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Export protein inhibitor shows activity against refractory myeloma
Think of it as a biological nuclear export ban: A combination of the nuclear export protein inhibitor selinexor and dexamethasone was associated with relatively good objective response rates and clinical benefit rates among some patients with relapsed or refractory multiple myeloma (MM).
In the dose-expansion portion of a phase 1 dose-finding trial, the objective response rate (ORR) among 12 patients treated with selinexor 45 mg/m2 and 20 mg dexamethasone twice weekly was 50%, and the clinical benefit rate – a composite of complete responses, very good partial responses, partial responses and minimal responses – was 58%, reported Christine Chen, MD, of Princess Margaret Cancer Centre in Toronto, and her colleagues.
“Selinexor is an oral agent with a completely novel mechanism of action and anti-MM activity in combination with dexamethasone that could provide a new option for patients suffering from this incurable disease,” wrote Dr. Chen and her colleagues. The report was published in Blood.
Selinexor is a selective oral inhibitor of the cellular nuclear export protein exportin 1 (XPO1). Inhibition of this protein causes tumor suppressor proteins to accumulate in the nuclei of malignant cells, leading to programmed cell death (apoptosis) of malignant cells, but with minimal effects on normal cells.
The study, performed in centers in Canada, the United States, and Denmark, was designed primarily to identify the recommended dose of oral selinexor for phase 2 trials, with or without corticosteroids.
A total of 84 patients were enrolled, including 22 with MM and 3 with Waldenstrom macroglobulinemia in the dose-escalation phase, and 59 with MM in the dose expansion phase.
In the dose-expansion phase, patients were treated with one of two dosing schemes: either selinexor at a dose of 45 or 60 mg/m2 plus dexamethasone 20 mg twice weekly in 28-day cycles, or selinexor in a 40 mg or 60 mg flat dose without corticosteroids in 21-day cycles.
As a single agent, selinexor showed minimal activity, with an ORR of 4%, and clinical benefit rate of 21% in 57 patients.
Among 12 patients assigned to the 45 mg/m2 selinexor dose plus dexamethasone, the ORR was 50%, consisting of one complete response and five partial responses. In addition, one patient at this dose level had a minimal response, three had stable disease, one had disease progression, and one was withdrawn from the study before disease assessment, with no evidence of progression.
There were no objective responses in the 60-mg/m2 selinexor dose group.
Among all 84 patients enrolled, the ORR with selinexor alone or in combination was 10%, and the clinical benefit rate was 25%. Of the patients with Waldenstrom macroglobulinemia, one had a partial response and one had a minimal response.
In the safety analysis, which included all patients who received at least one dose of selinexor, the most common grade 3 or 4 adverse events included thrombocytopenia in 45% of patients, hyponatremia in 26% of patients, and anemia and neutropenia in 23% each.
The most common nonhematologic adverse events – primarily grade 1 or 2 – included nausea, fatigue, anorexia, vomiting, and weight loss and diarrhea.
The combination of selinexor and dexamethasone is currently being investigated in the phase 2 Selinexor Treatment of Refractory Myeloma study, in combination with standard multiple myeloma therapies in the STOMP trial (Selinexor and Backbone Treatments of Multiple Myeloma Patients), and with bortezomib in the BOSTON trial (Bortezomib, Selinexor and Dexamethasone in Patients with Multiple Myeloma).
Dr. Chen reported no conflicts of interest. Her coauthors reported financial ties to Karyopharm Therapeutics, which funded the study.
hematologynews@frontlinemedcom.com
SOURCE: Chen C et al. Blood. 2018;131(8):855-63.
Think of it as a biological nuclear export ban: A combination of the nuclear export protein inhibitor selinexor and dexamethasone was associated with relatively good objective response rates and clinical benefit rates among some patients with relapsed or refractory multiple myeloma (MM).
In the dose-expansion portion of a phase 1 dose-finding trial, the objective response rate (ORR) among 12 patients treated with selinexor 45 mg/m2 and 20 mg dexamethasone twice weekly was 50%, and the clinical benefit rate – a composite of complete responses, very good partial responses, partial responses and minimal responses – was 58%, reported Christine Chen, MD, of Princess Margaret Cancer Centre in Toronto, and her colleagues.
“Selinexor is an oral agent with a completely novel mechanism of action and anti-MM activity in combination with dexamethasone that could provide a new option for patients suffering from this incurable disease,” wrote Dr. Chen and her colleagues. The report was published in Blood.
Selinexor is a selective oral inhibitor of the cellular nuclear export protein exportin 1 (XPO1). Inhibition of this protein causes tumor suppressor proteins to accumulate in the nuclei of malignant cells, leading to programmed cell death (apoptosis) of malignant cells, but with minimal effects on normal cells.
The study, performed in centers in Canada, the United States, and Denmark, was designed primarily to identify the recommended dose of oral selinexor for phase 2 trials, with or without corticosteroids.
A total of 84 patients were enrolled, including 22 with MM and 3 with Waldenstrom macroglobulinemia in the dose-escalation phase, and 59 with MM in the dose expansion phase.
In the dose-expansion phase, patients were treated with one of two dosing schemes: either selinexor at a dose of 45 or 60 mg/m2 plus dexamethasone 20 mg twice weekly in 28-day cycles, or selinexor in a 40 mg or 60 mg flat dose without corticosteroids in 21-day cycles.
As a single agent, selinexor showed minimal activity, with an ORR of 4%, and clinical benefit rate of 21% in 57 patients.
Among 12 patients assigned to the 45 mg/m2 selinexor dose plus dexamethasone, the ORR was 50%, consisting of one complete response and five partial responses. In addition, one patient at this dose level had a minimal response, three had stable disease, one had disease progression, and one was withdrawn from the study before disease assessment, with no evidence of progression.
There were no objective responses in the 60-mg/m2 selinexor dose group.
Among all 84 patients enrolled, the ORR with selinexor alone or in combination was 10%, and the clinical benefit rate was 25%. Of the patients with Waldenstrom macroglobulinemia, one had a partial response and one had a minimal response.
In the safety analysis, which included all patients who received at least one dose of selinexor, the most common grade 3 or 4 adverse events included thrombocytopenia in 45% of patients, hyponatremia in 26% of patients, and anemia and neutropenia in 23% each.
The most common nonhematologic adverse events – primarily grade 1 or 2 – included nausea, fatigue, anorexia, vomiting, and weight loss and diarrhea.
The combination of selinexor and dexamethasone is currently being investigated in the phase 2 Selinexor Treatment of Refractory Myeloma study, in combination with standard multiple myeloma therapies in the STOMP trial (Selinexor and Backbone Treatments of Multiple Myeloma Patients), and with bortezomib in the BOSTON trial (Bortezomib, Selinexor and Dexamethasone in Patients with Multiple Myeloma).
Dr. Chen reported no conflicts of interest. Her coauthors reported financial ties to Karyopharm Therapeutics, which funded the study.
hematologynews@frontlinemedcom.com
SOURCE: Chen C et al. Blood. 2018;131(8):855-63.
Think of it as a biological nuclear export ban: A combination of the nuclear export protein inhibitor selinexor and dexamethasone was associated with relatively good objective response rates and clinical benefit rates among some patients with relapsed or refractory multiple myeloma (MM).
In the dose-expansion portion of a phase 1 dose-finding trial, the objective response rate (ORR) among 12 patients treated with selinexor 45 mg/m2 and 20 mg dexamethasone twice weekly was 50%, and the clinical benefit rate – a composite of complete responses, very good partial responses, partial responses and minimal responses – was 58%, reported Christine Chen, MD, of Princess Margaret Cancer Centre in Toronto, and her colleagues.
