New approach to kill specific bacteria could be alternative to antibiotics

A new approach to killing C. difficile that silences key bacterial genes while sparing other bacteria may provide a new way to treat the most common hospital-acquired bacterial infection in the United States, according to researchers.

While conventional antibiotics treat bacterial infections, they can also cause a condition in the colon called C. difficile infection, due to the drug killing both good and bad bacteria in the gut.

In a lab, researchers created three new antibiotics that kill C. difficile by preventing the expression of bacterial genes that are important for its survival. This approach -- called antisense therapy -- allows the drug to kill only C. difficile, unlike many antibiotics that kill multiple forms of bacteria.

"We were able to show that these drugs can zero in on and kill C. difficile bacteria while leaving other bacteria alone," said Arun Sharma, associate professor of pharmacology, Penn State College of Medicine. "We're still working to refine these drugs and make them even better, with the eventual goal of testing them clinically."

David Stewart, an associate professor of surgery at the University of Arizona who along with Sharma is a co-principal investigator on this study, said the drug works in a completely different manner than the antibiotics currently used.

"These drugs are organism specific, meaning that they target only one kind of bacteria, kind of like smart antibiotics," Stewart said. "They're precise. And that's especially important with C. difficile infections because this bacteria is uniquely, selectively advantaged to exploit ecological disturbances in the human gut."

While C. difficile is normally present in the gut, other "good" bacteria are also present, and all these bacteria contribute to a person's microbiome. When a person's microbiome is healthy and balanced, it keeps bad bacteria like C. difficile under control.

But if a patient takes an antibiotic for another condition, the antibiotic kills many different types of bacteria, including the good ones keeping C. difficile under control. This allows C. difficile to thrive, causing an infection that can result in severe gastrointestinal symptoms. Since antibiotics can contribute to C. difficile infections, the researchers said a new, alternative treatment for these infections is desirable.

"Ideally, a treatment for C. difficile would have no effect on other bacteria," Stewart said.

The researchers, who recently published their findings in the Journal of Antibiotics, said that while most antibiotics lack organismal specificity -- the ability to target just one type of organism -- antisense treatments show great potential for being able to target only specific bacteria.

"Our antisense antibiotics contain genetic material which is complementary to bacterial genetic material, so we designed our genetic material to target specific genes in C. difficile," Stewart said. "And when our genetic material binds to the bacterial genetic material, it prevents the expression of bacterial genes. And that can cause C. difficile to die."

The drug tested in the study consisted of two components: the antisense compound that targeted the genetic material in C. difficile -- referred to as an antisense oligonucleotide (ASO) -- and a carrier compound that transported the ASO into the bacteria, referred to by the research team as a CAB. The researchers tested three versions of the drug, each with a different version of CAB.

The researchers tested each compound to see how much of the drug was required to kill C. difficile bacteria, whether it was toxic or not to human colon cells, and whether it also harmed other bacteria normally found in the gut -- like E. coli.

"Ultimately, we wanted these compounds to deliver the drug into the C. difficile bacteria without hurting other bacteria or the patient," Sharma said. "After testing these three, we found that one carrier in particular -- CYDE-21 -- was the best at delivering an effective dose of the drug into the bacteria."

 

In the future, the researchers said they will conduct further studies to continue to refine the carriers to increase their capacity and minimize their effect on other bacteria and human cells.

"In this study, as a first effort, the carrier is pretty good, and we'd like to do even better," Stewart said. "It has minimal antibacterial activity, minimal toxicity and it's an effective carrier of our cargo. So what we're working on now is modifying our carriers for future testing in preparation for animal studies."

Ref : https://www.nature.com/articles/s41429-018-0056-9

Two-drug combination provides more reliable, effective care for women suffering miscarriage

In continuation of my update on mifepristone

A combination of the drugs mifepristone and misoprostol can help bring closure to some women and their families suffering from miscarriage, and reduces the need for surgical intervention to complete the painful miscarriage process. Results of a new clinical trial led by researchers at the Perelman School of Medicine at the University of Pennsylvania, show that while the standard drug regimen using misoprostol on its own frequently fails to complete the miscarriage, a combination of misoprostol and the drug mifepristone works much more reliably. The report is published today in the New England Journal of Medicine.

   mifepristone   misoprostol 

Each year in the United States alone approximately 1 million women have miscarriages. When the body does not expel the pregnancy tissue on its own – the final part of a miscarriage – women need to undergo a surgical procedure or take the drug misoprostol. Though often preferable for its convenience and privacy – patients can take it in the comfort of their own homes – misoprostol does not always work, and many women who use misoprostol are still left with no option but to undergo an invasive procedure they wished to avoid, prolonging an already physically and emotionally difficult situation.

"Though rarely discussed openly, miscarriage is the most common complication of pregnancy, and the public health burden is both physical and psychological. For too many women, misoprostol alone just leads to frustration. I have seen my patients suffer from the insult of the treatment failure added to the injury of the initial loss," said study lead author Courtney A. Schreiber, MD, MPH, chief of the division of Family Planning and an associate professor of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania. "As physicians, we have to do better for these patients, and our new study shows that by combining mifepristone with misoprostol, we can."

Mifepristone is used along with misoprostol to induce abortion in early pregnancy. But the effectiveness of mifepristone-misoprostol for miscarriage patients, in comparison to the commonly used misoprostol alone, has been unclear.

