A systematic cost-effectiveness analysis of pregabalin in the management of fibromyalgia: an Iranian experience

Evaluation of COVID-19 treatments in Iran in comparison with local therapeutic recommendations: A population-level study on utilization and costs of prescription drugs

Objective:

In this study, we assess population-level data of COVID-19 treatments in Iran compared to Ministry of Health (MOH)-published guidelines to gain a better insight into the quality of care for this disease.

Methods:

National sales data of each recommended and nonrecommended COVID-19 medicine were used to proxy utilization between March 21, 2020, and March 21, 2021, or Iranian year 1399. COVID-19–attributed sales volume and number of patients were estimated by adjusting sales data with pre-COVID-19 average growth rate, recommended dose, and duration of treatment. Next, they were compared with the MOH guidelines in outpatient and inpatient settings. Furthermore, the list of top 10 molecules of the market and top 10 COVID-19–indicated molecules in terms of values were extracted to assess the economic burden of COVID-19 prescription drugs and their share.

Findings:

The estimated number of patients receiving COVID-19 treatments in some outpatient medicines such as recommended hydroxychloroquine was over 2.2 million. Favipiravir and remdesivir were collectively about two inpatient medicines 260,000; however, neither of these two medicines was recommended in the MOH guidelines. In some fewer specific medicines such as dexamethasone, prednisolone, azithromycin, and naproxen, the estimated number of COVID-19–attributed patients were incomparable with the officially announced number of confirmed cases in the year of study, which could be related to nonconfirmed diagnosed cases, irrational use, or prescribing, or limitations of our data and study. The total COVID-19–attributed market of candidate medicines was over 15 trillion IR Rials (almost 4.3% of the total market). Remdesivir, with over 60% of the total COVID-19 attributed market, followed by favipiravir, was among the highest value medicines.

Conclusion:

Despite the release of the COVID-19 guideline by Iran MOH, misalignment in the enforcement of decisions was a serious weakness (cases of favipiravir and remdesivir). This weakness led to some economic burden on the health-care system and raised ethical concerns.

Dynamic thiol and disulphide homoeostasis in fibromyalgia

INTRODUCTION

Thiol and disulphide levels are biomarkers that provide useful information about oxidative stress and antioxidant capacity, showing a different homoeostasis in inflammatory and proliferative diseases. We aimed to clarify the possible aetiology of this disease by using thiol and disulphide levels in patients with fibromyalgia, the basis of which has not yet been clearly elucidated.

MATERIAL AND METHODS

A total of 156 individuals: 86 patients with fibromyalgia and 70 age-matched controls were included in this prospective non-randomised case-control study. Demographic characteristics including smoking status, body mass index (BMI), the duration of complaints, and pain levels were carefully recorded. Dynamic thiol-disulphide homoeostasis in blood samples was determined by an automatic-spectrophotometric method. The Mann-Whitney U and Student's t-test were used to determine the differences between the groups.

RESULTS

Sex, BMI, and smoking status were similar between the groups (p = 0.62, p = 0.09, and p = 0.64, respectively). While native thiol levels were found to be high in patients with fibromyalgia (p = 0.018), disulphide levels and the rates of disulphide/native thiol and disulphide/total thiol were significantly low (p = 0.049, p = 0.007, and p = 0.007, respectively). Correlation analysis showed no significant relationship between thiol-disulphide levels and duration of complaints or pain level.

CONCLUSIONS

Thiol-disulphide balance in fibromyalgia was found to be similar to benign proliferative diseases, suggesting that the underlying mechanism is more likely to be of proliferative pattern rather than inflammatory. Additionally, fibromyalgia is not directly associated with increase in oxidative stress. The molecular mechanisms need to be elucidated.

Quality of life related to foot health status in women with fibromyalgia: a case-control study

INTRODUCTION

To date, the Foot Health Status Questionnaire (FHSQ) has not been applied to women who suffer from fibromyalgia. The main purpose of this study was to compare both foot and general health-related quality of life between women with fibromyalgia and healthy matched women. We hypothesized that women with fibromyalgia may present an impaired quality of life related to foot and general health.

MATERIAL AND METHODS

A sample of 208 women, mean age of 55.00 ±8.25 years, was recruited from an outpatient clinic and divided into 2 groups, 104 women with fibromyalgia (for the case group) and 104 healthy matched women (for the control group). Demographic data and the domains of the FHSQ scores were registered.

RESULTS

Statistically significant differences (p < 0.001) between case and control groups were found for both all specific foot domains (pain, foot function, foot health and footwear) and all general wellbeing domains (general health, physical activity, social capacity and vigor), showing a worse foot and general health-related quality of life (with lower scores for all FHSQ domains) in the women with fibromyalgia compared to healthy matched women.

CONCLUSIONS

Impaired foot and general health-related quality of life was observed in women who suffered from fibromyalgia compared to healthy matched women.

Linagliptin versus sitagliptin in patients with type 2 diabetes mellitus: a network meta-analysis of randomized clinical trials

Background

Diabetes is one of the most common chronic and costly diseases worldwide and type 2 diabetes is the most common type which accounts for about 90% of cases with diabetes. New medication-therapy regimens such as those containing linagliptin alone or in combination with other medications (within the category of DDP-4 inhibitors) must be evaluated in terms of efficacy and compared with other currently used drugs and then enter the medication list of the country. Hence, this study aimed to compare the clinical efficacy of the two drugs, i.e. linagliptin and sitagliptin, in patients with type 2 diabetes.

