Tag Archives: benefit

Habitat efforts look to benefit more than endangered species in North Dakota & Regional

Whooping cranes rank No. 1 among Karen Lonefight’s bird sightings.

The White Shield woman learned birding in Grand Forks and goes all over, collecting photographs and enjoying the wildlife. Also among her favorites are a hawk owl and a great gray owl, as well as piping plovers — a threatened species.

She was out near White Shield in the spring of 2019 and initially assumed the six tall birds she spotted in a field were sandhill cranes.

“As I got closer and I saw that they were white, I just kinda freaked out,” Lonefight said. She sat and watched, photographing the rare whoopers, an endangered species for decades.

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This post originally posted here usnews

Expats in Spain, France and more benefit from ‘amazing’ state pension Brexit deal

However, when it comes to the pension rights of Britons living in the likes of Spain, Portugal and France, one tax expert has revealed the nations came together in a rather “sensible agreement”.

According to Oliver Heslop from Global Expatriate Tax Services, as a result, there is some “amazing” news for Britons who are looking to claim their state pension while living in an EU state.

“There was a big rush before Christmas for people to get out there and people were doing that,” he explained while speaking on the Expat Focus podcast.

“Brits were moving to Spain and France and other places to guarantee rights as EU citizens because we all believe that post-January it wouldn’t be the same, there wouldn’t be protections for all sorts of immigration and pension problems that drove the rush.

READ MORE: Holidays: EU countries welcoming back double-jabbed Britons

Author: Aimee Robinson
Read more here >>> Daily Express

Double-jabbed Britons could benefit from fast track perk – Heathrow launches new trial

“We look forward to providing the data that proves it’s simple for fully vaccinated status to be verified and to the Government meeting its commitment to get the country moving again,” he said.

Virgin Atlantic, meanwhile, are hopeful the new scheme will aid the reopening of US-UK travel.

Shai Weiss, chief executive of Virgin Atlantic, said the trial shows the industry’s desire to “rapidly operationalise the new policy, and work with Government and authorities to ensure it is smoothly implemented at pace, supporting the reopening of the transatlantic corridor, without which £23 million is lost each day from the UK economy”.

In a joint statement, the airlines and Heathrow pointed out that the Government is not currently reaping “the economic and social rewards” of the UK’s “successful vaccine programme”.

Author: Aimee Robinson
Read more here >>> Daily Express

Tislelizumab Benefit in HCC Undimmed by Prior Therapies

With the novel immunotherapy tislelizumab, durable responses are achieved for patients with advanced hepatocellular carcinoma (HCC), regardless of the number of prior lines of therapy, show results from a phase 2, open-label trial.

RATIONALE 208 involved almost 250 patients with advanced HCC who were treated with the drug. Of those patients, 67% demonstrated ongoing responses at the data cutoff, and 79% were event free after 12 months.

With an objective response rate of 13% and a median overall survival of 13 months, the results are “encouraging,” commented lead author Ghassan K. Abou-Alfa MD, a medical oncologist at Memorial Sloan Kettering Cancer Center, New York City.

Tislelizumab showed “clinical activity and efficacy…in patients with HCC with a high unmet medical need,” he said, “despite the lack of randomization against a standard of care.”

He presented the data at the World Congress on Gastrointestinal Cancers 2021 (WCGC 2021) on July 1.

Tislelizumab is an anti-PD-1 antibody engineered to minimize Fc-gamma receptor binding on macrophages, which is a mechanism of T-cell clearance and potential anti-PD-1 resistance, he noted.

The drug is approved in China and has been licensed by Novartis from BeiGene for development in North America, Europe, and Japan.

Abou-Alfa noted that a large, global, randomized phase 3 study comparing tislelizumab with sorafenib as a first-line treatment for adults with advanced HCC is ongoing.

There is a “need for innovative options” to overcome primary and secondary resistance in HCC, commented Chris Verslype, MD, PhD, Digestive Oncology, University Hospitals Leuven, Leuven, Belgium, who was not involved in the study.