In the new study, 300 women who had been diagnosed with early pregnancy loss – described as a miscarriage in the first trimester – were assigned to receive the standard 800 micrograms of misoprostol placed vaginally. Half were also randomly assigned to receive pretreatment with a 200 mg pill of mifepristone, which primes the uterus to respond to misoprostol's contraction-inducing effect.

The researchers found that overall, 91.2 percent of women receiving the mifepristone pretreatment plus misoprostol experienced gestational sac expulsion -; the definition of a completed miscarriage -; 83.8 percent by their first follow-up visit, which occurred two days after the treatment on average. Misoprostol alone was only effective 75.8 percent of the time, with 67.1 percent completing by their first follow up visit.

The researchers looked at a variety of outcomes in the study, and essentially all were better for the women taking mifepristone plus misoprostol. Patients assigned to this group, for example, had a much lower chance (8.8 percent) of needing a surgical intervention by day 30, compared to 23.5 percent for the misoprostol-alone group. There were no significant differences between the groups in terms of pain, bleeding, or other side-effects. Notably, serious side effects were rare in both groups.

Mifepristone is a highly regulated medication. At present, the U.S. Food and Drug Administration requires that the drug be dispensed only in registered hospitals, clinics and doctor's offices, but not in retail pharmacies. Schreiber says that physicians who wish to treat women with miscarriages – including but not limited to physicians in obstetrics, internal medicine, emergency medicine, and family medicine – should consider registration.

"High-quality care for women who suffer miscarriage not only improves physical outcomes, but helps alleviate the psychosocial stress that can accompany the loss of a pregnancy," she says. "Given how common miscarriage is and the effectiveness of the drug combination as shown in this new study, any doctor who cares for women who become pregnant, and therefore could have a miscarriage, should be registered to prescribe and dispense mifepristone."​

Ref : https://www.pennmedicine.org/news/news-releases/2018/june/drug-combination-offers-more-effective-care-for-patients-suffering-miscarriage-penn-study-shows

Sunitinib (Sutent) May Spare Some Kidney Cancer Patients From Organ Removal

In continuation of my update on Sunitinib (Sutent)

Many people with advanced kidney cancer might not need to have their kidneys removed during treatment, something that until now has been standard practice.

Patients who only received a targeted drug for their kidney cancer survived just as well as those who had their cancerous organ removed before drug therapy, according to a new clinical trial.

"We believe this one study will change it so that patients won't get nephrectomies [kidney removal surgery]," said Dr. Bruce Johnson, chief clinical research officer at the Dana-Farber Cancer Institute, in Boston. "If anything, it looks like it's a little bit better if you don't take it out. We think this single study will change what people do."

For about two decades, kidney removal followed by drug therapy has been the standard of care for people with advanced kidney cancer, said Johnson, who is also president of the American Society of Clinical Oncology.

"One of the things that's been odd about kidney cancer is even if you have metastatic disease, where it started in your kidney and spread through your body, there was evidence patients lived longer if you took out their kidney," Johnson said.

Cases where the cancer has spread account for about 20 percent of all kidney cancers worldwide, said study lead researcher Dr. Arnaud Mejean, a urologist with the Georges-Pompidou European Hospital at Paris Descartes University, in France.

But in the intervening years, a number of targeted therapies have been developed that attack the ability of kidney cancer to grow and spread, the researchers added.

Mejean and his colleagues set out to test whether these new targeted drugs are so powerful that they've removed the need for painful, body-wracking kidney removal surgery.

The clinical trial enrolled 450 patients with metastatic kidney cancer, and assigned them to either take the targeted drug sunitinib (Sutent) or have their kidney removed and then take sunitinib.

Sunitinib attacks blood vessel growth that allows cancer to spread throughout the body, and it also blocks other means by which kidney cancer can grow, according to the American Cancer Society.

The patients were followed for about 51 months, and during that time the researchers found that survival was not worse for patients who just took sunitinib.

Overall, survival was 18.4 months without surgery versus 13.9 months with surgery. Similar survival rates also were found in people with an intermediate or poor prognosis.

The two patient groups had a similar rate of tumor shrinkage (just over 27 percent for surgery and 29 percent for sunitinib alone), the findings showed. In addition, average time until cancer progressed was slightly longer for patients who received sunitinib alone compared with those who also had surgery (8.3 months versus 7.2 months).

People who undergo kidney removal must heal before they can start targeted cancer drugs, often losing weeks they don't have to spare, the researchers noted. In some cases, the cancer spreads so quickly during this delay that there's no time to start the drug therapy.

However, the study authors said kidney removal is still the gold standard for people who do not need targeted drug therapy, such as those whose cancer has only spread to one other organ.

Despite these findings, it's not clear that all kidney removal surgeries will end for people with advanced kidney cancer, said Dr. Daniel Cho. He's a medical oncologist at NYU Langone Health's Perlmutter Cancer Center in New York City, and was not involved with the study.

"I don't think it should be across the board a standard of care yet," Cho said.

This approach may work for patients receiving targeted drug therapies, but may not be as effective in patients who are undergoing immunotherapy -- taking drugs to boost their immune system's ability to detect and kill cancer cells, he said.

Some people believe that large kidney tumors actually suppress the immune system and are not very responsive to immunotherapy drugs, Cho said. For the best results in these patients, kidney removal may be necessary.

"There's a certain rationale to remove the primary tumor if you're planning to give immunotherapy," Cho said. "The primary tumor may be creating a more immunosuppressive environment that makes the immune therapy less effective."

