Asthma & COPD Treatment Guideline Updates

This article provides a summary of the newly updated asthma and COPD treatment guidelines. The Global Initiative for Asthma (GINA) treatment guidelines were updated in 2022. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines were updated in 2023. Both the GINA and GOLD treatment guidelines are published by Science Committees composed of physicians from various countries; the Science Committees meet twice yearly to review published literature and update the guideline recommendations if necessary. The purpose of this article is to highlight some of the important updates to the GINA and GOLD treatment guidelines

Pneumococcal Vaccine Guidance 2022

PCV15 and PCV20 received FDA approval in 2021. This article provides an overview of all pneumococcal vaccines - PPSV23, PCV13, PCV15, and PCV20 and their place in therapy. It provides a summary of pneumococcal disease burden in the U.S., vaccine spectrum of activity, indications, adult/pediatric dosing schedules, efficacy, and common adverse drug reactions

Novel Drugs Approved in 2021-2022

This article provides an abbreviated overview of the newly Federal Drug Administration (FDA)approved novel drugs of 2021-2022 with their respective approved indication(s). The FDA serves as the governing body that regularly evaluates and approves medications that will eventually be introduced to the market for routine use. These medications include both drugs that are the same or related to previously approved products (e.g., Extended indications of priorly approved medications) and novel drugs. By definition, a novel drug is an innovative product which serves to improve quality care in patient populations with unmet or advanced medical needs to overall advance patient care and public health. This article was employed to highlight medications that may be seen in practice and to heighten overall awareness of these new drugs. From January 1, 2021, through June 13, 2022, the FDA approved 66 drugs characterized as novel (Table 1). The four drugs highlighted in this article were selected based on potential inpatient and outpatient utility, disease-state prevalence, and overall innovative medication-based treatment approaches. The four highlighted drugs are included in Table 2

Asthma & COPD Treatment Guideline Updates

This article provides a summary of the newly updated asthma and COPD treatment guidelines. The Global Initiative for Asthma (GINA) treatment guidelines were updated in 2022. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines were updated in 2023. Both the GINA and GOLD treatment guidelines are published by Science Committees composed of physicians from various countries; the Science Committees meet twice yearly to review published literature and update the guideline recommendations if necessary. The purpose of this article is to highlight some of the important updates to the GINA and GOLD treatment guidelines.</jats:p

Pneumococcal Vaccine Guidance 2022

PCV15 and PCV20 received FDA approval in 2021. This article provides an overview of all pneumococcal vaccines - PPSV23, PCV13, PCV15, and PCV20 and their place in therapy. It provides a summary of pneumococcal disease burden in the U.S., vaccine spectrum of activity, indications, adult/pediatric dosing schedules, efficacy, and common adverse drug reactions.</jats:p

Comparative analysis of outcomes in high KDPI spectrum kidney transplants using unsupervised machine learning algorithm.

BackgroundThe Kidney Donor Profile Index (KDPI) is a continuous metric used to estimate the risk of allograft failure for kidneys from deceased donors. Lower KDPI scores are associated with longer post-transplant kidney function. This study aims to evaluate the outcomes of kidney transplantation using high-KDPI kidneys (98-100%) compared to those with moderately high KDPI scores (85-97%), employing a novel case-matching approach using machine learning.MethodsWe conducted a retrospective analysis of the United Network for Organ Sharing (UNOS) database, examining kidney transplants performed in the United States between January 2000 and May 2020. An unsupervised machine learning algorithm was used to match recipients of KDPI 98-100% kidneys with recipients of KDPI 85-97% kidneys based on key baseline characteristics, including recipient age, body mass index (BMI), cold ischemia time, HLA mismatch, ethnicity, and gender.ResultsA total of 6,624 matched cases were selected for analysis. The mean follow-up duration was 4.5 years for the KDPI 98-100% cohort and 4.6 years for the KDPI 85-97% cohort. The five-year allograft survival was 51.7% for the KDPI 98-100% group versus 58% for the KDPI 85-97% group (P ConclusionTransplantation with high-KDPI kidneys, though associated with lower survival rates, remains a viable option for expanding the donor pool. With appropriate recipient selection, high-KDPI kidneys can improve patient quality of life, reduce wait times, and lower healthcare costs. Our findings support a more nuanced approach to organ allocation using advanced matching strategies

