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Sunday, June 3, 2018

1-Hour Exercise, 3 Times a Week Boosts Cognition in Older Adults


Exercising for 52 hours over a 6-month period may be an optimal dose for cognitive improvement in older adults, a systematic review of 98 randomized clinical trials suggested.
Interventions that averaged 52 hours over a span of 6 months — averaging about an hour, 3 times a week — were linked to specific cognitive improvements in adults with and without cognitive impairment, reported Joyce Gomes-Osman, PT, PhD, of the University of Miami Miller School of Medicine, and colleagues in Neurology: Clinical Practice.
“The constructs of cognition that were most amenable to exercise were processing speed and executive function,” Gomes-Osman told MedPage Today. “This is an encouraging result because those two constructs are among the first that start to go with the aging process. “This is evidence that you can actually turn back the clock of aging in your brain by adopting a regular exercise regimen.”
Interestingly, statistical associations did not hold for memory improvement, noted Art Kramer, PhD, of Northeastern University in Boston, who was not involved in the study. “Despite the fact that animal studies have found robust memory benefits from exercise, memory benefits were not consistently observed in the human studies that were reviewed.”
Gomes-Osman’s group searched medical databases in December 2016 for randomized controlled trials that tested the effect of exercise on cognition. After a review of 4,612 relevant studies, they included 98 trials with a total of 11,061 participants in their review. Participants had an average age of 73 and 67.58% were female. Of the total sample, 59.41% of participants were classified as older healthy adults, 25.74% had mild cognitive impairment (MCI), and 14.85% had dementia.
The clinical trials assessed exercises that included walking, biking, dancing, strength training, tai chi, and yoga over spans from 4 weeks to 1 year. Most participants (58.2%) did not exercise regularly before enrolling in a study. Most studies used either high (37.8%) or medium intensity (36.7%) exercise.
Aerobic exercise, strength training, mind-body exercises like yoga and tai-chi, and combinations of exercises all were linked to improved cognitive skills in both healthy individuals and those with MCI. Only the total length of time over a 6-month period was linked to improved cognitive skills, not weekly exercise minutes.
“Although half of the exercise in the studies we assessed was in support of aerobic exercise, it doesn’t mean that aerobic exercise necessarily was more effective,” said Gomes-Osman. “It just means that more trials have actually studied aerobic exercise.”
Within aerobic exercise interventions, the most common exercise was walking, Gomes-Osman noted. “It’s encouraging to know that you don’t need to be running. If you start walking, you’re going to get benefit. But this is not window-shopping; this is walking. It’s physical exercise, not just physical activity.”
Since most participants did not exercise regularly before joining a trial, this data also “strongly supports that decreasing sedentary behavior is something associated with brain health,” Gomes-Osman said.
The effect of exercise on overall cognition is not clear because so few studies have assessed this, she added. And it’s possible that future trials — ones that compare different types of exercise, or evaluate exercise in both physically fit and sedentary people — may show different results.
Nonetheless, some cognitive benefit is clear. “I believe in giving people knowledge about outcomes,” Gomes-Osman said. “If you tell people to be active, they may be less interested overall than if you say ‘You can do this, this, this, or this, and you need to keep it up a couple times a week for about 6 months, and then you should get a benefit.’ I think that’s a better sell for patients.”
The study was supported by the Evelyn F. McKnight Institute at the University of Miami Miller School of Medicine.
Gomes-Osman and co-authors disclosed relevant relationships with Neosync, Starlab, Neuronix, Neuroelectrics, Constant Therapy, Cognito, and Novavision.
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Twice-weekly interferon called option in MS treatment


