Matching articles for "corticosteroids"
Givinostat (Duvyzat) for Duchenne Muscular Dystrophy
The Medical Letter on Drugs and Therapeutics • December 23, 2024; (Issue 1718)
Givinostat (Duvyzat – Italfarmaco), an oral histone
deacetylase inhibitor, has been approved by the FDA
for treatment of patients ≥6 years old with Duchenne
muscular dystrophy (DMD), regardless of the...
Givinostat (Duvyzat – Italfarmaco), an oral histone
deacetylase inhibitor, has been approved by the FDA
for treatment of patients ≥6 years old with Duchenne
muscular dystrophy (DMD), regardless of the DMD-causing
mutation. It is the first nonsteroidal drug to be
approved for this indication. The oral corticosteroids
deflazacort (Emflaza) and vamorolone (Agamree)
are also approved for treatment of patients with all
genetic variants of DMD.
Drugs for Asthma
The Medical Letter on Drugs and Therapeutics • November 25, 2024; (Issue 1716)
The goal of asthma treatment is to control symptoms,
prevent exacerbations, and maintain normal lung
function. Management of acute exacerbations in the
emergency department is not discussed...
The goal of asthma treatment is to control symptoms,
prevent exacerbations, and maintain normal lung
function. Management of acute exacerbations in the
emergency department is not discussed here.
Axatilimab (Niktimvo) for Chronic Graft-Versus-Host Disease (online only)
The Medical Letter on Drugs and Therapeutics • November 11, 2024; (Issue 1715)
Axatilimab-csfr (Niktimvo – Incyte), a colony
stimulating factor-1 receptor-blocking antibody, has
been approved by the FDA for intravenous treatment
of chronic graft-versus-host disease (cGVHD)...
Axatilimab-csfr (Niktimvo – Incyte), a colony
stimulating factor-1 receptor-blocking antibody, has
been approved by the FDA for intravenous treatment
of chronic graft-versus-host disease (cGVHD) after
failure of at least 2 lines of systemic therapy in patients
weighing ≥40 kg. Corticosteroids are generally the
first-line treatment for cGVHD. The oral kinase
inhibitors ibrutinib (Imbruvica), ruxolitinib (Jakafi),
and belumosudil (Rezurock) are also approved for
treatment of cGVHD. Extracorporeal photopheresis
has been used off-label.
Risankizumab (Skyrizi) for Ulcerative Colitis
The Medical Letter on Drugs and Therapeutics • November 11, 2024; (Issue 1715)
The injectable interleukin (IL)-23 antagonist
risankizumab-rzza (Skyrizi – Abbvie), previously
approved by the FDA for treatment of Crohn's disease
(CD), has now been approved for treatment of
moderately...
The injectable interleukin (IL)-23 antagonist
risankizumab-rzza (Skyrizi – Abbvie), previously
approved by the FDA for treatment of Crohn's disease
(CD), has now been approved for treatment of
moderately to severely active ulcerative colitis (UC)
in adults. Risankizumab is the first IL-23 antagonist
to be approved for treatment of both CD and UC. It is
also approved for treatment of plaque psoriasis and
psoriatic arthritis.
Drugs for Plaque Psoriasis
The Medical Letter on Drugs and Therapeutics • September 30, 2024; (Issue 1712)
Mild to moderate plaque psoriasis can be treated
with topical drugs and phototherapy. Patients
with moderate to severe disease generally require
systemic therapy. Guidelines for the treatment of
psoriasis...
Mild to moderate plaque psoriasis can be treated
with topical drugs and phototherapy. Patients
with moderate to severe disease generally require
systemic therapy. Guidelines for the treatment of
psoriasis with topical therapy, phototherapy, and
systemic drugs have recently been published.
Roflumilast Cream (Zoryve) for Atopic Dermatitis
The Medical Letter on Drugs and Therapeutics • September 16, 2024; (Issue 1711)
The FDA has approved a 0.15% cream formulation
of the phosphodiesterase-4 (PDE4) inhibitor
roflumilast (Zoryve – Arcutis) for topical treatment of
mild to moderate atopic dermatitis (AD) in patients
≥6...
