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Oral clozapine, long-acting injectables tied to lower relapse risk in schizophrenia
Clozapine and long-acting injectable antipsychotic medications were most effective at preventing rehospitalization and treatment failure among patients with schizophrenia, according to a large prospective cohort study reported online June 7.
“The risk of rehospitalization is about 20% to 30% lower during long-acting injectable treatments, compared with equivalent oral formulations,” wrote Jari Tiihonen, MD, PhD, of the department of clinical neuroscience at the Karolinska Institutet in Stockholm, together with his associates.
Selection bias is a major problem in clinical trials of antipsychotics because up to 90% of patients are excluded for suicidal or antisocial behavior, substance abuse, refusal to participate, or comorbidities, the researchers noted. Observational studies also suffer from selection bias because of residual confounding. To address this issue, the researchers analyzed linked databases of 29,823 adults in Sweden with schizophrenia by using within-individual Cox proportional hazards regression analysis, in which each patient serves as his or her own control. Patients were diagnosed by 2006 and followed through 2013 (JAMA Psychiatry. 2017 June 7. doi: 10.1001/jamapsychiatry.2017.1322). A total of 13,042 patients (44%) were rehospitalized during follow-up. Rehospitalization was significantly less likely when patients were receiving oral clozapine or long-acting injectable antipsychotics, including paliperidone, zuclopenthixol, perphenazine, and olanzapine, than when they were not on antipsychotics. Hazard ratios for these comparisons were statistically significant, ranging from 0.51 to 0.58, the researchers reported.
In the overall cohort, patients were about 22% less likely to be rehospitalized when they received long-acting injectable antipsychotics instead of equivalent oral formulations (HR, 0.78; 95% confidence interval, 0.72-0.84; P less than .001). For newly diagnosed patients, this protective effect reached 32% (HR, 0.68; 95% CI, 0.53-0.86). The overall rate of treatment failure was 72%, but this outcome was significantly less likely when patients received clozapine (HR, 0.58; 95% CI, 0.53-0.63) or any of the long-acting injectable antipsychotics (HR, 0.65-0.80) instead of the most widely used medication, oral olanzapine. Those trends held up during several sensitivity analyses, the researchers noted.
The major reason long-acting injectables led to better outcomes probably is tied to adherence, “and the rationale for developing long-acting injectable formulations was to improve adherence,” Dr. Tilhonen and his associates wrote.
Dr. Tiihonen and his associates cited several limitations. For example, their results comparing the effectiveness of antipsychotics “can be generalized only to white populations and high-income countries in which all antipsychotic treatments are reimbursed by the state,” they wrote.
Nevertheless, they concluded that their results suggest that substantial differences exist “between specific antipsychotic agents and between routes of administration concerning the risk of rehospitalization and treatment failure among patients with schizophrenia.”
Janssen-Cilag funded the study. Dr. Tiihonen disclosed ties to Janssen-Cilag and several other pharmaceutical companies.
Clozapine and long-acting injectable antipsychotic medications were most effective at preventing rehospitalization and treatment failure among patients with schizophrenia, according to a large prospective cohort study reported online June 7.
“The risk of rehospitalization is about 20% to 30% lower during long-acting injectable treatments, compared with equivalent oral formulations,” wrote Jari Tiihonen, MD, PhD, of the department of clinical neuroscience at the Karolinska Institutet in Stockholm, together with his associates.
Selection bias is a major problem in clinical trials of antipsychotics because up to 90% of patients are excluded for suicidal or antisocial behavior, substance abuse, refusal to participate, or comorbidities, the researchers noted. Observational studies also suffer from selection bias because of residual confounding. To address this issue, the researchers analyzed linked databases of 29,823 adults in Sweden with schizophrenia by using within-individual Cox proportional hazards regression analysis, in which each patient serves as his or her own control. Patients were diagnosed by 2006 and followed through 2013 (JAMA Psychiatry. 2017 June 7. doi: 10.1001/jamapsychiatry.2017.1322). A total of 13,042 patients (44%) were rehospitalized during follow-up. Rehospitalization was significantly less likely when patients were receiving oral clozapine or long-acting injectable antipsychotics, including paliperidone, zuclopenthixol, perphenazine, and olanzapine, than when they were not on antipsychotics. Hazard ratios for these comparisons were statistically significant, ranging from 0.51 to 0.58, the researchers reported.
In the overall cohort, patients were about 22% less likely to be rehospitalized when they received long-acting injectable antipsychotics instead of equivalent oral formulations (HR, 0.78; 95% confidence interval, 0.72-0.84; P less than .001). For newly diagnosed patients, this protective effect reached 32% (HR, 0.68; 95% CI, 0.53-0.86). The overall rate of treatment failure was 72%, but this outcome was significantly less likely when patients received clozapine (HR, 0.58; 95% CI, 0.53-0.63) or any of the long-acting injectable antipsychotics (HR, 0.65-0.80) instead of the most widely used medication, oral olanzapine. Those trends held up during several sensitivity analyses, the researchers noted.
The major reason long-acting injectables led to better outcomes probably is tied to adherence, “and the rationale for developing long-acting injectable formulations was to improve adherence,” Dr. Tilhonen and his associates wrote.
Dr. Tiihonen and his associates cited several limitations. For example, their results comparing the effectiveness of antipsychotics “can be generalized only to white populations and high-income countries in which all antipsychotic treatments are reimbursed by the state,” they wrote.
Nevertheless, they concluded that their results suggest that substantial differences exist “between specific antipsychotic agents and between routes of administration concerning the risk of rehospitalization and treatment failure among patients with schizophrenia.”
Janssen-Cilag funded the study. Dr. Tiihonen disclosed ties to Janssen-Cilag and several other pharmaceutical companies.
Clozapine and long-acting injectable antipsychotic medications were most effective at preventing rehospitalization and treatment failure among patients with schizophrenia, according to a large prospective cohort study reported online June 7.
“The risk of rehospitalization is about 20% to 30% lower during long-acting injectable treatments, compared with equivalent oral formulations,” wrote Jari Tiihonen, MD, PhD, of the department of clinical neuroscience at the Karolinska Institutet in Stockholm, together with his associates.
Selection bias is a major problem in clinical trials of antipsychotics because up to 90% of patients are excluded for suicidal or antisocial behavior, substance abuse, refusal to participate, or comorbidities, the researchers noted. Observational studies also suffer from selection bias because of residual confounding. To address this issue, the researchers analyzed linked databases of 29,823 adults in Sweden with schizophrenia by using within-individual Cox proportional hazards regression analysis, in which each patient serves as his or her own control. Patients were diagnosed by 2006 and followed through 2013 (JAMA Psychiatry. 2017 June 7. doi: 10.1001/jamapsychiatry.2017.1322). A total of 13,042 patients (44%) were rehospitalized during follow-up. Rehospitalization was significantly less likely when patients were receiving oral clozapine or long-acting injectable antipsychotics, including paliperidone, zuclopenthixol, perphenazine, and olanzapine, than when they were not on antipsychotics. Hazard ratios for these comparisons were statistically significant, ranging from 0.51 to 0.58, the researchers reported.
In the overall cohort, patients were about 22% less likely to be rehospitalized when they received long-acting injectable antipsychotics instead of equivalent oral formulations (HR, 0.78; 95% confidence interval, 0.72-0.84; P less than .001). For newly diagnosed patients, this protective effect reached 32% (HR, 0.68; 95% CI, 0.53-0.86). The overall rate of treatment failure was 72%, but this outcome was significantly less likely when patients received clozapine (HR, 0.58; 95% CI, 0.53-0.63) or any of the long-acting injectable antipsychotics (HR, 0.65-0.80) instead of the most widely used medication, oral olanzapine. Those trends held up during several sensitivity analyses, the researchers noted.
The major reason long-acting injectables led to better outcomes probably is tied to adherence, “and the rationale for developing long-acting injectable formulations was to improve adherence,” Dr. Tilhonen and his associates wrote.
Dr. Tiihonen and his associates cited several limitations. For example, their results comparing the effectiveness of antipsychotics “can be generalized only to white populations and high-income countries in which all antipsychotic treatments are reimbursed by the state,” they wrote.
Nevertheless, they concluded that their results suggest that substantial differences exist “between specific antipsychotic agents and between routes of administration concerning the risk of rehospitalization and treatment failure among patients with schizophrenia.”
Janssen-Cilag funded the study. Dr. Tiihonen disclosed ties to Janssen-Cilag and several other pharmaceutical companies.
FROM JAMA PSYCHIATRY
Key clinical point: Clozapine and long-acting injectable antipsychotic medications were associated with the lowest rates of relapse in patients with schizophrenia.
Major finding: Patients were about 22% less likely to be rehospitalized when receiving long-acting injectable antipsychotics instead of equivalent oral formulations (HR, 0.78; 95% CI, 0.72-0.84).
Data source: A prospective observational study of 29,823 adults diagnosed with schizophrenia living in Sweden who served as their own controls.
Disclosures: Janssen-Cilag funded the study. Dr. Tiihonen disclosed ties to Janssen-Cilag and several other pharmaceutical companies.
Late-to-bed adolescents may be early-to-diabetes
BOSTON – Late chronotype may have a deleterious impact on glucose homeostasis independent of obesity in preadolescents aged 10-13 years, according to a small study.
Late chronotype – or an individual’s preference for later sleep and food intake – is associated with higher body mass index (BMI), risk incidence of type 2 diabetes mellitus, hemoglobin A1c, and risk of hypertension in adults. It is also associated with higher BMI, lower dietary restraint, and lower HDL cholesterol in adolescents. This study was the first to focus on chronotype and glycemic control in children on the cusp of or in early puberty.
In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days – an objective measure of chronotype – was associated positively with fasting plasma glucose (P = 0.048). “This is an important point because it highlights the objective measure of chronotype, whereas questionnaires can be more subjective,” said Magdalena Dumin, MD, at the annual meeting of Associated Professional Sleep Societies.
The researcher also noted that higher sleep fragmentation and lower sleep efficiency were both associated with hyperglycemia and hyperinsulinemia, independent of obesity.
