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Infliximab acts through the inhibition of tumor necrosis factor (TNF)-alpha, which is responsible for the induction of inflammatory cytokines, the enhancement of leukocyte migration, and the activation of neutrophil and eosinophil functional activity. Infliximab was approved on September 27, 2006, for the treatment of adult patients with chronic severe (ie, extensive and/or disabling) plaque psoriasis who are candidates for systemic therapy and when other systemic therapies are medically less appropriate.

This agent targets the overexpression of histone deacetylase (HDAC) or the aberrant recruitment of HDACs to oncogenic transcription factors in cancer cells. Vorinostat was approved on October 6, 2006, for the treatment of cutaneous manifestations in patients with cutaneous T-cell lymphoma (CTCL) who have progressive, persistent, or recurrent disease following 2 systemic therapies.

Many new web-based decision support tools and care management solutions have emerged, aimed specifically at the member to complement other resources available at plan web sites. Forward-thinking health plans already have begun launching online support tools within their member portals or are actively planning to do so. Even those who have already begun to roll out such tools are thinking of new, more powerful ways to integrate them into their overall member platform. Here is a quick review of what the field looks like:

Many new web-based decision support tools and care management solutions have emerged, aimed specifically at the member to complement other resources available at plan web sites. Forward-thinking health plans already have begun launching online support tools within their member portals or are actively planning to do so. Even those who have already begun to roll out such tools are thinking of new, more powerful ways to integrate them into their overall member platform. Here is a quick review of what the field looks like:

The influenza immunization rate is a closely watched HEDIS measure among plans. Influenza vaccine is about 80% effective in preventing infection in general, although its effectiveness is lower in the elderly. In addition, its effectiveness can vary from year to year, depending on the match between the vaccine and the particular strains of influenza circulating that year.

Insurance fronting arrangements are more commonly utilized in the property and casualty industry. However, MCOs also have uses for these structures in certain circumstances. For example, many HMOs discover that they have a need to offer products on insurance paper (PPO plans) but do not have the resources to form a separate insurance company. Or, a provider organization may ask an HMO to front for it with respect to a particular product line or sector.

Insurance fronting arrangements are more commonly utilized in the property and casualty industry. However, MCOs also have uses for these structures in certain circumstances. For example, many HMOs discover that they have a need to offer products on insurance paper (PPO plans) but do not have the resources to form a separate insurance company. Or, a provider organization may ask an HMO to front for it with respect to a particular product line or sector.

When it comes to public health, experts agree: Fail to plan and the health plan fails.

Every organization is accountable to its stakeholders, and Caremark, the Nashville-based pharmacy benefit manager, is no exception. Caremark, however, is also accountable to its customers for clinical execution, so performance metrics are both wide and deep.

Medication therapy management (MTM) has long been a part of the pharmacy lexicon and is based on the premise that the right medication in the right dose gets to the right patient. This is to ensure that optimal outcomes are achieved with the highest safety. Numerous examples of pharmacy programs in diverse settings utilize the skills of the pharmacist to optimize drug therapy and improve outcomes and assure safety. The Veterans Administration, academia, health plans, as well as community pharmacies have all been settings where medication management of the patient has occurred.

Heartfelt sympathies to any of you who at this moment are holding a fistful of soggy tissues and cough drops as you read.

Pay-for-Performance (P4P) provides home health agencies an opportunity to show their value and expertise to the healthcare industry. The primary goal of home health has always been to educate the client and family on how to proactively manage a chronic illness and avoid the reoccurrence of an acute illness. Home health nurses are the eyes and ears of the physician, often recommending modifications to the plan of care based on their knowledge of the patient's medical condition and home environment. With the advancement of healthcare technologies and pending P4P regulations, this knowledge becomes a more important basis for assessing patient and family compliance to care recommendations.

Recent reports of Medicare Part D beneficiaries who have been caught in the doughnut hole have related how some have cut back on medications.

A 0.5-mg/kg dose of a low molecular weight heparin, enoxaparin, resulted in less non-coronary-artery bypass grafting (CABG) bleeding compared with unfractionated heparin in the first 48 hours after elective percutaneous coronary intervention (PCI), according to a prospective, open-label, multicenter, randomized trial reported in the New England Journal of Medicine.

Intensive lipid lowering with high-dose 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) provides a significant benefit over standard-dose statin therapy in preventing nonfatal cardiovascular outcomes and also may reduce the incidence of cardiovascular death, according to results of a meta-analysis published in the Journal of the American College of Cardiology.

