Endocrine Practice最新文献

{"title":"Optimal use of once-weekly basal insulin efsitora alfa in type 1 and type 2 diabetes: A systematic review and meta-analysis.","authors":"Deep Dutta, Lakshmi Nagendra, Manoj Kumar, A B M Kamrul-Hasan, Saptarshi Bhattacharya","doi":"10.1016/j.eprac.2024.12.013","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.12.013","url":null,"abstract":"<p><strong>Objective: </strong>No meta-analysis has holistically analyzed and summarized the efficacy and safety of the novel once-weekly basal insulin efsitora alfa in managing type 1 diabetes (T1D) and type 2 diabetes (T2D).</p><p><strong>Methods: </strong>Clinical trials involving subjects with T1D and T2D receiving once-weekly efsitora alfa in the intervention arm and once-daily basal insulins in the control arm were searched throughout the electronic databases. The primary outcome assessed was the change from baseline in HbA1c.</p><p><strong>Results: </strong>Data from 6 studies (2,465 subjects) were analyzed (follow-up 26-54 weeks). Once-weekly efsitora alfa and once-daily degludec achieved comparable HbA1c reduction in study subjects with T2D (mean difference [MD] 0.02% [-0.11, 0.16]; P = 0.74) and T1D (MD 0.11% [-0.01, 0.22]; P = 0.08). Efsitora and degludec were similarly effective in reducing fasting plasma glucose and achieving HbA1c <7% in subjects with T2D. Individuals with T2D and T1D in the two groups had comparable time in range, time above range, and time below range. Subjects with T2D receiving efsitora and once-daily basal insulin had comparable total adverse events (TAEs), severe adverse events (SAEs), injection-site reactions, hypersensitivity events, and overall and severe hypoglycemia; however, nocturnal hypoglycemia risk was lower with efsitora (risk ratio 0.85 [0.74, 0.98]; P = 0.03). However, in individuals with T1D, TAEs, SAEs, and injection-site reactions were higher with efsitora, with comparable risks of hypersensitivity events and overall, severe and nocturnal hypoglycemia.</p><p><strong>Conclusion: </strong>Once-weekly basal insulin efsitora alfa is well tolerated with glycaemic efficacy similar to once-daily degludec.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter protein-2 inhibitors on treating metabolic dysfunction-associated steatotic liver disease or metabolic dysfunction-associated steatohepatitis: systematic review and network meta-analysis of randomised controlled trials.","authors":"Ruhan Xu, Bo Liu, Xianghai Zhou","doi":"10.1016/j.eprac.2024.11.017","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.11.017","url":null,"abstract":"<p><strong>Objective: </strong>To assess glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) and sodium-glucose cotransporter protein-2 inhibitors (SGLT-2 inhibitors) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH)(previously known as nonalcoholic fatty liver disease(NAFLD) and nonalcoholic steatohepatitis (NASH)), we performed a systematic review and network meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>The study searched Pubmed, Embase, the Cochrane Library, and Web of Science databases up to November 26, 2023. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias.</p><p><strong>Results: </strong>37 studies were included in the analysis. GLP-1 receptor agonists were found to be more effective than placebo in resolving NASH (RR: 2.48, 95%CI:1.86 to 3.30). Both drugs were superior to placebo in reducing liver fat content, as well as decreasing levels of liver enzyme. Network meta-analysis indicated that SGLT-2 inhibitors were more effective than GLP-1 receptor agonists in reducing ALT and AST levels. According to the surface under the cumulative probability ranking curve (SUCRA) values, GLP-1 receptor agonists and SGLT-2 inhibitors consistently ranked among the top two in terms of reducing anthropometric data compared to other included drugs.</p><p><strong>Conclusions: </strong>GLP-1 receptor agonists and SGLT-2 inhibitors have significant effects on reducing liver fat content and liver enzymes in NAFLD or NASH patients compared to placebo. GLP-1 receptor agonists were found to be superior to placebo in resolving NASH. SGLT-2 inhibitors were more effective than GLP-1 receptor agonists in reducing ALT and AST levels.