LAS VEGAS—While women may have their first total joint replacement (TJR) at an older age, they are less likely to have complications related to their surgery or require revision surgery, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The findings contradict the theory that TJR is underutilized in female patients because they have worse outcomes than men.

Researchers reviewed patient databases from an Ontario hospital for first-time primary total hip replacement (THR) and total knee replacement (TKR) patients between 2002 and 2009. There were 37,881 THR surgeries (53.8% female) and 59,564 TKR surgeries (60.5% female). Women who underwent THR were significantly older than males (70 years vs. 65 years); however, there was no difference in age between male and female patients undergoing TKR (median age 68 years for both). A greater proportion of female patients undergoing TJR were defined as frail (6.6% vs. 3.5% for THR; and, 6.7% vs. 4% for TKR).

Following surgery, men were:

• 15% more likely to return to the emergency department within 30 days of hospital discharge following either THR or TKR.

• 60% and 70% more likely to have an acute myocardial infarction within 3 months following THR and TKR, respectively.

• 50% more likely to require a revision arthroplasty within 2 years of TKR.

• 25% more likely to be readmitted to the hospital and 70% more likely to experience an infection or revision surgery within 2 years of TKR, compared to women.

“Despite the fact that women have a higher prevalence of advanced hip and knee arthritis, prior research indicates that North American women with arthritis are less likely to receive joint replacement than men,” said lead study author Bheeshma Ravi, MD, PhD, an orthopedic surgery resident at the University of Toronto. “One possible explanation is that women are less often offered or accept surgery because their risk of serious complications following surgery is greater than that of men.

“In this study, we found that while overall rates of serious complications were low for both groups, they were lower for women than for men for both hip and knee replacement, particularly the latter” said Dr. Ravi. “Thus, the previously documented sex difference utilization of TJR cannot be explained by differential risks of complications following surgery.”

LAS VEGAS—While women may have their first total joint replacement (TJR) at an older age, they are less likely to have complications related to their surgery or require revision surgery, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The findings contradict the theory that TJR is underutilized in female patients because they have worse outcomes than men.

Researchers reviewed patient databases from an Ontario hospital for first-time primary total hip replacement (THR) and total knee replacement (TKR) patients between 2002 and 2009. There were 37,881 THR surgeries (53.8% female) and 59,564 TKR surgeries (60.5% female). Women who underwent THR were significantly older than males (70 years vs. 65 years); however, there was no difference in age between male and female patients undergoing TKR (median age 68 years for both). A greater proportion of female patients undergoing TJR were defined as frail (6.6% vs. 3.5% for THR; and, 6.7% vs. 4% for TKR).

Following surgery, men were:

• 15% more likely to return to the emergency department within 30 days of hospital discharge following either THR or TKR.

• 60% and 70% more likely to have an acute myocardial infarction within 3 months following THR and TKR, respectively.

• 50% more likely to require a revision arthroplasty within 2 years of TKR.

• 25% more likely to be readmitted to the hospital and 70% more likely to experience an infection or revision surgery within 2 years of TKR, compared to women.

“Despite the fact that women have a higher prevalence of advanced hip and knee arthritis, prior research indicates that North American women with arthritis are less likely to receive joint replacement than men,” said lead study author Bheeshma Ravi, MD, PhD, an orthopedic surgery resident at the University of Toronto. “One possible explanation is that women are less often offered or accept surgery because their risk of serious complications following surgery is greater than that of men.

“In this study, we found that while overall rates of serious complications were low for both groups, they were lower for women than for men for both hip and knee replacement, particularly the latter” said Dr. Ravi. “Thus, the previously documented sex difference utilization of TJR cannot be explained by differential risks of complications following surgery.”

LAS VEGAS—While women may have their first total joint replacement (TJR) at an older age, they are less likely to have complications related to their surgery or require revision surgery, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The findings contradict the theory that TJR is underutilized in female patients because they have worse outcomes than men.

Researchers reviewed patient databases from an Ontario hospital for first-time primary total hip replacement (THR) and total knee replacement (TKR) patients between 2002 and 2009. There were 37,881 THR surgeries (53.8% female) and 59,564 TKR surgeries (60.5% female). Women who underwent THR were significantly older than males (70 years vs. 65 years); however, there was no difference in age between male and female patients undergoing TKR (median age 68 years for both). A greater proportion of female patients undergoing TJR were defined as frail (6.6% vs. 3.5% for THR; and, 6.7% vs. 4% for TKR).

Following surgery, men were:

• 15% more likely to return to the emergency department within 30 days of hospital discharge following either THR or TKR.

• 60% and 70% more likely to have an acute myocardial infarction within 3 months following THR and TKR, respectively.

• 50% more likely to require a revision arthroplasty within 2 years of TKR.

• 25% more likely to be readmitted to the hospital and 70% more likely to experience an infection or revision surgery within 2 years of TKR, compared to women.

“Despite the fact that women have a higher prevalence of advanced hip and knee arthritis, prior research indicates that North American women with arthritis are less likely to receive joint replacement than men,” said lead study author Bheeshma Ravi, MD, PhD, an orthopedic surgery resident at the University of Toronto. “One possible explanation is that women are less often offered or accept surgery because their risk of serious complications following surgery is greater than that of men.

“In this study, we found that while overall rates of serious complications were low for both groups, they were lower for women than for men for both hip and knee replacement, particularly the latter” said Dr. Ravi. “Thus, the previously documented sex difference utilization of TJR cannot be explained by differential risks of complications following surgery.”

LAS VEGAS—Black and Hispanic patients were 62% and 50%, respectively, more likely to be readmitted to the hospital within 30 days after total joint replacement (TJR) surgery compared to white patients, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). In addition, Medicaid patients were 40% more likely to be readmitted to the hospital than patients with private insurance. Poorer outcomes, due in part to patient comorbidities, may reflect limited access to primary care, insufficient patient-doctor communication, researchers suggest.

Disparities in the provision of health care services have long been documented, including that black patients utilize hip and total knee replacement at rates nearly 40% less than white patients, despite having comparable or higher rates of osteoarthritis.

In this study, researchers analyzed 5 years of data—demographic (including race/ethnicity), clinical, and billing—on nearly 53,000 patients admitted to Connecticut hospitals for TJR from 2008 to 2012. The average patient age was 67 years, and the vast majority of patients were white (87%), covered by Medicare (56.7%), and female (61%).

The overall 30-day readmission rate for patients was 5.2%. The most common reasons for readmission were postoperative infection (8%), infection and inflammatory reaction due to internal joint prosthesis (6%), hematoma complications during a procedure (3%), and dislocation of a prosthetic joint (3%). Among the other study findings:

• Readmission rates were 83.5 per thousand for black patients, 78.9 for Hispanic patients, and 53.3 for white patients.

• Longer length of hospital stay was significantly associated with increased odds of readmission.

• When controlling for comorbidities and type of insurance coverage, the readmission rate for Hispanic patients dropped 44%, and for black patients, 38%. Black patients remained significantly more likely than white patients to be readmitted following surgery, after controlling for comorbidities.

• Patients covered by Medicare were 30% more likely to be readmitted within 30 days following discharge compared to patients covered by private insurance, and Medicaid patients were 40% more likely.

Recent research using national data on Medicare suggests that community-based factors, such as availability of general practitioners in the area, may be as or more important than hospital factors in determining readmission rates, and that patients may have few options other than hospital care for both urgent and non-urgent conditions related to their surgery or other conditions.

“Using an all-payer database, our study shows that black patients who undergo total knee replacement may have poorer outcomes,” said lead study author and orthopedic surgeon Courtland Lewis, MD. “After controlling for two key variables implicated in race and ethnic disparities in hospital readmission—preoperative comorbidities and type of insurance coverage—black patients still have a 35% higher likelihood of all-cause, 30-day readmission compared to white patients.

“Our ongoing research in this area is focused on other factors, such as the patient’s connection to primary care and patient-provider communication, that may explain this troubling finding,” said Dr. Lewis.

