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DESTINY-Breast02, a randomized, open-label, phase 3 study, aimed to compare the efficacy and safety of trastuzumab deruxtecan with the provider's choice of treatment (either capecitabine plus trastuzumab or capecitabine plus lapatinib) in patients with HER2-positive metastatic breast cancer who had previously failed trastuzumab emtansine.

The study enrolled 608 patients (603 female and 5 male) and randomly assigned them to receive either trastuzumab deruxtecan (5.4 mg/kg IV once every 21 days) or capecitabine (1,250 mg/m² orally b.i.d. on days 1 to 14) plus trastuzumab (8 mg/kg IV on day 1, then 6 mg/kg once per day); or capecitabine (1,000 mg/m²) plus lapatinib (1,250 mg orally once per day on days 1 to 21). Tumor assessments were conducted regularly, and treatment continued until disease progression or unacceptable toxicity occurred. The primary endpoint was progression-free survival, and secondary endpoints included patient-reported outcomes and hospitalization data.

Results showed that patients on trastuzumab deruxtecan had longer time to definitive deterioration over provider's choice (14.1 months versus 5.9 months), as well as better results in global health status, physical functioning, pain symptoms, breast symptoms, and overall self-rated health compared to provider's choice treatment. Although both treatments had similar hospitalization rates, trastuzumab deruxtecan delayed the time to first hospitalization (133 days versus 83 days).

Overall, trastuzumab deruxtecan improved progression-free survival, maintained quality of life, and delayed symptom deterioration compared to provider's choice treatment in patients with HER2-positive metastatic breast cancer who had previously failed trastuzumab emtansine. The study highlights the importance of patient-reported outcomes in evaluating treatment benefits as well as the need for continuous data collection and patient engagement in future studies. (Fehm, T., et al. (2024). Trastuzumab deruxtecan versus treatment of physician's choice in patients with HER2-positive metastatic breast cancer (DESTINY-Breast02): Patient-reported outcomes from a randomised, open-label, multicentre, phase 3 trial. The Lancet, Oncology. 25(5), 614–625. Retrieved April 2024 from https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00128-1/fulltext?rss=yes)

Released: May 2024

Nursing Drug Handbook

© 2024 Wolters Kluwer

Led by researchers from the University of Milano-Bicocca, the nested case-control study analyzed data from 215,547 patients age 65 and older who initiated antihypertensive treatment between 2009 and 2012. Of these individuals, 13,812 developed dementia or Alzheimer disease over the follow-up period of 7.3 years. Approximately 80% of those patients were treated with a renin-angiotensin-system blocker as monotherapy, and if a second drug was prescribed, it was commonly a diuretic.

Findings revealed a significant association between higher exposure to antihypertensive drugs and progressively lower risk of dementia (low, intermediate, and high exposure exhibited a 2%, 12%, and 24% risk reduction, respectively), even in patients age 85 and older and those considered frail. The researchers explain that, although there may be differences among antihypertensive agents, the real benefit is in overall reduction in blood pressure, regardless of the drug used. This observational evidence contributes to the growing body of research supporting the link between lower blood pressure and reduced dementia risk, although the exact mechanisms underlying this relationship remain unclear.

Researchers acknowledge that different types of cognitive impairment, such as Alzheimer disease, may have distinct processes, necessitating further investigation into these complexities. Additionally, questions remain regarding the impact of variations in blood pressure readings and medication adherence rates, particularly in older adults who may experience age-related changes affecting blood pressure regulation.

