Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 Adam, the study on MK-869 you brought our attention to was conducted on guinea pigs -- not human guinea pigs but oink-oink guinea pigs. That, together with the fact that the drug is still be referred to by number and not name (part of a drug company's promotion is to use it's copyrighted name) leads me to believe the research is years from human trials. Although, the article was from 1998, so we should be seeing something about this in 2002. But most important, the article only talks about use of MK-869 as an anti-depressant/anti-anxiolytic. Nothing related to rosacea. Medications that block Substance P are used *topically* for control of neurogenic pain -- I know of one available on the market now. although I understand it is not uniformly successful and has side effects. I'm familiar with its use on diabetic feet or post-herpetic zoster pain, not on the face. The trade name is Zostrix. Perhaps Zostrix is what Dr. Nase was referring to, since as your father correctly noted, Zofran is used to counteract the nausau and vomiting of chemotherapy. I'm quite familiar with Zofran from my residency days, and I can't fathom a use in rosacea for it. Marjorie Marjorie Lazoff, MD > Ok, while I'm on the subject of things that I don't really understand.. > > In Dr Nase's book, he talks about how Substance P may play an important role in cea. He mentions a doctor who has had success in treating vascular cea using the drug Zofran. When I first got this book months ago I went through all the medicines listed in it with my dad and asked him which ones were safe to take, and he told me Zofran was used for chemotherapy or cancer or something and had alot of possible side effects. Anyway, Dr Nase mentions a selective substance P blocker MK-869 " currently undergoing extensive testing in human clinical trials " that " shows great promise " . Well, now apparantly the studies have been done. > > Well, in the following article I found, it talks about substance P's role in pain perception. The article talks about MK-869 which has been tested, and found to be a useful antidepressant and antianxiety medication. The article mentions that MK-869 has a very low incidence of side effects. So, the way I understand it (please Nobody misconstrue this as a fact)... MK-869 is a pain-relieving, flush-reducing, antidepressant/anti-anxiety medication with minimal side effects that no doctors anywhere are using to treat cea. Can somebody please explain to me where exactly I got mixed up? This doesn't sound right.. > > Here is the link: > http://www.hosppract.com/cc/1998/cc9812.htm > > Adam > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 Adam, the study on MK-869 you brought our attention to was conducted on guinea pigs -- not human guinea pigs but oink-oink guinea pigs. That, together with the fact that the drug is still be referred to by number and not name (part of a drug company's promotion is to use it's copyrighted name) leads me to believe the research is years from human trials. Although, the article was from 1998, so we should be seeing something about this in 2002. But most important, the article only talks about use of MK-869 as an anti-depressant/anti-anxiolytic. Nothing related to rosacea. Medications that block Substance P are used *topically* for control of neurogenic pain -- I know of one available on the market now. although I understand it is not uniformly successful and has side effects. I'm familiar with its use on diabetic feet or post-herpetic zoster pain, not on the face. The trade name is Zostrix. Perhaps Zostrix is what Dr. Nase was referring to, since as your father correctly noted, Zofran is used to counteract the nausau and vomiting of chemotherapy. I'm quite familiar with Zofran from my residency days, and I can't fathom a use in rosacea for it. Marjorie Marjorie Lazoff, MD > Ok, while I'm on the subject of things that I don't really understand.. > > In Dr Nase's book, he talks about how Substance P may play an important role in cea. He mentions a doctor who has had success in treating vascular cea using the drug Zofran. When I first got this book months ago I went through all the medicines listed in it with my dad and asked him which ones were safe to take, and he told me Zofran was used for chemotherapy or cancer or something and had alot of possible side effects. Anyway, Dr Nase mentions a selective substance P blocker MK-869 " currently undergoing extensive testing in human clinical trials " that " shows great promise " . Well, now apparantly the studies have been done. > > Well, in the following article I found, it talks about substance P's role in pain perception. The article talks about MK-869 which has been tested, and found to be a useful antidepressant and antianxiety