On the other hand, "there are those patients who are more likely to have rapidly growing disease, and therefore would more likely benefit from immediate systemic therapy," Cho added. "I really believe we have to be thoughtful about it."

Experimental Drug, Taselisib, Shows 'Modest' Benefit in Slowing Advanced Breast Cancer

A new and highly targeted drug slowed the growth of advanced breast cancers by about an average of two months, researchers report.

"The findings in this study show a modest benefit to a subgroup of women with estrogen receptor-positive tumors," said Dr. Stephanie Bernik, a breast cancer specialist who wasn't involved in the research.

Estrogen receptor-positive tumors are a common subtype of breast cancer that grow in the presence of estrogen. The experimental drug used in the new study, called taselisib, targets a gene called PIK3CA that's tied to cancer growth.

"About 40 percent of all patients with advanced breast cancer estrogen receptor-positive have PIK3CA mutations, which means they could benefit from taselisib," explained study author Dr. Jose Baselga. He's physician-in-chief at Memorial Sloan Kettering Cancer Center in New York City.

"Our findings are proof that targeting this pathway in breast cancer is effective. However, the benefit to patients was more modest than we had hoped for, and there is a risk of considerable side effects with the addition of taselisib," Baselga said in a news release from the American Society of Clinical Oncology (ASCO).

As the researchers explained, taselisib has already proven beneficial for people fighting head-and-neck cancers or certain gynecological tumors. Would it do the same for hormone-sensitive breast cancers?

To find out, Baselga's group worked with 516 women with either locally advanced or metastatic estrogen receptor-positive breast cancers. About two-thirds of the women received taselisib and a standard chemotherapy drug, fulvestrant, while the remaining third received fulvestrant and a placebo.

Women on the drug combo regimen had 30 percent lower odds of their cancer worsening, compared with those who got standard chemo alone, the study found. Women who got taselisib typically went an average of 7.4 months without signs that their cancer was worsening, compared to 5.4 months without the drug -- a two-month difference.

Tumor shrinkage was much more evident in women taking taselisib (28 percent of patients) versus those on fulvestrant alone (12 percent), the findings showed.

However, there was a downside: While 17 percent of women taking taselisib had to quit their treatment because of side effects, that was true for just 2 percent of those who weren't taking the medicine, the investigators found.

Still, Bernik said the study offers breast cancer patients some hope.

"Although tumor growth was only suppressed by two months, this medication opens the door to further investigation with drugs that target cancers with the PIK3CA gene mutation," she said.

"One would hope that because we know targeting this gene decreases tumor growth, perhaps combining it with various other drugs might make it more effective, and also direct research to developing other drugs that work in a similar fashion," Bernik reasoned.

Dr. Alice Police directs breast surgery at Northwell Health Cancer Institute in Sleepy Hollow, N.Y. She called targeted therapies like taselisib "a wonderful new field that looks for medications that keep cancer cells from growing while protecting normal tissue."

Still, "this drug was a little disappointing to the researchers in that its benefit was not as great as they had hoped, and the drug was more toxic than they had hoped," Police said.

The findings were scheduled for presentation on Saturday at ASCO's annual meeting, in Chicago. Because the new study was presented at a medical meeting, its findings should be considered preliminary until published in a peer-reviewed journal.

Ortho Dermatologics Receives FDA Approval for Altreno (tretinoin 0.05%) Lotion For Acne

Ortho Dermatologics, one of the largest prescription dermatology health care businesses in the world and a division of Bausch Health Companies Inc.  announced that the U.S. Food and Drug Administration (FDA) has approved the New Drug Application for Altreno (tretinoin 0.05%) lotion, indicated for the topical treatment of acne vulgaris in patients 9 years of age and older. Altreno is the first formulation of tretinoin in a lotion, and has been shown to be effective and generally well-tolerated. Altreno is expected to be available during the fourth quarter of 2018.

FDA approval of Altreno builds upon our strong acne portfolio, providing physicians and patients a trusted retinoid in a lotion formulated to enhance the user's experience with the inclusion of moisturizing attributes of hyaluronic acid, glycerin and collagen," said Bill Humphries, president, Ortho Dermatologics. "Altreno lotion spreads easily and is quickly absorbed into the skin allowing acne patients to easily incorporate this once-daily treatment into their skin care regimen."

Extensive clinical data has shown that retinoids are highly effective in treating acne and are considered a cornerstone of topical therapy. However, a common perceived barrier to their use is that treatment with retinoids is associated with skin irritation, such as dryness and peeling, and sensitivity. In clinical trials, Altreno lotion provided the proven efficacy of tretinoin, a retinoid, in a generally well-tolerated formulation with skin dryness, pain, swelling, irritation and peeling reported in ≤4% of patients.1,2

"Topical retinoids are a foundational treatment for all patients with acne, but they often cause skin irritation," said Joshua Zeichner, M.D., director, Cosmetic and Clinical Research in Dermatology, The Mount Sinai Hospital, New York City. "With the efficacy expected from a retinoid, plus a proven tolerability profile, Altreno will be an ideal choice for many of my patients."

