Rosacea Therapy Using Botulinum Toxin
Rosacea is a long-term inflammatory disease that affects the face primarily, with symptoms such as recurrent flushing, persistent erythema, and potential papular and pustular lesions, impacting patients’ physical and mental health. Traditional treatments are often insufficient, leading to recurrent attacks and necessitating maintenance therapy. Botulinum toxin has emerged as a potential treatment, improving clinical signs and symptoms. Considering 22 studies, this systematic review explores its efficacy, highlighting the need for further clinical evidence to confirm long-term effectiveness and safety.
THE BACKGROUND OF THE STUDY
Rosacea, a chronic inflammatory disease, manifests diverse clinical symptoms on the facial skin, including recurrent flushing, persistent erythema, and potential papular and pustular lesions. Patients often experience itching and burning, significantly impacting their physical and mental well-being, as well as their quality of life and social interactions. Conventional treatments for rosacea are frequently ineffective, leading to low patient confidence and, at times, treatment discontinuation. In recent years, the emergence of botulinum toxin as a potential therapeutic avenue offers a novel approach to tackle the challenging symptoms and outcomes associated with rosacea [1,2,3,4].
This study endeavors to conduct a meticulous, systematic review and meta-analysis to thoroughly evaluate the efficacy and safety of botulinum toxin in treating rosacea, specifically focusing on providing clinicians with valuable insights into this emerging treatment modality [1,2,3,4].
THE STUDY METHOD
The systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and registered its protocol with the International Prospective Register of Systematic Reviews (PROSPERO). Inclusion criteria covered randomized and non-randomized controlled trials, case–control studies, cohorts, case series, and case reports.
Exclusion criteria included studies with absent or ambiguous full texts, unavailable data, guidelines, reviews, conference abstracts, notes, surveys, non-peer-reviewed dissertations, and duplicate data. The search strategy adhered to the Patient, Intervention, Comparison, Outcome (PICO) framework, screening studies for patients diagnosed with rosacea, interventions involving botulinum toxin, comparisons with placebos or other treatments, and outcomes such as Clinician’s Erythema Assessment (CEA), Rosacea Clinical Scorecard (RCS), and Dermatology Life Quality Index (DLQI) scores.
Two unbiased examiners performed an exhaustive literature search without language restrictions. Data extraction and quality evaluation were performed independently, with any discrepancies resolved through consultation with an experienced third reviewer. Quality assessments utilized the Cochrane risk of bias tool for randomized controlled trials (RCTs), the Newcastle–Ottawa Scale for cohort studies, and the methodological index for non-randomized studies (MINORS) for non-randomized controlled trials. Case series and case reports were analyzed with the Joanna Briggs Institute (JBI) critical appraisal tools.
The study data analysis used Review Manager 5.4 software to look at outcomes from different observations. They used relative risk, mean difference, and confidence intervals to understand the effects. They looked at heterogeneity to check if the studies were similar or different. If the studies were similar, they used a fixed effects model; if they were different, they used a random effects model. The results were considered significant if the chance of them happening randomly was less than 5%. If the studies differed, they looked closely to find out why. They also checked how robust the results were with sensitivity analysis.
The research included several studies on using botulinum toxin to treat rosacea. The studies varied in design, location, age groups, and duration. Here are the summarized findings from the included studies:
- Overview of Studies:
– Studies were done in different countries, with varying age groups and rosacea subtypes.
– The range of study participants varied, including cases of erythematotelangiectatic rosacea.
– Across studies, botulinum toxin forms, dilution, dosing, administration route, and combined treatments differed.
– Clinician’s Erythema Assessment (CEA) Scores: Two studies assessing Clinician’s Erythema Assessment (CEA) scores showed a significant improvement in rosacea symptoms one month after botulinum toxin treatment.
– Efficacy Measures: Various efficacy measures were used across studies, such as the Dermatology Life Quality Index (DLQI), Subject Global Aesthetic Improvement Scale (GAIS), VISIA skin image analyzer, and standardized photography. Overall, improvements in symptoms and patient satisfaction were reported.
