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The Trump administration’s plans to study the “threat” posed by psychiatric medications in children have medical societies and mental health professionals concerned that the administration may be considering restrictions on the use of psychotropic drugs in pediatric patients.

An executive order signed last week created the “Make American Healthy Again Commission” to investigate the nation’s “escalating health crisis,” particularly in child health. Recently confirmed Secretary of the US Department of Health and Human Services Robert F. Kennedy Jr. will chair the effort.

As part of its investigation, the executive order directed the commission to assess “the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors (SSRIs), antipsychotics, mood stabilizers, stimulants, and weight-loss drugs.”

A report on the commission’s findings is due in a little less than 100 days. Eighty days later, the commission must submit recommendations for federal action.

Although who the commission members are and the scope of its work is unclear, the language in the executive order — namely the implication that the Trump administration views psychotropic medication as a “threat” to children — was enough to prompt psychiatrists from across the country to contact the American Psychiatric Association (APA) about possible limitations on the use of psychotropic medications in pediatric patients.

“It’s concerning and surprising that some of our nation’s most vulnerable children who need these treatments to participate fully in life would be under scrutiny in this way,” Marketa Wills, MD, MBA, chief executive officer and medical director for the APA, told this news organization.

“If these medications are under threat and children decompensate that would not be good from a public health perspective, for the healthcare system or for the families we serve,” Wills said.

 

Past Comments Fuel Distress

Past comments by the commission chair have only fueled distress over the commission’s goals. Kennedy has long expressed skepticism about antidepressants, especially (SSRIs), questioning their safety and suggesting they are as addictive as heroin. 

“I know people, including members of my family, who’ve had a much worse time getting off of SSRIs than they have getting off of heroin,” Kennedy said during his Senate confirmation hearing in late January.

But there is no evidence to suggest SSRIs or other antidepressants are addictive, Leslie A. Hulvershorn, MD, chair and associate professor of psychiatry at Indiana University School of Medicine, told this news organization.

“They don’t work in the systems of the brain that drive addiction. A large amount of research suggests that they are safe to take for a long time,” she said. “I suspect the confusion comes from the difference between it not being wise to come off of the medication, because of a concern for relapse of a psychiatric illness, and some transient discomfort from abruptly stopping SSRIs without tapering them off versus being addicted to it, like heroin.”

During the hearing, Kennedy was also asked to respond to comments he made during a 2023 livestream on X in which he claimed that the use of antidepressants have contributed to the increase in school shootings in the United States.

“I am also going to look very closely at the role of psychiatric drugs in these events and there are no good studies right now that should have been done years ago on this issue because there is a tremendous circumstantial evidence that SSRIs and benzos and other drugs are doing this,” he said in the livestream. 

Research has shown that there is no link between school shootings and antidepressant use.

In a 2024 interview on the Latino Capitalist podcast, Kennedy said that he wanted create “wellness farms” for adults addicted to illicit drugs and children who take antidepressants or stimulants for ADHD could be “reparented.”

“The views on those wellness farms are concerning for us here at the American Psychiatric Association. It remains to be seen if he brings that back up in his new role at HHS. There is currently no evidence of their efficacy,” Wills said.

 

Fear Is a ‘Real Concern’

These controversial comments, combined with the commission’s charge to investigate the potential “threat” psychotropic medications pose to children, worry clinicians and families fear that access to medication could be restricted.

“Psychiatrists and patients are very concerned about the risk these statements may pose,” Hulvershorn said.

“Certainly, there is evidence that psychotropic medications are overprescribed, particularly in children who are in state care — like wards of the state — and who are part of Medicaid programs, but there is tremendous overall benefit associated with psychotropic medications in youth and adults. They are lifesaving and game changing in many instances,” she added.

Psychiatrists who’ve contacted the APA since last week’s announcement echo Hulvershorn’s comments. 

“The fear is the real concern,” Wills said. “No parent takes the decision lightly to put their child on medication. With all interventions, particularly with children, there are risks and benefits that must be carefully weighed. The best person to weigh those risks and benefits is the child and adolescent psychiatrist, in conjunction with the child’s parents.”

The focus on medication also overlooks the fact that psychosocial interventions — not medication — are first-line treatment for children with mental health issues and that guidelines recommend medication be used alongside nonpharmacological therapy.

“Extensive research, including large national multi-site studies, have examined the most effective ways to reduce psychological symptoms among youth, including anxiety, depression, and ADHD. Results consistently reveal that both psychotropic medications and psychological interventions can offer significant improvements, often in combination,” Mitch Prinstein, PhD, chief of psychology strategy and integration at the American Psychological Association, told this news organization. 

“Given the substantial challenges for many in gaining access to psychotherapy and a national shortage of licensed psychologists, reducing access to medications would undoubtedly have a debilitating effect of the already concerning youth mental health crisis,” Prinstein said. 

 

A Seat at The Table

While the launch of the commission has left some feeling uneasy, experts agree that a national focus on children’s mental health is needed.

The APA would “welcome an opportunity to be part of this national conversation following the evidence base, following settled science that shows when and how these medications are effective and helpful for children and families,” said Wills. “We also think it’s very important that child and adolescent psychiatrists be at the table for this national conversation on behalf of the families they serve.” 

In a joint letter with the APA, officials with the American Academy of Child and Adolescent Psychiatry also expressed interest in playing a role in the commission’s work. 

“We are in the middle of a mental health crisis, with a record number of Americans struggling with mental health and substance use disorders. We strongly urge you to prioritize strengthening the ability to respond to an increasing demand for psychiatric services, especially for children,” the letter stated.

Indeed, looking beyond just the use of psychotropic medications is vital to the success of any strategy to address the youth mental health crisis, Hulvershorn noted. 

“There are already many programs underway to examine the overprescribing. In my view, the lack of supports by payors for behavioral interventions, such as evidence-based family interventions, psychotherapies, etc., is the major driver for overuse of medications,” she said.

“Every pediatrician and child psychiatrist I know would rather try a behavioral intervention with a family first, but those are services that our systems do not financially support well and are, thus, underdeveloped, and very difficult to access,” Hulvershorn added.

More funding for evidence-based interventions — both behavioral and pharmacological — is desperately needed, she said. Support for workforce development should also be a part of any proposed solution. 

“Adequate and responsible funding in all of those areas is needed, but we have some low hanging fruit in terms of figuring out how to just deliver the interventions that science has shown us do work,” Hulvershorn said. “Many of those interventions don’t involve medication and I think every expert in the field would be glad to see more effort put into system reform to better deliver interventions that work to youth and their families.”

A version of this article first appeared on Medscape.com.

The Trump administration’s plans to study the “threat” posed by psychiatric medications in children have medical societies and mental health professionals concerned that the administration may be considering restrictions on the use of psychotropic drugs in pediatric patients.

An executive order signed last week created the “Make American Healthy Again Commission” to investigate the nation’s “escalating health crisis,” particularly in child health. Recently confirmed Secretary of the US Department of Health and Human Services Robert F. Kennedy Jr. will chair the effort.

As part of its investigation, the executive order directed the commission to assess “the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors (SSRIs), antipsychotics, mood stabilizers, stimulants, and weight-loss drugs.”

A report on the commission’s findings is due in a little less than 100 days. Eighty days later, the commission must submit recommendations for federal action.

Although who the commission members are and the scope of its work is unclear, the language in the executive order — namely the implication that the Trump administration views psychotropic medication as a “threat” to children — was enough to prompt psychiatrists from across the country to contact the American Psychiatric Association (APA) about possible limitations on the use of psychotropic medications in pediatric patients.

“It’s concerning and surprising that some of our nation’s most vulnerable children who need these treatments to participate fully in life would be under scrutiny in this way,” Marketa Wills, MD, MBA, chief executive officer and medical director for the APA, told this news organization.

“If these medications are under threat and children decompensate that would not be good from a public health perspective, for the healthcare system or for the families we serve,” Wills said.

 

Past Comments Fuel Distress

Past comments by the commission chair have only fueled distress over the commission’s goals. Kennedy has long expressed skepticism about antidepressants, especially (SSRIs), questioning their safety and suggesting they are as addictive as heroin. 

“I know people, including members of my family, who’ve had a much worse time getting off of SSRIs than they have getting off of heroin,” Kennedy said during his Senate confirmation hearing in late January.

But there is no evidence to suggest SSRIs or other antidepressants are addictive, Leslie A. Hulvershorn, MD, chair and associate professor of psychiatry at Indiana University School of Medicine, told this news organization.

“They don’t work in the systems of the brain that drive addiction. A large amount of research suggests that they are safe to take for a long time,” she said. “I suspect the confusion comes from the difference between it not being wise to come off of the medication, because of a concern for relapse of a psychiatric illness, and some transient discomfort from abruptly stopping SSRIs without tapering them off versus being addicted to it, like heroin.”

During the hearing, Kennedy was also asked to respond to comments he made during a 2023 livestream on X in which he claimed that the use of antidepressants have contributed to the increase in school shootings in the United States.

“I am also going to look very closely at the role of psychiatric drugs in these events and there are no good studies right now that should have been done years ago on this issue because there is a tremendous circumstantial evidence that SSRIs and benzos and other drugs are doing this,” he said in the livestream. 

Research has shown that there is no link between school shootings and antidepressant use.

In a 2024 interview on the Latino Capitalist podcast, Kennedy said that he wanted create “wellness farms” for adults addicted to illicit drugs and children who take antidepressants or stimulants for ADHD could be “reparented.”

“The views on those wellness farms are concerning for us here at the American Psychiatric Association. It remains to be seen if he brings that back up in his new role at HHS. There is currently no evidence of their efficacy,” Wills said.

 

Fear Is a ‘Real Concern’

These controversial comments, combined with the commission’s charge to investigate the potential “threat” psychotropic medications pose to children, worry clinicians and families fear that access to medication could be restricted.

“Psychiatrists and patients are very concerned about the risk these statements may pose,” Hulvershorn said.

“Certainly, there is evidence that psychotropic medications are overprescribed, particularly in children who are in state care — like wards of the state — and who are part of Medicaid programs, but there is tremendous overall benefit associated with psychotropic medications in youth and adults. They are lifesaving and game changing in many instances,” she added.

Psychiatrists who’ve contacted the APA since last week’s announcement echo Hulvershorn’s comments. 

“The fear is the real concern,” Wills said. “No parent takes the decision lightly to put their child on medication. With all interventions, particularly with children, there are risks and benefits that must be carefully weighed. The best person to weigh those risks and benefits is the child and adolescent psychiatrist, in conjunction with the child’s parents.”

The focus on medication also overlooks the fact that psychosocial interventions — not medication — are first-line treatment for children with mental health issues and that guidelines recommend medication be used alongside nonpharmacological therapy.

“Extensive research, including large national multi-site studies, have examined the most effective ways to reduce psychological symptoms among youth, including anxiety, depression, and ADHD. Results consistently reveal that both psychotropic medications and psychological interventions can offer significant improvements, often in combination,” Mitch Prinstein, PhD, chief of psychology strategy and integration at the American Psychological Association, told this news organization. 

“Given the substantial challenges for many in gaining access to psychotherapy and a national shortage of licensed psychologists, reducing access to medications would undoubtedly have a debilitating effect of the already concerning youth mental health crisis,” Prinstein said. 

 

A Seat at The Table

While the launch of the commission has left some feeling uneasy, experts agree that a national focus on children’s mental health is needed.

The APA would “welcome an opportunity to be part of this national conversation following the evidence base, following settled science that shows when and how these medications are effective and helpful for children and families,” said Wills. “We also think it’s very important that child and adolescent psychiatrists be at the table for this national conversation on behalf of the families they serve.” 

In a joint letter with the APA, officials with the American Academy of Child and Adolescent Psychiatry also expressed interest in playing a role in the commission’s work. 

“We are in the middle of a mental health crisis, with a record number of Americans struggling with mental health and substance use disorders. We strongly urge you to prioritize strengthening the ability to respond to an increasing demand for psychiatric services, especially for children,” the letter stated.

Indeed, looking beyond just the use of psychotropic medications is vital to the success of any strategy to address the youth mental health crisis, Hulvershorn noted. 

“There are already many programs underway to examine the overprescribing. In my view, the lack of supports by payors for behavioral interventions, such as evidence-based family interventions, psychotherapies, etc., is the major driver for overuse of medications,” she said.

“Every pediatrician and child psychiatrist I know would rather try a behavioral intervention with a family first, but those are services that our systems do not financially support well and are, thus, underdeveloped, and very difficult to access,” Hulvershorn added.