Ref : https://www.drugs.com/history/altreno.html

FDA Approves Olumiant (baricitinib) 2 mg Tablets for the Treatment of Adults with Moderately-to-Severely Active Rheumatoid Arthritis

Eli Lilly and Company (NYSE: LLY) and Incyte Corporation (NASDAQ: INCY) announced today that the U.S. Food and Drug Administration (FDA) has approved the 2-mg dose of Olumiant (baricitinib), a once-daily oral medication for the treatment of adults with moderately-to-severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more tumor necrosis factor (TNF) inhibitor therapies.  Use of Olumiant in combination with other Janus kinase (JAK) inhibitors or biologic disease-modifying antirheumatic drugs (bDMARDs), or with potent immunosuppressants such as azathioprine and cyclosporine is not recommended.  Olumiant may be used as monotherapy or in combination with methotrexate (MTX) or other non-biologic DMARDs.

"We are pleased to provide RA patients in the U.S. an effective treatment option with Olumiant, as people with RA who have had an inadequate response to TNF inhibitors are generally considered to be some of the most difficult to treat RA patients," said Christi Shaw, president, Lilly Bio-Medicines.

The Olumiant clinical trial program included the RA-BEACON study, a randomized, double-blind, placebo-controlled study in which patients were randomly assigned to receive Olumiant 2 mg, baricitinib 4 mg or placebo, in addition to conventional DMARDs that they were currently using.  This study included 527 patients who had an inadequate response or intolerance to one or more TNF inhibitor therapies.  Patients could have had prior therapy with other bDMARDs. 

The study results showed that significantly higher ACR20 response rates and improvement in all individual ACR20 component scores were observed at Week 12 with Olumiant.1 The study found that patients treated with Olumiant had significantly higher rates of ACR20 response versus placebo-treated patients at Week 12 (49% of Olumiant-treated patients versus 27% of placebo-treated patients).1Olumiant also demonstrated early symptom relief, with ACR20 responses seen as early as Week 1.1Patients treated with Olumiant reported significant improvements in physical function based on the Health Assessment Questionnaire Disability Index (HAQ-DI) (recording an average score of 1.71 before treatment and 1.31 at Week 12) compared to placebo-treated patients (who recorded an average score of 1.78 before treatment and 1.59 at Week 12). 

Olumiant is approved with a Boxed Warning for the risk of serious infections, malignancies and thrombosis. Serious infections leading to hospitalization or death, including tuberculosis and bacterial, invasive fungal, viral, and other opportunistic infections, have occurred in patients receiving Olumiant. Lymphoma and other malignancies have been observed in patients treated with Olumiant as well. Additionally, thrombosis, including deep venous thrombosis, pulmonary embolism and arterial thrombosis, some fatal, have occurred in patients treated with Olumiant.  Other warnings and precautions include gastrointestinal perforations, laboratory abnormalities (including neutropenia, lymphopenia, anemia, liver enzyme elevations, and lipid elevations) and a warning against the use of live vaccines with Olumiant.  The most common adverse events (occurring in greater than or equal to 1% of Olumiant 2 mg- and baricitinib 4 mg-treated patients in placebo-controlled trials) included upper respiratory tract infections, nausea, herpes simplex and herpes zoster. 

As part of the approval, the companies have agreed to conduct a randomized controlled clinical trial to evaluate the long-term safety of baricitinib in patients with rheumatoid arthritis.

"Despite the advancements we've seen in the RA treatment landscape over the past several decades, many patients are still failing to achieve their disease management goals," said Seth Ginsberg, co-founder and president of CreakyJoints and the Global Healthy Living Foundation. "As it's important for RA patients to have multiple treatment options available to best suit their disease characteristics and experiences, the approval of Olumiant is very encouraging for our community."

RA is a chronic, painful and progressive form of arthritis  It is estimated that about two-thirds of established RA patients will not reach clinical remission with their first TNF inhibitor therapy, and a significant percentage will not maintain efficacy as time goes on. 

"In my clinical practice, I continue to see patients who experience debilitating symptoms and who are waiting for a medicine that may be right for them," said Elizabeth L. Perkins, M.D., Rheumatology Care Center, Birmingham, Alabama. "Olumiant is an important option for rheumatologists to help address these patients' unmet needs."

"RA patients continue to experience unique challenges accessing the treatments prescribed by their healthcare providers. Therefore, we are determined to continue our work with stakeholders to demonstrate value across the healthcare system so providers have greater choice in prescribing treatments to fit individual patient needs," said Shaw.

Lilly will launch Olumiant in the U.S. by the end of the second quarter of 2018. The price of Olumiant will be 60% less than the leading TNF inhibitor.5 Lilly will be offering a patient support program, Olumiant Together™. For more information about this program, please call 1-844-Olumiant.

Incyte is now eligible to receive a $100 million milestone payment from Lilly as a result of the Olumiant approval, which Incyte expects to recognize in the second quarter of 2018. 

FDA Approves Consensi (amlodipine and celecoxib) for Treatment of Hypertension and Osteoarthritis Pain

  

In continuation of my update on amlodipine and celecoxib

Kitov Pharma Ltd. an innovative bio pharmaceutical      co.,  announced  that the U.S. Food and Drug Administration (FDA) has approved Consensi (amlodipine and celecoxib) oral tablets for marketing.                               amlodipine                                                     celecoxib      

Consensi is a patent-protected combination of celecoxib, a non-steroidal anti-inflammatory drug (NSAID), and amlodipine besylate, an antihypertensive calcium channel blocker. Consensi was approved for once daily use in three dosage forms, corresponding to the current approved dosages of amlodipine (2.5, 5, and 10 mg) for hypertension and a 200 mg dose of celecoxib for the treatment of osteoarthritis pain.

