A team of investigators conducted a study to determine if the presence of sickle cell trait (SCT) was associated with worse outcomes of COVID-19. An increased risk of mortality and acute kidney failure was observed in patients with SCT after experiencing COVID-19. 

Further understanding of the relationship between SCT and the prepandemic health conditions in individuals of the Million Veteran Program (MVP), as well as  the assessment of the severity and consequence of COVID-19 were the research motivations.

According to the results, individuals with SCT who previously had COVID-19 also had various preexisting kidney conditions that were associated with poor outcomes.

"Our findings support the inclusion of SCT as an adverse prognostic factor for COVID-19 and development of SCT-tailored interventions. Our work has broad implications for the detection and clinical management of SCT," investigators wrote. 

Lead author, Anurag Verma, PhD, Corporal Michael J. Crescenz VA Medical Center, included 2729 individuals with sickle cell trait, and 129,848 indiviudals who did not have the trait in this genetic association study. Of those with SCT, 353 had COVID-19, and 13,488 who were SCT-negative had experienced COVID-19.

The aim was to identify any associations between SCT and COVID-19 outcomes. To examine this, investigators implemented firth regression. Analyses were performed by ancestry and adjusted for sex, age, age squared, and ancestral principal components to account for population stratification. 

More specifically, 4 COVID-19 outcomes were evaluated in regard to the World Health Organization (WHO) severity scale. Phenotypes were then derived from codes in the electronic records of 

It was revealed that sickle cell trait correlated with increased COVID-19 mortality and as well as multiple preexisting chronic medical conditions in individuals of African ancestry.

Among the 132 577 MVP participants with COVID-19, data displayed the mean age at the index date was 64.8 (standard deviation: 13.1) years and sickle cell trait was present in 7.8% of individuals of African ancestry and associated with a history of chronic kidney disease, diabetic kidney disease, hypertensive kidney disease, pulmonary embolism, and cerebrovascular disease. 

When the 4 clinical outcomes of COVID-19 we're assessed, SCT was associated with an increased COVID-19 mortality in individuals of African ancestry (n = 3749; odds ratio, 1.77; 95% CI, 1.13 to 2.77; 

Additionally, investigators reported that the 60 days following COVID-19, SCT was associated with an increased incidence of acute kidney failure. An estimation by counterfactual mediation framework showed that on average, 20.7% (95% CI, −3.8% to 56.0%) of the total effect of SCT on COVID-19 fatalities was due to acute kidney failure.

"In this genetic association study, SCT was associated with increased COVID-19 mortality and a number of preexisting chronic medical conditions in African ancestry individuals. Our findings support the inclusion of SCT as an adverse prognostic factor for COVID-19 and development of SCT-tailored interventions. Our work has broad implications for the detection and clinical management of SCT," investigators concluded.

Association of Kidney Comorbidities and Acute Kidney Failure With Unfavorable Outcomes After COVID-19 in Individuals With the Sickle Cell Trait"

Articles

Study Suggests Sickle Cell Trait as an Adverse Prognostic Factor for COVID-19

Atheroscleortic plaque was highly prevalent in older adults in China, with a substantial proportion of individuals reaching stenosis of 50% or greater, according to new findings published in 

“This study set the basis for the evaluation of atherosclerosis progression and risk stratification for future vascular events with longitudinal follow-up data,” wrote study author Yongjun Wang, MD, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University and and Tiemin Wei, MD, Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine. 

Investigators noted that previous data show subclinical carotid atherosclerosis and coronary artery calcification increased the risk of vascular events. However, there are limited findings on the prevalence, vascular distribution, and burden of polyvascular atherosclerosis in the arterial system with intracranial, coronary, and peripheral vascular territories.

As a result, the current cross-sectional study evaluated the prevalence, vascular distribution, and burden of polyvascular atherosclerosis in a community population based on a baseline survey of the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study.

It enrolled community-dwelling adults who were aged 50 - 75 years based on cluster sampling from 6 villages and 4 living communities of Lushui city in southeast China between May 2017 - September 2019.

