View news from the 2021 SABCS, including session summaries, poster write-ups, and interviews with key opinion leaders.

Coverage of the 2021 San Antonio Breast Cancer Symposium

View news from the 2021 ACAAI Annual Scientific Meeting, including session summaries, poster write-ups, and interviews with key opinion leaders.

Coverage of 2021 ACAAI Annual Scientific Meeting

If 2020 was dominated by the news of how COVID-19 spread across the globe, then 2021 has so far been focused on ending the pandemic through vaccine distribution.

A Timeline of COVID-19 Vaccine Developments in 2021

This AJMC® Profiles in Care provides an in-depth look into the results of the outcomes-based agreement between Boehringer Ingelheim and Highmark Inc.

AJMC® Profiles in Care Launches

With no current treatments available to reverse the damage caused by 

, unmet needs in patients also include management of pain, gastrointestinal, and sleepiness issues, said Robert J. Hopkin, MD, clinical geneticist, Cincinnati Children's Hospital Medical Center.

What are some unmet challenges regarding management of Fabry disease?

The treatments that we have right now are well studied and they slow down the progression of kidney disease and heart disease reasonably well, and that's well documented. But the treatments don't appear to adequately control the pain, which is a major quality-of-life issue.

They also don't reverse the damage that's already been done. So, the current average age for starting therapy for Fabry disease is about age 30. By that age, people with the classic severe form of Fabry disease will already have some irreversible damage to kidneys and/or heart in many cases. We need to get earlier recognition.

So, pain management, early recognition. We need earlier and more effective treatment for the lymphedema, earlier more effective treatment for the GI [gastrointestinal] symptoms. Hearing loss is something that is not well studied, but does impact a significant number of patients. And then the fatigue and sleepiness issues.

All of those are essentially unaddressed at this point—other than the people who are very interested in Fabry disease, treating patients on an individual basis as best they can for those problems.

Videos

Robert J. Hopkin, MD, clinical geneticist, Cincinnati Children's Hospital Medical Center, addresses major unmet needs in Fabry disease, ranging from uncontrolled pain to irreversible damage prior to treatment initiation.

Dr Robert Hopkin on Unmet Needs in Fabry Disease

® since 2019 after receiving his Bachelor's degree at Rutgers University–New Brunswick in journalism and economics.

, with and without concomitant psoriatic arthritis (PsA), were significantly more likely to report complete skin clearance and improved quality of life (QOL) when treated with brodalumab vs ustekinumab. The results were published in 

In the treatment of PsA, early diagnosis and treatment is vital to reduce the risk of joint damage, disability, and comorbidities. Although biologics are effective in the treatment of moderate-to-severe psoriasis, in PsA, which 

 after the development of psoriasis, they have conversely been shown to be associated with failed sustained response in patients.


“The therapeutic goals for patients with PsA are to minimize disease activity, prevent disease progression, alleviate symptoms, improve QOL, and restore functional ability,” noted researchers.

In a prior post-hoc analysis of the 52-week phase 3 AMAGINE-2 and -3 studies, brodalumab, a fully human monoclonal antibody that binds with high affinity to the interleukin-17 receptor subunit A (IL-17RA), was 

 to be effective in achieving and maintaining higher levels of complete skin clearance and QOL compared with ustekinumab in the treatment of patients with moderate-to-severe psoriasis. 

Conducting another post-hoc analysis of the AMAGINE-2 and -3 studies, researchers sought to examine the efficacy of brodalumab vs ustekinumab in patients with moderate-to-severe plaque psoriasis with and without concomitant PsA.

In the study, participants were assessed for complete skin clearance (100% improvement of Psoriasis Area and Severity Index [PASI 100]), improvement in symptom severity (Psoriasis Symptom Inventory [PSI] response), and QOL (Dermatology Life Quality Index [DLQI] score of 0/1) by concomitant PsA status.

Of the 929 patients with moderate-to-severe plaque psoriasis included in the analysis, concomitant PsA was present in 79 of 339 (23%) receiving brodalumab 210 mg and in 110 of 590 (19%) receiving ustekinumab.

