Pub Date : 2024-08-15eCollection Date: 2024-09-01DOI: 10.1016/j.eclinm.2024.102789
Candace Jarade, Tetiana Zolotarova, Areesha Moiz, Mark J Eisenberg
Despite the availability of a wide range of antihypertensive agents, a significant proportion of individuals with resistant hypertension (RHTN) struggle to achieve blood pressure (BP) control. Obesity ranks among the most significant modifiable risk factors for RHTN, with 56-91% of patients with RHTN classified as overweight or obese. Glucagon-like peptide-1 receptor agonist (GLP-1 RAs) are a class of anti-obesity medications that have recently demonstrated efficacy in reducing BP and improving cardiovascular (CV) outcomes in individuals with overweight or obesity. Among the available GLP-1-based therapies, liraglutide, semaglutide, and tirzepatide have been approved for chronic weight management in this population. Tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist, has the greatest effect on weight loss and BP reduction compared to GLP-1 RAs alone. To our knowledge, no trials have directly evaluated the effect of GLP-1 RAs or dual GLP-1/GIP receptor agonists on RHTN management. In this review article, we propose that targeting weight loss through GLP-1-based therapies should be explored as a treatment option for individuals with RHTN who are overweight or obese.
{"title":"GLP-1-based therapies for the treatment of resistant hypertension in individuals with overweight or obesity: a review.","authors":"Candace Jarade, Tetiana Zolotarova, Areesha Moiz, Mark J Eisenberg","doi":"10.1016/j.eclinm.2024.102789","DOIUrl":"10.1016/j.eclinm.2024.102789","url":null,"abstract":"<p><p>Despite the availability of a wide range of antihypertensive agents, a significant proportion of individuals with resistant hypertension (RHTN) struggle to achieve blood pressure (BP) control. Obesity ranks among the most significant modifiable risk factors for RHTN, with 56-91% of patients with RHTN classified as overweight or obese. Glucagon-like peptide-1 receptor agonist (GLP-1 RAs) are a class of anti-obesity medications that have recently demonstrated efficacy in reducing BP and improving cardiovascular (CV) outcomes in individuals with overweight or obesity. Among the available GLP-1-based therapies, liraglutide, semaglutide, and tirzepatide have been approved for chronic weight management in this population. Tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist, has the greatest effect on weight loss and BP reduction compared to GLP-1 RAs alone. To our knowledge, no trials have directly evaluated the effect of GLP-1 RAs or dual GLP-1/GIP receptor agonists on RHTN management. In this review article, we propose that targeting weight loss through GLP-1-based therapies should be explored as a treatment option for individuals with RHTN who are overweight or obese.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"75 ","pages":"102789"},"PeriodicalIF":9.6,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-15eCollection Date: 2024-09-01DOI: 10.1016/j.eclinm.2024.102777
Matthew Anson, Alex E Henney, Nicholas Broadwell, Sizheng S Zhao, Gema H Ibarburu, Gregory Y H Lip, John P H Wilding, Daniel J Cuthbertson, Uazman Alam
<p><strong>Background: </strong>Tirzepatide, a novel dual agonist of glucagon-like-peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), has demonstrated greater magnitude of weight loss compared to semaglutide in a phase 3 clinical trial. However, the effect of tirzepatide on incidence of type 2 diabetes (T2D) in individuals with overweight and obesity, and the effect on major adverse cardiovascular outcomes in individuals with pre-existing T2D, remains unknown.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of anonymised electronic medical records using the TriNetX network (TriNetX LLC, Cambridge, MA, USA) a global federated database. The data used in this study was collected on 5th June 2024. Two cohorts of individuals were generated: <b>1)</b> without pre-existing T2D and, <b>2)</b> with T2D. We adopted an active comparator new user design on new initiations of either tirzepatide <i>or</i> semaglutide therapy. Analysis began from the index event which was defined as individuals on respective therapy for 6 months only. Analysis of outcomes was conducted off-drug, in individuals without a pre-existing history of the disease of interest. Individuals were followed up for 12 months post the index event. <b>Primary outcome</b> for <b>cohort 1</b> was incidence of T2D, and for <b>cohort 2</b> was composite: all-cause mortality, cerebral infarction, acute coronary syndrome, and heart failure. <b>Secondary outcomes</b> for <b>cohort 1</b> were change in HbA1c and body weight and for <b>cohort 2</b>: incidence of micro- and macrovascular complications, suicidal ideation and/or attempt, and all-cause mortality. We propensity score matched (1:1) for potential confounders: baseline demographics, socioeconomic circumstances, HbA1c, weight, relevant co-morbidities, and anti-obesity, hypoglycaemic and cardioprotective agents.</p><p><strong>Findings: </strong>The study population without T2D consisted of 13,846 individuals, equally split between tirzepatide and semaglutide users. Tirzepatide was associated with both lower risk for incident T2D (HR 0.73, 95% CI 0.58-0.92, p < 0.001) and greater weight loss (-7.7 kg, [95% CI -6.8, -8.5 kg], p < 0.001), compared to semaglutide (-4.8 kg, [95% CI -3.9, -5.6 kg], p < 0.001). In individuals with pre-existing T2D (n = 8446), tirzepatide was associated with lower risk of the composite outcome (HR 0.54, 95% CI 0.38-0.76, p < 0.001), cerebral infarction (HR 0.45, 95% CI 0.24-0.84, p = 0.010) and all-cause mortality (HR 0.33, 95% CI 0.15-0.73, p = 0.004) compared to semaglutide.</p><p><strong>Interpretation: </strong>Tirzepatide is associated with significantly reduced risk of developing T2D and major adverse cardiovascular events in individuals living with obesity and T2D respectively. Randomised controlled trials investigating the utility of dual incretin agonists in the primary prevention of T2D and cardiovascular disease in higher risk populations are now required.</p><p
