China party chief stresses reform, censors relax grasp on internet

BEIJING (Reuters) – China must deepen reforms to perfect its market economy and strengthen rule of law, Communist Party chief Xi Jinping said in southern Guangdong, echoing groundbreaking comments by reformist senior leader Deng Xiaoping in the same province 20 years ago.

Xi’s call for reform was reported on Monday, coinciding with an apparent easing of Internet search restrictions that the party has energetically used to suppress information that could threaten one-party rule.

China’s largest microblog service unblocked searches for the names of many top political leaders in a possible sign of looser controls a month after new senior officials were named to head the ruling party.

Searches on the popular Twitter-like Sina Weibo microblog for party chief Xi Jinping, Vice Premier Li Keqiang and other leaders – terms that have long been barred under strict censorship rules – revealed detailed lists of news reports and user comments.

Xi’s comments on the economy came on Sunday during a trip to Guangdong where he paid tribute to Deng, whose visit in 1992 ushered in an era of breakneck economic reform and growth.

“The government earnestly wants to study the issues that are being brought up, and wants to perfect the market economy system … by deepening reform, and resolve the issues by strengthening rule of law,” Xi was quoted by Xinhua state news agency as saying.

Experts say that unless the stability-obsessed party leadership pushes through stalled reforms, the nation risks economic malaise and social woes that could deepen unrest and threaten its grip on power.

It was too early to detect a change of heart on censorship, but Zhan Jiang, a professor at Beijing Foreign Studies University, said the signs were good.

“Things are changing quietly, and it matches what Xi Jinping said before – to achieve progress and change in a steady way,” Zhan said.

Various search terms for Premier Wen Jiabao, who was at the centre of recent New York Times reports that said his family had accumulated massive fortunes during his tenure, were still blocked on Monday.

Chinese social media sites have posed a unique challenge for party leaders whose overarching goal is to maintain political control, while at the same time allowing people to blow off steam.

Analysts have been searching for signs that China’s new leaders might steer a path of political reform. Many expected at least a temporary loosening of censorship rules after the 18th Party Congress.

“Excessively strict control of the Internet will only make things worse,” said Hu Xingdou, a professor at Beijing Institute of Technology. “So we need to allow people to speak and allow them to voice their grievances.”

(Writing by Michael Martina and Terril Yue Jones. Additional reporting by Ben Blanchard, Sally Huang and Sui-Lee Wee; Editing by Nick Macfie)

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Seeing Through the Fog of ‘Chemo-Brain’

Two weeks ago, Diem Brown, contestant of the Real World/Road Rules Challenge, shared on her PEOPLE.com blog her frustration with her chemo-brain, after having received chemotherapy over the Thanksgiving holiday for recently diagnosed ovarian cancer.

She writes, “Stressed out, overwhelmed and soooo annoyed that your mind isn’t working as it should. This, my friends, is an example of chemo brain!”

Unfortunately, as a surgeon, I have witnessed too many patients get the diagnosis of cancer. If they can transcend the initial shock, there is a desperation to understand what their lives will be like as cancer patients, and what the odds are that they will be cancer survivors.

But for many women, their fear of death is as strong as their fear of chemotherapy, the poison that along with hope, is inseparable from the Hollywood images of the sick, nauseated, thin and bald.

Diem refers to “chemo-brain”, also known as “chemo-fog”, a side effect of chemotherapy that causes problems with memory, information processing, and mood –- effects that can persistent for as many as 20 years after treatment has subsided.

Mental dullness or fatigue and an inability to focus characterized by difficulty organizing thoughts and keeping memories has also been described by patients who suffer from chemotherapy induced cognitive dysfunction.

For years, chemo-brain went largely unrecognized by health care professionals, and those who suffered from it were left without answers to their confusion.

Recently, through the Internet, web chatting and blogging, many women who suffered from chemo-brain realized they were not alone, and over the last few years, several studies have been done giving credit to the condition. But, as they say, you have to see it to believe it.

