Twelve‐month maintenance treatment of heroin‐dependent outpatients with buprenorphine

The aim of this study was to assess the efficacy of 1‐mg, 3‐mg, and 8‐mg/day doses of buprenorphine in the maintenance treatment of heroin‐dependent patients over a 12‐month treatment period. Subjects were allocated randomly to three dosage groups. Participants consisted of 123 male heroin dependents who met the DSM‐IV criteria for opioid dependence and were seeking treatment. Their mean age was 31.4 years ranging from 16 to 64 (SD=9.4). Subjects received buprenorphine at a dose of 1?mg, 3?mg, or 8?mg/day and were treated in an urban outpatient clinic, offering a 1‐h weekly individual counselling session. Days retained in treatment were measured. Overall, 49 patients (39.8%) completed the 12‐month study. Completion rates by dosage group were 7 (17.1)% for the 1‐mg dose group, 16 (39%) for the 3‐mg dose group, and 26 (63.4%) for the 8‐mg dose group. Retention in the 8‐mg dose group was significantly better than in the 1‐mg dose group (p=0.00002) and in the 3‐mg dose group (p=0.027); other comparison (1‐mg dose with 3‐mg dose) was also significant (p=0.027). The results support the efficacy and safety of buprenorphine for outpatient treatment of heroin dependence and seem to indicate that the highest dose (8?mg) of buprenorphine was the best of the three doses for Iranian heroin dependents to increase their retention in treatment.     

Prognostic impact of hs‐CRP and IL‐6 in patients with persistent atrial fibrillation treated with electrical cardioversion

Objective. The aim of this study was to assess the role of inflammatory processes in the development of atrial fibrillation (AF) and the prognostic impact of inflammatory markers in predicting long‐term risk of AF recurrence after electrical cardioversion (CV). Methods. High‐sensitivity C‐reactive protein (hs‐CRP) and interleukin‐6 (IL‐6) were measured in 56 patients with persistent AF (lasting mean 128 days (range 14–960), mean age 65 years (34–84)), 19 healthy volunteers and 19 patients with permanent AF. Patients with persistent AF underwent CV. Blood samples were taken prior to CV and after 1, 30 and 180 days. Results. The immediate success rate of CV was 88?%, while the total recurrence rate after 180 days was 68?%. Patients with permanent AF had significantly higher levels of hs‐CRP and IL‐6 than patients with persistent AF (p = 0.0011, p<0.001). Patients in sinus rhythm (SR) after 180 days had significantly lower baseline hs‐CRP (1.25?mg/L (0.5–2.4) versus 2.0?mg/L (0.9–3.3), p<0.001) and IL‐6 (1.96?pg/mL (1.35–2.7) versus 2.75?pg/mL (1.55–3.62), p<0.001) than patients with recurrent AF. Baseline IL‐6 was the only independent predictor of recurrent AF (p = 0.04) in a multivariate Cox analysis. Patients in the lowest hs‐CRP quartile (<0.8?mg/L) had significantly lower AF recurrence rates after 180 days (50?% versus 74?% in the other three quartiles combined; p = 0.0069). Conclusion. Patients with AF had elevated levels of inflammatory markers. Low hs‐CRP and IL‐6 prior to CV are associated with a lower risk of AF recurrence after CV.     

Normal S‐cholesterol indicates unchanged S‐LDL,S‐HDL and S‐triglycerides in patients with previously acceptable blood lipids

Background. Analysis of blood lipids should be repeated routinely in many patients, and limiting testing to total cholesterol may eliminate the need for fasting prior to sampling, thereby saving time and money. The primary aim was to investigate the sufficiency of S‐cholesterol analysis (TC) in monitoring all blood lipids. Material and Methods. The results of blood lipid measurement in blood samples taken at a primary care unit over a 10‐year period were studied retrospectively, and the probability of TC predicting acceptable levels of LDL, HDL and TG was calculated. Results. Blood lipid levels from two samples in 518 patients taken within an interval of 0.5 to 3 years were accessible for study. If TC, LDL, HDL and TG levels were previously acceptable within this interval, a single acceptable TC was a predictor of acceptable LDL (97?%), HDL (94–97?%) and TG levels (96?%). Conclusions. In patients requiring blood lipid monitoring, it may be concluded that if TC, LDL, HDL and TG levels are acceptable in one blood sample, this is sufficient to monitor TC levels. If TC levels remain acceptable, there is no need to analyse LDL, HDL and TG levels more than every second year.     

