Matthew Gavidia

 apnea (OSA) was identified as an independent risk factor for severe coronavirus disease 2019 (COVID-19) resulting in hospitalization, according to 

As a result of researchers examining at-risk populations amid the pandemic, OSA has been 

 as a potentially prominent factor contributing to COVID-19 hospitalization. 

 were significantly higher in patients who were eventually transferred to critical care units compared with those who were not.

Moreover, the researchers of the present study highlight that OSA is associated with several known risk factors linked with severe COVID-19: body mass index (BMI), diabetes, older age, and male gender.

“Such risk would have substantial effect as OSA is a common disease affecting at least 8% of the population, with higher prevalence in older age groups reaching to over 20% in individuals over 60 years of age,” noted the study authors.

Examining patients who participated in the 

 (N = 260,405), the researchers sought to investigate whether OSA is a risk factor for COVID-19 infection or for severe COVID-19, defined by requirement of hospitalization, independent of these potential risk factors: age, sex, BMI, hypertension, type 1 and type 2 diabetes, coronary heart disease, asthma, and 

Association was assessed via multivariate logistic regression model, with comorbidities for either COVID-19 or OSA selected as covariates. The researchers also performed a meta-analysis with previous studies, analyzing the association between OSA and severe COVID-19.

In the analysis, 445 patients (37.3% male; mean age, 52.7 years) with COVID-19 were identified,  38 of whom had diagnosed OSA (8.5%; 50% male; mean age, 61.3 years).

“This reflects a similar prevalence of OSA diagnoses in COVID-19–infected [individuals] as in the normal population in FinnGen, where prevalence is 8%,” noted the researchers.

Of the patients requiring hospitalization for severe COVID-19 (n = 91; 36.3% male; mean age,  65.9 years), more than 1 in 5 had OSA (n = 19; 20.9%), which was shown to be associated with COVID-19 hospitalization independent from age, sex, BMI, and comorbidities. However, there was no significant difference in risk for contracting COVID-19 between patients with OSA and those without.

The meta-analysis also showed that among 15,835 control patients with COVID-19, the patients who had OSA and severe cases of COVID-19 (n = 1294) had more than double the risk of hospitalization (odds ratio, 2.37; 95% CI, 1.14-4.95; 

“We believe that our finding may help in identifying high-risk individuals for severe forms of COVID-19 infection, and therefore screening for previous indications of OSA could be beneficial among individuals testing positive for the virus,” concluded the researchers.

Strausz S, Kiiskinen T, Broberg M, et al. Sleep apnoea is a risk factor for severe COVID-19. 

. Published online January 12, 2021. doi:10.1136/bmjresp-2020-000845


Articles

Obstructive sleep apnea was identified as an independent risk factor for severe coronavirus disease 2019 (COVID-19) resulting in hospitalization.

Obstructive Sleep Apnea Linked With Higher Risk of COVID-19 Hospitalization, Complications

Machine learning was shown to identify patients with 

 (RA) who present an increased chance of achieving clinical response with sarilumab, with those selected also showing an inferior response to adalimumab, according to 

 presented at ACR Convergence, the annual meeting of the 

In prior phase 3 trials comparing the interleukin 6 receptor (IL-6R) inhibitor sarilumab with placebo and the tumor necrosis factor α (TNF-α) inhibitor adalimumab, sarilumab appeared to provide superior efficacy for patients with moderate to severe RA. Although promising, the researchers of the abstract highlight that treatment of RA requires a more individualized approach to maximize efficacy and minimize risk of adverse events.

“The characteristics of patients who are most likely to benefit from sarilumab treatment remain poorly understood,” noted researchers.

Seeking to better identify the patients with RA who may best benefit from sarilumab treatment, the researchers applied machine learning to select from a predefined set of patient characteristics, which they hypothesized may help delineate the patients who could benefit most from either anti–IL-6R or anti–TNF-α treatment.

Following their extraction of data from the sarilumab clinical development program, the researchers utilized a decision tree classification approach to build predictive models on ACR response criteria at week 24 in patients from the phase 3 

 trial, focusing on the 200-mg dose of sarilumab. They incorporated the Generalized, Unbiased, Interaction Detection and Estimation (GUIDE) algorithm, including 17 categorical and 25 continuous baseline variables as candidate predictors. “These included protein biomarkers, disease activity scoring, and demographic data,” added the researchers.

Endpoints used were ACR20, ACR50, and ACR70 at week 24, with the resulting rule validated through application on independent data sets from the following trials:

MOBILITY (N = 1197; sarilumab [150 mg and 200 mg combined], n = 799; placebo, n = 398)

 (N = 546; sarilumab [150 mg and 200 mg combined], n = 365; placebo, n = 181)

 (N = 369; sarilumab, n = 184; adalimumab, n = 185)

 (N = 202; sarilumab [150 mg and 200 mg combined], n = 100; tocilizumab, 102)

Assessing the end points used, it was found that the most successful GUIDE model was trained against the ACR20 response. From the 42 candidate predictor variables, the combined presence of anticitrullinated protein antibodies (ACPA) and C-reactive protein >12.3 mg/L was identified as a predictor of better treatment outcomes with sarilumab, with those patients identified as rule-positive.

