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, February 26, 2008)
JAMA NEWS RELEASES
SWITCHING MEDICATIONS, ADDING PSYCHOTHERAPY MAY HELP TEENS WHOSE INITIAL MEDICATION FOR DEPRESSION IS INEFFECTIVE
USE OF ADULT STEM CELLS MAY BE BENEFICIAL FOR SOME PATIENTS WITH CERTAIN CARDIOVASCULAR DISORDERS AND AUTOIMMUNE DISEASES
AGENTS USED FOR TREATMENT OF ANEMIA ASSOCIATED WITH INCREASED RISK OF BLOOD CLOTS, DEATH IN PATIENTS WITH CANCER
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
ADULT STEM CELLS ARE HELPING PATIENTS WITH AUTOIMMUNE DISEASES AND CARDIOVASCULAR DISORDERS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
SAVE THE DATE: JAMA will present new research from its theme issue on Genetics and Genomics at a media briefing on Tuesday, March 18, from 10 a.m. – 12:15 p.m., at the National Press Club in Washington, D.C. To register, go to www.jamamedia.org and click on the Events tab, or call 312-464-JAMA. Program information will be included in a future email.
TV Note: This week's JAMA Video News Report is on the use of adult stem cells for the treatment of certain diseases and disorders. The report will be fed Tuesday, February 26, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 26, 2008
Media Advisory: To contact David Brent, M.D., call Megan Grote Quatrini at 412-647-3555.
SWITCHING MEDICATIONS, ADDING PSYCHOTHERAPY MAY HELP TEENS WHOSE INITIAL MEDICATION FOR DEPRESSION IS INEFFECTIVE
CHICAGO—For adolescents with depression not responding to an initial treatment with a selective serotonin reuptake inhibitor (SSRI; a class of antidepressant drugs), switching medications and adding cognitive behavioral therapy resulted in an improvement in symptoms, compared to just changing medications, according to a study in the February 27 issue of JAMA.
Adolescent depression is a common, chronic, recurrent and impairing condition. "Untreated depression results in impairment in school, interpersonal relationships, occupational adjustment, and increases the risk for suicidal behavior and completed suicide. Therefore, the proper treatment of adolescent depression has profound public health implications for youth in this critical stage of development," the researchers write.
Clinical guidelines for the treatment of adolescent depression recommend the prescribing of SSRI medications, psychotherapy, or both. While these treatments alone or in combination have been shown to be effective, at least 40 percent of adolescents with depression do not show an adequate clinical response to these interventions.
David Brent, M.D., of the University of Pittsburgh, and colleagues examined the relative efficacy of medication type, cognitive behavioral therapy (CBT), and the combination of both for the treatment of resistant adolescent depression. The randomized controlled trial, conducted from 2000-2006, included 334 patients, age 12 to 18 years, with a primary diagnosis of major depressive disorder who had not responded to a two-month initial treatment with an SSRI. For 12 weeks, participants were randomized to one of four treatments: switch to a second, different SSRI (paroxetine, citalopram, or fluoxetine); switch to a different SSRI plus CBT; switch to venlafaxine (a selective serotonin and noradrenergic reuptake inhibitor [SNRI], an antidepressant shown in some studies to be superior to an SSRI in the management of treatment-resistant adult depression); switch to venlafaxine plus CBT.
"In this study of adolescents with moderately severe and chronic depression who had not responded to an adequate course of treatment with an SSRI antidepressant, switching to a combination of CBT and another antidepressant resulted in a higher rate of clinical response [54.8 percent] than switching to another medication without CBT [40.5 percent]. There was no differential effect between switching to another SSRI [47.0 percent] or to venlafaxine [48.2 percent]," the authors write.
There were also no differential treatment effects on change in self-rated depressive symptoms, suicidal ideation, or on the rate of harm-related or other adverse events. There was a greater increase in diastolic blood pressure and pulse and more frequent occurrence of skin problems during venlafaxine than SSRI treatment.
"...the clinician should convey hope to the adolescent with depression and his or her family that, despite a first unsuccessful treatment for depression, persistence with additional appropriate interventions can result in substantial clinical improvement," the researchers conclude.
(JAMA. 2008;299[8]:901-913. 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, February 26, 2008
Media Advisory: To contact Richard K. Burt, M.D., call Marla Paul at 312-503-8928.
USE OF ADULT STEM CELLS MAY BE BENEFICIAL FOR SOME PATIENTS WITH CERTAIN CARDIOVASCULAR DISORDERS AND AUTOIMMUNE DISEASES
CHICAGO—A review of previously published research suggests that stem cells harvested from an adult’s blood or marrow may provide treatment benefit to select patients for some autoimmune diseases and cardiovascular disorders, according to an article in the February 27 issue of JAMA.
