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M. Alexander Otto began his reporting career early in 1999 covering the pharmaceutical industry for a national pharmacists' magazine and freelancing for the Washington Post and other newspapers. He then joined BNA, now part of Bloomberg News, covering health law and the protection of people and animals in medical research. Alex next worked for the McClatchy Company. Based on his work, Alex won a year-long Knight Science Journalism Fellowship to MIT in 2008-2009. He joined the company shortly thereafter. Alex has a newspaper journalism degree from Syracuse (N.Y.) University and a master's degree in medical science -- a physician assistant degree -- from George Washington University. Alex is based in Seattle.
Gout management best practices require getting around misconceptions
MAUI, HAWAII – Urate-lowering therapy doesn’t have to be suspended while gout patients are treated for acute attacks, according to rheumatologist Orrin Troum of Santa Monica, Calif.
In fact, there are arguments against it; stopping allopurinol or other urate-lowering therapies (ULTs) during an attack doesn’t seem to help, and there’s a chance that patients might have another attack when it’s reintroduced. Still, the practice persists despite evidence and recommendations to the contrary, Dr. Troum said at the 2015 Rheumatology Winter Clinical Symposium.
Gout is a curable or at least eminently manageable condition, but it remains a tricky problem to treat. Part of that is because referring physicians might be using an out-of-date playbook before sending patients for a rheumatology consult; another issue is that optimal care requires follow-up visits, which might not always be possible.
Gout management guidelines from the European League Against Rheumatism (Ann. Rheum. Dis. 2006;65:1312-24) and the American College of Rheumatology (Arthritis Care Res. 2012;64:1431-46) now largely concur on how best to handle the condition, which might help bring uniformity to gout management if their message filters through to other branches of medicine, said rheumatologist and copresenter Martin Bergman of the department of rheumatology at Drexel University in Philadelphia.
Another persistent misconception is that ULT can’t be started during an acute attack. “There are some very good studies showing” that it can so long as antiflare drugs are on board and patients follow up to check for hypersensitivity reactions and other potential ULT problems, said Dr. Bergman, also chief of rheumatology at Taylor Hospital in Ridley Park, Pa.
Starting low and going slow, a key concept with ULT, hasn’t fully taken hold outside the rheumatology community, either. With allopurinol, that means starting at 100 mg/day – and 50 mg/day in those with chronic kidney disease – then titrating up slowly over several follow-up visits to an effective serum uric acid (SUA)–lowering dose. The idea is to lower serum uric acid slowly, to avoid precipitating an acute attack.
Even so, patients are still sometimes started on 300 mg/day, and although more than half will need more than 300 mg/day to reach SUA targets, that dose is still sometimes considered to be the maximum allowable.
Overall, the consensus on both sides of the Atlantic is that gout patients need to have serum urate levels below 6 mg/dL, and below 5 mg/dL if they have tophi.
“So the next question is, ‘How low do you go?’ ” It’s recently been found that “lifelong maintenance on very low levels of uric acid might actually increase the risk of neurodegenerative diseases, such as Parkinson’s, multiple sclerosis, and dementia.” Uric acid is a strong antioxidant that, perhaps, has protective effects in the central nervous system, Dr. Troum said.
It might be best to go below 5 mg/dL in severe gout for only 3-5 years, then loosen the target to 5-6 mg/dL (Nat. Rev. Rheumatol. 2014;10:271-83), he added.
Among other recent developments, it’s now known that psoriasis and psoriatic arthritis substantially increase the risk of gout (Ann. Rheum. Dis. 2014 March 20 [doi:10.1136/annrheumdis-2014-205212]), so it’s important to check for gout crystals when aspirating inflamed joints in those conditions. It remains unclear, however, if psoriasis or gout should take precedence when crystals are found, Dr. Bergman said.
Also, it makes sense to screen patients for their HLA-B genotype. Carriers of the variant allele HLA-B*5801 are at high risk for severe cutaneous adverse reactions with allopurinol, so another ULT is probably a better option. The variant is most common in individuals of Korean, Han Chinese, or Thai descent (Clin. Pharmacol. Ther. 2013;93:153-8).
Dr. Troum is an adviser, consultant, speaker, or grant recipient for several companies, including AbbVie, Amgen, Bristol-Myers Squibb, Centocor, Novartis, Pfizer, and Roche. He holds shares in Theralogix. Dr. Bergman is an adviser, speaker, or consultant for several companies, as well, including AbbVie, Celgene, Amgen, and Roche. He holds shares in Bristol-Myers Squibb, Pfizer, and Johnson & Johnson.
MAUI, HAWAII – Urate-lowering therapy doesn’t have to be suspended while gout patients are treated for acute attacks, according to rheumatologist Orrin Troum of Santa Monica, Calif.
In fact, there are arguments against it; stopping allopurinol or other urate-lowering therapies (ULTs) during an attack doesn’t seem to help, and there’s a chance that patients might have another attack when it’s reintroduced. Still, the practice persists despite evidence and recommendations to the contrary, Dr. Troum said at the 2015 Rheumatology Winter Clinical Symposium.
Gout is a curable or at least eminently manageable condition, but it remains a tricky problem to treat. Part of that is because referring physicians might be using an out-of-date playbook before sending patients for a rheumatology consult; another issue is that optimal care requires follow-up visits, which might not always be possible.
Gout management guidelines from the European League Against Rheumatism (Ann. Rheum. Dis. 2006;65:1312-24) and the American College of Rheumatology (Arthritis Care Res. 2012;64:1431-46) now largely concur on how best to handle the condition, which might help bring uniformity to gout management if their message filters through to other branches of medicine, said rheumatologist and copresenter Martin Bergman of the department of rheumatology at Drexel University in Philadelphia.
Another persistent misconception is that ULT can’t be started during an acute attack. “There are some very good studies showing” that it can so long as antiflare drugs are on board and patients follow up to check for hypersensitivity reactions and other potential ULT problems, said Dr. Bergman, also chief of rheumatology at Taylor Hospital in Ridley Park, Pa.