“Selinexor is an oral agent with a completely novel mechanism of action and anti-MM activity in combination with dexamethasone that could provide a new option for patients suffering from this incurable disease,” wrote Dr. Chen and her colleagues. The report was published in Blood.
Selinexor is a selective oral inhibitor of the cellular nuclear export protein exportin 1 (XPO1). Inhibition of this protein causes tumor suppressor proteins to accumulate in the nuclei of malignant cells, leading to programmed cell death (apoptosis) of malignant cells, but with minimal effects on normal cells.
The study, performed in centers in Canada, the United States, and Denmark, was designed primarily to identify the recommended dose of oral selinexor for phase 2 trials, with or without corticosteroids.
A total of 84 patients were enrolled, including 22 with MM and 3 with Waldenstrom macroglobulinemia in the dose-escalation phase, and 59 with MM in the dose expansion phase.
In the dose-expansion phase, patients were treated with one of two dosing schemes: either selinexor at a dose of 45 or 60 mg/m2 plus dexamethasone 20 mg twice weekly in 28-day cycles, or selinexor in a 40 mg or 60 mg flat dose without corticosteroids in 21-day cycles.
As a single agent, selinexor showed minimal activity, with an ORR of 4%, and clinical benefit rate of 21% in 57 patients.
Among 12 patients assigned to the 45 mg/m2 selinexor dose plus dexamethasone, the ORR was 50%, consisting of one complete response and five partial responses. In addition, one patient at this dose level had a minimal response, three had stable disease, one had disease progression, and one was withdrawn from the study before disease assessment, with no evidence of progression.
There were no objective responses in the 60-mg/m2 selinexor dose group.
Among all 84 patients enrolled, the ORR with selinexor alone or in combination was 10%, and the clinical benefit rate was 25%. Of the patients with Waldenstrom macroglobulinemia, one had a partial response and one had a minimal response.
In the safety analysis, which included all patients who received at least one dose of selinexor, the most common grade 3 or 4 adverse events included thrombocytopenia in 45% of patients, hyponatremia in 26% of patients, and anemia and neutropenia in 23% each.
The most common nonhematologic adverse events – primarily grade 1 or 2 – included nausea, fatigue, anorexia, vomiting, and weight loss and diarrhea.
The combination of selinexor and dexamethasone is currently being investigated in the phase 2 Selinexor Treatment of Refractory Myeloma study, in combination with standard multiple myeloma therapies in the STOMP trial (Selinexor and Backbone Treatments of Multiple Myeloma Patients), and with bortezomib in the BOSTON trial (Bortezomib, Selinexor and Dexamethasone in Patients with Multiple Myeloma).
Dr. Chen reported no conflicts of interest. Her coauthors reported financial ties to Karyopharm Therapeutics, which funded the study.
hematologynews@frontlinemedcom.com
SOURCE: Chen C et al. Blood. 2018;131(8):855-63.
FROM BLOOD
Key clinical point:
Major finding: The objective response rate among 12 patients with multiple myeloma treated at a dose of 45 mg/m2 selinexor and 20 mg dexamethasone was 50%.
Data source: Phase 1 dose-escalation and expansion study of 81 patients with relapsed or refractory multiple myeloma and three patients with Waldenstrom macroglobulinemia.
Disclosures: Dr. Chen reported no conflicts of interest. Her coauthors reported financial ties to Karyopharm Therapeutics, which funded the study.
Source: Chen C et al. Blood. 2018;131(8):855-63.
Letter from the Editor: IBD drugs, ‘liquid biopsies,’ and DDW
The coming months will provide us a welcome relief from health care politics as we turn our attention to the science of medicine. Digestive Disease Week® (DDW) will occur from June 2 to 5 in Washington, DC. Major themes already are emerging and implications for our clinical practices are exciting. In this month’s issue of GI & Hepatology News, we summarize a presentation about the IBD medication pipeline given by Dr. Bill Sandborn (UCSD) at the Crohn’s & Colitis CongressTM (a partnership between the Crohn’s & Colitis Foundation and AGA, in Las Vegas). The number of medications that will enter clinical practice is impressive and so is the variety of antigen targets. Over the last several decades, we have defined multiple inflammatory pathways that can lead to IBD and developed medications that modify abnormal immune responses. We are entering an era of precision medicine never before seen in our specialty. Most of these biological medications can be given orally or subcutaneously, precluding the need for infusion centers. I anticipate an enormous offering of IBD-related science at DDW®.
The Board of Editors appreciates the feedback that many of you sent us in our latest readership survey. Each month, we try hard to collect articles of clinical interest to the wide variety of clinicians and researchers that read GI & Hepatology News. We will continue to improve our offerings based on your valuable opinions.
John I. Allen, MD, MBA, AGAF
Editor in Chief
The coming months will provide us a welcome relief from health care politics as we turn our attention to the science of medicine. Digestive Disease Week® (DDW) will occur from June 2 to 5 in Washington, DC. Major themes already are emerging and implications for our clinical practices are exciting. In this month’s issue of GI & Hepatology News, we summarize a presentation about the IBD medication pipeline given by Dr. Bill Sandborn (UCSD) at the Crohn’s & Colitis CongressTM (a partnership between the Crohn’s & Colitis Foundation and AGA, in Las Vegas). The number of medications that will enter clinical practice is impressive and so is the variety of antigen targets. Over the last several decades, we have defined multiple inflammatory pathways that can lead to IBD and developed medications that modify abnormal immune responses. We are entering an era of precision medicine never before seen in our specialty. Most of these biological medications can be given orally or subcutaneously, precluding the need for infusion centers. I anticipate an enormous offering of IBD-related science at DDW®.
The Board of Editors appreciates the feedback that many of you sent us in our latest readership survey. Each month, we try hard to collect articles of clinical interest to the wide variety of clinicians and researchers that read GI & Hepatology News. We will continue to improve our offerings based on your valuable opinions.
John I. Allen, MD, MBA, AGAF
Editor in Chief
The coming months will provide us a welcome relief from health care politics as we turn our attention to the science of medicine. Digestive Disease Week® (DDW) will occur from June 2 to 5 in Washington, DC. Major themes already are emerging and implications for our clinical practices are exciting. In this month’s issue of GI & Hepatology News, we summarize a presentation about the IBD medication pipeline given by Dr. Bill Sandborn (UCSD) at the Crohn’s & Colitis CongressTM (a partnership between the Crohn’s & Colitis Foundation and AGA, in Las Vegas). The number of medications that will enter clinical practice is impressive and so is the variety of antigen targets. Over the last several decades, we have defined multiple inflammatory pathways that can lead to IBD and developed medications that modify abnormal immune responses. We are entering an era of precision medicine never before seen in our specialty. Most of these biological medications can be given orally or subcutaneously, precluding the need for infusion centers. I anticipate an enormous offering of IBD-related science at DDW®.
The Board of Editors appreciates the feedback that many of you sent us in our latest readership survey. Each month, we try hard to collect articles of clinical interest to the wide variety of clinicians and researchers that read GI & Hepatology News. We will continue to improve our offerings based on your valuable opinions.
John I. Allen, MD, MBA, AGAF
Editor in Chief
Can You Predict How Often Patients Will Have Seizures?
A mathematical formula may help determine the variability in the frequency of patients’ seizures, according to researchers from the National Institutes of Health, Beth Israel Deaconess Medical Center, and other institutions.
- Because clinicians and researchers have yet to develop a reliable way to predict the range of each patient’s seizure counts, investigators analyzed 3 independent seizure diary databases to look for patterns.
