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Switching drugs may not be the best option

When patients with depression don't respond adequately to an antidepressant, many practitioners try switching them to a different antidepressant. A new study of 1,522 patients with major depressive disorder (85% male) indicates that adding a second antidepressant or an antipsychotic drug may be a more effective approach.


Patients included in the study had been diagnosed with nonpsychotic major depressive disorder and were unresponsive to at least one antidepressant course meeting minimal standards for treatment dose and duration. They were placed in one of three treatment groups:


* switch to a different antidepressant, bupropion (switch group, n = 511)


* augment current treatment with bupropion (augment-bupropion group, n = 506)


* augment with an atypical antipsychotic, aripiprazole (augment-aripiprazole group, n = 505).



Patients were followed for 12 weeks (acute treatment phase) and up to 36 weeks for longer-term follow-up (continuation phase). The primary outcome was remission during the acute treatment phase. Secondary outcomes included response, relapse, and adverse reactions.


At 12 weeks, remission rates were approximately 22% for the switch group, 27% for the augment-bupropion group, and 29% for the augment-aripiprazole group.


Response was greater for the augment-aripiprazole group (74%) than for either the switch group (62%) or the augment-bupropion group (66%). No significant treatment differences were observed for relapse.


Anxiety was more common in both bupropion groups compared with the augment-aripiprazole group. Somnolence, akathisia, and weight gain were more common in the augment-aripiprazole group.


Researchers concluded that among a predominantly male population with major depressive disorder unresponsive to antidepressant treatment, augmentation with aripiprazole resulted in a "statistically significant but only modestly increased likelihood of remission during 12 weeks of treatment compared with switching to bupropion monotherapy. Given the small effect size and adverse effects associated with aripiprazole, further analysis including cost-effectiveness is needed to understand the net utility of this approach."


Source: Mohamed S, Johnson GR, Chen P, et al. Effect of antidepressant switching vs augmentation on remission among patients with major depressive disorder unresponsive to antidepressant treatment: The VAST-D randomized clinical trial. JAMA. 2017;318(2):132-145.



Patient education falling on deaf ears?

Research has shown that most parents make decisions about immunizing an infant before the infant's birth, and that their decision is influenced by positive and negative information from various sources. In a new study, researchers were disappointed to find that although receiving negative information about vaccination is associated with delays in vaccinations, receiving positive information had no impact on improving vaccination timeliness. Timely administration of childhood vaccines is key to their effectiveness.


The study sample included 6,182 pregnant women. Results were based on enrollment interviews of participating pregnant women and on data from a New Zealand national immunization registry.


The researchers found that family and friends were the most common source of information discouraging vaccination, while information received from healthcare professionals was almost entirely encouraging. Compared with women receiving no immunization information, women receiving both encouraging and discouraging information during pregnancy were more likely to delay immunizations, possibly because conflicting information fosters uncertainty. The odds of timely immunizations didn't improve when women received encouraging information after hearing discouraging information.


The investigators call for more research into the content of influential discouraging information to help develop effective strategies for counteracting its significant negative impact. Meanwhile, they say, healthcare professionals must continue promoting child health issues. "This very important aspect of medical education should not be left until after the child is born," says coauthor Cameron C. Grant, MBChB, PhD. "Health professionals caring for pregnant women have a very important role to play in determining the immunization intentions of these future parents, and in promoting infant immunization."


Sources: Veerasingam P, Grant CC, Chelimo C, et al. Vaccine education during pregnancy and timeliness of infant immunization. Pediatrics. [e-pub Aug. 18, 2017.] Anti-vaccine family members, friends spur many moms to delay baby's shots. HealthDay. August 18, 2017.



Hold the steroids

Oral steroids don't reduce the duration or severity of symptoms of lower respiratory tract infection in adults who don't have asthma or another chronic pulmonary disease, a new study shows. Nearly 400 nonasthmatic adults with acute chest infections but no evidence of pneumonia and who didn't require immediate antibiotic treatment were randomly split into two groups. Those in one group received 40 mg of the oral steroid prednisolone for 5 days; those in the other group received a placebo for 5 days. The researchers found no difference in the duration of cough or the severity of associated symptoms between 2 and 4 days after treatment, when symptoms are typically most severe.


"Corticosteroids like prednisolone are increasingly being used to try to reduce the symptoms of chest infections, but without sufficient evidence," says lead investigator Alastair Hay. "Our study does not support the continued use of steroids as they do not have a clinically useful effect on symptom duration or severity. We would not recommend their use for this group of patients."


Sources: Hay AD, Little P, Harnden A, et al. Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial. JAMA. 2017; 318(8):721-730. Steroids not effective for chest infections in non-asthmatic adults. University of Bristol. News release. August 22, 2017.



New drug for acute lymphoblastic leukemia

The FDA recently approved inotuzumab ozogamicin (Besponsa) for adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL). These patients have a limited life expectancy and few treatment options.


The new drug's safety and effectiveness was evaluated in a randomized trial involving 326 patients with relapsed or refractory B-cell ALL who'd received one or two prior treatments. Among patients receiving inotuzumab, 35.8% achieved complete remission for a median of 8 months. In contrast, 17.4% of patients treated with alternative chemotherapy achieved complete remission for a median of 4.9 months.


The new drug can cause many serious adverse reactions, including thrombocytopenia, neutropenia, leukopenia, infection, anemia, QT interval prolongation, and hemorrhage. The labeling carries boxed warnings about the risk of hepatotoxicity and an increased risk of death for patients taking inotuzumab after receiving a certain type of stem cell transplant.


Source: FDA approves new treatment for adults with relapsed or refractory acute lymphoblastic leukemia. Food and Drug Administration. News release. August 17, 2017.