Bianca Nogrady

A stepped-care intervention balancing pain relief, self-management strategies, and cognitive-behavioral therapy achieves significant improvements in chronic pain compared with usual care by pharmacological and nonpharmacological means, according to a paper published in JAMA Internal Medicine.

A randomized, controlled trial of 241 veterans with chronic and disabling musculoskeletal pain found that veterans of the Iraq and Afghanistan conflicts treated with the stepped intervention experienced a more than twofold greater reduction in Roland Morris Disability Scale and Graded Chronic Pain Scale severity scores, compared to those in the control arm (–3.7 vs. –1.7, P = .002, and –11.1 vs. –4.5, P = .001) at 9 months after randomization.

The intervention involved 12 weeks of optimized analgesic therapy combined with the teaching of pain self-management strategies, followed by an additional 12 weeks including adapted cognitive-behavioral therapy (JAMA Intern. Med. 2015 March 9 [doi:10.1001/jamainternmed.2015.97]).

“The patients spoke about their evolving understanding of their pain experience during the trial and how this new understanding helped them manage their pain more effectively,” wrote Dr. Matthew J. Bair of the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, and his associates.

Among the limitations cited by Dr. Bair is that the participants were recent veterans with chronic musculoskeletal pain, so the results might not be generalizable to veterans from earlier wars or to nonveterans.

The study was supported by Veterans Affairs Rehabilitation Research and Development, and one author reported unrelated honoraria from Eli Lilly.

A stepped-care intervention balancing pain relief, self-management strategies, and cognitive-behavioral therapy achieves significant improvements in chronic pain compared with usual care by pharmacological and nonpharmacological means, according to a paper published in JAMA Internal Medicine.

A randomized, controlled trial of 241 veterans with chronic and disabling musculoskeletal pain found that veterans of the Iraq and Afghanistan conflicts treated with the stepped intervention experienced a more than twofold greater reduction in Roland Morris Disability Scale and Graded Chronic Pain Scale severity scores, compared to those in the control arm (–3.7 vs. –1.7, P = .002, and –11.1 vs. –4.5, P = .001) at 9 months after randomization.

The intervention involved 12 weeks of optimized analgesic therapy combined with the teaching of pain self-management strategies, followed by an additional 12 weeks including adapted cognitive-behavioral therapy (JAMA Intern. Med. 2015 March 9 [doi:10.1001/jamainternmed.2015.97]).

“The patients spoke about their evolving understanding of their pain experience during the trial and how this new understanding helped them manage their pain more effectively,” wrote Dr. Matthew J. Bair of the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, and his associates.

Among the limitations cited by Dr. Bair is that the participants were recent veterans with chronic musculoskeletal pain, so the results might not be generalizable to veterans from earlier wars or to nonveterans.

The study was supported by Veterans Affairs Rehabilitation Research and Development, and one author reported unrelated honoraria from Eli Lilly.

A stepped-care intervention balancing pain relief, self-management strategies, and cognitive-behavioral therapy achieves significant improvements in chronic pain compared with usual care by pharmacological and nonpharmacological means, according to a paper published in JAMA Internal Medicine.

A randomized, controlled trial of 241 veterans with chronic and disabling musculoskeletal pain found that veterans of the Iraq and Afghanistan conflicts treated with the stepped intervention experienced a more than twofold greater reduction in Roland Morris Disability Scale and Graded Chronic Pain Scale severity scores, compared to those in the control arm (–3.7 vs. –1.7, P = .002, and –11.1 vs. –4.5, P = .001) at 9 months after randomization.

The intervention involved 12 weeks of optimized analgesic therapy combined with the teaching of pain self-management strategies, followed by an additional 12 weeks including adapted cognitive-behavioral therapy (JAMA Intern. Med. 2015 March 9 [doi:10.1001/jamainternmed.2015.97]).

“The patients spoke about their evolving understanding of their pain experience during the trial and how this new understanding helped them manage their pain more effectively,” wrote Dr. Matthew J. Bair of the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, and his associates.

Among the limitations cited by Dr. Bair is that the participants were recent veterans with chronic musculoskeletal pain, so the results might not be generalizable to veterans from earlier wars or to nonveterans.

The study was supported by Veterans Affairs Rehabilitation Research and Development, and one author reported unrelated honoraria from Eli Lilly.

A monoclonal antibody targeting an interleukin-23 subunit has shown a significant reduction in psoriasis area and disease severity in 77 psoriasis patients, according to data from a randomized, placebo-controlled phase I trial.

Three doses of intravenous tildrakizumab (0.05–10 mg/kg1) – given 1-2 months apart – were associated with 50%-80% reductions in mean placebo-corrected psoriasis area and severity index (PASI) scores at 112 days after commencing treatment, and was well tolerated with minor adverse events.

Researchers observed 50% reductions in PASI score 308 days after the last administered dose, and all subjects given 3 or 10 mg/kg achieved a 75% reduction in PASI score by day 196, according to a paper published online March 9 in Nature (doi: 10.1038/nature14175).

“Further development of tildrakizumab is warranted based on these results to determine whether selective targeting of IL-23 can provide similar or better efficacy while reducing safety concerns that are associated with other biologic agents currently approved for the treatment of psoriasis,” wrote Dr. Tamara Kopp, from the Juvenis Medical Center, Vienna, and coauthors.

The study was funded by tildrakizumab-developer Merck & Co. Inc, and several authors were employees of Merck & Co. Inc.

A monoclonal antibody targeting an interleukin-23 subunit has shown a significant reduction in psoriasis area and disease severity in 77 psoriasis patients, according to data from a randomized, placebo-controlled phase I trial.

Three doses of intravenous tildrakizumab (0.05–10 mg/kg1) – given 1-2 months apart – were associated with 50%-80% reductions in mean placebo-corrected psoriasis area and severity index (PASI) scores at 112 days after commencing treatment, and was well tolerated with minor adverse events.

Researchers observed 50% reductions in PASI score 308 days after the last administered dose, and all subjects given 3 or 10 mg/kg achieved a 75% reduction in PASI score by day 196, according to a paper published online March 9 in Nature (doi: 10.1038/nature14175).