{"title":"Incidence of new onset type 2 diabetes in adults living with obesity treated with tirzepatide or semaglutide: real world evidence from an international retrospective cohort study.","authors":"Matthew Anson, Alex E Henney, Nicholas Broadwell, Sizheng S Zhao, Gema H Ibarburu, Gregory Y H Lip, John P H Wilding, Daniel J Cuthbertson, Uazman Alam","doi":"10.1016/j.eclinm.2024.102777","DOIUrl":"10.1016/j.eclinm.2024.102777","url":null,"abstract":"<p><strong>Background: </strong>Tirzepatide, a novel dual agonist of glucagon-like-peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), has demonstrated greater magnitude of weight loss compared to semaglutide in a phase 3 clinical trial. However, the effect of tirzepatide on incidence of type 2 diabetes (T2D) in individuals with overweight and obesity, and the effect on major adverse cardiovascular outcomes in individuals with pre-existing T2D, remains unknown.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of anonymised electronic medical records using the TriNetX network (TriNetX LLC, Cambridge, MA, USA) a global federated database. The data used in this study was collected on 5th June 2024. Two cohorts of individuals were generated: <b>1)</b> without pre-existing T2D and, <b>2)</b> with T2D. We adopted an active comparator new user design on new initiations of either tirzepatide <i>or</i> semaglutide therapy. Analysis began from the index event which was defined as individuals on respective therapy for 6 months only. Analysis of outcomes was conducted off-drug, in individuals without a pre-existing history of the disease of interest. Individuals were followed up for 12 months post the index event. <b>Primary outcome</b> for <b>cohort 1</b> was incidence of T2D, and for <b>cohort 2</b> was composite: all-cause mortality, cerebral infarction, acute coronary syndrome, and heart failure. <b>Secondary outcomes</b> for <b>cohort 1</b> were change in HbA1c and body weight and for <b>cohort 2</b>: incidence of micro- and macrovascular complications, suicidal ideation and/or attempt, and all-cause mortality. We propensity score matched (1:1) for potential confounders: baseline demographics, socioeconomic circumstances, HbA1c, weight, relevant co-morbidities, and anti-obesity, hypoglycaemic and cardioprotective agents.</p><p><strong>Findings: </strong>The study population without T2D consisted of 13,846 individuals, equally split between tirzepatide and semaglutide users. Tirzepatide was associated with both lower risk for incident T2D (HR 0.73, 95% CI 0.58-0.92, p < 0.001) and greater weight loss (-7.7 kg, [95% CI -6.8, -8.5 kg], p < 0.001), compared to semaglutide (-4.8 kg, [95% CI -3.9, -5.6 kg], p < 0.001). In individuals with pre-existing T2D (n = 8446), tirzepatide was associated with lower risk of the composite outcome (HR 0.54, 95% CI 0.38-0.76, p < 0.001), cerebral infarction (HR 0.45, 95% CI 0.24-0.84, p = 0.010) and all-cause mortality (HR 0.33, 95% CI 0.15-0.73, p = 0.004) compared to semaglutide.</p><p><strong>Interpretation: </strong>Tirzepatide is associated with significantly reduced risk of developing T2D and major adverse cardiovascular events in individuals living with obesity and T2D respectively. Randomised controlled trials investigating the utility of dual incretin agonists in the primary prevention of T2D and cardiovascular disease in higher risk populations are now required.</p><p","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"75 ","pages":"102777"},"PeriodicalIF":9.6,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13eCollection Date: 2024-09-01DOI: 10.1016/j.eclinm.2024.102755
Szu-Yu Zoe Kao, Kinpritma Sangha, Naoto Fujiwara, Yujin Hoshida, Neehar D Parikh, Amit G Singal
Background: Hepatocellular carcinoma (HCC) surveillance is currently performed using a one-size-fits-all strategy with ultrasound plus AFP (US + AFP). There is increasing interest in risk-stratified and precision surveillance strategies incorporating individual risk and variance in surveillance test performance; however, the cost-effectiveness of these approaches has not been evaluated.
Methods: We conducted a cost-effectiveness analysis to evaluate four surveillance strategies (no surveillance, universal US + AFP surveillance, risk-stratified surveillance, and precision surveillance) in a simulated cohort of 50-year-old patients with compensated cirrhosis. The most cost-effective strategy was that with the highest incremental cost-effectiveness ratio (ICER) and below the willingness-to-pay (WTP) threshold of $150,000/QALY gained. Model inputs were based on literature review, and costs were derived from the Medicare fee schedule.
Findings: The precision surveillance strategy demonstrated variation in recommended surveillance test based on HCC risk category and patient factors. US + AFP, risk-stratified, and precision surveillance detected more HCC cases per 100,000 population than no surveillance, with a higher proportion of early-stage cases for precision surveillance (67.6%) than risk-stratified (63.8%), universal ultrasound (63.2%), and no surveillance (38.0%). Compared to no surveillance, precision surveillance was most cost-effective, with an ICER of $104,614/QALY gained, whereas US + AFP and risk-stratified surveillance were both dominated. Compared to US + AFP, risk-stratified surveillance was cost saving and dominated US + AFP, whereas precision surveillance was cost-effective, with an ICER of $98,103/QALY gained. Results were sensitive to survival with early-stage HCC, cost of early-stage HCC treatment, and surveillance utilization. Precision surveillance remained the most cost-effective when WTP thresholds exceeded $110,000/QALY gained.
Interpretation: A precision surveillance strategy is the most cost-effective method for HCC surveillance. This approach could maximize surveillance benefits in high-risk patients, while minimizing surveillance harms in low-risk individuals.
Funding: National Cancer Institute (U01 CA230694, R01 CA222900, R01 CA212008, and U24ca086368) and Cancer Prevention Research Institute of Texas (CPRIT) (RP200554).
