Latest Clinical Edge

Post date: 02/18/2020 - 17:43

Key clinical point: Hypofractionated radiotherapy is not inferior to conventional radiotherapy for treating localized prostate cancer.

Major finding: The 8-year rate of freedom from biochemical or clinical failure was 80.6% with 74 Gy/37 fractions and a noninferior 83.7% with 60 Gy/20 fractions (HR, 0.85; P = .11) but a potentially inferior 78.5% with 57 Gy/19 fractions (HR, 1.17; P = .10).

Study details: Update of a phase 3 trial of 3,216 men with node-negative T1b-T3a localized prostate cancer who received conventional vs. hypofractionated...

Post date: 02/18/2020 - 15:57

Key clinical point: Benefit of first-line docetaxel in metastatic hormone-sensitive prostate cancer appears to hinge on molecular subtype.

Major finding: Adding docetaxel to androgen deprivation therapy significantly prolonged overall survival among men with the luminal B subtype (52.1 months vs. 29.8 months; P = .007) but not among men with the basal subtype (49.2 months vs. 47.1 months; P = .60).

Study details: A correlative analysis of 160 men with newly diagnosed metastatic hormone-sensitive prostate cancer enrolled in the phase 3 CHAARTED...

Post date: 02/18/2020 - 15:39

Key clinical point: A randomized study representing real-world clinical practice did not confirm that patients with very early rheumatoid arthritis (RA) obtain an outsized benefit from first-line etanercept plus methotrexate compared with a strategy of methotrexate and delayed etanercept.

Major finding: A 14% difference in remission rate was not on par with a 30% effect size seen in an exploratory analysis of the...

Post date: 02/18/2020 - 15:38

Key clinical point: Fewer RA patients met remission criteria based on the Disease Activity Score in 28 joints (DAS28), compared with the Clinical Disease Activity Index (CDAI).

Major finding: For patients on conventional synthetic disease-modifying antirheumatic drugs, the proportion of DAS28 nonremission for patients in CDAI remission was 19.4%, while the proportion of CDAI nonremission in patients with DAS28...

Post date: 02/18/2020 - 15:36

Key clinical point: Use of tumor necrosis factor inhibitors (TNFi) as monotherapy was associated with increased treatment failure for rheumatoid arthritis patients younger than 75, but the disadvantage of TNFi monotherapy on drug survival disappeared among patients aged 75 and older.

Major finding: Patients aged 75 and older on TNFi monotherapy were more likely to discontinue because of adverse events and less likely...

Post date: 02/18/2020 - 15:35

Key clinical point: Ultrasound in rheumatoid arthritis patients identified new or persistent synovitis in joint replacements and operations of joint areas and detected response to treatment in replaced joints.

Major finding: At baseline, all replaced joints had grayscale ultrasound scores greater than 1 and 92% had power Doppler scores greater than 1; both of these scores showed significant improvement with treatment...

Post date: 02/18/2020 - 15:34

Key clinical point: Prescriptions of the biosimilar infliximab-dyyb remain low compared with those for bio-originator infliximab and other tumor necrosis factor inhibitors.

Major finding: Prescriptions for the infliximab biosimilar known as infliximab-dyyb accounted for 3.5% of all prescriptions of tumor necrosis factor inhibitors between January 2017 and September 2018; patients remained on the biosimilar for...

Post date: 02/18/2020 - 14:29

Key clinical point: These acquisitions might lead to greater efficiencies, but the impact on practice stability and patient care remains unclear.

Major finding: Private equity firms acquired 355 physician practice acquisitions from 2013 to 2016.

Study details: A review of physician group practice acquisitions by private equity firms using the Irving Levin Associates Health Care M&A data set.

Disclosures: No disclosures were reported.

Post date: 02/18/2020 - 13:58

Key clinical point: Infants are vulnerable to infection with the virus that causes COVID-19.

Major finding: Nine infants younger than 1 year of age have tested positive for the 2019 novel coronavirus; all nine had at least one infected family member.

