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Selke Krulichová I, Selke GW, Eichler U, Lappe V, Godman B, Schubert I. Impact of EU risk assessment process and administrative regulations for manufacturers of combined hormonal contraceptive prescribing. An analysis of developments in Germany and the implications. Curr Med Res Opin 2019; 35:697-704. [PMID: 30362365 DOI: 10.1080/03007995.2018.1541317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Combined hormonal contraceptives (CHC) exhibit differing risks for cardiovascular and thrombotic events (VTE). A European referral process confirmed higher VTE risks for 3rd generation gestagens and drospirenone. CHC are now grouped in risk classes (RC) I, II, and III, with RC III having a higher risk than RC I and X (risk not yet known). Marketing authorization holders were obliged to implement pharmacovigilance measures and risk minimization measures including changes of prescribing information. The study assessed whether these activities induced changes in prescription patterns. METHODS German prescription data for 1.1 million women below 20 years of age were used to analyze the effects of interventions and potential influence factors using logistic regression. Descriptive statistics were calculated for prescriptions for 3.3 million women from January 2011 to March 2016. RESULTS Shares of RC I and RC X recipients rose substantially over the observation period, while RC III recipient share showed a steady decrease. The referral induced a slightly faster decrease in RC III and increase in RC X. The implementation of pharmacovigilance measures manifested no additional effect. CONCLUSION The decrease in RC III share already observed before the referral process can be explained with pre-existing discussions around CHC. The effect attributable to the referral was statistically significant, although very small. While evidence for a connection between interventions and prescription change is only indirect, the study shows that routine data are suitable for impact analyses, and monitoring prescribing patterns can be recommended as feedback after regulatory or political interventions. This is being followed up.
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Affiliation(s)
- Iva Selke Krulichová
- a Department of Medical Biophysics, Faculty of Medicine in Hradec Králové , Charles University , Hradec Králové , Czech Republic
| | | | - Uwe Eichler
- b AOK Research Institute (WIdO) , Berlin , Germany
| | - Veronika Lappe
- c PMV research group, Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy of Children and Adolescents, Cologne University , Germany
| | - Brian Godman
- d Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , UK
- e Health Economics Centre , Liverpool University Management School , Liverpool , UK
- f Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm , Sweden
- g Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa, South Africa
| | - Ingrid Schubert
- c PMV research group, Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy of Children and Adolescents, Cologne University , Germany
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Abstract
Bipolar disorder places a significant burden on the affected individuals, their family, healthcare systems and the overall economy. More treatment options are needed, especially those with better efficacy and tolerability. Asenapine is a second-generation antipsychotic approved in Europe (brand name Sycrest®) for the treatment of moderate-to-severe manic episodes associated with bipolar I disorder in adults, and in the US (brand name Saphris®) for the treatment of manic or mixed episodes of bipolar I disorder in adults and children aged 10-17 years. It is the antagonistic activity at the D2 receptor that is likely responsible for the antimanic properties of asenapine. Clinical trials have demonstrated that asenapine mono- and add-on therapy is effective in the short- and long-term treatment of mania associated with bipolar I disorder in adult and paediatric patients. In addition, post hoc and pooled data analyses have shown that asenapine is effective in reducing clinically significant depressive symptoms in patients with bipolar I disorder. The most common adverse events associated with asenapine are somnolence, dizziness, extrapyramidal symptoms, increased bodyweight and oral hypoesthesia. However, the incidence of these events, particularly weight gain, is generally lower than with olanzapine. In one study, asenapine has been shown to improve health-related quality of life. Economic analyses indicate that the use of asenapine can, over time, lead to a reduction in the costs of treatment.
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Affiliation(s)
- Eduard Vieta
- Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 08036, Barcelona, Catalonia, Spain.
| | - José Manuel Montes
- Psychiatry Section of the Ramón y Cajal University Hospital, IRYCIS, CIBERSAM, University of Alcalá, Ctra. Colmenar Viejo, km. 9,100, 28034, Madrid, Spain
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Kalaba M, Kosutic J, Godman B, Radonjic V, Vujic A, Jankovic S, Srebro D, Kalaba Z, Stojanovic R, Prostran M. Experience with developing antibiotic stewardship programs in Serbia: potential model for other Balkan countries? J Comp Eff Res 2018; 7:247-258. [DOI: 10.2217/cer-2017-0055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Antimicrobial resistance and inappropriate use of antibiotics in children are important issues. Consequently, there is a need to develop comprehensive stewardship programs even in hospitals with limited resources starting with children's hospitals. Methods: Retrospective observational analysis of antimicrobial utilization and resistance patterns over 5 years in a tertiary care children's hospital in Serbia. Results: Cumulative antimicrobial resistance decreased but was still high, with high cumulative resistance rates among the most widely used antibiotics in the hospital. Total antibiotic use decreased from 2010 to 2014 although there was still high prescribing of reserved antibiotics. Conclusion: Concerns with inappropriate use and high resistance rates among some antibiotics used in the hospital are being used to develop guidance on future antibiotic use in this hospital, building on the recently introduced antibiotic stewardship program, as well as encourage other hospitals in Serbia to review their policies.
