Gleevec shown to prevent rheumatoid arthritis in mice
This is somewhat unexpected:
Although there are two documented cases in which individuals taking imatinib to treat their cancer showed clinical improvement in their RA, there had been no study of the effects of imatinib in a mouse pre-clinical model of RA. So, William Robinson and colleagues administered imatinib to mice with an RA-like disease. Imatinib both prevented the onset of disease and the development of established disease. It did this by inhibiting the function of many of the immune cells that contribute to disease in patients with RA. Importantly, imatinib was also shown to inhibit the proliferation of cells taken from the joints of patients with RA. This study indicates that imatinib might provide relief to the many individuals suffering from RA.
Somewhat unrelated, but what would you do for a patient who develops RA after he starts treatment for his newly-discovered HIV? Talk about contraindications!
[tags]Medicine, pharmacy, Gleevec, rheumatoid arthritis, arthritis[/tags]
Remicade (infliximab) for ulcerative colitis
I've got a soft spot in my heart for GI disorders since I suffer from one myself. They suck. So when I read this the other day I was a bit surprised.
"For people with active ulcerative colitis who do not respond to corticosteroids or immunosuppressive agents, infliximab is effective in inducing clinical remission, inducing clinical response, promoting mucosal healing and reducing the need for colectomy, at least in the short term," said review co-author Dr. Anthony Kwaku Akobeng.
[...]
"Infliximab is another option if steroids fail," said Peter Higgins, M.D., an assistant professor in gastroenterology at the University of Michigan Medical Center in Ann Arbor.
And here I was, thinking this was common knowledge. In fact I during my hospitalization a few weeks ago whilst on vacation I had a discussion about UC with the tech doing my CT scan. She was telling me one of her friends had severe UC, and that he was on steroids. I distinctly remember suggesting Remicade or Humira instead of prednisone through my drug-induced stupor. She was telling me he hated the side effects. What a surprise. Then I think I started rambling about monoclonals and the lack of a generic approval pathway for biologics in general. She stopped talking to me after that.
She was cute, too. Really cute.
But hey, more studies are always good. Too bad Remicade is WAY more expensive than prednisone…
[tags]Medicine, pharmacy, Remicade, infliximab, ulcerative colitis[/tags]
Postponing antibiotic usage in children with ear infections
Hat tip to MRSA Notes for this one. An study published in JAMA suggests that by telling parents to wait 48 hours to fill scripts for ear infection, physicians can help curb antibiotic overuse in children. It's not a bad idea, and it's something that I've often thought about myself. As a child I had chronic ear infections until the age of 10 when I stopped consuming dairy products. I had tubes six times. Throughout that time in my life I was averaging around one ear infection per month. In my case, waiting a day or two didn't do anything except make things worse.
Ironically, I'm sitting here now and I've got an ear infection in my left ear that I'm currently taking antibiotics for. Even more messed up is that I got the infection while on a 7 day regiment of Levaquin and Flagyl. (That's whack, eh?) Anyway, when I was a kid I wondered what people did before antibiotics. Did they go deaf? Did they walk around with chronic ear pain? Did their eardrums burst? None of my infections ever went away on their own, so I thought they stuck around until you made them go away with drugs.
Of course I know better now, and it warms the concerned medical professional and microbiology enthusiast in me to see experts pushing for moderation in antibiotic use.
Out of 238 patients aged 6 months to 12 years brought to a hospital emergency room complaining of ear infections, two-thirds of the parents who were told to wait ultimately did not fill their prescriptions.
The group that did not fill the prescriptions recovered at the same rate as children who had prescriptions filled right away, an indication the condition often clears up on its own.
Those are some impressive findings. But it doesn't get past the sense of entitlement that patients have when then visit a doctor's office. People often want antibiotics now because germs are bad, mmkay? Why else would we have all these alcohol-based antibiotic cleansers on the market that we see so heavily advertised on TV? Surely it's more than marketing…
[tags]Medicine, pharmacy, antibiotics, ear infections[/tags]
Dapoxetine for premature ejaculation
Dapoxetine, an SSRI patented by ALZA pharmaceuticals is showing some real promise combatting premature ejaculation. Dapoxetine, of course, has been around for a little while, though it's not available yet by prescription. (It's currently in Phase III trials.)
The analysis involved over 2600 men with moderate to severe premature ejaculation and their partners. Patients were randomly assigned to receive placebo (870), 30 mg dapoxetine (874), or 60 mg dapoxetine (870) and were instructed to take a dose 1-3 hours before sexual intercourse. On average, at the start of the study, the men ejaculated under a minute after penetration. The researchers found that after 12 weeks the time to ejaculation was 1.75 minutes for placebo, 2.78 minutes for 30 mg dapoxetine, and 3.32 minutes for 60 mg dapoxetine.
