News

With its FDA approval in November, valdecoxib becomes the hird COX-2 inhibitor to gain US market clearance. This Focus article examines valdecoxib's pharmacologic, pharmacokinetic, and therapeutic aspects and considers its role in relation to other COX-2 inhibitors and traditional NSAIDs. Special attention is devoted to its comparative COX-1:COX-2 inhibitory ratio and an array of unpublished efficacy and safety trials.

This 287-study meta-analysis aimed to address unanswered questions about antiplatelet therapy in patients at high risk for occlusive vascular events. It yielded several new findings or clarifications, including these: (1) Antiplatelets protect against vascular events in patients with unstable angina, intermittent claudication, and atrial fibrillation. (2) Antiplatelet therapy can be started promptly during acute ischemic stroke and continued long-term. (3) Daily aspirin doses of 75 to 150 mg seem to be as effective as higher doses for long-term treatment.

Fluoroquinolones and nitrofurantoin have surpassed trimethoprim-sulfamethoxazole (TMP-SMZ) as the most frequently prescribed antibiotics for uncomplicated urinary tract infections (UTIs) in women, according to a new national analysis. This is despite well-established recommendations (from the Infectious Disease Society of America and others) that TMP-SMZ is the drug of choice for UTIs due to cost and concerns about antibiotic resistance.

A three-tier pharmacy benefit can reduce prescription drug spending without increasing other medical resource use or fueling medication discontinuation rates. So concludes the fully published report of an analysis whose preliminary results were presented last year and reported by Formulary (2001;36:522). It is the first well-designed, controlled study to explore such consequences of three-tier benefits.

Emerging data are continually refining our understanding of the risks and benefits of hormone replacement therapy (HRT) in postmenopausal women. This review assesses the current state of evidence on these various risks and benefits, concluding with an outline of what's established and where varying degrees of uncertainty remain. Algorithms for use of HRT for several established indications are featured.

Weathering the storm

Dental, vision and hearing programs are surviving the recession, but they might not be out of the woods yet

Progressive behavior

They say that if you love something, you should set it free. If it comes back to you, it's yours. If it doesn't, it never was.

Ranolazine, the first in a new class of antianginal agents called the partialfatty acid oxidation (pFOX) inhibitors, improves exercise performance andreduces angina frequency in patients who still have symptoms despite treatmentwith other antianginal medications, according to Bernard Chaitman, MD. Hereported the results of a Phase III study called the Combination Assessmentof Ranolazine in Stable Angina (CARISA).

An agent developed specifically for the treatment of angina reduces theincidence of major coronary events, reported Henry Dargie, MD, who presentedthe results of a trial known as the Impact of Nicorandil in Angina (IONA).It is believed to be the first large-scale trial to report on the effectsof a specific antianginal drug on clinical outcome.

The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, sertraline,and paroxetine are equally effective and tolerated in depressed patientsacross a broad range of outcome measures. So finds an open-label, randomizedstudy in 573 patients treated for depression for 9 months in a primary caresetting.