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Paying a high price for cancer drugs

ID-10062361The Lancet recently published an editorial “Paying a high price for cancer” bringing attention of their readers to a large problem of growing cost of cancer therapies as discussed in the Mayo Clinic Proceedings commentary and co-signed by 118 US cancer physicians. There was a 5-10 fold increase in new cancer drugs prices during the past 15 years. For example the cost of a cancer drug that was approved in 2014 exceeds $120,000 per year of use. A post approval pricing review by Medicare which may include negotiating drug prices and importing drugs from neighboring countries are two possible suggested solutions to reduce the cost of cancer drugs. Moreover, a recently published research from Oxford, UK showed positive results for the use of widely available, inexpensive class of medications for the treatment of early breast cancer in postmenopausal women that could reduce disease recurrence and mortality. The WHO updated its’ list of “Essential Medicines” to include 16 new cancer drugs such as the costly imatinib, however the high cost of such essential drugs is an obstacle that restricts health systems from providing hope to their cancer patients.  What are your thoughts about this dilemma? How often do you dispense the costly cancer treatments?

For additional information please see The Lancet.

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Addressing opioid drug misuse in America

ID-100317718Morbidity and Mortality Weekly Report published a study that links prescription opioid misuse with illicit opioid use, specifically heroin. The study investigated tendencies of heroin users in the US from 2002 to 2013, among all demographics. There was a 90% increase in the rate of people diagnosed with past-year heroin use or dependence; the majority of which were among men, 19-25 years old, people of less than US$ 20000 annual household income, people living in urban areas, and those without health insurance. Moreover, there was a highest (138%) increase in past year heroin users who reported past year use of non-medical opioid pain relievers, followed by reports of cocaine use.  Some of the initiatives taken to minimize opioid misuse problems include the hand-held auto injector for naloxone that was approved by the FDA and the extensive Prescription Drug Abuse Prevention Plan lunched by the White House. In addition, a recommended action against opioid misuse was to provide better access and insurance coverage to evidence-based substance abuse treatments such as buprenorphine or methadone, promoting naloxone use for opioid pain reliever abuse and heroin overdoses. What programs related to opioid misuse are offered through your practice?

For additional information please read THE LANCET

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New safety warnings for two classes of diabetes drugs: What pharmacists should know?

ID-100265172New safety warnings were issued by the FDA for dipeptidyl peptidase–4 (DPP-4) inhibitors, and sodium–glucose linked transporter–2 (SGLT-2) which are two oral agents for blood glucose control in type 2 diabetes. Warning of heart failure risk associated with one of the DPP-4 inhibitors, saxagliptin, were voted to be included on the drug label based on a large study (SAVOR). The study had nearly 16,500 people with type 2 diabetes and risk factors for cardiovascular events; more hospitalization due to heart failure occurred in the saxagliptin group (3.5%) than in the placebo group (2.8%) over 2 years of follow up. However, two other large randomized controlled trials (EXAMINE and TECOS) did not confirm this risk. The safety warning for SGLT-2 inhibitors was published after reports of diabetic ketoacidosis (DKA), a dangerous accumulation of acid in the blood, which required emergency visit or hospitalization in people with type 1 and type 2 diabetes. Yet, the reports did not prove a cause and effect link between the medications and DKA. When dispensing DPP-4 inhibitors and SGLT-2 inhibitors, it is recommended for pharmacists to assess patients’ specific risk factors and weigh them against benefits, providing appropriate patient counseling. How many of your patients are prescribed these two classes of drugs?

For additional information please visit APhA

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Knowledge and Attitudes Regarding Antibiotic Use Among Adult Consumers, Adult Hispanic Consumers, and Health Care Providers

ID-100316690The Center for Disease Control (CDC) analyzed Internet survey data from 2012-2013 about the knowledge and the consequent attitudes towards antibiotics of approximately 15,000 health care providers and adult consumers, from both Hispanic and non-Hispanic communities in the US. Based on the data, 48% of Hispanic while only 25% of non-Hispanic consumers believed that taking an antibiotic would cure their cold faster. Also, the majority of Hispanic adult consumers were obtaining their antibiotics from sources other than physicians (e.g., family members, friends, neighborhood grocery stores). Fifty four percent of health care providers believed that patients expect them to prescribe an antibiotic when they complain of cough and cold, while only 26% of all consumers had the same expectation.  Participating providers were discouraged from prescribing antibiotics because of the potential for resistance, side effects or allergic reactions, and cost. Moreover, knowledge of antibiotic resistance and their negative effects on the normal bacteria were lacking among the Hispanic consumers. The CDC believes improving access to health care might help reducing the risks of antibiotic self-administration, and also recommends public health initiatives to minimize inappropriate antibiotic use for Hispanic and other minority populations. The CDC encourages the use of their multilingual patient education programs such as “Get Smart: Know When Antibiotics Work” (http://www.cdc.gov/GetSmart/Community). If you are working with patients from diverse ethnic groups, do you see the same pattern in your community? How do you deal with antibiotic use and its challenges with your patients?