After 52 weeks, patients with concomitant PsA were shown to be greater than 3 times more likely to report complete clearance with brodalumab vs ustekinumab (odds ratio [OR], 3.15; 95% CI, 1.52-6.55; 

 = .0015), as well as 2-fold more likely to achieve DLQI 0/1 (OR, 2.05; 95% CI, 1.07-3.90; 

 = .0277) and 3.4-fold more likely to report PSI less than or equal to 8 (OR, 3.42; 95% CI, 1.43-8.18; 

Higher levels of significant improvement was also observed in patients without PsA who were treated with brodalumab vs ustekinumab for complete skin clearance (OR, 3.05; 95% CI, 2.19-4.26; 

 < .0001), DLQI 0/1 (OR, 1.83; 95% CI, 1.32-2.53; 

 = .0002), and PSI less than or equal to 8 (OR, 1.40; 95% CI, 1.01-1.95; 

Cumulative incidence of patients achieving PASI 100 after 52 weeks was indicated to be significantly higher for brodalumab vs ustekinumab in patients with concomitant PsA (

 = .0001) and in those without concomitant PsA (

Kokolakis G, Vadstrup K, Hansen JB, Carrascosa JM. Brodalumab is associated with high rates of complete clearance and quality of life improvement: A subgroup analysis of patients with psoriasis and concomitant psoriatic arthritis. 

. Published online November 25, 2021. doi:10.1159/000520290

Articles

Patients with concomitant psoriasis and psoriatic arthritis (PsA) were shown to be 3.1-fold more likely to achieve complete skin clearance when treated with brodalumab vs ustekinumab after 52 weeks, with further improvements reported for quality of life (QOL).

Brodalumab Improves Skin Clearance, QOL vs Ustekinumab in Comorbid Psoriasis, PsA

Early diagnosis and treatment initiation is key for patients with 

 (SMA), an inherited degenerative neuromuscular disease characterized by muscle weakening, atrophy, and death in infants. A recent 

 found that a pilot newborn screening program in Australia identified at-risk patients with high specificity and could be effectively incorporated into clinical practice.

SMA is caused by mutation or deletion of the survival motor neuron 1 (

) gene, leading to a deficiency in SMN protein and the subsequent clinical manifestations of the disease. The 

gene does not typically allow for sufficient production of SMN, but in recent years, the therapeutic landscape has evolved and continues to expand. Even so, early diagnosis and treatment initiation before permanent loss of existing neurons is paramount to positive outcomes.

The study authors stated that newborn bloodspot screening (NBS) in Australia “continues to be one of the most successful population health programs, yielding greatly improved health outcomes for identified cases achieved by a combination of very early diagnosis and expedient initiation of treatment and management.” They suggested adding SMA to newborn screening panels could enhance the quality, efficiency, and efficacy of NBS programs based on the pilot study results.

The New South Wales and the Australian Capital Territory NBS program, in which parents are urged but not required to enroll their newborns, offers screening for over 30 congenital conditions and typically screens approximately 100,000 newborns each year. For SMA, the absence of 

 exon 7 alleles was considered screen positive. The authors noted that this does not detect heterozygous deletions or point mutations on the 

 gene, which account for about 2%-5% of the SMA population. 

copy number did not factor into screen positivity, to allow for proficiency testing in the pilot study.

A total of 252,081 newborns were screened in the NBS program over the study period (August 2018 to January 2021), and 22 had positive screenings for SMA. Of those infants, 21 had confirmed SMA with homozygous deletions in exon 7 of 

. Twelve of these infants had 2 copies of 

8 had 3 copies, and 1 infant had 4 copies. Greater 

copy number generally correlates with milder phenotypes.

Participants received positive screening results a median of 3 days after birth, received diagnostic confirmation a median of 15 days after birth, and therapy initiation at a median of 25 days after birth. The overall incidence of SMA in the program during the study period was 1 in 11,458 newborns. Compound muscle action potentials (CMAPs) were recorded at diagnosis, and there were significant differences between infants with different SMA genotypes. One of 3 newborns included in longitudinal assessment of CMAPs showed significant reductions in amplitude at symptom onset. Overall, these findings suggest NBS is crucial for diagnosis prior to motor neuron degeneration.

