Updated Interaction Advice for Simvastatin | Reanna7 | Page 3

Updated Interaction Advice for Simvastatin

The Medicines and Healthcare products Regulatory Agency (MHRA) has written to healthcare professionals with updated advice about drug interactions between medications containing simvastatin (Zocor, Inegy) and other drugs that may be prescribed at the same time.

Simvastatin is a drug taken to reduce cholesterol and is something that Birdshotters may be taking to counteract a side effect of their medication for Birdshot.

It states that:- “Simvastatin can cause muscle weakness (myopathy) or muscle breakdown leading to kidney damage (rhabdomyolysis) and it was already known that at high doses and if certain other medicines are taken at the same time this risk is increased.”

Of particular note are two drugs which a few our of our members also take are in the list of medicines not be taken at the same time as simvastatin.

They are the immunosuppressant known as Cyclosporine/ciclosporin (Neoral, Sandimmune)

and Amlodine which is  common blood pressure medication.    In this instance it recommends that simvastatin should not be used at a dose of more than 20mg daily

As with cyclosporine it is also important to note that grapefruit juice should be avoided by anyone taking simvastatin.

What does this mean to Birdshotters?

If any of our members are worried about this you  should talk to your doctor or health care professional  about it, rather than just stop taking the medication, because the benefits of treatment with simvastatin continue to outweigh the risks for most people who are on them.

To read the whole alert follow the link below.

http://uk.mediguard.org/alerts/alert/2164.html

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Orphan drug status for GEVOKIZUMAB

Gevokizumab is a monoclonal antibody that shuts down inflammation brought on by a protein in our bodies called interleukin-1 beta.

The pharma that produces Gevokizumab has been focusing on diabetes but now, with the orphan drug status , it means that it will get financial help to trial the drug on non-infectious and pan uveitis.

We don’t know, at this stage, whether is will work on Birdshot, but it is exciting to see new drugs coming on to the market.  It is even more exciting to see pharmas getting orphan drug status for new medications.

Read the full article at:

http://www.bizjournals.com/sanfrancisco/blog/biotech/2012/08/xoma-gevokizumab-uveitis-orphan-drug.html

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OCT on Retinas of Birdshotters

Three people from Lausanne, Switzerland, including Carl Herbort who has been very supportive of BUS, have looked at the retinas of 28 Birdshot eyes and retrospectively evaluated the OCT findings of these eyes, to see what changes there are in the retina over a long period of time.

They looked at the OCT results in early Birdshot (less than 1 year), intermediate (1 to 6 years) and late (more than 6 years).

What they found was that in early Birdshot, the retinal thickness was significantly elevated (i.e. it was thicker than usual) because of the inflammation and vasculitis.  The thickness begins to diminish in intermediate Birdshot and by late Birdshot, the retina is significantly thinned.  They also observed that 92% of these eyes had developed an epiretinal membrane by late Birdshot.  An epiretinal membrane is a thin sheet of fibrous tissue that grows over the retina.  For those of us with Birdshot, an epiretinal membrane may develop because the vitreous (the jelly inside our eyes) pulls away from the retina due to the inflammation. Epiretinal membranes can cause visual problems, although most of us with an epiretinal membrane do not even notice any issues.

The interesting thing about this research is that if some-one has had a delayed diagnosis, their OCT results may help determine approximately how long they have had Birdshot for.

For more information on this piece of research, follow the link:

http://www.ncbi.nlm.nih.gov/pubmed/22909176

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New Study Links Bisphosphonates to Vision Problems Risk

We have posted before about oral bisphosphonates (including Fosamax) and emerging evidence that first-time use of these is associated with a greater risk of developing two inflammatory diseases: uveitis and scleritis.

We have also posted on the risks of bisphosphonates in relation to atypical femur fractures.

The article highlights both these risks and can be found at:

http://www.prweb.com/releases/2012/9/prweb9883870.htm

The important thing to remember is that you need advice about your drug regime and the interactions of each of your medications, as well as the potential benefits and risks, so you can make an informed decision.  The risks highlighted in this article may be outweighed by the benefits in individual case – only you and your consultant can decide between you.