{"title":"Cost-effectiveness of a precision hepatocellular carcinoma surveillance strategy in patients with cirrhosis.","authors":"Szu-Yu Zoe Kao, Kinpritma Sangha, Naoto Fujiwara, Yujin Hoshida, Neehar D Parikh, Amit G Singal","doi":"10.1016/j.eclinm.2024.102755","DOIUrl":"10.1016/j.eclinm.2024.102755","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) surveillance is currently performed using a one-size-fits-all strategy with ultrasound plus AFP (US + AFP). There is increasing interest in risk-stratified and precision surveillance strategies incorporating individual risk and variance in surveillance test performance; however, the cost-effectiveness of these approaches has not been evaluated.</p><p><strong>Methods: </strong>We conducted a cost-effectiveness analysis to evaluate four surveillance strategies (no surveillance, universal US + AFP surveillance, risk-stratified surveillance, and precision surveillance) in a simulated cohort of 50-year-old patients with compensated cirrhosis. The most cost-effective strategy was that with the highest incremental cost-effectiveness ratio (ICER) and below the willingness-to-pay (WTP) threshold of $150,000/QALY gained. Model inputs were based on literature review, and costs were derived from the Medicare fee schedule.</p><p><strong>Findings: </strong>The precision surveillance strategy demonstrated variation in recommended surveillance test based on HCC risk category and patient factors. US + AFP, risk-stratified, and precision surveillance detected more HCC cases per 100,000 population than no surveillance, with a higher proportion of early-stage cases for precision surveillance (67.6%) than risk-stratified (63.8%), universal ultrasound (63.2%), and no surveillance (38.0%). Compared to no surveillance, precision surveillance was most cost-effective, with an ICER of $104,614/QALY gained, whereas US + AFP and risk-stratified surveillance were both dominated. Compared to US + AFP, risk-stratified surveillance was cost saving and dominated US + AFP, whereas precision surveillance was cost-effective, with an ICER of $98,103/QALY gained. Results were sensitive to survival with early-stage HCC, cost of early-stage HCC treatment, and surveillance utilization. Precision surveillance remained the most cost-effective when WTP thresholds exceeded $110,000/QALY gained.</p><p><strong>Interpretation: </strong>A precision surveillance strategy is the most cost-effective method for HCC surveillance. This approach could maximize surveillance benefits in high-risk patients, while minimizing surveillance harms in low-risk individuals.</p><p><strong>Funding: </strong>National Cancer Institute (U01 CA230694, R01 CA222900, R01 CA212008, and U24ca086368) and Cancer Prevention Research Institute of Texas (CPRIT) (RP200554).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"75 ","pages":"102755"},"PeriodicalIF":9.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12eCollection Date: 2024-09-01DOI: 10.1016/j.eclinm.2024.102731
Natalia Hernandez-Pacheco, Anna Kilanowski, Ashish Kumar, John A Curtin, Núria Olvera, Sara Kress, Xander Bertels, Lies Lahousse, Laxmi Bhatta, Raquel Granell, Sergi Marí, Jose Ramon Bilbao, Yidan Sun, Casper-Emil Tingskov Pedersen, Tarik Karramass, Elisabeth Thiering, Christina Dardani, Simon Kebede Merid, Gang Wang, Jenny Hallberg, Sarah Koch, Judith Garcia-Aymerich, Ana Esplugues, Maties Torrent, Jesus Ibarluzea, Lesley Lowe, Angela Simpson, Ulrike Gehring, Roel C H Vermeulen, Graham Roberts, Anna Bergström, Judith M Vonk, Janine F Felix, Liesbeth Duijts, Klaus Bønnelykke, Nic Timpson, Guy Brusselle, Ben M Brumpton, Arnulf Langhammer, Stephen Turner, John W Holloway, Syed Hasan Arshad, Anhar Ullah, Adnan Custovic, Paul Cullinan, Clare S Murray, Maarten van den Berge, Inger Kull, Tamara Schikowski, Jadwiga A Wedzicha, Gerard Koppelman, Rosa Faner, Àlvar Agustí, Marie Standl, Erik Melén
Background: Chronic obstructive pulmonary disease (COPD) is caused by interactions between many factors across the life course, including genetics. A proportion of COPD may be due to reduced lung growth in childhood. We hypothesized that a polygenic risk score (PRS) for COPD is associated with lower lung function already in childhood and up to adulthood.
Methods: A weighted PRS was calculated based on the 82 association signals (p ≤ 5 × 10-8) revealed by the largest GWAS of airflow limitation (defined as COPD) to date. This PRS was tested in association with lung function measures (FEV1, FVC, and FEV1/FVC) in subjects aged 4-50 years from 16 independent cohorts participating in the Chronic Airway Diseases Early Stratification (CADSET) Clinical Research Collaboration. Age-stratified meta-analyses were conducted combining the results from each cohort (n = 45,406). These findings were validated in subjects >50 years old.
Findings: We found significant associations between the PRS for airflow limitation and: (1) lower pre-bronchodilator FEV1/FVC from school age (7-10 years; β: -0.13 z-scores per one PRS z-score increase [-0.15, -0.11], q-value = 7.04 × 10-53) to adulthood (41-50 years; β: -0.16 [-0.19, -0.13], q-value = 1.31 × 10-24); and (2) lower FEV1 (from school age: 7-10 years; β: -0.07 [-0.09, -0.05], q-value = 1.65 × 10-9, to adulthood: 41-50 years; β: -0.17 [-0.20, -0.13], q-value = 4.48 x 10-20). No effect modification by smoking, sex, or a diagnosis of asthma was observed.
Interpretation: We provide evidence that a higher genetic risk for COPD is linked to lower lung function from childhood onwards.
Funding: This study was supported by CADSET, a Clinical Research Collaboration of the European Respiratory Society.
{"title":"Exploring the genetics of airflow limitation in lung function across the lifespan - a polygenic risk score study.","authors":"Natalia Hernandez-Pacheco, Anna Kilanowski, Ashish Kumar, John A Curtin, Núria Olvera, Sara Kress, Xander Bertels, Lies Lahousse, Laxmi Bhatta, Raquel Granell, Sergi Marí, Jose Ramon Bilbao, Yidan Sun, Casper-Emil Tingskov Pedersen, Tarik Karramass, Elisabeth Thiering, Christina Dardani, Simon Kebede Merid, Gang Wang, Jenny Hallberg, Sarah Koch, Judith Garcia-Aymerich, Ana Esplugues, Maties Torrent, Jesus Ibarluzea, Lesley Lowe, Angela Simpson, Ulrike Gehring, Roel C H Vermeulen, Graham Roberts, Anna Bergström, Judith M Vonk, Janine F Felix, Liesbeth Duijts, Klaus Bønnelykke, Nic Timpson, Guy Brusselle, Ben M Brumpton, Arnulf Langhammer, Stephen Turner, John W Holloway, Syed Hasan Arshad, Anhar Ullah, Adnan Custovic, Paul Cullinan, Clare S Murray, Maarten van den Berge, Inger Kull, Tamara Schikowski, Jadwiga A Wedzicha, Gerard Koppelman, Rosa Faner, Àlvar Agustí, Marie Standl, Erik Melén","doi":"10.1016/j.eclinm.2024.102731","DOIUrl":"10.1016/j.eclinm.2024.102731","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is caused by interactions between many factors across the life course, including genetics. A proportion of COPD may be due to reduced lung growth in childhood. We hypothesized that a polygenic risk score (PRS) for COPD is associated with lower lung function already in childhood and up to adulthood.</p><p><strong>Methods: </strong>A weighted PRS was calculated based on the 82 association signals (<i>p</i> ≤ 5 × 10<sup>-8</sup>) revealed by the largest GWAS of airflow limitation (defined as COPD) to date. This PRS was tested in association with lung function measures (FEV<sub>1</sub>, FVC, and FEV<sub>1</sub>/FVC) in subjects aged 4-50 years from 16 independent cohorts participating in the Chronic Airway Diseases Early Stratification (CADSET) Clinical Research Collaboration. Age-stratified meta-analyses were conducted combining the results from each cohort (n = 45,406). These findings were validated in subjects >50 years old.</p><p><strong>Findings: </strong>We found significant associations between the PRS for airflow limitation and: <i>(1)</i> lower pre-bronchodilator FEV<sub>1</sub>/FVC from school age (7-10 years; β: -0.13 z-scores per one PRS z-score increase [-0.15, -0.11], <i>q</i>-value = 7.04 × 10<sup>-53</sup>) to adulthood (41-50 years; β: -0.16 [-0.19, -0.13], <i>q</i>-value = 1.31 × 10<sup>-24</sup>); and <i>(2)</i> lower FEV<sub>1</sub> (from school age: 7-10 years; β: -0.07 [-0.09, -0.05], <i>q</i>-value = 1.65 × 10<sup>-9</sup>, to adulthood: 41-50 years; β: -0.17 [-0.20, -0.13], <i>q</i>-value = 4.48 x 10<sup>-20</sup>). No effect modification by smoking, sex, or a diagnosis of asthma was observed.</p><p><strong>Interpretation: </strong>We provide evidence that a higher genetic risk for COPD is linked to lower lung function from childhood onwards.</p><p><strong>Funding: </strong>This study was supported by CADSET, a Clinical Research Collaboration of the European Respiratory Society.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"75 ","pages":"102731"},"PeriodicalIF":9.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06eCollection Date: 2024-09-01DOI: 10.1016/j.eclinm.2024.102770
S E Boman, I Hed Myrberg, G Bruze, A Martling, C Nordenvall, P J Nilsson
Background: Colorectal cancer is common and prognosis is improving. The conditions of survivors of treatment, including financial consequences, are thus important. The aim of this study was to quantify loss of earnings and work loss in working-age patients with colon and rectal cancer relative to matched comparators.
