Rare cutaneous adverse reactions associated with GLP-1 agonists: a review of the published literature.

Glucagon-like-peptide-1 (GLP-1) agonists are an emerging class of medications used to manage type 2 diabetes mellitus (T2DM) and weight loss, with demonstrated efficacy in reducing hemoglobin A1c levels, body mass index, and adverse cardiovascular events. While previous studies have reviewed notable cutaneous adverse effects with other antidiabetic medications, little is known about GLP-1 agonist-induced cutaneous reactions. Nevertheless, rare but significant cutaneous adverse reactions have been reported, including but not limited to dermal hypersensitivity reactions, eosinophilic panniculitis, bullous pemphigoid, and morbilliform drug eruptions. As GLP-1 induced cutaneous reactions are diverse, diagnosis requires clinical suspicion, thorough history-taking, and supportive histopathological findings when available. Management involves cessation of the offending agent with a tailored regimen to address inflammatory and/or immunogenic etiologies as well as irritative symptoms. This review aims to consolidate available information from case reports and case series regarding rare skin-related adverse outcomes due to GLP-1 use, aiming to provide a comprehensive overview of the presentation, pathogenesis, and management for dermatologists and other clinicians.

Analysis of Cutaneous Lupus Hospitalizations: A United States National Population-Based Study.

Background There are limited studies analyzing cutaneous lupus erythematosus (CLE) hospitalizations. In this study, we aimed to analyze baseline demographics of systemic lupus erythematosus (SLE) and CLE patients, identify the most common reasons for hospitalizations, and find out the hospitalization outcomes.  Materials and methods We performed the analysis using the National (Nationwide) Inpatient Sample (NIS) database between 2016 and 2019. For the CLE cohort, data for adults aged 18 years and older with the primary or secondary diagnosis of CLE using International Classification of Disease - 10th revision (ICD-10) codes were extracted. For comparison, the SLE cohort was identified by patients aged 18 years and older with primary or secondary diagnoses of SLE using ICD-10 codes. Chi-squared test was used to compare baseline demographic characteristics. Multivariable logistic and linear regression was used to calculate outcomes of interest. Results In comparison to the SLE cohort, the CLE cohort was not only older in age and lower percentage female, but also had shorter length of stay, less total hospital charge, and the majority had Medicare as primary insurance. The SLE cohort included predominantly African American patients while the CLE cohort was majority Caucasian patients. The cardiovascular risks were more prevalent in the CLE cohort and most commonly admitted for sepsis, cardiovascular disease, and mental health disorders. Conclusion Our study highlights the importance of outpatient follow-up in CLE patients to closely monitor cardiovascular risk factors, early identification of infections, and routine mental health screenings to reduce hospitalizations and resource utilization.

JAK Inhibitors: A New Weapon in the Skin Care Providers' Arsenal.

A number of chronic skin diseases, such as vitiligo and alopecia areata, are historically resistant to or respond poorly to treatment. Additionally, disorders such as atopic dermatitis and psoriasis have subtypes that are inadequately treated by current medications. Lastly, in the field of dermatology there are a number of conditions, some genetic (such as Darier's disease and Hailey-Hailey disease) and others caused by aberrant inflammatory responses (macrophage-driven conditions such as sarcoidosis and autoimmune conditions such as localized scleroderma) where effective treatments have been limited to date. A new class of anti-inflammatory medications that inhibit the Janus Kinase-Signal transducer and activator of transcription pathway (JAK-STAT) show great promise in providing new and effective treatment of these formerly recalcitrant conditions. This brief review will cover inhibitors of the JAK-STAT pathway (JAK inhibitors) currently approved for use in treating dermatologic diseases including several very recently approved medications. It will also touch on additional conditions under study or where early reports of efficacy are promising.

Analysis of Emergency Department Visits by Patients With Giant Cell Arteritis: A National Population-Based Study.

Background There is scarcity of national level data on the reasons for Emergency Department (ED) presentation among patients with Giant cell arteritis (GCA) in the United States. This study aims to outline the most common reasons for ED presentation among these patients, and the baseline characteristics and outcomes of ED visits principally for GCA.  Materials and methods We obtained data from the Nationwide Emergency Department Sample (NEDS) 2018 database. Each ED visit in the NEDS has a principal diagnosis (the main reason for the visit) and can have up to 34 other secondary diagnoses. We searched for ED visits for patients aged ≥50 with any diagnosis of GCA using ICD-10 codes. The most common principal discharge diagnoses were divided into organ systems, and specific principal discharge diagnoses were recorded for ED visits among patients with GCA in descending order of frequency. We then outlined baseline characteristics and outcomes of ED visits with a principal diagnosis of GCA. Results There were 20,886 ED visits for patients with GCA in 2018. Infections, as well as rheumatologic and cardiovascular disease were the most common reasons for ED presentation, and GCA was the most common specific principal discharge diagnosis for ED visits. There were 3888 ED visits with a principal diagnosis of GCA. These patients were predominantly elderly females, admitted, Medicare insured, with minimal comorbidity burden, and presented to metropolitan teaching hospitals in the south. Conclusion GCA patients are most likely to present to the ED due to their underlying GCA. Infections and CV are also common reasons for presentation to the ED.

