Study: Statins & Cerebral Malaria

Photo Credit CDC

 

# 6808

 

 

Increasingly, statins – common cholesterol lowering drugs – are being looked at for their inflammation-reducing properties in the treatment of other diseases.

 

Long time readers of this blog will recall that Dr. David Fedson - former Professor of Medicine at the University of Virginia School of Medicine and formerly Director of Medical Affairs, Aventis Pasteur MSD – has advocated research into the potential role of low-cost statins during an influenza pandemic (see Lancet: David Fedson On Statins For Pandemic Influenza).

 

For more on statins, and how they might be used against pandemic influenza, you may wish to revisit:

 

Study: Statins, Influenza, & Mortality

Another Study On Statins And Pneumonia

Dr. David Fedson: The Case For Using Statins In A Pandemic

Statins Revisited

 

A couple of years ago we saw a video presentation at the 2010 ICAAC Conference called A Role for Statins in Infectious Disease? #ICAAC) (excerpt below).

 

Statins are well-known as a class of drugs that are used to help lower cholesterol but recent evidence suggests they might be good for more than your heart. They may play a role in preventing and treating certain bacterial infections including pneumonia and sepsis. Presenters at ICAAC discuss the latest research on the potential of these drugs.

• Reimar Thomsen, Aarhus University Hospital, Aalborg, Denmark
• Matthew Falagas, Alfa Institute of Biomedical Sciences, Athens, Greece
• Nasia Safdar, University of Wisconsin, Madison, WI, United States

 

These presenters suggest that statins may directly affect viruses and fungi, as well as help dampen the body’s inflammatory response. One study discussed found a 30% reduction in 30-day pneumonia mortality among patients already on statins.

 

The caveat being that much of the evidence for statins efficacy comes from in vitro studies, or observational studies that can sometimes be influenced by what is known as the `healthy user bias’.  

 

Simply put, patients who are already on statins when they develop pneumonia, sepsis, or influenza may be more likely to have a healthy lifestyle than those not on statins, potentially skewing the results.

 

Still, the results to date have been intriguing, if not totally convincing.

 

Which brings us to a a new study, appearing in PloS Pathogens, that looks at the potential role of statins in the treatment of cerebral Malaria.

 

According to the WHO:

There were about 219 million cases of malaria in 2010 and an estimated 660 000 deaths. Africa is the most affected continent: about 90% of all malaria deaths occur there.

 

Between 2000 and 2010, malaria mortality rates fell by 26% around the world. In the WHO African Region the decrease was 33%. During this period, an estimated 1.1 million malaria deaths were averted globally, primarily as a result of a scale-up of interventions.

 

Rarely mentioned in all of these figures are the (often life-long) neurological sequelae that cerebral malaria may produce, particularly among children.

 

These may include blindness, epilepsy, decreased motor skills, hearing impairment, aphasia (loss of speech), and behavioral problems, as noted in the following BMC Research Note.

 

 

Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children

Richard Idro, Angelina Kakooza-Mwesige, Stephen Balyejjussa, Grace Mirembe, Christine Mugasha, Joshua Tugumisirize and Justus Byarugaba

Conclusions

In addition to previously described neurological and cognitive sequelae, severe behaviour problems may follow cerebral malaria in children. The observed differences in patterns of sequelae may be due to different pathogenic mechanisms, brain regions affected or extent of injury. Cerebral malaria may be used as a new model to study the pathogenesis of ADHD.

 

The PloS Pathogens study, which looks at the potential use of statins for cerebral malaria in a murine (mouse) model, involved infecting lab mice with the malaria parasite, and then treating half of them with just chloroquine, and the other half with chloroquine and Lovastatin. 

 

Mice that received the combination treatment saw a significantly reduced rate of post-infection cognitive dysfunction.

 

Statins Decrease Neuroinflammation and Prevent Cognitive Impairment after Cerebral Malaria

Patricia A. Reis mail, Vanessa Estato, Tathiany I. da Silva, Joana C. d'Avila, Luciana D. Siqueira, Edson F. Assis, Patricia T. Bozza, Fernando A. Bozza, Eduardo V. Tibiriça, Guy A. Zimmerman, Hugo C. Castro-Faria-Neto

Author Summary

Cerebral malaria (CM) is the direst consequence of Plasmodium falciparum infection. Cognitive impairment is a common sequela in children surviving CM. Identification of adjunctive therapies that reduce the complications of CM in survivors is a priority. Statins have been suggested for the treatment of neuroinflammatory disorders due to their pleiotropic effects.