- The databases included 3106 entries in Seizure Tracker, 93 from the Human Epilepsy Project, and 15 from NeuroVista.
- The analysis looked at the relationship between mean seizure frequency and the standard deviation of seizure frequency.
- The analysis revealed that the logarithm of the mean seizure count had a linear relationship with the log of the standard deviation (R2 >0.83).
- Using this mathematical relationship, researchers were able to predict variability in seizure frequency with a 94% accuracy rate, compared to only 77% using traditional prediction methods.
Goldenholz DM, Goldenholz SR, Moss R, et al. Is seizure frequency variance a predictable quantity? Ann Clin Transl Neurol. 2018;5(2):201-207.
A mathematical formula may help determine the variability in the frequency of patients’ seizures, according to researchers from the National Institutes of Health, Beth Israel Deaconess Medical Center, and other institutions.
- Because clinicians and researchers have yet to develop a reliable way to predict the range of each patient’s seizure counts, investigators analyzed 3 independent seizure diary databases to look for patterns.
- The databases included 3106 entries in Seizure Tracker, 93 from the Human Epilepsy Project, and 15 from NeuroVista.
- The analysis looked at the relationship between mean seizure frequency and the standard deviation of seizure frequency.
- The analysis revealed that the logarithm of the mean seizure count had a linear relationship with the log of the standard deviation (R2 >0.83).
- Using this mathematical relationship, researchers were able to predict variability in seizure frequency with a 94% accuracy rate, compared to only 77% using traditional prediction methods.
Goldenholz DM, Goldenholz SR, Moss R, et al. Is seizure frequency variance a predictable quantity? Ann Clin Transl Neurol. 2018;5(2):201-207.
A mathematical formula may help determine the variability in the frequency of patients’ seizures, according to researchers from the National Institutes of Health, Beth Israel Deaconess Medical Center, and other institutions.
- Because clinicians and researchers have yet to develop a reliable way to predict the range of each patient’s seizure counts, investigators analyzed 3 independent seizure diary databases to look for patterns.
- The databases included 3106 entries in Seizure Tracker, 93 from the Human Epilepsy Project, and 15 from NeuroVista.
- The analysis looked at the relationship between mean seizure frequency and the standard deviation of seizure frequency.
- The analysis revealed that the logarithm of the mean seizure count had a linear relationship with the log of the standard deviation (R2 >0.83).
- Using this mathematical relationship, researchers were able to predict variability in seizure frequency with a 94% accuracy rate, compared to only 77% using traditional prediction methods.
Goldenholz DM, Goldenholz SR, Moss R, et al. Is seizure frequency variance a predictable quantity? Ann Clin Transl Neurol. 2018;5(2):201-207.
Amygdalohippocampectomy For Intractable Mesial TLE
Amygdalohippocampectomy may offer hope for select patients with intractable temporal lobe epilepsy according to a review published in Brain Sciences by Warren Boling, MD, a neurosurgeon at Loma Linda University Health.
- Patients with mesial temporal lobe epilepsy that does not respond to medical therapy may experience freedom from their seizures by means of resection surgery.
- Two surgical approaches worth considering in this patient population are standard anterior temporal removal and selective amygdalohippocampectomy.
- The advantage of selective amygdalohippocampectomy is the potential to remove the seizure focal point, thus avoiding the removal of portions of the temporary lobe that are not actually part of the epileptogenic zone.
- Selective amygdalohippocampectomy (SAH), if performed using a minimally access approach, also has the advantage of allowing patients to recover more quickly.
- Evidence also suggests that SAH may provide cognitive benefits that standard temporal resections do not.
Boling WW. Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy. Brain Sciences. 2018;8:35. doi:10.3390/brainsci8020035.
Amygdalohippocampectomy may offer hope for select patients with intractable temporal lobe epilepsy according to a review published in Brain Sciences by Warren Boling, MD, a neurosurgeon at Loma Linda University Health.
- Patients with mesial temporal lobe epilepsy that does not respond to medical therapy may experience freedom from their seizures by means of resection surgery.
- Two surgical approaches worth considering in this patient population are standard anterior temporal removal and selective amygdalohippocampectomy.
- The advantage of selective amygdalohippocampectomy is the potential to remove the seizure focal point, thus avoiding the removal of portions of the temporary lobe that are not actually part of the epileptogenic zone.
- Selective amygdalohippocampectomy (SAH), if performed using a minimally access approach, also has the advantage of allowing patients to recover more quickly.
- Evidence also suggests that SAH may provide cognitive benefits that standard temporal resections do not.
Boling WW. Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy. Brain Sciences. 2018;8:35. doi:10.3390/brainsci8020035.
Amygdalohippocampectomy may offer hope for select patients with intractable temporal lobe epilepsy according to a review published in Brain Sciences by Warren Boling, MD, a neurosurgeon at Loma Linda University Health.
- Patients with mesial temporal lobe epilepsy that does not respond to medical therapy may experience freedom from their seizures by means of resection surgery.
- Two surgical approaches worth considering in this patient population are standard anterior temporal removal and selective amygdalohippocampectomy.
- The advantage of selective amygdalohippocampectomy is the potential to remove the seizure focal point, thus avoiding the removal of portions of the temporary lobe that are not actually part of the epileptogenic zone.
- Selective amygdalohippocampectomy (SAH), if performed using a minimally access approach, also has the advantage of allowing patients to recover more quickly.
- Evidence also suggests that SAH may provide cognitive benefits that standard temporal resections do not.
Boling WW. Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy. Brain Sciences. 2018;8:35. doi:10.3390/brainsci8020035.
Intermittent dosing cuts time to extubation for surgical patients
SAN ANTONIO – according to a preliminary analysis of a randomized trial.
Additionally, the researchers found that much lower amounts of sedation and analgesia were given to patients who underwent intermittent dosing, compared with patients who received a continuous infusion.
Of the 95 patients in the trial, 39 were randomized to intermittent dosing and 56 to the control group of continuous infusion, with the drugs midazolam and fentanyl having been given to both groups.
Mean mechanical ventilation time was 65 hours in the intermittent dosing arm, versus 111 hours in the continuous infusion arm (P less than 0.03), noted Dr. Sich, a fourth-year general surgery resident at Abington Memorial Hospital, Abington, Pa., during his presentation.
Patients in the continuous infusions arm of the trial received a mean of 73.1 mg of midazolam, compared with 18 mg for the intermittent dosing arm, a difference that approached very closely to statistical significance (P = 0.06) and was thrown off in the latest iteration by an outlier, Dr. Sich explained. The relative difference between the mean fentanyl doses administered was even greater between the two groups, with 5,848 mcg given to patients in the control group, versus the 942 mcg given to participants in the intermittent dosing group (P less than 0.01).
“This is a new way to use an old drug, and it really might be beneficial, and can even be used as first-line therapy and a way to keep patients awake and off the ventilator,” said Dr. Sich, referring to the intermittent dosing. Continuous infusions leave patients oversedated and prolong ventilation time.
“What we propose, rather, is using a sliding-scale intermittent pain and sedation regimen,” he said. “We believe that it won’t compromise patient care and won’t compromise patient comfort, and it will lead to shorter mechanical ventilation times for surgical patients than continuous infusions.”
Dr. Sich also pointed out that there was no difference in time spent at target levels of sedation and analgesia between the two trial groups. Referring to this finding, he noted that “we wanted to make sure that in the intermittent arm we’re giving them less drug, but we don’t want them to be [less comfortable].”
One potential drawback to the intermittent dosing approach is that it is more nursing intensive, according to Dr. Sich, since it is based on a nursing treatment protocol to give medications every hour.
