Sobre la equivalencia terapéutica y los nuevos anticoagulantes orales / Therapeutic equivalence of the new oral anticoagulants

En un intento de mitigar el impacto económico que supone la incorporación de fármacos innovadores, se ha promovido y respaldado por las autoridades sanitarias la evaluación y posicionamiento de medicamentos como alternativas terapéuticas equivalentes. Esta cuestión ha adquirido en los últimos tiempos un protagonismo significativo, posiblemente debido a la coyuntura económica actual. Las alternativas terapéuticas equivalentes se justifican por la necesidad de competir por precio, y las autoridades recomiendan establecer la equivalencia terapéutica en el momento de establecer el precio y la financiación de los medicamentos. El establecimiento de los nuevos anticoagulantes orales como alternativa terapéutica equivalente es problemático si nos basamos en la ausencia de comparaciones directas entre los diferentes fármacos y en la discutible metodología utilizada en las comparaciones indirectas actuales. De momento, es difícil precisar cuándo es más recomendable un nuevo anticoagulante oral frente a otro, pero se están haciendo esfuerzos para proponer alternativas en la elección basadas en las características de los pacientes (AU9

In an attempt to minimize the economic impact due to the incorporation of innovative drugs, health authorities have promoted and supported the evaluation and market positioning of drugs, as equivalent therapeutic alternatives. This issue has recently gained importance, possibly due to the current economic crisis. The equivalent therapeutic alternatives are justified by the need to compete on price, and by the authorities recommendation to establish therapeutic equivalence, price and financing of medicinal products at the same time. The establishment of the new oral anticoagulants and the equivalent therapeutic alternatives is a problematic issue if it is based on the absence of direct comparisons between different drugs and the questionable methodology used in the current indirect comparisons. Currently, it is difficult to determine when a new oral anticoagulant is more recommendable than others, but efforts are being made in order to propose alternatives for the decision based on patient characteristics (AU)

[Therapeutic equivalence of the new oral anticoagulants]. / Sobre la equivalencia terapéutica y los nuevos anticoagulantes orales.

In an attempt to minimize the economic impact due to the incorporation of innovative drugs, health authorities have promoted and supported the evaluation and market positioning of drugs, as equivalent therapeutic alternatives. This issue has recently gained importance, possibly due to the current economic crisis. The equivalent therapeutic alternatives are justified by the need to compete on price, and by the authorities recommendation to establish therapeutic equivalence, price and financing of medicinal products at the same time. The establishment of the new oral anticoagulants and the equivalent therapeutic alternatives is a problematic issue if it is based on the absence of direct comparisons between different drugs and the questionable methodology used in the current indirect comparisons. Currently, it is difficult to determine when a new oral anticoagulant is more recommendable than others, but efforts are being made in order to propose alternatives for the decision based on patient characteristics.

Effectiveness of oxaliplatin desensitization protocols

INTRODUCTION: Hypersensitivity reaction (HSR) to antineoplastic drugs can force doctors to stop treatment and seek other alternatives. These alternatives may be less effective, not as well tolerated and/or more expensive. Another option is to use desensitization protocols that induce a temporary state of tolerance by gradually administering small quantities of the antineoplastic drug until the therapeutic dosage is reached. The aim of this study is to assess the effectiveness of oxaliplatin desensitization protocols. MATERIALS AND METHODS: A retrospective observational study was carried out between January 2006 and May 2011. The inclusion criteria were patients undergoing chemotherapy treatment with oxaliplatin who had developed an HSR to the drug and who were candidates for continuing the treatment using a desensitization protocol. The patients' clinical records were reviewed and variables were gathered relating to the patient, the treatment, the HSR, and the desensitization protocol administered. The data were analysed using version 18.0 of the statistics program SPSS. RESULTS: A total of 53 desensitization protocols were administered to 21 patients. In 89 % of these cases, no new reactions occurred while the drug was being administered. New reactions of mild severity only occurred in 11 % of cases, and none of these reactions were severe enough for treatment to be stopped. All patients were able to complete the desensitization protocol. CONCLUSION: This study confirms that oxaliplatin desensitization protocols are safe and effective and allow patients to continue with the treatment that initially caused an HSR (AU)

Algunas reflexiones sobre los medicamentos genéricos / No disponible

No disponible

[Use of enteral nutrition products in a general hospital]. / Utilización de productos de nutrición enteral en un hospital general.

The present work aims to study the use of enteral nutrition (EN) products during the period between October 1996 and January 1997, in a general hospital with a nutrition unit. The EN expenditure ascended to 3,343,475 Pesetas, with the supplements representing the greatest cost percentage (39.1%). An indication-prescription study was carried out by reviewing 120 clinical histories of patients who had received EN during that period. The patients originated in different departments of the hospital, excluding the ICU, chronic patients, pediatrics, and palliative care. Data regarding sex, age, diagnosis, diet used, calories/day given, route of administration, and selection criterion for the diet were analysed. The average age of the patients was 64.59 years. The most common diagnoses were solid tumors (32.5% of the cases), followed by cerebrovascular accidents (16.7% of the cases). The most commonly used EN preparation was the Pentadrink hypercaloric diet (36.7% of the cases), followed by the standard diet (25.8%). The route of administration used most frequently was the oral route in 63.3% of the cases. The calories/day given varied per diet, with this being 886 cal for the hypercaloric diet, and 1,839 cal for the standard diet. Among the criteria for selecting an EN diet 50% of the patients had abnormal protein metabolism and a normal digestive capacity with slight or moderate stress, 12.5% were diabetic; and the remainder presented other criteria that influenced the choice for a specific type of EN diet. From the analysis of the results it is clear that Pentadrink is used as a supplement, and that there are patients with a sometimes insufficient caloric supply.