Students share their experience in the virtual classroom, navigating new requirements, and the lessons learned from their position in a global pandemic.

How COVID-19 Transformed Medical Education

Anne Dixon, MD, joins Lungcast to discuss obesity's effect on asthma, and the newest recommendations for managed care.

New Asthma Management Guidelines: A Podcast Primer

Expert David W. Goodman, MD, explains why adults with ADHD may face unknown challenges during the pandemic.

Adult ADHD Challenges During COVID-19

What you need to know about vaccinator and patient education, counseling, billing, and reimbursement.

ACP Policy Statement on COVID-19 Vaccine Distribution and Administration

New ADA guidelines list more than 40 recommendations related to blood pressure targets, screening and diagnosis, and overall management strategies.

Cardiovascular Disease in Diabetes: How to Manage Risks

An American Red Cross discusses the importance of National Blood Donor Month and the challenges faced during the COVID-19 pandemic.

The National Blood Shortage: An Unprecedented Challenge

 Brad Glick, DO, brought on cosmetic dermatologist Valerie Callender, MD, to discuss practices in cosmetic dermatology. The conversation centered on Callender’s practice, the challenges faced during the COVID-19 pandemic, and the most frequent procedures performed over these past months.

For this episode, Glick continues this robust discussion on trends and technologies in cosmetic dermatology—this time gauging the experiences and perspective of board-certified dermatologist Rebecca Kazin, MD, Director of Clinical Research of Icon Dermatology and Aesthetics. 

Kazin, an experienced injector and trainer, detailed her own cosmetic practices, breaking down the procedures that are most common for her. She spoke in great length on the use of dermal fillers, including differences in injectables, best application practices, and ways to ensure optimal patient satisfaction.

Glick and Kazin also touched on approaches to related procedures, such as skin tightening, cryolipolysis, and micro-needling, thus highlighting the nuances in care, which methods are most effective, and how to navigate the patient-doctor dialgoue. 

The conversation spotlighted a hair product that Kazin developed with the intention of offering an over-the-counter hydrocortisone washout for dry scalp and related conditions. She offered some thoughts on its cosmetic and dermatologic potential and described its journey from inception to marketing.

on iTunes and Spotify to stay up-to-date on all the latest discussions with Brad Glick, DO.

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Rebecca Kazin, MD, offers some insight into her cosmetic dermatology practices, including a new hair product that she developed.

News

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Dermatology

Plaque Psoriasis

Atopic Dermatitis

Atopic Dermatitis condition center page, resources on the topics of medical news and expert insight into eczema can be found. Content includes articles, interviews, videos, podcasts, and breaking news on dermatitis research, treatment, and drug development.

Rebecca Kazin, MD: Cosmetic Dermatology Trends, Technologies, and Practices

Monoclonal antibody dupilumab (Dupixent) was associated with sustained symptomatic improvement from 

 among pediatric patients treated for up to 52 weeks.

In new data from the phase 3, open-label extension LIBERTY AD PED-OLE trial, presented at the 

American Academy of Dermatology (AAD) Virtual Meeting Experience

 this weekend, the Sanofi- and Regeneron-sponsored research showed patients aged ≥6 to <12 years old with moderate to severe atopic dermatitis showed sustained, if not improved, metrics of disease management such as Investigators Global Assessment (IGA) and Eczema Area Severity Index (EASI) scoring up to 1 year of care with the biologic.

The new findings come nearly 1 year after 

dupilumab was approved by the US Food and Drug Administration (FDA)

 for the add-on treatment of moderate to severe, uncontrolled atopic dermatitis in children aged 6-11 years old.

Led by Michael J. Cork, MD, of Sheffield Dermatology Research at the University of Sheffield in the UK, investigators sought to observe ongoing, long-term efficacy and safety outcomes among LIBERTY AD PED-OLE trial participants receiving dupilumab. As they noted, long-term pediatric atopic dermatitis therapy options are currently limited.

Cork and colleagues enrolled patients from the previous LIBERTY PEDS trial for the open-label extension. The children and adolescent participants received 300mg dupilumab every 4 weeks, with the option of an up-titration in the event of inadequate clinical response by week 16. The new assessment includes 362 patients at the extension baseline, 309 patients observed through week 4, and 34 patients observed at week 52.

Mean patient age was 8.6 years old at baseline, with 48.6% reported as male and 72.7% identified as White. Mean duration of atopic dermatitis in each patient was 7.4 years.

