Joint Treatment for Asthma?

Once again, Word on Health brings you news of a potential breakthrough in the treatment of asthma.  Researchers in Australia believe that a drug used to treat rheumatoid arthritis could also help patients with asthma. According to a paper published in the Lancet the scientists from Down Under have identified two mutant genes that may predispose a person to asthma. After comparing 58,000 DNA samples of people living in Australia, Europe and the United States they found two regions of the DNA that are consistently different between asthmatics and non-asthmatics.”  One of the genes is also linked to rheumatoid arthritis (RA) and the researchers suggested that the drug tocilizumab, which is used to treat RA, may also work for asthma. Tocilizumab, marketed under the brand Actemra by Genentech, targets a certain molecule in the body called “interleukin-6 receptor” and reduces inflammation in RA patients. “Targeting interleukin-6 receptor may be a good strategy to reduce or prevent inflammation (in asthma) in the same way that it is used to prevent or reduce inflammation in rheumatoid arthritis,” suggests lead author Manuel Ferreira at the Queensland Institute of Medical Research. Word on Health awaits further research to confirm if and how the drug may help asthma patients. We’ll bring you further news as we hear it.

Rogue Reporting

According to an article just published in the Journal of General Internal Medicine, results of drug studies published in medical journals may be misleading.

The UCLA-Harvard study says that the drug trials published in the most influential medical journals including the New England Journal of Medicine, the Journal of the American Medical Association, The Lancet, the Annals of Internal Medicine, the British Medical Journal and the Archives of Internal Medicine are frequently designed in a way that yields misleading or confusing results.

Investigators analyzed all the randomized drug trials published in the above journals between June 1, 2008, and Sept. 30, 2010, to determine the prevalence of outcome measures that make data interpretation difficult.  In addition, they reviewed each study’s abstract to determine the percentage that reported results using relative rather than absolute numbers, which can also be misleading.

They specifically looked at three outcome measures that have received increasing criticism from scientific experts: surrogate outcomes, composite outcomes and disease-specific mortality and found that :

• 37% of the studies analyzed used surrogate outcomes – intermediate markers, such as a heart medication’s ability to lower blood pressure, but which may not be a good indicator of the medication’s impact on more important clinical outcomes, like heart attacks

• 34% used composite outcomes which consist of multiple individual outcomes of unequal importance lumped together, such as hospitalizations and mortality, making it difficult to understand the effects on each outcome individually

• 27% used disease-specific mortality, which measures deaths from a specific cause rather than from any cause. This may be a misleading measure because, even if a given treatment reduces one type of death, it could increase the risk of dying from another cause, to an equal or greater extent

“Patients and doctors care less about whether a medication lowers blood pressure than they do about whether it prevents heart attacks and strokes or decreases the risk of premature death,” said the study’s lead author, Dr. Michael Hochman, a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at the David Geffen School of Medicine at UCLA’s division of general internal medicine and health services research, and at the U.S. Department of Veterans Affairs’ Los Angeles Medical Center.

Dr. Danny McCormick, the study’s senior author and a physician at the Cambridge Health Alliance and Harvard Medical School, added: “Patients also want to know, in as much detail as possible, what the effects of a treatment are, and this can be difficult when multiple outcomes of unequal importance are lumped together.”

The authors also found that 45% of exclusively commercially funded trials used surrogate endpoints, whereas only 29% of trials receiving non-commercial funding did. Furthermore, while 39% of exclusively commercially funded trials used disease-specific mortality, only 16% of trials receiving non-commercial funding did.

The study also showed that 44% of abstracts reported results in relative rather than absolute numbers, which can be misleading.  “The way in which study results are presented is critical,” McCormick said. “It’s one thing to say a medication lowers your risk of heart attacks from two-in-a-million to one-in-a-million, and something completely different to say a medication lowers your risk of heart attacks by 50 percent. Both ways of presenting the data are technically correct, but the second way, using relative numbers, could be misleading.”

To remedy the problems identified by their analysis, Hochman and McCormick believe that studies should report results in absolute numbers, either instead of, or in addition to, relative numbers, and that committees overseeing research studies should closely scrutinize study outcomes to ensure that lower-quality outcomes, like surrogate makers, are only used in appropriate circumstances.

So who’s to blame?  The pharma companies for using outcomes that are most likely to indicate favorable results for their products, the study authors for writing them up that way or the journals for accepting the manuscripts?  Let us know what you think.

An aspirin a day keeps bowel cancer away?

Aspirin is not only an effective painkiller, it is thought to help fight conditions ranging from cardiovascular disease, cancer and stroke to migraine headache and high blood pressure in pregnancy. Some studies have suggested it can double the chances of a successful IVF pregnancy while others have suggested it may even block the spread of certain viruses.

Now, researchers at Oxford University have found that a daily aspirin tablet may help to prevent both bowel cancer and bowel cancer deaths.

The study followed over 14,000 patients for a period of 20 years.  The results, published in the current edition of The Lancet, show that low-dose aspirin reduced the risk of the incidence of bowel cancer by 24% and of dying from the disease by 35%.

“Aspirin taken for several years at doses of at least 75mg daily reduced long-term incidence and mortality due to colorectal cancer. Benefit was greatest for cancers of the proximal colon, which are not otherwise prevented effectively by screening with sigmoidoscopy or colonoscopy.” concluded the study authors.

The findings build on previous research on the issue and offer great hope for individuals with a high risk of bowel cancer, such as those with obesity or a family history of the disease.

One in 20 people in the US develops bowel cancer over their lifetime, making it the third most common cancer. Current figures from the National Cancer Institute indicate that there are more than 140,000 new cases of bowel cancer diagnosed in the US each year and more than 50,000 deaths.

Mark Flannagan, Chief Executive of Beating Bowel Cancer, said the study provided very positive findings.  “This was a big study over a long period of time and reinforces the message that aspirin may be important in significantly reducing the number of cases and deaths from bowel cancer.”

Aspirin is already one of the most widely used medications in the world.  An estimated 40,000 tons of it are consumed worldwide, each year.  SRxA’s Word on Health wonders just how much more will be sold as a result of this.

Let us know your thoughts.