Not being a lifestyle drug player-hater, I'm happy to see some progress being made on premature ejaculation. Count me as one person who had no idea it was so common. As with erectile dysfunction, I'm happy that these lifestyle afflictions — which I'm sure are traumatic for these men and their partners — are treatable. By the same token, I'm glad that we've reached a point in time where things like erectile dysfunction and premature ejaculation are now treatable. Some would have us go back to the dark ages ignoring these "umimportant" problems, but I think it's nice that we are in a society that can afford to do life-saving research and life-enriching research simultaneously. Though, like many other medical professionals, I sometimes wonder if one is being done at the expense of the other.
[Image from ScienceBase]
Research confirms what I learned the hard way:
It's nearly impossible to effectively study and learn challenging material while your consciousness is being bombarded with external stimuli. I learned the hard way that learning challenging material is impossible with a lot going on around you. I wasted lots of money learning it, too. Dorms rooms, you see, are full of external stimuli. The best studying sessions I ever did were in some of the quiet study rooms in the Tosteson Medical Education Center at Harvard Med. Chalkboards, no distractions and plenty of space to spread out. I even engaged in some *ahem* extracurricular activity there once or twice upon a time. (Study break, you know.) It was awesome. I loved studying there.
In any event, the research confirms what most of us who have completed or are are in the process of completing a rigorous course of study learned at one point: it's easier to study when it's quiet. Teenagers and 20-somethings know this, too, despite their assertions to the contrary. (See what they do to the volume on their car stereos when they're driving somewhere they've never been, and they're on the lookout sometime…)
Opening therapeutic doors with ultrasound
Researchers have shown how ultrasound energy can briefly "open a door" in the protective outer membranes of living cells to allow entry of drugs and other therapeutic molecules – and how the cells themselves can then quickly close the door. Understanding this mechanism could advance the use of ultrasound for delivering gene therapies, targeting chemotherapy and administering large-molecule drugs that cannot readily move through cell membranes.
Using five different microscopy techniques, the researchers showed that the violent collapse of bubbles – an effect caused by the ultrasound – creates enough force to open holes in the membranes of cells suspended in a liquid medium. The holes, which are closed by the cells in a matter of minutes, allow entry of therapeutic molecules as large as 50 nanometers in diameter – larger than most proteins and similar in size to the DNA used for gene therapy.
"The holes are made by mechanical interaction with the collapsing bubbles," said Mark Prausnitz, a professor in the School of Chemical and Biomolecular Engineering at the Georgia Institute of Technology. "The bubbles oscillate in the ultrasound field and collapse, causing a shock wave to be released. Fluid movement associated with the resulting shock wave opens holes in the cell membranes, which allow molecules from the outside to enter. The cells then respond to the creation of the holes by mobilizing intracellular vesicles to patch the holes within minutes."
Generic clopidogrel: whiplash for the masses
Saturday morning, we received a voicemail sent to all of the branches in our chain about the stopped production of generic clopidogrel. You may recall that Apotex shipped all of the generic it had on hand as soon as their deal with S-A and BMS fell through. Well a judge has just ordered Apotex to stop producing and shipping the generic, so you can see why Apotex was in a hurry to get everything they had out the door, just in case.
Fortunately, there's not going to be a recall, so Judge Stein certainly made the right decision in that case, but I'm waiting to hear what the shakeout ends up being. Will generic clopidogrel remain on the market or will it disappear? The voicemail made it sound like our company's supplies of the generic will hold for as long as it takes to resolve the matter once and for all, but that could just as well have been in response to Apotex assurances that everything would go swimmingly. The possibility that Apotex might lose wasn't even considered, which I found disingenuous. That's in stark contrast to this WaPo article which makes it sound as though Apotex has no chance of winning at all. (Which very well could mean that it was written from a press release from Sanofi-Aventis, given that there's no stock response information for BMS listed, who also has a huge stake in Plavix's fate.)
Frankly, I don't know what to think. I'm not a lawyer, and I'm not familar with the patent dispute in this particular case. The folks at Patent Baristas don't have much more, either. If the generic disappears, it's going to piss a lot of people off, both patients and providers. Myself included. No one likes being jerked around, particularly when it affects their wallet.
[tags]Medicine, pharmacy, plavix, clopidogrel, Apotex[/tags]