Venous thromboembolism risk is lower in patients with atopic dermatitis than other immune-mediated inflammatory diseases: A retrospective, observational, comparative cohort study using US claims data

BACKGROUND

Certain immune-mediated inflammatory diseases (IMIDs) may increase patients' risk for venous thromboembolisms (VTEs), yet how atopic dermatitis (AD) influences VTE risk remains unclear.

OBJECTIVE

Describe VTE incidence in patients with AD compared with other IMIDs and unaffected, AD-matched controls.

METHODS

This retrospective, observational, comparative cohort study used Optum Clinformatics United States claims data (2010-2019) of adults with AD, rheumatoid arthritis (RA), Crohn's disease (CD), ulcerative colitis (UC), psoriasis (PsO), psoriatic arthritis (PsA), or ankylosing spondylitis (AS). Unaffected control patients were matched 1:1 with patients with AD.

RESULTS

Of 2,061,222 patients with IMIDs, 1,098,633 had AD. Patients with AD had a higher VTE incidence (95% CI) than did unaffected, AD-matched controls (0.73 [0.72-0.74] versus 0.59 [0.58-0.60] cases/100 person-years). When controlling for baseline VTE risk factors, however, AD was not associated with increased VTE risk (HR 0.96 [0.90-1.02]). VTE risk was lower in patients with AD versus RA, UC, CD, AS, or PsA; VTE risk was similar to patients with PsO.

LIMITATIONS

Disease activity and severity were not accounted for.

CONCLUSION

AD did not increase VTE risk when accounting for underlying risk factors. AD was associated with lower VTE risk compared with several rheumatologic and gastrointestinal IMIDs.

317 Comparative risk of venous thromboembolism (VTE) among patients with atopic dermatitis (AD) or other immune-mediated diseases: a cohort study using United States claims data

Patients with rheumatoid arthritis (RA) or inflammatory bowel disease (IBD) are at increased risk for thrombotic events, but less is known about the underlying risk of VTE with immune-mediated skin conditions. The objective of our study was to describe the incidence of VTE among patients diagnosed with AD and compare VTE incidence among patients with other immune-mediated inflammatory diseases, as well as among individuals without such conditions. This retrospective, observational, comparative cohort study used a large national administrative claims database Optum® (Clinformatics® Data Mart). Adults (aged ≥18 years) diagnosed with AD, RA, IBD (Crohn’s disease [CD] or ulcerative colitis [UC]) or other immune-mediated diseases during 2010–2019 were included. Disease cohorts were not mutually exclusive. A non-diseased control population with no such diagnoses was matched 1 : 1 to patients in the AD cohort by age, sex and calendar time of cohort entry. All patients had to have at least 12 months of enrolment (baseline) before a confirmed diagnosis (or matched cohort entry date for controls) and at least 1 day of follow-up data following diagnosis. All patients received normal clinical care and were followed until the earliest VTE event, end of health plan enrolment, death or end of data availability (30 June 2021). The primary outcome was the incidence of VTE (deep vein thrombosis [DVT] or pulmonary embolism [PE]) defined as an inpatient hospitalization with a VTE diagnosis and length of stay ≥1 day or an outpatient VTE diagnosis followed by initiation of an anticoagulant within 7 days. Incidence per 100 person-years (PY) and 95% CI were calculated. Crude and adjusted hazard ratios (HRs) were determined using Cox proportional hazards regression models and adjusted for demographic and comorbid disease factors. The secondary outcome was the incidence of VTE limited to inpatient events. A total of 1,098,633 adults with AD were included in the analysis; the mean (SD) age was 54.1 (18.5) years, 65.3% were female and 1.1% had a history of VTE. A total of 15,456 VTE events (primary outcome) were reported among patients with AD during 2,113,668.9 PY for a crude incidence (95%CI) of 0.73 (0.72, 0.74) cases/100 PY. The incidence of VTE was 1.33 (1.30, 1.36) cases/100 PY among patients with RA or IBD (n = 578,021) and 0.59 (0.58, 0.60) cases/100 PY among AD-matched controls. The adjusted risk for VTE was higher among patients with RA or IBD compared with patients with AD with an adjusted HR (95% CI) of 1.46 (1.43, 1.49). Patients with AD had a slightly higher risk for VTE compared with AD-matched controls with an adjusted HR of 1.09 (1.06, 1.12). Similar results were observed when DVT and PE were assessed separately. Patients with CD or UC had the highest risk for VTE relative to patients with AD with an adjusted HR of 1.61 (1.54, 1.69) and 1.57 (1.5, 1.63), respectively. Patients with RA also had a higher risk for VTE relative to patients with AD with an adjusted HR of 1.42 (1.38–1.46). Similar results were also observed when the assessment of the incidence and risk of VTE was limited to inpatient events. Patients with RA or IBD had a higher risk of VTE compared with patients with AD. The risk of VTE was slightly higher among patients with AD compared with AD-matched controls. Because VTE risk is increased in RA and IBD during periods of active disease, observed rates may depend on the proportion of patients with uncontrolled disease. Characterization of baseline VTE risk among patients with AD may better inform treatment benefit–risk assessments and shared decision-making.

