Latest Clinical Edge

Post date: 12/08/2020 - 09:55

Key clinical point: Bifidobacterium dentium, a normal colonizer of the healthy adult gut, modulates the gut and brain serotonergic system, which appears to influence behavior.

Major finding: Acetate produced by B. dentium stimulated serotonin production by mouse and human enterochromaffin cells. B. dentium increased serotonin receptor expression in the gut and brain and modified behavior in mice.

Data source: Gram staining, immunostaining, quantitative PCR, mass spectrometry, and RNA in situ hybridization of B. dentium, its...

Post date: 12/07/2020 - 15:06

Key clinical point: Duvelisib is demonstrating activity and manageable toxicities among patients with relapsed/refractory peripheral T-cell lymphoma in an ongoing phase 2 trial.

Major finding: In the ongoing dose-expansion phase, the overall response rate is 52%, including a 36% complete response rate.

Study details: A report on the completed dose-optimization phase including 33 patients and the ongoing dose-expansion phase including 25 patients with relapsed/refractory peripheral T-cell lymphoma.

Disclosures: Support for the study came...

Post date: 12/07/2020 - 14:23

Key clinical point: 2016 guidelines have reduced endoscopy oversurveillance, but more work needs to be done.

Major finding: Just over 30% of subjects with nondysplastic Barrett’s esophagus were recommended to have surveillance in less than 3 years.

Study details: A retrospective analysis of the GI Quality Improvement Consortium Registry (135,704 endoscopies among 114,894 individual patients).

Disclosures: The study was funded by the University of Colorado department of medicine. The article authors have consulted for various companies. Dr....

Post date: 12/07/2020 - 12:33

Key clinical point: Long-term survivors of childhood Hodgkin lymphoma may need evaluation for neurocognitive problems.

Major finding: Compared with sibling controls, Hodgkin survivors had lower scores on four neurocognitive domains.

Study details: A surveillance study of 1,564 survivors and 725 controls.

Disclosures: The CCSS is funded by the National Cancer Institute. Drs. Williams, Palawi, and Kelly all reported no relevant conflicts of interest to disclose.

Post date: 12/07/2020 - 12:01

Key clinical point: A once-daily 4-mg dose of baricitinib (Olumiant) was safe and effective over 148 weeks for patients with early and treatment-resistant rheumatoid arthritis.

Major finding: At week 148, up to 61% of DMARD-naïve patients initially treated with baricitinib and 59% of patients who switched to baricitinib after inadequate response to methotrexate had low disease activity based on Simplified Disease Activity Index scores of 11 or less...

Post date: 12/07/2020 - 12:01

Key clinical point: Atherosclerosis was significantly more prevalent in rheumatoid arthritis patients whose sera showed the presence of antibodies targeting Aggregatibacter actinomycetemcomitans serotype b (anti‐Aa) and/or Aa leukotoxin A (anti-LtxA).

Major finding: Coronary artery calcification scores were significantly higher among rheumatoid arthritis patients with anti‐Aa or anti-LtxA antibodies, compared to individuals...

Post date: 12/07/2020 - 11:56

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,...

Post date: 12/07/2020 - 11:51

Key clinical point: A composite major cardiovascular event outcome did not differ significantly between treatment groups.

Major finding: MI incidence was higher in people taking hydroxychloroquine versus methotrexate.

Study details: Observational study of 35,699 people taking methotrexate and 23,630 taking hydroxychloroquine....

Post date: 12/07/2020 - 11:49

Key clinical point: Rheumatoid arthritis patients who failed to respond to upadacitinib (Rinvoq) or adalimumab showed improvements in disease activity after switching to the other drug.

Major finding: At 6 months after switching drugs, low disease activity based on the Clinical Disease Activity Index occurred in 36% and 47% of nonresponders switched to adalimumab and upadacitinib, respectively, and in 45% and 58% of incomplete responders switched...

Post date: 12/07/2020 - 10:23

Key clinical point: Involvement of genital, inguinal, and neck regions had higher risk for hidradenitis suppurativa (HS) severity. Comorbidity, longer disease duration, delayed diagnosis, and a higher number of smoking pack-years were other factors associated with disease severity.

