Medical Bulletin 06/ December/ 2024 - Video

Research at National Jewish Health and other institutions has shown that the biologic dupilumab improves signs and symptoms of moderate-to-severe atopic dermatitis (eczema) in young children whether or not they have another inflammatory condition, such as asthma, allergic rhinitis or food allergies. Dupilumab had previously been shown to be effective in the treatment of atopic dermatitis, but this research is the first to examine the drug’s efficacy in children with atopic dermatitis and co-morbid conditions. The study was recently published in the journal Advances in Therapy.

“Dupilumab has proven to be an important treatment for pediatric patients suffering from atopic dermatitis. Our recent research was to help us know if the drug would be as effective in patients with both atopic dermatitis and other common atopic diseases that could add to the inflammatory burden,” said Mark Boguniewicz, MD, pediatric allergist and immunologist at National Jewish Health and lead author on the study.

“With this illness, the quality of life of our patients and their families is negatively impacted, and this takes a toll on school or job performance and social interactions,” said Dr. Boguniewicz

For the study, investigators evaluated children aged 6 months to 5 years with moderate-to-severe atopic dermatitis who had been treated with either dupilumab or a placebo. Researchers compared patients who had only atopic dermatitis to those who had atopic dermatitis plus additional “type 2” inflammatory diseases, such as asthma and allergies. Results showed that dupilumab improved atopic dermatitis signs and symptoms in both groups of patients.

“Many children suffer from multiple allergic conditions at the same time, so knowing that dupilumab can be used to safely and effectively treat their atopic dermatitis whether or not they have additional atopic diseases such as asthma or allergies is an important step forward,” explained Dr. Boguniewicz.

Reference: Boguniewicz, M., Sher, L.D., Paller, A.S. et al. Dupilumab is Efficacious in Young Children with Atopic Dermatitis Regardless of Type 2 Comorbidities. Adv Ther 41, 4601–4616 (2024). https://doi.org/10.1007/s12325-024-02998-4

Consuming dark, but not milk, chocolate may be associated with lower risk of developing type 2 diabetes (T2D), according to a new study from Harvard T.H. Chan School of Public Health. The study was published online in The BMJ.

The researchers used data from the Nurses’ Health Studies I and II and the Health Professionals Follow-up Study. Over the course of 30+ years, 192,000 adult participants who were free of diabetes at the study’s outset reported on their food habits, including chocolate consumption, as well as their diabetes status and body weight. By the end of the study period, nearly 19,000 of the total participants reported being diagnosed with T2D. Of the nearly 112,000 who reported specifically on their dark and milk chocolate intake, nearly 5,000 were diagnosed with T2D.

Key points from the study are:

Study participants who consumed at least five servings of any chocolate per week showed a 10% lower risk of type 2 diabetes (T2D) compared to those who rarely or never ate chocolate. Dark chocolate had an even bigger impact: Participants who consumed at least five servings of this chocolate per week showed a 21% lower risk of T2D.

Consumption of milk chocolate, but not dark chocolate, was not associated with T2D risk; it was associated with excessive long term weight gain, a potential contributor to the development of T2D.

According to the researchers, opting for dark chocolate rather than milk chocolate can make a big difference for health. They also noted that average chocolate consumption among study participants was relatively low, so the findings may not extrapolate to people with very high levels of consumption.

“We were surprised by the clear split between dark and milk chocolate’s impact on diabetes risk and long-term weight management,” said corresponding author Qi Sun, associate professor in the Departments of Nutrition and Epidemiology. “Even though dark and milk chocolate have similar levels of calories and saturated fat, it appears that the rich polyphenols in dark chocolate might offset the effects of saturated fat and sugar on weight gain and diabetes. It’s an intriguing difference that’s worth exploring more.”

Reference: “Chocolate intake and risk of type 2 diabetes: prospective cohort studies,” Binkai Liu, Geng Zong, Lu Zhu, Yang Hu, JoAnn E. Manson, Molin Wang, Eric B. Rimm, Frank B. Hu, Qi Sun, The BMJ, published online December 4, 2024, doi: 10.1136/bmj-2023-078386

New research published by a team of researchers from the University of Toronto in collaboration with colleagues from the University of Alberta has found that women who have had both ovaries surgically removed before the age of 50 and carry a variant of the apolipoprotein gene, the APOE4 allele, are at high risk of late-life Alzheimer disease (AD). Use of hormone therapy mitigates this risk.