And now we can see it. In the process of presenting my own research discussing the use of imaging in breast cancer patients at this week’s San Antonio Breast Cancer Symposium, I stumbled across a presentation discussing how scientists are trying to clear the chemo-fog by imaging the brain.

Dr. Bernadine Cimprich from the University of Michigan, along with a group of scientists from the University of Washington and University of Toronto took the stage in San Antonio Friday to shed some light through the fog, and offer a strategy at prevention.

Since chemo-brain doesn’t affect all cancer patients to the same degree, they asked the question, are some patients who receive chemotherapy predisposed to developing the disease?

Chemo-brain has been studied before, but has been difficult to characterize because so many different types of drugs and regimens are used, and for the most part patient’s memory and cognition are not studied prior to starting cancer therapy.

To help shed some light on the subject, these researchers used functional magnetic resonance imaging, or fMRI – a technology that uses magnets to image the brain as it works.

By taking pictures of the brain before and after chemotherapy, they found that patients who suffered from this condition had inherently different function from those who did not before they had even received treatment.

“Brain imaging before treatment showed reduced function in frontal [brain] regions” says Dr. Cimprich, the precise regions that are needed to perform working memory and guide our day-to-day activities, such as remembering the shopping list, our finding our way home.

Identifying patients who may be predisposed to developing chemo-brain can help oncologists alter treatment strategies in efforts to reduce or eliminate the fog.

Who are the patients at highest risk? Dr. Cimprich’s team used surveys to evaluate pre-treatment cognitive function and found that fatigue is a major factor. He suggests that “early interventions targeting fatigue may improve cognitive function and reduce the distress of chemo-brain”.

While the small study involved 98 patients, only 29 of which received chemotherapy, it still lays ground to understand the true nature of chemo-brain, and as Dr. Cimprich emphasizes, identifying the problem early is crucial, because early cognitive problems can become worse over time.

In her blog, Diem suggests making lists as a way to overcome her chemo-brain. And while we all know that stressful times can side track our minds and dull our spirits, until science can give us better answers, research suggests that a deep breath and a little yoga may help do the job of lifting the fog on chemo-brain.

Dr. Christopher Tokin is a surgical resident at the University of California, San Diego School of Medicine and a resident alumnus of the ABC News Medical Unit.

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McAfee wants to return to US, ‘normal life’

BACALAR, Mexico (AP) — Software company founder John McAfee said Sunday he wants to return to the United States and “settle down to whatever normal life” he can.

In a live-stream Internet broadcast from the Guatemalan detention center where he is fighting a government order that he be returned to Belize, the 67-year-old said “I simply would like to live comfortably day by day, fish, swim, enjoy my declining years.”

Police in neighboring Belize want to question McAfee in the fatal shooting of a U.S. expatriate who lived near his home on a Belizean island in November.

The creator of the McAfee antivirus program again denied involvement in the killing during the Sunday Internet video hook-up, during which he answered what he said were reporters’ questions.

His comments were sometimes contradictory. McAfee is an acknowledged practical joker who has dabbled in yoga, ultra-light aircraft and the production of herbal medications.

The British-born McAfee first said that returning to the United States “is my only hope now.” But he later added, “I would be happy to go to England, I have dual citizenship.”

He was emphatic that “I cannot ever return to Belize …. there is no hope for my life if I am ever returned to Belize.”

“If I am returned,” he said, “bad things will clearly happen to me.”

He descibed the health problems that had him briefly hospitalized earlier this week after Guatemalan authorities detained him for entering the country illegally. He apparently snuck in across a rural, unguarded spot along the border.

“I did not eat for two days, I drank very little liquids, and for the first time in many years I’ve been smoking almost non-stop,” he said. “I stood up, passed out hit my head on the wall, came to,” though he now said he was feeling better.

McAfee praised the role his 20-year-old Belizean girlfriend, Samantha Vanegas, played in his escape from Belize, where he claims he is being persecuted by corrupt politicians. Authorities in Belize deny that they are persecuting him and have questioned his mental state.

