Adjuvant pembrolizumab (Keytruda) following complete melanoma resection could soon move to an earlier stage in the management of high-risk disease, suggest results from KEYNOTE-716. However, the results raise many questions, says an expert invited to discuss the new data.

Adjuvant pembrolizumab is already approved in the United States for use in patients with melanoma with lymph node involvement following complete resection, having been shown to prolong both recurrence-free and distant metastasis-free survival (DMFS) in stage 3 melanoma.

This latest trial involved patients with slightly earlier disease, those with resected stage 2B and 2C melanoma. These patients are at “high risk” of disease recurrence and have similar outcomes to stage 3A and 3B melanoma patients, explained study presenter Jason J. Luke, MD, director of the Cancer Immunotherapeutics Center at UPMC Hillman Cancer Center, Pittsburgh.

Results from the KEYNOTE-716 trial showed that adjuvant pembrolizumab is also beneficial in this earlier stage disease: it improved recurrence-free survival (RFS) by 35% and improved distant metastasis-free survival by 40% compared with placebo.

Adjuvant pembrolizumab is an “effective treatment option with a favorable benefit-risk profile for patients with high-risk stage 2 melanoma,” Dr. Luke concluded.

The manufacturer, Merck, has said that these new results have already been accepted for priority review by the U.S. Food and Drug Administration, making it likely that the indication will be extended to include patients with earlier disease.  

Dr. Luke presented the results at the European Society of Medical Oncology 2021 annual meeting.

Invited discussant Omid Hamid, MD, chief of research/immuno-oncology, the Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, said that Dr. Luke’s presentation was “amazing.”

However, these new results have “sabotaged how we think about how we treat our patients and how we’re going to think about what we do in the future.”

Dr. Hamid noted that the incidence of stage 2B and 2C melanoma is “equal” to that of stage 3 disease, “so with a proposed approval” of pembrolizumab in this earlier setting, “we will have a lot more patients” to treat earlier in their disease course.

Of course, this raises the inevitable question of how to treat these patients when they relapse, and how to treat these patients in the metastatic setting “having already exhausted single-agent PD-1 therapy,” he commented.

Dr. Hamid said that the current results also reveal the “current problem” with adjuvant therapy, which is that “we don’t know who benefits,” and there is a subset patients who “never recur” even if they are untreated.

So the questions are: “How come all get treated? What about the risks of toxicity? The costs? And where do we fit these patients into clinic?”

As with so many presentations of immunotherapy trial data, the need for biomarkers was raised, with Dr. Hamid emphasizing the need for predictive biomarkers that could exclude patients, and save them from toxicity.

He noted that there were data with another checkpoint inhibitor, nivolumab (Opdivo), in the adjuvant setting (from the CheckMate 238 trial) that suggested higher tumor mutation burden and tumor interferon-gamma levels could play a role, and he hopes that similar data may be available from this latest trial.

Also, there are ongoing and upcoming trials in patients with stage 2B and 2C melanoma that may answer some of the outstanding questions, including a study of neoadjuvant PD-1 blockade before resection, and the DETECTION trial, which is exploring circulating tumor DNA-guided therapy postsurgery.

Then there is the NivoMela trial that will look at nivolumab in stage 2A as well as 2B and 2C disease, while the REFINE trial will assess whether giving immunotherapy less often to patients with advanced cancer, including those with melanoma, results in fewer side effects while continuing to be effective.

The current results also raise the question of whether to go “earlier and earlier” with adjuvant immunotherapy into “poor risk” stage 1 melanoma, which is already being tried in the United States, although there is “no clear understanding of what to do for those patients.”

Overall, Dr. Hamid said that the results of KEYNOTE-716 have “created more questions than answers,” including its impact on the inclusion criteria for phase 3/4 clinical trials, “which now exclude patients who have received adjuvant therapy within 6 months.”

“That will have to change,” he suggested.

Some of the questions raised by Dr. Hamid were discussed on social media, sparking a lively Twitter debate on how best to take the results forward and into the clinic.

Florentia Dimitriou, MD, a dermatology consultant in the Skin Cancer Clinic, University Hospital Zurich, Switzerland, said the data were “great” but she was “still unclear” over who needs adjuvant immunotherapy in this setting.

She also emphasized that, for her, the greater RFS benefit seen in T3b than in T4b disease “doesn’t make sense,” and she also highlighted the finding of long-term toxicity in approximately 18% of patients.

Dr. Luke replied that he agrees that the T3b/T4b results are puzzling but he said the event rate was “low” and the data are “immature,” and that he hopes to have “more info soon.”

He acknowledged that around 18% of patients taking pembrolizumab went on to receive hormone therapy for adverse events, including 13.9% due to hypothyroidism, and others including hypophysitis, adrenal sufficiency, and type 1 diabetes. However, he also pointed out that about 5% of patients in this study had background thyroid issues. The risks and benefits of treatment need to be discussed with patients, he added.

Over a series of tweets, Rebecca J. Lee, PhD, NIHR clinical lecturer in medical oncology at the University of Manchester, United Kingdom, said, “we need to know more” about the distant metastasis-free survival results, and that results for overall survival are “really” needed.

She also emphasized the need for biomarkers to identify those patients who are likely to benefit, and whether benefit can be upfront or early on in treatment. Dr. Lee added that, as endocrine thyroid toxicity occurs after a median of 3.3 months, “pretreatment biomarkers will be more important than on-treatment biomarkers in this setting.”

Details of the results in earlier stage disease

The KEYNOTE-716 trial enrolled patients with newly diagnosed, resected, high-risk stage 2 melanoma aged ≥ 12 years and a good performance status. The majority (~64%) had stage 2B melanoma, and the rest had stage 2C. T3b disease was present in 41% of patients, 23% had T4a disease, and 35% had T4b disease.

Patients were randomized to receive pembrolizumab or placebo.

In a subsequent part of the study, patients with recurrence will be unblended, with either crossover from the placebo to active treatment group or rechallenge with pembrolizumab for up to 2 years.

Presenting the first part, Dr. Luke said that, of 487 patients assigned to pembrolizumab, 483 started treatment, of whom 206 have completed treatment, 133 are still on therapy, and 144 have discontinued.

In the placebo group, 489 patients were assigned and 486 began treatment. Of those, 229 completed treatment, 152 are still ongoing, and 105 discontinued.

The two groups were well balanced in terms of baseline characteristics. The median age was approximately 60 years, with only one patient enrolled who was aged 12-17 years.