Longitudinal Trends of Hospitalizations for Giant Cell Arteritis: A 21-Year Longitudinal National Population-Based Study.

Background Long-term longitudinal studies on giant cell arteritis (GCA) hospitalizations are limited. Here we aim to fill gaps in knowledge by analyzing longitudinal trends of GCA hospitalizations over the last two decades in the United States (U.S.). Materials and methods We performed a 21-year longitudinal trend analysis of GCA hospitalizations using data obtained from the National Inpatient Sample (NIS) database between 1998 and 2018. Using the NIS database, we searched for hospitalizations for patients aged ≥ 50 years with a principal diagnosis of GCA using ICD billing codes. The principal diagnosis was the main reason for hospitalization. We used all hospitalizations in patients without GCA aged ≥50 years as the control population. Multivariable logistic and linear regression analysis was utilized to calculate the adjusted p-trend for outcomes of interest. Results The incidence of GCA hospitalization remained stable at about one per 100,000 U.S. persons throughout the study period. There was no statistically significant change in the inpatient mortality for the GCA group during the study period (adjusted p-trend=0.111). In comparison, inpatient mortality reduced from 4.4% to 3.1% from 1998 to 2018 (adjusted p-trend <0.0001) in the control group. The proportion of whites reduced, while the proportion of racial minorities increased over time in both the GCA and control groups. Conclusion The non-GCA control population saw significant reductions in mortality over time, but unfortunately, the GCA group did not see such improvements. More research into additional treatment modalities for inpatient GCA management may help improve mortality.

Verruciform Xanthomas in the Setting of COVID-19: A Case Series and Review of Other Conditions Associated With This Benign Cutaneous Neoplasm.

Verruciform xanthoma is a rare benign neoplasm that predominantly affects the oral mucosa but can also affect cutaneous sites on the face, trunk, extremities, and genitalia. It is usually identified in isolation; however, there are several known associations with other conditions. Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus that emerged in December 2019 and caused a worldwide pandemic. It primarily manifests as a respiratory illness although various associations and sequelae of COVID-19 are still being elucidated. The clinical and pathologic presentations of two cases of Verruciform xanthoma associated with documented COVID-19 infection at our institution after the start of lockdowns during the COVID-19 pandemic in 2020-2021 are described. In addition, we reviewed the literature for other infectious and non-infectious diseases associated with Verruciform xanthomas to see if there is any basis for a potential link between this rare benign neoplasm and novel viral infection.

Cytokine Release Syndrome Following Blinatumomab Therapy.

New therapeutic solutions have emerged in the last few decades with the growth and expansion of the field of cancer research. Amongst these new agents, immunotherapy has been prominent, particularly regarding the treatment of hematologic malignancies. One of the most worrisome complications of immunotherapy is cytokine release syndrome (CRS), which represents a supraphysiologic response resulting in excessive release of cytokines and a wide range of systemic manifestations. In this case report, we present a case of cytokine release syndrome following blinatumomab therapy despite premedication with dexamethasone.

Renal Involvement in Granulomatosis With Polyangiitis Increases Economic Health Care Burden: Insights From the National Inpatient Sample Database.

Background This study aims to compare outcomes of hospitalizations of granulomatosis with polyangiitis (GPA) with and without renal involvement. The primary outcome was inpatient mortality, whereas secondary outcomes were hospital length of stay (LOS) and total hospital charge. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 databases. The NIS was searched for GPA hospitalizations with and without renal involvement as the principal or secondary diagnosis using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) codes. GPA hospitalizations for adult patients from the above groups were identified. Multivariate logistic and linear regression analyses were used to adjust for possible confounders for the primary and secondary outcomes, respectively. Results There were more than 71 million discharges included in the combined 2016 and 2017 NIS database, of which 23,670 were for adult patients who had either a principal or secondary ICD-10 code for GPA, and 8,265 (34.92%) of these GPA hospitalizations had renal involvement. Hospitalizations for GPA with renal involvement had similar inpatient mortality (3.8% vs. 3.7%; adjusted OR: 1.14; 95% CI: 0.84-1.56; p=0.406) compared to those without renal involvement. GPA with renal involvement hospitalizations had an increase in adjusted mean LOS of 1.36 days (95% CI: 0.82-1.91; p=0.0001) compared to those without renal involvement. GPA with renal involvement hospitalizations had an increase in adjusted total hospital charges of $18,723 (95% CI: 9,595-27,852; p=0.0001) compared to those without renal involvement. Conclusions GPA with renal involvement hospitalizations had similar inpatient mortality compared to those without renal involvement. However, LOS and total hospital charges were greater in those with renal involvement.

