Findings Are Mixed on Use of Clot-Busting Drugs in the Elderly
Clot-busting drugs such as tPA have proved a lifesaver in the treatment of heart attacks and strokes--in young and middle-age adults, that is. For elderly patients, they may actually be life threatening.
The clinical trials of tPA, as with other new drugs, left out children and the elderly. Researchers have been able to determine the drugs’ effects on these groups only by looking at patients after the fact. As in similar cases, that provided a surprise.
Dr. David R. Thiemann of Johns Hopkins University and his associates studied data on 7,864 Medicare patients ages 65 to 86 who arrived at hospitals with a heart attack and who were candidates for clot-dissolving therapy. There were 5,191 patients ages 65 to 75 and 2,673 patients 76 to 86.
The team reported in Tuesday’s issue of the journal Circulation (https://circ.ahajournals.org) that 6.8% of the patients in the younger group who received the clot-busting drug died, compared with 9.8% of those who did not receive it. The findings were reversed in the older group, however: 18% of those treated with the drug died, compared with 15.4% of those who were not treated with it.
Antidepressant May Aid Women’s Sexual Arousal
Physicians rarely talk about wonder drugs anymore, but a small study indicates researchers may have found one in bupropion, an antidepressant that can help women both stop smoking and possibly have a better sex life.
As many as 20% of American women suffer from a syndrome called hypoactive sexual desire disorder, which means, simply, that they rarely get aroused, have few sexual fantasies and aren’t often interested in sexual activity.
Dr. R. Taylor Segraves of Case Western Reserve University School of Medicine in Cleveland and his colleagues studied 66 non-depressed women, ranging from 23 to 65 years old, who had been hyposexual for an average of six years. Each of the women received a placebo for four weeks and then 51 received bupropion for eight weeks.
Segraves reported Wednesday at a Chicago meeting of the American Psychiatric Assn. that, on average, the number of sexual arousals doubled when the women were taking bupropion, as did the number of sexual fantasies and the incidence of interest in sexual activities. Nearly 40% of the women given the drug reported being satisfied with their sexual desire at the end of the study, while 100% were dissatisfied before starting treatment. Bupropion is marketed as Wellbutrin for treating depression and as Zyban for stopping smoking. The study was funded by Glaxo Wellcome Inc., which sells Wellbutrin.
Possible Relief for Post-Cancer Hot Flashes
Another antidepressant may provide the first effective treatment for hot flashes in survivors of breast cancer, researchers from Georgetown University Medical Center reported Thursday at the same American Psychiatric Assn. meeting.
As many as 55% of breast cancer survivors suffer from hot flashes in the aftermath of their treatment. Many fear taking estrogen to relieve the symptoms because of the risk that it might cause a relapse of their cancer. Dr. Vered Stearns of Georgetown found there is an alternative for such women.
Stearns and his colleagues gave 31 women in the study a placebo for one week and then the antidepressant paroxetine for five weeks. Two-thirds of the women reported having half as many hot flashes while taking the drug, and three-quarters said the hot flashes they did have were less severe. Twenty-five of the women chose to continue taking the drug after the study was completed. Paroxetine, marketed as Paxil, is also used for relieving social anxiety.
Parkinson’s Team Backs New Treatment
The new drug ropinirole should replace levodopa as the first-line treatment for Parkinson’s disease because it has fewer side effects, researchers reported Thursday in the New England Journal of Medicine (https://www.nejm.org).
The question of which drug to use to control tremors and shaking early in the course of the disease has long been a contentious one among gerontologists, but the new results may resolve the dispute.
A multinational team in France studied 179 patients who received ropinirole and 89 who received levodopa as their first treatment for the disease. After five years, 45% of those receiving levodopa had developed movement disorders called dyskinesia--severe twitching and shaking--compared with 20% of those receiving the new drug. All other health measures were equivalent for the two drugs.
Arthritis Drug May Help Preemie Brains Develop
Indomethacin, a drug used for treating arthritis in adults, can help protect brain development in infants born prematurely, according to Yale researchers.
Premature infants suffer from a variety of problems, including a 10- to 15-point IQ loss compared with full-term infants. That deficit is caused, at least in part, by bleeding in the brain, and the Yale team hoped that indomethacin would reduce the bleeding.
Dr. Laura Ment and her colleagues studied 505 premature infants born between 1989 and 1992. Each infant underwent a cranial ultrasound six hours after birth to check for bleeding and a variety of developmental tests up to age 8. Half were given indomethacin at birth and half were given a placebo.
Ment reported Monday at a Boston meeting of the American Academy of Pediatrics that 31% of those who received indomethacin required special services in school compared with 58% of those who received a placebo. Children who received the drug also had higher verbal IQ scores, vocabulary scores and reading recognition scores.
Combo Therapy Fared Best in Depression Study
A combination of an antidepressant and psychotherapy is much more effective at treating depression than either alone, according to new research headquartered at Brown University. An estimated 14 million Americans suffer from severely debilitating chronic depression.
Researchers at a dozen clinics and medical centers studied 681 patients who had been depressed, on average, for 20 years. One-third received 16 to 20 sessions of specially designed psychotherapy over a 12-week period, one-third received the antidepressant Serzone (nefazodone), and the rest received both therapies.
The team reported in Thursday’s New England Journal of Medicine (https://www.nejm.org) that 85% of those receiving the combination therapy showed a significant response, compared with 55% of those receiving only the drug and 52% of those receiving only psychotherapy.
“For some of the study’s patients, who underwent the combination therapy, it was the first time in more than 20 years that they could sustain pleasure and function fully at work and with family and friends,” said Dr. Martin B. Keller, who headed the study.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