Prevalence of non-tuberculous mycobacteria among previously treated TB patients in the Gulf of Guinea, Africa

Objective

Differentiation between non-tuberculous mycobacteria (NTM) and Mycobacterium tuberculosis complex (MTBC) is crucial for case management with the appropriate antimycobacterials. This study was undertaken in three West and Central African countries to understand NTM associated with pulmonary tuberculosis in the sub-region.

Methods

A collection of 503 isolates (158 from Cameroon, 202 from Nigeria and 143 from Ghana) obtained from solid and liquid cultures were analysed. The isolates were tested for drug susceptibility, and MTBC were confirmed using IS6110. All IS6110-negative isolates were identified by 65-kilodalton heat shock protein (hsp65) gene amplification, DNA sequencing and BLAST analysis.

Results

Overall, the prevalence of NTM was 16/503 (3.2%), distributed as 2/202 (1%) in Nigeria, 2/158 (1.3%) in Cameroon and 12/143 (8.4%) in Ghana. The main NTM isolates included 5/16 (31.3%) M. fortuitum, 2/16 (12.5%) M. intracellulare and 2/16 (12.5%) M. engbaekii. Eight (57.1%) of the 14 previously treated patients harboured NTM (odds ratio 0.21, 95% confidence interval 0.06-0.77; P=0.021). Three multi-drug-resistant strains were identified: M. engbaekii, M. fortuitum and M. intracellulare.

Conclusion

NTM were mainly found among individuals with unsuccessful treatment. This highlights the need for mycobacterial species differentiation using rapid molecular tools for appropriate case management, as most are resistant to routine first-line antimycobacterials.

The CannTeen study: verbal episodic memory, spatial working memory, and response inhibition in adolescent and adult cannabis users and age-matched controls

BACKGROUND

Preclinical and human studies suggest that adolescent cannabis use may be associated with worse cognitive outcomes than adult cannabis use. We investigated the associations between chronic cannabis use and cognitive function in adolescent and adult cannabis users and controls. We hypothesised user-status would be negatively associated with cognitive function and this relationship would be stronger in adolescents than adults.

METHODS

As part of the 'CannTeen' project, this cross-sectional study assessed cognitive performance in adolescent cannabis users (n = 76; 16-17-year-olds), adolescent controls (n = 63), adult cannabis users (n = 71; 26-29-year-olds) and adult controls (n = 64). Users used cannabis 1-7 days/week. Adolescent and adult cannabis users were matched on cannabis use frequency (4 days/week) and time since last use (2.5 days). Verbal episodic memory (VEM) was assessed using the prose recall task, spatial working memory (SWM) was assessed using the spatial n-back task, and response inhibition was assessed with the stop-signal task. Primary outcome variables were: delayed recall, 3-back discriminability, and stop signal reaction time, respectively.

