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Background: Several observational studies have reported acute kidney injury from intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs for retinal diseases. However, systematic reviews and meta-analyses of randomized controlled trials on this critical topic are scant. Objective: To evaluate acute kidney injury risk associated with intravitreal anti-VEGF drugs in patients with retinal diseases. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials on 12 July, 2023, and included randomized controlled trials reporting acute kidney injury between anti-VEGF drugs (e.g., aflibercept, bevacizumab, brolucizumab, and ranibizumab) and controls for retinal diseases (e.g., age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy/diabetic macular edema, retinal vein occlusion, and myopic choroidal neovascularization). Data were synthesized by a fixed-effects model for pooling odds ratios (ORs) using the Peto method. Results: We included 13 randomized controlled trials (four and nine trials for aflibercept and ranibizumab, respectively) with a total of 4282 participants. The meta-analysis indicated intravitreal anti-VEGF drugs did not increase the acute kidney injury risk, compared with controls (odds ratio [OR]: 1.00, 95% confidence interval [CI] 0.49–2.04, I2: 0%), and no differences in the acute kidney injury risk were observed between different anti-VEGF drugs (OR: 1.10, 95% CI 0.27–4.43, I2: 0% for aflibercept; OR: 0.97, 95% CI 0.42–2.22, I2: 0% for ranibizumab) and between different retinal diseases (OR: 4.61, 95% CI 0.07–284.13, I2: not applicable for age-related macular degeneration; OR: 0.90, 95% CI 0.42–1.93, I2: 0% for diabetic retinopathy/diabetic macular edema; OR: 1.57, 95% CI 0.16–15.88, I2: 0% for retinal vein occlusion). Conclusions: Intravitreal anti-VEGF drugs were not associated with an acute kidney injury risk, regardless of which anti-VEGF drugs (aflibercept or ranibizumab) or retinal diseases (age-related macular degeneration, diabetic retinopathy/diabetic macular edema, or retinal vein occlusion) were involved. Systematic Review Protocol Registration: PROSPERO CRD42021267854. [ABSTRACT FROM AUTHOR]

Radiotherapy (RT) is an important modality for laryngeal cancer treatment to preserve laryngeal function. During beam delivery, laryngeal motion remains uncontrollable and may compromise tumor-targeting efficacy. We aimed to examine real-time laryngeal motion by developing a surface depth-sensing technique with preliminary testing during RT-based treatment of patients with laryngeal cancer. A surface depth-sensing (SDS) camera was set up and integrated into RT simulation procedures. By recording the natural swallowing of patients, SDS calculation was performed using the Pose Estimation Model and deep neural network technique. Seven male patients with laryngeal cancer were enrolled in this prospective study. The calculated motion distances of the laryngeal prominence (mean ± standard deviation) were 1.6 ± 0.8 mm, 21.4 ± 5.1 mm, 6.4 ± 3.3 mm, and 22.7 ± 4.9 mm in the left–right, cranio–caudal, and anterior–posterior directions and for the spatial displacement, respectively. The calculated differences in the 3D margins for generating the planning tumor volume by senior physicians with and without SDS data were −0.7 ± 1.0 mm (−18%), 11.3 ± 6.8 mm (235%), and 1.8 ± 2.6 mm (45%) in the left–right, cranio–caudal, and anterior–posterior directions, respectively. The SDS technique developed for detecting laryngeal motion during swallowing may be a practical guide for individualized RT design in the treatment of laryngeal cancer. [ABSTRACT FROM AUTHOR]

Background: Anti−vascular endothelial growth factors (VEGFs) treatment has been associated with an increased risk of thromboembolic events. Therefore, the use of anti−VEGFs for patients with colorectal cancers (CRC) has raised concerns about the potential risk of retinal vein occlusion (RVO), an ocular disease caused by embolism or venous stasis. This study aims to evaluate the risk of RVO in patients with CRC treated with anti−VEGFs. Method: We conducted a retrospective cohort study using the Taiwan Cancer Registry and National Health Insurance Database. The study cohort comprised patients newly diagnosed with CRC between 2011 and 2017, who received anti-VEGF treatment. For each patient in the study cohort, a control group comprising four patients newly diagnosed with CRC, but not receiving anti-VEGF treatment, was randomly selected. A washout period of 12 months was implemented to identify new cases. The index date was defined as the date of the first prescription of anti-VEGF drugs. The study outcome was the incidence of RVO, as identified by ICD-9-CM (362.35 and 362.36) or ICD-10-CM codes (H3481 and H3483). Patients were followed from their index date until the occurrence of RVO, death or the end of the study period. Covariates, including patients' age at index date, sex, calendar year of CRC diagnosis, stage of CRC and comorbidities related to RVO, were included. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HRs) with adjustments for all covariates to compare the risk of RVO between the anti-VEGF and control groups. Results: We recruited 6285 patients in the anti-VEGF group and 37,250 patients in the control group, with mean ages of 59.49 ± 12.11 and 63.88 ± 13.17 years, respectively. The incidence rates were 1.06 per 1000 person-years for the anti-VEGF group, and 0.63 per 1000 person-years for the controls. There was no statistically significant difference in RVO risk between the anti-VEGF and control groups (HR: 2.21, 95% CI: 0.87–5.61). Conclusion: Our results indicated no association between use of anti-VEGF and occurrence of RVO among CRC patients, although the crude incidence rate of RVO was higher in patients receiving anti-VEGF, compared to control patients. Future study with larger sample size is required to confirm our findings. [ABSTRACT FROM AUTHOR]