At 12 months, the study met its primary endpoint.

Relapse-fee survival was 90.5% in patients treated with pembrolizumab versus 83.1% in the placebo group, at a hazard ratio for recurrence of 0.65 (P = .00658).

“Despite this trial hitting this primary endpoint very early, there are a number of patients who are censored later in the curves,” Dr. Luke said, adding that “we will continue to see these data mature.”

“In fact, it’s our full expectation that curves will continue to separate over time.”

When looking at key subgroups, Dr. Luke showed that the results favored pembrolizumab when stratifying patients by age, gender, race, and performance status.

Interestingly, patients with T3b disease did a lot better on pembrolizumab compared with those who had T4b disease, at a hazard ratio for recurrence of 0.44 versus 0.94.

Data on recurrence patterns revealed that 11.1% of patients taking pembrolizumab had an event, with 6.4% experiencing skin and/or lymph node regional recurrence and 4.7% distant recurrence.

In the placebo group, 16.8% of patients had a recurrence event, with 8.4% having a loco-regional recurrence and 7.8% a distant recurrence.

Dr. Luke explained that this equates to an approximate 40% reduction in distant recurrence with pembrolizumab over placebo.

Finally, the researchers examined change in global health status on the EORTC QLQ-C30 quality of life score. Examining mean change over time, they found that there were no clinically meaningful changes, and the scores in the pembrolizumab and placebo groups tracked each other during the course of follow-up.

Quality of life was, therefore, “only minimally changed,” Dr. Luke said.

The study was funded by MSD. Dr. Luke and Dr. Hamid have declared relationships with multiple companies.

A version of this article first appeared on Medscape.com.

Adjuvant pembrolizumab (Keytruda) following complete melanoma resection could soon move to an earlier stage in the management of high-risk disease, suggest results from KEYNOTE-716. However, the results raise many questions, says an expert invited to discuss the new data.

Adjuvant pembrolizumab is already approved in the United States for use in patients with melanoma with lymph node involvement following complete resection, having been shown to prolong both recurrence-free and distant metastasis-free survival (DMFS) in stage 3 melanoma.

This latest trial involved patients with slightly earlier disease, those with resected stage 2B and 2C melanoma. These patients are at “high risk” of disease recurrence and have similar outcomes to stage 3A and 3B melanoma patients, explained study presenter Jason J. Luke, MD, director of the Cancer Immunotherapeutics Center at UPMC Hillman Cancer Center, Pittsburgh.

Results from the KEYNOTE-716 trial showed that adjuvant pembrolizumab is also beneficial in this earlier stage disease: it improved recurrence-free survival (RFS) by 35% and improved distant metastasis-free survival by 40% compared with placebo.

Adjuvant pembrolizumab is an “effective treatment option with a favorable benefit-risk profile for patients with high-risk stage 2 melanoma,” Dr. Luke concluded.

The manufacturer, Merck, has said that these new results have already been accepted for priority review by the U.S. Food and Drug Administration, making it likely that the indication will be extended to include patients with earlier disease.  

Dr. Luke presented the results at the European Society of Medical Oncology 2021 annual meeting.

Invited discussant Omid Hamid, MD, chief of research/immuno-oncology, the Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, said that Dr. Luke’s presentation was “amazing.”

However, these new results have “sabotaged how we think about how we treat our patients and how we’re going to think about what we do in the future.”

Dr. Hamid noted that the incidence of stage 2B and 2C melanoma is “equal” to that of stage 3 disease, “so with a proposed approval” of pembrolizumab in this earlier setting, “we will have a lot more patients” to treat earlier in their disease course.

Of course, this raises the inevitable question of how to treat these patients when they relapse, and how to treat these patients in the metastatic setting “having already exhausted single-agent PD-1 therapy,” he commented.

Dr. Hamid said that the current results also reveal the “current problem” with adjuvant therapy, which is that “we don’t know who benefits,” and there is a subset patients who “never recur” even if they are untreated.

So the questions are: “How come all get treated? What about the risks of toxicity? The costs? And where do we fit these patients into clinic?”

As with so many presentations of immunotherapy trial data, the need for biomarkers was raised, with Dr. Hamid emphasizing the need for predictive biomarkers that could exclude patients, and save them from toxicity.

He noted that there were data with another checkpoint inhibitor, nivolumab (Opdivo), in the adjuvant setting (from the CheckMate 238 trial) that suggested higher tumor mutation burden and tumor interferon-gamma levels could play a role, and he hopes that similar data may be available from this latest trial.

Also, there are ongoing and upcoming trials in patients with stage 2B and 2C melanoma that may answer some of the outstanding questions, including a study of neoadjuvant PD-1 blockade before resection, and the DETECTION trial, which is exploring circulating tumor DNA-guided therapy postsurgery.

Then there is the NivoMela trial that will look at nivolumab in stage 2A as well as 2B and 2C disease, while the REFINE trial will assess whether giving immunotherapy less often to patients with advanced cancer, including those with melanoma, results in fewer side effects while continuing to be effective.

The current results also raise the question of whether to go “earlier and earlier” with adjuvant immunotherapy into “poor risk” stage 1 melanoma, which is already being tried in the United States, although there is “no clear understanding of what to do for those patients.”

Overall, Dr. Hamid said that the results of KEYNOTE-716 have “created more questions than answers,” including its impact on the inclusion criteria for phase 3/4 clinical trials, “which now exclude patients who have received adjuvant therapy within 6 months.”

“That will have to change,” he suggested.

Some of the questions raised by Dr. Hamid were discussed on social media, sparking a lively Twitter debate on how best to take the results forward and into the clinic.

Florentia Dimitriou, MD, a dermatology consultant in the Skin Cancer Clinic, University Hospital Zurich, Switzerland, said the data were “great” but she was “still unclear” over who needs adjuvant immunotherapy in this setting.

She also emphasized that, for her, the greater RFS benefit seen in T3b than in T4b disease “doesn’t make sense,” and she also highlighted the finding of long-term toxicity in approximately 18% of patients.

Dr. Luke replied that he agrees that the T3b/T4b results are puzzling but he said the event rate was “low” and the data are “immature,” and that he hopes to have “more info soon.”

He acknowledged that around 18% of patients taking pembrolizumab went on to receive hormone therapy for adverse events, including 13.9% due to hypothyroidism, and others including hypophysitis, adrenal sufficiency, and type 1 diabetes. However, he also pointed out that about 5% of patients in this study had background thyroid issues. The risks and benefits of treatment need to be discussed with patients, he added.

