Type 2 diabetes mellitus (T2DM) represents one of the most significant metabolic challenges of the modern era, with more than 828 million people worldwide living with diabetes. Obesity and insulin resistance are major modifiable contributors to T2DM risk and progression, although the disease is heterogeneous and arises from complex interactions among β-cell dysfunction, hepatic glucose dysregulation, adipose-tissue dysfunction, altered incretin biology, chronic low-grade inflammation, and genetic susceptibility. In individuals with obesity and insulin resistance, progression through prediabetes to overt hyperglycaemia represents an important, although not universal, disease trajectory and provides a clinically relevant window for preventive intervention. This review examines pharmacological strategies relevant to T2DM prevention in individuals without established diabetes who have prediabetes and/or obesity associated with a high risk of progression to T2DM, with particular emphasis on incretin-based obesity pharmacotherapy. Metformin remains the glucose-lowering agent with the most established long-term evidence for diabetes prevention in selected high-risk individuals with prediabetes, acting through multiple hepatic and intestinal mechanisms involving both AMPK-dependent and AMPK-independent pathways. Other established antihyperglycaemic drug classes are discussed primarily to distinguish therapies with evidence for delaying progression to diabetes from agents whose principal role remains the treatment of established T2DM. SGLT2 inhibitors provide substantial cardiovascular and renal protection, although current evidence is insufficient to support their routine use solely for T2DM prevention. GLP-1 receptor agonists and the dual GIP/GLP-1 receptor agonist tirzepatide have substantially advanced obesity pharmacotherapy, producing clinically meaningful weight loss and broader cardiometabolic benefits that may reduce progression to T2DM in high-risk individuals.Next-generation incretin-based therapies, including triple receptor agonists, may further expand therapeutic options but remain an evolving area of investigation. Lifestyle intervention and sustained weight management remain the foundation of T2DM prevention, with pharmacological strategies selected according to individual metabolic risk, obesity-related treatment indications, comorbidities, and the strength of evidence supporting diabetes prevention.
OBJECTIVE:This study evaluated and compared healthcare costs associated with apixaban versus low molecular weight heparin (LMWH) treatment among cancer patients who have venous thromboembolism (VTE). METHODS:A retrospective database analysis was conducted using IQVIA's PharMetrics Plus healthcare claims database, from which patients with active cancer newly diagnosed with VTE and who initiated apixaban or LMWH on or within 30 days following the VTE diagnosis were identified. Data from 01 January 2016 through 31 December 2021 were analyzed, including a 12-month baseline and a variable (minimum one month) follow-up period. Stabilized inverse probability treatment weighting (IPTW) was applied to balance patient characteristics between treatment cohorts. All-cause costs were assessed along with recurrent VTE-, major bleeding (MB), and clinically relevant non-major (CRNM) bleeding-related costs. Two-part generalized linear models (GLM) were used to calculate cost ratios for apixaban vs. LMWH, and bootstrapping was implemented to estimate predicted costs. Costs were expressed as per patient per month (PPPM). RESULTS:Apixaban was associated with significantly lower predicted mean PPPM all-cause costs compared with the LMWH cohort ($16,408 vs. $21,203, p < 0.0001), with 23% lower PPPM costs versus LMWH (cost ratio: 0.77; 95% confidence interval [CI]: 0.74-0.81). Recurrent VTE-, MB-, and CRNM bleeding-related predicted costs were also lower with apixaban ($713 vs. $1274 [p < 0.0001], $518 vs. $1244 [p < 0.0001], and $733 vs. $980 [p = 0.014], respectively) compared to LMWH. CONCLUSION:Among cancer patients with VTE, apixaban was associated with lower all-cause, recurrent-VTE-, MB-, and CRNM bleeding-related predicted costs compared with LMWH.
