“Patients need to look at the data for themselves because the doctor who suggests a new drug has almost certainly been lobbied by the drug company to prescribe it—and given free samples to pass out—that’s the way the system works,” says Kay Dickersin, M.A., Ph.D., director of the U.S. Cochrane Center and the Center for Clinical Trials at Johns Hopkins Bloomberg School of Public Health.

According to Dr. Dickersin, making drug decisions based on solid research evidence starts with three simple questions: 1) Is the “old” drug helping my problem? 2) Is it free of annoying side effects? 3) Is it working quickly or long enough?

When a drug falls short, point your browser to FDA.gov, a repository of safety data—some on efficacy—on all FDA-approved medicines. To research off-label (non-approved) uses or how one drug stacks up against another, turn to Cochrane Reviews.

The international collaboration, established in 1993, prepares and updates systematic reviews of clinical trial data based on head-to-head comparisons—active treatment versus active treatment.

“The Cochrane Collaboration puts all the evidence about what works in one place,” explains Dr. Dickersin. She describes it as one-stop shopping for 5000+ summaries of up-to-date, high-quality evidence on a particular drug or condition. Viewing the podcasts and reviews is free. And if you need to dig deeper, the Cochrane Library holds additional data. “We really do want to help,” says Dr. Dickersin.

Free online courses offered by the U.S. Cochrane Center help healthcare consumers better understand evidence-based healthcare.

“Patient values and opinions are important when making treatment decisions. But providing healthcare without research evidence is no way to practice medicine,” advises Dr. Dickersin.

New Medicine? The Saturday Evening Post

“Warmer temperatures and lack of significant freeze events in much of the country have placed the current allergy season in early-entrance mode,” says asthma and allergy expert Dr. David Wilson, Medical Director, The Lung Institute at Columbus Regional Hospital in Indiana.

Yet there is some happier news. While allergy season will definitely be longer this spring, it probably won’t be any worse than usual for susceptible individuals, according to Dr. Wilson, who offers these tips to reduce spring pollen exposure—and its irritating consequences:

• Change the filter, turn on the air conditioning, and enjoy the great indoors.

• Cover up. Wear an all-purpose and inexpensive mask (available online or from your pharmacy) when outside.

• Hand off yard work such as mowing and raking during high-pollen seasons.

• Use a home or commercial dryer (rather than a backyard clothesline) to dry sheets and clothing.

Many people with allergies don’t have asthma—but most with asthma do have allergies. When avoiding triggers isn’t enough to control symptoms, it’s time to consult an allergy and asthma specialist for proper diagnosis and an individualized treatment plan.

Fortunately, simple breath tests to measure a marker of airway inflammation called FENO (fraction of exhaled nitric oxide) can help doctors detect and track asthma and changes in allergen exposure.

“Breathlessness and wheezing in adults are often attributed to disorders such as COPD, interstitial lung disease, and others,” explains Dr. Wilson. “FENO testing with the handheld NIOX MINO device provides a very sensitive indicator of asthma activity and symptoms, helping doctors more effectively diagnose and therefore manage the disease.”

Doctors prescribe asthma medicines (inhalers, pills, liquids, and injections) to stop, control, and prevent symptoms.

Prescription and OTC antihistamines, decongestants, and steroids help tame allergies. A new treatment option for nasal allergy symptoms— QNASL Nasal Aerosol (Teva Pharmaceuticals)—is expected to be available by prescription in April 2012. The novel “dry” steroid spray is indicated for seasonal or yearlong allergy sufferers ages 12 and older.

For more about managing asthma and allergies and to find local specialists, turn to the Asthma and Allergies Foundation of America and the American College of Allergy, Asthma & Immunology.

Easing Allergies and Asthma The Saturday Evening Post

Drug Options to Keep Cholesterol in Check The Saturday Evening Post

James,

Manteca, California

Nocturnal hyperhidrosis, commonly known as night sweats, may be triggered by an underlying condition, such as sleep apnea, overactive thyroid, diabetes, or gastroesophageal reflux disease. Medications to treat depression and fever may also be to blame. In rare cases, night sweats may signal a serious illness such as tuberculosis or even certain types of cancer, which is why it’s best to consult with a doctor, especially when the symptoms recur. In addition to addressing any underlying cause, doctors may prescribe injectable Robinul or oral propranolol to tame the excessive sweating.

Night Sweats Return The Saturday Evening Post

Psoriasis, an autoimmune disorder that occurs when skin cells grow too quickly, affects about 6 million Americans. And nearly 1 million adults might be candidates for the new treatment, which is not indicated for children. Stelara disables proteins released by the immune system that play a role in the overproduction of skin cells and inflammation.

At the close of a busy afternoon at his dermatology practice, Dr. Lebwohl, who was involved in the clinical testing of the new drug, discussed with us the promise (and potential drawbacks) of Stelara and other drugs that treat disease by targeting the immune system.

