Sunday, March 5, 2017

Acne Treatment Trials May Be Too Short


Patients with acne typically see their dermatologist for treatment longer than most studies have assessed the benefits of acne therapy, researchers reported here.

In a retrospective study, the mean duration of treatment for acne was 0.79 years (about 9 months) and half of patients stopped going to the dermatologist after 0.44 years, reported Karen Huang, MS, of Wake Forest School of Medicine in Winston-Salem, N.C., and colleagues during a late-breaking session at the American Academy of Dermatology meeting.

"We found that half of patients continue to visit the dermatologist for acne at least 0.44 years, but, in contrast, many clinical trials are a lot shorter," Huang said, noting that a review of the 40 most recent acne studies listed in showed that they were typically only 12 weeks or 3 months long.

"It may be of interest in the future to design clinical trials that more closely simulate how long an average patient is treated," she added.

Overall, about 85% to 90% of people will have acne at some point in their lifetime, but the duration of an acne episode is not well characterized.

So Huang and colleagues looked at electronic records from Wake Forest Baptist Hospital between Jan. 1, 2009 and Nov. 15, 2012 to assess how long patients typically visited the dermatologist for acne treatment.

accutane resultsThey calculated the difference between the patient's first and last visit during that time, and to control for whether patients completed all their acne treatment by the cutoff point, they censored those who had a visit in the 3 months prior to that time, assuming they may still be seeing the doctor.

Huang noted that the analysis looked at the duration of care rather than how long the acne itself persisted.

There were 2,250 patients who had at least one visit for acne. Of these, 57% had only one visit while 43% had multiple visits. The censoring rates were similar between groups.

Overall, 25% of patients continued to see their dermatologist for 1 year.

When assessed by treatment, patients were more likely to have multiple visits if they were taking isotretinoin products (such as Accutane) or non-isotretinoin oral products.

They also found that visits fall off significantly more rapidly for isotretinoin products than for topical or other oral products, which have a much more gradual depletion of patients, Huang said (P=0.004).

Huang noted that if clinicians help patients set expectations of what their treatment may be like, it could help improve adherence.

doctor7online.comThe results are generalizable to patients in an academic dermatology setting and possibly to private practice settings, but may not be applicable in primary care, she noted.

The study was limited by the fact that it may have missed over-the-counter oral medications that were not recorded in medical records, so the study may not as effectively characterize the topical products group.

Also, it provides a "good lower bound," Huang said, but it's possible that patients may only visit the dermatologist once or twice until they are referred back to primary care clinicians.

Richard Gallo, MD, PhD, of the University of California San Diego, who moderated the session at which the findings were presented, noted that the study had two potential confounding variables.

One is the efficacy of the therapy, as patients may stop treatment because they're better, Gallo said. The other is the severity of the initial diagnosis, as patients with mild acne may garner benefit from topical therapy and discontinue seeing their doctor.


Tuesday, January 31, 2017

Alternative medicine might help treat premature ejaculation


Complementary and alternative medicine options may help men manage premature ejaculation, according to a new review of existing research.

The improvements were small, and the studies were of varying quality, but preliminary evidence suggests that acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine and a Korean topical cream may all have desirable effects, researchers conclude in the journal Sexual Medicine, online December 29.

"There are a range of treatments available for premature ejaculation, including drug treatments, behavioral techniques and counseling, however, some men may not want to visit the doctor, take drugs long-term or be on a long wait list for counseling," said lead author Katy Cooper of the University of Sheffield in the UK.

"It's important to evaluate the evidence for other therapies," she told Reuters Health by email. "To our knowledge, this is the first systematic review to assess complementary and alternative medicine for premature ejaculation."

In the current study, researchers evaluated 10 randomized controlled trials that included comparisons either to another type of treatment or to a placebo. Two studies were of acupuncture, five were of Chinese herbal medicine, one of Ayurvedic herbal medicine and two of Korean topical "severance secret" cream.

Together, the two acupuncture studies found that the treatment slightly increased intravaginal ejaculatory latency time (IELT) by about half a minute compared to placebo.

Chinese herbal medicine increased IELT by about two minutes, Ayurvedic herbal medicine increased IELT by nearly a minute and topical cream increased IELT by more than eight minutes.

In some instances, a combination of traditional and alternative options was the most effective. For example, Chinese medicine paired with selective serotonin reuptake inhibitors (SSRIs) increased IELT by two minutes longer than SSRIs alone and nearly three minutes longer than the Chinese medicine alone.

"There are no approved treatments for premature ejaculation," said Donald Patrick, vice chair for research at the University of Washington in Seattle. "This is a common condition that has serious psychological effects on relationships," said Patrick, who wasn't involved in the study. "We need treatments to address it, and it should be treated with equal seriousness as erectile dysfunction."

The prevalence of premature ejaculation is difficult to measure because of the differing definitions of the problem and some men's reluctance to report it. Some studies suggest that between 20 and 30 percent of men report early ejaculation concerns, but the International Society for Sexual Medicine estimates that about 4 percent of men have a lifelong condition.

"Although it is not openly discussed in the media - at least not as much as erectile problems have been discussed in the post-Viagra era - numerous studies report men feel frustrated, depressed and anxious because of this problem," said Ege Can Serefoglu of the Bagcilar Training and Research Hospital in Istanbul, Turkey.

The main limitation of the study is the underlying weakness of the studies evaluated. Bias was unclear in most of the studies, and only five used stopwatches to measure IELT, which is the "gold standard" for premature ejaculation studies, Patrick said.

In addition, the authors write, the studies are so different, it's tough to draw conclusions about the different options. For example, the five Chinese medicine studies tested different substances, including Qilin pills, Yimusake and Uighur.

Some studies, but not all, discussed side effects such as gastrointestinal discomfort, dizziness, mild pain and decreased libido. When they were reported, the adverse effects were generally mild, the study team writes.

"Nowadays, I am encountering alternative medicine-obsessed patients more than I used to, and it doesn't make sense to argue with them about the treatment they want," Serefoglu told Reuters Health by email. "After all, the placebo is a well-known clinical phenomenon, and some of my patients report surprisingly favorable outcomes."