Long-term inhaled corticosteroid use for COPD linked to serious long-term health risks, suggests research

Inhaled corticosteroids (ICS) are commonly prescribed for chronic obstructive pulmonary disease (COPD), but not recommended as first-line treatment unless patients have asthma/COPD overlap or frequent exacerbations. This study examined whether long-term ICS use (more than two years) increases the risk of serious health conditions compared with short-term use (less than 4 months).

Researchers analyzed electronic health records from over 20 million patients, focusing on individuals aged 45 and older with a COPD diagnosis. They created two groups: a prevalent cohort (patients diagnosed with COPD at any time) and an inception cohort (patients newly diagnosed with COPD). Using propensity score matching, they compared long-term ICS users with those with short-term use. Researchers examined the risk of developing both a composite outcome (any of five major conditions) and individual health outcomes for over 500,000 people.

Main Results:

Overall Risk (Composite Outcome)

• Compared with those using ICS for a short time, long-term ICS users were more than twice as likely to develop at least one of the following conditions:

• Type 2 diabetes

• Cataracts

• Pneumonia

• Osteoporosis

• Nontraumatic fractures

Prevalent cohort (all COPD patients): risk was 165% higher Inception cohort (newly diagnosed COPD patients): risk was 160% higher Among newly diagnosed COPD patients, 1 in 5 long-term ICS users developed at least one of these conditions.

Recurrent Cases

• Some conditions were also analyzed for recurrent cases (meaning patients who developed them more than once):

• People on long-term ICS were nearly three times as likely to have repeated cases of pneumonia Fractures were also more likely to happen again

Individual Outcomes

Diabetes, cataracts, pneumonia, osteoporosis, and fractures were also more common in long-term ICS users before being combined into the composite outcome.

Why It Matters: Many patients with COPD are prescribed ICS even when not medically necessary, exposing them to serious long-term risks.

Reference:

Pace, W. D., et al. (2025). Adverse Outcomes Associated With Inhaled Corticosteroid Use in Individuals With Chronic Obstructive Pulmonary Disease. The Annals of Family Medicine. doi.org/10.1370/afm.240030.

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FDA Grants Accelerated Approval to Atrasentan for IgA Nephropathy

The US FDA has granted accelerated approval to atrasentan (Vanrafia) for reducing proteinuria in adults with primary immunoglobulin A (IgA) nephropathy, according to an announcement by Novartis. Vanrafia is the first and only selective endothelin receptor antagonist approved for this use.It is indicated for patients at high risk of rapid disease progression, identified by a urine protein-to-creatinine ratio (UPCR) of 1.5 g/g or higher.This marks a significant advancement in treatment options for patients battling progressive IgA nephropathy.

Vanrafia was granted accelerated approval based on a prespecified interim analysis of the Phase III ALIGN study measuring the reduction of proteinuria at 36 weeks compared to placebo. It has not been established whether Vanrafia slows kidney function decline in patients with IgAN. The continued approval of Vanrafia may be contingent upon the verification of clinical benefit from the ongoing Phase III ALIGN study evaluating whether Vanrafia slows disease progression as measured by estimated glomerular filtration rate (eGFR) decline at week 136. The eGFR data are expected in 2026 and intended to support traditional FDA approval.

“Today’s approval marks an important milestone for people living with IgA nephropathy, offering a new option that can be seamlessly integrated into their existing treatment plan, with no REMS requirement,” said Richard Lafayette, M.D., F.A.C.P., Professor of Medicine, Nephrology and Director of the Glomerular Disease Center at Stanford University Medical Center, and Vanrafia ALIGN Study Investigator and Steering Committee Member. “Vanrafia is a selective ETA receptor antagonist that effectively reduces proteinuria, a major risk factor in IgAN. Taking early, decisive action is critical to help improve outcomes for these patients who too often progress toward kidney failure.”

IgAN is a progressive, rare kidney disease in which the immune system attacks the kidneys, often causing glomerular inflammation and proteinuria. With almost 13 out of every million people in the US diagnosed per year, it is one of the most common autoimmune kidney diseases, and each person’s journey is unique. Up to 50% of IgAN patients with persistent proteinuria progress to kidney failure within 10 to 20 years of diagnosis, often requiring maintenance dialysis and/or kidney transplantation, and response to treatment can vary. Effective, targeted therapies with different mechanisms of action can help physicians select the most appropriate treatment for patients.