“Further development of tildrakizumab is warranted based on these results to determine whether selective targeting of IL-23 can provide similar or better efficacy while reducing safety concerns that are associated with other biologic agents currently approved for the treatment of psoriasis,” wrote Dr. Tamara Kopp, from the Juvenis Medical Center, Vienna, and coauthors.

The study was funded by tildrakizumab-developer Merck & Co. Inc, and several authors were employees of Merck & Co. Inc.

A monoclonal antibody targeting an interleukin-23 subunit has shown a significant reduction in psoriasis area and disease severity in 77 psoriasis patients, according to data from a randomized, placebo-controlled phase I trial.

Three doses of intravenous tildrakizumab (0.05–10 mg/kg1) – given 1-2 months apart – were associated with 50%-80% reductions in mean placebo-corrected psoriasis area and severity index (PASI) scores at 112 days after commencing treatment, and was well tolerated with minor adverse events.

Researchers observed 50% reductions in PASI score 308 days after the last administered dose, and all subjects given 3 or 10 mg/kg achieved a 75% reduction in PASI score by day 196, according to a paper published online March 9 in Nature (doi: 10.1038/nature14175).

“Further development of tildrakizumab is warranted based on these results to determine whether selective targeting of IL-23 can provide similar or better efficacy while reducing safety concerns that are associated with other biologic agents currently approved for the treatment of psoriasis,” wrote Dr. Tamara Kopp, from the Juvenis Medical Center, Vienna, and coauthors.

The study was funded by tildrakizumab-developer Merck & Co. Inc, and several authors were employees of Merck & Co. Inc.

Patients coinfected with HIV and hepatitis C genotype 1 show high response rates to a three-drug regimen of ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir, plus ribavirin, according to an open-label, uncontrolled pilot study published in JAMA.

Among the 63 patients – who were either HCV treatment-naive or had previously experienced treatment failure with peginteferon plus ribavirin – treated with the all-oral ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir (known as 3D) plus ribavirin regimen, 94% of those treated for 12 weeks and 91% of those treated for 24 weeks achieved a sustained virologic response 12 weeks (SVR12) after treatment.

There were no confirmed HIV breakthroughs or serious adverse events – even though the study group included some patients with compensated cirrhosis – although around half of patients experienced treatment-related fatigue, 19% experienced insomnia, 18% experienced nausea, and 16% experienced headache (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1328]).

“The efficacy and safety of the 3D-plus-ribavirin regimen for patients co-infected with HCV/HIV-1 need to be further investigated in larger studies; however, response rates reported here are similar to those in studies of HCV-monoinfected patients, which suggest that difficult-to-cure patients, such as prior [pegylated interferon] null responders with cirrhosis and HCV genotype 1a, may benefit from longer treatment duration,” wrote Dr. Mark S. Sulkowski, director of the viral hepatitis center and professor of medicine at Johns Hopkins University, Baltimore, and his colleagues.

In another study, researchers found that a 12-week course of a fixed-dose combination of ledipasvir and sofosbuvir in treatment-naive patients with hepatitis C genotype 1 and HIV coinfection achieved sustained virologic response rates of 98% at 12 weeks after treatment.

The open-label, phase 2b study in 50 patients recorded one case of relapse at week 4, which may have been linked to resistance-associated mutation, but no discontinuations or serious adverse events attributable to the study drug (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1373]).

The study excluded individuals with cirrhosis, but many participants had poor prognostic factors, including African American race, male sex, IL28B non-CC genotype, and genotype 1a infection.

“These results show for the first time, to our knowledge, that an interferon- and ribavirin-free therapy is associated with high SVR rates in patients co-infected with HCV and HIV,” wrote Dr. Anu Osinusi of the University of Maryland, Baltimore, and her colleagues.

Dr. Sulkowski’s study was funded by AbbVie. Some of his coauthors declared a range of funding and consultancies from pharmaceutical companies including AbbVie and several coauthors are employees of AbbVie.

Dr. Osinusi’s study was funded by the National Institutes of Health, the German Research Foundation, and Gilead Sciences. Four coauthors reported speaking engagements, consultancies, fees, grants, stocks and other support from pharmaceutical companies including Gilead.

Patients coinfected with HIV and hepatitis C genotype 1 show high response rates to a three-drug regimen of ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir, plus ribavirin, according to an open-label, uncontrolled pilot study published in JAMA.

Among the 63 patients – who were either HCV treatment-naive or had previously experienced treatment failure with peginteferon plus ribavirin – treated with the all-oral ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir (known as 3D) plus ribavirin regimen, 94% of those treated for 12 weeks and 91% of those treated for 24 weeks achieved a sustained virologic response 12 weeks (SVR12) after treatment.

There were no confirmed HIV breakthroughs or serious adverse events – even though the study group included some patients with compensated cirrhosis – although around half of patients experienced treatment-related fatigue, 19% experienced insomnia, 18% experienced nausea, and 16% experienced headache (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1328]).

“The efficacy and safety of the 3D-plus-ribavirin regimen for patients co-infected with HCV/HIV-1 need to be further investigated in larger studies; however, response rates reported here are similar to those in studies of HCV-monoinfected patients, which suggest that difficult-to-cure patients, such as prior [pegylated interferon] null responders with cirrhosis and HCV genotype 1a, may benefit from longer treatment duration,” wrote Dr. Mark S. Sulkowski, director of the viral hepatitis center and professor of medicine at Johns Hopkins University, Baltimore, and his colleagues.

In another study, researchers found that a 12-week course of a fixed-dose combination of ledipasvir and sofosbuvir in treatment-naive patients with hepatitis C genotype 1 and HIV coinfection achieved sustained virologic response rates of 98% at 12 weeks after treatment.

The open-label, phase 2b study in 50 patients recorded one case of relapse at week 4, which may have been linked to resistance-associated mutation, but no discontinuations or serious adverse events attributable to the study drug (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1373]).

The study excluded individuals with cirrhosis, but many participants had poor prognostic factors, including African American race, male sex, IL28B non-CC genotype, and genotype 1a infection.

“These results show for the first time, to our knowledge, that an interferon- and ribavirin-free therapy is associated with high SVR rates in patients co-infected with HCV and HIV,” wrote Dr. Anu Osinusi of the University of Maryland, Baltimore, and her colleagues.

