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Latest Clinical Edge

Post date: 11/25/2020 - 13:52

Key clinical point: Receipt of immune checkpoint inhibitors (ICIs) does not increase the risk of developing or dying from COVID-19, according to two studies.

Major finding: In one study, the incidence of COVID-19 was 1.4% with ICI therapy and 1.0% without it (odds ratio, 1.38; P = .15). In another study of cancer patients with a COVID-19 diagnosis, ICI therapy in the past year did not increase the risk of dying from COVID-19 (28% vs. 36%; odds ratio, 0.36; P = .23).

Study details: A retrospective cohort study of 1,545 cancer patients prescribed ICIs and 20,418...

Post date: 11/25/2020 - 12:20

Key clinical point: Medicaid expansion under the Affordable Care Act was associated with a significant reduction in breast, colon, and lung cancer mortality, likely because of earlier stage of cancer diagnosis.

Major finding: After Medicaid expansion, mortality significantly decreased in expansion states (hazard ratio, 0.98; P = .008) but not in nonexpansion states (HR, 1.01; P  = .43).

Study details: A review of 523,802 patients in the National Cancer Database.

Disclosures: The study was funded by Harvard Catalyst, the...

Post date: 11/25/2020 - 12:15

Key clinical point: Patients may be more likely to express a preference for dermatologic care from a physician of their own race or ethnicity.

Major finding: The race or ethnicity of their dermatologist was of some level of importance to 42% of Black and 44% of Hispanics patients seeking care vs. 2% of White patients.

Data Source: A survey of 92 patients receiving dermatology care at George Washington University.

Disclosures: Dr. Friedman reports no potential conflicts of interest.

Post date: 11/25/2020 - 12:07

Key clinical point: Lack of professional interventions may have contributed to infections that could have been prevented.

Major finding: Female patients with STIs are more likely to contract HIV, regardless of insurance status.

Study details: Multivariate logistic regression analyses of 13,074 female patients.

Disclosures: The authors reported no potential conflicts of interest.

Post date: 11/25/2020 - 09:31

Key clinical point: Combination neoadjuvant nivolumab and CMP-001 is efficacious in patients with high-risk resectable melanoma.

Major finding: Fully 60% of patients achieved a major pathologic response, and those who did had a 1-year relapse-free survival rate of 89%.

Study details: A single-arm, phase 2 trial of neoadjuvant nivolumab and CMP-001 in 31 patients with stage IIIB/C/D melanoma having clinically apparent lymph node disease (Neo-C-Nivo trial).

Disclosures: The trial was funded by Checkmate Pharmaceuticals. Dr. Davar disclosed...

Post date: 11/25/2020 - 09:13

Key clinical point: Most cases of tumor necrosis factor (TNF) inhibitor-induced psoriasis improved or resolved with topical medications, and switching the TNF inhibitor often led to persistence or worsening of TNF inhibitor-induced psoriasis.

Major finding: With topical medications alone, TNF inhibitor-induced psoriasis resolved in 63.5% of patients. Improvement or resolution occurred in 5 of 5 patients receiving cyclosporine and in 7 of 13 (53.8%) patients receiving methotrexate or glucocorticoids.

Study details: A single-center retrospective analysis of 102...

Post date: 11/25/2020 - 09:04

Key clinical point: Doctors commonly perform pelvic examinations approximately 6 weeks following hysterectomy to assess the integrity of the vaginal cuff, but this practice may not be necessary if patients do not have symptoms.

Major finding: Asymptomatic patients were more likely to have normal pelvic examination findings, compared with patients with posthysterectomy symptoms (86.4% vs. 54.3%). All 13 patients who experienced complete cuff dehiscence had an intact vaginal cuff at their 6-week examination.

Study details: A retrospective study of data from 2,051...

Post date: 11/24/2020 - 15:26

Key clinical point: Doctors may be able diagnose endometriosis by looking at a gene expression signature through analyzing samples from endometrial biopsies, instead of relying on more invasive methods.

Major finding: A biomarker based on five genes that were down-regulated in patients with endometriosis differentiated samples from patients with and without the disease with an area under the receiver operating characteristic curve of approximately 0.99.

Study details: An observational cohort study that included 50 women with endometriosis and 35 controls.

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Post date: 11/24/2020 - 14:31

Key clinical point: Major depressive disorder (MDD) is associated with an increased risk for falls and fall-related injuries in older adults; antidepressant use explains a significant proportion, but not a majority, of the association between depression and greater fall risk.

