1. Osteoporosis medications improve bone health in men with prostate cancer receiving androgen deprivation therapy
Abstract: http://annals.org/aim/article/doi/10.7326/M16-2577
Editorial: http://annals.org/aim/article/doi/10.7326/M17-1800
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Both bisphosphonates and denosumab improve bone mineral density (BMD) in men with nonmetastatic prostate cancer who are receiving androgen deprivation therapy (ADT). The results from a systematic review and meta-analysis are published in Annals of Internal Medicine.
One in two men with prostate cancer receives ADT at some point after diagnosis. While ADT has been the mainstay of treatment for decades, it is associated with many potential adverse effects, including significant bone loss and increased risk of fractures. Gaps in quality bone health care for men with prostate cancer and low rates of education about the adverse effects of ADT have led experts to call for a more systematic approach to the prevention of bone loss and fracture risk among men with this disease.
A multi-disciplinary panel reviewed 30 studies evaluating the effectiveness of bone-targeted therapies aimed at preventing fracture and improving bone mineral density in men with nonmetastatic prostate cancer receiving ADT. Overall, evidence showed improvements in BMD with bisphosphonates, but whether this is associated with reduced fractures remains unclear. Evidence from available trials showed fracture reduction was restricted to one drug: denosumab. Further trials studying fracture outcomes among this population are needed, researchers say.
Media contact: For an embargoed PDF, please contact Cara Graeff at cgraeff@acponline.org. For an interview with Shabbir Alibhai, MD or Katherine Zukotynski, MD, please contact Maggie Paiva at Maggie.Paiva@cancercare.on.ca or Jayani Perera at Jayani.Perera@cancercare.on.ca.
2. HCV treatment administered by nonspecalist providers as safe and effective as that provided by specialists
Task-shifting to general practitioners could bridge existing gaps in the care for patients with HCV
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0118
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Direct-acting antiviral (DAA) therapy administered by nonspecialist providers, such as nurse practitioners and primary care physicians, is safe and effective and could expand treatment access for previously challenging subpopulations affected by the hepatitis C virus (HCV) epidemic. The findings of a nonrandomized clinical trial are published in Annals of Internal Medicine.
Highly-effective and well-tolerated DAA therapy for HCV has raised the possibility of treatment expansion and widespread cure. Despite this scientific breakthrough, 2.7 million Americans are still living with HCV infection and the current specialist workforce is insufficient to meet the demand. Task-shifting of HCV therapy to general practitioners may be an effective strategy for patients with uncomplicated infections and can improve access to HCV care. However, there is limited data on the success of nonspecialists practicing independent of specialist supervision.
Investigators from the Institute of Human Virology at the University of Maryland School of Medicine sought to determine the efficacy of HCV treatment by nonspecialist providers from a real-world cohort of patients in an urban setting. In the ASCEND (A Phase IV Pilot Study to Assess Community-Based Treatment Efficacy in Chronic Hepatitis C Monoinfection and Coinfection With HIV in the District of Columbia) trial, 600 patients with chronic HCV infection were assigned in a nonrandomized fashion to receive treatment from 1 of 3 provider types: licensed NP, primary care physician or a specialist (gastroenterology-hepatology and infectious disease physicians). Of those, 516 patients achieved sustained virologic response (SVR) and response rates were consistent across the three provider types. These findings support the efficacy of general DAA therapy and suggest that most patients with uncomplicated cases of HCV infection who adhere to medication will achieve cure, regardless of provider type.
Media contact: For an embargoed PDF, please contact Cara Graeff at cgraeff@acponline.org. For an interview, please contact Nora Samaranayake at nsamaranayake@gvn.org. Dr. Sarah Kattakuzhy can also be reached directly at skattakuzhy@ihv.umaryland.edu.
3. Single measures of viral load may overestimate HIV suppression status
Routine monitoring of viral suppression status and subsequent treatment is important for reducing transmission risk
Abstract: http://annals.org/aim/article/doi/10.7326/L17-0278
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A review of data reported to the National HIV Surveillance System through June 2016 suggests that a single measure of viral load may overestimate how many persons with HIV infection have durable viral suppression. The data also showed that some persons who seemed to have received regular care for HIV infection still had viral loads high enough to substantially increase transmission risk. The brief report is published in Annals of Internal Medicine.
Researchers from the Centers for Disease Control and Prevention (CDC) reviewed data for 630,965 persons aged 13 years or older who were diagnosed with HIV infection through 2013 to determine the usefulness of a single measure of viral load for understanding long-term suppression and to examine the extent of cumulative HIV burden for understanding the potential risk for transmission. The researchers used information about sex, age, transmission category, and race/ethnicity to calculate the percentage of persons with HIV infection whose last viral load in 2014 was less than 200 copies/mL. They also calculated the percentage of persons in whom all viral loads in 2014 were less than 200 copies/mL (durable viral suppression), the percentage of persons in whom all viral loads in 2014 were 200 copies/mL or greater (viral suppression never achieved), and "copy year," which is a measure of viremia that assesses a person's exposure to HIV over time similar to the way pack-years measures a person's exposure to tobacco smoke over time.
The data showed that of all persons with HIV infection, 57.3 percent had a suppressed viral load on their most recent test in 2014, a total of 47.6 percent had durable viral suppression throughout 2014, and 8.1 percent never achieved viral suppression during 2014. Those who never achieved viral suppression in 2014 had an average of 17,530 copy-years of viremia and 56.3 percent of those people had at least two tests for viral load in 2014, suggesting that they had regular care for their infection. The findings emphasize the importance of routine monitoring of viral suppression status and of more effective delivery of appropriate therapy in response to the results of such monitoring.
Media contact: For an embargoed PDF, please contact Cara Graeff at cgraeff@acponline.org. For an interview with an author, please contact the CDC's National Center for HIV/AIDS/ Viral Hepatitis, STD and TB Prevention at NCHHSTPmediateam@cdc.gov or 404-639-8895.
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Also new in this issue:
Annals Understanding Clinical Research: Evaluating the Meaning of a Summary Estimate in a Meta-analysis
John E. Cornell, PhD; Joshua M. Liao, MD, MSc; Catharine B. Stack, PhD, MS; and Cynthia D. Mulrow, MD, MSc
Research and Reporting Methods
http://annals.org/aim/article/doi/10.7326/M17-1454
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Journal
Annals of Internal Medicine