Q: What sets Stelara apart from conventional therapies for moderate-to-severe psoriasis?

Dr. Mark LebwohlCourtesy of Dr. Mark Lebwohl

Dr. Lebwohl: We have never had anything that works precisely this way. It is the first drug therapy that requires just four shots a year, and the overwhelming majority of patients improve dramatically. The approved treatment schedule is two injections four weeks apart, followed by maintenance injections every 12 weeks. Other injectable therapies are given weekly, twice a week, or every other week.

Q: What type of benefit have you observed with Stelara in your patients or study participants?

Dr. Lebwohl: We have seen benefit in many patients. In fact, it would be unusual for it not to work. On day one, people get the first injection. Four weeks later, there is a dramatic benefit. They get the second injection at that time and then return three months later for a third shot. At that visit, most patients are clear or close to clear.

Q: Has Stelara been tested for the type of psoriasis that affects people’s joints?

Dr. Lebwohl: It has been studied for joint disease, and it was beneficial. The study dose was higher than the one used for skin disease, and given once a week for four weeks.

Q: Do people inject themselves with Stelara or come to the doctor’s office?

Dr. Lebwohl: It is approved for administration in the doctor’s office. If you review the FDA deliberations on this approval, it seems their conclusion is based on the fact that Stelara is a systemic drug, it affects the immune system, and patients ought to be seen by doctors at least four times a year.

Q: Any word yet on insurance coverage?

Dr. Lebwohl: We expect approval from federal insurers, and the drugmaker, Centocor Ortho Biotech, has set up a phone line for physicians to check with the other insurances. However, the insurers have not yet had time to respond.

Q: What do people considering treatment with Stelara need to know?

Dr. Lebwohl: Clinical trials of Stelara were conducted in more than 2,000 patients. Some have taken the drug for longer than three years, and many for a shorter period of time. No clear side effect that emerged.

Stelara is an antibody that blocks a component of two chemicals: IL (interleukin) 12 and IL 23. It turns out that some people are born without that target component. In other words, they are born as though they had Stelara on board. Research on 41 of these people shows that their main problem has been susceptibility to Salmonella infections and also mycobacterial infections, such as tuberculosis.

In the studies of Stelara, there were no cases of either kind of infection–perhaps because we are giving the drug intermittently as opposed to having a lifelong genetic abnormality.

Nonetheless, people should be tested for tuberculosis prior to initiating Stelara therapy. In addition, they should never receive BCG (bacille Calmette-Guérin) vaccines, a type of vaccine used in other countries (but not in the United States) that contains mycobacteria. The usually harmless bacteria caused serious infections in those 41 people; that’s how their genetic abnormality was discovered. People on Stelara should get flu vaccines, but not one containing the live virus. For example, patients on this treatment should not get the seasonal flu vaccine in the inhaled form that has a live virus. They should instead get the shot that contains inactive virus and has no chance of infecting them.

Q: Are you involved in clinical trials of other dermatologic treatments or promising research projects?

Dr. Lebwohl: Yes. At least two experimental biologic agents for psoriasis act upon newly identified molecular targets and appear to be effective. We will be seeing more biologics as time goes on.

Highly targeted biologic therapies are very effective and safe. The drawback, however, is they are very expensive to make. The same is true for biologics to treat diseases other than psoriasis. For example, some cancer drugs target the tumor and spare normal cells that are nearby. Biologics are very costly but have the potential of significantly changing our lives for the better. It’s important that we figure out better ways to develop and manufacture these promising therapies.

Dr. Mark Lebwohl is president of the New York State Society of Dermatology and has served as chairman of the Section on Dermatology of the New York Academy of Medicine. Dr. Lebwohl is a member of the medical advisory board of the National Psoriasis Foundation and editor of Psoriasis Forum as well as medical editor of The Bulletin of the National Psoriasis Foundation.

New & Effective Psoriasis Drug The Saturday Evening Post

My mother has blotches on her arms and legs that look like blood vessels have burst below the skin surface. They spread across the arms and/or legs and are purple and black in color. It’s very distressing to her. What causes these to appear, and how might we address the problem?

R
Alabama

Keep Skin Moist to Prevent Bruising The Saturday Evening Post

We recently received a letter from Post reader Mrs. J. V. Moore of Lancaster, Pennsylvania, who writes that her neuropathy “feels like 1,000 bees stinging. After a stroke triggered the pain in 2005, her neurologist prescribed Cymbalta (duloxetine hydrochloride), a drug first approved for treating depression and now used for some cases of peripheral neuropathy. She reports that taking one capsule daily certainly makes her life more comfortable. Lyrica (pregabalin) may be another drug option for you and your doctor to consider.
According to the Physicians’

Desk Reference (PDR), people should take Lyrica at about the same time every day.

Medicines for Nerve Pain The Saturday Evening Post

Water Pill Options When Allergic to Sulfa The Saturday Evening Post