Major finding: Individuals with MDD were more likely to experience a fall (odds ratio [OR], 1.924; P less than .001) and a fall injury (OR, 1.864; P = .004) over 2 years. Use of any antidepressant medication was a significant mediator of the association between...

Post date: 11/24/2020 - 14:30

Key clinical point: This study found a strong association between overt behaviors of anger attacks and elevated suicidal ideation (SI) in outpatients with major depressive disorder (MDD).

Major finding: At baseline, MDD participants with vs. without anger attacks had higher levels of SI (Cohen's d effect size [d] = 1.20). Those with 9 or more anger attacks reported significantly higher SI than those with 1–2 (d = 1.21), 3–4 (d = 1.48), and 5–8 (d = 0.94) anger attacks. Additionally, the higher levels of SI...

Post date: 11/24/2020 - 14:29

Key clinical point: Patient Health Questionnaire-9 (PHQ-9) shows favorable validity and reliability and a higher adaptability for patients with major depressive disorder (MDD) in psychiatric hospitals.

Major finding: The total Hamilton Depression Scale-17 (HAMD-17) scores positively correlated with total PHQ-9 scores (P less than .001). HAMD-17 total scores and PHQ-9 total scores had good consistency (depression severity and intraclass correlation; both P less than .001). Patients who underwent repeat assessment had a test-retest...

Post date: 11/24/2020 - 14:28

Key clinical point: Decreased serum uric acid levels were associated with suicide risk in female patients with major depressive disorder (MDD).

Major finding: Serum uric acid levels were significantly lower in MDD patients with suicide risk (245.01 μmol/L ) vs. those without suicide risk (274.17 μmol/L; P = .017) and healthy controls (271.42 μmol/L; P = .030). Binary logistic regression analysis showed a significant association between suicide risk and decreased serum uric acid levels in MDD patients (odds ratio, 0.989; P = .019...

Post date: 11/24/2020 - 14:28

Key clinical point: More time spent sitting or lying down was associated with significantly increased risk of heart failure in older women.

Major finding: The hazard ratio for heart failure increased as study participants spent more time sitting down; for women in the most active tertile the HR was 1.00 versus 1.42 for women in the least active tertile.

Study details: The data come from 80,982 women aged 50-79 years enrolled in the Women’s Health Initiative Observational Study with no known heart failure at baseline.

Disclosures: The study...

Post date: 11/24/2020 - 14:27

Key clinical point: Major depressive disorder (MDD) is an independent risk factor for the development of psoriasis, with an increased risk in men.

Major finding: The risk for psoriasis was higher in patients with MDD vs. those without (adjusted hazard ratio [aHR], 1.32). The association was significant in both genders but was higher in men (aHR: women, 1.28; men, 1.42). The aHRs for psoriasis in the 2-, 3-, 4-, and 5-year study periods were 1.33, 1.32, 1.33, and 1.32, respectively.

Study details:...

Post date: 11/24/2020 - 11:57

Key clinical point: Withdrawal of methotrexate leads to better outcomes than withdrawal of etanercept following a stringently determined disease remission.

Major finding: At week 48, 28.7% of the methotrexate-only group were in remission, compared with 49.5% of the etanercept-only group and 52.9% of patients on combined therapy.

Study details: A randomized, controlled trial in which 253 patients were assigned 2:2:1 to withdraw etanercept, withdraw methotrexate, or continue on both drugs.

Disclosures: The study was funded by Amgen. Dr....

Post date: 11/24/2020 - 10:53

Key clinical point: Circulating microRNAs may provide an early method of noninvasive diagnosis of multiple myeloma.

Major finding: The overall sensitivity and specificity of using microRNA to diagnose multiple myeloma were 0.81 and 0.85, respectively.

Study details: A meta-analysis of 32 studies from 15 articles comprising 2,053 MM patients and 1,118 healthy controls.

Disclosures: The study received no outside funding and the researchers reported that they had no conflicts.

Post date: 11/24/2020 - 10:00

Key clinical point: Patients undergoing active treatment for localized prostate cancer had worse long-term self-reported quality of life. Men who underwent radical prostatectomy faired especially badly, particularly in relation to long-term sexual outcomes.

Major finding: At 15 years, persisting problems with erectile dysfunction were common in all treatment groups (range, 62.3% [active surveillance/watchful waiting, n=33/53] to 83.0% [non-nerve sparing radical prostatectomy, n=117/141] for treatment groups; 42.7% [n=44/103] in...