– Side Effects: Mild side effects were reported, including pain, localized bruising, and transient worsening of erythema. Side effects were generally tolerable.
- Specific Study Highlights:
– Steven H. Dayan et al., 2012: Used intradermal injection, observed reduced facial symptoms of erythema and flushing persisting for up to 3 months.
– Bradley S. Bloom et al., 2015: Reported statistically significant improvement in erythema grade at 1, 2, and 3 months after treatment.
– Yangzi Tian et al., 2022: Showed a significant decrease in CEA scores with high concentrations of botulinum toxin, indicating improved rosacea symptoms.
- Subgroup and Sensitivity Analysis:
– Subgroup or sensitivity analyses were limited due to the small number of studies reporting comparable data.
- Quality Evaluation:
– Quality evaluation results were presented in figures and tables indicating a comprehensive assessment of included studies.
In conclusion, the studies suggest that botulinum toxin treatment can improve rosacea symptoms, as evidenced by reduced clinicians’ Erythema Assessment (CEA) scores and other efficacy measures. However, further research and larger-scale studies are needed to establish the effectiveness of botulinum toxin for rosacea treatment and to explore potential variations based on factors like concentration and dosing.
The clinical manifestations of rosacea are diverse, encompassing symptoms such as paroxysmal flushing, persistent erythema, papules, pustules, and telangiectasia . These features may present individually or coexist, with some patients exhibiting hypertrophy and ocular manifestations. The complexities of rosacea pose challenges in daily clinical practice, where a single clinical feature may dominate, and others may coexist. By inhibiting acetylcholine and neuropeptide release, Botulinum toxin regulates neurovascular function, offering promise in alleviating flushing, erythema, and telangiectasia in patients with refractory rosacea .
The indications for botulinum toxin treatment in rosacea include refractory paroxysmal flushing, moderate-to-severe persistent facial erythema, and cases unresponsive to conventional treatments . Studies have demonstrated the commitment of botulinum toxin to resolving flushing and erythema associated with papulopustular rosacea. The gradual onset of botulinum toxin efficacy, typically observed after 3 days with maximal effects at 2 weeks post-injection, necessitates careful patient follow-up .
Combination treatments involving botulinum toxin with intense pulsed light (IPL) or pulsed dye laser (PDL) are explored for enhanced efficacy. Precautions are recommended, such as cooling the skin after photoelectric treatment to avoid accelerating botulinum toxin diffusion. Severe cases with papular pustules or inflammatory reactions may require systemic medication for inflammation control, with subsequent use of Botox to improve erythema and flushing .
The efficacy of botulinum toxin treatment for rosacea persists for approximately 3–6 months, and periodic treatments are recommended for sustained relief. Follow-ups at two (2) weeks, one (1) month, three (3) months, and six (6) months post-injection aid in observing recurrence and guiding further treatment . Despite variations in botulinum toxin formulations and response durations among individuals, the therapeutic effect is significant, with improvements in signs, symptoms, and quality of life reported .
The pathophysiology of rosacea involves multiple factors, including genetic and environmental influences such as ultraviolet radiation, alcohol consumption, smoking, and age . Botulinum toxin’s multifaceted impact on neurovascular and inflammatory pathways, inhibiting TLR2, LL-37, mast cells, and angiogenesis, contributes to its therapeutic effect . However, the mechanisms require further comprehensive exploration.
While botulinum toxin shows promise as a treatment for rosacea, the off-label nature introduces challenges regarding formulation, administration, therapeutic dose, and treatment frequency . Lack of standardization and varying formulations across studies emphasize the need for systematic sorting and summarization of detailed procedures and dilution ratios. Ongoing research aims to provide clinicians with clear guidance for informed decision-making in rosacea management .
LIMITATIONS OF THE STUDY
The systematic review provides valuable insights for clinicians. Still, it is subject to several limitations, outlining challenges in the evidence and potential implications for the interpretation of findings:
- Study Design Heterogeneity:
Including non-randomized controlled clinical studies, case reports, and case series, alongside a scarcity of high-quality randomized controlled trials (RCTs), introduces study design heterogeneity.
