Medical Year in Review

A look at study data released during the last year that will transform the way diseases and conditions are managed.

During the past year, key findings were presented at major medical conferences and meetings that will impact the way diseases and conditions are treated going forward. Pharmacy Times has compiled some of the most important updates from 2010 and 2011, including new treatments and drug indications, trends in prescribing, treatment guidelines, screening recommendations, medication adherence trends, and new data on procedures for conditions including arthritis, diabetes, chronic obstructive pulmonary disease, irritable bowel disease, asthma, and allergy. We’ve organized the information presented at several different conferences into 11 major therapeutic categories.

PAIN/INFLAMMATION

2010 Scientific Sessions of the American College of Rheumatology

• Use of anti-tumor necrosis factor inhibitors was associated with a 56% reduction in the risk of developing Alzheimer’s disease in patients with rheumatoid arthritis (RA), according to a large-scale study by researchers at Dartmouth Medical School.
• The use of special mobility shoes can help ease knee pain and slow disease progression in individuals with osteoarthritis, according to researchers from Rush University in Chicago, who found that specialized footwear was beneficial in reducing knee loads substantially over 6 months.
• Research from the first trial to study the use of statins in children with lupus shows that although statins decrease C-reactive protein and lipid levels and appear to be safe in this population, they do not have enough of a positive effect to be routinely prescribed in those with lupus.
• Systemic inflammation and rheumatoid arthritis disease activity may contribute to the progression of atherosclerosis in people with RA, according to study data which also show that this progression may be modified favorably by tumor necrosis factor inhibitors and detrimentally by glucocorticoids. American Pain Society 29th Annual Scientific Meeting
• As part of a symposium presented during the APS, Perry Fine, MD, of the University of Utah discussed how the number of methadone prescriptions has increased nearly 4-fold in the last 10 to 15 years, primarily for patients with chronic pain and other forms of pain. Although it is a viable option because of its relative low cost, versatility in dosing, and long duration of action, use of methadone must be monitored extremely closely, Dr. Fine said.

EAR/EYE/NOSE/THROAT

American College of Allergy, Asthma & Immunology 2010 Annual Scientific Meeting

• A study of patients 12 years and older with seasonal allergic rhinitis found that once-daily mometasone furoate nasal spray relieves nighttime and early morning nasal congestion, one of the most problematic of all symptoms of seasonal allergic rhinitis.
• Adding the nasal antihistamine olopatadine to oral antibiotic therapy was found to accelerate the resolution of serous otitis media in children and limit the damage to the middle ear.
• Findings from a study of asthmatic children who take the inhaled steroid budesonide indicate that these patients do not have an increased risk for cataracts or elevated intraocular pressure, which can lead to glaucoma.

Association for Research in Vision and Ophthalmology 2011 Annual Meeting

• Two-year data from a study comparing bevacizumab (Avastin) to ranibizumab (Lucentis) for treating neovascular age-related macular degeneration confirm findings from a 1-year study showing that bevacizumab is generally comparable in safety while being significantly less expensive than ranibizumab.

American Society of Pediatric Ophthalmology and Strabismus 37th Annual Meeting

• Although most cases of congenital nasolacrimal duct obstruction resolve spontaneously by 1 year of age, the traditional approach has been that if probing isn’t done before age 2, patients must be treated with a tubing procedure. Now, researchers believe that children can undergo duct probing up to age 5 years.

DIABETES

American Association of Clinical Endocrinologists 20th Annual Meeting and Clinical Congress

• The new clinical practice guidelines released by AACE emphasize an individualized approach to managing diabetes and achieving blood glucose targets with care plans that take into account risk factors for complications, comorbid conditions, expected life span, and psychological, social, and economic status. The guidelines also state that providers discuss with patients the importance of medical nutrition therapy, physical activity, avoidance of tobacco products, and adequate quantity and quality of sleep.
• Survey data show that 55% of people with type 2 diabetes in the United States report that they have experienced hypoglycemia, often during typical daily activities such as working (42%), exercising (26%), and driving (19%).
• Although colesevelam (Welchol) might not be a first choice for many health care providers for the treatment of type 2 diabetes, analysis of 3 large randomized controlled trials demonstrated that it might be a viable option as an add-on therapy for patients who have both type 2 diabetes and high cholesterol.

