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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

CKS Updates

Clinical Knowledge Summaries has been updated in May for the following clinical areas:

The update also provides pointers to information about the Health Protection Agency National Knowledge Service - TB pilot and the National Library for Health Heavy Menstrual Bleeding National Knowledge Week. Heavy Menstrual Bleeding has also been the topic for a NICE Guideline.

Action: Clinicians who see patients with any of these conditions may find the updated information useful when reviewing current clinical practice.

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Postmarketing studies contribute little

The Center for the Study of Drug Development at Tufts University has published the results of a survey revealing that over two thirds of postmarketing study sponsors believe that the study results contributed either marginally or not at all to their understanding of the safety, efficacy, or quality of their product.

The results also revealed that 45% of studies are delayed beyond the projected completion date due to enrolment problems, technical difficulties, additional regulatory authority requirements or changes to the scope of the study.

In America, over half of all postmarketing studies are voluntarily initiated by the drugs industry with less than a quarter being requested by regulatory agencies as a condition of approval.

Given the apparent lack of value placed on these studies and the voluntary nature of the majority of these studies it is easy to see why many believe that these studies are designed to encourage greater use of new drugs rather than to genuinely provide greater understanding of the safety, efficacy, and quality of the study drug.

Action: Clinicians who participate in research work should carefully consider the study criteria for each study to ensure the research is appropriate and valid before agreeing to participate in the research.

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DTB review

The latest Drugs and Therapeutics Bulletin contains a review of rimonabant for weight loss and an update on drugs for overactive bladder syndrome.

The review of rimonabant (Acomplia®) contains information about the clinical efficacy, side effects, cautions and cost of rimonabant. It is suggested that orlistat is used first line in patients who fail to loose weight with diet and lifestyle changes. The authors conclude that, "we do not believe that rimonabant represents a significant advance for patients with obesity".

The update on drugs for overactive bladder provides a background to overactive bladder syndrome and details the different drug treatments. The update highlights that, in terms of efficacy, there is little to choose between the treatments and therefore the most cost effective option is immediate release oxybutynin. Where this choice causes intolerable side effects an alternative oral product should be tried taking into consideration the product cost. Transdermal products may avoid antimuscarinic side effects but these are at the expense of application site reactions.

Action: Clinicians who are asked to prescribe treatments to aid weight loss in obese patients or who treat patients with overactive bladder syndrome will find this issue of the DTB to be a useful update of the current evidence.

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