Clinical Edge Journal Scan

Data are limited regarding the effect of interrupting radiation therapy for patients with BC. A retrospective study by Chow and colleagues looked at 35,845 patients with nonmetastatic triple-negative BC from the National Cancer Database who had received external beam radiation therapy as part of the management of their BC. The analysis showed inferior overall survival in patients with a longer duration of radiation treatment (hazard ratio 1.023; 95% CI 1.015-1.031) The more days of interruption, the higher the likelihood of mortality seen. In reference to 0-1 days of interruption, patients with 2-5 interrupted days (hazard ratio 1.069; 95% CI 1.002-1.140), 6-10 interrupted days (hazard ratio 1.239; 95% CI 1.140-1.348), and 11-15 interrupted days (hazard ratio 1.265; 95% CI 1.126-1.431) did worse. These findings should encourage further studies to explore ways to minimize treatment interruptions among patients with BC.

A lack of adherence to adjuvant endocrine therapy has been associated with increased mortality among women with BC. The retrospective study by Zheng and Thomas  included 25,796 older women (> 65 years old) diagnosed with stage I-III hormone receptor–positive BC and looked at associations between adherence to and persistence with adjuvant endocrine therapy and mortality in this cohort. Their findings showed that the risk for all-cause mortality was reduced by 25% in patients with vs without cumulative adherence to endocrine therapy (hazard ratio 0.75; P < .001), although no association was seen with BC-specific mortality. Persistence with endocrine therapy, which was defined as having taken the treatment for ≥ 180 continuous days, was associated with 11% reduction in all-cause mortality and 37% reduction in BC-specific mortality. This study supports prior studies in highlighting the importance of endocrine therapy adherence among women with hormone-positive BC.

Tumor-infiltrating lymphocytes (TIL) are considered significant prognostic markers in patients with BC, although the prognostic effect of TIL in human epidermal growth factor reception 2 (HER2)–low BC has not been identified. A large-cohort, single-institution retrospective analysis by Sun and colleagues investigated the prognostic role of TIL in HER2-low early-stage BC. The analysis included 1763 patients with early-stage BC who underwent surgery, of whom 429 patients were HER2+, 739 were HER2-low, and 595 were HER2-0. No differences in disease-free survival (DFS) were seen between the three cohorts. However, in patients with HER2-low BC, high (>10%) vs low (≤10%) TIL levels were associated with a 53% improvement in DFS overall (hazard ratio 0.47; P = .035), and a 58% improvement in DFS was seen for the hormone receptor–positive/HER2-low cohort (hazard ratio 0.42; P = .032).

Data are limited regarding the effect of interrupting radiation therapy for patients with BC. A retrospective study by Chow and colleagues looked at 35,845 patients with nonmetastatic triple-negative BC from the National Cancer Database who had received external beam radiation therapy as part of the management of their BC. The analysis showed inferior overall survival in patients with a longer duration of radiation treatment (hazard ratio 1.023; 95% CI 1.015-1.031) The more days of interruption, the higher the likelihood of mortality seen. In reference to 0-1 days of interruption, patients with 2-5 interrupted days (hazard ratio 1.069; 95% CI 1.002-1.140), 6-10 interrupted days (hazard ratio 1.239; 95% CI 1.140-1.348), and 11-15 interrupted days (hazard ratio 1.265; 95% CI 1.126-1.431) did worse. These findings should encourage further studies to explore ways to minimize treatment interruptions among patients with BC.

A lack of adherence to adjuvant endocrine therapy has been associated with increased mortality among women with BC. The retrospective study by Zheng and Thomas  included 25,796 older women (> 65 years old) diagnosed with stage I-III hormone receptor–positive BC and looked at associations between adherence to and persistence with adjuvant endocrine therapy and mortality in this cohort. Their findings showed that the risk for all-cause mortality was reduced by 25% in patients with vs without cumulative adherence to endocrine therapy (hazard ratio 0.75; P < .001), although no association was seen with BC-specific mortality. Persistence with endocrine therapy, which was defined as having taken the treatment for ≥ 180 continuous days, was associated with 11% reduction in all-cause mortality and 37% reduction in BC-specific mortality. This study supports prior studies in highlighting the importance of endocrine therapy adherence among women with hormone-positive BC.

Tumor-infiltrating lymphocytes (TIL) are considered significant prognostic markers in patients with BC, although the prognostic effect of TIL in human epidermal growth factor reception 2 (HER2)–low BC has not been identified. A large-cohort, single-institution retrospective analysis by Sun and colleagues investigated the prognostic role of TIL in HER2-low early-stage BC. The analysis included 1763 patients with early-stage BC who underwent surgery, of whom 429 patients were HER2+, 739 were HER2-low, and 595 were HER2-0. No differences in disease-free survival (DFS) were seen between the three cohorts. However, in patients with HER2-low BC, high (>10%) vs low (≤10%) TIL levels were associated with a 53% improvement in DFS overall (hazard ratio 0.47; P = .035), and a 58% improvement in DFS was seen for the hormone receptor–positive/HER2-low cohort (hazard ratio 0.42; P = .032).

Data are limited regarding the effect of interrupting radiation therapy for patients with BC. A retrospective study by Chow and colleagues looked at 35,845 patients with nonmetastatic triple-negative BC from the National Cancer Database who had received external beam radiation therapy as part of the management of their BC. The analysis showed inferior overall survival in patients with a longer duration of radiation treatment (hazard ratio 1.023; 95% CI 1.015-1.031) The more days of interruption, the higher the likelihood of mortality seen. In reference to 0-1 days of interruption, patients with 2-5 interrupted days (hazard ratio 1.069; 95% CI 1.002-1.140), 6-10 interrupted days (hazard ratio 1.239; 95% CI 1.140-1.348), and 11-15 interrupted days (hazard ratio 1.265; 95% CI 1.126-1.431) did worse. These findings should encourage further studies to explore ways to minimize treatment interruptions among patients with BC.

