Monday, April 28, 2014
Higher Muscle Mass Linked with Better Physical Function, Quality of Life in Dialysis Patients
Among 105 maintenance dialysis patients, higher BMI at study initiation was linked with shorter 6-minute walking distances when first measured, and again after 6 months and 12 months. Results of the CJASN study were similar for waist circumference and intra-abdominal fat. On the other hand, higher levels of mid-thigh muscle (which indicates higher muscle mass) were linked with longer 6-minute walking distances. After adjusting for BMI, increases in mid-thigh muscle were also strongly linked with higher physical and mental health scores at the start of the study, but only weakly so at later times.
Greater Risk of Hip Fracture Associated with Hemodialysis vs. Peritoneal Dialysis
Patients on hemodialysis were 52% more likely to experience hip fractures than patients on peritoneal dialysis in a recent analysis that included 28,048 hemodialysis patients and 3506 peritoneal dialysis patients. The incidence rate of hip fracture was 13.60 per 1000 patient-years in the hemodialysis group and 6.25 per 1000 patient-years in the peritoneal dialysis group. Dialysis modality, sex, age, presence of cardiovascular disease, diabetes, medication with antiepileptic drugs, diuretics, steroids, and vitamin D had statistically significant associations with hip fracture. The findings are published in Osteoporosis International.
Marijuana use may be linked to cardiovascular risks.
The Los Angeles Times (4/24, Healy) “Science Now” blog reports that in the Journal of the American Heart Association, researchers “warned that ‘clinical evidence ... suggests the potential for serious cardiovascular risks associated with marijuana use.’”
The Huffington Post (4/24, Chan) reports that the study’s “findings are based on data from the addictovigilance system in France, which includes cardiovascular-related complications associated with marijuana use between 2006 and 2010.” The investigators found that “during this time period, there were 1,979 marijuana-related reports to the addictovigilance network, 35 of which had to do specifically with cardiovascular-related complications.”
On its website, FOX News (4/23) reports that “the cases...included 20 heart attacks and nine patient deaths.”
On its website, CBS News (4/24, Firger) reports that the investigators “say they suspect the number of cardiovascular-related health complications and deaths among marijuana users is actually much higher. Studies have found people who use marijuana are also more likely to develop dependence on other drugs and alcohol.”
The CNN (4/23, Henry) “The Chart” blog reports that although the research “doesn’t identify a particular level of risk of marijuana use, it does call for more research on the subject, and warns doctors that there seems to be at least some danger.” Also covering the story are Reuters (4/24, Seaman), HealthDay (4/24, Thompson), Medscape (4/24, Wood), and MedPage Today (4/24, Neale).
FDA to announce long-awaited regulations on e-cigarettes, other tobacco products.
Today the FDA is set to announce “sweeping” regulations for electronic cigarettes, news which generated heavy coverage across print and web media, with at least three major papers featuring the story on their front page. Beyond e-cigarettes, some sources also note that the FDA has also proposed new rules on cigars and other tobacco products that are less heavily regulated like shisha and pipe tobacco. The main proposals in the Federal rules include banning the sale of e-cigarettes and cigars to minors, especially on the Internet, and also requiring e-cigarette and cigar makers to disclose to FDA the list of ingredients used in their products. At the same time, the new rules do not ban any flavors in e-cigarettes or cigars, as this would require FDA to quantify how flavoring introduces children to smoking or e-cigarette use, and also do not affect e-cigarette marketing for the most part.
In a front-page story, the New York Times (4/24, A1, Tavernise, Subscription Publication) reports that the FDA’s new rule proposals will “extend its regulatory authority” to e-cigarettes “for the first time” in an environment where the “popular” devices have exploded “into a multibillion-dollar business with virtually no federal oversight or protections for American consumers.” The article notes that the new rules “will take at least another year” before coming into effect, but could be held up by litigation. The FDA Center for Tobacco Products Director Mitchell Zeller comments in the article on the agency’s accommodation of flavors, saying that “You can’t get to the flavors until you have regulatory authority over them,” further noting that FDA’s regulatory blueprint is “foundational.” The article also mentions how industry observers have “cautioned that too high a regulatory bar could stifle smaller e-cigarette producers and help deep-pocketed tobacco companies.”