Intermittent dosing is “more hands-on” than a typical continuous infusion approach and so was more challenging for nurses who, per the treatment protocol, had to give medications every hour, he explained. However, “when they saw the data in the months and year as we’ve been going on, they’re actually quite proud of our work and their work.”
Gilman Baker Allen, MD, a pulmonologist and intensivist at the University of Vermont Medical Center, Burlington, said the study was “terrific work” and acknowledged the importance of gauging nurse satisfaction with the protocol.
“I think that when you feed this kind of data back to nursing staff, they may not be satisfied with the intensity of the work, but when they see the rewards at the end, it oftentimes is a very positive experience,” said Dr. Allen, who moderated the session.
Dr. Sich and his colleagues had no financial disclosures or conflicts of interest related to the study.
SOURCE: Sich N et al. CCC47, Abstract 18.
SAN ANTONIO – according to a preliminary analysis of a randomized trial.
Additionally, the researchers found that much lower amounts of sedation and analgesia were given to patients who underwent intermittent dosing, compared with patients who received a continuous infusion.
Of the 95 patients in the trial, 39 were randomized to intermittent dosing and 56 to the control group of continuous infusion, with the drugs midazolam and fentanyl having been given to both groups.
Mean mechanical ventilation time was 65 hours in the intermittent dosing arm, versus 111 hours in the continuous infusion arm (P less than 0.03), noted Dr. Sich, a fourth-year general surgery resident at Abington Memorial Hospital, Abington, Pa., during his presentation.
Patients in the continuous infusions arm of the trial received a mean of 73.1 mg of midazolam, compared with 18 mg for the intermittent dosing arm, a difference that approached very closely to statistical significance (P = 0.06) and was thrown off in the latest iteration by an outlier, Dr. Sich explained. The relative difference between the mean fentanyl doses administered was even greater between the two groups, with 5,848 mcg given to patients in the control group, versus the 942 mcg given to participants in the intermittent dosing group (P less than 0.01).
“This is a new way to use an old drug, and it really might be beneficial, and can even be used as first-line therapy and a way to keep patients awake and off the ventilator,” said Dr. Sich, referring to the intermittent dosing. Continuous infusions leave patients oversedated and prolong ventilation time.
“What we propose, rather, is using a sliding-scale intermittent pain and sedation regimen,” he said. “We believe that it won’t compromise patient care and won’t compromise patient comfort, and it will lead to shorter mechanical ventilation times for surgical patients than continuous infusions.”
Dr. Sich also pointed out that there was no difference in time spent at target levels of sedation and analgesia between the two trial groups. Referring to this finding, he noted that “we wanted to make sure that in the intermittent arm we’re giving them less drug, but we don’t want them to be [less comfortable].”
One potential drawback to the intermittent dosing approach is that it is more nursing intensive, according to Dr. Sich, since it is based on a nursing treatment protocol to give medications every hour.
Intermittent dosing is “more hands-on” than a typical continuous infusion approach and so was more challenging for nurses who, per the treatment protocol, had to give medications every hour, he explained. However, “when they saw the data in the months and year as we’ve been going on, they’re actually quite proud of our work and their work.”
Gilman Baker Allen, MD, a pulmonologist and intensivist at the University of Vermont Medical Center, Burlington, said the study was “terrific work” and acknowledged the importance of gauging nurse satisfaction with the protocol.
“I think that when you feed this kind of data back to nursing staff, they may not be satisfied with the intensity of the work, but when they see the rewards at the end, it oftentimes is a very positive experience,” said Dr. Allen, who moderated the session.
Dr. Sich and his colleagues had no financial disclosures or conflicts of interest related to the study.
SOURCE: Sich N et al. CCC47, Abstract 18.
SAN ANTONIO – according to a preliminary analysis of a randomized trial.
Additionally, the researchers found that much lower amounts of sedation and analgesia were given to patients who underwent intermittent dosing, compared with patients who received a continuous infusion.
Of the 95 patients in the trial, 39 were randomized to intermittent dosing and 56 to the control group of continuous infusion, with the drugs midazolam and fentanyl having been given to both groups.
Mean mechanical ventilation time was 65 hours in the intermittent dosing arm, versus 111 hours in the continuous infusion arm (P less than 0.03), noted Dr. Sich, a fourth-year general surgery resident at Abington Memorial Hospital, Abington, Pa., during his presentation.
Patients in the continuous infusions arm of the trial received a mean of 73.1 mg of midazolam, compared with 18 mg for the intermittent dosing arm, a difference that approached very closely to statistical significance (P = 0.06) and was thrown off in the latest iteration by an outlier, Dr. Sich explained. The relative difference between the mean fentanyl doses administered was even greater between the two groups, with 5,848 mcg given to patients in the control group, versus the 942 mcg given to participants in the intermittent dosing group (P less than 0.01).
“This is a new way to use an old drug, and it really might be beneficial, and can even be used as first-line therapy and a way to keep patients awake and off the ventilator,” said Dr. Sich, referring to the intermittent dosing. Continuous infusions leave patients oversedated and prolong ventilation time.
“What we propose, rather, is using a sliding-scale intermittent pain and sedation regimen,” he said. “We believe that it won’t compromise patient care and won’t compromise patient comfort, and it will lead to shorter mechanical ventilation times for surgical patients than continuous infusions.”
Dr. Sich also pointed out that there was no difference in time spent at target levels of sedation and analgesia between the two trial groups. Referring to this finding, he noted that “we wanted to make sure that in the intermittent arm we’re giving them less drug, but we don’t want them to be [less comfortable].”
One potential drawback to the intermittent dosing approach is that it is more nursing intensive, according to Dr. Sich, since it is based on a nursing treatment protocol to give medications every hour.
Intermittent dosing is “more hands-on” than a typical continuous infusion approach and so was more challenging for nurses who, per the treatment protocol, had to give medications every hour, he explained. However, “when they saw the data in the months and year as we’ve been going on, they’re actually quite proud of our work and their work.”
Gilman Baker Allen, MD, a pulmonologist and intensivist at the University of Vermont Medical Center, Burlington, said the study was “terrific work” and acknowledged the importance of gauging nurse satisfaction with the protocol.
“I think that when you feed this kind of data back to nursing staff, they may not be satisfied with the intensity of the work, but when they see the rewards at the end, it oftentimes is a very positive experience,” said Dr. Allen, who moderated the session.
Dr. Sich and his colleagues had no financial disclosures or conflicts of interest related to the study.
SOURCE: Sich N et al. CCC47, Abstract 18.
Reporting from CCC47
Key clinical point: Among patients requiring ventilation, intermittent administration of sedation and analgesia significantly reduced mechanical ventilation time and total amount of drugs versus a continuous infusion approach.
Major finding: Mean mechanical ventilation time was 65 hours in the intermittent dosing arm, versus 111 hours in the continuous infusion arm (P less than 0.03).
Data source: A single-blinded, randomized, controlled trial of 95 surgical patients requiring ventilation.
Disclosures: The authors reported no financial disclosures or conflicts of interest related to the study.
Source: Sich N et al. CCC47, Abstract 18.
Do Seizures Have an Impact on Autism Symptom Severity?
Young children with autism spectrum disorder seem to experience less severe symptomology if they have a history of seizures according to a recent study published in Developmental Neurorehabilitation.
- To reach that conclusion, investigators reviewed patient records with the help of a licensed clinical psychologist.
- The study looked at the severity of autism symptoms and developmental functioning in young children, comparing children with and without a history of seizures and comparing those with autism to those who had atypical development.
- Among children with autism spectrum disorders whose parents reported a history of seizures, symptoms of autism were less severe, when compared to children without seizures.