Drug-resistant epilepsy (DRE) is associated with substantial healthcare utilization, impaired quality of life (QOL), and considerable societal costs. Vagus nerve stimulation (VNS) has become an established adjunctive treatment for patients who are not suitable candidates for resective epilepsy surgery or who fail to achieve adequate seizure control with pharmacotherapy. This structured narrative review critically evaluates the current evidence on the cost-effectiveness of VNS in DRE. A comprehensive literature search was conducted across PubMed, Web of Science, Embase, Google Scholar, CNKI, and Wanfang Data, and 24 eligible studies comprising observational investigations, real-world database analyses, and economic modelling studies were included. The review synthesized evidence on direct medical costs, indirect societal costs, healthcare utilization, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs), while considering methodological characteristics including study design, modelling approach, time horizon, and healthcare perspective. Overall, many studies, particularly from high-income countries, suggest that although VNS requires substantial upfront costs related to device implantation, these costs may be partially offset time through reductions in seizure frequency, hospitalizations, emergency department visits, and other epilepsy-related healthcare utilization, with several analyses reporting favorable ICERs within accepted willingness-to-pay thresholds. However, considerable heterogeneity exists across the available evidence owing to differences in healthcare systems, reimbursement policies, patient populations, device pricing, modelling assumptions, economic perspectives, outcome measures, and study durations. Consequently, the reported economic outcomes are not directly comparable across settings and should be interpreted cautiously. Furthermore, most evidence originates from high-income countries, while data from middle- and low-income settings remain limited, and many economic evaluations rely on long-term model projections rather than extended real-world follow-up. Current evidence indicates that VNS may provide favorable long-term economic value for appropriately selected patients with DRE, but its cost-effectiveness is context dependent rather than universal. Future research should prioritize standardized economic evaluation methodologies, longer-term prospective studies, and region-specific cost analyses to improve the generalizability of findings and support evidence-based healthcare policy and reimbursement decisions.
OBJECTIVE:To evaluate the relationship between standardized arm and calf blood pressure (BP) measurements obtained in the habitual posture of hemodialysis (HD) and to derive calf BP values corresponding to abnormal arm BP thresholds. METHODS:This cross-sectional study included 277 HD participants. Arm and calf BP were measured immediately before dialysis in the habitual HD posture. Linear regression estimated calf values corresponding to arm BP thresholds of 140/90 mmHg and 130/80 mmHg. Receiver operating characteristic (ROC)/Youden analysis identified optimal calf cutoffs. Cutoff-specific sensitivity, specificity, and area under the curve (AUC) were calculated, and agreement was assessed using Bland-Altman analysis. RESULTS:Participants were 55 ± 14 years old, and 64% were male. Mean arm and calf BP were 140 ± 24/83 ± 14 mmHg and 167 ± 29/92 ± 17 mmHg, respectively. Arm-calf correlations ranged from 0.72 to 0.74. Regression-derived calf values corresponding to arm BP 140/90 mmHg and 130/80 mmHg were 167/98 mmHg and 158/89 mmHg, respectively. ROC-optimized calf cutoffs were 171.5/96.7 mmHg for arm BP 140/90 mmHg and 162.2/91.2 mmHg for 130/80 mmHg. For combined SBP-or-DBP classification, the ROC-optimized cutoffs yielded sensitivity/specificity of 79.6%/76.6% and 83.7%/80.8%, with AUCs of 0.781 and 0.823, respectively. Mean calf-arm biases were +26.5 mmHg for SBP and +8.8 mmHg for DBP, with wide limits of agreement indicating substantial individual variability. CONCLUSION:In conclusion, when upper-arm BP measurement is not feasible in HD patients, ROC-derived calf BP cutoffs of approximately 170/100 mmHg and 160/90 mmHg may help identify contemporaneous arm BP thresholds of 140/90 mmHg and 130/80 mmHg, respectively. However, calf and arm BP are not interchangeable, and these cutoffs should be considered exploratory until externally validated.
