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CDC: Beware Brazil yellow fever outbreak
The Centers for Disease Control and Prevention recommends that travelers who haven’t been vaccinated against yellow fever should avoid travel to Brazil, according to a media teleconference by CDC officials.
“The most important new recommendation ... is that travelers should not go to these yellow fever hot spots in Brazil, unless they are vaccinated,” stated Martin Cetron, MD, director of the Division of Global Migration and Quarantine at the CDC. “Health officials in Brazil recently confirmed more than 920 cases of yellow fever, including more than 300 deaths, during this outbreak” he added.
Since the beginning of 2018, 10 travel-related cases of yellow fever have been reported among international travelers returning from Brazil. Four of these travelers died. All 10 travelers had not received the yellow fever vaccine. Of these 10 travelers, 8 acquired the disease on Ilha Grande, an island off the coast of Rio De Janeiro that is popular among tourists.
The CDC is urging travelers to get vaccinated because of the potentially fatal effects of yellow fever. Vaccinations are recommended for any eligible person 9 months of age or older traveling to Brazil, specifically Espírito Santo, São Paulo, and Rio de Janeiro states, and certain cities in Bahia state, as well as Ilha Grande in particular.
Individuals heading to Brazil should receive the vaccination at least 10 days before travel. If a traveler is unvaccinated and cannot get the vaccination in the appropriate amount of time, areas where vaccination is recommended should be avoided.
The Food and Drug Administration–approved yellow fever vaccine, YF-VAX, is not currently available because of manufacturing issues. Stamaril, another yellow fever vaccine, is available at a limited number of yellow fever vaccination clinics in the United States.
In light of these supply issues, the CDC has provided resources to locate yellow fever vaccination clinics.
Dr. Cetron reemphasized that unvaccinated individuals planning to vacation in Brazil may want to reconsider their travel plans.
“People who have never been vaccinated against yellow fever should not travel to the areas in Brazil affected by the outbreak. Particularly the hot spot of Ilha Grande.”
Information for clinicians and travelers is available on the travel notice portion of the CDC site. The travel notice for Brazil includes a map of the yellow fever–affected areas in Brazil, as well as other informational resources.
The related CDC Morbidity and Mortality Weekly Report is available online.
The Centers for Disease Control and Prevention recommends that travelers who haven’t been vaccinated against yellow fever should avoid travel to Brazil, according to a media teleconference by CDC officials.
“The most important new recommendation ... is that travelers should not go to these yellow fever hot spots in Brazil, unless they are vaccinated,” stated Martin Cetron, MD, director of the Division of Global Migration and Quarantine at the CDC. “Health officials in Brazil recently confirmed more than 920 cases of yellow fever, including more than 300 deaths, during this outbreak” he added.
Since the beginning of 2018, 10 travel-related cases of yellow fever have been reported among international travelers returning from Brazil. Four of these travelers died. All 10 travelers had not received the yellow fever vaccine. Of these 10 travelers, 8 acquired the disease on Ilha Grande, an island off the coast of Rio De Janeiro that is popular among tourists.
The CDC is urging travelers to get vaccinated because of the potentially fatal effects of yellow fever. Vaccinations are recommended for any eligible person 9 months of age or older traveling to Brazil, specifically Espírito Santo, São Paulo, and Rio de Janeiro states, and certain cities in Bahia state, as well as Ilha Grande in particular.
Individuals heading to Brazil should receive the vaccination at least 10 days before travel. If a traveler is unvaccinated and cannot get the vaccination in the appropriate amount of time, areas where vaccination is recommended should be avoided.
The Food and Drug Administration–approved yellow fever vaccine, YF-VAX, is not currently available because of manufacturing issues. Stamaril, another yellow fever vaccine, is available at a limited number of yellow fever vaccination clinics in the United States.
In light of these supply issues, the CDC has provided resources to locate yellow fever vaccination clinics.
Dr. Cetron reemphasized that unvaccinated individuals planning to vacation in Brazil may want to reconsider their travel plans.
“People who have never been vaccinated against yellow fever should not travel to the areas in Brazil affected by the outbreak. Particularly the hot spot of Ilha Grande.”
Information for clinicians and travelers is available on the travel notice portion of the CDC site. The travel notice for Brazil includes a map of the yellow fever–affected areas in Brazil, as well as other informational resources.
The related CDC Morbidity and Mortality Weekly Report is available online.
The Centers for Disease Control and Prevention recommends that travelers who haven’t been vaccinated against yellow fever should avoid travel to Brazil, according to a media teleconference by CDC officials.
“The most important new recommendation ... is that travelers should not go to these yellow fever hot spots in Brazil, unless they are vaccinated,” stated Martin Cetron, MD, director of the Division of Global Migration and Quarantine at the CDC. “Health officials in Brazil recently confirmed more than 920 cases of yellow fever, including more than 300 deaths, during this outbreak” he added.
Since the beginning of 2018, 10 travel-related cases of yellow fever have been reported among international travelers returning from Brazil. Four of these travelers died. All 10 travelers had not received the yellow fever vaccine. Of these 10 travelers, 8 acquired the disease on Ilha Grande, an island off the coast of Rio De Janeiro that is popular among tourists.
The CDC is urging travelers to get vaccinated because of the potentially fatal effects of yellow fever. Vaccinations are recommended for any eligible person 9 months of age or older traveling to Brazil, specifically Espírito Santo, São Paulo, and Rio de Janeiro states, and certain cities in Bahia state, as well as Ilha Grande in particular.
Individuals heading to Brazil should receive the vaccination at least 10 days before travel. If a traveler is unvaccinated and cannot get the vaccination in the appropriate amount of time, areas where vaccination is recommended should be avoided.
