Adults with type 1 diabetes are seeing increasing rates of obesity and now have a higher age-adjusted risk for chronic kidney disease than people with type 2 diabetes, according to researchers.
“Our study shows that obesity rates in adults with type 1 diabetes are increasing and mirror the rates in the general adult population,” Elizabeth Selvin, PhD, MPH, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health and John Hopkins University, said in a press release. “Our research also highlights the high risk of kidney disease in people with type 1 diabetes. Kidney disease is often considered more common in people with type 2 diabetes, but our data shows adults with type 1 diabetes actually had a higher risk of kidney disease than those with type 2.”
Selvin and colleagues analyzed data from all patients with type 1 diabetes (n = 4,060; median age, 39 years; 48.5% women) and type 2 diabetes (n = 135,458; median age, 62 years; 50.6% women) from the Geisinger Health System from 2004 to 2018. Trends in obesity (BMI 30 kg/m2), low estimated glomerular filtration rate ( 60 mL/min/1.73 m2) and albuminuria (urine albumin-to-creatinine ratio 30 mg/g) were evaluated along with associations between obesity and CKD.
From 2004 to 2018, there was an increase in obesity rates among patients with type 1 diabetes from 32.6% to 36.8% (P for trend = .0091), whereas obesity rates among patients with type 2 diabetes remained stable at approximately 60%.
Researchers also observed a higher crude prevalence of low eGFR among patients with type 2 diabetes compared with those with type 1 diabetes in 2004 (26.6% vs. 17.5%) and 2018 (30.6% vs. 16.1%). However, after age adjustments, this prevalence was lower among patients with type 2 diabetes compared with those with type 1 diabetes in all years; for example, 9.3% vs. 16.2% in 2018.
Researchers observed obesity increased the likelihood of low eGFR with both type 1 diabetes (adjusted OR = 1.52; 95% CI, 1.12-2.08) and type 2 diabetes (aOR = 1.29; 95% CI, 1.23-1.35).
“Our results highlight the need for interventions to prevent weight gain and end-stage kidney disease in people with type 1 diabetes,” Selvin said.
High levels of body fat are associated with a lower bone mineral density, with the association more pronounced in men compared with women, according to study data published in The Journal of Clinical Endocrinology & Metabolism.
“While higher BMI is generally associated with higher bone density, our study demonstrates that lean and fat mass affect bone density differently and that obesity is not a guarantee against osteoporosis,” Rajesh K. Jain, MD, assistant professor in the section of endocrinology, diabetes and metabolism and director of the endocrinology fellowship program at the University of Chicago Medicine, told Healio. “Patients with obesity should still undergo recommended bone density screening, especially if they have other risk factors, such as older age, previous fracture, family history or steroid use.”
Jain and colleagues analyzed data from 10,814 adults aged 20 to 59 years who participated in the National Health and Nutrition Examination Survey from 2011 to 2018 and underwent a total body DXA scan. T-scores were calculated to determine total body BMD. Lean mass index and fat mass index were calculated to assess the effects of body composition on BMD.
After adjusting for age, sex, race and ethnicity, height, smoking status, lean mass index and fat mass index, every 1 kg/m2 of lean mass index was associated with a 0.19 higher total body BMD T-score (P < .001). Conversely, each 1 kg/m2 increase in fat mass index was associated with a 0.1 decrease in BMD T-score (P < .001).
The association between fat mass index and BMD T-score differed for men and women. Women had a BMD T-score decrease of 0.08 points for every 1 kg/m2 increase in fat mass index, whereas men had a 0.13 lower BMD T-score with every 1 kg/m2 increase in fat mass index (P for interaction < .001). The association between fat mass index and BMD T-score did not differ by age group. For lean mass index, Mexican American adults had a lower BMD T-score increase of 0.16 for each 1 kg/m2 increase compared with a 0.21 BMD T-score increase for each 1 kg/m2 for white adults (P for interaction = .004). There were no other differences observed between race and ethnicity groups.