The FDA has approved a 0.15% cream formulation
of the phosphodiesterase-4 (PDE4) inhibitor
roflumilast (Zoryve – Arcutis) for topical treatment of
mild to moderate atopic dermatitis (AD) in patients
≥6 years old. Roflumilast is the second PDE4 inhibitor
to be approved in the US for treatment of AD;
crisaborole (Eucrisa), which can be used in patients
≥3 months old, was the first. Roflumilast is available
as Zoryve in a 0.3% cream for treatment of plaque
psoriasis and a 0.3% foam for treatment of seborrheic
dermatitis. It is also available in an oral formulation
(Daliresp) for treatment of chronic obstructive
pulmonary disease.
Sarilumab (Kevzara) for Polymyalgia Rheumatica
The Medical Letter on Drugs and Therapeutics • May 13, 2024; (Issue 1702)
The FDA has approved the interleukin (IL)-6 inhibitor
sarilumab (Kevzara – Sanofi/Regeneron) for treatment
of polymyalgia rheumatica (PMR) in adults who
had an inadequate response to corticosteroids...
The FDA has approved the interleukin (IL)-6 inhibitor
sarilumab (Kevzara – Sanofi/Regeneron) for treatment
of polymyalgia rheumatica (PMR) in adults who
had an inadequate response to corticosteroids or
cannot tolerate a corticosteroid taper. Sarilumab is
the first biologic drug to be approved for treatment
of PMR; it was previously approved for treatment of
rheumatoid arthritis.
Roflumilast Foam (Zoryve) for Seborrheic Dermatitis
The Medical Letter on Drugs and Therapeutics • April 15, 2024; (Issue 1700)
The FDA has approved a 0.3% foam formulation of
the phosphodiesterase-4 (PDE4) inhibitor roflumilast
(Zoryve – Arcutis) for topical treatment of seborrheic
dermatitis in patients ≥9 years old....
The FDA has approved a 0.3% foam formulation of
the phosphodiesterase-4 (PDE4) inhibitor roflumilast
(Zoryve – Arcutis) for topical treatment of seborrheic
dermatitis in patients ≥9 years old. Roflumilast is
the first PDE4 inhibitor to be approved in the US for
this indication. It is also available in a 0.3% cream
formulation (Zoryve) for treatment of plaque psoriasis
and in an oral formulation (Daliresp, and generics) for
treatment of chronic obstructive pulmonary disease.
A 0.15% cream formulation for treatment of atopic
dermatitis in patients ≥6 years old will be reviewed by
the FDA in July.
Drugs for Gout
The Medical Letter on Drugs and Therapeutics • October 30, 2023; (Issue 1688)
Drugs for gout are used to reduce the pain and
inflammation of acute flares, decrease the frequency
of exacerbations, and lower serum urate levels to
prevent recurrent flares, development of tophi,...
Drugs for gout are used to reduce the pain and
inflammation of acute flares, decrease the frequency
of exacerbations, and lower serum urate levels to
prevent recurrent flares, development of tophi, and
joint damage.
Delandistrogene Moxeparvovec (Elevidys) for Duchenne Muscular Dystrophy
The Medical Letter on Drugs and Therapeutics • October 2, 2023; (Issue 1686)
Delandistrogene moxeparvovec-rokl (Elevidys –
Sarepta), an adeno-associated virus (AAV) vector-based
gene therapy, has received accelerated
approval from the FDA for treatment of ambulatory
children 4-5...
Delandistrogene moxeparvovec-rokl (Elevidys –
Sarepta), an adeno-associated virus (AAV) vector-based
gene therapy, has received accelerated
approval from the FDA for treatment of ambulatory
children 4-5 years old with Duchenne muscular
dystrophy (DMD) who have a confirmed mutation in
the dystrophin gene. It is the first gene therapy to be
approved in the US for treatment of DMD. Accelerated
approval was based on expression of microdystrophin
in skeletal muscle, a surrogate endpoint.
