Poniedziałek, 22 Listopad 2010

Clinical Conversations interviews Dr. Harlan Krumholz, editor of Journal Watch Cardiology and CardioExchange, about the happenings at last week's American Heart Association meeting in Chicago. Dr. Krumholz comments on studies examining the experimental drug anacetrapib, kidney denervation in hypertensive patients, and rivaroxaban versus warfarin, among others.

Poniedziałek, 22 Listopad 2010

The FDA has approved denosumab (marketed as Xgeva) for the prevention of fracture and bone pain in patients with cancer that has metastasized to the bone. The drug, given as a once-monthly injection, is a monoclonal antibody to RANKL, a protein necessary for osteoclast formation, function, and survival. Its most serious side effects include hypocalcemia and osteonecrosis of the jaw.

Poniedziałek, 22 Listopad 2010

Ezetimibe/simvastatin (marketed as Vytorin) lowers the risk for major vascular events in patients with chronic kidney disease, according to an industry-funded, multicenter study presented over the weekend at the American Society of Nephrology's annual meeting. The SHARP study, which enrolled nearly 9500 adults with chronic kidney disease, found that the incidence of myocardial infarction, cardiac death, stroke, or revascularization over roughly 5 years' follow-up was significantly lower in patients randomized to ezetimibe/simvastatin than in those assigned to placebo (absolute difference between the groups, 3%). The difference was driven mainly by reductions in nonhemorrhagic stroke and revascularization procedures.

Poniedziałek, 22 Listopad 2010

Proteinuria and low estimated glomerular filtration rate (eGFR) should both be considered when assessing a patient's risk for — and prognosis after — acute kidney injury, according to a large study presented at the American Society of Nephrology's annual meeting and published online in the Lancet. Among more than 900,000 adults in Canada tracked for some 35 months, risk for acute kidney injury requiring hospital admission or dialysis increased with increases in proteinuria alone and with decreases in eGFR alone; heavy proteinuria plus low eGFR conferred the highest risk. In turn, acute kidney injury was associated with increased mortality at all levels of proteinuria and eGFR, but particularly in patients with heavy proteinuria and normal eGFR.

Poniedziałek, 22 Listopad 2010

The FDA is requesting that manufacturers of the painkiller propoxyphene pull the drug from the market because of concerns over cardiotoxicity. (Propoxyphene is marketed alone as Darvon and combined with acetaminophen as Darvocet.) The agency's request is based on data showing that, even when taken at therapeutic doses, the drug can lead to potentially dangerous changes in the heart's electrical activity, including prolonged PR and QT intervals and widened QRS complex.

Piątek, 19 Listopad 2010

The CDC has updated its 2002 guidelines on the prevention of group B streptococcus (GBS) transmission to infants during labor. The recommendations appear in MMWR.

Piątek, 19 Listopad 2010

Acute gastroenteritis due to E. coli O157:H7 seems associated with increased long-term risk for hypertension and other cardiorenal complications, according to a BMJ study of a large Canadian outbreak. Researchers tracked some 2000 adults whose well water was contaminated with livestock waste during flooding. About half the cohort reported symptoms compatible with gastroenteritis; both E. coli O157:H7 and Campylobacter species were widely recovered from stool samples taken at the time of the incident.

Czwartek, 18 Listopad 2010

This week, Journal Watch Cardiology and Physician's First Watch have brought you breaking news from the American Heart Association meeting in Chicago. Please have a look (most of the studies were presented at the meeting and published in peer-reviewed journals at the same time):

Czwartek, 18 Listopad 2010

Anacetrapib, a cholesteryl ester transfer protein inhibitor, had "robust effects" on LDL and HDL cholesterol levels in an industry-funded, phase III study presented Wednesday at the American Heart Association meeting and published in the New England Journal of Medicine. Some 1600 adults who were already taking statins were randomized to receive 100 mg of anacetrapib or placebo daily for 18 months. At 6 months, the mean LDL level had dropped from 81 to 45 mg/dL with anacetrapib, compared with a drop from 82 to 77 mg/dL with placebo. Similarly, mean HDL increased significantly more with the drug (from 41 to 101 mg/dL) than with placebo (40 to 46 mg/dL).

Czwartek, 18 Listopad 2010

A perspective in the New England Journal of Medicine outlines the FDA's plans for addressing the growing problem of opioid abuse and unintentional overdose. The FDA has been revising its proposed Risk Evaluation and Mitigation Strategy (REMS) after an advisory group voted in July that the plan wasn't strict enough. The group recommended mandatory training for prescribing physicians in the appropriate use of opioids. The FDA proposed limiting the REMS to long-acting and extended-release opioids, but some advisors wanted the REMS to cover all opioids.

