| Tuesday, July 04, 2006 |
| Gabapentin Cools Hot Flashes As Well As Estrogen |
University of Rochester researchers, who have been investigating new therapies for hot flashes for several years, report in the July Obstetrics and Gynecology journal that the seizure drug gabapentin is as effective as estrogen, which used to be the gold standard treatment for menopause symptoms.
Estrogen is no longer the preferred therapy because recent, large studies have shown that the hormone increases the risk of heart disease, stroke, breast cancer and Alzheimer's disease for some women. Given that news, millions of women have abandoned hormone replacement therapy (HRT) and are seeking other ways to ease symptoms. So-called natural remedies such as soy, herbal products or acupuncture have not proven safe or effective at this point.
The latest Rochester study is the first to compare gabapentin and estrogen head-to-head against a placebo. Although it showed a substantial placebo effect similar to other menopause studies - women taking the sugar pill reported a 54-percent reduction in hot flashes - the women taking gabapentin and estrogen reported even better results, with a 71 percent to 72 percent decline in symptoms.
"Gabapentin does appear to be as effective as estrogen," said lead author Sireesha Y. Reddy, M.D., assistant professor of Obstetrics and Gynecology at the University of Rochester Medical Center. "Until now its efficacy relative to estrogen was unknown."
Approximately 75 percent of postmenopausal women between the ages of 35 and 60 experience hot flashes. Gabapentin (sold under the trade name Neurontin) was approved by the FDA in 1994 to treat epileptic seizures but has been used off-label for years to treat headaches, shingles pain and other ailments. Scientists hypothesize that gabapentin may reduce hot flashes by regulating the flow of calcium in and out of cells, which is one mechanism for controlling body temperature.
An expert panel on menopause convened by the National Institutes of Health last year cautioned against the tendency to use treatments with scant safety data, and concluded that nothing to date was as effective as estrogen therapy although more research was needed.
In the latest study, Reddy and colleagues enrolled 60 women in a randomized, double-blind, placebo-controlled trial for 12 weeks. Initially the researchers received more than 1,500 calls from women who wanted to participate, but after screening the callers to meet the study's protocol, the number was whittled to 60, with 53 women complying with every step.
They were randomly divided into three groups: 20 women received gabapentin at 2,400 mg per day and a daily placebo or fake estrogen pill; 20 received estrogen in the form of Premarin at 0.625 mg per day and a fake gabapentin pill; 20 received sugar pills resembling gabapentin and estrogen. The women recorded the frequency and severity of their hot flashes in diaries.
Results were tabulated using two statistical methods to compare the women's hot flash reports throughout the 12-week period with their baseline symptoms. Doctors did find that women who took gabapentin complained more often of headaches, dizziness or disorientation. Researchers believe that slowly ramping up the medication and taking it with meals can alleviate the side effects.
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The NIH funded the study. Pfizer Inc. supplied gabapentin but had no role in the research. A co-author on the paper, Thomas Guttuso Jr., M.D., has a patent for the use of gabapentin in the treatment of hot flashes. Guttuso is a former neurologist at the University of Rochester who is now on the faculty at the University of Buffalo.
Contact: Leslie Orr
University of Rochester Medical Center |
| posted by Jennie Tate @ 5:08 AM |
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| Monday, July 03, 2006 |
| Effects Of Calcium On Weight Maintenance Among Middle-Aged Adults |
Increased total calcium intake in the form of supplements can help middle-aged adults maintain their weight over a number of years, with particular benefits to women, according to researchers at the Fred Hutchinson Cancer Research Center in Seattle.
The study looked at relationships between calcium and weight change over an eight-to-12-year period among more than 10,000 men and women in their mid-50s. Previous studies have found connections between calcium intake and people's body mass index, but those studies focused on calcium in food, not supplements, according to the researchers.
The study examined people's intakes of dietary calcium, supplemental calcium and total calcium (supplements plus diet) to discover which forms of calcium were associated with weight change. The researchers found "dietary calcium alone had no significant effect on 10-year weight change," but that women who took calcium supplements saw some improvement.
"Although more evidence from randomized clinical trials is needed before calcium supplements can be recommended specifically for weight loss, this study suggests that calcium supplements taken for other reasons (e.g., prevention of osteoporosis) may have a small beneficial influence on reducing weight gain, particularly among women approaching midlife."
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Contact: Julia Dombrowski
American Dietetic Association |
| posted by Jennie Tate @ 7:05 AM |
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| Saturday, July 01, 2006 |
| Smoking And Obesity May Increase The Risk Of Erectile Dysfunction |
A prospective study by researchers from the Harvard School of Public Health (HSPH) has found that obesity and smoking are strongly associated with a greater risk of erectile dysfunction (ED). Meanwhile, regular physical activity appeared to have a significant impact on lowering the risk of ED. This is the first large-scale prospective study to examine the links between ED and smoking, obesity, alcohol and a sedentary lifestyle. The study will appear in the July 2006 issue of The Journal of Urology.
