Heidi Splete

Use of tumor necrosis factor antagonist agents significantly reduced the risk of cardiovascular events in rheumatoid arthritis patients, according to an analysis of data from more than 10,000 patients.

Although previous studies have not shown that anti-TNF therapy reduces the risk of cardiovascular events in RA patients, "promising results for improving cardiovascular outcomes with TNF antagonist use have been reported by two European studies," Dr. Jeffrey D. Greenberg of New York University and colleagues wrote in the April Annals of the Rheumatic Diseases.

In this North American study, patients who used TNF antagonists had a 61% lower risk of a primary end point of composite cardiovascular events (HR, 0.39), compared with reference patients who used nonbiologic disease-modifying antirheumatic drugs (DMARDs). The researchers analyzed data from 10,156 patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) RA registry between Oct. 1, 2001, and Dec. 31, 2006. The average age of the patients was 59 years and 75% were women (Ann. Rheum. Dis. 2011;70:576-82).

During the study period, the researchers identified 88 composite cardiovascular events including 26 myocardial infarctions, 45 strokes or transient ischemic attacks, and 17 cardiovascular-related deaths. The incidence rate for composite cardiovascular events in patients who used TNF antagonists was 2.93/1,000 patient-years of exposure, compared with 6.73/1,000 patient-years for methotrexate and 7.51 for the reference group of patients who used DMARDs.

Methotrexate use did not have a significant impact on reducing cardiovascular risk. However, prednisone use was significantly associated with an increasing risk for cardiovascular events, compared with nonuse, the researchers noted.

When the researchers examined specific cardiovascular events, TNF antagonist use was associated with a significantly lower risk of myocardial infarction and a trend toward a significantly lower risk of transient ischemic attack or stroke.

The mechanism by which TNF antagonists could reduce cardiovascular risk remains unclear. Data suggest that TNF antagonists might stabilize atheromatous plaques, while other results have shown improved flow-mediated vasodilation and endothelial function associated with TNF antagonists, the researchers said.

Additional studies are needed to assess the role of inflammation in populations at increased risk for cardiovascular events, the researchers wrote. But "TNF antagonist drugs may represent a promising therapeutic strategy to attenuate the heightened cardiovascular risk associated with RA," they wrote.

In an editorial accompanying the report, Dr. Johan Askling and Dr. Will Dixon said that one of the unanswered questions in studying the relationship between anti-TNF therapy and a reduced risk of cardiovascular events is whether the risk reduction is only a shift in the risk between different subsets of patients.

The dramatic reduction in cardiovascular risk in the anti-TNF group could be due to a higher incidence of cardiovascular events in patients who do not receive anti-TNF therapy for any reason, the investigators said. More studies in other RA populations are needed, and might explain the disparate results seen in previous studies of anti-TNF and cardiovascular risk, they noted (Ann. Rheum. Dis. 2011;70:561-2).

"As evidence accumulates in this important topic, we move closer towards a true understanding of the effect of drug therapies on cardiovascular outcomes," said Dr. Askling of Karolinska University, Stockholm, and Dr. Dixon of the University of Manchester (England).

Disclosures were not provided for Dr. Askling and Dr. Dixon. Dr. Greenberg said he has received research grants from the National Institutes of Health, the Arthritis Foundation, and Bristol-Myers Squibb. He has served on advisory boards from multiple pharmaceutical companies including Centocor, Genentech, and Roche.

Use of tumor necrosis factor antagonist agents significantly reduced the risk of cardiovascular events in rheumatoid arthritis patients, according to an analysis of data from more than 10,000 patients.

Although previous studies have not shown that anti-TNF therapy reduces the risk of cardiovascular events in RA patients, "promising results for improving cardiovascular outcomes with TNF antagonist use have been reported by two European studies," Dr. Jeffrey D. Greenberg of New York University and colleagues wrote in the April Annals of the Rheumatic Diseases.

In this North American study, patients who used TNF antagonists had a 61% lower risk of a primary end point of composite cardiovascular events (HR, 0.39), compared with reference patients who used nonbiologic disease-modifying antirheumatic drugs (DMARDs). The researchers analyzed data from 10,156 patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) RA registry between Oct. 1, 2001, and Dec. 31, 2006. The average age of the patients was 59 years and 75% were women (Ann. Rheum. Dis. 2011;70:576-82).

During the study period, the researchers identified 88 composite cardiovascular events including 26 myocardial infarctions, 45 strokes or transient ischemic attacks, and 17 cardiovascular-related deaths. The incidence rate for composite cardiovascular events in patients who used TNF antagonists was 2.93/1,000 patient-years of exposure, compared with 6.73/1,000 patient-years for methotrexate and 7.51 for the reference group of patients who used DMARDs.

Methotrexate use did not have a significant impact on reducing cardiovascular risk. However, prednisone use was significantly associated with an increasing risk for cardiovascular events, compared with nonuse, the researchers noted.

When the researchers examined specific cardiovascular events, TNF antagonist use was associated with a significantly lower risk of myocardial infarction and a trend toward a significantly lower risk of transient ischemic attack or stroke.

The mechanism by which TNF antagonists could reduce cardiovascular risk remains unclear. Data suggest that TNF antagonists might stabilize atheromatous plaques, while other results have shown improved flow-mediated vasodilation and endothelial function associated with TNF antagonists, the researchers said.

Additional studies are needed to assess the role of inflammation in populations at increased risk for cardiovascular events, the researchers wrote. But "TNF antagonist drugs may represent a promising therapeutic strategy to attenuate the heightened cardiovascular risk associated with RA," they wrote.

In an editorial accompanying the report, Dr. Johan Askling and Dr. Will Dixon said that one of the unanswered questions in studying the relationship between anti-TNF therapy and a reduced risk of cardiovascular events is whether the risk reduction is only a shift in the risk between different subsets of patients.

The dramatic reduction in cardiovascular risk in the anti-TNF group could be due to a higher incidence of cardiovascular events in patients who do not receive anti-TNF therapy for any reason, the investigators said. More studies in other RA populations are needed, and might explain the disparate results seen in previous studies of anti-TNF and cardiovascular risk, they noted (Ann. Rheum. Dis. 2011;70:561-2).

"As evidence accumulates in this important topic, we move closer towards a true understanding of the effect of drug therapies on cardiovascular outcomes," said Dr. Askling of Karolinska University, Stockholm, and Dr. Dixon of the University of Manchester (England).

Disclosures were not provided for Dr. Askling and Dr. Dixon. Dr. Greenberg said he has received research grants from the National Institutes of Health, the Arthritis Foundation, and Bristol-Myers Squibb. He has served on advisory boards from multiple pharmaceutical companies including Centocor, Genentech, and Roche.

Use of tumor necrosis factor antagonist agents significantly reduced the risk of cardiovascular events in rheumatoid arthritis patients, according to an analysis of data from more than 10,000 patients.

Although previous studies have not shown that anti-TNF therapy reduces the risk of cardiovascular events in RA patients, "promising results for improving cardiovascular outcomes with TNF antagonist use have been reported by two European studies," Dr. Jeffrey D. Greenberg of New York University and colleagues wrote in the April Annals of the Rheumatic Diseases.

In this North American study, patients who used TNF antagonists had a 61% lower risk of a primary end point of composite cardiovascular events (HR, 0.39), compared with reference patients who used nonbiologic disease-modifying antirheumatic drugs (DMARDs). The researchers analyzed data from 10,156 patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) RA registry between Oct. 1, 2001, and Dec. 31, 2006. The average age of the patients was 59 years and 75% were women (Ann. Rheum. Dis. 2011;70:576-82).

During the study period, the researchers identified 88 composite cardiovascular events including 26 myocardial infarctions, 45 strokes or transient ischemic attacks, and 17 cardiovascular-related deaths. The incidence rate for composite cardiovascular events in patients who used TNF antagonists was 2.93/1,000 patient-years of exposure, compared with 6.73/1,000 patient-years for methotrexate and 7.51 for the reference group of patients who used DMARDs.

Methotrexate use did not have a significant impact on reducing cardiovascular risk. However, prednisone use was significantly associated with an increasing risk for cardiovascular events, compared with nonuse, the researchers noted.

When the researchers examined specific cardiovascular events, TNF antagonist use was associated with a significantly lower risk of myocardial infarction and a trend toward a significantly lower risk of transient ischemic attack or stroke.

The mechanism by which TNF antagonists could reduce cardiovascular risk remains unclear. Data suggest that TNF antagonists might stabilize atheromatous plaques, while other results have shown improved flow-mediated vasodilation and endothelial function associated with TNF antagonists, the researchers said.

Additional studies are needed to assess the role of inflammation in populations at increased risk for cardiovascular events, the researchers wrote. But "TNF antagonist drugs may represent a promising therapeutic strategy to attenuate the heightened cardiovascular risk associated with RA," they wrote.

In an editorial accompanying the report, Dr. Johan Askling and Dr. Will Dixon said that one of the unanswered questions in studying the relationship between anti-TNF therapy and a reduced risk of cardiovascular events is whether the risk reduction is only a shift in the risk between different subsets of patients.

The dramatic reduction in cardiovascular risk in the anti-TNF group could be due to a higher incidence of cardiovascular events in patients who do not receive anti-TNF therapy for any reason, the investigators said. More studies in other RA populations are needed, and might explain the disparate results seen in previous studies of anti-TNF and cardiovascular risk, they noted (Ann. Rheum. Dis. 2011;70:561-2).

"As evidence accumulates in this important topic, we move closer towards a true understanding of the effect of drug therapies on cardiovascular outcomes," said Dr. Askling of Karolinska University, Stockholm, and Dr. Dixon of the University of Manchester (England).

