Patients with Rheumatic Diseases Bail on Biosimilars

Almost one-quarter (24%) of patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis who switched from infliximab (Remicade) to its biosimilar CT-P13 discontinued the biosimilar by 6 months, primarily for subjective reasons, Dutch researchers found.

"The discontinuation rate of 24% in the transition group is much higher than expected," the authors commented.

"In our view, the reason for the substantial discontinuation rate in open-label studies is the awareness of both patients and physicians of the transition to the biosimilar," they wrote.

In recent surveys, some patients expressed concerns about the safety and efficacy of biosimilars, suggesting that the lower cost might mean decreased efficacy.

"Pretreatment expectancy" is a recognized influence in treatment outcomes. "Patients' own negative expectations may induce negative symptoms (hyperalgesia or adverse events) during treatment, the so-called nocebo response," the researchers observed. In addition, adverse events that occur following the transition could be incorrectly attributed by patients to the treatment even if they are independent of the medication.

Mainstream telehealth needs vendors to address pain points

Many of us are impatient for a future where telehealth reduces our visits to health professionals. Whether you are geographically isolated, tired of waiting hours in a waiting room for an overdue appointment or simply have felt the pain of dragging yourself from your sick bed to a doctor’s surgery to acquire a sick note for an employer, consumers are keen to see a change. Current health providers are expanding their services to include remote health. Health tech startups such as mediconecta and couch are creating new stand-alone services for remote care.

However substantial barriers exist for telehealth in practice according to a new survey of the 114 chief information officers, IT directors, telehealth managers and other professionals by the College of Healthcare Information Management Executives and KLAS.

About 59% of respondents listed reimbursement as a limitation, noting that some payers have been slow to reimburse telehealth visits1 and or reimburse at rates lower than face-to-face care. Most said integration between their electronic medical record and virtual care platform vendor was nonexistent or unidirectional. They also cited improved patient access as a major benefit, and three-quarters reported that they were actively planning to either expand the number of specialties served or expand patient access to providers using their present solution.  

According to Adam Gale, president of KLAS: “Telehealth holds enormous promise. However, the underlying technology needs to evolve faster. In particular, integration of telehealth with provider EMRs is still at a primitive level. Vendors need to step up in terms of technology and improved support.” 

Dietary Supplement Dampens Brain Hyperexcitability Seen in Epilepsy

Another interesting pharmacological crossover. Lots of people take glucosamine.....

Seizure disorders — including epilepsy — are associated with pathological hyperexcitability in brain neurons. Unfortunately, there are limited available treatments that can prevent this hyperexcitability. However, University of Alabama at Birmingham researchers have found that inducing a biochemical alteration in brain proteins via the dietary supplement glucosamine was able to rapidly dampen that pathological hyperexcitability in rat and mouse models.

These results represent a potentially novel therapeutic target for the treatment of seizure disorders, and they show the need to better understand the physiology underlying these neural and brain circuit changes.

Proteins are the workhorses of living cells, and their activities are tightly and rapidly regulated in responses to changing conditions. Adding or removing a phosphoryl group to proteins is a well-known regulator for many proteins, and it is estimated that human proteins may have as many as 230,000 sites for phosphorylation.

An Alzheimer's Drug Has Been Found to Help Teeth Repair Themselves in Just 6 Weeks

Odd drug crossover effect of the week.......

Dental fillings may soon be left in the ash heap of history, thanks to a recent discovery about a drug called Tideglusib.

Developed for and trialled to treat Alzheimer's disease, the drug also happens to promote the natural tooth regrowth mechanism in mice, allowing the tooth to repair cavities.

Tideglusib works by stimulating stem cells in the pulp of teeth, the source of new dentine. Dentine is the mineralised substance beneath tooth enamel that gets eaten away by tooth decay.

Teeth can naturally regenerate dentine without assistance, but only under certain circumstances. The pulp must be exposed through infection (such as decay) or trauma to prompt the manufacture of dentine.

But even then, the tooth can only regrow a very thin layer naturally - not enough to repair cavities caused by decay, which are generally deep. Tideglusib changes this outcome because it turns off the GSK-3 enzyme, which stops dentine from forming.

In the research, the team inserted small, biodegradable sponges made of collagen soaked in Tideglusib into cavities. The sponges triggered dentine growth and within six weeks, the damage was repaired.

The collagen structure of the sponges melted away, leaving only the intact tooth.

Thus far, the procedure has only been used in mouse teeth.

Allergy Drug Improves Function in Patients with Chronic Injury from Multiple Sclerosis

In light of previous laboratory studies of the antihistamine compound at UCSF, the researchers said, the drug most likely exerted its effect by repairing damage MS had inflicted on myelin, an insulating membrane that speeds transmission of electrical signals in the nervous system.

The drug tested in the trial, clemastine fumarate, was first identified as a candidate treatment for MS in 2013 by UCSF’s Jonah R. Chan, PhD, Debbie and Andy Rachleff Distinguished Professor of Neurology, vice chief of the Division of Neuroinflammation and Glial Biology, and senior author of the new study. First approved by the U.S. Food and Drug Administration (FDA) in 1977 for allergies, the drug has been available over the counter in generic form since 1993.

The researchers said that the Phase II results, published online on Oct. 10, 2017, in The Lancet, are the first in which a drug has been shown to reliably restore any brain function damaged by a neurological disease in human patients.

“To the best of our knowledge this is the first time a therapy has been able to reverse deficits caused by MS. It’s not a cure, but it’s a first step towards restoring brain function to the millions who are affected by this chronic, debilitating disease,” said the trial’s principal investigator, Ari Green, MD, also Debbie and Andy Rachleff Distinguished Professor of Neurology, chief of the Division of Neuroinflammation and Glial Biology, and medical director of the UCSF Multiple Sclerosis and Neuroinflammation Center.