The Food and Drug Administration–approved yellow fever vaccine, YF-VAX, is not currently available because of manufacturing issues. Stamaril, another yellow fever vaccine, is available at a limited number of yellow fever vaccination clinics in the United States.
In light of these supply issues, the CDC has provided resources to locate yellow fever vaccination clinics.
Dr. Cetron reemphasized that unvaccinated individuals planning to vacation in Brazil may want to reconsider their travel plans.
“People who have never been vaccinated against yellow fever should not travel to the areas in Brazil affected by the outbreak. Particularly the hot spot of Ilha Grande.”
Information for clinicians and travelers is available on the travel notice portion of the CDC site. The travel notice for Brazil includes a map of the yellow fever–affected areas in Brazil, as well as other informational resources.
The related CDC Morbidity and Mortality Weekly Report is available online.
Match Day 2018: A slow year for dermatology
according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions filled (up 4.7%), PGY-1 positions (up 4.9%) filled, and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions filled (up 4.7%), PGY-1 positions (up 4.9%) filled, and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions filled (up 4.7%), PGY-1 positions (up 4.9%) filled, and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
CT angiography boosts success in chronic total occlusion revascularization
WASHINGTON – When performed prior to revascularization, CT angiography almost doubles the likelihood of successful revascularization of chronic total occlusion relative to no CT angiography, according to a meta-analysis.
Because the meta-analysis relied primarily on retrospective data, the conclusion was characterized as hypothesis-generating. But the author, Wael Abuzeid, MD, an interventional cardiologist and assistant professor at Queen’s University, Kingston, Ont., suggested that there are several arguments to be made for pursuing a randomized trial.
This is not a new idea, according to results of a systematic review of the literature. Although only four articles met prespecified criteria for entry into the meta-analysis that was eventually conducted, Dr. Abuzeid and his coauthors found 424 articles on this subject in a search of three literature databases.
Only one of the four studies entered into the meta-analysis involved prospective data collection, but three of the four found a significant advantage for preprocedural CTA when compared with no CTA for procedural success, meaning restoration of blood flow in the target CTO. The fourth study also associated preprocedural CTA with improved procedural success, but the advantage did not reach statistical significance.
When the data were combined for a meta-analysis, the odds ratio for procedural success for conducting a preprocedural CTA relative to no preprocedural CTA was 1.89 with a significant 95% confidence interval (1.18-3.04; P less than .05).
The four studies were published during 2012-2015. Two of them used CTA with only a 64-slice capacity, raising the possibility that an even greater improvement in results would have been achieved with CTA using the greater resolutions now available.
There were several important limitations of the study, particularly the potential for selection bias from the nonrandomized designs in the studies evaluated, Dr. Abuzeid acknowledged. However, the most likely selection bias would be funneling of more challenging cases to preprocedural CTA, a potential disadvantage for CTA if this resulted in a patient population likely to have a poor outcome.
Currently, few centers employ preprocedural CTA in routine management of CTO, according to Dr. Abuzeid.
“CTA prior to revascularization in CTO is not a standard approach even in complex patients,” Dr. Abuzeid said. However, he believes an argument can already be made for preprocedural CTA in some types of challenging patients, such as those with particularly long target lesions. In such cases, CTA could provide advance information about negative distal remodeling and the likelihood that a retrograde approach might be needed.
“For the junior operator, I think the information provided by preprocedural CTA could be very useful in planning,” Dr. Abuzeid said.
The arguments against preprocedural CTA include higher radiation exposure and a delay in the time to procedure by adding the extra step of first conducting the imaging study. In addition to verifying that procedural success is achieved with preprocedural CTA, these issues are among those that deserve evaluation in a prospective study.
“The appropriate randomized trial would be conducted at high-volume centers with all comers, not just complex patients, randomized to undergo a preprocedural CTA or no preprocedural imaging,” Dr. Abuzeid suggested. He said the appropriate primary outcome is relative success at restoring Thrombolysis in Myocardial Infarction grade 2 flow, but suggested that other endpoints, such as procedure time and rate of complications, would be useful for determining the value of this approach.
Dr. Abuzeid reports having no financial relationships.
SOURCE: Abuzeid W. CRT 18.
WASHINGTON – When performed prior to revascularization, CT angiography almost doubles the likelihood of successful revascularization of chronic total occlusion relative to no CT angiography, according to a meta-analysis.
Because the meta-analysis relied primarily on retrospective data, the conclusion was characterized as hypothesis-generating. But the author, Wael Abuzeid, MD, an interventional cardiologist and assistant professor at Queen’s University, Kingston, Ont., suggested that there are several arguments to be made for pursuing a randomized trial.
This is not a new idea, according to results of a systematic review of the literature. Although only four articles met prespecified criteria for entry into the meta-analysis that was eventually conducted, Dr. Abuzeid and his coauthors found 424 articles on this subject in a search of three literature databases.
Only one of the four studies entered into the meta-analysis involved prospective data collection, but three of the four found a significant advantage for preprocedural CTA when compared with no CTA for procedural success, meaning restoration of blood flow in the target CTO. The fourth study also associated preprocedural CTA with improved procedural success, but the advantage did not reach statistical significance.
When the data were combined for a meta-analysis, the odds ratio for procedural success for conducting a preprocedural CTA relative to no preprocedural CTA was 1.89 with a significant 95% confidence interval (1.18-3.04; P less than .05).
The four studies were published during 2012-2015. Two of them used CTA with only a 64-slice capacity, raising the possibility that an even greater improvement in results would have been achieved with CTA using the greater resolutions now available.