More funding for evidence-based interventions — both behavioral and pharmacological — is desperately needed, she said. Support for workforce development should also be a part of any proposed solution. 

“Adequate and responsible funding in all of those areas is needed, but we have some low hanging fruit in terms of figuring out how to just deliver the interventions that science has shown us do work,” Hulvershorn said. “Many of those interventions don’t involve medication and I think every expert in the field would be glad to see more effort put into system reform to better deliver interventions that work to youth and their families.”

A version of this article first appeared on Medscape.com.

The Trump administration’s plans to study the “threat” posed by psychiatric medications in children have medical societies and mental health professionals concerned that the administration may be considering restrictions on the use of psychotropic drugs in pediatric patients.

An executive order signed last week created the “Make American Healthy Again Commission” to investigate the nation’s “escalating health crisis,” particularly in child health. Recently confirmed Secretary of the US Department of Health and Human Services Robert F. Kennedy Jr. will chair the effort.

As part of its investigation, the executive order directed the commission to assess “the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors (SSRIs), antipsychotics, mood stabilizers, stimulants, and weight-loss drugs.”

A report on the commission’s findings is due in a little less than 100 days. Eighty days later, the commission must submit recommendations for federal action.

Although who the commission members are and the scope of its work is unclear, the language in the executive order — namely the implication that the Trump administration views psychotropic medication as a “threat” to children — was enough to prompt psychiatrists from across the country to contact the American Psychiatric Association (APA) about possible limitations on the use of psychotropic medications in pediatric patients.

“It’s concerning and surprising that some of our nation’s most vulnerable children who need these treatments to participate fully in life would be under scrutiny in this way,” Marketa Wills, MD, MBA, chief executive officer and medical director for the APA, told this news organization.

“If these medications are under threat and children decompensate that would not be good from a public health perspective, for the healthcare system or for the families we serve,” Wills said.

 

Past Comments Fuel Distress

Past comments by the commission chair have only fueled distress over the commission’s goals. Kennedy has long expressed skepticism about antidepressants, especially (SSRIs), questioning their safety and suggesting they are as addictive as heroin. 

“I know people, including members of my family, who’ve had a much worse time getting off of SSRIs than they have getting off of heroin,” Kennedy said during his Senate confirmation hearing in late January.

But there is no evidence to suggest SSRIs or other antidepressants are addictive, Leslie A. Hulvershorn, MD, chair and associate professor of psychiatry at Indiana University School of Medicine, told this news organization.

“They don’t work in the systems of the brain that drive addiction. A large amount of research suggests that they are safe to take for a long time,” she said. “I suspect the confusion comes from the difference between it not being wise to come off of the medication, because of a concern for relapse of a psychiatric illness, and some transient discomfort from abruptly stopping SSRIs without tapering them off versus being addicted to it, like heroin.”

During the hearing, Kennedy was also asked to respond to comments he made during a 2023 livestream on X in which he claimed that the use of antidepressants have contributed to the increase in school shootings in the United States.

“I am also going to look very closely at the role of psychiatric drugs in these events and there are no good studies right now that should have been done years ago on this issue because there is a tremendous circumstantial evidence that SSRIs and benzos and other drugs are doing this,” he said in the livestream. 

Research has shown that there is no link between school shootings and antidepressant use.

In a 2024 interview on the Latino Capitalist podcast, Kennedy said that he wanted create “wellness farms” for adults addicted to illicit drugs and children who take antidepressants or stimulants for ADHD could be “reparented.”

“The views on those wellness farms are concerning for us here at the American Psychiatric Association. It remains to be seen if he brings that back up in his new role at HHS. There is currently no evidence of their efficacy,” Wills said.

 

Fear Is a ‘Real Concern’

These controversial comments, combined with the commission’s charge to investigate the potential “threat” psychotropic medications pose to children, worry clinicians and families fear that access to medication could be restricted.

“Psychiatrists and patients are very concerned about the risk these statements may pose,” Hulvershorn said.

“Certainly, there is evidence that psychotropic medications are overprescribed, particularly in children who are in state care — like wards of the state — and who are part of Medicaid programs, but there is tremendous overall benefit associated with psychotropic medications in youth and adults. They are lifesaving and game changing in many instances,” she added.

Psychiatrists who’ve contacted the APA since last week’s announcement echo Hulvershorn’s comments. 

“The fear is the real concern,” Wills said. “No parent takes the decision lightly to put their child on medication. With all interventions, particularly with children, there are risks and benefits that must be carefully weighed. The best person to weigh those risks and benefits is the child and adolescent psychiatrist, in conjunction with the child’s parents.”

The focus on medication also overlooks the fact that psychosocial interventions — not medication — are first-line treatment for children with mental health issues and that guidelines recommend medication be used alongside nonpharmacological therapy.

“Extensive research, including large national multi-site studies, have examined the most effective ways to reduce psychological symptoms among youth, including anxiety, depression, and ADHD. Results consistently reveal that both psychotropic medications and psychological interventions can offer significant improvements, often in combination,” Mitch Prinstein, PhD, chief of psychology strategy and integration at the American Psychological Association, told this news organization. 

“Given the substantial challenges for many in gaining access to psychotherapy and a national shortage of licensed psychologists, reducing access to medications would undoubtedly have a debilitating effect of the already concerning youth mental health crisis,” Prinstein said. 

 

A Seat at The Table

While the launch of the commission has left some feeling uneasy, experts agree that a national focus on children’s mental health is needed.

The APA would “welcome an opportunity to be part of this national conversation following the evidence base, following settled science that shows when and how these medications are effective and helpful for children and families,” said Wills. “We also think it’s very important that child and adolescent psychiatrists be at the table for this national conversation on behalf of the families they serve.” 

In a joint letter with the APA, officials with the American Academy of Child and Adolescent Psychiatry also expressed interest in playing a role in the commission’s work. 

“We are in the middle of a mental health crisis, with a record number of Americans struggling with mental health and substance use disorders. We strongly urge you to prioritize strengthening the ability to respond to an increasing demand for psychiatric services, especially for children,” the letter stated.

Indeed, looking beyond just the use of psychotropic medications is vital to the success of any strategy to address the youth mental health crisis, Hulvershorn noted. 

“There are already many programs underway to examine the overprescribing. In my view, the lack of supports by payors for behavioral interventions, such as evidence-based family interventions, psychotherapies, etc., is the major driver for overuse of medications,” she said.

“Every pediatrician and child psychiatrist I know would rather try a behavioral intervention with a family first, but those are services that our systems do not financially support well and are, thus, underdeveloped, and very difficult to access,” Hulvershorn added.

More funding for evidence-based interventions — both behavioral and pharmacological — is desperately needed, she said. Support for workforce development should also be a part of any proposed solution. 

“Adequate and responsible funding in all of those areas is needed, but we have some low hanging fruit in terms of figuring out how to just deliver the interventions that science has shown us do work,” Hulvershorn said. “Many of those interventions don’t involve medication and I think every expert in the field would be glad to see more effort put into system reform to better deliver interventions that work to youth and their families.”

A version of this article first appeared on Medscape.com.

A diet high in omega-3 and low in omega-6 fatty acids, alongside fish oil supplements, may curb the growth of prostate cancer cells in men with early-stage disease, new data showed.

Among men on active surveillance for prostate cancer, consuming this diet for a year led to a significant decrease in the prostate cancer tissue Ki-67 index, a biomarker for prostate cancer progression, metastasis, and death, according to findings from the phase 2 CAPFISH-3 study presented at the 2025 American Society of Clinical Oncology Genitourinary Cancers Symposium.

“This data is certainly intriguing and supports studies looking at this further in prostate cancer,” Bradley Alexander McGregor, MD, from Dana-Farber Cancer Institute, Boston, Massachusetts, who wasn’t involved in the study, told this news organization. But, McGregor noted, patients were on the diet for 1 year, and the long-term implications of this diet are not known.

 

Growing Evidence on Diet

Diets that include fried and processed foods tend to be high in omega 6s, while those that include salmon and tuna are higher in omega 3s.

Research has shown that consuming more omega-3 fatty acids is associated with a lower risk for mortality from prostate cancer, explained study investigator William Aronson, MD, with David Geffen School of Medicine at University of California, Los Angeles (UCLA). Research suggests that ingesting more omega-6 accelerates the growth of human tumors in mice, while raising omega-3 levels lowers it. High omega-3 and low omega-6 are also known to have an inhibitory effect on M2-like macrophages, which are the predominant immune cell type in prostate cancer metastasis.

To investigate the impact of these fatty acids on early-stage prostate cancer, Aronson and colleagues conducted a single-center, phase 2, randomized, open-label study in 100 men with grade 1/2 prostate cancer who elected active surveillance.

Patients were randomly allocated 1:1 to a control group that continued their normal diet (minus fish oil) or to an intervention group that followed a low omega-6/high omega-3 diet, supplemented with fish oil (2.2 g/d), for 1 year.

The primary endpoint was the change in Ki-67 index from baseline to 1 year from same-site biopsies between the groups.

For the primary endpoint, the Ki-67 index decreased in the intervention group by 15% from baseline to 1 year and increased in the control group by 24%. The difference between groups was statistically significant (P = .043).

For the secondary endpoints, the intervention led to a reduction in triglyceride levels and macrophage colony stimulating factor but no change in tumor volume grade group, PSA level, or Decipher 22 gene score.

Aronson said the findings support future phase 3 trials incorporating this intervention among men on active surveillance for prostate cancer.

McGregor said it’s important to note that this was “an aggressive intervention with dietary changes and addition of fish oil and patients need to be highly motivated.” Four men discontinued due to adverse effects — primarily gastrointestinal adverse effects such as diarrhea and nausea — larger sample sizes will be key to better understand the tolerability.

Bottom line, said McGregor, “based on this data alone, it should not be recommended but can be considered for highly motivated patients after discussion of the limitations of available data and side effects.”

The study was funded in part by the National Cancer Institute, the UCLA Health Jonsson Comprehensive Cancer Center, Howard B. Klein, and the Seafood Industry Research Fund. Aronson disclosed relationships with AstraZeneca, Bayer, Blue Earth Diagnostics, Janssen Oncology, and Pfizer/Astellas. McGregor disclosed relationships with Arcus Biosciences, Astellas Pharma, Bristol Myers Squibb, Daiichi Sankyo/AstraZeneca, Eisai, Exelixis, Genmab, Gilead Sciences, Loxo/Lilly, Pfizer, and Seattle Genetics/Astellas.

A version of this article first appeared on Medscape.com.

A diet high in omega-3 and low in omega-6 fatty acids, alongside fish oil supplements, may curb the growth of prostate cancer cells in men with early-stage disease, new data showed.

Among men on active surveillance for prostate cancer, consuming this diet for a year led to a significant decrease in the prostate cancer tissue Ki-67 index, a biomarker for prostate cancer progression, metastasis, and death, according to findings from the phase 2 CAPFISH-3 study presented at the 2025 American Society of Clinical Oncology Genitourinary Cancers Symposium.

“This data is certainly intriguing and supports studies looking at this further in prostate cancer,” Bradley Alexander McGregor, MD, from Dana-Farber Cancer Institute, Boston, Massachusetts, who wasn’t involved in the study, told this news organization. But, McGregor noted, patients were on the diet for 1 year, and the long-term implications of this diet are not known.

 

Growing Evidence on Diet

Diets that include fried and processed foods tend to be high in omega 6s, while those that include salmon and tuna are higher in omega 3s.

Research has shown that consuming more omega-3 fatty acids is associated with a lower risk for mortality from prostate cancer, explained study investigator William Aronson, MD, with David Geffen School of Medicine at University of California, Los Angeles (UCLA). Research suggests that ingesting more omega-6 accelerates the growth of human tumors in mice, while raising omega-3 levels lowers it. High omega-3 and low omega-6 are also known to have an inhibitory effect on M2-like macrophages, which are the predominant immune cell type in prostate cancer metastasis.

To investigate the impact of these fatty acids on early-stage prostate cancer, Aronson and colleagues conducted a single-center, phase 2, randomized, open-label study in 100 men with grade 1/2 prostate cancer who elected active surveillance.

Patients were randomly allocated 1:1 to a control group that continued their normal diet (minus fish oil) or to an intervention group that followed a low omega-6/high omega-3 diet, supplemented with fish oil (2.2 g/d), for 1 year.

The primary endpoint was the change in Ki-67 index from baseline to 1 year from same-site biopsies between the groups.

For the primary endpoint, the Ki-67 index decreased in the intervention group by 15% from baseline to 1 year and increased in the control group by 24%. The difference between groups was statistically significant (P = .043).

