Mepolizumab for treatment of adolescents and adults with eosinophilic oesophagitis: a multicentre, randomised, double-blind, placebo-controlled clinical trial.

OBJECTIVE: We aimed to determine whether mepolizumab, an anti-IL-5 antibody, was more effective than placebo for improving dysphagia symptoms and decreasing oesophageal eosinophil counts in eosinophilic oesophagitis (EoE). METHODS: We conducted a multicentre, randomised, double-blind, placebo-controlled, trial. In the first part, patients aged 16-75 with EoE and dysphagia symptoms (per EoE Symptom Activity Index (EEsAI)) were randomised 1:1 to 3 months of mepolizumab 300 mg monthly or placebo. Primary outcome was change in EEsAI from baseline to month 3 (M3). Secondary outcomes included histological, endoscopic and safety metrics. In part 2, patients initially randomised to mepolizumab continued 300 mg monthly for 3 additional months (mepo/mepo), placebo patients started mepolizumab 100 mg monthly (pbo/mepo), and outcomes were reassessed at month 6 (M6). RESULTS: Of 66 patients randomised, 64 completed M3, and 56 completed M6. At M3, EEsAI decreased 15.4±18.1 with mepolizumab and 8.3±18.0 with placebo (p=0.14). Peak eosinophil counts decreased more with mepolizumab (113±77 to 36±43) than placebo (146±94 to 160±133) (p<0.001). With mepolizumab, 42% and 34% achieved histological responses of <15 and ≤6 eos/hpf compared with 3% and 3% with placebo (p<0.001 and 0.02). The change in EoE Endoscopic Reference Score at M3 was also larger with mepolizumab. At M6, EEsAI decreased 18.3±18.1 points for mepo/mepo and 18.6±19.2 for pbo/mepo (p=0.85). The most common adverse events were injection-site reactions. CONCLUSIONS: Mepolizumab did not achieve the primary endpoint of improving dysphagia symptoms compared with placebo. While eosinophil counts and endoscopic severity improved with mepolizumab at 3 months, longer treatment did not yield additional improvement. TRIAL REGISTRATION NUMBER: NCT03656380.

Communication Between Primary Care Pediatricians and the Pediatric Emergency Department.

OBJECTIVES: This study aimed to measure the quality of communication from primary care pediatricians (PCPs) to the pediatric emergency department (ED). We also sought to determine whether the quality of this communication affected patient outcomes. METHODS: We conducted a retrospective chart review of patients sent from their pediatrician to the pediatric ED during a 4-year period. The quality of communication was classified as no communication, incomplete communication, or complete communication, based on compliance with Joint Commission requirements. Outcome measures included overnight admission, total length of hospital stay, repetition of diagnostic tests, ED revisits, hospital readmissions, and initial follow-up pediatrician visit. RESULTS: Fifty-five patients were included in the analysis. Communication was complete in 22% of cases, incomplete in 16% of cases, and absent in 62% of cases. Medications and allergies were most often missing. The quality of communication was not associated with any of the prespecified covariates or outcome measures. Chief complaint of respiratory distress and greater severity score were associated with a greater likelihood of hospital admission from the ED. CONCLUSIONS: Our study demonstrates a lack of documented communication between PCPs and a pediatric ED, albeit with no statistically significant impact on patient outcomes. Practices to increase the quality of PCP-ED communication could include standardizing interfacility referrals, maximizing shared electronic health record use between clinical environments, and increased collaboration between ED physicians and PCPs. Further research to investigate subjective outcomes, such as patient expectations or satisfaction associated with PCP-ED communication, may reveal other consequences of incomplete communication.

Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study.

BACKGROUND: Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women. OBJECTIVE: This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women. METHODS: A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview. RESULTS: Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women. CONCLUSIONS: The one-time verbal introduction of MyChart does not meet current patients' needs. Data reveal the need for more consistent patient education and support programs, tailored to patients' previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use.