News Release 

L-thyroxine did not improve symptoms or tiredness in older persons with subclinical hypothyroidism and high symptom burden

American College of Physicians

1. L-thyroxine did not improve symptoms or tiredness in older persons with subclinical hypothyroidism and high symptom burden

Abstract: http://annals.org/aim/article/doi/10.7326/M19-3193

Free patient summary: http://annals.org/aim/article/doi/10.7326/P20-0005 URL goes live when the embargo lifts

In older adults with subclinical hypothyroidism (SCH) and high symptom burden, L-thyroxine did not improve symptoms or relieve tiredness compared with placebo. These results do not support routine use of L-thyroxine in this population. Findings from a secondary analysis of a randomized trial are published in Annals of Internal Medicine.

Subclinical hypothyroidism is an early form of a condition where the thyroid gland doesn't make enough thyroid hormone, resulting in slightly abnormal hormone levels. The recent TRUST trial (Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism Trial) compared thyroid hormone treatment with placebo among older adults with SCH and found no difference in symptoms. However, whether a subset of patients with subclinical hypothyroidism who have greater symptoms might still benefit continues to be debated.

Researchers from Bern University Hospital and University of Bern, Switzerland studied 638 persons aged 65 years or older with persistent SCH to determine whether L-thyroxine could improve hypothyroid symptoms and tiredness among older adults with SCH and high symptom burden. The researchers found that patients who were treated with thyroid medication did not experience greater improvement in symptoms, quality of life, or handgrip strength regardless of the severity of their symptoms before treatment. In the absence of another randomized clinical trial specifically designed for persons with SCH and high symptom burden, these results do not support routine use of L-thyroxine therapy for these patients.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Maria de Montmollin, MD, can be reached directly at maria.demontmollin@insel.ch.

2. Three-drug combination, RHB-105, effectively eradicates H pylori infection in adults

Abstract: http://annals.org/aim/article/doi/10.7326/M19-3734

URL goes live when the embargo lifts

The three-drug combination of omeprazole, amoxicillin, and rifabutin in one capsule, RHB-105, effectively eradicates Helicobacter pylori infection in adults. The novel formulation was found to still be effective and well-tolerated in an environment of clinically significant antibiotic resistance. Findings from a double-blind randomized trial are published in Annals of Internal Medicine.

H. pylori infection is the main cause of gastrointestinal diseases, such as peptic ulcer, gastritis, and gastric cancer. Current guidelines recommend eradication of the infection, but it is difficult to treat because success with previously effective therapies has declined, related largely to the worldwide increase in antibiotic resistance. Both the World Health Organization and the US Food and Drug Administration (FDA) have designated clarithromycin-resistant H pylori as a focus for new drug development, and the FDA included it as a pathogen with "the potential to pose a serious threat to public health."

Researchers at 55 clinical research sites in the United States, led by researchers from the Michael E. De-Bakey Veterans Affairs Medical Center, randomly assigned 455 treatment-naive adults with epigastric discomfort and confirmed H pylori infection to triple therapy with RBH-105 or dual therapy of amoxicillin/omeprazole to assess the effectiveness of RHB-105 for H pylori eradication. The researchers found that H. pylori eradication rate was significantly greater following treatment with the rifabutin-based triple therapy than with high-dose amoxicillin/omeprazole dual therapy. Eradication rates were not affected by H. pylori resistance to clarithromycin or metronidazole, which suggests that RHB-105 should be considered as a first-line empirical therapy of H pylori infection.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, David Graham, MD, please contact Sandy Norris at norriscommunicationsgroup@comcast.net.

3. HIV-positive men who have sex with men not getting recommended STD prevention services Men also report engaging in risky sexual behaviors

Abstract: http://annals.org/aim/article/doi/10.7326/M19-4051

URL goes live when the embargo lifts

Men who have sex with men (MSM) that are being treated for HIV are not getting recommended prevention services or annual sexually transmitted disease (STD) testing. These same men report engaging in risky sexual behaviors, which puts them at increased risk for acquiring and spreading infection. Findings from a large, nationally representative survey are published in Annals of Internal Medicine.

Researchers from the Centers for Disease Control and Prevention describe results from the Medical Monitoring Project, an annual, 2-stage, complex sample survey designed to produce national representative estimates of behavioral and clinical characteristics of adults in the U.S. diagnosed with HIV. The survey of 4,000 people assessed self-reported behaviors for STD transmission, including sexual behaviors, drug and alcohol use before or during sex, and receipt of HIV or STD prevention services during the past 12 months. Among people with diagnosed HIV, two-thirds reported having anal sex without a condom in the past year, putting them at risk for acquiring STDs and potentially transmitting HIV and STDs, including hepatitis C. However, many did not receive recommended prevention services and STD testing. Risk behaviors for acquiring STDs were similar among patients being treated at all facilities, but those being treated at Ryan White HIV/AIDS Program-funded facilities were more likely to receive recommended STD prevention services and STD testing.

According to the researchers these finding suggest that closer adherence to guidelines for delivering prevention services and STD testing to HIV-positive men is needed. Meeting these requirements is necessary for helping to prevent STDs and end the HIV epidemic.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. The lead author, John Weiser, MD, can be reached at jweiser@cdc.gov.

Also new in this issue:

Eosinophilic Esophagitis
David A. Katzka, MD
In the Clinic
Abstract: http://annals.org/aim/article/doi/10.7326/AITC202005050

A Cautionary Tale: The 2019 Orphaning of Hahnemann's Graduate Medical Trainees
David Jacob Aizenberg, MD; William C. Boyer, DHSc, MS; and Lia Suzanne Logio, MD
Academia and the Profession http://annals.org/aim/article/doi/10.7326/M20-0043

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