LAS VEGAS—Black and Hispanic patients were 62% and 50%, respectively, more likely to be readmitted to the hospital within 30 days after total joint replacement (TJR) surgery compared to white patients, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). In addition, Medicaid patients were 40% more likely to be readmitted to the hospital than patients with private insurance. Poorer outcomes, due in part to patient comorbidities, may reflect limited access to primary care, insufficient patient-doctor communication, researchers suggest.

Disparities in the provision of health care services have long been documented, including that black patients utilize hip and total knee replacement at rates nearly 40% less than white patients, despite having comparable or higher rates of osteoarthritis.

In this study, researchers analyzed 5 years of data—demographic (including race/ethnicity), clinical, and billing—on nearly 53,000 patients admitted to Connecticut hospitals for TJR from 2008 to 2012. The average patient age was 67 years, and the vast majority of patients were white (87%), covered by Medicare (56.7%), and female (61%).

The overall 30-day readmission rate for patients was 5.2%. The most common reasons for readmission were postoperative infection (8%), infection and inflammatory reaction due to internal joint prosthesis (6%), hematoma complications during a procedure (3%), and dislocation of a prosthetic joint (3%). Among the other study findings:

• Readmission rates were 83.5 per thousand for black patients, 78.9 for Hispanic patients, and 53.3 for white patients.

• Longer length of hospital stay was significantly associated with increased odds of readmission.

• When controlling for comorbidities and type of insurance coverage, the readmission rate for Hispanic patients dropped 44%, and for black patients, 38%. Black patients remained significantly more likely than white patients to be readmitted following surgery, after controlling for comorbidities.

• Patients covered by Medicare were 30% more likely to be readmitted within 30 days following discharge compared to patients covered by private insurance, and Medicaid patients were 40% more likely.

Recent research using national data on Medicare suggests that community-based factors, such as availability of general practitioners in the area, may be as or more important than hospital factors in determining readmission rates, and that patients may have few options other than hospital care for both urgent and non-urgent conditions related to their surgery or other conditions.

“Using an all-payer database, our study shows that black patients who undergo total knee replacement may have poorer outcomes,” said lead study author and orthopedic surgeon Courtland Lewis, MD. “After controlling for two key variables implicated in race and ethnic disparities in hospital readmission—preoperative comorbidities and type of insurance coverage—black patients still have a 35% higher likelihood of all-cause, 30-day readmission compared to white patients.

“Our ongoing research in this area is focused on other factors, such as the patient’s connection to primary care and patient-provider communication, that may explain this troubling finding,” said Dr. Lewis.

LAS VEGAS—Black and Hispanic patients were 62% and 50%, respectively, more likely to be readmitted to the hospital within 30 days after total joint replacement (TJR) surgery compared to white patients, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). In addition, Medicaid patients were 40% more likely to be readmitted to the hospital than patients with private insurance. Poorer outcomes, due in part to patient comorbidities, may reflect limited access to primary care, insufficient patient-doctor communication, researchers suggest.

Disparities in the provision of health care services have long been documented, including that black patients utilize hip and total knee replacement at rates nearly 40% less than white patients, despite having comparable or higher rates of osteoarthritis.

In this study, researchers analyzed 5 years of data—demographic (including race/ethnicity), clinical, and billing—on nearly 53,000 patients admitted to Connecticut hospitals for TJR from 2008 to 2012. The average patient age was 67 years, and the vast majority of patients were white (87%), covered by Medicare (56.7%), and female (61%).

The overall 30-day readmission rate for patients was 5.2%. The most common reasons for readmission were postoperative infection (8%), infection and inflammatory reaction due to internal joint prosthesis (6%), hematoma complications during a procedure (3%), and dislocation of a prosthetic joint (3%). Among the other study findings:

• Readmission rates were 83.5 per thousand for black patients, 78.9 for Hispanic patients, and 53.3 for white patients.

• Longer length of hospital stay was significantly associated with increased odds of readmission.

• When controlling for comorbidities and type of insurance coverage, the readmission rate for Hispanic patients dropped 44%, and for black patients, 38%. Black patients remained significantly more likely than white patients to be readmitted following surgery, after controlling for comorbidities.

• Patients covered by Medicare were 30% more likely to be readmitted within 30 days following discharge compared to patients covered by private insurance, and Medicaid patients were 40% more likely.

Recent research using national data on Medicare suggests that community-based factors, such as availability of general practitioners in the area, may be as or more important than hospital factors in determining readmission rates, and that patients may have few options other than hospital care for both urgent and non-urgent conditions related to their surgery or other conditions.

“Using an all-payer database, our study shows that black patients who undergo total knee replacement may have poorer outcomes,” said lead study author and orthopedic surgeon Courtland Lewis, MD. “After controlling for two key variables implicated in race and ethnic disparities in hospital readmission—preoperative comorbidities and type of insurance coverage—black patients still have a 35% higher likelihood of all-cause, 30-day readmission compared to white patients.

“Our ongoing research in this area is focused on other factors, such as the patient’s connection to primary care and patient-provider communication, that may explain this troubling finding,” said Dr. Lewis.

LAS VEGAS—The number of total hip replacements (THRs) nearly doubled among middle-age patients between 2002 and 2011, primarily due to the expansion of the middle-age population in the United States, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Continued growth in utilization of hip replacement surgery in patients ages 45 to 64 years, an increase in revision surgeries for this population as they age, and a nearly 30% decline in the number of surgeons who perform THR could have significant implications for future health care costs, THR demand, and access, researchers said.

The researchers used the Nationwide Inpatient Sample (NIS) to identify primary THRs performed between 2002 and 2011 in patients ages 45 to 64 years, as well as related hospital charges. Population data and projections were obtained from the US Census Bureau and surgeon workforce estimates from the AAOS.

In 2011, 42.3% of THRs were performed in patients ages 45 to 64 years compared to 33.9% in 2002. Utilization of THR in this age group increased 89.2% from 2002 to 2011, from approximately 68,000 THRs in 2002 to 128,000 THRs in 2011. The overall population increased 21.3%. In addition, the authors found that:

• Growth of THR utilization in the 45- to 64-year-old age group grew 2.4 times faster than it did in the Medicare-aged population (age > 65 years).

• A rise in the prevalence of obesity, a known risk factor for hip osteoarthritis, among middle-age Americans was not significantly associated with increased THR utilization.

• Mean hospital charges in the THR 45- to 64-year-old age group declined 5.7% from 2002 to 2011, and declined 2.5% in the Medicare population (age > 65 years).

• Mean physician reimbursement per THR, in 2011 US dollars, declined 26.2% over the same period.

• Concurrently, the number of physicians reporting that they performed THR surgeries declined 28.2%.

“The purpose of this study was to identify potential drivers of THR utilization in the middle-age patient segment,” said lead study author Alexander S. McLawhorn, MD, MBA, an orthopedic surgery resident at the Hospital for Special Surgery in New York City. “Our multivariable statistical model suggested that the observed growth was best explained by an expansion of the middle-age population in the US. This particular age group is projected to continue expanding, and as such the demand for THR in this active group of patients will likely continue to rise as well. Our results underscore concerns about consumption of premium-priced implants in younger patients and the future revision burden this trend implies in the face of a dwindling number of physicians who specialize in hip arthroplasty surgery.”

LAS VEGAS—The number of total hip replacements (THRs) nearly doubled among middle-age patients between 2002 and 2011, primarily due to the expansion of the middle-age population in the United States, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Continued growth in utilization of hip replacement surgery in patients ages 45 to 64 years, an increase in revision surgeries for this population as they age, and a nearly 30% decline in the number of surgeons who perform THR could have significant implications for future health care costs, THR demand, and access, researchers said.

The researchers used the Nationwide Inpatient Sample (NIS) to identify primary THRs performed between 2002 and 2011 in patients ages 45 to 64 years, as well as related hospital charges. Population data and projections were obtained from the US Census Bureau and surgeon workforce estimates from the AAOS.