medication. The article mentions that MK-869 has a very low incidence of side effects. So, the way I understand it (please Nobody misconstrue this as a fact)... MK-869 is a pain-relieving, flush-reducing, antidepressant/anti-anxiety medication with minimal side effects that no doctors anywhere are using to treat cea. Can somebody please explain to me where exactly I got mixed up? This doesn't sound right.. > > Here is the link: > http://www.hosppract.com/cc/1998/cc9812.htm > > Adam > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 Adam, the study on MK-869 you brought our attention to was conducted on guinea pigs -- not human guinea pigs but oink-oink guinea pigs. That, together with the fact that the drug is still be referred to by number and not name (part of a drug company's promotion is to use it's copyrighted name) leads me to believe the research is years from human trials. Although, the article was from 1998, so we should be seeing something about this in 2002. But most important, the article only talks about use of MK-869 as an anti-depressant/anti-anxiolytic. Nothing related to rosacea. Medications that block Substance P are used *topically* for control of neurogenic pain -- I know of one available on the market now. although I understand it is not uniformly successful and has side effects. I'm familiar with its use on diabetic feet or post-herpetic zoster pain, not on the face. The trade name is Zostrix. Perhaps Zostrix is what Dr. Nase was referring to, since as your father correctly noted, Zofran is used to counteract the nausau and vomiting of chemotherapy. I'm quite familiar with Zofran from my residency days, and I can't fathom a use in rosacea for it. Marjorie Marjorie Lazoff, MD > Ok, while I'm on the subject of things that I don't really understand.. > > In Dr Nase's book, he talks about how Substance P may play an important role in cea. He mentions a doctor who has had success in treating vascular cea using the drug Zofran. When I first got this book months ago I went through all the medicines listed in it with my dad and asked him which ones were safe to take, and he told me Zofran was used for chemotherapy or cancer or something and had alot of possible side effects. Anyway, Dr Nase mentions a selective substance P blocker MK-869 " currently undergoing extensive testing in human clinical trials " that " shows great promise " . Well, now apparantly the studies have been done. > > Well, in the following article I found, it talks about substance P's role in pain perception. The article talks about MK-869 which has been tested, and found to be a useful antidepressant and antianxiety medication. The article mentions that MK-869 has a very low incidence of side effects. So, the way I understand it (please Nobody misconstrue this as a fact)... MK-869 is a pain-relieving, flush-reducing, antidepressant/anti-anxiety medication with minimal side effects that no doctors anywhere are using to treat cea. Can somebody please explain to me where exactly I got mixed up? This doesn't sound right.. > > Here is the link: > http://www.hosppract.com/cc/1998/cc9812.htm > > Adam > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 Hi Adam, The reason is that for the moment any use on rosacea is largely " hypothetical " with only one or two doctors using it. Most doctors are conservative and will not prescribe medications that are " off-label " (i.e. they are not indicated by the manufacturer as a application of the drug). At the very least many doctors will want to see a well regarded initial study on a drug and its application before they prescribe it... This is in some ways unfortunate but we have to remember that Doctors have a huge amount of drugs and diseases to keep up to date with. They can't find out the safety and applicability of drugs within a single sitting with a patient so (unforutanely for us) are sometimes dissimissive. At the end of the day, they are reponsible for any " mishaps " and with rosacea not a life threatening (but certainly life altering and unpleasant) disease, they are unwilling to take risks. Lets hope that someone does preliminary trials on drugs like the Substance P blocker and the new topical medications on rosacea sufferers. Perhaps Dr. Marjorie Lazaroff who is currently contributing actively to the group can help us start this process. . > Ok, while I'm on the subject of things that I don't really understand.. > > In Dr Nase's book, he talks about how Substance P may play an important role in cea. He mentions a doctor who has had success in treating vascular cea using the drug Zofran. When I first got this book months ago I went through all the medicines listed in it with my dad and asked him which ones were safe to take, and he told me Zofran was used for chemotherapy or cancer or something