Laurent Azoulay

Depression screening and patient outcomes in pregnancy or postpartum: A systematic review

OBJECTIVEnClinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or the postpartum period.nnnMETHODSnSearches included the CINAHL, EMBASE, ISI, MEDLINE, and PsycINFO databases through April 1, 2013; manual journal searches; reference list reviews; citation tracking of included articles; and trial registry reviews. RCTs in any language that compared depression outcomes between women during pregnancy or postpartum randomized to undergo depression screening versus women not screened were eligible.nnnRESULTSnThere were 9,242 unique titles/abstracts and 15 full-text articles reviewed. Only 1 RCT of screening postpartum was included, but none during pregnancy. The eligible postpartum study evaluated screening in mothers in Hong Kong with 2-month-old babies (N=462) and reported a standardized mean difference for symptoms of depression at 6 months postpartum of 0.34 (95% confidence interval=0.15 to 0.52, P<0.001). Standardized mean difference per 44 additional women treated in the intervention trial arm compared to the non-screening arm was approximately 1.8. Risk of bias was high, however, because the status of outcome measures was changed post-hoc and because the reported effect size per woman treated was 6-7 times the effect sizes reported in comparable depression care interventions.nnnCONCLUSIONnThere is currently no evidence from any well-designed and conducted RCT that screening for depression would benefit women in pregnancy or postpartum. Existing guidelines that recommend depression screening during pregnancy or postpartum should be re-considered.

The Use of Metformin and Colorectal Cancer Incidence in Patients with Type II Diabetes Mellitus

Background: Experimental studies have suggested that metformin may decrease the incidence of colorectal cancer in patients with type II diabetes. However, previous observational studies have reported contradictory results, which are likely due to important methodologic limitations. Thus, the objective of this study was to assess whether the use of metformin is associated with the incidence of colorectal cancer in patients with type II diabetes. Methods: A cohort study of patients newly treated with non-insulin antidiabetic agents was assembled using the United Kingdom Clinical Practice Research Datalink. A nested case–control analysis was conducted, where all incident cases of colorectal cancer occurring during follow-up were identified and randomly matched with up to 10 controls. Conditional logistic regression was used to estimate adjusted rate ratios (RR) of colorectal cancer associated with ever use, and cumulative duration of use of metformin. All models accounted for latency and were adjusted for relevant potential confounding factors. Results: Overall, ever use of metformin was not associated with the incidence of colorectal cancer [RR: 0.93; 95% confidence interval (CI), 0.73–1.18]. Similarly, no dose–response relationship was observed in terms of cumulative duration of use. Conclusions: The use of metformin was not associated with the incidence of colorectal cancer in patients with type II diabetes. Impact: The results of this study do not support the launch of metformin randomized controlled trials for the chemoprevention of colorectal cancer. Cancer Epidemiol Biomarkers Prev; 22(10); 1877–83. ©2013 AACR.

An analysis of the treatment effect of panitumumab on overall survival from a phase 3, randomized, controlled, multicenter trial (20020408) in patients with chemotherapy refractory metastatic colorectal cancer.

Panitumumab is a fully human monoclonal antibody that targets the epidermal growth factor receptor. Results from the primary analysis of a phase 3, randomized, controlled study showed a statistically significant improvement in progression-free survival for patients receiving panitumumab; however, overall survival was confounded by best supportive care (BSC) patients that crossed over to panitumumab therapy after disease progression. Three post hoc analyses are presented that approximate the panitumumab overall survival treatment effect in both the all-randomized and wild-type (WT) KRAS populations by using the BSC patients with mutant (MT) KRAS as the comparator group to discount the effect of crossover from BSC to panitumumab. The primary post hoc analysis showed a median overall survival of 6.4xa0months for all KRAS-evaluable patients randomized to panitumumab versus 4.4xa0months for patients with MT KRAS tumors randomized to BSC, yielding an adjusted hazard ratio (95xa0% CI) of 0.764 (0.598-0.977). Similar results were observed for the two secondary post hoc analyses. These analyses suggest a positive treatment effect of panitumumab in both the overall and WT KRAS patient populations consistent with an improvement in overall survival relative to BSC.

Incidence, risk factors, and obstetrical outcomes of women with breast cancer in pregnancy.

Abstract:u2002 Breast cancer in pregnancy is a rare condition. The objective of our study was to describe the incidence, risk factors, and obstetrical outcomes of breast cancer in pregnancy. We conducted a population‐based cohort study on 8.8u2003million births using data from the Healthcare Cost and Utilization Project – Nationwide Inpatient Sample from 1999–2008. The incidence of breast cancer was calculated and logistic regression analysis was used to evaluate the independent effects of demographic determinants on the diagnosis of breast cancer and to estimate the adjusted effect of breast cancer on obstetrical outcomes. There were 8,826,137 births in our cohort of which 573 cases of breast cancer were identified for an overall 10‐year incidence of 6.5 cases per 100,000 births with the incidence slightly increasing over the 10‐year period. Breast cancer appeared to be more common among women >35u2003years of age, odds ratio (OR)u2003=u20033.36 (2.84–3.97); women with private insurance plans, ORu2003=u20031.39 (1.10–1.76); and women who delivered in an urban teaching hospital, ORu2003=u20032.10 (1.44–3.06). After adjusting for baseline characteristics, women with pregnancy‐associated breast cancer were more likely to have an induction of labor, ORu2003=u20032.25 (1.88, 2.70), but similar rates of gestational diabetes, preeclampsia, instrumental deliveries, and placental abruption. The incidence of breast cancer in pregnancy appears higher than previously reported with women over 35 being at greatest risk. Aside from an increased risk for induction of labor, women with breast cancer in pregnancy have similar obstetrical outcomes.

Authors’ reply to Moore

We would like to respond to Moore’s thoughtful comments.1 2 nnFirstly, we considered this important point in our analyses—we adjusted the models for the use of drugs related to the indications for non-steroidal anti-inflammatory drugs (NSAIDs). These included antibiotics (related to short term infections) and immunosuppressive agents (related to conditions associated with …

Androgen Deprivation Therapy and Acute Kidney Injury—Reply

fects. However, there is no evidence that metabolic effects of soy are involved in such protective activity. Thus, it seems unlikely that the amounts of calcium, protein, or sugars in the intervention and placebo products could have biased or diluted effects on biochemical occurrence because the amounts were identical in both products and the biochemical recurrence rate predicted based on data from the major clinical site (27%) was close to the rates observed in the 2 treatment groups (27.2%-29.5%).