There were several important limitations of the study, particularly the potential for selection bias from the nonrandomized designs in the studies evaluated, Dr. Abuzeid acknowledged. However, the most likely selection bias would be funneling of more challenging cases to preprocedural CTA, a potential disadvantage for CTA if this resulted in a patient population likely to have a poor outcome.
Currently, few centers employ preprocedural CTA in routine management of CTO, according to Dr. Abuzeid.
“CTA prior to revascularization in CTO is not a standard approach even in complex patients,” Dr. Abuzeid said. However, he believes an argument can already be made for preprocedural CTA in some types of challenging patients, such as those with particularly long target lesions. In such cases, CTA could provide advance information about negative distal remodeling and the likelihood that a retrograde approach might be needed.
“For the junior operator, I think the information provided by preprocedural CTA could be very useful in planning,” Dr. Abuzeid said.
The arguments against preprocedural CTA include higher radiation exposure and a delay in the time to procedure by adding the extra step of first conducting the imaging study. In addition to verifying that procedural success is achieved with preprocedural CTA, these issues are among those that deserve evaluation in a prospective study.
“The appropriate randomized trial would be conducted at high-volume centers with all comers, not just complex patients, randomized to undergo a preprocedural CTA or no preprocedural imaging,” Dr. Abuzeid suggested. He said the appropriate primary outcome is relative success at restoring Thrombolysis in Myocardial Infarction grade 2 flow, but suggested that other endpoints, such as procedure time and rate of complications, would be useful for determining the value of this approach.
Dr. Abuzeid reports having no financial relationships.
SOURCE: Abuzeid W. CRT 18.
WASHINGTON – When performed prior to revascularization, CT angiography almost doubles the likelihood of successful revascularization of chronic total occlusion relative to no CT angiography, according to a meta-analysis.
Because the meta-analysis relied primarily on retrospective data, the conclusion was characterized as hypothesis-generating. But the author, Wael Abuzeid, MD, an interventional cardiologist and assistant professor at Queen’s University, Kingston, Ont., suggested that there are several arguments to be made for pursuing a randomized trial.
This is not a new idea, according to results of a systematic review of the literature. Although only four articles met prespecified criteria for entry into the meta-analysis that was eventually conducted, Dr. Abuzeid and his coauthors found 424 articles on this subject in a search of three literature databases.
Only one of the four studies entered into the meta-analysis involved prospective data collection, but three of the four found a significant advantage for preprocedural CTA when compared with no CTA for procedural success, meaning restoration of blood flow in the target CTO. The fourth study also associated preprocedural CTA with improved procedural success, but the advantage did not reach statistical significance.
When the data were combined for a meta-analysis, the odds ratio for procedural success for conducting a preprocedural CTA relative to no preprocedural CTA was 1.89 with a significant 95% confidence interval (1.18-3.04; P less than .05).
The four studies were published during 2012-2015. Two of them used CTA with only a 64-slice capacity, raising the possibility that an even greater improvement in results would have been achieved with CTA using the greater resolutions now available.
There were several important limitations of the study, particularly the potential for selection bias from the nonrandomized designs in the studies evaluated, Dr. Abuzeid acknowledged. However, the most likely selection bias would be funneling of more challenging cases to preprocedural CTA, a potential disadvantage for CTA if this resulted in a patient population likely to have a poor outcome.
Currently, few centers employ preprocedural CTA in routine management of CTO, according to Dr. Abuzeid.
“CTA prior to revascularization in CTO is not a standard approach even in complex patients,” Dr. Abuzeid said. However, he believes an argument can already be made for preprocedural CTA in some types of challenging patients, such as those with particularly long target lesions. In such cases, CTA could provide advance information about negative distal remodeling and the likelihood that a retrograde approach might be needed.
“For the junior operator, I think the information provided by preprocedural CTA could be very useful in planning,” Dr. Abuzeid said.
The arguments against preprocedural CTA include higher radiation exposure and a delay in the time to procedure by adding the extra step of first conducting the imaging study. In addition to verifying that procedural success is achieved with preprocedural CTA, these issues are among those that deserve evaluation in a prospective study.
“The appropriate randomized trial would be conducted at high-volume centers with all comers, not just complex patients, randomized to undergo a preprocedural CTA or no preprocedural imaging,” Dr. Abuzeid suggested. He said the appropriate primary outcome is relative success at restoring Thrombolysis in Myocardial Infarction grade 2 flow, but suggested that other endpoints, such as procedure time and rate of complications, would be useful for determining the value of this approach.
Dr. Abuzeid reports having no financial relationships.
SOURCE: Abuzeid W. CRT 18.
REPORTING FROM CRT 2018
Key clinical point:
Major finding: In a meta-analysis of data from four studies, CT angiography almost doubled the likelihood of procedural success (OR 1.89; P less than .05).
Study details: A systematic review and meta-analysis of four studies.
Disclosures: Dr. Abuzeid reports having no financial relationships.
Source: Abuzaid W. CRT 18.
Match Day 2018: Internal medicine increases positions, matches
Internal medicine helped to make the 2018 Main Residency Match the largest ever as the specialty offered and filled about 4% more residency slots than in 2017, according to the National Resident Matching Program (NRMP).
Internal medicine brought 7,542 PGY-1 positions – more than any other specialty – to the Match Day party this year and filled 44.9% of them with U.S. graduates and 96.7% overall. Despite the increase in IM residency slots, however, the number and percentage of U.S. seniors matching declined, as it has done each year since 2015. For all specialties, U.S. graduates filled 58.7% of the record-high 30,232 available spots, and the overall fill rate was 96.1%, the NRMP said in its 2018 Main Residency Match report.
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total (up 4.7%) and PGY-1 positions (up 4.9%) filled, and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Internal medicine helped to make the 2018 Main Residency Match the largest ever as the specialty offered and filled about 4% more residency slots than in 2017, according to the National Resident Matching Program (NRMP).
