FRIDAY, Feb. 23, 2024 (HealthDay News) -- Fungal keratitis prevalence appears to be twice as high in rural versus nonrural areas, according to a research letter published online Feb. 15 in JAMA Ophthalmology.

Kaitlin Benedict, M.P.H., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues estimated fungal keratitis prevalence among commercially insured U.S. patients. The analysis included Merative MarketScan Commercial and Medicare Databases claims data (Jan. 1, 2016, through Jan. 31, 2023).

The researchers identified 870,810 individuals with continuous enrollment and a diagnostic code for keratitis. Of these, 0.8 percent had a natamycin prescription. Overall fungal keratitis prevalence was 1.8 per 100,000 enrollees but was higher among males (1.9), adults aged 65 years and older (6.6), and patients living in the South (2.7) and rural areas (3.6). Corneal ulcer was the most common associated condition (94.2 percent). Common medications included ophthalmic antibiotic (80.7 percent) or corticosteroid (43.5 percent). More than one in seven (15.0 percent) had contact lens-associated diagnostic codes. Nearly three-quarters (74.9 percent) underwent diagnostic testing, and 10.6 percent received a corneal transplant.

"Given the potential for poor vision outcomes and the possibility of climate change-associated geographic expansion of pathogenic fungi, monitoring fungal keratitis trends, improving rural eye care access, and promoting early diagnosis and treatment are crucial," the authors write.

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FRIDAY, Feb. 23, 2024 (HealthDay News) -- For patients with nonepithelioid pleural mesothelioma, pegargiminase plus chemotherapy is associated with improved survival versus placebo plus chemotherapy, according to a study published online Feb. 15 in JAMA Oncology.

Peter W. Szlosarek, M.D., Ph.D., from Queen Mary University of London, and colleagues examined the effect of pegargiminase-based chemotherapy on survival in nonepithelioid pleural mesothelioma in a phase 2 to 3 double-blind randomized clinical trial conducted at 43 centers in five countries. A total of 249 patients were randomly assigned (1:1) to receive weekly intramuscular pegargiminase (36.8 mg/m2) or placebo. In addition, all patients received intravenous pemetrexed (500 mg/m2) and platinum chemotherapy every three weeks for up to six cycles.

The researchers found that median overall survival was 9.3 and 7.7 months with pegargiminase-chemotherapy and placebo-chemotherapy, respectively (hazard ratio [HR] for death, 0.71). The corresponding median progression-free survival was 6.2 and 5.6 months, respectively (HR, 0.65). Grade 3 to 4 adverse events occurred in 28.8 percent of patients with pegargiminase and 16.9 percent of patients with placebo. Drug hypersensitivity and skin reactions occurred in 2.4 and 1.6 percent of patients, respectively, in the pegargiminase arm versus none in the placebo arm.

"The pegargiminase-pemetrexed-platinum triplet was safe and validates arginine deprivation as a novel therapeutic antimetabolite strategy for patients with nonepithelioid mesothelioma," the authors write. "Additional studies of pegargiminase-based regimens are warranted in patients with other urea cycle-dysregulated cancers."

Several authors disclosed ties to pharmaceutical companies, including Polaris Group, which is developing pegargiminase and funded the study.

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FRIDAY, Feb. 23, 2024 (HealthDay News) -- Therapeutic intervention with abatacept is feasible for patients at risk for rheumatoid arthritis, according to a study published online Feb. 13 in The Lancet.

Andrew P. Cope, M.D., from King's College London, and colleagues conducted a multicenter trial involving patients at risk for rheumatoid arthritis with serum antibodies to citrullinated protein antigens and rheumatoid factor with inflammatory joint pain. Participants were randomly assigned (1:1) to 125-mg abatacept subcutaneous injections on a weekly basis or placebo for 12 months (110 and 103, respectively) and were then followed for 12 months.

The researchers found that the primary end point (time to development of clinical synovitis in three or more joints or rheumatoid arthritis according to the American College of Rheumatology and European Alliance of Associations for Rheumatology 2010 criteria, whichever was met first) was met by 6 and 29 percent of patients in the abatacept and placebo groups, respectively, during the treatment period. At 24 months, 25 percent of participants in the abatacept group and 37 percent in the placebo group had progressed to rheumatoid arthritis. At 12 months, the estimated proportion remaining arthritis-free was 92.8 and 69.2 percent, respectively. Over 24 months, Kaplan-Meier arthritis-free survival plots favored abatacept. Compared with placebo, abatacept was associated with improvements in pain scores, functional well-being, and quality-of-life measurements during treatment, as well as low scores of subclinical synovitis by ultrasonography.

"Treatment of adults at high risk of developing rheumatoid arthritis with abatacept reduces progression to clinically apparent arthritis during the treatment phase," the authors write.

Several authors disclosed ties to Bristol Myers Squibb, which manufactures abatacept and funded the study.

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