The European Society for Medical Oncology (ESMO) has published a proposed scale that would rank molecular targets for various cancers by how well they can be treated with new or emerging drugs.

The ESMO Scale of Clinical Actionability for Molecular Targets is designed to “harmonize and standardize the reporting and interpretation of clinically relevant genomics data,” according to Joaquin Mateo, MD, PhD, from the Vall d’Hebron Institute of Oncology in Barcelona, Spain, and his fellow members of the ESMO Translational Research and Precision Medicine Working Group.

“A major challenge for oncologists in the clinic is to distinguish between findings that represent proven clinical value or potential value based on preliminary clinical or preclinical evidence from hypothetical gene-drug matches and findings that are currently irrelevant for clinical practice,” they wrote in Annals of Oncology.

The scale groups targets into one of six tiers based on levels of evidence ranging from the gold standard of prospective, randomized clinical trials to targets for which there are no evidence and only hypothetical actionability. The primary goal is to help oncologists assign priority to potential targets when they review results of gene-sequencing panels for individual patients, according to the developers.

Briefly, the six tiers are:

Tier I includes targets that are agreed to be suitable for routine use and a recommended specific drug when a specific molecular alteration is detected. Examples include trastuzumab for human epidermal growth factor receptor 2 (HER2)–positive breast cancer, and inhibitors of epidermal growth factor receptor (EGFR) in patients with non–small cell lung cancer positive for EGFR mutations.

Tier II includes “investigational targets that likely define a patient population that benefits from a targeted drug but additional data are needed.” This tier includes agents that work in the phosphatidylinostiol 3-kinase pathway.

Tier III is similar to Tier II, in that it includes investigational targets that define a patient population with proven benefit from a targeted therapy, but in this case the target is detected in a different tumor type that has not previously been studied. For example, the targeted agent vemurafenib (Zelboraf), which extends survival of patients with metastatic melanomas carrying the BRAF V600E mutation, has only limited activity against BRAF-mutated colorectal cancers.

Tier IV includes targets with preclinical evidence of actionability.

Tier V includes targets with “evidence of relevant antitumor activity, not resulting in clinical meaningful benefit as single treatment but supporting development of cotargeting approaches.” The authors cite the example of PIK3CA inhibitors in patients with estrogen receptor–positive, HER2-negative breast cancers who also have PIK3CA activating mutations. In clinical trials, this strategy led to objective responses but not change outcomes.

The final tier is not Tier VI, as might be expected, but Tier X, with the X in this case being the unknown – that is, alterations/mutations for which there is neither preclinical nor clinical evidence to support their hypothetical use as a drug target.

“This clinical benefit–centered classification system offers a common language for all the actors involved in clinical cancer drug development. Its implementation in sequencing reports, tumor boards, and scientific communication can enable precise treatment decisions and facilitate discussions with patients about novel therapeutic options,” Dr. Mateo and his associates wrote in their conclusion.

The development process was supported by ESMO. Multiple coauthors reported financial relationships with various companies as well as grants/support from other foundations or charities.

SOURCE: Mateo J et al. Ann Oncol. 2018 Aug 21. doi: 10.1093/annonc/mdy263.

The European Society for Medical Oncology (ESMO) has published a proposed scale that would rank molecular targets for various cancers by how well they can be treated with new or emerging drugs.

The ESMO Scale of Clinical Actionability for Molecular Targets is designed to “harmonize and standardize the reporting and interpretation of clinically relevant genomics data,” according to Joaquin Mateo, MD, PhD, from the Vall d’Hebron Institute of Oncology in Barcelona, Spain, and his fellow members of the ESMO Translational Research and Precision Medicine Working Group.

“A major challenge for oncologists in the clinic is to distinguish between findings that represent proven clinical value or potential value based on preliminary clinical or preclinical evidence from hypothetical gene-drug matches and findings that are currently irrelevant for clinical practice,” they wrote in Annals of Oncology.

The scale groups targets into one of six tiers based on levels of evidence ranging from the gold standard of prospective, randomized clinical trials to targets for which there are no evidence and only hypothetical actionability. The primary goal is to help oncologists assign priority to potential targets when they review results of gene-sequencing panels for individual patients, according to the developers.

Briefly, the six tiers are:

Tier I includes targets that are agreed to be suitable for routine use and a recommended specific drug when a specific molecular alteration is detected. Examples include trastuzumab for human epidermal growth factor receptor 2 (HER2)–positive breast cancer, and inhibitors of epidermal growth factor receptor (EGFR) in patients with non–small cell lung cancer positive for EGFR mutations.

Tier II includes “investigational targets that likely define a patient population that benefits from a targeted drug but additional data are needed.” This tier includes agents that work in the phosphatidylinostiol 3-kinase pathway.

Tier III is similar to Tier II, in that it includes investigational targets that define a patient population with proven benefit from a targeted therapy, but in this case the target is detected in a different tumor type that has not previously been studied. For example, the targeted agent vemurafenib (Zelboraf), which extends survival of patients with metastatic melanomas carrying the BRAF V600E mutation, has only limited activity against BRAF-mutated colorectal cancers.

Tier IV includes targets with preclinical evidence of actionability.

Tier V includes targets with “evidence of relevant antitumor activity, not resulting in clinical meaningful benefit as single treatment but supporting development of cotargeting approaches.” The authors cite the example of PIK3CA inhibitors in patients with estrogen receptor–positive, HER2-negative breast cancers who also have PIK3CA activating mutations. In clinical trials, this strategy led to objective responses but not change outcomes.

The final tier is not Tier VI, as might be expected, but Tier X, with the X in this case being the unknown – that is, alterations/mutations for which there is neither preclinical nor clinical evidence to support their hypothetical use as a drug target.

“This clinical benefit–centered classification system offers a common language for all the actors involved in clinical cancer drug development. Its implementation in sequencing reports, tumor boards, and scientific communication can enable precise treatment decisions and facilitate discussions with patients about novel therapeutic options,” Dr. Mateo and his associates wrote in their conclusion.

The development process was supported by ESMO. Multiple coauthors reported financial relationships with various companies as well as grants/support from other foundations or charities.

SOURCE: Mateo J et al. Ann Oncol. 2018 Aug 21. doi: 10.1093/annonc/mdy263.

The European Society for Medical Oncology (ESMO) has published a proposed scale that would rank molecular targets for various cancers by how well they can be treated with new or emerging drugs.

The ESMO Scale of Clinical Actionability for Molecular Targets is designed to “harmonize and standardize the reporting and interpretation of clinically relevant genomics data,” according to Joaquin Mateo, MD, PhD, from the Vall d’Hebron Institute of Oncology in Barcelona, Spain, and his fellow members of the ESMO Translational Research and Precision Medicine Working Group.

“A major challenge for oncologists in the clinic is to distinguish between findings that represent proven clinical value or potential value based on preliminary clinical or preclinical evidence from hypothetical gene-drug matches and findings that are currently irrelevant for clinical practice,” they wrote in Annals of Oncology.

The scale groups targets into one of six tiers based on levels of evidence ranging from the gold standard of prospective, randomized clinical trials to targets for which there are no evidence and only hypothetical actionability. The primary goal is to help oncologists assign priority to potential targets when they review results of gene-sequencing panels for individual patients, according to the developers.

Briefly, the six tiers are:

Tier I includes targets that are agreed to be suitable for routine use and a recommended specific drug when a specific molecular alteration is detected. Examples include trastuzumab for human epidermal growth factor receptor 2 (HER2)–positive breast cancer, and inhibitors of epidermal growth factor receptor (EGFR) in patients with non–small cell lung cancer positive for EGFR mutations.

Tier II includes “investigational targets that likely define a patient population that benefits from a targeted drug but additional data are needed.” This tier includes agents that work in the phosphatidylinostiol 3-kinase pathway.

Tier III is similar to Tier II, in that it includes investigational targets that define a patient population with proven benefit from a targeted therapy, but in this case the target is detected in a different tumor type that has not previously been studied. For example, the targeted agent vemurafenib (Zelboraf), which extends survival of patients with metastatic melanomas carrying the BRAF V600E mutation, has only limited activity against BRAF-mutated colorectal cancers.

Tier IV includes targets with preclinical evidence of actionability.

Tier V includes targets with “evidence of relevant antitumor activity, not resulting in clinical meaningful benefit as single treatment but supporting development of cotargeting approaches.” The authors cite the example of PIK3CA inhibitors in patients with estrogen receptor–positive, HER2-negative breast cancers who also have PIK3CA activating mutations. In clinical trials, this strategy led to objective responses but not change outcomes.

The final tier is not Tier VI, as might be expected, but Tier X, with the X in this case being the unknown – that is, alterations/mutations for which there is neither preclinical nor clinical evidence to support their hypothetical use as a drug target.

“This clinical benefit–centered classification system offers a common language for all the actors involved in clinical cancer drug development. Its implementation in sequencing reports, tumor boards, and scientific communication can enable precise treatment decisions and facilitate discussions with patients about novel therapeutic options,” Dr. Mateo and his associates wrote in their conclusion.

The development process was supported by ESMO. Multiple coauthors reported financial relationships with various companies as well as grants/support from other foundations or charities.

SOURCE: Mateo J et al. Ann Oncol. 2018 Aug 21. doi: 10.1093/annonc/mdy263.

Men who undergo MRI of the prostate around the time of a low-risk prostate cancer diagnosis are nearly twice as likely to be managed with active surveillance as are men who do not get MRI, investigators found.

roobcio/Thinkstock.com

The findings suggest that MRI at the time of diagnosis can enhance patient and physician confidence in the decision to choose active surveillance (AS) over immediate surgery or radiation therapy in men with low-risk disease, according to Michael S. Leapman, MD, and his colleagues from Yale University, New Haven, Conn.

“Despite initial high costs associated with obtaining and interpreting MRI studies of the prostate, economic modeling studies imply that MRI would be cost effective if it resulted in increased utilization of AS for low- and very-low-risk PCa [prostate cancer]. The association identified in our study between MRI use and initial observation may serve as an informative basis for examining strategies to improve the quality of PCa care with the anticipated growing use of this technology,” they wrote in Urology.

Although active surveillance is increasingly accepted as an initial management strategy for patients with low-risk (Gleason score 6 or less) localized prostate cancer, the majority of patients with low-risk disease still receive definitive treatment.

“Although longitudinal studies support the safety of AS, uncertainty about the possibility of underestimating an indvidual’s risk of harboring aggressive disease remains a strong motivator to treat,” Dr. Leapman and his associates noted.

To see whether MRI of the prostate may have an effect on the use of active surveillance in men with low-risk disease, the investigators reviewed records from the Surveillance, Epidemiology and End Results (SEER) Medicare database to identify men diagnosed with low-risk prostate cancer during 2010-2013.

They looked at the association between MRI and patient management (ascertained by claims) and evaluated clinical and demographic factors associated with the receipt of MRI.

