Medical journal news series - January 2023
Mindfulness for Anxiety
Mindfulness classes (2.5 hrs per week for eight weeks with an instructor) were shown to be similar in effectiveness to medications.
Dr. Neuman says: There were 208 people in the trial, so not a huge trial, and only eight weeks did they seem to collect data. So, take these results to mean mindfulness vs. meds are similar in the short-term with questions about longer out. Though quite promising for many looking for good options to help with anxiety. An educated guess is that combining these tools is even more powerful!
Does this apply to you? I'm always here to discuss how your mental health is doing. We could brainstorm how things are going and where you want to be.
Exciting medical breakthrough!
The FDA approved a new treatment, etranocogene dezaparvovec. This treatment is the first-ever gene therapy approved by the FDA.
Dr. Neuman says:
The Good - Some of the first gene therapies have arrived. Gene therapies modify your very genes. So cool! And especially sweet for those with the rare blood disorders Hemophilia A and Hemophilia B. They are famous historically (and unfortunately for them) for cursing many European royalties. It is a disease that can suddenly cause profound fatigue, pain, and terrible bleeding episodes.
Because these diseases have just one gene mutation that causes them, the new tech can target that gene. And in the case of Hemophilia B and treatment etranacogene dezaparvovec (please do not ask me to pronounce it, trade name is Hemgenix), the disease was kept at bay for 25.5 years in 80% of patients—big win. And the one to treat Hemophilia A had excellent two-year outcomes, and I'd expect it to be approved in the future as well.
This is a bright sign for other single gene mutations (although, unfortunately, sickle cell anemia had a step back when the current formula made the first patient to receive it have a low blood count). Some single-gene mutation diseases include inherited high genetic cholesterol, neurofibromatosis, Marfan syndrome, Huntington's, Cystic fibrosis, Tay-Sachs, and Duchenne's Muscular Dystrophy.
The Bad news - List price for one dose? $3.5 Million. Yuck.
FDA Approval Announcement link Article link Study with the medical evidence behind the treatment
An Antibody Preventing Type 1 Diabetes
The FDA approves Teplizumab-mzwv (Tzeild) as the first antibody to delay type 1 diabetes. Teplizumab delayed diagnosis in a study of 76 children up to age 18 with a high risk of developing type 1 diabetes.
Dr. Neuman says:
An antibody (the one that can fight off infections by generating an immune system to respond) can delay the onset of Type 1 Diabetes (formally called Juvenile Diabetes). What a future we live in! This is because Type 1 Diabetes is an auto-immune disease, where the body confuses its immune cells into attacking the insulin-producing cells in the pancreas. Without pancreatic beta cells, which are destroyed, the body cannot make insulin, the hormone that tells our body to use the sugar we got in the body. Not a fun illness to have. The new antibody, Teplizumab, can tell the body's immune cells (specifically, T cells) not to attack the pancreas. And it has excellent results - four times the number of high-risk under 18-year-olds avoided Type 1 Diabetes if they got the infusion after five years than if they got a placebo infusion. And it delayed disease in those who got it by an average of around two years.
This could be exciting for kids at risk of Type 1 Diabetes. Unfortunately, it does not help those with it currently (although there are some exciting things with closed-loop insulin devices in the future). Many people ended up getting type 1 diabetes even with gene therapy, though the question is if they had it first appear later if that also leads to better long-term outcomes. For now, the question is how to balance the benefits and risks for each child. My thoughts:
Benefits - potential for a big win, likely at least a minor success for preventing Type 1 Diabetes.
Risks - some side effects, a chance of some white blood cell lowering that does not worsen infection rates and rashes, a price point of $200,000 for the treatment (daily infusion for two weeks)
Link to science article about Teplizumab. Link to FDA announcement Link to Article
Fluvoxamine is not effective against COVID-19
Fluvoxamine or a placebo was given to 1331 people infected with COVID-19. The fluvoxamine group had to go to the hospital 3.9% of the time and 3.8% with a placebo. The Fluvoxamine group improved after 12 days, placebo for 13 days.
Dr. Neuman says:
Fluvoxamine, an antidepressant (Luvox), was one of the compounds speculated to help against COVID-19. It will now be added to the list of compounds unlikely to help based on solid quality evidence: azithromycin, hydroxychloroquine, colchicine, antibiotics, ivermectin, and Vitamin D, to name a few.
Does this apply to you? If you do get COVID, please know you can reach out as soon as possible. Most healthy people do not need anything besides time and symptom treatment (like ibuprofen for muscle aches in those who can take it) if they wish it. Though for those who would like to be treated (treatment offers shorter time with symptoms) or for those who are at higher risk (diabetes, high blood pressure, heart, lung, or kidney disease, smoker which can be helpful to take medication treatment regimen to avoid complications), please reach out for complete discussion.
