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Physician's First Watch:
Medical News from Journal Watch
A free daily alert on current news that affects your practice — from medical journals, government agencies, scientific conferences, and major media reports.
June 19, 2013
When It Comes to Stroke Treatment, Just 15 Minutes Can Make a Difference
By Amy Orciari Herman
In patients with acute ischemic stroke, even small reductions in the time to thrombolytic therapy are associated with improved outcomes, according to a study in JAMA.
Using a national stroke registry, U.S. researchers examined outcomes among some 58,000 patients, at nearly 1400 hospitals, who received intravenous tissue plasminogen activator (tPA) within 4.5 hours after symptom onset. They found that with each 15-minute decrease in time to tPA therapy, patients were significantly less likely to die in the hospital or experience intracranial hemorrhage (odds ratio for each, 0.96). In addition, each 15-minute reduction was significantly associated with a greater likelihood to walk independently at discharge (OR, 1.04) and to be discharged home (OR, 1.03).
"These findings support intensive efforts to accelerate hospital presentation and thrombolytic treatment in patients with stroke," the researchers conclude.
LINK(S):
JAMA article (Free abstract)
Published in Physician's First Watch June 19, 2013
FDA Investigating Two Deaths Linked to Schizophrenia Drug
By Amy Orciari Herman
The FDA is investigating the deaths of two patients following injection of the long-acting antipsychotic olanzapine pamoate (Zyprexa Relprevv). The deaths occurred 3 to 4 days after injection, well beyond the 3-hour monitoring period that the drug requires.
Postmortem blood tests revealed very high levels of olanzapine. The drug's label includes a warning about post-injection delirium sedation syndrome, the FDA notes. This occurs when the drug enters the bloodstream too quickly, leading to sedation and possibly coma, as well as delirium. High doses can also lead to cardiopulmonary arrest and arrhythmias, according to the agency.
The FDA is reminding providers who prescribe olanzapine pamoate to follow its Risk Evaluation and Mitigation Strategy, which includes injection at a certified facility, at least 3 hours of monitoring following injection, and accompaniment to one's home afterward.
LINK(S):
FDA MedWatch safety alert (Free)
Published in Physician's First Watch June 19, 2013
Prenatal Exposure to Air Pollution Associated with Autism
By Kelly Young
Prenatal exposure to air pollution is associated with increased risk for autism spectrum disorders in childhood, according to a case-control study in Environmental Health Perspectives.
Using data from the Nurses' Health Study II, researchers matched 325 children with autism to 22,000 control children without autism. Contemporary EPA-modeled air pollution concentrations were identified for the children's addresses at birth.
After adjustment for socioeconomic status and other potential confounders, the highest quintile of exposures to diesel, lead, manganese, mercury, methylene chloride, and overall metals was associated with increased risk for autism spectrum disorders, compared with the lowest quintile (odds ratios, 1.5 to 2.0). The associations were stronger among boys than girls, but that may be related to the low number of girls with autism in the study, the authors note.
They conclude that the results "strongly support previous evidence of associations" between air pollution and autism spectrum disorders.
LINK(S):
Environmental Health Perspectives article (Free PDF)
Background: Journal Watch Pediatrics and Adolescent Medicine summary on traffic-related air pollution and autism (Your Journal Watch registration required)
Published in Physician's First Watch June 19, 2013
Breathing Easier: Smoking Down to 18% of U.S. Adults
By the Editors
The proportion of U.S. adults who identify themselves as smokers stands at 18%, according to 2012 data just released from the National Health Interview Survey.
That's down from nearly 25% in 1997, and almost a full percentage point lower than in 2011.
LINK(S):
CDC's National Center for Health Statistics data (Free PDF)
Published in Physician's First Watch June 19, 2013
MMR Booster Found Not to Increase Disease Activity in Juvenile Arthritis
By Joe Elia
Children with juvenile idiopathic arthritis who've undergone primary vaccination for measles, mumps, and rubella (MMR) do not risk an increase in arthritis activity after revaccination with a live attenuated booster, according to a JAMA study.
Researchers in the Netherlands randomized 130 patients to receive either booster vaccination or no revaccination; the children, aged 4 to 9, were followed for 1 year. (Those receiving biologic therapies, such as the tumor necrosis factor antagonist etanercept, suspended those treatments around the time of the booster.)
At 1 year, measures of arthritis disease activity did not differ significantly between the groups. In addition, children receiving the booster had higher antibody concentrations against MMR than did the controls.