“My son was diagnosed with IgA nephropathy long before there were any medicines approved to treat this condition, so the availability of multiple treatment options is incredibly meaningful for this community,” said Bonnie Schneider, Director and Co-Founder, IgA Nephropathy Foundation. “The approval of Vanrafia broadens the treatment landscape and expands the opportunity to tailor care in a disease that can impact each patient so differently.”

Data supporting approval

In the ongoing Phase III ALIGN study, patients receiving Vanrafia in combination with a RAS inhibitor achieved clinically meaningful and statistically significant proteinuria reduction of 36.1% (P<0.0001) compared to placebo, with results seen as early as week 6 and sustained through week 36. The effect of Vanrafia on UPCR was consistent across subgroups, including age, sex, race, and baseline disease characteristics, such as eGFR and proteinuria levels, in the main study cohort1. A similar treatment effect of Vanrafia was seen in an additional group of patients treated with both a RAS inhibitor and an SGLT2 inhibitor (37.4% reduction in UPCR vs. placebo).

The ALIGN study showed that Vanrafia has a favorable safety profile consistent with previously reported data. Adverse events reported in ≥2% of patients treated with Vanrafia, and more frequently than placebo, include peripheral edema, anemia, and liver transaminase elevation. Because some endothelin receptor antagonists have caused elevations of aminotransferases, hepatotoxicity, and liver failure, clinicians should obtain liver enzyme testing before initiating Vanrafia and during treatment when clinically indicated. Vanrafia may cause serious birth defects. Vanrafia does not require a REMS program.

Transforming care in kidney disease

“We are proud to expand the treatment landscape in IgA nephropathy with today’s FDA accelerated approval of Vanrafia. IgAN is a heterogenous condition that requires differentiated therapies with unique mechanisms of action, and with our multi-asset kidney disease portfolio, we are well positioned to support a broad patient population and advance care for this disease,” said Victor Bultó, President, US, Novartis. “Building on our longstanding legacy in nephrology, we continue to rapidly grow our capabilities in this space. Each launch enables us to more effectively reach patients with the most suitable treatment option and deliver on our promise to transform kidney disease care.”

This is the third US approval received by Novartis for its kidney disease portfolio in the last year, with Fabhalta® having been granted FDA approval in C3 glomerulopathy (C3G) in March 2025 and accelerated approval in IgAN in August 2024. Fabhalta is also being studied in a broad range of rare kidney diseases, including atypical hemolytic uremic syndrome (aHUS), immune complex membranoproliferative glomerulonephritis (IC-MPGN) and lupus nephritis (LN). Studies are ongoing to evaluate the safety and efficacy profiles in these investigational indications and support potential regulatory submissions. An investigational subcutaneously administered anti-APRIL monoclonal antibody, zigakibart, is currently in Phase III development in IgAN, with results expected in 2026.

About ALIGN

The ALIGN study  is a global, randomized, multicenter, double-blind, placebo-controlled Phase III clinical trial comparing the efficacy and safety of Vanrafia versus placebo in patients with IgAN at risk of progressive loss of kidney function. In total, 340 individuals with biopsy-proven IgAN with baseline total proteinuria ≥1 g/day despite optimized RAS inhibitor treatment were randomized to receive once-daily, oral Vanrafia (0.75 mg) or placebo for approximately 132 weeks. Patients continue receiving a maximally tolerated and stable dose of a RAS inhibitor as supportive care (unless they are unable to tolerate RAS inhibitor therapy). An additional group of 64 patients receiving an SGLT2 inhibitor for at least 12 weeks was also enrolled. The primary efficacy endpoint for the interim analysis is change in proteinuria, a marker of kidney damage, as measured by 24-hour UPCR from baseline to 36 weeks. Secondary and exploratory objectives include evaluating the change in kidney function from baseline to 136 weeks as measured by eGFR, as well as safety and tolerability.

VANRAFIA Indications

VANRAFIA is a prescription medicine used to reduce protein in the urine (proteinuria) in adults with a kidney disease called primary immunoglobulin A nephropathy (IgAN) who are at risk of their disease getting worse quickly. It is not known if VANRAFIA is safe and effective in children.

VANRAFIA is approved based on a reduction of proteinuria. Continued approval may require results from an ongoing study to determine whether VANRAFIA slows decline in kidney function.

