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Saturday, September 7, 2019

Greater Cognitive Decline Seen in Seniors Unaware of Having Hypertension

For adults aged 55 years and older, those unaware they have hypertension have greater cognitive decline, according to a study presented at the American Heart Association Hypertension 2019 Scientific Sessions, held from Sept. 5 to 8 in New Orleans.
Shumin Rui, from Columbia University in New York City, and colleagues followed a national sample of 10,958 mid-aged and elderly Chinese for four years. The correlation of hypertension status and treatment with cognitive decline over time was assessed in different age groups.
The researchers observed a decrease in overall cognition scores, from 11.01 in 2011 to 10.24 in 2015. For 6,971 participants aged 55 years and older, there was a 0.57-point larger cognition decline for patients with hypertension who were not aware of their condition compared with those without hypertension; compared with those who were unaware of their hypertension, those on antihypertensive treatment had a 0.56-point smaller cognition decline. Cognition decline was similar for patients on antihypertensive treatment and those without hypertension. After adjustment for education, gender, and residency, the results were similar. No differences in cognition decline were seen for any group of participants aged 45 to 54 years.
“We think efforts should be made to expand high blood pressure screenings, especially for at-risk populations, because so many people are not aware that they have high blood pressure that should be treated,” Rui said in a statement.

Diabetes Control Has Stalled Across U.S.

U.S. adults with diabetes are no more likely to meet disease control targets than they were in 2005, a new study finds.
Typically, diabetes treatment focuses on controlling blood sugar, blood pressure and cholesterol levels, as well as not smoking.
For the study, Massachusetts General Hospital researchers analyzed data on diabetes care in the United States from 2005 through 2016. The investigators found that one in four adults with diabetes was not diagnosed, and nearly one in three was not receiving appropriate care for diabetes.
“Fewer than one in four American adults with diagnosed diabetes achieve a controlled level of blood sugar, blood pressure and cholesterol and do not smoke tobacco,” said study lead author Pooyan Kazemian, of the hospital’s Medical Practice Evaluation Center.
“Our results suggest that, despite major advances in diabetes drug discovery and movement to develop innovative care delivery models over the past two decades, achievement of diabetes care targets has not improved in the United States since 2005,” Kazemian said in a hospital news release.
More than 30 million Americans have diabetes. Most have type 2, which is linked to lifestyle.
Certain groups of patients were less likely to achieve diabetes care targets, according to the study.
“Younger age (18-44), female and nonwhite adults with diabetes had lower odds of achieving the composite blood sugar, blood pressure, cholesterol and nonsmoking target,” Kazemian said.
Patients with insurance coverage were most likely to have been diagnosed with diabetes and to have achieved treatment targets, the researchers noted.
According to study senior author Dr. Deborah Wexler, “Barriers accessing health care, including lack of health insurance and high drug costs, remain major factors that have not been adequately addressed on a population level.” Wexler is with the hospital’s diabetes unit and is an instructor in medicine at Harvard Medical School.
“Treatment advances in diabetes mellitus can meaningfully improve outcomes only if they effectively reach the populations at risk. Our findings suggest this is not the case in the U.S.,” Wexler said.
The findings, she added, indicate an immediate need for better approaches to diabetes care delivery, “including a continued focus on reaching underserved populations with persistent disparities in care.”
The study was published online recently in JAMA Internal Medicine.