Introduction: Dose escalation is one of the treatment approaches studied and suggested in advanced therapies for Crohn's disease (CD) and ulcerative colitis (UC). This study aimed to identify and characterize the dosing escalation patterns of advanced therapies in CD and UC. Methods: Two systematic literature reviews (SLRs) were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE®, Embase®, and Cochrane Library were searched for articles published between January 2011 and October 2021 and limited to non-interventional studies in English language. Congress and bibliographic searches were also conducted. Articles were screened by two independent researchers. Dose escalation patterns were described and summarized considering the regional regulatory label recommendation (in North America [NA] or outside of North America [ONA]). Results: Among 3190 CD and 2116 UC articles identified in the Ovid searches, 100 CD and 54 UC studies were included in the SLR, with more studies conducted ONA. Most studies reported an initial maintenance dose pattern aligned with the lower starting dose per local regulatory label; however, several ONA studies (n = 13 out of 14) reported ustekinumab every 8 weeks as starting maintenance pattern in CD. In ONA studies, the median within-guideline escalation rates in CD and UC were 43% in ustekinumab (CD only), 33% and 32% for vedolizumab; 29% and 39% for adalimumab; and 14% and 10% for infliximab. Evidence regarding dose escalation patterns for tofacitinib, certolizumab pegol, and golimumab was limited. Some dose escalation patterns outside of label recommendations were observed including ustekinumab every 8 weeks to every 4 weeks and vedolizumab every 8 weeks to every 6 weeks. Conclusion: Dose escalation strategies are widely documented in the literature. The reported dose escalation patterns and escalation rates vary by region and by CD and UC. Most escalation patterns reported were aligned with regulatory recommendations while some reported more diverse or aggressive dose escalation. Prospero Registration: CRD42021289251. [ABSTRACT FROM AUTHOR]

Summary: Background: Crohn's disease has a substantial negative impact on health‐related quality of life (HRQoL). Aim: To examine the effects of risankizumab on HRQoL in Crohn's disease Methods: We analysed data from patients with Crohn's disease from 12‐week induction trials ADVANCE (N = 850) and MOTIVATE (N = 569) with risankizumab 600 mg or 1200 mg intravenous (IV) versus placebo IV and a 52‐week maintenance trial FORTIFY (N = 462) with risankizumab 180 or 360 mg subcutaneous (SC) versus placebo SC. Outcomes included Inflammatory Bowel Disease Questionnaire (IBDQ), Functional Assessment of Chronic Illness Therapy‐Fatigue (FACIT‐F), 36‐item Short Form Health Survey (SF‐36), EuroQol 5‐Dimension‐5‐Level (EQ‐5D‐5L) and work productivity. The mean change and percentages of patients achieving clinically meaningful improvement in all outcomes were determined at weeks 12 and 52. Results: At week 12, more patients in the risankizumab 600 or 1200 mg groups achieved IBDQ response than with placebo (ADVANCE: 70.2%, 75.5% vs. 47.8%, p ≤ 0.001; MOTIVATE: 61.7%, 68.5% vs. 48.2%, p ≤ 0.01) and FACIT‐F response (ADVANCE: 51.3%, 48.0% vs. 35.7%, p ≤ 0.01; MOTIVATE: 44.2%, 49.1% vs. 33.7%, p < 0.05). These improvements persisted at week 52 with risankizumab maintenance treatment. Similar trends were observed for SF‐36 physical and mental component summary scores, EQ‐5D‐5L and activity impairment within work productivity measures. Conclusions: Risankizumab induction therapy (600 or 1200 mg IV) led to clinically meaningful improvements in disease‐specific and general patient‐reported outcomes, including fatigue, in patients with moderate to severe Crohn's disease. These improvements were sustained after 52 weeks of risankizumab (180 or 360 mg SC) maintenance therapy. [ABSTRACT FROM AUTHOR]

Based on the concept of "governance through scientism", this article aims to reveal the tacit practices of the institutional culture of scientism among Taiwan Biobank's elite scientists, whose imaginaries have shaped the dominance of a deficit model of the public in dealing with public controversy and establishing regulatory mechanisms. Examining three periods of ELSI controversies from 2000 to 2021, we identify three types of scientific imaginaries of publics, namely the silent public (2000–2004), the anti-science public (2005–2010), and the EGC as the lawful public supervisory body (2010–2021). In 2010, the Human Biobank Management Act (HBMA) was passed in Taiwan as a solution to public controversy and as a strategy to bypass public engagement. However, the overemphasis on formative legislation caused actors to overlook the processual approach in which ongoing critical reflections are required for the changing operations of TBB [ABSTRACT FROM AUTHOR]

There is a need for clear criteria to guide treatment decisions and disease management in patients with atopic dermatitis (AD). The recently developed minimal disease activity (MDA) concept aims to optimize AD management through shared decision-making between patients and clinicians in a treat-to-target approach, and is based on consensus recommendations from 87 physicians and insights from 88 patients globally.This study aims to evaluate how achieving MDA affects outcomes in patients with AD. Observed-case data from three phase 3 clinical trials involving adolescents and adults with moderate-to-severe AD were integrated and analysed (NCT03568318, NCT03569293 and NCT03607422). The MDA criteria were applied to clinician-reported measures [Eczema Area and Severity Index (EASI), SCORing of Atopic Dermatitis, validated Investigator Global Assessment, and body surface area] and patient-reported measures [Worst Pruritus Numerical Rating Scale (WP-NRS), Patient-Oriented Eczema Measure, Atopic Dermatitis Symptom Scale (ADerm-SS) Skin Pain score, Atopic Dermatitis Impact Scale (ADerm-IS) Sleep disturbance score, Hospital Anxiety and Depression Scale and Dermatology Life Quality Index]. Patients were stratified into three mutually exclusive groups by achievement of treatment targets per measurement at week 16: (i) achieving the optimal target (i.e. MDA) criteria [e.g. EASI improvement ≥90% (EASI 90); WP-NRS ≤1], (ii) achieving the moderate but not optimal target criteria [e.g. EASI improvement ≥75% and <90%; WP-NRS improvement (reduction) ≥4 and WP-NRS >1] and (iii) not achieving either target criteria. Among the stratified target groups (optimal, moderate and neither), patients' symptoms, quality of life, work productivity and treatment satisfaction were assessed based on achieving meaningful clinically important differences in ADerm-SS 7-item total symptom score (ADerm-SS TSS-7; improvement ≥28), ADerm-IS Daily Activities score (improvement ≥14), ADerm-IS Emotional State score (improvement ≥11), percentage-point improvement in Work Productivity and Activity Impairment (WPAI) Overall Work Productivity score and proportion reporting Patient Global Impressions of Treatment of 'Extremely/Very Satisfied'. Stratified target groups were compared with a chi-squared or t -test for categorical or continuous variables, respectively, based on observed data. This analysis included 2392 patients. Patients in the optimal target (MDA) group based on EASI (EASI 90) vs. those in the moderate or neither target group had a higher proportion reporting meaningful improvements in ADerm-SS TSS-7 (optimal = 82.6% vs. moderate = 56.8% or neither = 27.4%; P < 0.001 for both comparisons), ADerm-IS Daily Activities (87.2% vs. 66.2% or 39.9%; both P < 0.001) and ADerm-IS Emotional State (86.1% vs. 67.1% or 36.8%; both P < 0.001); a greater percentage-point improvement in WPAI Overall Work Productivity (36.8% vs. 29.2% or 16.6%; both P < 0.01); and a higher proportion reporting being very/extremely satisfied with treatment (73.5% vs. 54.0% or 23.5%; both P < 0.001). Patients in the optimal target (MDA) group based on itch (WP-NRS ≤1) vs. those in the moderate or neither target group had a higher proportion reporting meaningful improvements in ADerm-SS TSS-7 (94.3% vs. 79.7% or 19.1%; both P < 0.001), ADerm-IS Daily Activities (97.3% vs. 84.7% or 33.6%; both P < 0.001) and ADerm-IS Emotional State (94.5% vs. 84.5% or 31.7%; both P < 0.001); a greater percentage-point improvement in WPAI Overall Work Productivity [39.7% vs. 35.2% (not significant) or 14.6% (P < 0.001)]; and a higher proportion reporting being very/extremely satisfied with treatment (79.7% vs. 60.5% or 26.8%; both P < 0.001). Trends were similar in other clinician- and patient-reported measures, with patients who achieved MDA generally reporting better outcomes. Achieving MDA from both a clinician and patient perspective was generally associated with greater improvements in AD symptoms, daily activities, emotional state, work productivity and higher satisfaction. These results demonstrate the value of achieving MDA and support implementing MDA in clinical practice to help improve the current standard of AD care. [ABSTRACT FROM AUTHOR]