Czwartek, 18 Listopad 2010

Catheter-based renal denervation dramatically lowers blood pressure in uncontrolled hypertension, according to a manufacturer's study in the Lancet that was presented at the American Heart Association meeting. Researchers randomized 100 patients either to radiofrequency ablation of the renal nerves (plus continuation of usual medications) or to the medications alone. All patients had systolic pressures of at least 160 mm Hg (150 for those with diabetes). By 6 months, average systolic blood pressure in the intervention group had dropped by 32 mm Hg; it remained unchanged in controls.

środa, 17 Listopad 2010

This week, Journal Watch Cardiology and Physician's First Watch has been bringing you breaking news from the American Heart Association meeting in Chicago. Please have a look (most of the studies were presented at the meeting and published in peer-reviewed journals at the same time):

środa, 17 Listopad 2010

Remote telemonitoring of patients recently discharged for heart failure has no benefit, according to a 6-month study in the New England Journal of Medicine presented at the American Heart Association meeting. A research group that had found a mortality and hospital-readmission benefit in an earlier, smaller study reexamined the question in a large nationwide study. Nearly 1700 patients discharged for heart failure were randomized to either usual care or telemonitoring. Intervention patients were asked to call in daily, using a touch-tone pad to deliver information on weight and symptoms. Clinicians would follow-up on any variance from expected results.

Wtorek, 16 Listopad 2010

This week, Journal Watch Cardiology and Physician's First Watch will be bringing you breaking news from the American Heart Association meeting in Chicago. Please have a look (most of the studies were presented at the meeting and published in peer-reviewed journals at the same time):

Wtorek, 16 Listopad 2010

Eribulin mesylate (marketed as Halaven) has been approved for the treatment of metastatic breast cancer, the FDA announced on Monday. The drug is intended for patients who have already received at least two regimens of chemotherapy for late-stage disease. Approval for the injectable drug — a microtubule inhibitor that limits growth of cancer cells — was based on a study of some 760 women in which those who received eribulin had better overall survival than those who received a different single-agent therapy (median survival, 13.1 months vs. 10.6 months).

Wtorek, 16 Listopad 2010

Rivaroxaban may be an effective alternative to warfarin in prevention of stroke and emboli in patients with atrial fibrillation, according to the ROCKET AF trial, whose results were presented at the annual American Heart Association meeting on Monday. Roughly 14,000 patients with atrial fibrillation not related to heart valve dysfunction were randomized to receive either warfarin or oral rivaroxaban (20 mg/day), an experimental drug that targets clotting factor Xa. Patients were treated for an average of 19 months.

Wtorek, 16 Listopad 2010

Drugs with high copayments are most likely to be left at the pharmacy, according to an Annals of Internal Medicine study. Using databases from a large retail pharmacy chain and a pharmacy benefits manager, U.S. researchers examined factors associated with prescription abandonment over a 3-month period. Of more than 10 million prescriptions bottled, 1.8% were abandoned at the pharmacy.

Poniedziałek, 15 Listopad 2010

This week, Journal Watch Cardiology and Physician's First Watch will be bringing you breaking news from the American Heart Association meeting in Chicago. Please have a look (most of the studies were presented at the meeting and published in peer-reviewed journals at the same time).

Poniedziałek, 15 Listopad 2010

Use of a device that performs both cardiac resynchronization therapy (CRT) and defibrillation reduces mortality even more than defibrillator therapy alone in patients with mild-to-moderate heart failure and a wide QRS complex, researchers reported yesterday in the New England Journal of Medicine and at the American Heart Association 2010 Scientific Sessions. Some 1800 patients (with New York Heart Association class II or III disease and left-ventricular ejection fractions of 30% or less) were randomized to receive a defibrillator with or without CRT in the manufacturer-supported study. During more than 3 years of follow-up, the rates of all-cause mortality and heart-failure hospitalizations — the composite primary outcome — were significantly lower with than without CRT. Those with mild versus moderate heart failure benefited similarly.

Piątek, 12 Listopad 2010

The FDA has approved tesamorelin (Egrifta) to treat HIV-infected patients with lipodystrophy, a side effect of many antiretroviral agents. The drug, a growth hormone-releasing factor, is given once daily as an injection. Approval was based on two clinical trials, comprising some 800 patients, in which those treated with tesamorelin had greater reductions in abdominal fat than those treated with placebo. The most common adverse effects were arthralgia, stomach pain, swelling, myalgia, and erythema and pruritus at the injection site.