Clinical Outcomes Among Bullous Pemphigoid Patients—A Comparison of Urban and Rural Populations

Background Bullous pemphigoid (BP) is the most common autoimmune blistering disease. It can be challenging to manage and is associated with an increased risk of mortality. Access to dermatologic care is essential for patients with BP. However, the influence of geographic residence and distance to specialty care on patient outcomes or treatment regimens is unknown. Objective Assess whether the rural-dwelling or urban-dwelling geographic status of our patients impacts the treatment duration of systemic corticosteroids (CS) in the management of BP. Numerous secondary outcomes were evaluated including the cumulative systemic corticosteroid dose received, steroid-sparing agent utilized, and duration and number of follow-up appointments. Methods Retrospective analysis of patient records from January 2013 to May 2019 seen at the university-associated clinic in Edmonton, Alberta. Patients were stratified based on their rural-dwelling or urban-dwelling status via their Forward Sortation Area. Results There were 59 patients with BP. Of these, 37 completed their systemic corticosteroid course. The time required for 51.0% of the urban group to complete their steroid course was 543 days, and for 51.5% of the rural group it was 507 days. Methotrexate and azathioprine were the most common steroid-sparing agents utilized in both groups. Rural patients were seen in follow-up significantly less often than urban patients. Conclusion Our findings demonstrate that the location of a patient’s geographic residence does not influence the systemic corticosteroid or steroid-sparing agent use at our center. Interestingly, rural patients are able to receive similar treatment to urban patients despite having significantly fewer follow-up appointments.

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Increased risk of venous thromboembolism in patients with bullous pemphigoid

Thrombosis and Haemostasis ◽

10.1160/th15-04-0309 ◽

2016 ◽

Vol 115 (01) ◽

pp. 193-199 ◽

Cited By ~ 13

Author(s):

Paolo Bucciarelli ◽

Ylenia Balice ◽

Giuseppe Cianchini ◽

Pietro Quaglino ◽

Piergiacomo Calzavara Pinton ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Bullous Pemphigoid ◽

Acute Phase ◽

Hazard Ratio ◽

Autoimmune Blistering Disease ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Blistering Disease

SummaryActivation of blood coagulation has been demonstrated in bullous pemphigoid (BP), a rare autoimmune blistering disease, potentially leading to a prothrombotic state. In order to evaluate the incidence of venous thromboembolism (VTE) in BP, a cohort study was carried out on 432 BP patients (59 % females; median age 76 years, interquartile range [IQR]: 68–82). At diagnosis, autoimmune bullous skin disorder intensity score (ABSIS) was calculated. VTE incidence was standardised with rates of the general population. Multivariable Cox proportional hazard model was used to estimate the hazard ratio of VTE according to ABSIS and concomitant risk factors. During a median follow-up of 4.2 years, 31 objectively-diagnosed VTE events were recorded. The incidence rate of VTE (per 1000 patient-years) was 17.2 overall (95 % confidence interval [CI]: 11.1–23.2), 56.7 (95 %CI: 33.0–80.4) during acute phase (22 VTE) and 6.3 (95 %CI: 2.8–11.3) during remission (9 VTE). The standardised incidence ratio was 4.06 (95 %CI: 2.73–5.65), higher during the acute phase (14.86, 95 %CI: 9.20–21.88) than during remission (1.48, 0.66–2.63). The adjusted hazard ratio of VTE was 2.74 (95 %CI: 1.07–7.04) for ABSIS > 48 vs ABSIS < 28, and 2.56 (95 %CI: 1.00–6.70) in patients with [uni2265] 2 concomitant risk factors. In conclusion, BP patients have a 15-fold increased VTE risk during acute phase, proportional to disease severity and heightened by concomitant risk factors.

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717. Cumulative Incidence of Asthma/Wheezing Among Neonates/Infants/Toddlers Clinically Diagnosed with Respiratory Syncytial Virus Infection in the United States: A Retrospective Database Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.724 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S257-S258

Author(s):

Veronique Wyffels ◽

Maartje Smulders ◽

Sandra Gavart ◽

Debasish Mazumder ◽

Rohit Tyagi ◽

...

