View previews and the latest developments from this year's European Hematology Association Congress, being held in a hybrid format, including session summaries, poster write-ups, and interviews with key opinion leaders.

Coverage of EHA2022

Click here for news from the 2022 ASCO Annual Meeting: session summaries, poster and abstract write-ups, expert interviews, and more.

Coverage of ASCO 2022

Click here for news from the the annual meeting of the Associated Professional Sleep Societies, including session summaries, poster write-ups, and interviews with key opinion leaders.

Coverage of Sleep 2022

 (HMs) encounter barriers to early palliative care (EPC) despite this care type being known to significantly improve quality of life (QOL) for those with advanced cancer. 

provides insight into recent research on EPC in HMs and potential models to facilitate integration of EPC for patients with HMs.

Patients with solid tumors often have EPC integrated into their disease management, but patients with HMs are often referred later in the course of their disease. This is despite patients with HMs having similar symptom burdens and psychosocial distress to patients with solid tumors, the review authors note.

“Patients with HMs could benefit greatly from the interdisciplinary approach offered by PC, which is focused on improving symptoms, communication, shared decision making, psychosocial support, community care resources, advance care planning, and caregiver support,” the authors wrote. “Moreover, there is emerging evidence that supports early specialized PC in HM.”

The authors highlight a conceptual model that stratifies PC into 3 categories: primary, secondary, and tertiary. Primary PC, which entails practices to relieve pain, nausea, and mood disorders, is handled by primary care clinicians who are well versed in PC. Hospitals and specialists provide secondary PC, which oncologists should all be knowledgeable about. PC consultants provide tertiary PC, which is more specialized and helps manage refractory symptoms, severe psychosocial issues, and family conflicts, for example.

HMs can have less predictable disease tracks than solid tumors, but the review separates them into 3 main risk groups based on disease trajectory, care settings, and PC delivery challenges: aggressive HMs, indolent HMs, and HMs with bone marrow failure that rely on blood transfusions.

Aggressive HMs, such as acute leukemias, aggressive lymphomas, or graft-versus-host disease after stem cell transplantation, are difficult to prognosticate and carry a possibility of curative treatment until just days before death. The courses of such diseases can have a roller-coaster effect and lead to patient and provider uncertainty.

Indolent HMs, like chronic lymphocytic leukemia (CLL), indolent lymphomas, and multiple myeloma in many cases, are incurable but may face prolonged prognosis and multiple relapses. With novel drug options evolving, patients with advanced disease may achieve remissions, but prognostication is difficult.

The third group includes myelodysplastic syndromes, myelofibrosis, aplastic anemia, and end-stage HMs with bone marrow disease infiltration or aplasia after treatment. Patients with severe anemia rely on blood transfusions to relieve a host of symptoms, including fatigue, shortness of breath, and chest pain. With chronic bone marrow failure can come severe neutropenia and subsequent bacterial and fungal infections.

Despite the extensive and often overwhelming symptoms of HMs, these patients are not sufficiently referred to PC. In addition, although psychological distress is a significant symptom considering the potentially roller-coaster–like disease courses, few are referred to psychologists. All solid tumor oncologists reported referring patients to PC in one study, while only 30% of hemato-oncologists had referred patients to PC. For patients with HMs, PC is often only discussed when death is imminent, and they are less likely to have been prescribed opioids for pain management at hospice care initiation. This suggests symptom management may be inadequate compared with patients with solid tumors.

The barriers to integration of PC in patients with HM include prognostication difficulties, differing attitudes toward PC in hemato-oncology vs other specialties, and hospice criteria that can limit access to therapies that may benefit QOL for patients with HMs.

Randomized controlled trials have demonstrated benefits of EPC in solid tumors, but data on EPC from randomized trials in HMs is only just emerging. Solid tumor studies have also been conducted in inpatient and outpatient settings, while studies in HMs have been conducted nearly exclusively in the inpatient setting. In the inpatient setting, EPC effectively reduced anxiety and improved QOL for patients with HM in one study, which also showed benefits for caregivers. More trials are underway to confirm the benefits of EPC for patients with HMs. Trials of PC in the outpatient setting for multiple myeloma and trials of blood transfusions in hospice settings may provide better options for patients with indolent HMs and HMs with bone marrow failure.

Further research is also needed on models of referral to tertiary PC, which can be based on physician judgment or automated. Clinician referral is currently most common, but as discussed, referral is not typically adequate for patients with HMs compared with patients with solid tumors. Better training for oncologists who provide secondary PC services could also improve patient experiences.

“As the understanding of the biology of HMs and targeted treatments continue to progress, HM patients will continue to face challenges in maintaining QOL and in making treatment decisions in the context of prognostic uncertainty,” the authors concluded. “With its interdisciplinary and holistic approach, PC has much to offer these patients. Increased understanding of PC by haemato-oncologists as well as improved models for integration of tertiary PC will open the door to improved quality of care for this underserved population.”

Shaulov A, Aviv A, Alcalde J, Zimmermann C. Early integration of palliative care for patients with haematological malignancies. 

. Published online June 7, 2022. doi:10.1111/bjh.18286

Interviews

A recent review explored current palliative care practices for patients with hematologic cancers compared with solid tumor cancers. 


