Jerry Fahrni

Tag: Therapeutics

  • Remdesivir, the pharmacy budget buster

    I saw the discussion below in one of the pharmacy forums. Fact check true on this one.

    Gilead would have everyone believe that remdesivir is a magic bullet for COVID-19 infection. Not true. Helpful? Useful tool? Maybe.

    Remdesivir, while potentially beneficial, has limitations. For one, it should only be used on hospitalized patients that have falling oxygen saturation and chest infiltrates. Second, while it has been shown to potentially shorten the course of the disease, it has not been shown to reduce mortality.(1)

    On the flipside, the drug is relatively expensive, has been overused, and contrary to data showing that it may shorten the course of the disease, may inadvertently lengthen hospital stays.

    Based on the “Solidarity” trial, a WHO guideline committee went as far as to recommend against the use of remdesivir.(2)

    “The Solidarity Trial published interim results on 15 October 2020. It found that all 4 treatments evaluated (remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon) had little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalized patients… So far, only corticosteroids have been proven effective against severe and critical COVID-19. [see RECOVERY trial (3)]… The researchers determined the evidence quality to be low for remdesivir in regard to improving time to clinical improvement, hospitalization duration and mechanical ventilation duration.”

    However, you won’t find physicians touting this particular WHO recommendation. Why not? Simply put, it doesn’t fit the narrative put forward by Gilead and the media. Nor does the WHO recommendation give practitioners access to this new therapeutic toy. A combination of marketing and fear has led to remdesivir rapidly evolving into “best practice”. It is basically spreading through hospitals unchecked.

    But Jerry, no hospital could have predicted the pandemic and therefor the cost of remdesivir. True. However, if remdesivir truly cut hospital stays by a couple of days and reduced time on mechanical ventilation, the cost of the drug would be a wash. I have not seen any large-scale data to support this notion. As of today, hospitals have spent millions upon millions of dollars on remdesivir. Not to mention that there are reports of providers prolonging patient stays to complete remdesivir treatment courses even when patients have met criteria for discharge. Such practice spits in the face of common sense.

    But Jerry, even if it saves one life it will have been worth it. Ah yes, the battle cry of people who want something done, regardless of the consequences. Such sentiment seems reasonable on the surface, but quickly fades with analysis and thought. A philosophical debate for another time. Suffice it to say that real life doesn’t work that way.  

    Overall, the unfettered use of remdesivir, combined with failure of healthcare to provide clear, concise, science-based use criteria, has created a budget pitfall that will take years to climb out of, if at all. It’s this type of fiscal irresponsibility that makes the U.S. healthcare system so special.

    ———-

    1. Healio.com. 2021. Remdesivir shortens time to improvement, but has no significant mortality effect. [online] Available at: <https://www.healio.com/news/primary-care/20210331/remdesivir-shortens-time-to-improvement-but-has-no-significant-mortality-effect> [Accessed 29 April 2021].
    2. Who.int. 2021. “Solidarity” clinical trial for COVID-19 treatments. [online] Available at: <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments> [Accessed 30 April 2021].
    3. New England Journal of Medicine, 2021. Dexamethasone in Hospitalized Patients with Covid-19. 384(8), pp.693-704.

  • Saturday morning coffee [December 14 2013]

    “Never tell your problems to anyone…20% don’t care and the other 80% are glad you have them.” – Lou Holtz

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    MUG_SMC
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  • Saturday morning coffee [November 23 2013]

    “Wrong does not cease to be wrong because the majority share in it.” ― Leo Tolstoy, A Confession

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    MUG_SMC
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  • Saturday morning coffee [September 6 2013]: The Butler, Surface, Med Adherence, Note 3

    “Hardships often prepare ordinary people for an extraordinary destiny.” ~ C.S.Lewis

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    I have officially run out of coffee mugs from which to pull for my SMC posts. The coffee mug below was a Christmas present from my youngest daughter, Mikaela, and will be used as my official SMC mug for the time being.

    MUG_SMC
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  • Saturday morning coffee [August 17 2013]: Elysium, Pharmacogenomics, Gonorrhea, Limo Joust

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug below comes straight from Canada. My family and I spent a little time in Victoria, British Columbia this summer. What a beautiful place. It’s a great little town, and we were blessed with awesome weather. It was sunny and in the 70’s-80’s the entire time we were there. We spent some time milling around the town, rented a car and drove around the beach areas, and took a short trek to Butchart Gardens. I’m not a gardens-type of guy, but Butchart Gardens is really neat. We took a boat tour of the area and stayed for the fireworks show that took place late one night. Great memories. I would do it again.