Over a series of tweets, Rebecca J. Lee, PhD, NIHR clinical lecturer in medical oncology at the University of Manchester, United Kingdom, said, “we need to know more” about the distant metastasis-free survival results, and that results for overall survival are “really” needed.

She also emphasized the need for biomarkers to identify those patients who are likely to benefit, and whether benefit can be upfront or early on in treatment. Dr. Lee added that, as endocrine thyroid toxicity occurs after a median of 3.3 months, “pretreatment biomarkers will be more important than on-treatment biomarkers in this setting.”

Details of the results in earlier stage disease

The KEYNOTE-716 trial enrolled patients with newly diagnosed, resected, high-risk stage 2 melanoma aged ≥ 12 years and a good performance status. The majority (~64%) had stage 2B melanoma, and the rest had stage 2C. T3b disease was present in 41% of patients, 23% had T4a disease, and 35% had T4b disease.

Patients were randomized to receive pembrolizumab or placebo.

In a subsequent part of the study, patients with recurrence will be unblended, with either crossover from the placebo to active treatment group or rechallenge with pembrolizumab for up to 2 years.

Presenting the first part, Dr. Luke said that, of 487 patients assigned to pembrolizumab, 483 started treatment, of whom 206 have completed treatment, 133 are still on therapy, and 144 have discontinued.

In the placebo group, 489 patients were assigned and 486 began treatment. Of those, 229 completed treatment, 152 are still ongoing, and 105 discontinued.

The two groups were well balanced in terms of baseline characteristics. The median age was approximately 60 years, with only one patient enrolled who was aged 12-17 years.

At 12 months, the study met its primary endpoint.

Relapse-fee survival was 90.5% in patients treated with pembrolizumab versus 83.1% in the placebo group, at a hazard ratio for recurrence of 0.65 (P = .00658).

“Despite this trial hitting this primary endpoint very early, there are a number of patients who are censored later in the curves,” Dr. Luke said, adding that “we will continue to see these data mature.”

“In fact, it’s our full expectation that curves will continue to separate over time.”

When looking at key subgroups, Dr. Luke showed that the results favored pembrolizumab when stratifying patients by age, gender, race, and performance status.

Interestingly, patients with T3b disease did a lot better on pembrolizumab compared with those who had T4b disease, at a hazard ratio for recurrence of 0.44 versus 0.94.

Data on recurrence patterns revealed that 11.1% of patients taking pembrolizumab had an event, with 6.4% experiencing skin and/or lymph node regional recurrence and 4.7% distant recurrence.

In the placebo group, 16.8% of patients had a recurrence event, with 8.4% having a loco-regional recurrence and 7.8% a distant recurrence.

Dr. Luke explained that this equates to an approximate 40% reduction in distant recurrence with pembrolizumab over placebo.

Finally, the researchers examined change in global health status on the EORTC QLQ-C30 quality of life score. Examining mean change over time, they found that there were no clinically meaningful changes, and the scores in the pembrolizumab and placebo groups tracked each other during the course of follow-up.

Quality of life was, therefore, “only minimally changed,” Dr. Luke said.

The study was funded by MSD. Dr. Luke and Dr. Hamid have declared relationships with multiple companies.

A version of this article first appeared on Medscape.com.

Adjuvant pembrolizumab (Keytruda) following complete melanoma resection could soon move to an earlier stage in the management of high-risk disease, suggest results from KEYNOTE-716. However, the results raise many questions, says an expert invited to discuss the new data.

Adjuvant pembrolizumab is already approved in the United States for use in patients with melanoma with lymph node involvement following complete resection, having been shown to prolong both recurrence-free and distant metastasis-free survival (DMFS) in stage 3 melanoma.

This latest trial involved patients with slightly earlier disease, those with resected stage 2B and 2C melanoma. These patients are at “high risk” of disease recurrence and have similar outcomes to stage 3A and 3B melanoma patients, explained study presenter Jason J. Luke, MD, director of the Cancer Immunotherapeutics Center at UPMC Hillman Cancer Center, Pittsburgh.

Results from the KEYNOTE-716 trial showed that adjuvant pembrolizumab is also beneficial in this earlier stage disease: it improved recurrence-free survival (RFS) by 35% and improved distant metastasis-free survival by 40% compared with placebo.

Adjuvant pembrolizumab is an “effective treatment option with a favorable benefit-risk profile for patients with high-risk stage 2 melanoma,” Dr. Luke concluded.

The manufacturer, Merck, has said that these new results have already been accepted for priority review by the U.S. Food and Drug Administration, making it likely that the indication will be extended to include patients with earlier disease.  

Dr. Luke presented the results at the European Society of Medical Oncology 2021 annual meeting.

Invited discussant Omid Hamid, MD, chief of research/immuno-oncology, the Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, said that Dr. Luke’s presentation was “amazing.”

However, these new results have “sabotaged how we think about how we treat our patients and how we’re going to think about what we do in the future.”

Dr. Hamid noted that the incidence of stage 2B and 2C melanoma is “equal” to that of stage 3 disease, “so with a proposed approval” of pembrolizumab in this earlier setting, “we will have a lot more patients” to treat earlier in their disease course.

Of course, this raises the inevitable question of how to treat these patients when they relapse, and how to treat these patients in the metastatic setting “having already exhausted single-agent PD-1 therapy,” he commented.

Dr. Hamid said that the current results also reveal the “current problem” with adjuvant therapy, which is that “we don’t know who benefits,” and there is a subset patients who “never recur” even if they are untreated.

So the questions are: “How come all get treated? What about the risks of toxicity? The costs? And where do we fit these patients into clinic?”

As with so many presentations of immunotherapy trial data, the need for biomarkers was raised, with Dr. Hamid emphasizing the need for predictive biomarkers that could exclude patients, and save them from toxicity.

He noted that there were data with another checkpoint inhibitor, nivolumab (Opdivo), in the adjuvant setting (from the CheckMate 238 trial) that suggested higher tumor mutation burden and tumor interferon-gamma levels could play a role, and he hopes that similar data may be available from this latest trial.

Also, there are ongoing and upcoming trials in patients with stage 2B and 2C melanoma that may answer some of the outstanding questions, including a study of neoadjuvant PD-1 blockade before resection, and the DETECTION trial, which is exploring circulating tumor DNA-guided therapy postsurgery.

