2023-11-14 18:34:28
Hello Health Rounds readers! Today we present data presented at major medical meetings that promise practice-changing benefits in heart and liver disease. In the first case, a drug from a new class of blood thinners was tested that appears to be significantly safer than the widely used stroke prevention drugs. The second presents an experimental weight loss drug that reduces liver fat in patients with early-stage fatty liver disease. A third study from Canada found that genetic testing before prescribing antidepressants is of great benefit.
New drug to prevent stroke appears safer
A new class of blood thinners being tested in late-stage stroke prevention trials might prove significantly safer for patients than the currently widely used blood clot-preventing drugs, according to trial data on one of the experimental drugs.
In a safety study of more than 1,200 people at increased risk of stroke due to the cardiac arrhythmia atrial fibrillation, researchers compared the frequency of bleeding episodes during treatment with monthly injections of abelacimab, developed by Anthos Therapeutics, with the daily pill Xarelto (rivaroxaban ) from Bayer BAYN.
Abelacimab was so significantly superior to rivaroxaban that investigators stopped the study earlier than originally planned.
Overall, bleeding was reduced by more than 60 percent in the abelacimab group, they reported Sunday at the American Heart Association’s Scientific Sessions (link) in Philadelphia.
At the most effective dose, abelacimab reduced major bleeding requiring hospitalization by 81 percent compared with rivaroxaban, the researchers said.
Rivaroxaban and similar drugs, such as Bristol Myers Squibb BMY’s top-selling Eliquis (apixaban) and Pfizer PFE, work by inhibiting a protein called factor Xa, which helps the body form blood clots. Abelacimab inhibits factor XI, a protein that plays a role in the body’s ability to form clots that cause strokes, but not in the formation of clots that control bleeding from blood vessel injuries.
The current study was not designed to test the effectiveness of abelacimab in preventing strokes.
“Assuming the data from the ongoing (large, late-stage trials) confirm the benefit of factor Christian Ruff of Brigham and Women’s Hospital in Boston said in a statement.
New drug may reverse early-stage fatty liver disease
Nearly 9 in 10 obese adults with early-stage fatty liver disease had their liver fat reduced to the point where they were no longer classified as having the disease, in a study testing Eli Lilly LLY’s experimental weight-loss drug retatrude.
“The implications of this study are that we might eliminate the fat very early in the course of this disease, before it becomes a real threat to the liver, and potentially reduce the long-term cardiac, metabolic, kidney and liver-related damage caused by obesity,” said study leader Dr. Arun Sanyal of Virginia Commonwealth University in Richmond said in a statement.
The 98 study volunteers took part in a larger study testing different doses of retatruide to treat obesity. The data were presented on Monday at the annual meeting of the American Association for the Study of Liver Diseases (link) in Boston.
All had a condition called metabolic dysfunction-associated steatotic liver disease (MASLD), in which fat makes up 5 percent or more of liver weight.
At the start of the study, all participants had a liver fat content of at least 10 percent. By week 48, liver fat content had decreased to less than 5 percent in more than 85 percent of patients.
More than 3 million cases of MASLD are diagnosed annually in the United States alone, and the disease is a leading cause of end-stage liver disease and liver transplantation.
Many companies have tried and failed to develop an effective treatment for this disease, formerly known as NASH (nonalcoholic steatohepatitis).
The reduction in liver fat in the study was associated with reductions in body weight, waist circumference and abdominal fat, as well as improvements in insulin sensitivity and blood levels of cholesterol and other lipids, the researchers report.
“These results are encouraging and show how they can potentially help combat a disease for which there are currently no approved therapies,” said Sanyal.
Genetic testing can improve treatment for depression
Genetic testing of patients with moderate to severe depression might help determine which antidepressants are most likely to work, so patients don’t have to try several different medications before finding one that works, researchers in Canada say.
The benefits of such an approach “might be enormous, including higher remission rates and better quality of life, while also leading to significant cost savings by eliminating the need for people to go to hospitals and more intensive care pathways,” said study leader Stirling Bryan of the University of British Columbia (UBC ) in a statement.
Previous studies have shown that up to 42 percent of differences in patients’ response to antidepressants can be attributed to genetic factors, researchers said.
A new study published Tuesday in the CMAJ (link) estimates that over a 20-year period in the province of British Columbia, using so-called pharmacogenomic tests to determine the right medication resulted in 37 percent fewer patients with depression, who do not respond to treatment. A cheek swab, blood or saliva sample is usually taken for the test.
The researchers estimated that pharmacogenomic-guided treatment might save the province’s health system regarding $956 million over 20 years.
“Genes play an important role in the way our bodies metabolize different antidepressants, which ultimately affects their effectiveness,” said co-author Dr. Jehannine Austin, also from UBC.
“The genetic insights gained from pharmacogenomic testing can help physicians make more informed treatment decisions and reduce the lengthy trial-and-error process that many patients go through when searching for an effective drug,” said Austin.
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