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  The Medical Letter
  [SJR: 0.142]   [H-I: 16]   [6 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 0025-732X - ISSN (Online) 1523-2859
   Published by The Medical Letter, Inc Homepage  [1 journal]
  • Sacubitril/Valsartan (Entresto) for Heart Failure
    • Authors: admin
      Abstract: Date:  August 3, 2015 Issue #:  1474 Summary:  The FDA has approved Entresto (Novartis), an oral fixed-dose combination of the neprilysin inhibitor sacubitril and the angiotensin receptor blocker (ARB) valsartan, to reduce the risk of cardiovascular death and heart failure hospitalization in patients with heart failure with reduced ejection fraction. Sacubitril is the first neprilysin inhibitor to become available in the US.
      PubDate: Thu, 16 Jul 2015 18:18:03 +000
  • In Brief: Duopa - A Carbidopa/Levodopa Enteral Suspension for
           Parkinson's Disease
    • Authors: admin
      Abstract: Date:  August 3, 2015 Issue #:  1474 Summary:  The FDA has approved Duopa (Abbvie), a carbidopa/levodopa enteral suspension, for treatment of motor fluctuations in patients with advanced Parkinson's disease (PD). It has been available in Europe since 2001.

      In patients with advanced PD, emptying of the stomach may be delayed and unpredictable, which can affect the rate and amount of absorption of carbidopa/levodopa and its efficacy. To bypass the stomach, the new formulation is delivered through a nasojejunal (NJ) tube or percutaneous endoscopic gastrostomy with jejunal (PEG-J) tube.

      A randomized, double-blind, active-controlled, 12-week trial in 66 levodopa-responsive patients with advanced PD and motor complications found that Duopa reduced daily mean "off" time from baseline significantly more than oral immediate-release carbidopa/levodopa (by 4.04 hours vs 2.14 hours). Mean "on" time without troublesome dyskinesia increased by 4.11 hours with the new formulation and by 2.24 hours with immediate-release tablets.1

      Duopa is available in a 100-mL single-use cassette containing 4.63 mg of carbidopa and 20 mg of levodopa per mL. It should be administered over 16 hours through a NJ or PEG-J tube with the CADD-Legacy 1400 portable infusion pump. Patients should be switched to oral immediate-release carbidopa/levodopa before starting Duopa; the labeling has instructions for conversion from immediate-release tablets to Duopa. The maximum recommended daily dose of levodopa is 2000 mg (1 cassette/day). Patients must also take oral immediate-release carbidopa/levodopa in the evening after disconnecting the pump. The medication cassette should be stored in the refrigerator and removed 20 minutes before administration.

      One month's supply of Duopa costs $60542; PEG-J tube insertion and administration-related expenses will significantly increase the cost of treatment.3

      CW Olanow et al. Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson's disease: a randomised, controlled, double-blind, double-dummy study. Lancet Neurol 2014; 13:141.
      Approximate WAC. WAC = wholesaler acquisition cost or manufacturer's published price to wholesalers; WAC represents a published catalogue or list price and may not represent an actual transactional price. Source: AnalySource® Monthly. July 5, 2015. Reprinted with permission by First Databank, Inc. All rights reserved. ©2015.
      F Valldeoriola et al. Cost analysis of the treatments for patients with advanced Parkinson's disease: SCOPE study. J Med Econ 2013; 16:191.

      Download complete U.S. English article

      PubDate: Wed, 15 Jul 2015 12:05:23 +000
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