In Brief: Tafasitamab (Monjuvi) for Diffuse Large B-Cell Lymphoma (online only)
The Medical Letter on Drugs and Therapeutics • August 7, 2023; (Issue 1682)
Tafasitamab-cxix (Monjuvi – Morphosys), a CD19-directed cytolytic antibody, has received accelerated
approval from the FDA for use in combination with
lenalidomide (Revlimid) for treatment of relapsed...
Tafasitamab-cxix (Monjuvi – Morphosys), a CD19-directed cytolytic antibody, has received accelerated
approval from the FDA for use in combination with
lenalidomide (Revlimid) for treatment of relapsed or
refractory diffuse large B-cell lymphoma (DLBCL),
not otherwise specified, including DLBCL arising from
low grade lymphoma, in adults who are not eligible
for autologous stem cell transplant. Accelerated
approval was based on overall response rates.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • July 10, 2023; (Issue 1680)
Ulcerative colitis (UC) and Crohn's disease (CD),
referred to collectively as inflammatory bowel disease
(IBD), are chronic immune-mediated inflammatory
conditions. Guidelines for treatment of UC and...
Ulcerative colitis (UC) and Crohn's disease (CD),
referred to collectively as inflammatory bowel disease
(IBD), are chronic immune-mediated inflammatory
conditions. Guidelines for treatment of UC and CD
have been updated in recent years
Expanded Table: Some Drugs for Inflammatory Bowel Disease (online only)
The Medical Letter on Drugs and Therapeutics • July 10, 2023; (Issue 1680)
...
View the Table: Some Drugs for Inflammatory Bowel Disease
Table: Safety of Drugs for IBD in Pregnancy (online only)
The Medical Letter on Drugs and Therapeutics • July 10, 2023; (Issue 1680)
...
View the Table: Safety of Drugs for IBD in Pregnancy
Three Drugs for Atopic Dermatitis (Adbry, Cibinqo, and Rinvoq)
The Medical Letter on Drugs and Therapeutics • April 3, 2023; (Issue 1673)
The subcutaneously injected interleukin-13 (IL-13)
antagonist tralokinumab-ldrm (Adbry – Leo) and
the oral Janus kinase (JAK) inhibitors abrocitinib
(Cibinqo – Pfizer) and upadacitinib (Rinvoq –...
The subcutaneously injected interleukin-13 (IL-13)
antagonist tralokinumab-ldrm (Adbry – Leo) and
the oral Janus kinase (JAK) inhibitors abrocitinib
(Cibinqo – Pfizer) and upadacitinib (Rinvoq – Abbvie)
have been approved by the FDA for treatment of
moderate to severe atopic dermatitis.
Olopatadine/Mometasone (Ryaltris) for Allergic Rhinitis
The Medical Letter on Drugs and Therapeutics • January 23, 2023; (Issue 1668)
The FDA has approved Ryaltris (Hikma), a fixed-dose
combination nasal spray containing the H1-antihistamine olopatadine hydrochloride (Patanase,
and generics) and the corticosteroid mometasone
furoate...
The FDA has approved Ryaltris (Hikma), a fixed-dose
combination nasal spray containing the H1-antihistamine olopatadine hydrochloride (Patanase,
and generics) and the corticosteroid mometasone
furoate (Nasonex 24 HR Allergy, and generics), for
treatment of seasonal allergic rhinitis symptoms
in persons ≥12 years old. Ryaltris is the second
intranasal antihistamine/corticosteroid combination
to be approved for this indication; azelastine 0.1%/fluticasone propionate (Dymista, and generics), which
is approved for use in persons ≥6 years old, was the
first. Both products are available only by prescription.
Topical Roflumilast (Zoryve) for Plaque Psoriasis
The Medical Letter on Drugs and Therapeutics • January 23, 2023; (Issue 1668)
The FDA has approved a 0.3% cream formulation of
the phosphodiesterase-4 (PDE4) inhibitor roflumilast
(Zoryve – Arcutis) for topical treatment of plaque
psoriasis in patients ≥12 years old. Roflumilast...
