In April 2008, the dementia antipsychotic withdrawal trial (DART-AD) showed that stopping antipsychotic treatment in elderly patients with Alzheimer’s disease did not worsen cognitive, functional or behavioral status in most patients (PLoS Med 2008 Apr 1;5(4):e76 full-text).  Based on results of short-term trials, the Food and Drug Administration has previously warned against the use of both conventional and atypical antipsychotics for dementia-related psychosis due to increased mortality risk (FDA MedWatch 2008 Jun 16).  Now, a follow-up of DART-AD provides evidence of increased long-term mortality with antipsychotics (level 2 [mid-level] evidence).  In a modified intention-to-treat analysis including 128 patients who started treatment, cumulative 12-month survival was 70% for the antipsychotic group vs. 77% for the control (p = 0.03, NNH 14).  The difference in survival increased at succeeding timepoints: 46% vs. 71% at 24 months (NNH 4), 30% vs. 59% at 36 months (NNH 3), and 26% vs. 53% at 42 months (NNH 3) (Lancet Neurol 2009 Feb;8(2):151).  For more information, see the Behavioral disturbance in patients with dementia topic in DynaMed.

This past week, there was widespread media coverage of a joint American Society of Clinical Oncology (ASCO) and American Urological Association (AUA) guideline regarding the use of 5-alpha-reductase inhibitors (5-ARIs) for prostate cancer chemoprevention.  DynaMed Editors elected to review the recommendations. The AUA commissioned the guideline, which was primarily based on a 2008 Cochrane review (Cochrane Database Syst Rev 2008 Apr 16;(2):CD007091).  The major randomized trial, the Prostate Cancer Prevention Trial (PCPT), was published in 2003 (N Engl J Med 2003 Jul 17;349(3):215). The new guideline recommends counseling patients regarding the risks and benefits of 5-ARIs for preventing prostate cancer, including: (1) reduction in the overall risk of prostate cancer, (2) possible increased risk of high grade prostate cancers, and (3) adverse effects, including sexual dysfunction. They recommend having a similar discussion with men taking 5-ARIs for treatment of obstructive prostatic symptoms (J Urol 2009 Apr;181:1642 PDF, J Clin Oncol 2009 Mar 20;27(9):1502 PDF). For more information, see the Prostate cancer topic in DynaMed.