Recently the media reported that a class of medicine) are known, the angiotensin receptor blocker (ARB patients tens of millions is a significant increase in tumors of lung cancer. This is the conclusion of a study published online recently Sipahi et al considered by the medical journal Lancet Oncology.
A cascade of hormonal reactions, based mainly on the renin-angiotensin-aldosterone (RAA) hormonal system is of central importanceMaintenance of blood pressure. The first step in the chain is the production of renin in the kidneys when the kidneys to detect lower blood pressure. Renin stimulates and then the formation of a protein called angiotensin I, which is then converted by angiotensin II-converting enzyme (ACE) to angiotensin lung. Angiotensin II is known to be the most powerful constrictor of blood vessels, and this constraint leads to high blood pressure. Angiotensin II also causes the release of a hormoneAldosterone, which causes a further increase in blood pressure further. Any drug that prevents the production of angiotensin II on the RAA is therefore useful in reducing blood pressure. The two classes of drugs that have significant effects on the RAA system, angiotensin receptor blockers (ARB) drug, and ACE-inhibitors (ACE inhibitors) and are more distant failure for the treatment of high blood pressure, heart andDiabetic kidney damage. The mechanisms of the two drugs are different, but same result: the reduction in blood pressure or hypertension. For example, ACE inhibitors reduce blood pressure not only by blocking the production of angiotensin II, but increasing the amount of powerful chemicals, including nitric oxide, which expand the arteries.
Since the use of reserpine, a drug used to treat high blood pressure one used, but no longerwas left with an increased risk of breast cancer more than 50 years, the problem of antihypertensive drugs and cancer has not come. Beta-blockers have been linked with lung cancer, thiazide diuretics with renal cell carcinoma and colon cancer and calcium antagonists with cancer in general. In most cases, the risk is small and not supported by experimental biochemical and epidemiological data. The reportbetween diuretics and renal cell carcinoma is supported by a variety of clinical and biochemical experimental data and remains of concern, especially for women.
A correlation between ACE inhibitors and cancer was first displayed when the results of the Candesartan in Heart Failure Assessment of Reduction in Mortality and morbidity (CHARM) study were published in 2003. The results of the CHARM study showed that patients treated with candesartan, a significantIncrease the risk of cancer death compared with control subjects, but investigators have concluded this finding was probably by accident. Since then, several other studies noted, including LIVE, ONTARGET and TRANSCEND an excess of malignancies in patients given ARBs versus placebo.
Basic Sipahi et al meta-analysis to determine if the diagnosis of this influence ARB had cancer. Data were collected from all available scientific data and publicrandomized trials in which patients were treated with angiotensin receptor blockers to treat hypertension, heart failure and diabetic kidney damage. The five tests of new data on cancer were committed ONTARGET, LIFE, Transcend, and CHARM-Overall. In addition, data for cancer deaths in life, Transcend, brave and Val-HeFT. controlled 85.7% of the studies, telmisartan, marketed as Aleve, is used by other names. Telmisartan wascommercially available for the treatment of hypertension after its approval in 1998. It 'also suitable for use in reducing the risk of myocardial infarction, stroke or death from cardiovascular disease (CVD), approved for patients 55 years or older who were at high risk for developing major cardiovascular events and must take ACE inhibitors. Therefore, it is the effect of telmisartan on the new cancer, the analysis itself, access to this goal.
The analysis was approximately 61 590Patients: Researchers have found an increase of 11 percent for total cancer and 25 percent for lung cancer in people who took drugs ARB. Overall, patients in court, some were randomized to ARB had increased risk of newly diagnosed cancer compared to placebo in patients assigned to a (7.2% vs 6%). The body of solid tumors studied, only an increased risk of lung cancer) was identified, compared with the control group (0.9% vs 0.7%. Thetranslated into a modest but significant effect of a case of cancer for every 105 patients taking the drug for four years, apparently not at high risk, but is similar to that seen with passive smoking. However, this is the first time that such an association has been made, and although the risk to the individual patient is not huge, the clinical significance of these surpluses cancer risk is unknown.
Given the millions of patients in thisThis is an important number because it gives an idea of drug potentially the number of excess cancers could be caused by these drugs. The finding of an increase of 1.2% in absolute risk of cancer over an average of 4 years for these to interpret the risk of cancer in relation to the estimated service life of 41%. Set against the backdrop of this meta-analysis, the researchers said it is up to date on important safety issues regarding the use of ARBs was. "However,clinical trials with ARB have assessed, in particular their effects on cardiovascular and renal endpoints, and are not generally reported incidence of cancer, "the researchers said. wrote angiotensin receptor blockers with other drugs, blood pressure can be replaced, according to the researchers, but do not warn patients of the face consultation with a doctor as a failure of these drugs have positive implications for the control of blood pressure and heart rate.
Officials with BoehringerIngelheim, the manufacturers of telmisartan disputed the findings and said in a statement that "internal conflicts with a complete analysis of the data security of primary data on the findings of an increased risk of malignant potential." They also noted that the finding of a small increased risk of cancer of the new meta-analysis is "primarily based on the combination of ramipril and telmisartan arm [Altace, King Pharmaceuticals], an ACE inhibitor, and not in ONTARGETarms of the study of each compound separately, "he says, noting that they recommend the product labeling for telmisartan, the combination with ACE inhibitors.
In most studies and meta-analysis, the risk of cancer by blocking the RAA system was either equal to or less than their comparators (including placebo). So this study shows a slightly increased risk of new cancer diagnostics with ARB and is certainly unexpected and warrants further controlInvestigation. While the meta-analysis has its strengths, in particular the size, completeness of the literature and using appropriate filters to eliminate potentially unreliable data, there are also serious deficiencies, which confirm the investigators, including the nature of post-hoc these proceedings, only a few drugs in the ARB class, and learned that the studies were examined, for the endpoints to explore cancer.
In aEditorial of this meta-analysis, Steven E. Nissen said that although the researchers "reasonably prudent" are the conclusions from the analysis because it remains unknown whether other ARBs irbesartan (Avapro, Bristol-Myers Squibb / Sanofi-Aventis), valsartan (Diovan, Novartis), olmesartan (Benicar Daiichi Sankyo), and eprosartan (TEVETEN, Abbott) incidence are associated with a higher risk of new cancers, it was "disturbing and proactive." Further studies are neededFinally, to define any cancer risk associated with these drugs. In addition, possible mechanism for the increase in new cancer events associated with the unknown ARBs, according to the authors. There is little, if appropriate, the biological plausibility, that a drug for a few years only exposure diagnostics could increase the risk of new cancers. Cigarette smoking, cancer is a risk factor more 'powerful for lung cancer, which requires 10 years or moreexposure significantly increased risk of lung cancer. It 'is therefore highly unlikely that the short-term drug exposure as it would be in clinical trials, ARBs have a clinical effect of relevance attached. However, regulatory authorities should review the possible association between use of ARBs and cancer, and the results immediately. Meanwhile, the ARB, which is often prescribed in all cases, be reserved for patients intolerant to ACE inhibitors.
No comments:
Post a Comment