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Abstract

AbstractHigher autism risk with valproate in pregnancy?Data from the north‐west of England suggest that use of sodium valproate during pregnancy is associated with an increased risk of autism spectrum disorders in infants (Neurology 2008;71: 1923–4).In a cohort of 632 children born between 2000 and 2006, 249 were exposed to an antiepileptic drug (AED) in early pregnancy. Ten children were diagnosed with autism, of whom seven were exposed to AEDs; four of these were exposed to valproate monotherapy and one to valproate plus lamotrigine. The incidence of autism in the control group was 0.9 per cent. The authors caution that their study was small and that the children are relatively young for a definitive diagnosis of autism.• The charity Epilepsy Action cautions many women with epilepsy are not receiving advice about AED use during pregnancy. Its evidence shows that 25 per cent of women who gave birth in the last five years did not receive preconception counselling and 68 per cent did not receive the joint care recommended by NICE. About 5000 women with epilepsy become pregnant each year.Pill over the counter?Pharmacies in south London will be supplying oral contraceptives without a prescription in a pilot scheme to start next summer (Pharm J 2008; 281:687).The DoH is keen to cut the number of unwanted pregnancies by increasing access to contraception. In a scheme planned by Southwark PCT, oral contraceptives will be supplied under a patient group direction. The RCGP said it would feel ‘more comfortable’ if GPs initiate supplies after taking a history, choosing a product and reviewing treatment options.MHRA safety concernsThe latest issue of the MHRA's Drug Safety Update (December 2008) includes warnings of the risk neurotoxicity associated with prolonged use of nitrous oxide, and progressive multifocal leucoencephalopathy with rituximab (Mabthera) and efalizumab (Raptiva).It also reminds prescribers that the tacrolimus brands Prograf and Advagraf have different dose schedules and are not interchangeable.Adding rituximab improves CLL survivalAdding rituximab (Mabthera) to standard chemotherapy increases median progression‐free survival in patients with chronic lymphocytic leukaemia (CLL) by 35–40 per cent, according to data presented at the Annual Meeting of the American Society of Hematology in San Francisco.Rituximab is a monoclonal antibody against the B‐cell protein CD20. The CLL8 trial in 817 previously untreated patients with CD20‐positive CLL showed that adding rituximab to treatment with fludarabine (Fludara) and cyclophosphamide increased progression‐free survival to 42.8 months compared with 32.3 months with chemotherapy alone. Complete remission rates were 52 and 27 per cent respectively.The REACH trial, in 552 previously‐treated patients, reported median progression‐free survival of 30.6 months with rituximab plus chemotherapy and 20.6 months with chemotherapy alone. Complete remission rates were 24 and 13 per cent.Tamsulosin POM to P?Consultations are underway on rescheduling tamsulosin to pharmacy‐only status under the brand Flomax Relief. Boehringer‐Ingelheim wants up to 10 weeks' supply at a dose of 400µg per day to be made available to men aged over 45 following a pharmacy assessment, continuing up to one year after confirmation of the diagnosis by a doctor.More data on fracture risk with glitazonesLong‐term treatment with rosiglitazone or pioglitazone doubles the risk of fracture in women with type 2 diabetes, say Canadian investigators (CMAJ 2009;180(1). DOI:10.1503/cmaj.080486).Their meta‐analysis comprised 10 RCTs and two observational studies. The overall odds ratio (OR) for fracture associated with at least one year's treatment was 1.45, but in five RCTs the OR was 2.23 for women and 1.00 for men. The observational studies showed a reduction in bone mineral density in the lumbar spine and hip, with a greater effect in women than men. The number needed to harm after one year's treatment was 55 for women aged 56 and 21 for women aged 72. Copyright © 2009 Wiley Interface Ltd