Starting low and going slow, a key concept with ULT, hasn’t fully taken hold outside the rheumatology community, either. With allopurinol, that means starting at 100 mg/day – and 50 mg/day in those with chronic kidney disease – then titrating up slowly over several follow-up visits to an effective serum uric acid (SUA)–lowering dose. The idea is to lower serum uric acid slowly, to avoid precipitating an acute attack.
Even so, patients are still sometimes started on 300 mg/day, and although more than half will need more than 300 mg/day to reach SUA targets, that dose is still sometimes considered to be the maximum allowable.
Overall, the consensus on both sides of the Atlantic is that gout patients need to have serum urate levels below 6 mg/dL, and below 5 mg/dL if they have tophi.
“So the next question is, ‘How low do you go?’ ” It’s recently been found that “lifelong maintenance on very low levels of uric acid might actually increase the risk of neurodegenerative diseases, such as Parkinson’s, multiple sclerosis, and dementia.” Uric acid is a strong antioxidant that, perhaps, has protective effects in the central nervous system, Dr. Troum said.
It might be best to go below 5 mg/dL in severe gout for only 3-5 years, then loosen the target to 5-6 mg/dL (Nat. Rev. Rheumatol. 2014;10:271-83), he added.
Among other recent developments, it’s now known that psoriasis and psoriatic arthritis substantially increase the risk of gout (Ann. Rheum. Dis. 2014 March 20 [doi:10.1136/annrheumdis-2014-205212]), so it’s important to check for gout crystals when aspirating inflamed joints in those conditions. It remains unclear, however, if psoriasis or gout should take precedence when crystals are found, Dr. Bergman said.
Also, it makes sense to screen patients for their HLA-B genotype. Carriers of the variant allele HLA-B*5801 are at high risk for severe cutaneous adverse reactions with allopurinol, so another ULT is probably a better option. The variant is most common in individuals of Korean, Han Chinese, or Thai descent (Clin. Pharmacol. Ther. 2013;93:153-8).
Dr. Troum is an adviser, consultant, speaker, or grant recipient for several companies, including AbbVie, Amgen, Bristol-Myers Squibb, Centocor, Novartis, Pfizer, and Roche. He holds shares in Theralogix. Dr. Bergman is an adviser, speaker, or consultant for several companies, as well, including AbbVie, Celgene, Amgen, and Roche. He holds shares in Bristol-Myers Squibb, Pfizer, and Johnson & Johnson.
MAUI, HAWAII – Urate-lowering therapy doesn’t have to be suspended while gout patients are treated for acute attacks, according to rheumatologist Orrin Troum of Santa Monica, Calif.
In fact, there are arguments against it; stopping allopurinol or other urate-lowering therapies (ULTs) during an attack doesn’t seem to help, and there’s a chance that patients might have another attack when it’s reintroduced. Still, the practice persists despite evidence and recommendations to the contrary, Dr. Troum said at the 2015 Rheumatology Winter Clinical Symposium.
Gout is a curable or at least eminently manageable condition, but it remains a tricky problem to treat. Part of that is because referring physicians might be using an out-of-date playbook before sending patients for a rheumatology consult; another issue is that optimal care requires follow-up visits, which might not always be possible.
Gout management guidelines from the European League Against Rheumatism (Ann. Rheum. Dis. 2006;65:1312-24) and the American College of Rheumatology (Arthritis Care Res. 2012;64:1431-46) now largely concur on how best to handle the condition, which might help bring uniformity to gout management if their message filters through to other branches of medicine, said rheumatologist and copresenter Martin Bergman of the department of rheumatology at Drexel University in Philadelphia.
Another persistent misconception is that ULT can’t be started during an acute attack. “There are some very good studies showing” that it can so long as antiflare drugs are on board and patients follow up to check for hypersensitivity reactions and other potential ULT problems, said Dr. Bergman, also chief of rheumatology at Taylor Hospital in Ridley Park, Pa.
Starting low and going slow, a key concept with ULT, hasn’t fully taken hold outside the rheumatology community, either. With allopurinol, that means starting at 100 mg/day – and 50 mg/day in those with chronic kidney disease – then titrating up slowly over several follow-up visits to an effective serum uric acid (SUA)–lowering dose. The idea is to lower serum uric acid slowly, to avoid precipitating an acute attack.
Even so, patients are still sometimes started on 300 mg/day, and although more than half will need more than 300 mg/day to reach SUA targets, that dose is still sometimes considered to be the maximum allowable.
Overall, the consensus on both sides of the Atlantic is that gout patients need to have serum urate levels below 6 mg/dL, and below 5 mg/dL if they have tophi.
“So the next question is, ‘How low do you go?’ ” It’s recently been found that “lifelong maintenance on very low levels of uric acid might actually increase the risk of neurodegenerative diseases, such as Parkinson’s, multiple sclerosis, and dementia.” Uric acid is a strong antioxidant that, perhaps, has protective effects in the central nervous system, Dr. Troum said.
It might be best to go below 5 mg/dL in severe gout for only 3-5 years, then loosen the target to 5-6 mg/dL (Nat. Rev. Rheumatol. 2014;10:271-83), he added.
Among other recent developments, it’s now known that psoriasis and psoriatic arthritis substantially increase the risk of gout (Ann. Rheum. Dis. 2014 March 20 [doi:10.1136/annrheumdis-2014-205212]), so it’s important to check for gout crystals when aspirating inflamed joints in those conditions. It remains unclear, however, if psoriasis or gout should take precedence when crystals are found, Dr. Bergman said.
Also, it makes sense to screen patients for their HLA-B genotype. Carriers of the variant allele HLA-B*5801 are at high risk for severe cutaneous adverse reactions with allopurinol, so another ULT is probably a better option. The variant is most common in individuals of Korean, Han Chinese, or Thai descent (Clin. Pharmacol. Ther. 2013;93:153-8).
Dr. Troum is an adviser, consultant, speaker, or grant recipient for several companies, including AbbVie, Amgen, Bristol-Myers Squibb, Centocor, Novartis, Pfizer, and Roche. He holds shares in Theralogix. Dr. Bergman is an adviser, speaker, or consultant for several companies, as well, including AbbVie, Celgene, Amgen, and Roche. He holds shares in Bristol-Myers Squibb, Pfizer, and Johnson & Johnson.