At baseline, 18% of patients reported IGA scores of 0-1. The rate improved to 24.6% at week 4, then 44.1% at week 52.

Mean percent change in EASI score from the parent trial baseline to open-label extension baseline was -59.4%. Scores continually improved by week 4 (-71.1%) and week 52 (-85.7%).

Reduction of ≥75% in EASI (EASI 75) was achieved by 41.2% of patients at open-label extension baseline relative to parent trial baseline EASI scores. By week 4, the rate of EASI 75 improved to 54.4% of students, then to 58.9% at week 52.

Treatment emergent events were reported in a majority of observed open-label patients (58.8%), though just 2.5% experienced a serious event. The most commonly reported events among patients included exacerbations (15.5%) and nasopharyngitis (13.0%).

Cork and colleagues concluded the findings support the known benefits and safety of dupilumab in moderate to severe atopic dermatitis among pediatric patients treated through a year.

“Long-term treatment with dupilumab showed sustained improvement in signs of AD in the cohort of patients who completed up to 52 weeks,” they wrote. “Data were consistent with the known dupilumab safety profile.”

Long-Term Efficacy and Safety Data for Dupilumab in a Phase 3, Open-Label Extension Trial (LIBERTY AD PED-OLE) in Patients Aged =6 to <12 Years With Uncontrolled, Moderate-to-Severe Atopic Dermatitis (AD)

Articles

Phase 3 open-label extension data suggest young patients may even improve skin clearance scores after a year on the biologic therapy.

Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Pediatrics

Dupilumab Sustains Pediatric Atopic Dermatitis Improvement at 52 Weeks

Bimekizumab was associated with greater 100% skin clearance than comparator biologic secukinumab (Cosentyx) in both short-term and long-term treatment periods in new data from the phase 3b BE RADIANT trial.

In a UCB Pharma-funded study presented at the 

American Academy of Dermatology (AAD) 2021 Virtual Meeting Experience

 this weekend, investigators provided a comparison of the 2 interleukin-17 (IL-17) inhibitor biologic therapies for patients with 

The findings, conducted by Kristian Reich, MD, PhD, of the University Medical Center Hamburg-Eppendorf, and Richard B. Warren, MD, PhD, of the University of Manchester, show significant improvement in 100% Psoriasis Area Severity Index (PASI) scores at weeks 16 and 48 with bimekizumab. However, they also indicated a greater risk of oral candidiasis with investigative therapy.

Bimekizumab is a humanized monoclonal antibody which selectively inhibits the IL-17A and IL-17F pathway—both of which are believed to drive inflammation and plaque psoriasis pathobiology in affected patients. Comparatively, secukinumab only blocks the IL-17A pathway.

Investigators randomly assigned patients with moderate to severe plaque psoriasis 1:1 to either 320 mg bimekizumab every 4 weeks or 300 mg secukinumab once weekly for 4 weeks, followed by every 4 weeks. The trial treatment duration was 48 weeks.

Reich, Warren and colleagues sought a primary endpoint of PASI 100 from baseline at week 16 of treatment. Originally, the primary analysis sought the noninferiority of bimekizumab to secukinumab by -10 percentage points on PASI 100 prevalence, before being tested for treatment superiority.

Eligible patients were aged 18 years or older with plaque psoriasis for at least 6 months prior to screening, with moderate to severe disease defined as a PASI score of ≥12 at baseline, at least 10% body-surface area affected by psoriasis, and an Investigator’s Global Assessment (IGA) score of ≥3.

A total of 743 patients were assigned to either bimekizumab (n = 373) or secukinumab (n = 370). More than 60% (230 [61.7%]) of patients to receive bimekizumab achieved PASI 100 at week 16, versus just 48.9% (181) patients receiving secukinumab, indicating a 12.7 percentage-point adjusted-risk difference (95% CI, 5.8 – 19.6).

Investigators additionally observed a noninferiority and superiroirty to secukinumab (

By week 48, two thirds (67.0%) of patients treated with bimekizumab achieved PASI 100 response, while the rate of secukinumab-treated patients to achieve the mark had decreased to 46.2% (171). The adjusted risk difference increased to 20.9 percentage points in the extended time period (95% CI, 14.1 – 27.7; 

However, Riech, Warren and colleagues observed a significantly greater prevalence of oral candidiasis in the bimekizumab arm (72 [19.3%]) than the secukinumab arm (11 [3.0%]). All but 2 cases among the bimekizumab arm were mild or moderate in severity, and none led to treatment discontinuation.