These rule-positive patients, which ranged from 34% to 51% in the sarilumab groups across the 4 trials, were shown to have more severe disease and poorer prognostic factors at baseline. They also exhibited better outcomes than rule-negative patients for most end points assessed, except for patients with inadequate response to TNF inhibitors.

Notably, rule-positive patients had a better response to sarilumab but an inferior response to adalimumab, except for patients of the HAQ-Disability Index minimal clinically important difference 

“If verified in prospective studies, this rule could facilitate treatment decision-making for patients with RA,” concluded the researchers.

Rehberg M, Giegerich C, Praestgaard A, et al. Identification of a rule to predict response to sarilumab in patients with rheumatoid arthritis using machine learning and clinical trial data. Presented at: ACR Convergence 2020; November 5-9, 2020. Accessed January 15, 2021. 021. Abstract 2006. https://acrabstracts.org/abstract/identification-of-a-rule-to-predict-response-to-sarilumab-in-patients-with-rheumatoid-arthritis-using-machine-learning-and-clinical-trial-data/

Machine learning identified patients with rheumatoid arthritis who may have an increased chance of achieving clinical response with sarilumab, with those selected also showing an inferior response to adalimumab.

Machine Learning Identifies Patient Response to Sarilumab in Rheumatoid Arthritis 

 dominated headlines amid the coronavirus disease 2019 (COVID-19) pandemic and debates surrounding the future of the Affordable Care Act (ACA) and Medicare program.

As one of the largest online health insurance exchanges in the United States, eHealth published 20 reports this past year assessing consumer costs and plan selection trends in the Medicare and ACA markets. Compiling notable takeaways from their respective surveys and index reports, eHealth sought to answer the question, “What did we learn in 2020 about US health insurance consumers and the Medicare and ACA markets?”

” report, researchers assessed several aspects prominent this year, including the impact that COVID-19 and subsequent restrictions had on social life and the response of insurers. Additionally, the current state and future of the ACA market was addressed, in which 64% of ACA plan enrollees feel the law needs to be reworked to better serve consumers like themselves.

Analyses on the average ACA plan premium found that an unsubsidized middle-income family of 4 pays, on average, $1437 per month or $17,244 per year, an extensive cost burden further added to by the average family deductible for a family of 4, $7767, totaling to approximately $25,000 in health insurance–related expenditures for the year.

, eHealth senior vice president of marketing, Andrew Shea, MBA, discusses report findings on potential cost savings for American families, as well as how the pandemic may cause significant lifestyle changes in the behavior of Medicare beneficiaries over the long term, including potential hesitancy against taking a COVID-19 vaccine.


Your report touched on Medicare reforms, as well as noteworthy consumer behavior trends such as the popularity of Medicare Advantage plans. Based on potential savings, what factors should be top of mind for Medicare beneficiaries going into the new year?

: Prescription drug costs and monthly plan premiums are the 2 most common concerns we hear about from Medicare recipients. We saw the same thing in a recent eHealth survey in which nearly two-thirds (63% of people with Medicare) said more should be done to make prescription medicines more affordable. They want to know how the Biden administration will address this important issue.

At the same time, too many Medicare beneficiaries are leaving potential drug savings on the table now. A lot of them are enrolled in Medicare plans that don’t properly match their needs.

 we invite beneficiaries to identify their current Medicare plan and their personal drug regimen, allowing us to show them which of the Medicare Part D or Medicare Advantage Prescription Drug plans we offer could save them money in combined premiums and co-pays, based on their personal drug needs. Last year we found that fewer than 1 in 10 (8%) Medicare beneficiaries were currently enrolled in the plan that covered their prescription drugs most affordably. We found that if they enrolled in the optimal plan they could have saved an average of $65.17 per month, or $782 per year.

What consumer behavior trends noted in the report do you foresee continuing or further growing in influence in 2021?

The biggest wild card heading into 2021 is definitely the COVID-19 coronavirus. First of all, how willing are Medicare beneficiaries to be vaccinated? Nearly half (47%) of the Medicare beneficiaries we surveyed in the fall told us they were either “somewhat” or “very” uncomfortable getting a vaccine.

It will also be interesting to see how the coronavirus experience changes the behavior of Medicare beneficiaries over the long term. Some of the lifestyle changes they’ve adopted may continue for years after the virus is eradicated. For example, 68% of Medicare beneficiaries we surveyed told us that even after the coronavirus is gone they’ll be less likely to go on a cruise, 53% said they’ll be less likely to visit an amusement park, and nearly half (49%) said they’ll be less likely to fly on a plane again.

Another likely long-term change—many Medicare beneficiaries utilized telemedicine services for the first time during the COVID-19. Heavy use of telemedicine services is new for medical providers and insurers but it makes sense for seniors in a lot of cases. It’s convenient and less risky in terms of exposure to new viruses for a population that’s at greater risk from flu, for example. Most importantly, it helps rural Medicare recipients gain access to services that aren’t easy to obtain in their areas, like psychiatry. I think it’s a safe bet we’ll see demand for telemedicine services persist.