A lack of adherence to adjuvant endocrine therapy has been associated with increased mortality among women with BC. The retrospective study by Zheng and Thomas  included 25,796 older women (> 65 years old) diagnosed with stage I-III hormone receptor–positive BC and looked at associations between adherence to and persistence with adjuvant endocrine therapy and mortality in this cohort. Their findings showed that the risk for all-cause mortality was reduced by 25% in patients with vs without cumulative adherence to endocrine therapy (hazard ratio 0.75; P < .001), although no association was seen with BC-specific mortality. Persistence with endocrine therapy, which was defined as having taken the treatment for ≥ 180 continuous days, was associated with 11% reduction in all-cause mortality and 37% reduction in BC-specific mortality. This study supports prior studies in highlighting the importance of endocrine therapy adherence among women with hormone-positive BC.

Tumor-infiltrating lymphocytes (TIL) are considered significant prognostic markers in patients with BC, although the prognostic effect of TIL in human epidermal growth factor reception 2 (HER2)–low BC has not been identified. A large-cohort, single-institution retrospective analysis by Sun and colleagues investigated the prognostic role of TIL in HER2-low early-stage BC. The analysis included 1763 patients with early-stage BC who underwent surgery, of whom 429 patients were HER2+, 739 were HER2-low, and 595 were HER2-0. No differences in disease-free survival (DFS) were seen between the three cohorts. However, in patients with HER2-low BC, high (>10%) vs low (≤10%) TIL levels were associated with a 53% improvement in DFS overall (hazard ratio 0.47; P = .035), and a 58% improvement in DFS was seen for the hormone receptor–positive/HER2-low cohort (hazard ratio 0.42; P = .032).

The addition of pertuzumab to trastuzumab plus chemotherapy has demonstrated improvement in pathologic complete response (pCR) rates compared with trastuzumab plus chemotherapy in early-stage HER2-positive breast cancer.³ The framework of oncology is built on clinical trials through their rigorous design, enrollment, and synthesis of data; however, real-world studies are an integral component of cancer research because they provide a more representative sample of the general population treated in routine clinical practice. Neopearl was a retrospective, observational, real-world study that evaluated the efficacy and safety of trastuzumab plus chemotherapy with or without pertuzumab among 271 patients with stage II-III HER2-positive breast cancer (Fabbri et al). The addition of pertuzumab led to an increase in pCR rate (49% vs 62%; odds ratio 1.74; P = .032) and improvement in 5-year event-free survival (81% vs 93%; hazard ratio 2.22; P = .041), and the benefit on univariate analysis was restricted to patients with positive axillary nodes. Furthermore, there were no significant differences in adverse events, including cardiac, between the two groups. These results serve to strengthen the available data regarding the clinical efficacy and favorable safety profile of dual HER2-targeted therapy combined with neoadjuvant chemotherapy.

Lifestyle factors, including physical activity and diet, are becoming increasingly recognized as important determinants of various cancer-specific outcomes and overall health. Furthermore, because these are modifiable, there is often motivation on behalf of an individual to change behaviors that can affect their outcome. Adherence to the Mediterranean diet (MD) has been associated with reduced risk for breast cancer development and lower mortality among women with breast cancer.^4,5 Data from a prospective multicenter European cohort including 13,270 breast cancer survivors demonstrated that low compared with medium adherence to a MD before a breast cancer diagnosis was associated with a 13% higher risk for all-cause mortality (hazard ratio 1.13; 95% CI 1.01-1.26). A three-unit increase in the adapted relative MD score was associated with an 8% reduced risk for overall mortality (hazard ratio_3-unit 0.92; 95% CI 0.87-0.97); this result was sustained in the postmenopausal population and strengthened in metastatic disease (Castro-Espin et al). The connection between diet and cancer outcomes is complex, and future research evaluating specific dietary interventions and the underlying biologic pathways by which nutrition exerts its effects will be important to inform our counseling for patients with breast cancer in the survivorship setting.

Additional References

1. Whelan TJ, Olivotto IA, Parulekar WR, et al, for the MA.20 Study Investigators. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373:307-16. doi:10.1056/NEJMoa1415340
2. ClinicalTrials.gov. Regional radiotherapy in biomarker low-risk node positive and T3N0 breast cancer (TAILOR RT). National Library of Medicine. Last updated November 23, 2022. https://www.clinicaltrials.gov/study/NCT03488693
3. Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): A randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13:25-32. doi:10.1016/S1470-2045(11)70336-9
4. Buckland G, Travier N, Cottet V, et al. Adherence to the mediterranean diet and risk of breast cancer in the European prospective investigation into cancer and nutrition cohort study. Int J Cancer. 2013;132:2918-27. doi:10.1002/ijc.27958
5. Haslam DE, John EM, Knight JA, et al. Diet quality and all-cause mortality in women with breast cancer from the Breast Cancer Family Registry. Cancer Epidemiol Biomarkers Prev. 2023;32:678-686. doi:10.1158/1055-9965.EPI-22-1198

The addition of pertuzumab to trastuzumab plus chemotherapy has demonstrated improvement in pathologic complete response (pCR) rates compared with trastuzumab plus chemotherapy in early-stage HER2-positive breast cancer.³ The framework of oncology is built on clinical trials through their rigorous design, enrollment, and synthesis of data; however, real-world studies are an integral component of cancer research because they provide a more representative sample of the general population treated in routine clinical practice. Neopearl was a retrospective, observational, real-world study that evaluated the efficacy and safety of trastuzumab plus chemotherapy with or without pertuzumab among 271 patients with stage II-III HER2-positive breast cancer (Fabbri et al). The addition of pertuzumab led to an increase in pCR rate (49% vs 62%; odds ratio 1.74; P = .032) and improvement in 5-year event-free survival (81% vs 93%; hazard ratio 2.22; P = .041), and the benefit on univariate analysis was restricted to patients with positive axillary nodes. Furthermore, there were no significant differences in adverse events, including cardiac, between the two groups. These results serve to strengthen the available data regarding the clinical efficacy and favorable safety profile of dual HER2-targeted therapy combined with neoadjuvant chemotherapy.

