Rheumatoid Arthritis Drugs Have Same Impact on Time Lost at Work: Study

Patients gained no more benefit from higher-priced biologic drug Remicade vs. cheaper medications

By Robert Preidt

HealthDay Reporter

MONDAY, July 1 (HealthDay News) -- Treatment with a pricey biological drug was no better than cheaper, conventional therapy in terms of reducing time off from work for people with rheumatoid arthritis, a new study finds.

Swedish researchers assessed lost work days among rheumatoid arthritis patients who had not responded to initial treatment with a standard medication, methotrexate.

The group of 204 patients were randomly given either the biological drug infliximab (Remicade) or conventional combination therapy with the non-biologics sulfasalazine plus hydroxychloroquine.

At the start of the study, the average amount of lost work time was 17 days per month for all patients. During the 21-month study, the patients receiving conventional therapy lost about six fewer days of work per month, compared with about five fewer days for those taking Remicade -- not a significant difference.

Regardless of the drugs used, early and aggressive treatment for patients who've failed to respond to methotrexate "not only stops the trend of increasing work loss days but partly reverses it," concluded researchers led by Jonas Eriksson of the Karolinska Institute in Stockholm.

However, the team say they "did not find any difference" in terms of work absentee rates depending on which drugs the patients took, even though Remicade did seem to provide "significantly improved disease control."

Experts not connected to the study said the relative price tags of these drugs is another key factor to consider.

"Currently, there are nine biologics FDA-approved for the treatment of rheumatoid arthritis," explained Dr. Steven Carsons, chief of the division of rheumatology, clinical immunology and allergy at Winthrop-University Hospital in Mineola, N.Y.

However, he said that biologics can cost between $15,000 to $20,000 per year, while the two non-biologics included in the Swedish study might cost only a tenth of that amount.

So, the new findings are "reassuring in terms of having effective, lower-cost alternatives with established safety profiles available for patients who do not have coverage for the more expensive biologics," Carsons said.

He added, however, that in the "real world" each patient responds differently to various rheumatoid arthritis medications, and many do fare much better on a biologic drug.

Another rheumatologist, Dr Diane Horowitz of North Shore University Hospital in Manhasset, N.Y., said the new study "brings into question the utility of choosing the more expensive [treatment] option" if ability to function well at work is a key consideration.

It's not clear, however, if the work-related benefits of a biologic would improve over a longer period of use. According to Horowitz, who is also a rheumatologist at Long Island Jewish Medical Center in New Hyde Park, N.Y., "further reseach needs to be done" to answer that question.

The study was published July 1 in the journal JAMA Internal Medicine.

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Cholesterol Drugs Might Boost Kidney Cancer Survival

Study finds statin medications tied to lower death risk after nearly 4 years of follow-up

By Robert Preidt

HealthDay Reporter

TUESDAY, May 7 (HealthDay News) -- Cholesterol-lowering statin drugs that are taken by millions of Americans might also improve survival from a type of kidney cancer called renal cell carcinoma, a new study suggests.

Statins -- drugs such as Crestor, Lipitor, Pravachol and Zocor -- have anti-inflammatory and cell self-destruction properties, and previous research has shown that these drugs may lower the risk of developing some types of cancer. The new research, presented Tuesday at the annual meeting of the American Urological Association in San Diego, suggests that the drugs might fight kidney cancer.

"Given that one in four Americans over 45 years of age take a statin and renal cell carcinoma occurs most often in men ages 50 to 70, it may be prudent to prospectively evaluate if statins protect against [cancer] progression," study author Dr. Scott Eggener, an associate professor of urologic oncology at the University of Chicago, said in a meeting press release.

One expert not connected to the study wasn't surprised by the findings.

"The use of statins has shown promise in previous studies with reducing overall cancer-related mortality," said Dr. Michael Palese, an associate professor of urology at the Icahn School of Medicine at Mount Sinai, in New York City. He added that certain characteristics of renal cell carcinomas might render statins "beneficial" for patients.

In the study, Eggener's team reviewed data from more than 900 patients who had surgery for renal cell carcinoma between 1995 and 2010. After an average follow-up period approaching four years, statin use was associated with a reduced risk of cancer progression, the team reported.

Over three years, 10 percent of the patients who took statins died of their cancer, compared with 17 percent of those who did not take this type of drug.

After accounting for other factors, the researchers concluded that statin use was independently associated with both improved overall survival and disease-specific survival.

Another expert said the finding echoes those seen in other studies involving cancer patients.

"Last year in a study published in the New England Journal of Medicine, Danish researchers studied 13 different cancers and found that in all types, the use of statins was associated with longer cancer specific survival," said Dr. Manish Vira, director of the fellowship program in urologic oncology at North Shore-LIJ's Arthur Smith Institute for Urology in Lake Success, N.Y.

But he stressed that the data so far come from observational trials, which can prove an association but not a cause-and-effect relationship between statin use and improved survival.

"Given the current data and known cardiovascular protective effects of statins, certainly it seems prudent to design clinical trials to study the potential of statin therapy in breast, colon, prostate and now kidney cancer treatment," Vira said.

Studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

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FDA Warns Pregnant Women About Migraine Drugs

Medicines containing valproate linked to lower IQs in children, agency says

By Robert Preidt

HealthDay Reporter

MONDAY, May 6 (HealthDay News) -- Pregnant women who struggle with migraine headaches should never use medicines containing the ingredient valproate because they can lower the IQ scores of their children, the U.S. Food and Drug Administration said Monday.

