Photo by Rhoda Baer

Deaths from cancer are on the decline in the US, but new cases of cancer are on the rise, according to the 7th annual American Association for Cancer Research (AACR) Cancer Progress Report.

The data suggest the cancer death rate declined by 35% from 1991 to 2014 for children and by 25% for adults, a reduction that translates to 2.1 million cancer deaths avoided.

However, 600,920 people in the US are projected to die from cancer in 2017.

And the number of new cancer cases is predicted to rise from 1.7 million in 2017 to 2.3 million in 2030.

The report also estimates there will be 62,130 new cases of leukemia in 2017 and 24,500 leukemia deaths this year.

This includes:

• 5970 cases of acute lymphocytic leukemia and 1440 deaths
• 20,110 cases of chronic lymphocytic leukemia and 4660 deaths
• 21,380 cases of acute myeloid leukemia (AML) and 10,590 deaths
• 8950 cases of chronic myeloid leukemia and 1080 deaths.

The estimate for lymphomas is 80,500 new cases and 21,210 deaths.

This includes:

• 8260 cases of Hodgkin lymphoma (HL) and 1070 deaths
• 72,240 cases of non-Hodgkin lymphoma and 20,140 deaths.

The estimate for myeloma is 30,280 new cases and 12,590 deaths.

The report says the estimated new cases of cancer are based on cancer incidence rates from 49 states and the District of Columbia from 1995 through 2013, as reported by the North American Association of Central Cancer Registries. This represents about 98% of the US population.

The estimated deaths are based on US mortality data from 1997 through 2013, taken from the National Center for Health Statistics of the Centers for Disease Control and Prevention.

Drug approvals

The AACR report notes that, between August 1, 2016, and July 31, 2017, the US Food and Drug Administration (FDA) approved new uses for 15 anticancer agents, 9 of which had no previous FDA approval.

Five of the agents are immunotherapies, which the report dubs “revolutionary treatments that are increasing survival and improving quality of life for patients.”

Among the recently approved therapies are 3 used for hematology indications:

• Ibrutinib (Imbruvica), approved to treat patients with relapsed/refractory marginal zone lymphoma who require systemic therapy and have received at least 1 prior anti-CD20-based therapy
• Midostaurin (Rydapt), approved as monotherapy for adults with advanced systemic mastocytosis and for use in combination with standard cytarabine and daunorubicin induction, followed by cytarabine consolidation, in adults with newly diagnosed AML who are FLT3 mutation-positive, as detected by an FDA-approved test.
• Pembrolizumab (Keytruda), approved to treat adult and pediatric patients with refractory classical HL or those with classical HL who have relapsed after 3 or more prior lines of therapy.

Disparities and costs

The AACR report points out that advances against cancer have not benefited everyone equally, and cancer health disparities are some of the most pressing challenges.

Among the disparities listed is the fact that adolescents and young adults (ages 15 to 39) with AML have a 5-year relative survival rate that is 22% lower than that of children (ages 1 to 14) with AML.

And Hispanic children are 24% more likely to develop leukemia than non-Hispanic children.

Another concern mentioned in the report is the cost of cancer care. The direct medical costs of cancer care in 2014 were estimated to be nearly $87.6 billion. This number does not include the indirect costs of lost productivity due to cancer-related morbidity and mortality.

With this in mind, the AACR is calling for a $2 billion increase in funding for the National Institutes of Health in fiscal year 2018, for a total funding level of $36.2 billion.

The AACR also recommends an $80 million increase in the FDA budget, bringing it to $2.8 billion for fiscal year 2018.

Photo by Rhoda Baer

Deaths from cancer are on the decline in the US, but new cases of cancer are on the rise, according to the 7th annual American Association for Cancer Research (AACR) Cancer Progress Report.

The data suggest the cancer death rate declined by 35% from 1991 to 2014 for children and by 25% for adults, a reduction that translates to 2.1 million cancer deaths avoided.

However, 600,920 people in the US are projected to die from cancer in 2017.

And the number of new cancer cases is predicted to rise from 1.7 million in 2017 to 2.3 million in 2030.

The report also estimates there will be 62,130 new cases of leukemia in 2017 and 24,500 leukemia deaths this year.

This includes:

• 5970 cases of acute lymphocytic leukemia and 1440 deaths
• 20,110 cases of chronic lymphocytic leukemia and 4660 deaths
• 21,380 cases of acute myeloid leukemia (AML) and 10,590 deaths
• 8950 cases of chronic myeloid leukemia and 1080 deaths.

The estimate for lymphomas is 80,500 new cases and 21,210 deaths.

This includes:

• 8260 cases of Hodgkin lymphoma (HL) and 1070 deaths
• 72,240 cases of non-Hodgkin lymphoma and 20,140 deaths.

The estimate for myeloma is 30,280 new cases and 12,590 deaths.

The report says the estimated new cases of cancer are based on cancer incidence rates from 49 states and the District of Columbia from 1995 through 2013, as reported by the North American Association of Central Cancer Registries. This represents about 98% of the US population.

The estimated deaths are based on US mortality data from 1997 through 2013, taken from the National Center for Health Statistics of the Centers for Disease Control and Prevention.

Drug approvals

The AACR report notes that, between August 1, 2016, and July 31, 2017, the US Food and Drug Administration (FDA) approved new uses for 15 anticancer agents, 9 of which had no previous FDA approval.

Five of the agents are immunotherapies, which the report dubs “revolutionary treatments that are increasing survival and improving quality of life for patients.”

Among the recently approved therapies are 3 used for hematology indications:

• Ibrutinib (Imbruvica), approved to treat patients with relapsed/refractory marginal zone lymphoma who require systemic therapy and have received at least 1 prior anti-CD20-based therapy
• Midostaurin (Rydapt), approved as monotherapy for adults with advanced systemic mastocytosis and for use in combination with standard cytarabine and daunorubicin induction, followed by cytarabine consolidation, in adults with newly diagnosed AML who are FLT3 mutation-positive, as detected by an FDA-approved test.
• Pembrolizumab (Keytruda), approved to treat adult and pediatric patients with refractory classical HL or those with classical HL who have relapsed after 3 or more prior lines of therapy.

Disparities and costs

The AACR report points out that advances against cancer have not benefited everyone equally, and cancer health disparities are some of the most pressing challenges.

Among the disparities listed is the fact that adolescents and young adults (ages 15 to 39) with AML have a 5-year relative survival rate that is 22% lower than that of children (ages 1 to 14) with AML.

And Hispanic children are 24% more likely to develop leukemia than non-Hispanic children.

Another concern mentioned in the report is the cost of cancer care. The direct medical costs of cancer care in 2014 were estimated to be nearly $87.6 billion. This number does not include the indirect costs of lost productivity due to cancer-related morbidity and mortality.

With this in mind, the AACR is calling for a $2 billion increase in funding for the National Institutes of Health in fiscal year 2018, for a total funding level of $36.2 billion.

