<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_442"
                     title="Most Mountaineers Can Enjoy the View (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/tb/18359?impressionId=1265791408659"
                     
      &lt;p&gt;Although the vistas from some of the world&apos;s highest peaks are literally &quot;eye-popping,&quot; most climbers don&apos;t have to worry about their high-altitude vision.&lt;/p&gt;
&lt;p&gt;Corneal thickness did swell significantly among mountaineers at elevations up to 6,300 meters (about 21,000 feet), but they had no loss in visual acuity, Martina Monika Bosch, MD, of University Hospital Zurich in Switzerland, and colleagues reported in the February &lt;em&gt;Archives of Ophthalmology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;It seems that visual acuity in healthy corneas is not adversely affected despite the presence of edema at altitudes up to 6,300 meters,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Yet they warned that altitudes above 8,000 meters, or 26,000 feet, &quot;may result in profuse edema leading to dangerous visual loss.&quot;&lt;/p&gt;
&lt;p&gt;Mt. Everest is just over 29,000 feet high.&lt;/p&gt;
&lt;p&gt;Research has shown that hypobaric atmospheric conditions are linked to acute mountain sickness, as well as to the more unusual cerebral edema.&lt;/p&gt;
&lt;p&gt;High altitudes have also been associated with decreases in visual acuity, as was the case for Dr. Beck Weathers, a Mount Everest climber who had lasik surgery prior to his climb and experienced severe vision loss before reaching the summit.&lt;/p&gt;
&lt;p&gt;So, to investigate the effects of very high altitudes on corneal thickness, the researchers conducted a study of 28 healthy mountaineers ages 26 to 62, who were on a medical research expedition to Mount Muztagh Ata in China, an elevation of 24,757 feet.&lt;/p&gt;
&lt;p&gt;The climbers were randomly assigned to two groups: one had a shorter time to acclimate to altitude conditions prior to reaching a camp at 21,736 feet.&lt;/p&gt;
&lt;p&gt;The researchers measured corneal thickness via ultrasound pachymetry.&lt;/p&gt;
&lt;p&gt;They found that corneal thickness increased in both groups at higher altitudes, with shorter acclimatization times leading to greater differences (&lt;em&gt;P&lt;/em&gt;=0.048). For this group, mean corneal thickness increased from 537 mcm to 572 mcm.&lt;/p&gt;
&lt;p&gt;Corneal thickness in the group that had more time to acclimate rose from 534 mcm to 563 mcm.&lt;/p&gt;
&lt;p&gt;Visual acuity didn&apos;t significantly decrease during the course of the expedition. However, the researchers warned that higher altitudes induce more endothelial pump function failure and may result in profuse edema, leading to vision loss.&lt;/p&gt;
&lt;p&gt;While the cause of corneal swelling in hypoxic conditions is still controversial, the researchers suggested that a higher concentration of lactate may reduce activity of the eye&apos;s endothelial pump function, resulting in corneal swelling.&lt;/p&gt;
&lt;p&gt;There were no differences in mountain sickness between the groups, but oxygen saturation during the expedition was significantly lower than at baseline in both.&lt;/p&gt;
&lt;p&gt;Changes in oxygen saturation paralleled those of corneal thickness, the researchers said, indicating that slower acclimatization resulted in less corneal edema.&lt;/p&gt;
&lt;p&gt;Also, climbers with more acute mountain sickness had thicker corneas, possibly due to their higher overall susceptibility to hypoxia.&lt;/p&gt;
&lt;p&gt;&quot;These findings further support our hypothesis that blood oxygen saturation becomes more important for the endothelial pump function when environmental oxygen pressure and, thus, tear film oxygen saturation, is reduced to a critical level,&quot; they wrote. &quot;Our results thus highlight the importance of aqueous humor oxygen delivery.&quot;&lt;/p&gt;
&lt;p&gt;The study was limited by the inability to measure corneal thickness daily due to adverse weather conditions.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the Swiss National Research Science Foundation, the Swiss Society of Mountain Medicine, and Pfizer.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_444"