The new warning will be included on the labels of medicines that contain valproate. These medicines already carry a boxed warning about fetal risk, including birth defects. Valproate products include valproate sodium (Depacon); divalproex sodium (Depakote, Depakote CP, and Depakote ER); valproic acid (Depakene and Stavzor); and their generic versions.

"Valproate medications should never be used in pregnant women for the prevention of migraine headaches because we have even more data now that show the risks to the children outweigh any treatment benefits for this use," Dr. Russell Katz, director of the division of neurology products in the FDA's Center for Drug Evaluation and Research, said in an agency news release.

Valproate medicines have several FDA-approved uses including: prevention of migraines, treatment of epileptic seizures and treatment of bipolar disorder.

This new warning was issued after a study found that children whose mothers took valproate drugs to protect against epilepsy during pregnancy scored eight to 11 points lower on IQ tests at age 6 than children who were exposed to other antiepileptic drugs in the womb.

It's not known if there's a specific time during pregnancy when valproate can result in decreased IQ in children. The women in the study took the antiepileptic valproate drugs throughout their pregnancies, the FDA said.

Valproate may have some value in treating bipolar disorder and epileptic seizures in pregnant women, but should only be taken if other medications have failed to control the symptoms or are otherwise unacceptable, according to the agency.

The FDA also said that:

Women who can become pregnant should not use valproate unless it is essential to managing their medical condition.Women of childbearing age taking valproate products should use effective birth control.Women who are pregnant or who become pregnant while taking valproate medications should talk to their health-care professional immediately. Women should not stop taking their medication without talking to their health-care professional because stopping treatment suddenly can cause serious and life-threatening medical problems for the woman or the fetus.

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Cholesterol Drugs Might Boost Kidney Cancer Survival

TUESDAY, May 7 (HealthDay News) -- Cholesterol-lowering statin drugs that are taken by millions of Americans might also improve survival from a type of kidney cancer called renal cell carcinoma, a new study suggests.

Statins -- drugs such as Crestor, Lipitor, Pravachol and Zocor -- have anti-inflammatory and cell self-destruction properties, and previous research has shown that these drugs may lower the risk of developing some types of cancer. The new research, presented Tuesday at the annual meeting of the American Urological Association in San Diego, suggests that the drugs might fight kidney cancer.

"Given that one in four Americans over 45 years of age take a statin and renal cell carcinoma occurs most often in men ages 50 to 70, it may be prudent to prospectively evaluate if statins protect against [cancer] progression," study author Dr. Scott Eggener, an associate professor of urologic oncology at the University of Chicago, said in a meeting press release.

One expert not connected to the study wasn't surprised by the findings.

"The use of statins has shown promise in previous studies with reducing overall cancer-related mortality," said Dr. Michael Palese, an associate professor of urology at the Icahn School of Medicine at Mount Sinai, in New York City. He added that certain characteristics of renal cell carcinomas might render statins "beneficial" for patients.

In the study, Eggener's team reviewed data from more than 900 patients who had surgery for renal cell carcinoma between 1995 and 2010. After an average follow-up period approaching four years, statin use was associated with a reduced risk of cancer progression, the team reported.

Over three years, 10 percent of the patients who took statins died of their cancer, compared with 17 percent of those who did not take this type of drug.

After accounting for other factors, the researchers concluded that statin use was independently associated with both improved overall survival and disease-specific survival.

Another expert said the finding echoes those seen in other studies involving cancer patients.

"Last year in a study published in the New England Journal of Medicine, Danish researchers studied 13 different cancers and found that in all types, the use of statins was associated with longer cancer specific survival," said Dr. Manish Vira, director of the fellowship program in urologic oncology at North Shore-LIJ's Arthur Smith Institute for Urology in Lake Success, N.Y.

But he stressed that the data so far come from observational trials, which can prove an association but not a cause-and-effect relationship between statin use and improved survival.

"Given the current data and known cardiovascular protective effects of statins, certainly it seems prudent to design clinical trials to study the potential of statin therapy in breast, colon, prostate and now kidney cancer treatment," Vira said.

Studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Michael Palese, M.D., associate professor, urology, Icahn School of Medicine at Mount Sinai, New York City; Manish A. Vira, M.D, director, fellowship program in urologic oncology, North Shore-LIJ Arthur Smith Institute for Urology, Lake Success, N.Y.; American Urological Association, news release, May 7, 2013

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HIV Drugs May Help Protect Young Patients' Hearts: Study

Far from harming the cardiovascular health of infected children, drug cocktails may give benefit

By Robert Preidt

HealthDay Reporter

MONDAY, April 22 (HealthDay News) -- Long-term use of powerful drug cocktails known as highly active antiretroviral therapy (HAART) may help protect the hearts of children and teens infected with HIV, a new study reports.

HAART is a form of antiretroviral therapy that is widely used to treat people with HIV, the virus that causes AIDS. Prior to the introduction of antiretroviral therapies, youngsters infected with HIV were at increased risk for heart failure, noted a team led by Dr. Steven Lipshultz of the University of Miami Miller School of Medicine.

Since the advent of powerful HIV-suppressing medications, "the effects of HIV and [antiretroviral therapy] on the cardiovascular system of HIV-infected children are not completely understood," the researchers wrote in the April 22 online issue of JAMA Pediatrics. They pointed out that such children are exposed to these drugs for many years, often beginning while they are still in the womb, but the effects on their cardiovascular systems "are unknown."

The new study sought to clear that up. It included nearly 600 HIV-infected and uninfected patients from 14 pediatric HIV clinics across the United States.

According to the team, heart function was better among HIV-infected children receiving HAART than those who were infected with HIV and did not receive HAART, and children who were exposed to HIV but not infected.

