Bispebjerg Hospital is one of the hospitals in the Capital Region of Denmark. Along with a number of other hospitals and the University of Copenhagen (the Faculty of Health Sciences), Bispebjerg Hospital forms part of the Copenhagen University Hospital. The hospital is a teaching hospital for medical students from Copenhagen University..
It remains undetermined whether gastrointestinal bleeding (GIB) associated with direct oral anticoagulant (DOAC) or vitamin K antagonists (VKA) is more severe. In Danish nationwide registries, we identified patients with atrial fibrillation (AF) treated with anticoagulation with gastrointestinal bleeding (GIB). Logistic regression models were used to compare GIB severity between DOAC and VKA users, defined by 1. red blood cell transfusion or in-hospital death and 2. endoscopies. From 2012–2018, 6,784 anticoagulated AF patients with GIB were identified; 3,724 patients VKA users and 3,060 DOAC (apixaban, dabigatran or rivaroxaban) users. The proportion of upper GIB was 49
This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA2LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
BACKGROUND:Smoking is associated with hidradenitis suppurativa (HS), but the clinical significance of smoking history is poorly understood. OBJECTIVES:To examine the impact of smoking history and change in smoking behaviour on disease severity and treatment outcomes in patients with HS. METHODS:Patients with hospital-diagnosed HS from two independent prospective cohorts, the Copenhagen Hidradenitis Suppurativa Cohort (HIS-COP) and the Danish Skin Cohort (DSC), were included. Data on Hurley stage, International Hidradenitis Suppurativa Severity Score System (IHS4), Dermatology Life Quality Index (DLQI), boil-associated pain and disease-related bother were extracted from HIS-COP to assess the association between smoking status at baseline and treatment outcomes. The DSC was used to assess the effect of change in smoking status on self-reported disease severity and DLQI. RESULTS:In HIS-COP (n = 787), current smoking (53.9%) was associated with being Hurley stage III relative to I (OR = 2.38, 95% CI: 1.02-5.56, p = 0.044), higher IHS4 (OR = 1.05, 95% CI: 1.01-1.10, p = 0.018), higher DLQI (OR = 1.06, 95% CI: 1.03-1.09, p < 0.001) and greater overall disease-related bother (OR = 1.14, 95% CI: 1.07-1.22, p < 0.001) relative to never smokers when adjusted for. Increasing pack years smoked and the number of cigarettes smoked per day were significantly associated with higher IHS4 (p < 0.01 and p < 0.05, respectively); however, after adjusting for age and sex, p > 0.05. Among patients initiated on tetracycline-class treatment, current smokers had a significantly smaller mean (SD) reduction in IHS4 (2.5 (3.2) vs. 4.7 (4.9), p < 0.001), DLQI (4.2 (6.2) vs. 6.0 (6.4), p < 0.05) and percentage reduction in overall disease-related bother (2.9 (4.0) vs. 4.3 (4.0), p < 0.05), compared to non-smokers at follow-up. Smoking cessation and initiation both showed a trend towards increased self-reported disease severity after 12 months follow-up; however, data were limited. CONCLUSIONS:Smoking is associated with greater disease severity, poorer quality of life and worse treatment outcomes among patients with HS.
PURPOSE:Neoadjuvant immune checkpoint inhibition has shown promise in localized deficient mismatch repair (dMMR) colorectal cancer, yet the optimal treatment duration, regimen, and methods for response evaluation remain undefined. This trial aimed to investigate the efficacy and safety of neoadjuvant pembrolizumab for patients with localized dMMR colon cancer. METHODS:Participants received a single cycle of pembrolizumab (4 mg/kg, max 400 mg, every-6-weeks dosing regimen), followed by a preoperative endoscopy with biopsies and surgery 3-5 weeks later. The primary end point was pathologic complete response (pCR); secondary and exploratory end points included major pathologic response (MPR), safety, survival, and endoscopic response assessment. RESULTS:From February 2023 to March 2024, 85 patients (median age 74 years) were enrolled. All received pembrolizumab; one patient declined surgery. Among 84 patients, pCR was achieved in 44% (37 of 84; 95% CI, 33 to 55), and MPR in 57% (48 of 84; 95% CI, 46 to 68). Two (2%) patients died of complications within 30 days of surgery. At a median follow-up of 18.4 months (IQR, 16.3-21.1), one patient had a recurrence, resulting in overall and disease-free survival rates of 98% and 96%. Grade 3 adverse events occurred in 11% of patients (9 of 85; 95% CI, 3 to 16), with three treatment-related events. In 81 patients, the sensitivity, specificity, and accuracy of the biopsies for predicting pCR were 68%, 75%, and 72%, respectively. In 76 patients, the sensitivity, specificity, and accuracy of the endoscopic images for predicting pCR were 77%, 93%, and 86%, respectively. CONCLUSION:A single cycle of neoadjuvant pembrolizumab led to pCR in nearly half of patients undergoing surgery for localized dMMR colon cancer. The utility of endoscopic evaluation may inform future strategies for patient selection in nonoperative management pathways.
Background:Systemic corticosteroid use in severe asthma is associated with morbidity and mortality. Little is known about the long-term corticosteroid burden prior to biologic therapy. This study aims to estimate the cumulative corticosteroid burden in patients initiating biologic therapy and impact of pre-biologic disease trajectories on corticosteroid burden. Methods:Patients in the Danish Severe Asthma Register initiating biologic therapy between 2016 and 2022 had their redemptions of inhaled, nasal and systemic corticosteroids from 1995 until first administration of biologic therapy retrieved. Prednisolone-equivalent doses were calculated for all redeemed corticosteroids, presented as either cumulative or daily exposure. Results:A total of 542 patients (median follow-up 16 years) were included. Prior to biologic initiation, the median (IQR) total corticosteroid burden during follow-up was 17.1 g (8.4-36.2) of which 7.2 g (3.3-16.3) were systemic corticosteroids. 56.3% of patients were exposed to more systemic than inhaled corticosteroids. Two-thirds of patients experienced a corticosteroid exposure ≥5 mg prednisolone equivalents daily in the year prior to biologic therapy. Additionally, 10% had inhaled corticosteroid exposure ≥5 mg daily prednisolone equivalents for over two decades. Cumulative exposure was highest in chronic severe asthma patients compared to those with gradual- or recent-onset severe asthma. 72% (12.4 g (3.9-34.2)) of total corticosteroid exposure occurred prior to the first registered specialist visit. Conclusion:Patients with severe asthma have substantial cumulative corticosteroid exposure prior to biologic therapy, with the majority occurring prior to specialist assessment. Exposure reduction is a key priority to minimise corticosteroid exposure-related comorbidities.
