Optimizing Medication Therapy & Improving Outcomes

February 29, 2016

Monoclonal Antibodies for the Treatment of Hypercholesterolemia

Cholesterol concentrations in many patients with familial hypercholesterolemia are poorly controlled despite dietary changes and maximum pharmacologic therapy. Increased concentrations of proprotein convertase subtilisin/kexin type 9 (PCSK9) contribute to elevated concentrations of LDL cholesterol (LDL-C) in these patients. Monoclonal antibodies, which inhibit PCSK9, have been shown to significantly reduce LDL-C in those with familial hypercholesterolemia. Two recently approved monoclonal antibodies—evolocumab and alirocumab—are injected subcutaneously either biweekly or monthly and have demonstrated favorable safety profiles, in addition to efficacy in lowering LDL-C. A third monoclonal antibody is currently being investigated. Long-term studies are necessary to determine the effectiveness of these new agents in preventing cardiovascular disease. Read more.

Dual Antiplatelet Therapy Duration in Patients With Drug-Eluting Stents

Complications seen with percutaneous coronary intervention led to the development of bare metal stents and, later, drug-eluting stents. To prevent progressive atherosclerosis in the case of drug-eluting stents, current guidelines suggest a course of dual antiplatelet therapy for 12 months. Results from recent trials that analyzed outcomes of altering this duration of therapy suggest that, in comparison with second-generation drug-eluting stents, the extension of dual antiplatelet therapy in patients with first-generation drug-eluting stents shows benefits. Clinical decision making should also take into account the similarity in mortality rates between both types of drug-eluting stents and the increased risk of bleeding associated with extension of therapy. Read more.

Recommending Aspirin for Primary Prevention of Cardiovascular Disease

The benefit of aspirin use for secondary prevention of cardiovascular disease is well established; the efficacy of aspirin use for primary prevention, however, is less evident. Trials evaluating aspirin for primary prevention provide little direction regarding when it should be used. Certain populations, such as patients who are at higher risk for cardiovascular disease or have multiple risk factors, may be candidates for low-dose aspirin therapy when the benefits of taking aspirin for cardiovascular protection outweigh the harms. Other high-risk populations, such as patients with diabetes and those with a 10-year cardiovascular risk exceeding 10%, may also benefit from low-dose aspirin therapy. Read more.

Medication Therapy Management in the News

Dupilumab Appears to Significantly Improve Nasal Polyps in Sinusitis

A drug used for asthma and atopic dermatitis shows promise for improvement of nasal polyps in patients with chronic sinusitis. Read more.

Mortality Risk Decreases for Older Diabetes Patients

According to a new study, providing effective depression treatment for older patients with diabetes not only can help resolve their mental health issues, it actually can improve overall health status. Read more

MS Drug Linked to Increased Risk of Biomarker for Damaging Brain Condition

A German study suggests that multiple sclerosis patients taking the drug natalizumab appear to have a 10 times greater risk of developing a risk biomarker for activity of the John Cunningham virus. Read more.

Marijuana Use Dropped With Topiramate, but Side Effects Problematic, Brown University Study Shows

While combining topiramate with psychological counseling reduced marijuana use among young smokers, more than half of study participants dropped out because of the medication’s side effects. Read more.