Investigators concluded the data suggest IL-17A and IL-17F inhibition may be associated with greater clinical benefit in moderate to severe plaque psoriasis treatment than lone IL-17A inhibition.

Though the trial was limited by a lacking placebo group, insignificant patient racial diversity, and exclusion of IL-17 inhibitor-unresponsive patients, the team emphasized the BE RADIANT findings warrant a greater understanding of specific IL-17 pathway targeting in the treatment of plaque psoriasis.

“Longer and larger trials are required to determine the relative effects of interleukin-17A and interleukin-17F inhibition as compared with inhibition of interleukin-17A alone in psoriasis,” they wrote.

The study, “Bimekizumab versus Secukinumab in Plaque Psoriasis,” was published online in 

A comparison of the IL-17 inhibitors suggest the more dynamic pathway-targeting biologic is more efficacious, but linked to more oral candidiasis.

Inflammation

Bimekizumab Betters Plaque Psoriasis Clearance Versus Secukinumab at 48 Weeks

The increase in hospitalized patients has many worried about an additional increase in 

A team, led by Jessica R. Allegretti, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, evaluated the prevalence, patient characteristics, and clinical outcomes of CDI among hospitalized patients with COVID‐19.

Gastrointestinal symptoms has been a hallmark of COVID-19 since the beginning of the pandemic, with about a third of patients suffering from diarrhea.

While the US Food and Drug Administration (FDA) has yet to approve a treatment for COVID-19, hospitalized patients often are treated with broad-spectrum antibiotics, which is escalated as the clinical status of the patients deteriorates.

However, this class of treatment has been associated with an increased risk of CDI, even as hospitals take measures to limit the person-to-person spread of the virus.

“Strict isolation and social‐distancing protocols adopted by hospitals since the start of the pandemic may help mitigate this risk,” the authors wrote.

In the retrospective cohort study, the investigators examined hospitalized COVID-19 patients from 9 hospitals in Massachusetts.

Each patient in the cohort underwent stool testing for C diff infections and were confirmed to be positive with COVID-19 from a nasopharyngeal swab polymerase chain reaction (PCR) test, and testing was performed via glutamate dehydrogenase (GDH) and enzyme‐linked immunosorbent assay (ELISA) immunoassay (EIA) for toxin and considered diagnostic if both tests were positive.

The researchers compared outcomes and mortality for hospitalized COVID-19 patients with and without CDI. All CDI patients were exposed to at least 2 (2-8) antibiotics prior to their CDI diagnosis.

‐test and Fisher's exact tests for continuous variables and categorical variables, respectively, on univariate analyses.

Overall, there were 97 (24.9%) patients who were tested for CDI, with a mean age of 62.4 years old. Of this group, 5 (5.2%) patients tested positive for CDI, which was lower than the overall inpatient CDI-positive rate in 2019 (n = 280; 9.8% of tests performed). However, this was not statistically significant (

GDH/EIA‐positive rates were similar between the COVID‐19 and historical cohort (5.2% 

In addition, the PCR positive rate among GDH/EIA‐indeterminant patients was significantly lower among COVID‐19 patients (n = 0; 0% 

“In comparison, rates of confirmed CDI were lower among patients hospitalized with COVID‐19,” the authors wrote. “This difference was entirely driven by patients who were PCR positive but GDH/EIA indeterminant as the rates of GDH/EIA positivity were similar between COVID‐19 and the historical cohorts. This may suggest lower rates of 

 colonization despite a similar risk of CDI.”

However, the findings do show that COVID-19 patients who receive at least 2 systemic antibiotics are at a significant risk of developing CDI.

On the other hand, some of the measures taken up because of COVID-19 do show the importance of hand hygiene, contact precautions, and appropriate isolation of patients in lowering hospital‐acquired CDI.

“In conclusion, the prevalence of CDI among hospitalized COVID‐19 patients was not higher despite widespread use of multiple antibiotics, likely due to aggressive contact precaution and isolation measures implemented for COVID‐19,” the authors wrote. “The development of CDI was associated with poor outcomes and a high mortality rate among hospitalized COVID‐19 patients. A low threshold for early CDI testing should be implemented among COVID‐19 patients to ensure prompt diagnosis and appropriate therapeutic intervention.”

