Latest news with #patients
Medscape
15 hours ago
- Health
- Medscape
Rituximab No Better Than Standard Therapy for EGPA Remission
TOPLINE: Rituximab did not show superiority over conventional therapy in inducing remission in patients with eosinophilic granulomatosis with polyangiitis (EGPA). Both treatment groups had similar remission rates at 180 and 360 days, with no significant differences in relapse rates or adverse events. METHODOLOGY: A phase 3, multicenter, randomized, controlled superiority trial was conducted in France to compare rituximab with conventional therapy for EGPA remission induction. A total of 105 adult patients with active EGPA (mean age, 58.4 years; 52.4% women), defined by a Birmingham Vasculitis Activity Score (BVAS, version 3) ≥ 3, were enrolled between December 2016 and October 2019 and randomly assigned to receive either rituximab (n = 52) or conventional therapy on the basis of the five-factor score (n = 53). Patients in the rituximab group received 1 g of rituximab on days 1 and 15, along with glucocorticoids on a tapering schedule; those with a five-factor score ≥ 1 received placebo-cyclophosphamide and placebo-uromitexan. The conventional therapy group received glucocorticoids on a tapering schedule with or without cyclophosphamide on the basis of a five-factor score ≥ 1. The primary endpoint was the proportion of patients who achieved remission, defined as the absence of EGPA disease activity (indicated by a BVAS of 0 at a prednisone dose of ≤ 7.5 mg/d), at 180 days. Secondary endpoints included the duration of remission, glucocorticoid dose, and safety, with follow-up visits scheduled up to 360 days. TAKEAWAY: At 180 days, 63.5% of patients in the rituximab group and 60.4% in the conventional group achieved remission (relative risk, 1.05; P = .75). At 360 days, remission rates were similar between the groups: 59.6% in the rituximab group and 64.2% in the conventional group. The time to remission was a median of 2 weeks in both the groups. Among patients who achieved a BVAS of 0, the mean duration of remission was comparable — 48.5 weeks for rituximab and 49.1 weeks for conventional therapy. No significant differences were observed in relapse rates or serious adverse event rates between the rituximab and conventional therapy groups. Infections and cardiovascular events were the most common serious adverse events. IN PRACTICE: 'On the basis of the results of this trial, the role of rituximab in the therapeutic management of EGPA has been updated,' the authors of the study wrote. 'In most of the study population with nonsevere EGPA, the lack of a clinically meaningful effect of rituximab in addition to the conventional strategy of glucocorticoids alone may appropriately inform clinical decision-making,' they added. SOURCE: The study was led by Benjamin Terrier, MD, PhD, Université Paris Cité in Paris, France. It was published online on July 28, 2025, in Annals of Internal Medicine. LIMITATIONS: The study's design as a superiority trial may not adequately address the equivalence between rituximab and conventional therapy. The limited sample size, due to the rarity of EGPA, affected the precision of subgroup analyses. The focus on remission induction in the vasculitis phase may differ from other studies. DISCLOSURES: The study was funded by research grants from the French Ministry of Health and sponsored by Assistance Publique-Hôpitaux de Paris. Additional disclosures are noted in the original article online. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
15 hours ago
- Health
- Medscape
Hydroxychloroquine Use May Be Beneficial in Lupus Nephritis
TOPLINE: Hydroxychloroquine exposure in patients with lupus nephritis was associated with a substantially lower risk for estimated glomerular filtration rate (eGFR) decline of ≥ 30%, particularly among those with chronic kidney disease (CKD) stage ≥ 3. METHODOLOGY: Researchers conducted a retrospective study involving 209 patients with biopsy-proven incident lupus nephritis (mean age at diagnosis, 38 years; 75% women) between 1994 and 2019 identified at a single center in Wisconsin to examine the effect of hydroxychloroquine on kidney function. Hydroxychloroquine exposure status (median dose, > 5 vs ≤ 5 mg/kg/d) was determined at each visit using electronic health records, with positive exposure ascertained by an active prescription for at least 3 months at each follow-up. The primary outcome was eGFR decline of ≥ 30% at a minimum of two follow-up visits compared with baseline eGFR, or the requirement of sustained renal replacement therapy, with a mean follow-up duration of 5.4 years. The secondary outcome included an eGFR decline of ≥ 40%, and the annual eGFR slope to assess kidney function decline over time. TAKEAWAY: Time-varying exposure to hydroxychloroquine was associated with a 59% lower risk for an eGFR decline of ≥ 30% (adjusted hazard ratio [aHR], 0.41; P = .007). Similarly, hydroxychloroquine exposure was associated with a 66% lower risk for an eGFR decline of ≥ 40% (aHR, 0.34; P = .004). In patients with CKD stage ≥ 3 at lupus nephritis diagnosis, hydroxychloroquine exposure was associated with a 77% lower risk for an eGFR decline of ≥ 30% (aHR, 0.23; P = .03). Exposure to hydroxychloroquine led to significant annual reductions in eGFR slope declines of 5.12 mL/min/1.73 m2 within 5 years of a lupus nephritis diagnosis and 3.17 mL/min/1.73 m2 within 10 years. IN PRACTICE: 'These findings emphasize the importance of starting early and continuing HCQ [hydroxychloroquine] therapy to preserve kidney health alongside overall disease control even if SLE [systemic lupus erythematosus] is limited to the kidneys [lupus nephritis],' the authors of the study wrote. SOURCE: This study was led by Shivani Garg, MD, PhD, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin. It was published online on July 20, 2025, in Arthritis Care & Research. LIMITATIONS: The single academic institution setting potentially affected population representation. Data on hydroxychloroquine blood levels were unavailable to assess adherence and absorption variability. Decline of eGFR may have been missed in patients lost to follow-up or those who died at outside institutions. DISCLOSURES: This study received support from the University of Wisconsin-Madison, Institute for Clinical and Translational Research and the Clinical and Translational Science Award program from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences. One author reported receiving funding through the NIH and honoraria for presentation at a conference. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