                     title="Huntington Drug Produces Slight Benefit (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Neurology/GeneralNeurology/tb/18363?impressionId=1265791408659"
                     
      &lt;p&gt;An investigational drug that protects mitochondria in nerve cells helped restore some cognitive function in patients with Huntington&apos;s disease, researchers said.&lt;/p&gt;
&lt;p&gt;Patients receiving three months of treatment with latrepirdine (Dimebon), formerly known as dimebolin, showed a mean increase of 0.86 points (SD 0.31) on the Mini-Mental State Exam (MMSE), compared to an average decline of 0.12 points (SD 0.31,&lt;em&gt; P&lt;/em&gt;=0.03) in a placebo group, Karl Kieburtz, MD, MPH, at the University of Rochester in Rochester, N.Y., and colleagues reported in the February &lt;em&gt;Archives of Neurology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The treatment was also well tolerated in the 91-patient randomized trial, though no differences from placebo were seen in other measures of efficacy, including the Unified Huntington&apos;s Disease Rating Scale and the cognition component of the Alzheimer&apos;s Disease Assessment Scale.&lt;/p&gt;
&lt;p&gt;Kieburtz and colleagues concluded that latrepirdine &quot;may have a beneficial effect on cognition&quot; in Huntington&apos;s disease patients and that additional trials are warranted.&lt;/p&gt;
&lt;p&gt;Latrepirdine stabilizes the mitochondrial membrane in neurons. Disruption in the membrane leads to neuronal apoptosis and appears to play a role in neuron death associated with several neurodegenerative syndromes, including Huntington&apos;s and Alzheimer&apos;s diseases, the authors noted.&lt;/p&gt;
&lt;p&gt;&quot;Nonclinical data available to date suggest that the mechanism of action of latrepirdine is to enhance mitochondrial function in the setting of cellular stress,&quot; Kieburtz and colleagues explained in the report.&lt;/p&gt;
&lt;p&gt;A phase III study of latrepirdine in Alzheimer&apos;s disease, &lt;a href=&quot;http://www.medpagetoday.com/Geriatrics/AlzheimersDisease/10174&quot; mce_href=&quot;http://www.medpagetoday.com/Geriatrics/AlzheimersDisease/10174&quot; target=&quot;_blank&quot;&gt;reported in 2008&lt;/a&gt;, produced modest benefits. Two additional phase III trials were started late last year, according to the drug&apos;s co-developers, Medivation and Pfizer.&lt;/p&gt;
&lt;p&gt;The drug was once sold in Russia as a nasal decongestant, but is no longer available anywhere.&lt;/p&gt;
&lt;p&gt;The drug&apos;s generic name was originally dimebolin but the companies requested the change to latrepirdine last year.&lt;/p&gt;
&lt;p&gt;In the current study, designed primarily as a safety assessment, Kieburtz and colleagues randomized middle-age patients with mild to moderate Huntington&apos;s disease symptoms to either placebo or 20 mg of latrepirdine three times daily.&lt;/p&gt;
&lt;p&gt;Adverse events of various types were reported in 70% of the latrepirdine patients and 80% of the placebo group. Falls, headache, dizziness, nausea, and chorea were the most common in both groups, with no significant differences in rates between the drug and placebo.&lt;/p&gt;
&lt;p&gt;Headache (three cases) and somnolence (three cases) were somewhat more common with latrepirdine than with placebo ( three cases and one case, respectively).&lt;/p&gt;
&lt;p&gt;On none of the 11 motor or cognitive components of the Unified Huntington&apos;s Disease Rating Scale did patients receiving latrepirdine show a significant difference from the placebo group.&lt;/p&gt;
&lt;p&gt;Patients showed similar declines in mean scores on the Alzheimer&apos;s Disease Assessment Scale&apos;s cognitive component, both decreasing about one point from a mean at baseline of 20.&lt;/p&gt;
&lt;p&gt;Mean baseline scores on the MMSE were 25.3. The 0.97-point advantage of latrepirdine over placebo in this measure after 90 days was statistically significant (95% CI 0.10 to 1.85), although the clinical change was relatively small.&lt;/p&gt;