Background: Neuro-ophthalmic manifestations after vaccines are rare, with optic neuritis (ON) being the most common presentation. Patients with vaccine-related ON are similar to those with idiopathic ON. The temporal relationship between vaccination against and the occurrence of ON is vital. Here, we report a case of bilateral ON after the administration of the ChAdOx1-S nCoV-19 SARS-CoV-2 vaccine. Case: A 49-year-old healthy Asian female presented with sudden onset of bilateral blurred vision within 2 days. She complained of photophobia and extraocular pain upon movement over 3 days. Upon examination, her best corrected visual acuity (BCVA) was 20/30 in the right eye and 20/200 in the left eye. Anterior segment findings were unremarkable, with normal intraocular pressure. Fundoscopic examination revealed bilateral disc edema with vessel engorgement. Visual field examination revealed profound visual field defect in both eyes. She denied any trauma, use of new medication or medical history. She had received the ChAdOx1 nCoV-19 SARS-CoV-2 vaccine 14 days prior. Under suspicion of vaccine-related optic neuritis, she was given intravenous methylprednisolone 1 gm/day for 3 days, shifting to oral prednisolone under gradual tapering for 2 weeks. Conclusions: Typically presenting with sudden-onset visual decline and extraocular pain during movement, acute ON is generally idiopathic. Bilateral ON is rare, but quick identification is important because it can potentially lead to permanent loss of vision if left untreated. Vaccination-induced ON is even rarer but not difficult to treat. However, such patients require further evaluation and long-term follow-up because they may be prone to other neurological disorders in the future. [ABSTRACT FROM AUTHOR]

This document is a correction to an article titled "An imagined future community: Taiwan Biobank, Taiwanese genome, and nation-building." The article is an expansion and revision of a previously published Mandarin-language work, incorporating new empirical evidence from interviews with Taiwan BioBank participants and a comprehensive review of relevant literature. The correction adds an explicit citation to the previous publication that was omitted in the original article. The authors are affiliated with the Institute of Sociology, Academia Sinica, and the Department of Sociology, NSYSU. [Extracted from the article]

Background and Aims Risankizumab, an interleukin-23 antibody, demonstrated efficacy and acceptable safety in a phase 2 study of patients with moderate-to-severe refractory Crohn's disease. This open-label extension investigated the long-term safety, pharmacokinetics, immunogenicity and efficacy of risankizumab in responders to risankizumab in the parent phase 2 study. Methods Enrolled patients had achieved clinical response [decrease in Crohn's Disease Activity Index from baseline ≥100] without clinical remission [Crohn's Disease Activity Index <150] at Week 26, or clinical response and/or remission at Week 52 in the parent phase 2 study and received open-label subcutaneous risankizumab 180 mg every 8 weeks. Results Sixty-five patients were enrolled, including four who had lost response in the parent study and were first reinduced with risankizumab 600 mg every 4 weeks [three infusions]. Patients received risankizumab for a median of 33 months [total: 167.0 patient-years]. The rate of serious adverse events was 24.6 events/100 patient-years; the majority were gastrointestinal in nature. Rates of serious infections, opportunistic infections and fungal infections were 4.2, 1.8, and 6.6 events/100 patient-years, respectively. No deaths, malignancies, adjudicated major adverse cardiovascular events, latent/active tuberculosis or herpes zoster were reported. Treatment-emergent anti-drug antibodies developed in eight patients [12.3%]; none were neutralizing. Efficacy outcomes were maintained during the study, including the proportions of patients [observed analysis] with clinical remission [>71%] and endoscopic remission [>42%]. Conclusions Long-term maintenance treatment with subcutaneous risankizumab 180 mg every 8 weeks was well tolerated by patients with Crohn's disease, with no new safety signals. Clinical trial registration number: NCT02513459 [ABSTRACT FROM AUTHOR]