Methods: The study utilised data from the CRCBaSe database that is generated from the nationwide Swedish ColoRectal Cancer Register and includes data from several Swedish nationwide registers. The study period was 1995-2020 for rectal cancer patients and 2007-2020 for colon cancer patients. A retrospective population-based nationwide cohort study on earnings, disposable income, and work loss, in survivors of stage I-III colorectal cancer treatment was undertaken. Median regression was used to analyse earnings and disposable income, and logistic regression to analyse the probability of work loss.
Findings: A cohort of 8863 colorectal cancer survivors diagnosed before 2017 and 52,514 comparators matched on birth year, legal sex, and county of residence, was analysed. There was a clear reduction in earnings between the calendar year prior to and the calendar year after diagnosis, from € 31,319 to € 23,924 for colon cancer patients and from € 32,636 to € 22,647 for rectal cancer patients, and earnings never fully recovered during the 5-year follow-up. Disposable income was practically unaltered. The probability of work loss increased in the calendar year of diagnosis, from 29.8% to 25.3% the previous year to 83.3% and 84.4% for colon and rectal cancer patients respectively, and never fully recovered. The probability of work loss was similar between colon and rectal cancer survivors, but was higher among patients with rectal cancer who had received neoadjuvant therapy.
Interpretation: This study shows that despite an extensive welfare system providing maintained disposable income, there is a financial burden in the form of increased risk of work loss and a reduction in earnings among survivors of colorectal cancer.
Funding: The study was supported by the Swedish Cancer Society, the Swedish Cancer and Allergy Foundation, and the Stockholm Cancer Society, and supported by grants provided by the Regional Agreement on Medical Training and Clinical Research (ALF) between the Stockholm County Council and Karolinska Institutet.
{"title":"Earnings and work loss after colon and rectal cancer: a Swedish nationwide matched cohort study.","authors":"S E Boman, I Hed Myrberg, G Bruze, A Martling, C Nordenvall, P J Nilsson","doi":"10.1016/j.eclinm.2024.102770","DOIUrl":"https://doi.org/10.1016/j.eclinm.2024.102770","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is common and prognosis is improving. The conditions of survivors of treatment, including financial consequences, are thus important. The aim of this study was to quantify loss of earnings and work loss in working-age patients with colon and rectal cancer relative to matched comparators.</p><p><strong>Methods: </strong>The study utilised data from the CRCBaSe database that is generated from the nationwide Swedish ColoRectal Cancer Register and includes data from several Swedish nationwide registers. The study period was 1995-2020 for rectal cancer patients and 2007-2020 for colon cancer patients. A retrospective population-based nationwide cohort study on earnings, disposable income, and work loss, in survivors of stage I-III colorectal cancer treatment was undertaken. Median regression was used to analyse earnings and disposable income, and logistic regression to analyse the probability of work loss.</p><p><strong>Findings: </strong>A cohort of 8863 colorectal cancer survivors diagnosed before 2017 and 52,514 comparators matched on birth year, legal sex, and county of residence, was analysed. There was a clear reduction in earnings between the calendar year prior to and the calendar year after diagnosis, from € 31,319 to € 23,924 for colon cancer patients and from € 32,636 to € 22,647 for rectal cancer patients, and earnings never fully recovered during the 5-year follow-up. Disposable income was practically unaltered. The probability of work loss increased in the calendar year of diagnosis, from 29.8% to 25.3% the previous year to 83.3% and 84.4% for colon and rectal cancer patients respectively, and never fully recovered. The probability of work loss was similar between colon and rectal cancer survivors, but was higher among patients with rectal cancer who had received neoadjuvant therapy.</p><p><strong>Interpretation: </strong>This study shows that despite an extensive welfare system providing maintained disposable income, there is a financial burden in the form of increased risk of work loss and a reduction in earnings among survivors of colorectal cancer.</p><p><strong>Funding: </strong>The study was supported by the Swedish Cancer Society, the Swedish Cancer and Allergy Foundation, and the Stockholm Cancer Society, and supported by grants provided by the Regional Agreement on Medical Training and Clinical Research (ALF) between the Stockholm County Council and Karolinska Institutet.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"75 ","pages":"102770"},"PeriodicalIF":9.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11359760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05eCollection Date: 2024-09-01DOI: 10.1016/j.eclinm.2024.102771
Bengt Glimelius, Tanweera Khan, Karin Adolfsson, Eva Angenete, Åke Berglund, Kristina Bonde, Nils Elander, Tone Fokstuen, Johan Haux, Israa Imam, Cecilia Lagerbäck, Ingrid Ljuslinder, Andrzej Piwowar, Marie Zajicova, Per J Nilsson
Background: Total neoadjuvant treatment (TNT) for locally advanced rectal cancer (LARC) increases pathologic complete response (pCR) rate and reduces the risk of systemic recurrences over chemoradiotherapy (CRT) in randomised trials, e.g., the RAPIDO trial. A modified RAPIDO schedule was prospectively explored in Sweden to evaluate TNT in routine health care before the RAPIDO results were published.
Methods: Between July 2016 and June 2020, 273 patients with high-risk LARC (clinical tumour stage cT4, clinical nodal stage cN2, extramural vascular invasion, involved mesorectal fascia or enlarged lateral lymph nodes) were treated in a prospective observational cohort study at 16 hospitals (LARCT-US). Another 189 patients at 18 (including the 16) hospitals were similarly treated (ad modum LARCT-US, AdmL) during the same period. Inclusion and exclusion criteria were identical to the RAPIDO trial. Patients received short-course radiotherapy (5 × 5 Gy for 5 days) followed by four cycles of CAPOX or six FOLFOX-6, followed by total mesorectal excision or, if clinical complete response (cCR), inclusion into a watch-and-wait (W&W) study. The primary endpoint was complete response (CR), i.e., the sum of pCR in specimens and cCR exceeding one year in W&W patients. Safety was assessed in all patients.