Lifestyle factors, including physical activity and diet, are becoming increasingly recognized as important determinants of various cancer-specific outcomes and overall health. Furthermore, because these are modifiable, there is often motivation on behalf of an individual to change behaviors that can affect their outcome. Adherence to the Mediterranean diet (MD) has been associated with reduced risk for breast cancer development and lower mortality among women with breast cancer.^4,5 Data from a prospective multicenter European cohort including 13,270 breast cancer survivors demonstrated that low compared with medium adherence to a MD before a breast cancer diagnosis was associated with a 13% higher risk for all-cause mortality (hazard ratio 1.13; 95% CI 1.01-1.26). A three-unit increase in the adapted relative MD score was associated with an 8% reduced risk for overall mortality (hazard ratio_3-unit 0.92; 95% CI 0.87-0.97); this result was sustained in the postmenopausal population and strengthened in metastatic disease (Castro-Espin et al). The connection between diet and cancer outcomes is complex, and future research evaluating specific dietary interventions and the underlying biologic pathways by which nutrition exerts its effects will be important to inform our counseling for patients with breast cancer in the survivorship setting.

Additional References

1. Whelan TJ, Olivotto IA, Parulekar WR, et al, for the MA.20 Study Investigators. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373:307-16. doi:10.1056/NEJMoa1415340
2. ClinicalTrials.gov. Regional radiotherapy in biomarker low-risk node positive and T3N0 breast cancer (TAILOR RT). National Library of Medicine. Last updated November 23, 2022. https://www.clinicaltrials.gov/study/NCT03488693
3. Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): A randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13:25-32. doi:10.1016/S1470-2045(11)70336-9
4. Buckland G, Travier N, Cottet V, et al. Adherence to the mediterranean diet and risk of breast cancer in the European prospective investigation into cancer and nutrition cohort study. Int J Cancer. 2013;132:2918-27. doi:10.1002/ijc.27958
5. Haslam DE, John EM, Knight JA, et al. Diet quality and all-cause mortality in women with breast cancer from the Breast Cancer Family Registry. Cancer Epidemiol Biomarkers Prev. 2023;32:678-686. doi:10.1158/1055-9965.EPI-22-1198

The addition of pertuzumab to trastuzumab plus chemotherapy has demonstrated improvement in pathologic complete response (pCR) rates compared with trastuzumab plus chemotherapy in early-stage HER2-positive breast cancer.³ The framework of oncology is built on clinical trials through their rigorous design, enrollment, and synthesis of data; however, real-world studies are an integral component of cancer research because they provide a more representative sample of the general population treated in routine clinical practice. Neopearl was a retrospective, observational, real-world study that evaluated the efficacy and safety of trastuzumab plus chemotherapy with or without pertuzumab among 271 patients with stage II-III HER2-positive breast cancer (Fabbri et al). The addition of pertuzumab led to an increase in pCR rate (49% vs 62%; odds ratio 1.74; P = .032) and improvement in 5-year event-free survival (81% vs 93%; hazard ratio 2.22; P = .041), and the benefit on univariate analysis was restricted to patients with positive axillary nodes. Furthermore, there were no significant differences in adverse events, including cardiac, between the two groups. These results serve to strengthen the available data regarding the clinical efficacy and favorable safety profile of dual HER2-targeted therapy combined with neoadjuvant chemotherapy.

Lifestyle factors, including physical activity and diet, are becoming increasingly recognized as important determinants of various cancer-specific outcomes and overall health. Furthermore, because these are modifiable, there is often motivation on behalf of an individual to change behaviors that can affect their outcome. Adherence to the Mediterranean diet (MD) has been associated with reduced risk for breast cancer development and lower mortality among women with breast cancer.^4,5 Data from a prospective multicenter European cohort including 13,270 breast cancer survivors demonstrated that low compared with medium adherence to a MD before a breast cancer diagnosis was associated with a 13% higher risk for all-cause mortality (hazard ratio 1.13; 95% CI 1.01-1.26). A three-unit increase in the adapted relative MD score was associated with an 8% reduced risk for overall mortality (hazard ratio_3-unit 0.92; 95% CI 0.87-0.97); this result was sustained in the postmenopausal population and strengthened in metastatic disease (Castro-Espin et al). The connection between diet and cancer outcomes is complex, and future research evaluating specific dietary interventions and the underlying biologic pathways by which nutrition exerts its effects will be important to inform our counseling for patients with breast cancer in the survivorship setting.

Additional References

1. Whelan TJ, Olivotto IA, Parulekar WR, et al, for the MA.20 Study Investigators. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373:307-16. doi:10.1056/NEJMoa1415340
2. ClinicalTrials.gov. Regional radiotherapy in biomarker low-risk node positive and T3N0 breast cancer (TAILOR RT). National Library of Medicine. Last updated November 23, 2022. https://www.clinicaltrials.gov/study/NCT03488693
3. Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): A randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13:25-32. doi:10.1016/S1470-2045(11)70336-9
4. Buckland G, Travier N, Cottet V, et al. Adherence to the mediterranean diet and risk of breast cancer in the European prospective investigation into cancer and nutrition cohort study. Int J Cancer. 2013;132:2918-27. doi:10.1002/ijc.27958
5. Haslam DE, John EM, Knight JA, et al. Diet quality and all-cause mortality in women with breast cancer from the Breast Cancer Family Registry. Cancer Epidemiol Biomarkers Prev. 2023;32:678-686. doi:10.1158/1055-9965.EPI-22-1198

Key clinical point: Having siblings and being born second or later is associated with a marginally reduced lifetime risk of developing atopic dermatitis (AD).