The investigators assessed atherosclerotic plaque and stenosis at baseline in multiple vascular territories. It included brain vessel wall magnetic resonance imaging (MRI) for intracranial and extracranial arteries and computer tomography angiography (CTA) for coronary, subclavian, aorta, renal, and iliofemoral arteries. At baseline survey, they performed ankle-brachial index.

Then, the extent of atherosclerosis was assessed according to the number of these 8 vascular sites that were affected, while polyvascular arterosclerotic lesions were defined as ≥2 affected sites in these arteries.

There were a total of 3433 of 4202 invited individuals who consented to participate in the study. Following exclusions, including 366 participants with contraindications for MRI or CTA scanning, a total of 3067 community-dwelling adults were enrolled.

Data show the mean age was 61.2 years, including 1640 (53.5%) women and 74 (2.4%) had prevalent atherosclerotic cardiovascular disease (ASCVD). Most participants (n = 2546; 84.0%) had at least 1 traditional risk factor, while 892 (29.1%) had 2 and 654 (21.3%) had 3 or more risk factors.

Most of the participants (n = 2870 [93.6%]) were found to have atherosclerotic plaque in at least 1 vascular territory. Moreover, atherosclerotic plaques were mostly detected in the aorta (n = 2419 [79.6%]) and iliofemoral arteries (n = 2312 [75.8%]).

This was followed by subclavian (n = 1500 [49.8%]), coronary (n = 1366 [44.9%]), extracranial (n = 1110 [36.4%]), renal (n = 873 [28.7%]), and intracranial (n = 542 [17.7%]) arteries.

Additionally, polyvascular atherosclerotic plaque was observed in 2541 participants (82.8%), with 1436 (46.8%) with plaque affecting 4 or more vascular territories. Polyvascular stenosis was observed in 412 patients (13.4%).

The study, “Prevalence and Vascular Distribution of Multi Territorial Atherosclerosis Among Community-Dwelling Adults in Southeast China,” was published in 

A substantial number of individuals (nearly 40%) reached arterial stenosis of at least 50%, according to the findings. 

Atherosclerotic Plaque Found Highly Prevalent in Older Population in China 

New phase 2 data shows vurolenatide could be an effective agent in treating 

The data, announced by 9 Meters Biopharma, comes from preliminary topline results of the VIBRANT study (

), a multicenter, double-blind, placebo-controlled parallel group study testing the safety, efficacy, and tolerability of the proprietary, long-acting GLP-1 receptor agonist.

The trial included 4 parallel treatments arms of vurolenatide 50 mg weekly, 50 mg every other week, vurolenatide 100 mg every other week, and placebo.

The results are based on the complete randomization block, with the study ongoing and blinded to collect additional safety data and potentially enable the use of the complete data to support a New Drug Application (NDA) in the future.

The data is from 11 randomized patients with appropriate distribution across 4 different arms of the VIBRANT study. The investigators believe they have identified the most effective and tolerable dose and dosing interval to further test in the planned phase 3 trial.

In the preliminary results, 7 participants met the primary efficacy definition of total stool output (TSO) responder of greater than or equal to a 10% reduction from baseline in a 24 hour span over the 6-week efficacy evaluation period.

The investigators anticipate a mean reduction in TSO of greater than 25% taken into the upcoming phase 3 trial.

The team also sought a secondary endpoint of parenteral support volume over the 6-week treatment period and found 3 of the 5 patients in the study with a parenteral support requirement showed a mean decrease of greater than or equal to 20% in their parenteral support volume after being randomly assigned to the active drug.

For safety, vurolenatide was well-tolerated, without only mild to moderate and transient side effects identified. This included nausea and vomiting, which are typical side effects for GLP-1 agonists. Overall, there were no adverse events that led to an early withdrawal from the study.

There were a pair of serious adverse events found, which the investigators did not relate to vurolenatide as they were both central catheter infections, common in patients with a central line.

The company has scheduled an end-of-Phase 2 meeting with the US Food and Drug Administration in the coming months.

"Given the severity and life-threatening nature of SBS, as well as the significant impact on quality of life, we are very pleased to have identified a vurolenatide dose and dosing interval to progress into Phase 3 development,” Patrick H. Griffin, MD, FACP, Chief Medical Officer at 9 Meters, said in a 

. “Vurolenatide may offer a novel and alternative approach to treating appropriate individuals with SBS as it has been shown to decrease total stool output and reduce parenteral support needs which are critical to the health and well-being of individuals with short bowel syndrome."

