Advances in Therapy最新文献

{"title":"Humanistic Burden and Gaps in Care and Treatment Policies of Obesity in Canada: A Systematic Review.","authors":"Christine Longuet, Esther Artime, Jennifer Glass, Sam Riley, Rachel Kewley, Jennifer L Kuk, Ian Patton, David C W Lau","doi":"10.1007/s12325-026-03736-8","DOIUrl":"https://doi.org/10.1007/s12325-026-03736-8","url":null,"abstract":"<p><strong>Introduction: </strong>This article aims to describe the results of a systematic literature review of the humanistic impact of obesity in adults in Canada and to identify gaps in obesity care and treatment policies.</p><p><strong>Methods: </strong>Databases, conference proceedings, and guidelines were searched for recent publications evaluating the humanistic burden of obesity and barriers, guidelines, and treatment policies regarding obesity management worldwide, with results reported here for publications from Canada.</p><p><strong>Results: </strong>Overall, 17,130 publications were identified, of which 22 publications from Canada were included. Of these, four publications reported on humanistic burden, six reported on the barriers towards effective obesity management, and 12 reported on obesity management guidelines and treatment policies. Multimorbidity was associated with poor mental health among people with obesity (PwO), while the communication style adopted by healthcare providers perpetuated the bias and stigma faced by PwO. Barriers to effective treatment included lack of alignment on treatment goals between PwO and physicians, physicians' attitudes toward obesity, inadequate healthcare access, and underutilization of the guideline-recommended pillars of obesity management.</p><p><strong>Interpretation: </strong>The Canada-specific evidence highlighted in this review suggest a negative humanistic impact of obesity, particularly in relation to mental health outcomes and weight stigma. Findings from observational, survey-based, and environmental scan sources also suggest misalignment between guideline-recommended obesity care and real-world access, coverage, or uptake across Canadian jurisdictions. Interpretation of these findings should consider the broad scope and heterogenous nature of the evidence identified.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757412","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 and Economic Burden of Autologous Skin Grafting for Nonthermal Full-Thickness Wounds Across Care Settings: A US Retrospective Claims Study.","authors":"Lauren A Do, Mihail Samnaliev, Matthew Sussman, Roselle E Crombie, Lisa J Gould","doi":"10.1007/s12325-026-03747-5","DOIUrl":"https://doi.org/10.1007/s12325-026-03747-5","url":null,"abstract":"<p><strong>Introduction: </strong>The clinical and economic burden among patients with non-thermal full-thickness wounds (NFTW) resulting from trauma or surgery and undergoing autologous skin grafts is not well characterized. Assessing burden of care can inform treatment choice, evaluation of emerging wound therapies, and payer coverage decisions.</p><p><strong>Methods: </strong>Clarivate's Real-world Data Repository^® national claims database between 01/01/2019 and 08/31/2024 was used to select patients aged ≥ 15 years with a primary NFTW diagnosis who underwent an autologous skin graft procedure (index). Separate cohorts were analyzed according to the site of care where the index procedure was performed (inpatient, outpatient hospital, office/clinic). Kaplan-Meier estimates of the 90-day post-index adverse outcome rates, select adjunct procedures, and select medication use were generated. All-cause 12-month healthcare resource utilization (HRU) and costs [in 2024 United States (US) dollars] were also estimated.</p><p><strong>Results: </strong>Of the 26,117 patients with a NFTW, the mean age was 59.3 years and 43.3% were female. During the 12-month pre-index period 41.2% were smokers, 32.0% were obese, 31.8% had diabetes or diabetes-related comorbidities, and 21.5% were malnourished. Drug or alcohol abuse (15.6%), frailty (13.6%), and autoimmune diseases/immunodeficiency (10.4%) were also common. Traumatic wounds accounted for 56.1% and surgical wounds for 29.7% of all cases. Within 90 days, regrafting and graft failure occurred in 7.6% and 4.9% of the inpatient cohort, 3.4% and 3.1% of the outpatient hospital cohort, and 3.5% and 0.1% of the office/clinic cohort, respectively. Total mean annual costs were $266,231 (standard deviation (SD) = $458,484] per patient in the inpatient, $62,619 (SD = $132,510) in the outpatient hospital, and $14,261 (SD = $36,894) in the office/clinic cohorts with an average all-cohort cost of $128,959 (SD = $306,485).</p><p><strong>Conclusion: </strong>Patients receiving autologous skin grafts for NFTW are medically complex with high rates of complications and significant costs, highlighting the need for novel interventions or adjunct therapies to reduce the associated clinical and economic burden.