"Our results indicate that the current use of combination [antiretroviral therapy], usually HAART, appears to be cardioprotective in HIV-infected children and adolescents," the study authors reported. "This finding is even more relevant in the developing world where the prevalence of HIV disease in children is much higher."

The researchers added that further study comparing different drug regimens might be beneficial "in optimizing HIV outcomes and protecting long-term cardiac health" of children with HIV.

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How do blood pressure drugs work and how can I find the one that’s right for me?

Posted June 10, 2013, 2:00 am

How do blood pressure drugs work? And how will my doctor know which one is right for me?

There are many different drugs for blood pressure and they work in different ways. Finding which one will work best for you may involve a process of trial-and-error. But in the end, you’ll be rewarded with a medication that offers the best blood pressure control with the fewest side effects.

If you have other health conditions — diabetes and heart disease often accompany hypertension, for instance — certain drugs can lower blood pressure while also helping to treat these conditions.

I’ll briefly summarize the different classes of blood pressure drugs and how they work. I won’t go into the potential side effects of these drugs here, but you should discuss them with your doctor. (I’ve put tables with examples of the different types of drugs at the end of this post.)

Diuretics, or “water pills,” help the kidneys eliminate sodium and water from the body. This decreases blood volume, so the heart has less to pump with each beat. Of all the blood pressure drugs used today, diuretics have been around the longest and their beneficial effects are solidly proven.ACE inhibitors decrease blood volume by preventing the kidneys from retaining sodium and water. They do this by deactivating angiotensin-converting enzyme (ACE). ACE is a natural chemical (an enzyme) that converts another natural chemical, angiotensin I, to the chemical called angiotensin II. Angiotensin I is inactive, but angiotensin II raises blood pressure. So reducing the amount of angiotensin II by reducing ACE, the enzyme that makes angiotensin II, helps lower blood pressure.Angiotensin-receptor blockers (ARBs) block the blood pressure-raising effects of angiotensin II. So, the ACE inhibitors reduce the amount of angiotensin II the body makes, and the ARBs reduce the blood pressure-raising effect of angiotensin II.Calcium-channel blockers slow the movement of calcium into the smooth-muscle cells that are in the heart and the walls of the blood vessels. This makes heart muscle pump less forcefully (but still forcefully enough), which reduces blood pressure. Calcium-channel blockers also relax the muscle in the blood vessel walls, which makes blood vessels open wider, lowering blood pressure.Anti-adrenergics limit the action of the hormones epinephrine and norepinephrine. This relaxes the blood vessels and reduces the speed and force of the heart’s contractions.Direct-acting vasodilators relax the arteries. They act quickly and are often used in emergencies.Direct renin inhibitors inhibit the activity of renin, the enzyme largely responsible for angiotensin II levels. Aliskiren (Tekturna) is a renin inhibitor.

There really is no “best” blood pressure medication. The goal is to find the right medication for you. Often, more than one type of medicine used in combination proves the best. That means finding the medicine or medicine combo that effectively lowers your blood pressure while not causing side effects — and not costing more than you can afford.

Weakness, confusion, potassium depletion, gout, fatigue, thirst, frequent urination, lightheadedness, muscle cramps, diarrhea or constipation, increased sensitivity to sunlight, allergic reaction in people allergic to sulfa drugs, impotence.Esidrix, HydroDiuril, MicrozideWeakness, confusion, potassium depletion, gout, fatigue, thirst, diarrhea or constipation, increased sensitivity to sunlight, allergic reaction in people allergic to sulfa drugs, impotence.Potassium-sparing diuretics/aldosterone-receptor blockers*Excessive potassium levels, especially in patients with kidney disease; breast enlargement and erectile dysfunction in men; menstrual irregularities in women.Headache, dizziness, diarrhea, fatigue, upset stomach, and breast enlargement or tenderness.*Note: Potassium-sparing diuretics also directly or indirectly block aldosterone, a hormone that raises blood pressure by causing the kidneys to conserve sodium and water. As a result, these four medications are sometimes also known as aldosterone-receptor blockers. Amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium) also affect other hormones and thus carry some unwanted side effects, such as breast enlargement and impotence in men and menstrual irregularities in women.Beta blockers (cardioselective)acebutolol (Sectral)atenolol (Tenormin)betaxolol (Kerlone)bisoprolol (Zebeta)metoprolol (Lopressor)metoprolol extended release (Toprol-XL)nebivolol (Bystolic)penbutolol (Levatol)Wheezing, dizziness, depression, impotence, fatigue, insomnia, decreased HDL cholesterol levels, lower exercise tolerance. Can worsen peripheral vascular disease and heart failure. Abrupt withdrawal may trigger angina or a heart attack in patients with heart disease.nadolol (Corgard)pindolol (Visken)propranolol (Inderal, Inderal LA)sotalol (Betapace)timolol (Blocadren)doxazosin (Cardura)prazosin (Minipress)terazosin (Hytrin)A drop in blood pressure upon standing up, fainting, weakness, heart palpitations, headache, nasal congestion, dry mouth.carvedilol (Coreg)labetalol (Normodyne, Trandate)Wheezing, depression, insomnia, diarrhea, lightheadedness, dizziness, unusual tiredness or weakness, drying of the eyes, erectile dysfunction, headache, dry mouth, nasal congestion, decreased HDL cholesterol levels, lower exercise tolerance, a drop in blood pressure upon standing up, fainting, heart palpitations. Can worsen peripheral vascular disease and heart failure. Abrupt withdrawal may trigger angina or a heart attack in patients with heart disease.clonidine (Catapres, Catapres-TTS)methyldopa (Aldomet)A drop in blood pressure upon standing up, drowsiness, sedation, dry mouth, fatigue, erectile dysfunction, depression, dizziness. Catapres-TTS (a patch) may cause a rash.Peripheral nerve–acting agentsguanethidine (Ismelin)reserpine (Serpalan)A drop in blood pressure upon standing up, depression, nasal stuffiness, nightmares. Guanethidine may slow heart rate, and reserpine may cause indigestion. Headaches, palpitations, weakness, flushing, nausea. Minoxidil may cause hair growth, fluid retention, and increased blood sugar.Headache, dizziness, edema, and heartburn. Nifedipine can cause palpitations. Diltiazem and verapamil can cause constipation and a slowed heartbeat.Cough, rash, fluid retention, high potassium levels, and loss of taste. May cause low blood pressure and fainting. Can worsen kidney impairment if narrowed arteries feed both kidneys. May cause spontaneous abortion. window.fbAsyncInit = function() { FB.init({appId: "199616670120169", status: true, cookie: true, xfbml: true});}; (function() { var e = document.createElement("script"); e.async = true; e.src = document.location.protocol + "//connect.facebook.net/en_US/all.js"; document.getElementById("fb-root").appendChild(e);}());