Tiny fat bubbles key to rebooting immune system, calming disease process

People living with inflammatory autoimmune disease could benefit from an ‘immune system reboot’, and researchers have isolated specific cells to target.
The University of Queensland’s Professor Ranjeny Thomas said the research findings give hope for similar new immunotherapies for people with diseases like rheumatoid arthritis and vasculitis.
People with these diseases currently require daily medications to modify or suppress their immune system.
Rheumatoid arthritis and vasculitis have a huge impact on those living with them because there is no cure, and medication generally cannot be stopped.
We think a better strategy would be to restore and re-regulate the specific part of the immune response that has gone wrong.”
Professor Ranjeny Thomas, University of Queensland
She said such “precision medicines” were a big focus for researchers seeking new ways to treat and prevent autoimmune diseases.
Her research team has reported an “antigen-specific immunotherapy”, and demonstrate that it could re-regulate the rogue immune T-cells that are markers of inflammatory arthritis or vasculitis in mice.
“We found that dendritic cells – conductors of the immune system orchestra – absorb tiny fat bubbles we generated, restoring immune regulation,” Professor Thomas said.
“These fat bubbles, called liposomes, held the key to rebooting the immune system and calming the disease process.
“This study shows in mice that antigen-specific immunotherapy can be used to treat existing inflammatory autoimmune diseases, as well as to prevent future disease.
“Importantly, it shows that inflammatory activity is not a barrier to restoring regulation in the immune system.”
People living with rheumatoid arthritis or vasculitis have rogue T-cells that attack the body’s own tissues, escaping the normal regulation that keeps these cells in check.
The antigen-specific liposome immunotherapy treatment helps restore immune cells to healthy function.
The research brings doctors closer to understanding the best ways to use precision medicine for human inflammatory autoimmune diseases.
Source:
Journal reference:
Galea, R. et al. (2019) PD-L1 and calcitriol dependent liposomal antigen-specific regulation of systemic inflammatory autoimmune disease. JCI Insightdoi.org/10.1172/jci.insight.126025.

Focus on Biden health underscores Trump attacks

Conservative media’s focus on Joe Biden’s health this week underscores how attacks on the former vice president’s age are likely to be a big part of the race if he’s the Democratic nominee.
Biden will turn 77 this fall, and the issue of his age has repeatedly resurfaced since he entered the presidential race.
President Trump, who is just four years younger than Biden, already has made a number of allusions to Biden’s age, accusing the former vice president just last month of “not playing with a full deck.”
Democrats and Republicans alike say they expect Trump to continue to play the age card, particularly whenever Biden makes a gaffe.
“They’re going to make it all about him not being physically fit for the job,” said Shermichael Singleton, a Republican strategist who briefly worked for the Trump administration. “Republicans will use it to point out that he’s not ready for the job on day one.”
The Drudge Report this week made a banner headline out of a story from the conservative Washington Examiner about a broken blood vessel in Biden’s left eye.
Mainstream media outlets barely mentioned the incident, and the blood in Biden’s eye was hardly noticeable for many people watching the climate summit hosted live by CNN.
But right-wing outlets played Biden’s eye as a major piece of news, foreshadowing attacks likely to come next summer and fall if Biden, the Democratic front-runner, wins his party’s nomination.
The effort would be familiar to anyone who remembered attacks on Hillary Clinton’s age and physical stamina in 2016.
Singleton predicted that Republicans will use “the same tactics” they used against Clinton in 2016 after she had pneumonia and nearly fainted at a Sept. 11 event that year.
Democrats — particularly those who worked for Clinton — agree with that sentiment.
Zac Petkanas, a Democratic strategist who worked on Clinton’s 2016 campaign, said it’s part of a larger narrative driven by conservatives.
“All candidates should be on the lookout,” Petkanas said, adding that it “certainly did have an impact” on Clinton’s campaign and could also dent candidates such as Biden.
He also suggested the argument could also be used against any Democrat who could be classified as a senior citizen. The two Democrats chasing Biden in polls are Sen. Elizabeth Warren (D-Mass.), who is 70, and Sen. Bernie Sanders (I-Vt.), who is 77.
“Anybody over 60 would be susceptible,” Petkanas said.
Adam Parkhomenko, who also worked on Clinton’s 2016 campaign, added that it’s “part of a limited line of attacks” that Republicans have “always used and are clearly planning to use this time.”
Other Democrats haven’t made an issue of Biden’s age, though some strategists say it will be fair game this fall as the race gets hotter — particularly if Biden makes more verbal flubs.
Implicit, age-based attacks already are appearing.
Tech businessman Andrew Yang, for example, said this week that electing Biden would take the country back in time — a nod to the attack by some Democrats that Biden is not from the generation that should lead the party in the future.
It wasn’t an attack on Biden’s health or even a direct attack on his age, but it skirted close to the issue.
Rep. Tim Ryan (D-Ohio), one of the lower-tier Democratic challengers, also said he didn’t think Biden had what it takes to defeat Trump.
“I just think Biden is declining. I don’t think he has the energy,” Ryan said, according to Bloomberg News. “You see it almost daily. And I love the guy.”
Ryan later added he did not know he was speaking to a reporter and that he was trying to raise money for his campaign, Bloomberg reported.
“The Democratic presidential campaign is as much a generational battle as it is an ideological contest,” said Democratic strategist Brad Bannon, adding that the Democratic victories in 2018 of young progressive candidates such as Reps. Alexandria Ocasio-Cortez (D-N.Y.) and Ayanna Pressley (D-Mass.) against older Democrats “were manifestations of generational conflict.”
Biden’s campaign declined to comment for this story.
Sanders and Warren may not want to make age an issue, but former Rep. Beto O’Rourke (D-Texas) and South Bend, Ind., Mayor Pete Buttigieg may try “to capitalize,” Bannon said.
“So any physical problem like Biden’s eye that raises questions about a 70-something candidate’s health will be an ongoing storyline for the media and a problem for his campaign,” he added.
Biden allies say they expect Trump to continue to come after the candidate as the primary plays out and the former vice president looks to retain his front-runner status.
https://thehill.com/homenews/campaign/460319-focus-on-biden-health-underscores-future-trump-attacks