Disclosures were not provided for Dr. Askling and Dr. Dixon. Dr. Greenberg said he has received research grants from the National Institutes of Health, the Arthritis Foundation, and Bristol-Myers Squibb. He has served on advisory boards from multiple pharmaceutical companies including Centocor, Genentech, and Roche.

Partially or fully ablative lasers are safe and effective tools to treat many types of scars and keloids, Dr. Suzanne L. Kilmer reported.

In treating scars, "the challenge is to normalize the color and the texture and to somehow repopulate that area with normal collagen and return it to normal skin color for that individual," she said in an interview.

Photo courtesy Dr. Suzanne L. Kilmer

A key challenge to treatment is managing patient expectations. She described three treatment techniques to improve the appearance of scars and keloids at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF): pulsed dye lasers, fractional lasers, and fully ablative erbium/CO2 laser resurfacing.

Each of these lasers has its pros and cons for scar treatment, Dr. Kilmer explained. "In most cases now I will go straight to a fractional device, and depending on location, patient's tolerance for downtime, pain, and budget constraints, I will proceed with the best choice."

Pulsed-dye lasers help improve erythema by targeting hemoglobin, and they can also aid in collagen remodeling, reported Dr. Kilmer of the Laser & Skin Surgery Center of Northern California, Sacramento.

Fractional lasers heat up or even ablate thousands of tiny 120-mcm columns of tissue, allowing tissue remodeling and the regeneration of more normal collagen. This normal collagen gradually takes over the area with scar tissue and helps to return the skin to its prescar appearance. This is also helpful for striae (stretch marks), she noted.

Fractional resurfacing is often effective for pigment, texture, or vascular changes. The fractional laser produces a microthermal zone up to 1,500 mcm deep that creates lateral reepithelialization and promotes skin healing. A Fraxel 1550-nm erbium laser (Solta) or a StarLux 1540-nm laser (Palomar) is a good choice for these procedures.

Most patients find the Fraxel 1550-nm laser more painful, and anesthesia is needed for the entire procedure, she reported. However, the Fraxel is faster, so it is a better choice for procedures involving the full face, and provides a more even treatment.

By contrast, the StarLux 1,540-nm laser often allows the clinician to treat small areas without the need for anesthesia, and these areas blend easily into nontreated skin, Dr. Kilmer pointed out. Small areas of the skin can be treated quickly, but the StarLux can be slow and uneven when used on larger areas.

Swelling is common – but not usually painful – after nonablative fractional resurfacing, she explained, and most patients need only minimal aftercare. Usually ice or hydration is sufficient.

Fractional ablative laser resurfacing carries more risk and requires more downtime than do other scar treatments, but it offers "the greatest efficacy for a single treatment," noted Dr. Kilmer. This treatment allows the clinician to sculpt more deeply with less thermal damage, and provides the most predictable results, including skin tightening and smoothing of acne scar ridges. The fractional ablative component allows for deeper scar remodeling and can be done at the same time, but with caution, she noted.

Dr. Kilmer emphasized that clinicians who are new to laser scar treatments should go slowly while they become familiar with the device. "And go lighter when you are off the face," she added.

Dr. Kilmer has received research support from Palomar and Solta. SDEF and this news organization are owned by Elsevier.

Partially or fully ablative lasers are safe and effective tools to treat many types of scars and keloids, Dr. Suzanne L. Kilmer reported.

In treating scars, "the challenge is to normalize the color and the texture and to somehow repopulate that area with normal collagen and return it to normal skin color for that individual," she said in an interview.

Photo courtesy Dr. Suzanne L. Kilmer

A key challenge to treatment is managing patient expectations. She described three treatment techniques to improve the appearance of scars and keloids at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF): pulsed dye lasers, fractional lasers, and fully ablative erbium/CO2 laser resurfacing.

Each of these lasers has its pros and cons for scar treatment, Dr. Kilmer explained. "In most cases now I will go straight to a fractional device, and depending on location, patient's tolerance for downtime, pain, and budget constraints, I will proceed with the best choice."

Pulsed-dye lasers help improve erythema by targeting hemoglobin, and they can also aid in collagen remodeling, reported Dr. Kilmer of the Laser & Skin Surgery Center of Northern California, Sacramento.

Fractional lasers heat up or even ablate thousands of tiny 120-mcm columns of tissue, allowing tissue remodeling and the regeneration of more normal collagen. This normal collagen gradually takes over the area with scar tissue and helps to return the skin to its prescar appearance. This is also helpful for striae (stretch marks), she noted.

Fractional resurfacing is often effective for pigment, texture, or vascular changes. The fractional laser produces a microthermal zone up to 1,500 mcm deep that creates lateral reepithelialization and promotes skin healing. A Fraxel 1550-nm erbium laser (Solta) or a StarLux 1540-nm laser (Palomar) is a good choice for these procedures.

Most patients find the Fraxel 1550-nm laser more painful, and anesthesia is needed for the entire procedure, she reported. However, the Fraxel is faster, so it is a better choice for procedures involving the full face, and provides a more even treatment.

By contrast, the StarLux 1,540-nm laser often allows the clinician to treat small areas without the need for anesthesia, and these areas blend easily into nontreated skin, Dr. Kilmer pointed out. Small areas of the skin can be treated quickly, but the StarLux can be slow and uneven when used on larger areas.

Swelling is common – but not usually painful – after nonablative fractional resurfacing, she explained, and most patients need only minimal aftercare. Usually ice or hydration is sufficient.

Fractional ablative laser resurfacing carries more risk and requires more downtime than do other scar treatments, but it offers "the greatest efficacy for a single treatment," noted Dr. Kilmer. This treatment allows the clinician to sculpt more deeply with less thermal damage, and provides the most predictable results, including skin tightening and smoothing of acne scar ridges. The fractional ablative component allows for deeper scar remodeling and can be done at the same time, but with caution, she noted.

Dr. Kilmer emphasized that clinicians who are new to laser scar treatments should go slowly while they become familiar with the device. "And go lighter when you are off the face," she added.

Dr. Kilmer has received research support from Palomar and Solta. SDEF and this news organization are owned by Elsevier.

Partially or fully ablative lasers are safe and effective tools to treat many types of scars and keloids, Dr. Suzanne L. Kilmer reported.

In treating scars, "the challenge is to normalize the color and the texture and to somehow repopulate that area with normal collagen and return it to normal skin color for that individual," she said in an interview.

Photo courtesy Dr. Suzanne L. Kilmer

A key challenge to treatment is managing patient expectations. She described three treatment techniques to improve the appearance of scars and keloids at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF): pulsed dye lasers, fractional lasers, and fully ablative erbium/CO2 laser resurfacing.

Each of these lasers has its pros and cons for scar treatment, Dr. Kilmer explained. "In most cases now I will go straight to a fractional device, and depending on location, patient's tolerance for downtime, pain, and budget constraints, I will proceed with the best choice."

Pulsed-dye lasers help improve erythema by targeting hemoglobin, and they can also aid in collagen remodeling, reported Dr. Kilmer of the Laser & Skin Surgery Center of Northern California, Sacramento.

Fractional lasers heat up or even ablate thousands of tiny 120-mcm columns of tissue, allowing tissue remodeling and the regeneration of more normal collagen. This normal collagen gradually takes over the area with scar tissue and helps to return the skin to its prescar appearance. This is also helpful for striae (stretch marks), she noted.

Fractional resurfacing is often effective for pigment, texture, or vascular changes. The fractional laser produces a microthermal zone up to 1,500 mcm deep that creates lateral reepithelialization and promotes skin healing. A Fraxel 1550-nm erbium laser (Solta) or a StarLux 1540-nm laser (Palomar) is a good choice for these procedures.

Most patients find the Fraxel 1550-nm laser more painful, and anesthesia is needed for the entire procedure, she reported. However, the Fraxel is faster, so it is a better choice for procedures involving the full face, and provides a more even treatment.

By contrast, the StarLux 1,540-nm laser often allows the clinician to treat small areas without the need for anesthesia, and these areas blend easily into nontreated skin, Dr. Kilmer pointed out. Small areas of the skin can be treated quickly, but the StarLux can be slow and uneven when used on larger areas.

Swelling is common – but not usually painful – after nonablative fractional resurfacing, she explained, and most patients need only minimal aftercare. Usually ice or hydration is sufficient.

Fractional ablative laser resurfacing carries more risk and requires more downtime than do other scar treatments, but it offers "the greatest efficacy for a single treatment," noted Dr. Kilmer. This treatment allows the clinician to sculpt more deeply with less thermal damage, and provides the most predictable results, including skin tightening and smoothing of acne scar ridges. The fractional ablative component allows for deeper scar remodeling and can be done at the same time, but with caution, she noted.

Dr. Kilmer emphasized that clinicians who are new to laser scar treatments should go slowly while they become familiar with the device. "And go lighter when you are off the face," she added.

Dr. Kilmer has received research support from Palomar and Solta. SDEF and this news organization are owned by Elsevier.

Direct infusion of the gene for glutamic acid decarboxylase into the subthalamic nucleus of patients with Parkinson’s disease significantly improved measures of motor function, compared with patients who underwent a sham procedure, according to the results of a phase II trial in 45 patients.

The study was "the first successful randomized, double-blind gene therapy trial for a neurological disorder" and serves as a proof of concept for similar studies, justifying its continued development, Dr. Peter A. LeWitt of Wayne State University, Detroit, and his colleagues reported online March 17 in the Lancet Neurology.

