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.

Apr 15, 2014 Issue
Apixaban (Eliquis) for Stroke Prevention in Atrial Fibrillation
Apixaban is at least as effective as aspirin or warfarin for preventing strokes in high-risk patients with nonvalvular atrial fibrillation, especially those who cannot or will not take warfarin. It is slightly less likely to cause major bleeding and may have better compliance because it does not require frequent laboratory monitoring. However, apixaban is significantly more expensive than warfarin or aspirin, and its anticoagulation effect cannot be reversed in the event of an emergency.

Feb 15, 2014 Issue
Roflumilast (Daliresp) for Chronic Obstructive Pulmonary Disease
Roflumilast therapy has a limited role in patients with severe COPD, and no role in patients with mild to moderate COPD. It will not decrease the number of hospitalizations.

Dec 15, 2013 Issue
Ticagrelor (Brilinta) for Secondary Prevention of Thrombotic Events Following Acute Coronary Syndrome
Ticagrelor is an alternative to clopidogrel for secondary prevention of cardiovascular death in patients with acute coronary syndrome. In an international study it was found to be more effective, but patients in the United States did not experience superior outcomes.

Oct 15, 2013 Issue
Emtricitabine/Tenofovir (Truvada) for HIV Prophylaxis
When used with a comprehensive HIV prevention strategy, emtricitabine/tenofovir effectively prevents HIV-1 infection in high-risk patients. Adherence to daily dosing is important to maintain protection. The cost of therapy may limit access, and not all insurance companies currently cover its use for HIV prophylaxis.

Aug 15, 2013 Issue
Vilazodone (Viibryd) for the Treatment of Depression
The available evidence does not support the routine use of vilazodone in the treatment of depression. It is significantly more expensive than generic alternatives and is no more effective for moderate to severe depression than selective serotonin reuptake inhibitors or tricyclic antidepressants.

Jun 15, 2013 Issue
Spinosad (Natroba) for Head Lice
Spinosad is safe and effective for the treatment of head lice; most patients will be lice-free after a single treatment. Nit combing following treatment is not necessary. These benefits must be weighed against its prescription-only status and higher cost compared with nonprescription treatments.

May 15, 2013 Issue
Bromocriptine Mesylate (Cycloset) for Type 2 Diabetes Mellitus
Cycloset will lower A1C levels by 0.3 to 0.5 percent when taken alone or in combination with a sulfonylurea, without undesirable adverse effects such as hypoglycemia and weight gain. It will not cause further improvement of glucose control when used with insulin, metformin, or other hypoglycemic agents. Whether it decreases mortality or diabetes-related morbidity is not known.

Feb 1, 2013 Issue
Fidaxomicin (Dificid) for Clostridium difficile Infection
Fidaxomicin is effective for the treatment of C. difficile infection, but it is much more expensive than traditional therapy. Until it is known that the benefits outweigh the significant cost, metronidazole or oral vancomycin is the preferred treatment for most patients.

Dec 15, 2012 Issue
Linagliptin (Tradjenta) for the Treatment of Diabetes Mellitus
Linagliptin reduces A1C levels to a lesser extent than first-line therapy (metformin) and is significantly more expensive than metformin and sulfonylureas. Importantly, its ability to affect diabetes-related morbidity and mortality is not known.

Oct 15, 2012 Issue
Rivaroxaban (Xarelto) for Prevention of Thromboembolic Events
In patients at high risk of stroke because of nonvalvular atrial fibrillation, rivaroxaban is as safe and effective as warfarin. However, it should not be used in patients at risk of stroke for reasons other than nonvalvular atrial fibrillation until research shows its relative safety and effectiveness.

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