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VIDEO: Ovarian function is exciting possible CV risk marker
HONOLULU– A woman’s ovarian “clock” is dissociated from her general health, according to widely accepted thinking – but a new study has suggested the opposite.
That study showed greater cardiovascular risk in women with markers of greater ovarian aging. Dr. Marcelle I. Cedars of the University of California, San Francisco, and her associates presented the results at the annual meeting of the American Society for Reproductive Medicine, where the study won an award.
In a video interview, the society’s vice president, Dr. Owen K. Davis, described the potential significance of the study.
Women with cardiovascular disease tend to get diagnosed later and have worse outcomes, compared with men. If markers of ovarian function can help identify cardiovascular risk earlier in some women, the women may be candidates for more intensive surveillance, said Dr. Davis, professor of ob.gyn. and reproductive medicine at Weill Cornell Medical College, New York.
Dr. Davis reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
HONOLULU– A woman’s ovarian “clock” is dissociated from her general health, according to widely accepted thinking – but a new study has suggested the opposite.
That study showed greater cardiovascular risk in women with markers of greater ovarian aging. Dr. Marcelle I. Cedars of the University of California, San Francisco, and her associates presented the results at the annual meeting of the American Society for Reproductive Medicine, where the study won an award.
In a video interview, the society’s vice president, Dr. Owen K. Davis, described the potential significance of the study.
Women with cardiovascular disease tend to get diagnosed later and have worse outcomes, compared with men. If markers of ovarian function can help identify cardiovascular risk earlier in some women, the women may be candidates for more intensive surveillance, said Dr. Davis, professor of ob.gyn. and reproductive medicine at Weill Cornell Medical College, New York.
Dr. Davis reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
HONOLULU– A woman’s ovarian “clock” is dissociated from her general health, according to widely accepted thinking – but a new study has suggested the opposite.
That study showed greater cardiovascular risk in women with markers of greater ovarian aging. Dr. Marcelle I. Cedars of the University of California, San Francisco, and her associates presented the results at the annual meeting of the American Society for Reproductive Medicine, where the study won an award.
In a video interview, the society’s vice president, Dr. Owen K. Davis, described the potential significance of the study.
Women with cardiovascular disease tend to get diagnosed later and have worse outcomes, compared with men. If markers of ovarian function can help identify cardiovascular risk earlier in some women, the women may be candidates for more intensive surveillance, said Dr. Davis, professor of ob.gyn. and reproductive medicine at Weill Cornell Medical College, New York.
Dr. Davis reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
EXPERT ANALYSIS FROM ASRM 2014
Ovarian aging may be tip-off for cardiovascular risk
HONOLULU – Women with greater ovarian reserve had lower cardiovascular risk in a prospective study of 1,092 healthy, ovulating women aged 25-45 years, 250 of whom were followed for 3-5 years.
Measures of ovarian aging at baseline were inversely correlated with measures of systemic cellular aging. At the follow-up assessment, women who’d had lower ovarian reserve at baseline were more likely to have higher Framingham Heart Study assessment scores predicting increased risk for cardiovascular events.
“The ovary may be particularly sensitive to cellular aging” and could provide a relatively simple, objective way to identify long-term cardiovascular risk earlier in some women, Dr. Marcelle I. Cedars said at the annual meeting of the American Society for Reproductive Medicine.
She and her associates tested the women for anti-Müllerian hormone levels (AMH) and antral follicle counts (AFC) as markers of ovarian reserve. They assessed cellular aging by examining telomere length and mitochondrial DNA copy numbers in circulating white blood cells as biomarkers of cellular senescence. Shorter telomere length has been associated with worse cardiovascular risk in previous studies, she noted. The current study also measured lipid levels, fasting glucose, insulin levels, body mass index, waist circumference, and blood pressure.
Women with higher AFC and AMH at baseline had healthier lipid profiles at follow-up 3-5 years later, reported Dr. Cedars, director of the division of reproductive endocrinology and of the Center for Reproductive Health at the University of California, San Francisco. The upper 10th percentile of AFC levels were associated with significantly longer telomeres and significantly lower numbers of mitochondrial DNA copies, compared with the lowest 10th percentile of AFC.
Women with higher AFC or AMH at baseline had significantly lower Framingham risk scores at follow-up, compared with women with low AFC or average AFC, she said. The Framingham scores at follow-up showed a 10-year risk of MI of 2.1% in women in the low AFC tertiles, 1.3% in women in middle AFC tertiles, and 1.1% in women in high AFC tertiles.
The difference in cardiovascular risk level was statistically significant between the high and low tertiles for AFC and between the middle and low tertiles for AFC. For AMH levels, the difference in cardiovascular risk was significant between high and low tertiles, between high and middle tertiles, and between middle and low tertiles.
The ovary’s sensitivity to oxidative stress and telomere shortening plus the need for functional mitochondrial DNA in the oocyte may underlie the process that makes ovarian age a potential window onto cardiovascular risk, the investigators hypothesized.
Previous studies have shown that women with cardiovascular disease tend to be diagnosed later and generally to have a worse prognosis, compared with men, Dr. Cedars said. Using ovarian “age” as a window onto cardiovascular risk might help close that gap, she suggested.
Dr. Cedars reported financial associations with Nora Therapeutics, Ferring Pharmaceuticals, and the founders of Telome Health, a company that measures telomere length.
On Twitter @sherryboschert
This study supports the systemic view of reproductive health in the context of one’s overall health. Ovarian aging is something that can be measured fairly easily and it could become a useful way to identify women at particular risk for cardiovascular disease. Because women are typically diagnosed later in the course of their cardiovascular disease and have a worse prognosis than men, new ways to earlier identify women at particular risk could help improve outcomes for them.
Dr. Rebecca Z. Sokol is president of the American Society for Reproductive Medicine. She gave these comments in a statement released by the society, which said that she has no financial disclosures.
This study supports the systemic view of reproductive health in the context of one’s overall health. Ovarian aging is something that can be measured fairly easily and it could become a useful way to identify women at particular risk for cardiovascular disease. Because women are typically diagnosed later in the course of their cardiovascular disease and have a worse prognosis than men, new ways to earlier identify women at particular risk could help improve outcomes for them.
Dr. Rebecca Z. Sokol is president of the American Society for Reproductive Medicine. She gave these comments in a statement released by the society, which said that she has no financial disclosures.
This study supports the systemic view of reproductive health in the context of one’s overall health. Ovarian aging is something that can be measured fairly easily and it could become a useful way to identify women at particular risk for cardiovascular disease. Because women are typically diagnosed later in the course of their cardiovascular disease and have a worse prognosis than men, new ways to earlier identify women at particular risk could help improve outcomes for them.
Dr. Rebecca Z. Sokol is president of the American Society for Reproductive Medicine. She gave these comments in a statement released by the society, which said that she has no financial disclosures.
HONOLULU – Women with greater ovarian reserve had lower cardiovascular risk in a prospective study of 1,092 healthy, ovulating women aged 25-45 years, 250 of whom were followed for 3-5 years.
Measures of ovarian aging at baseline were inversely correlated with measures of systemic cellular aging. At the follow-up assessment, women who’d had lower ovarian reserve at baseline were more likely to have higher Framingham Heart Study assessment scores predicting increased risk for cardiovascular events.
“The ovary may be particularly sensitive to cellular aging” and could provide a relatively simple, objective way to identify long-term cardiovascular risk earlier in some women, Dr. Marcelle I. Cedars said at the annual meeting of the American Society for Reproductive Medicine.
She and her associates tested the women for anti-Müllerian hormone levels (AMH) and antral follicle counts (AFC) as markers of ovarian reserve. They assessed cellular aging by examining telomere length and mitochondrial DNA copy numbers in circulating white blood cells as biomarkers of cellular senescence. Shorter telomere length has been associated with worse cardiovascular risk in previous studies, she noted. The current study also measured lipid levels, fasting glucose, insulin levels, body mass index, waist circumference, and blood pressure.
Women with higher AFC and AMH at baseline had healthier lipid profiles at follow-up 3-5 years later, reported Dr. Cedars, director of the division of reproductive endocrinology and of the Center for Reproductive Health at the University of California, San Francisco. The upper 10th percentile of AFC levels were associated with significantly longer telomeres and significantly lower numbers of mitochondrial DNA copies, compared with the lowest 10th percentile of AFC.
Women with higher AFC or AMH at baseline had significantly lower Framingham risk scores at follow-up, compared with women with low AFC or average AFC, she said. The Framingham scores at follow-up showed a 10-year risk of MI of 2.1% in women in the low AFC tertiles, 1.3% in women in middle AFC tertiles, and 1.1% in women in high AFC tertiles.
The difference in cardiovascular risk level was statistically significant between the high and low tertiles for AFC and between the middle and low tertiles for AFC. For AMH levels, the difference in cardiovascular risk was significant between high and low tertiles, between high and middle tertiles, and between middle and low tertiles.
The ovary’s sensitivity to oxidative stress and telomere shortening plus the need for functional mitochondrial DNA in the oocyte may underlie the process that makes ovarian age a potential window onto cardiovascular risk, the investigators hypothesized.
Previous studies have shown that women with cardiovascular disease tend to be diagnosed later and generally to have a worse prognosis, compared with men, Dr. Cedars said. Using ovarian “age” as a window onto cardiovascular risk might help close that gap, she suggested.
Dr. Cedars reported financial associations with Nora Therapeutics, Ferring Pharmaceuticals, and the founders of Telome Health, a company that measures telomere length.