Palliative Care Shortcomings for Patients With Hematologic Malignancies Addressed in New Review

Findings from a new investigation of hospitalization outcomes among patients having a 

 (HF) exacerbation who also have gout show that gout flares may be the primary driver behind these patients’ longer hospital length of stay (LOS), according to the study published in 

Therapeutic Advances In Musculoskeletal Disease

Data on the patients for this retrospective cohort study were gleaned from electronic medical records at Columbia University Irving Medical Center. Patients with gout were identified by their having at least 2 

International Classification of Diseases, Ninth Revision

 codes for a gout diagnosis, and patients with HF were identified by at least 1 hospitalization between July 1, 2012, and June 30, 2017, with a primary discharge diagnosis of HF. For the study period, the investigators found 293 patients with gout who had 545 HF-related hospitalizations and 3798 patients with 5461 HF-related hospitalizations who did not have gout. The final analysis covered 246 patients in the study group and 492 matched controls (for both: mean [SD] age, 71.67 [13.95] years; 61.7% male).

“We aimed to compare the length of stay for patients with both gout and HF who were admitted for a primary diagnosis of HF exacerbation to those with HF without a gout diagnosis,” the authors wrote. “We hypothesized that patients admitted to the hospital for a primary HF exacerbation who then suffer a concomitant gout flare would likely have longer hospitalizations than those who do not experience concomitant gout flares.”

The study data show that the average ejection fraction in each group, 38.96% in the gout group and 36.97% in the nongout group, indicated most patients had HF with reduced ejection fraction. As well, the severity of their HF was indicated by alarmingly high brain natriuretic peptide (BNP) levels, which were 5145.41 mEq/L in the gout group and 5539.9 mEq/L in the nongout group. 

Although hospital LOS was equal in the groups, at a median 6 days, the interquartile range was 2 days shorter in the nongout group. In addition, the log LOS was considered significantly longer in the gout vs nongout group: 1.86 (0.95) vs 1.72 (0.94).

Gout flares were confirmed in 13% of hospital admissions, and when there was a flare, HF hospitalizations were 10 days vs 6 days each for those with no flare and the control group. The group with a gout flare also had a longer log LOS vs patients who did not have gout: 2.41 (0.96) vs 1.72 (0.94).

Adjusting for such characteristics as age, kidney function, cardiac function, and socioeconomic status produced a significant association between gout flare and longer LOS (

 < .0001). Although to a lesser degree, the investigators highlighted, history of nonflare gout was also associated with a longer hospital LOS (

The predicted median LOS was highest, and close to twice as long among those who had gout and flared (10.96 days) compared with study participants who did not have gout (5.96 days).

Additional study findings show that at baseline, most patients in the gout cohort had Medicare coverage (51.2%), while commercial insurance was the most common coverage in the nongout group (49.4%); overweight was the most common weight classification, with the average body mass indices being 29.04 and 28.28, respectively; the control group had more pronounced chronic kidney disease, with a baseline creatinine of 2.22 vs 1.76 mEq/L; and elevated troponin was more common in the control group, at 22.6% vs 15.9%.

“Interventions that aim to improve gout outcomes and diminish the preponderance of flares in this high-risk population are warranted,” the study authors concluded.

Future areas of study that the authors focused their attention on were the evaluation of factors not studied herein that may increase the risk of a gout flare in patients with HF and addressing patient, provider, and health care system barriers that may lead to inadequate gout management.

DeMizio D, Wu G Wei Y, Bathon J, Wang R. Gout increases length of stay in patients hospitalized for heart failure exacerbation. 

. Published online June 14, 2022. doi:10.1177/1759720X221102853

Using the Nationwide Inpatient Database for trends studied between 1993 and 2011, investigators from Columbia University Irving Medical Center evaluated hospitalization outcomes among patients with heart failure and comorbid gout.

Gout Flare Likely Increases Hospital LOS in Heart Failure

Matthew is an associate editor of The American Journal of Managed Care® (AJMC®). He has been working on AJMC® since 2019 after receiving his Bachelor's degree at Rutgers University–New Brunswick in journalism and economics.

Adherence of topical and oral drugs for the treatment of 

 (AD) in children can be difficult, but there are several strategies that can promote uptake, said Robert Sidbury, MD, MPH, Chief, Division of Dermatology, Seattle Children's Hospital.

What strategies can promote therapeutic adherence in pediatric patients with AD?

It's hard, right? So, with younger kids or really anyone, first and foremost, topical therapy is foundational for the care of eczema. We've got all these new medications, but one of the things I'll see for instance with some of the kids who've had eczema all their lives, in my experience so far, it's just been to dupilumab, they finally go on dupilumab and they’re so much better, and they're just so sick of doing topical stuff so they stop.

That's not the recommendation, we tell still want them to moisturize, but many do, and I totally get why they do. Then, oftentimes, you may see them start to get a little bit of recurrence or persistence of involvement and they may not if they just continued to moisturize. So, partly, kids get incentivized themselves, because they see how much better they do when they do moisturize.

With the younger kids, when I'm trying to get them to buy into the program of what they're doing, I will sort of describe how when any of us get into a bathtub, shower, or swimming pool and our fingertips wrinkle after 5-10 minutes—I say use that as a timer. If you're in the bath long enough for your fingertips to wrinkle, your whole body has absorbed moisture, other than above the neck when you aren't in the bath, perhaps, and that's a timer, your skin is saturated. Get out, pat dry. Before those fingertips unwrinkle, get your moisturizer on the good areas and the medicine on the bad areas before they unwrinkle.

That's going to keep all of that moisture, all of that hydration in the skin and not let it evaporate and actually cause drying, if you let that happen. So called soak and smear. And that's how, number one, bathing and moisturizing can be more effective, and number 2, you can sort of optimize adherence with kids to kind of almost turn it into a game where they use their fingertips as this this sort of timer, both the during the bath for the length of it and then after the bath for the application of the medication. So, [these are] little tricks you can play.