For the secondary endpoints, the intervention led to a reduction in triglyceride levels and macrophage colony stimulating factor but no change in tumor volume grade group, PSA level, or Decipher 22 gene score.

Aronson said the findings support future phase 3 trials incorporating this intervention among men on active surveillance for prostate cancer.

McGregor said it’s important to note that this was “an aggressive intervention with dietary changes and addition of fish oil and patients need to be highly motivated.” Four men discontinued due to adverse effects — primarily gastrointestinal adverse effects such as diarrhea and nausea — larger sample sizes will be key to better understand the tolerability.

Bottom line, said McGregor, “based on this data alone, it should not be recommended but can be considered for highly motivated patients after discussion of the limitations of available data and side effects.”

The study was funded in part by the National Cancer Institute, the UCLA Health Jonsson Comprehensive Cancer Center, Howard B. Klein, and the Seafood Industry Research Fund. Aronson disclosed relationships with AstraZeneca, Bayer, Blue Earth Diagnostics, Janssen Oncology, and Pfizer/Astellas. McGregor disclosed relationships with Arcus Biosciences, Astellas Pharma, Bristol Myers Squibb, Daiichi Sankyo/AstraZeneca, Eisai, Exelixis, Genmab, Gilead Sciences, Loxo/Lilly, Pfizer, and Seattle Genetics/Astellas.

A version of this article first appeared on Medscape.com.

A diet high in omega-3 and low in omega-6 fatty acids, alongside fish oil supplements, may curb the growth of prostate cancer cells in men with early-stage disease, new data showed.

Among men on active surveillance for prostate cancer, consuming this diet for a year led to a significant decrease in the prostate cancer tissue Ki-67 index, a biomarker for prostate cancer progression, metastasis, and death, according to findings from the phase 2 CAPFISH-3 study presented at the 2025 American Society of Clinical Oncology Genitourinary Cancers Symposium.

“This data is certainly intriguing and supports studies looking at this further in prostate cancer,” Bradley Alexander McGregor, MD, from Dana-Farber Cancer Institute, Boston, Massachusetts, who wasn’t involved in the study, told this news organization. But, McGregor noted, patients were on the diet for 1 year, and the long-term implications of this diet are not known.

 

Growing Evidence on Diet

Diets that include fried and processed foods tend to be high in omega 6s, while those that include salmon and tuna are higher in omega 3s.

Research has shown that consuming more omega-3 fatty acids is associated with a lower risk for mortality from prostate cancer, explained study investigator William Aronson, MD, with David Geffen School of Medicine at University of California, Los Angeles (UCLA). Research suggests that ingesting more omega-6 accelerates the growth of human tumors in mice, while raising omega-3 levels lowers it. High omega-3 and low omega-6 are also known to have an inhibitory effect on M2-like macrophages, which are the predominant immune cell type in prostate cancer metastasis.

To investigate the impact of these fatty acids on early-stage prostate cancer, Aronson and colleagues conducted a single-center, phase 2, randomized, open-label study in 100 men with grade 1/2 prostate cancer who elected active surveillance.

Patients were randomly allocated 1:1 to a control group that continued their normal diet (minus fish oil) or to an intervention group that followed a low omega-6/high omega-3 diet, supplemented with fish oil (2.2 g/d), for 1 year.

The primary endpoint was the change in Ki-67 index from baseline to 1 year from same-site biopsies between the groups.

For the primary endpoint, the Ki-67 index decreased in the intervention group by 15% from baseline to 1 year and increased in the control group by 24%. The difference between groups was statistically significant (P = .043).

For the secondary endpoints, the intervention led to a reduction in triglyceride levels and macrophage colony stimulating factor but no change in tumor volume grade group, PSA level, or Decipher 22 gene score.

Aronson said the findings support future phase 3 trials incorporating this intervention among men on active surveillance for prostate cancer.

McGregor said it’s important to note that this was “an aggressive intervention with dietary changes and addition of fish oil and patients need to be highly motivated.” Four men discontinued due to adverse effects — primarily gastrointestinal adverse effects such as diarrhea and nausea — larger sample sizes will be key to better understand the tolerability.

Bottom line, said McGregor, “based on this data alone, it should not be recommended but can be considered for highly motivated patients after discussion of the limitations of available data and side effects.”

The study was funded in part by the National Cancer Institute, the UCLA Health Jonsson Comprehensive Cancer Center, Howard B. Klein, and the Seafood Industry Research Fund. Aronson disclosed relationships with AstraZeneca, Bayer, Blue Earth Diagnostics, Janssen Oncology, and Pfizer/Astellas. McGregor disclosed relationships with Arcus Biosciences, Astellas Pharma, Bristol Myers Squibb, Daiichi Sankyo/AstraZeneca, Eisai, Exelixis, Genmab, Gilead Sciences, Loxo/Lilly, Pfizer, and Seattle Genetics/Astellas.

A version of this article first appeared on Medscape.com.

TOPLINE: Gulf War Illness (GWI) symptom severity shows negative correlation with predicted binding affinity of anthrax vaccine antigen to Human Leukocyte Antigen (HLA) Class II molecules. Stronger binding affinity is associated with weaker symptoms, with correlation coefficient r = -0.356 (P < .001).

METHODOLOGY: 

•      Researchers analyzed 458 Gulf War veterans: 397 men, 61 women, mean (SD) age 56.3 (0.5) years.
•      The aim was to determine the association between GWI symptom severity and binding affinity of anthrax Protective Antigen to HLA Class II molecules.
•      Analysis included in silico estimation of predicted binding affinity between 750 15-amino acid length subsequences of protective antigen and specific HLA Class II alleles carried by each participant.
•      Investigators assessed GWI symptom severity across 6 domains: fatigue, pain, neurological/cognitive/mood, respiratory, gastrointestinal, and dermatologic symptoms that began during or after Gulf War and lasted > 6 months. 

TAKEAWAY:

•      GWI symptom severity demonstrated significant negative correlation with strength of predicted binding affinity of protective antigen peptides to HLA-II molecules (correlation coefficient [r], −0.356; P < .001), independent of age (partial correlation, −0.376; P < .001).
•      Researchers identified 180 of 750 (24%) 15-mer epitopes with strong binding affinities to HLA-II molecules, suggesting good potential for CD4+ lymphocyte engagement.
•      Analysis revealed that DPB1 (15/31, 48%) and DRB1 (13/44, 30%) alleles showed strong binding affinity with Protective Antigen epitopes, while all DQB1 alleles (18/18, 100%) showed no strong binding.
•      The number of strong binding hits per individual ranged from 3 to 168, indicating wide variability in potential antibody production capability across participants.

IN PRACTICE: "The current findings, demonstrating a robust negative association between HLAanthrax vaccine PA binding and GWI symptom severity, strongly support the hypothesized role of reduced antibody production against anthrax vaccine PA in GWI that most probably underlies the findings supporting anthrax antigen persistence in GWI, in the broader context of antigen persistence in other diseases," Lisa M. James and Apostolos P. Georgopoulos write. 

SOURCE: The study was led by Lisa M. James and Apostolos P. Georgopoulos of the Brain Sciences Center at the Minneapolis Veterans Affairs Health Care System. It was published online on January 18 in Vaccines.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Gulf War Illness (GWI) symptom severity shows negative correlation with predicted binding affinity of anthrax vaccine antigen to Human Leukocyte Antigen (HLA) Class II molecules. Stronger binding affinity is associated with weaker symptoms, with correlation coefficient r = -0.356 (P < .001).

METHODOLOGY: 

•      Researchers analyzed 458 Gulf War veterans: 397 men, 61 women, mean (SD) age 56.3 (0.5) years.
•      The aim was to determine the association between GWI symptom severity and binding affinity of anthrax Protective Antigen to HLA Class II molecules.
•      Analysis included in silico estimation of predicted binding affinity between 750 15-amino acid length subsequences of protective antigen and specific HLA Class II alleles carried by each participant.
•      Investigators assessed GWI symptom severity across 6 domains: fatigue, pain, neurological/cognitive/mood, respiratory, gastrointestinal, and dermatologic symptoms that began during or after Gulf War and lasted > 6 months. 

TAKEAWAY:

•      GWI symptom severity demonstrated significant negative correlation with strength of predicted binding affinity of protective antigen peptides to HLA-II molecules (correlation coefficient [r], −0.356; P < .001), independent of age (partial correlation, −0.376; P < .001).
•      Researchers identified 180 of 750 (24%) 15-mer epitopes with strong binding affinities to HLA-II molecules, suggesting good potential for CD4+ lymphocyte engagement.
•      Analysis revealed that DPB1 (15/31, 48%) and DRB1 (13/44, 30%) alleles showed strong binding affinity with Protective Antigen epitopes, while all DQB1 alleles (18/18, 100%) showed no strong binding.
•      The number of strong binding hits per individual ranged from 3 to 168, indicating wide variability in potential antibody production capability across participants.

IN PRACTICE: "The current findings, demonstrating a robust negative association between HLAanthrax vaccine PA binding and GWI symptom severity, strongly support the hypothesized role of reduced antibody production against anthrax vaccine PA in GWI that most probably underlies the findings supporting anthrax antigen persistence in GWI, in the broader context of antigen persistence in other diseases," Lisa M. James and Apostolos P. Georgopoulos write. 

SOURCE: The study was led by Lisa M. James and Apostolos P. Georgopoulos of the Brain Sciences Center at the Minneapolis Veterans Affairs Health Care System. It was published online on January 18 in Vaccines.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Gulf War Illness (GWI) symptom severity shows negative correlation with predicted binding affinity of anthrax vaccine antigen to Human Leukocyte Antigen (HLA) Class II molecules. Stronger binding affinity is associated with weaker symptoms, with correlation coefficient r = -0.356 (P < .001).

METHODOLOGY: 

•      Researchers analyzed 458 Gulf War veterans: 397 men, 61 women, mean (SD) age 56.3 (0.5) years.
•      The aim was to determine the association between GWI symptom severity and binding affinity of anthrax Protective Antigen to HLA Class II molecules.
•      Analysis included in silico estimation of predicted binding affinity between 750 15-amino acid length subsequences of protective antigen and specific HLA Class II alleles carried by each participant.
•      Investigators assessed GWI symptom severity across 6 domains: fatigue, pain, neurological/cognitive/mood, respiratory, gastrointestinal, and dermatologic symptoms that began during or after Gulf War and lasted > 6 months. 

TAKEAWAY:

•      GWI symptom severity demonstrated significant negative correlation with strength of predicted binding affinity of protective antigen peptides to HLA-II molecules (correlation coefficient [r], −0.356; P < .001), independent of age (partial correlation, −0.376; P < .001).
•      Researchers identified 180 of 750 (24%) 15-mer epitopes with strong binding affinities to HLA-II molecules, suggesting good potential for CD4+ lymphocyte engagement.
•      Analysis revealed that DPB1 (15/31, 48%) and DRB1 (13/44, 30%) alleles showed strong binding affinity with Protective Antigen epitopes, while all DQB1 alleles (18/18, 100%) showed no strong binding.
•      The number of strong binding hits per individual ranged from 3 to 168, indicating wide variability in potential antibody production capability across participants.

IN PRACTICE: "The current findings, demonstrating a robust negative association between HLAanthrax vaccine PA binding and GWI symptom severity, strongly support the hypothesized role of reduced antibody production against anthrax vaccine PA in GWI that most probably underlies the findings supporting anthrax antigen persistence in GWI, in the broader context of antigen persistence in other diseases," Lisa M. James and Apostolos P. Georgopoulos write. 

SOURCE: The study was led by Lisa M. James and Apostolos P. Georgopoulos of the Brain Sciences Center at the Minneapolis Veterans Affairs Health Care System. It was published online on January 18 in Vaccines.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

People with vasculitis may need at least three or four vaccinations for COVID-19 before they start to show an immune response against SARS-CoV-2 infection, new research has suggested.

In a longitudinal retrospective study, serum antibody neutralization against the Omicron variant of the virus and its descendants was found to be “largely absent” after the first two doses of COVID-19 vaccine had been given to patients. But increasing neutralizing antibody titers were seen after both the third and fourth vaccine boosters had been administered.

Results also showed that the more recently people had been treated with the B cell–depleting therapy rituximab, the lower the levels of immunogenicity that were achieved, and thus protection against SARS-CoV-2.

“Our results have significant implications for individuals treated with rituximab in the post-Omicron era, highlighting the value of additive boosters in affirming increasing protection in clinically vulnerable populations,” the team behind the work at the University of Cambridge in England, has reported in Science Advances.