The majority of patients in the phase 2 study met the primary efficacy endpoint of a greater than or equal to a 10% reduction in total stool output over the 6-week efficacy evaluation period.

Vurolenatide Showing Promise Treating Short Bowel Syndrome

New findings suggest maternal deaths in the United States increased substantially at the onset of the 

This figure (33.3%) was higher than a 22% overall excess death estimate associated with the pandemic itself and the increases were highest for Hispanic and non-Hispanic Black women.

“Change in maternal deaths during the pandemic may involve conditions directly related to COVID-19 (respiratory of viral infection) or conditions exacerbated by COVID-19 or other health care disruptions (diabetes or cardiovascular disease), but could not be discerned from the data,” wrote study author Marie E. Thoma, PhD, Department of Family Science, School of Public Health, University of Maryland.

Between 2019 and 2020, data from the National Center for Health Statistics (NCHS) reported an 18.4% increase in US maternal mortality. As such, the relative increase was 44.4% among Hispanic, 25.7% among non-Hispanic Black, and 6.1% among non-Hispanic White women.

To examine the role of the pandemic in maternal death rates, investigators used deidentified NCHS mortality and natality files from 2018 to 2020. Analyses were limited to maternal deaths based on underlying causes of death. They did not exclusively identify COVID-19 as the cause, even when it was a factor in maternal death.

Therefore, investigators noted COVID-19 was ascertained as a secondary cause from the multiple causes of death area, remaining consistent with other reports on excess mortality from COVID-19. The deaths were stratified by month and year of death into before (2018, 2019, and January - March 2020) or during (April - December 2020) the pandemic

Data show a total of 1588 maternal deaths (18.8 per 100,000 live births) occurred before the pandemic vs 684 deaths (25.1 per 100,000 live births) during the pandemic, at a relative increase of 33.3%. The findings additionally show late maternal mortality increased by 41%.

Moreover, the absolute and relative changes were highest for Hispanic (8.9 per 100,000 live births; 40.2%) and non-Hispanic Black (16.8 per 100,000 live births; 40.2%) women, compared to non-Hisapnic White (2.9 per 100,000 live births; 17.2%) women.

Investigators found the secondary code for COVID-19 was listed in 14.9% (102 of 684) of maternal deaths in quarters 2 to 4, with 0% reported in quarter 1 of 2020. The percentage was highest among Hispanic women (32.1%), followed by non-Hispanic Black (12.9%) and non-Hispanic White (7.3%) women.

Regarding underlying cause-of-death codes, data show the largest relative increase was among indirect causes (56.9%). The relative increases in direct causes (27.7%) were mostly associated with diabetes in pregnancy (95.9%), hypertensive disorders (39.0%), and other specified pregnancy-related conditions (48.0%).

Meanwhile, COVID-19 was often listed as a secondary condition with other viral diseases (16 of 16 deaths [100%]) and diseases of the respiratory system (11 of 19 deaths [57.9%]).

“Future studies of maternal death should examine the contribution of the pandemic to racial and ethnic disparities and should identify specific causes of maternal deaths overall and associated with COVID-19,” Thoma concluded.

All-Cause Maternal Mortality in the US Before vs During the COVID-19 Pandemic

The increase was highest for Hispanic and non-Hispanic Black Women. 

Maternal Deaths in US Saw Substantial Increase at Onset of COVID-19 Pandemic

Despite having no prior history of psoriasis, data from a new Danish cohort revealed that some patients with immune-mediated inflammatory diseases who were treated with tumor necrosis factor-a inhibitor (TNFi) or other conventional therapies developed nonpustular types of psoriasis.

Though not as common, patients in the cohort who developed pustular types of psoriasis had the highest relative risk.

Broadly speaking, biologics have been shown to be highly effective for a number of inflammatory diseases such as psoriasis, inflammatory bowel disease (IBD), and rheumatoid arthritis. However, TNFi-associated psoriasis has developed in a myriad of patients during treatment, and studies regarding the epidemiology of these events are rare.