Findings: Compared to the RAPIDO trial, patients were older, and tumours more advanced. Median follow-up was 4.8 years (IQR 4.2-5.2). In LARCT-US all patients received radiotherapy and 268 (98%) started chemotherapy whereas in AdmL all patients received radiotherapy and chemotherapy. In LARCT-US 34 patients had pCR and 31 sustained cCR resulting in a CR-rate of 24% (95% CI 20-28). In AdmL, results were similar (23%, 95% CI 17-30). Locoregional recurrences were 6% (95% CI 4-10) and 5% (95% CI 2-9), respectively, both at 3 years and at last follow-up. Neurotoxicity, recorded in LARCT-US, was lower than in RAPIDO (EORTC-QLQ-CIPN20 tingling toes or feet mean score 24 (SD 31) vs 43 (SD 37)). One treatment-associated death occurred.
Interpretation: Despite older patients and more advanced tumours, results similar to the RAPIDO trial were obtained. Hence, two chemotherapy cycles less do not compromise the results maintaining a high CR-rate. This TNT schedule resulted in favourable outcomes in a nation-wide real-life situation.
Funding: Swedish Cancer Society.
背景:在RAPIDO试验等随机试验中,局部晚期直肠癌(LARC)的全新辅助治疗(TNT)与化放疗(CRT)相比,可提高病理完全反应率(pCR)并降低全身复发风险。在RAPIDO结果公布之前,瑞典对修改后的RAPIDO计划进行了前瞻性探索,以评估TNT在常规医疗保健中的应用:方法:2016 年 7 月至 2020 年 6 月期间,一项前瞻性观察性队列研究(LARCT-US)在 16 家医院对 273 例高风险 LARC 患者(临床肿瘤分期 cT4、临床结节分期 cN2、壁外血管侵犯、累及直肠间筋膜或外侧淋巴结肿大)进行了治疗。同期,18 家医院(包括这 16 家医院)的另外 189 名患者也接受了类似治疗(ad modum LARCT-US,AdmL)。纳入和排除标准与 RAPIDO 试验相同。患者先接受短程放疗(5 × 5 Gy,5 天),然后接受四个周期的 CAPOX 或六个周期的 FOLFOX-6,最后进行全直肠系膜切除术,如果出现临床完全反应(cCR),则纳入观察和等待(W&W)研究。主要终点是完全反应(CR),即标本中的 pCR 和 W&W 患者超过一年的 cCR 之和。对所有患者进行了安全性评估:与RAPIDO试验相比,患者年龄更大,肿瘤更晚期。中位随访时间为4.8年(IQR为4.2-5.2)。在LARCT-US试验中,所有患者都接受了放疗,268名患者(98%)开始接受化疗,而在AdmL试验中,所有患者都接受了放疗和化疗。在LARCT-US中,34名患者获得pCR,31名患者持续获得cCR,CR率为24%(95% CI 20-28)。AdmL的结果类似(23%,95% CI 17-30)。3年后和最后一次随访时,局部复发率分别为6%(95% CI 4-10)和5%(95% CI 2-9)。LARCT-US记录的神经毒性低于RAPIDO(EORTC-QLQ-CIPN20脚趾或脚趾刺痛平均得分为24(标度31) vs 43(标度37))。发生了一起与治疗相关的死亡事件:尽管患者年龄更大、肿瘤更晚期,但仍获得了与RAPIDO试验相似的结果。因此,减少两个化疗周期并不会影响维持高CR率的结果。这种TNT方案在全国范围内的实际情况中取得了良好的效果:瑞典癌症协会。
{"title":"Total neoadjuvant treatment using short-course radiotherapy and four CAPOX cycles in locally advanced rectal cancer with high-risk criteria for recurrence: a Swedish nationwide cohort study (LARCT-US).","authors":"Bengt Glimelius, Tanweera Khan, Karin Adolfsson, Eva Angenete, Åke Berglund, Kristina Bonde, Nils Elander, Tone Fokstuen, Johan Haux, Israa Imam, Cecilia Lagerbäck, Ingrid Ljuslinder, Andrzej Piwowar, Marie Zajicova, Per J Nilsson","doi":"10.1016/j.eclinm.2024.102771","DOIUrl":"10.1016/j.eclinm.2024.102771","url":null,"abstract":"<p><strong>Background: </strong>Total neoadjuvant treatment (TNT) for locally advanced rectal cancer (LARC) increases pathologic complete response (pCR) rate and reduces the risk of systemic recurrences over chemoradiotherapy (CRT) in randomised trials, e.g., the RAPIDO trial. A modified RAPIDO schedule was prospectively explored in Sweden to evaluate TNT in routine health care before the RAPIDO results were published.</p><p><strong>Methods: </strong>Between July 2016 and June 2020, 273 patients with high-risk LARC (clinical tumour stage cT4, clinical nodal stage cN2, extramural vascular invasion, involved mesorectal fascia or enlarged lateral lymph nodes) were treated in a prospective observational cohort study at 16 hospitals (LARCT-US). Another 189 patients at 18 (including the 16) hospitals were similarly treated (<i>ad modum</i> LARCT-US, AdmL) during the same period. Inclusion and exclusion criteria were identical to the RAPIDO trial. Patients received short-course radiotherapy (5 × 5 Gy for 5 days) followed by four cycles of CAPOX or six FOLFOX-6, followed by total mesorectal excision or, if clinical complete response (cCR), inclusion into a watch-and-wait (W&W) study. The primary endpoint was complete response (CR), i.e., the sum of pCR in specimens and cCR exceeding one year in W&W patients. Safety was assessed in all patients.</p><p><strong>Findings: </strong>Compared to the RAPIDO trial, patients were older, and tumours more advanced. Median follow-up was 4.8 years (IQR 4.2-5.2). In LARCT-US all patients received radiotherapy and 268 (98%) started chemotherapy whereas in AdmL all patients received radiotherapy and chemotherapy. In LARCT-US 34 patients had pCR and 31 sustained cCR resulting in a CR-rate of 24% (95% CI 20-28). In AdmL, results were similar (23%, 95% CI 17-30). Locoregional recurrences were 6% (95% CI 4-10) and 5% (95% CI 2-9), respectively, both at 3 years and at last follow-up. Neurotoxicity, recorded in LARCT-US, was lower than in RAPIDO (EORTC-QLQ-CIPN20 tingling toes or feet mean score 24 (SD 31) vs 43 (SD 37)). One treatment-associated death occurred.</p><p><strong>Interpretation: </strong>Despite older patients and more advanced tumours, results similar to the RAPIDO trial were obtained. Hence, two chemotherapy cycles less do not compromise the results maintaining a high CR-rate. This TNT schedule resulted in favourable outcomes in a nation-wide real-life situation.</p><p><strong>Funding: </strong>Swedish Cancer Society.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"75 ","pages":"102771"},"PeriodicalIF":9.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02eCollection Date: 2024-09-01DOI: 10.1016/j.eclinm.2024.102774
Anna Evans Phillips, Joseph Bejjani, Stacey Culp, Jennifer Chennat, Peter J Lee, Jorge D Machicado, Vikesh K Singh, Elham Afghani, Mitchell L Ramsey, Pedram Paragomi, Kimberly Stello, Melica Nikahd, Phil A Hart, Georgios I Papachristou
Background: Exocrine Pancreatic insufficiency (EPI) occurs following acute pancreatitis (AP) at variably reported rates and with unclear recovery timeline. The aim of this study was to establish the prevalence and predictors of EPI at 12 months after AP in a prospective cohort.