There is also “a need for predictive markers to guide therapy and sequencing,” he added.

But the main question that arises when considering a novel agent in this field, he went on, is, “what is the added value” when compared to similar drugs.

He noted that KEYNOTE-240, a phase 3 trial of pembrolizumab vs placebo in a similar cohort of patients with HCC, suggests that in terms of response rates, progression-free survival, overall survival, and adverse events, the outcomes were “in line with” those seen with tislelizumab.

However, he questioned whether the ongoing phase 3 study with tislelizumab is “likely to yield new clinical insights,” because the drug is comparable to other PD-1 inhibitors, and previous studies have shown that anti-PD-1 agents do not offer any benefits over sorafenib.

In the post-presentation discussion, Abou-Alfa said he agreed with Verslype that comparison between tislelizumab and other anti-PD-1 agents is important but that the “first step” in taking the drug forward is the ongoing phase 3 trial.

He said this “will at least establish tislelizumab in comparison with a standard of care…and then the other steps will be further fine-tuning.”

Abou-Alfa emphasized that the current results “remain very encouraging,” especially in consideration of the relatively high median overall survival “within the context of a phase 2 trial.”

For the phase 2 study, patients with advanced HCC were included if they had received at least one prior line of systemic therapy that did not include a checkpoint inhibitor and had good performance status and a relatively good prognosis.

They were treated with intravenous tislelizumab every 3 weeks until intolerable toxicity, withdrawal of consent, or the patient was deemed to be no longer benefiting from the study therapy.

A total of 249 patients were included in the analysis. The vast majority (80.3%) had extrahepatic spread.

The majority of HCC cases were due to hepatitis B (51.4%); 14.5% were caused by hepatitis C; and 36.1% were nonviral. PD-L1 expression on tumor cells was ≥1% in 6.0% of patients.

All patients had received prior systemic therapy; 138 patients had received one line of therapy, and 111 patients had received at least two lines.

Radiologic assessments were performed every 6 weeks for the first 18 weeks and then every 9 weeks.

On the basis of these assessments, across the patient cohort, the objective response rate was 13.3%, the disease control rate was 53.0%, and the clinical benefit rate was 24.1%.

The team also found that 79.2% of patients had a response to tislelizumab that lasted at least 12 months; 66.7% of responses were ongoing at the time of data cutoff on February 27, 2020.

The median duration of response was not reached.

Abou-Alfa noted that the response to tislelizumab in patients who had received at least two prior lines of therapy was comparable to that seen in those who had previously been treated with one line of therapy.

The disease control rate was 53.2% among patients who had received at least two prior therapies, vs 52.9% among patients who were less heavily pretreated. The clinical benefit rate was 21.6% vs 26.1%; 73.0% had a response that lasted at least 12 months, vs 82.6% among patients who were less heavily pretreated.

Subgroup analysis showed that responses were also comparable regardless of patient gender, geographic region, performance status, HCC prognosis, PD-L1 expression, and extrahepatic spread, among other factors.

Interestingly, there was a signal for a greater objective response rate among patients with HCC associated with hepatitis C, at 22.6%.

Overall survival was 13.2 months across the whole cohort; 54.3% of patients were alive at 12 months.

Over a median follow-up of 16.4 months, median progression-free survival was 2.7 months, and 79.2% of patients were event free at 12 months.

Grade ≥3 treatment-emergent adverse events occurred in 48.6% of patients; 14.5% had grade ≥3 treatment-related adverse events.

The most common treatment-related adverse events of any grade were as follows: increased aspartate aminotransferase levels, in 12.9% of patients; increased alanine aminotransferase levels, in 9.2%; asethenia, in 7.6%; and hypothyroidism, in 7.6%.

For both survival outcomes and in terms of adverse events, patients who had received at least two prior lines of systemic therapy performed as well as those who had received only one prior therapy before treatment with tislelizumab.