Moreover, because the use of rituximab reduced the neutralization of not just wild-type (WT) Omicron but also the Omicron-descendant variants BA.1, BA.2, BA.4, and XBB, this highlights “the urgent need for additional adjunctive strategies to enhance vaccine-induced immunity as well as preferential access for such patients to updated vaccines using spike from now circulating Omicron lineages,” the team added.

 

Studying Humoral Responses to SARS-CoV-2 Vaccines

Corresponding author Ravindra K. Gupta, BMBCh, MA, MPH, PhD, told this news organization that studying humoral responses to SARS-CoV-2 vaccines in immunocompromised individuals such as those with vasculitis was important for two main reasons.

“It is really important at individual level for their own health, of course, but also because we know that variants of concern have often evolved and developed within patients and can then spread in wider populations,” he said.

Gupta, who is professor of clinical microbiology at the Cambridge Institute for Therapeutic Immunology & Infectious Disease added: “We believe that the variants of concern that we’re having to deal with right now, including Omicron, have come from such [immunocompromised] individuals.”

Omicron “was a big shift,” Gupta noted. “It had a lot of new mutations on it, so it was almost like a new strain of the virus.” Few studies have looked at the longitudinal immunogenicity proffered by COVID vaccines in the post-Omicron era, particularly in those with vasculitis who are often treated with immunosuppressive drugs, including rituximab.

 

Two-Pronged Study Approach

For the study, a population of immunocompromised individuals diagnosed with vasculitis who had been treated with rituximab in the past 5 years was identified. Just over half (58%) had received adenovirus-based AZD1222/ChAdOx1 nCoV-19 (AstraZeneca-Oxford; AZN) and 37% BNT162b2 (Pfizer-BioNTech; mRNA) as their primary vaccines. Patients with antineutrophil cytoplasmic antibody–associated vasculitis comprised the majority of those who received rituximab (83%), compared with less than half of those who did not take rituximab (48%).

A two-pronged approach was taken with the researchers first measuring neutralizing antibody titers before and 30 days after four successive COVID vaccinations in a group of 32 individuals with available samples. They then performed a cross-sectional, case-control study in 95 individuals to look at neutralizing antibody titers and antibody-dependent cell-mediated cytotoxicity (ADCC) in individuals who had (n = 64) and had not (n = 31) been treated with rituximab in the past 5 years and had samples available after their third and fourth COVID vaccinations.

The first analysis was done to see how people were responding to vaccination over time. “That told us that there was a problem with the first two doses and that we got some response after doses three and four, but the response was uniformly quite poor against the new variants of concern,” Gupta said.

A human embryonic kidney cell model had been used to determine individuals’ neutralizing antibody titers in response to WT, BA.1, BA.2, BA.4, and XBB pseudotyped viruses. After the first and second COVID vaccinations, the geometric mean titer (GMT) against each variant barely increased from a baseline of 40.0. The greatest increases in GMT was seen with the WT virus, at 43.7, 90.7, 256.3, and 394.2, after the first, second, third and fourth doses, respectively. The lowest increases in GMT were seen with the XBB variant, with respective values of 40.0, 40.8, 45.7, and 53.9.

 

Incremental Benefit Offers Some ‘Reassurance’

Vasculitis specialist Rona Smith, MA, MB BChir, MD, who was one of the authors of the paper, told this news organization separately that the results showed there was “an incremental benefit of having COVID vaccinations,” which “offers a little bit of reassurance” that there can be an immune response in people with vasculitis.

Although results of the cross-sectional study showed that there was a significant dampening effect of rituximab treatment on the immune response, “I don’t think it’s an isolated effect in our [vasculitis] patients,” Smith suggested, adding the results were “probably still relevant to patients who receive routine dosing of rituximab for other conditions.”

Neutralizing antibody titers were consistently lower among individuals who had been treated with rituximab vs those who had not, with treatment in the past 18 months found to significantly impair immunogenicity.

The ADCC response was better preserved than the neutralizing antibody response, Gupta said, although it was still significantly lower in the rituximab-treated than in the non–rituximab-treated patients.

 

When to Vaccinate in Vasculitis?

Regarding when to give vaccines to people with vasculitis, Smith said: “Current recommendations are that patients should receive any vaccines that they’re offered routinely, whether that be COVID vaccines, flu vaccines, pneumococcal vaccines.”

As for the timing of those vaccinations, she observed that the current thinking was that vaccinations should “ideally be at least 1 month before a rituximab treatment, and ideally 3-4 [months] after their last dose. However, as many patients are on a 6-month dosing cycle, it can be difficult for some of them to find a suitable time window to have the COVID vaccine when it is offered.”

Additional precautions, such as wearing masks in crowded places and avoiding visits to acutely unwell friends or relatives, may still be prudent, Smith acknowledged, but he was clear that people should not be locking themselves away as they did during the COVID-19 pandemic.

When advising patients, “our general recommendation is that it is better to have a vaccine than not, but we can’t guarantee how well you will respond to it, but some response is better than none,” Smith said.

The study was independently supported. Gupta had no relevant financial relationships to disclose. Smith was a coauthor of the paper and has received research grant funding from Union Therapeutics, GlaxoSmithKline/Vir Biotechnology, Addenbrooke’s Charitable Trust, and Vasculitis UK. Another coauthor reported receiving research grants from CSL Vifor, Roche, and GlaxoSmithKline and advisory board, consultancy, and lecture fees from Roche and CSL Vifor.

A version of this article first appeared on Medscape.com.

People with vasculitis may need at least three or four vaccinations for COVID-19 before they start to show an immune response against SARS-CoV-2 infection, new research has suggested.

In a longitudinal retrospective study, serum antibody neutralization against the Omicron variant of the virus and its descendants was found to be “largely absent” after the first two doses of COVID-19 vaccine had been given to patients. But increasing neutralizing antibody titers were seen after both the third and fourth vaccine boosters had been administered.

Results also showed that the more recently people had been treated with the B cell–depleting therapy rituximab, the lower the levels of immunogenicity that were achieved, and thus protection against SARS-CoV-2.

“Our results have significant implications for individuals treated with rituximab in the post-Omicron era, highlighting the value of additive boosters in affirming increasing protection in clinically vulnerable populations,” the team behind the work at the University of Cambridge in England, has reported in Science Advances.

Moreover, because the use of rituximab reduced the neutralization of not just wild-type (WT) Omicron but also the Omicron-descendant variants BA.1, BA.2, BA.4, and XBB, this highlights “the urgent need for additional adjunctive strategies to enhance vaccine-induced immunity as well as preferential access for such patients to updated vaccines using spike from now circulating Omicron lineages,” the team added.

 

Studying Humoral Responses to SARS-CoV-2 Vaccines

Corresponding author Ravindra K. Gupta, BMBCh, MA, MPH, PhD, told this news organization that studying humoral responses to SARS-CoV-2 vaccines in immunocompromised individuals such as those with vasculitis was important for two main reasons.

“It is really important at individual level for their own health, of course, but also because we know that variants of concern have often evolved and developed within patients and can then spread in wider populations,” he said.

Gupta, who is professor of clinical microbiology at the Cambridge Institute for Therapeutic Immunology & Infectious Disease added: “We believe that the variants of concern that we’re having to deal with right now, including Omicron, have come from such [immunocompromised] individuals.”

Omicron “was a big shift,” Gupta noted. “It had a lot of new mutations on it, so it was almost like a new strain of the virus.” Few studies have looked at the longitudinal immunogenicity proffered by COVID vaccines in the post-Omicron era, particularly in those with vasculitis who are often treated with immunosuppressive drugs, including rituximab.

 

Two-Pronged Study Approach

For the study, a population of immunocompromised individuals diagnosed with vasculitis who had been treated with rituximab in the past 5 years was identified. Just over half (58%) had received adenovirus-based AZD1222/ChAdOx1 nCoV-19 (AstraZeneca-Oxford; AZN) and 37% BNT162b2 (Pfizer-BioNTech; mRNA) as their primary vaccines. Patients with antineutrophil cytoplasmic antibody–associated vasculitis comprised the majority of those who received rituximab (83%), compared with less than half of those who did not take rituximab (48%).

A two-pronged approach was taken with the researchers first measuring neutralizing antibody titers before and 30 days after four successive COVID vaccinations in a group of 32 individuals with available samples. They then performed a cross-sectional, case-control study in 95 individuals to look at neutralizing antibody titers and antibody-dependent cell-mediated cytotoxicity (ADCC) in individuals who had (n = 64) and had not (n = 31) been treated with rituximab in the past 5 years and had samples available after their third and fourth COVID vaccinations.

The first analysis was done to see how people were responding to vaccination over time. “That told us that there was a problem with the first two doses and that we got some response after doses three and four, but the response was uniformly quite poor against the new variants of concern,” Gupta said.

A human embryonic kidney cell model had been used to determine individuals’ neutralizing antibody titers in response to WT, BA.1, BA.2, BA.4, and XBB pseudotyped viruses. After the first and second COVID vaccinations, the geometric mean titer (GMT) against each variant barely increased from a baseline of 40.0. The greatest increases in GMT was seen with the WT virus, at 43.7, 90.7, 256.3, and 394.2, after the first, second, third and fourth doses, respectively. The lowest increases in GMT were seen with the XBB variant, with respective values of 40.0, 40.8, 45.7, and 53.9.

 

Incremental Benefit Offers Some ‘Reassurance’

Vasculitis specialist Rona Smith, MA, MB BChir, MD, who was one of the authors of the paper, told this news organization separately that the results showed there was “an incremental benefit of having COVID vaccinations,” which “offers a little bit of reassurance” that there can be an immune response in people with vasculitis.

Although results of the cross-sectional study showed that there was a significant dampening effect of rituximab treatment on the immune response, “I don’t think it’s an isolated effect in our [vasculitis] patients,” Smith suggested, adding the results were “probably still relevant to patients who receive routine dosing of rituximab for other conditions.”

Neutralizing antibody titers were consistently lower among individuals who had been treated with rituximab vs those who had not, with treatment in the past 18 months found to significantly impair immunogenicity.

The ADCC response was better preserved than the neutralizing antibody response, Gupta said, although it was still significantly lower in the rituximab-treated than in the non–rituximab-treated patients.

 

When to Vaccinate in Vasculitis?

Regarding when to give vaccines to people with vasculitis, Smith said: “Current recommendations are that patients should receive any vaccines that they’re offered routinely, whether that be COVID vaccines, flu vaccines, pneumococcal vaccines.”

As for the timing of those vaccinations, she observed that the current thinking was that vaccinations should “ideally be at least 1 month before a rituximab treatment, and ideally 3-4 [months] after their last dose. However, as many patients are on a 6-month dosing cycle, it can be difficult for some of them to find a suitable time window to have the COVID vaccine when it is offered.”

Additional precautions, such as wearing masks in crowded places and avoiding visits to acutely unwell friends or relatives, may still be prudent, Smith acknowledged, but he was clear that people should not be locking themselves away as they did during the COVID-19 pandemic.

When advising patients, “our general recommendation is that it is better to have a vaccine than not, but we can’t guarantee how well you will respond to it, but some response is better than none,” Smith said.

The study was independently supported. Gupta had no relevant financial relationships to disclose. Smith was a coauthor of the paper and has received research grant funding from Union Therapeutics, GlaxoSmithKline/Vir Biotechnology, Addenbrooke’s Charitable Trust, and Vasculitis UK. Another coauthor reported receiving research grants from CSL Vifor, Roche, and GlaxoSmithKline and advisory board, consultancy, and lecture fees from Roche and CSL Vifor.

A version of this article first appeared on Medscape.com.

People with vasculitis may need at least three or four vaccinations for COVID-19 before they start to show an immune response against SARS-CoV-2 infection, new research has suggested.

In a longitudinal retrospective study, serum antibody neutralization against the Omicron variant of the virus and its descendants was found to be “largely absent” after the first two doses of COVID-19 vaccine had been given to patients. But increasing neutralizing antibody titers were seen after both the third and fourth vaccine boosters had been administered.

Results also showed that the more recently people had been treated with the B cell–depleting therapy rituximab, the lower the levels of immunogenicity that were achieved, and thus protection against SARS-CoV-2.

“Our results have significant implications for individuals treated with rituximab in the post-Omicron era, highlighting the value of additive boosters in affirming increasing protection in clinically vulnerable populations,” the team behind the work at the University of Cambridge in England, has reported in Science Advances.

