Change of the guard for the world’s biggest cancer companies

Roche is set to lose its crown as the largest oncology player to the newly merged Bristol-Myers Squelgene, while Astrazeneca is forecast to streak up the rankings.

Roche’s long domination of the cancer space is coming to an end. The company’s failure to replace its huge antibody franchise, as well as deal making and clinical wins elsewhere, mean that the Swiss pharma giant is the main loser in a fragmenting oncology world.
Several firms are in the ascendance, primarily Bristol-Myers Squibb, which will be catapulted into the number one spot when the takeover of Celgene finally goes through. Merck & Co and Astrazeneca are also predicted to grow strongly in the coming years, though the latter has the most to prove.
Astra and Daichii Sankyo’s anti-Her2 antibody-drug conjugate trastuzumab deruxtecan is considered the sector’s most valuable oncology R&D project by some way – at least according to sellside forecasts, which sit at an incredible $2.7bn by 2024. The FDA will rule on accelerated approval in the second quarter of 2020, the partners said this week; that decision, and the product’s subsequent launch, are shaping up to be the among the most pivotal events for the oncology world next year.

Consensus forecasts from EvaluatePharma, derived from sellside models, show that Bristol’s oncology sales are set to top those of Roche from 2020, until at least 2024.
Driving the numbers are Opdivo and, for the next few years at least, Revlimid. The new group is also on track to achieve the annual cancer drug sales over $30bn in 2021 through 2023, before the full force of Revlimid generics hits. This would be the first time a company has broken that barrier.
Roche’s cancer sales are seen peaking this year at $29bn, not far off that level. But Herceptin, Avastin and Rituxan, which will together bring in almost $20bn in sales this year, are in decline. It is not surprising that the company has struggled to replace such huge products, and it has also failed to keep up in the new immuno-oncology world.
Other climbers
Other big movers on this league table include Merck & Co. Before 2017 the US pharma giant was not even in the top 10, but is now firmly in the big league, entirely down to Keytruda.
Astrazeneca is also forecast to expand its cancer drug sales in the coming years, and has several products contributing to this growth. The targeted small molecules Tagrisso and Lynparza and the anti-PD-L1 antibody Imfinzi are the heavy lifters, though the blood cancer product Calquence, and newly acquired trastuzumab deruxtecan have big numbers attached.
Daiichi Sankyo, from which Astra bought trastuzumab deruxtecan rights in a huge deal earlier this year, will book most of the sales attributed to the project – Astra’s share amounts to $754m in 2024 – but with half of the profits flowing Astra’s way the company is fully vested in its success.
Still, ADCs have struggled to progress, clinically and commercially – only this week Roche abandoned RG6148, which is thought to be an anti-Her2 ADC – and there will be many who doubt the sellside’s bullish numbers.
Another interesting aspect of this picture is EvaluatePharma’s approximation of market share, which points to a something of a fragmentation of the oncology market over the next couple of years. The graph below is interactive; hovering the cursor over the columns will display the companies’ names.
Roche’s declining grip is the most dramatic image here. It is also notable that in each year there were six companies that managed to amass more than a 5% share.

Given the sector’s huge preoccupation with oncology it is perhaps not surprising that this field is now shared more widely, with more smaller players.
As well as deal making, clinical setbacks and other surprises are bound to change this picture in the coming years. The only certainty is that the world of oncology will be far from quiet.
https://www.evaluate.com/vantage/articles/data-insights/other-data/change-guard-worlds-biggest-cancer-companies

‘Complete Disruption’ of Supply of Essential Pediatric Chemo

Once again, there is a looming shortage of an essential anti-cancer medicine.
Vincristine, which has been used for more than half a century and serves as a backbone of treatment regimens for most childhood cancers, is rapidly disappearing from the shelves of hospital pharmacies.
This isn’t the first time that vincristine has been in short supply, but the situation now is more dire than during previous shortages.
“We have experienced shortages before but never a complete disruption like now, where there is no supply coming into the country,” said Peter C. Adamson, MD, chair, Children’s Oncology Group, Philadelphia, Pennsylvania. “We’ve been worried before, but the supply has never been disrupted like it is now.”
Both Pfizer and Teva manufactured vincristine for the US marketplace, but this past July, Teva announced that it was permanently halting production. According to the US Food and Drug Administration (FDA), “Teva made a business decision to discontinue the product.”
Without Teva, Pfizer became the only source of vincristine for patients being treated in the US. But production has been on shaky ground, as the company has run into some snags while ramping up its inventory to fill the gap left by Teva’s withdrawal from the market.
“It seems that this shortage resulted from manufacturing problems experienced by Pfizer, since they are now the sole supplier,” Michael Link MD, of Stanford University School of Medicine and Lucile Packard Children’s Hospital in California, told Medscape Medical News.
According to the New York Times , the FDA says that they are working closely with Pfizer and “exploring all options” to ensure that vincristine is available to patients who need it.

