ASIDE Journals (American Society for Inclusion, Diversity, and Equity in Healthcare)
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Safety and Efficacy of Metformin for Idiopathic Intracranial Hypertension: A U.S.-Based Real-World Data Retrospective Multicenter Cohort Study
Get PDFoai:ojs2.asidejournals.com:article/1Introduction: Managing idiopathic intracranial hypertension (IIH) is challenging due to limited treatment options. This study evaluates metformin as a potential therapy for IIH, examining its impact on disease outcomes and safety.
Methods: We performed a retrospective cohort study using the TriNetX database, covering data from 2009 to August 2024. The study included IIH patients, excluding those with other causes of raised intracranial pressure or pre-existing diabetes. Propensity score matching adjusted for age, sex, race, ethnicity, Hemoglobin A1C, and baseline BMI at metformin initiation. We assessed outcomes up to 24 months.
Results: Initially, 1,268 patients received metformin and 49,262 served as controls, showing disparities in various parameters. After matching, both groups consisted of 1,267 patients each. Metformin users had significantly lower risks of papilledema, headache, and refractory IIH at all follow-ups (p<0.0001). They also had fewer spinal punctures and reduced acetazolamide use. BMI reductions were more significant in the metformin group from 6 months onward (p<0.0001), with benefits persisting regardless of BMI changes. Metformin’s safety profile was comparable to the control group.
Conclusions: The study indicates metformin’s potential as a disease-modifying treatment in IIH, with improvements across multiple outcomes independent of weight loss. This suggests complex mechanisms at play, supporting further research through prospective clinical trials to confirm metformin’s role in IIH management and its mechanisms of action
The Impact of Idiopathic Intracranial Hypertension on Cardiovascular Disease Risk Among UK Women: An Obesity-Adjusted Analysis
Get PDFIntroduction: Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disease (CVD) risk, but the extent to which obesity and IIH-specific factors contribute to this risk is not well understood. WE aim to separate the effects of obesity from IIH-specific factors on the risk of stroke and CVD, building on previous findings that indicate a two-fold increase in cardiovascular events in women with IIH compared to BMI-matched controls.
Methods: An obesity-adjusted risk analysis was conducted using Indirect Standardization based on data from a cohort study by Adderley et al., which included 2,760 women with IIH and 27,125 matched healthy controls from The Health Improvement Network (THIN). Advanced statistical models were employed to adjust for confounding effects of obesity and determine the risk contributions of IIH to ischemic stroke and CVD, independent of obesity. Four distinct models explored the interactions between IIH, obesity, and CVD risk.
Results: The analysis showed that IIH independently contributes to increased cardiovascular risk beyond obesity alone. Risk ratios for cardiovascular outcomes were significantly higher in IIH patients compared to controls within similar obesity categories. Notably, a synergistic effect was observed in obese IIH patients, with a composite CVD risk ratio of 6.19 (95% CI: 4.58-8.36, p<0.001) compared to non-obese controls.
Conclusions: This study underscores a significant, independent cardiovascular risk from IIH beyond obesity. The findings advocate for a shift in managing IIH to include comprehensive cardiovascular risk assessment and mitigation. Further research is required to understand the mechanisms and develop specific interventions for this group
Real-World Epidemiological Analysis of Gastrointestinal Neuroendocrine Carcinomas: A TriNetX-Based Study
Get PDFIntroduction: Gastrointestinal neuroendocrine carcinomas (GI-NECs) are a diverse group of aggressive tumors with variable clinical outcomes. Although progress has been made in classifying and treating these cancers, detailed real-world data on their anatomical distribution and survival rates are scant. This study utilizes a large database to explore the epidemiological and anatomical distribution patterns and to assess the survival outcomes of GI-NECs.
Methods: We accessed the TriNetX global health research network, comprising about 197 million patient records from 160 healthcare organizations, to perform a retrospective analysis of GI-NEC cases through November 2024. Patients were identified via the ICD-O-3 morphology code 8246/3. We analyzed TNM staging and survival rates across various GI locations.
Results: We identified 4,515 cases of NECs with a nearly equal gender distribution (47.27% male, 47.35% female) and an average age of 71 years. Unknown primary sites were the most common (n=692) followed by Small intestinal NECs (n=682) and others. The least common were liver and intrahepatic biliary NECs (n=71). Survival varied significantly by site, from a high of 37.5% in small intestinal NECs to just 11.4% in hepatic/biliary NECs, highlighting notable differences even within the same organ, such as between appendiceal and cecal NECs (44.8% vs. 26.4%).
Conclusions: This study highlights the necessity for site-specific treatment and improved diagnostic strategies, especially for the worst-prognosis NECs found in hepatic and biliary locations. Our findings are vital for developing targeted therapies and refining prognostic tools based on anatomical sites