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Guidelines on GLP1RAs and continuous glucose monitors are among biggest news in diabetes
glucagonlike peptide-1 receptor agonists (GLP1RAs) and continuous glucose monitoring (CGM) technology. I am hoping my discussion about these major advances in this edition of Highlights will be helpful to those caring for patients with diabetes.
Tirzepatide
The first GLP1RA, exenatide, was released in April 2005. Since then, numerous daily and weekly drugs of this class have been developed. We’ve learned they are effective glucose lowering drugs, and the weekly agents dulaglutide and semaglutide have shown impressive weight reduction properties as well as cardiovascular benefits.
Secondary outcomes have also shown renal benefits to these agents, and studies for primary renal efficacy are pending. Due to all of these properties, the GLP1RAs are recommended as the first injectable for the treatment of type 2 diabetes, prior to insulin initiation.1
The next generation of these agents are a combination of a GLP1RA and a glucose-dependent insulinotropic polypeptide (GIP). Glucagonlike peptide-1 (GLP-1) stimulates insulin secretion, inhibits glucagon secretion, delays gastric emptying, and has central effects inducing satiety.
We now understand that GIP is the main incretin hormone in those without diabetes, causative of most of the incretin effects. But the insulin response after GIP secretion in type 2 diabetes is strongly reduced. It is now appreciated that this poor effect of GIP can be reduced when used in combination with a GLP1RA. This combination incretin, called by some a “twincretin,” is the basis for the drug tirzepatide which was approved by the Food and Drug Administration in May of 2022.
The data supporting this agent for both diabetes and obesity are impressive. For example, in a 40-week study with a baseline HbA1c of 8.0%, those randomized to tirzepatide at 5 mg, 10 mg, and 15 mg had HbA1c reductions of 1.87%, 1.89%, and 2.07% respectively.2 Over 81% at all doses had HbA1c levels less than 6.5% at 40 weeks.
For the 5-mg, 10-mg, and 15-mg doses, weight change from baseline was 7.9%, 9.3%, and 11.0% respectively. Like older GLP1RAs, gastrointestinal side effects were the main problem. For the three doses, 3%, 5%, and 7%, respectively, had to stop the drug, compared with the 3% who stopped taking the placebo. In another study, tirzepatide was noninferior or superior at all three doses compared with semaglutide 1 mg weekly.3
In a population without diabetes, with 40% of patients having prediabetes, weight loss percentages for the three doses were 15.0%, 19.5%, and 20.9% respectively.4 Discontinuation percentages due to side effects were 4%-7%. The exciting part is we now have a drug that approaches weight loss from bariatric surgery. The cardiovascular and renal outcome trials are now underway, but the enthusiasm for this drug is clear from the data.
Like other GLP1RAs, the key is to start low and go slowly. It is recommended to start tirzepatide at 2.5 mg four times a week, then increase to 5 mg. Due to gastrointestinal side effects, some patients will do better at the lower dose before increasing. For those switching from another GLP1RA, there are no data to guide us but, in my practice, I start those patients at 5 mg weekly.
Continuous glucose monitoring
Data continue to accumulate that this form of glycemic self-monitoring is effective to reduce HbA1c levels and minimize hypoglycemia in both type 1 and type 2 diabetes. The most important change to the 2022 American Diabetes Association (ADA) standards of care is recognizing CGM as level A evidence for those receiving basal insulin without mealtime insulin.5 There are four CGMs on the market, but most of the market uses the Dexcom G6 or the Libre 2. Both of these devices will be updated within the next few months to newer generation sensors.
While there are similarities and differences between the two devices, by late 2022 and early 2023 changes to both will reduce the dissimilarities.
The next generation Libre (Libre 3) will be continuous, and “scanning” will no longer be required. For those unable to get insurance to cover CGM, the Libre will continue to be more affordable than the Dexcom. Alerts will be present on both, but the Dexcom G7 will be approved for both the arm and the abdomen. The Dexcom also can communicate with several automated insulin delivery systems and data can be shared real-time with family members.
For clinicians just starting patients on this technology, my suggestion is to focus on one system so both the provider and staff can become familiar with it. It is key to review downloaded glucose metrics, in addition to the “ambulatory glucose profile,” a graphic overview of daily glycemia where patterns can be identified. It is also helpful to ask for assistance from endocrinologists who have experience with CGMs, in addition to the representatives of the companies.
COVID-19 and new-onset diabetes
From the beginning of the COVID 19 pandemic in 2020, it was clear that stress hyperglycemia and glucose dysregulation was an important observation for those infected. What was not known at the time is that for some, the hyperglycemia continued, and permanent diabetes ensued.
In one study of over 2.7 million U.S. veterans, men infected with COVID-19, but not women, were at a higher risk of new incident diabetes at 120 days after infection compared to no infection (odds ratio for men = 2.56).6
Another literature review using meta-analyses and cross-sectional studies concluded new-onset diabetes following COVID-19 infection can have a varied phenotype, with no risk factors, presenting from diabetic ketoacidosis to milder forms of diabetes.7
The current thought is that COVID-19 binds to the ACE2 and TMPRSS2 receptors which appear to be located on the beta-cells in the islet, resulting in insulin deficiency, in addition to the insulin resistance that seems to persist after the acute infection. Much more needs to be learned about this, but clinicians need to appreciate this appears to be a new form of diabetes and optimal treatments are not yet clear.
Dr. Hirsch is an endocrinologist, professor of medicine, and diabetes treatment and teaching chair at the University of Washington, Seattle. He has received research grant support from Dexcom and Insulet and has provided consulting to Abbott, Roche, Lifescan, and GWave. You can contact him at [email protected].
References
1. American Diabetes Association Professional Practice Committee. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S125-S143.
2. Rosenstock J et al. Efficacy and safety of a novel GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): A double-blind, randomised, phase 3 trial. Lancet. 2021;398:143-55.
3. Frias JP et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med. 2021;385:503-15.
4. Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387:205-16.
5. American Diabetes Association Professional Practice Committee. Diabetes technology: Standards of Medical Care in Diabetes–2022. Diabetes Care. 2022;45(Suppl 1):S97-S112.
6. Wander PL et al. The incidence of diabetes in 2,777,768 veterans with and without recent SARS-CoV-2 infection. Diabetes Care 2022;45:782-8.
7. Joshi SC and Pozzilli P. COVID-19 induced diabetes: A novel presentation. Diabetes Res Clin Pract. 2022 Aug 6;191:110034.
glucagonlike peptide-1 receptor agonists (GLP1RAs) and continuous glucose monitoring (CGM) technology. I am hoping my discussion about these major advances in this edition of Highlights will be helpful to those caring for patients with diabetes.
Tirzepatide
The first GLP1RA, exenatide, was released in April 2005. Since then, numerous daily and weekly drugs of this class have been developed. We’ve learned they are effective glucose lowering drugs, and the weekly agents dulaglutide and semaglutide have shown impressive weight reduction properties as well as cardiovascular benefits.
Secondary outcomes have also shown renal benefits to these agents, and studies for primary renal efficacy are pending. Due to all of these properties, the GLP1RAs are recommended as the first injectable for the treatment of type 2 diabetes, prior to insulin initiation.1
The next generation of these agents are a combination of a GLP1RA and a glucose-dependent insulinotropic polypeptide (GIP). Glucagonlike peptide-1 (GLP-1) stimulates insulin secretion, inhibits glucagon secretion, delays gastric emptying, and has central effects inducing satiety.
We now understand that GIP is the main incretin hormone in those without diabetes, causative of most of the incretin effects. But the insulin response after GIP secretion in type 2 diabetes is strongly reduced. It is now appreciated that this poor effect of GIP can be reduced when used in combination with a GLP1RA. This combination incretin, called by some a “twincretin,” is the basis for the drug tirzepatide which was approved by the Food and Drug Administration in May of 2022.
The data supporting this agent for both diabetes and obesity are impressive. For example, in a 40-week study with a baseline HbA1c of 8.0%, those randomized to tirzepatide at 5 mg, 10 mg, and 15 mg had HbA1c reductions of 1.87%, 1.89%, and 2.07% respectively.2 Over 81% at all doses had HbA1c levels less than 6.5% at 40 weeks.