Major finding: Children born in the birth order ≥2 vs 1 had a 9% lower risk for ever AD (pooled risk ratio [RR] 0.91; 95% CI 0.84-0.98), and a sibship size ≥2 vs 1 was associated with an 8% lower risk for ever AD (RR 0.92; 95% CI 0.86-0.97) and a 10% lower risk for current AD (RR 0.90; 95% CI 0.83-0.98).

Study details: Findings are from a meta-analysis of 102 observational studies that analyzed the association between birth order or sibship size and the risk for AD.

Disclosures: This study did not disclose the source of funding. H Kankaanranta declared receiving lecture and consulting fees from various sources. The other authors declared no conflicts of interest.

Source: Lisik D et al. Birth order, sibship size, and risk of atopic dermatitis, food allergy, and atopy: A systematic review and meta‐analysis. Clin Transl Allergy. 2023;13(6):e12270 (Jun 17). Doi: 10.1002/clt2.12270

Key clinical point: Having siblings and being born second or later is associated with a marginally reduced lifetime risk of developing atopic dermatitis (AD).

Major finding: Children born in the birth order ≥2 vs 1 had a 9% lower risk for ever AD (pooled risk ratio [RR] 0.91; 95% CI 0.84-0.98), and a sibship size ≥2 vs 1 was associated with an 8% lower risk for ever AD (RR 0.92; 95% CI 0.86-0.97) and a 10% lower risk for current AD (RR 0.90; 95% CI 0.83-0.98).

Study details: Findings are from a meta-analysis of 102 observational studies that analyzed the association between birth order or sibship size and the risk for AD.

Disclosures: This study did not disclose the source of funding. H Kankaanranta declared receiving lecture and consulting fees from various sources. The other authors declared no conflicts of interest.

Source: Lisik D et al. Birth order, sibship size, and risk of atopic dermatitis, food allergy, and atopy: A systematic review and meta‐analysis. Clin Transl Allergy. 2023;13(6):e12270 (Jun 17). Doi: 10.1002/clt2.12270

Key clinical point: Having siblings and being born second or later is associated with a marginally reduced lifetime risk of developing atopic dermatitis (AD).

Major finding: Children born in the birth order ≥2 vs 1 had a 9% lower risk for ever AD (pooled risk ratio [RR] 0.91; 95% CI 0.84-0.98), and a sibship size ≥2 vs 1 was associated with an 8% lower risk for ever AD (RR 0.92; 95% CI 0.86-0.97) and a 10% lower risk for current AD (RR 0.90; 95% CI 0.83-0.98).

Study details: Findings are from a meta-analysis of 102 observational studies that analyzed the association between birth order or sibship size and the risk for AD.

Disclosures: This study did not disclose the source of funding. H Kankaanranta declared receiving lecture and consulting fees from various sources. The other authors declared no conflicts of interest.

Source: Lisik D et al. Birth order, sibship size, and risk of atopic dermatitis, food allergy, and atopy: A systematic review and meta‐analysis. Clin Transl Allergy. 2023;13(6):e12270 (Jun 17). Doi: 10.1002/clt2.12270

Key clinical point: Probiotic intake by breastfeeding mothers reduced atopic dermatitis (AD) incidence in children by half, whereas in children receiving probiotic supplementation, AD incidence decreased by 22% only.

Major finding: Probiotic intake by pregnant and breastfeeding mothers, pregnant and breastfeeding mothers and children, and pregnant mothers and children reduced the incidence of pediatric AD by 49% (relative risk [RR] 0.51; 95% CI 0.39-0.66), 39% (RR 0.61; 95% CI 0.43-0.86), and 27% (RR 0.73; 95% CI 0.63-0.86), respectively. Children receiving probiotics vs placebo had a 22% lower incidence of AD (RR 0.78; 95% CI 0.64-0.94).

Study details: Findings are from a systematic review and meta-analysis of 75 studies on the prophylactic (n = 8754 participants) or therapeutic (n = 2021 children) effects of probiotics in children age ≤ 18 years, including 17 studies involving 2844 children who received probiotics or placebo.

Disclosures: This study did not declare the source of funding. M Steinhoff declared receiving research funds from and serving as an advisor and consultant for various organizations.

Source: Husein-ElAhmed H and Steinhoff M. Meta-analysis on preventive and therapeutic effects of probiotic supplementation in infant atopic dermatitis. J Dtsch Dermatol Ges. 2023 (Jun 22). Doi: 10.1111/ddg.15120

Key clinical point: Probiotic intake by breastfeeding mothers reduced atopic dermatitis (AD) incidence in children by half, whereas in children receiving probiotic supplementation, AD incidence decreased by 22% only.

Major finding: Probiotic intake by pregnant and breastfeeding mothers, pregnant and breastfeeding mothers and children, and pregnant mothers and children reduced the incidence of pediatric AD by 49% (relative risk [RR] 0.51; 95% CI 0.39-0.66), 39% (RR 0.61; 95% CI 0.43-0.86), and 27% (RR 0.73; 95% CI 0.63-0.86), respectively. Children receiving probiotics vs placebo had a 22% lower incidence of AD (RR 0.78; 95% CI 0.64-0.94).

Study details: Findings are from a systematic review and meta-analysis of 75 studies on the prophylactic (n = 8754 participants) or therapeutic (n = 2021 children) effects of probiotics in children age ≤ 18 years, including 17 studies involving 2844 children who received probiotics or placebo.

Disclosures: This study did not declare the source of funding. M Steinhoff declared receiving research funds from and serving as an advisor and consultant for various organizations.

Source: Husein-ElAhmed H and Steinhoff M. Meta-analysis on preventive and therapeutic effects of probiotic supplementation in infant atopic dermatitis. J Dtsch Dermatol Ges. 2023 (Jun 22). Doi: 10.1111/ddg.15120

Key clinical point: Probiotic intake by breastfeeding mothers reduced atopic dermatitis (AD) incidence in children by half, whereas in children receiving probiotic supplementation, AD incidence decreased by 22% only.

