Non-steroidal anti-inflammatory drugs and the risk of oral cancer: a nested case-control study

Biotin-Pt (IV)-indomethacin hybrid: A targeting anticancer prodrug providing enhanced cancer cellular uptake and reversing cisplatin resistance

A Pt(IV) prodrug (2) composed of cancer-targeting biotin and nonsteroidal anti-inflammatory drug indomethacin in the axial positions of the six-coordinated octahedral geometry derived from cisplatin was developed, which could be highly accumulated in cancer cells more than normal ones and activated by endogenous reducing molecules to release cisplatin and indomethacin moieties simultaneously to inhibit tumor progression synergistically. In vitro assays revealed that 2 exhibited significantly selective inhibition to the tested cancer cell lines and sensitivity to cisplatin resistant cancer cells. Moreover, 2 presented cyclooxygenases inhibition properties to reduce tumor-associated inflammation, reduced the invasiveness of the highly aggressive PC-3 cells, and disrupted capillary-like tube formation in EA.hy926 cells. In all, this study offers a new strategy to enhance sensitivity and reduce toxicity of cisplatin.

Incidence of Data Duplications in a Randomly Selected Pool of Life Science Publications

Since the solution to many public health problems depends on research, it is critical for the progress and well-being for the patients that we can trust the scientific literature. Misconduct and poor laboratory practice in science threatens the scientific progress, leads to loss of productivity and increased healthcare costs, and endangers lives of patients. Data duplication may represent one of challenges related to these problems. In order to estimate the frequency of data duplication in life science literature, a systematic screen through 120 original scientific articles published in three different cancer related journals [journal impact factor (IF) <5, 5-10 and >20] was completed. The study revealed a surprisingly high proportion of articles containing data duplication. For the IF < 5 and IF > 20 journals, 25% of the articles were found to contain data duplications. The IF 5-10 journal showed a comparable proportion (22.5%). The proportion of articles containing duplicated data was comparable between the three journals and no significant correlation to journal IF was found. The editorial offices representing the journals included in this study and the individual authors of the detected articles were contacted to clarify the individual cases. The editorial offices did not reply and only 1 out of 29 cases were apparently clarified by the authors, although no supporting data was supplied. This study questions the reliability of life science literature, it illustrates that data duplications are widespread and independent of journal impact factor and call for a reform of the current peer review and retraction process of scientific publishing.

Assessing incremental value of biomarkers with multi-phase nested case-control studies

Accurate risk prediction models are needed to identify different risk groups for individualized prevention and treatment strategies. In the Nurses' Health Study, to examine the effects of several biomarkers and genetic markers on the risk of rheumatoid arthritis (RA), a three-phase nested case-control (NCC) design was conducted, in which two sequential NCC subcohorts were formed with one nested within the other, and one set of new markers measured on each of the subcohorts. One objective of the study is to evaluate clinical values of novel biomarkers in improving upon existing risk models because of potential cost associated with assaying biomarkers. In this paper, we develop robust statistical procedures for constructing risk prediction models for RA and estimating the incremental value (IncV) of new markers based on three-phase NCC studies. Our method also takes into account possible time-varying effects of biomarkers in risk modeling, which allows us to more robustly assess the biomarker utility and address the question of whether a marker is better suited for short-term or long-term risk prediction. The proposed procedures are shown to perform well in finite samples via simulation studies.

Scientific Misconduct and the Myth of Self-Correction in Science

The recent Stapel fraud case came as a shattering blow to the scientific community of psychologists and damaged both their image in the media and their collective self-esteem. The field responded with suggestions of how fraud could be prevented. However, the Stapel fraud is only one among many cases. Before basing recommendations on one case, it would be informative to study other cases to assess how these frauds were discovered. The authors analyze a convenience sample of fraud cases to see whether (social) psychology is more susceptible to fraud than other disciplines. They also evaluate whether the peer review process and replications work well in practice to detect fraud. There is no evidence that psychology is more vulnerable to fraud than the biomedical sciences, and most frauds are detected through information from whistleblowers with inside information. On the basis of this analysis, the authors suggest a number of strategies that might reduce the risk of scientific fraud.

