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Formulary E-News
September 10, 2010
TOP SEARCHES: Multiple Sclerosis // Drug approvals // Medication safety
In this issue
Bisphosphonates
Revised RA classification
Ulcer hospital stays decrease
Rimonabant trial terminated
Grandfathered status
AMCP supports CER
PLATO genetic substudy
Subanalysis of RE-LY trial
FDA transparency
Lamotrigine risk
Midodrine
Leflunomide warning
Metformin reduces risk
Opioid-opioid combo
Key Topic Updates

Survey

This month we would like to know...

What do you see as the current status of “value-based” drug benefit designs?

a) Never gained traction, likely to fade away in the future
   
b) Some initial uptake, but losing momentum rapidly
   
c) Moderate but stable growth, with continued promise for future
   
d) Likely to be the most common standard benefit design of the future
   
   

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Bisphosphonate exposure not linked to esophageal cancer
There appears to be no association between the use of oral bisphosphonates and the risk of esophageal or gastric cancer, according to research published in the Aug. 11 issue of the Journal of the American Medical Association, as reported by HealthDay News. More...
New classification system may allow for earlier identification, treatment of RA
A revised system of classification for rheumatoid arthritis (RA) may allow for earlier identification of the disease, earlier treatment, and ultimately better patient outcomes. The new system has been published in the September issues of the Annals of the Rheumatic Diseases and Arthritis & Rheumatism, as reported by HealthDay News. More...
Research shows decline in hospitalizations for peptic ulcer disease, H. pylori
Hospitalization rates for peptic ulcer disease (PUD) and Helicobacter pylori infection have decreased substantially since 1998, according to an analysis in the September issue of Emerging Infectious Diseases, as reported by HealthDay News. More...
Suicide concerns prompt early termination of rimonabant trial
A study evaluating the cardiovascular outcomes related to rimonabant was discontinued because of concerns regarding the risk of suicide associated with the weight-loss drug, according to a report in the Aug. 14 issue of The Lancet, as reported by HealthDay News. More...
AMCP urges HHS not to consider formulary changes when determining “grandfathered” status for health plans under reform law
The Academy of Managed Care Pharmacy (AMCP) has provided comments in response to a June 17 Federal Register notice on the Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act (PPACA), also known as The Grandfathering Rule. More...
AMCP voices support for a national inventory of comparative effectiveness research
The Academy of Managed Care Pharmacy (AMCP) has responded to a request from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the Department of Health and Human Services (HHS). In this request, ASPE indicates that it is developing a national inventory of comparative effectiveness research (CER) and CER-related information driven by the American Recovery and Reinvestment Act, signed into law by President Obama in 2009. ASPE indicates that the process of cataloguing CER and infrastructure will be critical to tracking ongoing and future investments in CER. More...
Genetic substudy shows fewer major cardiovascular events with ticagrelor, regardless of relevant genetic variability in ACS patients
A new genetic substudy of PLATO (A Study of PLATelet Inhibition and Patient Outcomes) showed that the effects on a combined primary end point of cardiovascular death, myocardial infarction, or stroke seen in patients with acute coronary syndromes (ACS) who received the investigational oral antiplatelet treatment, ticagrelor (Brilinta, AstraZeneca), were maintained, whether or not they had the genetic variability that has been previously shown to affect a patient’s response to clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi Pharmaceuticals). More...
Data compare dabigatran etexilate to dose-adjusted warfarin across RE-LY trial centers
Boehringer Ingelheim announced Aug. 29 that results from a pre-specified, retrospective, unblinded subanalysis of the RE-LY trial — the largest atrial fibrillation outcomes trial ever conducted — were published in The Lancet. The subanalysis evaluated the primary outcomes of RE-LY in relation to each center’s average time in therapeutic range (cTTR) (INR 2.0–3.0) for patients taking warfarin (Coumadin, Bristol-Myers Squibb). More...