For the 5-mg, 10-mg, and 15-mg doses, weight change from baseline was 7.9%, 9.3%, and 11.0% respectively. Like older GLP1RAs, gastrointestinal side effects were the main problem. For the three doses, 3%, 5%, and 7%, respectively, had to stop the drug, compared with the 3% who stopped taking the placebo. In another study, tirzepatide was noninferior or superior at all three doses compared with semaglutide 1 mg weekly.3
In a population without diabetes, with 40% of patients having prediabetes, weight loss percentages for the three doses were 15.0%, 19.5%, and 20.9% respectively.4 Discontinuation percentages due to side effects were 4%-7%. The exciting part is we now have a drug that approaches weight loss from bariatric surgery. The cardiovascular and renal outcome trials are now underway, but the enthusiasm for this drug is clear from the data.
Like other GLP1RAs, the key is to start low and go slowly. It is recommended to start tirzepatide at 2.5 mg four times a week, then increase to 5 mg. Due to gastrointestinal side effects, some patients will do better at the lower dose before increasing. For those switching from another GLP1RA, there are no data to guide us but, in my practice, I start those patients at 5 mg weekly.
Continuous glucose monitoring
Data continue to accumulate that this form of glycemic self-monitoring is effective to reduce HbA1c levels and minimize hypoglycemia in both type 1 and type 2 diabetes. The most important change to the 2022 American Diabetes Association (ADA) standards of care is recognizing CGM as level A evidence for those receiving basal insulin without mealtime insulin.5 There are four CGMs on the market, but most of the market uses the Dexcom G6 or the Libre 2. Both of these devices will be updated within the next few months to newer generation sensors.
While there are similarities and differences between the two devices, by late 2022 and early 2023 changes to both will reduce the dissimilarities.
The next generation Libre (Libre 3) will be continuous, and “scanning” will no longer be required. For those unable to get insurance to cover CGM, the Libre will continue to be more affordable than the Dexcom. Alerts will be present on both, but the Dexcom G7 will be approved for both the arm and the abdomen. The Dexcom also can communicate with several automated insulin delivery systems and data can be shared real-time with family members.
For clinicians just starting patients on this technology, my suggestion is to focus on one system so both the provider and staff can become familiar with it. It is key to review downloaded glucose metrics, in addition to the “ambulatory glucose profile,” a graphic overview of daily glycemia where patterns can be identified. It is also helpful to ask for assistance from endocrinologists who have experience with CGMs, in addition to the representatives of the companies.
COVID-19 and new-onset diabetes
From the beginning of the COVID 19 pandemic in 2020, it was clear that stress hyperglycemia and glucose dysregulation was an important observation for those infected. What was not known at the time is that for some, the hyperglycemia continued, and permanent diabetes ensued.
In one study of over 2.7 million U.S. veterans, men infected with COVID-19, but not women, were at a higher risk of new incident diabetes at 120 days after infection compared to no infection (odds ratio for men = 2.56).6
Another literature review using meta-analyses and cross-sectional studies concluded new-onset diabetes following COVID-19 infection can have a varied phenotype, with no risk factors, presenting from diabetic ketoacidosis to milder forms of diabetes.7
The current thought is that COVID-19 binds to the ACE2 and TMPRSS2 receptors which appear to be located on the beta-cells in the islet, resulting in insulin deficiency, in addition to the insulin resistance that seems to persist after the acute infection. Much more needs to be learned about this, but clinicians need to appreciate this appears to be a new form of diabetes and optimal treatments are not yet clear.
Dr. Hirsch is an endocrinologist, professor of medicine, and diabetes treatment and teaching chair at the University of Washington, Seattle. He has received research grant support from Dexcom and Insulet and has provided consulting to Abbott, Roche, Lifescan, and GWave. You can contact him at [email protected].
References
1. American Diabetes Association Professional Practice Committee. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S125-S143.
2. Rosenstock J et al. Efficacy and safety of a novel GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): A double-blind, randomised, phase 3 trial. Lancet. 2021;398:143-55.
3. Frias JP et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med. 2021;385:503-15.
4. Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387:205-16.
5. American Diabetes Association Professional Practice Committee. Diabetes technology: Standards of Medical Care in Diabetes–2022. Diabetes Care. 2022;45(Suppl 1):S97-S112.
6. Wander PL et al. The incidence of diabetes in 2,777,768 veterans with and without recent SARS-CoV-2 infection. Diabetes Care 2022;45:782-8.
7. Joshi SC and Pozzilli P. COVID-19 induced diabetes: A novel presentation. Diabetes Res Clin Pract. 2022 Aug 6;191:110034.
glucagonlike peptide-1 receptor agonists (GLP1RAs) and continuous glucose monitoring (CGM) technology. I am hoping my discussion about these major advances in this edition of Highlights will be helpful to those caring for patients with diabetes.
Tirzepatide
The first GLP1RA, exenatide, was released in April 2005. Since then, numerous daily and weekly drugs of this class have been developed. We’ve learned they are effective glucose lowering drugs, and the weekly agents dulaglutide and semaglutide have shown impressive weight reduction properties as well as cardiovascular benefits.
Secondary outcomes have also shown renal benefits to these agents, and studies for primary renal efficacy are pending. Due to all of these properties, the GLP1RAs are recommended as the first injectable for the treatment of type 2 diabetes, prior to insulin initiation.1
The next generation of these agents are a combination of a GLP1RA and a glucose-dependent insulinotropic polypeptide (GIP). Glucagonlike peptide-1 (GLP-1) stimulates insulin secretion, inhibits glucagon secretion, delays gastric emptying, and has central effects inducing satiety.
We now understand that GIP is the main incretin hormone in those without diabetes, causative of most of the incretin effects. But the insulin response after GIP secretion in type 2 diabetes is strongly reduced. It is now appreciated that this poor effect of GIP can be reduced when used in combination with a GLP1RA. This combination incretin, called by some a “twincretin,” is the basis for the drug tirzepatide which was approved by the Food and Drug Administration in May of 2022.
The data supporting this agent for both diabetes and obesity are impressive. For example, in a 40-week study with a baseline HbA1c of 8.0%, those randomized to tirzepatide at 5 mg, 10 mg, and 15 mg had HbA1c reductions of 1.87%, 1.89%, and 2.07% respectively.2 Over 81% at all doses had HbA1c levels less than 6.5% at 40 weeks.
For the 5-mg, 10-mg, and 15-mg doses, weight change from baseline was 7.9%, 9.3%, and 11.0% respectively. Like older GLP1RAs, gastrointestinal side effects were the main problem. For the three doses, 3%, 5%, and 7%, respectively, had to stop the drug, compared with the 3% who stopped taking the placebo. In another study, tirzepatide was noninferior or superior at all three doses compared with semaglutide 1 mg weekly.3
In a population without diabetes, with 40% of patients having prediabetes, weight loss percentages for the three doses were 15.0%, 19.5%, and 20.9% respectively.4 Discontinuation percentages due to side effects were 4%-7%. The exciting part is we now have a drug that approaches weight loss from bariatric surgery. The cardiovascular and renal outcome trials are now underway, but the enthusiasm for this drug is clear from the data.
Like other GLP1RAs, the key is to start low and go slowly. It is recommended to start tirzepatide at 2.5 mg four times a week, then increase to 5 mg. Due to gastrointestinal side effects, some patients will do better at the lower dose before increasing. For those switching from another GLP1RA, there are no data to guide us but, in my practice, I start those patients at 5 mg weekly.
Continuous glucose monitoring
Data continue to accumulate that this form of glycemic self-monitoring is effective to reduce HbA1c levels and minimize hypoglycemia in both type 1 and type 2 diabetes. The most important change to the 2022 American Diabetes Association (ADA) standards of care is recognizing CGM as level A evidence for those receiving basal insulin without mealtime insulin.5 There are four CGMs on the market, but most of the market uses the Dexcom G6 or the Libre 2. Both of these devices will be updated within the next few months to newer generation sensors.
While there are similarities and differences between the two devices, by late 2022 and early 2023 changes to both will reduce the dissimilarities.
The next generation Libre (Libre 3) will be continuous, and “scanning” will no longer be required. For those unable to get insurance to cover CGM, the Libre will continue to be more affordable than the Dexcom. Alerts will be present on both, but the Dexcom G7 will be approved for both the arm and the abdomen. The Dexcom also can communicate with several automated insulin delivery systems and data can be shared real-time with family members.
For clinicians just starting patients on this technology, my suggestion is to focus on one system so both the provider and staff can become familiar with it. It is key to review downloaded glucose metrics, in addition to the “ambulatory glucose profile,” a graphic overview of daily glycemia where patterns can be identified. It is also helpful to ask for assistance from endocrinologists who have experience with CGMs, in addition to the representatives of the companies.
