Drug Topics - November 24, 2008 - (Page 3) Clinical MEETINGS/CONFERENCES Fred Gebhart, Contributing Editor Advances in bone disease treatment reported at ACR gathering Do you have patients on long term glucocorticoids such as prednisone for arthritis, asthma, COPD, or some other chronic condition? They are likely at risk for osteoporosis. And that risk is likely not being addressed. One percent of the U.S. population is on chronic glucocorticoids, said Dr. Kenneth Saag, professor of medicine and epidemiology, University of Alabama, Birmingham. Long-term steroid therapy is the second most common cause of osteoporosis after postmenopausal bone mineral density loss. “The bulk of patients are not receiving treatment for osteoporosis when they are on chronic steroid therapy,” he reminded the American College of Rheumatology (ACR) Scientific Sessions meeting in San Francisco. “They should be. We have found that an alChad Deal, Cleveland Clinic ternative treatment is as effective as alendronate (Fosamax, Merck). The alternative agent, teriparatide (Forteo, Lilly), is one of several positive reports on arthritis-related bone disease released at ACR. A head-to-head trial of Forteo versus Fosamax in patients on glucocorticoids for three months or longer found that Forteo is significantly more Nancy Lane, UC Davis Aging Center effective in boosting BMD at the lumbar spine and femoral neck. Both are common fracture sites for chronic glucocorticoid patients. Patients taking Forteo also suffered significantly fewer vertebral fractures. Both drugs were equally well tolerated, Saag said. The rate of nonvertebral fractures were similar in both arms of the 36-month study. Similar results from the first 18 months of data were published in the New England Journal of Medicine in 2007. “Glucocorticoid-induced osteoporosis is commonly undetected,” Saag said. “Even when considered, it is often undertreated. This study suggests that teriparatide is an additional treatment option for chronic glucocorticoid users at high risk of fractures.” On the biologic side, the investigational agent denosumab was significantly more effective than Fosamax at increasing BMD in postmenopausal women during a 12-month randomized controlled trial. The denosumab group also showed significantly lower levels of bone resorption markers. The agent is a human monoclonal antibody that binds to the receptor for RANKL, a protein that modulates the activity of osteoclasts, which resorb bone. Blocking RANKL inhibits osteoclast activity, which reduces bone resorption and allows osteoblast activity to rebuild BMD. “This study showed that denosumab is superior to Fosamax in terms of BMD and reduced bone turnover markers,” said lead researcher Dr. Chad Deal, head of the Center for Osteoporosis and Metabolic Bone disease at the Cleveland Clinic. “There are also practical issues favoring denosumab.” Denosumab is given as a subcutaneous injection every six months. That could boost treatment adherence compared to Fosamax, an oral agent taken weekly, Deal said. A new biologic, Puricase (pegloticase, Savient Pharmaceuticals) may emerge as the first new agent to treat gout in more than 40 years. The PEGylated recombinant mammalian uricase reduces the concentration of uric acid responsible for the searing pain of severe gout. “Most gout patients do well with allopurinol (Zyloprim, Prometheus Laboratories), said Dr. John Sundy, PhD, associate professor medicine, Duke University Medical Center, Durham, NC. “But there is a subset of about 50,000 patients who don’t respond or who can’t tolerate allopurinol. These are the patients who need a new therapeutic option.” Puricase is being developed as an orphan drug, Sundy PHOTOGRAPHY: FRED GEBHART W W W.D R U GTO P I C S .C O M N OV. 24, 2008 DRUG TOPICS 3 http://WWW.DRUGTOPICS.COM
Table of Contents Feed for the Digital Edition of Drug Topics - November 24, 2008 Drug Topics - November 24, 2008 Contents Advances in Bone Disease Treatment Reported at ACR Gathering APHA Taps New VP, CEO FDA Deaths from Prescription Drugs on the Rise Drug Topics - November 24, 2008 Drug Topics - November 24, 2008 - Contents (Page 1) Drug Topics - November 24, 2008 - Contents (Page 2) Drug Topics - November 24, 2008 - Advances in Bone Disease Treatment Reported at ACR Gathering (Page 3) Drug Topics - November 24, 2008 - APHA Taps New VP, CEO (Page 4) Drug Topics - November 24, 2008 - Deaths from Prescription Drugs on the Rise (Page 5)
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