New arthritis treatment
A new treatment for arthritis could save the NHS up to £700 million by cutting joint replacement operations, and because it offers a safe alternative to potentially dangerous painkillers, it could also save lives.
In 2012 total knee replacement operations in England alone cost the health service £691 million—while the direct cost of osteoarthritis to the NHS was over £5.2 billion. Tens of billions more are lost to the economy in indirect costs. But a new study has shown that the costs, both economic and human, could be far greater.
Research published this month in the BMJ found that commonly used painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs) can almost double the risk of developing an irregular heartbeat condition that could trigger a fatal stroke or heart failure.
About seven million people in the UK take prescription painkillers, including non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac and ibuprofen for arthritis pain management.
The long-term study of 8,423 adults aged 55 and over concluded that the drugs, which include ibuprofen, aspirin and naproxen, can increase the likelihood of developing atrial fibrillation (AF) by as much as 84%. Complications of AF include stroke, heart failure and death.
NSAIDs have previously been associated with potential risk of cardiovascular events, particularly in people with existing cardiovascular diseases. They have also been blamed for serious upper gastrointestinal adverse events, including bleeding, and kidney damage.
Of the study’s participants, those who had taken NSAIDs during the past 15 to 30 days had a 76% increased risk of AF, compared with those who had never taken NSAIDS. Those who had used them within the previous 30 days also had an 84% increased risk compared with those who never had.
The study’s lead author, Bruno Stricker, a professor of pharma-co-epidemiology at Erasmus University Medical Centre in Rotterdam, said NSAIDs had also been linked to coronary artery disease and heart attacks. “I would really strongly advise that older people be very careful with using these drugs,” Dr Stricker said. “They don’t do anything except relieve pain. Pain is a nuisance, but dying is a nuisance too.”
A spokesman for Arthritis Research UK said: “There is a real need for new painkillers for chronic conditions like arthritis without the unacceptable side-effects.”
A new treatment called Flexiseq treats a root cause of the pain rather than simply blocking the symptoms. The drug-free gel was launched in the UK in January. Commenting on the launch the Prime Minister David Cameron said “It was great to launch Pro Bono Bio during my trade mission to Moscow in 2011. And it is great that less than three years later this innovative treatment for osteoarthritis sufferers has now arrived in the UK.”
Developed using nano-physical science, Flexiseq is clinically proven to be as effective for pain management as celecoxib—but without any of the dangerous side-effects. Results from six separate clinical studies involving more than 4,000 patients found Flexiseq helps joint mobility and eases pain in those afflicted. One study of 1,300 patients in the UK found the treatment creates a natural lubricant for affected joints.
These studies also demonstrate the excellent safety profile of Flexiseq, and so the product can be used in patients at risk of the side effects of commonly used pain killers.
New breakthrough for breast and ovarian cancer risk
Cancer researchers at Queen’s University Belfast have made a breakthrough which could signal new treatments for women at high risk of breast and ovarian cancer.
Currently around one in 1,000 women in the UK carry what is known as a BRCA1 mutation. They have up to an 85% risk of developing breast cancer, and up to 40% risk of developing ovarian cancer, in their lifetimes.
Until now, preventive surgery —mastectomy (breasts) and oophorectomy (ovaries)—has been the only way of reducing the risk of developing both types of cancers.
The new discovery by researchers in Queen’s Centre for Cancer Research and Cell Biology (CCRCB) may mean women affected with BRCA1 could use drugs, which are already available, to reduce their risk of developing the disease, rather than undergo irreversible surgery. In turn, such treatments would open up the possibility of some of these women, who might otherwise have an oophorectomy, still being able to have children.
The new research by Dr Kienan Savage and Professor Paul Harkin at CCRCB proves there is a direct link between high levels of oestrogen and DNA damage, which causes cancer, in the breasts and ovaries.
Specifically, the scientists discovered that the cells of women with the BRCA1 mutation cannot effectively fight the very high levels of oestrogen that exist in all women’s breasts and ovaries, leaving them vulnerable to DNA damage.
While this link between oestrogen, breast/ovarian cancer and BRCA1 mutation has been suspected by the scientific community for years, it has not been proven until now.
Dr Kienan Savage, from the CCRCB, and who led the research, said: “This discovery is very significant in the management of women with the BRCA1 gene mutation. It’s the first really credible evidence that oestrogen is driving cancer in women with a BRCA1 gene mutation. Because of this discovery, we now have the opportunity to propose an alternative treatment to surgery. It also opens up the possibility of pausing treatment for a period in order for women to have children, if desired. What also makes this exciting is that there are drugs already on the market which turn off oestrogen production. In theory, we could use these drugs to chemically reduce oestrogen production in women which could negate the need for irreversible surgery.”
Chemotherapy for high risk bladder cancer improves survival
Contrary to treatment guidelines for high risk bladder cancer, chemotherapy before or after surgery is not commonly used in routine clinical practice. The findings are published early online in Cancer, a peer-reviewed journal of the American Cancer Society.
Clinical trials have shown that survival is improved in patients with muscle-invasive bladder cancer who are given chemotherapy before surgery. There is less evidence about whether chemotherapy after surgery also improves survival. To investigate the use of peri-operative chemotherapy in this disease, Christopher Booth, MD, FRCPC, of the Queen’s University Cancer Research Institute in Canada, examined records pertaining to all 2944 patients who had surgery for high risk bladder cancer in Ontario between 1994 and 2008.
Use of chemotherapy before surgery remained stable (an average of 4% of patients) over the study period, which is surprising given the evidence that this is a standard of care that has been demonstrated to improve survival. The use of chemotherapy after surgery increased over time: 16% of patients in 1994 to 1998, 18% in 1999 to 2003, and 22% in 2004 to 2008. Study results showed that use of chemotherapy after surgery was associated with better survival.
“Results from our study demonstrate that chemotherapy given after surgery improves patient survival—probably on the same order of magnitude as chemotherapy before surgery,” said Dr. Booth. “Patients having surgery for bladder cancer should have chemotherapy, either before or after surgery. Efforts are needed to improve uptake of this treatment, which appears to be vastly underutilised.”