Post date: 11/24/2020 - 09:54

Key clinical point: This Mendelian randomization (MR) study found no clear evidence to support the causal role of genetically predicted depression on the risk of prostate cancer.

Major finding: No evidence was found for a potential causal effect of major depressive disorder (MDD) on the risk of prostate cancer in inverse‐variance weighted (odds ratio [OR], 1.12; P = .135), MR‐Egger (OR, 0.89; P = .833), and weighted median (OR, 1.08; P = .350). The result of inverse‐variance weighted showed that depressive...

Post date: 11/24/2020 - 09:53

Key clinical point: In men with prostate cancer (PCa) who underwent nodal dissection at radical prostatectomy (RP), more extensive pelvic lymph node dissection (PLND) was not associated with improved oncologic outcomes.

Major finding: Seven-year biochemical recurrence‐free survival (bRFS), overall survival (OS), and PCa‐specific mortality were similar with 14 or more vs. less than 14 lymph nodes dissected (P less than .05 for all). Among node-positive patients, 7‐year bRFS differed (75% for undetectable [UDT] prostate-...

Post date: 11/24/2020 - 09:52

Key clinical point: Salvage radiotherapy failed to meet non-inferiority endpoint of biochemical progression compared with adjuvant radiotherapy, but had lower genitourinary toxicity.

Major finding: Five-year freedom from biochemical progression in the adjuvant radiotherapy group was 86% (95% confidence interval [CI], 81-92) and in the salvage radiotherapy group was 87% (95% CI, 82-93). Grade 2 or worse genitourinary toxicity rates in the adjuvant and salvage radiotherapy groups were 70% and 50%.

Study...

Post date: 11/24/2020 - 09:50

Key clinical point: In patients with prostate cancer undergoing radical prostatectomy (RP), adjuvant radiotherapy was comparable to salvage radiotherapy in PSA biochemical progression, but had worse urinary and bowel morbidity.

Major finding: At 5 years, biochemical progression-free survival rate was 85% in the adjuvant radiotherapy group and 88% in the salvage radiotherapy group (hazard ratio, 1.10; P = .56). The adjuvant vs salvage radiotherapy group reported worse urinary incontinence (P = .0023) and fecal incontinence (P...

Post date: 11/24/2020 - 09:26

Key clinical point: Pigment traits and sun sensitivity were associated with the risk of developing non-Hodgkin lymphomas (NHL) and chronic lymphocytic leukemia (CLL).

Major finding: The hazard ratio for “many or very many nevi” was 3.00 for CLL vs. 1.32 for NHL.

Study details: Analysis of a prospective cohort of 92,097 women in France.

Disclosures: The study was sponsored by the French government. The authors stated that they had no conflicts of interest.

Source: Garcin L-M et al. Cancer Med. 2020....

Post date: 11/23/2020 - 15:43

Key clinical point: Slow withdrawal from antimalarial medication after at least 1 year of remission does not increase the risk of lupus flare, nor does the discontinuation of hydroxychloroquine in older patients.

Major finding: Lupus patients who tapered off AMs had fewer flares (45.9%), compared with patients who withdrew abruptly (72.6%).

Study details: A retrospective analysis of patients on antimalarial medications from a long-term observational cohort study at the University of Toronto’s lupus clinic.

Disclosures: One of the authors of...

Post date: 11/23/2020 - 14:46

Key clinical point: Combo treatment can be effective in achieving sustained virologic response (SVR) in patients with HCV genotype 3.

Major finding: The pooled SVR rate was 94.4% in treatment-naive patients and 88.0% in treatment-experienced patients.

Study details: Meta-analysis of 34 articles from Jan. 1, 2016, to Sept. 10, 2019, that examined the sustained virologic response (SVR) rate to DAA treatment.

Disclosures: The study was funded by the Chinese government and public institutions. The authors reported that they had no conflicts of...

Post date: 11/23/2020 - 09:53

Key clinical point: The safety profile of upadacitinib was similar to adalimumab for serious infections, malignancies, venous thromboembolism, and major adverse cardiac events when used to treat adults with rheumatoid arthritis.

Major finding: Doses of upadacitinib at either 15 mg or 30 mg yielded similar safety profiles to adalimumab on most serious adverse events and cardiovascular events, but rates of herpes zoster, creatine phosphokinase elevations were higher compared with both adalimumab and methotrexate....

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