- On the other hand, among children with atypical development, the direction of the correlation was the opposite, with those children with atypical development experiencing more severe symptoms if they had a history of seizures.
Burns CO, Matson JL. An investigation of the association between seizures, autism symptomology, and developmental functioning in young children. [Published online ahead of print February 20, 2018] Dev Neurorehabil. doi: 10.1080/17518423.2018.1437842.
Young children with autism spectrum disorder seem to experience less severe symptomology if they have a history of seizures according to a recent study published in Developmental Neurorehabilitation.
- To reach that conclusion, investigators reviewed patient records with the help of a licensed clinical psychologist.
- The study looked at the severity of autism symptoms and developmental functioning in young children, comparing children with and without a history of seizures and comparing those with autism to those who had atypical development.
- Among children with autism spectrum disorders whose parents reported a history of seizures, symptoms of autism were less severe, when compared to children without seizures.
- On the other hand, among children with atypical development, the direction of the correlation was the opposite, with those children with atypical development experiencing more severe symptoms if they had a history of seizures.
Burns CO, Matson JL. An investigation of the association between seizures, autism symptomology, and developmental functioning in young children. [Published online ahead of print February 20, 2018] Dev Neurorehabil. doi: 10.1080/17518423.2018.1437842.
Young children with autism spectrum disorder seem to experience less severe symptomology if they have a history of seizures according to a recent study published in Developmental Neurorehabilitation.
- To reach that conclusion, investigators reviewed patient records with the help of a licensed clinical psychologist.
- The study looked at the severity of autism symptoms and developmental functioning in young children, comparing children with and without a history of seizures and comparing those with autism to those who had atypical development.
- Among children with autism spectrum disorders whose parents reported a history of seizures, symptoms of autism were less severe, when compared to children without seizures.
- On the other hand, among children with atypical development, the direction of the correlation was the opposite, with those children with atypical development experiencing more severe symptoms if they had a history of seizures.
Burns CO, Matson JL. An investigation of the association between seizures, autism symptomology, and developmental functioning in young children. [Published online ahead of print February 20, 2018] Dev Neurorehabil. doi: 10.1080/17518423.2018.1437842.
High dose of novel compound for relapsing-remitting MS shows promise
SAN DIEGO – Early results of the novel human endogenous retrovirus-W antagonist GNbAC1 in a phase 2 trial of patients with relapsing-remitting multiple sclerosis demonstrated evidence of remyelination at week 24 among high-dose users, but it did not meet its primary endpoint of active lesions seen on MRI.
In an interview at ACTRIMS Forum 2018, held by the Americas Committee for Treatment and Research in Multiple Sclerosis, study author Robert Glanzman, MD, said that GNbAC1 is a monoclonal antibody that targets and blocks the envelope protein pHER-W ENV, a potent agonist of Toll-like receptor 4. It thereby inhibits TLR4-mediated pathogenicity, which includes activation of macrophages and microglia into proinflammatory phenotypes and direct inhibition of remyelination via TLR4.
In a study known as CHANGE-MS, 270 patients with relapsing-remitting MS were randomized to one of three doses of the GNbAC1 (6, 12, or 18 mg/kg), or placebo via monthly IV infusion over 6 months. The study was conducted at 70 centers in 13 European countries over the past 3 years. It had a 24-week, double-blind, placebo-controlled period, followed by a 24-week, dose-blind, active-only treatment period, with placebo patients randomized to the three different doses of GNbA1C. Brain MRI scans were performed at weeks 12, 16, 20, 24, and 48, to look for evidence of remyelination.
The mean age of patients was 38 years and 65% were female. The researchers observed no safety concerns and no significant effect on inflammatory measures over weeks 12-24, even though the absolute number of lesions was reduced by about 50%. Although the primary endpoint of the cumulative number of gadolinium-enhancing lesions seen on brain MRI scans every 4 weeks during weeks 12-24 was not met, post hoc analyses suggest a decrease in neuroinflammation in the 18 mg/kg GNbA1C group at week 24, compared with placebo (P = .008). “A consistent increase in MT [magnetization transfer] ratio signal was observed in normal-appearing white matter and cerebral cortex at the highest dose, suggesting remyelination,” Dr. Glanzman added. “We gained about a quarter or half of percent in normal-appearing white matter at the cerebral cortex at the high dose. Normally, MS patients lose white matter over time, both in the cortex and in gray matter. We’re actually showing evidence of remyelination, which is really exciting. If these data are replicated and confirmed at week 48, we think we really have an exciting compound.”
GeNeuro sponsored the study.
Full 48-week analyses from CHANGE-MS are expected to be unveiled at the 2018 annual meeting American Academy of Neurology.
SOURCE: Glanzman R et al. Abstract P034.
SAN DIEGO – Early results of the novel human endogenous retrovirus-W antagonist GNbAC1 in a phase 2 trial of patients with relapsing-remitting multiple sclerosis demonstrated evidence of remyelination at week 24 among high-dose users, but it did not meet its primary endpoint of active lesions seen on MRI.
In an interview at ACTRIMS Forum 2018, held by the Americas Committee for Treatment and Research in Multiple Sclerosis, study author Robert Glanzman, MD, said that GNbAC1 is a monoclonal antibody that targets and blocks the envelope protein pHER-W ENV, a potent agonist of Toll-like receptor 4. It thereby inhibits TLR4-mediated pathogenicity, which includes activation of macrophages and microglia into proinflammatory phenotypes and direct inhibition of remyelination via TLR4.
In a study known as CHANGE-MS, 270 patients with relapsing-remitting MS were randomized to one of three doses of the GNbAC1 (6, 12, or 18 mg/kg), or placebo via monthly IV infusion over 6 months. The study was conducted at 70 centers in 13 European countries over the past 3 years. It had a 24-week, double-blind, placebo-controlled period, followed by a 24-week, dose-blind, active-only treatment period, with placebo patients randomized to the three different doses of GNbA1C. Brain MRI scans were performed at weeks 12, 16, 20, 24, and 48, to look for evidence of remyelination.
The mean age of patients was 38 years and 65% were female. The researchers observed no safety concerns and no significant effect on inflammatory measures over weeks 12-24, even though the absolute number of lesions was reduced by about 50%. Although the primary endpoint of the cumulative number of gadolinium-enhancing lesions seen on brain MRI scans every 4 weeks during weeks 12-24 was not met, post hoc analyses suggest a decrease in neuroinflammation in the 18 mg/kg GNbA1C group at week 24, compared with placebo (P = .008). “A consistent increase in MT [magnetization transfer] ratio signal was observed in normal-appearing white matter and cerebral cortex at the highest dose, suggesting remyelination,” Dr. Glanzman added. “We gained about a quarter or half of percent in normal-appearing white matter at the cerebral cortex at the high dose. Normally, MS patients lose white matter over time, both in the cortex and in gray matter. We’re actually showing evidence of remyelination, which is really exciting. If these data are replicated and confirmed at week 48, we think we really have an exciting compound.”
GeNeuro sponsored the study.
Full 48-week analyses from CHANGE-MS are expected to be unveiled at the 2018 annual meeting American Academy of Neurology.
SOURCE: Glanzman R et al. Abstract P034.
SAN DIEGO – Early results of the novel human endogenous retrovirus-W antagonist GNbAC1 in a phase 2 trial of patients with relapsing-remitting multiple sclerosis demonstrated evidence of remyelination at week 24 among high-dose users, but it did not meet its primary endpoint of active lesions seen on MRI.