“Our preliminary findings suggest that having a late chronotype and less efficient and more fragmented sleep in pre- and early adolescence may have a deleterious glycemic impact independent of obesity and pubertal stage,” she said.
“Advancing bedtimes may reduce glucose levels in preadolescents and adolescents,” Dr. Dumin surmised.
This study included 24 adolescents, 13 of whom were normal weight and 11 of whom were obese. They all underwent anthropometric measurements with fasting glucose, insulin, C-peptide, HbA1c, and lipid levels. Exclusion criteria included a clinical diagnosis of sleep, behavioral, or dietary problems. The obese subjects also underwent a 180-minute glucose tolerance test.
Chronotype was assessed via actigraphy over 1 week to provide mid-sleep time on free days, and secondarily through administration to chronotype questionnaires – the Children’s ChronoType Questionnaire and the Morningness-Eveningness Scale for Children.
Among the normal-weight participants, 31% were morning and 23% evening chronotype (the rest being neutral chronotype), and, in the obese subjects, 27% were morning and 36% were evening chronotype.
The obese subjects were more likely to be in puberty, and had higher systolic blood pressures, higher fasting plasma insulin and levels of insulin resistance, as measured by Homeostatic Model Assessment of Insulin Resistance. Hemoglobin A1c tended to be higher in the obese subjects (P = .06), but fasting plasma glucose did not differ significantly between the obese and normal-weight participants (P = .68).
“We chose this population due to the shift from morningness to eveningness that occurs during adolescence followed by a progressive return to an intermediate or early chronotype at the end of adolescence,” Dr. Dumin said.
Bedtime, wake time, and total sleep time were nearly identical between the two groups (7.84 hours and 7.62 hours; P = .49), although sleep efficiency was numerically lower in the obese subjects (87.0 vs. 89.8; P = .14), while sleep fragmentation was somewhat greater (20.16 vs. 17.38; P = .18).
Dr. Dumin suggested that a continuation of her research with more patients would be useful.
This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine. Dr. Dumin reported having no financial disclosures.
BOSTON – Late chronotype may have a deleterious impact on glucose homeostasis independent of obesity in preadolescents aged 10-13 years, according to a small study.
Late chronotype – or an individual’s preference for later sleep and food intake – is associated with higher body mass index (BMI), risk incidence of type 2 diabetes mellitus, hemoglobin A1c, and risk of hypertension in adults. It is also associated with higher BMI, lower dietary restraint, and lower HDL cholesterol in adolescents. This study was the first to focus on chronotype and glycemic control in children on the cusp of or in early puberty.
In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days – an objective measure of chronotype – was associated positively with fasting plasma glucose (P = 0.048). “This is an important point because it highlights the objective measure of chronotype, whereas questionnaires can be more subjective,” said Magdalena Dumin, MD, at the annual meeting of Associated Professional Sleep Societies.
The researcher also noted that higher sleep fragmentation and lower sleep efficiency were both associated with hyperglycemia and hyperinsulinemia, independent of obesity.
“Our preliminary findings suggest that having a late chronotype and less efficient and more fragmented sleep in pre- and early adolescence may have a deleterious glycemic impact independent of obesity and pubertal stage,” she said.
“Advancing bedtimes may reduce glucose levels in preadolescents and adolescents,” Dr. Dumin surmised.
This study included 24 adolescents, 13 of whom were normal weight and 11 of whom were obese. They all underwent anthropometric measurements with fasting glucose, insulin, C-peptide, HbA1c, and lipid levels. Exclusion criteria included a clinical diagnosis of sleep, behavioral, or dietary problems. The obese subjects also underwent a 180-minute glucose tolerance test.
Chronotype was assessed via actigraphy over 1 week to provide mid-sleep time on free days, and secondarily through administration to chronotype questionnaires – the Children’s ChronoType Questionnaire and the Morningness-Eveningness Scale for Children.
Among the normal-weight participants, 31% were morning and 23% evening chronotype (the rest being neutral chronotype), and, in the obese subjects, 27% were morning and 36% were evening chronotype.
The obese subjects were more likely to be in puberty, and had higher systolic blood pressures, higher fasting plasma insulin and levels of insulin resistance, as measured by Homeostatic Model Assessment of Insulin Resistance. Hemoglobin A1c tended to be higher in the obese subjects (P = .06), but fasting plasma glucose did not differ significantly between the obese and normal-weight participants (P = .68).
“We chose this population due to the shift from morningness to eveningness that occurs during adolescence followed by a progressive return to an intermediate or early chronotype at the end of adolescence,” Dr. Dumin said.
Bedtime, wake time, and total sleep time were nearly identical between the two groups (7.84 hours and 7.62 hours; P = .49), although sleep efficiency was numerically lower in the obese subjects (87.0 vs. 89.8; P = .14), while sleep fragmentation was somewhat greater (20.16 vs. 17.38; P = .18).
Dr. Dumin suggested that a continuation of her research with more patients would be useful.
This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine. Dr. Dumin reported having no financial disclosures.
BOSTON – Late chronotype may have a deleterious impact on glucose homeostasis independent of obesity in preadolescents aged 10-13 years, according to a small study.
Late chronotype – or an individual’s preference for later sleep and food intake – is associated with higher body mass index (BMI), risk incidence of type 2 diabetes mellitus, hemoglobin A1c, and risk of hypertension in adults. It is also associated with higher BMI, lower dietary restraint, and lower HDL cholesterol in adolescents. This study was the first to focus on chronotype and glycemic control in children on the cusp of or in early puberty.
In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days – an objective measure of chronotype – was associated positively with fasting plasma glucose (P = 0.048). “This is an important point because it highlights the objective measure of chronotype, whereas questionnaires can be more subjective,” said Magdalena Dumin, MD, at the annual meeting of Associated Professional Sleep Societies.
The researcher also noted that higher sleep fragmentation and lower sleep efficiency were both associated with hyperglycemia and hyperinsulinemia, independent of obesity.
“Our preliminary findings suggest that having a late chronotype and less efficient and more fragmented sleep in pre- and early adolescence may have a deleterious glycemic impact independent of obesity and pubertal stage,” she said.
“Advancing bedtimes may reduce glucose levels in preadolescents and adolescents,” Dr. Dumin surmised.
This study included 24 adolescents, 13 of whom were normal weight and 11 of whom were obese. They all underwent anthropometric measurements with fasting glucose, insulin, C-peptide, HbA1c, and lipid levels. Exclusion criteria included a clinical diagnosis of sleep, behavioral, or dietary problems. The obese subjects also underwent a 180-minute glucose tolerance test.
Chronotype was assessed via actigraphy over 1 week to provide mid-sleep time on free days, and secondarily through administration to chronotype questionnaires – the Children’s ChronoType Questionnaire and the Morningness-Eveningness Scale for Children.
Among the normal-weight participants, 31% were morning and 23% evening chronotype (the rest being neutral chronotype), and, in the obese subjects, 27% were morning and 36% were evening chronotype.
The obese subjects were more likely to be in puberty, and had higher systolic blood pressures, higher fasting plasma insulin and levels of insulin resistance, as measured by Homeostatic Model Assessment of Insulin Resistance. Hemoglobin A1c tended to be higher in the obese subjects (P = .06), but fasting plasma glucose did not differ significantly between the obese and normal-weight participants (P = .68).
“We chose this population due to the shift from morningness to eveningness that occurs during adolescence followed by a progressive return to an intermediate or early chronotype at the end of adolescence,” Dr. Dumin said.
Bedtime, wake time, and total sleep time were nearly identical between the two groups (7.84 hours and 7.62 hours; P = .49), although sleep efficiency was numerically lower in the obese subjects (87.0 vs. 89.8; P = .14), while sleep fragmentation was somewhat greater (20.16 vs. 17.38; P = .18).
Dr. Dumin suggested that a continuation of her research with more patients would be useful.
This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine. Dr. Dumin reported having no financial disclosures.
AT SLEEP 2017
Key clinical point: Preadolescents with a late chronotype show impaired glucose homeostasis independent of obesity.
Major finding: In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days was positively associated with fasting plasma glucose (P = .048).
Data source: Observational study including 24 adolescents between 10 and 13 years of age. Thirteen were normal weight and 11 were obese.
Disclosures: Dr. Dumin reported having no financial disclosures. This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine.
VIDEO: Shorter oxaliplatin-based therapy suffices for some patients with stage III CRC
CHICAGO – When it comes to oxaliplatin-based therapy for stage III colon cancer patients with low recurrence risk, 3 is preferable to 6 months and may also be preferable in those with higher recurrence risk – particularly if they are receiving oxaliplatin with capecitabine (CAPOX), according to findings from a prospective pooled analysis of data from six phase III trials.
The findings have immediate practice-changing implications, according to Axel Grothey, MD, of the Mayo Clinic Cancer Center, Rochester, Minn.
The preplanned analysis of the concurrently conducted trials (the International Duration Evaluation of Adjuvant chemotherapy [IDEA] collaboration), which included 12,834 patients receiving either oxaliplatin with fluorouracil and folinic acid (FOLFOX) or CAPOX, showed that, at a median follow-up of 39 months, the overall 3-year disease-free survival (DFS) rates differed by only 0.9% between those receiving 3 vs. 6 months of therapy (DFS, 74.6% and 75.5%, respectively). The difference between the groups was not statistically significant (estimated disease-free hazard ratio, 1.07), Dr. Grothey reported during a press briefing at the annual meeting of the American Society of Clinical Oncology.
However, grade 2 or greater neurotoxicity was greatly reduced, occurring in 17% vs. 48% of FOLFOX patients treated for 3 vs. 6 months, respectively, and in 15% vs. 45% of CAPOX patients treated for 3 vs. 6 months, respectively.
When outcomes were analyzed based on risk of recurrence, low-risk patients (those with T1-3 N1 disease) had 3-year disease-free survival rates of 83.1% and 83.3% with 3 vs. 6 months of therapy, and high-risk patients (T4 or N2 disease) had 3-year disease-free survival of 62.7% vs. 64.4% with 3 vs. 6 months of therapy.