American Diabetes Association 70th Annual Scientific Sessions

• A community-based lifestyle intervention program, modeled after one used in Healthy Living Partnerships to Prevent Diabetes, a government-funded diabetes prevention study, can help participants in a group setting achieve weight loss and blood glucose reductions comparable with those achieved with individual counseling from health professionals. Society of Behavioral Medicine 32nd Annual Meeting and Scientific Sessions
• Perceived stress and stressful life events were shown to predict the development of impaired glucose metabolism over 5 years in previously normoglycemic individuals, according to the authors of a study, who believe that incorporating stress management into health behavioral interventions can help more effectively prevent and manage diabetes.

PEDIATRICS

American Academy of Child and Adolescent Psychiatry 57th Annual Meeting

• The most effective behavioral treatment for bed-wetting involves putting a monitor on either the bed pad or the child’s underwear that triggers an alarm in the event of an episode, according to researchers. Other methods—for which there is little clinical data—include implementing cognitive and motivational therapy using a reward system; bladder training to increase capacity; sphincter training exercises; and prescribed medications such as desmopressin acetate, imipramine, anticholinergic agents, combination treatment, and atomoxetine.

Pediatric Academic Societies and Asian Society for Pediatric Research 2011 Annual Meeting

• Because narcotics are usually given to young children in liquid formulations, which are difficult for parents to measure correctly, infants and children routinely receive overdose amounts, according to a study, which also found that ambulatory prescriptions filled outside the hospital are problematic because they may not account for the child’s weight when prescribing.

American Academy of Pediatrics 2010 National Conference and Exhibition

• In the updated guidelines for management of iron deficiency in children, the AAP recommends that breast-fed infants are supplemented with 1 mg/kg per day of oral iron from 4 months of age until iron-rich foods are introduced. The guidelines also state that infants aged 6 to 12 months should get 11 mg per day of iron; toddlers aged 1 to 3 need 7 mg per day of iron; and all preterm infants should have at least 2 mg/kg per day of iron until 12 months of age.
• Use of VitalStim, a pharyngeal electrical stimulation device, was shown to improve swallowing in preterm and term infants in the neonatal intensive care unit, according to study data, which also found that neonates were less likely to require a gastrostomy tube when the device was employed.

FIRST AID

ACAAI 2010 Annual Scientific Meeting

• Emergency department (ED) physicians are failing to prescribe inhaled corticosteroids to asthma patients upon discharge, according to a survey of 7 inner-city pediatric EDs in the New York City area. Although 99% of respondents said they believed use of inhaled corticosteroids could reduce ED visits and hospitalizations, only 35% said they prescribed an inhaled corticosteroid at discharge, and 55% said they believed that prescribing an inhaled corticosteroid was the role of the primary care physician.

National Medical Association 2010 Annual Convention and Scientific Assembly

• Lansoprazole is effective for patients who have frequent nighttime heartburn and can be safely taken on an as-needed basis and dispensed over the counter, according to the results of a study that is the first to assess the effectiveness of a proton pump inhibitor for nocturnal episodes of heartburn. Lansoprazole, a medication prescribed for the treatment of daytime symptoms associated with acid reflux disease, is typically taken in the morning.
• A study from Georgetown University in Washington, DC, found that African American children were 4.15 times more likely and Hispanic children were 4.39 times more likely than Caucasian children to undergo a tonsillectomy or adenotonsillectomy for an obstruction. Findings also indicated that children under the age of 2 were 4.4 times more likely than those aged 5 to 12 years to have an obstruction.

American Academy of Pediatrics 2010 National Conference and Exhibition

• Treatment with Biobrane, a biosynthetic wound dressing constructed of a silicone film, resulted in quicker healing for children with partial-thickness burns compared with beta-glucan collagen, according to a retrospective review.

VITAMINS AND SUPPLEMENTS

AACE 20th Annual Meeting and Clinical Congress

• Both clinical recommendations and the judgment of health care providers should be used to determine the proper calcium and vitamin D requirements for each individual, according to analysis presented at AACE, particularly when determining whether vitamin D or calcium intake is associated with increased cardiovascular mortality in a particular patient.

Pri-Med Southwest 2011

• Routine screening for vitamin D deficiency is recommended in high-risk patients, including seniors, women who are pregnant or who are 50 years or older, and individuals who are dark-skinned, live in a long-term care facility, are prone to intestinal malabsorption, or have chronic aches, multiple fractures, or coronary heart disease. Aside from sun exposure, vitamin D supplements in the form of vitamin D2 or vitamin D3 are the best option for obtaining vitamin D, with the maximum daily amount being 4000 IU.