Prevalence and impact of Clostridioides difficile infection among hospitalized patients with coronavirus disease 2019

Journal of Gastroenterology and Hepatology

COVID-19 patients receiving at least 2 antibiotics were at a higher CDI risk.

C Difficile Infection

C. difficile condition center page, resources on the topics of medical news and expert insight into Clostridium difficile can be found. Content includes articles, interviews, videos, podcasts, and breaking news on C. diff research, treatment, and drug development.

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, IBS and IBD, Crohn's disease, and more.

Coronavirus

Infectious Disease

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Hospital Medicine

COVID-19 Measures Reduce Risk of C Diff Infections

A recent study found that over 32% of patients diagnosed with 

 use disorder (OUD) between 2001 and 2018 were prescribed non-cancer opioid analgesics prior to OUD diagnosis.

The proportion of opioid analgesic prescription prior to OUD peaked at 40% in 2011, but the percentage stabilized afterward and then declined.

Investigators, led by Bohdan Nosyk, PhD, of the BC Centre for Excellence in HIV/AIDS at St. Paul’s Hospital in Vancouver, said a link has been found between levels of opioid analgesic prescribing and mortality particularly in British Columbia (BC), Canada, where overdose rates are nearly 3 times higher than the national average.

Most overdoses in British Columbia had a history of long-term prescription opioid use but did not have an active prescription at the time of overdose, marking a transition to illicit opioid use.

Canada health experts recommend against the use of opioids for individuals with substance use disorders and doses exceeding 90 morphine milligram equivalents (MME/Day).

The team in the study aimed to characterize non-cancer opioid analgesic prescribing in British Columbia prior to OUD identification, as well as examining the extent of initial prescriptions concordant to current guidelines.

Investigators led a retrospective cohort study of a population-level linkage to define a cohort of individuals with OUD in British Columbia from January 1996 – September 2018.

Data was gathered using health records of 6 databases: PharmaNet, Discharge Abstract Database, Medical Services Plan, BC Vital Statistics, National Ambulatory Care Reporting System, and BC Corrections.

Individuals in the study were chosen based on who had accessed health services for OUD, but individuals who were diagnosed with cancer or had received palliative care were excluded from study.

Patients who initiated opioid analgesic therapy or identified with OUD between January 2001 and September 2018 were included in the study for 5 years of OUD identification data capturing.

The primary outcome of the study was initial observed opioid analgesic prescriptions. The doses of initial prescriptions in MME/day combined the product of drug strength per dose unit, number of units per day, and an MME conversion for comparison against different drug types.

Investigators identified 3 measures of initial analgesic prescriptions: high dose (≥90 MME/day), long-term (≥7 days), and concomitant sedative prescription.

The key exposure in the study was the source of prescription, with classifications by type of health system contact prior to initial prescription. These included inpatient-post discharge, non-inpatient acute or non-acute visit.

Sociodemographic and clinical characteristics such as age, sex, and substance use disorders were gathered to include key factors that may influence prescriptions, as well as other comorbid conditions.
Results 

The cohort in the study included 66,372 individuals identified with OUD from 2001 – 2018, with 32.1% having an opioid analgesic prescription prior to OUD identification.

The proportion increased from 3% (n = 79) in 2001 to 41% (n = 1535) in 2011 and decreased to 32.2% (n = 1667) in 2018.

Individuals receiving prescriptions prior to OUD were older and had a higher prevalence of comorbid conditions. The proportion of males grew from 57.9% (n = 4847) to 64.5% (n = 2182).

Across all sources, the percentage of individuals receiving high dose (≥90

MME/day) initial prescriptions decreased from 15.7% (n = 1314) to 14.5% (n = 490).

Long-term (≥7 day) prescriptions decreased from 52.8% (n = 4419) to 43.8% (n = 1484), and concomitant sedative prescriptions decreased from 16.5% (n = 1378) to 10.8% (n = 365).

Over half of initial opioid prescriptions originated from non-acute care visits, with a peak of 56.8% in 2001. The proportion of prescriptions from inpatient visits increased from 19.7% in 2001 to over 28% at the end of the study in 2018.

The probability of receiving non-guideline prescriptions decreased for all 3 measures for inpatient and non-inpatient acute care, but remained stable for non-acute care.

