As billionaires race to fund anti-aging projects, a much-discussed trial goes overlooked

“[Nir] Barzilai, the head of the Institute for Aging Research at the Albert Einstein College of Medicine, and scientific director for AFAR — the American Federation for Aging Research — has for more than a decade been leading the charge to test the idea of using drugs to extend human healthspan. In 2013, he and two other researchers got a grant from the National Institutes of Aging to develop a roadmap to conduct, for the first time in history, a clinical trial that targets aging. They planned to test metformin, a drug that had been approved in the ’90s for … Read More

The Quest by Circadian Medicine to Make the Most of Our Body Clocks

Excerpt – In the early 2000s, advances in the ability to detect the activity of genes in various tissues revealed that the cell clocks are organized into separate organ-level clocks representing every physiological system: There’s a skin clock and a liver clock and an immune-system clock; there’s a clock for the kidney, heart, lungs, muscles and reproductive system. Each of those clocks syncs itself to the central clock in the brain like an orchestra section following its conductor. But those sections also adjust how and when they perform based on guidance they receive both from the environment and from one … Read More

Intravenous Fluids—A Test Case for Learning Health Systems

“Explanatory trials evaluating the efficacy and safety of adding a new drug or device to current clinical care (A vs A-plus) are traditionally powered to detect the smallest difference in clinical outcomes that would justify incorporating the new treatment into care, considering its added risks, costs, and burdens. For example, the median minimal clinically important difference in mortality targeted by acute care trials has been approximately 8%, implying that smaller differences in mortality might not justify incorporation of the new treatments into care. These types of trials ask, “is this new treatment better than current care by enough to offset … Read More

Dr. Venture Capital: Insurance companies are supposed to cover high-quality care for patients. What happens when they dabble in investing?

“The insurance companies [Cigna and Kaiser Permanente] provided Ginger with access to millions of potential users. After its financial investments in Ginger, Cigna began offering no-cost access to Ginger’s behavioral health services in order to improve customers’ overall health and well-being, according to leadership from both organizations. Yes, it is possible that those customers will benefit from the platform. But given that Ginger’s valuation grew in multiples around the same time—at least in part because of the massive influx of customers from Cigna and Kaiser—it’s reasonable to suggest that the insurance company was double dipping. By sending its customers to … Read More

Testing for Primary Aldosteronism and Mineralocorticoid Receptor Antagonist Use Among U.S. Veterans: A Retrospective Cohort Study

“Hypertension affects 46% of the adult population in the United States and is a leading risk factor for disability, cardiovascular morbidity, and mortality. Although treatment reduces morbidity and mortality, approximately 17% to 20% of patients using antihypertensive medications have apparent treatment-resistant hypertension, defined as inadequately controlled blood pressure (BP) with 3 antihypertensive medications, including a diuretic, or a requirement for at least 4 antihypertensive medications to achieve adequate control. Compared with patients who require fewer antihypertensive agents, those with apparent treatment-resistant hypertension are at increased risk for cardiovascular and all-cause mortality, independent of BP control. High-quality evidence supports the use … Read More

Post-Transcriptional Genetic Silencing of BCL11A to Treat Sickle Cell Disease

“The standard curative treatment for sickle cell disease is allogeneic hematopoietic stem-cell transplantation. Matched sibling donor transplantation is curative in more than 90% of patients, but limitations include a higher risk of complications in older patients, a risk of severe graft-versus-host disease (GVHD), and lack of an available matched sibling in approximately 80% of cases. [..] In utero and during infancy, the abnormal HbS protein is produced at very low levels because the erythrocytes have not yet shifted from expression of the γ-globin gene (HBG), which encodes the developmentally regulated component of HbF, to expression of the HBB gene, a … Read More

Possible Consequences of the Approval of a Disease-Modifying Therapy for Alzheimer Disease

“While the aducanumab clinical trial data are complicated and the path to approval far from clear, approval is certainly possible, and other promising antibodies (such as Biogen’s BAN-2401 and Genentech’s gantenerumab) are just steps behind. Thus, the long-awaited advent of disease-modifying therapy for AD [Alzheimer disease] may be soon upon us, representing a major advance in the battle against AD and a beacon of much-needed hope for patients. [..] The approval of aducanumab or any disease-modifying therapy for AD likely will result in a considerable immediate demand for capacity to provide formal diagnoses of AD dementia, including cognitive and AD … Read More

Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials

“[Methods] we searched MEDLINE and Embase for articles published between March 1, 2015, and Aug 14, 2020, without any language restrictions. We included randomised controlled trials of cardiovascular outcomes of an LDL cholesterol-lowering drug recommended by the 2018 American College of Cardiology and American Heart Association guidelines, with a median follow-up of at least 2 years and data on older patients (aged ≥75 years). [..] [Findings] Data from six articles were included in the systematic review and meta-analysis, which included 24 trials from the Cholesterol Treatment Trialists’ Collaboration meta-analysis plus five individual trials. Among 244,090 patients from 29 trials, 21,492 … Read More

Screening and Intervention to Prevent Falls and Fractures in Older People

“We assessed the clinical effectiveness and cost-effectiveness of a brief falls-risk screening questionnaire, sent by mail, followed by an exercise program or a multifactorial intervention targeted to persons at increased risk for falls, as compared with no screening in community-dwelling older people. All participants received advice by mail. [Methods] [..] This was a three-group, pragmatic, cluster-randomized, controlled trial with parallel economic evaluation that included 63 general practices in seven rural and urban regions in England. Drawing from their patient registries, general practices contacted community-dwelling persons 70 years of age or older who were living in their own homes. Residents of … Read More

World Health Organization Guidelines on Treatment of Hepatitis C Virus Infection: Best Practice Advice From the American College of Physicians

“The World Health Organization (WHO) updated its evidence-based guideline on chronic HCV infection in July 2018. [..] We discuss implications of the WHO recommendations for clinicians and patients in the United States. The WHO recommends offering treatment to all persons older than 12 years who have chronic HCV infection, and it notes 3 major considerations for this “treat all” strategy: the effectiveness and safety of direct-acting antiviral agents (DAAs), the emergence of pangenotypic drug regimens, and reduction in the cost of treatment. In current treatment regimens, combination therapy with oral DAAs has replaced interferon and ribavirin. The WHO recommends pangenotypic … Read More