American journal of therapeutics最新文献

Background: Approximately 10% of adults and 7.6% of children in the United States have food allergies. Allergic reactions to foods can be life threatening, which requires patients and caregivers to be constantly diligent in avoiding foods that may trigger an immune-mediated event. Until recently, the only FDA-approved treatment for food allergy was oral immunotherapy (OIT), which involves daily ingestion of small doses of antigen to gradually build up a patient's tolerance. This therapy can be burdensome, requiring multiple office visits, and it is not without serious risk, including anaphylaxis. Anti-IgE therapy with omalizumab has recently been approved as an alternative to OIT to reduce the risk of allergic reaction associated with IgE-mediated food allergy.

Pharmacology: Omalizumab is an anti-IgE monoclonal antibody that has recently shown promising results for treating multiple food allergies in the first phase of the OUtMATCH clinical trial. This drug is administered by subcutaneous injection every 2-4 weeks based on a patient's weight and serum IgE levels. By binding and neutralizing serum IgE antibodies, omalizumab reduces the body's sensitivity to allergen exposure, allowing for an increased threshold dose of antigen exposure before an allergic reaction ensues.

Clinical trials: Small clinical trials of anti-IgE therapy for the management of food allergies have been reported since 2003. Monotherapy with omalizumab has been reported to increase the tolerance threshold to various foods, including peanut, cow's milk, egg, and wheat. When combined with OIT, small trials have demonstrated that omalizumab facilitated the speed of desensitization and reduced the risk of adverse allergic reactions compared with OIT alone. The OUtMATCH trial is the largest trial to date, and it has demonstrated that omalizumab significantly increases the threshold dose for experiencing an adverse allergic reaction among subjects with allergies to multiple foods, including peanuts, cashew, milk, egg, walnut, wheat, or hazelnut.

Therapeutic advance: Omalizumab is a novel treatment strategy for multiple food allergies. By increasing the tolerance to foods that induce allergies, patients may experience a reduced risk of immune-mediated reactions on accidental allergen exposure. Uncertainty remains about the ideal candidates for omalizumab, its comparative effectiveness, practical implementation, and long-term outcomes. Ongoing trials and future real-world data are expected to clarify these issues, including its impact on reducing anaphylaxis, ED visits, and hospitalizations. Patient-specific factors and available options should be discussed with the patient in the shared decision process as an essential component in choosing the therapeutic strategy.

Background: Antipsychotic medications are prescribed in the pediatric population for various psychiatric conditions, such as schizophrenia, autism spectrum disorder, mood disorders, and other disruptive behaviors. However, the use of antipsychotic medications, particularly atypical antipsychotic medications, has raised concerns because of their potential to cause weight gain.

Study questions: This review aims to compare the effects of different antipsychotic medications on weight gain in children and adolescents, particularly patients with childhood-onset schizophrenia, after 6-8 weeks of antipsychotic treatment.

Study design: We searched 5 online databases. Seventeen articles were included with 1360 participants being enrolled.

Measures and outcomes: Meta-insight was used for network meta-analysis. We used body weight gain (kilogram) collected in the included studies for calculation.

Results: Olanzapine caused the most significant weight gain. The ranking of clozapine is not as high as in adult studies. In contrast, molindone may actually reduce weight. Weight gain in patients with schizophrenia is more clinically significant than in the whole participants.

Conclusions: Our study indicated the effects of different antipsychotic medications on body weight gain among children. Childhood-onset schizophrenia may represent a more vulnerable group. Future studies exploring genetic and physiologic risk factors for weight gain, and potential preventive strategies, are needed.

Introduction: A substantial number of patients undergoing transcatheter aortic valve replacement (TAVR) require long-term oral anticoagulants (OAC) owing to comorbidities. This study examined whether continuing oral anticoagulation periprocedurally during TAVR is as safe and effective as interrupting it.

Methods: A systematic search of the major databases was performed to identify relevant studies. Effect estimates were calculated using risk ratios (RR) and 95% CIs by pooling the data using the inverse-variance random effects model. Statistical significance was set at P < 0.05.

Results: Four studies were included, with 2962 patients undergoing TAVR with continued OAC (n = 1318) and interrupted OAC (n = 1644). The pooled analysis demonstrated that TAVR with continued OAC had comparable risks for all-cause mortality (RR: 0.91; 95% CI, 0.62-1.34; P = 0.64), cardiovascular mortality (RR: 0.89; 95% CI, 0.43-1.84; P = 0.76), stroke (RR: 0.67; 95% CI, 0.42-1.08; P = 0.09), closure device failure (RR: 0.86; 95% CI, 0.47-1.59; P = 0.64), major/life-threatening bleeding (RR: 0.93; 95% CI, 0.74-1.15; P = 0.49), and major vascular complications (RR: 0.97; 95% CI, 0.79-1.20; P = 0.80) compared with TAVR with interrupted OAC.

Conclusions: In patients undergoing TAVR, continued OAC showed comparable safety and efficacy with interrupted OAC. These findings demonstrate that continuing OAC in the periprocedural period may be a viable option in patients with atrial fibrillation because of comorbidities requiring anticoagulants.