Introduction Network meta-analysis (NMA) provides useful information for medical decision makers via comprehensive indirect comparisons across therapies. As the targeted systemic therapy options for moderate-to-severe atopic dermatitis (AD) continue to grow, it is critical to update NMAs as well. Objectives: To assess the comparative efficacy of targeted systemic therapies with concomitant topical corticosteroids (TCS) in moderate-to-severe AD by including the latest Phase 3 combination therapy data for abrocitinib, lebrikizumab, and dupilumab in the NMA presented in Thyssen et al, 2021. Methods: Data from the Phase 3 combination therapy trial for lebrikizumab in moderate-to-severe AD (ADhere [NCT04250337]) as well as an additional abrocitinib-dupilumab head-to-head Phase 3 trial (JADE DARE [NCT04345367]) were included in the analyses along with other eligible trials for abrocitinib, baricitinib, dupilumab, tralokinumab, and upadacitinib identified through a systematic literature review in Thyssen et al., 2021. Outcomes included ≥90% and ≥75% improvement in Eczema Area and Severity Index (EASI 90, EASI 75) from baseline, ≥4-point improvement in Pruritus Numerical Rating Scale from baseline (ΔNRS ≥4), and Investigator Global Assessment (IGA) score of 0 or 1 (clear or almost clear) with a ≥2-point reduction from baseline (IGA 0/1), at the week 16 timepoint of each study. Bayesian NMA was performed with fixed and random effects models, with and without baseline risk-adjustment; fit statistics were assessed. Inconsistency was assessed via unrelated mean relative effects models. Odds ratio (OR), number needed to treat (NNT), placebo-unadjusted absolute response rate (ARR), and Surface Under the Cumulative RAnking curve (SUCRA) scores were estimated. Statistical significance was assessed by OR 95% credible intervals excluding 1. Results: The updated NMA analyzed 8 unique placebo-controlled trials and 1 active-controlled trial involving 4391 patients in 23 arms across 6 targeted therapies. Fit statistics supported fixed effects models across outcomes. All therapies were statistically more efficacious than placebo across all outcomes except baricitinib 2 mg for EASI-90. For EASI-90, upadacitinib 30 mg had the most favorable response estimates (ARR=63.2%, OR=11.3, NNT=2.0, SUCRA=98.3%), followed by abrocitinib 200 mg (ARR=55.8%, OR=8.3, NNT=2.4, SUCRA=90.0%), dupilumab 300 mg (ARR=44.8%, OR=5.3, NNT=3.2, SUCRA=68.3%), abrocitinib 100 mg (ARR=44.0%, OR=5.2, NNT=3.3, SUCRA=65.8%), upadacitinib 15 mg (ARR=42.9%, OR=4.9, NNT=3.4, SUCRA=64.3%), and the newly added lebrikizumab 250 mg (ARR=28.9%, OR=2.7, NNT=6.6, SUCRA=39.9%). The rank order for EASI-75 was similar (upadacitinib 30 mg [ARR=78.3%, OR=9.5, NNT=2.0, SUCRA=98.5%], abrocitinib 200 mg [ARR=73.0%, OR=7.1, NNT=2.3, SUCRA=89.1%], upadacitinib 15 mg [ARR=66.1%, OR=5.1, NNT=2.7, SUCRA=71.0%], dupilumab 300 mg [ARR=65.3%, OR=5.0, NNT=2.7, SUCRA=69.2%], abrocitinib 100 mg [ARR=60.3%, OR=4.0, NNT=3.2, SUCRA=54.0%], and lebrikizumab 250 mg [ARR=54.5%, OR=3.1, NNT=3.8, SUCRA=41.2%]). For ΔNRS ≥4, upadacitinib 30 mg had the most favorable response (ARR=68.9%, OR=10.0, NNT=2.1, SUCRA=99.9%), followed by upadacitinib 15 mg (ARR=56.6%, OR=5.9, NNT=2.7, SUCRA=84.0%), abrocitinib 200 mg (ARR=51.6%, OR=4.8, NNT=3.1, SUCRA=75.6%), dupilumab 300 mg (ARR=49.3%, OR=4.4, NNT=3.3, SUCRA=67.0%), baricitinib 4 mg (ARR=44.4%, OR=3.6, NNT=4.0, SUCRA=57.7%), and abrocitinib 100 mg (ARR=35.9%, OR=2.5, NNT=5.9, SUCRA=36.1%); lebrikizumab 250 mg ranked eighth (ARR=33.4%, OR=2.3, NNT=7.0, SUCRA=31.3%). For IGA 0/1, upadacitinib 30 mg (ARR=66.5%, OR=11.7, NNT=2.0, SUCRA=99.6%) had the most favorable estimates, followed by abrocitinib 200 mg (ARR=53.5%, OR=6.8, NNT=2.6, SUCRA=86.6%), upadacitinib 15 mg (ARR=48.0%, OR=5.4, NNT=3.0, SUCRA=76.2%), dupilumab 300 mg (ARR=42.1%, OR=4.3, NNT=3.7, SUCRA=64.7%), abrocitinib 100 mg (ARR=39.1%, OR=3.8, NNT=4.1, SUCRA=56.1%), and baricitinib 4 mg (ARR=30.6%, OR=2.6, NNT=6.4, SUCRA=39.9%); lebrikizumab 250 mg ranked seventh (ARR=29.2%, OR=2.4, NNT=7.0, SUCRA=35.8%). Baricitinib 2 mg and tralokinumab 300 mg were generally ranked lower across outcomes. Conclusions: Among targeted therapies for moderate-to-severe AD used with concomitant TCS for 16 weeks, upadacitinib 30 mg remained the most efficacious therapy in this NMA, generally followed by abrocitinib 200 mg, upadacitinib 15 mg or dupilumab 300 mg, abrocitinib 100 mg, and baricitinib 4 mg or lebrikizumab 250 mg. [ABSTRACT FROM AUTHOR]

Background: The association between cardioprotective aspirin and risk of age‐related macular degeneration (AMD) is still controversial up to date. We aimed to analyze the risk of AMD between aspirin users and non‐aspirin users. Method: This was a retrospective cohort study by using claims data from the National Health Insurance Research Database. Patients aged more than 45 years old who initiated aspirin during 2002 to 2012 were followed till 2013. We first selected an age and sex‐matched cohort, then identified aspirin users and non‐aspirin users as propensity score‐matched cohort. Cox proportional hazard regression model was applied to compare their hazards and 95% confidence intervals. Incidence of newly developed AMD, neovascular AMD, and other‐AMD was calculated. Results: We identified 204 085 regular aspirin users and 478 048 non‐aspirin users from our datasets. The univariate HR was 2.85 (95% CI, 2.75‐2.96), and the multivariate HR was 2.54 (95% CI, 2.44‐2.65). In the PS‐matched cohort, the HR was 2.38 (95% CI, 2.25‐2.52). The incidence of aspirin users for AMD risk was 11.95 per 1000 person‐year, while the incidence of non‐aspirin users was only 3.92 per 1000 person‐year. Conclusion: Patients with regular use of aspirin had higher risk in developing AMD compared to non‐aspirin users and suggest to have regular visual acuity and funduscopic examination. [ABSTRACT FROM AUTHOR]