Major finding: Probiotic intake by pregnant and breastfeeding mothers, pregnant and breastfeeding mothers and children, and pregnant mothers and children reduced the incidence of pediatric AD by 49% (relative risk [RR] 0.51; 95% CI 0.39-0.66), 39% (RR 0.61; 95% CI 0.43-0.86), and 27% (RR 0.73; 95% CI 0.63-0.86), respectively. Children receiving probiotics vs placebo had a 22% lower incidence of AD (RR 0.78; 95% CI 0.64-0.94).

Study details: Findings are from a systematic review and meta-analysis of 75 studies on the prophylactic (n = 8754 participants) or therapeutic (n = 2021 children) effects of probiotics in children age ≤ 18 years, including 17 studies involving 2844 children who received probiotics or placebo.

Disclosures: This study did not declare the source of funding. M Steinhoff declared receiving research funds from and serving as an advisor and consultant for various organizations.

Source: Husein-ElAhmed H and Steinhoff M. Meta-analysis on preventive and therapeutic effects of probiotic supplementation in infant atopic dermatitis. J Dtsch Dermatol Ges. 2023 (Jun 22). Doi: 10.1111/ddg.15120

Key clinical point: A history of herpes zoster (HZ) infection is a predictive factor for the occurrence of HZ in patients with moderate-to-severe atopic dermatitis (AD) during upadacitinib therapy.

Major finding: The incidence of a history of HZ was significantly higher in patients with vs without the occurrence of HZ in the 15 mg upadacitinib (70% vs 3%), 30 mg upadacitinib (100% vs 10%), and overall (79% vs 5%) groups (all P < .01). HZ history was significantly associated with the occurrence of HZ during treatment in the 15 mg upadacitinib (adjusted odds ratio [aOR] 172) and overall (aOR 74.6) groups (both P < .01).

Study details: Findings are from a retrospective analysis of 112 patients aged ≥12 years with moderate-to-severe AD who received 15 mg upadacitinib (n = 78) or 30 mg upadacitinib (n = 34) daily for 3-9 months.

Disclosures: This study did not declare the funding source. All authors, except E Fujimoto, declared receiving research funding or lecture fees from AbbVie GK.

Source: Hagino T et al. Background factors predicting the occurrence of herpes zoster in atopic dermatitis patients treated with upadacitinib. J Dermatol. 2023 (Jul 3). Doi: 10.1111/1346-8138.16879

Key clinical point: A history of herpes zoster (HZ) infection is a predictive factor for the occurrence of HZ in patients with moderate-to-severe atopic dermatitis (AD) during upadacitinib therapy.

Major finding: The incidence of a history of HZ was significantly higher in patients with vs without the occurrence of HZ in the 15 mg upadacitinib (70% vs 3%), 30 mg upadacitinib (100% vs 10%), and overall (79% vs 5%) groups (all P < .01). HZ history was significantly associated with the occurrence of HZ during treatment in the 15 mg upadacitinib (adjusted odds ratio [aOR] 172) and overall (aOR 74.6) groups (both P < .01).

Study details: Findings are from a retrospective analysis of 112 patients aged ≥12 years with moderate-to-severe AD who received 15 mg upadacitinib (n = 78) or 30 mg upadacitinib (n = 34) daily for 3-9 months.

Disclosures: This study did not declare the funding source. All authors, except E Fujimoto, declared receiving research funding or lecture fees from AbbVie GK.

Source: Hagino T et al. Background factors predicting the occurrence of herpes zoster in atopic dermatitis patients treated with upadacitinib. J Dermatol. 2023 (Jul 3). Doi: 10.1111/1346-8138.16879

Key clinical point: A history of herpes zoster (HZ) infection is a predictive factor for the occurrence of HZ in patients with moderate-to-severe atopic dermatitis (AD) during upadacitinib therapy.

Major finding: The incidence of a history of HZ was significantly higher in patients with vs without the occurrence of HZ in the 15 mg upadacitinib (70% vs 3%), 30 mg upadacitinib (100% vs 10%), and overall (79% vs 5%) groups (all P < .01). HZ history was significantly associated with the occurrence of HZ during treatment in the 15 mg upadacitinib (adjusted odds ratio [aOR] 172) and overall (aOR 74.6) groups (both P < .01).

Study details: Findings are from a retrospective analysis of 112 patients aged ≥12 years with moderate-to-severe AD who received 15 mg upadacitinib (n = 78) or 30 mg upadacitinib (n = 34) daily for 3-9 months.

Disclosures: This study did not declare the funding source. All authors, except E Fujimoto, declared receiving research funding or lecture fees from AbbVie GK.

Source: Hagino T et al. Background factors predicting the occurrence of herpes zoster in atopic dermatitis patients treated with upadacitinib. J Dermatol. 2023 (Jul 3). Doi: 10.1111/1346-8138.16879

Key clinical point: Infants with atopic dermatitis (AD) experience significant bronchial obstruction regardless of disease severity, food sensitivity, and a history of recurrent wheezing.

Major finding: Tidal breath analysis revealed that the AD vs control group had significantly lower time to peak tidal expiratory flow (TPTEF; P = .001), exhaled volume to peak tidal expiratory flow (VPTEF; P = .001), TPTEF/expiratory time (P < .001), VPTEF/total expiratory volume (P < .001), expiratory flow when 25% of tidal volume remains in the lungs (P < .001), and respiratory rate (P = .007), with no differences observed within the AD group when these parameters were compared based on disease severity, food sensitivity, and a history of recurrent wheezing (all P > .05).

Study details: This prospective cross-sectional study included 150 infants aged 0-3 years with AD and 80 control infants of similar age without chronic disease, acute or chronic infection, history of prematurity, developmental delay, neurometabolic disease, or atopy.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Koksal ZG and Uysal P. Beyond the skin: Reduced lung function associated with atopic dermatitis in infants. J Allergy Clin Immunol Pract. 2023 (Jul 3). Doi: 10.1016/j.jaip.2023.06.055

Key clinical point: Infants with atopic dermatitis (AD) experience significant bronchial obstruction regardless of disease severity, food sensitivity, and a history of recurrent wheezing.