On Twitter @sherryboschert
HONOLULU – Women with greater ovarian reserve had lower cardiovascular risk in a prospective study of 1,092 healthy, ovulating women aged 25-45 years, 250 of whom were followed for 3-5 years.
Measures of ovarian aging at baseline were inversely correlated with measures of systemic cellular aging. At the follow-up assessment, women who’d had lower ovarian reserve at baseline were more likely to have higher Framingham Heart Study assessment scores predicting increased risk for cardiovascular events.
“The ovary may be particularly sensitive to cellular aging” and could provide a relatively simple, objective way to identify long-term cardiovascular risk earlier in some women, Dr. Marcelle I. Cedars said at the annual meeting of the American Society for Reproductive Medicine.
She and her associates tested the women for anti-Müllerian hormone levels (AMH) and antral follicle counts (AFC) as markers of ovarian reserve. They assessed cellular aging by examining telomere length and mitochondrial DNA copy numbers in circulating white blood cells as biomarkers of cellular senescence. Shorter telomere length has been associated with worse cardiovascular risk in previous studies, she noted. The current study also measured lipid levels, fasting glucose, insulin levels, body mass index, waist circumference, and blood pressure.
Women with higher AFC and AMH at baseline had healthier lipid profiles at follow-up 3-5 years later, reported Dr. Cedars, director of the division of reproductive endocrinology and of the Center for Reproductive Health at the University of California, San Francisco. The upper 10th percentile of AFC levels were associated with significantly longer telomeres and significantly lower numbers of mitochondrial DNA copies, compared with the lowest 10th percentile of AFC.
Women with higher AFC or AMH at baseline had significantly lower Framingham risk scores at follow-up, compared with women with low AFC or average AFC, she said. The Framingham scores at follow-up showed a 10-year risk of MI of 2.1% in women in the low AFC tertiles, 1.3% in women in middle AFC tertiles, and 1.1% in women in high AFC tertiles.
The difference in cardiovascular risk level was statistically significant between the high and low tertiles for AFC and between the middle and low tertiles for AFC. For AMH levels, the difference in cardiovascular risk was significant between high and low tertiles, between high and middle tertiles, and between middle and low tertiles.
The ovary’s sensitivity to oxidative stress and telomere shortening plus the need for functional mitochondrial DNA in the oocyte may underlie the process that makes ovarian age a potential window onto cardiovascular risk, the investigators hypothesized.
Previous studies have shown that women with cardiovascular disease tend to be diagnosed later and generally to have a worse prognosis, compared with men, Dr. Cedars said. Using ovarian “age” as a window onto cardiovascular risk might help close that gap, she suggested.
Dr. Cedars reported financial associations with Nora Therapeutics, Ferring Pharmaceuticals, and the founders of Telome Health, a company that measures telomere length.
On Twitter @sherryboschert
AT THE ASRM ANNUAL MEETING
Key clinical point: “Older” ovaries were associated with increased cardiovascular risk.
Major finding: The 10-year risk of MI was 2.1% in women in the lowest tertiles of AFC, 1.3% in middle tertiles, and 1.1% in high tertiles.
Data source: Prospective measures of ovarian reserve in 1,092 healthy women and cardiovascular risk assessments on 250 at 3-5 years.
Disclosures: Dr. Cedars reported financial associations with Nora Therapeutics, Ferring Pharmaceuticals, and the founders of Telome Health, a company that measures telomere length.
Clomiphene bests letrozole, gonadotropins for ovarian stimulation
Using clomiphene citrate for ovarian stimulation led to a higher live birth rate, compared with using letrozole, and a lower multiple gestation rate, compared with using gonadotropins, in a randomized, multicenter trial in 900 women.
The rate of multiple gestations was roughly eight times higher among the 300 women randomized to ovarian stimulation with gonadotropins (10.3%) than among the 301 women who received clomiphene (1.3%) and fourfold higher than among the 299 women who received letrozole (2.7%), Dr. Michael P. Diamond and his associates reported at the 2014 annual meeting of the American Society for Reproductive Medicine.
The rate of conception was significantly lower in the letrozole group (28%), compared with the clomiphene group (35%) or the gonadotropins group (46%). Clinical pregnancies occurred in 22% of patients in the letrozole group, 28% in the clomiphene group, and 36% in the gonadotropin group (Fertil. Steril. 2014;102:e3 [doi:http://dx.doi.org/10.1016/j.fertnstert.2014.07.140]). Live births occurred in 19% of cycles in the letrozole group, 23% of cycles in the clomiphene group, and 32% of cycles in the gonadotropins group.
Clomiphene for ovarian stimulation followed by intrauterine insemination “remains a first-line therapy for couples with unexplained fertility wishing to conceive, in that it offers a balance of achieving clinical pregnancies with a lower multiple pregnancy rate,” said Dr. Diamond, professor and the William H. Brooks, M.D., Distinguished Chair in Obstetrics and Gynecology at Georgia Regents University, Augusta.
The investigators had hoped that using letrozole might result in fewer multiple gestations without worsening the live birth rate.
Among women in whom fetal heart rates could be identified, rates of multiple gestations were not significantly different in those who received letrozole (9 of 67, or 13%) and those who got clomiphene (8 of 85, or 9%), although the rates were significantly lower than that seen with gonadotropins (35 of 107, or 32% ).
Stimulation with gonadotropins produced 10 triplet gestations and 24 sets of twins, while all multiples in the letrozole and clomiphene groups were twins. The drugs appeared to be equally safe, with congenital anomalies occurring in 3% of infants in the clomiphene group and 4% in the letrozole and gonadotropins groups. Rates of other adverse events also were similar between groups.
The study included women aged 18-40 years having at least one patent fallopian tube and a minimum of nine spontaneous menstrual periods per year. Standardized protocols for administration and withholding of HCG (human chorionic gonadotropin) were followed in each group. Baseline characteristics of the patients were similar between groups.
Ovarian stimulation started on cycle day 3-5 with an initial cycle dosage of 5.0 mg/day of letrozole, 100 mg/day of clomiphene, or 150 IU/day of gonadotropin. The dosage could be adjusted for subsequent cycles in women who did not conceive in the initial cycle. All women underwent intrauterine insemination within 40 hours of HCG administration.
Patients’ baseline characteristics were similar between groups.
Although the findings support clomiphene as a first-line ovarian stimulation strategy, “revisions to current insurance reimbursement policies in most states will likely be required before couples are willing to reduce use of gonadotropins for ovarian stimulation,” Dr. Diamond said.
The National Institutes of Health and the National Institute of Child Health and Human Development funded the study. Dr. Diamond reported financial associations with Advanced Reproductive Care, Teijin Pharma, Auxogyn, ZSX Medical, Actamax Surgical Materials, AbbVie, and EMD Serono.
On Twitter @sherryboschert
The optimal treatment of unexplained infertility remains controversial. The objective of this trial was to compare directly the three most commonly used medications for ovulation induction or ovarian stimulation in couples with unexplained infertility – by using injectable gonadotropin medications, the aromatase inhibitor letrozole, or clomiphene citrate (Clomid). All couples also underwent intrauterine insemination.
To me, the somewhat-surprising result was that letrozole seemed to have a lower live birth rate than either clomiphene or gonadotropin injections. This is in contrast to a recent study looking at women with polycystic ovarian syndrome, in which letrozole was found to be slightly superior to clomiphene for ovulation induction and pregnancies in that population. I guess it just shows the complexity of treating infertility, that a drug that worked well in one condition maybe isn’t the optimal choice in another population of patients.
Among women who already are ovulating and simply have unexplained infertility, it would appear that use of either clomiphene or gonadotropin injections would be the preferred means of stimulating the ovary prior to intrauterine insemination.
However, the gonadotropin injections also were associated with quite a high multiple birth rate in this study. The final conclusion was that perhaps the best starting strategy for couples with unexplained infertility would be clomiphene and intrauterine insemination.
This doesn’t really change my practice. It reinforces what I do and what many infertility doctors do, which is to start with clomiphene and intrauterine insemination as a first-line therapy. It’s probably not a big surprise to most reproductive endocrinologists that with the use of gonadotropin injections and intrauterine insemination, there was a trend toward a higher pregnancy rate in that arm, but the rate of multiple gestation is a well-known complication of that therapy. I’ve never used that as a first-line therapy anyway, and this study reinforces that belief.
It does suggest to me that, although in the past I might have used letrozole or clomiphene kind of interchangeably in unexplained infertile patients, Clomiphene may be the preferred option for those patients. The main surprising thing in this study was the inferiority of letrozole.
Dr. Bradley J. Van Voorhis is professor of obstetrics and gynecology at the University of Iowa, Iowa City. He reported having no financial disclosures.
The optimal treatment of unexplained infertility remains controversial. The objective of this trial was to compare directly the three most commonly used medications for ovulation induction or ovarian stimulation in couples with unexplained infertility – by using injectable gonadotropin medications, the aromatase inhibitor letrozole, or clomiphene citrate (Clomid). All couples also underwent intrauterine insemination.
To me, the somewhat-surprising result was that letrozole seemed to have a lower live birth rate than either clomiphene or gonadotropin injections. This is in contrast to a recent study looking at women with polycystic ovarian syndrome, in which letrozole was found to be slightly superior to clomiphene for ovulation induction and pregnancies in that population. I guess it just shows the complexity of treating infertility, that a drug that worked well in one condition maybe isn’t the optimal choice in another population of patients.