Prescription Databases May Miss Opioid-Benzo Combinations

Prescription data alone underestimated how many patients combined opioids and benzodiazepines, an analysis of Quest Diagnostics drug test data indicated.
Among a selected sample of patients whose drug test indicated concurrent benzodiazepine and opioid use, 64% had at least one benzodiazepine or opioid that was not prescribed, according to Quest researcher Leland McClure, PhD, and colleagues in a poster presentation at the 2018 PAINWeek conference.
“Clinicians need to be aware if their patients are using potentially dangerous combinations of drugs like benzodiazepines and opioids,” McClure told MedPage Today. “Because state-based prescription drug monitoring programs are limited to drugs prescribed, more effective detection of drug use is achieved by supplementing the prescribed drug database information with objective methods like drug testing.”
Benzodiazepines can increase the respiratory depressant effects of opioids: a recent review of health claims data showed that among opioid users, concurrent use of benzodiazepines more than doubled the risk of an overdose-related emergency room or inpatient visit. An estimated 23% of people who died of an opioid overdose in 2015 also tested positive for benzodiazepines. Both prescription opioids and benzodiazepines now carry FDA boxed warnings highlighting the dangers of using these drugs together.
The Quest Diagnostics analysis was based on 456,675 sets of test results from 276,953 patients in 50 states and the District of Columbia in 2017. Specimens were from patients who were prescribed at least one drug and who were tested for both opioids and benzodiazepines. All results included a report indicating what tested medication was prescribed and whether the prescribed drugs were detected in a specimen.
The laboratories performed drug testing with quantitative definitive tandem mass spectrometry; presumptive immunoassay screens preceded some of these tests. Immunoassays were performed using tests modified to detect target drugs exhibiting low cross-reactivity. “Our analysis defined relationship groups to ensure that drugs that could be metabolites of other drugs did not falsely inflate positivity rates,” McClure added.
In this cohort, 68.2% of specimens tested positive for opioids (including buprenorphine and methadone) and 29.2% tested positive for benzodiazepines. Overall, 20.6% of specimens tested positive for concurrent use of benzodiazepines and opioids. Of these patients, 36% had been prescribed both drug classes and 64% had at least one non-prescribed drug.
About 16% of specimens that tested positive for prescribed opioids also tested positive for non-prescribed benzodiazepines. Similarly, about 13% of specimens that tested positive for prescribed benzodiazepines tested positive for non-prescribed opioids.
“The extent of concurrent use of benzodiazepines and opioids, particularly non-prescribed use, cannot be determined by prescription drug database monitoring programs alone,” the researchers concluded.
The CDC recommends reviewing prescription drug monitoring program data to determine whether a patient is receiving combinations like opioids and benzodiazepines that may create a high risk for overdose, performing urine drug tests before starting patients on opioid therapy, and considering drug testing at least annually to assess for prescribed medications and illicit drugs.
The analysis has several limitations: With 68% of specimens testing positive for opioids, the results may be more representative of a monitored group of patients than the general population; also, complete prescribing information may not have been available.
This analysis was funded by Quest Diagnostics.
The authors are employees of Quest or consultants for the company; they reported having no other conflicts of interest.
Primary Source
PAINWeek
Source Reference: Gudin J, et al “Concurrent use of opioid and benzodiazepine:what the prescription drug monitoring database does not tell you” PAINWeek 2018; Abstract 44.