“Unfortunately, body composition is not a routine clinical measurement, so we rarely know what a patient’s body fat or body lean mass is,” Jain said. “Factors that correlate with high body fat and low lean mass are often associated with osteoporosis or fractures, and their presence should prompt clinicians to consider osteoporosis screening. This includes, for example, the presence of diabetes or poor performance on physical activity measures, such as grip strength.”
Jain said future research should examine the effects that weight loss may have on BMD.
“In general, weight loss has been associated with bone loss and fractures, but this study suggests the type of weight loss — lean vs. fat mass — may be important in determining if or how much bone loss occurs,” Jain said.
Rajesh K. Jain, MD, can be reached at rjain2@medicine.bsd.uchicago.edu.
Mone Zaidi, MD, PhD, MBA, MACP, FRCP
Over the past two decades, we have worked on the idea that pituitary hormones have diverse functions beyond the unitary actions that appear traditionally in endocrine textbooks. We found, for the first time, that thyroid-stimulating hormone and follicle-stimulating hormone have direct actions on bone. The implication of these studies was that low TSH and high follicle-stimulating hormone levels in hyperthyroidism and after menopause likely contribute to the bone loss hitherto attributed solely to high thyroid hormone and low estrogen levels, respectively (Abe E, et al. Cell. 2003;doi:10.1016/s0092-8674(03)00771-2).
Correlative studies in cohorts across the globe have shown strong associations between serum TSH or follicle-stimulating hormone, markers of bone remodeling, bone mineral density and fracture risk, independently of thyroxine or estrogen. Focusing on the effects of follicle-stimulating hormone, we developed a targeted follicle-stimulating hormone blocking antibody that prevented bone loss in mouse models (Zhu LL, et al. Proc Natl Acad Sci U S A. 2012;doi:10.1073/pnas.1212806109). Intriguingly, the follicle-stimulating hormone blocking antibody also reduced body fat and converted white adipose tissue to thermogenic beige adipose tissue (Liu X, et al, Nature. 2017;doi:10.1038/nmeth.4436) and, in a separate study, prevented cognitive decline and Alzheimer-like neuropathology in mouse models (Xiong, et al, Nature, 2022; in press).
Our humanized monoclonal follicle-stimulating hormone blocking antibody replicates these actions and has shown promise in preclinical studies toward first-in-human clinical trials in the very near future. Our admittedly ambitious premise is to treat osteoporosis, obesity and neurodegeneration with a single drug.
Mone Zaidi, MD, PhD, MBA, MACP, FRCP
Professor of Medicine and Pharmacological Sciences
Director, Center for Translational Medicine and Pharmacology
Director, Mount Sinai Bone Program
Icahn Sinai School of Medicine at Mount Sinai
One in five adults in the National Health and Nutrition Examination Survey 2017-2018 reported prescriptions for obesogenic medications, according to results published in Obesity.
Craig M. Hales
“The prevalence of obesity among adults in the U.S. has been increasing for decades. Using certain prescription medications can lead to weight gain and can hinder weight-loss efforts,” Craig M. Hales, MD, MPH, MS, a medical epidemiologist with the National Center for Health Statistics at the CDC, told Healio. “However, it was unknown how commonly adults use these medications. We set out to evaluate trends in the use of obesogenic prescription medications among U.S. adults from 1999 to 2018, both overall and by therapeutic class. We also wanted to see if there is a relationship between obesity and use of obesogenic prescription medications for each therapeutic class.”
Researchers assessed cross-sectional data of 52,340 adults aged 20 years and older from the 1999 to 2018 NHANES. Obesogenic medications were defined according to the 2015 Endocrine Society guidelines, and weight status was categorized by BMI as normal weight (BMI < 25 kg/m2; n = 2,792), overweight (BMI 25-29.9 kg/m2; n = 3,357), class 1 and 2 obesity (BMI 30-39.9 kg/m2; n = 3,402) and class 3 obesity (BMI > 40 kg/m2; n = 893).
In the NHANES 2017-2018, 20.3% of adults reported using at least one obesogenic medication, which was a significant increase from the 13.2% observed in 1999-2000. The most common obesogenic medications were beta-blockers and diabetes drugs, with 9.8% and 5.7% of participants reporting their use, respectively. Conversely, antipsychotics were the least commonly prescribed obesogenic medications with only 1% of patients.
