The current issue of the British Medical Journal debates the over-diagnosis of depression in a "Head to Head".
Gordon Parker, from the School of Psychiatry at the University of New South Wales, argues that depression is over-diagnosed. He points out that current thresholds in diagnostic criteria are too low and therefore medicalise normal human emotional states.
Ian Hickie, from the Brain and Mind Research Institute at the University of Sydney, argues that depression is not over-diagnosed. He points out that the increased rate of diagnosis of depression in the last 15 years has reduced suicides and increased productivity.
Action: Clinicians who diagnose and treat patients with depression will find this debate an interesting read.
The Scottish Medicines Consortium (SMC) has issued new guidance on several medicines including nebivolol in chronic heart failure, clopidogrel in ST-segment elevation myocardial infarction (STEMI) and pregabalin for central neuropathic pain in adults.
Nebivolol has been accepted for the treatment of stable mild and moderate chronic heart failure (CHF) in addition to standard therapies in elderly patients 70 years or older.
Clopidogrel has been accepted for restricted use for patients with acute ST-segment elevation myocardial infarction (STEMI), in combination with aspirin. Treatment is restricted to continuation for 4 weeks.
Pregabalin has been rejected for central neuropathic pain in adults. The SMC note that in a randomised controlled trial pregabalin was superior to placebo in terms of the primary efficacy variable, the weekly mean pain score but the economic analysis did not demonstrate value for money.
Action: Clinicians should be aware of this latest advice and ensure that the recommendations are adopted into current practice.
Lumiracoxib (Prexige®) has been taken off the market in Australia by the Therapeutic Goods Administration (TGA) following several reports of hepatotoxicity, some of which proved fatal.
The TGA is the Australian equivalent of the American Food and Drugs Administration (FDA) and the British Medicines and Healthcare products Regulatory Agency (MHRA).
This action has been prompted following receipt of eight reports of serious liver adverse reactions associated with use of lumiracoxib in 6 months. These reports included two fatalities and two patients require liver transplants.
The manufacturers have given a press release to the National electronic Library for Medicine that suggests that this problem is dose-related and is not a concern with the lower 100mg strength of the drug.
Action: As previously recommended, lumiracoxib already has a very limited place in therapy. It would be prudent to review any current prescriptions for this drug with a view to stopping or changing treatment. It would also be sensible to perform liver function tests in any patients who are taking or have recently taken lumiracoxib.
The expected High Court Judicial Review of the Alzheimer's drugs guidance produced by the National Institute for Health and Clinical Excellence (NICE) is complete. The BBC and PharmaTimes have reported the findings of the review.
A press release (PDF) on the NICE reveals that the guidance was supported in five of the six areas that were challenged.
The rulings in the six areas were as follows:
- Benefits to carers were considered
- Long term care costs were accurately calculated
- Procedural fairness was not breached by providing a 'read-only' economic model
- Concluding that there is no cumulative benefit after six months treatment was not irrational
- Consideration of the AD 2000 study was not irrational
- NICE failed in its duties by not offering guidance specific to certain patient groups, namely those with learning difficulties or whose first language is not English
NICE has been asked to clarify the guidance within 28 days in respect of ensuring equal access for people with learning difficulties or whose first language is not English. NICE have undertaken to comply fully with this ruling.
Action: Clinicians who prescribe treatments for Alzheimer's disease can now feel confident in fully implementing the current NICE guidance.
According to the National electronic Library for Medicines, lansoprazole suspension (Zoton®) is to be discontinued.
The place in therapy for the suspension formulation has always been limited to patients who struggled to swallow a solid dosage form like a tablet or a capsule. The FasTab® formulation of lansoprazole would appear to be a cost-effective and suitable alternative. The Drug Tariff for August 2007 lists current prices as follows:
- Lansoprazole 30mg orodispersible tablets (28) - £11.00
- Lansoprazole 30mg gastro-resistant granules sachets (8) - £33.97
Action: Clinicians should be aware of this product discontinuation and ensure prescriptions are altered to a suitable alternative before supply issues arise.