In the study, 22 Parkinson’s patients with Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores of 25 or more were randomized to gene therapy and 23 were randomized to sham surgery. The gene therapy involved inserting the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus using the adeno-associated viral vector, AAV2.

GAD is the rate-limiting enzyme for the neurotransmitter gamma-aminobutyric acid (GABA). The destruction of nigrostriatal dopaminergic neurons in Parkinson’s disease alters the dynamics of inhibitory GABA input to the subthalamic nucleus, which worsens parkinsonian symptoms. Improvement of symptoms has been shown previously with infusions of a GABA agonist into the subthalamic nucleus of Parkinson’s disease patients during surgery for deep brain stimulation and also in animal models of parkinsonism.

After 6 months, patients in the AAV2-GAD group showed a 23% improvement (an average 8.1-point decrease) in UPDRS scores in the "off" state (while not on medications), compared with a 13% improvement (an average 4.7-point decrease) in the sham group (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70039-4]).

"The change of UPDRS scores from baseline differed significantly between treatment groups across all three postoperative time points" at 1, 3, and 6 months, the researchers noted.

The only severe adverse event reported during the study period was a case of bowel obstruction in the AAV2-GAD group. Mild and moderate adverse events included headaches and nausea.

In addition, the investigator’s clinical global impression of Parkinson’s disease severity improved significantly from baseline to 6 months in the treatment group vs. the sham group (3.4 vs. 3.9).

The patients’ ages ranged from 30 to 75 years. A total of 6 patients in the treatment group and 2 in the sham group did not receive the complete intervention, leaving efficacy groups of 16 and 21, respectively.

The findings were limited by the study’s small size and the possibility of inadequate blinding of the procedures because the patients were awake during their surgeries. However, "it is unlikely that the benefits in the AAV2-GAD treatment group were caused by the temporary placement of catheters in the subthalamic nucleus rather than from the infusion of the gene product," the researchers wrote.

Although the study findings are promising, questions remain as to how long the effects of the gene therapy will last and what advantages it might have over deep brain stimulation, Dr. Michael Hutchinson of New York University, wrote in an accompanying editorial. The added value of the study is that the placebo effect is not large enough to explain the benefits of gene therapy seen in open-label surgical trials, Dr. Hutchinson said. The significant difference in outcomes between the groups is "a tribute" to the researchers’ attention to detail in a small surgical trial, he added (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70041-2]).

The study was funded by Neurologix Inc. Many of the investigators reported serving as speakers or consultants or receiving grant funding from many companies that manufacture treatments for Parkinson’s disease. Dr. Hutchinson had no financial conflicts to disclose.

Direct infusion of the gene for glutamic acid decarboxylase into the subthalamic nucleus of patients with Parkinson’s disease significantly improved measures of motor function, compared with patients who underwent a sham procedure, according to the results of a phase II trial in 45 patients.

The study was "the first successful randomized, double-blind gene therapy trial for a neurological disorder" and serves as a proof of concept for similar studies, justifying its continued development, Dr. Peter A. LeWitt of Wayne State University, Detroit, and his colleagues reported online March 17 in the Lancet Neurology.

In the study, 22 Parkinson’s patients with Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores of 25 or more were randomized to gene therapy and 23 were randomized to sham surgery. The gene therapy involved inserting the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus using the adeno-associated viral vector, AAV2.

GAD is the rate-limiting enzyme for the neurotransmitter gamma-aminobutyric acid (GABA). The destruction of nigrostriatal dopaminergic neurons in Parkinson’s disease alters the dynamics of inhibitory GABA input to the subthalamic nucleus, which worsens parkinsonian symptoms. Improvement of symptoms has been shown previously with infusions of a GABA agonist into the subthalamic nucleus of Parkinson’s disease patients during surgery for deep brain stimulation and also in animal models of parkinsonism.

After 6 months, patients in the AAV2-GAD group showed a 23% improvement (an average 8.1-point decrease) in UPDRS scores in the "off" state (while not on medications), compared with a 13% improvement (an average 4.7-point decrease) in the sham group (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70039-4]).

"The change of UPDRS scores from baseline differed significantly between treatment groups across all three postoperative time points" at 1, 3, and 6 months, the researchers noted.

The only severe adverse event reported during the study period was a case of bowel obstruction in the AAV2-GAD group. Mild and moderate adverse events included headaches and nausea.

In addition, the investigator’s clinical global impression of Parkinson’s disease severity improved significantly from baseline to 6 months in the treatment group vs. the sham group (3.4 vs. 3.9).

The patients’ ages ranged from 30 to 75 years. A total of 6 patients in the treatment group and 2 in the sham group did not receive the complete intervention, leaving efficacy groups of 16 and 21, respectively.

The findings were limited by the study’s small size and the possibility of inadequate blinding of the procedures because the patients were awake during their surgeries. However, "it is unlikely that the benefits in the AAV2-GAD treatment group were caused by the temporary placement of catheters in the subthalamic nucleus rather than from the infusion of the gene product," the researchers wrote.

Although the study findings are promising, questions remain as to how long the effects of the gene therapy will last and what advantages it might have over deep brain stimulation, Dr. Michael Hutchinson of New York University, wrote in an accompanying editorial. The added value of the study is that the placebo effect is not large enough to explain the benefits of gene therapy seen in open-label surgical trials, Dr. Hutchinson said. The significant difference in outcomes between the groups is "a tribute" to the researchers’ attention to detail in a small surgical trial, he added (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70041-2]).

The study was funded by Neurologix Inc. Many of the investigators reported serving as speakers or consultants or receiving grant funding from many companies that manufacture treatments for Parkinson’s disease. Dr. Hutchinson had no financial conflicts to disclose.

Direct infusion of the gene for glutamic acid decarboxylase into the subthalamic nucleus of patients with Parkinson’s disease significantly improved measures of motor function, compared with patients who underwent a sham procedure, according to the results of a phase II trial in 45 patients.

The study was "the first successful randomized, double-blind gene therapy trial for a neurological disorder" and serves as a proof of concept for similar studies, justifying its continued development, Dr. Peter A. LeWitt of Wayne State University, Detroit, and his colleagues reported online March 17 in the Lancet Neurology.

In the study, 22 Parkinson’s patients with Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores of 25 or more were randomized to gene therapy and 23 were randomized to sham surgery. The gene therapy involved inserting the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus using the adeno-associated viral vector, AAV2.

GAD is the rate-limiting enzyme for the neurotransmitter gamma-aminobutyric acid (GABA). The destruction of nigrostriatal dopaminergic neurons in Parkinson’s disease alters the dynamics of inhibitory GABA input to the subthalamic nucleus, which worsens parkinsonian symptoms. Improvement of symptoms has been shown previously with infusions of a GABA agonist into the subthalamic nucleus of Parkinson’s disease patients during surgery for deep brain stimulation and also in animal models of parkinsonism.

After 6 months, patients in the AAV2-GAD group showed a 23% improvement (an average 8.1-point decrease) in UPDRS scores in the "off" state (while not on medications), compared with a 13% improvement (an average 4.7-point decrease) in the sham group (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70039-4]).

"The change of UPDRS scores from baseline differed significantly between treatment groups across all three postoperative time points" at 1, 3, and 6 months, the researchers noted.

The only severe adverse event reported during the study period was a case of bowel obstruction in the AAV2-GAD group. Mild and moderate adverse events included headaches and nausea.

In addition, the investigator’s clinical global impression of Parkinson’s disease severity improved significantly from baseline to 6 months in the treatment group vs. the sham group (3.4 vs. 3.9).

The patients’ ages ranged from 30 to 75 years. A total of 6 patients in the treatment group and 2 in the sham group did not receive the complete intervention, leaving efficacy groups of 16 and 21, respectively.

The findings were limited by the study’s small size and the possibility of inadequate blinding of the procedures because the patients were awake during their surgeries. However, "it is unlikely that the benefits in the AAV2-GAD treatment group were caused by the temporary placement of catheters in the subthalamic nucleus rather than from the infusion of the gene product," the researchers wrote.

Although the study findings are promising, questions remain as to how long the effects of the gene therapy will last and what advantages it might have over deep brain stimulation, Dr. Michael Hutchinson of New York University, wrote in an accompanying editorial. The added value of the study is that the placebo effect is not large enough to explain the benefits of gene therapy seen in open-label surgical trials, Dr. Hutchinson said. The significant difference in outcomes between the groups is "a tribute" to the researchers’ attention to detail in a small surgical trial, he added (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70041-2]).

The study was funded by Neurologix Inc. Many of the investigators reported serving as speakers or consultants or receiving grant funding from many companies that manufacture treatments for Parkinson’s disease. Dr. Hutchinson had no financial conflicts to disclose.

Direct infusion of the gene for glutamic acid decarboxylase into the subthalamic nucleus of patients with Parkinson’s disease significantly improved measures of motor function, compared with patients who underwent a sham procedure, according to the results of a phase II trial in 45 patients.

The study was "the first successful randomized, double-blind gene therapy trial for a neurological disorder" and serves as a proof of concept for similar studies, justifying its continued development, Dr. Peter A. LeWitt of Wayne State University, Detroit, and his colleagues reported online March 17 in the Lancet Neurology.

In the study, 22 Parkinson’s patients with Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores of 25 or more were randomized to gene therapy and 23 were randomized to sham surgery. The gene therapy involved inserting the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus using the adeno-associated viral vector, AAV2.

GAD is the rate-limiting enzyme for the neurotransmitter gamma-aminobutyric acid (GABA). The destruction of nigrostriatal dopaminergic neurons in Parkinson’s disease alters the dynamics of inhibitory GABA input to the subthalamic nucleus, which worsens parkinsonian symptoms. Improvement of symptoms has been shown previously with infusions of a GABA agonist into the subthalamic nucleus of Parkinson’s disease patients during surgery for deep brain stimulation and also in animal models of parkinsonism.

