Dangerous Medicine: Examples of Animal-Based “Safety” Tests Gone Wrong
By John J. Pippin, M.D., and Kristie Stoick, M.P.H.
Biological differences between and within species require scientists
to proceed with caution when interpreting the results of any experiment.
Animals of different ages, sexes, developmental stages, and of
different health status can all respond differently to experimental
treatments. It is no surprise, then, that humans respond differently
to administered pharmaceuticals than other animals. The surprise
comes when scientists, physicians, and regulatory officials are
willing to risk the health of patients by relying on animal experiments
to predict the effects of drugs in humans—sometimes with
grave results.
According to some estimates, adverse drug reactions are responsible
for 2.2 million hospitalizations and 106,000 deaths annually.1
Furthermore, as many as 50 percent of FDA-approved drugs are withdrawn
or relabeled due to unanticipated side effects in humans.2 A shockingly
low 56 percent of known human teratogens are positive in one of
six species surveyed.3 Below are a few selected examples to illustrate
the dire need for better, more human-specific drug safety tests.
Thalidomide
Perhaps the most famous teratogen,
this drug was given to pregnant women in the 1950’s to control
nausea, causing more than 10,000 births with limb-reduction defects.4,5
After thalidomide was withdrawn from the market, tests in pregnant
mice, rats, and guinea pigs were negative; finally, one strain
of rabbit (the New Zealand white rabbit) was found to be susceptible.
Cats, hamsters, rats, and mice were later found to be sensitive
only to extremely high doses.3
Oraflex, Opren (Benoxaprofen)
Even though year-long tests in rhesus
monkeys6 gave no indication of risk, months after this non-steroidal
anti-inflammatory (NSAID) was released onto the market in 1982,
patients began experiencing severe liver toxicity and phototoxicity,7,8
eventually resulting in withdrawl of the drug, but only after more
than 3,500 serious adverse events and 60 deaths occurred in Britain
alone.9
Flenac (Fenclofenac)
This NSAID, despite passing animal toxicity
tests in 10 animal species (mice, rats, guinea pigs, ferrets, rabbits,
cats, dogs, pigs, horses, and monkeys), produced severe liver toxicity
in humans.10
Butazolidin (Phenylbutazone)
This NSAID is commonly used in equine
medicine to reduce pain and inflammation, but in humans can produce
serious phototoxicity,11 as well as serious or fatal liver12 or
bone marrow13 disease. Bone marrow toxicity was demonstrated in
human cell cultures after the drug was released and produced more
than 10,000 fatal cases of aplastic anemia.14-16
Cylert (Pemoline)
Fifteen children suffered acute liver failure
after taking this attention deficit hyperactivity disorder treatment,
and 12 of those cases resulted in liver transplant or death.17
No animal tests that showed an indication of hepatic toxicity could
be found.
Rezulin (Troglitazone)
This drug, intended to treat type 2 (adult-onset)
diabetes, was approved by the FDA in 1997. Rezulin lowered the
blood sugar in rats without producing adverse effects, but reports
of severe and even fatal liver failure appeared immediately after
approval. Due largely to an aggressive investigation by the Los Angeles Times and
after four label changes, Rezulin was withdrawn in 2000 after 391
deaths were attributed to the drug.18
Propulsid (Cisapride)
Propulsid was approved by the FDA in 1993
and was used primarily to treat gastric reflux in children. Heart
rhythm disturbances had appeared in clinical trials, but not in
animal studies. By 1995, heart rhythm deaths in children became
evident through adverse events reports. The drug remained on the
market with five label changes, until being withdrawn in 2000 after
causing over 300 deaths.18
Inocor (Amrinone)
This short-term therapy option for patients with
severe heart failure produced severe and sometimes fatal thrombocytopenia
(decreased blood clotting ability) in humans, despite no evidence
of this effect in 2-year-long animal tests. Only after approval,
and only in marmosets and a very specific, metabolically compromised
strain of rat, were similar effects found.7
Baycol (Cerivastatin)
Baycol was a popular drug approved in 1997
for the treatment of dyslipidemia (abnormal cholesterol levels),
but it was withdrawn after substantial risk for severe or fatal
rhabdomyolysis (muscle wasting) was revealed in patients. Muscle
wasting was not seen in pre-clinical animal tests, including rats,
mice, minipigs, dogs, or monkeys; only at very high doses were
indications of effects on muscle tissue seen.19 The authors concluded
that cerivastatin was well tolerated in all species. Post-withdrawal
tests using rat and human muscle cells in vitro revealed
that rat cells are 200 times more resistant to the drug’s
effects.20 Eventually more than 100 deaths were linked to cerivastatin.
