News from the Annals of Internal Medicine: Feb. 18, 2014
1. Aortic valve replacement improves function but may not improve quality of life
Transcatheter aortic valve replacement (TAVR) improves functional status but may not improve overall quality of life, according to an article being published in Annals of Internal Medicine. Aortic stenosis (AS) is the most common valvular heart disease in developing countries and it affects up to 3 percent of adults older than 75. In recent years, TAVR has emerged as an alternative treatment to surgical aortic valve replacement (SAVR) for high-risk or inoperable patients with symptomatic severe AS. Researchers reviewed 62 published studies to evaluate the changes in functional status and quality of life after TAVR. The research suggested that TAVR improved symptoms, physical function, and disease-specific measures of quality of life compared with conservative treatment. However, the benefits in psychological dimension and general health measures were often small and inconsistent, which may be an important consideration for older patients looking to improve quality of remaining life.
2. Rituximab may not benefit patients with primary Sjögren syndrome
Rituximab appears to offer no long term benefit to patients with primary Sjögren syndrome (pSS), according to an article published in Annals of Internal Medicine. pSS is a chronic autoimmune disorder characterized by dryness of the eyes and mouth. Up to half of patients have systemic involvement, with fatigue being a symptom associated with significant disability. No systemic treatment has been proved to significantly improve symptoms. Mounting evidence on B cell involvement in pSS suggests that B-cell depletion could be an effective treatment for pSS. The CD20 antigen, a transmembrane protein found on pre-B and mature B cells, is the most widely studied target for achieving B-cell depletion. Rituximab is an anti-CD20 antibody. Researchers conducted a multicenter, double-blind, placebo-controlled, randomized trial to evaluate the efficacy and harms of rituximab in adults with recent-onset or systemic pSS. They found that rituximab given in two infusions over two weeks alleviated some symptoms, particularly fatigue, early in the trial but did not alleviate symptoms or disease activity at 24 months. More infusion reactions occurred with rituximab than placebo. The data do not support use of rituximab for treating pSS.
3. Microsporidiosis a possible cause of infection in transplant patients
Microsporidiosis should be considered in febrile transplant patients when common infections are not found or response to standard therapies is poor, according to an article being published in Annals of Internal Medicine. Microsporidiosis is an opportunistic infection that can cause a spectrum of disease from mild diarrhea to disseminated, life-threatening infections. The disease is especially serious in immumosuppressed individuals, such as transplant recipients. Researchers conducted an investigation into the cause of febrile illness in three patients receiving solid organs from the same donor. After treatment for suspected brucellosis and other common infection causes, the donor recipients remained ill. Kidney biopsy samples from one patient tested positive for infection with Encephalitozoon cuniculi, a microsporidial species recognized as a pathogen in humans. Serologic evidence of infection with this microsporidian was found in the donor and all three recipients had the same Encephalitozoon cuniculi genotype, confirming that the infection was transplant-transmitted. Donor-derived disease should be considered when multiple recipients are ill.