Moreover, because the use of rituximab reduced the neutralization of not just wild-type (WT) Omicron but also the Omicron-descendant variants BA.1, BA.2, BA.4, and XBB, this highlights “the urgent need for additional adjunctive strategies to enhance vaccine-induced immunity as well as preferential access for such patients to updated vaccines using spike from now circulating Omicron lineages,” the team added.

 

Studying Humoral Responses to SARS-CoV-2 Vaccines

Corresponding author Ravindra K. Gupta, BMBCh, MA, MPH, PhD, told this news organization that studying humoral responses to SARS-CoV-2 vaccines in immunocompromised individuals such as those with vasculitis was important for two main reasons.

“It is really important at individual level for their own health, of course, but also because we know that variants of concern have often evolved and developed within patients and can then spread in wider populations,” he said.

Gupta, who is professor of clinical microbiology at the Cambridge Institute for Therapeutic Immunology & Infectious Disease added: “We believe that the variants of concern that we’re having to deal with right now, including Omicron, have come from such [immunocompromised] individuals.”

Omicron “was a big shift,” Gupta noted. “It had a lot of new mutations on it, so it was almost like a new strain of the virus.” Few studies have looked at the longitudinal immunogenicity proffered by COVID vaccines in the post-Omicron era, particularly in those with vasculitis who are often treated with immunosuppressive drugs, including rituximab.

 

Two-Pronged Study Approach

For the study, a population of immunocompromised individuals diagnosed with vasculitis who had been treated with rituximab in the past 5 years was identified. Just over half (58%) had received adenovirus-based AZD1222/ChAdOx1 nCoV-19 (AstraZeneca-Oxford; AZN) and 37% BNT162b2 (Pfizer-BioNTech; mRNA) as their primary vaccines. Patients with antineutrophil cytoplasmic antibody–associated vasculitis comprised the majority of those who received rituximab (83%), compared with less than half of those who did not take rituximab (48%).

A two-pronged approach was taken with the researchers first measuring neutralizing antibody titers before and 30 days after four successive COVID vaccinations in a group of 32 individuals with available samples. They then performed a cross-sectional, case-control study in 95 individuals to look at neutralizing antibody titers and antibody-dependent cell-mediated cytotoxicity (ADCC) in individuals who had (n = 64) and had not (n = 31) been treated with rituximab in the past 5 years and had samples available after their third and fourth COVID vaccinations.

The first analysis was done to see how people were responding to vaccination over time. “That told us that there was a problem with the first two doses and that we got some response after doses three and four, but the response was uniformly quite poor against the new variants of concern,” Gupta said.

A human embryonic kidney cell model had been used to determine individuals’ neutralizing antibody titers in response to WT, BA.1, BA.2, BA.4, and XBB pseudotyped viruses. After the first and second COVID vaccinations, the geometric mean titer (GMT) against each variant barely increased from a baseline of 40.0. The greatest increases in GMT was seen with the WT virus, at 43.7, 90.7, 256.3, and 394.2, after the first, second, third and fourth doses, respectively. The lowest increases in GMT were seen with the XBB variant, with respective values of 40.0, 40.8, 45.7, and 53.9.

 

Incremental Benefit Offers Some ‘Reassurance’

Vasculitis specialist Rona Smith, MA, MB BChir, MD, who was one of the authors of the paper, told this news organization separately that the results showed there was “an incremental benefit of having COVID vaccinations,” which “offers a little bit of reassurance” that there can be an immune response in people with vasculitis.

Although results of the cross-sectional study showed that there was a significant dampening effect of rituximab treatment on the immune response, “I don’t think it’s an isolated effect in our [vasculitis] patients,” Smith suggested, adding the results were “probably still relevant to patients who receive routine dosing of rituximab for other conditions.”

Neutralizing antibody titers were consistently lower among individuals who had been treated with rituximab vs those who had not, with treatment in the past 18 months found to significantly impair immunogenicity.

The ADCC response was better preserved than the neutralizing antibody response, Gupta said, although it was still significantly lower in the rituximab-treated than in the non–rituximab-treated patients.

 

When to Vaccinate in Vasculitis?

Regarding when to give vaccines to people with vasculitis, Smith said: “Current recommendations are that patients should receive any vaccines that they’re offered routinely, whether that be COVID vaccines, flu vaccines, pneumococcal vaccines.”

As for the timing of those vaccinations, she observed that the current thinking was that vaccinations should “ideally be at least 1 month before a rituximab treatment, and ideally 3-4 [months] after their last dose. However, as many patients are on a 6-month dosing cycle, it can be difficult for some of them to find a suitable time window to have the COVID vaccine when it is offered.”

Additional precautions, such as wearing masks in crowded places and avoiding visits to acutely unwell friends or relatives, may still be prudent, Smith acknowledged, but he was clear that people should not be locking themselves away as they did during the COVID-19 pandemic.

When advising patients, “our general recommendation is that it is better to have a vaccine than not, but we can’t guarantee how well you will respond to it, but some response is better than none,” Smith said.

The study was independently supported. Gupta had no relevant financial relationships to disclose. Smith was a coauthor of the paper and has received research grant funding from Union Therapeutics, GlaxoSmithKline/Vir Biotechnology, Addenbrooke’s Charitable Trust, and Vasculitis UK. Another coauthor reported receiving research grants from CSL Vifor, Roche, and GlaxoSmithKline and advisory board, consultancy, and lecture fees from Roche and CSL Vifor.

A version of this article first appeared on Medscape.com.

A new analysis of long-COVID patients has identified five distinct subtypes that researchers say will help doctors diagnose the condition.

The new five-type index, developed by federal researchers with the National Institutes of Health’s RECOVER COVID Initiative, identified the most common symptoms in 14,000 people with long COVID, with data from an additional 4000 people added to the updated 2024 index.

By using the index, physicians and researchers can better understand the condition, which is difficult to treat and diagnose because no standard definitions or therapies have been developed. Doctors can use the index to offer more targeted care and help patients manage their symptoms more effectively.

The index may also help researchers find more treatments for long COVID. Because long COVID can affect so many different parts of the body, it will take time to fully understand how to treat it, but studies like this are making progress in the right direction, experts said.

This new index uses an updated point system, where points are allotted to each symptom in a list of the 44 most reported symptoms in people with likely long COVID based on how often they occur. Among people in the study with prior COVID infection, 2213 (18%) met the threshold for long COVID.

The 44 most common symptoms were then distributed among 5 subtypes, with each representing a difference in impact on quality of life and overall health. The most common symptoms were fatigue (85.8%), postexertional malaise (87.4%), and postexertional soreness (75.0%) — where persistent fatigue and discomfort occur after physical or mental exertion — dizziness (65.8%), brain fog (63.8%), gastrointestinal symptoms (59.3%), and palpitations (58%).

For those with prior COVID infection, symptoms were more prevalent in all cases.

 

Subtype 1

Those grouped into subtype 1 did not report a high incidence of impact on quality of life, physical health, or daily function. Only 21% of people in subtype 1 reported a “poor or fair quality of life.”

A change in smell or taste — usually a symptom that’s bothersome but doesn’t seriously impact overall health — was most present in subtype 1, with 100% of people in subtype 1 reporting it.

The only other symptoms in over 50% of people with subtype 1— which were 490 of the 2213 with prior COVID infection — were fatigue (66%), postexertional malaise (53%), and postexertional soreness (55%).

Though these two symptoms can certainly impact quality of life, they became much more prevalent in other subtypes.

 

Subtype 2

The prevalence of possibly debilitating symptoms like postexertional malaise (94%), fatigue (81%), and chronic cough (100%) rose dramatically in people grouped into subtype 2. 

Plus, 25% of people in subtype 2 reported a “poor or fair quality of life. Postexertional malaise, I think, is probably one of the most debilitating of the symptoms. When somebody comes in and tells me that they’re tired and I think they might have long COVID, the first thing I try to do is see if it is postexertional malaise vs just postinfectious fatigue,” said Lisa Sanders, MD, medical director of Yale’s Long Covid Multidisciplinary Care Center in New Haven, Connecticut.

Postinfectious fatigue usually resolves much more quickly than postexertional malaise. The latter accounts for several symptoms as also associated with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS is a chronic illness that causes severe fatigue and makes it difficult for sufferers to perform routine, daily activities.

“Postexertional malaise is an additive symptom of ME/CFS, and that can take a long time to resolve,” Sanders added.

The similarity between these two symptoms highlights the importance that physicians must place in scrutinizing symptoms to a high degree when they suspect a patient of having long COVID, experts said. By doing so, clinicians can unveil the mask of overlapping symptoms between long COVID symptoms and symptoms of other illnesses.

 

Subtype 3

About 37% of people grouped in subtype 3 reported a poor or fair quality of life, a significant rise from subtypes 1 and 2.

Fatigue symptoms were reported by 92%, whereas 82% reported postexertional soreness, and 70% reported dizziness. Additionally, 100% of people in subtype 3 reported brain fog as a symptom.

Sanders said these symptoms are also common in people with postural orthostatic tachycardia syndrome. This condition results from a reduced volume of blood returning to the heart after standing up, which leads to an abnormally fast heart rate. Palpitations and fainting can then occur.

Brain fog can be especially debilitating in people who are used to multitasking. With brain fog, people accustomed to easily alternating between tasks or doing multiple tasks at once can only do one thing at a time. This can cause stress and an overload of thoughts, even precipitating a change in careers if severe enough.

Though brain fog tends to resolve within 6-9 months after infection, it can last up to 18 months or more. Experts say doctors should always be on the lookout if a patient complains they have trouble concentrating or multitasking in the months after a COVID infection. A neurological exam and cognitive testing can identify abnormalities in brain function.

 

Subtype 4

About 40% of people in the study grouped into subtype 4 reported a poor or fair quality of life, a modest increase from those with subtype 3. About 65% reported symptoms of brain fog and 92% reported palpitations.

Dizziness was also prevalent at 71%, whereas 60% reported gastrointestinal issues, and 36% said they experienced fever, sweats, and chills.

Nearly 700 of the 2213 people fell into this subtype group, by far the highest number.

 

Subtype 5

A whopping 66% of people in subtype 5 reported a poor to fair quality of life. These people usually reported multisystem symptoms.

In terms of prevalence rises across the spectrum of 44 common long-COVID symptoms, 99% reported shortness of breath; 98%, postexertional soreness; 94%, dizziness; 92%, postexertional malaise; 80%, GI problems; 78%, weakness; and 69%, chest pain.

A higher proportion of Hispanic and multiracial participants were classified as having subtype 5. Also, according to the study, “higher proportions of unvaccinated participants and those with SARS-CoV-2 infection before circulation of the Omicron variant were in subtype 5.”

This suggests the severity of the Delta variant of COVID-19 be linked to some of the worst long COVID symptoms, but further study would have to be done to conclusively determine may be just a correlation.

 

When Do Symptoms Resolve?

According to Sanders, around 17 million Americans are thought to have long COVID. Although 90%-100% of people typically recover within 3 years, that still leaves possibly around 5% of those who don’t recover.

“What people usually say is, ‘I got COVID, and I never quite recovered,” Sanders said.

“Five percent of 17 million turns out to be a lot. It’s a lot of suffering,” she added. “I would say that the most common symptoms are fatigue, brain fog, anosmia or dysgeusia, and sleep disorders,” as evidenced by the high percentage of people in certain subtypes of the study reporting a poor quality of life.

A version of this article first appeared on Medscape.com.

A new analysis of long-COVID patients has identified five distinct subtypes that researchers say will help doctors diagnose the condition.

The new five-type index, developed by federal researchers with the National Institutes of Health’s RECOVER COVID Initiative, identified the most common symptoms in 14,000 people with long COVID, with data from an additional 4000 people added to the updated 2024 index.

By using the index, physicians and researchers can better understand the condition, which is difficult to treat and diagnose because no standard definitions or therapies have been developed. Doctors can use the index to offer more targeted care and help patients manage their symptoms more effectively.

The index may also help researchers find more treatments for long COVID. Because long COVID can affect so many different parts of the body, it will take time to fully understand how to treat it, but studies like this are making progress in the right direction, experts said.

This new index uses an updated point system, where points are allotted to each symptom in a list of the 44 most reported symptoms in people with likely long COVID based on how often they occur. Among people in the study with prior COVID infection, 2213 (18%) met the threshold for long COVID.

The 44 most common symptoms were then distributed among 5 subtypes, with each representing a difference in impact on quality of life and overall health. The most common symptoms were fatigue (85.8%), postexertional malaise (87.4%), and postexertional soreness (75.0%) — where persistent fatigue and discomfort occur after physical or mental exertion — dizziness (65.8%), brain fog (63.8%), gastrointestinal symptoms (59.3%), and palpitations (58%).

