Saint Louis University School of Medicine

WEDNESDAY, Nov. 13, 2024 -- Use of palliative care for heart failure remains low in the United States, according to a study recently published online in the Journal of the American Heart Association . Zidong Zhang, Ph.D., from the Saint Louis University School of Medicine, and colleagues investigated national palliative care use for adults with heart failure. A national all‐payer electronic health record database was used to identify 127,712 adults with newly diagnosed heart failure (2011 to 2018) and to determine when they received their first palliative care consultation and the associations with clinical factors following diagnosis of heart failure. During a median 792 days of follow-up, 18.3 percent of patients received palliative care consultation in five years. The researchers found that shorter time to receive palliative care consultation was associated with diagnoses of heart failure in 2016 to 2018 (compared with 2010 to 2015: adjusted hazard ratio [aHR], 1.421), as well as advanced heart failure diagnosis (aHR, 2.065), cardiogenic shock (aHR, 2.587), implantable cardioverter‐defibrillator use (aHR, 5.718), and visits at academic medical centers (aHR, 1.439). There was variance in palliative care uptake for early/moderate heart failure stages by race, geographics, payer, and selection of advanced treatments. "Barriers to palliative care should [be] addressed at a systemic level, including educating patients and providers on the role and benefits of palliative care consultation, expanding the palliative care service availability, making consensus practice guidelines, and reforming the payment method," the authors write. Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

THURSDAY, Aug. 15, 2024 -- No longer meeting diagnostic criteria for posttraumatic stress disorder ( PTSD ) is associated with a lower risk for poor diabetes outcomes, particularly among younger veterans, according to a study published online Aug. 13 in JAMA Network Open . Jeffrey F. Scherrer, Ph.D., from the Saint Louis University School of Medicine, and colleagues examined the association between meeting diagnostic criteria for PTSD and risk for poor type 2 diabetes (T2D) outcomes among 10,002 veterans. The researchers found that before controlling for confounding with entropy balancing, patients who no longer met PTSD diagnostic criteria had similar incidence rates for starting insulin (22.4 versus 24.4 per 1,000 person-years), poor glycemic control (137.1 versus 133.7 per 1,000 person-years), any microvascular complication (108.4 versus 104.8 per 1,000 person-years), and all-cause mortality (11.2 versus 11.0 per 1,000 person-years) compared with patients with persistent PTSD. However, when controlling for confounding, there was a lower risk for microvascular complications (hazard ratio [HR], 0.92) among those no longer meeting PTSD criteria. For younger veterans (ages 18 to 49 years), no longer meeting PTSD criteria was associated with a lower risk for insulin initiation (HR, 0.69) and all-cause mortality (HR, 0.39). No longer meeting PTSD criteria was also associated with a lower risk for insulin initiation among patients without depression (HR, 0.73). "The findings of this study suggest that PTSD is a modifiable risk factor for some adverse T2D outcomes among patients with comorbid PTSD and T2D," the authors write. Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

Eisai unveiled new data for its Biogen-partnered Alzheimer's disease therapy Leqembi (lecanemab-irmb), putting forward a case for continuous treatment with the anti-amyloid antibody beyond the initial 18-month period studied in the pivotal Clarity AD trial.Clarity AD, which led to Leqembi's full FDA approval in 2023, had previously demonstrated a 27% slowing of cognitive decline over 18 months compared to placebo, based on Clinical Dementia Rating-Sum of Boxes (CDR-SB).The new findings, presented at the Alzheimer's Association International Conference (AAIC), looked at one set of patients who were administered Leqembi continuously for three years as part of Clarity AD and its open-label extension study, while another group received placebo for the first 18 months before switching to Leqembi for the same duration. Eisai also monitored a separate cohort outside the trial who remained untreated for three years.Cognitive impactLynn Kramer, Eisai's chief clinical officer of deep human biology learning, noted that the difference in cognitive decline between the Leqembi early-starters and those who were untreated throughout the study grew wider. Specifically, after three years, the drug was found to slow cognitive decline by 31% compared to what would be expected in similar patients who did not receive treatment.According to Kramer, the drug "interrupts the natural progression of the disease, and it has an effect more and more."The study included an optional tau PET substudy involving 41 patients with no tau or a low accumulation of tau in the brain, representing an early stage in the disease course. After three years of Leqembi treatment, over half of the patients showed improvement or no decline in cognitive and functional assessments, including 59% on the CDR-SB, 63% on the ADAS-Cog14, and 63% on the ADCS MCI-ADL."This suggests that earlier initiation of treatment with [Leqembi] may have a significant positive impact on disease progression and may provide continued benefits to patients with early [Alzheimer's disease] over the long-term," the company said.ARIA 'low and similar' to placeboMoreover, no new safety issues were found after three years of Leqembi. Eisai said most amyloid-related imaging abnormalities (ARIA) occurred in the first six months and then were "low and similar" to placebo rates. Analyses showed ARIA had no impact on cognition or function, and was not linked to faster long-term progression, it added. The risk of ARIA was one of the safety concerns raised by European regulators last week, who concluded that Leqemb’s benefits are outweighed by the associated serious adverse events.The three-year data release comes amid a shift in the Alzheimer's space with the arrival of a key drug rival. Just weeks ago, the FDA approved Eli Lilly's competing anti-amyloid antibody Kisunla (donanemab-azbt). Unlike Leqembi, which is administered indefinitely, Kisunla's treatment regimen allows for discontinuation once amyloid plaques are cleared from the brain.The difference in approach has become a key point of discussion among experts. In a recent interview with FirstWord, George Grossberg, director of geriatric psychiatry at Saint Louis University School of Medicine, noted that Kisunla's limited-duration regimen "is very attractive," referring to the possibility of stopping treatment after 10 to 12 months if brain scans show amyloid clearance.Drawback of stoppingHowever, Eisai's new data puts up a possible challenge. The company cites data from Study 201, a mid-stage involving early Alzheimer's patients who, following the 18-month core study, participated in an open-label extension after temporarily stopping treatment for two years on average.Eisai's analysis showed that even after amyloid plaques are cleared, Alzheimer's continues to progress when treatment is stopped. Patients who discontinued Leqembi saw their rate of cognitive decline revert to that of untreated patients, suggesting a need for ongoing therapy to maintain benefits, according to the company.Eisai noted that Leqembi is the only widely available early Alzheimer's treatment that offers a dual mechanism targeting both amyloid plaques and protofibrils, which accumulate early in the Alzheimer's brain and lead to nerve cell function loss, abnormal nerve processes, inflammation, and memory loss. “Continuing treatment is important if you would like to maintain cognition and functionality longer,” Kramer said, adding “the concept is, if you stop [treatment], you get worse.”For more, see – Physician Views In-Depth: Though Eli Lilly’s new Alzheimer's treatment is a fast favourite, Kisunla is unlikely to be kiss of death for Leqembi.