Major finding: Tidal breath analysis revealed that the AD vs control group had significantly lower time to peak tidal expiratory flow (TPTEF; P = .001), exhaled volume to peak tidal expiratory flow (VPTEF; P = .001), TPTEF/expiratory time (P < .001), VPTEF/total expiratory volume (P < .001), expiratory flow when 25% of tidal volume remains in the lungs (P < .001), and respiratory rate (P = .007), with no differences observed within the AD group when these parameters were compared based on disease severity, food sensitivity, and a history of recurrent wheezing (all P > .05).

Study details: This prospective cross-sectional study included 150 infants aged 0-3 years with AD and 80 control infants of similar age without chronic disease, acute or chronic infection, history of prematurity, developmental delay, neurometabolic disease, or atopy.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Koksal ZG and Uysal P. Beyond the skin: Reduced lung function associated with atopic dermatitis in infants. J Allergy Clin Immunol Pract. 2023 (Jul 3). Doi: 10.1016/j.jaip.2023.06.055

Key clinical point: Infants with atopic dermatitis (AD) experience significant bronchial obstruction regardless of disease severity, food sensitivity, and a history of recurrent wheezing.

Major finding: Tidal breath analysis revealed that the AD vs control group had significantly lower time to peak tidal expiratory flow (TPTEF; P = .001), exhaled volume to peak tidal expiratory flow (VPTEF; P = .001), TPTEF/expiratory time (P < .001), VPTEF/total expiratory volume (P < .001), expiratory flow when 25% of tidal volume remains in the lungs (P < .001), and respiratory rate (P = .007), with no differences observed within the AD group when these parameters were compared based on disease severity, food sensitivity, and a history of recurrent wheezing (all P > .05).

Study details: This prospective cross-sectional study included 150 infants aged 0-3 years with AD and 80 control infants of similar age without chronic disease, acute or chronic infection, history of prematurity, developmental delay, neurometabolic disease, or atopy.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Koksal ZG and Uysal P. Beyond the skin: Reduced lung function associated with atopic dermatitis in infants. J Allergy Clin Immunol Pract. 2023 (Jul 3). Doi: 10.1016/j.jaip.2023.06.055

Key clinical point: In patients with moderate-to-severe atopic dermatitis (AD), baricitinib with or without topical corticosteroids (TCS) resulted in rapid achievement of the recommended absolute Eczema Area and Severity Index (EASI) and SCORing of AD (SCORAD) outcomes, which were sustained until week 16.

Major finding: An EASI score of ≤7 and a SCORAD score of <25 were achieved by significantly more patients receiving baricitinib (2 or 4 mg) vs placebo at all timepoints from week 1 (all P ≤ .01 and all P ≤ .05, respectively) and those receiving 4 mg baricitinib + TCS vs placebo + TCS at all timepoints from week 2 (all P ≤ .05 for both).

Study details: This post hoc analysis included 1316 patients with moderate-to-severe AD who received baricitinib (2 or 4 mg) or placebo in BREEZE-AD1/AD2 or baricitinib (2 or 4 mg)+TCS or placebo+TCS in BREEZE-AD7 for 16 weeks.

Disclosures: This study was funded by Eli Lilly and Company. Some authors reported ties with various organizations, including Eli Lilly. Three authors declared being current or former employees or shareholders of Eli Lilly.

Source: Thyssen JP et al. Baricitinib provides rapid and sustained improvements in absolute EASI and SCORAD outcomes in adults with moderate-to-severe atopic dermatitis. J Dermatolog Treat. 2023;34(1):2216322 (Jun 21). Doi: 10.1080/09546634.2023.2216322

Key clinical point: In patients with moderate-to-severe atopic dermatitis (AD), baricitinib with or without topical corticosteroids (TCS) resulted in rapid achievement of the recommended absolute Eczema Area and Severity Index (EASI) and SCORing of AD (SCORAD) outcomes, which were sustained until week 16.

Major finding: An EASI score of ≤7 and a SCORAD score of <25 were achieved by significantly more patients receiving baricitinib (2 or 4 mg) vs placebo at all timepoints from week 1 (all P ≤ .01 and all P ≤ .05, respectively) and those receiving 4 mg baricitinib + TCS vs placebo + TCS at all timepoints from week 2 (all P ≤ .05 for both).

Study details: This post hoc analysis included 1316 patients with moderate-to-severe AD who received baricitinib (2 or 4 mg) or placebo in BREEZE-AD1/AD2 or baricitinib (2 or 4 mg)+TCS or placebo+TCS in BREEZE-AD7 for 16 weeks.

Disclosures: This study was funded by Eli Lilly and Company. Some authors reported ties with various organizations, including Eli Lilly. Three authors declared being current or former employees or shareholders of Eli Lilly.

Source: Thyssen JP et al. Baricitinib provides rapid and sustained improvements in absolute EASI and SCORAD outcomes in adults with moderate-to-severe atopic dermatitis. J Dermatolog Treat. 2023;34(1):2216322 (Jun 21). Doi: 10.1080/09546634.2023.2216322

Key clinical point: In patients with moderate-to-severe atopic dermatitis (AD), baricitinib with or without topical corticosteroids (TCS) resulted in rapid achievement of the recommended absolute Eczema Area and Severity Index (EASI) and SCORing of AD (SCORAD) outcomes, which were sustained until week 16.

Major finding: An EASI score of ≤7 and a SCORAD score of <25 were achieved by significantly more patients receiving baricitinib (2 or 4 mg) vs placebo at all timepoints from week 1 (all P ≤ .01 and all P ≤ .05, respectively) and those receiving 4 mg baricitinib + TCS vs placebo + TCS at all timepoints from week 2 (all P ≤ .05 for both).

