Coxibs, NSAIDs, and Heart Attack Risk
The risk of heart attack in patients with arthritis is modestly increased with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors (Coxibs) at high doses, which suggests that they should be used on the basis of their relative gastrointestinal and cardiovascular safety profiles rather than the selectivity of their class.
A study out of Stanford University School of Medicine investigated the risk of acute myocardial infarction in 650,590 patients over 18 years of age diagnosed with arthritis and treated with NSAIDs or selective COX-2 inhibitors between January 1999 and June 2004.
The researchers found that many of the NSAIDs increased the probability of heart attacks: indomethacin (Indocin)-71%, sulindac (Clinoril)-41%, and ibuprofen-11%. Among the coxibs, rofecoxib (Vioxx) increased the risk by 32% and celecoxib (Celebrex) by 9%. Noncoxib NSAIDs increased the risk of acute myocardial infarction by 12%, while rofecoxib was the only coxib that had a significantly increased risk of heart attacks compared to noncoxibs.
The risk of heart attack appeared to be dose-dependent. Rofecoxib, for example, increased the risk from 16% at daily doses of 12.5 mg to 240% at daily doses over 50 mg.
Limited Use of Nesiritide Suggested
A panel of heart experts recently recommended limiting the use of the heart drug nesiritide (Natrecor) until the manufacturer, Johnson and Johnson, conducts additional clinical trials. The company had asked the panel to evaluate all data on the heart failure drug after reports began to circulate claiming that it increased the rate of kidney failure and death.
The panel said use of the drug should be strictly limited to severely ill congestive heart failure patients who are hospitalized. The drug should not be used for patients who are not hospitalized and should not be used to improve kidney function. The panel also suggested that Johnson and Johnson create educational programs for clinicians to learn the drug's appropriate uses.
Alternative Uses for Viagra
Sildenafil (Viagra), normally used to treat erectile dysfunction, can be used to treat certain other rare diseases.
The newly Food and Drug Administration-approved drug Revatio contains sildenafil, the main ingredient of Viagra, and is used to treat pulmonary hypertension. Clinical trials found that Revatio causes minor side-effects similar to those of Viagra, including headache and flushing.
Sildenafil may also help treat childhood pulmonary arterial hypertension, a serious heart-lung condition with a high mortality rate. The current treatment is prostacyclin, which must be mixed daily by the parents and administered continuously through an infusion pump.
In a small study, patients ages 5 to 18 were given age-appropriate doses of sildenafil for 1 year. At the end of the study, the children could walk significantly further, had reductions in pulmonary vascular resistance, and could breathe more comfortably. Most of all, the side effects were minimal and the drug was easy to take. This study must be repeated on a larger group to be confirmed.
Biofilms Cause Otitis Media
A new study, presented recently at the American Society of Pediatric Otolaryngology (ASPO) annual meeting in Las Vegas, confirms that otitis media is caused by drug-resistant bacterial conglomerations called biofilms. Biofilms are bacteria attached to a surface and sheathed by a protective material.
Otitis media, more commonly referred to as middle ear infection, is one of the most diagnosed illnesses in American children, second only to the common cold. It is also the most common reason for pediatric surgeries requiring general anesthesia and for prescribing antibiotics for children.
This study examined nine children with otitis media. Forty-four percent of them had biofilm formations, and 44% had microscopic evidence indicating biofilm formations. Since biofilms are resistant to antibiotics, these findings will cause researchers to rethink current therapies and develop new ones.