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Researchers find little evidence Tamiflu reduces flu complications in otherwise healthy people

December 9th, 2009

From The Associated Press:

British researchers say there is little evidence Tamiflu stops complications in healthy people who catch the flu, though public health officials contend the swine flu drug reduces flu hospitalizations and deaths.

Researchers at the Cochrane Review, an international nonprofit that reviews health information, looked at previously published papers on Tamiflu as used for seasonal flu. They found insufficient data to prove whether the antiviral reduces complications like pneumonia in otherwise healthy people but concluded the drug shortens flu symptoms by about a day. The papers were published online Tuesday in the British journal, BMJ.

The researchers said the benefits of Tamiflu were small and that authorities should consider its side effects before using the drug in healthy people. While the reviewed studies only looked at Tamiflu use for seasonal flu, the experts said their conclusions raised questions about the widespread use of the drug in people with any flu-like illness, including swine flu.

Fiona Godlee, BMJ’s editor, said the papers cast doubt not only on how safe and effective Tamiflu is, but on the drug regulatory system that approved it. “Governments around the world have spent billions of pounds (dollars) on a drug that the scientific community now finds itself unable to judge,” she said in a statement.

But the World Health Organization disagreed. They said data from countries around the world show that when given early, Tamiflu can reduce the severity of swine flu symptoms, though the agency recommends the drug be saved for people at risk of complications, like pregnant women, the elderly, children, and those with underlying medical problems.

“This will not change our (Tamiflu) guidelines,” said Charles Penn, a WHO antivirals expert. Penn said that while past studies show Tamiflu only has a modest benefit, when patients with severe illness or at risk of complications are treated early, there are fewer hospitalizations and deaths.

And Roche, the maker of Tamiflu, defended the drug, saying in a statement that they “firmly believe in the robustness of the data.”

Both the British researchers and WHO said there is little evidence to support the widespread use of Tamiflu in otherwise healthy people — precisely the policy Britain has adopted to fight swine flu.

In addition to recommending Tamiflu be saved for at-risk groups, WHO recommends Tamiflu only be used on a doctor’s recommendation.

In Britain, however, Tamiflu is regularly dispensed to healthy people who catch the flu. The drug is given out via a national swine flu hotline by call center workers with no medical training.

Study Shows Women With a Gene Variant Respond Better to Tamoxifen Treatment

November 15th, 2009

Comment by Dr. Perlmutter:
This particular detoxification genetic marker is easily tested and widely available.
From WebMD.com:

A single gene variant predicts breast cancer survival after tamoxifen treatment, a new study finds.

In the 46% of women with the “good” gene, tamoxifen works as well as newer drugs. For women with the gene variant linked to poor response to tamoxifen treatment, other treatment strategies would be a better choice.

In the past 25 years, tamoxifen has prevented more than half a million deaths from breast cancer. The drug helps prevent breast cancer recurrence after surgery. Tamoxifen is still a useful drug, although newer drugs called aromatase inhibitors seem to work better in clinical trials.

Now it appears that some women will do at least as well if they’re treated with tamoxifen. Such women carry a version of a gene called CYP2D6 that makes tamoxifen work better.

The gene encodes an enzyme crucial to tamoxifen activity. About 46% of women have a version of the gene that contributes to high enzyme activity. Others have genes that contribute to low or intermediate activity of the enzyme.

Werner Schroth, PhD, of Germany’s Fischer-Bosch Institute of Clinical Pharmacology, and colleagues analyzed CYP2D6 genes in 1,325 postmenopausal women treated with tamoxifen for early-stage breast cancer in Germany and in the U.S.

They found that women with the highly active version of the gene were significantly less likely to have their breast cancer come back after five years of tamoxifen treatment. These women had outcomes similar to those seen in women treated with aromatase inhibitors.

“[This] should provide new impetus to the medical and scientific community to revisit the issue of the relative efficacy of these two approaches in women with early breast cancer,” Schroth and colleagues conclude.

The researchers suggest that genetic testing could identify women who should not be treated with tamoxifen.

Schroth and colleagues report the findings in the Oct. 7 issue of TheJournal of the American Medical Association.

ADHD Drug Abuse Rising Among Teens

November 13th, 2009

From WebMD.com:

The abuse of attention deficit hyperactivity disorder (ADHD) drugs by teenagers is growing, according to a new study.

Researchers found calls to poison control centers for adolescent ADHD prescription drug abuse increased out of proportion to other poison center calls in recent years, which suggests a growing problem with abuse of these stimulant drugs.