COVID-19 and new-onset diabetes
From the beginning of the COVID 19 pandemic in 2020, it was clear that stress hyperglycemia and glucose dysregulation was an important observation for those infected. What was not known at the time is that for some, the hyperglycemia continued, and permanent diabetes ensued.
In one study of over 2.7 million U.S. veterans, men infected with COVID-19, but not women, were at a higher risk of new incident diabetes at 120 days after infection compared to no infection (odds ratio for men = 2.56).6
Another literature review using meta-analyses and cross-sectional studies concluded new-onset diabetes following COVID-19 infection can have a varied phenotype, with no risk factors, presenting from diabetic ketoacidosis to milder forms of diabetes.7
The current thought is that COVID-19 binds to the ACE2 and TMPRSS2 receptors which appear to be located on the beta-cells in the islet, resulting in insulin deficiency, in addition to the insulin resistance that seems to persist after the acute infection. Much more needs to be learned about this, but clinicians need to appreciate this appears to be a new form of diabetes and optimal treatments are not yet clear.
Dr. Hirsch is an endocrinologist, professor of medicine, and diabetes treatment and teaching chair at the University of Washington, Seattle. He has received research grant support from Dexcom and Insulet and has provided consulting to Abbott, Roche, Lifescan, and GWave. You can contact him at [email protected].
References
1. American Diabetes Association Professional Practice Committee. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S125-S143.
2. Rosenstock J et al. Efficacy and safety of a novel GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): A double-blind, randomised, phase 3 trial. Lancet. 2021;398:143-55.
3. Frias JP et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med. 2021;385:503-15.
4. Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387:205-16.
5. American Diabetes Association Professional Practice Committee. Diabetes technology: Standards of Medical Care in Diabetes–2022. Diabetes Care. 2022;45(Suppl 1):S97-S112.
6. Wander PL et al. The incidence of diabetes in 2,777,768 veterans with and without recent SARS-CoV-2 infection. Diabetes Care 2022;45:782-8.
7. Joshi SC and Pozzilli P. COVID-19 induced diabetes: A novel presentation. Diabetes Res Clin Pract. 2022 Aug 6;191:110034.
Poor physician access linked with unplanned return ED visits
Difficulty in accessing a family physician is associated with a higher risk for unplanned return visits to the emergency department among patients aged 75 years and older, new data indicate.
In a prospective, observational study that included almost 2,000 patients in this age group, 16% of participants attempted to contact their family physicians before their ED visits. Of this group, more than half reported having difficulty seeing their physicians for urgent problems, more than 40% had difficulty speaking with their family physicians by telephone, and more than one-third had difficulty booking appointments for new health problems.
write study author Marc Afilalo, MD, director of the ED at Jewish General Hospital in Montreal, and colleagues. “Therefore, community-based programs that target patient education and improved access to primary care are necessary not only for reducing return visits to the ED, but also for continuity of care and patient satisfaction.”
The study was published in Canadian Family Physician.
Comorbidities increased risk
Researchers have estimated that half of Canadians aged 75 years or older use emergency services. Data indicate that the number of unplanned return visits to the ED is associated with increased functional decline and death. But the question of how patient access to primary care services affects unplanned ED return visits has received little attention, according to the investigators.
They conducted a multicenter study at three tertiary adult teaching hospitals in Montreal. From 2012 to 2014, they recruited patients aged 75 years and older who had visited the ED and who lived in their own homes or in an autonomous residence.
Investigators collected data through structured interviews, administrative databases, and medical chart reviews. They followed up with participants at 3 months by telephone. The study’s main outcome was return visit to the ED.
The researchers identified 4,577 patients and included 1,998 in their analysis. Of that total, 33% were 85 or older, 34% lived alone, and 91% had a family physician. Within 3 months, 562 patients (28%) had made 894 return visits to the ED.
Among patients aged 85 years or older (relative risk, 0.80), as well as those whose triage score was less severe (RR, 0.83) and those who were admitted during the index ED visit (RR, 0.76), rates of return ED visits were lower. Among patients who had trouble booking appointments with their family doctors to address new problems (RR, 1.19), as well as those who had made ED visits within the previous 6 months (RR, 1.47) or had a higher Charlson comorbidity index score (RR, 1.06 for every 1-unit increase), rates of return visits were higher.
Factors associated with a higher likelihood of return visits were visits to the ED in the previous 6 months (odds ratio, 2.11), increased Charlson comorbidity index score (OR, 1.41 for every 1-unit increase), and having received help from local community services (OR, 3.00).
Primary care access
The study suggests that improvements in primary care access are needed to decrease return visits to the ED, Samir Sinha, MD, DPhil, director of geriatrics at Mount Sinai and the University Health Network Hospitals in Toronto, told this news organization. Dr. Sinha was not involved in the study.
“It reminds us of the importance of having a strong primary care system,” he added. “Of this population, 91% had primary care providers. And what the paper demonstrates is that those who are having trouble accessing their primary care providers are more likely to be readmitted to an ED. We can only imagine how much worse the outcomes are for people who don’t have a primary care provider.”
Patients are frequently advised to visit the ED when they contact their primary care providers, said Mark Rosenberg, PhD, professor of geography and planning and the Canada Research Chair in Aging, Health, and Development at Queens University in Kingston, Ont., said in an interview. He noted that primary care is organized as an appointment-based system. Dr. Rosenberg did not participate in the study.
“If I were to call my primary care provider in the middle of the afternoon and say that I have got chest pains, they are going to simply tell me to go to emergency,” said Dr. Rosenberg. “It is not just older people. Many people end up in the ED because they are told to go to the ED.”
Associations with age
“The higher your Charlson comorbidity index, the more multiple, complex health issues you’re dealing with,” said Sinha. He added that the data suggest the frailty of the study population.
The association between age 85 years or older and a lower rate of a return ED visits might mean that the patient did not return to independent living after the ED visit, Dr. Rosenberg speculated. “If it’s a serious health problem, you’re more likely to end up going into long-term care at that stage, and you are not going back to living in the community in your home,” he said. “You’re likely going into some sort of transition care or alternative care.”
People aged 85 years or older who are hospitalized are more likely not to survive their index hospital admission, compared with patients who are aged 75-85 years. There would be no possibility that such patients would revisit the ED in the future, said Dr. Sinha.
Expanding primary care
The major solution to decreasing reliance on the ED lies in revamping primary health care so that it offers an expanded level of care and 24/7 access, said Dr. Rosenberg.
Providing continuity of care, identifying problems, and managing them in the community before they become urgent or require a hospitalization are priorities for primary care and will help shift away from return visits to the ED, which should be a last resort for patients, said Dr. Sinha.
Moreover, patients must be able to access primary care in various ways, be it a telephone consultation, a video consultation, or a face-to-face consultation, he added. Face-to-face consultations can take place in a provider’s office or even in a patient’s home when warranted, he said. “What we need to make sure of is that all three types of consultations are available, so that people can actually get the most appropriate care at the time they’re calling.”
The study had no external funding. Dr. Afilalo, Dr. Sinha, and Dr. Rosenberg have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Difficulty in accessing a family physician is associated with a higher risk for unplanned return visits to the emergency department among patients aged 75 years and older, new data indicate.
In a prospective, observational study that included almost 2,000 patients in this age group, 16% of participants attempted to contact their family physicians before their ED visits. Of this group, more than half reported having difficulty seeing their physicians for urgent problems, more than 40% had difficulty speaking with their family physicians by telephone, and more than one-third had difficulty booking appointments for new health problems.
write study author Marc Afilalo, MD, director of the ED at Jewish General Hospital in Montreal, and colleagues. “Therefore, community-based programs that target patient education and improved access to primary care are necessary not only for reducing return visits to the ED, but also for continuity of care and patient satisfaction.”
The study was published in Canadian Family Physician.
Comorbidities increased risk
Researchers have estimated that half of Canadians aged 75 years or older use emergency services. Data indicate that the number of unplanned return visits to the ED is associated with increased functional decline and death. But the question of how patient access to primary care services affects unplanned ED return visits has received little attention, according to the investigators.
They conducted a multicenter study at three tertiary adult teaching hospitals in Montreal. From 2012 to 2014, they recruited patients aged 75 years and older who had visited the ED and who lived in their own homes or in an autonomous residence.