More than 99.9% of all newborns in New South Wales were included in NBS, which had a sensitivity rate of 100%, specificity greater than 99.9%. The false-positive rate was less than 0.001%, and the positive predictive value was 95.5%.

Implementation challenges included shipping delays, which lengthened time to completing the diagnostic workups, including 

copy number results. This was addressed by the NBS laboratory obtaining accreditation for 

testing with digital droplet polymerase chain reaction on dried bloodspots. Another challenge was managing urgent referrals. NBS staff partnered with neuromuscular specialists to work the NBS SMA pilot into established pathways and neuromuscular models of care.

Multidisciplinary collaboration and communication between a neuromuscular team, families, and community health care providers also proved important. Study authors noted that a decision support analysis and national clinical guidelines for SMA are warranted.

Overall, the results of the pilot program suggest SMA testing within NBS provided opportunities for early intervention in newborn patients and gave all families — regardless of financial, geographic, cultural or linguistic barriers — access to appropriate diagnosis and care for SMA.

“The results from this study can be used as a blueprint for NBS programs globally, as they work to expand the number of disorders screened, alongside providing a personalized model of care for identified individuals,” the authors concluded.

D'Silva AM, Kariyawasam DST, Best S, et al. Integrating newborn screening for spinal muscular atrophy into health care systems: an Australian pilot programme. 

. Published online November 28, 2021. doi:10.1111/dmcn.15117

Testing for spinal muscular atrophy in an Australian newborn screening program identified patients across socioeconomic and cultural demographics, mitigating inequity and providing patients with access to multidisciplinary treatment. 

Pilot Program Underscores Importance of Newborn Screening to Identify, Treat SMA

The results of a meta-analysis published in 

 showed that a high fractional exhaled nitric oxide (FeNO) value before starting inhaled corticosteroid (ICS) therapy could be linked to higher treatment response rates in patients with chronic cough.

The authors also noted that FeNO values can help predict steroid responsiveness and have a better performance at higher cut-off values.

Defined as a cough lasting more than 8 weeks, chronic cough has a global prevalence of 9.6% and can impair quality of life.

“Up to 44% of diagnostic and therapeutic failures have been documented among patients with chronic cough, thus leading to the new paradigm of a neuropathic syndrome with its own pathophysiology, known as cough hypersensitivity syndrome (CHS),” the study authors wrote. “In parallel, such diagnostic and therapeutic challenges called for the development of specific guidelines for chronic cough aimed at improving the current management strategies.”

The authors added that such guidelines rely on a common principle based on the identification and treatment of the disease potentially responsible for CHS. There are multiple diseases that can cause it, including asthma, eosinophilic bronchitis, pulmonary fibrosis, gastroesophageal reflux disease, postnasal drip syndrome, chronic obstructive pulmonary disease, and respiratory tract infections (RTIs). External factors such as exposure to cigarette smoke or environmental pollution or use of blood pressure medications could also be potential causes.

To conduct this systematic review, researchers included 2237 studies that reported the rate of ICS response in people with chronic cough with high and low FeNO, later narrowing it down to 9 articles with a total of 740 participants with chronic cough.

The mean age among all studies ranged from 39.8 to 59.2 years, and the mean body mass index ranged from 25.7 to 30.1 kg/m

. Asthma was documented in 0% to 54.8% of patients, atopic status was documented in 5.2% to 100%, recent RTI was documented in 0% to 13%, and smoking history was documented in 0% to 51.9%.

“Mean values of [forced expiratory volume in 1 second (FEV

)] ranged from 86.2% to 113.2% predicted, while the FEV

/[forced vital capacity] ratio was between 72.8 and 88.9,” the authors noted. “Data on the use of [angiotensin-converting enzyme inhibitors] and on the proportion of steroid naïve patients lacked in most included studies.”

The response rate to ICS was 87.4% in 317 patients with chronic cough and a high FeNO, and 46.3% in 423 patients in the control group. The researchers noted an attributable proportion of 47.0% and a corresponding odds ratio of 9.1 (95% CI, 3.7-22.4: 

 < .001). There was significant heterogeneity among the studies that was not reduced by the exclusion of one study at a time.

