JAMA current issueA 43-Year-Old Man With Angina, Elevated Troponin, and Lateral ST Depression [Clinical Crossroads]Ship, A.
Uniform Format for Disclosure of Competing Interests in ICMJE Journals [Editorial]Drazen, J. M., Van Der Weyden, M. B., Sahni, P., Rosenberg, J., Marusic, A., Laine, C., Kotzin, S., Horton, R., Hebert, P. C., Haug, C., Godlee, F., Frizelle, F. A., de Leeuw, P. W., DeAngelis, C. D.
This Week in JAMA [This Week in JAMA] Effect of Tarenflurbil on Cognitive Decline and Activities of Daily Living in Patients With Mild Alzheimer Disease: A Randomized Controlled Trial [Original Contribution]Green, R. C., Schneider, L. S., Amato, D. A., Beelen, A. P., Wilcock, G., Swabb, E. A., Zavitz, K. H., for the Tarenflurbil Phase 3 Study Group
Context Amyloid-β peptide (Aβ42) has been implicated in the pathogenesis of Alzheimer disease (AD). Tarenflurbil, a selective Aβ42-lowering agent, demonstrated encouraging results on cognitive and functional outcomes among mildly affected patients in an earlier phase 2 trial.
Objective To determine the efficacy, safety, and tolerability of tarenflurbil.
Design, Setting, and Patients A multicenter, randomized, double-blind, placebo-controlled trial enrolling patients with mild AD was conducted at 133 trial sites in the United States between February 21, 2005, and April 30, 2008. Concomitant treatment with cholinesterase inhibitors or memantine was permitted.
Intervention Tarenflurbil, 800 mg, or placebo, administered twice a day.
Main Outcome Measures Co-primary efficacy end points were the change from baseline to month 18 in total score on the subscale of the Alzheimer Disease Assessment Scale–Cognitive Subscale (ADAS-Cog, 80-point version) and Alzheimer Disease Cooperative Studies–activities of daily living (ADCS-ADL) scale. Additional prespecified slope analyses explored the possibility of disease modification.
Results Of the 1684 participants randomized, 1649 were included in the analysis, and 1046 completed the trial. Tarenflurbil had no beneficial effect on the co-primary outcomes (difference in change from baseline to month 18 vs placebo, based on least squares means: 0.1 for ADAS-Cog; 95% CI, –0.9 to 1.1; P = .86 and –0.5 for ADCS-ADL; 95% CI, –1.9 to 0.9; P = .48) using an intent-to-treat analysis. No significant differences occurred in the secondary outcomes. The ADAS-Cog score decreased by 7.1 points over 18 months. The tarenflurbil group had a small increase in frequency of dizziness, anemia, and infections.
Conclusion Tarenflurbil did not slow cognitive decline or the loss of activities of daily living in patients with mild AD.
Trial Registration clinicaltrials.gov Identifier: NCT00105547
Association of Plasma Leptin Levels With Incident Alzheimer Disease and MRI Measures of Brain Aging [Original Contribution]Lieb, W., Beiser, A. S., Vasan, R. S., Tan, Z. S., Au, R., Harris, T. B., Roubenoff, R., Auerbach, S., DeCarli, C., Wolf, P. A., Seshadri, S.
Context The adipokine leptin facilitates long-term potentiation and synaptic plasticity in the hippocampus, promotes β-amyloid clearance, and improves memory function in animal models of aging and Alzheimer disease (AD).
Objective To relate baseline circulating leptin concentrations in a community-based sample of individuals without dementia to incident dementia and AD during follow-up and magnetic resonance imaging (MRI) measures of brain aging in survivors.
Design, Setting, and Participants Prospective study of plasma leptin concentrations measured in 785 persons without dementia (mean [SD] age, 79 [5] years; 62% female), who were in the Framingham original cohort at the 22nd examination cycle (1990-1994). A subsample of 198 dementia-free survivors underwent volumetric brain MRI between 1999 and 2005, approximately 7.7 years after leptin was assayed. Two measures of brain aging, total cerebral brain volume and temporal horn volume (which is inversely related to hippocampal volume) were assessed.
Main Outcome Measure Incidence of dementia and AD during follow-up until December 31, 2007.
Results During a median follow-up of 8.3 years (range, 0-15.5 years), 111 participants developed incident dementia; 89 had AD. Higher leptin levels were associated with a lower risk of incident dementia and AD in multivariable models (hazard ratio per 1-SD increment in log leptin was 0.68 [95% confidence interval, 0.54-0.87] for all-cause dementia and 0.60 [95% confidence interval, 0.46-0.79] for AD). This corresponds to an absolute AD risk over a 12-year follow-up of 25% for persons in the lowest quartile (first quartile) vs 6% for persons in the fourth quartile of sex-specific leptin levels. In addition, a 1-SD elevation in plasma leptin level was associated with higher total cerebral brain volume and lower temporal horn volume, although the association of leptin level with temporal horn volume did not reach statistical significance.
Conclusion Circulating leptin was associated with a reduced incidence of dementia and AD and with cerebral brain volume in asymptomatic older adults.
Association Between Carrier Screening and Incidence of Cystic Fibrosis [Original Contribution]Castellani, C., Picci, L., Tamanini, A., Girardi, P., Rizzotti, P., Assael, B. M.
Context A downward trend in cystic fibrosis (CF) birth incidence has been reported in some areas.
Objective To evaluate the association between carrier screening and CF birth incidence.
Design, Setting, and Participants In northeastern Italy, CF birth incidence is monitored by means of a long-standing neonatal screening program. In the same area, 2 sections using different carrier detection approaches were identified—the western region, in which CF carrier tests are offered only to relatives of patients or to couples planning in vitro fertilization; and the eastern region, in which carrier testing is offered to relatives and carrier screening to infertile couples and to couples of reproductive age. A total of 779 631 newborns underwent CF neonatal screening between January 1993 and December 2007, of whom 195 had CF detected.
Main Outcome Measure Cystic fibrosis birth incidence in the 2 regions.
Results A time-related decrease in birth incidence was found, with a mean annual percentage decrease of 0.16 per 10 000 neonates (P < .001). In the western region, 2559 carrier tests were performed, 314 carriers were identified, and 9 carrier couples were detected. In the eastern region, 87 025 carrier tests were performed, 3650 carriers were identified, and 82 carrier couples were detected. The birth rate decrease was greater in the eastern region (decrease rate, 0.24; 95% confidence interval [CI], 0.12-0.36) than in the western region (decrease rate, 0.04; 95% CI, –0.16 to 0.08; P = .01). The increase in the number of screened carriers over time was significantly correlated with the decrease in CF birth incidence (correlation coefficient = –0.53; 95% CI, –0.20 to –0.74; P = .003).
Conclusion In northeastern Italy, carrier screening was associated with a decrease in the incidence of CF.
Subscribe to Associations RSS feed 