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Bulletin Today

Need for more patient–provider dialogue as deprescribing medicine for older adults catches on

Findings from the University of Michigan National Poll on Healthy Aging suggest that older adults are supportive of the idea of deprescribing medications.

The survey found that 82% of adults ages 50 to 80 years old would be willing to stop taking one or more of the prescription medicines they have been using for more than a year if a health care provider said it was feasible.

The survey also revealed that 26% of respondents have already done so in the past 2 years.

“Deprescribing, which can include prescription medications, over-the-counter medications, and dietary supplements, should be based on dialogue between patients and providers, and sometimes family members,” said Sarah Vordenberg, PharmD, MPH, a University of Michigan College of Pharmacy clinical associate professor who worked on the poll, in a statement.

More than a third of the older adults who said they stopped taking a prescription medication that they had been using for more than a year said they did so without consulting a health professional. The poll also found that 82% of people 50 to 80 years old take at least one prescription medicine regularly; of those 28% said they believe they take too many medications.

More than one-half of respondents said they take three or more prescription medications; 11% said they take three or more OTC medicines regularly; and 38% take three or more vitamins, minerals, or supplements.

The survey also indicated that more people should use a comprehensive medication review by a pharmacist or other provider—a benefit offered by Medicare and other insurance.

“While we found that over 90% of older adults who take at least one prescription medicine expect their provider to review their list of medicines at least annually, research has shown this is often not the case,” Vordenberg said. ■


FDA approves RSV vaccine for older adults

FDA approved GSK’s respiratory syncytial virus (RSV) vaccine (Arexvy) for adults aged 60 years and older.

GSK anticipates the vaccine will be available in pharmacies, clinics, and other health care sites this fall. GSK has not yet released a price, but insurance companies usually pay for much of the cost of many vaccines.

A recent study published in NEJM found that GSK’s vaccine was nearly 83% effective in preventing lower respiratory tract illness in adults ages 60 years and older.

In March 2023, an FDA advisory panel reviewed data from trials for two RSV vaccines designed for older adults: one developed by GSK and another by Pfizer. The panel advised FDA to approve both vaccines.

According to data provided to the FDA panel, two individuals in the trial who received the Pfizer vaccine and one individual who received the GSK vaccine developed Guillain-Barré syndrome 2 days after the vaccines were administered.

RSV causes roughly 6,000 to 10,000 deaths annually in adults ages 65 years and older and at least 60,000 annual hospitalizations in that age group. It is also a leading cause of death among children globally. ■


Most children recover from Lyme disease within 6 months of treatment, says study

New findings from researchers at the National Institute of Allergy and Infectious Disease (NIAID) conclude that most children with Lyme disease recovered from their symptoms within 6 months.

The findings, which were based on survey responses from the parents of 102 children ages 5 to 18 years, revealed that 75% of children fully recovered within 6 months of completing antibiotic treatment: 31% of all children recovered within 1 month; 30% recovered in 1 to 3 months; and 14% recovered in 4 to 6 months.

Approximately 22% of children in the study experienced at least one symptom that persisted 6 or more months after completing treatment. Of those, 9% had symptoms classified as post-treatment Lyme disease (PTLD) syndrome. Six percent of the children were not fully recovered at the time of the survey, with 1% experiencing symptoms significant enough to impair daily functioning, the authors noted.

The children had all been diagnosed with Lyme disease between 6 months and 10 years before enrollment. Adolescents ages 10 to 18 years old were also invited to complete adolescent-specific questionnaires.

Antibiotic treatment resulting in full recovery is successful in most Lyme cases.

Common symptoms of Lyme disease include fever, headache, fatigue, and a distinct skin rash called erythema migrans. Without treatment, the infection can spread to joints, the heart, and the nervous system.

For some, however, symptoms of pain, fatigue, or difficulty thinking persist or return after antibiotic treatment. Symptoms that substantially reduce levels of activity and impact quality of life for more than 6 months after treatment are classified as PTLD syndrome.

According to the researchers, who were from NIAID and the Children’s National Research Institute, the study supports previous data showing an excellent overall prognosis for children with Lyme disease, which should help alleviate understandable parental and guardian stress associated with lingering nonspecific symptoms among infected children.

The research team also suggested these new data could help reduce the potential for families seeking dangerous alternative therapies for children who experience prolonged recovery times. PTLD syndrome remains poorly understood in children and adults, and more research is needed to better recognize these prolonged symptoms and identify treatment targets, according to the authors. ■


DEA announces extension for telemedicine prescribing of certain drugs

DEA has said that for now it is extending emergency telehealth policies set during the COVID-19 pandemic, enabling certain health care providers to have greater leeway in prescribing some controlled substances.