&lt;p&gt;However, Kieburtz and colleagues expressed surprise at finding any significant difference in this measure, &quot;given that the MMSE is generally considered a relatively insensitive measure of cognitive function.&quot;&lt;/p&gt;
&lt;p&gt;They indicated that the MMSE provides a broader measure of cognitive function than either the Huntington- or Alzheimer-specific instruments. The Unified Huntington&apos;s Disease Rating Scale is intended for monitoring long-term changes in function, rather than the effects of a short-term intervention such as this one, the researchers argued.&lt;/p&gt;
&lt;p&gt;They added that the Alzheimer assessment may not fully capture the cognitive domains most affected in Huntington&apos;s disease.&lt;/p&gt;
&lt;p&gt;Kieburtz and colleagues also pointed out that the improvements seen with latrepirdine were similar to those found in the earlier trial in Alzheimer&apos;s disease.&lt;/p&gt;
&lt;p&gt;The small number of patients and the relatively short treatment duration were limitations of the study.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by Medivation.&lt;/p&gt;&lt;p&gt;Study authors reported relationships other than research support with Medivation, Abbott Laboratories, Biogen Idec, Ceregene, EMD Serono, FoldRx, Impax, Ipsen, Eli Lilly, Lundbeck, Merz, NeuroSearch, Novartis, Orion Health, Prestwick Pharmaceuticals, Schering-Plough, Solvay SA, Teva, UCB Pharma, Pfizer, and the Welding Rod Litigation defendants.&lt;/p&gt;&lt;p&gt;Two co-authors were employees of Medivation.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_390"
                     title="Vegetative State May Still Harbor Consciousness (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/Neurology/GeneralNeurology/tb/18283?impressionId=1265791408659"
                     
      Researchers in England are reporting they have been able to establish limited communication with a man in a persistent vegetative state by using functional magnetic resonance imaging (fMRI).&lt;br&gt;
&lt;br&gt;The 34-year-old man was able to answer simple Yes or No questions by imagining different types of activity, which caused changes in brain activity that could be seen in the machine, according to Martin Monti, PhD, of the Medical Research Council Cognition and Brain Sciences Unit in Cambridge, England, and colleagues.&lt;br&gt;
&lt;br&gt;The finding shows that at least some patients who are otherwise unresponsive may have some residual awareness, the researchers reported online in the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;The incredible thing is that we could never do something like that at the bedside,&quot; Monti told &lt;em&gt;MedPage Today&lt;/em&gt;. Outside of the fMRI machine, he said, the patient remained unresponsive to standard tests.&lt;br&gt;
&lt;br&gt;The study is likely to arouse controversy, Monti conceded, especially in the light of such high-profile cases as that of Terry Schiavo, which eventually went to the U.S. Supreme Court.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;In the Schiavo case, relatives were bitterly divided on whether to withdraw&lt;strong&gt; &lt;/strong&gt;life support for the woman, who had been in a persistent vegetative state for several years.&lt;/p&gt;
&lt;p&gt;&quot;People will have a tendency to overinterpret this,&quot; Monti said, adding &quot;this finding in one patient does not imply that all patients may or may not have the ability to do this.&quot;&lt;/p&gt;
&lt;p&gt;Indeed, the researchers tested 54 people and found only five who could apparently respond to direction by imagining either motor or spatial activity. Imagining those activities uses different parts of the brain and their activation can be seen by the fMRI scan.&lt;/p&gt;
&lt;p&gt;Several of the responders were already what is called &quot;minimally responsive,&quot; meaning that occasionally they were able to react to external stimuli.&lt;/p&gt;
