News & Analysis
Clinical Trials Update Short Therapy Reduces Depression in Family Caregivers of Patients With Dementia Therapy using a series of coping strategies to provide stress relief and emotional support for family members caring for relatives with dementia can reduce depression and anxiety and improve well-being at no extra cost to standard care, according to a randomized clinical trial conducted in the United Kingdom (Livingston G et al. Lancet Psychiatry. doi:10.1016/S2215-0366[14]00073-X [published online November 18, 2014]). In the study, 260 family caregivers who were free of depression were assigned 2:1 to receive either the 8-session START (Strategies for Relatives) program or treatment as usual, which consisted of medical, psychological, and social services for the person with dementia. Psychology graduates administered the START intervention and gave caregivers strategies focused on relaxation, communication, behavior management, changing negative thoughts, and future planning. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale total score (HADS-T). The current study found that family caregivers receiving the START program reported a significant 2.58-point improvement in the HADS-T compared with the usual treatment group after 2 years and were 7 times less likely to develop clinically significant depression than those given usual care. The START program was also no more expensive to provide than usual care.
Hyperkalemia Controlled With 2 Novel Medications Three recent randomized clinical trials have shown that 2 distinct oral medications can effectively lower plasma potassium levels in patients with hyperkalemia, a notoriously challenging but common problem in chronic kidney disease and heart failure. The drugs, which haven’t been approved by the US Food and Drug Administration, have different mechanisms of action. Patiromer binds potassium, primarily in the colon. Sodium zirconium cyclosilicate is a highly selective cation exchanger that traps potassium in the intestines. jama.com
In one trial, patients with chronic kidney disease and hyperkalemia who were taking RAAS (renin-angiotensin-aldosterone system) inhibitors maintained normal potassium levels after treatment with patiromer (Weir MR et al. N Engl J Med. doi:10 .1056/NEJMoa1410853 [published online November 21, 2014]). During the treatment stage of the 2-phase study, 237 patients were administered 1 of 2 patiromer doses: 4.2 g for mild hyperkalemia or 8.4 g for moderate-severe hyperkalemia, twice daily for 4 weeks. Patients enrolled in the withdrawal phase were assigned to continue receiving patiromer or placebo for 8 weeks if their serum potassium level reached target range (3.8 to
Clinical Trials Update Short Therapy Reduces Depression in Family Caregivers of Patients With Dementia Therapy using a series of coping strategies to provide stress relief and emotional support for family members caring for relatives with dementia can reduce depression and anxiety and improve well-being at no extra cost to standard care, according to a randomized clinical trial conducted in the United Kingdom (Livingston G et al. Lancet Psychiatry. doi:10.1016/S2215-0366[14]00073-X [published online November 18, 2014]). In the study, 260 family caregivers who were free of depression were assigned 2:1 to receive either the 8-session START (Strategies for Relatives) program or treatment as usual, which consisted of medical, psychological, and social services for the person with dementia. Psychology graduates administered the START intervention and gave caregivers strategies focused on relaxation, communication, behavior management, changing negative thoughts, and future planning. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale total score (HADS-T). The current study found that family caregivers receiving the START program reported a significant 2.58-point improvement in the HADS-T compared with the usual treatment group after 2 years and were 7 times less likely to develop clinically significant depression than those given usual care. The START program was also no more expensive to provide than usual care.
Hyperkalemia Controlled With 2 Novel Medications Three recent randomized clinical trials have shown that 2 distinct oral medications can effectively lower plasma potassium levels in patients with hyperkalemia, a notoriously challenging but common problem in chronic kidney disease and heart failure. The drugs, which haven’t been approved by the US Food and Drug Administration, have different mechanisms of action. Patiromer binds potassium, primarily in the colon. Sodium zirconium cyclosilicate is a highly selective cation exchanger that traps potassium in the intestines. jama.com
In one trial, patients with chronic kidney disease and hyperkalemia who were taking RAAS (renin-angiotensin-aldosterone system) inhibitors maintained normal potassium levels after treatment with patiromer (Weir MR et al. N Engl J Med. doi:10 .1056/NEJMoa1410853 [published online November 21, 2014]). During the treatment stage of the 2-phase study, 237 patients were administered 1 of 2 patiromer doses: 4.2 g for mild hyperkalemia or 8.4 g for moderate-severe hyperkalemia, twice daily for 4 weeks. Patients enrolled in the withdrawal phase were assigned to continue receiving patiromer or placebo for 8 weeks if their serum potassium level reached target range (3.8 to
