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Background: Psoriasis is a prevalent, chronic skin disease with a potential impact on work productivity, medical consumption costs, and quality of life. The influence of the extent of skin lesions on these outcomes is not well known. Objective: We determined associations of self-reported skin lesions with self-reported work productivity, medical consumption costs, and health-related quality of life in respondents with psoriasis. Methods: In this cross-sectional study, we included respondents with self-reported psoriasis in the Netherlands in an online questionnaire. We assessed the self-reported percentage body surface area (BSA) of psoriasis lesions. We used validated instruments to assess work productivity (WPAI-PsO), medical consumption costs (iMCQ), and health-related quality of life (EQ-5D-5L and the DLQI). We used ordinal logistic regression to associate BSA categories >1% versus 0-1% with outcomes adjusted for multiple confounders. Results: We included 501 respondents with a mean age of 43 ± 12 years; 64% were men. Median BSA was 2% (interquartile range 1–5%). A higher BSA was associated with higher overall work impairment due to psoriasis (common odds ratio [cOR] 2.44, 95% confidence interval [CI] 1.40–4.29; n = 205), higher medical consumption costs (cOR 2.06, 95% CI 1.45–2.94) and lower health-related quality of life. Associations were strongest with a BSA cutoff of 0% or 1% compared to 2% or higher categories. Discussion: In our study, having few to no lesions in psoriasis was associated with lower overall work impairment due to psoriasis, lower medical consumption costs, and higher health-related quality of life. [ABSTRACT FROM AUTHOR]

Study Question: Are patients' characteristics, such as anti-Müllerian hormone (AMH) and BMI, reliable factors to predict ovarian response in couples with unexplained subfertility undergoing IUI with ovarian hyperstimulation (IUI-OH)?Summary Answer: We observed no solid relationship between serum AMH and ovarian response.What Is Known Already: Ovarian stimulation during IUI treatment could lead to a higher chance of pregnancy, but also a higher incidence of multiple pregnancies, unless strict cancellation criteria are being used. Several factors could influence the result of the stimulation, such as age, BMI and hormonal status of the female. In IVF treatment, AMH has shown to be a useful predictor of ovarian stimulation to optimize the outcome; however, in a milder stimulation protocol, such as IUI, this has not been investigated.Study Design, Size, Duration: We performed a prospective cohort study and evaluated the first IUI stimulation cycle of 492 patients. The study was conducted between 2012 and 2017. Follow-up ended if patients were not pregnant after the first cycle. If pregnancy did occur, follow-up lasted until delivery.Participants/materials, Setting, Methods: PRORAILS is a large multicentre nationwide cohort study executed in the Netherlands. Eligible women aged 18-43 years who were diagnosed with unexplained subfertility or mild male subfertility according to the Dutch guideline, with a regular indication for IUI-OH, were asked to participate. Ovarian response was assessed using a transvaginal ultrasound 5-7 days after initiation of the stimulation and was repeated according to the size of the leading follicles. Ovarian response was defined as optimal or suboptimal based on the total number of dominant follicles >15 mm. A successful stimulation was defined as the presence of two to three follicles >15 mm on the day of hCG administration. Serum AMH (µg/l) was measured by ELISA, and samples were taken on day 2, 3 or 4 of the menstrual cycle. Poisson regression was used to estimate the risk of a suboptimal ovarian response.Main Results and the Role Of Chance: Of the 492 participants, the mean age was 33 years and the mean subfertility duration was 2.5 years. The median serum AMH was 2.1 (µg/l). The majority of patients had a suboptimal response: 326 women (66%), of whom 224 (45%) had a hypo response (defined as 15 mm) and 102 (21%) had a hyper response (defined as more than three follicles sized >15 mm). The lowest AMH category showed a trend towards a smaller risk of a suboptimal response (relative risk ratio 0.76 (95% CI 0.54, 1.06)), but this effect did not reach statistical significance. In the prediction models, BMI and serum basal FSH were significant predictors of a hypo response, while for hyper response the factors age, BMI and serum FSH were significant. A higher BMI showed a higher risk for hypo response, as did a higher FSH whereas a lower BMI and lower FSH showed a higher risk for