RESULTS

Users had worse VEM than controls (F(1,268) = 7.423, p = 0.007). There were no significant differences between user-groups on SWM or response inhibition. Null differences were supported by Bayesian analyses. No significant interactions between age-group and user-group were found for VEM, SWM, or response inhibition.

CONCLUSIONS

Consistent with previous research, there was an association between chronic cannabis use and poorer VEM, but chronic cannabis use was not associated with SWM or response inhibition. We did not find evidence for heightened adolescent vulnerability to cannabis-related cognitive impairment.

Response, time to progression, and overall survival of patients with stage III lung cancer in a minority-based cohort

7558

Background: Lung cancer is the leading cause of cancer death. Response and survival of patients (pts) with stage III lung cancer in minority population is not well studied. Methods: 79 pts treated between 2001 and 2006 were studied as a retrospective cohort. Clinical and survival data were analyzed using fisher's test, chi square test, Kaplan Meier analyses. Results: 33 Pts had Stage IIIA; Median age at diagnosis was 58 yrs (37–75). 14 were males (42.4%) 19 females (57.6%) 26 African American (78.8%) and 7 Caucasians (21.2%). Median number of co morbidities 2 (0–4). Mean follow up was 25 months (mo) (2 - 93), 19 had surgery (12 Lobectomy (36.4%), 7 Pneumonectomy (21.2%)) and 14 were unresectable (42.4%). All pts received adjuvant chemotherapy. Unresectable pts received chemotherapy and radiation, 8 carboplatin and gemcitabine and 6 cisplatin and etoposide. Median time to progression in resectable IIIA was 23 mo (2- 67), unresectable IIIA was 12 mo (3–93). Median survival in pts with resection was 26 mo (2 - 67), unresectable was 12 mo (5 - 93). Overall survival and time to progression was not influenced by sex, race, tumor type. 46 pts had stage IIIB, median age at diagnosis 57.5 yrs (40–68). 31 were males (67.4%) 15 females (32.6%) 29 African Americans (63%) 11 Caucasians (23.9) 3 Asians (6.5%) and 3 Hispanics (6.5%). Median follow up was 10 mo (3–97). All pts received chemotherapy and radiation. 23 received cisplatin and etoposide (50%), 14 carboplatin and gemcitabine (30%), 5 carboplatin and etoposide (9%), 5 carboplatin and paclitaxel (9%). 13 had complete response (28.3%), 15 partial response (32.6%), 2 stable disease (4.3%) and 10 Progression (21.7%). Median time to progression was 9 mo (3–97). Median overall survival was 10 mo (3–97). Overall survival and time to progression was not influenced by sex, race, tumor type, chemotherapy regimen. Conclusions: In this minority based cohort response, time to progression, overall survival in both IIIA and IIIB pts is much lower then historical controls. The overall survival and time to progression in both IIIA and IIIB is not influenced by race, sex, tumor type and type of chemotherapy regimen. Further investigations of disease and healthcare disparities in the underserved minority population, are warranted.

No significant financial relationships to disclose.

Effects of YM 435 and A 77636 on dopamine D-1 receptors in bovine retina in vitro

1. Homogenates of bovine retinas were used to study the capacities of two new dopamine (DA) receptor agonists, e.g. YM 435 and A 77636, to interact with D1 receptors. 2. Adenylate cyclase experiments. YM 435 and A 77636 enhanced cAMP accumulation, with EC50 values of 1.97 microM and 22.9 nM, respectively. The receptor-mediated nature of the effects of these two novel D1 agonists was shown by the abilities of both SCH 23390 or (+)-butaclamol to inhibit the agonist-induced increase of cAMP formation. 3. Binding experiments. The same agonists were also tested for competition with 3H-SCH 23390 for binding to D1 receptors. IC50 values for YM 435 and A 77636 were 8.15 microM and 6.15 nM, respectively. 4. The results of the present report demonstrate the suitability of bovine retina in vitro to evaluate the specificity of new DA D1 agonists at the receptor level.