With oral medications, any oral medication, I try to get older kids to time it with something they do every day. If it's a medication we'd like them to take with food well then always pair it with breakfast or dinner or something that they won't forget. If it's a medication they do relatively close to bedtime, we'll put it right next to their toothbrush which hopefully they're doing every night. 

So, things like that, just little ways to sort of link it to things and make it habitual, rather than something that they have to remember anew each night, which is hard to do.

Videos

Robert Sidbury, MD, MPH, Chief, Division of Dermatology, Seattle Children's Hospital, speaks on strategies that clinicians can employ to promote adherence of topical and oral medications in pediatric patients with atopic dermatitis.

Dr Robert Sidbury on Promoting Therapeutic Adherence in Pediatric Atopic Dermatitis

Interim results of a phase 2 trial show that combination daratumumab, pomalidomide, dexamethasone, and ixazomib (DIPd) is well tolerated and effective in early relapsed or refractory 

 American Society of Clinical Oncology Annual Meeting.

The quadruplet combination sees the addition of ixazomib to the triplet of daratumumab, pomalidomide, and dexamethasone (DPd) that has produced durable responses and high rates of minimal residual disease (MRD) negativity in relapsed or refractory MM. The DIPd regimen aims to improve on those response rates and efficacy.

Main end points of the ongoing prospective, multicenter, single-arm phase 2 trial include the safety, efficacy, and overall response rate (ORR) of DIPd in early relapsed or refractory MM. Progression-free survival (PFS), overall survival (OS), and MRD negativity rate are secondary end points.

Eligibility requirements included no prior exposure to daratumumab or ixazomib and no progression on pomalidomide. Eligible patients received 1 to 3 previous lines of treatment. The study used a Simon’s optimal 2-stage design and included 14 patients in stage 1 and 32 patients in stage 2. Patients with a very good or partial response (VGPR) or with potential complete response (CR) to the regimen were assessed for MRD, and custom panel mass cytometry was used to assess pharmacodynamic changes in the tumor microenvironments.

In the safety run-in, 6 patients received 16 mg/kg of intravenous daratumumab weekly for 8 doses, biweekly for 8 doses, and then monthly. On days 1 to 21 of a 28-day cycle, patients received 4 mg of pomalidomide orally each day and 4 mg of ixazomib on days 1, 8, and 15 of each 28-day cycle. Each week, patients also received 20 to 40 mg of dexamethasone. During the safety run-in, all patients experienced grade 3 or 4 neutropenia, and the Data and Safety Monitoring Board reduced the ixazomib and pomalidomide doses to 3 mg each.

At the time of the interim analysis, 14 participants had been treated in stage 1 and 18 in stage 2. The median patient age was 61 years, half of the patients were female, and 72% of the patients reported White as their racer. The median time on treatment was 4 months, and 11 patients were still on the DIPd regimen at the time of the analysis. Five patients died —4 due to disease progression and 1 from sepsis. All of the patients had previously received lenalidomide, and 47% showed high-risk cytogenic features.

The median OS was 38.9 months, and the median PFS was 9.5 months. The ORR was 84%, with 26% of patients showing stringent CR, 21% achieving VGPR, and 37% experiencing partial response. The immunophenotypic changes that took place were similar to those seen in patients treated with DPd.

Neutropenia, infection, leukopenia, respiratory conditions, psychiatric disturbance, and thrombosis were the most common grade 3 or 4 adverse events (78%, 30%, 11%, 7%, 4%, and 4%, respectively).

Overall, the interim results suggest that DIPd is safe and effective with a favorable ORR in relapsed or refractory MM. It was also well tolerated and showed efficacy, even in patients who had high-risk cytogenic abnormalities.

Kumar AD, Rosenberg A, Padilla M, et al. Phase II study of the combination of daratumumab, ixazomib, pomalidomide, and dexamethasone as salvage therapy in relapsed/refractory multiple myeloma: Stage 2 interim results. Poster presented at: 2022 American Society of Clinical Oncology Annual Meeting; June 3-7, 2022; Chicago, IL. Accessed June 22, 2022. https://meetings.asco.org/abstracts-presentations/207926

Early results of a multicenter phase 2 trial exploring the efficacy of daratumumab, pomalidomide, dexamethasone, and ixazomib treatment suggest the regimen is safe and effective in relapsed or refractory multiple myeloma (MM). 


Interim Phase 2 Trial Results Show Quadruplet Regimen Tolerable, Effective in MM

Julia is an associate editor of The American Journal of Managed Care

since 2022 after receiving her Bachelor's degree at Rutgers University–New Brunswick in English and Creative Writing.

 found that the trivalent seasonal influenza vaccine (TIV) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) can reduce the risk of hospitalization for acute exacerbations of chronic obstructive pulmonary disease (

), pneumonia, and other related illnesses.

In this self-controlled, before-and-after cohort study, all patients were all from Tangshan City of Hebei Province in China and recruited in September 2018. They needed to have been a COPD diagnosis and a postbronchodilator forced expiratory volume in 1 second-to-forced vital capacity ratio of less than 0.702 to be eligible for the study.

Three groups of patients were formed based on the vaccines received: The TIV group received TIV only, the PPSV23 group received PPSV23 only, and the TIV and PPSV23 group received both vaccines. Vaccination started on October 31, 2019, and concluded on November 15, 2019.