and had alot of possible side effects. Anyway, Dr Nase mentions a selective substance P blocker MK-869 " currently undergoing extensive testing in human clinical trials " that " shows great promise " . Well, now apparantly the studies have been done. > > Well, in the following article I found, it talks about substance P's role in pain perception. The article talks about MK-869 which has been tested, and found to be a useful antidepressant and antianxiety medication. The article mentions that MK-869 has a very low incidence of side effects. So, the way I understand it (please Nobody misconstrue this as a fact)... MK-869 is a pain-relieving, flush-reducing, antidepressant/anti-anxiety medication with minimal side effects that no doctors anywhere are using to treat cea. Can somebody please explain to me where exactly I got mixed up? This doesn't sound right.. > > Here is the link: > http://www.hosppract.com/cc/1998/cc9812.htm > > Adam > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 Hi Adam, The reason is that for the moment any use on rosacea is largely " hypothetical " with only one or two doctors using it. Most doctors are conservative and will not prescribe medications that are " off-label " (i.e. they are not indicated by the manufacturer as a application of the drug). At the very least many doctors will want to see a well regarded initial study on a drug and its application before they prescribe it... This is in some ways unfortunate but we have to remember that Doctors have a huge amount of drugs and diseases to keep up to date with. They can't find out the safety and applicability of drugs within a single sitting with a patient so (unforutanely for us) are sometimes dissimissive. At the end of the day, they are reponsible for any " mishaps " and with rosacea not a life threatening (but certainly life altering and unpleasant) disease, they are unwilling to take risks. Lets hope that someone does preliminary trials on drugs like the Substance P blocker and the new topical medications on rosacea sufferers. Perhaps Dr. Marjorie Lazaroff who is currently contributing actively to the group can help us start this process. . > Ok, while I'm on the subject of things that I don't really understand.. > > In Dr Nase's book, he talks about how Substance P may play an important role in cea. He mentions a doctor who has had success in treating vascular cea using the drug Zofran. When I first got this book months ago I went through all the medicines listed in it with my dad and asked him which ones were safe to take, and he told me Zofran was used for chemotherapy or cancer or something and had alot of possible side effects. Anyway, Dr Nase mentions a selective substance P blocker MK-869 " currently undergoing extensive testing in human clinical trials " that " shows great promise " . Well, now apparantly the studies have been done. > > Well, in the following article I found, it talks about substance P's role in pain perception. The article talks about MK-869 which has been tested, and found to be a useful antidepressant and antianxiety medication. The article mentions that MK-869 has a very low incidence of side effects. So, the way I understand it (please Nobody misconstrue this as a fact)... MK-869 is a pain-relieving, flush-reducing, antidepressant/anti-anxiety medication with minimal side effects that no doctors anywhere are using to treat cea. Can somebody please explain to me where exactly I got mixed up? This doesn't sound right.. > > Here is the link: > http://www.hosppract.com/cc/1998/cc9812.htm > > Adam > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 > Adam, the study on MK-869 you brought our attention to was > conducted on guinea pigs -- not human guinea pigs but oink-oink > guinea pigs. I'm sorry! I missed the second study, that WAS conducted on humans. I was wondering how they could use a point scale system measuring depression on guinea pigs -- especially when they came to the conclusion that sexual side effects were infrequent! Still, the MK-869 tests were for psychiatric conditions, not rosacea. Perhaps there are topical MK-869 studies, similiar to Zostrix? Marjorie Marjorie Lazoff, MD That, together with the fact that the drug is still be referred > to by number and not name (part of a drug company's promotion is to > use it's copyrighted name) leads me to believe the research is years > from human trials. Although, the article was from 1998, so we should > be seeing something about this in 2002. > > But most important, the article only talks about use of MK-869 as an > anti-depressant/anti-anxiolytic. Nothing related to rosacea. > > Medications that block Substance P are used *topically* for control > of neurogenic pain -- I know of one available on the market now. > although I understand it is not uniformly