Wednesday, February 9, 2022
Okla. AG OKs Prescribing Ivermectin, Hydroxychloroquine
Oklahoma Attorney General John O'Connor said Tuesday his office has found no legal basis for medical boards to discipline doctors for prescribing ivermectin or hydroxychloroquine to treat COVID-19.
The U.S. Food and Drug Administration has approved ivermectin for use by people and animals for some parasitic worms, head lice and skin conditions. However, the FDA has not approved its use to treat or prevent COVID-19 in humans. Also, no scientific studies have found the anti-malaria drug hydroxychloroquine effective in preventing or treating COVID-19.
O'Connor said in a statement that his office neither condones nor condemns a specific course of treatment for COVID-19.
"I stand behind doctors who believe it is in their patients' best interests to receive ivermectin and hydroxychloroquine," O'Connor said.
A northwest Arkansas jail and its doctor are being sued by inmates who say they were unknowingly given ivermectin to treat COVID-19, despite health officials' warnings that the drug shouldn't be used for that purpose.
Chronic Marijuana Use Linked to Recurrent Stroke
Young adults hospitalized for a stroke are much more likely to be admitted for a recurrent stroke if they have cannabis use disorder (CUD), new observational research suggests.
 Akhil Jain "Our analysis shows young marijuana users with a history of stroke or transient ischemic attack remain at significantly high risk for future strokes," lead study author, Akhil Jain, MD, a resident physician at Mercy Fitzgerald Hospital in Darby, Pennsylvania, told theheart.org | Medscape Cardiology. "It's essential to raise awareness among young adults about the impact of chronic habitual use of marijuana, especially if they have established cardiovascular risk factors or previous stroke." The study will be presented during the 2022 International Stroke Conference (ISC) being held in New Orleans and online February 9 to 11. An increasing number of jurisdictions are allowing marijuana use. To date, 18 states and the District of Columbia have legalized recreational cannabis use, the investigators note. |
Research suggests CUD — defined as the chronic habitual use of cannabis — is more prevalent in the young adult population. But Jain said the population of marijuana users is "a changing dynamic."
Cannabis use has been linked to an increased risk for first-time stroke or transient ischemic attack (TIA). Traditional stroke risk factors include hypertension, diabetes, and diseases related to blood vessels or blood circulation, including atherosclerosis.
Young adults might have additional stroke risk factors, such as behavioral habits like substance abuse, low physical activity, and smoking, oral contraceptives use among females, and brain infections, especially in the immunocompromised, said Jain.
Research from the American Heart Association (AHA) shows stroke rates are increasing among adults 18 to 45 years of age. Each year, young adults account for up to 15% of strokes in the United States.
Prevalence and risk for recurrent stroke in patients with previous stroke or TIA in cannabis users have not been clearly established, the researchers point out.
For this new study, Jain and colleagues used data from the National Inpatient Sample from October 2015 to December 2017. They identified hospitalizations among young adults 18 to 44 years of age with a previous history of stroke or TIA.
They then grouped these patients into those with CUD (4,690) and those without CUD (156,700). The median age in both cohorts was 37 years.
The analysis did not include those who were considered in remission from CUD.
Results showed that 6.9% of those with CUD were hospitalized for a recurrent stroke, compared with 5.4% of those without CUD (P < .001).
After adjustment for demographic factors (age, sex, race, household income), and pre-existing conditions, patients with CUD were 48% more likely to be hospitalized for recurrent stroke than those without CUD (odds ratio, 1.48; 95% CI, 1.28 - 1.71; P < .001).
Compared with the group without CUD, the CUD group had more men (55.2% vs 40.2%), more African American people (44.6% vs 37.2%), and more use of tobacco (73.9% vs 39.6%) and alcohol (16.5% vs 3.6%). They also had a greater percentage of chronic obstructive pulmonary disease, depression, and psychoses.
But a smaller percentage of those with CUD had hypertension (51.3% vs 55.6%; P = .001) and diabetes (16.3% vs 22.7%; P < .001), which is an "interesting" finding, said Jain.
"We observed that even with a lower rate of cardiovascular risk factors, after controlling for all the risk factors, we still found the cannabis users had a higher rate of recurrent stroke."
He noted this was a retrospective study without a control group. "If both groups had comparable hypertension, then this risk might actually be more evident," said Jain. "We need a prospective study with comparable groups."
Living in low-income neighbourhoods and in northeast and southern regions of the United States was also more common in the CUD group.