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Modern airflow ventilation systems in OT fails to reduce the post surgery infection rate: Study

A new study published in The New England Journal of Medicine Evidence showed that the post-surgery infection marker (PSIM) rate during orthopedic surgery was not decreased by the installation of wall-mounted plasma air purifiers in contemporary operating rooms with conventional, moderate airflow ventilation systems.

The total estimated incidence of surgical site infections (SSI) following orthopedic surgery is between 1% and 4%, even with clean operating rooms (ORs), surface sterilization, and medicines. Therefore, it is crucial to prevent SSIs. There is a chance of postoperative infection because airflow in the operating room might disperse airborne particles.

These airborne particles, which are mostly emitted into the surrounding air of the operating room by the surgical team members and the patient, comprise dust, textile fibers, skin scales, and breathing aerosols. They are packed with live bacteria, including Staphylococcus aureus. Modern ventilation systems have had modest effectiveness in lowering SSI rates, despite their considerable cost and resource requirements. Thus, this study was set to determine whether SSI rates following orthopedic surgery may be decreased by using a cheap air filter.

This research enrolled all patients receiving orthopedic surgery throughout the study period in a multicenter trial that was conducted worldwide. While the control group had surgery in operating rooms with the identical air purifiers that were not in use, the intervention group had surgery in operating rooms with active Novaerus NV800 air purifiers.

As a PSIM, a customized composite outcome based on registry information for prescription antibiotics, diagnoses, and surgical procedures, the primary end objective was SSI within 12 weeks after surgery. The primary outcome was assessed using logistic regression.

Out of the 40,547 patients who were examined, 20,678 were in the control group and 19,869 were in the intervention group. The innovation group’s PSIM rate was 9.2%, whereas the control group’s was 9.4%. The intervention group’s odds ratio was 0.98 (95% CI 0.91 to 1.05). This result was true for several subgroups according to ventilation modes, hospital levels, and diagnoses.

Overall, in the current operating rooms with typical, moderate airflow ventilation systems, adding wall-mounted plasma air purifiers did not diminish the PSIM rate following orthopedic surgery.

Source:

Persson, A., Atroshi, I., Tyszkiewicz, T., Hailer, N. P., Lazarinis, S., Eisler, T., Brismar, H., Mukka, S., Kernell, P.-J., Mohaddes, M., Sköldenberg, O., & Gordon, M. (2025). Effect of plasma air purifiers on infection rates in orthopedic surgery. NEJM Evidence, 4(4), EVIDoa2400289. https://doi.org/10.1056/EVIDoa2400289

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Post-Bariatric Surgery Pregnancies Pose Higher Neonatal Risks Despite Maternal Benefits

Researchers found in a new study that pregnancies after metabolic bariatric surgery (BS) are linked to both maternal health improvement and more neonatal risk. A national study done in France included 55,941 pregnancies after BS over 10 years and revealed that pregnancies following BS were less common for gestational hypertension, preeclampsia, and gestational diabetes but higher risk of SGA babies, prematurity, stillbirth, and perinatal mortality. This study was published in The Lancet Regional Health journal by Pierre B.L. and fellow researchers.

The analysis was done on data from a French nationwide retrospective cohort of post-BS pregnancies between January 1, 2013, and December 31, 2022. 55,941 post-BS pregnancies were compared to 223,712 control pregnancies that were matched for delivery date, parity, age, obesity, hypertension, diabetes, and socioeconomic status. 11,777 post-BS pregnancies were also compared with pre-BS pregnancies in the same women. Generalized estimating equations and conditional logistic regression were employed to evaluate maternal and neonatal outcomes, with testing of interactions with BS type, time from BS to conception, and malnutrition.

Maternal Outcomes

Post-BS pregnancies compared with control pregnancies were associated with a lower risk of maternal complications:

  • Gestational hypertension was lower (OR 0.57, 95% CI 0.53–0.62).

  • Risk of preeclampsia was lower (OR 0.59, 95% CI 0.55–0.64).

  • Incidence of gestational diabetes was lower (OR 0.64, 95% CI 0.62–0.66).

  • The reductions were even greater when compared to pre-BS pregnancies.

Neonatal Risks

Post-BS pregnancies were linked with higher neonatal complications:

  • Risk of SGA was significantly increased (OR 1.74, 95% CI 1.68–1.79) when compared to controls and even greater (OR 1.88, 95% CI 1.64–2.16) when compared to pre-BS pregnancies.