They identified 8,144 patients with low-risk prostate cancer during the study period, of whom 495 (6.1%) had undergone MRI scans. They found that the use of MRI in patients with low-risk cancer increased from 3.4% in 2010 to 10.5% in 2013.

MRI was performed significantly more frequently among 3,060 patients who were managed with observation, with 265 (8.7%) receiving scans, compared with 230 (4.5%) of the 5,084 patients who underwent treatment within a year of diagnosis.

In multivariable analysis that controlled for demographics, factors significantly associated with increased likelihood of undergoing observation versus definitive therapy included MRI, white vs. nonwhite race, later years of diagnosis, higher income status (by ZIP code), unmarried vs. married, treatment region (more common in the West and Midwest versus Northeast or South), and in referral regions with higher population density of urologists.

In a propensity score–matched analysis designed to smooth out potential confounders, the investigators found that receipt of MRI around the time of diagnosis was associated with a significantly higher likelihood of active surveillance, with an odds ratio of 1.90 (95% confidence interval, 1.56-2.32).

“Efforts to facilitate observational approaches for low-risk PCa are highly valuable to improving the quality of cancer care. Because the use of prostate MRI has grown, and is likely to continue expanding, the cost-effectiveness of MRI-driven pathways are increasingly relevant to the sustainability of the practice,” the authors wrote.

SOURCE: Leapman MS et al. Urology. 2018 Aug 11. doi: 10.1016/j.urology.2018.07.041.

Men who undergo MRI of the prostate around the time of a low-risk prostate cancer diagnosis are nearly twice as likely to be managed with active surveillance as are men who do not get MRI, investigators found.

roobcio/Thinkstock.com

The findings suggest that MRI at the time of diagnosis can enhance patient and physician confidence in the decision to choose active surveillance (AS) over immediate surgery or radiation therapy in men with low-risk disease, according to Michael S. Leapman, MD, and his colleagues from Yale University, New Haven, Conn.

“Despite initial high costs associated with obtaining and interpreting MRI studies of the prostate, economic modeling studies imply that MRI would be cost effective if it resulted in increased utilization of AS for low- and very-low-risk PCa [prostate cancer]. The association identified in our study between MRI use and initial observation may serve as an informative basis for examining strategies to improve the quality of PCa care with the anticipated growing use of this technology,” they wrote in Urology.

Although active surveillance is increasingly accepted as an initial management strategy for patients with low-risk (Gleason score 6 or less) localized prostate cancer, the majority of patients with low-risk disease still receive definitive treatment.

“Although longitudinal studies support the safety of AS, uncertainty about the possibility of underestimating an indvidual’s risk of harboring aggressive disease remains a strong motivator to treat,” Dr. Leapman and his associates noted.

To see whether MRI of the prostate may have an effect on the use of active surveillance in men with low-risk disease, the investigators reviewed records from the Surveillance, Epidemiology and End Results (SEER) Medicare database to identify men diagnosed with low-risk prostate cancer during 2010-2013.

They looked at the association between MRI and patient management (ascertained by claims) and evaluated clinical and demographic factors associated with the receipt of MRI.

They identified 8,144 patients with low-risk prostate cancer during the study period, of whom 495 (6.1%) had undergone MRI scans. They found that the use of MRI in patients with low-risk cancer increased from 3.4% in 2010 to 10.5% in 2013.

MRI was performed significantly more frequently among 3,060 patients who were managed with observation, with 265 (8.7%) receiving scans, compared with 230 (4.5%) of the 5,084 patients who underwent treatment within a year of diagnosis.

In multivariable analysis that controlled for demographics, factors significantly associated with increased likelihood of undergoing observation versus definitive therapy included MRI, white vs. nonwhite race, later years of diagnosis, higher income status (by ZIP code), unmarried vs. married, treatment region (more common in the West and Midwest versus Northeast or South), and in referral regions with higher population density of urologists.

In a propensity score–matched analysis designed to smooth out potential confounders, the investigators found that receipt of MRI around the time of diagnosis was associated with a significantly higher likelihood of active surveillance, with an odds ratio of 1.90 (95% confidence interval, 1.56-2.32).

“Efforts to facilitate observational approaches for low-risk PCa are highly valuable to improving the quality of cancer care. Because the use of prostate MRI has grown, and is likely to continue expanding, the cost-effectiveness of MRI-driven pathways are increasingly relevant to the sustainability of the practice,” the authors wrote.

SOURCE: Leapman MS et al. Urology. 2018 Aug 11. doi: 10.1016/j.urology.2018.07.041.

Men who undergo MRI of the prostate around the time of a low-risk prostate cancer diagnosis are nearly twice as likely to be managed with active surveillance as are men who do not get MRI, investigators found.

roobcio/Thinkstock.com

The findings suggest that MRI at the time of diagnosis can enhance patient and physician confidence in the decision to choose active surveillance (AS) over immediate surgery or radiation therapy in men with low-risk disease, according to Michael S. Leapman, MD, and his colleagues from Yale University, New Haven, Conn.

“Despite initial high costs associated with obtaining and interpreting MRI studies of the prostate, economic modeling studies imply that MRI would be cost effective if it resulted in increased utilization of AS for low- and very-low-risk PCa [prostate cancer]. The association identified in our study between MRI use and initial observation may serve as an informative basis for examining strategies to improve the quality of PCa care with the anticipated growing use of this technology,” they wrote in Urology.

Although active surveillance is increasingly accepted as an initial management strategy for patients with low-risk (Gleason score 6 or less) localized prostate cancer, the majority of patients with low-risk disease still receive definitive treatment.

“Although longitudinal studies support the safety of AS, uncertainty about the possibility of underestimating an indvidual’s risk of harboring aggressive disease remains a strong motivator to treat,” Dr. Leapman and his associates noted.

To see whether MRI of the prostate may have an effect on the use of active surveillance in men with low-risk disease, the investigators reviewed records from the Surveillance, Epidemiology and End Results (SEER) Medicare database to identify men diagnosed with low-risk prostate cancer during 2010-2013.

They looked at the association between MRI and patient management (ascertained by claims) and evaluated clinical and demographic factors associated with the receipt of MRI.

They identified 8,144 patients with low-risk prostate cancer during the study period, of whom 495 (6.1%) had undergone MRI scans. They found that the use of MRI in patients with low-risk cancer increased from 3.4% in 2010 to 10.5% in 2013.

MRI was performed significantly more frequently among 3,060 patients who were managed with observation, with 265 (8.7%) receiving scans, compared with 230 (4.5%) of the 5,084 patients who underwent treatment within a year of diagnosis.

In multivariable analysis that controlled for demographics, factors significantly associated with increased likelihood of undergoing observation versus definitive therapy included MRI, white vs. nonwhite race, later years of diagnosis, higher income status (by ZIP code), unmarried vs. married, treatment region (more common in the West and Midwest versus Northeast or South), and in referral regions with higher population density of urologists.

In a propensity score–matched analysis designed to smooth out potential confounders, the investigators found that receipt of MRI around the time of diagnosis was associated with a significantly higher likelihood of active surveillance, with an odds ratio of 1.90 (95% confidence interval, 1.56-2.32).

“Efforts to facilitate observational approaches for low-risk PCa are highly valuable to improving the quality of cancer care. Because the use of prostate MRI has grown, and is likely to continue expanding, the cost-effectiveness of MRI-driven pathways are increasingly relevant to the sustainability of the practice,” the authors wrote.

SOURCE: Leapman MS et al. Urology. 2018 Aug 11. doi: 10.1016/j.urology.2018.07.041.

Rituximab plus lenalidomide had efficacy similar to that of rituximab plus chemotherapy in treatment of follicular lymphoma, according to results from a phase 3 trial.

Patho/Wikimedia Commons/CC BY-SA 3.0(http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

RELEVANCE (NCT01476787) was a multicenter, international, randomized, open-label trial designed to determine the superiority of rituximab/lenalidomide over rituximab/chemotherapy.

This trial randomized 1,030 patients with previously untreated follicular lymphoma to receive either rituximab plus lenalidomide (n = 513) or rituximab plus chemotherapy (n = 517) for 18 cycles; both groups then went on to receive rituximab maintenance therapy for 12 cycles. The total duration of treatment was 120 weeks. The median age of the combined groups was 59 years. The study was published in the New England Journal of Medicine.

One of the coprimary endpoints was complete response (confirmed or unconfirmed) by the end of the treatment period; the other was progression-free survival, which was planned to be assessed through three analyses, including two interim analyses, the first of which was reported in this study.

After a median follow-up of 37.9 months, the rates of coprimary endpoints were similar between the two groups. Complete response (confirmed or unconfirmed) was seen in 48% of the rituximab/lenalidomide group (95% confidence interval [CI], 44-53) and in 53% of the rituximab/chemotherapy group (95% CI, 49-57; P = .13). The hazard ratio for progression or death from any cause was 1.10 (95% CI, 0.85-1.43; P = .48).

In the subgroup analyses, the efficacy of rituximab plus chemotherapy was greater in low-risk patients (based on Follicular Lymphoma International Prognostic Index scores) and in patients whose follicular lymphoma was Ann Arbor stage I or II, whereas efficacy of rituximab/lenalidomide was independent of prognostic factors.

Safety was the biggest area of difference, with some events being more common in one group than in the other. For example, cutaneous reactions, diarrhea, rash, and myalgia were more common with rituximab/lenalidomide treatment, whereas anemia, fatigue, nausea, and febrile neutropenia were more common with rituximab/chemotherapy treatment. Among grade 3 or 4 events, cutaneous reactions were more common with rituximab/lenalidomide, and grade 3 or 4 neutropenia was more common with rituximab/chemotherapy.

“Overall, both treatment groups showed good outcomes, and a median has not yet been reached for either progression-free survival or overall survival,” the study authors wrote.

The RELEVANCE trial was sponsored by Celgene and the Lymphoma Academic Research Organisation. The study authors reported various disclosures, including financial ties to Celgene.

[email protected]

SOURCE: Morschhauser F et al. N Engl J Med. 2018;379:934-47.

Rituximab plus lenalidomide had efficacy similar to that of rituximab plus chemotherapy in treatment of follicular lymphoma, according to results from a phase 3 trial.

Patho/Wikimedia Commons/CC BY-SA 3.0(http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

RELEVANCE (NCT01476787) was a multicenter, international, randomized, open-label trial designed to determine the superiority of rituximab/lenalidomide over rituximab/chemotherapy.

This trial randomized 1,030 patients with previously untreated follicular lymphoma to receive either rituximab plus lenalidomide (n = 513) or rituximab plus chemotherapy (n = 517) for 18 cycles; both groups then went on to receive rituximab maintenance therapy for 12 cycles. The total duration of treatment was 120 weeks. The median age of the combined groups was 59 years. The study was published in the New England Journal of Medicine.

One of the coprimary endpoints was complete response (confirmed or unconfirmed) by the end of the treatment period; the other was progression-free survival, which was planned to be assessed through three analyses, including two interim analyses, the first of which was reported in this study.

