Drug Pipeline

A three-tier pharmacy benefit can reduce prescription drug spending without increasing other medical resource use or fueling medication discontinuation rates. So concludes the fully published report of an analysis whose preliminary results were presented last year and reported by Formulary (2001;36:522). It is the first well-designed, controlled study to explore such consequences of three-tier benefits.

Clinicians must use caution in adopting newly revised national guidelines for treating elevated cholesterol, concludes a new study from the University of Maryland Pharmaceutical Health Services Research Department.

An experimental antiviral medication can shorten the duration of colds and reduce the severity of cold symptoms, reported Frederick Hayden, MD. He presented a pooled analysis of data from two phase III trials of the drug at the 41st annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), held recently in Chicago.

Emerging data are continually refining our understanding of the risks and benefits of hormone replacement therapy (HRT) in postmenopausal women. This review assesses the current state of evidence on these various risks and benefits, concluding with an outline of what's established and where varying degrees of uncertainty remain. Algorithms for use of HRT for several established indications are featured.

While government agencies and private health plans struggle to deal with rising pharmacy bills, the federal government is expanding support for biomedical research and FDA

Idaho State University, Pocatello-Evidence in the literature has suggested that a pharmacist-run clinic provides quality care in chronic disease state management. In addition

VA Medical Center, Miami-ACE inhibitor therapy is recognized as the gold standard treatment for congestive heart failure (CHF) as well as diabetic nephropathy due to its effect on the morbidity and mortality associated with these conditions.

New combination, NME as component: Weekly contraceptive skin patch

New formulations: Single isomer form of methylphenidate for treatment of ADHD

New indication: Beta blocker cleared for severe HF

Biologic: Biologic for adults with severe sepsis at high risk of death

NME: First oral agent for treatment of pulmonary arterial hypertension

As health care costs and pharmaceutical expenditures continue to climb, the effect of these trends on health care coverage and economic development is emerging as a central issue for 2002.

Biologic: First IL-1 receptor blocker for moderate to severe rheumatoid arthritis

NME: Once-daily injectable carbapenem for treatment of various infections

NME: COX-2 inhibitor for rheumatoid arthritis, osteoarthritis, and dysmenorrhea

Prime Therapeutics, St. Paul, MN-Do quantity limits on abortive migraine medications (ie, triptans) and educational efforts to increase the use of prophylactic therapy reduce total health care costs over the long term?

ValleyCare Health System, Pleasanton, CA-The expansion of decentralized clinical pharmacy services at this health system served as the impetus to improve their clinical intervention documentation process.

Two new real-world comparisons of the tumor necrosis factor (TNF) blockers infliximab (Remicade) and etanercept (Enbrel) show that the two agents are highly comparable treatments for rheumatoid arthritis

While tiered benefit plans aim to spur use of lower-cost alternative drugs, they may leave patients in the dark about what those alternatives are and how much out-of-pocket savings they can bring.

Ranolazine, the first in a new class of antianginal agents called the partialfatty acid oxidation (pFOX) inhibitors, improves exercise performance andreduces angina frequency in patients who still have symptoms despite treatmentwith other antianginal medications, according to Bernard Chaitman, MD. Hereported the results of a Phase III study called the Combination Assessmentof Ranolazine in Stable Angina (CARISA).

An agent developed specifically for the treatment of angina reduces theincidence of major coronary events, reported Henry Dargie, MD, who presentedthe results of a trial known as the Impact of Nicorandil in Angina (IONA).It is believed to be the first large-scale trial to report on the effectsof a specific antianginal drug on clinical outcome.

Anaheim, CA-The largest trial of cholesterol-lowering therapy ever conducted extends the current indications for statin therapy, reported Rory Collins, MD.

The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, sertraline,and paroxetine are equally effective and tolerated in depressed patientsacross a broad range of outcome measures. So finds an open-label, randomizedstudy in 573 patients treated for depression for 9 months in a primary caresetting.

A step-down approach from proton pump inhibitor (PPI) therapy is successful in most patients with uncomplicated GERD, reducing costs without compromising quality of life. So concludes a new prospective study.

Differences among oral selective serotonin agonists (triptans) are small but clinically relevant for the individual patient, according to a comprehensive meta-analysis.

Although sensitivity analysis is a widely used technique for testing the uncertainty in pharmacoeconomic modeling parameters, it does have limitations. This month's column introduces probabilistic sensitivity analysis as an alternative method for examining uncertainty.

Tenofovir disoproxil fumarate (Viread) recently gained accelerated FDA approval. It is the first member of a new antiretroviral class and also the first antiretroviral approved on the basis of efficacy trials conducted almost exclusively in treatment-experienced patients. This Focus article reviews these studies and considers how other pending and planned trials may refine tenofovir's role.

Like their older counterparts, the newer anticonvulsants gabapentin, lamotrigine, and topiramate show promise for treating various off-label psychiatric and neurologic disorders. This review examines the quality of current evidence for these new uses, identifies where gaps in the evidence lie, and discusses which emerging uses of individual agents appear most justified.

Clinicians at Nebraska Methodist Hospital, a not-for-profit acute care facility, developed and implemented an automatic interchange program for the ACE inhibitor class of drugs. This article presents the ACE inhibitor review upon which the formulary decisions were based as well as the initial clinical and economic results of the interchange program. (This pdf version includes an appendix that was not included in the print issue)