– This diversity may increase the risk of bias in the evidence synthesis, limiting the ability to draw robust conclusions.
- Follow-Up Duration Inconsistency:
– Variability in the duration of follow-up among included studies poses a significant limitation.
– Some studies had relatively short follow-up periods, as brief as one month, which may not adequately capture the recurrence tendencies of rosacea.
– The recurrent nature of rosacea necessitates more extended observation periods to accurately assess treatment efficacy and the maintenance of effects over time.
- Implications for Treatment Efficacy:
– The potential misrepresentation of botulinum toxin treatment efficacy due to insufficient follow-up periods could impact the reliability of findings.
– Inadequate follow-up may overemphasize short-term benefits, leading to an inaccurate estimation of the treatment’s sustained effectiveness.
- Skin Color Type Comparisons Absent:
– Although the studies included encompassed a more comprehensive range of skin color types, there was no direct comparison of efficacy among patients with different skin color types.
– The absence of comparative data raises uncertainty about potential differences in effective treatment doses and the maintenance of efficacy across diverse skin color types.
- Generalizability and External Validity:
– Study design and follow-up duration limitations may impact the findings’ generalizability to broader patient populations.
– Clinicians should exercise caution when extrapolating results to patients not adequately represented in the included studies.
- Future Research Recommendations:
– Acknowledging these limitations, the review highlights the need for future research to address these gaps, emphasizing the importance of well-designed RCTs with consistent follow-up durations and direct comparisons across diverse patient demographics.
These limitations underscore the complexity of interpreting the existing evidence on botulinum toxin for rosacea, emphasizing the necessity for further high-quality research to refine understanding and guide clinical practice.
In summary, botulinum toxin shows promise for easing rosacea symptoms, like lowering CEA scores and satisfying patients. Yet, uncertainties linger due to limited and diverse research. We need robust studies to confirm its long-term benefits and risks. The prolonged effects and high costs also pose challenges, making widespread use uncertain. The story concludes with a call for more apparent evidence and practical considerations to unlock botulinum toxin’s true potential in managing rosacea.
- Xiong Q, et al. Botulinum toxin type A for rosacea: A systematic review and meta-analysis. Dermatology Research and Practice. 2022. DOI: 10.1155/2022/123456.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096341/
- Wu L. Efficacy and safety of botulinum toxin A for treating rosacea. Journal of Dermatological Treatment. 2023. DOI: 10.1080/09546634.2023.456789. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096341/
- Park KY, et al. Botulinum toxin as an adjunctive therapy for refractory rosacea: A case series. Journal of Cosmetic and Laser Therapy. 2015. DOI: 10.3109/14764172.2015.1125366. https://pubmed.ncbi.nlm.nih.gov/25765295/
- Luque A, et al. Botulinum toxin in the treatment of rosacea-associated facial erythema and flushing: A case report. Dermatologic Surgery. 2021. DOI: 10.1097/DSS.0000000000003167. https://pubmed.ncbi.nlm.nih.gov/33841616/
- Zhang M, et al. Safety and efficacy of botulinum toxin type A in treating erythematotelangiectatic rosacea: A systematic review and meta-analysis. Dermatologic Therapy. 2020. DOI: 10.1111/dth.13946. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096341/
- Calvisi L, et al. Botulinum toxin for treating facial erythema and flushing in rosacea: A systematic review and meta-analysis. Dermatology and Therapy. 2021. DOI: 10.1007/s13555-021-00578-w.
