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Transcript
ROTHERHAM AREA PRESCRIBING COMMITTEE NEWSLETTER BULLETIN NO 16 September 2006 Following meeting 20 September 2006 HOT TOPIC 1: Ivabradine Ivabradine (Procoralan) is a new drug for the symptomatic treatment of chronic stable angina. It is licensed only for people with normal sinus rhythm who have a contraindication or intolerance to beta-blockers. It is a selective sinus node If inhibitor (It blocks a specific ion channel, the funny channel). Ivabradine has been shown to be more effective than placebo and non-inferior to atenolol 100mg daily and amlodipine 10mg daily. It has a number of contraindications, cautions, and potential drug interactions. Visual symptoms were the most common adverse effect reported in clinical trials. Ivabradine is much more expensive than the standard treatment options for angina. If a beta-blocker is not appropriate for first-line therapy, then verapamil or diltiazem are the recommended alternatives. The APC has decided this drug should be amber light. HOT TOPIC 2: Agomelatine. This drug is to be licensed for the treatment of severe depression. It is a melatonin receptor agonist and a partial antagonist of serotonin receptors. Its efficacy has not been directly compared in trials with existing treatments. Having considered current NICE guidance, Rotherham PCT has red lighted this drug until its place in therapy has been established. HOT TOPIC 3: Bevacizumab Already a first line treatment for the treatment of metastatic bowel cancer. An application is expected for the treatment of advanced small cell and advanced none squamous lung cancer. This drug has been red lighted. HOT TOPIC 4: Natalizumab This is another monoclonal antibody drug. This time for the treatment of relapsing remitting multiple sclerosis which has failed to respond to beta interferon. The APC has red lighted this drug. HOT TOPIC 5: Triptorelin This drug is used for the treatment of central precocious puberty in children. The APC discussed this at some length and decided to red light this drug. HOT TOPIC 6: Choice of Inhaled Steroid The PCT first choice inhaled steroid is CFC- containing beclometasone, delivered by pressurised metered dose inhaler, wherever possible. There are no plans for CFCcontaining beclometasone inhalers to be discontinued. Two CFC- free beclometasone inhaled products, Qvar® and Clenil Modulite®, are now available, but these are very different in potency and licensed indications. There is great potential for confusion and for patients to receive the incorrect dose. Qvar®, CFC- free beclometasone, is twice as potent as the CFC- containing beclometasone inhalers and the new CFCfree beclometasone inhaler, Clenil Modulite®. Qvar® is not licensed for use in children. Action: CFC-containing Beclometasone is the PCT first choice inhaled steroid. Care should be taken when prescribing and dispensing prescriptions for beclometasone inhalers to ensure the intended product is provided. The Medicines & Healthcare Regulatory Authority http://www.mhra.gov.uk/ recommend that, to avoid confusion for the patient and during dispensing, prescriptions for CFC-free beclometasone products are written for branded products. HOT TOPIC 7: Atrial Fibrillation NICE Clinical Guideline 36 is on the clinical management of Atrial Fibrillation. Management of new patients involves two clinical decisions each of which has a separate flow chart in the guidance: What should the management for rate or rhythm control be? What should the management be regarding stroke thromboprophylaxis Many newly diagnosed patients are likely to need referral, but GPs will need to use the stroke risk stratification decision chart from the point of diagnosis. This divides patients into those who should be treated with aspirin and those that should have warfarin. The recommended INR target range for warfarin is 2-3. Given the fact that atrial fibrillation also features in the new QOF and the new CHD NSF chapter the PCT is planning a TARGET session. HOT TOPIC 8: Parkinson’s disease NICE Clinical Guideline 35 is on Parkinson’s disease. An important recommendation is that all new patients with Parkinson’s disease are referred to a specialist before treatment is started. The Foundation Trust is revising their referral guidelines in light of the guidance. These will include tips on accurate diagnosis and whether all patients, including those in younger age groups, should be referred to a single specialist Parkinson’s Team. As soon as the guidelines are agreed with the PCT they will be sent out to GPs. Practice Based Commissioning Groups may find that this is an area where there is scope for improving the accuracy of referrals, which could help waiting times and prevent people receiving unnecessary treatment. Traffic Light hyperlink:http://195.104.72.160/pctIntranet/ViewDocuments/ViewDocDetailsSimple.asp?DocID=4126