The Wall Street Journal (4/24, Burton, Esterl, Subscription Publication) reports that the blueprint of regulations is far less restrictive than rules on traditional cigarettes, but consumer groups are supporting the rules for their protections for consumers with respect to Federal monitoring of the ingredients used in e-cigarette liquids. FDA Commissioner Margaret Hamburg calls the regulations an important step in the FDA’s history and for the national interest of public health, saying that the agency is concerned with children having access to both e-cigarettes and flavored cigars.
Reuters (4/24, Clarke) reports that warnings will be required on e-cigarettes noting that nicotine is an addictive drug but stipulate no further warnings related to health. In advertising, furthermore, e-cigarette companies cannot claim their products as a healthy alternative to smoking. There is a 75-day period of public comment on the FDA’s collection of proposals.
On its front page, the Washington Post (4/24, A1, Dennis) reports that rules limiting e-cigarette flavors “might come eventually,” but the FDA will first have to have “more rigorous research” proving “a scientific basis for tougher rules.” Like many of the other articles, the Washington Post notes that big tobacco companies have been entering the e-cigarette market.
The Los Angeles Times (4/24, A1, Clozel) reports on its front page that “in addition to concern about the effect on users, opponents of” e-cigarettes “have warned about secondary risks, particularly from the liquid nicotine that consumers can buy to refill some devices.” Over “the last few years, poison centers across the country have reported a sharp increase in nicotine poisoning, particularly of small children.”
CNN (4/24, Young) quotes Hamburg as saying, “It’s really the wild, wild west out there.” She added that “e-cigarettes are increasingly in the marketplace. They’re coming in different sizes, shapes and flavors in terms of the nicotine in them, and there’s very worrisome data that show that young people in particular are starting to take up e-cigarettes, especially the flavored ones and that might be a gateway to other harmful tobacco products.”
Bloomberg News (4/24, Edney) reports that “the industry may choose to sue the FDA to fight the proposal,” but “Zeller said he’s confident the agency would be able to back up their regulatory attempt with science.”
Obesity Does Not Offer Survival Benefits in Diabetic Dialysis Patients
In a study that examined the effect of obesity on the risk of premature death among 98 maintenance hemodialysis patients with diabetes who were followed for a median of 33 months, mortality rates (per 100 person-years) were: 3.4 for nondiabetic obese, 8.6 for nondiabetic nonobese, 14.3 for diabetic nonobese, and 18.1 for diabetic obese patients. After adjusting for adipokines, a greater effect modification by diabetes was observed, while adjusting for inflammatory markers did not influence the effect modification. Thefindings are published in Renal Failure.
Does Increased Water Intake Affect ADPKD Progression?
Among 34 autosomal dominant polycystic kidney disease (ADPKD) patients divided into high- and free-water–intake groups, urine volume increased in the high intake group but not in the free intake group over the course of the 1-year study. Total kidney volume and kidney function slopes were not significantly different between the groups, although they became worse in the high intake group but not in the free intake group when compared with a prestudy period. The Nephrology Dialysis Transplantation study concluded a long-term randomized study is necessary before conclusions may be drawn about the clinical effects of increased water intake on ADPKD progression.
Critical Illness Linked with Significant and Sustained Decreases in Serum Creatinin
Critical illness was associated with significant decreases in serum creatinine from admission to discharge among 700 ICU patients (66% with AKI). In patients with known baseline creatinine, discharge creatinine was lower in all patients except those with severe AKI, who had no significant difference. Median hospital duration was associated with a 30% decrease in creatinine from baseline in the absence of AKI. After allowing for this effect, AKI was associated with a 29% increase in predicted hospital discharge creatinine. These effects can offset, potentially masking significant kidney dysfunction in survivors of critical illness complicated by AKI, according to theCJASN study.
Nutrition, Food Intake during First Year of Dialysis Is Important for Patient Survival
Among 251 dialysis patients who survived at least 1 year after dialysis onset and were followed for 44.9 months, the secondary target weight change during the first year (calculated after the initial phase of fluid removal) was a strong predictor of survival. The 2 groups above and below the median of the secondary target weight change were not different according to age, diabetes, or cardiovascular history, but those above the median had a significant higher interdialytic weight gain and protein intake. The Nephron Clinical Practicefindings highlight the importance of nutrition and food intake in the first year of dialysis.
