Research in Medicine

Oral insulin capsule trial a success, company says

Israel’s Oramed, which is racing Novo Nordisk of Denmark to develop the world’s first insulin pill, moved a step closer to its goal on Thursday by announcing successful results from a small mid-stage test.

The oral drug delivery specialist said its insulin capsule had met all primary and secondary endpoints in a Phase IIa clinical trial and it now plans to launch a larger mid-stage study in the third quarter.

Shares in the Nasdaq-listed company opened 10 percent higher at $28.50 on the news. The stock has surged from around $4 since the end of 2012 on rising hopes for its insulin pill.

The concept of oral insulin as a way to relieve diabetics of several daily injections has been around since the 1930s, but making it a reality is extremely difficult because insulin is destroyed by enzymes in the digestive system.

Oramed believes that it has now found a solution to allow enough insulin to survive the onslaught of digestive juices to still do some good.

At least 90 percent of the more than 382 million diabetes sufferers worldwide are in the type 2 category, according to the International Diabetes Foundation, which expects the number of diabetes patients to near 600 million by 2035.

Consensus analyst forecasts suggest that the overall diabetes drug market, worth $37 billion a year at present, will reach more than $57 billion by 2018, according to Thomson Reuters Pharma.

Oral insulin could make it easier for sufferers to start early treatment, slow progression of the disease and delay the need for injections, Oramed said. Unlike injections, the ingested form passes first into the liver, which regulates the secretion of insulin into the bloodstream.

The new year-long Phase IIb study in the United States will study 150 type 2 diabetes patients and mainly test for the drug’s effectiveness, Chief Executive Nadav Kidron told Reuters after the company issued results of the Phase IIa trial.

During the Phase IIa trial, conducted under a new U.S. Food and Drug Administration (FDA) drug protocol, 30 patients with type 2 diabetes entered an in-patient setting for one week.

“The FDA wanted us to show one thing – that it was safe so they will let us do a IIb trial,” Kidron said.

While Oramed was not checking for efficacy, Kidron said the IIa trial revealed that it was effective, though the sample size was too small for FDA purposes.

Oramed will also need to conduct a final large-scale Phase III trial before the drug is licensed for sale, so the capsule is still years away from hitting the market.

The company is, however, ahead of Novo Nordisk, which has yet to start Phase II testing.

Oramed is hoping to partner with large pharmaceutical firms for development and sales of the drug. But Kidron said that only preliminary discussions have taken place so far.

The company also plans to initiate a Phase IIa FDA study for type 1 diabetes in the near term.

The global expense for diabetes is about $500 billion and an oral version could bring a large drop in costs.

Oramed noted that the pill would not eliminate the eventual need for injections but could delay the shift to needles by many years.

Source: Yahoo news

Peanut allergy treatment ‘a success’

Doctors say a potential treatment for peanut allergy has transformed the lives of children taking part in a large clinical trial.

The 85 children had to eat peanut protein every day – initially in small doses, but ramped up during the study.

The findings, published in the Lancet, suggest 84% of allergic children could eat the equivalent of five peanuts a day after six months.

Experts have warned that the therapy is not yet ready for widespread use.

Peanuts are the most common cause of fatal allergic reactions to food.

There is no treatment so the only option for patients is to avoid them completely, leading to a lifetime of checking every food label before a meal.

The trial, at Addenbrooke’s Hospital in Cambridge, tried to train the children’s immune systems to tolerate peanut protein.

Every day they were given a peanut protein powder – starting off on a dose equivalent to one 70th of a peanut.

The theory was that patients started at the extremely low dose, well below the threshold for an allergic response.

Once a fortnight the dose was increased while the children were in hospital, in case there was an reaction, and then they continued taking the higher dose at home.

The majority of patients learned to tolerate the peanut.

Lena Barden, 11, from Histon in Cambridgeshire, said: “It meant a trip to the hospital every two weeks.

“A year later I could eat five whole peanuts with no reaction at all.

“The trial has been an experience and adventure that has changed my life and I’ve had so much fun, but I still hate peanuts!”

‘Dramatic transformation’
One of the researchers, Dr Andrew Clark, told the BBC: “It really transformed their lives dramatically; this really comes across during the trial.

“It’s a potential treatment and the next step is to make it available to patients, but there will be significant costs in providing the treatment – in the specialist centres and staff and producing the peanut to a sufficiently high standard.”

