Cases of the most commonly reported STDs reached an “unprecedented” high in the US in 2015, with > 1.5 million chlamydia cases, nearly 400,000 gonorrhea cases, and nearly 24,000 cases of primary and secondary syphilis.

According to the CDC’s annual Sexually Transmitted Disease Surveillance Report, between 2014 and 2015, the number of syphilis cases rose by 19%, followed by gonorrhea (12.8%) and chlamydia (5.9%). Young people aged 15 to 24 accounted for nearly two thirds of chlamydia diagnoses and half of gonorrhea diagnoses. Men who have sex with men accounted for most new gonorrhea and syphilis cases. The report also notes that antibiotic-resistant gonorrhea may be higher in this group.

Syphilis diagnoses in women jumped by > 27% in 1 year, which presents  a serious risk for infants. For example, reported congenital syphilis (transmitted from a pregnant woman to the baby) rose by 6%.

But all 3 of those STDs are not only treatable, they’re curable with antibiotics. Widespread access to screening and treatment would reduce the spread. Undiagnosed and untreated, these diseases pose severe and often irreversible health consequences, including infertility, chronic pain, and a greater risk of acquiring HIV. The CDC also estimates a ”substantial economic burden” of nearly $16 billion a year.

In recent years, > 50% of state and local STD programs have had their budgets cut, the report notes, and  > 20 health department STD clinics closed their doors in 1 year alone. “STD prevention resources across the nation are stretched thin,” said Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

The CDC says an effective national response to the epidemic requires engagement from many players. One suggestion: making screening a standard part of medical care, especially for pregnant women, and integrating STD prevention and treatment into prenatal care and other routine visits.

Cases of the most commonly reported STDs reached an “unprecedented” high in the US in 2015, with > 1.5 million chlamydia cases, nearly 400,000 gonorrhea cases, and nearly 24,000 cases of primary and secondary syphilis.

According to the CDC’s annual Sexually Transmitted Disease Surveillance Report, between 2014 and 2015, the number of syphilis cases rose by 19%, followed by gonorrhea (12.8%) and chlamydia (5.9%). Young people aged 15 to 24 accounted for nearly two thirds of chlamydia diagnoses and half of gonorrhea diagnoses. Men who have sex with men accounted for most new gonorrhea and syphilis cases. The report also notes that antibiotic-resistant gonorrhea may be higher in this group.

Syphilis diagnoses in women jumped by > 27% in 1 year, which presents  a serious risk for infants. For example, reported congenital syphilis (transmitted from a pregnant woman to the baby) rose by 6%.

But all 3 of those STDs are not only treatable, they’re curable with antibiotics. Widespread access to screening and treatment would reduce the spread. Undiagnosed and untreated, these diseases pose severe and often irreversible health consequences, including infertility, chronic pain, and a greater risk of acquiring HIV. The CDC also estimates a ”substantial economic burden” of nearly $16 billion a year.

In recent years, > 50% of state and local STD programs have had their budgets cut, the report notes, and  > 20 health department STD clinics closed their doors in 1 year alone. “STD prevention resources across the nation are stretched thin,” said Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

The CDC says an effective national response to the epidemic requires engagement from many players. One suggestion: making screening a standard part of medical care, especially for pregnant women, and integrating STD prevention and treatment into prenatal care and other routine visits.

Cases of the most commonly reported STDs reached an “unprecedented” high in the US in 2015, with > 1.5 million chlamydia cases, nearly 400,000 gonorrhea cases, and nearly 24,000 cases of primary and secondary syphilis.

According to the CDC’s annual Sexually Transmitted Disease Surveillance Report, between 2014 and 2015, the number of syphilis cases rose by 19%, followed by gonorrhea (12.8%) and chlamydia (5.9%). Young people aged 15 to 24 accounted for nearly two thirds of chlamydia diagnoses and half of gonorrhea diagnoses. Men who have sex with men accounted for most new gonorrhea and syphilis cases. The report also notes that antibiotic-resistant gonorrhea may be higher in this group.

Syphilis diagnoses in women jumped by > 27% in 1 year, which presents  a serious risk for infants. For example, reported congenital syphilis (transmitted from a pregnant woman to the baby) rose by 6%.

But all 3 of those STDs are not only treatable, they’re curable with antibiotics. Widespread access to screening and treatment would reduce the spread. Undiagnosed and untreated, these diseases pose severe and often irreversible health consequences, including infertility, chronic pain, and a greater risk of acquiring HIV. The CDC also estimates a ”substantial economic burden” of nearly $16 billion a year.

In recent years, > 50% of state and local STD programs have had their budgets cut, the report notes, and  > 20 health department STD clinics closed their doors in 1 year alone. “STD prevention resources across the nation are stretched thin,” said Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

The CDC says an effective national response to the epidemic requires engagement from many players. One suggestion: making screening a standard part of medical care, especially for pregnant women, and integrating STD prevention and treatment into prenatal care and other routine visits.

Vial of heparin

Many surgical patients may be receiving anticoagulants they don’t need, according to research published in Annals of Surgery.

The study challenges standard of care guidelines, which recommend that all general surgery patients receive treatment to prevent venous thromboembolism (VTE).

The new findings suggest that anticoagulants may be unnecessary for most surgical patients and could even be harmful to some.

“A ‘one-size-fits-all approach’ doesn’t always make sense,” said study author Christopher Pannucci, MD, of the University of Utah in Salt Lake City.

“A healthy 35-year-old is very different from someone who is 85 and has a history of clots. Our research indicates that there could be a substantial number of people who are being over-treated.”

Dr Pannucci and his colleagues reviewed data from 13 studies to determine which surgical patients were most likely, and least likely, to benefit from anticoagulants. There was data on VTE events in 11 studies (n=14,776) and data on clinically relevant bleeding in 8 studies (n=7590).

In most of the studies, patients received mechanical VTE prophylaxis, which meant elastic compression and/or sequential compression devices.

Some studies compared mechanical prophylaxis to anticoagulants, including heparin, low-molecular-weight heparin, direct factor Xa inhibitors, direct thrombin inhibitors, warfarin, dextran, and aspirin.

The studies included a broad range of surgical patients, from individuals with few VTE risk factors to those with multiple risk factors, such as obesity, advanced age, and personal or family history of VTE.

The patients were divided into 1 of 5 categories indicating overall VTE risk. Assessment was based on the Caprini score.

VTE risk without anticoagulant treatment

There were 11 studies in which some patients did not receive anticoagulants (n=6085).

Among these patients, those who were classified as having the highest risk of VTE were 14 times more likely to develop VTE than patients in the low-risk category—10.7% vs 0.7%.

These findings were independent of surgery type.

“It was eye-opening to see that there is this huge variability in risk among the overall group of patients that walk into your office,” Dr Pannucci said. “Unless you consider a patient’s risk based on their individual factors, you would never know.”

VTE outcomes by risk score

When given, anticoagulants did significantly reduce the risk of VTE for the overall study population and for high-risk patients.

The odds ratios (ORs) were 0.66 (P=0.001) for the overall population, 0.60 (P=0.04) for patients with Caprini scores of 7 to 8, and 0.41 (P=0.0002) for patients with scores higher than 8.

Unfortunately, anticoagulants did not make a significant difference in VTE rates for mid- or low-risk patients.

The ORs were 0.45 (P=0.31) for patients with Caprini scores of 0 to 2, 1.31 (P=0.57) for patients with scores of 3 to 4, and 0.96 (P=0.85) for patients with scores of 5 to 6.

Risk of bleeding

Anticoagulants significantly increased clinically relevant bleeding for the overall population. The OR was 1.69 (P=0.006).

Patients who received anticoagulants were not significantly more likely to have clinically relevant bleeding if they had risk scores of 0 to 2 (OR=2.47, P=0.61), 3 to 4 (OR=1.05, P=0.87), 5 to 6 (OR=2.10, P=0.06), 7 to 8 (OR=3.15, P=0.16), or >8 (OR=2.31, P=0.16).

“For the first time, we have data that prophylaxis for the highest-risk groups is beneficial, and data that suggests that lower-risk patients may need no prophylaxis,” said study author Peter Henke, MD, of the University of Michigan in Ann Arbor.

He and his colleagues noted, however, that prospective studies are needed to confirm these findings.

Vial of heparin

Many surgical patients may be receiving anticoagulants they don’t need, according to research published in Annals of Surgery.