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700512","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":"Difelikefalin Treatment in Chronic Kidney Disease-Associated Pruritus: Modelling Infection-Related Hospitalisation Cost Offsets Using Trial and Real-World Data Across Seven European Countries.","authors":"Annabel Rayner, James Fotheringham, Praveen Thokala, Marco Soro, Juan-Jesus Carrero, Anne-Laure Faucon","doi":"10.1007/s12325-026-03735-9","DOIUrl":"https://doi.org/10.1007/s12325-026-03735-9","url":null,"abstract":"<p><strong>Introduction: </strong>We estimated cost offsets from treating moderate-to-severe chronic kidney disease-associated pruritus (CKD-aP) with difelikefalin, through reduced infection-related hospitalisations (IRHs).</p><p><strong>Methods: </strong>Using Stockholm CREAtinine Measurements study data, IRH rates were estimated for patients who developed incident CKD-aP while on maintenance haemodialysis (2006-2021). Real-world IRH rates were applied to the time patients spent with resolved (mild/none) or persistent (moderate/severe) CKD-aP, based on randomised controlled trials of difelikefalin. Two-year national cost offsets of difelikefalin treatment were estimated using country-specific costs, the proportion of patients on haemodialysis, and established CKD-aP prevalence data for France, Italy, Portugal, Spain, Sweden, Switzerland, and the UK. Scenario analyses using alternative sources of CKD-aP prevalence and catheter infection rates were also conducted.</p><p><strong>Results: </strong>Of 2329 patients free from CKD-aP at baseline, 17.6% developed CKD-aP during follow-up. IRH rates were 1.5-fold higher with incident CKD-aP versus those who remained CKD-aP free [incidence rate ratio 1.48 (95% confidence interval 1.19-1.83); P < 0.001]. Combining incidence rates with trial data, over 2 years, patients on difelikefalin were projected to have 61.7 weeks free of CKD-aP, versus 38.1 weeks with placebo. Estimated IRH-associated 2-year offsets through difelikefalin treatment were: €2-6.4 million in France, €1.2-3.5 million in Spain, €1.1-2.6 million in Italy, €1-3 million in the UK, €0.5-1.4 million in Portugal, €0.25-0.73 million in Switzerland, and €0.23-0.66 million in Sweden.</p><p><strong>Conclusion: </strong>Modelling difelikefalin's clinical benefits on real-world IRH-associated costs projected substantial potential cost offsets nationally, indicating how CKD-aP management may offer economic value in patients undergoing haemodialysis.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700579","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":"Golimumab for the Treatment of Axial Spondyloarthritis: Integrating Clinical Outcomes with Real-World Patient Benefits.","authors":"Atul Deodhar, Tae-Jong Kim, Victoria Navarro-Compán, Sergio Fonseca, José Antunes, Arun Singh, Richard Milek, Jordan Wu, Sofia Ramiro","doi":"10.1007/s12325-026-03742-w","DOIUrl":"https://doi.org/10.1007/s12325-026-03742-w","url":null,"abstract":"<p><p>Axial spondyloarthritis is an immune-mediated inflammatory disease that primarily affects the sacroiliac joints, the spine, and the peripheral entheses and joints. The disease is associated with reduced functional ability and quality of life due to pain, fatigue, stiffness, sleep disruption, and inflammation-induced structural damage. The pathogenesis of axial spondyloarthritis involves, among other etiologies, the activation of immune-mediated proinflammatory cytokines, including tumor necrosis factor alpha, which is inhibited by golimumab, an approved treatment for the disease. Golimumab is produced using a recombinant cell line, and the antibody was derived from genetically modified mice immunized with human tumor necrosis factor alpha. This narrative review presents the primary efficacy and safety endpoints from the pivotal randomized controlled trials of golimumab. Additionally, it presents data from the post hoc analyses and real-world studies, which demonstrated benefits including decreased back pain, sleep disruption, fatigue, and disease activity as well as improved quality of life and work productivity and prolonged drug survival. Not only was golimumab associated with improvements in quality of life, general health status, and daily productivity, but a decrease in disease activity was significantly associated with these outcomes. Furthermore, golimumab was found to have a favorable safety profile, and the adverse event pattern observed was consistent with other tumor necrosis factor alpha inhibitors. Collectively, these studies showed that golimumab is an effective and safe treatment for axial spondyloarthritis.