The study was sponsored by BeiGene, Ltd. Abou-Alfa reports relationships with Arcus, Agios, Astra Zeneca, Bayer, BeiGene, Berry Genomics, BioNtech, BMS, Celgene, CytomX, Eisai, Eli Lilly, Exelixis, Flatiron, Genentech/Roche, Genoscience, Helio, Incyte, Ipsen, Legend Biotech, Loxo, Merck, MINA, Polaris, Puma, QED, Redhill, Rafael, Silenseed, Sillajen, Sobi, Surface Oncology, Therabionics, Twoxar, Vector, and Yiviva. Verslype reports relationships with Roche, Bayer, Ipsen, Lilly. No other relevant financial relationships have been disclosed.

World Congress on Gastrointestinal Cancers 2021 (WCGC 2021): Abstract: O-1. Presented July 1, 2021.

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Author: Liam Davenport
Read more here >>> Medscape Medical News

Car tax changes scrapped in major UK city after report highlights a ‘marginal’ benefit

Reading Council had looked into charging drivers for parking their vehicles at work to reduce the number of cars on the roads. The proposals would have also introduced a Clean Air Zone charging drivers of highly-polluting commercial vehicles for using the roads.

The scheme was bookmarked for 2026/27 but new analysis means the plans have been ditched.

A major sticking point came after analysis found almost 100 percent of vehicles would be below the threshold at the time of launch.

Under the original plans, Reading Council aimed to reduce concerns of ‘rat running’ in the town centre.

Statistics suggested one in three vehicles which used the roads in the town centre had no origin, destination or purpose in Reading.

READ MORE: New car tax changes could ‘threaten’ classic cars

However, plans to rip up the scheme have been met with opposition by councillors who were pushing for a charge.

Liberal Democrat councillor Ricky Duveen said the twin has an “issue” with air quality that needed to be addressed.

He said: “We have an issue with air quality in the town and I don’t think we can simply delay matters for another five years and essentially ignore the problem.

“Maybe ignore is a strong word but we’re not paying enough attention to it.”

Transport boss Tony Page said the council are committed to a “whole range of measures to deal with climate concerns.

He confirmed dealing with air quality was a “top concern” for the council which would be addressed.

The next Clean Air Zone to be introduced will be in London where the Ultra Low Emissions Zone is set to be expanded from October.

Author: Luke Chillingsworth
Read more here >>> Daily Express :: Life and Style
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HMRC lose child benefit appeal as Rishi Sunak is urged to axe charge ‘in his next budget’

Child benefit can be claimed by most parents but for those on high incomes, certain costs may arise. People may have to pay the HICBC if they have an individual income over £50,000 and either they or their partner gets child benfit or, someone else gets child benefit for a child living with them and they contribute at least an equal amount towards the child’s upkeep.

Claimants who earn between £50,000 and £60,000 per year will have to repay a portion of their child benefit as extra income tax.

One percent of the family’s child benefit will have to be paid back for every extra £100 earned over £50,000.

If either parent has an income of more than £60,000 a year, they’ll have to repay all their child benefit payments.

These repayments are usually paid through a self assessment but recently, a decision from the Upper Tribunal may impact how the process works, affecting thousands of families in the process.

READ MORE: Inheritance tax: HMRC updates a number of forms & contact information

This ruling could have drastic ramifications for child benefit claimants as Kay Ingram, a Public Policy Director at national financial planning group LEBC, detailed.

Ms Ingram said: “While the ruling may be welcome news for the many taxpayers who have paid the HICBC under discovery assessments, the threshold income of £50,100 at which this charge applies is far too low, not having been increased since it was introduced in 2013.

“It hits single parent families particularly hard as it is based on one individual exceeding the threshold, not on total household income.

“It would be timely for the Chancellor to remove this charge in his next Budget as it appears to be causing administrative problems for HMRC and taking money away from children.

Ms Ingram concluded: “In both cases the individual can also benefit from tax relief on the amount given or saved at the highest marginal rate of income tax they pay.

