UA Center for Education and Research in Therapeutics Awarded $3.9 Million; UA Center to Promote Safe Medication Use Receives Federal Funds
The University of Arizona Center for Education and Research in Therapeutics (AzCERT) has been awarded $3.9 million over five years by the U.S. Agency for Healthcare Research and Quality to continue its efforts to promote the safe and effective use of medications.
AzCERT is part of a national network of seven centers - all based at academic health sciences centers - that are independent, federally funded programs to improve therapeutic outcomes and reduce adverse events caused by medications. AzCERT focuses on preventing harm from drug interactions, especially those affecting women. This is accomplished through basic research, clinical research and a broad range of educational programs to educate physicians, nurses, pharmacists and the public about optimal use of medications.
"Patients and physicians need unbiased research to allow those who prescribe and those who take drugs to make informed and cost-effective choices of therapies," says Raymond Woosley, MD, PhD, UA Vice President for Health Sciences and principal investigator of AzCERT. "That is the key mission of the Centers for Education and Research in Therapeutics," adds Dr. Woosley, an internationally respected pharmacologist and health care administrator.
AzCERT specifically is devoted to education and research on prevention of adverse drug reactions that cause arrhythmias (heart rhythm abnormalities). Physicians are encouraged to report incidents of drug-induced arrhythmias to an international web-based registry maintained by AzCERT, www.Qtdrugs.org, which serves as the mechanism for initiating these studies.
"Five of the 10 drugs removed from the market in the last four years caused cardiac toxicity that resulted from adverse drug interactions (ADIs)," Dr. Woosley notes. "These and many other drugs still marketed today have been shown to increase the risk of a potentially fatal arrhythmia, torsades de pointes (TdP)," he says. "Concurrent use of two or more of these drugs is expected to further increase the risk."
However, the prevalence and clinical outcomes from concurrent prescription of QT-prolonging drugs is not well characterized. More importantly, effective means to prevent these and other ADIs have not been identified or implemented, he says.
Previously based at Georgetown University, the Center moved to the UA when Dr. Woosley became UA Vice President of Health Sciences in September 2001. (Dr. Woosley is the individual who first proposed that the federal government establish a consortium of academically based Centers for Education and Research in Therapeutics.)
Following the move to Arizona, the new AzCERT has continued the study of drug-drug interactions that result in arrhythmias. An outstanding team of health researchers has joined AzCERT. Dr. Woosley continues to lead the Center's Pharmacodynamics Core, which also include cardiologist Julia Indik, MD, PhD, and Ellen Pearson, RN, MPH, an experienced clinical investigator who maintains the Center's web sites and web-based international registry.
The Pharmacoeconomics Outcomes Core is led by Dan Malone, PhD, associate professor of Pharmacy and an expert in drug interactions. Lane Johnson, MD, MPH, an expert on botanical medications, serves as project leader for one of the studies in the Drug-Herbal Outcomes Core. Barbara Timmermann, PhD, an internationally recognized natural products chemist and director of one of six NIH-sponsored Phytomedicine Centers, serves as a consultant to this Core. Carlos C. "Kent" Campbell, MD, MPH, an internationally respected health services researcher and director of the Arizona Area Health Education Centers, is director of the Educational Core and Mary Brown, PhD, and Marietta Anthony, PhD, AHSC Associate Vice President for Women's Health Research, are responsible for public education and outreach programs.
International Registry Uncovers Problem with Long-used Drug Methadone
A major finding, resulting from cases reported to the AzCERT's international registry, is the observation that methadone can induce lethal heart arrhythmias.
An established treatment for narcotic addiction and pain for more than 45 years, methadone is inexpensive and previously thought to be well-tolerated. However, it has been associated with an increased incidence of sudden death (which previously was assumed to be a result of a return to heroin use). Cases reported to the registry prompted Dr. Woosley and his team to examine methadone in their laboratory and they found that it had the ability to cause serious heart rhythm disorders in some patients, especially those given high dosages.
AzCERT is conducting a clinical study to identify the risk factors for methadone-related arrhythmias. The potential life-saving project will be performed in collaboration with the Southern Arizona Veterans Health Care System and La Frontera Hope Center, a Tucson-area addiction treatment center that offers drug detoxification and methadone maintenance.
"This research should result in hundreds of lives saved from preventable drug toxicity," Dr. Woosley says.