Latest news and product developments

OFT wants PPRS reform

The Office of Fair Trading ( www.oft.gov.uk) says reform of the Pharmaceutical Price Regulatory Scheme (PPRS) would allow the NHS to re‐ invest £500 million in drugs it needs.

Its investigation of the 50‐ year‐old PPRS concludes that the scheme does not reflect the therapeutic value of drugs and, while providing a financial safety net for the industry, it mitigates against innovation.

The OFT believes drugs should be priced according to their therapeutic value based on their cost effectiveness. Analyses would be fast‐ tracked for new drugs or, if there are insufficient data, a risk‐sharing scheme should be adopted.

The ABPI insists that its medicines offer the NHS value for money and believes the OFT's proposal for drug‐ by‐drug pricing would delay access to new medicines.

Switching saves money and is problem free

Switching to cheaper alternatives within a drug class does not affect the quality of care and offers substantial savings, say UK researchers (Int J Clin Pract 2007;61:15‐23).

They switched selected patients from atorvastatin (Lipitor) to simvastatin and from losartan (Cozaar) to candesartan (Amias). Exclusion criteria included previous unsuccessful use, poor control of lipids or blood pressure, contraindications and potential drug interactions.

In 70 patients switched to simvastatin, there was no change in mean total cholesterol after four months; one patient reverted to atorvastatin due to adverse effects. Of 115 switched to candesartan, seven reverted to losartan; in the remainder, blood pressure was slightly reduced after four months. The switch was not associated with adverse effects. Savings for the year 2005/06 were estimated at £12 716 for statins and £13 374 for antihypertensive drugs.

Scotland gets donepezil for mild to moderate AD

The Scottish Medicines Consortium ( www.scottish medicines.org.uk) has approved the use of orodispersible donepezil (Aricept Evess) for the treatment of mild to moderate Alzheimer's disease in NHS Scotland. The decision conflicts with NICE advice that the drug is not appropriate for patients with mild disease.

The SMC has not approved rimonabant (Acomplia) as adjunctive treatment for obese patients.

Adherence threatens anticoagulation

Patients find it difficult to adhere to anticoagulant treatment –significantly impairing the quality of anticoagulation, US investigators have shown (Arch Intern Med 2007;167:229‐35).

Using electronic containers to monitor dose adherence over 32 weeks in 136 patients, they found that 92 per cent opened the container at least once too often or too little and one‐third missed 20 per cent of scheduled openings. Patients with less than 20 per cent adherence were twice as likely to be undercoagulated compared with adherent patients. Those with overadherence were overcoagulated.

Hypo risk greatest with glibenclamide

Glibenclamide is associated with a significantly greater risk of hypoglycaemic events than other secretagogues, a new systematic review has concluded (Diabetes Care 2007;30:389‐94).

The review of 21 randomised trials found that the risk of experiencing at least one hypoglycaemic event was 52 per cent greater with glibenclamide compared with other secretagogues and 83 per cent greater than with other sulphonylureas. In three comparative trials with insulin, there was no significant difference in the risk of hypoglycaemia (though this could not be excluded) but only insulin was associated with weight gain.

Glibenclamide was not associated with significantly increased risks of cardiovascular events, weight gain or death. Few major hypoglycaemic events were reported in these trials.

Drug groups implicated in ADR admissions

Four classes of drugs account for half of hospital admissions for adverse reactions, according to a new systematic review (Br J Clin Pharmacol 2007;63:136‐47).

Antiplatelet agents (16 per cent of admissions), diuretics (16 per cent), NSAIDs (11 per cent) and anticoagulants (8 per cent) were implicated in drug‐ related admissions according to a review of nine studies. Analysis of five studies also showed that adherence problems were associated with one‐third of drug‐related admissions. The authors suggest that focussing resources in these areas could substantially reduce admissions.

Value of pharmacist MUR questioned

Pharmacist medicines use review (MUR) for older patients does not reduce hospital readmission and is not cost effective by current standards, according to a study from Norfolk (Pharmacoeconomics 2007;25:171‐80).

A total of 872 patients aged over 80 who had been admitted as an emergency and discharged taking two or more drugs were randomised to MUR by a pharmacist or usual care. The pharmacist visited twice, providing education, removing out‐of‐date drugs and checking for adverse effects, interactions and the need for compliance aids.

After six months, the admissions rate was not reduced among patients who received MUR and quality of life was not significantly improved. The estimated cost per QALY gained was £54 454 – above the conventional threshold for cost effectiveness of £30 000.

MHRA review of LABAs

The MHRA has clarified which aspects of long‐acting beta‐agonists (LABAs) are being addressed in its current review. This full review of salmeterol (Serevent) and formoterol, following advice issued in December last year, will consider recent research, whether the two agents differ significantly, dose‐response relationships, the effect of concurrent treatment with inhaled steroid and how they are used in practice. Manufacturers have been asked to provide data by the end of March.

Interventions for weight gain in schizophrenia

There is not enough evidence to support the use of drugs to reduce weight gain associated with schizophrenia, a new Cochrane review has found (Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD005148. DOI: 10.1002/14651858. CD005148.pub2).

Noting a lack of adequate trials, the review found that cognitive/behavioural interventions effectively prevented weight gain by a mean of 3.4kg and reduced established weight gain by a mean of 1.7kg. Drugs prevented weight gain by about 1.2kg.

Switching anti‐TNFs

An analysis of a UK rheumatoid arthritis (RA) registry has shown that patients who stop treatment with their first anti‐TNF agent should be switched to a second (Arthr Rheum 2007;56:13‐20).

Every UK patient with RA who receives an anti‐TNF agent is included in the British Society for Rheumatology Biologics Register. Analysis of this database identified 6739 patients who started treatment, of whom 841 stopped within 15 months due to lack of efficacy and 1023 due to toxicity. Of these, 503 and 353 respectively were switched to another anti‐ TNF agent.

Overall, 73 per cent of patients remained on their second drug by the end of follow‐up, but patients were two to three times more likely to stop their second treatment for the same reason they discontinued their first. Copyright © 2007 Wiley Interface Ltd