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U.S. says results encouraging for healthcare delivery reforms

By David Morgan

WASHINGTON Thu Jan 30, 2014 3:42pm EST

Janet Perez (R) oversees specialists (top) as they help callers and potential customers find health insurance at a customer contact and call center for HealthSource RI, Rhode Island's health insurance exchange program for the Affordable Care Act or ''ObamaCare,'' in Providence, Rhode Island October 25, 2013. REUTERS/Brian Snyder

Janet Perez (R) oversees specialists (top) as they help callers and potential customers find health insurance at a customer contact and call center for HealthSource RI, Rhode Island’s health insurance exchange program for the Affordable Care Act or ”ObamaCare,” in Providence, Rhode Island October 25, 2013.

Credit: Reuters/Brian Snyder

WASHINGTON (Reuters) – The Obama administration on Thursday reported what it called encouraging results from efforts to reduce healthcare costs and improve the quality of care for more than 5 million Medicare beneficiaries under Obamacare

As part of President Barack Obama’s healthcare reform law, the efforts center around more than 360 accountable care organizations (ACOs), which are networks of doctors, hospitals and other providers specially organized to help move Medicare away from traditional fee-for-service medicine.

The U.S. Centers for Medicare and Medicaid Services (CMS) said preliminary data show that the ACOs produced $380 million in savings vis-a-vis traditional Medicare in 2012 by giving doctors and other healthcare providers the incentive to focus on improved outcomes for patients instead of fees from tests and services.

Medicare, the $575 billion government healthcare system for 51 million elderly and disabled beneficiaries, faces growing financial pressures as a result of America’s aging population. A mainstay, the trust fund that pays for hospitalization, is expected to be exhausted in 2026.

Deficit hawks view Medicare as a future driver of the federal debt and have called for major systemic reforms. But the Obama administration has pursued gradual changes including the reform of care delivery systems.

So-called fee-for-service medicine is widely viewed as a cause of rising healthcare costs, because it calls for paying healthcare providers for tests and services that are sometimes unnecessary.

Obamacare seeks to tackle costs by exploring ACOs and other new healthcare business models intended to find savings that do not jeopardize care. A main goal is to generate savings large enough to be shared between Medicare and providers. But some experts are skeptical, saying significant cost reductions could be hard to maintain over time.

But CMS, an agency within the U.S. Department of Health and Human Services, runs two different ACO programs. In its largest, 54 of 114 ACO networks achieved lower than expected expenditures. But only 29 saw savings big enough to share with providers. All told, the program produced $128 million in net savings for Medicare’s trust funds.

“Overall, the ACO program’s a net saver to the Medicare program,” CMS principal deputy administrator Jon Blum told reporters in a conference call.

“It’s giving us great confidence that this is the right course for the Medicare program and we are confident that it will continue to show quality improvement and cost savings.”

Officials said the ACOs also achieved a wide range of quality goals. But CMS released no quality statistics.

Thursday’s government release drew some cautious optimism from the healthcare industry.

“Today’s report reflects important steps. More work is needed to modernize our antiquated Medicare payment system and base payment on evidence-based quality measures and proven patient outcomes,” said Dr. John Noseworthy, chief executive of the Mayo Clinic in Rochester, Minnesota, which is not part of the government’s program.

“As results of the team-based care models are analyzed, those most effective in driving down health care costs without compromising safety and quality should become part of the healthcare system,” he said.

(Reporting by David Morgan; Editing by Chizu Nomiyama)

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Seeing ultrasound rarely changes abortion plans: study

By Shereen Jegtvig

NEW YORK (Reuters Health) – NEW YORK Thu Jan 30, 2014 2:37pm EST

NEW YORK (Reuters Health) – NEW YORK (Reuters Health) – Nearly 99 percent of women went ahead with an abortion after voluntarily viewing an ultrasound image of the fetus beforehand, according to a large new U.S. study.

Based on medical records for more than 15,000 women seeking abortion at Los Angeles Planned Parenthood clinics, researchers found that only a small fraction of the women changed their minds after seeing the image.