Low Testosterone May be Associated with Increased Risk of Premature Death in Men with CKD Stages 3–4
A recent study of 2419 men with CKD stages 3–4 found that patients within the second lowest quintile of testosterone level had a 53% increased risk of dying over a median follow-up of 2.3 years compared with men in the highest quintile. Each 1 log unit increment in serum testosterone level was associated with a 30% decreased risk of death. Higher eGFR levels and being of African American descent were linked with decreased risks of hypogonadism (total testosterone <350ng/dL). Diabetes and increasing BMI were associated with increased risks, according to the American Journal of Kidney Diseases study.
Sunday, April 27, 2014
Treating Hyperuricemia May Attenuate Kidney Function Decline in Some Patients with ADPKD
Among 365 patients with autosomal dominant polycystic kidney disease (ADPKD), those with hyperuricemia showed a faster annual decline in eGFR (-6.3% vs. -0.9% per year); however, after adjusting for various factors, serum uric acid was no longer associated with annual eGFR decline or the development of ESRD. Among 53 patients who received hypouricemic treatment, the annual eGFR decline was attenuated after hypouricemic treatment (pretreatment vs. posttreatment: -5.3 vs. 0.2 mL/min/1.73 m² per year). The BMC Nephrology findings suggest that hyperuricemia is not an independent factor for progression in ADPKD, but correcting it may attenuate kidney function decline in some patients.
Prenatal Factors Linked with Increased Risk for Childhood CKD
A recent study shows that infants with low birth weight were 3 times more likely to develop childhood CKD than infants with normal birth weight. Infants also had 54% increased odds of developing CKD if their mothers had gestational diabetes, 24% increased odds if their mothers were overweight, and 26% increased odds if their mothers were obese. Investigators studied 1994 patients with childhood CKD and 20,032 controls without the disease, and then linked maternal and infant characteristics in birth records from 1987 to 2008 to hospital discharge data. The CKD prevalence was 126.7 cases per 100,000 births, according to the JASN findings.
Heart medicine ivabradine gets fast-track status by FDA.
Forbes (4/17) reported Amgen disclosed yesterday that the FDA has given fast-track status to “its new chronic heart failure drug ivabradine.” The medicine has been sold for several years in Europe “by Servier under the brand name of Procoralan.” Amgen has noted that it plans to submit the application for the agency’s approval “in the second half of this year,” Forbes added.
Scientists grow stem cells from adults using cloning techniques for the first time.
In a front-page story, the Washington Post (4/18, Cha) reports that “scientists have grown stem cells from adults using cloning techniques for the first time — bringing them closer to developing patient-specific lines of cells that can be used to treat a whole host of ailments.” The scientists “‘reprogrammed’ an egg cell by removing its DNA and replaced it with that of an adult donor.” They then “zapped the cell with electricity, which made it divide and multiply,” resulting in cells that “were identical in DNA to the donor.”
The Wall Street Journal (4/18, Naik, Subscription Publication) reports that the findings were published yesterday in Cell Stem Cell.
The Los Angeles Times (4/18, Morin) points out that “experts who were not involved in the” research “said the achievement was significant because it offered clear confirmation that so-called therapeutic cloning is possible with human cells.”
However, in a piece titled “Let’s All Chill Out About Clones,” Forbes (4/18) contributor Elizabeth Lopatto writes that “it’s an advance, but an incremental one.”
TIME (4/18, Park) reports on its website that the researchers used “the same cloning technique that produced Dolly the sheep in 1996.” The article points out that “last year, a group at Oregon Health & Science University generated stem cells using the Dolly technique, but with cells from fetuses and infants.”
On its website, NBC News (4/18, Fox) reports, “If verified, it would be only the second confirmed time someone’s been able to use cloning methods to make human embryonic stem cells.”
Report: Medications, procedures cost far more in US than in eight other countries.
The Los Angeles Times (4/18, Pfeifer) “Money & Co.” blog reports, “Medical procedures, tests, scans and prescription medicine cost far more in the United States than in eight other countries, the International Federation of Health Plans said” yesterday “in its annual report,” which “examined healthcare costs in Argentina, Australia, Canada, England, the Netherlands, New Zealand, Spain, Switzerland and the” US. Tom Sackville, the group’s chief executive, said, “The price variations bear no relation to health outcomes; they merely demonstrate the relative ability of providers to profiteer at the expense of patients, and in some cases reflect a damaging degree of market failure.”