Fellow researcher Dr Pamela Ewan added: “This large study is the first of its kind in the world to have had such a positive outcome, and is an important advance in peanut allergy research.”

But she said further studies would be needed and that people should not try this on their own as this “should only be done by medical professionals in specialist settings”.

The research has been broadly welcomed by other researchers in the field, but some concerns about how any therapy could be introduced have been raised.

Caution
Prof Gideon Lack, who is running a peanut allergy trial at the Evelina Children’s Hospital in London, told the BBC: “This is a really important research step in trying to improve our management of peanut allergy, but is not yet ready for use in clinical practice.

“We need a proper risk assessment needs to be done to ensure we will not make life more dangerous for these children.

He warned that 60% of people with a peanut allergy were also allergic to other nuts so a carefree lifestyle would rarely be an option.

Prof Barry Kay, from the department of allergy and clinical immunology at Imperial College London, said: “The real issues that still remain include how long the results will last, and whether the positive effects might lead affected individuals to have a false sense of security.

“Another issue to address is whether there will be long term side-effects of repeated peanut exposure even where full allergic reaction does not occur, such as inflammation of the oesophagus.

“So, this study shows encouraging results that add to the current literature, but more studies are needed to pin down these issues before the current advice to peanut allergy sufferers, which is to avoid eating peanuts, is changed.”

Maureen Jenkins, director of clinical services at Allergy UK, said: “The fantastic results of this study exceed expectation.

“Peanut allergy is a particularly frightening food allergy, causing constant anxiety of a reaction from peanut traces.

Source: BBC news

Scratching Away at the Mystery of Itch

The sensation of feeling itchy is pretty universal, and yet scientists still don’t completely understand the complex processes that give us the urge to scratch.

Itching can be annoying, but like pain, a little bit can be a good thing. Itching can help people learn to avoid dangers such as mosquitoes carrying malaria, or poison ivy. But many people suffer from chronic itch, which has no direct cause and can be a debilitating condition with few options for relief.

“When people hear about itch, they think about a mosquito bite or chicken pox, which is irritating but very temporary,” said Diana Bautista, a cell and developmental biologist at the University of California, Berkeley, who wrote an article summarizing our current understanding of itch

Bautista said people often laugh when she tells them she studies itch. But “from a clinical perspective, chronic itch is a really widespread problem, and incredibly difficult to treat,” she told LiveScience.
Itch, or ouch?

Like the feelings of touch, temperature and pain, itching involves a complex system of molecules, cells and circuits reaching from the skin into the brain. Most over-the-counter treatments for itching target histamine, a compound involved in inflammation. But many kinds of itch can’t be treated with antihistamines or other available treatments.

Skin conditions such as eczema and psoriasis, systemic conditions including multiple sclerosis, and even some cancers, can all lead to chronic itch, which affects about 10 percent of the world’s population at some point during their lives, Bautista said.

Recent research on itch is revealing its mysterious relationship with pain, according to the paper. For example, scientists have found that the reason scratching an itch offers relief is because scratching causes pain, which suppresses the itch, at least temporarily. They’ve also found that the cells and circuits that transmit pain and itch overlap somewhat.

But although pain can block out itch, some painkillers – such as morphine – can cause itchiness. And some things that cause itch also cause pain, such as capsaicin, the ingredient that makes chili peppers hot.

Scientists now have several theories about this odd connection between pain and itch. One theory suggests the same set of neurons produce an itch when activated slightly, but result in pain when activated fully. Alternatively, different cells might trigger pain and itch signals, but the signals might interact in the spinal cord. There is some evidence for both ideas, Bautista said.

Itching to understand

But itch and pain don’t always go together.

For example, the antimalarial drug chloroquine is known to have a side effect of severe itch. In one recent study, scientists bred mice to have nerves that lacked a receptor that responds to chloroquine. These mice didn’t show signs of itching, but they did have normal responses to pain. The findings suggest these nerve cells are required for itch, but not necessarily for pain, the researchers said.

Many itch receptors found in mice are also found in humans. Often, researchers take molecules known to play a role in chronic itch in humans, and study the effects in mice that lack these molecules.

From this research, scientists have identified some of neurons and signals involved in chronic itch, but the search for treatments continues.

“It’s an exciting time, because there have been a lot of basic discoveries in the last five years,” Bautista said.

