DISEASE-MODIFYING DRUGS MAY NOT BE EFFECTIVE IN LONG-TERM RA THERAPY
Results of a 10-year prospective study indicate that patients with rheumatoid
arthritis (RA) have excess mortality and deteriorating function despite continuous
treatment with disease-modifying drugs.
BREAST CANCER RISK DETERMINES COST-EFFECTIVENESS OF HRT VERSUS RALOXIFENE
In postmenopausal women at average risk for breast cancer and coronary heart disease,
hormone replacement therapy (HRT) is a more cost-effective means of extending
life expectancy than raloxifene, according to a recent report.
Disease-Modifying Drugs May Not Be Effective in Long-Term RA Therapy
NEW YORK (Reuters Health) Dec 26 - Results of a 10-year prospective study indicate
that patients with rheumatoid arthritis (RA) have excess mortality and deteriorating
function despite continuous treatment with disease-modifying drugs, UK researchers
report.
Dr. Terence Gibson from Guy's Hospital, London, and colleagues collected data
on 289 RA patients who remained on disease-modifying drugs such as methotrexate,
sulfasalazine, and azathioprine during 10 years of follow-up. During the period,
71 patients died for a standardized mortality rate of 1.302. Ninety-two patients
were alive but not available for follow-up, according to the report in the November
issue of the Journal of Rheumatology.
At baseline and at 5 and 10 years, median joint tenderness, morning stiffness,
grip strength, and hemoglobin did not significantly differ, and although the
erythrocyte sedimentation rate decreased, the decrease was not significant,
the researchers found.
However, during the study, Health Assessment Questionnaire scores decreased
(p = 0.004). Radiographs of hands and feet also showed a deteriorating condition
(p = 0.001). Worsening radiographs were seen in patients with short, medium
and long histories of RA, and "correlations between disability, radiographic
scores and joint tenderness were apparent at the start and conclusion of the
study," Dr. Gibson's group reports.
"It was in 1988 that Pincus suggested that short-term studies may give
rise to false expectations, and that radiological and laboratory values are
overemphasized at the expense of long-term outcomes of functional status and
death," Dr. Gibson and colleagues comment. "Perhaps our study serves
to reinforce this message."
J Rheumatol 2001;28:2409-2415.
Breast Cancer Risk Determines Cost-Effectiveness
of HRT Versus Raloxifene
NEW YORK (Reuters Health) Dec 27 - In postmenopausal women at average risk for
breast cancer and coronary heart disease, hormone replacement therapy (HRT) is
a more cost-effective means of extending life expectancy than raloxifene, according
to a recent report. For women with one or more major breast cancer risk factors,
the opposite is true.
Dr. Katrina Armstrong and colleagues, from the University of Pennsylvania in
Philadelphia, used a time-dependent Markov model to estimate the cost-effectiveness
of either treatment strategy in healthy 50-year-old postmenopausal women.
Compared with no therapy, both HRT and raloxifene were cost-effective methods
of increasing life expectancy, the investigators note in the December issue of
Obstetrics and Gynecology.
For women with average breast cancer and coronary heart disease risks, lifetime
HRT provided a greater increase in quality-adjusted life years than lifetime
raloxifene therapy and was also much less expensive, the authors point out.
Raloxifene was the cost-effective choice for women with a lifetime risk of
breast cancer of 15% or higher and for women who receive 10 years of less of
postmenopausal therapy. In addition, if HRT was assumed to reduce the coronary
heart disease risk by less than 20%, raloxifene was the more cost-effective
therapy.
"Until the results of large scale randomized trials of HRT as primary
prevention become available, women and physicians continue to face difficult
decisions about postmenopausal therapy," the researchers state. The current
findings suggest that raloxifene is the cost-effective choice for women with
an elevated breast cancer risk, while women with average risk benefit most from
HRT.
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