Latest news with #MEDLINE
Medscape
24-07-2025
- Health
- Medscape
Caution Needed in Prescribing IBD Meds in CKD
TOPLINE: Most inflammatory bowel disease (IBD) therapies — particularly biologic agents — appear safe in patients with chronic kidney disease (CKD); however, caution is required with certain conventional therapies, including immunomodulators and aminosalicylates, as well as with JAK inhibitors. METHODOLOGY: From 4%-23% of patients with IBD also have renal disease, which can affect how the body processes medications; however, little data is available to guide physicians in choosing safe and effective IBD treatments for patients with advanced CKD. Researchers conducted a review of studies about IBD treatments in the setting of CKD by searching MEDLINE and EMBASE through March 31, 2025, using relevant keywords. IBD treatments evaluated were corticosteroids, aminosalicylates, immunomodulators (such as thiopurines and methotrexate), calcineurin inhibitors, biologics (such as monoclonal antibodies against tumor necrosis factors (anti-TNFs), integrin receptors, and interleukins), and small molecules (such as JAK inhibitors and sphingosine-1-phosphate [S1P] receptor modulators). TAKEAWAY: Corticosteroids in advanced kidney disease, including in patients requiring dialysis, do not require dosage adjustment. Budesonide is preferred over prednisolone, and corticosteroids are typically administered at the lowest effective dose for the shortest duration. Mesalazine, an aminosalicylate, can trigger acute interstitial nephritis; the immunomodulator methotrexate, even at 2-4 mg/wk, may cause irreversible renal decline, profound myelosuppression, and higher mortality in patients with end-stage kidney disease on hemodialysis; and calcineurin inhibitors can be nephrotoxic by reducing renal blood flow and glomerular filtration rate. Monoclonal antibodies, including anti-TNF, anti-integrin, and anti-interleukin 12/23 therapies, demonstrated safety in renal insufficiency and hemodialysis. For JAK inhibitors and thiopurines, dose adjustments were recommended in advanced renal disease, whereas S1P receptor modulators could be used in CKD without any dose adjustments. IN PRACTICE: 'Selecting appropriate therapeutics for managing IBD in patients with CKD necessitates a tailored approach, emphasizing diligent surveillance of renal function to optimize treatment efficacy and minimize renal compromise. Dose adjustments of IBD therapeutics are not required for patients with stage I or II CKD. Depending on specific drug metabolism and renal excretion, dose adjustments may be required at more advanced-stage CKD,' the authors wrote. SOURCE: The study, led by Lynna Chen, Eastern Health Clinical School, Monash University in Melbourne, Australia, was published online in Alimentary Pharmacology & Therapeutics. LIMITATIONS: This review did not discuss limitations. DISCLOSURES: The authors received no specific funding for this work. Two authors disclosed receiving advisory fees and serving as speakers for various pharmaceutical companies. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
22-07-2025
- Health
- Medscape
Methotrexate Success Varies in Ectopic Pregnancy Types
TOPLINE: Overall success rates for intramuscular (IM) methotrexate were comparable between recurrent and primary ectopic pregnancy cases, but single-dose treatment was less effective in recurrent cases. Analysis of 3944 patients revealed that multidose regimens achieved similar success rates in both groups, suggesting a potential benefit of routine multidose treatment for recurrent cases. METHODOLOGY: Researchers conducted systematic searches of MEDLINE, EMBASE, and Scopus databases through February 2025, following PRISMA guidelines for meta-analysis. Analysis included 3944 patients (502 with recurrent and 3442 with primary ectopic pregnancy) from 15 observational studies, with patients aged ≥ 18 years receiving IM methotrexate treatment. The primary outcome measure was treatment success, defined as complete resolution of ectopic pregnancy without requiring further intervention. TAKEAWAY: Single-dose IM methotrexate had lower success rates in patients with recurrent ectopic pregnancy than in those with a primary ectopic pregnancy (relative risk [RR], 0.79; 95% CI, 0.63-1.00; P = .050). Multidose IM methotrexate treatment showed no significant difference in success rates between recurrent and primary ectopic pregnancy groups (RR, 1.14; 95% CI, 0.71-1.84; P = .590). Substantial heterogeneity was observed among studies analyzing single-dose (I² = 73.0%) and multidose (I² = 64.0%) treatment outcomes. IN PRACTICE: 'Current observational data suggest that patients with recurrent ectopic pregnancy should be considered for multidose IM methotrexate to achieve similar rates of success compared with primary ectopic pregnancy,' wrote the authors of the study. SOURCE: The study was led by Shreya Bhat, MBChB, PGDipOMG, Department of Obstetrics and Gynaecology, Palmerston North Hospital, Te Whatu Ora MidCentral in Palmerston North, Aotearoa New Zealand. It was published online in Obstetrics & Gynecology. LIMITATIONS: According to the authors, substantial heterogeneity in outcome definitions and baseline cohort characteristics between studies affected the analysis. Most studies were retrospective cohort designs, introducing potential selection bias and confounding factors. The researchers noted that over 50% of studies failed to identify relevant confounding variables, which likely contributed to the large observed CIs for effect estimates. DISCLOSURES: The authors did not report any potential conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