OBJECTIVE:To assess adherence and healthcare resource utilization (HCRU) among adults diagnosed with schizophrenia who transitioned from oral aripiprazole or aripiprazole monohydrate once-monthly (AOM) to aripiprazole monohydrate 2-month ready-to-use (Ari 2MRTU). METHODS:Data for patients who transitioned to Ari 2MRTU were retrospectively obtained from the Kythera Labs United States closed-claims database. Outcomes were examined 6 months pre- versus post-index (first Ari 2MRTU claim = index). RESULTS:Following transition from oral aripiprazole (n = 153), proportion of days covered (PDC) and medication possession ratio (MPR) increased by 21.3% and 24.6%, respectively, and proportion of adherent patients (MPR ≥ 0.8) increased by 59.2% (all p < 0.001). Mean ± standard deviation all-cause inpatient visits and hospital length of stay (LOS) were lower post- versus pre-index (0.28 ± 0.88 vs 0.67 ± 1.85 visits and 1.05 ± 3.95 vs 2.63 ± 6.14 days, p = 0.019 and p = 0.008, respectively). For schizophrenia-related HCRU, mean LOS (0.19 ± 1.05 vs 0.91 ± 3.94, p = 0.031) and proportion of patients with ≥ 1 outpatient visit (36.0% vs 54.9%, p = 0.019) were lower post- versus pre-index. Following transition from AOM (n = 526), PDC and MPR increased by 38.8% and 36.6%, respectively, and proportion of adherent patients increased by 47.9% (all p < 0.001). All-cause LOS was lower post- versus pre-transition (0.64 ± 2.63 vs 1.05 ± 3.93 days, p = 0.047). CONCLUSION:Transitioning to Ari 2MRTU was associated with significantly improved adherence and reductions in certain HCRU measures in patients diagnosed with schizophrenia.
OBJECTIVE:To evaluate whether sublingual immunotherapy (SLIT) for Japanese cedar pollinosis is associated with subsequent initiation of antidepressants, and to assess its clinical implications for mental health management in real-world clinical practice. METHODS:We conducted a retrospective real-world cohort study using a large nationwide administrative claims database in Japan from 2014 to 2021. Adult patients diagnosed with Japanese cedar pollinosis were identified and classified as SLIT users or non-users using a new-user design. Propensity score matching was performed to balance patients' baseline characteristics, including age, sex, insurance type, and medical history. The primary outcome was initiation of antidepressant prescriptions. Hazard ratios were estimated using matched cohorts. RESULTS:A total of 4,126 SLIT users and 88,455 non-users were identified, with 3,991 propensity-matched patients in each group. Before matching, mental disorders were more prevalent among SLIT users than among non-users, whereas allergic rhinitis severity was similar between groups. Crude initiation rates of antidepressants were 5.0 and 2.9 per 1,000 person-years among SLIT users and non-users, respectively. After matching, no statistically significant association was observed between SLIT use and antidepressant initiation (hazard ratio = 1.11, 95% confidence interval = 0.73-1.69). Kaplan-Meier analysis also showed no significant between-group differences. CONCLUSION:No statistically significant association was observed between SLIT for Japanese cedar pollinosis and antidepressant initiation. These findings suggest that mental health outcomes should continue to be monitored independently of immunotherapy use in routine clinical practice. Further adequately powered studies with longer follow-up periods are warranted to better characterize depressive outcomes in this population.
An infographic titled 'What to Expect in 2026-2027: Important Health Economics and Outcomes Research (HEOR) Topics' outlines five key HEOR areas. 1. HEOR Models: AI is transforming HEOR with advanced data, but needs validation to avoid errors. 2. Real World Evidence: Essential in healthcare, it connects clinical trials with real-life practice for improved access and regulation. 3. Prevention Economics: Now a policy focus, showing that investing in prevention is financially crucial for effective implementation. 4. Health Equity: Involves expanding access, integrating social determinants and developing methods to measure healthcare impact. 5. Healthcare Resource Reallocation: Spending is shifting from austerity to resilience, emphasizing prevention for better fiscal outcomes than defense spending. The infographic includes decorative elements.An infographic listing top five HEOR topics for 2026-2027, numbered 1 to 5 with headings and summaries.
