News Roundup

New and Noteworthy Information—March 2015



Moderate physical activity is associated with a lower risk of coronary heart disease, venous thromboembolic events, and cerebrovascular disease in women, according to a study published online ahead of print February 16 in Circulation. Participants included 1.1 million women in the United Kingdom with no history of cancer, heart disease, stroke, blood clots, or diabetes who joined the Million Women study between 1996 and 2001. Their average age when they joined the study was 56. Women who performed strenuous physical activity two to three times per week were 20% less likely to develop heart disease, strokes, or blood clots, compared with participants who reported little or no activity. More frequent physical activity did not result in further reductions in the risk of heart disease.

The FDA has approved Rytary, an extended-release oral capsule formulation of carbidopa–levodopa, for the treatment of Parkinson’s disease, post-encephalitic parkinsonism, and parkinsonism that may follow carbon monoxide intoxication or manganese intoxication. Rytary contains immediate-release and extended-release beads that contain carbidopa and levodopa in a 1:4 ratio, and provides initial and extended levodopa plasma concentrations after a single dose. In a trial of 393 randomized patients with advanced Parkinson’s disease, treatment with Rytary reduced the percentage of off time during waking hours from baseline to the end of the study, versus immediate-release carbidopa–levodopa. Rytary may be swallowed whole or opened, and the beads may be sprinkled on applesauce and consumed immediately. The drug is manufactured by Impax Pharmaceuticals (Hayward, California).

The FDA has approved Duopa, an enteral suspension of carbidopa and levodopa, as an orphan drug for the treatment of motor fluctuations in people with advanced Parkinson’s disease. The approval of Duopa is based on a phase III, 12-week, double-blind, double-placebo, active control, parallel-group, multicenter trial that compared the efficacy and safety of Duopa with that of oral, immediate-release carbidopa–levodopa tablets in patients with advanced Parkinson’s disease. Duopa significantly reduced daily mean off time at 12 weeks by four hours, which resulted in an average of 1.9 fewer hours of off time, when compared with carbidopa–levodopa tablets. Duopa is administered using a small, portable infusion pump that delivers carbidopa and levodopa directly into the small intestine continuously for 16 hours via a surgically-placed tube. The drug is manufactured by AbbVie (North Chicago, Illinois).

A link exists between brain structure and postconcussive symptoms among young male athletes who are otherwise healthy, according to a study published in the February issue of the Journal of Pediatrics. Researchers used advanced imaging technology and cognitive testing to assess 29 ice hockey players between ages 14 and 23, some of whom had a sports-related concussion. As the severity of the athletes’ concussion symptoms increased, the cortex became thinner in areas of the brain where it should be dense for players of these ages. Investigators believe that injury to a developing brain may be more severe than injury to an adult brain. “Years of playing contact sports and repeatedly getting your head knocked around probably is not good for the brain, especially in young children whose brains are still maturing,” the researchers stated.

Children whose urine drug screens tested positive for tetrahydrocannabinol (THC) met multiple sleep latency tests (MSLT) criteria for narcolepsy or had multiple sleep-onset REM periods, according to a study published January 15 in Journal of Clinical Sleep Medicine. The 10-year retrospective study included 383 children who underwent drug screens on the morning before MSLT. Of children with urine drug screens that were positive for marijuana, 43% had MSLT results consistent with narcolepsy or abnormal REM sleep patterns. Approximately 24% of children who tested negative for marijuana had MSLT results consistent with narcolepsy. No child younger than 13 had a positive urine drug screen. Males were more likely to have a positive urine drug screen and MSLT findings that were consistent with narcolepsy, compared with other groups.

Low plasma levels of APOE are associated with increased risk of future Alzheimer’s disease and all dementia in the general population, independent of ε2, ε3, and ε4 APOE genotype, according to a study published in the February issue of Annals of Neurology. The study included 75,708 participants. Multifactorially adjusted hazard ratios for lowest versus highest APOE tertile were 2.68 and 1.80 for Alzheimer’s disease and all dementia, respectively. After further adjustment for APOE genotype, plasma APOE tertiles remained associated with Alzheimer’s disease and all dementia. Researchers determined that the low level of APOE in the blood reflects a low level of APOE in the brain, indicating that β-amyloid is less effectively removed. Plasma levels of APOE may be a new, easily accessible preclinical biomarker, said the authors.

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