Impact of Human Papillomavirus Vaccination on Cervical Precancers
The Centers for Disease Control and Prevention has released an analysis of cervical precancer trends in the United States from 2008 to 2022, focusing on the effect of human papillomavirus (HPV) vaccination and changes in screening practices. The study used data from the Human Papillomavirus Vaccine Impact Monitoring Project (HPV-IMPACT), which tracks cervical intraepithelial neoplasia (CIN) cases in five U.S. sites.
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The researchers analyzed trends in CIN2+ and CIN3+ incidence among screened women, adjusting for changes in frequency of screenings. They found substantial decreases in precancer occurrence in 2022 compared to 2008 among younger women (ages 20 to 24), particularly a substantial decline in cases for both CIN2+ (79.5% lower incidence) and CIN3+ (80.3% lower incidence), correlating with increased HPV vaccination in this age group.
Conversely, older age groups (ages 25 to 64) initially showed an increased precancer incidence, likely due to longer gaps in screening and more sensitive HPV testing. However, recent data indicates that precancer incidence in the 25 to 29 age group has begun to decrease, particularly in CIN3+ cases, suggesting the delayed impact of HPV vaccination as those vaccinated at younger ages enter this demographic.
Limitations of the study include potential inaccuracies in estimated screening rates, variations in screening and management, and the nature of the data, which doesn't directly establish causality. Despite these limitations, the trends strongly suggest that HPV vaccination and appropriate screening are crucial for preventing cervical cancer.
Overall, the data demonstrates the importance of HPV vaccination on reducing cervical precancers, especially in younger women. It also shows a potential future reduction in precancer in older age groups as those vaccinated at younger ages progress. The study emphasizes the importance of continued HPV vaccination and adherence to cervical cancer screening guidelines. (Gargano, J. W., et al. [2025]. Trends in cervical precancers identified through population-based surveillance—Human Papillomavirus Vaccine Impact Monitoring Project, five sites, United States, 2008–2022. MMWR, 74[6], 96–101. Retrieved March 2025 from https://www.cdc.gov/mmwr/volumes/74/wr/mm7406a4.htm)
Released: April 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.
Inhaled Versus Intravenous Sedation for Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is a serious lung condition, requiring mechanical ventilation, and optimal sedation strategies are crucial for patient management. Propofol is commonly used in critically ill patients on ventilation; however, guidance for patients with moderate to severe ARDS is limited. A recent study investigated the effectiveness and safety of inhaled sevoflurane versus intravenous propofol for sedation in this patient population.
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The study was a multicenter, randomized, phase 3 trial which ran from May 2020 through October 2023 in 37 intensive care units in France, involving 687 adult patients with ARDS. Patients were randomized to receive either sevoflurane or propofol, with initial deep sedation and neuromuscular blockade followed by lighter sedation. The primary outcome was the number of ventilator-free days at 28 days, and secondary outcomes assessed 90-day survival and safety measures.
The findings showed that patients receiving sevoflurane had fewer ventilator-free days (0.0 to 11.9 versus 0.0 to 18.7 with propofol) and a lower 90-day survival rate (47.1%) compared to those receiving propofol (55.7%). Additionally, the sevoflurane group experienced higher serum lactate levels, increased norepinephrine doses, and a higher incidence of acute kidney injury and nephrogenic diabetes insipidus.
These results contradict previous studies suggesting potential advantages of inhaled volatile anesthetics in critically ill patients. The researchers' explanations for the adverse outcomes include possible hemodynamic instability and kidney injury associated with sevoflurane, as well as potential issues related to the delivery device impacting carbon dioxide levels.
The study concluded that inhaled sevoflurane was associated with worse clinical outcomes than intravenous propofol in patients with moderate to severe ARDS. The findings suggest that propofol remains the preferred sedation agent in this patient population, and further research is needed to explore the effects of other volatile anesthetics and shorter durations of sevoflurane use. (Jabaudon, M., et al. [2025]. Inhaled sedation in acute respiratory distress syndrome: The SESAR randomized clinical trial. JAMA. Advance online publication. Retrieved March 2025 from https://jamanetwork.com/journals/jama/fullarticle/2831857)
Released: April 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.
