Platelet E-News – December 18, 2008

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP Research and Treatments

General Health and Medicine

Hospitals, Insurance, and Medical Care


ITP Research and Treatments
The following articles were presented at the Dec. 2008 ASH Meeting in San Francisco, CA

ITP Increases Risk for Blood Clots
Although patients with ITP experience a low platelet count and bleeding, they are at risk for blood clots, according to a British review of patient records from 1992 to 2005. In a case review of 840 adults with ITP versus 3,360 adults without the disease, those with ITP had slightly higher risk of clotting. Commenting on the study, David Kuter, of Massachusetts General Hospital listed several possible reasons: In ITP patients, platelets are younger and more active. Although platelets are shattered by antibodies in ITP, the fragments can cause clotting. And ITP treatments may cause platelet count to rise too rapidly. The research has not yet been published; it was presented at December’s meeting of the American Society for Hematology (ASH).

Long-Term Safety Data For Nplate Is Promising
Romiplostim (Nplate) appears safe in the long-term (over 48 weeks) for patients with ITP, according to two studies reported at ASH. Bleeding events decreased over time, with no increase in blood clotting, which occurred in 4% of patients. Nplate received FDA approval in August for patients whose ITP had not responded to other therapies. Long-term safety is important since platelet counts fall after the drug is stopped. Both studies were sponsored by Amgen, the drug’s maker.

Rituximab Boosts Effectiveness of Dexamethasone in ITP
Addition of rituximab (Rituxan) to dexamethasone improved initial response, sustained response, and active rescue of patients previously untreated for ITP. 101 patients were randomly assigned to receive dexamethasone alone or dexamethasone plus rituximab. Both initial response at 30 days and sustained response at 6 months were higher in those who received both drugs. The Italian authors suggest that rituximab plus dexamethasone is worth using before splenectomy.

Close To Half Of ITP Patients On Eltrombopag Reduce Other Medications   
Of 69 patients in an open-label study of eltrombopag (Promacta), 33 were able to reduce or stop other medications at least temporarily during the 18-month study, according to University of California, San Francisco researchers. Corticosteroids were the medications most frequently stopped.

Eltrombopag Increased Platelet Counts And Reduced Bleeding In ITP
Patients receiving eltrombopag were eight times more likely than those on placebo to achieve target platelet counts in RAISE, a placebo-controlled, double blind, randomized phase 3 study. 197 patients with chronic ITP received either 6 months of daily oral eltrombopag (Promacta) or placebo. More patients in the eltrombopag group were able to stop or reduce other medications and they required less rescue medication than the placebo group. The benefit occurred in patients with and without their spleens. Promacta received accelerated approval from the FDA in November. The study was funded by GlaxoSmithKline, the drug’s maker.

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General Health and Medicine

Vitamin K May Fight Diabetes In Men
In a surprise finding from a study of vitamin K supplements to protect bones, Tufts researchers found that the vitamin also reduces insulin resistance—a precursor to diabetes—in older men. The 3-year, randomized, double-blind study in 355 men and women ages 60 to 80 found that a 500-microgram supplement of vitamin K1 can make a difference. The authors note that people can easily get 500 micrograms from their diet. Good sources are green leafy vegetables (kale, spinach, escarole, endive, collard greens, turnip greens, Swiss chard, Romaine lettuce) and broccoli, Brussels sprouts, spring onions, and pistachios. One cup of cooked kale carries 1,062 micrograms of vitamin K1, which is also important for blood clotting.

Vitamin K May Fight Diabetes. Tufts Health & Nutrition Letter. December 2008, pg. 1-2.

Vitamin C Reduces Bone Loss In Men
Bone health is not just about calcium and vitamin D, according to a Tufts University study. A review of bone mineral density (BMD) in 344 men and 540 women, average age 75, and vitamin C intake in the Framingham Osteoporosis Study indicated that men with high intakes of vitamin C—through diet or supplements—had higher BMD in the hip bones. Protection began at 250 milligrams of vitamin C. For people who don’t eat the recommended 5 to 9 servings of fruit and vegetables, supplementation may be necessary to reach this level.

Vitamin C Joins the Fight for Healthier Bones. Tufts Health & Nutrition Letter. December 2008, pg. 8.

Group Urges USDA To Tighten Not Loosen Rules On Genetically Engineered Crops
The U.S. Department of Agriculture (USDA) is rushing through regulations that weaken oversight of all genetically engineered (GE) crops, according to the Center for Food Safety. “The proposed rule has the same gaping holes as the policy it is replacing, and creates a few new ones, as well.” Biotech companies, which grow crops engineered to produce drugs will be able to assess their own crops to determine whether USDA should regulate them. Companies will be allowed to grow untested GE crops with no oversight. The proposed rule bars state and local regulation of GE crops that is more protective than federal regulations.

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Hospitals, Insurance, and Medical Care

Hidden Dangers For Patients Taking Multiple Medications
Many drug combinations have not been tested for safety. “Elderly people are especially vulnerable because they often have several medical problems for which they see different doctors, each prescribing drugs, often without knowing what else the patient is taking,” according to a 2007 article by Jane Brody in the New York Times. Tell your doctors and pharmacist every medication you take so they can determine dangers. Discovery Health has a website for checking drug interactions:

In Tough Economic Times Patients Scrimp On Medications
People are trying to save money by not filling their prescriptions. Prescription drug sales are down, according to IMS Health, a research firm that tracks prescriptions. Doctors talk of patients scrimping on Lipitor, the cholesterol-lowering medicine, and on their osteoporosis medication. The average co-pay for drugs on insurers’ preferred lists rose to $25 in 2007 from $15 in 2000, according to the Kaiser Family Foundation.

Saul S. In Sour Economy, Some Scale Back on Medications. The New York Times. October 22, 2008.

Splitting Pills Not Always Safe
Pill splitting can save on prescription costs—a 200 mg dose typically costs the same as a 100 mg dose—but not every pill can be split safely. Correct dosage is essential for medications for epilepsy, certain heart problems, and for hormone medications. Other pills that shouldn’t be split: extended release pills, pills containing more than one medication, pills coated to protect the stomach, pills that crumble easily, pills that are difficult to swallow because of bitter taste, and power or gel capsules. Pills that are scored to make cutting easier indicate FDA approval for splitting. But don’t split by hand or knife; buy a pill splitter, which costs about $10.

House Calls. Health After 50, Johns Hopkins, pg. 8.

Fewer Primary Care Doctors Accepting Medicare Patients
More Medicare patients are having trouble finding a new primary care doctor to care for them. The trend appears to be based on physician fears about potential cuts in reimbursement rates from the Federal government and the slow pace of reimbursement and layers of paperwork required. The Medicare Payment Advisory Commission reported in December that nearly 30 percent of 2.6 million Medicare beneficiaries who sought out a new primary care doctor over the past year had trouble finding one. That number is up from 25 percent in 2005. In Virginia, just 2.5 physicians are accepting Medicare per 100 beneficiaries, according to the American College of Emergency Physicians. The national average is 3.2 per 100.

Jenkins CL. The Doctor is Out. The Washington Post, December 9, 2008, Pg. F1, F4.

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