The AACR also recommends an $80 million increase in the FDA budget, bringing it to $2.8 billion for fiscal year 2018.

Photo by Rhoda Baer

Deaths from cancer are on the decline in the US, but new cases of cancer are on the rise, according to the 7th annual American Association for Cancer Research (AACR) Cancer Progress Report.

The data suggest the cancer death rate declined by 35% from 1991 to 2014 for children and by 25% for adults, a reduction that translates to 2.1 million cancer deaths avoided.

However, 600,920 people in the US are projected to die from cancer in 2017.

And the number of new cancer cases is predicted to rise from 1.7 million in 2017 to 2.3 million in 2030.

The report also estimates there will be 62,130 new cases of leukemia in 2017 and 24,500 leukemia deaths this year.

This includes:

• 5970 cases of acute lymphocytic leukemia and 1440 deaths
• 20,110 cases of chronic lymphocytic leukemia and 4660 deaths
• 21,380 cases of acute myeloid leukemia (AML) and 10,590 deaths
• 8950 cases of chronic myeloid leukemia and 1080 deaths.

The estimate for lymphomas is 80,500 new cases and 21,210 deaths.

This includes:

• 8260 cases of Hodgkin lymphoma (HL) and 1070 deaths
• 72,240 cases of non-Hodgkin lymphoma and 20,140 deaths.

The estimate for myeloma is 30,280 new cases and 12,590 deaths.

The report says the estimated new cases of cancer are based on cancer incidence rates from 49 states and the District of Columbia from 1995 through 2013, as reported by the North American Association of Central Cancer Registries. This represents about 98% of the US population.

The estimated deaths are based on US mortality data from 1997 through 2013, taken from the National Center for Health Statistics of the Centers for Disease Control and Prevention.

Drug approvals

The AACR report notes that, between August 1, 2016, and July 31, 2017, the US Food and Drug Administration (FDA) approved new uses for 15 anticancer agents, 9 of which had no previous FDA approval.

Five of the agents are immunotherapies, which the report dubs “revolutionary treatments that are increasing survival and improving quality of life for patients.”

Among the recently approved therapies are 3 used for hematology indications:

• Ibrutinib (Imbruvica), approved to treat patients with relapsed/refractory marginal zone lymphoma who require systemic therapy and have received at least 1 prior anti-CD20-based therapy
• Midostaurin (Rydapt), approved as monotherapy for adults with advanced systemic mastocytosis and for use in combination with standard cytarabine and daunorubicin induction, followed by cytarabine consolidation, in adults with newly diagnosed AML who are FLT3 mutation-positive, as detected by an FDA-approved test.
• Pembrolizumab (Keytruda), approved to treat adult and pediatric patients with refractory classical HL or those with classical HL who have relapsed after 3 or more prior lines of therapy.

Disparities and costs

The AACR report points out that advances against cancer have not benefited everyone equally, and cancer health disparities are some of the most pressing challenges.

Among the disparities listed is the fact that adolescents and young adults (ages 15 to 39) with AML have a 5-year relative survival rate that is 22% lower than that of children (ages 1 to 14) with AML.

And Hispanic children are 24% more likely to develop leukemia than non-Hispanic children.

Another concern mentioned in the report is the cost of cancer care. The direct medical costs of cancer care in 2014 were estimated to be nearly $87.6 billion. This number does not include the indirect costs of lost productivity due to cancer-related morbidity and mortality.

With this in mind, the AACR is calling for a $2 billion increase in funding for the National Institutes of Health in fiscal year 2018, for a total funding level of $36.2 billion.

The AACR also recommends an $80 million increase in the FDA budget, bringing it to $2.8 billion for fiscal year 2018.

Photo by Graham Colm

Previous research has suggested that astronauts develop anemia during space flight, but a new study indicates this is not the case for astronauts on long space missions.

“There is an idea of ‘space anemia’ that is associated with space flight,” said Richard Simpson, PhD, of the University of Houston in Texas.

“However, this is based on blood samples from astronauts collected after flight, which may be influenced by various factors—for example, the stress of landing and re-adaptation to conditions on Earth.”

“For this study . . ., living, whole blood samples were collected during space flight and returned to Earth for analysis. This unique sample allowed us to track hematological parameters—such as concentrations of red blood cells, hemoglobin, or hematocrit—in astronauts on board the International Space Station during flight.”

Dr Simpson and his colleagues reported their findings in BMC Hematology.

The researchers found that, during space flight, concentrations of red blood cells (RBCs), platelets, and hemoglobin were higher compared to pre-flight levels. Hematocrit also increased significantly during space flight.

While previous studies had shown this to be the case during the first few days of flight, this is the first study to show that RBC concentrations and hematocrit remain at higher levels even after astronauts’ bodies have adapted to microgravity.

To find out how the blood of astronauts may change if they spend a long time in space, the researchers collected blood samples from 31 astronauts who spent up to 6 months on the International Space Station (ISS). There were 6 female and 25 male subjects, and their mean age was 52 (range, 38–61).

Samples were collected at 180 days and 45 days before the astronauts flew to the ISS. Blood was also collected while they were in space—during the first 2 weeks (early time point), between 2 and 4 months (mid time point), and about 6 months into the mission (late time point).

Samples were returned to Earth for analysis either in Houston or at Star City, Russia, within 48 hours of collection. Post-flight samples were collected 3 to 8 hours after landing and 30 days after the mission had ended.

Results

The researchers said some of the changes observed in the in-flight blood samples were to be expected due to the 48-hour processing delay between sample collection and analysis.

However, the team found that RBC concentration was significantly elevated at all 3 in-flight time points, when compared to the 180-day pre-mission time point (baseline). And RBC counts returned to baseline levels upon Earth landing.

The mean RBC concentrations (x 10⁶ cells/μL) were:

• 4.4 ± 0.4 (range, 3.5–5.1) at baseline
• 4.8 ± 0.5 (range, 3.9–5.7) at the early time point (P<0.05)
• 4.7 ± 0.4 (range, 3.9–5.4) at the mid time point (P<0.05)
• 4.7 ± 0.4 (range, 4.1–5.6) at the late time point (P<0.05).

Hemoglobin was elevated early in flight but returned to pre-flight levels during the mission and fell below baseline levels on landing day. The mean hemoglobin (g/dL) levels were:

• 14.1 ± 1.4 (range, 11.0–17.8) at baseline
• 15.0 ± 1.9 (range, 10.7–17.5) at the early time point (P<0.05)
• 13.5 ± 1.4 (range, 10.1–15.9) on landing day (P<0.05).

Mean corpuscular hemoglobin (MCH) decreased during the mission and was significantly lower than baseline at the late time point. However, MCH returned to pre-flight values upon landing. The mean MCH (pg) was:

• 31.7 ± 1.6 (range, 28.8–36.4) at baseline
• 31.3 ± 1.9 (range 26.3–34.0) at the late time point (P<0.05).