In 2011, 42.3% of THRs were performed in patients ages 45 to 64 years compared to 33.9% in 2002. Utilization of THR in this age group increased 89.2% from 2002 to 2011, from approximately 68,000 THRs in 2002 to 128,000 THRs in 2011. The overall population increased 21.3%. In addition, the authors found that:

• Growth of THR utilization in the 45- to 64-year-old age group grew 2.4 times faster than it did in the Medicare-aged population (age > 65 years).

• A rise in the prevalence of obesity, a known risk factor for hip osteoarthritis, among middle-age Americans was not significantly associated with increased THR utilization.

• Mean hospital charges in the THR 45- to 64-year-old age group declined 5.7% from 2002 to 2011, and declined 2.5% in the Medicare population (age > 65 years).

• Mean physician reimbursement per THR, in 2011 US dollars, declined 26.2% over the same period.

• Concurrently, the number of physicians reporting that they performed THR surgeries declined 28.2%.

“The purpose of this study was to identify potential drivers of THR utilization in the middle-age patient segment,” said lead study author Alexander S. McLawhorn, MD, MBA, an orthopedic surgery resident at the Hospital for Special Surgery in New York City. “Our multivariable statistical model suggested that the observed growth was best explained by an expansion of the middle-age population in the US. This particular age group is projected to continue expanding, and as such the demand for THR in this active group of patients will likely continue to rise as well. Our results underscore concerns about consumption of premium-priced implants in younger patients and the future revision burden this trend implies in the face of a dwindling number of physicians who specialize in hip arthroplasty surgery.”

LAS VEGAS—The number of total hip replacements (THRs) nearly doubled among middle-age patients between 2002 and 2011, primarily due to the expansion of the middle-age population in the United States, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Continued growth in utilization of hip replacement surgery in patients ages 45 to 64 years, an increase in revision surgeries for this population as they age, and a nearly 30% decline in the number of surgeons who perform THR could have significant implications for future health care costs, THR demand, and access, researchers said.

The researchers used the Nationwide Inpatient Sample (NIS) to identify primary THRs performed between 2002 and 2011 in patients ages 45 to 64 years, as well as related hospital charges. Population data and projections were obtained from the US Census Bureau and surgeon workforce estimates from the AAOS.

In 2011, 42.3% of THRs were performed in patients ages 45 to 64 years compared to 33.9% in 2002. Utilization of THR in this age group increased 89.2% from 2002 to 2011, from approximately 68,000 THRs in 2002 to 128,000 THRs in 2011. The overall population increased 21.3%. In addition, the authors found that:

• Growth of THR utilization in the 45- to 64-year-old age group grew 2.4 times faster than it did in the Medicare-aged population (age > 65 years).

• A rise in the prevalence of obesity, a known risk factor for hip osteoarthritis, among middle-age Americans was not significantly associated with increased THR utilization.

• Mean hospital charges in the THR 45- to 64-year-old age group declined 5.7% from 2002 to 2011, and declined 2.5% in the Medicare population (age > 65 years).

• Mean physician reimbursement per THR, in 2011 US dollars, declined 26.2% over the same period.

• Concurrently, the number of physicians reporting that they performed THR surgeries declined 28.2%.

“The purpose of this study was to identify potential drivers of THR utilization in the middle-age patient segment,” said lead study author Alexander S. McLawhorn, MD, MBA, an orthopedic surgery resident at the Hospital for Special Surgery in New York City. “Our multivariable statistical model suggested that the observed growth was best explained by an expansion of the middle-age population in the US. This particular age group is projected to continue expanding, and as such the demand for THR in this active group of patients will likely continue to rise as well. Our results underscore concerns about consumption of premium-priced implants in younger patients and the future revision burden this trend implies in the face of a dwindling number of physicians who specialize in hip arthroplasty surgery.”

Use of long-acting reversible contraception (LARC) has increased nearly 5-fold in the last decade, reported the Centers for Disease Control and Prevention (CDC) in a National Center for Health Statistics (NCHS) Data Brief on the trends in LARC use among US women aged 15 to 44.¹ 

Data from the National Survey of Family Growth indicate that LARCs, which include intrauterine devices (IUDs) and subdermal hormonal implants, are gaining popularity because of their high efficacy in preventing unintended pregnancies. LARCs have demonstrated greater efficacy in preventing unintended pregnancy among all women compared with other contraceptive methods, including the oral contraceptive pill and the transdermal patch.

Age-related trends
For women aged 15 to 44, LARC use doubled between 2002 (1.5%) and the period 2006–2010 (3.8%) and then nearly doubled again for 2011–2013 (7.2%). IUD use increased 83% from the 2006–2010 period (3.5%) to the 2011–2013 period (6.4%). Implant use tripled from 2002 (0.3%) to the 2011–2013 period (0.8%).

LARC use was higher among women aged 25 to 34 than among women aged 15 to 24. The difference in LARC use was not statistically significant between women aged 25 to 34 and women aged 35 to 44.

•  LARC use increased nearly 4-fold for women aged 15 to 24 between 2002 (0.6%) and 2006–2010 (2.3%), and doubled again for 2011–2013 (5.0%).
• LARC use almost doubled among women aged 25 to 34 from 2006–2010 to 2011–2013 (5.3% to 11.1%).
• LARC use tripled between 2002 (1.1%) and 2006–2010 (3.8%) for women aged 35 to 44, and increased to 5.3% in 2011–2013.

Patterns of use by race
Although LARC use tripled for non-Hispanic white women and increased 4-fold for non-Hispanic black women between 2002 and 2006–2010, use among Hispanic women declined 10% during this period. LARC use increased by 129% among Hispanic women and by 128% among non-Hispanic white women from 2006–2010 to 2011–2013. Use of LARCs in non-Hispanic black women increased by 30% during this same period.

Parous vs nulliparous women
Women who have had at least one birth use LARC at a higher rate than women who have had no previous births. During the period 2011–2013, rate of use was 3 times greater among parous (11.0%) women compared with nulliparous (2.8%) women.

• Among parous women, LARC use increased from 2.4% in 2002 to 6.3% in 2006–2010, and to 10.6% in 2011–2013.
• In nulliparous women, LARC use increased 10-fold between 2006–2010 and 2011–2013.

For additional information, visit the NCHS Data Brief at http://www.cdc.gov/nchs/data/databriefs/db188.htm

Share your thoughts on this article! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.

Use of long-acting reversible contraception (LARC) has increased nearly 5-fold in the last decade, reported the Centers for Disease Control and Prevention (CDC) in a National Center for Health Statistics (NCHS) Data Brief on the trends in LARC use among US women aged 15 to 44.¹ 

Data from the National Survey of Family Growth indicate that LARCs, which include intrauterine devices (IUDs) and subdermal hormonal implants, are gaining popularity because of their high efficacy in preventing unintended pregnancies. LARCs have demonstrated greater efficacy in preventing unintended pregnancy among all women compared with other contraceptive methods, including the oral contraceptive pill and the transdermal patch.

Age-related trends
For women aged 15 to 44, LARC use doubled between 2002 (1.5%) and the period 2006–2010 (3.8%) and then nearly doubled again for 2011–2013 (7.2%). IUD use increased 83% from the 2006–2010 period (3.5%) to the 2011–2013 period (6.4%). Implant use tripled from 2002 (0.3%) to the 2011–2013 period (0.8%).

LARC use was higher among women aged 25 to 34 than among women aged 15 to 24. The difference in LARC use was not statistically significant between women aged 25 to 34 and women aged 35 to 44.

•  LARC use increased nearly 4-fold for women aged 15 to 24 between 2002 (0.6%) and 2006–2010 (2.3%), and doubled again for 2011–2013 (5.0%).
• LARC use almost doubled among women aged 25 to 34 from 2006–2010 to 2011–2013 (5.3% to 11.1%).
• LARC use tripled between 2002 (1.1%) and 2006–2010 (3.8%) for women aged 35 to 44, and increased to 5.3% in 2011–2013.