After a median follow-up of 37.9 months, the rates of coprimary endpoints were similar between the two groups. Complete response (confirmed or unconfirmed) was seen in 48% of the rituximab/lenalidomide group (95% confidence interval [CI], 44-53) and in 53% of the rituximab/chemotherapy group (95% CI, 49-57; P = .13). The hazard ratio for progression or death from any cause was 1.10 (95% CI, 0.85-1.43; P = .48).

In the subgroup analyses, the efficacy of rituximab plus chemotherapy was greater in low-risk patients (based on Follicular Lymphoma International Prognostic Index scores) and in patients whose follicular lymphoma was Ann Arbor stage I or II, whereas efficacy of rituximab/lenalidomide was independent of prognostic factors.

Safety was the biggest area of difference, with some events being more common in one group than in the other. For example, cutaneous reactions, diarrhea, rash, and myalgia were more common with rituximab/lenalidomide treatment, whereas anemia, fatigue, nausea, and febrile neutropenia were more common with rituximab/chemotherapy treatment. Among grade 3 or 4 events, cutaneous reactions were more common with rituximab/lenalidomide, and grade 3 or 4 neutropenia was more common with rituximab/chemotherapy.

“Overall, both treatment groups showed good outcomes, and a median has not yet been reached for either progression-free survival or overall survival,” the study authors wrote.

The RELEVANCE trial was sponsored by Celgene and the Lymphoma Academic Research Organisation. The study authors reported various disclosures, including financial ties to Celgene.

[email protected]

SOURCE: Morschhauser F et al. N Engl J Med. 2018;379:934-47.

Rituximab plus lenalidomide had efficacy similar to that of rituximab plus chemotherapy in treatment of follicular lymphoma, according to results from a phase 3 trial.

Patho/Wikimedia Commons/CC BY-SA 3.0(http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

RELEVANCE (NCT01476787) was a multicenter, international, randomized, open-label trial designed to determine the superiority of rituximab/lenalidomide over rituximab/chemotherapy.

This trial randomized 1,030 patients with previously untreated follicular lymphoma to receive either rituximab plus lenalidomide (n = 513) or rituximab plus chemotherapy (n = 517) for 18 cycles; both groups then went on to receive rituximab maintenance therapy for 12 cycles. The total duration of treatment was 120 weeks. The median age of the combined groups was 59 years. The study was published in the New England Journal of Medicine.

One of the coprimary endpoints was complete response (confirmed or unconfirmed) by the end of the treatment period; the other was progression-free survival, which was planned to be assessed through three analyses, including two interim analyses, the first of which was reported in this study.

After a median follow-up of 37.9 months, the rates of coprimary endpoints were similar between the two groups. Complete response (confirmed or unconfirmed) was seen in 48% of the rituximab/lenalidomide group (95% confidence interval [CI], 44-53) and in 53% of the rituximab/chemotherapy group (95% CI, 49-57; P = .13). The hazard ratio for progression or death from any cause was 1.10 (95% CI, 0.85-1.43; P = .48).

In the subgroup analyses, the efficacy of rituximab plus chemotherapy was greater in low-risk patients (based on Follicular Lymphoma International Prognostic Index scores) and in patients whose follicular lymphoma was Ann Arbor stage I or II, whereas efficacy of rituximab/lenalidomide was independent of prognostic factors.

Safety was the biggest area of difference, with some events being more common in one group than in the other. For example, cutaneous reactions, diarrhea, rash, and myalgia were more common with rituximab/lenalidomide treatment, whereas anemia, fatigue, nausea, and febrile neutropenia were more common with rituximab/chemotherapy treatment. Among grade 3 or 4 events, cutaneous reactions were more common with rituximab/lenalidomide, and grade 3 or 4 neutropenia was more common with rituximab/chemotherapy.

“Overall, both treatment groups showed good outcomes, and a median has not yet been reached for either progression-free survival or overall survival,” the study authors wrote.

The RELEVANCE trial was sponsored by Celgene and the Lymphoma Academic Research Organisation. The study authors reported various disclosures, including financial ties to Celgene.

[email protected]

SOURCE: Morschhauser F et al. N Engl J Med. 2018;379:934-47.

Supreme Court justice nominee Brett Kavanaugh suggested precedent would guide his thinking when it comes to deliberating on any Roe v. Wade challenges, but he came short of saying that he would not support overturning the landmark abortion rights case.

Courtesy C-SPAN

Testifying Sept. 5 before the Senate Judiciary Committee during a confirmation hearing, Judge Kavanaugh noted that the decision of Roe v. Wade has been reaffirmed in follow-up cases, and that would play a significant role in his approach to future challenges.

Sen. Dianne Feinstein (D-Calif.), the ranking Democrat on the panel, asked Judge Kavanaugh if he agreed with Justice Sandra Day O’Connor that “a woman’s right to control her reproductive life impacts her ability to ‘participate equally in the economic and social life of the nation?’ ”

“As a general proposition, I understand the importance of the precedent set forth in Roe v. Wade,” Judge Kavanaugh replied. “So Roe v. Wade held, of course, and is reaffirmed in Planned Parenthood v. Casey, that a woman has a constitutional right to obtain an abortion before viability, subject to reasonable regulation by the state up to the point where that regulation constitutes an undue burden on the woman’s right to obtain an abortion. One of the reasons for that holding, as explained by the court in Roe and also in Planned Parenthood v. Casey more fully, is along the lines of what you said, Sen. Feinstein, about the quote from Justice O’Connor.”

He continued: “That’s one of the rationales that undergirds Roe v. Wade. It’s one of the rationales that undergirds Planned Parenthood v. Casey.”

Sen. Feinstein followed by noting reports quoting Judge Kavanaugh as saying Roe v. Wade was “settled law,” inquired what that term means, and asked for further clarification as to whether it was settled precedent and whether it could be overturned.

“Senator, I said that it’s settled as a precedent of the Supreme Court, entitled the respect of principles of stare decisis,” he responded, referencing the legal principle of determining points in litigation according to precedent. “One of the important things to keep in mind about Roe v. Wade is that it has been reaffirmed many times over the past 45 years, as you know, and most prominently, most importantly reaffirmed in Planned Parenthood v. Casey in 1992. And as you well recall, Senator, I know when that case came up, the Supreme Court didn’t just reaffirm it in passing, the court specifically went through all factors of stare decisis in considering whether to overrule it.”

He noted that the joint opinion of Justice Anthony Kennedy, Justice O’Connor, and Justice David Souter, went to “great length” to go through those factors.

Judge Kavanaugh called Planned Parenthood v. Casey a “precedent-on-precedent. It is not as if it’s just a run-of-the-mill case that was decided and never been reconsidered. Casey specifically reconsidered [Roe v. Wade], applied the stare decisis factors and decided to reaffirm it. That makes Casey precedent-on-precedent.”

That said, Judge Kavanaugh did not say outright that Row v. Wade would not be overturned because of these factors.

The first 2 days of Judge Kavanaugh’s confirmation hearing were frequently interrupted by protesters shouting objections to his nomination. At press time, more than 120 protesters had been arrested, according to the U.S. Capitol Police.

Health care did surface in questions about the Affordable Care Act and in specific the current legal action in Texas that is looking to kill the health care law, but Judge Kavanaugh declined to answer any questions surrounding it, stating that he did not want to prejudge any potential case that could come before him.

Much of the questioning he faced was more geared toward opinions on presidential powers, including whether presidents could avoid subpoenas and whether a president could pardon himself, but he declined to answer those questions because they are ones that could come before him given the current political environment.

Judge Kavanaugh painted himself as of independent thought, pushing back at those who are saying that he will serve to protect the president and act as his puppet on the bench, citing cases where he went against former President George W. Bush, for whom he served as White House staff secretary and who eventually was appointed him to the D.C. Circuit Court in May 2006.

[email protected]

Supreme Court justice nominee Brett Kavanaugh suggested precedent would guide his thinking when it comes to deliberating on any Roe v. Wade challenges, but he came short of saying that he would not support overturning the landmark abortion rights case.

Courtesy C-SPAN

Testifying Sept. 5 before the Senate Judiciary Committee during a confirmation hearing, Judge Kavanaugh noted that the decision of Roe v. Wade has been reaffirmed in follow-up cases, and that would play a significant role in his approach to future challenges.

Sen. Dianne Feinstein (D-Calif.), the ranking Democrat on the panel, asked Judge Kavanaugh if he agreed with Justice Sandra Day O’Connor that “a woman’s right to control her reproductive life impacts her ability to ‘participate equally in the economic and social life of the nation?’ ”

“As a general proposition, I understand the importance of the precedent set forth in Roe v. Wade,” Judge Kavanaugh replied. “So Roe v. Wade held, of course, and is reaffirmed in Planned Parenthood v. Casey, that a woman has a constitutional right to obtain an abortion before viability, subject to reasonable regulation by the state up to the point where that regulation constitutes an undue burden on the woman’s right to obtain an abortion. One of the reasons for that holding, as explained by the court in Roe and also in Planned Parenthood v. Casey more fully, is along the lines of what you said, Sen. Feinstein, about the quote from Justice O’Connor.”

He continued: “That’s one of the rationales that undergirds Roe v. Wade. It’s one of the rationales that undergirds Planned Parenthood v. Casey.”

Sen. Feinstein followed by noting reports quoting Judge Kavanaugh as saying Roe v. Wade was “settled law,” inquired what that term means, and asked for further clarification as to whether it was settled precedent and whether it could be overturned.

“Senator, I said that it’s settled as a precedent of the Supreme Court, entitled the respect of principles of stare decisis,” he responded, referencing the legal principle of determining points in litigation according to precedent. “One of the important things to keep in mind about Roe v. Wade is that it has been reaffirmed many times over the past 45 years, as you know, and most prominently, most importantly reaffirmed in Planned Parenthood v. Casey in 1992. And as you well recall, Senator, I know when that case came up, the Supreme Court didn’t just reaffirm it in passing, the court specifically went through all factors of stare decisis in considering whether to overrule it.”

He noted that the joint opinion of Justice Anthony Kennedy, Justice O’Connor, and Justice David Souter, went to “great length” to go through those factors.

Judge Kavanaugh called Planned Parenthood v. Casey a “precedent-on-precedent. It is not as if it’s just a run-of-the-mill case that was decided and never been reconsidered. Casey specifically reconsidered [Roe v. Wade], applied the stare decisis factors and decided to reaffirm it. That makes Casey precedent-on-precedent.”

That said, Judge Kavanaugh did not say outright that Row v. Wade would not be overturned because of these factors.

The first 2 days of Judge Kavanaugh’s confirmation hearing were frequently interrupted by protesters shouting objections to his nomination. At press time, more than 120 protesters had been arrested, according to the U.S. Capitol Police.

Health care did surface in questions about the Affordable Care Act and in specific the current legal action in Texas that is looking to kill the health care law, but Judge Kavanaugh declined to answer any questions surrounding it, stating that he did not want to prejudge any potential case that could come before him.

