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Medscape
a day ago
- Health
- Medscape
How the Shingles Vaccine Guards Against Dementia: New Clues
How do vaccines reduce dementia risk? A new study suggested that immune-boosting adjuvants contained in some vaccines may offer one explanation. Adults who received the recombinant shingles vaccine Shingrix or the respiratory syncytial virus (RSV) vaccine Arexvy — both of which contain the AS01 adjuvant — had a lower risk for dementia in the 18 months after vaccination than peers who received the flu vaccine, which does not contain the AS01 adjuvant, investigators found. 'The findings are striking. We need studies to confirm whether the adjuvant present in some vaccines contributes to the reduced dementia risk and to understand how it does so,' senior author Paul Harrison, PhD, with the University of Oxford, Oxford, England, said in a statement. The study was published online on June 25 in the journal npj Vaccines . Vaccine or the Adjuvant? For this study, investigators built on a prior analysis of the US patient database TriNetX that showed that adults who received the AS01 shingles vaccine had a lower risk for dementia than peers who received the older shingles vaccine (Zostavax), which does not contain the AS01 adjuvant. To test the hypothesis that the AS01 adjuvant could be the key driver of the dementia-protective effect, researchers turned again to the TriNetX database and identified 103,798 people who received the AS01 shingles vaccine only, 35,938 who received the AS01 RSV vaccine only, and 78,658 who received both. These cohorts were propensity score matched to an equal number of people who received the flu vaccine and neither the shingles nor the RSV vaccine. In the 18 months following vaccination, compared to those who received the flu vaccine, the risk for dementia diagnosis was 29% lower in those who received the AS01 RSV vaccine (restricted mean time lost [RMTL] ratio, 0.71) and 18% lower in those who received the AS01 shingles vaccine (RMTL, 0.82). Individuals receiving both AS01 vaccines had a 37% reduced risk for dementia diagnosis (RMTL, 0.63). These effects were consistent in men and women and were not explained by reductions in RSV or shingles infections alone. And no difference was observed between the two AS01 adjuvant vaccines, 'suggesting that the AS01 adjuvant itself plays a direct role in lowering dementia risk,' the investigators said. 'Our data provide support for the hypothesis that, besides protection against their target infection, these vaccines could well protect against dementia via the action of the AS01 components through specific immunological pathways,' they wrote. In particular, the AS01 adjuvant includes monophosphoryl lipid A (MPL), which activates immune cells, and QS-21, a plant-derived extract that amplifies the immune response. Animal studies have shown that MPL can improve Alzheimer-related pathology, and other work suggests it triggers immune activity that might reduce the formation of amyloid plaques, a hallmark of Alzheimer's disease. Caveats and Cautionary Notes Several experts not involved in the study offered perspective on this research in a statement from the UK nonprofit Science Media Centre. Julia Dudley, head of Research at Alzheimer's Research UK, said a strength of the study is that it adjusted for factors that could influence risk, such as underlying health conditions and some lifestyle and environmental factors. 'However, as the study is observational and examined past health data, the researchers cannot conclude how the Shingrix and Arexvy vaccines may protect against dementia. We also cannot rule out that the link between vaccine and dementia risk is due to other factors not captured in this study, such as social and lifestyle factors,' Dudley said. A limitation of the study, highlighted by the authors, is that people could be living with dementia without having a formal diagnosis, 'which could skew the findings,' Dudley commented. In addition, 'we do not know if the adjuvant is reducing the risk of dementia or delaying its onset. The follow-up period was only 18 months, so more research is needed to determine the potential long-term effects of the vaccines,' Dudley said. Kevin McConway, PhD, emeritus professor of applied statistics, The Open University, Milton Keynes, England, said the study is 'an interesting, worthwhile, and statistically competent piece of work, but a lot more research needs to be done to make good sense of its possible implications for healthcare.' 'Previous research has provided pretty convincing evidence that vaccination against shingles, in older people, can reduce dementia risk [but] exactly how AS01 might be involved in reducing dementia risk' is unclear, McConway said, and 'we're not yet anywhere near the stage of using the results of the new study to change clinical practice.' Andrew Pollard, FMedSci, director of the Oxford Vaccine Group, University of Oxford, agreed. 'It is premature to be too certain about the mechanism by which vaccines might reduce dementia risk, but these observations provide further incentive for those eligible to turn up for their scheduled vaccination visits to prevent the unpleasant and potentially serious and life-threatening infections for which they were designed, but with the added possible benefit of a longer dementia-free lifespan. What's not to like?' Pollard commented.