Data fraud in clinical trials

Highly publicized cases of fabrication or falsification of data in clinical trials have occurred in recent years and it is likely that there are additional undetected or unreported cases. We review the available evidence on the incidence of data fraud in clinical trials, describe several prominent cases, present information on motivation and contributing factors and discuss cost-effective ways of early detection of data fraud as part of routine central statistical monitoring of data quality. Adoption of these clinical trial monitoring procedures can identify potential data fraud not detected by conventional on-site monitoring and can improve overall data quality.

Non-steroidal anti-inflammatory drugs use is associated with reduced risk of inflammation-associated cancers: NIH-AARP study

Background

Chronic inflammation has been linked to cancers, and use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with reduced risk of several cancers. To further refine the magnitude of NSAID-related associations, in particular for cancers related to inflammation, such as alcohol-, infection-, obesity-, and smoking-related cancers, as well as for less common cancers, we evaluated the use of NSAIDs and cancer risk in a very large cohort. We used propensity scores to account for potential selection bias and hypothesized that NSAID use is associated with decreased cancer incidence.

Methods

We conducted a prospective study among 314,522 participants in the NIH-AARP Diet and Health Study. Individuals who completed the lifestyle questionnaire, which included NSAID use, in 1996–1997 were followed through 2006. Information on cancer incidence was ascertained by linking to cancer registries and vital status databases.

Findings

During 2,715,994 person-years of follow-up (median 10.1 person-years), there were 51,894 incident cancers. Compared with non-users of NSAIDs, individuals who reported use in the 12 months prior to interview had a significantly lower risk of all inflammation-related cancer, alcohol-related, infection-related, obesity-related, and smoking-related cancers [hazard ratio (HR) (95% CI)) 0.90 (0.87–0.93), 0.80 (0.74–0.85), 0.82 (0.78–0.87), 0.88 (0.84–0.92), and 0.88 (0.85–0.92) respectively)].

Conclusions

After accounting for potential selection bias, our data showed an inverse association between NSAID use and alcohol-related, infection-related, obesity-related, and smoking-related cancers and support the hypothesis that inflammation is related to an increased risk of certain cancers.

Errors in medical literature: not a question of impact

The editorial and peer-review processes should guarantee readers as to the reliability of published data. The first step of these processes is to check for errors. The aim of our study was to look for the presence of objective errors in consecutive articles published on three of the most authoritative clinical journals. Two reviewers evaluated the presence of any error in 200 consecutive original articles containing at least two tables, allowing a reanalysis of the data, published between October 2010 and April 2011. Error was considered any action different from what was planned. Errors were listed as: methodological, numerical and slips. They were considered as severe if numbers in the abstract were completely different from numbers reported in the full text. Among the 125 articles included in the study, 102 (82 %, 95 % CI 74-88 %) contained some kind of error, even multiple. Nine articles (7 %, 95 % CI 3-13 %) contained one slip, 92 articles (74 %, 95 % CI 65-81 %) contained at least one numerical error, and 22 articles (18 %, 95 % CI 11-25 %) contained one methodological error. Five articles (4 %, 95 % CI 1-9 %) contained one serious error. None of the errors retrieved (0 %, 95 % CI 0-2 %) would have changed the results of the studies. Most of the articles published in the most important medical journals present mistakes. Our results could be a clue to editorial and peer review systems system weaknesses. A debate within the scientific medical community about these systems, and possible alternative adjustments are needed.

Retracted publications in the drug literature

Recent studies have suggested an increase in the number of retracted scientific publications. It is unclear how broadly the issue of misleading and fraudulent publications pertains to retractions of drug therapy studies. Therefore, we sought to determine the trends and factors associated with retracted publications in drug therapy literature. A PubMed search was conducted to identify retracted drug therapy articles published from 2000-2011. Articles were grouped according to reason for retraction, which was classified as scientific misconduct or error. Scientific misconduct was further divided into data fabrication, data falsification, questions of data veracity, unethical author conduct, and plagiarism. Error was defined as duplicate publication, scientific mistake, journal error, or unstated reasons. Additional data were extracted from the retracted articles, including type of article, funding source, author information, therapeutic area, and retraction issue. A total of 742 retractions were identified from 2000-2011 in the general biomedical literature, and 102 drug studies met our inclusion criteria. Of these, 73 articles (72%) were retracted for a reason classified as scientific misconduct, whereas 29 articles (28%) were retracted for error. Among the 73 articles classified as scientific misconduct, those classified as unethical author conduct (32 articles [44%]) and data fabrication (24 articles [33%]) constituted the majority. The median time from publication of the original article to retraction was 31 months (range 1-130). Fifty percent of retracted articles did not state a funding source, whereas pharmaceutical manufacturer funding accounted for only 13 articles (13%) analyzed. Many retractions were due to repeat offenses by a small number of authors, with nearly 40% of the retracted studies associated with two individuals. We found that a greater proportion of drug therapy articles were retracted for reasons of misconduct and fraud compared with other biomedical studies. It is important for health care practitioners to monitor the literature for retractions so that recommendations for drug therapy and patient management may be modified accordingly.