A pooled analysis of diagnostic indexes demonstrated a sensitivity of 68.5% (95% CI, 46.7%-84.4%) and a specificity of 81.9% (95% CI, 63.0%-92.3%). It also showed a positive likelihood ratio of 3.79 (95% CI, 1.24-7.47) and a negative likelihood ratio of 0.38 (95% CI, 0.22-0.66).

The authors also found that, among 6 studies, 321 patients with chronic cough responding to ICS therapy showed significantly higher FeNO values compared with 240 nonresponders.

“The analysis of the funnel plot for studies evaluating FeNO levels among responders and nonresponders to ICS suggested the absence of publication bias for this additional analysis, also confirmed by the Egger’s test (

The authors concluded that high FeNO values in patients with chronic cough prior to starting ICS therapy may be associated with a higher response rate.

“These findings are supported by sensitivity and meta-regression analyses, showing no impact of several clinical and demographic variables on the observed results, including those related to cough aetiology and duration,” they said. “Furthermore, this meta-analysis offers interesting insights into the identification of the optimal FeNO cut-off for predicting response to steroids.”

They also mentioned that FeNO has recently emerged as a useful and noninvasive method to identify chronic inflammation of airway diseases, and it is successful in monitoring adherence to steroid treatment in patients with asthma.

“Considering that steroids are able to reduce eosinophilic inflammation documented in most asthma phenotypes, FeNO is the perfect biomarker for monitoring steroid response in this clinical setting,” the authors said. “Further studies are needed to evaluate the real usefulness of this biomarker to guide cough therapy and optimise strategies in different healthcare settings (community, hospital, rehabilitation).”

Ambrosino P, Accardo M, Mosella M, et al. Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis. 

. 2021;53(1):1659-1672. doi:10.1080/07853890.2021.1979242

A systematic review showed that a high fractional exhaled nitric oxide (FeNO) value before starting inhaled corticosteroid (ICS) therapy may be associated with higher response rates in patients with chronic cough.

FeNO Values Linked to ICS Therapy Response Rates in Patients With Chronic Cough

School districts across the state may be able to partner with their local ophthalmologists or optometrists, said Victoria Ly, MD, MPH, an intern resident physician at University of Texas Southwestern Medical Center in ophthalmology.

What can be done to increase vision screening follow-up rates among Arkansas children? 

and increase follow-up rates, I would focus more on pursuing tactics that improve accessibility to the eye care. I, as a medical student, was volunteering at this free school physical day at the Children's Hospital. And it pretty much was a couple of days through the week where busloads of students from across the Tri-County area would come to the hospital and we volunteered and did their school sports physicals for free. I think we could kind of model something like that, where across the state school districts could partner with their local optometrists or local ophthalmologists and have the busloads of kids that had failed their school vision screenings come to the clinic, get their assessment done. Then they could bring that report back to their parents. I think that would help mitigate some issues such as financial and logistical barriers that parents might face when taking their kids to the doctor. For instance, I know in Arkansas, there are a lot of medically underserved areas. So transporting your child from home to the next eye doctor, maybe 40 or 60 miles away, can be an issue especially, if you have a lot of kids at home that you have to be taken care of as well. So that could be something.

Victoria Ly, MD, MPH, outlines one method of tackling vision screening follow-up rate disparities among children in Arkansas. 



Dr Victoria Ly Offers Potential Solutions to Vision Screening Follow-up Disparities 

 who are overweight and obese are significantly more likely to have bronchial obstruction compared with children of normal or low body weight, according to a new study.

The study is based on a comparison of spirometric measures with body mass indicators. The results were 

Investigators, including corresponding author Tatyana I. Eliseeva, MD, DSc, of the Privolzhsky Research Medical University in Russia, wrote that from a scientific standpoint it is believed that all patients with bronchial asthma could successfully control their disease. However, as many as half of patients with the disease do not have their asthma under control, largely due to comorbid conditions such as obesity and being overweight.

Solving the problem is difficult, though, since there is conflicting data regarding how excess weight affects spirometry readings, the authors said. One reason for the conflicting data, they posited, could be the imprecision of using body mass index (BMI) as a stand-in for weight in pediatric patients.