There were a total of 474 patients who received at least 1 vaccine for this study: 109 received TIV, 69 received PPSV23, and 296 received both. The median age of the patients was 66 (IQR, 62-70) years. There were 285 patients (60.13%) who were 65 years and older, 78.48% were male participants, and 73.84% were coal miners or former coal miners. COPD degree was mostly moderate or severe.

There were 427 outcome-related events that were reported in the 2-year follow-up period. AECOPD, pneumonia, and hospitalizations accounted for 30.91%; AECOPD and pneumonia, 8.43%; AECOPD and hospitalization, 36.77%; pneumonia and hospitalization, 3.04%; AECOPD, 19.20% only; and  pneumonia, 1.64%.

Number of AECOPD, pneumonia, and related hospitalization outcomes before and after vaccination were 58 and 19, 23 and 9, and 39 and 19, respectively, in the TIV group; 59 and 26, 28 and 15, and 35 and 22, respectively, in the PPSV23 group; and 190 and 55, 90 and 23, and 138 and 49, respectively, in the TIV and PPSV23 group.

Incident densities of AECOPD, pneumonia, and related hospitalization decreased by 67.24%, 60.85%, and 51.29%, respectively, in the TIV group; 55.93%, 46.43%, and 37.15% in the PPSV23 group; and 71.05%, 74.45%, and 64.50% in the TIV and PPSV23 group. Incidence density of AECOPD decreased the most.

Incidence densities were greater in patients who were 65 years and older vs patients younger than 65 years. Incident densities were also lower in women.

Vaccine effectiveness for preventing AECOPD, pneumonia, and related hospitalization was 70% (95% CI, 49%-82%), 59% (95% CI, 11%-81%), and 58% (95% CI, 26%-76%), respectively, in the TIV group; 54% (95% CI, 26%-71%), 53% (95% CI, 8%-76%), and 46% (95% CI, 8%-69%) in the PPSV23 group; and 72% (95% CI, 62%-79%), 73% (95% CI, 58%-83%), and 69% (95% CI, 57%-77%) in the TIV and PPSV23 group after adjustment for age, gender, occupation, COPD severity, smoking status, and underlying disease.

Vaccine effectiveness was proven to be more effective outside of the nonpharmaceutical intervention COVID-19 period in AECOPD, pneumonia, and related hospitalization prevention.

There were some limitations in this study. Effectiveness of the vaccines may have been influenced by nonpharmaceutical intervention due to the COVID-19 pandemic and the participants self-chose their group, which may lead to difference in study group composition and could influence the generalizability of the findings.

The researchers concluded that the TIV and PPSV23 vaccines were effective in reducing risk of AECOPD, pneumonia, and related hospitalizations, with AECOPD prevention the greatest success.

“Considering consistency of our results with similar studies, we infer that the effectiveness of both vaccines together is superior to effectiveness of TIV alone and that TIV is more effective than PPSV23 alone,” the authors wrote.

Li Y, Zhang P, An Z, et al. Effectiveness of influenza and pneumococcal vaccines on chronic obstructive pulmonary disease exacerbations. 

. Published online June 15, 2022. doi:10.1111/resp.14309

A cohort study found that influenza and 23-valent pneumococcal polysaccharide vaccines (PPSV23) can reduce the risk of chronic obstructive pulmonary disease (COPD)- and pneumonia-related hospitalizations.

Influenza and PPSV23 Vaccines Evaluated for Their Ability to Stem COPD Exacerbations 

As hormonal treatments are increasingly being used for treating 

 among adolescents, researchers of a new 

 are highlighting the potential use of these treatments in female patients.

Combined oral contraceptives (COCs) and, more recently, spironolactone, have been identified as options for adolescent females with acne and hidradenitis suppurativa (HS), though varying levels of data are available supporting their use in these patients.

“Beyond being vital to normal cutaneous homeostasis, hormones, particularly androgens, also play a role in the pathogenesis of multiple disorders affecting the pilosebaceous unit, the prototype being acne vulgaris,” wrote the researchers. “This is mediated through both increased production of sebum and upregulation of inflammatory cytokines in the local follicular microenvironment. An understanding of the role that androgens play in the pathogenesis of follicular disorders can be leveraged by clinicians treating these conditions.”

Less quality data are available on the use of spironolactone, and as a result, the American Academy of Dermatology recommends its use in select patients with acne, and the North American clinical management guidelines gave the treatment a “grade c” recommendation for HS. The researchers of the paper wrote that while there’s insufficient data to support conclusions on its efficacy, several studies have shown promise in acne and suggested favorable safety for long-term treatment. They note that there are little data on its effectiveness in HS.

With more data available on the effectiveness of estrogen-containing COCs, those with doses of estrogen doses of 30 to 35 mg and third- or fourth-generation progestins are recommended for both acne and HS. The researchers recommend that providers consider initiating COC in patients 2 years after menarche (or at 14 years) as concerns have been raised over whether the relatively low doses of estrogen included in most COCs are sufficient for bone mass acquisition in adolescents.

For use in acne, there are data from multiple randomized controlled trials (RCTs) available. One meta-analysis of 31 studies comprising of more than 12,000 patients demonstrated that, among 9 of 10 trials comparing COCs with placebo, COCs yielded statistically significant improvements in acne for patients, ranging from lesion counts to patient-reported outcomes. Treatments included levonorgestrel, norethindrone acetate, and norgestimate. The researchers noted that comparisons across the different COCs were not able to be made.

Another meta-analysis of 32 RCTs of COCs and oral antibiotics showed that while oral antibiotics led to slightly improved reductions in mean inflammatory lesion counts by 3 months (53.2% vs 35.6%), the benefit no longer remained at 6 months. Based on the findings, coupled with concerns of prolonged use of antibiotics for acne, the researchers suggested COCs as a more appropriate first-line treatment in appropriate female patients.