Effects of tolvaptan discontinuation in patients with autosomal dominant polycystic kidney disease: a post hoc pooled analysis

Abstract Background Tolvaptan slows kidney function decline in patients with autosomal dominant polycystic kidney disease (ADPKD) who are at risk of rapid progression. Given that treatment requires commitment to long-term use, we evaluated the effects of tolvaptan discontinuation on the trajectory of ADPKD progression. Methods This was a post hoc analysis of pooled data from two clinical trials of tolvaptan (TEMPO 2:4 [NCT00413777] and TEMPO 3:4 [NCT00428948]), an extension trial (TEMPO 4:4 [NCT01214421]), and an observational study (OVERTURE [NCT01430494]) that enrolled patients from the other trials. Individual subject data were linked longitudinally across trials to construct analysis cohorts of subjects with a tolvaptan treatment duration > 180 days followed by an off-treatment observation period of > 180 days. For inclusion in Cohort 1, subjects were required have ≥ 2 outcome assessments during the tolvaptan treatment period and ≥ 2 assessments during the follow-up period. For Cohort 2, subjects were required to have ≥ 1 assessment during the tolvaptan treatment period and ≥ 1 assessment during the follow-up period. Outcomes were rates of change in estimated glomerular filtration rate (eGFR) and total kidney volume (TKV). Piecewise-mixed models compared changes in eGFR or TKV in the on-treatment and post-treatment periods. Results In the Cohort 1 eGFR population (n = 20), the annual rate of eGFR change (in mL/min/1.73 m2) was -3.18 on treatment and -4.33 post-treatment, a difference that was not significant (P = 0.16), whereas in Cohort 2 (n = 82), the difference between on treatment (-1.89) and post-treatment (-4.94) was significant (P < 0.001). In the Cohort 1 TKV population (n = 11), TKV increased annually by 5.18% on treatment and 11.69% post-treatment (P = 0.06). In Cohort 2 (n = 88), the annual TKV growth rates were 5.15% on treatment and 8.16% post-treatment (P = 0.001). Conclusions Although limited by small sample sizes, these analyses showed directionally consistent acceleration in measures of ADPKD progression following the discontinuation of tolvaptan

Prolonged Blood Storage and Risk of Posttransfusion Acute Kidney Injury

Background Erythrocyte transfusions are independently associated with acute kidney injury. Kidney injury may be consequent to the progressive hematologic changes that develop during storage. This study therefore tested the hypothesis that prolonged erythrocyte storage increases posttransfusion acute kidney injury. Methods The Informing Fresh versus Old Red Cell Management (INFORM) trial randomized 31,497 patients to receive either the freshest or oldest available matching erythrocyte units and showed comparable mortality with both. This a priori substudy compared the incidence of posttransfusion acute kidney injury in the randomized groups. Acute kidney injury was defined by the creatinine component of the Kidney Disease: Improving Global Outcomes criteria. Results The 14,461 patients included in this substudy received 40,077 erythrocyte units. For patients who received more than one unit, the mean age of the blood units was used as the exposure. The median of the mean age of blood units transfused per patient was 11 days [interquartile range, 8, 15] in the freshest available blood group and 23 days [interquartile range, 17, 30] in the oldest available blood group. In the primary analysis, posttransfusion acute kidney injury was observed in 688 of 4,777 (14.4%) patients given the freshest available blood and 1,487 of 9,684 (15.4%) patients given the oldest available blood, with an estimated relative risk (95% CI) of 0.94 (0.86 to 1.02; P = 0.132). The secondary analysis treated blood age as a continuous variable (defined as duration of storage in days), with an estimated relative risk (95% CI) of 1.00 (0.96 to 1.04; P = 0.978) for a 10-day increase in the mean age of erythrocyte units. Conclusions In a population of patients without severely impaired baseline renal function receiving fewer than 10 erythrocyte units, duration of blood storage had no effect on the incidence of posttransfusion acute kidney injury. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New </jats:sec