A case of gynaecomastia with poly‐substance abuse

Hypnotherapy continues to be a misunderstood and maligned subject Its effectiveness, nevertheless, is perhaps becoming more clearly demonstrated and appreciated. Contemporary views emphasize indirect as well as direct hypnotic suggestion, the use of hypnosis as a context for amplifying other forms of psychotherapy, and the desirability of an individualized approach to cater for clients' unique needs and goals. In the field of addictive behaviours, it is argued with reference to clinical data and empirical research, that hypnotherapy is a valuable tool in assisting individuals to achieve greater control. As applicable to all forms of psychotheapy, however, commitment to desired changes, active participation in the therapeutic process and a good working alliance are prerequisite.     

Cytokine Profiling in Patients with VCP‐Associated Disease

Valosin containing protein (VCP) disease (also known as Inclusion Body Myopathy, Paget Disease of Bone and Frontotemporal Dementia [IBMPFD] syndrome) is caused by mutations in the gene encoding VCP classically affecting the muscle, bone and brain. Although the genetic cause has been identified, details regarding the pathogenesis of IBMPFD have not been fully determined. Muscle wasting observed in VCP disease is suggestive of cytokine imbalance. We hypothesized that dysfunctional protein homeostasis caused by VCP mutations leads to cytokine imbalances thereby contributing to the muscle wasting phenotype. Circulating levels of interleukin‐4 (IL‐4), interleukin‐6 (IL‐6), tumor necrosis factor alpha (TNF a) and epidermal growth factor (EGF) were measured in plasma of patients with VCP disease or controls. TNF a and EGF were significantly altered in VCP disease as compared to control. TNF a was up‐regulated, consistent with a cachexia phenotype and EGF levels were increased. No significant differences were observed in IL‐4 and IL‐6. Cytokine imbalances may be associated with VCP disease and may play a contributory role in VCP myopathy. Further understanding of how VCP dysfunction leads to aberrant protein homeostasis and subsequent cytokine imbalances may also aid in the understanding of other proteinopathies and in the development of novel treatments.     

Insulin‐like growth factor (IGF)‐I,IGF‐II and IGF‐binding protein (IGFBP)‐3 levels in Arab subjects with coronary heart disease

Objective. Insulin‐like growth factors (IGF‐I, IGF‐II) and their binding protein (IGFBP‐3) may be risk markers for coronary heart disease (CHD). This study aimed to assess the levels and determinants of the serum levels of IGF‐I, IGF‐II and IGFBP‐3 in Arab patients with established CHD. Material and methods. Two groups of subjects were matched for age, gender, BMI and waist–hip ratio (WHR): (i) CHD (n = 105), median age 51.0 (range 40.0–60.0) years; (ii) controls (n = 97) aged 49.0 (range 37.0–60.0) years. We measured fasting serum levels of glucose and lipoproteins (total cholesterol, triglycerides, LDL, HDL, apo B), insulin, HOMA‐IR, IGF‐I, IGF‐II and IGFBP‐3 and compared the results between groups. The effects of body mass and the metabolic syndrome (MS) on IGF levels were also examined, and linear correlations were sought between the various parameters. Results. The levels of IGF‐I, IGF‐II and IGFBP‐3 were significantly lower (all p<0.01) for the CHD group than for the control group. These differences were not influenced by BMI or with the presence of MS. In CHD, there were no significant correlations between levels of IGF‐I and IGF‐II and age, BMI, WHR, lipoprotein concentrations and insulin sensitivity, although IGFBP‐3 had weakly significant relationships with some of the lipoproteins. Conclusions. Levels of IGF‐I, IGF‐II and IGFBP3 are reduced in male Arab patients with CHD, and did not appear influenced by traditional CHD risk factors such as age, BMI, insulin sensitivity and presence of MS. Perturbations in the IGF/IGFBP‐3 axis may be potential additional targets for pharmacological manipulation in CHD.     

