Michael Iskedjian

Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: Evidence from a meta-analysis

BACKGROUND Rates of patient adherence (compliance) to pharmacotherapy range from <5% to >90%. Negative determinants include multiple daily dosing (MDD), chronic duration, and asymptomatic disease. Reports suggest that once-daily (QD) dosing may improve adherence, but their findings are inconclusive. OBJECTIVE The purpose of this study was to compare the rates of adherence with QD, twice-daily (BID), and MDD antihypertensive drug regimens. METHODS MEDLINE, Embase, and International Pharmaceutical Abstracts databases were searched to identify comparative trials of patient adherence to antihypertensive medication in solid, oral formulations. Data were combined using a random-effects meta-analytic model. RESULTS Eight studies involving a total of 11,485 observations were included (1,830 for QD dosing, 4405 for BID dosing, 4147 for dosing >2 times daily [>BID], and 9655 for MDD), in which the primary objective was to assess adherence. The average adherence rate for QD dosing (91.4%, SD = 2.2%) was significantly higher (Z = 4.46, P < 0.001) than for MDD (83.2%, SD = 3.5%). This rate was also significantly higher (Z = 2.22, P = 0.026) than for BID dosing (92.7% [SD = 2.3%] vs 87.1% [SD = 2.9%]). The difference in adherence rates between BID dosing (90.8%, SD = 4.7%) and >BID dosing (86.3%, SD = 6.7%) was not significant (Z = 1.82, P = 0.069). CONCLUSIONS The results of this meta-analysis demonstrate that with antihypertensive medications, QD dosing regimens are associated with higher rates of adherence than either BID or MDD regimens.

Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain

ABSTRACT Objective: Debilitating pain, occurring in 50–70% of multiple sclerosis (MS) patients, is poorly understood and infrequently studied. We summarized efficacy and safety data of cannabinoid-based drugs for neuropathic pain. Data sources: Studies were identified from Medline, Embase, and Cochrane databases; Bayer Healthcare provided additional trials. Study selection: Accepted were randomized, double-blinded placebo-controlled trials of cannabinoid-based treatments for MS-related/neuropathic pain in adults ≥ 18 years of age. Data extraction: Two reviewers identified studies and extracted data; a third adjudicated disagreements. Data included baseline and endpoint pain scores on visual analog or 11-point ordinal scales. Data synthesis: Of 18 articles and three randomized controlled trial (RCT) reports identified, 12 articles and two reports were rejected (9 = inappropriate disease or outcome, 1 = duplicate, 1 = review, and 1 = abstract); six accepted articles and one RCT-report involved 298 patients (222 treated, 76 placebo); four examined Sativex* (a cannabidiol/delta-9-tetrahydrocannabinol (THC) buccal spray) (observations = 196), five cannabidiol (n = 41), and three dronabinol (n = 91). Homogeneity χ2 values were non-significant, allowing data combination. Analyses focused on baseline-endpoint score differences. The cannabidiol/THC buccal spray decreased pain 1.7 ± 0.7 points ( p = 0.018), cannabidiol 1.5 ± 0.7 ( p = 0.044), dronabinol 1.5 ± 0.6 ( p = 0.013), and all cannabinoids pooled together 1.6 ± 0.4 ( p < 0.001). Placebo baseline-endpoint scores did not differ (0.8 ± 0.4 points, p = 0.023). At endpoint, cannabinoids were superior to placebo by 0.8 ± 0.3 points ( p = 0.029). Dizziness was the most commonly observed adverse event in the cannabidiol/THC buccal spray arms (39 ± 16%), across all cannabinoid treatments (32.5 ± 16%) as well as in the placebo arms (10 ± 4%). Conclusion: Cannabinoids including the cannabidiol/THC buccal spray are effective in treating neuropathic pain in MS. Limitations: This review was based on a small number of trials and patients. Pain related to MS was assumed to be similar to neuropathic pain.

Remission, dropouts, and adverse drug reaction rates in major depressive disorder: a meta-analysis of head-to-head trials.

ABSTRACT Objective: To summarize remission rates and dropouts due to adverse drug reactions (ADRs) or lack of efficacy (LoE) of serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin-reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs) in treating major depressive disorder. Methods: We searched MEDLINE, EMBASE, IPA, and the Cochrane International Library from 1980–2005. Meta-analysis summarized outcomes from head-to-head randomized clinical trials comparing ≥ 2 drugs from three antidepressants classes (SNRIs, and/or SSRIs, and/or TCAs) followed by ≥ 6 weeks of treatment. Remission was a final Hamilton Depression Rating Scale (HAMD) score ≤ 7 or Montgomery-Åsberg Depression Rating Scale (MADRS) ≤ 12. Intent-to-treat data were combined across study arms using random effects models, producing point estimates with 95% confidence intervals. Results: We obtained data from 30 arms of 15 head-to-head trials with 2458 patients. SNRIs had the highest ITT remission rate (49.0%), then TCAs (44.1%), and SSRIs (37.7%) ( p > 0.05 for SNRIs versus TCAs; p < 0.001 for TCAs versus SSRIs and SNRIs versus SSRIs). When categorized as inpatients ( n = 582) and outpatients ( n = 1613), SNRIs had the highest remission rates (52.0% for 144 inpatients and 49.3% for 559 outpatients). SNRIs had lowest overall dropouts (26.1%), followed by SSRIs (28.4%), and TCAs (35.7%). Dropouts due to ADRs and LoE were 10.3% and 6.2% for SNRIs, 8.3% and 7.2% for SSRIs, and 19.8% and 9.9% for TCAs, respectively ( p > 0.05 for ADR dropouts only). One limitation was the inclusion of only venlafaxine‐XR; results may not be the same for immediate release forms. In addition, few studies reported remission rates. Conclusions: SNRIs had the highest efficacy remission rates (statistically significant for inpatients and outpatients), and the lowest overall dropout rates, suggesting clinical superiority in treating major depression.

Cost of glaucoma in Canada: analyses based on visual field and physician's assessment.

PurposeA longitudinal, retrospective study investigated the cost of primary open angle glaucoma (POAG). MethodsPatient files from two tertiary care glaucoma practices were reviewed. Patients diagnosed with POAG and ≥2.5 years of follow-up data were included. Data collected included visual field mean deviation, physicians assessment, and resource utilization (physician visits, procedures, and medications). Costs, reported in 2001 Canadian dollars, were compared between groups, based on initial visual field mean deviation, including mild (<5 dB), moderate (5 to <12 dB), and severe (≥12 dB), and based on physicians assessment, including controlled, uncontrolled, or patients initially uncontrolled for 12 months who become controlled. ResultsOf 411 patient charts extracted, 265 were included; 35 were excluded for ocular comorbidities and 111 patients with insufficient follow-up. Mean (standard deviation) yearly costs overall (N = 265) and for mild (n = 90), moderate (n = 91), and severe (n = 84) groups were

Sensitivity Analysis in Health Economic and Pharmacoeconomic Studies

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An examination of the effect of cytochrome P450 drug interactions of hydroxymethylglutaryl-coenzyme a reductase inhibitors on health care utilization: A Canadian population-based study

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PHARMACOECONOMIC ANALYSIS OF VENLAFAXINE IN THE TREATMENT OF MAJOR DEPRESSIVE DISORDER

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Quality assessment of economic evaluations in selected pharmacy, medical, and health economics journals

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Direct health care costs of 4 common skin ulcers in New Mexico Medicaid fee-for-service patients.

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Quality assessment of pharmacoeconomic abstracts of original research articles in selected journals.

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