New in Medicine Issue XXVIII
I. Drugs
Assessment of combination therapy responses in early rheumatoid arthritis defined by
presence or absence of anti- citrullinated protein antibodies (ACPA)
Source: The Lancet, February 14
Link: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60358-5/fulltext
In the study, combination DMARDs (disease-modifying anti-rheumatic drugs) and
corticosteroids provided radiological, disease activity, and physical health benefits only to
patients with ACPA-positive early rheumatoid arthritis. These findings suggest that ACPA is
an important biomarker for guiding treatment decisions in rheumatoid arthritis. They
indicate that current guidelines advocating combination DMARDs and corticosteroids in all
patients with early active disease might require reconsideration.
Trimethoprim- sulfamethoxazole (TMP-SMX) versus trimethoprim- sulfamethoxazole plus
doxycycline as oral eradicative treatment for melioidosis
Source: The Lancet, March 14
Link: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61951-0/fulltext
TMP-SMX is not inferior to TMP-SMX plus doxycycline for the oral phase of melioidosis
treatment, and is preferable on the basis of safety and tolerance by patients.
Effects of adjuvant exemestane versus anastrozole on bone mineral density for women
with early breast cancer
Source: The Lancet, March 14
Link: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70035-X/fulltext
The results demonstrate that adjuvant treatment with aromatase inhibitors can be
considered for breast cancer patients who have T-scores less than −2·0.
Effect of 13-valent pneumococcal conjugate vaccine on admissions to hospital 2 years
after its introduction in the USA
Source: The Lancet, March 14
Link: http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70032-3/fulltext
Only 2 years into the US programme, PCV13 significantly reduced residual invasive and noninvasive pneumococcal hospital admissions in children younger than 5 years, as well as in
some adult age groups. The study design captured the total prevented hospital burden
(directly and indirectly by herd protection) and also showed a reversal of the PCV7 era
increase in paediatric empyema related to strain replacement.
Atacicept in multiple sclerosis
Source: The Lancet, March 14
Link: http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70028-6/fulltext
Increased clinical disease activity associated with atacicept suggests that the role of B cells
and humoral immunity in multiple sclerosis is complex. For studies that explore therapeutic
immuno-modulation in multiple sclerosis, rigorous monitoring for negative effects on clinical
and MRI outcomes is warranted.
Boceprevir Contraindications
Source: JAMA, February 14
Link: http://jama.jamanetwork.com/article.aspx?articleid=1832521&resultClick=3
The hepatitis C medication boceprevir may have harmful interactions with calcium channel
blockers and α1-adrenoreceptor antagonists, according to changes to the drug’s label
recently approved by the US Food and Drug Administration (FDA).
FDA Asks Physicians to Stop Prescribing High-Dose Acetaminophen Products
Source: JAMA, February 14
Link: http://jama.jamanetwork.com/article.aspx?articleid=1829680&resultClick=3
After only limited success in persuading drug manufacturers to reduce the amount of the
painkiller acetaminophen in prescription combination products, the US Food and Drug
Administration (FDA) has now called on physicians to avoid prescribing these products if the
acetaminophen content is too high. Liver failure, a need for liver transplantation, or death
can occur when individuals exceed a certain daily dosage.
Idelalisib and Rituximab in Relapsed Chronic Lymphocytic Leukemia (CLL)
Source: NEJM, March 14
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1315226
The combination of idelalisib and rituximab, as compared with placebo and rituximab,
significantly improved progression-free survival, response rate, and overall survival among
patients with relapsed CLL who were less able to undergo chemotherapy.
An Inactivated Enterovirus 71 (EV71) Vaccine in Healthy Children
Source: NEJM, February 14
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1303224
The inactivated EV71 vaccine elicited EV71-specific immune responses and protection
against EV71-associated hand, foot, and mouth disease.
Improved Survival with Bevacizumab in Advanced Cervical Cancer
Source: NEJM, February 14
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1309748
The addition of bevacizumab to combination chemotherapy in patients with recurrent,
persistent, or metastatic cervical cancer was associated with an improvement of 3.7 months
in median overall survival.
Victory Over Polio
Link: http://ehealth.eletsonline.com/2014/02/victory-over-polio/
India, long one of the biggest sources of the paralysing virus, has gone three years without a
new case, which means it will soon be certified as having wiped out the scourge. On the
three-year anniversary of the last case, on January 13, Health Minister Ghulam Nabi Azad
hailed the “monumental milestone” and promised a celebration in honour of the officials,
volunteers, NGOs and UN agencies which made it possible.
II. Clinical Research
Efficacy of a monovalent human-bovine (116E) rotavirus vaccine in Indian infants
Source: The Lancet, March 14
Link: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62630-6/fulltext
Monovalent human-bovine (116E) rotavirus vaccine is effective and well tolerated in Indian
infants.