The FDA has approved a 0.3% cream formulation of
the phosphodiesterase-4 (PDE4) inhibitor roflumilast
(Zoryve – Arcutis) for topical treatment of plaque
psoriasis in patients ≥12 years old. Roflumilast is
the first topical PDE4 inhibitor to be approved by the
FDA for this indication; crisaborole (Eucrisa), another
topical PDE4 inhibitor, is approved for treatment
of atopic dermatitis. Oral roflumilast (Daliresp)
is approved for treatment of chronic obstructive
pulmonary disease.
Risankizumab (Skyrizi) - An IL-23 Antagonist for Crohn's Disease
The Medical Letter on Drugs and Therapeutics • December 26, 2022; (Issue 1666)
The injectable interleukin (IL)-23 antagonist
risankizumab-rzaa (Skyrizi – Abbvie) has been
approved by the FDA for treatment of moderately
to severely active Crohn's disease (CD) in adults.
Risankizumab...
The injectable interleukin (IL)-23 antagonist
risankizumab-rzaa (Skyrizi – Abbvie) has been
approved by the FDA for treatment of moderately
to severely active Crohn's disease (CD) in adults.
Risankizumab was approved earlier for treatment of
plaque psoriasis and psoriatic arthritis.
An EUA for Anakinra (Kineret) for COVID-19 (online only)
The Medical Letter on Drugs and Therapeutics • December 12, 2022; (Issue 1665)
The recombinant interleukin-1 (IL-1) receptor
antagonist anakinra (Kineret – Sobi) has been
granted an FDA Emergency Use Authorization
(EUA) for treatment of hospitalized adults with
confirmed COVID-19...
The recombinant interleukin-1 (IL-1) receptor
antagonist anakinra (Kineret – Sobi) has been
granted an FDA Emergency Use Authorization
(EUA) for treatment of hospitalized adults with
confirmed COVID-19 pneumonia who require low- or
high-flow supplemental oxygen, are at risk of
progressing to severe respiratory failure, and are
likely to have elevated plasma levels of soluble
urokinase plasminogen activator receptor (suPAR).
Anakinra has been available in the US for years; it
is FDA-approved for multiple indications, including
rheumatoid arthritis. Assays for suPAR are not
commercially available in the US.
Ruxolitinib Cream (Opzelura) for Nonsegmental Vitiligo
The Medical Letter on Drugs and Therapeutics • October 3, 2022; (Issue 1660)
The 1.5% cream formulation of the Janus kinase
(JAK) inhibitor ruxolitinib (Opzelura – Incyte) has
been approved by the FDA for topical treatment of
nonsegmental vitiligo (NSV) in patients ≥12 years...
The 1.5% cream formulation of the Janus kinase
(JAK) inhibitor ruxolitinib (Opzelura – Incyte) has
been approved by the FDA for topical treatment of
nonsegmental vitiligo (NSV) in patients ≥12 years old.
Opzelura is the first product to be approved by the
FDA for this indication. It was previously approved for
treatment of atopic dermatitis.
Baricitinib (Olumiant) for Severe Alopecia Areata
The Medical Letter on Drugs and Therapeutics • September 5, 2022; (Issue 1658)
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...
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.
Upadacitinib (Rinvoq): A Second JAK Inhibitor for Ulcerative Colitis
The Medical Letter on Drugs and Therapeutics • September 5, 2022; (Issue 1658)
The FDA has approved the oral Janus kinase (JAK)
inhibitor upadacitinib (Rinvoq – Abbvie) for treatment
of moderately to severely active ulcerative colitis in
adults who have had an inadequate response to...