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management Aspects of Medical Therapy in Graves' Disease.","authors":"Rutu Shah, Samantha E Adamson, Sina Jasim","doi":"10.1016/j.eprac.2024.12.012","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.12.012","url":null,"abstract":"<p><strong>Objective: </strong>Graves' disease is the most common cause of hyperthyroidism. Treatment options include antithyroid drugs, radioactive iodine, and surgery. In this review, we focus on the medical aspects of managing Graves' Disease.</p><p><strong>Methods: </strong>Authors conducted a literature review of PubMed to include studies and review articles on Graves' disease management, antithyroid drugs, long term safety of antithyroid drugs, hyperthyroidism in pregnancy, Graves' ophthalmopathy and special circumstances related to hyperthyroidism.</p><p><strong>Results: </strong>In adjunction to antithyroid drugs, medical management for Graves' disease also includes beta blockers, glucocorticoids, and iodine containing agents. Antithyroid drugs are currently the preferred option for initial management of Graves' disease, reflecting a shift in practice observed in the US over the past two decades. Antithyroid drugs in appropriate doses are well tolerated and safe when used for longer duration, during pregnancy and other circumstances discussed in this article. Routine thyroid function tests are important for monitoring. TRAb plays an essential role in determining duration of treatment and assessing the likelihood of recurrence.</p><p><strong>Conclusion: </strong>Medical management of Graves' Disease with ATD is safe and effective. Long term use beyond 24 months in patients with elevated TRAb is a reasonable alternative option to surgery and RAI due to higher rates of remission.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Life's Essential 8 and Diabetic Kidney Disease in patients with Diabetes mellitus: Evidence from NHANES 2005-2018.","authors":"Yi Wei, Jiangyi Yu","doi":"10.1016/j.eprac.2024.12.010","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.12.010","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD) is often connected with an elevated cardiovascular disease risk. A novel index, the Life's Essential 8 (LE8), was developed with the American Heart Association (AHA) to ascertain cardiovascular health. In people with diabetes mellitus (DM), we aimed to estimate if LE8 possessed a connection with DKD risk.</p><p><strong>Methods: </strong>We implemented data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. The correlation between LE8 and DKD was evaluated with weighted multivariate logistic regression models and restricted cubic spline (RCS) models with covariate adjustments. In addition, we performed subgroup analyses and interaction tests.</p><p><strong>Results: </strong>After taking into account relevant confounding factors, the findings indicated that higher levels of LE8 was linked to a decreased probability of developing DKD (per 10-point increase in LE8, OR=0.75, 95%CI=0.68-0.84, P<0.001). The subscales of the LE8 similarly demonstrated negative associations with DKD risk. After grouping the LE8 scores, it was found that individuals with high LE8 were significantly less likely to develop DKD compared to those with low LE8 (OR=0.32, 95%CI=0.15-0.70, P=0.005). The association between LE8 and DKD was consistent across different subgroups.</p><p><strong>Conclusion: </strong>LE8 scores were shown to have a significantly negative association with the risk of DKD in people with DM. By concentrating on the state of cardiovascular health, it may be possible to lessen the impact of DKD.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics, and Prevalence of Hepatic and Bone Mineral Density Abnormalities in Patients with Sheehan Syndrome: Data from a Tertiary Care Centre.","authors":"Shoiab Mohd Patto, Mohammad Hayat Bhat, Mohammad Salem Baba, Shabir Ahmad Bhat, Shahnawaz Mir, Suhail Shafi Lone, Pinaki Dutta","doi":"10.1016/j.eprac.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.12.008","url":null,"abstract":"<p><strong>Objective: </strong>Sheehan syndrome (SS), or postpartum pituitary necrosis occurs due to reduced vascular supply following postpartum hemorrhage, often linked to coagulation abnormalities, and pituitary antibodies. A smaller sella turcica volume is a risk factor for SS, consequent to compressive effects on the pituitary stalk. Hypopituitarism in SS increases the risk of metabolic liver and bone diseases. This study aims to assess the clinical profile of SS, estimate sella turcica volume, and quantify liver fat and bone mineral density.