Update on nonsteriodal anti-inflammatory drugs

PURPOSE OF REVIEW

This review addresses recent concerns about the cardiovascular safety of nonsteroidal anti-inflammatory drugs, the disease-modifying role of these drugs in ankylosing spondylitis, and their use in the understudied pediatric population.

RECENT FINDINGS

Several recent observational and controlled studies highlight the cardiovascular toxicity of rofecoxib, celecoxib, parecoxib, valdecoxib and naproxen. Concerns about cardiovascular safety raise questions about the chronic use of nonsteroidal anti-inflammatory drugs in patients with rheumatic diseases, including children. The risks of these drugs in the pediatric population are not well known and this review addresses the limited data available concerning nonsteroidal anti-inflammatory drug use in children. A recent trial in ankylosing spondylitis patients demonstrated continuous nonsteroidal anti-inflammatory drug use reduced the rate of syndesmophyte formation, suggesting that they may have a disease-modifying role in these patients.

SUMMARY

Nonsteroidal anti-inflammatory drugs have been in the spotlight this year. While preliminary evidence has supported novel roles for these drugs in ankylosing spondylitis and in cancer prevention, accumulating evidence shows that some cyclooxygenase-2 and perhaps all nonsteroidal anti-inflammatory drugs are associated with cardiovascular toxicity. Further research is needed to understand the magnitude and mechanism of this risk. Clinicians are compelled to weigh carefully the benefits and risks of therapy. Concerns about safety are balanced by optimism about their potential role in delaying the progression of ankylosing spondylitis.

Cyclooxygenase-2 inhibitors and most traditional nonsteroidal anti-inflammatory drugs cause similar moderately increased risks of cardiovascular disease

Cyclooxygenase-2 inhibitors relieve pain from inflammatory conditions by decreasing the gastrointestinal side effects from traditional nonsteroidal anti-inflammatory drugs. Basic research provided plausible mechanisms and some observational epidemiological studies, case-control and cohort, indicated that patients prescribed with cyclooxygenase-2 inhibitors and nonsteroidal anti-inflammatory drugs had increased risks for myocardial infarction and stroke. Because patients prescribed with cyclooxygenase-2 inhibitors were systematically different, uncontrolled and uncontrollable confounding by indication was as large as the observed risks. Thus, epidemiological studies or their meta-analyses could not discern whether, and if so, how much, the risks were real. A comprehensive meta-analysis of randomized trials indicated that cyclooxygenase-2 inhibitors increased the risk of vascular events by 42%, almost exclusively myocardial infarction, as did high-dose regimens of ibuprofen and diclofenac, but not naproxen. Individual clinical judgments and policy decisions should include cardiovascular disease and noncardiovascular disease risks including gastrointestinal side effects and clinical benefits including improved quality of life from less pain and disability.

Evaluation of the effect of Neptune Krill Oil on chronic inflammation and arthritic symptoms

OBJECTIVES

a) To evaluate the effect of Neptune Krill Oil (NKO) on C-reactive protein (CRP) on patients with chronic inflammation and b) to evaluate the effectiveness of NKO on arthritic symptoms.

METHODS

Randomized, double blind, placebo controlled study. Ninety patients were recruited with confirmed diagnosis of cardiovascular disease and/or rheumatoid arthritis and/or osteoarthritis and with increased levels of CRP (>1.0 mg/dl) upon three consecutive weekly blood analysis. Group A received NKO (300 mg daily) and Group B received a placebo. CRP and Western Ontario and McMaster Universities (WOMAC) osteoarthritis score were measured at baseline and days 7, 14 and 30.