We, with Birdshot, who take high doses of steroids need to protect our bones.  So, becoming informed about our condition, our medication regimes, interactions and risks and benefits is really important.

Updated Interaction Advice for Simvastatin | Reanna7 | Page 3

Worms Again!

We have posted before about helminthic therapy – worms that can modulate the immune system and prevent it from attacking the body’s own tissues and organs.

Well, the time has come for mid stage trials on this therapy.  Currently, 220 people with Crohn’s Disease in the US are being enrolled on a mid stage trial and in Europe a further mid stage trial is being started.

The drug is called Trichuris Suis Ova (TSO) and consists of thousands of microscopic parasite eggs, suspended in saline solution – the drug is swallowed just like a tablet.  The parasites are killed off in our stomachs, but the hypothesis is that, before they die off, they are able to modulate our immune systems.

If these trials go well, we are not too far off from having this new drug available on the market.

Read the full story at:

http://www.reuters.com/article/2012/08/30/us-usa-health-parasites-idUSBRE87T14720120830

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Autoimmune Researcher Gets Money

At long last it looks as though the world has finally woken up to the fact that autoimmune diseases are the modern day health problem.  There are over 100 different autoimmune diseases, many of them rare, and more and more people are being diagnosed with autoimmune diseases and no-one knows why.

A researcher in Australia, Chris Goodhew has received a grant from GlaxoSmithKline and he will look at why the immune system is attacking in the first place.  He has a vested interest as his mother has an autoimmune disease, lupus!

It is really good to see a major pharma investing in auto-immune diseases.

Read the full article at

http://www.canberratimes.com.au/act-news/80000-boost-for-autoimmune-researcher-20120911-25qs6.html

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Documentary on Rare Diseases

Two showings of RARE, a feature documentary that provides a closer look at the relationship between patients, advocacy groups and researchers involved in developing new treatments for rare diseases has just been aired in the US.

It is a really interesting documentary and highlights the importance of patient organisations like BUS being fully involved in the research process.  In fact, if you see the documentary, it is strangely reminiscent of the development of BUS!

If you want to see a short version of the documentary go to:

http://vimeo.com/46443548

If you want to read the article go to

http://scopeblog.stanford.edu/2012/09/07/stanford-filmakers-documentary-on-rare-diseases-to-air-next-week-on-kqed/

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What your eyes reveal about your health

The Wall Street Journal published a really interesting article in August on how your eyes can reveal clues to your general health.

An ophthalmologist, Dr David Ingvoldstad from Midwest Eye Care in Omaha, Nebraska regularly alerts his patients to possible autoimmune diseases they may be at risk from or have, such as rheumatoid arthritis and lupus.  He does this through their vision changes, or through the state of health of their eyes.  He has even been able to monitor the progression of a patient’s diabetes through their eyes, and once alerted a patient to the fact that they had a brain tumour, based on the changes in their vision.

He is able to do this because the body’s systems are interconnected, and changes in the eye can reflect changes in the vascular, nervous and immune system.

The article suggests that, with regular monitoring, ophthalmologists can be the first to spot certain medical conditions and can ensure that patients receive early care and treatment.

We, with Birdshot, are regularly monitored!  One benefit of having Birdshot.

Read the full article at:

http://online.wsj.com/article/SB10000872396390444184704577587211317837868.html

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Help Us Make Birdshot a Priority For Research!

We are re-posting this, as the survey ends on 31 July, and we need as many responses as we can get, in order to make sure that Birdshot becomes a priority for research.  If you have not already done so, please complete this survey.  It is quick and simple to do.  We have posted some ideas about what kind of research is needed into Birdshot at the end of this post, to help stimulate debate, and give you some ideas.  Remember that the more people who respond mentioning Birdshot, the more likely we are to get Birdshot as a priority!