Keyword(s):

Logistic Regression ◽

Respiratory Syncytial Virus ◽

Cumulative Incidence ◽

The United States ◽

Term Infants ◽

Increased Risk ◽

Study Results ◽

Syncytial Virus ◽

Time Required

Abstract Background The role of respiratory syncytial virus (RSV) in the development of asthma/wheezing (AW) has been evaluated in several studies, mostly among pre-term infants or among infants after developing severe RSV-related disease. We describe the cumulative incidence (CI) of AW among hospitalized/ambulatory neonates/infants/toddlers after RSV/bronchiolitis infection diagnosis, in a large clinical database. Methods Using deidentified Optum Integrated commercial claims and electronic medical records, we identified patients (0–<3 years old) with a first clinical diagnosis of RSV/bronchiolitis infection from 01 January 2008–31 March 2016. Patients with a diagnosis of asthma/wheezing ≤30 days after first RSV/bronchiolitis diagnosis were excluded. Three cohorts were created with 1/3/5 years of follow-up time required, respectively. Patients were grouped by specific high-risk factors (HRF+/−), including pre-term births and predefined pre-existing disease. Descriptive statistics are reported, with comparisons made by logistic regression analyses. Results 9,811/4,524/1,788 patients with RSV/bronchiolitis infection and HRF− were included in the 1/3/5-years follow-up cohorts. 14.9%/28.2%/36.3% had AW events by the end of follow-up in the three cohorts. 6.5%/6.9%/5.8% were hospitalized for RSV/bronchiolitis. 3,030/1,378/552 patients with RSV/bronchiolitis infection and HRF+ were included in the 1/3/5-years follow-up cohorts. 18.1%/32.9%/37.9% had AW events by the end of follow-up in the three cohorts. 11.4%/11.1%/11.6% were hospitalized for RSV/bronchiolitis. The CI rates of AW in the 1/3/5-year HRF+/− cohorts, stratified by hospitalized for RSV/bronchiolitis Y/N, are shown in Figure 1. Logistic regression confirmed that hospitalization for RSV/bronchiolitis was associated with an increased (P < 0.05) likelihood of AW, for HRF+ and HRF− patients at each follow-up year. Conclusion Thirty-eight percent of RSV/bronchiolitis infants/neonates/toddlers HRF+, and 36% among infants/neonates/toddlers HRF−, developed AW in the 5 years after first RSV/bronchiolitis diagnosis. RSV/bronchiolitis hospitalization was associated with a significantly increased risk of AW development in 1/3/5 years of follow-up; confirming previous observational study results. Disclosures V. Wyffels, Janssen: Employee, Salary. M. Smulders, SmaertAnalyst: Consultant, Consulting fee. S. Gavart, Janssen: Employee, Salary. D. Mazumder, SmartAnalyst: Consultant, Consulting fee. R. Tyagi, SmartAnalyst: Consultant, Consulting fee. N. Gupta, SmartAnalyst: Consultant, Consulting fee. R. Fleischhackl, Janssen: Employee, Salary.

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Abstract 14962: Empagliflozin’s Cardiovascular Impact in High-Risk Patients With Type 2 Diabetes and Obstructive Pulmonary Disease: An Inquiry From EMPA-REG OUTCOME

Circulation ◽

10.1161/circ.142.suppl_3.14962 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Stefan D Anker ◽

David H Fitchett ◽

Bernard Zinman ◽

Anne Pernille Ofstad ◽

Christoph Wanner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Pulmonary Disease ◽

Cox Regression ◽

Baseline Risk ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Similar Treatment ◽

Increased Risk

Introduction: Type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD) often co-exist yielding increased risk of cardiovascular (CV) complications, including heart failure (HF). In the EMPA-REG OUTCOME trial, empagliflozin (EMPA) reduced the risk of CV death and hospitalization for HF (HHF) in patients with T2D and CV disease (CVD). We hypothesized that patients with COPD had a higher risk of CV outcomes than those without COPD, but similar treatment benefits on CV outcomes from EMPA as the overall population. Methods: In total, 7020 patients were treated with EMPA 10mg, 25mg, or placebo (PBO) with median follow-up of 3.1 years. We defined COPD at baseline (BL) by investigator reported presence of COPD or emphysema, or the use of medications for obstructive airways disease. We explored the effect of pooled EMPA groups vs. PBO within the subgroups of patients with vs. without COPD on CV death, HHF, HHF or CV death (excluding fatal stroke), all-cause death and 3-point-MACE by Cox regression adjusted for baseline risk factors. Results: The 707 (10.1%) patients with COPD at BL were slightly older (65±8 vs. 63±9 yrs), had more often HF at BL (17 vs. 9%) and coronary artery disease (84 vs. 75%), used insulin (56 vs. 47%) and diuretics (57 vs. 42%,) more frequently, but had similar beta-blocker use (64 vs. 65%) as compared to those without COPD. During follow-up, those with COPD in the placebo group had increased risk of HHF (HR 2.15 [95%CI 1.32-3.49], p=0.002), HHF or CV death (HR 1.60 [1.10-2.33], p<0.015), and all-cause death (HR 1.60 [1.09-2.35], p<0.02). EMPA consistently reduced all CV outcomes irrespective of COPD status (Fig). Conclusions: In EMPA-REG OUTCOME, 10% of patients had concomitant COPD. COPD patients were at increased risk of HHF, HHF or CV death, as well as all-cause death. EMPA consistently reduced these outcomes vs PBO among patients with and without COPD. These data suggest that EMPA’s benefits in patients with T2D and CVD are not attenuated by presence of COPD.