Such a high error rate begs the question: How many possibly life-saving
therapies have clinicians never investigated because of toxicities
in other animal species? Penicillin, which was originally discovered
in 1929, wasn’t used until 1939 because of its ineffectiveness
in curing infected rabbits. If it had been “safety” tested
in cats, guinea pigs, or hamsters, it would have been abandoned
as toxic.21
Furosemide (Lasix) is one of our most important diuretics, used
to reduce fluid retention during heart failure and other diseases.
Though experiments in mice show extensive liver damage, decades
of clinical use have proven its safety for humans.22,23
One of our most relied-upon pain relievers, Aspirin (Acetylsalicylic
acid), causes teratogenic malformations in mice, rats, dogs, cats,
rabbits, and monkeys.3
What You Can Do
- More funding must be dedicated to the development of
better, human-based drug safety tests. Write your federal legislators
to explain this urgent need.
- Encourage the National Institutes of Health to fund
studies using non animal methods, such as the examples listed
at the right. Contact NIH here:
Elias Zerhouni, Director
National Institutes of Health
9000 Rockville Pike
Bethesda, MD 20892
- Support only health charities that fund non-animal research.
A full list of those with the Humane Charity Seal of Approval
can be found at www.HumaneSeal.org.
References
1. Lazarou et al. JAMA 1998 Apr 15;279(15):1200-5.
2. United States
General Accounting Office (GAO) GAO/PEMD-90-15 Apr1990.
3. Bailey
et al. Biogenic Amines 2005 19(2):97-145.
4. March of Dimes: http://www.marchofdimes.com/professionals/681_1172.asp
5. Rajkumar SV. Mayo Clinic Proceed 2004; 79:899-903.
6.
Dahl SL and JR Ward. Phamacotherapy 1982;2(6): 354-66.
7. Eason
et al. Reg Tox Pharm 1990;11:288-307.
8. Parke et al. Pol J Occ
Med 1990;3(1):15-41.
9. Medawar C. BMJ 1982; 285:459-60.
10. Gad S. J Am Coll Tox
1990;9:291-302.
11. Becker et al. Acta Derm Venerol 1996 Sep;76(5):337-40.
12. Peters.
Tox Path 2005;33:146-154.
13. Neumuller J and M Tohidast-Akrad.
Arzneimittelforschung 1994 May;44(5):636-41.
14. Wolfe S. Lancet
1984;1:353.
15. Venning. BMJ 1983 Jan 15;286:199-202.
16. Venning. BMJ 1983
Jan 29;286:365-8.
17. FDA safety alert 1999: http://www.fda.gov/medwatch/safety/1999/cylert.htm
18. Willman D. Los Angeles Times, December 20,
2000.
19. von Keutz, E and G Schluter. Am J Cardiol 1998;82:11J-17J.
20.
Johnson et al. Toxicol Appl Pharm 2004 Nov 1; 200(3):237-50.
21.
Fleming, A. ATLA 1994;22:207-9.
22. Mitchell et al. Nature 1974
Oct 11;251(5475):508-11.
23. Hutcheon DE and G Leonard. J Clin Pharmacol
J New Drugs 1967 Jan-Feb;7(1):26-33.
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