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FDA Approves 1st in New Class of Type 2 Diabetes Drugs

Title: FDA Approves 1st in New Class of Type 2 Diabetes Drugs
Category: Health News
Created: 3/29/2013 6:35:00 PM
Last Editorial Review: 4/1/2013 12:00:00 AM

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Alzheimer's Drugs May Benefit Heart, Study Finds

Fewer heart attacks, deaths for patients taking cholinesterase inhibitors

By Robert Preidt

HealthDay Reporter

WEDNESDAY, June 5 (HealthDay News) -- Drugs used to treat early-stage Alzheimer's disease may also reduce patients' risk of heart attack and death, according to a new study.

Researchers followed more than 7,000 Alzheimer's disease patients in Sweden for more than three years. Those taking cholinesterase inhibitors had a 38 percent lower risk of heart attack, a 26 percent lower risk of death from cardiovascular causes such as stroke and a 36 percent lower risk of death from any cause, compared to those who did not take the drugs.

Patients who took the highest recommended doses of cholinesterase inhibitors (ChEIs) had the lowest risk of heart attack or death -- 65 percent and 46 percent lower, respectively, than those who never took the drugs, according to the study, which was published online June 5 in the European Heart Journal.

"If you translate these reductions in risk into absolute figures, it means that for every 100,000 people with Alzheimer's disease, there would be 180 fewer heart attacks (295 as opposed to 475) and 1,125 fewer deaths from all causes (2,000 versus 3,125) every year among those taking ChEIs compared to those not using them," study author Professor Peter Nordstrom, of Umea University in Sweden, said in a journal news release.

No cure exists for Alzheimer's disease, an age-related brain disorder and the most common form of dementia. However, cholinesterase inhibitors, such as donepezil (brand name Aricept), galantamine (Razadyne, Reminyl) and rivastigmine (Exelon), are prescribed to help manage symptoms and slow disease progression in people with early- to moderate-stage disease.

Previous research has found that these drugs have a beneficial effect on the vagus nerve, which controls heart rate, and may have anti-inflammatory properties.

"As far as we know, this is the first time that the use of ChEIs has been linked to a reduced risk of heart attacks and deaths from cardiovascular disease in general or from any cause," Nordstrom said.

"As this is an observational study, we cannot say that ChEI use is causing the reduction in risk, only that it is associated with a reduction," he said. "However, the strengths of the associations make them very interesting from the clinical point of view, although no clinical recommendations should be made on the basis of the results from our study."

An analysis of previous randomized, controlled trials would produce answers on which clinical recommendations could be based, Nordstrom added.

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FDA Approves 1st in New Class of Type 2 Diabetes Drugs

Invokana works by blocking reabsorption of glucose in body

By Robert Preidt

HealthDay Reporter

FRIDAY, March 29 (HealthDay News) -- The first in a new class of type 2 diabetes drugs was approved Friday by the U.S. Food and Drug Administration.

Invokana (canaglifozin) tablets are to be taken, in tandem with a healthy diet and exercise, to improve blood sugar control in adults with type 2 diabetes.

Invokana belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors. It works by blocking the reabsorption of glucose (sugar) by the kidney and increasing glucose excretions in urine, the FDA said in a news release.

"We continue to advance innovation with the approval of new drug classes that provide additional treatment options for chronic conditions that impact public health," Dr. Mary Parks, director of the division of metabolism and endocrinology products in the FDA's Center for Drug Evaluation and Research, said in the news release.

About 24 million Americans have type 2 diabetes, and it accounts for more than 90 percent of diabetes cases diagnosed in the United States, the FDA said. If blood sugar levels are not carefully controlled, there is an increased risk for serious complications, including heart disease, blindness, and nerve and kidney damage, the agency added.

The FDA approval is based on the findings of nine clinical trials involving more than 10,000 patients. Patients who took the drug showed improvement in hemoglobin A1c levels (a measure of blood sugar control) and fasting blood sugar levels.

Invokana should not be used by people with type 1 diabetes or people with type 2 diabetes who have increased ketones in their blood or urine (diabetic ketoacidosis), severe kidney disease, kidney failure or who are on dialysis, the FDA said.

The agency told drug maker Janssen Pharmaceuticals that it must conduct five post-approval studies of the drug to determine the risk of problems such as heart disease, cancer, pancreatitis, liver abnormalities and pregnancy complications.