Then there is the NivoMela trial that will look at nivolumab in stage 2A as well as 2B and 2C disease, while the REFINE trial will assess whether giving immunotherapy less often to patients with advanced cancer, including those with melanoma, results in fewer side effects while continuing to be effective.

The current results also raise the question of whether to go “earlier and earlier” with adjuvant immunotherapy into “poor risk” stage 1 melanoma, which is already being tried in the United States, although there is “no clear understanding of what to do for those patients.”

Overall, Dr. Hamid said that the results of KEYNOTE-716 have “created more questions than answers,” including its impact on the inclusion criteria for phase 3/4 clinical trials, “which now exclude patients who have received adjuvant therapy within 6 months.”

“That will have to change,” he suggested.

Some of the questions raised by Dr. Hamid were discussed on social media, sparking a lively Twitter debate on how best to take the results forward and into the clinic.

Florentia Dimitriou, MD, a dermatology consultant in the Skin Cancer Clinic, University Hospital Zurich, Switzerland, said the data were “great” but she was “still unclear” over who needs adjuvant immunotherapy in this setting.

She also emphasized that, for her, the greater RFS benefit seen in T3b than in T4b disease “doesn’t make sense,” and she also highlighted the finding of long-term toxicity in approximately 18% of patients.

Dr. Luke replied that he agrees that the T3b/T4b results are puzzling but he said the event rate was “low” and the data are “immature,” and that he hopes to have “more info soon.”

He acknowledged that around 18% of patients taking pembrolizumab went on to receive hormone therapy for adverse events, including 13.9% due to hypothyroidism, and others including hypophysitis, adrenal sufficiency, and type 1 diabetes. However, he also pointed out that about 5% of patients in this study had background thyroid issues. The risks and benefits of treatment need to be discussed with patients, he added.

Over a series of tweets, Rebecca J. Lee, PhD, NIHR clinical lecturer in medical oncology at the University of Manchester, United Kingdom, said, “we need to know more” about the distant metastasis-free survival results, and that results for overall survival are “really” needed.

She also emphasized the need for biomarkers to identify those patients who are likely to benefit, and whether benefit can be upfront or early on in treatment. Dr. Lee added that, as endocrine thyroid toxicity occurs after a median of 3.3 months, “pretreatment biomarkers will be more important than on-treatment biomarkers in this setting.”

Details of the results in earlier stage disease

The KEYNOTE-716 trial enrolled patients with newly diagnosed, resected, high-risk stage 2 melanoma aged ≥ 12 years and a good performance status. The majority (~64%) had stage 2B melanoma, and the rest had stage 2C. T3b disease was present in 41% of patients, 23% had T4a disease, and 35% had T4b disease.

Patients were randomized to receive pembrolizumab or placebo.

In a subsequent part of the study, patients with recurrence will be unblended, with either crossover from the placebo to active treatment group or rechallenge with pembrolizumab for up to 2 years.

Presenting the first part, Dr. Luke said that, of 487 patients assigned to pembrolizumab, 483 started treatment, of whom 206 have completed treatment, 133 are still on therapy, and 144 have discontinued.

In the placebo group, 489 patients were assigned and 486 began treatment. Of those, 229 completed treatment, 152 are still ongoing, and 105 discontinued.

The two groups were well balanced in terms of baseline characteristics. The median age was approximately 60 years, with only one patient enrolled who was aged 12-17 years.

At 12 months, the study met its primary endpoint.

Relapse-fee survival was 90.5% in patients treated with pembrolizumab versus 83.1% in the placebo group, at a hazard ratio for recurrence of 0.65 (P = .00658).

“Despite this trial hitting this primary endpoint very early, there are a number of patients who are censored later in the curves,” Dr. Luke said, adding that “we will continue to see these data mature.”

“In fact, it’s our full expectation that curves will continue to separate over time.”

When looking at key subgroups, Dr. Luke showed that the results favored pembrolizumab when stratifying patients by age, gender, race, and performance status.

Interestingly, patients with T3b disease did a lot better on pembrolizumab compared with those who had T4b disease, at a hazard ratio for recurrence of 0.44 versus 0.94.

Data on recurrence patterns revealed that 11.1% of patients taking pembrolizumab had an event, with 6.4% experiencing skin and/or lymph node regional recurrence and 4.7% distant recurrence.

In the placebo group, 16.8% of patients had a recurrence event, with 8.4% having a loco-regional recurrence and 7.8% a distant recurrence.

Dr. Luke explained that this equates to an approximate 40% reduction in distant recurrence with pembrolizumab over placebo.

Finally, the researchers examined change in global health status on the EORTC QLQ-C30 quality of life score. Examining mean change over time, they found that there were no clinically meaningful changes, and the scores in the pembrolizumab and placebo groups tracked each other during the course of follow-up.

Quality of life was, therefore, “only minimally changed,” Dr. Luke said.

The study was funded by MSD. Dr. Luke and Dr. Hamid have declared relationships with multiple companies.

A version of this article first appeared on Medscape.com.

Key clinical point: Diagnostic specificity and sensitivity were high enough to distinguish uterine fibroids (UFs) from adenomyosis when a combination of transvaginal ultrasound (TVUS) and strain ratio (SR) elastography (SE) techniques was implemented.

Major finding: Patients with histologically confirmed UFs vs. those with adenomyosis had a significantly lower mean (5.20±1.81 vs 11.42±1.87) and max (5.78±2.08 vs 13.43±4.10) SR values (both P < .001). Diagnostic sensitivity (90.56% vs. 86.2%) and specificity (96.15% vs 91.37%) were higher for UFs than adenomyosis.

Study details: Findings are from a pilot, prospective study including 79 patients who underwent hysterectomy for suspicion of either UF (n=53) or adenomyosis (n=25), diagnosed on the basis of 2-dimensional TVUS in combination with SE findings.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Săsăran V et al. J Pers Med. 2021 Aug 23. doi: 10.3390/jpm11080824.

Key clinical point: Diagnostic specificity and sensitivity were high enough to distinguish uterine fibroids (UFs) from adenomyosis when a combination of transvaginal ultrasound (TVUS) and strain ratio (SR) elastography (SE) techniques was implemented.

Major finding: Patients with histologically confirmed UFs vs. those with adenomyosis had a significantly lower mean (5.20±1.81 vs 11.42±1.87) and max (5.78±2.08 vs 13.43±4.10) SR values (both P < .001). Diagnostic sensitivity (90.56% vs. 86.2%) and specificity (96.15% vs 91.37%) were higher for UFs than adenomyosis.