The Sight Loss and Vision Survey is a joint initiative between Fight for Sight, The Royal College of Ophthalmologists, The College of Optometrists, the National Institute of Health Research, RNIB and The James Lind Alliance.  It has been set up to find those areas of research that have not yet been identified.  For us with Birdshot, this is really important, as we have a rare disease, and very little research has been carried out to date.  This is our opportunity to get Birdshot (and other rare, auto-immune forms of posterior uveitis) on the national agenda.  Because the survey will be completed by patients, it will have great credibility and it is hoped that funds can then be identified for some of the research needs.

The James Lind Alliance is a non-profit making organisation, funded by the National Institute for Health Research, which will oversee this initiative ensuring the exercise produces an unbiased result, with equal weighting being given to each of the participating groups – so your opinion really will count.

The Sight Loss and Vision Survey will allow you to identify your most pressing questions about the prevention, diagnosis and treatment of Birdshot.

The more Birdshotters that complete the survey the more likely we are to be able to influence the research agenda and receive valuable funding from the government for research into Birdshot – we really do need you to take part.

To complete the survey and learn more about this initiative please visit www.sightlosspsp.org.uk where you will find both the online survey and can request alternative formats – post/fax or telephone.

The survey takes less than 10 minutes to complete so please take this opportunity to represent Birdshot and help change the future of eye research.

Thank you!

1.  What causes Birdshot?

2.  Which part of the immune system becomes disregulated?

3.  How do you re-regulate the immune system without damaging the body?

4.  How can we find less toxic medication that does not adversely affect mental health and quality of life, but preserves vision?

5.  How can we ensure early detection of Birdshot to prevent sight loss?

6.  What are the genetic links and why are several generations of some families affected, and why does it seem to affect mainly Caucasians?

7.  Why is there a ‘spectrum’ of Birdshot?

8.  Why do different people respond differently to different medication regimes?

9.  Why is Birdshot treated systemically with toxic medications which adversely affect mental health and quality of life, when it seems to be confined to the eyes?

10.What does the link to HLA A29 mean in relation to treatment?

11.  What is the risk/benefit analysis of toxic treatment to prevent blindness versus blindness?

12.  What are the long term costs to health and social care of blindness which could have been prevented through the use of off license or off label medications?

13.  Is Birdshot best treated by ophthalmologists or should a clinical specialism of immunology be developed?

14.  Can holistic therapies such as acupuncture, meditation, hypnotherapy help in preventing or treating Birdshot?

15.  Can supplements, such as vitamin D or other therapies treat Birdshot less toxically than current medications?

 

Updated Interaction Advice for Simvastatin | Reanna7 | Page 3

Accessing unlicensed medications

The Medicines and Healthcare products Regulatory Agency (MHRA) is the agency that regulates all new medicines.  They weigh up the risks and benefits of each new medicine, following the completion of phase III trials and then decide whether to license it or not.  Some of us with Birdshot will know that we are unable to get some medications that may be licensed elsewhere (e.g. in the US) or that have been tested at phase III trials, but have to go through the sometimes lengthy procedure to be licensed.

The MHRA is now consulting on whether they should provide early access to medicines before they are formally licensed.  The consultation period ends on 5 October, and if the MHRA goes ahead with this scheme, it may mean that those of us who have tried all the more traditional approaches to controlling our Birdshot without success can get hold of newer medications earlier.

There are a few provisos, of course!  The scheme will be voluntary and limited to medicines that show a “significant advance in treatment in an area of unmet need”.  The MHRA also expects to limit the scheme to only one or two medicines each year.  Finally, the scheme will be limited to those medicines that have reached phase III trials (apart from exceptional cases – yet to be defined).  If this scheme goes ahead, the MHRA will provide an opinion of the risks and benefits of the medicine on its web site to help clinicians and patients decide, and it would then be up to the funding body (your local clinical commissioning group made up of GPs in your area; or specialist commissioning group) to decide whether to fund the medicine or not.

So, even if the scheme is launched, there will still be hurdles to jump over, but at least it provides hope for those of us who are struggling to get hold of medicines on the NHS which are not licensed here.

It would be really, really helpful if our patient and professional members could give their comments to the MHRA

To read more about the proposed scheme, please click on the link below:

http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON174774

If you want to give your comment on this scheme, you can email earlyaccess@mhra.gsi.gov.uk by 5 October 2012