Summary: Background: There is an increasing body of evidence showing that earlier use of biologics improves clinical outcomes in Crohn's disease (CD). Aim: To perform a systematic review and meta‐analysis to assess the impact of early biologic use in the treatment of CD. Methods: PubMed and Embase databases were searched for English language papers and conference abstracts published through April 30, 2019. Studies were selected for inclusion if patients initiated biologics within 2 years of a CD diagnosis or if earlier biologics use (top‐down) was compared with a conventional step‐up strategy. Random‐effects meta‐analyses were conducted to compare clinical remission (CR), relapse and endoscopic healing rates between early biologic treatment (<2 years of disease duration or top‐down treatment strategy) and late/conventional treatment (biologic use after >2 years of disease duration or conventional step‐up treatment strategy). Results: A total of 3069 records were identified, of which 47 references met the selection criteria for systematic review. A total of 18 471 patients were studied, with a median follow‐up of 64 weeks (range 10‐416). Meta‐analysis found that early use of biologics was associated with higher rates of clinical remission (OR 2.10 [95% CI: 1.69‐2.60], n = 2763, P <.00001), lower relapse rates (OR 0.31 [95% CI: 0.14‐0.68], n = 596, P =.003) and higher mucosal healing rates (OR 2.37 [95% CI: 1.78‐3.16], n = 994, P <.00001) compared with late/conventional management. Conclusions: Early biologic treatment is associated with improved clinical outcomes in both adult and paediatric CD patients, not only in prospective clinical trials but also in real‐world settings. [ABSTRACT FROM AUTHOR]

