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Fatty acids re-enter the MS arena
THE LANCET
SCIENCE AND MEDICINE
A walk a week may reduce gestational diabetes
E
Greenhill Picture LIbrary
morbidly obese women, who are at xtremely overweight women particularly high risk of GDM can cut their risk of developing (Am J Epidemiol 1997; 148: 961–65). diabetes during pregnancy by About 4·5% of overweight women taking a moderate amount of (BMI 29–33) and about 1·5% of exercise, according to a report those with a normal from the University of BMI had GDM, Rochester and the regardless of exercise. State University of “We were struck by New York (NY, USA). the high prevalence 10·3% of morbidly of obesity and low obese women (bodyfrequency of exermass index [BMI] >33) cise”, says lead author who took no exercise Tim Dye. “A third of developed gestational the women were sigdiabetes mellitus nificantly overweight (GDM), compared before they became with 5·7% of those who pregnant, and 10% did any exercise one or had morbidly obese more times a week. “A Wheeling or walking helps BMIs.” 58% of all walk in the shopping women did no exercise. mall for half an hour to an hour a There is no obvious explanation couple of times a week is all that is for the study finding that morbidly needed”, says author Raul Artal. obese women who did not exercise The authors collected retrospecand had health insurance were tive information on nearly 13 000 three times more likely to develop women who had delivered a live GDM as their counterparts who infant in central New York State were covered by Medicaid. between Oct 1, 1995, and July 31, 1996. Exercise was associated with reduced rates of GDM only in Dorothy Bonn
Herpesvirus 6 might trigger multiple sclerosis were collected at the National Institute of Health Clinical Center, Bethesda, MD, USA. 73% of relapsing-remitting MS patients were positive for anti-HHV6 p41/38 IgM compared with 18% of normal controls. Also, HHV6 DNA was isolated by PCR in 15 of 50 MS patients, and none of the controls. Lorna Layward, of the UK Multiple Sclerosis Fatty acids re-enter the MS arena Society, notes that MS Laurence Harbige (University of Greenwich and St might be associated Thomas’ Hospital London, UK) reported a potential with two viral infectreatment for MS at the British Society for tions, one early in life Immunology meeting in Brighton, UK (Dec 2–5). and a second around Some long-chain linoleic-acid (LA) metabolites puberty. And Jeremy protect rodents against acute monophasic Garson, virologist at experimental allergic encephalomyelitis and its University College chronic relapsing forms, said Harbige. The London, UK, points to metabolites seem to act via the immune system, he recent evidence for an explained, since in rodents and in healthy volunteers MS-associated retroanti-inflammatory cytokines and eicosanoids are virus. “A herpesvirus upregulated by the fatty acids. A dose-finding trial of . . . may act as a coLA metabolites will start at St Thomas’ in 1998, but factor activating this LA treatment for MS is not new. Two 1970s trials retrovirus and thus showed that 20 g LA daily reduced relapse rate and play some part in the disease severity in patients with low disability. But pathogenesis of MS”, then, said Harbige, the therapy was thought to work he speculates.
uman herpesvirus 6 (HHV6) could be a trigger for multiple sclerosis (MS), according to a report this week. IgM but not IgG responses to an HHV6 early antigen (p41/38) are increased in patients with relapsing-remitting MS compared with other patients and healthy controls (Nat Med 1997; 3: 1394–97). Serum samples from 102 people
H
Shock as troglitazone withdrawn in UK laxoWellcome has shocked its US partner Warner-Lambert by withdrawing the new diabetes drug troglitazone (Romozin) from the UK market, after numerous new reports of hepatotoxicity. Warner-Lambert, which markets the drug in the USA as Rezulin, had already issued an alert on Nov 3 after receiving about 35 reports of liver damage among US and Japanese patients, with one death (see Lancet, Nov 15, p 1451). But after the alert, the reports began to flood in. According to the US Food and Drug Administration, a total of 150 serious reactions have now been reported, including six deaths. The reactions have included hepatic necrosis and failure, with a mean time to onset of 3 months. GlaxoWellcome said its decision was “voluntary”, though taken “with the agreement of the UK Medicines Control Agency”. The company had applied for regulatory approval to market the drug across the European Union but has withdrawn the applications because of the safety issues. Although only one adverse reaction has occurred in the UK, the MCA now says the drug’s risks outweigh its benefits, especially as there are no known risk factors for the adverse reactions. And the MCA also acknowledged that there could be substantial under-reporting of adverse events. Warner-Lambert is clearly shaken, claiming that GlaxoWellcome’s decision is “temporary”, and insisting that the worldwide picture shows a “favourable benefit-to-risk relationship”. But US doctors will this week receive a letter warning them to monitor serum transaminase values in patients taking Rezulin. Warnings of possible liver damage will now be “prominently” featured on the labelling, said the FDA. Sankyo will continue to market troglitazone in Japan as Noscal, with similar labelling changes. About 600 000 US and 200 000 Japanese patients with type 2 diabetes have been prescribed troglitazone since March, plus a further 5000 in the UK since its launch in October. It has been one of the fastest-selling drugs in history, with Rezulin sales estimated at US$137 million in the 3 months to October.
