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Anti-acid drugs might induce vitamin B12 deficiency when used long term

MD-FM Thursday December 12, 2013 



SARAH:

MD FM: Medical News from around the world with Peter Goodwin.

SEGMENT 1: Vitamin B12 Deficiency: Long-term use of anti-acid medication associated with higher risk of vitamin deficiency. 

 

PETER:

Hello, and with me is Sarah Maxwell. To begin with, long-term use of gastric acid-suppressing medications can induce vitamin B12 deficiencies in some people. That’s according to a study published in JAMA.

 

SARAH:

Yes, and that’s particularly in those who have normal to borderline levels to begin with. The data showed that using proton pump inhibitors for at least two years was associated with a 65 per cent increased risk of vitamin B12 deficiency. And the higher the dose the patients took, the higher the risk. For those on histamine-2 receptor antagonists, the risk was increased by 25 per cent. Study co-author Douglas Corley said that when they analyzed a sample of the 26,000 patients with vitamin B12 deficiencies more closely, they discovered the majority had symptoms:

 

CORLEY:

“Almost of the people who had a diagnosis of vitamin B12 deficiency were having their laboratory checked for some reason. They were having symptoms, such as numbness or tingling in their hands or their feet or difficulty in the steadiness of their walking, problems with dementia or having an anemia. So how much the vitamin B12 deficiency was contributing to those problems, it’s hard to determine, but most of the people who where diagnosed with vitamin B12 deficiency, it was done in the context of some symptom, it wasn’t just done as a screening and it’s kind of a coincidental finding.” 

 

SARAH:

That was Dr. Douglas Corley, from Kaiser Permanente in Oakland, California, who pointed out that acid is important for digestion: it sterilizes food that goes into the stomach and helps with the absorption of several nutrients. And this new finding doesn’t mean that all patients on anti-acid drugs should start taking supplements or (even more importantly) should stop their treatment for indigestion if they need it.

 

CORLEY

“Most people who are on these medications are on them for a reason. But it does suggest that people should probably use the lowest effective dose and the lowest effective type of medication. The results raise the question of whether or not people who are on long-term acid suppressing medications should have, at least on a one time basis, screening test for vitamin B12 deficiency. It’s hard to make that recommendation universally right now but I think at least the results raise that question.” 

 

SARAH:

Dr. Douglas Corley, from Oakland.



SEGMENT 2: Chemo-free treatment reduces mortality survival better than standard treatment in elderly patients with multiple myeloma.

 

 

PETER:

Breaking news now from the American Society of Hematology annual meeting held this week in New Orleans: For older patients with newly diagnosed multiple myeloma, a new chemotherapy-free drug combination significantly improved overall survival compared to the gold standard chemotherapy regimen. According to some: a new milestone in the treatment of the disease.

 

SARAH:

Yes, the trial showed that, after three years, patients on lenalidomide plus dexamethasone were nearly 30 per cent less likely to die or have their disease progress, compared to those on the standard combination of melphalan, prednisone and thalidomide (or MPT). There were also improvements in overall response rate and duration of response. This is the largest study of its kind to date, with over 16 hundred patients including older people, some even with renal failure, and patients ineligible for stem cell transplantation. Dr. Thierry Facon, from France, who presented the results during the ASH plenary session, said the safety profiles of both regimens were similar.

 

FACON:

“It’s totally in line with what we know from the safety profile of lenalidomide + dexamethasone because this combination is used in relapse myeloma. The good news is also that the incidence of second primary malignancy, especially hematological SPM, was extremely low with lenalidomide and low dose dexamethasone, and as you know we got some SPM in the past with some lenalidomide studies, so… The regimen is manageable, the regimen is safe and, basically, we were able to show that lenalidomide and low dose dexamethasone is a better regimen that MPT.” 

 

SARAH:

That was Professor Thierry Facon, from Lille hospital in France, who said this combination should become a new standard of care.

 

FACON:

“As you know the registration decision is the decision of colleagues in regulatory agencies but, as a hematologist, I would say that it is a new standard of care for myeloma patients.” 

 

SARAH:

Thierry Facon. And after talking with him we met up with Dr George Canellos, from Harvard University, who acknowledged that haematologists were already adopting lenalidomide in a big way. And his reactions to the findings presented by Dr Facon?

 

CANELLOS:

“Well I’m not surprised. Lenalidmomide in randomised trials for a number of diseases, CLL, myeloma and probably lymphoma, has been shown to be an additive, positive, agent and when you look at this data with 1600 patients it’s somewhat better, not dramatically better but it’s somewhat better and that’s not a surprise!”

 

SARAH:

George Canellos, of the Dana-Farber Cancer Institute, in Boston.   .

 

 

SEGMENT 3: First glycoprotein Ib antagonist could become potent antithrombotic agent.