Researchers observed glucose metabolism, hypertension, neuralgia or neuritis, heart disease and musculoskeletal pain and/or inflammation as the most common reasons for obesogenic medication prescriptions.
Researchers observed an increase in the proportional use of obesogenic medications from 34.4% in 1999 to 55% in 2018 for anticonvulsants. However, there was a decrease in antidepressants (32.1% vs. 18.8%), diabetes drugs (82.9% vs. 52.5%) and beta-blockers (83.9% vs. 80.7%) during the same period.
Obesogenic medication proportional use was not associated with weight status in patients, except for antipsychotic medications., according to the researchers.
“The most important limitation of this study is that there is no consensus list of obesogenic medications,” Hales said. “Different systematic reviews of obesogenic medications have led to variations in which medications are identified as obesogenic.”
Ehlers-Danlos syndrome can be a devastating disease in patients who are severely affected — a situation made worse by the current scarcity of treatment options.
“The life expectancy for those patients is really diminished, perhaps around 50 to 51 years of age, depending on what form they have,” David R. Deyle, MD, medical geneticist at the Mayo Clinic in Rochester, Minnesota, told Healio. “For those who are severely affected, it can be really bad.”
The FDA in December granted orphan drug designation to enzastaurin (AR101, Aytu Biopharma) for the treatment of Ehlers-Danlos syndrome. Aytu Biopharma is undertaking the PREVEnt trial to study the effectiveness of enzastaurin in preventing cardiac or arterial events in patients with vascular Ehlers-Danlos syndrome confirmed to have COL3A1 gene mutations.
Healio spoke with Deyle about vascular Ehlers-Danlos syndrome and the FDA’s recent orphan-drug announcement.
Healio: What causes vascular Ehlers–Danlos syndrome?
Deyle: We know that variants or changes in the COL3A1 gene, type 3 collagen, lead to vascular Ehlers-Danlos syndrome. Type 3 collagen is primarily in tubular structures — so, arteries. It is also in the intestine and uterus. This is where we see many of the complications from vascular Ehlers-Danlos syndrome.
David R. Deyle
One way it can happen is that abnormal collagen incorporated into the triple helix, where three proteins come together, is then going on to cause problems. In subgroups of patients with vascular Ehlers-Danlos syndrome, mutations may lead to a loss of collagen production. There are two ways that can happen. One, an error can create technically the right amount of collagen, but it may not be getting out, or the collagen may be not quite right. Or, you may only make half as much collagen, and that’s what we know leads to vascular Ehlers’s Danlos syndrome.
Healio: What are symptoms of Ehlers–Danlos syndrome and how is it diagnosed?
Deyle: That depends sometimes on the particular mutation. Patients who only make half as much collagen tend to have milder cases than patients who make an altered copy. In milder cases, the main criteria for diagnosis are arterial ruptures, spontaneous arterial ruptures, spontaneous intestinal ruptures and spontaneous uterine ruptures.
In more severe cases, you might also see thin, translucent skin, where you can really see all the underlying veins, particularly in the chest and sometimes even in the arms. The hands may look older than they should. Some patients may have a small nose, a small pointy chin or thin lips. Some patients can have flexible joints.
Something that we see first and foremost is unusual bleeding or bruising. Patients may also have hemothorax, a hole in the lung, just spontaneously — no reason why. People who have hypermobility can have joint subluxation dislocation.
Healio: When do symptoms manifest?
Deyle: The more severe cases can happen in childhood. Although vascular Ehlers-Danlos syndrome can present at any age, some children can have arterial rupture, but mostly we see intestinal rupture first.
The statistics are that at roughly age 25 years, 50% of patients will have had a major event, including arterial rupture, intestinal rupture or uterine rupture. In patients approximately 40 years old, 85% of them will have had an event of some sort. Every year thereafter, the percentage gets closer to 100%.
