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Allergy and Immunology - Asthma and COPD
Dupilumab-induced seronegative arthritis and enthesitis (September 2022)
Dupilumab is an IL-4/IL-13 inhibitor approved for the treatment of atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyposis, and eosinophilic esophagitis. An analysis of nearly 38,000 adverse reactions to dupilumab reported to VigiBase, the World Health Organization's global pharmacovigilance database, found a 9 percent rate of musculoskeletal and connective tissue adverse effects.3 Specifically, dupilumab was associated with diseases sharing T helper 17 (Th17) immunogenetics, including seronegative arthritis, enthesitis/enthesopathy, and iridocyclitis. Based on these data, we suggest that all patients initiating treatment with dupilumab be counseled about the risk of new-onset joint pain, which is mild in most cases and typically does not require discontinuation of treatment.
Cardiovascular Medicine - Coronary Heart Disease, Stable
Efficacy of moderate-dose statin plus ezetimibe for secondary prevention of cardiovascular disease (September 2022)
The long-term efficacy of combination therapy with ezetimibe plus a moderate-dose statin for the secondary prevention of cardiovascular disease (CVD) has not been well studied. In the RACING trial, which randomly assigned nearly 3800 patients with CVD to combination therapy with moderate-dose rosuvastatin plus ezetimibe or high-dose rosuvastatin monotherapy, rates of a composite of cardiovascular death, major cardiovascular events, or nonfatal stroke at three years were similar between the treatment groups (9.1 versus 9.9 percent, respectively).4 Patients receiving combination therapy were more likely to have low-density lipoprotein cholesterol <70 mg/dL, and discontinuation or dose reduction of the study drug was less frequent in the combination versus monotherapy group. In patients with CVD, ezetimibe plus a moderate-dose statin may be an alternative to high-dose statin therapy, particularly in those with an intolerance to high-dose statins.
Family Medicine - Adult General Internal Medicine
Psychiatric disorders following recovery from COVID-19 (May 2022, Modified September 2022)
Patients who recover from acute COVID-19 are at increased risk for psychiatric disorders, although the risk for some of these disorders may decrease over time. In a large retrospective study, incident psychiatric disorders, including anxiety, depressive, posttraumatic stress, sleep, and substance use disorders, occurred more frequently in patients who survived COVID-19 than in patients without a history of COVID-19 (hazard ratio 1.5).1 In another retrospective study of over 1.2 million patients with a history of COVID-19, the risk of psychopathology in the first six months following infection was greater than that among matched controls with a different respiratory infection.2 However, after another three months, the excess risk of anxiety disorders, insomnia, and mood disorders had diminished. By contrast, a history of COVID-19 was associated with a higher risk of cognitive impairment and psychotic disorders during the entire two-year follow-up period. Patients with COVID-19 can be reassured that eventually the risk of some psychiatric sequelae is no greater than that with other respiratory infections, but some patients with certain post-COVID-19 psychiatric disorders may require psychotherapy and/or pharmacotherapy.
1. Xie Y, Xu E, Al-Aly Z SO. Risks of mental health outcomes in people with covid-19: cohort study. BMJ. 2022;376:e068993. Epub 2022 Feb 16. [Context Link]
2. Taquet M, Sillett R, Zhu L, et al Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients. Lancet Psychiatry. 2022. [Context Link]
3. Bridgewood C, Wittmann M, Macleod T, et al T Helper 2 IL-4/IL-13 Dual Blockade with Dupilumab Is Linked to Some Emergent T Helper 17-Type Diseases, Including Seronegative Arthritis and Enthesitis/Enthesopathy, but Not to Humoral Autoimmune Diseases. J Invest Dermatol. 2022. [Context Link]
4. Kim BK, Hong SJ, Lee YJ, et al Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. Lancet. 2022;400(10349):380. Epub 2022 Jul 18. [Context Link]
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