“So doing good or saving for retirement can enable child benefit to be paid tax-free without having to pay the High Income child benefit charge.”

Child benefit itself can be claimed by anyone who is responsible for raising a child who is under 16 or under 20 if they’re in approved education or training.

Claims for eldest or only children will generate £21.15 per week, with additional children bringing in £14.

Author: Connor Coombe-Whitlock
Read more here >>> Daily Express :: Finance Feed

Low-Dose Nitrous Oxide Shows Benefit for Resistant Depression

A 1-hour treatment with a low concentration of nitrous oxide, commonly known as “laughing gas,” appears to relieve symptoms of treatment-resistant major depression (TRMD), with effects lasting as long as several weeks, new research suggests.

In a trial with a crossover design, investigators randomly assigned 28 patients with severe TRMD to receive a single 1-hour inhalation of placebo or nitrous oxide once a month over a 3-month period. Participants received an inhalation of placebo; a 25% concentration of nitrous oxide; and a 50% concentration of nitrous oxide. Sessions were conducted 4 weeks apart.

Both doses of nitrous oxide were associated with substantial improvement in depressive symptoms for roughly 85% of participants. However, the 25% concentration had a lower risk for adverse effects, which included sedation, nausea, and mild dissociation, compared to the 50% concentration.

“Twenty-five percent nitrous has similar efficacy, compared to 50% nitrous oxide, and reduced side effects fourfold,” lead author Peter Nagele, MD, chair and professor of anesthesia and critical care, University of Chicago, Chicago, Illinois, told Medscape Medical News.

“We also observed that many patients had a 2-week improvement of depressive symptoms after a nitrous oxide treatment,” said Nagele, who is also a professor of psychiatry and behavioral neuroscience.

The study was published online June 9 in Science Translational Medicine.

Further Refinement

A previous proof-of-principle study conducted by the same researchers demonstrated that a 1-hour inhalation of 50% nitrous oxide had rapid antidepressant effects for patients with TRMD.

The current phase 2 trial “is a follow-up study to our earlier 2015 pilot trial and was designed to further refine the dose of nitrous oxide needed for antidepressant efficacy,” Nagele said.

“An important secondary aim [of the current study] was to determine whether a lower dose — 25% — would reduce side effects, and a third aim was to determine how long the antidepressants effects last,” he explained.

To investigate, the researchers enrolled 28 patients (median [interquartile range (IQR)] age, 39 years [26 – 68] years; 71% women; 96% White) to have three inhalation sessions (placebo, 25%, and 50% nitrous oxide) at 4-week intervals. Twenty patients completed all three inhalation sessions, and four completed ≥1 treatment.

Participants had “sustained and refractory depressive illness,” with a mean illness lifetime duration of 17.5 years and an extensive history of antidepressant drug failure (median, 4.5 [2 – 10] adequate-dose/duration antidepressants).

Some patients had undergone vagus nerve stimulation, electroconvulsive therapy, repetitive transcranial magnetic stimulation, or had received ketamine (4%, 8%, 13%, and 8%, respectively).

The primary outcome was improvement on the 21-item Hamilton Depression rating Scale (HDRS-21) score over a 2-week observation period.

“Stronger Evidence”

Compared to placebo, nitrous oxide significantly improved depressive symptoms in comparison with placebo (P = .01). There was no significant difference between the 25% and the 50% concentrations (P = .58).

The estimated difference in HDRS-21 scores between the placebo and various treatment groups are shown in the following table.

Time 25% Concentration 50% Concentration Combined groups
2 hours −.75 points (P = .73) −.87 (P = .69) −.81 (P = .66)
24 hours −1.41 (P = .52) −1.93 (P = .37) −1.67 (P = .37)
Week 1 −4.35 (P = .05) −2.44 (P = .25) −3 35 (P = .07)
Week 2 −5.19 (P = .02) −7.00 (P = .001) −6.13 (P = .001)

To ensure there where were carryover effects between the two doses, the researchers performed an analysis to ascertain whether order of receipt of the higher dose was related to the 2-week HDRS-21 score; they found no significant effect of trial order (P = .22).