  • Risk of prematurity was increased (OR 1.27, 95% CI 1.22–1.31) when compared to controls but was not significantly different from pre-BS pregnancies (OR 0.95, 95% CI 0.85–1.06).

  • Risk of stillbirth was increased (OR 1.2, 95% CI 1.06–1.35), mostly mediated by SGA.

  • Risk of perinatal death was increased (OR 1.5, 95% CI 1.13–1.99), mediated by prematurity and SGA.

Risk Factors for Neonatal Complications

The research identified certain factors that increased neonatal risks:

  • Malnutrition: SGA risk was increased (OR 2.38, 95% CI 1.96–2.88) and prematurity (OR 2.45, 95% CI 1.99–3.00).

Decreased intervals between BS and conception:

  • <6 months: Higher SGA risk (OR 1.95, 95% CI 1.72–2.21, pinteraction = 0.01).

  • 6–12 months: Increased SGA risk (OR 1.86, 95% CI 1.70–2.04, pinteraction = 0.02).

  • Gastric bypass surgery: Increased SGA risk (OR 1.88, 95% CI 1.77–2.00, pinteraction = 0.027) and prematurity risk (OR 1.46, 95% CI 1.36–1.57, pinteraction = 0.0003).

The study authors concluded that pregnancies after bariatric surgery are accompanied by a reduced risk of maternal complications but with higher risks for adverse neonatal outcomes, especially SGA, prematurity, stillbirth, and perinatal death. Pregnancies after BS need special prenatal care to provide improved maternal and neonatal outcomes.

Reference:

Bel Lassen, P., Tropeano, A.-I., Arnoux, A., Lu, E., Romengas, L., Katsahian, S., Ségrestin, B., Lelièvre, B., Mitanchez, D., Gascoin, G., Poghosyan, T., Lazzati, A., Heude, B., Nizard, J., Czernichow, S., Ciangura, C., & Rives-Lange, C. (2025). Maternal and neonatal outcomes of pregnancies after metabolic bariatric surgery: a retrospective population-based study. The Lancet Regional Health. Europe, 51(101263), 101263. https://doi.org/10.1016/j.lanepe.2025.101263

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High C-Reactive Protein Levels May Double Stroke Risk, Study Finds

China: A recent study published in the Journal of the American Heart Association has illuminated the association between C-reactive protein (CRP) levels and stroke risk, offering crucial insights into how inflammation may influence different types of stroke.

The UK Biobank study found that increasing or consistently elevated CRP levels were linked to a higher risk of stroke. Elevated CRP was associated with a 44% increased risk of any stroke and a 65% greater likelihood of ischemic stroke. The highest risk was observed in individuals with persistently high CRP, nearly doubling their chances of hemorrhagic stroke. Genetic analysis further confirmed CRP’s significant connection to stroke risk.

Stroke affects one in four individuals worldwide, ranking as the second leading cause of death and a major contributor to disability. Ischemic strokes account for about 80% of cases. Inflammation plays a key role in stroke risk, with CRP serving as a recognized biomarker. While most studies focus on single CRP measurements, variations over time may offer better risk assessment. Genetic factors also influence stroke susceptibility, yet no research has fully explored the genome-wide link between CRP changes and stroke risk. Understanding these connections could improve stroke prediction and prevention strategies.

Against the above background, Jun Lyu, Department of Clinical Research Jinan University First Affiliated Hospital Guangzhou, Guangdong, China, and colleagues sought to investigate the relationship between changes in CRP levels and the risk of stroke and its subtypes.

For this purpose, the researchers analyzed UK Biobank data to explore the link between CRP changes and stroke risk using Cox proportional hazards regression. They further conducted genetic analyses, including genetic correlation, pairwise genome-wide association studies, and polygenic risk scores. The study included 14,754 participants with a median follow-up of 10.4 years.

The study led to the following findings:

  • Participants with an increased CRP percentage had a higher risk of any stroke (HR 1.44) and ischemic stroke (HR 1.65).
  • Those whose CRP levels became high had an increased risk of any stroke (HR 1.45), while those with persistently high CRP faced the greatest risk (HR 1.74).
  • Similar trends were observed for ischemic stroke.
  • Persistently high CRP levels were also linked to a greater risk of hemorrhagic stroke (HR 1.91).
  • Genetic analysis revealed a significant genetic correlation between CRP and stroke.
  • Five shared genomic regions between CRP and stroke were identified.
  • Individuals with both high stroke polygenic risk scores and elevated or persistently high CRP levels had the highest stroke risk.