Vox (4/18) reports that for nearly every “item they studied, from Nexium [esomeprazole] to MRI scans to bypass surgery, the United States is always the most expensive.”
Atrasentan Provides Health Benefits to Patients with Diabetic Nephropathy
Low-dose atrasentan (0.75 mg/day) decreased albuminuria by 36% without major side effects in a randomized trial of 211 type 2 diabetic nephropathy patients who received a placebo, low-dose atrasentan, or 1.25 mg/day atrasentan for 12 weeks. The low dose of atrasentan also lowered blood pressure and cholesterol levels. The higher dose had similar benefits but caused more fluid retention. Patients in the JASN study had CKD stages 2 and 3 with albuminuria and were receiving maximum tolerated doses of RAS inhibitors. Atrasentan targets the endothelin receptor A and may have beneficial effects on kidney blood vessels while also reducing kidney inflammation and scarring.
Simple, Short HCV Regimen Has High Cure Rate
Published: Apr 12, 2014
LONDON -- A single pill once a day for 8 weeks is enough to cure more than 90% of hepatitis C virus (HCV) patients with relatively uncomplicated disease, a researcher said.
In a large phase III open-label trial, 94% of patients with HCV genotype 1 and no cirrhosis were able to clear the virus after just 8 weeks of sofosbuvir (Sovaldi) and ledipasvir co-formulated in a single once-daily pill, according to Kris Kowdley, MD, of Virginia Mason Medical Center in Seattle.
Neither a longer duration of treatment nor the addition of the antiviral drug ribavirin had any effect on the combination's efficacy, Kowdley reported here at the annual meeting of the European Association for the Study of the Liver andonline in the New England Journal of Medicine.
The fixed-dose combination was "safe and well tolerated" with adverse events more common among patients treated with ribavirin, Kowdley told a crowded plenary session of the meeting.
The outcome is “pretty dramatic,” commented Adrian Di Bisceglie, MD, of St. Louis University School of Medicine in St. Louis, Mo., an investigator in the study and moderator of the plenary session at which it was presented.
"You're talking about one pill once a day for 8 weeks," he told MedPage Today, a stark contrast to the "year of torture" involved in treating the disease only a few years ago.
Whether regimens can go even shorter remains up in the air. Kowdley said a 4-week regimen would be the "holy grail" for clinicians -- because it would mean a single prescription -- but that so far has eluded researchers.
Di Bisceglie said most people getting the combination were negative for the virus by 4 weeks: "How much consolidation beyond that does one need?"
But even 8 weeks, he said "makes this very manageable for patients."
Sofosbuvir, approved last year, is one of the so-called direct-acting agents against HCV; it's a nucleotide analog NS5B polymerase inhibitor that targets part of viral replication process. Ledipasvir, which blocks the action of the viral nonstructural protein 5A, remains under investigation, but the drugs have been put together as a single pill.
The so-called ION-3 trial is one of several phase III studies here reporting how the fixed-dose combination of the two drugs worked in different patient populations.
ION-3, Kowdley said, enrolled 647 previously untreated patients and randomly assigned them to get ledipasvir-sofosbuvir for 8 weeks, the combination plus ribavirin also for 8 weeks, or the two drugs alone for 12 weeks.
The primary endpoint was sustained virologic response at 12 weeks after the end of therapy, or SVR12, defined as a lack of detectable HCV RNA at that point. The SVR12 is regarded as tantamount to a cure because few patients relapse after they have achieved that milestone.
Kowdley and colleagues found that the SVR12 rate was:
- 94% with 8 weeks of ledipasvir-sofosbuvir alone
- 93% if ribavirin was added for 8 weeks
- 95% with 12 weeks of ledipasvir-sofosbuvir alone
The minimal differences suggested that the 8-week ledipasvir-sofosbuvir regimen had efficacy that was noninferior to either of the other two, Kowdley said.
In each of the three arms, he said, response rates were high and similar based on subgroups defined by such things as sex, race, HCV sub-genotype, and baseline HCV viral load.
