Some Medical Letter consultants have suggested that our recent article on dermal fillers (Med Lett Drugs Ther 2007; 49:39) should have included stronger warnings about the risk of fillers that are not biodegradable, such as Artefill. The polymethylmethacrylate (PMMA, the same material that makes up Plexiglas) beads in Artefill can over time, even with the best technique, cause foreignbody granulomas and hypertrophic scarring, which may require surgical removal. Granulomas and nodules have been especially frequent when Artefill was injected into the lips. Complications are less likely with...

Cobicistat, a pharmacokinetic enhancer that boosts levels of some HIV drugs but has no antiretroviral activity of its own, is now available alone as Tybost (Gilead) and in fixed-dose combinations with the protease inhibitors atazanavir (Evotaz — BMS) and darunavir (Prezcobix — Janssen) for treatment of HIV-1 infection. Both atazanavir and darunavir have traditionally been used in combination with the CYP3A inhibitor ritonavir (Norvir) to boost their serum concentrations, but neither is available in a fixed-dose combination with ritonavir.

View the Expanded Table: Some Drugs for Chronic Idiopathic Constipation

The oral Janus kinase (JAK) inhibitor baricitinib (Olumiant – Lilly), which was previously approved by the FDA for treatment of moderately to severely active rheumatoid arthritis and treatment of COVID-19 in certain hospitalized adults, has now been approved for treatment of severe alopecia areata in adults. Baricitinib is the first systemic treatment to be approved in the US for this indication.

Men with primary or secondary hypogonadism require lifelong androgen replacement to prevent osteoporosis and maintain normal muscle mass, erythropoiesis and sexual function (AM Matsumoto, Endocrinol Metab Clin North Am, 23:857, 1994). Until recently, the standard treatment for male hypogonadism has been an intramuscular injection of a long-acting testosterone ester every two to three weeks, which leads to serum testosterone concentrations that are high for a few days, normal for a few days more, and then may be subnormal until the next dose. Two transdermal preparations of testosterone...

The FDA has approved pegvisomant (Somavert Pfizer), a growth hormone receptor antagonist, for parenteral treatment of acromegaly in patients who are not candidates for or have had an inadequate response to surgery or other treatment. This review describes the disease of acromegaly and its standard treatment options. Also included are sections on the mechanism of action, pharmacokinetics, adverse effects, drug interactions, and the dosage and cost of pegvisomant. Results of clinical studies are discussed. The conclusion provides an overall assessment of the prospects for this new drug.

Bexxar, a combination of the monoclonal antibody tositumomab and radiolabeled Iodine-131 tositumomab (Corixa Corp/GlaxoSmithKline) has been approved by the FDA for a single treatment of relapsed follicular non-Hodgkin's lymphoma (NHL) in patients who are refractory to rituximab (Rituxan - Medical Letter 1998; 40:65). It is the second radioimmunoconjugate to be approved for refractory NHL; yttrium-90 linked to ibritumomab tiuxetan (Zevalin) was approved in 2002. Tositumomab, like ibritumomab, is a monoclonal antibody of mouse origin that binds to the CD20 antigen present on the surface of >90%...

The FDA has approved pegaptanib sodium (Macugen - Pfizer/Eyetech) as an intravitreous injection for treatment of all subtypes of neovascular (wet) age-related macular degeneration (AMD). The only other approved treatment for this condition is photodynamic therapy with intravenous verteporfin (Visudyne), which is recommended only for patients with one subtype (predominantly classic) of neovascular AMD.

Femcon Fe (Warner Chilcott) is being advertised as the world's only chewable oral contraceptive. It was formerly marketed as Ovcon 35 Fe. Each packet provides 21 tablets containing 0.4 mg norethindrone and 35 mcg ethinyl estradiol, and 7 tablets with only 75 mg of ferrous fumarate. Femcon Fe has the same active hormonal ingredients as Ovcon 35 (Warner Chilcott), which has been available since 1976, and its generic equivalent Balziva (Barr); neither formulation contains iron. The spearmint-flavored Femcon Fe pill can be chewed or swallowed whole. According to the package labeling, if the pill...

Some patients with primary immune deficiency are injected with intravenous immune globulin (IVIG) every 3-4 weeks. Now a subcutaneous immune globulin (SCIG) has also been approved in the US for this indication (Vivaglobin - CSL Behring). SCIG has been used in Europe for about 10 years.