As such, an investigative team led by Alexander Egeberg, MD, PhD, from the University of Copenhagen, sought to determine the risk of new-onset psoriasis in patients with IBD or RA throughout TNFi treatment compared to conventional nonbiologic therapies.

The team utilized data from the Danish National Patient Registry, the Danish Register of Medicinal Product Statistics, and the National Population Registry to identify all patients in Denmark with IBS or RA from 1995-2018.

Patients with a history of any type of psoriasis prior to treatment or those who did not receive relevant pharmacotherapy after 18 years of age were excluded.

Relevant treatments were defined as either biological or nonbiological, with a distinction in the former being made between TNFi treatment and non-TNFi biological therapy.

Among the 109,085 patients enrolled in the cohort study, 108,024 received conventional therapy while 20,910 received TNFi treatment.

Throughout the follow-up period, 1471 (1.4%) patients developed a type of new-onset psoriasis. Of these patients, 1332 (91%) developed nonpustular psoriasis, and 139 (9%) developed pustular psoriasis. Among the patients who developed pustular psoriasis, 127 (91%) would go on to develop palmoplantar pustulosis, and 12 (9%) developed generalized pustulosis.

Meanwhile, the incidence rates for new-onset psoriasis per 1000 patient years were 3 for conventional therapy and 7.8 for TNFi treatment.

Regarding nonpustular andpustular psoriasis, the incidence rates for conventional therapy was 2.8 and 0.2, respectively. Incidence rates for TNFi treatment, however, was 6.5 and 1.3, respectively,

Investigators noted that 241 patient-years were required for 1 additional patient to be for any type of TNFi-associated psoriasis, while 342 patient-years were needed for nonpustular psoriasis, and 909 patient-years were needed for pustular psoriasis.

Despite an increased risk of new-onset psoriasis from TNFi treatment, investigators considered the absolute risk to be “modest” with 241 patient-years of exposure needed for 1 additional event.

“Practitioners and patients should be aware and observant of the potential for TNFi-associated psoriasis during TNFi treatment but keep in mind that the absolute risk appears to be low,” they wrote,

“Absolute and Relative Risk of New-Onset Psoriasis Associated With Tumor Necrosis Factor-α Inhibitor Treatment in Patients With Immune-Mediated Inflammatory Diseases,” 

Despite an increased risk of new-onset psoriasis from TNFi treatment, investigators considered the absolute risk to be “modest”, with 241 patient-years of exposure needed for 1 additional event.

Increased Risk of TNFi-Related Psoriasis Observed in Patients with IBD, Rheumatoid Arthritis 

The inclusion of twice-daily 1 mg varenicline in smoking cessation programs for patients with 

 may result in prolonged abstinence without serious adverse events, according to new findings published in 

The findings suggest the agent was efficacious at weeks 12, 24, and 52 of the randomized clinical trial, in comparison to placebo.

“The findings suggest that substantial changes in smoking habits may occur among patients with type 2 diabetes who intend to stop smoking, leading to prolonged abstinence from smoking,” wrote study author Riccardo Polosa, MD, PhD, Centro per la Prevenzione e Cura del Tabagismo, Azienda Ospedaliero Universitaria Policlinico-V. Emanuele dell’Università di Catania.

Prior observations have noted that stopping smoking has been associated with reduced mortality risk in patients with T2D, so providing counseling on quitting smoking should be a component of routine diabetes care. Varenicline has been shown to be efficacious in smokers with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), or depressive disorders, but it has not been studied in smokers with diabetes.

The multicenter, double-blind, placebo-controlled RCT included patients from 6 outpatient clinics in 5 hospitals in Italy. Investigators screened eligibility of patients with T2D who were receiving treatment in an outpatient diabetic clinic, smoking ≥10 cigarettes a day, and intending to quit smoking.

It consisted of a 12-week treatment phase followed by a 40-week follow-up, non-treatment phase, with intention-to-treat analysis was performed from December 2020 - April 2021. The primary efficacy endpoint was the continuous abstinence rate (CAR) at weeks 9 to 24.

