Drug and Therapeutics Bulletin recent issues

{blacktriangledown}Aliskiren for hypertension in adults

2008-10-01

High blood pressure is a major risk factor for cardiovascular disease worldwide.1 Drug treatments include those that target the renin-angiotensin system, a key hormone cascade in the regulation of blood pressure. One of these is aliskiren (Rasilez – Novartis), which belongs to a new class of drugs, direct renin inhibitors.2 Here we assess its place in managing adults with hypertension.

{blacktriangledown}Retapamulin for impetigo and other infections

2008-10-01

Last year, we concluded that topical fusidic acid should be first-line treatment for impetigo.1 Since then, retapamulin ointment (Altargo – GlaxoSmithKline), a new antibacterial, has been licensed in the European Union as a short-term treatment for impetigo and infected small lacerations, abrasions or sutured wounds in people aged 9 months or above.2 Advertisements claim that the product "treats localised impetigo in just 5 days";3 by comparison, the British National Formulary (BNF) advises a 7-day course of fusidic acid.4 Here we consider the place of retapamulin in impetigo and its other licensed indications.

{blacktriangledown}Erdosteine for copd exacerbations

2008-10-01

The mucolytic drug erdosteine (Erdotin – Galen) is licensed in the UK as treatment for up to 10 days "for the symptomatic treatment of acute exacerbations of chronic bronchitis in adults".1 This indication differs from that for carbocisteine and mecysteine, two older mucolytic drugs that are licensed for adjunctive treatment in respiratory disorders characterised by viscous mucus, and typically used for longer to prevent exacerbations of chronic obstructive pulmonary disease (COPD).2 Does erdosteine have a role for people with COPD exacerbations?

Blood pressure guidelines - where are we now?

2008-09-10

In June 2006, the National Institute for Health and Clinical Excellence (NICE) updated its recommendations on the management of patients with hypertension (published in 2004), in light of "significant new data" relating to drug treatment.1,2 The update, published in collaboration with the British Hypertension Society (BHS), recommended first-line use of a calcium-channel blocker or a thiazide-type diuretic in patients aged over 55 years or an ACE inhibitor in those aged under 55 years, and advised that beta-blockers should no longer be used for routine initial therapy.1 Recently published data from England suggest that primary care prescribing has changed in line with this new guideline.3 However, interpretation of the evidence that underpins some of the key recommendations is open to debate, particularly as there are differences from some other major guidelines in the recommendations for first-line therapy. Here we consider the updated NICE guideline, the rationale for its treatment recommendations, and the subsequent change in clinical practice. In particular, we focus on the initial drug management of adults without conditions such as diabetes mellitus or coronary heart disease that would in themselves be a key determinant of management.

{blacktriangledown}Natalizumab for multiple sclerosis?

2008-09-10

Around 2.5 million people worldwide have multiple sclerosis, of whom about 85,000 are in the UK.1 Natalizumab (pronounced na-ta-liz-you-mab; Tysabri – Biogen Idec), the first in a new class known as selective adhesion-molecule inhibitors, is licensed in the UK as monotherapy for "highly active" relapsing/remitting multiple sclerosis.2 Here we review natalizumab and assess its place for patients with multiple sclerosis.

Rituximab and {blacktriangledown}abatacept for rheumatoid arthritis

2008-08-06

Estimates from the UK indicate that around 0.5–1.0% of the population have rheumatoid arthritis.1 Here we assess the place of rituximab (MabThera – Roche Products Ltd) and abatacept (Orencia – Bristol-Myers-Squibb), drugs in two new classes, which are licensed for certain adults with the condition.

What role for {blacktriangledown}tigecycline in infections?

2008-08-06

Tigecycline (pronounced tie-ge-sigh-cleen; Tygacil – Wyeth) is a broad-spectrum antibacterial and the first glycylcycline to be marketed in the UK. It is active against certain resistant bacteria, including meticillin-resistant Staphylococcus aureus (MRSA) and bacteria that produce extended-spectrum β-lactamase (ESBL).1, 2 Tigecycline is licensed for intravenous treatment of adults with complicated skin and soft tissue infections, and complicated intra-abdominal infections.1 We review tigecycline and assess its place for these infections.

Correction: surgery for obesity in adults

2008-08-06

Our review on Surgery for obesity in adults (DTB 2008; 46: 41–5) incorrectly suggested that, in relation to advice from the National Institute for Health and Clinical Excellence (NICE), "PCTs are obliged to provide funding to patients who meet the [NICE] criteria for surgery". In fact, the criteria referred to appear in a current NICE clinical guideline (CG) and, as a result, funding of provision is not mandatory. This is different from recommendations that appear in NICE technology appraisal guidance (TAG), which are usually mandatory within 3 months. This error does not affect our article’s Conclusion.

Three new drugs for type 2 diabetes

2008-07-04

For many patients with type 2 diabetes mellitus, metformin plus appropriate treatment for cardiovascular risk factors form the cornerstone of drug therapy.1 However, the progressive impairment of both the secretion and action of insulin in the condition mean that high blood glucose concentrations usually worsen over time, so necessitating escalation of hypoglycaemic therapy.1 Three drugs in two new classes that act on the hormonal regulation of insulin secretion have been launched recently for use as add-in therapies in patients with type 2 diabetes: exenatide (Byetta – Eli Lilly), sitagliptin (Januvia – MSD), and vildagliptin (Galvus – Novartis). Here we consider whether they have a role in the management of such individuals.

Update on managing bell's palsy

2008-07-04

Each year in the UK, around 1 in 5,000 people develops Bell’s palsy – idiopathic unilateral lower motor neurone facial weakness of rapid onset.1 Of those who are not treated, about 16% end up with permanent moderate to severe weakness, which can result in facial dysfunction and disfigurement, and psychological difficulties.2^–5 There has been longstanding controversy about what, if any, treatment should be given, with potential alternatives including corticosteroids, antiviral drugs, acupuncture and physiotherapy.6 We last reviewed this condition in 2006, indicating that "published trials on the efficacy of drug treatments have been poor and no firm conclusions can be drawn about the benefit of any single drug", and "it is unclear what place, if any, acupuncture and physiotherapy have in the management of patients with Bell’s palsy".6 Here we update our conclusions in the light of recently published evidence.

Tests for equivalence or non-inferiority - why?

2008-07-04

Drugs are sometimes assessed in clinical trials designed to test their equivalence or non-inferiority to a standard therapy. Non-inferiority trials, in particular, appear to be increasingly used to test new drugs, such as the oral hypoglycaemics reviewed in this issue of DTB.1 Here we summarise the main features of equivalence and non-inferiority trials and suggest what to look out for when reading study reports.