successful and has side > effects. I'm familiar with its use on diabetic feet or post- herpetic > zoster pain, not on the face. The trade name is Zostrix. > > Perhaps Zostrix is what Dr. Nase was referring to, since as your > father correctly noted, Zofran is used to counteract the nausau and > vomiting of chemotherapy. I'm quite familiar with Zofran from my > residency days, and I can't fathom a use in rosacea for it. > > Marjorie > > Marjorie Lazoff, MD > > > > > > > Ok, while I'm on the subject of things that I don't really > understand.. > > > > In Dr Nase's book, he talks about how Substance P may play an > important role in cea. He mentions a doctor who has had success > in treating vascular cea using the drug Zofran. When I first got > this book months ago I went through all the medicines listed in it > with my dad and asked him which ones were safe to take, and he told > me Zofran was used for chemotherapy or cancer or something and had > alot of possible side effects. Anyway, Dr Nase mentions a selective > substance P blocker MK-869 " currently undergoing extensive testing in > human clinical trials " that " shows great promise " . Well, now > apparantly the studies have been done. > > > > Well, in the following article I found, it talks about substance > P's role in pain perception. The article talks about MK-869 which > has been tested, and found to be a useful antidepressant and > antianxiety medication. The article mentions that MK-869 has a very > low incidence of side effects. So, the way I understand it (please > Nobody misconstrue this as a fact)... MK-869 is a pain-relieving, > flush-reducing, antidepressant/anti-anxiety medication with minimal > side effects that no doctors anywhere are using to treat cea. > Can somebody please explain to me where exactly I got mixed up? This > doesn't sound right.. > > > > Here is the link: > > http://www.hosppract.com/cc/1998/cc9812.htm > > > > Adam > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 > Adam, the study on MK-869 you brought our attention to was > conducted on guinea pigs -- not human guinea pigs but oink-oink > guinea pigs. I'm sorry! I missed the second study, that WAS conducted on humans. I was wondering how they could use a point scale system measuring depression on guinea pigs -- especially when they came to the conclusion that sexual side effects were infrequent! Still, the MK-869 tests were for psychiatric conditions, not rosacea. Perhaps there are topical MK-869 studies, similiar to Zostrix? Marjorie Marjorie Lazoff, MD That, together with the fact that the drug is still be referred > to by number and not name (part of a drug company's promotion is to > use it's copyrighted name) leads me to believe the research is years > from human trials. Although, the article was from 1998, so we should > be seeing something about this in 2002. > > But most important, the article only talks about use of MK-869 as an > anti-depressant/anti-anxiolytic. Nothing related to rosacea. > > Medications that block Substance P are used *topically* for control > of neurogenic pain -- I know of one available on the market now. > although I understand it is not uniformly successful and has side > effects. I'm familiar with its use on diabetic feet or post- herpetic > zoster pain, not on the face. The trade name is Zostrix. > > Perhaps Zostrix is what Dr. Nase was referring to, since as your > father correctly noted, Zofran is used to counteract the nausau and > vomiting of chemotherapy. I'm quite familiar with Zofran from my > residency days, and I can't fathom a use in rosacea for it. > > Marjorie > > Marjorie Lazoff, MD > > > > > > > Ok, while I'm on the subject of things that I don't really > understand.. > > > > In Dr Nase's book, he talks about how Substance P may play an > important role in cea. He mentions a doctor who has had success > in treating vascular cea using the drug Zofran. When I first got > this book months ago I went through all the medicines listed in it > with my dad and asked him which ones were safe to take, and he told > me Zofran was used for chemotherapy or cancer or something and had > alot of possible side effects. Anyway, Dr Nase mentions a selective > substance P blocker MK-869 " currently undergoing extensive testing in > human clinical trials " that " shows great promise " . Well, now > apparantly the studies have been done. > > > > Well, in the following article I found, it talks about substance > P's role in pain perception. The article talks about MK-869 which > has been tested, and found to be a useful antidepressant and > antianxiety medication. The article mentions that MK-869 has a very > low incidence of side effects. So, the way I understand it (please > Nobody misconstrue this as a fact)... MK-869 is a pain-relieving, > flush-reducing, antidepressant/anti-anxiety