hyper response. The addition of AMH to the models did not improve the predictive abilities.Limitations, Reasons For Caution: Although the study was prospective, the main analyses were cross-sectional with characteristics measured at one time-point. The study was not powered to provide insight into predictors of pregnancy and live births and, therefore, the result for pregnancy should be interpreted with caution.Wider Implications Of the Findings: This was the first large multicentre study that investigated the characteristics of ovarian response categories using standardized methods and centrally analysed laboratory measures. PRORAILS is a nationwide study with 15 hospitals and, therefore, these results are generalizable to other hospitals in the Netherlands. This study provides high-quality outcomes advancing the subfertility research field. Future studies would benefit from a randomized design investigating the effectiveness of an individualized approach versus a fixed dose. Also, the relation between a good ovarian stimulation and pregnancy rate could be further investigated.Study Funding/competing Interest(s): The PRORAILS study is sponsored by Merck B.V., Schiphol-Rijk, the Netherlands, an affiliation of Merck KGaA, Darmstadt, Germany (EMR700623_612). Merck KGaA, Darmstadt, Germany, reviewed the manuscript prior to submission. The opinions remain those of the authors. Merck KGaA, Darmstadt, Germany, had no influence on the use of medication in this study. The recombinant FSH was mostly provided by Merck B.V. or MSD. F.B. is a member of the external advisory board for Merck B.V., Schiphol-Rijk, the Netherlands, and has received a research grant from Merck B.V., Schiphol-Rijk. H.v.B. is an employee from IQVIA, which is a commercial data-analysing company, and received payment for her part in the article.Trial Registration Number: NCT01662180. [ABSTRACT FROM AUTHOR]

Introduction: Low vitamin D and vitamin K status are both associated with cardiovascular risk. New evidence from experimental studies on bone health suggest an interaction between vitamin D and K, however a joint association with vascular health outcomes is largely unknown. Hypothesis: We assessed the hypothesis that the combination of low vitamin D and low vitamin K status is associated with higher systolic and diastolic blood pressure in 402 participants and with incident hypertension in 231 participants free of hypertension at baseline. Methods: We used data from a subsample of the Longitudinal Aging Study Amsterdam (LASA), a population-based cohort of Dutch participants 55-65 years. Vitamin D and K status were assessed by measuring 25-hydroxyvitamin D [25(OH)D] and dephosphorylated uncarboxylated matrix gla protein (dp-ucMGP). High dp-ucMGP is indicative of a low vitamin K status. Generalized estimating equation and Cox proportional hazard models were used for the association of vitamin D and vitamin K status with blood pressure and incident hypertension (systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg or using anti-hypertensive medication). Results: During a median follow-up of 6.4 years, 62% of the participants (n=143) developed hypertension. Vitamin D and vitamin K status were categorized in groups: 25(OH)D <50/≥50 mmol/L and median dp-ucMGP <323/≥323pmol/L. The combination of low 25(OH)D <50 nmol/L and high dp-ucMGP ≥323 pmol/L was associated with increased systolic 4.8 mmHg (95% CI 0.1-9.5) and diastolic 3.1 mmHg (0.5-5.7) blood pressure compared to 25(OH)D ≥50 mmol/L and dp-ucMGP <323 pmol/L, after adjusting for age and sex, BMI, alcohol consumption, smoking, education, season of blood collection, total cholesterol and estimated glomerular filtration rate. A similar trend was seen for incident hypertension HR:1.62 (0.96-2.73). Conclusions: The combination of low vitamin D and K status was associated with increased blood pressure and might play a role in the development of hypertension. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin K is a fat soluble vitamin and is required as a co-factor for the carboxylation of several proteins. Matrix gla-protein (MGP) requires vitamin K for its activation and is a potent vascular calcification inhibitor. High concentrations of dephosphorylated uncarboxylated MGP (dp-ucMGP) -a functional marker of vitamin K status- are associated with increased coronary artery calcification and cardiovascular disease, but the underlying mechanism remains unclear. Hypothesis: We hypothesized that higher levels of dp-ucMGP (indicating low vitamin K status) are associated with unfavorable measures of cardiac structure and function after 7 years of follow-up. Methods: In the Hoorn Study, a