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Formoterol effective for asthma exacerbations

By Jeremy Cockerill | March 15, 2010

Results from a systematic review and meta-analysis indicate that the long-acting beta-2 agonist (LABA) formoterol is as effective for the treatment of asthma exacerbations as short-acting beta-2 agonists (SABAs).

“The treatment of acute asthma includes the repetitive administration of SABAs, often in combination with inhaled anticholinergic agents, systemic corticosteroids, and supplemental oxygen,” say Gustavo Rodrigo (Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay) and colleagues.

However, they add that a number of studies have suggested that formoterol could be equivalent to salbutamol or terbutaline for the treatment of acute asthma.

“The rationale for using formoterol as a substitute to SABAs in the acute care setting relates to its duration of action and potential for reducing the need for repeated administration of bronchodilator therapy,” the researchers explain.

They therefore conducted a literature search for studies that compared formoterol with SABAs (salbutamol or terbutaline) for the treatment of asthma exacerbations in children and/or adults who presented to an emergency department or equivalent care-setting.

The primary outcomes were spirometric measures (FEV1 or peak expiratory flow) as absolute or predicted values, or change from baseline at various time points after administration of the study drugs.

In total, nine randomized controlled trials involving 576 patients were included in the final analysis.

The researchers found no significant differences in spirometric measures between formoterol- and SABA-treated patients at 30–40 minutes after the first administration, at the end of treatment, and at 60–90 minutes after the last dose.

There were also no significant differences between formoterol- and SABA-treated patients regarding the secondary endpoints of final serum potassium level, heart rate, QT interval, hospitalization rate, and total withdrawals.

Rodrigo and team conclude in the Annals of Allergy and Asthma Immunology: “The results of this systematic review support the efficacy and safety of formoterol as an alternative to SABA (salbutamol or terbutaline) as reliever therapy in mild to severe acute asthma exacerbations.”

They add: “Future trials are needed to assess the comparison of formoterol with SABAs in patients with acute life-threatening asthma and to examine the use of formoterol plus inhaled corticosteroids in acute asthma treatment.”

Statins May Help Improve Symptoms Of Psoriasis.

By Jeremy Cockerill | March 12, 2010

WebMD (3/8, Laino) reported, “Already linked to a reduced risk of rheumatoid arthritis, diabetes, multiple sclerosis, and cancer, statins also may help to improve symptoms of psoriasis,” according to research presented at that American Academy of Dermatology annual meeting. Investigators, “in a study of 232 people taking medication for psoriasis,” found that participants “who also took statins had fewer of the thick, red, scaly, itchy patches that are the hallmark sign of psoriasis, compared with people who didn’t take the cholesterol-lowering drugs.”

Direct measurement of cholesterol levels comparable to standard methods

By Jeremy Cockerill | March 12, 2010

Direct measurement of both high- and low-density lipoprotein cholesterol (HDL-C and LDL-C) using modern assay techniques reveals similar levels to those found using standard methods, say US researchers.

In the past, a number of issues have made direct measurement of cholesterol values difficult. For example, HDL-C measurement required a manual precipitation step.

The Friedewald formula has been the standard method used to estimate LDL-C levels. However, now that high-throughput, standardized, automated assays are available, Schaefer and co-workers were able to check how closely cholesterol levels calculated using the new techniques correlated with those using the Friedewald formula and HDL-C following manual precipitation.

Ernst Schaefer (Tufts University, Boston, Massachusetts) and co-workers analysed fasting plasma samples from patients from the Framingham Offspring study. Samples from 1508 men (1335 controls, 173 coronary heart disease [CHD] cases) and 1680 women (1606 controls, 74 CHD cases) were included in the analysis.

The researchers found that values for direct LDL-C and HDL-C correlated well with standard methods. They note that the correlation between calculated and direct values for HDL-C is important since direct HDL-C assays are now very widely used and have not previously been evaluated in large-scale populations studies of CHD risk. However, the calculated and direct measurements differed by more than 10% for 7.7% of samples for LDL-C, and for 8.5% of samples for HDL-C.