Medscape
19-06-2025
- Health
- Medscape
Dupilumab Linked to Higher Psoriasis Risk in AD
Treating atopic dermatitis (AD) with dupilumab vs other systemic agents increased the risk of developing psoriasis over 3 years, a cohort study found. METHODOLOGY: Addressing postmarketing reports of psoriasis in patients treated with dupilumab for AD, researchers conducted a population-based retrospective cohort study of 214,430 adults with AD from the TriNetX Global Collaborative Network, with a 3-year follow-up. Analyses were completed on October 19, 2024. The study compared 9860 adults newly prescribed dupilumab vs 9860 prescribed other systemic agents, which were corticosteroids, methotrexate, cyclosporine, azathioprine, or mycophenolate mofetil. The mean age in both groups was about 45 years; about 55% were women; about half were White, 18% were Black, and 10% were Asian. The primary outcome measure was incident psoriasis, and the secondary outcome was psoriatic arthritis (PsA). TAKEAWAY: Over 3 years, 2.0% of patients on dupilumab developed psoriasis vs 1.1% of those taking other systemic agents ( P < .001). < .001). Psoriasis risk was significantly higher in patients on dupilumab (hazard ratio [HR], 1.58; 95% CI, 1.25-1.99). The number needed to harm (NNH) for psoriasis was 94 for dupilumab vs the other systemic agents. Psoriasis risk was also higher in patients on dupilumab who were older than 60 years (HR, 1.77; 95% CI, 1.22-2.58), men (HR, 1.55; 95% CI, 1.08-2.22), women (HR, 1.63; 95% CI, 1.19-2.24), and White (HR, 1.43; 95% CI, 1.05-1.93). At 3 years, PsA incidence with dupilumab vs other systemic agents was similar (0.20% vs 0.13%; P = .53). The risk was not statistically significant (HR, 1.97; 95% CI, 0.75-5.18). IN PRACTICE: The study found an increased relative risk for psoriasis among those treated with dupilumab, the study authors wrote, adding that an estimated NNH of 94 reflected the limited clinical relevance of the absolute risk, and 'risk should be weighed against dupilumab's proven efficacy in treating AD.' They noted that the rate of psoriasis was in the range of psoriasis prevalence in general AD populations, suggesting that 'dupilumab may act more as a trigger rather than a decisive factor in promoting psoriatic eruption in patients with AD.' SOURCE: The study was led by Teng-Li Lin, MD, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation in Chiayi, Taiwan. It was published online on June 18 in JAMA Dermatology . LIMITATIONS: Limitations included the observational design, possible misclassification bias in outcome reporting, and absence of information on AD severity, physician specialties, photodocumentation, and treatment response. Because the database only supported time-fixed medication exposure analyses, data on dosage, duration, and adherence were unavailable. DISCLOSURES: The research received support from the National Science Technology Council and Taichung Veterans General Hospital, both in Taiwan. The authors had no competing interests.