When outcomes were analyzed by regimen, the FOLFOX patients (about 60% of the patient population) had 3-year DFS of 73.6% and 76.0% with 3 vs. 6 months of therapy, and the CAPOX patients had 3-year DFS of 75.9% and 74.8%, respectively.
In this video interview, Dr. Grothey discusses the findings, as well as the importance of federal funding for cancer research, which is underscored by the findings.
He also discusses the IDEA Collaboration consensus based on the results, which calls for 3 months of therapy in low-risk patients and for an individualized approach based on tolerability of therapy, patient preference, assessment of recurrence risk, and treatment regimen (CAPOX vs. FOLFOX) in higher-risk patients.
“We now have very important, very solid data to engage patients in discussion [about] how to individualize the duration of therapy,” he said.
Dr. Grothey reported having no relevant disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – When it comes to oxaliplatin-based therapy for stage III colon cancer patients with low recurrence risk, 3 is preferable to 6 months and may also be preferable in those with higher recurrence risk – particularly if they are receiving oxaliplatin with capecitabine (CAPOX), according to findings from a prospective pooled analysis of data from six phase III trials.
The findings have immediate practice-changing implications, according to Axel Grothey, MD, of the Mayo Clinic Cancer Center, Rochester, Minn.
The preplanned analysis of the concurrently conducted trials (the International Duration Evaluation of Adjuvant chemotherapy [IDEA] collaboration), which included 12,834 patients receiving either oxaliplatin with fluorouracil and folinic acid (FOLFOX) or CAPOX, showed that, at a median follow-up of 39 months, the overall 3-year disease-free survival (DFS) rates differed by only 0.9% between those receiving 3 vs. 6 months of therapy (DFS, 74.6% and 75.5%, respectively). The difference between the groups was not statistically significant (estimated disease-free hazard ratio, 1.07), Dr. Grothey reported during a press briefing at the annual meeting of the American Society of Clinical Oncology.
However, grade 2 or greater neurotoxicity was greatly reduced, occurring in 17% vs. 48% of FOLFOX patients treated for 3 vs. 6 months, respectively, and in 15% vs. 45% of CAPOX patients treated for 3 vs. 6 months, respectively.
When outcomes were analyzed based on risk of recurrence, low-risk patients (those with T1-3 N1 disease) had 3-year disease-free survival rates of 83.1% and 83.3% with 3 vs. 6 months of therapy, and high-risk patients (T4 or N2 disease) had 3-year disease-free survival of 62.7% vs. 64.4% with 3 vs. 6 months of therapy.
When outcomes were analyzed by regimen, the FOLFOX patients (about 60% of the patient population) had 3-year DFS of 73.6% and 76.0% with 3 vs. 6 months of therapy, and the CAPOX patients had 3-year DFS of 75.9% and 74.8%, respectively.
In this video interview, Dr. Grothey discusses the findings, as well as the importance of federal funding for cancer research, which is underscored by the findings.
He also discusses the IDEA Collaboration consensus based on the results, which calls for 3 months of therapy in low-risk patients and for an individualized approach based on tolerability of therapy, patient preference, assessment of recurrence risk, and treatment regimen (CAPOX vs. FOLFOX) in higher-risk patients.
“We now have very important, very solid data to engage patients in discussion [about] how to individualize the duration of therapy,” he said.
Dr. Grothey reported having no relevant disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – When it comes to oxaliplatin-based therapy for stage III colon cancer patients with low recurrence risk, 3 is preferable to 6 months and may also be preferable in those with higher recurrence risk – particularly if they are receiving oxaliplatin with capecitabine (CAPOX), according to findings from a prospective pooled analysis of data from six phase III trials.
The findings have immediate practice-changing implications, according to Axel Grothey, MD, of the Mayo Clinic Cancer Center, Rochester, Minn.
The preplanned analysis of the concurrently conducted trials (the International Duration Evaluation of Adjuvant chemotherapy [IDEA] collaboration), which included 12,834 patients receiving either oxaliplatin with fluorouracil and folinic acid (FOLFOX) or CAPOX, showed that, at a median follow-up of 39 months, the overall 3-year disease-free survival (DFS) rates differed by only 0.9% between those receiving 3 vs. 6 months of therapy (DFS, 74.6% and 75.5%, respectively). The difference between the groups was not statistically significant (estimated disease-free hazard ratio, 1.07), Dr. Grothey reported during a press briefing at the annual meeting of the American Society of Clinical Oncology.
However, grade 2 or greater neurotoxicity was greatly reduced, occurring in 17% vs. 48% of FOLFOX patients treated for 3 vs. 6 months, respectively, and in 15% vs. 45% of CAPOX patients treated for 3 vs. 6 months, respectively.
When outcomes were analyzed based on risk of recurrence, low-risk patients (those with T1-3 N1 disease) had 3-year disease-free survival rates of 83.1% and 83.3% with 3 vs. 6 months of therapy, and high-risk patients (T4 or N2 disease) had 3-year disease-free survival of 62.7% vs. 64.4% with 3 vs. 6 months of therapy.
When outcomes were analyzed by regimen, the FOLFOX patients (about 60% of the patient population) had 3-year DFS of 73.6% and 76.0% with 3 vs. 6 months of therapy, and the CAPOX patients had 3-year DFS of 75.9% and 74.8%, respectively.
In this video interview, Dr. Grothey discusses the findings, as well as the importance of federal funding for cancer research, which is underscored by the findings.
He also discusses the IDEA Collaboration consensus based on the results, which calls for 3 months of therapy in low-risk patients and for an individualized approach based on tolerability of therapy, patient preference, assessment of recurrence risk, and treatment regimen (CAPOX vs. FOLFOX) in higher-risk patients.
“We now have very important, very solid data to engage patients in discussion [about] how to individualize the duration of therapy,” he said.
Dr. Grothey reported having no relevant disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ASCO 2017
VIDEO: Pertuzumab prolongs disease-free survival in HER2+ early breast cancer
CHICAGO –
At a median follow-up of 45.4 months, invasive disease-free survival (IDFS) events occurred in 171 of 2,400 patients (7.1%) who received pertuzumab, compared with 210 of 2,405 patients (8.7%) who received placebo (hazard ratio, 0.81). This 19% reduction in risk of an IDFS event was statistically significant, Gunter von Minckwitz, MD, PhD, reported at the annual meeting of the American Society of Clinical Oncology.
The estimated IDFS rate at 3 years was 94.1% in the pertuzumab arm, and 93.2% in the placebo arm, said Dr. von Minckwitz of the German Breast Group, Neu-Isenburg.
Study subjects were patients with adequately excised HER2-positive, pT1-3 early breast cancer. Patients were randomized to receive adjuvant chemotherapy plus 1 year of either trastuzumab plus pertuzumab, or trastuzumab plus placebo.
In a video interview, Dr. von Minckwitz discusses the study results, including outcomes in node-positive vs. node-negative patients, early overall survival findings, and safety.
“We are using pertuzumab right now in many countries for the neoadjuvant setting,” he said, explaining that existing approvals were granted conditionally in the absence of evidence regarding long-term benefits. “With the APHINITY study ... use of pertuzumab either in the neoadjuvant setting or in the higher-risk adjuvant setting is something that is supported now with evidence.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO –
At a median follow-up of 45.4 months, invasive disease-free survival (IDFS) events occurred in 171 of 2,400 patients (7.1%) who received pertuzumab, compared with 210 of 2,405 patients (8.7%) who received placebo (hazard ratio, 0.81). This 19% reduction in risk of an IDFS event was statistically significant, Gunter von Minckwitz, MD, PhD, reported at the annual meeting of the American Society of Clinical Oncology.
The estimated IDFS rate at 3 years was 94.1% in the pertuzumab arm, and 93.2% in the placebo arm, said Dr. von Minckwitz of the German Breast Group, Neu-Isenburg.
Study subjects were patients with adequately excised HER2-positive, pT1-3 early breast cancer. Patients were randomized to receive adjuvant chemotherapy plus 1 year of either trastuzumab plus pertuzumab, or trastuzumab plus placebo.
In a video interview, Dr. von Minckwitz discusses the study results, including outcomes in node-positive vs. node-negative patients, early overall survival findings, and safety.
“We are using pertuzumab right now in many countries for the neoadjuvant setting,” he said, explaining that existing approvals were granted conditionally in the absence of evidence regarding long-term benefits. “With the APHINITY study ... use of pertuzumab either in the neoadjuvant setting or in the higher-risk adjuvant setting is something that is supported now with evidence.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO –
At a median follow-up of 45.4 months, invasive disease-free survival (IDFS) events occurred in 171 of 2,400 patients (7.1%) who received pertuzumab, compared with 210 of 2,405 patients (8.7%) who received placebo (hazard ratio, 0.81). This 19% reduction in risk of an IDFS event was statistically significant, Gunter von Minckwitz, MD, PhD, reported at the annual meeting of the American Society of Clinical Oncology.
The estimated IDFS rate at 3 years was 94.1% in the pertuzumab arm, and 93.2% in the placebo arm, said Dr. von Minckwitz of the German Breast Group, Neu-Isenburg.
Study subjects were patients with adequately excised HER2-positive, pT1-3 early breast cancer. Patients were randomized to receive adjuvant chemotherapy plus 1 year of either trastuzumab plus pertuzumab, or trastuzumab plus placebo.
In a video interview, Dr. von Minckwitz discusses the study results, including outcomes in node-positive vs. node-negative patients, early overall survival findings, and safety.
“We are using pertuzumab right now in many countries for the neoadjuvant setting,” he said, explaining that existing approvals were granted conditionally in the absence of evidence regarding long-term benefits. “With the APHINITY study ... use of pertuzumab either in the neoadjuvant setting or in the higher-risk adjuvant setting is something that is supported now with evidence.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ASCO 2017
HIV study: Vaginal bacteria rapidly metabolized topical tenofovir
Certain species of vaginal bacteria rapidly metabolized topical tenofovir, which was three times less effective at preventing HIV in women with predominantly these vaginal microbiota, according to results of a study published in Science.