Much of the questioning he faced was more geared toward opinions on presidential powers, including whether presidents could avoid subpoenas and whether a president could pardon himself, but he declined to answer those questions because they are ones that could come before him given the current political environment.

Judge Kavanaugh painted himself as of independent thought, pushing back at those who are saying that he will serve to protect the president and act as his puppet on the bench, citing cases where he went against former President George W. Bush, for whom he served as White House staff secretary and who eventually was appointed him to the D.C. Circuit Court in May 2006.

[email protected]

Supreme Court justice nominee Brett Kavanaugh suggested precedent would guide his thinking when it comes to deliberating on any Roe v. Wade challenges, but he came short of saying that he would not support overturning the landmark abortion rights case.

Courtesy C-SPAN

Testifying Sept. 5 before the Senate Judiciary Committee during a confirmation hearing, Judge Kavanaugh noted that the decision of Roe v. Wade has been reaffirmed in follow-up cases, and that would play a significant role in his approach to future challenges.

Sen. Dianne Feinstein (D-Calif.), the ranking Democrat on the panel, asked Judge Kavanaugh if he agreed with Justice Sandra Day O’Connor that “a woman’s right to control her reproductive life impacts her ability to ‘participate equally in the economic and social life of the nation?’ ”

“As a general proposition, I understand the importance of the precedent set forth in Roe v. Wade,” Judge Kavanaugh replied. “So Roe v. Wade held, of course, and is reaffirmed in Planned Parenthood v. Casey, that a woman has a constitutional right to obtain an abortion before viability, subject to reasonable regulation by the state up to the point where that regulation constitutes an undue burden on the woman’s right to obtain an abortion. One of the reasons for that holding, as explained by the court in Roe and also in Planned Parenthood v. Casey more fully, is along the lines of what you said, Sen. Feinstein, about the quote from Justice O’Connor.”

He continued: “That’s one of the rationales that undergirds Roe v. Wade. It’s one of the rationales that undergirds Planned Parenthood v. Casey.”

Sen. Feinstein followed by noting reports quoting Judge Kavanaugh as saying Roe v. Wade was “settled law,” inquired what that term means, and asked for further clarification as to whether it was settled precedent and whether it could be overturned.

“Senator, I said that it’s settled as a precedent of the Supreme Court, entitled the respect of principles of stare decisis,” he responded, referencing the legal principle of determining points in litigation according to precedent. “One of the important things to keep in mind about Roe v. Wade is that it has been reaffirmed many times over the past 45 years, as you know, and most prominently, most importantly reaffirmed in Planned Parenthood v. Casey in 1992. And as you well recall, Senator, I know when that case came up, the Supreme Court didn’t just reaffirm it in passing, the court specifically went through all factors of stare decisis in considering whether to overrule it.”

He noted that the joint opinion of Justice Anthony Kennedy, Justice O’Connor, and Justice David Souter, went to “great length” to go through those factors.

Judge Kavanaugh called Planned Parenthood v. Casey a “precedent-on-precedent. It is not as if it’s just a run-of-the-mill case that was decided and never been reconsidered. Casey specifically reconsidered [Roe v. Wade], applied the stare decisis factors and decided to reaffirm it. That makes Casey precedent-on-precedent.”

That said, Judge Kavanaugh did not say outright that Row v. Wade would not be overturned because of these factors.

The first 2 days of Judge Kavanaugh’s confirmation hearing were frequently interrupted by protesters shouting objections to his nomination. At press time, more than 120 protesters had been arrested, according to the U.S. Capitol Police.

Health care did surface in questions about the Affordable Care Act and in specific the current legal action in Texas that is looking to kill the health care law, but Judge Kavanaugh declined to answer any questions surrounding it, stating that he did not want to prejudge any potential case that could come before him.

Much of the questioning he faced was more geared toward opinions on presidential powers, including whether presidents could avoid subpoenas and whether a president could pardon himself, but he declined to answer those questions because they are ones that could come before him given the current political environment.

Judge Kavanaugh painted himself as of independent thought, pushing back at those who are saying that he will serve to protect the president and act as his puppet on the bench, citing cases where he went against former President George W. Bush, for whom he served as White House staff secretary and who eventually was appointed him to the D.C. Circuit Court in May 2006.

[email protected]

Maryland is alone at the top of the rheumatology care class, but the number of failing states is even smaller, according to the American College of Rheumatology.

Maryland was the only state to earn an A on the “Rheumatic Disease Report Card,” and while no state failed, two – Alabama and Oklahoma – did receive Ds. Among the 47 other states and the District of Columbia, there were 14 Bs and 34 Cs.

Maryland posted strong scores in all three of the report card’s broad categories of care: 38.25 out of 50 points (third among all states) for access, 35 out of 50 (tied for first with New York) for affordability, and 40 out of 50 (tied for ninth) for activity/lifestyle. Arkansas had the highest score (42.25) for access and Nebraska got 50 out of 50 for activity/lifestyle. Inferiority, however, turned out to be a lot more widespread, as eight states were tied for the low of 10 points in the access category, 26 states got a 0 for affordability, and six states earned 15 points for activity/lifestyle, the ACR said.

Arkansas’s high marks for access were based primarily on “state lawmakers’ recent efforts to address [pharmacy benefit manager] transparency by enacting legislation that should serve as a model for future action in other states looking to address this issue,” ACR officials said in a statement. Nebraska did well in both of the measures used in the activity/lifestyle category – age-adjusted prevalence of arthritis attributable activity limitations among adults and percent of adults who are physically inactive; it also did well because it is home to at least one YMCA-sponsored and one National Recreation and Park Association–sponsored arthritis intervention program funded in part by the Centers for Disease Control and Prevention.

Patients across the country face a shortage of rheumatologists, the ACR noted, and the situation is expected to get worse in the coming years as demand increases and supply decreases. The college’s projections show that almost 6,800 rheumatologists will be needed by 2020 but less than 4,500 will be available, and by 2030 the demand will rise to need for almost 8,200 rheumatologists, while supply is expected to drop below 3,500, according to the report.

“We are at a critical juncture in rheumatology care. The rheumatology workforce is not growing fast enough to keep up with demand and too many of our patients struggle to access and afford the breakthrough therapies they need to manage pain and avoid long-term disability,” ACR President David Daikh, MD, PhD wrote in the report.

[email protected]

Maryland is alone at the top of the rheumatology care class, but the number of failing states is even smaller, according to the American College of Rheumatology.

Maryland was the only state to earn an A on the “Rheumatic Disease Report Card,” and while no state failed, two – Alabama and Oklahoma – did receive Ds. Among the 47 other states and the District of Columbia, there were 14 Bs and 34 Cs.

Maryland posted strong scores in all three of the report card’s broad categories of care: 38.25 out of 50 points (third among all states) for access, 35 out of 50 (tied for first with New York) for affordability, and 40 out of 50 (tied for ninth) for activity/lifestyle. Arkansas had the highest score (42.25) for access and Nebraska got 50 out of 50 for activity/lifestyle. Inferiority, however, turned out to be a lot more widespread, as eight states were tied for the low of 10 points in the access category, 26 states got a 0 for affordability, and six states earned 15 points for activity/lifestyle, the ACR said.

Arkansas’s high marks for access were based primarily on “state lawmakers’ recent efforts to address [pharmacy benefit manager] transparency by enacting legislation that should serve as a model for future action in other states looking to address this issue,” ACR officials said in a statement. Nebraska did well in both of the measures used in the activity/lifestyle category – age-adjusted prevalence of arthritis attributable activity limitations among adults and percent of adults who are physically inactive; it also did well because it is home to at least one YMCA-sponsored and one National Recreation and Park Association–sponsored arthritis intervention program funded in part by the Centers for Disease Control and Prevention.

Patients across the country face a shortage of rheumatologists, the ACR noted, and the situation is expected to get worse in the coming years as demand increases and supply decreases. The college’s projections show that almost 6,800 rheumatologists will be needed by 2020 but less than 4,500 will be available, and by 2030 the demand will rise to need for almost 8,200 rheumatologists, while supply is expected to drop below 3,500, according to the report.

“We are at a critical juncture in rheumatology care. The rheumatology workforce is not growing fast enough to keep up with demand and too many of our patients struggle to access and afford the breakthrough therapies they need to manage pain and avoid long-term disability,” ACR President David Daikh, MD, PhD wrote in the report.

[email protected]

Maryland is alone at the top of the rheumatology care class, but the number of failing states is even smaller, according to the American College of Rheumatology.

Maryland was the only state to earn an A on the “Rheumatic Disease Report Card,” and while no state failed, two – Alabama and Oklahoma – did receive Ds. Among the 47 other states and the District of Columbia, there were 14 Bs and 34 Cs.

Maryland posted strong scores in all three of the report card’s broad categories of care: 38.25 out of 50 points (third among all states) for access, 35 out of 50 (tied for first with New York) for affordability, and 40 out of 50 (tied for ninth) for activity/lifestyle. Arkansas had the highest score (42.25) for access and Nebraska got 50 out of 50 for activity/lifestyle. Inferiority, however, turned out to be a lot more widespread, as eight states were tied for the low of 10 points in the access category, 26 states got a 0 for affordability, and six states earned 15 points for activity/lifestyle, the ACR said.

Arkansas’s high marks for access were based primarily on “state lawmakers’ recent efforts to address [pharmacy benefit manager] transparency by enacting legislation that should serve as a model for future action in other states looking to address this issue,” ACR officials said in a statement. Nebraska did well in both of the measures used in the activity/lifestyle category – age-adjusted prevalence of arthritis attributable activity limitations among adults and percent of adults who are physically inactive; it also did well because it is home to at least one YMCA-sponsored and one National Recreation and Park Association–sponsored arthritis intervention program funded in part by the Centers for Disease Control and Prevention.

Patients across the country face a shortage of rheumatologists, the ACR noted, and the situation is expected to get worse in the coming years as demand increases and supply decreases. The college’s projections show that almost 6,800 rheumatologists will be needed by 2020 but less than 4,500 will be available, and by 2030 the demand will rise to need for almost 8,200 rheumatologists, while supply is expected to drop below 3,500, according to the report.

“We are at a critical juncture in rheumatology care. The rheumatology workforce is not growing fast enough to keep up with demand and too many of our patients struggle to access and afford the breakthrough therapies they need to manage pain and avoid long-term disability,” ACR President David Daikh, MD, PhD wrote in the report.

[email protected]

Children born from assisted reproductive technologies such as in vitro fertilization and intracytoplasmic sperm injection may be at risk of developing arterial hypertension due to premature vascular aging, according to a study published in the Journal of the American College of Cardiology.

©ktsimage/iStockphoto.com

In a previous study, Emrush Rexhaj, MD, director of arterial hypertension and altitude medicine at Inselspital, University Hospital, Bern, Switzerland, and his colleagues assessed vascular function in participants who were born with assisted reproductive technology (ART) such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI); the investigators found vascular dysfunction in this patient population not “related to parental factors but to the ART procedure itself,” they said.

