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Positive EU opinion for apixaban in VTE prevention

The new factor Xa inhibitor, apixaban, (Pfizer/Bristol-Myers Squibb), has received a positive opinion from the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP), for the prevention of venous thromboembolic events (VTE) in adult patients who have undergone elective hip or knee replacement surgery. Apixaban is one of a number of new oral anticoagulants that are expected to replace warfarin.

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Meanwhile, the AVERROES trial, in which apixaban was shown to be preferable to aspirin in patients with atrial fibrillation who are not candidates for warfarin therapy, has now been published (in the March 3rd issue of the New England Journal of Medicine). The results were first presented at the European Society of Cardiology congress last year.

Price reduction for iron replacement product

The NHS price of intravenous ferric carboxymaltose (Ferinject®, Vifor Pharma) has been reduced by 12% from £108 to £95.50 for a pack of 5 x 2 ml vials and from £543.75 to £377.50 for 5 x 10 ml vials. Used for the treatment of iron deficiency when oral iron preparations are ineffective or cannot be used, the product in doses up to 1,000 mg iron can be administered in a 15-minute infusion.

Adherence therapy reduces hypertension

A high proportion of patients with hypertension are failing to take their medication properly and would benefit from a course of “adherence therapy”, according to new research published online by the Journal of Human Hypertension (doi: 10.1038/jhh.2010.133).

Researchers from the Faculty of Health, Nursing and Midwifery, University of East Anglia, studied 136 patients with high blood pressure from three outpatient clinics in Jordan. Half were given a course of seven weekly 20 minute ‘adherence therapy’ sessions and half continued with their usual treatment.

The results show that patients given adherence therapy took 97% of their medications compared with only 71% for those receiving standard treatment. The adherence therapy group, on average, reduced their blood pressure by around 14% – taking it to just above the healthy range. The total cost of delivering a course of seven weekly sessions is calculated to be approximately £80 per person.

Smoking cessation aided by new oral spray

A new oromucosal nicotine replacement therapy (NRT) will relieve the cravings of smokers attempting to quit faster than others, according to research presented recently at the Society for Research on Nicotine and Tobacco conference in Toronto, Canada.

Studies suggest that the oral spray (Nicorette® QuickMist, McNeil Products Ltd.) is 2.5 times more effective at helping smokers quit compared with placebo at 52 weeks (13.8% quit on QuickMist vs. 5.6% on placebo; p<0.01). It administers nicotine instantaneously, resulting in more rapid absorption than other NRTs.

The National Institute for Health and Clinical Excellence (NICE) has recommended NRT combination therapy for smokers who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past. In these cases, a flexible format such as a mouthspray for craving control could complement the use of a nicotine patch for background relief.

The spray has been released under a general sale list (GSL) license, priced at £11.48 per single dispenser and £18.50 per double dispenser pack. One or two sprays are recommended every half hour to an hour, each mouthspray containing at least 150 sprays.

New NICE guidance for anaemia treatment in in CKD

Haemoglobin (Hb) levels in patients with chronic kidney disease (CKD) being treated for anaemia should be kept lower than was previously believed, according to updated guidelines from the National Institute for Health and Clinical Excellence (NICE).

In response to recent studies, NICE now advises that Hb be maintained between 10 and 12 g/dl for adults, teenagers and children over two years, and to between 9.5 and 11.5 g/dl for those under two years of age (http://www.nice.org.uk/CG114). NICE is also urging doctors to not wait until their patients’ Hb levels are outside of these ranges before adjusting their treatments but to act when their patient’s Hb levels are within 0.5 g/dl of the range’s limit.

…and therapeutic hypothermia

More people who suffer cardiac arrests could soon be offered therapeutic hypothermia – a cooling treatment to reduce the risk of death and severe brain damage.  New NICE guidance (www.nice.org.uk/IPG386) advises that the treatment is safe and works well enough for routine use in certain patients.

Clinical trial database app

This new iPhone app enables clinicians access to a database of hundreds of cardiovascular clinical trials searchable by acronyms, authors and medications. Users can select and annotate particular trials and share summaries with colleagues. The app (‘Quest’, AstraZeneca) also features a live news feed. UK healthcare professionals can download it via a direct link on www.ACSunited.co.uk

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