Some promising treatment approaches involve targeting receptors on immune cells, which may be somewhat effective against forms of itch that can’t be treated with anti-histamines.

“As we learn more about the system, and which cell types we should target,” Bautista said, “I think we’re going to be able to treat chronic itch more effectively.”

Source: huffington post

Antioxidants speed lung cancer growth: Study

Although some people spend countless dollars on antioxidant supplements to improve their health, many studies have found that these would-be panaceas could actually exacerbate the diseases they claim to prevent.

Now, a team of Swedish scientists has shown that two antioxidants—vitamin E and N-acetylcysteine (NAC)—can fuel the growth of lung cancers in mice. The team also worked out why.

Antioxidants protect cells from chemically unstable molecules called reactive oxygen species (ROS), which can easily react with DNA and cause damage that leads to cancer. But Martin Bergo’s team at the University of Gothenburg showed that antioxidants neutralize ROS in tumors as well as healthy cells. “If we give extra antioxidants in the diet, we’re helping the tumor to reduce radicals that would otherwise block its growth,” Bergo said. “Then it can speed up all it wants.”

The results, published today (January 29) in Science Translational Medicine, are particularly important for people with an increased risk of lung cancer, including smokers or people with chronic obstructive pulmonary disorder (COPD). “There’s no scientific evidence to suggest that these people should take extra antioxidants,” said Bergo. “It may even be harmful”

“They might have a small undiagnosed tumor, and no one knows the frequency of those,” he added. “There’s a possibility that antioxidants would speed up the growth of those tumors.” This word of caution is especially relevant to people with COPD, who often take large amounts of NAC to relieve the build-up of mucus in their airways.

“A warning seems appropriate for everyone who has been seduced to use antioxidants or vitamins on a regular basis, as a preventive measure,” the University of Syndey’s Nico van Zandwijk told The Scientist in an e-mail.

These results fit with those from a long line of human clinical trials, in which antioxidants failed to prevent disease or made things worse. The first of these was published in the New England Journal of Medicine in 1994, and showed that male smokers who took beta-carotene supplements were more likely to develop and die of lung cancer than those who did not. Other trials found similar results for other antioxidants and other cancers, and some of those studies were even stopped early.

In 2012, the Cochrane Collaboration analyzed the results of 78 earlier trials and, based on the most careful of them, concluded that people who took antioxidant supplements (including both healthy people and those with chronic diseases) were more likely to die prematurely than those who did not.

Few studies had looked at the reasons behind these seemingly paradoxical effects. Bergo’s team, led by graduate student Volkan Sayin, began by feeding NAC and vitamin E to mice with early lung cancers, at doses comparable to those in human multivitamin pills. The mice that ingested the antioxidants developed tumors that were three times bigger, and they died twice as fast.

Sayin then showed that tumors normally have lower levels of ROS than normal tissues. The antioxidants reduced these levels even further, protecting the tumors from DNA damage. They also dramatically reduced the activity of p53—a guardian protein that prevents cancer by detecting damaged DNA and putting the brakes on cell division.

By lifting p53’s suppression, the antioxidants allowed the cancer cells to grow and divide faster than usual. Indeed, when the team abolished p53 entirely, neither NAC nor vitamin E affected the growth of the lung tumors. “P53 is normally inactivated in late-stage lung cancer, so what we’re doing is speeding up the progression of malignancy,” said Bergo.

“This is an extremely striking observation, but not surprising given the rather disappointing outcomes of patients at risk for developing lung cancer who had been treated with various antioxidants,” David Tuveson from Cold Spring Harbor Laboratory, who was not involved in the work, said in an e-mail. “We should now consider whether people consuming high doses of antioxidants are ironically promoting cancers that they seek to prevent.”

Although Bergo’s team focused on mice in this study, the scientists found the same mechanisms at work in human cells. They also used mice with the same genetic defects as those that cause human lung cancers, and whose tumors look identical to human ones under the microscope.

They are now doing similar experiments in melanomas, leukaemias, and gastrointestinal tumors to see whether the same mechanisms hold true for other types of cancer.

Source: The Scientist

Breath Test May Detect Signs of Lung Cancer: Study

Examining breath samples from patients with suspicious growths might help determine who needs surgery

Researchers tested the exhaled breath of people with suspicious lung lesions that were detected on CT scans. The breath was tested for levels of four cancer-specific substances, called “carbonyls.”