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Non-Bullous Pemphigoid: A Single-Center Retrospective Study

Dermatology ◽

10.1159/000515954 ◽

2021 ◽

pp. 1-7

Author(s):

Agata Moar ◽

Alan Azzolini ◽

Gianpaolo Tessari ◽

Donatella Schena ◽

Giampiero Girolomoni

Keyword(s):

Myocardial Infarction ◽

Bullous Pemphigoid ◽

Rating Scale ◽

Numerical Rating Scale ◽

Delayed Diagnosis ◽

Categorical Variables ◽

Continuous Variables ◽

Aged Patients ◽

Increased Risk

Introduction: Bullous pemphigoid (BP) is an autoimmune disease that typically presents with blisters, but sometimes early lesions may be eczematous, maculopapular, or urticarial. The aim of the present study was to highlight possible differences between typical bullous and non-bullous pemphigoid (NBP) and compare results with the literature. Material & methods: Patients receiving a diagnosis of BP between January 2000 and December 2019 were analyzed. Patients who developed a blister after 3 months from the onset of pruritus were considered as NBP. Demographic features, clinical findings at diagnosis and at 2-year follow-up, histological features, auto-antibodies titers, comorbidities and their treatment were retrieved. Categorical variables were evaluated for normal distribution using a histogram and a Q-Q plot. The χ2 and Fisher’s exact tests were used to compare categorical variables between the groups. Continuous variables were compared between the groups using analysis of variance and the independent-samples t test. For multivariate analysis, logistic regression was performed. Results: A total of 532 patients received a diagnosis of BP. A total of 122 patients were enrolled in the study; 63 were females, and the mean age at the diagnosis was 77.2 years (±11.9 SD). 98 were affected by BP and 24 were categorized as NBP. Mean time to diagnosis was 2.9 months (±5.8 SD) for BP and 30.4 months (±59.8 SD) for NBP (p = 0.0001). Skin manifestations in NBP patients were, in order of frequency: urticarial, papular or nodular, eczematous, and excoriations. Pruritus intensity was high but similar in the two groups (Numerical Rating Scale – NRS, 9.3 vs. 8.9). Seven out of 24 NBP patients (29%) never developed blisters; the other patients developed blisters after a mean follow-up time of 24.9 months (±54.9 SD). NBP patients had a more frequent history of myocardial infarction than BP patients (37.5 vs. 10.2%; p < 0.003). More NBP patients were taking diuretics than BP patients (66.7 vs. 49%; p = 0.03). NBP patients had a worse response to pruritus compared to BP patients at 2 years (NRS 3.7 vs. 11; p 0.001). Conclusions: NBP patients have a delayed diagnosis and may be at an increased risk of cardiovascular disease, especially myocardial infarction. Severely and persistently itchy skin disorders in aged patients should be investigated for BP diagnosis.

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Bullous pemphigoid. Clinical and immunologic follow-up after successful therapy

Archives of Dermatology ◽

10.1001/archderm.113.8.1043 ◽

1977 ◽

Vol 113 (8) ◽

pp. 1043-1046 ◽

Cited By ~ 68

Author(s):

A. R. Ahmed

Keyword(s):

Bullous Pemphigoid ◽

Successful Therapy

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Review for "Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11 Years of Follow-up in Catalonia, Spain"

10.1002/jbmr.3984/v1/review1 ◽

2019 ◽

Author(s):

David Scott

Keyword(s):

Cohort Study ◽

Longitudinal Cohort Study ◽

Longitudinal Cohort ◽

Increased Risk

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Review for "Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11 Years of Follow-up in Catalonia, Spain"

10.1002/jbmr.3984/v2/review2 ◽

2020 ◽

Author(s):

David Scott

Keyword(s):

Cohort Study ◽

Longitudinal Cohort Study ◽

Longitudinal Cohort ◽

Increased Risk

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Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.233.kf1 ◽

2014 ◽

Vol 23 (3) ◽

pp. 255-259 ◽

Cited By ~ 11

Author(s):

Kilian Friedrich ◽

Sabine G. Scholl ◽

Sebastian Beck ◽

Daniel Gotthardt ◽

Wolfgang Stremmel ◽

...

Keyword(s):

Antibiotic Treatment ◽

Respiratory Infection ◽

Endoscopic Procedure ◽

Shortness Of Breath ◽

Respiratory Complications ◽

Endoscopic Procedures ◽

Increased Risk ◽

High Incidence ◽

Respiratory Complaints

Background & Aims: Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.Method: In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

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