Among multiple sclerosis (MS) patients experiencing breakthrough disease on standard-dose once-a-week interferon beta 1-a (IFN-1α), switching to twice-weekly dosing may offer advantages, a researcher reported here.
More than half of patients with breakthrough disease and adequate follow-up (26/52 patients) who were switched to twice-weekly treatment had no further clinical relapses, new T2 lesions, or enhanced lesions on MRI, or worsening of Expanded Disability Status Scale (EDSS) during at least 14 months (range 14 to 192 months) of follow-up, according to Robert Baumhefner, MD, of the VA Greater Los Angeles Healthcare System.
He presented data on a 17-year experience treating MS patients with the twice-weekly dosage of intramuscular IFNβ-1a at the Consortium of Multiple Sclerosis Centers (CMSC) annual meeting.
Baumhefner told MedPage Today that standard practice for experiencing breakthrough disease on interferon treatment is to switch them to another drug. Eighteen drugs have been approved for the treatment of MS, but around half became available within the past decade.
“The long-term side effects of these newer agents are not known, so it might be advantageous to keep many of these patients — if they stabilize — on a drug that has been proven to be safe for 25 years,” Baumhefner said.
Several previous studies, including the PRISMS trial, have suggested a dose-response effect for IFN-β in the treatment of MS, but other studies have failed to show this. Baumhefner noted that prior studies have not addressed the strategy of doubling the IFN dosage and treatment schedule for IFN-treated patients with breakthrough disease.
A total of 107 MS patients were started on intramuscular IFNβ-1a at the MS clinic of the VA West Los Angeles Medical Center from 1995 to 2015, and 59 of these patients with breakthrough disease were switched to twice-weekly intramuscular IFNβ-1a. Fifty-two patients were followed for at least 2 years.
Patients were evaluated, on average, every 4 months. At each visit an interval history of any relapse, Incapacity Status Scale, Functional Systems Scale, Expanded Disability Status Scale (EDSS), and a proprietary graded neurologic examinations were obtained.
Annual MRI of the brain using a contrast-enhanced MS protocol was also obtained for most patients.
Breakthrough disease was defined as continued clinical relapses, new T2 or enhanced lesions on MRI, or worsening of EDSS or neurologic examination.
Five patients did not tolerate the increase in frequency of administration. IFNβ neutralizing antibody testing was performed on 25 patients while on twice-weekly dosing, and one patient who failed twice-weekly IFNβ had consistently elevated titers on two determinations (4%).
African-American patients, patients with a higher EDSS score when switching, and patients with a longer duration of stability on once-weekly treatment were less likely to respond.
Baumhefner said for many patients with breakthrough disease on standard IFNβ-1a, increasing the treatment dosage with twice-weekly therapy may be an acceptable alternative to switching treatments.
June Halper, MSN, MSCN, CMCS CEO, agreed, noting that “it makes a lot of sense for some patients to stay on a drug that has worked for them, and tweak the therapy if there is a breakthrough instead of automatically moving on to another drug,” she told MedPage Today.
Baumhefner said a prospective, blinded, randomized trial comparing once-weekly and twice-weekly intramuscular IFNβ-1a may be warranted.
Baumhefner disclosed no relevant relationships with industry.