“Sam saved the day many times” during their escape, he said, and suggested he would take her with him to the United States if he is allowed to go there.

He confirmed that journalists from Vice magazine who accompanied him on his escape after weeks of hiding in Belize had unwittingly posted photos with embedded data that revealed his exact location.

“It was an error anyone could make,” he said, noting they were under a lot of pressure at the time.

McAfee has led an eccentric life since he sold his stake in the anti-virus software company named after him in the early 1990s and moved to Belize about three years ago to lower his taxes.

He told The New York Times in 2009 that he had lost all but $ 4 million of his $ 100 million fortune in the U.S. financial crisis. However, a story on the Gizmodo website quoted him as describing that claim as “not very accurate at all.”

McAfee’s Guatemalan attorney, Telesforo Guerra, says that he has filed three separate legal appeals in the hope that his client can stay in Guatemala, where his political asylum request was rejected.

Guerra said he filed an appeal for a judge to make sure McAfee’s physical integrity is protected, an appeal against the asylum denial and a petition with immigration officials to allow his client to stay in this Central American country indefinitely.

The appeals could take several days to resolve, Guerra said. He added that he could still use several other legal resources but wouldn’t give any other details.

Fredy Viana, a spokesman for the Immigration Department, said that before the agency looks into the request to allow McAfee to stay in Guatemala, a judge must first deal with the appeal asking that authorities make sure McAfee’s physical integrity is protected.

“We won’t look into (allowing him to stay) until the other appeal is resolved,” Viana said. “The law gives me 30 days to resolve the issue.”

McAfee went on the run last month after Belizean officials tried to question him about the killing of Gregory Viant Faull, who was shot to death in early November.

McAfee acknowledges that his dogs were bothersome and that Faull had complained about them, but denies killing Faull. Faull’s home was a couple of houses down from McAfee’s compound in Ambergris Caye, off Belize’s Caribbean coast.

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U.S. judge names lead plaintiffs in Facebook litigation

NEW YORK (Reuters) – A group of investors including state pension funds in North Carolina and Arkansas will be the lead plaintiffs in securities lawsuits arising out of Facebook Inc’s $ 16 billion initial public offering, a U.S. judge ruled on Thursday.

The investors, in a proposed class-action case, have accused Facebook of misrepresenting its financial condition in the run-up to the May stock offering. They are represented by law firms Bernstein Litowitz Berger & Grossmann and Labaton Sucharow.

The ruling helps set a structure for the Facebook IPO litigation, a headache for the social media company and a nagging reminder of the technical glitches in the highly anticipated stock market debut.

U.S. District Judge Robert Sweet in Manhattan also named lead plaintiffs for lawsuits against NASDAQ OMX Group Inc stemming from the IPO. NASDAQ was sued over allegations that orders to buy and sell Facebook were not properly executed on the first day of trading.

Facebook, which has defended its pre-IPO disclosures, declined to comment on Thursday. A spokesman for NASDAQ declined to comment on the litigation.

Facebook shares made their debut at $ 38 per share, and later fell as much as 50 percent. On Thursday, they closed at $ 26.90, down 2.6 percent.

Sweet consolidated the cases and picked lead plaintiffs to head up most of the 42 lawsuits before him arising out of the IPO.

Under a federal law governing securities lawsuits, courts routinely select a lead plaintiff in class actions. The lead plaintiff typically is the shareholder with the biggest losses, though judges have discretion to pick a different investor.

The plaintiff group picked to lead 31 cases alleging securities violations against Facebook includes the North Carolina Retirement Systems, Arkansas Teacher Retirement System, the Fresno County Employees’ Retirement Association and Banyan Capital Master Fund Ltd.

The group has collectively claimed a combined $ 7.1 million in losses.

“Its members are large, institutional investors with experience representing shareholder classes in similar litigation with the resources to pursue the action,” Sweet said.

In the securities lawsuits against NASDAQ, the judge said First New York Securities LLC, T3 Trading Group LLC, and Avatar Securities LLC would act as co-lead plaintiffs. The group traded a combined $ 316 million in Facebook shares the day of the IPO, the decision said.