 

Here, we examined the effects of lovastatin on neuroinflammation in experimental CM, and its effect on the prevention of cognitive impairment. Lovastatin reduced adhesion and rolling of leukocytes in brain vessels, inhibited blood-brain barrier disruption, and reversed decreases in cerebral capillary density. Lovastatin also inhibited ICAM-1 and CD11b mRNA expression while increasing HMOX-1 mRNA levels. Proinflammatory cytokines and markers of oxidative stress were lower in the brains of infected mice treated with lovastatin.

 

Lovastatin administered together with antimalarial drugs during the acute phase of the disease-protected survivors from impairment in both contextual and aversive memory 15 days after infection. Similar results were observed in a model of bacterial sepsis.

 

Our findings support the possibility that statins may be valuable pharmacologic tools in treatment of patients with neuroinflammation associated with severe systemic inflammatory syndromes. Clinical trials with statins in CM and sepsis should be speedily considered to examine this point.

Of course, what works in mice isn’t guaranteed to work in humans.  The authors caution:

 

These models may provide important insights into the pathogenesis of cognitive dysfunction associated with cerebral malaria and related disorders that may be relevant to human conditions [7]. While differences between murine models of CM and the human syndrome are often emphasized [10], [11], there are also important similarities [3], [7], [12]–[14]. Nevertheless, caution must be exerted when translating experimental findings to the clinical scenario.

 

 

The VOA has a nice write up of this study (see Mice Study Indicates Cholesterol Drug Might Help Treat Serious Malaria Cases), including an interview with one of the authors, who recommends that:

 

Zimmerman recommends lovastatin be added to treatments for malaria as well as for sepsis, a systemic blood infection commonly known as blood poisoning that sickens and threatens the lives of more people worldwide than cerebral malaria.

 

The problem with statins is that these are are cheap, generic drugs.  They provide little financial incentive for their manufacturers to mount expensive human trials in order to prove their effectiveness against malaria, pneumonia, sepsis, or influenza.

 

So, while the evidence continues to suggest benefits to using statins for `off label’ purposes,  real proof of their effectiveness may be a long time in coming.

Lancet: David Fedson On Statins For Pandemic Influenza

 

Photo Credit CDC PHIL

# 6307

 

Dr. David Fedson – former Professor of Medicine at the University of Virginia School of Medicine and formerly Director of Medical Affairs, Aventis Pasteur MSD - has long championed the idea that we should be looking at statins for pandemic flu, which he believes may help modulate the immune response.

 

If they can be proved effective, statins have the advantage of being cheap, easy to manufacture and distribute, and have relatively few side effects.

 

A couple of earlier papers from Dr. Fedson include:

 

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis

David S. Fedson

New Approaches to Confronting an Imminent Influenza Pandemic

Dr. Fedson and Peter Dunnill, DSc,FREng

 

 

The big `if’ in all of this is just how beneficial statins really are for pandemic influenza, and while we’ve a number of encouraging studies, not all have shown positive results.

A quick roundup includes:

 

Statin drugs lower respiratory death risk: study

Tue Apr 10, 2007 12:40pm EDT

By Maggie Fox, Health and Science Editor

 

A study presented in October of 2009 at the annual meeting of the IDSA, the Infectious Diseases Society of America, in Philadelphia suggested that statins cut the mortality rate for seasonal flu by 50%.

 

Maryn McKenna writing for CIDRAP brought us the details.

 

Statins may help patients with severe seasonal flu

Maryn McKenna Contributing Writer

Oct 29, 2009 (CIDRAP News) – Commonly available drugs that are sold in lower-cost generic versions improve the survival of patients hospitalized for seasonal influenza, researchers reported today, raising the possibility of a widely available treatment that could be used in a severe flu pandemic if other drugs are in short supply.

 

Again in 2011, a study by the London School of Hygiene and Tropical Medicine published in the BMJ –looked at 6 month post-pneumonia survival rates among those taking statins, and those not taking these medications.

 

While there may have been other factors at work - survival rates were considerably higher (87% vs 80%) among those already taking statins when they fell ill  (see Statins & Pneumonia: Revisited).

 

But not all of the studies have been positive.

 

In July of 2009 there was a report that found no evidence of benefit among pneumonia patients (see Another Take On Statins And Pneumonia) taking statins.

 

 

So while not all of these studies are in agreement, many of them have supported the notion that statins may be of considerable value during a pandemic, and may contribute to the survival rate of patients with pneumonia.

 

Which brings us to a short op-ed piece in The Lancet today, where Dr. Fedson and Steven M. Opal write on what they see as the practical response to the H5N1 transmission study controversy.