Dr. Sulkowski’s study was funded by AbbVie. Some of his coauthors declared a range of funding and consultancies from pharmaceutical companies including AbbVie and several coauthors are employees of AbbVie.

Dr. Osinusi’s study was funded by the National Institutes of Health, the German Research Foundation, and Gilead Sciences. Four coauthors reported speaking engagements, consultancies, fees, grants, stocks and other support from pharmaceutical companies including Gilead.

Patients coinfected with HIV and hepatitis C genotype 1 show high response rates to a three-drug regimen of ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir, plus ribavirin, according to an open-label, uncontrolled pilot study published in JAMA.

Among the 63 patients – who were either HCV treatment-naive or had previously experienced treatment failure with peginteferon plus ribavirin – treated with the all-oral ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir (known as 3D) plus ribavirin regimen, 94% of those treated for 12 weeks and 91% of those treated for 24 weeks achieved a sustained virologic response 12 weeks (SVR12) after treatment.

There were no confirmed HIV breakthroughs or serious adverse events – even though the study group included some patients with compensated cirrhosis – although around half of patients experienced treatment-related fatigue, 19% experienced insomnia, 18% experienced nausea, and 16% experienced headache (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1328]).

“The efficacy and safety of the 3D-plus-ribavirin regimen for patients co-infected with HCV/HIV-1 need to be further investigated in larger studies; however, response rates reported here are similar to those in studies of HCV-monoinfected patients, which suggest that difficult-to-cure patients, such as prior [pegylated interferon] null responders with cirrhosis and HCV genotype 1a, may benefit from longer treatment duration,” wrote Dr. Mark S. Sulkowski, director of the viral hepatitis center and professor of medicine at Johns Hopkins University, Baltimore, and his colleagues.

In another study, researchers found that a 12-week course of a fixed-dose combination of ledipasvir and sofosbuvir in treatment-naive patients with hepatitis C genotype 1 and HIV coinfection achieved sustained virologic response rates of 98% at 12 weeks after treatment.

The open-label, phase 2b study in 50 patients recorded one case of relapse at week 4, which may have been linked to resistance-associated mutation, but no discontinuations or serious adverse events attributable to the study drug (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1373]).

The study excluded individuals with cirrhosis, but many participants had poor prognostic factors, including African American race, male sex, IL28B non-CC genotype, and genotype 1a infection.

“These results show for the first time, to our knowledge, that an interferon- and ribavirin-free therapy is associated with high SVR rates in patients co-infected with HCV and HIV,” wrote Dr. Anu Osinusi of the University of Maryland, Baltimore, and her colleagues.

Dr. Sulkowski’s study was funded by AbbVie. Some of his coauthors declared a range of funding and consultancies from pharmaceutical companies including AbbVie and several coauthors are employees of AbbVie.

Dr. Osinusi’s study was funded by the National Institutes of Health, the German Research Foundation, and Gilead Sciences. Four coauthors reported speaking engagements, consultancies, fees, grants, stocks and other support from pharmaceutical companies including Gilead.

The annual hospitalization rate for community-acquired pneumonia in children is 15.7 cases per 10,000, according to a prospective population-based study that found the hospitalization burden was greatest in those aged under 5 years.

The multicenter EPIC study of 2,358 children hospitalized with pneumonia showed that about half had an underlying condition such as asthma or reactive airways disease, according to a paper published online in the New England Journal of Medicine.

A pathogen was detected in 81% of cases, the most common of which were respiratory syncytial virus (28%) – most prevalent in children aged under 2 years – human rhinovirus (27%), human metapneumovirus (13%), adenovirus (11%), and Mycoplasma pneumoniae (8%) (N. Engl. J. Med. 2015;372:835-45.

“The burden of community-acquired pneumonia in children was associated with multiple different and codetected pathogens, underscoring a need for the enhancement of sensitive, inexpensive, and rapid diagnostic tests to accurately identify pneumonia pathogens,” wrote Dr. Seema Jain of the Centers for Disease Control and Prevention, and associates.

The CDC supported the study. Several authors reported grants and personal fees from the CDC and from the pharmaceutical industry, and one reported a patent relating to a reovirus vaccine.

The annual hospitalization rate for community-acquired pneumonia in children is 15.7 cases per 10,000, according to a prospective population-based study that found the hospitalization burden was greatest in those aged under 5 years.

The multicenter EPIC study of 2,358 children hospitalized with pneumonia showed that about half had an underlying condition such as asthma or reactive airways disease, according to a paper published online in the New England Journal of Medicine.

A pathogen was detected in 81% of cases, the most common of which were respiratory syncytial virus (28%) – most prevalent in children aged under 2 years – human rhinovirus (27%), human metapneumovirus (13%), adenovirus (11%), and Mycoplasma pneumoniae (8%) (N. Engl. J. Med. 2015;372:835-45.

“The burden of community-acquired pneumonia in children was associated with multiple different and codetected pathogens, underscoring a need for the enhancement of sensitive, inexpensive, and rapid diagnostic tests to accurately identify pneumonia pathogens,” wrote Dr. Seema Jain of the Centers for Disease Control and Prevention, and associates.

The CDC supported the study. Several authors reported grants and personal fees from the CDC and from the pharmaceutical industry, and one reported a patent relating to a reovirus vaccine.

The annual hospitalization rate for community-acquired pneumonia in children is 15.7 cases per 10,000, according to a prospective population-based study that found the hospitalization burden was greatest in those aged under 5 years.

The multicenter EPIC study of 2,358 children hospitalized with pneumonia showed that about half had an underlying condition such as asthma or reactive airways disease, according to a paper published online in the New England Journal of Medicine.

A pathogen was detected in 81% of cases, the most common of which were respiratory syncytial virus (28%) – most prevalent in children aged under 2 years – human rhinovirus (27%), human metapneumovirus (13%), adenovirus (11%), and Mycoplasma pneumoniae (8%) (N. Engl. J. Med. 2015;372:835-45.

“The burden of community-acquired pneumonia in children was associated with multiple different and codetected pathogens, underscoring a need for the enhancement of sensitive, inexpensive, and rapid diagnostic tests to accurately identify pneumonia pathogens,” wrote Dr. Seema Jain of the Centers for Disease Control and Prevention, and associates.