Study details: Findings are from a pilot, prospective study including 79 patients who underwent hysterectomy for suspicion of either UF (n=53) or adenomyosis (n=25), diagnosed on the basis of 2-dimensional TVUS in combination with SE findings.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Săsăran V et al. J Pers Med. 2021 Aug 23. doi: 10.3390/jpm11080824.

Key clinical point: Diagnostic specificity and sensitivity were high enough to distinguish uterine fibroids (UFs) from adenomyosis when a combination of transvaginal ultrasound (TVUS) and strain ratio (SR) elastography (SE) techniques was implemented.

Major finding: Patients with histologically confirmed UFs vs. those with adenomyosis had a significantly lower mean (5.20±1.81 vs 11.42±1.87) and max (5.78±2.08 vs 13.43±4.10) SR values (both P < .001). Diagnostic sensitivity (90.56% vs. 86.2%) and specificity (96.15% vs 91.37%) were higher for UFs than adenomyosis.

Study details: Findings are from a pilot, prospective study including 79 patients who underwent hysterectomy for suspicion of either UF (n=53) or adenomyosis (n=25), diagnosed on the basis of 2-dimensional TVUS in combination with SE findings.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Săsăran V et al. J Pers Med. 2021 Aug 23. doi: 10.3390/jpm11080824.

Key clinical point: Hereditary leiomyomatosis and renal cell cancer (HLRCC) can be distinguished from sporadic uterine leiomyomas (ULs) by clinical characteristics and morphologic features of fumarate hydratase (FH)-mutant leiomyomas aided by Bcl-2 and CD34 immunohistochemistry.

Major finding: Women with HLRCC vs. sporadic ULs were significantly younger (33.8 years vs 45.4 years), more frequently symptomatic (95% vs 6.5%), and had numerous ULs (more than 4 tumors, 88.9% vs 30.8%; all P < .0001). Stronger Bcl-2 staining (P = .003) and higher microvessel density highlighted by CD34 immunostaining (P < .0001) distinguished HLRCC-related leiomyomas from sporadic leiomyomas.

Study details: Findings are from a nationwide study including 20 women with a known FH germline mutation and 77 women with sporadic ULs.

Disclosures: This study was supported by the Academy of Finland, Sigrid Jusélius Foundation, Cancer Society of Finland, and Finnish Medical Foundation. The authors declared no conflict of interests.

Source: Uimari O et al. Acta Obstet Gynecol Scand. 2021 Sep 3. doi: 10.1111/aogs.14248.

Key clinical point: Hereditary leiomyomatosis and renal cell cancer (HLRCC) can be distinguished from sporadic uterine leiomyomas (ULs) by clinical characteristics and morphologic features of fumarate hydratase (FH)-mutant leiomyomas aided by Bcl-2 and CD34 immunohistochemistry.

Major finding: Women with HLRCC vs. sporadic ULs were significantly younger (33.8 years vs 45.4 years), more frequently symptomatic (95% vs 6.5%), and had numerous ULs (more than 4 tumors, 88.9% vs 30.8%; all P < .0001). Stronger Bcl-2 staining (P = .003) and higher microvessel density highlighted by CD34 immunostaining (P < .0001) distinguished HLRCC-related leiomyomas from sporadic leiomyomas.

Study details: Findings are from a nationwide study including 20 women with a known FH germline mutation and 77 women with sporadic ULs.

Disclosures: This study was supported by the Academy of Finland, Sigrid Jusélius Foundation, Cancer Society of Finland, and Finnish Medical Foundation. The authors declared no conflict of interests.

Source: Uimari O et al. Acta Obstet Gynecol Scand. 2021 Sep 3. doi: 10.1111/aogs.14248.

Key clinical point: Hereditary leiomyomatosis and renal cell cancer (HLRCC) can be distinguished from sporadic uterine leiomyomas (ULs) by clinical characteristics and morphologic features of fumarate hydratase (FH)-mutant leiomyomas aided by Bcl-2 and CD34 immunohistochemistry.

Major finding: Women with HLRCC vs. sporadic ULs were significantly younger (33.8 years vs 45.4 years), more frequently symptomatic (95% vs 6.5%), and had numerous ULs (more than 4 tumors, 88.9% vs 30.8%; all P < .0001). Stronger Bcl-2 staining (P = .003) and higher microvessel density highlighted by CD34 immunostaining (P < .0001) distinguished HLRCC-related leiomyomas from sporadic leiomyomas.

Study details: Findings are from a nationwide study including 20 women with a known FH germline mutation and 77 women with sporadic ULs.

Disclosures: This study was supported by the Academy of Finland, Sigrid Jusélius Foundation, Cancer Society of Finland, and Finnish Medical Foundation. The authors declared no conflict of interests.

Source: Uimari O et al. Acta Obstet Gynecol Scand. 2021 Sep 3. doi: 10.1111/aogs.14248.

Key clinical point: Ovarian arteries embolization (OAE) improved quality of life (QoL) and lowered rates of subsequent surgery in women who experienced persistent symptoms after uterine arteries embolization (UAE) for uterine fibroids (UF).

Major finding: Less than a fifth of the cohort underwent subsequent hysterectomy. Almost 90.9% of patients who underwent magnetic resonance imaging after 12 months of OAE showed a decrease in uterine volume and complete devascularization of the dominant fibroid tumor. After a mean follow-up of 70 months, 8 of the 10 patients who responded to the QoL questionnaire reported an improvement or stability of symptoms.

Study details: Findings are from a retrospective analysis of 1,300 women treated with UAE for symptomatic UF, of which 18 women underwent a second embolization through one or both ovarian arteries.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Ifergan H et al. Abdom Radiol (NY). 2021 Aug 25. doi: 10.1007/s00261-021-03255-w.

Key clinical point: Ovarian arteries embolization (OAE) improved quality of life (QoL) and lowered rates of subsequent surgery in women who experienced persistent symptoms after uterine arteries embolization (UAE) for uterine fibroids (UF).

Major finding: Less than a fifth of the cohort underwent subsequent hysterectomy. Almost 90.9% of patients who underwent magnetic resonance imaging after 12 months of OAE showed a decrease in uterine volume and complete devascularization of the dominant fibroid tumor. After a mean follow-up of 70 months, 8 of the 10 patients who responded to the QoL questionnaire reported an improvement or stability of symptoms.