Patients who only make half as much collagen and may not present until later in life primarily have vessel issues, either arterial dissection or rupture, but they may not have some of the physical findings. You couldn’t really pick them out from anybody else. They tend to live longer, so they can have more normal lifespans because their symptoms are milder and they don’t present until later. But we still see a lot of patients who have significant complications in their 20s and 30s.
Healio: How is Ehlers–Danlos syndrome treated?
Deyle: There are no treatment options currently for vascular Ehlers-Danlos syndrome. Treatment is about empowering our patients with knowledge of the underlying condition because there are certain things they should avoid, primarily anything that can lead to trauma.
These patients have very fragile vessels so we do not recommend elective surgery, because that can be lethal. Particularly for cardiovascular surgery, if you can’t put the vessel back together it can be catastrophic. We also recommend that patients keep an emergency letter with them and wear a MedicAlert bracelet, because one of the things to avoid is any kind of instrumentation within the vessel, which can lead to more damage. Instrumentation can rip the vessels. So, it’s really about avoiding situations that can lead to more damage.
We also don’t recommend patients have colonoscopies routinely because that blowing up of the colon can cause a rupture. We do recommend screening of the vessels, looking at what the arterial system looks like, but we do not currently have any kind of therapeutic and surgery can be fraught with problems.
With surveillance, we look at changes in the arterial system or whether there has been a dissection. If somebody has abdominal trauma, you want to know what the arteries looked like before, compared with after, but there are no active therapeutics, no medication.
Healio: The FDA recently gave the drug enzastaurin orphan drug status for the treatment of Ehlers–Danlos syndrome. How do you see this new medication changing the treatment paradigm, if at all?
Deyle: It would be great if it works, but I want to see the data after patients are treated. Does the mechanism work in patients who are only making 50% of the collagen they are supposed to be making, but still have normal collagen? We need to see how it affects people. Does the dose lead to side effects that people cannot tolerate? The bigger thing is to see how it works, but if it does, fantastic.
Researchers demonstrated for the first time that infusions of antibodies can prevent HIV infection.
According to clinical trial results presented at the HIV Research for Prevention virtual meeting, infusions of a broadly neutralizing antibody (bNAb) called VRC01 were effective at preventing infection from HIV strains that were sensitive to the antibody, although the infusions offered no protection against unsusceptible strains.
“The trial, as a test of concept, was wonderfully successful and sets the landmark that we can use broadly neutralizing antibodies for the prevention of HIV,” Lawrence Corey, MD, president and director emeritus of the Fred Hutchinson Cancer Research Center, said during a press briefing.
“This will be a new modality and a new toolbox, and it opens up the field for the development of antibody cocktails and monoclonal antibodies,” said Corey, who is protocol chair of the Antibody-Mediated Prevention (AMP) studies and the principal investigator of the HIV Vaccine Trials Network (HVTN).
75% effective
In one study, Corey and colleagues enrolled around 2,700 transgender people and cisgender men who have sex with men in Brazil, Peru, Switzerland and the United States. Another study enrolled more than 1,900 HIV-negative cisgender women in seven African countries — Botswana, Kenya, Malawi, Mozambique, South Africa, Tanzania and Zimbabwe. Participants received an IV infusion of VRC01 every 8 weeks for 80 weeks at a dose of either 10 mg/kg or 30 mg/kg, or a placebo. They were assessed for HIV acquisition in 4-week intervals.
VRC01 was calculated to be 75% effective at preventing HIV infection from isolates sensitive to the antibody. However, because only 30% of isolates were sensitive to the antibody, protection from VRC01 was not statistically significant overall compared with placebo, the researchers reported.
Nyaradzo M. Mgodi, MBChB, MMed, a researcher on the VRC01 trials, told journalists in a preconference webinar that they set out to answer four questions: “Is VRC01 safe to give to people? Are people able to tolerate the antibody without becoming too uncomfortable? Does the antibody lower people’s chances of getting HIV? And if it does, what is the optimal dose?”
Mgodi said there are no plans to seek licensure for VRC01. Instead, the proof of concept study will be used to design future studies to evaluate antibodies and combinations of antibodies to prevent HIV.