The study, published in Pediatrics, tracked calls to U.S. poison control centers from 1998 to 2005 among 13- to 19-year-olds.

“Calls related to teenaged victims of prescription ADHD medication abuse rose 76%, which is faster than calls for victims of substance abuse generally and teen substance abuse,” write researcher Jennifer Setlik, MD, of Cincinnati Children’s Hospital Medical Center and colleagues.

ADHD affects between 8% and 12% of children and 4% of adults worldwide, and there has been a significant increase in the sale of stimulant drugs designed to treat the condition in recent years.

Overall, researchers say the sharp rise in ADHD drug abuse mirrored a similar increase in the prescription numbers among teens, but the abuse of certain types of ADHD drugs is outpacing sales.

There are two main types of stimulant ADHD drugs: methylphenidates and amphetamines.

During the eight-year study period, calls by teens to poison control centers for all types of stimulant ADHD drug abuse rose by 76%. During the same period, prescriptions for these medications for 10- to 19-year-olds rose by 86%.

But the percentage of poison center calls related to amphetamine ADHD drugs, such as Adderall, rose from 22% to 70%, which outpaced sales of these ADHD drugs.

Researchers say most adolescents use their ADHD drugs appropriately, but the growing popularity of these drugs is fueling a similar growth in the abuse of these drugs because more have access to the medicine

Statins + coenzyme Q10 may benefit heart failure patients

November 4th, 2009

From OliofSpices.com:

WUHAN CITY, CHINA. There is now growing evidence that oxidative stress and inflammation are involved in chronic heart failure. Statin drugs such as atorvastatin, simvastatin and pravastatin have recently been shown to posses anti-inflammatory properties and coenzyme Q10 is a powerful antioxidant and essential for cardiac mitochondrial energy production. Unfortunately, statin drugs reduce the level of coenzyme Q10, sometimes to the point of fostering muscle-related problems (myopathies) like rhabdomyolysis.

A team of Chinese researchers at Wuhan University has now come up with the idea of combining the statin drug atorvastatin (Lipitor) with coenzyme Q10 in the treatment of patients with congestive heart failure. They conducted a clinical trial in which heart failure patients on standard treatment were randomized into receiving atorvastatin, coenzyme Q10, atorvastatin + Q10, or a placebo. At the end of the 6-month treatment period the following changes were observed:

* The level of the inflammatory marker C-reactive protein (CRP) had dropped from 5.5 mg/L (0.55 mg/dL) to 2.0 mg/L in the atorvastatin + coenzyme Q10 group. Levels of the inflammatory marker tumor necrotic factor alpha and the oxidative stress marker malondialdehyde also dropped significantly in the atorvastatin + Q10 group.

* Left ventricular ejection fraction had increased from 30% to 43% in the atorvastatin + Q10 group.

* No significant changes were observed in the control group.

Statins Show Dramatic Drug And Cell Dependent Effects In The Brain

October 31st, 2009

From ScienceDaily.com:

Besides their tremendous value in treating high cholesterol and lowering the risk of heart disease, statins have also been reported to potentially lower the risks of other diseases, such as dementia. However, a study in the October Journal of Lipid Research finds that similar statin drugs can have profoundly different effects on brain cells -both beneficial and detrimental.
These findings reinforce the idea that great care should be taken when deciding on the dosage and type of statin given to individuals, particularly the elderly.
John Albers and colleagues compared the effects of two commercially used statins, simvastatin and pravastatin, on two different types of brain cells, neurons and astrocytes (support cells that help repair damage). By directly applying the drugs to cells as opposed to administering them to animals, they could eliminate differences in the drugs’ ability to cross the blood-brain barrier as a reason for any differing effects. Albers and colleagues looked at the expression of genes related to neurodegeneration, and found that indeed, despite using biologically equivalent drug concentrations, differences were seen both between cells, and between drugs; for example, simvastatin reduced the expression of the cholesterol transporter ABCA1 by approximately 80% in astrocytes, while pravastatin lowered expression by only around 50%. Another interesting difference was that while both statins decreased expression of the Tau protein -associated with Alzheimer’s disease — in astrocytes, they increased Tau expression in neurons; pravastatin also increased the expression of another Alzheimer’s hallmark, amyloid precursor protein (APP).
While increased levels of these two proteins may account for potential risks of disease, Albers and colleagues also note that large decreases in cholesterol proteins like ABCA1 should be considered. Brain cholesterol levels tend to be reduced in elderly people, and in such individuals the long-term effects of statin therapy could lead to transient or permanent cognitive impairment.