Sodium-glucose co-transporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors on major liver outcomes in metabolic dysfunction-associated steatotic liver disease.

AIM: To compare the effectiveness of sodium-glucose co-transporter-2 inhibitors (SGLT2is) with dipeptidyl peptidase-4 inhibitors (DPP4is) on major liver outcomes (MLO) in patients with type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD). MATERIALS AND METHODS: We included adult patients with T2D and MASLD, using metformin without specific liver conditions or surgeries, from the Merative MarketScan database. Patients initiating SGLT2is or DPP4is from 1 January 2014 to 31 December 2022 were identified. The primary outcome was time to MLO diagnosis. Overlap weighting balanced covariates, integrated with a Cox proportional hazards model for survival analysis. RESULTS: Among 44 651 patients, 22 100 initiated SGLT2is, and 22 551 began DPP4is. After weighting, the incidence rate of MLO in the SGLT2i group was 3.8 per 1000 person-years, and it was 3.9 per 1000 person-years in the DPP4i group, resulting in an adjusted hazard ratio (aHR) of 0.82 (95% CI, 0.60-1.10). SGLT2i initiation was not associated with cirrhosis (aHR: 0.77; 95% CI, 0.55-1.06) or hepatocellular carcinoma (aHR: 0.99; 95% CI, 0.47-1.83) separately. Subgroup and sensitivity analyses did not yield significant results. CONCLUSIONS: In patients with T2D and MASLD, SGLT2is did not show a lower risk of MLO compared with DPP4is. Clinicians should consider the overall patient conditions and the additional benefits of SGLT2is to support the decision to switch from DPP4is.

High rifaximin out-of-pocket costs are associated with decreased treatment retention among patients with hepatic encephalopathy.

BACKGROUND AND AIMS: Hepatic encephalopathy (HE) is associated with significant morbidity and mortality for those with cirrhosis. Despite the known benefits of rifaximin use for HE, treatment retention remains low. This study aimed to evaluate the impact of out-of-pocket (OOP) rifaximin cost on treatment retention among commercially insured patients in the United States. METHODS: Adult patients with cirrhosis and HE were identified from the IBM MarketScan claims database. Those who began rifaximin treatment between January 1, 2011, and December 1, 2021 were included. Regression models were used to analyze the relationship between patients' 30-day OOP rifaximin cost and rifaximin retention (≥80% eligible days with rifaximin supply) at 180, 360, and 540 days. Models were controlled for patient demographic and clinical characteristics including age, sex, comorbid conditions, Charlson comorbidity index (CCI), and lactulose use. RESULTS: A total of 6839 adult patients were included. Most patients were between 55 and 64 years (57.1%), male (60.4%), and living in urban settings (84.6%). Treatment retention was low for all time periods; retention rates for rifaximin were 42%, 25%, and 16% at 180, 360, and 540 days, respectively. In multivariable analysis, 30-day OOP costs of ≥ $150 were associated with a decreased likelihood of rifaximin retention at 180, 360, and 540 days [relative risk (RR) = 0.67, RR = 0.62, and R = 0.60, respectively]. Younger age was associated with reduced treatment retention for all time periods. Metastatic cancer and depression were associated with reduced treatment retention at 180 days (RR = 0.70 and RR = 0.87, respectively). CONCLUSIONS: Rates of rifaximin treatment retention are low despite the known benefits of rifaximin use for breakthrough HE. High 30-day OOP cost is associated with reduced rifaximin treatment retention.

Prevalence, trends, and characteristics of polypharmacy among US pregnant women aged 15 to 44 years: NHANES 1999 to 2016.

Polypharmacy has become a major health issue for pregnant woman due to the increased trend of medication use during pregnancy. However, data on medication use in pregnancy are limited since pregnant women are rarely included in clinical trials. Our study aimed to investigate the trends of and characteristics associated with polypharmacy among pregnant women in the US. This study was conducted using data from The National Health and Nutrition Examination Survey in the US. Nine The National Health and Nutrition Examination Survey cycles between 1999 and 2016 were used to identify pregnant women aged 15 to 44 years. Polypharmacy was defined as more than 1 medication prescription used during pregnancy. Descriptive statistics were used to report the prevalence and trends of polypharmacy. Multivariable logistic regression models were used to evaluate characteristics associated with polypharmacy among US pregnant women. Among 3,350,983 US pregnant women, about 7.4% of them (247,525) experienced polypharmacy. The prevalence of polypharmacy increased from 2.8% (1999-2000) to 10.0% (2015-2016) (P < .01) over-the time period examined in this study. Pregnant women were less likely to have experienced polypharmacy than were nonpregnant women (7.4% vs 23.5%, P < .01). Levothyroxine and albuterol were 2 prescriptions commonly taken by pregnant women. Pregnant women who were non-Hispanic white (P < .05) or had asthma (P < .05) or diabetes (P < .01) were more likely to report polypharmacy. Regarding personal characteristics, women with a poor or fair self-reported general health condition (odds ratio: 5.12, 95% confidence interval: 1.23-21.34) and those with chronic conditions (odds ratio: 6.91, 95% confidence interval: 3.08-15.50) were found to be associated with polypharmacy. An increased trend of polypharmacy was found in the US from 1999 to 2016. Non-Hispanic white pregnant women with a poor health status and chronic diseases were at an increased risk of polypharmacy.

SMAD3 Hypomethylation as a Biomarker for Early Prediction of Colorectal Cancer.

The incidence and mortality rates of colorectal cancer (CRC) have been high in recent years. Prevention and early detection are crucial for decreasing the death rate. Therefore, this study aims to characterize the alteration patterns of mothers against decapentaplegic homolog 3 (SMAD3) in patients with CRC and its applications in early detection by using a genome-wide methylation array to identify an aberrant hypomethylation site in the intron position of the SMAD3 gene. Quantitative methylation-specific polymerase chain reaction showed that hypomethylated SMAD3 occurred in 91.4% (501/548) of Taiwanese CRC tissues and 66.6% of benign tubular adenoma polyps. In addition, SMAD3 hypomethylation was observed in 94.7% of patients with CRC from The Cancer Genome Atlas dataset. A decrease in circulating cell-free methylation SMAD3 was detected in 70% of CRC patients but in only 20% of healthy individuals. SMAD3 mRNA expression was low in 42.9% of Taiwanese CRC tumor tissues but high in 29.4% of tumors compared with paired adjacent normal tissues. Hypomethylated SMAD3 was found in cancers of the digestive system, such as liver cancer, gastric cancer, and colorectal cancer, but not in breast cancer, endometrial cancer, and lung cancer. In conclusion, SMAD3 hypomethylation is a potential diagnostic marker for CRC in Western and Asian populations.