The study challenges standard of care guidelines, which recommend that all general surgery patients receive treatment to prevent venous thromboembolism (VTE).

The new findings suggest that anticoagulants may be unnecessary for most surgical patients and could even be harmful to some.

“A ‘one-size-fits-all approach’ doesn’t always make sense,” said study author Christopher Pannucci, MD, of the University of Utah in Salt Lake City.

“A healthy 35-year-old is very different from someone who is 85 and has a history of clots. Our research indicates that there could be a substantial number of people who are being over-treated.”

Dr Pannucci and his colleagues reviewed data from 13 studies to determine which surgical patients were most likely, and least likely, to benefit from anticoagulants. There was data on VTE events in 11 studies (n=14,776) and data on clinically relevant bleeding in 8 studies (n=7590).

In most of the studies, patients received mechanical VTE prophylaxis, which meant elastic compression and/or sequential compression devices.

Some studies compared mechanical prophylaxis to anticoagulants, including heparin, low-molecular-weight heparin, direct factor Xa inhibitors, direct thrombin inhibitors, warfarin, dextran, and aspirin.

The studies included a broad range of surgical patients, from individuals with few VTE risk factors to those with multiple risk factors, such as obesity, advanced age, and personal or family history of VTE.

The patients were divided into 1 of 5 categories indicating overall VTE risk. Assessment was based on the Caprini score.

VTE risk without anticoagulant treatment

There were 11 studies in which some patients did not receive anticoagulants (n=6085).

Among these patients, those who were classified as having the highest risk of VTE were 14 times more likely to develop VTE than patients in the low-risk category—10.7% vs 0.7%.

These findings were independent of surgery type.

“It was eye-opening to see that there is this huge variability in risk among the overall group of patients that walk into your office,” Dr Pannucci said. “Unless you consider a patient’s risk based on their individual factors, you would never know.”

VTE outcomes by risk score

When given, anticoagulants did significantly reduce the risk of VTE for the overall study population and for high-risk patients.

The odds ratios (ORs) were 0.66 (P=0.001) for the overall population, 0.60 (P=0.04) for patients with Caprini scores of 7 to 8, and 0.41 (P=0.0002) for patients with scores higher than 8.

Unfortunately, anticoagulants did not make a significant difference in VTE rates for mid- or low-risk patients.

The ORs were 0.45 (P=0.31) for patients with Caprini scores of 0 to 2, 1.31 (P=0.57) for patients with scores of 3 to 4, and 0.96 (P=0.85) for patients with scores of 5 to 6.

Risk of bleeding

Anticoagulants significantly increased clinically relevant bleeding for the overall population. The OR was 1.69 (P=0.006).

Patients who received anticoagulants were not significantly more likely to have clinically relevant bleeding if they had risk scores of 0 to 2 (OR=2.47, P=0.61), 3 to 4 (OR=1.05, P=0.87), 5 to 6 (OR=2.10, P=0.06), 7 to 8 (OR=3.15, P=0.16), or >8 (OR=2.31, P=0.16).

“For the first time, we have data that prophylaxis for the highest-risk groups is beneficial, and data that suggests that lower-risk patients may need no prophylaxis,” said study author Peter Henke, MD, of the University of Michigan in Ann Arbor.

He and his colleagues noted, however, that prospective studies are needed to confirm these findings.

Vial of heparin

Many surgical patients may be receiving anticoagulants they don’t need, according to research published in Annals of Surgery.

The study challenges standard of care guidelines, which recommend that all general surgery patients receive treatment to prevent venous thromboembolism (VTE).

The new findings suggest that anticoagulants may be unnecessary for most surgical patients and could even be harmful to some.

“A ‘one-size-fits-all approach’ doesn’t always make sense,” said study author Christopher Pannucci, MD, of the University of Utah in Salt Lake City.

“A healthy 35-year-old is very different from someone who is 85 and has a history of clots. Our research indicates that there could be a substantial number of people who are being over-treated.”

Dr Pannucci and his colleagues reviewed data from 13 studies to determine which surgical patients were most likely, and least likely, to benefit from anticoagulants. There was data on VTE events in 11 studies (n=14,776) and data on clinically relevant bleeding in 8 studies (n=7590).

In most of the studies, patients received mechanical VTE prophylaxis, which meant elastic compression and/or sequential compression devices.

Some studies compared mechanical prophylaxis to anticoagulants, including heparin, low-molecular-weight heparin, direct factor Xa inhibitors, direct thrombin inhibitors, warfarin, dextran, and aspirin.

The studies included a broad range of surgical patients, from individuals with few VTE risk factors to those with multiple risk factors, such as obesity, advanced age, and personal or family history of VTE.

The patients were divided into 1 of 5 categories indicating overall VTE risk. Assessment was based on the Caprini score.

VTE risk without anticoagulant treatment

There were 11 studies in which some patients did not receive anticoagulants (n=6085).

Among these patients, those who were classified as having the highest risk of VTE were 14 times more likely to develop VTE than patients in the low-risk category—10.7% vs 0.7%.

These findings were independent of surgery type.

“It was eye-opening to see that there is this huge variability in risk among the overall group of patients that walk into your office,” Dr Pannucci said. “Unless you consider a patient’s risk based on their individual factors, you would never know.”

VTE outcomes by risk score

When given, anticoagulants did significantly reduce the risk of VTE for the overall study population and for high-risk patients.

The odds ratios (ORs) were 0.66 (P=0.001) for the overall population, 0.60 (P=0.04) for patients with Caprini scores of 7 to 8, and 0.41 (P=0.0002) for patients with scores higher than 8.

Unfortunately, anticoagulants did not make a significant difference in VTE rates for mid- or low-risk patients.

The ORs were 0.45 (P=0.31) for patients with Caprini scores of 0 to 2, 1.31 (P=0.57) for patients with scores of 3 to 4, and 0.96 (P=0.85) for patients with scores of 5 to 6.

Risk of bleeding

Anticoagulants significantly increased clinically relevant bleeding for the overall population. The OR was 1.69 (P=0.006).

Patients who received anticoagulants were not significantly more likely to have clinically relevant bleeding if they had risk scores of 0 to 2 (OR=2.47, P=0.61), 3 to 4 (OR=1.05, P=0.87), 5 to 6 (OR=2.10, P=0.06), 7 to 8 (OR=3.15, P=0.16), or >8 (OR=2.31, P=0.16).

“For the first time, we have data that prophylaxis for the highest-risk groups is beneficial, and data that suggests that lower-risk patients may need no prophylaxis,” said study author Peter Henke, MD, of the University of Michigan in Ann Arbor.

He and his colleagues noted, however, that prospective studies are needed to confirm these findings.

Cancer patient receiving
chemotherapy
Photo by Rhoda Baer

A new study shows that 5-year survival rates for US patients with hematologic malignancies have increased greatly since the 1950s, but there is still room for improvement, particularly for patients with acute myeloid leukemia (AML).

Researchers found the absolute difference in improvement for 5-year survival from 1950-1954 to 2008-2013 ranged from 38.2% for non-Hodgkin lymphoma (NHL) to 56.6% for Hodgkin lymphoma.

And although the 5-year survival rate for Hodgkin lymphoma patients reached 86.6% for 2008-2013, the 5-year survival rate for patients with AML only reached 27.4%.

This study also revealed large disparities in overall cancer mortality rates between different counties across the country.

Ali H. Mokdad, PhD, of the Institute for Health Metrics and Evaluation in Seattle, Washington, and his colleagues reported these findings in JAMA.

Overall cancer deaths

The researchers found there were 19,511,910 cancer deaths recorded in the US between 1980 and 2014. Cancer mortality decreased by 20.1% between 1980 and 2014, from 240.2 deaths per 100,000 people to 192.0 deaths per 100,000 people.

In 1980, cancer mortality ranged from 130.6 per 100,000 in Summit County, Colorado, to 386.9 per 100,000 in North Slope Borough, Alaska.

In 2014, cancer mortality ranged from 70.7 per 100,000 in Summit County, Colorado, to 503.1 per 100,000 in Union County, Florida.

“Such significant disparities among US counties is unacceptable,” Dr Mokdad said. “Every person should have access to early screenings for cancer, as well as adequate treatment.”

