Sunday, February 21, 2010

Research Highlights

Opioid Prescriptions for Chronic Pain and Overdose
By Lori Fingerhut

Use of opioids on a long-term basis has increased recently, and with this increase in opioid treatment has come an increased rate of fatal overdose. This study, published in the Annals in Internal Medicine, was performed to determine approximate opioid overdose rates in relation to daily dose in patients prescribed opioids for long-term therapy.

This study consisted of 9940 patients who were prescribed opioids more than 3 times in a 90 day period for non-cancer related chronic pain. Fatal or non-fatal outcomes were determined from records of inpatient and outpatient care received during opioid treatment in relation to the prescribed dosage.

Using data collected, this study found those patients who had a 1-20 mg daily dose of opioids showed a 0.2% annual overdose rate, patients receiving a 50-99 mg daily dose showed a 0.7% annual overdose rate, and a 1.8% annual overdose rate was found in patients with over a 100 mg daily opioid dose. Overall, 6 deaths and 51 overdoses in patients receiving opioid treatment were found.

According to this study, those receiving a higher daily dosage of opioids had a greater risk of overdose. As a result, the medical community should take extra precaution in following up with patients and regulating their opioid dosage.

Annals of Internal Medicine, vol. 152 no. 2 85-92

Analyzing Obesity and Overweight in Adults from 1999-2008
By: Eriene-Heidi Sidhom

Between 1976 and 1994, there was an increasing prevalence of obesity in the United States. Therefore, using results from the National Health and Nutrition Examination Survey (NHANES), obesity trends from 1999 to 2008 were analyzed, as well as the current prevalence for 2007-2008. The NHANES is a representative sample of the United States population, and has been collecting data since 1960, with continuous surveys since 1999.

In this study, the height and weight measurements from 5555 men and women, aged 20 and older, from 2007-2008 were compared to the NHANES results from 1999 to 2006. Estimates of the prevalence of overweight and obesity in adults were measured according to Body Mass Index (BMI), which is weight in kilograms divided by height in meters squared, rounded to the nearest tenth. Overweight was classified as a BMI between 25.0 and 29.0 and obesity was classified as having a BMI over 30.0. Additionally, individuals were grouped by age and race and ethnicity were self-reported.

In 2007-2008 the prevalence of obesity was found to be 33.8% overall, with 32.2% in men and 35.5% in women. The prevalence of overweight and obesity combined was found to be 68.0% overall with 72.3% in men and 64.1% in women. The results varied by age, racial and ethnic backgrounds. However, over the 10 years, there was no significant trend among women. Although there was a significant linear trend for men, but most recent data points showed no significant difference.

JAMA. 2010;303(3):235-241

A Placebo-Controlled Trial of Oral Cladribine for Relapsing Multiple Sclerosis

By: Namratha Rao

The New England Journal of Medicine published a study by the CLARITY Study Group that researched the effects of Cladribine tablets on patients with Relapsing Multiple Sclerosis.

Relapsing Multiple Sclerosis is a chronic auto-immune disorder of the nervous system. 1326 random patients were each given either 2 doses of the Cladribine tablets (either 3.5 mg or 5.25 mg per kilogram) or matching placebos for a 96 week period.

The results obtained suggested that the group that was given the Cladribine tables had a significantly lower rate of annualized relapse as compared with the placebo group. Additionally, the Cladribine tablet group had a relapse-free rate of 79.7% and 78.9% respectively as compared to 60.9% of the placebo group. The Cladribine group also showed a lower risk of 3-month sustained progression of disability and significant reduction in brain lesion count as compared to the placebo group.

However, of the Cladribine group, 21.6% in the 3.5-mg group and 31.5% in the 5.25-mg group, showed signs of lymphocytopenia as opposed to 1.8% of the placebo group. Another adverse effect in the Cladribine group was that 8 out of 12 patients had herpes zoster as compared to 0 patients with similar conditions in the placebo group. Despite the tablets’ adverse effects, the study concludes that the adverse effects of the Cladribine tablets should not overshadow its benefits in curbing Relapsing Multiple Sclerosis.

NEJM. 10.1056/NEJMoa0902533. January 20, 2010

Association of Antiretroviral Therapy Adherence and Health Care Costs

Jeremy Nowak

This research study examined how antiretroviral therapy (ART) adherence, a process which follows the progression of the HIV virus, affects direct health care costs. This examination lasted for approximately six years and took place in a disease management program in South Africa. Researchers averaged the monthly direct health care costs to determine the overall cost impact of ART.

The results of this program showed that an average of $370 was spent for monthly costs. Of this money, the mean cost of ART was $32. Other components of the monthly health care costs included hospitalizations ($151), consultations ($76), investigations ($37), and non-ART medications ($53). Throughout the study, the total mean monthly costs ranged anywhere from $313 to $376. The principal limitation of this examination was the fact that indirect health care costs were not accounted for.

Researchers arrived at the conclusion that a relatively high adherence to ART was connected to lower mean monthly direct health care costs, including reduced hospitalization costs. These results were specific to the HIV cohort research setting in South Africa.

Annals of Internal Medicine. vol. 152 no. 1 18-25
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