Recurrent serious infections are relatively common among individuals with rheumatoid arthritis, particularly in the first year after an infection, according to findings from a study of the British Society for Rheumatology Biologics Register–Rheumatoid Arthritis.

Sujith Subesinghe, MBBS, from the academic department of rheumatology at King’s College London and his coauthors identified 5,289 individuals from the registry who had experienced at least one episode of serious infection. All patients were also on either conventional synthetic disease-modifying antirheumatic drugs (DMARDs) or biologic DMARDs at the time of their index infection.

TongRo Images/Thinkstock

“It has been shown previously that a history of SI [serious infection] is a strong predictor of subsequent SI, but what has not been shown before is that the organ class of the index event has a large impact on the likelihood of recurrent SI,” the authors wrote.

Each decade of increased age was associated with a 34% increase in risk of recurrent infection. Noting that multiple drug use was a surrogate measure of comorbidity at baseline, researchers found that individuals taking 6-10 drugs at baseline had a 26% increased risk for recurrent infection, while those treated with 11 or more drugs had a 74% increased risk.

The authors observed that baseline steroid use was higher among patients suffering sepsis, compared with other types of serious infection.

They observed that, although a strong association between serious infection and steroid use has been reported, no firm conclusions have been reached by systematic reviews or meta-analyses “Steroids are more likely to be prescribed to patients with more aggressive, recalcitrant disease; this group has a higher baseline infection risk, and therefore, there is potential for confounding by indication.”

However, baseline disease activity score, disease duration, seropositivity, and smoking did not significantly predict the likelihood of infection recurrence, despite the fact that these are traditional predictors of infection. The authors suggested this may be the result of a form of selection bias.

“Patients readmitted with SI were from an already at-risk group and therefore lack of association between traditional predictors of infection and recurrent SI may be spurious.”

Commenting on their findings, the authors observed that individuals with rheumatoid arthritis and a history of infection were a complex group to manage, and even small differences in relative infection risk with different biologics may become significant.

“Further research needs to be undertaken to understand the patterns of recurrent infection and to appreciate the nuances in differential infection profiles of immunosuppressive drugs, to promote safe therapeutic decisions and promote personalization of care.”

The study was supported by the British Society for Rheumatology. Two authors declared speaking fees or honoraria from the pharmaceutical industry.

[email protected]

SOURCE: Subesinghe S et al. Rheumatology [Oxford]. 2018 Jan 10. doi: 10.1093/rheumatology/kex469.

Recurrent serious infections are relatively common among individuals with rheumatoid arthritis, particularly in the first year after an infection, according to findings from a study of the British Society for Rheumatology Biologics Register–Rheumatoid Arthritis.

Sujith Subesinghe, MBBS, from the academic department of rheumatology at King’s College London and his coauthors identified 5,289 individuals from the registry who had experienced at least one episode of serious infection. All patients were also on either conventional synthetic disease-modifying antirheumatic drugs (DMARDs) or biologic DMARDs at the time of their index infection.

TongRo Images/Thinkstock

“It has been shown previously that a history of SI [serious infection] is a strong predictor of subsequent SI, but what has not been shown before is that the organ class of the index event has a large impact on the likelihood of recurrent SI,” the authors wrote.

Each decade of increased age was associated with a 34% increase in risk of recurrent infection. Noting that multiple drug use was a surrogate measure of comorbidity at baseline, researchers found that individuals taking 6-10 drugs at baseline had a 26% increased risk for recurrent infection, while those treated with 11 or more drugs had a 74% increased risk.

The authors observed that baseline steroid use was higher among patients suffering sepsis, compared with other types of serious infection.

They observed that, although a strong association between serious infection and steroid use has been reported, no firm conclusions have been reached by systematic reviews or meta-analyses “Steroids are more likely to be prescribed to patients with more aggressive, recalcitrant disease; this group has a higher baseline infection risk, and therefore, there is potential for confounding by indication.”

However, baseline disease activity score, disease duration, seropositivity, and smoking did not significantly predict the likelihood of infection recurrence, despite the fact that these are traditional predictors of infection. The authors suggested this may be the result of a form of selection bias.

“Patients readmitted with SI were from an already at-risk group and therefore lack of association between traditional predictors of infection and recurrent SI may be spurious.”

Commenting on their findings, the authors observed that individuals with rheumatoid arthritis and a history of infection were a complex group to manage, and even small differences in relative infection risk with different biologics may become significant.

“Further research needs to be undertaken to understand the patterns of recurrent infection and to appreciate the nuances in differential infection profiles of immunosuppressive drugs, to promote safe therapeutic decisions and promote personalization of care.”

The study was supported by the British Society for Rheumatology. Two authors declared speaking fees or honoraria from the pharmaceutical industry.

[email protected]

SOURCE: Subesinghe S et al. Rheumatology [Oxford]. 2018 Jan 10. doi: 10.1093/rheumatology/kex469.

Recurrent serious infections are relatively common among individuals with rheumatoid arthritis, particularly in the first year after an infection, according to findings from a study of the British Society for Rheumatology Biologics Register–Rheumatoid Arthritis.

Sujith Subesinghe, MBBS, from the academic department of rheumatology at King’s College London and his coauthors identified 5,289 individuals from the registry who had experienced at least one episode of serious infection. All patients were also on either conventional synthetic disease-modifying antirheumatic drugs (DMARDs) or biologic DMARDs at the time of their index infection.

TongRo Images/Thinkstock

“It has been shown previously that a history of SI [serious infection] is a strong predictor of subsequent SI, but what has not been shown before is that the organ class of the index event has a large impact on the likelihood of recurrent SI,” the authors wrote.

Each decade of increased age was associated with a 34% increase in risk of recurrent infection. Noting that multiple drug use was a surrogate measure of comorbidity at baseline, researchers found that individuals taking 6-10 drugs at baseline had a 26% increased risk for recurrent infection, while those treated with 11 or more drugs had a 74% increased risk.

The authors observed that baseline steroid use was higher among patients suffering sepsis, compared with other types of serious infection.

They observed that, although a strong association between serious infection and steroid use has been reported, no firm conclusions have been reached by systematic reviews or meta-analyses “Steroids are more likely to be prescribed to patients with more aggressive, recalcitrant disease; this group has a higher baseline infection risk, and therefore, there is potential for confounding by indication.”

However, baseline disease activity score, disease duration, seropositivity, and smoking did not significantly predict the likelihood of infection recurrence, despite the fact that these are traditional predictors of infection. The authors suggested this may be the result of a form of selection bias.

“Patients readmitted with SI were from an already at-risk group and therefore lack of association between traditional predictors of infection and recurrent SI may be spurious.”

Commenting on their findings, the authors observed that individuals with rheumatoid arthritis and a history of infection were a complex group to manage, and even small differences in relative infection risk with different biologics may become significant.

“Further research needs to be undertaken to understand the patterns of recurrent infection and to appreciate the nuances in differential infection profiles of immunosuppressive drugs, to promote safe therapeutic decisions and promote personalization of care.”

The study was supported by the British Society for Rheumatology. Two authors declared speaking fees or honoraria from the pharmaceutical industry.

[email protected]

SOURCE: Subesinghe S et al. Rheumatology [Oxford]. 2018 Jan 10. doi: 10.1093/rheumatology/kex469.

Inotuzumab ozogamicin appeared active and safe when added to reduced-intensity chemotherapy for older patients with Philadelphia chromosome–negative acute lymphoblastic leukemia, according to the results of a single-arm phase 2 study.

After a median follow-up of 29 months, 2-year progression-free survival was 59% with a median of 25 months for 52 patients with newly diagnosed disease who were aged 60 years or older, Hagop Kantarjian, MD, and his associates reported online in the Lancet Oncology.

Nearly every patient experienced an overall response (98%). The treatment also appeared to be safe, Dr. Kantarjian and associates wrote.

They reported that no patient died within 4 weeks of treatment and that four patients experienced veno-occlusive disease. Common grade 3 or 4 side effects included thrombocytopenia (81%), consolidation chemotherapy (69%), hyperglycemia (54%), infections during induction (52%), hypokalemia (31%), increased aminotransferases (19%), hyperbilirubinemia (17%), and hemorrhage (15%). Six patients died from treatment-related side effects, five of whom died from sepsis and one of whom died as a result of veno-occlusive disease.

Inotuzumab ozogamicin is an anti-CD22 monoclonal antibody that is bound to the toxin calicheamicin. It has shown “substantial improvements” for some patient subgroups when added to hyper-CVAD chemotherapy (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and high-dose cytarabine); however, older patients have yet to experience a similar benefit, Dr. Kantarjian and his associates said.

Both CVAD and inotuzumab ozogamicin have shown to be quite toxic for older patients. So – in order limit increased toxicity – Dr. Kantarjian and his associates lowered the intensity of hyper-CVAD. They accomplished this by reducing some aspects of the regimen by up to 50% and eliminating anthracyclines altogether. The researchers referred to this regimen as “mini–hyper-CVD.” The mini–hyper-CVD did not appear to impact activity.

“In our study, activity did not appear to be compromised by the use of lower-intensity chemotherapy in combination with a novel monoclonal antibody,” they wrote.

Dr. Kantarjian and his associates noted that, while they observed fewer deaths compared with previously published data, the number of deaths they did observe in patients who achieved a complete response was high.

They suggested that modifications to the regimen could further improve safety and that such modifications required further research.

For the time being, however, the researchers noted that this low-intensity regimen, in combination in inotuzumab ozogamicin, is highly effective and that these data now require prospective confirmation in a randomized, phase 3 setting.

The study was funded by the MD Anderson Cancer Center. Researchers reported that Pfizer provided inotuzumab ozogamicin free of charge and that Dr. Kantarjian and two other researchers received grants from Pfizer.