For those with prior COVID infection, symptoms were more prevalent in all cases.

 

Subtype 1

Those grouped into subtype 1 did not report a high incidence of impact on quality of life, physical health, or daily function. Only 21% of people in subtype 1 reported a “poor or fair quality of life.”

A change in smell or taste — usually a symptom that’s bothersome but doesn’t seriously impact overall health — was most present in subtype 1, with 100% of people in subtype 1 reporting it.

The only other symptoms in over 50% of people with subtype 1— which were 490 of the 2213 with prior COVID infection — were fatigue (66%), postexertional malaise (53%), and postexertional soreness (55%).

Though these two symptoms can certainly impact quality of life, they became much more prevalent in other subtypes.

 

Subtype 2

The prevalence of possibly debilitating symptoms like postexertional malaise (94%), fatigue (81%), and chronic cough (100%) rose dramatically in people grouped into subtype 2. 

Plus, 25% of people in subtype 2 reported a “poor or fair quality of life. Postexertional malaise, I think, is probably one of the most debilitating of the symptoms. When somebody comes in and tells me that they’re tired and I think they might have long COVID, the first thing I try to do is see if it is postexertional malaise vs just postinfectious fatigue,” said Lisa Sanders, MD, medical director of Yale’s Long Covid Multidisciplinary Care Center in New Haven, Connecticut.

Postinfectious fatigue usually resolves much more quickly than postexertional malaise. The latter accounts for several symptoms as also associated with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS is a chronic illness that causes severe fatigue and makes it difficult for sufferers to perform routine, daily activities.

“Postexertional malaise is an additive symptom of ME/CFS, and that can take a long time to resolve,” Sanders added.

The similarity between these two symptoms highlights the importance that physicians must place in scrutinizing symptoms to a high degree when they suspect a patient of having long COVID, experts said. By doing so, clinicians can unveil the mask of overlapping symptoms between long COVID symptoms and symptoms of other illnesses.

 

Subtype 3

About 37% of people grouped in subtype 3 reported a poor or fair quality of life, a significant rise from subtypes 1 and 2.

Fatigue symptoms were reported by 92%, whereas 82% reported postexertional soreness, and 70% reported dizziness. Additionally, 100% of people in subtype 3 reported brain fog as a symptom.

Sanders said these symptoms are also common in people with postural orthostatic tachycardia syndrome. This condition results from a reduced volume of blood returning to the heart after standing up, which leads to an abnormally fast heart rate. Palpitations and fainting can then occur.

Brain fog can be especially debilitating in people who are used to multitasking. With brain fog, people accustomed to easily alternating between tasks or doing multiple tasks at once can only do one thing at a time. This can cause stress and an overload of thoughts, even precipitating a change in careers if severe enough.

Though brain fog tends to resolve within 6-9 months after infection, it can last up to 18 months or more. Experts say doctors should always be on the lookout if a patient complains they have trouble concentrating or multitasking in the months after a COVID infection. A neurological exam and cognitive testing can identify abnormalities in brain function.

 

Subtype 4

About 40% of people in the study grouped into subtype 4 reported a poor or fair quality of life, a modest increase from those with subtype 3. About 65% reported symptoms of brain fog and 92% reported palpitations.

Dizziness was also prevalent at 71%, whereas 60% reported gastrointestinal issues, and 36% said they experienced fever, sweats, and chills.

Nearly 700 of the 2213 people fell into this subtype group, by far the highest number.

 

Subtype 5

A whopping 66% of people in subtype 5 reported a poor to fair quality of life. These people usually reported multisystem symptoms.

In terms of prevalence rises across the spectrum of 44 common long-COVID symptoms, 99% reported shortness of breath; 98%, postexertional soreness; 94%, dizziness; 92%, postexertional malaise; 80%, GI problems; 78%, weakness; and 69%, chest pain.

A higher proportion of Hispanic and multiracial participants were classified as having subtype 5. Also, according to the study, “higher proportions of unvaccinated participants and those with SARS-CoV-2 infection before circulation of the Omicron variant were in subtype 5.”

This suggests the severity of the Delta variant of COVID-19 be linked to some of the worst long COVID symptoms, but further study would have to be done to conclusively determine may be just a correlation.

 

When Do Symptoms Resolve?

According to Sanders, around 17 million Americans are thought to have long COVID. Although 90%-100% of people typically recover within 3 years, that still leaves possibly around 5% of those who don’t recover.

“What people usually say is, ‘I got COVID, and I never quite recovered,” Sanders said.

“Five percent of 17 million turns out to be a lot. It’s a lot of suffering,” she added. “I would say that the most common symptoms are fatigue, brain fog, anosmia or dysgeusia, and sleep disorders,” as evidenced by the high percentage of people in certain subtypes of the study reporting a poor quality of life.

A version of this article first appeared on Medscape.com.

A new analysis of long-COVID patients has identified five distinct subtypes that researchers say will help doctors diagnose the condition.

The new five-type index, developed by federal researchers with the National Institutes of Health’s RECOVER COVID Initiative, identified the most common symptoms in 14,000 people with long COVID, with data from an additional 4000 people added to the updated 2024 index.

By using the index, physicians and researchers can better understand the condition, which is difficult to treat and diagnose because no standard definitions or therapies have been developed. Doctors can use the index to offer more targeted care and help patients manage their symptoms more effectively.

The index may also help researchers find more treatments for long COVID. Because long COVID can affect so many different parts of the body, it will take time to fully understand how to treat it, but studies like this are making progress in the right direction, experts said.

This new index uses an updated point system, where points are allotted to each symptom in a list of the 44 most reported symptoms in people with likely long COVID based on how often they occur. Among people in the study with prior COVID infection, 2213 (18%) met the threshold for long COVID.

The 44 most common symptoms were then distributed among 5 subtypes, with each representing a difference in impact on quality of life and overall health. The most common symptoms were fatigue (85.8%), postexertional malaise (87.4%), and postexertional soreness (75.0%) — where persistent fatigue and discomfort occur after physical or mental exertion — dizziness (65.8%), brain fog (63.8%), gastrointestinal symptoms (59.3%), and palpitations (58%).

For those with prior COVID infection, symptoms were more prevalent in all cases.

 

Subtype 1

Those grouped into subtype 1 did not report a high incidence of impact on quality of life, physical health, or daily function. Only 21% of people in subtype 1 reported a “poor or fair quality of life.”

A change in smell or taste — usually a symptom that’s bothersome but doesn’t seriously impact overall health — was most present in subtype 1, with 100% of people in subtype 1 reporting it.

The only other symptoms in over 50% of people with subtype 1— which were 490 of the 2213 with prior COVID infection — were fatigue (66%), postexertional malaise (53%), and postexertional soreness (55%).

Though these two symptoms can certainly impact quality of life, they became much more prevalent in other subtypes.

 

Subtype 2

The prevalence of possibly debilitating symptoms like postexertional malaise (94%), fatigue (81%), and chronic cough (100%) rose dramatically in people grouped into subtype 2. 

Plus, 25% of people in subtype 2 reported a “poor or fair quality of life. Postexertional malaise, I think, is probably one of the most debilitating of the symptoms. When somebody comes in and tells me that they’re tired and I think they might have long COVID, the first thing I try to do is see if it is postexertional malaise vs just postinfectious fatigue,” said Lisa Sanders, MD, medical director of Yale’s Long Covid Multidisciplinary Care Center in New Haven, Connecticut.

Postinfectious fatigue usually resolves much more quickly than postexertional malaise. The latter accounts for several symptoms as also associated with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS is a chronic illness that causes severe fatigue and makes it difficult for sufferers to perform routine, daily activities.

“Postexertional malaise is an additive symptom of ME/CFS, and that can take a long time to resolve,” Sanders added.

The similarity between these two symptoms highlights the importance that physicians must place in scrutinizing symptoms to a high degree when they suspect a patient of having long COVID, experts said. By doing so, clinicians can unveil the mask of overlapping symptoms between long COVID symptoms and symptoms of other illnesses.

 

Subtype 3

About 37% of people grouped in subtype 3 reported a poor or fair quality of life, a significant rise from subtypes 1 and 2.

Fatigue symptoms were reported by 92%, whereas 82% reported postexertional soreness, and 70% reported dizziness. Additionally, 100% of people in subtype 3 reported brain fog as a symptom.

Sanders said these symptoms are also common in people with postural orthostatic tachycardia syndrome. This condition results from a reduced volume of blood returning to the heart after standing up, which leads to an abnormally fast heart rate. Palpitations and fainting can then occur.

Brain fog can be especially debilitating in people who are used to multitasking. With brain fog, people accustomed to easily alternating between tasks or doing multiple tasks at once can only do one thing at a time. This can cause stress and an overload of thoughts, even precipitating a change in careers if severe enough.

Though brain fog tends to resolve within 6-9 months after infection, it can last up to 18 months or more. Experts say doctors should always be on the lookout if a patient complains they have trouble concentrating or multitasking in the months after a COVID infection. A neurological exam and cognitive testing can identify abnormalities in brain function.

 

Subtype 4

About 40% of people in the study grouped into subtype 4 reported a poor or fair quality of life, a modest increase from those with subtype 3. About 65% reported symptoms of brain fog and 92% reported palpitations.

Dizziness was also prevalent at 71%, whereas 60% reported gastrointestinal issues, and 36% said they experienced fever, sweats, and chills.

Nearly 700 of the 2213 people fell into this subtype group, by far the highest number.

 

Subtype 5

A whopping 66% of people in subtype 5 reported a poor to fair quality of life. These people usually reported multisystem symptoms.

In terms of prevalence rises across the spectrum of 44 common long-COVID symptoms, 99% reported shortness of breath; 98%, postexertional soreness; 94%, dizziness; 92%, postexertional malaise; 80%, GI problems; 78%, weakness; and 69%, chest pain.

A higher proportion of Hispanic and multiracial participants were classified as having subtype 5. Also, according to the study, “higher proportions of unvaccinated participants and those with SARS-CoV-2 infection before circulation of the Omicron variant were in subtype 5.”

This suggests the severity of the Delta variant of COVID-19 be linked to some of the worst long COVID symptoms, but further study would have to be done to conclusively determine may be just a correlation.

 

When Do Symptoms Resolve?

According to Sanders, around 17 million Americans are thought to have long COVID. Although 90%-100% of people typically recover within 3 years, that still leaves possibly around 5% of those who don’t recover.

“What people usually say is, ‘I got COVID, and I never quite recovered,” Sanders said.

“Five percent of 17 million turns out to be a lot. It’s a lot of suffering,” she added. “I would say that the most common symptoms are fatigue, brain fog, anosmia or dysgeusia, and sleep disorders,” as evidenced by the high percentage of people in certain subtypes of the study reporting a poor quality of life.

A version of this article first appeared on Medscape.com.

This article is a based on a video essay. The transcript has been edited for clarity.

I’d like to discuss what I think is a very interesting analysis that we need to see much more of. It’s perhaps not surprising, but the data, I think, are sobering. The paper was published in JAMA Network Open, entitled, “Trends and Disparities in Next-Generation Sequencing in Metastatic Prostate and Urothelial Cancers.”

As I think most of the listening audience is aware, we are in the midst of an ongoing — I would argue, accelerating — revolution in our understanding of cancer, its development and treatments, based upon our characterization at the molecular level of individual cancers.

This, of course, is changing the treatment paradigms and the drugs that we might have available in the first-, second-, and third-line settings. The question to be asked is, how are we, at a clinical level, keeping up with all of these changes, like those approved by the US Food and Drug Administration, and new diagnostic testing with a variety of molecular platforms?

This particular analysis looked at that specific question in metastatic prostate cancer and urothelial malignancies, obviously including bladder cancer. With the new approvals — including tumor agnostic testing, very specific testing, and very molecularly based drugs that are approved for particular abnormalities — they looked at the percentages of patients and the potential disparities in terms of the testing that has been performed.

There were 11,927 patients with prostate cancer. There were 6490 patients with advanced urothelial malignancies; the majority of these were male, but there were females included in this group.

The researchers looked at 2015 vs 2022 data. It’s not 2024 data, but it goes all the way to the end of 2022, so, not that long ago. In the metastatic prostate cancer group, 19% of patients had undergone molecular testing or next-generation sequencing in 2015.