The CDC supported the study. Several authors reported grants and personal fees from the CDC and from the pharmaceutical industry, and one reported a patent relating to a reovirus vaccine.

Lower respiratory illness in childhood is associated with later development of asthma and wheeze that can persist into adulthood, and that are considered risk factors for adult chronic obstructive pulmonary disease, a prospective study has found.

Researchers assessed the lung function of 646 children – 338 of whom had experienced lower respiratory illness (LRI) before age 2 and 308 controls – and found those who had early pneumonia had a nearly twofold increase in the risk of asthma and wheeze up to age 26.

© Louis-Paul St-Onge/iStockphoto

They also had the most severe subsequent deficits in lung function, while those with early nonpneumonia LRI had smaller but still significant impairments in lung function and an increased risk of wheeze, according to a report published online March 2 in Pediatrics (2015;135 [doi:10.1542/peds.2014-3060]).

The children who were included in this study were part of a birth cohort of 1,246 healthy infants enrolled between 1980 and 1984 in the Tucson Children’s Respiratory Study.

Participants included in the current study were required to have complete follow-up for LRIs during the first 3 years of life and to have at least one pulmonary function test completed at ages 11, 16, 22, or 26 years.

Physician-diagnosed asthma with active symptoms and active wheeze during the previous year were assessed prospectively by questionnaires completed by the participant’s parents at ages 11, 13, and 16 years and by the participant at ages 18, 22, 24, 26, and 29 years, according to the researchers.

After the investigators adjusted for covariates, participants with early pneumonia had a significantly higher risk of active physician-diagnosed asthma (odds ratio: 1.95; 95% confidence interval: 1.11-3.44) during the previous year up to age 29 years, compared with those with no LRI during early life.

Early pneumonia was also associated with a significantly increased risk of active wheeze during the previous year up to age 29 years (OR: 1.94; 95% CI: 1.28-2.95) as were other LRIs, although the association with the latter was much weaker than that for pneumonia (OR: 1.37; 95% CI: 1.09-1.72), according to the authors.

“Because there is considerable evidence that asthma associated with airflow limitation is a strong risk factor for subsequent chronic obstructive pulmonary disease, the prevention of early-life pneumonia and of the factors that determine low lung function in infancy may contribute significantly to decrease the public health burden of chronic obstructive pulmonary disease,” wrote Dr. Johnny Y.C. Chan of Kwong Wah Hospital, Kowloon, Hong Kong, and the University of Arizona, Tucson, and his coauthors.

The study was funded by the National Institutes of Health, and no conflicts of interest were declared.

Lower respiratory illness in childhood is associated with later development of asthma and wheeze that can persist into adulthood, and that are considered risk factors for adult chronic obstructive pulmonary disease, a prospective study has found.

Researchers assessed the lung function of 646 children – 338 of whom had experienced lower respiratory illness (LRI) before age 2 and 308 controls – and found those who had early pneumonia had a nearly twofold increase in the risk of asthma and wheeze up to age 26.

© Louis-Paul St-Onge/iStockphoto

They also had the most severe subsequent deficits in lung function, while those with early nonpneumonia LRI had smaller but still significant impairments in lung function and an increased risk of wheeze, according to a report published online March 2 in Pediatrics (2015;135 [doi:10.1542/peds.2014-3060]).

The children who were included in this study were part of a birth cohort of 1,246 healthy infants enrolled between 1980 and 1984 in the Tucson Children’s Respiratory Study.

Participants included in the current study were required to have complete follow-up for LRIs during the first 3 years of life and to have at least one pulmonary function test completed at ages 11, 16, 22, or 26 years.

Physician-diagnosed asthma with active symptoms and active wheeze during the previous year were assessed prospectively by questionnaires completed by the participant’s parents at ages 11, 13, and 16 years and by the participant at ages 18, 22, 24, 26, and 29 years, according to the researchers.

After the investigators adjusted for covariates, participants with early pneumonia had a significantly higher risk of active physician-diagnosed asthma (odds ratio: 1.95; 95% confidence interval: 1.11-3.44) during the previous year up to age 29 years, compared with those with no LRI during early life.

Early pneumonia was also associated with a significantly increased risk of active wheeze during the previous year up to age 29 years (OR: 1.94; 95% CI: 1.28-2.95) as were other LRIs, although the association with the latter was much weaker than that for pneumonia (OR: 1.37; 95% CI: 1.09-1.72), according to the authors.

“Because there is considerable evidence that asthma associated with airflow limitation is a strong risk factor for subsequent chronic obstructive pulmonary disease, the prevention of early-life pneumonia and of the factors that determine low lung function in infancy may contribute significantly to decrease the public health burden of chronic obstructive pulmonary disease,” wrote Dr. Johnny Y.C. Chan of Kwong Wah Hospital, Kowloon, Hong Kong, and the University of Arizona, Tucson, and his coauthors.

The study was funded by the National Institutes of Health, and no conflicts of interest were declared.

Lower respiratory illness in childhood is associated with later development of asthma and wheeze that can persist into adulthood, and that are considered risk factors for adult chronic obstructive pulmonary disease, a prospective study has found.

Researchers assessed the lung function of 646 children – 338 of whom had experienced lower respiratory illness (LRI) before age 2 and 308 controls – and found those who had early pneumonia had a nearly twofold increase in the risk of asthma and wheeze up to age 26.

© Louis-Paul St-Onge/iStockphoto

They also had the most severe subsequent deficits in lung function, while those with early nonpneumonia LRI had smaller but still significant impairments in lung function and an increased risk of wheeze, according to a report published online March 2 in Pediatrics (2015;135 [doi:10.1542/peds.2014-3060]).

The children who were included in this study were part of a birth cohort of 1,246 healthy infants enrolled between 1980 and 1984 in the Tucson Children’s Respiratory Study.

Participants included in the current study were required to have complete follow-up for LRIs during the first 3 years of life and to have at least one pulmonary function test completed at ages 11, 16, 22, or 26 years.