The researchers noted that data backing COC use in HS remains mainly anecdotal and generalized from acne studies. Hormones are considered to play a role in the condition, as up to 44% to 57% of female patients report having flare ups during their premenstrual period, and despite the lack of quality data, the North American clinical management guidelines support the use of estrogen-containing COCs in appropriate patients.

“Despite the overall well-tolerated nature of COCs, adverse events do occur, and particular considerations must be taken into account when prescribing these agents for the treatment of dermatologic conditions in adolescents. Common side effects of COCs include headache, nausea, and breast tenderness, although these often resolve with continued use,” commented the researchers. “Intermenstrual bleeding is another commonly reported phenomenon and may possibly be decreased with the use of third-generation progestin-containing formulations, commonly used for acne and HS.”

Svoboda R, Nawaz N, Zaenglein A. Hormonal treatment of acne and hidradenitis suppurative in adolescent patients. 

. 2022;40(2):167-178. doi:10.1016/j.det.2021.12.004

Combined oral contraceptives (COCs) and, more recently, spironolactone, have been identified as options for adolescent females with acne and hidradenitis suppurativa (HS), although varying levels of data are available supporting their use in these patients.




Researchers Outline Use of Hormonal Therapies in Acne, Hidradenitis Suppurativa

 found that talking about dialysis and chronic kidney disease (

) was avoided by most patients, as dialysis was the source of much of the stress relating to the disease. Researchers also found family involvement varied by CKD treatment plans.

The researchers used the CKD Renal Epidemiology and Information Network (CKD-REIN) study for their population. CKD-REIN enrolled 3033 patients with nondialysis CKD between 2013 and 2016. At the third follow-up, 3 years after the study began, 2260 patients who had not started kidney replacement therapy (KRT) were invited to enroll in a qualitative investigation.

All participants were evaluated via the Hospital Anxiety and Depression Scale and the Center for Epidemiologic Studies-Depression scale, with a grade above 8 signifying anxiety symptoms. Interviews took place between January 2018 and January 2019.

Participants who consented to an interview were younger, less likely to be widowed, and had a higher education level, greater anxiety, better literacy skills, and more often discussed KRT with relatives. The mean (SD) age of the interviewed participants was 62.2 (12.2) years, 42% were women, and 68.0% had stage 4-5 CKD.

A lexicometric analysis was done using the text corpus comprising the interviews. This contained 264,875 words and 5715 units of context, which were divideds into 4 classes.

 (Class 1) consisted of 29% of the corpus and is characterized by temporal indicators (

) and words demonstrating temporal relationships (

). This class was associated with anxious and depressed patients, nonattendance at patient education about KRT, and not talking about KRT with relatives. Patients with stage IV CKD are significantly absent from this class.

 (Class 2) consists of 15% of the corpus and is characterized by 2 subclasses: dialysis modalities and daily life and patient education and treatment choice. This class finds dialysis to be numerous and burdensome. The class is associated with stage IV CKD, attendance at patient education sessions, discussions about treatment with their family, and no depression symptoms.

 (Class 3) consists of 13% of the corpus and is characterized by 2 subclasses: talking about the illness and talking about transplantation. Mention of dialysis is significantly absent from this class. The researchers found that some patients do not speak about their illness and the quantity of details they use depends on the person they talk to. This class is associated with depression and attendance at patient education sessions and  opposes Class 2, which implies that dialysis and transplantation do not appear together in a patient's discourse.

Disease, treatment choice, and introspection

 (Class 4) consists of 43% of the corpus. The class is divided into 3 subclasses: a normal life, avoiding thinking about CKD, and research participation, treatment choice, and acceptance:

Belonging to the a normal life subclass implies that some patients believe themselves to have a normal life and do not think about their illness from day to day.

Belonging to the avoiding thinking about CKD subclass demonstrates that if CKD has few effects a day-to-day life, patients claim to not think about their illness. Some words that are found in this subclass do not exactly correlate to this conclusion (

Patients in the research participation, treatment choice, and acceptance subclass tend to feel that decision making is not a current concern. Class 4 is charactered through demonstratives, relatives, and indefinites that designate without naming.

There were some limitations to this study. The study was cross-sectional and only reflected what the patients were feeling at the time, which meant that some patients were not facing KRT decision making. It was also based on word count, which can be problematic if people used different words to describe the same or similar experiences. The results are also not generalizable due to the qualitative nature, and the researchers  hypothesized that the interviewees were more concerned with KRT due to their youth, higher education, severity of CKD, and anxiety.

“This study underlines that cognitive avoidance is common in patients and that dialysis and transplantation belong to 2 distinct decision-making processes,” the authors wrote.

Montalescot L, Dorard G, Speyer E, et al. Patient perspectives on chronic kidney disease and decision-making about treatment. Discourse of participants in the French CKD-REIN cohort study. 

. 2022;35(5):1387-1397. doi:10.1007/s40620-022-01345-6

A qualitative study found that patients with chronic kidney disease (CKD) were more likely to avoid thinking about their disease because of the stress from dialysis.

Patients With CKD Avoid Thinking About Disease, According to Study

Certain environmental and lifestyle factors may predispose preschool children to greater risk of 

 (AD) development, according to study findings published in 

One of the most prevalent inflammatory skin diseases among children, AD risk has been 

 to be potentially influenced by genetic, environmental, and social factors. Moreover, residential and household environment variables may also play a role regarding risk of AD, although few studies have investigated this effect in children.


 such as vegetable and fruit intake and lifestyle factors (eg, 

) may also increase odds of eczema. But current findings have partially been conflicting, which may be because there are many confounders in dietary and lifestyle factors,” they added.

