Biotin beware: Physician, patient knowledge about lab interference
Authors of a recent JAAD letter highlight how biotin supplementation can interfere with laboratory testing. While some patients have clinically diagnosed biotin deficiency, the authors note that far more patients are taking biotin without documented deficiency despite a lack of evidence supporting the efficacy of biotin for treatment of hair, skin, or nail conditions.
[FDA’s biotin warning: Was it enough to educate physicians, patients about the risk? Read more inDermWorld Weekly.]
In a survey of nearly 150 physicians (predominantly dermatologists), 44% recommended biotin supplementation, mostly for nail (87%) and hair (59%) disorders, despite the majority acknowledging the lack of randomized trials demonstrating improvement in hair, nail, or skin growth. While many physicians were aware of laboratory interaction with thyroid (62.5%) and troponin (58.6%), few knew of interactions with 25-OH vitamin D, beta-human chorionic gonadotropin (both 7%), hepatitis (2.3%), or HIV serology (1.6%). Nearly a quarter were fully unaware of interference and almost half reported that they do not routinely recommend discontinuation of biotin prior to lab testing.
In a survey of 447 patients in an outpatient dermatology clinic, 34% reported past or current use of biotin. More than half had self-prescribed biotin. The majority of these patients had blood testing during supplementation (56%), although 93% were unaware of the FDA warning, and just over 1% received physician counseling about biotin interference.
DermWorld Insights and Inquiries: The rhythm of RIME
Mucosal ulceration urgently gets everyone’s attention. How many times have you been asked to evaluate a patient for suspected Stevens-Johnson syndrome (SJS)? It is not always an easy task to differentiate erythema multiforme (EM) from pemphigus vulgaris, paraneoplastic pemphigus, or erosive lichen planus. Although the association of Mycoplasma pneumoniae with EM-like eruptions has been long-recognized, rendering diagnoses such as “incomplete SJS” may obfuscate more than illuminate.
In 2015, Canavan et al proposed the term “Mycoplasma-induced rash and mucositis” (MIRM) after performing a comprehensive literature review of 95 articles detailing 202 cases. Patients were often young (mean age: 11.9 years) and male (66%). Cutaneous involvement ranged from absent (34%), to sparse (47%), to moderate (19%). Oral, ocular, and urogenital mucositis was reported in 94%, 82%, and 63% of cases, respectively. Treatments included antibiotics (80%), systemic corticosteroids (35%), supportive care alone (8%), and/or intravenous immunoglobulin (8%). Complications included mucosal damage (10%), cutaneous scarring (5.6%), recurrence (8%), and mortality (3%). Because of the distinct morphology, mild disease course, and potential clinical implications regarding treatment, the authors proposed revising nomenclature, suggest the term MIRM for these cases. Keep reading!
Infections in children treated with dupilumab
In an article published in Pediatric Dermatology, more than 600 pediatric patients ages six to 17 years with moderate-to-severe atopic dermatitis (AD) were analyzed for risk of infection with dupilumab versus placebo.
[What is the path forward for treating children with severe AD with dupilumab? Read more.]
In two 16-week clinical trials, 205 patients received placebo and 407 received dupilumab. Patients who received dupilumab had lower overall rates of infection, particularly skin and soft-tissue infection, compared with those who received placebo. Patients who received dupilumab were less likely to be prescribed antibacterial agents during the trial period. The authors’ data suggest that children with AD treated with dupilumab are not at increased risk of infection and may be associated with lower rates of skin infections compared with placebo.
Pediatric dermatologists share struggles and successes obtaining treatments for their patients. Read more inDermWorld.
Cutaneous adverse events are associated with increased survival in patients on anti-PD-1, anti-PD-L1 therapy
In a retrospective cohort study published in JAMA Dermatology, the authors analyzed data from 7,008 patients who developed cutaneous immune-related adverse events (cirAEs) in response to anti-PD-1 or anti-PD-L1 therapy. During the six-month analysis, patients who developed cirAEs had statistically significant protection against mortality compared with matched controls. Specific cutaneous features associated with improved survival were pruritus, xerosis, drug eruptions, and nonspecific rashes. Eczematous dermatitis, vitiligo, bullous pemphigoid, and Grover disease were all associated with strong protective clinical effects. Development of cirAEs in response to immune checkpoint inhibitor therapy was associated with therapeutic response and improved patient survival.
“When it comes to medications that I never prescribe, I learn from my patients who present with findings that compel me to do my homework.” Read more from Dr. Heymann in DermWorld Insights and Inquiries.
Will biosimilars cut spending for biologic therapy in the U.S.?
According to a study published in theAmerican Journal of Managed Care, biosimilar drugs could drive down prices for biologic drugs and generate savings of about $38.4 billion between 2021 and 2025, or nearly 6% of projected spending on biologics during the same period. According to the paper, nearly $25 billion of savings would come from downward pressure on reference biologic prices rather than lower biosimilar prices. In an upper-bound scenario that assumes greater biosimilar uptake, more robust price competition, and quicker biosimilar entry, the savings could increase to $124.5 billion.
Biosimilar substitution laws have passed in 50 states, but the details vary. Read more in DermWorld.
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