Physician-diagnosed asthma with active symptoms and active wheeze during the previous year were assessed prospectively by questionnaires completed by the participant’s parents at ages 11, 13, and 16 years and by the participant at ages 18, 22, 24, 26, and 29 years, according to the researchers.

After the investigators adjusted for covariates, participants with early pneumonia had a significantly higher risk of active physician-diagnosed asthma (odds ratio: 1.95; 95% confidence interval: 1.11-3.44) during the previous year up to age 29 years, compared with those with no LRI during early life.

Early pneumonia was also associated with a significantly increased risk of active wheeze during the previous year up to age 29 years (OR: 1.94; 95% CI: 1.28-2.95) as were other LRIs, although the association with the latter was much weaker than that for pneumonia (OR: 1.37; 95% CI: 1.09-1.72), according to the authors.

“Because there is considerable evidence that asthma associated with airflow limitation is a strong risk factor for subsequent chronic obstructive pulmonary disease, the prevention of early-life pneumonia and of the factors that determine low lung function in infancy may contribute significantly to decrease the public health burden of chronic obstructive pulmonary disease,” wrote Dr. Johnny Y.C. Chan of Kwong Wah Hospital, Kowloon, Hong Kong, and the University of Arizona, Tucson, and his coauthors.

The study was funded by the National Institutes of Health, and no conflicts of interest were declared.

Researchers have identified unique plasma immune signatures that appear earlier in the course of myalgic encephalomyelitis – also known as chronic fatigue syndrome – but which are not present in individuals with a longer duration of illness or healthy controls.

Analysis of data from two large, multicenter cohort studies in 298 cases and 348 controls showed that patients with shorter duration of illness were more than 100 times more likely to have a higher level of interferon-gamma (odds ratio, 104.777; 95% confidence interval, 6.975-1574.021; P = .001) and 50% more likely to have a higher level of interleukin (IL)-12p40 (OR, 1.501; 95% CI, 1.075-2.096; P = .017) than were those with a longer duration of illness.

Overall, researchers noted significant differences in more than half the 51 cytokines studied according to the duration of illness, finding that individuals with shorter illness duration (3 or fewer years; 52 patients) generally had higher cytokine levels than did those with longer duration (246 patients), Dr. Mady Hornig of Columbia University, New York, and coauthors reported online Feb. 27 in Science Advances.

Compared with healthy controls, patients with a shorter duration of illness had significantly elevated classical proinflammatory cytokines, such as IL-1a, IL-8, IL-12, IL-17A, and TNF-alpha, and anti-inflammatory cytokines such as IL-1 receptor antagonist, IL-4, and IL-13.

However, they also had reduced levels of CD40 ligand (CD40L) and platelet-derived growth factor BB (PDGFBB), compared with controls (Sci. Adv. 2015;1:e1400121 [doi:10.1126/sciadv.1400121]).

“For cytokines that differed between short- and long-duration groups, levels were correlated with duration of illness, and in the expected direction: inverse correlations with duration of illness for cytokines that were increased in the short-duration group, and positive correlations for the two cytokines with reduced levels in the short-duration group,” the investigators wrote.

But when long-duration subjects were compared with healthy controls, the opposite was true; those cytokines that were elevated in patients with short-duration illness, compared with controls, were lower than controls in patients with long-duration illness, with the exception of CD40L and PDGFBB.

When patients with short and long duration of illness were combined into one group, the analysis showed no significant differences in plasma immune signatures, compared with healthy controls.

The analysis also revealed unusual regulatory relationships among the cytokines in the short-duration illness group that were not evident in controls or the long-duration illness group.

“Whereas CD40L drove most of the inverse relationships with other immune molecules in long-duration ME/CFS and controls, CD40L was only related to five other cytokines in the short-duration ME/CFS group; furthermore, only one of these associations, PDGFBB, was negative,” the authors wrote.

The authors said this was the first study to show altered plasma immune signatures early in the course of myalgic encephalomyelitis that are not evident either in healthy controls or in patients who have had the illness for longer.

Previous efforts to identify immune biomarkers of myalgic encephalomyelitis have led to inconclusive findings, and laboratory assays are only used to rule out other conditions rather than to make a positive diagnosis of the disease.

The study was funded by the Chronic Fatigue Initiative at Hutchins Family Foundation and the National Institutes of Health. The authors declared no conflicts of interest.

Researchers have identified unique plasma immune signatures that appear earlier in the course of myalgic encephalomyelitis – also known as chronic fatigue syndrome – but which are not present in individuals with a longer duration of illness or healthy controls.

Analysis of data from two large, multicenter cohort studies in 298 cases and 348 controls showed that patients with shorter duration of illness were more than 100 times more likely to have a higher level of interferon-gamma (odds ratio, 104.777; 95% confidence interval, 6.975-1574.021; P = .001) and 50% more likely to have a higher level of interleukin (IL)-12p40 (OR, 1.501; 95% CI, 1.075-2.096; P = .017) than were those with a longer duration of illness.

Overall, researchers noted significant differences in more than half the 51 cytokines studied according to the duration of illness, finding that individuals with shorter illness duration (3 or fewer years; 52 patients) generally had higher cytokine levels than did those with longer duration (246 patients), Dr. Mady Hornig of Columbia University, New York, and coauthors reported online Feb. 27 in Science Advances.

Compared with healthy controls, patients with a shorter duration of illness had significantly elevated classical proinflammatory cytokines, such as IL-1a, IL-8, IL-12, IL-17A, and TNF-alpha, and anti-inflammatory cytokines such as IL-1 receptor antagonist, IL-4, and IL-13.

However, they also had reduced levels of CD40 ligand (CD40L) and platelet-derived growth factor BB (PDGFBB), compared with controls (Sci. Adv. 2015;1:e1400121 [doi:10.1126/sciadv.1400121]).

“For cytokines that differed between short- and long-duration groups, levels were correlated with duration of illness, and in the expected direction: inverse correlations with duration of illness for cytokines that were increased in the short-duration group, and positive correlations for the two cytokines with reduced levels in the short-duration group,” the investigators wrote.

But when long-duration subjects were compared with healthy controls, the opposite was true; those cytokines that were elevated in patients with short-duration illness, compared with controls, were lower than controls in patients with long-duration illness, with the exception of CD40L and PDGFBB.

