SARTANS OF THE SECOND GENERATION: THERAPEUTIC POTENTIAL EXTENSION

Peculiarities of the treatment with angiotensin II receptor blocker telmisartan are analyzed taking into account its clinical and pharmacological characteristics. Special attention is paid to the telmisartan benefits in comparison with other sartans. Key details of telmisartan interaction with peroxisome proliferator-activated receptors (PPAR) are discussed. Mode of this interaction distinguishes pharmacodynamic effects of different medicines. On the basis of presented data author concludes that antihypertensive therapy with telmisartan provides significant benefits

Pharmacoeconomic analysis of alogliptin use in the treatment of type 2 diabetes

Aim of the study: Determine the validity of alogliptin choice in comparison with other DPP-4 inhibitors, available in Russia (saxagliptin, linagliptin, vildagliptin, sitagliptin) for add-on treatment in patients with inadequate glycemic control on metformin monotherapy, basing on pharmacoeconomic analysis Methodology. Retrospective modeling was performed according to standard pharmacoeconomic methods: cost-minimization analysis, cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and sensitivity analyzes. To predict the long-term impact of the compared therapies on CUA results, a Markov model with 10-year simulation horizon has been used. Results. CEA results showed that lowering HbA1C level by 1% using alogliptin was less expensive than using other agents of the group (sitagliptin, vildagliptin, saxagliptin, linagliptin). The calculated cost per QALY gained for alogliptin therapy was 27 150 rubles, which made the use of alogliptin cost-effective. Conclusions. Alogliptin is a cost-effective alternative in comparison with any other DPP-4 inhibitors (sitagliptin, vildagliptin, saxagliptin, linagliptin) for adding to unsuccessful metformin monotherapy

Evaluation of the health care budget impact of secukinumab treatment in patients with ankylosing spondylitis

Objective: clinical and economic analysis of including of secukinumab (SEC) in the essential drug list (EDL) and Federal Reimbursement (ONLS) to ensure the availability of the drug to patients with ankylosing spondylitis (AS) at the expense of health. Material and methods. A budget impact analysis was used. Only cost of drugs was taken into account. Adalimumab (ADA) and infliximab (INF) were used for comparison. Basing on the calculated number of patients treated with these drugs in 2016 from the budget of health care system impact on 3-years budgets of State Guarantee Program (SGP) and ONLS was analyzed. The analysis scenario was based on the replacement of ADA and INF with SEC. Results. Expenditure of a 3-year therapy cycle with SEC amounted to 1.703 million rubles, which was 41.6% less than that with ADA (2.917 million rubles) and 57.7% less than that with INF (4.022 million rubles) in the same period. The budget impact analysis to estimate the cost of SGP demonstrated that the use of SEC during a 3-year period would result in a reduction in expenses by 51.2% (saving of 3.8 billion rubles). When SEC is used within the ONLS, its cost during 3 years will be reduced by 51.9% (savings of 1.9 billion rubles). Conclusion. The inclusion of SEC in EDL and ONLS is appropriately and economically justified, as it enables a substantial reduction in the expenditure of health care budgets to treat patients with AS and to maintain the clinical effectiveness of therapy

Economic evaluation of the fixed combination of insulin glargine and lixisenatide in Diabetes Mellitus type 2

