Pharmacy & Therapeutics - February 2009 - (Page 105)

NEW DRUGS continued from page 76 DRUG NEWS of hysterectomies among women in the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial. In a retrospective analysis from Great Britain and Germany, 34% of 1,057 women taking tamoxifen (Nolvadex, AstraZeneca) for localized early breast cancer were experiencing adverse events, such as vaginal hemorrhage and leukorrhea, compared with 21% of 3,092 women taking the company’s anastrozole (Arimidex). Pain, vaginal hemorrhage, and leukorrhea were investigated more often in the tamoxifen group, leading to more interventions. Twice as many women using tamoxifen under went oophorectomies (50 vs. 23), and 102 (5%) women taking tamoxifen had hysterectomies, compared with 26 (1.3%) of women taking anastrozole. In both groups, almost 75% of the hysterectomies were related to benign diagnoses. Most of the gynecological adverse events took place in the first three years. The researchers suggest that this highlights the risks of adopting a sequencing strategy, prospectively initiating tamoxifen with the intention to switch to a nonsteroidal aromatase inhibitor at two to three years. The results of their analysis, they conclude, corroborate the wealth of evidence provided by the ATAC trial showing that anastrozole is the more effective and better-tolerated treatment. The data also support the use of anastrozole as an initial therapy for postmenopausal women with localized hormone receptor–positive breast cancer. Source: Am J Obstet Gynecol 2009;200: 80.e1–80.e7 tiple mechanisms might be at work. Estrogen therapy, for instance, may increase collagen turnover and weaken the structure of the connective tissues supporting the urethra. Moreover, the researchers note, hormone therapy is associated with neurovascular disease, which could affect bladder innervation and increase the risk of urge urinary incontinence. Source: Am J Obstet Gynecol 2009;200: 86.e1–86.e5 docarditis and three cases of osteomyelitis. Three of the four complications were detected within one week, suggesting that they would have occurred regardless of treatment strategy. Source: Am J Kidney Dis 2008;53: 107–111 Low-Dose Aspirin Doesn’t Prevent Diabetes Subclinical inflammation has been linked to the development of type-2 diabetes, and some research indicates that women might be at a higher risk. Thus, the thinking goes, long-term, low-dose aspirin might help prevent diabetes among women; however, researchers at Brigham and Women’s Hospital and Harvard Medical School say the data don’t support that hypothesis. They evaluated data on 38,716 women in the Women’s Health Study, a 10-year, placebo-controlled trial of aspirin (100 mg on alternate days) and vitamin E for the primary prevention of cardiovascular disease and cancer. No statistically significant difference was noted in the incidence of type-2 diabetes. Among 19,326 women assigned to receive aspirin, 849 developed diabetes, as did 847 of 19,390 women in the placebo group. The researchers caution that their findings do not pertain to the salicylate agents currently being evaluated for diabetes treatment or to intermediate or high doses of long-term aspirin. However, even at the low dose used in this trial, the use of aspirin was associated with a significant increase in clinically important bleeding events. Source: Diabetes Care 2009;32:3–8 Locking Out Bacteria An antibiotic lock allowed catheters to be salvaged in 61% of hemodialysis patients with Enterococcus catheterrelated bacteremia (CRB) in a study at the University of Alabama, Birmingham. In a previous study evaluating antibiotic locks, the researchers had treated 12 hemodialysis patients with vancomycin-sensitive Enterococcus CRB with three weeks of systemic vancomycin and gentamicin therapy in conjunction with a vancomycin-gentamicin-heparin catheter lock. In that study, Candida species grew in five patients, according to blood cultures taken one week after completing the antibiotic course. The researchers speculated that this complication was a consequence of prolonged exposure to broad- spectrum antibiotics. They subsequently revised the protocol to use vancomycin alone with a vancomycin– heparin lock. Their current study evaluated that protocol in 64 patients with vancomycin-sensitive Enterococcus CRB. The earlier study showed a treatment success rate of only 40%, with a higher rate of serious complications (10%). By contrast, in the new study, 10 patients had persistent fever; their infected catheters were removed. Fever resolved in another 15 patients, but bacteremia recurred. In all, 39 patients had clinical cure. Serious complications developed in four of the patients—one case of en- Is Anastrozole (Arimidex) Safer than Tamoxifen (Nolvadex) in Breast Cancer? Tamoxifen causes significantly more gynecological adverse effects than anastrozole—nearly quadrupling the number NIH NEWS Device Predicts Colorectal Cancer Risk Researchers at the National Cancer Institute (NCI) have developed an online tool for calculating colorectal cancer risk in men and women 50 years of age and Vol. 34 No. 2 • February 2009 • P&T® 105

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Pharmacy & Therapeutics - February 2009 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Pushing an Expanded Role for Pharmacists Better Asthma Management with Advanced Technology Pharmaceutical Approval Update 58th Annual Meeting, American Society of Human Genetics, 2008 American Society of Hematology, 50th Annual Meeting and Exposition 2008 San Antonio Breast Cancer Symposium Stahl’s Essential Psychopharmacology, 3rd Edition Author Guidelines

Pharmacy & Therapeutics - February 2009

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