When patients with short and long duration of illness were combined into one group, the analysis showed no significant differences in plasma immune signatures, compared with healthy controls.

The analysis also revealed unusual regulatory relationships among the cytokines in the short-duration illness group that were not evident in controls or the long-duration illness group.

“Whereas CD40L drove most of the inverse relationships with other immune molecules in long-duration ME/CFS and controls, CD40L was only related to five other cytokines in the short-duration ME/CFS group; furthermore, only one of these associations, PDGFBB, was negative,” the authors wrote.

The authors said this was the first study to show altered plasma immune signatures early in the course of myalgic encephalomyelitis that are not evident either in healthy controls or in patients who have had the illness for longer.

Previous efforts to identify immune biomarkers of myalgic encephalomyelitis have led to inconclusive findings, and laboratory assays are only used to rule out other conditions rather than to make a positive diagnosis of the disease.

The study was funded by the Chronic Fatigue Initiative at Hutchins Family Foundation and the National Institutes of Health. The authors declared no conflicts of interest.

Researchers have identified unique plasma immune signatures that appear earlier in the course of myalgic encephalomyelitis – also known as chronic fatigue syndrome – but which are not present in individuals with a longer duration of illness or healthy controls.

Analysis of data from two large, multicenter cohort studies in 298 cases and 348 controls showed that patients with shorter duration of illness were more than 100 times more likely to have a higher level of interferon-gamma (odds ratio, 104.777; 95% confidence interval, 6.975-1574.021; P = .001) and 50% more likely to have a higher level of interleukin (IL)-12p40 (OR, 1.501; 95% CI, 1.075-2.096; P = .017) than were those with a longer duration of illness.

Overall, researchers noted significant differences in more than half the 51 cytokines studied according to the duration of illness, finding that individuals with shorter illness duration (3 or fewer years; 52 patients) generally had higher cytokine levels than did those with longer duration (246 patients), Dr. Mady Hornig of Columbia University, New York, and coauthors reported online Feb. 27 in Science Advances.

Compared with healthy controls, patients with a shorter duration of illness had significantly elevated classical proinflammatory cytokines, such as IL-1a, IL-8, IL-12, IL-17A, and TNF-alpha, and anti-inflammatory cytokines such as IL-1 receptor antagonist, IL-4, and IL-13.

However, they also had reduced levels of CD40 ligand (CD40L) and platelet-derived growth factor BB (PDGFBB), compared with controls (Sci. Adv. 2015;1:e1400121 [doi:10.1126/sciadv.1400121]).

“For cytokines that differed between short- and long-duration groups, levels were correlated with duration of illness, and in the expected direction: inverse correlations with duration of illness for cytokines that were increased in the short-duration group, and positive correlations for the two cytokines with reduced levels in the short-duration group,” the investigators wrote.

But when long-duration subjects were compared with healthy controls, the opposite was true; those cytokines that were elevated in patients with short-duration illness, compared with controls, were lower than controls in patients with long-duration illness, with the exception of CD40L and PDGFBB.

When patients with short and long duration of illness were combined into one group, the analysis showed no significant differences in plasma immune signatures, compared with healthy controls.

The analysis also revealed unusual regulatory relationships among the cytokines in the short-duration illness group that were not evident in controls or the long-duration illness group.

“Whereas CD40L drove most of the inverse relationships with other immune molecules in long-duration ME/CFS and controls, CD40L was only related to five other cytokines in the short-duration ME/CFS group; furthermore, only one of these associations, PDGFBB, was negative,” the authors wrote.

The authors said this was the first study to show altered plasma immune signatures early in the course of myalgic encephalomyelitis that are not evident either in healthy controls or in patients who have had the illness for longer.

Previous efforts to identify immune biomarkers of myalgic encephalomyelitis have led to inconclusive findings, and laboratory assays are only used to rule out other conditions rather than to make a positive diagnosis of the disease.

The study was funded by the Chronic Fatigue Initiative at Hutchins Family Foundation and the National Institutes of Health. The authors declared no conflicts of interest.

Patients coinfected with HIV and hepatitis C genotype 1 show high response rates to a three-drug regimen of ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir, plus ribavirin, according to an open-label, uncontrolled pilot study published in JAMA.

Among the 63 patients – who were either HCV treatment-naive or had previously experienced treatment failure with peginteferon plus ribavirin – treated with the all-oral ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir (known as 3D) plus ribavirin regimen, 94% of those treated for 12 weeks and 91% of those treated for 24 weeks achieved a sustained virologic response 12 weeks (SVR12) after treatment.

There were no confirmed HIV breakthroughs or serious adverse events – even though the study group included some patients with compensated cirrhosis – although around half of patients experienced treatment-related fatigue, 19% experienced insomnia, 18% experienced nausea, and 16% experienced headache (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1328]).

“The efficacy and safety of the 3D-plus-ribavirin regimen for patients co-infected with HCV/HIV-1 need to be further investigated in larger studies; however, response rates reported here are similar to those in studies of HCV-monoinfected patients, which suggest that difficult-to-cure patients, such as prior [pegylated interferon] null responders with cirrhosis and HCV genotype 1a, may benefit from longer treatment duration,” wrote Dr. Mark S. Sulkowski, director of the viral hepatitis center and professor of medicine at Johns Hopkins University, Baltimore, and his colleagues.

In another study, researchers found that a 12-week course of a fixed-dose combination of ledipasvir and sofosbuvir in treatment-naive patients with hepatitis C genotype 1 and HIV coinfection achieved sustained virologic response rates of 98% at 12 weeks after treatment.

The open-label, phase 2b study in 50 patients recorded one case of relapse at week 4, which may have been linked to resistance-associated mutation, but no discontinuations or serious adverse events attributable to the study drug (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1373]).

The study excluded individuals with cirrhosis, but many participants had poor prognostic factors, including African American race, male sex, IL28B non-CC genotype, and genotype 1a infection.

“These results show for the first time, to our knowledge, that an interferon- and ribavirin-free therapy is associated with high SVR rates in patients co-infected with HCV and HIV,” wrote Dr. Anu Osinusi of the University of Maryland, Baltimore, and her colleagues.