This study highlights the association between CRP changes and stroke risk, showing that elevated or persistently high CRP levels increase the likelihood of any stroke and ischemic stroke. In contrast, hemorrhagic stroke is linked only to sustained high CRP levels. Genetic analyses further revealed shared biological pathways between CRP and stroke, identifying five common genomic regions. Individuals with both high stroke polygenic risk scores and elevated or persistent CRP levels faced the greatest stroke risk.

“These findings emphasize the importance of monitoring CRP changes over time for improved stroke risk assessment and may inform future prevention strategies,” the authors concluded.

Reference: https://doi.org/10.1161/JAHA.124.03808

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Quetiapine bests Lithium for Treatment-Resistant Depression, finds research

Researchers have found in a new pragmatic clinical trial that quetiapine was more effective than lithium for augmenting treatment-resistant depression. Quetiapine also led to greater improvements in quality-adjusted life years and was likely more cost-effective. The study highlighted the importance of predicting patient tolerance and response to augmentation strategies.

Lithium and quetiapine are first-line augmentation options for treatment-resistant depression; however, few studies have compared them directly, and none for longer than 8 weeks. We aimed to assess whether quetiapine augmentation therapy is more clinically effective and cost-effective than lithium for patients with treatment-resistant depression over 12 months.

They did this pragmatic, open-label, parallel-group, randomised controlled superiority trial at six National Health Service trusts in England. Eligible participants were adults (aged ≥18 years) with a current episode of major depressive disorder meeting DSM-5 criteria, with a score of 14 or higher on the 17-item Hamilton Depression Rating Scale at screening who had responded inadequately to two or more therapeutic antidepressant trials. Exclusion criteria included having a diagnosis of bipolar disorder or current psychosis. Participants were randomly assigned (1:1) to the decision to prescribe lithium or quetiapine, stratified by site, depression severity, and treatment resistance, using block randomisation with randomly varying block sizes. After randomisation, pre-prescribing safety checks were undertaken as per standard care before proceeding to trial medication initiation. The coprimary outcomes were depressive symptom severity over 12 months, measured weekly using the Quick Inventory of Depressive Symptomatology, and time to all-cause treatment discontinuation. Economic analyses compared the cost-effectiveness of the two treatments from both an NHS and personal social services perspective, and a societal perspective. Primary analyses were done in the intention-to-treat population, which included all randomly assigned participants. People with lived experience were involved in the trial. Findings: Between Dec 5, 2016, and July 26, 2021, 212 participants (97 [46%] male gender and 115 [54%] female gender) were randomly assigned to the decision to prescribe quetiapine (n=107) or lithium (n=105). The mean age of participants was 42·4 years (SD 14·0 years) and 188 (89%) of 212 participants were White, seven (3%) were of mixed ethnicity, nine (4%) participants were Asian, four (2%) were Black, three (1%) were of Other ethnicity, and ethnicity was not recorded for one (1%) participant. Participants in the quetiapine group had a significantly lower overall burden of depressive symptom severity than participants in the lithium group (area under the between-group differences curve –68·36 [95% CI –129·95 to –6·76; p=0·0296). Time to discontinuation did not significantly differ between the two groups. Quetiapine was more cost-effective than lithium. 32 serious adverse events were recorded in 18 participants, one of which was deemed possibly related to the trial medication in a female participant in the lithium group. The most common serious adverse event was overdose, occurring in three (3%) of 107 participants in the quetiapine group (seven events) and three (3%) of 105 participants in the lithium group (five events). Results of the trial suggest that quetiapine is more clinically effective than lithium as a first-line augmentation option for reducing symptoms of depression in the long-term management of treatment-resistant depression, and is probably more cost-effective than lithium.