Internal medicine brought 7,542 PGY-1 positions – more than any other specialty – to the Match Day party this year and filled 44.9% of them with U.S. graduates and 96.7% overall. Despite the increase in IM residency slots, however, the number and percentage of U.S. seniors matching declined, as it has done each year since 2015. For all specialties, U.S. graduates filled 58.7% of the record-high 30,232 available spots, and the overall fill rate was 96.1%, the NRMP said in its 2018 Main Residency Match report.
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total (up 4.7%) and PGY-1 positions (up 4.9%) filled, and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Internal medicine helped to make the 2018 Main Residency Match the largest ever as the specialty offered and filled about 4% more residency slots than in 2017, according to the National Resident Matching Program (NRMP).
Internal medicine brought 7,542 PGY-1 positions – more than any other specialty – to the Match Day party this year and filled 44.9% of them with U.S. graduates and 96.7% overall. Despite the increase in IM residency slots, however, the number and percentage of U.S. seniors matching declined, as it has done each year since 2015. For all specialties, U.S. graduates filled 58.7% of the record-high 30,232 available spots, and the overall fill rate was 96.1%, the NRMP said in its 2018 Main Residency Match report.
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total (up 4.7%) and PGY-1 positions (up 4.9%) filled, and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Match Day 2018: Psychiatry increases positions and matches
as the specialty increased residency slots by 4.1% and accepted 3.3% more applicants, compared with 2017, according to the National Resident Matching Program.
Psychiatry brought 1,556 PGY-1 positions to the Match Day table this year and filled 63.1% of them with U.S. graduates – up for the fourth consecutive year – and 99.0% overall. For all specialties, U.S. graduates filled 58.7% of the record-high 30,232 available spots, and the overall fill rate was 96.1%, the NRMP said in its 2018 Main Residency Match report.
as the specialty increased residency slots by 4.1% and accepted 3.3% more applicants, compared with 2017, according to the National Resident Matching Program.
Psychiatry brought 1,556 PGY-1 positions to the Match Day table this year and filled 63.1% of them with U.S. graduates – up for the fourth consecutive year – and 99.0% overall. For all specialties, U.S. graduates filled 58.7% of the record-high 30,232 available spots, and the overall fill rate was 96.1%, the NRMP said in its 2018 Main Residency Match report.
as the specialty increased residency slots by 4.1% and accepted 3.3% more applicants, compared with 2017, according to the National Resident Matching Program.
Psychiatry brought 1,556 PGY-1 positions to the Match Day table this year and filled 63.1% of them with U.S. graduates – up for the fourth consecutive year – and 99.0% overall. For all specialties, U.S. graduates filled 58.7% of the record-high 30,232 available spots, and the overall fill rate was 96.1%, the NRMP said in its 2018 Main Residency Match report.
Match Day 2018: Big increases for neurology
Neurology helped to make the 2018 Main Residency Match the largest ever as the specialty offered and filled over 12% more residency slots than in 2017, according to the National Resident Matching Program (NRMP).
The third consecutive year with a double-digit increase in PGY-1 positions enabled neurology to bring 552 slots to the Match Day party this year: 50.7% were filled with U.S. graduates and the overall fill rate was 97.6%. For all specialties, U.S. graduates filled 58.7% of the record-high 30,232 available spots, and the overall fill rate was 96.1%, the NRMP said in its 2018 Main Residency Match report.
The total number of child neurology PGY-1 positions offered rose to 134, of which 96.3% were filled (75.4% by U.S. graduates). Another seven of eight PGY-2 child neurology positions were filled. Of 26 PGY-2 physician positions offered for child neurology, 12 were filled.
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total (up 4.7%) and PGY-1 positions (up 4.9%) filled, and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Neurology helped to make the 2018 Main Residency Match the largest ever as the specialty offered and filled over 12% more residency slots than in 2017, according to the National Resident Matching Program (NRMP).
The third consecutive year with a double-digit increase in PGY-1 positions enabled neurology to bring 552 slots to the Match Day party this year: 50.7% were filled with U.S. graduates and the overall fill rate was 97.6%. For all specialties, U.S. graduates filled 58.7% of the record-high 30,232 available spots, and the overall fill rate was 96.1%, the NRMP said in its 2018 Main Residency Match report.
The total number of child neurology PGY-1 positions offered rose to 134, of which 96.3% were filled (75.4% by U.S. graduates). Another seven of eight PGY-2 child neurology positions were filled. Of 26 PGY-2 physician positions offered for child neurology, 12 were filled.
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total (up 4.7%) and PGY-1 positions (up 4.9%) filled, and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Neurology helped to make the 2018 Main Residency Match the largest ever as the specialty offered and filled over 12% more residency slots than in 2017, according to the National Resident Matching Program (NRMP).
The third consecutive year with a double-digit increase in PGY-1 positions enabled neurology to bring 552 slots to the Match Day party this year: 50.7% were filled with U.S. graduates and the overall fill rate was 97.6%. For all specialties, U.S. graduates filled 58.7% of the record-high 30,232 available spots, and the overall fill rate was 96.1%, the NRMP said in its 2018 Main Residency Match report.
The total number of child neurology PGY-1 positions offered rose to 134, of which 96.3% were filled (75.4% by U.S. graduates). Another seven of eight PGY-2 child neurology positions were filled. Of 26 PGY-2 physician positions offered for child neurology, 12 were filled.