By 2022, that number had increased, but only to 27%. Three out of four patients with metastatic prostate cancer had not undergone testing to know whether they were potential candidates for specific therapies. I won’t even get into the question of potential germline abnormalities that might be observed that are relevant for other discussions.

Among patients with urothelial cancer, in 2015, 14% had undergone such testing. By 2022, this number was substantially increased to 46.6%, but still, that’s less than 1 out of 2 patients. More than 50% of patients had not undergone the testing, and yet we have therapy that might be available for these populations based on such testing.

I should add that the population of Black, African American, and Hispanic patients was actually considerably lower, percentage-wise, than the numbers that I’ve quoted.

Clearly, there are explanations. There are socioeconomic explanations and insurance coverage explanations. However, the bottom line is that we have therapies available today, and we’ll have more in the future, that are based on knowledge of this testing.

Based on these data, which most recently included 2022 — we’ll see where we are in 2024 and 2025, and with other types — more than half of patients are not getting the testing to know if this is relevant for them and their care.

These are major questions that need to be addressed. Hopefully, answers will be forthcoming and we will see in the future that these percentages will be much higher for the benefit of our patients.

Dr Markman, Professor of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center; President, Medicine & Science, City of Hope Atlanta, Chicago, Phoenix, has disclosed the following relevant financial relationships with GlaxoSmithKline and AstraZeneca.

A version of this article first appeared on Medscape.com.

This article is a based on a video essay. The transcript has been edited for clarity.

I’d like to discuss what I think is a very interesting analysis that we need to see much more of. It’s perhaps not surprising, but the data, I think, are sobering. The paper was published in JAMA Network Open, entitled, “Trends and Disparities in Next-Generation Sequencing in Metastatic Prostate and Urothelial Cancers.”

As I think most of the listening audience is aware, we are in the midst of an ongoing — I would argue, accelerating — revolution in our understanding of cancer, its development and treatments, based upon our characterization at the molecular level of individual cancers.

This, of course, is changing the treatment paradigms and the drugs that we might have available in the first-, second-, and third-line settings. The question to be asked is, how are we, at a clinical level, keeping up with all of these changes, like those approved by the US Food and Drug Administration, and new diagnostic testing with a variety of molecular platforms?

This particular analysis looked at that specific question in metastatic prostate cancer and urothelial malignancies, obviously including bladder cancer. With the new approvals — including tumor agnostic testing, very specific testing, and very molecularly based drugs that are approved for particular abnormalities — they looked at the percentages of patients and the potential disparities in terms of the testing that has been performed.

There were 11,927 patients with prostate cancer. There were 6490 patients with advanced urothelial malignancies; the majority of these were male, but there were females included in this group.

The researchers looked at 2015 vs 2022 data. It’s not 2024 data, but it goes all the way to the end of 2022, so, not that long ago. In the metastatic prostate cancer group, 19% of patients had undergone molecular testing or next-generation sequencing in 2015.

By 2022, that number had increased, but only to 27%. Three out of four patients with metastatic prostate cancer had not undergone testing to know whether they were potential candidates for specific therapies. I won’t even get into the question of potential germline abnormalities that might be observed that are relevant for other discussions.

Among patients with urothelial cancer, in 2015, 14% had undergone such testing. By 2022, this number was substantially increased to 46.6%, but still, that’s less than 1 out of 2 patients. More than 50% of patients had not undergone the testing, and yet we have therapy that might be available for these populations based on such testing.

I should add that the population of Black, African American, and Hispanic patients was actually considerably lower, percentage-wise, than the numbers that I’ve quoted.

Clearly, there are explanations. There are socioeconomic explanations and insurance coverage explanations. However, the bottom line is that we have therapies available today, and we’ll have more in the future, that are based on knowledge of this testing.

Based on these data, which most recently included 2022 — we’ll see where we are in 2024 and 2025, and with other types — more than half of patients are not getting the testing to know if this is relevant for them and their care.

These are major questions that need to be addressed. Hopefully, answers will be forthcoming and we will see in the future that these percentages will be much higher for the benefit of our patients.

Dr Markman, Professor of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center; President, Medicine & Science, City of Hope Atlanta, Chicago, Phoenix, has disclosed the following relevant financial relationships with GlaxoSmithKline and AstraZeneca.

A version of this article first appeared on Medscape.com.

This article is a based on a video essay. The transcript has been edited for clarity.

I’d like to discuss what I think is a very interesting analysis that we need to see much more of. It’s perhaps not surprising, but the data, I think, are sobering. The paper was published in JAMA Network Open, entitled, “Trends and Disparities in Next-Generation Sequencing in Metastatic Prostate and Urothelial Cancers.”

As I think most of the listening audience is aware, we are in the midst of an ongoing — I would argue, accelerating — revolution in our understanding of cancer, its development and treatments, based upon our characterization at the molecular level of individual cancers.

This, of course, is changing the treatment paradigms and the drugs that we might have available in the first-, second-, and third-line settings. The question to be asked is, how are we, at a clinical level, keeping up with all of these changes, like those approved by the US Food and Drug Administration, and new diagnostic testing with a variety of molecular platforms?

This particular analysis looked at that specific question in metastatic prostate cancer and urothelial malignancies, obviously including bladder cancer. With the new approvals — including tumor agnostic testing, very specific testing, and very molecularly based drugs that are approved for particular abnormalities — they looked at the percentages of patients and the potential disparities in terms of the testing that has been performed.

There were 11,927 patients with prostate cancer. There were 6490 patients with advanced urothelial malignancies; the majority of these were male, but there were females included in this group.

The researchers looked at 2015 vs 2022 data. It’s not 2024 data, but it goes all the way to the end of 2022, so, not that long ago. In the metastatic prostate cancer group, 19% of patients had undergone molecular testing or next-generation sequencing in 2015.

By 2022, that number had increased, but only to 27%. Three out of four patients with metastatic prostate cancer had not undergone testing to know whether they were potential candidates for specific therapies. I won’t even get into the question of potential germline abnormalities that might be observed that are relevant for other discussions.

Among patients with urothelial cancer, in 2015, 14% had undergone such testing. By 2022, this number was substantially increased to 46.6%, but still, that’s less than 1 out of 2 patients. More than 50% of patients had not undergone the testing, and yet we have therapy that might be available for these populations based on such testing.

I should add that the population of Black, African American, and Hispanic patients was actually considerably lower, percentage-wise, than the numbers that I’ve quoted.

Clearly, there are explanations. There are socioeconomic explanations and insurance coverage explanations. However, the bottom line is that we have therapies available today, and we’ll have more in the future, that are based on knowledge of this testing.

Based on these data, which most recently included 2022 — we’ll see where we are in 2024 and 2025, and with other types — more than half of patients are not getting the testing to know if this is relevant for them and their care.

These are major questions that need to be addressed. Hopefully, answers will be forthcoming and we will see in the future that these percentages will be much higher for the benefit of our patients.

Dr Markman, Professor of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center; President, Medicine & Science, City of Hope Atlanta, Chicago, Phoenix, has disclosed the following relevant financial relationships with GlaxoSmithKline and AstraZeneca.

A version of this article first appeared on Medscape.com.

Dear Friends,

Over the last year, I have been reading more about professional identity and professional branding, all of which have evolved in the setting of social media. However, the root of it remains constant — finding the intersection(s) of what you love. A common problem, especially as a trainee and early-career gastroenterologist, is that you may have many interests: various disease processes, innovation, medical education, leadership development, and much more. Since becoming faculty, I continue to define and refine my professional niche, trying to distinguish my “interests” from “passions.” It is a journey that my mentors advise me not to rush through and I am enjoying every moment of it!

In this issue’s “In Focus,” Dr. Hamza Salim, Dr. Anni Chowdhury, and Dr. Lavanya Viswanathan provide a practical guide for the clinical evaluation of chronic constipation and a systematic approach to treatment.

 

In the first of a two-part series in the “Short Clinical Review” section, Dr. Christopher Velez and Dr. Kara J. Jencks discuss the health inequities among sexual and gender minority (SGM) patients, particularly with disorders of brain-gut interaction (DBGI). They review common SGM terminology, sample verbiage for trauma-informed care, and case presentations to help guide our approach to providing care for SGM patients with DGBI. 

The transition from trainee to early faculty may be difficult for those who are interested in research but struggle with the change from being a part of a research team to running one. In the “Early Career” section, Dr. Lauren Feld and colleagues describes her experience establishing a research lab as an early-career academic, from creating a niche to time management and mentorship.

The Federal Trade Commission’s noncompete ban made big news in April 2024 but there is still a lot of gray area for physicians. Dr. Timothy Craig Allen explains the ruling, what it means to physicians, the status of it today, and what the future may hold. Lastly, for “Private Practice Perspectives” in collaboration with Digestive Health Physicians Alliance, I interview Dr. Vasu Appalaneni on her use of artificial intelligence in private practice.

If you are interested in contributing or have ideas for future TNG topics, please contact me (tjudy@wustl.edu) or Danielle Kiefer (dkiefer@gastro.org), Communications/Managing Editor of TNG.

Until next time, I leave you with a historical fun fact because we would not be where we are now without appreciating where we were: Polyethylene glycol was first used in the 1940s and 1950s to understand the physiology of the intestines, and first published as a compound for colonoscopy bowel preparation in 1981. 

 

Yours truly, 

Judy A. Trieu, MD, MPH

Editor-in-Chief

Assistant Professor of Medicine

Interventional Endoscopy, Division of Gastroenterology

Washington University in St. Louis

Dear Friends,

Over the last year, I have been reading more about professional identity and professional branding, all of which have evolved in the setting of social media. However, the root of it remains constant — finding the intersection(s) of what you love. A common problem, especially as a trainee and early-career gastroenterologist, is that you may have many interests: various disease processes, innovation, medical education, leadership development, and much more. Since becoming faculty, I continue to define and refine my professional niche, trying to distinguish my “interests” from “passions.” It is a journey that my mentors advise me not to rush through and I am enjoying every moment of it!

In this issue’s “In Focus,” Dr. Hamza Salim, Dr. Anni Chowdhury, and Dr. Lavanya Viswanathan provide a practical guide for the clinical evaluation of chronic constipation and a systematic approach to treatment.

 

In the first of a two-part series in the “Short Clinical Review” section, Dr. Christopher Velez and Dr. Kara J. Jencks discuss the health inequities among sexual and gender minority (SGM) patients, particularly with disorders of brain-gut interaction (DBGI). They review common SGM terminology, sample verbiage for trauma-informed care, and case presentations to help guide our approach to providing care for SGM patients with DGBI. 

The transition from trainee to early faculty may be difficult for those who are interested in research but struggle with the change from being a part of a research team to running one. In the “Early Career” section, Dr. Lauren Feld and colleagues describes her experience establishing a research lab as an early-career academic, from creating a niche to time management and mentorship.

The Federal Trade Commission’s noncompete ban made big news in April 2024 but there is still a lot of gray area for physicians. Dr. Timothy Craig Allen explains the ruling, what it means to physicians, the status of it today, and what the future may hold. Lastly, for “Private Practice Perspectives” in collaboration with Digestive Health Physicians Alliance, I interview Dr. Vasu Appalaneni on her use of artificial intelligence in private practice.

If you are interested in contributing or have ideas for future TNG topics, please contact me (tjudy@wustl.edu) or Danielle Kiefer (dkiefer@gastro.org), Communications/Managing Editor of TNG.

Until next time, I leave you with a historical fun fact because we would not be where we are now without appreciating where we were: Polyethylene glycol was first used in the 1940s and 1950s to understand the physiology of the intestines, and first published as a compound for colonoscopy bowel preparation in 1981. 

 

Yours truly, 

Judy A. Trieu, MD, MPH

Editor-in-Chief

Assistant Professor of Medicine

Interventional Endoscopy, Division of Gastroenterology

Washington University in St. Louis

Dear Friends,

Over the last year, I have been reading more about professional identity and professional branding, all of which have evolved in the setting of social media. However, the root of it remains constant — finding the intersection(s) of what you love. A common problem, especially as a trainee and early-career gastroenterologist, is that you may have many interests: various disease processes, innovation, medical education, leadership development, and much more. Since becoming faculty, I continue to define and refine my professional niche, trying to distinguish my “interests” from “passions.” It is a journey that my mentors advise me not to rush through and I am enjoying every moment of it!

In this issue’s “In Focus,” Dr. Hamza Salim, Dr. Anni Chowdhury, and Dr. Lavanya Viswanathan provide a practical guide for the clinical evaluation of chronic constipation and a systematic approach to treatment.