After 6 months, patients in the AAV2-GAD group showed a 23% improvement (an average 8.1-point decrease) in UPDRS scores in the "off" state (while not on medications), compared with a 13% improvement (an average 4.7-point decrease) in the sham group (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70039-4]).

"The change of UPDRS scores from baseline differed significantly between treatment groups across all three postoperative time points" at 1, 3, and 6 months, the researchers noted.

The only severe adverse event reported during the study period was a case of bowel obstruction in the AAV2-GAD group. Mild and moderate adverse events included headaches and nausea.

In addition, the investigator’s clinical global impression of Parkinson’s disease severity improved significantly from baseline to 6 months in the treatment group vs. the sham group (3.4 vs. 3.9).

The patients’ ages ranged from 30 to 75 years. A total of 6 patients in the treatment group and 2 in the sham group did not receive the complete intervention, leaving efficacy groups of 16 and 21, respectively.

The findings were limited by the study’s small size and the possibility of inadequate blinding of the procedures because the patients were awake during their surgeries. However, "it is unlikely that the benefits in the AAV2-GAD treatment group were caused by the temporary placement of catheters in the subthalamic nucleus rather than from the infusion of the gene product," the researchers wrote.

Although the study findings are promising, questions remain as to how long the effects of the gene therapy will last and what advantages it might have over deep brain stimulation, Dr. Michael Hutchinson of New York University, wrote in an accompanying editorial. The added value of the study is that the placebo effect is not large enough to explain the benefits of gene therapy seen in open-label surgical trials, Dr. Hutchinson said. The significant difference in outcomes between the groups is "a tribute" to the researchers’ attention to detail in a small surgical trial, he added (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70041-2]).

The study was funded by Neurologix Inc. Many of the investigators reported serving as speakers or consultants or receiving grant funding from many companies that manufacture treatments for Parkinson’s disease. Dr. Hutchinson had no financial conflicts to disclose.

Direct infusion of the gene for glutamic acid decarboxylase into the subthalamic nucleus of patients with Parkinson’s disease significantly improved measures of motor function, compared with patients who underwent a sham procedure, according to the results of a phase II trial in 45 patients.

The study was "the first successful randomized, double-blind gene therapy trial for a neurological disorder" and serves as a proof of concept for similar studies, justifying its continued development, Dr. Peter A. LeWitt of Wayne State University, Detroit, and his colleagues reported online March 17 in the Lancet Neurology.

In the study, 22 Parkinson’s patients with Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores of 25 or more were randomized to gene therapy and 23 were randomized to sham surgery. The gene therapy involved inserting the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus using the adeno-associated viral vector, AAV2.

GAD is the rate-limiting enzyme for the neurotransmitter gamma-aminobutyric acid (GABA). The destruction of nigrostriatal dopaminergic neurons in Parkinson’s disease alters the dynamics of inhibitory GABA input to the subthalamic nucleus, which worsens parkinsonian symptoms. Improvement of symptoms has been shown previously with infusions of a GABA agonist into the subthalamic nucleus of Parkinson’s disease patients during surgery for deep brain stimulation and also in animal models of parkinsonism.

After 6 months, patients in the AAV2-GAD group showed a 23% improvement (an average 8.1-point decrease) in UPDRS scores in the "off" state (while not on medications), compared with a 13% improvement (an average 4.7-point decrease) in the sham group (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70039-4]).

"The change of UPDRS scores from baseline differed significantly between treatment groups across all three postoperative time points" at 1, 3, and 6 months, the researchers noted.

The only severe adverse event reported during the study period was a case of bowel obstruction in the AAV2-GAD group. Mild and moderate adverse events included headaches and nausea.

In addition, the investigator’s clinical global impression of Parkinson’s disease severity improved significantly from baseline to 6 months in the treatment group vs. the sham group (3.4 vs. 3.9).

The patients’ ages ranged from 30 to 75 years. A total of 6 patients in the treatment group and 2 in the sham group did not receive the complete intervention, leaving efficacy groups of 16 and 21, respectively.

The findings were limited by the study’s small size and the possibility of inadequate blinding of the procedures because the patients were awake during their surgeries. However, "it is unlikely that the benefits in the AAV2-GAD treatment group were caused by the temporary placement of catheters in the subthalamic nucleus rather than from the infusion of the gene product," the researchers wrote.

Although the study findings are promising, questions remain as to how long the effects of the gene therapy will last and what advantages it might have over deep brain stimulation, Dr. Michael Hutchinson of New York University, wrote in an accompanying editorial. The added value of the study is that the placebo effect is not large enough to explain the benefits of gene therapy seen in open-label surgical trials, Dr. Hutchinson said. The significant difference in outcomes between the groups is "a tribute" to the researchers’ attention to detail in a small surgical trial, he added (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70041-2]).

The study was funded by Neurologix Inc. Many of the investigators reported serving as speakers or consultants or receiving grant funding from many companies that manufacture treatments for Parkinson’s disease. Dr. Hutchinson had no financial conflicts to disclose.

Direct infusion of the gene for glutamic acid decarboxylase into the subthalamic nucleus of patients with Parkinson’s disease significantly improved measures of motor function, compared with patients who underwent a sham procedure, according to the results of a phase II trial in 45 patients.

The study was "the first successful randomized, double-blind gene therapy trial for a neurological disorder" and serves as a proof of concept for similar studies, justifying its continued development, Dr. Peter A. LeWitt of Wayne State University, Detroit, and his colleagues reported online March 17 in the Lancet Neurology.

In the study, 22 Parkinson’s patients with Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores of 25 or more were randomized to gene therapy and 23 were randomized to sham surgery. The gene therapy involved inserting the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus using the adeno-associated viral vector, AAV2.

GAD is the rate-limiting enzyme for the neurotransmitter gamma-aminobutyric acid (GABA). The destruction of nigrostriatal dopaminergic neurons in Parkinson’s disease alters the dynamics of inhibitory GABA input to the subthalamic nucleus, which worsens parkinsonian symptoms. Improvement of symptoms has been shown previously with infusions of a GABA agonist into the subthalamic nucleus of Parkinson’s disease patients during surgery for deep brain stimulation and also in animal models of parkinsonism.

After 6 months, patients in the AAV2-GAD group showed a 23% improvement (an average 8.1-point decrease) in UPDRS scores in the "off" state (while not on medications), compared with a 13% improvement (an average 4.7-point decrease) in the sham group (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70039-4]).

"The change of UPDRS scores from baseline differed significantly between treatment groups across all three postoperative time points" at 1, 3, and 6 months, the researchers noted.

The only severe adverse event reported during the study period was a case of bowel obstruction in the AAV2-GAD group. Mild and moderate adverse events included headaches and nausea.

In addition, the investigator’s clinical global impression of Parkinson’s disease severity improved significantly from baseline to 6 months in the treatment group vs. the sham group (3.4 vs. 3.9).

The patients’ ages ranged from 30 to 75 years. A total of 6 patients in the treatment group and 2 in the sham group did not receive the complete intervention, leaving efficacy groups of 16 and 21, respectively.

The findings were limited by the study’s small size and the possibility of inadequate blinding of the procedures because the patients were awake during their surgeries. However, "it is unlikely that the benefits in the AAV2-GAD treatment group were caused by the temporary placement of catheters in the subthalamic nucleus rather than from the infusion of the gene product," the researchers wrote.

Although the study findings are promising, questions remain as to how long the effects of the gene therapy will last and what advantages it might have over deep brain stimulation, Dr. Michael Hutchinson of New York University, wrote in an accompanying editorial. The added value of the study is that the placebo effect is not large enough to explain the benefits of gene therapy seen in open-label surgical trials, Dr. Hutchinson said. The significant difference in outcomes between the groups is "a tribute" to the researchers’ attention to detail in a small surgical trial, he added (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70041-2]).

The study was funded by Neurologix Inc. Many of the investigators reported serving as speakers or consultants or receiving grant funding from many companies that manufacture treatments for Parkinson’s disease. Dr. Hutchinson had no financial conflicts to disclose.

Direct infusion of the gene for glutamic acid decarboxylase into the subthalamic nucleus of patients with Parkinson’s disease significantly improved measures of motor function, compared with patients who underwent a sham procedure, according to the results of a phase II trial in 45 patients.

The study was "the first successful randomized, double-blind gene therapy trial for a neurological disorder" and serves as a proof of concept for similar studies, justifying its continued development, Dr. Peter A. LeWitt of Wayne State University, Detroit, and his colleagues reported online March 17 in the Lancet Neurology.

In the study, 22 Parkinson’s patients with Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores of 25 or more were randomized to gene therapy and 23 were randomized to sham surgery. The gene therapy involved inserting the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus using the adeno-associated viral vector, AAV2.

GAD is the rate-limiting enzyme for the neurotransmitter gamma-aminobutyric acid (GABA). The destruction of nigrostriatal dopaminergic neurons in Parkinson’s disease alters the dynamics of inhibitory GABA input to the subthalamic nucleus, which worsens parkinsonian symptoms. Improvement of symptoms has been shown previously with infusions of a GABA agonist into the subthalamic nucleus of Parkinson’s disease patients during surgery for deep brain stimulation and also in animal models of parkinsonism.

After 6 months, patients in the AAV2-GAD group showed a 23% improvement (an average 8.1-point decrease) in UPDRS scores in the "off" state (while not on medications), compared with a 13% improvement (an average 4.7-point decrease) in the sham group (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70039-4]).