The breath samples were analyzed using a special device developed at the University of Louisville.

Having elevated levels of three of the four carbonyls was predictive of lung cancer in 95 percent of patients, while having normal levels of these substances was predictive of a noncancerous growth in 80 percent of patients, the researchers found.
Elevated carbonyl levels returned to normal after lung cancer patients had surgery to remove the cancer, according to the study, which was to be presented Tuesday at the Society of Thoracic Surgeons annual meeting in Orlando, Fla.

“Instead of sending patients for invasive biopsy procedures when a suspicious lung mass is identified, our study suggests that exhaled breath could identify which patients” may be referred for immediate surgery, study author Dr. Michael Bousamra, of the University of Louisville, said in a society news release.

This approach offers something new, he said, including “the simplicity of sample collection and ease for the patient.”

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Source: webmd

High-tech scan a boon for bone marrow cancer patients

Here comes a unique Magnetic Resonance Imaging (MRI) scan that could improve care for bone marrow cancer patients, says IANS.

The new whole-body, diffusion-weighted MRI scans showed the spread of cancer throughout the bone marrow of patients with myeloma – one of the most common forms of blood cancer – more accurately than standard tests.
The scans also showed whether the patients were responding to cancer treatments, said researchers at the Institute of Cancer Research, London, and the Royal Marsden NHS Foundation Trust. In the study, 26 patients had whole-body MRI scans before and after treatment.

In 86 percent of cases, experienced doctors trained in imaging were able to correctly identify whether patients responded to treatment. The doctors also correctly identified those patients who weren’t responding to treatment 80 percent of the time.
Using the scanning technique, doctors could pinpoint exactly where the cancer was in the bones, with the results available immediately. Conventional tests include bone marrow biopsies and blood tests but neither shows accurately where the cancer is present in the bones.

“This is the first time we’ve been able to obtain information from all the bones in the entire body for myeloma in one scan without having to rely on individual bone X-rays,” said Nandita deSouza, professor of translational imaging at the Institute of Cancer Research.

“We can look on the screen and see straight away where the cancer is and measure how severe it is. The scan is better than blood tests which don’t tell us in which bones the cancer is located,” she added. “It also reduces the need for uncomfortable biopsies which do not reveal the extent or severity of the disease,” said the study.
“In the future, we hope this new tool would help doctors extend the life of more myeloma patients,” added Faith Davies, member of the Myeloma targeted treatment team at the Institute of Cancer Research and honorary consultant at The Royal Marsden.

Source: The Free Press Journal

New drug may stop spread of breast cancer

Researchers have identified a new compound that completely halts the spread of metastatic breast cancer in mice.

The vast majority of deaths from cancer result from its progressive spread to vital organs such as the brain and lungs – a process known as metastasis.

In a recent series of studies researchers identified a previously unknown critical role for a potential cancer causing gene, Bcl3, in metastatic breast cancer.

“We showed that suppressing this gene reduced the spread of cancer by more than 80 per cent,” said Dr Richard Clarkson from Cardiff University’s European Cancer Stem Cell Research Institute.

“Our next goal was to then find a way to suppress Bcl3 pharmacologically. Despite great improvements in therapy of early stage breast cancer, the current therapeutic options for patients with late stage metastatic disease are limited.

“There is therefore a clear unmet clinical need to identify new drugs to reverse or at least to slow down disease progression,” he added.

Clarkson and his team joined up with researchers Dr Andrea Brancale and Dr Andrew Westwell from the Cardiff University School of Pharmacy and Pharmaceutical Sciences, to develop small chemical inhibitors of the Bcl3 gene.

Computer aided modelling of how the Bcl3 gene functions inside the cell allowed the group to identify a pocket on the surface of Bcl3 essential for its function.
By screening a virtual compound library for chemicals that could fit inside this pocket, using state-of-the-art computer software, they identified a drug candidate that potently inhibits Bcl3.

The compound was then trialled on mice with metastatic disease. The resulting effect was that the drug completely inhibited the development of the mice’s metastatic tumours.
Researchers are now working to conduct clinical trials of the compound. The aim is to develop a therapeutic agent capable of blocking metastatic disease in breast cancer and a variety of tumour types.

