassification of cases.

Looking ahead, researchers recommend several areas for future study. These include more comprehensive real-world data collection, comparison with newer alternative therapies, and better understanding of non-demyelinating conditions. There’s also a need to investigate the specific risk profile of TNF inhibitor-related CNS inflammation, as it appears distinct from typical multiple sclerosis cases.

Despite these limitations, this research represents the most comprehensive analysis to date of the relationship between TNF inhibitors and inflammatory CNS diseases. The findings underscore the importance of careful patient monitoring and informed decision-making when prescribing these medications.

For healthcare providers, the message is clear: while TNF inhibitors remain valuable treatment options for autoimmune diseases, the risk of neurological complications should be considered and discussed with patients. Regular monitoring and prompt evaluation of any neurological symptoms are essential components of patient care.

Reference

Xie W, Sun Y, Zhang W, Zhu N, Xiao S. Risk of Inflammatory Central Nervous System Diseases After Tumor Necrosis Factor–Inhibitor Treatment for Autoimmune Diseases: A Systematic Review and Meta-Analysis. JAMA Neurol. Published online October 21, 2024. doi:10.1001/jamaneurol.2024.3524

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