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INTRODUCTION: The comparative effectiveness of upadacitinib and tofacitinib for ulcerative colitis (UC) is poorly understood. METHODS: In this retrospective cohort study, we compared steroid-free clinical remission (SFCR) and endoscopic response/remission at 52 weeks among adults initiating upadacitinib or tofacitinib for UC. RESULTS: A total of 155 patients initiated upadacitinib (n = 81; 30% prior tofacitinib exposure) or tofacitinib (n = 74; 0% prior upadacitinib exposure). After inverse probability of treatment-weighted logistic regression, upadacitinib was associated with significantly higher odds of SFCR (odds ratio 3.01, 95% confidence interval 1.39-6.55) vs tofacitinib. There were no differences for endoscopic response/remission. DISCUSSION: Upadacitinib was more effective at achieving SFCR in UC at 52 weeks vs tofacitinib.
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Background: ß-blockers (BBs) have shown promise in improving overall survival (OS) in patients with breast, ovarian, pancreatic and lung cancer. However, few studies have evaluated the impact of BBs on unresectable hepatocellular carcinoma (HCC). Methods: The authors compared clinical data and outcomes between unresectable HCC patients based on whether they were prescribed BBs. Results: There was significantly decreased disease progression in the BB group compared with the non-BB group (22.8 vs 28.0%; p < 0.05). No difference was seen in OS or progression-free survival between groups. Those specifically on selective BBs had improved OS (hazard ratio: 0.75; 95% CI: 0.61-0.94; p = 0.01) and progression-free survival (hazard ratio: 0.66; 95% CI: 0.45-0.96; p = 0.03) compared with non-BB patients. Conclusion: Although the authors' study did not demonstrate that BBs improve OS in HCC, it did show decreased disease progression among patients with HCC who were taking BBs compared with those who were not.
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Constipation is a condition that is very prevalent and is reported in up to 40 percent of individuals with intellectual and developmental disabilities (IDD). Constipation in this patient population is most commonly secondary to neuromuscular abnormalities, immobility, suboptimal diet, and medication side effects. History taking is frequently limited in adults with IDD due to communication barriers, often leading to a missed diagnosis of constipation. Inadequately treated constipation may lead to adverse effects including behavioral disturbances, fecal impaction, intestinal obstruction, and even death from intestinal perforation and sepsis. As a result, a high index of suspicion must exist for this patient population. Treatment in these patients requires an individualized approach, to reduce the constipation and its associated health complications.
ABSTRACT
Intellectual disability (ID) encompasses a wide variety of disorders that can severely affect an individual's cognitive, social, emotional, and physical development, even when identified early in life. Initially, individuals with such disorders had shorter life expectancies. However, medical advances have increased the life expectancy of individuals with ID similar to that of the general population. More attention must be paid to manage diseases affecting the intellectually disabled elderly, such as diabetes, cardiovascular disease, chronic constipation, and behavioral disorders.