Mortality rates for hematologic malignancies

In 2014, the mortality rates, per 100,000 people, for hematologic malignancies were:

• 0.4 for Hodgkin lymphoma (rank out of all cancers, 27)
• 8.3 for NHL (rank, 7)
• 3.9 for multiple myeloma (rank, 16)
• 9.0 for all leukemias (rank, 6)
• 0.7 for acute lymphoid leukemia (ALL)
• 2.6 for chronic lymphoid leukemia (CLL)
• 5.1 for AML
• 0.6 for chronic myeloid leukemia (CML).

The leukemia subtypes were not assigned a rank.

5-year survival rates for hematologic malignancies

Hodgkin lymphoma

• 30% for 1950-54
• 68.6% for 1973-77
• 72.1% for 1978-82
• 86.6% for 2008-2013
• Absolute difference (between the first and latest year of data), 56.6%.

NHL

• 33% for 1950-54
• 45.3% for 1973-77
• 48.7% for 1978-82
• 71.2% for 2008-2013
• Absolute difference, 38.2%.

Multiple myeloma

• 6% for 1950-54
• 23.4% for 1973-77
• 26.6% for 1978-82
• 49.8% for 2008-2013
• Absolute difference, 43.8%.

Leukemia

• 10% for 1950-54
• 34% for 1973-77
• 36.3% for 1978-82
• 60.1% for 2008-2013
• Absolute difference, 50.1%.

ALL

• 39.2% for 1973-77
• 50.5% for 1978-82
• 68.1% for 2008-2013
• Absolute difference, 28.9%.

CLL

• 67% for 1973-77
• 66.3% for 1978-82
• 82.5% for 2008-2013
• Absolute difference, 15.5%.

AML

• 6.2% for 1973-77
• 7.9% for 1978-82
• 27.4% for 2008-2013
• Absolute difference, 21.2%.

CML

• 21.1% for 1973-77
• 25.8% for 1978-82
• 66.4% for 2008-2013
• Absolute difference, 45.3%.

For the leukemia subtypes, there was no data for 1950 to 1954.

Cancer patient receiving
chemotherapy
Photo by Rhoda Baer

A new study shows that 5-year survival rates for US patients with hematologic malignancies have increased greatly since the 1950s, but there is still room for improvement, particularly for patients with acute myeloid leukemia (AML).

Researchers found the absolute difference in improvement for 5-year survival from 1950-1954 to 2008-2013 ranged from 38.2% for non-Hodgkin lymphoma (NHL) to 56.6% for Hodgkin lymphoma.

And although the 5-year survival rate for Hodgkin lymphoma patients reached 86.6% for 2008-2013, the 5-year survival rate for patients with AML only reached 27.4%.

This study also revealed large disparities in overall cancer mortality rates between different counties across the country.

Ali H. Mokdad, PhD, of the Institute for Health Metrics and Evaluation in Seattle, Washington, and his colleagues reported these findings in JAMA.

Overall cancer deaths

The researchers found there were 19,511,910 cancer deaths recorded in the US between 1980 and 2014. Cancer mortality decreased by 20.1% between 1980 and 2014, from 240.2 deaths per 100,000 people to 192.0 deaths per 100,000 people.

In 1980, cancer mortality ranged from 130.6 per 100,000 in Summit County, Colorado, to 386.9 per 100,000 in North Slope Borough, Alaska.

In 2014, cancer mortality ranged from 70.7 per 100,000 in Summit County, Colorado, to 503.1 per 100,000 in Union County, Florida.

“Such significant disparities among US counties is unacceptable,” Dr Mokdad said. “Every person should have access to early screenings for cancer, as well as adequate treatment.”

Mortality rates for hematologic malignancies

In 2014, the mortality rates, per 100,000 people, for hematologic malignancies were:

• 0.4 for Hodgkin lymphoma (rank out of all cancers, 27)
• 8.3 for NHL (rank, 7)
• 3.9 for multiple myeloma (rank, 16)
• 9.0 for all leukemias (rank, 6)
• 0.7 for acute lymphoid leukemia (ALL)
• 2.6 for chronic lymphoid leukemia (CLL)
• 5.1 for AML
• 0.6 for chronic myeloid leukemia (CML).

The leukemia subtypes were not assigned a rank.

5-year survival rates for hematologic malignancies

Hodgkin lymphoma

• 30% for 1950-54
• 68.6% for 1973-77
• 72.1% for 1978-82
• 86.6% for 2008-2013
• Absolute difference (between the first and latest year of data), 56.6%.

NHL

• 33% for 1950-54
• 45.3% for 1973-77
• 48.7% for 1978-82
• 71.2% for 2008-2013
• Absolute difference, 38.2%.

Multiple myeloma

• 6% for 1950-54
• 23.4% for 1973-77
• 26.6% for 1978-82
• 49.8% for 2008-2013
• Absolute difference, 43.8%.

Leukemia

• 10% for 1950-54
• 34% for 1973-77
• 36.3% for 1978-82
• 60.1% for 2008-2013
• Absolute difference, 50.1%.

ALL

• 39.2% for 1973-77
• 50.5% for 1978-82
• 68.1% for 2008-2013
• Absolute difference, 28.9%.

CLL

• 67% for 1973-77
• 66.3% for 1978-82
• 82.5% for 2008-2013
• Absolute difference, 15.5%.

AML

• 6.2% for 1973-77
• 7.9% for 1978-82
• 27.4% for 2008-2013
• Absolute difference, 21.2%.

CML

• 21.1% for 1973-77
• 25.8% for 1978-82
• 66.4% for 2008-2013
• Absolute difference, 45.3%.

For the leukemia subtypes, there was no data for 1950 to 1954.

Cancer patient receiving
chemotherapy
Photo by Rhoda Baer

A new study shows that 5-year survival rates for US patients with hematologic malignancies have increased greatly since the 1950s, but there is still room for improvement, particularly for patients with acute myeloid leukemia (AML).

Researchers found the absolute difference in improvement for 5-year survival from 1950-1954 to 2008-2013 ranged from 38.2% for non-Hodgkin lymphoma (NHL) to 56.6% for Hodgkin lymphoma.

And although the 5-year survival rate for Hodgkin lymphoma patients reached 86.6% for 2008-2013, the 5-year survival rate for patients with AML only reached 27.4%.

This study also revealed large disparities in overall cancer mortality rates between different counties across the country.

Ali H. Mokdad, PhD, of the Institute for Health Metrics and Evaluation in Seattle, Washington, and his colleagues reported these findings in JAMA.

Overall cancer deaths

The researchers found there were 19,511,910 cancer deaths recorded in the US between 1980 and 2014. Cancer mortality decreased by 20.1% between 1980 and 2014, from 240.2 deaths per 100,000 people to 192.0 deaths per 100,000 people.

In 1980, cancer mortality ranged from 130.6 per 100,000 in Summit County, Colorado, to 386.9 per 100,000 in North Slope Borough, Alaska.

In 2014, cancer mortality ranged from 70.7 per 100,000 in Summit County, Colorado, to 503.1 per 100,000 in Union County, Florida.

“Such significant disparities among US counties is unacceptable,” Dr Mokdad said. “Every person should have access to early screenings for cancer, as well as adequate treatment.”

Mortality rates for hematologic malignancies

In 2014, the mortality rates, per 100,000 people, for hematologic malignancies were:

• 0.4 for Hodgkin lymphoma (rank out of all cancers, 27)
• 8.3 for NHL (rank, 7)
• 3.9 for multiple myeloma (rank, 16)
• 9.0 for all leukemias (rank, 6)
• 0.7 for acute lymphoid leukemia (ALL)
• 2.6 for chronic lymphoid leukemia (CLL)
• 5.1 for AML
• 0.6 for chronic myeloid leukemia (CML).

The leukemia subtypes were not assigned a rank.

5-year survival rates for hematologic malignancies

Hodgkin lymphoma

• 30% for 1950-54
• 68.6% for 1973-77
• 72.1% for 1978-82
• 86.6% for 2008-2013
• Absolute difference (between the first and latest year of data), 56.6%.

NHL

• 33% for 1950-54
• 45.3% for 1973-77
• 48.7% for 1978-82
• 71.2% for 2008-2013
• Absolute difference, 38.2%.

Multiple myeloma

• 6% for 1950-54
• 23.4% for 1973-77
• 26.6% for 1978-82
• 49.8% for 2008-2013
• Absolute difference, 43.8%.

