JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, April 3, 2007)
JAMA NEWS RELEASES
STUDY SUGGESTS SOME DRUG RESISTANCE TO INFLUENZA B MEDICATIONS
COMBINATION TREATMENT FOR MIGRAINE MORE EFFECTIVE THAN SINGLE MEDICATIONS
TIMING OF START OF HORMONE THERAPY MAY HAVE EFFECT ON RISK OF CORONARY HEART DISEASE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
ESTROGEN-ONLY HORMONE THERAPY SAFE FOR WOMEN’S HEART HEALTH WITHIN TEN YEARS OF ONSET OF MENOPAUSE
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Embargoed for Release: 3:00 p.m. CT, Tuesday, April 3, 2007
Media Advisory: To contact corresponding author Yoshihiro Kawaoka, D.V.M., Ph.D., call Terry Devitt at 608-262-8282. To contact editorial co-author Anne Moscona, M.D., call Leslie Greenberg at 212-821-0566.
STUDY SUGGESTS SOME DRUG RESISTANCE TO INFLUENZA B MEDICATIONS
CHICAGO—Use of certain common antiviral drugs during a recent influenza B epidemic in Japan showed the development of viruses with partial resistance to the drugs, according to a study in the April 4 issue of JAMA.
Two antiviral drugs, zanamivir and oseltamivir, which are a type of drugs known as neuraminidase inhibitors, have been effective against influenza and are used extensively. There has been documented evidence of the emergence of oseltamivir-resistant type A viruses, but similar information on influenza B viruses has been limited. Influenza B viruses are associated with annual outbreaks of illness and increased death rates worldwide, according to background information in the article.
Shuji Hatakeyama, M.D., Ph.D., of the University of Tokyo, Japan, and colleagues examined the prevalence and transmissibility of influenza B viruses with reduced sensitivity to neuraminidase inhibitors in Japan, where zanamivir and oseltamivir are now used more extensively than anywhere else in the world. In the winter of 2004-2005, an influenza B virus caused a widespread epidemic in Japan, creating an opportunity to assess the effectiveness of neuraminidase inhibitors. The researchers collected influenza B isolates from 74 children before and after oseltamivir therapy and from 348 untreated patients with influenza (including 66 adults). Four hundred twenty-two viruses from untreated patients and 74 samples from patients after oseltamivir therapy were analyzed.
The researchers identified a variant with reduced drug sensitivity in one (1.4 percent) of the 74 children who had received oseltamivir, and seven (1.7 percent) of the 422 influenza B viruses isolated from untreated patients were found to have reduced sensitivity to zanamivir, oseltamivir, or both. Review of the clinical and viral genetic information available on these seven patients indicated that four were likely infected in a community setting, while the remaining three were probably infected through contact with siblings shedding the mutant viruses.
“Continued surveillance for the emergence or spread of neuraminidase inhibitor–resistant influenza viruses is critically important,” the authors write. “Further evaluation of the biological properties of neuraminidase inhibitor–resistant influenza viruses is needed to fully assess their pathogenicity in humans.”
(JAMA. 2007;297:1435-1442. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: NEWS ABOUT INFLUENZA B DRUG RESISTANCE THAT CANNOT BE IGNORED
In an accompanying editorial, Anne Moscona, M.D., of Weill Medical College of Cornell University, New York, and Jennifer McKimm-Breschkin, Ph.D., of Molecular and Health Technologies, Parkville, South Victoria, Australia, comment on the findings concerning possible drug resistance to influenza B medications.
“The report by Hatakeyama et al raises more questions than it answers, including questions about viral evolution, biological fitness, and transmissibility. But some facts are strikingly clear. Influenza B mutants with reduced sensitivity to neuraminidase inhibitors are circulating, and these viruses can cause infections with no difference in duration of symptoms, level of viral shedding, or clinical outcome. Contrary to what had been hoped until now, some resistant variants are vigorous pathogens. Whether these viruses arise by spontaneous mutation or through drug selection, or whether they are transmitted within families or acquired from the community, the resistant variants may be here to stay. In light of the recent observation that oseltamivir may be less effective against influenza B than against influenza A, an important concern is whether suboptimal dosing for these viruses will lead to increased selection of viruses with high-level resistance.”
“Influenza viruses evolve rapidly and nimbly, which compels ongoing investigation of antiviral therapies that use alternative mechanisms of action and target different points in the viral life cycle. The emergence of drug-resistant influenza B should draw attention to the importance of continual monitoring of strains over time and to the need for frequent rethinking of policies for use of antiviral drugs. While the news about resistance is not good and certainly calls into question some of the current assumptions about drug-resistant viruses, an effective response to this news can help contend with the new challenges of influenza.”
(JAMA. 2007;297:1492-1494. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the editorial for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, April 3, 2007
Media Advisory: To contact Jan Lewis Brandes, M.D., call 615-284-4682.
COMBINATION TREATMENT FOR MIGRAINE MORE EFFECTIVE THAN SINGLE MEDICATIONS
CHICAGO—Combining two different types of treatment for migraine results in better symptom relief than taking either one of the medications, according to a study in the April 4 issue of JAMA.
