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Statins may slow down the progression of multiple sclerosis

MD-FM Thursday October the 18th, 2012

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

PETER: Hello, and to begin with, news from the annual meeting of the European Committee for Treatment and Research in Multiple Sclerosis, ECTRIMS, which took place in France (in Lyon) last week: STATINS may slow down the progression of a subtype of MS…

SARAH: Yes: high-doses of statins reduced brain atrophy by roughly 40% and slowed the progression of disabilities for 2 years, in patients with secondary progressive MS:

Bob-Chataway-1: “For this group of secondary progressive multiple sclerosis, there is no proven treatment to reduce the rate of progression... So in summary we woud say this is very encouraging, it’s a phase 2 trial, one shouldn’t extrapolate into clinical practice, but it gives us, if you like, ammunition to go forward to do a definitive phase 3 trial”

SARAH: That was Dr. Chataway, from University College London Hospitals, who led the randomized trial, in which patients received 80 mg/day of simvastatin --so twice as much as what it used in practice to lower lipid levels. Listen to his comments on safety:

Bob-Chataway-2: “Statins per se are generally safe, they were safe in this trial, but it is well known that in high dose there can be occasional severe side effects --affecting the muscles, the kidneys and the liver. We didn’t see that in this trial and it was well tolerated but nonetheless this dose of drug was only applicable in a trial setting”

SARAH: Leaders at the ECTRIMS meeting said Dr. Chataway’s findings were encouraging, but that it was too soon to say that it is effective against this secondary progressive form of the disease. A phase III trial using clinical outcomes as primary endpoints is now expected.

PETER: More from ECTRIMS: interesting new data on the possibility of QUANTIFYING MS patients’ risk of developing progressive multifocal leukoencephalopathy (or “PML”) when taking natalizumab...

SARAH: Yes Peter – because not all patients have the same level of risk, even though they test positive for PML risk factors...

PETER: Which are?

SARAH: Testing positive for anti-JC virus antibodies, the prior use of immunosuppressants, and a treatment with natalizumab exceeding 2 years. Listen to Patrick Vermersch, from Lille University in France, speaking to us at the Lyon meeting:

Bob-Vermersch: “Patients with a very high level of antibodies against JCV: we are quite sure they are at high risk to develop PML after 2 years. We have another population with a low level of antibodies, and we think these patients are with a low risk to develop PML. We have a third population, and we observe progressively over time an increase of the titration of the antibodies against JCV. And we have some data suggesting that a progressive increase in the titer of the antibodies is also a risk to develop PML.
So in the near future, for neurologists who monitor patients on natazilumab, we would like to have not only positive or negative, but eventually in positive patients, a titration of the antibodies. And probably we will discuss the fact that in patients with a high number we need to stop the treatment, to continue to have a clear clinical vision in patients who are positive but with a stable low level, and if we observe an increase of their antibodies, we need perhaps to stop also the treatment.”

SARAH: Professor Vermersch, from Lille, was part of ECTRIMS’ scientific advisory committee this year.


PETER: Last piece of news from the ECTRIMS meeting: several presentations confirmed that chronic cerebrospinal venous insufficiency does not exist as a clinical entity, and that the treatments offered are dangerous and associated with significant morbidity in MS patients. The term was invented in 2008 to describe compromised flow of blood in the veins draining the central nervous system, some speculating it played a role in the cause or evolution of MS.

PETER: Findings on a controversial front: hormone replacement therapy may lower heart risks...

SARAH: Yes, women who started HTR during the early stages of their menopause --1 to 2 years after symptoms appear -- had a 50% reduced risk of heart attacks, heart failure and mortality at ten years. Also: HTR didn’t increase their risk for cancer or venous thromboembolism. These are the findings of a BMJ study including 1,000 newly menopausal women randomized to HRT or placebo, and followed for up to 10 years.

PETER: The benefits of HRT have been controversial since the early 2000s, when the Women's Health Initiative reported elevated risks of breast cancer and heart disease for women on HRT.

SARAH: Yes, but lead author of the study, Dr. Schierbeck, said the main reasons for the divergence in findings can probably be attributed to what is known as the “timing hypothesis”: HRT is beneficial when given during the early stages of menopause.

Bob Louison: “International groups on menopause and women’s health are working on new guidelines but, at least, I would say: if women are suffering from menopausal symptoms and they are still quite close to menopause, there’s really no need to be anxious of the side effects. Of course each women must be considered individually, but I believe the positive effects over-rule the possible negative effects”

SARAH: That was Dr. Louise Schierbeck, from Bispebjerg Hospital in Copenhagen, Denmark.

PETER: And… is everyone convinced?

SARAH: Well.. several experts said they would remain cautious about prescribing HRT long-term until more evidence piles up.


PETER: Patients who undergo bariatric surgery may be at increased risk for substance abuse following surgery…

SARAH: Yes, new findings report a composite risk for drug, alcohol and cigarette abuse. In particular: patients who undergo Roux-en-Y gastric bypass may be at particular risk of alcohol abuse, compared to those undergoing gastric banding. Listen to Alexis Conason, lead author of the Archives of Surgery study:

Bob Conason: “It makes kind of a J shape curve where, immediately following surgery, patients actually have a decrease in substance use, including alcohol use. They’re usually pretty strictly following the surgeon’s recommendations, they’ve just undergone this fairly major procedure, they’re often times feeling pretty sick and lousy. By three months it starts to increase, by one year it’s back around where they started and then it continues to go up between one and two years.”

SARAH: That was Dr. Conason, from Columbia University in New York. She said the increased risk was not associated to any subtype of eating behavior prior to surgery, such as binge-eating disorder -a hypothesis that was initially put forward. Rather, Dr. Conason speculated they could stem from the procedure itself:

Bob Conason: “We know from previous research that the Roux-en-Y gastric bypass produces changes in all kinds of things, including the hormones and the brain... I wonder if it’s also creating changes in the reward pathways, where the alcohol itself is becoming more rewarding to people following surgery.”  

SARAH: Again, that was Dr. Conason, who concluded more research is needed on that front, and that in the meantime, practitioners should follow patients who have undergone the procedure closely and long-term.

BREVE 1 Sur fond musical
PETER: Finally, in brief: Some hairstylists seem to be spontaneously educating their clients about skin cancer prevention. In an Archives of Dermatology study, 70% of hairstylists surveyed reported having already noticed a suspect skin lesion on a client, all of whom recommended the lesion be examined by a physician. These findings support the hypothesis that dermatologists could partner with salons to launch community-based skin cancer preventions campaigns.

And …..

Linezolid could become an option for patients with treatment-refractory extensively drug-resistant pulmonary tuberculosis. In a study published in the NEJM, 41 patients with sputum-culture–positive extensively drug-resistant tuberculosis, and who didn’t respond to other chemotherapeutic options, were randomly assigned to linezolid. 6 months after linezolid administration, 87% of them had a negative sputum culture. However, adverse events were frequent and significant.

That's all from MDFM for now. We'll be back next week


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Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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