Latest news with #TriNetX
Medscape
26-05-2025
- Health
- Medscape
Third-Generation Progestins Linked to Lowest Melasma Risk
A study found that fourth-generation progestins in oral contraceptive pills (OCPs) were associated with more than double the risk for melasma than with no exposure, while third-generation progestins showed the lowest risk among all synthetic progestin types. METHODOLOGY: Researchers analyzed data from 51,101 women with melasma and 51,101 matched controls without melasma using the TriNetX research network on March 25, 2025. The mean age of participants was 45.1 years. About 54% of participants were White, about 14% were Black, about 8% were Asian, and nearly 15% were Hispanic/Latino. Those with melasma had a higher prevalence of exposure to estrogen/progestin combinations (21.58% vs 10.03%; P < .001) and to progestins alone (15.04% vs 7.75%; P < .001) than those without melasma. < .001) and to progestins alone (15.04% vs 7.75%; < .001) than those without melasma. The researchers examined the risk for melasma within 10 years after a progestin prescription. TAKEAWAY: All four generations of synthetic progestins were associated with a higher melasma risk than no exposure. The risk was highest for fourth-generation (hazard ratio [HR], 2.262; 95% CI, 1.797-2.846) and lowest for third-generation progestins (HR, 1.417; 95% CI, 1.317-1.524). Exposure to fourth-generation progestins was associated with a higher risk for melasma than exposure to first-generation (HR, 1.366; 95% CI, 1.148-1.627), second-generation (HR, 1.191; 95% CI, 1.000-1.419), and third-generation progestins (HR, 1.785; 95% CI, 1.464-2.176). Exposure to third-generation progestins was associated with a lower risk for melasma than exposure to second-generation (HR, 0.841; 95% CI, 0.754-0.937) and fourth-generation progestins (HR, 0.604; 95% CI, 0.503-0.726). IN PRACTICE: Based on these findings, 'choosing oral contraceptive pills containing third-generation progestins may mitigate melasma risk associated with hormonal contraceptives,' the study authors wrote. 'Further studies of the role of progestins in melasma pathophysiology may improve our understanding of this disorder,' they added. SOURCE: The study, led by Amit Singal, BA, Rutgers New Jersey Medical School, Newark, New Jersey, and Shari Lipner, MD, Department of Dermatology, Weill Cornell Medicine, New York City, was published online on May 21 in the Journal of the American Academy of Dermatology . LIMITATIONS: Information on dosing, route, duration of use, and adherence to hormone therapy was not available. The study lacked data on ultraviolet exposure, family history of melasma, and clinical reasons for hormone use. International Classification of Diseases, 10th Revision, coding limitations may have affected diagnostic accuracy. DISCLOSURES: This study did not receive any funding. The authors had no competing interests.
Medscape
21-05-2025
- Health
- Medscape
Copper IUDs Linked to Higher Risk for STI Than Hormonal IUDs
MINNEAPOLIS — Copper intrauterine devices (IUDs) are associated with an increased risk for several sexually transmitted infections (STIs) and other vaginal conditions than IUDs containing levonorgestrel, according to a retrospective chart review presented at the American College of Obstetricians and Gynecologists (ACOG) 2025 Annual Meeting. 'Most prior research focuses on bacterial vaginosis and pelvic inflammatory disease risk in IUD users,' wrote Celeste Traub, medical student at the University of Texas Medical Branch in Galveston, Texas, and her colleagues. 'Limited data exist regarding the broader impact of IUDs on other common reproductive tract infections.' The researchers therefore analyzed data from TriNetX, a group of databases that include information for 56,444,363 patients. They identified 74,219 patients who used the copper IUD without previous use of a levonorgestrel IUD and 451,769 patients who used the levonorgestrel IUD without previous use of a copper IUD. These patients were then matched for age at IUD placement, race, and ethnicity to come up with 73,123 patients in each IUD group. The analysis included only data from within 3 years of IUD placement. Patients were an average of 30 years old at the time of IUD placement. The cohort included 63.7% White, 21% Hispanic/Latina, 9.9% Black/African American, 5.3% Asian, 0.5% Pacific Islander, and 0.4% Native American patients. Copper IUDs were associated with a modestly higher risk for chlamydia (risk ratio [RR], 1.41), syphilis (RR, 1.4), gonorrhea (RR, 1.37), and HIV (RR, 1.27) than levonorgestrel IUDs. Copper IUDs were also associated with a higher risk for chronic vulvitis (RR, 1.46), acute vulvitis (RR, 1.41), chronic vaginitis (RR, 1.4), and acute vaginitis (RR, 1.12) than levonorgestrel IUDs. Risks for anogenital warts, herpes simplex virus 2, candidiasis, and trichomoniasis were not significantly different between copper IUDs and levonorgestrel IUDs. The risk for pelvic inflammatory disease, meanwhile, was lower with the copper IUDs (RR, 0.85) than with the levonorgestrel IUDs. Despite the large population included, the retrospective design limits what conclusions can be drawn from the findings and there could be unmeasured confounders such as differences in sexual behaviors or socioeconomic factors that affected the results. The study may also have potential selection bias if women who choose different IUD types have different health behaviors. 