Methods: In this prospective, multicentre, longitudinal cohort study, adult participants (≥18 years) admitted to the hospital with an AP attack (defined by Revised Atlanta Classification) were enrolled in a United States multi-centre longitudinal cohort (Sites: The Ohio State University, University of Pittsburgh, and Johns Hopkins University). Patients were excluded if they had pancreatic cancer, chronic pancreatitis, or malabsorptive disease (including previously diagnosed EPI). Participant data was obtained by interview and by review of the electronic medical record. EPI was assessed by stool fecal elastase (FE-1) levels collected at baseline, 3 months, and 12 months (primary endpoint). EPI was defined by FE-1 <200 μg/g; severe FE-1 level ≤100 μg/g; mild FE-1 101-200 μg/g. Multivariable logistic regression was used to identify predictors of EPI at 12 months. This study is registered with ClinicalTrials.gov, NCT03063398.
Findings: EPI was observed in 29 (34.1%) of the 85 participants [44 (51.8%) male, mean age 54.7 ± 14.1 years] who provided stool samples at 12 months. For the study overall, participants were recruited between June 22, 2017 and October 18, 2021. A total of 5794 individuals were screened, 311 of whom were eligible for the study. 112 participants provided stool samples at baseline, 79 completed stool samples at 3 months, and 85 completed samples at 12 months. 64 participants included samples at all 3 timepoints. In univariable analysis, factors significantly associated with EPI at 12 months included recurrent (versus index) AP, pre-existing diabetes, alcohol, and idiopathic etiologies, and increasing severity of AP. In multivariable analysis, the odds of having EPI at 12 months increased 4-fold with idiopathic AP etiology (Odds Ratio 4.095, 95% Confidence Interval [CI] 1.418, 11.826), and 3-fold with moderately severe or severe AP (Odds Ratio 3.166, 95% CI 1.156, 8.670), and baseline diabetes mellitus (Odds Ratio 3.217, 95% CI 1.113, 9.298). Even individuals with an index mild attack of AP (n = 39) developed severe EPI at 12 months (prevalence 12.8%).
Interpretation: EPI as diagnosed by FE-1 is present in over one third of prospectively assessed patients at 12 months post-AP. Since EPI develops in patients with mild AP, investigations are needed to understand the mechanisms of injury and identify methods for tailored screening.
Funding: This study was supported by an Investigator Initiated Research Grant from AbbVie, Inc.
背景:急性胰腺炎(AP)后会出现胰腺外分泌功能不全(EPI),报告的发生率各不相同,恢复时间也不明确。本研究的目的是在前瞻性队列中确定急性胰腺炎后 12 个月 EPI 的发生率和预测因素:俄亥俄州立大学、匹兹堡大学和约翰霍普金斯大学)。如果患者患有胰腺癌、慢性胰腺炎或消化不良性疾病(包括之前诊断出的 EPI),则排除在外。通过访谈和查阅电子病历获得参与者的数据。EPI 通过基线、3 个月和 12 个月(主要终点)收集的粪便弹性蛋白酶 (FE-1) 水平进行评估。EPI 的定义是 FE-1 检测结果:在 85 名参与者中,有 29 人(34.1%)在 12 个月时提供了粪便样本,其中 44 人(51.8%)为男性,平均年龄为 54.7 ± 14.1 岁。就整个研究而言,参与者是在 2017 年 6 月 22 日至 2021 年 10 月 18 日期间招募的。共筛选出 5794 人,其中 311 人符合研究条件。112 名参与者在基线时提供了粪便样本,79 人在 3 个月时完成了粪便样本,85 人在 12 个月时完成了样本。64 名参与者在所有 3 个时间点都提供了样本。在单变量分析中,与 12 个月时 EPI 显著相关的因素包括:复发性 AP(相对于指数性 AP)、原有糖尿病、酒精、特发性病因以及 AP 的严重程度增加。在多变量分析中,特发性 AP 病因导致 12 个月后出现 EPI 的几率增加了 4 倍(Odds Ratio 4.095,95% 置信区间 [CI] 1.418,11.826),中度或重度 AP 增加了 3 倍(Odds Ratio 3.166,95% CI 1.156,8.670),基线糖尿病增加了 3 倍(Odds Ratio 3.217,95% CI 1.113,9.298)。即使是指数为轻度发作的 AP 患者(n = 39)也会在 12 个月后发展为重度 EPI(发病率为 12.8%):解释:在 AP 后 12 个月的前瞻性评估中,超过三分之一的患者出现了由 FE-1 诊断的 EPI。由于轻度 AP 患者也会出现 EPI,因此需要进行调查以了解损伤机制并确定有针对性的筛查方法:本研究由艾伯维公司(AbbVie, Inc.
