The National Prescribing Centre has published a MeReC Bulletin (PDF)that provides an update on drug treatment in rheumatoid arthritis.
The bulletin provides a brief introduction into the early diagnosis of the disease and covers the place in therapy for disease modifying anti-rheumatic drugs (DMARDs), biologic agents and corticosteroids.
In addition, combination therapy is also discussed as well as consideration of the safety issues around methotrexate, monitoring of DMARDs and biologic agents and how to limit corticosteroid-induced osteoporosis.
Perhaps the most valuable part of this Bulletin is the summary table of recommendations for monitoring for adverse effects from DMARDs and biologic therapies.
Action: Clinicians involved in the diagnosis and treatment of rheumatoid arthritis, or in the monitoring of drug therapy, will find this bulletin useful and informative.
The National Prescribing Centre (NPC) has published MeReC Extra 29 (PDF). It covers the cardiovascular risks of rosiglitazone and discusses some recent favourable evidence to support the use of patient decision aids.
The review of rosiglitazone details the latest evidence and advice from the Medicines and Healthcare products Regulatory Agency (MHRA). The continued advice is to review the continued risks and benefits of treatment with rosiglitazone at the patient's next routine appointment.
The discussion of patient decision aids (PDA) covers recent evidence that PDAs may aid adherence to treatment. A Cochrane review also found that knowledge is improved, expectations are more realistic and more people are able to make a decision when PDAs are used. It is also noted the PDAs will be available on the forthcoming NPCi website.
Action: Clinicians will find this MeReC Extra to be useful and informative. It is of the usual high standard expected from the NPC.
The UK Government, via the Department for Business, Enterprise and Regulatory Reform, has announced that it will be renegotiating the Pharmaceutical Price Regulation Scheme (PPRS) with the pharmaceutical industry over the coming months.
In February 2007, the Office of Fair Trading (OFT) published a report that recommended a patient-focussed, value-based pricing scheme to replace the existing mechanism of reimbursement for branded drugs.
In the full response document the government point out the PPRS has been effective in providing a stable pricing system and has supported a strong pharmaceutical industry over the last 50 years. However, they also agree with the OFT that better mechanisms are required to deliver fair prices and value for money for the NHS.
The new scheme will focus upon:
- Delivering value for money
- Encouraging and rewarding innovation
- Assisting the uptake of new medicines
- Providing stability, sustainability and predictability
The ultimate aim of the new scheme will be to ensure that "NHS patients will get the drugs they need at a fair price to the public purse and the pharmaceutical industry will continue to be encouraged to develop important new medicines".
Action: Clinicians can expect changes to the pricing system used for branded medicines in the coming months. How these changes will affect the cost of prescribing is currently unknown but is worth monitoring for the budget concious, in the meantime, preferential use of generic drugs will help to contain costs.
The National Institute for Health and Clinical Excellence (NICE) has published guidance accepting varenicline (Champix®) for use on the NHS in England and Wales.
The appraisal contains the following two recommendations:
- Varenicline is recommended within its licensed indications as an option for smokers who have expressed a desire to quit smoking
- Varenicline should normally be prescribed only as part of a programme of behavioural support
Action: Clinicians should be aware of and implement the recommendations made by NICE. Varenicline is an option along with nicotine replacement therapy and bupropion.
The Medicines and Healthcare products Regulatory Agency (MHRA) has launched Drug Safety Update, a new monthly electronic bulletin containing the latest information and clinical advice from the MHRA. It is aimed at healthcare professionals and has been designed to allow rapid access to information relevant to an individual's area of clinical practice.
The first bulletin contains several drug safety advice articles (specified below) and information from the Yellow Card scheme, hot topics (including isotretinoin for severe acne and smoking cessation aids) and a reminder of the topics covered in recent letters to healthcare professionals and drug alerts.
- Gadolinium-containing contrast agents and nephrogenic systemic fibrosis
- Extraneal and products that contain (or are metabolised to) maltose, xylose, or galactose: false glucose reading
- Alpha-1-adrenoreceptor antagonists and intraoperative floppy iris syndrome
- Cabergoline: risk of cardiovalvulopathy
- Linezolid: restriction of indication
- Dopamine agonists and pathological gambling, increased libido, and hypersexuality
- Antidepressants and risk of suicidal behaviour
Action: This new monthly summary contains a wealth of drug safety information that all frontline clinicians will find useful. The option to receive a free e-mail notification when a new bulletin is published will provide a timely reminder for busy professionals.
Thanks to Rob Davies for spotting this launch.
