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Medscape
11-07-2025
- Health
- Medscape
Good News for Tofacitinib in Recent Study of Acute Severe UC
A head-to-head comparison of the JAK inhibitor drug tofacitinib and chimeric monoclonal antibody infliximab in the treatment of acute severe ulcerative colitis (ASUC) shows that, contrary to concerns, tofacitinib is not associated with worse postoperative complications and in fact may reduce the risk of the need for colectomy. 'Tofacitinib has shown efficacy in managing ASUC, but concerns about postoperative complications have limited its adoption,' reported the authors in research published in Clinical Gastroenterology and Hepatology. 'This study shows that tofacitinib is safe and doesn't impair wound healing or lead to more infections if the patient needs an urgent colectomy, which is unfortunately common in this population,' senior author Jeffrey A. Berinstein, MD, of the Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan, told Medscape Medical News. Recent treatment advances for UC have provided significant benefits in reducing the severity of symptoms; however, about a quarter of patients go on to experience flares, with fecal urgency, rectal bleeding, and severe abdominal pain of ASUC potentially requiring hospitalization. The standard of care for those patients is rapid induction with intravenous (IV) corticosteroids; however, up to 30% of patients don't respond to those interventions, and even with subsequent treatment of cyclosporine and infliximab helping to reduce the risk for an urgent colectomy, patients often don't respond, and ultimately, up to a third of patients with ASUC end up having to receive a colectomy. While JAK inhibitor therapies, including tofacitinib and upadacitinib, have recently emerged as potentially important treatment options in such cases, showing reductions in the risk for colectomy, concerns about the drugs' downstream biologic effects have given many clinicians reservations about their use. 'Anecdotally, gastroenterologists and surgeons have expressed concern about JAK inhibitors leading to poor wound healing, as well as increasing both intraoperative and postoperative complications, despite limited data to support these claims,' the authors wrote. To better understand those possible risks, first author Charlotte Larson, MD, of the Department of Internal Medicine, Michigan Medicine, and colleagues conducted a multicenter, retrospective, case-control study of 109 patients hospitalized with ASUC at two centers in the US and 14 in France. Of the patients, 41 were treated with tofacitinib and 68 with infliximab prior to colectomy. Among patients treated with tofacitinib, five (12.2%) received infliximab and four (9.8%) received cyclosporine rescue immediately prior to receiving tofacitinib during the index admission. In the infliximab group, one (1.5%) received rescue cyclosporine. In a univariate analysis, the tofacitinib-treated patients showed significantly lower overall rates of postoperative complications than infliximab-treated patients (31.7% vs 64.7%; odds ratio [OR], 0.33; P = .006). The tofacitinib-treated group also had lower rates of serious postoperative complications (12% vs 28.9; OR, 0.20; P = .016). After adjusting for multivariate factors including age, inflammatory burden, nutrition status, 90-day cumulative corticosteroid exposure and open surgery, there was a trend favoring tofacitinib but no statistically significant difference between the two treatments in terms of serious postoperative complications ( P = .061). However, a significantly lower rate of overall postoperative complications with tofacitinib was observed after the adjustment (odds ratio, 0.38; P = .023). Importantly, a subanalysis showed that the 63.4% of tofacitinib-treated patients receiving the standard FDA-approved induction dose of 10 mg twice daily did indeed have significantly lower rates than infliximab-treated patients in terms of serious postoperative complications (OR, .10; P = .031), as well as overall postoperative complications (OR, 0.23; P = .003), whereas neither of the outcomes were significantly improved among the 36.6% of patients who received the higher-intensity thrice-daily tofacitinib dose ( P = .3 and P = .4, respectively). Further complicating the matter, in a previous case-control study that the research team conducted, it was the off-label, 10 mg thrice-daily dose of tofacitinib that performed favorably and was associated with a significantly lower risk for colectomy than the twice-daily dose (hazard ratio 0.28; P = .018); the twice-daily dose was not protective. Berinstein added that a hypothesis for the benefits overall, with either dose, is that tofacitinib's anti-inflammatory properties are key. 'We believe that lowering inflammation as much as possible, with the colon less inflamed, could be providing the benefit in lowering complications rate in surgery,' he explained. Regarding the dosing, 'it's a careful trade-off,' Berinstein added. 