Patient‐treatment matching with anti‐craving medications in alcohol‐dependent patients: A review on phenotypic,endophenotypic and genetic indicators

Objectives: Craving plays an important role in the development and maintenance of alcohol dependence and in relapse after periods of abstinence. Anti‐craving compounds, such as acamprosate, naltrexone or serotonergic compounds, are found to be only moderately effective. These moderate effects might be due to inadequate matching of specific patients to specific treatments. In 1999, Verheul et al. proposed a three‐pathway model of craving in alcoholics, which hypothesised that reward drinkers would better respond to naltrexone, relief drinkers to acamprosate and obsessive drinkers to serotonergic compounds. However, these matching hypotheses are not yet validated. This article reviews the literature on predictors and matching variables of the effectiveness of pharmacological interventions in alcohol dependent patients directed at the reduction of craving and the prevention of relapse.

Methods: Studies were selected through a literature search in September 2004, focusing on matching or predicting variables for anti‐craving compounds in the treatment of alcoholics. Matching or predicting variables were categorised as either phenotypic (e.g., level of baseline anxiety), endophenotypic (e.g., physiological cue reactivity) or genetic (e.g., µ opioid receptor polymorphisms).

Results: Studies using clinical or phenotypic effect modifiers have produced inconsistent and rather disappointing results. In contrast, the predictive value of genetic effect modifiers are quite promising (e.g., µ opioid receptor polymorphisms). No studies that looked at endophenotypic predicting or matching variables were identified.

Conclusion: It is concluded that phenotypic matching variables might be too distal, i.e., far removed from the pathogenic process, and that matching research should shift its attention toward more proximal variables (e.g., genetic and endophenotypic variables).     

Methicillin‐resistant Staphylococcus aureus among elderly patients with community-acquired pneumonia

IntroductionThe 2019 American Thoracic Society/Infectious Diseases Society of America guidelines for community-acquired pneumonia (CAP) recommend methicillin‐resistant Staphylococcus aureus (MRSA) coverage for patients with prior sputum isolation of MRSA. This study aimed to determine the impact of MRSA coverage on in-hospital mortality in elderly patients with CAP among whom MRSA was isolated.MethodsConsecutive elderly patients who were admitted for CAP and had positive sputum culture for MRSA were retrospectively included, and the association between MRSA coverage and in-hospital mortality was analyzed.ResultsTwenty (18%) of 111 patients received MRSA coverage. Although patients who received MRSA coverage tended to have more frequent prior isolation of MRSA compared to those who did not, no significant difference in in-hospital mortality was observed between both groups (2/20, 10% vs. 8/91, 9%). MRSA coverage was not associated with in-hospital mortality (odds ratio: 1.15; 95% CI: 0.23–5.89, p = 0.864); however, advanced age, hemoglobin level, a high A-DROP score, and C-reactive protein levels were associated with in-hospital mortality. MRSA coverage may not improve the prognosis of elderly patients with CAP who had positive sputum culture for MRSA.ConclusionsA randomized control study is required to determine the efficacy of MRSA coverage on the management of CAP in elderly patients.     

Hyperthyroidism affects arterial stiffness,plasma NT‐pro‐B‐type natriuretic peptide levels,and subendocardial perfusion in patients with Graves' disease

Background. Arterial stiffness is thought to play a critical role in the pathogenesis of cardiovascular events, and in hyperthyroidism increased cardiovascular event rates have been reported.

Aim. To investigate markers of systemic arterial stiffness, volume homeostasis, and subendocardial perfusion and its interrelationship in patients with Graves' disease (GD) in hyperthyroidism and euthyroidism.

Method. Aortic augmentation index (AIx@75) as a measure of systemic arterial stiffness and subendocardial viability ratio (SEVR) as a surrogate measure of subendocardial perfusion were assessed by applanation tonometry in 59 patients with GD in hyperthyroidism and euthyroidism, and measurements were compared to plasma levels of NT‐pro‐B‐type natriuretic peptide (NT‐ProBNP).

Results. AIx@75 and NT‐ProBNP levels were significantly increased in hyperthyroidism compared to euthyroidism and were positively correlated with each other. SEVR was significantly decreased in hyperthyroidism compared to euthyroidism, mainly due to increased heart rates as shown by the heart rate‐corrected SEVR₇₅.

Conclusions. In hyperthyroidism, patients with GD exhibited increased systemic arterial stiffness, paralleled by increased levels of NT‐ProBNP, a marker of volume overload. The decreased subendocardial perfusion in hyperthyroidism seemed to be mainly due to increased heart rates. The observed unfavorable hemodynamic alterations in hyperthyroidism may serve to explain increased cardiovascular event rates in patients with GD.     