Beyond the coronavirus, it seems likely that we’ll see interest in Medicare Advantage plans continue. There’s been a lot of benefit innovation in that category over the past several years—home-delivered meals, over-the-counter drug stipends, medical alert pendants, and the $0 premium Medicare Advantage plans remain a big draw for many. Medicare recipients and their care providers will be watching to see if this popular Medicare program is changed or enhanced in the next few years.

: A few years ago, medical insurance companies began acquiring pharmaceutical benefit providers as a way to better coordinate care; the drugs you take are inextricably tied to the medical care you receive. More recently, managed care companies have either acquired retail pharmacies or expanded their relationships with them.

Expect to see these trends continue and for medical care and care management programs to be made more accessible by making them accessible in the health care setting most often visited by seniors. We used to think of coordinated care as a function of improved cooperation between ambulatory and inpatient providers. It’s become much bigger in recent years. Retail pharmacies and managed care companies are important for the most accountable care possible. There is a blurring of the old, outdated lines that distinguished payers from providers. This more modern form of care is good for everyone.

Based on US health insurance consumer behavior reported in the eHealth Insights: 2020 Retrospective report, notable trends of the past year to watch for in 2021 include the popularity of $0 premium Medicare Advantage plans, the rise of telemedicine, and potential hesitancy against taking a vaccine for coronavirus disease 2019. 

Addressing Health Insurance Consumer Behavior in 2020, Potential Trends to Watch in 2021

Focused ultrasound subthalamotomy was shown to improve motor features among patients with 

 (PD) who present with asymmetric symptom severity, according to study findings published in 

As a minimally invasive image-guided procedure, 

 involves creating therapeutic lesions in deep-brain structures through focusing on sound waves inside the body.

“This allows doctors to interrupt faulty brain circuits or destroy unwanted tissue,” explains an accompanying 

. “Magnetic-resonance imaging allows doctors to monitor the procedure in real time, and to make adjustments as needed to obtain the best patient outcomes.”

Notably, deep-brain structures influenced by the procedure include the subthalamic nucleus, which researchers say is the preferred neurosurgical target for 

 (DBS) in treating motor symptoms of PD. They sought to examine whether the technology would benefit patients with asymmetrical Parkinson symptoms, in which symptoms present much more severe on 1 side of the body.

Collaborating with the Centro Intregral de Neurociencias in Spain, researchers of the University of Virginia (UVA) Department of Neurology recruited 40 volunteers in the randomized, double-blind study. At a 2:1 ratio, participants with asymmetric PD who had motor signs not fully controlled by medication or who were ineligible for DBS received either focused ultrasound subthalamotomy (n = 27) on the side opposite their main motor signs or a sham procedure (n = 13).


In the study, researchers assessed the primary efficacy outcome of between-group difference in the change from baseline to 4 months in the 

Movement Disorder Society–Unified Parkinson’s Disease Rating Scale III

 (MDS-UPDRS) motor score for the more affected body side in the off-medication state, in which higher scores on a scale of 1–44 indicate worse parkinsonism. The primary safety outcome, procedure-related complications, was assessed at 4 months.

For participants given the procedure, the mean MDS-UPDRS III score for the most affected side showed a decrease from 19.9 at baseline to 9.9 at 4 months (least-squares mean difference (LSMD) = 9.8 points; 95% CI, 8.6–11.1), compared with a decrease from 18.7 to 17.1 in the control group (LSMD = 1.7 points; 95% CI, 0.0–3.5), exhibiting a significant between-group difference of 8.1 points (95% CI, 6.0–10.3; 

Addressing the safety aspects of the procedure, adverse events in the treatment group included dyskinesia, weakness on the treated side, speech disturbance, facial weakness, and gait disturbance. “In 6 patients in the active-treatment group, some of these deficits were present at 12 months,” noted researchers.

"This small brain region, the subthalamic nucleus, had a very strong and potent effect on parkinsonian symptoms when we targeted it with precise, focused ultrasound energy," said study author Jeff Elias, MD, neurosurgeon at UVA Health, in a 

. "The key for the ultimate adoption of this new procedure will be further refinements of the technology to ensure reliability and safety."

Martínez-Fernández R, Máñez-Miró JU, Rodríguez-Rojas R, et al. Randomized trial of focused ultrasound subthalamotomy for Parkinson disease. 

. Published online December 24, 2020. doi:10.1056/NEJMoa2016311

Focused ultrasound subthalamotomy was shown to improve motor features among patients with Parkinson disease who present with asymmetric symptom severity.

Matthew Gavidia

Articles

Obstructive Sleep Apnea Linked With Higher Risk of COVID-19 Hospitalization, Complications

Machine Learning Identifies Patient Response to Sarilumab in Rheumatoid Arthritis

Addressing Health Insurance Consumer Behavior in 2020, Potential Trends to Watch in 2021

Focused Ultrasound Shown to Improve Motor Symptoms in Parkinson Disease