 

 

The Lancet Infectious Diseases, Volume 12, Issue 5, Pages 364 - 365, May 2012

doi:10.1016/S1473-3099(12)70079-8

Research into transmissibility of influenza A H5N1: a practical response to the controversy

David S Fedson , Steven M Opal

 

Access to this article requires free registration.

 

The authors maintain that the real issue is not whether or not the controversial H5N1 studies should be published, but rather, why influenza scientists and their sponsors have not undertaken serious research into the efficacy and effectiveness of immunomodulatory agents (like statins) in treating pandemic flu.

 

Unfortunately, the answer to that question may simply boil down to the fact that since many statins are off-patent - and can sold generically for pennies a pill - there is little financial incentive for the pharmaceutical industry to invest a lot of money into laboratory and clinical research.

Assuming the real priority is saving lives during a pandemic, what is needed is government sponsorship of appropriate research, or a private support by a non-profit organization with deep pockets.

 

For more on statins, and their potential role in pandemic influenza, you may wish to revisit:

 

Study: Statins, Influenza, & Mortality

Another Study On Statins And Pneumonia

Dr. David Fedson: The Case For Using Statins In A Pandemic

First Statins, Now Fibrates

Statins Revisited

Study: Statins, Influenza, & Mortality

 

 

 

# 6008

 

We’ve a study today that lends additional weight to the argument that statins – a class of cholesterol lowering drugs – may have a role to play in the treatment of influenza.

 

This would be of particular value during a severe pandemic, when the world would need a cheap (preferably generic) medication that is shelf stable, easy to dispense, has a low incidence of side effects, and can reduce influenza morbidity and mortality.

 

That’s a tall order, but there are some researchers who believe that statins might fit the bill.

 

Over the years we’ve seen a number of studies that have suggested that taking statins can improve survival rates among those with influenza and/or pneumonia.

 

The idea of using them in a pandemic has been largely championed by Dr. David Fedson – former Professor of Medicine at the University of Virginia School of Medicine and formerly Director of Medical Affairs, Aventis Pasteur MSD who has urged that scientists look seriously at statins, which he believes may help modulate the immune response.

 

A couple of his papers on the subject include:

 

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis

David S. Fedson

New Approaches to Confronting an Imminent Influenza Pandemic

Dr. Fedson and Peter Dunnill, DSc,FREng

 

While we’ve seen a number of studies (see here, here, and here) supporting the notion that statins might reduce mortality due to pneumonia and/or influenza, not every study has been positive.

 

In July of 2009 there was a report that found no evidence of benefit among pneumonia patients (see Another Take On Statins And Pneumonia) taking statins.

 

Today, from the IDSA’s Journal of Infectious Disease we have a new study that looked at the 30 day survival rates of hospitalized influenza patients either taking, or not taking, statins. 

 

They found, after adjusting for:

• age;
• race;
• cardiovascular, pulmonary, and renal disease;
• influenza vaccination and antiviral administration

 

Those not already on statins, or placed on statins during their hospital stay, were nearly twice as likely to die within 30 days of hospitalization as those who received statins.

 

A cautionary note: This was an observational study, not a Randomized Controlled Trial – and so there may have been confounding factors not adjusted for by the authors. Additionally, this study did not attempt to track the amount of statins used by patients during their hospitalization.

 

First a link to the study’s abstract, followed by a few excerpts to the press release, and then a link to an accompanying editorial.

 

 

Association Between Use of Statins and Mortality Among Patients Hospitalized With Laboratory-Confirmed Influenza Virus Infections: A Multistate Study

J Infect Dis. jir695 first published online December 13, 2011 doi:10.1093/infdis/jir695

Meredith L. Vandermeer, Ann R. Thomas, Laurie Kamimoto, Arthur Reingold, Ken Gershman, James Meek, Monica M. Farley, Patricia Ryan, Ruth Lynfield, Joan Baumbach, William Schaffner, Nancy Bennett and Shelley Zansky

 

Since the bulk of this study is behind a pay wall, the press release from the IDSA provides some valuable details.

 

Infectious Diseases Society of America

Statins may reduce mortality in patients hospitalized with influenza

[EMBARGOED FOR DEC. 14, 2011] The two main ways to prevent and control influenza today are annual immunization and antiviral drugs. A team of investigators has found that statins, cholesterol-lowering drugs, may offer an additional treatment to complement these approaches and reduce mortality among patients hospitalized with influenza. The findings are published in The Journal of Infectious Diseases and are now available online.