Patterns of use by race
Although LARC use tripled for non-Hispanic white women and increased 4-fold for non-Hispanic black women between 2002 and 2006–2010, use among Hispanic women declined 10% during this period. LARC use increased by 129% among Hispanic women and by 128% among non-Hispanic white women from 2006–2010 to 2011–2013. Use of LARCs in non-Hispanic black women increased by 30% during this same period.

Parous vs nulliparous women
Women who have had at least one birth use LARC at a higher rate than women who have had no previous births. During the period 2011–2013, rate of use was 3 times greater among parous (11.0%) women compared with nulliparous (2.8%) women.

• Among parous women, LARC use increased from 2.4% in 2002 to 6.3% in 2006–2010, and to 10.6% in 2011–2013.
• In nulliparous women, LARC use increased 10-fold between 2006–2010 and 2011–2013.

For additional information, visit the NCHS Data Brief at http://www.cdc.gov/nchs/data/databriefs/db188.htm

Share your thoughts on this article! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.

Use of long-acting reversible contraception (LARC) has increased nearly 5-fold in the last decade, reported the Centers for Disease Control and Prevention (CDC) in a National Center for Health Statistics (NCHS) Data Brief on the trends in LARC use among US women aged 15 to 44.¹ 

Data from the National Survey of Family Growth indicate that LARCs, which include intrauterine devices (IUDs) and subdermal hormonal implants, are gaining popularity because of their high efficacy in preventing unintended pregnancies. LARCs have demonstrated greater efficacy in preventing unintended pregnancy among all women compared with other contraceptive methods, including the oral contraceptive pill and the transdermal patch.

Age-related trends
For women aged 15 to 44, LARC use doubled between 2002 (1.5%) and the period 2006–2010 (3.8%) and then nearly doubled again for 2011–2013 (7.2%). IUD use increased 83% from the 2006–2010 period (3.5%) to the 2011–2013 period (6.4%). Implant use tripled from 2002 (0.3%) to the 2011–2013 period (0.8%).

LARC use was higher among women aged 25 to 34 than among women aged 15 to 24. The difference in LARC use was not statistically significant between women aged 25 to 34 and women aged 35 to 44.

•  LARC use increased nearly 4-fold for women aged 15 to 24 between 2002 (0.6%) and 2006–2010 (2.3%), and doubled again for 2011–2013 (5.0%).
• LARC use almost doubled among women aged 25 to 34 from 2006–2010 to 2011–2013 (5.3% to 11.1%).
• LARC use tripled between 2002 (1.1%) and 2006–2010 (3.8%) for women aged 35 to 44, and increased to 5.3% in 2011–2013.

Patterns of use by race
Although LARC use tripled for non-Hispanic white women and increased 4-fold for non-Hispanic black women between 2002 and 2006–2010, use among Hispanic women declined 10% during this period. LARC use increased by 129% among Hispanic women and by 128% among non-Hispanic white women from 2006–2010 to 2011–2013. Use of LARCs in non-Hispanic black women increased by 30% during this same period.

Parous vs nulliparous women
Women who have had at least one birth use LARC at a higher rate than women who have had no previous births. During the period 2011–2013, rate of use was 3 times greater among parous (11.0%) women compared with nulliparous (2.8%) women.

• Among parous women, LARC use increased from 2.4% in 2002 to 6.3% in 2006–2010, and to 10.6% in 2011–2013.
• In nulliparous women, LARC use increased 10-fold between 2006–2010 and 2011–2013.

For additional information, visit the NCHS Data Brief at http://www.cdc.gov/nchs/data/databriefs/db188.htm

Share your thoughts on this article! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.

The National Heart, Lung, and Blood Institute offers an online resource you can use to reinforce what you’ve taught your patients about the need for adequate sleep. “Your Guide to Healthy Sleep” can be downloaded from http://www.nhlbi.nih.gov/files/docs/public/sleep/healthy_sleep.pdf. It describes the beneficial effects of sleep on an individual’s mood, memory, hormones, and heart; explains common sleep disorders and where to find treatment for them; and dispels the Top 10 Sleep Myths.

The National Heart, Lung, and Blood Institute offers an online resource you can use to reinforce what you’ve taught your patients about the need for adequate sleep. “Your Guide to Healthy Sleep” can be downloaded from http://www.nhlbi.nih.gov/files/docs/public/sleep/healthy_sleep.pdf. It describes the beneficial effects of sleep on an individual’s mood, memory, hormones, and heart; explains common sleep disorders and where to find treatment for them; and dispels the Top 10 Sleep Myths.

The National Heart, Lung, and Blood Institute offers an online resource you can use to reinforce what you’ve taught your patients about the need for adequate sleep. “Your Guide to Healthy Sleep” can be downloaded from http://www.nhlbi.nih.gov/files/docs/public/sleep/healthy_sleep.pdf. It describes the beneficial effects of sleep on an individual’s mood, memory, hormones, and heart; explains common sleep disorders and where to find treatment for them; and dispels the Top 10 Sleep Myths.

The Centers for Disease Control and Prevention has updated its online hepatitis C fact sheet. “Hepatitis C: General Information” is available at http://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFactSheet.pdf. It explains what hepatitis C is, how it’s spread, who should get tested, and how it can be prevented.

The Centers for Disease Control and Prevention has updated its online hepatitis C fact sheet. “Hepatitis C: General Information” is available at http://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFactSheet.pdf. It explains what hepatitis C is, how it’s spread, who should get tested, and how it can be prevented.

The Centers for Disease Control and Prevention has updated its online hepatitis C fact sheet. “Hepatitis C: General Information” is available at http://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFactSheet.pdf. It explains what hepatitis C is, how it’s spread, who should get tested, and how it can be prevented.

I’m not on Facebook, either professionally or personally.

My office doesn’t have a Twitter account.

In fact, my only nod to social media at all is a rarely updated LinkedIn page, which is really just a public CV.

Why, in this age of connectedness, do I hide from these things? One reason is time. There isn’t much of it in the course of a day. Between my practice (patients, dictations, forms, returning calls, reviewing tests, rinse, wash, repeat), my family (wife, kids, dogs, house), and all the other things that make up a day (driving, finances, bathing, sleep), I don’t have much extra time. I really have no desire to see what others had for breakfast, look at pictures of a distant cousin’s kids, or have an online political argument with in-laws.

Another reason is privacy. Most patients are good people, but there are scary ones, too. I don’t want them knowing my kids’ names, or what school they go to, or seeing their pictures. In this age trying to have a degree of personal privacy is hard enough. I don’t want to make it any easier for someone looking to cause trouble.

I have nothing against my patients. I like the majority of them. But I don’t want to be online friends with them, either. Practicing objective medicine requires a degree of emotional distance, and I don’t want to do anything to shorten that. Social media connections with someone may also clue you into their personal and political beliefs, and, as I’ve said before, I think knowing those about patients (and them knowing mine) can only make the relationship difficult.

And the last is from a medical-legal view. The definition of what constitutes medical advice seems to be quite vague, and I worry anything I innocuously post or tweet could be taken to mean that I had an established treating medical relationship with someone or that my malpractice carrier could raise my rates by saying I was doing online medicine.

There’s also the simple fact that anything can be interpreted in any way. I worry that something I might put up could be used against me in court. Let’s say a patient dies while I’m on vacation, and the family decides to sue. Pictures of me relaxing with my kids on the trip could be used to make me look like an uncaring, callous doctor, even if I had no idea what was going on back home.

I’ll keep my somewhat under-the-radar personal existence as it is. Others may feel I’m missing out on the wonders of the social age, but I’m happy with keeping my home life just that – at home.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’m not on Facebook, either professionally or personally.

My office doesn’t have a Twitter account.

In fact, my only nod to social media at all is a rarely updated LinkedIn page, which is really just a public CV.