population-based cohort, 598 participants mean age 70.1±6.6 years, 51% female, had physical examinations in 2000-2001 (baseline for the current analyses), of whom 249 had a follow-up in 2007-2009. Plasma dp-ucMGP levels were measured with ELISA in baseline samples. We studied the cross-sectional and prospective association of dp-ucMGP with echocardiographic measures of left ventricular mass index (LVMI), ejection fraction and left atrium volume index using linear regression analyses, adjusted for age, sex, BMI, education, smoking, type 2 diabetes and LDL-cholesterol. Results: Median plasma dp-ucMGP was 567 (392-701) pmol/l and mean follow-up time was 7.0±0.7 year. Cross-sectionally, the highest dp-ucMGP quartile ≥701 pmol/l compared to the lowest quartile <392 pmol/l was associated with a 2.7 g/m2.7 (95% CI -0.8, 6.2) greater LVMI. In the prospective analysis adjusting for baseline LVMI and follow-up time, the association was more pronounced and became significant 6.5 g/m2.7 (95% CI 1.5, 11.4). This result was confirmed by the continuous association (Figure 1). No significant associations were observed between dp-ucMGP with ejection fraction and left atrium volume index. Conclusion: In conclusion, these results suggest that a low vitamin K status is prospectively associated with a greater LVMI. [ABSTRACT FROM AUTHOR]

Aims: Since omeprazole and esomeprazole reduce the effect of clopidogrel on the inhibition of platelet aggregation, concomitant use of these drugs has been discouraged by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) since 2010. Currently, it is unknown how often this undesired drug-drug combination is prescribed. The aim of this article is to determine the proportion of patients using omeprazole or esomeprazole among patients using clopidogrel with gastroprotective drugs and to identify differences between these two groups with regard to patient characteristics and prescriber characteristics., Methods: This was a retrospective analysis of Dutch outpatient medication prescription records between 2015 and 2022. The database had a coverage of approximately 62% of all outpatient prescriptions dispensed in The Netherlands., Results: The proportion of patients using omeprazole or esomeprazole as gastroprotective drug in combination with clopidogrel declined from 19.7% to 8.7% between 2015 and 2022. The undesired drug-drug combination was more often prescribed by internists, to women and to patients with polypharmacy (using >10 drugs)., Conclusions: Although the proportion of patients using clopidogrel together with omeprazole or esomeprazole declined between 2015 and 2022, the undesired combination is still frequently prescribed in The Netherlands. Education about this drug-drug interaction for pharmacists and prescribers is needed since pharmacotherapeutic alternatives are available., (© 2025 The Author(s). British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)

Objective: Caution has been advocated recently when using Janus kinase inhibitors (JAKi) in rheumatoid arthritis (RA) patients with an unfavourable cardiovascular risk profile. We aimed to compare the incidences in cardiovascular events between JAKi and biologic DMARDs (bDMARDs) in a large population of RA patients., Methods: RA patients starting a new bDMARD or JAKi between 1 August 2018 and 31 January 2022 have been selected from IQVIA's Dutch Real-World Data Longitudinal Prescription database, covering about 63% of outpatient prescriptions in the Netherlands. Study outcome was a cardiovascular event, defined as the start of platelet aggregation inhibitors during the study period. The incidence densities of cardiovascular events were compared between JAKi and bDMARDs using multilevel Poisson regression, adjusted for exposure time and confounders., Results: The number of unique patients included was 15 191, with 28 481 patient-years on treatment with either JAKi (2373) or bDMARDs (26 108). Most patients were female (72%) and median age was 62 years. We found 36 cardiovascular events (1.52 events/100 patient-years) during therapy with JAKi and 383 events (1.47 events/100 patient-years) during therapy with bDMARDs, resulting in an adjusted incidence rate ratio (IRR) of 0.99 for JAKi compared with bDMARDs (95% CI: 0.70, 1.41). Sub-analyses in patients >65 years, by sex, or separately for tofacitinib and baricitinib, yielded similar results., Conclusion: In a large Dutch general RA population, the risk of cardiovascular events seems not to be different between JAKi users and those using bDMARDs, although a small increase in higher risk patients cannot be excluded., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)