 

In an observational study led by Meredith L. Vandermeer, MPH, then with the Oregon Public Health Division in Portland, researchers used data for hospitalized adults during the 2007-2008 influenza season to evaluate the association between patients prescribed statins and influenza-related deaths. The data were drawn from the Centers for Disease Control and Prevention's Emerging Infections Program, which conducts active surveillance for patients hospitalized with confirmed influenza in 59 counties in 10 states.

 

Among 3,043 hospitalized patients with laboratory-confirmed influenza, 33 percent were given statin medications prior to or during hospitalization. After adjusting for various factors, patients not receiving statins were almost twice as likely to die from influenza as those who did receive the medication.

 

"Our study found that statins were associated with a decrease in odds of dying among cases hospitalized with laboratory-confirmed influenza, when adjusted for age, race, cardiovascular disease, chronic lung disease, renal disease, influenza vaccine receipt, and initiation of antivirals within 48 hours of admission," the study authors wrote.

(Continue . . .)

 

You’ll find an accompanying editorial, also published today, titled:

 

Statins and Influenza: Can We Move Forward?

Edward E. Walsh

 

More than 2 years ago, the Reveres at the now shuttered Effect Measure Blog took an in depth look at the statin controversy, and why we still don’t know if they are effective against influenza.

 

While the Revere’s are greatly missed in Flublogia, that archive is still online, and very much worth revisiting.

 

Statins for influenza. Why don't we know if it works yet?

Category: Infectious disease • Influenza treatment

Statins for influenza are in the news again, this time because of a paper given at the Annual Meeting of the Infectious Disease Society of America (IDSA). We'll get to it in a moment, but first a little background.

Read on »

 

 

For more on the potential utilization of statins during a pandemic, or for seasonal influenza and pneumonia, you may wish to revisit these earlier blogs:

 

Statins & Pneumonia: Revisited

Statins Revisited

First Statins, Now Fibrates

Statins & Pneumonia: Revisited

 

# 5465

 

 

The idea certainly isn’t new.  

 

If fact, I mentioned it in this blog as far back as 2006, and have written about it extensively probably a dozen times since then.  

 

While unproven, and not without controversy, over the years we’ve seen several studies suggesting that taking statins - cholesterol reducing drugs - can improve survival rates among those with influenza and/or pneumonia.

 

Dr. David Fedson – former Professor of Medicine at the University of Virginia School of Medicine and formerly Director of Medical Affairs, Aventis Pasteur MSD - has long championed the idea that we should be looking at statins for pandemic flu, which he believes may help modulate the immune response.

 

A couple of his papers on the subject include:

 

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis

David S. Fedson^a

 

New Approaches to Confronting an Imminent Influenza Pandemic

Dr. Fedson and Peter Dunnill, DSc,FREng

 

 

In 2007 we saw a study that seemed to support the idea, one that indicated that statins lowered the mortality rate of people with pneumonia.

 

 

Statin drugs lower respiratory death risk: study

Tue Apr 10, 2007 12:40pm EDT

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.

 

And in 2008 this encouraging report made the headlines:

 

Statins may cut pneumonia death, blood clot risks

27 Oct 2008 20:00:13 GMT

Source: Reuters

By Will Dunham

WASHINGTON, Oct 27 (Reuters) - Cholesterol-fighting drugs known as statins reduced the risk of dying from pneumonia or developing dangerous blood clots in the legs, adding to a growing list of benefits from the popular drugs, two research groups said on Monday.

 

 

But not all of the studies have been positive.

 

In July of 2009 there was a report that found no evidence of benefit among pneumonia patients (see Another Take On Statins And Pneumonia) taking statins.

 

 

But another study, presented in October of 2009 at the annual meeting of the IDSA, the Infectious Diseases Society of America, in Philadelphia suggested the opposite - that statins cut the mortality rate for seasonal flu by 50%.

 

Maryn McKenna writing for CIDRAP brought us the details.

 

Statins may help patients with severe seasonal flu

Maryn McKenna Contributing Writer

Oct 29, 2009 (CIDRAP News) – Commonly available drugs that are sold in lower-cost generic versions improve the survival of patients hospitalized for seasonal influenza, researchers reported today, raising the possibility of a widely available treatment that could be used in a severe flu pandemic if other drugs are in short supply.

 

 

So while not all of these studies are in agreement, many of them have supported the notion that statins may be of considerable value during a pandemic, and may contribute to the survival rate of patients with pneumonia.

 

 

Today we’ve another study – this time by the London School of Hygiene and Tropical Medicine published in the BMJ – that looks at 6 month post-pneumonia survival rates among those taking statins, and those not taking these medications.

