For decades, chelation therapy has been promoted as a treatment for atherosclerosis—with no proof of efficacy. In a randomized, double-blind, placebo-controlled trial that enrolled 1708 patients with a history of myocardial infarction (median, 4.6 years prior), Lamas and colleagues found that compared with placebo, use of an intravenous EDTA-based chelation regimen—40 infusions over 1 to 3 years—modestly reduced the risk of a composite of adverse cardiovascular outcomes during a median follow-up of 55 months. In an editorial, Nissen discusses aspects of the trial design and execution that compromise the reliability of the evidence generated. An editorial by Bauchner and colleagues describes evaluation of the study at JAMA and factors considered in the publication decision.
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Two articles in this issue report results of clinical trials that investigated long-term macrolide maintenance therapy for patients with non–cystic fibrosis (non-CF) bronchiectasis and frequent pulmonary exacerbations. Altenburg and colleagues randomly assigned 83 patients to receive either azithromycin (250 mg daily) or placebo for 1 year and found that patients receiving azithromycin had fewer infectious exacerbations. Serisier and colleagues randomly assigned 117 patients to receive either erythromycin (400 mg, twice daily) or placebo for 12 months and found a modest decrease in pulmonary exacerbations among patients receiving erythromycin. In an editorial, Elborn and Tunney discuss the need to balance benefits of long-term macrolide therapy with concerns regarding development of antibiotic resistance.
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Experimental and clinical evidence suggest phosphodiesterase-5 (PDE-5) inhibition may enhance cardiovascular function in patients with heart failure with preserved ejection fraction. In a randomized, placebo-controlled trial involving 216 patients with heart failure and preserved ejection fraction, Redfield and colleagues found that PDE-5 inhibition with sildenafil did not improve patients' exercise capacity or clinical status.
Sublingual immunotherapy is approved in Europe but not the United States. However, some US physicians use aqueous allergens, off-label, for sublingual desensitization. In a systematic review, Lin and colleagues identified 63 randomized trials (involving 5131 child and adult participants) of sublingual immunotherapy for allergic rhinoconjunctivitis or asthma and found moderate-grade evidence to support the effectiveness of sublingual immunotherapy for these conditions. High-quality studies are needed to determine optimal dosing strategies. In an editorial, Nelson discusses many unanswered questions regarding the efficacy of sublingual immunotherapy.
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A patient with HIV infection who has been taking antiretroviral medication for 1 year presents with lipodystrophy confined to the cervicodorsal region. Laboratory findings, including complete metabolic and endocrine panels, are normal. What would you do next?
More than 50 years after initiating newborn screening for congenital disorders, the approach remains one of the United States' most successful public health interventions.
A systematic plan for firearms law reform
Mental illness and gun law reform
Economics of genomic medicine
Crossing the omic chasm
“While the general public is shocked at the wholesale trauma guns bring at Columbine, Aurora, or Sandy Hook, we in medicine are not as surprised.” From “The NRA Let Me Down.”
Dr Fontanarosa summarizes and comments on this week's issue. Go to www.jama.com
Join Phillip Boiselle, MD, Wednesday April 17, 2013, from 2 to 3 PM eastern time to discuss computed tomography screening for lung cancer. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about treatment of varicose veins.
This Week in JAMA. JAMA. 2013;309(12):1201. doi:10.1001/jama.2012.145324