Safety of teplizumab in patients with high-risk for diabetes mellitus type 1:A systematic review

BACKGROUND The incidence of diabetes mellitus type 1(DM1)has been rising worldwide because of improvements in diagnostic techniques and improved access to care in countries with lower socioeconomic status.A new anti-CD4 antibody,Teplizumab,has been shown to delay the progression of DM1 and is the only medication approved for this indication.However,more information is needed about the safety profile of this drug.AIM To identify the odds ratios(OR)of systems-based adverse effects for Teplizumab when compared to Placebo.METHODS An extensive systematic review was conducted from the inception of the medication until December 31,2023.All clinical trials and studies that evaluated Teplizumab vs placebo were included in the initial review.The study protocol was designed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guidelines and was registered in PROSPERO(ID:CRD42024496169).Crude OR were generated using RevMan Software version 5.4.RESULTS After screening and review,5 studies were selected to determine the risk of adverse effects of teplizumab compared to placebo.A total of 561 patients were included in the study population.Total adverse effects and system-based adverse effects were studied and reported.We determined that patients receiving Teplizumab had a higher risk of developing gastrointestinal(GI)(OR=1.60,95%CI:1.01-2.52,P=0.04),dermatological(OR=6.33,95%CI:4.05-9.88,P<0.00001)and hematological adverse effects(OR=19.03,95%CI:11.09-32.66,P<0.00001).These patients were also significantly likely to have active Epstein-Barr Virus infection(OR=3.16,95%CI:1.51-6.64,P<0.002).While our data showed that patients receiving Teplizumab did have a higher incidence of total adverse effects vs placebo,this finding did not reach statistical significance(OR=2.25,95%CI:0.80-6.29,P=0.12).CONCLUSION Our systematic review suggests that Teplizumab patients are at risk for significant adverse effects,primarily related to GI,dermatological,and hematological systems.The total adverse effect data is limited as study populations are small.More studies should be conducted on this medication to better inform the target population of potential adverse effects.

Artificial intelligence in sleep medicine:Present and future

Artificial intelligence(AI)has impacted many areas of healthcare.AI in healthcare uses machine learning,deep learning,and natural language processing to analyze copious amounts of healthcare data and yield valuable outcomes.In the sleep medicine field,a large amount of physiological data is gathered compared to other branches of medicine.This field is primed for innovations with the help of AI.A good quality of sleep is crucial for optimal health.About one billion people are estimated to have obstructive sleep apnea worldwide,but it is difficult to diagnose and treat all the people with limited resources.Sleep apnea is one of the major contributors to poor health.Most of the sleep apnea patients remain undiagnosed.Those diagnosed with sleep apnea have difficulty getting it optimally treated due to several factors,and AI can help in this situation.AI can also help in the diagnosis and management of other sleep disorders such as insomnia,hypersomnia,parasomnia,narcolepsy,shift work sleep disorders,periodic leg movement disorders,etc.In this manuscript,we aim to address three critical issues about the use of AI in sleep medicine:(1)How can AI help in diagnosing and treating sleep disorders?(2)How can AI fill the gap in the care of sleep disorders?and(3)What are the ethical and legal considerations of using AI in sleep medicine?