“This study was motivated in large part by the current political and popular interest in what role ultrasound viewing plays in women’s decisions about abortion,” said one of the authors, Katrina Kimport at the University of California San Francisco School of Medicine.

Ten states have enacted laws that require doctors to perform ultrasounds before abortions, and three of those require the woman to view the image during the ultrasound. The others require doctors to offer women the option of viewing it.

A 2011 North Carolina ultrasound law, considered one of the strictest in the nation, was struck down by a federal judge earlier this month because it forced doctors to explain the image while showing it to the patient. The U.S. District Court held that forced speech to be unconstitutional.

Advocates for ultrasound laws base the requirement on the idea that showing a woman the image of her fetus might cause her to have a change of heart about terminating the pregnancy.

Kimport said there’s been a lot of discussion about what effects viewing would have on women who are seeking or considering abortions, but there was very little research on what actually happens.

“We were interested in bringing in an empirical perspective to these conversations,” she told Reuters Health.

The researchers reviewed medical records from 15,575 visits at 19 Planned Parenthood clinics in Los Angeles during 2011. These facilities routinely perform ultrasounds before abortion procedures and regularly ask the patients if they want to see the images. It’s also standard practice to ask each patient how confident she is about her decision to terminate the pregnancy.

Responses to both of these questions are noted in the patient’s electronic medical record, according to the researchers.

Kimport and her colleagues analyzed those records and found that most women (85.4 percent) said they were certain they had made the right decision to have the abortion. A smaller number (7.4 percent) were classified as having medium or low levels of certainty about getting the procedure.

Although all of the women included in the study had ultrasounds, less than half (42.5 percent) chose to see the image.

A total of 98.8 percent of the planned abortions took place. Among women who did not view their ultrasounds, 99 percent went through with the procedure. Among those who did view the images, 98.4 percent of the women had abortions.

The images appeared to have the greatest effect among women who had expressed low or medium certainty about the procedure. In that group, those who viewed the ultrasounds were slightly less likely to go through with the abortion: 95.2 percent did have the procedure, compared to 97.5 percent of uncertain women who did not view the ultrasound.

Women who expressed high certainty about their decision showed no differences, whether or not they had viewed the ultrasound.

The study team also looked at other factors that might affect the women’s decisions and found that how far along the pregnancy was turned out to be much more significant than whether a woman viewed ultrasound images.

Women at 17 to 19 weeks of gestation were almost 20 times as likely to back out of the abortion compared to women at less than 9 weeks gestation.

Based on their results, the authors conclude in the journal Obstetrics and Gynecology that mandatory viewing of ultrasound images is not likely to significantly influence how many women get abortions.

Women should be offered the opportunity to view their ultrasound before an abortion, the authors write, but mandatory viewing should be avoided.

“I think that when we start moving from a place where it’s about a patient decision to a legal requirement, we’re moving into the space that the literature around health suggests is going to have negative effects on women’s health outcomes,” Kimport said.

The researchers did not study other possible effects of viewing, or not viewing, ultrasound images, such as their emotional impact on the women.

Another unknown is what might happen when women feel forced to view ultrasounds rather than making the choice to see the images, the study authors write.

“There’s extensive literature looking at a range of health-related issues that show that when a patient feels they have made a decision – and they feel engaged in the decision-making – they have better satisfaction with their care and better health outcomes,” Kimport said.

SOURCE: bit.ly/LhAKlE Obstetrics and Gynecology, online December 9, 2013.

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Lilly's quarterly sales largely offset Cymbalta slide

By Ransdell Pierson

Thu Jan 30, 2014 11:08am EST

(Reuters) – Drugmaker Eli Lilly and Co’s quarterly revenue fell far less than expected, it reported on Thursday, as plunging sales of its Cymbalta depression treatment were largely offset by higher revenues for most of its other prescription drugs.

The company earned $728 million, or 67 cents per share, in the fourth quarter. That compared with $827 million, or 74 cents per share, in the year-earlier quarter, when Lilly took charges for asset impairments and restructuring.