Aim: a prognosis of clinical-economic efficacy of the fixed combination of insulin glargine and lixisenatide (Soliqua SoloStar®) in comparison with standard therapy with focus on micro- and macrovascular complications of Diabetes Mellitus type 2 (T2DM) in the real practice.Materials and Methods. Model of Burden of T2DM has been created in Microsoft Excel 2010 program. Direct (costs of medicines, treatment of main T2DM complications — myocardial infarction, stroke, etc.) as well as indirect costs (GPD losses, disability related payments, etc.) were calculated. Complications’ rate was took from Federal Diabetes Register. Influence on Burden of T2DM was tested with the additional model which can calculate expenditures with different drugs including Soliqua SoloStar® usage.Results. Direct medical costs with Soliqua SoloStar® usage were less in compare with insulin glargine 100 UI/ml on 23,5 % per year due to decreasing level of severe hypoglycemia and possible protective effect on complications of T2DM (better control). Total expenditures for Soliqua SoloStar® were less on 2,5 % annually, in the same time insulin glargine led to total cost increase by 18,4 % per year. So, difference between expenditures in case of Soliqua SoloStar® were less on appr 21 % vs insulin glargine 100 UI/ml. Budget saving is expected as 6,78 ml RUR per year / 1 000 patients in case of Soliqua SoloStar® usage.Conclusion. Soliqua SoloStar® has economic benefits due to T2DM complications and severe hypoglycemia reduction risks

EFFECT OF ANTIHYPERTENSIVE THERAPY WITH RILMENIDINE ON COGNITIVE FUNCTION IN ELDERLY HYPERTENSIVE PATIENTS

Aim.  To assess antihypertensive efficacy of rilmenidine (Albarel, EGIS, Hungary) and its effect on cognitive function in elderly hypertensive patients. Material and methods. 30 elderly (in average 68 y.o.) hypertensive patients were observed. Each patient received therapy with rilmenidine 2 mg daily during 6 months. 24 hours monitoring of blood pressure before and after therapy was done in each patient. In order to assess cognitive disorders all patients passed neuropsychological tests, which allowed revealing damages of memory, attention, concentration, mental efficiency and psychomotor functions. Raten tests, Veksler test, vocal activity, memory (10 words), serial counting and kinetic probes were used. Results. After 24 weeks of monotherapy with rilmenidine, decrease in daily average systolic blood pressure (SBP) by 7.2% (p<0.01) and diastolic blood pressure (DBP) by 5.5% (p<0.05) was observed. Therapy with rilmenidine showed decrease in daily average burden by SBP and by DBP (by 25.3% and 18.8% respectively; p<0.05) and daily average time index of hypertension for SBP and DBP (by 32.5 and 60.6% respectively; p<0.05) According to the results of neuropsychological tests at the end of treatment, average time for Raten test completion decreased by 16.7% (p<0.05), and for Veksler test completion – by 15.6% (p<0.05). At the same time significant increase in vocal activity of patients is noted: number of words at free associations tests, verbs and plants denomination have grown by 5.8%, 5.1% and 6.3% respectively (p<0.05); number of mistakes in these tests decreased respectively by 71.4%, 50% and 33.3% (p<0.05). Positive dynamics in characteristics of memory: number of words at first and last immediate and postponed reproduction increased respectively by 36.4%, 21.6% and 14.1% (p<0.05),  average time of serial counting and average time of memorization decreased respectively by 13.2% and 31.8% (p<0.05). Velocity in both hands increased, which was observed both in tests on grip and fingering, and on reciprocal coordination. Conclusion. Well-defined antihypertensive effect of rilmenidine in elderly AH patients is accompanied by significant improvement of cognitive functions. This greatly expands opportunities of treatment with rilmenidine in this age group

Multicriteria analysis of the assortment of innovative drugs in oncohematology as a tool for supporting decision-making in the field of drug provision

On the basis of multicriteria analysis, a pilot complex system for evaluating medicinal products (MP) used in the therapy of oncohematological diseases has been developed. The obtained results allow to rank MPs by priority of choice when making decisions on procurement of drugs or inclusion in MP lists in the framework of programs of preferential drug provision of the population. It has been shown that, according to the set of criteria, ibrutinib in treatment of chronic lymphocytic leukemia (CLL) has the highest priority, followed by obinutuzumab (CLL treatment) and ruxolitinib (treatment of myelofibrosis)

Individualisation of basal insulin therapy of type 2 diabetes: evidence from large randomized controlled trials

