in succession page 1595 of this iss...

in succession page 1595 of this issue, you will find the first in a of the present day series of short drug updates called "STEPS" This acronym stands for the [i]clavis[/i] components of the update: Safety, Tolerability, Effectiveness, Price and Simplicity. The series is coordinated according to Allen F. Shaughnessy, Pharm.D., who is director of medical education at Pinnacle Health plan Harrisburg, Pa., and one of AFP's contributing medical editors. The article in this issue, "Ezetimibe for Hypercholesterolemia," is written from Spencer Morris, Pharm.D., and rook Tiller, M.D., Greenwood (S.C.) Family Practice Residency. If you have been wondering whether ezetimibe (Zetia) is right for your patients, you will probably appreciate their succinct review, which judges with this bottom-line recommendation:

"Ezetimibe is safe and effective for lowering LDL cholesterol and triglyceride flats but has not been shown to affect patient-oriented issues It can be used as monotherapy or in combination with a low-dose statin, although the combination is more expensive than the maximum dose of the statin. Ezetimibe is reasonable adjunct therapy for patients who have not reached LDL goals forward maximum statin dosage or who cannot tolerate maximum doses of statins. Ezetimibe also is an acceptable treatment option for patients with hyperlipidemia who are intolerant of statins, as in extent as they understand that there is no proven benefit regarding clinical outcomes"

These short reviews will appear formerly or twice a month and will tender physicians snapshots of new put drugs intos that they may be considering for their armamentarium of physic choices. Upcoming topics include atomoxetine (Strattera), desloratidine (Clarinex), escitalopram (Lexapro), tiotropium (Spiriva), teriparatide (Forteo), adefovir (Hepsera), telithromycin (Ketek) tegaserod (Zelnorm), and eplerenone (Inspra).

The safety section, Dr Shaughnessy points public will include a summary of the known side consequences of the drug. However, the safety profiles of strange drugs are not as clear as those of older more established medications. When safety is an issue for a patient, the physician may wish to prorogue trying it for the first year or in the way that after release to benefit from accumulating safety data.

The section forward tolerability will focus on the les serious adverse validitys of the drug, such as drowsiness or insomnia. When comparing tolerability of various unsalable articles Dr. Shaughnessy suggests evaluating "pool dropout rates," or the percentage of patients who stop taking a remedy during clinical trials.

The discussion in succession effectiveness will include a comparison of the of recent origin drug against the drugs in popular use, with an emphasis upon patient-oriented outcomes rather than physiologic or disease-oriented conclusion points. Data directly comparing the effectiveness of therapy may not be available at the time a physic is first marketed.

Price issues, also a point of discussion in gradations can be complex, according to Dr Shaughnessy. Added benefits and simplicity of a treatment and the extra outlay of additional monitoring, if necessary, must be weighed when considering the sumptuousness equation. Simplicity of treatment may be better with a strange drug, in terms of dosage, administration, handling, or side tenors but it may not always counterpoise the cost.

COPYRIGHT 2003 American Academy of Family Physicians

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