Investigators collected data through structured interviews, administrative databases, and medical chart reviews. They followed up with participants at 3 months by telephone. The study’s main outcome was return visit to the ED.
The researchers identified 4,577 patients and included 1,998 in their analysis. Of that total, 33% were 85 or older, 34% lived alone, and 91% had a family physician. Within 3 months, 562 patients (28%) had made 894 return visits to the ED.
Among patients aged 85 years or older (relative risk, 0.80), as well as those whose triage score was less severe (RR, 0.83) and those who were admitted during the index ED visit (RR, 0.76), rates of return ED visits were lower. Among patients who had trouble booking appointments with their family doctors to address new problems (RR, 1.19), as well as those who had made ED visits within the previous 6 months (RR, 1.47) or had a higher Charlson comorbidity index score (RR, 1.06 for every 1-unit increase), rates of return visits were higher.
Factors associated with a higher likelihood of return visits were visits to the ED in the previous 6 months (odds ratio, 2.11), increased Charlson comorbidity index score (OR, 1.41 for every 1-unit increase), and having received help from local community services (OR, 3.00).
Primary care access
The study suggests that improvements in primary care access are needed to decrease return visits to the ED, Samir Sinha, MD, DPhil, director of geriatrics at Mount Sinai and the University Health Network Hospitals in Toronto, told this news organization. Dr. Sinha was not involved in the study.
“It reminds us of the importance of having a strong primary care system,” he added. “Of this population, 91% had primary care providers. And what the paper demonstrates is that those who are having trouble accessing their primary care providers are more likely to be readmitted to an ED. We can only imagine how much worse the outcomes are for people who don’t have a primary care provider.”
Patients are frequently advised to visit the ED when they contact their primary care providers, said Mark Rosenberg, PhD, professor of geography and planning and the Canada Research Chair in Aging, Health, and Development at Queens University in Kingston, Ont., said in an interview. He noted that primary care is organized as an appointment-based system. Dr. Rosenberg did not participate in the study.
“If I were to call my primary care provider in the middle of the afternoon and say that I have got chest pains, they are going to simply tell me to go to emergency,” said Dr. Rosenberg. “It is not just older people. Many people end up in the ED because they are told to go to the ED.”
Associations with age
“The higher your Charlson comorbidity index, the more multiple, complex health issues you’re dealing with,” said Sinha. He added that the data suggest the frailty of the study population.
The association between age 85 years or older and a lower rate of a return ED visits might mean that the patient did not return to independent living after the ED visit, Dr. Rosenberg speculated. “If it’s a serious health problem, you’re more likely to end up going into long-term care at that stage, and you are not going back to living in the community in your home,” he said. “You’re likely going into some sort of transition care or alternative care.”
People aged 85 years or older who are hospitalized are more likely not to survive their index hospital admission, compared with patients who are aged 75-85 years. There would be no possibility that such patients would revisit the ED in the future, said Dr. Sinha.
Expanding primary care
The major solution to decreasing reliance on the ED lies in revamping primary health care so that it offers an expanded level of care and 24/7 access, said Dr. Rosenberg.
Providing continuity of care, identifying problems, and managing them in the community before they become urgent or require a hospitalization are priorities for primary care and will help shift away from return visits to the ED, which should be a last resort for patients, said Dr. Sinha.
Moreover, patients must be able to access primary care in various ways, be it a telephone consultation, a video consultation, or a face-to-face consultation, he added. Face-to-face consultations can take place in a provider’s office or even in a patient’s home when warranted, he said. “What we need to make sure of is that all three types of consultations are available, so that people can actually get the most appropriate care at the time they’re calling.”
The study had no external funding. Dr. Afilalo, Dr. Sinha, and Dr. Rosenberg have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Difficulty in accessing a family physician is associated with a higher risk for unplanned return visits to the emergency department among patients aged 75 years and older, new data indicate.
In a prospective, observational study that included almost 2,000 patients in this age group, 16% of participants attempted to contact their family physicians before their ED visits. Of this group, more than half reported having difficulty seeing their physicians for urgent problems, more than 40% had difficulty speaking with their family physicians by telephone, and more than one-third had difficulty booking appointments for new health problems.
write study author Marc Afilalo, MD, director of the ED at Jewish General Hospital in Montreal, and colleagues. “Therefore, community-based programs that target patient education and improved access to primary care are necessary not only for reducing return visits to the ED, but also for continuity of care and patient satisfaction.”
The study was published in Canadian Family Physician.
Comorbidities increased risk
Researchers have estimated that half of Canadians aged 75 years or older use emergency services. Data indicate that the number of unplanned return visits to the ED is associated with increased functional decline and death. But the question of how patient access to primary care services affects unplanned ED return visits has received little attention, according to the investigators.
They conducted a multicenter study at three tertiary adult teaching hospitals in Montreal. From 2012 to 2014, they recruited patients aged 75 years and older who had visited the ED and who lived in their own homes or in an autonomous residence.
Investigators collected data through structured interviews, administrative databases, and medical chart reviews. They followed up with participants at 3 months by telephone. The study’s main outcome was return visit to the ED.
The researchers identified 4,577 patients and included 1,998 in their analysis. Of that total, 33% were 85 or older, 34% lived alone, and 91% had a family physician. Within 3 months, 562 patients (28%) had made 894 return visits to the ED.
Among patients aged 85 years or older (relative risk, 0.80), as well as those whose triage score was less severe (RR, 0.83) and those who were admitted during the index ED visit (RR, 0.76), rates of return ED visits were lower. Among patients who had trouble booking appointments with their family doctors to address new problems (RR, 1.19), as well as those who had made ED visits within the previous 6 months (RR, 1.47) or had a higher Charlson comorbidity index score (RR, 1.06 for every 1-unit increase), rates of return visits were higher.
Factors associated with a higher likelihood of return visits were visits to the ED in the previous 6 months (odds ratio, 2.11), increased Charlson comorbidity index score (OR, 1.41 for every 1-unit increase), and having received help from local community services (OR, 3.00).
Primary care access
The study suggests that improvements in primary care access are needed to decrease return visits to the ED, Samir Sinha, MD, DPhil, director of geriatrics at Mount Sinai and the University Health Network Hospitals in Toronto, told this news organization. Dr. Sinha was not involved in the study.
“It reminds us of the importance of having a strong primary care system,” he added. “Of this population, 91% had primary care providers. And what the paper demonstrates is that those who are having trouble accessing their primary care providers are more likely to be readmitted to an ED. We can only imagine how much worse the outcomes are for people who don’t have a primary care provider.”
Patients are frequently advised to visit the ED when they contact their primary care providers, said Mark Rosenberg, PhD, professor of geography and planning and the Canada Research Chair in Aging, Health, and Development at Queens University in Kingston, Ont., said in an interview. He noted that primary care is organized as an appointment-based system. Dr. Rosenberg did not participate in the study.
“If I were to call my primary care provider in the middle of the afternoon and say that I have got chest pains, they are going to simply tell me to go to emergency,” said Dr. Rosenberg. “It is not just older people. Many people end up in the ED because they are told to go to the ED.”
Associations with age
“The higher your Charlson comorbidity index, the more multiple, complex health issues you’re dealing with,” said Sinha. He added that the data suggest the frailty of the study population.
The association between age 85 years or older and a lower rate of a return ED visits might mean that the patient did not return to independent living after the ED visit, Dr. Rosenberg speculated. “If it’s a serious health problem, you’re more likely to end up going into long-term care at that stage, and you are not going back to living in the community in your home,” he said. “You’re likely going into some sort of transition care or alternative care.”
People aged 85 years or older who are hospitalized are more likely not to survive their index hospital admission, compared with patients who are aged 75-85 years. There would be no possibility that such patients would revisit the ED in the future, said Dr. Sinha.
Expanding primary care
The major solution to decreasing reliance on the ED lies in revamping primary health care so that it offers an expanded level of care and 24/7 access, said Dr. Rosenberg.
Providing continuity of care, identifying problems, and managing them in the community before they become urgent or require a hospitalization are priorities for primary care and will help shift away from return visits to the ED, which should be a last resort for patients, said Dr. Sinha.
Moreover, patients must be able to access primary care in various ways, be it a telephone consultation, a video consultation, or a face-to-face consultation, he added. Face-to-face consultations can take place in a provider’s office or even in a patient’s home when warranted, he said. “What we need to make sure of is that all three types of consultations are available, so that people can actually get the most appropriate care at the time they’re calling.”
