Tuesday, July 5, 2011

The Biggest Chantix News: Pfizer's $12.3 Million Buys No News

By now most of you have heard about this recent study linking the use of Pfizer's anti-smoking drug Chantix with a small increase in heart attacks and arrhythmias. The meta-analysis of 14 double-blind controlled trials indicates that in patients without a history of heart disease, Chantix increases the rate of serious cardiac events from 0.82% of those assigned to placebo to 1.06% of those on Chantix. This is not a huge increase, but considering the millions of people who are prescribed the drug yearly, it could amount to a large public health problem.

Another piece of big news (to those of us who follow the world of industry-supported CME) is the fact the Pfizer-funded smoking cessation program, CS2day (Cease Smoking Today) doesn't mention the study on its website. Recall that CS2day was announced with much fanfare in 2008, when Dr. George Mejicano convinced Pfizer to pay $12.3 million for a national CME program to educate doctors about how to help patients quit smoking (see the Medical Meetings article here). The program was quickly criticized for not disclosing Chantix's many side effects in one of its CME programs.

Given that this new meta-analysis is hitting most major news outlets, you would think that the multi-million dollar CME website could find a writer to post something about the study. But apparently this is something Pfizer would prefer that physicians not get continually medically educated about.

File under: CME programs that are noncompliant with AMA's new ethical guidelines.

10 comments:

yobluemama said...

A small increase perhaps, but how about for the psychiatric population that are already taking drugs with cardiovascular risks that are being targeted?

ShrinkWrapped said...

I am curious as to the risk of cardiac events in a smoking control group versus those who actually stop smoking with Chantix. I understand that stopping smoking by using a placebo is preferable to stopping by using a drug (though the numbers seem pretty small; how large was the "n"?) but wouldn't a comparison with those who don't stop smoking also be informative?

Anonymous said...

Smoking increases the rate of serious cardiac events as well.

Daniel Carlat, M.D. said...

The point of my post was not to discuss the complexities of the risk/benefit ratio of Chantix, but rather to point out that the flow of crucial information is controlled in industry funded CME based on promotional agendas--exactly the wrong way to educate physicians. Chantix may be a great drug for many patients, but we need to know all the efficacy and safety data to make that decision.

alicecbrown said...

I thought the FDA was going to enforce a sanction against prescribing drugs off-ticket, or whatever the phrase is. I design software for medical devices, and the tests we have to go through are for the SPECIFIC purpose for the device, not anything the doc wants to use it for.
So how do you stop a psychiatrist from prescribing Zantak, Resperidone and MethylPhrenidate for a 7 year old for ADHD?

alicecbrown said...

If I am asking this question at the wrong place, please let me know where I can ask it. Is East Carolina Medical school well regarded? Where do I find those ratings?
Resperitol, Methyl phenidrate and another psychotropic drug is being used by my daughter's child's shrink and I think she's being led around by the drug companies. Isn't the FDA supposed to forbid off-lable use? My grandson has ADHD, not OCD which is the only condition that F.....is supposed to be used for children. He can't concentrate, but is supposed to go to school in 2 weeks. He's 7.

Are there any long-term studies to ascertain brain damage from these pscyho tropic drugs used on children?
Thanks. F.... is in the same family with Paxil...just can't remember it.

usualtreatment said...

And FWIW-- based on the percentages Carlat cited, you would need to give 417 patients (NNH) Chantix to cause one patient to have a serious cardiac event. The NNT in order to get one year of smoking abstinence is 8 (based on the 2006 JAMA data). And since NNH/NNT is far larger than one, this implies that the benefits of Chantix may very well be worth the risk of cardiac events. But I don't prescribe Chantix anyway; the haphazard psychosis and suicidality induction scares me...

Parwathy Narayan said...

Unfortunately many prescribe medications without knowing the full facts about the affects it has on their patients.

sean paul said...

What about the recently pusblished data implicating significantly higher psychiatriac symptoms like worsening depression and suicidal ideation as compared to buproprion or nicotine replacement? I "Chant" be using chantix....

terri said...

I can only comment on what Chantix did to/for me. Keep in mind that people do not go to the trouble and expense of getting this script filled...w/hopes of suffering horrendous side effects.

Feared drugs as a teen. Can describe first-hand in vivid detail at 55...an hallucination. I was thrilled when Chantix hit the market! Immediately made an appt. w/doc. Couldn't WAIT to get started! Took two scripts back/back in '07. Endured two, long, hospital stays PLUS psyche unit in '08.

Like a fool, I BLINDLY trusted everyone involved in the process of getting this script. Never again. Learned the hard way, no one has your back. No one.