2 Minute Medicine Rewind March 18, 2024
1. Paxlovid use from the first day of confirmed COVID-19 infection for those with autoimmune rheumatic diseases was associated with a reduced risk of cardiovascular complications.
Evidence Rating Level: 2 (Good)
Paxlovid is an oral antiviral treatment that is used to reduce hospitalization and mortality rates in patients with COVID-19. Patients with rheumatic diseases are known to have an increased risk for infections and complications; therefore, it is important to control COVID-19 infections for these patients early in the course of illness. Researchers aimed to determine whether treatment with Paxlovid within the first day of COVID-19 diagnosis reduces the risk of cardiovascular complications in patients who survive COVID-19 and have underlying autoimmune rheumatic diseases (AIRDs). 238,142 patients with AIRDs and COVID-19 infection in 2022 were included in this cohort study via the US Collaborative Network TriNetX data. This cohort was divided into two groups: those who were treated with Paxlovid and those who were not. Compared to the non-Paxlovid group, Paxlovid use was associated with lower risks of cerebrovascular complications (HR = 0.65 [0.47–0.88]), arrhythmia outcomes (HR = 0.81 [0.68–0.94]), ischemic heart disease and other cardiac disorders (HR = 0.51 [0.35–0.74]) heart failure (HR = 0.41 [0.26–0.63]), major adverse cardiac events (HR = 0.56 [0.44–0.70]) and deep vein thrombosis (HR = 0.46 [0.24–0.87]). A limitation of this study is that information on healthcare insurance status could not be obtained, which was known to be an important potential confounding variable influencing healthcare utilization during the COVID-19 pandemic. Overall, this study demonstrates that Paxlovid use during COVID-19 infection among those with AIRDs is associated with a reduced risk of cardiovascular complications.
1. For women with CIN2, the risk of preterm birth was similar for those who underwent active surveillance compared to immediate loop electrosurgical excision procedure (LEEP), while the risk of preterm birth was greater for those who underwent delayed LEEP compared to immediate LEEP.
Evidence Rating Level: 2 (Good)
Cervical intraepithelial neoplasia grade 2 (CIN2) is typically managed via surgical excision. 50-60% of CIN2 cases regress spontaneously within 2 years; therefore, managing all cases with surgical excision may be over-treatment. In addition, surgical treatment is associated with an increased risk of future obstetric complications, including preterm birth and preterm premature rupture of membranes. In this cohort study, researchers aimed to compare the risk of pre-term birth between women with CIN2 undergoing active surveillance vs. immediate loop electrosurgical excision procedure (LEEP). 10,537 Danish women with CIN2 and singleton births were included in this study. 42% underwent active surveillance, while 58% were managed via immediate LEEP. 8.2% of overall births were preterm. The risk of preterm birth was similar between active surveillance and immediate LEEP (RR, 1.03; 95% CI, 0.90-1.18). For women who underwent delayed LEEP after a period of active surveillance, the risk of preterm birth was greater compared to women treated with immediate LEEP (RR, 1.29; 95% CI, 1.08-1.55). A limitation of this study is that the authors lacked information on some confounding variables that could impact the risk of preterm birth, such as socioeconomic status. Overall, this study demonstrates that for women with CIN2, the risk of preterm birth was similar for those who underwent active surveillance compared to LEEP, while the risk of preterm birth was greater for those who underwent delayed LEEP compared to immediate LEEP.
Teen Pregnancy and Risk of Premature Mortality
1. In this cohort study of female teenagers in Ontario, Canada, the risk of premature death was greater among females with one teen pregnancy, and even greater among those who experienced two or more teen pregnancies.