The researchers said they observed significant increases in mean corpuscular volume (MCV) during space flight. However, these reflect the changes observed following the 48-hour processing delay. So there were no variations in MCV attributable to space flight.

The changes observed in hematocrit during space flight were “striking,” according to the researchers. The mean hematocrit levels were:

• 40.9 ± 3.9 (range, 33.1–48.0) at baseline
• 45.9 ± 4.7 (range 38.2–52.1) at the early time point (P<0.05)
• 45.9 ± 5.5 (range 38.9–58.3) at the mid time point (P<0.05)
• 45.0 ± 2.5 (range 38.9–49.9) at the late time point (P<0.05).

Compared to pre-flight levels, hematocrit increased by 12.2% at early, 12.2% at mid, and 10.0% at late time points. In comparison, there was a 4.7% increase in hematocrit in reference samples from non-astronauts after the 48-hour processing delay.

Finally, the researchers found that platelet concentrations were elevated in flight, at the early and mid time points. However, platelets were not significantly elevated at the late time point, and they were stable upon landing.

For all of the astronauts, all blood parameters returned to pre-flight levels within 30 days of landing on Earth.

The researchers said these results are susceptible to the possible influence of dehydration or plasma volume alterations. However, the findings do suggest the increases observed in the ISS samples are partly due to a true in-flight increase in RBC count.

“Although the data does not indicate that significant anemia is present, it must be interpreted in the context of crew plasma volume during flight,” Dr Simpson said. “Overall plasma volume has been shown to be reduced during space flight, but this has not been assessed during long-duration missions.”

“In order to fully interpret the changes to RBC, hematocrit, and other parameters observed in this study, further research into plasma volume during long space missions is needed. This will be addressed in a separate, ongoing NASA investigation.”

Photo by Graham Colm

Previous research has suggested that astronauts develop anemia during space flight, but a new study indicates this is not the case for astronauts on long space missions.

“There is an idea of ‘space anemia’ that is associated with space flight,” said Richard Simpson, PhD, of the University of Houston in Texas.

“However, this is based on blood samples from astronauts collected after flight, which may be influenced by various factors—for example, the stress of landing and re-adaptation to conditions on Earth.”

“For this study . . ., living, whole blood samples were collected during space flight and returned to Earth for analysis. This unique sample allowed us to track hematological parameters—such as concentrations of red blood cells, hemoglobin, or hematocrit—in astronauts on board the International Space Station during flight.”

Dr Simpson and his colleagues reported their findings in BMC Hematology.

The researchers found that, during space flight, concentrations of red blood cells (RBCs), platelets, and hemoglobin were higher compared to pre-flight levels. Hematocrit also increased significantly during space flight.

While previous studies had shown this to be the case during the first few days of flight, this is the first study to show that RBC concentrations and hematocrit remain at higher levels even after astronauts’ bodies have adapted to microgravity.

To find out how the blood of astronauts may change if they spend a long time in space, the researchers collected blood samples from 31 astronauts who spent up to 6 months on the International Space Station (ISS). There were 6 female and 25 male subjects, and their mean age was 52 (range, 38–61).

Samples were collected at 180 days and 45 days before the astronauts flew to the ISS. Blood was also collected while they were in space—during the first 2 weeks (early time point), between 2 and 4 months (mid time point), and about 6 months into the mission (late time point).

Samples were returned to Earth for analysis either in Houston or at Star City, Russia, within 48 hours of collection. Post-flight samples were collected 3 to 8 hours after landing and 30 days after the mission had ended.

Results

The researchers said some of the changes observed in the in-flight blood samples were to be expected due to the 48-hour processing delay between sample collection and analysis.

However, the team found that RBC concentration was significantly elevated at all 3 in-flight time points, when compared to the 180-day pre-mission time point (baseline). And RBC counts returned to baseline levels upon Earth landing.

The mean RBC concentrations (x 10⁶ cells/μL) were:

• 4.4 ± 0.4 (range, 3.5–5.1) at baseline
• 4.8 ± 0.5 (range, 3.9–5.7) at the early time point (P<0.05)
• 4.7 ± 0.4 (range, 3.9–5.4) at the mid time point (P<0.05)
• 4.7 ± 0.4 (range, 4.1–5.6) at the late time point (P<0.05).

Hemoglobin was elevated early in flight but returned to pre-flight levels during the mission and fell below baseline levels on landing day. The mean hemoglobin (g/dL) levels were:

• 14.1 ± 1.4 (range, 11.0–17.8) at baseline
• 15.0 ± 1.9 (range, 10.7–17.5) at the early time point (P<0.05)
• 13.5 ± 1.4 (range, 10.1–15.9) on landing day (P<0.05).

Mean corpuscular hemoglobin (MCH) decreased during the mission and was significantly lower than baseline at the late time point. However, MCH returned to pre-flight values upon landing. The mean MCH (pg) was:

• 31.7 ± 1.6 (range, 28.8–36.4) at baseline
• 31.3 ± 1.9 (range 26.3–34.0) at the late time point (P<0.05).

The researchers said they observed significant increases in mean corpuscular volume (MCV) during space flight. However, these reflect the changes observed following the 48-hour processing delay. So there were no variations in MCV attributable to space flight.

The changes observed in hematocrit during space flight were “striking,” according to the researchers. The mean hematocrit levels were:

• 40.9 ± 3.9 (range, 33.1–48.0) at baseline
• 45.9 ± 4.7 (range 38.2–52.1) at the early time point (P<0.05)
• 45.9 ± 5.5 (range 38.9–58.3) at the mid time point (P<0.05)
• 45.0 ± 2.5 (range 38.9–49.9) at the late time point (P<0.05).

Compared to pre-flight levels, hematocrit increased by 12.2% at early, 12.2% at mid, and 10.0% at late time points. In comparison, there was a 4.7% increase in hematocrit in reference samples from non-astronauts after the 48-hour processing delay.

Finally, the researchers found that platelet concentrations were elevated in flight, at the early and mid time points. However, platelets were not significantly elevated at the late time point, and they were stable upon landing.

For all of the astronauts, all blood parameters returned to pre-flight levels within 30 days of landing on Earth.

The researchers said these results are susceptible to the possible influence of dehydration or plasma volume alterations. However, the findings do suggest the increases observed in the ISS samples are partly due to a true in-flight increase in RBC count.

“Although the data does not indicate that significant anemia is present, it must be interpreted in the context of crew plasma volume during flight,” Dr Simpson said. “Overall plasma volume has been shown to be reduced during space flight, but this has not been assessed during long-duration missions.”

“In order to fully interpret the changes to RBC, hematocrit, and other parameters observed in this study, further research into plasma volume during long space missions is needed. This will be addressed in a separate, ongoing NASA investigation.”

