事情有點大條，是所有ARB嗎? 還是micardis/blopress?只增加lung cancer嗎?每143個人治療4年多一個cancer多不多?

Angiotensin-Receptor Blockers and Cancer: An Inconvenient Truth?

A meta-analysis fuels uncertainty about safety, highlighting an imperative need for more data.

In 2003, the Candesartan in Heart failure Assessment of Reduction in Mortality and Morbidity (CHARM) investigators reported a small but significant elevation in the rate of cancer deaths in patients treated with candesartan versus placebo. Now, U.S. investigators have conducted a meta-analysis of randomized controlled trials of angiotensin-receptor blockers (ARBs) to learn more about their effect on cancer.

Telmisartan was the ARB used in most of the studies. Of the five trials that included data on new cancer occurrence, the overall cancer rate was higher in the ARB groups than in the control groups (7.2% vs. 6.0%; relative risk, 1.08; 95% confidence interval, 1.01–1.15). When the analysis was restricted to the three trials in which cancer was a prespecified endpoint, the excess risk associated with ARBs persisted (RR, 1.11; 95% CI, 1.04–1.18). In the one study in which patients received concomitant angiotensin-converting enzyme (ACE)-inhibitor treatment, ARBs were associated with a 13% increase in risk for incident cancer (95% CI, 1.03–1.24). The number needed to harm was estimated to be 143 with 4 years of treatment.

Comment: Nearly 7 years after the CHARM study raised questions about ARB-associated cancer risk, this analysis of the available evidence only heightens the concern. Unfortunately, we are no closer to understanding whether this is truly a problem than we were in 2003. Is the risk real? Is it restricted to certain drugs, is it a class effect of ARBs, or does it involve all drugs that affect the renin-angiotensin system? No similar elevation in cancer risk has yet been associated with ACE inhibitors, although more data on this drug class is also needed. The current results point to the importance of thorough and timely collection of safety data on drugs — and the necessity of analyzing all relevant data, published and unpublished. Clinicians and patients need more information to accurately weigh the benefits and risks of using ARBs.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology June 13, 2010

Citation(s):

Sipahi I et al. Angiotensin-receptor blockade and risk of cancer: Meta-analysis of randomized controlled trials. Lancet 2010 Jun 14; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1470-2045(10)70106-6)

Nissen SE. Angiotensin-receptor blockers and cancer: Urgent regulatory review needed. Lancet 2010 Jun 14; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1470-2045(10)70142-X)

留言

張貼留言

這個網誌中的熱門文章

即便是用IGRA, 有時也要等大於三個月才能決定TB contact

圖片
接觸TB後，TST大抵上2-12週轉陽，IGRA大抵上6-10週，但IGRA可以長到3個月以上 TB Tests Can Have a Lengthy Window Period Two studies suggest that interferon- release assay conversion sometimes occurs more than 3 months after exposure to active tuberculosis. Increasingly, interferon- release assays (IGRAs) are being used for diagnosing latent tuberculosis (TB). Although the tuberculin skin test (TST) traditionally used for this purpose converts to positive within 2 to 12 weeks after an individual is exposed to someone with active TB, the interval for IGRA conversion has remained unclear. Current guidelines recommend repeating an initially negative IGRA after 6 to 10 weeks, but this recommendation is not based on controlled studies. Two recent investigations address this issue. Anibarro and colleagues conducted a longitudinal prospective analysis among contacts of TB patients in Spain. The 152 contacts received a TST and an IGRA at first visit; for individuals with negative or conflicting results, t
閱讀完整內容

early vs late tracheostomy, 早切不會降低死亡率，不會降低VAP，不會降低LOS, wait!

April 27, 2010 — Early vs late tracheotomy (6 - 8 days vs 13 - 15 days after mechanical ventilation) may not significantly lower the risk for ventilator-associated pneumonia in adult patients in the intensive care unit (ICU), according to the results of a randomized controlled trial reported in the April 21 issue of the Journal of the American Medical Association . "Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged ventilation; however, there is considerable variability in the time considered optimal for performing tracheotomy," write Pier Paolo Terragni, MD, from Università di Torino in Turin, Italy, and colleagues. "This is of clinical importance because timing is a key criterion for performing a tracheotomy and patients who receive one require a large amount of health care resources." The goal of this study was to compare early tracheotomy vs late tracheotomy in the incide
閱讀完整內容