'These findings highlight the importance of considering vaginal health outcomes when counseling patients about contraceptive outcomes,' the researchers concluded. 'We have thought that one contraceptive mechanism by which hormonal IUDs work is through thickening cervical mucus; this serves as a barrier to sperm,' Hugh S. Taylor, MD, a professor of Ob/Gyn at Yale School of Medicine and chief of Ob/Gyn at Yale New Haven Hospital in Connecticut, told Medscape Medical News . 'It is not surprising that this also serves as a barrier to many STIs.' He further noted that the study's large size allows the detection of very small differences and highlighted that the risks for any infection with the copper IUD remains small. Further, 'IUDs do not adequately protect against any infection,' Taylor said. 'Barrier methods should be used whenever there is any risk of STI.' The research was funded by the UTMB Institute for Translational Sciences and the National Institutes of Health. The authors had no relevant financial disclosures. Taylor reported grants to Yale University from AbbVie and Organon unrelated to this research.
Medscape
20-05-2025
- Health
- Medscape
RZV Cuts Death but Has No Effect on Heart Health
Recombinant zoster vaccine (RZV) had no significant effect on major adverse cardiovascular events; however, it reduced all-cause mortality in patients with immune-mediated inflammatory diseases receiving Janus kinase inhibitors. The mortality benefit was particularly notable in women and patients aged 65 years or older. METHODOLOGY: Researchers conducted a new user design study utilizing the TriNetX network (United States) to assess the effect of RZV on cardiac health in patients with rheumatoid arthritis, spondyloarthritis, or psoriatic diseases who were receiving Janus kinase inhibitors. Overall, 1756 patients and an equal number of propensity-matched control participants (mean age, 61.3 years; 76% women in both cohorts) were included from October 1, 2017, to March 31, 2024. Primary outcome measures were major adverse cardiovascular events, including myocardial infarction, ischemic stroke, hemorrhagic stroke, heart failure, ventricular arrhythmia, and cardiac arrest, and the secondary outcome measure was all ‐ cause mortality. TAKEAWAY: No significant differences were reported in the risk for major adverse cardiovascular events between the vaccinated and unvaccinated cohorts (hazard ratio [HR], 1.121; 95% CI, 0.901-1.395); this finding also persisted when specific conditions were examined. The risk for major adverse cardiovascular events also did not differ significantly based on factors such as age, sex, race, and zoster history. The vaccinated cohort demonstrated a 39% reduction in all-cause mortality (HR, 0.610; 95% CI, 0.427-0.870; P = .005). = .005). The risk for all-cause mortality was low particularly in women, those aged 65 years or older, White individuals, and those without zoster history. IN PRACTICE: 'In elderly patients, the long-term persistence of vaccine efficacy may result in greater benefit, as this high-risk group is more susceptible to mortality following zoster reactivation. These findings underscore the importance of encouraging RZV vaccination in this high-risk population to achieve better survival outcomes,' the authors wrote. SOURCE: This study was led by James Cheng-Chung Wei and Pui-Ying Leong, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. It was published online on March 5, 2025, in Journal of Medical Virology . LIMITATIONS: The non-population–based nature of the TriNetX database might limit the generalizability of the study findings. Potential follow-up loss could have occurred because patients may have received vaccinations at healthcare organizations outside the TriNetX network, possibly leading to misclassification of the vaccination status. Additionally, disease activity assessment could not be conducted owing to electronic health record limitations. DISCLOSURES: The authors received no specific funding for this work. No conflicts of interest were reported.