Study details: This post hoc analysis included 1316 patients with moderate-to-severe AD who received baricitinib (2 or 4 mg) or placebo in BREEZE-AD1/AD2 or baricitinib (2 or 4 mg)+TCS or placebo+TCS in BREEZE-AD7 for 16 weeks.

Disclosures: This study was funded by Eli Lilly and Company. Some authors reported ties with various organizations, including Eli Lilly. Three authors declared being current or former employees or shareholders of Eli Lilly.

Source: Thyssen JP et al. Baricitinib provides rapid and sustained improvements in absolute EASI and SCORAD outcomes in adults with moderate-to-severe atopic dermatitis. J Dermatolog Treat. 2023;34(1):2216322 (Jun 21). Doi: 10.1080/09546634.2023.2216322

Key clinical point: Upadacitinib demonstrated an acceptable safety profile and led to significant and sustained improvements in disease signs and symptoms through 48 weeks of observation in patients with moderate-to-severe atopic dermatitis (AD) who were unresponsive to conventional treatments.

Major finding: At weeks 16 and 48, an Eczema Area and Severity Index-75 response was achieved by 78.2% and 87.6% of patients, respectively, with a significant reduction in mean sleeplessness, skin pain, and itch Numeric Rating Scale scores (all P < .001). Most adverse events were of mild-to-moderate severity.

Study details: This real-world prospective study included 146 adult patients with moderate-to-severe AD who were unresponsive, intolerant, or had contraindications to the approved therapies for moderate-to-severe AD and received 15 or 30 mg upadacitinib alone or combined with corticosteroids for 48 weeks.

Disclosures: This study did not receive any funding. Some authors, including the lead author, declared serving as investigators, speakers, advisory board members, or consultants for or receiving lecture or speaker honoraria, research grants, or personal fees from various sources.

Source: Chiricozzi A et al. Long-term effectiveness and safety of upadacitinib for atopic dermatitis in a real-world setting: An interim analysis through 48 weeks of observation. Am J Clin Dermatol. 2023 (Jun 15). Doi: 10.1007/s40257-023-00798-0

Key clinical point: Upadacitinib demonstrated an acceptable safety profile and led to significant and sustained improvements in disease signs and symptoms through 48 weeks of observation in patients with moderate-to-severe atopic dermatitis (AD) who were unresponsive to conventional treatments.

Major finding: At weeks 16 and 48, an Eczema Area and Severity Index-75 response was achieved by 78.2% and 87.6% of patients, respectively, with a significant reduction in mean sleeplessness, skin pain, and itch Numeric Rating Scale scores (all P < .001). Most adverse events were of mild-to-moderate severity.

Study details: This real-world prospective study included 146 adult patients with moderate-to-severe AD who were unresponsive, intolerant, or had contraindications to the approved therapies for moderate-to-severe AD and received 15 or 30 mg upadacitinib alone or combined with corticosteroids for 48 weeks.

Disclosures: This study did not receive any funding. Some authors, including the lead author, declared serving as investigators, speakers, advisory board members, or consultants for or receiving lecture or speaker honoraria, research grants, or personal fees from various sources.

Source: Chiricozzi A et al. Long-term effectiveness and safety of upadacitinib for atopic dermatitis in a real-world setting: An interim analysis through 48 weeks of observation. Am J Clin Dermatol. 2023 (Jun 15). Doi: 10.1007/s40257-023-00798-0

Key clinical point: Upadacitinib demonstrated an acceptable safety profile and led to significant and sustained improvements in disease signs and symptoms through 48 weeks of observation in patients with moderate-to-severe atopic dermatitis (AD) who were unresponsive to conventional treatments.

Major finding: At weeks 16 and 48, an Eczema Area and Severity Index-75 response was achieved by 78.2% and 87.6% of patients, respectively, with a significant reduction in mean sleeplessness, skin pain, and itch Numeric Rating Scale scores (all P < .001). Most adverse events were of mild-to-moderate severity.

Study details: This real-world prospective study included 146 adult patients with moderate-to-severe AD who were unresponsive, intolerant, or had contraindications to the approved therapies for moderate-to-severe AD and received 15 or 30 mg upadacitinib alone or combined with corticosteroids for 48 weeks.

Disclosures: This study did not receive any funding. Some authors, including the lead author, declared serving as investigators, speakers, advisory board members, or consultants for or receiving lecture or speaker honoraria, research grants, or personal fees from various sources.

Source: Chiricozzi A et al. Long-term effectiveness and safety of upadacitinib for atopic dermatitis in a real-world setting: An interim analysis through 48 weeks of observation. Am J Clin Dermatol. 2023 (Jun 15). Doi: 10.1007/s40257-023-00798-0

Key clinical point: Dupilumab rapidly reduced the skin abundance of Staphylococcus aureus in patients with moderate-to-severe atopic dermatitis (AD), and the reduction correlated with improvements in all AD severity measurements except itch.

Major finding: At day 3, the dupilumab vs placebo group showed a 7.5-fold reduction (P = .02) in the skin abundance of S. aureus. A significant positive correlation was observed between the reduction in abundance and SCORing Atopic Dermatitis score with dupilumab (repeated measure correlation coefficient 0.39; P < .001), which was similar for other AD severity measurements except pruritus Numeric Rating Scale score.

Study details: Findings are from the multicenter, double-blind ADRN09 trial including 71 adult patients with moderate-to-severe AD who were randomly assigned to receive dupilumab (n = 45) or placebo (n = 26).

Disclosures: This study was supported by the US National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, Colorado. Some authors declared serving as consultants or investigators for and receiving research grants from various organizations.

Source: Simpson EL et al. Rapid reduction in Staphylococcus aureus in atopic dermatitis subjects following dupilumab treatment. J Allergy Clin Immunol. 2023 (Jun 12). Doi: 10.1016/j.jaci.2023.05.026

Key clinical point: Dupilumab rapidly reduced the skin abundance of Staphylococcus aureus in patients with moderate-to-severe atopic dermatitis (AD), and the reduction correlated with improvements in all AD severity measurements except itch.