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700600","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":"Survival Motor Neuron Protein Requirement-Supply Mismatch in Spinal Muscular Atrophy: A Conceptual Framework.","authors":"Kentaro Okamoto","doi":"10.1007/s12325-026-03743-9","DOIUrl":"https://doi.org/10.1007/s12325-026-03743-9","url":null,"abstract":"<p><p>Spinal muscular atrophy (SMA) results from biallelic loss of functional survival motor neuron 1 (SMN1), reducing production of full-length survival motor neuron (SMN) protein and leaving endogenous SMN supply largely dependent on inefficient survival motor neuron 2 (SMN2) splicing. This review conceptualizes SMA as a disorder in which available SMN supply fails to meet tissue- and stage-specific SMN requirement, defined as the minimum effective SMN level needed to maintain normal cellular or tissue function. Disease-modifying therapies (DMTs) have transformed SMA outcomes, particularly when initiated presymptomatically or very early after symptom onset. However, treatment responses remain heterogeneous, especially among infants with two SMN2 copies and patients treated after symptomatic progression. These observations suggest that therapeutic response is shaped not only by SMN restoration but also by timing, residual SMN reserve, and tissue vulnerability already present at treatment initiation. This review argues that SMN requirement varies across tissues, developmental stages, and biological states. It proposes a three-component framework: developmental mismatch, post-developmental dynamic mismatch, and tissue-state transitions. Developmental mismatch is the most directly supported component and highlights tissue- and stage-specific vulnerability before and shortly after birth, particularly in the motor unit; early SMN insufficiency may leave latent developmental vulnerability even after early DMT. Post-developmental dynamic mismatch is presented as an evidence-informed, hypothesis-generating extension in which constrained SMN supply may be sufficient at baseline but inadequate during maintenance, remodeling, repair, intercurrent illness, or catabolic stress. Tissue-state transitions distinguish preserved tissue, functionally impaired but structurally retained tissue, and structurally degenerated tissue with limited reversibility. Together, this framework may help interpret residual deficits after early treatment, incomplete recovery after delayed treatment, and the need for multimodal biomarkers and longitudinal monitoring strategies that distinguish potentially reversible functional impairment from structural degeneration with limited reversibility.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700530","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":"Longitudinal Dosing Patterns and Treatment Costs Among Patients with Spinal Muscular Atrophy Initiating Nusinersen and Risdiplam.","authors":"Walter Toro Jimenez, Min Yang, Wei Song, Esteban Lemus Wirtz, Dongni Ye","doi":"10.1007/s12325-026-03687-0","DOIUrl":"https://doi.org/10.1007/s12325-026-03687-0","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal muscular atrophy (SMA) is a neuromuscular disorder historically associated with high morbidity, mortality, and healthcare costs. Disease-modifying therapies have improved outcomes, but their long-term economic burden remains uncertain. Nusinersen and risdiplam, both chronic therapies, differ from onasemnogene abeparvovec, a one-time gene therapy. Understanding real-world treatment costs of chronic SMA therapies is critical to inform therapeutic choice.</p><p><strong>Methods: </strong>This retrospective cohort study used the Komodo Health Research Database (2016-2024). Patients with SMA aged ≥ 2 years who initiated nusinersen or risdiplam were followed up to 5 years. Dosing patterns and drug acquisition and administration costs (2024 USD) were assessed annually, overall and by age group and scoliosis status.</p><p><strong>Results: </strong>Among 3864 eligible patients, 2743 initiated nusinersen and 1121 initiated risdiplam (mean age 21.4 vs. 25.3 years, respectively; 51.5% vs. 46.1% male). Median follow-up was 5.5 years for nusinersen and 1.1 years for risdiplam. Persistence declined over time, with 39.5% of patients treated with nusinersen and 63.7% of patients treated with risdiplam remaining on their index therapy at years 5 and 4. Patients treated with nusinersen received 3.6 injections on average in year 1 and 2.8-3.1 annually thereafter. Median annualized nusinersen treatment costs were $504,173 in year 1 and $438,788-548,608 in years 2-5. Patients treated with risdiplam had a median of 96 days of supply in year 1 (51.5% with > 90 days); median annualized drug costs were $143,331 overall in year 1 and $259,419 among those with > 90 days of supply, increasing to $264,701-289,340 in years 2-4. Costs were similar across subgroups.</p><p><strong>Conclusion: </strong>Nusinersen and risdiplam persistence declined over time. Among patients remaining on their index therapy, both treatments had high long-term costs, highlighting the substantial and ongoing financial burden of chronic SMA therapies and the need for real-world evidence to inform healthcare planning.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier, NCT07378943.