The proportion of patients reporting adverse events was numerically higher in the ribavirin-containing arm, he reported, as were grade 3 and 4 lab abnormalities. As expected, hemoglobin declines were more common among the patients getting ribavirin.
Primary source: New England Journal of Medicine
Source reference: Kowdley K, et al "Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis' N Engl J Med 2014: DOI: 10.1056/NEJMoa1402355.
Source reference: Kowdley K, et al "Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis' N Engl J Med 2014: DOI: 10.1056/NEJMoa1402355.
Monday, April 14, 2014
New medications shown to eradicate hepatitis C.
On its front page Saturday, the Los Angeles Times (4/12, Healy) reported that twenty-five years “after scientists first identified the hepatitis C virus, doctors are declaring victory over an infection that afflicts more than 3 million Americans and kills more of them than HIV. In a series of clinical trial results, a new generation of antiviral medications was able to clear the liver-ravaging virus from virtually all patients’ bloodstreams in as little as eight weeks.” The new medications “are ‘a triumph of modern medical technology,’ said Dr. Jeffrey Tice, a UC San Francisco physician who was not involved in any of the clinical trials.”
Friday, April 11, 2014
Analysis Finds No Effect of Chromium Supplements on Fasting Glucose
Chromium supplements are not effective at lowering fasting blood sugar in healthy individuals or diabetics, according to a meta-analysis of 3 decades of data. The Biological Trace Element Research analysis looked at 16 randomized, placebo-controlled trials that included 809 participants (440 diabetics and 369 nondiabetics) between 36 and 67 years of age. The chromium supplements included in the analysis were chromium chloride, chromium picolinate, chromium nicotinate, chromium dinicocysteinate, and chromium yeast. Doses of chromium ranged from 200 to 1000 μg per day.
Meta-Analysis Links Diabetes and Pancreatic Cancer
Individuals with diabetes have double the risk of developing pancreatic cancer compared with nondiabetics, according to a meta-analysis of 88 studies. The risk of pancreatic cancer was greatest early after the diagnosis of diabetes, but remained elevated long after the diagnosis. The individual-level relative risk ranged from 6.69 at <1 year to 1.36 at 10 years. The Annals of Surgical Oncology findings suggest that selective screening of patients with new-onset diabetes for pancreatic cancer needs to be considered.
Brain Enzyme Aberrantly Expressed by Renal Cancer Cells May Be Attractive Therapeutic Target
When researchers put renal cancer cells from established cell lines into an extracellular matrix that promotes tumor growth, the cells expressed high levels of RNA for a kinase normally found in neurons in the brain. When the investigators inhibited the kinase, cancer cell division and spread halted. This suggests that the kinase was not just a cancer marker, but played an important role in cancer growth. The kinase was also expressed at high levels in kidney tumors from patients. The research was presented at the American Association for Cancer Research’s Annual Meeting.
Kidney Transplantation Provides Best Survival Benefit for Lupus Patients with ESRD
Among 1998 lupus patients with ESRD, the 1-year, 5-year, 10-year patient survival rates were best for those who underwent kidney transplantation (100%, 98.1%, and 94.4%, respectively), followed by peritoneal dialysis (88.3%, 79.1%, and 76%, respectively), and hemodialysis (53.6%, 46.0%, and 41.6%, respectively). For those who underwent kidney transplantation within 1 year after ESRD, no significant worse patient survival and graft survival were observed than for those who underwent transplantation 1 year later. The findings are published in Transplantation Proceedings.
Hemodialysis Catheter Design Does Not Affect Risks for Thrombosis and Infection
Among 302 hemodialysis patients who required a tunneled cuffed catheter for vascular access, primary assisted patency and incidence of infection and thrombosis were similar for both the Palindrome Symmetric Tip Dialysis Catheter and the HemoStar Long-Term Hemodialysis Catheter. The Palindrome catheter group had a higher number of catheters that never required thrombolysis (58% and 45%) and achieved higher blood flow rates than the HemoStar catheter (333 mL/min and 304mL/min). TheAmerican Journal of Kidney Diseases findings suggest that mechanical catheter design may improve catheter flow but does not affect risks for thrombosis and infection and therefore catheter survival.