Okadaic acid modulates exocytotic and transporter-dependent release of dopamine in bovine retina in vitro

Bovine retinas were isolated for the study of the modulation of exocytotic and transporter-dependent release of dopamine (DA) in vitro. Endogenous DA was measured in the medium using HPLC with electrochemical detection under successive incubations with transfers in fresh medium every 30 min. As expected, potassium caused a calcium-dependent exocytotic liberation of DA. Amphetamine or tyramine induced a calcium-independent release by reversing DA transport across the plasma membrane. Okadaic acid, a specific inhibitor of phosphatases 1 and 2A, induced a slight but significant DA release in the absence of calcium. Furthermore, the toxin increased potassium-, amphetamine- or tyramine-induced DA release independently of extracellular calcium. In addition, okadaic acid completely annulled the ability of a calcium-free extracellular environment to inhibit the potassium-induced DA release. Finally, the toxin prevented the time-dependent decline in the efficacies of amphetamine or tyramine to release DA. In agreement with proposed schemes described for rat striatum, the results of the present study confirmed the existence of distinct release modes of DA in bovine retina. The results obtained with okadaic acid suggest that phosphatase 1 and/or phosphatase 2A constitute part of a direct or indirect mechanism to inhibit both exocytotic and transporter-dependent DA release.

Agonist-induced desensitization of dopamine D-1 receptors in bovine retina and rat striatum

We have investigated agonist-induced desensitization of dopamine (DA) D-1 receptor mediated accumulation of adenosine 3':5'-cyclic monophosphate (cAMP) in bovine retinas and rat striata in vitro. Tissues were exposed to various pharmacological agents for 60 min, washed and homogenized. D-1 agonist-promoted accumulation of cAMP in the presence of adenosine 5'-triphosphate (ATP) and 5'-guanylylimidodiphosphate (GppNHp) was then measured. Retinas and striata incubated with DA or (+) SKF 38393 (100 microM each) displayed diminished capacities to accumulate cAMP when they were re-exposed to the same drugs. As expected, retinas and striata treated wtih (+) SKF 38393 also showed an attenuated formation of cAMP when restimulated with DA. In addition, D-1 receptors in retinas that had been treated with quinpirole, a D-2 agonist, did not become desensitized. Furthermore, 0.2 microM SCH 23390 prevented D-1 receptor subsensitivity caused by 100 microM DA. Interestingly, retinas and striata incubated with forskolin, a direct stimulator of adenylyl cyclase, also displayed a diminished enzymatic response to restimulation by the same agent, as well as by DA. Additionally, retinas incubated with 100 microM DA were refractory to forskolin-induced cAMP formation. Finally, results of 3H-SCH 23390 binding to control and DA-treated retinas indicated that agonist treatment did not induce significant changes in either receptor density or binding affinity. The data indicate that bovine retinas and striatal slices in vitro are suitable to investigate various aspects of the desensitization of neuronal responses to DA D-1 agonists or forskolin.

Potentiation by the tetraphenylboron anion of the effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and its pyridinium metabolite

