Disaster

Lenient Afib rate control is fine

From the great Hospital Medicine Quick Hits blog:

This was in NEJM this week--I like the concept of "lenient" atrial fibrillation control as easier to achieve and no worse for patients than strict control of heart rate.  Looks like 110 is the new speed limit in atrial fibrillation.

Cool name of the day: Harley Benz

It's funny how the news cycle can turn regular people just doing their jobs into overnight celebrities.

The Chile quake, obviously, is a huge catastrophe, and it will be days before we fully understand the magnitude of the damage.  As a resident of a quake-prone part of the world, I commiserate with residents near Santiago.

FDA, public comments, and REMS programs

I have long maintained that the FDA REMS programs mainly serve the purpose of big drug companies looking to avoid class-action litigation, while they limit access to drugs and create additional administrative tasks for clinicians.

Perhaps Bill Gates could have saved King Tut

Here's a full reprint of a JAMA press release I just got detailing what killed King Tut. DNA analysis suggests that malaria might have brought down the mighty pharaoh at only 19 years of age.

CHICAGO – Using several scientific methods, including analyzing DNA from royal mummies, research findings suggest that malaria and bone abnormalities appear to have contributed to the death of Egyptian pharaoh King Tutankhamun, with other results appearing to identify members of the royal family, including King Tut’s father and mother, according to a study in the February 17 issue of JAMA.

FYI: FDA just changed warfarin label--again!

The changes in 2007 suggesting pharmacogenomic testing didn't go far enough, evidently, so now, with pretty minimal evidence, FDA has gone ahead and upped the ante with specific recommendations for starting doses depending on the VKORC polymorphism profile. They cite "multiple studies" to justify a dosing table (!), which is news to me.

FDA pulls psoriasis drug from shelves today

There weren't many patients on the drug but a skittish FDA pulled Raptiva from the market today over concerns of PML the rare brain infection. Three patients died of the brain infection this year alone and given the alternatives in the market and the (usually) non life-threatening course of psoriasis the decision seems justified. The drug recognizes CD11a and is a monoclonal antibody.

Gleevec gets post-op prevention indication for GIST

Gastrointestinal stromal tumor (GIST) is a critical cancer of the gastrointestinal tract. It is also known as soft tissue sarcomas. The prevalence of GIST is likely to be 4 500 - 6 000 new cases per year in the US. Surgery is the normal treatment of local GIST. GIST tumors more often recurs in as many as one of two patients after its initial removal. Repeated GISTs are frequently more persistent than primary tumors with relapses related with lower survival rates. Gleevec is the lone treatment recognized to delay the recurrence of this aggressive cancer.

Long-term eltrombopag results released look promising

Eltrombopag is a targeted platelet growth factor recently approved by the FDA for the treatment of patients with low platelets of unknown etiology. It is a thrombopoietin receptor agonist that has been revealed in pre-clinical research and early phase clinical trials to inspire the propagation and differentiation of platelet precursor stem cells in the bone marrow.

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