EXPERT ANALYSIS AT RWCS 2015
VIDEO: SLE diagnosis takes more than high ANA levels
MAUI, Hawaii – Do not diagnose systemic lupus erythematosus based on vague clinical symptoms and an elevated antinuclear antibody blood test.
As incredible as it seems, Dr. Alvin Wells, director of the Rheumatology and Immunotherapy Center in Franklin, Wis., said he sees doctors doing that all the time in his practice.
SLE is a serious and tricky diagnosis that has long-standing consequences for patients, he said.
Even road rage before an appointment can throw off blood tests. Also, SLE doesn’t seem to be one disease, so drugs have to be picked based on manifestations. Belimumab is a good example of that. Dr. Wells explained those and other insights at the Rheumatology Winter Clinical Symposium.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, Hawaii – Do not diagnose systemic lupus erythematosus based on vague clinical symptoms and an elevated antinuclear antibody blood test.
As incredible as it seems, Dr. Alvin Wells, director of the Rheumatology and Immunotherapy Center in Franklin, Wis., said he sees doctors doing that all the time in his practice.
SLE is a serious and tricky diagnosis that has long-standing consequences for patients, he said.
Even road rage before an appointment can throw off blood tests. Also, SLE doesn’t seem to be one disease, so drugs have to be picked based on manifestations. Belimumab is a good example of that. Dr. Wells explained those and other insights at the Rheumatology Winter Clinical Symposium.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, Hawaii – Do not diagnose systemic lupus erythematosus based on vague clinical symptoms and an elevated antinuclear antibody blood test.
As incredible as it seems, Dr. Alvin Wells, director of the Rheumatology and Immunotherapy Center in Franklin, Wis., said he sees doctors doing that all the time in his practice.
SLE is a serious and tricky diagnosis that has long-standing consequences for patients, he said.
Even road rage before an appointment can throw off blood tests. Also, SLE doesn’t seem to be one disease, so drugs have to be picked based on manifestations. Belimumab is a good example of that. Dr. Wells explained those and other insights at the Rheumatology Winter Clinical Symposium.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT RWCS 2015
VIDEO: True remission necessary before tapering or discontinuing RA drugs
MAUI, HAWAII– Discontinuing medications when rheumatoid arthritis patients are doing well is a hot topic in rheumatology lately, but it’s tricky.
The idea is to give patients a break from the costs and side effects of steroids, methotrexate, and biologics. Whether or not doing so is a good idea has a lot to do with how you define remission, and the odds of recapturing patients if they flare.
Advice from Dr. Roy Fleischmann, a clinical professor of rheumatology at the University of Texas Southwestern Medical Center in Dallas, might help. At the 2015 Rheumatology Winter Clinical Symposium, he shared his know-how about tapering and discontinuing treatments, culled from his professional experience and the literature on the subject in a video interview.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII– Discontinuing medications when rheumatoid arthritis patients are doing well is a hot topic in rheumatology lately, but it’s tricky.
The idea is to give patients a break from the costs and side effects of steroids, methotrexate, and biologics. Whether or not doing so is a good idea has a lot to do with how you define remission, and the odds of recapturing patients if they flare.
Advice from Dr. Roy Fleischmann, a clinical professor of rheumatology at the University of Texas Southwestern Medical Center in Dallas, might help. At the 2015 Rheumatology Winter Clinical Symposium, he shared his know-how about tapering and discontinuing treatments, culled from his professional experience and the literature on the subject in a video interview.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII– Discontinuing medications when rheumatoid arthritis patients are doing well is a hot topic in rheumatology lately, but it’s tricky.
The idea is to give patients a break from the costs and side effects of steroids, methotrexate, and biologics. Whether or not doing so is a good idea has a lot to do with how you define remission, and the odds of recapturing patients if they flare.
Advice from Dr. Roy Fleischmann, a clinical professor of rheumatology at the University of Texas Southwestern Medical Center in Dallas, might help. At the 2015 Rheumatology Winter Clinical Symposium, he shared his know-how about tapering and discontinuing treatments, culled from his professional experience and the literature on the subject in a video interview.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT RWCS 2015
VIDEO: Homeopathic injectables topped placebo for knee osteoarthritis
MAUI, HAWAII – Two homeopathic injectables, as well as the familiar combination of glucosamine and chondroitin, showed promise in two studies of alternative treatments for osteoarthritis.
In an interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. Martin J. Bergman, of the department of rheumatology at Drexel University in Philadelphia, shared the recent results from the two investigations.
The first pitted intra-articular injections of two homeopathic products, Traumeel and Zeel, against placebo saline injections for knee osteoarthritis; the work was sponsored by the products’ German maker, Biologische Heilmittel Heel.
In the second trial, glucosamine and chondroitin sulfate went head to head against celecoxib (Celebrex), also for knee OA. The work was sponsored by Bioibérica, a Spanish company that makes chondroitin and glucosamine, and the investigators reported financial ties to the company.
Traumeel and Zeel may sound exotic, but they aren’t unknown in the rheumatology world – some U.S. rheumatologists are using them, Dr. Bergman, also chief of rheumatology at Taylor Hospital in Ridley Park, Pa., said.
Dr. Bergman disclosed that he has served as an advisor, speaker, or consultant for AbbVie, Amgen, Celgene, and Roche, and holds shares in Bristol-Myers Squibb, Johnson & Johnson, and Pfizer.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – Two homeopathic injectables, as well as the familiar combination of glucosamine and chondroitin, showed promise in two studies of alternative treatments for osteoarthritis.
In an interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. Martin J. Bergman, of the department of rheumatology at Drexel University in Philadelphia, shared the recent results from the two investigations.
The first pitted intra-articular injections of two homeopathic products, Traumeel and Zeel, against placebo saline injections for knee osteoarthritis; the work was sponsored by the products’ German maker, Biologische Heilmittel Heel.
In the second trial, glucosamine and chondroitin sulfate went head to head against celecoxib (Celebrex), also for knee OA. The work was sponsored by Bioibérica, a Spanish company that makes chondroitin and glucosamine, and the investigators reported financial ties to the company.
Traumeel and Zeel may sound exotic, but they aren’t unknown in the rheumatology world – some U.S. rheumatologists are using them, Dr. Bergman, also chief of rheumatology at Taylor Hospital in Ridley Park, Pa., said.