The most common side effects of Invokana are vaginal yeast infections and urinary tract infections. It may also cause dizziness and fainting.

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More Kids Being Poisoned by Prescription Drugs: Study

Blood pressure meds, diabetes drugs and narcotic painkillers most common culprits, researchers say

By Steven Reinberg

HealthDay Reporter

MONDAY, June 3 (HealthDay News) -- As the number of adults taking prescription drugs has grown, so has the number of children being accidentally poisoned by them, a new study finds.

"We found between 2000 and 2009 [that] rates of pediatric exposure to adult medications were increasing," said lead researcher Dr. Lindsey Burghardt, from the division of emergency medicine at Boston Children's Hospital.

In addition, there was an association between the number of prescriptions written for these medications for adults and the increase in the number of children being poisoned by them, she said.

"This is the first step, to identify the extent of the problem," Burghardt said. "Despite all these precautions that have been put in place to try to prevent these poisonings in kids the problem persists," she said. "In fact, the number of poisonings has been increasing."

The next step is to try to identify why this is happening, Burghardt said. That, however, isn't clear at this point, she added.

Burghardt advises keeping these medications out of the reach of young children. Particularly, those under 5 who are at the greatest risk.

The greatest risk for teen misuse is from narcotic painkillers, Burghardt said, mostly intended for recreational use or to attempt suicide.

The report was published in the June 3 online edition of Pediatrics.

"What we see a lot is open prescription bottles from parents or grandparents, and ingestion of diabetic and other drugs by kids," said Dr. Vincenzo Maniaci, a pediatric emergency medicine doctor at Miami Children's Hospital. "Kids are going to get into everything."

Medications need to be kept high up, in locked boxes, so children can't get at them, Maniaci said. Medications should not be kept on countertops, in purses or on nightstands.

If a parent suspects a child had ingested a prescription medication, the first step is to call poison control, Maniaci said.

To try to get a handle on the extent of the problem, Burghardt's team used the National Poison Data System surveys for 2000 through 2009 to track poisoning from prescription drugs among infants to 5-year-olds, children aged 6 to 12 and teens aged 13 to 19.

Specifically, they looked at poisoning from drugs used to treat diabetes, high cholesterol and high blood pressure, as well as narcotic painkillers.

They found young children had the greatest risk of being poisoned by diabetes drugs (60.2 percent) and blood pressure drugs (59.7 percent).

The most serious injuries and hospitalizations, however, were cause by narcotic painkillers and diabetes drugs.

Prescription pills aren't the only drugs kids are finding and taking. A recent study in the online edition of JAMA Pediatrics found that since medical marijuana was legalized in Colorado, more than a dozen young children have been unintentionally poisoned with the drug.

About half of the cases resulted from kids eating marijuana-laced cookies, brownies, sodas or candy. In many cases, the marijuana came from their grandparents' stash, the investigators said.

But doctors aren't familiar with marijuana poisoning in children, so unless the parents are forthcoming it can take time and tests to diagnose the problem, the Colorado researchers explained. Symptoms of marijuana poisoning in children include sleepiness and balance problems while walking.

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Cholesterol Drugs Linked to Muscle, Joint Problems: Study

But heart benefits of statins outweigh risks, expert says

By Steven Reinberg

HealthDay Reporter

MONDAY, June 3 (HealthDay News) -- People taking statin drugs to lower their cholesterol may slightly increase their risk for muscle and joint diseases as well as strains and sprains, a new study suggests.

Statins, such as Zocor and Lipitor, are widely used to reduce cholesterol levels and help prevent heart disease. But they're also thought to contribute to muscle weakness, muscle cramps and tendon problems.

This new study, based on nearly 14,000 U.S. active-duty soldiers and veterans, confirmed an association between the drugs' use and musculoskeletal injuries and diseases. But the findings need to be replicated in other types of studies and should not deter people at risk of heart disease from taking the medications, said lead researcher Dr. Ishak Mansi, from the VA North Texas Health Care System in Dallas.

"Do not stop taking statins; these medications have been life-savers for some patients," Mansi said. "But talk to your doctor about the benefit-risk ratio for you."

Whether statins should be prescribed universally in people without risk factors for heart disease, as some in the health care field suggest, is another matter, Mansi said.

"The side effects of statins are not totally known yet," Mansi said. "Advocating widespread use, specifically for primary prevention in otherwise healthy subjects, is unsound."

The researchers matched nearly 7,000 statin users with a similar number of nonusers to assess the risk of musculoskeletal problems associated with statin use. The results were published online June 3 in the journal JAMA Internal Medicine.

They found that people taking statins had a 19 percent greater risk of having musculoskeletal problems compared with nonusers. Specifically, statin users were 13 percent more likely to suffer dislocations, strains or sprains. They were only 0.7 percent more likely to develop osteoarthritis or other joint problems, which was not considered statistically significant, the researchers found.

The greater likelihood of strains, sprains and dislocations with statin use has not been previously reported, the researchers said. The findings might have implications for physically active people, such as members of the military.

Dr. Gregg Fonarow, spokesman for the American Heart Association, said statin users should be reassured by the findings.

"This study provides further evidence that the proven cardiovascular benefits outweigh any potential risks, including musculoskeletal issues," said Fonarow, a professor of cardiology at the University of California, Los Angeles.

"Statins have been demonstrated in multiple large-scale, prospective, randomized, placebo-controlled trials to reduce the risk of ... cardiovascular events in men and women with or at risk for cardiovascular disease," he said. "In these gold-standard clinical trials there has been no increased risk of musculoskeletal disease."