The study had no external funding. Dr. Afilalo, Dr. Sinha, and Dr. Rosenberg have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
FROM CANADIAN FAMILY PHYSICIAN
Is it COVID or long COVID? Your organs may know
There’s little doubt long COVID is real. The federal government recognizes long COVID as a condition and said in two reports issued in August that one in five adult COVID-19 survivors have a health condition related to their illness.
COVID-19 can damage multiple organs in the body. Sometimes this damage leads to long COVID; sometimes other reasons are at play. Doctors are beginning to sort it out.
“COVID itself can actually cause prolonged illness, and we don’t really call that long COVID,” said Nisha Viswanathan, MD, a doctor at UCLA Health in Los Angeles. But if symptoms extend beyond 12 weeks, that puts patients in the realm of long COVID.
Symptoms can range from mild to severe and can keep people from resuming their normal lives and jobs. Sometimes they last for months, according to the U.S. Department of Health & Human Services.
Multiorgan damage
Lung scarring and other lung problems are common after COVID, said Leora Horwitz, MD, an internal medicine specialist at New York University. Even after a mild case, people can have breathing issues for months, a team at Johns Hopkins Medicine, Baltimore, said in an online briefing. One study published in the journal Radiology found damage in people a full year after a COVID-19 diagnosis.
Some people have persistent heart, kidney, liver, and nervous system problems after COVID-19. A study published in 2020 in JAMA Cardiology found 60% of people who had COVID-19 had ongoing signs of heart inflammation. Nearly a third of people hospitalized for COVID-19 get kidney damage that can become chronic, and some end up needing dialysis or a transplant, said C. John Sperati, MD, a kidney specialist at Johns Hopkins Medicine.
This might be, in part, because SARS-CoV-2, the virus that causes COVID-19, directly infects the cells in many organs.
Nicole Bhave, MD, a cardiologist at University of Michigan Health, Ann Arbor is concerned that COVID-19 appears to increase the risk of heart problems in some people.
“Some of the uptick may just be recognition bias, in that people with symptoms are seeking care,” she said. “But there’s definitely a biological basis by which COVID could tip people over into a new diagnosis of heart failure.”
Inflammation
Inflammation is probably a key part of the long-term effects of COVID-19.
Some people have a serious immune reaction to COVID-19 called a cytokine storm, said Nitra Aggarwal Gilotra, MD, a cardiologist at Johns Hopkins Medicine. This release of inflammation-causing molecules called cytokines is meant to attack the invading virus. But it can be so severe that it wreaks havoc on healthy tissues and organs and causes lasting damage – if patients even survive it.
In some people, inflammation can affect the heart, causing myocarditis. Myocarditis symptoms include chest pain, breathlessness, and heart palpitations. Though rare, it can be serious and can raise the risk of other heart problems, including heart failure, down the line.
Long COVID may also trigger an autoimmune condition, said Eline Luning Prak, MD, PhD, a pathologist at the Hospital of the University of Pennsylvania, Philadelphia. Long COVID can share many hallmark symptoms with autoimmune diseases, including fatigue, widespread pain, memory problems, and mood disorders.
Blood clots
Studies have shown the overcharged inflammatory response to COVID-19 can cause blood clots. This sometimes overwhelming clotting was an early hallmark of COVID-19 infection, and when clots restrict blood flow in the brain, lungs, kidneys, or limbs, they can cause long-term damage. Some can be deadly. Researchers in Sweden found patients were at risk of deep vein thrombosis – a blood clot usually in the leg – up to 3 months after infection and at higher risk of a blood clot in the lung, called pulmonary embolism, for as long as 3 months.
Viral reservoirs
The virus itself may also linger in a patient’s body, causing continued symptoms and, potentially, new flare-ups. Zoe Swank, PhD, of Harvard Medical School, Boston, and colleagues reported in a preprint study that they found pieces of the SARS-CoV-2 virus in the blood of most patients with long COVID symptoms they tested – some as long as a year after infection. The study has not yet been peer reviewed.
Another team found evidence of the virus in stool up to 7 months later, which suggests the virus hides out in the gut. Other early studies have found bits of viral RNA in the appendix, breast tissue, heart, eyes, and brain.
Diabetes
Diabetes is a risk factor for getting severe COVID-19, and multiple studies have shown people can get diabetes both while battling infection and afterward. One study of veterans, published in The Lancet Diabetes and Endocrinology, found COVID-19 survivors were about 40% more likely to get diabetes over the next year.
There are a few ways this might happen. Insulin-producing cells in the pancreas have SARS-CoV-2 receptors – a type of molecular doorway the coronavirus can attach to. Damage to these cells could make the body less able to produce insulin, which in turn can lead to diabetes. The virus could also disrupt the balance in the body or cause inflammation that leads to insulin resistance, which can develop into diabetes, Ziad Al-Aly, MD, of the Veterans Affairs St. Louis Health Care System, and colleagues wrote.
Nervous system issues
People who get COVID-19 are also more vulnerable to postural orthostatic tachycardia syndrome (POTS). This affects what’s known as the autonomic nervous system, which regulates blood circulation, and includes those things that happen in your body without your having to think about them, like breathing, heartbeat, and digestion. POTS can cause common long COVID neurologic symptoms, including headaches, fatigue, brain fog, insomnia, and problems thinking and concentrating. “This was a known condition prior to COVID, but it was incredibly rare,” said Dr. Viswanathan. “After COVID, I’ve seen it with increasing frequency.”
Long-term outlook
Lasting issues after COVID-19 are much more likely after a moderate or severe infection. Still, plenty of people are battling them even after a mild illness. “As for why, that’s the billion-dollar question,” said Dr. Horwitz. “It’s well known that viral infections can cause long-term dysregulation. Why that is, we really just don’t know.”
Whether it’s virus hiding out in the body, long-term organ damage, or an autoimmune reaction likely differs from person to person. “I’m believing, increasingly, that it’s a combination of all of these, just based on how different patients are responding to different medications,” said Dr. Viswanathan. “One patient will respond to something beautifully, and another patient won’t at all.”
But it’s clear a significant number of people are facing long-term health struggles because of COVID-19, which has infected at least 580 million people globally and 92 million – likely many more – in the United States, according to Johns Hopkins University.
Even a small increased risk of conditions like heart disease or diabetes translates to a huge number of people, Dr. Horwitz said. “If even 1% of people getting COVID have long-term symptoms, that’s a major public health crisis, because that’s 1% of pretty much everybody in the country.”
A version of this article first appeared on WebMD.com.
There’s little doubt long COVID is real. The federal government recognizes long COVID as a condition and said in two reports issued in August that one in five adult COVID-19 survivors have a health condition related to their illness.
COVID-19 can damage multiple organs in the body. Sometimes this damage leads to long COVID; sometimes other reasons are at play. Doctors are beginning to sort it out.
“COVID itself can actually cause prolonged illness, and we don’t really call that long COVID,” said Nisha Viswanathan, MD, a doctor at UCLA Health in Los Angeles. But if symptoms extend beyond 12 weeks, that puts patients in the realm of long COVID.
Symptoms can range from mild to severe and can keep people from resuming their normal lives and jobs. Sometimes they last for months, according to the U.S. Department of Health & Human Services.
Multiorgan damage
Lung scarring and other lung problems are common after COVID, said Leora Horwitz, MD, an internal medicine specialist at New York University. Even after a mild case, people can have breathing issues for months, a team at Johns Hopkins Medicine, Baltimore, said in an online briefing. One study published in the journal Radiology found damage in people a full year after a COVID-19 diagnosis.
Some people have persistent heart, kidney, liver, and nervous system problems after COVID-19. A study published in 2020 in JAMA Cardiology found 60% of people who had COVID-19 had ongoing signs of heart inflammation. Nearly a third of people hospitalized for COVID-19 get kidney damage that can become chronic, and some end up needing dialysis or a transplant, said C. John Sperati, MD, a kidney specialist at Johns Hopkins Medicine.
This might be, in part, because SARS-CoV-2, the virus that causes COVID-19, directly infects the cells in many organs.
Nicole Bhave, MD, a cardiologist at University of Michigan Health, Ann Arbor is concerned that COVID-19 appears to increase the risk of heart problems in some people.
“Some of the uptick may just be recognition bias, in that people with symptoms are seeking care,” she said. “But there’s definitely a biological basis by which COVID could tip people over into a new diagnosis of heart failure.”
