1. Long-term use of isradipine does not slow Parkinson's progression
Abstract: http://annals.org/aim/article/doi/10.7326/M19-2534
Editorial: http://annals.org/aim/article/doi/10.7326/M20-1023
Free Summary for Patients: http://annals.org/aim/article/doi/10.7326/P20-0004
URL goes live when the embargo lifts
Long-term treatment with immediate-release isradipine does not seem to slow the clinical progression of early-stage Parkinson's disease. Findings from a multicenter, randomized, parallel-group, double-blind, placebo-controlled trial are published in Annals of Internal Medicine.
Despite multiple prior studies, there are no proven strategies for slowing the progression of Parkinson's disease. Isradipine, a dihydropyridine calcium-channel blocker approved for the treatment of hypertension, has been shown to be neuroprotective in animal models Parkinson's disease. Several epidemiologic studies have demonstrated a reduced risk for Parkinson's disease in persons receiving dihydropyridines compared with other antihypertensive agents, leading researchers to hypothesize that isradipine may have the potential to slow the progression of the disease when used in its early stages.
Researchers from the Parkinson Study Group STEADY-PD III Investigators team randomly assigned 336 patients with early-stage Parkinson's disease at 57 Parkinson Study Group sites in North America to either 5 mg of immediate-release isradipine twice daily or placebo for 36 months. None of the participants were taking dopaminergic medications at enrollment. The researchers found no significant difference in the change in Unified Parkinson's Disease Rating Scale (UPDRS) scores over 36 months in patients receiving isradipine twice daily versus those receiving placebo. None of the secondary outcome measures demonstrated benefit of isradipine. According to the researchers, these results do not support the hypothesis that isradipine at this dose slows the progression of early-stage Parkinson's disease.
Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Tanya Simuni, MD, please contact Marla Paul at marla-paul@northwestern.edu.
2. Allergy to metal used in pacemaker casing could cause asthma in susceptible patients
Case report describes clinicians' 'golden solution' to the problem
Abstract: http://annals.org/aim/article/doi/10.7326/L19-0647
URL goes live when the embargo lifts
An allergic reaction to the metal used in a pacemaker's casing could cause asthma in susceptible patients. Clinicians from Ozarks Medical Center in West Plains, Missouri cite the case of a 58-year-old woman who had new episodes of wheezing, chest tightness, and worsening shortness of breath on minimal exertion 3 weeks after implantation of a permanent pacemaker. The case report is published in Annals of Internal Medicine.
Previous reports of complications after insertion of a permanent cardiac pacemaker have described rare local reactions caused by metal allergy that can be severe enough to cause wound dehiscence and require pacemaker removal. While asthma induced by the metal allergy has not previously been described, the patient's reaction prompted clinicians to review her medical records for allergies. Her records revealed that she had been hypersensitive to costume jewelry as an adolescent, which led the team to order skin testing for metal allergies. The patient had positive reactions to titanium, nickel, and mercury, but not gold, so the clinicians replaced her titanium-encased pacemaker with a gold-encased pacemaker, and her asthma symptoms disappeared within 24 hours.
Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. The lead author, Biplab K. Saha, MD, can be contacted directly at spanophiliac@yahoo.com.
Also new in this issue:
Love in the Times of Corona
Simone V. Benatti, MD
On Being a Doctor
Free content: http://annals.org/aim/article/doi/10.7326/M20-1137
URL goes live when the embargo lifts
Media contact: Dr. Benatti can be reached at simone.benatti@hotmail.it.
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Journal
Annals of Internal Medicine