Dr. Bergman disclosed that he has served as an advisor, speaker, or consultant for AbbVie, Amgen, Celgene, and Roche, and holds shares in Bristol-Myers Squibb, Johnson & Johnson, and Pfizer.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – Two homeopathic injectables, as well as the familiar combination of glucosamine and chondroitin, showed promise in two studies of alternative treatments for osteoarthritis.
In an interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. Martin J. Bergman, of the department of rheumatology at Drexel University in Philadelphia, shared the recent results from the two investigations.
The first pitted intra-articular injections of two homeopathic products, Traumeel and Zeel, against placebo saline injections for knee osteoarthritis; the work was sponsored by the products’ German maker, Biologische Heilmittel Heel.
In the second trial, glucosamine and chondroitin sulfate went head to head against celecoxib (Celebrex), also for knee OA. The work was sponsored by Bioibérica, a Spanish company that makes chondroitin and glucosamine, and the investigators reported financial ties to the company.
Traumeel and Zeel may sound exotic, but they aren’t unknown in the rheumatology world – some U.S. rheumatologists are using them, Dr. Bergman, also chief of rheumatology at Taylor Hospital in Ridley Park, Pa., said.
Dr. Bergman disclosed that he has served as an advisor, speaker, or consultant for AbbVie, Amgen, Celgene, and Roche, and holds shares in Bristol-Myers Squibb, Johnson & Johnson, and Pfizer.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT RWCS 2015
VIDEO: Ask patients about metal-on-metal hip implants
MAUI, HAWAII – Rheumatologists and other providers need to ask patients if they’ve had metal-on-metal hip implants.
That goes for hip resurfacing – which by definition is metal on metal – as well as actual metal-on-metal hips. Signs of trouble can be as subtle as mental status changes, and they go well beyond the traditional issues with worn-out artificial joints.
During a video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. Bill Bugbee, an orthopedic surgeon and professor at the University of California, San Diego, explained the problems and the warning signs for which physicians should watch.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – Rheumatologists and other providers need to ask patients if they’ve had metal-on-metal hip implants.
That goes for hip resurfacing – which by definition is metal on metal – as well as actual metal-on-metal hips. Signs of trouble can be as subtle as mental status changes, and they go well beyond the traditional issues with worn-out artificial joints.
During a video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. Bill Bugbee, an orthopedic surgeon and professor at the University of California, San Diego, explained the problems and the warning signs for which physicians should watch.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – Rheumatologists and other providers need to ask patients if they’ve had metal-on-metal hip implants.
That goes for hip resurfacing – which by definition is metal on metal – as well as actual metal-on-metal hips. Signs of trouble can be as subtle as mental status changes, and they go well beyond the traditional issues with worn-out artificial joints.
During a video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. Bill Bugbee, an orthopedic surgeon and professor at the University of California, San Diego, explained the problems and the warning signs for which physicians should watch.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT RWCS 2015
VIDEO: As biosimilars arrive in U.S., treatment questions arise
MAUI, HAWAII – There’s been fairly brisk uptake of biosimilar infliximab in Europe, both for new patients and as a possible switch from Remicade.
That biosimilar infliximab, Remsima, was submitted for U.S. approval in 2014, and a Food and Drug Administration advisory panel recently recommended approval of a biosimilar for filgrastim (Neupogen).
The agents are in the vanguard of what is sure to be an expanding market in the United States as biologics come off patent. Additional infliximab replacements are in the works, as well as biosimilars for etanercept, adalimumab, rituximab, and others.
For rheumatologists, that could mean less expensive treatments for patients, but it’s also likely to make treatment more complicated. Given the complexity of the molecules, the differences between biosimilars and familiar brands could be a bit more marked than those between small-molecule generics and their branded counterparts.
In a video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. Arthur F. Kavanaugh, a rheumatology professor at the University of California, San Diego, outlined the latest developments and shared his thoughts on the rapidly evolving field.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – There’s been fairly brisk uptake of biosimilar infliximab in Europe, both for new patients and as a possible switch from Remicade.
That biosimilar infliximab, Remsima, was submitted for U.S. approval in 2014, and a Food and Drug Administration advisory panel recently recommended approval of a biosimilar for filgrastim (Neupogen).
The agents are in the vanguard of what is sure to be an expanding market in the United States as biologics come off patent. Additional infliximab replacements are in the works, as well as biosimilars for etanercept, adalimumab, rituximab, and others.
For rheumatologists, that could mean less expensive treatments for patients, but it’s also likely to make treatment more complicated. Given the complexity of the molecules, the differences between biosimilars and familiar brands could be a bit more marked than those between small-molecule generics and their branded counterparts.
In a video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. Arthur F. Kavanaugh, a rheumatology professor at the University of California, San Diego, outlined the latest developments and shared his thoughts on the rapidly evolving field.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – There’s been fairly brisk uptake of biosimilar infliximab in Europe, both for new patients and as a possible switch from Remicade.
That biosimilar infliximab, Remsima, was submitted for U.S. approval in 2014, and a Food and Drug Administration advisory panel recently recommended approval of a biosimilar for filgrastim (Neupogen).
The agents are in the vanguard of what is sure to be an expanding market in the United States as biologics come off patent. Additional infliximab replacements are in the works, as well as biosimilars for etanercept, adalimumab, rituximab, and others.
For rheumatologists, that could mean less expensive treatments for patients, but it’s also likely to make treatment more complicated. Given the complexity of the molecules, the differences between biosimilars and familiar brands could be a bit more marked than those between small-molecule generics and their branded counterparts.
In a video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. Arthur F. Kavanaugh, a rheumatology professor at the University of California, San Diego, outlined the latest developments and shared his thoughts on the rapidly evolving field.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT RWCS 2015
VIDEO: Biologics Slowly Taming Metastatic Melanoma
MAUI, HAWAII – Though costly, newer biologics increase 1-year survival with metastatic melanoma from perhaps 40% to more than 70%.
Among the latest are nivolumab and pembrolizumab, antibodies against PD-1 (programmed cell death) cell surface receptors that were approved in 2014 for unresectable melanoma no longer responding to other drugs; another anti-PD-1 is in development.