A total of 300 patients were randomized to either varenicline (n = 150) or placebo (n = 150) treatment, with a mean age of 57.4 years. There were 117 men [78.0%] in the varenicline group and 119 men [79.3%] in the placebo group. Investigators noted the baseline characteristics were comparable between groups and treatment discontinuation was frequent (approximately 30%).

Data show the CAR at weeks 9 to 24 were significantly higher for the varenicline group versus the placebo group (24.0% vs 6.0%; odds ratio [OR], 4.95; 95% CI, 2.29 - 10.70; 

Moreover, the CARs at weeks 9 to 12 (31.3% vs 7.3%; OR, 5.77; 95% CI, 2.85 - 11.66; 

 <.001) and weeks 9 to 52 (18.7% vs 5.3%; OR, 4.07; 95% CI, 1.79 - 9.27; 

 <.001) were also significantly higher for varenclinice, as were the 7-day point prevalence of abstinence at weeks 12, 24, and 52.

Few adverse events were reported (n = 380) and only a few withdrawals from the study occurred as a result (n = 11), according to the investigators. The most frequent adverse events occurring in the varenicline group compared with the placebo group were nausea (41 [27.3%] vs 17 [11.4%], insomnia (29 [19.4%] vs 19 [12.7%], abnormal dreams (19 [12.7%] vs 5 [3.4%]), anxiety (17 [11.4%] vs 11 [7.3%]), and irritability (14 [9.4%] vs 8 [5.4%]).

“These findings support the notion that patients with type 2 diabetes who smoke have greater difficulty quitting when provided with only cessation counseling,” Polosa concluded.

Efficacy and Safety for Varenicline for Smoking Cessation in Patients with Type 2 Diabetes: A Randomized Clinical Trials

Varenicline was efficacious at weeks 12, 24, and 52 of the trial compared with placebo in a smoking cessation program. 

Varenicline Use Benefits Smoking Cessation in Patients with Type 2 Diabetes  

When focusing on the population of individuals who live with 

, there's a subset of them who seek out buprenorphine without obtaining a prescription for it. The medication is highly effective in reducing opioid use, overdose and mortality, however, it's also a highly underutilized treatment for the disorder, and access to it in medical settings is limited. 

Because buprenorphine can also greatly help to improve individuals quality of life while reducing their opioid use, a team of investigators decided to 

 this population for markers of readiness for addiction treatment.

The observational retrospective analysis was collected from a large multi-state nationwide opioid treatment program and throughout the research process, investigators became particularly fascinated by what they were reading in the patient intake notes, according to one of the authors. 

 for an interview to discuss his team's findings. He serves as the director of the Center for Health Services Research at the 

Rutgers Institute for Health, Health Care Policy and Aging Research

, and is a Distinguished Research Professor at the Rutgers School of Social Work.

"More than half of these patients who were coming into formal treatment for the first time with buprenorphine, were actually already testing positive for the for the drug," Crystal said.

Many of the notes detailed that patients disclosed that they were getting buprenorphine from the street in order to manage their withdrawal symptoms before they came in for treatment. 

Crystal found this extremely interesting. 

He explained that buprenorphine serves as a partial opioid blocker that is very effective in helping to reduce the harms of opioid use disorder, facilitate recovery and help patients lead a functional life. 

"The partial blockade, if it's dosed properly, will block the high from other medications, from other opioids that people have gotten used to using to get high with, and it will reduce cravings," Crystal said. "It's much more of a steady state. It  doesn't fully block the opioid receptor but it blocks it enough to block the effects of other medications without giving the same kind of extreme highs."

Crystal said that after reviewing the relationship between this subset of patients who began treatment already on buprenorphine and the positive clinical outcomes of the treatment program, it makes sense. 

"The people who had selected themselves and had gotten used to the experience of being on a partial blocker, retained in treatment better, and were better able to remain in treatment without using other street opioids," he said.

"But, we believe that it has a lot of implications for the widespread concern about buprenorphine diversion," Crystal continued. "The issue of buprenorphine diversion has sort of been used as a reason for this very highly regulated, highly bureaucratized system that we have with special DEA licenses and X waivers to prescribe buprenorphine."