“Company sales were stronger than thought, but a lot of that upside came from drugs that are already off patent or about to lose patent protection,” said Edward Jones analyst Judson Clark.

Excluding special items, Lilly earned 74 cents per share, matching analysts’ average forecasts, according to Thomson Reuters I/B/E/S.

Shares in the company dropped 1.4 percent to 53.21, after earlier reaching their lowest in two weeks at $53.05.

Lilly’s global sales fell 2 percent to $5.81 billion, but topped Wall Street forecasts of $5.46 billion. Sales would have been flat if not for the stronger dollar, which lowers the value of sales in overseas markets.

Sales of Cymbalta, which lost U.S. patent protection last month, fell 38 percent to $883 million. But they came in about $100 million higher than Wall Street expected, analysts said.

Lilly’s sales, earnings, and its share price, have been badly hurt since late 2011, when its Zyprexa schizophrenia drug lost U.S. patent protection.

Once Lilly’s biggest product, with annual sales of $5 billion, it now has sales of only $1.5 billion.

The situation worsened last month, when Cymbalta – which also had $5 billion in annual sales at its peak – began facing cheaper generics in the United States.

The company’s “patent cliff” will become more daunting in March, when $1 billion-a-year osteoporosis drug Evista faces U.S. generics.

“We haven’t wasted the crisis,” Chief Executive John Lechleiter said Thursday in a conference call with industry analysts. “We’re more agile, we’re leaner and I believe we’re better operators today.”

Lilly has cut more than 5,000 employees from its workforce in order to reduce annual costs by $1 billion over the last three years to deal with patent expirations on its drugs.

It has also restructured itself to focus on cancer and diabetes – lucrative specialties that are two of the company’s longstanding strengths.

Clark said sales of Cymbalta could eventually decline 80 percent, which has been the case for many other blockbuster medicines in recent years. He questioned whether gains for other products seen in the fourth quarter will be sustainable.

PRICE INCREASES

Sales of many products over the quarter showed double-digit sales increases, including Lilly’s Humalog insulin, Cialis anti-impotence treatment, Forteo and Evista osteoporosis drugs, and Straterra for attention deficit disorder.

But price increases in the United States accounted for much of those sales gains.

The Indianapolis drugmaker is expecting a return to company sales growth next year, from increased sales of drugs that still have patent protection and from launches of new treatments for cancer and diabetes.

It hopes to launch three new drugs this year: ramucirumab for stomach cancer, and dulaglutide and empagliflozin for type 2 diabetes – the most common form of the disease, which is closely linked to obesity.

Although analysts have forecast annual sales of more than $650 million for ramucirumab, they are concerned the new diabetes drugs may have a hard time competing with similar drugs already on the market.

The company has introduced no new products in recent years.

In a recent interview, Lechleiter said it was time for Lilly “to go back on offense”, helped by a pipeline of nearly 40 medicines in mid- and late-stage studies, compared with only seven in those stages of development a decade ago.

(Reporting by Ransdell Pierson; Editing by Lisa Von Ahn and Sophie Hares)

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ADHD tied to more traffic accidents; medication may help

By Andrew M. Seaman

NEW YORK Wed Jan 29, 2014 4:22pm EST

NEW YORK (Reuters Health) – People with attention-deficit/hyperactivity disorder (ADHD) are more likely to be in a serious traffic accident, but medication may counteract that risk for some, according to a new study from Sweden.

Researchers found that people with ADHD are about 50 percent more likely to be in serious traffic accidents, compared to people without the condition.

But taking medication to control some of the symptoms may help reduce that increased risk – at least among men, according to the study’s lead author.

“It has been known for a while that ADHD is associated with traffic accidents and traffic violations,” Zheng Chang said. But, he added, “there are no studies from the population level looking at ADHD medication.”

Chang is currently at the University of Oxford in the UK, but completed the research while at the Karolinska Institute in Stockholm.