G
by correcting an LA deficiency. Jane Bradbury Peter Moore
Vol 350 • December 6, 1997
Peter Mitchell
1685
SCIENCE AND MEDICINE
A walk a week may reduce gestational diabetes
E
Greenhill Picture LIbrary
morbidly obese women, who are at xtremely overweight women particularly high risk of GDM can cut their risk of developing (Am J Epidemiol 1997; 148: 961–65). diabetes during pregnancy by About 4·5% of overweight women taking a moderate amount of (BMI 29–33) and about 1·5% of exercise, according to a report those with a normal from the University of BMI had GDM, Rochester and the regardless of exercise. State University of “We were struck by New York (NY, USA). the high prevalence 10·3% of morbidly of obesity and low obese women (bodyfrequency of exermass index [BMI] >33) cise”, says lead author who took no exercise Tim Dye. “A third of developed gestational the women were sigdiabetes mellitus nificantly overweight (GDM), compared before they became with 5·7% of those who pregnant, and 10% did any exercise one or had morbidly obese more times a week. “A Wheeling or walking helps BMIs.” 58% of all walk in the shopping women did no exercise. mall for half an hour to an hour a There is no obvious explanation couple of times a week is all that is for the study finding that morbidly needed”, says author Raul Artal. obese women who did not exercise The authors collected retrospecand had health insurance were tive information on nearly 13 000 three times more likely to develop women who had delivered a live GDM as their counterparts who infant in central New York State were covered by Medicaid. between Oct 1, 1995, and July 31, 1996. Exercise was associated with reduced rates of GDM only in Dorothy Bonn
Herpesvirus 6 might trigger multiple sclerosis were collected at the National Institute of Health Clinical Center, Bethesda, MD, USA. 73% of relapsing-remitting MS patients were positive for anti-HHV6 p41/38 IgM compared with 18% of normal controls. Also, HHV6 DNA was isolated by PCR in 15 of 50 MS patients, and none of the controls. Lorna Layward, of the UK Multiple Sclerosis Fatty acids re-enter the MS arena Society, notes that MS Laurence Harbige (University of Greenwich and St might be associated Thomas’ Hospital London, UK) reported a potential with two viral infectreatment for MS at the British Society for tions, one early in life Immunology meeting in Brighton, UK (Dec 2–5). and a second around Some long-chain linoleic-acid (LA) metabolites puberty. And Jeremy protect rodents against acute monophasic Garson, virologist at experimental allergic encephalomyelitis and its University College chronic relapsing forms, said Harbige. The London, UK, points to metabolites seem to act via the immune system, he recent evidence for an explained, since in rodents and in healthy volunteers MS-associated retroanti-inflammatory cytokines and eicosanoids are virus. “A herpesvirus upregulated by the fatty acids. A dose-finding trial of . . . may act as a coLA metabolites will start at St Thomas’ in 1998, but factor activating this LA treatment for MS is not new. Two 1970s trials retrovirus and thus showed that 20 g LA daily reduced relapse rate and play some part in the disease severity in patients with low disability. But pathogenesis of MS”, then, said Harbige, the therapy was thought to work he speculates.
uman herpesvirus 6 (HHV6) could be a trigger for multiple sclerosis (MS), according to a report this week. IgM but not IgG responses to an HHV6 early antigen (p41/38) are increased in patients with relapsing-remitting MS compared with other patients and healthy controls (Nat Med 1997; 3: 1394–97). Serum samples from 102 people
H
Shock as troglitazone withdrawn in UK laxoWellcome has shocked its US partner Warner-Lambert by withdrawing the new diabetes drug troglitazone (Romozin) from the UK market, after numerous new reports of hepatotoxicity. Warner-Lambert, which markets the drug in the USA as Rezulin, had already issued an alert on Nov 3 after receiving about 35 reports of liver damage among US and Japanese patients, with one death (see Lancet, Nov 15, p 1451). But after the alert, the reports began to flood in. According to the US Food and Drug Administration, a total of 150 serious reactions have now been reported, including six deaths. The reactions have included hepatic necrosis and failure, with a mean time to onset of 3 months. GlaxoWellcome said its decision was “voluntary”, though taken “with the agreement of the UK Medicines Control Agency”. The company had applied for regulatory approval to market the drug across the European Union but has withdrawn the applications because of the safety issues. Although only one adverse reaction has occurred in the UK, the MCA now says the drug’s risks outweigh its benefits, especially as there are no known risk factors for the adverse reactions. And the MCA also acknowledged that there could be substantial under-reporting of adverse events. Warner-Lambert is clearly shaken, claiming that GlaxoWellcome’s decision is “temporary”, and insisting that the worldwide picture shows a “favourable benefit-to-risk relationship”. But US doctors will this week receive a letter warning them to monitor serum transaminase values in patients taking Rezulin. Warnings of possible liver damage will now be “prominently” featured on the labelling, said the FDA. Sankyo will continue to market troglitazone in Japan as Noscal, with similar labelling changes. About 600 000 US and 200 000 Japanese patients with type 2 diabetes have been prescribed troglitazone since March, plus a further 5000 in the UK since its launch in October. It has been one of the fastest-selling drugs in history, with Rezulin sales estimated at US$137 million in the 3 months to October.
G
by correcting an LA deficiency. Jane Bradbury Peter Moore
Vol 350 • December 6, 1997
Peter Mitchell
1685