Photo by Graham Colm

Previous research has suggested that astronauts develop anemia during space flight, but a new study indicates this is not the case for astronauts on long space missions.

“There is an idea of ‘space anemia’ that is associated with space flight,” said Richard Simpson, PhD, of the University of Houston in Texas.

“However, this is based on blood samples from astronauts collected after flight, which may be influenced by various factors—for example, the stress of landing and re-adaptation to conditions on Earth.”

“For this study . . ., living, whole blood samples were collected during space flight and returned to Earth for analysis. This unique sample allowed us to track hematological parameters—such as concentrations of red blood cells, hemoglobin, or hematocrit—in astronauts on board the International Space Station during flight.”

Dr Simpson and his colleagues reported their findings in BMC Hematology.

The researchers found that, during space flight, concentrations of red blood cells (RBCs), platelets, and hemoglobin were higher compared to pre-flight levels. Hematocrit also increased significantly during space flight.

While previous studies had shown this to be the case during the first few days of flight, this is the first study to show that RBC concentrations and hematocrit remain at higher levels even after astronauts’ bodies have adapted to microgravity.

To find out how the blood of astronauts may change if they spend a long time in space, the researchers collected blood samples from 31 astronauts who spent up to 6 months on the International Space Station (ISS). There were 6 female and 25 male subjects, and their mean age was 52 (range, 38–61).

Samples were collected at 180 days and 45 days before the astronauts flew to the ISS. Blood was also collected while they were in space—during the first 2 weeks (early time point), between 2 and 4 months (mid time point), and about 6 months into the mission (late time point).

Samples were returned to Earth for analysis either in Houston or at Star City, Russia, within 48 hours of collection. Post-flight samples were collected 3 to 8 hours after landing and 30 days after the mission had ended.

Results

The researchers said some of the changes observed in the in-flight blood samples were to be expected due to the 48-hour processing delay between sample collection and analysis.

However, the team found that RBC concentration was significantly elevated at all 3 in-flight time points, when compared to the 180-day pre-mission time point (baseline). And RBC counts returned to baseline levels upon Earth landing.

The mean RBC concentrations (x 10⁶ cells/μL) were:

• 4.4 ± 0.4 (range, 3.5–5.1) at baseline
• 4.8 ± 0.5 (range, 3.9–5.7) at the early time point (P<0.05)
• 4.7 ± 0.4 (range, 3.9–5.4) at the mid time point (P<0.05)
• 4.7 ± 0.4 (range, 4.1–5.6) at the late time point (P<0.05).

Hemoglobin was elevated early in flight but returned to pre-flight levels during the mission and fell below baseline levels on landing day. The mean hemoglobin (g/dL) levels were:

• 14.1 ± 1.4 (range, 11.0–17.8) at baseline
• 15.0 ± 1.9 (range, 10.7–17.5) at the early time point (P<0.05)
• 13.5 ± 1.4 (range, 10.1–15.9) on landing day (P<0.05).

Mean corpuscular hemoglobin (MCH) decreased during the mission and was significantly lower than baseline at the late time point. However, MCH returned to pre-flight values upon landing. The mean MCH (pg) was:

• 31.7 ± 1.6 (range, 28.8–36.4) at baseline
• 31.3 ± 1.9 (range 26.3–34.0) at the late time point (P<0.05).

The researchers said they observed significant increases in mean corpuscular volume (MCV) during space flight. However, these reflect the changes observed following the 48-hour processing delay. So there were no variations in MCV attributable to space flight.

The changes observed in hematocrit during space flight were “striking,” according to the researchers. The mean hematocrit levels were:

• 40.9 ± 3.9 (range, 33.1–48.0) at baseline
• 45.9 ± 4.7 (range 38.2–52.1) at the early time point (P<0.05)
• 45.9 ± 5.5 (range 38.9–58.3) at the mid time point (P<0.05)
• 45.0 ± 2.5 (range 38.9–49.9) at the late time point (P<0.05).

Compared to pre-flight levels, hematocrit increased by 12.2% at early, 12.2% at mid, and 10.0% at late time points. In comparison, there was a 4.7% increase in hematocrit in reference samples from non-astronauts after the 48-hour processing delay.

Finally, the researchers found that platelet concentrations were elevated in flight, at the early and mid time points. However, platelets were not significantly elevated at the late time point, and they were stable upon landing.

For all of the astronauts, all blood parameters returned to pre-flight levels within 30 days of landing on Earth.

The researchers said these results are susceptible to the possible influence of dehydration or plasma volume alterations. However, the findings do suggest the increases observed in the ISS samples are partly due to a true in-flight increase in RBC count.

“Although the data does not indicate that significant anemia is present, it must be interpreted in the context of crew plasma volume during flight,” Dr Simpson said. “Overall plasma volume has been shown to be reduced during space flight, but this has not been assessed during long-duration missions.”

“In order to fully interpret the changes to RBC, hematocrit, and other parameters observed in this study, further research into plasma volume during long space missions is needed. This will be addressed in a separate, ongoing NASA investigation.”

Institute of Pathology

The US Food and Drug Administration (FDA) has accepted for priority review a supplemental new drug application (sNDA) for arsenic trioxide (TRISENOX®) injection.

With this sNDA, Teva Pharmaceutical Industries Ltd. is seeking approval for arsenic trioxide to be used in combination with all-trans retinoic acid (ATRA) for induction of remission and consolidation in patients with newly diagnosed, low- or intermediate-risk acute promyelocytic leukemia (APL) characterized by the presence of the t(15;17) translocation or PML/RAR-alpha gene expression.

Currently, arsenic trioxide is FDA-approved as monotherapy for induction of remission and consolidation in patients with APL who are refractory to, or have relapsed from, retinoid and anthracycline chemotherapy, and whose APL is characterized by the presence of the t(15;17) translocation or PML/RAR-alpha gene expression.

For more details, see the full prescribing information.

The FDA has accepted the arsenic trioxide sNDA for priority review and expects to make a decision on the application in the first quarter of 2018.

The FDA grants priority review to applications for products that may provide significant improvements in the treatment, diagnosis, or prevention of serious conditions.

The agency’s goal is to take action on a priority review application within 6 months of receiving it, rather than the standard 10 months.

Phase 3 study results

The sNDA for arsenic trioxide is supported by results from the APL0406 study. Updated results from this phase 3 study were published in the Journal of Clinical Oncology in February.

The study included 276 adults (ages 18 to 71) with newly diagnosed, low- or intermediate-risk APL. Patients were randomized to receive ATRA plus arsenic trioxide or ATRA plus chemotherapy.

A total of 263 patients were evaluable for response to induction. One hundred percent of patients in the arsenic trioxide arm (127/127) achieved a complete response (CR), as did 97% (132/136) of patients in the chemotherapy arm (P=0.12).