ADHD is a neurodevelopmental condition that results in people having trouble paying attention and controlling impulsive behaviors and being overly active, according to the U.S. Centers for Disease Control and Prevention (CDC).

The CDC says about 11 percent of children between four and 17 years old were diagnosed with ADHD as of 2011. The condition often lasts into adulthood.

For the new study, the researchers used data collected between 2006 and 2009 from 17,408 Swedish adults with ADHD.

During that time, there were about 214 serious accidents among every 10,000 men with ADHD each year. That compared to about 77 accidents per 10,000 men without ADHD.

There were also about 120 accidents for every 10,000 women with ADHD per year during the study, versus about 52 accidents per 10,000 women without ADHD.

The researchers write in JAMA Psychiatry that while they can’t say why there appeared to be an increased risk of serious traffic accidents among people with ADHD, past research has attributed it to inattentiveness and impulsivity.

Next, the researchers compared driving data from people with ADHD who had a prescription for ADHD medication to those who weren’t prescribed medication.

They found men who had a prescription were 29 percent less likely to be involved in a serious traffic accident.

To eliminate differences between the men included in the study, the researchers compared data from times when each man was on ADHD medication to times when the same man wasn’t on medication.

In that analysis, men were 58 percent less likely to be in an accident while they were taking ADHD medication, compared to times when they weren’t getting treatment.

For women, however, there was no difference in risk. Chang said the study may not have been able to pick up subtle differences, because fewer women were included.

Overall, the researchers said that between 41 percent and 49 percent of accidents among men with ADHD may have been prevented if they were on medication.

Chang told Reuters Health the findings may actually underestimate the risks of ADHD and the benefits of medication, because his team only looked at serious accidents.

“This is just the tip of the iceberg,” Daniel Cox said. “It’s only reporting on accidents that resulted in the hospitalization of ADHD drivers.”

Cox was not involved with the study but has done research on traffic accidents among people with ADHD. He’s also director of the Virginia Driving Safety Laboratory at the University of Virginia in Charlottesville.

He said the study can’t say how many people who were prescribed ADHD medications were actually taking them.

“What it says is if you drive and have ADHD, you really have to think of this as something very different from a non-ADHD driver,” he said. “That it is a risk.”

Cox also said that not everyone with ADHD necessarily has an increased risk of accidents.

“We need to drill down and identify those at risk and focus on those,” he said.

SOURCE: bit.ly/P0ZWgC JAMA Psychiatry, online January 29, 2014.

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Lilly CEO: 'It's time to go back on offense'

By Ransdell Pierson

Wed Jan 29, 2014 3:55pm EST

Eli Lily and Company's President and CEO John Lechleiter speaks during the APEC CEO summit in Honolulu, Hawaii November 11, 2011. REUTERS/Chris Wattie

Eli Lily and Company’s President and CEO John Lechleiter speaks during the APEC CEO summit in Honolulu, Hawaii November 11, 2011.

Credit: Reuters/Chris Wattie

(Reuters) – After three years of seeing major drugs like Zyprexa for schizophrenia lose patent protection and wipe away billions of dollars in revenue, Eli Lilly and Co Chief Executive Officer John Lechleiter wants to change the game plan.

“It’s time to go back on offense,” Lechleiter said in a recent interview. New treatments for diabetes and cancer now awaiting approval and increased sales of animal-health products and drugs in China and Japan are some of the aggressive moves he has in mind.

He is also counting on a robust success rate among three dozen other experimental drugs now in mid- and late-stage trials, including a cancer drug called ramucirumab.

“We’re on the cusp of launching products in cancer and diabetes, two therapeutic areas where we’re well established and where we have built out the infrastructure we need,” Lechleiter said. “And we believe that’s going to be the beginning of our return to growth.”

Skeptical investors only now appear to be catching on to Lilly’s potential upside. After rising only 3 percent in 2013, badly underperforming a 27 percent average advance for other large drugmakers, the stock is up 6 percent this month.