Initiation of insulin therapy with basal insulin analogues has become the standard of care for type 2 diabetes mellitus (T2DM). Timely administration of insulin allows not only to slow down the progression of type 2 diabetes, but also to reduce the frequency and severity of complications associated with it. This paper reviews the efficacy and safety of the use of the latest basal insulin analogues in type 2 diabetes from the perspective of current clinical guidelines, and also reviews updated data on the efficacy and safety of therapy by various members of the class. In this paper a review of the efficacy and safety of latest basal insulin analogues use in T2DM from the standpoint of current clinical guidelines has been carried out, and updated data on the efficacy and safety of therapy by various members of the class have been reviewed, taking into account their impact on the risk of hypoglycemia and glycemic variability. The available data indicate that insulin degludec 200 U/mL may be the drug of choice for those at high risk of developing severe forms of hypoglycemia. Since severe hypoglycemia and high glycemic variability are important risk factors for cardiovascular events and mortality, it has been shown that a differentiated approach to insulin therapy in the treatment of T2DM is currently advisable, taking into account the effect on the risk of hypoglycemia and glycemic variability

Pharmacoeconomic analysis of anti-angiogenic therapy for diabetic macular edema

Te purpose of the study is to assess the economic consequences of the use of various anti-VEGF drugs in patients with diabetic macular edema (DME).Materials and methods. Te cost–effectiveness analysis and budget impact analysis was conducted from the payer perspective (health insurance system).Results. In accordance to the results from RCT (Protocol T) aflibercept required a lower number of intravitreal injections (IVI) and laser coagulations for frst year and it has tendency for lower number of IVI for the second year of treatment that resulted in lower costs for aflibercept therapy by 122,819 rubles (12.7 %) per patient within frst 2 years (1st year – 66,632 rubles, 2nd year – 61,186 rubles) in comparison with ranibizumab. Te cost–effectiveness analysis showed that aflibercept is a “cost–effective” method of treating patients with DME compared to ranibizumab in Pro Re Nata (PRN) mode. Te budget impact analysis has shown savings for the health insurance system (12 million rubles) for the analyzed patient cohort (n = 100) with aflibercept in 2 years (1st year – 6.163 million rubles; 2nd year – 6.119 million rubles). Te analysis of “lost opportunities” in a cohort of 100 patients showed that the use of aflibercept in DME can free up to 216 hospitalizations within 2 years (109 cases in the 1st year and 107 in the 2nd year). As a result, about 14 patients with DME can be additionally treated with aflibercept for two years within a fxed budget.Conclusion. Treatment of DME with aflibercept can save resources of health insurance system compared to use of ranibizumab

Фармакоэкономический анализ применения препарата цефтазидим+авибактам (Завицефта®) при лечении сепсиса, вызванного карбапенеморезистентными энтеробактериями