After a median follow-up of 40.6 months, the event-free survival was 97.3% in the arsenic trioxide arm and 80% in the chemotherapy arm (P<0.001). The cumulative incidence of relapse was 1.9% and 13.9%, respectively (P=0.0013).

At 50 months, the overall survival was 99.2% in the arsenic trioxide arm and 92.6% in the chemotherapy arm (P=0.0073).

After induction, there were 2 relapses and 1 death in CR in the arsenic trioxide arm.

In the chemotherapy arm, there were 2 instances of molecular resistance after third consolidation, 15 relapses, 5 deaths in CR, and 2 patients who developed a therapy-related myeloid neoplasm.

Institute of Pathology

The US Food and Drug Administration (FDA) has accepted for priority review a supplemental new drug application (sNDA) for arsenic trioxide (TRISENOX®) injection.

With this sNDA, Teva Pharmaceutical Industries Ltd. is seeking approval for arsenic trioxide to be used in combination with all-trans retinoic acid (ATRA) for induction of remission and consolidation in patients with newly diagnosed, low- or intermediate-risk acute promyelocytic leukemia (APL) characterized by the presence of the t(15;17) translocation or PML/RAR-alpha gene expression.

Currently, arsenic trioxide is FDA-approved as monotherapy for induction of remission and consolidation in patients with APL who are refractory to, or have relapsed from, retinoid and anthracycline chemotherapy, and whose APL is characterized by the presence of the t(15;17) translocation or PML/RAR-alpha gene expression.

For more details, see the full prescribing information.

The FDA has accepted the arsenic trioxide sNDA for priority review and expects to make a decision on the application in the first quarter of 2018.

The FDA grants priority review to applications for products that may provide significant improvements in the treatment, diagnosis, or prevention of serious conditions.

The agency’s goal is to take action on a priority review application within 6 months of receiving it, rather than the standard 10 months.

Phase 3 study results

The sNDA for arsenic trioxide is supported by results from the APL0406 study. Updated results from this phase 3 study were published in the Journal of Clinical Oncology in February.

The study included 276 adults (ages 18 to 71) with newly diagnosed, low- or intermediate-risk APL. Patients were randomized to receive ATRA plus arsenic trioxide or ATRA plus chemotherapy.

A total of 263 patients were evaluable for response to induction. One hundred percent of patients in the arsenic trioxide arm (127/127) achieved a complete response (CR), as did 97% (132/136) of patients in the chemotherapy arm (P=0.12).

After a median follow-up of 40.6 months, the event-free survival was 97.3% in the arsenic trioxide arm and 80% in the chemotherapy arm (P<0.001). The cumulative incidence of relapse was 1.9% and 13.9%, respectively (P=0.0013).

At 50 months, the overall survival was 99.2% in the arsenic trioxide arm and 92.6% in the chemotherapy arm (P=0.0073).

After induction, there were 2 relapses and 1 death in CR in the arsenic trioxide arm.

In the chemotherapy arm, there were 2 instances of molecular resistance after third consolidation, 15 relapses, 5 deaths in CR, and 2 patients who developed a therapy-related myeloid neoplasm.

Institute of Pathology

The US Food and Drug Administration (FDA) has accepted for priority review a supplemental new drug application (sNDA) for arsenic trioxide (TRISENOX®) injection.

With this sNDA, Teva Pharmaceutical Industries Ltd. is seeking approval for arsenic trioxide to be used in combination with all-trans retinoic acid (ATRA) for induction of remission and consolidation in patients with newly diagnosed, low- or intermediate-risk acute promyelocytic leukemia (APL) characterized by the presence of the t(15;17) translocation or PML/RAR-alpha gene expression.

Currently, arsenic trioxide is FDA-approved as monotherapy for induction of remission and consolidation in patients with APL who are refractory to, or have relapsed from, retinoid and anthracycline chemotherapy, and whose APL is characterized by the presence of the t(15;17) translocation or PML/RAR-alpha gene expression.

For more details, see the full prescribing information.

The FDA has accepted the arsenic trioxide sNDA for priority review and expects to make a decision on the application in the first quarter of 2018.

The FDA grants priority review to applications for products that may provide significant improvements in the treatment, diagnosis, or prevention of serious conditions.

The agency’s goal is to take action on a priority review application within 6 months of receiving it, rather than the standard 10 months.

Phase 3 study results

The sNDA for arsenic trioxide is supported by results from the APL0406 study. Updated results from this phase 3 study were published in the Journal of Clinical Oncology in February.

The study included 276 adults (ages 18 to 71) with newly diagnosed, low- or intermediate-risk APL. Patients were randomized to receive ATRA plus arsenic trioxide or ATRA plus chemotherapy.

A total of 263 patients were evaluable for response to induction. One hundred percent of patients in the arsenic trioxide arm (127/127) achieved a complete response (CR), as did 97% (132/136) of patients in the chemotherapy arm (P=0.12).

After a median follow-up of 40.6 months, the event-free survival was 97.3% in the arsenic trioxide arm and 80% in the chemotherapy arm (P<0.001). The cumulative incidence of relapse was 1.9% and 13.9%, respectively (P=0.0013).

At 50 months, the overall survival was 99.2% in the arsenic trioxide arm and 92.6% in the chemotherapy arm (P=0.0073).

After induction, there were 2 relapses and 1 death in CR in the arsenic trioxide arm.

In the chemotherapy arm, there were 2 instances of molecular resistance after third consolidation, 15 relapses, 5 deaths in CR, and 2 patients who developed a therapy-related myeloid neoplasm.

The FP recognized a “Christmas tree” pattern on the patient’s back, which led to a diagnosis of pityriasis rosea. Because there are no lab tests to confirm pityriasis rosea, it is usually a clinical diagnosis.

The Christmas tree pattern that signals pityriasis rosea is caused by the long axis of the plaques following the skin lines of the back. While it is a helpful indicator of pityriasis rosea when present, most cases do not show this pattern. In this case, a collarette scale pattern was also visible. This is seen when scaling is visibly raised on the edge of the plaques, like the collar of a shirt.

Pityriasis rosea can be difficult to distinguish from secondary syphilis, which can also present as a papulosquamous eruption. Therefore, taking a sexual history is important when a diagnosis of pityriasis rosea is being considered. In patients with a history of sexually transmitted diseases or high-risk sexual practices, a rapid plasma reagin test should be ordered.

The FP assured the patient and his mother that the pityriasis rosea rash was not contagious, would not cause scarring, and would resolve in one to 2 months without any treatment. The patient declined any medication for the pruritus. At a subsequent visit for a sports physical, the skin was found to be completely clear with no evidence of scarring.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Henderson D, Usatine R. Pityriasis rosea. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 896-900.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

The FP recognized a “Christmas tree” pattern on the patient’s back, which led to a diagnosis of pityriasis rosea. Because there are no lab tests to confirm pityriasis rosea, it is usually a clinical diagnosis.