Despite these uncertainties, the study reinforces the potential importance of antihypertensive treatment in mitigating dementia risk among older adults and offering valuable insights for clinical practice and further investigation. Future research should focus on identifying optimal blood pressure targets for reducing dementia risk and clarifying the relationship between antihypertensive medication and cognitive outcomes. (Rea, F., et al. (2024). Risk of dementia during antihypertensive drug therapy in the elderly. J Am Coll Cardiol, 83(13), 1194–1203. Retrieved April 2024 from https://www.sciencedirect.com/science/article/abs/pii/S0735109724002584?via%3Dihub; Cox, C. E. (2024). Antihypertensives linked to lower long-term dementia risk. TCTMD. Retrieved April 2024 from https://www.tctmd.com/news/antihypertensives-linked-lower-long-term-dementia-risk

Released: May 2024

Nursing Drug Handbook

© 2024 Wolters Kluwer

A randomized, double-blind, placebo-controlled trial was conducted across multiple hospitals in China to investigate the efficacy of a single low dose of esketamine in reducing depression among mothers with prenatal depression. A total of 364 participants were assessed using validated scales, including depression, anxiety, and social support. Patients were randomly assigned to receive either esketamine (0.2 mg/kg) or placebo (20 mL normal saline) via IV infusion over 40 minutes after childbirth.

The primary endpoint of the trial was the prevalence of major depressive episodes at 42 days postpartum. The results showed a significant reduction in major depressive episodes among mothers who received esketamine compared to those who received a placebo (major depressive episode occurred in 6.7% of esketamine group versus 25.4% of placebo). Secondary endpoints, including pain intensity, also favored the esketamine group (persistent pain at 42 days: 35.2% with esketamine versus 47.5% with placebo). Exploratory analyses supported the antidepressant effects of esketamine as well, with higher rates of improvement in depression scores among the esketamine group.

Safety assessments revealed transient neuropsychiatric symptoms among esketamine recipients, but these were generally well-tolerated and didn't require treatment. Overall, esketamine was found to be an effective intervention for reducing perinatal depression in mothers with prenatal depression. These results should prompt further research on esketamine's effectiveness in more severe cases of depression. (Wang, S., et al. (2024). Efficacy of a single low dose of esketamine after childbirth for mothers with symptoms of prenatal depression: Randomised clinical trial. BMJ, 385, Article e078218. Retrieved April 2024 from https://www.bmj.com/content/385/bmj-2023-078218)

Released: May 2024

Nursing Drug Handbook

© 2024 Wolters Kluwer

This retrospective cohort study investigated the impact of statin use on clinical outcomes in non-Hodgkin lymphoma using data from the Taiwan National Health Insurance Research Database and the National Cancer Registry. After analyzing 15,466 patients diagnosed with non-Hodgkin lymphoma between 2012 and 2019, statin users (those who received statins within 6 months before lymphoma diagnosis and continued for more than 90% of the subsequent 30-day period) were compared with non-statin users. Of the patients in the study, 55.0% were male, with an average age of 62.7 years, and 14.6% were statin users. The main outcomes assessed were heart failure (HF) events, major arterial or venous events, and overall survival.

The study found that statin users had a 19% lower risk of HF events compared to nonstatin users (0.6% versus 0.9%, respectively). Statin use was also associated with improved overall survival (cumulative incidence of death: 45.6% for statin users versus 50.3% for nonstatin users) and a lower risk of cancer-related deaths (29.8% for statin users versus 35.0% for nonstatin users). There were no significant differences in the risk of arterial or venous events between statin groups.

Although the results of this study are promising, the relationship between statins and cancer is still unclear. Further randomized trials are needed to confirm these findings and clarify the potential benefits of statins in this patient population. (Chen, C.-Y., et al. (2024). Statin use is associated with reduced heart failure and risk of death in non-Hodgkin lymphoma. JACC: CardioOncology, 6(1), 133–>135. Retrieved April 2024 from https://www.sciencedirect.com/science/article/pii/S2666087324000048?via%3Dihub; Azvolinksy, A. (2024). Statin use linked to reduced heart failure, risk of death among patients with non-Hodgkin lymphoma. ASH Clinical News. Retrieved April 2024 from https://ashpublications.org/ashclinicalnews/news/7800/Statin-Use-Linked-to-Reduced-Heart-Failure-Risk-of)

Released: May 2024

Nursing Drug Handbook

© 2024 Wolters Kluwer