“The same BMI values may correspond to different types of nutritional status in children of different ages and genders,” the authors wrote. “For example, a BMI of 17.0 in a boy of 11 years 1 month with average physical development (143 cm) will correspond to the median, a girl of 5 years 1 month (height 110 cm)—overweight (+1 Z-score [Z]), and a girl of 17 years (height 163 cm)—protein-energy deficiency (–2Z).”

Eliseeva and colleagues decided to supplement BMI by using a relative BMI (RBMI), which uses a ratio of the patient’s BMI to the average BMI for children with the same age and gender.

The investigators recruited 54 patients with bronchial asthma between the ages of 8 to 17 years old. Most of the patients (33) were boys. The patients had a range of nutritional statuses based on BMI Z-scores: 5 had low body weight, 18 had normal body weight, 17 were considered overweight, and 14 were considered obese.

The patients were evaluated using a number of spirogram parameters, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and maximum expiratory flow at the point of 25% loop flow-volume (MEF 25).

An analysis of the readings showed that as body weight increased, FEV1/FVC ratio and MEF 25 both decreased. Notably, those findings held true not only for BMI, but also when evaluated against other measures of weight, including RBMI and percentage of body fat.

“It is obvious that there may be various pathogenetic mechanisms of the influence of obesity on the physiology of the lungs, including, inter alia, an imbalance of pro- and anti-inflammatory cytokines,” they wrote.

For instance, they said, adipokines have been linked with bronchial inflammation and hyperreactivity.

Yet, they added that it is also possible the reverse is true: that asthma leads to nutritional changes.

“And this is due not only to changes in the level of physical activity in connection with the disease and the reception of exogenous glucocorticoids, but also with the possibility of local synthesis of alpha-melanocyte stimulating hormone, respectively, and its predecessor-adrenocorticotropic hormone,” they wrote.

Overall, the authors said the potential causal links remain a topic of open scientific question. They said deeper research is needed to understand practical issues such as how to diagnose, treat, and effectively control children with bronchial asthma who are obese.

“An increase in BMI, an indirect indicator of obesity, is a predictor of worsening bronchial patency in patients with [bronchial asthma] regardless of the sex of the child,” they concluded.

Khramova RN, Tush EV, Khramov AA, et al. Relationship of nutritional status and spirometric parameters in children with bronchial asthma. 

. 2021;12(3):12-23. doi:10.17691/stm2020.12.3.02

The trend was true when investigators used body mass index to classify weight, and when measures such as relative body mass index and percentage of body fat were used.

Increased Weight Worsens Bronchial Patency in Children, Study Finds

New research from Finland highlights a potential link between 

 (PCOS) and receiving a diagnosis of a severe mental, or psychotic, disorder, according to 

Although much is known regarding the risk for certain psychological comorbidities among women with PCOS—chiefly, depression, anxiety, bipolar disorder, and disordered eating—less is known about the risk of more severe psychiatric diseases, such as schizophrenia, among this group.

“Against this background, the objective of the present work was to investigate whether women with PCOS are at higher risk for psychotic disorders,” the authors wrote.

The Northern Finland Birth Cohort 1966 provided the authors their study population (124 women with PCOS vs 2145 controls), with the PCOS cohort identified via questions on their oligo-amenorrhea and hirsutism status. The data was collected from participants at age 31

National register data on psychiatric diagnoses were also provided, and the Social Anhedonia Scale (SAS), Physical Anhedonia Scale (PHAS), Perceptual Aberration Scale (PAS), Hypomanic Personality Scale (HPS), Bipolar II scale (BIP2), and Schizoidia Scale (SCHD) helped to identify psychopathological symptoms.

More women in the PCOS group had a body mass index (BMI) of at least 25 or 30 kg/m2 (53.7% vs 29.8%), their testosterone levels were higher (1.39 [range, 1.17-1.79] vs 0.98 [range, 0.75-1.16] nmol/L; 

< .001), and their free androgen index (FAI) more often fell in the upper quartile (67.1% vs 20.1%;

< .001). Incidence of parental psychosis was almost equal between the PCOS and control groups, respectively: 6.5% vs 6.2%.