RESULTS

After 7 days of treatment NKO reduced CRP by 19.3% compared to an increase by 15.7% observed in the placebo group (p = 0.049). After 14 and 30 days of treatment NKO further decreased CRP by 29.7% and 30.9% respectively (p < 0.001). The CRP levels of the placebo group increased to 32.1% after 14 days and then decreased to 25.1% at day 30. The between group difference was statistically significant; p = 0.004 at day 14 and p = 0.008 at day 30. NKO showed a significant reduction in all three WOMAC scores. After 7 days of treatment, NKO reduced pain scores by 28.9% (p = 0.050), reduced stiffness by 20.3% (p = 0.001) and reduced functional impairment by 22.8% (p = 0.008).

CONCLUSION

The results of the present study clearly indicate that NKO at a daily dose of 300 mg significantly inhibits inflammation and reduces arthritic symptoms within a short treatment period of 7 and 14 days.

That's not science! The role of moral philosophy in the science/non-science divide

The science/non-science distinction has become increasingly blurred. This paper investigates whether recent cases of fraud in science can shed light on the distinction. First, it investigates whether there is an absolute distinction between science and non-science with respect to fraud, and in particular with regards to manipulation and fabrication of data. Finding that it is very hard to make such a distinction leads to the second step: scrutinizing whether there is a normative distinction between science and non-science. This is done by investigating one of the recent internationally famous frauds in science, the Sudbø case. This case demonstrates that moral norms are not only needed to regulate science because of its special characteristics, such as its potential for harm, but moral norms give science its special characteristics. Hence, moral norms are crucial in differentiating science from non-science. Although this does not mean that ethics can save the life of science, it can play a significant role in its resuscitation.

What can we learn from the Hwang and Sudbø affairs?

The recent publication, in prestigious scientific journals, of two major studies that were subsequently shown to contain fabricated data may compel reviewers and editors to adopt a more rigorous policy in accepting articles for publication. The current manner of peer reviewing research articles provides no assurance that the proffered work is not the result of fraud. The present guidelines for contributors in large team investigations may need to be updated to avoid giving credit to co-authors who may have made little, if any, contribution to the work.

Update on guidelines for the treatment of chronic musculoskeletal pain

Chronic musculoskeletal pain is a major - and growing - burden on today's ageing populations. Professional organisations including the American College of Rheumatology (ACR), American Pain Society (APS) and European League Against Rheumatism (EULAR) have published treatment guidelines within the past 5 years to assist clinicians achieve effective pain management. Safety is a core concern in all these guidelines, especially for chronic conditions such as osteoarthritis that require long-term treatment. Hence, there is a consensus among recommendations that paracetamol should be the first-line analgesic agent due to its favourable side effect and safety profile, despite being somewhat less effective in pain relief than anti-inflammatory drugs. Cyclooxygenase-2 (COX-2)-selective anti-inflammatory drugs were developed with the goal of delivering effective pain relief without the serious gastrointestinal (GI) side effects linked with traditional non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Clinical trial evidence supported these benefits, and COX-2 inhibitors were widely adopted, both in clinical practice and in official guidelines. Recently, accumulating data have linked COX-2 inhibitors with serious cardiovascular and/or cardiorenal effects and/or serious cutaneous adverse reactions (SCARs), particularly at anti-inflammatory doses or when used long term. Regulatory authorities in both Europe and the USA have responded to these data with the withdrawal of rofecoxib and valdecoxib, and the strengthening of prescribing advice on all anti-inflammatory drugs. COX-2 inhibitors and non-selective NSAIDs should now be used with increased caution in patients at increased cardiovascular and/or cardiorenal risk, e.g., patients with congestive heart failure, hypertension, etc. Regulatory advice and good clinical practice are to use anti-inflammatory drugs at the lowest effective dose and for the shortest possible time. There are as yet no updated official guidelines that incorporate these new data and regulatory advice. An international multidisciplinary panel, the Working Group on Pain Management, has generated new recommendations for the treatment of moderate-to-severe musculoskeletal pain. These guidelines, formulated in response to recent developments concerning COX-2 inhibitors and other NSAIDs, focus on paracetamol as the baseline drug for chronic pain management; when greater analgesia is desired, the addition of weak opioids is recommended based on a preferable GI and cardiovascular profile, compared with non-steroidal anti-inflammatory drugs.