Walking May Be an Effective Anti-Inflammatory Therapy for Patients with CKD
In an acute exercise study conducted in 15 patients with CKD, 30 minutes of walking improved the responsiveness of neutrophils to a bacterial challenge in the post exercise period. It also induced a systemic anti-inflammatory environment in the body. Additionally, in a regular exercise study, 6 months of regular walking (30 minutes/day, 5 times/week) reduced immune cell activation and markers of systemic inflammation in 20 CKD patients compared with another 20 CKD patients who did not increase their usual activity levels over the same period of time. The JASNstudy noted kidney function, proteinuria, and blood pressure were unaffected.
Fruit and Vegetable Consumption Linked to Prolonged Survival
New research links eating 7 servings of fruits and vegetables per day with a 42% lower risk of premature death from all causes, a 25% reduced risk of death from cancer, and a 31% reduced risk of death from heart disease/stroke, after excluding deaths within the first year. Two to three daily portions of vegetables were linked with a 19% lower risk of premature death, compared with a 10% lower risk for the equivalent amount of fruit. The BMJanalysis followed 65,000 adults aged ≥35 years for an average of 7.5 years.
Preliminary Study Shows Renal Artery Embolization Could Help Patients with ADPKD
Among 5 patients with autosomal dominant polycystic kidney disease who underwent bilateral or unilateral renal artery embolization using a mixture of N-butyl cyanoacrylate and iodized oil with low density, the technical and clinical success was 100%. All patients had severe refractory symptoms secondary to enlarged kidneys after dialysis initiation. The average basal renal volume before embolization was 2222 cm³, and average reduction rates were 83.0%, 65.5%, 62.9%, and 50.9% at 1, 3, 6, and 12 months, respectively. The findings, presented at the Society for Interventional Radiology’s annual meeting, were highlighted in a Renal & Urology News article.
Trial of heart failure medication ended early due to positive results.
The Wall Street Journal (3/31, MacLucas, Subscription Publication) reports that Novartis AG said that it has halted a study of a heart failure medication known as LCZ696 after researchers found that the medication was shown to benefit patients.
The Bloomberg News (3/31, von Schaper) reports that investigators “followed more than 8,000 patients with a certain type of heart failure who received either the Novartis drug or enalapril, the standard treatment.” The researchers found that patients given the experimental medication “lived longer without being hospitalized than” the “group who received” enalapril.
Reuters (3/31) explains that the trial was evaluating the new medication in individuals with reduced ejection fraction chronic heart failure
Renal denervation may not benefit patients with uncontrolled hypertension.
The New York Times (3/30, Grady, Subscription Publication) reported on the unexpected finding of “a landmark study” that found renal denervation may not benefit individuals with uncontrolled hypertension. The study of 535 patients split them into groups that received the actual procedure or a fake procedure that was designed to fool patients. After six months, “both groups experienced drops in blood pressure, but there was no significant difference.”
Reuters (3/31, Emery, Berkrot) reports that the study was presented at the American College of Cardiology meeting and published in the New England Journal of Medicine.
Forbes (3/30) contributor Larry Husten wrote that the researchers “noted that despite the widespread hype, enough information was available to predict that the trial would not produce the large, dramatic reductions in BP that many experts had predicted.” Medscape (3/30, O'Riordan) also covers the story.
Study: Artificial valve system cut patient death rates more than open-heart surgery.
Bloomberg News (3/29) reported that Medtronic Inc. artificial aortic valve system, inserted without opening the chest, “reduced patient death rates more than open-heart surgery in the first study to ever record such a finding.” The article noted that about “14 percent of patients in the 747-person trial died within a year of treatment with Medtronic’s CoreValve,” compared with “19 percent of those who underwent open-heart surgery died,” citing a study unveiled at the American College of Cardiology meeting in Washington. Bloomberg pointed out that the results “were so robust” that US regulators noted “they won’t require the standard review by outside experts before approving the device.”
Medscape (3/31) reports that Dr. David Adams of Mount Sinai Medical Center in New York presented the results, which were also published in the New England Journal of Medicine.
MedPage Today (3/31) and CardioSource (3/31) also report this story.
Diet drinks linked to heart risks in older women.
NBC Nightly News (3/30, story 5, 0:40, Holt) reported, “Research presented at the American College of Cardiology” meeting suggests that diet drinks may increase heart risks in older women.