In the current study, three-quarters of the participants were taking simvastatin (brand name Zocor) and about 20 percent were taking atorvastatin (Lipitor). Smaller numbers were prescribed pravastatin (Pravachol), rosuvastatin (Crestor), fluvastatin (Lescol) or lovastatin (Mevacor).

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Experimental Drugs Show Promise Against Prostate Cancer

Tumor growth suppressed in lab tests; human trials still needed, study authors say

By Mary Elizabeth Dallas

HealthDay Reporter

FRIDAY, May 31 (HealthDay News) -- Researchers have identified a new class of drugs that show promise for treating advanced prostate cancer. The drugs, known as peptidomimetics, interfere with the signaling necessary for prostate cancer cells to grow, according to a new study.

Prostate cancer depends upon the actions of androgens, such as the hormone testosterone. Androgens activate androgen receptors, resulting in a signal that causes prostate cancer cells to grow.

To stop tumor growth, men with prostate cancer have been treated with drugs to block the production of androgens or block the receptor where androgens bind. However, tumors can grow despite this treatment because of mutations in androgens or receptors.

In the latest study, published online May 28 in Nature Communications, a team of researchers led by Dr. Ganesh Raj, associate professor of urology at UT Southwestern Medical Center at Dallas, found the nontoxic peptidomimetic agents could disrupt androgen-receptor signaling and prevent tumor growth.

When tested in mouse and human tissue models, the drugs blocked the activity of androgens by attacking the protein in a different spot from where the androgen binds, the researchers explained. As a result, prostate cancer cells do not receive the signal to grow -- even when the androgen receptor is activated.

"We are hopeful that this novel class of drugs will shut down androgen-receptor signaling and lead to added options and increased longevity for men with advanced prostate cancer," Raj, the study's senior author, noted in a university news release.

One expert was optimistic about the new findings.

"The study represents a significant step forward in the development of a new molecular targeted therapy for advanced prostate cancer," said Dr. Manish Vira, director of the Fellowship Program in Urologic Oncology at North Shore-LIJ's Arthur Smith Institute for Urology in Lake Success, N.Y.

He said the new drug works at "preventing the [cell] receptor from promoting cancer cell growth signaling," and added that "the study is proof in principle that rationale design of peptidomimetics can lead to the development of a new class of anti-cancer therapy."

The researchers noted more testing is needed before the drugs could progress to clinical trials involving humans. Results obtained in laboratory experiments are not always replicated in humans.

"Most drugs now available to treat advanced prostate cancer improve survival rates by three or four months," Raj added. "Our new agents may offer hope for men who fail with the current drugs."

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New Drugs Might Give Heart Patients an Edge

Cangrelor, Inspra and inclacumab seem to improve outcomes in company-funded trials

By E.J. Mundell

HealthDay Reporter

SUNDAY, March 10 (HealthDay News) -- In the search for better medicines to safely help heart patients, clinical trials testing three new drugs appear to offer some promise.

Two of the drugs, cangrelor and inclacumab, might improve outcomes for patients undergoing cardiac interventions such as angioplasty or stenting, while a third drug, Inspra, seems to lower heart patients' odds for death and heart failure following a heart attack.

All three trials were funded by the respective drugs' makers, and all three were presented Sunday at the annual meeting of the American College of Cardiology (ACC) in San Francisco.

In the first trial, researchers compared an as-yet unapproved blood thinner called cangrelor against the current standard medication, Plavix (clopidogrel), for patients who have recently had a stent implanted in an artery to help improve blood flow.

According to the ACC, more than 600,000 coronary artery stent procedures are conducted in the United States each year, but doctors have long sought safer alternatives to Plavix to help prevent clots. Plavix comes with one big drawback for patients rushed to the hospital with suspected heart attack: It is taken in pill form, and its anti-clotting effects (with accompanying bleeding risk) may not wear off for up to a week.

That means that pre-treating a new patient with Plavix can trigger long delays in needed heart surgery, as the patient waits for the bleeding risk to subside.

Cangrelor may help get around that issue. Even though it is delivered intravenously and begins acting quickly, its anti-clotting effects also fade quickly -- within an hour -- should any bleeding complications occur, the study authors said.

So, doctors might feel free to give heart patients cangrelor upon admittance to the hospital and then send them immediately for angioplasty -- a minimally invasive procedure to reopen clogged vessels -- or stenting, if needed.

In the trial, which was funded by cangrelor's maker, New Jersey-based The Medicines Company, researchers compared short-term outcomes for 11,000 patients who underwent stent placement at one of 153 centers around the world.

Some of the patients got cangrelor, while others got Plavix. The study was also published online Sunday in The New England Journal of Medicine.

The research team reported that cangrelor reduced by 22 percent the odds of a patient dying, having a heart attack or having a clot develop in the stented vessel within two days of the procedure, compared to patients who took Plavix. Safety profiles were similar: Severe bleeding at 48 hours after the stenting procedure occurred in 0.16 percent of those on cangrelor and 0.11 percent of those given Plavix.

Commenting at a press conference on Sunday, Dr. Cindy Grines, a cardiologist at Detroit Medical Center, said that if cangrelor receives U.S. Food and Drug Administration approval it could have a "huge impact" for heart patients.

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Newer Rheumatoid Arthritis Drugs Don't Seem to Increase Risk of Shingles

By Serena Gordon

HealthDay Reporter

TUESDAY, March 5 (HealthDay News) -- The newest medications used to treat autoimmune diseases such as rheumatoid arthritis don't appear to raise the risk of developing shingles, new research indicates.

