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The Daily Telegraph carried a story today detailing the findings of a study of 20,000 diabetics that found up to two thirds of patients were putting their health at risk by not taking their medication correctly.
This is of great concern but is not something new, the Medicines Partnership considered compliance for a wide range of conditions and produced a report on October 2003. In this report there are references1 that estimate that 50% of patients with coronary heart disease stop taking their cholesterol lowering therapy within a year and this increases to 85% in the second year. Similarly, at the end of the West of Scotland Coronary Prevention study2 (WOSCOPS) participants found that a quarter of them were classed as non compliant at five years.
This latest study adds to the growing evidence that patients' compliance with their medicines is not as expected.
Action: Compliance (or lack of it) should be a primary consideration in any treatment failure. Many cases of treatment failure could be attributable to poor compliance with prescribed therapies; drugs cannot work if they are not taken. Reasons for poor compliance should be explored with the patient before considering changes or additions to treatment.
- The problems of compliance to cholesterol altering therapy. Insull W, Journal of Internal Medicine;241:317-325.
- Prevention of coronary heart disease with pravastatin in men with hypercholesterolaemia. Shepard J et al, New England Journal of Medicine;333:1301-1307.
The Scottish Medicines Consortium has completed an appraisal following a re-submission for Lyrica (Pregabalin).
They have concluded that based on current data clinical and cost effectiveness has not been demonstrated for patients who fail to respond to current treatments.
Action: Continue using conventional therapies for the treatment of pain caused by peripheral damage to nerves. Do not use Pregabalin when other treatments fail.
Duloxetine (Cymbalta) has been restricted for use in Scotland by the Scottish Medicines Consortium.
This decision is based upon limited evidence of efficacy in comparison to other antidepressants in major depression. The product is therefore restricted to use in patients who are unable to tolerate or have not responded to initial treatment options.
The recommendation made here still stands that treatment with this drug in Primary Care is not recommended based on the fact that most patients in primary care have mild depression.
Action: Duloxetine should not be used as an antidepressant in a Primary Care Setting.
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