Leukemia

• 10% for 1950-54
• 34% for 1973-77
• 36.3% for 1978-82
• 60.1% for 2008-2013
• Absolute difference, 50.1%.

ALL

• 39.2% for 1973-77
• 50.5% for 1978-82
• 68.1% for 2008-2013
• Absolute difference, 28.9%.

CLL

• 67% for 1973-77
• 66.3% for 1978-82
• 82.5% for 2008-2013
• Absolute difference, 15.5%.

AML

• 6.2% for 1973-77
• 7.9% for 1978-82
• 27.4% for 2008-2013
• Absolute difference, 21.2%.

CML

• 21.1% for 1973-77
• 25.8% for 1978-82
• 66.4% for 2008-2013
• Absolute difference, 45.3%.

For the leukemia subtypes, there was no data for 1950 to 1954.

Lenalidomide (Revlimid®)
Photo courtesy of Celgene

Health Canada has expanded the approved indication for lenalidomide (Revlimid®) to include the treatment of patients with multiple myeloma (MM).

Lenalidomide is now approved for use in combination with dexamethasone to treat patients newly diagnosed with MM who are not eligible for stem cell transplant.

Lenalidomide was previously approved in Canada for the treatment of patients with transfusion-dependent anemia due to low- or intermediate-1-risk myelodysplastic syndromes associated with a deletion 5q cytogenetic abnormality, with or without additional cytogenetic abnormalities.

Lenalidomide is a product of Celgene Corporation.

“The expanded indication of Revlimid® provides [MM] patients with a treatment much earlier in their disease and offers this patient population an all-oral, melphalan-free option for a disease that continues to be difficult to treat,” said Donna Reece, MD, of Princess Margaret Hospital in Toronto, Ontario, Canada.

The expanded approval of lenalidomide is based on safety and efficacy results from the phase 3 FIRST trial. Updated results from this study were published in the Journal of Clinical Oncology last November.

The trial included 1623 patients with newly diagnosed MM who were not eligible for stem cell transplant.

Patients were randomized to receive:

• Lenalidomide and low-dose dexamethasone (Rd) in 28-day cycles until disease progression (n=535)
• 18 cycles of Rd (Rd18) for 72 weeks (n=541)
• Melphalan, prednisone, and thalidomide (MPT) for 72 weeks (n=547).

In the intent-to-treat population, the overall response rate was 81% for the continuous Rd group, 79% for the Rd18 group, and 67% in the MPT group. The complete response rates were 21%, 20%, and 12%, respectively.

The median progression-free survival (PFS) was 26.0 months in the continuous Rd group, 21.0 months in the Rd18 group, and 21.9 months in the MPT group. At 4 years, the PFS rates were 33%, 14%, and 13%, respectively.

The median overall survival (OS) was 58.9 months in the continuous Rd group, 56.7 months in the Rd18 group, and 48.5 months in the MPT group. At 4 years, the OS rates were 60%, 57%, and 51%, respectively.

The most frequent grade 3/4 hematologic treatment-emergent adverse events were neutropenia and anemia. The rate of grade 3/4 neutropenia was higher in the MPT group than the continuous Rd or Rd18 groups.

Infections were the most common grade 3/4 non-hematologic treatment-emergent adverse events. The rate of grade 3/4 infections was higher in the Rd groups than the MPT group.

“With this new clinical evidence, we know that keeping newly diagnosed multiple myeloma patients on Revlimid® may help delay disease progression and reduce the risk of death,” Dr Reece said. “As such, we are looking forward to having Revlimid® as a key option in the first-line setting for the appropriate patients.”

Lenalidomide (Revlimid®)
Photo courtesy of Celgene

Health Canada has expanded the approved indication for lenalidomide (Revlimid®) to include the treatment of patients with multiple myeloma (MM).

Lenalidomide is now approved for use in combination with dexamethasone to treat patients newly diagnosed with MM who are not eligible for stem cell transplant.

Lenalidomide was previously approved in Canada for the treatment of patients with transfusion-dependent anemia due to low- or intermediate-1-risk myelodysplastic syndromes associated with a deletion 5q cytogenetic abnormality, with or without additional cytogenetic abnormalities.

Lenalidomide is a product of Celgene Corporation.

“The expanded indication of Revlimid® provides [MM] patients with a treatment much earlier in their disease and offers this patient population an all-oral, melphalan-free option for a disease that continues to be difficult to treat,” said Donna Reece, MD, of Princess Margaret Hospital in Toronto, Ontario, Canada.

The expanded approval of lenalidomide is based on safety and efficacy results from the phase 3 FIRST trial. Updated results from this study were published in the Journal of Clinical Oncology last November.

The trial included 1623 patients with newly diagnosed MM who were not eligible for stem cell transplant.

Patients were randomized to receive:

• Lenalidomide and low-dose dexamethasone (Rd) in 28-day cycles until disease progression (n=535)
• 18 cycles of Rd (Rd18) for 72 weeks (n=541)
• Melphalan, prednisone, and thalidomide (MPT) for 72 weeks (n=547).

In the intent-to-treat population, the overall response rate was 81% for the continuous Rd group, 79% for the Rd18 group, and 67% in the MPT group. The complete response rates were 21%, 20%, and 12%, respectively.

The median progression-free survival (PFS) was 26.0 months in the continuous Rd group, 21.0 months in the Rd18 group, and 21.9 months in the MPT group. At 4 years, the PFS rates were 33%, 14%, and 13%, respectively.

The median overall survival (OS) was 58.9 months in the continuous Rd group, 56.7 months in the Rd18 group, and 48.5 months in the MPT group. At 4 years, the OS rates were 60%, 57%, and 51%, respectively.

The most frequent grade 3/4 hematologic treatment-emergent adverse events were neutropenia and anemia. The rate of grade 3/4 neutropenia was higher in the MPT group than the continuous Rd or Rd18 groups.

Infections were the most common grade 3/4 non-hematologic treatment-emergent adverse events. The rate of grade 3/4 infections was higher in the Rd groups than the MPT group.

“With this new clinical evidence, we know that keeping newly diagnosed multiple myeloma patients on Revlimid® may help delay disease progression and reduce the risk of death,” Dr Reece said. “As such, we are looking forward to having Revlimid® as a key option in the first-line setting for the appropriate patients.”

Lenalidomide (Revlimid®)
Photo courtesy of Celgene

Health Canada has expanded the approved indication for lenalidomide (Revlimid®) to include the treatment of patients with multiple myeloma (MM).

Lenalidomide is now approved for use in combination with dexamethasone to treat patients newly diagnosed with MM who are not eligible for stem cell transplant.

Lenalidomide was previously approved in Canada for the treatment of patients with transfusion-dependent anemia due to low- or intermediate-1-risk myelodysplastic syndromes associated with a deletion 5q cytogenetic abnormality, with or without additional cytogenetic abnormalities.

Lenalidomide is a product of Celgene Corporation.

“The expanded indication of Revlimid® provides [MM] patients with a treatment much earlier in their disease and offers this patient population an all-oral, melphalan-free option for a disease that continues to be difficult to treat,” said Donna Reece, MD, of Princess Margaret Hospital in Toronto, Ontario, Canada.

The expanded approval of lenalidomide is based on safety and efficacy results from the phase 3 FIRST trial. Updated results from this study were published in the Journal of Clinical Oncology last November.

The trial included 1623 patients with newly diagnosed MM who were not eligible for stem cell transplant.

Patients were randomized to receive:

• Lenalidomide and low-dose dexamethasone (Rd) in 28-day cycles until disease progression (n=535)
• 18 cycles of Rd (Rd18) for 72 weeks (n=541)
• Melphalan, prednisone, and thalidomide (MPT) for 72 weeks (n=547).

In the intent-to-treat population, the overall response rate was 81% for the continuous Rd group, 79% for the Rd18 group, and 67% in the MPT group. The complete response rates were 21%, 20%, and 12%, respectively.

The median progression-free survival (PFS) was 26.0 months in the continuous Rd group, 21.0 months in the Rd18 group, and 21.9 months in the MPT group. At 4 years, the PFS rates were 33%, 14%, and 13%, respectively.

The median overall survival (OS) was 58.9 months in the continuous Rd group, 56.7 months in the Rd18 group, and 48.5 months in the MPT group. At 4 years, the OS rates were 60%, 57%, and 51%, respectively.

