PREGNANCY LOSS

Low-dose aspirin improves outcomes

To determine the effect of preconception-initiated low-dose aspirin (LDA) therapy on pregnancy loss and live birth, researchers conducted a study of 1,227 women between ages 18 and 40. Each woman had experienced one or two pregnancy losses and was attempting to become pregnant again.

Relative to placebo, adherence to LDA therapy for 5 of 7 days per week led to 8 more pregnancies, 15 more live births, and 6 fewer pregnancy losses for every 100 women in the trial. "Early adoption of LDA with maximal daily adherence promoted pregnancy and live birth and protected against pregnancy loss in women trying to become pregnant after a history of pregnancy loss," the authors concluded. "Increasing adherence to daily LDA seems to be key to improving effectiveness."

Sources: Naimi AI, Perkins NJ, Sjaarda LA, et al. The effect of preconception-initiated low-dose aspirin on human chorionic gonadotropin-detected pregnancy, pregnancy loss, and live birth: per protocol analysis of a randomized trial. Ann Intern Med. [e-pub January 26, 2021] Adherence to low-dose aspirin improves pregnancy outcomes. HealthDay News. January 26, 2021.

PANCREATIC CANCER

Opioid use may be an unrecognized factor

The rate of pancreatic cancer is increasing in the US, as is the rate of prescription and illicit opioid use. Using national databases, researchers investigated whether opioid usage patterns over time could explain state- and national-based variations in pancreatic cancer rates from 1999 to 2016. They found an increase in pancreatic cancer over time at both the national and state levels. The opioid death rates increased over time as well. Among other potential risk factors for pancreatic cancer, only obesity prevalence increased during the study period. "Opioid use may be an unidentified risk factor contributing to the increasing incidence of [pancreatic cancer] in the US," the authors write. "These novel findings need to be verified by population-based studies."

Source: Barlass U, Deshmukh A, Beck T, Bishehsari F. Opioid use as a potential risk factor for pancreatic cancer in the United States: an analysis of state and national level databases. PLoS One. [e-pub January 6, 2021]

CHEMOTHERAPY

New drug prevents bone marrow suppression

Recently approved by the FDA, Cosela (trilaciclib) is the first therapy in its class to reduce the frequency of chemotherapy-induced bone marrow suppression in adults receiving certain types of chemotherapy for extensive-stage small cell lung cancer. Classified as a kinase inhibitor, the new drug is administered as a 30-minute I.V. infusion completed within 4 hours before the start of chemotherapy on each day chemotherapy is administered.

In three randomized, placebo-controlled studies, patients who received Cosela had a lower chance of developing severe neutropenia compared with patients who received a placebo. Among those who had severe neutropenia, patients who received Cosela experienced it for a shorter time on average. The most common adverse reactions were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, increased aspartate aminotransferase, headache, and pneumonia. Patients should be counseled about injection site reactions and the potential for acute drug hypersensitivity reactions, interstitial lung disease/pneumonitis, and embryo-fetal toxicity.

Source: US Food and Drug Administration. FDA approves drug to reduce bone marrow suppression caused by chemotherapy. News release. February 12, 2021.

IMMUNOSUPPRESSANT THERAPY

COVID-19 outcomes not affected

Patients taking immunosuppressant drugs prior to hospitalization for COVID-19 do not have worse outcomes, according to a retrospective cohort study of 2,121 consecutive adults with acute inpatient hospital admission between March 4 and August 29, 2020. Chronic immunosuppression was defined as prescriptions for immunosuppressive drugs current at the time of admission. Among the study cohort, 108 patients (5%) were classified as immunosuppressed before COVID-19, primarily with prednisone, tacrolimus, or mycophenolate mofetil.

In the full cohort, 311 patients (15%) received mechanical ventilation. The median length of stay was 5.2 days and 1,927 patients (91%) survived to discharge. No significant differences in the risk of mechanical ventilation, length of stay, or mortality were found between chronically immunosuppressed patients and those who were not immunosuppressed. The authors write, "Our results contribute to a growing body of evidence that should provide reassurance to clinicians and patients using chronic immunosuppressive medicines."

Source: Andersen KM, Mehta HB, Palamuttam N, et al. Association between chronic use of immunosuppresive drugs and clinical outcomes from coronavirus disease 2019 (COVID-19) hospitalization: a retrospective cohort study in a large US health system. Clin Infect Dis. [e-pub January 7, 2021]

OPHTHALMOLOGY

Medicated drops help close macular holes

The macula, located in the retina, enables sharp central vision. Macular holes are age-related and usually affect people over age 60. Depending on their size and precise location, they can cause distorted or blurred vision, or a dark patch in central vision. Some holes close without treatment, but many require vitrectomy for surgical repair.

Investigating a possible alternative to surgery in patients with macular holes, researchers prescribed a daily three-drug regimen of medicated eye drops containing drugs that are FDA-approved and routinely used for other eye conditions: prednisolone or difluprednate, ketorolac or bromfenac, and brinzolamide or dorzolamide. The length of time the drops were administered ranged from 3 1/2 to 20 months. The goal was to dehydrate patients' retinas to decrease edema and allow the edges of the macular holes to come together.

In 12 of 14 patients receiving the medicated eye drops, macular holes closed in 2 to 8 weeks, which is two to four times faster than spontaneous closure rates for macular holes. The two patients who did not have closure within this period had missed multiple follow-up appointments. The treatment was most effective for small macular holes less than 200 micrometers in diameter.

"Adding a nonsurgical approach to even a small subset of patients is refreshing," said study coauthor Ronald Gentile, MD. The authors hope to conduct a prospective randomized trial to further study the benefits of an eye drop regimen for treating macular holes compared with the natural history of macular holes that close spontaneously.

Sources: Sokol JT, Schechet SA, Komati R, et al. Macular hole closure with medical treatment. Ophthalmol Retina. [e-pub December 16, 2020] University of Chicago Medical Center. Medicated drops may help close macular holes, helping some patients avoid surgery. News release. January 21, 2021.

IMMUNIZATIONS

Updated adult vaccine schedule now available

Based on recommendations from the Advisory Committee on Immunization Practices (ACIP), an updated adult immunization schedule for 2021 was recently issued by the CDC. The schedule includes a new section providing COVID-19 vaccine recommendations as well as new or updated ACIP recommendations for influenza vaccine, hepatitis A vaccine, hepatitis B vaccine, human papillomavirus vaccine, pneumococcal vaccines, meningococcal serogroups A, C, W, and Y vaccines, meningococcal B vaccines, and zoster vaccine. The updated vaccine schedule and a link to interim ACIP recommendations for the use of COVID-19 vaccines can be accessed at http://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html.

Source: Freedman MS, Ault K, Bernstein H. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older-United States, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(6):193-196.