Preliminary research suggests people who suffered fatal cardiac arrest were more likely to have taken antidepressants and other psychiatric drugs than those who survived heart attacks.
But the findings haven’t been confirmed elsewhere, and it’s not clear whether the medications directly cause any problems. Those who take the drugs could have other medical issues that contribute to a higher death rate, the researchers noted.
“It is too early to give concrete advice” to patients who take the drugs, said study author Dr. Jussi Honkola, a researcher at the University of Oulu in Finland. “We need further studies about this possible relationship.”
In other words, there’s no indication that anyone needs to change the drugs that they take for conditions such as depression and anxiety.
At issue is sudden cardiac death — when someone dies suddenly and unexpectedly, often within minutes, after the heart stops functioning properly. Heart attacks can lead to cardiac arrest and then sudden cardiac death. But heart attacks are technically something else — the death of heart tissue because blood flow is disrupted.
A variety of conditions can cause sudden cardiac death, including the clogging of arteries caused by coronary heart disease.
And, “despite many years of intensive research we still don’t know how to identify people who are at risk for sudden cardiac death,” Honkola said.
In the new study, the Finnish researchers examined the medications taken by 321 victims of cardiac death compared with those taken by 609 patients who survived heart attacks.
The findings were to be released Thursday at the Heart Rhythm Society’s annual meeting, in Boston.
The study doesn’t reveal specifically which psychiatric drugs were examined, but it does say that those who died of cardiac death were more likely to have taken one of three types.
Almost 11 percent of those who suffered sudden cardiac death took antipsychotics, compared to 1.4 percent of those who survived heart attacks. The numbers for antidepressants were 7.4 percent and 3 percent, respectively, and 18.4 percent and 5 percent for benzodiazepines, which include drugs such as Xanax.
Those who survived heart attacks were more likely to take aspirin and the heart drugs known as beta blockers.
The findings “are interesting, even provocative, but much more work remains to be done in order to have a high degree of confidence in the results,” said Dr. Robert A. Harrington, director of the Duke Clinical Research Institute in Durham, N.C.
“For now, society should insist upon randomized clinical trials during and after the drug approval process that test therapies in patients who will likely take the drugs in ‘real life,’” Harrington said.
That means those who take part in tests of drugs represent those who ultimately take them when it comes to their medical conditions and the other drugs that they’re taking, he explained.
Friday, May 15, 2009
HPV: “Bad Virus” May Mean Better Prognosis for Throat Cancer
Human papillomavirus, or HPV, is a sexually transmitted virus that can wreak havoc in the body, causing genital warts and cancers of the cervix, anus, head, or neck, depending on where and what strain of the virus strikes.
Now a new study suggests that this “bad news” virus may actually be good news for people who already have cancers of the upper throat or back of the tongue. People with these types of tumors, known as cancers of the oropharynx, have a better chance of survival if the tumors contain HPV than if they don’t, according to a study released this week that is to be presented at the American Society of Clinical Oncology meeting later this month.
In fact, the difference is so substantial that researchers say that these types of tongue and throat cancers should be studied and treated as if they are two separate types of cancer—one probably caused by HPV and the other caused by other factors, usually prolonged use of cigarettes or alcohol.
The American Cancer Society says that more than 35,000 people in the United States were diagnosed with oral or oropharyngeal cancer in 2008, and more than 7,500 people died of the disease.
In the study, 64% of people with oropharyngeal cancer were found to have HPV-positive tumors, and these patients were about half as likely to die within five years of diagnosis as those with HPV-free tumors. This was true even after the researchers took into account six major factors that can affect survival, including treatment.
“HPV tumor status was found to be markedly associated with overall survival,” says lead author Maura Gillison, MD, PhD, professor of medicine, epidemiology, and otolaryngology at Ohio State University in Columbus. At two years, 88% of patients with HPV-positive tumors were alive compared to 66% for HPV-negative tumors.
In the study, the researchers looked at 323 people with oropharyngeal cancer who were treated with a combination of chemotherapy and radiation in the Radiation Therapy Oncology Group clinical trial. About 9% of patients with HPV-positive cancers went on to develop a second type of cancer, compared with 18.5% of patients with HPV-free tumors. (These types of second tumors are common in oropharyngeal cancer survivors.)