In this video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. George Martin of the Dermatology and Laser Center of Maui explains the latest developments and shares his excitement about them.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – Though costly, newer biologics increase 1-year survival with metastatic melanoma from perhaps 40% to more than 70%.
Among the latest are nivolumab and pembrolizumab, antibodies against PD-1 (programmed cell death) cell surface receptors that were approved in 2014 for unresectable melanoma no longer responding to other drugs; another anti-PD-1 is in development.
In this video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. George Martin of the Dermatology and Laser Center of Maui explains the latest developments and shares his excitement about them.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – Though costly, newer biologics increase 1-year survival with metastatic melanoma from perhaps 40% to more than 70%.
Among the latest are nivolumab and pembrolizumab, antibodies against PD-1 (programmed cell death) cell surface receptors that were approved in 2014 for unresectable melanoma no longer responding to other drugs; another anti-PD-1 is in development.
In this video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. George Martin of the Dermatology and Laser Center of Maui explains the latest developments and shares his excitement about them.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT RWCS 2015
VIDEO: Biologics slowly taming metastatic melanoma
MAUI, HAWAII – Though costly, newer biologics increase 1-year survival with metastatic melanoma from perhaps 40% to more than 70%.
Among the latest are nivolumab and pembrolizumab, antibodies against PD-1 (programmed cell death) cell surface receptors that were approved in 2014 for unresectable melanoma no longer responding to other drugs; another anti-PD-1 is in development.
In this video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. George Martin of the Dermatology and Laser Center of Maui explains the latest developments and shares his excitement about them.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – Though costly, newer biologics increase 1-year survival with metastatic melanoma from perhaps 40% to more than 70%.
Among the latest are nivolumab and pembrolizumab, antibodies against PD-1 (programmed cell death) cell surface receptors that were approved in 2014 for unresectable melanoma no longer responding to other drugs; another anti-PD-1 is in development.
In this video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. George Martin of the Dermatology and Laser Center of Maui explains the latest developments and shares his excitement about them.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MAUI, HAWAII – Though costly, newer biologics increase 1-year survival with metastatic melanoma from perhaps 40% to more than 70%.
Among the latest are nivolumab and pembrolizumab, antibodies against PD-1 (programmed cell death) cell surface receptors that were approved in 2014 for unresectable melanoma no longer responding to other drugs; another anti-PD-1 is in development.
In this video interview at the 2015 Rheumatology Winter Clinical Symposium, Dr. George Martin of the Dermatology and Laser Center of Maui explains the latest developments and shares his excitement about them.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT RWCS 2015
NASH on the Rise as a Cause of Liver Transplants
Since 2004, there’s been almost a tripling of the number of nonalcoholic steatohepatitis patients waiting for liver transplants; the condition is now the second leading reason to be put on the waiting list in the United States, according a study published online in Gastroenterology.
Even so and for reasons that are not fully clear, adults with nonalcoholic steatohepatitis (NASH) are less likely to survive for 90 days on the wait list than are patients with alcoholic liver disease (ALD), and less likely to get a new liver within 90 days than are patients with ALD, hepatitis C virus (HCV), or a blend of both. For now, HCV remains the No. 1 reason for liver transplants in the United States (Gastroenterology 2014 Nov. 24 [doi: 10.1053/j.gastro.2014.11.039]).
“Our study provides valuable information about the changing epidemiology of chronic liver disease among wait-listed patients, and adds greatly to our understanding of the epidemiology of NASH in the United States,” the researchers wrote. The rapid rise in the prevalence of NASH is “a direct consequence of the worldwide obesity epidemic” as well as greater awareness of the condition. An expected decline in HCV-related cirrhosis due to effective antiviral therapy “will further contribute to the changing epidemiology of patients awaiting liver transplants in the United States,” said the authors, led by Dr. Robert Wong of the division of gastroenterology and hepatology at Highland Hospital, Oakland, Calif.
“Given the expected continued rise in the number of NASH patients awaiting liver transplant, additional research is needed to improve wait-list survival and ... outcomes among this cohort. In addition, the projection that overall donor availability will significantly diminish in the next 15-20 years emphasizes the need for additional research to improve liver transplant opportunities for NASH patients, including the option of living donor[s],” they said.
The researchers analyzed data from the United Network for Organ Sharing and Organ Procurement and Transplantation Network registry.
From 2004 to 2013, new wait-list registrants with NASH increased by 170% from 804 to 2,174; those with ALD increased by 45% from 1,400 to 2,024; and those with HCV increased by 14% from 2,887 to 3,291. Registrants with both HCV and ALD decreased by 9% from 880 to 803. NASH became the second-leading disease among liver transplant wait-list registrants in 2013.
Continue for ALD and HCV comparison >>
Patients with ALD had a significantly higher Model for End-Stage Liver Disease (MELD) score at the time of registration than did others. However, after adjustment for MELD and other variables, patients with ALD were less likely to die within 90 days than were NASH patients (OR 0.77; 95% CI 0.67–0.89; P < .001). No difference was seen in wait-list mortality between NASH and HCV and HCV/ALD patients.
Compared with NASH, patients with HCV (OR 1.45; 95% CI 1.35–1.55; P < .001), ALD (OR 1.15; 95% CI: 1.06–1.24; P < .001), and HCV/ALD (OR 1.29; 95% CI 1.18–1.42; P < .001) were all significantly more likely to receive a liver after 3 months on the wait list.
A “potential explanation for these observations might be etiology-specific differences in disease progression, such that more aggressive etiologies (e.g., HCV or HCV/ALD) can have a more rapid rise in MELD score, receive liver transplant, and have lower wait-list mortality, and etiologies with less rapid progression (e.g., NASH) can have slower rise in MELD score over time, lower rates of LT, but no significant increase in wait-list mortality,” the investigators said.
Overall 1-year wait-list survival among NASH patients decreased from 42.8% in 2004-2008 to 25.6% in 2009-2013, and overall 1-year probability of receiving liver transplant among NASH patients also decreased from 42.1% in 2004-2008 to 39.6% in 2009-2013. The trends were similar for other etiologies, perhaps in part because there are more people waiting for a liver.