The most frequent grade 3/4 hematologic treatment-emergent adverse events were neutropenia and anemia. The rate of grade 3/4 neutropenia was higher in the MPT group than the continuous Rd or Rd18 groups.

Infections were the most common grade 3/4 non-hematologic treatment-emergent adverse events. The rate of grade 3/4 infections was higher in the Rd groups than the MPT group.

“With this new clinical evidence, we know that keeping newly diagnosed multiple myeloma patients on Revlimid® may help delay disease progression and reduce the risk of death,” Dr Reece said. “As such, we are looking forward to having Revlimid® as a key option in the first-line setting for the appropriate patients.”

Clinical question: Does hydrocortisone therapy prevent progression to septic shock in patients with severe sepsis without shock?

Background: Current sepsis management guidelines recommend use of hydrocortisone in patients with septic shock who are unable to restore hemodynamic stability with IV fluids and pressors; current guidelines also recommend against use of corticosteroids without shock. However, these recommendations are based on two RCTs and remain controversial.

Study design: Multicenter, placebo-controlled, double-blind RCT.

Setting: Thirty-four intermediate or intensive care units in German university and community hospitals.

Synopsis: Investigators randomly assigned 380 patients to hydrocortisone or placebo. Patients were included if they had clinical evidence of infection, evidence of SIRS (systemic inflammatory response syndrome), and evidence of organ dysfunction. Patients were excluded if they had any of the following: sepsis-induced hypotension, separate indication for systemic steroid use, or hypersensitivity to steroids. Primary outcome was the occurrence of septic shock within 14 days. Secondary outcomes included time to septic shock or death, death in the ICU or hospital, organ dysfunction, ventilator therapy, renal replacement therapy, and secondary infection.

Study results showed no significant difference in the primary outcome between groups, or in any of the secondary outcomes. In a post-hoc analysis, there was more hyperglycemia and less delirium in the study group.

Study limitations are inclusion of patients only after consent, potentially missing early septic shock, and the fact that many analyses were done post-hoc.

Bottom line: Steroids should be avoided in severe sepsis without shock.

Citation: Keh D, Trips E, Marx G, et al. Effect of hydrocortisone on development of shock among patients with severe sepsis. JAMA. 2016;316(17):1775-85.
 

Dr. Graves is an assistant professor at the University of Utah School of Medicine and associate program director of quality and patient safety for the University of Utah Internal Medicine residency training program.

Clinical question: Does hydrocortisone therapy prevent progression to septic shock in patients with severe sepsis without shock?

Background: Current sepsis management guidelines recommend use of hydrocortisone in patients with septic shock who are unable to restore hemodynamic stability with IV fluids and pressors; current guidelines also recommend against use of corticosteroids without shock. However, these recommendations are based on two RCTs and remain controversial.

Study design: Multicenter, placebo-controlled, double-blind RCT.

Setting: Thirty-four intermediate or intensive care units in German university and community hospitals.

Synopsis: Investigators randomly assigned 380 patients to hydrocortisone or placebo. Patients were included if they had clinical evidence of infection, evidence of SIRS (systemic inflammatory response syndrome), and evidence of organ dysfunction. Patients were excluded if they had any of the following: sepsis-induced hypotension, separate indication for systemic steroid use, or hypersensitivity to steroids. Primary outcome was the occurrence of septic shock within 14 days. Secondary outcomes included time to septic shock or death, death in the ICU or hospital, organ dysfunction, ventilator therapy, renal replacement therapy, and secondary infection.

Study results showed no significant difference in the primary outcome between groups, or in any of the secondary outcomes. In a post-hoc analysis, there was more hyperglycemia and less delirium in the study group.

Study limitations are inclusion of patients only after consent, potentially missing early septic shock, and the fact that many analyses were done post-hoc.

Bottom line: Steroids should be avoided in severe sepsis without shock.

Citation: Keh D, Trips E, Marx G, et al. Effect of hydrocortisone on development of shock among patients with severe sepsis. JAMA. 2016;316(17):1775-85.
 

Dr. Graves is an assistant professor at the University of Utah School of Medicine and associate program director of quality and patient safety for the University of Utah Internal Medicine residency training program.

Clinical question: Does hydrocortisone therapy prevent progression to septic shock in patients with severe sepsis without shock?

Background: Current sepsis management guidelines recommend use of hydrocortisone in patients with septic shock who are unable to restore hemodynamic stability with IV fluids and pressors; current guidelines also recommend against use of corticosteroids without shock. However, these recommendations are based on two RCTs and remain controversial.

Study design: Multicenter, placebo-controlled, double-blind RCT.

Setting: Thirty-four intermediate or intensive care units in German university and community hospitals.

Synopsis: Investigators randomly assigned 380 patients to hydrocortisone or placebo. Patients were included if they had clinical evidence of infection, evidence of SIRS (systemic inflammatory response syndrome), and evidence of organ dysfunction. Patients were excluded if they had any of the following: sepsis-induced hypotension, separate indication for systemic steroid use, or hypersensitivity to steroids. Primary outcome was the occurrence of septic shock within 14 days. Secondary outcomes included time to septic shock or death, death in the ICU or hospital, organ dysfunction, ventilator therapy, renal replacement therapy, and secondary infection.

Study results showed no significant difference in the primary outcome between groups, or in any of the secondary outcomes. In a post-hoc analysis, there was more hyperglycemia and less delirium in the study group.

Study limitations are inclusion of patients only after consent, potentially missing early septic shock, and the fact that many analyses were done post-hoc.

Bottom line: Steroids should be avoided in severe sepsis without shock.

Citation: Keh D, Trips E, Marx G, et al. Effect of hydrocortisone on development of shock among patients with severe sepsis. JAMA. 2016;316(17):1775-85.
 

Dr. Graves is an assistant professor at the University of Utah School of Medicine and associate program director of quality and patient safety for the University of Utah Internal Medicine residency training program.

WASHINGTON – Rep. Tom Price, MD (R-Ga.), dodged specifics on Medicaid reform and the issue of block grants for funding Medicaid during a hearing Jan. 24 before the Senate Financing Committee.

The committee will be voting to move forward to the full Senate his nomination as secretary of the Department of Health & Human Services.

[email protected]

WASHINGTON – Rep. Tom Price, MD (R-Ga.), dodged specifics on Medicaid reform and the issue of block grants for funding Medicaid during a hearing Jan. 24 before the Senate Financing Committee.

The committee will be voting to move forward to the full Senate his nomination as secretary of the Department of Health & Human Services.

[email protected]

WASHINGTON – Rep. Tom Price, MD (R-Ga.), dodged specifics on Medicaid reform and the issue of block grants for funding Medicaid during a hearing Jan. 24 before the Senate Financing Committee.

The committee will be voting to move forward to the full Senate his nomination as secretary of the Department of Health & Human Services.

[email protected]

ORLANDO – Intracardiac echocardiography (ICE) can be safely substituted for transesophageal echocardiography (TEE) as a less invasive option in the placement of an investigational percutaneous device for left atrial appendage (LAA) occlusion, according to data presented at the annual International AF Symposium.

The relative safety and efficacy of ICE and TEE for placement of the device, called the Amplatzer Amulet, was evaluated as a subanalysis of a large, nonrandomized, observational study, according to Boris Schmidt, MD, of Cardiovascular Center Bethanien, Frankfurt, Germany.

The Amplatzer Amulet device, which is designed to prevent LAA-associated thromboembolism in patients with nonvalvular atrial fibrillation (AF), has been available in Europe for several years. It functions much like Boston Scientific’s Watchman implant. A registration trial in the United States was initiated in 2016.

In the study that provided the basis for this analysis, 1,088 AF patients were implanted. The average age was 75 years, and the population was relatively high risk for both stroke and bleeding. The CHA₂DS₂-VASc score was at least 4 in 65% of patients, with an average score of 4.2. Prior stroke (28%) and transient ischemic attack (11%) had occurred in more than one-third. Reflecting the fact that 72% had a history of a major bleed, the average HAS-BLED score was 3.3. More than 80% were hypertensive.

The decision to place the device with TEE, which Dr. Schmidt characterized as the standard, or ICE was left up to the discretion of the implanter. Ultimately, 958 (88.4%) of the devices were placed with TEE and 126 (11.6%) with ICE.