Clinical validity of circulating tumour cells (CTC) in patients with metastatic breast cancer:
a pooled analysis of individual patient data
Source: The Lancet, March 14
Link: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70069-5/fulltext
The data confirm the independent prognostic effect of CTC count on progression-free
survival and overall survival. CTC count also improves the prognostication of metastatic
breast cancer when added to full clinico- pathological predictive models, whereas serum
tumour markers do not.
Assessment of Mycobacterium tuberculosis transmission in Oxfordshire, UK, 2007–12,
with whole pathogen genome sequences
Source: The Lancet, March 14
Link: http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70027-X/fulltext
Although inward migration has contributed to the overall tuberculosis incidence, our
findings suggest that most patients born in high-incidence countries reactivate latent
infection acquired abroad and are not involved in local onward transmission. Systematic
screening of new entrants could further improve tuberculosis control, but it is important
that health care remains accessible to all individuals, especially high-risk groups, if
tuberculosis control is not to be jeopardised.
Effect of oral cladribine on time to conversion to clinically definite multiple sclerosis (MS)
in patients with a first demyelinating event
Source: The Lancet, March 14
Link: http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70005-5/fulltext
Both doses of cladribine significantly delayed MS diagnosis compared with placebo. The
safety profile of cladribine was similar to that noted in a trial in patients with relapsingremitting MS. Further research could clarify the potential effects of oral cladribine
treatment in the early stages of MS.
Ionising radiation-free whole-body MRI versus 18F-fluorodeoxyglucose PET/CT scans for
children and young adults with cancer
Source: The Lancet, March 14
Link: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70021-X/fulltext
Ferumoxytol-enhanced whole-body diffusion-weighted MRI could be an alternative to 18FFDG PET/CT for staging of children and young adults with cancer that is free of ionising
radiation. This new imaging test might help to prevent long-term side-effects from
radiographic staging procedures.
Hypercaloric enteral nutrition in patients with amyotrophic lateral sclerosis
Source: The Lancet, February 14
Link: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60222-1/fulltext
The results provide preliminary evidence that hypercaloric enteral nutrition is safe and
tolerable in patients with amyotrophic lateral sclerosis, and support the study of nutritional
interventions in larger randomised controlled trials at earlier stages of the disease.
Comparison of 2 Transvaginal Surgical Approaches and Perioperative Behavioral Therapy
for Apical Vaginal Prolapse
Source: JAMA, March 14
Link: https://jama.jamanetwork.com/article.aspx?articleid=1840237
Two years after vaginal surgery for prolapse and stress urinary incontinence, neither ULS nor
SSLF was significantly superior to the other for anatomic, functional, or adverse event
outcomes. Perioperative BPMT did not improve urinary symptoms at 6 months or prolapse
outcomes at 2 years.
Constitutive Activation of PKA (protein kinase A) Catalytic Subunit in Adrenal Cushing's
Syndrome
Source: NEJM, March 14
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1310359
Genetic alterations of the catalytic subunit of PKA were found to be associated with human
disease. Germline duplications of this gene resulted in bilateral adrenal hyperplasias,
whereas somatic PRKACA mutations resulted in unilateral cortisol-producing adrenal
adenomas.
Mutant Adenosine Deaminase 2 (ADA2) in a Polyarteritis Nodosa Vasculopathy
Source: NEJM, March 14
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1307362
Recessive loss-of-function mutations of ADA2, a growth factor that is the major extracellular
adenosine deaminase, can cause polyarteritis nodosa vasculopathy with highly varied
clinical expression.
Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer
Source: NEJM, March 14
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1311593
Extended follow-up confirmed a substantial reduction in mortality after radical
prostatectomy; the number needed to treat to prevent one death continued to decrease
when the treatment was modified according to age at diagnosis and tumor risk. A large
proportion of long-term survivors in the watchful-waiting group have not required any
palliative treatment.
Gene Editing of CCR5 in Autologous CD4 T Cells of Persons Infected with HIV
Source: NEJM, March 14
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1300662
CCR5 is the major coreceptor for human immunodeficiency virus (HIV). Researchers
investigated whether site-specific modification of the gene (“gene editing”) — in this case,
the infusion of autologous CD4 T cells in which the CCR5 gene was rendered permanently
dysfunctional by a zinc-finger nuclease (ZFN) — is safe. The conclusion is CCR5-modified
autologous CD4 T-cell infusions are safe within the limits of this study.