Corey noted that the cost of antibodies is gradually dropping and that bNAb treatment could be economically feasible in the future.
“HIV is always a formidable pathogen — what you hope happens doesn’t always necessarily happen,” he said. “We’re not disappointed in this study because we got what we really wanted — to have a marker of success that leads the field forward and showed that we could demonstrate the proof of concept.”
‘Foundation’ for future research
In a statement, National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, said the findings “establish the concept that passive administration of a broadly neutralizing antibody can prevent acquisition of susceptible HIV strains.”
“Insights gleaned from the AMP studies lay the foundation for future development of long-acting antibody-based HIV prevention tools and, ultimately, a vaccine,” Fauci said.
As noted on the trial’s website, giving people infusions of antibodies skips the step of vaccinating them and directly gives them the antibodies they might produce after vaccination.
Scientists have long sought a vaccine against HIV.
According to Pontiano Kaleebu, MD, PhD, who heads the Uganda Virus Research Institute, more than 250 HIV vaccine trials have reached phase 1 or 2 development since 1987, and 10 have reached phase 2b or phase 3. Kaleebu recorded a presentation on the subject for journalists covering the conference.
Early last year, Fauci’s NIAID stopped a phase 2b/3 trial, HVTN 702, after an independent data and safety monitoring board found that the vaccine was not working — a result that generated a lot of disappointment in the scientific community.
The trial had enrolled more than 5,400 participants at 14 sites in South Africa to test a vaccine based on a regimen that was found to be around 31% effective during a vaccine trial in Thailand, according to results released in 2009.
The cancellation left three ongoing HIV vaccine efficacy trials, including the phase 2b HVTN 705 trial, nicknamed Imbokodo, which is being conducted in five southern African countries; and the phase 3 HVTN 706 trial, called Mosaico, which is taking place in eight North American, South American and European countries, including the U.S. Both are evaluating investigational vaccines that use “mosaic” immunogens designed to provide maximum coverage against circulating HIV strains, Kaleebu said.
There also is a lot of interest in using messenger RNA vaccine technology — the same technology used in the two authorized COVID-19 vaccines in the U.S. — for HIV and other infections, including malaria and tuberculosis, according to Fauci.
Moderna, which developed one of the COVID-19 vaccines, has already expanded its mRNA program to develop vaccines against HIV, influenza and Nipah virus.
“HIV research absolutely helped COVID-19. Now that we have a successful vaccine with mRNA, it’s going to go back,” Fauci told journalists ahead of the conference. “Everything that goes around comes around. We’re going to hopefully get more insight into HIV vaccines.”
References:
Mkhize NN, et al. Abstract 1188. Presented at: HIV Research for Prevention; Jan. 27-28 and Feb. 3-4, 2021 (virtual meeting).
Broadly neutralizing antibodies, which arise naturally in some people living with HIV, could have a role in HIV prevention or treatment. This study from the HIV Vaccine and Prevention Trial Networks (HTN 704/HPTN 085) was a proof of concept study to determine if a bNAb named VRC01 (targeting the CD4 binding site of HIV-1) decreased HIV acquisition among men and transgender persons who have sex with men (MSM/TG) and women. Study participants were randomly assigned to receive 10 IV infusions over 80 weeks of VRC01 at two dosing regimens or placebo. Moreover, sensitivity of the HIV strains to the bNAb was determined by a test that measures viral susceptibility to neutralization. Overall, VRC01 was 75% effective at preventing acquisition of sensitive HIV strains across the 80-week study period in both women in sub-Saharan Africa and MSM/TG in the Americas and Europe. The key determinant of how well the antibody worked to prevent HIV was whether the HIV strain to which a person was exposed was susceptible; indeed, VRC01 did not prevent acquisition of resistant HIV strains.
This study is relevant in that it suggests that bNAbs will be effective as another tool in HIV prevention, although a combination of bNAbs may be required to offer effective protection against a wide variety of HIV strains. This study also has relevance for HIV vaccines, which would be designed to stimulate such antibodies. Therefore, this is a very exciting proof of concept study for the role of bNAbs in HIV prevention.