For additional information please visit CDC

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Alirocumab Approved to Help Lower LDL Cholesterol.

ID-100252464On July 24 the FDA approved alirocumab, a new add-on drug to lower low-density lipoprotein (LDL) cholesterol in certain people. This monoclonal antibody injection drug works to inhibit protein convertase subtilisin/kexin type 9 (PCSK9). PCSK9 binds to the low-density lipoprotein receptors (LDLR) on the surface of hepatocytes to promote their degradation within the liver. LDLR is the primary receptor that clears circulating LDL cholesterol, therefore, the decrease in LDLR levels by PCSK9 results in higher blood levels of LDL-C. By inhibiting the binding of PCSK9 to LDLR, alirocumab increases the number of LDLRs available to clear LDL, thereby lowering LDL cholesterol levels.  Initial dose is 75 mg by subcutaneous injection every two weeks. This dose may be increased to the maximum of 150 mg by subcutaneous injection every two weeks if a patient’s plasma LDL cholesterol concentration needs more reduction. The most common side effects are nasopharyngitis, influenza, and injection site itching, swelling, pain and/or bruising. What are your thoughts and concerns about this new drug?

For more information please see ASHP.

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Did reports of side effects contribute to drop in bone drug use?

The JID-10036305ournal of Bone and Mineral Research recently published a study that examines effects of media reports on the use of oral bisphosphonates. Google trends were utilized to get data from 1996 to 2012 for the media reports; the Medical Expenditure Panel Survey and the National Inpatient Sample were used to obtain data regarding fracture outcomes in the United States. Researchers studied patients aged 55 years and older and those hospitalized for hip fractures. In 2008, 15.8% of women older than 55 were using bisphosphonates and in 2010, 1.9% of men used this category of agents. Despite a decade of bisphosphonates use and their effectiveness and lower safety risks concerns, a sharp decline (more than 50%) in their use was noticed between 2008 and 2012 corresponding with a series of media reports that highlighted a rare yet serious adverse effects of bisphosphonates. Series of spikes in Internet search activity for alendronate (Fosamax) occurred between 2006 and 2010 immediately after media reports. The decline in use was mostly noted among white women, rural residents and women with less than a high school degree. It occurred even though doctors and drug regulators did not make recommendations to stop the use. The negative reports about bisphosphonates overlooked the risk of fall-related injuries manifested by osteoporosis, or thinning bones. It is also possible that newer medicines for osteoporosis have contributed to this decline of the decades-old bisphosphonates. What are your thoughts about the methodology of this research, biophosphonates, and the findings?

For additional information please read Journal of Bone and Mineral Research

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Judging a Pill by Its Color

A recent stuID-100232382dy that included people from the US, China and Colombia looked at how patients perceive the usefulness of medications based on their colors and shapes. Each of the 97 US participants rated the pill’s taste, effectiveness and swallowing difficulty solely from its look. showed identical findings. Based on patients’ feedback – white pills were the most effective, red ones were most mentally stimulating, light blue pills were less bitter and the diamond shaped ones were the hardest to swallow. Researches confirmed that the way patients predict how their medications work from their appearance could highly affect their behavior toward them. What have you discovered in terms of patients’ compliance when you counsel them, especially when their pills have changed in color or shape?

For additional information please read WSJ

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Lower Is Better — LDL Cholesterol and IMPROVE-IT

The Imheartproved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) by Cannon et al. is the first clinical trial to show a benefit of adding a non statin lipid-modifying agent to statin therapy. The trial included 18,144 patients with an acute coronary syndrome who were randomly assigned to either simvastatin (40 mg) plus ezetimibe (10 mg) or to simvastatin (40 mg) plus placebo. After 7 years cardiovascular death, major coronary event or nonfatal stroke were 2 % significantly lower in the simvastatin-plus-ezetimibe group than in the simvastatin-monotherapy group (32.7% vs. 34.7%). The IMPROV-IT trial supported that excess low-density lipoprotein (LDL) cholesterol is a causal factor in the development of atherosclerotic vascular disease; suggesting that reducing LDL cholesterol levels, regardless of the mechanism, should produce a corresponding reduction in cardiovascular events. What are your thoughts about the results of this research? How will this change your practice?

For additional information please read NEJM

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Risk of intracranial hemorrhage linked to co-treatment with antidepressants and NSAIDs.

ID-100275843A retrospective cohort study looked at more than four million people in Korea who were taking an antidepressant with or without NSAIDS. Investigators found that patients who were on an antidepressant and an NSAID was added in the first 30 days of the treatment are at a higher risk for an intra-crainal hemorrhage. How will this affect the way you counsel patients who are starting an antidepressant?

For more information please see  BMJ

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