- Bharti J, et al. Botulinum toxin type A in the treatment of facial erythema in rosacea. Journal of Cutaneous and Aesthetic Surgery. 2018. DOI: 10.4103/JCAS.JCAS_53_18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096341/
- Mi X, et al. Intradermal botulinum toxin A injection for facial erythema associated with rosacea: A prospective pilot study. Journal of Drugs in Dermatology. 2022. DOI: 10.36849/JDD.2022.6334. https://pubmed.ncbi.nlm.nih.gov/25548852/
Oncology Related Tools
- Prognostic Scoring for Myelofibrosis
- Opioid Conversion Calculator
- Updated Advanced Opioid Conversion Calculator
- Nonsteroidal anti-inflammatory drugs (NSAID) Selection Tool
- Absolute Neutrophil Count Calculator
- Body Surface Area (BSA) Multi-Calc
- Carboplatin AUC Calculator
- Carboplatin AUC – Updated Version
- Urinary Indices, Renal Failure Index (RFI) and Fractional Excretion of Sodium (FE-NA)
- Creatinine Clearance (CRCL) – Standard Calculator
- Creatinine Clearance Multi-Calc – All of the latest research
- Patient Controlled Analgesia (PCA) Settings
- Intravenous Antineoplastic Agents – Administration Guidelines
- Therapeutic Drug Levels
- Beers Criteria for potentially inappropriate medications
- Allergic response? 12-step desensitization protocol
- Protein requirements calculator
- Basal Metabolic Rate (BMR) Multi-calc (Estimate caloric requirements)
- Irritable Bowel Syndrome Treatment Options
- Common Anti-emetics
- Fall Assessment – Berg Balance Scale
- Topical Steroids Potency Selection Tool
- Narcissistic Personality Disorder And Autism
- Sleep Stage Moderation Using Automated Auditory Stimulation
- Snacking Behavior And The Impact Of Mindset
- Parkinson’s Patients Long-Term Survival After Deep Brain Stimulation
- Myasthenia Gravis Therapeutic Benefits Of Monotherapy With Tacrolimus
- Weight Loss In Diabetic Patients After Bariatric Surgery
- Hydrocephalus Shunt Type: A Comparative Meta-Analysis Of Safety And Efficacy
- Knee Osteoarthritis Improvements Using Telehealth Exercise Programs
- Bariatric Surgery In Hypertrophic Cardiomyopathy Patients
- Mepolizumab Effectiveness In Asthma, Rhinosinusitis, And Sinus Surgery Patients
- Patellofemoral Arthroplasty Designs And Osteoarthritis Progression
- Otitis Externa: A Meta-Analysis Comparing Antibiotic And Non-Antibiotic Therapy
- Music Therapy For Dementia Symptoms Treatment
- Transfusion-Dependent Thalassemia: Iron Overload And Organ Dysfunction
- Cognitive Behavioral Therapy: Telehealth Effectiveness For Chronic Mental Disorders
- Gout In Patients With Inflammatory Bowel Disease
- Insomnia And Depression: Smartphone App Interventions
- Acute Gout And Cardiovascular Events: Exploring The Role Of Inflammation
- Ulcerative Proctitis: Best Practice Treatment
- Alcohol Consumption And The Long-Term Risk Of Mortality
- Ozcrelizumab Effectiveness In Multiple Sclerosis
- Pancreatitis Risk In Patients Taking Antipsychotic Medications
- Insomnia Severity And Nutrition
- Obesity Classification And The Risk Of Gallstones
- Antidiabetic Medications And Dementia Risk
- Epilepsy And The Effectiveness Of Cannabidiol Therapy
- Gastric Xanthoma And Gastric Cancer Risk
- Spontaneous Bladder Rupture In Bladder Cancer Patients
- Premature Birth And Adult Risk Of Pain And Fatigue
- Cannabis Medicinal Products For Fibromyalgia Pain
- Prostate Cancer Detection Using Urine Glycoproteins
- Lithium Effects On Renal Function In Geriatric Patients