 

PETER:

Also from the ASH meeting: a glycoprotein Ib antagonist, extracted from snake venom, was found to be a safe and effective anti-platelet agent, in a phase I clinical trial with 94 healthy volunteers. Anfibatide targets the platelet receptor involved in clotting, and it was well tolerated and inhibited up to 90 per cent of ristocetin-specific platelet aggregation. Currently there are no drugs targeting glycoprotein Ib and the researchers say anfibatide has great potential for future anti-thrombotic therapy.

 

 

SEGMENT 4: 20 percent sales tax on sugar-sweetened drinks would reduce obesity and overweight in the UK.

 

 

PETER:

There have been yet more discussions about taxing sugar-sweetened drinks, this time in the UK:

 

SARAH:

That’s right, a study reported in the British Medical Journal, estimated that a 20 per cent sales tax on sugar-sweetened drinks could reduce the number of people in the UK who are obese or overweight by nearly half a million.

 

PETER:

But there has been a lot of debate on whether a tax really can reduce obesity and if it might disproportionately affect the poor; and whether it might push people to indulge in other types of sugary foods instead, hasn’t there?

 

SARAH:

Yes there has but lead study author Mike Rayner, said they took all of this into consideration with their calculations:

 

RAYNER:

“We modelled what would happen in the real world and its seems that the tax would affect different income groups fairly evenly, or equally, and we found that young people would be more likely to be affected by the tax and we found that the most likely substitution that they would make is towards diet drinks, so low calorie drinks or zero calorie drinks.”

 

SARAH:

Dr Mike Rayner, from the University of Oxford, who added that, what could help decision-makers, would be to get data from countries that have already implemented such a tax. Michel Chauliac, from the Health Ministry in France, where a “soda tax” was passed in early 2012, told MDFM that, while it’s difficult to get data on the tax’s actual impact on weight, results do show that, for the first time in 40 years, the sale of sodas in France declined by about four per cent in 2012, while sales of other soft drinks continued to rise.

 

 

SEGMENT 5: Elderly patients with type-2-diabetes at high-risk of hypoglycemia.

 

 

PETER:

Diabetes now: and besides the well-known cardiovascular complications associated with it in old age, older patients are apparently also at high-risk of hypoglycemia. That’s according to data published in JAMA Internal Medicine.

 

SARAH:

Yes, hypoglycemia was ranked as one of the most common complications in patients with type-2 diabetes, aged 60 years or older. And this is the first description to be published in the past 20 years looking at this patient population.

 

HUANG:

“This particular group, which is 60 or 65 years and above, is actually about 50 per cent of the diabetes population. And there tends actually to be less clinical research in this population than in younger groups. And what was new here, was that hypoglycemia has now emerged as the second or third most common complication for older people. That probably encourages the biggest change in the way we’ve approached diabetes care. You know, diabetes care has typically had a focus on glucose control, but we probably need to move away from that among the oldest patients.”

 

SARAH:

That was lead study author Dr Elbert Huang, from the University of Chicago. Other complications included eye disease and microvascular complications, and Dr Huang’s team looked at rates of complications, by different age groups and by duration of diabetes, in over 72 thousand patients

HUANG:

“Unfortunately the older you are, and the longer you’ve had the disease, the higher the incidence of all complications. The group with the worst sort of picture is actually 80 year olds who’ve had diabetes for over 10 years and, of course, they’re the group that we never study. And so that tells you that the more successful we are at keeping people alive means that they live with diabetes longer and that they’re at higher risk of developing all these complications.”

 

SARAH:

Elbert Huang, from Chicago.



IN BRIEF 1: Compression stockings did not prevent post-thrombotic syndrome after deep venous thrombosis.

 

PETER:

Finally, in brief: Wearing elastic compression stockings routinely, after a first episode of deep venous thrombosis, did not prevent post-thrombotic syndrome (PTS). That’s the finding of the first large-scale trial of its kind, published in The Lancet. 800 patients were randomized to either wearing active stockings or placebo stockings during two years: and the cumulative incidence of PTS, at six months, was between 12 and 14 per cent in both groups.

 

IN BRIEF 2: Continuous positive airway pressure reduced blood pressure in patients with hypertension and obstructive sleep apnoea.

 

PETER:

Continuous positive airway pressure (CPAP) reduced blood pressure in patients with difficult to treat hypertension and obstructive sleep apnoea. In a study, reported in JAMA, 194 participants were randomized to have a 12-week course of CPAP or not. Results showed a decrease in 24-hour average- and diastolic- blood pressures, and an improvement in the nocturnal blood pressure pattern, for patients who received CPAP, compared to those who didn’t.


PETER:

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then from me Peter Goodwin, goodbye!

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