Seeking to investigate the associations of dietary habits, residential/household environment, and lifestyle with risk of children AD, researchers conducted a cross-sectional analysis of data on preschool children in Shenzhen, China, derived from the nationwide China-Children-Homes-Health (CCHH) study between 2015-2016.


“The rapid urbanization and industrialization in China have changed people’s consumption patterns, lifestyles, and living environments," noted the study authors. "Meanwhile, the prevalence of eczema in children has also increased rapidly."

Of the 4614 questionnaires collected across 30 kindergartens in Shenzhen, China, 2781 were included in the analysis. Several factors were assessed regarding dietary habits, residential/household environment, and lifestyle, with logistic regression models used to analyze the associations:

dietary habits examined were meats, seafood, fruits, vegetables, beans/grains, rice/pasta, eggs, milk, and fast food

residential environment included the location (residential area and located near a highway or not), size, age, and the type of dwelling

household environment, being the indoor environment formed by individual habits, encompassed mold, damp stains, water damage, window condensation, and house decoration status (floor materials and repainting the child’s room or not)

lifestyles were defined as the daily routine and living habits of children and their families, including the frequency of cleaning and ventilating and airing bedclothes, the time spent watching TV/playing with a computer, keeping pets at home, and smoking in the child’s room

the effect of ambient air pollution was adjusted in the regression models

Across the study cohort, prevalence of AD among preschool children was 24.6%, which was comparable to trends observed in other Chinese cities, such as Wuhan (23%) and Shanghai (21.1%), as well as in developed countries of Spain (21.9%) and Sweden (23.0%), suggesting that AD is a widely distributed problem of public health.

Significiant associations for doctor-diagnosed AD and AD-like symptoms, respectively, were observed for several variables, including the use of composite wood floors (adjusted OR [aOR], 1.777; aOR, 1.911), living in a villa/townhouse (aOR, 3.102; aOR, 2.156), the presence of mold or damp stains in the child’s room (aOR, 1.807; aOR, 2.279), and rarely cleaning the child’s room (aOR, 1.513; aOR, 1.540).

Furthermore, watching TV/playing computer games for more than 1 hour per day was significantly associated with doctor-diagnosed AD (aOR, 1.172) and AD-like symptoms (aOR, 1.174). Eating rice/pasta one to 3 times per week was also indicated to elevate the risk of AD-like symptoms (aOR, 1.343), which researchers said warrants further investigation.

As ambient air pollution was included in the adjusted covariates, they added this may also affect risk of childhood AD.

“Parents and kindergarten staff should make an attempt to avoid giving their children too many electronics-based tasks and create a low risk living environment for children during their growth stage,” concluded researchers.

Liu Y, Sun S, Zhang D, Li W, Duan Z, Lu S. Effects of residential environment and lifestyle on atopic eczema among preschool children in Shenzhen, China. 

. Published online May 16, 2022. doi:10.3389/fpubh.2022.844832

Several environmental and lifestyle factors were associated with significant risk of atopic dermatitis development in preschool children of Shenzhen, China, including the presence of mold in the child’s room, living in a villa/townhouse, and using composite wood floors.

Study Finds Environmental, Lifestyle Risk Factors of Atopic Dermatitis in Preschool Children

Christopher Thompson, MD, MSc, FASGE, FACG, AGAF, FJGES, director of endoscopy and codirector of the Center for Weight Management and Wellness at Brigham & Women’s Hospital, professor of medicine at Harvard Medical School,discusses findings on treatment with duodenal jejunal bypass liner for patients experiencing type 2 diabetes and obesity. This interview took place during the recent annual meeting, Digestive Disease Week.

In this first part of a 2-part interview, Thompson discusses a study involving duodenal jejunal bypass liner (DJBL). This interview is edited lightly for clarity.

When treating patients with type 2 diabetes and obesity who were being treated with insulin, what are some patient experiences you saw firsthand?

I'm a gastroenterologist and an endoscopist, so I spend most of my time doing procedures. I do remember taking care of patients with diabetes when I was a resident. I know that once they get on insulin, they start to have a decline in their health; insulin causes weight gain and causes all sorts of other problems—it's not well tolerated. So, I guess I would say this is kind of a unique niche for gastroenterologists to care for obesity. There's a growing number of us but since I've really started caring for obesity, I started to see these diabetic patients again, and nothing seemed to have improved. I mean, it was so many years ago, 20 years ago, when I was a resident—actually more than that probably—taking care of patients with diabetes and it seemed like it was very similar. There's more oral antidiabetic medications available now, but still, once they go on insulin, they don't seem to do very well. So, it's definitely time for a change, and whatever technology we can have to help these patients I think would be very welcomed.

Can you first explain how the duodenal jejunal bypass liner (DJBL) works, and what makes it different from other treatments for patients with T2D and obesity trying to achieve similar results (such as bariatric surgery)? Why is this new method needed?