Evidence Rating Level: 2 (Good)
Deaths during teen pregnancy and childbirth, including those due to hemorrhage, hypertensive disorders, or sepsis, are rare events. However, researchers postulated that teen pregnancy may be a marker of adverse childhood experiences (ACEs) before or during formative teenage years, which may increase the risk for premature mortality. This cohort study included 2,242,929 females alive at age 12 between 1991 and 2021 in Ontario, Canada. Among this cohort, 7.3% experienced a teen pregnancy at a median age of 18 years. The median age at follow-up was 25 years for those without a teen pregnancy and 31 years for those with a teen pregnancy. Among those with a teen pregnancy, 36.8% ended in a live birth, while 65.1% ended in an induced abortion. Among those without a teen pregnancy, death occurred at 1.9 per 10,000 person-years (95% CI, 1.9-2.0 per 10,000 person-years), among those with one teen pregnancy, death occurred at 4.1 per 10,000 person-years (95% CI, 3.8-4.5 per 10 000 person-years), and among those with two or more teen pregnancies, death occurred at 6.1 per 10 000 person-years (95% CI, 5.5-6.8 per 10 000 person-years). Compared to 0 pregnancies, the risk of of premature death was greater for those with one pregnancy, (adjusted HR [AHR], 1.51; 95% CI, 1.39-1.63), and those with two or more pregnancies (AHR, 2.14; 95% CI, 1.92-2.39). This study may have implications for clinical practice and policy-making, indicating that a teen pregnancy may be an important time point for identifying individuals who would benefit from increased social support. Overall, this study demonstrates that the risk of premature death is greater among females with one teen pregnancy, and even greater among those with two or more teen pregnancies.
1. In this large population-based study of adults in South Korea, there was an increased risk of developing encephalitis within 28 days of COVID-19 vaccination only for those who received the AstraZeneca (ChAdOx1-S) vaccine, but no increased risk of developing meningitis post-vaccination.
Evidence Rating Level: 2 (Good)
Over 5.5 billion people worldwide have received at least one dose of a COVID-19 vaccine. Encephalitis and meningitis have been reported as rare but serious adverse events of special interest (AESIs). In this self-controlled case series analysis, researchers used data from the Korea Disease Control Agency between February 2021 and March 2022 to assess the medical claims for adults in Korea who had received at least one dose of a COVID-19 vaccine. The risk window for developing meningitis or encephalitis was defined as days 1-28 after vaccination, while the control window was defined as the remainder of the 240-day follow-up period. Overall, there were 129,956,027 COVID-19 vaccine doses administered to a total of 44,564,345 participants. Among this group, there were 251 cases of encephalitis and 398 cases of meningitis diagnosed during the risk window. There was an increased risk of developing encephalitis in the first 28 days after COVID-19 immunization, which was only significant for those who received the AstraZeneca (ChAdOx1-S) vaccine (IRR 1.26; 95% CI 1.08–1.47). There was no increased risk of developing meningitis observed following the administration of any type of COVID-19 vaccine (IRR 1.03; 95% CI 0.91–1.16). Future research could examine whether there are any long-term risks for neurological complications after COVID-19 vaccination, which was not addressed in this study. Overall, this study demonstrates an increased risk of developing encephalitis, only for those who received the AstraZeneca vaccine, and no significant association between COVID-19 vaccination and meningitis.
1. In this retrospective, population-based cohort study, adherence to health surveillance guidelines among adult survivors of childhood cancer in Ontario, Canada was suboptimal.
Evidence Rating Level: 2 (Good)
It is known that adherence to long-term health surveillance guidelines among adult cancer survivors is poor. In this retrospective, population-based cohort study, researchers aimed to assess the adherence to surveillance guidelines for high-yield tests among adult survivors of childhood cancer. Participants in this study included adults who were diagnosed with childhood cancer between 1986 and 2014 in Ontario, Canada. Data were collected from healthcare administrative data from this province. All 3241 participants in this study were at an increased risk for therapy-related complications. 3205 (99%) had an increased risk of cardiomyopathy, 234 (7%) had an increased risk of breast cancer, and 327 (10%) had an increased risk of developing colorectal cancer. Among these three cohorts, only 53%, 6%, and 13% were adherent to the surveillance guidelines, respectively. Researchers found a higher degree of comorbidity was associated with greater adherence to the surveillance guidelines. A limitation of this study is that the data may not be generalizable to populations outside of Ontario or outside of Canada. Adherence may be even poorer in areas without the publicly funded health insurance that was available to participants in this study. Overall, this study demonstrates that adherence to surveillance guidelines among adult survivors of childhood cancer in Ontario, Canada is suboptimal.
Image: PD
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