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<p><strong>Background: </strong>Internet exclusion and depressive symptoms are prevalent phenomena among older adults; however, the association between internet exclusion and depressive symptoms remains limited. This study aims to investigate the association between internet exclusion and depressive symptoms among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>We conducted a comprehensive longitudinal, cross-cultural analysis, and the participants were adults aged 60 years and older from 32 countries participating in five nationally representative longitudinal cohort studies: the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Ageing Study (MHAS). Internet exclusion was defined as the self-reported absence from internet use. Depressive symptoms were evaluated using the Centre for Epidemiologic Studies of Depression scale (CES-D) or the Euro-Depression scale (Euro-D). These five cohorts, being heterogeneous, were respectively conducted with panel data analysis. Logistic regression, implemented within the generalized estimating equations framework, was used to examine the association between internet exclusion and the likelihood of experiencing depressive symptoms, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age, education, labour force status, household wealth level, marital status, co-residence with children, residence status, cognitive impairment, and functional ability.</p><p><strong>Findings: </strong>Our study included a total of 129,847 older adults during the period from 2010 to 2020, with a median follow-up of 5 (2, 7) years. The pooled proportion of internet exclusion was 46.0% in HRS, 32.6% in ELSA, 54.8% in SHARE, 92.3% in CHARLS, and 65.3% in MHAS. Internet exclusion was significantly associated with depressive symptoms across all cohort studies: HRS (OR = 1.13, 95% CI 1.07-1.20), ELSA (OR = 1.22, 95% CI 1.11-1.34), SHARE (OR = 1.55, 95% CI 1.47-1.62), CHARLS (OR = 1.49, 95% CI 1.26-1.77), and MHAS (OR = 1.48, 95% CI 1.39-1.58). Moreover, internet exclusion was found to be associated with all dimensions of depression in the SHARE, MHAS, and ELSA cohorts (except for sleep and felt sad) cohorts.</p><p><strong>Interpretation: </strong>A considerable proportion of older adults experienced internet exclusion, particularly those in LMICs. Internet exclusion among older adults, irrespective of their geographic location in HICs or LMICs, was associated with a higher likelihood of experiencing depressive symptoms, which demonstrated the importance of addressing barriers to internet access and promoting active participation in the internet society among older adults.</p><p><strong>Funding: </strong>National Key R&D P
背景:互联网排斥和抑郁症状是老年人中普遍存在的现象;然而,互联网排斥和抑郁症状之间的关联仍然有限。本研究旨在调查高收入国家(HICs)和中低收入国家(LMICs)老年人中互联网排斥与抑郁症状之间的关联:我们进行了一项全面的跨文化纵向分析,参与者是来自 32 个国家的 60 岁及以上的成年人,他们参与了五项具有国家代表性的纵向队列研究:健康与退休研究(HRS)、英国老龄化纵向研究(ELSA)、欧洲健康、老龄化与退休调查(SHARE)、中国健康与退休纵向研究(CHARLS)以及墨西哥健康与老龄化研究(MHAS)。互联网排斥的定义是自我报告没有使用互联网。抑郁症状采用抑郁流行病学研究中心量表(CES-D)或欧洲抑郁量表(Euro-D)进行评估。这五个队列具有异质性,因此分别采用了面板数据分析方法。在广义估计方程框架内实施的逻辑回归被用来研究互联网排斥与抑郁症状发生可能性之间的关系,并对因果导向-关联图(DAG)最小充分调整集(MSAS)进行调整,包括性别、年龄、教育程度、劳动力状况、家庭财富水平、婚姻状况、与子女同住、居住状况、认知障碍和功能能力:我们的研究在 2010 年至 2020 年期间共纳入了 129847 名老年人,中位随访时间为 5(2,7)年。在HRS、ELSA、SHARE、CHARLS和MHAS中,互联网排斥的总比例分别为46.0%、32.6%、54.8%、92.3%和65.3%。在所有队列研究中,网络排斥与抑郁症状均有明显关联:HRS(OR = 1.13,95% CI 1.07-1.20)、ELSA(OR = 1.22,95% CI 1.11-1.34)、SHARE(OR = 1.55,95% CI 1.47-1.62)、CHARLS(OR = 1.49,95% CI 1.26-1.77)和 MHAS(OR = 1.48,95% CI 1.39-1.58)。此外,在SHARE、MHAS和ELSA队列中(除睡眠和感到悲伤外),网络排斥与抑郁的所有方面都有关联:相当一部分老年人,尤其是低收入和中等收入国家的老年人,都有过被网络排斥的经历。无论老年人的地理位置是在高收入国家还是低收入国家,他们被互联网排斥都与出现抑郁症状的可能性较高有关,这表明了解决老年人上网障碍和促进他们积极参与互联网社会的重要性:国家重点研发计划(批准号:2022ZD0160704)、郑州大学第一附属医院科研创新团队(批准号:ZYCXTD2023005)、郑州市协同创新重大项目(批准号:20XTZX08017)、河南省医学科技联合项目(批准号:LHGJ20220428)、国家自然科学基金(批准号:82373341)。
{"title":"Association between internet exclusion and depressive symptoms among older adults: panel data analysis of five longitudinal cohort studies.","authors":"Rui Yan, Xinwei Liu, Ruyue Xue, Xiaoran Duan, Lifeng Li, Xianying He, Fangfang Cui, Jie Zhao","doi":"10.1016/j.eclinm.2024.102767","DOIUrl":"10.1016/j.eclinm.2024.102767","url":null,"abstract":"<p><strong>Background: </strong>Internet exclusion and depressive symptoms are prevalent phenomena among older adults; however, the association between internet exclusion and depressive symptoms remains limited. This study aims to investigate the association between internet exclusion and depressive symptoms among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>We conducted a comprehensive longitudinal, cross-cultural analysis, and the participants were adults aged 60 years and older from 32 countries participating in five nationally representative longitudinal cohort studies: the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Ageing Study (MHAS). Internet exclusion was defined as the self-reported absence from internet use. Depressive symptoms were evaluated using the Centre for Epidemiologic Studies of Depression scale (CES-D) or the Euro-Depression scale (Euro-D). These five cohorts, being heterogeneous, were respectively conducted with panel data analysis. Logistic regression, implemented within the generalized estimating equations framework, was used to examine the association between internet exclusion and the likelihood of experiencing depressive symptoms, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age, education, labour force status, household wealth level, marital status, co-residence with children, residence status, cognitive impairment, and functional ability.</p><p><strong>Findings: </strong>Our study included a total of 129,847 older adults during the period from 2010 to 2020, with a median follow-up of 5 (2, 7) years. The pooled proportion of internet exclusion was 46.0% in HRS, 32.6% in ELSA, 54.8% in SHARE, 92.3% in CHARLS, and 65.3% in MHAS. Internet exclusion was significantly associated with depressive symptoms across all cohort studies: HRS (OR = 1.13, 95% CI 1.07-1.20), ELSA (OR = 1.22, 95% CI 1.11-1.34), SHARE (OR = 1.55, 95% CI 1.47-1.62), CHARLS (OR = 1.49, 95% CI 1.26-1.77), and MHAS (OR = 1.48, 95% CI 1.39-1.58). Moreover, internet exclusion was found to be associated with all dimensions of depression in the SHARE, MHAS, and ELSA cohorts (except for sleep and felt sad) cohorts.</p><p><strong>Interpretation: </strong>A considerable proportion of older adults experienced internet exclusion, particularly those in LMICs. Internet exclusion among older adults, irrespective of their geographic location in HICs or LMICs, was associated with a higher likelihood of experiencing depressive symptoms, which demonstrated the importance of addressing barriers to internet access and promoting active participation in the internet society among older adults.</p><p><strong>Funding: </strong>National Key R&D P","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"75 ","pages":"102767"},"PeriodicalIF":9.6,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Premature ovarian failure (POF) is a prevalent and severe condition that impairs female health but there is currently no effective treatment available to restore ovarian function. Human amniotic epithelial cells (hAECs) exhibit ovarian protection in pre-clinical models. Thus, we conducted a single-arm, phase 1 clinical trial to assess the safety and efficacy of allogenic hAECs in treating POF.