The DJBL is quite unique in that it uses the body's physiology and an understanding of the physiology to treat type 2 diabetes. What it's doing is sheltering the duodenum from seeing any food, and it's also preventing the mixing of food with bile or pancreatic juices. Well, I could start by saying the DJBL is a 60-centimeter-long sheath, like a sleeve, is anchored in the duodenal bulb and extends all the way to just about the jejunum. What it does is it shelters the duodenal from contact with food or chyme, and it prevents the mixing of that food or chyme with bile and/or pancreatic juices. So, it is getting this undigested food and bile to the distal small bowel in a state where it has a pretty dramatic effect on incretin-producing cells—we think—such as L-cells, so that we're exploiting the cells production of GLP-1 and probably other substances that then have some beneficial effects on type 2 diabetes. They're known to increase insulin production and decrease glucagon, and cross the blood-brain barrier as a neurotransmitter and signal that the patient may be full, also slows gastric emptying. These substances, these gut hormones, have several beneficial effects.

Can you summarize your research and findings into the utilization of the DJBL for this patient group?

This was an FDA [approved] clinical trial, and they had some predefined end points. It was a randomized, sham-controlled trial with 2-to-1 randomization, so patients would be randomized. For every 2 patients, they got the procedure, 1 would get a sham procedure. The patients were blinded, as were the investigators that were following them. The predefined end points were both related to safety as well as efficacy. The efficacy end point involved hemoglobin A1C (A1C), and they wanted to see a change—an improvement—in A1C of at least .4% above the sham. Then, the safety end point was that they wanted the rate of serious adverse event-related device removal to be less than 15%.

So, the study did meet both of those end points, those primary end points. … the treatment group was 1.1% drop in A1C. The sham was .3%. Clearly, it was well above that .4% margin, as an efficacy end point. The safety end point, I think it was just above 9% removals due to SAEs [serious adverse event-related device removal] and that's well below the 15%. So, it did meet both of those end points. However, what did also occur in this study was that the hepatic abscess rate was unexpectedly higher than they thought. This was not something they anticipated. All the patients did well, all hepatic abscesses resolved with antibiotics and some cases some percutaneous drainage. But that was just something that caught them off guard, so the company stopped the trial due to that.1

 Is there another study taking place as a result of these findings?

 There’s another registry trial run by a Dr Bob Ryder out of England. He's an endocrinologist. He has over 1000 patients in that and the hepatic abscess rate is only 1.1%, I believe. That's a lower rate than we were seeing in our study, but it has much more patients. It turns out that in our protocol, the PPI [proton pump inhibitor], we had maximum-dose PPIs; we were using very high-dose PPIs, and the rest of these patients the registry, they weren't. It makes sense that PPIs are certainly—they’re an independent risk factor for hepatic acid formation, and very high doses in diabetic population certainly could be the cause.

We started another trial. Now, we do not have the patients on PPIs. We’re using H2-receptor antagonists, and they're doing really quite well.2 We've not seen any recurrence of hepatic abscesses so far. We've also instituted some measures to make sure that we would catch anything early as well. The patients have Wifi-enabled thermometers, and they take their temperatures every day, and they get monthly ultrasounds to look at the liver. We've not seen any further hepatic abscesses since we stopped PPIs, so we're cautiously optimistic

How did this study ensure a diverse population? How do the findings reflect the needs of patients in various demographics?

It is an FDA [approved] clinical trial, so they have in there—kind of baked into it—they make sure you have a certain amount of diversity. What you try to do is find centers that are in different locations that would make sure to pull in a nice, wide, diverse population. We did, I think, have quite good diversity. Over 50% were women—of the patients—and we had a good breakdown from underrepresented minority status as well.

What are the long-term implications of DJBLs? This study had a 12-month follow-up; are there any implications for a longer follow-up?

Some other folks have looked at this. Ours—you know—the analysis was done at 12 months because the sham patients were then offered an open-label placement of the device. That's really all you could do as far as the analysis goes, but other studies have looked at it more longitudinally. It seems like the results you see during the treatment period persist well after device removal, and it's not clear exactly why that's happening. It might be due to some kind of remodeling of the duodenal mucosa. There are other companies are looking at just ablating the mucosa, and they're getting good anti-diabetic effects as well. So, it might be that the duodenum itself changes over time, and that's what leads to the durability of the results.

What other lifestyle changes do patients with DJBLs need to make?

 I think lifestyle is hugely important in achievement of obesity and diabetes, and keep in mind this population was a population of patients with obesity and diabetes, so it wasn't thin type 2 diabetics, which is a different population. No one had type 1 diabetes. Additionally, no one in this study was on insulin. That’s probably another important point to make, that these were people that you were trying to prevent them from going on insulin, right? It's not to say that it might not help get people off insulin, but I think that just the focus of the trial was to have a uniform population in a sense, and give it enough power and be able to understand the results. We had limited to people  that were kind of poorly controlled diabetics, so their A1C had to be above 7.5% to 10%, somewhere in that range, and kind of maximal therapy, if you would, just short of insulin. We were trying to kind of look at that population specifically. 

Caiazzo R, Branche J, Raverdy V, et al. Efficacy and safety of the duodeno-jejunal bypass liner in patients with metabolic syndrome: a multicenter randomized controlled trial (ENDOMETAB). 

. 2020;272(5):696-702. doi: 10.1097/SLA.0000000000004339

Thompson CC, Jirapinyo P, Brethauer S, et al. A multicenter sham-controlled trial of a duodenal jejunal bypass liner for the treatment of type 2 diabetes. Presented at: Digestive Disease Week, May 21-24, 2022; San Diego, CA; Presentation No. 294

Christopher Thompson, MD, MSc, FASGE, FACG, AGAF, FJGES, director of endoscopy and codirector of the Center for Weight Management and Wellness at Brigham & Women’s Hospital, professor of medicine at Harvard Medical School, discusses duodenal jejunal bypass liner treatment and future innovations in gastroenterology.