“Instead of having to play defense and manage through this difficult patent cliff, the company will be able to use additional cash flow to invest in its pipeline, to partner with others or make bolt-on acquisitions,” said Atlantic Equities analyst Richard Purkiss. “The outlook is much brighter, and they’ll try to get that message across in coming months.”

Lilly, which reports quarterly and 2013 results on Thursday, has forecast earnings of $2.77 to $2.85 per share this year, the final and worst year of its patent cliff. That’s 41 percent less than 2010.

‘THE PIPELINE WILL DISAPPOINT’

Lilly last year sought U.S. approvals for four drugs, three of which Lechleiter said could be approved in 2014: ramucirumab for stomach cancer, and dulaglutide and empagliflozin for type 2 diabetes – the most common form of diabetes, which is closely linked to obesity.

Analysts have forecast annual sales of more than $650 million for ramucirumab, saying sales could be far higher if the drug also wins approval for cancers of the colon, lung or liver. But they caution that the diabetes drugs may have a hard time competing against existing options.

Lechleiter said Lilly plans to seek approval of necitumumab for squamous-cell lung cancer this year. The medicine, like ramucirumab, was acquired by Lilly through its $6.5 billion purchase of ImClone Systems in 2008.

If approved, necitumumab could capture eventual annual sales of more than $1 billion, analysts say. Such sales could make a big difference for Lilly, whose annual revenue of $20 billion is far lower than Big Pharma rivals like Pfizer Inc and Merck & Co.

In the meantime, Lilly is testing nearly 40 medicines in mid- and late stage studies, compared with only 7 in those stages of development a decade ago. They include new treatments for cholesterol, psoriasis, lupus, rheumatoid arthritis and Alzheimer’s disease.

Animal health unit Elanco, with annual sales of about $2 billion, is thriving as Lilly introduces new products and has expanded the business in China and other fast-growing markets.

Many analysts are wary, however, of the company’s ability to win approvals of prescription drugs because it has not launched any major products in recent years and has suffered setbacks in clinical trials, including ramucirumab’s failure to delay progression of breast cancer.

Of 20 analysts tracked by Thomson Reuters, 12 have hold or sell ratings on Lilly, versus 8 with buy ratings. Lilly shares trade at 19 times expected 2014 per-share earnings, compared to a price-to-earnings ratio of 14.6 for other large drugmakers. That could be more a reflection of the company’s poor earnings this year than excitement about the stock.

“We believe that overall the pipeline will disappoint investors,” said Alex Arfaei of BMO Capital Markets in a research note, citing low sales expectations for ramucirumab and the new diabetes drugs.

SIDESTEPPING MEGAMERGER SIDE EFFECTS

When Lilly’s Zyprexa was confronted with cheaper generic treatments for schizophrenia in October 2011, it faced one of the industry’s steepest patent cliffs ever, quickly losing 80 percent of its onetime $5 billion in annual sales.

Similarly precipitous declines are expected for Cymbalta, Lilly’s $5 billion-a-year antidepressant, which lost U.S. patent protection last month, and for blockbuster osteoporosis treatment Evista, which goes generic in March.

Many other large drugmakers, when faced with patent expirations and earnings declines of lesser scope, have resorted to megamergers to cushion the blow from generics and prop up earnings with cost savings. Huge layoffs, sapped morale and poor track records in introducing new drugs are more common results.

Pfizer Inc stands out, having snapped up U.S. rivals Warner-Lambert, Pharmacia and Wyeth since 2000.

Lechleiter, who began his career at Lilly in 1979 as a senior organic chemist, has steadfastly spurned any suggestion of a big merger: “It’s never entered our minds, and we remain adamantly opposed.”

John Boris, an analyst for Suntrust Robinson Humphrey, said he expects Lilly earnings to grow an average of 10 percent a year between 2015 and 2020, which would make it second to Bristol-Myers Squibb Co in profit growth over that period.

Atlantic Equities’ Purkiss said he anticipates Lilly will deliver industry-topping earnings growth in the “mid-teens” percentage range in 2015, 2016 and 2017.

