A workhorse drug for rheumatoid arthritis causing an excessive number of deaths in Australia
Eight Deaths Linked to Methotrexate in Australia
Dr. Jack Cush writing in Rheumnow reported methotrexate (MTX), a cornerstone drug used to treat rheumatoid arthritis (RA), has led to 90 hospitalizations and 8 deaths according to a recent report from the Medical Journal of Australia.
Many of these events were the result of inappropriate higher or more frequent doses than that prescribed. Such practices led to gastrointestinal tract ulceration, liver toxicity, bone marrow suppression, septicemia, and death.
In a nationwide search of MTX-related death rates, three datasets discovered that over 90 dosing error cases were reported from 2004 to 2015.
Twenty-two died from taking MTX, but only 7 deaths were directly attributed to overdosing. The United States Food and Drug Administration has noted 25 MTX deaths over a four-year timeframe.
The authors recommended changes in packaging and tablet appearance to reduce the incidence of these events.
Comment: Methotrexate is still the disease modifying drug of choice for rheumatoid arthritis. It has to be monitored though.
A picture is worth a 1,000 words… next
Graphic warnings may lead more smokers to try to quit
On its website, NBC News reported smokers are more likely to try quitting and more successful at quitting if they are given cigarette packs with graphic warnings compared to smokers given cigarette packs with only text warnings, according to a study published in JAMA Internal Medicine. The researchers found that 40% of smokers who got cigarette packs with graphic warnings tried to quit during the study period compared to 34% of smokers who got only text warnings on their packs.
Comment: I remember an old poster of a man who had lost his arms and legs because of cigarettes and he was still smoking through his tracheostomy.
A word of caution to patients who take biologics
Most Patients Do Not Store Their Biologic Drugs Within the Recommended Temperature Range
Dr. Kevin Deane writing in Medscape reported on a Dutch study which evaluated the temperatures at which patients with rheumatic diseases stored their biologic disease-modifying antirheumatic drugs (DMARDs). They did this by providing patients with an electronic temperature logger.
Of the 293 study participants given a temperature logger, 255 (87.0%) returned their logger to the pharmacy. Of these 255 participants, only 17 (6.7%) had stored their medication within the recommended temperature range. Of those who did not, 24.3% stored their medication for more than 2 hours outside of the recommended range.
The authors did not evaluate the effect of these storage conditions on the biologic activity of the medication but speculated that storing these medications outside of the recommended temperature range may adversely affect their efficacy.
Comment: It’s important to know what the temperature restrictions are for your medication.
An over the counter preparation that could be life-threatening… next
FDA warns OTC antacids with aspirin can cause stomach or intestinal bleeding
Lydia Wheeler writing in The Hill reported that the Food and Drug Administration “is warning consumers to beware of over-the-counter drugs that contain both an antacid and aspirin.” According to the agency, these products “can cause stomach or intestinal bleeding.” Although rare, the FDA says it has identified eight cases of serious bleeding since 2009.
Comment: Not a big surprise here. In the old days when we used high doses of aspirin, people would get bleeding ulcers frequently.
Are you a runner… the next item is for you…
Running Barefoot May Protect Against Some Musculoskeletal Injuries
Dr. Lara Pullen writing in enews rheum reported on a study published in the British Journal of Sports Medicine. “We aren’t seeing more musculoskeletal injuries in barefoot runners,” explains Dr. Altman-Singles, one of the authors, in an interview. “If anything, we are seeing fewer of certain types of musculoskeletal injuries.”
The researchers examined the differences in injuries between habitually barefoot and habitually shod runners. They categorized participants as barefoot runners if individuals spent at least 50% of their running time barefoot. Barefoot runners were allowed to run in minimalist footwear for the balance of their running time. In many cases, barefoot runners had experienced injuries, such as fasciitis and iliotibial band syndrome, prior to switching to barefoot running.
The researchers also noted that plantar fasciitis was more common in the shod group than the barefoot group. Additionally, shod runners experienced more patellofemoral pain syndrome and ITBS than did barefoot runners. Dr. Altman-Singles describes this difference as huge. Although barefoot running may have offered some protection against plantar fasciitis, barefoot runners had a greater number of Achilles or calf and posterior tibialis strains when compared with shod runners.