  Dr Christopher Thompson Discusses Innovative Treatment for Type 2 Diabetes and Obesity

 (RCC) or unexplained chronic cough (UCC) showed characteristics consistent with already-published profiles associated with chronic cough, according to a study published in 

These characteristics include cough duration, severity, and 24-hour frequency.

The study also found that individuals with RCC or UCC reported substantial burden arising from the condition and demonstrated symptoms consistent with cough-reflex hypersensitivity.

To come to these findings, the study authors included 2044 adult participants with chronic cough enrolled in the COUGH-1 and COUGH-2 trials. Three-quarters of participants were women, the mean (SD) age was 58 (12) years, and mean cough duration was approximately 11 years, with all participants experiencing chronic cough for at least 1 year.

The authors noted that most participants (73%) received a diagnosis of asthma, gastroesophageal reflux disease (GERD), or upper airway cough syndrome  prior to the study.

On a 100-mm cough severity visual analog scale (VAS) at screening and baseline, all included patients had a score greater than 40 mm, with a mean (SD) weekly cough severity VAS of 68 (14) mm. Additionally, geometric mean 24-hour cough frequency was 19.2 coughs per hour in this study.

According to the authors, these results are generally consistent with prior research findings. They noted, though, that many previous studies recruited patients from specialized cough clinics or did not stratify by cough severity, which may affect the results.

The proportion of women in this study was higher than in prior chronic cough research, but supports the observation that individuals with chronic cough are more likely to be female. The mean age and cough duration were also similar to those found in similar studies.

“The overall characterization of participants with RCC or UCC reported in this study is also generally consistent with a previous analysis of baseline characteristics of a smaller population of participants from the United States and United Kingdom with RCC or UCC, in a phase 2 clinical trial of gefapixant,” the authors noted. “In contrast, the current analysis includes participants from 26 countries across several geographic regions, highlighting the global nature of RCC and UCC.”

Regarding other similarities, mean Leicester Cough Questionnaire (LCQ) total score was 10.4 in this study, similar to the mean LCQ score of 11.3 in other studies. Mean Hull Airway Reflux Questionnaire score was similar but slightly higher in this study, with a score of 39.6 in this study and 33 in past research.

Rates of asthma, GERD, and upper airway cough syndrome comorbidities in the COUGH-1 and COUGH-2 trials were also consistent, and history of medication use was reflective of conditions and treatments associated with the patient’s cough.

“This analysis of participants diagnosed with RCC or UCC reflects a global population with severe and long-lasting cough who share characteristics with individuals in previous studies of CC,” the authors wrote. “These data highlight the existing burden of cough that is unresponsive to treatment of presumed associated conditions and reinforces the need for an effective treatment of chronic cough.”

Dicpinigaitis PV, Birring SS, Blaiss M, et al. Demographic, clinical, and patient-reported outcome data from two global, phase 3 trials of chronic cough. 

. Published online May 12, 2022. doi:10.1016/j.anai.2022.05.003 

Individuals with refractory or unexplained chronic cough had characteristics consistent of those with chronic cough in general, including cough duration, severity, and 24-hour frequency.

Identifying Consistent Characteristics Among Patients With Refractory, Unexplained Chronic Cough 

Prevalence of cardiovascular risk factors (CVRFs) and cardiovascular events (CVEs) are higher in patients with 

 (PsA) vs the general population, although low-density lipoprotein (LDL) cholesterol levels did not differ between the groups. The results were published in 

PsA and other inflammatory diseases, such as rheumatoid arthritis (RA), have recently been listed by European Cardiology Association guidelines as inherent CVRFs associated with increased cardiovascular morbidity and mortality. In determining risk of CVEs, measurement of LDL cholesterol levels have been recommended by European guidelines.

“Control of CVRFs is essential. This is exemplified by the decrease in CVEs in patients with RA and PsA treated with statins,” wrote the study authors.

They conducted an observational cross-sectional monocentric case-control study among patients with PsA and matched controls from the general population to compare prevalence of CVRFs, CVEs, the cardiovascular risk (CVR), and the proportion of individuals in both populations who reach the recommended LDL cholesterol level and are treated with statins.

A total of 207 patients with PsA aged 25 to 85 years (mean [SD] age, 54.7 [11.4] years) who met the Classification for Psoriatic Arthritis (CASPAR) criteria and 414 controls (mean [SD] age, 54.8 [10.7] years) extracted from the MOnitoring NAtionaL du rISque Artériel (MONALISA) study were included in the analysis.

“The CVR was first assessed using SCORE and QRISK2 equations. Then, the SCORE equation was corrected by applying a 1.5 multiplication factor, as recommended by the European League Against Rheumatism (EULAR) for RA (SCORE-PsA), and the QRISK2 was corrected using the RA item (QRISK2-PsA),” explained the study authors.

After controlling for age and gender, patients with PsA exhibited higher CVRFs vs controls (body mass index, prevalence of hypertension, triglycerides, C reactive protein (CRP), prevalence of smoking, and prevalence of metabolic syndrome). Compared with controls, patients with PsA additionally had lower levels of LDL cholesterol, high-density lipoprotein cholesterol, and total cholesterol serum creatinine (all, 

 < .001), as well as a lower prevalence of dyslipidaemia (

Atherothrombotic disease was increased in the PsA population (SCORE, 

 = .001), whereas prevalence of myocardial infarction, stroke, and obliterating arteriopathy of the lower limbs was numerically higher in these patients but without statistically significant difference.

Patients with psoriatic arthritis (PsA) exhibited a higher prevalence of cardiovascular risk factors and events vs the general population, including atherothrombotic disease.