Key culprits were Gardnerella vaginalis and other anaerobic species associated with bacterial vaginosis, reported Nichole R. Klatt, PhD, of the University of Washington, Seattle, and her associates. The findings could help explain the lower and widely variable efficacy rates of topical microbicides in clinical HIV prevention trials, they added.
Lactobacillus was the primary genus in 423 women (62%), while non-Lactobacillus microbiota predominated in the remaining 256 women. Compared with placebo, tenofovir decreased the incidence of HIV infections by 61% (95% confidence interval, 0.16-0.89; P = .01) in women whose vaginal microbiota consisted mainly of Lactobacillus species, but by only 18% (95% CI, 0.37-1.77; P = .6) when nonlactobacilli predominated. These findings did not change after the investigators controlled for sexually transmitted infections, use of antibiotics, use of depot medroxyprogesterone acetate (DMPA), and sexual behaviors (including frequency of sex, number of partners, and condom use). Furthermore, the two groups were clinically, behaviorally, and demographically similar and had similar rates of adherence to tenofovir gel during the trial.
The non-Lactobacillus group had more bacterial diversity and several distinct subgroups, the largest of which was dominated by Gardnerella vaginalis and other bacteria associated with bacterial vaginosis. This subgroup had lower mucosal levels of tenofovir, compared with women with primarily lactobacilli, the investigators reported. Tenofovir concentrations fell by 51% in the in vivo cultures of G. vaginalis but dropped only slightly in cultures of two common Lactobacillus species (P less than .004 for each comparison). After 24 hours, tenofovir concentrations had decreased by 67% in cultures with G. vaginalis but by only 9%-14% in cultures with lactobacilli.
The researchers also tested three other subtypes of G. vaginalis, all of which metabolized tenofovir. The findings revealed a biologic mechanism that is probably part of “a multifactorial process, including increased vaginal inflammation and adherence, leading to varying levels of HIV prevention efficacy observed across topical microbicide trials,” they concluded. Screening by testing vaginal pH or microbiota might help “guide and enhance prevention of HIV in women,” they wrote.
Funders included the Canadian Institutes of Health Research, the University of Washington, the Public Health Agency of Canada, and the U.S. Agency for International Development. The investigators had no disclosures.
Certain species of vaginal bacteria rapidly metabolized topical tenofovir, which was three times less effective at preventing HIV in women with predominantly these vaginal microbiota, according to results of a study published in Science.
Key culprits were Gardnerella vaginalis and other anaerobic species associated with bacterial vaginosis, reported Nichole R. Klatt, PhD, of the University of Washington, Seattle, and her associates. The findings could help explain the lower and widely variable efficacy rates of topical microbicides in clinical HIV prevention trials, they added.
Lactobacillus was the primary genus in 423 women (62%), while non-Lactobacillus microbiota predominated in the remaining 256 women. Compared with placebo, tenofovir decreased the incidence of HIV infections by 61% (95% confidence interval, 0.16-0.89; P = .01) in women whose vaginal microbiota consisted mainly of Lactobacillus species, but by only 18% (95% CI, 0.37-1.77; P = .6) when nonlactobacilli predominated. These findings did not change after the investigators controlled for sexually transmitted infections, use of antibiotics, use of depot medroxyprogesterone acetate (DMPA), and sexual behaviors (including frequency of sex, number of partners, and condom use). Furthermore, the two groups were clinically, behaviorally, and demographically similar and had similar rates of adherence to tenofovir gel during the trial.
The non-Lactobacillus group had more bacterial diversity and several distinct subgroups, the largest of which was dominated by Gardnerella vaginalis and other bacteria associated with bacterial vaginosis. This subgroup had lower mucosal levels of tenofovir, compared with women with primarily lactobacilli, the investigators reported. Tenofovir concentrations fell by 51% in the in vivo cultures of G. vaginalis but dropped only slightly in cultures of two common Lactobacillus species (P less than .004 for each comparison). After 24 hours, tenofovir concentrations had decreased by 67% in cultures with G. vaginalis but by only 9%-14% in cultures with lactobacilli.
The researchers also tested three other subtypes of G. vaginalis, all of which metabolized tenofovir. The findings revealed a biologic mechanism that is probably part of “a multifactorial process, including increased vaginal inflammation and adherence, leading to varying levels of HIV prevention efficacy observed across topical microbicide trials,” they concluded. Screening by testing vaginal pH or microbiota might help “guide and enhance prevention of HIV in women,” they wrote.
Funders included the Canadian Institutes of Health Research, the University of Washington, the Public Health Agency of Canada, and the U.S. Agency for International Development. The investigators had no disclosures.
Certain species of vaginal bacteria rapidly metabolized topical tenofovir, which was three times less effective at preventing HIV in women with predominantly these vaginal microbiota, according to results of a study published in Science.
Key culprits were Gardnerella vaginalis and other anaerobic species associated with bacterial vaginosis, reported Nichole R. Klatt, PhD, of the University of Washington, Seattle, and her associates. The findings could help explain the lower and widely variable efficacy rates of topical microbicides in clinical HIV prevention trials, they added.
Lactobacillus was the primary genus in 423 women (62%), while non-Lactobacillus microbiota predominated in the remaining 256 women. Compared with placebo, tenofovir decreased the incidence of HIV infections by 61% (95% confidence interval, 0.16-0.89; P = .01) in women whose vaginal microbiota consisted mainly of Lactobacillus species, but by only 18% (95% CI, 0.37-1.77; P = .6) when nonlactobacilli predominated. These findings did not change after the investigators controlled for sexually transmitted infections, use of antibiotics, use of depot medroxyprogesterone acetate (DMPA), and sexual behaviors (including frequency of sex, number of partners, and condom use). Furthermore, the two groups were clinically, behaviorally, and demographically similar and had similar rates of adherence to tenofovir gel during the trial.
The non-Lactobacillus group had more bacterial diversity and several distinct subgroups, the largest of which was dominated by Gardnerella vaginalis and other bacteria associated with bacterial vaginosis. This subgroup had lower mucosal levels of tenofovir, compared with women with primarily lactobacilli, the investigators reported. Tenofovir concentrations fell by 51% in the in vivo cultures of G. vaginalis but dropped only slightly in cultures of two common Lactobacillus species (P less than .004 for each comparison). After 24 hours, tenofovir concentrations had decreased by 67% in cultures with G. vaginalis but by only 9%-14% in cultures with lactobacilli.
The researchers also tested three other subtypes of G. vaginalis, all of which metabolized tenofovir. The findings revealed a biologic mechanism that is probably part of “a multifactorial process, including increased vaginal inflammation and adherence, leading to varying levels of HIV prevention efficacy observed across topical microbicide trials,” they concluded. Screening by testing vaginal pH or microbiota might help “guide and enhance prevention of HIV in women,” they wrote.
Funders included the Canadian Institutes of Health Research, the University of Washington, the Public Health Agency of Canada, and the U.S. Agency for International Development. The investigators had no disclosures.
FROM SCIENCE
Key clinical point: Certain species of vaginal bacteria rapidly metabolized topical tenofovir.
Major finding: After 24 hours in culture, tenofovir concentrations had decreased by 67% in cultures with Gardnerella vaginalis but by only 9%-14% in culture with lactobacilli.
Data source: Mass spectrometry–based proteomics of vaginal specimens from 668 HIV-negative women.
Disclosures: Funders included the Canadian Institutes of Health Research, the University of Washington, the Public Health Agency of Canada, and the U.S. Agency for International Development. The investigators had no disclosures.
CDC specifies risk-reduction strategies for HIV-discordant conception
When HIV-discordant couples wish to conceive, several strategies can effectively prevent men from infecting their female partners, according to an analysis in Morbidity and Mortality Weekly Report.
Using sperm from an HIV-negative donor remains the safest choice, but current methods of sperm washing make in vitro fertilization (IVF) or intrauterine insemination (IUI) a low-risk alternative, especially when used together with highly active antiretroviral therapy (HAART) and preexposure prophylaxis (PrEP), wrote Jennifer F. Kawwass, MD, and her associates in the division of reproductive health at the Centers for Disease Control and Prevention, Atlanta (MMWR Morb Mortal Wkly Rep. 2017;66:554-7).
Previously, the CDC recommended against insemination with semen from HIV-infected men. The new report reverses that position, citing epidemiologic and laboratory evidence that conception can occur safely when HIV-discordant couples use combined strategies including HAART, PrEP, and either condomless intercourse limited to the time around ovulation, or sperm washing prior to IVF or IUI.
Sperm washing has been around for about 2 decades, but current techniques appear to significantly cut the risk of HIV transmission, based on epidemiologic data. Among 11,500 IVF or IUI cycles in which uninfected females used washed sperm from their HIV-infected male partners, there have been no cases of HIV transmission to women or their children, the CDC authors emphasized. The use of HAART and PrEP can add an extra layer of protection, they added.
Serodiscordant couples may also consider or prefer natural conception. An HIV-infected male on HAART whose plasma viral load is undetectable can expect to infect his female partner only about 0.16 times for every 10,000 exposures during condomless intercourse, the report noted. Limiting condomless intercourse to the time of ovulation and using PrEP by the uninfected female can further minimize the risk of sexual transmission, the authors added. Experienced medical providers can help HIV-discordant couples further evaluate the “unique risk profile” of each approach to conception, they concluded.
Dr. Kawwass and her associates had no conflicts of interest.
When HIV-discordant couples wish to conceive, several strategies can effectively prevent men from infecting their female partners, according to an analysis in Morbidity and Mortality Weekly Report.
Using sperm from an HIV-negative donor remains the safest choice, but current methods of sperm washing make in vitro fertilization (IVF) or intrauterine insemination (IUI) a low-risk alternative, especially when used together with highly active antiretroviral therapy (HAART) and preexposure prophylaxis (PrEP), wrote Jennifer F. Kawwass, MD, and her associates in the division of reproductive health at the Centers for Disease Control and Prevention, Atlanta (MMWR Morb Mortal Wkly Rep. 2017;66:554-7).