CVS moving to change healthcare: A timeline since the Aetna acquisition

Since buying health insurer Aetna in November, CVS Health has emphasized holistic healthcare rather than just selling medicine. The company said it hopes its strategic shift will lead to healthier communities and lower healthcare costs.
Below is a timeline of health-related moves from CVS reported by Becker’s Hospital Review since it finalized its deal with Aetna. The timeline doesn’t include the CVS acquisitions of other retail pharmacies.
Nov. 28, 2018. CVS Health closes its $69 billion acquisition of Aetna. CVS Health President and CEO Larry Merlo says the deal “will simplify a complicated system and will help people achieve better health at a lower cost. We are also leading change in healthcare by challenging the status quo with new technologies, business models and partnerships.”
Jan. 9. Mr. Merlo says CVS will kick-start specialized services for Aetna members with cardiovascular disease and pilot a readmission prevention program. Under the program, CVS plans to schedule MinuteClinic follow-ups within 14 days of hospital discharge when patients are unable to see a physician.
Jan. 14. CVS announces it will spend $100 million over the next five years on community health initiatives. It pledges to give $20 million annually to initiatives in three categories: improving local access to affordable, quality care; impacting public health challenges; and partnering with local communities.
Jan. 30. Reports surface that CVS is piloting dental services. Under the program, CVS will help fit people for invisible braces via SmileDirectClub, a startup that offers direct-to-consumer teeth-straightening kits. Six of its drugstores will add a SmileShopExpress for customers to receive a 3D scan of their teeth to create invisible braces.
Feb. 13. CVS Health unveils three redesigned health-focused concept stores in the Houston market. The pilot stores, called HealthHubs, have space for services to help customers manage such chronic conditions as diabetes, hypertension and asthma. Each store also has an expanded health clinic with a lab for blood testing and health screenings. The stores have respiratory specialists and dietitians on staff.
Feb. 26. It is announced that CVS will spend $325 million and $350 million on technology to support offering more convenient healthcare.
March 20. CVS starts selling cannabis-based products in eight states
April 4. CVS expands its same-day prescription delivery service to 6,000 stores. The move comes as such retailers as CVS and Walgreens fight to compete with Amazon, which offers same-day delivery on toothpaste, bandages and other consumer health products.
May 1. CVS Health and Allentown, Pa.-based Lehigh Valley Health Network sign a five-year agreement that allows Lehigh Valley Health to share its EHR data with CVS to help connect the dots between patients, pharmacies, physicians and other health networks.
May 6. CVS Health’s subsidiary ProCare Pharmacy announces it will buy healthcare improvement company Premier’s specialty pharmacy.
June 4. After success with its pilot sites in Houston, CVS Health announces plans to open 1,500 HealthHub stores by the end of 2021.
June 11. CVS Health launches a platform that will allow its pharmacy benefit management clients to better manage contracts with third-party health and wellness vendors. The tool, Vendor Benefit Management, will offer CVS Caremark clients access to data on negotiated pricing, real-time eligibility verification and simpler billing and payment processing.
July 10. MinuteClinic, CVS Health’s retail medical clinic, launches telehealth programs in eight more states. Patients with minor illnesses, injuries or skin conditions now can seek care through virtual video visits in Arkansas, Connecticut, Hawaii, Indiana, Minnesota, Missouri, Oklahoma and Texas.
July 17. CVS Health starts clinical trials of a home kidney dialysis device, HemoCare — a move that could shake up the end-stage kidney care market and create a new healthcare business for the retail pharmacy giant. The move to provide at-home dialysis care sets up the retail pharmacy giant to compete with two of the largest operators of U.S. dialysis centers, Fresenius Medical Care and DaVita.
July 24. CVS Health launches a network to help connect Aetna’s most vulnerable patients to support services in their communities. CVS will collaborate with Unite Us, a social care coordination platform, to help Aetna’s Medicaid and dual-eligible Medicaid and Medicare members more easily access social services in their communities. Under the program, eligible members will be able to access Unite Us’ network of social care providers.
July 30. CVS Health selects Sree Chaguturu, MD, to serve as CMO of its pharmacy benefits management business, CVS Caremark. Dr. Chaguturu served as chief population health officer for Boston-based Partners HealthCare.
Aug. 5. CVS Health expands its pharmacy loyalty and membership program nationwide. The CarePass program offers delivery of products ranging from shampoo to prescription medications. To participate, program customers pay $5 a month, or $48 annually, for one- to two-day delivery of drugstore products and prescription drugs, 24/7 access to a pharmacist helpline and a 20 percent discount on CVS Health-branded products.
https://www.beckershospitalreview.com/pharmacy/cvs-moving-to-change-healthcare-a-timeline-since-the-aetna-acquisition.html