OBJECTIVE:To compare clinical and echocardiographic characteristics of ischemic and hemorrhagic stroke using sex-stratified analyses and to assess whether routine echocardiographic findings provide complementary cardiovascular information. METHODS:This retrospective observational study included 220 adults with neuroimaging-confirmed stroke treated at a secondary-care hospital specializing in physical medicine and rehabilitation between January 2023 and December 2024. Patients were classified as having ischemic stroke (n = 171) or hemorrhagic stroke (n = 49). Demographic characteristics, cardiovascular comorbidities, and routinely reported transthoracic echocardiographic findings were analyzed. Separate multivariable logistic regression models were constructed for women and men using variables with p < 0.10 in univariate analyses. RESULTS:Patients with ischemic stroke were older than those with hemorrhagic stroke (68.4 ± 10.6 vs. 63.4 ± 13.9 years; p = 0.022), and hypertension was more frequent (94.2% vs. 81.6%; p = 0.017). Among men, left ventricular diastolic dysfunction (48.1% vs. 24.1%; p = 0.021) and hypertension (95.2% vs. 79.3%; p = 0.014) were more frequent in ischemic stroke. In the male multivariable model, left ventricular diastolic dysfunction (OR = 4.835, 95% CI 1.593-14.679; p = 0.005) and hypertension (OR = 9.471, 95% CI 2.053-43.691; p = 0.004) were independently associated with ischemic rather than hemorrhagic stroke, whereas ascending aortic dilatation showed an inverse association (OR = 0.235, 95% CI 0.080-0.692; p = 0.009). No variable was independently associated with stroke subtype in women. CONCLUSION:Sex-stratified analyses identified different cardiovascular association patterns across stroke subtypes. Routine echocardiographic findings, particularly left ventricular diastolic dysfunction, may complement cardiovascular characterization in men with stroke. These exploratory findings require confirmation in larger prospective multicenter studies with formal interaction testing.
BACKGROUND:Prediabetes is a condition characterized with chronic inflammation. Alterations in hemogram parameters, especially, red cell distribution width (RDW), and mean platelet volume (MPV) are associated with inflammatory diseases. In present study, we aimed to compare hemogram parameters of subjects with prediabetes to healthy volunteers. METHODS:Patients with prediabetes were enrolled to the study who visited outpatient internal medicine clinics of our institution Hospital, between January 2023 and September 2025. Control subjects were healthy individuals who visited our clinics for a routine check-up. Hemogram parameters of prediabetes and control groups were compared. RESULTS:Study cohort was consisted of 324 subjects; 172 in prediabetes and 152 in control group. Median RDW of the prediabetes group (15,3 (2,1)%) was significantly higher than the RDW of control subjects (14,75 (3,1)%), (p < 0.001). Median MPV of the patients with prediabetes (7,9 (2,4)fL), was significantly lower than that of the controls (8,59 (2,4)fL), (p = 0.01). RDW, but not MPV, was significantly correlated with FPG (r = 0.18, p = 0.001), HbA1c (r = 0.4, p < 0.001), triglyceride (r = 0.23, p < 0.001), and serum albumin (r = 0.5, p < 0.001). The sensitivity and specificity of RDW (when higher than 14.7%) in detecting prediabetes were 69% and 49%, respectively (AUC: 0.67, p < 0.001, 95%CI: 0.61-0.73). Regression analysis, considering RDW, age, triglyceride, FPG and BMI, revealed that RDW was an independent predictor of prediabetes (OR: 1.6, p < 0.001, 95%CI: 1.3-1.9). CONCLUSIONS:We suggest that RDW reflects certain changes in cardiometabolic health that occur in association with the development of prediabetes.
BACKGROUND:Fetal growth restriction (FGR) can affect fetal brain development despite adaptive circulatory redistribution. The fetal Evans Index (EI)-the ratio of frontal horn width to inner cranial diameter-may capture proportional cranial remodeling in FGR. METHODS:In a prospective case-control study of singleton pregnancies ≥32 weeks, FGR was defined by Delphi consensus criteria. EI and frontal proportional ratios were obtained on the standardized axial transventricular plane. We evaluated how well EI distinguished FGR cases from controls and whether its association with NICU admission was independent of conventional fetal growth measurements. RESULTS:The cohort comprised 129 pregnancies (67 FGR, 62 controls). EI was lower in FGR than in controls (0.28 ± 0.02 vs 0.30 ± 0.02; p < 0.001), alongside reduced frontal horn width and a lower FABD/OFD ratio (p < 0.001). EI correlated strongly with frontal horn width (r = 0.752, p < 0.001). EI provided moderate discrimination for FGR (AUC = 0.707, 95% CI 0.617-0.797; cut-off 0.297; sensitivity 78.8%, specificity 51.6%). NICU admission was markedly higher in FGR (44.8% vs 4.8%; p < 0.001). EI ≥ 0.297 was associated with reduced NICU odds in univariate analysis (OR = 0.20, 95% CI 0.07-0.62), but not after adjustment (adjusted OR = 0.38, 95% CI 0.11-1.38); abdominal circumference percentile remained independently associated with NICU admission (adjusted OR = 0.97, 95% CI 0.95-0.99). CONCLUSIONS:Late-onset FGR is associated with reduced EI and altered frontal proportional indices, suggesting subtle anterior cerebral remodeling rather than ventriculomegaly. EI may provide complementary neurosonographic information, but its stand-alone diagnostic or prognostic value appears limited.
