A New Non-Hormonal Treatment for Hot Flashes? Not So Fast…

There’s news this week about a new, hormone-free treatment for menopause-related hot flashes and night sweats.  It’s called Pristiq, and it was originally approved by the FDA last year as a remedy for depression.  The agency just gave the green light to Wyeth, the drugmaker, to also market it as a safe solution for women experiencing moderate to severe hot flashes.  Is this welcome news? I decided to “double-click” on this story to see if this falls under the category of “it’s too good to be true.”

First, there’s skepticism among some physicians that there’s nothing new about Pristiq. It’s a modified version of Wyeth’s earlier anti-depressant drug, Effexor XR, whose patent expired last year.  “Every patient who takes Effexor produces Pristiq in their own body, at no additional charge,” said Dr. Daniel Carlat, a psychiatrist who wrote about Pristiq on his personal blog last year.

Second,  I wonder about the integrity of any research that is conducted and/or funded by the manufacturer.  In this case, a 26-week double-blind, placebo controlled study, which was “supported in part” by Wyeth Research, was led by David Archer, MD, a professor of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk and four additional physician-researchers.  As described on the school’s website, Dr. Archer is past president and a former board member of the North American Menopause Society (NAMS), which is largely funded by Wyeth (and advocates the use of conjugated hormones made by Wyeth).  He is a consultant for Wyeth Research and has received grants and honoraria from the Wyeth Speakers Bureau. And by the way, the four other physicians who conducted the study are either consultants for, or employees of Wyeth Research.  One of them, Dr. Ginger D. Constantine co-authored an article praising Wyeth entitled “Wyeth: The Leader in Women’s Health – Yesterday, Today and Tomorrow” that appeared in a publication for the American Society for Reproductive Medicine (9/2004).

Dr. Archer also stated, a full year before the FDA approved Pristiq as a treatment for menopausal hot flashes, that “Pristiq is going to fill a needed void. For women who can’t take estrogens… it should be made available.”  Was he speaking as a researcher or promoter for Wyeth’s drug?

Another study that monitored 689 women on Pristiq or placebo over a 12 month period of time was led by Dr. Margery Gass, a professor of obstetrics and gynecology at the University of Cincinnati.  Dr. Gass has disclosed that she is a consultant and receives funding from Wyeth.

Oddly, the only study that concluded that Pristiq did not work much better than placebo and was inferior to a hot-flash-relieving drug not available in the U.S. was authored by a researcher who works for Wyeth, Dr. James Pickar.

So, what to make of all of this?  Know that Pristiq is NOT a new drug – it was approved for the treatment of depression one year ago.  While this class of drugs can correct the neurotransmitter imbalances that cause hot flashes and night sweats in some menopausal women, they can have side effects such as sexual dysfunction, sleep disorders, dry mouth, and nausea.

Also know that research studies tend to reach conclusions that the funders – in this case, Wyeth – are seeking.  From what I’ve been able to read on the web,  every physician-researcher involved with Pristiq has had ties to the company.  The FDA doesn’t seem to mind but if I were in charge of the health and welfare of this country’s population, I would insist on unbiased, third-party research.  Is there such a thing?