&lt;p&gt;Of those five, the researchers only tried to communicate with one  --  the man in a persistent vegetative state  --  using his ability to reliably activate different brain areas when asked to imagine either playing tennis or looking around a room in his house.&lt;/p&gt;
&lt;p&gt;While in the machine, he was asked simple questions, such whether his father&apos;s name was Alexander. To answer Yes, he was to imagine playing tennis, while for No he was to imagine looking around the room.&lt;/p&gt;
&lt;p&gt;He was able to answer five out of six questions, the researchers reported, adding it was unclear why he was unable to answer the sixth but no brain activity was seen in response to the question.&lt;/p&gt;
&lt;p&gt;Outside experts also cautioned against overinterpreting the results.&lt;/p&gt;
&lt;p&gt;&quot;The percentage of patients showing a response was low, and longer-term follow-up studies are needed to determine whether such fMRI findings by themselves have meaningful predictive value,&quot; argued Alan Faden, MD, of the University of Maryland School of Medicine in Baltimore.&lt;/p&gt;
&lt;p&gt;&quot;This study may well raise questions for some with regard to medical or legal decisions based upon state of consciousness,&quot; Faden said in an e-mail, &quot;but the findings primarily underscore the limitations of current categorizations for diminished states of consciousness.&quot;&lt;/p&gt;
&lt;p&gt;He said that as technology gets better, it will likely mean that doctors will have to modify their diagnostic categories for what he called &quot;states of diminished consciousness.&quot;&lt;/p&gt;
&lt;p&gt;In an accompanying editorial in the journal, Allan Ropper, MD, of Brigham and Women&apos;s Hospital in Boston, wrote that such research is &quot;easily subject to overinterpretation and sensationalism.&quot;&lt;/p&gt;
&lt;p&gt;He cautioned that brain activation was seen only in a few patients and only in those with a traumatic brain injury, rather than global ischemia and anoxia.&lt;/p&gt;
&lt;p&gt;And, he wrote, the brain activity seen in the patients is not evidence of such things as memory, self-awareness, anxiety, or despair. &quot;We cannot be certain whether we are interacting with a sentient, much less a competent, person&quot; Ropper wrote.&lt;/p&gt;
&lt;p&gt;Despite such caveats, the research is &quot;critically important,&quot; according to Michael DeGeorgia, MD, of University Hospitals Case Medical Center in Cleveland.&lt;/p&gt;
&lt;p&gt;It &quot;illustrates both the complexities of this area and the limitations of our bedside clinical examination,&quot; he said in an e-mail, adding that more research will be needed to figure out how to use the technology and how to interpret the results.&lt;/p&gt;
&lt;p&gt;The research &quot;does raise difficult medical and legal questions,&quot; DeGeorgia said.&lt;/p&gt;
&lt;p&gt;&quot;We always need to be upfront and honest with families about what we know for certain and what we do not know for certain,&quot; he said. &quot;In many of these cases, the honest answer is that we cannot be absolutely 100% certain that their loved one isn&apos;t &apos;in there somewhere.&apos;&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from the Medical Research Council, the European Commission, Fonds de la Recherche Scientifique, the James S. McDonnell Foundation, the Mind Science Foundation, the Reine Elisabeth Medical Foundation, the Belgian French-Speaking Community Concerted Research Action, University Hospital of Liege, the University of Liege, and the National Institute for Health Research Biomedical Research Centre.&lt;/p&gt;&lt;p&gt;The researchers said they had no potential conflicts.&lt;/p&gt;&lt;p&gt;Hopper did not report any conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_372"
                     title="Low Serotonin Eyed as Mechanism for SIDS (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Neurology/GeneralNeurology/tb/18262?impressionId=1265791408659"
                     
      Low brainstem levels of serotonin and the enzyme that makes it could underlie sudden infant death syndrome (SIDS), researchers suggested.&lt;br&gt;
