Clinique Medicale La Delivrance

19/02/2025

This site is intended for healthcare professionals

Medscape Pediatrics
COMMENTARY

Not All Children Respond to Vaccinations the Same
ID Consult
Michael E. Pichichero, MD

DISCLOSURES | February 07, 2025

6
46
Add to Email Alerts
Children do not respond equally to vaccines, nor do adults. Eight years ago, my group introduced the concept of low vaccine responder‒ and normal vaccine responder children. We tested 499 infants for antibody levels to multiple routine vaccines given in a 2-4-6 month series. Surprisingly, we found that 11% were what we termed “low responders” because the children developed subprotective antibody levels to at least four of six vaccine antigens (ingredients in diphtheria, tetanus, pertussis, and Haemophilus influenzae type b vaccines). We tested to seven other vaccines (polio serotypes 1, 2, 3, hepatitis B, and three pneumococcal conjugate vaccine components) and 50% developed subprotective antibody levels, which we termed “low responders.”

Michael E. Pichichero, MD
When we studied the immunity of the low responder infants, we found that they had problems with all three types of immunity cells: B cells that make antibody, T cells that help B cells and kill viruses, and antigen-presenting cells (APCs) that take the vaccine ingredients to the lymph nodes and spleen, where the immune processing occurs. Taken together, the immunity profile of the infants suggested delayed immunologic maturation compared with normal vaccine responders, and we introduced the term “prolonged neonatal-like immune profile.” Since we had identified the immune problem in 11% of all the infants we studied, we realized that we had discovered the most common immune problem ever described, with the closest second being selective IgA deficiency, occurring in 1 in 600 children.

My group recently published another paper on the topic of variation in vaccine responsiveness in children. The specific focus of our newest paper was on examining how children’s vaccine response changes over time, from the primary vaccine responses in year 1 of life through the booster vaccinations in year 2. We sought to define four vaccine response groups based on antibody levels rather than two groups, to allow better resolution of the broad range of antibody measurements. The new study involved a secondary analysis of a subset of 357 of the 499 children included in our prior paper because we wanted to include only children who had a measurement of antibody at age 9 or 12 months and at least one measurement at another time through 36 months of age. We restricted our study to healthy, full-term-at-birth infants residing in urban, suburban, and rural areas of Rochester, New York, with broad representation in race and ethnicity, who had been prospectively enrolled and had clinical samples collected longitudinally during 2006-2017. Enrollment occurred at age 6 months after completion of a primary series of three vaccinations. Blood sampling at age 6, 9, 12, 15, 18, 24, and 30-36 months was prespecified in the study protocol, although samples were often not provided at all age time points. Demographic factors that may affect vaccine responsiveness were prospectively collected by parent questionnaire. All children received age-appropriate vaccinations according to the recommendations by the Centers for Disease Control andPrevention, confirmed by review of the medical record.

To define vaccine response groups, we developed a novel method. We took the antibody levels to six vaccine antigens (DTaP and H. flu b PRP) and divided each by their threshold of protection, and the ratio was considered a “normalized” level. The geometric mean of the six normalized levels was calculated to derive an antibody response score. We then used a mathematical approach using the antibody score at age 9 or 12 months to divide the children into four groups: very low vaccine responder (vLVR; bottom 10th percentile of vaccine responders), LVR (bottom 10th-25th percentile), NVR (25th-75th percentile), and HVR (top 25th percentile). See Figure. Using this new method seemed to correlate well with the prior method, evidenced by the finding that 50% of vLVR children met the prior definition of subprotective responses to two thirds or more of the vaccines tested, and the percentage of children with 6/6 to 0/6 antibody levels below protection changed stepwise from the vLVR through HVR groups.

