New Blood Thinner Beats Plavix When Paired With Low-Dose Aspirin (HealthDay)

MONDAY, June 27 (HealthDay News) -- Brilinta, an experimental anti-clotting medication currently awaiting U.S. Food and Drug Administration approval, performed better than the industry standard, Plavix, when used in tandem with low-dose aspirin, a new study finds.

Heart patients who took Brilinta (ticagrelor) with low-dose aspirin (less than 300 milligrams) had fewer cardiovascular complications than those taking Plavix (clopidogrel) plus low-dose aspirin, researchers found.

However, patients who took Brilinta with higher doses of aspirin (more than 300 milligrams) had worse outcomes than those who took Plavix plus high-dose aspirin, the investigators reported.

Antiplatelet drugs are used to prevent potentially dangerous blood clots from forming in patients with acute coronary syndrome, including those who have had a heart attack.

Brilinta has already been approved for use in many other countries. In July 2010, an FDA panel voted 7-to-1 to approve the use of Brilinta for U.S. patients undergoing angioplasty or stenting to open blocked arteries, but the approval process is still ongoing.

The panel's recommendation was based in part on prior findings from this study, called the Platelet Inhibition and Patient Outcomes (PLATO) trial.

In this latest analysis of PLATO findings, researchers found that patients who took Brilinta with low-dose aspirin were 16 percent less likely than those who took Plavix with low-dose aspirin to have a heart attack or stroke, or to die within a year.

The findings were reported Monday in an American Heart Association online conference.

One expert said the new information is valuable.

"The study highlights that if one chooses to use ticagrelor in subjects with acute coronary syndromes, it would be logical to use aspirin 81 milligrams per day (and not 325 mg daily)," said Dr. Jeffrey S. Berger, assistant professor of medicine and director of cardiovascular thrombosis at NYU Langone Medical Center in New York City. "Of note, there is little reason to ever use aspirin 325 mg except in the acute setting of a heart attack or stroke," he added. "A higher aspirin dose (325 mg versus 81 mg) increases the risk of bleeding without increasing the efficacy of the drug."

A study author agreed that for most patients, using the drug with a lower dose of aspirin is usually warranted.

"Patients with acute coronary syndrome have options to prevent recurrent events," study lead author Dr. Kenneth W. Mahaffey, co-director of cardiovascular research at the Duke Clinical Research Institute, and associate professor of medicine at Duke University Medical Center, said in an AHA news release. "Physicians choosing to use ticagrelor in countries where it is approved and available should consider using a low-dose of maintenance aspirin with the drug."

The data and conclusions of the research should be viewed as preliminary until published in a peer-reviewed journal.

More information

The American Academy of Family Physicians outlines medicines used to treat patients with acute coronary syndrome.

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Wal-Mart hikes branded diabetes drug prices-study (Reuters)

SAN DIEGO (Reuters) – Big-box retailers Wal-Mart Stores and Kmart, pioneers in the push to cut consumer prices for generic drugs, have been raising prices for the most popular brand-name diabetes drugs, according to a new study.

Wal-Mart, the world's largest retailer began in 2006 to sell some generic drugs in the United States for $4 per monthly prescription -- a tactic since adopted by a number of other pharmacy operators.

"Since 2008, everybody has lowered generic prices close to the level of Wal-Mart," said Dr. Ronald Tamler, an endocrinologist at New York's Mount Sinai Medical Center, and co-author of the price study. "But the differential in pricing for brand-name drugs is huge."

His study, presented here at the annual meeting of the American Diabetes Association, found that the differential between pharmacy prices for generic diabetes drugs fell 60 percent between 2008 and 2010, compared with an increase of 113 percent for brand-name drugs.

The study also showed that Wal-Mart raised prices for the most-prescribed branded diabetes treatments by 32 percent between 2008 and 2010, while Kmart, a unit of Sears Holding Corp, raised its branded prices by 35 percent. The increase over the same two-year period was 21 percent at other pharmacies, which includes chain drugstores, mail-order firms and independent pharmacies, according to the study.

