. Prior to joining MJH Life Sciences in 2019, he worked as a digital reporter covering nanotechnology, life sciences, material science and more with 

. He graduated with a degree in journalism from Temple University in 2008 and began his career as a local reporter for a chain of weekly newspapers based on the Jersey shore. When not working, he enjoys going to the beach and enjoying the shore in the summer and watching North Carolina Tar Heel basketball in the winter.

Kenny Walter

Credit: University of North Carolina at Chapel Hill

There are several predictors for being up-to-date on 

 screenings for older adults, including insurance type, distance to the nearest endoscopy facility, and being high school educated.

A team, led by Kristen Hassmiller Lich, PhD, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, examined both individual and county-level predictors for staying up-to-date on colorectal cancer screenings past the age of 45.

“Routine CRC screening is the most effective way to reduce risk of and death from [colorectal cancer],” the authors wrote. “An individual is considered up-to-date with [colorectal cancer] screening if they have a colonoscopy at least once every 10 years.”

Recently, the guidelines for colorectal cancer screenings were updated where it is recommended for all individuals aged 45-75 years to regularly receiving screenings. Prior to 2021, the recommendations were for all individuals beginning at age 50.

There is currently a need to assess the factors associated with being up-to-date for colorectal cancer screening to identify populations where targeted interventions could be needed.

In the study, the investigators used Medicare and private insurance claims for data on residents of North Carolina to identify up-to-date status in the 10th year of continuous enrollment in the claims data and in the available subsequent years. They used guidelines from the United States Preventative Service Task Force (USPSTF) to define up-to-date status for multiple recommended modalities and used Area Health Resources Files for geographic and health care service provider data at the county level.

The team also used a generalized estimating equation logistic regression model to examine the association between individual- and county-level characteristics and being up-to-date with colorectal cancer screening.

The results show 75% (n = 274,660) participants aged 59-75 years were up-to-date between 2012-2016. The investigators also identified several individual predictors including sex, age, insurance type, recent visits with a primary care provider, distance to nearest endoscopy facility, and insurance type, as well as county-level predictors, such as percentage of residents with a high school education, without insurance, and unemployed as being up-to-date.

An example of this is individuals with higher odds of being up-to-date were aged 73-75 years compared to aged 59 years (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.09, 1.15).

This was also true for individuals living in counties with more primary care physicians (OR, 1.03; 95% CI, 1.01-1.06).

“This study identified 12 individual- and county-level demographic characteristics related to being up-to-date with screening to inform how interventions may optimally be targeted,” the authors wrote.

 Multi-level predictors of being up-to-date with colorectal cancer screening. 

 (2023). https://doi.org/10.1007/s10552-023-01723-w

Articles

There were  several individual predictors including sex, age, recent visits with a primary care provider, distance to nearest endoscopy facility, and insurance type, as well as county-level predictors, such as percentage of residents with a high school education, without insurance, and unemployed as being up-to-date. 

Investigators Find Demographic Predictors of Up-to-Date Colorectal Cancer Screenings 

 sample tests in French hospitals did not result in a reduction in healthcare-associated infections according to new research.

A team, led by Madeline L. Berg, MPH, Department of Infection Prevention and Control, UPMC Presbyterian/Shadyside, assessed the impact of a 24-hour autocancellation of uncollected Clostridioides difficile samples in reducing reported healthcare-associated infections.

 is a priority healthcare-associated pathogen, but testing for 

 poorly distinguishes colonized patients from those with an active infection,” the authors wrote. “As many as 4%–15% of hospitalized patients may be asymptomatically colonized with 

 colonization is 5–10 times more common than symptomatic 

In the quality-improvement, before-and-after implementation study, the investigators examined C difficile sample data from 17 hospitals in Pennsylvania. Any tests not collected within 24 hours were deemed automatically canceled through the electronic health record.

The intervention took place at 2 facilities between November 2021 and July 2022 and 15 additional facilities between April 2022 and July 2022. The team looked at various quality measures including the percentage of orders canceled, C difficile healthcare-associated infection rate, percent of positivity of completed tests, and potential adverse outcomes of canceled or delayed testing.

There were 6101 orders included in the study, 17.9% (n = 1090) of which were automatically canceled after not being collected for 24 hours during the intervention periods.