Study details: The data come from a retrospective study of nine Chinese infants aged 28 days to 1 year of age diagnosed with COVID-19.

Disclosures: The study was supported by the National Natural Science Foundation of China and the Fundamental Research Funds for the Central Universities. The...

Post date: 02/18/2020 - 10:57

Key clinical point: Patients taking LD-MTX have a small-to-modest increase in the risk of some adverse events, including gastrointestinal, infectious, and hematologic.

Major finding: The relative rate of an adverse event of interest was 17% higher in the LD-MTX group than in the placebo group (HR, 1.17; 95% CI, 1.10-1.25).

Study details: A double-blind, placebo-controlled, randomized trial of 4,786 patients with known cardiovascular disease and diabetes or metabolic syndrome.

Disclosures: The National Institutes of Health funded the study....

Post date: 02/18/2020 - 10:44

Key clinical point: Increases in trimethylamine N-oxide were significantly linked with greater heart disease risk over 10 years.

Major finding: Women in the top tertile of trimethylamine N-oxide had a significantly increased risk of coronary heart disease (relative risk, 1.58), compared with other tertiles.

Study details: The data come from a prospective, nested, case-control study of coronary heart disease incidence in 760 women who were healthy at baseline and participants in the Nurses’ Health Study.

Disclosures: The study was sponsored...

Post date: 02/18/2020 - 10:33

Key clinical point: Some physician-authors of American College of Rheumatology clinical practice guidelines are not fully disclosing their financial conflicts of interest, which may impact their decisions when making guideline recommendations.

Major finding: Since 2014, 56 of 89 total physician-authors across five ACR guidelines have been paid a total of $9,728,751 from industry sources. Nineteen of 89 authors received $1,961,362 in industry payments that were directly relevant to a guideline’s recommendations, and $699,561 of these payments (35.7%) were undisclosed.


Post date: 02/18/2020 - 10:19

Key clinical point: Denosumab every 3 months could help reduce bone turnover markers and bone pain in patients with fibrous dysplasia/McCune-Albright syndrome (FD/MAS) that is refractory to bisphosphonate therapy.

Major finding: After treatment with denosumab, serum alkaline phosphatase activity and propeptide of type 1 procollagen levels were respectively reduced from 212 IU/L to 79 IU/L (P = .004) and from 346.2 ng/mL to 55.7 ng/mL (P = .023) and...

Post date: 02/18/2020 - 10:16

Key clinical point: Patients receiving long-term care for thyroid cancer should be monitored for osteoporotic risks, which include lower levels of thyroid stimulating hormone (but not serum TSH), being female and/or older, and using androgen.

Major finding: Osteoporosis occurred more frequently in patients with thyroid cancer than in controls (7.3% vs. 5.3%, respectively; odds ratio, 1.33; 95% confidence interval, 1.18-1.49).


Post date: 02/18/2020 - 10:14

Key clinical point: History of gastrectomy is associated with elevated bone resorption, decreased areal bone mineral density, increased fracture risk, and is more prominent long after the surgery.

Major finding: Gastrectomy was associated with a significantly higher risk of osteoporotic fractures after adjusting for confounding variables (hazard ratio, 2.55; 95% confidence interval, 1.17-5.55) even in those who survived 20 years or more after the surgery (HR, 3.56;...

Post date: 02/18/2020 - 10:07

Key clinical point: Low muscle mass is associated with osteoporosis in both men and women for all age groups, excluding men aged 50-64 years.

Major finding: Low muscle mass was significantly associated with osteoporosis in the lumbar spine and femoral neck in women (lumbar spine: odds ratio, 1.52, 95% confidence interval, 1.17-1.97; femoral neck: OR, 2.09, 95% CI, 1.56-2.80) and men (lumbar spine: OR, 1.73; 95% CI, 1.08-2.76; femoral neck: OR, 3.39; 95% CI, 1.69-6.80).

Post date: 02/18/2020 - 10:00

Key clinical point: Zoledronate after denosumab discontinuation prevented the complete return of bone mineral density to baseline levels.

