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New potent antiviral could boost treatment of genital herpes

MD-FM Thursday January 16, 2014 

 

Sarah:

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

 

 

SEGMENT 1:  INFECTIOUS DISEASES: new agent with novel mode of action raises hope of improving genital herpes treatment 

 

PETER:

Hello. To begin with, for treating genital herpes, for the first time in three decades there have been promising results with a new antiviral agent … Here’s Sarah Maxwell:

 

SARAH:

In a randomized placebo-controlled trial, published in the New England Journal of Medicine, one month of pritelivir significantly reduced the number of days with genital lesions and the frequency of genital virus “shedding” (that’s when you can detect the virus on the genital surface). Now, more studies are needed to determine whether pritelivir, which uses a novel mode of action, is actually more potent than currently available drugs. Dr. Richard Whitley, from the University of Alabama in Birmingham, wrote an editorial on the study:

 

WHITLEY:

The issues with the medications that have already been tested for genital herpes are, number one: yes they’re efficacious but they don’t totally prevent reactivation if you take it on a suppressive basis. Number two is, in certain populations we are beginning to see the development of resistance. Those populations are individuals who have HIV infection and have advanced disease and also the hematopoietic stem cell transplant recipients. So having a new medication that has a different mechanism of action becomes very important, when we think about the development of resistance and potentially for those people who have routine genital herpetic infection.

 

SARAH:

Richard Whitley. And the study’s lead author, Dr. Anna Wald from the University of Washington, in Seattle, acknowledged that current standard of treatment can provide a reduction in sexual transmission of the herpes virus …

 

WALD:

It does reduce it by 50 per cent: and you can look at it as the cup being half full or half empty -- but most patients tend to see it as being half empty. So there’s definitely a desire in the patient community for more potent drugs.

 

SARAH:

Pritelivir inhibits herpes without targeting DNA polymerase and Dr. Wald noted that although they didn’t find any evidence of toxicity during their trial, the drug was recently put on hold by the FDA because of toxicity issues reported in an animal study using higher doses.

 

 

SEGMENT 2: Screening for cervical cancer still beneficial beyond 65 years old

 

PETER:

Screening for cervical cancer still benefits older women, even beyond 65 years of age. That’s according to the first evidence of its kind, reported this week in PLOS Medicine...

 

SARAH:

Yes, first of all, the study showed that screening up to age 65 years greatly reduced the risk of cervical cancer during the following decade. Screening at least every five years between the ages of 50 and 64, was associated with a 75 per cent lower risk of cervical cancer between the ages 65 and 79 years. Senior study author Peter Sasieni, from the UK:

 

SASIENI:

There was very little evidence until now and so there were some people who were saying: actually we don’t need to continue screening beyond the age of about 50. They were saying to just do one HPV test in the early 50s and if that’s negative, there’s no need for more screening, women aren’t going to get a new HPV infection… Other people are saying: well women are living longer, they’re more likely to have new sexual partners after the age of 55 and their husbands are more likely to have extra-marital affairs… Perhaps particularly in France… So stopping screening at age 55 doesn’t seem to be rational. So there was a variety of views going on and yet virtually no evidence.

 

SARAH:

Professor Sasieni said this study now provides evidence of the benefit, but the story doesn’t end here. They also found the protection provided by screening wanes after about 10 years. So, is the risk high enough to warrant screening beyond 65? The study didn’t address this particular issue, but Professor Sasieni said it could be considered:

 

SASIENI:

From this you might say well maybe it should be 10-yearly screening over 65, maybe one more screen of women in their early 70s would make a lot of sense and potentially be cost effective and we are trying to think of way that we could make that screen easier, potentially using HPV testing on a cell sample for instance, that wouldn’t need speculum examination.

 

SARAH:

Peter Sasieni, from Queen Mary University of London.

 

 

SEGMENT 3: Risk of cervical and vaginal cancer higher in women previously treated for cervical intraepithelial neoplasia 

 

PETER:  

The risk of developing and dying from cervical or vaginal cancer are higher in women previously treated for precancerous cervical lesions categorised as cervical intra-epithelial neoplasia grade-3. That’s according to a study, published in the British Medical Journal, that showed the risk apparently accelerates after 60 years of age, and is also higher when treatment for CIN-3 was performed later in life. However, the incidence of both cancers is still very low.