“This seems to be a well-conducted study and very insightful analysis,” says Douglas Blayney, MD, president-elect at the American Society of Clinical Oncology. “Now we have two kinds of oropharyngeal cancer that we’ve recognized—HPV-positive and non-HPV-associated cancers.”
Dr. Gillison says that HPV-related cancers are on the rise, and the virus is now the number one cause of throat cancer in the United States—more than smoking or alcohol.
“In the U.S., the proportion of the population that smokes has gone down over time; so has the per capita consumption of alcohol. The number of sexual partners has gone up over time,” she says. “The patient population that we’ve seen [in terms of oropharyngeal cancer] has completely changed over the last 10 years. I used to see almost exclusively smokers and drinkers and now it’s almost exclusively young patients with HPV-related cancers.”
She estimates that HPV causes 20,000 cancers each year, about half of them cervical cancer.
Although new HPV vaccines, such as Gardasil, are aimed at preventing cervical cancer, they may also protect against oral cancers, she says.
“There is reason to be optimistic that the HPV vaccine will prevent oral infections that lead to cancer. Most of the HPV-positive cancers are caused by HPV-16, and the vaccine covers this type,” she says. “There’s every reason to suspect that it will be effective, but of course that remains to be demonstrated.”
In the meantime, HPV testing may help determine what type of treatment should be used for individual oropharyngeal cancer patients.
“I think HPV status determination will be part of standard of care. Patients are starting to demand it because of its prognostic implications,” says Dr. Gillison. “It’s having a pretty profound impact on how we design clinical trials for head and neck cancer because of the profound difference in survival between the two groups.”
Now a new study suggests that this “bad news” virus may actually be good news for people who already have cancers of the upper throat or back of the tongue. People with these types of tumors, known as cancers of the oropharynx, have a better chance of survival if the tumors contain HPV than if they don’t, according to a study released this week that is to be presented at the American Society of Clinical Oncology meeting later this month.
In fact, the difference is so substantial that researchers say that these types of tongue and throat cancers should be studied and treated as if they are two separate types of cancer—one probably caused by HPV and the other caused by other factors, usually prolonged use of cigarettes or alcohol.
The American Cancer Society says that more than 35,000 people in the United States were diagnosed with oral or oropharyngeal cancer in 2008, and more than 7,500 people died of the disease.
In the study, 64% of people with oropharyngeal cancer were found to have HPV-positive tumors, and these patients were about half as likely to die within five years of diagnosis as those with HPV-free tumors. This was true even after the researchers took into account six major factors that can affect survival, including treatment.
“HPV tumor status was found to be markedly associated with overall survival,” says lead author Maura Gillison, MD, PhD, professor of medicine, epidemiology, and otolaryngology at Ohio State University in Columbus. At two years, 88% of patients with HPV-positive tumors were alive compared to 66% for HPV-negative tumors.
In the study, the researchers looked at 323 people with oropharyngeal cancer who were treated with a combination of chemotherapy and radiation in the Radiation Therapy Oncology Group clinical trial. About 9% of patients with HPV-positive cancers went on to develop a second type of cancer, compared with 18.5% of patients with HPV-free tumors. (These types of second tumors are common in oropharyngeal cancer survivors.)
“This seems to be a well-conducted study and very insightful analysis,” says Douglas Blayney, MD, president-elect at the American Society of Clinical Oncology. “Now we have two kinds of oropharyngeal cancer that we’ve recognized—HPV-positive and non-HPV-associated cancers.”
Dr. Gillison says that HPV-related cancers are on the rise, and the virus is now the number one cause of throat cancer in the United States—more than smoking or alcohol.
“In the U.S., the proportion of the population that smokes has gone down over time; so has the per capita consumption of alcohol. The number of sexual partners has gone up over time,” she says. “The patient population that we’ve seen [in terms of oropharyngeal cancer] has completely changed over the last 10 years. I used to see almost exclusively smokers and drinkers and now it’s almost exclusively young patients with HPV-related cancers.”
She estimates that HPV causes 20,000 cancers each year, about half of them cervical cancer.
Although new HPV vaccines, such as Gardasil, are aimed at preventing cervical cancer, they may also protect against oral cancers, she says.
“There is reason to be optimistic that the HPV vaccine will prevent oral infections that lead to cancer. Most of the HPV-positive cancers are caused by HPV-16, and the vaccine covers this type,” she says. “There’s every reason to suspect that it will be effective, but of course that remains to be demonstrated.”