Major finding: The most important determinants of disease severity were male sex (odds ratio [OR], 2.211) and involvement of the genital (OR, 3.387), inguinal (OR, 2.253), and neck (OR, 2.197) areas (P less than .001 for all). Patients with obesity (OR, 1.846),...

Post date: 12/07/2020 - 10:22

Key clinical point: Thyroid disease and active smoking may be associated with more severe hidradenitis suppurativa (HS).

Major finding: Multivariable analysis demonstrated that active smoking and thyroid disease were associated with a higher stage of HS based on the Hurley classification (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.11-1.65 and OR, 1.30; 95% CI, 1.09-1.76, respectively) and IHS4 score system (OR, 1.23; 95% CI, 1.09-1.64 and OR, 1.42; 95% CI, 1.19-1.66, respectively).


Post date: 12/07/2020 - 10:11

Key clinical point: Nearly half of patients with hidradenitis suppurativa (HS) reported having a first-degree relative affected by the condition.

Major finding: 57.5% of patients reported HS in either first- or second-degree relatives, including 49.5% who had an affected first-degree relative.

Study details: Analysis of detailed family history data from 676 HS patients collected using questionnaires.

Disclosures: The study was funded by the...

Post date: 12/07/2020 - 10:10

Key clinical point: Sweets, bread/pasta/rice, dairy, and high-fat foods in fat are likely to cause exacerbations in patients with hidradenitis suppurativa (HS).

Major finding: 32.6% of participants identified HS-symptom-exacerbating foods, whereas only 12.0% identified alleviating foods. The most commonly reported exacerbating foods were sweets (67.9%), bread/pasta/rice (51.1%), dairy (50.6%), and high-fat foods (42.2%). Alleviating foods included vegetables (78.7%), fruit (56.2%), chicken (51.7%), and fish (42.7%)....

Post date: 12/07/2020 - 10:08

Key clinical point: Severe pain is common among patients with hidradenitis suppurativa (HS) presenting to the emergency department (ED) and opioids are frequently prescribed.

Major finding: An estimated 383000 ED visits for HS were recorded during the study period (2006-2017); such visits increased from 25260 in 2006 to 131430 in 2017. Severe pain was reported at 69.9% of visits, with 40.1% of patients rating pain as 10 on a 10-point pain scale. At discharge, 58.3% (95% confidence interval, 41.0%-73.8%) of patients were prescribed...

Post date: 12/07/2020 - 09:11

Key clinical point: In patients with advanced resectable melanoma, neoadjuvant intralesional talimogene laherparepvec plus surgery remained superior to immediate surgery at 3 years of follow-up.

Major finding: The 3-year rate of recurrence-free survival was 46.5% with talimogene laherparepvec plus surgery and 31.0% with immediate surgery (hazard ratio, 0.67; P = .043).

Study details: A phase 2 trial of talimogene laherparepvec followed by surgery versus immediate surgery in 150 patients with resectable stage IIIB–IV M1a melanoma.


Post date: 12/06/2020 - 13:31

Key clinical point: Cilta-cel was associated with rapid, deep, and durable responses in patients with heavily pretreated multiple myeloma.Major finding: The overall response rate was 96.9%, with most responses VGPR or better.

Study details: Prospective phase 1b/2 trial in 97 patients with relapsed/refractory multiple myeloma.

Disclosures: The study was sponsored by Janssen Research & Development and Legend Biotech. Dr. Madduri disclosed honoraria, consultancy, and speakers bureau activities for those companies and others.

Post date: 12/06/2020 - 12:32

Key clinical point: In patients with T-cell lymphoma, allogeneic transplant can lead to durable remissions among patients who might otherwise have poor outcomes.

Major finding: Five-year progression-free survival approached 40% and 5-year overall survival was over 50%.

Study details: Retrospective analysis including 508 consecutive T-cell lymphoma patients receiving allogeneic transplants at 12 academic centers between 2000 and 2019.

Disclosures: Dr. Mehta-Shah reported research funding from Bristol Myers-Squibb, Celgene, Verastem, Corvus,...