Why, in this age of connectedness, do I hide from these things? One reason is time. There isn’t much of it in the course of a day. Between my practice (patients, dictations, forms, returning calls, reviewing tests, rinse, wash, repeat), my family (wife, kids, dogs, house), and all the other things that make up a day (driving, finances, bathing, sleep), I don’t have much extra time. I really have no desire to see what others had for breakfast, look at pictures of a distant cousin’s kids, or have an online political argument with in-laws.

Another reason is privacy. Most patients are good people, but there are scary ones, too. I don’t want them knowing my kids’ names, or what school they go to, or seeing their pictures. In this age trying to have a degree of personal privacy is hard enough. I don’t want to make it any easier for someone looking to cause trouble.

I have nothing against my patients. I like the majority of them. But I don’t want to be online friends with them, either. Practicing objective medicine requires a degree of emotional distance, and I don’t want to do anything to shorten that. Social media connections with someone may also clue you into their personal and political beliefs, and, as I’ve said before, I think knowing those about patients (and them knowing mine) can only make the relationship difficult.

And the last is from a medical-legal view. The definition of what constitutes medical advice seems to be quite vague, and I worry anything I innocuously post or tweet could be taken to mean that I had an established treating medical relationship with someone or that my malpractice carrier could raise my rates by saying I was doing online medicine.

There’s also the simple fact that anything can be interpreted in any way. I worry that something I might put up could be used against me in court. Let’s say a patient dies while I’m on vacation, and the family decides to sue. Pictures of me relaxing with my kids on the trip could be used to make me look like an uncaring, callous doctor, even if I had no idea what was going on back home.

I’ll keep my somewhat under-the-radar personal existence as it is. Others may feel I’m missing out on the wonders of the social age, but I’m happy with keeping my home life just that – at home.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’m not on Facebook, either professionally or personally.

My office doesn’t have a Twitter account.

In fact, my only nod to social media at all is a rarely updated LinkedIn page, which is really just a public CV.

Why, in this age of connectedness, do I hide from these things? One reason is time. There isn’t much of it in the course of a day. Between my practice (patients, dictations, forms, returning calls, reviewing tests, rinse, wash, repeat), my family (wife, kids, dogs, house), and all the other things that make up a day (driving, finances, bathing, sleep), I don’t have much extra time. I really have no desire to see what others had for breakfast, look at pictures of a distant cousin’s kids, or have an online political argument with in-laws.

Another reason is privacy. Most patients are good people, but there are scary ones, too. I don’t want them knowing my kids’ names, or what school they go to, or seeing their pictures. In this age trying to have a degree of personal privacy is hard enough. I don’t want to make it any easier for someone looking to cause trouble.

I have nothing against my patients. I like the majority of them. But I don’t want to be online friends with them, either. Practicing objective medicine requires a degree of emotional distance, and I don’t want to do anything to shorten that. Social media connections with someone may also clue you into their personal and political beliefs, and, as I’ve said before, I think knowing those about patients (and them knowing mine) can only make the relationship difficult.

And the last is from a medical-legal view. The definition of what constitutes medical advice seems to be quite vague, and I worry anything I innocuously post or tweet could be taken to mean that I had an established treating medical relationship with someone or that my malpractice carrier could raise my rates by saying I was doing online medicine.

There’s also the simple fact that anything can be interpreted in any way. I worry that something I might put up could be used against me in court. Let’s say a patient dies while I’m on vacation, and the family decides to sue. Pictures of me relaxing with my kids on the trip could be used to make me look like an uncaring, callous doctor, even if I had no idea what was going on back home.

I’ll keep my somewhat under-the-radar personal existence as it is. Others may feel I’m missing out on the wonders of the social age, but I’m happy with keeping my home life just that – at home.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Lab mouse

In developing a compound that exhibits activity against a type of acute myeloid leukemia (AML), investigators have shown that transcription factors are, in fact, “druggable.”

The compound, AI-10-49, selectively binds to the mutated transcription factor CBFβ-SMMHC, and this prevents CBFβ-SMMHC from binding to another transcription factor, RUNX1.

In this way, AI-10-49 restores RUNX1 transcriptional activity, which leads to the death of inv(16) AML cells in vitro and in vivo.

“This drug that we’ve developed is . . . targeting a class of proteins that hasn’t been targeted for drug development very much in the past,” said study author John H. Bushweller, PhD, of the University of Virginia Health System in Charlottesville.

“It’s really a new paradigm, a new approach to try to treat these diseases. This class of proteins is very important for determining how much of many other proteins are made, so it’s a unique way of changing the way the cell behaves.”

Dr Bushweller and his colleagues described their work in Science.

The investigators noted that CBFβ-SMMHC is expressed in AML with the chromosome inversion inv(16)(p13q22). And CBFβ-SMMHC outcompetes wild-type CBFβ for binding to RUNX1, thereby deregulating RUNX1 activity in hematopoiesis and inducing AML.

“When you target a mutated protein in a cancer, you would ideally like to inhibit that mutated form of the protein but not affect the normal form of the protein that’s still there,” Dr Bushweller said. “In the case of [AI-10-49], we’ve achieved that.”

He and his colleagues tested AI-10-49 in 11 leukemia cells lines and found that only ME-1 cells were highly sensitive to the treatment. AI-10-49 effectively dissociated RUNX1 from CBFβ-SMMHC in ME-1 cells, with 90% dissociation after 6 hours of treatment.

But the drug had a modest effect on CBFβ-RUNX1 association. It also had negligible activity in normal human bone marrow cells.

The investigators then tested AI-10-49 in a mouse model of inv(16) AML. Control mice (vehicle-treated) succumbed to leukemia in a median of 33.5 days, compared to a median of 61 days for mice that received AI-10-49.

Dr Bushweller and his colleagues did not evaluate toxicity after long-term exposure to AI-10-49, but they found no evidence of toxicity after 7 days of AI-10-49 treatment.

Next, the investigators tested AI-10-49 in 4 primary inv(16) AML cell samples. They saw a reduction in leukemia cell viability when AI-10-49 was administered at 5 μM and 10 μM concentrations. Bivalent AI-10-49 was more potent than monovalent AI-10-47.

The team said these results suggest that direct inhibition of CBFβ-SMMHC may be an effective therapeutic approach for inv(16) AML, and the findings provide support for therapies targeting transcription factors.

Lab mouse

In developing a compound that exhibits activity against a type of acute myeloid leukemia (AML), investigators have shown that transcription factors are, in fact, “druggable.”

The compound, AI-10-49, selectively binds to the mutated transcription factor CBFβ-SMMHC, and this prevents CBFβ-SMMHC from binding to another transcription factor, RUNX1.

In this way, AI-10-49 restores RUNX1 transcriptional activity, which leads to the death of inv(16) AML cells in vitro and in vivo.

“This drug that we’ve developed is . . . targeting a class of proteins that hasn’t been targeted for drug development very much in the past,” said study author John H. Bushweller, PhD, of the University of Virginia Health System in Charlottesville.

“It’s really a new paradigm, a new approach to try to treat these diseases. This class of proteins is very important for determining how much of many other proteins are made, so it’s a unique way of changing the way the cell behaves.”

Dr Bushweller and his colleagues described their work in Science.

The investigators noted that CBFβ-SMMHC is expressed in AML with the chromosome inversion inv(16)(p13q22). And CBFβ-SMMHC outcompetes wild-type CBFβ for binding to RUNX1, thereby deregulating RUNX1 activity in hematopoiesis and inducing AML.

“When you target a mutated protein in a cancer, you would ideally like to inhibit that mutated form of the protein but not affect the normal form of the protein that’s still there,” Dr Bushweller said. “In the case of [AI-10-49], we’ve achieved that.”

He and his colleagues tested AI-10-49 in 11 leukemia cells lines and found that only ME-1 cells were highly sensitive to the treatment. AI-10-49 effectively dissociated RUNX1 from CBFβ-SMMHC in ME-1 cells, with 90% dissociation after 6 hours of treatment.

But the drug had a modest effect on CBFβ-RUNX1 association. It also had negligible activity in normal human bone marrow cells.