Using an age cutoff of 50 years, this investigation found an almost 3-fold higher lifetime prevalence up to age 50 of any psychoses in the PCOS cohort compared with the control group: 8.1% vs 2.8%. In addition, the lifetime prevalence of psychoses other than schizophrenia was 3.5 times greater, at 5.6% vs 1.6% (

An analysis of women aged 31 to 50 showed similar results. Women with PCOS had a greater incidence of psychosis compared with controls (5.8% vs 2.2%; 

 = .023). In particular, while no difference was seen in schizophrenia incidence between the groups (0.8% and 0.9%, respectively; 

 = .96), the overall incidence of other psychoses was almost 4-fold higher in the women with PCOS (5.7% vs 1.5%; 

When looking at risks of lifetime diagnoses of psychosis, analyses up until age 50 years and women ages 31 to 50 years continued the trend of elevated findings in women with PCOS. A Cox regression model and adjusting for parental psychoses both showed close to a 200% higher risk of any psychosis:

Cox regression model: HR, 2.99 (95% CI, 1.53-5.83)

Parental psychoses: HR, 2.98 (95% CI, 1.52-5.82)

The finding of schizophrenia risk until age 50 was not considered statistically significant, while risk of other psychoses alone and from parental psychoses again were higher:

Other psychoses: HR, 3.66 (95% CI, 1.62-8.26)

Parental psychoses: HR, 3.62 (95% CI, 1.61-6.10)

For women aged 31 to 50 with PCOS, elevated risks of psychoses continued to be seen following a Cox regression model and after adjusting for parental history of psychoses, at HRs of 2.69 (95% CI, 1.21-5.94) and 2.68 (95% CI, 1.21-5.92), respectively.

Additionally, for women who agreed to a clinical examination and blood tests at age 31 and were shown to have hirsutism, the incidence of a psychosis diagnosis between ages 31 and 50 was more than 3 times higher (9.5% vs 2.8%). Adjusting for testosterone level (HR, 3.03; 95% CI, 1.26-7.31) and FAI (HR, 2.85; 95% CI, 1.09-7.49) showed elevated risks, too, for women with PCOS.

The psychopathology scales showed mixed results. While the scales for PAS and HPS were significantly higher among the women with PCOS compared with the controls, similar results were not seen for SAS, PHAS, or BIP2.

When explaining why their findings are significant, the authors noted that their community-based findings are the first to show elevated psychoses risk among women with PCOS vs a control population to age 50. In particular, that parental history of psychosis did not influence this risk nor did isolated PCOS symptoms, BMI, or biochemical hyperandrogenism in adulthood.

Underestimation of the prevalence of severe psychiatric comorbidity in women with PCOS was a principal limitation on these study findings and the results of self-reported PCOS diagnoses, low attendance to data collection, and the low totals of schizophrenia and psychosis cases among the women with PCOS.

“Future research should focus on investigating the mechanisms behind this association, thus enabling prevention and new treatment strategies,” the authors concluded. “The fact that women with PCOS seem to have a high risk of psychiatric comorbidities warrants devoting more resources and greater efforts to improve awareness, treatment modalities, and quality of life.”

Karjula S, Arffman RK, Morin-Papunen L, et al. A population-based follow-up study shows high psychosis risk in women with PCOS. 

Published online November 29, 2021. doi:10.1007/s00737-021-01195-4

This new study from Finland highlights both the potential for severe psychiatric disturbances among women with polycystic ovary syndrome (PCOS) and lack of extensive knowledge of the toll of psychoses among this group.


PCOS May Predispose Women to Higher Risk of Psychosis, Study Suggests

Incidence of dupilumab-induced ocular surface disease (DIOSD) is common in patients with 

 (AD), particularly those with asthma and a family history of AD, according to study findings published in 


As the first approved biologic agent for moderate to severe AD, dupilumab has demonstrated efficacy and a favorable safety profile, but it also has been associated with risk of conjunctivitis and other more severe ocular toxicities. Notably, patients with AD are prone to developing 

, with severe AD and inflammatory conditions 

“Risk factors for DIOSD among patients with AD treated with dupilumab are unclear," noted the researchers. “Reported rates of DIOSD range from 16.4% to 31% in clinical trials and higher in short-term retrospective studies of real-world patients at 43% to 48.6%.”