Medscape
18-06-2025
- Health
- Medscape
Medications During Infancy May Shape Future Allergy Risk
Exposure to acid-suppressive medications or antimicrobials in infancy was linked to higher risks for food allergies and anaphylaxis in early childhood, with the risks increasing further with multiple antimicrobial prescriptions. METHODOLOGY: Researchers conducted a retrospective study using the US TriNetX Network to examine whether the use of acid-suppressive medications or antimicrobials during infancy influences the risk of developing allergic diseases in childhood. They identified infants who were prescribed proton pump inhibitors (PPIs; n = 15,375), histamine 2 receptor antagonists (H2RAs; n = 42,913), at least one antibiotic course (n = 740,121), or three or more antibiotic courses (n = 163,098) during the first year of life and compared them with 1,510,074 infants who received none of these medications during their first 2 years. Three allergic outcomes, namely anaphylaxis, food allergy, and atopic dermatitis, were assessed at 2 years of age. TAKEAWAY: Infants prescribed PPIs during their first year of life had more than a fivefold higher risk for food allergy (risk ratio [RR], 5.33; 95% CI, 4.97-5.71) and nearly a 2.5-fold higher risk for anaphylaxis (RR, 2.49; 95% CI, 1.40-4.41) by 2 years of age than unexposed infants. Similarly, infants prescribed H2RAs had a 4.2-fold higher risk for food allergy (RR, 4.21; 95% CI, 4.01-4.41), a 1.4-fold higher risk for atopic dermatitis (RR, 1.41; 95% CI, 1.35-1.48), and nearly a 4.5-fold higher risk for anaphylaxis (RR, 4.48; 95% CI, 3.43-5.86) than unexposed infants. Infants with at least one antimicrobial prescription during infancy showed nearly twice the risk for food allergy and more than twice the risk for both atopic dermatitis and anaphylaxis than unexposed infants. Infants who received three or more antimicrobial prescriptions in their first year faced sharply elevated 2-year risks compared with unexposed infants — nearly 2.8-fold for food allergy, 3.4-fold for atopic dermatitis, and 3.7-fold for anaphylaxis. IN PRACTICE: 'The composition of the gut microbiota is strongly associated with allergic manifestations, as the commensal bacteria in the gastrointestinal tract promote healthy development of the gut immune system with promotion of food tolerance,' the study authors wrote. 'Antibiotic exposure disrupts these microbial communities, which in turn affects individuals' immune response and likely increases their susceptibility for allergic manifestations,' they added. SOURCE: Mohamad R. Chaaban, with the Head & Neck Institute, Cleveland Clinic, Cleveland, was the corresponding author of the study, which was published online on May 30 in the Journal of Clinical Medicine . LIMITATIONS: The misdiagnosis of infant food allergies as gastroesophageal reflux disease and higher acid-suppressive medication use in more severe cases may have confounded the associations between these medications and food allergy. DISCLOSURES: This project was supported in part by the Clinical and Translational Science Collaborative of Northern Ohio, which is funded by the National Center for Advancing Translational Sciences of the National Institutes of Health. The authors reported having no conflicts of interest.
Medscape
26-05-2025
- Health
- Medscape
Third-Generation Progestins Linked to Lowest Melasma Risk
A study found that fourth-generation progestins in oral contraceptive pills (OCPs) were associated with more than double the risk for melasma than with no exposure, while third-generation progestins showed the lowest risk among all synthetic progestin types. METHODOLOGY: Researchers analyzed data from 51,101 women with melasma and 51,101 matched controls without melasma using the TriNetX research network on March 25, 2025. The mean age of participants was 45.1 years. About 54% of participants were White, about 14% were Black, about 8% were Asian, and nearly 15% were Hispanic/Latino. Those with melasma had a higher prevalence of exposure to estrogen/progestin combinations (21.58% vs 10.03%; P < .001) and to progestins alone (15.04% vs 7.75%; P < .001) than those without melasma. < .001) and to progestins alone (15.04% vs 7.75%; < .001) than those without melasma. The researchers examined the risk for melasma within 10 years after a progestin prescription. TAKEAWAY: All four generations of synthetic progestins were associated with a higher melasma risk than no exposure. The risk was highest for fourth-generation (hazard ratio [HR], 2.262; 95% CI, 1.797-2.846) and lowest for third-generation progestins (HR, 1.417; 95% CI, 1.317-1.524). Exposure to fourth-generation progestins was associated with a higher risk for melasma than exposure to first-generation (HR, 1.366; 95% CI, 1.148-1.627), second-generation (HR, 1.191; 95% CI, 1.000-1.419), and third-generation progestins (HR, 1.785; 95% CI, 1.464-2.176). Exposure to third-generation progestins was associated with a lower risk for melasma than exposure to second-generation (HR, 0.841; 95% CI, 0.754-0.937) and fourth-generation progestins (HR, 0.604; 95% CI, 0.503-0.726). IN PRACTICE: Based on these findings, 'choosing oral contraceptive pills containing third-generation progestins may mitigate melasma risk associated with hormonal contraceptives,' the study authors wrote. 'Further studies of the role of progestins in melasma pathophysiology may improve our understanding of this disorder,' they added. SOURCE: The study, led by Amit Singal, BA, Rutgers New Jersey Medical School, Newark, New Jersey, and Shari Lipner, MD, Department of Dermatology, Weill Cornell Medicine, New York City, was published online on May 21 in the Journal of the American Academy of Dermatology . LIMITATIONS: Information on dosing, route, duration of use, and adherence to hormone therapy was not available. The study lacked data on ultraviolet exposure, family history of melasma, and clinical reasons for hormone use. International Classification of Diseases, 10th Revision, coding limitations may have affected diagnostic accuracy. DISCLOSURES: This study did not receive any funding. The authors had no competing interests.