In an interview at ACTRIMS Forum 2018, held by the Americas Committee for Treatment and Research in Multiple Sclerosis, study author Robert Glanzman, MD, said that GNbAC1 is a monoclonal antibody that targets and blocks the envelope protein pHER-W ENV, a potent agonist of Toll-like receptor 4. It thereby inhibits TLR4-mediated pathogenicity, which includes activation of macrophages and microglia into proinflammatory phenotypes and direct inhibition of remyelination via TLR4.
In a study known as CHANGE-MS, 270 patients with relapsing-remitting MS were randomized to one of three doses of the GNbAC1 (6, 12, or 18 mg/kg), or placebo via monthly IV infusion over 6 months. The study was conducted at 70 centers in 13 European countries over the past 3 years. It had a 24-week, double-blind, placebo-controlled period, followed by a 24-week, dose-blind, active-only treatment period, with placebo patients randomized to the three different doses of GNbA1C. Brain MRI scans were performed at weeks 12, 16, 20, 24, and 48, to look for evidence of remyelination.
The mean age of patients was 38 years and 65% were female. The researchers observed no safety concerns and no significant effect on inflammatory measures over weeks 12-24, even though the absolute number of lesions was reduced by about 50%. Although the primary endpoint of the cumulative number of gadolinium-enhancing lesions seen on brain MRI scans every 4 weeks during weeks 12-24 was not met, post hoc analyses suggest a decrease in neuroinflammation in the 18 mg/kg GNbA1C group at week 24, compared with placebo (P = .008). “A consistent increase in MT [magnetization transfer] ratio signal was observed in normal-appearing white matter and cerebral cortex at the highest dose, suggesting remyelination,” Dr. Glanzman added. “We gained about a quarter or half of percent in normal-appearing white matter at the cerebral cortex at the high dose. Normally, MS patients lose white matter over time, both in the cortex and in gray matter. We’re actually showing evidence of remyelination, which is really exciting. If these data are replicated and confirmed at week 48, we think we really have an exciting compound.”
GeNeuro sponsored the study.
Full 48-week analyses from CHANGE-MS are expected to be unveiled at the 2018 annual meeting American Academy of Neurology.
SOURCE: Glanzman R et al. Abstract P034.
REPORTING FROM ACTRIMS FORUM 2018
Key clinical point:
Major finding: Although the primary endpoint was not met, post hoc analyses suggest a decrease in neuroinflammation in the 18 mg/kg GNbA1C group at week 24, compared with placebo (P = .008).
Study details: A phase 2 study of 270 patients with relapsing-remitting MS who were randomized to one of three doses of GNbAC1.
Disclosures: Dr. Glanzman is chief medical officer for GeNeuro, which sponsored the study.
Source: Glanzman R et al. Abstract P034.
Racial disparities by region persist despite multiple liver transplant allocation schemes
Racial and regional disparities in liver transplant allocation persist despite multiple allocation schemes as identified in a large dataset spanning at least 30 years, according to a study.
The Model for End-Stage Liver Disease (MELD) score was put forth in 1998 by the Organ Procurement and Transplantation Network under the guidance of the Centers for Medicare & Medicaid Services and the Department of Health & Human Services, to indicate that organs should be allocated to the sickest patients as interpreted by the MELD score. Since then, four separate liver allocation systems are being followed across the country owing to disagreements over a universal allocation scheme. These include MELD score, the initial three-tier UNOS (United Network for Organ Sharing) Status, Share 35, and now MELD Na.
Unfavorable supply and demand ratios for liver allograft allocation persist across the country with differential and limited access to care, which leads to decreased wellness, lower life expectancies, and higher baseline morbidity and mortality rates in some areas. Furthermore, a short cold storage capacity of liver allografts limits greater allocation and distribution schema.
Dominique J. Monlezun, MD, PhD, MPH, and his colleagues at the Tulane Transplant Institute at Tulane University, New Orleans, evaluated the effect of MELD and other allocation schemes on the incidence of racial and regional disparities in a study published in Surgery. They performed fixed-effects multivariate logistic regression augmented by modified forward and backward stepwise-regression of transplanted patients from the United Network for Organ Sharing Standard Transplant Analysis and Research database (1985-2016) to assess causal inference of such disparities.
“Significant disparities in the odds of receiving a liver were found: African Americans, odds ratio, 1.12 (95% confidence interval, 1.08-1.17); Asians, 1.12 (95% CI, 1.07-1.18); females, 0.80 (95% CI, 0.78-0.83); and malignancy 1.18 (95% CI, 1.13-1.22). Significant racial disparities by region were identified using Caucasian Region 7 (Ill., Minn., N.D., S.D., and Wisc.) as the reference: Hispanic Region 9 (N.Y., West Vt.) 1.22 (1.02-1.45), Hispanic Region 1 (New England) 1.26 (1.01-1.57), Hispanic Region 4 (Ok., Tex.) 1.23 (1.05-1.43), and Asian Region 4 (Ok., Tex.) 1.35 (1.05-1.73).” Since the transplantation rate in Region 7 closely approximated the sex and race-matched rate of the national post–Share 35 average, it was used as a reference in the study.
“Although traditional disparities as with African Americans and [whites] have been improved during the past 30 years, new disparities as with Hispanics and Asians have developed in certain regions,” stated the authors.
They acknowledged the limitations in the observational nature of the study and those of the statistical analyses, which could only approximate, rather than perfectly replicate, a randomized trial. Big Data tools such as artificial intelligence–based machine learning can provide real-time analysis of large heterogeneous datasets for patients across different regions.
The authors reported no conflicts of interest.
SOURCE: Monlezun DJ et al. Surgery. 2018 doi: 10.1016/j.surg.2017.10.009.
Racial and regional disparities in liver transplant allocation persist despite multiple allocation schemes as identified in a large dataset spanning at least 30 years, according to a study.
The Model for End-Stage Liver Disease (MELD) score was put forth in 1998 by the Organ Procurement and Transplantation Network under the guidance of the Centers for Medicare & Medicaid Services and the Department of Health & Human Services, to indicate that organs should be allocated to the sickest patients as interpreted by the MELD score. Since then, four separate liver allocation systems are being followed across the country owing to disagreements over a universal allocation scheme. These include MELD score, the initial three-tier UNOS (United Network for Organ Sharing) Status, Share 35, and now MELD Na.
Unfavorable supply and demand ratios for liver allograft allocation persist across the country with differential and limited access to care, which leads to decreased wellness, lower life expectancies, and higher baseline morbidity and mortality rates in some areas. Furthermore, a short cold storage capacity of liver allografts limits greater allocation and distribution schema.
Dominique J. Monlezun, MD, PhD, MPH, and his colleagues at the Tulane Transplant Institute at Tulane University, New Orleans, evaluated the effect of MELD and other allocation schemes on the incidence of racial and regional disparities in a study published in Surgery. They performed fixed-effects multivariate logistic regression augmented by modified forward and backward stepwise-regression of transplanted patients from the United Network for Organ Sharing Standard Transplant Analysis and Research database (1985-2016) to assess causal inference of such disparities.
“Significant disparities in the odds of receiving a liver were found: African Americans, odds ratio, 1.12 (95% confidence interval, 1.08-1.17); Asians, 1.12 (95% CI, 1.07-1.18); females, 0.80 (95% CI, 0.78-0.83); and malignancy 1.18 (95% CI, 1.13-1.22). Significant racial disparities by region were identified using Caucasian Region 7 (Ill., Minn., N.D., S.D., and Wisc.) as the reference: Hispanic Region 9 (N.Y., West Vt.) 1.22 (1.02-1.45), Hispanic Region 1 (New England) 1.26 (1.01-1.57), Hispanic Region 4 (Ok., Tex.) 1.23 (1.05-1.43), and Asian Region 4 (Ok., Tex.) 1.35 (1.05-1.73).” Since the transplantation rate in Region 7 closely approximated the sex and race-matched rate of the national post–Share 35 average, it was used as a reference in the study.