The Christmas tree pattern that signals pityriasis rosea is caused by the long axis of the plaques following the skin lines of the back. While it is a helpful indicator of pityriasis rosea when present, most cases do not show this pattern. In this case, a collarette scale pattern was also visible. This is seen when scaling is visibly raised on the edge of the plaques, like the collar of a shirt.

Pityriasis rosea can be difficult to distinguish from secondary syphilis, which can also present as a papulosquamous eruption. Therefore, taking a sexual history is important when a diagnosis of pityriasis rosea is being considered. In patients with a history of sexually transmitted diseases or high-risk sexual practices, a rapid plasma reagin test should be ordered.

The FP assured the patient and his mother that the pityriasis rosea rash was not contagious, would not cause scarring, and would resolve in one to 2 months without any treatment. The patient declined any medication for the pruritus. At a subsequent visit for a sports physical, the skin was found to be completely clear with no evidence of scarring.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Henderson D, Usatine R. Pityriasis rosea. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 896-900.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

The FP recognized a “Christmas tree” pattern on the patient’s back, which led to a diagnosis of pityriasis rosea. Because there are no lab tests to confirm pityriasis rosea, it is usually a clinical diagnosis.

The Christmas tree pattern that signals pityriasis rosea is caused by the long axis of the plaques following the skin lines of the back. While it is a helpful indicator of pityriasis rosea when present, most cases do not show this pattern. In this case, a collarette scale pattern was also visible. This is seen when scaling is visibly raised on the edge of the plaques, like the collar of a shirt.

Pityriasis rosea can be difficult to distinguish from secondary syphilis, which can also present as a papulosquamous eruption. Therefore, taking a sexual history is important when a diagnosis of pityriasis rosea is being considered. In patients with a history of sexually transmitted diseases or high-risk sexual practices, a rapid plasma reagin test should be ordered.

The FP assured the patient and his mother that the pityriasis rosea rash was not contagious, would not cause scarring, and would resolve in one to 2 months without any treatment. The patient declined any medication for the pruritus. At a subsequent visit for a sports physical, the skin was found to be completely clear with no evidence of scarring.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Henderson D, Usatine R. Pityriasis rosea. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 896-900.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

ANSWER

The correct answer is pityriasis rosea (choice “d”).

Virtually all patients with this condition believe that they have a terrible case of “ringworm” (ie, fungal infection; choice “a”)—an opinion all too often corroborated by the medical provider unacquainted with pityriasis rosea. The two can be difficult to distinguish, but the “herald” patch, oval shape, odd color, and fine scale all serve to confirm the diagnosis. When necessary, a KOH prep or biopsy can be done.

Psoriasis (choice “b”) can manifest acutely, but it is distinctly salmon-pink under coarse, white scale that affects the palms, nails (with pits), and scalp. Psoriasis lesions are round (rather than oval), with coarser scale and without a herald patch.

The lack of antecedent sores and denial of sexual contact ruled out secondary syphilis (choice “c”). Patients with secondary syphilis often present with low-grade fever, malaise, and palmar scaly papules—all of which were missing in this case. Syphilis serology (rapid plasma reagin) can be easily obtained if doubt persists.

DISCUSSION

Pityriasis rosea (PR) is a papulosquamous eruption that is common in younger populations. About 40% of affected patients pre­sent with a large scaly lesion, which is followed by the appearance of multiple smaller oval lesions within days. In most cases, PR is fairly easy to diagnose: the lesion’s oval shape, pinkish-brown color, centripetal fine scale, herald patch, and adherence to skin tension lines are all characteristic findings.

Though the exact organism has not been identified, PR is almost certainly viral in origin. Like many viral exanthems, occurrence tends to peak in the spring and fall. There are also indications that the body builds immunity to the infection, since recurrence outside the acute phase is rare.

Treatment options are unsatisfactory, though exposure to UV sources appears to help. Patients must be informed that their condition will, unfortunately, last for at least six to nine weeks, during which crops of lesions will come and go.

ANSWER

The correct answer is pityriasis rosea (choice “d”).

Virtually all patients with this condition believe that they have a terrible case of “ringworm” (ie, fungal infection; choice “a”)—an opinion all too often corroborated by the medical provider unacquainted with pityriasis rosea. The two can be difficult to distinguish, but the “herald” patch, oval shape, odd color, and fine scale all serve to confirm the diagnosis. When necessary, a KOH prep or biopsy can be done.

Psoriasis (choice “b”) can manifest acutely, but it is distinctly salmon-pink under coarse, white scale that affects the palms, nails (with pits), and scalp. Psoriasis lesions are round (rather than oval), with coarser scale and without a herald patch.

The lack of antecedent sores and denial of sexual contact ruled out secondary syphilis (choice “c”). Patients with secondary syphilis often present with low-grade fever, malaise, and palmar scaly papules—all of which were missing in this case. Syphilis serology (rapid plasma reagin) can be easily obtained if doubt persists.

DISCUSSION

Pityriasis rosea (PR) is a papulosquamous eruption that is common in younger populations. About 40% of affected patients pre­sent with a large scaly lesion, which is followed by the appearance of multiple smaller oval lesions within days. In most cases, PR is fairly easy to diagnose: the lesion’s oval shape, pinkish-brown color, centripetal fine scale, herald patch, and adherence to skin tension lines are all characteristic findings.

Though the exact organism has not been identified, PR is almost certainly viral in origin. Like many viral exanthems, occurrence tends to peak in the spring and fall. There are also indications that the body builds immunity to the infection, since recurrence outside the acute phase is rare.

Treatment options are unsatisfactory, though exposure to UV sources appears to help. Patients must be informed that their condition will, unfortunately, last for at least six to nine weeks, during which crops of lesions will come and go.

ANSWER

The correct answer is pityriasis rosea (choice “d”).

Virtually all patients with this condition believe that they have a terrible case of “ringworm” (ie, fungal infection; choice “a”)—an opinion all too often corroborated by the medical provider unacquainted with pityriasis rosea. The two can be difficult to distinguish, but the “herald” patch, oval shape, odd color, and fine scale all serve to confirm the diagnosis. When necessary, a KOH prep or biopsy can be done.

Psoriasis (choice “b”) can manifest acutely, but it is distinctly salmon-pink under coarse, white scale that affects the palms, nails (with pits), and scalp. Psoriasis lesions are round (rather than oval), with coarser scale and without a herald patch.

The lack of antecedent sores and denial of sexual contact ruled out secondary syphilis (choice “c”). Patients with secondary syphilis often present with low-grade fever, malaise, and palmar scaly papules—all of which were missing in this case. Syphilis serology (rapid plasma reagin) can be easily obtained if doubt persists.