There were no significant differences in implant success or safety when the two methods for guiding implantation were compared. Specifically, success was achieved in 99.2% of the ICE group with 90.5% of cases requiring only one device. In the TEE group, the device was successfully implanted in 98.4%, and 94.4% needed only one device. The first device to be selected was ultimately implanted in 96.5% of the ICE group and 94.4% of the TEE group. The LAA closure rate, defined as gap of less than 3 mm, was 100% at implant and 3 months after transplant in the ICE group, when evaluated by an independent core laboratory. The closure rates in the TEE group at the time of implant and 3 months later were 99.8% and 98.6%, respectively. No difference between imaging methods approached statistical significance.

Adverse events, which were also adjudicated by independent investigators, occurred at low rates and also did not differ by imaging strategy. In the ICE and TEE groups, respectively, these included vascular complications in 0.9% and 1.6%, pericardial effusion in 1.0% and 0.8%, stroke in 0.3% and 0%, and embolization in 0.1% and 0%. With a median follow-up of 6.6 months, there have been four deaths. Two were considered to be device related by the adjudicators. One involved a perforation and another a cardiac arrest. Both were observed in the TEE group.

The Amplatzer Amulet device consists of a lobe that is designed to fit inside the LAA neck and a disk that provides a complete seal at the orifice. It was first introduced in Europe in 2008 but has undergone several modifications. In the United States, the Watchman, which opens like an umbrella in order to block passage of thromboemboli when deployed in the LAA, received FDA approval in 2015. Other LAA closure strategies are in development. There are no large randomized trials in which LAA closure devices have been compared.

Dr. Schmidt has financial relationships with Boston Scientific and St. Jude Medical.

[email protected]

ORLANDO – Intracardiac echocardiography (ICE) can be safely substituted for transesophageal echocardiography (TEE) as a less invasive option in the placement of an investigational percutaneous device for left atrial appendage (LAA) occlusion, according to data presented at the annual International AF Symposium.

The relative safety and efficacy of ICE and TEE for placement of the device, called the Amplatzer Amulet, was evaluated as a subanalysis of a large, nonrandomized, observational study, according to Boris Schmidt, MD, of Cardiovascular Center Bethanien, Frankfurt, Germany.

The Amplatzer Amulet device, which is designed to prevent LAA-associated thromboembolism in patients with nonvalvular atrial fibrillation (AF), has been available in Europe for several years. It functions much like Boston Scientific’s Watchman implant. A registration trial in the United States was initiated in 2016.

In the study that provided the basis for this analysis, 1,088 AF patients were implanted. The average age was 75 years, and the population was relatively high risk for both stroke and bleeding. The CHA₂DS₂-VASc score was at least 4 in 65% of patients, with an average score of 4.2. Prior stroke (28%) and transient ischemic attack (11%) had occurred in more than one-third. Reflecting the fact that 72% had a history of a major bleed, the average HAS-BLED score was 3.3. More than 80% were hypertensive.

The decision to place the device with TEE, which Dr. Schmidt characterized as the standard, or ICE was left up to the discretion of the implanter. Ultimately, 958 (88.4%) of the devices were placed with TEE and 126 (11.6%) with ICE.

There were no significant differences in implant success or safety when the two methods for guiding implantation were compared. Specifically, success was achieved in 99.2% of the ICE group with 90.5% of cases requiring only one device. In the TEE group, the device was successfully implanted in 98.4%, and 94.4% needed only one device. The first device to be selected was ultimately implanted in 96.5% of the ICE group and 94.4% of the TEE group. The LAA closure rate, defined as gap of less than 3 mm, was 100% at implant and 3 months after transplant in the ICE group, when evaluated by an independent core laboratory. The closure rates in the TEE group at the time of implant and 3 months later were 99.8% and 98.6%, respectively. No difference between imaging methods approached statistical significance.

Adverse events, which were also adjudicated by independent investigators, occurred at low rates and also did not differ by imaging strategy. In the ICE and TEE groups, respectively, these included vascular complications in 0.9% and 1.6%, pericardial effusion in 1.0% and 0.8%, stroke in 0.3% and 0%, and embolization in 0.1% and 0%. With a median follow-up of 6.6 months, there have been four deaths. Two were considered to be device related by the adjudicators. One involved a perforation and another a cardiac arrest. Both were observed in the TEE group.

The Amplatzer Amulet device consists of a lobe that is designed to fit inside the LAA neck and a disk that provides a complete seal at the orifice. It was first introduced in Europe in 2008 but has undergone several modifications. In the United States, the Watchman, which opens like an umbrella in order to block passage of thromboemboli when deployed in the LAA, received FDA approval in 2015. Other LAA closure strategies are in development. There are no large randomized trials in which LAA closure devices have been compared.

Dr. Schmidt has financial relationships with Boston Scientific and St. Jude Medical.

[email protected]

ORLANDO – Intracardiac echocardiography (ICE) can be safely substituted for transesophageal echocardiography (TEE) as a less invasive option in the placement of an investigational percutaneous device for left atrial appendage (LAA) occlusion, according to data presented at the annual International AF Symposium.

The relative safety and efficacy of ICE and TEE for placement of the device, called the Amplatzer Amulet, was evaluated as a subanalysis of a large, nonrandomized, observational study, according to Boris Schmidt, MD, of Cardiovascular Center Bethanien, Frankfurt, Germany.

The Amplatzer Amulet device, which is designed to prevent LAA-associated thromboembolism in patients with nonvalvular atrial fibrillation (AF), has been available in Europe for several years. It functions much like Boston Scientific’s Watchman implant. A registration trial in the United States was initiated in 2016.

In the study that provided the basis for this analysis, 1,088 AF patients were implanted. The average age was 75 years, and the population was relatively high risk for both stroke and bleeding. The CHA₂DS₂-VASc score was at least 4 in 65% of patients, with an average score of 4.2. Prior stroke (28%) and transient ischemic attack (11%) had occurred in more than one-third. Reflecting the fact that 72% had a history of a major bleed, the average HAS-BLED score was 3.3. More than 80% were hypertensive.

The decision to place the device with TEE, which Dr. Schmidt characterized as the standard, or ICE was left up to the discretion of the implanter. Ultimately, 958 (88.4%) of the devices were placed with TEE and 126 (11.6%) with ICE.

There were no significant differences in implant success or safety when the two methods for guiding implantation were compared. Specifically, success was achieved in 99.2% of the ICE group with 90.5% of cases requiring only one device. In the TEE group, the device was successfully implanted in 98.4%, and 94.4% needed only one device. The first device to be selected was ultimately implanted in 96.5% of the ICE group and 94.4% of the TEE group. The LAA closure rate, defined as gap of less than 3 mm, was 100% at implant and 3 months after transplant in the ICE group, when evaluated by an independent core laboratory. The closure rates in the TEE group at the time of implant and 3 months later were 99.8% and 98.6%, respectively. No difference between imaging methods approached statistical significance.

Adverse events, which were also adjudicated by independent investigators, occurred at low rates and also did not differ by imaging strategy. In the ICE and TEE groups, respectively, these included vascular complications in 0.9% and 1.6%, pericardial effusion in 1.0% and 0.8%, stroke in 0.3% and 0%, and embolization in 0.1% and 0%. With a median follow-up of 6.6 months, there have been four deaths. Two were considered to be device related by the adjudicators. One involved a perforation and another a cardiac arrest. Both were observed in the TEE group.

The Amplatzer Amulet device consists of a lobe that is designed to fit inside the LAA neck and a disk that provides a complete seal at the orifice. It was first introduced in Europe in 2008 but has undergone several modifications. In the United States, the Watchman, which opens like an umbrella in order to block passage of thromboemboli when deployed in the LAA, received FDA approval in 2015. Other LAA closure strategies are in development. There are no large randomized trials in which LAA closure devices have been compared.

Dr. Schmidt has financial relationships with Boston Scientific and St. Jude Medical.

[email protected]

Comatose children who survived cardiac arrest in the hospital do not benefit more from treatment with therapeutic hypothermia than from keeping their body temperatures normal, according to results from a randomized trial conducted in 37 hospitals in three countries.

