Drug and Therapeutics Bulletin recent issues

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.

Surgery for obesity in adults

2008-06-04

Figures from the UK indicate that around 1 in 4 adults are obese (body mass index [BMI] above 30kg/m²) and 2% are morbidly obese (BMI above 40kg/m²).1 Being obese is associated with morbidity (e.g. type 2 diabetes mellitus, certain cancers, cardiovascular and musculoskeletal diseases) and premature death.2^–6 Weight loss can reduce such problems and improve quality of life, but options such as dietary, lifestyle and drug interventions are often ineffective.7^–17 Here we consider the place of surgery in the management of adults with obesity.

Switching to CFC-free beclometasone for asthma

2008-06-04

Chlorofluorocarbon (CFC) compounds, the traditional propellants in aerosol metered-dose inhalers (MDIs), damage the ozone layer in the atmosphere. Following adoption of the Montreal Protocol on Substances that Deplete the Ozone Layer almost 20 years ago, the UK Government produced a transition strategy to enable CFC-containing MDIs to be phased out as quickly as possible.1, 2 Hydrofluoroalkanes (HFAs) are now being used as propellants in most MDIs (i.e. CFC-free inhalers). However, there have been particular difficulties in developing CFC-free beclometasone inhalers, as this drug dissolves in the new propellant. There are now two CFC-free beclometasone inhalers available in the UK – Qvar (Teva) and Clenil Modulite (Trinity-Chiesi), both licensed for asthma. CFC-containing beclometasone MDIs will become unavailable as stocks run out (within the next year). Here we discuss the issues around switching to the CFC-free beclometasone inhalers.

{blacktriangledown}Varenicline for smoking cessation

2008-05-07

Varenicline (pronounced va-re-nik-leen) (Champix – Pfizer), a nicotinic receptor partial agonist, is the first medicine of this type licensed for smoking cessation in adults. Launched in the UK in December 2006, the drug accounted for 14% of all prescription items and 22% of total expenditure, for smoking cessation products dispensed in the community in 2007*.1^–4 Marketing materials claim that it has a "unique dual action", a "significantly higher quit rate" than bupropion, and a "favourable safety and tolerability profile". Here we discuss the evidence for varenicline and consider its role in smoking cessation.

Preconception care for women with diabetes

2008-05-07

Diabetes mellitus is one of the commonest pre-existing medical disorders complicating pregnancy in the UK.1 Having either type 1 or type 2 diabetes increases the likelihood of poor pregnancy outcomes.2 Here we review specific advice women with diabetes should receive before conception to help reduce such risks.