DISCUSSION

Pityriasis rosea (PR) is a papulosquamous eruption that is common in younger populations. About 40% of affected patients pre­sent with a large scaly lesion, which is followed by the appearance of multiple smaller oval lesions within days. In most cases, PR is fairly easy to diagnose: the lesion’s oval shape, pinkish-brown color, centripetal fine scale, herald patch, and adherence to skin tension lines are all characteristic findings.

Though the exact organism has not been identified, PR is almost certainly viral in origin. Like many viral exanthems, occurrence tends to peak in the spring and fall. There are also indications that the body builds immunity to the infection, since recurrence outside the acute phase is rare.

Treatment options are unsatisfactory, though exposure to UV sources appears to help. Patients must be informed that their condition will, unfortunately, last for at least six to nine weeks, during which crops of lesions will come and go.

SAN FRANCISCO – Routine lab tests for estimating the average glomerular filtration rate (GFR) are too imprecise, according to Michael G. Shlipak, MD.

“If you study 100 patients, the average GFR based on creatinine is going to be pretty close to estimated GFR,” Dr. Shlipak said at the UCSF Annual Advances in Internal Medicine meeting. “But with individual patients, the average GFR is going to be plus or minus 30%, which is a lot. If the estimated GFR is 70 mL/min per 1.73 m², the real GFR could be between 50 and 90 mL/min per 1.73 m²; so that’s a wide range.”

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Routine lab tests for estimating the average glomerular filtration rate (GFR) are too imprecise, according to Michael G. Shlipak, MD.

“If you study 100 patients, the average GFR based on creatinine is going to be pretty close to estimated GFR,” Dr. Shlipak said at the UCSF Annual Advances in Internal Medicine meeting. “But with individual patients, the average GFR is going to be plus or minus 30%, which is a lot. If the estimated GFR is 70 mL/min per 1.73 m², the real GFR could be between 50 and 90 mL/min per 1.73 m²; so that’s a wide range.”

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Routine lab tests for estimating the average glomerular filtration rate (GFR) are too imprecise, according to Michael G. Shlipak, MD.

“If you study 100 patients, the average GFR based on creatinine is going to be pretty close to estimated GFR,” Dr. Shlipak said at the UCSF Annual Advances in Internal Medicine meeting. “But with individual patients, the average GFR is going to be plus or minus 30%, which is a lot. If the estimated GFR is 70 mL/min per 1.73 m², the real GFR could be between 50 and 90 mL/min per 1.73 m²; so that’s a wide range.”

dbrunk@frontlinemedcom.com

Patients in their 50s who have chronic epilepsy seem to have cognitive deficits that may be linked to metabolic, inflammatory, and vascular abnormalities, according to a clinical study that included 40 patients with chronic localized epilepsy and 152 controls.

• To reach that conclusion, researchers conducted neuropsychological assessment, clinical examination, and blood testing to evaluate patients’ vascular status.
• The evaluation included systolic and diastolic blood pressure, body mass index (BMI), high density lipoprotein, homocysteine levels, and inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), and interleukin-6.
• The metabolic assessment included measurement of insulin resistance by means of glucose levels and homeostatic model assessment of insulin resistance (HOMA-IR).
• Patients with epilepsy had impaired cognitive factor scores across the board.
• These patients also had abnormal BMI, hs-CRP, fasting glucose, and HOMA-IR.
• There was also a link between higher HOMA-IR and poor immediate memory and visuospatial ability.
• Elevated hs-CRP was associated with poorer visuospatial and verbal abilities.

Hermann BP, Sager MA, Koscik RL, Young K, Nakamura K. Vascular, inflammatory, and metabolic factors associated with cognition in aging persons with chronic epilepsy. [Published online ahead of print Sept 4, 2017]. Epilepsia. 

Patients in their 50s who have chronic epilepsy seem to have cognitive deficits that may be linked to metabolic, inflammatory, and vascular abnormalities, according to a clinical study that included 40 patients with chronic localized epilepsy and 152 controls.

• To reach that conclusion, researchers conducted neuropsychological assessment, clinical examination, and blood testing to evaluate patients’ vascular status.
• The evaluation included systolic and diastolic blood pressure, body mass index (BMI), high density lipoprotein, homocysteine levels, and inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), and interleukin-6.
• The metabolic assessment included measurement of insulin resistance by means of glucose levels and homeostatic model assessment of insulin resistance (HOMA-IR).
• Patients with epilepsy had impaired cognitive factor scores across the board.
• These patients also had abnormal BMI, hs-CRP, fasting glucose, and HOMA-IR.
• There was also a link between higher HOMA-IR and poor immediate memory and visuospatial ability.
• Elevated hs-CRP was associated with poorer visuospatial and verbal abilities.

Hermann BP, Sager MA, Koscik RL, Young K, Nakamura K. Vascular, inflammatory, and metabolic factors associated with cognition in aging persons with chronic epilepsy. [Published online ahead of print Sept 4, 2017]. Epilepsia. 

Patients in their 50s who have chronic epilepsy seem to have cognitive deficits that may be linked to metabolic, inflammatory, and vascular abnormalities, according to a clinical study that included 40 patients with chronic localized epilepsy and 152 controls.

• To reach that conclusion, researchers conducted neuropsychological assessment, clinical examination, and blood testing to evaluate patients’ vascular status.
• The evaluation included systolic and diastolic blood pressure, body mass index (BMI), high density lipoprotein, homocysteine levels, and inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), and interleukin-6.
• The metabolic assessment included measurement of insulin resistance by means of glucose levels and homeostatic model assessment of insulin resistance (HOMA-IR).
• Patients with epilepsy had impaired cognitive factor scores across the board.
• These patients also had abnormal BMI, hs-CRP, fasting glucose, and HOMA-IR.
• There was also a link between higher HOMA-IR and poor immediate memory and visuospatial ability.
• Elevated hs-CRP was associated with poorer visuospatial and verbal abilities.

Hermann BP, Sager MA, Koscik RL, Young K, Nakamura K. Vascular, inflammatory, and metabolic factors associated with cognition in aging persons with chronic epilepsy. [Published online ahead of print Sept 4, 2017]. Epilepsia. 

Patients who have seizures at night are more likely to die suddenly from epilepsy, according to a recent study that compared seizures occurring while patients were awake to those who experienced them during sleep.

• Researchers point out that patients with epilepsy are 20 times more likely to experience sudden death, compared with the general public.
• The most frequent risk factor for these deaths is uncontrolled seizures.
• Researchers tracked respiratory parameters, comparing adults with epilepsy during wake and sleep periods.
• Sleep-related seizures were linked to lower oxygen saturation when compared with wakeful seizures, and this association remained significant during the ictal and postictal periods.
• Sleep-related seizures were also associated with greater drops in saturation.
• Postseizure EEG suppression occurred more often after sleep-related seizures as well.
• Researchers concluded that sudden unexpected death in epilepsy (SUDEP) is more likely to happen during sleep and that it is linked to more severe and longer occurrences of hypoxemia.