There has been concern that these medications, called anti-tumor necrosis factor (anti-TNF) drugs, might increase the chances of a shingles infection (also known as herpes zoster) because they work by suppressing a part of the immune system that causes the autoimmune attack.

"These are commonly used drugs for people with rheumatoid arthritis and other autoimmune diseases, and the issue was whether or not they increased the risk of [shingles]. We found there is no increased risk when using these drugs, which was reassuring," said study author Dr. Kevin Winthrop, associate professor of infectious disease and public health and preventive medicine at Oregon Health and Science University in Portland.

Results of the study are published in the March 6 issue of the Journal of the American Medical Association.

Shingles is a major concern for people with autoimmune conditions, particularly people who are older and more at risk for developing shingles in general. Shingles is caused when the same virus that causes chickenpox is reactivated.

The symptoms of shingles, however, are often far more serious than chickenpox. It typically starts with a burning or tingling pain, which is followed by the appearance of fluid-filled blisters, according to the U.S. National Institutes of Neurological Disorders and Stroke. Shingles pain can vary from mild to so severe that even the lightest touch causes intense pain.

People who have rheumatoid arthritis already have an increased risk of shingles, although Winthrop said it's not exactly clear why. It may be due to older age, or it may have something to do with the disease itself.

Rheumatoid arthritis and other autoimmune conditions are treated with many different medications that help dampen the immune system and, hopefully, the autoimmune attack. Corticosteroids such as prednisone often are the first line of treatment, but because these drugs have many side effects, the goal is to be on the lowest dose possible or off them altogether.

Two other classes of drugs -- the "biologic" anti-TNF drugs and a group of medications called non-biologic disease-modifying anti-rheumatic drugs (DMARDs) -- are newer medications that can be used to treat rheumatoid arthritis and other autoimmune conditions. Examples of biologics are adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade). A commonly used DMARD is methotrexate.

Winthrop and his colleagues reviewed data from almost 60,000 people with various autoimmune conditions, such as rheumatoid arthritis, inflammatory bowel disease, psoriasis, psoriatic arthritis and ankylosing spondylitis. More than 33,000 were taking biologic anti-TNF drugs, and almost 26,000 were on DMARDs. The study period ran from 1998 through 2008.

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Bath Salts Drugs: Problems, Ingredients, Dangers, and More

"Ivory Wave," "Purple Wave," Vanilla Sky," and "Bliss" are among the many street names of so-called designer drugs known as “bath salts,” which have sparked thousands of calls to poison centers across the U.S.

These drugs contain synthetic chemicals that are similar to amphetamines. Some, but not all, of the chemicals used to make them are illegal.

"Is this what we put in our bathtubs, like Epsom salts? No," says Zane Horowitz, MD, an ER doctor and medical director of the Oregon Poison Center.

These drugs have nothing to do with real bath salts -- or "jewelry cleaner," or "plant food," or "phone screen cleaner," which they're also sometimes called, according to the National Institute on Drug Abuse.

Exactly which chemicals are in the drugs isn't known. 

"The presumption is that most ‘bath salts’ are MDPV, or methylenedioxypyrovalerone, although newer... derivatives are being made by illegal street chemists," Horowitz says. "Nobody really knows, because there has been no way to test for these substances. However, that is changing, and some tests for certain of these chemicals have been developed."

The effects can include agitation, paranoia, hallucinations, chest pain, increased pulse, high blood pressure, and suicidal thinking/behavior, Horowitz says.

Suicidal thinking/behavior may last "even after the stimulatory effects of the drugs have worn off," Horowitz says. "At least for MDPV, there have been a few highly publicized suicides a few days after their use."

In July 2012, the Synthetic Drug Abuse Prevention Act made it illegal to possess, use, or distribute many of the chemicals used to make bath salts, including Mephedrone and MDPV. Methylone, another such chemical, remains under a DEA regulatory ban. In all, the law covers 26 chemicals, all of them ingredients in synthetic drugs.

That's a "help," says DEA spokeswoman Barbara Carreno, "but we haven't controlled everything out there."

"The federal law passed [in 2012] bans a handful of the chemicals used to make them but not all of them," Horowitz says. "Those chemicals are now labeled as schedule 1 drugs, which means they have no medicinal value but a high potential for abuse."

"We don’t know if they are addictive. We have not had enough long-term experience with it," Horowitz says. However, he points out that many stimulant drugs do make people crave them.

The main problem is the toxic effects that these drugs have right away.

"They snort it, shoot it, mix it with food and drink," Horowitz says.

"Drug makers will keep creating new combinations at home and in illicit labs," Horowitz says.

"It’s almost impossible to keep up... Enforcement of the laws is difficult but it's getting better. But there's an ongoing battle between those trying to develop the technology to test for these chemicals and the street chemists who are trying to stay ahead of the law. Unfortunately, the law won't make this problem disappear. We're going to continue to see a lot of this type of thing. It will always be in the shadows."

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Drugs May Help Relieve Restless Legs Syndrome

By Steven Reinberg

HealthDay Reporter

MONDAY, March 4 (HealthDay News) -- People suffering from restless legs syndrome may find some relief by taking one of several drugs approved to treat the condition, a new review confirms.

The medications, which include Requip (ropinirole), levodopa, Neurontin (gabapentin) and Lyrica (pregabalin), appear to reduce symptoms of the syndrome in more than 60 percent of patients, researchers report. The first two drugs raise dopamine levels in the body, and the last two drugs reduce the amount of calcium reaching brain cells and trigger the production of other chemicals that help reduce pain. Dopamine is a brain chemical that regulates movement and mood.