The FDA has approved the oral Janus kinase (JAK)
inhibitor upadacitinib (Rinvoq – Abbvie) for treatment
of moderately to severely active ulcerative colitis in
adults who have had an inadequate response to or
cannot tolerate one or more tumor necrosis factor
(TNF) inhibitors. Upadacitinib is the second JAK
inhibitor to be approved for this indication; tofacitinib
(Xeljanz) was the first. Upadacitinib is also approved
for treatment of rheumatoid arthritis, psoriatic
arthritis, atopic dermatitis, and ankylosing spondylitis.
Delayed-Release Budesonide (Tarpeyo) for Primary Immunoglobulin A Nephropathy
The Medical Letter on Drugs and Therapeutics • May 16, 2022; (Issue 1650)
The FDA has approved Tarpeyo (Calliditas), a delayed-release
capsule formulation of the corticosteroid
budesonide, to reduce proteinuria in adults with
primary immunoglobulin A nephropathy (IgAN;...
The FDA has approved Tarpeyo (Calliditas), a delayed-release
capsule formulation of the corticosteroid
budesonide, to reduce proteinuria in adults with
primary immunoglobulin A nephropathy (IgAN; also
called Berger's disease) who are at risk of rapid
disease progression. It is the fi rst drug to be approved
in the US for this indication. Oral formulations
of budesonide have been available for years for
treatment of inflammatory bowel disease.
A Drug-Eluting Contact Lens for Allergic Conjunctivitis
The Medical Letter on Drugs and Therapeutics • April 18, 2022; (Issue 1648)
The FDA has approved Acuvue Theravision with
Ketotifen (Johnson & Johnson Vision Care), a daily-wear,
disposable, vision-correcting soft contact
lens that releases the H1-antihistamine ketotifen,...
The FDA has approved Acuvue Theravision with
Ketotifen (Johnson & Johnson Vision Care), a daily-wear,
disposable, vision-correcting soft contact
lens that releases the H1-antihistamine ketotifen, for
prevention of ocular itch due to allergic conjunctivitis
in contact lens users. This is the first approval for a
drug-eluting contact lens. Ketotifen eye drops (Alaway,
Zaditor, and others) are available over the counter.
Efgartigimod alfa (Vyvgart) for Myasthenia Gravis
The Medical Letter on Drugs and Therapeutics • April 18, 2022; (Issue 1648)
Efgartigimod alfa-fcab (Vyvgart – Argenx), a first-in-class neonatal Fc receptor (FcRn) antagonist,
has been approved by the FDA for IV treatment of
generalized myasthenia gravis in adults who...
Efgartigimod alfa-fcab (Vyvgart – Argenx), a first-in-class neonatal Fc receptor (FcRn) antagonist,
has been approved by the FDA for IV treatment of
generalized myasthenia gravis in adults who are
anti-acetylcholine receptor (AChR) antibody positive.
The IV complement inhibitor eculizumab (Soliris) was
approved for the same indication in 2017.
Nonopioid Drugs for Pain
The Medical Letter on Drugs and Therapeutics • March 7, 2022; (Issue 1645)
Nonopioid drugs can be used in the treatment of
many nociceptive and neuropathic pain conditions.
For severe pain, especially severe chronic cancer
pain, use of opioids may be necessary....
Nonopioid drugs can be used in the treatment of
many nociceptive and neuropathic pain conditions.
For severe pain, especially severe chronic cancer
pain, use of opioids may be necessary. Noninvasive
nonpharmacologic treatments, including physical
and psychological therapies, have been shown to
improve pain and function in patients with some
common chronic pain conditions and are unlikely
to cause serious harms. A multimodal approach to
analgesic therapy can increase pain control while
reducing opioid use and adverse effects.
Ruxolitinib (Opzelura) for Atopic Dermatitis
The Medical Letter on Drugs and Therapeutics • January 24, 2022; (Issue 1642)
The FDA has approved a 1.5% topical cream
formulation of the Janus kinase (JAK) inhibitor
ruxolitinib (Opzelura – Incyte) for short-term, non-continuous
chronic treatment of mild to moderate
atopic...