Intensive lipid lowering with high-dose 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) provides a significant benefit over standard-dose statin therapy in preventing nonfatal cardiovascular outcomes and also may reduce the incidence of cardiovascular death, according to results of a meta-analysis published in the Journal of the American College of Cardiology.

An angiotensin receptor blocker (ARB) valsartan-based regimen offered advantages over a calcium channel blocker (CCB) amlodipine-based regimen in preventing heart failure (HF) and diabetes in patients with hypertension, according to results of an analysis published in Hypertension.

TNF inhibitor approved for inhibiting joint damage, improving physical function in psoriatic arthritis

Although acting FDA Commissioner Andrew von Eschenbach, MD, has been on the job since September 2005, it was only last month that he received approval from the Senate's Health, Education, Labor and Pension (HELP) committee for his nomination as FDA commissioner to be considered by the full Senate. However, the step was an incremental one at best for Dr von Eschenbach and the agency, which has been without an officially appointed commissioner for all but 18 months over the past 5? years.

Patients taking clozapine for schizophrenia should be regularly monitored because of an increased risk for metabolic abnormalities, according to a study published in the American Journal of Psychiatry.

A review of adverse event data associated with the synthetic vitamin A retinoid isotretinoin between 1997 and 2002 suggests that the acne treatment is a "probable" cause of inflammatory bowel disease (IBD) and may precipitate its presentation within a certain subset of patients who are either predisposed to the disease or have subclinical symptoms.

An ointment containing calcipotriol (50mcg/g) plus betamethasone diproprionate (0.5mg/g) demonstrated significant efficacy against psoriasis within 4 weeks compared with 12 weeks of biological therapy, regardless of disease severity, as measured by the Psoriasis Area and Severity Index (PASI), according to a meta-analysis recently reported in the International Journal of Dermatology.

Atorvastatin reduced the overall incidence of strokes and cardiovascular events in patients without known coronary disease who had recently experienced a stroke or a transient ischemic attack (TIA), according to a randomized, placebo-controlled, double-blind study of 4,731 patients. Results from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study, however, also demonstrated an increase in the incidence of hemorrhagic strokes among those receiving atorvastatin compared with placebo.

Disease-modifying antirheumatic drugs (DMARDs) reduce the risk of acute myocardial infarction (MI) in patients with rheumatoid arthritis (RA), according to results of an observational study published in the journal Arthritis & Rheumatism.

Approximately 17 million people in the United States have type 2 diabetes, and the prevalence continues to rise.1 More than 45% of patients with end-stage renal disease have type 2 diabetes as an etiology, and a patient with type 2 diabetes has the same risk of developing an acute coronary syndrome (unstable angina, myocardial infarction [MI]) over the next 10 years as someone who has had an acute coronary syndrome in the past.2 In addition to these complications, type 2 diabetes also increases the risk of blindness, neuropathy, and amputation.3

Drug-eluting stents (DES) represent an innovative application of pharmaceutical technology that has piqued the interest of hospital and managed care decision-makers. Since their introduction to the US market in 2004, the sirolimus- and paclitaxel-eluting stents have featured drugs employing different mechanisms of action to reduce the risk of restenosis following percutaneous coronary intervention (PCI) in an attempt to improve cardiovascular outcomes.

Despite the variety of medications available to treat type 2 diabetes, the disease is inadequately controlled in many patients. In order to improve glycemic control, manufacturers are pursuing compounds that affect the incretin hormones that stimulate insulin release in response to increased glucose levels. Although stimulation of the incretin receptors by the glucagon-like peptide-1 (GLP-1) enhances the body's ability to produce insulin in response to elevated blood glucose concentrations, the clinical usefulness of GLP-1 is limited by its rapid degradation by dipeptidyl peptidase-IV (DPP-IV). Drug companies have developed compounds intended to act as inhibitors of DPP-IV. Vildagliptin (Galvus, Novartis) is the second DPP-IV inhibitor under investigation by FDA to offer this new mechanism to achieve glycemic control. An NDA for vildagliptin was submitted to FDA in March 2006, 1 month after the submission of the first DPP-IV inhibitor, sitagliptin.

Dalteparin (Fragmin, Pfizer) for the extended treatment of symptomatic venous thromboembolism (proximal deep vein thrombosis and/or pulmonary embolus) to prevent recurrent venous thromboembolism in patients with cancer