 Latreille V, Abdennadher M, Dworetzky BA, et al. Nocturnal seizures are associated with more severe hypoxemia and increased risk of postictal generalized EEG suppression. Epilepsia. 2017;58(9):e127-e131.

Patients who have seizures at night are more likely to die suddenly from epilepsy, according to a recent study that compared seizures occurring while patients were awake to those who experienced them during sleep.

• Researchers point out that patients with epilepsy are 20 times more likely to experience sudden death, compared with the general public.
• The most frequent risk factor for these deaths is uncontrolled seizures.
• Researchers tracked respiratory parameters, comparing adults with epilepsy during wake and sleep periods.
• Sleep-related seizures were linked to lower oxygen saturation when compared with wakeful seizures, and this association remained significant during the ictal and postictal periods.
• Sleep-related seizures were also associated with greater drops in saturation.
• Postseizure EEG suppression occurred more often after sleep-related seizures as well.
• Researchers concluded that sudden unexpected death in epilepsy (SUDEP) is more likely to happen during sleep and that it is linked to more severe and longer occurrences of hypoxemia.

 Latreille V, Abdennadher M, Dworetzky BA, et al. Nocturnal seizures are associated with more severe hypoxemia and increased risk of postictal generalized EEG suppression. Epilepsia. 2017;58(9):e127-e131.

Patients who have seizures at night are more likely to die suddenly from epilepsy, according to a recent study that compared seizures occurring while patients were awake to those who experienced them during sleep.

• Researchers point out that patients with epilepsy are 20 times more likely to experience sudden death, compared with the general public.
• The most frequent risk factor for these deaths is uncontrolled seizures.
• Researchers tracked respiratory parameters, comparing adults with epilepsy during wake and sleep periods.
• Sleep-related seizures were linked to lower oxygen saturation when compared with wakeful seizures, and this association remained significant during the ictal and postictal periods.
• Sleep-related seizures were also associated with greater drops in saturation.
• Postseizure EEG suppression occurred more often after sleep-related seizures as well.
• Researchers concluded that sudden unexpected death in epilepsy (SUDEP) is more likely to happen during sleep and that it is linked to more severe and longer occurrences of hypoxemia.

 Latreille V, Abdennadher M, Dworetzky BA, et al. Nocturnal seizures are associated with more severe hypoxemia and increased risk of postictal generalized EEG suppression. Epilepsia. 2017;58(9):e127-e131.

An anion gap above 10, measured in the first 2 hours after a seizure, may help clinicians in the emergency department distinguish between psychogenic nonepileptic seizures (PNES) and generalized convulsive epileptic seizures (ES), according to an analysis of more than 1300 patients at a tertiary care center. Details of the analysis include the following:

• Investigators looked at anion gap, bicarbonate, and Denver Seizure Scores and found 27 patients with PNES and 27 with ES, using clinical signs and symptoms in conjunction with EEGs.
• Multivariate logistic regression helped detect a link between an anion gap above 10 and seizure type but also found that sensitivity and negative predictive value dropped off dramatically when samples were drawn more than 2 hours after the event.
• Anion gap values above 10 yielded a sensitivity of 81.8% and specificity of 100% when measured within 2 hours of the seizure.

Li Y, Matzka L, Maranda L, Weber D. Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting. Epilepsia. 2017;58(9):e132-e135.

An anion gap above 10, measured in the first 2 hours after a seizure, may help clinicians in the emergency department distinguish between psychogenic nonepileptic seizures (PNES) and generalized convulsive epileptic seizures (ES), according to an analysis of more than 1300 patients at a tertiary care center. Details of the analysis include the following:

• Investigators looked at anion gap, bicarbonate, and Denver Seizure Scores and found 27 patients with PNES and 27 with ES, using clinical signs and symptoms in conjunction with EEGs.
• Multivariate logistic regression helped detect a link between an anion gap above 10 and seizure type but also found that sensitivity and negative predictive value dropped off dramatically when samples were drawn more than 2 hours after the event.
• Anion gap values above 10 yielded a sensitivity of 81.8% and specificity of 100% when measured within 2 hours of the seizure.

Li Y, Matzka L, Maranda L, Weber D. Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting. Epilepsia. 2017;58(9):e132-e135.

An anion gap above 10, measured in the first 2 hours after a seizure, may help clinicians in the emergency department distinguish between psychogenic nonepileptic seizures (PNES) and generalized convulsive epileptic seizures (ES), according to an analysis of more than 1300 patients at a tertiary care center. Details of the analysis include the following:

• Investigators looked at anion gap, bicarbonate, and Denver Seizure Scores and found 27 patients with PNES and 27 with ES, using clinical signs and symptoms in conjunction with EEGs.
• Multivariate logistic regression helped detect a link between an anion gap above 10 and seizure type but also found that sensitivity and negative predictive value dropped off dramatically when samples were drawn more than 2 hours after the event.
• Anion gap values above 10 yielded a sensitivity of 81.8% and specificity of 100% when measured within 2 hours of the seizure.

Li Y, Matzka L, Maranda L, Weber D. Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting. Epilepsia. 2017;58(9):e132-e135.

LISBON – Patients with type 2 diabetes mellitus who also have moderate-to-severe chronic kidney disease (CKD) may be as effectively treated with the glucagonlike peptide–1 receptor agonist dulaglutide (Trulicity) as insulin glargine, the results of an international study showed.

Although comparable effects on glycemic control were seen, patients who received dulaglutide rather than insulin glargine in conjunction with prandial insulin lispro (Humalog) exhibited greater weight loss, had fewer episodes of hypoglycemia, and experienced beneficial effects on two important renal parameters.

Sara Freeman/Frontline Medical News

This article was updated September 28, 2017.

LISBON – Patients with type 2 diabetes mellitus who also have moderate-to-severe chronic kidney disease (CKD) may be as effectively treated with the glucagonlike peptide–1 receptor agonist dulaglutide (Trulicity) as insulin glargine, the results of an international study showed.

Although comparable effects on glycemic control were seen, patients who received dulaglutide rather than insulin glargine in conjunction with prandial insulin lispro (Humalog) exhibited greater weight loss, had fewer episodes of hypoglycemia, and experienced beneficial effects on two important renal parameters.

Sara Freeman/Frontline Medical News

This article was updated September 28, 2017.

LISBON – Patients with type 2 diabetes mellitus who also have moderate-to-severe chronic kidney disease (CKD) may be as effectively treated with the glucagonlike peptide–1 receptor agonist dulaglutide (Trulicity) as insulin glargine, the results of an international study showed.

Although comparable effects on glycemic control were seen, patients who received dulaglutide rather than insulin glargine in conjunction with prandial insulin lispro (Humalog) exhibited greater weight loss, had fewer episodes of hypoglycemia, and experienced beneficial effects on two important renal parameters.

Sara Freeman/Frontline Medical News

This article was updated September 28, 2017.