17 hours ago
- Health
- Medscape
Social Media Reveals IBS Woes Missed by Clinics
TOPLINE: An analysis of irritable bowel syndrome (IBS)-related posts on X reveals discussions spanning symptoms, dietary triggers, peer support, and mental health — suggesting that traditional healthcare settings may not fully meet patients' needs and underscoring the value of integrating social media insights into IBS care models. METHODOLOGY: Social media platforms like X are frequentlly used to share health experiences and provide patient-generated insights. Researchers analyzed 12,345 IBS-related posts on X (April 2006-August 2024), using search terms capable of capturing user experiences and concerns. The dataset was processed to retain relevant information from texts and emojis. Posts with fewer than three words were removed. Sentiment analysis (score range, -1 to +1) was applied to 8864 posts, which were classified as positive, neutral, or negative. Topic modeling was applied to 2532 posts with ≥ 50 words to identify core subjects and themes. TAKEAWAY: Sentiment was primarily neutral (45.9%), followed by positive (35.4%) and negative (18.7%), suggesting that users often shared advice or information rather than strong emotions. Sentiment remained relatively consistent over time, with fluctuations linked to major IBS-related milestones (eg, new diagnostic criteria, high-profile publications, awareness campaigns). Main post themes included physical symptoms (15.6%), diet/triggers (15.1%), social support (14.2%), comorbidities (12.2%), research and treatment (12.2%), quality of life (12.0%), awareness (11.5%), and mental health (7.2%). Posts on physical symptoms had the highest proportion of negative sentiment (32.4%), whereas social support post were the most positive (53.7%). Mental health and research/treatment posts were mostly neutral due to their educational or informational nature. Post contributors included self-identified IBS patients (61.3%), healthcare professionals (12.8%), organizations/advocacy groups (10.5%), and general commenters (15.4%). IN PRACTICE: 'Patients turn to social media primarily because of unmet informational needs regarding day-to-day symptom management (evidenced by the prevalence of dietary and trigger discussions) and desires for experiential validation that clinical encounters may not provide (demonstrated by the high engagement with personal narrative content),' the authors wrote. SOURCE: This study was led by Ravi Shankar and Alexander Wenjun Yip, Alexandra Hospital in Singapore. It was published online in Scientific Reports. LIMITATIONS: Data were limited to X and may not reflect the entire spectrum of online IBS discussions. Users not active in online discussions — especially older adults or those with limited digital literacy/access — may have been underrepresented. DISCLOSURES: This study did not receive any specific grant funding. The authors declared having no competing interests. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
19 hours ago
- Health
- Medscape
JAK Inhibitors Raise Venous Thromboembolism Risk in AD
TOPLINE: JAK inhibitors demonstrated significantly higher risk for venous thromboembolism than dupilumab and methotrexate in patients with atopic dermatitis (AD) in a retrospective study. METHODOLOGY: Researchers conducted three propensity score-matched analyses comparing patients with AD initiating JAK inhibitors with those receiving dupilumab (n = 1006), methotrexate (n = 958), or cyclosporine (n = 948) from the TriNetX global database. The mean patient age was 41.7-43.3 years; about 62% were women; 54% were White individuals, and 46% were non-White individuals across the groups. Study outcomes were the incidence of myocardial infarction (MI), stroke, pulmonary embolism (PE), and deep vein thrombosis (DVT) within 3 years of treatment initiation. TAKEAWAY: Among patients treated with JAK inhibitors, the risks for PE (hazard ratio [HR], 2.75; P = .014) and DVT (HR, 2.54; P = .017) were significantly higher, corresponding to eight and nine additional cases per 1000 patients (risk differences of 0.8% and 0.9%), respectively. The overall risk for stroke was comparable in the two groups. JAK inhibitors were associated with a higher risk for DVT (HR, 2.41; P = .017) than methotrexate, corresponding to seven additional cases per 1000 patients (risk difference of 0.7%). The risks for PE, MI, and stroke were similar in the two groups. Compared with cyclosporin, the researchers noted no significant differences in the 3-year risk for PE, DVT, stroke, or MI. IN PRACTICE: Based on the results, 'patients with AD initiating JAK inhibitors are at an elevated risk of PE and DVT as compared to those managed by dupilumab,' and JAK inhibitors 'were associated with an increased risk of DVT as compared to methotrexate,' the authors of the study wrote. These results, they concluded, 'support a cautious, individualized approach to the use of JAK inhibitors, particularly in patients with elevated baseline thromboembolic risk.' SOURCE: The study was led by Khalaf Kridin, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany, and was published online on July 21 in the Journal of the European Academy of Dermatology and Venereology. LIMITATIONS: The study used retrospective observational data, and JAK inhibitors were analyzed as a class, not by individual drug or dose. DISCLOSURES: The study did not receive any funding, and the authors reported having no 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.
Daily Mail
21 hours ago
- Health
- Daily Mail
A new injection could REVERSE hearing loss and allow thousands to ditch their hearing aids. This is everything you need to know about it
For some two million people in the UK, hearing aids are a vital lifeline, allowing them to stay in touch with the world around them. But they cannot restore hearing – the devices work by amplifying sounds – and despite modern, sleek designs, for many people there is still a stigma attached to wearing them.