&lt;br&gt;In an autopsy study, SIDS cases showed 26% lower serotonin levels in two major components of the medulla&apos;s serotonin system  --  the raph&amp;#233; obscurus (&lt;em&gt;P&lt;/em&gt;=0.05) and paragigantocellularis lateralis (&lt;em&gt;P&lt;/em&gt;=0.04)  --  compared with age-adjusted controls who died from known causes.&lt;br&gt;
&lt;br&gt;These brainstem circuits control breathing, blood pressure, and heart rate during sleep, Hannah C. Kinney, MD, of Children&apos;s Hospital Boston, and colleagues reported in the Feb. 3 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;A baby with an abnormality in control of these systems might not be able to respond to a life-threatening challenge like asphyxia by rousing from sleep or turning its head the researchers explained.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;SIDS occurs in the &quot;critical first year of life, when homeostatic systems are still maturing,&quot; they noted.&lt;/p&gt;
&lt;p&gt;Mary McClain, RN, MS, of Boston University Medical Center, who counsels families that have lost a baby to SIDS, commented that these findings help establish the biological basis for urging parents to place their babies on their backs to sleep.&lt;/p&gt;
&lt;p&gt;The researchers obtained tissue samples from autopsies of 41 children who died from SIDS, seven who died acutely from known causes (including a car accident, drowning, pneumonia, and unsuspected congenital heart disease), and five who died in the hospital with chronic conditions causing hypoxia-ischemia.&lt;/p&gt;
&lt;p&gt;SIDS cases had mean serotonin levels of 31.4 pmol/mg of protein in the paragigantocellularis lateralis, compared with 40.0 pmol/mg among the controls who died acutely (&lt;em&gt;P&lt;/em&gt;=0.04).&lt;/p&gt;
&lt;p&gt;Levels averaged 55.4 versus 75.5 pmol/mg of protein, respectively, in the raph&amp;#233; obscurus (&lt;em&gt;P&lt;/em&gt;=0.05).&lt;/p&gt;
&lt;p&gt;These abnormalities in the medulla did not appear to involve the catecholamine system. Catecholamine levels were similar between SIDS cases and controls.&lt;/p&gt;
&lt;p&gt;Nor was there evidence for excessive degradation of dopamine or neurotransmitter turnover in SIDS cases, supporting the idea that the key abnormality is reduced synthesis of serotonin, the researchers said.&lt;/p&gt;
&lt;p&gt;Another marker of serotonin function  --  tryptophan hydroxylase (TPH2), the key enzyme involved in synthesis of serotonin  --  also supported this conclusion, with 22% lower levels in the raph&amp;#233; obscurus in SIDS than in controls (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;Serotonin receptor binding was 29% to 55% lower in three medullary nuclei that receive serotonin projections, notable for a decrease in binding with older age in SIDS cases, but not controls, the researchers noted.&lt;/p&gt;
&lt;p&gt;Given similar findings in three previous investigations, this &quot;may reflect a progressive decrease with age in those infants with the &apos;SIDS abnormality,&apos;&quot; they wrote. Or it&apos;s possible that those with a &quot;stronger abnormality take longer to outgrow the risk period for SIDS and continue to die at older ages,&quot; Kinney&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;Likewise, serotonin receptor binding in infants who died from SIDS was significantly lower in those without known risk factors for SIDS, such as &lt;a href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/17365&quot; mce_href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/17365&quot; target=&quot;_blank&quot;&gt;sleeping face down&lt;/a&gt;, &quot;suggesting that additional risk factors are necessary to precipitate death when the medullary serotonin system is less compromised,&quot; they added.&lt;/p&gt;
&lt;p&gt;Although repetitive apnea and agonal &lt;a href=&quot;http://www.medpagetoday.com/Pulmonology/SleepDisorders/2817&quot; mce_href=&quot;http://www.medpagetoday.com/Pulmonology/SleepDisorders/2817&quot; target=&quot;_blank&quot;&gt;impaired gasping&lt;/a&gt; before death have been reported in some SIDS cases, chronic impaired oxygenation in the hospitalized children in the study produced a very different serotonin pattern than that seen in SIDS.&lt;/p&gt;
