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19 December 2006 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

Black Cohosh No More Effective for Symptoms of Menopause than Dummy Pill

Data from the HALT study, Herbal Alternatives for Menopause, found that black cohosh, in three formulations, was no better than placebo in reducing symptoms of hot flashes and night sweats during menopause (Article, p. 869). The randomized, controlled trial assigned women to one of five groups taking: a black cohosh pill, a multibotanical pill with black cohosh and nine other ingredients, the multibotanical pill plus counseling to encourage intake of soy products, hormone therapy (estrogen with or without progestin), or a placebo pill. Hormone therapy worked as expected in substantially reducing the number and severity of symptoms. None of the black cohosh formulations worked any better than placebo. Black cohosh products are widely used as treatments for menopausal symptoms.

An accompanying editorial says that the study is a “well-designed, adequately powered RCT that makes an important contribution, albeit one that will disappoint women who have been hoping for an effective, safe alternative to estrogen” (Editorial, p. 924). The good news, says the writer, is that women in the placebo group experienced about a 30 percent reduction in severity and frequency of symptoms during the 12-month follow-up period. This means that many women will probably have fewer symptoms within six to 12 months without any treatment at all.

Enzyme Replacement Slowed Progression of Complications of Fabry Disease

Agalsidease-beta therapy for Fabry disease slowed progression of kidney, heart and nervous system complications and death compared to placebo, a new study found. Fabry disease is a hereditary disease in which a faulty gene causes inadequate metabolism of certain fats in the body. The randomized, double-blind, placebo-controlled trial was completed by only 74 people with advanced Fabry disease and mild to moderate kidney disease. Only one third of participants developed clinical events. An editorial writer notes the high cost of lifelong therapy with agalasidase beta and says that therapy should be supplemented with the best standard medical care with particular emphasis on preventing stroke.

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