Lowly Lifesaver

Gout drug aids heart victims

Seldom has a drug company been so modest about one of its products.

In describing Anturane, Ciba-Geigy Pharmaceuticals said only: "Its pharmacologic activity is limited almost exclusively to the potentiation of the urinary excretion of uric acid." In plain English, Anturane was considered useful only for the treatment of gout. But last week the preliminary results of a massive study, involving 1,475 heart-attack victims at 26 medical centers in the U.S. and Canada, produced a stunning surprise: the soft-sell gout drug may save or prolong the lives of hundreds of thousands of heart patients.

Each year in the U.S., nearly 1.1 million men and women suffer heart attacks of various types, and almost 700,000 die immediately or within a week or two. Among the 400,000 survivors, 47,000 die within a year. But the 96-member team reporting in the New England Journal of Medicine found that after treatment averaging SY2 months, the heart death rate (on an annual basis) among 733 patients who took Anturane four times a day was only 4.9%. In a comparison group of 742 patients who received only dummy pills (placebos), the rate was 9.5%.

The second cardiac catastrophe that kills so many original heart-attack victims within a year may be of two major types: occlusion (blockage) of a major coronary artery, or arrhythmia, a failure of the heart's electrical timing system. While expert opinions differ, occlusions may cause only about one-third of second-attack deaths, with electrical failures responsible for most of the rest. In this second group the deathrate reduction among patients taking Anturane was even more striking: only 2.7%, as against 6.3% for those on the placebo. There is no evidence as to how a reduction in blood levels of uric acid can affect the heart's electrical system. The most plausible explanation, still not fully understood, of Anturane's beneficial effects is that it somehow inhibits blood platelets from forming clots.

The researchers, headed by Temple University's Dr. Sol Sherry, at first intended to let all patients remain in the trial for one to two years (the study has already cost Ciba-Geigy about $3.8 million). But the preliminary results were so startling that they felt impelled to publish them. This created an ethical problem: if it is known that an available treatment will save lives--perhaps 10,000 to 15,000 a year in the U.S.--is it morally permissible to continue treating patients with a placebo? The Solomonic solution: describe the trial program explicitly to the patients, and let them decide whether they want to remain in the study.

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