The 20 patients who completed the entire course of treatment “experienced a clinically significant improvement in depressive symptoms from a median baseline HDRS-21 score of 20.5 (IQR, 19.0 to 25.5) to 8.5 (IQR, 2.0 to 16.0) at study completion, corresponding to a median change of −11.0 points (IQR, −3.3 to −14.0 points; P < 0.0001) after the 3-month study period,” investigators note.

The types of treatment response and improvement in depressive symptoms from baseline to study completion are listed in the table below.

Symptom improvement Number of patients
Reduction of ≥ 50% in HDRS-21 points 11 (55%)
Remission 8 (40%)
Improvement in ≥1 category (eg, from severe to moderate) 17 (85%)

There were statistically significant differences in adverse events between the two treatment doses; 47 events occurred following inhalation of the 50% concentration, compared to 11 after inhalation of the 25% concentration. There were six adverse events after inhalation of placebo (P < .0001).

“None of the adverse events were serious, and nearly all occurred either during or immediately after the treatment session and resolved within several hours,” the authors report.

“We need to be remindful that — despite the exciting results of the study — the study was small and cannot be considered definitive evidence; as such, it is too early to advocate for the use of nitrous oxide in everyday clinical practice,” Nagele commented.

Nevertheless, on the basis of the current findings, “the evidence [for the use of nitrous oxide in depression] has become stronger,” he stated.

Rapid-Acting Antidepressants

Commenting on the study for Medscape Medical News, Roger McIntyre, MD, professor of psychiatry and pharmacology, University of Toronto, in Toronto, Canada, and head of the Mood Disorders Psychopharmacology Unit, noted that the research into nitrous oxide is “part of an interest in rapid-acting antidepressants.”

McIntyre, who is also the chairman and executive director of the Brain and Cognition Discovery Foundation, Toronto, and was not involved with the study, found it “interesting” that “almost 20% of the sample had previously had suboptimal outcomes to ketamine and/or neurostimulation, meaning these patients had serious refractory illness, but the benefit [of nitrous oxide] was sustained at 2 weeks.”

Studies of the use of nitrous oxide for patients with bipolar depression “would be warranted, since it appears generally safe and well tolerated,” said McIntyre, who is the director of the Depression and Bipolar Support Alliance (DBSA).

The study was sponsored by an award to Nagele from the NARSAD Independent Investigator Award from the Brain and Behavior Research Foundation and an award to Nagele and other coauthors from the Taylor Family Institute for Innovative Psychiatric Research at Washington University School of Medicine. Nagele receives funding from the NIMH, the American Foundation for Prevention of Suicide, and the Brain Behavior Foundation; has received research funding and honoraria from Roche Diagnostics and Abbott Diagnostics; and has previously filed for intellectual property protection related to the use of nitrous oxide in major depression. The other authors’ disclosures are listed on the original article. McIntyre has received research grant support from CIHR/GACD/Chinese National Natural Research Foundation; speaker/consultation fees from Lundbeck, Janssen, Purdue, Pfizer, Otsuka, Allergan, Takeda, Neurocrine, Sunovion, Eisai, Minerva, Intra-Cellular, and Abbvie. McIntyre is also CEO of AltMed.

Sci Transl Med. Published online June 9, 2021. Abstract

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This post originally appeared on Medscape Medical News Headlines

Luspatercept Benefit Also in Non-Transfusion-Dependent Thalassemia

The first-in-class erythroid maturation agent luspatercept (Reblozyl) is already approved for the treatment of anemia in adult patients with beta thalassemia who require red blood cell (RBC) transfusions.

Now it has also shown to be beneficial for patients with beta thalassemia who are not dependent on transfusions. There is no drug specifically indicated as yet for this patient population, who often develop chronic anemia and iron overload.

The new results come from the phase 2 BEYOND trial, and were presented at the European Hematology Association 2021 annual meeting, held virtually because of the ongoing pandemic.