American Heart Association Annual Scientific Sessions 2010

• Levels of vitamin D appear to explain at least part of the disparity in hypertension typically seen between African American and Caucasian individuals, according to a cross-sectional study. The results held true even after researchers adjusted for numerous socio-demographic characteristics, health and health care—related factors, behavioral risk factors, and biomarkers.

American Thoracic Society 2010 International Conference

• Taking vitamin E on a regular basis may help protect women against the development of chronic lung disease, according to data from a large-scale study presented by investigators from Cornell University and Brigham and Women’s Hospital. In a randomized study, vitamin E supplementation reduced the risk of diseases such chronic bronchitis, emphysema, and bronchiectasis by 10% after 10 years of use.

American Academy of Dermatology 69th Annual Meeting

• Analysis of the Women’s Health Initiative study suggests that taking calcium and vitamin D supplements can lower the risk of melanoma in women who are at high risk for the disease because of a history of nonmelanoma skin cancers such as basal cell and squamous cell carcinoma.

WOMEN’S HEALTH

American College of Rheumatology 74th Annual Scientific Meeting

• Women who consume fructose-rich beverages such as soft drinks and orange juice are at an increased risk for developing gout, according to data from a 22-year study, which show that even 1 serving per day can increase serum uric acid.

American Congress of Obstetricians and Gynecologists 59th Annual Clinical Meeting

• Data from a large-scale study show that nearly 1 of every 3 new mothers who reported smoking more than 10 cigarettes per day also demonstrated symptoms of postpartum depression. In the study, smokers who were younger, were African American, or had low levels of education were more likely to be depressed.
• Two phase 3 studies have found that a combination of sustained-release naltrexone and bupropion can produce significant weight loss in overweight and obese women, regardless of menopausal status. Naltrexone is an opioid receptor antagonist approved to treat alcohol or opioid dependence, and bupropion is a norepinephrine/dopamine reuptake inhibitor approved to treat depression.

Society for Maternal-Fetal Medicine 31st Annual Meeting

• A study of more than 19,000 births assessing the effect of the dietary and supplementary intake of folate from 6 months before pregnancy through the beginning of the third trimester found that it was not significantly related to spontaneous preterm delivery.

Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer

• Women 70 years and older should continue to get regular Pap smears to screen for cervical cancer, according to a study. Patients in this age group account for more than 1 in 10 cases of cervical cancer in the United States, and are more frequently diagnosed with advanced cancer that is more difficult to treat than cervical cancer diagnosed in younger women.

ORAL CARE

Society for Maternal-Fetal Medicine 31st Annual Meeting

• A small, controlled clinical trial found that when pregnant women with periodontal disease use an antibacterial mouth rinse twice a day, the incidence of preterm birth decreases by more than 15%. Women who used a nonalcoholic mouth rinse were also more likely to deliver infants of higher gestational age and higher birth weight.

International Association of Dental Research 89th General Session and Exhibition

• Oral bisphosphonates do not increase the risk for osteonecrosis of the jaw, according to study data, which uncovered a 6-fold increased risk for osteonecrosis of the jaw in patients taking intravenous bisphosphonates.
• In a phase 2 clinical trial, thiazolidinedione pioglitazone was found to partially or completely eliminate two-thirds of leukoplakia lesions, which are usually caused by irritation, and can sometimes become cancerous.

International Association of Dental Research 89th General Session and Exhibition

• Treatment of periodontal disease may be not be consistent, according to a survey, which found that in patients with severe periodontitis, 34% of dentists prescribed systemic antibiotics, 42% prescribed local antibiotics, and 32% prescribed host response modifiers.
• Patients with diabetes who don’t receive routine dental care and get immediate treatment for periodontitis incur $2484 in costs to insurance companies, according to a study examining the mean cost for diabetes medical care. The findings are especially true for men, who saved significantly more money than women when they sought regular dental care.

TOPICALS

Society for Healthcare Epidemiology of America 20th Annual Scientific Meeting

• A new application for the iPhone and iPod Touch designed to record and analyze hand-hygiene observations and provide instant feedback has been shown to improve hand washing compliance in health care workers. The application, called iScrub, is linked to a Web site to generate feedback in near—real time, which can help standardize the recording and collection of data.