Long-term prescriptions had the highest decrease measures, as inpatient visits decreased from 53.3% (95% CI, 50.9 - 55.8) in 2001 to 37.2% (95% CI, 33.9 - 40.5) in 2018.

Investigators concluded that although opioid analgesic prescription rates prior to OUD identification has declined since a peak in 2011, individuals identified with OUD in 2018 had previously received prescription opioid analgesics.

The team noted that current guidelines in opioid prescription may still need to adapt to reduce opioid use harms for patients and educate prescribers on the dangers.

“While understanding the causal contribution of opioid prescriptions to the rise in OUD prevalence in BC remains critical to evaluating current guidelines, evidence on the implications of opioid prescribing before and after OUD identification may be equally important in shaping policies to reduce opioid-related harms,” investigators wrote.

Opioid analgesic prescribing for opioid-naïve individuals prior to identification of opioid use disorder in British Columbia, Canada

New research over 2 decades shows patients with opioid use disorder are often prescribed opioid analgesic prior to OUD diagnosis, although rates have decreased in recent years.

Opioid-induced Constipation

Addiction

Addiction medicine condition center page, resources on the topics of medical news and expert insight into clinical addiction can be found. Content includes articles, interviews, videos, podcasts, and breaking news on addiction therapy research, treatment, and drug development.

Chronic Pain

Opioid Analgesic Prescription Contributes to One-Third of OUDs in British Columbia

Videos

ABX464 is being tested for numerous indications, including ulcerative colitis.

Ulcerative Colitis

Ulcerative Colitis condition center page, resources on the topics of medical news and expert insight into colitis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on UC research, treatment, and drug development.

Family Medicine

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The Potential of ABX464 for Ulcerative Colitis

The monoclonal antibody was linked to significant improvements in endoscopic nasal polyp and nasal obstruction symptom visual analogue scale scores. 

Pulmonology

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Internal Medicine

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Add-On Mepolizumab Promising Option for Chronic Rhinosinusitis with Nasal Polyps

Dr. Anthony Fauci believes the Johnson & Johnson vaccine pause will soon end. 

Vaccination

US COVID-19 Vaccine Program Expanding Again

Recommendations for properly treating pediatric and adult patients with inflammatory bowel disease based on common changes to the disease trajectory and it’s progressive nature.

Peers Perspectives

Expert Perspectives on the Optimal Management of Inflammatory Bowel Disease

Anti-VEGF administration did increase the risk of nonocular hemorrhages, mostly in patients with AMD.

Diabetic Macular Edema

Ophthalmology

Cardiology

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Heart Failure

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Endocrinology

Geriatrics

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Anti-VEGF Treatment does not Increase Cardiovascular Event Risk

A new study finds patients with atrial fibrillation or venous thromboembolism were at higher risk of increased bleeding and hospitalization when treated with combination DOAC and aspirin. 

Arterial Disease

Arterial Disease condition center page, resources on the topics of medical news and expert insight into PAD / CAD can be found. Content includes articles, interviews, videos, podcasts, and breaking news on peripheral artery and coronary artery disease research, treatment, and drug development.

Venous Thromboembolism

Deep Vein Thrombosis 

Aspirin and Anticoagulant Treatment Linked to Bleeding Risks in AFib, VTE Patients 

The approval expands the current sublingual tablet treatment indications to include children with a ragweed pollen allergy. 

FDA Approves RAGWITEK for Children, Adolescents with Ragweed Allergies


A trio of experts from the Cleveland Clinic join Dr. Rizzo for a talk on lung transplant trends and challenges in the US.

COPD

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Surgery

Advancements in Lung Transplants with the Cleveland Clinic Team

Ennis James, MD, discusses the challenges and lingering questions associated with sarcoidosis 

Rare Disease Report®

The Rare Disease Report Podcast: Sarcoidosis

Raising awareness about proper treatment adherence is one method of working toward eliminating hepatitis C.

Latest Clinical News

Rebecca Kazin, MD: Cosmetic Dermatology Trends, Technologies, and Practices

Dupilumab Sustains Pediatric Atopic Dermatitis Improvement at 52 Weeks

Bimekizumab Betters Plaque Psoriasis Clearance Versus Secukinumab at 48 Weeks

COVID-19 Measures Reduce Risk of C Diff Infections

Opioid Analgesic Prescription Contributes to One-Third of OUDs in British Columbia