Lung involvement in systemic sclerosis is associated with adverse hospital outcomes: insights from the National Inpatient Sample.

This study aimed to compare outcomes of systemic sclerosis (SSc) hospitalizations with and without lung involvement. The primary outcome was inpatient mortality while secondary outcomes were hospital length of stay (LOS) and total hospital charge. Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. This database is the largest collection of inpatient hospitalization data in the USA. The NIS was searched for SSc hospitalizations with and without lung involvement as principal or secondary diagnosis using International Classification of Diseases 10th Revision (ICD-10) codes. SSc hospitalizations for patients aged ≥18 years from the above groups were identified. Multivariate logistic and linear regression analysis was used to adjust for possible confounders for the primary and secondary outcomes, respectively. There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 62,930 hospitalizations were for adult patients who had either a principal or secondary ICD-10 code for SSc. 5095 (8.10%) of these hospitalizations had lung involvement. Lung involvement group had greater inpatient mortality (9.04% vs 4.36%, adjusted OR 2.09, 95% CI 1.61 to 2.73, p<0.0001), increase in mean adjusted LOS of 1.81 days (95% CI 0.98 to 2.64, p<0.0001), and increase in mean adjusted total hospital charge of $31,807 (95% CI 14,779 to 48,834, p<0.0001), compared with those without lung involvement. Hospitalizations for SSc with lung involvement have increased inpatient mortality, LOS and total hospital charge compared with those without lung involvement. Collaboration between the pulmonologist and the rheumatologist is important in optimizing outcomes of SSc hospitalizations with lung involvement.

Reasons for Hospitalization of Psoriasis Patients: A Report From the National Inpatient Sample.

Background We used a large United States population-based database to analyze the reasons for hospitalization of psoriasis patients. Methods International Classification of Diseases, 10th revision (ICD-10) code was used to identify hospitalizations in National Inpatient Sample (NIS) 2017 with a principal or secondary diagnosis of psoriasis. The reasons for hospitalization were divided into 19 categories based on their principal discharge ICD-10 diagnosis code. We also ranked the five most common specific reasons for hospitalization of psoriasis patients. Results There were over 35 million discharges included in the 2017 NIS database. A total of 165215 hospitalizations had either a principal or secondary ICD 10 code for psoriasis. Based on ICD-10 code categories, the top five reasons for hospitalization in patients with history of psoriasis were: Cardiovascular (CV) (26605, 16.10%), rheumatologic (19555, 11.84%), digestive (18465, 11.18%), infection (16395, 9.92%), and respiratory (14865, 9.00%). Sepsis was the most common principal diagnosis of psoriasis hospitalizations. Conclusion CV diseases were the most common ICD category, and sepsis was the most common principal diagnosis for psoriasis hospitalization. Management of medical co-morbidities is important in reducing rates of hospitalization of psoriasis patients.

An Analysis of Rheumatoid Arthritis Hospitalizations.

Background We used a large United States (US) population-based database to analyze the reasons for hospitalization of rheumatoid arthritis (RA) patients. Methods The International Classification of Diseases, Tenth Revision (ICD-10) code was used to search for hospitalizations in 2017 in the National Inpatient Sample (NIS) database with RA as the principal or secondary diagnosis. The reasons for hospitalization were divided into 19 categories based on their principal discharge ICD-10 diagnosis code. We also ranked the five most common specific reasons for hospitalization. Results There were over 35 million discharges included in the 2017 NIS database; 565,440 hospitalizations had either a principal or secondary ICD-10 code for RA. The top five reasons for RA hospitalization by ICD-10 code categories were as follows: cardiovascular (CV): 93,825 (16.59%), rheumatologic: 82,785 (14.64%), respiratory: 66,895 (11.83%), infection: 62,660 (11.09%), and injury/poisoning: 56,460 (9.96%). Sepsis was the most common principal diagnosis for RA hospitalizations. Conclusion CV diseases were the most common ICD category, and sepsis was the most common principal diagnosis for RA hospitalizations. Management of medical comorbidities (such as CV) and prevention of infection is essential for reducing the rates of RA hospitalizations.