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In This Issue of JAMA
September 17, 2014

Highlights

JAMA. 2014;312(11):1073-1075. doi:10.1001/jama.2013.279725
Research

Antenatal magnesium sulfate given to women at imminent risk of very preterm delivery reduces the risk of cerebral palsy in early childhood. In a follow-up study of 867 school-aged children born very preterm and whose mothers had been randomly assigned to receive antenatal magnesium sulfate or placebo, Doyle and colleagues found that maternal treatment with magnesium sulfate was not associated with neurological, cognitive, behavioral, growth, or functional outcomes in the children at ages 6 to 11 years. A mortality advantage of magnesium sulfate treatment could not be excluded.

Randomized, placebo-controlled studies of patients with chronic obstructive pulmonary disease (COPD) have demonstrated that combination therapy, consisting of long-acting β-agonists (LABA) and inhaled corticosteroids, decreases disease exacerbations and possibly mortality. Gershon and colleagues assessed the comparative effectiveness of newly prescribed combination therapy vs LABA alone in a propensity score–matched cohort of 11 872 patients with COPD. The authors found that combination therapy was associated with a lower risk of a composite outcome of death or COPD hospitalization—particularly among patients with asthma and those not receiving inhaled long-acting anticholinergic medication. In an Editorial, Calverley discusses the value of administrative data analyses to inform patient care.

Editorial

Author Video Interview

There are many treatment strategies for acute venous thromboembolism (VTE), but little guidance as to which drug is most effective and safe. In a network meta-analysis of data from 45 randomized trials (44 989 patients) examining 8 anticoagulation options, Castellucci and colleagues found no significant differences in clinical and safety outcomes associated with most treatment strategies compared with the low-molecular-weight heparin and vitamin K antagonist combination. However, the unfractionated heparin and vitamin K antagonist combination may be the least effective strategy and rivaroxaban and apixaban may be associated with the lowest risk of bleeding.

Author Audio Interview

Clinical Review & Education

Older adults’ physiological and functional heterogeneity adds complexity to treatment decisions for hypercholesterolemia. Strandberg and colleagues present 3 illustrative cases of older patients with hypercholesterolemia and report results of a literature review on the role of statins in primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in older patients. Based on their review of the evidence (26 articles and recent cholesterol treatment guidelines), the authors conclude that ideally, treatment of hypercholesterolemia for patients at risk of ASCVD should start before age 80 years. Because no randomized clinical trial evidence exists to guide statin initiation after age 80 years, decisions to use statins in older patients must be individualized.

Continuing Medical Education

An article in JAMA Psychiatry reported that among patients with prescription opioid dependence, a treatment regimen involving a 4-week buprenorphine taper and subsequent naltrexone maintenance therapy resulted in higher rates of opioid abstinence at 12 weeks than a 2- or 1-week buprenorphine taper regimen. In this From the JAMA Network article, Ruetsch discusses treatment of opioid use disorder.

This JAMA Diagnostic Test Interpretation article by Neuner and Carnahan presents the case of a 69-year-old white woman who had a screening dual-energy x-ray absorptiometry (DXA) scan that showed low bone mineral density of the spine. Menopause began at age 39 years, the patient has never smoked, and she has no history of fractures or falls. How would you interpret the DXA scan results?

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