Medscape
21-05-2025
- Health
- Medscape
Copper IUDs Linked to Higher Risk for STI Than Hormonal IUDs
MINNEAPOLIS — Copper intrauterine devices (IUDs) are associated with an increased risk for several sexually transmitted infections (STIs) and other vaginal conditions than IUDs containing levonorgestrel, according to a retrospective chart review presented at the American College of Obstetricians and Gynecologists (ACOG) 2025 Annual Meeting. 'Most prior research focuses on bacterial vaginosis and pelvic inflammatory disease risk in IUD users,' wrote Celeste Traub, medical student at the University of Texas Medical Branch in Galveston, Texas, and her colleagues. 'Limited data exist regarding the broader impact of IUDs on other common reproductive tract infections.' The researchers therefore analyzed data from TriNetX, a group of databases that include information for 56,444,363 patients. They identified 74,219 patients who used the copper IUD without previous use of a levonorgestrel IUD and 451,769 patients who used the levonorgestrel IUD without previous use of a copper IUD. These patients were then matched for age at IUD placement, race, and ethnicity to come up with 73,123 patients in each IUD group. The analysis included only data from within 3 years of IUD placement. Patients were an average of 30 years old at the time of IUD placement. The cohort included 63.7% White, 21% Hispanic/Latina, 9.9% Black/African American, 5.3% Asian, 0.5% Pacific Islander, and 0.4% Native American patients. Copper IUDs were associated with a modestly higher risk for chlamydia (risk ratio [RR], 1.41), syphilis (RR, 1.4), gonorrhea (RR, 1.37), and HIV (RR, 1.27) than levonorgestrel IUDs. Copper IUDs were also associated with a higher risk for chronic vulvitis (RR, 1.46), acute vulvitis (RR, 1.41), chronic vaginitis (RR, 1.4), and acute vaginitis (RR, 1.12) than levonorgestrel IUDs. Risks for anogenital warts, herpes simplex virus 2, candidiasis, and trichomoniasis were not significantly different between copper IUDs and levonorgestrel IUDs. The risk for pelvic inflammatory disease, meanwhile, was lower with the copper IUDs (RR, 0.85) than with the levonorgestrel IUDs. Despite the large population included, the retrospective design limits what conclusions can be drawn from the findings and there could be unmeasured confounders such as differences in sexual behaviors or socioeconomic factors that affected the results. The study may also have potential selection bias if women who choose different IUD types have different health behaviors. 'These findings highlight the importance of considering vaginal health outcomes when counseling patients about contraceptive outcomes,' the researchers concluded. 'We have thought that one contraceptive mechanism by which hormonal IUDs work is through thickening cervical mucus; this serves as a barrier to sperm,' Hugh S. Taylor, MD, a professor of Ob/Gyn at Yale School of Medicine and chief of Ob/Gyn at Yale New Haven Hospital in Connecticut, told Medscape Medical News . 'It is not surprising that this also serves as a barrier to many STIs.' He further noted that the study's large size allows the detection of very small differences and highlighted that the risks for any infection with the copper IUD remains small. Further, 'IUDs do not adequately protect against any infection,' Taylor said. 'Barrier methods should be used whenever there is any risk of STI.' The research was funded by the UTMB Institute for Translational Sciences and the National Institutes of Health. The authors had no relevant financial disclosures. Taylor reported grants to Yale University from AbbVie and Organon unrelated to this research.
