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Cheap, Older Gout Drug Could Be a Lifesaver After Heart Attack

By Dennis Thompson
HealthDay Reporter

SUNDAY, Nov. 17, 2019 (HealthDay News) — A cheap drug that’s been around for centuries as a gout treatment might also shield heart attack survivors from future heart crises, new trial results show.

The drug, colchicine, is derived from a plant called the autumn crocus, researchers explained Saturday at the annual meeting of the American Heart Association, in Philadelphia.

In the new trial, colchicine reduced by as much as 34% a heart attack survivor’s combined risk of either dying from heart disease or having cardiac arrest, a heart attack, a stroke or angioplasty.

Experts described the study as a “landmark” effort.

“These results provide confirmation that inflammation management reduces cardiovascular risk, and it was an example of a successful repurposing of a broadly available and relatively safe generic drug for a new application,” said Dr. Aruna Pradhan, a preventive medicine doctor at Brigham and Women’s Hospital in Boston.

Colchicine currently is used to treat gout and pericarditis (inflammation of the heart’s lining), two conditions caused by inflammation, said lead researcher Dr. Jean-Claude Tardif, director of research at the Montreal Heart Institute.

“You just give a few tablets of colchicine and the pain, the warmth, the redness, all the inflammatory signs go away,” Tardif said.

Tardif and his colleagues reasoned that colchicine might be able to reduce the risk of future heart problems by lowering inflammation in heart attack patients.

The trial involved more than 4,700 heart patients, with about half given daily low-dose colchicine taken by mouth and the rest provided a placebo. Nearly all patients also received the drug regimen normally prescribed to heart attack survivors — aspirin, blood thinners, statins and/or beta blockers.

Three years later, results showed that people on colchicine fared significantly better than those taking a placebo.

Besides the 34% reduction in all adverse heart events, the trial also found that patients taking colchichine had a 74% reduction in stroke risk, and a 50% reduction in their likelihood of being rushed to hospital for angioplasty/stenting after suffering chest pain.

The drug also appears to be safe. The most concerning side effect appears to be an increased risk of pneumonia, which affected about 1% of colchicine patients. Pradhan said pneumonia risk might be affected by the drug’s effect on inflammation.

Continued

Tardif said his research team is proceeding with a second trial focusing on heart risk among patients with type 2 diabetes.

Based on these findings, heart doctors will be thinking long and hard about adding colchicine to the drug cocktail prescribed to heart attack patients, said Dr. Donald Lloyd-Jones, chair of preventive medicine at Northwestern University Feinberg School of Medicine.

“When you have a safe drug that is easily available, it’s going to be hard to hold this back,” Lloyd-Jones said.

The trial was funded by the provincial government of Quebec and received no drug company funding. However, colchicine’s new promise already appears to be affecting its sticker price, even though it’s a generic drug, Lloyd-Jones added.

He said that he recently saw a patient with gout on Thursday who complained that his colchicine prescription costs had unexpectedly skyrocketed.

“He told me that just in the last month, his colchicine out-of-pocket costs went from $ 50 to $ 270 a month in Chicago,” Lloyd-Jones said. “I really wonder whether there’s some gaming going on here, and I do not want to see that.”

Tardif expressed shock, given colchicine’s low cost in Canada.

“There’s something wrong with a system where 90 minutes away you get a drug for 50 times less what others are paying,” Tardif said, referring to what his patients pay in Montreal, an hour-and-a-half flight away.

The results were also published Saturday in the New England Journal of Medicine.

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Sources

SOURCES: Aruna Pradhan, M.D., MPH, preventive medicine doctor, Brigham and Women’s Hospital, Boston; Jean-Claude Tardif, M.D., director, research,  Montreal Heart Institute; Donald Lloyd-Jones, M.D., ScM, chair, preventive medicine, Northwestern University Feinberg School of Medicine, Chicago; Nov. 16, 2019,New England Journal of Medicine, Nov. 16, 2019, presentation, American Heart Association annual meeting, Philadelphia

Copyright © 2013-2018 HealthDay. All rights reserved.