“The vincristine shortage is a game-changer as it is the single most widely used chemotherapeutic in childhood cancer,” said Yoram Unguru, MD, a pediatric hematologist/oncologist at The Herman and Walter Samuelson Children’s Hospital at Sinai and Johns Hopkins Berman Institute of Bioethics in Baltimore, Maryland. “Nearly every child with cancer in the US will receive multiple doses of vincristine over the course of their treatment.  For some children with cancer, vincristine comprises one half of all chemotherapy administered.”
What makes this shortage more critical than previous ones is that there is no other company to pick up the slack. “We are now faced with a tragic situation,” Unguru told Medscape Medical News. “When Teva stepped down from making vincristine, the tea leaves were present for all to read.”
“It doesn’t take a medical economist to appreciate that with only a single company manufacturing vincristine, a shortage was highly probable, if not inevitable,” he continued. “Instead of uproar and meaningful steps to bolster vincristine supply, instead we got silence.”

However, the current situation appears more related to Pfizer’s manufacturing woes than to Teva. Adamson explained that Teva only had a relatively small share of the market for vincristine, so when the FDA reached out to Pfizer, they didn’t think it would be a challenge to close the gap left by Teva. “But inevitably they ran into a manufacturing problem, and now Teva isn’t available to help fill that gap,” he said.
Jessica Smith, a spokesperson for Pfizer, told Medscape Medical News that “due to a competitor’s outage, we are expediting additional shipments of this critical product over the next few weeks to support three to four times our typical production output. Pfizer is committed to providing this important medicine to patients.”
According to the FDA’s latest report, Pfizer plans on having vincristine available by late October, with an estimated full recovery by December or January, depending on the vial size.
Adamson is hopeful that vincristine will become available in the designated time frame, which will mitigate any significant disruption in care. “But if we had to wait until December or January, then I think it will impact treatment and outcomes,” he said.

Endless Shortages

Drug shortages, unfortunately, have become the “new normal” in US healthcare. While a wide range of drugs used to treat a variety of ailments have been in short supply —on and off and off and on — during the past decade, there has been a chronic stream of shortages of chemotherapeutic agents essential to the treatment of childhood cancers. Most of the drugs used in these regimens are older, generic injectables, and shortages tend to affect them disproportionately. They are more difficult to manufacture but command low prices, a combination which is less than enticing for pharmaceutical companies to embrace.
Almost a decade ago, in 2010, the American Society of Health-System Pharmacists reported that the current shortages were the worst that have ever been experienced in hospital pharmacies, and the shortage of intravenous agents was approaching a national crisis.
Vincristine was one of the drugs gone missing, along with carboplatin, cisplatin, doxorubicin, etoposide, leucovorin, and nitrogen mustard.

At that time, Link, the Stanford oncologist, told Medscape Medical News that “in some of these cases, there are no equivalents, there are no work-arounds.”
In 2012, vincristine was one of two dozen anti-cancer agents that were reported to be in short supply, and again, virtually all of them were older generics. Early last year, vincristine, along with etoposide, once again became scarce.
“The primary difference between the prior vincristine shortage in February 2018 and the current shortage is that now there is now only a single supplier,” said Unguru. “There is no alternative or substitute for vincristine.
Adamson agrees, noting that vincristine is widely used across childhood cancers and a shortage has the potential to cause enormous problems. “The majority of childhood cancers require it and the majority of children with cancer need it,” he said. “It is mind boggling that this is happening in the US, and that doctors may have to make judgment calls or ration it.”