The FDA has approved a 1.5% topical cream
formulation of the Janus kinase (JAK) inhibitor
ruxolitinib (Opzelura – Incyte) for short-term, non-continuous
chronic treatment of mild to moderate
atopic dermatitis (AD) in non-immunocompromised
patients ≥12 years old whose disease has not been
adequately controlled with other topical prescription
drugs. Ruxolitinib is the first JAK inhibitor to be
approved for topical use and the first to be approved
in the US for treatment of AD. An oral formulation
of ruxolitinib (Jakafi) is approved for treatment of
myelofibrosis, polycythemia vera, and graft-versus-host
disease.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • November 15, 2021; (Issue 1637)
Rheumatoid arthritis (RA) is prevalent in 0.5% of
adults in the US; it is about 2.5 times more common
in women than in men. Guidelines for treatment
of RA from the American College of Rheumatology
were...
Rheumatoid arthritis (RA) is prevalent in 0.5% of
adults in the US; it is about 2.5 times more common
in women than in men. Guidelines for treatment
of RA from the American College of Rheumatology
were recently updated. The goal of treatment is to
minimize disease activity and prevent irreversible
joint damage.
Belimumab (Benlysta) for Lupus Nephritis (online only)
The Medical Letter on Drugs and Therapeutics • September 23, 2021; (Issue 1634)
The B-lymphocyte stimulator (BLyS)-specific inhibitor
belimumab (Benlysta – GSK), which was approved
earlier for treatment of active, autoantibody-positive,
nonrenal, systemic lupus erythematosus (SLE),...
The B-lymphocyte stimulator (BLyS)-specific inhibitor
belimumab (Benlysta – GSK), which was approved
earlier for treatment of active, autoantibody-positive,
nonrenal, systemic lupus erythematosus (SLE), has
now been approved for use in addition to standard
therapy for treatment of active lupus nephritis in
adults. Belimumab is the first drug to be approved in
the US for treatment of both SLE and lupus nephritis.
Anifrolumab (Saphnelo) for Systemic Lupus Erythematosus
The Medical Letter on Drugs and Therapeutics • September 20, 2021; (Issue 1633)
The FDA has approved anifrolumab-fnia (Saphnelo – AstraZeneca), a type I interferon receptor antagonist, for IV treatment of adults with moderate to severe systemic lupus erythematosus (SLE) who are receiving...
The FDA has approved anifrolumab-fnia (Saphnelo – AstraZeneca), a type I interferon receptor antagonist, for IV treatment of adults with moderate to severe systemic lupus erythematosus (SLE) who are receiving standard treatment. Anifrolumab has not been studied in patients with severe active lupus nephritis or severe active CNS lupus. It is the first type I interferon receptor antagonist to become available
in the US.
Ozanimod (Zeposia) for Ulcerative Colitis
The Medical Letter on Drugs and Therapeutics • September 20, 2021; (Issue 1633)
The oral sphingosine 1-phosphate (S1P) receptor
modulator ozanimod (Zeposia – Bristol Myers Squibb)
has been approved by the FDA for treatment of adults
with moderately to severely active ulcerative...
The oral sphingosine 1-phosphate (S1P) receptor
modulator ozanimod (Zeposia – Bristol Myers Squibb)
has been approved by the FDA for treatment of adults
with moderately to severely active ulcerative colitis. It
is the first S1P receptor modulator to be approved for
treatment of ulcerative colitis. Ozanimod was approved
in March 2020 for use in adults with relapsing forms of
multiple sclerosis.
Voclosporin (Lupkynis) for Lupus Nephritis
The Medical Letter on Drugs and Therapeutics • August 23, 2021; (Issue 1631)
Voclosporin (Lupkynis – Aurinia), an oral calcineurin
inhibitor, has been approved by the FDA for use
in combination with the antimetabolite immunosuppressant
mycophenolate mofetil (Cellcept,...
Voclosporin (Lupkynis – Aurinia), an oral calcineurin
inhibitor, has been approved by the FDA for use
in combination with the antimetabolite immunosuppressant
mycophenolate mofetil (Cellcept, and
generics) and a corticosteroid for treatment of adults
with active lupus nephritis. It is the first calcineurin
inhibitor to be approved in the US for this indication.