They conducted a multicenter retrospective cohort study of consecutive adult outpatients treated with dupilumab for moderate to severe AD from 2017 through 2021 at Sunnybrook Health Sciences Centre and Women’s College Hospital, 2 tertiary care academic dermatology clinics in Toronto, Canada.

Participants were assessed for clinical characteristics, associated risk factors, treatment strategies, and long-term outcomes of DIOSD (N = 210; mean [SD] age, 44.2 [14.9] years; 51% female). Blepharoconjunctivitis, corneal scarring, cicatricial ectropion, burning/stinging/dryness, epiphora, pruritus, blurred vision, and photophobia were classified as DIOSD.

Stepwise multivariable logistic regression was used to assess the association between patient characteristics and development of DIOSD.

Among the study cohort, 37% (n = 78) developed DIOSD over the 52-week follow-up period. Patients with AD were shown to be almost 3 times more likely to develop DIOSD if they had a history of asthma (OR, 2.94; 95% CI, 1.26-6.87; 

 = .01) and just over 2.5-fold more likely if they had a family history of AD (OR, 2.58; 95% CI, 1.08-6.17; 


Vision-threatening complications, including corneal scarring and cicatricial ectropion, were found in 1% (n = 3) of patients, with the following clinical features also reported:

Overall, 63% of patients with DIOSD were given treatments for their ocular condition, with artificial tears (56%) and corticosteroid drops (29%) most commonly used. Dupilumab was discontinued because of DIOSD in 4% of patients with AD.

The researchers concluded that future prospective studies with an objective assessment and comparison of various interventions may be needed to help determine the underlying mechanism of DIOSD and optimal management strategies.


“Rare but vision-threatening complications, including corneal scarring and cicatricial ectropion, and disruptions in the dupilumab treatment course secondary to DIOSD may be mitigated with prompt recognition and management using topical ocular interventions,” they added.

Felfeli T, Georgakopoulos JR, Jo CE, et al. Prevalence and characteristics of dupilumab-induced ocular surface disease in adults with atopic dermatitis. 

. Published online October 20, 2021. doi:10.1097/ICO.0000000000002866

More than 1 in 3 patients with atopic dermatitis reported incidence of dupilumab-induced ocular surface disease (DIOSD), with asthma and family history of AD shown to further increase the risk of developing DIOSD.

Dupilumab-Induced Ophthalmic Disease Common in Adults With Atopic Dermatitis

A recent review and meta-analysis suggests a link between 

(PD) and inflammatory bowel disease (IBD) and calls for randomized controlled trials in order to gain a better understanding of shared disease processes.

The gut-brain axis—or the relationship between the enteric nervous system and the central nervous system (CNS)—has become a focus of researchers in recent years. Recent work has explored the idea that PD is tied to inflammation in the gastrointestinal tract, and IBD, an umbrella term which includes ulcerative colitis (UC) and Crohn disease (CD), has been implicated in neuroinflammation.

, the authors said they wanted to update what is currently known about this possible association, as previous studies have had conflicting results.

Using PubMed, Embase, and Cochrane databases, the authors retrieved observational studies of IBD and PD published from inception to October 2019. Case reports, letters, reviews, editorials, retrospective designs lacking controls, and genetic studies that only reported risk alleles were excluded. Studies were also excluded if they were judged to have a high risk of bias as assessed by the Newcastle-Ottawa Scale.

After an initial screening returned 1033 articles, 9 observational studies including 12,177,520 patients were included in the final analysis. One of the 9 studies was both a cohort and case-control study based on the same population. Of the 9 studies, 6 were cohort studies, 3 were case-control studies, and 1 was a cross-sectional study.

The studies came from Denmark, Sweden, the United States, Taiwan, and Switzerland. Researchers pooled the unadjusted and adjusted estimate effects separately, adjusted for confounders, and excluded heterogeneous studies.