As expected, the level of antibody following vaccination changed over time for all the children, reflecting the response after completion of the primary vaccines and then antibody decay until boosters were given, resulting in an increase in antibody and then decay again. What was striking to us was that individual children tended to stay in their vaccine response group over time. So, if a child was a vLVR after the primary series, they tended to remain vLVR before and after their boosters, and similarly for the other classifications. When we assessed this observation by looking at antibody responses to the other seven vaccines we tested (polio serotypes 1, 2, 3; hepatitis B; and three pneumococcal conjugate vaccine components), the same phenomena occurred: A child who was a vLVR after the primary series tended to remain vLVR before and after their boosters, and similarly for the other classifications. When we assessed this observation by looking at antibody responses to all 13 vaccine antigens, the conclusion was the same. This meant that vaccine response and trajectory established in an individual child tended to remain the same throughout the booster series in the second year of life, which had never been reported before.
We looked at variables that might explain why children ended up in a vaccine response group. We collected data on demographic variables of s*x, ethnicity, race, siblings in the home, breastfeeding, smokers in the home, and daycare attendance. We found that African American/multiracial children were less frequently vLVR and LVR than White children, and we found that attendance at daycare (typically associated with more frequent infections and antibiotic exposure) occurred more often in vLVR and vLVR/LVR combined. We then looked at environmental variables and found that antibiotic treatmentoccurred significantly more often in vLVR children, confirming a recent earlier report from our group. Finally, we showed that low vaccine responsiveness was linked to more frequent antibiotic-treated bacterial infections.

The conclusions of our work were:

When vaccine-induced antibody levels are used to define vaccine response groups, individual children tend to persist in their initially established group but may change groups over time.
Changes in vaccine group are associated with demographic variables and are influenced by antibiotic exposures.
Lower vaccine responsiveness can be linked to more frequent antibiotic-treated bacterial infections.
6

Medscape Medical News
Blood Test Predicts How Long Vaccines Will Protect You
Pr Dominique Baudon

February 13, 2025

How long will vaccine protection last? A simple blood test may have the answer. Researchers at Stanford School of Medicine, Stanford, California, have identified a molecular signature in the blood that appears days after vaccination and predicts the durability of the immune response. Published in Nature Immunology in January, this discovery could transform vaccine development, testing, and personalization of vaccines. The study also offers insights into why some vaccines provide lifelong immunity while others lose effectiveness within months.

Vaccine Durability
A major challenge in vaccinology is ensuring long-lasting, protective immunity. Vaccine protection varies depending on the vaccine and individual. Accurately determining the duration of immunity is essential for designing effective public health strategies. Scientists have long wondered why some vaccines enable the body to produce antibodies for decades or even a lifetime, whereas other vaccines offer protection for only a few months.

Live attenuated viral vaccines, such as smallpox and yellow fever vaccines, induce lifelong antibody responses. The measles-mumps-rubella vaccine also provides long-term protection, although boosters are recommended. In contrast, waning antibody responses have been observed with vaccines such as the inactivated seasonal influenza subunit vaccine and those against Bordetella pertussis, Salmonella typhi, and Neisseria meningitidis. The same holds true for malaria RTS,S and candidate HIV vaccines.

Adjuvants are vaccine components that enhance the strength and longevity of immune responses. For those aged > 70 years, insoluble aluminum salts (alum) have been the only adjuvants approved for human use. However, in the past three decades, several adjuvants have been introduced, including:

Oil-in-water emulsions (MF59 and AS03) used in influenza vaccines
TLR4 agonist adjuvants (eg, 3-O-desacyl-4’-monophosphoryl lipid A) used in vaccines against respiratory syncytial virus, herpes zoster, and human papillomavirus
Oligonucleotide adjuvants used in hepatitis B vaccines
Saponin-based adjuvants (eg, Matrix-M) in the recombinant COVID-19 vaccine and the R217 malaria vaccine.
Molecular Signature
Advances in immune system analysis now allow scientists to identify molecular signatures that predict the efficacy and duration of vaccine action. Previous studies on vaccines against yellow fever, seasonal influenza, and other diseases have shown that molecular markers in blood correlate with vaccine response.

A recent meta-analysis of over 3000 blood samples from 820 adults across 28 studies on 13 vaccines revealed a plasma cell signature that could predict antibody responses to many vaccines.
However, no study to date has identified a cellular or molecular signature capable of predicting the duration of an immune response.

Researchers at Stanford sought to identify the factors influencing both the magnitude and duration of vaccine-induced immunity. They discovered a molecular signature in the blood that appears a few days after vaccination and predicts the duration of the immune response. According to the authors, this provides “important insights into the mechanisms by which vaccines induce durable immunity.”