2003 Medicare Payment Reform Part of Problem

As the frequency of cancer drug shortages continued to increase and persist, many studies and experts have weighed in on the causes and possible solutions. But in an open letter written this week to the oncology community, Adamson points out that while “the issues that lead to shortages are complex and involve aging manufacturing facilities overseas and a consolidation of suppliers,” he also feels it fair to point out that Europe is impacted to a far lesser extent compared to the US, and that economic factors play a role in many of the shortages.
The shortages primarily involve generic sterile injectables, he said, and while perhaps not the primary cause, at least some of the issues can be traced to the 2003 Medicare payment reform. This legislation capped the amount of money that could be charged for intravenous drugs at 6% over the “average sales price,” to be adjusted every 6 months. The average sales price this year for a vial of vincristine was about $5, and thus, “the economics of supplying drugs like vincristine are challenging.”
Adamson also notes that a significantly higher amount is spent on generics in Europe, and a lower amount on newer drugs, which is the opposite situation of that in the US. “The bottom line,” he stressed, “is that long-term solutions to this problem involve US Medicare regulations, economic, and other policies.”

Call for Action

Long-term solutions are needed to ensure an uninterrupted drug supply, but it is a multifaceted process. Unguru emphasizes that greater government involvement is essential, as well as offering manufacturers incentives and subsidies to guarantee adequate and affordable access to these lifesaving drugs.

Essential medicines should be viewed in the same manner as public utilities, and reasonable reimbursement needs to be provided for sterile generic injectables. “We need to recognize that shortages are primarily the result of economic considerations and business decisions,” he said, and, accordingly, partner with and leverage the innovative business model of groups like Civica Rx as long as these outfits commit to produce a range of essential and critical infrastructure drugs, including chemotherapeutics.
Civica Rx is a not-for-profit generic drug company that was created in 2018, with a “mission to ensure that essential generic medications are accessible and affordable.” Their plan is either to directly manufacture generic drugs or subcontract manufacturing to reputable contract manufacturing organizations, and the first two drugs on their list are the antibiotics vancomycin and daptomycin.
Unguru also pointed out that beyond the immediate negative effects of shortages, such as the effect on lives and inferior care, there is an “equally concerning, albeit often overlooked downstream effects of shortages —namely, quality.”

“Specifically, there exists a clear link between drug shortages and drug quality — the US healthcare system imports close to 90% of the raw ingredients we rely upon for the drugs we use,” he said. “Many of these ingredients come from countries like China and India and from plants and manufacturing sites that have censured for poor quality and outright data manipulation.”
In an attempt to mitigate the shortages, the FDA has actually imported ingredients for chemotherapy drugs from foreign plants already censured for poor quality. “The end result, inferior and poor quality drugs, were administered to children and adults with cancer who were unaware of this,” Unguru explained.
Adamson issued a “call to action” in his letter, emphasizing that the focus needs to be on solutions for children with cancer right now, along with efforts for longer-term, economic policy solutions. “In the upcoming days and weeks, I am hopeful we can arrive at focused action items for advocacy solutions that have the goal of guaranteeing cancer drug supplies for children in the United States,” he writes.

Some proposals that merit consideration include establishing and maintaining a national stockpile of key cancer drugs used for the treatment of children with cancer and US government purchasing contracts that provide a guaranteed buyer and may help stabilize a fragile market.
But a stopgap measure is needed right now for cancer patients currently undergoing treatment. “There were children who were supposed to receive vincristine this week but who didn’t get it, and some centers have a week’s supply and they are doing the best they can,” said Adamson. “It may be a small number impacted right now but any number is outrageous.”
He emphasized that immediate relief is needed. “We need a strategy that we can implement in the next month, and we also need real solutions.”
https://www.medscape.com/viewarticle/920039#vp_1

Mizuho Starts Bullish Coverage On Health Insurance

Mizuho recommended buying three health insurer stocks as it initiated coverage of the sector Thursday.

The Analyst

Mizuho’s Ann Hynes initiated coverage of Humana Inc. HUM 1.29% with a Buy rating and $316 price target.
Hynes started Cigna Corp. CI 1.28% with a Buy and $180 price target.
Hynes initiated UnitedHealth Group Inc. UNH 0.75% with a Buy and $270 price target.
Hynes initiated Anthem Inc. ANTM 0.14% with a Neutral and $262 price target.

Humana

Medicare Advantage, in which private insurers contract with Medicare to cover care, is the “crown jewel” at the center of Humana’s business, Hynes said in the initiation note. (See her track record here.)
Humana has a 17% share of the Medicare Advantage market, and the plans make up about a quarter of the insurer’s medical membership, the analyst said — three times the industry average.
That’s good for Humana, because Medicare is estimated to be the fastest-growing segment of insurance spending over the next decade, she said.
“We think HUM is nicely leveraged to the underlying industry growth fundamentals.”