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683024","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":"Real-World Effect of Ruxolitinib Cream: Decreased Use of Additional Topical Therapies and Limited Escalation to Systemic Treatments.","authors":"Jinan Liu, Karishma Desai, Chia-Chen Teng, Peter Chen, Vincent Willey, Daniel Sturm","doi":"10.1007/s12325-026-03670-9","DOIUrl":"https://doi.org/10.1007/s12325-026-03670-9","url":null,"abstract":"<p><strong>Introduction: </strong>Ruxolitinib cream has demonstrated efficacy and safety in patients aged ≥ 2 years with mild to moderate atopic dermatitis (AD) in clinical trials. Early real-world data have demonstrated results consistent with clinical trial observations and have indicated that initiation of ruxolitinib cream may reduce the need for other AD therapies, both topical and systemic. This analysis investigated the longer-term (18-month) effect of ruxolitinib cream on AD treatment patterns.</p><p><strong>Methods: </strong>In this retrospective, observational study, US claims data from the Healthcare Integrated Research Database (HIRD^®) were used to identify new ruxolitinib cream users aged ≥ 12 years between October 1, 2021 and July 31, 2022. The 6 months prior to the index date (first claim for ruxolitinib cream) comprised the baseline period. The 18-month follow-up period was divided into months 1-6, 7-12, and 13-18 to evaluate short- and long-term effects of ruxolitinib cream on AD treatment patterns.</p><p><strong>Results: </strong>A total of 1269 patients were included in the analysis. The mean (SD; range) number of ruxolitinib cream fills during the 18-month follow-up period was 2.4 (2.3; 1-19). By months 13-18 of follow-up, claims for topical corticosteroids, topical calcineurin inhibitors, and topical PDE4 inhibitors were reduced from baseline by 52%, 63%, and 70%, respectively. Use of oral corticosteroids was reduced by 28%, with a 32% reduction in the mean cumulative prednisone-equivalent dose. Among patients with baseline biologic AD therapy (n = 231), 35.5% did not receive biologics during months 13-18 of follow-up. Additionally, among patients without baseline biologic use (n = 1038), > 90% remained off biologics.</p><p><strong>Conclusion: </strong>Use of both topical and systemic AD therapies, including biologics, decreased over 18 months following initiation of ruxolitinib cream. These data suggest that ruxolitinib cream may reduce the need for additional topical therapies and limit escalation to systemic therapies for adults and adolescents with AD.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676681","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 Outcomes with High-Dose Amoxycillin-Clavulanate Suspension in Children with Respiratory Tract Infections: A Prospective, Multicentre, Phase IV Study in India.","authors":"Rajib Ray, Ashil Dilipbhai Manavadaria, Monjori Mitra, Saurabh Gandhi, Neeraj Yadav, Prakash Wari, Richa Giri, Chikkalingaiah Siddegowda, Suma Priya Molugu, Jitendra Shukla, M V Prashanth, Sandeep Kumar Gupta, Apurva Shetty, Shruti Saha, Supriya Sonowal, Sucheta Pandit, Dipak Patil, Gaurav Puppalwar, Pravin Ghadge, Suyog Mehta","doi":"10.1007/s12325-026-03722-0","DOIUrl":"https://doi.org/10.1007/s12325-026-03722-0","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory tract infections (RTIs) are the leading causes of paediatric morbidity worldwide, particularly in regions with high antimicrobial resistance (AMR). High-dose amoxycillin-clavulanate formulations, which increase amoxycillin exposure while maintaining standard clavulanate levels, offer enhanced antibacterial coverage with acceptable tolerability. This phase IV study evaluated the safety and observed clinical outcomes of a high-dose oral suspension of amoxycillin (600 mg/5 mL) and potassium clavulanate (42.9 mg/5 mL) in Indian children with upper RTIs or non-severe lower RTIs.</p><p><strong>Methods: </strong>This prospective, multicentre, open-label study enrolled children aged ≥ 3 months to < 18 years with tonsillopharyngitis, acute bacterial sinusitis, acute otitis media, or lobar and/or bronchopneumonia across 12 Indian centres. Participants received amoxycillin-clavulanate at 90/6.4 mg/kg/day in two divided doses for 5-10 days. The primary endpoint was the incidence of treatment-emergent adverse events (TEAEs). Secondary endpoints included serious adverse events (SAEs), diarrhoea incidence, clinical cure, clinical improvement, clinical failure, clinical relapse and time to symptom resolution. Safety analyses used the safety population, while clinical outcomes were analysed using the modified intention-to-treat population.