Predicting Response Longevity
The researchers conducted a systems vaccinology analysis to investigate immune responses in humans to the H5N1 influenza vaccine, with and without the AS03 adjuvant. Fifty healthy individuals were randomly assigned to receive two doses of the avian influenza vaccine with or without an adjuvant.

Blood samples taken within 100 days of vaccination revealed a molecular signature linked to long-lasting antibody responses. This signature consists of RNA fragments from bone marrow megakaryocytes that are carried into the bloodstream by platelets.

The link between this molecular signature and megakaryocytes was first demonstrated in mice vaccinated with the avian influenza vaccine. Activation of megakaryocytes by thrombopoietin enhanced the durability of vaccine-induced antibody responses. This activation also promoted the survival of human bone marrow plasma cells through β1/β2 integrin-mediated cell interactions, leading to the production of molecules that increase plasma cell survival.

Building on this, a machine-learning model based on this platelet-associated signature was developed to predict the longevity of vaccine-induced immunity. Researchers analyzed antibody response data from 244 participants who had received seven different vaccines, including seasonal influenza, yellow fever, malaria, and COVID-19. Across these vaccines, the same platelet RNA molecules, indicating megakaryocyte activation, were consistently associated with more durable antibody production.

The ultimate goal is to develop a simple blood test based on platelet-associated markers to estimate vaccine durability using this molecular signature. Researchers also aim to validate these tests across different vaccines and populations globally. This could accelerate vaccine clinical trials and lead to the development of personalized vaccination strategies.

This story was translated from JIM using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Comments
FIND US ON
ABOUT
About Medscape
Privacy Policy
Editorial Policy
Cookies
Terms of Use
Advertising Policy
Help Center
MEMBERSHIP
Become a Member
About You
Professional Information
Newsletters & Alerts
Market Research
APP
Medscape
EDITIONS
English
Deutsch
Español
Français
Português
UK
All material on this website is protected by copyright, Copyright © 1994-2025 by WebMD LLC. This website also contains material copyrighted by 3rd parties.

30/08/2024

30/08/2024

13/02/2024

This site is intended for healthcare professionals

Medscape Medical News
ADHD Symptoms Linked With Physical Comorbidities
Anne-Gaëlle Moulun

January 15, 2024

Investigators from the French Health and Medical Research Institute (INSERM), University of Bordeaux, and Charles Perrens Hospital, alongside their Canadian, British, and Swedish counterparts, have shown that attention deficit disorder hyperactivity disorder (ADHD) or attention deficit disorder without hyperactivity is linked with physical health problems. Cédric Galéra, MD, PhD, child and adolescent psychiatrist and epidemiologist at the Bordeaux Population Health Research Center (INSERM/University of Bordeaux) and the Charles Perrens Hospital, explained these findings to Medscape Medical News.

A Bilateral Association
ADHD is a neurodevelopmental condition that develops in childhood and is characterized by high levels of inattention or agitation and impulsiveness. Some studies have revealed a link between ADHD and medical comorbidities, but these studies were carried out on small patient samples and were cross-sectional.

A new longitudinal study published in Lancet Child and Adolescent Health has shown a reciprocal link between ADHD and physical health problems. The researchers conducted statistical analyses to measure the links between ADHD symptoms and subsequent development of certain physical conditions and, conversely, between physical problems during childhood and subsequent development of ADHD symptoms.

Children From Quebec
The study was conducted by a team headed by Galéra in collaboration with teams from Britain, Sweden, and Canada. "We studied a Quebec-based cohort of 2000 children aged between 5 months and 17 years," said Galéra.

"The researchers in Quebec sent interviewers to question parents at home. And once the children were able to answer for themselves, from adolescence, they were asked to answer the questions directly," he added.

The children were assessed on the severity of their ADHD symptoms as well as their physical condition (general well-being, any conditions diagnosed, etc.).

Dental Caries, Excess Weight
"We were able to show links between ADHD in childhood and physical health problems in adolescence. There is a greater risk for dental caries, infections, injuries, wounds, sleep disorders, and excess weight.

