News in brief - Nov. 10, 2003

Slowing Alzheimer's - Vaccine rumors - Tri-monthly contraceptive may be cost-effective - Medical societies release obesity, overweight treatment guides

Slowing Alzheimer's

The first drug to treat late-stage Alzheimer's patients was approved Oct. 17 by the Food and Drug Administration. Memantine, which will be marketed by Forest Laboratories Inc. as Namenda, has been effective in slowing the course of the disease for some patients. However, there is no evidence that the drug halts the disease's progression.

The new drug is an N-methyl-D-asparate antagonist and is thought to work by blocking the action of glutamate.

The most frequently reported adverse effects of the drug were dizziness, reported in 7% of those taking it; headache, reported in 6%; and constipation, 6%.

The drug has been used in Germany since 1980.

Memantine was studied in two U.S. double-blind studies, each about six months long, involving 250 and 400 patients respectively. The larger study was carried out in patients taking donepezil, a drug already approved for treatment of Alzheimer's disease.

Both studies showed that patients on memantine experienced less deterioration in their symptoms compared with patients treated with placebo. A third study, conducted in nursing homes in Latvia, was a 12-week double blind study in 166 patients with severe Alzheimer's disease. Memantine also demonstrated a statistically significant advantage over placebo in that study.

Vaccine rumors

There is no truth to a rumor that a contaminated lot of flu vaccine has been recalled, said the Food and Drug Administration and the Centers for Disease Control and Prevention. No contamination of any flu vaccine has been identified anywhere in the United States and the FDA has not recalled any lot of flu vaccines, said the joint Oct. 17 announcement.

The agencies note that flu vaccine can result in side effects such as arm soreness, redness or swelling where the shot was given, fever or achiness. More serious reactions are rare.

The FDA and CDC are investigating several reports of possible significant allergic reactions to flu vaccine; however, those reactions do not suggest any problem with the vaccine.

The agencies also noted that, while serious reactions to the flu vaccine are rare, the flu itself each year causes about 114,000 people in the United States to be hospitalized and 36,000 to die. October and November are the best months to get vaccinated but vaccination in December or later will still provide protection, said the federal health agencies.

Tri-monthly contraceptive may be cost-effective

Oral contraceptives that allow only four menstrual cycles per year may be associated with significant cost savings for patients and society when compared with standard regimens that allow for 12 per year, according to a paper published in the October Obstetrics and Gynecology.

Researchers at Johns Hopkins University in Baltimore analyzed the medical literature since 1966 regarding cost studies associated with the monthly pill. The analysis considered money paid for the medication, female hygiene products, pain relievers, iron tablets, pregnancy tests and physician visits. Researchers also considered the cost of lost productivity because of menstrual symptoms or doctors' appointments. They found that as long as the tri-monthly was priced no more than 9% over the monthly version, it would save individuals $41 a year per patient with no additional cost to third-party payers.

The Food and Drug Administration approved the first tri-monthly contraceptive in September. It is expected to be available by the end of the year.

Medical societies release obesity, overweight treatment guides

Two major medical societies are publishing guidebooks to help physicians aid the growing number of patients in their practices who are overweight or obese.

The American Academy of Family Physicians in September published "Practical Advice for Family Physicians to Help Overweight Patients." The American Medical Association in December plans to release a 10-booklet set called "Assessment and Management of Adult Obesity." The series is part of the AMA's Roadmaps for Clinical Practice -- Case Studies in Disease Prevention and Health Promotion, published in conjunction with the U.S. Dept. of Health and Human Services.

Both publications include information about the evaluation of overweight patients, assessment of readiness to change and information about treatment options.

"It is important to recognize that this advice does not focus on dieting," said Thomas McKnight, MD, MPH, editor of the AAFP's guide. "It points to the fact that in the long-term, prevention of additional weight gain may be as important to health as weight loss. Small lifestyle changes in eating and activity habits can have the most significant impact on people's health because they are the kinds of changes that can be sustained throughout one's lifetime."

According to the Centers for Disease Control and Prevention, 65% of Americans are overweight or obese.