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total (up 4.7%) and PGY-1 positions (up 4.9%) filled, and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Match Day 2018: A slow year for pediatrics
Pediatrics saw modest gains in residency slots and matches in what was the largest Match Day on record, according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions and PGY-1 positions filled (up 4.7% and 4.9%, respectively), and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Pediatrics saw modest gains in residency slots and matches in what was the largest Match Day on record, according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions and PGY-1 positions filled (up 4.7% and 4.9%, respectively), and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Pediatrics saw modest gains in residency slots and matches in what was the largest Match Day on record, according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions and PGY-1 positions filled (up 4.7% and 4.9%, respectively), and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Match Day 2018: Surgery increases positions and matches
Surgery helped to make the 2018 Main Residency Match the largest ever as the specialty offered and filled 3% more residency slots than it did in 2017, according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions and PGY-1 positions filled (up 4.7% and 4.9%, respectively), and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Surgery helped to make the 2018 Main Residency Match the largest ever as the specialty offered and filled 3% more residency slots than it did in 2017, according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions and PGY-1 positions filled (up 4.7% and 4.9%, respectively), and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Surgery helped to make the 2018 Main Residency Match the largest ever as the specialty offered and filled 3% more residency slots than it did in 2017, according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions and PGY-1 positions filled (up 4.7% and 4.9%, respectively), and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Match Day 2018: Family medicine increases positions, matches
as the specialty increased residency slots by 8% and accepted 9% more applicants, compared with 2017, according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions and PGY-1 positions filled (up 4.7% and 4.9%, respectively), and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
as the specialty increased residency slots by 8% and accepted 9% more applicants, compared with 2017, according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions and PGY-1 positions filled (up 4.7% and 4.9%, respectively), and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
as the specialty increased residency slots by 8% and accepted 9% more applicants, compared with 2017, according to the National Resident Matching Program (NRMP).
The 2018 Match also set new highs for total positions offered (up 4.4% over last year), total positions and PGY-1 positions filled (up 4.7% and 4.9%, respectively), and total applicants (up 1.7%). “The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
Febuxostat increases cardiovascular mortality in CARES trial
ORLANDO – Long-term treatment with febuxostat in gout patients with comorbid cardiovascular disease conferred significantly higher risks of both cardiovascular death and all-cause mortality, compared with allopurinol, in the Food and Drug Administration–mandated postmarketing CARES trial, William B. White, MD, reported at the annual meeting of the American College of Cardiology.
CARES (Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout and Cardiovascular Disease) was a prospective, double-blind, 320-center North American clinical trial in which 6,190 patients were randomized to febuxostat (Uloric) at 40-80 mg once daily or 200-600 mg of allopurinol once daily. The postmarketing safety study was required by the FDA as a condition of marketing approval for febuxostat in light of preapproval evidence suggestive of a possible increased risk of cardiovascular events, explained Dr. White, professor of medicine and chief of the division of hypertension and clinical pharmacology at the University of Connecticut, Farmington.
The warning klaxon sounded when investigators scrutinized the individual components of the primary endpoint. They found that the 4.3% cardiovascular death rate in the febuxostat group was significantly higher than the 3.2% rate in the allopurinol group, representing a statistically significant 34% increase in relative risk. The event curves began to separate roughly 30 months into the trial. Moreover, all-cause mortality was also significantly increased in the febuxostat group, by a margin of 7.8% to 6.4%, for a 22% increase in risk.
The increased cardiovascular mortality in the febuxostat group was driven by a higher adjudicated sudden cardiac death rate: 2.7%, compared with 1.8% in the allopurinol group.
In a prespecified per protocol analysis of cardiovascular events occurring while patients were actually on treatment or within 1 month after discontinuation, the key findings remained unchanged: no between-group difference in the primary composite endpoint, but a 49% increase in the relative risk of cardiovascular death in the febuxostat-treated patients.
A hefty 45% of participants stopped taking their assigned drug early. Dr. White said this isn’t unusual; high dropout rates are common in clinical trials of patients with painful conditions. Because of the high lost-to-follow-up rate, however, the investigators hired a private investigator to scour the country looking for missed deaths among enrollees. This turned up an extra 199 deaths. When those were added to the total, all-cause mortality in the febuxostat group was no longer significantly higher than for allopurinol.
The puzzle over nonfatal events
A puzzling key study finding was that except for cardiovascular death, the other components of the primary composite endpoint – that is, nonfatal MI, nonfatal stroke, and urgent revascularization due to unstable angina – were all either neutral or numerically favored febuxostat.
“That’s been the biggest challenge in the trial: The nonfatal events didn’t go in the same direction as the fatal events. And we don’t have a real mechanism to explain why,” Dr. White told a panel of discussants.
“I scanned the medical literature over the last 4 decades, and I did not see another prospective, randomized, double-blind trial in which mortality was increased when none of the nonfatal events were increased. The finding is unique. Statistically there is only a 4% chance that the mortality finding is wrong,” the cardiologist said.
The CARES leadership included rheumatologists and nephrologists as well as cardiologists. Dr. White said he and the others were at a loss to come up with an explanation for the findings.
Patients in the febuxostat arm were significantly more likely to achieve serum urate levels below 6 and 5 mg/dL. Their flare rate was 0.68 events per person-year, similar to the 0.63 per person-year rate in the allopurinol group.
Among the pieces of the study puzzle: The majority of cardiovascular deaths occurred in patients who were no longer on therapy, yet investigators could find no evidence of a legacy effect. The mortality risk was 2.3-fold greater with febuxostat than with allopurinol among patients on NSAID therapy, but there was no significant between-group difference among patients not taking NSAIDs. There was a trend for more cardiovascular deaths with febuxostat than allopurinol among patients not on low-dose aspirin. And the cardiovascular mortality was 2.2-fold greater in the febuxostat arm than with allopurinol in patients on colchicine during the study.