Improved Atrial Fibrillation Treatment
For people with atrial fibrillation, undergoing cryoballoon ablation lowers the risk by 70% of needing to be hospitalized due to complications of the dangerous rhythm. This was shown to be more effective than medication therapy at preventing hospitalizations.
Dr. Neuman says:
There were risks associated with the procedure in the short term, though, by three years, the harms of not having the procedure outweighed the short-term risks for most individuals.
Does this apply to you? If you have atrial fibrillation and have not undergone the procedure and would like to discuss it more, I'd be happy to discuss it. Many individuals choose to at least meet with the Cardiologists (the subspecialty Cardiologists called Electrophysiologists, who I can help you find) who do these procedures.
Empagliflozin (Jardiance) slows the rate of kidney disease progression
Empagliflozin (Jardiance) slowed the progression of kidney disease 28% more than placebo in people with even advanced forms of kidney disease. The Study was not done on people on dialysis.
Dr. Neuman says:
If you have diabetes, kidney, or heart disease, empagliflozin could be an excellent medicine. The benefits are even more apparent if you have a combination of these illnesses.
Does this apply to you? If you are interested in this medication (either for type 2 diabetes, heart disease, or kidney disease), please reach out.
Social Isolation and Loneliness increase the risk of diseases
Social isolation and loneliness are increasingly considered risk factors for various illnesses (heart disease, stroke, dementia, anxiety, depression, and even infections like COVID-19.
Does this apply to you? There are many ways to help with social isolation. Reach out, and we can brainstorm ways that sound exciting to you.
More equitable equations
An equation that calculates kidney performance underperformed in people of color. This could explain the significant shortcoming where some people who had worse kidney disease were unaware of how bad their condition was (including their treating doctors). This is potentially one of the reasons people of color experience worse kidney disease outcomes. The new equation is more accurate in people of color and maintains similar accuracy in people not of color.
Dr. Neuman says: Institutionalized racism has been in medicine and is in the field of medicine now. Though thanks to the new equation, we have a step, albeit small, in the right direction.
New Alzheimer's drug complicated
Lecanemab (trade name Lezembi) is a new medicine for slowing the rate of Alzheimer's disease. Results in a study of 898 people saw a 1.44 average point improvement in a 90-point scale change over a placebo for cognitive function over 18 months. Update: In 02/2023, it gained FDA approval. Side effects were a concern.
Dr. Neuman says: Given the 12% risk of brain swelling, a 1.41 out of 90 change over placebo may not be worth $26,500 annually. If I were in this situation, I would likely use the money instead to hire a physical therapist for exercise training, a personal chef, adaptive equipment, and that new shiny ultrasound machine I'd always wanted.
Genetic favorability testing for different medicines for depression complicated
Testing decreased the number of gene-drug interactions, and it helped 1.5% more people than placebo recover in the short term. At the two-year mark, it did not significantly improve symptom outcomes over a placebo in a study of 1,944 people with depression.
Dr. Neuman says: Sounds fancy. I worry that if only a 1.5% improvement over the placebo and only in the short term, these tests could drive up costs without making a real difference for people.
Tirzepatide (trade name Mounjaro) is another option for weight loss
Semaglutide (trade names WeGovy, Rybelsus, Ozempic) is a standard medicine used for weight loss. It is an anti-diabetes medicine with generally good side effect profiles and can reduce weight by 15% in just over a year (compared to a 3% placebo). Tirzepatide showed similar weight loss (20% in 1.5 years) and safety in a study of 1,944 people.
Dr. Neuman says: Not right for everyone, and some risks (stomach side effects when first starting and some rare but serious risks). Though these medicines have been considered a breakthrough for those who can afford them (and find them as supply has been up and down). If people are on a weight journey and ask me for help, medicine is only a small part of the discussion—an essential part for some and a non-existent part for others. My job is to help those who wish to consider their options.
Does this apply to you? Reach out if you are interested in the medication or want to explore options if you are on a weight journey.
Semaglutide study Tirzepatide study Article
Thanks for reading!
'Does this apply to you' section will launch on 09/01/2023.
We will regularly update members on health news like this starting 09/01/2023—periodic publication on this website for all.
As always, reach out if you have questions.
Best way to reach us:
-Appointments in person available: starting 9/1/23
-Advice by email/text/phone call/video call available: starting 9/1/23
Best, and with love,
Dr. Neuman
Here is something we usually put at the end of our education monthly. Put these numbers in your phone! If not for you, for a friend.
If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line (Opens in a new tab)
at 741-741 or call the National Suicide Prevention Lifeline
at 1-800-273-8255.
Trans Lifeline - https://translifeline.org/ 877-565-8860
-565-8860
