Important Drugs for Glaucoma., Cancer, Diabetes

Jack M. Rosenberg, PharmD, PhD, professor of clinical pharmacy and pharmacology at Long Island University (LIU), and director of the International Drug Information Center, both in Brooklyn, NY.

Also participating in the interview were Lorraine Cicero, a research fellow at the Center, and Saryapal Pareddy, adjunct assistant professor of drug information at LIU.

Several years ago, the Food and Drug Admin-istration approved a number of drugs for the treatment of diabetes and glaucoma ...plus a drug that boosts the effectiveness of cancer chemotherapy.

Cancer

Many anticancer drugs are highly toxic to the heart. This risk of heart damage keeps doctors from giving the high doses that are sometimes needed to destroy a malignancy.

Good News :

A drug called dexrazoxane (Zinecard) helps counteract this cardiotoxiciry. So people with breast cancer, liver cancer or another serious malignancy will be able to take high-dose chemo-without a heightened risk of heart disease.

Diabetes

People with adult-onset diabetes who cannot control the disease with a special diet usually resort to Micronase, Diabeta or another drug that boosts the body's insulin output. When these oral medications don't work, diabetics have always had to opt for daily insulin injections.

Two oral drugs make shots unnecessary even for people with hard-to-control diabetes. Acar-bose (Precose) slows carbohydrate digestion, keeping blood sugar levels steady. Metformin (Glucophage) slows the conversion of stored starch into sugar. It also helps the body use its own insulin more effectively. These medications can be combined with standard antidiabetic medications for a double-barreled effect.

Many people experience stomach upset when they begin taking Precose, but this usually disappears in time.

Glucophage, too, can cause digestive distress, though lowering the dose often helps. It can also interfere with the absorption of vitamin B-12 and folic acid. People taking the drug should ask their doctor about taking vitamin supplements.

Glaucoma

A drug called dorzolamide (Trusopt) is great news for the millions of people with glaucoma. That's the potentially blinding disease marked by increased pressure in the eye.

The usual glaucoma treatment-eyedrops containing beta-blocker drugs like timolol (Tim-optic)-is quite effective at lowering eyeball pressure. But beta-blockers don't always work. People with asthma shouldn't use them at all.

Trusopt limits the secretion of the fluid that accumulates in the eyeball. It's just as effective as beta-blockers-and much less likely to cause troublesome side effects. Used together, the two drugs may bring pressure down to nor-mal when neither works alone.

Side Effects:

Burning or stinging in the eye, blurred vision, dryness, sensitivity to light.

Expt vaccine can help immune system fight lymphoma: study

Researchers have found that an experimental vaccine could prime the immune system to help fight an aggressive form of lymphoma - cancer of lymph node - even though prior therapy had eliminated virtually all of the B cells thought necessary to mount such a defence.

The finding demonstrated that few, if any, B cells were needed to trigger an effective T-cell immune response, a finding which overturned the commonly accepted notion that both were needed to prime the human immune system, they said.

The results of the study by researchers at The University of Texas M D Anderson Cancer Center and the National Cancer Institute would be published in the September issue of Nature Medicine.

Their research also tested the use of personalised vaccines to help lymphoma patients fend off a recurrence of their cancer after treatment. Several such cancer vaccines were in the human testing stage.

In the study, conducted at the Center for Cancer Research, National Cancer Institute (NCI), treatment with a B-cell depleting treatment regimen followed by an experimental vaccine resulted in an impressive 89 per cent survival rate at 46 months for 26 patients with mantle cell lymphoma, which was difficult to control.

"This is the first human cancer vaccine study to see T-cell responses in the absence of B cells, and this paves the way to use vaccines in a number of hematological cancers that are treated by eliminating diseased B cells," said the study's first author, Sattva Neelapu, an assistant professor in the Department of Lymphoma at M.D. Anderson.

Those cancers include forms of lymphoma and leukemia in which the cancer evolved in B-cell lymphocytes, white blood cells which produce antibodies that activate a response by the immune system. New treatments, such as rituximab, were designed to completely wipe out diseased as well as healthy B cells and could prolong patient survival.

However, because researchers were concerned that B-cell depletion from rituximab may impede immune responses to cancer vaccines, and animal studies were contradictory, rituximab had been omitted from lymphoma vaccine studies, Wyndham Wilson, the study's principal investigator and Chief, Lymphoid Malignancies Therapeutic Section, NCI, said.

This question had now been answered, said senior author Larry Kwak, professor and chair of the Department of Lymphoma at M D Anderson. "We were frankly surprised to find that B cells were coming back in patients that were already primed to fight their tumors," he says. "Now we know B cells are not needed for T-cell immunity."

The study was designed to address the immunological effects of B-cell depletion and to assess the use of idiotype vaccine in mantle cell lymphoma, a rare type of non-Hodgkin's lymphoma for which there is no effective long-term therapy, the majority of patients relapse and succumb to their disease.

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