Objective To characterize the prevalence of metabolic syndrome (MetS), its five components and their pharmacological treatment in US adults by gender and race over time. Background MetS is a constellation of clinical risk factors for cardiovascular disease, stroke, kidney disease and type 2 diabetes mellitus. Methods Prevalence estimates were estimated in adults (≥20 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999–2010 (in 2-year survey waves). The biological thresholds, defined by the 2009 Joint Scientific Statement, were: (1) waist circumference ≥ 102 cm (males), and ≥ 88 cm (females) (2) fasting plasma glucose ≥100 mg/dl (3) blood pressure of ≥130/85 mm Hg (4) triglycerides ≥150 mg/dl (5) high-density lipoprotein-cholesterol (HDL-C) <40 mg/dl (males) and <50 mg/dl (females). Prescription drug use was estimated for lipid-modifying agents, anti-hypertensives, and anti-hyperglycemic medications. Results From 1999/2000 to 2009/10, the age-adjusted prevalence of MetS (based on biologic thresholds) decreased from 25.5% (95%CI: 22.5–28.6) to 22.9% (20.3–25.5). During this period, hypertriglyceridemia prevalence decreased (33.5% to 24.3%), as did elevated blood pressure (32.3% to 24.0%). The prevalence of hyperglycemia increased (12.9% to 19.9%), as did elevated waist circumference (45.4% to 56.1%). These trends varied considerably by gender and race/ethnicity groups. Decreases in elevated blood pressure, suboptimal triglycerides and HDL-C prevalence have corresponded with increases in anti-hypertensive and lipid-modifying drugs, respectively. Conclusion The increasing prevalence of abdominal obesity, particularly among females, highlights the urgency of addressing abdominal obesity as a healthcare priority. The use of therapies for MetS components aligns with favorable trends in their prevalence.

Penn-Pfizer Alliance and American Heart Association.

Background Improving inhaled corticosteroid (ICS) adherence should improve asthma outcomes. Objective In a randomized controlled trial we tested whether an individualized problem-solving intervention improves ICS adherence and asthma outcomes. Methods Adults with moderate or severe asthma from clinics serving inner-city neighborhoods were randomized to problem-solving (PS) (defining specific barriers to adherence, proposing/ weighing solutions, trying the best, assessing, and revising) or standard asthma education (AE) for 3 months, then observed for 3 months. Adherence was monitored electronically. Outcomes included: asthma control, FEV1, asthma-related quality of life, emergency department (ED) visits, and hospitalizations. In an intention-to-treat-analysis, longitudinal models using random effects and regression were employed. Results 333 adults were randomized: 49±14 years, 72% female, 68% African American, 7% Latino, mean FEV1 66%±19%, 103(31%) with hospitalizations and 172(52%) with ED visits for asthma in the prior year. There was no difference between groups in overall change in any outcome (p>0.20). Mean adherence (61%±27%) declined significantly (p=0.0004) over time by 14% and 10% in the AE and PS groups, respectively. Asthma control improved overall by 15% (p=0.002). In both groups, FEV1 and quality of life improved: 6% (p=0.01) and 18% (p<0.0001), respectively. However, the improvement in FEV1 only occurred during monitoring but not subsequently after randomization. Rates of ED visits and hospitalizations did not significantly decrease over the study period. Conclusion Problem-solving was not better than asthma education in improving adherence or asthma outcomes. However, monitoring ICS use with provision of medications and attention, imposed on both groups, was associated with improvement in FEV1 and asthma control. Clinical Trials registration ClinicalTrials.gov number NCT00115323.

Although specific clinical circumstances should guide therapy, our cost-effectiveness analysis supports the strategy of testing for EGFR mutations in patients with stage IV or recurrent adenocarcinoma of the lung, rebiopsying patients if insufficient tissue is available for testing, and treating patients with EGFR mutations with erlotinib as first-line therapy.