Post date: 12/06/2020 - 12:00

Key clinical point: Axicabtagene ciloleucel (axi-cel) yields high rates of response and has a favorable safety profile in previously treated indolent B-cell lymphomas.

Major finding: The overall response rate was 92%, including complete responses in 76% and a median duration of response that had not been reached at a median of 17.5 months follow-up.

Study details: Primary analysis of the phase 2 ZUMA-5 study including 146 patients with relapsed/refractory indolent non-Hodgkin lymphoma.

Disclosures: Authors reported disclosures related to...

Post date: 12/05/2020 - 15:21

Key clinical point: Data from a COVID-19 registry suggest patients with hematologic disease may experience substantial morbidity and mortality related to SARS-CoV-2 infection, but do not support discontinuing treatment of the underlying disease for favorable prognosis patients.

Major finding: Overall mortality was 28%. Deaths and poor COVID-19-related outcomes occurred more frequently in poorer-prognosis patients and those with relapsed/refractory disease.

Study details: A report from the ASH Research Collaborative Data Hub including data from 250 patients with...

Post date: 12/04/2020 - 14:42

Key clinical point: A vaginal cleansing protocol significantly reduced deep surgical-site infections (SSIs) after cesarean in high-risk women, such as women in labor or with ruptured membranes.

Major finding: The rate of SSIs was 22% in the standard care group, 17% in the vaginal cleansing group, and 15% in the vaginal cleansing plus azithromycin group.

Study details: A quality improvement study of the effects of a stepwise implementation of vaginal cleansing and azithromycin to reduce SSIs at cesarean delivery in 1,033 deliveries that qualified for the study by...

Post date: 12/04/2020 - 12:37

Key clinical point: A survey of renal cell carcinoma (RCC) survivors suggests many fear cancer recurrence.

Major finding: More than half (55%) of patients who survived localized RCC said they fear recurrence.

Study details: A survey on distress and fear of cancer recurrence given to 412 survivors of localized RCC.

Disclosures: The study did not receive specific funding. The authors disclosed relationships with many companies, which are listed in the paper.

Post date: 12/04/2020 - 12:20

Key clinical point: Age older than 65 years was significantly associated with increased odds of death for hospitalized inflammatory bowel disease patients.

Major finding: In a multivariate analysis, age older than 65 years was independently associated with increase in risks of mortality for patients with Crohn’s disease (odds ratio, 3.47) and ulcerative colitis (OR, 2.75).

Study details: The data come from a retrospective study of about 162,800 hospital admissions for Crohn’s disease and 96,450 for ulcerative colitis between 2016 and 2017 using information from...

Post date: 12/04/2020 - 12:12

Key clinical point: Obesity and hypoxia at hospital admission were associated with increased risk of severe respiratory disease, while lower lymphocyte counts and higher C-reactive protein predicted more severe multisystem inflammatory syndrome in children hospitalized with COVID-19.

Major finding: In multivariate analysis, obesity and hypoxia significantly predicted severe respiratory disease in children with COVID-19, with odds ratios of 3.39 and 4.01, respectively.

Study details: The data come from a multicenter study including 281 pediatric patients aged 22...

Post date: 12/04/2020 - 11:44

Key clinical point: Obesity phenotyping matched patients to a more effective, personalized weight-loss drug intervention.

Major finding: The rate of greater than 10% weight loss after 1 year was 79% with phenotype-guided treatment and 35% without.

Study details: A single-center, prospective, randomized study.

Disclosures: The study received no commercial funding. Dr. Acosta is a consultant to Rhythm Pharmaceuticals and General Mills and has received research support from Novo Nordisk, Rhythm Pharmaceuticals, Satiogen, and Vivus. Dr. Clark...

Post date: 12/04/2020 - 10:53

Key clinical point: Patients with impaired fasting glucose (IFG) and diabetes mellitus (DM) have a lower risk for incident osteoporosis.

Major finding: The risk of osteoporosis significantly decreased (P less than .001 for all) above the fourth quartile of fasting glucose levels in men and above the third quartile in women compared with the first quartile. The risk of osteoporosis was significantly lower (P less than .001 for all) with IFG (men: hazard ratio [HR], 0.84; women: HR, 0.93) and DM (men: HR, 0.77; women: HR, 0....