- Age as the Major Predictive Factor of Long-Term Response to Splenectomy in ITP
- Drug Price Comparisons on NY State Website
- New Drug Shows Promise Treating Several Autoimmune Diseases
- Acid Blockers May Increase Risk of Pneumonia
- Officials Call for Continued Surveillance of Pneumococcal Vaccine
- Chemicals in Plastics Tied to Allergies
- Patient Safety Initiatives Show Little Progress
AGE AS THE MAJOR PREDICTIVE FACTOR OF LONG-TERM RESPONSE TO SPLENECTOMY IN IMMUNE THROMBOCYTOPENIC PURPURA
British researchers state “age over 40 was identified as the only significant risk factor for response to splenectomy using the Cox multivariate analysis.”
This study evaluated 61 consecutive patients undergoing splenectomy for chronic ITP. Fifty-four patients were followed for an average time of 7.6 years. Thirty-nine (72%) had an immediate complete response (platelet count rose to >100 x 109 / l.) and 9 (17%) had an immediate partial response (platelet count rose to 30 – 100 x 109 / l.). However there was a constant relapse rate during the first 36 months of follow-up and further relapse starting 70 months after surgery. The researchers used a multivariate model to determine any association of sex, age, platelet count, years of thrombocytopenia, associated disease, time of splenectomy , and the response to medical therapy. They state “age over 40 was identified as the only significant risk factor for response to splenectomy using the Cox multivariate analysis.” While the timing pattern of relapse was similar for both age groups, the rate of relapse was significantly greater for those over 40. Two years out, of the initial 48 responders, 8%of the younger group but 25% of the older group relapsed. More alarming, 15 years out 38% of the less than 40 age group relapsed but 75 % of those in the over 40 age group had relapsed. The authors conclude “splenectomy is an effective treatment for chronic ITP but the response rate decreases with time. Choosing splenectomy for ITP treatment requires individual case analysis because only young age seems to be a predictive factor for a good response.
F. Fabris, et al, “Age as the Major Predictive Factor of Long-Term Response to Splenectomy in Immune Thrombocytopenia Purpura”, British Journal of Haematology, 2001, vol. 112 pp 637 -640.
Note: This study was published in March 2001 but came to our attention as part of Dr. Terry Gernsheimer’s presentation during the ITP Conference 2004 in Baltimore. We are contacted frequently by older patients being considered for splenectomy and we wanted to make more people aware of these findings.
DRUG PRICE COMPARISONS ON NY STATE WEBSITE
The office of New York State Attorney General, Elliot Spitzer, has unveiled a website offering drug price comparisons at pharmacies across New York State.
The prescription drug website (www.nyagrx.org) reports the prices of 25 commonly prescribed drugs at certain pharmacies across the state. Users will be able to search by zip code and distance or by city or county. The survey includes only pharmacies in New York State. While the prices posted on the website are based on a survey of New York State pharmacies, the information can be useful to anyone shopping for prescription drugs.
From News Services
NEW DRUG SHOWS PROMISE TREATING SEVERAL AUTOIMMUNE DISEASES
A new drug being developed by Abbott Laboratories with the designation ABT-874 has shown promise in treating Crohn’s disease and may also be effective in treating other autoimmune diseases.
Researchers at the National Institutes of Health (NIH) and elsewhere found that weekly injections of ABT-874 reduced symptoms in as many as 75% of Crohn’s patients, three times as many as placebo injections. The drug might also be effective in treating other autoimmune diseases such as multiple sclerosis and arthritis. Abbott Laboratories has not decided whether to conduct further tests. The study was headed by Peter Mannon of the National Institute of Allergy and Infectious Diseases. It was reported in the November 11, 2004 New England Journal of Medicine.
Washington Post, November 11, 2004, p.A16.
ACID BLOCKERS MAY INCREASE RISK OF PNEUMONIA
A study drawing on the medical records of more that 360,000 people found that drugs such as Nexium, Pepcid, and Prilosec used to treat heartburn might increase a person’s chance of getting pneumonia.