"Physicians and patients now have better information on the effectiveness and harms of two types of drug treatments for patients with at least moderately severe restless legs symptoms in which to guide treatment choices," said review author Dr. Timothy Wilt, core investigator at the Minneapolis VA Health Care System.

Restless legs syndrome causes a person to feel a powerful urge to move his or her legs. The legs become uncomfortable when lying down or sitting, and the condition can disrupt sleep and take a toll on the quality of life, the researchers said.

One expert, Dr. Martin Niethammer, a neurologist at the Movement Disorders Center of North Shore-LIJ's Cushing Neuroscience Institute in Manhasset, N.Y., said this study is merely a review of the current treatments for restless legs syndrome.

"There is nothing new here at all," he said. "It doesn't add anything to the field."

This is just a compilation of evidence that follows guidelines that have been long established in both Europe and the United States, Niethammer said.

"These are the only treatments approved by the [U.S. Food and Drug Administration]," he added.

The report was published in the March 4 online issue of JAMA Internal Medicine.

For the analysis, Wilt's team reviewed 29 clinical trials. The researchers found that 61 percent of those taking dopamine agonists showed at least a 50 percent improvement in their symptoms, compared with 41 percent of those taking an inactive placebo.

In addition, those taking dopamine agonists slept better and scored higher on measures of quality of life. Dopamine agonists were originally developed to treat Parkinson's disease.

Side effects of dopamine agonists can include euphoria, hallucinations, weight loss, nausea, insomnia, tiredness or weakness, dizziness and drowsiness.

There are generic versions of Requip that cost far less, running between $11 and $22 a month. Insurance covers the treatment in most cases, so actual out-of-pocket costs will vary by insurance plan. The same is true for levodopa, Wilt said.

Neurontin and Lyrica also helped relieve symptoms in 61 percent of patients, compared with 37 percent of those taking a placebo, the researchers found.

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Newest Diabetes Drugs Linked to Higher Pancreatitis Risk

Title: Newest Diabetes Drugs Linked to Higher Pancreatitis Risk
Category: Health News
Created: 2/25/2013 4:36:00 PM
Last Editorial Review: 2/26/2013 12:00:00 AM

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Existing Breast Cancer Drugs May Help More Women

ByCharlene Laino
WebMD Health News Reviewed byLaura J. Martin, MD

Dec. 7, 2012 (San Antonio) -- Current screening tests may miss as many as 1 in 50 women with breast cancer who would benefit from treatment with highly effective breast cancer drugs.

At issue is HER2-positive breast cancer, an aggressive form of the disease that was difficult to treat until the FDA approved the drug Herceptin in 1998. Herceptin revolutionized the treatment of HER2-positive breast cancer, reducing the risk of recurrence and prolonging lives.

Since then, two other drugs, Tykerb and Perjeta, have been approved for the treatment of HER2-positive breast cancer. Others are in the pipeline.

The new study involved 1,500 women found to be HER2-negative on routine HER2 testing. Genetic analysis showed 25 had HER2 mutations.

"These mutations would be missed by current HER2 testing," says researcher Ron Bose, MD, PhD, of the Washington University School of Medicine in St. Louis.

"As a result, the women would not receive potentially lifesaving treatment with HER2 targeted drugs," he says.

The findings were presented at the San Antonio Breast Cancer Symposium (SABCS) here and published online in the journal Cancer Discovery.

A Visual Guide to Breast Cancer

HER2 Mutations

A patient must have more than the normal two copies of the HER2 gene to be classified as HER2-positive. About 20% to 25% of women with breast cancer fall into this category. The excess HER2 drives tumor growth.

The HER2 mutations stimulate tumor growth in a different way. "Many turn on HER2 activity in an inappropriate manner, which probably results in abnormal, unregulated HER2 signaling. This is likely driving the cancer cell," Bose says.

The genetic analyses revealed that 1.5% to 2% of all breast cancer patients have these genetic mutations. With about 230,000 new cases of breast cancer in the United States each year, even this modest percentage translates into more than 4,000 patients per year.

Will HER2 Targeted Drugs Help?

In laboratory tests, Herceptin and Tykerb killed many of the mutant cells. Two mutations that were resistant to Tykerb responded well to neratinib, an experimental anti-HER2 drug.

Some mutations were found to be "silent," meaning they did not drive tumor growth and therefore would likely not respond to anti-HER2 drugs, Bose says.

Now the researchers have launched a study in which women will be screened for HER2 mutations. Those who have the mutations will be given neratinib. Doctors will follow the women to see if the drug is effective and safe.

Asked if the high cost of genetic analysis would prohibit its routine use, Bose says that it is increasingly being used in other forms of disease, such as lung cancer.

If trial results show that attacking the newfound mutations can prevent recurrences and save lives, then gene tests -- and their cost -- will quickly be accepted as part of the standard of care.

"In the future, we will probably be talking about panels of relevant genes that will need to be sequenced in breast cancer," he says.

SABCS co-director Kent Osborne, MD, a breast cancer specialist at Baylor College of Medicine in Houston, says he believes even more mutations that drive breast cancer growth will be discovered in coming years.

And it's likely the newly discovered mutations may promote growth of other types of tumors as well, he says.

Osborne says he would also like to see studies testing whether the anti-HER2 drugs already on the market benefit women with the mutations.

View Article Sources

SOURCES:

San Antonio Breast Cancer Symposium, San Antonio, Texas, Dec. 4-8, 2012.

Bose, R. Cancer Discovery, published online Dec. 7, 2012.

Ron Bose, MD, PhD, Washington University School of Medicine, St. Louis.

Kent Osborne, MD, Baylor College of Medicine, Houston.

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