PHARMACY

Study: Statin users are less adherent when multiple physicians, trips to pharmacy are involved

BY Alaric DeArment

NEW YORK — Patients taking cardiovascular drugs may become less adherent if they have to see multiple physicians and make frequent trips to the pharmacy, according to a new study published in the journal Archives of Internal Medicine.

Researchers at Brigham and Women’s Hospital, Harvard Medical School in Boston and CVS Caremark analyzed data from 1.8 million patients taking statins and 1.5 million taking angiotensin receptor blockers or angiotensin-converting enzymes from between June 2006 and May 2007.

They found that greater complexity in prescribing and filling prescriptions resulted in lower levels of adherence, and those with the least refill consolidation had adherence rates 8% lower than those with the most. The researchers concluded that strategies to reduce the complexity of prescribing and filling prescriptions could help improve medication adherence.

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Compliance today saves dollars tomorrow, and pharmacy is here to help

BY Michael Johnsen

WHAT IT MEANS AND WHY IT’S IMPORTANT — Life doesn’t give you too many of those Magic 8 Ball moments, at least not the kind you can find at the pharmacy counter. Just ask the 8 Ball if medicine compliance is important for retail pharmacy, and the answer undoubtedly will come back, “It is decidedly so.”

(THE NEWS: Surgeon general, NCL introduce Script Your Future campaign. For the full story, click here)

Everyone knows that compliance today saves dollars tomorrow. The question is whether or not stakeholders — from the payers down to the patients — realize that the most accessible compliance tool is the white-coated healthcare professional who just adjudicated that prescription.

The fact is, if you increase compliance to prescription regimens, people are healthier for it to the tune of $290 billion in annual savings. And the pharmacy counter is just about the best place to realize those savings.

And that means the Script Your Future campaign could become the straw that stirs that value-of-pharmacy-awareness concoction. Ask the Magic 8 Ball what the chances of that are, and the answer very well may be, “Without a doubt.”

Because if you take a look at the list of sponsors and partners of the program, there certainly are a number of pharmacy influencers on the list, including pharmacy operators CVS Caremark, Kerr Drug and Walgreens.

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Researchers find TZDs may pose certain health risks for diabetics

BY Michael Johnsen

MARYLAND HEIGHTS, Mo. — According to a report in the May issue of Cell Metabolism, while drugs known as thiazolidinediones, or TZDs, are widely used in diabetes treatment, they have effects on the kidneys that lead to fluid retention as the volume of plasma in the bloodstream expands.

"TZDs usually increase body weight by several kilograms," stated George Seki of the University of Tokyo. "However, TZDs sometimes cause massive volume expansion, resulting in heart failure."

The findings may lead to the development of improved diabetes therapies.

TZDs act on a hormone receptor known as peroxisome proliferator-activated receptor γ. PPARγ is a master gene of fat cell biology and differentiation, Seki explained, making it an ideal target for diabetes treatment.

However, TZDs also lead to changes in gene expression that enhance the sodium transport system of the kidney and lead to the reabsorption of water and salt, as scientists knew. But, Seki said, that mechanism alone didn’t seem to be enough to explain the volume expansion.

Seki’s team has found that TZDs also have direct effects on channels in the kidney known as the proximal tubules. TZDs rapidly stimulate sodium-coupled bicarbonate absorption from renal proximal tubules. Inhibitors of PPARγ or other players in the pathway suppress that stimulation, they reported.

The discovery helps to explain the speed with which side effects of TZDs sometimes can arise, and may lead to strategies to improve insulin resistance without the accompanying severe cardiovascular side effects, the researchers noted. "Massive volume expansion in human subjects usually occurs after weeks of use of TZDs," they wrote. "However, it can also occur as rapidly as four days after use of TZDs, supporting the involvement of multiple mechanisms. Thus, combination therapy with different diuretics targeting both renal proximal tubules and the distal nephrons could be a therapeutic option in case of TZD-induced massive volume expansion."

The findings also raise the possibility that other small molecules might bind PPARγ in slightly different ways, leading to different biological responses, the researchers added. In fact, several selective PPARγ modulators already have been developed and appear to induce less fluid retention, at least in animals. Whether that will prove to work in humans to prevent massive fluid retention remains to be seen.

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