Dr. Rexhaj and his colleagues then reassessed vascular function in 54 participants (mean age 16.5 years old) who returned from the previous study 5 years after the initial assessment and compared the results with 43 matched patients in a control group (mean age, 17.4 years). There were no significant differences regarding body mass index, lipid, creatinine, electrolyte plasma concentrations, high-sensitive C-reactive protein, birth weight, and gestational age between children in either group, as well as no significant differences in maternal BMI, cardiovascular risk profile, and smoking status.

The investigators – with Théo A. Meister, MD, also of the university, as a joint lead author with Dr. Rexhaj – performed blinded endothelium-dependent and endothelium­-independent vasodilation of the brachial artery in a supine position at room temperature and after 15 minutes of rest. They also measured carotid intima-media thickness (IMT), large artery stiffness, 24-hour ambulatory blood pressure monitoring, and short-term blood pressure variability.

“It only took five years for differences in arterial blood pressure to show,” Dr. Rexhaj stated in a press release. “This is a rapidly growing population and apparently healthy children are showing serious signs of concern for early cardiovascular risk, especially when it comes to arterial hypertension.”

Specifically, there was an approximately 25% reduction in flow-mediated dilation in the ART group (7%) compared with the control group (9%), which the investigators attributed to endothelial dysfunction (P less than .001). In ART patients, carotid IMT (463 mm) and carotid pulse-wave velocity (7.7 m/s) was significantly increased, compared with carotid IMT (435 mm; P less than .01) and pulse-wave velocity (7.2 m/s; P equals .033) in the control group.

With regard to arterial hypertension, 24-hour systolic blood pressure in the ART group (120 mm Hg) was “markedly” higher than in the control group (116 mm Hg; P equals .02); 24-hour diastolic blood pressure was also significantly higher in the ART group (71 mm Hg) compared with the control group (69 mm Hg; P equals .03). Investigators noted 8 of the 52 patients (15%) in the ART group met clinical criteria for arterial hypertension according to ambulatory blood pressure monitoring, compared with 1 of the 40 patients (2%) in the control group.

“The increased prevalence of arterial hypertension in ART participants is what is most concerning,” Dr. Rexhaj stated in the release. “There is growing evidence that ART alters the blood vessels in children, but the long-term consequences were not known. We now know that this places ART children at a six times higher rate of hypertension than children conceived naturally.”

The investigators cited as a limitation the fact that they studied only children born from singleton births recruited from a single center, which may have a lower cardiovascular risk profile than other patient populations.

This study was supported by the Swiss National Science Foundation, the Placide Nicod Foundation, the Swiss Society of Hypertension, the Swiss Society of Cardiology and Mach-Gaensslen Stiftung (Schweiz). The authors reported no conflicts of interest.
 

SOURCE: Meister TA et al. J Am Coll Cardiol. 2018 Sep 3. doi: 10.1016/j.jacc.2018.06.060.

Children born from assisted reproductive technologies such as in vitro fertilization and intracytoplasmic sperm injection may be at risk of developing arterial hypertension due to premature vascular aging, according to a study published in the Journal of the American College of Cardiology.

©ktsimage/iStockphoto.com

In a previous study, Emrush Rexhaj, MD, director of arterial hypertension and altitude medicine at Inselspital, University Hospital, Bern, Switzerland, and his colleagues assessed vascular function in participants who were born with assisted reproductive technology (ART) such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI); the investigators found vascular dysfunction in this patient population not “related to parental factors but to the ART procedure itself,” they said.

Dr. Rexhaj and his colleagues then reassessed vascular function in 54 participants (mean age 16.5 years old) who returned from the previous study 5 years after the initial assessment and compared the results with 43 matched patients in a control group (mean age, 17.4 years). There were no significant differences regarding body mass index, lipid, creatinine, electrolyte plasma concentrations, high-sensitive C-reactive protein, birth weight, and gestational age between children in either group, as well as no significant differences in maternal BMI, cardiovascular risk profile, and smoking status.

The investigators – with Théo A. Meister, MD, also of the university, as a joint lead author with Dr. Rexhaj – performed blinded endothelium-dependent and endothelium­-independent vasodilation of the brachial artery in a supine position at room temperature and after 15 minutes of rest. They also measured carotid intima-media thickness (IMT), large artery stiffness, 24-hour ambulatory blood pressure monitoring, and short-term blood pressure variability.

“It only took five years for differences in arterial blood pressure to show,” Dr. Rexhaj stated in a press release. “This is a rapidly growing population and apparently healthy children are showing serious signs of concern for early cardiovascular risk, especially when it comes to arterial hypertension.”

Specifically, there was an approximately 25% reduction in flow-mediated dilation in the ART group (7%) compared with the control group (9%), which the investigators attributed to endothelial dysfunction (P less than .001). In ART patients, carotid IMT (463 mm) and carotid pulse-wave velocity (7.7 m/s) was significantly increased, compared with carotid IMT (435 mm; P less than .01) and pulse-wave velocity (7.2 m/s; P equals .033) in the control group.

With regard to arterial hypertension, 24-hour systolic blood pressure in the ART group (120 mm Hg) was “markedly” higher than in the control group (116 mm Hg; P equals .02); 24-hour diastolic blood pressure was also significantly higher in the ART group (71 mm Hg) compared with the control group (69 mm Hg; P equals .03). Investigators noted 8 of the 52 patients (15%) in the ART group met clinical criteria for arterial hypertension according to ambulatory blood pressure monitoring, compared with 1 of the 40 patients (2%) in the control group.

“The increased prevalence of arterial hypertension in ART participants is what is most concerning,” Dr. Rexhaj stated in the release. “There is growing evidence that ART alters the blood vessels in children, but the long-term consequences were not known. We now know that this places ART children at a six times higher rate of hypertension than children conceived naturally.”

The investigators cited as a limitation the fact that they studied only children born from singleton births recruited from a single center, which may have a lower cardiovascular risk profile than other patient populations.

This study was supported by the Swiss National Science Foundation, the Placide Nicod Foundation, the Swiss Society of Hypertension, the Swiss Society of Cardiology and Mach-Gaensslen Stiftung (Schweiz). The authors reported no conflicts of interest.
 

SOURCE: Meister TA et al. J Am Coll Cardiol. 2018 Sep 3. doi: 10.1016/j.jacc.2018.06.060.

Children born from assisted reproductive technologies such as in vitro fertilization and intracytoplasmic sperm injection may be at risk of developing arterial hypertension due to premature vascular aging, according to a study published in the Journal of the American College of Cardiology.

©ktsimage/iStockphoto.com

In a previous study, Emrush Rexhaj, MD, director of arterial hypertension and altitude medicine at Inselspital, University Hospital, Bern, Switzerland, and his colleagues assessed vascular function in participants who were born with assisted reproductive technology (ART) such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI); the investigators found vascular dysfunction in this patient population not “related to parental factors but to the ART procedure itself,” they said.

Dr. Rexhaj and his colleagues then reassessed vascular function in 54 participants (mean age 16.5 years old) who returned from the previous study 5 years after the initial assessment and compared the results with 43 matched patients in a control group (mean age, 17.4 years). There were no significant differences regarding body mass index, lipid, creatinine, electrolyte plasma concentrations, high-sensitive C-reactive protein, birth weight, and gestational age between children in either group, as well as no significant differences in maternal BMI, cardiovascular risk profile, and smoking status.

The investigators – with Théo A. Meister, MD, also of the university, as a joint lead author with Dr. Rexhaj – performed blinded endothelium-dependent and endothelium­-independent vasodilation of the brachial artery in a supine position at room temperature and after 15 minutes of rest. They also measured carotid intima-media thickness (IMT), large artery stiffness, 24-hour ambulatory blood pressure monitoring, and short-term blood pressure variability.

“It only took five years for differences in arterial blood pressure to show,” Dr. Rexhaj stated in a press release. “This is a rapidly growing population and apparently healthy children are showing serious signs of concern for early cardiovascular risk, especially when it comes to arterial hypertension.”

Specifically, there was an approximately 25% reduction in flow-mediated dilation in the ART group (7%) compared with the control group (9%), which the investigators attributed to endothelial dysfunction (P less than .001). In ART patients, carotid IMT (463 mm) and carotid pulse-wave velocity (7.7 m/s) was significantly increased, compared with carotid IMT (435 mm; P less than .01) and pulse-wave velocity (7.2 m/s; P equals .033) in the control group.

With regard to arterial hypertension, 24-hour systolic blood pressure in the ART group (120 mm Hg) was “markedly” higher than in the control group (116 mm Hg; P equals .02); 24-hour diastolic blood pressure was also significantly higher in the ART group (71 mm Hg) compared with the control group (69 mm Hg; P equals .03). Investigators noted 8 of the 52 patients (15%) in the ART group met clinical criteria for arterial hypertension according to ambulatory blood pressure monitoring, compared with 1 of the 40 patients (2%) in the control group.

“The increased prevalence of arterial hypertension in ART participants is what is most concerning,” Dr. Rexhaj stated in the release. “There is growing evidence that ART alters the blood vessels in children, but the long-term consequences were not known. We now know that this places ART children at a six times higher rate of hypertension than children conceived naturally.”

The investigators cited as a limitation the fact that they studied only children born from singleton births recruited from a single center, which may have a lower cardiovascular risk profile than other patient populations.

This study was supported by the Swiss National Science Foundation, the Placide Nicod Foundation, the Swiss Society of Hypertension, the Swiss Society of Cardiology and Mach-Gaensslen Stiftung (Schweiz). The authors reported no conflicts of interest.
 

SOURCE: Meister TA et al. J Am Coll Cardiol. 2018 Sep 3. doi: 10.1016/j.jacc.2018.06.060.

Clinical question: Can aromatherapy with isopropyl alcohol confer an adjunctive and lasting benefit as an antiemetic in ED patients who do not otherwise need IV access?

Background: Prior studies have shown a benefit of aromatherapy with isopropyl alcohol for postoperative nausea and vomiting, and it is both widely available and safe. Only one randomized, controlled study exists documenting use of aromatherapy with isopropyl alcohol in the ED, but this monitored for effects for only 10 minutes and did not compare it with other antiemetic therapies used in the emergency department.

Study design: Randomized, double-blinded, placebo-controlled trial.

Setting: Single urban tertiary care center emergency department.

