Semaglutide may show promise for smoking cessation

Embargoed for release until 5:00 p.m. ET on Monday 29 July 2024     
Annals of Internal Medicine Tip Sheet      

@Annalsofim     
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.     

----------------------------     

1. Semaglutide may show promise for smoking cessation

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2718

URL goes live when the embargo lifts      

New use of semaglutide was associated with a lower risk for medical care related to tobacco use disorder (TUD) in smokers with type 2 diabetes compared with 7 other anti-diabetes medications. Those who used semaglutide were less likely to have a medical encounter that included a diagnosis of TUD, prescribing of smoking cessation medication, or smoking cessation counseling during the study timeframe. These findings suggest the need for clinical trials to evaluate semaglutide’s potential for use in smoking cessation. The study is published in Annals of Internal Medicine. 

Previous reports of reduced desire to smoke in patients treated with semaglutide, a glucagon-like peptide receptor agonist (GLP-1RA) medication for type 2 diabetes mellitus and obesity, have raised interest about its potential benefit for tobacco use disorders. Researchers from the National Institute on Drug Abuse, National Institutes of Health and Case Western Reserve University School of Medicine used a target trial emulation framework to evaluate the comparative effectiveness of the new use of semaglutide versus the new use of 7 other anti-diabetes medications, including other GLP-1RAs, on TUD-related health care measures in 3 study populations: patients with comorbid type 2 diabetes and TUD, patients with comorbid type 2 diabetes and TUD who had a diagnosis of obesity, and those who did not have a diagnosis of obesity. The researchers found that semaglutide was associated with a lower risk for smoking-related health care utilization—including use that would indicate smoking cessation efforts. Similar effects were observed in subpopulations without and with a diagnosis of obesity and results were seen primarily within 30 days of prescription. While the findings were consistent with the hypothesis that semaglutide might be beneficial for smoking cessation, the authors say study limitations preclude firm conclusions and should not be interpreted to justify clinicians’ use of semaglutide off-label for smoking cessation.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Nora D. Volkow, MD, please email media@nida.nih.gov.

----------------------------     

2. Black persons fall victim to guns at 20 times the rate of White persons

The epidemic rages on as gun violence injures 1 person every 4 minutes and kills 1 person every 12 minutes in the U.S.

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2251             

URL goes live when the embargo lifts      

A retrospective, cross-sectional study of national data from 2019 and 2020 shows that firearm injury is still very much an epidemic in the United States, with racial and ethnic minorities bearing much of the burden. During the study period, there were 2 nonfatal injuries for every death. And while Black persons made up only 12.6% of the U.S. population in 2020, they suffered 61.5% of all firearm assaults, died of firearm homicide, and experienced a rate of nonfatal firearm assaults both at a rate 20-fold higher than White persons. The findings are published in Annals of Internal Medicine.

Researchers from the University of Pennsylvania collected fatal injury data from the CDC wide-ranging ONline Data for Epidemiologic Research Underlying Cause of Death database for 2019 and 2020 to calculate rates of death and injury in various racial and ethnic groups. Data on nonfatal injuries were collected from NEDS, the Nationwide Emergency Department Sample. While the data on fatal injury are well-established, nonfatal injury data is hard to come by and NEDS is the largest sample of national-level emergency care visits and incorporated race/ethnicity variables for the first time in 2019. The data showed more than 250,000 firearm-related injuries during the study timeframe, approximately a third of which resulted in death, with the highest case fatality among injuries due to self-harm. Men were disproportionately affected by firearm injury and rates of self-harm were highest among White persons. Rates of assault and unintentional injuries were highest among Black persons. Rates were alarmingly high among Black boys and men aged 15 to 34 years, with an overall rate of 291 firearm assault injuries per 100 000, making firearm assault injuries more common in this group than ED visits for sports injuries are in any age group. Native American persons accounted for just 0.7% of total firearm injuries but had the second-highest case fatality ratios for assault and law enforcement–associated injury. This could be because Native Americans are overrepresented in rural areas, and case fatalities in rural areas were higher across the board, which has been attributed to differences in weapon type and caliber, shooter skill and intentionality, and limited access to trauma care. According to the authors, better data are needed to accurately capture underlying causes of firearm injury and case fatality are needed to focus resources and interventions.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Elinore J. Kaufman, MD, MSHP, please email Kelsey Geesler at Kelsey.Geesler@pennmedicine.upenn.edu.   

