News from Nov. 11, 2014 Annals of Internal Medicine

November 10, 2014

1. AABB releases new guidelines on the appropriate use of platelet transfusion in adult patients

Free content

New guidelines from the AABB (formerly, the American Association of Blood Banks) specify clinical situations in which platelet transfusion is recommended in adult patients. The guidelines are being published in Annals of Internal Medicine. Platelet transfusions are administered to prevent or treat bleeding in patients with quantitative or qualitative platelet disorders. To inform its recommendations, researchers for the AABB conducted a systematic review of randomized, clinical trials and observational studies that reported clinical outcomes in patients receiving prophylactic or therapeutic platelet transfusions. They developed guidelines that address several common clinical situations and attempt to identify a platelet count threshold below which platelet transfusion may improve hemostatis and above which platelet transfusion is unlikely to benefit the patient. Based on strong evidence, the AABB recommends prophylactic platelet transfusion to reduce the risk for spontaneous bleeding in hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia and a platelet count of 10# x #109 cells/L. Weaker evidence suggests that prophylactic platelet transfusion should be administered in patients having elective central venous catheter placement with a platelet count of less than 20# x #109 cells/L or patients having elective diagnostic lumbar puncture or major elective nonneuraxial surgery with a platelet count less than 50# x #109 cells/L. The AABB recommends against routine prophylactic platelet transfusion in patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass but suggests (without recommending) that those with perioperative bleeding and thrombocytopenia or platelet dysfunction may benefit from transfusion.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Jessica Maki Caragher at jcaragher@partners.org or 617-525-6373.

2. Multidrug, multitarget regimen results in higher remission rates for lupus nephritis patients

A multidrug, multitarget regimen proves superior to intravenous cyclophosphamide (IVCY) as induction therapy for lupus nephritis (LN), according to a randomized, controlled trial being published in Annals of Internal Medicine. LN is the inflammation of the kidney caused by systemic lupus erythematosus. Treatment is challenging and usually consists of an initial induction phase to achieve rapid remission, followed by long-term maintenance. Complete remission with current induction therapy regimens remains low. Therefore, more effective induction regimens are needed. Researchers sought to assess the efficacy and safety of a multitarget therapy consisting of tacrolimus, mycophenolate mofetil, and steroid compared with IVCY and steroid as induction therapy for patients with LN. Three hundrend sixty-eight patients between the ages of 18 and 65 with LN were randomly assigned to one of two treatment groups. All participants received intravenous methylprednisolone pulse therapy for three days, followed by a dose of oral prednisone (0.6 mg/kg per day) each morning for four weeks. The dose of prednisone was tapered by 5 mg/d every day for two weeks, and then by 2.5 mg/d every two weeks. The maintenance dose of prednisone was 10 mg/d. After the initial treatment, the multitarget group received mycophenolate mofetil (0.5 g) and tacrolimus (2 mg) each two times per day. The IVCY group received cyclophosphamide at a dose of 0.75 g/m2 body surface area, and then adjusted the dose to 0.5 to 1.0 g/m2 body surface area every four weeks for six doses. The patients were evaluated at two and four weeks, and then every four weeks until 24 weeks for changes in levels of proteinuria and serum albumin, and drug-related adverse effects. Both groups had high adherence rates. Patients in the multitarget group had greater changes in urine protein and serum albumin and at week 24, approximately 84 percent of patients were in partial or complete remission compared to 63 percent of patients in the IVCY group. The authors suggest that the multitarget regimen should be considered as an alternative to conventional therapies for LN.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. The lead author, Dr. Zhi-Hong Liu, can be contacted directly at liuzhihong@nju.edu.cn or 13952093539.
-end-


American College of Physicians

Related Clinical Trials Articles from Brightsurf:

Nearly 1 in 5 cancer patients less likely to enroll in clinical trials during pandemic
A significant portion of cancer patients may be less likely to enroll in a clinical trial due to the ongoing coronavirus pandemic.

COVID-19 clinical trials lack diversity
Despite disproportionately higher rates of COVID-19 infection, hospitalization and death among people of color, minority groups are significantly underrepresented in COVID-19 clinical trials.

Why we should trust registered clinical trials
In a time when we have to rely on clinical trials for COVID-19 drugs and vaccines, a new study brings good news about the credibility of registered clinical trials.

Inclusion of children in clinical trials of treatments for COVID-19
This Viewpoint discusses the exclusion of children from coronavirus disease 2019 (COVID-19) clinical trials and why that could harm treatment options for children.

Review evaluates how AI could boost the success of clinical trials
In a review publishing July 17, 2019 in the journal Trends in Pharmacological Sciences, researchers examined how artificial intelligence (AI) could affect drug development in the coming decade.

Kidney patients are neglected in clinical trials
The exclusion of patients with kidney diseases from clinical trials remains an unsolved problem that hinders optimal care of these patients.

Clinical trials beginning for possible preeclampsia treatment
For over 20 years, a team of researchers at Lund University has worked on developing a drug against preeclampsia -- a serious disorder which annually affects around 9 million pregnant women worldwide and is one of the main causes of death in both mothers and unborn babies.

Underenrollment in clinical trials: Patients not the problem
The authors of the study published this month in the Journal of Clinical Oncology investigated why many cancer clinical trials fail to enroll enough patients.

When designing clinical trials for huntington's disease, first ask the experts
Progress in understanding the genetic mutation responsible for Huntington's disease (HD) and at least some molecular underpinnings of the disease has resulted in a new era of clinical testing of potential treatments.

New ALS therapy in clinical trials
New research led by Washington University School of Medicine in St.

Read More: Clinical Trials News and Clinical Trials Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.