</p><p><strong>Methods: </strong>This case-control study recruited 50 patients with SS and an equal number of healthy controls.</p><p><strong>Results: </strong>The mean age (52.14±8.47 vs 51.20±7.46 years, p=0.55) and BMI (23.33±3.61 vs 23.46±3.10 kg/m², p=0.86) were similar between SS patients and controls. Lactational failure occurred in 88%, and 96% had secondary amenorrhea. Growth hormone deficiency was present in 94%, hypogonadism in 96%, thyrotroph failure in 96%, and corticotroph failure in 92%. Sella turcica volume was lower in SS patients than in controls (350.90±109.05 mm³ vs 565.47±85.15 mm³, p≤0.01) but showed no correlation with age, BMI, childbirth duration, IGF-1, or number of pituitary hormone deficiencies. Hepatic steatosis was mild in 4%, moderate in 8%, and severe in 12%. Mild fibrosis was seen in 10%, moderate in 4%, and none had severe fibrosis. Osteopenia was present in 30% and osteoporosis in 60%.</p><p><strong>Conclusion: </strong>In conclusion, SS patients had a lower Sella turcica volume than controls. Additionally, 90% had osteoporosis or osteopenia, with many also showing hepatic steatosis or fibrosis.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Study Comparing Continuous Glucose Monitoring and Capillary Glucose Testing in Patients with Type 2 Diabetes After Hospital Discharge.","authors":"Guillermo E Umpierrez, Iris Castro-Revoredo, Bobak Moazzami, Irina Nayberg, Zohyra Zabala, Rodolfo J Galindo, Priyathama Vellanki, Limin Peng, David C Klonoff","doi":"10.1016/j.eprac.2024.11.018","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.11.018","url":null,"abstract":"<p><strong>Objective: </strong>The benefits of continuous glucose monitoring (CGM) in managing hyperglycemia in hospitalized patients with type 2 diabetes (T2D) have been documented in observation and intervention clinical studies. However, the benefits of CGMs after hospital discharge in improving the care of patients with T2D remain unknown.</p><p><strong>Methods: </strong>This pilot randomized clinical trial aimed to compare the effectiveness and safety of using the FreeStyle Libre 2 CGM versus capillary point-of-care (POC) glucose testing (standard of care) in insulin-treated patients with T2D for up to 12 weeks after hospital discharge. We assessed safety (hypoglycemia), efficacy (mean daily glucose), and healthcare utilization (emergency room visits and hospital admissions) associated with the use of FreeStyle Libre 2 CGM compared to capillary POC testing following hospital discharge.</p><p><strong>Results: </strong>Among 100 participants (mean age 54.3±10.7 years, HbA1c 10.46 ± 2.24%, median diabetes duration of 9.0 years, IQR 1.0, 42), there were no significant differences in baseline clinical characteristics between the groups at discharge. We observed a trend toward improved glycemic control in the CGM group, including increased time in range (TIR) 70-180 mg/dl, reduced time above range (TAR) > 180 and 250 mg/dl, and decreased hypoglycemia and insulin requirements after discharge compared to the POC group. There were no differences in emergency room visits or hospitalization between the study groups.</p><p><strong>Conclusion: </strong>The results of this pilot study indicate that the use of CGM leads to improved glycemic control, reduced hypoglycemia, and decreased glucose variability compared to POC glucose testing after hospital discharge.</p><p><strong>Clinicaltrials: </strong>gov ID #: 05822232.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Predictive Model for Graves' Disease Recurrence After Antithyroid Drug Therapy: A Retrospective Multi-Center Cohort Study.","authors":"Omar El Kawkgi, David Toro-Tobon, Freddy J K Toloza, Sebastian Vallejo, Cristian Soto Jacome, Ivan N Ayala, Bryan A Vallejo, Camila Wenczenovicz, Olivia Tzeng, Horace J Spencer, Jeff D Thostenson, Dingfeng Li, Jacob Kohlenberg, Eddy Lincango, Sneha Mohan, Jessica Castellanos-Diaz, Spyridoula Maraka, Naykky Singh Ospina, Juan P Brito","doi":"10.1016/j.eprac.