Another aim of the study was to assess whether patients with CHD had reached the recommended goals for LDL-C (2.6 mmol/l; 100 mg/dl) set by the Adult Treatment Panel of the National Cholesterol Education Program of the National Institutes of Health. However the values for both men (2.99 mmol/l; 115.7 mg/dl Friedewald/ 3.07 mmol/l; 118.8 mg/dl direct) and women (3.33 mmol/l; 128.9 mg/dl Friedewald/3.46 mmol/l; 133.9 mg/dl direct) were well above this target.

Schaefer and co-workers note that despite four-fold greater use of cholesterol-lowering medication in male and female cases versus controls, less than half of cases were receiving such medication.

“Overall, our data indicate that the direct assays for both LDL-C and HDL-C provide an acceptable guide for lipid treatment, and that in this population there is still substantial residual CHD risk and under-treatment of LDL-C values, with a very high percentage of CHD cases not being at the recommended LDL-C targets, especially in women,” they conclude in the journal Atherosclerosis.

Seven-point checklist reasonably effective for diagnosing melanoma

By Jeremy Cockerill | March 12, 2010

Source: MedWire News

The seven-point checklist algorithm for detecting melanoma is relatively effective for predicting melanoma, but use of complementary information increases accuracy, show study results.

Holger Haenssle (Georg August University Göttingen, Germany) and colleagues assessed the diagnostic performance of the dermatoscopic seven-point checklist for diagnosing melanoma.

The seven criteria were defined as: gray-blue areas, atypical vascular pattern, atypical pigment network, irregular diffuse pigmentation, regression pattern, radial streaming or streaks, and irregular dots and globules. Melanoma was diagnosed or strongly suspected if a patient had a score of three points or more.

The researchers screened 688 patients who were at increased risk for melanoma using naked eye examination, the seven-point checklist, and digital dermatoscopy at regular intervals over a 10-year period.

In total, 127 melanomas were detected over the 10-year follow-up period, with a mean Breslow thickness of invasive melanomas of 0.57 mm.

In total, 79 melanomas were scored as having three points or more on the seven-point checklist, resulting in a sensitivity score of 62%. The other 48 melanomas scored less than three points, but were excised due to use of complementary information such as lesional history, and dynamic changes detected using digital dermatoscopy.

Specificity of the seven-point checklist was better at 97%.

The points most strongly associated with increased relative risk for melanoma were regression patterns, atypical vascular patterns, and radial streaming, which increased relative risk for melanoma 3.26-, 3.04-, and 2.91-fold, respectively.

Of note, melanomas that were thicker than 0.50 mm had significantly more regression and atypical vascular patterns than thinner lesions.

“The differentiation between atypical benign nevi and early melanoma is a considerable challenge for the clinician,” write the authors in the Journal of the American Academy of Dermatology.

They conclude that “the seven-point checklist for dermatoscopy was less sensitive but highly specific in this prospective surveillance study of patients at high risk in comparison with previous retrospective analyses.”

“However, complementary information (eg, derived from anamnestic data or digital dermatoscopy) helped to identify 48 (38%) additional melanomas and, therefore, clearly increased the sensitivity.”

Drugmakers Increasingly Using Patient Testimonials To Appeal To Consumers.

By Jeremy Cockerill | March 2, 2010

The Wall Street Journal (2/25, Rockoff) reports that drugmakers are increasingly trying to capitalize on trends in peer influence in drug marketing by using more patient testimonials in ads. In fact, Pfizer Inc. began running print and TV ads for its smoking-cessation drug Chantix [varenicline] that featured patient stories after focus groups showed the testimonials tested well. Jim Sage, a Pfizer marketing official, noted, “The role of the peer is important because it really provides a positive example” to help people quit smoking.