In the next segment of his interview with HCPLive, Crystal goes into detail about the limitations surrounding buprenorphine and the role these regulations play in the overall treatment of opioid use disorder. 

Videos

During the analysis, investigators became fascinated by how many patients entered the buprenorphine treatment program for OUD having already been taking the drug without a prescription. 

Stephen Crystal, PhD: Buprenorphine Use Prior to Treatment Linked with Better Outcomes

Despite the bevy of biologics available for people struggling with Crohn’s disease and ulcerative colitis (UC), not all patients are able to respond to or tolerate a vast majority of approved therapies.

Fortunately, new data presented at Digestive Disease Week (DDW) 2022 suggests that ustekinumab (STELARA) could function as an alternative option to bio-failure and bio-naïve patients living with these inflammatory bowel diseases (IBD).

Pooled data from four long-term phase 2 and 3 studies of bio-naïve IBD patients found that event rate per 100 patient-years for adverse events (AE), serious AEs, infection, malignancies, and more were similar and/or numerically lower for patients who received ustekinumab compared to those on placebo.

Similar event rates were observed in five phase 2/3 IBD studies of bio-failure patients over a 5-year period.

Remo Panaccione, MD, FRCPC, Director of the Inflammatory Bowel Disease Clinic and Director of Gastroenterology Research at the University of Calgary in Alberta, Canada, spoke with Assistant Managing Editor Kenny Walter of the implications of the new long-term data on IBD care.

“Overall, I think it just builds on the safety history of STELARA; we know STELARA is a highly effective therapy in IBD, not only when it's used first-line, but in patients who've been previously exposed to other advanced therapy,” Panaccione said. “I think this data gives us confidence that in addition to its ability to be able to achieve efficacy across a multitude of endpoints, that it can be used safely in the long-term benefit are patients with inflammatory bowel disease.”

Similarly, new phase 2 data form the GALAXI 1 trial featured at DDW showed that participants treated with guselkumab who had inadequate responses to conventional therapies achieved high levels of clinical-biomarker response, endoscopic response, and clinical remissionC-reactive protein (CRP) ≤3 mg/L or fecal calprotectin ≤250 μg/g (39.3-66.7%) at 48 weeks across all dose groups.

Panaccione spoke noted that these therapuetic options could provide relief for patients affected by either Crohn’s disease and UC.

“When you have data that shows that it's approved in both indications, then you don’t need to- for lack of a better word-hedge your bets,” he said. “I think it's really important because, it gives (patients) a sense of comfort. In both Crohn's disease and ulcerative colitis, the dosing is the same. As physicians, we use drugs that we have a lot of experience with much better in clinical practice. So having that dual indication is extremely important.”

Podcasts

Dr. Remo Panaccione speaks on promising long-term data of ustekinumab for Crohn's disease and ulcerative colitis, and how it could function as either a first-line treatment or alternative option for patients who were previously exposed biologic therapies.

What Ustekinumab Provides in Long-Term IBD Care

Guselkumab was associated with longer treatment adherence and greater proxy remission rates among treated patients with 

 versus those treated with other biologic therapies in a new study.

Findings from a new descriptive analysis show differences in time to discontinuation and remission rates among patients with psoriasis treated with either adalimumab, secukinumab, ixekizumab or guselkumab. The data highlight the need for more consistent treatment plans for patients with the chronic skin condition.

A team led by Timothy Fitzgerald, an investigator with Janssen Scientific Affairs, conducted a database-sourced analysis of long-term psoriasis treatment with either of the 4 identified biologics.

“Given the chronic nature of plaque psoriasis, medication persistence is essential to long-term disease control and, potentially, remission,” investigators wrote. “This analysis described persistence of patients with psoriasis initiated on 4 current biologics as well as rates of remission using a treatment patterns-derived proxy.”

They identified adults with psoriasis initiated on adalimumab, ixekizumab, guselkumab or secukinumab in relevant databases between July 13, 2017 and July 31, 2020.

Index dates were defined as the date of the first claim for an included biologic, while discontinuation was defined as gaps between days of index biologic supply based on ≥1-fold and ≥2-fold increases in frequency of administration per label for each therapy—meaning >60 days for guselkumab or <30 days for adalimumab, ixekizumab, or secukinumab.