“We are very pleased with Consensi’s approval and would like to thank the members of Kitov’s team, consultants and investigators, as well as the FDA’s Division of Cardiovascular and Renal Products, for all of their support and assistance,” said Dr. J. Paul Waymack, Chairman of Kitov's Board and Chief Medical Officer. “Consensi provides a safe and effective combination treatment option for the millions of Americans who suffer from osteoarthritis pain and hypertension.

“Now that Consensi has been approved for marketing, our clinical and regulatory teams will focus on leveraging their drug development expertise to advance NT219, an exciting investigational new drug candidate currently in development for various oncology indications.”

Isaac Israel, Kitov’s CEO, added: “This approval demonstrates the Kitov team’s ability and experience in expertly guiding Consensi through clinical trials and regulatory review, from Investigational New Drug (IND) submission to FDA approval in less than four years.

“Over 50 million Americans suffer from osteoarthritis. About 1 of 3 U.S. adults or about 75 million people have high blood pressure*, known as the “silent killer” due to the absence of noticeable symptoms. As a result, patients’ adherence to the hypertension treatment regimen is low. We believe that Consensi, as a single pill combination treatment for osteoarthritis and hypertension, presents a unique value proposition of potentially increasing treatment adherence.

“We recently expanded our commercialization network for Consensi by securing a second licensing agreement in Asia with a major Chinese pharmaceutical company. The FDA approval of Consensi puts us in a stronger position towards securing commercial partnerships for the U.S. and other key territories.”

The FDA-approved Consensi New Drug Application included the positive results from the Company’s Phase III clinical trial. These data demonstrated that the study met its primary endpoint of showing that the drug lowers daytime systolic blood pressure by at least 50% of the reduction in blood pressure achieved in patients treated with amlodipine besylate only, with statistical significance of p=0.001. Kitov also submitted the positive results from its randomized double-blind, placebo-controlled renal function Phase III/IV clinical trial of Consensi. Data from this study validated the primary efficacy endpoint achieved in the completed Phase III clinical trial. This study also demonstrated that treatment with Consensi led to a statistically significant reduction of serum creatinine, a marker of renal function, from its baseline value (p=0.0005), demonstrating improved renal function in patients treated with the combination. In contrast, neither amlodipine besylate nor placebo lowered creatinine to a statistically significant level.

Drug to treat alcohol addiction also helps with suppression of HIV

In continuation of my update  on naltrexone

A medication commonly prescribed to treat alcohol use disorder also appears to help maintain or improve suppression of HIV among individuals at risk for a lapse in HIV treatment, Yale researchers said.

In a new study, a research team led by Dr. Sandra Springer conducted a placebo-controlled, randomized trial involving individuals incarcerated in Connecticut who had both HIV and alcohol use disorders. Upon release, the 100 study participants were given either extended-release naltrexone—an FDA-approved drug that treats alcohol addiction—or a placebo. The researchers followed the individuals for six months from the time of release.

At the end of the study period, the research team found that the study participants taking extended-release naltrexone were more likely to have either maintained or improved suppression of HIV.

The study findings confirm the benefit of extended-release naltrexone for people who have alcohol use disorders and HIV disease, and demonstrate its effectiveness in helping patients to meet the goals of HIV treatment. The paper is published in the Journal of Acquired Immune Deficiency Syndrome.

More information: Sandra A. Springer et al. Extended-release naltrexone improves viral suppression levels in prisoners with HIV and alcohol use disorders who are transitioning to the community, JAIDS Journal of Acquired Immune Deficiency Syndromes (2018)

Ribavirin for treating Crimean Congo hemorrhagic fever—latest Cochrane review

In continuation of my update on Ribavirin

In a viral haemorrhagic disease where up to 40% of people developing it die, it is remarkable that doctors still do not agree whether the only recognised treatment, an antiviral drug called ribavirin, makes a difference. In a new Cochrane Review a team of authors at LSTM, along with colleagues in London, The Philippines and in Greece, evaluated the evidence to assess the effectiveness of treating Crimean Congo haemorrhagic fever (CCHF).

Crimean Congo haemorrhagic fever is spread by the bite of an infected tick, and is becoming more common, with outbreaks in Turkey, Eastern Europe and the Eastern Mediterranean. Doctors treat the infection in hospital with intravenous fluids, blood and good nursing care. The debates around ribavirinare common amongst clinicians treating the disease, with strong advocates on one side, and others who have policies not to use it, so the authors hoped the review would settle the debate.

The review authors found just one trial with 136 participants, and some observational comparative studies of 612 participants: overall the analysis did not provide a clear answer. When the authors examined studies that were often quoted as showing benefit, they were critically biased. Although fewer people died in groups receiving ribavirin, the apparent effect could be due to the drug, or equally because those getting the drug may have also been less sick, or received high quality nursing and medical care earlier in the disease.

Lead author, LSTM's Dr. Samuel Johnson, said: "Some doctors advocate giving ribavirin, and state that not to give it is even unethical. The problem is that the studies claiming to demonstrate benefit from the drug are designed in such a way we cannot separate the effect of the drug from other factors, and thus we do not know if ribavirin is effective at all."

The review clarifies the need for reliable research from a randomised control trial to establish whether ribavirin is effective. "The irony is that the strong beliefs and the widespread use of the drug may make it difficult to actually carry out the research needed" states Dr. Johnson. "What we need to know is whether it works, when it works, and how good it is."

