Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
1. Rifampin regimen found to be cheaper than isoniazid for latent tuberculosis
These findings could potentially change the way the disease is treated
Abstract: https://www.acpjournals.org/doi/10.7326/M19-3741
URL goes live when the embargo lifts
A 4-month rifampin regimen was found to be cheaper than a 9-month course of isoniazid for the treatment of latent tuberculosis in a cost-comparison study published in the Annals of Internal Medicine. Currently, isoniazid is the standard of treatment in most countries for latent tuberculosis infection. The finding that 4 months rifampin treatment is cheaper adds to previously published evidence that this treatment is as effective, while also significantly safer and more likely to be completed, than 6 months or 9 months isoniazid treatment. These findings have the potential to change the way latent tuberculosis is treated.
An estimated one quarter of the global population has latent tuberculosis infection. If left untreated, 10 percent of these 1.7 billion people will develop tuberculosis disease. Latent tuberculosis infection treatment is not new. Monotherapy with isoniazid for 6 to 12 months has been long proven to reduce the risk for developing active tuberculosis by up to 90 percent. The long treatment duration and the fear of serious, even fatal adverse events have limited acceptance and completion.
Researchers from McGill University studied data from two multicenter randomized clinical trials conducted in adults and children with risk factors for developing tuberculosis. They compared health care use and associated costs of treatment with 4 months of rifampin and 9 months of isoniazid in these studies. The analysis indicated that latent tuberculosis infection treatment with 4 months of rifampin resulted in less health service use and significantly lower costs than 9 months of isoniazid for both adults and children. These trials included participants from diverse treatment settings in 9 countries. According to the researchers, these findings suggest that tuberculosis programs in all countries should consider adoption of the 4-month rifampin regimen as a first-line therapy for latent tuberculosis infection.
Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead authors Dick Menzies, MD, MSc and Mayara Bastos, MD, MSc, please contact Fabienne Landry at Fabienne.Landry@MUHC.MCGILL.CA.
2. Cannabis improves blood pressure stability by reducing triggers of autonomic dyreflexia in patient with spinal cord injury
Abstract: https://www.acpjournals.org/doi/10.7326/L20-0090
URL goes live when the embargo lifts
Regular cannabis use improved blood pressure stability by reducing triggers of autonomic dyreflexia in a patient with spinal cord injury. A case report is published in Annals of Internal Medicine.
Autonomic dyreflexia, a condition that emerges after spinal cord injury, causes high blood pressure, pounding headache, flushed face, and sweating, among other troublesome symptoms. Episodes can be severe enough to cause life-threatening medical emergencies. Current pharmacologic approaches to treating autonomic dyreflexia are often expensive and ineffective.
Researchers from the University of British Columbia and G.F. Strong Rehabilitation Centre report the case of a 41-year-old patient with a C5 spinal cord injury who has been self-managing his autonomic dysreflexia symptoms with daily cannabis use for the past 13 years. The patient reported using a vaporizer throughout the day to inhale about 1000 mg of a cannabis concentrate that contains 20 percent THC. He also consumes 2 to 3 edibles per day that contain approximately 2000 to 2500 mg of THC. The researchers monitored his blood pressure using a 24-hour home blood pressure monitor to document the effect. They found that his blood pressure stability was worse on days when he did not use cannabis and better on days when he did. Further, the cannabis use reduced the frequency of autonomic dysreflexia by 135 percent and its severity by 43 percent. These findings suggest that cannabis may be an effective way to manage autonomic dyreflexia.
Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Andrei V. Krassioukov, MD, PhD, please contact Cheryl Niamath at niamath@icord.org.
Also in this issue:
Blood Transfusion Safety in Low-Resourced Countries: Aspiring to a Higher Standard
Evan M. Bloch, MBChB, MS; Eric A. Gehrie, MD; Paul M. Ness, MD; Jeremy Sugarman, MD, MPH, MA; Aaron A.A.R. Tobian, MD, PhD
Ideas and Opinions
https://www.acpjournals.org/doi/10.7326/M20-0203
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Journal
Annals of Internal Medicine