Baby Teeth May Predict Autism


Zinc and copper metabolism cycles in the layers of baby teeth may be able to predict which children will develop autism spectrum disorder, a longitudinal analysis suggests.
This is the first study to generate a 90% accurate fetal and early childhood biomarker of autism by tracking metabolic pathways over time and could lead to new diagnostic tools, reported Paul Curtin, PhD, of Icahn School of Medicine at Mount Sinai in New York City, and colleagues in Science Advances.
Using novel tooth-matrix biomarkers that directly measured uptake of elements, the researchers found that children who later developed autism had disrupted zinc-copper rhythmicity in utero or in their earliest months of life.
“We looked at the naturally shed teeth of children and explored them much as you would explore the growth rings of a tree, using them as a sort of retrospective biomarker to see what children were exposed to in the womb and in early life. When we derived measures of metabolic cycles and used machine-learning algorithms to predict which children would develop autism, we found out we were 90% accurate in our predictions,” he told MedPage Today.
Prenatal and newborn children form a new tooth layer daily, which captures an imprint of chemicals circulating in the body and produces a chronological exposure record. Zinc and copper pathways are central regulators of multiple metals; disruption of the pathways may have downstream effects that may affect the metabolism of other essential elements and toxic metals.
For this study, the researchers analyzed teeth from 193 participants in four case-control samples — a discovery population of twins from Sweden, two similar groups from the United States, and a birth cohort from the United Kingdom — using a laser ablation technique to sample each tooth at an average of 152 locations. “The data from the teeth we analyzed covered primarily the second and third trimesters through a few months after birth,” Curtin said.
In all four study sets and in the pooled analysis, zinc-copper rhythmicity was disrupted in autism cases. The autism cases had three quantifiable characteristics altered: the average duration of zinc-copper cycles, the regularity with which the cycles recurred, and the number of complex features within a cycle.
Using two different classification models, the researchers achieved 90% accuracy in classifying cases and controls, with sensitivity to autism diagnosis ranging from 85% to 100% and specificity ranging from 90% to 100%.
“These cycles haven’t been well documented in the past,” said Curtin. “Here we are showing they are critical to neurodevelopment and when they are disrupted, we find that disruption is linked to autism and in fact, can be used to predict autism.”
The study also represents a new direction in autism biomarker research, he added. While many studies have assessed exposure levels, this analysis examined cycles to see how metabolism might be disrupted.
“With this research, we are shifting the focus to looking at metabolic cycles to understand how children are processing nutrients, as opposed to just looking at their exposure to toxicants.”
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#ASCO18: Merck seals up lung cancer lead with another solo Keytruda win


Merck’s Keytruda already boasts a standalone approval for lung cancer patients who haven’t been treated before, so long as their tumors bear high levels of the PD-L1 biomarker.  But it could soon reach beyond that group, thanks to data unveiled Sunday.
At the American Society of Clinical Oncology annual meeting, the New Jersey drugmaker rolled out results showing the drug helped patients live longer, regardless of PD-L1 level.
Keytruda monotherapy cut the risk of death by 19%, compared with chemo, in all patients who tested positive for the PD-L1 biomarker. The trial, Keynote-042 covered patients with both the squamous and non-squamous forms of non-small cell lung cancer.
Among patients with high PD-L1 levels, the drug performed even better. In those with levels of 20% or higher, Keytruda pared down the risk of death by 23%, and in those at 50% or higher, it cut the risk of death by 31%

Merck, for its part, wasn’t surprised by the data, said Roy Baynes, Merck SVP and head of global clinical development. He pointed out that Keytruda has recorded a survival benefit in each of five randomized controlled lung cancer trials. The company has “a lot of confidence in the molecule,” he said.
The question now, though, is how doctors will use the data. Merck’s Keytruda-chemo combo has already put up a stellar phase 3 showing in previously untreated patients, including cutting the risk of death by 51%.
“I think all things being equal, we would say that chemo combo offers a very, very good probability of a good outcome. If patients have comorbidities or reasons for which either the patient or the physician might be concerned that chemo may not be the best option, and if the patient is PD-L1 positive, it’s at least our position that monotherapy offers a reasonable option,” Baynes said.

After some major victories recentlyl, Keytruda is in prime position to run the all-important first-line lung cancer market. Also Sunday at ASCO, the company unveiled positive chemo-combo data in squamous first-line lung cancer, filling a hole in its patient population. Previously its data had focused mostly on patients with non-squamous disease.
“There are options for pretty much all patients in frontline,” Baynes said. With “really favorable data for a positive outcome,” Keytruda can now address “pretty much all of the lung cancer patients” other than those with specific mutations.

#ASCO18 Nektar presentation

In conjunction with ASCO’s Annual Meeting, management held an Analyst and Investor event to review presented data in Chicago on June 2 at 7:45 pm
Weblink: https://edge.media-server.com/m6/p/zxzhu7sh

#ASCO18 Immunomedics investor event webcast


Management hosts an Investor Event in conjunction with the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago on June 3 at 8:30 am
Weblink: https://edge.media-server.com/m6/p/ybfykk7o

#ASCO18 Celgene investor webcast today


Analyst and Investor Event will be held in conjunction with the American Society of Clinical Oncology’s (ASCO) Annual Meeting in Chicago on June 3 at 7:30 pm.
Weblink: https://edge.media-server.com/m6/p/j598ynwn