Background: Guselkumab is an interleukin-23 inhibitor indicated for treatment of moderate-to-severe plaque psoriasis. Objective: The objective was to determine the relative efficacy and safety of guselkumab compared to other biologics. Methods: A systematic review was performed to identify randomized controlled trials (RCTs). Bayesian network meta-analyses (NMAs) were conducted using meta-regression analyses that adjusted for cross-trial differences and risk differences. The primary outcome was Psoriasis Area and Severity Index (PASI) 90 response. Other efficacy and safety outcomes were considered. Several meta-regressions were performed to account for variations in patient and study characteristics: baseline risk adjustment (ie, control group response), prior biologic use, duration of psoriasis, weight, age, race, and baseline PASI/dermatology life quality index scores. The best-fitting model using predefined criteria was selected. Results: Forty-five RCTs were identified. Patient and study characteristics differed between RCTs as reflected in variations in control group response. Both the baseline risk-adjusted NMA and the risk-difference NMA fit the data best and suggested guselkumab has one of the highest PASI 90 responses. Pairwise comparisons from the baseline risk-adjusted PASI 90 NMA suggested guselkumab has comparable efficacy with ixekizumab (relative risk [RR]: 0.999, 95% credible intervals [CrIs]: 0.89-1.13) and brodalumab (RR: 1.04, 95% CrIs: 0.91-1.17) and superior efficacy versus all other treatments in the network (RR range, 1.20 to 43.22). Guselkumab was superior or comparable to other therapies for other efficacy outcomes and had a more favorable safety profile than most. Conclusions: Guselkumab has one of the highest PASI 90 responses among psoriasis treatments; similar findings were observed for other efficacy outcomes. Guselkumab has a favorable benefit-risk balance compared to moderate-to-severe psoriasis therapies.

Shortages of injectable oncology drugs appear to be widespread and to be having a significant impact on patient care. Currently available information about shortages does not meet administrative or clinical needs.

Gorham-Stout disease is a rare disease characterized by osteolysis, angiomatosis, and soft-tissue swelling. It is a diagnosis of exclusion and has an unknown etiology. Chylothorax is a common complication of the disease that is associated with a high mortality rate. There is no standard of treatment. We report a case of a 16-year-old female with Gorham-Stout disease and recurrent pleural effusions who was successfully treated with concurrent zoledronic acid and peg-interferon α-2b.

Summary Background Total work productivity loss (WPL) and associated indirect costs contribute to the economic burden of psoriasis. Objectives To estimate total WPL and related indirect costs, and identify predictors of WPL associated with psoriasis severity in France, Germany, Spain, the U.K. and Italy (EU5) and the U.S.A. Methods Data from the 2015 Adelphi Real World Psoriasis Disease Specific Programme, analysed for absenteeism, presenteeism and total WPL, were quantified (0–100%) from participants who completed the Work Productivity and Activity Impairment (WPAI) instrument. These measures were converted to indirect costs using the human capital method. Univariate and multivariate statistical analyses controlling for patient demographic and clinical characteristics were conducted. Results Of the 936 respondents (29·6% U.S.A., 70·4% EU5) who completed the WPAI, 32·6%, 40·7% and 26·6% had mild [body surface area (BSA) 0–2%], moderate (BSA 3–10%) and severe (BSA > 10%) psoriasis, respectively. Average age, Dermatology Life Quality Index (DLQI) score and BSA were, respectively, 42·4 years, 5·1 and 9·6%; and 37·2% of respondents were female. Mean percentages of total WPL for respondents with mild, moderate and severe psoriasis were 10·1%, 18·9% and 29·4%, respectively. Presenteeism contributed considerably more to total WPL than did absenteeism across all countries and disease severity classes. Mean annual indirect costs per patient due to WPL ranged from 3742 U.S. dollars in Spain to 9591 U.S. dollars in the U.S.A. Multivariate regression showed that a one‐unit increase in DLQI score increases total WPL by 1·8% (P < 0·001). Conclusions WPL increased progressively with increasing DLQI scores and BSA, confirming the relationship between psoriasis severity and its economic burden. What's already known about this topic? The economic burden of psoriasis is exceptionally high given the high prevalence and lifelong nature of the condition. Several studies have attempted to assess the overall economic burden of psoriasis but there is a lack of comparative data from different countries, and issues around inconsistent methodologies, including statistical analyses. Total work productivity loss (WPL) and associated indirect costs are believed to contribute to the economic burden of psoriasis. What does this study add? This study measured total WPL and indirect costs via the same method and at the same time point in the U.S.A., France, Germany, Spain, U.K. and Italy. Total WPL increased progressively with psoriasis disease severity. Disease severity and Dermatology Life Quality Index scores significantly correlated with WPL after controlling for patient demographic and clinical characteristics. The U.S.A. had the highest annual mean indirect costs associated with total WPL. Linked Comment: Drabo et al. Br J Dermatol 2020; 183:420–421.