In the meantime, HPV testing may help determine what type of treatment should be used for individual oropharyngeal cancer patients.
“I think HPV status determination will be part of standard of care. Patients are starting to demand it because of its prognostic implications,” says Dr. Gillison. “It’s having a pretty profound impact on how we design clinical trials for head and neck cancer because of the profound difference in survival between the two groups.”
Swine Flu Closes 3 Schools in NYC
In a troubling sign that the swine flu outbreak has yet to run its current course in the United States, three New York City public schools were closed Thursday after dozens of flu-like infections surfaced and an assistant principal was in critical condition on a ventilator, according to published reports.
New York Mayor Michael Bloomberg said four students and the assistant principal at a Queens middle school had documented cases of swine flu. More than 50 students have gone home sick with flulike symptoms. At another middle school in Queens, more than 200 students were absent Thursday, and dozens more were sick at an elementary school, The New York Times and the Associated Press reported.
The assistant principal reportedly had underlying health problems before he fell ill. The students who have taken sick in this latest round of infections seem to be experiencing mild symptoms, similar to routine flu, as has been the case for most people in the United States touched by the swine flu.
When the outbreak began more than three weeks ago, hundreds of students and staffers at St. Francis Preparatory School, also in Queens, were sickened. Reports at the time said several St. Francis students had spent spring vacation in Cancun, Mexico. Mexico is believed to be the source of the global outbreak that has now infected more than 7,000 people worldwide.
Meanwhile, vaccine manufacturers and other health experts met Thursday at the World Health Organization headquarters in Geneva, Switzerland, to plot potential strategies to combat the swine flu virus.
The AP reported that drug companies were ready to start producing a swine flu vaccine, but many questions remain. They include how many doses to produce, particularly in relation to needed doses of seasonal flu vaccine.
The expert group’s recommendations will be forwarded to the WHO’s director-general, Margaret Chan, who is expected to issue advice to vaccine manufacturers and the World Health Assembly next week, the AP said.
But at least one infectious-disease expert said it was a “foregone conclusion” that drug manufacturers would be told to proceed with a vaccine for swine flu, technically known as H1N1 flu.
“If we don’t invest in an H1N1 (swine flu) vaccine, then possibly we could have a reappearance of this virus in a mild, moderate, or catastrophic form and we would have absolutely nothing,” said Dr. David Fedson, a vaccine expert and former professor of medicine at the University of Virginia.
One factor complicating a decision is that most flu vaccine companies can only make limited amounts of both seasonal flu vaccine and pandemic vaccine, such as that needed for swine flu, and not at the same time. The producers also can’t make large quantities of both types of vaccine because that would exceed manufacturing capacity, the AP said.
On Thursday, the U.S. Centers for Disease Control and Prevention was reporting 4,298 U.S. cases of swine flu in 47 states, and three deaths. For the most part, the infections continue to be mild — similar to seasonal flu — and recovery is fairly quick.
The World Health Organization on Friday was reporting 7,520 cases in 34 countries.
The swine flu is a highly unusual mix of swine, bird and human flu viruses. Experts worry that, if the new flu virus mutates, people would have limited immunity to fight the infection.
The CDC is concerned with what will happen as this new virus moves into the Southern Hemisphere, where the flu season is about to start. The agency is also preparing for the virus’ likely return in the fall to the Northern Hemisphere.
Testing has found that the swine flu virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza, according to the CDC.
Earlier this week, U.S. health officials said they were seeing some complications among pregnant women as the swine flu continues to spread across the country, and that this high-risk group needs to take antiviral drugs as soon as infection is suspected.
“Pregnant women are at higher risk of complications of influenza, whether it’s the seasonal influenza or pandemics of the past. We are also seeing some severe complications in women with this year’s novel H1N1 virus,” Dr. Anne Schuchat, the CDC’s interim deputy director for science and public health program, said during a Tuesday teleconference.
The CDC was investigating 20 cases of pregnant women with the swine flu, several of whom experienced complications, Schuchat said. Complications can include pneumonia, dehydration and premature birth.