Methods

A systematic review was conducted to identify all clinical trials published by 2015 which compared the two drugs in patients with type 2 diabetes. Using keywords such as “linagliptin”, “type 2 diabetes mellitus”, “sitagliptin” and related combinations, we searched databases including Scopus, PubMed, and Web of Science. The quality of the selected studies was evaluated using the Jadad score. Considering primary and secondary outcomes extracted from the reviewed studies, a network meta-analysis was used to conduct a systematic comparison between the two studied drugs.

Results

This network meta-analysis included 32 studies (Linagliptin vs PLB: n = 8, Sitagliptin vs PLB: n = 13, Linagliptin + MET vs PLB + MET: n = 4, and Sitagliptin + MET vs PLB + MET: n = 7) and a total of 13,747 patients. The results showed no significant difference between linagliptin and sitagliptin in terms of key efficacy and safety outcomes such as HbA1c changes from baseline, body weight change from baseline, percentage of patients achieving HbA1c <7, and percentage of patients experiencing hypoglycemic events (p > 0.05). The results showed that the efficacy of the two drug regimens was the same.

Conclusions

Based on the results, there was no significant difference between the two drugs, i.e. linagliptin and sitagliptin, in terms of efficacy; in other words, the efficacy of the two drugs was the same. Therefore, the use of these two drugs depends on their availability and cost.

Graphical abstract

Graphical abstract of the network meta-analysis performed to evaluate the alternatives under the study.

Electronic supplementary material

The online version of this article (10.1186/s40199-017-0189-6) contains supplementary material, which is available to authorized users.

Medication Treatment Efficacy and Chronic Orofacial Pain

Chronic pain in the orofacial region has always been a vexing problem for dentists to diagnose and treat effectively. For trigeminal neuropathic pain, there are 3 medications (gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors) to use plus topical anesthetics that have therapeutic efficacy. For chronic daily headaches (often migraine in origin), 3 prophylactic medications have reasonable therapeutic efficacy (β-blockers, tricyclic antidepressants, and antiepileptic drugs). The 3 Food and Drug Administration-approved drugs for fibromyalgia (pregabalin, duloxetine, and milnacipran) are not robust, with poor efficacy. For osteroarthritis, nonsteroidal anti-inflammatory drugs have therapeutic efficacy and when gastritis contraindicates them, corticosteriod injections are helpful.

Is Taurolidine-citrate an effective and cost-effective hemodialysis catheter lock solution? A systematic review and cost- effectiveness analysis

BACKGROUND

Prevention of catheter-related infection is of prime importance,. However, because of the risks caused by the leakage of circulating antibiotics and development of resistance to antibiotics, they are replaced by lock solutions. The aim of this study was to evaluate the efficacy and cost- effectiveness of taurolidine-citrate as a hemodialysis catheter lock solution compared to other common alternatives in Iran.

METHODS

To evaluate the efficacy of taurolidine-citrate, a systematic review was conducted by searching electronic databases. The outcomes of interest for cost-effectiveness analysis were as follows: "Catheter-related bacteremia episodes"; "catheter-related bacteremia-free survival"; "catheter thrombosis rate" for efficacy evaluation and "reduction of catheter-related infection". For evidence synthesis, a meta-analysis was conducted on the extracted efficacy data. To evaluate the cost of treatments, direct medical costs were included, and the incremental cost-effectiveness ratio was calculated for each comparison. The payers' (patients and insurance companies) perspectives were used for cost analysis.

RESULTS

After carrying out the systematic process, three articles were included in the analysis. Considering 95% confidence interval, the relative difference was -0.16 (-0.25 to -0.07) for catheterrelated bacteremia episode, indicating that the rate of catheter-related infections in hemodialysis patients who used taurolidine-citrate was 16% less than in those hemodialysis patients who received heparin. Considering 95% confidence interval, the relative difference was 0.13 (-0.06 0.32) for catheter thrombosis, showing that the rate of catheter-related thrombosis in hemodialysis patients who used taurolidine-citrate was 13% more than in hemodialysis patients who received heparin. The results of this analysis indicated that taurolidine-citrate, compared to heparin, was more effective in preventing catheter-related infection; therefore, it could be considered as a superior strategy. Nevertheless, compared to heparin-gentamicin combination, taurolidine-citrate is an inferior strategy because of its higher cost and lower infection prevention.

CONCLUSION

Compared to heparin, taurolidine-citrate is a superior option, but it is an inferior strategy compared to heparin-gentamicin combination. The clinical evidences on taurolidine-citrate, heparin and gentamicin/heparin are not sufficient for making confident decisions.

Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia

Fibromyalgia is a chronic debilitating medical syndrome with limited therapeutic options. Pregabalin, an anticonvulsant and α-2-Δ subunit receptor ligand, is one of the anchor drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. The drug has shown clinically meaningful benefits across multiple symptom domains of fibromyalgia. Efficacy of pregabalin in fibromyalgia pain has been evaluated in at least five high-quality randomized trials, two long-term extension studies, a meta-analysis, a Cochrane database systematic review, and several post hoc analyses. These studies also hint towards a meaningful benefit on sleep, functioning, quality of life, and work productivity. Side effects of pregabalin, although common, are mild to moderate in intensity. They are noted early during therapy, improve or disappear with dose reduction, and are not usually life- or organ threatening. In most patients, tolerance develops to the most common side effects, dizziness, and somnolence, with time. With close clinical monitoring at initiation or dose titration, pregabalin can be effectively used in primary care setting. Pregabalin is cost saving with long-term use and its cost-effectiveness profile is comparable, if not better, to that of other drugs used in fibromyalgia. In the present era of limited therapeutic options, pregabalin undoubtedly retains its role as one of cardinal drugs used in the treatment of fibromyalgia. This review intends to discuss the clinical utility of pregabalin in the management of fibromyalgia with a focus on efficacy, safety, and cost-effectiveness.