"Accounting for socioeconomic status and mental health problems such as anxiety and depression or medical treatments, we observed that dental caries, wounds, excess weight, and restless legs syndrome were the conditions that cropped up time and time again," said Galéra.

On the other hand, the researchers noted that certain physical health issues in childhood were linked with the onset of ADHD at a later stage. "We discovered that asthma in early childhood, injuries, sleep disturbances, epilepsy, and excess weight were associated with ADHD. Taking all above-referenced features into account, we were left with just wounds and injuries as well as restless legs syndrome as being linked to ADHD," Galéra concluded.

For Galéra, the study illustrates the direction and timing of the links between physical problems and ADHD. "This reflects the link between physical and mental health. It's important that all healthcare professionals be alert to this. Psychiatrists and mental health professionals must be vigilant about the physical health risks, and pediatricians and family physicians must be aware of the fact that children can present with physical conditions that will later be linked with ADHD. Each of them must be able to refer their young patients to their medical colleagues to ensure that these people receive the best care," he emphasized.

The team will continue to study this cohort to see which problems emerge in adulthood. They also wish to study the Elfe cohort, a French longitudinal study of children.

30/11/2023

Exercise as Good as Vi**ra for ED: Study
Courtney Southwick

October 23, 2023

28
230
Add to Email Alerts
Exercising for at least 30 minutes three times a week can be just as effective as Vi**ra and similar medications at improving erectile function, according to a new analysis of the best research to date on aerobic exercise and erectile function.

The study, published this month in The Journal of Sexual Medicine, found that aerobic activities – such as walking or cycling – improved erectile function in all men with erectile dysfunction, regardless of body weight, overall health, or medication use. Men with the most severe erectile dysfunction saw the greatest benefit.

"This study provides physicians and patients the proof needed to definitively recommend aerobic activity as part of ED management," said study author Larry E. Miller, PhD.

Doctors have long known that erectile function is linked to cardiovascular health, but there is limited high-quality evidence on the impact of exercise on the disorder.

The researchers scoured the scientific literature and found 11 randomized, controlled trials – a gold-standard study design where participants are randomly assigned to receive an intervention or not. Of the 1,100 men involved in the studies, 600 were assigned to "experimental" groups that typically exercised for 30 to 60 minutes, three to five times a week, while 500 were assigned to "control" groups with no exercise plan.

The worse the ED was, the more exercise helped, the researchers found. On a standardized scale of 6 to 30, men with severe ED who exercised reported a 5-point improvement in erectile function. Those with mild and moderate ED saw improvements of 2 and 3 points, respectively.

By comparison, phosphodiesterase-5 inhibitors -- like sildenafil (Vi**ra) or tadalafil (Cialis) – can lead to improvements of 4 to 8 points, the study authors note. And testosterone replacement therapy can lead to an improvement of 2 points.

"We were particularly impressed by the finding that men with more severe erectile dysfunction saw greater improvements with exercise, and these improvements were similar to those seen in men taking" drugs like Vi**ra, Miller said.

ED and Heart Health
Erectile dysfunction can often be traced to the same causes as cardiovascular disease, including inflammation, a narrowing of the arteries (endothelial dysfunction), or a hardening of the arteries (atherosclerosis).

"It's important to recognize that erectile dysfunction can often serve as an indicator or barometer of underlying cardiovascular health," said Amy Pearlman, MD, a urologist specializing in male s*xual health at Prime Institute in Miami.

Pearlman was not involved in the study but thinks the results make sense. "It stands to reason that any intervention aimed at enhancing cardiovascular health may also have a positive impact on erectile health."

But what was surprising was that aerobic exercise reduced symptoms on par with medications like Vi**ra, said urologist Rahul Mehan, MD, founder of East Valley Urology Center, in Mesa, AZ. (Mehan was also not involved in the study.)

While erectile dysfunction medications are generally affordable and accessible, some patients don't want to take them or can't tolerate the side effects. These can include "headache, heartburn, nausea, flushing, and pain in muscles, back, arms, or legs," said Mehan. He adds, "Everyone can exercise."

Some doctors, including Mehan, already recommend exercise to their patients with ED.