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.12.011","url":null,"abstract":"<p><strong>Objectives: </strong>Predicting recurrence after antithyroid drug (ATD) cessation is crucial for optimal treatment decision-making in patients with Graves' disease (GD). We aimed to identify factors associated with GD recurrence and to develop a model using routine pretherapeutic clinical parameters to predict GD recurrence risk during the first year following ATD discontinuation.</p><p><strong>Methods: </strong>This electronic health records-based observational cohort study analyzed patients with GD treated with ATDs at three U.S. academic centers. Demographic, clinical characteristics and GD recurrence within one year following ATD discontinuation were assessed. Univariable and multivariable analyses were performed. A predictive model for GD recurrence was developed and visualized as a nomogram.</p><p><strong>Results: </strong>Among the 523 patients included in the study, 211 (40.34%) discontinued treatment. Of these, the 142 (67.29%) that had a follow-up period exceeding 12 months after stopping ATD were used for the development of the predictive model. Among the patients included in the model, the majority were women (n=111, 78.16%), with a mean age of 49.29 years (SD 16.31) and baseline free T4 (FT4) levels averaging 3.39 ng/dl (SD 2.25). Additionally, 79/211 patients (37.44%) experienced recurrence within one year. Multivariable analysis indicated a 31% increased risk of GD recurrence per additional decade of age (OR 1.31, 95% CI 1.03-1.66, p = 0.0258), and a 65% increased risk of GD recurrence for every 2.0 ng/dL rise in baseline FT4 (OR 1.65, 95% CI 1.08-2.50, p = 0.0192). The recurrence predictive model's AUC was 0.69 in the derivation dataset and 0.65 in cross-validation.</p><p><strong>Conclusions: </strong>This study introduced a practical model that can be used during the initial therapeutic decision-making process. It utilizes easily accessible baseline clinical data to predict the likelihood of GD recurrence after one year of ATD therapy. Further research is needed to identify other factors affecting risk of recurrence and develop more precise predictive models.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Mineral Density Improvement After Resolution of Endogenous Cushing Syndrome: A Systematic Review and Meta-analysis.","authors":"Nipith Charoenngam, Thanitsara Rittiphairoj, Charalampos Plessias, Thanathip Suenghataiphorn, Thitiphan Srikulmontri, Phuuwadith Wattanachayakul, Merve Kurt","doi":"10.1016/j.eprac.2024.12.009","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.12.009","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to identify all evidence to evaluate bone mineral density (BMD) improvement after resolution of endogenous Cushing syndrome (eCS).</p><p><strong>Methods: </strong>Potentially eligible studies were identified from the EMBASE and PubMed databases from inception to February 2024, utilizing a search strategy incorporating terms related to \"Bone mineral density\" and \"Cushing syndrome\". Eligible studies must include patients diagnosed with eCS. These studies must present lumbar spine (LS) or femoral neck (FN) BMD measurements before and after resolution of eCS. Point estimates with standard errors were extracted from each study and combined using the generic inverse variance method. Meta-regression analysis was utilized to explore factors influencing BMD improvement.</p><p><strong>Results: </strong>After systematic review, 5,085 records were identified. After systematic review, 12 studies (302 patients, mean age of 13 - 44 years, % female patients 57 - 92%, follow-up time 16 - 60 months) were eligible. The meta-analysis demonstrated that resolution of eCS resulted in improvements in LS BMD (pooled MD T-score: +0.86, I² 80.4 %; 95%CI 0.51 - 1.21; Z-score: +0.86, 95%CI 0.57 - 1.16, I² 75.9%) and FN BMD (pooled MD: T-score: +0.38, 95%CI 0.26 - 0.51, I² 0.0%; Z-score: +0.44, 95%CI 0.31 - 0.57, I² 20.3%). The meta-regression analysis identified factors potentially influencing LS BMD increases, including longer follow-up time, higher %female patients and lower mean baseline 24-hour UFC, while none of these factors were significantly associated with FN BMD changes.</p><p><strong>Conclusion: </strong>Our study presents the degree and influencing factors of BMD improvement following eCS resolution. These findings offer guidance for management of eCS-associated osteoporosis.