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Australian Journal of Pharmacy : March 2005
pharmacy ed u cdi: news notes been carried out.1 Between May 2001, and February 2002, the use of oral simvastatin (80mg daily) was investigated in 30 individuals with relapsing-remitting multiple sclerosis. The subjects, who were aged 18 to 55 years with clinically definite relapsing-remitting multiple sclerosis, were enrolled into a pre-treatment phase. They had had no treatment with interferons or glatiramer in the previous three months or corticosteroids within 30 days of screening. The participants were monitored for three months, and had monthly brain MRI scans. Those with at least one gadolinium- enhancing lesion detected during this phase were eligible to receive simvastatin for six months. Brain MRI scans were repeated at months four, five and six of treatment. Reference to the original article is required for details of analysis of the results obtained. The authors summarised their results by stating: ‘These findings suggest that an 80mg daily dose of oral simvastatin over a six-month period could inhibit the inflammatory components of multiple sclerosis that lead to neurological disability. ‘However, our results, combined with the published work on the immunological effects of statins, lend support to the case for randomised controlled clinical trials to establish the safety and efficacy of statins in the treatment of relapsing-remitting multiple sclerosis.’ In a commentary2 on this research it is concluded: ‘Vollmer and colleagues’ study is a big step forward because it is the first to provide some evidence of an effect with a statin in multiple sclerosis; but it is only an initial step. Additional data are required to more precisely determine the clinical effects of statins, to explore the optimum dose, the therapeutic window, and the differential potency of statins, and to evaluate whether combination therapy might be more effective than monotherapy.’ 1. Vollmer Timothy, Key Lyndon, Durkalski Valerie, et al. Oral simvastatin treatment in relapsing-remitting multiple sclerosis. Lancet 2004;363:1607-08. 2. Polman CH, Killestein J. Statins for the treatment of multiple sclerosis: cautious hope. Lancet 2004;363:1570. Simvastatin—Lipex, Zocor. ANY elderly people suffer from both osteomalacia (softening of bones resulting from deficiency of vitamin D and calcium), and osteoporosis (a reduction in the amount of bone mass, leading to fractures after minimal trauma). Falls among elderly individuals occur frequently, increase with age, and, as a result of suffering from osteomalacia and/or osteoporosis, result in substantial morbidity and mortality. Treatment of osteomalacia primarily aims at correcting any underlying deficiency states, and vitamin D substances, calcium, or phosphate supplements are administered orally as necessary. Calcium and vitamin D supplements are recommended, particularly to elderly people, for the treatment of osteoporosis, even though studies with vitamin D when given in pharma- cological or supplemental doses have produced conflicting results. The use of vitamin D in the treatment or prevention of these two conditions is well recognised but the possible role of vitamin D in preventing falls among elderly people is not so well established. A meta-analysis of double-blind randomised, controlled trials (RCTs) of vitamin D in elderly populations (mean age, 60 years) that examined falls resulting from low trauma for which the method of fall ascertainment and definition of falls were defined explicitly has been carried out to assess the effectiveness of vitamin D in preventing an older person from falling.1 An extensive search was carried out to identify as complete coverage of published reports as possible, but studies including patients in unstable health states were excluded. 212 ? THE AUSTRALIAN JOURNAL OF PHARMACY, VOL.86 MARCH 2005 Vitamin D reduces falls in elderly people M Five of 38 identified studies were included in the primary analysis and five other studies were included in a sensitivity analysis. Analysis of the data obtained showed the following. • Based on five RCTs involving 1,237 participants (in stable health, and with a mean age of 60 years), vitamin D reduced the corrected odds ratio (OR) of falling by 22 per cent com- pared with patients receiving calcium or placebo. • From the pooled risk difference, it was calculated that 15 patients would need to be treated with vitamin D to prevent one person from falling. The inclusion of five additional studies, involving 10,001 participants, in a sensitivity analysis resulted in a smaller but still significant effect size. Subgroup analyses suggested that the effect size was independent of calcium supplementation, type of vitamin D, duration of therapy, and sex. ¦