The case is In re Facebook, Inc, IPO Securities and Derivative Litigation, U.S. District Court, Southern District of New York, MDL No. 12-2389.

(Reporting by Nate Raymond; Editing by Martha Graybow)

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Cablevision to raise Internet prices by $5 a month

(Reuters) – Cablevision Systems Corp, the New York-based cable operator, said on Thursday it would raise its Internet prices by $ 5 in January, representing an average hike of 3.2 percent for customers’ total monthly bills.

The company said in a statement that prices for its video and phone services will not be affected and that prices for promotional packages, which generally last one year, will not rise.

But all customers who have Internet service as part of their video or phone package will see prices rise.

Cablevision said it had not raised Internet prices in a decade. It raised video prices in 2011, which saw customer bills rise by 2.88 percent on average.

The company said it has invested $ 140 million in improving its Internet network, deployed more than 50,000 WiFi “hotspots,” and puts no usage caps on its service, unlike some cable competitors.

Canaccord Genuity analyst Tom Eagan downgraded his Cablevision rating from “buy” to “hold” on November 27 and said that Cablevision would lose customers if it were to decide to raise prices not long after Superstorm Sandy.

“Given the massive service outages among its subscribers (after Sandy), we don’t believe the company can raise rates … without incurring material customer churn,” Eagan said.

The cable provider, which is controlled by the Dolan family, said in early November that costs from Sandy, which knocked out service for as many as half its customers, would be substantially higher than its $ 16 million bill from Hurricane Irene in 2011.

Like bigger operators Comcast and Time Warner Cable, Cablevision has been losing customers to rivals such as satellite television provider DirecTV and telephone operator Verizon Communications.

Cablevision shares closed up 2.6 percent, at $ 14.16, on Thursday.

(Reporting By Liana B. Baker; Editing by Steve Orlofsky and Leslie Adler)

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Health workers march in Spain’s capital against cuts, reforms

MADRID (Reuters) – Thousands of health workers, on strike since last month, marched on Sunday in Madrid to protest against budget cuts and plans from the Spanish capital’s regional government to privatize the management of public hospitals and medical centers.

It was the third time doctors, nurses and health workers have rallied since the local authorities put forward a plan in October to place six hospitals and dozens of medical practices under private management. The plan also calls for patients to be charged a fee of 1 euro for prescriptions.

Workers launched an indefinite strike last month against the plan, which has not been endorsed by the centre-right government of Prime Minister Mariano Rajoy. Health workers in the capital are striking Monday-Thursday each week and seeing patients only on Fridays, while also responding to emergencies.

Spain’s 17 autonomous regions control health and education policies and spending. They have all had to implement steep cuts this year as the country struggles to meet tough European Union-agreed deficit targets.

Dressed in white scrubs, the protesters shouted slogans such as “Health is not for sale” and “Health 100 percent public, no to privatizations”.

“Of course, privatization can be reversed. Actually the question is not if it can be reversed, because privatization should never have a future,” said Luis Alvarez, an unemployed man from Madrid attending the demonstration.

Belen Padilla, a doctor at Madrid’s hospital Gregorio Maranon, said one million citizens had already signed a petition rejecting the plan.

(Reporting by Reuters Television; Writing by Julien Toyer; Editing by Peter Graff)

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Wall St Week Ahead: “Cliff” worries may drive tax selling

NEW YORK (Reuters) – Investors typically sell stocks to cut their losses at year end. But worries about the “fiscal cliff” – and the possibility of higher taxes in 2013 – may act as the greatest incentive to sell both winners and losers by December 31.

The $ 600 billion of automatic tax increases and spending cuts scheduled for the beginning of next year includes higher rates for capital gains, making tax-related selling even more appealing than usual.

Tax-related selling may be behind the weaker trend in the shares of market leader Apple , analysts said. The stock is down 20 percent for the quarter, but it’s still up nearly 32 percent for the year.