The authors said they have no financial conflicts to disclose.
Since 2004, there’s been almost a tripling of the number of nonalcoholic steatohepatitis patients waiting for liver transplants; the condition is now the second leading reason to be put on the waiting list in the United States, according a study published online in Gastroenterology.
Even so and for reasons that are not fully clear, adults with nonalcoholic steatohepatitis (NASH) are less likely to survive for 90 days on the wait list than are patients with alcoholic liver disease (ALD), and less likely to get a new liver within 90 days than are patients with ALD, hepatitis C virus (HCV), or a blend of both. For now, HCV remains the No. 1 reason for liver transplants in the United States (Gastroenterology 2014 Nov. 24 [doi: 10.1053/j.gastro.2014.11.039]).
“Our study provides valuable information about the changing epidemiology of chronic liver disease among wait-listed patients, and adds greatly to our understanding of the epidemiology of NASH in the United States,” the researchers wrote. The rapid rise in the prevalence of NASH is “a direct consequence of the worldwide obesity epidemic” as well as greater awareness of the condition. An expected decline in HCV-related cirrhosis due to effective antiviral therapy “will further contribute to the changing epidemiology of patients awaiting liver transplants in the United States,” said the authors, led by Dr. Robert Wong of the division of gastroenterology and hepatology at Highland Hospital, Oakland, Calif.
“Given the expected continued rise in the number of NASH patients awaiting liver transplant, additional research is needed to improve wait-list survival and ... outcomes among this cohort. In addition, the projection that overall donor availability will significantly diminish in the next 15-20 years emphasizes the need for additional research to improve liver transplant opportunities for NASH patients, including the option of living donor[s],” they said.
The researchers analyzed data from the United Network for Organ Sharing and Organ Procurement and Transplantation Network registry.
From 2004 to 2013, new wait-list registrants with NASH increased by 170% from 804 to 2,174; those with ALD increased by 45% from 1,400 to 2,024; and those with HCV increased by 14% from 2,887 to 3,291. Registrants with both HCV and ALD decreased by 9% from 880 to 803. NASH became the second-leading disease among liver transplant wait-list registrants in 2013.
Continue for ALD and HCV comparison >>
Patients with ALD had a significantly higher Model for End-Stage Liver Disease (MELD) score at the time of registration than did others. However, after adjustment for MELD and other variables, patients with ALD were less likely to die within 90 days than were NASH patients (OR 0.77; 95% CI 0.67–0.89; P < .001). No difference was seen in wait-list mortality between NASH and HCV and HCV/ALD patients.
Compared with NASH, patients with HCV (OR 1.45; 95% CI 1.35–1.55; P < .001), ALD (OR 1.15; 95% CI: 1.06–1.24; P < .001), and HCV/ALD (OR 1.29; 95% CI 1.18–1.42; P < .001) were all significantly more likely to receive a liver after 3 months on the wait list.
A “potential explanation for these observations might be etiology-specific differences in disease progression, such that more aggressive etiologies (e.g., HCV or HCV/ALD) can have a more rapid rise in MELD score, receive liver transplant, and have lower wait-list mortality, and etiologies with less rapid progression (e.g., NASH) can have slower rise in MELD score over time, lower rates of LT, but no significant increase in wait-list mortality,” the investigators said.
Overall 1-year wait-list survival among NASH patients decreased from 42.8% in 2004-2008 to 25.6% in 2009-2013, and overall 1-year probability of receiving liver transplant among NASH patients also decreased from 42.1% in 2004-2008 to 39.6% in 2009-2013. The trends were similar for other etiologies, perhaps in part because there are more people waiting for a liver.
The authors said they have no financial conflicts to disclose.
Since 2004, there’s been almost a tripling of the number of nonalcoholic steatohepatitis patients waiting for liver transplants; the condition is now the second leading reason to be put on the waiting list in the United States, according a study published online in Gastroenterology.
Even so and for reasons that are not fully clear, adults with nonalcoholic steatohepatitis (NASH) are less likely to survive for 90 days on the wait list than are patients with alcoholic liver disease (ALD), and less likely to get a new liver within 90 days than are patients with ALD, hepatitis C virus (HCV), or a blend of both. For now, HCV remains the No. 1 reason for liver transplants in the United States (Gastroenterology 2014 Nov. 24 [doi: 10.1053/j.gastro.2014.11.039]).
“Our study provides valuable information about the changing epidemiology of chronic liver disease among wait-listed patients, and adds greatly to our understanding of the epidemiology of NASH in the United States,” the researchers wrote. The rapid rise in the prevalence of NASH is “a direct consequence of the worldwide obesity epidemic” as well as greater awareness of the condition. An expected decline in HCV-related cirrhosis due to effective antiviral therapy “will further contribute to the changing epidemiology of patients awaiting liver transplants in the United States,” said the authors, led by Dr. Robert Wong of the division of gastroenterology and hepatology at Highland Hospital, Oakland, Calif.
“Given the expected continued rise in the number of NASH patients awaiting liver transplant, additional research is needed to improve wait-list survival and ... outcomes among this cohort. In addition, the projection that overall donor availability will significantly diminish in the next 15-20 years emphasizes the need for additional research to improve liver transplant opportunities for NASH patients, including the option of living donor[s],” they said.
The researchers analyzed data from the United Network for Organ Sharing and Organ Procurement and Transplantation Network registry.
From 2004 to 2013, new wait-list registrants with NASH increased by 170% from 804 to 2,174; those with ALD increased by 45% from 1,400 to 2,024; and those with HCV increased by 14% from 2,887 to 3,291. Registrants with both HCV and ALD decreased by 9% from 880 to 803. NASH became the second-leading disease among liver transplant wait-list registrants in 2013.
Continue for ALD and HCV comparison >>
Patients with ALD had a significantly higher Model for End-Stage Liver Disease (MELD) score at the time of registration than did others. However, after adjustment for MELD and other variables, patients with ALD were less likely to die within 90 days than were NASH patients (OR 0.77; 95% CI 0.67–0.89; P < .001). No difference was seen in wait-list mortality between NASH and HCV and HCV/ALD patients.