The investigators then tested AI-10-49 in a mouse model of inv(16) AML. Control mice (vehicle-treated) succumbed to leukemia in a median of 33.5 days, compared to a median of 61 days for mice that received AI-10-49.

Dr Bushweller and his colleagues did not evaluate toxicity after long-term exposure to AI-10-49, but they found no evidence of toxicity after 7 days of AI-10-49 treatment.

Next, the investigators tested AI-10-49 in 4 primary inv(16) AML cell samples. They saw a reduction in leukemia cell viability when AI-10-49 was administered at 5 μM and 10 μM concentrations. Bivalent AI-10-49 was more potent than monovalent AI-10-47.

The team said these results suggest that direct inhibition of CBFβ-SMMHC may be an effective therapeutic approach for inv(16) AML, and the findings provide support for therapies targeting transcription factors.

Lab mouse

In developing a compound that exhibits activity against a type of acute myeloid leukemia (AML), investigators have shown that transcription factors are, in fact, “druggable.”

The compound, AI-10-49, selectively binds to the mutated transcription factor CBFβ-SMMHC, and this prevents CBFβ-SMMHC from binding to another transcription factor, RUNX1.

In this way, AI-10-49 restores RUNX1 transcriptional activity, which leads to the death of inv(16) AML cells in vitro and in vivo.

“This drug that we’ve developed is . . . targeting a class of proteins that hasn’t been targeted for drug development very much in the past,” said study author John H. Bushweller, PhD, of the University of Virginia Health System in Charlottesville.

“It’s really a new paradigm, a new approach to try to treat these diseases. This class of proteins is very important for determining how much of many other proteins are made, so it’s a unique way of changing the way the cell behaves.”

Dr Bushweller and his colleagues described their work in Science.

The investigators noted that CBFβ-SMMHC is expressed in AML with the chromosome inversion inv(16)(p13q22). And CBFβ-SMMHC outcompetes wild-type CBFβ for binding to RUNX1, thereby deregulating RUNX1 activity in hematopoiesis and inducing AML.

“When you target a mutated protein in a cancer, you would ideally like to inhibit that mutated form of the protein but not affect the normal form of the protein that’s still there,” Dr Bushweller said. “In the case of [AI-10-49], we’ve achieved that.”

He and his colleagues tested AI-10-49 in 11 leukemia cells lines and found that only ME-1 cells were highly sensitive to the treatment. AI-10-49 effectively dissociated RUNX1 from CBFβ-SMMHC in ME-1 cells, with 90% dissociation after 6 hours of treatment.

But the drug had a modest effect on CBFβ-RUNX1 association. It also had negligible activity in normal human bone marrow cells.

The investigators then tested AI-10-49 in a mouse model of inv(16) AML. Control mice (vehicle-treated) succumbed to leukemia in a median of 33.5 days, compared to a median of 61 days for mice that received AI-10-49.

Dr Bushweller and his colleagues did not evaluate toxicity after long-term exposure to AI-10-49, but they found no evidence of toxicity after 7 days of AI-10-49 treatment.

Next, the investigators tested AI-10-49 in 4 primary inv(16) AML cell samples. They saw a reduction in leukemia cell viability when AI-10-49 was administered at 5 μM and 10 μM concentrations. Bivalent AI-10-49 was more potent than monovalent AI-10-47.

The team said these results suggest that direct inhibition of CBFβ-SMMHC may be an effective therapeutic approach for inv(16) AML, and the findings provide support for therapies targeting transcription factors.

Micrograph showing SCD

Image by Graham Beards

Results of a small study suggest there may be a high prevalence of sleep disordered breathing (SDB) in adults with sickle cell disease (SCD).

Of the 32 patients included in the study, 44% had a clinical diagnosis of SDB.

These patients had significantly increased REM latency, a significantly higher mean score on the Epworth Sleepiness Scale, and a significantly higher oxygen desaturation index (ODI) than patients who did not have SDB.

However, there was no significant difference between SDB and non-SDB patients with regard to insomnia, delayed sleep phase syndrome, nocturia, or SCD complications.

Sunil Sharma, MD, of Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and his colleagues recounted these results in the Journal of Clinical Sleep Medicine.

“Previous research identified pain and sleep disturbance as 2 common symptoms of adult sickle cell disorder,” Dr Sharma said. “We wanted to examine the reasons for the sleep disturbances, as it can have a strong impact on our patients’ quality of life and overall health. We discovered a high incidence of sleep disordered breathing in patients with sickle cell disease who also report trouble with sleep.”

Dr Sharma and his colleagues analyzed 32 consecutive adult SCD patients who had reported symptoms suggesting disordered sleep or had an Epworth Sleepiness Scale score of 10 or greater. The patients underwent a comprehensive sleep evaluation and overnight polysomnography in an accredited sleep center.

SDB was defined as having an apnea-hypopnea index (AHI, events/hour) of 5 or greater. SDB was considered mild if the AHI was 5 to < 15, moderate if the AHI was 15 to < 30, and severe if the AHI was ≥ 30. Once they determined which patients had SDB, the researchers compared these patients to those without the condition.

The team found that 44% of patients (n=14) had SDB. It was mild in 8 patients, moderate in 4, and severe in 2.

Compared to non-SDB patients, those with SDB had a significantly higher mean AHI (1.6 and 17, respectively; P=0.0001), a significantly increased REM latency (98 and 159 minutes, respectively; P=0.014), and a significantly higher mean score on the Epworth Sleepiness Scale (8.6 and 13, respectively; P=0.017).

Patients with SDB also had a significantly higher ODI than non-SDB patients (13 and 1.6, respectively; P=0.0009). Significant oxygen desaturation was defined as oxygen saturation < 89% for 5 cumulative minutes or more. The ODI was the number of recorded oxygen desaturations ≥ 4% per hour of sleep.

There was no significant difference between SDB and non-SDB patients in the incidence of nocturia (2.3 and 1.6, respectively; P=0.063), insomnia (57% and 72%, respectively; P=0.46), or delayed sleep phase syndrome (57% and 50%, respectively; P=0.73).

Delayed sleep phase syndrome was defined as a delay in sleep onset of 2 hours or greater from the desired sleep time and an inability to awaken at the desired time. Insomnia was defined as difficulty initiating sleep (sleep latency greater than 60 minutes) or difficulty maintaining sleep (more than 2 awakenings requiring more than 20 minutes to fall back asleep) on the majority of nights for more than 4 weeks.

There was no significant difference between SDB and non-SDB patients with regard to SCD complications, including crises during sleep (44% and 39%, respectively; P=0.67), average hospital admissions in the last 5 years (9.1 and 6.0, respectively; P=0.15), or average mini-crises per month (2.7 and 3.6, respectively; P=0.69).

Dr Sharma said the diagnosis of SDB could be missed in adults with SCD because they are not generally obese, a common risk factor for SDB, and daytime sleepiness is attributed to the pain medications used to treat the symptoms of SCD. He hopes this study will increase awareness among physicians who can screen patients for SDB.

“Our study suggests that patients with sickle cell disorder should be screened using a questionnaire to identify problems with sleep,” Dr Sharma said. “For further testing, an oxygen desaturation index is another low-cost screening tool that can identify sleep disordered breathing in this population.”

Micrograph showing SCD

Image by Graham Beards

Results of a small study suggest there may be a high prevalence of sleep disordered breathing (SDB) in adults with sickle cell disease (SCD).

Of the 32 patients included in the study, 44% had a clinical diagnosis of SDB.

These patients had significantly increased REM latency, a significantly higher mean score on the Epworth Sleepiness Scale, and a significantly higher oxygen desaturation index (ODI) than patients who did not have SDB.

However, there was no significant difference between SDB and non-SDB patients with regard to insomnia, delayed sleep phase syndrome, nocturia, or SCD complications.

Sunil Sharma, MD, of Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and his colleagues recounted these results in the Journal of Clinical Sleep Medicine.