Now they can tell patients that it's "a proven approach backed by high-quality data from randomized studies," Miller said. "Exercise is low risk and affordable, making it an ideal first-line treatment option for erectile difficulties, especially for patients unwilling or unable to use medications."

Sources
Larry E. Miller, PhD, president, founder, Miller Scientific Consulting, Johnson City, TN.

Rahul Mehan, MD, founder, East Valley Urology Center; chief medical officer, Geviti, Mesa, AZ.

Amy Pearlman, MD, urologist specializing in s*xual and hormonal health, Prime Institute, Miami.

Cleveland Clinic: "Phosphodiesterase Inhibitors."

The Journal of Sexual Health: "Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomized controlled trials."

27/09/2023

Medscape Logo
News > WebMD Health News
Study Says Casual Pot Use Harmful to Teens
Jay Croft

May 19, 2023

0
Add to Email Alerts
Recreational ma*****na use by teenagers isn't as harmless as many people seem to think, even as it becomes increasingly legal in this country, authors of a new study say.

Teenagers who use cannabis recreationally are 2 to 3 times more likely to have depression and suicidal thoughts than those who don't use it. And teens who have cannabis use disorder – which means they can't stop using it despite health and social problems – are 4 times more likely to have those same thoughts and feelings.

The study was published in the Journal of the American Medical Association (JAMA). It looked at information from 68,000 teens in the National Survey on Drug Use and Health.

Ma*****na use was also linked to other issues including not doing well in school, skipping school, and getting in trouble with the police.

"Kids, year by year, have been moving towards a view that ma*****na is safe and benign — that's factually incorrect," lead author of the study, Ryan Sultan, MD, an assistant professor of clinical psychiatry at Columbia University, told Yahoo Life.

The child psychiatrist said he was surprised that recreational users had a much higher risk of mental health issues. "We typically think of recreational use as not being a concerning behavior," he said.

The study did not seek to explain the link between mental health problems and cannabis use.

"The more you use it, the more it negatively affects your thinking. That's increasing the likelihood of depression and more suicidal thoughts," Sultan said. "It's feedback that spirals downward and gets to a place that really concerns us as child psychiatrists."

Sultan said parents should talk to their children about ma*****na use, depression, and anxiety.

Sources
JAMA Network: "Nondisordered Cannabis Use Among US Adolescents."

07/08/2023

Intense exercise may increase stroke risk among patients with moderate or severe stenosis, new research suggests.

Investigators simulated blood flow in a sophisticated computational model of the internal carotid artery (ICA) at three stages of stenosis ― without blockage, with mild (30%) blockage, and with moderate (50%) blockage. They compared the effect of exercise-induced elevated heart rate (140 bpm) to that of two resting heart rates (67 and 100 bpm).

As expected, intense exercise was beneficial for the patients with healthy arteries and for those with mild stenosis, but it showed potential for adversely affecting arteries among patients with moderate or higher levels of stenosis because it increased the arterial wall shear stress (WSS) at the stenosis zone.

"Increased shear stress at the stenosis zone may lead to the rupture of stenosis, and the ruptured plaque then may go directly to the brain through the ICA by blocking the blood supply to the brain and causing ischemic stroke," study investigator Somnath Roy, PhD, associate professor, Department of Mechanical Engineering and Centre for Computational and Data Sciences, Indian Institute of Technology, Kharagpur, India, told Medscape Medical News.

The study was published online June 20 in Physics of Fluids.

Physics-Based Prediction
"The behavior of arterial WSS is substantially influenced by the local hemodynamics, which is directly related to the development of atherosclerosis," the authors write.

"Disturbed flow in the post-stenotic region further promotes arterial dysfunction by activating various pro-atherosclerotic and pro-inflammatory genes in the endothelial cells," they add.

Arterial locations that are subjected to low or oscillatory WSS "behave as atherogenic sites." Two hemodynamic parameters — time-average WSS and oscillatory shear index (OSI) — are used extensively to "quantify the low and fluctuating behavior of WSS in an arterial flow.

"Stenosis in the internal carotid arteries can disrupt the blood supply to the brain and may lead to ischemic stroke," Roy said.

