THIS WEEK
November 30 , 2000
in the New England Journal of Medicine

 
A Comparison of Etanercept and Methotrexate for Early Rheumatoid Arthritis
graph Tumor necrosis factor is overproduced in the joints of patients with rheumatoid arthritis, and etanercept is a soluble tumor necrosis factor receptor fusion protein that blocks the action of this cytokine. In this one-year study, the effects of two doses of etanercept (10 mg and 25 mg, each given twice weekly) were compared with the effects of methotrexate. The higher dose of etanercept was more effective than methotrexate in ameliorating symptoms and signs, and it resulted in a slower rate of progression of joint erosion and narrowing.

Infliximab and Methotrexate in the Treatment of Rheumatoid Arthritis
Short-term administration of infliximab, a monoclonal antibody against tumor necrosis factor (alpha), reduces joint inflammation in patients with rheumatoid arthritis. This study examined the effects of two doses of infliximab, given every 4 or 8 weeks, plus methotrexate with those of methotrexate alone for 54 weeks in 428 patients with the disease. Among the patients who were treated with infliximab and methotrexate, 51.8 percent had a decrease in the clinical manifestations of arthritis, as compared with 17.0 percent of the patients given methotrexate alone.

Fecal Occult-Blood Screening and Colorectal Cancer
Although both annual screening and biennial screening for fecal occult blood significantly reduce mortality from colorectal cancer, the effect of screening on the incidence of colorectal cancer is uncertain. The diagnosis and removal of precancerous lesions as a result of screening should reduce the number of cancers. This analysis of 18 years of follow-up data in the Minnesota Colon Cancer Control Study shows that both annual and biennial fecal occult-blood testing significantly reduced the incidence of colorectal cancer.

Folic Acid Antagonists, Such as Trimethoprim and Sulfasalazine, and the Risk of Birth Defects

graphPregnant women who take multivitamins containing folate are less likely to have infants with cardiovascular defects, oral clefts, and urinary tract defects than are women who do not take multivitamins. To determine the role of folic acid antagonism in causing these defects, the authors interviewed the mothers of 6932 infants with one of these defects and the mothers of 8387 control infants. The risks of cardiovascular and urinary tract defects and oral clefts were approximately doubled by exposure to folic acid antagonists such as trimethoprim and sulfasalazine early in gestation.

Conflict of Interest in Biomedical Research

There has been growing concern about financial conflicts of interest in biomedical research. One specific issue is that conflicts of interest on the part of investigators conducting clinical trials may compromise the well-being of research subjects. Three articles and an editorial in this issue of the Journal address these questions. McCrary et al. report on a survey of conflict-of-interest policies at U.S. medical schools and other research institutions, journals, and federal agencies. They found substantial variation in the policies of the medical schools and research institutions and discovered that many scientific journals and funding agencies do not require disclosure of conflicts of interest. Lo et al. found wide variations in the policies governing conflicts of interest at the 10 medical schools in the United States that receive the largest amount of research funding from the National Institutes of Health. In a Sounding Board article, Martin and Kasper discuss the issues raised by investigators' conflicts of interest and call for medical schools to adopt uniform policies. Finally, in an editorial, Drazen and Koski support the call for uniform policies.