Drawing on medical records compiled between 1995 and 2002 for more than 360,000 people, researchers found that those using acid blockers were 4.5 times more likely to develop pneumonia as people of the same age and gender who had never used these drugs. The researchers also matched each of 475 individuals using acid blockers with 10 people of the same age, gender, and general health who had stopped taking the drugs at some earlier date. This analysis demonstrated that a person taking an acid blocker has twice the risk of getting pneumonia as does someone who has stopped taking the drug. Stomach acid aids digestion and kills pathogens. Speculation suggests that reducing stomach acid increases stomach bacteria that can migrate up the esophagus and enter the lungs. These findings are particularly worrisome for individuals with compromised or suppressed immune systems or individuals with chronic lung conditions. This research also raises questions about the long-term use of these medications.
N. Seppa, “Affairs of the Heartburn”, Science News, October 30, 2004, p 277.
(Note: Many ITP treatments suppress the immune system)
OFFICIALS CALL FOR CONTINUED SURVEILLANCE OF PNEUMOCOCCAL VACCINE
“Rare but potentially serious” events such as serum sickness, thrombocytopenia, anaphylactic shock, and seizures prompt officials to recommend continued surveillance of the 7-valent pneumococcal conjugate vaccine, Prevnar.
This vaccine was tested and proved effective in 19,000 infants and children in clinical trials prior to FDA approval. During the two years following approval, there were 4,154 events (13.2 per 100,000 doses) reported to the Vaccine Adverse Event Reporting System (VAERS). Most commonly reported were fussiness, rashes, fever, and injection site reactions. Immune mediated events accounted for 31.3% of the reports, anaphylactic reactions occurred in 14 cases, thrombocytopenia was reported in 14 cases and serum sickness in 6 others. Seizures were reported in 393 cases, mostly in individuals with a previous history of the problem. The FDA and the CDC will continue to monitor reports of adverse events for this vaccine and encourage clinicians to report such events to VAERS.
M. Rauscher, “Continued Surveillance of Pneumococcal Vaccine Adverse Events Warranted”, Medscape from JAMA 2004;292:1702-1710.
CHEMICALS IN PLASTICS TIED TO ALLERGIES
Phthalates used in certain plastics and floor coverings were identified as a possible source of environmental triggers for allergies.
Phthalates are used in the manufacture of soft plastics and some vinyl flooring. They are also used in cosmetics and plastic toys. These chemicals separate out from the products that contain them and attach to dust particles. Researchers in Sweden, in an effort to determine whether high concentrations of phthalates in dust correlate with allergies, studied children in 400 homes. They found that children exposed to the greatest concentrations of di-ethylhexyl phthalate (DEHP) were almost 3 times more likely to have asthma as were children exposed to the lowest concentrations. Also in homes with the greatest concentrations of butyl benzyl phthalate, children were approximately 3 times more likely as the other children to have rhinitis and eczema. Other phthalates studied were not associated with these three diseases. The study highlights the different phthalate exposures in children with and without allergy related illnesses. The study does not address or demonstrate a causal relationship between phthalates and the several diseases studied. Other important variables such as the humidity and the cleanliness of the homes was not evaluated or studied.
B. Harder, “Dangerous Dust? Chemicals in plastics are tied to allergies”, Science News, July 4, 2004, pp52-53.
PATIENT SAFETY INITIATIVES SHOW LITTLE PROGRESS
Resources and the political will to support safety research and implement safeguards in hospitals and physician’s offices across the nation are lacking.
The 1999 report of the Institute of Medicine warned of outdated and sometimes nonexistent safety practices that were causing widespread errors in physician’s offices, operating rooms, and pharmacies. The report claimed that between 44,000 and 98,000 lives were lost each year as the result of preventable mistakes. Now, five years later, the debate centers on what to measure not on how to save lives. The reluctance of physicians to share authority with other health care professionals may be at the center of the problem. The report recommended physicians, nurses and other health care professional work as a team. The team work aboard aircraft was cited as a model. A 2000 study reported that 50% of surgeons felt the decisions of the leader in their field should never be questioned when making decisions; less than 10% of pilots responded the same way. Much work remains to be done in this area.
T. Zwillich, “Little Progress Seen in Patient Safety Measures”, Medscape, http//www.medscape.com/viewarticle/493127.