Annals of Internal Medicine tip sheet for Nov. 6, 2007

1. American College of Physicians Issues Comprehensive Guidelines for Diagnosis and Treatment of Stable Chronic Obstructive Pulmonary Disease

Long-acting inhaled therapies, supplemental oxygen, and pulmonary rehab are beneficial.

(Clinical Guidelines, p. 633. Background paper, p. 639. Separate news release is issued.)

2. Nutrient Reduces Need for Steroids in Those with Stubborn Ulcerative Colitis

Ulcerative colitis, a disease that causes inflammation and ulcers in the lining of the rectum and colon, is often treated with corticosteroids. Since long-term steroid use carries dangerous side effects, immunosuppressant drugs are often substituted, but these too can have dangerous side effects. When immunosuppressant therapy fails, there are few good options for treatment. In a new, 12-week study of 60 adults with steroid-resistant ulcerative colitis, 80 percent of patients given a slow-release version of phosphatidylcholine (a nutrient or essential fatty acid) were able to stop steroid therapy and improved clinically (Article, p. 603). Only 10 percent of those who received a placebo were able to quit steroids and improved clinically.

3. Antipsychotic Drug Reduces Persistent Depression

Although standard initial drug therapy is very effective in treating depression, some patients do not get better and require additional treatment. The atypical antipsychotic drug risperidone, when added to standard antidepressants, improved symptoms of long-term depression more often than placebo, according to a new six-week study (Article, p. 593). Researchers randomly assigned 274 adults with major depressive disorder that was not responding to standard antidepressant therapy to a group that received risperidone or to a group that received a placebo. Both groups continued to take their other antidepressant medications.

4. Study Finds ACE Inhibitors and ARBs Both Control Blood Pressure

Drugs that interfere with the renin-angiotensin system are effective. Two classes of drugs exist. One reduces the synthesis of angiotensin. The other blocks its effect on the body. A systematic review of randomized trials comparing angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) found that they had similar effects on blood pressure control and equivalent effects on death and cardiovascular events, major adverse events, and quality of life.

Note: This article is released early online at the Web site of Annals of Internal Medicine www.annals.org. It will appear in the Jan. 1, 2008, print edition of the journal.

5. ACE Inhibitors and ARBs Both Reduce Proteinuria; Together They’re More Effective Than Either Alone.

A meta-analysis of data on the effectiveness of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on proteinuria found that both reduce excess urinary protein excretion. The combination of the two is more effective than either drug alone. Proteinuria is a condition in which urine contains an abnormal amount of protein. Proteinuria is an early sign of kidney disease and accelerates the loss of kidney function in patients with kidney disease.

Note: This article is released early online at the Web site of Annals of Internal Medicine www.annals.org. It will appear in the Jan. 1, 2008, print edition of the journal.

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