Background and Aims Management of Crohn's disease and ulcerative colitis has typically relied upon treatment intensification driven by symptoms alone. However, a 'treat-to-target' management approach may help to address underlying inflammation, minimise disease activity at early stages of inflammatory bowel disease, limit progression, and improve long-term outcomes. Methods A systematic literature review was conducted to identify data relevant to a treat-to-target approach in inflammatory bowel disease, published between January 1, 2007 and May 15, 2017. Results Consistent with recommendations of the Selecting Therapeutic Targets in Inflammatory Bowel Disease [STRIDE] working group, studies have investigated factors influencing the achievement of both endoscopic and histological mucosal healing and patient-level outcomes in inflammatory bowel disease [IBD]. Histological healing and biomarker levels have also been shown to be modifiable outcomes. Although there is a lack of prospectively derived evidence validating mucosal healing as a treatment target, data are emerging to suggest that targeting mucosal healing or inflammation rather than symptoms may be cost-effective in some settings. The review highlighted several strategies that may support the implementation of a treat-to-target approach in IBD. The prospective randomised CALM study demonstrated how tight control [whereby treatment decisions are based on close monitoring of inflammatory biomarkers] leads to improvements in endoscopic and clinical outcomes. The review also considered the influence of coordinated care from a multidisciplinary team and patient engagement with improved adherence, as well as the role of therapeutic drug monitoring in inflammatory bowel disease management. Conclusions A treat-to-target strategy may impact on disease progression and improve outcomes in inflammatory bowel disease. Prospective studies including long-term data are required to ensure that the most appropriate targets and strategies are identified. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic, inflammatory disease characterized by typical clinical signs (erythema, edema/papulation, oozing/crusting, excoriation, lichenification and dryness) and prominent itch that can markedly impact a patient's sleep and quality of life (QoL). Upadacitinib is a selective oral Janus kinase (JAK) inhibitor with greater inhibitory potency for JAK1 vs. JAK2, JAK3 and tyrosine kinase 2. The SCORing Atopic Dermatitis (SCORAD) measure is a validated assessment tool that evaluates the extent of disease based on the area of the body affected, intensity of clinical signs of AD, and itch and sleeplessness due to AD. In this integrated post hoc analysis of the Measure Up 1 and Measure Up 2 studies, we compared the effects of upadacitinib (15 and 30 mg) vs. placebo on the intensity of the individual signs assessed by the SCORAD at Week 2 and Week 16. Measure Up 1 and Measure Up 2 are replicate phase 3 multicenter, randomized, double-blind studies comparing the safety and efficacy of upadacitinib 15 mg and upadacitinib 30 mg to placebo in adolescent and adult patients with moderate-to-severe AD. Patients were randomized to upadacitinib 15 mg, upadacitinib 30 mg or placebo orally once daily. All patients received additive-free, bland emollient twice daily for at least 7 days before baseline and during the study until week 16. The current study assessed the intensity of the six clinical signs assessed by the SCORAD (erythema, edema/papulation, oozing/crusting, excoriation, lichenification and dryness with a 4-level rating scale of none, mild, moderate and severe). The proportions of patients achieving resolution (i.e. an intensity rating of 'none') of each clinical sign at Week 2 and Week 16 were evaluated among patients with mild, moderate or severe intensity at baseline. Resolution rates were compared using the Mantel–Haenszel test. Missing data were handled using nonresponder imputation. A total of 1679 participants (placebo, 558; upadacitinib 15 mg, 557; upadacitinib 30 mg, 564) were included in the analysis of integrated data from the Measure Up 1 and Measure Up 2 studies. Differences in the proportion of patients achieving resolution for both upadacitinib doses (15 mg/30 mg) vs. placebo were observed at Week 2 (P < 0.0001) for erythema (3.1%/6.0% vs. 0.0%), edema/papulation (13.1%/16.6% vs. 1.3%), oozing/crusting (49.8%/59.1% vs. 15.6%), excoriation (26.9%/34.6% vs. 3.1%), lichenification (9.6%/13.5% vs. 1.4%) and dryness (8.6%/11.9% vs. 1.8%). Resolution rates were also higher with upadacitinib (15 mg/30 mg) vs. placebo at Week 16 (P < 0.0001) for erythema (22.2%/29.7% vs. 2.2%), edema/papulation (33.6%/42.8% vs. 4.9%), oozing/crusting (62.1%/72.0% vs. 20.5%), excoriation (43.3%/54.6% vs. 8.5%), lichenification (30.8%/40.7% vs. 5.2%) and dryness (28.7%/35.9% vs. 4.4%). Greater proportions of patients treated with upadacitinib 15 mg or upadacitinib 30 mg achieved resolution of erythema, edema/papulation, oozing/crusting, excoriation, lichenification or dryness compared with placebo at Week 2 and Week 16. Complete resolution of these clinical signs of AD may correspond to reductions in disease burden that translate to improved QoL. Consideration of the clinical signs of AD as assessed by the SCORAD may help inform physicians as they tailor their treatment choices specifically to the unique skin manifestations of each individual patient. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic, inflammatory disease characterized by sensitive and dry skin, eczematous lesions and intense pruritus. Patients with moderate-to-severe AD often require systemic treatments if their symptoms are insufficiently controlled with topical treatments or phototherapy. While numerous systemic therapies are currently available for moderate-to-severe AD, more data evaluating patient satisfaction with various characteristics of these treatments are needed to help guide physicians and their patients with joint treatment decision-making. This study aims to investigate patient satisfaction with AD treatments according to the degree and speed of itch improvement and the degree of skin clearance. A cross-sectional, web-based survey was used to evaluate patient preferences for characteristics associated with systemic AD therapies. Respondents were required to have a physician-confirmed diagnosis of AD (currently moderate or severe), to be aged ≥18 years, to be a US resident, and to read and understand English. Assessments included worst itch experienced in the past 24 h (using a scale from 0 to 10, with 0 defined as no itch and 10 defined as the worst imaginable itch), time to noticeable itch reduction following initiation of their current treatment (1–6 days, 7–13 days or ≥14 days) and the amount of body surface area still affected by AD (≤2%, 3–10% or >10%; patient-assessed). Patient satisfaction with itch improvement, speed of itch improvement and skin clearance with their current treatment was also assessed and classified into three categories: satisfied, dissatisfied or neither. P values were determined by Chi-square tests (or Fisher's exact test where appropriate). Of the 213 individuals recruited by physicians to participate in the survey, 200 respondents fulfilled the eligibility criteria, consented to participate and completed surveys. A total of 186 respondents indicated that they were currently receiving treatment for their AD; treatments included over-the-counter creams, ointments or medicines (26.9%, n = 50), prescription creams (72.0%, n = 134), oral corticosteroids (16.7%, n = 31) or dupilumab (11.3%, n = 21). Treatment satisfaction differed based on the patient's itch level within the past 24 h (P < 0.001): 85.2% (n = 23) of the 27 patients reporting the lowest levels of itch (0–1) indicated they were satisfied with their current treatment, whereas only 7.1% (n = 1) of the 14 patients reporting the worst levels of itch (8–10) were satisfied with their current treatment. Among the 73 respondents who experienced the fastest itch reduction (within 1–6 days), 65.8% (n = 48) were satisfied with their treatment. For the 36 respondents experiencing itch reduction ≥14 days post treatment, 13.9% (n = 5) were satisfied with their treatment (P < 0.001). Of the 75 respondents with the highest degree of skin clearance (≤2% of body surface area still affected), 65.3% (n = 49) were satisfied with their treatment. Among the 21 respondents with the lowest degree of skin clearance (>10% of body surface area still affected), 14.3% (n = 3) were satisfied with their treatment (P < 0.001). Safety was not evaluated, which may limit the findings in this analysis. In patients with moderate-to-severe AD, the majority of respondents experiencing the lowest levels of itch, the fastest onset of itch improvement and the highest degree of skin clearance also reported satisfaction with their current treatment. These findings underscore the stringent thresholds for both the degree and speed of symptom improvement required to achieve patient satisfaction. This highlights patients' desire for treatments offering both rapid and extensive itch reduction and skin clearance and may help broaden physicians' understanding of patient preferences and inform treatment decisions. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is characterized by intense itch and symptoms that adversely impact quality of life (QoL). Upadacitinib is a selective Janus kinase-1 inhibitor approved for moderate-to-severe AD. We assessed the effect of once daily oral upadacitinib (15 or 30 mg), with or without concurrent topical corticosteroid treatment, on patient-reported outcomes for adults and adolescents with moderate-to-severe atopic dermatitis during the double-blind, placebo-controlled phase 3 clinical trials, Measure Up 1 (NCT03569293), Measure Up 2 (NCT03607422) and AD Up (NCT03568318). Assessments included itch (Worst Pruritus Numerical Rating Scale), skin pain and symptom severity (AD Symptom Scale), symptom frequency (Patient Oriented Eczema Measure) and sleep, daily activities and emotional state (AD Impact Scale). Post hoc analysis of 2240 adults and 344 adolescents randomized patients was performed. By Week 2, more patients receiving upadacitinib achieved a clinically relevant response in itch, skin pain, symptom severity, symptom frequency, sleep, daily activities and emotional state vs. placebo across studies among adults (upadacitinib 15 mg: 30.8–87.3%; upadacitinib 30 mg: 38.0–89.9%; placebo: 2.1–43.1%; nominal P < 0.001 for all comparisons) and adolescents (upadacitinib 15 mg: 19.4–82.9%; upadacitinib 30 mg: 35.3–97.6%; placebo: 0–41.0%; nominal P < 0.05 for 37/42 comparisons). These trends continued through week 16 where response rates for all outcomes improved with upadacitinib vs. placebo in adults (upadacitinib 15 mg: 42.9–80.4%; upadacitinib 30 mg: 60.9–84.6%; placebo: 10.1–38.1%; nominal P < 0.001 for all comparisons) and adolescents (upadacitinib 15 mg: 33.3–78.0%; upadacitinib 30 mg: 50.0–85.7%; placebo: 2.8–43.6%; nominal P < 0.05 for 41/42 comparisons). These findings highlight the rapid, sustained efficacy of once daily oral upadacitinib in improving symptom burden and QoL in adults and adolescents with moderate-to-severe AD. [ABSTRACT FROM AUTHOR]