SOURCE: Kantarjian H et al. Lancet Oncol. 2018 Jan 15. doi: 10.1016/S1470-2945(18)30011-1.

Inotuzumab ozogamicin appeared active and safe when added to reduced-intensity chemotherapy for older patients with Philadelphia chromosome–negative acute lymphoblastic leukemia, according to the results of a single-arm phase 2 study.

After a median follow-up of 29 months, 2-year progression-free survival was 59% with a median of 25 months for 52 patients with newly diagnosed disease who were aged 60 years or older, Hagop Kantarjian, MD, and his associates reported online in the Lancet Oncology.

Nearly every patient experienced an overall response (98%). The treatment also appeared to be safe, Dr. Kantarjian and associates wrote.

They reported that no patient died within 4 weeks of treatment and that four patients experienced veno-occlusive disease. Common grade 3 or 4 side effects included thrombocytopenia (81%), consolidation chemotherapy (69%), hyperglycemia (54%), infections during induction (52%), hypokalemia (31%), increased aminotransferases (19%), hyperbilirubinemia (17%), and hemorrhage (15%). Six patients died from treatment-related side effects, five of whom died from sepsis and one of whom died as a result of veno-occlusive disease.

Inotuzumab ozogamicin is an anti-CD22 monoclonal antibody that is bound to the toxin calicheamicin. It has shown “substantial improvements” for some patient subgroups when added to hyper-CVAD chemotherapy (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and high-dose cytarabine); however, older patients have yet to experience a similar benefit, Dr. Kantarjian and his associates said.

Both CVAD and inotuzumab ozogamicin have shown to be quite toxic for older patients. So – in order limit increased toxicity – Dr. Kantarjian and his associates lowered the intensity of hyper-CVAD. They accomplished this by reducing some aspects of the regimen by up to 50% and eliminating anthracyclines altogether. The researchers referred to this regimen as “mini–hyper-CVD.” The mini–hyper-CVD did not appear to impact activity.

“In our study, activity did not appear to be compromised by the use of lower-intensity chemotherapy in combination with a novel monoclonal antibody,” they wrote.

Dr. Kantarjian and his associates noted that, while they observed fewer deaths compared with previously published data, the number of deaths they did observe in patients who achieved a complete response was high.

They suggested that modifications to the regimen could further improve safety and that such modifications required further research.

For the time being, however, the researchers noted that this low-intensity regimen, in combination in inotuzumab ozogamicin, is highly effective and that these data now require prospective confirmation in a randomized, phase 3 setting.

The study was funded by the MD Anderson Cancer Center. Researchers reported that Pfizer provided inotuzumab ozogamicin free of charge and that Dr. Kantarjian and two other researchers received grants from Pfizer.

SOURCE: Kantarjian H et al. Lancet Oncol. 2018 Jan 15. doi: 10.1016/S1470-2945(18)30011-1.

Inotuzumab ozogamicin appeared active and safe when added to reduced-intensity chemotherapy for older patients with Philadelphia chromosome–negative acute lymphoblastic leukemia, according to the results of a single-arm phase 2 study.

After a median follow-up of 29 months, 2-year progression-free survival was 59% with a median of 25 months for 52 patients with newly diagnosed disease who were aged 60 years or older, Hagop Kantarjian, MD, and his associates reported online in the Lancet Oncology.

Nearly every patient experienced an overall response (98%). The treatment also appeared to be safe, Dr. Kantarjian and associates wrote.

They reported that no patient died within 4 weeks of treatment and that four patients experienced veno-occlusive disease. Common grade 3 or 4 side effects included thrombocytopenia (81%), consolidation chemotherapy (69%), hyperglycemia (54%), infections during induction (52%), hypokalemia (31%), increased aminotransferases (19%), hyperbilirubinemia (17%), and hemorrhage (15%). Six patients died from treatment-related side effects, five of whom died from sepsis and one of whom died as a result of veno-occlusive disease.

Inotuzumab ozogamicin is an anti-CD22 monoclonal antibody that is bound to the toxin calicheamicin. It has shown “substantial improvements” for some patient subgroups when added to hyper-CVAD chemotherapy (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and high-dose cytarabine); however, older patients have yet to experience a similar benefit, Dr. Kantarjian and his associates said.

Both CVAD and inotuzumab ozogamicin have shown to be quite toxic for older patients. So – in order limit increased toxicity – Dr. Kantarjian and his associates lowered the intensity of hyper-CVAD. They accomplished this by reducing some aspects of the regimen by up to 50% and eliminating anthracyclines altogether. The researchers referred to this regimen as “mini–hyper-CVD.” The mini–hyper-CVD did not appear to impact activity.

“In our study, activity did not appear to be compromised by the use of lower-intensity chemotherapy in combination with a novel monoclonal antibody,” they wrote.

Dr. Kantarjian and his associates noted that, while they observed fewer deaths compared with previously published data, the number of deaths they did observe in patients who achieved a complete response was high.

They suggested that modifications to the regimen could further improve safety and that such modifications required further research.

For the time being, however, the researchers noted that this low-intensity regimen, in combination in inotuzumab ozogamicin, is highly effective and that these data now require prospective confirmation in a randomized, phase 3 setting.

The study was funded by the MD Anderson Cancer Center. Researchers reported that Pfizer provided inotuzumab ozogamicin free of charge and that Dr. Kantarjian and two other researchers received grants from Pfizer.

SOURCE: Kantarjian H et al. Lancet Oncol. 2018 Jan 15. doi: 10.1016/S1470-2945(18)30011-1.

ATLANTA – Minimal residual disease-guided treatment with azacitidine is an effective strategy for preventing or delaying hematological relapse in patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) who are at high risk for relapse, according to findings from the open-label, interventional RELAZA2 trial.

Of 205 patients screened between 2011 and 2015 at 11 centers in Germany, 53 became minimal residual disease (MRD) positive while remaining in hematological remission. All 53 started azacitidine-based preemptive treatment, and 6 months after the initiation of the MRD-guided therapy, 31 (58%) were still in complete remission, while 22 (42%) relapsed after a median of three treatment cycles, Uwe Platzbecker, MD, reported at the annual meeting of the American Society of Hematology.

Of those still in complete remission, 21 patients responded with a decline of MRD below a predefined threshold, and 10 achieved stabilization in the absence of relapse, said Dr. Platzbecker of the University Hospital Carl Gustav Carus Dresden, Germany.

The overall response rate was greater in those who underwent allogeneic hematopoietic stem cell transplantation (71% vs. 48%), he noted.

“After 6 months, 24 patients continued to receive a median of nine subsequent azacitidine cycles. Seven patients completed 24 months of treatment according to protocol. Eventually, hematologic relapse occurred in eight of those patients (33%) but was delayed until a median of 397 days after initial MRD detection,” he said in an interview, adding that, overall, 26 of the 53 patients in the study (49%) experienced hematologic relapse, which was delayed until a median of 422 days after initial MRD detection.

Study subjects were adults with a median age of 59 years with measurable MRD suggestive of imminent relapse but who were still in CR. Most (48) had AML, and 5 had MDS. They were treated preemptively with six cycles of 75 mg/m² of azacitidine given subcutaneously on days 1-7 of each 1-month cycle. Those who continued treatment beyond the initial 6 months were treated with risk-adapted azacitidine-based therapy for up to 18 additional months.

Treatment was well tolerated. Grade 3 or 4 thrombocytopenia occurred in three patients, and grade 3 or 4 neutropenia occurred in 45 patients. Infections and pneumonia, which occurred in four and three patients, respectively, were the main serious side effects during the first 6 cycles.

“With a median follow-up of 13 months after the start of MRD-guided preemptive treatment, the actual overall and progression free survival rate was 76% and 42%, respectively,” Dr. Platzbecker said.

Chemotherapy frequently results in complete remission in patients with MDS or AML, but a substantial proportion of patients relapse even after allogeneic stem cell transplantation, he said, noting that treatment options in these patients are limited.

In the prospective RELAZA 1 trial, short-term preemptive azacitidine therapy was associated with sustained responses. RELAZA2 was designed to assess the ability of early nonintensive azacitidine treatment, directed by MRD monitoring after allogeneic stem cell transplantation and chemotherapy, prior to avert relapse.

The findings suggest that this approach is effective in patients at higher risk of relapse, but the success of treatment seems to be context dependent, Dr. Platzbecker said, explaining that this finding emphasizes the potential immunomodulatory role of hypomethylating agents.

“The study supports the prognostic importance of MRD in AML and may serve as a platform for future studies in combining hypomethylating agents and novel targeted therapies,” he concluded.

The RELAZA2 trial is sponsored by Technische Universität Dresden. Dr. Platzbecker reported serving as a consultant for, and receiving honoraria and research funding from Celgene, Janssen, Novartis, and Acceleron.

[email protected]

SOURCE: Platzbecker U et al. ASH 2017 Abstract #565.

ATLANTA – Minimal residual disease-guided treatment with azacitidine is an effective strategy for preventing or delaying hematological relapse in patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) who are at high risk for relapse, according to findings from the open-label, interventional RELAZA2 trial.

Of 205 patients screened between 2011 and 2015 at 11 centers in Germany, 53 became minimal residual disease (MRD) positive while remaining in hematological remission. All 53 started azacitidine-based preemptive treatment, and 6 months after the initiation of the MRD-guided therapy, 31 (58%) were still in complete remission, while 22 (42%) relapsed after a median of three treatment cycles, Uwe Platzbecker, MD, reported at the annual meeting of the American Society of Hematology.

Of those still in complete remission, 21 patients responded with a decline of MRD below a predefined threshold, and 10 achieved stabilization in the absence of relapse, said Dr. Platzbecker of the University Hospital Carl Gustav Carus Dresden, Germany.