medication with minimal > side effects that no doctors anywhere are using to treat cea. > Can somebody please explain to me where exactly I got mixed up? This > doesn't sound right.. > > > > Here is the link: > > http://www.hosppract.com/cc/1998/cc9812.htm > > > > Adam > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 > Adam, the study on MK-869 you brought our attention to was > conducted on guinea pigs -- not human guinea pigs but oink-oink > guinea pigs. I'm sorry! I missed the second study, that WAS conducted on humans. I was wondering how they could use a point scale system measuring depression on guinea pigs -- especially when they came to the conclusion that sexual side effects were infrequent! Still, the MK-869 tests were for psychiatric conditions, not rosacea. Perhaps there are topical MK-869 studies, similiar to Zostrix? Marjorie Marjorie Lazoff, MD That, together with the fact that the drug is still be referred > to by number and not name (part of a drug company's promotion is to > use it's copyrighted name) leads me to believe the research is years > from human trials. Although, the article was from 1998, so we should > be seeing something about this in 2002. > > But most important, the article only talks about use of MK-869 as an > anti-depressant/anti-anxiolytic. Nothing related to rosacea. > > Medications that block Substance P are used *topically* for control > of neurogenic pain -- I know of one available on the market now. > although I understand it is not uniformly successful and has side > effects. I'm familiar with its use on diabetic feet or post- herpetic > zoster pain, not on the face. The trade name is Zostrix. > > Perhaps Zostrix is what Dr. Nase was referring to, since as your > father correctly noted, Zofran is used to counteract the nausau and > vomiting of chemotherapy. I'm quite familiar with Zofran from my > residency days, and I can't fathom a use in rosacea for it. > > Marjorie > > Marjorie Lazoff, MD > > > > > > > Ok, while I'm on the subject of things that I don't really > understand.. > > > > In Dr Nase's book, he talks about how Substance P may play an > important role in cea. He mentions a doctor who has had success > in treating vascular cea using the drug Zofran. When I first got > this book months ago I went through all the medicines listed in it > with my dad and asked him which ones were safe to take, and he told > me Zofran was used for chemotherapy or cancer or something and had > alot of possible side effects. Anyway, Dr Nase mentions a selective > substance P blocker MK-869 " currently undergoing extensive testing in > human clinical trials " that " shows great promise " . Well, now > apparantly the studies have been done. > > > > Well, in the following article I found, it talks about substance > P's role in pain perception. The article talks about MK-869 which > has been tested, and found to be a useful antidepressant and > antianxiety medication. The article mentions that MK-869 has a very > low incidence of side effects. So, the way I understand it (please > Nobody misconstrue this as a fact)... MK-869 is a pain-relieving, > flush-reducing, antidepressant/anti-anxiety medication with minimal > side effects that no doctors anywhere are using to treat cea. > Can somebody please explain to me where exactly I got mixed up? This > doesn't sound right.. > > > > Here is the link: > > http://www.hosppract.com/cc/1998/cc9812.htm > > > > Adam > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 > Most doctors are conservative and will not prescribe medications > that are " off-label " (i.e. they are not indicated by the > manufacturer as a application of the drug). , once a drug is approved, it can be legally prescribed by a physician for any use. As you note, the indications for use come from the drug company's application to the FDA; it usually takes a few years for physicians to become comfortable prescribing it for other indications as new studies, word-of-mouth recommendations by colleagues, and common sense suggests. Unless there are marketing benefits, it's not worth the expense for drug companies to refile for every new indication. So a good rule of thumb is that the older a drug is, the more likely and appropriately it will be prescribed " off- label. " (Physicians may be limited in prescribing based on their patient's HMO formulary which may reimburse only for certain conditions or manners of use, but that's a different problem.) > At the very least many doctors will > want to see a well regarded initial study on a drug and its > application before they prescribe it... I don't believe a single initial study, no matter how well regarded, would satisfy most physicians. ly, many physicians I know like to wait 2 years or so after a systemically-acting