Reference:

Clinical and cost-effectiveness of lithium versus quetiapine augmentation for treatment-resistant depression: a pragmatic, open-label, parallel-group, randomised controlled superiority trial in the UK. Cleare, Anthony JRucker, James et al. The Lancet Psychiatry, Volume 12, Issue 4, 276 – 288

Keywords:

Quetiapine, bests, Lithium, Treatment-Resistant, Depression, finds, research, The Lancet Psychiatry

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Brain functional networks adapt in response to surgery and Botox for facial palsy, reports study

For patients undergoing nerve transfer surgery for facial palsy, Botox injections can improve facial symmetry by reducing overactivity of the muscles on the unaffected side, suggests a study in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

The added benefit of Botox reflects modifications in brain functional network connectivity, according to the new research, led by Ye-Chen Lu, MD, PhD, and Wei Wang, MD, PhD, of Shanghai Jiao Tong University School of Medicine, China. They write, “These findings imply that enhanced connectivity between brain functional networks play a vital role in the recovery process from neurological disorders.”

BoNT-A improves outcomes of surgery for facial palsy

Facial nerve injury can cause paralysis on the affected side of the face, leading to functional and cosmetic impairments. For patients with this condition, nerve transfer surgery is recommended to restore facial nerve function and symmetry.

However, many patients have persistent impairment after surgery, especially drooping of the corner of the mouth (oral commissure) on the affected side. This condition has been linked to overactivity of the muscles on the opposite side, leading to facial asymmetry even at rest.

Such patients have been successfully treated using botulinum toxin-A (BoNT-A; best known by the brand name Botox) to produce temporary relaxation of overactive muscles on the unaffected side. Previous studies suggest lasting improvement, even after the effects of BoNT-A fade.

Benefits linked to changes in brain network connectivity

“We hypothesize that BoNT-A treatment triggers extensive cortical plasticity, offering a potential explanation for its long-lasting therapeutic impact on patients with facial asymmetry,” the researchers write. They used functional magnetic resonance imaging (fMRI) scans to assess functional activity of brain networks before and after surgery and BoNT-A treatment.

The study included 38 patients with facial palsy and “severe oral commissure drooping” after surgery for benign tumors (acoustic neuromas). All underwent nerve transfer surgery followed by facial training and rehabilitation. In addition, patients were randomly assigned to a treatment group receiving a series of BoNT-A injections of the facial muscles on the unaffected side; or a control group receiving no BoNT-A.

Patients receiving BoNT-A had significant improvement in facial asymmetry. “BoNT-A injections improved facial static function without affecting smile function,” the researchers write. As in previous studies, the benefits persisted beyond six months, after the effects of BoNT-A wore off.

Before surgery and one year later, patients underwent fMRI scans to assess changes in in brain functional network connectivity. Of nine resting state networks (RSNs) studied, five showed “significant differences of spatial distribution” between groups. Patients receiving BoNT-A “displayed an overall stronger interaction between several RSNs” – notably including the sensorimotor and visual networks.

“Our research provides evidence of long-term and widespread changes in cerebral networks among facial paralysis patients,” Drs Lu and Wang and coauthors write. These effects may explain why the improvement persists even after the effects of BoNT-A dissipate.

BoNT-A injections “may create a “window of time for nerve reanimation, allowing the brain to learn and restore proper facial muscle activity.” The researchers conclude: “These findings imply that enhanced connectivity between brain functional networks play a vital role in the recovery process from neurological disorders.”

Reference:

Ma, Hao MD1; Zhou, Yu-lu MD1,3; Wang, Wen-jin PhD1; Chen, Gang MD1; Zhang, Chen-hao MD2; Lu, Ye-chen MD1,3; Wang, Wei MD2,3. Facial Symmetry Enhancement and Brain Network Modifications in Facial Palsy Patients after Botulinum Toxin Type A Treatment. Plastic and Reconstructive Surgery 155(3):p 586e-596e, March 2025. | DOI: 10.1097/PRS.0000000000011689

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Hyperemesis gravidarum Exposure not linked to Long-Term Outcomes of children, claims research

Researchers using a sibling-comparison design have found in a new study that there is no link between hyperemesis gravidarum (HG) exposure and children’s long-term educational, neurodevelopmental, or health outcomes when accounting for shared family influences.