Inflammation
Inflammation is probably a key part of the long-term effects of COVID-19.
Some people have a serious immune reaction to COVID-19 called a cytokine storm, said Nitra Aggarwal Gilotra, MD, a cardiologist at Johns Hopkins Medicine. This release of inflammation-causing molecules called cytokines is meant to attack the invading virus. But it can be so severe that it wreaks havoc on healthy tissues and organs and causes lasting damage – if patients even survive it.
In some people, inflammation can affect the heart, causing myocarditis. Myocarditis symptoms include chest pain, breathlessness, and heart palpitations. Though rare, it can be serious and can raise the risk of other heart problems, including heart failure, down the line.
Long COVID may also trigger an autoimmune condition, said Eline Luning Prak, MD, PhD, a pathologist at the Hospital of the University of Pennsylvania, Philadelphia. Long COVID can share many hallmark symptoms with autoimmune diseases, including fatigue, widespread pain, memory problems, and mood disorders.
Blood clots
Studies have shown the overcharged inflammatory response to COVID-19 can cause blood clots. This sometimes overwhelming clotting was an early hallmark of COVID-19 infection, and when clots restrict blood flow in the brain, lungs, kidneys, or limbs, they can cause long-term damage. Some can be deadly. Researchers in Sweden found patients were at risk of deep vein thrombosis – a blood clot usually in the leg – up to 3 months after infection and at higher risk of a blood clot in the lung, called pulmonary embolism, for as long as 3 months.
Viral reservoirs
The virus itself may also linger in a patient’s body, causing continued symptoms and, potentially, new flare-ups. Zoe Swank, PhD, of Harvard Medical School, Boston, and colleagues reported in a preprint study that they found pieces of the SARS-CoV-2 virus in the blood of most patients with long COVID symptoms they tested – some as long as a year after infection. The study has not yet been peer reviewed.
Another team found evidence of the virus in stool up to 7 months later, which suggests the virus hides out in the gut. Other early studies have found bits of viral RNA in the appendix, breast tissue, heart, eyes, and brain.
Diabetes
Diabetes is a risk factor for getting severe COVID-19, and multiple studies have shown people can get diabetes both while battling infection and afterward. One study of veterans, published in The Lancet Diabetes and Endocrinology, found COVID-19 survivors were about 40% more likely to get diabetes over the next year.
There are a few ways this might happen. Insulin-producing cells in the pancreas have SARS-CoV-2 receptors – a type of molecular doorway the coronavirus can attach to. Damage to these cells could make the body less able to produce insulin, which in turn can lead to diabetes. The virus could also disrupt the balance in the body or cause inflammation that leads to insulin resistance, which can develop into diabetes, Ziad Al-Aly, MD, of the Veterans Affairs St. Louis Health Care System, and colleagues wrote.
Nervous system issues
People who get COVID-19 are also more vulnerable to postural orthostatic tachycardia syndrome (POTS). This affects what’s known as the autonomic nervous system, which regulates blood circulation, and includes those things that happen in your body without your having to think about them, like breathing, heartbeat, and digestion. POTS can cause common long COVID neurologic symptoms, including headaches, fatigue, brain fog, insomnia, and problems thinking and concentrating. “This was a known condition prior to COVID, but it was incredibly rare,” said Dr. Viswanathan. “After COVID, I’ve seen it with increasing frequency.”
Long-term outlook
Lasting issues after COVID-19 are much more likely after a moderate or severe infection. Still, plenty of people are battling them even after a mild illness. “As for why, that’s the billion-dollar question,” said Dr. Horwitz. “It’s well known that viral infections can cause long-term dysregulation. Why that is, we really just don’t know.”
Whether it’s virus hiding out in the body, long-term organ damage, or an autoimmune reaction likely differs from person to person. “I’m believing, increasingly, that it’s a combination of all of these, just based on how different patients are responding to different medications,” said Dr. Viswanathan. “One patient will respond to something beautifully, and another patient won’t at all.”
But it’s clear a significant number of people are facing long-term health struggles because of COVID-19, which has infected at least 580 million people globally and 92 million – likely many more – in the United States, according to Johns Hopkins University.
Even a small increased risk of conditions like heart disease or diabetes translates to a huge number of people, Dr. Horwitz said. “If even 1% of people getting COVID have long-term symptoms, that’s a major public health crisis, because that’s 1% of pretty much everybody in the country.”
A version of this article first appeared on WebMD.com.
There’s little doubt long COVID is real. The federal government recognizes long COVID as a condition and said in two reports issued in August that one in five adult COVID-19 survivors have a health condition related to their illness.
COVID-19 can damage multiple organs in the body. Sometimes this damage leads to long COVID; sometimes other reasons are at play. Doctors are beginning to sort it out.
“COVID itself can actually cause prolonged illness, and we don’t really call that long COVID,” said Nisha Viswanathan, MD, a doctor at UCLA Health in Los Angeles. But if symptoms extend beyond 12 weeks, that puts patients in the realm of long COVID.
Symptoms can range from mild to severe and can keep people from resuming their normal lives and jobs. Sometimes they last for months, according to the U.S. Department of Health & Human Services.
Multiorgan damage
Lung scarring and other lung problems are common after COVID, said Leora Horwitz, MD, an internal medicine specialist at New York University. Even after a mild case, people can have breathing issues for months, a team at Johns Hopkins Medicine, Baltimore, said in an online briefing. One study published in the journal Radiology found damage in people a full year after a COVID-19 diagnosis.
Some people have persistent heart, kidney, liver, and nervous system problems after COVID-19. A study published in 2020 in JAMA Cardiology found 60% of people who had COVID-19 had ongoing signs of heart inflammation. Nearly a third of people hospitalized for COVID-19 get kidney damage that can become chronic, and some end up needing dialysis or a transplant, said C. John Sperati, MD, a kidney specialist at Johns Hopkins Medicine.
This might be, in part, because SARS-CoV-2, the virus that causes COVID-19, directly infects the cells in many organs.
Nicole Bhave, MD, a cardiologist at University of Michigan Health, Ann Arbor is concerned that COVID-19 appears to increase the risk of heart problems in some people.
“Some of the uptick may just be recognition bias, in that people with symptoms are seeking care,” she said. “But there’s definitely a biological basis by which COVID could tip people over into a new diagnosis of heart failure.”
Inflammation
Inflammation is probably a key part of the long-term effects of COVID-19.
Some people have a serious immune reaction to COVID-19 called a cytokine storm, said Nitra Aggarwal Gilotra, MD, a cardiologist at Johns Hopkins Medicine. This release of inflammation-causing molecules called cytokines is meant to attack the invading virus. But it can be so severe that it wreaks havoc on healthy tissues and organs and causes lasting damage – if patients even survive it.
In some people, inflammation can affect the heart, causing myocarditis. Myocarditis symptoms include chest pain, breathlessness, and heart palpitations. Though rare, it can be serious and can raise the risk of other heart problems, including heart failure, down the line.
Long COVID may also trigger an autoimmune condition, said Eline Luning Prak, MD, PhD, a pathologist at the Hospital of the University of Pennsylvania, Philadelphia. Long COVID can share many hallmark symptoms with autoimmune diseases, including fatigue, widespread pain, memory problems, and mood disorders.
Blood clots
Studies have shown the overcharged inflammatory response to COVID-19 can cause blood clots. This sometimes overwhelming clotting was an early hallmark of COVID-19 infection, and when clots restrict blood flow in the brain, lungs, kidneys, or limbs, they can cause long-term damage. Some can be deadly. Researchers in Sweden found patients were at risk of deep vein thrombosis – a blood clot usually in the leg – up to 3 months after infection and at higher risk of a blood clot in the lung, called pulmonary embolism, for as long as 3 months.
Viral reservoirs
The virus itself may also linger in a patient’s body, causing continued symptoms and, potentially, new flare-ups. Zoe Swank, PhD, of Harvard Medical School, Boston, and colleagues reported in a preprint study that they found pieces of the SARS-CoV-2 virus in the blood of most patients with long COVID symptoms they tested – some as long as a year after infection. The study has not yet been peer reviewed.
Another team found evidence of the virus in stool up to 7 months later, which suggests the virus hides out in the gut. Other early studies have found bits of viral RNA in the appendix, breast tissue, heart, eyes, and brain.
Diabetes
Diabetes is a risk factor for getting severe COVID-19, and multiple studies have shown people can get diabetes both while battling infection and afterward. One study of veterans, published in The Lancet Diabetes and Endocrinology, found COVID-19 survivors were about 40% more likely to get diabetes over the next year.