“The sentiment has been very negative on Lilly, but it looks like it will go from one of the most growth-starved to the fastest growing of the major U.S. drugmakers and the European players,” Purkiss said.

By avoiding a disruptive megamerger, Lilly has allowed itself to press ahead with ambitious research, said Barclays analyst Tony Butler. He said to date the company has met long-term sales and earnings forecasts it provided in 2009 – before patents went over the cliff – while maintaining its generous dividend, with a current yield of 3.6 percent.

“At the time, the market was incredibly skeptical about Lilly’s ability to fund its dividend and to have enough remaining cash flow to fund its business,” said Butler. “Lilly proved everybody wrong.”

(Reporting by Ransdell Pierson; Editing by Prudence Crowther)

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Fourth Canadian farm hit by pig killing virus: Ontario official

Wed Jan 29, 2014 2:34pm EST

(Reuters) – The piglet killing Porcine Epidemic Diarrhea virus has spread to a fourth farm in the Canadian province of Ontario, the provincial government said on Wednesday, despite the hog industry’s efforts to stop it by disinfecting delivery trucks and clothing used on farms.

The virus has killed more than 1 million piglets in the United States but it has so far been contained within Canada to southern Ontario farms. The fourth case has been confirmed in Norfolk County along the north shore of Lake Erie, said Mark Cripps, a spokesman for Ontario Premier Kathleen Wynne.

The other confirmed cases are farms further west in Middlesex County and near Chatham-Kent.

“Given the virulent nature of this virus, it is disappointing, but not unexpected that PED would be found in Canada and it is likely that more cases will be identified in the coming days and weeks,” Cripps said in an email.

Ontario confirmed the first Canadian case last week.

PEDv – which causes diarrhea, vomiting and severe dehydration in hogs – has turned up in 23 of the 50 states since its discovery in the United States last April.

The virus, which is already established in Europe and Asia, poses no threat to humans and is not a food safety risk.

(Reporting by Rod Nickel in Winnipeg, Manitoba; Editing by Grant McCool)

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Scientists hail breakthrough in embryonic-like stem cells

By Kate Kelland

LONDON Wed Jan 29, 2014 7:04am EST

LONDON (Reuters) – In experiments that could open a new era in stem cell biology, scientists have found a cheap and easy way to reprogramme mature cells from mice back into an embryonic-like state that allowed them to generate many types of tissue.

The research, described as game-changing by experts in the field, suggests human cells could in future be reprogrammed by the same technique, offering a simpler way to replace damaged cells or grow new organs for sick and injured people.

Chris Mason, chair of regenerative medicine bioprocessing at University College London, who was not involved in the work, said its approach was “the most simple, lowest-cost and quickest method” to generate so-called pluripotent cells – able to develop into many different cell types – from mature cells.

“If it works in man, this could be the game changer that ultimately makes a wide range of cell therapies available using the patient’s own cells as starting material – the age of personalized medicine would have finally arrived,” he said.

The experiments, reported in two papers in the journal Nature on Wednesday, involved scientists from the RIKEN Center for Developmental Biology in Japan and Brigham and Women’s Hospital and Harvard Medical School in the United States.

Beginning with mature, adult cells, researchers let them multiply and then subjected them to stress “almost to the point of death”, they explained, by exposing them to various events including trauma, low oxygen levels and acidic environments.

Within days, the scientists found that the cells survived and recovered from the stressful stimulus by naturally reverting into a state similar to that of an embryonic stem cell.

These stem cells created by this exposure to stresses – dubbed STAP cells by the researchers – were then able to differentiate and mature into different types of cells and tissue, depending on the environments they were given.

“If we can work out the mechanisms by which differentiation states are maintained and lost, it could open up a wide range of possibilities for new research and applications using living cells,” said Haruko Obokata, who lead the work at RIKEN.

Stem cells are the body’s master cells and are able to differentiate into all other types of cells. Scientists say that, by helping to regenerate tissue, they could offer ways of tackling diseases for which there are currently only limited treatments – including heart disease, Parkinson’s and stroke.