“Although traditional disparities as with African Americans and [whites] have been improved during the past 30 years, new disparities as with Hispanics and Asians have developed in certain regions,” stated the authors.
They acknowledged the limitations in the observational nature of the study and those of the statistical analyses, which could only approximate, rather than perfectly replicate, a randomized trial. Big Data tools such as artificial intelligence–based machine learning can provide real-time analysis of large heterogeneous datasets for patients across different regions.
The authors reported no conflicts of interest.
SOURCE: Monlezun DJ et al. Surgery. 2018 doi: 10.1016/j.surg.2017.10.009.
Racial and regional disparities in liver transplant allocation persist despite multiple allocation schemes as identified in a large dataset spanning at least 30 years, according to a study.
The Model for End-Stage Liver Disease (MELD) score was put forth in 1998 by the Organ Procurement and Transplantation Network under the guidance of the Centers for Medicare & Medicaid Services and the Department of Health & Human Services, to indicate that organs should be allocated to the sickest patients as interpreted by the MELD score. Since then, four separate liver allocation systems are being followed across the country owing to disagreements over a universal allocation scheme. These include MELD score, the initial three-tier UNOS (United Network for Organ Sharing) Status, Share 35, and now MELD Na.
Unfavorable supply and demand ratios for liver allograft allocation persist across the country with differential and limited access to care, which leads to decreased wellness, lower life expectancies, and higher baseline morbidity and mortality rates in some areas. Furthermore, a short cold storage capacity of liver allografts limits greater allocation and distribution schema.
Dominique J. Monlezun, MD, PhD, MPH, and his colleagues at the Tulane Transplant Institute at Tulane University, New Orleans, evaluated the effect of MELD and other allocation schemes on the incidence of racial and regional disparities in a study published in Surgery. They performed fixed-effects multivariate logistic regression augmented by modified forward and backward stepwise-regression of transplanted patients from the United Network for Organ Sharing Standard Transplant Analysis and Research database (1985-2016) to assess causal inference of such disparities.
“Significant disparities in the odds of receiving a liver were found: African Americans, odds ratio, 1.12 (95% confidence interval, 1.08-1.17); Asians, 1.12 (95% CI, 1.07-1.18); females, 0.80 (95% CI, 0.78-0.83); and malignancy 1.18 (95% CI, 1.13-1.22). Significant racial disparities by region were identified using Caucasian Region 7 (Ill., Minn., N.D., S.D., and Wisc.) as the reference: Hispanic Region 9 (N.Y., West Vt.) 1.22 (1.02-1.45), Hispanic Region 1 (New England) 1.26 (1.01-1.57), Hispanic Region 4 (Ok., Tex.) 1.23 (1.05-1.43), and Asian Region 4 (Ok., Tex.) 1.35 (1.05-1.73).” Since the transplantation rate in Region 7 closely approximated the sex and race-matched rate of the national post–Share 35 average, it was used as a reference in the study.
“Although traditional disparities as with African Americans and [whites] have been improved during the past 30 years, new disparities as with Hispanics and Asians have developed in certain regions,” stated the authors.
They acknowledged the limitations in the observational nature of the study and those of the statistical analyses, which could only approximate, rather than perfectly replicate, a randomized trial. Big Data tools such as artificial intelligence–based machine learning can provide real-time analysis of large heterogeneous datasets for patients across different regions.
The authors reported no conflicts of interest.
SOURCE: Monlezun DJ et al. Surgery. 2018 doi: 10.1016/j.surg.2017.10.009.
FROM SURGERY
Key clinical point: The existence of racial disparity in liver allograft distribution is undisputed. Disagreements persist over optimal allocation schemes, with centers using different schemes.
Major finding: A rigorous causal inference statistic on a large national dataset spanning at least 30 years showed that racial disparities by region persist despite multiple allocation schemes.
Study details: Patients from the United Network for Organ Sharing Standard Transplant Analysis and Research database (1985-2016) were used to assess causal inference of racial and regional disparities.
Disclosures: None reported.
Source: Monlezun DJ et al. Surgery. 2018. doi: 10.1016/j.surg.2017.10.009.
Americans support the right to affordable health care
Despite the rhetorical winds blowing out of Washington, 92% of Americans believe that they have the right to affordable health care, according to a recent survey by the Commonwealth Fund.
Political affiliation, it turns out, does not appear to determine support for such a right. Democrats aged 19-64 years voiced their support to the tune of 99% in favor of a right to affordable care, compared with 82% of Republicans and 92% of independents, the Commonwealth Fund said in a survey brief released March 1.
“This survey’s finding that strong majorities of U.S. adults, regardless of party affiliation, believe that all Americans should have a right to affordable health care suggests there may be popular support for a discussion over our preferred path,” the report’s authors wrote.
The survey showed that 36% of those who have health care insurance through the Affordable Care Act marketplaces are pessimistic about their chances of keeping that coverage, compared with 27% of those with Medicaid and 9% of adults with employer-sponsored health benefits.
Among those who lacked confidence about maintaining their coverage, the largest proportion (32%) of respondents believe that they will lose it because the “Trump administration will not carry out the law” and 19% think that they won’t be able to afford it in the future, they said.
“ Such a shift also would provide a more stable regulatory environment for insurers participating in both the marketplaces and Medicaid,” according to the report.
The Commonwealth Fund’s sixth Affordable Care Act Tracking Survey was conducted by the research firm SSRS between Nov. 2 and Dec. 27, 2017, with responses from 2,410 adults aged 19-64 years. The overall margin of error was ±2.7 percentage points at the 95% confidence level.
Despite the rhetorical winds blowing out of Washington, 92% of Americans believe that they have the right to affordable health care, according to a recent survey by the Commonwealth Fund.
Political affiliation, it turns out, does not appear to determine support for such a right. Democrats aged 19-64 years voiced their support to the tune of 99% in favor of a right to affordable care, compared with 82% of Republicans and 92% of independents, the Commonwealth Fund said in a survey brief released March 1.
“This survey’s finding that strong majorities of U.S. adults, regardless of party affiliation, believe that all Americans should have a right to affordable health care suggests there may be popular support for a discussion over our preferred path,” the report’s authors wrote.
The survey showed that 36% of those who have health care insurance through the Affordable Care Act marketplaces are pessimistic about their chances of keeping that coverage, compared with 27% of those with Medicaid and 9% of adults with employer-sponsored health benefits.
Among those who lacked confidence about maintaining their coverage, the largest proportion (32%) of respondents believe that they will lose it because the “Trump administration will not carry out the law” and 19% think that they won’t be able to afford it in the future, they said.
“ Such a shift also would provide a more stable regulatory environment for insurers participating in both the marketplaces and Medicaid,” according to the report.
The Commonwealth Fund’s sixth Affordable Care Act Tracking Survey was conducted by the research firm SSRS between Nov. 2 and Dec. 27, 2017, with responses from 2,410 adults aged 19-64 years. The overall margin of error was ±2.7 percentage points at the 95% confidence level.
Despite the rhetorical winds blowing out of Washington, 92% of Americans believe that they have the right to affordable health care, according to a recent survey by the Commonwealth Fund.
Political affiliation, it turns out, does not appear to determine support for such a right. Democrats aged 19-64 years voiced their support to the tune of 99% in favor of a right to affordable care, compared with 82% of Republicans and 92% of independents, the Commonwealth Fund said in a survey brief released March 1.
