english.prescrire.org > Prescrire International > N°75 - February 2005

n°75

February 2005

Issue Contents
Editorial

Free  Health professionals on health economics

p.2
The drug price explosion
Health professionals have every right to take an interest in the costs of drugs and other therapeutic options. They should not feel intimidated by the complexity of data or by economic jargon.

Marketing Authorisations

Fludarabine (new indication)

p.3-5
First-line treatment of CLL: unconvincing evidence

Teriparatide (new preparation)

p.5-9
Osteoporosis: less well evaluated than alendronic acid

Pegvisomant (new preparation)

p.10-13
A last resort in acromegaly

Dalteparin (new indication)

p.14-15
Prophylaxis in medical patients: no advance

Docetaxel (new indication)

p.16-18
First-line treatment of non small-cell lung cancer: no advance

Sertaline and venlafaxine (new indication)

p.19-20
Prevention of recurrent depression: no advance

Adverse Effects

Topical steroid allergy and dependence

p.21-22
When a topical steroid fails to control a skin condition, allergy or dependence are possible causes. Stopping the topical steroid should be considered.

Coxib toxicity: a likely class effect

p.22
Regulators were slow to react to the increased cardiovascular risk of rofecoxib. A class effect is likely. Increased prescribing of coxib, supposedly safer, was associated with an increased incidence of gastrointestinal bleeding.

Accidental child poisoning with methylergometrine intended for the mother

p.23-24
Confusions between injectable forms in delivery rooms, or oral forms at home, can be prevented through better care organisation.

Suicide and antidepressants in children (continued)

p.24
Beware prescribing based on limited data

Coxibs and thrombosis

p.24
Higher incidence of thrombosis

Reviews

Adult hypertension

p.25-33
Reducing cardiovascular morbidity and mortality
Intervention thresholds and target values should be associated with more benefits than harms in trials with clinical endpoints. Non drug measures (salt intake, exercise) and first-line use of thiazide diuretic; selected betablockers (second-line), selected ACE (third-line), and selected calcium channel blockers (fourth-line). Choices are different in the case of diabetes or complications.

Outlook

"The Drug Price Explosion"

p.34

The drug price explosion - Key points

p.35

Free  The flagrant example of atorvastatin

p.36
The atorvastatin case illustrated a combination of failings in basic and continuous education, huge promotional campaigns, and very high price. The result was an undue drug bill. Rev Prescrire 2002 ; 22 (234) : 855-859.

The International War on Cheap Drugs

p.37
Claims that European countries benefit as free riders from research efforts done in the USA are unfounded

Minimal agreement on hospital pricing in France

p.38-39
Deregulation is a major feature of the hospital drug market in France.

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