MANAGING CHRONIC PAIN
Limit NSAIDs for older adults
Drastically reduce the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for treating chronic pain in older adults, advises new pain management guidelines from the American Geriatrics Society. Instead, practitioners should consider opioids for older patients with moderate-to-severe pain or decreased quality of life due to pain.
Previous guidelines called for using over-the-counter or prescription nonselective NSAIDs (such as ibuprofen) and COX-2 selective NSAIDs (such as celecoxib) to treat persistent pain in older adults. Opioids were generally recommended only if these drugs were ineffective. But in older patients, cardiovascular, gastrointestinal, and other risks associated with NSAIDs typically outweigh the benefits. The new guidelines advise healthcare providers to prescribe these drugs rarely and with extreme caution in carefully selected patients. They also cover the use of adjuvant medications in older patients with chronic pain.
The new guidelines will appear in the August issue of the Journal of the American Geriatrics Society. For more information, visit the American Geriatrics Society Web site at http://www.americangeriatrics.org and search for "Pharmacological Management of Persistent Pain in Older Persons (2009)."
Experimental drug reins in HCV infection
Fewer than half of people infected with hepatitis C virus (HCV) genotype 1 respond to current therapies. But in two recent studies, the experimental protease inhibitor telaprevir rapidly reduced HCV RNA levels in patients with this type of HCV infection. In two studies involving telaprevir, about two-thirds of patients who took the drug along with standard therapy for 6 months had no detectable serum HCV RNA levels. The down side was that compared with control groups, more people taking telaprevir experienced adverse reactions, such as pruritus, rash, and anemia, leading to a high discontinuation of therapy rate.
The studies were sponsored by Vertex Pharmaceuticals, Inc., which is developing telaprevir. According to the company, telaprevir acts by inhibiting a unique HCV enzyme that aids viral replication and may also help the virus evade immune responses. Currently in late-stage testing, this oral drug isn't yet commercially available.
Sources: McHutchison JG, Everson GT, Gordon SC, et al. Telaprevir with peginterferon and ribavirin for chronic HCV genotype 1 infection. N Engl J Med. 2009;360(18):1827-1838; Hezode C, Forestier N, Dusheiko G, et al. Telaprevir and peginterferon with or without ribavirin for chronic HCV infection. N Engl J Med. 2009;360(18):1839-1850.
SERUM GLUCOSE CONTROL
Voglibose may prevent diabetes onset
In a study of 1,780 Japanese adults at high risk for type 2 diabetes, significantly fewer people who took the alpha-glucosidase inhibitor voglibose went on to develop diabetes compared with those who took a placebo. In fact, because the drug was so much more effective than placebo, an independent monitoring panel stopped the planned 3-year study after just 1 year.
About half of study participants took voglibose three times a day and half took a placebo. Fifty of the patients in the voglibose group developed diabetes, compared with 106 who took the placebo. Those numbers translate to a 40% lower risk of progression to type 2 diabetes among those who took voglibose. Patients who took voglibose were also 54% more likely to achieve normal blood glucose levels than those taking the placebo.
The researchers conclude that "voglibose, in addition to lifestyle modification, can reduce the development of type 2 diabetes in high-risk Japanese individuals with impaired glucose tolerance." The study was funded by Takeda Pharmaceutical Company Limited, which markets voglibose in Japan under the trade name Basen.
Source: Kawamori R, Tajima N, Iwamoto Y, et al. Voglibose for prevention of type 2 diabetes: a randomized, double-blind trial in Japanese individuals with impaired glucose tolerance. Lancet. 2009;373(9675):1607-1614.
Avoid valproate during pregnancy
Women with epilepsy who are pregnant or plan to become pregnant should avoid the antiepileptic drug (AED) valproate (Depakene, Epival) during the first trimester of pregnancy if possible, according to the updated practice parameters from the American Academy of Neurology. Good evidence suggests that the drug increases the risk of major congenital malformations (MCMs). The guidelines recommend that women switch from valproate to another AED well before pregnancy, to make sure that the new AED adequately prevents seizures and to avoid the risk of MCMs.
Source: Harden CL, Hopp J, Ting TY, et al. Practice parameter update: management issues for women with epilepsy-focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes. Report of the quality standards subcommittee and therapeutics and technology assessment subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009 April 27. [Epub ahead of print]