&lt;p&gt;Children who died with chronic hypoxia conditions had 55% higher serotonin levels in the raph&amp;#233; obscurus (&lt;em&gt;P&lt;/em&gt;=0.02) and 126% higher levels in the paragigantocellularis lateralis (&lt;em&gt;P&lt;/em&gt;=0.002) than the SIDS cases.&lt;/p&gt;
&lt;p&gt;They also had 640% higher dopamine levels in the raph&amp;#233; obscurus than the SIDS cases (&lt;em&gt;P&lt;/em&gt;=0.006).&lt;/p&gt;
&lt;p&gt;This suggested &quot;that the primary mechanisms underlying serotonin abnormalities in SIDS are not mediated by chronic hypoxia-ischemia,&quot; Kinney&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that their neurotransmitter measurements may have been off somewhat due to prolonged postmortem intervals.&lt;/p&gt;
&lt;p&gt;They also warned that the study was limited by inability to perform these measurements at the synapse in postmortem tissues and by the small sample of controls.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the First Candle/SIDS Alliance, CJ Martin Overseas Fellowship (National Health and Medical Research Council of Australia), CJ Murphy Foundation for Solving the Puzzle of SIDS, CJ Foundation for SIDS, National Institute of Child Health and Development, and the Developmental Disabilities Research Center at Children&apos;s Hospital Boston.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;McClain provided no information on conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_354"
                     title="AMD Drugs Equally Effective (CME/CE)"
                     score="0.007"
                     href="http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/tb/18238?impressionId=1265791408659"
                     
      Visual acuity showed similar improvements with two vascular endothelial growth factor inhibitors used to treat age-related macular degeneration (AMD), data from a retrospective study showed.&lt;br&gt;
&lt;br&gt;About a fourth of patients treated with bevacizumab (Avastin) or ranibizumab (Lucentis) had &amp;#8805;20/40 vision at 12 months.&lt;br&gt;
&lt;br&gt;The frequency of adverse events did not differ between treatment groups, but bevacizumab patients received fewer injections over the course of a year, investigators at Kaiser Permanente Southern California in Pasadena reported in the February issue of &lt;em&gt;Ophthalmology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;What this article principally does is that it reassures patients and ophthalmologists that bevacizumab appears to be just as effective as ranibizumab,&quot; said first author Donald Fong, MD. &quot;It provides more reassurance than changing practice.&quot;&lt;br&gt;
&lt;br&gt;The results likely will not end discussion about the relative safety and efficacy of the two drugs for treatment of AMD.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Ranibizumab was developed specifically for treatment of neovascular (wet) AMD, while bevacizumab was developed for oncology but is widely used off-label for treatment of AMD.&lt;/p&gt;
&lt;p&gt;Much of the debate over the drugs involves cost, as ranibizumab costs about $2,000 per injection compared with about $50 for bevacizumab.&lt;/p&gt;
&lt;p&gt;The two drugs are being compared in an NIH-sponsored multicenter clinical trial, but results are not expected before 2011.&lt;/p&gt;
&lt;p&gt;In an indirect comparison of the two drugs, Fong and co-authors retrospectively reviewed records of 452 patients treated for exudative AMD with bevacizumab or ranibizumab, both of which inhibit angiogenesis via vascular endothelial growth factor.&lt;/p&gt;
&lt;p&gt;The study population comprised 324 patients treated with bevacizumab and 128 treated with ranibizumab.&lt;/p&gt;
&lt;p&gt;The bevacizumab patients were younger (78 versus 82 on average), and 83% of the ranibizumab patients were 75 or older compared with 70% of the bevacizumab group.&lt;/p&gt;
&lt;p&gt;A higher proportion of bevacizumab patients had baseline visual acuity &amp;#8804;20/200 (40.1% versus 33.6%), but a similar proportion in each group had visual acuity &amp;lt;20/40 (86.4% versus 88.3%).&lt;/p&gt;