Aim: to assess the economic outcomes of using ceftazidime + avibactam (compared with the recommended treatments) in adult patients with sepsis caused by carbapenem-resistant enterobacteria.Methods. The economic assessment was made using the cost-effectiveness analysis and budget impact analysis. The cost-effectiveness and budget impact analyses were performed using the Microsoft Excel software.Results. The treatment efficacy analysis showed that patients treated with the fixed-dose combination ceftazidime + avibactam had fewer days spent in the ICU and higher clinical cure rates than patients receiving the reference drug combinations (8 vs 18 days and 75% vs 34.8%, respectively, p=0.031). The cost of treatment with ceftazidime + avibactam amounted to 228.3 thousand rubles, which was lower than the cost of using the alternative treatment regimens by 34.5-229.5 thousand rubles or 13.12-50.14%. According to the cost-effectiveness analysis, the use of ceftazidime + avibactam is pharmacoeconomically effective as it reduces the cost of patient clinical cure case by 61-72% (depending on the treatment regimen used); in addition, the ceftazidime + avibactam allows for managing the hospitalized patient at a cost lower by 76270 thousand rubles or 16-40% than the compared treatment. The median economic benefit from using the fixed dose combination ceftazidime + avibactam is 154 thousand rubles (28% savings compared with the current practice). The budget impact analysis showed that the reduction in the health budget burden would reach 29% or 34.3 million rubles in year. The sensitivity analysis confirmed the above results.Conclusion. Based on the obtained results, we conclude that the ceftazidime + avibactam combination in patients with sepsis caused by carbapenem-resistant bacteria is economically preferable as compared with the current antibiotic therapy regimens.Цель - провести оценку экономических последствий применения препарата цефтазидим+авибактам в сравнении с рекомендованными схемами терапии у взрослых пациентов с сепсисом, вызванным карбапенеморезистентными энтеробактериями.Материалы и методы. Оценка экономических последствий проведена с использованием анализа «затраты-эффективность » и анализа влияния на бюджет. Расчет затрат проводился в модели, разработанной в программе Microsoft Excel.Результаты. Анализ эффективности показал, что пациенты, получавшие фиксированную комбинацию цефтазидим/авибактам, характеризовались меньшим количеством дней, проведенных в отделении реанимации и интенсивной терапии (ОРИТ) и более высокими показателями клинического излечения, чем пациенты, получающие комбинации сравнения в течение 14 дней от начала лечения (8 против 18 дней и 75% против 34,8% соответственно, р=0,031). Стоимость курса цефтазидим+авибактам составила 228,3 тыс. руб., что на 34,5-229,5 тыс. руб. (13,12-50,14%) ниже расходов на альтернативные схемы лечения. По результатам анализа «затраты-эффективность» показано, что применение препарата цефтазидим+авибактам фармакоэкономически эффективно и позволяет снизить стоимость случая клинического излечения больного на 61-72% в зависимости от используемой схемы терапии, при этом характеризуясь наименьшей стоимостью ведения больного, позволяя сократить сумму прямых затрат на ведение больного на 76270 тыс. руб. (16-40%). Медиана экономической выгоды при использовании фиксированной комбинации цефтазидим+авибактам составляет 154 тыс. руб. (28% экономии в сравнении с текущей практикой). Анализ влияния на бюджет показал, что это приведет к снижению нагрузки на бюджет системы здравоохранения на 29%, или на 34,3 млн руб. в год. Анализ чувствительности подтвердил полученные результаты.Заключение. На основании комплексного фармакоэкономического исследования можно сделать вывод о том, что применение препарата цефтазидим+авибактам у пациентов с сепсисом, вызванным карбапенеморезистентными бактериями с экономической точки зрения является предпочтительной опцией по сравнению с применением текущих схем антибактериальной терапии

Improving blood pressure control, organoprotection and metabolic disorders correction in patients with hypertension switching from diuretic-based combinations to fixed combination lisinopril + amlodipine + rosuvastatin

The aim of the study was to assess the possibility of fixed combination Lisinopril + amlodipine + rozuvastatin to improve arterial elesticity in patients with hypertension and high pulse wave velocity, despite previous diuretic-based combination antihypertensive therapy. Materials and methods. In an open, observational study duration of 24 weeks was included 60 patients on previous diuretic-based combination antihypertensive therapy. All participants underwent 24-hour blood pressure monitoring, applanation tonometry (augmentation index and central blood pressure), pulse wave velocity measurement, laboratory tests (lipid profile, fasting glucose, insulin resistance index - NOMA), leptin, high-sensitivity C-reactive protein before and after the switching to a fixed combination of lisinopril + amlodipine + rosuvastatin. Results. According to measurements of office blood pressure switching of patients on double combinations based on diuretics to a fixed combination of lisinopril + amlodipine + rosuvastatin, a further decrease in systolic blood pressure (SBP) by 13.7% and diastolic BP (DBP) by 18.8% was observed. According to the ABPM, the decline in the average daily SBP was 15.8%, DBP - 22.5%, average SBP - 16.2%, DBP - 19.8%. The combination of lisinopril + amlodipine + rosuvastatin reduced PWV by 15.9%, augmentation index by 13.5%, central SBP by 8.4% (