The study did not investigate the possible mechanisms by which marijuana use might increase stroke risk, but Jain speculated that these could include factors such as impaired blood vessel function, changes in blood supply, an increased tendency of blood clotting, impaired energy production in brain cells, and an imbalance between molecules that harm healthy tissue and the antioxidant defences that neutralize them.
As cannabis use may pose a different risk for a new stroke, as opposed a previous stroke, Jain said it would be interesting to study the amount of "residual function deficit" experienced with the first stroke.
The new study represents "foundational research" upon which other research teams can build, said Jain. "Our study is hypothesis-generating research for a future prospective randomized controlled trial."
A limitation of the study is that it did not consider the effect of various doses, duration, and forms of cannabis abuse, or use of medicinal cannabis or other drugs.
Robert L. Page II, PharmD, professor, Departments of Clinical Pharmacy and Physical Medicine/Rehabilitation, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, provided a comment on this new research.
A CUD diagnosis provides "specific criteria" with regard to chronicity of use and reflects "more of a physical and psychological dependence upon cannabis," said Page, who chaired the writing group for the AHA 2020 cannabis and cardiovascular disease scientific statement.
He explained what sets people with CUD apart from "run-of-the-mill" recreational cannabis users is that "these are individuals who use a cannabis product, whether it's smoking it, vaping it, or consuming it via an edible, and are using it on a regular basis, in a chronic fashion."
The study received no outside funding. The authors report no relevant disclosures.
International Stroke Conference 2022. Abstract 139.
Ill. gov to lift indoor mask mandate for most places by end of February
Illinois Gov. J.B. Pritzker (D) announced his intention to lift the state's indoor mask mandate for most places by the end of February, though the decision would not affect K-12 schools, WGN-TV reported.
The indoor mask mandate will be lifted in most places by Feb. 28, Pritzker said ahead of an expected announcement regarding details of the plan, according to the local news outlet.
"My intention is as we've seen these numbers peak at about 7,400 hospitalizations, and heading downward significantly — we're now I think under 2,500 hospitalizations, so that's almost a third of where we were at the peak and heading even further downward — to lift the mask mandate in the indoor locations by Feb. 28," the governor said in a press conference on Wednesday ahead of his expected announcement, according to NBC Chicago.
Noting that COVID-19 conditions were improving across the state, he acknowledged that K-12 schools were still “sensitive locations.”
“Of course, we still have the sensitive locations of K-12 schools, where we have lots of people who are, you know, joined together in smaller spaces, thousands of people interacting in one location at a time,” Pritzker said, according to NBC Chicago. “And so that's something that will come weeks hence. But very importantly, things are getting better across the state of Illinois."
New York Gov. Kathy Hochul (D) sounded a similar note on Wednesday, saying that both the indoor mask and vaccine requirements for her state would end on Thursday while noting that schools would still require masks to be worn.
But health officials are urging states against relaxing COVID-19 measures, which some worry is premature. Centers for Disease Control and Prevention Director Rochelle Walensky said during a White House briefing on Wednesday that recommendations to relax mask mandates were not yet being issued by the agency.
"We are working on that guidance," Walensky said, but "our hospitalizations are still high, our death rates are still high. So as we work towards that and as we are encouraged by the current trends, we are not there yet."
After Fabry Trial Setback, Avrobio Hopes Rebound With Lysosomal Storage Disorder Data
Avrobio Inc's
gene therapy for a rare lysosomal storage disorder showed potential durability in the first three patients more than one year after infusion.- The data comes from a Phase 1/2 trial testing the safety and efficacy of AVR-RD-04 for cystinosis who had previously been given cysteamine, which is a standard treatment that reduces the buildup of cystine crystals in the kidneys for people with the inherited disease.
- The first three patients on the gene therapy, dubbed AVR-RD-04, remain off oral cysteamine between 12 and 26 months after the treatment infusion.
- A fourth patient received the therapy in November 2021. None of the patients have experienced adverse events to date.
- In January, the Company axed its Fabry disease gene therapy program.
- Biopsies of the skin and intestinal mucosa, or the inner lining of the intestinal tract, showed the gene therapy led to one-year reductions in average crystals per cell of 35%, 64%, and 81% in the three patients.
- Rectal biopsies showed a 53% reduction in the first patient after 18 months, and the other two patients experienced drops of 28% and 86% after 12 months.
- The Company expects to initiate the AVROBIO-sponsored trial in 2023 in the U.S.