The 2 Minute Medicine Podcast Episode 16

Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians. On this podcast, twice a month, we cover the latest in healthcare news and research evidence.

Our episode is live!

Episode Description

We begin this episode by discussing our article of the week which comes from  Our article of the week comes from The Lancet and is entitled “Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial.” In the second half of our episode, we bring a medical eye to popular events. First, we take a closer look at how the FDA has recommended making a hormonal contraceptive pill, Opill, available over the counter. We then have a conversation about the recent pancreatic cancer vaccine trial, delving deeper into the subject of cancer immunotherapy. We conclude with a conversation about how Montana has become the first state to fully ban TikTok. We discuss the implications of social media on mental health, specifically among teenagers.

Click here to listen to this episode on Apple podcast

Click here to listen to this episode on Spotify

Transcript

[Deepti] Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians.

For our full suite of daily medical study summaries and updates written by practicing doctors, please visit our website at 2minutemedicine.com to start reading new daily content right now, for free. On this podcast, twice a month, we cover the latest in healthcare news and research evidence. We are your hosts Deepti and Andrew. On today’s episode, we’ll start off by discussing our two articles of the week. In the second half of the episode, we will look at health issues that have arisen in popular media. 

[Andrew] Our article of the week comes from The Lancet and is entitled “Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial.”

IgA nephropathy is the most common cause of primary glomerulonephritis worldwide. Although renin-angiotensin blockers (or ARBs), such as irbesartan, have been primarily used for treatment, some patients continue to have persistent proteinuria. Sparsentan, a novel single-molecule, endothelin and angiotensin II receptor antagonist, may have improved efficacy in patients with refractory proteinuria although existing trials suggest mixed results. This randomized controlled trial aimed to assess the safety and efficacy of sparsentan in adults with IgA nephropathy.

Between Dec 20, 2018, and May 26, 2021, 671 patients were screened for eligibility across 134 clinical sites in 18 countries. Included were patients ≥ 18 years with biopsy-confirmed IgA nephropathy and using angiotensin-converting enzyme (ACE) inhibitor or ARB therapy. Altogether, 404 patients (202 in sparsentan and 202 in irbesartan) were included in the final analysis. The primary efficacy outcome was the mean change in protein excretion from baseline to 26 weeks while a secondary outcome included remission of proteinuria.

The primary outcome of reduction in urine protein excretion at 36 weeks was significantly greater in the sparsentan group (-49.8%) than the irbesartan group (-15.1%; geometric least squares mean ratio 0.59 [95 % CI 0.51-0.69], p<0.0001). Similarly, complete remission of proteinuria occurred in 21% of sparsentan patients compared to 8% of irbesartan patients (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.6-5.8, p=0.0005). Treatment-related adverse events and change in body weight were comparable between both groups; there were no fatalities.

Overall, findings from this study suggest that sparsentan may be safe and effective for treatment of proteinuria in patients with biopsy-proven IgA nephropathy. According to study results, once-daily sparsentan significantly reduced proteinuria compared to irbesartan. This study was strengthened by a randomized design with individuals from multiple clinical sites across various countries, thus increasing its generalizability, though it is important to note that this is an interim analysis and not the final study results.

[Andrew] Now for the Scan by 2 Minute Medicine®,  a pop-culture medical newsletter and exclusive benefit for 2 Minute Medicine Plus subscribers. We will start off by talking about over-the-counter birth control. 

The Story: This past month, an advisory panel at the Food and Drug Administration (FDA) has recommended making a hormonal contraceptive pill, Opill, available over the counter (OTC). This news comes in the context of a highly charged political environment around access to abortion, which has diminished significantly since the overturning of Roe v. Wade last year. If approved this summer, it could mean significantly greater access to contraception for women across the country.

You might be wondering, how do birth control pills work? 

[Deepti] Hormonal birth control pills are a widely used method of contraception for women. Opill is a contraceptive pill that only contains progestin, a synthetic form of the hormone progesterone. These progestin-only pills work by thickening the cervical mucus, making it difficult for sperm to reach and fertilize the egg. They also thin the lining of the uterus, reducing the chances of a fertilized egg implanting and growing. When taken at the same time every day, these pills have a failure rate of about 1%, making them highly reliable for preventing unwanted pregnancies. While Opill has fewer side effects than a combination birth control pill (one that includes both estrogen and progestin), patients are still at risk of unscheduled bleeding, breast tenderness, and mood changes. Moreover, not everyone can take hormonal birth control – research suggests that taking a progestin-only pill like Opill can worsen pre-existing liver disease or breast cancer. Up until now, individuals have required a prescription from their primary care provider to access birth control. At these health visits, they typically have discussed potential side effects and pre-existing medical conditions to ensure safe usage.