Major finding: At day 3, the dupilumab vs placebo group showed a 7.5-fold reduction (P = .02) in the skin abundance of S. aureus. A significant positive correlation was observed between the reduction in abundance and SCORing Atopic Dermatitis score with dupilumab (repeated measure correlation coefficient 0.39; P < .001), which was similar for other AD severity measurements except pruritus Numeric Rating Scale score.

Study details: Findings are from the multicenter, double-blind ADRN09 trial including 71 adult patients with moderate-to-severe AD who were randomly assigned to receive dupilumab (n = 45) or placebo (n = 26).

Disclosures: This study was supported by the US National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, Colorado. Some authors declared serving as consultants or investigators for and receiving research grants from various organizations.

Source: Simpson EL et al. Rapid reduction in Staphylococcus aureus in atopic dermatitis subjects following dupilumab treatment. J Allergy Clin Immunol. 2023 (Jun 12). Doi: 10.1016/j.jaci.2023.05.026

Key clinical point: Dupilumab rapidly reduced the skin abundance of Staphylococcus aureus in patients with moderate-to-severe atopic dermatitis (AD), and the reduction correlated with improvements in all AD severity measurements except itch.

Major finding: At day 3, the dupilumab vs placebo group showed a 7.5-fold reduction (P = .02) in the skin abundance of S. aureus. A significant positive correlation was observed between the reduction in abundance and SCORing Atopic Dermatitis score with dupilumab (repeated measure correlation coefficient 0.39; P < .001), which was similar for other AD severity measurements except pruritus Numeric Rating Scale score.

Study details: Findings are from the multicenter, double-blind ADRN09 trial including 71 adult patients with moderate-to-severe AD who were randomly assigned to receive dupilumab (n = 45) or placebo (n = 26).

Disclosures: This study was supported by the US National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, Colorado. Some authors declared serving as consultants or investigators for and receiving research grants from various organizations.

Source: Simpson EL et al. Rapid reduction in Staphylococcus aureus in atopic dermatitis subjects following dupilumab treatment. J Allergy Clin Immunol. 2023 (Jun 12). Doi: 10.1016/j.jaci.2023.05.026

Key clinical point: Atopic dermatitis (AD) is not associated with an overall increased risk for malignancy in children and adults; however, the risk for lymphoma is significantly higher in both children and adults with severe AD.

Major finding: The risk for overall malignancy was similar between the AD and non-AD groups of children (adjusted hazard ratio [aHR] 1.02; 95% CI 0.92-1.12) and adults (aHR 1.00; 95% CI 0.99-1.02); however, the risk for lymphoma (non-cutaneous T-cell type) was significantly higher in children (aHR 3.18; 95% CI 1.41-7.16) and adults (aHR 1.95; 95% CI 1.62-2.36) with severe AD.

Study details: This population-based cohort study included matched children (<18 years) with (n = 409,431) and without (n = 1,809,029) AD and matched adults with (n = 625,083) and without (n = 2,678,888) AD.

Disclosures: This study was funded by Pfizer, Inc. Some authors declared receiving research grants, consulting fees, or honoraria from Pfizer, Inc., and others. AR Lemeshow declared being an employee of Pfizer, Inc.

Source: Wan J et al. Malignancy risk in patients with atopic dermatitis: A population-based cohort study. Br J Dermatol. 2023;189(1):53-61 (Jul 7). Doi: 10.1093/bjd/ljad072

Key clinical point: Atopic dermatitis (AD) is not associated with an overall increased risk for malignancy in children and adults; however, the risk for lymphoma is significantly higher in both children and adults with severe AD.

Major finding: The risk for overall malignancy was similar between the AD and non-AD groups of children (adjusted hazard ratio [aHR] 1.02; 95% CI 0.92-1.12) and adults (aHR 1.00; 95% CI 0.99-1.02); however, the risk for lymphoma (non-cutaneous T-cell type) was significantly higher in children (aHR 3.18; 95% CI 1.41-7.16) and adults (aHR 1.95; 95% CI 1.62-2.36) with severe AD.

Study details: This population-based cohort study included matched children (<18 years) with (n = 409,431) and without (n = 1,809,029) AD and matched adults with (n = 625,083) and without (n = 2,678,888) AD.

Disclosures: This study was funded by Pfizer, Inc. Some authors declared receiving research grants, consulting fees, or honoraria from Pfizer, Inc., and others. AR Lemeshow declared being an employee of Pfizer, Inc.

Source: Wan J et al. Malignancy risk in patients with atopic dermatitis: A population-based cohort study. Br J Dermatol. 2023;189(1):53-61 (Jul 7). Doi: 10.1093/bjd/ljad072

Key clinical point: Atopic dermatitis (AD) is not associated with an overall increased risk for malignancy in children and adults; however, the risk for lymphoma is significantly higher in both children and adults with severe AD.

Major finding: The risk for overall malignancy was similar between the AD and non-AD groups of children (adjusted hazard ratio [aHR] 1.02; 95% CI 0.92-1.12) and adults (aHR 1.00; 95% CI 0.99-1.02); however, the risk for lymphoma (non-cutaneous T-cell type) was significantly higher in children (aHR 3.18; 95% CI 1.41-7.16) and adults (aHR 1.95; 95% CI 1.62-2.36) with severe AD.

Study details: This population-based cohort study included matched children (<18 years) with (n = 409,431) and without (n = 1,809,029) AD and matched adults with (n = 625,083) and without (n = 2,678,888) AD.

Disclosures: This study was funded by Pfizer, Inc. Some authors declared receiving research grants, consulting fees, or honoraria from Pfizer, Inc., and others. AR Lemeshow declared being an employee of Pfizer, Inc.

Source: Wan J et al. Malignancy risk in patients with atopic dermatitis: A population-based cohort study. Br J Dermatol. 2023;189(1):53-61 (Jul 7). Doi: 10.1093/bjd/ljad072