Previously, the CDC recommended against insemination with semen from HIV-infected men. The new report reverses that position, citing epidemiologic and laboratory evidence that conception can occur safely when HIV-discordant couples use combined strategies including HAART, PrEP, and either condomless intercourse limited to the time around ovulation, or sperm washing prior to IVF or IUI.
Sperm washing has been around for about 2 decades, but current techniques appear to significantly cut the risk of HIV transmission, based on epidemiologic data. Among 11,500 IVF or IUI cycles in which uninfected females used washed sperm from their HIV-infected male partners, there have been no cases of HIV transmission to women or their children, the CDC authors emphasized. The use of HAART and PrEP can add an extra layer of protection, they added.
Serodiscordant couples may also consider or prefer natural conception. An HIV-infected male on HAART whose plasma viral load is undetectable can expect to infect his female partner only about 0.16 times for every 10,000 exposures during condomless intercourse, the report noted. Limiting condomless intercourse to the time of ovulation and using PrEP by the uninfected female can further minimize the risk of sexual transmission, the authors added. Experienced medical providers can help HIV-discordant couples further evaluate the “unique risk profile” of each approach to conception, they concluded.
Dr. Kawwass and her associates had no conflicts of interest.
When HIV-discordant couples wish to conceive, several strategies can effectively prevent men from infecting their female partners, according to an analysis in Morbidity and Mortality Weekly Report.
Using sperm from an HIV-negative donor remains the safest choice, but current methods of sperm washing make in vitro fertilization (IVF) or intrauterine insemination (IUI) a low-risk alternative, especially when used together with highly active antiretroviral therapy (HAART) and preexposure prophylaxis (PrEP), wrote Jennifer F. Kawwass, MD, and her associates in the division of reproductive health at the Centers for Disease Control and Prevention, Atlanta (MMWR Morb Mortal Wkly Rep. 2017;66:554-7).
Previously, the CDC recommended against insemination with semen from HIV-infected men. The new report reverses that position, citing epidemiologic and laboratory evidence that conception can occur safely when HIV-discordant couples use combined strategies including HAART, PrEP, and either condomless intercourse limited to the time around ovulation, or sperm washing prior to IVF or IUI.
Sperm washing has been around for about 2 decades, but current techniques appear to significantly cut the risk of HIV transmission, based on epidemiologic data. Among 11,500 IVF or IUI cycles in which uninfected females used washed sperm from their HIV-infected male partners, there have been no cases of HIV transmission to women or their children, the CDC authors emphasized. The use of HAART and PrEP can add an extra layer of protection, they added.
Serodiscordant couples may also consider or prefer natural conception. An HIV-infected male on HAART whose plasma viral load is undetectable can expect to infect his female partner only about 0.16 times for every 10,000 exposures during condomless intercourse, the report noted. Limiting condomless intercourse to the time of ovulation and using PrEP by the uninfected female can further minimize the risk of sexual transmission, the authors added. Experienced medical providers can help HIV-discordant couples further evaluate the “unique risk profile” of each approach to conception, they concluded.
Dr. Kawwass and her associates had no conflicts of interest.
FROM MMWR
Study validates endometriosis fertility index
VANCOUVER – The Endometriosis Fertility Index accurately predicts a woman’s chances to conceive naturally with endometriosis, according to findings from a prospective cohort study.
“We’re quite confident that this is a very good system to give women a reasonable idea of their chances of conceiving naturally versus a recommendation to have IVF,” Aaron Budden, Bmed, Mmed, of the Royal Hospital for Women in Sydney, said at the World Congress on Endometriosis.
The Endometriosis Fertility Index (EFI) was first published in 2010 (Fertil Steril. 2010 Oct;94[5]:1609-15). In the recent study, researchers found that live birth rates after 3 years closely matched the rates calculated by the tool. “This is one of the most useful systems I’ve ever seen, because it takes into account historical events, as well as the time of endometriosis surgery,” Dr. Budden said.
The researchers enrolled 141 consecutive women who had undergone fertility-saving laparoscopic excision of stage III or stage IV endometriosis and attempted to conceive naturally. During follow-up, the researchers contacted the patients to determine live births, and calculated the EFI score based on a woman’s age, duration of infertility, previous pregnancy, American Society for Reproductive Medicine endometriosis classification, and their least adnexal function score. “The least function score is based off the functional capacity of the fallopian tube, fimbriae, and ovary, where the score is calculated by which of these is least functional on both right and left side,” Dr. Budden said.
The researchers included women with stage III and stage IV endometriosis because this group is often referred for in vitro fertilization (IVF). “But we found that in women with an advanced stage of endometriosis, those with EFI scores of 9 and 10 still had quite a significant chance of conceiving at 3 years, compared to women who had EFI scores of 0 to 2,” Dr. Budden said.
More than a third of the women (35%) had stage III endometriosis, and 65% had stage IV. The mean follow-up period was 56 months. Overall, 46% achieved live births.
In women with an EFI score of 9-10, the success rate was 67% at 3 years. Nearly half (48%) of women with scores of 7-8 were successful at 3 years, as were 38% with scores of 5-6, and 17% with scores of 3-4. Among women with scores of 0-2, there were no live births at 3 years.
About 58% of the women in the study had undergone previous laparoscopic surgery. The researchers found that live births were associated with complete resection of disease (hazard ratio, 2.33; P = .036) and no previous laparoscopy (HR, 2.36; P less than .001).
“One of the things we have to say is that your best chance at conceiving is if you excise all the endometriosis and you do it the first time, rather than needing a second surgery,” Dr. Budden said.
The tool can also be used to help identify patients most likely to benefit from assisted reproduction. Women with EFI scores of 0-2 had a 0% chance of conceiving naturally when followed out to 5 years, but a 39% chance with IVF. “That’s a group that you would thoroughly recommend going to IVF rather than trying to conceive naturally,” Dr. Budden said in an interview.
The study was funded by a variety of non-industry sources. Dr. Budden reported having no financial disclosures.
VANCOUVER – The Endometriosis Fertility Index accurately predicts a woman’s chances to conceive naturally with endometriosis, according to findings from a prospective cohort study.
“We’re quite confident that this is a very good system to give women a reasonable idea of their chances of conceiving naturally versus a recommendation to have IVF,” Aaron Budden, Bmed, Mmed, of the Royal Hospital for Women in Sydney, said at the World Congress on Endometriosis.
The Endometriosis Fertility Index (EFI) was first published in 2010 (Fertil Steril. 2010 Oct;94[5]:1609-15). In the recent study, researchers found that live birth rates after 3 years closely matched the rates calculated by the tool. “This is one of the most useful systems I’ve ever seen, because it takes into account historical events, as well as the time of endometriosis surgery,” Dr. Budden said.
The researchers enrolled 141 consecutive women who had undergone fertility-saving laparoscopic excision of stage III or stage IV endometriosis and attempted to conceive naturally. During follow-up, the researchers contacted the patients to determine live births, and calculated the EFI score based on a woman’s age, duration of infertility, previous pregnancy, American Society for Reproductive Medicine endometriosis classification, and their least adnexal function score. “The least function score is based off the functional capacity of the fallopian tube, fimbriae, and ovary, where the score is calculated by which of these is least functional on both right and left side,” Dr. Budden said.
The researchers included women with stage III and stage IV endometriosis because this group is often referred for in vitro fertilization (IVF). “But we found that in women with an advanced stage of endometriosis, those with EFI scores of 9 and 10 still had quite a significant chance of conceiving at 3 years, compared to women who had EFI scores of 0 to 2,” Dr. Budden said.
More than a third of the women (35%) had stage III endometriosis, and 65% had stage IV. The mean follow-up period was 56 months. Overall, 46% achieved live births.
In women with an EFI score of 9-10, the success rate was 67% at 3 years. Nearly half (48%) of women with scores of 7-8 were successful at 3 years, as were 38% with scores of 5-6, and 17% with scores of 3-4. Among women with scores of 0-2, there were no live births at 3 years.
About 58% of the women in the study had undergone previous laparoscopic surgery. The researchers found that live births were associated with complete resection of disease (hazard ratio, 2.33; P = .036) and no previous laparoscopy (HR, 2.36; P less than .001).
“One of the things we have to say is that your best chance at conceiving is if you excise all the endometriosis and you do it the first time, rather than needing a second surgery,” Dr. Budden said.
The tool can also be used to help identify patients most likely to benefit from assisted reproduction. Women with EFI scores of 0-2 had a 0% chance of conceiving naturally when followed out to 5 years, but a 39% chance with IVF. “That’s a group that you would thoroughly recommend going to IVF rather than trying to conceive naturally,” Dr. Budden said in an interview.
The study was funded by a variety of non-industry sources. Dr. Budden reported having no financial disclosures.
VANCOUVER – The Endometriosis Fertility Index accurately predicts a woman’s chances to conceive naturally with endometriosis, according to findings from a prospective cohort study.
“We’re quite confident that this is a very good system to give women a reasonable idea of their chances of conceiving naturally versus a recommendation to have IVF,” Aaron Budden, Bmed, Mmed, of the Royal Hospital for Women in Sydney, said at the World Congress on Endometriosis.
The Endometriosis Fertility Index (EFI) was first published in 2010 (Fertil Steril. 2010 Oct;94[5]:1609-15). In the recent study, researchers found that live birth rates after 3 years closely matched the rates calculated by the tool. “This is one of the most useful systems I’ve ever seen, because it takes into account historical events, as well as the time of endometriosis surgery,” Dr. Budden said.
The researchers enrolled 141 consecutive women who had undergone fertility-saving laparoscopic excision of stage III or stage IV endometriosis and attempted to conceive naturally. During follow-up, the researchers contacted the patients to determine live births, and calculated the EFI score based on a woman’s age, duration of infertility, previous pregnancy, American Society for Reproductive Medicine endometriosis classification, and their least adnexal function score. “The least function score is based off the functional capacity of the fallopian tube, fimbriae, and ovary, where the score is calculated by which of these is least functional on both right and left side,” Dr. Budden said.
The researchers included women with stage III and stage IV endometriosis because this group is often referred for in vitro fertilization (IVF). “But we found that in women with an advanced stage of endometriosis, those with EFI scores of 9 and 10 still had quite a significant chance of conceiving at 3 years, compared to women who had EFI scores of 0 to 2,” Dr. Budden said.