Doctors can be reluctant to treat pregnant women with antiviral drugs such as Tamiflu and Relenza, and pregnant women may be reluctant to take them out of fear that they may pose a risk during pregnancy, Schuchat said. “Experts who have looked into this situation strongly say that the benefits of using antiviral drugs to treat influenza in a pregnant woman outweigh the theoretical concerns about the drugs,” she said.
Of the three swine-flu-related deaths in the United States, one involved a 33-year-old pregnant woman from Texas who had other health problems before she was infected with the virus.
New York Mayor Michael Bloomberg said four students and the assistant principal at a Queens middle school had documented cases of swine flu. More than 50 students have gone home sick with flulike symptoms. At another middle school in Queens, more than 200 students were absent Thursday, and dozens more were sick at an elementary school, The New York Times and the Associated Press reported.
The assistant principal reportedly had underlying health problems before he fell ill. The students who have taken sick in this latest round of infections seem to be experiencing mild symptoms, similar to routine flu, as has been the case for most people in the United States touched by the swine flu.
When the outbreak began more than three weeks ago, hundreds of students and staffers at St. Francis Preparatory School, also in Queens, were sickened. Reports at the time said several St. Francis students had spent spring vacation in Cancun, Mexico. Mexico is believed to be the source of the global outbreak that has now infected more than 7,000 people worldwide.
Meanwhile, vaccine manufacturers and other health experts met Thursday at the World Health Organization headquarters in Geneva, Switzerland, to plot potential strategies to combat the swine flu virus.
The AP reported that drug companies were ready to start producing a swine flu vaccine, but many questions remain. They include how many doses to produce, particularly in relation to needed doses of seasonal flu vaccine.
The expert group’s recommendations will be forwarded to the WHO’s director-general, Margaret Chan, who is expected to issue advice to vaccine manufacturers and the World Health Assembly next week, the AP said.
But at least one infectious-disease expert said it was a “foregone conclusion” that drug manufacturers would be told to proceed with a vaccine for swine flu, technically known as H1N1 flu.
“If we don’t invest in an H1N1 (swine flu) vaccine, then possibly we could have a reappearance of this virus in a mild, moderate, or catastrophic form and we would have absolutely nothing,” said Dr. David Fedson, a vaccine expert and former professor of medicine at the University of Virginia.
One factor complicating a decision is that most flu vaccine companies can only make limited amounts of both seasonal flu vaccine and pandemic vaccine, such as that needed for swine flu, and not at the same time. The producers also can’t make large quantities of both types of vaccine because that would exceed manufacturing capacity, the AP said.
On Thursday, the U.S. Centers for Disease Control and Prevention was reporting 4,298 U.S. cases of swine flu in 47 states, and three deaths. For the most part, the infections continue to be mild — similar to seasonal flu — and recovery is fairly quick.
The World Health Organization on Friday was reporting 7,520 cases in 34 countries.
The swine flu is a highly unusual mix of swine, bird and human flu viruses. Experts worry that, if the new flu virus mutates, people would have limited immunity to fight the infection.
The CDC is concerned with what will happen as this new virus moves into the Southern Hemisphere, where the flu season is about to start. The agency is also preparing for the virus’ likely return in the fall to the Northern Hemisphere.
Testing has found that the swine flu virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza, according to the CDC.
Earlier this week, U.S. health officials said they were seeing some complications among pregnant women as the swine flu continues to spread across the country, and that this high-risk group needs to take antiviral drugs as soon as infection is suspected.
“Pregnant women are at higher risk of complications of influenza, whether it’s the seasonal influenza or pandemics of the past. We are also seeing some severe complications in women with this year’s novel H1N1 virus,” Dr. Anne Schuchat, the CDC’s interim deputy director for science and public health program, said during a Tuesday teleconference.
The CDC was investigating 20 cases of pregnant women with the swine flu, several of whom experienced complications, Schuchat said. Complications can include pneumonia, dehydration and premature birth.
Doctors can be reluctant to treat pregnant women with antiviral drugs such as Tamiflu and Relenza, and pregnant women may be reluctant to take them out of fear that they may pose a risk during pregnancy, Schuchat said. “Experts who have looked into this situation strongly say that the benefits of using antiviral drugs to treat influenza in a pregnant woman outweigh the theoretical concerns about the drugs,” she said.
Of the three swine-flu-related deaths in the United States, one involved a 33-year-old pregnant woman from Texas who had other health problems before she was infected with the virus.
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