Evaluating empathy in interviewing: Comparing self‐report with actual behavior

The purpose of this study was to compare responses on the Medical Helping Relationship Inventory (MHRI), an instrument recently developed for evaluation of medical communications skills, with ratings of medical students’ videotaped interview behavior. Fifty videotapes of student interviews were evaluated by two trained raters, using the Carkhuff Empathic Understanding Scale, an adapted version of the Arizona Clinical Interview Rating scale, and additional items developed to measure specific interviewing behavior. Measures of empathy based on rated behavior were highly intercorrelated; however, expected positive relations between rated empathy and the MHRI Understanding subscale were not found. It would appear that preferences for Understanding responses on the MHRI multiple‐choice survey did not reflect the ratings of the students’ actual interview behavior.     

Real‐Time RT‐PCR Ct Values for Blood GAPDH Correlate with Measures of Vascular Endothelial Function in Humans

Purpose

To date, there is a wide range of methods in use to assess endothelial function, each with its own advantages and limitations. Here, we tested hypothesis that real‐time RT‐PCR threshold value (Ct), which is reflective of mRNA level, for Glyceraldehyde‐3‐phosphate dehydrogenase (GAPDH) from whole blood is indicative of endothelial function in humans.

Materials and Methods

To assess vascular function, we measured baseline skin perfusion, postocclusion reactive hyperemia (PORH), and brachial artery flow‐mediated dilatation (FMD) and tested for a possible correlation between vascular responses and blood GAPDH real‐time RT‐PCR Ct value in 75 healthy volunteers.

Results

Tests known to measure, at least in part, endothelial function such as baseline skin perfusion, the 2‐minute recovery PORH, and FMD exhibited significant positive correlations with blood GAPDH Ct values. In contrast, there was no significant correlation between Ct values for blood GAPDH and peak PORH, an endothelium‐independent parameter.

Conclusions

Based on these findings, we report that GAPDH mRNA level in the blood correlates with vascular function in healthy subjects. This suggests that GAPDH mRNA level could be a potential biomarker of vascular endothelial function.     

Feasibility of Neoadjuvant Ad‐REIC Gene Therapy in Patients with High‐Risk Localized Prostate Cancer Undergoing Radical Prostatectomy

In a phase I/IIa study of in situ gene therapy using an adenovirus vector carrying the human REIC/Dkk‐3 gene (Ad‐REIC), we assessed the inhibitory effects of cancer recurrence after radical prostatectomy (RP), in patients with high risk localized prostate cancer (PCa). After completing the therapeutic interventions with initially planned three escalating doses of 1.0 × 10¹⁰, 1.0 × 10¹¹, and 1.0 × 10¹² viral particles (VP) in 1.0–1.2 mL (n = 3, 3, and 6), an additional higher dose of 3.0 × 10¹² VP in 3.6 mL (n = 6) was further studied. Patients with recurrence probability of 35% or more within 5 years after RP as calculated by Kattan''s nomogram, were enrolled. They received two ultrasound‐guided intratumoral injections at 2‐week intervals, followed by RP 6 weeks after the second injection. Based on the findings of MRI and biopsy mapping, as a rule, one track injection to the most prominent cancer area was given to initial 12 patients and 3 track injections to multiple cancer areas in additional 6 patients. As compared to the former group, biochemical recurrence‐free survival of the latter showed a significantly favorable outcome. Neoadjuvant Ad‐REIC, mediating simultaneous induction of cancer selective apoptosis and augmentation of antitumor immunity, is a feasible approach in preventing cancer recurrence after RP. (199)     

Liposome‐mediated transfection with extract from neonatal rat cardiomyocytes induces transdifferentiation of human adipose‐derived stem cells into cardiomyocytes

Objective. Recent studies indicate that direct cell‐to‐cell interaction is involved in transdifferentiation of adult stem cells into cardiomyocytes. We investigated whether transdifferentiation of human adipose‐tissue‐derived stem cells could be achieved by transfecting the cells with a nuclear neonatal cardiomyocyte extract using a liposome‐based transfection system. Material and methods. In this study, we isolated stem cells derived from human subcutaneous adipose tissue. These cells were transfected with nuclear protein extracts from either isolated cardiomyocytes or whole hearts of neonatal rats. Results. We found that transfection induced expression of the cardiac markers α‐sarcomeric actin, Nk×2.5, troponin I and troponin T after 1–3 weeks. Whole‐heart protein extracts showed the additional capacity to induce differentiation into endothelial‐like and smooth muscle‐like cells. Conclusion. We demonstrate that transfection with nuclear protein extracts from neonatal rat cardiomyocytes can induce a cardiomyogenic differentiation pathway in human stem cells.     