 

While there may be other factors at work here – and more research is needed - survival rates were considerably higher (87% vs 80%) among those already taking statins when they fell ill.

 

As of this posting, the study has not appeared on the BMJ website.  I assume it will shortly. 

 

Here are excerpts from the LSHTM press release:

 

 

Pneumonia death rate lower among people who take statins

Tuesday, 5 April 2011

LSHTM study finds evidence for protective effect of cholesterol-lowering medication

 

Taking statins could help prevent people dying from pneumonia, according to a study by the London School of Hygiene and Tropical Medicine.

 

The researchers found that the risk of death in the six month period after diagnosis of pneumonia was substantially lower among those who were already receiving the cholesterol-lowering drugs compared with those who were not.

 

Previous studies have suggested that statins may be associated with a more favourable outcome after bacterial infection.

 

This study, published online in the BMJ today, supports a possible protective effect of statins against mortality in patients with pneumonia.

 

But the researchers point out that as they looked at patients who were already taking the medication when they developed pneumonia, a randomised clinical trial is needed to determine whether starting a statin at the time of diagnosis has a similar effect.

(CONTINUE  . . . . )

Notes to Editors:

Title of study online at BMJ: “Effect of statin treatment on short term mortality after pneumonia episode: cohort study” by Ian Douglas, Stephen Evans and Liam Smeeth.

 

 

The $64 question is whether administering statins after a pneumonia diagnosis provides any protective benefits.  There are reasons to believe that it might, but further studies are needed to prove or disprove it.

 

If you’d like to learn more about Dr. David Fedson and some of his ideas on statins, there are three 1-hour radio interviews available from 2009 that were conducted by Sharon Sanders of FluTrackers. 

 

You’ll find them archived at the FluTrackers links below.

 

David Fedson 06 April 2009

http://www.flutrackers.com/forum/aud...pril062009.mp3

David Fedson 18 May 2009

http://www.flutrackers.com/forum/aud...May18.2009.mp3

David Fedson 02 November 2009

http://www.flutrackers.com/forum/aud...Nov02.2009.mp3

Dr. David Fedson: The Case For Using Statins In A Pandemic

 

 

# 4750

 

 

During a major influenza pandemic, millions of people could fall desperately ill during the first few months.  Pharmaceutical interventions – like vaccines – take months to produce and distribute, and antivirals are in short supply as well. 

 

What the world really needs is a cheap (preferably generic) medication that will help treat severe influenza cases.

 

Ideally it would be a shelf stable pill, one that is easy to dispense, has a low incidence of side effects, and can reduce influenza morbidity and mortality.

 

A tall order.    But perhaps not impossible to fill.

 

At least, that’s the hope of a number of scientists who are looking into whether statins, or corticosteroids (or a combination of the two), might prove effective in reducing some of the most serious flu symptoms.

 

Dr. David Fedson has long championed the idea that we should be investigating statins and other cheaper drugs that may help modulate the immune response.

 

Fedson is a former Professor of Medicine at the University of Virginia School of Medicine and was formerly Director of Medical Affairs, Aventis Pasteur MSD.

 

 

A couple of his papers on the subject include:

 

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis

David S. Fedson^a

 

New Approaches to Confronting an Imminent Influenza Pandemic

Dr. Fedson and Peter Dunnill, DSc,FREng

 

In 2007 we saw a study that seemed to support the idea, one that indicated that statins lowered the mortality rate of people with pneumonia.

 

Statin drugs lower respiratory death risk: study

Tue Apr 10, 2007 12:40pm EDT

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.

 

And in 2008 this encouraging report made the headlines:

 

Statins may cut pneumonia death, blood clot risks

27 Oct 2008 20:00:13 GMT

Source: Reuters

By Will Dunham

WASHINGTON, Oct 27 (Reuters) - Cholesterol-fighting drugs known as statins reduced the risk of dying from pneumonia or developing dangerous blood clots in the legs, adding to a growing list of benefits from the popular drugs, two research groups said on Monday.

 

Of course, not all of the studies have been positive.

  

Last July there was a report that found no evidence of benefit among pneumonia patients (see Another Take On Statins And Pneumonia) taking statins.

 

But another study, presented in October of last year at the annual meeting of the IDSA, the Infectious Diseases Society of America, in Philadelphia suggested the opposite - that statins cut the mortality rate for seasonal flu by 50%.

 

Maryn McKenna writing for CIDRAP brought us the details.