The overall response rate was greater in those who underwent allogeneic hematopoietic stem cell transplantation (71% vs. 48%), he noted.

“After 6 months, 24 patients continued to receive a median of nine subsequent azacitidine cycles. Seven patients completed 24 months of treatment according to protocol. Eventually, hematologic relapse occurred in eight of those patients (33%) but was delayed until a median of 397 days after initial MRD detection,” he said in an interview, adding that, overall, 26 of the 53 patients in the study (49%) experienced hematologic relapse, which was delayed until a median of 422 days after initial MRD detection.

Study subjects were adults with a median age of 59 years with measurable MRD suggestive of imminent relapse but who were still in CR. Most (48) had AML, and 5 had MDS. They were treated preemptively with six cycles of 75 mg/m² of azacitidine given subcutaneously on days 1-7 of each 1-month cycle. Those who continued treatment beyond the initial 6 months were treated with risk-adapted azacitidine-based therapy for up to 18 additional months.

Treatment was well tolerated. Grade 3 or 4 thrombocytopenia occurred in three patients, and grade 3 or 4 neutropenia occurred in 45 patients. Infections and pneumonia, which occurred in four and three patients, respectively, were the main serious side effects during the first 6 cycles.

“With a median follow-up of 13 months after the start of MRD-guided preemptive treatment, the actual overall and progression free survival rate was 76% and 42%, respectively,” Dr. Platzbecker said.

Chemotherapy frequently results in complete remission in patients with MDS or AML, but a substantial proportion of patients relapse even after allogeneic stem cell transplantation, he said, noting that treatment options in these patients are limited.

In the prospective RELAZA 1 trial, short-term preemptive azacitidine therapy was associated with sustained responses. RELAZA2 was designed to assess the ability of early nonintensive azacitidine treatment, directed by MRD monitoring after allogeneic stem cell transplantation and chemotherapy, prior to avert relapse.

The findings suggest that this approach is effective in patients at higher risk of relapse, but the success of treatment seems to be context dependent, Dr. Platzbecker said, explaining that this finding emphasizes the potential immunomodulatory role of hypomethylating agents.

“The study supports the prognostic importance of MRD in AML and may serve as a platform for future studies in combining hypomethylating agents and novel targeted therapies,” he concluded.

The RELAZA2 trial is sponsored by Technische Universität Dresden. Dr. Platzbecker reported serving as a consultant for, and receiving honoraria and research funding from Celgene, Janssen, Novartis, and Acceleron.

[email protected]

SOURCE: Platzbecker U et al. ASH 2017 Abstract #565.

ATLANTA – Minimal residual disease-guided treatment with azacitidine is an effective strategy for preventing or delaying hematological relapse in patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) who are at high risk for relapse, according to findings from the open-label, interventional RELAZA2 trial.

Of 205 patients screened between 2011 and 2015 at 11 centers in Germany, 53 became minimal residual disease (MRD) positive while remaining in hematological remission. All 53 started azacitidine-based preemptive treatment, and 6 months after the initiation of the MRD-guided therapy, 31 (58%) were still in complete remission, while 22 (42%) relapsed after a median of three treatment cycles, Uwe Platzbecker, MD, reported at the annual meeting of the American Society of Hematology.

Of those still in complete remission, 21 patients responded with a decline of MRD below a predefined threshold, and 10 achieved stabilization in the absence of relapse, said Dr. Platzbecker of the University Hospital Carl Gustav Carus Dresden, Germany.

The overall response rate was greater in those who underwent allogeneic hematopoietic stem cell transplantation (71% vs. 48%), he noted.

“After 6 months, 24 patients continued to receive a median of nine subsequent azacitidine cycles. Seven patients completed 24 months of treatment according to protocol. Eventually, hematologic relapse occurred in eight of those patients (33%) but was delayed until a median of 397 days after initial MRD detection,” he said in an interview, adding that, overall, 26 of the 53 patients in the study (49%) experienced hematologic relapse, which was delayed until a median of 422 days after initial MRD detection.

Study subjects were adults with a median age of 59 years with measurable MRD suggestive of imminent relapse but who were still in CR. Most (48) had AML, and 5 had MDS. They were treated preemptively with six cycles of 75 mg/m² of azacitidine given subcutaneously on days 1-7 of each 1-month cycle. Those who continued treatment beyond the initial 6 months were treated with risk-adapted azacitidine-based therapy for up to 18 additional months.

Treatment was well tolerated. Grade 3 or 4 thrombocytopenia occurred in three patients, and grade 3 or 4 neutropenia occurred in 45 patients. Infections and pneumonia, which occurred in four and three patients, respectively, were the main serious side effects during the first 6 cycles.

“With a median follow-up of 13 months after the start of MRD-guided preemptive treatment, the actual overall and progression free survival rate was 76% and 42%, respectively,” Dr. Platzbecker said.

Chemotherapy frequently results in complete remission in patients with MDS or AML, but a substantial proportion of patients relapse even after allogeneic stem cell transplantation, he said, noting that treatment options in these patients are limited.

In the prospective RELAZA 1 trial, short-term preemptive azacitidine therapy was associated with sustained responses. RELAZA2 was designed to assess the ability of early nonintensive azacitidine treatment, directed by MRD monitoring after allogeneic stem cell transplantation and chemotherapy, prior to avert relapse.

The findings suggest that this approach is effective in patients at higher risk of relapse, but the success of treatment seems to be context dependent, Dr. Platzbecker said, explaining that this finding emphasizes the potential immunomodulatory role of hypomethylating agents.

“The study supports the prognostic importance of MRD in AML and may serve as a platform for future studies in combining hypomethylating agents and novel targeted therapies,” he concluded.

The RELAZA2 trial is sponsored by Technische Universität Dresden. Dr. Platzbecker reported serving as a consultant for, and receiving honoraria and research funding from Celgene, Janssen, Novartis, and Acceleron.

[email protected]

SOURCE: Platzbecker U et al. ASH 2017 Abstract #565.

Micrograph showing MDS

Researchers have developed a technique that may help predict whether patients with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML) will respond to treatment with azacytidine (AZA).

“The new method, called AZA-MS, utilizes a cutting-edge technique known as mass spectrometry to measure the different forms of AZA inside blood cells of patients—such as the AZA molecules that are incorporated into the DNA or RNA,” said Ashwin Unnikrishnan, PhD, of the University of New South Wales in Sydney, Australia.

With this method, Dr Unnikrishnan and his colleagues found that patients who do not respond to AZA may incorporate fewer AZA molecules in their DNA and have lower DNA demethylation than responders. However, this is not always the case.

The researchers reported these findings in Leukemia.

The team initially tested AZA-MS in AZA-treated RKO cells and found that AZA-MS could quantify the ribonucleoside (5-AZA-cR) and deoxyribonucleoside (5-AZA-CdR) forms of AZA in RNA, DNA, and the cytoplasm—all in the same sample.

The researchers also found that AZA induced dose-dependent DNA demethylation but did not have an effect on RNA methylation.

The team then used AZA-MS to analyze bone marrow samples from patients with MDS (n=4) or CMML (n=4) who were undergoing treatment with AZA. All of the patients had received at least 6 cycles of the drug.

Each patient had 3 bone marrow samples collected—one immediately before starting treatment; one on day 8 of cycle 1 (C1d8); and one on day 28 of cycle 1 (C1d28), when they had spent 20 days off the drug.

Four of the patients were complete responders, and 4 were nonresponders. In each group, 2 patients had MDS, and 2 had CMML.

At C1d8, DNA-5-AZA-CdR was significantly greater in responders than nonresponders. And, overall, responders had increased DNA demethylation compared to nonresponders.

However, the researchers also observed differences among the nonresponders. Two nonresponders had very low levels of DNA-5-AZA-CdR at C1d8 and no demethylation. The other 2 nonresponders had much higher DNA-5-AZA-CdR and DNA demethylation levels, which were comparable to levels in responders.

The researchers said they could detect AZA and DNA-5-AZA-CdR intracellularly, as well as RNA-AZA, in the nonresponders with minimal DNA-5-AZA-CdR and DNA demethylation.

The team said this suggests that neither cellular uptake nor intracellular metabolism explain the low DNA-5-AZA-CdR in these patients. Instead, the researchers believe these patients may have a greater proportion of bone marrow cells that are quiescent and not undergoing DNA replication.

The researchers also believe the nonresponders with higher DNA-5-AZA-CdR may be explained by a failure to induce an interferon response, which is necessary for a clinical response.

On the other hand, these nonresponders could have defective immune cell-mediated clearance of dysplastic cells or increased tolerance to this clearance, the researchers said.

The team also noted that, at C1d28, DNA-5-AZA-CdR levels dropped (but were still detectable) in all 8 patients, and DNA methylation had nearly returned to pretreatment levels in all patients.

Micrograph showing MDS

Researchers have developed a technique that may help predict whether patients with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML) will respond to treatment with azacytidine (AZA).

“The new method, called AZA-MS, utilizes a cutting-edge technique known as mass spectrometry to measure the different forms of AZA inside blood cells of patients—such as the AZA molecules that are incorporated into the DNA or RNA,” said Ashwin Unnikrishnan, PhD, of the University of New South Wales in Sydney, Australia.

With this method, Dr Unnikrishnan and his colleagues found that patients who do not respond to AZA may incorporate fewer AZA molecules in their DNA and have lower DNA demethylation than responders. However, this is not always the case.

The researchers reported these findings in Leukemia.

The team initially tested AZA-MS in AZA-treated RKO cells and found that AZA-MS could quantify the ribonucleoside (5-AZA-cR) and deoxyribonucleoside (5-AZA-CdR) forms of AZA in RNA, DNA, and the cytoplasm—all in the same sample.

The researchers also found that AZA induced dose-dependent DNA demethylation but did not have an effect on RNA methylation.