The authors caution that few of the children were taking biologics, and more data would be needed to reassure safety in those cases. Also, they emphasize that the patients primarily had low disease activity.
LINK(S):
JAMA article (Free abstract)
Published in Physician's First Watch June 19, 2013
June 18, 2013
Statin Toxicity Associated with CYP3A4-Inhibiting Antibiotics
By Joe Elia
Higher rates of hospitalization for rhabdomyolysis occur among patients on statins who also start taking clarithromycin or erythromycin, which inhibit statin metabolism, according to an Annals of Internal Medicine study.
Using provincial databases, researchers examined 30-day outcomes among some 140,000 Ontario residents who were taking a statin metabolized by the cytochrome P450 isoenzyme 3A4 (CYP3A4). All participants were aged 66 or older. Roughly half were starting a prescription for the CYP3A4-inhibiting antibiotics clarithromycin or erythromycin, and the other half were starting azithromycin.
CYP3A4-inhibiting antibiotics were associated with a 0.02% increase in absolute risk for hospitalization with rhabdomyolysis, the study's primary outcome, compared with azithromycin (relative risk, 2.17). Increased risks for acute kidney injury and all-cause mortality were also noted.
The authors recommend that coprescribing a CYP3A4-metabolized statin (atorvastatin, simvastatin, or lovastatin) and a CYP3A4-inhibiting antibiotic (clarithromycin or erythromycin) "be avoided when possible."
LINK(S):
Annals of Internal Medicine study (Free abstract)
Published in Physician's First Watch June 18, 2013
Public Health Officials Urge Meningococcal Vaccination in MSM Ahead of NYC's Gay Pride
By Kelly Young
Several health departments are recommending that men who have sex with men (MSM) receive meningococcal vaccinations before traveling to New York City following an outbreak of invasive meningococcal disease there. The city is expecting as many as 1 million people to attend gay pride events at the end of June, public health experts note in the Annals of Internal Medicine.
Since 2010, 22 MSM have contracted invasive meningococcal disease in New York. Seven of those cases have been fatal. The city already recommends vaccination for all men who've had "intimate contact with a man met through an online Web site, digital application or at a bar or party." Over 11,000 people have been vaccinated, and there have been no new confirmed cases since February. Los Angeles, meanwhile, has had four cases since December.
The authors urge clinicians to be aware of the outbreak and discuss it with their MSM patients.
LINK(S):
Annals of Internal Medicine article (Free abstract)
New York City Department of Health and Mental Hygiene's website on meningococcal meningitis (Free)
Background: Journal Watch Infectious Diseases summary on meningitis outbreak (Your Journal Watch subscription required)
Published in Physician's First Watch June 18, 2013
Increases in Red Meat Intake Linked to Heightened Diabetes Risk
By Amy Orciari Herman
Adults who increase their consumption of red meat over several years significantly elevate their risk for type 2 diabetes, according to a JAMA study.
Some 150,000 U.S. health professionals regularly completed food-frequency questionnaires and reported their diabetes status. During nearly 2 million person-years of follow-up, 7540 were diagnosed with diabetes.
After multivariable adjustment, participants who increased their intake of red meat (beef, pork, or lamb) by one-half serving daily over a 4-year period had a significant, 48% increase in diabetes risk during the subsequent 4 years, relative to those whose consumption was stable. Further adjustment for weight gain attenuated the association, but the risk increase remained significant (30%).
A corresponding decrease in intake, on the other hand, conferred a significant, 14% risk reduction, although the effect didn't become apparent until after 12 to 16 years.
A commentator points out that the culprit is the saturated fat content of the meat — not the type of meat.
LINK(S):
JAMA Internal Medicine article (Free abstract)
JAMA Internal Medicine comment (Subscription required)
Published in Physician's First Watch June 18, 2013
Supreme Court Says Drug Makers Can Be Sued for Agreements That Delay Generics
By Kelly Young
Drug makers can be sued by federal regulators for so-called "pay-for-delay" deals, the U.S. Supreme Court ruled Monday in a 5-to-3 vote.
These agreements had allowed brand-name drug manufacturers to pay generic drug companies to delay releasing the cheaper versions to market. Now, brand-name manufacturers could face charges of antitrust violations for such agreements.
The New York Times reports that with the Supreme Court ruling, consumers could benefit from "sharply lower" drug prices.
LINK(S):
U.S. Supreme Court opinion (Free PDF)
New York Times story (Free)
Background: Physician's First Watch coverage of oral arguments (Free)
Published in Physician's First Watch June 18, 2013