Apple dropped 8.9 percent in the past week alone. For a stock that gained more than 25 percent a year for four consecutive years, the embedded capital gains suddenly look like a selling opportunity if one’s tax bill is going to jump sharply just because the calendar changes.

“Tax-loss selling is always a factor (but) tax-gains selling has been a factor this year,” said Paul Mendelsohn, chief investment strategist at Windham Financial Services in Charlotte, Vermont.

“You have a lot of high-net-worth individuals in taxable accounts, and that could be what’s affecting stocks like Apple. If you look at the stocks that people have their largest gains in, they seem to be under a little bit more pressure here than usual.”

Of this year’s top 20 performers in the S&P 1500 index, which includes large, small and mid-cap stocks, all but four have lost ground in the last five trading sessions.

The rush to avoid higher taxes on portfolio gains could cause additional weakness.

The S&P 500 ended the week up just 0.1 percent after another week of trading largely tied to fiscal cliff negotiation news, which has pushed the market in both directions.

A PAIN PILL FROM THE FED?

This week’s Federal Reserve meeting could offer some relief if policymakers announce further plans to help the lackluster U.S. economy. The Federal Open Market Committee will meet on Tuesday and Wednesday. The policy statement is expected at about 12:30 p.m. EST on Wednesday after the conclusion of the meeting – the Fed’s last one for the year.

Friday’s jobs report showing non-farm payrolls added 146,000 jobs in November eased worries that superstorm Sandy had hit the labor market hard.

“After the FOMC meeting, I think it’s going to be downhill from there as worries about the fiscal cliff really take center stage and prospects of a deal become less and less likely,” said Mohannad Aama, managing director of Beam Capital Management LLC in New York.

“I think we are likely to see an escalation in profit-taking ahead of tax rates going up next year,” he said.

MORE VOLUME AND VOLATILITY

Volume could increase as investors try to shift positions before year end, some analysts said.

While most of that would be in stocks, some of the extra trading volume could spill over into options, said J.J. Kinahan, TD Ameritrade’s chief derivatives strategist.

Volatility could pick up as well, and some of that is already being seen in Apple’s stock.

“The actual volatility in Apple has been very high while the market itself has been calm. I expect Apple’s volatility to carry over into the market volatility,” said Enis Taner, global macro editor at RiskReversal.com, an options trading firm in New York.

Shares of Apple, the largest U.S. company by market value, on Friday registered their worst week since May 2010. In another bearish sign, the stock’s 50-day moving average fell to $ 599.52 – below its 200-day moving average at $ 601.38.

“There’s a lot of tax-related selling happening now, and it will continue to happen. Apple is an example, even (though) there are other factors involved with Apple,” Aama said.

If tax rates are going up, an investor would sell now to book gains and pay lower capital gains taxes, according to Aama. But if an investor has capital losses, then “you take losses and have them count against capital gains or regular income if you do not have any offsetting capital gains.

“In essence, higher capital gains tax rates will give your losses a higher value next year than this year as the income tax shield will be worth more in 2013. So if you have no capital gains this year, you are better off holding off on selling your losers in 2012 and waiting till 2013,” he said in an email.

While investors may be selling stocks to avoid higher taxes in 2013, companies may continue to announce special and accelerated dividend payments before year end. Among the latest, Expedia announced a special dividend of 52 cents a share to be paid on December 28.

To be sure, the big sell-off in stocks following the November 6 election was likely related to tax selling, making it hard to judge how much more is to come.

Even with stocks’ recent declines, the three major U.S. stock indexes are still up for the year. The Dow Jones industrial average <.dji> is up 7.7 percent for 2012 so far, while the benchmark Standard & Poor’s 500 index <.spx> is up 12.8 percent and the Nasdaq Composite Index <.ixic> is up 14.3 percent for the year to date.</.ixic></.spx></.dji>

Bruce Zaro, chief technical strategist at Delta Global Asset Management in Boston, said there is a decent chance that the market could rally before the year ends.

“Even with little or spotty news that one would put in the positive bucket regarding the (cliff) negotiations, the market has basically hung in there, and I think it’s hung in there in anticipation of something coming,” he said.