 

In the first of a two-part series in the “Short Clinical Review” section, Dr. Christopher Velez and Dr. Kara J. Jencks discuss the health inequities among sexual and gender minority (SGM) patients, particularly with disorders of brain-gut interaction (DBGI). They review common SGM terminology, sample verbiage for trauma-informed care, and case presentations to help guide our approach to providing care for SGM patients with DGBI. 

The transition from trainee to early faculty may be difficult for those who are interested in research but struggle with the change from being a part of a research team to running one. In the “Early Career” section, Dr. Lauren Feld and colleagues describes her experience establishing a research lab as an early-career academic, from creating a niche to time management and mentorship.

The Federal Trade Commission’s noncompete ban made big news in April 2024 but there is still a lot of gray area for physicians. Dr. Timothy Craig Allen explains the ruling, what it means to physicians, the status of it today, and what the future may hold. Lastly, for “Private Practice Perspectives” in collaboration with Digestive Health Physicians Alliance, I interview Dr. Vasu Appalaneni on her use of artificial intelligence in private practice.

If you are interested in contributing or have ideas for future TNG topics, please contact me (tjudy@wustl.edu) or Danielle Kiefer (dkiefer@gastro.org), Communications/Managing Editor of TNG.

Until next time, I leave you with a historical fun fact because we would not be where we are now without appreciating where we were: Polyethylene glycol was first used in the 1940s and 1950s to understand the physiology of the intestines, and first published as a compound for colonoscopy bowel preparation in 1981. 

 

Yours truly, 

Judy A. Trieu, MD, MPH

Editor-in-Chief

Assistant Professor of Medicine

Interventional Endoscopy, Division of Gastroenterology

Washington University in St. Louis

Below are some selections from what I am reading in the AGA journals, highlighting clinically applicable and possibly practice-changing expert reviews and studies.

Esophagus

Reed CC et al. Daily or Twice Daily Treatment with Topical Steroids Results in Similar Responses in Eosinophilic Esophagitis. Clin Gastroenterol Hepatol. 2024 Nov. doi: 10.1016/j.cgh.2024.10.016.

Patel RV et al. Functional Lumen Imaging Probe Provides an Accurate Assessment of Esophageal Diameter in Patients With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol. 2024 Dec. doi: 10.1016/j.cgh.2024.10.032.

Stomach

Shah SC et al. AGA Clinical Practice Update on Screening and Surveillance in Individuals at Increased Risk for Gastric Cancer in the United States: Expert Review. Gastroenterology. 2024 Dec. doi: 10.1053/j.gastro.2024.11.001.

IBD

Griffiths BJ et al. Hypercoagulation after Hospital Discharge in Acute Severe Ulcerative Colitis: A Prospective Study. Clin Gastroenterol Hepatol. 2024 Dec. doi: 10.1016/j.cgh.2024.10.031.

Liver

Lassailly G et al. Resolution of MASH with no worsening of fibrosis after bariatric surgery improves 15-year survival: a prospective cohort study. Clin Gastroenterol Hepatol. 2024 Dec. doi: 10.1016/j.cgh.2024.10.025. 

Norman JS et al. Model for Urgency for Liver Transplantation in Hepatocellular Carcinoma: A Practical Model to Prioritize Patients With Hepatocellular Carcinoma on the Liver Transplant Waiting List. Gastroenterology. 2024 Nov. doi: 10.1053/j.gastro.2024.11.015.

Davis JPE et al. AGA Clinical Practice Update on Management of Portal Vein Thrombosis in Patients With Cirrhosis: Expert Review. Gastroenterology. 2024 Dec. doi: 10.1053/j.gastro.2024.10.038.

Pancreas

Drewes AM et al. Pain in Chronic Pancreatitis: Navigating the Maze of Blocked Tubes and Tangled Wires. Gastroenterology. 2024 Dec. doi: 10.1053/j.gastro.2024.11.026.

Endoscopy

Kindel TL et al; American Gastroenterological Association; American Society for Metabolic and Bariatric Surgery; American Society of Anesthesiologists; International Society of Perioperative Care of Patients with Obesity; Society of American Gastrointestinal and Endoscopic Surgeons. Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. 2024 Oct. doi: 10.1016/j.cgh.2024.10.003.

Schmidt KA et al. Understanding Patients’ Current Acceptability of Artificial Intelligence During Colonoscopy for Polyp Detection: A Single-Center Study. Techniques and Innovations in Gastrointestinal Endoscopy. 2024 Dec. doi: 10.1016/j.tige.2024.250905.

Chandramouli S et al. Endoscopic Surveillance Patterns and Management of Helicobacter pylori in Newly Diagnosed Gastric Intestinal Metaplasia. Techniques and Innovations in Gastrointestinal Endoscopy. 2024 Dec. doi: 10.1016/j.tige.2024.250904.

Practice Management

Tsai C et al. Trauma-Informed Care in Gastroenterology: A Survey of Provider Attitudes, Knowledge, and Skills. Clin Gastroenterol Hepatol. 2024 Oct. doi: 10.1016/j.cgh.2024.09.015.

Mintz KM et al. Incorporating a GI Dietitian into Your GI Practice. Gastroenterology. 2024 Nov. doi: 10.1053/j.gastro.2024.10.022.

Dr. Trieu is assistant professor of medicine, interventional endoscopy, in the Division of Gastroenterology at Washington University in St. Louis School of Medicine, Missouri.

Below are some selections from what I am reading in the AGA journals, highlighting clinically applicable and possibly practice-changing expert reviews and studies.

Esophagus

Reed CC et al. Daily or Twice Daily Treatment with Topical Steroids Results in Similar Responses in Eosinophilic Esophagitis. Clin Gastroenterol Hepatol. 2024 Nov. doi: 10.1016/j.cgh.2024.10.016.

Patel RV et al. Functional Lumen Imaging Probe Provides an Accurate Assessment of Esophageal Diameter in Patients With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol. 2024 Dec. doi: 10.1016/j.cgh.2024.10.032.

Stomach

Shah SC et al. AGA Clinical Practice Update on Screening and Surveillance in Individuals at Increased Risk for Gastric Cancer in the United States: Expert Review. Gastroenterology. 2024 Dec. doi: 10.1053/j.gastro.2024.11.001.

IBD

Griffiths BJ et al. Hypercoagulation after Hospital Discharge in Acute Severe Ulcerative Colitis: A Prospective Study. Clin Gastroenterol Hepatol. 2024 Dec. doi: 10.1016/j.cgh.2024.10.031.

Liver

Lassailly G et al. Resolution of MASH with no worsening of fibrosis after bariatric surgery improves 15-year survival: a prospective cohort study. Clin Gastroenterol Hepatol. 2024 Dec. doi: 10.1016/j.cgh.2024.10.025. 

Norman JS et al. Model for Urgency for Liver Transplantation in Hepatocellular Carcinoma: A Practical Model to Prioritize Patients With Hepatocellular Carcinoma on the Liver Transplant Waiting List. Gastroenterology. 2024 Nov. doi: 10.1053/j.gastro.2024.11.015.

Davis JPE et al. AGA Clinical Practice Update on Management of Portal Vein Thrombosis in Patients With Cirrhosis: Expert Review. Gastroenterology. 2024 Dec. doi: 10.1053/j.gastro.2024.10.038.

Pancreas

Drewes AM et al. Pain in Chronic Pancreatitis: Navigating the Maze of Blocked Tubes and Tangled Wires. Gastroenterology. 2024 Dec. doi: 10.1053/j.gastro.2024.11.026.

Endoscopy

Kindel TL et al; American Gastroenterological Association; American Society for Metabolic and Bariatric Surgery; American Society of Anesthesiologists; International Society of Perioperative Care of Patients with Obesity; Society of American Gastrointestinal and Endoscopic Surgeons. Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. 2024 Oct. doi: 10.1016/j.cgh.2024.10.003.

Schmidt KA et al. Understanding Patients’ Current Acceptability of Artificial Intelligence During Colonoscopy for Polyp Detection: A Single-Center Study. Techniques and Innovations in Gastrointestinal Endoscopy. 2024 Dec. doi: 10.1016/j.tige.2024.250905.

Chandramouli S et al. Endoscopic Surveillance Patterns and Management of Helicobacter pylori in Newly Diagnosed Gastric Intestinal Metaplasia. Techniques and Innovations in Gastrointestinal Endoscopy. 2024 Dec. doi: 10.1016/j.tige.2024.250904.

Practice Management

Tsai C et al. Trauma-Informed Care in Gastroenterology: A Survey of Provider Attitudes, Knowledge, and Skills. Clin Gastroenterol Hepatol. 2024 Oct. doi: 10.1016/j.cgh.2024.09.015.

Mintz KM et al. Incorporating a GI Dietitian into Your GI Practice. Gastroenterology. 2024 Nov. doi: 10.1053/j.gastro.2024.10.022.

Dr. Trieu is assistant professor of medicine, interventional endoscopy, in the Division of Gastroenterology at Washington University in St. Louis School of Medicine, Missouri.

Below are some selections from what I am reading in the AGA journals, highlighting clinically applicable and possibly practice-changing expert reviews and studies.

Esophagus

Reed CC et al. Daily or Twice Daily Treatment with Topical Steroids Results in Similar Responses in Eosinophilic Esophagitis. Clin Gastroenterol Hepatol. 2024 Nov. doi: 10.1016/j.cgh.2024.10.016.

Patel RV et al. Functional Lumen Imaging Probe Provides an Accurate Assessment of Esophageal Diameter in Patients With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol. 2024 Dec. doi: 10.1016/j.cgh.2024.10.032.

Stomach

Shah SC et al. AGA Clinical Practice Update on Screening and Surveillance in Individuals at Increased Risk for Gastric Cancer in the United States: Expert Review. Gastroenterology. 2024 Dec. doi: 10.1053/j.gastro.2024.11.001.

IBD

Griffiths BJ et al. Hypercoagulation after Hospital Discharge in Acute Severe Ulcerative Colitis: A Prospective Study. Clin Gastroenterol Hepatol. 2024 Dec. doi: 10.1016/j.cgh.2024.10.031.

Liver

Lassailly G et al. Resolution of MASH with no worsening of fibrosis after bariatric surgery improves 15-year survival: a prospective cohort study. Clin Gastroenterol Hepatol. 2024 Dec. doi: 10.1016/j.cgh.2024.10.025. 

Norman JS et al. Model for Urgency for Liver Transplantation in Hepatocellular Carcinoma: A Practical Model to Prioritize Patients With Hepatocellular Carcinoma on the Liver Transplant Waiting List. Gastroenterology. 2024 Nov. doi: 10.1053/j.gastro.2024.11.015.

Davis JPE et al. AGA Clinical Practice Update on Management of Portal Vein Thrombosis in Patients With Cirrhosis: Expert Review. Gastroenterology. 2024 Dec. doi: 10.1053/j.gastro.2024.10.038.

Pancreas

Drewes AM et al. Pain in Chronic Pancreatitis: Navigating the Maze of Blocked Tubes and Tangled Wires. Gastroenterology. 2024 Dec. doi: 10.1053/j.gastro.2024.11.026.

Endoscopy

Kindel TL et al; American Gastroenterological Association; American Society for Metabolic and Bariatric Surgery; American Society of Anesthesiologists; International Society of Perioperative Care of Patients with Obesity; Society of American Gastrointestinal and Endoscopic Surgeons. Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. 2024 Oct. doi: 10.1016/j.cgh.2024.10.003.

Schmidt KA et al. Understanding Patients’ Current Acceptability of Artificial Intelligence During Colonoscopy for Polyp Detection: A Single-Center Study. Techniques and Innovations in Gastrointestinal Endoscopy. 2024 Dec. doi: 10.1016/j.tige.2024.250905.

Chandramouli S et al. Endoscopic Surveillance Patterns and Management of Helicobacter pylori in Newly Diagnosed Gastric Intestinal Metaplasia. Techniques and Innovations in Gastrointestinal Endoscopy. 2024 Dec. doi: 10.1016/j.tige.2024.250904.

Practice Management

Tsai C et al. Trauma-Informed Care in Gastroenterology: A Survey of Provider Attitudes, Knowledge, and Skills. Clin Gastroenterol Hepatol. 2024 Oct. doi: 10.1016/j.cgh.2024.09.015.

Mintz KM et al. Incorporating a GI Dietitian into Your GI Practice. Gastroenterology. 2024 Nov. doi: 10.1053/j.gastro.2024.10.022.

Dr. Trieu is assistant professor of medicine, interventional endoscopy, in the Division of Gastroenterology at Washington University in St. Louis School of Medicine, Missouri.