Among women who already are ovulating and simply have unexplained infertility, it would appear that use of either clomiphene or gonadotropin injections would be the preferred means of stimulating the ovary prior to intrauterine insemination.
However, the gonadotropin injections also were associated with quite a high multiple birth rate in this study. The final conclusion was that perhaps the best starting strategy for couples with unexplained infertility would be clomiphene and intrauterine insemination.
This doesn’t really change my practice. It reinforces what I do and what many infertility doctors do, which is to start with clomiphene and intrauterine insemination as a first-line therapy. It’s probably not a big surprise to most reproductive endocrinologists that with the use of gonadotropin injections and intrauterine insemination, there was a trend toward a higher pregnancy rate in that arm, but the rate of multiple gestation is a well-known complication of that therapy. I’ve never used that as a first-line therapy anyway, and this study reinforces that belief.
It does suggest to me that, although in the past I might have used letrozole or clomiphene kind of interchangeably in unexplained infertile patients, Clomiphene may be the preferred option for those patients. The main surprising thing in this study was the inferiority of letrozole.
Dr. Bradley J. Van Voorhis is professor of obstetrics and gynecology at the University of Iowa, Iowa City. He reported having no financial disclosures.
The optimal treatment of unexplained infertility remains controversial. The objective of this trial was to compare directly the three most commonly used medications for ovulation induction or ovarian stimulation in couples with unexplained infertility – by using injectable gonadotropin medications, the aromatase inhibitor letrozole, or clomiphene citrate (Clomid). All couples also underwent intrauterine insemination.
To me, the somewhat-surprising result was that letrozole seemed to have a lower live birth rate than either clomiphene or gonadotropin injections. This is in contrast to a recent study looking at women with polycystic ovarian syndrome, in which letrozole was found to be slightly superior to clomiphene for ovulation induction and pregnancies in that population. I guess it just shows the complexity of treating infertility, that a drug that worked well in one condition maybe isn’t the optimal choice in another population of patients.
Among women who already are ovulating and simply have unexplained infertility, it would appear that use of either clomiphene or gonadotropin injections would be the preferred means of stimulating the ovary prior to intrauterine insemination.
However, the gonadotropin injections also were associated with quite a high multiple birth rate in this study. The final conclusion was that perhaps the best starting strategy for couples with unexplained infertility would be clomiphene and intrauterine insemination.
This doesn’t really change my practice. It reinforces what I do and what many infertility doctors do, which is to start with clomiphene and intrauterine insemination as a first-line therapy. It’s probably not a big surprise to most reproductive endocrinologists that with the use of gonadotropin injections and intrauterine insemination, there was a trend toward a higher pregnancy rate in that arm, but the rate of multiple gestation is a well-known complication of that therapy. I’ve never used that as a first-line therapy anyway, and this study reinforces that belief.
It does suggest to me that, although in the past I might have used letrozole or clomiphene kind of interchangeably in unexplained infertile patients, Clomiphene may be the preferred option for those patients. The main surprising thing in this study was the inferiority of letrozole.
Dr. Bradley J. Van Voorhis is professor of obstetrics and gynecology at the University of Iowa, Iowa City. He reported having no financial disclosures.
Using clomiphene citrate for ovarian stimulation led to a higher live birth rate, compared with using letrozole, and a lower multiple gestation rate, compared with using gonadotropins, in a randomized, multicenter trial in 900 women.
The rate of multiple gestations was roughly eight times higher among the 300 women randomized to ovarian stimulation with gonadotropins (10.3%) than among the 301 women who received clomiphene (1.3%) and fourfold higher than among the 299 women who received letrozole (2.7%), Dr. Michael P. Diamond and his associates reported at the 2014 annual meeting of the American Society for Reproductive Medicine.
The rate of conception was significantly lower in the letrozole group (28%), compared with the clomiphene group (35%) or the gonadotropins group (46%). Clinical pregnancies occurred in 22% of patients in the letrozole group, 28% in the clomiphene group, and 36% in the gonadotropin group (Fertil. Steril. 2014;102:e3 [doi:http://dx.doi.org/10.1016/j.fertnstert.2014.07.140]). Live births occurred in 19% of cycles in the letrozole group, 23% of cycles in the clomiphene group, and 32% of cycles in the gonadotropins group.
Clomiphene for ovarian stimulation followed by intrauterine insemination “remains a first-line therapy for couples with unexplained fertility wishing to conceive, in that it offers a balance of achieving clinical pregnancies with a lower multiple pregnancy rate,” said Dr. Diamond, professor and the William H. Brooks, M.D., Distinguished Chair in Obstetrics and Gynecology at Georgia Regents University, Augusta.
The investigators had hoped that using letrozole might result in fewer multiple gestations without worsening the live birth rate.
Among women in whom fetal heart rates could be identified, rates of multiple gestations were not significantly different in those who received letrozole (9 of 67, or 13%) and those who got clomiphene (8 of 85, or 9%), although the rates were significantly lower than that seen with gonadotropins (35 of 107, or 32% ).
Stimulation with gonadotropins produced 10 triplet gestations and 24 sets of twins, while all multiples in the letrozole and clomiphene groups were twins. The drugs appeared to be equally safe, with congenital anomalies occurring in 3% of infants in the clomiphene group and 4% in the letrozole and gonadotropins groups. Rates of other adverse events also were similar between groups.
The study included women aged 18-40 years having at least one patent fallopian tube and a minimum of nine spontaneous menstrual periods per year. Standardized protocols for administration and withholding of HCG (human chorionic gonadotropin) were followed in each group. Baseline characteristics of the patients were similar between groups.
Ovarian stimulation started on cycle day 3-5 with an initial cycle dosage of 5.0 mg/day of letrozole, 100 mg/day of clomiphene, or 150 IU/day of gonadotropin. The dosage could be adjusted for subsequent cycles in women who did not conceive in the initial cycle. All women underwent intrauterine insemination within 40 hours of HCG administration.
Patients’ baseline characteristics were similar between groups.
Although the findings support clomiphene as a first-line ovarian stimulation strategy, “revisions to current insurance reimbursement policies in most states will likely be required before couples are willing to reduce use of gonadotropins for ovarian stimulation,” Dr. Diamond said.
The National Institutes of Health and the National Institute of Child Health and Human Development funded the study. Dr. Diamond reported financial associations with Advanced Reproductive Care, Teijin Pharma, Auxogyn, ZSX Medical, Actamax Surgical Materials, AbbVie, and EMD Serono.
On Twitter @sherryboschert
Using clomiphene citrate for ovarian stimulation led to a higher live birth rate, compared with using letrozole, and a lower multiple gestation rate, compared with using gonadotropins, in a randomized, multicenter trial in 900 women.
The rate of multiple gestations was roughly eight times higher among the 300 women randomized to ovarian stimulation with gonadotropins (10.3%) than among the 301 women who received clomiphene (1.3%) and fourfold higher than among the 299 women who received letrozole (2.7%), Dr. Michael P. Diamond and his associates reported at the 2014 annual meeting of the American Society for Reproductive Medicine.
The rate of conception was significantly lower in the letrozole group (28%), compared with the clomiphene group (35%) or the gonadotropins group (46%). Clinical pregnancies occurred in 22% of patients in the letrozole group, 28% in the clomiphene group, and 36% in the gonadotropin group (Fertil. Steril. 2014;102:e3 [doi:http://dx.doi.org/10.1016/j.fertnstert.2014.07.140]). Live births occurred in 19% of cycles in the letrozole group, 23% of cycles in the clomiphene group, and 32% of cycles in the gonadotropins group.
Clomiphene for ovarian stimulation followed by intrauterine insemination “remains a first-line therapy for couples with unexplained fertility wishing to conceive, in that it offers a balance of achieving clinical pregnancies with a lower multiple pregnancy rate,” said Dr. Diamond, professor and the William H. Brooks, M.D., Distinguished Chair in Obstetrics and Gynecology at Georgia Regents University, Augusta.
The investigators had hoped that using letrozole might result in fewer multiple gestations without worsening the live birth rate.
Among women in whom fetal heart rates could be identified, rates of multiple gestations were not significantly different in those who received letrozole (9 of 67, or 13%) and those who got clomiphene (8 of 85, or 9%), although the rates were significantly lower than that seen with gonadotropins (35 of 107, or 32% ).
Stimulation with gonadotropins produced 10 triplet gestations and 24 sets of twins, while all multiples in the letrozole and clomiphene groups were twins. The drugs appeared to be equally safe, with congenital anomalies occurring in 3% of infants in the clomiphene group and 4% in the letrozole and gonadotropins groups. Rates of other adverse events also were similar between groups.
The study included women aged 18-40 years having at least one patent fallopian tube and a minimum of nine spontaneous menstrual periods per year. Standardized protocols for administration and withholding of HCG (human chorionic gonadotropin) were followed in each group. Baseline characteristics of the patients were similar between groups.
Ovarian stimulation started on cycle day 3-5 with an initial cycle dosage of 5.0 mg/day of letrozole, 100 mg/day of clomiphene, or 150 IU/day of gonadotropin. The dosage could be adjusted for subsequent cycles in women who did not conceive in the initial cycle. All women underwent intrauterine insemination within 40 hours of HCG administration.
Patients’ baseline characteristics were similar between groups.
Although the findings support clomiphene as a first-line ovarian stimulation strategy, “revisions to current insurance reimbursement policies in most states will likely be required before couples are willing to reduce use of gonadotropins for ovarian stimulation,” Dr. Diamond said.