Compared with NASH, patients with HCV (OR 1.45; 95% CI 1.35–1.55; P < .001), ALD (OR 1.15; 95% CI: 1.06–1.24; P < .001), and HCV/ALD (OR 1.29; 95% CI 1.18–1.42; P < .001) were all significantly more likely to receive a liver after 3 months on the wait list.
A “potential explanation for these observations might be etiology-specific differences in disease progression, such that more aggressive etiologies (e.g., HCV or HCV/ALD) can have a more rapid rise in MELD score, receive liver transplant, and have lower wait-list mortality, and etiologies with less rapid progression (e.g., NASH) can have slower rise in MELD score over time, lower rates of LT, but no significant increase in wait-list mortality,” the investigators said.
Overall 1-year wait-list survival among NASH patients decreased from 42.8% in 2004-2008 to 25.6% in 2009-2013, and overall 1-year probability of receiving liver transplant among NASH patients also decreased from 42.1% in 2004-2008 to 39.6% in 2009-2013. The trends were similar for other etiologies, perhaps in part because there are more people waiting for a liver.
The authors said they have no financial conflicts to disclose.
FROM GASTROENTEROLOGY
NASH on the rise as a cause of liver transplants
Since 2004, there’s been almost a tripling of the number of nonalcoholic steatohepatitis patients waiting for liver transplants; the condition is now the second leading reason to be put on the waiting list in the United States, according to a study published in the March issue of Gastroenterology.*
Even so and for reasons that are not fully clear, adults with nonalcoholic steatohepatitis (NASH) are less likely to survive for 90 days on the wait list than are patients with alcoholic liver disease (ALD), and less likely to get a new liver within 90 days than are patients with ALD, hepatitis C virus (HCV), or a blend of both. For now, HCV remains the No. 1 reason for liver transplants in the United States (Gastroenterology 2014 Nov. 24 [doi: 10.1053/j.gastro.2014.11.039]).
“Our study provides valuable information about the changing epidemiology of chronic liver disease among wait-listed patients, and adds greatly to our understanding of the epidemiology of NASH in the United States,” the researchers wrote. The rapid rise in the prevalence of NASH is “a direct consequence of the worldwide obesity epidemic” as well as greater awareness of the condition. An expected decline in HCV-related cirrhosis due to effective antiviral therapy “will further contribute to the changing epidemiology of patients awaiting liver transplants in the United States,” said the authors, led by Dr. Robert Wong of the division of gastroenterology and hepatology at Highland Hospital, Oakland, Calif.
“Given the expected continued rise in the number of NASH patients awaiting liver transplant, additional research is needed to improve wait-list survival and ... outcomes among this cohort. In addition, the projection that overall donor availability will significantly diminish in the next 15-20 years emphasizes the need for additional research to improve liver transplant opportunities for NASH patients, including the option of living donor[s],” they said.
The researchers analyzed data from the United Network for Organ Sharing and Organ Procurement and Transplantation Network registry.
From 2004 to 2013, new wait-list registrants with NASH increased by 170% from 804 to 2,174; those with ALD increased by 45% from 1,400 to 2,024; and those with HCV increased by 14% from 2,887 to 3,291. Registrants with both HCV and ALD decreased by 9% from 880 to 803. NASH became the second-leading disease among liver transplant wait-list registrants in 2013.
Patients with ALD had a significantly higher Model for End-Stage Liver Disease (MELD) score at the time of registration than did others. However, after adjustment for MELD and other variables, patients with ALD were less likely to die within 90 days than were NASH patients (OR 0.77; 95% CI 0.67–0.89; P < .001). No difference was seen in wait-list mortality between NASH and HCV and HCV/ALD patients.
Compared with NASH, patients with HCV (OR 1.45; 95% CI 1.35–1.55; P < .001), ALD (OR 1.15; 95% CI: 1.06–1.24; P < .001), and HCV/ALD (OR 1.29; 95% CI 1.18–1.42; P < .001) were all significantly more likely to receive a liver after 3 months on the wait list.
A “potential explanation for these observations might be etiology-specific differences in disease progression, such that more aggressive etiologies (e.g., HCV or HCV/ALD) can have a more rapid rise in MELD score, receive liver transplant, and have lower wait-list mortality, and etiologies with less rapid progression (e.g., NASH) can have slower rise in MELD score over time, lower rates of LT, but no significant increase in wait-list mortality,” the investigators said.
Overall 1-year wait-list survival among NASH patients decreased from 42.8% in 2004-2008 to 25.6% in 2009-2013, and overall 1-year probability of receiving liver transplant among NASH patients also decreased from 42.1% in 2004-2008 to 39.6% in 2009-2013. The trends were similar for other etiologies, perhaps in part because there are more people waiting for a liver.
The authors said they have no financial conflicts to disclose.
*A change was made to the text on 3/12/2015.
Since 2004, there’s been almost a tripling of the number of nonalcoholic steatohepatitis patients waiting for liver transplants; the condition is now the second leading reason to be put on the waiting list in the United States, according to a study published in the March issue of Gastroenterology.*
Even so and for reasons that are not fully clear, adults with nonalcoholic steatohepatitis (NASH) are less likely to survive for 90 days on the wait list than are patients with alcoholic liver disease (ALD), and less likely to get a new liver within 90 days than are patients with ALD, hepatitis C virus (HCV), or a blend of both. For now, HCV remains the No. 1 reason for liver transplants in the United States (Gastroenterology 2014 Nov. 24 [doi: 10.1053/j.gastro.2014.11.039]).
“Our study provides valuable information about the changing epidemiology of chronic liver disease among wait-listed patients, and adds greatly to our understanding of the epidemiology of NASH in the United States,” the researchers wrote. The rapid rise in the prevalence of NASH is “a direct consequence of the worldwide obesity epidemic” as well as greater awareness of the condition. An expected decline in HCV-related cirrhosis due to effective antiviral therapy “will further contribute to the changing epidemiology of patients awaiting liver transplants in the United States,” said the authors, led by Dr. Robert Wong of the division of gastroenterology and hepatology at Highland Hospital, Oakland, Calif.