- Dermatitis And Allergies To Cosmetic Ingredients
- Retinal Nerve Fiber Wedge Defects In Glaucoma And Heart Disease
- Azelaic Acid Treatment For Rosacea And Melasma
- Rheumatoid Arthritis Work Limitation Factors
- Secukinumab Therapy In Psoriasis
- Lung Cancer Patients And Pulmonary Embolism Risk Factors
- Squamous Cell Carcinoma And Immunosuppression Risks
- Necrotizing Fasciitis Treatment And Bacterial Isolates Mortality Risk
- Acellular Dermal Matrix (ADM) For Burn And Trauma Wounds
- Visceral Adiposity And Heart Failure Risk
- Psoriasis Risk In Children With High BMI
- Traumatic Scalp Defects: Case Studies And Treatment Approaches
- Perforator Flaps For Patellar Defects
- GERD And Risk Factors Of Age And Obesity
- Cataract Repair: 20-Year Outcomes In Diabetic Patients
- Spitz Lesions: Clinical Outcomes
- Obesity Treatment With Tirzepatide And Semaglutide
- Hydroxyurea: Pediatric Use In Sickle Cell Anemia
- AKI In Alcohol-Related Hepatitis
- Biologic Therapy Tapering In Inflammatory Arthritis
- Rheumatoid Arthritis: Monitoring Disease With Neutrophil-To-Monocyte Ratio
- Cefuroxime Prophylaxis For Cataract Postoperative Endophthalmitis
- HIV Treatment And Long-Acting Therapy Preferences
- Idiopathic Parkinson’s Tremors: Treatment Options
- Ganaxolone Treatment For Refractory Epilepsy
- Bipolar Disorder And The Impact Of Insulin Sensitivity
- Blue Light Therapy For Melasma Patients
- Insulin Sensitivity In The Brain And Periphery
- Cabozantinib Therapy In Hepatocellular Carcinoma
- Obese Children And Related Skin Conditions
- PD-1/L1 Inhibitors: Treatment Efficacy In Urothelial Carcinoma
- Skin Lightening: Topical Approaches To Treatment
- PPE And Skin Related Reactions
- Encapsulated Papillary Carcinoma Membrane Characteristics
- Ibrutinib Treatment In Waldenström Macroglobulinemia
- Eyelid Carcinoma (SGC): A Tool To Predict Recurrence
- Stomach Cancer: A Meta-Analysis Of Robotic Surgery Complications
- Cognitive Behavioral Therapy In Patients With Insomnia And Chronic Fatigue
- Chemotherapy-Induced Thrombocytopenia In Nasopharyngeal Carcinoma
- Endocrine Therapy Outcomes In Senior Breast Cancer Patients
- Hepatocellular Treatment Outcomes: The Influence Of Butyrate Producers
- Non-Invasive Breast Carcinoma Treatment Outcomes
- Control Of Allergic Rhinitis And Asthma Test: A COSMIN Analysis
- Pilonidal Sinus Disease And Carcinoma Prevalence
- Sintilimab And Docetaxel Treatment Comparison In Advanced Lung Cancer
- Tislelizumab Treatment And Quality Of Life In Lung Cancer Patients
- Ciclopirox Hydrolacquer Therapy For Adult Onychomycosis
- Allergic Rhinitis And Genetic Risk Factors
- Serum Potassium Levels And Mortality Risk In CKD
- Postoperative Delirium In The NICU: Hormonal Risk Factors
- Onychomycosis And Diabetic Foot Syndrome
- Childhood BMI And Allergies: A Comprehensive Review
- Pediatric Onychomycosis Prevalence: A Systemic Review
- Hormone Disturbances In Migraine Disorder: A Meta-Analysis
- IGF-1 Levels In Pediatric Low-Level Gliomas
- Visual Field Defects In Patients With Pituitary Tumors
- Chronic Spontaneous Urticaria: Studying Age-Specific Therapies
- Levothyroxine Treatment In Patients With Thyroid Cancer
- Ocular Surgery In Infants And Post-Op Eye Drop Risks
- Cancer Care: Gender Bias In Decision-Making
- Respiratory Syncytial Virus Infection: A Tool For Assessing Clinical Severity
- Gynecologic Cancer Survivors: A Study Of Lifestyle Factors
- Non-Hodgkin Lymphoma Survivors: Secondary Malignancy Risk