“We now have a new agent that showed benefit in improving anemia with non-transfusion-dependent thalassemia,” lead author Ali T. Taher, MD, PhD, told Medscape Medical News.

“With the rising body of evidence on the detrimental impact of anemia in these patients, this presents a landmark achievement for a patient population who do not have many treatment options,” said Taher, director of the Basile Cancer Institute at the American University of Beirut Medical Center, Beirut, Lebanon.

In commenting on the study, Kevin H.M. Kuo, MD, an assistant professor in the Division of Hematology at the University of Toronto, Canada, said the findings are encouraging in addressing the non-transfusion subgroup’s treatment needs. 

“I think luspatercept is an exciting addition to the armamentarium in the treatment of beta thalassemia,” he told Medscape Medical News. “I think this is something we have always looked forward to because these non-transfusion-dependent patients have been a very neglected subgroup of patients.”

“This is mainly because there is a perception that they tend to do better than their transfusion-dependent counterparts, but we realize that’s not the case because these patients have complications stemming from both hemolysis and ineffective erythropoiesis,” Kuo said.

“So, I’m pleased that we may be seeing a better treatment option for these patients.”

Results From the BEYOND Trial

For the multicenter, double-blind, phase 2 BEYOND trial, 145 patients with non-transfusion-dependent beta thalassemia, who received no more than 5 RBC units in the 24 weeks prior to randomization, were randomly assigned to treatment with luspatercept 1 mg/kg, with titration up to 1.25 mg/kg (n = 96) or placebo (n = 49) subcutaneously every 3 weeks for at least 48 weeks. The patients had a median age of 40, and 41.7% were male

Throughout the trial, both groups received the best supportive care, with sporadic RBC transfusions when needed and iron chelation therapy.

Twenty patients (13.8%) received RBC transfusions (maximum 5 units) in the 24 weeks prior to treatment. The median baseline hemoglobin level was 8.2 g/dL (range 5.3-10.1).

The primary endpoint was an increase of at least 1.0 g/dL in hemoglobin from baseline to weeks 13 through 24 in the absence of RBC transfusions. This was achieved by as many as 74 of the 96 luspatercept patients (77.1%), compared with none in the placebo group (P < .0001).

Of the 55 patients with mean baseline hemoglobin levels of less than 8.5 g/dL in the luspatercept group, 40 (72.7%) achieved the primary endpoint vs none in the placebo group (P < .0001).

And of 41 with a mean baseline hemoglobin of 8.5 g/dL or higher in the luspatercept group, 34 (82.9%) achieved the primary endpoint vs none in the placebo group (P < .0001).

Overall, 52.1% of patients in the luspatercept arm achieved the secondary endpoint of an increase of 1.5 g/dL hemoglobin or more at weeks 13 through 24, vs none in the placebo arm (P < .0001).

The need for transfusions also declined with luspatercept, with most treated patients (89.6%) not requiring RBC transfusions at weeks 1 through 24, compared with 67.3% in the placebo group (P = .0013).

Patient-Reported Outcomes

There were no significant differences in patient-reported scores of tiredness and weakness among the patient groups at weeks 13 through 24 and the scores were marginally improved in the luspatercept group at weeks 37 through 48 (P = .051).

The differences were similar in patients with a baseline hemoglobin of less than 8.5 g/dL. However, the improvement in scores correlated with the level of hemoglobin increase, Taher noted.

“When we actually look at patients who had an increase in hemoglobin levels, we see a clearer benefit in the tiredness and weakness score,” he told Medscape Medical News.

“And for me as a clinician, this is what matters and what I expect, as we don’t expect patients who did not have hemoglobin improvement to have better quality of life,” he added.

Luspatercept was well-tolerated, with the most common treatment-emergent adverse events of any grade as follows: bone pain, in 36.5% of luspatercept patients and 6.1% of placebo patients; headache, 30.2% vs 20.4%; and arthralgia, 20.2% vs 14.3%.