The team then used AZA-MS to analyze bone marrow samples from patients with MDS (n=4) or CMML (n=4) who were undergoing treatment with AZA. All of the patients had received at least 6 cycles of the drug.

Each patient had 3 bone marrow samples collected—one immediately before starting treatment; one on day 8 of cycle 1 (C1d8); and one on day 28 of cycle 1 (C1d28), when they had spent 20 days off the drug.

Four of the patients were complete responders, and 4 were nonresponders. In each group, 2 patients had MDS, and 2 had CMML.

At C1d8, DNA-5-AZA-CdR was significantly greater in responders than nonresponders. And, overall, responders had increased DNA demethylation compared to nonresponders.

However, the researchers also observed differences among the nonresponders. Two nonresponders had very low levels of DNA-5-AZA-CdR at C1d8 and no demethylation. The other 2 nonresponders had much higher DNA-5-AZA-CdR and DNA demethylation levels, which were comparable to levels in responders.

The researchers said they could detect AZA and DNA-5-AZA-CdR intracellularly, as well as RNA-AZA, in the nonresponders with minimal DNA-5-AZA-CdR and DNA demethylation.

The team said this suggests that neither cellular uptake nor intracellular metabolism explain the low DNA-5-AZA-CdR in these patients. Instead, the researchers believe these patients may have a greater proportion of bone marrow cells that are quiescent and not undergoing DNA replication.

The researchers also believe the nonresponders with higher DNA-5-AZA-CdR may be explained by a failure to induce an interferon response, which is necessary for a clinical response.

On the other hand, these nonresponders could have defective immune cell-mediated clearance of dysplastic cells or increased tolerance to this clearance, the researchers said.

The team also noted that, at C1d28, DNA-5-AZA-CdR levels dropped (but were still detectable) in all 8 patients, and DNA methylation had nearly returned to pretreatment levels in all patients.

Micrograph showing MDS

Researchers have developed a technique that may help predict whether patients with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML) will respond to treatment with azacytidine (AZA).

“The new method, called AZA-MS, utilizes a cutting-edge technique known as mass spectrometry to measure the different forms of AZA inside blood cells of patients—such as the AZA molecules that are incorporated into the DNA or RNA,” said Ashwin Unnikrishnan, PhD, of the University of New South Wales in Sydney, Australia.

With this method, Dr Unnikrishnan and his colleagues found that patients who do not respond to AZA may incorporate fewer AZA molecules in their DNA and have lower DNA demethylation than responders. However, this is not always the case.

The researchers reported these findings in Leukemia.

The team initially tested AZA-MS in AZA-treated RKO cells and found that AZA-MS could quantify the ribonucleoside (5-AZA-cR) and deoxyribonucleoside (5-AZA-CdR) forms of AZA in RNA, DNA, and the cytoplasm—all in the same sample.

The researchers also found that AZA induced dose-dependent DNA demethylation but did not have an effect on RNA methylation.

The team then used AZA-MS to analyze bone marrow samples from patients with MDS (n=4) or CMML (n=4) who were undergoing treatment with AZA. All of the patients had received at least 6 cycles of the drug.

Each patient had 3 bone marrow samples collected—one immediately before starting treatment; one on day 8 of cycle 1 (C1d8); and one on day 28 of cycle 1 (C1d28), when they had spent 20 days off the drug.

Four of the patients were complete responders, and 4 were nonresponders. In each group, 2 patients had MDS, and 2 had CMML.

At C1d8, DNA-5-AZA-CdR was significantly greater in responders than nonresponders. And, overall, responders had increased DNA demethylation compared to nonresponders.

However, the researchers also observed differences among the nonresponders. Two nonresponders had very low levels of DNA-5-AZA-CdR at C1d8 and no demethylation. The other 2 nonresponders had much higher DNA-5-AZA-CdR and DNA demethylation levels, which were comparable to levels in responders.

The researchers said they could detect AZA and DNA-5-AZA-CdR intracellularly, as well as RNA-AZA, in the nonresponders with minimal DNA-5-AZA-CdR and DNA demethylation.

The team said this suggests that neither cellular uptake nor intracellular metabolism explain the low DNA-5-AZA-CdR in these patients. Instead, the researchers believe these patients may have a greater proportion of bone marrow cells that are quiescent and not undergoing DNA replication.

The researchers also believe the nonresponders with higher DNA-5-AZA-CdR may be explained by a failure to induce an interferon response, which is necessary for a clinical response.

On the other hand, these nonresponders could have defective immune cell-mediated clearance of dysplastic cells or increased tolerance to this clearance, the researchers said.

The team also noted that, at C1d28, DNA-5-AZA-CdR levels dropped (but were still detectable) in all 8 patients, and DNA methylation had nearly returned to pretreatment levels in all patients.

SAN FRANCISCO – Colorectal cancer originating on the right side carries a higher risk of recurrence or death after adjuvant oxaliplatin-based chemotherapy, suggests a new analysis of data from the SCOT (Short Course Oncology Therapy) trial. But patients with right-sided disease fare about the same whether given the usual 6 months of chemotherapy or half that.

“It’s becoming clear that right-sided tumors are different from left-sided tumors,” commented first author Mark P. Saunders, MD, PhD, a consultant oncologist at the Christie NHS Foundation Trust, Manchester, England. A large meta-analysis showed that early right-sided tumors were associated with poorer overall survival (JAMA Oncol. 2016 Oct 27. doi: 10.1001/jamaoncol.2016.4227), but it remains unclear at what point(s) in the course of disease and its treatment sidedness is exerting its influence.

Findings in context

“This study was interesting, but I feel that we still need more data coming from the main study,” session chair Michael J. Hall, MD, MS, a medical oncologist at the Fox Chase Cancer Center, Philadelphia, said in an interview. “It’s important to let us know that adjuvant chemotherapy appears to be beneficial, regardless of side, but there are still some other important questions.”

More detail on the difference by side according to chemotherapy duration and according to regimen (because recent data suggest CAPOX may have an edge over FOLFOX) could help tailor treatment, he proposed. For example, it is possible that patients with right-sided tumors will fare better if given 6 months of the CAPOX regimen.

Study details

The majority of the 3,219 patients studied, 63%, had tumors originating on the left side (splenic flexure or distally), according to data reported at the symposium, sponsored by the American Gastroenterological Association, the American Society for Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology.

Compared with patients who had left-sided tumors, those with right-sided tumors (including any in the transverse colon) were older (median, 66 vs. 64 years; P less than .001), less often male (53% vs. 66%; P less than .001), more often had T4 stage (41% vs. 24%; P less than .001), and less often had stage II disease (17% vs. 21%; P =.001).

Patients with right-sided tumors had poorer 3-year disease-free survival (73% vs. 80%; hazard ratio, 1.401; P less than .0001), reported Dr. Saunders. This association weakened slightly after adjustment for T stage and N stage (HR, 1.215; P = .009).

However, benefit of 3 months versus 6 months of chemotherapy was similar whether patients had right-sided tumors (HR, 1.049) or left-sided tumors (HR, 0.910), with no statistically significant heterogeneity between these groups (P =.327).

A large translational substudy, Trans SCOT, is looking at various biomarkers such as microsatellite instability and mutations, and may shed more light on the mechanisms driving the different outcomes for right- and left-sided colorectal cancer, according to Dr. Saunders.

However, even when starting with more than 3,000 patients, drilling down by tumor sidedness and then further by characteristics such as molecular features (or regimen, overall stage, or T and N components) may result in underpowered analyses, he cautioned.

Dr. Saunders disclosed that he received honoraria from and has a consulting or advisory role with Amgen, Merck, Roche, and Servier.

[email protected]

SOURCE: Saunders MP et al. 2018 Gastrointestinal Cancers Symposium, Abstract 558.

SAN FRANCISCO – Colorectal cancer originating on the right side carries a higher risk of recurrence or death after adjuvant oxaliplatin-based chemotherapy, suggests a new analysis of data from the SCOT (Short Course Oncology Therapy) trial. But patients with right-sided disease fare about the same whether given the usual 6 months of chemotherapy or half that.

“It’s becoming clear that right-sided tumors are different from left-sided tumors,” commented first author Mark P. Saunders, MD, PhD, a consultant oncologist at the Christie NHS Foundation Trust, Manchester, England. A large meta-analysis showed that early right-sided tumors were associated with poorer overall survival (JAMA Oncol. 2016 Oct 27. doi: 10.1001/jamaoncol.2016.4227), but it remains unclear at what point(s) in the course of disease and its treatment sidedness is exerting its influence.

Findings in context

“This study was interesting, but I feel that we still need more data coming from the main study,” session chair Michael J. Hall, MD, MS, a medical oncologist at the Fox Chase Cancer Center, Philadelphia, said in an interview. “It’s important to let us know that adjuvant chemotherapy appears to be beneficial, regardless of side, but there are still some other important questions.”

More detail on the difference by side according to chemotherapy duration and according to regimen (because recent data suggest CAPOX may have an edge over FOLFOX) could help tailor treatment, he proposed. For example, it is possible that patients with right-sided tumors will fare better if given 6 months of the CAPOX regimen.

Study details

The majority of the 3,219 patients studied, 63%, had tumors originating on the left side (splenic flexure or distally), according to data reported at the symposium, sponsored by the American Gastroenterological Association, the American Society for Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology.

Compared with patients who had left-sided tumors, those with right-sided tumors (including any in the transverse colon) were older (median, 66 vs. 64 years; P less than .001), less often male (53% vs. 66%; P less than .001), more often had T4 stage (41% vs. 24%; P less than .001), and less often had stage II disease (17% vs. 21%; P =.001).

Patients with right-sided tumors had poorer 3-year disease-free survival (73% vs. 80%; hazard ratio, 1.401; P less than .0001), reported Dr. Saunders. This association weakened slightly after adjustment for T stage and N stage (HR, 1.215; P = .009).

