Used Alone, Drug May Worsen Asthma Attacks
A drug widely used by itself to treat asthma may actually worsen symptoms if not taken with other drugs, according to UC San Francisco researchers.
The drug is salmeterol xinafoate, sold as Serevent, from a class known as long-acting beta-agonists. It relieves asthma symptoms by dilating the airway and is generally recommended for use with inhaled steroids, but some doctors have begun prescribing it alone. That is not a good idea, according to the new study, because Serevent does not alleviate the underlying inflammation that is nearly always present in the airways of asthmatics, said Dr. Stephen Lazarus of UCSF.
In a study of 164 patients with mild to moderate asthma, reported in the May 23 Journal of the American Medical Assn., Lazarus and his colleagues found that patients using only Serevent had more asthma attacks and more inflammation than those using only an inhaled steroid. A second study of 175 patients in the same journal found that use of Serevent allowed patients with persistent asthma to cut their steroid doses in half without worsening the disease. But asthma control deteriorated significantly when they stopped using the steroids altogether. Both studies were sponsored by the National Institutes of Health.
Fast-Acting Drug Found to Aid Asthma Sufferers
A new form of the asthma drug montelukast given intravenously can resolve acute asthma crises in as few as 20 minutes, according to preliminary results presented last week at the American Thoracic Society meeting in San Francisco.
Dr. Carlos Camargo and his colleagues at Massachusetts General Hospital studied 201 patients with acute, severe asthma who visited the Mass General emergency room.
Half received standard therapy plus intravenous montelukast and half received standard therapy plus a placebo. Patients receiving the drug had lung improvement in about 20 minutes, while those receiving the placebo required 60 minutes or more. Montelukast is the active ingredient in Singulair--which is intended for prevention and treatment of chronic asthma--but researchers cautioned that the Singulair pills should not be used to treat asthma crises.
New Drug Reportedly Eases Crohn’s Disease
A new class of investigational drugs called alpha-4 integrin inhibitors can reduce the symptoms of Crohn’s disease, according to preliminary results presented last week at the Digestive Diseases Week meeting in Atlanta.
Crohn’s disease, which affects as many as half a million Americans, is caused by inflammation of the small intestine. It is marked by diarrhea, cramping, intense pain, fever and bleeding. The new drug, called Antegren, is a so-called monoclonal antibody designed to prevent immune cells from migrating from blood vessels to the site of inflammation.
A team headed by Dr. Paul Rutgeerts of the Universitaire Ziekenhuizen Leuven in Belgium studied 244 patients with moderate to severe Crohn’s disease. The patients were divided into four groups, which received either one of three different Antegren regimens or a placebo. They found that patients receiving the optimum dose of the drug had a 74% reduction in symptoms, compared with a 38% reduction in those receiving a placebo. Remission was achieved in 46% of the optimum-dose patients, compared with 27% in the placebo group. The drug must now undergo longer-term testing before it can be approved by the Food and Drug Administration.
Homespun Advice May Be True After All
“Feed a cold and starve a fever” may be good advice--if the fever is caused by a bacterial infection, according to Danish researchers who studied the effect of eating on the immune system.
Dr. Gijs Van Den Brink and colleagues at the Academic Medical Center in Amsterdam measured immune cell production of IFN-gamma (a measure of virus-fighting prowess) and IL-4 (a marker of bacteria-killing ability) in patients who either fasted or ate a liquid meal containing the caloric equivalent of a Big Mac and fries.
They reported last week at the Digestive Diseases Week meeting in Atlanta that, six hours after the meal, IFN-gamma production rose 450%. After overnight fasting, however, it fell to 83% of its normal level. In contrast, food intake produced a 42% increase in IL-4 levels, but fasting produced a 400% rise. Colds are caused by viruses.
Study Raises Alarm on Hypertension Drug
Heart patients taking the anti-hypertension drug Cardura should be aware that they are twice as likely to suffer heart failure as those taking the older drug chlorthalidone, according to a federal study. Although that fact has been known for more than a year, it has not been made widely known to patients and does not appear on the drug’s package insert, according to a class-action lawsuit filed on behalf of patients.
As part of a large trial of heart medications conducted by the National Institutes of Health, researchers compared Cardura to chlorthalidone in one arm. The arm was halted prematurely because of the increased incidence of heart failure, and patients were switched to chlorthalidone. It is not clear whether Cardura increases the risk of heart failure or chlorthalidone reduces it. But a spokesman for Pfizer, the drug’s manufacturer, said Thursday that there is no evidence that the drug itself causes heart problems.
Possible Treatment for Muscle Disease
Laboratory studies by University of Pennsylvania researchers suggest that vitamin B12 and folic acid could be beneficial to patients with spinal muscular atrophy, a rare genetic disorder marked by muscle weakness and wasting.
Most patients with the disorder die in infancy, but some don’t become reliant on wheelchairs until their 20s, and others can live relatively normally until later in life.
Biochemist Gideon Dreyfuss and his colleagues reported in the June Molecular Cell that both folic acid and vitamin B12 play a key role in a crucial intracellular pathway that is deficient in victims of the disorder. “We are not suggesting that this is a cure,” Dreyfuss said. “But it may help.”
Long-Lasting Insulin Available
A new form of long-lasting insulin that persists in the bloodstream for 24 hours is now available by prescription. The longest-acting insulin previously available persists for only 14.5 hours.
The new product is called insulin glargine and is trade-named Lantus. It was approved by the Food and Drug Administration in April but is just now reaching pharmacies. The drug is not meant to replace short-acting insulins, which provide a dose of the hormone at mealtimes, but rather to provide a continuous low dose of the hormone throughout the day.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