Synopsis: The study separated 120 patients with nausea who did not otherwise need intravenous access into three treatment groups. They were assessed for improvement in nausea using a visual analog scale 30 minutes after administration of either oral ondansetron 4 mg and inhaled isopropyl alcohol, oral placebo and inhaled isopropyl alcohol, or oral ondansetron and inhaled saline. The mean decrease in nausea visual analog scale score was 30 mm (95% confidence interval, 22-37 mm), 32 mm (95% CI, 25-39 mm), and 9 mm (95% CI, 5-14 mm), respectively. The need for rescue antiemetics was 27.5%, 25%, and 45%, respectively. This study is limited by its small size, its relatively healthy population with a predominant diagnosis of gastroenteritis, and that patients who required IV catheters were excluded; therefore, it may not be generalizable to sicker patients with alternative etiologies for nausea. Furthermore, many patients were able to distinguish isopropyl alcohol from placebo inhalant by smell so the blinding was possibly ineffective. However, since isopropyl alcohol is low risk, inexpensive, and readily available, it may be reasonable to consider this as a therapeutic option for some patients.

Bottom line: In ED patients who did not otherwise need intravenous access, aromatherapy with inhaled isopropyl alcohol alone or with ondansetron was superior for nausea relief when compared with ondansetron alone.

Citation: April MD et al. Aromatherapy versus oral ondansetron for antiemetic therapy among adult emergency department patients: A randomized controlled trial. Ann Emerg Med. 2018 Feb 17. doi: 10.1016/j.annemergmed.2018.01.016.
 

Dr. Sayers is an assistant professor in the division of hospital medicine at the University of Kentucky, Lexington.

Clinical question: Can aromatherapy with isopropyl alcohol confer an adjunctive and lasting benefit as an antiemetic in ED patients who do not otherwise need IV access?

Background: Prior studies have shown a benefit of aromatherapy with isopropyl alcohol for postoperative nausea and vomiting, and it is both widely available and safe. Only one randomized, controlled study exists documenting use of aromatherapy with isopropyl alcohol in the ED, but this monitored for effects for only 10 minutes and did not compare it with other antiemetic therapies used in the emergency department.

Study design: Randomized, double-blinded, placebo-controlled trial.

Setting: Single urban tertiary care center emergency department.

Synopsis: The study separated 120 patients with nausea who did not otherwise need intravenous access into three treatment groups. They were assessed for improvement in nausea using a visual analog scale 30 minutes after administration of either oral ondansetron 4 mg and inhaled isopropyl alcohol, oral placebo and inhaled isopropyl alcohol, or oral ondansetron and inhaled saline. The mean decrease in nausea visual analog scale score was 30 mm (95% confidence interval, 22-37 mm), 32 mm (95% CI, 25-39 mm), and 9 mm (95% CI, 5-14 mm), respectively. The need for rescue antiemetics was 27.5%, 25%, and 45%, respectively. This study is limited by its small size, its relatively healthy population with a predominant diagnosis of gastroenteritis, and that patients who required IV catheters were excluded; therefore, it may not be generalizable to sicker patients with alternative etiologies for nausea. Furthermore, many patients were able to distinguish isopropyl alcohol from placebo inhalant by smell so the blinding was possibly ineffective. However, since isopropyl alcohol is low risk, inexpensive, and readily available, it may be reasonable to consider this as a therapeutic option for some patients.

Bottom line: In ED patients who did not otherwise need intravenous access, aromatherapy with inhaled isopropyl alcohol alone or with ondansetron was superior for nausea relief when compared with ondansetron alone.

Citation: April MD et al. Aromatherapy versus oral ondansetron for antiemetic therapy among adult emergency department patients: A randomized controlled trial. Ann Emerg Med. 2018 Feb 17. doi: 10.1016/j.annemergmed.2018.01.016.
 

Dr. Sayers is an assistant professor in the division of hospital medicine at the University of Kentucky, Lexington.

Clinical question: Can aromatherapy with isopropyl alcohol confer an adjunctive and lasting benefit as an antiemetic in ED patients who do not otherwise need IV access?

Background: Prior studies have shown a benefit of aromatherapy with isopropyl alcohol for postoperative nausea and vomiting, and it is both widely available and safe. Only one randomized, controlled study exists documenting use of aromatherapy with isopropyl alcohol in the ED, but this monitored for effects for only 10 minutes and did not compare it with other antiemetic therapies used in the emergency department.

Study design: Randomized, double-blinded, placebo-controlled trial.

Setting: Single urban tertiary care center emergency department.

Synopsis: The study separated 120 patients with nausea who did not otherwise need intravenous access into three treatment groups. They were assessed for improvement in nausea using a visual analog scale 30 minutes after administration of either oral ondansetron 4 mg and inhaled isopropyl alcohol, oral placebo and inhaled isopropyl alcohol, or oral ondansetron and inhaled saline. The mean decrease in nausea visual analog scale score was 30 mm (95% confidence interval, 22-37 mm), 32 mm (95% CI, 25-39 mm), and 9 mm (95% CI, 5-14 mm), respectively. The need for rescue antiemetics was 27.5%, 25%, and 45%, respectively. This study is limited by its small size, its relatively healthy population with a predominant diagnosis of gastroenteritis, and that patients who required IV catheters were excluded; therefore, it may not be generalizable to sicker patients with alternative etiologies for nausea. Furthermore, many patients were able to distinguish isopropyl alcohol from placebo inhalant by smell so the blinding was possibly ineffective. However, since isopropyl alcohol is low risk, inexpensive, and readily available, it may be reasonable to consider this as a therapeutic option for some patients.

Bottom line: In ED patients who did not otherwise need intravenous access, aromatherapy with inhaled isopropyl alcohol alone or with ondansetron was superior for nausea relief when compared with ondansetron alone.

Citation: April MD et al. Aromatherapy versus oral ondansetron for antiemetic therapy among adult emergency department patients: A randomized controlled trial. Ann Emerg Med. 2018 Feb 17. doi: 10.1016/j.annemergmed.2018.01.016.
 

Dr. Sayers is an assistant professor in the division of hospital medicine at the University of Kentucky, Lexington.

The majority of adults with childhood-onset systemic lupus erythematosus in a longitudinal Dutch study developed significant damage at a young age, remain on corticosteroids in adulthood, and have an impaired health-related quality of life.

Courtesy Wikimedia Commons/doktorinternet/Creative Commons License

The findings in the study, dubbed Childhood-Onset SLE in the Netherlands (CHILL-NL), highlighted the need for preventive screening measures to be put in place before the age of 30 to facilitate a better outcome for patients, who still face high morbidity from childhood-onset systemic lupus erythematosus (cSLE) despite improved survival. Such information is helpful to “answer questions from children and parents regarding the future course of the disease,” wrote Noortje Groot, PhD, of the department of pediatric rheumatology at Erasmus Medical Center–Sophia Children’s Hospital in Rotterdam, the Netherlands, and her colleagues. The report is in Arthritis & Rheumatology.

The current study included all adult SLE patients treated in any Dutch public hospital during the period of November 2013 to April 2016 who were diagnosed with the autoimmune disease prior to their 18th birthday.

All 111 patients involved in the study were seen for a 1.5-hour visit at Erasmus University Medical Center or a local hospital of their choice. During the appointment, a medical history was taken, a physical examination was performed, and the patients completed questionnaires on health-related quality of life (HRQOL).

The average age of patients at the study visit was 33 years, 91% were female, and 72% were white. Median disease duration was 20 years and disease activity was low (median SLE Disease Activity Index 2000 [SLEDAI-2k] = 4). Low complement (32%), skin rashes (14%), and proteinuria (13%) were the most common SLEDAI items reported.

Overall, 68% of the cohort (n = 76) were taking hydroxychloroquine (HCQ), 29% of whom (n = 22) were taking it as monotherapy.

Furthermore, 68% of patients at the study visit were taking corticosteroids and/or non-HCQ disease-modifying antirheumatic drugs (DMARDs), and just over half (51%) of patients (n = 56) were taking corticosteroids either alone or with a non-HCQ DMARD.

“This [finding] is worrying as corticosteroids are associated with the development of damage. Patients are certainly eager to limit corticosteroid use, as almost all patients in the CHILL-NL cohort reported to have negative experiences with prednisone regarding their physical appearance and or mental well-being,” the study authors wrote.

Results also showed that 62% of the patients had damage, predominantly in the musculoskeletal, neuropsychiatric, and renal systems.

Most organ systems became involved within the first 2 years of diagnosis, but after 5 years of disease the nature of disease manifestations tended to shift to damage such as myocardial infarctions.

Notably, after 10-20 years, when cSLE patients were in their early 20s and 30s, significant damage had occurred in more than half of the patients, the authors noted.

“This shift to damage has also been observed in adult-onset SLE patients and urges for preventative screening measures of such (cardiovascular) damage and healthy lifestyle advice (healthy diet, regular exercise, abstinence from smoking),” they wrote.

Multivariate logistic regression showed that damage accrual was associated with disease duration (odds ratio, 1.15; P less than .001), antiphospholipid‐antibody positivity (OR, 3.56; P = .026), and hypertension (OR, 3.21; P = .043). On the other hand, current HCQ monotherapy was associated with an SLICC-Damage Index score of 0 (OR, 0.16; P = .009).

The HRQOL of the cohort, assessed via the Short Form–36, was also impaired compared with the general population, the researchers discovered. For example, the presence of damage reduced HRQOL in one domain, and high disease activity, defined as SLEDAI-2k of 8 or more, strongly reduced HRQOL in four of eight domains. Changes in physical appearance lowered HRQOL in seven of eight domains.

“HRQOL of adults with cSLE is impaired and affected by other factors than disease activity or damage alone. By identifying and addressing these factors, like physical appearance and potentially coping styles, HRQOL may be improved,” they advised.

The study was supported financially by the Dutch Arthritis Foundation and the Dutch national patient association for lupus, antiphospholipid syndrome, scleroderma, and mixed connective tissue diseases.

SOURCE: Groot N et al. Arthritis Rheumatol. 2018 Aug 27. doi: 10.1002/art.40697

The majority of adults with childhood-onset systemic lupus erythematosus in a longitudinal Dutch study developed significant damage at a young age, remain on corticosteroids in adulthood, and have an impaired health-related quality of life.

Courtesy Wikimedia Commons/doktorinternet/Creative Commons License

The findings in the study, dubbed Childhood-Onset SLE in the Netherlands (CHILL-NL), highlighted the need for preventive screening measures to be put in place before the age of 30 to facilitate a better outcome for patients, who still face high morbidity from childhood-onset systemic lupus erythematosus (cSLE) despite improved survival. Such information is helpful to “answer questions from children and parents regarding the future course of the disease,” wrote Noortje Groot, PhD, of the department of pediatric rheumatology at Erasmus Medical Center–Sophia Children’s Hospital in Rotterdam, the Netherlands, and her colleagues. The report is in Arthritis & Rheumatology.

The current study included all adult SLE patients treated in any Dutch public hospital during the period of November 2013 to April 2016 who were diagnosed with the autoimmune disease prior to their 18th birthday.

All 111 patients involved in the study were seen for a 1.5-hour visit at Erasmus University Medical Center or a local hospital of their choice. During the appointment, a medical history was taken, a physical examination was performed, and the patients completed questionnaires on health-related quality of life (HRQOL).

