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84, p=0.003). However, the incidence of central nervous system (CNS) progression was not associated with PD-L1 positivity, with a two-year cumulative CNS progression rate of 26.3% and 28.4% in PD-L1-positive and PD-L1-negative patients, respectively (log rank p=0.944). Furthermore, positive PD-L1 expression did not affect CNS progression or overall survival in patients with synchronous brain metastasis (long rank p=0.513 and 0.592, respectively).
Initial brain metastases are common in NSCLC patients with positive PD-L1 expression. Further studies are necessary to understand the relationship between early brain metastasis and cancer immunity.
Initial brain metastases are common in NSCLC patients with positive PD-L1 expression. Further studies are necessary to understand the relationship between early brain metastasis and cancer immunity.
Optimal strategies for managing lupus medications after end-stage renal disease (ESRD) have not been addressed. This study identifies the current United States-wide prescribing patterns of hydroxychloroquine (HCQ) and oral corticosteroids (CS), among SLE patients with incident ESRD enrolled in the US Renal Disease Systems (USRDS) registry.
We identified incident ESRD patients ≥18 years with SLE as a primary cause of ESRD between January 2006 and June 2013. Patients who were started on dialysis at ESRD onset and enrolled in Medicare Part D within 93 days as required by Medicare were included.
Among the 2654 new-onset ESRD patients with Part D, the median (IQR) duration of follow-up was 761 (374, 1375) days. At baseline, 1076 (41%) were not on HCQ or CS, 220 (8%) were prescribed HCQ alone, 509 (19%) were prescribed both HCQ and CS, and 849 (32%) were prescribed CS alone. Of the 1983 patients who either never received or discontinued HCQ after ESRD onset, 667 (34%) continued CS to the end of the follow-up period. The median (IQR) CS dose was lower for patients on HCQ (14 [9, 21] mg), compared to patients who were never prescribed HCQ (15 [9, 27] mg), or patients who discontinued HCQ after ESRD (17 [10, 27] mg), p=0.001.
About one third of patients with lupus nephritis and new onset ESRD received CS monotherapy at high doses. As CS-related complications contribute to hospitalizations and deaths in SLE ESRD, changing these prescribing practices may improve morbidity and mortality outcomes.
About one third of patients with lupus nephritis and new onset ESRD received CS monotherapy at high doses. As CS-related complications contribute to hospitalizations and deaths in SLE ESRD, changing these prescribing practices may improve morbidity and mortality outcomes.The aim of this study was to evaluate the impact of renal impairment on the pharmacokinetics (PKs), safety, and tolerability of daridorexant, a dual orexin receptor antagonist intended for the treatment of insomnia. A single-center, open-label study evaluated the PKs of daridorexant in patients with severe renal function impairment (SRFI; determined by creatinine clearance using the Cockcroft-Gault equation; N = 8) not on dialysis, and in matched control subjects (based on sex, age, and body weight; N = 7). A single oral dose of daridorexant 25 mg was orally administered in the morning. Blood samples were collected up to 72 h postdose for PK assessments of daridorexant. In patients with SRFI, maximum plasma concentrations (Cmax ; geometric mean ratio [GMR] and 90% confidence interval [CI] 0.94 [0.60-1.46]), time to reach Cmax (Tmax ; median difference [90% CI] of -0.25 h [-0.75 to 0.25]), and half-life (GMR [90% CI] of 0.99 [0.66-1.48]), were virtually unchanged. Exposure (area under the plasma concentration-time profile) to daridorexant was slightly higher in patients with SRFI than in control subjects with the GMR (90% CI) being 1.16 (0.63-2.12). No safety issue of concern was detected as all adverse events were transient and of mild or moderate intensity, and no treatment-related effects on vital signs, clinical laboratory, or electrocardiogram variables were observed following daridorexant administration in patients with SRFI and control subjects. Based on these observations, PK alterations of daridorexant due to renal function impairment are not considered of clinical relevance and no dose adjustment is necessary in these patients.
To describe high-dose biologic use when treating juvenile idiopathic arthritis (JIA).
Patients with JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry and treated with a biologic after enrollment were eligible. We described frequency of high-dose biologic use and characteristics of patients on high-dose biologics. We utilized regression modeling to compare 6-month outcomes (using disease activity measures) between those who increased their biologic from standard to high dose (high dose) to those who initiated and remained on standard dosing (no change), and to those who switched biologic agents (biologic switch). We also compared serious adverse events (SAEs) between groups.
5,352 patients with JIA were treated with biologics following enrollment; 1,080 (20%) had ever received a high-dose biologic. There were no significant differences in outcomes between the high dose group and the biologic switch group; both improved disease activity measures including clinical juvenile arthritis disease activity score-10 (-3.53 and -3.95, respectively; p=0.68). Although the SAE rates in the high-dose group and the biologic switch group were numerically higher than the no change group, the event rates were similar and neither rate was significantly higher than the no change group (unadjusted incident rate ratio 2.5 [0.7-8.5] and 1.8 [0.7-4.6], respectively).
Dosing escalation appears to be a reasonable choice to improve disease control, however, large, prospective, randomized studies evaluating specific biologic agents are needed.
Dosing escalation appears to be a reasonable choice to improve disease control, however, large, prospective, randomized studies evaluating specific biologic agents are needed.
Computed tomography (CT)-guided lung biopsy is a frequently performed procedure in the diagnostic workup for suspicious lung nodules that can be complicated by pneumothorax. This retrospective study assessed the efficacy of biopsy tract occlusion with a gelatin sponge slurry for preventing post-biopsy pneumothorax.
Retrospective analysis was conducted on consecutive adult patients who underwent CT-guided lung biopsy over a 10-year period. Age, gender, existing chronic obstructive pulmonary disease (COPD), evidence of emphysema on CT, location of the lesion and the presence of pneumothorax on post-procedure CT and 4-h chest radiograph were recorded.
Two hundred and ninety-six patients were included (126 patients in the non-gelfoam group and 170 in the gelfoam group). Ipatasertib mouse When gelfoam was used, risk of developing an immediate pneumothorax was lower (P=0.032). Patients with emphysema were 2.4 times more likely to develop a delayed pneumothorax without gelfoam (P=0.034). There was a significantly higher risk of both immediate and delayed pneumothorax in non-peripheral lesions without gelfoam (P=0.