"The change of UPDRS scores from baseline differed significantly between treatment groups across all three postoperative time points" at 1, 3, and 6 months, the researchers noted.

The only severe adverse event reported during the study period was a case of bowel obstruction in the AAV2-GAD group. Mild and moderate adverse events included headaches and nausea.

In addition, the investigator’s clinical global impression of Parkinson’s disease severity improved significantly from baseline to 6 months in the treatment group vs. the sham group (3.4 vs. 3.9).

The patients’ ages ranged from 30 to 75 years. A total of 6 patients in the treatment group and 2 in the sham group did not receive the complete intervention, leaving efficacy groups of 16 and 21, respectively.

The findings were limited by the study’s small size and the possibility of inadequate blinding of the procedures because the patients were awake during their surgeries. However, "it is unlikely that the benefits in the AAV2-GAD treatment group were caused by the temporary placement of catheters in the subthalamic nucleus rather than from the infusion of the gene product," the researchers wrote.

Although the study findings are promising, questions remain as to how long the effects of the gene therapy will last and what advantages it might have over deep brain stimulation, Dr. Michael Hutchinson of New York University, wrote in an accompanying editorial. The added value of the study is that the placebo effect is not large enough to explain the benefits of gene therapy seen in open-label surgical trials, Dr. Hutchinson said. The significant difference in outcomes between the groups is "a tribute" to the researchers’ attention to detail in a small surgical trial, he added (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70041-2]).

The study was funded by Neurologix Inc. Many of the investigators reported serving as speakers or consultants or receiving grant funding from many companies that manufacture treatments for Parkinson’s disease. Dr. Hutchinson had no financial conflicts to disclose.

Direct infusion of the gene for glutamic acid decarboxylase into the subthalamic nucleus of patients with Parkinson’s disease significantly improved measures of motor function, compared with patients who underwent a sham procedure, according to the results of a phase II trial in 45 patients.

The study was "the first successful randomized, double-blind gene therapy trial for a neurological disorder" and serves as a proof of concept for similar studies, justifying its continued development, Dr. Peter A. LeWitt of Wayne State University, Detroit, and his colleagues reported online March 17 in the Lancet Neurology.

In the study, 22 Parkinson’s patients with Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores of 25 or more were randomized to gene therapy and 23 were randomized to sham surgery. The gene therapy involved inserting the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus using the adeno-associated viral vector, AAV2.

GAD is the rate-limiting enzyme for the neurotransmitter gamma-aminobutyric acid (GABA). The destruction of nigrostriatal dopaminergic neurons in Parkinson’s disease alters the dynamics of inhibitory GABA input to the subthalamic nucleus, which worsens parkinsonian symptoms. Improvement of symptoms has been shown previously with infusions of a GABA agonist into the subthalamic nucleus of Parkinson’s disease patients during surgery for deep brain stimulation and also in animal models of parkinsonism.

After 6 months, patients in the AAV2-GAD group showed a 23% improvement (an average 8.1-point decrease) in UPDRS scores in the "off" state (while not on medications), compared with a 13% improvement (an average 4.7-point decrease) in the sham group (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70039-4]).

"The change of UPDRS scores from baseline differed significantly between treatment groups across all three postoperative time points" at 1, 3, and 6 months, the researchers noted.

The only severe adverse event reported during the study period was a case of bowel obstruction in the AAV2-GAD group. Mild and moderate adverse events included headaches and nausea.

In addition, the investigator’s clinical global impression of Parkinson’s disease severity improved significantly from baseline to 6 months in the treatment group vs. the sham group (3.4 vs. 3.9).

The patients’ ages ranged from 30 to 75 years. A total of 6 patients in the treatment group and 2 in the sham group did not receive the complete intervention, leaving efficacy groups of 16 and 21, respectively.

The findings were limited by the study’s small size and the possibility of inadequate blinding of the procedures because the patients were awake during their surgeries. However, "it is unlikely that the benefits in the AAV2-GAD treatment group were caused by the temporary placement of catheters in the subthalamic nucleus rather than from the infusion of the gene product," the researchers wrote.

Although the study findings are promising, questions remain as to how long the effects of the gene therapy will last and what advantages it might have over deep brain stimulation, Dr. Michael Hutchinson of New York University, wrote in an accompanying editorial. The added value of the study is that the placebo effect is not large enough to explain the benefits of gene therapy seen in open-label surgical trials, Dr. Hutchinson said. The significant difference in outcomes between the groups is "a tribute" to the researchers’ attention to detail in a small surgical trial, he added (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70041-2]).

The study was funded by Neurologix Inc. Many of the investigators reported serving as speakers or consultants or receiving grant funding from many companies that manufacture treatments for Parkinson’s disease. Dr. Hutchinson had no financial conflicts to disclose.

Direct infusion of the gene for glutamic acid decarboxylase into the subthalamic nucleus of patients with Parkinson’s disease significantly improved measures of motor function, compared with patients who underwent a sham procedure, according to the results of a phase II trial in 45 patients.

The study was "the first successful randomized, double-blind gene therapy trial for a neurological disorder" and serves as a proof of concept for similar studies, justifying its continued development, Dr. Peter A. LeWitt of Wayne State University, Detroit, and his colleagues reported online March 17 in the Lancet Neurology.

In the study, 22 Parkinson’s patients with Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores of 25 or more were randomized to gene therapy and 23 were randomized to sham surgery. The gene therapy involved inserting the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus using the adeno-associated viral vector, AAV2.

GAD is the rate-limiting enzyme for the neurotransmitter gamma-aminobutyric acid (GABA). The destruction of nigrostriatal dopaminergic neurons in Parkinson’s disease alters the dynamics of inhibitory GABA input to the subthalamic nucleus, which worsens parkinsonian symptoms. Improvement of symptoms has been shown previously with infusions of a GABA agonist into the subthalamic nucleus of Parkinson’s disease patients during surgery for deep brain stimulation and also in animal models of parkinsonism.

After 6 months, patients in the AAV2-GAD group showed a 23% improvement (an average 8.1-point decrease) in UPDRS scores in the "off" state (while not on medications), compared with a 13% improvement (an average 4.7-point decrease) in the sham group (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70039-4]).

"The change of UPDRS scores from baseline differed significantly between treatment groups across all three postoperative time points" at 1, 3, and 6 months, the researchers noted.

The only severe adverse event reported during the study period was a case of bowel obstruction in the AAV2-GAD group. Mild and moderate adverse events included headaches and nausea.

In addition, the investigator’s clinical global impression of Parkinson’s disease severity improved significantly from baseline to 6 months in the treatment group vs. the sham group (3.4 vs. 3.9).

The patients’ ages ranged from 30 to 75 years. A total of 6 patients in the treatment group and 2 in the sham group did not receive the complete intervention, leaving efficacy groups of 16 and 21, respectively.

The findings were limited by the study’s small size and the possibility of inadequate blinding of the procedures because the patients were awake during their surgeries. However, "it is unlikely that the benefits in the AAV2-GAD treatment group were caused by the temporary placement of catheters in the subthalamic nucleus rather than from the infusion of the gene product," the researchers wrote.

Although the study findings are promising, questions remain as to how long the effects of the gene therapy will last and what advantages it might have over deep brain stimulation, Dr. Michael Hutchinson of New York University, wrote in an accompanying editorial. The added value of the study is that the placebo effect is not large enough to explain the benefits of gene therapy seen in open-label surgical trials, Dr. Hutchinson said. The significant difference in outcomes between the groups is "a tribute" to the researchers’ attention to detail in a small surgical trial, he added (Lancet Neurol. 2011 March 17 [doi:10.1016/S1474-4422(11)70041-2]).

The study was funded by Neurologix Inc. Many of the investigators reported serving as speakers or consultants or receiving grant funding from many companies that manufacture treatments for Parkinson’s disease. Dr. Hutchinson had no financial conflicts to disclose.

Millions of Americans aged 65 years and older are not receiving potentially lifesaving preventive services, according to a report issued by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services on March 14.

Approximately 85% of flu-related deaths and 63% of flu-related hospitalizations occur in adults aged 65 years and older. Data have shown that the pneumococcal vaccine is a cost-effective way to improve survival and reduce hospital stay in older adults with community-acquired pneumonia, according to the authors of the report, "Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap."

However, in 2009, more than 31% of older adults had not received an influenza vaccination in the past year, while more than 33% reported that they had never received a pneumococcal vaccination.

The report included eight indicators to measure the use of clinical preventive health services by U.S. adults aged 65 years and older: influenza vaccination; pneumococcal vaccination; counseling for smoking cessation; and screening for breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis.

Breast cancer screening and cholesterol screening were the most widely used services. Only 17% of women aged 65 and older reported not receiving breast cancer screening in the past 2 years, while only 5% of adults aged 65 and older said they had not had blood cholesterol screening in the past 5 years.

The report also highlighted ethnic disparities in many of the preventive services for older adults. Approximately 49% of Asian/Pacific Islanders and 47% of Hispanics in the United States reported that they had not undergone colorectal cancer screening, compared with 37% of blacks, 35% of American Indians/Alaska Natives, and 34% of whites. In addition, approximately 51% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of American Indians/Alaska Natives reported never receiving a pneumococcal vaccine, compared with 30% of whites.

The report recommended interventions for improving preventive care for older adults, including promoting annual wellness visits, reducing barriers to preventive care services, and tailoring preventive health messages to the needs of each individual.

The report also recommended several additional preventive services for older adults: screening and counseling for alcohol misuse; zoster vaccination; aspirin use; blood pressure screening; cervical cancer screening; depression screening and counseling; and obesity screening and counseling.

