July 22, 2011

MS Drugs: Balancing High Cost with High Need

Karen Blitz-Shabbir, MD

The journal Neurology just published a population-based study to evaluate the cost-effectiveness of disease-modifying therapies (DMTs, or drugs that change the course or progression of the disease) in the United States compared to basic supportive therapy without DMT for patients with relapsing multiple sclerosis. The study concluded that the use of disease-modifying therapies in multiple sclerosis “results in health gains that come at a very high cost.”

Drugs for multiple sclerosis (which have been available since 1993) have dramatically changed the course of this often devastating disease. The arsenal of medications has been shown to slow progression of disability, prevent exacerbations and improve quality of life.

But pharmaceutical costs have gone up at unprecedented rates. Cost-effectiveness studies have shown that hospitalization rates dramatically decrease decrease with the use of drugs for multiple sclerosis, so the cost of the drugs was warranted and “paid off” when the patients did not have to incur hospitalization costs.

Studies that discuss the high cost of multiple sclerosis drugs should not lose sight of the high need for treatment in our patients, and should focus our attention on the need to rein in the pharmaceutical industry with regard to cost.
 

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July 20, 2011

Olive Oil Associated with Lower Risk of Ischemic Stroke

Richard Libman, MD

Previous studies have shown that a Mediterranean-style diet has been associated with protection against dementia, as well as stroke. However, the exact components of the Mediterranean diet which may be protective have not been clarified by the studies. 

We know that olive oil, an important component of a Mediterranean diet, has previously been shown to be associated with a lower risk of heart attacks. A recent study published in Neurology, reported that olive oil was associated with a lower risk of ischemic stroke  (a blood clot in the brain). 
 
In the study, French researchers from the University of Bordeaux and the National Institutes of Health and Medical Research looked at the medical records of 7, 625 people ages 65 and older from three cities in France. Participants had no history of stroke. Olive oil consumption was categorized as “no use,” “moderate use,” and “intensive use.” After five years, there were 148 strokes. The study found that those who regularly used olive oil for both cooking and as a dressing had a 41 percent lower risk of stroke compared to those who never used olive oil in their diet. Most of the study participants used extra virgin olive oil.
 
This is most encouraging and may be useful in the general population to decrease the risk of stroke. A major caveat, however, exists with this type of study in that it is an observational study, not a randomized trial. For this reason, it is subject to multiple sources of bias, both measured and unmeasured, which can potentially give false results. As such, the study findings should not be taken as the final answer, but should stimulate further research. Full Post - to Detail View

July 18, 2011

Taking Antidepressants During Pregnancy May Cause Autism

Natalie Meirowitz, MD

A study recently performed by researchers at Stanford University found that environmental factors could be a possible cause of autism. The study, which was published recently in Archives of General Psychiatry, defined “environmental” factors as anything unrelated to genetic code. These factors could include advanced maternal or paternal age, assisted reproductive technology, artificial insemination and giving birth to multiples.

Another environmental factor that could cause an even greater risk of autism is the intake of antidepressants during pregnancy. The risk was three times higher if mothers took medication during early pregnancy, compared to children without the developmental disorder.

But even though taking antidepressants during pregnancy could harm the baby, going off the antidepressants could harm the baby as well as the mother in many ways. It may not be the best choice for mothers to go off their medication when pregnant. If they do, they may self-medicate in other ways such as using drugs and alcohol, failing to eat right and failing to keep their prenatal appointments.

The decision to stop medications must be carefully considered between the patient, her psychiatrist, obstetrician and significant other. Full Post - to Detail View

July 15, 2011

Not Enough Who Suffer Ischemic Stroke Get Clot-Busting Drug

David Langer, MD

Stroke remains one of the leading causes of death and disability in the United States. Unfortunately, the treatment of stroke remains problematic due to the difficulties involved in getting patients diagnosed and treated in a timely fashion. The clot-busting drug tPA remains the only Food and Drug Administration (FDA)-approved drug for acute ischemic stroke (AIS) which is caused by a blood clot in the brain. In order for tPA to be effective, it should be administered within the first three hours after the initial onset of stroke symptoms.

Recently, researchers from the University of Cincinnati reported in the American Heart Association’s Stroke journal that 3.4 percent to 5.2 percent of Americans who suffered from an ischemic stroke in 2009 received tPA compared to 1.8 percent to 2.1 percent in 2005. While this finding is a sign of improvement, it is still very low. As such, we must continue to improve our treatment of stroke patients. Time remains a critical element in stroke management.

Current efforts both in basic science, as well as in system-based work flows in stroke management, are ongoing in efforts to improve the outcome of stroke patients. The goal is to preserve the brain, while improving identification of stroke and treatment.

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