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Cheap, Older Gout Drug, Colchicine, Could Be a Lifesaver After Heart Attack

SUNDAY, Nov. 17, 2019 — A cheap drug that’s been around for centuries as a gout treatment might also shield heart attack survivors from future heart crises, new trial results show.

The drug, colchicine, is derived from a plant called the autumn crocus, researchers explained Saturday at the annual meeting of the American Heart Association, in Philadelphia.

In the new trial, colchicine reduced by as much as 34% a heart attack survivor’s combined risk of either dying from heart disease or having cardiac arrest, a heart attack, a stroke or angioplasty.

Experts described the study as a “landmark” effort.

“These results provide confirmation that inflammation management reduces cardiovascular risk, and it was an example of a successful repurposing of a broadly available and relatively safe generic drug for a new application,” said Dr. Aruna Pradhan, a preventive medicine doctor at Brigham and Women’s Hospital in Boston.

Colchicine currently is used to treat gout and pericarditis (inflammation of the heart’s lining), two conditions caused by inflammation, said lead researcher Dr. Jean-Claude Tardif, director of research at the Montreal Heart Institute.

“You just give a few tablets of colchicine and the pain, the warmth, the redness, all the inflammatory signs go away,” Tardif said.

Tardif and his colleagues reasoned that colchicine might be able to reduce the risk of future heart problems by lowering inflammation in heart attack patients.

The trial involved more than 4,700 heart patients, with about half given daily low-dose colchicine taken by mouth and the rest provided a placebo. Nearly all patients also received the drug regimen normally prescribed to heart attack survivors — aspirin, blood thinners, statins and/or beta blockers.

Three years later, results showed that people on colchicine fared significantly better than those taking a placebo.

Besides the 34% reduction in all adverse heart events, the trial also found that patients taking colchichine had a 74% reduction in stroke risk, and a 50% reduction in their likelihood of being rushed to hospital for angioplasty/stenting after suffering chest pain.

The drug also appears to be safe. The most concerning side effect appears to be an increased risk of pneumonia, which affected about 1% of colchicine patients. Pradhan said pneumonia risk might be affected by the drug’s effect on inflammation.

Tardif said his research team is proceeding with a second trial focusing on heart risk among patients with type 2 diabetes.

Based on these findings, heart doctors will be thinking long and hard about adding colchicine to the drug cocktail prescribed to heart attack patients, said Dr. Donald Lloyd-Jones, chair of preventive medicine at Northwestern University Feinberg School of Medicine.

“When you have a safe drug that is easily available, it’s going to be hard to hold this back,” Lloyd-Jones said.

The trial was funded by the provincial government of Quebec and received no drug company funding. However, colchicine’s new promise already appears to be affecting its sticker price, even though it’s a generic drug, Lloyd-Jones added.

He said that he recently saw a patient with gout on Thursday who complained that his colchicine prescription costs had unexpectedly skyrocketed.

“He told me that just in the last month, his colchicine out-of-pocket costs went from $ 50 to $ 270 a month in Chicago,” Lloyd-Jones said. “I really wonder whether there’s some gaming going on here, and I do not want to see that.”

Tardif expressed shock, given colchicine’s low cost in Canada.

“There’s something wrong with a system where 90 minutes away you get a drug for 50 times less what others are paying,” Tardif said, referring to what his patients pay in Montreal, an hour-and-a-half flight away.

The results were also published Saturday in the New England Journal of Medicine.

More information

The Mayo Clinic has more about colchicine.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

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Some May Be Vulnerable to Severe Skin Reaction While Using Gout Drug

TUESDAY, Oct. 1, 2019 — Some gout patients with heart or kidney disease might be more susceptible to severe skin reactions while taking the gout medication allopurinol, researchers report.