The full report is available online at http://www.cdc.gov/Features/PreventiveServices.

Millions of Americans aged 65 years and older are not receiving potentially lifesaving preventive services, according to a report issued by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services on March 14.

Approximately 85% of flu-related deaths and 63% of flu-related hospitalizations occur in adults aged 65 years and older. Data have shown that the pneumococcal vaccine is a cost-effective way to improve survival and reduce hospital stay in older adults with community-acquired pneumonia, according to the authors of the report, "Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap."

However, in 2009, more than 31% of older adults had not received an influenza vaccination in the past year, while more than 33% reported that they had never received a pneumococcal vaccination.

The report included eight indicators to measure the use of clinical preventive health services by U.S. adults aged 65 years and older: influenza vaccination; pneumococcal vaccination; counseling for smoking cessation; and screening for breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis.

Breast cancer screening and cholesterol screening were the most widely used services. Only 17% of women aged 65 and older reported not receiving breast cancer screening in the past 2 years, while only 5% of adults aged 65 and older said they had not had blood cholesterol screening in the past 5 years.

The report also highlighted ethnic disparities in many of the preventive services for older adults. Approximately 49% of Asian/Pacific Islanders and 47% of Hispanics in the United States reported that they had not undergone colorectal cancer screening, compared with 37% of blacks, 35% of American Indians/Alaska Natives, and 34% of whites. In addition, approximately 51% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of American Indians/Alaska Natives reported never receiving a pneumococcal vaccine, compared with 30% of whites.

The report recommended interventions for improving preventive care for older adults, including promoting annual wellness visits, reducing barriers to preventive care services, and tailoring preventive health messages to the needs of each individual.

The report also recommended several additional preventive services for older adults: screening and counseling for alcohol misuse; zoster vaccination; aspirin use; blood pressure screening; cervical cancer screening; depression screening and counseling; and obesity screening and counseling.

The full report is available online at http://www.cdc.gov/Features/PreventiveServices.

Millions of Americans aged 65 years and older are not receiving potentially lifesaving preventive services, according to a report issued by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services on March 14.

Approximately 85% of flu-related deaths and 63% of flu-related hospitalizations occur in adults aged 65 years and older. Data have shown that the pneumococcal vaccine is a cost-effective way to improve survival and reduce hospital stay in older adults with community-acquired pneumonia, according to the authors of the report, "Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap."

However, in 2009, more than 31% of older adults had not received an influenza vaccination in the past year, while more than 33% reported that they had never received a pneumococcal vaccination.

The report included eight indicators to measure the use of clinical preventive health services by U.S. adults aged 65 years and older: influenza vaccination; pneumococcal vaccination; counseling for smoking cessation; and screening for breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis.

Breast cancer screening and cholesterol screening were the most widely used services. Only 17% of women aged 65 and older reported not receiving breast cancer screening in the past 2 years, while only 5% of adults aged 65 and older said they had not had blood cholesterol screening in the past 5 years.

The report also highlighted ethnic disparities in many of the preventive services for older adults. Approximately 49% of Asian/Pacific Islanders and 47% of Hispanics in the United States reported that they had not undergone colorectal cancer screening, compared with 37% of blacks, 35% of American Indians/Alaska Natives, and 34% of whites. In addition, approximately 51% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of American Indians/Alaska Natives reported never receiving a pneumococcal vaccine, compared with 30% of whites.

The report recommended interventions for improving preventive care for older adults, including promoting annual wellness visits, reducing barriers to preventive care services, and tailoring preventive health messages to the needs of each individual.

The report also recommended several additional preventive services for older adults: screening and counseling for alcohol misuse; zoster vaccination; aspirin use; blood pressure screening; cervical cancer screening; depression screening and counseling; and obesity screening and counseling.

The full report is available online at http://www.cdc.gov/Features/PreventiveServices.

Millions of Americans aged 65 years and older are not receiving potentially lifesaving preventive services, according to a report issued by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services on March 14.

Approximately 85% of flu-related deaths and 63% of flu-related hospitalizations occur in adults aged 65 years and older. Data have shown that the pneumococcal vaccine is a cost-effective way to improve survival and reduce hospital stay in older adults with community-acquired pneumonia, according to the authors of the report, "Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap."

However, in 2009, more than 31% of older adults had not received an influenza vaccination in the past year, while more than 33% reported that they had never received a pneumococcal vaccination.

The report included eight indicators to measure the use of clinical preventive health services by U.S. adults aged 65 years and older: influenza vaccination; pneumococcal vaccination; counseling for smoking cessation; and screening for breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis.

Breast cancer screening and cholesterol screening were the most widely used services. Only 17% of women aged 65 and older reported not receiving breast cancer screening in the past 2 years, while only 5% of adults aged 65 and older said they had not had blood cholesterol screening in the past 5 years.

The report also highlighted ethnic disparities in many of the preventive services for older adults. Approximately 49% of Asian/Pacific Islanders and 47% of Hispanics in the United States reported that they had not undergone colorectal cancer screening, compared with 37% of blacks, 35% of American Indians/Alaska Natives, and 34% of whites. In addition, approximately 51% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of American Indians/Alaska Natives reported never receiving a pneumococcal vaccine, compared with 30% of whites.

The report recommended interventions for improving preventive care for older adults, including promoting annual wellness visits, reducing barriers to preventive care services, and tailoring preventive health messages to the needs of each individual.

The report also recommended several additional preventive services for older adults: screening and counseling for alcohol misuse; zoster vaccination; aspirin use; blood pressure screening; cervical cancer screening; depression screening and counseling; and obesity screening and counseling.

The full report is available online at http://www.cdc.gov/Features/PreventiveServices.

Millions of Americans aged 65 years and older are not receiving potentially lifesaving preventive services, according to a report issued by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services on March 14.

Approximately 85% of flu-related deaths and 63% of flu-related hospitalizations occur in adults aged 65 years and older. Data have shown that the pneumococcal vaccine is a cost-effective way to improve survival and reduce hospital stay in older adults with community-acquired pneumonia, according to the authors of the report, "Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap."

However, in 2009, more than 31% of older adults had not received an influenza vaccination in the past year, while more than 33% reported that they had never received a pneumococcal vaccination.

The report included eight indicators to measure the use of clinical preventive health services by U.S. adults aged 65 years and older: influenza vaccination; pneumococcal vaccination; counseling for smoking cessation; and screening for breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis.

Breast cancer screening and cholesterol screening were the most widely used services. Only 17% of women aged 65 and older reported not receiving breast cancer screening in the past 2 years, while only 5% of adults aged 65 and older said they had not had blood cholesterol screening in the past 5 years.

The report also highlighted ethnic disparities in many of the preventive services for older adults. Approximately 49% of Asian/Pacific Islanders and 47% of Hispanics in the United States reported that they had not undergone colorectal cancer screening, compared with 37% of blacks, 35% of American Indians/Alaska Natives, and 34% of whites. In addition, approximately 51% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of American Indians/Alaska Natives reported never receiving a pneumococcal vaccine, compared with 30% of whites.

The report recommended interventions for improving preventive care for older adults, including promoting annual wellness visits, reducing barriers to preventive care services, and tailoring preventive health messages to the needs of each individual.

The report also recommended several additional preventive services for older adults: screening and counseling for alcohol misuse; zoster vaccination; aspirin use; blood pressure screening; cervical cancer screening; depression screening and counseling; and obesity screening and counseling.

The full report is available online at http://www.cdc.gov/Features/PreventiveServices.

Millions of Americans aged 65 years and older are not receiving potentially lifesaving preventive services, according to a report issued by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services on March 14.

Approximately 85% of flu-related deaths and 63% of flu-related hospitalizations occur in adults aged 65 years and older. Data have shown that the pneumococcal vaccine is a cost-effective way to improve survival and reduce hospital stay in older adults with community-acquired pneumonia, according to the authors of the report, "Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap."

However, in 2009, more than 31% of older adults had not received an influenza vaccination in the past year, while more than 33% reported that they had never received a pneumococcal vaccination.

The report included eight indicators to measure the use of clinical preventive health services by U.S. adults aged 65 years and older: influenza vaccination; pneumococcal vaccination; counseling for smoking cessation; and screening for breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis.

Breast cancer screening and cholesterol screening were the most widely used services. Only 17% of women aged 65 and older reported not receiving breast cancer screening in the past 2 years, while only 5% of adults aged 65 and older said they had not had blood cholesterol screening in the past 5 years.

The report also highlighted ethnic disparities in many of the preventive services for older adults. Approximately 49% of Asian/Pacific Islanders and 47% of Hispanics in the United States reported that they had not undergone colorectal cancer screening, compared with 37% of blacks, 35% of American Indians/Alaska Natives, and 34% of whites. In addition, approximately 51% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of American Indians/Alaska Natives reported never receiving a pneumococcal vaccine, compared with 30% of whites.

The report recommended interventions for improving preventive care for older adults, including promoting annual wellness visits, reducing barriers to preventive care services, and tailoring preventive health messages to the needs of each individual.

The report also recommended several additional preventive services for older adults: screening and counseling for alcohol misuse; zoster vaccination; aspirin use; blood pressure screening; cervical cancer screening; depression screening and counseling; and obesity screening and counseling.

The full report is available online at http://www.cdc.gov/Features/PreventiveServices.

Millions of Americans aged 65 years and older are not receiving potentially lifesaving preventive services, according to a report issued by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services on March 14.