The National Institutes of Health and the National Institute of Child Health and Human Development funded the study. Dr. Diamond reported financial associations with Advanced Reproductive Care, Teijin Pharma, Auxogyn, ZSX Medical, Actamax Surgical Materials, AbbVie, and EMD Serono.
On Twitter @sherryboschert
AT THE ASRM ANNUAL MEETING
Key clinical point: Clomiphene provided the best balance of live births and fewest multiple gestations, compared with letrozole or gonadotropins.
Major finding: Live birth rates were 19% of cycles with letrozole, 23% of cycles with clomiphene citrate, and 32% of cycles with gonadotropins.
Data source: A prospective, randomized, multicenter trial of the three most common ovarian stimulation strategies in 900 women with unexplained infertility.
Disclosures:Dr. Diamond reported financial associations with Advanced Reproductive Care, Teijin Pharma, Auxogyn, ZSX Medical, Actamax Surgical Materials, AbbVie, and EMD Serono.
Select biologics for dose escalation in psoriasis
SONOMA, CALIF.– Data support dosage escalation or intensification for patients who don’t respond to biologic therapy for psoriasis, but only for three of the four biologic agents available in the United States, Dr. April W. Armstrong said at the annual Coastal Dermatology Symposium.
It may make sense to increase the dose or shorten the intervals between doses in some patients with psoriasis who don’t respond to etanercept, adalimumab, or ustekinumab, she suggested.
For infliximab, however, increasing the standard 5-mg/kg dose to 10 mg/kg in nonresponders did not significantly improve efficacy in one randomized study of patients with moderate to severe psoriasis. Consider combination therapy instead of dose escalation in those patients, said Dr. Armstrong, director of the psoriasis program at the University of Colorado, Denver.
Most clinical trials of dose escalation for psoriasis target patients in whom conventional doses produce only a partial response, defined as a Psoriasis Area and Severity Index (PASI) score of 50-75, or no response, defined as a PASI score below 50, she said.
A conventional dosage of etanercept for psoriasis uses 50 mg twice weekly for 12 weeks, followed by 50 mg once weekly for maintenance, Dr. Armstrong said. In an open-label extension of a study of 912 patients with moderate to severe psoriasis who received 12 weeks of etanercept therapy, nonresponders who escalated the maintenance dosage to 50 mg twice weekly boosted the likelihood of achieving a PASI 75 from 33% at 12 weeks to 44% at 48 weeks and 43% at 72 weeks (J. Drugs Dermatol. 2010;9:928-37).
Safety profiles were similar between standard dosing and escalated or intensified dosing in studies of all four biologic therapies, Dr. Armstrong said at the symposium, jointly presented by the University of Louisville (Ky.) and the Global Academy for Medical Education.
In the etanercept study, rates of serious infections were 0.9 events per 100 patient-years on standard maintenance therapy and 1.9 events per 100 patient-years on the escalated dosage. Myocardial infarctions occurred in none of 321 patients on standard maintenance therapy and in 2 of 591 patients on the twice-weekly dosage.
The conventional dosage of adalimumab for psoriasis is 80 mg at the start of therapy, followed by 40 mg every other week starting at week 1. In an open-label extension of a study of 147 patients, those who did not achieve a PASI 50 by week 25 were allowed to escalate the maintenance therapy dosage to 40 mg weekly. By week 60, 64% of patients in the dose-escalation group achieved a PASI 75, compared with 56% of patients who had been on the standard regimen and 45% of patients who had started with placebo for 12 weeks and then went on the standard dosage (J. Am. Acad. Dermatol. 2006;55:598-606). The mean PASI score improved by 27% after 8 weeks on the escalated dose, Dr. Armstrong said.
Three malignancies and two cardiovascular events (one leading to death) developed in the escalated-dosage group, compared with two malignancies and a serious case of coccidiomycosis in the standard-therapy group, she noted.
The conventional dosage for ustekinumab is 45 mg in patients weighing up to 100 kg or 90 mg in heavier patients, administered in subcutaneous injections at weeks 0 and 4, then every 12 weeks thereafter. In the only head-to-head study comparing biologic therapies for psoriasis, ustekinumab was more effective than etanercept in the first 3 months, Dr. Armstrong noted. The 12-week Active Comparator (CNTO1275/Enbrel) Psoriasis Trial (ACCEPT) found that 74% of 347 patients on 90 mg of ustekinumab and 68% of 209 patients on 45 mg of ustekinumab achieved a PASI 75, compared with 57% of 347 patients on etanercept (N. Engl. J. Med. 2010;362:118-28).
In a separate study of 158 patients with psoriasis who only partially responded to standard ustekinumab therapy after 24 weeks, maintenance dose escalation to every 8 weeks instead of 12 significantly improved response rates in patients on 90 mg but not in those on 45 mg. By week 52, 69% of patients receiving 90 mg ustekinumab every 8 weeks achieved a PASI 75, compared with 33% of patients on ustekinumab 90 mg every 12 weeks (Lancet 2008;371:1675-84). In the patients on 45 mg ustekinumab, the proportions achieving PASI 75 by week 52 did not differ significantly between those receiving the drug every 8 or 12 weeks.
One cutaneous malignancy, one noncutaneous malignancy, and two other serious adverse events occurred in the intensified-therapy groups, compared with one serious infection and two other serious adverse events in the standard-therapy groups.
The conventional dosage of infliximab for psoriasis is 5 mg/kg at weeks 0, 2, and 6, then every 8 weeks. A study that randomized 33 patients with moderate to severe psoriasis to 10 weeks of therapy with placebo or 5 mg/kg or 10 mg/kg of infliximab at weeks 0, 2, and 6 found that 91% of patients on the escalated dose and 82% on the standard dose of infliximab achieved a Physician Global Assessment score of good, excellent, or clear, compared with 18% of patients on placebo (Lancet 2001;357:1842-7).
The proportions of patients achieving a PASI 75 were not significantly different between the standard-dosage group and the escalated-dosage group (82% vs. 73%, respectively), although both were significantly higher than in the placebo group (18%). “So, there’s not much difference if you give 5 or 10 mg/kg” of infliximab, Dr. Armstrong said.
One of 11 patients on 5 mg/kg infliximab developed a dental abscess, and 1 of 11 patients on 10 mg/kg infliximab developed pneumonia.
Dr. Armstrong reported financial associations with AbbVie, Amgen, Celgene, Lilly, Novartis, Merck, Pfizer, UCB, Modernizing Medicine, and Janssen. This publication and the Global Academy for Medical Education are owned by the same parent company.
On Twitter @sherryboschert
SONOMA, CALIF.– Data support dosage escalation or intensification for patients who don’t respond to biologic therapy for psoriasis, but only for three of the four biologic agents available in the United States, Dr. April W. Armstrong said at the annual Coastal Dermatology Symposium.
It may make sense to increase the dose or shorten the intervals between doses in some patients with psoriasis who don’t respond to etanercept, adalimumab, or ustekinumab, she suggested.
For infliximab, however, increasing the standard 5-mg/kg dose to 10 mg/kg in nonresponders did not significantly improve efficacy in one randomized study of patients with moderate to severe psoriasis. Consider combination therapy instead of dose escalation in those patients, said Dr. Armstrong, director of the psoriasis program at the University of Colorado, Denver.
Most clinical trials of dose escalation for psoriasis target patients in whom conventional doses produce only a partial response, defined as a Psoriasis Area and Severity Index (PASI) score of 50-75, or no response, defined as a PASI score below 50, she said.
A conventional dosage of etanercept for psoriasis uses 50 mg twice weekly for 12 weeks, followed by 50 mg once weekly for maintenance, Dr. Armstrong said. In an open-label extension of a study of 912 patients with moderate to severe psoriasis who received 12 weeks of etanercept therapy, nonresponders who escalated the maintenance dosage to 50 mg twice weekly boosted the likelihood of achieving a PASI 75 from 33% at 12 weeks to 44% at 48 weeks and 43% at 72 weeks (J. Drugs Dermatol. 2010;9:928-37).
Safety profiles were similar between standard dosing and escalated or intensified dosing in studies of all four biologic therapies, Dr. Armstrong said at the symposium, jointly presented by the University of Louisville (Ky.) and the Global Academy for Medical Education.
In the etanercept study, rates of serious infections were 0.9 events per 100 patient-years on standard maintenance therapy and 1.9 events per 100 patient-years on the escalated dosage. Myocardial infarctions occurred in none of 321 patients on standard maintenance therapy and in 2 of 591 patients on the twice-weekly dosage.
The conventional dosage of adalimumab for psoriasis is 80 mg at the start of therapy, followed by 40 mg every other week starting at week 1. In an open-label extension of a study of 147 patients, those who did not achieve a PASI 50 by week 25 were allowed to escalate the maintenance therapy dosage to 40 mg weekly. By week 60, 64% of patients in the dose-escalation group achieved a PASI 75, compared with 56% of patients who had been on the standard regimen and 45% of patients who had started with placebo for 12 weeks and then went on the standard dosage (J. Am. Acad. Dermatol. 2006;55:598-606). The mean PASI score improved by 27% after 8 weeks on the escalated dose, Dr. Armstrong said.
Three malignancies and two cardiovascular events (one leading to death) developed in the escalated-dosage group, compared with two malignancies and a serious case of coccidiomycosis in the standard-therapy group, she noted.