The results show the reported C difficile healthcare-acquired infections rates per 10,000 patient days did not significantly change. The rates were 8.07 in the 6-month preintervention period and 8.77 in the intervention period for facilities A and B combined (incidence rate ratio [IRR], 1.09; 95% confidence interval [CI], 0.88-1.34; 

There were also 5.23 healthcare-associated infections per 10,000 patient days in the 6-month preintervention period and 5.33 in the intervention period for the remaining 15 facilities combined (IRR, 1.02; 95% CI, 0.79–1.32; 

From the preintervention to the intervention periods, the percent positivity rates of completed tests increased by 1.1% for the first 2 facilities and by 1.4% for the remaining 15 facilities.

There were no adverse outcomes found in the study.

“The 24-hour autocancellation of uncollected 

 orders reduced testing but did not result in reported HAI reduction,” the authors wrote.

Berg, M., Baxter, C., Ayres, A., Chung, A., Slaughter, J., Bilderback, A., . . . Snyder, G. (2023). The impact of autocancellation of uncollected Clostridioides difficile specimens after 24 hours on reported healthcare-associated infections: A quality improvement intervention. 

Infection Control & Hospital Epidemiology,

The reported C difficile healthcare-acquired infections rates per 10,000 patient days did not significantly change. The rates were 8.07 in the 6-month preintervention period and 8.77 in the intervention period for facilities A and B combined.

Autocancellation of Uncollected CDI Test Orders Does Not Reduce Infection Rate

 (HCV) infected kidney donors for uninfected reciepents could be both effective and cost effective.

A team, led by Jessica S. Jay, PharmD, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, reported on a cost minimization analysis using the health system perspective to determine the least expensive DAA regimen using available published strategies.

Often trials that focus on 4-12 week courses of DAAs to treat HCV transmission from infected donors to uninfected kidney transplant recipients are limited in application due to costs and delayed access to the costly treatments.

However, a short prophylactic strategy could be both safer and cost-effective.

In the study, the investigators conducted a cost-minimization analyses from the health system perspective of 4 DAA regimens to prevent and/or treat HCV transmission from infected donors to uninfected kidney transplant recipients.

The team compared a 7-day prophylaxis with generic sofosbuvir/velpatasvir (SOF/VEL), with 12 week branded glecaprevir/pibrentasvir (G/P) for those with transmission, 8-day branded G/P prophylaxis, with 12-week branded sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) for those with transmission, 4-week peri-operative generic SOF/VEL prophylaxis, with 12-week branded G/P for those with transmission, or an 8-week branded G/P ‘transmit-and-treat.’

The investigators estimated the probability of viral transmission in patients who received DAA prophylaxis and a summed a 100% transmission rate for those who received the ‘transmit-and-treat’ approach using data from published literature.

The expected cost of the first strategy was $2,326 and $2,646 in the second strategy, compared to $4,859 for the third strategy and $18,525 for the fourth strategy.

However, after conducting a threshold analysesfor the 7-day SOF/VEL compared to the 8-day G/P, the investigators found there were reasonable input levels where the 8-day strategy could actually be the least costly.

In addition, the threshold values for the SOF/VEL prophylaxis strategies showed that the 4-week strategy likely won’t be less costly under any reasonable value of the input variables.

“Short duration DAA prophylaxis using 7 days of SOF/VEL or 8 days of G/P has the potential to yield significant cost savings for D+/R- transplants,” the authors wrote.

Access to direct-acting antivirals (DAA) for patients with chronic HCV helps improve outcomes, according to a 2022 study.

In the Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C), the investigators examined data from a national observational cohort of 96 clinical services, including specialist clinics and less traditional settings, including general practices.

Various factors decreased the likelihood of achieving SVR, including male gender (aOR, 0.56; 95% CI, 0.43-0.72), cirrhosis (aOR, 0.52; 95% CI, 0.41-0.64), recent injecting drug use (aOR, 0.64; 95% CI, 0.46-0.91), and previous DAA treatment (aOR, 0.50; 95% CI, 0.28-0.90).

However, other factors modified the loss to follow-up, including IDU ± opioid agonist therapy (OAT; IDU only: aOR, 1.75; 95% CI, 1.44-2.11; IDU + OAT: aOR, 1.39; 95% CI, 1.11-1.74; OAT only, aOR, 1.36; 95% CI, 1.13-1.68) and age (aOR, 0.97; 95% CI 0.97-0.98).

