Celiac disease (CD) is an immune-mediated gastrointestinal disorder driven by innate and adaptive immune responses to gluten. Patients with CD are at an increased risk of several neurological manifestations, frequently peripheral neuropathy and gluten ataxia. A systematic literature review of the most commonly reported neurological manifestations (neuropathy and ataxia) associated with CD was performed. MEDLINE, Embase, the Cochrane Library, and conference proceedings were systematically searched from January 2007 through September 2018. Included studies evaluated patients with CD with at least one neurological manifestation of interest and reported prevalence, and/or incidence, and/or clinical outcomes. Sixteen studies were included describing the risk of gluten neuropathy and/or gluten ataxia in patients with CD. Gluten neuropathy was a neurological manifestation in CD (up to 39%) in 13 studies. Nine studies reported a lower risk and/or prevalence of gluten ataxia with a range of 0%–6%. Adherence to a gluten-free diet appeared to improve symptoms of both neuropathy and ataxia. The prevalence of gluten neuropathy and gluten ataxia in patients with CD varied in reported studies, but the increased risk supports the need for physicians to consider CD in patients with ataxia and neurological manifestations of unknown etiology.

Introduction: Immunotherapies, including checkpoint inhibitors (CIs) such as cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed death-1 (PD-1) inhibitors, are revolutionizing the treatment of advanced melanoma. Combining CTLA-4 and PD-1 inhibitors provides additional clinical benefit compared with single agents alone. However, combination therapy can increase the incidence of gastrointestinal adverse events (GI AEs). This systematic review assessed the epidemiological, clinical, economic, and humanistic burden of GI AEs due to combination CIs in advanced melanoma. Methods: MEDLINE, EMBASE, and the Cochrane Library were systematically searched (December 2011 to December 2016) to identify primary studies, systematic reviews, meta-analyses, and conference proceedings (2014–2016) evaluating adults treated with ≥2 CIs for advanced melanoma. Results: Of the 3391 identified articles, 14 were included. Most studies examined the ipilimumab plus nivolumab combination. Any grade and grade 3–4 GI AEs occurred i...

Background: A timely and accurate diagnosis of Alzheimer’s disease (AD) can optimize treatment outcomes; however, few people are referred to a specialist for reasons that are not well understood. The objective of this study was to evaluate referral to a specialist by a primary care clinician (PCC) or other healthcare provider (HCP) among people diagnosed with cognitive impairment disorders, including AD (CIDiAD).Method: This retrospective cohort study analyzed claims data from the Optum de‐identified Normative Health Information database between 1/1/2016‐31/12/2021 (study period). Adults were required to have ≥2 ICD‐9/10‐CM diagnosis codes for AD from any provider during the study period. The index event was defined as the first CIDiAD diagnosis (Table 1) from a PCC or other HCP before or on the date of their diagnosis during the identification period (1/1/2017‐31/12/2020) (Table 2). Continuous medical enrollment was required in the pre‐ and postindex periods. No diagnoses of CIDiAD in the pre‐index period were allowed. People with a post‐index diagnosis of AD from a specialist comprised the referral cohort. Time to specialist referral was assessed, and characteristics of people who were or were not referred were summarized.Result: A total of 48,525 people with a CIDiAD diagnosis from a PCC or other HCP were included; of these, 13,074 (26.9%) were referred to a specialist. The overall median (IQR) time to first specialist visit was 10.0 (3.2‐20.7) months. Time to first specialist visit was longer for referrals from PCCs compared with those from other HCPs (10.8 [3.8‐21.6] vs 9.2 [2.8‐19.9] months, respectively; P<0.0001). No notable differences in sex, age, race and ethnicity, or geographic region were observed between people who were referred and those who were not (Table 3).Conclusion: The majority of people with CIDiAD were not referred to a specialist. Among people who were referred to a specialist, time to first visit was long. Approval of disease‐modifying therapies may accelerate referral to a specialist and shorten referral times as early diagnosis of AD becomes more important. Further analyses will inform geographic differences in specialist referral patterns.