'Obviously, we want to avoid the need for a colectomy in the first place, as it is a life-changing surgery, but we don't want to increase the risk of infections.' In other findings, the tofacitinib group had no increased risk for postoperative venous thrombotic embolisms (VTEs), which is important as tofacitinib exposure has previously been associated with an increased risk for VTEs independent of other prothrombotic factors common to patients with ASUC, including decreased ambulation, active inflammation, corticosteroid use, and major colorectal surgery. 'This observed absence of an increased VTE risk may alleviate some of the hypothetical postoperative safety concern attributed to JAK inhibitor therapy in this high-risk population,' the authors wrote. Overall, the results underscore that 'providers should feel comfortable using this medication if they need it and if they think it's most likely to help their patients avoid colectomy,' Berinstein said. 'They should not give pause over concerns of postoperative complications because we didn't show that,' he said. Commenting on the study, Joseph D. Feuerstein, MD, of the Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, noted that, in general, in patients with ASUC who fail on IV steroids, 'the main treatments are infliximab, cyclosporine, or a JAK inhibitor like tofacitinib or upadacitinib, [and] knowing that if someone needs surgery, the complication rates are similar and that pre-operative use is okay is reassuring.' Regarding the protective effect observed with some circumstances, 'I don't put too much weight into that,' he noted. '[One] could speculate that it is somehow related to faster half-life of the drug, and it might not sit around as long,' he said. Feuerstein added that 'the study design being retrospective is a limitation, but this is the best data we have to date.'
Daily Mirror
14-06-2025
- Health
- Daily Mirror
Diet that combines eating plans 'helps with IBS symptoms'
A low-FODMAP diet is usually recommended for patients with IBS, which focuses on avoiding certain foods that can exacerbate symptoms Those plagued by Irritable Bowel Syndrome (IBS) could see a significant reduction in their symptoms by merging two diets, it has been suggested. Typically, a low FODMAP diet is advised for those with IBS, which centres around avoiding foods that can worsen symptoms. FODMAP, an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, are specific carbohydrates that the small intestine struggles to absorb properly. When people with IBS consume FODMAP foods, they can experience a range of uncomfortable symptoms, including cramping, constipation, bloating, diarrhoea, and excessive gas. A broad variety of common foods fall under the FODMAP category, including: Dairy Wheat Apples Pears Peaches Asparagus Onions Garlic Beans Lentils As the low-FODMAP diet primarily focuses on avoiding certain foods, it can be paired with other diets that concentrate on consuming certain foods that are also low FODMAP. For instance, some clinical trials have shown a positive correlation between people adhering to the Mediterranean diet and an improvement in symptoms. In one trial that compared 30 people not following the diet to 29 following the diet, those who followed the diet demonstrated an improvement in gastrointestinal and psychological symptoms. Another pilot study from Michigan Medicine, which examined 20 participants, also showed similar promising results, with people following the Mediterranean diet showing an improvement in abdominal symptoms, reports Surrey Live. This study revealed that symptoms improved even more when participants followed the low-FODMAP diet, compared to just the Mediterranean diet. Given that both diets had a positive impact on IBS symptoms, it might be beneficial to follow both diets simultaneously for maximum benefits. Merging the low-FODMAP and Mediterranean diet Before those living with IBS consider incorporating the Mediterranean diet into their low-FODMAP diet, it's crucial to note that the Mediterranean diet does include some high-FODMAP foods. The Mediterranean diet isn't specifically designed for people with IBS or other gastrointestinal issues, but rather promotes eating foods traditionally found in Mediterranean countries like Spain, Italy, and Greece. It encourages the intake of plant-based foods, healthy fats (particularly those found in olive oil), lean protein, and low-fat dairy while limiting the consumption of saturated fats and red meat. Despite containing some high-FODMAP foods, there are still a wide variety of things that can be eaten while adhering to both diets, including: Olives and olive oil Sourdough bread Walnuts Almonds Fish Lean chicken Oranges Tomatoes Oats Leafy greens Research indicates that regular consumption of the Mediterranean Diet can reduce the risk of cardiovascular disease, support healthy blood sugar levels, lower cholesterol, and maintain a healthy body weight. Before making any drastic changes to your diet in an attempt to manage IBS, it's advised to have a chat with your GP or another healthcare professional. More information on how to handle IBS symptoms can be found on the NHS website.
