lupus

A transplant rejection drug may help stem kidney disease.

* THE QUESTION For three decades, the standard treatment for people with inflamed kidneys brought on by lupus, known as lupus nephritis, has been a chemotherapy drug. Side effects, however, can be severe, including infertility. Might a newer drug -- one used mainly to combat organ rejection in kidney, heart and liver transplants -- offer an alternative without the toxic complications?

* THIS STUDY involved 140 people with lupus nephritis, mostly women and slightly more than half of them black. They were randomly given monthly injections of the chemotherapy drug Cytoxan (cyclophosphamide) or daily oral doses of CellCept (micophenolate mofetil). After six months, symptoms had disappeared in 22 percent of those taking the oral drug, compared with 6 percent of the injection group. The injection group had fewer partial remissions (25 percent vs. 30 percent) and more adverse effects, including three deaths (vs. none), more severe infections and more hospitalizations. Diarrhea was more common among those taking the oral drug.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone with kidney disease caused by lupus, which affects about 1.5 million Americans -- 90 percent of them women, mostly young. Blacks are about three times more likely to have lupus than whites. The disease affects the kidneys about a third of the time.

* CAVEATS About 48 percent of people taking CellCept and 70 percent of the Cytoxan group either did not achieve at least partial remission or stopped treatment. Long-term effectiveness, including protection against relapse, was not determined. The study was funded in part by Roche Laboratories, which makes CellCept; two of 11 authors had received fees from the company.

* FIND THIS STUDY Nov. 24 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.

* LEARN MORE ABOUT lupus at www.lupus.org and www.rheumatology.org/public/factsheets.

diabetes

Daily use of Retin-A seems to help in the healing of foot sores.

* THE QUESTION Nerve damage and poor blood circulation, earmarks of diabetes, can cause otherwise simple foot ailments -- cuts, blisters, calluses, ingrown toenails and even dry skin -- to develop into ulcers. Might Retin-A (tretinoin), a topical skin rejuvenator, effectively treat these ulcers?

* THIS STUDY randomly assigned 24 men with diabetic foot ulcers to have the sores treated daily for four weeks with either Retin-A or a placebo. Solutions were left on the sores for 10 minutes and rinsed off with saline; the ulcer then was coated with an iodine gel. After four months, 46 percent of the foot ulcers treated with Retin-A had healed completely, compared with 18 percent of those in the placebo group; 85 percent (vs. 45 percent) had shrunk to at least half their size. Sores not fully healed were smaller and less deep in the treatment group.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with diabetes, which leads to foot ulcers about 15 percent of the time.

* CAVEATS Retin-A can cause serious skin irritation; several study participants reported mild to moderate pain at first, but not severe enough to discontinue treatment.

* FIND THIS STUDY November issue of the Archives of Dermatology; abstract available online at www.archdermatol.com.

* LEARN MORE ABOUT complications of diabetes at www.diabetes.org and http://familydoctor.org.

ANTIPSYCHOTICS

Mortality risk may be greater with older drugs.

* THE QUESTION The Food and Drug Administration (FDA) warned in April that the newer generation of antipsychotic medications, called atypical drugs, greatly increased the risk of death for older people with dementia. (Many such people, including more than a quarter of Medicare beneficiaries in nursing homes, are given these drugs for behavioral problems.) How does this danger compare with the risk associated with conventional antipsychotics?

* THIS STUDY reviewed prescription records and medical data on 22,890 people 65 and older who were taking either conventional or atypical antipsychotics for the first time. The drugs included the conventional antipsychotics Tindal, Thorazine, Prolixin, Permitil, Serentil, Trilafon, Mellaril, Stelazine, Vesprin, Taractan, Haldol, Loxitane, Moban, Orap and Navane and the atypical drugs Abilify, Clozaril, Zyprexa, Seroquel, Risperdal and Geodon. About 15 percent of those who took the atypical drugs died within six months of starting them, compared with 18 percent of those using the older-generation drugs. Overall, the conventional group had a 37 percent greater risk of death than the atypical drug group; risk was highest right after treatment started and for those taking higher doses. Whether people had dementia or lived in a nursing home did not alter the risk.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Older people.

* CAVEATS The FDA concluded that atypical antipsychotics increase the risk of death by 65 percent, compared with taking a placebo. Based on that, the current study suggests that conventional drugs roughly double a person's risk of dying, according to the authors. The study did not reveal causes of death, nor did it determine how or why antipsychotics affect mortality risk.

* FIND THIS STUDY Dec. 1 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.

* LEARN MORE ABOUT antipsychotics at www.intelihealth.com (search for "antipsychotic drugs" in quotation marks) and www.nimh.nih.gov.

-- Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.