Evidence into practice: key therapeutic topics

February 17, 2012 by admin 

What are the gaps between the evidence base for some important therapeutic areas and current prescribing data? The January MeReC bulletin from the National Prescribing Centre (NPC) is the first in a series of three highlighting some possible areas for action, starting with non-steroidal anti-inflammatory drugs (NSAIDS), antibiotic prescribing (especially quinolones and cephalosporins), and high-dose inhaled corticosteroids in asthma.

For example, the prescribing data show wide variation in the volumes of NSAIDS being prescribed and in the proportion that are ibuprofen or naproxen. Prescribing of NSAIDs should be reviewed routinely, especially for high-risk groups, and most of this prescribing should be for low-dose ibuprofen or for naproxen.

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Prescribing generically: how to decide

February 25, 2011 by admin 

Which medicines should not be prescribed generically and what are biosimilar medicines? These are some of the questions considered in a useful new bulletin from the MeReC on prescribing generically in primary care. It explains about generics, branding, costs and reimbursement, and the now-abandoned proposals for generic substitution in primary care in England (see here). Generic medicines given a licence have been deemed by the regulator to be as safe as the branded medicine and clinically equivalent, when used at the same dose for the same condition. There is little evidence to back concerns that switching has adverse effects.

There are some circumstances in which a specific product, branded or generic, should be prescribed and these include: drugs with a narrow therapeutic index such as phenytoin (although there is little good quality evidence to support concerns about these medicines, the concerns remain and the consequences are potentially serious); some modified-release or extended-release drugs (because of the differences resulting from different manufacturers’ formulations); certain administration devices such as some CFC-free beclometasone inhalers; multiple ingredient products such as oral contraceptives and emollient creams; ‘biosimilar’ medicines; if differences in appearance might lead to confusion or anxiety, reducing adherence to long–term medications; to avoid specific inactive formulation ingredients where they are not tolerated.

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Balancing safety concerns & benefits for inhaled COPD treatments

May 1, 2009 by admin 

Some studies have recently raised safety concerns about inhaled treatments for chronic obstructive pulmonary disease (COPD): this MeReC Bulletin discusses them and attempts to put them in the context of potential benefits and decision-making factors for individual patients (Volume 19 No 4). The safety issues concern anticholinergics, long-acting beta2 agonists (LABAs) and inhaled corticosteroids and the Bulletin makes clear that these should be considered alongside their potential benefits and side effects, responses to treatment, costs and patients’ preferences. Ultimately, the choice will probably come down to ‘whether the patient can use the device, tolerate the drug and how effective the medication is for their symptoms’.

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