1. Jay, J. S., Patterson, J. A., Zhang, Y., Ijioma, S. C., Carroll, N. V., Holdford, D. A., Sterling, R. K., Gupta, G., & Yakubu, I. (2023). Cost minimization analysis of short-duration anti-viral prophylaxis for hepatitis C positive donor kidney transplants. 

Journal of the American Pharmacists Association

. https://doi.org/10.1016/j.japh.2023.06.027

Access to direct-acting antivirals improves outcomes for hepatitis C patients

. HCP Live. https://www.hcplive.com/view/access-direct-acting-antivirals-outcomes-hepatitis-c-patients

The threshold values for the SOF/VEL prophylaxis strategies showed that the 4-week strategy likely won’t be less costly under any reasonable value of the input variables.

Short Duration DAA Prophylaxis Could Be Cost Beneficial Option for HCV Donor Transplantations

Mirikizumab continues to outperform placebo in data from a pair of new trials evaluating the drug in patients with 

A team, led by Geert D’Haens, MD, PhD, compared mirikizumab to placebo in both an induction trial and a maintenance trial involving patients with moderately to severely active ulcerative colitis.

In phase 2 trials, mirikizumab, which is a p19-directed antibody against interleukin-23, has shown promise in treating patients with ulcerative colitis.

The investigators reported results from a pair of phase 3, randomized, double-blind, placebo-controlled trials in adults with moderately to severely active ulcerative colitis.

In the induction trial, each participant was treated with either mirikizumab 300 mg or placebo intravenously every 4 weeks for 12 weeks and in the maintenance trial, each patient with a response to mirikizumab induction therapy was treated with mirikiziumab 200 mg or placebo subcutaneously every 4 weeks for an additional 40 weeks.

The investigators sought primary endpoints of clinical remission at week 12 in the induction trial and week 40 in the maintenance trial. They also looked at major secondary endpoints of clinical response, endoscopic remission, and improvement in bowel-movement urgency.

Patients who did not have a response in the induction trial were then allowed to be part of the open-label mirikiziumab during the first 12 weeks of the maintenance trial as an extended induction.

The induction trial included 1281 patients, 544 of which had a response to mirikiziumab and were entered into the maintenance trial.

There were higher percentages of patients treated with mirikizumab that had clinical remission at week 12 of the induction trial compared to the placebo group (24.2% vs. 13.3%; 

<0.001). This was also true at week 40 of the maintenance trial (49.9% vs. 25.1%; 

The criteria for all of the major secondary endpoints were met in both trials.

In the safety analysis, adverse events such as nasopharyngitis and arthralgia were more frequently reported in the mirikizumab group compared to placebo.

Of the 1217 patients in the mirikizumab group during the controlled and uncontrolled periods, 15 had opportunistic infections, including 6 participants with herpes zoster infections, and 8 had cancer, including 3 with colorectal cancer.

In the induction trial placebo group, 1 participant had a herpes zoster infection and there were no cases of cancer.

“Mirikizumab was more effective than placebo in inducing and maintaining clinical remission in patients with moderately to severely active ulcerative colitis,” the authors wrote. “Opportunistic infection or cancer occurred in a small number of patients treated with mirikizumab.”

In April, the US Food and Drug Administration (FDA) has issued a Complete Response Letter (CRL) for mirikizumab, citing issues related to the proposed manufacturing of the treatment.

The CRL, which was issued for the Biologic License Application (BLA) by Eli Lilly and Company, did not cite any concerns about the clinical data package, safety, or label for the medicine.

1. D’Haens, G., Dubinsky, M., Kobayashi, T., Irving, P. M., Howaldt, S., Pokrotnieks, J., Krueger, K., Laskowski, J., Li, X., Lissoos, T., Milata, J., Morris, N., Arora, V., Milch, C., Sandborn, W., & Sands, B. E. (2023). Mirikizumab as induction and maintenance therapy for ulcerative colitis. 

(26), 2444–2455. https://doi.org/10.1056/nejmoa2207940

U.S. Food and Drug Administration Issues Complete Response Letter for mirikizumab

. Eli Lilly and Company. (2023, April 13). Retrieved April 13, 2023, from https://investor.lilly.com/news-releases/news-release-details/us-food-and-drug-administration-issues-complete-response-1

There were higher percentages of patients treated with mirikizumab that had clinical remission at week 12 of the induction trial compared to the placebo group. This was also true at week 40 of the maintenance trial.