Health Rounds: Old cancer drug may help restore fertility for certain women

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By Nancy Lapid
June 30 (Reuters) - Hello Health Rounds readers! Today we highlight a potential new use for an old drug that may provide hope for some women prematurely unable to have babies. We also cover a large study that should allay fears of people who should be taking cholesterol-lowering statins. 

Old cancer drug may restore fertility in premature menopause
A decades-old cancer drug may allow eggs to mature in women with premature ovarian insufficiency, a condition that usually leads to infertility, a small pilot study suggests.
Three out of 10 women gave birth to healthy babies following  treatment with rituximab, which was first approved in 1997 for blood cancers and sold by Roche ROPC.S and Biogen BIIB.O under the brand name Rituxan.
In premature ovarian insufficiency, the ovaries cease to function before the age of 40, with autoimmune mechanisms, genetics and other factors playing a role. 
As reported in NEJM Evidence, the study involved 10 young women with autoimmune premature ovarian insufficiency whose bodies had mistakenly destroyed their ovaries’ egg-containing follicles.
They each underwent ovarian hormone stimulation both before and four to six months after treatment with rituximab, the first-approved cancer immunotherapy that also treats autoimmune conditions such as rheumatoid arthritis.
Ovarian stimulation involves daily hormone injections to encourage the ovaries to mature multiple eggs simultaneously.
Before treatment with rituximab, none of the women responded to the stimulation. After treatment, however, six of the 10 developed follicles that made it possible to retrieve eggs in response to ovarian stimulation.
“The results show that in some women there remains an egg reserve that can be activated when the autoimmune process is suppressed,” study leader Dr. Angelica Lindén Hirschberg of Karolinska Institutet in Sweden said in a statement.
In five of the women, the mature eggs could be frozen or fertilized. Three women later had embryos implanted, and all  gave birth to healthy babies. 
For safety reasons, embryo transfer took place no earlier than one year after treatment. One case of a serious side effect was reported and was linked to the hormone stimulation, not the immunotherapy, the researchers said.
The researchers called for larger studies to confirm the results and prove the method is safe. Such a study is now underway, they said.

New tool shows low risk of statin-related muscle problems
The vast majority of people with high cholesterol can use statin drugs without fear of serious muscle side effects, according to a large study using a new calculator for assessing such risks.
Concerns about muscle weakness and aches keep many people from using the medicines, unnecessarily it turns out. 
More than 98% of people identified by their doctors as eligible for statin treatment were predicted to be at low risk of serious muscle disorders over the next decade in the study published in The Lancet Digital Health. 
Using health records from more than 5.6 million people across England, researchers developed and then tested a calculator that estimates a person's risk of developing serious muscle disorders from statins.
The model incorporates 22 routinely recorded factors including age, sex, ethnicity, body mass index, smoking status, existing health conditions, previous muscle problems, vitamin D deficiency, and medication use to estimate an individual's risk of serious muscle disorders over one, five and 10 years.
More than 60% of people eligible for statin treatment were not taking them, despite some being at high risk of heart attack or stroke, the analysis also showed. Statins have been shown to significantly reduce the risk of heart attacks and strokes.
The researchers focused on serious muscle disorders leading to hospital admission or death, rather than milder symptoms such as aches and pains. Many mild muscle symptoms reported during statin treatment are not actually caused by statins and shouldn’t prevent patients from starting statin treatment, the researchers said. 
"Serious muscle disorders are one of the most widely discussed concerns about statins, but our findings suggest that the risk is very low for the vast majority of people who may benefit from treatment,” study leader Dr. Ting Cai at the University of Oxford said in a statement.
“For the small number of people at higher risk, it gives clinicians a clearer basis for discussing monitoring, checks or alternative treatment options,” Cai said.
Her team called for additional studies to test the tool in more diverse populations.
Separately, in studies in mice, researchers investigating why some people do develop statin myopathies found that when the drugs block the pathways that produce cholesterol, they also block production of other molecules. Those alterations may lead to metabolic stress and act as danger signals that activate inflammatory processes that can contribute to muscle wasting and cell death. 
Therefore, some side effects might arise from the loss of these other molecules rather than from cholesterol reduction itself, the researchers reported in Science Advances. 

 (Reporting by Nancy Lapid; Editing by Bill Berkrot)
 ((Nancy.Lapid@thomsonreuters.com))