The DEA decision affects buprenorphine for opioid addiction and stimulants such as amphetamine/dextroamphetamine (Adderall—Teva Pharmaceutics) used to treat ADHD.

“We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards,” said DEA administrator Anne Milgram.

Because of DEA’s extension of the policies, health care providers may write buprenorphine prescriptions to patients after evaluating them via phone or video. DEA also introduced new policies for buprenorphine that would require patients to visit their prescriber for an in-person exam within 30 days, and patients who began buprenorphine treatment under emergency rules would have a 180-day grace period before they would need to visit their provider in person. ■


Daily statin reduces CVD risk for those living with HIV

Among people living with HIV, a daily statin medication reduced the risk of CVD, according to results from a large NIH study.

The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study—the first large-scale clinical trial to test a primary cardiovascular prevention strategy in this population—found that participants who took pitavastatin calcium (a daily statin) lowered their risk of major adverse cardiovascular events by 35% compared to those taking a placebo. The trial was stopped early because of adequate evidence for efficacy.

Adverse drug events observed in the study were like those for the general population taking statin therapy.

“The REPRIEVE study reflects the evolution of HIV science, and progress from focusing mostly on approaches to treat and control the virus to finding ways to improve the overall health of people living with HIV,” said Hugh Auchincloss, MD, acting director for the National Institute of Allergy and Infectious Diseases, in a press statement.

Decades of research and advances in HIV treatment have drastically reduced AIDS-related complications and deaths. As people with HIV live longer, premature heart disease and other chronic conditions have emerged as leading causes of morbidity and mortality, contributing to persistent gaps in lifespan between people with HIV and the broader population.

In 2015, a total of 7,769 volunteers entered the clinical trial. Participants were 40 to 75 years old and more than 30% were women. They were all taking antiretroviral therapy, with CD4+ cell counts greater than 100 cells/mm3 and had low-to-moderate traditional CVD risk that would not typically be considered for statin treatment. The trial was conducted in 12 countries in Asia, Europe, North America, South America, and Africa. ■


CDC finds alarming trends in STIs, especially rise in syphilis cases

A new CDC report found that recorded cases of sexually transmitted infections (STIs) in U.S. patients continued to increase between 2020 and 2021.

While gonorrhea rates increased more than 4%, syphilis rates jumped by nearly 32% for all stages of the infection, with a total of 176,713 syphilis cases recorded in 2021. The last time cases were nearly this high was in 1950, when 217,558 cases were reported.

The report also found that cases of congenital syphilis, which happens when a baby is born with the infection after the mother passed it on during pregnancy, rose by 32%—from 2,148 to more than 2,800—with 220 stillbirths and infant deaths as a result.

Chlamydia rates increased nearly 4%, but—unlike gonorrhea and syphilis—still did not return to pre-pandemic levels. CDC said this raises concerns that screening continued to be affected by disruptions from COVID-19 during the second year of the pandemic.

CDC noted that while STIs are common in all groups and regions nationwide, some communities are particularly affected, such as bisexual and gay men and younger people. A disproportionate number of cases were diagnosed among American Indian/Alaska Native and Black/African American communities.

The report calls for expanded efforts with ubiquitous STI testing and treatment programs and in developing and approving more point-of-care rapid tests and self-tests as well as taking steps to advance scientific research in areas such as vaccines and post-exposure prophylaxis.

“For the first time in decades, we’re seeing promising new STI interventions on the horizon, but these alone will not solve this epidemic. It will take many of us working together to effectively use new and existing tools, to increase access to quality sexual health care services for more people, and to encourage ongoing innovation and prioritization of STI prevention and treatment in this country,” said Leandro Mena, MD, MPH, director of CDC’s division of STD prevention, in a CDC news release. ■


Study finds COVID-19 may increase risk of type 2 diabetes

Researchers recently reported that individuals infected with COVID-19 were significantly more likely to be diagnosed with type 2 diabetes within 1 year of their infection compared with those who had not been exposed to the virus. They also found that men were more likely than women to develop diabetes.

Additionally, those admitted to intensive care with COVID-19 were more than three times as likely to develop diabetes, according to the study findings.

The study, published on April 18, 2023, in JAMA Network Open, used a large data set from British Columbia to compare diabetes diagnoses among more than 125,000 individuals who had tested positive for COVID-19 in 2020 and 2021 with those of more than 500,000 unexposed individuals during the same period.

More than a dozen studies have examined the link between COVID-19 and diabetes, and a majority have reported an increase in diagnosis following infection as well as higher risks for men and those with severe disease. ■



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