Medscape
15-05-2025
- Health
- Medscape
Psoriasis Tied to Kidney Disease in T2D, Despite Treatment
Patients with type 2 diabetes (T2D) who have psoriasis showed an increased risk for renal disease, including diabetic neuropathy, chronic kidney disease (CKD), end-stage renal disease (ESRD), and dialysis despite renoprotective therapy, while CKD risk had increased at 10 years after starting treatment among those receiving biologics. METHODOLOGY: Researchers conducted a retrospective cohort analysis using TriNetX data from 2014-2024, which included patients with T2D who started treatment with angiotensin-converting enzyme inhibitors (ACEis), angiotensin II receptor blockers (ARBs), or sodium-glucose cotransporter-2 inhibitors (SGLT2is). After propensity score matching, 27,044 patients were included in two cohorts — with and without psoriasis, diagnosed before starting renoprotective therapy. A total of 7771 patients with psoriasis received biologics, including interleukin (IL)-23, IL-17, IL-12/23, or tumor necrosis factor (TNF) alpha inhibitors. Study outcomes were diabetic nephropathy, CKD, ESRD, and need for dialysis at 3, 5, and 10 years. TAKEAWAY: At 3 years, patients with psoriasis demonstrated a significantly higher risk for diabetic nephropathy (absolute risk increase [ARI], 1.31; P < .0001), CKD (ARI, 1.80; P < .0001), ESRD (ARI, 0.38; P < .0001), and dialysis (ARI, 0.28; P < .0001). < .0001), CKD (ARI, 1.80; < .0001), ESRD (ARI, 0.38; < .0001), and dialysis (ARI, 0.28; < .0001). The increased risk persisted at 5 years (ARI, 2.02, 3.28, 0.58, 0.42, respectively; all P < .0001), and at 10 years (ARI, 3.30, 6.33, 0.94, 0.63, respectively; all P < .0001). < .0001), and at 10 years (ARI, 3.30, 6.33, 0.94, 0.63, respectively; all < .0001). Patients with psoriasis who received biologics showed a higher risk for CKD at 10 years despite renoprotective therapy ( P < .0001) than those without psoriasis. IN PRACTICE: 'Psoriasis may trigger a T-helper-17-driven inflammatory response, leading to the production of cytokines such as IL-17, IL-12/23, and TNF,' which induce renal inflammation, and this process is 'not targeted by ACEis, ARBs, or SGLT2is,' which may explain the persistently elevated CKD risk in patients with both T2DM and psoriasis, according to the study authors. They added that the findings support earlier evidence that 'biologics do not ameliorate the deterioration of renal function' in those with existing renal issues and a prospective study is needed to confirm these associations. SOURCE: The study was led by Tarun Sontam, Texas A&M School of Medicine, Dallas, Texas, and was published online on May 7 in the Journal of the American Academy of Dermatology . LIMITATIONS: The study did not account for psoriasis severity or duration and adherence to renoprotective therapy. The authors noted that uncontrolled factors might influence the findings. DISCLOSURES: The authors reported having no conflicts of interest. The study had no funding source.
Medscape
07-05-2025
- Health
- Medscape
Do GLP-1s Lower CRC Risk in Patients With Obesity and T2D?
