Wednesday, August 09, 2000
Scientists find new uses for old drugs
By Don Colburn
Washington Post
The blood thinner warfarin recently was found to help ward off cancer in people treated for blood clots. The same week, three studies suggested that popular cholesterol-lowering drugs called statins may somehow reduce the risk of broken bones.
Huh? This sort of pharmaceutical serendipity is increasingly common: A drug approved for one use is found, by accident or design, to have other intriguing effects. It's distracting to health consumers already teetering on the risk-benefit balance beam.
Should a woman worried about osteoporosis consider taking statins, which are approved only against high cholesterol? Does it make sense for anyone without blood clots to start taking warfarin (brand name: Coumadin) — on the chance it could lessen the risk of cancer?
Not yet, experts say.
“I don't think anybody in their right mind would start taking Coumadin for this (anticancer) effect,” said Raymond Woosley, chairman of pharmacology at Georgetown University Medical Center. The evidence for its ability to prevent cancer falls short of proof, he said, and the drug is not without serious side effects, including bleeding. It can cause ulcers and, in rare cases, stroke.
Nor should people take statins for a possible preventive effect against osteoporosis, Mr. Woosley said. While they are relatively safe, statins (brand names: Lescol, Lipitor, Mevacor, Pravachol, Zocor) also have potential side effects, including muscle and kidney damage.
“These are exciting leads,” Mr. Woosley said of the warfarin and statin findings. But where they lead, he added, depends on whether the initial data are confirmed by more-elaborate cause-and-effect studies.
Whether those studies will be done is another question. Companies are reluctant to undertake such expensive studies in a drug such as Coumadin, whose patent has expired, Mr. Woosley said. They are more likely to focus on a similar but newer drug, whose approval for the new use would be much more lucrative.
In the warfarin study, Swedish researchers followed 854 patients treated for blood clots blocking blood flow in the legs or lungs. Half were given warfarin for six weeks, and half for six months. During the next six years, cancer was diagnosed in 16 percent of the patients who got the drug briefly, but only 10 percent of those who got it longer.
No one knows why blood clots might put people at higher risk of cancer, or why a blood thinner might help prevent cancer — or whether the apparent link is a statistical fluke, the mischief of some still-unidentified confounding factor.
“Our findings strongly support the impression that warfarin has an (anticancer) effect, but this idea will remain controversial in the absence of a demonstrated biochemical explanation,” the Swedish researchers noted in the New England Journal of Medicine.
An accompanying editorial said it's premature for cancer patients and others at high risk of cancer to start taking blood thinners. “For now,” it said, “the answer must be no.”
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