But is there any harm in just giving it in case it works? Dr. Johnson points out, "Using unreliable research as evidence of benefit if it doesn't work could potentially waste resources and harm patients, we would also need to investigate other options. On the other hand, if ribavirin does work, then it needs to be rolled out to all patients who could benefit, which is currently not the case."

Whilst research into emerging infectious diseases and during outbreaks is difficult, the team hopes that the reviewprovides an opportunity to strengthen the call for greater steps to be taken to facilitate rigorous research providing reliable results in outbreaks of infectious diseases.

Ref : http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD012713.pub2/abstract;jsessionid=9510BA3ECC4167F7B1CC8995CA6675B1.f03t03

Coffee helps teams work together, study suggests

In continuation of my update on coffee

Good teamwork begins with a cup of coffee for everyone, a new study suggests.

Researchers found that people gave more positive reviews for their group's performance on a task—and their own contribution—if they drank caffeinated coffee beforehand.

A second study showed that people talked more in a group setting under the influence of caffeinated coffee—but they also were more on-topic than those who drank decaf.

Coffee seems to work its magic in teams by making people more alert, said Amit Singh, co-author of the study and a doctoral student in marketing at The Ohio State University's Fisher College of Business.

"We found that increased alertness was what led to the positive results for team performance," Singh said.

"Not surprisingly, people who drank caffeinated coffee tended to be more alert."

Singh conducted the study with Vasu Unnava and H. Rao Unnava, both formerly at Ohio State and now with the Graduate School of Management at the University of California, Davis. The study appears online in the Journal of Psychopharmacology.

While many studies have looked at how caffeine affects individual performance, this is the first to examine the impact it has on teams, Singh said.

The first study involved 72 undergraduate students who said they were coffee drinkers. They were instructed not to drink coffee before the experiment.

Half of them first participated in what they were told was a coffee-tasting task. They were split into groups of five. After drinking a cup of coffee and rating its flavor, they were given 30 minutes of filler tasks to give the caffeine a chance to kick in. The other half of the participants did the coffee tasting at the end of the experiment.

Each group then read about and were asked to discuss a controversial topic—the Occupy movement, a liberal movement that highlighted social and economic inequality. After a 15-minute discussion, group members evaluated themselves and the other group members.

Results showed that those who drank the coffee before the discussion rated themselves and their fellow team members more positively than did those who drank coffee after the discussion, Singh said.

The second study was similar, except that 61 students all drank coffee at the beginning of the study. However, half drank decaf and the others drank caffeinated brew.

http://journals.sagepub.com/loi/jop

'Miracle treatment' long-term success for babies with diabetes

Over a decade, Emma Matthews has progressed from fearing for her son's life every night to being safe in the knowledge that his diabetes is well managed thanks to the long-term success of "miracle treatment" 

Until he was four, Jack frequently had life-threatening low blood sugar (hypos) at night as a result of the insulin injections he took several times a day to treat his neonatal diabetes. He was among the first to switch from insulin injections to sulphonylurea tablets 14 years ago, thanks to research led by the University of Exeter 'involving an international collaboration with groups in Norway, Italy, France and Poland. . Today, the team's new research in The Lancet Diabetes and Endocrinology reveals that the treatment is just as successful over the long-term and still providing excellent sugar control after 10 years.

Neonatal diabetes is diagnosed before the age of six months. Half of all cases are caused by a mutation in their KCNJ11 gene—which is involved in keeping insulin-producing cells in the pancreas working properly. This results in life threatening diabetes soon after birth. Led by the University of Exeter, the new decade-long analysis of 81 patients from 20 different countries was funded by the Wellcome Trust and Diabetes UK. It shows that these people can be treated successfully through sulphonylurea tablets, with excellent blood sugar control in the long term.

Professor Andrew Hattersley is the lead of the genetic diabetes research team at the University of Exeter Medical School. In 2006, they discovered that around half of people with neonatal diabetes can come off insulin injections and be treated more effectively with sulphonylurea tablets. In these people, the tablets provide the key to unlocking the closed door of the insulin-producing beta cells.Professor Hattersley said: "Switching from regular insulin injections was life-changing for these people who had been on insulin all their life; many described it as "a miracle treatment". Not only does this eradicate the need to inject with insulin several times a day, it also means much better blood sugar control. This is the first study to establish that this treatment is safe and works excellently for at least 10 years and all indications are that it will continue to work for decades more. This is great news for the thousands of patients who have made the switch from insulin."tablets.

Dr. Pamela Bowman, of the University of Exeter Medical School, who led the study, said: "It was incredibly exciting to help people make the switch from insulin to simple tablets—but the question was, would the benefits last? Half of people with type 2 diabetes treated with sulphonylureas no longer have good blood sugar control after five years. Our study has found that in neonatal diabetes, the tablets are safe and they work long term—with 93% of people in the study remaining on sulphonylureas alone after 10 years, with excellent blood sugar control."

Today, Jack's diabetes is so well managed that Emma has not had to worry about his condition since he changed treatment.

"It's like we've gone from living in a horror film to living in a rom com," said Emma, a nurse from Essex in the UK. "Before Jack switched treatment, every single night was a living nightmare. His blood sugar levels were all over the place, and I didn't think he was going to be alive when I went into his bedroom in the morning."

Now, Jack has recently celebrated his 18th birthday, with 150 guests. "We're so proud of our charming young man," said Emma. "He makes friends wherever he goes. Dealing with Jack's diabetes was particularly hard because of his severe learning difficulties. I honestly don't think he'd still be with us if it wasn't for the research at Exeter."

