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lancet medical journal
Leukemia drug alemtuzumab appears to be the “most effective” treatment for relapsing-remitting multiple sclerosis (MS), say British researchers.
During MS the body’s immune system turns on its own nerves causing debilitating muscle problems.
Researchers at the University of Cambridge say a cancer drug, which wipes out and resets the immune system, has better results than other options.
However, there is concern that a drugs company is about to increase the cost of the drug as a result.
Around 100,000 people in the UK have multiple sclerosis. When the condition is diagnosed most will have a form of the disease know as relapsing-remitting MS, in which the symptoms can almost disappear for a time, before suddenly returning.
The researchers tested a leukaemia drug, alemtuzumab, which had shown benefits for MS in small studies.
In leukaemia, a blood cancer, it controls the excess production of white blood cells. In MS patients, the dose eliminates the immune cells entirely, forcing a new immune system to be built from scratch which should not attack the nerves.
Two trials, published in the Lancet medical journal, compared the effectiveness of alemtuzumab with a first-choice drug, interferon beta-1a.
One compared the effectiveness in patients given the drug after being diagnosed, the other looked at patients given the drug after other treatments had failed.
Both showed the drug was around 50% more effective at preventing relapses and patients had less disability at the end of the study than when they started.
Leukemia drug alemtuzumab appears to be the “most effective” treatment for relapsing-remitting multiple sclerosis
Dr. Alasdair Coles, from the University of Cambridge, said: “Although other MS drugs have emerged over the last year, which is certainly good news for patients, none has shown superior effects on disability when compared to interferon except alemtuzumab.
“No other treatment has led to improvements in disability.”
He said: “It is certainly the most effective MS drug, based on these clinical trials, but this is definitely not a cure.”
However, he warned there were side-effects such as the risk of infection from a depleted immune system which meant the drug would not be suitable for everyone.
Dr. Alasdair Coles said he thought the drug would be most useful for patients for whom standard treatment had failed and in a “minority” of patients as a first-choice drug.
Eventually relapsing-remitting MS can become progressive MS as the good spells become shorter and less frequent. The drug will have no effect on this form of the disease.
The drug has been withdrawn from the market in Europe and the US as the manufacturer, Genzyme, intends to have it licensed as a treatment for MS.
A Lancet editorial warns: “There is concern that with a licence for multiple sclerosis, the cost of alemtuzumab could rise and might become too expensive for many patients and health systems.
“Finding promising treatments such as alemtuzumab is important. But so is keeping alemtuzumab accessible and affordable.”
Dr. Doug Brown, head of biomedical research at the MS Society, said: “These results are great news for people with relapsing-remitting multiple sclerosis.
“Alemtuzumab has been found to be an effective treatment for people with MS – but it’s only useful to them if it’s available on the NHS.
“We urge Genzyme to price the treatment responsibly so that if it’s licensed, it’s deemed cost-effective on the NHS.”
Genzyme said it would not come up with a price for the drug “until it is approved by regulatory authorities” and that it would “engage constructively” with the National Institute for Health and Clinical Excellence, which evaluates the cost-effectiveness of drugs for use in the NHS.
Having a highly demanding job, but little control over it, could be a deadly combination, British researchers have found.
They analyzed 13 existing European studies covering nearly 200,000 people and found “job strain” was linked to a 23% increased risk of heart attacks and deaths from coronary heart disease.
The risk to the heart was much smaller than for smoking or not exercising, the Lancet medical journal report said.
The British Heart Foundation said how people reacted to work stress was key.
Job strain is a type of stress. The research team at University College London said working in any profession could lead to strain, but it was more common in lower skilled workers.
Doctors who have a lot of decision-making in their jobs would be less likely to have job strain than someone working on a busy factory production line.
Having a highly demanding job, but little control over it, could be a deadly combination
There has previously been conflicting evidence on the effect of job strain on the heart.
In this paper, the researchers analyzed combined data from 13 studies.
At the beginning of each of the studies, people were asked whether they had excessive workloads or insufficient time to do their job as well as questions around how much freedom they had to make decisions.
They were then sorted into people with job strain or not and followed for an average of seven and a half years.
One of the researchers, Prof. Mika Kivimaki, from University College London, said: “Our findings indicate that job strain is associated with a small but consistent increased risk of experiencing a first coronary heart disease event, such as a heart attack.”
The researchers said eliminating job strain would prevent 3.4% of those cases, whereas there would be a 36% reduction if everyone stopped smoking.
Prof. Mika Kivimaki said the evidence of a direct effect of job strain on the heart was mixed.
He said job strain was linked to other lifestyle choices that were bad for the heart: “We know smokers with job strain are more likely to smoke a bit more, active people with job strain are more likely to become inactive and there is a link with obesity.