“Migraine is a prevalent, often debilitating disease manifested by attacks of bilateral or unilateral headache and associated symptoms, such as nausea, vomiting, and sensitivity to light and sound,” according to background information in the article. While advances have been made in treatment, results are still often unsatisfactory for many patients. None of the currently available medications taken alone provide broad coverage of the multiple pathogenic processes in migraine, which is thought to involve multiple neural pathways. A multimechanism-targeted therapy may confer advantages over a single therapy.
Jan Lewis Brandes, M.D., of the Nashville Neuroscience Group, Nashville, Tenn., and colleagues evaluated the effectiveness and safety of treating migraine by combining the migraine medications sumatriptan (in the class of drugs known as triptans) and naproxen sodium (a nonsteroidal anti-inflammatory drug; NSAID) compared with placebo and single therapy with either of the drugs. The research consisted of two identical, randomized, double-blind studies conducted among 1,461 (study 1) and 1,495 (study 2) patients at 118 U.S. clinical centers who were diagnosed as having migraine and received study treatment for a moderate or severe migraine attack. Patients were randomized to receive a single tablet containing both sumatriptan, 85 mg, and naproxen sodium, 500 mg; sumatriptan, 85 mg (monotherapy); naproxen sodium, 500 mg (monotherapy); or placebo, to be used after onset of a migraine with moderate to severe pain.
The researchers found that sumatriptan–naproxen sodium was more effective than placebo for headache relief at two hours after dosing (study 1, 65 percent vs. 28 percent; and study 2, 57 percent vs. 29 percent;), absence of photophobia (sensitivity to light) at two hours (58 percent vs. 26 percent; and 50 percent vs. 32 percent;), and absence of phonophobia (sensitivity to sound) at two hours (61 percent vs. 38 percent; and 56 percent vs. 34 percent). The absence of nausea two hours after dosing was higher with sumatriptan–naproxen sodium than placebo in study 1, but in study 2 rates of absence of nausea did not differ between sumatriptan–naproxen sodium and placebo. For 2- to 24-hour sustained pain-free response, sumatriptan–naproxen sodium was superior to sumatriptan monotherapy, naproxen sodium monotherapy and placebo. The incidence of adverse events was similar between sumatriptan–naproxen sodium and sumatriptan monotherapy.
“The superior efficacy of sumatriptan–naproxen sodium compared with sumatriptan monotherapy might be explained by its targeting of multiple pathogenic mechanisms in migraine,” the authors write.
(JAMA. 2007;297:1443-1454. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, April 3, 2007
Media Advisory: To contact Jacques E. Rossouw, M.D., call the NHLBI Communications Office at 301-496-4236.
TIMING OF START OF HORMONE THERAPY MAY HAVE EFFECT ON RISK OF CORONARY HEART DISEASE
CHICAGO—Women who initiate hormone therapy closer to menopause tend to have a reduced risk of coronary heart disease compared to women who begin treatment further from menopause, but researchers did not find this reduced risk was statistically significant, according to a study in the April 4 issue of JAMA.
Studies examining the effects of the use of postmenopausal hormone therapy on coronary heart disease (CHD) have yielded mixed results, depending on the type of study conducted. There may be a number of reasons for the differences, including the timing of initiation of hormone therapy, according to background information in the article.
Jacques E. Rossouw, M.D., of the National Heart, Lung, and Blood Institute, Bethesda, Md., and colleagues conducted a secondary analysis of data from the Women’s Health Initiative (WHI) trial to determine whether the effects of hormone therapy on risk of cardiovascular disease varied by age or years since menopause began. The WHI trial included 10,739 postmenopausal women who had undergone a hysterectomy who were randomized to conjugated equine estrogens (CEE) or placebo and 16,608 postmenopausal women who had not had a hysterectomy who were randomized to CEE plus medroxyprogesterone acetate (CEE + MPA) or placebo. Women age 50 to 79 years were recruited to the study from 40 U.S. clinical centers between September 1993 and October 1998.
“Although not statistically significant, these secondary analyses suggest that the effect of hormones on CHD may be modified by years since menopause and by the presence of vasomotor symptoms [such as hot flashes or night sweats], with higher risks in women who were 20 or more years since menopause (or aged 70 years or greater). Coronary heart disease tended to be nonsignificantly reduced by hormone therapy in younger women or women with less than 10 years since menopause, and the risk of total mortality was reduced in women aged 50 to 59 years,” the authors write.
“We did not have adequate statistical power to assess outcomes in the women aged 50 to 54 years or less than 5 years since menopause. As previously reported, CEE appeared to be associated with lower risk of CHD than CEE + MPA. Importantly, the risk of stroke was not influenced by years since menopause, the presence of vasomotor symptoms, or drug regimen, although there was no increased risk of stroke in women aged 50 to 59 years.”
“The absence of excess absolute risk of CHD and the suggestion of reduced total mortality in younger women offers some reassurance that hormones remain a reasonable option for the short-term treatment of menopausal symptoms, but does not necessarily imply an absence of harm over prolonged periods of hormone use. In contrast, risk of stroke did not depend on years since menopause or the presence of vasomotor symptoms. The findings are consistent with current recommendations that hormone therapy be used in the short-term for relief of moderate or severe vasomotor symptoms, but not in the longer term for prevention of cardiovascular disease,” the authors conclude.