The average age of patients at the study visit was 33 years, 91% were female, and 72% were white. Median disease duration was 20 years and disease activity was low (median SLE Disease Activity Index 2000 [SLEDAI-2k] = 4). Low complement (32%), skin rashes (14%), and proteinuria (13%) were the most common SLEDAI items reported.

Overall, 68% of the cohort (n = 76) were taking hydroxychloroquine (HCQ), 29% of whom (n = 22) were taking it as monotherapy.

Furthermore, 68% of patients at the study visit were taking corticosteroids and/or non-HCQ disease-modifying antirheumatic drugs (DMARDs), and just over half (51%) of patients (n = 56) were taking corticosteroids either alone or with a non-HCQ DMARD.

“This [finding] is worrying as corticosteroids are associated with the development of damage. Patients are certainly eager to limit corticosteroid use, as almost all patients in the CHILL-NL cohort reported to have negative experiences with prednisone regarding their physical appearance and or mental well-being,” the study authors wrote.

Results also showed that 62% of the patients had damage, predominantly in the musculoskeletal, neuropsychiatric, and renal systems.

Most organ systems became involved within the first 2 years of diagnosis, but after 5 years of disease the nature of disease manifestations tended to shift to damage such as myocardial infarctions.

Notably, after 10-20 years, when cSLE patients were in their early 20s and 30s, significant damage had occurred in more than half of the patients, the authors noted.

“This shift to damage has also been observed in adult-onset SLE patients and urges for preventative screening measures of such (cardiovascular) damage and healthy lifestyle advice (healthy diet, regular exercise, abstinence from smoking),” they wrote.

Multivariate logistic regression showed that damage accrual was associated with disease duration (odds ratio, 1.15; P less than .001), antiphospholipid‐antibody positivity (OR, 3.56; P = .026), and hypertension (OR, 3.21; P = .043). On the other hand, current HCQ monotherapy was associated with an SLICC-Damage Index score of 0 (OR, 0.16; P = .009).

The HRQOL of the cohort, assessed via the Short Form–36, was also impaired compared with the general population, the researchers discovered. For example, the presence of damage reduced HRQOL in one domain, and high disease activity, defined as SLEDAI-2k of 8 or more, strongly reduced HRQOL in four of eight domains. Changes in physical appearance lowered HRQOL in seven of eight domains.

“HRQOL of adults with cSLE is impaired and affected by other factors than disease activity or damage alone. By identifying and addressing these factors, like physical appearance and potentially coping styles, HRQOL may be improved,” they advised.

The study was supported financially by the Dutch Arthritis Foundation and the Dutch national patient association for lupus, antiphospholipid syndrome, scleroderma, and mixed connective tissue diseases.

SOURCE: Groot N et al. Arthritis Rheumatol. 2018 Aug 27. doi: 10.1002/art.40697

The majority of adults with childhood-onset systemic lupus erythematosus in a longitudinal Dutch study developed significant damage at a young age, remain on corticosteroids in adulthood, and have an impaired health-related quality of life.

Courtesy Wikimedia Commons/doktorinternet/Creative Commons License

The findings in the study, dubbed Childhood-Onset SLE in the Netherlands (CHILL-NL), highlighted the need for preventive screening measures to be put in place before the age of 30 to facilitate a better outcome for patients, who still face high morbidity from childhood-onset systemic lupus erythematosus (cSLE) despite improved survival. Such information is helpful to “answer questions from children and parents regarding the future course of the disease,” wrote Noortje Groot, PhD, of the department of pediatric rheumatology at Erasmus Medical Center–Sophia Children’s Hospital in Rotterdam, the Netherlands, and her colleagues. The report is in Arthritis & Rheumatology.

The current study included all adult SLE patients treated in any Dutch public hospital during the period of November 2013 to April 2016 who were diagnosed with the autoimmune disease prior to their 18th birthday.

All 111 patients involved in the study were seen for a 1.5-hour visit at Erasmus University Medical Center or a local hospital of their choice. During the appointment, a medical history was taken, a physical examination was performed, and the patients completed questionnaires on health-related quality of life (HRQOL).

The average age of patients at the study visit was 33 years, 91% were female, and 72% were white. Median disease duration was 20 years and disease activity was low (median SLE Disease Activity Index 2000 [SLEDAI-2k] = 4). Low complement (32%), skin rashes (14%), and proteinuria (13%) were the most common SLEDAI items reported.

Overall, 68% of the cohort (n = 76) were taking hydroxychloroquine (HCQ), 29% of whom (n = 22) were taking it as monotherapy.

Furthermore, 68% of patients at the study visit were taking corticosteroids and/or non-HCQ disease-modifying antirheumatic drugs (DMARDs), and just over half (51%) of patients (n = 56) were taking corticosteroids either alone or with a non-HCQ DMARD.

“This [finding] is worrying as corticosteroids are associated with the development of damage. Patients are certainly eager to limit corticosteroid use, as almost all patients in the CHILL-NL cohort reported to have negative experiences with prednisone regarding their physical appearance and or mental well-being,” the study authors wrote.

Results also showed that 62% of the patients had damage, predominantly in the musculoskeletal, neuropsychiatric, and renal systems.

Most organ systems became involved within the first 2 years of diagnosis, but after 5 years of disease the nature of disease manifestations tended to shift to damage such as myocardial infarctions.

Notably, after 10-20 years, when cSLE patients were in their early 20s and 30s, significant damage had occurred in more than half of the patients, the authors noted.

“This shift to damage has also been observed in adult-onset SLE patients and urges for preventative screening measures of such (cardiovascular) damage and healthy lifestyle advice (healthy diet, regular exercise, abstinence from smoking),” they wrote.

Multivariate logistic regression showed that damage accrual was associated with disease duration (odds ratio, 1.15; P less than .001), antiphospholipid‐antibody positivity (OR, 3.56; P = .026), and hypertension (OR, 3.21; P = .043). On the other hand, current HCQ monotherapy was associated with an SLICC-Damage Index score of 0 (OR, 0.16; P = .009).

The HRQOL of the cohort, assessed via the Short Form–36, was also impaired compared with the general population, the researchers discovered. For example, the presence of damage reduced HRQOL in one domain, and high disease activity, defined as SLEDAI-2k of 8 or more, strongly reduced HRQOL in four of eight domains. Changes in physical appearance lowered HRQOL in seven of eight domains.

“HRQOL of adults with cSLE is impaired and affected by other factors than disease activity or damage alone. By identifying and addressing these factors, like physical appearance and potentially coping styles, HRQOL may be improved,” they advised.

The study was supported financially by the Dutch Arthritis Foundation and the Dutch national patient association for lupus, antiphospholipid syndrome, scleroderma, and mixed connective tissue diseases.

SOURCE: Groot N et al. Arthritis Rheumatol. 2018 Aug 27. doi: 10.1002/art.40697

Decreased quality of life attributed to eating disorder symptoms among college students may in fact be related to comorbid depression, results of a recent analysis suggest.

Depression scores and shape concerns both accounted for significant variance in quality of life scores in the analysis. However, depression scores accounted for nearly 10% of the variance, while shape concerns accounted for less than 1%, according to graduate student Paige J. Trojanowski and associate professor Sarah Fischer, PhD, both of the department of psychology at George Mason University, Fairfax, Va.

“Considering the low base rate of eating disorders, interventions to improve student quality of life that target depression may yield more widespread results than those focused on targeting weight or eating concerns,” Ms. Trojanowski and Dr. Fischer reported in Eating Behaviors. Targeting depression might unintentionally improve quality of life in students with disordered eating or body image concerns, they added, noting that depression and eating disorders often are comorbid.

Previous studies looking at relationships between exercise, disordered eating, and quality of life have not included depressive symptoms. Thus, the investigators analyzed the relative impact of depression, eating disorder symptoms, and exercise on Quality of Life Inventory (QOLI) scores in a sample of 851 college students (mean age, about 19 years), three-quarters of whom identified as white. Most of the participants were women (n = 676).

Nearly 90% of the students reported some level of physical activity in the past month, with a mean of 885 minutes. Scores on the Beck Depression Inventory-II (BDI-II) ranged from 0 to 57, with 13.5%, 7.4% and 3.4% falling in the mild, moderate, and severe depression ranges, respectively.

A regression model developed as part of the analysis explained 28.9% of the variance in QOLI scores, Ms. Trojanowski and Dr. Fischer wrote.

Shape concern was the only symptom on the Eating Disorder Examination Questionnaire that had a significant effect on quality of life (P = .005). In addition, BDI-II scores accounted for significant variance (P less than .001).

However, only 0.77% of the total variance in QOLI scores was accounted for by unique variance in shape concern, while 9.55% was accounted for by unique variance in depressive symptoms, their analysis showed.

“While clinical level eating disorders are present on college campuses and deserve specific attention to reduce their significant negative effect on QOL in those students, these results show that depressive symptoms may have a more significant impact on the quality of life of college students at large,” they wrote.

Exercise frequency was not related to quality of life, after accounting for the contribution of eating disorder symptoms. However, exercising for mood improvement or enjoyment was significantly associated with quality of life, Ms. Trojanowski and Dr. Fischer reported. In the final model, identifying as a woman was tied to a lower quality of life.

“Future studies should examine exercising for reasons of enjoyment as a protective factor against decreased QOL in college students,” they wrote.

Limitations cited include the study’s cross-sectional design and the investigators’ reliance on self-report questionnaires.

The authors reported no conflicts of interest or research funding.

SOURCE: Trojanowski PJ et al. Eat Behav. 2018 Aug 18. doi: 10.1016/j.eatbeh.2018.08.005.

Decreased quality of life attributed to eating disorder symptoms among college students may in fact be related to comorbid depression, results of a recent analysis suggest.

Depression scores and shape concerns both accounted for significant variance in quality of life scores in the analysis. However, depression scores accounted for nearly 10% of the variance, while shape concerns accounted for less than 1%, according to graduate student Paige J. Trojanowski and associate professor Sarah Fischer, PhD, both of the department of psychology at George Mason University, Fairfax, Va.

“Considering the low base rate of eating disorders, interventions to improve student quality of life that target depression may yield more widespread results than those focused on targeting weight or eating concerns,” Ms. Trojanowski and Dr. Fischer reported in Eating Behaviors. Targeting depression might unintentionally improve quality of life in students with disordered eating or body image concerns, they added, noting that depression and eating disorders often are comorbid.

Previous studies looking at relationships between exercise, disordered eating, and quality of life have not included depressive symptoms. Thus, the investigators analyzed the relative impact of depression, eating disorder symptoms, and exercise on Quality of Life Inventory (QOLI) scores in a sample of 851 college students (mean age, about 19 years), three-quarters of whom identified as white. Most of the participants were women (n = 676).

Nearly 90% of the students reported some level of physical activity in the past month, with a mean of 885 minutes. Scores on the Beck Depression Inventory-II (BDI-II) ranged from 0 to 57, with 13.5%, 7.4% and 3.4% falling in the mild, moderate, and severe depression ranges, respectively.

