© Geriatric Times. All rights reserved.
Aging Senses in the News
by GT Staff
Geriatric Times July/August 2003 Vol. IV Issue 4
Psoriasis Medication Acquires Amended Labeling
Hoffman La Roche Inc. has received approval from the U.S. Food and Drug Administration to update its product labeling information for Soriatane (acitretin), an oral medication for psoriasis. The major changes include an amended indication for severe psoriasis in adults, clarified dosing flexibility, inclusion of data to support its use in maintenance therapy and instructions of how to use it in combination with phototherapy.
The label will now state that acitretin is indicated for "severe psoriasis in adults." Included in the labeling will also be the results from clinical trials that showed the medication to be effective in five major types of psoriasis: plaque, guttate, palmoplantar, crythrodermic and pustular.
Acitretin is the only oral systemic drug for severe psoriasis that is neither immunosuppressive nor cytotoxic. The medication can be used without the risk of reducing patients' resistance to common infections, making it effective when combined with phototherapy and systemic therapy. According to the 2002 National Psoriasis Foundation Benchmark Survey, these combination therapies are not employed very often. Only 35% of people with moderate-to-severe psoriasis have tried phototherapy or systemic therapy, and 27% were unsatisfied with their physicians' lack of aggressive treatment.
The revised labeling, which should assist doctors in prescribing the proper dosage to provide more effective treatment, changes the recommended initial dose from "25 mg/day or 50 mg/day" to "25 mg/day to 50 mg/day." The availability of 10 mg and 25 mg capsules gives prescribers the ability to adjust the dose in small increments. Acitretin is also indicated for maintenance therapy in doses of 25 mg/day to 50 mg/day once lesions have cleared--JK
Balance Problems Increase Risk for Falls After Stroke
Approximately 40% of stroke patients will suffer a fall within the first year after their stroke, and stroke survivors are four times more likely than others to suffer hip fractures during such falls. From a study in Stroke: Journal of the American Heart Association (2003;34[2]:494-501), researchers may have found an explanation for the prevalence of falls: balance problems. This study examined community-dwelling older women who had suffered a stroke in order to determine which activities of daily living carried the highest risk for falls.
Sarah E. Lamb, D.Phil., and colleagues used data collected by the Women's Health and Aging Study, an ongoing study of elderly women, in order to obtain a cohort of 124 elderly women. The women were all tested for a variety of movement tasks, including balance performance, pinch-grip strength, ability to dress themselves, walking and rising from a chair. The women were also tested for visual acuity, cognitive impairments, incontinence, knee strength and alcohol consumption.
During the 12-month follow-up, 48% of the women fell and 29% suffered repeated falls. The researchers also found that the women who had suffered a stroke and reported balance problems were seven times more likely to fall while attempting to dress themselves than were poststroke women who did not report balance problems. Residual balance, dizziness or a spinning sensation carried a fivefold greater risk for falling. In a statement to the press, Lamb explained the significance of these findings: "What is important here is that it is not the initial stroke symptoms, but what you are left with … that have a significant impact on fall risk."
The researchers suggested that therapies that address balance during complex activities and environmental adjustment could significantly reduce the incidence of falls and hip fractures--TB
Replacing Immune Cells May Impede Onset of Glaucoma
A study in the Journal of Experimental Medicine (2003;197[10]:1335-1344) found that inflammatory immune response, which is suppressed in the normal eye, might be an early step in the onset of pigment dispersion glaucoma. Pigment dispersion glaucoma occurs when the iris begins to shed melanin into the front part of the eye. This is followed by increasing pressure within the eye, which strangles the optic nerve and kills the retinal cells attached to it.
The researchers examined the eyes of model mice with pigment dispersion glaucoma before the visible onset of the disease and found that the diseased eyes failed to successfully suppress T-cells--white blood cells that cause the iris to shed pigment. This failure preceded clinical evidence of pigment dispersion. They also found that the eyes contained bone marrow-derived white blood cells that were programmed to cause inflammatory responses. Jun Song Mo, M.D., the study's lead author, told the press, "It is relevant that one of the two genes known to be responsible for pigment dispersion glaucoma in mice is active in these same white blood cells."
The research team concluded that the eyes of the genetically predisposed mice lost immune privilege before the pigment dispersion began.
"What this suggested to us," said J. Wayne Streilein, M.D., senior author of the study, "is that maybe the first thing that the genes for pigment dispersion glaucoma do is break down immune privilege and leave the eyes vulnerable to inflammation."
The researchers tested their theory of inappropriate immune response even further by replacing the bone marrow of mice predetermined to develop pigment dispersion glaucoma with bone marrow from normal mice. Following the procedure, the team found that the immune-privileged status was maintained in the eyes, inflammation never developed and pigment dispersion failed to occur.
"These results are very exciting and encouraging. We feel that this is a major breakthrough in understanding how this disease is triggered and may be cured," said Streilein. "We are eager to understand more completely the interrelationship between loss of immune privilege and development of glaucoma. Moreover, we are also interested to know whether a similar immune dependency might occur in other blinding eye diseases, such as macular degeneration and retinitis pigmentosa"--AR
Lifestyle, Supplement May Improve Outcomes in AMD
New research indicates changes in lifestyle, including having a lower body mass index, exercising and taking a dietary supplement, may reduce the risk and/or the severity of age-related macular degeneration (AMD), which affects 30% of people 75 years or older. A study of 261 patients age 60 or older with signs of non-advanced AMD was_recently published in the Archives of Ophthalmology (2003;121[6]:785-792).
Patients were followed for an average of 4.6 years, and their height, weight and blood pressure were measured annually. The data indicated that study participants with a high body mass index (BMI >25) were more than twice as likely to have their AMD worsen than were those with lower weight. Patients who exercised vigorously at least three times a week had a 25% reduction in the risk that the severity of the disease would increase.
Phototrop, a dietary supplement that combines acetyl-L-carnitine, highly concentrated omega-3 and coenzyme Q10, has resulted in statistically significant improvement in visual function when administered to people with early AMD, according to results presented at the Association for Research in Vision and Ophthalmology's annual meeting held May 4-9 in Fort Lauderdale, Fla. The 12-month, double-blind, placebo-controlled, single-center study conducted in Hungary included 106 patients between the ages of 55 and 70 diagnosed with early AMD. After six months, the Phototrop group showed statistically significant improvement in visual function. Following 12 months of treatment, the improvement was more pronounced. The primary response criterion was a change of the central 10º visual field mean defect between screening and 12 months.
Janos Feher, M.D., the study's lead researcher and professor in the department of ophthalmology at University of Rome La Sapienza, said in a press release, "A previous pilot study had shown that patients with early AMD showed an improvement when given this combination of acetyl-L-carnitine, omega-3 and coenzyme Q10. We used a double-blind, placebo-controlled study--an approach that is still quite rare in the field of dietary supplements--to confirm those findings."
Phototrop is not yet available in the United States.
Age-related macular degeneration is marked by the deterioration of the macula, which is the center of the retina. It is increasingly difficult for people with AMD to focus on objects directly in front of them, although peripheral vision is usually unaffected. The etiology of AMD is unclear, but several risk factors, including cigarette smoking, high levels of dietary fat and low levels of antioxidants, have been identified. Scientists suspect that a possible cause for the disease could be compromised blood flow to the retina--JK