 

Statins may help patients with severe seasonal flu

Maryn McKenna Contributing Writer

Oct 29, 2009 (CIDRAP News) – Commonly available drugs that are sold in lower-cost generic versions improve the survival of patients hospitalized for seasonal influenza, researchers reported today, raising the possibility of a widely available treatment that could be used in a severe flu pandemic if other drugs are in short supply.

 

So while not all of these studies are in alignment, many of them do support the idea that statins may be of considerable value during a pandemic.

 

Which brings us to a guest editorial posted today on the Center For Biosecurity’s Clinicians’ Biosecurity Network website.  

 

I’ve just reproduced the opening paragraph.  By all means, you’ll want to follow the link to read it in its entirety.

 

An Alternative Approach to Pandemic Influenza That Clinicians Everywhere Could Use

By David S. Fedson, MD, July 23, 2010

The initial waves of the first influenza pandemic of the 21st Century have passed. Despite the best efforts of influenza scientists, health officials, and companies, more than 90% of the world’s people did not have timely access to affordable supplies of vaccines and antiviral agents. Instead, they had to rely on 19th Century public health “technologies.” They should have (and probably could have) had something better.^1-5

(Continue . . . )

Investigating Statins And Steroids For Flu

 

 

# 3978

 

During a major influenza pandemic, a billion people . . .perhaps more, could fall seriously ill over the course of a few months. 

 

Vaccines take months to produce, and our production and distribution capacity is woefully inadequate for a planet of nearly 7 billion people.  

 

Antivirals are in short supply as well, and very expensive to boot.

 

What the world desperately needs is a cheap (preferably generic) medication that will help treat severe influenza cases.  It needs to be a shelf stable pill, that is easy to dispense, has a low incidence of side effects, and can reduce influenza morbidity and mortality.

 

A tall order.    But perhaps not impossible to fill.

At least, that’s the hope of a number of scientists who are looking into whether statins, or corticosteroids (or a combination of the two), might prove effective in reducing some of the most serious flu symptoms.

 

This is a subject we’ve covered many times before, most recently about two weeks ago in Statins Revisited.   The Reveres at Effect Measure have discussed this often as well, with their most recent essay being  Statins for influenza. Why don't we know if it works yet?.

 

 

Dr. David Fedson has long championed the idea that we should be investigating statins and other cheaper drugs that may modulate the immune response. Fedson is a former Professor of Medicine at the University of Virginia School of Medicine and was formerly Director of Medical Affairs, Aventis Pasteur MSD.

 

Fedson is the author of a number of journal articles, and in recent years has devoted a great deal of attention to how we can meet the challenge of a global pandemic.

 

Last March Fedson was interviewed on FluTrackers  by Sharon Sanders in the wake of the publication of his latest article in the CDC’s Journal of Emerging Infectious Disease, entitled Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries.

 

An overview of his work, including the recent FluTrackers Interview may be viewed on the following two blogs:

 

Fedson On Meeting The Challenge Of A Pandemic

FluTrackers Interview With Dr. David Fedson

 

Over night, Helen Branswell of The Canadian Press published a terrific article on new studies that intend to investigate these drugs to see if they could help save lives in this pandemic.

 

As with any Branswell article, it is absolutely worth your time to follow the link and read it in its entirety.

 

Can cheap drugs help save H1N1 patients? Studies aim to find out

By Helen Branswell Medical Reporter (CP) – 15 hours ago

TORONTO — Can cheap and readily available treatments like steroids and cholesterol-lowering statin drugs help save the sickest of H1N1 patients? New efforts by researchers in Canada, the United States and France could help answer this pressing question.

 

Randomized controlled studies looking at whether corticosteroids, statins or a combination of the two could contribute to improved survival rates in gravely ill pandemic flu patients are being organized in the three countries by linked networks of intensive care specialists, according to Dr. John Marshall, chair of the Canadian Critical Care Trials Group.

 

The aim is to try to gather data fast enough to answer the questions in real time, a goal that eluded researchers during SARS.

 

Toronto physicians treating SARS cases tried to mount a clinical trial to see whether the antiviral drug ribavirin - which was routinely given to SARS patients for lack of other options - was actually helping. But before the trial could be approved, the disease disappeared.

 

The same could happen with this effort, admits Marshall, a trauma surgeon and critical-care specialist at Toronto's St. Michael's Hospital, who says it will take quick work and international collaborations to generate enough data to clarify the role steroids and statins might play in treating H1N1 cases.

 

(Continue . . . )

 

 

        *         *         *         *         *        *          *         *

 

If you’d like to learn more about Dr. David Fedson, there are a couple of 1-hour radio interviews – conducted by Sharon Sanders of FluTrackers – archived on the Radio Sandy Springs website. 