Neither company responded to a request for comment.

The $4 generics have become a "loss leader" for stores looking to draw new customers, Tamler said.

"The message used to be to send uninsured and underinsured patients to Wal-Mart to get a great deal on generic drugs," he said. "Now, the message is to tell patients to shop around for their medications."

(Editing by Paul Simao)

(This article has been modified to correct paragraph 5 to indicate that the price changes refer to the differential between pharmacies. Also corrects paragraph 6 to show that Wal-Mart and Kmart price increases were for brand-name drugs)

Body Works: Human Body Quiz

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Single Reading Can't Gauge Blood Pressure Control: Study (HealthDay)

By Kathleen Doheny
HealthDay Reporter by Kathleen Doheny
healthday Reporter – Mon?Jun?20, 11:48?pm?ET

MONDAY, June 20 (HealthDay News) -- Evaluating how well a person responds to medication meant to lower blood pressure requires multiple readings, new research suggests.

Blood pressure often spikes at doctor appointments, a condition known as "white coat" hypertension, so readings should also be taken by patients at home, said the study's lead author, Dr. Benjamin Powers, assistant professor of medicine at Duke University Medical Center.

''Collecting just a few, five or six, blood pressure readings from home will help your doctor make much better decisions about whether your blood pressure is in or out of control," Powers said.

For the study, Powers and his colleagues evaluated 444 U.S. veterans with high blood pressure, about 90 percent of them men with an average age of 64. All had been diagnosed about 10 years earlier. Their blood pressure was considered uncontrolled, even though most took multiple blood pressure-lowering medications. Untreated, high blood pressure can lead to stroke.

The study compared blood pressure readings taken in three settings -- at home, in a doctor's office, and at a clinical research setting -- at the study start and again at 6, 12 and 18 months. The findings are published in the June 21 issue of the Annals of Internal Medicine.

The measurements varied widely, Powers found. "Only a third of them were consistently categorized as in or out of control by all three measures," he said.

That points to the importance of getting multiple measures from different settings, said Powers, who is also with the Durham Veterans Affairs Medical Center. Using just one reading as the basis for prescribing or adjusting blood pressure medication could endanger patients who suffer from "white coat" hypertension, the study authors said.

As many as six readings were needed to obtain the best estimate of true blood pressure, the authors said, adding that doctors should average the results.

Home monitoring of blood pressure has gained respect in recent years, Powers said. About 43 percent of people with high blood pressure use home monitors, according to background information in the study. Powers and his colleagues said their results support recent calls for reimbursement of home blood pressure monitoring.

"I think patients should expect their doctors to make decisions based on home blood pressure [in addition to other measures]," he said.

Those who buy a home blood pressure monitor should get it validated for accuracy at their doctor's office, Powers added.

Patients should be advised to measure their blood pressure at different times of the day, and to sit and relax for five minutes before taking it, Powers explained. Variations are to be expected, he noted.

According to Dr. Joseph Diamond, director of nuclear cardiology at Long Island Jewish Medical Center in Hyde Park, N.Y., blood pressure readings are perhaps "the most frequent assessment that results in a change of medical therapy."

Even so, the procedure is frequently flawed because of poor measurement technique or insufficient measurements, he said.

"This study confirms the need to improve both measurement technique and the number of measurements obtained so that a therapeutic decision to start or change medication is based on more accurate information," said Diamond.

Writing in an accompanying editorial of the journal, Dr. Lawrence J. Appel and colleagues from Johns Hopkins University said the findings point to a need for regulation of blood pressure screening. "It is time to get serious about BP measurement," they wrote.

More information

To learn more about home blood pressure monitoring, visit the British Hypertension Society.