Notably, prior to febuxostat’s marketing approval there were extensive studies of the drug’s potential effect on left ventricular function, thrombotic potential, possible arrhythmogenic effects, and impact upon atherosclerosis. Among these investigations was a QT-interval study conducted using febuxostat doses four times higher than the maximum therapeutic dose, which was prescient given the increased sudden cardiac death rate in the subsequent CARES trial. Yet no concerning signals were seen in any of this work, he continued.
“We’re still looking at some correlates that might have an impact. For example, my rheumatologist colleagues feel very strongly that we need to look really extensively at gout flares, even though rates were not that different between the two treatment groups. Gout flares are known to increase oxidative stress and perhaps cause temporary increases in endothelial dysfunction and possibly vasomotor abnormalities,” Dr. White said.
One would think, though, that if gout flares figured in the increase in cardiovascular mortality they would also have been associated with more urgent revascularization for unstable angina, when in fact the rate was actually numerically lower in the febuxostat group, he noted.
Discussant Athena Poppas, MD, director of the Lifespan Cardiovascular Institute at Rhode Island Hospital, Providence, said she couldn’t determine how much of the increased cardiovascular mortality in the febuxostat patients was due to the drug and how much resulted from the suboptimal use of guideline-directed medical therapy across both study arms. At baseline, only 60% of study participants – all by definition at high cardiovascular risk – were on aspirin, just under 75% were on lipid-lowering therapy, 58% were on a beta blocker, and 70% were on a renin-angiotensin system blocker, even though the majority of subjects had stage 3 chronic kidney disease.
Implications of findings and FDA’s next steps
Another discussant, C. Noel Bairey Merz, MD, called the CARES findings “curious.” But despite the lack of a plausible mechanistic explanation for the results, she said, the implications are clear.
“I would conclude that because your modified intention-to-treat as well as your per protocol analyses were consistent for the death endpoint, then despite the high dropout rate, that finding is relatively robust and probably should be used to inform policy,” said Dr. Merz, director of the Women’s Heart Center and the Preventive and Rehabilitative Cardiac Center in the Cedars-Sinai Heart Institute and professor of medicine at the University of California, Los Angeles.
At a press conference, Dr. White said the FDA will spend several months poring over the CARES results and that it would be premature to speculate on what action the agency might take on febuxostat. The drug is prescribed far less frequently than allopurinol for the nation’s estimated 8.2 million gout patients.
“I would certainly be concerned about our findings. However, rheumatologists take care of very ill patients and all the drugs they use have morbidity. So if they’re having substantial efficacy and the person has been on febuxostat for 8 years, I suspect they’re going to continue to give that drug to him,” he said.
Simultaneously with Dr. White’s presentation at ACC 2018, the CARES results were published in the New England Journal of Medicine (N Engl J Med. 2018 Mar 12. doi: 10.1056/NEJMoa1710895).
The CARES trial was funded by Takeda. Dr. White reported serving as a consultant to that company and Novartis and receiving research funding from the National Institutes of Health.
SOURCE: White W et al. ACC 18.
ORLANDO – Long-term treatment with febuxostat in gout patients with comorbid cardiovascular disease conferred significantly higher risks of both cardiovascular death and all-cause mortality, compared with allopurinol, in the Food and Drug Administration–mandated postmarketing CARES trial, William B. White, MD, reported at the annual meeting of the American College of Cardiology.
CARES (Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout and Cardiovascular Disease) was a prospective, double-blind, 320-center North American clinical trial in which 6,190 patients were randomized to febuxostat (Uloric) at 40-80 mg once daily or 200-600 mg of allopurinol once daily. The postmarketing safety study was required by the FDA as a condition of marketing approval for febuxostat in light of preapproval evidence suggestive of a possible increased risk of cardiovascular events, explained Dr. White, professor of medicine and chief of the division of hypertension and clinical pharmacology at the University of Connecticut, Farmington.
The warning klaxon sounded when investigators scrutinized the individual components of the primary endpoint. They found that the 4.3% cardiovascular death rate in the febuxostat group was significantly higher than the 3.2% rate in the allopurinol group, representing a statistically significant 34% increase in relative risk. The event curves began to separate roughly 30 months into the trial. Moreover, all-cause mortality was also significantly increased in the febuxostat group, by a margin of 7.8% to 6.4%, for a 22% increase in risk.
The increased cardiovascular mortality in the febuxostat group was driven by a higher adjudicated sudden cardiac death rate: 2.7%, compared with 1.8% in the allopurinol group.
In a prespecified per protocol analysis of cardiovascular events occurring while patients were actually on treatment or within 1 month after discontinuation, the key findings remained unchanged: no between-group difference in the primary composite endpoint, but a 49% increase in the relative risk of cardiovascular death in the febuxostat-treated patients.
A hefty 45% of participants stopped taking their assigned drug early. Dr. White said this isn’t unusual; high dropout rates are common in clinical trials of patients with painful conditions. Because of the high lost-to-follow-up rate, however, the investigators hired a private investigator to scour the country looking for missed deaths among enrollees. This turned up an extra 199 deaths. When those were added to the total, all-cause mortality in the febuxostat group was no longer significantly higher than for allopurinol.
The puzzle over nonfatal events
A puzzling key study finding was that except for cardiovascular death, the other components of the primary composite endpoint – that is, nonfatal MI, nonfatal stroke, and urgent revascularization due to unstable angina – were all either neutral or numerically favored febuxostat.
“That’s been the biggest challenge in the trial: The nonfatal events didn’t go in the same direction as the fatal events. And we don’t have a real mechanism to explain why,” Dr. White told a panel of discussants.
“I scanned the medical literature over the last 4 decades, and I did not see another prospective, randomized, double-blind trial in which mortality was increased when none of the nonfatal events were increased. The finding is unique. Statistically there is only a 4% chance that the mortality finding is wrong,” the cardiologist said.