“This survey’s finding that strong majorities of U.S. adults, regardless of party affiliation, believe that all Americans should have a right to affordable health care suggests there may be popular support for a discussion over our preferred path,” the report’s authors wrote.
The survey showed that 36% of those who have health care insurance through the Affordable Care Act marketplaces are pessimistic about their chances of keeping that coverage, compared with 27% of those with Medicaid and 9% of adults with employer-sponsored health benefits.
Among those who lacked confidence about maintaining their coverage, the largest proportion (32%) of respondents believe that they will lose it because the “Trump administration will not carry out the law” and 19% think that they won’t be able to afford it in the future, they said.
“ Such a shift also would provide a more stable regulatory environment for insurers participating in both the marketplaces and Medicaid,” according to the report.
The Commonwealth Fund’s sixth Affordable Care Act Tracking Survey was conducted by the research firm SSRS between Nov. 2 and Dec. 27, 2017, with responses from 2,410 adults aged 19-64 years. The overall margin of error was ±2.7 percentage points at the 95% confidence level.
Aesthetic procedures becoming more popular in skin of color patients
in a presentation at the Caribbean Dermatology Symposium.
In 2015, ethnic minority patients accounted for 25% of aesthetic procedures in the United States, up from 20% in 2010, according to data from the American Society for Aesthetic Plastic Surgery, said Dr. Alexis, chair of dermatology and director of the Skin of Color Center at Mount Sinai St. Luke’s and Mount Sinai West hospitals in New York.
Chemical peels can be used successfully to treat a range of conditions in skin of color patients, including postinflammatory hyperpigmentation, acne, melasma, textural irregularities, and pseudofolliculitis barbae. They also can be used for skin brightening, said Dr. Alexis, who recommended a chemical peel protocol of salicylic acid, glycolic acid, or Jessner’s every 2-4 weeks. “Consider hydroquinone 4% concurrently to enhance efficacy for treating hyperpigmentation and to prevent postinflammatory hyperpigmentation,” he said. Patients on retinoids should discontinue them for 1 week prior to a chemical peel, he added.
Dr. Alexis shared several treatment pearls to promote successful peels in skin of color patients:
- Salicylic acid: Resist the urge to overapply and “titrate according to patient tolerability.” The endpoint of a salicylic acid peel is white precipitate, not frost; cool compresses can be used for patient comfort and for later removal of the white precipitate.
- Glycolic acid: Stick to a contact time of 2-4 minutes to avoid epidermolysis. “Completely neutralize all areas of application to avoid overpeeling.”
- Trichloroacetic acid (TCA): TCA carries a greater risk of dyspigmentation, and should be reserved for patients who have not been successfully treated with salicylic or glycolic acid; a 10%-15% concentration of TCA, applied conservatively, is recommended.
Regardless of the type of chemical, potential pitfalls of peels in patients of color include using too much product, allowing too long of an application time, and applying the chemical to an inflamed or excoriated area, Dr. Alexis said. Patients who don’t discontinue retinoids before a peel are at increased risk of developing erosions or crusting, he added.
Dr. Alexis disclosed relationships with Allergan, BioPharmX, Dermira, Galderma, Novan, Novartis, RXi, Unilever, and Valeant.
Global Academy and this news organization are owned by the same parent company.
in a presentation at the Caribbean Dermatology Symposium.
In 2015, ethnic minority patients accounted for 25% of aesthetic procedures in the United States, up from 20% in 2010, according to data from the American Society for Aesthetic Plastic Surgery, said Dr. Alexis, chair of dermatology and director of the Skin of Color Center at Mount Sinai St. Luke’s and Mount Sinai West hospitals in New York.
Chemical peels can be used successfully to treat a range of conditions in skin of color patients, including postinflammatory hyperpigmentation, acne, melasma, textural irregularities, and pseudofolliculitis barbae. They also can be used for skin brightening, said Dr. Alexis, who recommended a chemical peel protocol of salicylic acid, glycolic acid, or Jessner’s every 2-4 weeks. “Consider hydroquinone 4% concurrently to enhance efficacy for treating hyperpigmentation and to prevent postinflammatory hyperpigmentation,” he said. Patients on retinoids should discontinue them for 1 week prior to a chemical peel, he added.
Dr. Alexis shared several treatment pearls to promote successful peels in skin of color patients:
- Salicylic acid: Resist the urge to overapply and “titrate according to patient tolerability.” The endpoint of a salicylic acid peel is white precipitate, not frost; cool compresses can be used for patient comfort and for later removal of the white precipitate.
- Glycolic acid: Stick to a contact time of 2-4 minutes to avoid epidermolysis. “Completely neutralize all areas of application to avoid overpeeling.”
- Trichloroacetic acid (TCA): TCA carries a greater risk of dyspigmentation, and should be reserved for patients who have not been successfully treated with salicylic or glycolic acid; a 10%-15% concentration of TCA, applied conservatively, is recommended.
Regardless of the type of chemical, potential pitfalls of peels in patients of color include using too much product, allowing too long of an application time, and applying the chemical to an inflamed or excoriated area, Dr. Alexis said. Patients who don’t discontinue retinoids before a peel are at increased risk of developing erosions or crusting, he added.
Dr. Alexis disclosed relationships with Allergan, BioPharmX, Dermira, Galderma, Novan, Novartis, RXi, Unilever, and Valeant.
Global Academy and this news organization are owned by the same parent company.
in a presentation at the Caribbean Dermatology Symposium.
In 2015, ethnic minority patients accounted for 25% of aesthetic procedures in the United States, up from 20% in 2010, according to data from the American Society for Aesthetic Plastic Surgery, said Dr. Alexis, chair of dermatology and director of the Skin of Color Center at Mount Sinai St. Luke’s and Mount Sinai West hospitals in New York.
Chemical peels can be used successfully to treat a range of conditions in skin of color patients, including postinflammatory hyperpigmentation, acne, melasma, textural irregularities, and pseudofolliculitis barbae. They also can be used for skin brightening, said Dr. Alexis, who recommended a chemical peel protocol of salicylic acid, glycolic acid, or Jessner’s every 2-4 weeks. “Consider hydroquinone 4% concurrently to enhance efficacy for treating hyperpigmentation and to prevent postinflammatory hyperpigmentation,” he said. Patients on retinoids should discontinue them for 1 week prior to a chemical peel, he added.
Dr. Alexis shared several treatment pearls to promote successful peels in skin of color patients:
- Salicylic acid: Resist the urge to overapply and “titrate according to patient tolerability.” The endpoint of a salicylic acid peel is white precipitate, not frost; cool compresses can be used for patient comfort and for later removal of the white precipitate.
- Glycolic acid: Stick to a contact time of 2-4 minutes to avoid epidermolysis. “Completely neutralize all areas of application to avoid overpeeling.”
- Trichloroacetic acid (TCA): TCA carries a greater risk of dyspigmentation, and should be reserved for patients who have not been successfully treated with salicylic or glycolic acid; a 10%-15% concentration of TCA, applied conservatively, is recommended.
Regardless of the type of chemical, potential pitfalls of peels in patients of color include using too much product, allowing too long of an application time, and applying the chemical to an inflamed or excoriated area, Dr. Alexis said. Patients who don’t discontinue retinoids before a peel are at increased risk of developing erosions or crusting, he added.
Dr. Alexis disclosed relationships with Allergan, BioPharmX, Dermira, Galderma, Novan, Novartis, RXi, Unilever, and Valeant.
Global Academy and this news organization are owned by the same parent company.
EXPERT ANALYSIS FROM THE CARIBBEAN DERMATOLOGY SYMPOSIUM