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Abstract

AbstractNSAIDs stroke riskNSAIDs have been linked with an increased risk of stroke in an epidemiological study from The Netherlands (Arch Intern Med 2008;168: 1219‐24).Nine years' follow‐up of 7636 older persons (mean age 70) identified 807 strokes. The risk of stroke was significantly increased for current use of nonselective NSAIDs (hazard ratio 1.72 for all strokes) and COX‐2 selective NSAIDs (HR 2.75 for all strokes; HR 4.54 for ischaemic stroke). Increased risk was found for several individual NSAIDs but was statistically significant only for naproxen (HR 2.63) and the withdrawn rofecoxib (HR 3.38).HPV vaccine chosenThe DoH has chosen GlaxoSmithKline's Cervarix HPV vaccine for the national immunisation campaign beginning in September.Cervarix is a bivalent vaccine conferring immunity against HPV16 and 18, which account for 70 per cent of cervical cancers worldwide. Its competitor, Gardasil, is a quadrivalent vaccine additionally protecting against HPV6 and 11, which cause 90 per cent of genital warts.The procurement process assessed the vaccines against ‘a wide range of criteria such as their scientific qualities and cost effectiveness’. The DoH has not revealed what it will pay for Cervarix.Melatonin for insomniaLundbeck has introduced melatonin (Circadin) as monotherapy for the short‐term treatment of primary insomnia characterised by poor quality of sleep in patients who are aged 55 or over.The dose is 2mg once daily two hours before bed‐time and after food for three weeks. A course costs £10.77.Fesoterodine launchedPfizer has introduced feso‐terodine (Toviaz), a prodrug for tolterodine (Detrusitol), for the treatment of symptoms of overactive bladder. Treatment is initiated at a dose of 4mg per day and increased to 8mg per day according to response. The full therapeutic effect may not occur until after two to eight weeks; treatment should be re‐evaluated after eight weeks.A month's treatment at either dose costs £29.03, the same as sustained‐release tolterodine (Detrusitol XL).Intensive glycaemic control for T2D?Two large trials of intensive glycaemic control in patients with type 2 diabetes have conflicting implications for clinical practice.The ACCORD study (N Engl J Med 2008;358:2545‐9) found that treating patients at high CVD risk to a target HbA1c of <6.0 per cent was associated with a 22 per cent increased risk of death and no reduction in macrovascular end‐points compared with a target of 7.0‐7.9 per cent.The ADVANCE study compared treating to a standard (HbA1c 7.3 per cent) or low (HBA1c 6.5 per cent) target. More intensive glycaemic control significantly reduced microvascular end‐points, primarily due to a reduction in nephropathy. There was no difference in the risk of retinopathy or macrovascular end‐points.Nicorandil as ulcer causeThe potassium‐channel activator nicorandil (Ikorel) may be associated with gastro‐intestinal ulceration but is frequently overlooked as a possible cause, warns the MHRA in its latest Drug Safety Update (2008;1:Issue 11).Ulceration may affect any portion of the gastro‐intestinal tract from the mouth to the perianal area, and it is frequently severe and may cause perforation. Ulcers due to nicorandil are refractory to treatment and only resolve on withdrawal of the drug. Withdrawal should be carried out under the supervision of a cardiologist.• This issue of Drug Safety Update also includes an overview of safety issues with natalizumab (Tysabri) for multiple sclerosis.Atypical antipsychotics diabetes risk ‘small’The excess risk of diabetes due to treatment with an atypical antipsychotic is small compared with older anti‐psychotics, say UK researchers (Br J Psychiatry 2008;192:406‐11).Their meta‐analysis of 11 studies found that, compared with the use of first‐generation antipsychotics in patients with schizophrenia, the over‐all increased risk of diabetes with atypicals was 32 per cent. Risperidone was associated with lowest excess risk (16 per cent), followed by quetiapine (Seroquel) and olanzapine (Zyprexa; 28 per cent) then clozapine (39 per cent). Most studies had method‐ological limitations. Copyright © 2008 Wiley Interface Ltd