Major finding: Women with osteoporosis who received a single infusion of zoledronate after discontinuing denosumab retained 66% of bone mineral density gains at the lumbar spine, 49% at the total hip, and 57% at the femoral neck.

Study details: The...

Post date: 02/18/2020 - 08:58

Key clinical point: Maternal schizophrenia is associated with poor birth outcomes in infants, which are partly explained by modifiable factors such as smoking and illicit drug use.

Main finding: Smoking was the biggest modifiable risk factor for adverse birth outcomes in women with schizophrenia, including prematurity (percentage of effect, 9.9%), small for gestational age (percentage of effect, 28.7%), and Apgar score less than 8 at 1 and 5 minutes (percentage of effect, 9....

Post date: 02/18/2020 - 08:56

Key clinical point: Patients with schizophrenia have higher serum levels of inflammatory markers, which can accurately predict therapeutic effects.

Major finding: The serum levels of the cytokines IL-1ß, IL-4, IL-6, and IL-8 were significantly elevated in patients with schizophrenia compared with controls. Higher levels of IL-6 (P = .027) and lower levels of IL-8 (P = .035) predicted better improvement in negative symptoms, whereas higher levels of...

Post date: 02/18/2020 - 08:50

Key clinical point: Lumateperone demonstrates efficacy with favorable safety and tolerability for the treatment of schizophrenia.

Major finding: Lumateperone 42 mg showed significant improvement from baseline to day 28 on the Positive and Negative Syndrome Scale total score (effect size, −0.3; P = .02) and the Clinical Global Impression-Severity of Illness score (effect size, −0.4; P = .003) vs. placebo. Lumateperone was well tolerated without any...

Post date: 02/18/2020 - 08:48

Key clinical point: Long-acting injections (LAIs) of antipsychotics are more effective than oral antipsychotics for preventing readmission of patients with schizophrenia in real-world settings.

Major finding: LAIs decreased the readmission rate by 29% compared with oral antipsychotic medications; readmissions were reduced by 58% in patients with repeated admissions.

Study details: A...

Post date: 02/18/2020 - 08:45

Key clinical point: N-acetylcysteine can be a useful adjunct to antipsychotics for the treatment of schizophrenia.

Major finding: Adjunctive treatment with N-acetylcysteine significantly improved negative and total Positive and Negative Syndrome Scale scores in schizophrenia after 24 weeks compared with placebo.

Study details: A meta-analysis of 7 randomized controlled trials that...

Post date: 02/14/2020 - 14:57

Key clinical point: Women who undergo anti-incontinence surgery show overall improvement in sexual function from baseline to 24 months postoperatively.

Major finding: The researchers observed no significant differences in mean Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form scores between the four treatment groups at the time of baseline (P = .07) or at the 12-and 24-month visits (P = .42 and P = .50, respectively).

Study details: A combined secondary analysis of 924 women enrolled in two trials.


Post date: 02/14/2020 - 13:27

Key clinical point: It’s not the stand-alone pulmonary artery pressure that matters on exercise testing, but the slope of PAP to cardiac output.

Major finding: A pulmonary artery pressure/cardiac output slope greater than 3 mm Hg/L/min on cardiopulmonary exercise tests more than doubled the risk of cardiovascular hospitalization and all-cause mortality.

Study details: Prospective, single-center study of 714 people with exertional dyspnea but preserved ejection fractions.

Disclosures: The work was funded by the National Institutes of Health...

Post date: 02/14/2020 - 12:19

Key clinical point: Tramadol, compared with other NSAIDs for chronic noncancer pain, was associated with increased hip fracture risk.

Major finding: Hip fracture incidence with tramadol vs. codeine was 3.7 vs. 2.9 per 1,000 person-years, respectively (HR, 1.28).

Study details: A large population-based cohort study including nearly 294,000 patients.

Disclosures: This study was supported by the National Institutes of Health, the National Natural Science Foundation of China, and the Postdoctoral Science Foundation of Central South University....