The findings were presented in Honolulu at the Critical Care Congress, sponsored by the Society for Critical Care Medicine, and published online Jan. 24 in the New England Journal of Medicine (2017 Jan 24. doi: 10.1056/NEJMoa1610493). They add to a growing consensus from adult studies that the use of induced hypothermia to prevent fevers and neurologic injury after cardiac arrest does not confer additional survival or functional benefit over normothermia. Less was known about children, particularly those whose cardiac arrest occurred in a hospital setting.

Frank W. Moler, MD, of the University of Michigan, Ann Arbor, led the study, which randomized 329 comatose children, from newborns to age 18 years, to either 120 hours of normothermia (target temperature, 36.8° C) or 48 hours of hypothermia (33°) followed by normal temperature maintenance to 120 days following an in-hospital cardiac arrest.

Fever prevention in both groups was achieved through active intervention, with hypothermia-treated patients also having been pharmacologically paralyzed and sedated. The investigators used the Vineland Adaptive Behavioral Scales to measure neurobehavioral function, with a score of 70 or higher deemed indicative of good function.

The study’s primary outcome was survival at 12 months after cardiac arrest and a favorable neurobehavioral outcome. In the 257 children with scores of 70 or higher before cardiac arrest, no significant differences were seen between the two different groups, with 36% of the hypothermia-treated patients (48/133) and 39% of normothermia-treated patients (48/124) surviving with a favorable neurobehavioral outcome (relative risk, 0.92; 95% confidence interval, 0.67-1.27; P = .63). In 317 children who could be evaluated for changes in neurobehavioral function, the changes from baseline between groups did not reach statistical significance (P = .70), and 1-year survival also did not differ significantly (49% for hypothermia-treated vs. 46% for normothermia; RR, 1.07; 95% CI, 0.85-1.34, P = .56). Adverse events did not differ significantly between groups.

The trial was stopped early for futility, leaving fewer than the hoped-for number of patients available for analysis, and wider confidence intervals. However, the investigators said their hypothesized 15 percentage point benefit for hypothermia treatment could be ruled out. Dr. Moler and his colleagues wrote in their analysis that unanswered questions remain regarding the role of body temperature interventions in this population, noting that different duration of treatment, different temperatures, and combination of temperature management with neuroprotective agents are worth considering for future studies. Dr. Moler and his colleagues’ study was funded by the National Heart, Lung, and Blood Institute. Four of its 49 coauthors disclosed commercial conflicts of interest.

Comatose children who survived cardiac arrest in the hospital do not benefit more from treatment with therapeutic hypothermia than from keeping their body temperatures normal, according to results from a randomized trial conducted in 37 hospitals in three countries.

The findings were presented in Honolulu at the Critical Care Congress, sponsored by the Society for Critical Care Medicine, and published online Jan. 24 in the New England Journal of Medicine (2017 Jan 24. doi: 10.1056/NEJMoa1610493). They add to a growing consensus from adult studies that the use of induced hypothermia to prevent fevers and neurologic injury after cardiac arrest does not confer additional survival or functional benefit over normothermia. Less was known about children, particularly those whose cardiac arrest occurred in a hospital setting.

Frank W. Moler, MD, of the University of Michigan, Ann Arbor, led the study, which randomized 329 comatose children, from newborns to age 18 years, to either 120 hours of normothermia (target temperature, 36.8° C) or 48 hours of hypothermia (33°) followed by normal temperature maintenance to 120 days following an in-hospital cardiac arrest.

Fever prevention in both groups was achieved through active intervention, with hypothermia-treated patients also having been pharmacologically paralyzed and sedated. The investigators used the Vineland Adaptive Behavioral Scales to measure neurobehavioral function, with a score of 70 or higher deemed indicative of good function.

The study’s primary outcome was survival at 12 months after cardiac arrest and a favorable neurobehavioral outcome. In the 257 children with scores of 70 or higher before cardiac arrest, no significant differences were seen between the two different groups, with 36% of the hypothermia-treated patients (48/133) and 39% of normothermia-treated patients (48/124) surviving with a favorable neurobehavioral outcome (relative risk, 0.92; 95% confidence interval, 0.67-1.27; P = .63). In 317 children who could be evaluated for changes in neurobehavioral function, the changes from baseline between groups did not reach statistical significance (P = .70), and 1-year survival also did not differ significantly (49% for hypothermia-treated vs. 46% for normothermia; RR, 1.07; 95% CI, 0.85-1.34, P = .56). Adverse events did not differ significantly between groups.

The trial was stopped early for futility, leaving fewer than the hoped-for number of patients available for analysis, and wider confidence intervals. However, the investigators said their hypothesized 15 percentage point benefit for hypothermia treatment could be ruled out. Dr. Moler and his colleagues wrote in their analysis that unanswered questions remain regarding the role of body temperature interventions in this population, noting that different duration of treatment, different temperatures, and combination of temperature management with neuroprotective agents are worth considering for future studies. Dr. Moler and his colleagues’ study was funded by the National Heart, Lung, and Blood Institute. Four of its 49 coauthors disclosed commercial conflicts of interest.

Comatose children who survived cardiac arrest in the hospital do not benefit more from treatment with therapeutic hypothermia than from keeping their body temperatures normal, according to results from a randomized trial conducted in 37 hospitals in three countries.

The findings were presented in Honolulu at the Critical Care Congress, sponsored by the Society for Critical Care Medicine, and published online Jan. 24 in the New England Journal of Medicine (2017 Jan 24. doi: 10.1056/NEJMoa1610493). They add to a growing consensus from adult studies that the use of induced hypothermia to prevent fevers and neurologic injury after cardiac arrest does not confer additional survival or functional benefit over normothermia. Less was known about children, particularly those whose cardiac arrest occurred in a hospital setting.

Frank W. Moler, MD, of the University of Michigan, Ann Arbor, led the study, which randomized 329 comatose children, from newborns to age 18 years, to either 120 hours of normothermia (target temperature, 36.8° C) or 48 hours of hypothermia (33°) followed by normal temperature maintenance to 120 days following an in-hospital cardiac arrest.

Fever prevention in both groups was achieved through active intervention, with hypothermia-treated patients also having been pharmacologically paralyzed and sedated. The investigators used the Vineland Adaptive Behavioral Scales to measure neurobehavioral function, with a score of 70 or higher deemed indicative of good function.

The study’s primary outcome was survival at 12 months after cardiac arrest and a favorable neurobehavioral outcome. In the 257 children with scores of 70 or higher before cardiac arrest, no significant differences were seen between the two different groups, with 36% of the hypothermia-treated patients (48/133) and 39% of normothermia-treated patients (48/124) surviving with a favorable neurobehavioral outcome (relative risk, 0.92; 95% confidence interval, 0.67-1.27; P = .63). In 317 children who could be evaluated for changes in neurobehavioral function, the changes from baseline between groups did not reach statistical significance (P = .70), and 1-year survival also did not differ significantly (49% for hypothermia-treated vs. 46% for normothermia; RR, 1.07; 95% CI, 0.85-1.34, P = .56). Adverse events did not differ significantly between groups.

The trial was stopped early for futility, leaving fewer than the hoped-for number of patients available for analysis, and wider confidence intervals. However, the investigators said their hypothesized 15 percentage point benefit for hypothermia treatment could be ruled out. Dr. Moler and his colleagues wrote in their analysis that unanswered questions remain regarding the role of body temperature interventions in this population, noting that different duration of treatment, different temperatures, and combination of temperature management with neuroprotective agents are worth considering for future studies. Dr. Moler and his colleagues’ study was funded by the National Heart, Lung, and Blood Institute. Four of its 49 coauthors disclosed commercial conflicts of interest.

In another sign that immune-suppressing drugs may cause skin cancer, a new Irish study links immunomodulator use in younger patients with inflammatory bowel disease (IBD) to higher rates of nonmelanoma skin cancer (NMSC).

The 19-year study lacks information about medication doses or duration, and it doesn’t confirm a cause-and-effect link. Still, researchers recommend that all patients with IBD be urged to comply with skin cancer prevention guidelines.

As the study notes, previous research has linked immunosuppression – such as that in transplant patients and those with AIDS and lymphoma – to higher rates of NMSC.

Studies have also linked IBD to higher rates of NMSC even before the age of 50, possibly as the result of immune system dysfunction and exposure to immunomodulators, especially thiopurines. The risk of tumor necrosis factor–alpha (TNF-alpha) inhibitors, the study says, is less clear.