The conventional dosage for ustekinumab is 45 mg in patients weighing up to 100 kg or 90 mg in heavier patients, administered in subcutaneous injections at weeks 0 and 4, then every 12 weeks thereafter. In the only head-to-head study comparing biologic therapies for psoriasis, ustekinumab was more effective than etanercept in the first 3 months, Dr. Armstrong noted. The 12-week Active Comparator (CNTO1275/Enbrel) Psoriasis Trial (ACCEPT) found that 74% of 347 patients on 90 mg of ustekinumab and 68% of 209 patients on 45 mg of ustekinumab achieved a PASI 75, compared with 57% of 347 patients on etanercept (N. Engl. J. Med. 2010;362:118-28).
In a separate study of 158 patients with psoriasis who only partially responded to standard ustekinumab therapy after 24 weeks, maintenance dose escalation to every 8 weeks instead of 12 significantly improved response rates in patients on 90 mg but not in those on 45 mg. By week 52, 69% of patients receiving 90 mg ustekinumab every 8 weeks achieved a PASI 75, compared with 33% of patients on ustekinumab 90 mg every 12 weeks (Lancet 2008;371:1675-84). In the patients on 45 mg ustekinumab, the proportions achieving PASI 75 by week 52 did not differ significantly between those receiving the drug every 8 or 12 weeks.
One cutaneous malignancy, one noncutaneous malignancy, and two other serious adverse events occurred in the intensified-therapy groups, compared with one serious infection and two other serious adverse events in the standard-therapy groups.
The conventional dosage of infliximab for psoriasis is 5 mg/kg at weeks 0, 2, and 6, then every 8 weeks. A study that randomized 33 patients with moderate to severe psoriasis to 10 weeks of therapy with placebo or 5 mg/kg or 10 mg/kg of infliximab at weeks 0, 2, and 6 found that 91% of patients on the escalated dose and 82% on the standard dose of infliximab achieved a Physician Global Assessment score of good, excellent, or clear, compared with 18% of patients on placebo (Lancet 2001;357:1842-7).
The proportions of patients achieving a PASI 75 were not significantly different between the standard-dosage group and the escalated-dosage group (82% vs. 73%, respectively), although both were significantly higher than in the placebo group (18%). “So, there’s not much difference if you give 5 or 10 mg/kg” of infliximab, Dr. Armstrong said.
One of 11 patients on 5 mg/kg infliximab developed a dental abscess, and 1 of 11 patients on 10 mg/kg infliximab developed pneumonia.
Dr. Armstrong reported financial associations with AbbVie, Amgen, Celgene, Lilly, Novartis, Merck, Pfizer, UCB, Modernizing Medicine, and Janssen. This publication and the Global Academy for Medical Education are owned by the same parent company.
On Twitter @sherryboschert
SONOMA, CALIF.– Data support dosage escalation or intensification for patients who don’t respond to biologic therapy for psoriasis, but only for three of the four biologic agents available in the United States, Dr. April W. Armstrong said at the annual Coastal Dermatology Symposium.
It may make sense to increase the dose or shorten the intervals between doses in some patients with psoriasis who don’t respond to etanercept, adalimumab, or ustekinumab, she suggested.
For infliximab, however, increasing the standard 5-mg/kg dose to 10 mg/kg in nonresponders did not significantly improve efficacy in one randomized study of patients with moderate to severe psoriasis. Consider combination therapy instead of dose escalation in those patients, said Dr. Armstrong, director of the psoriasis program at the University of Colorado, Denver.
Most clinical trials of dose escalation for psoriasis target patients in whom conventional doses produce only a partial response, defined as a Psoriasis Area and Severity Index (PASI) score of 50-75, or no response, defined as a PASI score below 50, she said.
A conventional dosage of etanercept for psoriasis uses 50 mg twice weekly for 12 weeks, followed by 50 mg once weekly for maintenance, Dr. Armstrong said. In an open-label extension of a study of 912 patients with moderate to severe psoriasis who received 12 weeks of etanercept therapy, nonresponders who escalated the maintenance dosage to 50 mg twice weekly boosted the likelihood of achieving a PASI 75 from 33% at 12 weeks to 44% at 48 weeks and 43% at 72 weeks (J. Drugs Dermatol. 2010;9:928-37).
Safety profiles were similar between standard dosing and escalated or intensified dosing in studies of all four biologic therapies, Dr. Armstrong said at the symposium, jointly presented by the University of Louisville (Ky.) and the Global Academy for Medical Education.
In the etanercept study, rates of serious infections were 0.9 events per 100 patient-years on standard maintenance therapy and 1.9 events per 100 patient-years on the escalated dosage. Myocardial infarctions occurred in none of 321 patients on standard maintenance therapy and in 2 of 591 patients on the twice-weekly dosage.
The conventional dosage of adalimumab for psoriasis is 80 mg at the start of therapy, followed by 40 mg every other week starting at week 1. In an open-label extension of a study of 147 patients, those who did not achieve a PASI 50 by week 25 were allowed to escalate the maintenance therapy dosage to 40 mg weekly. By week 60, 64% of patients in the dose-escalation group achieved a PASI 75, compared with 56% of patients who had been on the standard regimen and 45% of patients who had started with placebo for 12 weeks and then went on the standard dosage (J. Am. Acad. Dermatol. 2006;55:598-606). The mean PASI score improved by 27% after 8 weeks on the escalated dose, Dr. Armstrong said.
Three malignancies and two cardiovascular events (one leading to death) developed in the escalated-dosage group, compared with two malignancies and a serious case of coccidiomycosis in the standard-therapy group, she noted.
The conventional dosage for ustekinumab is 45 mg in patients weighing up to 100 kg or 90 mg in heavier patients, administered in subcutaneous injections at weeks 0 and 4, then every 12 weeks thereafter. In the only head-to-head study comparing biologic therapies for psoriasis, ustekinumab was more effective than etanercept in the first 3 months, Dr. Armstrong noted. The 12-week Active Comparator (CNTO1275/Enbrel) Psoriasis Trial (ACCEPT) found that 74% of 347 patients on 90 mg of ustekinumab and 68% of 209 patients on 45 mg of ustekinumab achieved a PASI 75, compared with 57% of 347 patients on etanercept (N. Engl. J. Med. 2010;362:118-28).
In a separate study of 158 patients with psoriasis who only partially responded to standard ustekinumab therapy after 24 weeks, maintenance dose escalation to every 8 weeks instead of 12 significantly improved response rates in patients on 90 mg but not in those on 45 mg. By week 52, 69% of patients receiving 90 mg ustekinumab every 8 weeks achieved a PASI 75, compared with 33% of patients on ustekinumab 90 mg every 12 weeks (Lancet 2008;371:1675-84). In the patients on 45 mg ustekinumab, the proportions achieving PASI 75 by week 52 did not differ significantly between those receiving the drug every 8 or 12 weeks.
One cutaneous malignancy, one noncutaneous malignancy, and two other serious adverse events occurred in the intensified-therapy groups, compared with one serious infection and two other serious adverse events in the standard-therapy groups.
The conventional dosage of infliximab for psoriasis is 5 mg/kg at weeks 0, 2, and 6, then every 8 weeks. A study that randomized 33 patients with moderate to severe psoriasis to 10 weeks of therapy with placebo or 5 mg/kg or 10 mg/kg of infliximab at weeks 0, 2, and 6 found that 91% of patients on the escalated dose and 82% on the standard dose of infliximab achieved a Physician Global Assessment score of good, excellent, or clear, compared with 18% of patients on placebo (Lancet 2001;357:1842-7).
The proportions of patients achieving a PASI 75 were not significantly different between the standard-dosage group and the escalated-dosage group (82% vs. 73%, respectively), although both were significantly higher than in the placebo group (18%). “So, there’s not much difference if you give 5 or 10 mg/kg” of infliximab, Dr. Armstrong said.
One of 11 patients on 5 mg/kg infliximab developed a dental abscess, and 1 of 11 patients on 10 mg/kg infliximab developed pneumonia.
Dr. Armstrong reported financial associations with AbbVie, Amgen, Celgene, Lilly, Novartis, Merck, Pfizer, UCB, Modernizing Medicine, and Janssen. This publication and the Global Academy for Medical Education are owned by the same parent company.
On Twitter @sherryboschert
EXPERT ANALYSIS FROM THE COASTAL DERMATOLOGY SYMPOSIUM
VIDEO: Winning health apps link patients, researchers
SANTA CLARA, CALIF. – The federal Patient-Centered Outcomes Research Institute picked three apps for $150,000 in award funding to help patients and researchers connect and collaborate.
The Institute’s Dr. Karen Odom Walker moderated a Hospital Innovation Roundtable session at the Health 2.0 fall conference. In a video interview at the meeting, she described the work of the Patient-Centered Outcomes Research Institute (PCORI), which was part of the Affordable Care Act and is based in Washington, D.C.
So far, PCORI has awarded more than $500 million to 300 projects for patient-centered research, and it plans to distribute another $3.5 billion by 2019, she said.
The winners of PCORI’s 2014 Matchmaking App Challenge, announced at the conference, developed ready-to-use Web-based or smartphone apps to link patients, caregivers, clinicians, and researchers in various ways.
First-place winner PatientPowered.us of San Francisco received $100,000 for its mobile network connecting patients with researchers and healthcare professionals to share ideas for solving their medical conditions, such as Crohn’s disease, sleep apnea, migraines, or others, and to connect patients with clinical trials.