There are two main types of stem cells: embryonic ones, harvested from embryos, and adult or iPS cells, which are taken from skin or blood and reprogrammed back into stem cells.

Because the harvesting of embryonic stem cells requires the destruction of a human embryo, the technique has been the subject of ethical concerns and protests from pro-life campaigners.

Dusko Ilic, a reader in stem cell science at Kings College London, said the Nature studies described “a major scientific discovery” and predicted their findings would open “a new era in stem cell biology”.

“Whether human cells would respond in a similar way to comparable environmental cues … remains to be shown,” he said in an emailed comment. “I am sure that the group is working on this and I would not be surprised if they succeed even within this calendar year.”

(Reporting by Kate Kelland; Editing by Kevin Liffey)

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Anti-VEGF drugs making a difference in vision, longterm care

By Shereen Jegtvig

NEW YORK Tue Jan 28, 2014 3:51pm EST

NEW YORK (Reuters Health) – A treatment introduced less than 10 years ago has already made a difference in the number of Americans losing their vision and being admitted to nursing homes, according to a new study.

Two Duke University economists looked at Medicare beneficiaries with so-called “wet” macular degeneration and found those diagnosed after the introduction of anti-VEGF drugs were less likely to go blind and less likely to move into long-term care.

“At last we have found a way of managing this horrible and very common disease among the oldest of the old,” said Frank Sloan, who led the new study.

Age-related macular degeneration (AMD) is the number one cause of blindness in the U.S. affecting older adults, usually after age 65. Most AMD patients have the dry form of the disease, but about 10 percent have wet AMD, which progresses more quickly than the dry form.

Past treatments weren’t very effective at managing wet AMD, but retinal surgeons began using injections of vascular endothelial growth factor inhibitors, known as anti-VEGF, in the mid 2000s.

Previous clinical research has indicated that anti-VEGF treatments are effective for wet AMD, but Sloan said those types of studies don’t let you see longer-term outcomes or how well the therapy works in a real-world setting.

The researchers used Medicare claims information from 1994 to 2011 to examine the vision outcomes and long-term care facility admissions of wet AMD patients who were treated with older methods or with the new anti-VEGF drugs.

The two most commonly used drugs, ranibizumab (Lucentis) and bevacizumab (Avastin), were introduced for eye therapy in 2006.

The researchers discovered that the use of anti-VEGF therapy reduced vision loss by 41 percent and the onset of severe vision loss and blindness by 46 percent, compared to earlier forms of treatment.

They also found that patients who received anti-VEGF were 19 percent less likely to be admitted to long-term care facilities during a two-year follow-up period compared to those treated before the drugs came into use.

The findings were published in JAMA Ophthalmology.

The new treatments may be changing the way some doctors think about wet AMD.

“We used to say it was better to have the dry form because it tended to be milder and slowly progressive as opposed to the wet AMD, which has a rapid onset and much more severe vision loss,” Dr. Michael Stewart told Reuters Health.

Stewart, who chairs the ophthalmology department at the Mayo Clinic in Jacksonville, Florida, was not involved in the new study.

Stewart said results like these actually call into question whether or not that old statement is still true because the anti-VEGF drugs are so effective.

“By and large, we are maintaining good vision in most people that we treat,” Stewart said.

Stewart also says the new drugs have revolutionized the way retinal surgeons approach these patients.

He says that early diagnosis with quick initiation of treatment is the best way of preserving vision. The typical course of treatment is to give an injection of the drug in to the eye, about one time per month, but treatment can be tapered to the patients’ needs.

“Patients and family – and most of us, actually – think of a needle in the eye as one of the worst medical procedures we can imagine,” Stewart said, “but the reality is patients tolerate them very, very well and very few patients actually forgo the treatment because of either imagined or real pain, discomfort and anxiety.”

SOURCE: bit.ly/Lk4WN6 JAMA Ophthalmology, online January 23, 2014.

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