Study details: Findings are from a retrospective analysis of 1,300 women treated with UAE for symptomatic UF, of which 18 women underwent a second embolization through one or both ovarian arteries.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Ifergan H et al. Abdom Radiol (NY). 2021 Aug 25. doi: 10.1007/s00261-021-03255-w.

Key clinical point: Ovarian arteries embolization (OAE) improved quality of life (QoL) and lowered rates of subsequent surgery in women who experienced persistent symptoms after uterine arteries embolization (UAE) for uterine fibroids (UF).

Major finding: Less than a fifth of the cohort underwent subsequent hysterectomy. Almost 90.9% of patients who underwent magnetic resonance imaging after 12 months of OAE showed a decrease in uterine volume and complete devascularization of the dominant fibroid tumor. After a mean follow-up of 70 months, 8 of the 10 patients who responded to the QoL questionnaire reported an improvement or stability of symptoms.

Study details: Findings are from a retrospective analysis of 1,300 women treated with UAE for symptomatic UF, of which 18 women underwent a second embolization through one or both ovarian arteries.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Ifergan H et al. Abdom Radiol (NY). 2021 Aug 25. doi: 10.1007/s00261-021-03255-w.

Key clinical point: The surgical approach for removal of uterine fibroids should consider the number and size of fibroids, surgical time, and reproductive diagnosis with minimally invasive routes offered whenever possible because of its better outcome on achieving pregnancy.

Major finding: Laparotomic myomectomy was favored when the number (P = .000) and weight (P = .004) of fibroids were considered. Robotic surgery took a longer time than others (P = .00). When the impact of number of fibroids on achieving pregnancy was analyzed, both groups with lesser (P = .017) and greater (P < .001) than 6 fibroids preferred minimally invasive routes like laparoscopic or robotic surgery.

Study details: Findings are from a retrospective, cross-sectional study including 69 patients with infertility who underwent myomectomy approaches, of which 21, 24, and 24 patients underwent laparotomy, conventional laparoscopy, and robotic-assisted laparoscopy, respectively.

Disclosures: No information on funding was available. The authors declared no conflict of interests.

Source: Morales HSG et al. JBRA Assist Reprod. 2021 Aug 20. doi: 10.5935/1518-0557.20210049.

Key clinical point: The surgical approach for removal of uterine fibroids should consider the number and size of fibroids, surgical time, and reproductive diagnosis with minimally invasive routes offered whenever possible because of its better outcome on achieving pregnancy.

Major finding: Laparotomic myomectomy was favored when the number (P = .000) and weight (P = .004) of fibroids were considered. Robotic surgery took a longer time than others (P = .00). When the impact of number of fibroids on achieving pregnancy was analyzed, both groups with lesser (P = .017) and greater (P < .001) than 6 fibroids preferred minimally invasive routes like laparoscopic or robotic surgery.

Study details: Findings are from a retrospective, cross-sectional study including 69 patients with infertility who underwent myomectomy approaches, of which 21, 24, and 24 patients underwent laparotomy, conventional laparoscopy, and robotic-assisted laparoscopy, respectively.

Disclosures: No information on funding was available. The authors declared no conflict of interests.

Source: Morales HSG et al. JBRA Assist Reprod. 2021 Aug 20. doi: 10.5935/1518-0557.20210049.

Key clinical point: The surgical approach for removal of uterine fibroids should consider the number and size of fibroids, surgical time, and reproductive diagnosis with minimally invasive routes offered whenever possible because of its better outcome on achieving pregnancy.

Major finding: Laparotomic myomectomy was favored when the number (P = .000) and weight (P = .004) of fibroids were considered. Robotic surgery took a longer time than others (P = .00). When the impact of number of fibroids on achieving pregnancy was analyzed, both groups with lesser (P = .017) and greater (P < .001) than 6 fibroids preferred minimally invasive routes like laparoscopic or robotic surgery.

Study details: Findings are from a retrospective, cross-sectional study including 69 patients with infertility who underwent myomectomy approaches, of which 21, 24, and 24 patients underwent laparotomy, conventional laparoscopy, and robotic-assisted laparoscopy, respectively.

Disclosures: No information on funding was available. The authors declared no conflict of interests.

Source: Morales HSG et al. JBRA Assist Reprod. 2021 Aug 20. doi: 10.5935/1518-0557.20210049.

Key clinical point: Uterine fibroids did not increase the risk for preterm births and were not associated with any clinical preterm birth subtype.

Major finding: Prevalence of fibroids was similar in pregnancies ending in preterm and term births (10.2% and 10.3%, respectively). Presence of fibroids was not associated with an overall risk for preterm birth (adjusted risk ratio [aRR], 0.88; 95% confidence interval [CI], 0.62-1.24) or preterm birth subtypes like medically indicated (aRR, 0.92; 95% CI, 0.43-1.96) or spontaneous (aRR, 1.27; 95% CI, 0.76-2.11) preterm births.

Study details: Findings are from a prospective cohort including 4,622 women with singleton pregnancies resulting in a live birth after 20 weeks of gestation.

Disclosures: This study was funded by National Institutes of Health, American Water Works Association Research Foundation, and the National Institute of General Medical Studies. The authors declared no conflict of interests.

Source: Sundermann AC et al. BMC Pregnancy Childbirth. 2021 Aug 17. doi: 10.1186/s12884-021-03968-2.

Key clinical point: Uterine fibroids did not increase the risk for preterm births and were not associated with any clinical preterm birth subtype.

Major finding: Prevalence of fibroids was similar in pregnancies ending in preterm and term births (10.2% and 10.3%, respectively). Presence of fibroids was not associated with an overall risk for preterm birth (adjusted risk ratio [aRR], 0.88; 95% confidence interval [CI], 0.62-1.24) or preterm birth subtypes like medically indicated (aRR, 0.92; 95% CI, 0.43-1.96) or spontaneous (aRR, 1.27; 95% CI, 0.76-2.11) preterm births.

Study details: Findings are from a prospective cohort including 4,622 women with singleton pregnancies resulting in a live birth after 20 weeks of gestation.

Disclosures: This study was funded by National Institutes of Health, American Water Works Association Research Foundation, and the National Institute of General Medical Studies. The authors declared no conflict of interests.

Source: Sundermann AC et al. BMC Pregnancy Childbirth. 2021 Aug 17. doi: 10.1186/s12884-021-03968-2.

