[RESEARCH] Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials
Objective To determine the effect of adjunctive antithyroid drugs on the risk of treatment failure, hypothyroidism, and adverse events after radioiodine treatment.
Design Meta-analysis.
Data sources Electronic databases (Cochrane central register of controlled trials, Medline, Embase) searched to August 2006 and contact with experts.
Review methods Three reviewers independently assessed trial eligibility and quality. Pooled relative risks for treatment failure and hypothyroidism after radioiodine treatment with and without adjunctive antithyroid drugs were calculated with a random effects model.
Results We identified 14 relevant randomised controlled trials with a total of 1306 participants. Adjunctive antithyroid medication was associated with an increased risk of treatment failure (relative risk 1.28, 95% confidence interval 1.07 to 1.52; P=0.006) and a reduced risk for hypothyroidism (0.68, 0.53 to 0.87; P=0.006) after radioiodine treatment. We found no difference in summary estimates for the different antithyroid drugs or for whether antithyroid drugs were given before or after radioiodine treatment.
Conclusions Antithyroid drugs potentially increase rates of failure and reduce rates of hypothyroidism if they are given in the week before or after radioiodine treatment, respectively.
Diabetes drugs and pregnancy: the Good, the Bad, the Ugly
I just read that the US Food and Drug Administration (FDA) has announced that it is re-classifying the drug NovoLog to allow its use by women with Type 1 diabetes who are pregnant. NovoLog is manufactured by drug-producing giant Novo Nordisk. The change came after a trial which found that pregnant women with T1 diabetes who took NovoLog had HbA1c levels and rates of maternal hypoglycemia comparable to women on regular insulin. The study did not, however, evaluate whether babies whose moms take the drug while pregnant have a greater risk of congenital malformations. On the other hand, women taking NovoLog benefited from a lower risk of diabetes-related pregnancy dangers such as preterm delivery.Pregnancy and drugs. It's a complicated issue. What's safe? What's not? If only it were so simple as dividing all drugs into one category or the other - the Good or the Bad. Unfortunately, many common medications are in a third category - the Ugly? These drugs, known as category B drugs, constitute a sort of pharmaceutical no-man's land. You see, these meds have not been proven to cause harm to unborn children, like category C drugs. Yet they have not been proven safe, either, like category A drugs. This means, as I discovered when I was pregnant in 2006, if you're sick and could benefit from some specific No-Man's-Land drug, odds are your doc will offer to write you a prescription for it. He or she will warn you that it's possible the drug causes harm and leave the decision of whether or not to take it up to you. Now, I don't want to go back to the Bad Old Days when doctors told patients "do this" or "do that," "take this" or "take that," and, by golly, you did it and didn't ask questions. But wouldn't it be nice to just know what to do? Or to know that your doc knows all the answers? What's a gal to do??
Fishing for Drugs
Filed under: Type 2, Adult Onset, Drugs, Research, Daily News
A Harvard Medical School scientist's experiments with fish discarded along the coast near Boston have led to a new class of diabetes drugs. The latest, from Novartis, may get U.S. approval this weekIn the late 1970s, Habener, a doctor specializing in diabetes care, began buying discarded fish to learn about the ways animals controlled blood sugar. By 1987 Habener discovered a protein in the pancreas of anglerfish that tells the pancreas to produce insulin. He called it glucagon-like peptide-1, or GLP-1. In 1995, researchers uncovered another use for Habener's discovery to treat diabetes. The scientists found an enzyme that digests GLP. By blocking the enzyme, they could increase the body's reserves of GLP, thereby raising insulin levels. Twenty years later, we will soon have the pleasure of meeting Novartis' concept for this chronology of discoveries in the form of liraglutide.
In clinical trials, patients taking liraglutide attained normal blood sugars without the common side effect of weight gain. In fact, liraglutide was more likely to make the patients slightly leaner. Depending on dosage and length of treatment, it may help patients to lose weight. The drug does not cause a change in appetite. Furthermore, none of the liraglutide patients experienced episodes of low blood sugar levels throughout the trials.
I'm no fisherman, but if all the seagulls of Big Pharma are swarming overhead - there's bound to be a school of fish below. However, this school is quite competitive. At last count, the five largest diabetic drug makers are using Habener's findings to create new medicines.
Blood thinner-statin combination may be safe after all
When it comes to prescribing medicine to someone with more than one medical condition, I'm certain that physicians must be very careful to prescribe right combination of medicines and to be sure that those medicines don't interact with each other. Until recently, it was thought that when heart patients took the anti-clotting drug clopidogrel with a statin to lower their cholesterol, they increased their risk of a dangerous interaction. But recent studies have been leading researchers and heart doctors to believe that the danger isn't significant after all. This is a relief to patients and those who treat them, because many who need anti-clotting drugs also should be taking statins.To hear more about the study's specifics, read this article from HealthDay.
A link between Cholesterol and Cancer ... and it's not what you think
Filed under: Drugs
Having low cholesterol will improve your chances against heart disease and other heart problems, but it appears that very low cholesterol has a bad side too -- it's been linked to cancer, according to a new study.The findings come out of a study that was measuring the amount of damage that statins--a type of cholesterol medication that includes the brand names Lipitor, Pravachol and Zocor--had on other organs in the body, including the liver. However, if you're on statins, there's no need to worry just yet. It's thought the risk is fairly minimal and researchers will have to investigate further to determine more information.