Hans India
01-06-2025
- Health
- Hans India
People with irritable bowel syndrome can find relief with Mediterranean diet: Study
New Delhi: A team of US researchers has found that the Mediterranean diet may provide symptom relief for people with irritable bowel syndrome (IBS). Irritable bowel syndrome affects an estimated 4-11 per cent of all people, and a majority of patients prefer dietary interventions to medication. The low FODMAP diet leads to symptom improvement in more than half of patients, but is restrictive and hard to follow. Previous investigations from Michigan Medicine researchers in the US into more accessible alternative diets led to a proposed 'FODMAP simple,' which attempted to only restrict the food groups in the FODMAP acronym that are most likely to cause symptoms. In the new study published in the journal Neurogastroenterology & Motility, participants were randomised into two groups, one following the Mediterranean diet and the other following the low FODMAP diet, a common restrictive diet for IBS. In the Mediterranean diet group, 73 per cent of the patients met the primary endpoint for symptom improvement, versus 81.8 per cent in the low FODMAP group. 'Restrictive diets, such as low FODMAP, can be difficult for patients to adopt,' said Prashant Singh, Michigan Medicine gastroenterologist and lead author on the paper. 'In addition to the issue of being costly and time-consuming, there are concerns about nutrient deficiencies and disordered eating when trying a low FODMAP diet. The Mediterranean diet interested us as an alternative that is not an elimination diet and overcomes several of these limitations related to a low FODMAP diet,' Kumar added. The Mediterranean diet is already popular among physicians for its benefits to cardiovascular, cognitive, and general health. Previous research on the effect of the Mediterranean diet on IBS, however, had yielded conflicting results. While the Mediterranean diet did provide symptom relief, the low FODMAP group experienced a greater improvement measured by both abdominal pain intensity and IBS symptom severity score. 'This study adds to a growing body of evidence which suggests that a Mediterranean diet might be a useful addition to the menu of evidence-based dietary interventions for patients with IBS,' said William Chey, chief of Gastroenterology at the University of Michigan.
Mint
20-05-2025
- Health
- Mint
Joe Biden had unrivaled medical care. How did his cancer go undetected?
How was Joe Biden's cancer not caught earlier? The news that the former president is battling an aggressive, stage-4 prostate cancer that has spread to the bone ignited a public debate about why a person with peerless access to medical care was diagnosed at such an advanced stage with a disease that is quite common in men his age. Many prostate cancers in the U.S. are detected with a blood test that measures prostate-specific antigen, or PSA. The test is cheap and can help find potential cancer before symptoms appear. There are some particularly aggressive prostate cancers that don't secrete enough PSA to be flagged on the test. But those are rare, doctors said. Whether Biden, 82, had been getting regular PSA screening before his diagnosis isn't publicly known, and prostate cancer screening for men in their 80s isn't considered standard care. The U.S. Preventive Services Task Force, a government-backed volunteer panel of experts that makes preventive health recommendations, advises against PSA screening for men ages 70 and above, based on concerns about false positives and overtreating low-risk forms of the disease. Other groups advise older men to make the decision about whether to continue screening in consultation with their doctors. 'It's in many ways unsettling that someone who has what is undoubtedly fantastic medical care could suddenly be diagnosed with aggressive, metastatic prostate cancer," said Dr. Todd Morgan, co-director of the Weiser Center for Prostate Cancer at Michigan Medicine. 'On the other hand, this is often how prostate cancer presents. We typically don't do PSA screening beyond 75 or late 70s." Biden, however, wasn't a typical patient. As the oldest president in U.S. history to seek re-election, his health was under considerable scrutiny by voters. His eldest son died of brain cancer at age 46, prompting Biden, then vice president, to launch his 'cancer moonshot" initiative to accelerate the fight against the disease. His poor performance in last year's presidential debate forced him out of the 2024 race, and new attention on his acuity while in office is amplifying concerns that his aides concealed his decline. Donald Trump—the second oldest president at age 78—does get screened. He released the results of his prostate cancer screening last month, showing a normal score. Barack Obama released his PSA score when he was president, as did George W. Bush. Speaking to reporters in the Oval Office on Monday evening, Trump said he is 'very sad" to hear about Biden's diagnosis and raised questions about why it wasn't discovered earlier. 