Cigna

The key to Cigna’s success is in the merger it closed last year with Express Scripts, the nation’s largest pharmacy benefit manager, Hynes said.
The two companies combined create revenue synergies supporting a 2021 EPS outlook of $21 to $22 and long-term annual EPS growth of more than 10%, the analyst said.
“Coupled with the reduced legislative risk associated with a change in the rebate model, this should set the stock up nicely to close the valuation gap versus peers.”

UnitedHealth

Leading national market share in commercial and government silos; a diverse revenue stream; strength in the company’s Optum business; its sound capital deployment strategy; and expectations for underlying market growth make the stock a good buy, Hynes said.
Business diversification into pharmacy, data and technology and other areas differentiates UnitedHealth, the analyst said.

Anthem

The lone Neutral rating of the group stems from expected headwinds in managed Medicaid, where Anthem is exposed, Hynes said.
While states have increasingly turned to private companies to manage their Medicaid programs, rules for eligibility are subject to the whims of lawmakers and regulators.
That uncertainty over eligibility is what’s keeping Mizuho on the sidelines, she said.
https://www.benzinga.com/general/health-care/19/10/14620261/mizuho-starts-bullish-coverage-on-health-insurance-stocks

Analysts Constructive On Intuitive Surgical Following Solid Quarter

Intuitive Surgical, Inc. ISRG 6.96% shares were sharply higher Friday following strong quarterly results.

The Analysts

Morgan Stanley analyst David Lewis reiterated an Overweight rating and $620 price target for Intuitive Surgical. (See his track record here)
Wells Fargo analyst Larry Biegelsen reiterated an Outperform rating and $620 price target. (See his track record here)

Morgan Stanley: We Remain Very Constructive On Intuitive

Intuitive Surgical’s results were better than expected, thanks to an acceleration in procedures, Lewis said in a note. The strong showing has come despite competitive fears.
Systems average selling price improved sequentially to the highest mark on the year, the analyst noted.
Despite the third-quarter seasonality, placements in Europe recovered. Lewis said with these, all of first-half concerns are virtually resolved.
The analyst expects fourth-quarter procedure growth of 17.5%, which he feels could prove conservative, as it represented a 100 basis-points of momentum deceleration.
Morgan Stanley said it remains very constructive on Intuitive Surgical, as “Phase 1 is still driving significant growth, the company is just scratching the surface on Phase 2, and it is building the foundation for Phase 3.”

Wells Fargo: ‘Solid Quarter Driven by Strong Q3 Results’

The robust third-quarter results were orchestrated by a number of factors, including higher procedure volume growth, systems shipped and ASPs, as well as higher gross margins and a lower effective tax rate, Biegelsen said.
The company raised its procedure volume growth guidance as well gross margin guidance. Wells Fargo raised its 2019 and 2020 estimates.
“Overall, it was a solid quarter and driven by strong Q3 results,” the analyst said.
https://www.benzinga.com/analyst-ratings/analyst-color/19/10/14620292/analysts-constructive-on-intuitive-surgical-following-solid-quarter

First evidence of immune response targeting brain cells in autism

Autism spectrum disorders affect one in 59 American children by age eight. With no known quantitative biological features, autism diagnoses are currently based on expert assessments of behavioral symptoms, including impaired social skills and communication, repetitive behaviors and restricted interests.

