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This Week in JAMA
JAMA. 2008;299(16):1867.
Everolimus-Eluting vs Paclitaxel-Eluting Stents
Currently available drug-eluting stents reduce but do not eliminate the risk of restenosis following percutaneous coronary intervention. Some preliminary data suggest improved clinical and angiographic outcomes with a stent that elutes the antiproliferative agent everolimus. In the SPIRIT III trial, 1002 patients with native coronary artery lesions were randomly assigned to receive either an everolimus-eluting stent or a paclitaxel-eluting stent, and angiographic follow-up was obtained 8 months after stent placement. Stone and colleagues (SEE ARTICLE) report that compared with the paclitaxel-eluting stent, the everolimus-eluting stent was associated with reduced angiographic in-segment late loss and similar rates of target vessel failure. In an editorial, Patel and Holmes (SEE ARTICLE) discuss the importance of assessing outcomes in broadly representative patient populations and long-term follow-up to ensure the safety and efficacy of interventional devices.
Comparison of Treatments for Anal Cancer
Concurrent fluorouracil/mitomycin plus radiation is the standard primary therapy for localized anal cancer and is associated with a 5-year disease-free survival rate of approximately 65%. Results of several pilot studies suggested that disease-free survival might be improved with induction chemotherapy prior to concurrent chemoradiation. Ajani and colleagues conducted a multicenter trial in which patients with anal cancer were randomly assigned to standard therapy with concurrent fluorouracil/mitomycin plus radiation or experimental therapy with fluorouracil-cisplatin induction chemotherapy followed by the same chemotherapy and concurrent radiation. The authors report that compared with standard mitomycin-based therapy, cisplatin-based therapy did not improve disease-free survival and was associated with higher rates of colostomy.
(SEE ARTICLE)
Medicare Part D: Beneficiaries' Knowledge and Costs
Medicare's prescription drug benefit (Part D) contains complex and high-level cost sharing provisions, including a coverage gap. Results of 2 studies that assessed Medicare beneficiaries' understanding of these provisions and the effects of Part D on personal spending for drugs and basic needs are reported in this issue. Hsu and colleagues (SEE ARTICLE) surveyed Medicare enrollees in the Kaiser Permanente-Northern California health system and found that the beneficiaries had limited knowledge of the Part D cost-sharing provisions or the meaning of the coverage gap, and more than one-third reported cost-coping behaviors such as switching to a cheaper drug or reducing drug adherence. Madden and colleagues (SEE ARTICLE) report results of an analysis of national data to assess Part D enrollees' cost-related medication nonadherence and spending on basic needs in the first year of coverage. The authors found evidence for small but significant decreases in cost-related medication nonadherence and the need to spend less on necessities to afford medications. In an editorial, Goldman and Joyce (SEE ARTICLE) discuss evidence relating to the success and deficiencies of Medicare Part D.
CLINICIAN'S CORNER
Treatment of Soil-Transmitted Helminth Infections
A systematic review and meta-analysis to assess the efficacies of currently recommended single-dose, oral preventive therapies against infections caused by the soil-transmitted helminthes Ascaris lumbricoides, hookworm, and Trichuris trichiura.
(SEE ARTICLE)
A Piece of My Mind
"My ass is Jimmy, a shy miniature donkey who has been the companion of my horse, Indy, on my 20-acre farm for almost four years." From "Thank Goodness for My Ass."
(SEE ARTICLE)
Medical News & Perspectives
Scientists are assessing strategies to better serve veterans, soldiers returning from active duty, and others with posttraumatic stress disorder by boosting screening and care for this condition in primary care settings.
(SEE ARTICLE)
Commentary
Limits of proposed FDA guidelines on off-label promotion
(SEE ARTICLE)
Editorial
Preserving confidentiality in the peer review process
(SEE ARTICLE)
Author in the Room Teleconference
Join Barbara Howard, PhD, and William Howard, MD, on May 21, 2008, from 2 to 3 PM eastern time to discuss lower blood pressure and cholesterol targets in diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
Readers Respond
How would you manage a 50-year-old man with chronic low back pain? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is April 30.
JAMA Patient Page
For your patients: Information about anal cancer.
(SEE ARTICLE)
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