    MUG_Canada

    Just a quick side note: this is the last coffee mug in my collection. Not sure what I plan to do for my next SMC. Any suggestions?
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  • Model for scheduling complex medication regimens

    The abstract below caught my attention. I can’t read the entire article because I don’t have a subscription to the journal (a pet peeve of mine – just sayin’). Nonetheless I found the abstract quite interesting. I think the conclusion is a bit overly optimistic, but the use of computers to calculate an optimized medication schedule for individual patients is a promising idea. (Comput Methods Programs Biomed. 2011 Dec;104(3):514-9. Epub 2011 Oct 5.)

     

    Abstract
    Medication adherence tends to affect the recovery of patients. Patients having poor medication adherence show a worsening of their condition and/or increased complications. Unfortunately, between 20% and 50% of chronic patients are unable to manage their medications. This study proposes a model to improve the patients’ medication compliance by reducing medication frequency.

    Published studies have shown that, based on the patients’ lifestyle, simplification of the medication frequency and remodeling of the medication schedule is able to help improve medication adherence. Therefore, this study tried to simplify medication frequency by combining therapies. Moreover, by adjusting according to lifestyle, the study also tries to remodel medication timing in relation to mealtimes to create personal medication schedules.

    In this study, we used 19,393,452 outpatient prescriptions from the National Health Insurance Research Database to verify our system (algorithm optimized). At the same time, we examined the differences between the frequency summarized by general public and experts’ advice medication behavior. Compared with the experts’ advice method, this system has reduced the medication frequency in about 49% of prescriptions.

    Using combined medication to simplify medication frequency is able to reduce the medication frequency significantly and improve medication adherence. Furthermore, this should also improve patient recovery, reduce drug hazards and result in less drug wastage.

  • Canada calls for national drug shortage registry [article]

    The Canadian Pharmacist Association is looking for a way to track drug shortages. They would like to get drug manufactures and hospitals to participate in a national reporting system. It’s a great idea and one that I think could provide value.

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  • Bacteria everywhere run scared as vancomycin gets new life

    vancomycinmedGadget: “Scientists from the Scripps Research Institute have successfully reengineered vancomycin. They have reported their findings in the Journal of the American Chemical Society. This research could be a solution in the treatment of patients infected with highly resistant bacteria. Vancomycin is often considered the antiobiotic of last resort, if other antibiotics have failed to do the job. But the emergence of vancomycin-resistant bacteria is becoming a major health problem. Vancomycin works by binding the D-alanyl-D-alanine terminal dipeptide of peptidoglycan precursors, used by bacteria for constructing their cell walls. By binding it, the bacteria can not use the peptidoglycan anymore and they die. But certain bacteria have altered their peptidoglycan by replacing an amide with an ester, resulting in vacomycin resistance.

    The reengineered vancomycin can bind the altered peptidoglycan and kill the bacteria once again using the same mechanism as described above. But besides binding the altered peptidoglycan, this new antibiotic can bind the original peptidoglycan as well. It took Dale L. Boger and his team some serious chemical engineering to redesign vancomycin into this new antibiotic. In the article down below you can read the report how they managed to synthesize this altered antibiotic and exchange a single atom in the vancomycin to reinstate its antimicrobial activity.”

    Vancomycin is an oldie, but a goodie. It continues to be useful despite its age. Several drugs have been developed over the years to replace it, but for one reason or another the newer agents tend to fall out of favor. With that said, vancomycin won’t last forever as bacteria are slowing finding ways to combat its mechanism of action. So instead of finding a new drug, someone decided to alter the old one. Go figure.

  • MedKeeper acquires DoseResponse

    It looks like MedKeeper is making a play in the therapeutic monitoring market by acquiring DoseResponse, a web-based outpatient anticoagulation management system from Keystone Therapeutics. The press release can be found here.

    Outpatient anticoagulation therapy, i.e. warfarin management, became a big deal when JCAHO made it one of their national patient safety goals a few years back. I’m specifically referring to National Patient Safety Goal 3E: Reducing Harm from Anticoagulation Therapy. If you feel like giving yourself a headache you can read through the entire Abulatory Health Care National Patient Safety Goals (PDF). I wouldn’t recommend it.
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  • “What’d I miss?” – Week of July 4, 2010

    As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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