Source: Business Standard

A pill ‘melts away’ common form of leukaemia

Use of a twice-daily pill could turn a deadly blood cancer into a highly treatable disease, according to scientists at Weill Cornell Medical College who led a multinational research team.

Their findings on the therapy for chronic lymphocytic leukaemia (CLL), reported in the New England Journal of Medicine, suggest that patients may be able to avoid having to take debilitating chemotherapy.

CLL is the most common form of leukaemia, a cancer of the white blood cells. Some 16,000 Americans are diagnosed with CLL annually, and about 5,000 die of it each year.

“The treatment today for CLL can be worse than the disease, leading to a great deal of side effects and death. This study, and others we have conducted on idelalisib, demonstrates that we may no longer need to use chemotherapy in CLL,” says the lead investigator, Dr Richard R Furman, the Richard A Stratton Associate Professor in Haematology and Oncology at Weill Cornell Medical College and a haematologist/oncologist at New York-Presbyterian/Weill Cornell Medical Centre. “Even if this cancer remains incurable, it now can be treated as if it was a chronic disease with a pill, in the same way that high blood pressure is treated.”

CLL is a cancer of B cells, which normally produce antibodies to fight infections. In CLL, B cells grow out of control, accumulating in all of a patient’s organs. Patients are typically treated with a combination of chemotherapeutic drugs, to which they commonly respond. Unfortunately, patients ultimately relapse and require repeated cycles of chemotherapy. With each relapse, the remissions become shorter until the patient either no longer responds, or is forced to stop taking the drugs because of their side effects, which are a result of the medications’ inability to differentiate between healthy cells and cancer cells.

In this randomized, double-blinded study, researchers from 19 medical centres in five countries tested a combination of two targeted drugs – medications that attack cancer without damaging healthy cells. They compared rituximab and idelalisib against rituximab and a placebo pill in 220 CLL patients who could not receive chemotherapy.

They found that those who received the combination of idelalisib and rituximab went longer without their disease worsening than those who received only rituximab, which has been the standard of care. Six months into the study, cancers in 93 per cent of participants in the combination therapy group had not worsened, compared to 46 per cent of those in the rituximab plus placebo group.

What’s more, just 13 per cent of patients treated with rituximab alone responded to the therapy, compared to 81 per cent of the participants in the idelalisib treatment group. A higher percentage of patients who received both drugs – some 92 per cent – were still alive a year after the study began, compared to 80 per cent of those who only received rituximab. About the same percentage of patients in each group suffered side effects from the treatments.

The contrast was so significant that an independent data-monitoring committee halted the study early, in October 2013, so that all of the study participants could receive idelalisib.

“We saw incredible responses in patients who used idelalisib. Their cancer quickly melted away,” says Dr Furman, who is also director of Weill Cornell’s CLL Research Centre and an associate professor of medicine. “These types of responses were even seen in patients who didn’t respond to chemotherapy.”

Chemotherapy-resistant patients are typically the most difficult patients to treat. “It is remarkable how quickly idelalisib worked in this heavily treated group of patients, many of whom were resistant to chemotherapy. We saw responses within a week,” Dr Furman says.

Previous studies led by Weill Cornell Medical College have shown equally significant results in newly diagnosed CLL patients and in those who could tolerate chemotherapy.

“Having a treatment like idelalisib, which is highly effective and well tolerated, and thus can generate responses in patients that are unable to tolerate treatment and unlikely to respond, indicates the potential for idelalisib in all patients,” Dr Furman says.

Idelalisib is the second targeted drug that Dr Furman has tested that shows strong activity against CLL. He also studied ibrutinib in a phase 2 clinical trial reported last July in the New England Journal of Medicine. Both drugs, known as tyrosine kinase inhibitors, work on different targets within the same molecular pathway.

Ibrutinib was approved for use in mantle cell lymphoma (another B cell lymphoma) in November by the US Food and Drug Administration. Because it targets B cells, Dr Furman is using the drug as a first-line treatment for all of his CLL patients — even those who are newly diagnosed. “I am now able to avoid all use of chemotherapy in these patients, which has long been my goal,” he says.

Dr Furman believes idelalisib and ibrutinib will become the treatments of choice for all B cell lymphomas. “These drugs will change the lives of many patients,” he says. “Given the long-term toxicities of chemotherapy, leading to bone marrow failure, infections, and death, moving this therapy up front in the treatment algorithm and providing it to all patients is the next step.”