If approved this summer, making Opill available over the counter could increase contraception availability for women across the country and lead to benefits such as more favorable pregnancy outcomes, improved child well-being, and decreased abortion rates. However, some FDA researchers have raised concerns about patient education when the pills are available over the counter and if women with certain medical conditions, such as breast cancer, would properly follow the warnings and avoid using the product. Others have questioned the ability of consumers to follow instructions to take the pill consistently and use other forms of contraception or abstain from sex in the case of a missed dose. The final decision by the FDA is expected this upcoming August.

Now let’s take a closer look at Pancreatic Cancer

[Andrew] As you may have heard, this past month, a trial for a cancer vaccine targeting a notorious pancreatic cancer has yielded positive results. Pancreatic cancer is the leading cause of cancer death in the United States. With an increasing incidence and a survival rate of 12% that has remained relatively stagnant for nearly 60 years, being diagnosed with cancer is far from favorable. After developing a novel cancer vaccine, the study researchers decided to test its efficacy on this particular life-threatening disease. The researchers chose to target the most common type of pancreatic cancer, pancreatic ductal adenocarcinoma (PDAC), which is lethal in 88% of patients. In the trial, over half of the patients who received the cancer vaccine remained free from relapse.

The pancreatic cancer vaccine operates on the same principles as a normal vaccine – a weakened version of the disease is injected into the patient, in the hopes that the patient’s immune system will learn about what the cancer “looks like” so it can recognize and eliminate when the cancer comes in full force. Like the COVID-19 vaccine, the pancreatic cancer vaccine in question is an mRNA vaccine. Unlike regular vaccines, the attenuated vaccine is taken from a sample of the patient’s own tumor. In this way, the vaccines are tailored to each patient’s individual tumor. In the results of the study, the vaccine was able to reduce relapse in half of those who received it. 

[Deepti] This is an example of cancer immunotherapy – harnessing the power of the immune system to defend the body against cancer. Of course, it is important to note that cancer vaccines have their weaknesses; they do not prevent cancer from developing in the first place, genetic testing is expensive, and personalized treatment isn’t available for all types of cancer. However, the success of this small trial is a testament to the power and potential of personalized medicine, which will continue to be a great opportunity for future cancer research. Now let’s take a look at Montana’s ban on TikTok

[Deepti] Recently, Montana has become the first state to fully ban TikTok. Although this decision comes in the context of cybersecurity and political tensions between the U.S. and China, school officials in other countries have also followed suit, deeming TikTok to be a significant public health risk to young students.

According to a recent report, TikTok has a particular tendency to expose teenagers to harmful content related to suicide, self-harm, eating disorders, and cyberbullying, often within minutes of them creating an account. This is particularly concerning since evidence suggests that exposure to maladaptive behavior may promote similar behavior among vulnerable youth. Moreover, online social reinforcement of these behaviors may be related to increased risk for serious psychological symptoms, such as anxiety and depression. In line with the current climate, the American Psychological Association (APA) has recommended that teenagers should receive proper training before entering the realm of social media. In doing so, youth would learn how to question the accuracy of social media content, refrain from excessive social comparisons online, and identify problematic social media use.

[Andrew] Absolutely. These recommendations align with the increasing efforts to combat harmful online content that can negatively impact adolescent mental health. With that said, Montana’s decision has been met with criticism from certain groups – critics say that it overlooks the potential advantages of the app, such as promoting online connections, creativity, and providing learning opportunities. Regardless, it seems that striking a balance and equipping youth with the necessary skills to navigate the digital landscape wisely is key.

We’d like to acknowledge the following members of our team for their contributions to this week’s episode

• Nuri Song
• Neel Mistry
• Teddy Guo

Thank you for joining us today for this episode of the 2 Minute Medicine Podcast. New episodes come out every other week and all of our content has been curated and written by practicing physicians.

Please head to our website at 2minutemedicine.com to learn more and to access all of our content including medical study summaries, visual abstracts, excerpts from our Classics book series which is available on Amazon, and The Scan, which is our medical newsletter.

Thank you so much once again. To make sure that you don’t miss any of our content please subscribe and follow us on Twitter or Instagram @2MinMed

©2023 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.