Approximately 85% of flu-related deaths and 63% of flu-related hospitalizations occur in adults aged 65 years and older. Data have shown that the pneumococcal vaccine is a cost-effective way to improve survival and reduce hospital stay in older adults with community-acquired pneumonia, according to the authors of the report, "Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap."

However, in 2009, more than 31% of older adults had not received an influenza vaccination in the past year, while more than 33% reported that they had never received a pneumococcal vaccination.

The report included eight indicators to measure the use of clinical preventive health services by U.S. adults aged 65 years and older: influenza vaccination; pneumococcal vaccination; counseling for smoking cessation; and screening for breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis.

Breast cancer screening and cholesterol screening were the most widely used services. Only 17% of women aged 65 and older reported not receiving breast cancer screening in the past 2 years, while only 5% of adults aged 65 and older said they had not had blood cholesterol screening in the past 5 years.

The report also highlighted ethnic disparities in many of the preventive services for older adults. Approximately 49% of Asian/Pacific Islanders and 47% of Hispanics in the United States reported that they had not undergone colorectal cancer screening, compared with 37% of blacks, 35% of American Indians/Alaska Natives, and 34% of whites. In addition, approximately 51% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of American Indians/Alaska Natives reported never receiving a pneumococcal vaccine, compared with 30% of whites.

The report recommended interventions for improving preventive care for older adults, including promoting annual wellness visits, reducing barriers to preventive care services, and tailoring preventive health messages to the needs of each individual.

The report also recommended several additional preventive services for older adults: screening and counseling for alcohol misuse; zoster vaccination; aspirin use; blood pressure screening; cervical cancer screening; depression screening and counseling; and obesity screening and counseling.

The full report is available online.

Millions of Americans aged 65 years and older are not receiving potentially lifesaving preventive services, according to a report issued by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services on March 14.

Approximately 85% of flu-related deaths and 63% of flu-related hospitalizations occur in adults aged 65 years and older. Data have shown that the pneumococcal vaccine is a cost-effective way to improve survival and reduce hospital stay in older adults with community-acquired pneumonia, according to the authors of the report, "Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap."

However, in 2009, more than 31% of older adults had not received an influenza vaccination in the past year, while more than 33% reported that they had never received a pneumococcal vaccination.

The report included eight indicators to measure the use of clinical preventive health services by U.S. adults aged 65 years and older: influenza vaccination; pneumococcal vaccination; counseling for smoking cessation; and screening for breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis.

Breast cancer screening and cholesterol screening were the most widely used services. Only 17% of women aged 65 and older reported not receiving breast cancer screening in the past 2 years, while only 5% of adults aged 65 and older said they had not had blood cholesterol screening in the past 5 years.

The report also highlighted ethnic disparities in many of the preventive services for older adults. Approximately 49% of Asian/Pacific Islanders and 47% of Hispanics in the United States reported that they had not undergone colorectal cancer screening, compared with 37% of blacks, 35% of American Indians/Alaska Natives, and 34% of whites. In addition, approximately 51% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of American Indians/Alaska Natives reported never receiving a pneumococcal vaccine, compared with 30% of whites.

The report recommended interventions for improving preventive care for older adults, including promoting annual wellness visits, reducing barriers to preventive care services, and tailoring preventive health messages to the needs of each individual.

The report also recommended several additional preventive services for older adults: screening and counseling for alcohol misuse; zoster vaccination; aspirin use; blood pressure screening; cervical cancer screening; depression screening and counseling; and obesity screening and counseling.

The full report is available online.

Millions of Americans aged 65 years and older are not receiving potentially lifesaving preventive services, according to a report issued by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services on March 14.

Approximately 85% of flu-related deaths and 63% of flu-related hospitalizations occur in adults aged 65 years and older. Data have shown that the pneumococcal vaccine is a cost-effective way to improve survival and reduce hospital stay in older adults with community-acquired pneumonia, according to the authors of the report, "Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap."

However, in 2009, more than 31% of older adults had not received an influenza vaccination in the past year, while more than 33% reported that they had never received a pneumococcal vaccination.

The report included eight indicators to measure the use of clinical preventive health services by U.S. adults aged 65 years and older: influenza vaccination; pneumococcal vaccination; counseling for smoking cessation; and screening for breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis.

Breast cancer screening and cholesterol screening were the most widely used services. Only 17% of women aged 65 and older reported not receiving breast cancer screening in the past 2 years, while only 5% of adults aged 65 and older said they had not had blood cholesterol screening in the past 5 years.

The report also highlighted ethnic disparities in many of the preventive services for older adults. Approximately 49% of Asian/Pacific Islanders and 47% of Hispanics in the United States reported that they had not undergone colorectal cancer screening, compared with 37% of blacks, 35% of American Indians/Alaska Natives, and 34% of whites. In addition, approximately 51% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of American Indians/Alaska Natives reported never receiving a pneumococcal vaccine, compared with 30% of whites.

The report recommended interventions for improving preventive care for older adults, including promoting annual wellness visits, reducing barriers to preventive care services, and tailoring preventive health messages to the needs of each individual.

The report also recommended several additional preventive services for older adults: screening and counseling for alcohol misuse; zoster vaccination; aspirin use; blood pressure screening; cervical cancer screening; depression screening and counseling; and obesity screening and counseling.

The full report is available online.

Patients who received methotrexate in combination with other disease-modifying antirheumatic drugs were significantly more likely to remain on anti–tumor necrosis factor therapy than were patients who received methotrexate monotherapy or other DMARDs without methotrexate, based on data from more than 10,000 patients in the British Society for Rheumatology Biologics Register. The findings were published online Feb. 17 in the Annals of the Rheumatic Diseases.

Previous studies have examined the impact of DMARDs on the continuation of anti-TNF therapy, but most of these did not compare the effects of specific DMARDs, said Dr. Moetaza M. Soliman of the University of Manchester (England) and colleagues (Ann. Rheum. Dis. 2011 Feb. 17 [doi:10.1136/ard.2010.139774]).

After 5 years of follow-up, patients who received methotrexate (MTX) in combination with either sulfasalazine or hydroxychloroquine or a combination of the two agents were significantly less likely to discontinue anti-TNF therapy, compared with those who received MTX alone. The adjusted hazard ratios were 0.76, 0.81, and 0.80, respectively, compared with methotrexate alone.

Patients who received no DMARDs were 40% more likely to discontinue anti-TNF, compared with those who received MTX. Patients who received leflunomide or sulfasalazine were 41% and 23% more likely, respectively, to discontinue anti-TNF therapy, compared with those who received MTX.

The study population included 3,339 patients receiving no DMARDs, 4,418 on MTX, 610 taking leflunomide, 308 receiving sulfasalazine, 902 on MTX plus sulfasalazine, 401 taking MTX plus hydroxychloroquine, and 418 on MTX plus a sulfasalazine and hydroxychloroquine combination. The average age of the patients was 56 years, and the average disease duration was 13 years.

The results were similar when the researchers controlled for reasons for discontinuation, including adverse events and lack of efficacy.

The study was limited by the smaller size of certain treatment groups, but it is the largest of its type to date. The results support the use of MTX alone or in combination with other DMARDs as a way to extend compliance with anti-TNF therapy, the researchers noted.

"Further study is required to understand if longer-term anti-TNF treatment persistence would be improved by simply stopping these DMARDs or whether they should be substituted, where possible, with other DMARDs such as MTX, if tolerated," they said.

The study was funded by the British Society for Rheumatology, which receives some income from pharmaceutical companies including Abbott Laboratories, Amgen, Roche, Schering-Plough, and Wyeth Pharmaceuticals.

Patients who received methotrexate in combination with other disease-modifying antirheumatic drugs were significantly more likely to remain on anti–tumor necrosis factor therapy than were patients who received methotrexate monotherapy or other DMARDs without methotrexate, based on data from more than 10,000 patients in the British Society for Rheumatology Biologics Register. The findings were published online Feb. 17 in the Annals of the Rheumatic Diseases.

Previous studies have examined the impact of DMARDs on the continuation of anti-TNF therapy, but most of these did not compare the effects of specific DMARDs, said Dr. Moetaza M. Soliman of the University of Manchester (England) and colleagues (Ann. Rheum. Dis. 2011 Feb. 17 [doi:10.1136/ard.2010.139774]).

After 5 years of follow-up, patients who received methotrexate (MTX) in combination with either sulfasalazine or hydroxychloroquine or a combination of the two agents were significantly less likely to discontinue anti-TNF therapy, compared with those who received MTX alone. The adjusted hazard ratios were 0.76, 0.81, and 0.80, respectively, compared with methotrexate alone.

Patients who received no DMARDs were 40% more likely to discontinue anti-TNF, compared with those who received MTX. Patients who received leflunomide or sulfasalazine were 41% and 23% more likely, respectively, to discontinue anti-TNF therapy, compared with those who received MTX.

The study population included 3,339 patients receiving no DMARDs, 4,418 on MTX, 610 taking leflunomide, 308 receiving sulfasalazine, 902 on MTX plus sulfasalazine, 401 taking MTX plus hydroxychloroquine, and 418 on MTX plus a sulfasalazine and hydroxychloroquine combination. The average age of the patients was 56 years, and the average disease duration was 13 years.

The results were similar when the researchers controlled for reasons for discontinuation, including adverse events and lack of efficacy.

The study was limited by the smaller size of certain treatment groups, but it is the largest of its type to date. The results support the use of MTX alone or in combination with other DMARDs as a way to extend compliance with anti-TNF therapy, the researchers noted.

"Further study is required to understand if longer-term anti-TNF treatment persistence would be improved by simply stopping these DMARDs or whether they should be substituted, where possible, with other DMARDs such as MTX, if tolerated," they said.