More than a third of the women (35%) had stage III endometriosis, and 65% had stage IV. The mean follow-up period was 56 months. Overall, 46% achieved live births.
In women with an EFI score of 9-10, the success rate was 67% at 3 years. Nearly half (48%) of women with scores of 7-8 were successful at 3 years, as were 38% with scores of 5-6, and 17% with scores of 3-4. Among women with scores of 0-2, there were no live births at 3 years.
About 58% of the women in the study had undergone previous laparoscopic surgery. The researchers found that live births were associated with complete resection of disease (hazard ratio, 2.33; P = .036) and no previous laparoscopy (HR, 2.36; P less than .001).
“One of the things we have to say is that your best chance at conceiving is if you excise all the endometriosis and you do it the first time, rather than needing a second surgery,” Dr. Budden said.
The tool can also be used to help identify patients most likely to benefit from assisted reproduction. Women with EFI scores of 0-2 had a 0% chance of conceiving naturally when followed out to 5 years, but a 39% chance with IVF. “That’s a group that you would thoroughly recommend going to IVF rather than trying to conceive naturally,” Dr. Budden said in an interview.
The study was funded by a variety of non-industry sources. Dr. Budden reported having no financial disclosures.
AT WCE 2017
Key clinical point:
Major finding: Women who scored 9-10 on the EFI had a 67% live birth rate at 3 years without IVF.
Data source: Prospective analysis of 141 women in Australia.
Disclosures: The study was funded by a variety of non-industry sources. Dr. Budden reported having no financial disclosures.
Noninvasive therapy cut COPD readmissions
WASHINGTON – The addition of noninvasive ventilation to home oxygen therapy regimens correlated with increased time to readmission or death among patients with exacerbated chronic obstructive pulmonary diseases (COPD), according to a study presented at an international conference of the American Thoracic Society.
Among 116 patients observed with COPD, the 57 patients given home oxygen and noninvasive ventilation reported an average time to readmission of 4.3 months, compared with 1.4 months among the 59 patients given only home oxygen, according to Patrick B. Murphy, PhD, of St. Thomas’ Hospital, London (JAMA. 2017 May 21. doi: 10.1001/jama.2017.4451), who presented this research on the same day it was published in JAMA. 
Dr. Murphy said the findings are encouraging for patients with COPD suffering from exacerbations from the disease.
“Patients with established chronic respiratory failure secondary to COPD have poor outcomes with limited treatment options available,” the investigators noted. “The results of the current trial are reassuring, suggesting that home noninvasive ventilation added to home oxygen therapy in this population improved the overall clinical outcome without adding to the health burden of the patient.”
In this 12-month, phase III, multicenter, randomized clinical trial, the average age of the patients was 67 years, and the average body mass index was 21.6 mg/k2. The patients had an average partial pressure of carbon dioxide (PaCo2) level of 59, indicating persistent hypercapnia.
The investigators gave those in the intervention group one of three noninvasive home ventilators – nasal, oronasal, or total face mask – to use for a minimum of 6 hours nightly. Patients in both groups received 15 hours of oxygen therapy daily.
Doctors gathered data from patients after 6 weeks, 3 months, 6 months, and 12 months.
After 12 months, risk of readmission or death in the intervention group was 63.4%, while those in the oxygen-only group reported a risk of 80.4%. Despite a 17% risk reduction, a similar number of patients died during the experiment in both groups: five in the noninvasive intervention group and four in the control group, according to the investigators.
At the end of the trial, 16 patients (28%) in the intervention group and 19 (32%) in the control group died.
Dr. Murphy and his peers asserted that these deaths do not take away from the success of the treatment, as the focus of the study was to find a way to reduce readmissions, not necessarily mortality.
“The driver of the clinical improvement in the home oxygen therapy plus home noninvasive ventilation group was readmission avoidance with no significant difference in mortality,” they wrote. “This study has major clinical relevance because readmission avoidance is beneficial to the patient in terms of preservation of lung function and health-related quality of life, as well as providing a direct and indirect cost saving.”
The study was limited by the lack of a double-blind design; however, investigators said that a sham device may have made patients’ respiratory failure worse.
Some patients in the control group were later given ventilation treatment for safety reasons. Eighteen patients were given noninvasive ventilation, although reportedly after the primary endpoint was reached.
Philips Respironics, ResMed, the ResMed Foundation, and the Guy’s and St. Thomas’ Charity funded the study. Dr. Murphy and his coinvestigators reported receiving some manner of financial support from ResMed, Philips Respironics, and B&D Electromedical.
[email protected]
On Twitter @eaztweets
Vera A. De Palo, MD, FCCP, MBA, comments: A goal for any patient with a chronic disease is the best possible quality of life. Increasing hospital-free and exacerbation-free days helps to improve that quality of life. The authors report that the addition of noninvasive ventilation therapy increased the time to readmission due to COPD exacerbation. This adds another tool to the armamentarium to help improve outcomes for our COPD patients.
Vera A. De Palo, MD, FCCP, MBA, comments: A goal for any patient with a chronic disease is the best possible quality of life. Increasing hospital-free and exacerbation-free days helps to improve that quality of life. The authors report that the addition of noninvasive ventilation therapy increased the time to readmission due to COPD exacerbation. This adds another tool to the armamentarium to help improve outcomes for our COPD patients.
Vera A. De Palo, MD, FCCP, MBA, comments: A goal for any patient with a chronic disease is the best possible quality of life. Increasing hospital-free and exacerbation-free days helps to improve that quality of life. The authors report that the addition of noninvasive ventilation therapy increased the time to readmission due to COPD exacerbation. This adds another tool to the armamentarium to help improve outcomes for our COPD patients.
WASHINGTON – The addition of noninvasive ventilation to home oxygen therapy regimens correlated with increased time to readmission or death among patients with exacerbated chronic obstructive pulmonary diseases (COPD), according to a study presented at an international conference of the American Thoracic Society.
Among 116 patients observed with COPD, the 57 patients given home oxygen and noninvasive ventilation reported an average time to readmission of 4.3 months, compared with 1.4 months among the 59 patients given only home oxygen, according to Patrick B. Murphy, PhD, of St. Thomas’ Hospital, London (JAMA. 2017 May 21. doi: 10.1001/jama.2017.4451), who presented this research on the same day it was published in JAMA.
Dr. Murphy said the findings are encouraging for patients with COPD suffering from exacerbations from the disease.
“Patients with established chronic respiratory failure secondary to COPD have poor outcomes with limited treatment options available,” the investigators noted. “The results of the current trial are reassuring, suggesting that home noninvasive ventilation added to home oxygen therapy in this population improved the overall clinical outcome without adding to the health burden of the patient.”
In this 12-month, phase III, multicenter, randomized clinical trial, the average age of the patients was 67 years, and the average body mass index was 21.6 mg/k2. The patients had an average partial pressure of carbon dioxide (PaCo2) level of 59, indicating persistent hypercapnia.
The investigators gave those in the intervention group one of three noninvasive home ventilators – nasal, oronasal, or total face mask – to use for a minimum of 6 hours nightly. Patients in both groups received 15 hours of oxygen therapy daily.
Doctors gathered data from patients after 6 weeks, 3 months, 6 months, and 12 months.
After 12 months, risk of readmission or death in the intervention group was 63.4%, while those in the oxygen-only group reported a risk of 80.4%. Despite a 17% risk reduction, a similar number of patients died during the experiment in both groups: five in the noninvasive intervention group and four in the control group, according to the investigators.
At the end of the trial, 16 patients (28%) in the intervention group and 19 (32%) in the control group died.
Dr. Murphy and his peers asserted that these deaths do not take away from the success of the treatment, as the focus of the study was to find a way to reduce readmissions, not necessarily mortality.
“The driver of the clinical improvement in the home oxygen therapy plus home noninvasive ventilation group was readmission avoidance with no significant difference in mortality,” they wrote. “This study has major clinical relevance because readmission avoidance is beneficial to the patient in terms of preservation of lung function and health-related quality of life, as well as providing a direct and indirect cost saving.”
The study was limited by the lack of a double-blind design; however, investigators said that a sham device may have made patients’ respiratory failure worse.
Some patients in the control group were later given ventilation treatment for safety reasons. Eighteen patients were given noninvasive ventilation, although reportedly after the primary endpoint was reached.
Philips Respironics, ResMed, the ResMed Foundation, and the Guy’s and St. Thomas’ Charity funded the study. Dr. Murphy and his coinvestigators reported receiving some manner of financial support from ResMed, Philips Respironics, and B&D Electromedical.
[email protected]
On Twitter @eaztweets
WASHINGTON – The addition of noninvasive ventilation to home oxygen therapy regimens correlated with increased time to readmission or death among patients with exacerbated chronic obstructive pulmonary diseases (COPD), according to a study presented at an international conference of the American Thoracic Society.
Among 116 patients observed with COPD, the 57 patients given home oxygen and noninvasive ventilation reported an average time to readmission of 4.3 months, compared with 1.4 months among the 59 patients given only home oxygen, according to Patrick B. Murphy, PhD, of St. Thomas’ Hospital, London (JAMA. 2017 May 21. doi: 10.1001/jama.2017.4451), who presented this research on the same day it was published in JAMA.
Dr. Murphy said the findings are encouraging for patients with COPD suffering from exacerbations from the disease.
“Patients with established chronic respiratory failure secondary to COPD have poor outcomes with limited treatment options available,” the investigators noted. “The results of the current trial are reassuring, suggesting that home noninvasive ventilation added to home oxygen therapy in this population improved the overall clinical outcome without adding to the health burden of the patient.”
In this 12-month, phase III, multicenter, randomized clinical trial, the average age of the patients was 67 years, and the average body mass index was 21.6 mg/k2. The patients had an average partial pressure of carbon dioxide (PaCo2) level of 59, indicating persistent hypercapnia.
The investigators gave those in the intervention group one of three noninvasive home ventilators – nasal, oronasal, or total face mask – to use for a minimum of 6 hours nightly. Patients in both groups received 15 hours of oxygen therapy daily.