The landscape of targeted systemic treatments for moderate-to-severe atopic dermatitis (AD) continues to expand. With limited head-to-head randomized controlled trials conducted in AD, a network meta-analysis (NMA) helps inform treatment decisions by providing indirect comparisons across therapies. This study aims to update an NMA presented in Silverberg et al. (2022), assessing the comparative efficacy of targeted systemic treatments without concomitant topical corticosteroids in moderate-to-severe AD by including the latest Phase 3 monotherapy data for lebrikizumab. Data from the two most recently published Phase 3 monotherapy trials for lebrikizumab in moderate-to-severe AD [ADvocate1 (NCT04146363); ADvocate2 (NCT04178967)] were included in the analyses along with other eligible Phase 3 or 4 randomized placebo-controlled trials for abrocitinib, baricitinib, dupilumab, tralokinumab and upadacitinib identified through a systemic literature review in Silverberg et al. (2022). Prespecified efficacy outcomes included ≥90% and ≥75% improvement in Eczema Area and Severity Index (EASI 90, EASI 75) from baseline, ≥4-point improvement in Pruritus Numerical Rating Scale from baseline (ΔNRS ≥4) and Investigator Global Assessment (IGA) score of 0 or 1 (clear or almost clear) with a ≥2-point reduction from baseline (IGA 0/1), at the primary endpoint timepoint for each study (Week 12 for abrocitinib, Week 16 for all other therapies). Bayesian NMA was performed with fixed-effect, random-effect and baseline risk-adjusted models; fit statistics and diagnostics were assessed. The odds ratio (OR), number needed to treat (NNT), placebo-unadjusted absolute response rate (ARR) and Surface Under the Cumulative RAnking curve (SUCRA) scores were estimated. Statistical significance was assessed by OR 95% credible intervals excluding 1. The updated NMA analysed 13 unique placebo-controlled trials involving 7105 patients in 32 arms across six targeted therapies. Fit statistics and diagnostics supported fixed-effect models for all outcomes analysed. All targeted therapies had significantly greater response rates compared with placebo across all outcomes. For EASI 90, upadacitinib 30 mg had the most favorable response estimates (ARR = 58.3%, OR = 23.1, NNT = 1.9, SUCRA = 98.5%), followed by abrocitinib 200 mg (ARR = 45.2%, OR = 13.5, NNT = 2.5, SUCRA = 84.3%), upadacitinib 15 mg (ARR = 43.7%, OR = 12.8, NNT = 2.6, SUCRA = 82.0%), dupilumab 300 mg (ARR = 27.3%, OR = 6.2, NNT = 4.7, SUCRA = 52.8%), abrocitinib 100 mg (ARR = 26.8%, OR = 6.0, NNT = 4.8, SUCRA = 48.4%), baricitinib 4 mg (ARR = 25.0%, OR = 5.5, NNT = 5.2, SUCRA = 45.5%) and lebrikizumab 250 mg (ARR = 23.6%, OR = 5.1, NNT = 5.6, SUCRA = 40.0%). A similar rank order was observed for EASI 75 [upadacitinib 30 mg (ARR = 72.3%, OR = 19.1, NNT = 1.7, SUCRA = 98.5%), abrocitinib 200 mg (ARR = 64.6%, OR = 13.3, NNT = 1.9, SUCRA = 87.3%), upadacitinib 15 mg (ARR = 59.8%, OR = 10.9, NNT = 2.1, SUCRA = 80.2%), dupilumab 300 mg (ARR = 45.3%, OR = 6.0, NNT = 3.0, SUCRA = 55.4%), abrocitinib 100 mg (ARR = 44.9%, OR = 5.9, NNT = 3.1, SUCRA = 53.5%) and lebrikizumab 250 mg (ARR = 44.7%, OR = 5.9, NNT = 3.1, SUCRA = 53.9%)]. For ΔNRS ≥4, upadacitinib 30 mg also had the most favorable response (ARR = 56.1%, OR = 12.9, NNT = 2.1, SUCRA = 99.0%), followed by abrocitinib 200 mg (ARR = 45.4%, OR = 8.3, NNT = 2.8, SUCRA = 83.6%), upadacitinib 15 mg (ARR = 42.9%, OR = 7.6, NNT = 3.0, SUCRA = 79.2%), dupilumab 300 mg (ARR = 33.9%, OR = 5.2, NNT = 4.0, SUCRA = 54.2%), lebrikizumab 250 mg (ARR = 33.9%, OR = 5.1, NNT = 4.1, SUCRA = 54.1%) and abrocitinib 100 mg (ARR = 31.5%, OR = 4.6, NNT = 4.5, SUCRA = 46.1%). For IGA 0/1, upadacitinib 30 mg (ARR = 61.8%, OR = 19.4, NNT = 1.9, SUCRA = 99.9%) and upadacitinib 15 mg (ARR = 48.1%, OR = 11.1, NNT = 2.5, SUCRA = 86.9%) had the most favorable estimates, followed by abrocitinib 200 mg (ARR = 39.3%, OR = 7.7, NNT = 3.2, SUCRA = 75.5%), dupilumab 300 mg (ARR = 32.4%, OR = 5.7, NNT = 4.1, SUCRA = 62.1%) and lebrikizumab 250 mg (ARR = 28.0%, OR = 4.7, NNT = 5.0, SUCRA = 49.1%). Baricitinib 2 mg and tralokinumab 300 mg were generally ranked lower across outcomes. Among targeted treatments for moderate-to-severe AD used without concomitant topical corticosteroids for 12–16 weeks, upadacitinib 30 mg remains the most efficacious therapy in this NMA, generally followed by abrocitinib 200 mg, upadacitinib 15 mg, dupilumab 300 mg and lebrikizumab 250 mg or abrocitinib 100 mg. [ABSTRACT FROM AUTHOR]