The study was funded by Gilead, for which Dr Furman has served as an advisor.

Source: India Medical Times

Fresh hope for hay fever sufferers

Researchers are set to discuss and make recommendations on the safety and efficacy of oral tablets used to treat ragweed allergy symptoms, during a public meeting of the Allergenic Products Advisory Committee, organized by the Food and Drug Administration (FDA).

There is more to seasonal allergies than a little congestion and sneezing. If you notice eating watermelon, cantaloupe or avocado make you cough and itch, it may be a symptom of ragweed allergy. But more help might be on the way for some of the 23 million hay fever sufferers.

“The committee is likely to approve these tablets which will mark great improvement in the fight against allergy,” allergist Michael Foggs, MD, president of the American College of Allergy, Asthma and Immunology (ACAAI), said. “Once the committee and then the FDA approve the tablets, allergy sufferers will have another form of treatment available to them.”

If the committee, which granted approval for grass allergy tablets in December, also approves the ragweed allergy tablets, the FDA will then have to approve both the grass and ragweed tablets before they can be made available to allergy sufferers.
Currently, the best treatment for those with moderate-to-severe allergy symptoms is allergy shots, also known as immunotherapy. This treatment requires tiny injections of purified allergen extracts.

A pill a day may seem more appealing than getting shots. So why bother with allergy shots anymore?
Dr. Foggs said that allergy shots can be customized to provide relief to multiple allergens, including tree, grass, weed, mold, house dust, dander, and mold, while offering the assurance of more than 100 years of experience in causing remission, not just symptom relief in allergy.
The researchers think there may be pros and cons of these differing forms of treatments. Board-certified allergists can help patients make good short-term and long-term choices.

Source: Yahoo news

Hormone Therapy & Joint Replacement in Women

Women who start hormone replacement therapy after having had hip or knee replacement surgery may cut their risk of needing another procedure in the same joint by nearly 40 percent, a new study suggests.

About 2 percent of those who have a hip or knee replacement need another surgery within three years. Most of these additional procedures are needed because of a complication known as osteolysis, which happens when tiny pieces of the implant seep into the tissue around the implant, causing inflammation that destroys the bone around the implant, the British researchers explained.

“There is evidence that drugs like hormone replacement therapy, used usually to prevent osteoporosis and fractures, might have a beneficial effect on implant survival in patients undergoing knee or hip replacement,” said lead researcher Dr. Nigel Arden, director of musculoskeletal epidemiology at the University of Oxford in England.

“These findings must be confirmed in further studies, but they are consistent with previous reports by our group showing an association between use of other drugs that have similar effects on bone and the risk of implant revision [surgery],” he said.

However, many women are nervous about taking hormone replacement therapy because of previously reported increased risks for heart disease and cancer. Since the risk of a second surgery is small, the question remains whether or not it’s worth starting hormone replacement therapy at all.

“Indeed, this is only a small added benefit of hormone replacement therapy. However, it is a relevant piece of information for women who have received a total knee or hip replacement and are considering hormone replacement therapy for menopausal symptoms,” Arden said.

The report was published online Jan. 22 in the Annals of the Rheumatic Diseases.

For the study, Arden and his colleagues collected data on more than 21,000 women who had not used hormone replacement therapy after a hip or knee replacement. The investigators compared these women with more than 3,500 women who had taken hormone replacement therapy for at least six months after surgery.

The researchers found that women who had taken hormone replacement therapy for six months after surgery were 38 percent less likely to need another surgery than those who had not.

Moreover, women who took hormone replacement therapy for a year or more after surgery were more than 50 percent less likely to need another surgery over three years of follow-up.

Taking hormone replacement therapy before joint replacement, however, didn’t make a difference in the risk for a repeat procedure, the researchers noted.

Dr. Neil Roth, an orthopedic surgeon at Lenox Hill Hospital in New York City, thinks there may be a role for drugs that help build and strengthen bone after knee and hip replacement surgeries. Based on this study, hormone replacement therapy might also be helpful, he added.

Roth noted, however, that this study only showed an association, and not a cause-and-effect link, between hormone replacement therapy and a lowered risk for another surgery.

“Right now, I wouldn’t make any changes in the way I clinically treat things based on this study, but I think it deserves further investigation,” he added.

Source: web md