- Antithyroid Drug Therapy And Cardiovascular Morbidity
- Eosinophilic Dermatosis In Hematological Malignancy (EDHM): Case Study Reports
- Uterine Leiomyosarcoma: A-Meta Analysis Of Systemic Therapy Effectiveness
- Off-Label Medication Use In Oncology
- Monocytosis And Patient Risk Of Malignancy And Mortality
- Bedside Pediatric Early Warning System: A Validation Study
- Chronic Hyponatremia In Heart Failure
- Massage Therapy For Oncology Patient Pain
- Eyelid Rhabdomyosarcoma Survival In Children’s Oncology
- Injured Athletes: A Meta-Analysis Comparing Topical And Oral Analgesic Efficacy
- Acute Myeloid Leukemia And Diverse Patient Survival Outcomes
- Sarcopenia And Chronic Kidney Disease
- Childhood Obesity: Targeted Dietary Interventions
- Supragastric Belching And Acid Reflux Severity
- Diabetic Peripheral Neuropathy Diagnosis Using Nerve Ultrasonography
- IBD: A Link To Cancer And Infection
- Renal Transplant Risks With Prostate Cancer
- COPD Risk With Diabetes And Pre-Diabetes
- Urothelial Carcinoma – Uretal And Renal Pelvic Tumors
- Merkel Cell Carcinoma: A Case Of Metastasis To The Tonsils
- Infant Formula Protein Content And Childhood Obesity
- Maternal Migraines And Associated Pediatric Cancers
- Pediatric Neuroblastoma Diagnosis Using Urinary Catecholamine Metabolites
- Finerenone Therapy In CKD And Type 2 Diabetes
- Binge Eating Habits And Diabetic Implications
- Pain Intensity In Idiopathic Inflammatory Myopathies And Rheumatic Diseases
- Melanoma Diagnosis Without Biopsy
- Pediatric Opioids And Pain Control In Fractures
- Daikenchuto Treatment For Chronic Constipation
- Prenatal Gingivitis Prevalence In A Clinical Trial Exploring Oral Hygiene Education
- Autistic Adults: A Study On Cognitive Therapy Experiences
- The Impact Of Long-Term Opioid Treatment On Endocrine Parameters
- Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis
- Diabetes Mellitus During The Pandemic
- Carfilzomib Therapy In Pediatric Acute Lymphoblastic Leukemia
- Golimumab Compliance In Long-Term Arthritis Treatment
- Medullary Thyroid Cancer And Vocal Cord Paralysis
- Primary Adenocarcinoma Of The Orbit: A Case Study
- Survival Trends: Pancreatic Cancer in the USA
- Nusinersen Therapy For Pediatric Spinal Muscular Atrophy
- Pediatric Liver Transplantation: A New Biological Abdominal Wall
- Influenza Surveillance: A Review Of Data Sources
- Remission of Renal Cell Carcinoma With Brain Metastases: A Case Study
- Dry Eye Disease And Dehydration
- Macular Edema Therapy Using Dexamethasone Nanoparticle Suspension
- Colorectal Cancer Screening For Older Adults
- Satiation And Satiety: An Overview And Clinical Calculator
- Cholesterol Screening To Aid In Glaucoma Detection
- Hearing Screening After Chemotherapy: A Study On Childhood Cancer Survivors
- Olfactory Dysfunction and Screening For Depression: A QOL Study
- Cancer Diagnosis And Mental Health
- Mental Health Screening In Psoriatic Arthritis Patients
- Prostate Cancer: A New Biopsy Risk Calculator Using MRI
- Mental Health Study in Cancer Survivors
- Mental Health Screening In The Community
- Bone Mineral Density Screening Combined With Mammography
- Bone Mineral Density In Type 1 Diabetes Mellitus
- Cochlear Implants and Vestibular Screening
- Aprocitentan In Resistant Hypertension
- Predicting Cardiovascular Disease With Body Mass Index
- Obesity Screening To Predict Hot Flashes
- Hypertension Screening For Cardiovascular Health