American Academy of Dermatology 69th Annual Meeting

• Consumption of pure chocolate can exacerbate facial acne vulgaris within days in individuals who have a history of the skin disorder, according to findings from a small-scale study that contradict results from earlier studies reporting no connection between chocolate and acne breakouts.
• Although ustekinumab and etanercept can help normalize the appearance of the skin in patients with psoriasis, the treatments do not cure the underlying disease process. In a 12-week study, researchers from Rockefeller University in New York found that although the therapies are effective, they only partially reverse the underlying molecular circuits that drive the disease.
• In addition to being safe and effective as standard-dose therapy for the treatment of acne, high-dose isotretinoin therapy is also associated with a low rate of relapse, and therefore is linked to a higher quality of life for patients, according to a retrospective review by researchers at Montefiore Medical Center.
• A research team from Kaiser Permanente Northern California reported that the rate of pediatric tinea capitis has declined dramatically in California, decreasing from an incidence of 1.3% in 1998 to 0.3% in 2007. Although the exact reason is unclear, higher prescription rates for antifungal agents were cited as a possible factor, along with efforts by dermatologists to educate pediatricians on how to diagnose and treat the condition.

STOMACH/GI

American College of Gastroenterology 75th Annual Meeting

• Having a vitamin D deficiency puts patients with inflammatory bowel disease (IBD) at greater risk of osteoporosis and osteopenia, and is associated with an overall higher rate of abnormal bone density, according to findings from a study presented at ACG. Out of 161 patients with IBD, 22% experienced a reduction in bone density with a diagnosis of osteoporosis or osteopenia.

Digestive Disease Week 2011

• The results of a 6-month study show that medication adherence in children aged 8 to 17 years with IBD is around 50%. In the study, pill bottles containing 5-aminosalicylic acid were opened 53% of the time, whereas bottles with mercaptopurine were opened 48% of the time.
• Preliminary data from a small-scale study show that adalimumab (Humira) actively but safely crosses the placenta in pregnant women with IBD and can be detected in neonatal serum for at least 3 months. In a group of 8 women, the drug was detected in all of the infants, and in every case, levels in cord blood and neonatal serum were higher than maternal levels.Despite the fact that liver-related disease—which encompasses cirrhosis, hepatocellular carcinoma, and liver failure—is a leading cause of death in the United States and results in about 6000 liver transplants annually, vaccination rates among patients with chronic liver disease and diabetes mellitus are low.
• An experimental drug pill that blocks the absorption of bile acids by the small intestine may help relieve chronic constipation in women, according to research presented at DDW, which also found that the drug, called A3309, may help lower low-density lipoprotein cholesterol.
• Dietary modification during pregnancy may reduce the risk of gallstone disease, which is a common cause of morbidity both during and after pregnancy, and is a common cause of maternal rehospitalizations in the first 60 days after delivery, according to research presented at DDW. The researchers stated that high consumption of carbohydrates, starch, and fructose may increase the risk of developing biliary sludge and stones during pregnancy.

COLD/COUGH/ALLERGY

American College of Allergy, Asthma & Immunology 2010 Annual Scientific Meeting

• Beclomethasone dipropionate hydrofluoroalkane (BDP HFA), a novel “dry” nasal aerosol spray formation, was found to effectively relieve symptoms of seasonal allergic rhinitis, according to data from a phase 3 trial. In a multicenter study, patients who took BDP HFA experienced statistically significant improvements in sneezing, runny nose, nasal itching, and nasal congestion compared with those who took a placebo.
• Occipitomental sinus x-rays (also called Waters view sinus x-rays) can be effective in evaluating the cause of chronic cough in children, according to new data. The technique, which is designed to examine the maxillary view of the sinus cavity, can eliminate the need for a computed tomography scan and help differentiate individuals who need antibiotics from those who do not.
• Findings from a phase 3 randomized trial show that a sublingual Timothy grass allergy immunotherapy (AIT) tablet approved in Europe to treat adults and children with allergic rhinoconjunctivitis from grass pollen is safe and effective for North American children as well. Treatment with AIT resulted in a significant reduction in total combined daily symptom and medication score and was well tolerated in patients aged 5 to 17, researchers found.

World Allergy Organization 2010 International Scientific Conference

• Prenatal exposure to acetaminophen is associated with wheezing and asthma in children, according to research from National Jewish Health in Denver, Colorado, which also linked a number of other factors to wheezing and asthma, including maternal vitamin D deficiency, domestic spray chemicals, tobacco smoke, and maternal use of antibiotics.
• Although 20% to 30% of the general public claim to have self-diagnosed food allergies, clinically confirmed cases have been identified in less than 6% of children and less than 2% in adults, according to food allergists. Identifying legitimate cases of food allergy requires a combination of history and immunologic testing, researchers stated.