The rates of treatment-emergent adverse events of grade 3 or higher were similar in the luspatercept vs placebo groups. There were no deaths or thromboembolic or thrombophlebitis events in either group.

Kuo noted that a key factor to be looked at in further studies is how the hemoglobin improvements relate to clinically meaningful patient-reported outcomes.

“An important question is how much does the hemoglobin increase [with luspatercept] correlate with changes in patient-reported outcomes,” he said.

“This was only up to 48 weeks, so we will have to see if there is more of a long-term benefit.”

An “Understudied” Population

EHA president John G. Gribben, DSc, agreed that the study importantly addresses an “understudied population” of beta thalassemia.

“Being classified as non-transfusion-dependent does not mean that these patients never need transfusion and indeed the decreased transfusion requirement was one of the positive aspects of the study,” he told Medscape Medical News.

“But there were also decreases in other factors like decreased iron overload, etc, which means that we could expect decreased long-term morbidities for these patients,” said Gribben, director of the Experimental Cancer Medicine Centre, University of London, UK,.

“As always, the number of patients was relatively small in this study and there is a need for longer term follow-up, but we were excited to see these data presented at this year’s EHA congress,” he said.  

The study was supported by Celgene, a Bristol-Myers Squibb Company. Taher disclosed research and/or consultancy relationships with Agios, Celgene, Ionis Pharmaceuticals, Novartis Pharmaceuticals, and Vifor Pharma. Kuo was an investigator on the BELIEVE Trial, involving luspatercept in transfusion-dependent thalassemia patients. He has been a consultant for Agios, Celgene/BMS, and Forma and has taken part in research collaboration with Phoenicia Biosciences.

European Hematology Association (EHA) 2021 Annual Meeting: Abstract S101. Presented June 11, 2021.

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This post originally appeared on Medscape Medical News Headlines

Unlevel Playing Field: New Transplant Policy Doesn't Benefit All States

The introduction of the new kidney allocation policy in the US initiated by the Organ Procurement and Transplantation Network (OPTN) may not benefit all states equally when the regional burden of end-stage kidney disease (ESKD) is taken into account, a new cross-sectional, population-based economic evaluation suggests.

The analysis shows that the probability of a patient with ESKD receiving a deceased donor kidney transplant varied threefold across the United States in 2017 — the lowest probability being in West Virginia, at 6.3%, and the highest likelihood being in the District of Columbia, at 18.6%.

“The rationale for the [OPTN] allocation changes was that the calculated waiting time for a deceased donor kidney transplant differed by more than 5 years, depending on the geographic location of the transplant center for a patient on the waitlist,” lead author Derek DuBay, MD, Medical University of South Carolina, Charleston, and colleagues observe.

“Our analysis demonstrates that states with the lowest transplant rates normalized for ESKD burden will not benefit from the changes by the OPTN, and several are projected to experience significant decreases in kidney organ allocation volume,” they add.

The study was published online May 26 in JAMA Surgery.

The new OPTN policy was approved in late 2019 and became effective March 15, 2021. The updated policy, on matching kidney and pancreas transplant candidates with organs from deceased donors, replaces distribution based on donation service area (DSA) and OPTN region. The new policy means that kidneys and pancreases will be first offered to candidates listed at transplant hospitals within 250 nautical miles of the donor hospital. Offers not accepted for any of these candidates will then be made for candidates beyond the 250 nautical mile distance.

Merged Dataset

For their study, DuBay and colleagues used a merged dataset from the United States Renal Disease System (USRDS) plus data from the Scientific Registry of Transplant Recipients (SRTR).

The population included both patients with ESKD as well as those who had undergone kidney transplantation during 2017. A total of 122,659 new patients with ESKD were included in the analysis, some 35,447 of whom were added to the kidney transplant waitlist during that year.

“Marked differences were found in ESKD incidence across the US; the highest rates are in the District of Columbia, the Southeast, West Virginia, and New Jersey,” DuBay and colleagues point out. The lowest incidence rates of ESKD were found in the Mountain West states, Minnesota, and some New England states.