III. Devices
New Nanoparticles Target Tumors, Release Killer Protein, Activate Immune System to Kill
Cancer
Link: http://www.medgadget.com/2014/03/new-nanoparticles-target-tumors-release-killerprotein-activate-immune-system-to-kill-cancer.html
The nanoparticles ferry interleukin-2 (IL -2), a protein that’s normally produced by the Tcells of the immune system to differentiate between foreign material and the body itself,
and to direct the actions of white blood cells. It has also been used in various therapies to
kill cancer cells.
Toshiba’s CT Myocardial Perfusion Imaging Technology FDA Cleared
Link:http://www.medgadget.com/2014/03/toshibas-ct-myocardial-perfusion-imagingtechnology-fda-cleared.html
Toshiba received FDA clearance to introduce its CT Myocardial Perfusion technology, now
being made available on the company’s flagship CT scanners, the Aquilion ONE and Aquilion
ONE ViSION Edition. CT Myocardial Perfusion allows the diagnosis of myocardial ischemia by
visualizing the flow of blood within the coronary vasculature.
Thermal-Electric Microfluidic Device Measures, Counts Microparticles
Link: http://www.medgadget.com/2014/03/thermal-electric-microfluidic-device-measurescounts-microparticles.html
Clinicians and medical researchers count and measure microparticles to identify pathogens,
spot cancer cells, and monitor how effective various therapies are at the cellular level.
Particle counters that measure the size of objects normally use a beam of light and light
sensors to identify objects, but researchers at North Carolina State University developed a
brand new method that uses changes in heat to identify particle size.
Boston Scientific’s REBEL Bare Chromium Coronary Stent CE Marked in Europe
Link:http://www.medgadget.com/2014/03/boston-scientifics-rebel-bare-chromiumcoronary-stent-ce-marked-in-europe.html
Boston Scientific received European regulatory approval for its bare metal REBEL Platinum
Chromium Coronary Stent System for treatment of coronary artery disease. The stent is
essentially the Promus PREMIER but without the everolimus drug coating.
Cayenne Mirror Unicompartmental Partial Knee Replacement System Released
Link:http://www.medgadget.com/2014/03/cayenne-mirror-unicompartmental-partial-kneereplacement-system-released.html
Cayenne Medical out of Scottsdale, Arizona just announced a launch of its Mirror partial
knee replacement system. The implant is surgically introduced using a
new unicompartmental procedure, hopefully restoring confidence in this approach among
orthopedic surgeons.
Google Glass Coming to Rhode Island Emergency Room to Help Diagnose Skin Conditions
Link:http://www.medgadget.com/2014/03/google-glass-coming-to-rhode-islandemergency-room-to-help-diagnose-skin-conditions.html
An ER doc will wear Google Glass while talking to the dermatologist who will be seeing a live
picture of what the ER doc is seeing. The dermatologist will be able to guide any appropriate
exams and will have the opportunity to make a diagnosis or determine a further course of
action.
Timesulin for Easy Tracking of Insulin Pen Injections
Link:http://www.medgadget.com/2014/03/timesulin-for-easy-tracking-of-insulin-peninjections.html
The Timesulin is a replacement cap for many insulin pens currently being used by diabetics
that simply displays how much time passed since the last injection. It features a sensor that
detects when the cap is removed and starts a clock on the face of the cap that shows the
time elapsed. There are no buttons on the device and there’s nothing to do except to snap it
onto the insulin pen to activate it.
FluidVision Accomodating Lens Implant Automatically Adjusts Focus of Eye
Link: http://www.medgadget.com/2014/03/fluidvision-lens.html
The FluidVision implant harnesses the natural forces the eye produces to move fluid in and
out of its lens. This allows the lens to change its thickness and so its refractive power. The
device is implanted using the same techniques as any other intraocular lens.
CareFusion’s V. Mueller New Line of Bipolar Electrosurgical Tools
Link:http://www.medgadget.com/2014/03/carefusions-v-mueller-new-line-of-bipolarelectrosurgical-tools.html
The bipolar energy delivery to the instrument through a single cord allows for less damage
to nearby tissue while preventing cords from tangling around each other and allowing
surgeons easier access around the surgical site.
IV. Treatment Guidelines
Osteoarthritis: Care and management in adults
Link: http://www.nice.org.uk/nicemedia/live/14383/66527/66527.pdf
This guideline update was originally intended to include recommendations based on a
review of new evidence about the use of paracetamol, etoricoxib and fixed-dose
combinations of NSAIDs (non-steroidal anti-inflammatory drugs) plus gastroprotective
agents in the management of osteoarthritis.
Psychosis and schizophrenia in adults: treatment and management
Link: http://www.nice.org.uk/nicemedia/live/14382/66534/66534.pdf
This guideline covers the treatment and management of psychosis and schizophrenia and
related disorders in adults (18 years and older) with onset before 60 years. It offers evidencebased advice on the care of adults with psychosis and schizophrenia.