11/02/09 Guest Dr. David Fedson

05/18/09 Guest Dr. David Fedson.

Dr. David Fedson Radio Interview Today

 

 

# 3933

 

 

Later today Dr. David Fedson will be interviewed on Radio Sandy Springs by Sharon Sanders of Flutrackers.

 

The show will air at 4pm EST, on Atlanta's 1620 AM, and will be simulcast on the Internet on Radio Sandy Springs.

 

If you are unable to listen at 4pm, the show is generally repeated at 6pm, and is archived for downloading within a couple of days.  Dr. Fedson’s was interviewed in May by Sharon, and that show may be listened to at 05/18/09 Guest Dr. David Fedson.

Fedson is a former Professor of Medicine at the University of Virginia School of Medicine and was formerly Director of Medical Affairs, Aventis Pasteur MSD.

 

Fedson is the author of a number of journal articles, and in recent years has devoted a great deal of attention to how we can meet the challenge of a global pandemic.

 

Last March Fedson was interviewed on FluTrackers by Sharon Sanders in the wake of the publication of his latest article in the CDC’s Journal of Emerging Infectious Disease, entitled Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries.

 

An overview of his work, including the recent FluTrackers Interview may be viewed on the following two blogs:

 

Fedson On Meeting The Challenge Of A Pandemic

FluTrackers Interview With Dr. David Fedson

 

One of the subjects sure to come up will be the potential of using statins – cholesterol lowering drugs – in the treatment of influenza.  An idea that Dr. Fedson has encouraged more research in for years.

I wrote about this subject on Friday in Statins Revisited as did Revere at Effect Measure in Statins for influenza. Why don't we know if it works yet?.

 

      *       *       *      *      *      *      *      *      *      *      *

 

Radio Sandy Springs 1620 AM, is a low-powered Atlanta based talk radio station that simulcasts on the Internet.   An archive of recent Infectious Disease Hour shows may be accessed here.

This ought to be an interesting hour, so make plans to listen, or to download the archive when it gets posted next week.

Referral: Effect Measure On Statins

 

 

# 3920

 

Revere over at Effect Measure has a terrific piece today about the frustrating lack of research on statins, which are suspected by some researchers to harbor promise as treatment for influenza.

 

I’d have recommended this blog, even if there wasn’t a very kind hat tip to AFD in it (thanks guys!). 

 

I’ll just step aside and send you to:

 

Statins for influenza. Why don't we know if it works yet?

Category: Infectious disease • Influenza treatment

Statins for influenza are in the news again, this time because of a paper given at the Annual Meeting of the Infectious Disease Society of America (IDSA). We'll get to it in a moment, but first a little background.

Read on »

 

 

As a reminder, Dr. David Fedson will be interviewed on Radio Sandy Springs by Sharon Sanders of FluTrackers this coming Monday, at 4pm (EST).    No doubt, statins will be part of the discussion.

Statins Revisited

 

 

# 3911

 

 

The question as to whether statins – commonly used cholesterol lowering drugs – might play a positive role in the treatment of influenza and pneumonia is one that we’ve discussed numerous times over the years.  

 

We’ve seen a see-sawing of opinion, driven by a parade of conflicting studies.  Today we’ve new research to look at, but first a review of the recent past.

 

Dr. David Fedson was probably the first to champion the idea of using statins for an influenza pandemic. In his paper on the subject, published in July of 2006.

 

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis

David S. Fedson^a

The next influenza pandemic may be imminent. Because antiviral agents and vaccines will be unavailable to people in most countries, we need to determine whether other agents could offer clinical benefits. Influenza is associated with an increase in acute cardiovascular diseases, and influenza viruses induce proinflammatory cytokines.

 

Statins are cardioprotective and have anti-inflammatory and immunomodulatory effects, and they thus might benefit patients with influenza.

 

 

In 2007 we saw a study that seemed to support the idea, that indicated that statins lowered the mortality rate of people with pneumonia.

 

Statin drugs lower respiratory death risk: study

Tue Apr 10, 2007 12:40pm EDT

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.

 

Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.

 

Dr Fedson and Peter Dunnill, DSc,FREng  then collaborated on a commentary, published in the Permanente Journal, Summer 2007 edition, on how we might confront an imminent pandemic.

 

The commentary was called New Approaches to Confronting an Imminent Influenza Pandemic, and in it the authors presented options including two possible routes to producing vaccine in quantity, and the use of statins  to mitigate the effects of a cytokine storm.