However, benefit of 3 months versus 6 months of chemotherapy was similar whether patients had right-sided tumors (HR, 1.049) or left-sided tumors (HR, 0.910), with no statistically significant heterogeneity between these groups (P =.327).

A large translational substudy, Trans SCOT, is looking at various biomarkers such as microsatellite instability and mutations, and may shed more light on the mechanisms driving the different outcomes for right- and left-sided colorectal cancer, according to Dr. Saunders.

However, even when starting with more than 3,000 patients, drilling down by tumor sidedness and then further by characteristics such as molecular features (or regimen, overall stage, or T and N components) may result in underpowered analyses, he cautioned.

Dr. Saunders disclosed that he received honoraria from and has a consulting or advisory role with Amgen, Merck, Roche, and Servier.

[email protected]

SOURCE: Saunders MP et al. 2018 Gastrointestinal Cancers Symposium, Abstract 558.

SAN FRANCISCO – Colorectal cancer originating on the right side carries a higher risk of recurrence or death after adjuvant oxaliplatin-based chemotherapy, suggests a new analysis of data from the SCOT (Short Course Oncology Therapy) trial. But patients with right-sided disease fare about the same whether given the usual 6 months of chemotherapy or half that.

“It’s becoming clear that right-sided tumors are different from left-sided tumors,” commented first author Mark P. Saunders, MD, PhD, a consultant oncologist at the Christie NHS Foundation Trust, Manchester, England. A large meta-analysis showed that early right-sided tumors were associated with poorer overall survival (JAMA Oncol. 2016 Oct 27. doi: 10.1001/jamaoncol.2016.4227), but it remains unclear at what point(s) in the course of disease and its treatment sidedness is exerting its influence.

Findings in context

“This study was interesting, but I feel that we still need more data coming from the main study,” session chair Michael J. Hall, MD, MS, a medical oncologist at the Fox Chase Cancer Center, Philadelphia, said in an interview. “It’s important to let us know that adjuvant chemotherapy appears to be beneficial, regardless of side, but there are still some other important questions.”

More detail on the difference by side according to chemotherapy duration and according to regimen (because recent data suggest CAPOX may have an edge over FOLFOX) could help tailor treatment, he proposed. For example, it is possible that patients with right-sided tumors will fare better if given 6 months of the CAPOX regimen.

Study details

The majority of the 3,219 patients studied, 63%, had tumors originating on the left side (splenic flexure or distally), according to data reported at the symposium, sponsored by the American Gastroenterological Association, the American Society for Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology.

Compared with patients who had left-sided tumors, those with right-sided tumors (including any in the transverse colon) were older (median, 66 vs. 64 years; P less than .001), less often male (53% vs. 66%; P less than .001), more often had T4 stage (41% vs. 24%; P less than .001), and less often had stage II disease (17% vs. 21%; P =.001).

Patients with right-sided tumors had poorer 3-year disease-free survival (73% vs. 80%; hazard ratio, 1.401; P less than .0001), reported Dr. Saunders. This association weakened slightly after adjustment for T stage and N stage (HR, 1.215; P = .009).

However, benefit of 3 months versus 6 months of chemotherapy was similar whether patients had right-sided tumors (HR, 1.049) or left-sided tumors (HR, 0.910), with no statistically significant heterogeneity between these groups (P =.327).

A large translational substudy, Trans SCOT, is looking at various biomarkers such as microsatellite instability and mutations, and may shed more light on the mechanisms driving the different outcomes for right- and left-sided colorectal cancer, according to Dr. Saunders.

However, even when starting with more than 3,000 patients, drilling down by tumor sidedness and then further by characteristics such as molecular features (or regimen, overall stage, or T and N components) may result in underpowered analyses, he cautioned.

Dr. Saunders disclosed that he received honoraria from and has a consulting or advisory role with Amgen, Merck, Roche, and Servier.

[email protected]

SOURCE: Saunders MP et al. 2018 Gastrointestinal Cancers Symposium, Abstract 558.

The annual direct health care expenditures per person with arthritis remained relatively stable over the years from 2008 to 2014, but the rise in proportion of the arthritis patients in the U.S. population led to billions more dollars being spent on this population, reported Amit D. Raval, PhD, and Ami Vyas, PhD, of the University of Rhode Island, Kingston.

Kativ/iStockphoto

During this time period, there was an increase in the percentage of Hispanics, poor, obese, and individuals with activity limitations and mental health disorders among both those with and without arthritis. This is consistent with the study findings that incremental health care expenditures in persons with arthritis were largely driven by difference in age, health status, and chronic conditions, such as hypertension, hyperlipidemia, and heart disease, among those with and without arthritis, Dr. Raval and Dr. Vyas said.

Annual total health care expenditures in persons with arthritis fell from $10,424 in 2008 to $9,910 in 2014. The average annual total out-of-pocket expenditures in 2008 was $1,493, which was 14% of total health care expenditures that year; in 2014, this fell to $1,099. There were similar trends in persons without arthritis, Dr. Raval and Dr. Vyas reported.

The top three expenditure categories in 2008 were outpatient (32.6%), inpatient (29.0%), and prescription drug costs (24.7%); in 2014, these changed to outpatient (33.8%), prescription drug (26.8%), and inpatient costs (26.4%). There are a number of ways to explain these trends, the researchers said. It is likely that outpatient services, such as outpatient orthopedic surgeries, are becoming “a common management option for arthritis.” Also, outpatient medication services now may include administration of injectables such as biologics. There also were “relatively stable” inpatient expenditures from 2008 to 2013 and a decline in 2014. “Our findings are consistent with studies assessing the effect of the Affordable Care Act, such as introduction of the Hospital Readmission Reduction Program,” said Dr. Raval and Dr. Vyas.

[email protected]

SOURCE: Amit R et al. J Rheumatol. 2018 Jan 15. doi: 10.3899/jrheum.170368.

The annual direct health care expenditures per person with arthritis remained relatively stable over the years from 2008 to 2014, but the rise in proportion of the arthritis patients in the U.S. population led to billions more dollars being spent on this population, reported Amit D. Raval, PhD, and Ami Vyas, PhD, of the University of Rhode Island, Kingston.

Kativ/iStockphoto

During this time period, there was an increase in the percentage of Hispanics, poor, obese, and individuals with activity limitations and mental health disorders among both those with and without arthritis. This is consistent with the study findings that incremental health care expenditures in persons with arthritis were largely driven by difference in age, health status, and chronic conditions, such as hypertension, hyperlipidemia, and heart disease, among those with and without arthritis, Dr. Raval and Dr. Vyas said.

Annual total health care expenditures in persons with arthritis fell from $10,424 in 2008 to $9,910 in 2014. The average annual total out-of-pocket expenditures in 2008 was $1,493, which was 14% of total health care expenditures that year; in 2014, this fell to $1,099. There were similar trends in persons without arthritis, Dr. Raval and Dr. Vyas reported.

The top three expenditure categories in 2008 were outpatient (32.6%), inpatient (29.0%), and prescription drug costs (24.7%); in 2014, these changed to outpatient (33.8%), prescription drug (26.8%), and inpatient costs (26.4%). There are a number of ways to explain these trends, the researchers said. It is likely that outpatient services, such as outpatient orthopedic surgeries, are becoming “a common management option for arthritis.” Also, outpatient medication services now may include administration of injectables such as biologics. There also were “relatively stable” inpatient expenditures from 2008 to 2013 and a decline in 2014. “Our findings are consistent with studies assessing the effect of the Affordable Care Act, such as introduction of the Hospital Readmission Reduction Program,” said Dr. Raval and Dr. Vyas.

[email protected]

SOURCE: Amit R et al. J Rheumatol. 2018 Jan 15. doi: 10.3899/jrheum.170368.

The annual direct health care expenditures per person with arthritis remained relatively stable over the years from 2008 to 2014, but the rise in proportion of the arthritis patients in the U.S. population led to billions more dollars being spent on this population, reported Amit D. Raval, PhD, and Ami Vyas, PhD, of the University of Rhode Island, Kingston.

Kativ/iStockphoto

During this time period, there was an increase in the percentage of Hispanics, poor, obese, and individuals with activity limitations and mental health disorders among both those with and without arthritis. This is consistent with the study findings that incremental health care expenditures in persons with arthritis were largely driven by difference in age, health status, and chronic conditions, such as hypertension, hyperlipidemia, and heart disease, among those with and without arthritis, Dr. Raval and Dr. Vyas said.

Annual total health care expenditures in persons with arthritis fell from $10,424 in 2008 to $9,910 in 2014. The average annual total out-of-pocket expenditures in 2008 was $1,493, which was 14% of total health care expenditures that year; in 2014, this fell to $1,099. There were similar trends in persons without arthritis, Dr. Raval and Dr. Vyas reported.

The top three expenditure categories in 2008 were outpatient (32.6%), inpatient (29.0%), and prescription drug costs (24.7%); in 2014, these changed to outpatient (33.8%), prescription drug (26.8%), and inpatient costs (26.4%). There are a number of ways to explain these trends, the researchers said. It is likely that outpatient services, such as outpatient orthopedic surgeries, are becoming “a common management option for arthritis.” Also, outpatient medication services now may include administration of injectables such as biologics. There also were “relatively stable” inpatient expenditures from 2008 to 2013 and a decline in 2014. “Our findings are consistent with studies assessing the effect of the Affordable Care Act, such as introduction of the Hospital Readmission Reduction Program,” said Dr. Raval and Dr. Vyas.

[email protected]

SOURCE: Amit R et al. J Rheumatol. 2018 Jan 15. doi: 10.3899/jrheum.170368.