Doctors gathered data from patients after 6 weeks, 3 months, 6 months, and 12 months.
After 12 months, risk of readmission or death in the intervention group was 63.4%, while those in the oxygen-only group reported a risk of 80.4%. Despite a 17% risk reduction, a similar number of patients died during the experiment in both groups: five in the noninvasive intervention group and four in the control group, according to the investigators.
At the end of the trial, 16 patients (28%) in the intervention group and 19 (32%) in the control group died.
Dr. Murphy and his peers asserted that these deaths do not take away from the success of the treatment, as the focus of the study was to find a way to reduce readmissions, not necessarily mortality.
“The driver of the clinical improvement in the home oxygen therapy plus home noninvasive ventilation group was readmission avoidance with no significant difference in mortality,” they wrote. “This study has major clinical relevance because readmission avoidance is beneficial to the patient in terms of preservation of lung function and health-related quality of life, as well as providing a direct and indirect cost saving.”
The study was limited by the lack of a double-blind design; however, investigators said that a sham device may have made patients’ respiratory failure worse.
Some patients in the control group were later given ventilation treatment for safety reasons. Eighteen patients were given noninvasive ventilation, although reportedly after the primary endpoint was reached.
Philips Respironics, ResMed, the ResMed Foundation, and the Guy’s and St. Thomas’ Charity funded the study. Dr. Murphy and his coinvestigators reported receiving some manner of financial support from ResMed, Philips Respironics, and B&D Electromedical.
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FROM ATS 2017
Key clinical point:
Major finding: The average time until readmission or death was 4.3 months for patients using both oxygen therapy and ventilation, compared with an average of 1.4 months for patients using only oxygen therapy.
Data source: Phase III, multicenter, randomized clinical trial of 116 COPD patients gathered from 13 U.K. medical centers between February, 2010, and April, 2015.
Disclosures: Philips Respironics, ResMed, the ResMed Foundation, and the Guy’s and St. Thomas’ Charity funded the study. Dr. Patrick B. Murphy and his coinvestigators reported receiving some manner of financial support from ResMed, Philips Respironics, and B&D Electromedical.
Alectinib in ALK+ NSCLC is a watershed moment
CHICAGO – In what’s being hailed as practice-changing findings, the anaplastic lymphoma kinase inhibitor alectinib (Alecensa) was associated with more than doubled progression-free survival (PFS), compared with crizotinib (Xalkori), the current standard of care, in patients with treatment-naive non–small cell lung cancer (NSCLC) positive for ALK.
Additionally, in the global, phase III trial, alectinib was associated with a significantly lower risk of progression to CNS metastases, a common complication of advanced ALK+ NSCLC, reported Alice T. Shaw, MD, PhD, of the Massachusetts General Hospital Cancer Center in Boston, on behalf of investigators in the ALEX trial.
“I view this as a watershed moment for the treatment of ALK mutant–positive lung cancer,” commented ASCO expert John Heymach, MD, PhD, of the University of Texas MD Anderson Cancer Center in Houston.
Unlike other head-to-head studies of similar drugs that frequently show only incremental benefit, the ALEX results showed a dramatic difference in outcomes for patients treated with alectinib, he said.
By comparison, the median PFS difference between chemotherapy and crizotinib in the PROFILE 1014 in patients with ALK-positive NSCLC trial was 10.9 vs. 7.0 months, Dr. Heymach pointed out.
The ALEX investigators enrolled 303 patients with untreated ALK-positive NSCLC confirmed by a central immunohistochemistry lab and randomly assigned them to treatment with either oral alectinib 600 mg twice daily or crizotinib 250 mg b.i.d.
At the primary data cutoff in February 2017, median PFS, the primary endpoint, was 11.1 months for patients treated with crizotinib, versus not reached for those treated with alectinib, translating into a hazard ratio for alectinib of 0.47 (P less than .0001).
Based on an independent review, the median PFS was determined to be 10.4 months for crizotinib, vs. 25.7 months with alectinib (HR, 0.50; P not shown).
The cumulative incidence of CNS progression, a secondary endpoint, was 41.4% in the crizotinib arm, vs. 9.41% in the alectinib arm (cause-specific HR, 0.16; P not shown).
In each arm, 97% of patients had any adverse event, and the incidence of serious adverse events was similar between the arms, at 29% for crizotinib and 28% for alectinib.
Adverse events leading to treatment discontinuation, dose reduction, or dose interruption were more frequent with crizotinib.
In the question and answer portion of the briefing, Dr. Shaw was asked whether crizotinib still had a role in this population.
“Going forward, I think that it’s pretty clear, if you have a newly diagnosed patient with metastatic ALK-positive lung cancer, that likely alectinib would be the preferred first choice,” she said.
The ALEX trial is supported by Roche. Dr. Shaw disclosed consulting or an advisory role with the company, and multiple coauthors disclosed similar relationships.
CHICAGO – In what’s being hailed as practice-changing findings, the anaplastic lymphoma kinase inhibitor alectinib (Alecensa) was associated with more than doubled progression-free survival (PFS), compared with crizotinib (Xalkori), the current standard of care, in patients with treatment-naive non–small cell lung cancer (NSCLC) positive for ALK.
Additionally, in the global, phase III trial, alectinib was associated with a significantly lower risk of progression to CNS metastases, a common complication of advanced ALK+ NSCLC, reported Alice T. Shaw, MD, PhD, of the Massachusetts General Hospital Cancer Center in Boston, on behalf of investigators in the ALEX trial.
“I view this as a watershed moment for the treatment of ALK mutant–positive lung cancer,” commented ASCO expert John Heymach, MD, PhD, of the University of Texas MD Anderson Cancer Center in Houston.
Unlike other head-to-head studies of similar drugs that frequently show only incremental benefit, the ALEX results showed a dramatic difference in outcomes for patients treated with alectinib, he said.
By comparison, the median PFS difference between chemotherapy and crizotinib in the PROFILE 1014 in patients with ALK-positive NSCLC trial was 10.9 vs. 7.0 months, Dr. Heymach pointed out.
The ALEX investigators enrolled 303 patients with untreated ALK-positive NSCLC confirmed by a central immunohistochemistry lab and randomly assigned them to treatment with either oral alectinib 600 mg twice daily or crizotinib 250 mg b.i.d.
At the primary data cutoff in February 2017, median PFS, the primary endpoint, was 11.1 months for patients treated with crizotinib, versus not reached for those treated with alectinib, translating into a hazard ratio for alectinib of 0.47 (P less than .0001).
Based on an independent review, the median PFS was determined to be 10.4 months for crizotinib, vs. 25.7 months with alectinib (HR, 0.50; P not shown).
The cumulative incidence of CNS progression, a secondary endpoint, was 41.4% in the crizotinib arm, vs. 9.41% in the alectinib arm (cause-specific HR, 0.16; P not shown).
In each arm, 97% of patients had any adverse event, and the incidence of serious adverse events was similar between the arms, at 29% for crizotinib and 28% for alectinib.
Adverse events leading to treatment discontinuation, dose reduction, or dose interruption were more frequent with crizotinib.
In the question and answer portion of the briefing, Dr. Shaw was asked whether crizotinib still had a role in this population.
“Going forward, I think that it’s pretty clear, if you have a newly diagnosed patient with metastatic ALK-positive lung cancer, that likely alectinib would be the preferred first choice,” she said.
The ALEX trial is supported by Roche. Dr. Shaw disclosed consulting or an advisory role with the company, and multiple coauthors disclosed similar relationships.
CHICAGO – In what’s being hailed as practice-changing findings, the anaplastic lymphoma kinase inhibitor alectinib (Alecensa) was associated with more than doubled progression-free survival (PFS), compared with crizotinib (Xalkori), the current standard of care, in patients with treatment-naive non–small cell lung cancer (NSCLC) positive for ALK.
Additionally, in the global, phase III trial, alectinib was associated with a significantly lower risk of progression to CNS metastases, a common complication of advanced ALK+ NSCLC, reported Alice T. Shaw, MD, PhD, of the Massachusetts General Hospital Cancer Center in Boston, on behalf of investigators in the ALEX trial.
“I view this as a watershed moment for the treatment of ALK mutant–positive lung cancer,” commented ASCO expert John Heymach, MD, PhD, of the University of Texas MD Anderson Cancer Center in Houston.
Unlike other head-to-head studies of similar drugs that frequently show only incremental benefit, the ALEX results showed a dramatic difference in outcomes for patients treated with alectinib, he said.
By comparison, the median PFS difference between chemotherapy and crizotinib in the PROFILE 1014 in patients with ALK-positive NSCLC trial was 10.9 vs. 7.0 months, Dr. Heymach pointed out.
The ALEX investigators enrolled 303 patients with untreated ALK-positive NSCLC confirmed by a central immunohistochemistry lab and randomly assigned them to treatment with either oral alectinib 600 mg twice daily or crizotinib 250 mg b.i.d.
At the primary data cutoff in February 2017, median PFS, the primary endpoint, was 11.1 months for patients treated with crizotinib, versus not reached for those treated with alectinib, translating into a hazard ratio for alectinib of 0.47 (P less than .0001).
Based on an independent review, the median PFS was determined to be 10.4 months for crizotinib, vs. 25.7 months with alectinib (HR, 0.50; P not shown).
The cumulative incidence of CNS progression, a secondary endpoint, was 41.4% in the crizotinib arm, vs. 9.41% in the alectinib arm (cause-specific HR, 0.16; P not shown).
In each arm, 97% of patients had any adverse event, and the incidence of serious adverse events was similar between the arms, at 29% for crizotinib and 28% for alectinib.
Adverse events leading to treatment discontinuation, dose reduction, or dose interruption were more frequent with crizotinib.
In the question and answer portion of the briefing, Dr. Shaw was asked whether crizotinib still had a role in this population.
“Going forward, I think that it’s pretty clear, if you have a newly diagnosed patient with metastatic ALK-positive lung cancer, that likely alectinib would be the preferred first choice,” she said.