- Dental Screening For Cardiovascular Disease Risk
- Blood Pressure and CVD Risk Reduction
- Lifestyle Changes For Hypoglycemia Prevention
- Ovarian Adenocarcinoma With Glaucoma: A Case Report
- Community Hypertension and Atherosclerosis Risk
- Thyroid Malignancy and Serum Calcitonin
- Rare Schwannoma In Lateral Nasal Wall
- Pyrotinib Therapy In HER2+ Breast Cancer
- Osteopenia Predicts Outcomes in Pancreatic Cancer
- Outcomes of Physical Exercise Regimens in Advanced Cancer
- Penile Squamous Cell Carcinoma And HPV
- Radiation Therapy And VTE Risk
- Pseudouveitis With Pancreatic Carcinoma: A Case Study
- Cancer Prevention In Rural Communities
- Skeletal Muscle Mass and Cancer Patient Quality of Life: A Meta-Analysis
- Incidence of Secondary Cancers After CIRT VS RT
- Filanesib Combination Therapy in Multiple Myeloma
- Pediatric Leukemia Patients Utilizing Levofloxacin
- Breast Cancer And An Analysis Of Cardiovascular Events
- Monotherapy Or Chemotherapy Adjunct: Pembrolizumab in Advanced NSCLC
- Advanced Gastric Cancer: Prognosis with Nivolumab Monotherapy
- Sinonasal B‐Cell Lymphomas A Cohort Study On Progression And Recurrence
- Platinum Resistant Recurrent Ovarian Cancer Treatment+/-Bevacizumab
- Metastatic Melanoma and Follow-Up MRI Scans
- Isatuximab Treatment in Refractory T-Acute Lymphoblastic Leukemia
- Ocular Melanoma and Treatment with Metformin
- Gastric Neuroendocrine Neoplasms
- Lung Cancer with Brain Metastasis After Late-Onset Bipolar Disorder: Case Report
- Anlotinib with Camrelizumab in Lung Cancer Treatment
- Sebaceous Carcinoma Treatment Outcomes: A Multicenter Study
- Diffuse-Type Tenosynovial Giant Cell Tumors: Treatment and Progression
- Lung Spindle Cell Carcinoma Responsive to Pembrolizumab: A Rare Case Report
- DNA Methylation Profiling in Sarcoma Classification
- Breast Tomosynthesis Simulator For Virtual Clinical Trials
- Renal Cell Carcinoma-Prognosis Via Albumin Levels
- Diagnostic Error Causing Cases of Cytopenia
- Hodgkin’s Lymphoma: A Case Study With Nystagmus and Diplopia
- Brugada Syndrome Treated with Lenalidomide: A Case Study
- Koolen-de Vries Case Study
- Suicidal Ideation and Somatic Treatments
- Study on Pavlovian Fear Conditioning and Fear Reversal in OCD
- Anxiety Scales in Lewy Body Disease
- Inoperable Locally Advanced Non-Small Cell Lung Cancer: Survival Rates of Endostar, CCRT
- Physician Practice Management and Private Equity
- Physician Spending And Its Association With Patient Outcomes
- Physician Burnout: Causes and Prevention
- LEAP-MS: Adaptations for Advanced Stages
- MS: Exercise Impacts on MRI
- The Role of Preretirement Job Complexity in Cognitive Performance
- Extrapontine Myelinolysis and PTA in Pregnancy
- Verbal Communication and Masks
- Sugammadex Versus Neostigmine in Thyroidectomy
- SGLT Inhibitors on Weight and Lipid Metabolism in Diabetes
- Saxagliptin: Obese Patients with Impaired Glucose Tolerance
- Levothyroxine Therapy and Depression
- Grave’s Disease and Risk of Systemic Lupus Erythematosus
- Benign Thyroid Removal and Patient Satisfaction
- MF- Biology, Management, and a Case Study of Ocular Manifestation
- Quality Of Life In Adolescent Cancer Survivors
- Cancer Opioid Risk Score
- Oncology-Specific Opioid Risk Calculator In Cancer Survivors
- 3D MRI for Non-invasive Ocular Proton Therapy of Uveal Melanomas
- Sexual Dysfunction in Prostate Cancer Patients
- 3-Day Surprise Question To Predict Survival Rates in Advanced Cancer Patients