Dr. Sulkowski’s study was funded by AbbVie. Some of his coauthors declared a range of funding and consultancies from pharmaceutical companies including AbbVie and several coauthors are employees of AbbVie.

Dr. Osinusi’s study was funded by the National Institutes of Health, the German Research Foundation, and Gilead Sciences. Four coauthors reported speaking engagements, consultancies, fees, grants, stocks and other support from pharmaceutical companies including Gilead.

Patients coinfected with HIV and hepatitis C genotype 1 show high response rates to a three-drug regimen of ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir, plus ribavirin, according to an open-label, uncontrolled pilot study published in JAMA.

Among the 63 patients – who were either HCV treatment-naive or had previously experienced treatment failure with peginteferon plus ribavirin – treated with the all-oral ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir (known as 3D) plus ribavirin regimen, 94% of those treated for 12 weeks and 91% of those treated for 24 weeks achieved a sustained virologic response 12 weeks (SVR12) after treatment.

There were no confirmed HIV breakthroughs or serious adverse events – even though the study group included some patients with compensated cirrhosis – although around half of patients experienced treatment-related fatigue, 19% experienced insomnia, 18% experienced nausea, and 16% experienced headache (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1328]).

“The efficacy and safety of the 3D-plus-ribavirin regimen for patients co-infected with HCV/HIV-1 need to be further investigated in larger studies; however, response rates reported here are similar to those in studies of HCV-monoinfected patients, which suggest that difficult-to-cure patients, such as prior [pegylated interferon] null responders with cirrhosis and HCV genotype 1a, may benefit from longer treatment duration,” wrote Dr. Mark S. Sulkowski, director of the viral hepatitis center and professor of medicine at Johns Hopkins University, Baltimore, and his colleagues.

In another study, researchers found that a 12-week course of a fixed-dose combination of ledipasvir and sofosbuvir in treatment-naive patients with hepatitis C genotype 1 and HIV coinfection achieved sustained virologic response rates of 98% at 12 weeks after treatment.

The open-label, phase 2b study in 50 patients recorded one case of relapse at week 4, which may have been linked to resistance-associated mutation, but no discontinuations or serious adverse events attributable to the study drug (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1373]).

The study excluded individuals with cirrhosis, but many participants had poor prognostic factors, including African American race, male sex, IL28B non-CC genotype, and genotype 1a infection.

“These results show for the first time, to our knowledge, that an interferon- and ribavirin-free therapy is associated with high SVR rates in patients co-infected with HCV and HIV,” wrote Dr. Anu Osinusi of the University of Maryland, Baltimore, and her colleagues.

Dr. Sulkowski’s study was funded by AbbVie. Some of his coauthors declared a range of funding and consultancies from pharmaceutical companies including AbbVie and several coauthors are employees of AbbVie.

Dr. Osinusi’s study was funded by the National Institutes of Health, the German Research Foundation, and Gilead Sciences. Four coauthors reported speaking engagements, consultancies, fees, grants, stocks and other support from pharmaceutical companies including Gilead.

Patients coinfected with HIV and hepatitis C genotype 1 show high response rates to a three-drug regimen of ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir, plus ribavirin, according to an open-label, uncontrolled pilot study published in JAMA.

Among the 63 patients – who were either HCV treatment-naive or had previously experienced treatment failure with peginteferon plus ribavirin – treated with the all-oral ombitasvir, paritaprevir codosed with ritonavir, and dasabuvir (known as 3D) plus ribavirin regimen, 94% of those treated for 12 weeks and 91% of those treated for 24 weeks achieved a sustained virologic response 12 weeks (SVR12) after treatment.

There were no confirmed HIV breakthroughs or serious adverse events – even though the study group included some patients with compensated cirrhosis – although around half of patients experienced treatment-related fatigue, 19% experienced insomnia, 18% experienced nausea, and 16% experienced headache (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1328]).

“The efficacy and safety of the 3D-plus-ribavirin regimen for patients co-infected with HCV/HIV-1 need to be further investigated in larger studies; however, response rates reported here are similar to those in studies of HCV-monoinfected patients, which suggest that difficult-to-cure patients, such as prior [pegylated interferon] null responders with cirrhosis and HCV genotype 1a, may benefit from longer treatment duration,” wrote Dr. Mark S. Sulkowski, director of the viral hepatitis center and professor of medicine at Johns Hopkins University, Baltimore, and his colleagues.

In another study, researchers found that a 12-week course of a fixed-dose combination of ledipasvir and sofosbuvir in treatment-naive patients with hepatitis C genotype 1 and HIV coinfection achieved sustained virologic response rates of 98% at 12 weeks after treatment.

The open-label, phase 2b study in 50 patients recorded one case of relapse at week 4, which may have been linked to resistance-associated mutation, but no discontinuations or serious adverse events attributable to the study drug (JAMA 2015 Feb. 23 [doi:10.1001/jama.2015.1373]).

The study excluded individuals with cirrhosis, but many participants had poor prognostic factors, including African American race, male sex, IL28B non-CC genotype, and genotype 1a infection.

“These results show for the first time, to our knowledge, that an interferon- and ribavirin-free therapy is associated with high SVR rates in patients co-infected with HCV and HIV,” wrote Dr. Anu Osinusi of the University of Maryland, Baltimore, and her colleagues.

Dr. Sulkowski’s study was funded by AbbVie. Some of his coauthors declared a range of funding and consultancies from pharmaceutical companies including AbbVie and several coauthors are employees of AbbVie.

Dr. Osinusi’s study was funded by the National Institutes of Health, the German Research Foundation, and Gilead Sciences. Four coauthors reported speaking engagements, consultancies, fees, grants, stocks and other support from pharmaceutical companies including Gilead.

Men with favorable intermediate-risk prostate cancer could be considered for active surveillance, say the authors of a study, published in JAMA Oncology, showing no significant increase in prostate cancer–specific mortality in this group, compared with those with low-risk disease.

The prospective cohort study in 5,580 men with brachytherapy-treated localized adenocarcinoma of the prostate defined favorable intermediate-risk disease as a Gleason score of 3 + 4 or less, below 50% positive biopsy scores, and one or fewer National Comprehensive Cancer Network determinants of intermediate-risk prostate cancer.

