Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2016 revision

BACKGROUND: Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update. OBJECTIVE: We sought to provide a targeted update of the ARIA guidelines. METHODS: The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. RESULTS: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient. CONCLUSIONS: Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.

Efficiency of pragmatic search strategies to update clinical guidelines recommendations.

BACKGROUND: A major challenge in updating clinical guidelines is to efficiently identify new, relevant evidence. We evaluated the efficiency and feasibility of two new approaches: the development of restrictive search strategies using PubMed Clinical Queries for MEDLINE and the use of the PLUS (McMaster Premium Literature Service) database. METHODS: We evaluated a random sample of recommendations from a national guideline development program and identified the references that would potentially trigger an update (key references) using an exhaustive approach. We designed restrictive search strategies using the minimum number of Medical Subject Headings (MeSH) terms and text words required from the original exhaustive search strategies and applying broad and narrow filters. We developed PLUS search strategies, matching Medical Subject Headings (MeSH) and Systematized Nomenclature of Medicine (SNOMED) terms with guideline topics. We compared the number of key references retrieved by these approaches with those retrieved by the exhaustive approach. RESULTS: The restrictive approach retrieved 68.1 % fewer references than the exhaustive approach (12,486 versus 39,136), and identified 89.9 % (62/69) of key references and 88 % (22/25) of recommendation updates. The use of PLUS retrieved 88.5 % fewer references than the exhaustive approach (4,486 versus 39,136) and identified substantially fewer key references (18/69, 26.1 %) and fewer recommendation updates (10/25, 40 %). CONCLUSIONS: The proposed restrictive approach is a highly efficient and feasible method to identify new evidence that triggers a recommendation update. Searching only in the PLUS database proved to be a suboptimal approach and suggests the need for topic-specific tailoring.

[A pharmacoepidemiological study of antiepileptic drug consumption (1992-2004)]. / Estudio farmacoepidemiológico del consumo de fármacos antiepilépticos (1992-2004).

INTRODUCTION: Epilepsy and the epileptic syndromes are common neurological diseases and represent an important public health problem that has given rise to marked social and healthcare concerns. AIM: To analyse the changes in the consumption of antiepileptic drugs in the Basque Country Autonomous Community over a 13 year period (1992-2004). MATERIALS AND METHODS: The consumption of the N03 subgroup has been studied using data from the ECOM database of the Spanish Ministry of Health and Consumer Affairs, which records the number of drug packets dispensed on National Health Service prescription. The results are expressed as defined daily doses per 1,000 inhabitants per day (DID). RESULTS: A significant increase is observed in the consumption of antiepileptic drugs over the study period (5.53-9 DID). The most widely used drugs were phenobarbital, carbamazepine, valproic acid and phenytoin and, in recent years, the extensive use of gabapentin is of particular note. CONCLUSION: Epidemiological studies on epilepsy are difficult to perform due to a number of methodological problems which are caused fundamentally by the heterogeneity of the disease. Pharmacoepidemiological studies constitute a simple, effective, low-cost tool for estimating the prevalence of the disease, and furthermore enumerates the drugs used, thus contributing to a rational use of these drugs.

Estudio farmacoepidemiológico del consumo de fármacos antiepilépticos (1992-2004) / A pharmacoepidemiological study of antiepileptic drug consumption (1992-2004)

Las epilepsias y los síndromes epilépticos constituyen enfermedades neurológicas frecuentes y representanun importante problema de salud pública, que ha dado lugar a una gran preocupación sanitaria y social. Objetivo. Analizar la evolución del consumo de fármacos antiepilépticos en la Comunidad Autónoma del País Vasco en un período de 13 años (1992-2004). Materiales y métodos. Se ha estudiado el consumo del subgrupo N03 con datos procedentes de la base de datos ECOM del Ministerio de Sanidad y Consumo de España, que ofrece el número de envases de medicamentos dispensadosmediante recetas realizadas a cargo del Servicio Nacional de Salud. Los resultados se presentan en dosis definidas diarias por 1.000 habitantes y día (DHD). Resultados. Se ha producido un aumento significativo en la utilización de fármacos antiepilépticos en el período estudiado (5,53-9 DHD). Los fármacos más utilizados han sido el fenobarbital, la carbamacepina, el ácido valproico y la fenitoína, y destaca en los últimos años el amplio uso de la gabapentina. Conclusiones. Los estudios epidemiológicos sobre epilepsia son difíciles de realizar por diversos problemas metodológicos, que fundamentalmente parten de la heterogeneidad de la enfermedad. Los estudios farmacoepidemiológicos constituyen una herramienta eficaz, fácil y de bajo coste para estimar la prevalencia de la enfermedad, además de dar a conocer los fármacos utilizados y contribuir al uso racional de los mismos (AU)