In broad terms, there are two types of stem cells, embryonic stem cells and adult stem cells. Human embryonic stem cells are isolated from a 4- to 5-day-old postfertilization blastocyst (an early form in the development of an embryo). Adult stem cells are located in tissues throughout the body and function as a reservoir to replace damaged or aging cells. Stem cell therapy is rapidly developing and shows great promise, "but clinical application has lagged due to ethical concerns or difficulties in harvesting or safely and efficiently expanding sufficient quantities. In contrast, clinical indications for blood-derived (from peripheral or umbilical cord blood) and bone marrow-derived stem cells, which can be easily and safely harvested, are rapidly increasing," the authors write.
Richard K. Burt, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, and colleagues conducted a review of articles regarding clinical indications and outcomes for use of blood- and bone marrow-derived stem cells. A search of databases identified 323 reports that were examined for feasibility and toxicity, and 69 that were evaluated for outcomes. These studies were published between January 1997 and December 2007.
For autoimmune diseases, 26 reports representing 854 patients reported treatment-related mortality of less than one percent (2/220 patients) for nonmyeloablative (not causing bone marrow suppression), less than two percent (3/197) for dose-reduced myeloablative, and 13 percent (13/100) for intense myeloablative regimens, i.e., those including total body irradiation or high-dose busulfan (a drug used in the treatment of some types of chronic leukemia).
"While all trials performed during the inflammatory stage of autoimmune disease suggested that transplantation of hematopoietic [formation of blood or blood cells] stem cells (HSCs) may have a potent disease-remitting effect, remission duration remains unclear, and no randomized trials have been published," the researchers write.
For reports involving cardiovascular diseases, including 17 reports involving 1,002 heart attack patients, 16 reports involving 493 patients with chronic coronary artery disease, and three meta-analyses, the evidence suggested that stem cell transplantation performed in patients with coronary artery disease may contribute to modest improvement in cardiac function.
"Stem cells harvested from blood or marrow, whether administered as purified HSCs or mesenchymal [cells that develop into connective tissue, blood vessels and lymphatic tissue] stem cells or as an unmanipulated or unpurified product can, under appropriate conditions in select patients, provide disease-ameliorating effects in some autoimmune diseases and cardiovascular disorders. Clinical trials are needed to determine the most appropriate cell type, dose, method, timing of delivery, and adverse effects of adult HSCs for these and other nonmalignant disorders," the authors conclude.
(JAMA. 2008;299[8]:925-936. 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, February 26, 2008
Media Advisory: To contact Charles L. Bennett, M.D., Ph.D., call Marla Paul at 312-503-8928.
AGENTS USED FOR TREATMENT OF ANEMIA ASSOCIATED WITH INCREASED RISK OF BLOOD CLOTS, DEATH IN PATIENTS WITH CANCER
CHICAGO—Treating anemia with a class of drugs known as erythropoiesis-stimulating agents (ESAs) is associated with an increased risk of venous thromboembolism (blood clots in the deep veins of the legs or in the lungs) and death among patients with cancer, according to an article in the February 27 issue of JAMA.
The ESAs erythropoietin and darbepoetin are widely used to treat anemia in patients with cancer. Some studies have indicated that there may be a higher risk of venous thromboembolism (VTE) with these medications, but it has not been known if there is an associated increased risk of death, according to background information in the article.
Charles L. Bennett, M.D., Ph.D., of the Northwestern University Feinberg School of Medicine, Chicago, and colleagues examined the rate of VTE and death associated with ESA administration for treatment of anemia among patients with cancer by conducting a review of phase 3 trials.
The researchers identified 51 clinical trials with 13,611 patients to examine survival. Analysis of the data indicated that the risk of death was significantly higher for patients with cancer who were treated with ESA vs. the control (placebo) group.
Venous thromboembolism was evaluated for 38 trials that included 8,172 patients. The researchers found that there was a significantly increased risk (57 percent) of VTE among patients treated with ESA (334 events among 4,610 patients treated with ESA vs. 173 events among 3,562 control patients).
"These risks are important given the prevalence of ESA use as a supportive care drug among patients with cancer as well as the dissemination of a series of safety advisories by the Food and Drug Administration (FDA) and ESA manufacturers," the authors write.
"Safety concerns account in large part for changes observed in patterns of use, reimbursement policies, clinical guidelines, and FDA-approved package inserts pertaining to ESAs in the oncology setting. Our findings, in conjunction with basic science reports on erythropoietin and erythropoietin receptors in solid cancers, raise concern about ESA safety for patients with cancer."