GENEVA – Healthy lifestyle changes produce significant improvement in both psoriasis severity and Dermatologic Life Quality Index scores in obese psoriasis patients, according to a systematic review and meta-analysis presented by Ching-Chi Chi, MD, at the annual congress of the European Academy of Dermatology and Venereology.

A plausible mechanism of benefit exists for these findings: “Fat tissue is known to be an endocrine organ that produces inflammatory cytokines, such as tumor necrosis factor. Reduce the amount of fat tissue and you reduce inflammation,” explained Dr. Chi, professor of dermatology at Chang Gung University in Taoyuan, Taiwan.

jancin

Also, participants in the dietary intervention studies averaged a 14.4-point improvement from baseline in Dermatologic Life Quality Index (DLQI) scores at week 24 versus a 2.2-point improvement in controls. Researchers consider a 5-point or greater improvement in the DLQI clinically meaningful.

A combined diet and exercise program resulted in a 45% increased likelihood that obese psoriasis patients would achieve a PASI 50 response at week 16, with a number needed to treat of 7. There was a trend in the active treatment arm for higher PASI 75 and PASI 100 responses than in controls as well, but it wasn’t statistically significant.

The one randomized trial of a walking exercise program coupled with continuous health education demonstrated a significant reduction in the rate of psoriasis flares, compared with controls, over a 3-year period.

In contrast, the studies of educational programs promoting a healthy lifestyle without an associated dietary or physical activity intervention failed to show a reduction in PASI scores.

Dr. Chi reported no financial conflicts of interest regarding his study, which was funded by Chang Gung Memorial Hospital.

[email protected]

SOURCE: Chi C. EADV 2017.

GENEVA – Healthy lifestyle changes produce significant improvement in both psoriasis severity and Dermatologic Life Quality Index scores in obese psoriasis patients, according to a systematic review and meta-analysis presented by Ching-Chi Chi, MD, at the annual congress of the European Academy of Dermatology and Venereology.

A plausible mechanism of benefit exists for these findings: “Fat tissue is known to be an endocrine organ that produces inflammatory cytokines, such as tumor necrosis factor. Reduce the amount of fat tissue and you reduce inflammation,” explained Dr. Chi, professor of dermatology at Chang Gung University in Taoyuan, Taiwan.

jancin

Also, participants in the dietary intervention studies averaged a 14.4-point improvement from baseline in Dermatologic Life Quality Index (DLQI) scores at week 24 versus a 2.2-point improvement in controls. Researchers consider a 5-point or greater improvement in the DLQI clinically meaningful.

A combined diet and exercise program resulted in a 45% increased likelihood that obese psoriasis patients would achieve a PASI 50 response at week 16, with a number needed to treat of 7. There was a trend in the active treatment arm for higher PASI 75 and PASI 100 responses than in controls as well, but it wasn’t statistically significant.

The one randomized trial of a walking exercise program coupled with continuous health education demonstrated a significant reduction in the rate of psoriasis flares, compared with controls, over a 3-year period.

In contrast, the studies of educational programs promoting a healthy lifestyle without an associated dietary or physical activity intervention failed to show a reduction in PASI scores.

Dr. Chi reported no financial conflicts of interest regarding his study, which was funded by Chang Gung Memorial Hospital.

[email protected]

SOURCE: Chi C. EADV 2017.

GENEVA – Healthy lifestyle changes produce significant improvement in both psoriasis severity and Dermatologic Life Quality Index scores in obese psoriasis patients, according to a systematic review and meta-analysis presented by Ching-Chi Chi, MD, at the annual congress of the European Academy of Dermatology and Venereology.

A plausible mechanism of benefit exists for these findings: “Fat tissue is known to be an endocrine organ that produces inflammatory cytokines, such as tumor necrosis factor. Reduce the amount of fat tissue and you reduce inflammation,” explained Dr. Chi, professor of dermatology at Chang Gung University in Taoyuan, Taiwan.

jancin

Also, participants in the dietary intervention studies averaged a 14.4-point improvement from baseline in Dermatologic Life Quality Index (DLQI) scores at week 24 versus a 2.2-point improvement in controls. Researchers consider a 5-point or greater improvement in the DLQI clinically meaningful.

A combined diet and exercise program resulted in a 45% increased likelihood that obese psoriasis patients would achieve a PASI 50 response at week 16, with a number needed to treat of 7. There was a trend in the active treatment arm for higher PASI 75 and PASI 100 responses than in controls as well, but it wasn’t statistically significant.

The one randomized trial of a walking exercise program coupled with continuous health education demonstrated a significant reduction in the rate of psoriasis flares, compared with controls, over a 3-year period.

In contrast, the studies of educational programs promoting a healthy lifestyle without an associated dietary or physical activity intervention failed to show a reduction in PASI scores.

Dr. Chi reported no financial conflicts of interest regarding his study, which was funded by Chang Gung Memorial Hospital.

[email protected]

SOURCE: Chi C. EADV 2017.

The sooner tranexamic acid is administered for hemorrhage, the better, according to an analysis of 40,138 patients with severe traumatic or postpartum bleeding.

Immediate treatment improved survival by more than 70% (odds ratio, 1.72; 95%; confidence interval, 1.42-2.10; P less than .0001), but the survival benefit decreased by 10% for every 15 minutes of treatment delay until hour 3, after which there was no benefit with tranexamic acid.

“Even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately,” said investigators led by Angele Gayet-Ageron, MD, PhD, of University Hospitals of Geneva.

“Trauma patients should be treated at the scene of injury and postpartum hemorrhage should be treated as soon as the diagnosis is made. Clinical audit should record the time from bleeding onset to tranexamic acid treatment, with feedback and best practice benchmarking,” they said in the Lancet.

The team found no increase in vascular occlusive events with tranexamic acid and no evidence of other adverse effects, so “it can be given safely as soon as bleeding is suspected,” they said.

Antifibrinolytics like tranexamic acid are known to reduce death from bleeding, but the effects of treatment delay have been less clear. To get an idea, the investigators ran a meta-analysis of subjects from two, large randomized tranexamic acid trials, one for trauma hemorrhage and the other for postpartum hemorrhage.

There were 1,408 deaths from bleeding among the 40,000-plus subjects. Most of the bleeding deaths (63%) occurred within 12 hours of onset; deaths from postpartum hemorrhage peaked at 2-3 hours after childbirth.

The authors had no competing interests. The trials were funded by the Britain’s National Institute for Health Research and Pfizer, among others.
 

[email protected]

SOURCE: Gayet-Ageron A et al. Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32455-8

The sooner tranexamic acid is administered for hemorrhage, the better, according to an analysis of 40,138 patients with severe traumatic or postpartum bleeding.

Immediate treatment improved survival by more than 70% (odds ratio, 1.72; 95%; confidence interval, 1.42-2.10; P less than .0001), but the survival benefit decreased by 10% for every 15 minutes of treatment delay until hour 3, after which there was no benefit with tranexamic acid.

“Even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately,” said investigators led by Angele Gayet-Ageron, MD, PhD, of University Hospitals of Geneva.

“Trauma patients should be treated at the scene of injury and postpartum hemorrhage should be treated as soon as the diagnosis is made. Clinical audit should record the time from bleeding onset to tranexamic acid treatment, with feedback and best practice benchmarking,” they said in the Lancet.

The team found no increase in vascular occlusive events with tranexamic acid and no evidence of other adverse effects, so “it can be given safely as soon as bleeding is suspected,” they said.

Antifibrinolytics like tranexamic acid are known to reduce death from bleeding, but the effects of treatment delay have been less clear. To get an idea, the investigators ran a meta-analysis of subjects from two, large randomized tranexamic acid trials, one for trauma hemorrhage and the other for postpartum hemorrhage.

There were 1,408 deaths from bleeding among the 40,000-plus subjects. Most of the bleeding deaths (63%) occurred within 12 hours of onset; deaths from postpartum hemorrhage peaked at 2-3 hours after childbirth.

The authors had no competing interests. The trials were funded by the Britain’s National Institute for Health Research and Pfizer, among others.
 

[email protected]

SOURCE: Gayet-Ageron A et al. Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32455-8

The sooner tranexamic acid is administered for hemorrhage, the better, according to an analysis of 40,138 patients with severe traumatic or postpartum bleeding.

Immediate treatment improved survival by more than 70% (odds ratio, 1.72; 95%; confidence interval, 1.42-2.10; P less than .0001), but the survival benefit decreased by 10% for every 15 minutes of treatment delay until hour 3, after which there was no benefit with tranexamic acid.

“Even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately,” said investigators led by Angele Gayet-Ageron, MD, PhD, of University Hospitals of Geneva.

“Trauma patients should be treated at the scene of injury and postpartum hemorrhage should be treated as soon as the diagnosis is made. Clinical audit should record the time from bleeding onset to tranexamic acid treatment, with feedback and best practice benchmarking,” they said in the Lancet.

The team found no increase in vascular occlusive events with tranexamic acid and no evidence of other adverse effects, so “it can be given safely as soon as bleeding is suspected,” they said.

Antifibrinolytics like tranexamic acid are known to reduce death from bleeding, but the effects of treatment delay have been less clear. To get an idea, the investigators ran a meta-analysis of subjects from two, large randomized tranexamic acid trials, one for trauma hemorrhage and the other for postpartum hemorrhage.

There were 1,408 deaths from bleeding among the 40,000-plus subjects. Most of the bleeding deaths (63%) occurred within 12 hours of onset; deaths from postpartum hemorrhage peaked at 2-3 hours after childbirth.

The authors had no competing interests. The trials were funded by the Britain’s National Institute for Health Research and Pfizer, among others.
 

[email protected]

SOURCE: Gayet-Ageron A et al. Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32455-8

The first time Dave Fuehrer was diagnosed with testicular cancer, he was knocked back. The twenty-something competitive bodybuilder, a recent New York State champion, was unprepared for his journey from wellness to disease, and then through treatments and their sequelae.