Severity of gouty arthritis is associated with Q-wave myocardial infarction: a large-scale, cross-sectional study

To examine whether serum urate level and other aspects of gouty arthritis are independently associated with Q-wave myocardial infarction (QWMI) in gouty population, we performed a cross-sectional study. A total of 22,572 gouty cases were enrolled. QWMI was defined as a positive finding by resting electrocardiographic criteria excluding the conditions producing pseudoinfarction. The variables of gout were tested univariately and multivariately, controlling for the covariates by logistic regression analysis. The above analysis was then repeated in subgroups of young-aged (<50 years), old-aged (> or = 50 years), male, and female patients. Increased serum urate level was significantly associated with QWMI in all subjects and male subgroup [odds ratio (OR), 1.120; 95% confidence interval (CI), 1.020-1.229; OR, 1.106; 95% CI, 1.001-1.223, respectively, for each mg/dl increment]. After controlling for serum urate level and the covariates, increased affected joint count was also independently associated with QWMI finding in all subjects, male and old-aged subgroups (OR, 1.098; 95% CI, 1.014-1.189; OR, 1.094; 95% CI, 1.005-1.192; OR, 1.095; 95% CI, 1.001-1.199, respectively). Tophi formation was independently associated with QWMI in young-aged subgroup (OR, 2.494; 95% CI, 1.159-5.366). None of the variables of gout including hyperuricemia was significantly associated with QWMI in female subgroup after controlling for covariates. This study first demonstrates that gout is associated with QWMI by both the severity of gouty arthritis and serum urate level, while the association of urate to QWMI could be different between age strata and genders.

Nonsteroidal antiinflammatory drugs, acetaminophen, and the risk of cardiovascular events

BACKGROUND

Although randomized trials of cyclooxygenase-2 (COX-2) inhibitors have shown increased cardiovascular risk, studies of nonselective, nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen have been inconsistent.

METHODS AND RESULTS

We examined the influence of NSAIDs and acetaminophen on the risk of major cardiovascular events (nonfatal myocardial infarction, fatal coronary heart disease, nonfatal and fatal stroke) in a prospective cohort of 70,971 women, aged 44 to 69 years at baseline, free of known cardiovascular disease or cancer, who provided medication data biennially since 1990. During 12 years of follow-up, we confirmed 2041 major cardiovascular events. Women who reported occasional (1 to 21 d/mo) use of NSAIDs or acetaminophen did not experience a significant increase in the risk of cardiovascular events. However, after adjustment for cardiovascular risk factors, women who frequently (> or =22 d/mo) used NSAIDs had a relative risk (RR) for a cardiovascular event of 1.44 (95% CI, 1.27 to 1.65) compared with nonusers, whereas those who frequently consumed acetaminophen had a RR of 1.35 (95% CI, 1.14 to 1.59). The elevated risk associated with frequent NSAID use was particularly evident among current smokers (RR=1.82; 95% CI, 1.38 to 2.42) and was absent among never smokers (Pinteraction=0.02). Moreover, we observed significant dose-response relations: Compared with nonusers, the RRs for a cardiovascular event among women who used > or =15 tablets per week were 1.86 (95% CI, 1.27 to 2.73) for NSAIDs and 1.68 (95% CI, 1.10 to 2.58) for acetaminophen.

CONCLUSIONS

Use of NSAIDs or acetaminophen at high frequency or dose is associated with a significantly increased risk for major cardiovascular events, although more moderate use did not confer substantial risk.

Statins and cancer prevention

Randomized controlled trials for preventing cardiovascular disease indicated that statins had provocative and unexpected benefits for reducing colorectal cancer and melanoma. These findings have led to the intensive study of statins in cancer prevention, including recent, large population-based studies showing statin-associated reductions in overall, colorectal and prostate cancer. Understanding the complex cellular effects (for example, on angiogenesis and inflammation) and the underlying molecular mechanisms of statins (for example, 3-hydroxy-3-methylglutaryl coenzyme-A (HMG-CoA) reductase-dependent processes that involve geranylgeranylation of Rho proteins, and HMG-CoA-independent processes that involve lymphocyte-function-associated antigen 1) will advance the development of molecularly targeted agents for preventing cancer. This understanding might also help the development of drugs for other ageing-related diseases with interrelated molecular pathways.