In a paper published in Annals of Neurology, Matthew P. Anderson, MD, Ph.D., a physician-scientist at Beth Israel Deaconess Medical Center (BIDMC), and colleagues report the presence of cellular features consistent with an immune response targeting specialized brain cells in more than two thirds of autistic brains analyzed postmortem. These cellular characteristics—not previously observed in autism—lend critical new insight into autism’s origins and could pave the way to improved diagnosis and treatment for people with this disorder.
“While further research is needed, determining the neuropathology of autism is an important first step to understanding both its causes and potential treatment,” said Anderson, who is Chief of Neuropathology in the Department of Pathology at BIDMC and an Associate Professor of Pathology at Harvard Medical School. “Investigators typically aim potential treatments at specific pathologies in brain diseases, such as the tangles and plaques that characterize Alzheimer’s disease and the Lewy bodies seen in Parkinson’s. Until now, we have not had a promising target like that in autism.”
Anderson was examining brains donated to Autism BrainNet, a non-profit tissue bank, when he noticed the presence of perivascular lymphocyte cuffs—an accumulation of immune cells surrounding blood vessels in the brain. He also noted mysterious bubbles or blisters that scientists call blebs accumulating around these cuffed blood vessels. Anderson and colleagues subsequently found these blebs contained debris from a subset of brain cells called astrocytes.
Not previously linked to autism, perivascular lymphocyte cuffing is a well-known indicator of chronic inflammation in the brain. Lymphocyte cuffs in the brain are telltale signs of viral infections or autoimmune disorders. But the pattern Anderson observed did not match any previously documented infection or autoimmune disorder of the brain. In the brains Anderson examined, the cuffs were subtle but distinct. “I’ve seen enough brains to know you shouldn’t see that,” he said.
To find out if the perivascular lymphocyte cuffs in this sample of autistic brains were linked to autism spectrum disorder, Anderson and colleagues compared 25 brains from donors diagnosed with the disorder to 30 brains from neurotypical brain donors. These neurotypical control cases were selected to approximate the age range and medical histories of the autism group. Present in more than two-thirds of the autistic brains, perivascular lymphocyte cuffing significantly surpassed that in the control cases.
In a second set of experiments, Anderson’s team determined that the perivascular cuffs were made up of killer T-cells, a subset of immune cells responsible for attacking and killing damaged, infected or cancerous cells or normal cells in autoimmune diseases. With no apparent evidence of viruses known to infect the brain, the presence of these tissue-attacking immune cells throughout the autistic brains suggested one of two scenarios, explained Anderson. Either the T-cells are reacting normally to a pathogen such as a virus, or they are reacting abnormally to normal tissue—the definition of an autoimmune disorder.
“With this new research, we haven’t proved causality, but this is one clue in support of the idea that autism might be an autoimmune disorder, just like multiple sclerosis is thought to be,” said Anderson.
In future research, Anderson and colleagues will work to develop a genetically-engineered animal model of this T-lymphocyte cuffing neuropathology in which to conduct studies to determine mechanism as well as cause and effect. The team also plans to search for biomarkers—a measurable diagnostic signature in patients’ urine or blood or other tissues—that may be used to identify these newly-documented cellular features in living patients. In turn, these biomarkers could one day assist clinicians in the diagnosis and long-term care of people with autism.

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Explore further

When your brain won’t hang up: Sustained connections associated with symptoms of autism

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More information: Marcello M. DiStasio et al, T‐lymphocytes and Cytotoxic Astrocyte Blebs Correlate Across Autism Brains, Annals of Neurology (2019). DOI: 10.1002/ana.25610

https://medicalxpress.com/news/2019-10-evidence-immune-response-brain-cells.html

Why respiratory infections are more deadly in those with diabetes

Since the Middle East respiratory syndrome coronavirus (MERS-CoV) first emerged in Saudi Arabia in 2012, there have been more than 2,400 confirmed cases of the infection, resulting in greater than 800 deaths—an alarming fatality rate of 35 percent. For this reason, researchers have been eager to identify any risk factors that contribute to the development of severe or lethal disease. Current clinical evidence points to diabetes as a major risk factor in addition to other comorbidities including kidney disease, heart disease, and lung disease.

Researchers from the University of Maryland School of Medicine (UMSOM) and the Johns Hopkins University School of Medicine have demonstrated in a new study, published earlier this week in the Journal of Clinical Investigation Insights, how diabetes contributes to mortality from MERS-CoV infections, and the finding could shed light on why other respiratory illnesses like the flu or pneumonia might strike those with diabetes more severely.
They investigated the connection between diabetes and MERS-CoV in a mouse model and discovered that although the virus did not replicate more readily in the diabetic mice compared to the healthy controls, the diabetic mice exhibited a delayed and prolonged inflammatory response in the lung. Diabetic mice had lower levels of inflammatory cytokines and fewer inflammatory macrophages and T cells. This indicates that the increased severity of MERS-CoV infection in patients with diabetes was likely due to a malfunction in the body’s response to infection.
“Understanding how diabetes contributes to disease severity following MERS-CoV infection in this context is critical,” said Matthew Frieman, Ph.D., associate professor of microbiology and immunology who is the corresponding author of the study. “Our next step is to determine what drives the altered immune response in diabetics and how to reverse those effects with therapeutics for treatment of patients.”
Follow up research could also explore whether health care providers should double their efforts to manage and stabilize glucose levels in patients with diabetes experiencing a dangerous respiratory infection and whether better management would help mitigate the effects of these infections.
“This is an important finding for patients with diabetes and physicians who treat them,” said UMSOM Dean E. Albert Reece, MD, Ph.D., MBA, who is also the Executive Vice President for Medical Affairs, University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor. “We have long known that diabetic patients have worse outcomes when they get a serious infectious disease, but this new insight on immune function could pave the way for better treatments.”