The study was funded by the British Society for Rheumatology, which receives some income from pharmaceutical companies including Abbott Laboratories, Amgen, Roche, Schering-Plough, and Wyeth Pharmaceuticals.

Patients who received methotrexate in combination with other disease-modifying antirheumatic drugs were significantly more likely to remain on anti–tumor necrosis factor therapy than were patients who received methotrexate monotherapy or other DMARDs without methotrexate, based on data from more than 10,000 patients in the British Society for Rheumatology Biologics Register. The findings were published online Feb. 17 in the Annals of the Rheumatic Diseases.

Previous studies have examined the impact of DMARDs on the continuation of anti-TNF therapy, but most of these did not compare the effects of specific DMARDs, said Dr. Moetaza M. Soliman of the University of Manchester (England) and colleagues (Ann. Rheum. Dis. 2011 Feb. 17 [doi:10.1136/ard.2010.139774]).

After 5 years of follow-up, patients who received methotrexate (MTX) in combination with either sulfasalazine or hydroxychloroquine or a combination of the two agents were significantly less likely to discontinue anti-TNF therapy, compared with those who received MTX alone. The adjusted hazard ratios were 0.76, 0.81, and 0.80, respectively, compared with methotrexate alone.

Patients who received no DMARDs were 40% more likely to discontinue anti-TNF, compared with those who received MTX. Patients who received leflunomide or sulfasalazine were 41% and 23% more likely, respectively, to discontinue anti-TNF therapy, compared with those who received MTX.

The study population included 3,339 patients receiving no DMARDs, 4,418 on MTX, 610 taking leflunomide, 308 receiving sulfasalazine, 902 on MTX plus sulfasalazine, 401 taking MTX plus hydroxychloroquine, and 418 on MTX plus a sulfasalazine and hydroxychloroquine combination. The average age of the patients was 56 years, and the average disease duration was 13 years.

The results were similar when the researchers controlled for reasons for discontinuation, including adverse events and lack of efficacy.

The study was limited by the smaller size of certain treatment groups, but it is the largest of its type to date. The results support the use of MTX alone or in combination with other DMARDs as a way to extend compliance with anti-TNF therapy, the researchers noted.

"Further study is required to understand if longer-term anti-TNF treatment persistence would be improved by simply stopping these DMARDs or whether they should be substituted, where possible, with other DMARDs such as MTX, if tolerated," they said.

The study was funded by the British Society for Rheumatology, which receives some income from pharmaceutical companies including Abbott Laboratories, Amgen, Roche, Schering-Plough, and Wyeth Pharmaceuticals.

Patients who received methotrexate in combination with other disease-modifying antirheumatic drugs were significantly more likely to remain on anti–tumor necrosis factor therapy than were patients who received methotrexate monotherapy or other DMARDs without methotrexate, based on data from more than 10,000 patients in the British Society for Rheumatology Biologics Register. The findings were published online Feb. 17 in the Annals of the Rheumatic Diseases.

Previous studies have examined the impact of DMARDs on the continuation of anti-TNF therapy, but most of these did not compare the effects of specific DMARDs, said Dr. Moetaza M. Soliman of the University of Manchester (England) and colleagues (Ann. Rheum. Dis. 2011 Feb. 17 [doi:10.1136/ard.2010.139774]).

After 5 years of follow-up, patients who received methotrexate (MTX) in combination with either sulfasalazine or hydroxychloroquine or a combination of the two agents were significantly less likely to discontinue anti-TNF therapy, compared with those who received MTX alone. The adjusted hazard ratios were 0.76, 0.81, and 0.80, respectively, compared with methotrexate alone.

Patients who received no DMARDs were 40% more likely to discontinue anti-TNF, compared with those who received MTX. Patients who received leflunomide or sulfasalazine were 41% and 23% more likely, respectively, to discontinue anti-TNF therapy, compared with those who received MTX.

The study population included 3,339 patients receiving no DMARDs, 4,418 on MTX, 610 taking leflunomide, 308 receiving sulfasalazine, 902 on MTX plus sulfasalazine, 401 taking MTX plus hydroxychloroquine, and 418 on MTX plus a sulfasalazine and hydroxychloroquine combination. The average age of the patients was 56 years, and the average disease duration was 13 years.

The results were similar when the researchers controlled for reasons for discontinuation, including adverse events and lack of efficacy.

The study was limited by the smaller size of certain treatment groups, but it is the largest of its type to date. The results support the use of MTX alone or in combination with other DMARDs as a way to extend compliance with anti-TNF therapy, the researchers noted.

"Further study is required to understand if longer-term anti-TNF treatment persistence would be improved by simply stopping these DMARDs or whether they should be substituted, where possible, with other DMARDs such as MTX, if tolerated," they said.

The study was funded by the British Society for Rheumatology, which receives some income from pharmaceutical companies including Abbott Laboratories, Amgen, Roche, Schering-Plough, and Wyeth Pharmaceuticals.

Patients who received methotrexate in combination with other disease-modifying antirheumatic drugs were significantly more likely to remain on anti–tumor necrosis factor therapy than were patients who received methotrexate monotherapy or other DMARDs without methotrexate, based on data from more than 10,000 patients in the British Society for Rheumatology Biologics Register. The findings were published online Feb. 17 in the Annals of the Rheumatic Diseases.

Previous studies have examined the impact of DMARDs on the continuation of anti-TNF therapy, but most of these did not compare the effects of specific DMARDs, said Dr. Moetaza M. Soliman of the University of Manchester (England) and colleagues (Ann. Rheum. Dis. 2011 Feb. 17 [doi:10.1136/ard.2010.139774]).

After 5 years of follow-up, patients who received methotrexate (MTX) in combination with either sulfasalazine or hydroxychloroquine or a combination of the two agents were significantly less likely to discontinue anti-TNF therapy, compared with those who received MTX alone. The adjusted hazard ratios were 0.76, 0.81, and 0.80, respectively, compared with methotrexate alone.

Patients who received no DMARDs were 40% more likely to discontinue anti-TNF, compared with those who received MTX. Patients who received leflunomide or sulfasalazine were 41% and 23% more likely, respectively, to discontinue anti-TNF therapy, compared with those who received MTX.

The study population included 3,339 patients receiving no DMARDs, 4,418 on MTX, 610 taking leflunomide, 308 receiving sulfasalazine, 902 on MTX plus sulfasalazine, 401 taking MTX plus hydroxychloroquine, and 418 on MTX plus a sulfasalazine and hydroxychloroquine combination. The average age of the patients was 56 years, and the average disease duration was 13 years.

The results were similar when the researchers controlled for reasons for discontinuation, including adverse events and lack of efficacy.

The study was limited by the smaller size of certain treatment groups, but it is the largest of its type to date. The results support the use of MTX alone or in combination with other DMARDs as a way to extend compliance with anti-TNF therapy, the researchers noted.

"Further study is required to understand if longer-term anti-TNF treatment persistence would be improved by simply stopping these DMARDs or whether they should be substituted, where possible, with other DMARDs such as MTX, if tolerated," they said.

The study was funded by the British Society for Rheumatology, which receives some income from pharmaceutical companies including Abbott Laboratories, Amgen, Roche, Schering-Plough, and Wyeth Pharmaceuticals.

Patients who received methotrexate in combination with other disease-modifying antirheumatic drugs were significantly more likely to remain on anti–tumor necrosis factor therapy than were patients who received methotrexate monotherapy or other DMARDs without methotrexate, based on data from more than 10,000 patients in the British Society for Rheumatology Biologics Register. The findings were published online Feb. 17 in the Annals of the Rheumatic Diseases.

Previous studies have examined the impact of DMARDs on the continuation of anti-TNF therapy, but most of these did not compare the effects of specific DMARDs, said Dr. Moetaza M. Soliman of the University of Manchester (England) and colleagues (Ann. Rheum. Dis. 2011 Feb. 17 [doi:10.1136/ard.2010.139774]).

After 5 years of follow-up, patients who received methotrexate (MTX) in combination with either sulfasalazine or hydroxychloroquine or a combination of the two agents were significantly less likely to discontinue anti-TNF therapy, compared with those who received MTX alone. The adjusted hazard ratios were 0.76, 0.81, and 0.80, respectively, compared with methotrexate alone.

Patients who received no DMARDs were 40% more likely to discontinue anti-TNF, compared with those who received MTX. Patients who received leflunomide or sulfasalazine were 41% and 23% more likely, respectively, to discontinue anti-TNF therapy, compared with those who received MTX.

The study population included 3,339 patients receiving no DMARDs, 4,418 on MTX, 610 taking leflunomide, 308 receiving sulfasalazine, 902 on MTX plus sulfasalazine, 401 taking MTX plus hydroxychloroquine, and 418 on MTX plus a sulfasalazine and hydroxychloroquine combination. The average age of the patients was 56 years, and the average disease duration was 13 years.

The results were similar when the researchers controlled for reasons for discontinuation, including adverse events and lack of efficacy.

The study was limited by the smaller size of certain treatment groups, but it is the largest of its type to date. The results support the use of MTX alone or in combination with other DMARDs as a way to extend compliance with anti-TNF therapy, the researchers noted.

"Further study is required to understand if longer-term anti-TNF treatment persistence would be improved by simply stopping these DMARDs or whether they should be substituted, where possible, with other DMARDs such as MTX, if tolerated," they said.

The study was funded by the British Society for Rheumatology, which receives some income from pharmaceutical companies including Abbott Laboratories, Amgen, Roche, Schering-Plough, and Wyeth Pharmaceuticals.