Monica Gandhi, MD, MPH
Professor of medicine
Associate chief, division of HIV, infectious diseases and global medicine
University of California, San Francisco
Disclosures: Gandhi reports no relevant financial disclosures.
We’ve known for years that circulating antibodies play a role in HIV control. While not the easy “home run” we may once have believed, this report provides extremely important insight into their potential role in preventing HIV acquisition. We know that HIV mutates in response to immunologic pressure as well as to the presence of less potent antiretroviral drugs. This trial employed an antibody chosen for its ability to neutralize a rather broad array of HIV isolates and infused this in individuals at risk of becoming HIV-infected and followed participants to see how many acquired HIV infection. The investigators report that the antibody infusions were very effective (about 75%) if the HIV to which they were exposed was sensitive to the antibody in the study. The treatment, however, did not prevent infection from HIV variants that were less sensitive to this antibody. While this approach is unlikely to find a common role in population-level HIV prevention strategies, it will still be very valuable to better design newer efforts to employ antibodies or combinations with broader neutralization and potentially exploring these as therapeutic agents in attempts to cure HIV infection. It’s great to see in HIV as well as in COVID-19 applications of antibodies in treatment and prevention.
Paul A. Volberding, MD
Chief Medical Editor, Infectious Disease News
Professor of medicine
Director of the AIDS Research Institute
University of California, San Francisco
The use of e-cigarettes as a smoking cessation method did not significantly prevent relapse or successful termination, according to survey findings published in Tobacco Control.
“This is the first survey in which e-cigarettes were less popular as a smoking cessation aid than FDA-approved pharmaceutical aids,” John P. Pierce, PhD, a distinguished professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego and UC San Diego Moores Cancer Center, said in a press release. “Not only were e-cigarettes not as popular, but they were associated with less successful quitting.”
Pierce and colleagues evaluated data from the nationally representative PATH cohort study to determine the effectiveness of e-cigarettes as a smoking cessation aid from 2017 — when sales for nicotine e-cigarettes increased in the U.S. — to 2019. The analysis included 3,578 participants who were established smokers in 2016 with a recent quit attempt and 1,323 recent former smokers.
Between 2016 and 2017, there was a more than 40% growth in sales for e-cigarette products in the U.S., according to the researchers.
In 2017, 12.6% (95% CI, 11.3-13.9) of smokers who recently attempted to quit reported using e-cigarettes as a cessation aid (8.7% e-cigarettes only, 3.2% e-cigarettes and nicotine replacement therapy/pharmaceutical aid, 0.5% e-cigarettes and other tobacco products, and 0.2% three or more products). This marked a decline from 17.4% in 2016, according to Pierce and colleagues.
Only 2.2% (95% CI, 0-4.4) of recent former smokers said they switched to a high nicotine e-cigarette. These products were most often used as a cessation aid by respondents aged 18 to 50 years compared with those aged older than 50 years. Also, non-Hispanic white individuals, those who attended college, those with higher incomes and daily smokers were more likely to report using e-cigarettes.
Meanwhile, 2.5% (95% CI, 1.9-3.1) of respondents reported using a non-e-cigarette tobacco product as a cessation aid and 20.6% (95% CI, 18.9-22.3) used a nicotine replacement therapy or pharmaceutical aid only. The researchers reported that most respondents (64.3%) attempted the “cold turkey” method, in which no products were used.
Among respondents who reported cigarette abstinence, 18.6% (95% CI, 16-21.2) said they did not use any aids. In contrast, a lower proportion (9.9%; 95% CI, 6.6-13.2) said they used e-cigarettes.
The results further showed that e-cigarettes were associated with lower abstinence rates at 12 or more months compared with pharmaceutical aids (adjusted risk difference [aRD] = 7.3%; 95% CI, 14.4 to –0.4) or any other method (aRD = 7.7%; 95% CI, 12.2 to –3.2), according to Pierce and colleagues.
Although the finding was insignificant, the researchers also noted that respondents who switched to e-cigarettes appeared to have a higher relapse rate than those who did not switch to e-cigarettes or other tobacco products. By 2019, nearly 60% of recent former smokers who used e-cigarettes daily had resumed cigarette smoking.