SAN DIEGO — Patients with obesity and type 2 diabetes treated with glucagon-like peptide 1 (GLP-1) receptor agonists had significantly reduced rates for colorectal cancer (CRC) risk and associated mortality compared with those undergoing bariatric surgery, new research showed. CRC risk was also lower for patients taking GLP-1s than the general population. 'Our findings show we might need to evaluate these therapies beyond their glycemic or weight loss [effects],' said first author Omar Al Ta'ani, MD, of the Allegheny Health Network, Pittsburgh. This supports future prospective studies examining GLP-1s for CRC reduction, added Ta'ani, who presented the results at Digestive Disease Week (DDW) 2025. Patients with type 2 diabetes and obesity are known to have a higher risk for CRC, stemming from metabolic risk factors. While prior studies suggested that GLP-1s decrease the risk for CRC compared with other antidiabetic medications, studies looking at the risk for CRC associated with bariatric surgery have had more mixed results, Ta'ani said. For the comparison, Ta'ani and colleagues conducted a retrospective analysis of the TriNetX database, identifying patients with type 2 diabetes and obesity (a body mass index [BMI] over 30), enrolled in the database between 2005 and 2019. Overall, the study included 94,098 GLP-1 users and 24,969 patients who underwent bariatric surgery. Those with a prior history of CRC were excluded. Using propensity score matching, patients treated with GLP-1s were matched 1:1 with patients who had bariatric surgery based on wide-ranging factors including age, race, gender, demographics, diseases, medications, personal and family history, and A1c. After the propensity matching, each group included 21,022 patients. About 64% in each group were women; their median age was 53 years and about 65% were White individuals. Overall, the results showed that patients on GLP-1s had a significantly lower CRC risk compared with those who had bariatric surgery (adjusted hazard ratio [aHR], 0.29; P < .0001). The lower risk was also observed among those with high obesity (defined as BMI over 35) compared with those who had surgery (aHR, 0.39; P < .0001). The results were consistent across genders, however, the differences between GLP-1s and bariatric surgery were not observed in the 18- to 45-year-old age group ( P = .0809, BMI > 30; P = .2318, BMI > 35). When compared with the general population, patients on GLP-1s also had a reduced risk for CRC (aHR, 0.28; P < .0001), however, the difference was not observed between the bariatric surgery group and the general population (aHR, 1.11; P = .3). Among patients with type 2 diabetes with CRC and a BMI over 30, the 5-year mortality rate was lower in the GLP-1 group vs the bariatric surgery group (aHR, 0.42, P < .001). Speculating on the mechanisms of GLP-1s that could result in a greater reduction in CRC risk, Ta'ani explained that the key pathways linking type 2 diabetes, obesity, and CRC include hyperinsulinemia, chronic inflammation, and impaired immune surveillance. Studies have shown that GLP-1s may be more effective in addressing the collective pathways, he said. They 'may improve insulin resistance and lower systemic inflammation.' Furthermore, GLP1s 'inhibit tumor pathways like Wnt/beta-catenin and PI3K/Akt/mTOR signaling, which promote apoptosis and reduce tumor cell proliferation,' he added. Bariatric Surgery Findings Questioned Meanwhile, 'bariatric surgery's impact on CRC remains mixed,' said Ta'ani. Commenting on the study, Vance L. Albaugh, MD, an assistant professor of metabolic surgery at the Metamor Institute, Pennington Biomedical Research Center, Baton Rouge, Louisiana, noted that prior studies, including a recent meta-analysis, suggest a potential benefit of bariatric surgery in cancer prevention. 'I think the [current study] is interesting, but it's been pretty [well-reported] that bariatric surgery does decrease cancer incidence, so I find it questionable that this study shows the opposite of what's in the literature,' Albaugh, an obesity medicine specialist and bariatric surgeon, told Medscape Medical News . Ta'ani acknowledged the study's important limitations, including that with a retrospective design, causality cannot be firmly established. And, as noted by an audience member in the session's Q and A, the study ended in 2019, which was before GLP-1s had taken off as anti-obesity drugs and before US Food and Drug Administration approvals for weight loss. Participants were matched based on BMI, however, Ta'ani pointed out. Albaugh agreed that the study ending in 2019 was a notable limitation, however, the relatively long study period — extending from 2005 to 2019 — was a strength. 'It's nice to have a very long period to capture people who are diagnosed, because it takes a long time to develop CRC,' he said. 'To evaluate effects [of more recent drug regimens], you would not be able to have the follow-up they had.' Other study limitations included the need to adjust for ranges of obesity severity, said Albaugh. 'The risk of colorectal cancer is probably much different for someone with a BMI of 60 vs a BMI of 30.' Ultimately, a key question the study results raise is whether GLP-1 drugs have protective effects above and beyond that of weight loss, he said. 'I think that's a very exciting question and that's what I think the researchers' next work should really focus on.'