'Someone is going to have to speak to his doctor," Trump said. 'I feel badly about it, and I think people should try and find out what happened." The Republican-led House Oversight and Government Reform Committee is currently probing whether top White House officials concealed negative information about Biden's decline. The probe began last Congress and included a request for an interview with Dr. Kevin O'Connor, Biden's physician as president, and testimony from former Biden aides—but those asks would need to be renewed. Chris Meagher, a spokesman for Biden, didn't respond to questions about whether Biden was screened for prostate cancer as president. O'Connor didn't respond to requests for comment. Biden's cancer appears to be hormone-sensitive and could therefore be receptive to hormone-reducing drugs, and cancer doctors have said that even patients with metastatic disease can live for years, thanks to newer therapies. But the disease probably isn't curable at this stage, and Biden will likely be grappling with it for the rest of his life. Around 10% of prostate cancers are already metastatic by the time they are diagnosed, prostate cancer specialists said. Symptoms including difficulty urinating or blood in the urine often don't appear until the disease is advanced. Biden's prostate cancer is one of the most aggressive kinds, implying that it is relatively fast-spreading, though it could have gone undetected for years, specialists said. 'It's possible that he could have had it growing in him for years, or it could be possible that this had a shorter time course," said Dr. Phillip Koo, chief medical officer at the Prostate Cancer Foundation. 'If someone were to get PSA screening annually after age 70, I'd imagine something like this would have been picked up earlier." Doctors have debated for decades how often to screen men for prostate cancer, and when to stop. The test can pick up cancers early while they are more treatable, but it can also flag false positives and pick up slow-growing cancers that would never have become life-threatening, particularly in older men, leading to overtreatment and corresponding harms. 'In the majority of cases, our guidelines really maximize their quality of life and reduce the harms associated with overdetection and aggressive screening," said Dr. Behfar Ehdaie, a urologic surgeon at Memorial Sloan Kettering Cancer Center, which says on its website that PSA testing after age 75 is 'rarely helpful." Many men stop screening at age 75 because doctors think men with a low or normal PSA value at that age have a low risk of developing life-threatening prostate cancer, said Dr. Jonathan Shoag, a urologist who specializes in oncology at University Hospitals and Case Comprehensive Cancer Center. But the number of later-stage, life-threatening diagnoses in the U.S. has increased in recent years, after medical groups started to advise less screening overall, Shoag and others said. There is no public battery of medical tests required for all presidents and no standard release forms showing results. O'Connor said in February 2024 that Biden was 'fit for duty" after a comprehensive assessment by a team of doctors. 'I would say it's surprising he did not get this test, given the fact that the proclivity of presidential physicians is to test more rather than less," said Dr. Ezekiel J. Emanuel, a physician and vice provost for global initiatives at the University of Pennsylvania, speaking Monday on MSNBC's 'Morning Joe." 'Either they didn't test for it, or they did test for it, they didn't report it, and we didn't get the information as a public," said Emanuel, a former White House health adviser. Trump has at times failed to be transparent about his health. But he made a point of bragging about his prostate screening results when he was running for president. 'My PSA has been very good," Trump said in a September 2016 interview with Mehmet Oz, who is now his Centers for Medicare and Medicaid Services administrator. 'It's always the first number I ask for. I say, 'Give me that number.'" Trump was 70 years old at the time and a candidate for president. Write to Brianna Abbott at and Annie Linskey at
Wall Street Journal
13-05-2025
- Health
- Wall Street Journal
The Latest in Hernia Repair: New Techniques, New Research
Hernias can be an unnerving manifestation of the body's wear and tear, creating a sudden bulge in the groin or abdomen when part of an internal organ or tissue—such as the intestine—pushes through the surrounding muscle or tissue. As the population ages, the incidence of hernias is increasing in the U.S. And research shows several age-related factors, such as weakened abdominal muscles, can make hernias harder to treat successfully. Researchers at the University of Michigan's Michigan Medicine found that about 1 in 6 older Americans who had undergone an operation to repair a hernia had repeat surgery less than 10 years later.