&lt;p&gt;The primary outcome of the analysis was visual acuity at 12 months. The authors reported that 22.9% of bevacizumab patients and 25.0% of ranibizumab patients attained visual acuity &amp;#8805;20/40 after a year of treatment.&lt;/p&gt;
&lt;p&gt;Additionally, 27.3% of bevacizumab patients and 20.2% of the ranibizumab group exhibited some degree of improvement at 12 months. Neither difference was statistically significant.&lt;/p&gt;
&lt;p&gt;Eight (2%) bevacizumab patients and four (3%) ranibizumab patients died before 12 months. Two patients in each group developed endophthalmitis.&lt;/p&gt;
&lt;p&gt;Bevacizumab patients received an average of 4.4 injections during 12 months, compared with 6.2 for the ranibizumab group. The authors speculated that the difference might reflect physicians&apos; belief that bevacizumab is a larger molecule with a longer intraocular half-life.&lt;/p&gt;
&lt;p&gt;In summarizing the results, the authors acknowledged the observational, nonrandomized nature of the study, as well as the lack of a standardized protocol for injecting the drugs.&lt;/p&gt;
&lt;p&gt;Moreover, some patients initially on bevacizumab switched to ranibizumab when the newer drug became available and that switch &quot;most likely accounted for some of the changes observed in the bevacizumab group.&quot;&lt;/p&gt;
&lt;p&gt;The authors also addressed differences between their findings and those from two Genentech-sponsored clinical trials.&lt;/p&gt;
&lt;p&gt;The trials showed that 94% of patients treated with ranibizumab did not have doubling of their visual angle versus 85% in the Kaiser chart review. The authors attributed the difference to the older age of their patients, the exclusion of patients with visual &amp;lt;20/320 in the Genentech studies, and the fewer ranibizumab injections (6.2 versus &amp;gt;11 in the Genentech studies).&lt;/p&gt;
&lt;p&gt;Despite the differences and limitations, the authors concluded that &quot;both treatments seem to be effective in stabilizing visual acuity loss.&quot;&lt;/p&gt;
&lt;p&gt;In a prepared statement, Genentech officials said they still believe ranibizumab &quot;is the most appropriate medicine for people with wet age-related macular degeneration because it was specifically designed, formally studied, manufactured for intraocular delivery, and is approved by the FDA.&lt;/p&gt;
&lt;p&gt;At the same time, Genentech does not interfere with doctors&apos; prescribing choices and believes that they should be able to prescribe the treatment they believe is most appropriate for their patients.&quot;&lt;/p&gt;
&lt;p&gt;In addition to limitations acknowledged by the authors, the statement also pointed out that the method for measuring visual acuity differed from the method used in most phase III clinical trials and that methods used to collect safety data differed from those typically used in prospective, randomized clinical trials.&lt;/p&gt;
&lt;p&gt;Genentech also questioned the lack of explanation for the higher proportion of patients who switched from bevacizumab to ranibizumab compared with ranibizumab to bevacizumab (23% versus 3%).&lt;/p&gt;
&lt;p&gt;A clinical spokesperson for the American Academy of Ophthalmology told &lt;em&gt;MedPage Today&lt;/em&gt; that the results of the Kaiser study tend to support ophthalmologists&apos; views about use of the two drugs to treat AMD.&lt;/p&gt;
&lt;p&gt;&quot;It looks like all the debate about the superiority or inferiority of one medicine over the other medicine is becoming essentially nullified,&quot; said Abdhish Bhavsar, MD, director of clinical research at the Retina Center of Minnesota in Minneapolis.&lt;/p&gt;
&lt;p&gt;&quot;I think that these medicines both do a good job at treating, and I don&apos;t think that distinction in clinical practice is relevant anymore.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Southern California Permanente Medical Group.&lt;/p&gt;&lt;p&gt;Co-author Peter Custis disclosed a relationship with Med E Direct.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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