Dr. Elizabeth Robertson, Director of Research at Diabetes UK, said: "It's so important that people living with rare forms of diabetes, like neonatal diabetes, receive the right diagnosis and treatment. That's why we are delighted to have been able to help fund this vital work, demonstrating for the first time that sulphonylurea tablets are a safe and effective way for some people with neonatal diabetes to manage their condition for the long term. Moving forward, we hope research will uncover ways to prevent the developmental issues people with neonatal diabetes face.

"Nine out of ten people with this condition can switch from insulin therapy when they get the right diagnosis, so we would like all children diagnosed with diabetes under six months to be tested for neonatal diabetes, so the right treatment can help them get the best start in life."

Ref : http://www.exeter.ac.uk/news/research/title_662952_en.html

Cancer fighting effects of aspirin revealed in bowel tumor study

Researchers have shed light on how taking aspirin can help to stave off bowel cancer.

Experts found that the painkiller blocks a key process linked to tumour formation.

Regular use of aspirin is known to reduce a person's risk of developing colon cancer but the drug's tumour fighting properties have not been well understood.

Researchers at the University of Edinburgh focused on a structure found inside cells called the nucleolus.

Activation of the nucleolus is known to drive tumour formation and dysfunction has also been linked to Alzheimer's and Parkinson's.

The team at the University's Cancer Research UK Edinburgh Centre tested the effects of aspirin on cells grown in the lab and on tumour biopsies removed from colon cancer patients.

They found that aspirin blocks a key molecule called TIF-IA, which is essential for the nucleolus to function.

Not all colon cancer patients respond to aspirin but the researchers say their findings could help pinpoint those most likely to benefit.

Aspirin has side effects that include internal bleeding and it can cause certain types of stroke. Long term use is not recommended. The researchers say the study paves the way for the development of new, safer therapies that mimic aspirin's effects.

The research, published in Nucleic Acids Research, was funded by the Medical Research Council and the Biotechnology and Biological Sciences Research Council. Worldwide Cancer Research, Bowel and Cancer Research and The Rosetrees Trust also supported the work.

Dr. Lesley Stark, of the Cancer Research UK Edinburgh Centre at the University of Edinburgh, said: "We are really excited by these findings as they suggest a mechanism by which aspirin may act to prevent multiple diseases. A better understanding of howaspirin blocks TIF-IA and nucleolar activity provides great promise for the development of new treatments and targeted therapy."

Experimental drug restores some bladder function after spinal cord injury, study finds

An experimental drug that blocks abnormal neural communication after spinal cord injury could one day be the key to improving quality of life by improving bladder function, new research suggests.

Researchers at The Ohio State University tested the drug—which is currently available only for research—to gauge its potential to improve bladder function after spinal cord injury in mice and saw promising results.

The experimental drug (LM11A-31) appears to help by blocking the dual activity of pro-nerve growth factor (proNGF) and a receptor called p75. ProNGF is known to be secreted from the cell after nerve injury.

After a month-long treatment after spinal cord injury in mice, bladder volume decreased significantly to a level close to normal, said lead researcher Sung Ok Yoon, an associate professor of biological chemistry and pharmacology at Ohio State.

The study appears in The Journal of Clinical Investigation.

In humans, spinal cord injuries sever the communication between the bladder and the brain, leading to the loss of the normal ability to urinate at will. This leads to bladder over-filling, which causes high pressure and bladder enlargement due to thickening of the muscular bladder walls. This can cause urine to return to the kidney, which can lead to kidney infection and disease, Yoon said.

People with spinal cord injury typically rely on a catheter to pass urine.

Eventually, Yoon said, a new circuit of nervous-system communication is formed within the spinal cord, and it allows urine to be expelled unexpectedly, causing incontinence.

"There are no approved medications to treat bladder dysfunction brought on by spinal cord injuries, something that is a major concern and diminishes quality of life for these patients," Yoon said."This drug appears to help maintain near-normal bladder pressure and less unexpected expulsion of urine in mice."

Because the experimental drug does not restore normal communication between the bladder and the brain, it is certainly not a cure, Yoon said. Based on the mouse study, however, patients are likely to experience reduced bladder volume, which would lower the risk of bladder infection and reflux to the kidney, and less incontinence.

"The structure as well as the integrity of the neural communication in the bladder is expected to improve as well, contributing to the overall health of the bladder," she said.

Yoon and her collaborators also confirmed—through samples from two recent spinal-cord injury patients—the presence of proNGF in the urine within hours after injury. Urine from healthy people does not contain the growth factor. Yoon said that since the drug counteracts proNGF action, these findings could potentially be extended to further research into other types of bladder dysfunction besides spinal cord injury.

https://www.jci.org/articles/view/97837

Ref : https://www.jci.org/

Spironolactone may be an alternative to antibiotics in women's acne treatment

In continuation of my update on spironolactone

In a finding that suggests the potential for practice change that would reduce the use of antibiotics in dermatology, researchers in the Perelman School of Medicine at the University of Pennsylvania have found the diuretic drug spironolactone may be just as effective as antibiotics for the treatment of women's acne. The study, published this month in the Journal of Drugs and Dermatology, found patients who were originally prescribed spironolactone changed to a different drug within one year at almost the same rate as those who were prescribed antibiotics. The prescription change is a proxy for ineffectiveness, since switching is often the result of treatment failure due to lack of efficacy, side effects, cost, or other factors.