Chan and Green are co-directors of the UCSF Small-Molecule Program for Remyelination, and both are members of the UCSF Weill Institute for Neurosciences.

The new results are particularly notable, Chan said, because patients in the trial had suffered from MS symptoms caused by injury to myelin for years. “People thought we were absolutely crazy to launch this trial, because they thought that only in newly diagnosed cases could a drug like this be effective – intuitively, if myelin damage is new, the chance of repair is strong. In the patients in our trial the disease had gone on for years, but we still saw strong evidence of repair.”

Scientists reverse advanced heart failure in an animal model

This is an exciting possibility. Heart failure is debilitating and lacks effective restorative treatments.....

This is a video

Researchers have discovered a previously unrecognized healing capacity of the heart. In a mouse model, they were able to reverse severe heart failure by silencing the activity of Hippo, a signaling pathway that can prevent the regeneration of heart muscle. Read more: 

Original Article:

On UTI Front, Chicken Dinner is No Winner

This is a little bizarre......

For years, researchers have been trying to confirm an apparent link between the Escherichia coli in poultry and urinary tract infections (UTIs) in humans. Now, there's another hint of a connection between contamination back on the farm and nasty germs in our bladders.

Researchers who examined meat from retail stores in California and urine from patients with UTIs found that nearly 25% of chicken and turkey samples shared the same genotypes that were found in the urine samples, according to Reina Yamaji, MD, PhD, of the University of California at Berkeley.

Analysis showed 72 E coli genotypes that were unique to retail meat, 49 genotypes unique to human UTIs, and 12 shared genotypes, Yamaji reported at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

Of the six most common E coli genotypes in humans, three of them were found in both retail meat and humans, she said.

The findings don't solve the mystery of whether the meats we eat -- especially poultry -- are directly related to human UTIs, an outside expert told MedPage Today.

"Evidence is growing, but a direct link has not been made yet," according to Amee Manges, PhD, of the University of British Columbia School of Population and Public Health in Vancouver. Still, she said, "these results add to the existing body of research."

Study Questions Durability of MMR Vaccine

The effectiveness of the mumps vaccine wanes at an average of 27 years after the last dose, potentially explaining the resurgence of cases over the past 11 years, researchers said here.

According to an analysis of epidemiological studies, the introduction of the measles-mumps-rubella (MMR) vaccine in the 1960s lowered case rates by more than 99%, according to the CDC, and annual cases in recent years have typically numbered in the hundreds, reported Joseph Lewnard, PhD, and Yonathan H. Grad, MD, PhD, both of the Harvard TH Chan School of Public Health in Boston.

But mumps cases spiked in 2006 and again in 2016 and 2017, they said in a presentation at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

The findings point to the need for booster doses in adults, according to Lewnard. "If you want to put mumps on the track to elimination, it's not an unreasonable expectation," he stated.

"We've largely eliminated it, but the [MMR] vaccine is not a perfect dose," said Paul Offit, MD, of the Children's Hospital of Philadelphia, to MedPage Today.

The CDC received reports of more than 6,300 cases in 2016 compared with just 229 in 2012.

Healthcare-Associated Infection Rates Wane Over Time

But notes which infections have declined and which haven't....

Hospitals appear to be doing better at preventing healthcare-associated infections (HAIs), a researcher said here.

A 2015 update of a 2011 point-prevalence survey showed a significant drop in HAIs over time, suggesting that national efforts to prevent the infections are having an effect, according to Shelley Magill, MD, PhD, of the CDC's Emerging Infections Program (EIP) in Atlanta.

The decline was driven by sharp drops in skin and soft tissue infections and urinary tract infections (UTI), Magill said at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

But some important conditions, notably pneumonia and Clostridium difficile infection, did not change significantly, suggesting there's more work to be done, Magill said.

You Don’t Need to Do a Prolonged Fast Before Surgery 

By the 1960s the term nil by mouth (or its Latin variant NPO, nil per os) after midnight had become the widely accepted guideline for all surgical patients. If you recently had an elective procedure, you might know that it has not changed much since—fasting before surgery, meaning no food and no water, is still advice routinely given to preoperative patients. Yet the evidence—and medical practice, and even the recommendations—have evolved since Mendelson. Medical practice has yet to catch up.

For one thing, anesthesiologists no longer use ether, a substance known to make patients nauseated. They also employ endotracheal tubes, which protect the airways from the aspiration of stomach contents. Knowledge about digestion has increased to the point where the rate of calories leaving the stomach is predictable: A spate of studies on gastric emptying found that patients who consume clear fluids two hours prior to an operation do not have higher gastric volumes than those who fast for longer. In 1999, the tide of mounting evidence pushed the American Society of Anesthesiologists to amend its preoperative fasting guidelines: Patients are now instructed to have a light meal six hours before a procedure and clear fluids—drinks that you can see through, such as pulp-free juices, black coffee, or tea without milk and cream—until two hours prior to the operation. Guidelines in other countries were similarly amended.

Nevertheless, most patients appear to still be getting outdated advice and arrive to surgery thirsty and irritable. A presentation at the 2016 Anesthesiology Annual Meeting found that only 25 percent of hospitals in Michigan adhered to the new guidelines. A 2016 study of oral and maxillofacial surgeons found that 99.1 percent of them did not adopt ASA guidelines, and a worrying analysis of pediatric practices discovered that most children were fasting longer than necessary before their medical procedures, leading to negative experiences. Prolonged fasting can be associated with dehydration, hypoglycemia, and electrolyte imbalance. Some patients experience headaches and nausea before surgery.