The researchers, led by Constance Bacon, a former post-doctoral fellow at HSPH, and Eric Rimm, associate professor of epidemiology and nutrition at HSPH, surveyed 22,086 healthy subjects between the ages of 40 and 75 from the Health Professionals Follow-up Study who reported good or very good erectile function and no major chronic disease before 1986. Among the participants, 17.7 percent (3,905) reported new onset of ED between 1986 and 2000. The researchers adjusted the results to take into account those with and without prostate cancer during the follow-up period, since prostate cancer treatments, such as radiation or surgery, may lead to ED.
The results showed that both smoking and obesity were associated with a higher risk of the development of ED among previously healthy men with good erectile function. The researchers also found that regular physical activity showed a strong inverse association with ED risk. "We found a 2.5-fold difference in risk of ED when we compared obese men who did little exercise with men who were not overweight and averaged 30 minutes of vigorous exercise a day. (Obesity was defined as a body mass index of more than 30 kilograms in weight divided by the square of height in meters.) For men younger than 55 there was a 4-fold difference in risk for the same comparison," said Rimm. Alcohol consumption did not increase the risk of ED. In general, men without prostate cancer showed stronger associations with these lifestyle factors than those with prostate cancer.
These results suggest that ED and coronary heart disease may share many of the same risk factors. Rimm said the results should encourage men to follow a more healthy lifestyle. "Many men may choose not to change to a healthier lifestyle, which includes exercise and a prudent diet, because they perceive heart disease as something that may only develop decades in the future. Hopefully, these results will help to motivate men to adopt a more active lifestyle to avoid a problem which may be more immediate," he said.
(The Health Professionals Follow-Up Study was launched in 1986 to examine diet and chronic disease among male health professionals in the U.S.)
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The study was supported by Pfizer, Inc., and by grants from the National Institutes of Health.
Contact: Todd Datz
Harvard School of Public Health |
| posted by Jennie Tate @ 10:59 AM |
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| New Insights Into The Impact Of Pregnancy On Inflammatory Arthritis |
During pregnancy, women with inflammatory arthritis usually experience disease improvement or even remission, while a disease flare regularly occurs within 3 to 4 months after delivery. A study featured in the July 2006 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis) sheds light on this widely reported yet little understood phenomenon.
Prenatal diagnostic tests have recently established that fetal cells and cell-free DNA routinely flow into the mother's bloodstream during normal pregnancy. On the strength of these findings, researchers in Seattle, Washington, supported in part by a grant from the Washington Women's Foundation and by grants from the National Institutes of Health, set out to investigate whether changes in serum fetal DNA levels correlate with changes in arthritis activity during and after pregnancy. They conducted a study on 25 pregnant women with inflammatory arthritis.
Ranging in age from 23 to 43, 17 of the women were classified as having adult-onset rheumatoid arthritis (RA) and 6 were classified as having juvenile idiopathic arthritis (JIA). Of the subjects, 24 had active disease in the 6 months prior to pregnancy, with one experiencing RA onset in her first trimester. 7 of the women were in their first pregnancy, 7 were in their second pregnancy, and 11 had been pregnant at least twice before. None of the patients took a disease-modifying antirheumatic drug during pregnancy, and patients taking prednisone took no more than 10 milligrams per day, with one exception. All pregnancies resulted in a single live birth.
Samples of peripheral venous blood were taken from all subjects, most 3 times or more during the course of pregnancy, as well as postpartum, within 3 months of delivery. Levels of cell-free fetal DNA were measured using real-time quantitative polymerase chain reaction targeting the fetus-specific genetic markers. Women were evaluated for changes in disease activity in each trimester and 3 to 4 months after giving birth.
During pregnancy, 21 of the 25 women - 79 percent of the RA patients and 100 percent of the JIA patients - experienced improvement or remission of inflammatory arthritis symptoms. Among these women, 62 percent showed signs of disease improvement in the first trimester. Once improvement occurred, it was sustained or progressively increased until delivery. Among these women, levels of serum fetal DNA also progressively rose throughout pregnancy. As fetal DNA quantities doubled, the likelihood of arthritis improvement increased 1.2 fold. By the third or fourth month after delivery, disease recurrence was observed in 90 percent of these patients, coinciding with a drop of serum fetal DNA to very low or undetectable levels.
The remaining 4 women, including the one who had RA onset during the first trimester, did not experience significant reduction of disease symptoms during or after pregnancy. For the women with active disease, serum levels of fetal DNA were dramatically lower - and even undetectable in 2 - throughout pregnancy, especially in the third trimester, compared with those women who experienced arthritis improvement.
This study, the first to focus on fetal DNA in women with RA during pregnancy, found a significant inverse correlation between arthritis activity and serum fetal DNA concentration over the course of pregnancy and postpartum. Yet, researchers acknowledge the study's limitations, including its small size, and inability to determine whether serum fetal DNA has any direct biologic effect on inflammatory arthritis or therapeutic value.
"Whether the dynamic changes in fetal DNA reflect the potential for immune modulation of maternal arthritis, are a result of disease activity changes, or are not causally related cannot be determined from these studies," notes researcher J. Lee Nelson, M.D. "If the former, further studies could generate new therapeutic strategies for RA."
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Contact: Amy Molnar
John Wiley & Sons, Inc. |
| posted by Jennie Tate @ 3:15 AM |
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