Heart rate increases during exercise, which brings stress to the arteries. Previous research shows that in healthy arteries without atherosclerosis or in arteries that are only mildly affected, the change in arterial stress levels produced by exercise is beneficial, he explained. However, many clinicians are confused about prescribing exercise regimens for patients who have a history of stroke or arterial blockage, said Roy.

"We have noted reports of sudden vascular strokes in individuals undergoing heavy exercise. We have noted that the flow behavior in arteries with stenotic blockage at high heart rate is not yet well explored."

For the study, the researchers observed the flow features and wall stress levels in a human carotid model at heart rates that correspond to those when at rest and under exercise conditions.

They used a computational model that enabled them to "solve the mass and momentum equation of blood flow in the virtual arterial domain," said Roy. This produced a "physics-based prediction of what might happen in human artery under such conditions."

Prescribe Exercise Carefully
The researchers found that strong recirculation, secondary velocity, and OSI zone develop inside a severely stenosed carotid artery at normal heart rate.

They observed that higher heart rates may improve arterial health by reducing OSI, but only in the absence of stenosis or in cases of mild stenosis.

By contrast, the increased heart rates (>120 bpm) worsened the arterial health of the severely stenosed arteries (≥50% blockage) by causing the onset of flow instabilities, which enhance the spread and severity of the recirculation zone and the magnitude of secondary velocity.

This leads to a drop in pressure across the stenosis and to the spread of the high OSI (≥0.2) zone downstream. Moreover, in cases of severe stenosis, the WSS at the stenosis throat rises significantly, which can contribute to plaque rupture and thrombus development.

Although the plaque rupture phenomenon itself was not studied, "the stress field that came through our prediction for stenosed artery at 120 bpm suggests that the risk of plaque rupture is high," Roy noted.

This ruptured plaque may then go directly to the brain through the ICA and block the blood supply, causing ischemic stroke. Apart from that, intense exercise also increases the risk of another stenosis formation in the poststenotic zone by "spreading the region exposed to high oscillating WSS," he said.

Roy hopes that the "detailed understanding of the flow features and stress distribution in stenosed carotid arteries at different heart rates may help clinicians to prescribe better exercise schedules for patients."

He and his colleagues "recommend checking arterial health regularly for the people who are doing intense workouts in gyms, or any other intense exercise."

Exercise regimens should be "carefully prescribed" for people with moderate or severe stenosis or who have a history of strokes "in light of the risk factors that emerged in the study," he advised.

"Novel" Findings
Commenting for Medscape Medical News, Seemant Chaturvedi, MD, Stewart Greenebaum Endowed Professor of Neurology and director of the Stroke Program at the University of Maryland School of Medicine, noted that it is known that WSS increases in narrowed (stenotic) carotid arteries with increased heart rate. However, the observation regarding "variance with differing heart rates are novel," he added.

At this stage, "there may not be a clear actionable item for health care providers. Sometimes, increased heart rate is beneficial," continued Chaturvedi, who was not involved with the study.

"For example, exercise boosts the heart rate and is recommended for preventing vascular disease. It is possible that patients with extreme narrowing may want to avoid very fast heart rates, but this should be an individual decision in consultation with a physician."

The research was funded by a grant from the National Super-Computing Mission, Government of India. Roy and co-authors and Chaturvedi have disclosed no relevant financial relationships.

Phys Fluids. Published online June 20, 2023. Full text

Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).

01/08/2023

22/07/2023

A new study suggests that prescriptions for low-dose oral minoxidil soared in the wake of a 2022 New York Times article that highlighted its utility for hair loss.

The weekly rate of first-time low-dose oral minoxidil (LDOM) prescriptions per 10,000 outpatient encounters was "significantly higher 8 weeks after vs. 8 weeks before article publication," at 0.9 prescriptions, compared with 0.5 per 10,000, wrote the authors of the research letter, published in JAMA Network Open. There was no similar bump for first-time finasteride or hypertension prescriptions, wrote the authors, from Harvard Medical School and Massachusetts General Hospital, Boston, and Truveta, a company that provides EHR data from U.S. health care systems.