Second-place winner WellSpringboard, from the University of Michigan, Ann Arbor, received $35,000 for its software platform to enable crowdfunding of patient-focused research. CareHubs of Beaverton, Ore. received $15,000 in third-place prize money for a platform for patient engagement in health systems.
Dr. Walker’s spouse works for MedImmune. She reported having no other financial disclosures.
On Twitter @sherryboschert
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SANTA CLARA, CALIF. – The federal Patient-Centered Outcomes Research Institute picked three apps for $150,000 in award funding to help patients and researchers connect and collaborate.
The Institute’s Dr. Karen Odom Walker moderated a Hospital Innovation Roundtable session at the Health 2.0 fall conference. In a video interview at the meeting, she described the work of the Patient-Centered Outcomes Research Institute (PCORI), which was part of the Affordable Care Act and is based in Washington, D.C.
So far, PCORI has awarded more than $500 million to 300 projects for patient-centered research, and it plans to distribute another $3.5 billion by 2019, she said.
The winners of PCORI’s 2014 Matchmaking App Challenge, announced at the conference, developed ready-to-use Web-based or smartphone apps to link patients, caregivers, clinicians, and researchers in various ways.
First-place winner PatientPowered.us of San Francisco received $100,000 for its mobile network connecting patients with researchers and healthcare professionals to share ideas for solving their medical conditions, such as Crohn’s disease, sleep apnea, migraines, or others, and to connect patients with clinical trials.
Second-place winner WellSpringboard, from the University of Michigan, Ann Arbor, received $35,000 for its software platform to enable crowdfunding of patient-focused research. CareHubs of Beaverton, Ore. received $15,000 in third-place prize money for a platform for patient engagement in health systems.
Dr. Walker’s spouse works for MedImmune. She reported having no other financial disclosures.
On Twitter @sherryboschert
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SANTA CLARA, CALIF. – The federal Patient-Centered Outcomes Research Institute picked three apps for $150,000 in award funding to help patients and researchers connect and collaborate.
The Institute’s Dr. Karen Odom Walker moderated a Hospital Innovation Roundtable session at the Health 2.0 fall conference. In a video interview at the meeting, she described the work of the Patient-Centered Outcomes Research Institute (PCORI), which was part of the Affordable Care Act and is based in Washington, D.C.
So far, PCORI has awarded more than $500 million to 300 projects for patient-centered research, and it plans to distribute another $3.5 billion by 2019, she said.
The winners of PCORI’s 2014 Matchmaking App Challenge, announced at the conference, developed ready-to-use Web-based or smartphone apps to link patients, caregivers, clinicians, and researchers in various ways.
First-place winner PatientPowered.us of San Francisco received $100,000 for its mobile network connecting patients with researchers and healthcare professionals to share ideas for solving their medical conditions, such as Crohn’s disease, sleep apnea, migraines, or others, and to connect patients with clinical trials.
Second-place winner WellSpringboard, from the University of Michigan, Ann Arbor, received $35,000 for its software platform to enable crowdfunding of patient-focused research. CareHubs of Beaverton, Ore. received $15,000 in third-place prize money for a platform for patient engagement in health systems.
Dr. Walker’s spouse works for MedImmune. She reported having no other financial disclosures.
On Twitter @sherryboschert
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE HEALTH 2.0 FALL CONFERENCE 2014
VIDEO: Software platform may improve care efficiency
SANTA CLARA, CALIF. – Electronic health records are everywhere, but how can a health system best use all the data that it collects?
Software platforms are emerging to organize and analyze the data for population health management. One new system from the company Acupera has been implemented in St. Vincent Health, an 18-hospital system in Indiana that’s part of Ascension Health, based in St. Louis.
The computerized platform led to a sixfold improvement in the efficiency of care managers, increasing their case loads from 14 patients to more than 85 patients per week, says Dr. Ronald Razmi, a former cardiologist who founded and serves as chief executive officer of San Francisco-based Acupera.
In a video interview at the Health 2.0 fall conference 2014, he described the platform, how it works, and how it could improve health outcomes.
On Twitter @sherryboschert
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SANTA CLARA, CALIF. – Electronic health records are everywhere, but how can a health system best use all the data that it collects?
Software platforms are emerging to organize and analyze the data for population health management. One new system from the company Acupera has been implemented in St. Vincent Health, an 18-hospital system in Indiana that’s part of Ascension Health, based in St. Louis.
The computerized platform led to a sixfold improvement in the efficiency of care managers, increasing their case loads from 14 patients to more than 85 patients per week, says Dr. Ronald Razmi, a former cardiologist who founded and serves as chief executive officer of San Francisco-based Acupera.
In a video interview at the Health 2.0 fall conference 2014, he described the platform, how it works, and how it could improve health outcomes.
On Twitter @sherryboschert
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SANTA CLARA, CALIF. – Electronic health records are everywhere, but how can a health system best use all the data that it collects?
Software platforms are emerging to organize and analyze the data for population health management. One new system from the company Acupera has been implemented in St. Vincent Health, an 18-hospital system in Indiana that’s part of Ascension Health, based in St. Louis.
The computerized platform led to a sixfold improvement in the efficiency of care managers, increasing their case loads from 14 patients to more than 85 patients per week, says Dr. Ronald Razmi, a former cardiologist who founded and serves as chief executive officer of San Francisco-based Acupera.
In a video interview at the Health 2.0 fall conference 2014, he described the platform, how it works, and how it could improve health outcomes.
On Twitter @sherryboschert
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE HEALTH 2.0 FALL CONFERENCE 2014
FDA Approves Hepatitis C Combination Pill
The first combination pill to treat chronic hepatitis C virus genotype 1 infection was approved by the Food and Drug Administration Oct. 10.
The once-daily tablet under the trade name Harvoni combines 400 mg of the already-approved hepatitis C drug sofosbuvir (Sovaldi) with 90 mg of a new drug, ledipasvir, and is the first approved regimen that does not require coadministration of interferon or ribaviron to treat hepatitis C in adults, according to the FDA.
In three clinical trials with a total of 1,518 patients, 94%-99% reached a sustained virologic response (no virus detected in the blood) at least 12 weeks (SVR 12) after finishing treatment, according to an FDA statement. The agency gave the drug fast-track consideration and approval under its breakthrough therapy designation.
“With the development and approval of new treatments for hepatitis C virus, we are changing the treatment paradigm for Americans living with the disease,” Dr. Edward Cox, director of the FDA Office of Antimicrobial Products said in a statement. “Until last year, the only available treatments for hepatitis C virus required administration with interferon and ribavirin. Now, patients and health care professionals have multiple treatment options, including a combination pill to help simplify treatment regimens,.”
The FDA approved sofosbuvir and another new drug to treat hepatitis C, simeprevir (Olysio), in late 2013. Since then, the high costs of these new treatments have generated controversy. Even before Harvoni’s approval, one analysis estimated that the new treatments could increase 2015 spending in Medicare’s Part D program by up to $5.8 billion.
Gilead, which markets sofosbuvir and the new combination pill, said in a statement that a typical 12-week course of Harvoni will cost $94,500, compared with Sovaldi’s price tag of $84,000 for 12 weeks, the New York Times reported. Some patients may be successfully treated after 8 weeks.
In the first of Harvoni’s three pivotal trials, cure rates were 94% after 8 weeks of treatment and 96% after 12 weeks of treatment in previously untreated patients with chronic hepatitis C infection. In the second trial including patients with and without cirrhosis, 99% were cured after 12 weeks of treatment. In the third trial of treatment-experience patients with or without cirrhosis, 94% were cured after 12 weeks of treatment and 99% after 24 weeks of treatment. Adding ribavirin did not improve response rates in any of the trials.
The FDA recommended a dosage duration of 12 weeks in patients with chronic hepatitis who have not previously been treated or who failed treatment but don’t have cirrhosis, or 24 weeks in patients with cirrhosis who failed previous treatment. Limiting treatment to 8 weeks may be considered in treatment-naive patients without cirrhosis who have pretreatment hepatitis C virus RNA levels below 6 million IU/mL.
The most common adverse reactions reported with Harvoni use included fatigue in 13%-18%, headache in 11%-17%, nausea in 6%-9%, diarrhea in 3%-7%, and insomnia in 3%-6%.
Both drugs in Harvoni interfere with enzymes needed by hepatitis C virus to multiply. Ledipasvir is a hepatitis C virus NS5A inhibitor, and sofosbuvir is a hepatitis C virus nucleotide analog NS5B polymerase inhibitor.
The first combination pill to treat chronic hepatitis C virus genotype 1 infection was approved by the Food and Drug Administration Oct. 10.
The once-daily tablet under the trade name Harvoni combines 400 mg of the already-approved hepatitis C drug sofosbuvir (Sovaldi) with 90 mg of a new drug, ledipasvir, and is the first approved regimen that does not require coadministration of interferon or ribaviron to treat hepatitis C in adults, according to the FDA.
In three clinical trials with a total of 1,518 patients, 94%-99% reached a sustained virologic response (no virus detected in the blood) at least 12 weeks (SVR 12) after finishing treatment, according to an FDA statement. The agency gave the drug fast-track consideration and approval under its breakthrough therapy designation.
“With the development and approval of new treatments for hepatitis C virus, we are changing the treatment paradigm for Americans living with the disease,” Dr. Edward Cox, director of the FDA Office of Antimicrobial Products said in a statement. “Until last year, the only available treatments for hepatitis C virus required administration with interferon and ribavirin. Now, patients and health care professionals have multiple treatment options, including a combination pill to help simplify treatment regimens,.”