“Previous research identified pain and sleep disturbance as 2 common symptoms of adult sickle cell disorder,” Dr Sharma said. “We wanted to examine the reasons for the sleep disturbances, as it can have a strong impact on our patients’ quality of life and overall health. We discovered a high incidence of sleep disordered breathing in patients with sickle cell disease who also report trouble with sleep.”

Dr Sharma and his colleagues analyzed 32 consecutive adult SCD patients who had reported symptoms suggesting disordered sleep or had an Epworth Sleepiness Scale score of 10 or greater. The patients underwent a comprehensive sleep evaluation and overnight polysomnography in an accredited sleep center.

SDB was defined as having an apnea-hypopnea index (AHI, events/hour) of 5 or greater. SDB was considered mild if the AHI was 5 to < 15, moderate if the AHI was 15 to < 30, and severe if the AHI was ≥ 30. Once they determined which patients had SDB, the researchers compared these patients to those without the condition.

The team found that 44% of patients (n=14) had SDB. It was mild in 8 patients, moderate in 4, and severe in 2.

Compared to non-SDB patients, those with SDB had a significantly higher mean AHI (1.6 and 17, respectively; P=0.0001), a significantly increased REM latency (98 and 159 minutes, respectively; P=0.014), and a significantly higher mean score on the Epworth Sleepiness Scale (8.6 and 13, respectively; P=0.017).

Patients with SDB also had a significantly higher ODI than non-SDB patients (13 and 1.6, respectively; P=0.0009). Significant oxygen desaturation was defined as oxygen saturation < 89% for 5 cumulative minutes or more. The ODI was the number of recorded oxygen desaturations ≥ 4% per hour of sleep.

There was no significant difference between SDB and non-SDB patients in the incidence of nocturia (2.3 and 1.6, respectively; P=0.063), insomnia (57% and 72%, respectively; P=0.46), or delayed sleep phase syndrome (57% and 50%, respectively; P=0.73).

Delayed sleep phase syndrome was defined as a delay in sleep onset of 2 hours or greater from the desired sleep time and an inability to awaken at the desired time. Insomnia was defined as difficulty initiating sleep (sleep latency greater than 60 minutes) or difficulty maintaining sleep (more than 2 awakenings requiring more than 20 minutes to fall back asleep) on the majority of nights for more than 4 weeks.

There was no significant difference between SDB and non-SDB patients with regard to SCD complications, including crises during sleep (44% and 39%, respectively; P=0.67), average hospital admissions in the last 5 years (9.1 and 6.0, respectively; P=0.15), or average mini-crises per month (2.7 and 3.6, respectively; P=0.69).

Dr Sharma said the diagnosis of SDB could be missed in adults with SCD because they are not generally obese, a common risk factor for SDB, and daytime sleepiness is attributed to the pain medications used to treat the symptoms of SCD. He hopes this study will increase awareness among physicians who can screen patients for SDB.

“Our study suggests that patients with sickle cell disorder should be screened using a questionnaire to identify problems with sleep,” Dr Sharma said. “For further testing, an oxygen desaturation index is another low-cost screening tool that can identify sleep disordered breathing in this population.”

Micrograph showing SCD

Image by Graham Beards

Results of a small study suggest there may be a high prevalence of sleep disordered breathing (SDB) in adults with sickle cell disease (SCD).

Of the 32 patients included in the study, 44% had a clinical diagnosis of SDB.

These patients had significantly increased REM latency, a significantly higher mean score on the Epworth Sleepiness Scale, and a significantly higher oxygen desaturation index (ODI) than patients who did not have SDB.

However, there was no significant difference between SDB and non-SDB patients with regard to insomnia, delayed sleep phase syndrome, nocturia, or SCD complications.

Sunil Sharma, MD, of Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and his colleagues recounted these results in the Journal of Clinical Sleep Medicine.

“Previous research identified pain and sleep disturbance as 2 common symptoms of adult sickle cell disorder,” Dr Sharma said. “We wanted to examine the reasons for the sleep disturbances, as it can have a strong impact on our patients’ quality of life and overall health. We discovered a high incidence of sleep disordered breathing in patients with sickle cell disease who also report trouble with sleep.”

Dr Sharma and his colleagues analyzed 32 consecutive adult SCD patients who had reported symptoms suggesting disordered sleep or had an Epworth Sleepiness Scale score of 10 or greater. The patients underwent a comprehensive sleep evaluation and overnight polysomnography in an accredited sleep center.

SDB was defined as having an apnea-hypopnea index (AHI, events/hour) of 5 or greater. SDB was considered mild if the AHI was 5 to < 15, moderate if the AHI was 15 to < 30, and severe if the AHI was ≥ 30. Once they determined which patients had SDB, the researchers compared these patients to those without the condition.

The team found that 44% of patients (n=14) had SDB. It was mild in 8 patients, moderate in 4, and severe in 2.

Compared to non-SDB patients, those with SDB had a significantly higher mean AHI (1.6 and 17, respectively; P=0.0001), a significantly increased REM latency (98 and 159 minutes, respectively; P=0.014), and a significantly higher mean score on the Epworth Sleepiness Scale (8.6 and 13, respectively; P=0.017).

Patients with SDB also had a significantly higher ODI than non-SDB patients (13 and 1.6, respectively; P=0.0009). Significant oxygen desaturation was defined as oxygen saturation < 89% for 5 cumulative minutes or more. The ODI was the number of recorded oxygen desaturations ≥ 4% per hour of sleep.

There was no significant difference between SDB and non-SDB patients in the incidence of nocturia (2.3 and 1.6, respectively; P=0.063), insomnia (57% and 72%, respectively; P=0.46), or delayed sleep phase syndrome (57% and 50%, respectively; P=0.73).

Delayed sleep phase syndrome was defined as a delay in sleep onset of 2 hours or greater from the desired sleep time and an inability to awaken at the desired time. Insomnia was defined as difficulty initiating sleep (sleep latency greater than 60 minutes) or difficulty maintaining sleep (more than 2 awakenings requiring more than 20 minutes to fall back asleep) on the majority of nights for more than 4 weeks.

There was no significant difference between SDB and non-SDB patients with regard to SCD complications, including crises during sleep (44% and 39%, respectively; P=0.67), average hospital admissions in the last 5 years (9.1 and 6.0, respectively; P=0.15), or average mini-crises per month (2.7 and 3.6, respectively; P=0.69).

Dr Sharma said the diagnosis of SDB could be missed in adults with SCD because they are not generally obese, a common risk factor for SDB, and daytime sleepiness is attributed to the pain medications used to treat the symptoms of SCD. He hopes this study will increase awareness among physicians who can screen patients for SDB.

“Our study suggests that patients with sickle cell disorder should be screened using a questionnaire to identify problems with sleep,” Dr Sharma said. “For further testing, an oxygen desaturation index is another low-cost screening tool that can identify sleep disordered breathing in this population.”

Drug production

Photo courtesy of the US FDA

The Israeli Ministry of Health has granted regulatory approval for the kinase inhibitor ponatinib (Iclusig) to treat certain adults with chronic myeloid leukemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL).

The drug can now be used to treat adults with any phase of CML who have the T315I mutation or are resistant to/cannot tolerate dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate.

Ponatinib is also approved to treat patients with Ph⁺ ALL who have the T315I mutation or are resistant to/cannot tolerate dasatinib and for whom subsequent treatment with imatinib is not clinically appropriate.

Ariad Pharmaceuticals, Inc., the company developing ponatinib, said the drug should be available in Israel in the second quarter of 2015.

Trial results

The Ministry of Health’s decision to approve ponatinib was based on results from the phase 2 PACE trial, which included patients with CML or Ph⁺ ALL who were resistant to or intolerant of prior tyrosine kinase inhibitor therapy, or who had the T315I mutation.

The median follow-up times were 15.3 months in chronic-phase CML patients, 15.8 months in accelerated-phase CML patients, and 6.2 months in patients with blast-phase CML or Ph⁺ ALL.

