AFP DEPARTMENT COLLECTION

STEPS

This department includes information about new drugs from the perspective of the five attributes to be considered when weighing the advantages of one drug over another: Safety, Tolerability, Effectiveness, Price, and Simplicity.

Feb 15, 2017 Issue
Rifaximin (Xifaxan) for Irritable Bowel Syndrome
Rifaximin has good overall tolerability. A relatively short course of treatment results in sustained clinical benefit for at least 10 weeks, eliminating the need for continued therapy, with an NNT of 10. However, it is expensive and should be reserved for patients who cannot tolerate or did not respond to more affordable therapies.


Jan 15, 2017 Issue
Umeclidinium (Incruse Ellipta) for COPD
Umeclidinium is an easy-to-use, once-daily, well-tolerated, and relatively low-cost anti-cholinergic agent for maintenance therapy in patients with moderate to severe COPD.


Dec 15, 2016 Issue
Empagliflozin (Jardiance) for Type 2 Diabetes Mellitus
Empagliflozin can be added to existing type 2 diabetes treatment to lower A1C levels, although there are less expensive options. In older patients with preexisting cardiovascular disease, empagliflozin can decrease all-cause mortality, cardiovascular mortality, and hospitalization for heart failure.


Nov 15, 2016 Issue
Evolocumab (Repatha) for the Treatment of Hyperlipidemia
Evolocumab is generally safe and effective at lowering serum LDL cholesterol levels for select patients who need marked cholesterol reduction and can tolerate injections. However, it remains unknown whether evolocumab prevents premature death from cardiovascular events.


Oct 15, 2016 Issue
Sacubitril/Valsartan (Entresto) for Heart Failure
Sacubitril/valsartan provides a small mortality benefit and decreases heart failure–related hospitalizations over and above an ACE inhibitor. It may be used in place of an ACE inhibitor in patients receiving optimal doses of guideline-directed medical therapy that includes ACE inhibitors, beta blockers, and aldosterone antagonists.


Sep 15, 2016 Issue
Ivermectin 1% Cream (Soolantra) for Inflammatory Lesions of Rosacea
Ivermectin cream is an effective treatment for moderate to severe pustular rosacea, but it is more expensive than some other available treatments and has not been studied in patients with milder forms of rosacea. Generic metronidazole cream is a less expensive alternative, and long-term oral doxycycline may be suitable for patients who want a more affordable alternative to a topical agent.


Aug 15, 2016 Issue
Alirocumab (Praluent) for Treatment of Hyperlipidemia
Alirocumab is a novel lipid-lowering therapy that is highly effective at lowering LDL cholesterol when used in addition to statin therapy and diet. Its use should be limited to patients with either heterozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease who do not tolerate an adequate dose of a statin.


Jul 15, 2016 Issue
Liraglutide (Saxenda) for Weight Loss
Liraglutide, combined with lifestyle counseling, produces a clinically significant and sustained weight loss that continues as long as it is used. Nausea and vomiting, however, are common adverse effects, and about one in 10 patients will discontinue treatment.


Jun 15, 2016 Issue
Suvorexant (Belsomra) for Insomnia
Suvorexant effectively increases total sleep time and decreases time to sleep onset. Because of its risk of abuse, significant incidence of next-day impairment, and high cost, it should be reserved for use in patients for whom other insomnia therapies, such as cognitive behavior therapy and lifestyle changes, have failed.


May 15, 2016 Issue
Flibanserin (Addyi) for Hypoactive Sexual Desire Disorder in Premenopausal Women
Although flibanserin results in a modest improvement in the number of satisfying sexual events (approximately one more per month vs. placebo), it does not improve other measures, is considerably expensive, and has significant adverse effects.


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