A regression model developed as part of the analysis explained 28.9% of the variance in QOLI scores, Ms. Trojanowski and Dr. Fischer wrote.

Shape concern was the only symptom on the Eating Disorder Examination Questionnaire that had a significant effect on quality of life (P = .005). In addition, BDI-II scores accounted for significant variance (P less than .001).

However, only 0.77% of the total variance in QOLI scores was accounted for by unique variance in shape concern, while 9.55% was accounted for by unique variance in depressive symptoms, their analysis showed.

“While clinical level eating disorders are present on college campuses and deserve specific attention to reduce their significant negative effect on QOL in those students, these results show that depressive symptoms may have a more significant impact on the quality of life of college students at large,” they wrote.

Exercise frequency was not related to quality of life, after accounting for the contribution of eating disorder symptoms. However, exercising for mood improvement or enjoyment was significantly associated with quality of life, Ms. Trojanowski and Dr. Fischer reported. In the final model, identifying as a woman was tied to a lower quality of life.

“Future studies should examine exercising for reasons of enjoyment as a protective factor against decreased QOL in college students,” they wrote.

Limitations cited include the study’s cross-sectional design and the investigators’ reliance on self-report questionnaires.

The authors reported no conflicts of interest or research funding.

SOURCE: Trojanowski PJ et al. Eat Behav. 2018 Aug 18. doi: 10.1016/j.eatbeh.2018.08.005.

Decreased quality of life attributed to eating disorder symptoms among college students may in fact be related to comorbid depression, results of a recent analysis suggest.

Depression scores and shape concerns both accounted for significant variance in quality of life scores in the analysis. However, depression scores accounted for nearly 10% of the variance, while shape concerns accounted for less than 1%, according to graduate student Paige J. Trojanowski and associate professor Sarah Fischer, PhD, both of the department of psychology at George Mason University, Fairfax, Va.

“Considering the low base rate of eating disorders, interventions to improve student quality of life that target depression may yield more widespread results than those focused on targeting weight or eating concerns,” Ms. Trojanowski and Dr. Fischer reported in Eating Behaviors. Targeting depression might unintentionally improve quality of life in students with disordered eating or body image concerns, they added, noting that depression and eating disorders often are comorbid.

Previous studies looking at relationships between exercise, disordered eating, and quality of life have not included depressive symptoms. Thus, the investigators analyzed the relative impact of depression, eating disorder symptoms, and exercise on Quality of Life Inventory (QOLI) scores in a sample of 851 college students (mean age, about 19 years), three-quarters of whom identified as white. Most of the participants were women (n = 676).

Nearly 90% of the students reported some level of physical activity in the past month, with a mean of 885 minutes. Scores on the Beck Depression Inventory-II (BDI-II) ranged from 0 to 57, with 13.5%, 7.4% and 3.4% falling in the mild, moderate, and severe depression ranges, respectively.

A regression model developed as part of the analysis explained 28.9% of the variance in QOLI scores, Ms. Trojanowski and Dr. Fischer wrote.

Shape concern was the only symptom on the Eating Disorder Examination Questionnaire that had a significant effect on quality of life (P = .005). In addition, BDI-II scores accounted for significant variance (P less than .001).

However, only 0.77% of the total variance in QOLI scores was accounted for by unique variance in shape concern, while 9.55% was accounted for by unique variance in depressive symptoms, their analysis showed.

“While clinical level eating disorders are present on college campuses and deserve specific attention to reduce their significant negative effect on QOL in those students, these results show that depressive symptoms may have a more significant impact on the quality of life of college students at large,” they wrote.

Exercise frequency was not related to quality of life, after accounting for the contribution of eating disorder symptoms. However, exercising for mood improvement or enjoyment was significantly associated with quality of life, Ms. Trojanowski and Dr. Fischer reported. In the final model, identifying as a woman was tied to a lower quality of life.

“Future studies should examine exercising for reasons of enjoyment as a protective factor against decreased QOL in college students,” they wrote.

Limitations cited include the study’s cross-sectional design and the investigators’ reliance on self-report questionnaires.

The authors reported no conflicts of interest or research funding.

SOURCE: Trojanowski PJ et al. Eat Behav. 2018 Aug 18. doi: 10.1016/j.eatbeh.2018.08.005.

More dermatologists in the United States practice in urban areas than in nonurban or rural areas, and this trend is likely to continue, according to data from a longitudinal study published online Sept. 5 in JAMA Dermatology.

Data from previous studies suggest that the demand for dermatologists continues to outpace the supply, thus dermatologists have their choice of locations and prefer urban areas because of greater professional opportunities, desire to live near family, and lack of financial incentives to relocate to underserved areas, wrote Hao Feng, MD, of the department of dermatology, New York University, and his colleagues.

To evaluate the latest longitudinal trends in dermatology and factors affecting geographic distribution, the researchers used the Area Health Resources File from 1995 to 2013 to examine the geographic densities of dermatologists and other physicians, as well as the age distribution of dermatologists. The counties were classified as rural, nonmetropolitan, and metropolitan.

Although the percentage changes in dermatologist density at the county level showed a greater increase during the study period in rural counties (30%) and nonmetropolitan counties (25%), compared with metropolitan counties (18%), the differences in actual density of dermatologists per 100,000 people were highest in urban areas.

Overall, dermatologist density in metropolitan areas increased from 3.47 to 4.11 per 100,000 people between 1995 and 2013. Dermatologist density in nonmetropolitan areas during this time increased from 0.84 in 1995 to 1.05 per 100,000 people in 2013, and from 0.065 to 0.085 per 100,000 people in rural areas during that time.

The researchers also evaluated dermatologist trends by age, and found that the number of dermatologists younger than 55 years increased by 21% in metropolitan areas and by 7% in nonmetropolitan and rural areas combined between 1995 and 2013.

The study findings were strengthened by the long time period, but limited by factors including inability to differentiate among full-time and part-time dermatologists, and among medical or cosmetic dermatologists and dermatologic surgeons, the researchers said. However, the results suggest that geographic disparities for dermatologists in the United States continue to increase, and strategies to correct it are important to maintain patient care, they wrote. “Careful workforce planning will be needed to consider alternative health care delivery models, dermatologist recruitment strategies, and the role of nonphysician practitioners and telemedicine, especially in nonmetropolitan or rural areas,” they noted.

The researchers had no financial conflicts to disclose.

SOURCE: Feng H et al. JAMA Dermatol. 2018 Sep 5. doi: 10.1001/jamadermatol.2018.3022.

More dermatologists in the United States practice in urban areas than in nonurban or rural areas, and this trend is likely to continue, according to data from a longitudinal study published online Sept. 5 in JAMA Dermatology.

Data from previous studies suggest that the demand for dermatologists continues to outpace the supply, thus dermatologists have their choice of locations and prefer urban areas because of greater professional opportunities, desire to live near family, and lack of financial incentives to relocate to underserved areas, wrote Hao Feng, MD, of the department of dermatology, New York University, and his colleagues.

To evaluate the latest longitudinal trends in dermatology and factors affecting geographic distribution, the researchers used the Area Health Resources File from 1995 to 2013 to examine the geographic densities of dermatologists and other physicians, as well as the age distribution of dermatologists. The counties were classified as rural, nonmetropolitan, and metropolitan.

Although the percentage changes in dermatologist density at the county level showed a greater increase during the study period in rural counties (30%) and nonmetropolitan counties (25%), compared with metropolitan counties (18%), the differences in actual density of dermatologists per 100,000 people were highest in urban areas.

Overall, dermatologist density in metropolitan areas increased from 3.47 to 4.11 per 100,000 people between 1995 and 2013. Dermatologist density in nonmetropolitan areas during this time increased from 0.84 in 1995 to 1.05 per 100,000 people in 2013, and from 0.065 to 0.085 per 100,000 people in rural areas during that time.

The researchers also evaluated dermatologist trends by age, and found that the number of dermatologists younger than 55 years increased by 21% in metropolitan areas and by 7% in nonmetropolitan and rural areas combined between 1995 and 2013.

The study findings were strengthened by the long time period, but limited by factors including inability to differentiate among full-time and part-time dermatologists, and among medical or cosmetic dermatologists and dermatologic surgeons, the researchers said. However, the results suggest that geographic disparities for dermatologists in the United States continue to increase, and strategies to correct it are important to maintain patient care, they wrote. “Careful workforce planning will be needed to consider alternative health care delivery models, dermatologist recruitment strategies, and the role of nonphysician practitioners and telemedicine, especially in nonmetropolitan or rural areas,” they noted.

The researchers had no financial conflicts to disclose.

SOURCE: Feng H et al. JAMA Dermatol. 2018 Sep 5. doi: 10.1001/jamadermatol.2018.3022.

More dermatologists in the United States practice in urban areas than in nonurban or rural areas, and this trend is likely to continue, according to data from a longitudinal study published online Sept. 5 in JAMA Dermatology.

Data from previous studies suggest that the demand for dermatologists continues to outpace the supply, thus dermatologists have their choice of locations and prefer urban areas because of greater professional opportunities, desire to live near family, and lack of financial incentives to relocate to underserved areas, wrote Hao Feng, MD, of the department of dermatology, New York University, and his colleagues.

To evaluate the latest longitudinal trends in dermatology and factors affecting geographic distribution, the researchers used the Area Health Resources File from 1995 to 2013 to examine the geographic densities of dermatologists and other physicians, as well as the age distribution of dermatologists. The counties were classified as rural, nonmetropolitan, and metropolitan.

Although the percentage changes in dermatologist density at the county level showed a greater increase during the study period in rural counties (30%) and nonmetropolitan counties (25%), compared with metropolitan counties (18%), the differences in actual density of dermatologists per 100,000 people were highest in urban areas.

Overall, dermatologist density in metropolitan areas increased from 3.47 to 4.11 per 100,000 people between 1995 and 2013. Dermatologist density in nonmetropolitan areas during this time increased from 0.84 in 1995 to 1.05 per 100,000 people in 2013, and from 0.065 to 0.085 per 100,000 people in rural areas during that time.

The researchers also evaluated dermatologist trends by age, and found that the number of dermatologists younger than 55 years increased by 21% in metropolitan areas and by 7% in nonmetropolitan and rural areas combined between 1995 and 2013.

The study findings were strengthened by the long time period, but limited by factors including inability to differentiate among full-time and part-time dermatologists, and among medical or cosmetic dermatologists and dermatologic surgeons, the researchers said. However, the results suggest that geographic disparities for dermatologists in the United States continue to increase, and strategies to correct it are important to maintain patient care, they wrote. “Careful workforce planning will be needed to consider alternative health care delivery models, dermatologist recruitment strategies, and the role of nonphysician practitioners and telemedicine, especially in nonmetropolitan or rural areas,” they noted.

The researchers had no financial conflicts to disclose.

SOURCE: Feng H et al. JAMA Dermatol. 2018 Sep 5. doi: 10.1001/jamadermatol.2018.3022.