“Our findings suggest that heart disease, like chronic kidney disease, is a risk factor for allopurinol-associated severe cutaneous adverse reactions that warrants adoption of precautionary measures against these reactions,” said researcher Dr. Hyon Choi, from the Department of Rheumatology, Allergy and Immunology at Massachusetts General Hospital in Boston.

Gout is form of inflammatory arthritis that develops in people who have high levels of uric acid in their blood. The acid can form needle-like crystals in joints and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling.

An earlier study found a link between heart disease and an increased risk of hospitalization for people who had a severe skin reaction to allopurinol.

For the latest study, Canadian and U.S. researchers used data from nearly 5 million people in British Columbia. More than 130,000 of these people were on allopurinol. Of these patients, those with heart disease and chronic kidney disease had a higher risk of severe skin reactions than those without such conditions.

People with the genetic marker HLA-B*5801, which is more common in Asian and black people, have a significantly higher risk of this adverse reaction than people without the mutation.

The report was published Sept. 30 in the CMAJ.

The U.S. Food and Drug Administration recently warned patients about the risk of cardiovascular events from the gout medication febuxostat, so the number of prescriptions for allopurinol will probably increase, the researchers noted.

But severe skin reactions are rare, and allopurinol plays an important role in managing gout, they added.

“Physicians who prescribe allopurinol should look for these risk factors so that they may consider initiating lower-dosage allopurinol and other precautions, which may prevent this rare but serious adverse reaction,” Choi and his co-authors concluded in a journal news release.

More information

For more on gout, see the Arthritis Foundation.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Genes, Not Diet, May Be Key to Gout Flare-Ups

By Robert Preidt

HealthDay Reporter

THURSDAY, Oct. 11, 2018 (HealthDay News) — Although many people suffering from painful gout flare-ups point to diet as the culprit, new research suggests DNA plays a much bigger role.

The findings challenge the long-held belief that diet is the major factor in gout, a joint disease that causes extreme pain and swelling. Gout is caused by hyperuricemia — high blood levels of uric acid, which forms crystals that collect around the joints.

In the study, New Zealand researchers analyzed genetic and diet data from nearly 17,000 American men and women of European ancestry.

The investigators found that diet was much less important than the individual patient’s genes in deciding whether or not they would develop hyperuricemia.

The findings “are important in showing the relative contributions of overall diet and inherited genetic factors” in gout, wrote a team led by Dr. Tony Merriman of the University of Otago.

In a related editorial, rheumatologist Dr. Ed Roddy, of Keele University in the United Kingdom, said the findings have important psychological implications for patients.

That’s because people with gout often face stigma due to the misconception that gout is a “self-inflicted” condition, caused by unhealthy lifestyle habits. That, in turn, can make some patients reluctant to seek medical help.

But the new research “provides important evidence that much of patients’ preponderance to hyperuricemia and gout is [genetic and] non-modifiable, countering these harmful but well-established views and practices,” Roddy said.

For centuries, diet was considered the main risk factor for gout, and recent studies suggest that certain foods such as meat, shellfish, alcohol and sugary soft drinks are associated with a higher risk of gout, while other foods such as fruit, vegetables, low-fat dairy products and coffee may protect against gout.

But other studies have also shown that genetics plays an important role in gout.

Dr. Waseem Mir is a rheumatologist at Lenox Hill Hospital in New York City. The new findings are “consistent with what I see in clinical practice,” he said.

“There is a lot of misunderstanding amongst patients as to why they are getting gout attacks. Diet seems to play little role even in clinical practice,” he said.

“What we learn from this study is that it is a genetic problem and needs to be addressed with medication and not just diet in most cases,” Mir added.

The study was published online Oct. 11 in the BMJ.

WebMD News from HealthDay

Sources

SOURCES: Waseem Mir, M.D., rheumatologist, Lenox Hill Hospital, New York City;BMJ, news release, Oct. 10, 2018

Copyright © 2013-2018 HealthDay. All rights reserved.


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Study Sees No Link Between Gout Drug, Kidney Disease