Remibrutinib Improves Symptoms in Chronic Spontaneous Urticaria
Chronic spontaneous urticaria (CSU) is marked by itching, hives, and angioedema, which can last over 6 weeks and greatly reduces quality of life in those affected. Standard treatment is with second-generation H1-antihistamines, but only half of treated patients receive adequate relief. Two phase 3 clinical trials (REMIX-1 and REMIX-2) evaluated remibrutinib, a Bruton tyrosine kinase inhibitor, for CSU in patients whose symptoms were not well-controlled with second-generation H1-antihistamines.
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The trials were randomized, double-blind, placebo-controlled studies where patients received either remibrutinib (25 mg twice daily) or a placebo for 24 weeks, in addition to their existing H1-antihistamine therapy. The primary endpoint was the change in the Urticaria Activity Score over 7 days (UAS7) from start to week 12. Key secondary endpoints were itch and hive severity scores, as well as the proportion of patients achieving well-controlled CSU (UAS7 score of 6 or less) and complete resolution of symptoms.
Results showed remibrutinib substantially improved UAS7, itch severity, and hive severity compared to placebo at week 12, with improvements seen as early as week 1 and sustained through week 24. A greater percentage of patients on remibrutinib achieved well-controlled CSU over placebo (49.8% vs. 24.8% in REMIX-1; 46.8% vs. 19.6% in REMIX-2). Likewise, remibrutinib demonstrated better rates of complete symptom resolution (31.1% vs. 10.5% in REMIX-1; 27.9% vs. 6.5% in REMIX-2).
Remibrutinib also demonstrated a favorable safety profile, with adverse events similar to placebo. Most events were mild or moderate, and serious adverse events were infrequent and unrelated to the study drug.
These clinical trials support the efficacy and safety of remibrutinib as an add-on therapy for patients with CSU who don't respond adequately to H1-antihistamines, offering a potential new treatment option for this condition. (Metz, M., et al. [2025]. Remibrutinib in chronic spontaneous urticaria. NEJM, 392(10), 984–994. Retrieved March 2025 from https://www.nejm.org/doi/full/10.1056/NEJMoa2408792)
Released: April 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.
Tezepelumab for Chronic Rhinosinusitis with Nasal Polyps
A phase 3, multicenter, double-blind, randomized, controlled clinical trial (WAYPOINT) assessed the efficacy and safety of tezepelumab, a monoclonal antibody that targets thymic stromal lymphopoietin (TSLP), in treating severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). CRSwNP is a condition defined by epithelial barrier dysfunction and type 2 inflammation that leads to symptoms like nasal congestion, facial pain, and loss of smell, greatly impacting quality of life for patients.
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Current treatments, such as intranasal glucocorticoids and surgery, often provide limited relief. Biologic therapies targeting type 2 inflammatory pathways have emerged, but unmet needs remain for patients with inadequate responses. Tezepelumab, by blocking TSLP, an upstream inflammatory driver, offers a potential new approach, as elevated TSLP levels are found in nasal polyp tissue.
The WAYPOINT trial, which ran from April 2021 through August 2023, involved 408 patients with severe CRSwNP, randomized to receive either tezepelumab (210 mg at week 0 and then every 4 weeks after) or placebo, alongside standard intranasal glucocorticoid therapy, over 52 weeks. The study measured changes in nasal polyp size, nasal congestion, loss of smell, sinus opacification, and the need for surgery or systemic glucocorticoids.
Results showed significantly greater reductions in nasal polyp size (mean difference, −2.07) and nasal congestion (mean difference, −1.03) in the tezepelumab group compared to placebo. In addition, tezepelumab led to improvements in loss of smell, sinus opacification, and reduced the need for surgery or systemic glucocorticoids. The treatment was well-tolerated, with adverse events similar to placebo.
The study concludes that tezepelumab is an effective and safe treatment option for severe, uncontrolled CRSwNP, offering symptom relief and reducing the need for invasive interventions. This suggests that targeting TSLP could be a promising therapeutic strategy for this challenging condition. (Lipworth, B. J., et al. [2025]. Tezepelumab in adults with severe chronic rhinosinusitis with nasal polyps. NEJM. Advance online publication. Retrieved March 2025 from https://www.nejm.org/doi/full/10.1056/NEJMoa2414482)
Released: April 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.