MD-FM Thursday November the 15th, 2012
MD FM — Medical News from around the the world with Peter Goodwin
PETER: Hello, and to begin with, fresh news from the American College of Rheumatology’s annual meeting in Washington: treatment with biologic medications may reduce the risk of premature death in people with rheumatoid arthritis.
SARAH: Yes Peter, this is the result of a match-controlled study from the Canadian Ministry of Health patients data. The study included all reported RA cases that received care between January 1996 and March 2006 and they were all followed until March 2010. All health care services used – including medications, hospitalizations and lab tests – were evaluated. Diane Lacaille.
Bob 1 Lacaille
The exposure to biologic agents was associated with a reduction of risk of mortality...a quarter of that people who were not on biologics
SARAH: Diane Lacaille is the leading autor and a rheumatologist at the British Columbia University, Canada. She also gave some additional results on the causes of these reduction of mortality with biologics.
Bob 2 Lacaille
We did not repeat the analysis for individual causes of death… the number that is significantly is reduced is cardiovascular disease
PETER: That is really reassuring for patients who are often afraid to take biologics because of the potential complications, even if the treatment is really effective.
PETER: Tapering TNF-inhibitor drugs in people with rheumatoid arthritis could be done in some patients without significantly increasing disease activity or impairing joint function. SARAH ?
SARAH: Yes Peter, the early treatment with TNF-inhibitors of the methotrexate-resistant RA patients represents a major step forward because nearly two-third of the patients could be in remission and some of them can increase the interval between doses of drugs and even stop all of their treatment.
PETER: Yes, that’s what the BeST study and many other have preciously shown. But the question is: how many patients can really stop their treatment ? And if so, how to do it ?
SARAH: Researchers in France looked into how increasing the interval between injections of TNF-inhibitor drugs might affect patients. They conducted an 18-month randomized, controlled trial involving 137 people with RA treated with anti-TNF, who were in stable remission for at least six months. After 18 months, the researchers found that 82 percent of the RA participants were able to space out OR stop their TNF-inhibitor injections, WITHOUT significant increases in EITHER disease activity OR functional impairment.
Bob Fautrel - 33’’
What we have demonstrated is that it was feasible....compared to the group who maintained completely the same regimen of injection
SARAH: That was Bruno Fautrel, rheumatologist at the Pitié-Salpêtrière University Hospital in Paris who said that a slow reduction is probably more appropriate once a patient has reached remission, but we still have to wait for the structural analysis.
Prescribing anti-TNF to treat rheumatoid arthritis may result in a 13 percent reduction in hospital admissions and a 47 percent reduction in the need for hip and knee surgery procedures. These are the results of an Irish national review of the hospital occupancy records from 1995 to 2010. The analyse of these 57,774 RA inpatient records shows that TNF-inhibitors improve not only health-related outcomes, but they may also reduce the direct and indirect costs of the RA-treatment.
PETER: Another great piece of news from another annual meeting, that of the American Association for the Study of Liver Diseases: patients with HBV-related liver cancer who receive antiviral therapy after surgical resection have a lower risk of tumor recurrence. SARAH?
SARAH : Higher HBV viral load has been reported to be an independent risk factor for hepatocellular carcinoma recurrence in patients with HBV-related HCC. Based on the Taiwan National Health Assurance Research Database, Dr. Chun-Ying Wu and colleagues, from the University of Taiwan, found that a group treated with nucleoside analogues had a 33 percent reduced risk of HCC short-term recurrence, and lower overall death rates, compared to patients who did not receive medication after surgery.
This paper alone is just confirming multiple smallest studies....I would recommend antivirus therapy
SARAH: That was Anna Lok, from the Ann Harbor University, Michigan, who did not participate in the trial but who wrote an editorial about the NEJM study.
One of the big stories in malaria in 2011 was the early efficacy data on the first vaccine trialled in Africa. Sarah Maxwell’s been hearing in Atlanta what’s happened since the initial results were announced:
A new childhood vaccine for malaria is safe and effective according to phase-three data presented this week at the 2012 American Society of Tropical Medicine and Hygiene meeting. Researchers in Kenya compared the RTS,S vaccination with a meningococcal-C conjugate vaccination in two age cohorts: five-17months and six-12 weeks old. 16,000 children were enrolled across Africa and results presented in Atlanta were on the one-year follow-up data:
“The vaccine itself generally safe as compared to other traditional routine immunisation vaccines within childhood vaccination, and we have seen that its highly immunogenic like we found in other previous phase 2 studies. But at the same time we have found that vaccine efficacy is about 30%, what it means: 1 third of the clinical cases of malaria or severe malaria have be averted or protected, and the most important thing is the vaccine efficacy that we obtained is on top of other malaria control measures. So the vaccine when its being brought is not like a silver bullet its going to be used on top of other existing malaria control measures like, insecticide treated nets where indoors spraying is used that can also be applied concurrently.”
Doctor John Lusingu, chair of the RTS,S Clinical Trial Partnership Committee, from Tanga in Tanzania.
I turned to Brian Greenwood from the London School of Hygiene and Tropical Medicine for his thoughts on these findings:
“I was a little surprised that we didn’t have a higher level of efficacy in these young children because in the previous report that came out last year we looked at the effect of the vaccine in slightly older children, they were vaccinated at five-seven months old and we got about 50% efficacy. And some of the earlier phase-2 trials, the smaller trials in infants in this young age, had given an efficacy of about 50% so I think we were expecting to see a 50% efficacy and it was only 30% so that was a bit surprising.”
Professor Brian Greenwood speaking to me at the ASTMH meeting in Atlanta
BREVE 1 Sur fond musical
PETER: Finally, in brief: babies of untreated mothers with bipolar disorder presented an increased risk of preterm birth and complications related to fetal growth restriction, compared to babies of bipolar mother under treatment. This is according to a BMJ study thus revealing that mood-stabilizer are not the sole reason for pregnancy and birth complications in such patients, whom should be carefully counseled about treatment options before pregnancy.
Migraines are linked with a higher incidence of brain lesions in women, according to a 10-year follow-up MRI study in JAMA. Women with migraines had more white matter hyperintensities than those without migraines --an association not found in men. However, the number, frequency, and severity of migraines were not associated with lesion progression in these women, and lesion volume was not associated with poorer cognitive performance.
That's all from MDFM for now. We'll be back next week