</p><p><strong>Results: </strong>All 174 enrolled children completed the study. Overall, 21 patients (12.1%) experienced 23 TEAEs (all mild and self-limiting). No SAEs, discontinuations or clinically significant laboratory or vital sign changes were reported. Diarrhoea occurred in 6.3% of patients. Overall clinical cure rate was 82.8% (95% CI 76.3-88.1), highest in acute bacterial sinusitis (95.8%), tonsillopharyngitis (83.7%), acute otitis media (76.9%) and pneumonia (76.5%). An additional 17.2% demonstrated clinical improvement without the need for alternative therapy. No clinical failures or relapses were observed. Overall median time to symptom resolution was 6 days.</p><p><strong>Conclusion: </strong>High-dose amoxycillin-clavulanate demonstrated a favourable safety profile. Observed clinical outcomes were favourable, with a clinical cure or improvement rate of 100% across all patients. These findings provide post-marketing safety and tolerability data to support clinical decision-making in settings with rising AMR.</p><p><strong>Trial registration: </strong>Prospectively registered on Clinical Trials Registry-India [CTRI/2023/08/056267] on 08th August 2023; URL: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=ODY5MzI=&Enc=&userName= .</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676694","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":"Impact of Loco-regional Anaesthetic Techniques Versus General Anaesthesia in Women Aged ≥ 65 Undergoing Primary Breast Cancer Surgery: A Systematic Review of the Literature.","authors":"Catriona Staunton, Rachel Lee, Troy S Wildes, Nick E Heiser, Kwok-Leung Cheung, Ruth Mary Parks","doi":"10.1007/s12325-026-03698-x","DOIUrl":"https://doi.org/10.1007/s12325-026-03698-x","url":null,"abstract":"<p><strong>Introduction: </strong>Women aged ≥ 65 with multiple comorbidities are at increased risk of perioperative complications, loco-regional anaesthetic techniques (LRA) may reduce perioperative complications compared to general anaesthesia (GA); however, evidence specific to patients aged ≥ 65 is limited.</p><p><strong>Methods: </strong>A systematic search was conducted using Cochrane, Embase, MEDLINE and Web of Science from database inception to 7 April 2025. Studies comparing LRA to GA, with any number of women aged ≥ 65 undergoing primary breast cancer surgeries, were included.</p><p><strong>Results: </strong>Eight studies with a total of 255,088 women, of whom 55,310 were aged ≥ 65, were included. Four studies were prospective and four were retrospective. 192,453 women received GA. Four studies compared local anaesthesia alone (number of women aged ≥ 65, n = 54,852) to GA, and one study each compared local + regional anaesthesia (n ≥ 65 = 389), pectoral nerve blocks (n ≥ 65 = 42), paravertebral block (n ≥ 65 = 26) and thoracic epidural (n ≥ 65 = 1) to GA. Overall, LRA techniques had lower rates of post-operative nausea and vomiting, confusion and operative duration.</p><p><strong>Conclusions: </strong>LRA may have a role in patients who are unfit for or cannot undergo GA for breast cancer surgery; however, data specific to women ≥ 65 years are sparse and there are many confounding factors which impact usability of LRA techniques, for example type of breast and axillary surgery and availability of technique.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676652","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 Relevance of Bile Acid and Bile Acid-Related Therapy in Liver Cirrhosis: A Review.","authors":"Guangwen Cao, Haonan Zhao, Guo Lin, Junxiu Chen, Cong Gao, Nahum Méndez-Sánchez, Fei Gao, Xingshun Qi","doi":"10.1007/s12325-026-03696-z","DOIUrl":"10.1007/s12325-026-03696-z","url":null,"abstract":"<p><p>Cirrhosis, the end stage of various chronic liver diseases, is characterized by complex pathophysiologies and poor outcomes. Recently, dysregulation of bile acid metabolism has been increasingly recognized as a key factor in the development and progression of liver cirrhosis and decompensation. Total bile acid (TBA) levels are often elevated in patients with liver cirrhosis and are associated with hepatic dysfunction, severity of fibrosis, and specific clinical outcomes, including hepatocellular carcinoma, acute-on-chronic liver failure, hepatic encephalopathy, and short-term survival or mortality. Therefore, bile acid, particularly total bile acid, may serve as potential biomarkers for evaluating the severity, progression, and prognosis of liver cirrhosis. This paper aims to review the biosynthesis and metabolic mechanisms of bile acid, as well as their characteristic changes in viral, cholestatic, alcoholic, and metabolic dysfunction-associated steatotic liver disease, and discuss the impact of bile acid in the assessment of hepatocellular carcinoma, acute-on-chronic liver failure, and other hepatic decompensation events. Meanwhile, recent advances in bile acid-related therapeutic strategies and their potential application in liver cirrhosis are briefly summarized.Infographic available for this article https://doi.org/10.6084/m9.figshare.32716986 . INFOGRAPHIC.</p>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676632","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}