Key clinical point: Uterine fibroids did not increase the risk for preterm births and were not associated with any clinical preterm birth subtype.

Major finding: Prevalence of fibroids was similar in pregnancies ending in preterm and term births (10.2% and 10.3%, respectively). Presence of fibroids was not associated with an overall risk for preterm birth (adjusted risk ratio [aRR], 0.88; 95% confidence interval [CI], 0.62-1.24) or preterm birth subtypes like medically indicated (aRR, 0.92; 95% CI, 0.43-1.96) or spontaneous (aRR, 1.27; 95% CI, 0.76-2.11) preterm births.

Study details: Findings are from a prospective cohort including 4,622 women with singleton pregnancies resulting in a live birth after 20 weeks of gestation.

Disclosures: This study was funded by National Institutes of Health, American Water Works Association Research Foundation, and the National Institute of General Medical Studies. The authors declared no conflict of interests.

Source: Sundermann AC et al. BMC Pregnancy Childbirth. 2021 Aug 17. doi: 10.1186/s12884-021-03968-2.

Key clinical point: The size of uterine leiomyoma commonly increases before 22-24 gestational weeks, with the growth being fastest before 11-14 weeks. The size remained almost unchanged from 22-24 weeks to the predelivery gestational weeks.

Major finding: The change in leiomyoma diameter from weeks 6-7 to 11-14, 11-14 to 22-24, 22-24 to 28-34, and 28-34 to predelivery gestational weeks was 0.767 cm, 0.367 cm, −0.133 cm, and −0.100 cm, respectively, with the difference between gestational intervals being statistically significant (P < .05). Overall, leiomyoma increased by 23.99% between weeks 6-7 to predelivery gestational weeks, with growth being highest between weeks 6-7 and 11-14 (9.92%).

Study details: Findings are from a prospective cross-sectional study including 394 pregnant women with uterine leiomyoma.

Disclosures: The study was funded by the Beijing Municipal Science & Technology Commission and Beijing Obstetrics and Gynecology Hospital. The authors declared no conflict of interests.

Source: Tian Y C et al. Int J Gynaecol Obstet. 2021 Aug 27. doi: 10.1002/ijgo.13903.

Key clinical point: The size of uterine leiomyoma commonly increases before 22-24 gestational weeks, with the growth being fastest before 11-14 weeks. The size remained almost unchanged from 22-24 weeks to the predelivery gestational weeks.

Major finding: The change in leiomyoma diameter from weeks 6-7 to 11-14, 11-14 to 22-24, 22-24 to 28-34, and 28-34 to predelivery gestational weeks was 0.767 cm, 0.367 cm, −0.133 cm, and −0.100 cm, respectively, with the difference between gestational intervals being statistically significant (P < .05). Overall, leiomyoma increased by 23.99% between weeks 6-7 to predelivery gestational weeks, with growth being highest between weeks 6-7 and 11-14 (9.92%).

Study details: Findings are from a prospective cross-sectional study including 394 pregnant women with uterine leiomyoma.

Disclosures: The study was funded by the Beijing Municipal Science & Technology Commission and Beijing Obstetrics and Gynecology Hospital. The authors declared no conflict of interests.

Source: Tian Y C et al. Int J Gynaecol Obstet. 2021 Aug 27. doi: 10.1002/ijgo.13903.

Key clinical point: The size of uterine leiomyoma commonly increases before 22-24 gestational weeks, with the growth being fastest before 11-14 weeks. The size remained almost unchanged from 22-24 weeks to the predelivery gestational weeks.

Major finding: The change in leiomyoma diameter from weeks 6-7 to 11-14, 11-14 to 22-24, 22-24 to 28-34, and 28-34 to predelivery gestational weeks was 0.767 cm, 0.367 cm, −0.133 cm, and −0.100 cm, respectively, with the difference between gestational intervals being statistically significant (P < .05). Overall, leiomyoma increased by 23.99% between weeks 6-7 to predelivery gestational weeks, with growth being highest between weeks 6-7 and 11-14 (9.92%).

Study details: Findings are from a prospective cross-sectional study including 394 pregnant women with uterine leiomyoma.

Disclosures: The study was funded by the Beijing Municipal Science & Technology Commission and Beijing Obstetrics and Gynecology Hospital. The authors declared no conflict of interests.

Source: Tian Y C et al. Int J Gynaecol Obstet. 2021 Aug 27. doi: 10.1002/ijgo.13903.

Key clinical point: Uterine fibroids (UFs) may grow continuously in some postmenopausal women, most likely because of the presence of small fibroids or obesity.

Major finding: The median growth rate of UFs was 12.9% every 6 months, with 79.5% of the UFs showing enlargement and 20.5% regressed spontaneously. The median growth rate of UFs was significantly higher in obese and overweight women than those with normal weight (P = .043). The growth was rapid in tumors with a diameter less than 3 cm vs greater than or equal to 5 cm (28.8% vs 9.1% in 6 months; P = .015).

Study details: Findings are from a retrospective longitudinal study including 102 postmenopausal women with 132 surgically identified UFs who had received at least 2 transvaginal ultrasound examinations in a 6-month interval.

Disclosures: This study was supported by the Capital Medical University Advanced Discipline Construction Project of Clinical Medicine. The authors declared no conflict of interests.

Source: Shen M et al. Menopause. 2021 Sep 6. doi: 10.1097/GME.0000000000001846.

Key clinical point: Uterine fibroids (UFs) may grow continuously in some postmenopausal women, most likely because of the presence of small fibroids or obesity.

Major finding: The median growth rate of UFs was 12.9% every 6 months, with 79.5% of the UFs showing enlargement and 20.5% regressed spontaneously. The median growth rate of UFs was significantly higher in obese and overweight women than those with normal weight (P = .043). The growth was rapid in tumors with a diameter less than 3 cm vs greater than or equal to 5 cm (28.8% vs 9.1% in 6 months; P = .015).

Study details: Findings are from a retrospective longitudinal study including 102 postmenopausal women with 132 surgically identified UFs who had received at least 2 transvaginal ultrasound examinations in a 6-month interval.

Disclosures: This study was supported by the Capital Medical University Advanced Discipline Construction Project of Clinical Medicine. The authors declared no conflict of interests.

Source: Shen M et al. Menopause. 2021 Sep 6. doi: 10.1097/GME.0000000000001846.

Key clinical point: Uterine fibroids (UFs) may grow continuously in some postmenopausal women, most likely because of the presence of small fibroids or obesity.