Use of the Dietary Supplement 5‐Aminiolevulinic Acid (5‐ALA) and Its Relationship with Glucose Levels and Hemoglobin A1C among Individuals with Prediabetes

Objective: This study examined the association between 5‐aminolevulinic acid (5‐ALA) and glucose tolerance. Design: A double blinded, randomized prospective parallel‐group comparison study. Setting: Participants were recruited from the community in Honolulu, Hawaii, using radio and TV ads, and at community events. Participants: One hundred fifty‐four males and females ages 40–70 years, with evidence of prediabetes: hemoglobin A1c (HbA1c) 5.8%–7.0% at the screening visit. Intervention: Participants were randomized equally to one of three study groups: (1) low dose 5‐ALA supplement (15 mg capsule); (2) high dose 5‐ALA (50 mg capsule); and (3) control (placebo capsule of identical size and color). Main outcome measures: HbA1c and 2 hours post‐oral glucose tolerance test (OGTT) glucose levels. Results: Among individuals taking 5‐ALA supplements for 12 weeks, 2 hours post‐OGTT glucose levels declined significantly compared to those not taking the supplement (p= 0.02). The relationships were stronger among those with baseline glucose intolerance, or 2 hours post‐OGTT glucose measurements greater than 140 mg/dL (p= 0.005 and p= 0.02 for the low and high dose group, respectively). Similar trends were observed for HbA1c but results were of borderline significance (p= 0.07). No untoward effects were reported. Conclusions: Further studies are indicated. The potential benefits of 5‐ALA dietary supplementation are affirmed by this investigation. Clin Trans Sci 2012; Volume 5: 314–320     

Association of Learning Styles with Research Self‐Efficacy: Study of Short‐Term Research Training Program for Medical Students

Purpose

With a growing need for developing future physician scientists, identifying characteristics of medical students who are likely to benefit from research training programs is important. This study assessed if specific learning styles of medical students, participating in federally funded short‐term research training programs, were associated with research self‐efficacy, a potential predictor of research career success.

Method

Seventy‐five first‐year medical students from 28 medical schools, selected to participate in two competitive NIH‐supported summer programs for research training in aging, completed rating scales to evaluate learning styles at baseline, and research self‐efficacy before and after training. We examined associations of individual learning styles (visual‐verbal, sequential‐global, sensing‐intuitive, and active‐reflective) with students’ gender, ranking of medical school, and research self‐efficacy.

Results

Research self‐efficacy improved significantly following the training programs. Students with a verbal learning style reported significantly greater research self‐efficacy at baseline, while visual, sequential, and intuitive learners demonstrated significantly greater increases in research self‐efficacy from baseline to posttraining. No significant relationships were found between learning styles and students’ gender or ranking of their medical school.

Conclusions

Assessments of learning styles may provide useful information to guide future training endeavors aimed at developing the next generation of physician‐scientists.     

The triangular treatment paradigm in dual‐diagnosis clients with a mental illness

Research evidence suggests that a large number of individuals with substance misuse problems also have accompanying psychopathology. Some of those individuals diagnosed with schizophrenia may warrant a dual‐diagnosis. The clinical area of psychiatric ‘dual diagnosis' – that is, serious mental illness associated with substance misuse – is often linked to the ‘revolving door’ admissions of individuals with this complex comorbidity picture. Often, there is limited sharing of information and cooperation between statutory agencies with reference to this highly vulnerable client group. The shortfall in appropriate clinical response to this client group has been highlighted by previous researchers. This article looks at the role of the specialist dual‐diagnosis worker in North Wales and how the appointee to this role has been able to facilitate the seamless transition of these individuals through the ‘system’ of mental health care. This process has been facilitated by the development of an Integrated Pathway of Care, which has been devised by the authors and called the Triangular Treatment Paradigm.     