The researchers analyzed a cohort of 34,603 women from a large dataset, the UK Biobank, and found that in this cohort, women who had had both ovaries surgically removed (bilateral oophorectomy) at the approximate age of 43 showed four times the odds of developing Alzheimer’s disease when compared to women who entered natural menopause at a mean age of 54. The paper was published online in the Journal of Alzheimer’s Disease.

“One of our most important findings was the fact that loss of the naturally occurring hormone (endogenous), estradiol, as a result of surgical removal of both ovaries, might interact with the APOE4 allele to further increase Alzheimer’s disease risk, placing women with early bilateral oophorectomy and APOE4 in a state of double jeopardy,” said Dr. Einstein. APOE4 is a known risk factor for Alzheimer’s disease in the general population but presents greater risk in women.

The study also identified resilience factors associated with the risk of Alzheimer’s disease for these women. A high level of education was linked to a 9% lower likelihood of developing Alzheimer’s disease in women with both types of menopause — that caused by ovarian removal and that caused by aging — supporting previous research showing education as a form of cognitive resilience in both women and men.

Surprisingly, there was also a modest relationship between body mass index (BMI) and Alzheimer’s disease risk, but only for the women with early bilateral oophorectomy. Each additional unit of BMI was associated with a 7% lower risk of developing Alzheimer’s disease.

Importantly, among women with early bilateral oophorectomy, ever taking hormone therapy was associated with less than half the odds of Alzheimer’s disease compared to those women who had not taken hormone therapy.

Reference: Calvo N, McFall GP, Ramana S, et al. Associated risk and resilience factors of Alzheimer’s disease in women with early bilateral oophorectomy: Data from the UK Biobank. Journal of Alzheimer’s Disease. 2024;102(1):119-128. doi:10.3233/JAD-240646

Physicians at the University of Oklahoma Health Sciences in Oklahoma City are leading a national clinical trial to help women with polycystic ovary syndrome (PCOS)-related infertility who want to become pregnant.

The trial, called REBALANCE, studies the safety and effectiveness of an investigational device developed by May Health that is designed to restore ovulation disrupted by PCOS.

Karl Hansen, M.D., Ph.D., chair of the Department of Obstetrics and Gynecology at the OU College of Medicine, who is leading the trial for OU, said about 80% of women with PCOS respond to oral medications designed to stimulate ovulation, and up to 50% of those women will achieve a pregnancy. However, approximately 20% of women do not begin ovulating with the medications. An alternative treatment involves gonadotropin injections, which require frequent monitoring and precise dosage adjustments. Another option, laparoscopic ovarian drilling, uses a needle-like device inserted through small abdominal incisions to deliver laser or radiofrequency energy to an ovary, aiming to restore ovulation. However, this procedure has become less common, Hansen said.

The investigational device from May Health aims to prompt ovulation in women with PCOS-related infertility through a minimally invasive outpatient procedure. The device is connected to a probe commonly used in transvaginal ultrasounds, which assesses the ovary before delivering electrothermal energy to perform the appropriate number of ablations on an ovary.

The REBALANCE trial will enroll approximately 195 patients with PCOS-related infertility at multiple sites across the United States. Researchers will assess how often women ovulate after the procedure. Secondary outcomes that will be measured include the pregnancy rate achieved after the procedure, other symptoms of PCOS, and how long the effects of the procedure endure. OU Health Sciences is co-leading the trial in conjunction with the University of Pennsylvania.

Reference: THE ULTRA TRIAL: TRANSVAGINAL ULTRASOUND-GUIDED OVARIAN ABLATION USING THE MAY HEALTH SYSTEM IN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS)-RELATED INFERTILITY: UP TO TWELVE MONTHS FOLLOW UP, Hansen, Karl R.et al. Fertility and Sterility, Volume 120, Issue 4, e291