Acne is one of the most common diseases in the world. It affects 85 percent of people under the age of 18, but it also regularly impacts adults. More than 50 percent of women in the United States are treated for acne between the ages of 20 and 29, while more than 35 percent are treated between the ages of 30 and 39.

Oral antibiotics are the most common systemic treatment for acne, and when combined with the large patient population, the result is that dermatologists prescribe the highest level of antibiotics per provider among all medical specialties, according to the Centers for Disease Control—a fact that contributes to concerns about increased resistance to antibiotics across all fields of medicine.

"It's clear that a safe alternative to oral antibiotics could have a huge benefit, and our data show spironolactone may be that alternative," said the study's lead author John S. Barbieri, MD, MBA, Dermatology chief resident at Penn. David J. Margolis, MD, Ph.D., a professor of Dermatology, was the study's senior author.

Spironolactone, marketed under the name aldactone, is currently approved to treat high blood pressure, heart failure, and conditions that cause people to retain fluid. It blocks the effects of male hormones like androgen, meaning it's not an option to treat acne in men. However, those same anti-hormonal effects can help prevent acne outbreaks in women. As a result, some dermatologists use it to treat female acne patients.

Researchers compared data on 6,684 women and girls taking spironolactone to 31,614 who were prescribed antibiotics. Within a year, 14.4 percent of spironolactone patients and 13.4 percent of antibiotic patients had switched to alternative treatments, suggesting each treatment was working at almost the same rate, despite the fact that tetracycline-class antibiotics are prescribed five times as frequently.

"These numbers suggest dermatologists should consider spironolactone first instead of antibiotics when it comes to women with acne," Barbieri said.

In addition to the benefits for antibiotic stewardship, Barbieri pointed to several studies showing long-term oral antibiotic use may be associated with antibiotic resistance, lupus, inflammatory bowel disease, and even colon and breast cancer.

"This indicates spironolactone may have a better safety profile than oral antibiotics, which is another factor that makes it such an appealing option," Barbieri said. He also noted spironolactone is less expensive, which may be relevant to patients with high deductibles or who are uninsured.

Spironolactone is not approved for the treatment of acne by the U.S. Food and Drug Administration despite expert opinion supporting its use, and Barbieri says the findings of this study should be confirmed by a randomized controlled trial that directly compares the two treatment options.

FDA Advisory Committee Recommends the Approval of Baricitinib 2mg, but not 4mg, for the Treatment of Moderately-to-Severely Active Rheumatoid Arthritis

Eli Lilly and Company (NYSE: LLY) and Incyte Corporation (NASDAQ: INCY) announced  that the U.S. Food and Drug Administration's (FDA) Arthritis Advisory Committee recommended approval of the 2-mg dose of baricitinib, a once-daily oral medication for the treatment of moderately-to-severely active rheumatoid arthritis (RA) for adult patients who have had an inadequate response or intolerance to methotrexate. While the Advisory Committee unanimously supported the efficacy of the 4-mg dose of baricitinib, it did not recommend approval of the 4-mg dose of baricitinib for the proposed indication based on the adequacy of the safety and benefit-risk profiles.

"We are confident that baricitinib, if approved, can help people in the U.S. manage the challenges of living with RA," said Christi Shaw, president of Lilly Bio-Medicines. "While we are disappointed with the Advisory Committee's assessment of the data for the 4-mg dose, we are confident in the positive benefit-risk profile of both the 2-mg and the 4-mg doses. We look forward to continuing our work with the FDA on our New Drug Application (NDA) and are hopeful that baricitinib will receive approval in the coming months."

Baricitinib 2-mg and 4-mg doses are approved in more than 40 countries, including the member states of the European Union and Japan.

For both doses, the Advisory Committee voted to support the assessment that baricitinib's data provide substantial evidence of efficacy. For the 2-mg dose, the Advisory Committee voted in favor of the assessment that baricitinib's safety data adequately support its approval. For the 4-mg dose, the Advisory Committee voted against the assessment that baricitinib's safety data was adequate to support its approval based on the proposed indication.

The Advisory Committee's recommendation was based on baricitinib's global development program, which included four completed Phase 3 studies. In total, 3,492 patients, who represented a range of treatment experiences, received baricitinib in the global RA development program. The Phase 3 studies evaluated baricitinib's treatment impact related to RA signs and symptoms, physical function, joint damage progression and other patient-reported outcomes. The Phase 3 program also evaluated recognized risks for RA patients, including serious infection, malignancy, major adverse cardiovascular events (MACE), venous thromboembolism (VTE), and gastrointestinal perforations, along with key laboratory changes. The safety profile of baricitinib is based on 7,860 patient-years of exposure.

"Despite advances in the management of RA over the last 20 years, which include early treatment, optimized use of traditional therapies for rheumatic disease and the advent of newer medications such as biologics, many patients are still struggling to meet treatment targets, and live with debilitating pain, fatigue and other symptoms of RA," said Peter Taylor, MA, PhD, professor, University of Oxford, an expert who attended the Advisory Committee Meeting. "Baricitinib could be a promising option for RA patients in the U.S. who are not achieving adequate disease control with currently available treatments."

The FDA is not required to follow the Advisory Committee's recommendation, but will consider it during its review of the NDA for baricitinib.

FDA Advisory Committee Recommends the Approval of Baricitinib 2mg, but not 4mg, for the Treatment of Moderately-to-Severely Active Rheumatoid Arthritis