Glaxo shares up despite Avandia mess
Filed under: Type 2, Drugs, Research, Complications
Oh, this is awesome news for anyone touched by the Avandia mess: manufacturer GlaxoSmithKline (GSK) has announced that its shares are up despite its troubles over the diabetes drug Avandia. The scandal arose over revelations that Avandia could cause heart problems. Things only escalated as details came to light, particularly the role of the US Food and Drug Administration and its completely inadequate response to the problem.Given all this bad publicity, wouldn't you expect GSK's stocks would take a dive? Well, they did during the quarter that Avandia hit the news. However, the company's overall outlook for the year 2007 still looks pretty darn good, apparently. As a result, projections for earnings-per-share remain stable and the company is expanding its share buyback program.
So much for suffering the consequences of your actions... On the other hand, GSK has vigorously defended Avandia against claims of heart damage. They would say: "Why should we suffer? We haven't done anything wrong."
Does your doctor take side-effects seriously?
Filed under: Drugs
A recent study has come up with some results that don't bode so well for doctors: it seems more often than not they "write off" concerns expressed by their patients regarding medication side-effects. The study included 650 adults who believed they were experiencing adverse drug reactions related to their cholesterol meds, and the majority of their doctors blew off the concerns and denied the possibility that the symptoms and the medications could be connected. This trend rings true even for the most commonly seen side-effects for the most commonly prescribed drugs -- what's up with that?The study wasn't designed to find out why this happened, just that it does. Some experts guess that it's simply because there are no laws (and no way to regulate) that doctors learn the side-effects of every medication they prescribe.
So I guess it's up to you, as the patient, to educate yourself and make sure you have a doctor who listens.
Should you have surgery?
Filed under: Prevention, Drugs, Surgery
Should you have angioplasty? That decision lies between you and your doctor, but according to this article, drugs may work as well as the popular procedure at unblocking clogged arteries. In fact, angioplasty is one of five surgeries the author thinks most people should avoid. Others include hysterectomy, lower back surgery, and heartburn surgery. Instead, the author suggests non-surgical alternatives that may work as well or better than surgery.The angioplasty vs. drug debate is one that's been in the headlines for a while, and a quick Google search turns up enough conflicting findings to make a person's head spin. But before you go under the knife for any procedure, it's worth your time to investigate alternatives and make sure you're making the best choice for your health, whatever that decision may be.
Accidental Diabetes Drug
Filed under: Type 2, Adult Onset, Drugs, Research
Much like a roadblock, but with a fortuitous outcome -- an experimental heart drug didn't achieve the primary goal of a late-stage trial but it did dramatically reduce the risk patients would develop diabetes.
The anti-oxidant, anti-inflammatory drug, the first of its kind, reduced the risk of developing diabetes by 64% and demonstrated a small but statistically significant reduction in blood sugar after 12 months. The study included data from 6,144-patients. The company believes this finding to be a serendipitous outcome, despite the initial shortcomings of the trial objective. They need to confirm it in a large clinical trial. The impressive diabetes results may come as a surprise to investors who have abandoned AtheroGenics or who have been betting the drug will fail.
Heart patients in the study received either 300 milligrams of the drug or a placebo on top of a host of standard-of-care medicines they were already taking, such as aspirin, cholesterol-lowering statins, blood thinners and/or diabetes medicines.
The drug had an undesirable impact on blood fats, raising bad LDL cholesterol by about 12% and lowering good HDL cholesterol by roughly the same amount. There were also some potentially troubling safety signals with a trend toward more heart failure in those taking the drug. In spite of the undesirable affects on blood lipids, the drug has a profound effect on diabetes. Further research will be conducted on the efficacy of this drug in reducing the risk of developing diabetes.
Medications that cause high blood sugar
Filed under: Type 1, Type 2, Childhood, Adult Onset, Drugs, Research, Support
Several commonly used drugs have adverse effects on glucose metabolism. Among these drugs are: aspirin, and an antibiotic.
Aspirin is a commonly used drug to relieve minor aches and pains, to reduce fever, as an anti-inflammatory and as a blood-thinner. However, studies show it leads to glucose metabolism impairment in insulin-sensitive tissues. A 3g daily dose of aspirin was administered over a three-day period. Although insulin release increased after the aspirin, the glucose remained unchanged. Despite the increased insulin, the body seemed to decrease cellular sensitivity to insulin in the aftermath of aspirin.
A healthcare facility in Scottsdale, AZ advises doctors to avoid giving gatifloxacin to patients with diabetes. They suggest selecting an antibiotic other than a fluoroquinolone for an elderly patient with diabetes, especially those taking sulfonylureas. Beyond elderly diabetics, any person who has recently undergone treatment with an antibiotic in the fluoroquinolone family should raise questions if they are diagnosed with diabetes or deemed pre-diabetic. Drugs included in this family are: Cipro, Ciproxin, Enroxil, Penetrex, Megalone, Maxaquin, Noroxin, Quinabic, Janacin, Floxin, Oxaldin, and Tarivid.