Irritable bowel syndrome with diarrhoea (IBS-D) is one of the most frequently encountered disorders of gut-brain interaction, yet its diagnosis remains challenging owing to the substantial symptom overlap with a wide range of conditions. These mimics, most notably microscopic colitis (MC), bile acid diarrhoea (BAD), small intestinal bacterial overgrowth (SIBO), coeliac disease, exocrine pancreatic insufficiency (EPI), endocrine disorders, lactase deficiency, sucrase-isomaltase deficiency, early inflammatory bowel disease (IBD) and functional diarrhoea (FD) can all present with identical clinical features, leading to diagnostic error, delayed treatment, and inappropriate symptom-based management. This narrative review synthesizes literature from 1997 to 2025, incorporating guideline recommendations (ACG, AGA, BSG, ECCO), RCTs, meta-analyses, systematic reviews, and expert consensus statements. This review highlights the most critical mistakes in diagnosing, evaluating, managing, and monitoring IBS-D and its mimics, with lapses in clinical reasoning and guideline adherence most consequential.
OBJECTIVES:To understand the real-world clinical and economic impact of relapsing-remitting multiple sclerosis (RRMS) in the United States (US). METHODS:This retrospective, matched-cohort study used a large, integrated US administrative health database from 01 January 2012 to 31 December 2021. People with RRMS (PwRRMS) were identified using a validated algorithm or through electronic health records and matched 1:1 to MS-free controls based on age, gender, race, region, and insurance. Demographics, comorbidities, healthcare resource utilization (HCRU), and healthcare costs (HCCs) were compared between the RRMS cohort and MS-free controls during 1-year follow-up. All costs were reported in 2021 US dollars. RESULTS:The final cohort comprised 9,290 people (RRMS, n = 4,645; MS-free controls, n = 4,645) with a mean ± SD age of 52.9 ± 14.4 years; 79.1% were female. During the follow-up period, compared with the controls, the RRMS cohort had significantly higher prevalence of infections (60.9% vs. 51.5%; p < 0.001) and MS-related comorbidities, including malaise/fatigue (34.3% vs. 15.7%), major depressive disorders (27.6% vs. 17.7%), anxiety (21.4% vs. 15.1%), burning/numbness (19.4% vs. 5.8%), and abnormal gait (16.1% vs. 5.2%) (all p < 0.001). RRMS was associated with significantly higher mortality (5.0% vs. 1.2%), hospitalizations (18.2% vs. 11.5%), emergency department visits (40.3% vs. 28.1%), and physician visits (13.7 vs. 10.0) (all p < 0.001) versus controls. Mean total HCCs were significantly higher for RRMS versus controls ($54,244 vs. $19,671; p < 0.001), driven primarily by medical claims ($31,154 vs. $15,944; p < 0.001). CONCLUSIONS:PwRRMS experienced a greater impact of comorbidities and significantly increased HCRU and HCCs, highlighting the need to integrate these impacts into everyday clinical decision‑making.