However, it was the second diagnosis of primary testicular cancer that really got to him, he said. This time, he was a recently married young professional who was working on starting a family. The second round of cancer took parenthood away from him and left him “feeling even more lost and ashamed” than the first diagnosis, he said in an interview. He felt isolated, alone, and very different from most of the other cancer patients he saw.

Now, Mr. Fuehrer and partners, all of whom have been affected by cancer, have developed a web-based mobile application they call Stupid Cancer. The app is designed to connect adolescents and young adults who have cancer, or are cancer survivors, with each other and with resources and information.

When users set up their profiles on the app, they indicate their status as person with cancer or family member/supporter, as well as their geographic region, age, and type and stage of cancer. Then, users can connect with each other in private one-on-one chats or in chat rooms. Users are anonymous.

The Stupid Cancer app, said Mr. Fuehrer, was a natural extension of the nonprofit of the same name – an event-based organization designed to serve the needs for information and connection with others that are in many ways unique to adolescents and young adults.

Mr. Fuehrer, who has a professional background in the pharmaceutical industry, said that he sorely missed that connection during his cancer journeys and saw a big unmet need. “I was the only guy my age in a roomful of men in their 60s and 70s at my urologist’s office,” said Mr. Fuehrer. “Nobody looked like me.”

But even within the adolescent and young adult community, the lived experience of cancer can be much different for a younger patient. “I feel like I missed out on part of my childhood,” said Dane Koomen. When he was diagnosed with advanced Burkitt lymphoma nearly 10 years ago, “Myspace was the only social media out there, and as an 11 year old, I wasn’t exactly going to be hanging out there,” he said.

If Twitter, Snapchat, or Instagram had been available when he was going through cancer treatment, said Mr. Koomen, he could have stayed in better touch with his friends as they finished 6th grade and prepared for the transition to junior high school. “There are experiences I missed – field trips I didn’t go on, parties I missed,” and even vicarious involvement through social media would have been better than the isolation he felt, he said.

He thinks social media could also have helped his friends understand his experience: “If I’d had Snapchat, then they could see what I’m going through, and it would have been easier for people to understand what’s going on,” he said.

Through social media with broader reach, like Twitter or Instagram, he could have found encouragement and hope from inspiring stories of other cancer patients who were completing treatment and reaching the cancer-free status he was hoping for, he said. And he also would have enjoyed telling his story to a wider audience, and gaining strength from others’ well wishes, on Twitter.

Ilia Buhtoiarov, MD, a pediatric oncologist at Cleveland Clinic Children’s Hospital, Ohio, said that he sees different groups using social media platforms in a variety of ways for support and information sharing.

Parents, he said in an interview, are big Facebook users. Beginning with the early, uncertain days after a cancer diagnosis, parents can share a lot of information “in a structured fashion,” through one post. “They can target the post to a number of people – so everyone hears exactly what you want to say,” he said. For parents and other caregivers, this strategy is efficient when time and energy are limited.

Facebook is also useful, he said, for marshaling resources, such as finding help with rides or after-school care for other children and for such things as letting friends know when the patient is feeling well enough to see others.

For young cancer patients, Dr. Buhtoiarov said, a platform like Instagram or Snapchat affords “the opportunity to start a conversation” with peers. “The barriers are lifted quite naturally,” he said, and he sees how “the likes, smiles, and emojis provide support” for the person with cancer as peers follow along with the cancer journey.

Like an increasing number of pediatric oncology programs nationwide, Cleveland Clinic Children’s Hospital has services tailored for adolescents and young adults with cancer, who may “fall through the cracks” between pediatric and adult oncology services. Dr. Buhtoiarov said that among his peers, Twitter is used extensively to keep apprised of clinical trial opportunities and to link to new research in the field. This is especially important for those caring for an age group that’s been identified as significantly underrepresented in clinical trials and for whom cancer survival rates are persistently flat.

Oncologists also need to help patients and families navigate the reams of sometimes unreliable information they’ll find on the Internet, said Dr. Buhtoiarov. Though professionals can connect with each other to help patients find an expert close to home, or to consider enrollment in a clinical trial, patients need to know that “this information should always be discussed with experts,” he said.

[email protected]

The first time Dave Fuehrer was diagnosed with testicular cancer, he was knocked back. The twenty-something competitive bodybuilder, a recent New York State champion, was unprepared for his journey from wellness to disease, and then through treatments and their sequelae.

However, it was the second diagnosis of primary testicular cancer that really got to him, he said. This time, he was a recently married young professional who was working on starting a family. The second round of cancer took parenthood away from him and left him “feeling even more lost and ashamed” than the first diagnosis, he said in an interview. He felt isolated, alone, and very different from most of the other cancer patients he saw.

Now, Mr. Fuehrer and partners, all of whom have been affected by cancer, have developed a web-based mobile application they call Stupid Cancer. The app is designed to connect adolescents and young adults who have cancer, or are cancer survivors, with each other and with resources and information.

When users set up their profiles on the app, they indicate their status as person with cancer or family member/supporter, as well as their geographic region, age, and type and stage of cancer. Then, users can connect with each other in private one-on-one chats or in chat rooms. Users are anonymous.

The Stupid Cancer app, said Mr. Fuehrer, was a natural extension of the nonprofit of the same name – an event-based organization designed to serve the needs for information and connection with others that are in many ways unique to adolescents and young adults.

Mr. Fuehrer, who has a professional background in the pharmaceutical industry, said that he sorely missed that connection during his cancer journeys and saw a big unmet need. “I was the only guy my age in a roomful of men in their 60s and 70s at my urologist’s office,” said Mr. Fuehrer. “Nobody looked like me.”

But even within the adolescent and young adult community, the lived experience of cancer can be much different for a younger patient. “I feel like I missed out on part of my childhood,” said Dane Koomen. When he was diagnosed with advanced Burkitt lymphoma nearly 10 years ago, “Myspace was the only social media out there, and as an 11 year old, I wasn’t exactly going to be hanging out there,” he said.

If Twitter, Snapchat, or Instagram had been available when he was going through cancer treatment, said Mr. Koomen, he could have stayed in better touch with his friends as they finished 6th grade and prepared for the transition to junior high school. “There are experiences I missed – field trips I didn’t go on, parties I missed,” and even vicarious involvement through social media would have been better than the isolation he felt, he said.

He thinks social media could also have helped his friends understand his experience: “If I’d had Snapchat, then they could see what I’m going through, and it would have been easier for people to understand what’s going on,” he said.

Through social media with broader reach, like Twitter or Instagram, he could have found encouragement and hope from inspiring stories of other cancer patients who were completing treatment and reaching the cancer-free status he was hoping for, he said. And he also would have enjoyed telling his story to a wider audience, and gaining strength from others’ well wishes, on Twitter.

Ilia Buhtoiarov, MD, a pediatric oncologist at Cleveland Clinic Children’s Hospital, Ohio, said that he sees different groups using social media platforms in a variety of ways for support and information sharing.

Parents, he said in an interview, are big Facebook users. Beginning with the early, uncertain days after a cancer diagnosis, parents can share a lot of information “in a structured fashion,” through one post. “They can target the post to a number of people – so everyone hears exactly what you want to say,” he said. For parents and other caregivers, this strategy is efficient when time and energy are limited.

Facebook is also useful, he said, for marshaling resources, such as finding help with rides or after-school care for other children and for such things as letting friends know when the patient is feeling well enough to see others.

For young cancer patients, Dr. Buhtoiarov said, a platform like Instagram or Snapchat affords “the opportunity to start a conversation” with peers. “The barriers are lifted quite naturally,” he said, and he sees how “the likes, smiles, and emojis provide support” for the person with cancer as peers follow along with the cancer journey.

Like an increasing number of pediatric oncology programs nationwide, Cleveland Clinic Children’s Hospital has services tailored for adolescents and young adults with cancer, who may “fall through the cracks” between pediatric and adult oncology services. Dr. Buhtoiarov said that among his peers, Twitter is used extensively to keep apprised of clinical trial opportunities and to link to new research in the field. This is especially important for those caring for an age group that’s been identified as significantly underrepresented in clinical trials and for whom cancer survival rates are persistently flat.

Oncologists also need to help patients and families navigate the reams of sometimes unreliable information they’ll find on the Internet, said Dr. Buhtoiarov. Though professionals can connect with each other to help patients find an expert close to home, or to consider enrollment in a clinical trial, patients need to know that “this information should always be discussed with experts,” he said.

[email protected]

The first time Dave Fuehrer was diagnosed with testicular cancer, he was knocked back. The twenty-something competitive bodybuilder, a recent New York State champion, was unprepared for his journey from wellness to disease, and then through treatments and their sequelae.

However, it was the second diagnosis of primary testicular cancer that really got to him, he said. This time, he was a recently married young professional who was working on starting a family. The second round of cancer took parenthood away from him and left him “feeling even more lost and ashamed” than the first diagnosis, he said in an interview. He felt isolated, alone, and very different from most of the other cancer patients he saw.

Now, Mr. Fuehrer and partners, all of whom have been affected by cancer, have developed a web-based mobile application they call Stupid Cancer. The app is designed to connect adolescents and young adults who have cancer, or are cancer survivors, with each other and with resources and information.

When users set up their profiles on the app, they indicate their status as person with cancer or family member/supporter, as well as their geographic region, age, and type and stage of cancer. Then, users can connect with each other in private one-on-one chats or in chat rooms. Users are anonymous.

The Stupid Cancer app, said Mr. Fuehrer, was a natural extension of the nonprofit of the same name – an event-based organization designed to serve the needs for information and connection with others that are in many ways unique to adolescents and young adults.