The New York Times article noted that LDOM was relatively unknown to patients and doctors — and not approved by the Food and Drug Administration for treating hair loss — but that it was inexpensive, safe, and very effective for many individuals. "The article did not report new research findings or large-scale randomized evidence," wrote the authors of the JAMA study.

Rodney Sinclair, MD, professor of dermatology at the University of Melbourne, who conducted the original research on LDOM and hair loss and was quoted in the Times story, told this news organization that "the sharp uplift after the New York Times article was on the back of a gradual increase." He added that "the momentum for minoxidil prescriptions is increasing," so much so that it has led to a global shortage of LDOM. The drug appears to still be widely available in the United States, however. It is not on the ASHP shortages list.

"There has been growing momentum for minoxidil use since I first presented our data about 6 years ago," Dr. Sinclair said. He noted that 2022 International Society of Hair Restoration Surgery survey data found that 26% of treating physicians always or often prescribed off-label oral minoxidil, up from 10% in 2019 and 0% in 2017, while another 20% said they prescribed it sometimes.

The authors of the new study looked at prescriptions for patients at eight health care systems before and after the Times article was published in August 2022. They calculated the rate of first-time oral minoxidil prescriptions for 2.5 mg and 5 mg tablets, excluding 10 mg tablets, which are prescribed for hypertension.

Among those receiving first-time prescriptions, 2,846 received them in the 7 months before the article and 3,695 in the 5 months after publication. Men (43.6% after vs. 37.7% before publication) and White individuals (68.6% after vs. 60.8% before publication) accounted for a higher proportion of prescriptions after the article was published. There was a 2.4-fold increase in first-time prescriptions among men, and a 1.7-fold increase among females, while people with comorbidities accounted for a smaller proportion after the publication.

"Socioeconomic factors, such as access to health care and education and income levels, may be associated with individuals seeking low-dose oral minoxidil after article publication," wrote the authors.

In an interview, Adam Friedman, MD, professor and chair of dermatology at George Washington University, Washington, said that he was not surprised to see an uptick in prescriptions after the Times article.

He and his colleagues were curious as to whether the article might have prompted newfound interest in LDOM. They experienced an uptick at George Washington, which Dr. Friedman thought could have been because he was quoted in the Times story. He and colleagues conducted a national survey of dermatologists asking if more patients had called, emailed, or come in to the office asking about LDOM after the article's publication. "Over 85% said yes," Dr. Friedman said in the interview. He and his coauthors also found a huge increase in Google searches for terms such as hair loss, alopecia, and minoxidil in the weeks after the article, he said.

The results are expected to published soon in the Journal of Drugs in Dermatology.

"I think a lot of people know about [LDOM] and it's certainly has gained a lot more attention and acceptance in recent years," said Dr. Friedman, but he added that "there's no question" that the Times article increased interest.

That is not necessarily a bad thing, he said. "With one article, education on a common disease was disseminated worldwide in a way that no one doctor can do," he said. The article was truthful, evidence-based, and included expert dermatologists, he noted.

"It probably got people who never thought twice about their hair thinning to actually think that there's hope," he said, adding that it also likely prompted them to seek care, and, more importantly, "to seek care from the person who should be taking care of this, which is the dermatologist."

However, the article might also inspire some people to think LDOM can help when it can't, or they might insist on a prescription when another medication is more appropriate, said Dr. Friedman.

Both he and Dr. Sinclair expect demand for LDOM to continue increasing.

"Word of mouth will drive the next wave of prescriptions," said Dr. Sinclair. "We are continuing to do work to improve safety, to understand its mechanism of action, and identify ways to improve equity of access to treatment for men and women who are concerned about their hair loss and motivated to treat it," he said.

Dr. Sinclair and Dr. Friedman report no relevant financial relationships.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

Latest News July 19, 2023 U.S. mammogram update sparks concern, reignites debates July 19, 2023 Kerry Dooley Young Kerry Dooley YoungJuly 19, 2023 MDedge ObGyn July 19, 2023 Humira biosimilars: Five things to know July 19, 2023 Lucy Hicks Lucy HicksJuly 19, 2023 MDedge Rheumatology July 19, 2023 Ver...