Investigators described time to discontinuation through Kaplan-Meier models, and reported the both proportion of patients who re-initiated index therapy after discontinuation and proportion who achieved proxy disease remission after discontinuation. They defined remission as patients having no claims for any psoriasis treatment after the index biologic discontinuation date among those with ≥6 months follow-up.

Their analysis included the following cohorts:

3408 patients on guselkumab (mean age, 47.9 years; 47.1% female)

8017 patients on adalimumab (mean age, 47.4 years; 54.1% female)

6123 patients on secukinumab (mean age, 49.4 years; 54.2% female)

3728 patients on ixekizumab (mean age, 49.1 years; 50.3%).

In the 1-fold gap of administration, median time to discontinuation was as follows in the cohorts:

Fitzgerald and colleagues observed 43.1% of patients re-initiate guselkumab following discontinuation; other rates were 37.2% for adalimumab, 50.8% for secukinumab, and 52.3% for ixekizumab. A greater rate of patients achieved proxy psoriasis remission on guselkumab (11.8%) than adalimumab (9.5%), secukinumab (7.2%), and ixekizumab (6.1%).

In the 2-fold gap, median time to discontinuation was as follows:

Investigators observed 22.9%, 21.1%, 31.9%, and 32.0% treatment re-initiation rates after discontinuation among guselkumab, adalimumab, secukinumab, and ixekizumab cohorts, respectively. Proxy remission was again most significant among patients treated with guselkumab (17.2%) versus adalimumab (12.4%), secukinumab (10.5%), and ixekizumab (9.0%).

“In this descriptive analysis, median time to discontinuation trended longer and proxy remission rate trended higher in patients with psoriasis initiated on guselkumab relative to other biologics,” investigators concluded.

The study, “Long-term Psoriasis Control with Guselkumab, Adalimumab, Secukinumab, or Ixekizumab in the United States,” was published online in 

An analysis suggests patients on the biologic fared better with adherence and outcomes than those on competitors including adalimumab.

Guselkumab Linked to Improved Psoriasis Treatment Continuation, Remission

 may not be at the forefront of thought among diagnosing clinicians when observing finely discernible signs and symptoms. But specialists have methodology—and ideal roles—designed to identify and address the potentially fatal disease.

Society of Dermatology Physician Assistants (SDPA) 2022 Annual Meeting

, Travis Vandergriff, MD, associate professor in the department of dermatology at UT Southwestern Medical Center, discussed the manifestation, presentation and diagnosis of SJS.

The very rare disease, with an incidence of approximately 1 in 1 million persons, represents a “severe cutaneous drug reaction” generally caused by an allergic response. The most common triggers include anti-epileptic, antibiotics, alpurinol, about 7-10 days after initiated care.

“It develops over time, usually within a week and often shorter than that, into a blistering eruption and affects the mucus membranes,” Vandergriff said. “When the skin blisters, that puts patients at risk of infection, so there is some risk of mortality.”

Some ethnic and race subpopulations are at increased risk of developing SJS based on medications, and identifiable risk factors exists. ““But for the most part it’s rare and difficult to predict who would be potentially susceptible to it,” Vandergriff explained. “It is something that, because it’s such a severe and life-threatening eruption, even trough it’s rare, it’s helpful to be aware of it.”

In the event of SJS presentation, Vandergriff believes dermatologists play the most critical role in early diagnosis: what may look non-specific to a primary care or other frontline caregiver may be distinct to them. He noted a dermatologist may be able to pick up on “subtle clues” including symptoms of skin pain, early blistering, a dusky rash appearance.

And while the disease management strategy can entail a variety of specialists, diagnosis is on the dermatologist in the most ideal scenario.

“So you want to make sure you’re taking a good history, and for patients on high-risk medications, the diagnosis should cross your mind even if there’s no blistering,” Vandergriff advised.

A dive into the manifestation of the rare skin condition, and the impactful role of dermatologists in diagnosing it early.

The Signs and Symptoms of Stevens-Johnson Syndrome

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

All News

Latest News