“If one has high stress at work you can still reduce risk by keeping a healthy lifestyle.”
Prof. Peter Weissberg, medical director at the British Heart Foundation, said: “We know that being under stress at work, and being unable to change the situation, could increase your risk of developing heart disease.
“This large study confirms this, but also shows that the negative effect of workplace strain is much smaller than, for example, the damage caused by smoking or lack of exercise.
“Though stresses at work may be unavoidable, how you deal with these pressures is important, and lighting up a cigarette is bad news for your heart. Eating a balanced diet, taking regular exercise and quitting smoking will more than offset any risk associated with your job.”
Dr. Bo Netterstrom, from Bispebjerg Hospital in Denmark, said other stresses at work such as job insecurity “are likely to be of major importance”.
He said job strain was “a measure of only part of a psychosocially damaging work environment”.
According to two studies, using small nets to extract blood clots from patients’ brains may be the future of stroke care.
Clots block blood vessels, starving parts of the brain of oxygen, which leads to symptoms such as paralysis and loss of speech.
Two studies, presented in the Lancet medical journal, suggest extracting clots with nets could improve recovery.
The Stroke Association said it was very excited by the treatment’s potential.
There are already techniques for reopening blocked blood vessels in people’s brains.
Some patients will be given “clot-busting” drugs, but this needs to be in the hours just after the stroke and is not suitable for everyone.
Other techniques have been developed to extract the clot. Some procedures pass a tube up through the groin to the brain. There the wire passes through the clot, forming a coil on the far side and then pulling the clot out. However, this is far from routine practice.
Clots block blood vessels, starving parts of the brain of oxygen, which leads to symptoms such as paralysis and loss of speech
The latest methods involve a tiny wire cage instead of a coil. This pushes the clot up against the walls of the artery and enmeshes the clot in the wires, allowing doctors to pull the clot back out of the groin.
Two similar devices were compared with the current coil methods. One trial of 113 patients showed 58% had good brain function after three months, compared with 33% of those treated with the coil method, as well as a lower death rate.
Another study in 178 patients showed almost double the chance of living independently after treatment.
One of the researchers involved, Prof. Jeffrey Saver from the University of California, Los Angeles, said these techniques would become more common, as they are more likely to clear clots than drugs.
“Clot-busting drugs only partially reopen 40% of large blocked arteries. These devices partially reopen 70-90% of large blocked arteries.
“Second, these devices can be used in patients in whom it is not safe to give ‘clot busting’ drugs, such as patients taking anticoagulant medications, patients who had recent surgery, and patients who are between 4.5 to eight hours after stroke onset.”
In the long term he can see drugs being used as a first option and then clot removal if the drugs fail or cannot be used.
Responding to the research, the Stoke Association’s Dr. Clare Walton said clot-busters did not work for all patients so new techniques could help many patients.
She added: “Clot retrieval devices have the potential to be used with more stroke patients and are better at removing blood clots than clot-busting drugs.
“We are very excited about this potential new treatment and look forward to further developments.”
Dr. Philip Gorelick, from Michigan State University, said the studies were “major steps forward in the successful treatment of acute ischaemic stroke, and pave the way for new treatment options”.
The research was published to coincide with a European Society of Cardiology meeting in Munich.
An analysis of 20 studies showed that eating dark chocolate daily resulted in a slight reduction in blood pressure.
The Cochrane Group’s report said chemicals in cocoa, chocolate’s key ingredient, relaxed blood vessels.
However, there are healthier ways of lowering blood pressure.
The theory is that cocoa contains flavanols which produce a chemical in the body called nitric oxide. This “relaxes” blood vessels making it easier for blood to pass through them, lowering the blood pressure.
An analysis of 20 studies showed that eating dark chocolate daily resulted in a slight reduction in blood pressure
However, studies have thrown up mixed results. The Cochrane analysis combined previous studies to see if there was really an effect.
There was a huge range in the amount of cocoa consumed, from 3 g to 105 g a day, by each participant. However, the overall picture was a small reduction in blood pressure.
A systolic blood pressure under 120 mmHg (millimetres of mercury) is considered normal. Cocoa resulted in a 2-3 mmHg reduction in blood pressure. However, the length of the trials was only two weeks so the longer term effects are unknown.
Lead researcher Karin Ried, from the National Institute of Integrative Medicine in Melbourne, Australia, said: “Although we don’t yet have evidence for any sustained decrease in blood pressure, the small reduction we saw over the short term might complement other treatment options and might contribute to reducing the risk of cardiovascular disease.”
High blood pressure is both common and deadly. It has been linked to 54% of strokes worldwide and 47% of cases of coronary heart disease.