Similarly, the likelihood of a new patient with ESKD being added to the transplant waitlist varied significantly across the United States. Patients most likely to be waitlisted were in Wyoming, Colorado, Minnesota, and several New England states.

In contrast, the lowest probabilities of a new patient with ESKD being waitlisted were in Hawaii, Oregon, Nevada, Oklahoma, Arkansas, Louisiana, and Ohio.

Most importantly, there were “stark differences” in the probability of a new ESKD patient actually receiving a living or deceased donor transplant across the United States, with again a greater than threefold difference in the probability of patients receiving any type of donor transplant, with those in Hawaii, at 9.1%, being the least likely, and those in Utah being the most likely, at over 31%.

Not a Level Playing Field

As the authors explain, the modeling method used by the OPTN to determine deceased donor allocation is based on DSAs, the nonprofit agencies that coordinate deceased donation.

“Based on kidney transplant frequency…one might expect with the new OPTN allocation system that Hawaii, West Virginia, Arkansas, Mississippi, and Nevada should receive the largest increase in deceased donor kidneys,” they note.

This turns out not to be the case, however, because DSAs from New York, Georgia, and Illinois are more likely to have the biggest increase in deceased donor allocation, they observe.

With the exception of Georgia, “these states with increased kidney allocation have transplant rates above the mean (of 50 states plus the District of Columbia).”

OPTN modeling also suggests that DSAs from Nevada, Ohio, and North Carolina are at most risk of experiencing the largest decrease in deceased donor allocations, yet these same states have transplant rates below the mean of 50 states plus the District of Columbia.  

In fact, New York City is expected to have the largest increase in deceased donor kidneys, at 124%, versus the state of Nevada, which is expected to see a 74% decrease in deceased donor kidneys based on the new OPTN modeling changes. 

“We strongly believe the best method to assess for organ allocation equity and geographic disparities is to estimate the proportion of patients with ESKD who receive a transplant,” the authors argue.

“Regrettably, ESKD burden is completely ignored in the changes approved by the OPTN to the kidney allocation system in late 2019, [and] until the playing field is level, it is important for the OPTN to not create policies that potentially worsen disparities in access to transplant,” they emphasize.

Pandemic Offered Opportunity for a Real-Life, Successful Experiment

Commenting on the findings, Kenneth Andreoni, MD, University of Florida, Gainesville, pointed out that the “real goal” of any national organ allocation policy should be to increase the availability of deceased donor transplants for all eligible candidates.

Paradoxically, this might be one of the few “silver linings” to emerge from the COVID-19 pandemic.

“After the declaration of a national public health emergency on March 13, 2020, the SRTR stated that they would not follow up recipient outcome after this date,” Andreoni explained.  

Freedom from this standard “punitive” regulation through program-specific reports was likely responsible for 2020 being a record year for transplant volume, he pointed out — despite having fewer living donor transplants, the pandemic burden on transplantation hospitals, and the risk of potential transplant recipients becoming infected with COVID-19. “The COVID-19 pandemic has allowed the real-life experiment to take place,” Andreoni observed.

“Removal of the threat of the program-specific reports has allowed the transplantation community to offer more lifesaving transplants to US recipients, despite the unprecedented healthcare stresses in 2020,” he underscored.

DuBay and Andreoni have reported no relevant financial relationships.

JAMA Surg. Published online May 26, 2021. Abstract

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This post originally appeared on Medscape Medical News Headlines

State pension, PIP & other benefit payments will come through early tomorrow – get ready

To be eligible for a state pension, a person will need at least 10 years of qualifying National Insurance contributions.

At least 35 years will be needed for the full amount of £179.60 per week.

Initial payments should come through within five weeks of reaching state pension age, so long as a claim is made.

Additionally, claimants can defer their claims if they’re not ready to retire and this could boost payments if it’s done for long enough.

This post originally appeared on Daily Express :: Finance Feed