There are a few ways this might happen. Insulin-producing cells in the pancreas have SARS-CoV-2 receptors – a type of molecular doorway the coronavirus can attach to. Damage to these cells could make the body less able to produce insulin, which in turn can lead to diabetes. The virus could also disrupt the balance in the body or cause inflammation that leads to insulin resistance, which can develop into diabetes, Ziad Al-Aly, MD, of the Veterans Affairs St. Louis Health Care System, and colleagues wrote.
Nervous system issues
People who get COVID-19 are also more vulnerable to postural orthostatic tachycardia syndrome (POTS). This affects what’s known as the autonomic nervous system, which regulates blood circulation, and includes those things that happen in your body without your having to think about them, like breathing, heartbeat, and digestion. POTS can cause common long COVID neurologic symptoms, including headaches, fatigue, brain fog, insomnia, and problems thinking and concentrating. “This was a known condition prior to COVID, but it was incredibly rare,” said Dr. Viswanathan. “After COVID, I’ve seen it with increasing frequency.”
Long-term outlook
Lasting issues after COVID-19 are much more likely after a moderate or severe infection. Still, plenty of people are battling them even after a mild illness. “As for why, that’s the billion-dollar question,” said Dr. Horwitz. “It’s well known that viral infections can cause long-term dysregulation. Why that is, we really just don’t know.”
Whether it’s virus hiding out in the body, long-term organ damage, or an autoimmune reaction likely differs from person to person. “I’m believing, increasingly, that it’s a combination of all of these, just based on how different patients are responding to different medications,” said Dr. Viswanathan. “One patient will respond to something beautifully, and another patient won’t at all.”
But it’s clear a significant number of people are facing long-term health struggles because of COVID-19, which has infected at least 580 million people globally and 92 million – likely many more – in the United States, according to Johns Hopkins University.
Even a small increased risk of conditions like heart disease or diabetes translates to a huge number of people, Dr. Horwitz said. “If even 1% of people getting COVID have long-term symptoms, that’s a major public health crisis, because that’s 1% of pretty much everybody in the country.”
A version of this article first appeared on WebMD.com.
Most people with Omicron don’t know they’re infected
Most people with Omicron likely don’t know it.
That’s according to a study in JAMA Network Open, which says 56% of people who have the Omicron variant of the coronavirus are unaware of their infection.
And it has an upside and a downside, depending on how you look at it, according to Time magazine.
“It’s good news, in some ways, since ) in vaccinated people,” Time says. “The downside is that many people are likely spreading the virus unintentionally.”
The study looked at 210 hospital patients and employees in the Los Angeles area. More than half who tested positive didn’t know it – because they had no symptoms, or they assumed they merely had a cold or allergies.
“The findings support early data from around the world suggesting that throughout the pandemic, anywhere from 25% to 40% of SARS-CoV-2 infections have been asymptomatic, which presents challenges for public health officials trying to control the spread of the virus,” Time reports.
The study found that awareness of infection rose after at-home tests became available this year. About three-quarters of people in January and February didn’t know their status, for example.
“Findings of this study suggest that low rates of Omicron variant infection awareness may be a key contributor to rapid transmission of the virus within communities,” the authors wrote. “Given that unawareness of active infection precludes self-initiated interventions, such as testing and self-isolation, even modest levels of undiagnosed infection can contribute to substantial population-level transmission.”
A version of this article first appeared on WebMD.com.
Most people with Omicron likely don’t know it.
That’s according to a study in JAMA Network Open, which says 56% of people who have the Omicron variant of the coronavirus are unaware of their infection.
And it has an upside and a downside, depending on how you look at it, according to Time magazine.
“It’s good news, in some ways, since ) in vaccinated people,” Time says. “The downside is that many people are likely spreading the virus unintentionally.”
The study looked at 210 hospital patients and employees in the Los Angeles area. More than half who tested positive didn’t know it – because they had no symptoms, or they assumed they merely had a cold or allergies.
“The findings support early data from around the world suggesting that throughout the pandemic, anywhere from 25% to 40% of SARS-CoV-2 infections have been asymptomatic, which presents challenges for public health officials trying to control the spread of the virus,” Time reports.
The study found that awareness of infection rose after at-home tests became available this year. About three-quarters of people in January and February didn’t know their status, for example.
“Findings of this study suggest that low rates of Omicron variant infection awareness may be a key contributor to rapid transmission of the virus within communities,” the authors wrote. “Given that unawareness of active infection precludes self-initiated interventions, such as testing and self-isolation, even modest levels of undiagnosed infection can contribute to substantial population-level transmission.”
A version of this article first appeared on WebMD.com.
Most people with Omicron likely don’t know it.
That’s according to a study in JAMA Network Open, which says 56% of people who have the Omicron variant of the coronavirus are unaware of their infection.
And it has an upside and a downside, depending on how you look at it, according to Time magazine.
“It’s good news, in some ways, since ) in vaccinated people,” Time says. “The downside is that many people are likely spreading the virus unintentionally.”
The study looked at 210 hospital patients and employees in the Los Angeles area. More than half who tested positive didn’t know it – because they had no symptoms, or they assumed they merely had a cold or allergies.
“The findings support early data from around the world suggesting that throughout the pandemic, anywhere from 25% to 40% of SARS-CoV-2 infections have been asymptomatic, which presents challenges for public health officials trying to control the spread of the virus,” Time reports.
The study found that awareness of infection rose after at-home tests became available this year. About three-quarters of people in January and February didn’t know their status, for example.
“Findings of this study suggest that low rates of Omicron variant infection awareness may be a key contributor to rapid transmission of the virus within communities,” the authors wrote. “Given that unawareness of active infection precludes self-initiated interventions, such as testing and self-isolation, even modest levels of undiagnosed infection can contribute to substantial population-level transmission.”
A version of this article first appeared on WebMD.com.
FROM JAMA NETWORK OPEN
Repeating TACE yields a survival benefit in intermediate-stage HCC
Key clinical point: A single session of transarterial chemoembolization (TACE) may not always confer significant survival benefits in patients with intermediate-stage hepatocellular carcinoma (HCC); initial nonresponders benefit from a second TACE session.
Major finding: The overall survival of responders to the first TACE was significantly better than that of nonresponders (36.7 vs 21.5 months; P = .071) and comparable with that of initial nonresponders who responded to the second TACE (36.7 vs 47.8 months; P = .701).
Study details: This retrospective study reviewed the data of 94 patients with intermediate-stage HCC who underwent TACE and magnetic resonance imaging before and after TACE.
Disclosures: This study was sponsored by the US National Institutes of Health/National Cancer Institute and Philips Research North America (PRNA), Cambridge, USA. Some authors reported being advisory board members or consultants for or receiving research grants from various sources. MD Lin is a former employee of PRNA.
Source: Zhao Y et al. Three-dimensional quantitative tumor response and survival analysis of hepatocellular carcinoma patients who failed initial transarterial chemoembolization: Repeat or switch treatment? Cancers (Basel). 2022;14(15):3615 (Jul 25). Doi: 10.3390/cancers14153615
Key clinical point: A single session of transarterial chemoembolization (TACE) may not always confer significant survival benefits in patients with intermediate-stage hepatocellular carcinoma (HCC); initial nonresponders benefit from a second TACE session.
Major finding: The overall survival of responders to the first TACE was significantly better than that of nonresponders (36.7 vs 21.5 months; P = .071) and comparable with that of initial nonresponders who responded to the second TACE (36.7 vs 47.8 months; P = .701).
Study details: This retrospective study reviewed the data of 94 patients with intermediate-stage HCC who underwent TACE and magnetic resonance imaging before and after TACE.
Disclosures: This study was sponsored by the US National Institutes of Health/National Cancer Institute and Philips Research North America (PRNA), Cambridge, USA. Some authors reported being advisory board members or consultants for or receiving research grants from various sources. MD Lin is a former employee of PRNA.
Source: Zhao Y et al. Three-dimensional quantitative tumor response and survival analysis of hepatocellular carcinoma patients who failed initial transarterial chemoembolization: Repeat or switch treatment? Cancers (Basel). 2022;14(15):3615 (Jul 25). Doi: 10.3390/cancers14153615
Key clinical point: A single session of transarterial chemoembolization (TACE) may not always confer significant survival benefits in patients with intermediate-stage hepatocellular carcinoma (HCC); initial nonresponders benefit from a second TACE session.