drug has been approved by the FDA, before they feel comfortable using it. Patients don't usually see all the recalls and post-production side effects that quell physicians' desire to jump on any new drug bandwagon. Topical medications are usually regarded as less suspect, especially for physicians who manage many patients with dermatologic conditions, so they're much more likely to be used immediately after FDA approval. > This is in some ways > unfortunate but we have to remember that Doctors have a huge amount > of drugs and diseases to keep up to date with. They can't find out > the safety and applicability of drugs within a single sitting with > a patient so (unforutanely for us) are sometimes dissimissive. > At the end of the day, they are reponsible for any " mishaps " and > with rosacea not a life threatening (but certainly life altering > and unpleasant) disease, they are unwilling to take risks. Keeping up with the massive amounts of medical information is tough, but physicians are not dismissive of new drugs! Quite the contrary. It's not a " CYA " situation, it's a " first, do no harm " situation. > Lets hope > that someone does preliminary trials on drugs like the Substance P > blocker and the new topical medications on rosacea sufferers. > Perhaps Dr. Marjorie Lazaroff who is currently contributing > actively to the group can help us start this process. I'm willing to help whenever appropriate, but I need more information from you to properly address this, as I just requested in email (or you can post it publicly if you desire). As I told you, from what I've seen, physicians don't use investigational drugs on a patient outside of a highly structured clinical trial -- usually, an academic setting involving hospital-based physicians -- or by compassionate use, which wouldn't apply for non-lethal conditions. Marjorie Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 > Most doctors are conservative and will not prescribe medications > that are " off-label " (i.e. they are not indicated by the > manufacturer as a application of the drug). , once a drug is approved, it can be legally prescribed by a physician for any use. As you note, the indications for use come from the drug company's application to the FDA; it usually takes a few years for physicians to become comfortable prescribing it for other indications as new studies, word-of-mouth recommendations by colleagues, and common sense suggests. Unless there are marketing benefits, it's not worth the expense for drug companies to refile for every new indication. So a good rule of thumb is that the older a drug is, the more likely and appropriately it will be prescribed " off- label. " (Physicians may be limited in prescribing based on their patient's HMO formulary which may reimburse only for certain conditions or manners of use, but that's a different problem.) > At the very least many doctors will > want to see a well regarded initial study on a drug and its > application before they prescribe it... I don't believe a single initial study, no matter how well regarded, would satisfy most physicians. ly, many physicians I know like to wait 2 years or so after a systemically-acting drug has been approved by the FDA, before they feel comfortable using it. Patients don't usually see all the recalls and post-production side effects that quell physicians' desire to jump on any new drug bandwagon. Topical medications are usually regarded as less suspect, especially for physicians who manage many patients with dermatologic conditions, so they're much more likely to be used immediately after FDA approval. > This is in some ways > unfortunate but we have to remember that Doctors have a huge amount > of drugs and diseases to keep up to date with. They can't find out > the safety and applicability of drugs within a single sitting with > a patient so (unforutanely for us) are sometimes dissimissive. > At the end of the day, they are reponsible for any " mishaps " and > with rosacea not a life threatening (but certainly life altering > and unpleasant) disease, they are unwilling to take risks. Keeping up with the massive amounts of medical information is tough, but physicians are not dismissive of new drugs! Quite the contrary. It's not a " CYA " situation, it's a " first, do no harm " situation. > Lets hope > that someone does preliminary trials on drugs like the Substance P > blocker and the new topical medications on rosacea sufferers. > Perhaps Dr. Marjorie Lazaroff who is currently contributing > actively to the group can help us start this process. I'm willing to help whenever appropriate, but I need more information from you to properly address this, as I just requested in email (or you can post it publicly if you desire). As I told you, from what I've seen, physicians don't