----------------------------     

3. Adding oral methotrexate to care reduces pain in knee osteoarthritis

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0303     

URL goes live when the embargo lifts     

A randomized, placebo-controlled trial found that oral methotrexate added to usual analgesia care showed statistically significant reduction in knee osteoarthritis pain at 6 months, with improvements also noted in some secondary outcomes. This is important because knee osteoarthritis is associated with significant pain and disability, and treatments are limited. The findings are published in Annals of Internal Medicine.

Researchers from the University of Leeds randomly assigned 155 participants with symptomatic knee osteoarthritis to either oral methotrexate once weekly or matched placebo with continued usual analgesia over 12 months to assess symptomatic benefits of methotrexate. The participants had knee osteoarthritis diagnosed by radiography and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication. The participants were assessed for knee pain at 6 months, with 12-month follow-up to assess longer term response. Secondarily, they were assessed for knee stiffness and function outcomes and adverse events. The researchers found that methotrexate added to usual analgesia showed statistically significant reduction in pain, with improvements in some secondary outcomes. The two treatment groups had similar outcomes by 12 months, although loss to follow-up was higher and mean methotrexate dose lower by 12 months in the methotrexate group. According to the authors, further work is required to understand adequate methotrexate dosing, whether benefits are greater in those with elevated systemic inflammation levels, and to consider cost-effectiveness before introducing this therapy for a potentially large population.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Philip G. Conaghan, PhD, please email p.conaghan@leeds.ac.uk or Natalie Stephenson at n.stephenson@versusarthritis.org.

----------------------------     

4. New ACP paper discusses the ethics around academic discourse, scientific integrity, uncertainty, and disinformation in medicine

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0648      

URL goes live when the embargo lifts     

The COVID-19 pandemic brought many issues in health care to light including the issues of scientific integrity; decision making in the face of scarce or conflicting data; and rapidly-changing guidance that raised and resulted in dis- and misinformation. These issues are discussed in a new ethics paper from the American College of Physicians (ACP) published in Annals of Internal Medicine.

The paper addresses four overarching themes including the evolving science through the lens of COVID-19 and history; bias and beyond: tactics straying from virtues and reasoned debate; institutional virtues and vices and health care literacy, disinformation and misinformation as well as detailed supporting positions specific to each theme.

A number of complex topics related to ethics and academic discourse are discussed in the paper including the tenet that if science is to function well, scientists and physicians must not stray from core values and practices. Additionally, promoting scientific integrity is about more than individual action; it requires attention to institutions and organizations. The paper touches on the need for conflict-of-interest policies that reinforce the physician’s first obligation to the individual patient. Mis- and disinformation, often for intellectual and/or financial gain and involving fraud, violate principles of ethics and can harm patients and the public.

Recognizing that scientific evidence is uncertain and changing, institutions should demonstrate humility and respect in the face of disagreement. The appropriate response is to create an institutional culture that supports openness, independence from social or political forces, objectivity, and organized skepticism – not to suppress ideas, but to promote more dialogue.

The position paper was developed on behalf of the ACP Ethics, Professionalism and Human Rights Committee (EPHRC) and makes clear that open discourse and debate based in principles of ethics, evidence, and scientific inquiry and integrity; and an understanding of evidence gaps, uncertainty and how to communicate about them are important values in the advancement of science and the practice of medicine.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Andy Hachadorian at ahachadorian@acponline.org.  

---------------------------                                  

Also published in this issue:

Breaking the Silence: Restoring Justice in Academic Medicine

Susan Thompson Hingle, MD

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00596

Physician Humility: A Review and Call to Revive Virtue in Medicine

Caroline L. Matchett, MD, Ellen L. Usher, PhD., John T. Ratelle, MD, Diego A. Suarez, MD, Andrea N. Leep Hunderfund, MD, MHPE, Ana M. Aragon Sierra, Adam P. Sawatsky, MD, MS

Academia and Medicine

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0842