While randomized clinical trials show improved cessation with e-cigarettes, they are often not conducted under “optimal conditions” and do not reflect “the effectiveness of the product in community settings,” Pierce and colleagues wrote.
“There is good evidence that [e-cigarettes] have become the initiation product of choice for adolescents,” Pierce told Healio. “The Surgeon General has labeled this an epidemic. Some are concerned that this effect on teens may be wiping out all of the successes in tobacco control over the past 3 decades.”
When talking to patients about smoking cessation, “clinicians can correct patient misperceptions that e-cigarettes will make their quit attempt more successful,” he said.
According to Pierce, individuals who smoke are advised to mix and match approved cessation aids. As an over-the-counter option, nicotine replacement therapy is the most popular aid, he said. It is often used in combination with varenicline or Zyban (bupropion hydrochloride, GlaxoSmithKline), he added.
In September, Pfizer voluntarily recalled all lots of its varenicline product Chantix “due to the presence of unacceptable N-nitroso-varenicline levels,” according to the FDA. The agency approved a generic version of varenicline (Par Pharmaceutical) in August.
Adoption of e-cigarettes for smoking cessation in 2017 low and ineffective. https://ucsdnews.ucsd.edu/pressrelease/adoption-of-e-cigarettes-for-smoking-cessation-in-2017-low-and-ineffective. Published Feb. 7, 2022. Accessed Feb. 11, 2022.
Chen R, et al. Tob Control. 2022;doi:10.1136/tobaccocontrol-2021-056901.
Endo launches first and only generic version of Chantix (varenicline) tablets in the United States. https://investor.endo.com/news-releases/news-release-details/endo-launches-first-and-only-generic-version-chantixr. Published Sept. 22, 2021. Accessed Feb. 16, 2022.
FDA updates and press announcements on nitrosamine in varenicline (Chantix). https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-nitrosamine-varenicline-chantix. Published Sept. 17, 2021. Accessed Feb. 16, 2022.
Laboratory analysis of varenicline products. https://www.fda.gov/drugs/drug-safety-and-availability/laboratory-analysis-varenicline-products. Published Aug. 23, 2021. Accessed Feb. 16, 2022.
Short-term air pollution exposure can increase the likelihood of psoriasis flares, according to a study.
“Environmental air pollution is defined by the World Health Organization (WHO) as the contamination of the ambient air by any chemical, physical or biological agent that modifies the natural characteristic of the atmosphere,” Francesco Bellinato, MD, of the section of dermatology and venereology at the University of Verona in Verona, Italy, and colleagues wrote. “Psoriasis is a chronic inflammatory disease with a relapsing-remitting course and selected environmental factors such as infections and/or drugs may trigger disease flares. Whether air pollution could trigger psoriasis flares is not known.”
Researchers conducted a case-crossover and cross-sectional, observational, retrospective study of 957 chronic plaque psoriasis patients.
Subjects had 4,398 follow-up visits and more than 15,000 air pollutant measurements.
Air pollutant concentrations were significantly higher in the 60 days before psoriasis flares for the 369 patients in the case-crossover analysis. This population included subjects with at least two consecutive visits, one psoriasis flare and a continuous systemic treatment for at least 6 months.
A median psoriasis area and severity index (PASI) score at the flare visit was 12 (interquartile range, 9-18), compared with PASI 1 at the control visit.
For the cross-sectional analysis, an air pollution or course particulate matter (PM) concentration were positively associated with an increase in PASI scores.
PASI scores of 5 or higher were more likely for those who had exposure to mean PM10 over 20 g/m3 (adjusted OR = 1.55; 95% CI, 1.21-1.99) and mean PM 2.5 over 15 g/m3 (aOR = 1.25; 95% CI, 1-1.57) in the 60 days before visits.
“Short-term air pollution exposure is associated with increased psoriasis activity and likelihood of having a psoriasis flare,” the authors wrote. “Further study is needed to examine whether these findings generalize to other populations and to better understand the mechanisms by which air pollution may affect psoriasis disease activity.”
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