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In a randomized trial involving 652 patients with active chronic rheumatoid arthritis (RA) despite treatment, the drug abatacept reduced disease activity, improved physical function and slowed joint damage when compared with placebo (Article, p. 865). Those receiving abatacept also had more serious infections (2.5 percent vs. 0.9 percent) and infusion reactions. The one-year study was limited to patients with established RA (mean duration of about nine years) and who had an inadequate response to methotrexate, a drug used to aggressively treat RA. Participants continued taking methotrexate during the trial.
An editorial writer notes that the trial, a so-called “registration trial” needed for FDA approval, compares a new drug to a placebo (sugar pill) rather than to the best alternative drug, which is what would be most useful to practicing clinicians (Editorial, p. 933). The writer also says that practicing clinicians will have to monitor patients receiving abatacept carefully until the drug’s safety profile becomes clearer with longer time on treatment.
In a study of nearly 70,000 patients hospitalized for chronic obstructive pulmonary disease (COPD), only 33 percent of the patients received ideal care (Improving Patient Care, p. 894). Ideal care was defined as receiving all five care elements recommended by American College of Physicians and American College of Chest Physicians joint guidelines and receiving none of five tests considered to be of uncertain or no benefit or even harmful. Individual hospital performance varied widely: fewer than 10 percent of patients received ideal care at some hospitals while more than 60 percent of patients at other hospitals got ideal care. The authors say their study points to specific interventions -- for example, increasing use of recommended tests and treatments and omitting useless ones -- that would “reduce large variations in practice between institutions and … improve care nationally.”