The CARES leadership included rheumatologists and nephrologists as well as cardiologists. Dr. White said he and the others were at a loss to come up with an explanation for the findings.
Patients in the febuxostat arm were significantly more likely to achieve serum urate levels below 6 and 5 mg/dL. Their flare rate was 0.68 events per person-year, similar to the 0.63 per person-year rate in the allopurinol group.
Among the pieces of the study puzzle: The majority of cardiovascular deaths occurred in patients who were no longer on therapy, yet investigators could find no evidence of a legacy effect. The mortality risk was 2.3-fold greater with febuxostat than with allopurinol among patients on NSAID therapy, but there was no significant between-group difference among patients not taking NSAIDs. There was a trend for more cardiovascular deaths with febuxostat than allopurinol among patients not on low-dose aspirin. And the cardiovascular mortality was 2.2-fold greater in the febuxostat arm than with allopurinol in patients on colchicine during the study.
Notably, prior to febuxostat’s marketing approval there were extensive studies of the drug’s potential effect on left ventricular function, thrombotic potential, possible arrhythmogenic effects, and impact upon atherosclerosis. Among these investigations was a QT-interval study conducted using febuxostat doses four times higher than the maximum therapeutic dose, which was prescient given the increased sudden cardiac death rate in the subsequent CARES trial. Yet no concerning signals were seen in any of this work, he continued.
“We’re still looking at some correlates that might have an impact. For example, my rheumatologist colleagues feel very strongly that we need to look really extensively at gout flares, even though rates were not that different between the two treatment groups. Gout flares are known to increase oxidative stress and perhaps cause temporary increases in endothelial dysfunction and possibly vasomotor abnormalities,” Dr. White said.
One would think, though, that if gout flares figured in the increase in cardiovascular mortality they would also have been associated with more urgent revascularization for unstable angina, when in fact the rate was actually numerically lower in the febuxostat group, he noted.
Discussant Athena Poppas, MD, director of the Lifespan Cardiovascular Institute at Rhode Island Hospital, Providence, said she couldn’t determine how much of the increased cardiovascular mortality in the febuxostat patients was due to the drug and how much resulted from the suboptimal use of guideline-directed medical therapy across both study arms. At baseline, only 60% of study participants – all by definition at high cardiovascular risk – were on aspirin, just under 75% were on lipid-lowering therapy, 58% were on a beta blocker, and 70% were on a renin-angiotensin system blocker, even though the majority of subjects had stage 3 chronic kidney disease.
Implications of findings and FDA’s next steps
Another discussant, C. Noel Bairey Merz, MD, called the CARES findings “curious.” But despite the lack of a plausible mechanistic explanation for the results, she said, the implications are clear.
“I would conclude that because your modified intention-to-treat as well as your per protocol analyses were consistent for the death endpoint, then despite the high dropout rate, that finding is relatively robust and probably should be used to inform policy,” said Dr. Merz, director of the Women’s Heart Center and the Preventive and Rehabilitative Cardiac Center in the Cedars-Sinai Heart Institute and professor of medicine at the University of California, Los Angeles.
At a press conference, Dr. White said the FDA will spend several months poring over the CARES results and that it would be premature to speculate on what action the agency might take on febuxostat. The drug is prescribed far less frequently than allopurinol for the nation’s estimated 8.2 million gout patients.
“I would certainly be concerned about our findings. However, rheumatologists take care of very ill patients and all the drugs they use have morbidity. So if they’re having substantial efficacy and the person has been on febuxostat for 8 years, I suspect they’re going to continue to give that drug to him,” he said.
Simultaneously with Dr. White’s presentation at ACC 2018, the CARES results were published in the New England Journal of Medicine (N Engl J Med. 2018 Mar 12. doi: 10.1056/NEJMoa1710895).
The CARES trial was funded by Takeda. Dr. White reported serving as a consultant to that company and Novartis and receiving research funding from the National Institutes of Health.
SOURCE: White W et al. ACC 18.
ORLANDO – Long-term treatment with febuxostat in gout patients with comorbid cardiovascular disease conferred significantly higher risks of both cardiovascular death and all-cause mortality, compared with allopurinol, in the Food and Drug Administration–mandated postmarketing CARES trial, William B. White, MD, reported at the annual meeting of the American College of Cardiology.
CARES (Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout and Cardiovascular Disease) was a prospective, double-blind, 320-center North American clinical trial in which 6,190 patients were randomized to febuxostat (Uloric) at 40-80 mg once daily or 200-600 mg of allopurinol once daily. The postmarketing safety study was required by the FDA as a condition of marketing approval for febuxostat in light of preapproval evidence suggestive of a possible increased risk of cardiovascular events, explained Dr. White, professor of medicine and chief of the division of hypertension and clinical pharmacology at the University of Connecticut, Farmington.
The warning klaxon sounded when investigators scrutinized the individual components of the primary endpoint. They found that the 4.3% cardiovascular death rate in the febuxostat group was significantly higher than the 3.2% rate in the allopurinol group, representing a statistically significant 34% increase in relative risk. The event curves began to separate roughly 30 months into the trial. Moreover, all-cause mortality was also significantly increased in the febuxostat group, by a margin of 7.8% to 6.4%, for a 22% increase in risk.
The increased cardiovascular mortality in the febuxostat group was driven by a higher adjudicated sudden cardiac death rate: 2.7%, compared with 1.8% in the allopurinol group.
In a prespecified per protocol analysis of cardiovascular events occurring while patients were actually on treatment or within 1 month after discontinuation, the key findings remained unchanged: no between-group difference in the primary composite endpoint, but a 49% increase in the relative risk of cardiovascular death in the febuxostat-treated patients.