(Wall St Week Ahead runs every Sunday. Questions or comments on this column can be emailed to: caroline.valetkevitch(at)thomsonreuters.com)

(Reporting by Caroline Valetkevitch; Editing by Jan Paschal; Multimedia versions of Reuters Top News are now available for:; 3000 Xtra: visit Reuters Top News; BridgeStation: view story .134; For London stock market outlook please click on <.l>; Pan-European stock market outlook <.eu>; Tokyo stock market outlook <.t>)</.t></.eu></.l>

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Google launches Snapseed photo editor on Android, makes iOS version free

After acquiring the makers of Snapseed in September, Google (GOOG) on Thursday released the popular photo application for Android smartphones and tablets. Google also updated the iOS version of the app to add Google+ integration and some new filters, and it cut the price of the original app from $ 4.99 to free. Snapseed is a simple yet powerful photo editor from Nik Software that allows users to enhance images with various tweaks and gesture-based touch ups, along Instagram-like filters. Snapseed is available now for the iPhone, iPad and Android smartphones and tablets.

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Rolling Stones hit NY for 50th anniversary gig

NEW YORK (AP) — “Time Waits for No One,” the Rolling Stones sang in 1974, but lately it’s seemed like that grizzled quartet does indeed have some sort of exemption from the ravages of time.

At an average age of 68-plus years, the British rockers are clearly in fighting form, sounding tight, focused and truly ready for the spotlight at a rapturously received pair of London concerts last month.

On Saturday, Mick Jagger, Keith Richards, Ronnie Wood and Charlie Watts hit New York for the first of three U.S. shows on their “50 and Counting” mini-tour, marking a mind-boggling half-century since the band first began playing its unique brand of blues-tinged rock.

And the three shows — Saturday’s at the new Barclays Center in Brooklyn, then two in Newark, N.J., on Dec. 13 and 15 — aren’t the only big dates on the agenda. Next week the Stones join a veritable who’s who of British rock royalty and U.S. superstars at the blockbuster 12-12-12 Sandy benefit concert at Madison Square Garden. Also scheduled to perform: Paul McCartney, the Who, Eric Clapton, Bruce Springsteen & The E Street Band, Alicia Keys, Kanye West, Eddie Vedder, Billy Joel, Roger Waters and Chris Martin.

The Stones‘ three U.S. shows promise to have their own special guests, too. Mary J. Blige will be at the Brooklyn gig, as well as guitarist Gary Clark Jr., the band has announced. (Blige performed a searing “Gimme Shelter” with frontman Jagger in London.) Rumors are swirling of huge names at the Dec. 15 show, which also will be on pay-per-view.

In a flurry of anniversary activity, the band also released a hits compilation last month with two new songs, “Doom and Gloom” and “One More Shot,” and HBO premiered a new documentary on their formative years, “Crossfire Hurricane.”

The Stones formed in London in 1962 to play Chicago blues, led at the time by the late Brian Jones and pianist Ian Stewart, along with Jagger and Richards, who’d met on a train platform a year earlier. Bassist Bill Wyman and drummer Charlie Watts were quick additions.

Wyman, who left the band in 1992, was a guest at the London shows last month, as was Mick Taylor, the celebrated former Stones guitarist who left in 1974 — to be replaced by Wood, the newest Stone and the youngster at 65.

The inevitable questions have been swirling about the next step for the Stones: another huge global tour, on the scale of their last one, “A Bigger Bang,” which earned more than $ 550 million between 2005 and 2007? Something a bit smaller? Or is this mini-tour, in the words of their new song, really “One Last Shot”?

The Stones won’t say. But in an interview last month, they made clear they felt the 50th anniversary was something to be marked.

“I thought it would be kind of churlish not to do something,” Jagger told The Associated Press. “Otherwise, the BBC would have done a rather dull film about the Rolling Stones.”

__

Associated Press writer David Bauder contributed to this report.