Epilepsy and the epileptic syndromes are common neurological diseases and represent an importantpublic health problem that has given rise to marked social and healthcare concerns. Aim. To analyse the changes in the consumption of antiepileptic drugs in the Basque Country Autonomous Community over a 13 year period (1992-2004). Materials and methods. The consumption of the N03 subgroup has been studied using data from the ECOM database of theSpanish Ministry of Health and Consumer Affairs, which records the number of drug packets dispensed on National Health Service prescription. The results are expressed as defined daily doses per 1,000 inhabitants per day (DID). Results. A significant increase is observed in the consumption of antiepileptic drugs over the study period (5.53-9 DID). The most widely used drugs were phenobarbital, carbamazepine, valproic acid and phenytoin and, in recent years, the extensive use of gabapentin is of particular note. Conclusion. Epidemiological studies on epilepsy are difficult to perform due to a number of methodological problems which are caused fundamentally by the heterogeneity of the disease. Pharmacoepidemiological studies constitute a simple, effective, low-cost tool for estimating the prevalence of the disease, and furthermore enumerates the drugs used, thus contributing to a rational use of these drugs (AU)

Prescripción de fármacos antiácidos y antiúlcera péptica en atención primaria / No disponible

El objetivo de este trabajo se centra en la valoración cuantitativa de la prescripción de fármacos antiácidosy antiúlcera péptica en un centro de salud durante tres años, la influencia del sexo y la edad, el coste económico asociado y el posible ahorro utilizando las alternativas más baratas existentes en el mercado. La muestra quedó compuesta por 13.248 pacientes. Los resultados se expresan en dosis definidas diarias por milhabitantes y día (DHD). También se ha analizado el coste total de las prescripciones y el coste por tratamientoy día, y se ha realizado un análisis minimizado de costes para estimar el posible ahorro que se podríahaber obtenido si se hubiera prescrito la alternativa más económica del mercado. Al 20,06% de los pacientesse les prescribió algún fármaco antiácido o antiúlcera péptica, habiendo más mujeres con prescripcionestanto en el total como en el grupo de edad de 45 a 64 años. La DHD total de estos fármacos asciende a 34,4140.Por principios activos el más prescrito fue ranitidina (DHD= 10,2327), seguida de omeprazol (DHD=7,4752). El coste total de la prescripción de este subgrupo se cifra en 487.288,42 € y el posible ahorro al elegir la alternativa más económica ascendería a 101.956,96 (el 20,92% del coste total)

The aim of the study is to monitor the prescription of the frequently employed antacid and peptic ulcer drugsin a health centre during a three year study period. The influence of sex, age, associated economic cost andconsequently possible savings, are also evaluated. The sample for the study consisted of 13248 patients. Theresults were expressed as Defined Daily Dosage per 1000 inhabitants per day (DID). The total prescriptioncost and the daily treatment cost were also evaluated. A cost-minimization analysis provided an estimationof the possible savings if the cheapest available active ingredient in the market was prescribed. Out of thetotal number of patients 20.06% were prescribed with antacid or peptic ulcer drugs. Women were prescribedmore when considering both the total amount of patients and the 45-64 year group. The total DID value forboth drug groups considered in the study reached 34.4140. When referring to the active ingredient, ranitidine (DID=10.2327) followed by omeprazole (DID= 7.4752) were the most prescribed drugs. The total cost for the prescription of antacids and peptic ulcer drugs amounted to 487,288.42 € and the potential saving by prescribing the cheapest commercial brand on the market could have been 101,956.96 € (20.92% of the total cost)