Flow‐mediated vasodilatation: variation and interrelationships with plasma lipids and lipoproteins

Objective. Endothelial dysfunction is a critical, prerequisite step in atherosclerosis, and may be evaluated by flow‐mediated vasodilatation (FMD). The objective of this study was to examine interrelationships between FMD and plasma lipids and lipoproteins, and to determine the between‐operator and within‐subject variability associated with this technique. Material and methods. FMD, plasma lipids and lipoproteins, including small dense LDL (sdLDL), were measured twice in 40 healthy volunteers, 4 weeks apart. Interrelationships between mean FMD responses and plasma lipids and lipoproteins were examined by correlation analysis. FMD measurements were taken by two independent operators, allowing determination of between‐operator variability. Within‐subject variability was determined by obtaining two measurements, 4 weeks apart, in every subject, and carried out by the same operator. Results. FMD was inversely related to plasma triglycerides (r = ?0.47, p = 0.002), total cholesterol/HDL cholesterol (r = ?0.35, p = 0.03) and apolipoprotein B (r = ?0.36, p = 0.02), but not to other plasma lipids and lipoproteins. When measuring variation in FMD, the following results were found: Between operators (SD = 4.0?FMD%) and within subjects (SD = 2.9?FMD%). Conclusions. The associations between FMD, plasma triglycerides and apoB provide evidence supporting a role for triglyceride‐rich lipoproteins in endothelial dysfunction.     

Circulating oxidized LDL is associated with the occurrence of echolucent plaques in the carotid artery in 61‐year‐old men

Objective. The aim of this study was to elucidate the relationship between the echogenicity of carotid artery plaques and the following risk factors: circulating oxLDL, hsCRP, the metabolic syndrome (MetS), and several of the traditional cardiovascular (CV) risk factors. Material and methods. A cross‐sectional population‐based study of 513 sixty‐one‐year‐old men. The levels of circulating oxLDL were determined in plasma samples by sandwich ELISA utilizing a specific murine monoclonal antibody (mAb‐4E6). High‐sensitivity CRP was measured in plasma by ELISA. Plaque occurrence, size and echogenicity were evaluated from B‐mode ultrasound registrations in the carotid arteries. Plaque echogenicity was assessed based on a four‐graded classification scale. Results. A higher frequency of echolucent carotid plaques was observed with increasing levels of oxLDL and systolic blood pressure (p = 0.008 and p = 0.041, respectively). Subjects with the MetS had a significantly higher frequency of echogenic plaques than subjects without the MetS (p = 0.009). In a multiple logistic regression analysis, oxLDL turned out to be independently associated with echolucent carotid plaques. Conclusions. The occurrence of echolucent carotid plaques was associated with oxLDL and systolic blood pressure, and oxLDL was associated with echolucent carotid plaques independently of systolic blood pressure.     

Novel approaches to treatment of advanced colorectal cancer with anti‐EGFR monoclonal antibodies

The standard treatment of metastatic colorectal cancer (mCRC) is combination of 5‐ fluorouracil/folinic acid with irinotecan or oxaliplatin‐based chemotherapy. Epidermal growth factor receptor (EGFR) is overexpressed in 70%–80% of colorectal cancers (CRC). EGFR overexpression is known to be involved in carcinogenic processes, such as cell proliferation, apoptosis, angiogenesis and metastasis. Monoclonal antibodies targeting EGFR have shown antitumor activity and improved the efficacy of chemotherapy. Cetuximab is a chimeric immunoglobulin (Ig) G1 anti‐EGFR monoclonal antibody (MoAb). Several clinical studies have shown cetuximab, either as a single agent or in combination with irinotecan, having promising efficacy in patients with metastatic CRC. Cetuximab with 5‐fluorouracil/LV (leucovorin) plus irinotecan or oxaliplatin‐based chemotherapy has shown higher response rate and longer time to progression as first‐line treatment of mCRC. Currently, there are no data showing that addition of cetuximab would prolong overall survival in randomized studies. Panitumumab, a fully human IgG2 monoclonal antibody, has also shown antitumor activity against EGFR‐expressing mCRC with less allergic reaction. Anti‐EGFR MoAbs are well tolerated and have limited overlapping toxicities in combination with other cytotoxic drugs. The most common side effect of anti‐EGFR MoAb is an acneform skin rash, which is a surrogate marker of efficacy of treatment with MoAbs. In this review, we will discuss the use of anti‐EGFR MoAbs in the treatment of mCRC, with focus on cetuximab and panitumumab.