(JAMA. 2007;297:1465-1477. Available to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
ESTROGEN-ONLY HORMONE THERAPY SAFE FOR WOMEN’S HEART HEALTH WITHIN TEN YEARS OF ONSET OF MENOPAUSE
INTRO:
Women who suffer from hot flashes and night sweats during menopause may want to seek relief through hormone therapy, but may worry about the health risks associated with hormones. A new study says estrogen therapy is largely safe for women’s heart health within ten years of the onset of menopause, but not after that. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Gerrye in exam room talking with clinician
Pharmacy tech putting estrogen pills in packets
Close-up pills
AUDIO:
ABOUT TEN YEARS AGO, WHEN GERRYE (JERRY) BOGGS WAS JUST BEGINNING MENOPAUSE, SHE JOINED THE WOMEN’S HEALTH INITIATIVE STUDY AND RESEARCHERS ASKED HER IF SHE’D TAKE HORMONES. SHE SAID “SURE.”
VIDEO:
SOT/FULL
@ :11
Super: Gerrye Boggs
Hormone study participant
Runs :07
AUDIO:
“We all thought that there was a benefit to taking the hormone was that it would protect our heart.”
VIDEO:
B-ROLL
Researchers talking in hallway
Cutaway Dr. Rossouw
Older women walking outside
Other older women walking outside
GFX/JAMA COVER
AUDIO:
RESEARCHERS SOON FOUND OUT THAT WAS NOT TRUE. BUT THEY CONTINUED TO STUDY THE WOMEN’S HEALTH INITIATIVE DATA TO SEE IF SOME WOMEN COULD TAKE HORMONE THERAPY WITHOUT INCREASING THEIR RISK OF HEART DISEASE. THE FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@:33
Super: Jacques Rossouw, M.D.
National Heart, Lung and Blood Institute
Runs :15
AUDIO:
“These findings are somewhat reassuring to younger women who want to use hormone therapy for relief of severe hot flashes and night sweats because of no increased risk of coronary heart disease and a trend toward a reduced risk of total mortality.”
VIDEO:
B-ROLL
Dr. Rossouw walking up stairs, into building
National Institutes of Health exterior/sign
Older women walking outside
AUDIO:
DR. JACQUES ROSSOUW (ROSS-oh) AND COLLEAGUES AT THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE, PART OF THE NATIONAL INSTITUTES OF HEALTH, FOUND THAT OLDER WOMEN WHO STILL HAD MENOPAUSAL SYMPTOMS AFTER TEN YEARS HAD THE GREATEST RISK OF HEART DISEASE.
VIDEO:
SOT/FULL
Jacques Rossouw, M.D.
National Heart, Lung and Blood Institute
Runs :11
AUDIO:
“There is something about hot flashes and night sweats at an older age which are linked to higher risk and this risk is then further increased if those women take hormone therapy.”
VIDEO:
B-ROLL
“Younger” women (early 50s)
Pharmacy tech counting out estrogen-only pills
AUDIO:
BUT FOR WOMEN CLOSER TO THE ONSET OF MENOPAUSE WHO SUFFER FROM THOSE SYMPTOMS, THE STUDY HAS GOOD NEWS, PARTICULARLY IF WOMEN TAKE ESTROGEN ONLY, NOT ESTROGEN PLUS PROGESTIN.
VIDEO:
SOT/FULL
Jacques Rossouw, M.D.
National Heart, Lung and Blood Institute
Runs :13
AUDIO:
“We found that estrogen plus progestin is worse for your heart health than estrogen only. For stroke, it didn’t matter. Both estrogen plus progestin and estrogen only increased the risk of stroke.”
VIDEO:
B-ROLL
Gerrye having blood pressure checked
Woman having mammogram
Gynecologist performing exam
Gerrye backtimed into bite
AUDIO:
YES, THERE IS STILL AN INCREASED RISK OF STROKE EVEN IN YOUNGER WOMEN, AND OF BREAST CANCER, SO WOMEN ON HORMONES SHOULD BE SURE TO GET THEIR BLOOD PRESSURE CHECKED, AND HAVE REGULAR MAMMOGRAMS. WOMEN WHO HAVE A UTERUS SHOULD NOT TAKE ESTROGEN ALONE BECAUSE OF AN INCREASED RISK OF UTERINE CANCER. GERI SAYS THE MORE INFORMATION, THE BETTER.
VIDEO:
SOT/FULL
Gerrye Boggs
Hormone study participant
Runs :10
AUDIO:
“So women my age would know that it might not be a good thing to take the hormones beyond that first ten-year period.”
VIDEO:
B-ROLL
Close up hormone pills
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
These findings confirm current recommendations for hormone use in post-menopausal women. By the way, Dr. Rossouw says only about ten percent of women still have hot flashes more than ten years after menopause. For most women, hot flashes or night sweats disappear in two or three years after the start of menopause. For more information, visit www.jama.com.
