OBJECTIVE:This meta-analysis evaluates the safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for the treatment of older adults with obesity compared to younger individuals. METHODS:A systematic review was conducted following PRISMA guidelines (PROSPERO CRD420251074381). PubMed, Embase, and Scopus were searched until May 17, 2025, for randomized controlled trials and observational studies assessing GLP-1 RA in adults ≥ 65 years with obesity with or without type 2 diabetes. Random effects meta-analyses calculated the log odds ratios (LOR) for dichotomous outcomes and the mean differences (MD) for continuous outcomes, with equivalence testing via two one-sided tests (TOST) and meta-regression for baseline adjustments. RESULTS:Five studies involving 1229 participants were included. No significant difference in serious adverse events was found between older and younger adults (pooled LOR: 0.06, p = 0.9). Older adults had a trend toward lower frequency of nausea (LOR: -0.44, p = 0.06) but higher incidence of constipation (LOR: 0.72, p = 0.02) and hypoglycemia (LOR: 0.97, p < 0.001). Efficacy in metabolic and weight control was comparable. Additionally, one study suggested that liraglutide could reduce fat mass without worsening sarcopenia. CONCLUSIONS:GLP-1 RA therapy seems to be safe and effective in older adults with obesity, achieving similar effects on weight loss and glycemic control as in younger individuals.
OBJECTIVES:The aim of this study was to describe the long-term effectiveness and treatment persistence of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (MAbs) in migraine and to identify baseline factors associated with 2-year treatment continuation. METHODS:A prospective observational multicenter registry-based study of anti-CGRP MAbs was conducted. We analyzed changes in monthly headache days (MHDs) at 24 months (M24) compared with baseline in those who reached M24 (ON-group). We analyzed patterns of response at 4 time points (6, 12, 18, and 24 months). We defined sustained response (SR) as a ≥50% reduction in MHDs at ≥3 of 4 time points. We compared baseline characteristics of the ON-group with those of the discontinuation group because of lack of effectiveness (OFF-group). RESULTS:A total of 1,340 individuals reached M24 (ON-group: median age 48.0 [41.0-55.0] years; 81.7% female). The median MHD at baseline was 20.0 (13.0-28.0) days. At M24, 60.4% of patients demonstrated ≥50% reduction in MHDs (809/1,340). The proportion of participants achieving SR at M24 was 53.8% (142/264). When compared with the ON-group (n = 1,340), the OFF-group (n = 1,057) showed statistically significant higher baseline MHDs (ON: 20.0 [13.0-28.0] vs OFF: 25.0 [16.0-28.0]) and a greater proportion of patients with aura (ON: 16.2% vs OFF: 22.9%), depression (ON: 22.8% vs OFF: 37.9%), and obesity (ON: 7.2% vs OFF: 19.1%) (p < 0.001). DISCUSSION:Sustained reductions in MHDs to anti-CGRP treatment at 2 years was observed. Delayed treatment onset, migraine with aura, depression, and obesity may negatively affect treatment persistence. CLASSIFICATION OF EVIDENCE:This study provides Class IV evidence that, in patients with migraine, treatment with anti-CGRP MAbs is associated with sustained reductions in MHDs over a 24-month period.