Major finding: The median growth rate of UFs was 12.9% every 6 months, with 79.5% of the UFs showing enlargement and 20.5% regressed spontaneously. The median growth rate of UFs was significantly higher in obese and overweight women than those with normal weight (P = .043). The growth was rapid in tumors with a diameter less than 3 cm vs greater than or equal to 5 cm (28.8% vs 9.1% in 6 months; P = .015).

Study details: Findings are from a retrospective longitudinal study including 102 postmenopausal women with 132 surgically identified UFs who had received at least 2 transvaginal ultrasound examinations in a 6-month interval.

Disclosures: This study was supported by the Capital Medical University Advanced Discipline Construction Project of Clinical Medicine. The authors declared no conflict of interests.

Source: Shen M et al. Menopause. 2021 Sep 6. doi: 10.1097/GME.0000000000001846.

Key clinical point: Women with uterine leiomyoma (UL) appeared to be at a higher risk of developing endometriosis. The risk increased further if UL was present along with comorbidities like infertility or endometritis.

Major finding: Patients with UL vs control participants were at a higher risk of developing endometriosis (adjusted hazard ratio [aHR], 6.44; P less than .001). The comorbidities significantly associated with risk for endometriosis were tube-ovarian infection (aHR, 2.86; P = .01), endometritis (aHR, 1.14; P < .001), infertility (aHR, 1.26; P <  .001), and allergic diseases (aHR, 1.11; P < .001).

Study details: Findings are from a large-scale nationwide cohort including 31,239 women with UL matched with 1,24,956 control participants and followed up for 14 years.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Lin KY et al. PLoS One. 2021 Aug 26. doi: 10.1371/journal.pone.0256772.

Key clinical point: Women with uterine leiomyoma (UL) appeared to be at a higher risk of developing endometriosis. The risk increased further if UL was present along with comorbidities like infertility or endometritis.

Major finding: Patients with UL vs control participants were at a higher risk of developing endometriosis (adjusted hazard ratio [aHR], 6.44; P less than .001). The comorbidities significantly associated with risk for endometriosis were tube-ovarian infection (aHR, 2.86; P = .01), endometritis (aHR, 1.14; P < .001), infertility (aHR, 1.26; P <  .001), and allergic diseases (aHR, 1.11; P < .001).

Study details: Findings are from a large-scale nationwide cohort including 31,239 women with UL matched with 1,24,956 control participants and followed up for 14 years.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Lin KY et al. PLoS One. 2021 Aug 26. doi: 10.1371/journal.pone.0256772.

Key clinical point: Women with uterine leiomyoma (UL) appeared to be at a higher risk of developing endometriosis. The risk increased further if UL was present along with comorbidities like infertility or endometritis.

Major finding: Patients with UL vs control participants were at a higher risk of developing endometriosis (adjusted hazard ratio [aHR], 6.44; P less than .001). The comorbidities significantly associated with risk for endometriosis were tube-ovarian infection (aHR, 2.86; P = .01), endometritis (aHR, 1.14; P < .001), infertility (aHR, 1.26; P <  .001), and allergic diseases (aHR, 1.11; P < .001).

Study details: Findings are from a large-scale nationwide cohort including 31,239 women with UL matched with 1,24,956 control participants and followed up for 14 years.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Lin KY et al. PLoS One. 2021 Aug 26. doi: 10.1371/journal.pone.0256772.

Key clinical point: Proton pump inhibitor (PPI) use was positively associated with the risk of developing psoriasis.

Major finding: Compared with PPI use of 30 or less cumulative defined daily doses (cDDD), PPI use of 120-365 (adjusted odds ratio [aOR], 1.52; 95% confidence interval [CI], 1.31-1.76) and higher than 365 (aOR, 1.54; 95% CI, 1.22-1.93) was associated with a significantly higher risk for psoriasis. Lansoprazole (OR, 1.25; 95% CI, 1.11-1.41), but not pantoprazole, esomeprazole, rabeprazole, or omeprazole, significantly contributed to psoriasis risk.

Study details: Findings are from a nationwide nested case-control study including 5,756 patients with prior exposure to PPIs, of which 2,878 patients had psoriasis.

Disclosures: The study was supported by Taipei Veterans General Hospital and Ministry of Science and Technology, Taiwan. The authors declared no potential conflict of interests.

Source: Li CY et al. Dermatology. 2021 Sep 2. doi: 10.1159/000517515.

Key clinical point: Proton pump inhibitor (PPI) use was positively associated with the risk of developing psoriasis.

Major finding: Compared with PPI use of 30 or less cumulative defined daily doses (cDDD), PPI use of 120-365 (adjusted odds ratio [aOR], 1.52; 95% confidence interval [CI], 1.31-1.76) and higher than 365 (aOR, 1.54; 95% CI, 1.22-1.93) was associated with a significantly higher risk for psoriasis. Lansoprazole (OR, 1.25; 95% CI, 1.11-1.41), but not pantoprazole, esomeprazole, rabeprazole, or omeprazole, significantly contributed to psoriasis risk.

Study details: Findings are from a nationwide nested case-control study including 5,756 patients with prior exposure to PPIs, of which 2,878 patients had psoriasis.

Disclosures: The study was supported by Taipei Veterans General Hospital and Ministry of Science and Technology, Taiwan. The authors declared no potential conflict of interests.

Source: Li CY et al. Dermatology. 2021 Sep 2. doi: 10.1159/000517515.

Key clinical point: Proton pump inhibitor (PPI) use was positively associated with the risk of developing psoriasis.

Major finding: Compared with PPI use of 30 or less cumulative defined daily doses (cDDD), PPI use of 120-365 (adjusted odds ratio [aOR], 1.52; 95% confidence interval [CI], 1.31-1.76) and higher than 365 (aOR, 1.54; 95% CI, 1.22-1.93) was associated with a significantly higher risk for psoriasis. Lansoprazole (OR, 1.25; 95% CI, 1.11-1.41), but not pantoprazole, esomeprazole, rabeprazole, or omeprazole, significantly contributed to psoriasis risk.

Study details: Findings are from a nationwide nested case-control study including 5,756 patients with prior exposure to PPIs, of which 2,878 patients had psoriasis.

Disclosures: The study was supported by Taipei Veterans General Hospital and Ministry of Science and Technology, Taiwan. The authors declared no potential conflict of interests.

Source: Li CY et al. Dermatology. 2021 Sep 2. doi: 10.1159/000517515.