“Given the expected continued rise in the number of NASH patients awaiting liver transplant, additional research is needed to improve wait-list survival and ... outcomes among this cohort. In addition, the projection that overall donor availability will significantly diminish in the next 15-20 years emphasizes the need for additional research to improve liver transplant opportunities for NASH patients, including the option of living donor[s],” they said.
The researchers analyzed data from the United Network for Organ Sharing and Organ Procurement and Transplantation Network registry.
From 2004 to 2013, new wait-list registrants with NASH increased by 170% from 804 to 2,174; those with ALD increased by 45% from 1,400 to 2,024; and those with HCV increased by 14% from 2,887 to 3,291. Registrants with both HCV and ALD decreased by 9% from 880 to 803. NASH became the second-leading disease among liver transplant wait-list registrants in 2013.
Patients with ALD had a significantly higher Model for End-Stage Liver Disease (MELD) score at the time of registration than did others. However, after adjustment for MELD and other variables, patients with ALD were less likely to die within 90 days than were NASH patients (OR 0.77; 95% CI 0.67–0.89; P < .001). No difference was seen in wait-list mortality between NASH and HCV and HCV/ALD patients.
Compared with NASH, patients with HCV (OR 1.45; 95% CI 1.35–1.55; P < .001), ALD (OR 1.15; 95% CI: 1.06–1.24; P < .001), and HCV/ALD (OR 1.29; 95% CI 1.18–1.42; P < .001) were all significantly more likely to receive a liver after 3 months on the wait list.
A “potential explanation for these observations might be etiology-specific differences in disease progression, such that more aggressive etiologies (e.g., HCV or HCV/ALD) can have a more rapid rise in MELD score, receive liver transplant, and have lower wait-list mortality, and etiologies with less rapid progression (e.g., NASH) can have slower rise in MELD score over time, lower rates of LT, but no significant increase in wait-list mortality,” the investigators said.
Overall 1-year wait-list survival among NASH patients decreased from 42.8% in 2004-2008 to 25.6% in 2009-2013, and overall 1-year probability of receiving liver transplant among NASH patients also decreased from 42.1% in 2004-2008 to 39.6% in 2009-2013. The trends were similar for other etiologies, perhaps in part because there are more people waiting for a liver.
The authors said they have no financial conflicts to disclose.
*A change was made to the text on 3/12/2015.
Since 2004, there’s been almost a tripling of the number of nonalcoholic steatohepatitis patients waiting for liver transplants; the condition is now the second leading reason to be put on the waiting list in the United States, according to a study published in the March issue of Gastroenterology.*
Even so and for reasons that are not fully clear, adults with nonalcoholic steatohepatitis (NASH) are less likely to survive for 90 days on the wait list than are patients with alcoholic liver disease (ALD), and less likely to get a new liver within 90 days than are patients with ALD, hepatitis C virus (HCV), or a blend of both. For now, HCV remains the No. 1 reason for liver transplants in the United States (Gastroenterology 2014 Nov. 24 [doi: 10.1053/j.gastro.2014.11.039]).
“Our study provides valuable information about the changing epidemiology of chronic liver disease among wait-listed patients, and adds greatly to our understanding of the epidemiology of NASH in the United States,” the researchers wrote. The rapid rise in the prevalence of NASH is “a direct consequence of the worldwide obesity epidemic” as well as greater awareness of the condition. An expected decline in HCV-related cirrhosis due to effective antiviral therapy “will further contribute to the changing epidemiology of patients awaiting liver transplants in the United States,” said the authors, led by Dr. Robert Wong of the division of gastroenterology and hepatology at Highland Hospital, Oakland, Calif.
“Given the expected continued rise in the number of NASH patients awaiting liver transplant, additional research is needed to improve wait-list survival and ... outcomes among this cohort. In addition, the projection that overall donor availability will significantly diminish in the next 15-20 years emphasizes the need for additional research to improve liver transplant opportunities for NASH patients, including the option of living donor[s],” they said.
The researchers analyzed data from the United Network for Organ Sharing and Organ Procurement and Transplantation Network registry.
From 2004 to 2013, new wait-list registrants with NASH increased by 170% from 804 to 2,174; those with ALD increased by 45% from 1,400 to 2,024; and those with HCV increased by 14% from 2,887 to 3,291. Registrants with both HCV and ALD decreased by 9% from 880 to 803. NASH became the second-leading disease among liver transplant wait-list registrants in 2013.
Patients with ALD had a significantly higher Model for End-Stage Liver Disease (MELD) score at the time of registration than did others. However, after adjustment for MELD and other variables, patients with ALD were less likely to die within 90 days than were NASH patients (OR 0.77; 95% CI 0.67–0.89; P < .001). No difference was seen in wait-list mortality between NASH and HCV and HCV/ALD patients.
Compared with NASH, patients with HCV (OR 1.45; 95% CI 1.35–1.55; P < .001), ALD (OR 1.15; 95% CI: 1.06–1.24; P < .001), and HCV/ALD (OR 1.29; 95% CI 1.18–1.42; P < .001) were all significantly more likely to receive a liver after 3 months on the wait list.
A “potential explanation for these observations might be etiology-specific differences in disease progression, such that more aggressive etiologies (e.g., HCV or HCV/ALD) can have a more rapid rise in MELD score, receive liver transplant, and have lower wait-list mortality, and etiologies with less rapid progression (e.g., NASH) can have slower rise in MELD score over time, lower rates of LT, but no significant increase in wait-list mortality,” the investigators said.
Overall 1-year wait-list survival among NASH patients decreased from 42.8% in 2004-2008 to 25.6% in 2009-2013, and overall 1-year probability of receiving liver transplant among NASH patients also decreased from 42.1% in 2004-2008 to 39.6% in 2009-2013. The trends were similar for other etiologies, perhaps in part because there are more people waiting for a liver.
The authors said they have no financial conflicts to disclose.
*A change was made to the text on 3/12/2015.
FROM GASTROENTEROLOGY
Key clinical point: As the epidemiology of liver transplantation changes in the United States, more needs to be done to ensure good outcomes in NASH patients.
Major finding: From 2004 to 2013, new wait-list registrants with NASH increased by 170% from 804 to 2,174.
Data source: The United Network for Organ Sharing and Organ Procurement and Transplantation Network registry.
Disclosures: The authors said they have no relevant disclosures.