OBJECTIVE:To indirectly compare the efficacy and value of biologic therapies for acetylcholine receptor antibody-positive generalized myasthenia gravis (gMG) using a network meta-analysis (NMA) of pivotal trials and a cost-per-responder analysis. METHODS:A de novo NMA was performed using data from Phase III placebo-controlled trials of efgartigimod IV, inebilizumab, nipocalimab, ravulizumab, rozanolixizumab, and zilucoplan, including recently approved therapies. Outcomes included ≥3- and ≥5-point improvements, and continuous changes, in Myasthenia Gravis-Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores. Treatment effects, ranking probabilities, and the surface under the cumulative ranking curve (SUCRA) values were estimated. Numbers needed to treat (NNTs) versus placebo were derived from NMA results. Cost per improved outcome (CPIO) was calculated using NNTs and 2026 US drug/administration costs. RESULTS:Most therapies demonstrated significantly greater efficacy than placebo across MG-ADL and QMG outcomes. Efgartigimod IV ranked highest across nearly all endpoints considering the probability of being the most effective and SUCRA values. It had the lowest NNTs for QMG improvement (2.18 [≥3-point]; 1.88 [≥5-point]), significantly lower than almost all treatments for QMG ≥3-point, and significantly lower than zilucoplan for QMG ≥5-point (p < 0.05). It had MG-ADL NNTs of 2.77 (at least 3-point) and 1.94 (at least 5-point), with the latter significantly lower than ravulizumab (4.68) and zilucoplan (4.78) (p < 0.05). Efgartigimod IV had the lowest CPIO across all QMG and MG-ADL thresholds, significantly lower than almost all other treatments (p < 0.05). CONCLUSIONS:Among approved effective biologic therapies for gMG, efgartigimod IV offers a favorable combination of clinical efficacy and economic value.
Prediabetic neuropathy refers to early dysfunction of peripheral and autonomic nerves and may be present in individuals with impaired glucose regulation before the diagnosis of type 2 diabetes. Epidemiological evidence suggests that a substantial proportion of individuals with prediabetes may show signs of neuropathic involvement, mainly affecting small sensory fibers and autonomic function. These changes are thought to arise from multiple interacting metabolic and vascular mechanisms, including oxidative stress, microvascular dysfunction, low-grade inflammation, and impaired insulin signaling. Despite this burden, pharmacological management remains limited and is mainly focused on preventing progression to type 2 diabetes rather than directly targeting early nerve dysfunction. Emerging approaches such as modulation of the renin angiotensin system, SGLT2 inhibition, mitochondrial-targeted antioxidants, and gene-based therapies are being investigated, although most evidence remains preclinical or early clinical. Their translation into routine practice is still limited by the lack of large randomized trials and ongoing underdiagnosis. Overall, current evidence suggests a potential role for earlier mechanism informed approaches that combine pharmacological and lifestyle strategies, although stronger clinical evidence is still needed.
BACKGROUND:Nasal adrenaline spray is a novel needle-free alternative for the emergency treatment of anaphylaxis. Evidence on its cost-effectiveness versus adrenaline auto-injectors (AAIs) is currently limited. This analysis evaluates the cost-effectiveness of the nasal adrenaline spray versus an AAI in individuals ≥ 30 kg (approximately 8 years of age) at risk of all-cause anaphylaxis in the United Kingdom (UK). METHODS:A de novo Markov cohort model was developed for the UK setting from a societal perspective over a lifetime horizon. Four health states captured the risks and consequences of anaphylaxis. Clinical inputs included the probability of initial and recurrent anaphylactic episodes, adrenaline carriage, whether used, administration accuracy and needle-related administration errors. Costs included product acquisition, training, emergency care, hospitalization, needle-related administration errors, and productivity loss. Outcomes were quality-adjusted life years (QALYs), with costs and benefits discounted at 3.5% annually. The impact of uncertainty was assessed using deterministic and probabilistic sensitivity analyses. RESULTS:In the base case, the nasal adrenaline spray was dominant versus the AAI, yielding 0.26 additional QALYs at a lower cost (-£681). Cost differences were mainly driven by product acquisition, hospitalization rates and productivity loss. Results were robust across scenario analyses but were sensitive to assumptions about adrenaline carriage and use. CONCLUSIONS:In the UK, the nasal adrenaline spray may be a cost-effective alternative to AAIs, largely due to assumed higher carriage and greater likelihood of use during anaphylactic episodes. Further real-world evidence is needed to validate these assumptions and their impact on cost-effectiveness.