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cardiovascular outcomes between liraglutide and dulaglutide among different chronic kidney disease (CKD) stages in patients with type 2 diabetes.","authors":"Yu-Xuan Cai, Feng-Hsuan Liu, Jui-Hung Sun, Chia-Hung Lin","doi":"10.1016/j.eprac.2024.11.016","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.11.016","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the effectiveness and safety of two glucagon-like peptide-1 receptor agonists (GLP-1 RAs), liraglutide and dulaglutide, in patients with T2DM at various stages of CKD. In addition to analyzing MACE as the primary outcome, kidney function deterioration, renal disease, and other drug-related safety events, such as urinary tract infections, pancreatitis, amputations, and cancers were measured.</p><p><strong>Research design and methods: </strong>This retrospective analysis included 362,842 T2DM patients from the Chang Gung Research Database (CGRD) between 2011 and 2019, identifying 2,830 GLP-1 RA users. After applying exclusion criteria, 1,572 patients (945 on liraglutide, 627 on dulaglutide) were included. The primary outcome was MACE incidence across CKD stages.</p><p><strong>Results: </strong>Of the included patients, 945 used liraglutide, and 627 used dulaglutide. This study found no significant difference in the incidence of MACE between the two drugs across varying kidney function levels. However, in patients using liraglutide, a significant increase in MACE incidence was observed with deteriorating kidney function, from an HR of 1.401 (95% CI 0.663-2.958) at an eGFR of 60-89 ml/min/1.73 m² to an HR of 4.078 (95% CI 1.111-14.971, p=0.0079) at an eGFR of <15 ml/min/1.73 m², a trend not observed in dulaglutide users (p = 0.1906).</p><p><strong>Conclusion: </strong>Both liraglutide and dulaglutide are effective GLP-1 RAs in T2DM patients, but their impact on cardiovascular outcomes varies with CKD stage in liraglutide users. In contrast, this trend was not observed with dulaglutide, suggesting a potentially greater cardiovascular benefit of dulaglutide at more advanced CKD stages.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rituximab Treatment as Second-line Therapy in Glucocorticoid Non-responsive Graves' Orbitopathy: a Non-randomized, Controlled, Interventional Study.","authors":"Sofia Manousou, Mats Holmberg, Elin Ekdahl, Helge Malmgren, Helena Filipsson Nyström","doi":"10.1016/j.eprac.2024.12.007","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.12.007","url":null,"abstract":"<p><strong>Objective: </strong>In moderate-to-severe Graves' orbitopathy (GO), rituximab is recommended as second-line therapy in patients non-responsive to intravenous glucocorticoids. We aimed to evaluate rituximab as early second-line therapy, as data is scarce and contradictory.</p><p><strong>Methods: </strong>In this non-randomized, controlled, interventional study, patients with GO started on intravenous glucocorticoids. After 4 weeks, patients with <2 points improvement in clinical activity score (CAS) were switched to rituximab [Non-Responders Rituximab (NR-RTX) group] and were compared to the remaining patients who continued with intravenous glucocorticoids for 12 weeks [Responders-Glucocorticoid (R-GC) group]. A retrospective group of non-responsive patients who were provided regular care with intravenous glucocorticoids for 12 weeks was used as control [Non-Responders-Regular Care (NR-RC) group]. Background data and CAS were recorded for all groups at 0, 4, 12, 18, and 68 weeks. Quality of life (QoL) and safety data were collected from the NR-RTX and R-GC groups.</p><p><strong>Results: </strong>The NR-RTX group (n=12) was similar to the others at baseline except for a 1-point lower median CAS compared to the NR-RC group (n=12) (p=0.03), and for having twice as many men compared to the R-GC group (n=13) (p=0.03). At 4 weeks, a linear mixed model indicated that the R-GC group had a 1.21-point (95%CI: -2.40 to -0.02) lower value for CAS compared to the NR-RTX group. CAS for all groups converged over time. Similar models for QoL revealed no treatment or time effects.</p><p><strong>Conclusion: </strong>Switch to RTX early in the treatment course did not result in better CAS or QoL, compared to continuous intravenous glucocorticoids.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}