 

 

SEGMENT 4: Daily probiotics could prevent colic and functional gastrointestinal disorders in neonates 

 

PETER:

Could you give a few drops of probiotics each day to prevent babies from having colic and other gastrointestinal disorders? Apparently yes. That’s according to data published in JAMA Pediatrics, looking at nearly 600 infants randomised to either placebo or daily prophylactic use of such active micro-organisms given for three months

 

SARAH:

Yes, the duration of so-called “inconsolable crying”, regurgitation and functional constipation during the time of treatment were significantly reduced with probiotics. Lead study author Flavia Indrio said as well as lowering parents’ emotional burden, the economic impact was also considerable. And it might also protect against bowel diseases or psychological disorders later in life…

 

INDRIO:

The speculation is this: the probiotics, first of all, reduce intestinal inflammation, second they improve intestinal motility and third, maybe, they can be used for communication between the gut and the brain.

 

SARAH:

That was Dr. Indrio, from the University of Bari in Italy, who said more and more people are using probiotics in neonates in her country.   

 

PETER:

But not all probiotics are the same and not all experts are convinced about using them systemically are they?

 

SARAH:

No they’re not. For instance, Dr. Valery Sung, from the Murdoch Children’s Research Institute in Australia, told MDFM she thinks there’s still “no clear evidence” that probiotics can treat or prevent infant colic. She added that more studies are needed to replicate these results in other parts of the world since the effects of probiotics could differ between countries.

 

 

SEGMENT 5: Tumour markers as effective as CT for detecting curable recurrences after surgery in patients with primary colorectal cancer

 

PETER:

For patients who’ve had curative surgery for primary colorectal cancer, both measuring tumour markers, such as blood carcino-embryonic antigen (CEA), and using CT scanning increased the chances of detecting cancer recurrences, which were then treated with curative intent. Both of these approaches were also better than minimal follow-up and this is the first solid evidence to confirm the benefits of intensive check-ups after surgery…

 

SARAH:

Yes, a randomized study, published in JAMA, looked at 12 hundred patients and found that, curative treatment of recurrence was much more commonly done for those in the more intensive follow-up groups compared with those having minimal follow-up with a single CT. Interestingly, combining CT and CEA-testing was not better than using either method alone. However, the authors could not confirm a survival benefit for intensive follow-up:

 

PRIMROSE:

When we set out to run this trial, we had an overall survival endpoint. But in the initial running phase of the trial, what we found is that the relapse rate was much lower than we had anticipated, which makes an overall survival endpoint very underpowered. Increasingly, in trials in colorectal cancer, because of better chemotherapy and revisional surgery, overall survival is becoming really difficult to use as an endpoint.

 

SARAH:

That was lead study author John Primrose, from the University of Southampton in the UK. He added that patients at all stages benefited from intensive follow-up, even those with early stage disease. So, his recommendations for the practice?

 

PRIMROSE:

Clearly, using tumour markers alone is likely to be much more economic and doesn’t risk the radiation dose of CT. So, I think, a single CT at about a year and regular CEA monitoring is probably the best most economical way of following our patients.

 

SARAH:  

Professor John Primrose.



IN BRIEF 1: Patients with glucokinase mutation have few vascular complications despite mild hyperglycemia

 

PETER:

Finally, in brief: Patients with a mutation in the gene that encodes the enzyme “glucokinase” have few microvascular or macrovascular complications, despite having lifelong hyper-glycemia (albeit mild). A study, reported in JAMA, showed that rates of complications in these patients were pretty similar to those of people without either diabetes or the mutation, and they were much lower than in patients with young-onset type-2-diabetes.

 

 

IN BRIEF 2: Lower sodium intake associated with lower rates of cardiovascular diseases and mortality 

 

PETER:

A lower sodium intake was associated with lower rates of cardiovascular diseases and mortality –that was in research findings published in the journal Circulation. Participants in the study with urinary sodium excretion rates below 2,300 mg per 24-hours (the gold standard for measuring sodium intake) had a lower risk compared to those with urinary rates between 3,600 and 4,800 mg per 24h. 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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