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Pfizer/Bristol drug cuts recurrence of blood clots – study

(Reuters) – A new blood clot preventer from Pfizer Inc and Bristol-Myers Squibb Co reduced the risk of recurrence of clots in veins and lungs and death by 80 percent with no increase in major bleeding in a study testing extended use of the drug.

In the year-long trial of 2,486 patients who had been previously treated for the condition known as venous thromboembolism (VTE) the drug, apixaban, met the combined primary goal by significantly reducing the recurrence of blood clots and death from any cause compared with a placebo, according to data presented at the American Society of Hematology (ASH) meeting in Atlanta, Georgia.

The rate of recurrence or death was 11.6 percent in the placebo group compared with 3.8 percent for those who got 2.5 milligrams of apixaban and 4.2 percent for the 5 mg dose of the drug. The results were also published in the New England Journal of Medicine.

The incidence of major bleeding, always a concern with blood thinners, was extremely low in all three arms of the trial, researchers said – 0.5 percent for placebo, 0.2 percent for the low dose of apixaban and 0.1 percent for the higher dose.

“Usually when you have an effective antithrombotic you have to pay a price in terms of bleeding. This was not the case in this study,” Dr. Giancarlo Agnelli, the study’s principal investigator, said in a telephone interview.

“There was no evidence at all of increased major bleeding and this is extremely important because you are comparing an active drug with placebo,” he said.

There was a slightly higher rate of clinically relevant nonmajor bleeding, such as nose bleeds that required medical attention, observed in patients taking the higher dose of apixaban at 4.2 percent compared with the low dose and placebo, researchers said.

Apixaban belongs to a new class of blood thinners that aim to replace decades old and difficult to use warfarin. The drug, which will be sold under the brand name Eliquis, is widely considered to be one of the most important new medicines for Pfizer and Bristol-Myers, both of which saw their top selling products lose patent protection in the past year.

AWAITING U.S. APPROVAL

It is approved in Europe and awaiting a U.S. approval decision for preventing blood clots and strokes in patients with atrial fibrillation – a type of irregular heart beat – and is also being tested against warfarin as a primary treatment for VTE with data expected next year.

A rival drug from Bayer and Johnson & Johnson called Xarelto is already approved for both conditions, but based on clinical data analysts have said they believe Eliquis is the best class.

An approval for extended use in VTE patients, during which they would take the drug for at least a year after initial treatment, could significantly boost future sales.

“The evidence is for one year. The next step would be to see whether this clinical benefit is extended after one year,” Agnelli said.

VTE consists of deep vein thrombosis, typically blood clots in the legs, and pulmonary embolism, which are dangerous clots in the lungs. Clots that begin in the extremities can travel to the heart and lungs and can be fatal. VTE is typically treated with warfarin for three to six months.

After that, “there is quite a remarkable level of uncertainty about whether to extend or not,” explained Agnelli, professor of internal medicine at the University of Perugia in Italy, who presented the data at the ASH meeting.

“Extended treatment might be clinically relevant because the recurrence rate after stopping treatment can be 10 percent in the first year,” Agnelli said. “Reducing the recurrence of VTE means reduced hospitalization costs and in some cases fewer fatal events.”

Physicians have been looking for alternatives to warfarin, which must be closely monitored to keep levels therapeutic but not toxic. The new drugs do not require monitoring or the dietary and lifestyle changes necessary with warfarin. But they still face an uphill battle as warfarin is far less expensive, and doctors have a comfort level using a drug that has been around for more than half a century despite the challenges.

Patients in the study had received treatment with warfarin for six to 12 months before starting the one-year extension trial that aimed to show further treatment could reduce recurrence rates and to see if the lower dose of apixaban was a viable option.

“It is quite clear that the lower dose is as effective as the higher. For the first time we showed that by reducing the dose of an antithrombotic agent in this clinical setting we can have the same efficacy with no major bleeding,” Agnelli said.

“This is actually something that could change clinical practice,” he added.

(Reporting by Bill Berkrot; Editing by Jilian Mincer, Berard Orr)

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