A hefty 45% of participants stopped taking their assigned drug early. Dr. White said this isn’t unusual; high dropout rates are common in clinical trials of patients with painful conditions. Because of the high lost-to-follow-up rate, however, the investigators hired a private investigator to scour the country looking for missed deaths among enrollees. This turned up an extra 199 deaths. When those were added to the total, all-cause mortality in the febuxostat group was no longer significantly higher than for allopurinol.
The puzzle over nonfatal events
A puzzling key study finding was that except for cardiovascular death, the other components of the primary composite endpoint – that is, nonfatal MI, nonfatal stroke, and urgent revascularization due to unstable angina – were all either neutral or numerically favored febuxostat.
“That’s been the biggest challenge in the trial: The nonfatal events didn’t go in the same direction as the fatal events. And we don’t have a real mechanism to explain why,” Dr. White told a panel of discussants.
“I scanned the medical literature over the last 4 decades, and I did not see another prospective, randomized, double-blind trial in which mortality was increased when none of the nonfatal events were increased. The finding is unique. Statistically there is only a 4% chance that the mortality finding is wrong,” the cardiologist said.
The CARES leadership included rheumatologists and nephrologists as well as cardiologists. Dr. White said he and the others were at a loss to come up with an explanation for the findings.
Patients in the febuxostat arm were significantly more likely to achieve serum urate levels below 6 and 5 mg/dL. Their flare rate was 0.68 events per person-year, similar to the 0.63 per person-year rate in the allopurinol group.
Among the pieces of the study puzzle: The majority of cardiovascular deaths occurred in patients who were no longer on therapy, yet investigators could find no evidence of a legacy effect. The mortality risk was 2.3-fold greater with febuxostat than with allopurinol among patients on NSAID therapy, but there was no significant between-group difference among patients not taking NSAIDs. There was a trend for more cardiovascular deaths with febuxostat than allopurinol among patients not on low-dose aspirin. And the cardiovascular mortality was 2.2-fold greater in the febuxostat arm than with allopurinol in patients on colchicine during the study.
Notably, prior to febuxostat’s marketing approval there were extensive studies of the drug’s potential effect on left ventricular function, thrombotic potential, possible arrhythmogenic effects, and impact upon atherosclerosis. Among these investigations was a QT-interval study conducted using febuxostat doses four times higher than the maximum therapeutic dose, which was prescient given the increased sudden cardiac death rate in the subsequent CARES trial. Yet no concerning signals were seen in any of this work, he continued.
“We’re still looking at some correlates that might have an impact. For example, my rheumatologist colleagues feel very strongly that we need to look really extensively at gout flares, even though rates were not that different between the two treatment groups. Gout flares are known to increase oxidative stress and perhaps cause temporary increases in endothelial dysfunction and possibly vasomotor abnormalities,” Dr. White said.
One would think, though, that if gout flares figured in the increase in cardiovascular mortality they would also have been associated with more urgent revascularization for unstable angina, when in fact the rate was actually numerically lower in the febuxostat group, he noted.
Discussant Athena Poppas, MD, director of the Lifespan Cardiovascular Institute at Rhode Island Hospital, Providence, said she couldn’t determine how much of the increased cardiovascular mortality in the febuxostat patients was due to the drug and how much resulted from the suboptimal use of guideline-directed medical therapy across both study arms. At baseline, only 60% of study participants – all by definition at high cardiovascular risk – were on aspirin, just under 75% were on lipid-lowering therapy, 58% were on a beta blocker, and 70% were on a renin-angiotensin system blocker, even though the majority of subjects had stage 3 chronic kidney disease.
Implications of findings and FDA’s next steps
Another discussant, C. Noel Bairey Merz, MD, called the CARES findings “curious.” But despite the lack of a plausible mechanistic explanation for the results, she said, the implications are clear.
“I would conclude that because your modified intention-to-treat as well as your per protocol analyses were consistent for the death endpoint, then despite the high dropout rate, that finding is relatively robust and probably should be used to inform policy,” said Dr. Merz, director of the Women’s Heart Center and the Preventive and Rehabilitative Cardiac Center in the Cedars-Sinai Heart Institute and professor of medicine at the University of California, Los Angeles.
At a press conference, Dr. White said the FDA will spend several months poring over the CARES results and that it would be premature to speculate on what action the agency might take on febuxostat. The drug is prescribed far less frequently than allopurinol for the nation’s estimated 8.2 million gout patients.
“I would certainly be concerned about our findings. However, rheumatologists take care of very ill patients and all the drugs they use have morbidity. So if they’re having substantial efficacy and the person has been on febuxostat for 8 years, I suspect they’re going to continue to give that drug to him,” he said.
Simultaneously with Dr. White’s presentation at ACC 2018, the CARES results were published in the New England Journal of Medicine (N Engl J Med. 2018 Mar 12. doi: 10.1056/NEJMoa1710895).
The CARES trial was funded by Takeda. Dr. White reported serving as a consultant to that company and Novartis and receiving research funding from the National Institutes of Health.
SOURCE: White W et al. ACC 18.
REPORTING FROM ACC 18
Key clinical point: Gout patients on febuxostat were 34% more likely to die of cardiovascular causes than were those on allopurinol.
Major finding: Death due to cardiovascular causes occurred in 4.3% of febuxostat-treated patients and 3.2% assigned to allopurinol.
Study details: This prospective, randomized, double-blind, 320-center clinical trial included nearly 6,200 gout patients with comorbid cardiovascular disease.
Disclosures: The FDA-mandated CARES trial was sponsored by Takeda. The study presenter is a consultant to the company.
Source: White W et al. ACC 18.