The FDA approved sofosbuvir and another new drug to treat hepatitis C, simeprevir (Olysio), in late 2013. Since then, the high costs of these new treatments have generated controversy. Even before Harvoni’s approval, one analysis estimated that the new treatments could increase 2015 spending in Medicare’s Part D program by up to $5.8 billion.
Gilead, which markets sofosbuvir and the new combination pill, said in a statement that a typical 12-week course of Harvoni will cost $94,500, compared with Sovaldi’s price tag of $84,000 for 12 weeks, the New York Times reported. Some patients may be successfully treated after 8 weeks.
In the first of Harvoni’s three pivotal trials, cure rates were 94% after 8 weeks of treatment and 96% after 12 weeks of treatment in previously untreated patients with chronic hepatitis C infection. In the second trial including patients with and without cirrhosis, 99% were cured after 12 weeks of treatment. In the third trial of treatment-experience patients with or without cirrhosis, 94% were cured after 12 weeks of treatment and 99% after 24 weeks of treatment. Adding ribavirin did not improve response rates in any of the trials.
The FDA recommended a dosage duration of 12 weeks in patients with chronic hepatitis who have not previously been treated or who failed treatment but don’t have cirrhosis, or 24 weeks in patients with cirrhosis who failed previous treatment. Limiting treatment to 8 weeks may be considered in treatment-naive patients without cirrhosis who have pretreatment hepatitis C virus RNA levels below 6 million IU/mL.
The most common adverse reactions reported with Harvoni use included fatigue in 13%-18%, headache in 11%-17%, nausea in 6%-9%, diarrhea in 3%-7%, and insomnia in 3%-6%.
Both drugs in Harvoni interfere with enzymes needed by hepatitis C virus to multiply. Ledipasvir is a hepatitis C virus NS5A inhibitor, and sofosbuvir is a hepatitis C virus nucleotide analog NS5B polymerase inhibitor.
The first combination pill to treat chronic hepatitis C virus genotype 1 infection was approved by the Food and Drug Administration Oct. 10.
The once-daily tablet under the trade name Harvoni combines 400 mg of the already-approved hepatitis C drug sofosbuvir (Sovaldi) with 90 mg of a new drug, ledipasvir, and is the first approved regimen that does not require coadministration of interferon or ribaviron to treat hepatitis C in adults, according to the FDA.
In three clinical trials with a total of 1,518 patients, 94%-99% reached a sustained virologic response (no virus detected in the blood) at least 12 weeks (SVR 12) after finishing treatment, according to an FDA statement. The agency gave the drug fast-track consideration and approval under its breakthrough therapy designation.
“With the development and approval of new treatments for hepatitis C virus, we are changing the treatment paradigm for Americans living with the disease,” Dr. Edward Cox, director of the FDA Office of Antimicrobial Products said in a statement. “Until last year, the only available treatments for hepatitis C virus required administration with interferon and ribavirin. Now, patients and health care professionals have multiple treatment options, including a combination pill to help simplify treatment regimens,.”
The FDA approved sofosbuvir and another new drug to treat hepatitis C, simeprevir (Olysio), in late 2013. Since then, the high costs of these new treatments have generated controversy. Even before Harvoni’s approval, one analysis estimated that the new treatments could increase 2015 spending in Medicare’s Part D program by up to $5.8 billion.
Gilead, which markets sofosbuvir and the new combination pill, said in a statement that a typical 12-week course of Harvoni will cost $94,500, compared with Sovaldi’s price tag of $84,000 for 12 weeks, the New York Times reported. Some patients may be successfully treated after 8 weeks.
In the first of Harvoni’s three pivotal trials, cure rates were 94% after 8 weeks of treatment and 96% after 12 weeks of treatment in previously untreated patients with chronic hepatitis C infection. In the second trial including patients with and without cirrhosis, 99% were cured after 12 weeks of treatment. In the third trial of treatment-experience patients with or without cirrhosis, 94% were cured after 12 weeks of treatment and 99% after 24 weeks of treatment. Adding ribavirin did not improve response rates in any of the trials.
The FDA recommended a dosage duration of 12 weeks in patients with chronic hepatitis who have not previously been treated or who failed treatment but don’t have cirrhosis, or 24 weeks in patients with cirrhosis who failed previous treatment. Limiting treatment to 8 weeks may be considered in treatment-naive patients without cirrhosis who have pretreatment hepatitis C virus RNA levels below 6 million IU/mL.
The most common adverse reactions reported with Harvoni use included fatigue in 13%-18%, headache in 11%-17%, nausea in 6%-9%, diarrhea in 3%-7%, and insomnia in 3%-6%.
Both drugs in Harvoni interfere with enzymes needed by hepatitis C virus to multiply. Ledipasvir is a hepatitis C virus NS5A inhibitor, and sofosbuvir is a hepatitis C virus nucleotide analog NS5B polymerase inhibitor.
FDA approves hepatitis C combination pill
The first combination pill to treat chronic hepatitis C virus genotype 1 infection was approved by the Food and Drug Administration Oct. 10.
The once-daily tablet under the trade name Harvoni combines 400 mg of the already-approved hepatitis C drug sofosbuvir (Sovaldi) with 90 mg of a new drug, ledipasvir, and is the first approved regimen that does not require coadministration of interferon or ribaviron to treat hepatitis C in adults, according to the FDA.
In three clinical trials with a total of 1,518 patients, 94%-99% reached a sustained virologic response (no virus detected in the blood) at least 12 weeks (SVR 12) after finishing treatment, according to an FDA statement. The agency gave the drug fast-track consideration and approval under its breakthrough therapy designation.
“With the development and approval of new treatments for hepatitis C virus, we are changing the treatment paradigm for Americans living with the disease,” Dr. Edward Cox, director of the FDA Office of Antimicrobial Products said in a statement. “Until last year, the only available treatments for hepatitis C virus required administration with interferon and ribavirin. Now, patients and health care professionals have multiple treatment options, including a combination pill to help simplify treatment regimens,.”
The FDA approved sofosbuvir and another new drug to treat hepatitis C, simeprevir (Olysio), in late 2013. Since then, the high costs of these new treatments have generated controversy. Even before Harvoni’s approval, one analysis estimated that the new treatments could increase 2015 spending in Medicare’s Part D program by up to $5.8 billion.
Gilead, which markets sofosbuvir and the new combination pill, said in a statement that a typical 12-week course of Harvoni will cost $94,500, compared with Sovaldi’s price tag of $84,000 for 12 weeks, the New York Times reported. Some patients may be successfully treated after 8 weeks.
In the first of Harvoni’s three pivotal trials, cure rates were 94% after 8 weeks of treatment and 96% after 12 weeks of treatment in previously untreated patients with chronic hepatitis C infection. In the second trial including patients with and without cirrhosis, 99% were cured after 12 weeks of treatment. In the third trial of treatment-experience patients with or without cirrhosis, 94% were cured after 12 weeks of treatment and 99% after 24 weeks of treatment. Adding ribavirin did not improve response rates in any of the trials.
The FDA recommended a dosage duration of 12 weeks in patients with chronic hepatitis who have not previously been treated or who failed treatment but don’t have cirrhosis, or 24 weeks in patients with cirrhosis who failed previous treatment. Limiting treatment to 8 weeks may be considered in treatment-naive patients without cirrhosis who have pretreatment hepatitis C virus RNA levels below 6 million IU/mL.
The most common adverse reactions reported with Harvoni use included fatigue in 13%-18%, headache in 11%-17%, nausea in 6%-9%, diarrhea in 3%-7%, and insomnia in 3%-6%.
Both drugs in Harvoni interfere with enzymes needed by hepatitis C virus to multiply. Ledipasvir is a hepatitis C virus NS5A inhibitor, and sofosbuvir is a hepatitis C virus nucleotide analog NS5B polymerase inhibitor.
On Twitter @sherryboschert
The first combination pill to treat chronic hepatitis C virus genotype 1 infection was approved by the Food and Drug Administration Oct. 10.
The once-daily tablet under the trade name Harvoni combines 400 mg of the already-approved hepatitis C drug sofosbuvir (Sovaldi) with 90 mg of a new drug, ledipasvir, and is the first approved regimen that does not require coadministration of interferon or ribaviron to treat hepatitis C in adults, according to the FDA.
In three clinical trials with a total of 1,518 patients, 94%-99% reached a sustained virologic response (no virus detected in the blood) at least 12 weeks (SVR 12) after finishing treatment, according to an FDA statement. The agency gave the drug fast-track consideration and approval under its breakthrough therapy designation.
“With the development and approval of new treatments for hepatitis C virus, we are changing the treatment paradigm for Americans living with the disease,” Dr. Edward Cox, director of the FDA Office of Antimicrobial Products said in a statement. “Until last year, the only available treatments for hepatitis C virus required administration with interferon and ribavirin. Now, patients and health care professionals have multiple treatment options, including a combination pill to help simplify treatment regimens,.”
The FDA approved sofosbuvir and another new drug to treat hepatitis C, simeprevir (Olysio), in late 2013. Since then, the high costs of these new treatments have generated controversy. Even before Harvoni’s approval, one analysis estimated that the new treatments could increase 2015 spending in Medicare’s Part D program by up to $5.8 billion.