Montelukast entered routine respiratory practice in the late 1990s and remains widely used for asthma, allergic rhinitis (AR), and exercise-induced bronchoconstriction (EIBC). Its continued use has been driven largely by once-daily oral administration, ease of implementation, broad indications, and perceived advantages in patients with poor adherence to or difficulty using inhaled therapies. However, over time, the role of montelukast has evolved as comparative efficacy data, long-term safety findings, and treatment guidelines have modified expectations regarding its clinical value. This review re-examines the contemporary role of montelukast via integrating evidence on its mechanism of action, comparative clinical efficacy, prescribing patterns, safety outcomes, and future directions for individualized therapy. Clinical evidence demonstrates measurable benefit across asthma, AR, and EIBC; however, treatment effects are generally modest and variable and typically inferior to inhaled corticosteroid (ICS)-based regimens or intranasal corticosteroids (INCS). Nevertheless, patients, with poor inhaler adherence, exercise-related symptoms, aspirin-exacerbated respiratory disease, concomitant AR, or preference for oral therapy, may derive clinically meaningful benefit. Post-marketing surveillance has altered the therapeutic positioning of montelukast. Recognition of infrequent, but potentially serious, neuropsychiatric adverse events culminated in strengthened regulatory warnings and more cautious prescribing practices. Current management, therefore, emphasizes patient selection, pre-treatment counseling, shared decision-making, monitoring for behavioral changes, and timely review of treatment response. Current guidelines generally position montelukast as an alternative or add-on controller rather than a preferred first-line therapy. In the future, advances in pharmacogenomics, biomarker development, and phenotype-guided treatment strategies may improve the identification of patients most likely to benefit from montelukast.
OBJECTIVE:To establish consensus recommendations for initiating dextromethorphan-bupropion extended release (45 mg/105 mg) (AUVELITY) for the treatment of major depressive disorder (MDD) in adults. METHODS:US-based healthcare providers (HCPs, n = 10) with clinical experience treating MDD participated in a 3-stage modified Delphi panel procedure. An initial literature review was performed to assist in the development of draft recommendation statements. The draft recommendations were discussed and revised in two live meetings, with a series of anonymous votes taken to reach consensus for each proposed statement. Recommendations required a mean score ≥3.0 (75% agreement) to reach consensus. RESULTS:The panel reached consensus on 27 final recommendations with a mean overall agreement score of 3.8. Key consensus recommendations (abbreviated here) included: (1) dextromethorphan-bupropion is recommended as a first-line treatment for MDD, including with co-occurring symptoms of anxiety; (2) HCPs should individualize treatment decisions that prioritize safety considerations noted in the Prescribing Information; (3) dextromethorphan-bupropion is recommended for patients with inadequate response, residual symptoms, and/or intolerable side effects associated with prior MDD treatment(s); (4) when switching from (or adding to current) medication, the potential for a drug interaction should be considered, consistent with the dextromethorphan-bupropion label; and (5) switching from ketamine or esketamine should be done with caution, and with an awareness of the short-to-intermediate elimination half-lives of these drugs. CONCLUSION:These consensus panel recommendations provide real-world guidance for initiating MDD treatment with dextromethorphan-bupropion extended release and address any perceived barriers for scenarios of interest.
OBJECTIVE:Respiratory syncytial virus (RSV) vaccines are approved in the United States (US) for adults at increased risk for severe RSV disease. However, RSV disease and vaccination knowledge gaps have been reported among US adults. This study provides an up-to-date assessment of knowledge, attitudes, and practices (KAP) regarding RSV disease and vaccination among US adults at increased risk for severe RSV disease. METHODS:Between December 2024 and January 2025, a web-based survey was conducted to assess RSV-related KAP. Adults aged 18-59 years were required to have ≥1 risk factor for severe RSV disease. Descriptive results were reported overall and by age (18-49, 50-59, 60-74, and ≥75 years); multivariable logistic regression modeling identified characteristics associated with RSV-related KAP. RESULTS:Overall (N = 1227), 75.3% of respondents had heard of RSV; of these, 34.8% reported feeling knowledgeable about RSV. Most (79.6%) considered RSV vaccination as beneficial for individuals of their age and health status, and 67.4% indicated being at least somewhat likely to receive RSV vaccination following healthcare professional (HCP) recommendation. Among adults aged ≥60 years, 49.0% reported having received an HCP recommendation for RSV vaccination, and 35.3% reported ever being vaccinated. The likelihood of having discussed RSV vaccination with and/or received a recommendation from an HCP varied significantly by age and knowledge of respiratory illnesses, among other characteristics. CONCLUSIONS:RSV knowledge and practice gaps remain among US adults at increased risk for severe RSV disease. Findings can help inform patient and HCP education efforts to increase access to RSV vaccination.