Methods: A total of 35 patients received 6 × 107 hAECs via ovarian artery and completed a five-month follow-up from December 30, 2020 to January 31, 2022. The follow-up assessments were conducted at various intervals after hAECs treatment, including one month (Visit-1, V-1), three months (Visit-2, V-2), and five months (Visit-3, V-3) post-treatment. The primary endpoints were incidence of adverse events (AEs), and clinically significant laboratory abnormalities. Secondary endpoints included evaluation of transvaginal ultrasound results, sex hormone levels, Menopausal Quality of Life (MENQOL) questionnaire, as well as reproductive indicators. This trial was registered at www.clinicaltrials.gov as NCT02912104.
Findings: No serious AEs were observed throughout the five-month follow-up period. The most common AE was hematoma (7/35, 20.00%), and other AEs include pelvic pain (4/35, 11.43%), fever (2/35, 5.71%), anaphylaxis (2/35, 5.71%), and hepatotoxicity (1/35, 2.86%). After hAECs transplantation (hAECT), significant improvements were observed in the levels of endometrial thickness, left ovarian volume, sex hormones (follicle-stimulating hormone (FSH) and estradiol (E2)), and MENQOL scores in all patients during the five-month follow-up period. Among them, 13 participants (37.14%) experienced spontaneous menstrual bleeding, and 20.00% (7/35) reported more than one regular menstrual bleeding post-hAECT. In this response group, significant improvements were observed in endometrial thickness, left ovarian volume, levels of FSH, E2, anti-Müllerian hormone (AMH), and MENQOL scores one month after hAECT in comparison to pre-hAECT.
Interpretation: hAECT via ovarian artery is safe, well-tolerated and temporarily ameliorates endometrial thickness, ovarian size, hormone levels, and menopausal symptoms in POF patients. Further randomized controlled trial of hAECs with longer follow-up period and a larger sample size is warranted.
Funding: National Natural Science Foundation of China (No. 82271664), the Interdisciplinary Program of Shanghai Jiao Tong University (YG2022ZD028), the Shanghai Municipal Health Committee (202240345), Shanghai Key Laboratory of Embryo Original Diseases (No. Shelab2022ZD01), Shanghai Municipal Education Commission (No. 20152236), and National Key Research and Development Program of China (No. 2018YFC1004802), Shanghai Clinical Research Center for Cell Therapy, China (No. 23J41900100).
{"title":"Safety and efficacy of allogenic human amniotic epithelial cells transplantation via ovarian artery in patients with premature ovarian failure: a single-arm, phase 1 clinical trial.","authors":"Lichun Weng, Liutong Wei, Qiuwan Zhang, Taotao Sun, Xiaojun Kuang, Qin Huang, Yunyun Cao, Xiaoyi Liu, Qian Wang, Ying Guo, Junyan Sun, Lulu Wang, Haihong Tang, Haiou Yang, Qian Chen, Jian Zhang, Bingshun Wang, Zhaoxia Qian, Dongmei Lai","doi":"10.1016/j.eclinm.2024.102744","DOIUrl":"10.1016/j.eclinm.2024.102744","url":null,"abstract":"<p><strong>Background: </strong>Premature ovarian failure (POF) is a prevalent and severe condition that impairs female health but there is currently no effective treatment available to restore ovarian function. Human amniotic epithelial cells (hAECs) exhibit ovarian protection in pre-clinical models. Thus, we conducted a single-arm, phase 1 clinical trial to assess the safety and efficacy of allogenic hAECs in treating POF.</p><p><strong>Methods: </strong>A total of 35 patients received 6 × 10<sup>7</sup> hAECs via ovarian artery and completed a five-month follow-up from December 30, 2020 to January 31, 2022. The follow-up assessments were conducted at various intervals after hAECs treatment, including one month (Visit-1, V-1), three months (Visit-2, V-2), and five months (Visit-3, V-3) post-treatment. The primary endpoints were incidence of adverse events (AEs), and clinically significant laboratory abnormalities. Secondary endpoints included evaluation of transvaginal ultrasound results, sex hormone levels, Menopausal Quality of Life (MENQOL) questionnaire, as well as reproductive indicators. This trial was registered at www.clinicaltrials.gov as NCT02912104.</p><p><strong>Findings: </strong>No serious AEs were observed throughout the five-month follow-up period. The most common AE was hematoma (7/35, 20.00%), and other AEs include pelvic pain (4/35, 11.43%), fever (2/35, 5.71%), anaphylaxis (2/35, 5.71%), and hepatotoxicity (1/35, 2.86%). After hAECs transplantation (hAECT), significant improvements were observed in the levels of endometrial thickness, left ovarian volume, sex hormones (follicle-stimulating hormone (FSH) and estradiol (E2)), and MENQOL scores in all patients during the five-month follow-up period. Among them, 13 participants (37.14%) experienced spontaneous menstrual bleeding, and 20.00% (7/35) reported more than one regular menstrual bleeding post-hAECT. In this response group, significant improvements were observed in endometrial thickness, left ovarian volume, levels of FSH, E2, anti-Müllerian hormone (AMH), and MENQOL scores one month after hAECT in comparison to pre-hAECT.</p><p><strong>Interpretation: </strong>hAECT via ovarian artery is safe, well-tolerated and temporarily ameliorates endometrial thickness, ovarian size, hormone levels, and menopausal symptoms in POF patients. Further randomized controlled trial of hAECs with longer follow-up period and a larger sample size is warranted.</p><p><strong>Funding: </strong>National Natural Science Foundation of China (No. 82271664), the Interdisciplinary Program of Shanghai Jiao Tong University (YG2022ZD028), the Shanghai Municipal Health Committee (202240345), Shanghai Key Laboratory of Embryo Original Diseases (No. Shelab2022ZD01), Shanghai Municipal Education Commission (No. 20152236), and National Key Research and Development Program of China (No. 2018YFC1004802), Shanghai Clinical Research Center for Cell Therapy, China (No. 23J41900100).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"74 ","pages":"102744"},"PeriodicalIF":9.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11334649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29eCollection Date: 2024-08-01DOI: 10.1016/j.eclinm.2024.102781
Ben Burwood
{"title":"European Society of Human Reproduction and Embryology annual meeting 2024.","authors":"Ben Burwood","doi":"10.1016/j.eclinm.2024.102781","DOIUrl":"https://doi.org/10.1016/j.eclinm.2024.102781","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"74 ","pages":"102781"},"PeriodicalIF":9.6,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11334637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}