The overall risk of PD was significantly higher in patients with IBD than in the general population (adjusted risk ratio [aRR], 1.24; 95% CI, 1.15-1.34; 

A meta-analysis of the temporal relationship illustrated the incidence of IBD as it related to PD diagnosis, with a significant increase before (adjusted HR [aHR], 1.26; 95% CI, 1.18-1.35; 

 < .001) and after (aRR, 1.40; 95% CI, 1.20-1.80; 

After excluding a heterogeneous study, the pooled risk of PD development in patients with UC (aHR, 1.25; 95% CI, 1.13-1.38; 

 < .001) or CD (aHR, 1.33, 95% CI, 1.21-1.45; 

By subgroup analysis, patients older than 65 with IBD (aHR, 1.32; 95% CI, 1.17-1.48) may have a higher risk of PD than those under age 65 (aHR, 1.24; 95% CI, 1.08-1.42).

In addition, patients with IBD who were not treated with anti–tumor necrosis factor-α or azathioprine had significantly higher PD risk (aHR, 1.6; 95% CI, 1.2-2.2).

However, there was no significant differences in risk between men and women.

The researchers noted that the data may not have contained complete insights into the timing of IBD and PD, since the studies that were reviewed were based on Medicare databases or hospital registries. Both diseases develop over years and may present with varying symptoms, which can make diagnosis challenging. 

Our findings suggest an urgent need for an individualized screening strategy for patients with IBD,” wrote the authors, noting that the use of early anti-inflammatory treatments for IBD may lessen the risk of PD, although they cautioned that more research is needed.

Zhu Y, Yuan M, Liu Y, et al. Association between inflammatory bowel diseases and Parkinson's disease: systematic review and meta-analysis. 

. 2022;17(2):344–353. doi:10.4103/1673-5374.317981

The meta-analysis sought to clarify previous research, which has explored the idea that Parkinson disease (PD) is tied to inflammation in the gastrointestinal tract, noting that inflammatory bowel disease (IBD) has been implicated in neuroinflammation. 

Review Suggests Having IBD May Increase Risk of PD

 since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey. 

Real-world data on the efficacy and safety of oral Ninlaro (ixazomib) -based maintenance therapy revealed the treatment is a favorable option for long-term administration among patients with 

 (MM) not undergoing transplantation. Findings were published in 

Patients with MM have a median survival of at least 10 years, and despite improvements in prognosis, almost all patients will eventually relapse, authors explained. “The paradigm of long-term therapy in MM has been widely accepted, since continuous or maintenance therapy after plateau demonstrated obvious prolonged disease control,” they added.

Ixazomib is an oral proteasome inhibitor (PI) approved for patients who have received at least 1 previous therapy for MM. To retrospectively evaluate the treatment in patients who plateaued after bortezomib-based regimens, researchers assessed real-world data collected from a single institution in China.

A total of 71 patients with newly diagnosed MM (NDMM; n = 37) or relapsing/remitting MM (RRMM; n = 34) were consecutively observed after plateauing between April 2018 and April 2020. All individuals received at least 2 cycles of ixazomib within 60 days of the completion of the induction therapy, researchers wrote.

Median patient age was 63 (IQR 41-80) and the majority of patients were male (60.6%). In addition, all patients received a median of 9 cycles of bortezomib (IQR 6-14; induction phase) and a median of 6 cycles of ixazomib (IQR 2-25; maintenance phase) for a median follow-up time of 26.5 months (IQR 7.1-56.8).

The overall response rate (ORR) was 81.7%, including 34 patients (47.9%) with a very good response rate or better (≥VGPR) after induction therapy

The ORR was transformed to 74.6% including 39 patients of ≥VGPR (54.9%) after maintenance therapy

Of these, 18 patients (25.4%) exhibited deepened responses

With 26.5 months median follow-up, median progression-free survival (PFS) was 28.4 and 16.5 months from the start of bortezomib and 16.2 and 10.0 months from the initiation of ixazomib in the NDMM and RRMM groups, respectively

Responses deepened during the maintenance phase (hazard ratio [HR], 0.270; 

=.007), and responses of ≥VGPR during the induction phase (HR, 0.218; 

< .001) were confirmed to independently predict longer PFS after multivariate analyses

Severe adverse events (AE) (grade 3/4) were relatively rare

Bortezomib-emergent peripheral neuritis (PN) was significantly relived after the transition to ixazomib (

Results of a retrospective study conducted in China assessed the safety and efficacy of ixazomib for multiple myeloma. 