PURPOSEBreast cancer (BC) is becoming a significant public health issue in Cape Verde. Understanding the profile of BC cases is crucial for improving patient outcomes and guiding public health initiatives. This study aimed to investigate the clinical and pathologic characteristics, treatment approaches, and outcomes of BC cases diagnosed and treated at Agostinho Neto University Hospital between January 2015 and July 2021 following implementation of an international treatment partnership.METHODSA retrospective analysis was conducted on 158 female patients with BC diagnosed during the study period. Data were collected on patient demographics, tumor characteristics, treatment protocols, and survival outcomes. Immunohistochemistry was performed on a subset of 114 patients to identify molecular subtypes. Descriptive statistics were used to summarize all variables. Overall survival was analyzed, and log-rank tests were performed to formally compare the survival curves and assess the statistical significance of any observed differences. Cox proportional hazard models were used to determine the independent effect of sociodemographic factors and clinical characteristics.RESULTSThe median age at diagnosis was 52.5 years, with patients ranging from 28 to 91 years. Most patients resided on Santiago Island. Invasive ductal carcinoma was the most common type, found in 93% of cases. Over half of the tumors were poorly differentiated, and 57% were diagnosed at advanced stages (III and IV). Subtype distribution mirrored sub-Saharan patterns, with 24% triple negative and 11% human epidermal growth factor receptor 2 positive. Among patients with potentially curable BC, 61.4% received adequate therapy that followed the National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for sub-Saharan Africa (SSA), including radiotherapy treatment, although this was performed abroad. The median follow-up calculated by reverse Kaplan-Meier was 33.7 months (IQR, 20.5-52.8 months). Patients treated according to stage-appropriate and phenotype-specific recommendations achieved better outcomes (79.9% 3-year survival).CONCLUSIONThis study emphasizes the importance of early diagnosis and adoption of the NCCN Harmonized Guidelines for SSA. Access to radiotherapy abroad, necessitated by the absence of local radiotherapy facilities, was correlated with improved survival. These findings underscore the feasibility of improving outcomes in low-resource settings through standardized treatment frameworks.
Accurately stratifying severity in low-flow, low-gradient (LFLG) aortic stenosis (AS) can be clinically challenging. The projected aortic valve area (AVAproj), which estimates the aortic valve area (AVA) at normal transvalvular flow rate, has been proposed as a more reliable marker of true stenosis. The TOPAS study previously demonstrated the prognostic relevance of AVAproj in identifying true severe aortic stenosis. To compare AS severity classification based on AVA estimated by continuity equation at peak dobutamine stress echocardiography (AVA-CE) versus AVAproj, and evaluate their prognostic value in predicting the composite outcome of aortic valve replacement (AVR) or all-cause mortality at 2 years. Single-center retrospective study including individuals with AS who underwent dobutamine stress echocardiography (DSE). AVA at rest (AVA-rest), AVA-CE, and AVAproj were assessed. Reclassification rates were analyzed. Logistic regression models were constructed to assess the association of AS severity (as defined by AVA-CE or AVAproj) with the composite outcome. From a total of 57 individuals with AS submitted to DSE, we included 24 patients with transvalvular flow rate at peak stress inferior to 250 mL/s. The mean age was 69±10 years, 83% were male. Echocardiographic parameters are summarized in Table 1. When comparing absolute AVA values, AVA-rest and AVA-CE were both significantly different from the AVAproj (p<0.001 and p=0.044, respectively). AVA-rest is also significantly different from AVA-CE (p=0.002). When using categorical severity classification (severe vs. moderate), 22 patients (92%) were classified as having true severe stenosis with AVA- CE and 14 patients (58%) were classified as having true severe stenosis with projected AVA. Between rest and AVA-CE, only 1 patient changed classification (1 from severe to moderate), with no statistically significant difference (p=1.000). In contrast, when comparing AVAproj to AVA-rest, 9 initially classified as severe were reclassified as moderate (p=0.004). When comparing AVAproj to AVA-CE, 8 classified as moderate by AVAproj were classified as severe at peak (p=0.008). Two logistic regression models were developed to predict the combined endpoint of AVR or death at 2 years. The first model, including rest LVEF and AVA-CE severity classification, did not reach statistical significance overall (χ²=5.75, p=0.056), and neither variable was individually predictive. The second model, which included rest LVEF and AVAproj classification, was statistically significant (χ²=10.70, p = 0.005), with AVAproj classification showing a strong association with the outcome (OR 16.17 [IC95%: 1,29–301,81], p=0.050). Projected AVA differed significantly from AVA-CE and demonstrated superior prognostic value for predicting AVR or death at 2 years. These findings support the clinical relevance of incorporating AVAproj in the evaluation of AS.Table 1.Echocardiographic parameters.