Botox rival shows crow's feet advantage in study (Reuters)

NEW YORK (Reuters) – Medicis Pharmaceutical Corp's newer anti-wrinkle drug Dysport proved significantly better than Botox at improving crow's feet in a small clinical study, a finding that could give frown lines to market leader Allergan Inc.

Allergan's Botox (onabutulinumtoxin A) was approved by U.S. regulators in 2002 to treat wrinkles between the eyebrows, while Dysport (abobutulinumtoxin A) won approval for the same indication in 2009. The drugs are similar forms of botulinum toxin, a chemical that can block nerve impulses.

Neither drug is specifically approved to treat crow's feet, the lines that radiate from the corners of the eye and are most obvious when you squint or smile. But both of the injectable drugs are commonly used by doctors to make the branching wrinkles less apparent.

Results of the 90-patient trial -- conducted by Kartik Nettar of the Maas Clinic, San Francisco, and by the University of California, San Francisco -- were described on Monday in the online edition of the Archives of Facial Plastic Surgery.

All participants received injections of one drug in the target area on the right side of the face and the other treatment on the left side, to assess potential benefit.

Researchers then assessed the site's appearance using a five-point scale and patients were also asked their own opinions.

The difference in crow's feet was deemed by researchers to be significantly favorable to Dysport, when subjects contracted the muscles as much as possible. Moreover, about two thirds of participants said they favored the side of their faces that was treated with Dysport, according to the study.

But the results were deemed limited in scope since no statistical difference between the two treatments was seen when the muscles were at rest.

More studies are needed to assess why one agent would perform better than the other and to compare the affect of the two drugs on other facial muscles, the researchers said.

Crow's feet are among the first wrinkles to form and can surface in the 30's. Sun exposure, squinting and smoking are among the biggest causes.

Medicis sells Dysport in the United States, Canada and Japan under a licensing agreement with French drugmaker Ipsen SA. Ipsen reported first-quarter sales of $50 million from Dysport, including its own sales of the product for cervical dystonia -- a painful contraction of neck muscles -- and royalties from Medicis for anti-wrinkle uses.

Botox has far bigger annual sales, expected to top $1.5 billion this year, from anti-wrinkle uses and for a variety of medical uses, including migraine headaches, cervical dystonia and stiffness in the elbow, wrist and fingers.

(Reporting by Ransdell Pierson; editing by Andre Grenon)

Dutch may label some cannabis as a hard drug (Reuters)

AMSTERDAM (Reuters) – The Netherlands, famous for its liberal soft drugs policies, said on Friday it may label some highly concentrated forms of cannabis as a hard drug on a par with cocaine or heroin, because of the risk of addiction.

With many coffee shops openly selling cannabis to customers and a tolerance of home-cultivation of marijuana plants, the Netherlands attracts attention in the global debate about soft drugs policies.

In the past three years, it has restricted and discouraged the use and sale of soft drugs on health and crime grounds, and wants to limit drug tourism, particularly in border towns.

The government has proposed special "weed passes" to stop visitors using coffee shops and restrict access to residents, which some analysts predict could lead to a fall in tourist numbers and spending.

Now, a Dutch commission has found that hashish and marijuana on sale in the Netherlands contain around 18 percent of THC, the main psychoactive substance, and advised the health minister that anything above 15 percent put drugs on a par with heroin or cocaine.

"I've been very worried for years about the THC concentration, especially if it is so high. We will take a serious look at it," Health Minister Edith Schippers told public broadcaster NOS.

"The addictive consequences are much stronger and severe. Clearly this is a worrying development."

When asked if tolerant soft drugs policies would end if some cannabis was labeled as a hard drug, she said: "The THC concentration fluctuates widely so the 15 percent level is not common. You'd have to look at how to change this development."

Law Professor Dirk Korf of the University of Amsterdam said he did not expect this change to have a clear impact on other countries' policies.

"In Europe you can see both liberalization and a more restrictive policy. It will depend on the country and which phase it is in," Korf said.