On its website, NBC News (3/30, Fox) reported that investigators “studied nearly 60,000 middle-aged women taking part in a decade-long study of women’s health.” Participants “filled out a questionnaire on food and drinks as part of the study, including detailed questions on diet sodas and diet fruit drinks.” The investigators, “after just under nine years...checked to see what happened to the womens’ health.”
The Huffington Post reported that “women who consumed two or more diet drinks daily were not only 30 percent more likely to suffer heart attacks and strokes, they were 50 percent more likely to die from some sort of cardiovascular disease, when compared with women who never or rarely drank diet drinks.” Also covering the story were Reuters (3/30, Pierson, Berkrot) reports, HealthDay(3/31), Medscape (3/30, Busko), MedPage Today (3/30, Phend).
CDC: Rate of invasive cancer in US declines.
FOX News (3/28, Rettner) carries a LiveScience story reporting that “rates of new cancer cases in the United States have fallen slightly in recent years, according to a new” CDC report to be published in Morbidity and Mortality Weekly Report. The report indicated that “between 2009 and 2010, the rate of invasive cancer...dropped from 459 new cases per 100,000 people, to 446 new cases per 100,000 people.”
HealthDay (3/28, Preidt) reports, “By tumor type, rates of advanced disease were highest for cancers of the prostate (126 per 100,000), female breast (119 per 100,000), lung and bronchial airways (62 per 100,000) and colon/rectum (40 per 100,000).” The data indicated that “prostate, lung and colorectal cancers were the most common advanced tumors among men, while breast, lung, colorectal and uterine cancers were most common among women.”
Medscape (3/28, Mulcahy) reports that the data indicated that “rates of new cancer cases were higher in men than in women (503 vs 405 per 100,000), highest in black patients (455 per 100,000), and ranged by state.”
7 Ways to Eat Healthy as You Age
Nutrition needs change as we age, and that’s why during week four of National Nutrition Month we’re sharing healthy eating tips so you can make good food decisions your entire life.
Here’s what you need to know:
READ:
Eating a balanced diet is critical especially for those ages 50+
Planning and preparing your own meals lets you control your portion sizes.
Your sense of smell and taste can fade as you age. Learn what causes it and ways to help improve the taste of food.
As you age, you may want to take dietary supplements to round out your nutrition. Learn which ones are best to take.
WATCH:
To make sure you’re the first to get all the healthy eating resources we’re sharing this month make sure to follow us on Twitter, Facebook, Google+ and our blog.
Steroid Therapy for COPD Exacerbations: Getting By With Less
Link: http://www.medpagetoday.com/resource-center/advances-in-copd/steroid-therapy
Steroid Therapy for COPD Exacerbations: Getting By With Less
Treating exacerbations of chronic obstructive pulmonary disease (COPD) with corticosteroids for 5 days is no less effective than treating patients for 1 or 2 weeks or even longer. In fact, 5-day treatment should be considered the norm for most patients, including those with the most severe disease.
Findings from the Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial,1 published in June 2013, prompted the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to revise its guidelines for the treatment of COPD flare-ups and call for the shorter course of steroid therapy instead of the 7 to 14 days of treatment that GOLD had previously recommended.
According to the 2014 GOLD guidelines, “A dose of 40 mg prednisone per day for 5 days is recommended (Evidence B), although there are insufficient data to provide firm conclusions concerning the optimal duration of corticosteroid therapy for acute exacerbations of COPD. Therapy with oral prednisolone is preferable. Nebulized budesonide alone may be an alternative (although more expensive) to oral corticosteroids in the treatment of exacerbations. Nebulized magnesium as an adjuvant to salbutamol treatment in the setting of acute exacerbations of COPD has no effect on FEV1.”2
Acute exacerbations of COPD are a major cause of hospitalization, lung function decline, and death. Treatment with corticosteroids can reduce the length of hospital stays and shorten recovery times, but long-term use has been associated with poorer patient outcomes and greater mortality.3,4 Even steroid use to treat COPD flare-ups for as short as a few weeks has been linked to adverse outcomes, including hyperglycemia, weight gain, and insomnia. And since the majority of patients experience at least 1 exacerbation a year, and as many as 10% experience 2 or more annually, the risk for cumulative exposures may be great.4,5
A 2011 Cochrane review of 7 studies including a total of 288 patients with COPD exacerbations showed no significant differences in clinical outcomes between patients treated with corticosteroids for more than 7 days and those treated for 7 days or less (5 studies used oral prednisolone and 2 used intravenous corticosteroids). But the Cochrane researchers concluded that the studies weren’t of sufficient quality to make firm recommendations regarding the duration of corticosteroid treatment during COPD exacerbations.6
“The beauty of the REDUCE trial is that it definitively told us whether we should be treating patients with a long or short course of therapy,” said Don D. Sin, MD, University of British Columbia professor of medicine and COPD researcher, in an interview. “In most cases, 5 days of prednisone at 40 mg per day is sufficient for acute exacerbation management. This is important to know because we don’t want to give these medications for longer periods or at higher doses than is necessary, because while they’re very effective, they also have severe toxicities.”