Hyperemesis gravidarum (HG), characterised by severe and constant nausea and vomiting in pregnancy, can lead to nutritional deficiencies and other pregnancy complications. In turn, HG has also been linked with adverse long-term health and neurodevelopmental outcomes for the children of women affected by hyperemesis gravidarum. However, previous studies have not accounted for potential confounding due to shared family-level factors. This study aimed to determine whether maternal HG was associated with long-term educational, neurodevelopmental, and health outcomes for children, and whether these findings were substantiated when using a sibling-comparison design. This population-based record linkage cohort study featured livebirths in New South Wales, Australia from 2002 to 2010. Maternal HG was classified using hospital admissions and emergency department presentations during pregnancy. Outcomes included standardised educational testing at Year 3 (age 7 to 9 years), disability service utilisation for neurodevelopmental disorders (NDDs), and age-specific hospitalisations up to 7 years of age. Robust Poisson models with generalised estimating equations were used to estimate the risk of lower educational performance and hospitalisations. Cox Proportional Hazards models with a robust sandwich estimator were used to assess the time to first NDD-related disability service. Inverse probability of treatment weighting was used to account for potential confounding. Analyses were also restricted to an exposure-discordant sibling cohort to account for unmeasured genetic and familial factors. Results: Of the 700,082 livebirths included in the study, 10,282 (1.5%) were born to mothers who had hyperemesis gravidarum during their pregnancy. Maternal hyperemesis gravidarum was associated with a higher risk of their offspring being below the national standard in reading, spelling, grammar and numeracy, as well as utilisation of NDD-related disability services and age-specific hospitalisations. However, for most outcomes these associations were nullified in the sibling cohort. They did not find an association between hyperemesis gravidarum exposure and long-term educational, neurodevelopmental, and health outcomes for children when accounting for shared family influences using a sibling-comparison design. The lack of evidence of a direct link between maternal hyperemesis gravidarum and long-term impacts on children is reassuring for mothers who are afflicted with this condition.

Reference:

Sarah Pont, Diana M. Bond, Antonia W. Shand, Iqra Khan, Simon Paget, Helga Zoega, Natasha Nassar. Long-term health, neurodevelopmental and educational outcomes of children born to mothers with hyperemesis gravidarum: A population-based sibling-design record linkage cohort study. American Journal of Obstetrics and Gynecology,

2025, ISSN 0002-9378. https://doi.org/10.1016/j.ajog.2025.02.044.

(https://www.sciencedirect.com/science/article/pii/S0002937825001504)

Keywords:

Hyperemesis, gravidarum, Exposure, linked, Long-Term, Child, Outcomes, claims, research, American Journal of Obstetrics and Gynecology, Sarah Pont, Diana M. Bond, Antonia W. Shand, Iqra Khan, Simon Paget, Helga Zoega, Natasha Nassar, Child, outcomes, cohort study, epidemiology, hyperemesis, gravidarum, pregnancy complications, sibling, cohort

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Women with Hashimoto’s Thyroiditis Face Increased Risk of Oral Lichen Planus: Study Finds

China: A recent study has found that in patients with Hashimoto’s thyroiditis (HT), the presence of thyroid nodules, a higher FT3/FT4 ratio, and positive thyroglobulin antibodies were associated with an increased risk of developing oral lichen planus (OLP).

“Those with both HT and OLP exhibited a greater prevalence of thyroid nodules (40.7% vs. 5.3%) and positive thyroglobulin antibodies (79.9% vs. 53.9%) compared to HT patients without OLP. Notably, this association was observed exclusively in female patients,” the researchers reported in BMC Oral Health.

OLP, a chronic inflammatory disorder affecting the oral mucosa, has been linked to various systemic diseases, including thyroid disorders. However, the extent of its connection with HT remains unclear. Considering this, Yang Liu, Nanjing Medical University, Wuxi People’s Hospital, Wuxi, Jiangsu, China, and colleagues investigated the potential association between oral lichen planus and Hashimoto’s thyroiditis, highlighting key laboratory indicators that may contribute to the coexistence of these conditions.

The case-control study included 135 patients diagnosed with HT, of whom 59 had OLP, while 76 had HT without OLP. Researchers analyzed five key thyroid-related serum indicators—thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4)—to determine any significant differences between the two groups.

The study revealed the following findings:

  • Patients with both Hashimoto’s thyroiditis (HT) and oral lichen planus (OLP) showed a higher prevalence of female predominance, thyroid nodules, positive thyroglobulin antibodies (TGAb), and an increased FT3/FT4 ratio compared to those with HT alone.
  • The presence of thyroid nodules was significantly associated with an increased risk of OLP in HT patients (OR: 10.328).
  • Positive TGAb levels were also linked to a higher likelihood of OLP occurrence in HT patients (OR: 6.936).
  • A higher FT3/FT4 ratio was significantly associated with OLP development in HT patients (OR: 2.577).
  • These associations were observed specifically in female patients (105 cases), while no significant correlation was found among male patients (30 cases).