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Affiliation(s)
- Marija Kalaba
- Primary Healthcare Centre ‘Zemun’, Šilerova 46, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovan Kosutic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- The Institute for Medical Care of Mother & Child of Serbia ‘Dr Vukan Cupic’, Radoja Dakića, Belgrade, Serbia
| | - Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, Strathclyde University, Glasgow, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
| | - Vesela Radonjic
- Medicine & Medical Device Agency of Serbia, Belgrade, Serbia
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Ana Vujic
- Clinical Center Kragujevac, Zmaj Jovina street 30, Kragujevac, Serbia
| | - Slobodan Jankovic
- Clinical Center Kragujevac, Zmaj Jovina street 30, Kragujevac, Serbia
| | - Dragana Srebro
- The Institute for Medical Care of Mother & Child of Serbia ‘Dr Vukan Cupic’, Radoja Dakića, Belgrade, Serbia
| | - Zlatko Kalaba
- Children Hospital for Pulmonary Diseases & Tuberculosis at University Hospital Center ‘Dr Dragisa Misovic’, Belgrade, Serbia
| | - Radan Stojanovic
- The Institute for Medical Care of Mother & Child of Serbia ‘Dr Vukan Cupic’, Radoja Dakića, Belgrade, Serbia
- Clinical Pharmacology Unit, Clinical Center Serbia, Belgrade, Serbia
| | - Milica Prostran
- The Institute for Medical Care of Mother & Child of Serbia ‘Dr Vukan Cupic’, Radoja Dakića, Belgrade, Serbia
- Clinical Pharmacology Unit, Clinical Center Serbia, Belgrade, Serbia
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Marković-Peković V, Škrbić R, Petrović A, Vlahović-Palčevski V, Mrak J, Bennie M, Fadare J, Kwon HY, Schiffers K, Truter I, Godman B. Polypharmacy among the elderly in the Republic of Srpska: extent and implications for the future. Expert Rev Pharmacoecon Outcomes Res 2015; 16:609-618. [PMID: 26671843 DOI: 10.1586/14737167.2016.1115347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prescribing of medicines is a fundamental component of care for the elderly; however, there is increasing concern with polypharmacy and its impact on morbidity, mortality and costs. As a result, long-term prescription-medicine use and the prevalence of polypharmacy in the elderly in the Republic of Srpska were analyzed. The findings were subsequently used to suggest potential future measures. A retrospective study of all elderly patients during 2005-2010 stratified by age group (three groups), sex and long-term medicine use was performed. Polypharmacy (five or more medicines) increased from 1.4% of the elderly taking medicines long-term to 3.6% by 2010, with 53.6% of elderly taking two or more medicines long-term. The most prevalent diseases were cardiovascular diseases and diabetes. Most prescriptions were in accordance with recent guidelines; however, there was a concern with appreciable prescribing of digoxin and aminophylline. Whilst polypharmacy rates are low in the Republic, the increasing rate is a concern. Further studies are planned.
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Affiliation(s)
- Vanda Marković-Peković
- a Department of Pharmacy , Ministry of Health and Social Welfare , Banja Luka , Republic of Srpska, Bosnia and Herzegovina.,b Medical Faculty, Department of Social Pharmacy , University Banja Luka , Banja Luka , Republic of Srpska, Bosnia and Herzegovina
| | - Ranko Škrbić
- c Medical Faculty, Department of Clinical Pharmacology , University Banja Luka , Banja Luka , Republic of Srpska, Bosnia and Herzegovina
| | | | | | - Jana Mrak
- f Control Department , Health Insurance Institute of Slovenia , Ljubljana , Slovenia
| | - Marion Bennie
- g Public Health and Intelligence Strategic Business Unit , NHS National Services Scotland , Edinburgh , Scotland.,h Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Joseph Fadare
- i Departments of Pharmacology/Medicine , Ekiti State University/Ekiti State University Teaching Hospital , Ado-Ekiti , Nigeria
| | - Hye-Young Kwon
- j Department of Global Health and Population , Harvard School of Public Health , Boston , MA , USA.,k Institute of Health and Environment, Graduate School of Public Health , Seoul National University , Seoul , South Korea
| | - Krijn Schiffers
- l Institute of Health Policy and Management, Erasmus University , Rotterdam , The Netherlands
| | - Ilse Truter
- m Drug Utilization Research Unit (DURU), Department of Pharmacy , Nelson Mandela Metropolitan University , Port Elizabeth , South Africa
| | - Brian Godman
- h Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,n Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet , Karolinska University Hospital Huddinge , Stockholm , Sweden
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Abstract
BACKGROUND Bipolar 1 disorders (BPD) are a chronic disorder with prevalence rates of up to 2.6% of the adult population or higher and appreciable direct and indirect costs. As a result, these are a concern to health authorities especially given the low age of onset. Consequently, there is a need to treat BPD patients well and improve their quality-of-life. Pharmacotherapy includes mood stabilizers and atypical antipsychotics (AAPs). AAPs have different mechanisms of action and side-effects, so treatment needs to be tailored. Asenapine in clinical trials is as effective as olanzapine, with less metabolic side-effects. METHODS Chitnis and colleagues assessed the cost-effectiveness of asenapine among patients in healthcare databases. RESULTS AND CONCLUSION They showed in routine care that asenapine also reduces hospital and emergency room admissions, making it cost neutral in BPD, which is of interest to health authorities and clinicians.
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Affiliation(s)
- Brian Godman
- a a Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
- b b Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow , UK
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