use investigational drugs on a patient outside of a highly structured clinical trial -- usually, an academic setting involving hospital-based physicians -- or by compassionate use, which wouldn't apply for non-lethal conditions. Marjorie Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 > Most doctors are conservative and will not prescribe medications > that are " off-label " (i.e. they are not indicated by the > manufacturer as a application of the drug). , once a drug is approved, it can be legally prescribed by a physician for any use. As you note, the indications for use come from the drug company's application to the FDA; it usually takes a few years for physicians to become comfortable prescribing it for other indications as new studies, word-of-mouth recommendations by colleagues, and common sense suggests. Unless there are marketing benefits, it's not worth the expense for drug companies to refile for every new indication. So a good rule of thumb is that the older a drug is, the more likely and appropriately it will be prescribed " off- label. " (Physicians may be limited in prescribing based on their patient's HMO formulary which may reimburse only for certain conditions or manners of use, but that's a different problem.) > At the very least many doctors will > want to see a well regarded initial study on a drug and its > application before they prescribe it... I don't believe a single initial study, no matter how well regarded, would satisfy most physicians. ly, many physicians I know like to wait 2 years or so after a systemically-acting drug has been approved by the FDA, before they feel comfortable using it. Patients don't usually see all the recalls and post-production side effects that quell physicians' desire to jump on any new drug bandwagon. Topical medications are usually regarded as less suspect, especially for physicians who manage many patients with dermatologic conditions, so they're much more likely to be used immediately after FDA approval. > This is in some ways > unfortunate but we have to remember that Doctors have a huge amount > of drugs and diseases to keep up to date with. They can't find out > the safety and applicability of drugs within a single sitting with > a patient so (unforutanely for us) are sometimes dissimissive. > At the end of the day, they are reponsible for any " mishaps " and > with rosacea not a life threatening (but certainly life altering > and unpleasant) disease, they are unwilling to take risks. Keeping up with the massive amounts of medical information is tough, but physicians are not dismissive of new drugs! Quite the contrary. It's not a " CYA " situation, it's a " first, do no harm " situation. > Lets hope > that someone does preliminary trials on drugs like the Substance P > blocker and the new topical medications on rosacea sufferers. > Perhaps Dr. Marjorie Lazaroff who is currently contributing > actively to the group can help us start this process. I'm willing to help whenever appropriate, but I need more information from you to properly address this, as I just requested in email (or you can post it publicly if you desire). As I told you, from what I've seen, physicians don't use investigational drugs on a patient outside of a highly structured clinical trial -- usually, an academic setting involving hospital-based physicians -- or by compassionate use, which wouldn't apply for non-lethal conditions. Marjorie Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 Ahh, thanks. I get it now. Hopefully when it does become available it will be a possible weapon in our fight against cea. I do think they had begun testing on humans even when the article was written: " A randomized double-blind study was conducted at four investigative sites, comparing the effects of MK-869 with those of paroxetine or placebo in depressive patients. " So by now it may be very close to market. (I hope?) The article doesn't mention anything about being used for cea, but Dr. Nase does briefly mention MK-869 in his book. That would be pretty neat if one medication could be used for depression and cea. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 Ahh, thanks. I get it now. Hopefully when it does become available it will be a possible weapon in our fight against cea. I do think they had begun testing on humans even when the article was written: " A randomized double-blind study was conducted at four investigative sites, comparing the effects of MK-869 with those of paroxetine or placebo in depressive patients. " So by now it may be very close to market. (I hope?) The article doesn't mention anything about being used for cea, but Dr. Nase does briefly mention MK-869 in his book. That would be pretty neat if one medication could be used for depression and cea. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 Ahh, thanks. I get it now. Hopefully when it does become available it will be a possible weapon in our fight against cea. I do think they had begun testing on humans even when the article was written: " A randomized double-blind study was conducted at four investigative sites, comparing the effects of MK-869 with those of paroxetine or placebo in depressive patients. " So by now it may be very close to market. (I hope?) The article doesn't mention anything about being used for cea, but Dr. Nase does briefly mention MK-869 in his book. That would be pretty neat if one medication could be used for depression and cea. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 > > I'm sorry! I missed the second study, that WAS conducted on humans. I > was wondering how they could use a point scale system measuring > depression on guinea pigs -- especially when they came to the > conclusion that sexual side effects were infrequent! > LOL ya, I would hate to be the guy who had to determine the effect of a medication on a guinea pig's libido > Still, the MK-869 tests were for psychiatric conditions, not rosacea. > Perhaps there are topical MK-869 studies, similiar to Zostrix? When Dr. Nase mentioned MK-869 in the book, he also mentioned that it was going to be an oral drug. It would be nice if it turns out there are some topical studies out there, but since Merck is testing it as a treatment for depression, the odds probably are against this. Maybe this could be one of the NRS's next experiments? Adam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 > > I'm sorry! I missed the second study, that WAS conducted on humans. I > was wondering how they could use a point scale system measuring > depression on guinea pigs -- especially when they came to the > conclusion that sexual side effects were infrequent! > LOL ya, I would hate to be the guy who had to determine the effect of a medication on a guinea pig's libido > Still, the MK-869 tests were for psychiatric conditions, not rosacea. > Perhaps there are topical MK-869 studies, similiar to Zostrix? When Dr. Nase mentioned MK-869 in the book, he also mentioned that it was going to be an oral drug. It would be nice if it turns out there are some topical studies out there, but since Merck is testing it as a treatment for depression, the odds probably are against this. Maybe this could be one of the NRS's next experiments? Adam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2002 Report Share Posted April 20, 2002 > > I'm sorry! I missed the second study, that WAS conducted on humans. I > was wondering how they could use a point scale system measuring > depression on guinea pigs -- especially when they came to the > conclusion that sexual side effects were infrequent! > LOL ya, I would hate to be the guy who had to determine the effect of a medication on a guinea pig's libido > Still, the MK-869 tests were for psychiatric conditions, not rosacea. > Perhaps there are topical MK-869 studies, similiar to Zostrix? When Dr. Nase mentioned MK-869 in the book, he also mentioned that it was going to be an oral drug. It would be nice if it turns out there are some topical studies out there, but since Merck is testing it as a treatment for depression, the odds probably are against this. Maybe this could be one of the NRS's next experiments? Adam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2002 Report Share Posted April 22, 2002 > When Dr. Nase mentioned MK-869 in the book, he also mentioned that it was > going to be an oral drug. It would be nice if it turns out there are some > topical studies out there, but since Merck is testing it as a treatment for > depression, the odds probably are against this. I agree, Adam, it doesn't look like MK-869 -- or Zofran, which apparently also blocks Substance P centrally -- panned out as a oral pain medication, for rosacea or anyone else. It could turn out to have an off-label indication for pain syndromes, like Elavil when it first started out, but from what we're hearing it doesn't sound very hopeful. Still, Substance P antagonists, whether peripheral or centrally- acting, was never expected to treat or cure rosacea, or even impact on the majority of rosaceas. But neurogenic pain -- if that's the cause of the burning and stinging in rosaceans -- is an active area of research in pain control. Again, another example of research not involving rosacea will likely help that group of rosaceans. I'm learning a lot. It's nice to read others' contributations to these research threads. Thank you. As an aside: has anyone with burning/stinging symptoms tried cea Care's strontium lotion? I'm not recommending it, I'm just curious. Marjorie Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
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