Major finding: The overall survival of responders to the first TACE was significantly better than that of nonresponders (36.7 vs 21.5 months; P = .071) and comparable with that of initial nonresponders who responded to the second TACE (36.7 vs 47.8 months; P = .701).
Study details: This retrospective study reviewed the data of 94 patients with intermediate-stage HCC who underwent TACE and magnetic resonance imaging before and after TACE.
Disclosures: This study was sponsored by the US National Institutes of Health/National Cancer Institute and Philips Research North America (PRNA), Cambridge, USA. Some authors reported being advisory board members or consultants for or receiving research grants from various sources. MD Lin is a former employee of PRNA.
Source: Zhao Y et al. Three-dimensional quantitative tumor response and survival analysis of hepatocellular carcinoma patients who failed initial transarterial chemoembolization: Repeat or switch treatment? Cancers (Basel). 2022;14(15):3615 (Jul 25). Doi: 10.3390/cancers14153615
Advanced HCC with PVTT: Sorafenib+TACE more efficacious when combined with an immune checkpoint inhibitor and radiotherapy
Key clinical point: The combination of sorafenib, an immune checkpoint inhibitor (camrelizumab/tislelizumab), transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SITS) is more effective than sorafenib plus TACE (ST) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), especially as a downstaging strategy.
Major finding: The SITS vs ST group had a significantly higher objective response rate (53.3% vs 25.0%; P = .036) and longer median progression-free survival (10.4 vs 6.3 months; P = .015) and overall survival (13.8 vs 8.8 months; P = .013), with 12 patients vs none experiencing successful downstaging.
Study details: Findings are from a retrospective study including 62 patients with advanced HCC and PVTT who received SITS (n = 30) or ST (n = 32).
Disclosures: This study was supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, China, and the Autonomous Exploration and Innovation Fund Subject for Graduate Student of Central South University, China. The authors declared no conflicts of interest.
Source: Zhang Z et al. A Combination of sorafenib, an immune checkpoint inhibitor, TACE and stereotactic body radiation therapy versus sorafenib and TACE in advanced hepatocellular carcinoma accompanied by portal vein tumor thrombus. Cancers (Basel). 2022;14(15):3619 (Jul 25). Doi: 10.3390/cancers14153619
Key clinical point: The combination of sorafenib, an immune checkpoint inhibitor (camrelizumab/tislelizumab), transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SITS) is more effective than sorafenib plus TACE (ST) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), especially as a downstaging strategy.
Major finding: The SITS vs ST group had a significantly higher objective response rate (53.3% vs 25.0%; P = .036) and longer median progression-free survival (10.4 vs 6.3 months; P = .015) and overall survival (13.8 vs 8.8 months; P = .013), with 12 patients vs none experiencing successful downstaging.
Study details: Findings are from a retrospective study including 62 patients with advanced HCC and PVTT who received SITS (n = 30) or ST (n = 32).
Disclosures: This study was supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, China, and the Autonomous Exploration and Innovation Fund Subject for Graduate Student of Central South University, China. The authors declared no conflicts of interest.
Source: Zhang Z et al. A Combination of sorafenib, an immune checkpoint inhibitor, TACE and stereotactic body radiation therapy versus sorafenib and TACE in advanced hepatocellular carcinoma accompanied by portal vein tumor thrombus. Cancers (Basel). 2022;14(15):3619 (Jul 25). Doi: 10.3390/cancers14153619
Key clinical point: The combination of sorafenib, an immune checkpoint inhibitor (camrelizumab/tislelizumab), transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SITS) is more effective than sorafenib plus TACE (ST) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), especially as a downstaging strategy.
Major finding: The SITS vs ST group had a significantly higher objective response rate (53.3% vs 25.0%; P = .036) and longer median progression-free survival (10.4 vs 6.3 months; P = .015) and overall survival (13.8 vs 8.8 months; P = .013), with 12 patients vs none experiencing successful downstaging.
Study details: Findings are from a retrospective study including 62 patients with advanced HCC and PVTT who received SITS (n = 30) or ST (n = 32).
Disclosures: This study was supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, China, and the Autonomous Exploration and Innovation Fund Subject for Graduate Student of Central South University, China. The authors declared no conflicts of interest.
Source: Zhang Z et al. A Combination of sorafenib, an immune checkpoint inhibitor, TACE and stereotactic body radiation therapy versus sorafenib and TACE in advanced hepatocellular carcinoma accompanied by portal vein tumor thrombus. Cancers (Basel). 2022;14(15):3619 (Jul 25). Doi: 10.3390/cancers14153619
HCC: Effective local tumor control with “no-touch” radiofrequency ablation
Key clinical point: Percutaneous no-touch radiofrequency ablation (NtRFA) provides effective tumor control in the treatment of hepatocellular carcinoma (HCC) ≤5 cm, with a lower local tumor progression (LTP) rate than that with conventional RFA.
Major finding: NtRFA offered a pooled overall LTP rate of 6% (95% CI 4%-8%) and significantly lower LTP rates compared with conventional RFA (hazard ratio 0.28; relative risk 0.26; both P < .01).
Study details: This was a meta-analysis of 12 studies that included 900 patients and evaluated LTP after NtRFA for HCC ≤5 cm.
Disclosures: This study was supported by a Korea Medical Device Development Fund grant funded by the Korea government. The authors declared no conflicts of interest.
Source: Kim TH et al. Can “no-touch” radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol. 2022 (Jul 30). Doi: 10.1007/s00330-022-08991-1
Key clinical point: Percutaneous no-touch radiofrequency ablation (NtRFA) provides effective tumor control in the treatment of hepatocellular carcinoma (HCC) ≤5 cm, with a lower local tumor progression (LTP) rate than that with conventional RFA.
Major finding: NtRFA offered a pooled overall LTP rate of 6% (95% CI 4%-8%) and significantly lower LTP rates compared with conventional RFA (hazard ratio 0.28; relative risk 0.26; both P < .01).
Study details: This was a meta-analysis of 12 studies that included 900 patients and evaluated LTP after NtRFA for HCC ≤5 cm.
Disclosures: This study was supported by a Korea Medical Device Development Fund grant funded by the Korea government. The authors declared no conflicts of interest.
Source: Kim TH et al. Can “no-touch” radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol. 2022 (Jul 30). Doi: 10.1007/s00330-022-08991-1
Key clinical point: Percutaneous no-touch radiofrequency ablation (NtRFA) provides effective tumor control in the treatment of hepatocellular carcinoma (HCC) ≤5 cm, with a lower local tumor progression (LTP) rate than that with conventional RFA.
Major finding: NtRFA offered a pooled overall LTP rate of 6% (95% CI 4%-8%) and significantly lower LTP rates compared with conventional RFA (hazard ratio 0.28; relative risk 0.26; both P < .01).
Study details: This was a meta-analysis of 12 studies that included 900 patients and evaluated LTP after NtRFA for HCC ≤5 cm.
Disclosures: This study was supported by a Korea Medical Device Development Fund grant funded by the Korea government. The authors declared no conflicts of interest.
Source: Kim TH et al. Can “no-touch” radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol. 2022 (Jul 30). Doi: 10.1007/s00330-022-08991-1
Better survival among children vs adults with HCC likely attributed to more aggressive surgical management
Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.
Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P = .02) and comparable metastasis rates (30% vs 28%; P = .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).
Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).
Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.
Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi: 10.1002/ijc.34215
Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.
Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P = .02) and comparable metastasis rates (30% vs 28%; P = .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).
Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).
Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.
Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi: 10.1002/ijc.34215
Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.
Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P = .02) and comparable metastasis rates (30% vs 28%; P = .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).
Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).
Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.
Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi: 10.1002/ijc.34215
Recurrent HCC: Adjuvant sorafenib after RFA offers survival benefit over RFA alone
Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.
Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P = .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.
Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.
Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.
Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3
Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.
Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P = .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.
Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.
Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.
Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3
Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.
Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P = .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.
Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.
Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.
Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3
HBV-related HCC: Clinical outcomes of patients on anti-PD-1 therapy not compromised by HBV viral load
Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.
Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P = .59) or progression-free survival (aHR 0.68; P = .098).
Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.
Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.
Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w
Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.
Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P = .59) or progression-free survival (aHR 0.68; P = .098).
Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.
Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.
Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w
Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.
Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P = .59) or progression-free survival (aHR 0.68; P = .098).
Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.
Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.
Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w