To better understand the risk of immunomodulators, researchers led by Julianne Clowry, MBBCh, of St Vincent’s University Hospital in Dublin tracked 2,053 IBD patients at a tertiary adult hospital from 1994 to 2013.

The median age at IBD diagnosis was 31 with a median of 19.6 years of illness, and the patients had both Crohn’s disease (41%) and ulcerative colitis (59%). Fifty-seven percent of patients had taken immunomodulating medication, although the database used didn’t disclose details about dose or duration, and 43% had not.

The study findings appeared Jan. 3 in the Journal of the European Academy of Dermatology and Venereology (doi: 10.1111/jdv.14105).

NMSC was diagnosed in 1.7% of the entire cohort, 1.4% of patients who’d taken immunosuppressants, and 1.9% of those who had not.

Older ages may explain the higher rate in those who didn’t take the medications. The researchers found that the standardized incidence ratio for the patients who took immunomodulators overall was 1.76 [confidence interval, 1.0-2.7], compared with a matched general population cohort, while the ratio was not considered significant among the nonimmunosuppressed [1.07; CI, 0.6-1.6].

The study links use of thiopurines alone and use of both thiopurines and TNF-alpha inhibitors to higher rates of NMSC [odds ratio, 5.26; 95% CI, 2.15-12.93; P less than .001, and OR: 6.45; 95% CI, 2.69-15.95; P less than .001, respectively].

The researchers note that 82% of those who had taken a TNF-alpha inhibitor also took a thiopurine at some point.

The study says the “relatively high” standardized incident ratios are worrisome amid more use of dual immunomodulators and higher IBD rates in kids and younger adults. But the medications are “vital,” the study says, and the researchers suggest “targeted dermatology referrals for IBD patients, particularly those exposed to dual immunomodulatory therapy from an early age.”

The study authors disclose no source of funding and report no relevant disclosures.

In another sign that immune-suppressing drugs may cause skin cancer, a new Irish study links immunomodulator use in younger patients with inflammatory bowel disease (IBD) to higher rates of nonmelanoma skin cancer (NMSC).

The 19-year study lacks information about medication doses or duration, and it doesn’t confirm a cause-and-effect link. Still, researchers recommend that all patients with IBD be urged to comply with skin cancer prevention guidelines.

As the study notes, previous research has linked immunosuppression – such as that in transplant patients and those with AIDS and lymphoma – to higher rates of NMSC.

Studies have also linked IBD to higher rates of NMSC even before the age of 50, possibly as the result of immune system dysfunction and exposure to immunomodulators, especially thiopurines. The risk of tumor necrosis factor–alpha (TNF-alpha) inhibitors, the study says, is less clear.

To better understand the risk of immunomodulators, researchers led by Julianne Clowry, MBBCh, of St Vincent’s University Hospital in Dublin tracked 2,053 IBD patients at a tertiary adult hospital from 1994 to 2013.

The median age at IBD diagnosis was 31 with a median of 19.6 years of illness, and the patients had both Crohn’s disease (41%) and ulcerative colitis (59%). Fifty-seven percent of patients had taken immunomodulating medication, although the database used didn’t disclose details about dose or duration, and 43% had not.

The study findings appeared Jan. 3 in the Journal of the European Academy of Dermatology and Venereology (doi: 10.1111/jdv.14105).

NMSC was diagnosed in 1.7% of the entire cohort, 1.4% of patients who’d taken immunosuppressants, and 1.9% of those who had not.

Older ages may explain the higher rate in those who didn’t take the medications. The researchers found that the standardized incidence ratio for the patients who took immunomodulators overall was 1.76 [confidence interval, 1.0-2.7], compared with a matched general population cohort, while the ratio was not considered significant among the nonimmunosuppressed [1.07; CI, 0.6-1.6].

The study links use of thiopurines alone and use of both thiopurines and TNF-alpha inhibitors to higher rates of NMSC [odds ratio, 5.26; 95% CI, 2.15-12.93; P less than .001, and OR: 6.45; 95% CI, 2.69-15.95; P less than .001, respectively].

The researchers note that 82% of those who had taken a TNF-alpha inhibitor also took a thiopurine at some point.

The study says the “relatively high” standardized incident ratios are worrisome amid more use of dual immunomodulators and higher IBD rates in kids and younger adults. But the medications are “vital,” the study says, and the researchers suggest “targeted dermatology referrals for IBD patients, particularly those exposed to dual immunomodulatory therapy from an early age.”

The study authors disclose no source of funding and report no relevant disclosures.

In another sign that immune-suppressing drugs may cause skin cancer, a new Irish study links immunomodulator use in younger patients with inflammatory bowel disease (IBD) to higher rates of nonmelanoma skin cancer (NMSC).

The 19-year study lacks information about medication doses or duration, and it doesn’t confirm a cause-and-effect link. Still, researchers recommend that all patients with IBD be urged to comply with skin cancer prevention guidelines.

As the study notes, previous research has linked immunosuppression – such as that in transplant patients and those with AIDS and lymphoma – to higher rates of NMSC.

Studies have also linked IBD to higher rates of NMSC even before the age of 50, possibly as the result of immune system dysfunction and exposure to immunomodulators, especially thiopurines. The risk of tumor necrosis factor–alpha (TNF-alpha) inhibitors, the study says, is less clear.

To better understand the risk of immunomodulators, researchers led by Julianne Clowry, MBBCh, of St Vincent’s University Hospital in Dublin tracked 2,053 IBD patients at a tertiary adult hospital from 1994 to 2013.

The median age at IBD diagnosis was 31 with a median of 19.6 years of illness, and the patients had both Crohn’s disease (41%) and ulcerative colitis (59%). Fifty-seven percent of patients had taken immunomodulating medication, although the database used didn’t disclose details about dose or duration, and 43% had not.

The study findings appeared Jan. 3 in the Journal of the European Academy of Dermatology and Venereology (doi: 10.1111/jdv.14105).

NMSC was diagnosed in 1.7% of the entire cohort, 1.4% of patients who’d taken immunosuppressants, and 1.9% of those who had not.

Older ages may explain the higher rate in those who didn’t take the medications. The researchers found that the standardized incidence ratio for the patients who took immunomodulators overall was 1.76 [confidence interval, 1.0-2.7], compared with a matched general population cohort, while the ratio was not considered significant among the nonimmunosuppressed [1.07; CI, 0.6-1.6].

The study links use of thiopurines alone and use of both thiopurines and TNF-alpha inhibitors to higher rates of NMSC [odds ratio, 5.26; 95% CI, 2.15-12.93; P less than .001, and OR: 6.45; 95% CI, 2.69-15.95; P less than .001, respectively].

The researchers note that 82% of those who had taken a TNF-alpha inhibitor also took a thiopurine at some point.

The study says the “relatively high” standardized incident ratios are worrisome amid more use of dual immunomodulators and higher IBD rates in kids and younger adults. But the medications are “vital,” the study says, and the researchers suggest “targeted dermatology referrals for IBD patients, particularly those exposed to dual immunomodulatory therapy from an early age.”

The study authors disclose no source of funding and report no relevant disclosures.

Atopic dermatitis (AD) is among the nuts and bolts of any dermatology practice, and as such, gets its time in the spotlight at SDEF’s Annual Hawaii Dermatology Seminar.

This year, SDEF celebrates 41 years of educating dermatologists with the latest in dermatology, featuring presentations from experts on topics ranging from AD treatments and skin cancer chemoprevention to botulinum toxin injections and fillers.

[email protected]

Atopic dermatitis (AD) is among the nuts and bolts of any dermatology practice, and as such, gets its time in the spotlight at SDEF’s Annual Hawaii Dermatology Seminar.

This year, SDEF celebrates 41 years of educating dermatologists with the latest in dermatology, featuring presentations from experts on topics ranging from AD treatments and skin cancer chemoprevention to botulinum toxin injections and fillers.

[email protected]

Atopic dermatitis (AD) is among the nuts and bolts of any dermatology practice, and as such, gets its time in the spotlight at SDEF’s Annual Hawaii Dermatology Seminar.

This year, SDEF celebrates 41 years of educating dermatologists with the latest in dermatology, featuring presentations from experts on topics ranging from AD treatments and skin cancer chemoprevention to botulinum toxin injections and fillers.

[email protected]