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Explore further

Researchers combine MERS and rabies viruses to create innovative 2-for-1 vaccine

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More information: Kirsten A. Kulcsar et al, Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection, JCI Insight (2019). DOI: 10.1172/jci.insight.131774

https://medicalxpress.com/news/2019-10-respiratory-infections-deadly-diabetes.html

Beyond Football: Concussions Occur in All High School Sports

Concussions among high school athletes occur across a wide range of contact and limited-contact or noncontact sports, a study published online October 14 in Pediatrics has shown.
Most of the injuries were the result of contact with another person. However, a substantial proportion were caused by contact with either the surface or equipment, according to Zachary Y. Kerr, PhD, MPH, from the University of North Carolina at Chapel Hill, and colleagues.
Because of the public health significance of high school sports–related concussions, ongoing evaluation of the incidence of these concussions is critical to understanding temporal patterns in concussion rates.
With this in mind, the researchers studied the epidemiology of concussions in 20 high school sports during 5 academic years (2013–2014 to 2017–2018).

Boys’ sports included in the study were football, wrestling, soccer, basketball, baseball, cross country, ice hockey, lacrosse, swimming and diving, and track and field. Girls’ sports were volleyball, soccer, basketball, softball, cross country, field hockey, lacrosse, swimming and diving, and track and field. Coed cheerleading was also included.
The investigators examined injury surveillance data for the study period and identified 9542 concussions across the 20 sports.
They defined concussion as injuries that occurred during an organized practice or competition, that required medical attention, and that were diagnosed as concussions.
The researchers calculated concussion rates per athlete exposure (AE) to a practice or competition in particular sports.

Concussions were reported in all 20 sports.
The highest overall concussion rates occurred in boys’ football (10.4 per 10,000 AEs), girls’ soccer (8.19 per 10,000 AEs), and boys’ ice hockey (7.69 per 10,000 AEs).
The lowest rates were in boys’ cross country (0.06 per 10,000 AEs), girls’ cross country (0.13 per 10,000 AEs), and boys’ track and field (0.17 per 10,000 AEs).
When the researchers investigated the mechanism by which the concussions occurred, they found that 62.3% resulted from contact with another person. Most of the remainder were caused by contact with the surface (17.5%) or equipment (15.8%).

During the 5-year study period, football concussion rates rose in association with competitions (33.19 to 39.07 per 10,000 AEs) but dropped in association with practice (5.47 to 4.44 per 10,000 AEs).
Most concussions across all 20 sports occurred during competitions (63.7%); cheerleading was the only one in which the concussion rate was higher during practice (3.60 vs 2.22 per 10,000 AEs).
This is important, the authors note, because not all states recognize cheerleading as a sport. As such, high school cheer squads may practice in less-than-ideal locations, they say, and participants may receive less medical oversight and coaching support than with other sports.
Data for sex-comparable sports showed higher concussion rates for girls than for boys (3.35 vs 1.51 per 10,000 AEs; injury rate ratio [IRR], 2.22; 95% confidence interval [CI], 2.07 – 2.39). Among these sports, girls also had more recurrent concussions (9.3% vs 6.4%; IRR, 1.44; 95% CI, 1.11 – 1.88).
Potential reasons for such differences between the sexes within the same sport have been reported in the literature, the authors write. These include differences in disclosure of injuries, neck musculature, blood flow to the brain, and hormonal regulation.
Concussions were more commonly reported in the latter halves of competitions and practices across numerous sports.
Understanding the epidemiology of concussion and its prevention is critical, especially in light of the rising number of high school athletes and ongoing changes in the field of concussion management.
Kerr and colleagues therefore believe their study results will benefit clinicians by helping to guide future concussion prevention and research efforts.
“Future research should continue to monitor trends and examine the effect of prevention strategies,” they stress. They highlight the need for pediatricians to provide “updated information to youth athletes to help them and their families understand the risk of concussion in their sports of interest.”
The study was supported in part by the Centers for Disease Control and Prevention and by research funding contributions of the National Federation of High School Associations, the National Operating Committee on Standards for Athletic Equipment, DonJoy Orthotics, and EyeBlack. The authors have disclosed no relevant financial relationships.
Pediatrics. Published online October 14, 2019. Abstract
https://www.medscape.com/viewarticle/920027