Certain Painkillers Tied to Raised Risk of

Death After Stroke

WEDNESDAY Nov. 5, 2014, 2014 -- Arthritis pain relievers known as COX-2 inhibitors,
including Celebrex and Lodine, are associated with an increased risk of dying within a month
after a stroke, according to a new study.
"This large study from Denmark adds to the prior concerns about COX-2 inhibitors and
stroke risks," said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller
School of Medicine.
"Patients at high risk for stroke should be cautious about taking such medications and should
consult their physicians as to the best medications to treat inflammation and pain," Sacco
said.
However, while the study found an association between use of these painkillers and death in
stroke patients, it did not prove cause-and-effect.
Other types of nonsteroidal anti-inflammatory painkillers (NSAIDs) -- including ibuprofen
(Advil, Motrin) and naproxen (Aleve) -- weren't linked to an increased risk of death after
stroke, the study authors said.
COX-2 inhibitors have previously been linked to an increased risk for both heart attack and
stroke. In 2004, Merck pulled the popular painkiller Vioxx from the market because of this
association.
The next year, the U.S. Food and Drug Administration asked Pfizer to voluntarily stop selling
Bextra (valdecoxib) because of its link with an increased risk of heart attack and stroke.
Celebrex (celecoxib), however, which is in the same class of drugs and also made by Pfizer,
remains on the market.
In the new study -- based on more than 100,000 people hospitalized for a first stroke between
2004 and 2012-- the investigators wanted to see if the painkillers affected recovery from a
stroke.
The researchers found that use of Celebrex prior to hospitalization for ischemic stroke was
associated with a 19 percent increase in risk of death within a month, compared with non-use
of the drug.

Ischemic stroke, the most common type of stroke, is caused by a clot that blocks blood flow
to the brain.
"Much of this result came from new users of the drugs, who were 42 percent more likely to
die from stroke than those who were not taking the drugs," said lead researcher Dr. Morten
Schmidt, the cardiovascular research coordinator at Aarhus University Hospital.
"The results were also stronger for those taking the older COX-2 inhibitors," he added.
The older drugs -- for example, Lodine (etodolac) -- raised the risk of dying from stroke by
53 percent, the researchers reported.
The report was published in the Nov. 5 online edition of the journal Neurology.
Of the more than 100,000 stroke patients the researchers looked at, 11 percent used
painkillers prior to admission and 8 percent were former users.
"There are several cardiovascular risks to consider when prescribing NSAIDs, in particular
COX-2 inhibitors," Schmidt said.
"Efforts should be made to ensure people with a higher risk of stroke are not prescribed these
medications when other options are available," he said.
More information
For more about stroke, visit the U.S. National Library of Medicine.

Posted: November 2014

Vaccine for Hepatitis C Inches Closer to

Reality

WEDNESDAY Nov. 5, 2014, 2014 -- An initial study suggests that a potential vaccine
against hepatitis C, a liver disease that affects at least 130 million people worldwide, is safe
in people.
The newly released findings are good news, said study co-author Dr. Ellie Barnes, a professor
of hepatology and experimental medicine at the University of Oxford in England.
The results indicate the vaccine can safely boost the immune system in a way that "targets
multiple parts of the hepatitis C virus," she said. "We hope it will have the capacity to prevent
people from being infected, and that's something we really need."
An estimated 1 percent of U.S. residents have chronic hepatitis C, which is usually
transmitted through infected blood. In many people, the disease leads to scarring of the liver - cirrhosis -- or liver cancer.
A powerful new drug called Sovaldi is expected to improve treatment of hepatitis C, but it
costs $1,000 per day, or $84,000 for the typical 12-week course. Also, drugs like Sovaldi are
least effective in patients with advanced liver disease and don't prevent reinfection, the study
authors said.
Vaccines exist for two other types of hepatitis: A and B. But it's been difficult to create a
vaccine to fight hepatitis C because the germs are sly when it comes to the immune system
soldiers known as antibodies, Barnes said.
"They can put on a disguise and prevent antibodies from seeing them. What we're trying to do
is develop a T-cell vaccine, which works by inducing T cells, a totally different part of the
immune system," she explained.
Part of the vaccine works by sneaking into the body through a chimpanzee cold germ that
human immune systems won't know to kill, Barnes said.
In the new study, a so-called phase I trial, researchers tested parts of the vaccine in 15 people.
The researchers reported that the participants tolerated the vaccine well overall, with some
mild or moderate side effects that largely resolved within 48 hours.

The study findings also suggest that the vaccine is achieving its goals on the immune system
front. But two more stages of research, each in larger groups of people, are needed before the
vaccine can be approved for use in the United States.
The second stage of research is already in progress, Barnes said, and results are expected in
2016. She declined to speculate how long it will take for the vaccine to become available if it
works.
The vaccine will be targeted at people at high-risk for hepatitis C, not the population at large
in Western countries where infection isn't widespread, Barnes said. High-risk groups include
users of illegal injection drugs. Countries such as Egypt, where 20 percent of the population
is thought to be infected, will need different strategies, Barnes said.
It's not clear how much the vaccine might cost, but Naglaa Shoukry, a hepatitis researcher
and associate professor at the University of Montreal, said it shouldn't be "outrageously
expensive."
Shoukry, who praised the new study, said drug companies don't make money off vaccines.
"That's why they are usually hesitant to develop them," she said.
The study appears in the Nov. 5 issue of the journal Science Translational Medicine.
More information
For more about hepatitis C, visit the U.S. National Library of Medicine.

Posted: November 2014