Researchers emphasized that the findings underscore the importance of oral health monitoring in female patients diagnosed with HT, particularly those presenting with thyroid nodules and elevated thyroid antibody levels. Given the chronic nature of HT and OLP, early identification of risk factors may aid in better disease management and timely intervention.

The study contributes valuable insights into the interplay between autoimmune thyroid disorders and inflammatory oral conditions. Although the findings highlight a strong correlation, researchers caution that high variability among study participants necessitates further investigation to establish causality. Future studies should focus on exploring demographic and clinical factors influencing the relationship between OLP and HT to optimize patient care.

“Overall, this research highlights the need for heightened awareness among healthcare providers regarding the potential oral manifestations of HT. Patients, particularly women diagnosed with HT, should be encouraged to undergo regular oral mucosal examinations to facilitate early detection and management of OLP,” the authors concluded.

Reference:

Liu, Y., Tang, Y., Zhou, Z. et al. Laboratory investigation of the association between oral lichen planus and Hashimoto’s thyroiditis. BMC Oral Health 25, 429 (2025). https://doi.org/10.1186/s12903-025-05780-2

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Certain biologics May Reduce Infection Risk among elderly with Psoriasis: JAMA

A new cohort study published in Journal of American Medical Association suggests that biologics targeting IL-12, IL-23, and IL-17 may be associated with lower rates of serious infection among older adults with psoriasis and psoriatic arthritis. Therefore considering their established efficacy, these biologics could be preferred over other treatment options for older patients. This study was conducted by Aaron M. and fellow researchers in Canada.

Systemic treatments for psoriatic disease affect immune function and may raise the risk of infections. Since older persons are at increased risk for infections, the relative safety of these treatments is important to know. This cohort study used population-based health administrative linked data in Ontario between 2002 and 2021. The research involved Ontario residents aged 66 years and older who were newly prescribed their first systemic psoriatic disease medication from April 1, 2002, to December 31, 2020. Data analysis took place between November 2021 and August 2024.

Participants were grouped according to the systemic medication prescribed to them, including:

  • Methotrexate

  • Other older systemic agents

  • Anti-tumor necrosis factor (anti-TNF) biologics

  • Other biologics (IL-12, IL-23, IL-17 targeting)

  • Tofacitinib

The main exposure was time-varying use of these agents, and the main outcome was time to serious infection, which was hospitalization for any infectious reason through March 2021.

Key Findings

  • There were a total of 11,641 patients enrolled, of whom 6,114 (53%) were female and median age 71 years (IQR: 68-76 years).

  • There were 1,967 serious infections during a median follow-up of 4.8 years (IQR: 2.3-8.4 years).

Rates of infections per 100 person-years differed by treatment group:

  • Methotrexate: 2.7 infections

  • Other older systemic therapies: 2.5 infections

  • Anti-TNF biologics: 2.2 infections

  • Other biologics (IL-12, IL-23, IL-17): 1.4 infections

  • Tofacitinib: 8.9 infections

Adjusted relative risk (RR) of serious infections versus non-use of respective treatments:

  • Methotrexate: RR = 0.95 (95% CI: 0.85-1.07)

  • Other older systemic therapies: RR = 0.92 (95% CI: 0.79-1.07)

  • Anti-TNF biologics: RR = 0.87 (95% CI: 0.69-1.10)

  • Other biologics (IL-12, IL-23, IL-17): RR = 0.65 (95% CI: 0.48-0.88)

  • Tofacitinib: RR = 2.89 (95% CI: 1.14-7.34)

  • Other biologics (IL-12, IL-23, IL-17) were associated with a reduced incidence of serious infections, whereas tofacitinib had an increased risk of infections.

The study authors conclude that biologics against IL-12, IL-23, and IL-17 can be a safer choice for elderly patients with psoriatic disease because they are less likely to cause serious infections. Conversely, tofacitinib was associated with a considerably increased risk of infection, necessitating cautious use in clinical practice. These results highlight the value of personalized treatment decisions to reconcile efficacy and safety in elderly patients with psoriatic disease.

Reference:

Drucker AM, Sutradhar R, Ling V, et al. Systemic Therapies for Psoriatic Disease and Serious Infections in Older Adults. JAMA Dermatol. Published online March 19, 2025. doi:10.1001/jamadermatol.2025.0144

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