BenevolentAI and Novartis sign AI R&D deal

The Artificial Intelligence (AI)-based drug development firm BenevolentAI has signed an agreement with Novartis to find potential new uses for oncology drugs already in its pipeline.
UK-based BenevolentAI said the collaboration programme will be led by Novartis’ Precision Medicine Team, within the company’s Global Drug Development operation.
The so-called “framework collaboration” will see the two companies investigate indications and responder groups for oncology drugs currently in clinical development.
BenevolentAI will apply its technology designed to enable better data-driven decisions to find new ways to treat disease and personalise drugs for patients.
The UK firm’s technology scans through molecular, clinical, pharmacological data and scientific literature to derive relationships in the data between genes, diseases, drugs and biological pathways leading to the proposal of novel or optimal drug targets.
It aims to support scientists designing and optimising drug molecules for defined patient populations.
Founded in 2013, London-based BenevolentAI is already well-established in the field of drug R&D and is considered to be a biotech “unicorn” – a privately-held company worth more than $1 billion.
This year it raised a further $115 million from new and existing investors to increase its value to more than $2 billion,
BenevolentAI already has several high-profile research collaborations, including AstraZeneca, and licensed in a group of drugs to develop from Janssen in 2016.
It has acquired a new R&D facility in Cambridge, where AstraZeneca has also located its new R&D hub.
The collaboration with AZ is based around research for new treatments for chronic kidney disease and idiopathic pulmonary fibrosis.
Big pharma is increasingly turning to AI to make the drug discovery process faster and more efficient, such as using the technology to sort through the countless millions of molecules that could react with a drug target.
Celgene recently signed an oncology R&D deal with BenevolentAI’s UK rival, Exscientia, which is also working with GlaxoSmithKline.
Earlier this week Hong Kong’s Insilico Medicine claimed a major victory after its AI system outperformed big pharma in early drug R&D.
The company’s AI and deep learning system designed, synthesised, and validated a novel drug candidate in 46 days – 15 times faster than the best pharma companies.