Objectives. TNF-a inhibitors (TNFIs) have a black box warning for increased risk of serious infection that was based on evidence from studies of adults. Evidence of the association is lacking for children. We aimed to examine the risk of infection posed by TNFIs compared with DMARDs in children with JIA. Methods. We conducted a cohort study using the 2009-13 Truven MarketScan Commercial Claims and Encounters database. Children<16 years old with JIA who initiated monotherapy with TNFIs or DMARDs were identified and followed for occurrence of serious bacterial infection requiring hospitalization. Cox proportional hazard models were used to estimate hazard ratios for infection associated with TNFIs compared with DMARDs, adjusting for potential confounders with high-dimensional propensity scores and time-varying CS use. Results. We identified 2013 DMARD initiators and 482 TNFI initiators with a mean follow-up of 255 and 307 days, respectively. We identified 18 and 11 patients with a serious infection in the DMARD and TNFI groups, resulting in crude rates of 1.28 (95% CI 0.76-2.02) and 2.72 (95%CI 1.36-4.86) per 100 person-years, respectively. In adjusted models, TNFIs were associated with an increased risk of serious bacterial infection compared with DMARDs (adjusted hazard ratio 2.72, 95% CI: 1.08, 6.86). Conclusion. Use of TNFIs poses a higher risk of serious infection compared with DMARDs in children with JIA. Our analysis confirms the US Food and Drug Administration warning about TNFI-associated infection in children with JIA. [ABSTRACT FROM AUTHOR]

Objective Self-injectable TNF inhibitors are increasingly used early in the chronic treatment of moderate to severe rheumatologic conditions. We estimated medication adherence/persistence over time following initiation in young adult and older adult patients with rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis. Methods We conducted a retrospective cohort study of patients aged 18+ years newly initiating etanercept, adalimumab, certolizumab pegol, or golimumab using the Truven Health MarketScan Database between 2009 and 2013. Pharmacy dispensing data were used to calculate 12-month medication possession ratios (MPR) and determine adherence (MPR ≥ 0.80) for up to 3 years after starting therapy. Persistence over each 12-month interval was defined as not having a ≥92-day treatment gap. Multivariable generalized estimating equation models were used to calculate odds ratios (OR) and robust 95% confidence intervals (CI) for associations between patient characteristics and repeated adherence/persistence measures over time. Results Among 53,477 new users, 14% were young adults (18–34 years), 49% middle-aged (35–54 years), and 37% older adults (55+ years). Overall, 37% of patients were adherent and 83% were persistent in the first year of therapy. The lowest adherence (17%) and persistence (70%) were observed among young adult patients by Year +3. Compared to older adults, middle-aged (OR = 0.73, 95% CI: 0.71–0.76) and young adults (OR = 0.50, 95% CI: 0.47–0.53) were less likely to be adherent. Higher Charlson comorbidity scores, hospitalizations, and emergency department visits were associated with non-adherence/non-persistence. Conclusions We observed low adherence to self-administered TNF inhibitors but most patients remained persistent over time. Further efforts to improve adherence in young adults and patients with greater comorbidity are needed. [ABSTRACT FROM AUTHOR]

This article presents a case of acute ocular toxoplasmosis in a 49-year-old man with symptoms of blurry vision and glare. Topics include diagnosis of the disease, its symptoms and its treatment with antimicrobial.

Objective To characterize the use of tumor necrosis factor-α inhibitors ( TNFIs) in children with juvenile idiopathic arthritis ( JIA) and young adults with rheumatoid arthritis ( RA). Methods Patients with incident JIA or RA were identified by using the Truven Health MarketScan Commercial Claims and Encounters database from 2009 to 2013. The incident diagnosis was defined as no prior claims with a JIA/ RA code and no JIA/ RA medications recorded during the previous 6 months. TNFI use patterns were examined, including switching among TNFIs, adherence, persistence, and time from diagnosis to TNFI use. Earlier TNFI treatment without prior use of traditional disease-modifying antirheumatic drugs ( DMARDs) and use of specific TNFIs were analyzed by age group. Results Of 6929 children and young adults with new diagnoses of JIA/ RA, 18.6% were treated with TNFIs. In these TNFI users, 39.1% received earlier TNFI therapy without prior use of DMARDs. The use of TNFIs was higher in patients diagnosed between 2012 and 2013 than that in patients diagnosed between 2009 and 2011 (hazard ratio 1.13, 95% confidence interval 1.00-1.28). Etanercept was the most commonly used, especially by children aged < 12 (75.5%) and adolescents aged 12 to 17 (62.5%) years. Adherence measured as mean proportion of days covered ranged from 70.4% to 93.2% for individual TNFI agents. Only about 60% of patients continuously took TNFIs for 12 months. When switching occurred, switching from etanercept to adalimumab was the most common pattern. Conclusion Earlier TNFI therapy was observed in 39.1% of children and young adults taking TNFIs. In addition, the time to the first TNFI prescription became shorter over the study period. Future research should evaluate the long-term effectiveness and safety of this more aggressive TNFI therapy. [ABSTRACT FROM AUTHOR]

Background: Vitamin B6 may directly or indirectly play a role in oxidative stress and the antioxidant defense system. Objective: The purpose of this study was to examine the associations of vitamin B6 status with cysteine, glutathione, and its related enzyme activities in mice with homocysteine-induced oxidative stress. Design: Four-week-old male BALB/c mice were weighed and divided into one of four dietary treatment groups fed either a normal diet (as a control group and a homocysteine group), a vitamin B6-deficient diet (as a B6-deficient group), or a B6-supplemented diet (a pyridoxine-HCl-free diet supplemented with 14 mg/kg of pyridoxine-HCl, as a B6 supplement group) for 28 days. Homocysteine thiolactone was then added to drinking water in three groups for 21 days to induce oxidative stress. At the end of the study, mice were sacrificed by decapitation and blood and liver samples were obtained. Results: Mice with vitamin B6-deficient diet had the highest homocysteine concentration in plasma and liver among groups. Significantly increased hepatic malondialdehyde levels were observed in the vitamin B6- deficient group. Among homocysteine-treated groups, mice with vitamin B6-deficient diet had the highest plasma glutathione concentration and relatively lower hepatic glutathione concentration. The glutathione peroxidase activities remained relatively stable in plasma and liver whether vitamin B6 was adequate, deficient, or supplemented. Conclusions: Mice with deficient vitamin B6 intakes had an aggravate effect under homocysteine-induced oxidative stress. The vitamin B6-deficient status seems to mediate the oxidative stress in connection with the redistribution of glutathione from liver to plasma, but not further affect glutathione-related enzyme activities in mice with homocysteine-induced oxidative stress. [ABSTRACT FROM AUTHOR]