Last week's articles on rheumatology topics in the major non-rheumatology journals
Faldaprevir and Deleobuvir for HCV Genotype 1 Infection
N Engl J Med, August 15, 2013
Two investigational direct-acting antivirals have been found effective against hepatitis C virus (HCV) in the absence of pegylated interferon. But ribavirin is still necessary. A phase 2b trial of 362 previously-untreated patients with HCV genotype 1 compared several dosages and several treatment durations of the three-drug therapy of faldaprevir, deleobuvir and ribavirin. Betweem 59% and 69% of patients in the three-drug groups met the primary end point, sustained virologic response, 12 weeks after completion of therapy. A small group received a two-drug ribavirin-free therapy, and were free of anemia, but only 39% of that group reached the primary end point. Deleobuvir is less active against genotype 1a than 1b, and patients with genotype 1a did worse. (This experimental results points toward a major advance against rheumatic disorders secondary to hepatitis C, because the current standard therapy including pegylated interferon is contraindicated in patients with autoimmune disorders.)
ALSO NEW THIS WEEK:
Original Investigation: Immunogenicity of Monoclonal Antibodies Against Tumor Necrosis Factor Used in Chronic Immune-Mediated Inflammatory Conditions. Systematic Review and Meta-analysis
JAMA Intern Med, August 12, 2013
Patients with rheumatoid arthritis who were treated with anti-tumor necrosis factor monoclonal antibodies (rituximab and abatacept) were likely to develop seropositivity against those monoclonal antibodies, which produced a worse response, and were more likely to discontinue the therapies. Seropositivity to etanercept, however, was low. Concommitant treatment with disease-modifying antirheumatic drugs, including azathioprine, decreased the risk of seropositivity.
Capitol Health Call: High-Cost Drugs Account for Most of Medicare Part B Spending
JAMA, August 14, 2013
Testimony Before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives. Medicare. Information on Highest-Expenditure Part B Drugs
United States Government Accountability Office. June 28, 2013
Rituximab was Medicare Part B’s most expensive rheumatology drug in 2010. Epoetin alfa for end-stage renal disease was Part B’s single most expensive drug ($2 billion) again in 2010. After that came rituximab ($1.3 billion) for rheumatoid arthritis and cancer. Infliximab was No. 5 ($900 million). When ranked by the number of patients treated, the most common rheumatology drug was zoledronic acid (218,000 patients), followed by hyaluronic acid (170,000 patients). The rheumatology drug with the greatest increase (800%) in Part B costs was intravenous immunoglobulin (Privigen).
In the US, a rise in prescriptions for opioid analgesics for persistent pain has been paralleled with an increase in deaths from these drugs. But a downward trend in reported deaths accompanied a comparable rise in opioid prescriptions in the UK – except for a rise in deaths from tramadol. Nonetheless, opioids are prescribed more often and for longer periods than the data on persistent pain would justify. A minority of patients have definite, persistent benefits, says this editorial, so it’s worth a try. “If opioids might help, they should not be withheld, but, importantly, if they don’t work in reasonable doses they should be stopped,” advises the author. This may be difficult to say to patients with intolerable pain and no other alternatives.