Mr. Fuehrer, who has a professional background in the pharmaceutical industry, said that he sorely missed that connection during his cancer journeys and saw a big unmet need. “I was the only guy my age in a roomful of men in their 60s and 70s at my urologist’s office,” said Mr. Fuehrer. “Nobody looked like me.”

But even within the adolescent and young adult community, the lived experience of cancer can be much different for a younger patient. “I feel like I missed out on part of my childhood,” said Dane Koomen. When he was diagnosed with advanced Burkitt lymphoma nearly 10 years ago, “Myspace was the only social media out there, and as an 11 year old, I wasn’t exactly going to be hanging out there,” he said.

If Twitter, Snapchat, or Instagram had been available when he was going through cancer treatment, said Mr. Koomen, he could have stayed in better touch with his friends as they finished 6th grade and prepared for the transition to junior high school. “There are experiences I missed – field trips I didn’t go on, parties I missed,” and even vicarious involvement through social media would have been better than the isolation he felt, he said.

He thinks social media could also have helped his friends understand his experience: “If I’d had Snapchat, then they could see what I’m going through, and it would have been easier for people to understand what’s going on,” he said.

Through social media with broader reach, like Twitter or Instagram, he could have found encouragement and hope from inspiring stories of other cancer patients who were completing treatment and reaching the cancer-free status he was hoping for, he said. And he also would have enjoyed telling his story to a wider audience, and gaining strength from others’ well wishes, on Twitter.

Ilia Buhtoiarov, MD, a pediatric oncologist at Cleveland Clinic Children’s Hospital, Ohio, said that he sees different groups using social media platforms in a variety of ways for support and information sharing.

Parents, he said in an interview, are big Facebook users. Beginning with the early, uncertain days after a cancer diagnosis, parents can share a lot of information “in a structured fashion,” through one post. “They can target the post to a number of people – so everyone hears exactly what you want to say,” he said. For parents and other caregivers, this strategy is efficient when time and energy are limited.

Facebook is also useful, he said, for marshaling resources, such as finding help with rides or after-school care for other children and for such things as letting friends know when the patient is feeling well enough to see others.

For young cancer patients, Dr. Buhtoiarov said, a platform like Instagram or Snapchat affords “the opportunity to start a conversation” with peers. “The barriers are lifted quite naturally,” he said, and he sees how “the likes, smiles, and emojis provide support” for the person with cancer as peers follow along with the cancer journey.

Like an increasing number of pediatric oncology programs nationwide, Cleveland Clinic Children’s Hospital has services tailored for adolescents and young adults with cancer, who may “fall through the cracks” between pediatric and adult oncology services. Dr. Buhtoiarov said that among his peers, Twitter is used extensively to keep apprised of clinical trial opportunities and to link to new research in the field. This is especially important for those caring for an age group that’s been identified as significantly underrepresented in clinical trials and for whom cancer survival rates are persistently flat.

Oncologists also need to help patients and families navigate the reams of sometimes unreliable information they’ll find on the Internet, said Dr. Buhtoiarov. Though professionals can connect with each other to help patients find an expert close to home, or to consider enrollment in a clinical trial, patients need to know that “this information should always be discussed with experts,” he said.

[email protected]

Cognitive processing therapy may offer a greater benefit over time for posttraumatic stress disorder, but writing therapy offers a viable treatment in fewer sessions.

“Our results add to mounting research showing that the dose of therapy needed for beneficial outcomes for individuals with PTSD is not as large as what was once previously thought,” wrote Denise M. Sloan, PhD, of the National Center for PTSD, Boston, and her colleagues. “Our findings extend those prior studies by demonstrating that not only can PTSD symptoms be reduced significantly with less therapeutic exposure but that not as many therapy sessions are required.”

In a 1:1 randomized clinical trial, Dr. Sloan and her colleagues compared the effectiveness of written exposure therapy (WET) and cognitive processing therapy (CPT) in treating PTSD in 126 veteran and nonveteran adults, split evenly into the two therapy groups. The WET protocol included 5 sessions in which the patient wrote for 30 minutes about a traumatic event and focused on details of the event, including thoughts and feelings associated with it. The CPT intervention was a 12-session trauma-focused therapy with a limited take-home writing component. It focused on helping patients recognize and challenge dysfunctional cognitions associated with traumatic events, the investigators wrote in JAMA Psychiatry.

When Dr. Sloan and her colleagues looked at the patients’ mean Clinician Administered PTSD Scale for DSM-5, or CAPS-5 score, a measure of PTSD symptom severity, they found that the WET and CPT groups’ scores were similar at 6 weeks, 12, weeks, and 36 weeks. At the 24-week assessment, the CAPS-5 score for those in the CPT group (20.92) was significantly lower than it was for those in the WET group (25.23) (mean difference, 4.31 points; 95% confidence interval, –1.37 to 9.99).

In addition, the CPT group had a higher dropout rate (31.7%) than did the WET group (6.3%). The investigators concluded, however, that both therapies are effective. “Written exposure therapy should be considered by clinicians to be a viable treatment option that can address some of the barriers to receiving and implementing CPT and prolonged exposure that have been noted in health care settings,” Dr. Sloan and her colleagues wrote.

This study was funded by a grant from the National Institute of Mental Health. None of the authors had financial conflicts to report. Further details on this information can be found here.

[email protected]

SOURCE: Sloan DM. 2018 Jan 17. doi: 10.1001/jamapsychiatry.2017.4249.

Cognitive processing therapy may offer a greater benefit over time for posttraumatic stress disorder, but writing therapy offers a viable treatment in fewer sessions.

“Our results add to mounting research showing that the dose of therapy needed for beneficial outcomes for individuals with PTSD is not as large as what was once previously thought,” wrote Denise M. Sloan, PhD, of the National Center for PTSD, Boston, and her colleagues. “Our findings extend those prior studies by demonstrating that not only can PTSD symptoms be reduced significantly with less therapeutic exposure but that not as many therapy sessions are required.”

In a 1:1 randomized clinical trial, Dr. Sloan and her colleagues compared the effectiveness of written exposure therapy (WET) and cognitive processing therapy (CPT) in treating PTSD in 126 veteran and nonveteran adults, split evenly into the two therapy groups. The WET protocol included 5 sessions in which the patient wrote for 30 minutes about a traumatic event and focused on details of the event, including thoughts and feelings associated with it. The CPT intervention was a 12-session trauma-focused therapy with a limited take-home writing component. It focused on helping patients recognize and challenge dysfunctional cognitions associated with traumatic events, the investigators wrote in JAMA Psychiatry.

When Dr. Sloan and her colleagues looked at the patients’ mean Clinician Administered PTSD Scale for DSM-5, or CAPS-5 score, a measure of PTSD symptom severity, they found that the WET and CPT groups’ scores were similar at 6 weeks, 12, weeks, and 36 weeks. At the 24-week assessment, the CAPS-5 score for those in the CPT group (20.92) was significantly lower than it was for those in the WET group (25.23) (mean difference, 4.31 points; 95% confidence interval, –1.37 to 9.99).

In addition, the CPT group had a higher dropout rate (31.7%) than did the WET group (6.3%). The investigators concluded, however, that both therapies are effective. “Written exposure therapy should be considered by clinicians to be a viable treatment option that can address some of the barriers to receiving and implementing CPT and prolonged exposure that have been noted in health care settings,” Dr. Sloan and her colleagues wrote.

This study was funded by a grant from the National Institute of Mental Health. None of the authors had financial conflicts to report. Further details on this information can be found here.

[email protected]

SOURCE: Sloan DM. 2018 Jan 17. doi: 10.1001/jamapsychiatry.2017.4249.

Cognitive processing therapy may offer a greater benefit over time for posttraumatic stress disorder, but writing therapy offers a viable treatment in fewer sessions.

“Our results add to mounting research showing that the dose of therapy needed for beneficial outcomes for individuals with PTSD is not as large as what was once previously thought,” wrote Denise M. Sloan, PhD, of the National Center for PTSD, Boston, and her colleagues. “Our findings extend those prior studies by demonstrating that not only can PTSD symptoms be reduced significantly with less therapeutic exposure but that not as many therapy sessions are required.”

In a 1:1 randomized clinical trial, Dr. Sloan and her colleagues compared the effectiveness of written exposure therapy (WET) and cognitive processing therapy (CPT) in treating PTSD in 126 veteran and nonveteran adults, split evenly into the two therapy groups. The WET protocol included 5 sessions in which the patient wrote for 30 minutes about a traumatic event and focused on details of the event, including thoughts and feelings associated with it. The CPT intervention was a 12-session trauma-focused therapy with a limited take-home writing component. It focused on helping patients recognize and challenge dysfunctional cognitions associated with traumatic events, the investigators wrote in JAMA Psychiatry.

When Dr. Sloan and her colleagues looked at the patients’ mean Clinician Administered PTSD Scale for DSM-5, or CAPS-5 score, a measure of PTSD symptom severity, they found that the WET and CPT groups’ scores were similar at 6 weeks, 12, weeks, and 36 weeks. At the 24-week assessment, the CAPS-5 score for those in the CPT group (20.92) was significantly lower than it was for those in the WET group (25.23) (mean difference, 4.31 points; 95% confidence interval, –1.37 to 9.99).

In addition, the CPT group had a higher dropout rate (31.7%) than did the WET group (6.3%). The investigators concluded, however, that both therapies are effective. “Written exposure therapy should be considered by clinicians to be a viable treatment option that can address some of the barriers to receiving and implementing CPT and prolonged exposure that have been noted in health care settings,” Dr. Sloan and her colleagues wrote.

This study was funded by a grant from the National Institute of Mental Health. None of the authors had financial conflicts to report. Further details on this information can be found here.

[email protected]

SOURCE: Sloan DM. 2018 Jan 17. doi: 10.1001/jamapsychiatry.2017.4249.