Researchers found no significant increases in prostate cancer–specific or all-cause mortality in the favorable intermediate-risk group, compared with the low-risk group (JAMA Oncology 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.284]).

“This lack of a significant difference in the risk of PCSM [prostate cancer–specific mortality] was evident even though men with low-risk PC had lower median PSA levels, did not have Gleason 3 + 4 disease, and were more likely to have AJCC T1c [American Joint Committee on Cancer T1c] disease, all of which could have caused men with favorable intermediate-risk PC to have a higher risk of PCSM,” wrote Dr. Ann C. Raldow from the Brigham and Women’s Hospital, Boston, and her coauthors.

There were no conflicts of interest declared.

Men with favorable intermediate-risk prostate cancer could be considered for active surveillance, say the authors of a study, published in JAMA Oncology, showing no significant increase in prostate cancer–specific mortality in this group, compared with those with low-risk disease.

The prospective cohort study in 5,580 men with brachytherapy-treated localized adenocarcinoma of the prostate defined favorable intermediate-risk disease as a Gleason score of 3 + 4 or less, below 50% positive biopsy scores, and one or fewer National Comprehensive Cancer Network determinants of intermediate-risk prostate cancer.

Researchers found no significant increases in prostate cancer–specific or all-cause mortality in the favorable intermediate-risk group, compared with the low-risk group (JAMA Oncology 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.284]).

“This lack of a significant difference in the risk of PCSM [prostate cancer–specific mortality] was evident even though men with low-risk PC had lower median PSA levels, did not have Gleason 3 + 4 disease, and were more likely to have AJCC T1c [American Joint Committee on Cancer T1c] disease, all of which could have caused men with favorable intermediate-risk PC to have a higher risk of PCSM,” wrote Dr. Ann C. Raldow from the Brigham and Women’s Hospital, Boston, and her coauthors.

There were no conflicts of interest declared.

Men with favorable intermediate-risk prostate cancer could be considered for active surveillance, say the authors of a study, published in JAMA Oncology, showing no significant increase in prostate cancer–specific mortality in this group, compared with those with low-risk disease.

The prospective cohort study in 5,580 men with brachytherapy-treated localized adenocarcinoma of the prostate defined favorable intermediate-risk disease as a Gleason score of 3 + 4 or less, below 50% positive biopsy scores, and one or fewer National Comprehensive Cancer Network determinants of intermediate-risk prostate cancer.

Researchers found no significant increases in prostate cancer–specific or all-cause mortality in the favorable intermediate-risk group, compared with the low-risk group (JAMA Oncology 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.284]).

“This lack of a significant difference in the risk of PCSM [prostate cancer–specific mortality] was evident even though men with low-risk PC had lower median PSA levels, did not have Gleason 3 + 4 disease, and were more likely to have AJCC T1c [American Joint Committee on Cancer T1c] disease, all of which could have caused men with favorable intermediate-risk PC to have a higher risk of PCSM,” wrote Dr. Ann C. Raldow from the Brigham and Women’s Hospital, Boston, and her coauthors.

There were no conflicts of interest declared.

Watchful waiting or active surveillance is underused in men with indolent prostate cancer, according to the authors of a study that found radiation therapy was the most common treatment regardless of stage, prostate-specific antigen level, grade, or risk.

The population-based study of 37,261 men with prostate cancer, published in JAMA Oncology, found that the use of watchful waiting or active surveillance increased in men aged over 70, but was significantly lower in men of Asian descent and married men.

Radiation therapy was the most common treatment (57.9%) – followed by radical prostatectomy (19.1% and watching waiting or active surveillance (9.6%) – and its use increased with age, comorbidities, tumor characteristics, and referral to a radiation oncologist (JAMA Oncol. 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.192]).

“Our finding that increased use of radiotherapy among patients with indolent disease portends to a collaborative need for increased dissemination of prostate cancer treatment guidelines among our radiation oncology colleagues,” wrote Dr. Karim Chamie of the University of California, Los Angeles, and coauthors.

The study was supported by the Department of Defense Prostate Cancer Physician Training Award and the National Institutes of Health. No other conflicts of interest were declared.

Watchful waiting or active surveillance is underused in men with indolent prostate cancer, according to the authors of a study that found radiation therapy was the most common treatment regardless of stage, prostate-specific antigen level, grade, or risk.

The population-based study of 37,261 men with prostate cancer, published in JAMA Oncology, found that the use of watchful waiting or active surveillance increased in men aged over 70, but was significantly lower in men of Asian descent and married men.

Radiation therapy was the most common treatment (57.9%) – followed by radical prostatectomy (19.1% and watching waiting or active surveillance (9.6%) – and its use increased with age, comorbidities, tumor characteristics, and referral to a radiation oncologist (JAMA Oncol. 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.192]).

“Our finding that increased use of radiotherapy among patients with indolent disease portends to a collaborative need for increased dissemination of prostate cancer treatment guidelines among our radiation oncology colleagues,” wrote Dr. Karim Chamie of the University of California, Los Angeles, and coauthors.

The study was supported by the Department of Defense Prostate Cancer Physician Training Award and the National Institutes of Health. No other conflicts of interest were declared.

Watchful waiting or active surveillance is underused in men with indolent prostate cancer, according to the authors of a study that found radiation therapy was the most common treatment regardless of stage, prostate-specific antigen level, grade, or risk.

The population-based study of 37,261 men with prostate cancer, published in JAMA Oncology, found that the use of watchful waiting or active surveillance increased in men aged over 70, but was significantly lower in men of Asian descent and married men.

Radiation therapy was the most common treatment (57.9%) – followed by radical prostatectomy (19.1% and watching waiting or active surveillance (9.6%) – and its use increased with age, comorbidities, tumor characteristics, and referral to a radiation oncologist (JAMA Oncol. 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.192]).

“Our finding that increased use of radiotherapy among patients with indolent disease portends to a collaborative need for increased dissemination of prostate cancer treatment guidelines among our radiation oncology colleagues,” wrote Dr. Karim Chamie of the University of California, Los Angeles, and coauthors.

The study was supported by the Department of Defense Prostate Cancer Physician Training Award and the National Institutes of Health. No other conflicts of interest were declared.