The REDUCE trial included 314 patients who presented with acute COPD exacerbations to 5 Swiss teaching hospital emergency departments between March 2006 and February 2011 and were randomized to treatment with 40 mg of prednisone daily for either 5 or 14 days in a placebo-controlled, double-blind fashion. The main outcome measure for the study was time to next exacerbation within 180 days.
A total of 289 patients (92%) were hospitalized after being seen in the ER; 311 were included in the intention-to-treat analysis and 296 were included in the per-protocol analysis. In the 5-day treatment group, 56 patients (35.9%) reached the main endpoint compared to 57 (36.8%) in the 14-day treatment group. Rates of re-exacerbation within 180 days were also similar in the 2 groups (37.2% [95% CI 29.5% to 44.9%] in the 5-day group and 38.4% [95% CI 30.6% to 46.3%] in the 14-day group, for a difference of -1.2% [95% CI -12.2% to 9.8%]).
Among patients with re-exacerbations, the median time to the event was 43.5 days (interquartile range [IQR], 13 to 118) in the 5-day treatment group and 29 days (IQR, 16 to 85) in the 14-day treatment group. No significant differences were seen among the 2 groups in time to death; the combined endpoint of exacerbation, death, or both; and recovery of lung function.
Not surprisingly, mean cumulative prednisone dose was significantly higher in the longer treatment group (793 mg [95% CI 710 to 876 mg] versus 379 mg [95% CI 311 to 446 mg], P<.001). Treatment-associated adverse reactions, however—including hyperglycemia and hypertension—were similar in both groups.
“Most of our patients had severe or very severe COPD: therefore, our results cannot necessarily be applied to less severe disease grades. However, it seems unlikely that patients with GOLD grades 1 and 2 would benefit from longer glucocorticoid treatment for COPD exacerbations,” lead researcher Jörg D. Leuppi, MD, PhD, and colleagues, wrote in the June 5, 2013 issue of JAMA.
Dr. Sin agrees. Although he wasn’t involved with the research, he wrote an editorial that was published with the Leuppi study. He noted that the 5-day treatment group had a 65% reduction in cumulative steroid exposure compared to the longer-treatment group (200 mg median prednisone exposure versus 560 mg).5
Dr. Sin said that while many clinicians had adopted the shorter course of steroid treatment for COPD exacerbations before the REDUCE trial, others—especially those trained decades ago when 6 to 8 weeks of treatment was the norm—still treat patients for 2 weeks or longer.
He added that although clinicians are doing a better job of treating COPD in general, this isn’t necessarily the case for COPD exacerbations.
“The sad reality is that the treatments we use for acute exacerbations today are no different from the ones we were using 20 years ago,” he said. “We used antibiotics then and we still do. We used oxygen and steroids then and we still do. The fundamental tenets of treatment haven’t changed over the past 20 or 30 years. We need better therapies.”
Published: 02/18/2014
References:
- Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA. 2013;309:2223-2231.
- Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2014.
- Davies L, Angus RM, Calverley PM. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial.Lancet. 1999;354:456-460.
- Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest. 2003;124:459-467.
- Sin DD, Park HY. Steroids for treatment of COPD exacerbations: less is clearly more. JAMA. 2013;309:2272-2273.
- Walters JA, Wang W, Morley C, et al. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011 Oct 5;(10):CD006897.
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