However, chocolate packs plenty of fat and sugar as well as cocoa so is not the ideal way of lowering blood pressure.
There has also been a warning in the Lancet medical journal that dark chocolate may contain fewer flavanols than you might think. Dark chocolate contains a higher cocoa count than milk chocolate so should contain more flavanols, however, they can also be removed as they have a bitter taste.
Experts at the Cedars-Sinai Heart Institute in US say that damage caused by a heart attack has been healed using stem cells gathered from the patient’s own heart.
The amount of scar tissue was halved in the small safety trial reported in the Lancet medical journal.
According to the authors, there was also an “unprecedented” increase in new heart muscle.
A heart attack happens when the organ is starved of oxygen, such as a clot blocking the flow of blood to the heart.
As the heart heals, the dead muscle is replaced with scar tissue, but because this does not beat like heart muscle the ability to pump blood around the body is reduced.
Doctors around the world are looking at ways of “regenerating” the heart to replace the scar tissue with beating muscle. Stem cells, which can transform into any other type of specialized cell, figure prominently in their plans.
This trial, at the Cedars-Sinai Heart Institute, was designed to test the safety of using stem cells taken from a heart attack patient’s own heart.
Within a month of a heart attack, a tube was inserted into a vein in the patient’s neck and was pushed down towards the heart. A sample of heart tissue, about “half the size of a raisin”, was taken.
This was taken to the laboratory where the stem cells were isolated and grown. Up to 25 million of these stem cells were then put into the arteries surrounding the heart.
Twenty five patients took part in the trial. Before the treatment, scar tissue accounted for an average of 24% of their left ventricle, a major chamber of the heart. It went down to 16% after six months and 12% after a year.
Healthy heart muscle appeared to take its place. The study said the cells “have an unprecedented ability to reduce scar and simultaneously stimulate the re-growth of healthy [heart] tissue”.
One of the researchers Dr. Eduardo Marban said: “While the primary goal of our study was to verify safety, we also looked for evidence that the treatment might dissolve scar and re-grow lost heart muscle.
“This has never been accomplished before, despite a decade of cell therapy trials for patients with heart attacks. Now we have done it.
“The effects are substantial, and surprisingly larger in humans than they were in animal tests.”
However, there was no increase in a significant measure of the heart’s ability to pump – the left ventricle ejection fraction: the percentage of blood pumped out of the left ventricle.
Prof. Anthony Mathur, who is coordinating a stem cell trial involving 3,000 heart attack patients, said that even if the study found an increase in ejection fraction then it would be the source of much debate.
He argued that as it was a proof-of-concept study, with a small group of patients, “proving it is safe and feasible is all you can ask”.
“The findings would be very interesting, but obviously they need further clarification and evidence,” he added.
A vaccine against one of the most common forms of childhood meningitis could reduce the number of deaths in the world.
The current vaccination programme protects against only some of the bacterial types involved.
A Chilean study, reported in The Lancet medical journal, found more evidence the new vaccine works against the B form of the disease.
This causes about 2,000 cases in the UK each year, mostly in the under-fives.
The meningitis vaccine programme here is thought to have saved many hundreds of lives over the past decade.
However, meningitis B has been an elusive target for vaccine developers, as it is a group of thousands of subtly-different strains of bacteria, making it difficult to find a single jab that could cover them all.
So while four other major strains are included in the vaccine, the danger from meningitis B remains.
The infection, which causes inflammation of membranes surrounding the spinal cord and brain, still causes more than 100 deaths a year, with many more children suffering serious and potentially disabling illness.
Meningitis B has been an elusive target for vaccine developers, as it is a group of thousands of subtly-different strains of bacteria, making it difficult to find a single jab that could cover them all
Scientists produced the “4CMenB” vaccine by analyzing the genetic structure of thousands of B strains, looking for shared features which could be targeted.
There have already been encouraging results when given to toddlers, and the latest study, carried out by University of Chile scientists, looked at its effectiveness when given to 11 to 17-year-olds.
More than 60% of bacterial meningitis cases in Chile involve type B, but two doses of the vaccine appeared to offer almost 100% protection.
The researchers said that the vaccine could now be considered for vaccination programmes in countries where the B type was prevalent, including many in Europe, and the United States.
Dr. Myron Christodoulides, a senior lecturer in Molecular Microbiology at the University of Southampton, said that the full range of type B strains covered by the vaccine was not yet proven.
He said: “Previous studies have shown that 4CMenB has the potential to provide significant protection when administered to infants – this new study shows it could also be highly protective in the adolescent age group.
“However, there are still a number of important questions to be answered such as how many strains it will protect against, how long the protection will last and whether it will stop the bacteria from being passed on to others, providing indirect protection to those not vaccinated.”