In chronic-phase CML, the primary endpoint was major cytogenetic response, and it occurred in 56% of patients. Among chronic-phase patients with the T315I mutation, 70% achieved a major cytogenetic response. Among patients who had failed treatment with dasatinib or nilotinib, 51% achieved a major cytogenetic response.

In accelerated-phase CML, the primary endpoint was major hematologic response. This occurred in 57% of all patients in this group, 50% of patients with the T315I mutation, and 58% of patients who had failed treatment with dasatinib or nilotinib.

The primary endpoint was major hematologic response in blast-phase CML/Ph⁺ ALL as well. Thirty-four percent of all patients in this group met this endpoint, as did 33% of patients with the T315I mutation and 35% of patients who had failed treatment with dasatinib or nilotinib.

Common non-hematologic adverse events included rash (38%), abdominal pain (38%), headache (35%), dry skin (35%), constipation (34%), fatigue (27%), pyrexia (27%), nausea (26%), arthralgia (25%), hypertension (21%), increased lipase (19%), and increased amylase (7%).

Hematologic events of any grade included thrombocytopenia (42%), neutropenia (24%), and anemia (20%). Serious adverse events of arterial thromboembolism, including arterial stenosis, occurred in patients with cardiovascular risk factors.

Safety issues

Extended follow-up data from the PACE trial, collected in 2013, suggested ponatinib can increase the risk of thrombotic events. When these data came to light, officials in the European Union and the US, where ponatinib had already been approved, began to investigate the drug.

Ponatinib was pulled from the US market for a little over 2 months, and trials of the drug were placed on partial hold while the Food and Drug Administration evaluated the drug’s safety. Ponatinib went back on the market in January 2014, with new safety measures in place.

The drug was not pulled from the market in the European Union, but the European Medicine’s Agency released recommendations for safer use of ponatinib. The Committee for Medicinal Products for Human Use reviewed data on ponatinib and decided the drug’s benefits outweigh its risks.

Drug production

Photo courtesy of the US FDA

The Israeli Ministry of Health has granted regulatory approval for the kinase inhibitor ponatinib (Iclusig) to treat certain adults with chronic myeloid leukemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL).

The drug can now be used to treat adults with any phase of CML who have the T315I mutation or are resistant to/cannot tolerate dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate.

Ponatinib is also approved to treat patients with Ph⁺ ALL who have the T315I mutation or are resistant to/cannot tolerate dasatinib and for whom subsequent treatment with imatinib is not clinically appropriate.

Ariad Pharmaceuticals, Inc., the company developing ponatinib, said the drug should be available in Israel in the second quarter of 2015.

Trial results

The Ministry of Health’s decision to approve ponatinib was based on results from the phase 2 PACE trial, which included patients with CML or Ph⁺ ALL who were resistant to or intolerant of prior tyrosine kinase inhibitor therapy, or who had the T315I mutation.

The median follow-up times were 15.3 months in chronic-phase CML patients, 15.8 months in accelerated-phase CML patients, and 6.2 months in patients with blast-phase CML or Ph⁺ ALL.

In chronic-phase CML, the primary endpoint was major cytogenetic response, and it occurred in 56% of patients. Among chronic-phase patients with the T315I mutation, 70% achieved a major cytogenetic response. Among patients who had failed treatment with dasatinib or nilotinib, 51% achieved a major cytogenetic response.

In accelerated-phase CML, the primary endpoint was major hematologic response. This occurred in 57% of all patients in this group, 50% of patients with the T315I mutation, and 58% of patients who had failed treatment with dasatinib or nilotinib.

The primary endpoint was major hematologic response in blast-phase CML/Ph⁺ ALL as well. Thirty-four percent of all patients in this group met this endpoint, as did 33% of patients with the T315I mutation and 35% of patients who had failed treatment with dasatinib or nilotinib.

Common non-hematologic adverse events included rash (38%), abdominal pain (38%), headache (35%), dry skin (35%), constipation (34%), fatigue (27%), pyrexia (27%), nausea (26%), arthralgia (25%), hypertension (21%), increased lipase (19%), and increased amylase (7%).

Hematologic events of any grade included thrombocytopenia (42%), neutropenia (24%), and anemia (20%). Serious adverse events of arterial thromboembolism, including arterial stenosis, occurred in patients with cardiovascular risk factors.

Safety issues

Extended follow-up data from the PACE trial, collected in 2013, suggested ponatinib can increase the risk of thrombotic events. When these data came to light, officials in the European Union and the US, where ponatinib had already been approved, began to investigate the drug.

Ponatinib was pulled from the US market for a little over 2 months, and trials of the drug were placed on partial hold while the Food and Drug Administration evaluated the drug’s safety. Ponatinib went back on the market in January 2014, with new safety measures in place.

The drug was not pulled from the market in the European Union, but the European Medicine’s Agency released recommendations for safer use of ponatinib. The Committee for Medicinal Products for Human Use reviewed data on ponatinib and decided the drug’s benefits outweigh its risks.

Drug production

Photo courtesy of the US FDA

The Israeli Ministry of Health has granted regulatory approval for the kinase inhibitor ponatinib (Iclusig) to treat certain adults with chronic myeloid leukemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL).

The drug can now be used to treat adults with any phase of CML who have the T315I mutation or are resistant to/cannot tolerate dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate.

Ponatinib is also approved to treat patients with Ph⁺ ALL who have the T315I mutation or are resistant to/cannot tolerate dasatinib and for whom subsequent treatment with imatinib is not clinically appropriate.

Ariad Pharmaceuticals, Inc., the company developing ponatinib, said the drug should be available in Israel in the second quarter of 2015.

Trial results

The Ministry of Health’s decision to approve ponatinib was based on results from the phase 2 PACE trial, which included patients with CML or Ph⁺ ALL who were resistant to or intolerant of prior tyrosine kinase inhibitor therapy, or who had the T315I mutation.

The median follow-up times were 15.3 months in chronic-phase CML patients, 15.8 months in accelerated-phase CML patients, and 6.2 months in patients with blast-phase CML or Ph⁺ ALL.

In chronic-phase CML, the primary endpoint was major cytogenetic response, and it occurred in 56% of patients. Among chronic-phase patients with the T315I mutation, 70% achieved a major cytogenetic response. Among patients who had failed treatment with dasatinib or nilotinib, 51% achieved a major cytogenetic response.

In accelerated-phase CML, the primary endpoint was major hematologic response. This occurred in 57% of all patients in this group, 50% of patients with the T315I mutation, and 58% of patients who had failed treatment with dasatinib or nilotinib.

The primary endpoint was major hematologic response in blast-phase CML/Ph⁺ ALL as well. Thirty-four percent of all patients in this group met this endpoint, as did 33% of patients with the T315I mutation and 35% of patients who had failed treatment with dasatinib or nilotinib.

Common non-hematologic adverse events included rash (38%), abdominal pain (38%), headache (35%), dry skin (35%), constipation (34%), fatigue (27%), pyrexia (27%), nausea (26%), arthralgia (25%), hypertension (21%), increased lipase (19%), and increased amylase (7%).

Hematologic events of any grade included thrombocytopenia (42%), neutropenia (24%), and anemia (20%). Serious adverse events of arterial thromboembolism, including arterial stenosis, occurred in patients with cardiovascular risk factors.

Safety issues

Extended follow-up data from the PACE trial, collected in 2013, suggested ponatinib can increase the risk of thrombotic events. When these data came to light, officials in the European Union and the US, where ponatinib had already been approved, began to investigate the drug.

Ponatinib was pulled from the US market for a little over 2 months, and trials of the drug were placed on partial hold while the Food and Drug Administration evaluated the drug’s safety. Ponatinib went back on the market in January 2014, with new safety measures in place.

The drug was not pulled from the market in the European Union, but the European Medicine’s Agency released recommendations for safer use of ponatinib. The Committee for Medicinal Products for Human Use reviewed data on ponatinib and decided the drug’s benefits outweigh its risks.