Gilead, which markets sofosbuvir and the new combination pill, said in a statement that a typical 12-week course of Harvoni will cost $94,500, compared with Sovaldi’s price tag of $84,000 for 12 weeks, the New York Times reported. Some patients may be successfully treated after 8 weeks.
In the first of Harvoni’s three pivotal trials, cure rates were 94% after 8 weeks of treatment and 96% after 12 weeks of treatment in previously untreated patients with chronic hepatitis C infection. In the second trial including patients with and without cirrhosis, 99% were cured after 12 weeks of treatment. In the third trial of treatment-experience patients with or without cirrhosis, 94% were cured after 12 weeks of treatment and 99% after 24 weeks of treatment. Adding ribavirin did not improve response rates in any of the trials.
The FDA recommended a dosage duration of 12 weeks in patients with chronic hepatitis who have not previously been treated or who failed treatment but don’t have cirrhosis, or 24 weeks in patients with cirrhosis who failed previous treatment. Limiting treatment to 8 weeks may be considered in treatment-naive patients without cirrhosis who have pretreatment hepatitis C virus RNA levels below 6 million IU/mL.
The most common adverse reactions reported with Harvoni use included fatigue in 13%-18%, headache in 11%-17%, nausea in 6%-9%, diarrhea in 3%-7%, and insomnia in 3%-6%.
Both drugs in Harvoni interfere with enzymes needed by hepatitis C virus to multiply. Ledipasvir is a hepatitis C virus NS5A inhibitor, and sofosbuvir is a hepatitis C virus nucleotide analog NS5B polymerase inhibitor.
On Twitter @sherryboschert
The first combination pill to treat chronic hepatitis C virus genotype 1 infection was approved by the Food and Drug Administration Oct. 10.
The once-daily tablet under the trade name Harvoni combines 400 mg of the already-approved hepatitis C drug sofosbuvir (Sovaldi) with 90 mg of a new drug, ledipasvir, and is the first approved regimen that does not require coadministration of interferon or ribaviron to treat hepatitis C in adults, according to the FDA.
In three clinical trials with a total of 1,518 patients, 94%-99% reached a sustained virologic response (no virus detected in the blood) at least 12 weeks (SVR 12) after finishing treatment, according to an FDA statement. The agency gave the drug fast-track consideration and approval under its breakthrough therapy designation.
“With the development and approval of new treatments for hepatitis C virus, we are changing the treatment paradigm for Americans living with the disease,” Dr. Edward Cox, director of the FDA Office of Antimicrobial Products said in a statement. “Until last year, the only available treatments for hepatitis C virus required administration with interferon and ribavirin. Now, patients and health care professionals have multiple treatment options, including a combination pill to help simplify treatment regimens,.”
The FDA approved sofosbuvir and another new drug to treat hepatitis C, simeprevir (Olysio), in late 2013. Since then, the high costs of these new treatments have generated controversy. Even before Harvoni’s approval, one analysis estimated that the new treatments could increase 2015 spending in Medicare’s Part D program by up to $5.8 billion.
Gilead, which markets sofosbuvir and the new combination pill, said in a statement that a typical 12-week course of Harvoni will cost $94,500, compared with Sovaldi’s price tag of $84,000 for 12 weeks, the New York Times reported. Some patients may be successfully treated after 8 weeks.
In the first of Harvoni’s three pivotal trials, cure rates were 94% after 8 weeks of treatment and 96% after 12 weeks of treatment in previously untreated patients with chronic hepatitis C infection. In the second trial including patients with and without cirrhosis, 99% were cured after 12 weeks of treatment. In the third trial of treatment-experience patients with or without cirrhosis, 94% were cured after 12 weeks of treatment and 99% after 24 weeks of treatment. Adding ribavirin did not improve response rates in any of the trials.
The FDA recommended a dosage duration of 12 weeks in patients with chronic hepatitis who have not previously been treated or who failed treatment but don’t have cirrhosis, or 24 weeks in patients with cirrhosis who failed previous treatment. Limiting treatment to 8 weeks may be considered in treatment-naive patients without cirrhosis who have pretreatment hepatitis C virus RNA levels below 6 million IU/mL.
The most common adverse reactions reported with Harvoni use included fatigue in 13%-18%, headache in 11%-17%, nausea in 6%-9%, diarrhea in 3%-7%, and insomnia in 3%-6%.
Both drugs in Harvoni interfere with enzymes needed by hepatitis C virus to multiply. Ledipasvir is a hepatitis C virus NS5A inhibitor, and sofosbuvir is a hepatitis C virus nucleotide analog NS5B polymerase inhibitor.
On Twitter @sherryboschert
VIDEO: Scabies epidemic plagues nursing homes
SONOMA, CALIF. – Dr. Miriam S. Bettencourt is seeing what she considers an epidemic of scabies among elderly patients in nursing homes.
The problem is a lack of detection, she said in an interview at the annual Coastal Dermatology Symposium.
Dermatologists who see elderly patients should look for scabies in unusual bodily locations and remember that scabies in the elderly can produce atypical lesions, said Dr. Bettencourt of the University of Nevada, Las Vegas.
Permethrin cream alone probably won’t be enough to treat these patients, she said at the symposium, jointly presented by the University of Louisville, Kentucky, and the Global Academy for Medical Education. This publication and the Global Academy for Medical Education are owned by the same parent company.
How would you treat scabies in an elderly patient? Dr. Bettencourt discussed several effective options.
Dr. Bettencourt reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
SONOMA, CALIF. – Dr. Miriam S. Bettencourt is seeing what she considers an epidemic of scabies among elderly patients in nursing homes.
The problem is a lack of detection, she said in an interview at the annual Coastal Dermatology Symposium.
Dermatologists who see elderly patients should look for scabies in unusual bodily locations and remember that scabies in the elderly can produce atypical lesions, said Dr. Bettencourt of the University of Nevada, Las Vegas.
Permethrin cream alone probably won’t be enough to treat these patients, she said at the symposium, jointly presented by the University of Louisville, Kentucky, and the Global Academy for Medical Education. This publication and the Global Academy for Medical Education are owned by the same parent company.
How would you treat scabies in an elderly patient? Dr. Bettencourt discussed several effective options.
Dr. Bettencourt reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
SONOMA, CALIF. – Dr. Miriam S. Bettencourt is seeing what she considers an epidemic of scabies among elderly patients in nursing homes.
The problem is a lack of detection, she said in an interview at the annual Coastal Dermatology Symposium.
Dermatologists who see elderly patients should look for scabies in unusual bodily locations and remember that scabies in the elderly can produce atypical lesions, said Dr. Bettencourt of the University of Nevada, Las Vegas.
Permethrin cream alone probably won’t be enough to treat these patients, she said at the symposium, jointly presented by the University of Louisville, Kentucky, and the Global Academy for Medical Education. This publication and the Global Academy for Medical Education are owned by the same parent company.
How would you treat scabies in an elderly patient? Dr. Bettencourt discussed several effective options.
Dr. Bettencourt reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
AT THE COASTAL DERMATOLOGY SYMPOSIUM
VIDEO: Don’t fear fungal infections in psoriasis patients on biologics
SONOMA, CALIF. – Concerns about the risk of developing deep fungal infections in patients on biologic therapies for psoriasis are real, but not as significant as some may think, Dr. Miriam S. Bettencourt said at the annual Coastal Dermatology Symposium.
Data suggest that 98% of all patients who developed deep fungal infection while taking a biologic drug also were taking another immunosuppressant, usually prednisone, said Dr. Bettencourt of the University of Nevada, Las Vegas.
Among a subgroup of patients taking a biologic drug for psoriasis or psoriatic arthritis, the risk of developing a deep fungal infection is significantly lower than among all patients on biologics, she said at the symposium, jointly presented by the University of Louisville (Ky.) and Global Academy for Medical Education. This publication and Global Academy for Medical Education are owned by the same parent company.
Dr. Bettencourt reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
SONOMA, CALIF. – Concerns about the risk of developing deep fungal infections in patients on biologic therapies for psoriasis are real, but not as significant as some may think, Dr. Miriam S. Bettencourt said at the annual Coastal Dermatology Symposium.
Data suggest that 98% of all patients who developed deep fungal infection while taking a biologic drug also were taking another immunosuppressant, usually prednisone, said Dr. Bettencourt of the University of Nevada, Las Vegas.
Among a subgroup of patients taking a biologic drug for psoriasis or psoriatic arthritis, the risk of developing a deep fungal infection is significantly lower than among all patients on biologics, she said at the symposium, jointly presented by the University of Louisville (Ky.) and Global Academy for Medical Education. This publication and Global Academy for Medical Education are owned by the same parent company.
Dr. Bettencourt reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
SONOMA, CALIF. – Concerns about the risk of developing deep fungal infections in patients on biologic therapies for psoriasis are real, but not as significant as some may think, Dr. Miriam S. Bettencourt said at the annual Coastal Dermatology Symposium.
Data suggest that 98% of all patients who developed deep fungal infection while taking a biologic drug also were taking another immunosuppressant, usually prednisone, said Dr. Bettencourt of the University of Nevada, Las Vegas.
Among a subgroup of patients taking a biologic drug for psoriasis or psoriatic arthritis, the risk of developing a deep fungal infection is significantly lower than among all patients on biologics, she said at the symposium, jointly presented by the University of Louisville (Ky.) and Global Academy for Medical Education. This publication and Global Academy for Medical Education are owned by the same parent company.
Dr. Bettencourt reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
AT THE COASTAL DERMATOLOGY SYMPOSIUM