(JAMA. 2008;299[8]:914-924. 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
ADULT STEM CELLS ARE HELPING PATIENTS WITH AUTOIMMUNE DISEASES AND CARDIOVASCULAR DISORDERS
INTRO:
Adult stem cell therapy has become a standard of care when treating several types of cancer. Now a review of clinical trials involving adult stem cells during the past ten years indicates they are helping patients who have a variety of diseases and even heart trouble. One patient diagnosed with multiple sclerosis says his symptoms are gone. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
Patient at computer
Keyboard, hand
Patient eyes
AUDIO:
BARRY GOUDY WAS DIAGNOSED WITH MULTIPLE SCLEROSIS IN 1995. HE BEGAN LOSING FEELING IN HIS LEFT LEG AND AS TROUBLE WITH HIS CENTRAL NERVOUS SYSTEM PROGRESSED HE STARTED TO LOSE HIS VISION.
VIDEO:
SOT/FULL
@ :14
Super:Barry Goudy
Had Stem Cell Transplant
Runs :08
AUDIO:
"You sit and you cry and you wonder why you and then I went back to my neurologist and said tell me how I can fight this."
VIDEO:
B-ROLL
Picture of patient – bald
Lab work
Stem cells
AUDIO:
BARRY ENROLLED IN A CLINICAL TRIAL IN 2003. AFTER FIVE DAYS OF CHEMOTHERAPY TO DESTROY HIS IMMUNE CELLS, DOCTORS USED HIS OWN STEM CELLS TO REBUILD HIS IMMUNE SYSTEM.
VIDEO:
SOT/FULL
Barry Goudy
Had Stem Cell Transplant
Runs :08
AUDIO:
"I have no symptoms of MS. I do no treatment for MS, I do no shots."
VIDEO:
B-ROLL
Researcher with colleagues
Lab work
SUPER
@: 45 to :50
Courtesy: Northwestern Memorial Hospital Video
Stem cell video
Patient getting transplant
AUDIO:
DR RICHARD BURT AND HIS COLLEAGUES AT NORTHWESTERN UNIVERSITY FEINBERG SCHOOL OF MEDICINE REVIEWED THE OUTCOMES OF ABOUT TWENTY-FIVE HUNDRED PATIENTS WHO HAD STEM CELL TRANSPLANTS. THEY FOUND THE CELLS APPEAR TO BE PUTTING SOME PATIENTS WITH AUTOIMMUNE DISEASES IN REMISSION AND ARE OFFERING SOME IMPROVEMENT IN HEART FUNCTION TO PATIENTS WHO HAVE SUFFERED HEART ATTACKS.
VIDEO:
SOT/FULL
@: 1:00
Richard Burt, M.D.
Northwestern University Feinberg School of Medicine
Runs :09
AUDIO:
"It’s a whole new approach to these diseases. Rather than just surgery or drugs that you can use, a cellular approach that seems in many different studies to be benefitting the patient."
VIDEO:
GXF/JAMA
Bag of blood
Stem cells
Patient getting transplant
AUDIO:
THE REVIEW APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. UNLIKE EMBRYONIC STEM CELLS THAT RESULT IN THE DESTRUCTION OF AN EMBRYO, ADULT STEM CELLS COME FROM YOUR OWN BLOOD OR BONE MARROW OR SOMEONE ELSE’S. THE TRANSPLANT APPEARS TO BE SAFE.
VIDEO:
SOT/FULL
Richard Burt, M.D.
Northwestern University Feinberg School of Medicine
Runs: 04
AUDIO:
"There’s very low risk. Less than one percent mortality from the procedure."
VIDEO:
B-ROLL
Patient reads
Picture coaching team
AUDIO:
BARRY NOW LEADS AN ACTIVE LIFESTYLE. HERE HE IS WITH THE ICE HOCKEY TEAM HE COACHES.
VIDEO:
SOT/FULL
Barry Goudy
Had Stem Cell Transplant
Runs: 07
AUDIO:
"I’ve had five years of good life. Five years. If I didn’t do the transplant I would probably be in a wheelchair today."
VIDEO:
B-ROLL
Patient walking
Picture patient with team
AUDIO:
HE KNOWS THERE ARE NO GUARANTEES HOW LONG HIS REMISSION MIGHT LAST BUT HE SAYS HE’S LIVING PROOF STEM CELL TRANSPLANTS DO WORK. JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
Stem cell clinical trials for liver disease have recently started and trials for cerebrovascular disease and spinal cord injuries are being considered. If you would like more information about where these trials are taking place and how to get involved you can log on to www.clinicaltrials.gov.