 

(More on Dr. Fedson at the bottom of this blog)

 

In January of 2008, Australian researchers announced encouraging results from studies conducted on mice given gemfibrozil, a fibrate, which is another class of cholesterol lowering drug.

 

And just a year ago, in October of 2008, we learned:

 

Statins may cut pneumonia death, blood clot risks

27 Oct 2008 20:00:13 GMT

Source: Reuters

By Will Dunham

WASHINGTON, Oct 27 (Reuters) - Cholesterol-fighting drugs known as statins reduced the risk of dying from pneumonia or developing dangerous blood clots in the legs, adding to a growing list of benefits from the popular drugs, two research groups said on Monday.

 

Statins, the world's top-selling drugs, cut heart attack and stroke risk, and research has suggested other benefits including possibly protecting against Alzheimer's disease.

 

 

Of course, not all of the news was positive.  

 

Just last July we heard that there were no signs of benefit among pneumonia patients (see  Another Take On Statins And Pneumonia), where I reported on this story:

 

Statins don't lower risk of pneumonia in elderly

British Medical Journal study includes 3,000 Group Health patients

SEATTLE— Taking popular cholesterol-lowering statin drugs, such as Lipitor® (atorvastatin), does not lower the risk of pneumonia. That's the new finding from a study of more than 3,000 Group Health patients published online on June 16 in advance of the British Medical Journal's June 20 print issue.

 

"Prior research based on automated claims data had raised some hope—and maybe some hype—for statins as a way to prevent and treat infections including pneumonia," said Sascha Dublin, MD, PhD, a physician at Group Health and assistant investigator at Group Health Center for Health Studies. "But when we used medical records to get more detailed information about patients, our findings didn't support that approach."

 

Conflicting medical studies are nothing new.  We see them all the time.  Science is often messy and we get to the truth by fits and starts – and that can sometimes take years.  

 

Today we’ve news of new research on statins, presented at the annual meeting of the IDSA, the Infectious Diseases Society of America, in Philadelphia.  

 

Maryn McKenna writing for CIDRAP brings us the details.

 

Statins may help patients with severe seasonal flu

Maryn McKenna Contributing Writer

Oct 29, 2009 (CIDRAP News) – Commonly available drugs that are sold in lower-cost generic versions improve the survival of patients hospitalized for seasonal influenza, researchers reported today, raising the possibility of a widely available treatment that could be used in a severe flu pandemic if other drugs are in short supply.

 

The research, by the US Centers for Disease Control and Prevention (CDC) and scientists in several states, is part of a slate of new flu reports being presented this weekend at the annual meeting of the Infectious Diseases Society of America (IDSA) in Philadelphia. Also on the agenda: findings that flu vaccination of pregnant women has a protective effect on their babies both before and after birth, and news of what may be the first person-to-person transmission in the United States of H1N1 flu strains resistant to antiviral drugs.

 

The research presented Thursday examined the effect of the cholesterol-lowering drugs called statins on the clinical course of people who were already taking the drugs and then were hospitalized with lab-confirmed flu infections in the 2007-08 flu season. Those who were already on statins were half as likely to die, Meredith Vandermeer of the Oregon Public Health Division said during a press briefing at the state of the meeting.

 

The patients were identified via surveillance in 10 states conducted by the CDC’s Emerging Infections Programs; data on their lab results, prescriptions and outcome were drawn from reviews of their medical records. There were 2,800 lab-confirmed cases of flu in the surveillance results, Vandermeer said; 801 of those patients were recorded as taking statins during their hospital stay, presumably because they had been prescribed them before admission. Among the 2,800, 17 people who were on statins died, versus 64 were not on statins. Proportionally, that is 2.1% of those on statins and 3.2% of those not taking the drugs—a risk reduction of approximately half, Vandermeer said.

 

(Continue . . .)

 

Maryn’s article has additional details, plus reports on vaccine benefits in pregnant women, and the transmission of resistant H1N1 at a summer camp.   Follow the link to read it in it’s entirety.

 

While not conclusive, this latest study offers some additional tantalizing evidence that statins might someday play a role in the treatment of influenza and pneumonia.  

 

Further studies and controlled trials are needed, of course, before we can know for sure.

 

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Dr. David Fedson, will be interviewed again on Radio Sandy Springs by Sharon Sanders of Flutrackers, at 4pm on Monday, Nov 2nd.  You can listen online, or download the archived show later in the week.

 

Sharon interviewed Dr. Fedson last may, and you can listen to that archived show at 05/18/09 Guest Dr. David Fedson.