The ALEX trial is supported by Roche. Dr. Shaw disclosed consulting or an advisory role with the company, and multiple coauthors disclosed similar relationships.
AT ASCO 2017
Key clinical point: Alectinib was associated with more than double the progression-free survival of standard of care crizotinib in patients with non–small cell lung cancer positive for the anaplastic lymphoma kinase.
Major finding: Median PFS by independent review was 10.4 months with crizotinib vs. 25.7 months with alectinib.
Data source: The ALEX trial, a phase III trial of 303 patients with ALK-positive NSCLC.
Disclosures: The ALEX trial is supported by Roche. Dr. Shaw disclosed consulting or an advisory role with the company, and multiple coauthors disclosed similar relationships
Committee and chapter involvement allows SHM member to give back
Editor’s note: Each month, SHM puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Log on to www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise to help SHM improve the care of hospitalized patients.
This month, The Hospitalist spotlights Paul Grant, MD, SFHM, assistant professor of medicine at the University of Michigan Medical School, Ann Arbor. Dr. Grant is the chair of SHM’s Membership Committee and an active member of SHM’s Michigan Chapter.
Why did you choose a career in hospital medicine, and how did you become an SHM member?
After residency, I completed a hospital medicine fellowship at the Cleveland Clinic. During my fellowship, I joined SHM. At that time, I knew nothing about the society, but that soon changed. My fellowship required me to attend the annual meeting and submit an abstract in the RIV competition, which was an extremely valuable experience for me. Not only was I blown away by the meeting, but my poster won the clinical vignette competition, as well! Needless to say, I’ve been an SHM member ever since.
What prompted you to join the Membership Committee? Can you discuss some of the projects the committee is currently working on?
Because SHM has done so much for my career as a hospitalist, I’ve tried to give back by volunteering on committees. After spending several years on the Early Career Hospitalist Committee, I felt the transition to the Membership Committee was a natural fit. Because SHM membership had been growing every year, our committee felt some pressure to keep this trend going. Thankfully, we have continued to see growth each year in every membership category.
Our committee has been working on several projects. One of the key demographics we have been targeting is the resident member. Residents play a significant role in the future of hospital medicine, as well as SHM membership. We are developing ways to reach out to residency program directors – particularly those running a hospital medicine track – to find ways they can benefit from SHM’s educational offerings. Additionally, our committee has been discussing ways to attract international members to SHM. Because hospital medicine is quite developed in the United States, we believe we have much to offer to hospitalists around the world.
Tell TH about your involvement with SHM’s Michigan Chapter. What does a typical chapter meeting entail?
A few years ago, at the end of SHM’s annual meeting, several of my hospital medicine colleagues in southeast Michigan happened to be on the same flight home. At the departure gate in the airport, we all agreed we should start an SHM chapter. After drawing straws, it was decided that I would be chapter president for our inaugural year. In a few short years, our chapter has grown into one of the largest in the country.
As for a typical meeting, each starts with a cocktail hour to encourage our members to network. We have a guest speaker, who presents on a hospital medicine topic, and then, we end the evening with a business meeting. We encourage students and residents to attend. More recently, we’ve been using interactive technology to broadcast our meetings to large hospital medicine groups in the western and northern parts of the state. Our chapter was thrilled to learn that we’d won the Outstanding Chapter award this year!
What value do you find in connecting with hospital medicine professionals at the local level?
Whether it’s a hospitalist working at a large, tertiary care center or one working in a small rural setting, it seems we all face similar challenges.
As a chapter, we can pull together our resources to address these issues. Furthermore, we have the ability to reach out to more trainees and show them what hospital medicine is all about. Our chapter has been able to partially fund both medical students and residents so they could attend SHM’s annual meeting. I’m always amazed at what I can learn from other hospitalists – in the state of Michigan and beyond.
Find a chapter near you and get involved at the local level at hospitalmedicine.org/chapters .
Felicia Steele is SHM’s communications coordinator.
Editor’s note: Each month, SHM puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Log on to www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise to help SHM improve the care of hospitalized patients.
This month, The Hospitalist spotlights Paul Grant, MD, SFHM, assistant professor of medicine at the University of Michigan Medical School, Ann Arbor. Dr. Grant is the chair of SHM’s Membership Committee and an active member of SHM’s Michigan Chapter.
Why did you choose a career in hospital medicine, and how did you become an SHM member?
After residency, I completed a hospital medicine fellowship at the Cleveland Clinic. During my fellowship, I joined SHM. At that time, I knew nothing about the society, but that soon changed. My fellowship required me to attend the annual meeting and submit an abstract in the RIV competition, which was an extremely valuable experience for me. Not only was I blown away by the meeting, but my poster won the clinical vignette competition, as well! Needless to say, I’ve been an SHM member ever since.
What prompted you to join the Membership Committee? Can you discuss some of the projects the committee is currently working on?
Because SHM has done so much for my career as a hospitalist, I’ve tried to give back by volunteering on committees. After spending several years on the Early Career Hospitalist Committee, I felt the transition to the Membership Committee was a natural fit. Because SHM membership had been growing every year, our committee felt some pressure to keep this trend going. Thankfully, we have continued to see growth each year in every membership category.
Our committee has been working on several projects. One of the key demographics we have been targeting is the resident member. Residents play a significant role in the future of hospital medicine, as well as SHM membership. We are developing ways to reach out to residency program directors – particularly those running a hospital medicine track – to find ways they can benefit from SHM’s educational offerings. Additionally, our committee has been discussing ways to attract international members to SHM. Because hospital medicine is quite developed in the United States, we believe we have much to offer to hospitalists around the world.
Tell TH about your involvement with SHM’s Michigan Chapter. What does a typical chapter meeting entail?
A few years ago, at the end of SHM’s annual meeting, several of my hospital medicine colleagues in southeast Michigan happened to be on the same flight home. At the departure gate in the airport, we all agreed we should start an SHM chapter. After drawing straws, it was decided that I would be chapter president for our inaugural year. In a few short years, our chapter has grown into one of the largest in the country.
As for a typical meeting, each starts with a cocktail hour to encourage our members to network. We have a guest speaker, who presents on a hospital medicine topic, and then, we end the evening with a business meeting. We encourage students and residents to attend. More recently, we’ve been using interactive technology to broadcast our meetings to large hospital medicine groups in the western and northern parts of the state. Our chapter was thrilled to learn that we’d won the Outstanding Chapter award this year!
What value do you find in connecting with hospital medicine professionals at the local level?
Whether it’s a hospitalist working at a large, tertiary care center or one working in a small rural setting, it seems we all face similar challenges.
As a chapter, we can pull together our resources to address these issues. Furthermore, we have the ability to reach out to more trainees and show them what hospital medicine is all about. Our chapter has been able to partially fund both medical students and residents so they could attend SHM’s annual meeting. I’m always amazed at what I can learn from other hospitalists – in the state of Michigan and beyond.
Find a chapter near you and get involved at the local level at hospitalmedicine.org/chapters .
Felicia Steele is SHM’s communications coordinator.
Editor’s note: Each month, SHM puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Log on to www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise to help SHM improve the care of hospitalized patients.
This month, The Hospitalist spotlights Paul Grant, MD, SFHM, assistant professor of medicine at the University of Michigan Medical School, Ann Arbor. Dr. Grant is the chair of SHM’s Membership Committee and an active member of SHM’s Michigan Chapter.
Why did you choose a career in hospital medicine, and how did you become an SHM member?
After residency, I completed a hospital medicine fellowship at the Cleveland Clinic. During my fellowship, I joined SHM. At that time, I knew nothing about the society, but that soon changed. My fellowship required me to attend the annual meeting and submit an abstract in the RIV competition, which was an extremely valuable experience for me. Not only was I blown away by the meeting, but my poster won the clinical vignette competition, as well! Needless to say, I’ve been an SHM member ever since.
What prompted you to join the Membership Committee? Can you discuss some of the projects the committee is currently working on?
Because SHM has done so much for my career as a hospitalist, I’ve tried to give back by volunteering on committees. After spending several years on the Early Career Hospitalist Committee, I felt the transition to the Membership Committee was a natural fit. Because SHM membership had been growing every year, our committee felt some pressure to keep this trend going. Thankfully, we have continued to see growth each year in every membership category.
Our committee has been working on several projects. One of the key demographics we have been targeting is the resident member. Residents play a significant role in the future of hospital medicine, as well as SHM membership. We are developing ways to reach out to residency program directors – particularly those running a hospital medicine track – to find ways they can benefit from SHM’s educational offerings. Additionally, our committee has been discussing ways to attract international members to SHM. Because hospital medicine is quite developed in the United States, we believe we have much to offer to hospitalists around the world.
Tell TH about your involvement with SHM’s Michigan Chapter. What does a typical chapter meeting entail?
A few years ago, at the end of SHM’s annual meeting, several of my hospital medicine colleagues in southeast Michigan happened to be on the same flight home. At the departure gate in the airport, we all agreed we should start an SHM chapter. After drawing straws, it was decided that I would be chapter president for our inaugural year. In a few short years, our chapter has grown into one of the largest in the country.
As for a typical meeting, each starts with a cocktail hour to encourage our members to network. We have a guest speaker, who presents on a hospital medicine topic, and then, we end the evening with a business meeting. We encourage students and residents to attend. More recently, we’ve been using interactive technology to broadcast our meetings to large hospital medicine groups in the western and northern parts of the state. Our chapter was thrilled to learn that we’d won the Outstanding Chapter award this year!
What value do you find in connecting with hospital medicine professionals at the local level?
Whether it’s a hospitalist working at a large, tertiary care center or one working in a small rural setting, it seems we all face similar challenges.
As a chapter, we can pull together our resources to address these issues. Furthermore, we have the ability to reach out to more trainees and show them what hospital medicine is all about. Our chapter has been able to partially fund both medical students and residents so they could attend SHM’s annual meeting. I’m always amazed at what I can learn from other hospitalists – in the state of Michigan and beyond.
Find a chapter near you and get involved at the local level at hospitalmedicine.org/chapters .
Felicia Steele is SHM’s communications coordinator.