The 1-methyl-4-phenylpyridinium species (MPP+) is the four-electron oxidation product of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and is widely assumed to be the actual neurotoxic species responsible for the MPTP-induced destruction of dopaminergic neurons. MPTP is oxidized by the enzyme monoamine oxidase-B to a dihydropyridinium intermediate which is oxidized further to MPP+, an effective inhibitor of the oxidation of the Complex I substrates glutamate/malate in isolated mitochondrial preparations. In the present study, the tetraphenylboron anion (TPB) greatly potentiated the inhibitory effects of MPP+ and other selected pyridinium species on glutamate/malate respiration in isolated mouse liver mitochondria. At 10 microM TPB, the potentiation ranged from approximately 50-fold to greater than 1,000-fold for the several pyridinium species tested. In other experiments, TPB greatly enhanced the accumulation of [3H]MPP+ by isolated mitochondrial preparations. This facilitation by TPB of MPP+ accumulation into mitochondria explains, at least in part, the potentiation by TPB of the above-mentioned inhibition of mitochondrial respiration. Moreover, TPB addition increased the amount of lactate formed during the incubation of mouse neostriatal tissue slices with MPTP and other tetrahydropyridines. The administration of TPB also potentiated the dopaminergic neurotoxicity of MPTP in male Swiss-Webster mice. All of these observations, taken together, are consistent with the premise that the inhibitory effect of MPP+ on mitochondrial respiration within dopaminergic neurons is the ultimate mechanism to explain MPTP-induced neurotoxicity.

Attenuation by dopamine uptake blockers of the inhibitory effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and some of its analogs on NADH-linked metabolism in mouse neostriatal slices

In previous studies it was shown that the pyridinium species formed by the monoamine-oxidase-catalyzed conversion of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and 1-methyl-4-(2'methylphenyl)-1,2,3,6-tetrahydropyridine (2'Me-MPTP) inhibited mitochondrial electron transport at Complex I. In addition, these substances, when incubated with mouse neostriatal slices, caused an increased lactate accumulation. However, it was not clear whether this inhibition could occur within dopamine nerve terminals. In the present study we investigated if dopamine uptake blockers, shown previously to protect against tetrahydropyridine-induced dopaminergic neurotoxicity, would attenuate MPTP- and 2'Me-MPTP-promoted lactate formation in neostriatal slices. 2'Me-MPTP-induced lactate accumulation in neostriatal slices from mice or rats with a lesion of the nigrostriatal pathway was also studied. The dopamine uptake blocker, Win 35,428 [8-azabicyclo[3.2.1]octane-2-carboxylic acid, 3-(4-fluorophenyl)-8-methyl-, methylester [1R-(exo, exol)]), attenuated the increased lactate formation caused by MPTP and 2'Me-MPTP. At low concentrations of 2'Me-MPTP (5 microM), the increased lactate production was inhibited completely by Win 35,428. These latter data suggest that at low concentrations of 2'Me-MPTP, the increased lactate accumulation was associated primarily with dopaminergic nerve terminals. Two other dopamine uptake inhibitors, McN 5908 [trans-4-(1,2,3,5,6,10b-hexahydropyrrolo[2,1-alpha]isoquinolin+ ++-6-yl) benzenamine hydrobromide methanolate (4:4:1)] and mazindol [5-(4-chlorophenyl)-2,5-dihydro-3H-imidazo- [2,1-alpha]isoindol-5-ol], also attenuated tetrahydropyridine-induced lactate formation. At concentrations selective for their respective uptake systems, norepinephrine- and serotonin-uptake inhibitors did not attenuate 2'Me-MPTP-induced lactate accumulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Mesencephalic dopamine neurons become less sensitive to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine toxicity during development in vitro

The in vitro development of monoamine oxidase (MAO) activity and [3H]dopamine (DA) uptake capacity of dissociated cell cultures from rat embryo mesencephalon were correlated with the potency of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and 1-methyl-4-phenylpyridine (MPP+) neurotoxicity. Specific activities of both MAO-A and MAO-B increased during in vitro development of the cultures, with MAO-B activity increasing 20-fold between the first and fourth week. Similarly, [3H]DA accumulation increased 2.6-fold between the first and third week in vitro, when it reached a plateau. Unexpectedly, the toxicities of MPTP and MPP+ were substantially decreased in the older cultures. Exposure to MPTP reduced [3H]DA accumulation per culture by 77% in 1-week-old cultures and by 36% in 4-week-old cultures. Similarly, damage caused by MPPT was reduced from 84% of control in the first week to 34% of control in the fourth week. The attenuation of neurotoxicity was not due to an increase in storage of MPP+ in the synaptic vesicles of DA neurons, nor to a change in the distribution of MPP+ between dopaminergic and other cellular components of the cultures. The damage to DA neurons caused by the mitochondrial toxin, rotenone, also showed a similar reduction in the older cultures. These observations coupled with an increase in lactate formation and glucose consumption during the in vitro development of the cultures suggest a shift toward increased glycolysis and decreased dependence on aerobic metabolism. This would render the cells more resistant to the inhibition of mitochondrial function by MPP+.

Effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) on dopamine synthesis and release in the rabbit retina in vitro

The effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) on the synthesis and release of dopamine (DA) was investigated in the retina of the rabbit in vitro. The results indicated that MPTP did not affect the synthesis of DA, but increased its release. Blockade of the activity of monoamine oxidase (MAO) with pargyline (100 microM) did not abolish the capacity of MPTP to release DA. Similarly, these pharmacological effects of MPTP were not dependent on the presence or absence of melanin.

Investigation of dopamine content, synthesis, and release in the rabbit retina in vitro: I. Effects of dopamine precursors, reserpine, amphetamine, and L-DOPA decarboxylase and monoamine oxidase inhibitors

The basal catecholamine content of rabbit retina was determined by liquid chromatography with electrochemical detection (LC-EC) and 3,4-dihydroxyphenylethylamine (dopamine, DA) found to be the major catecholamine. The immediate DA precursor, 3,4-dihydroxyphenylalanine (L-DOPA), and the metabolite, 3,4-dihydroxyphenylacetic acid (DOPAC), were also detected at about 2.8% and 17% of DA levels, respectively. When added exogenously, L-tyrosine did not increase the rate of DA synthesis over the basal level. In contrast, exogenous L-DOPA led to a 3.5-fold increase in DA, and to a 20-fold increase in DOPAC content. The monoamine oxidase inhibitors pargyline and (-)-deprenyl differentially affected the degradation of DA, since 100 microM pargyline was apparently more effective than 100 microM (-)-deprenyl. Reserpine and (+/-)-amphetamine each induced a Ca2+-independent decrease of DA stores. The separate actions of reserpine and (+/-)-amphetamine in lowering tissue DA levels were additive, suggesting two separate pools of DA available for release from presynaptic stores. The present study demonstrates that the LC-EC technique may be used to investigate the modulation of the synthesis and release of retinal DA in vitro, without the prior uptake of radiolabelled transmitter.

Investigation of dopamine content, synthesis, and release in the rabbit retina in vitro: II. Effects of high potassium, adenylate cyclase activators, and N-n-propyl-3-(3-hydroxyphenyl) piperidine

The modulation of 3,4-dihydroxyphenylethylamine (dopamine, DA) synthesis and release in rabbit retina in vitro by high K+; adenylate cyclase activators such as forskolin, 2-chloroadenosine, vasoactive intestinal polypeptide (VIP); and the putative DA autoreceptor agonist N-n-propyl-3-(3-hydroxyphenyl) piperidine (3-PPP) has been investigated. Incubation of retinas in 50 mM K+ resulted in the activation of tyrosine hydroxylase (TH). Activation did not require the presence of extracellular Ca2+. K+ 50 mM also induced a Ca2+-dependent release of DA. Forskolin 50 microM stimulated TH but 100 microM 2-chloroadenosine and 650 nM VIP did not. Individually, (+)-3-PPP, (-)-3-PPP, and (+/-)-3-PPP reduced DA synthesis and increased its release. The effects of (+/-)-3-PPP were dose-dependent and did not require the presence of extracellular Ca2+. The activation of TH induced by 50 mM K+, but not that induced by 50 microM forskolin, was abolished by 100 microM (+/-)-3-PPP.