MedPath

Fish oil

Generic Name
Fish oil
Brand Names
Omegaven
Drug Type
Biotech
Unique Ingredient Identifier
XGF7L72M0F
Background

Fish oil is a component of SMOFLIPID, which was FDA approved in July 2016. It is indicated in adults as a source of calories and essential fatty acids for parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated.

More commonly, fish oil refers to the omega-3-fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) . In general, dietary or pharmaceutical intake of these acids is primarily the only way to increase their levels in the human body where they are overall an essential element to dietary health as they have demonstrated abilities in minimizing or preventing hypertriglyceridemia when taken as an adjunct to a healthy diet .

Such fish oils are available in both non-prescription and prescription-only varieties at different concentrations. For many individuals, taking non-prescription fish oils as part of their multivitamin regimen is an effective way to supplement their diets with the healthy fatty acids. However, prescription-only fish oil products are sometimes prescribed for individuals who demonstrate severe (>= 500 mg/dL) hypertriglyceridemia .

Furthermore, a variety of studies regarding additional potential actions of fish oil omega-3-fatty acids EPA and DHA are ongoing. Such experimental actions include inflammation modulation, cardioprotective effects, the attenuation of oxidative stress, and more. Regardless, the specific mechanisms of action for these effects have yet to be formally elucidated.

Indication

Under FDA approval, fish oil pharmaceuticals are typically products consisting of a combination of the omega-3-fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and are indicated primarily as an adjunct to diet to reduce triglyceride levels in adult patients with severe (>=500 mg/dL) hypertriglyceridemia .

Under EMA approval, such fish oil pharmaceuticals comprised of virtually the same fish and fish oil derived omega-3-fatty acids EPA and DHA are indicated specifically for (a) adjuvant treatment in secondary prevention after myocardial infarction, in addition to other standard therapy (ie. statins, antiplatelet medicinal products, beta blockers, ACE inhibitors), and (b) as a supplement to diet when dietary measures alone are insufficient to produce an adequate response, particularly with type IV hypertriglyceridemia in monotherapy or type IIb/III in combination with statins, when control of triglycerides is insufficient . In addition, prescribing information for EMA approved fish oil pharmaceuticals are also indicated as an adjunct to diet to reduce very high (>=500 mg/dL) triglyceride levels in adult patients, much like similar FDA approved indications .

Associated Therapies
Dietary and Nutritional Therapies, Nutritional supplementation, Parenteral Nutrition

Omega-3 Rich Diet and Fish Oil Reduce Prostate Cancer Biomarker Ki-67

• A high omega-3, low omega-6 diet with fish oil significantly reduced the Ki-67 index in prostate cancer patients on active surveillance. • The CAPFISH-3 trial showed a 15% decrease in Ki-67 index in the intervention group compared to a 24% increase in the control group. • The dietary intervention included reducing omega-6 rich foods and increasing omega-3 rich foods, alongside fish oil supplementation. • Further phase 3 trials are warranted to confirm the efficacy and safety of this dietary intervention for prostate cancer management.

Omega-3 Supplementation and Cardiovascular Health: Mixed Results and Nuanced Benefits

• Clinical trials show mixed results regarding the benefits of omega-3 supplements in preventing major cardiovascular events, with some studies suggesting potential harm. • A subgroup analysis of the VITAL trial indicated a 19% reduction in major CVD events among those with higher omega-3 levels, particularly in reducing heart attacks. • The REDUCE-IT trial demonstrated a 25% reduction in major CVD events using icosapent ethyl in high-risk patients already on statins, leading to FDA approval for this specific use. • Experts recommend a heart-healthy diet rich in fish as the primary source of omega-3s, advising caution and medical supervision for high-dose supplementation.

Emerging Therapies Offer Hope for Usher Syndrome Patients

• The Usher Syndrome market is poised for growth with emerging therapies addressing the root cause of the disease, offering alternatives to supportive care. • Ultevursen, an investigational RNA therapy, targets the USH2A gene mutation and is currently in Phase II/III trials, showing promise in restoring functional usherin protein. • Nacuity Pharmaceuticals' NPI-001, a free radical scavenger, is in Phase I/II trials, aiming to reduce oxidative stress and preserve photoreceptor cells in Usher Syndrome patients. • The US has the highest prevalent cases of Usher Syndrome, with approximately 21,000 cases in 2023, highlighting the significant unmet need for effective treatments.
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