FDA launches new organizational performance management system to advance transparency
FDA has launched an innovative performance management system designed to advance transparency, public participation, and collaboration in the work of government. More...
FDA warns lamotrigine likely associated with aseptic meningitis
In mid August, FDA released a safety communication to prescribers and patients warning that lamotrigine (Lamictal, Lamictal ODT, Lamictal CD, Lamictal XR), a medication commonly used for seizures in children ≥2 years of age and bipolar disorder in adults, can cause an inflammation of the meninges (the protective membranes that cover the brain and spinal cord) called aseptic meningitis. More...
FDA proposes withdrawal of marketing approval for midodrine hydrochloride
In mid August, FDA issued a “Proposal to Withdraw Marketing Approval and Notice of Opportunity for a Hearing” to the companies that manufacture midodrine hydrochloride (ProAmatine, Shire Development Inc., and generics by Apotex Corp., Impax Laboratories Inc., Mylan Pharmaceuticals, Sandoz Inc., and Upsher-Smith Laboratories). Midodrine, a vasopressor used to lower blood pressure, was granted accelerated marketing approval in 1996 because the agency deemed it to be an important drug to treat a serious or life-threatening condition. However, such accelerated approvals by FDA require that manufacturers verify a drug’s clinical benefit to patients by conducting post-approval studies. More...
New black-boxed warning added to leflunomide prescribing information: warns of severe liver injury
In mid July, FDA released a drug safety communication to rheumatologists and family physicians warning them that the use of leflunomide (Arava, Sanofi-Aventis)—a drug to treat rheumatoid arthritis—has been linked to an increased risk of severe liver injury. This warning is also being included as a second black-boxed warning in leflunomide’s prescribing information; the first, being a contraindication for use in pregnant women or women of childbearing potential who are not using reliable contraception. More...
Findings of meta-analysis suggest concurrent metformin administration may reduce the metabolic risk of those taking atypical antipsychotic agents
A systematic review and meta-analysis conducted by researchers at the University of Connecticut (UCONN) School of Pharmacy, Storrs, Conn., and Hartford Hospital, Hartford, Conn., suggest that using metformin along with atypical antipsychotic agents (such as olanzapine, risperidone, quetiapine, and clozapine) may result in better anthropometric measurements and decreased insulin resistance. More...
MoxDuo IR study completion could yield primary pain relief end points
QRxPharma has announced a successful interim analysis of its final MoxDuo IR pivotal phase 3 study required for new drug application (NDA) submission. MoxDuo IR is a patented, immediate-release oral formulation combining morphine and oxycodone intended for the acute management of moderate to severe pain. Upon approval, it will be the first opioid-opioid combination product in the United States or elsewhere. More...
Key Topic Updates
FDA Approvals
Buprenorphine (Butrans): A mu opioid partial agonist analgesic and a Schedule III controlled substance for the management of chronic pain in patients requiring a continuous, around-the-clock opioid analgesic for an extended period of time
Mometasone furoate and formoterol fumarate dihydrate (Dulera): The newest combination inhaled corticosteroid and long-acting beta2-agonist for the management of asthma
FDA Actions in Brief August 2010 (Tribenzor, Daiichi Sankyo, Aricept, Eisai and Pfizer, Daytrana, Glassia, Zuplenz, Infergen, Cuvposa)
First-time generic approvals August 2010

In the Pipeline
FDA Pipeline Preview, August 2010 (Naproxcinod, Ticagrelor, Phenoxodiol, CBLB502, TOL101, Oral kinase inhibitor, GVAX CML vaccine, TXA127, Sapacitabine or CYC682, ICT-107, Perifosine or KRX-0401, BiovaxID, Phentermine/topiramate, Dasatinib, Denosumab, Cladribine)

Medication Safety
FDA warns of serious hematologic reactions with off-label use of quinine sulfate for night-time leg cramps
ARBs may increase risk of cancer development, according to meta-analysis

Clinical News
Transdermal patches effective for treatment of osteoarthritis pain
Seven-day transdermal buprenorphine gains FDA marketing approval for the treatment of chronic pain
ARBs may increase risk of cancer development, according to meta-analysis

Policy News
Drug recalls, shortages suggest FDA needs greater authority for manufacturer compliance

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