Tacrolimus (Prograf, and others) and cyclosporine
(Neoral, and others), the other available systemic
calcineurin inhibitors, are approved for prophylaxis of
organ rejection in transplant patients.
An EUA for Tocilizumab (Actemra) for COVID-19
The Medical Letter on Drugs and Therapeutics • July 26, 2021; (Issue 1629)
The interleukin-6 (IL-6) receptor antagonist tocilizumab (Actemra – Genentech) has received an
Emergency Use Authorization (EUA) from the FDA for IV treatment of COVID-19 in hospitalized patients ≥2
years...
The interleukin-6 (IL-6) receptor antagonist tocilizumab (Actemra – Genentech) has received an
Emergency Use Authorization (EUA) from the FDA for IV treatment of COVID-19 in hospitalized patients ≥2
years old who are receiving a systemic corticosteroid and require supplemental oxygen, mechanical
ventilation, or extracorporeal membrane oxygenation (ECMO). Tocilizumab has been approved by the FDA
for various indications, including rheumatoid arthritis and juvenile idiopathic arthritis.
Teprotumumab (Tepezza) for Thyroid Eye Disease
The Medical Letter on Drugs and Therapeutics • May 31, 2021; (Issue 1625)
Teprotumumab-trbw (Tepezza - Horizon), an insulin-like
growth factor-1 receptor (IGF-1R) inhibitor, has
been approved by the FDA for IV treatment of thyroid
eye disease. It is the first drug to be approved...
Teprotumumab-trbw (Tepezza - Horizon), an insulin-like
growth factor-1 receptor (IGF-1R) inhibitor, has
been approved by the FDA for IV treatment of thyroid
eye disease. It is the first drug to be approved in the US
for this indication.
Drugs for Allergic Rhinitis and Allergic Conjunctivitis
The Medical Letter on Drugs and Therapeutics • April 19, 2021; (Issue 1622)
The choice of drugs for treatment of allergic rhinitis
depends on the severity of symptoms and whether
they are intermittent or persistent (see Table...
The choice of drugs for treatment of allergic rhinitis
depends on the severity of symptoms and whether
they are intermittent or persistent (see Table 1).
Drugs for Atopic Dermatitis
The Medical Letter on Drugs and Therapeutics • June 15, 2020; (Issue 1600)
Atopic dermatitis (AD; also known as eczema) is
frequently associated with other atopic disorders
such as allergic rhinitis, asthma, and food allergy. It
commonly presents in infancy and early childhood
and...
Atopic dermatitis (AD; also known as eczema) is
frequently associated with other atopic disorders
such as allergic rhinitis, asthma, and food allergy. It
commonly presents in infancy and early childhood
and has a relapsing course, often improving by
adolescence, but sometimes persisting into (or first
appearing in) adulthood or even old age.
Cetirizine Ophthalmic Solution (Zerviate) for Allergic Conjunctivitis
The Medical Letter on Drugs and Therapeutics • June 1, 2020; (Issue 1599)
A 0.24% ophthalmic solution of the second-generation
H1-antihistamine cetirizine (Zerviate – Eyevance) is now
available by prescription for treatment of ocular itching
associated with allergic...
A 0.24% ophthalmic solution of the second-generation
H1-antihistamine cetirizine (Zerviate – Eyevance) is now
available by prescription for treatment of ocular itching
associated with allergic conjunctivitis in patients ≥2
years old. Oral cetirizine (Zyrtec, and others), which is
used for treatment of allergic conjunctivitis and rhinitis,
has been available over the counter (OTC) for years.
In Brief: Neuropsychiatric Events with Montelukast
The Medical Letter on Drugs and Therapeutics • May 4, 2020; (Issue 1597)
The FDA is requiring stronger warnings in the labeling of
the leukotriene receptor antagonist montelukast (Singulair,
and generics) about the risk of suicidal behavior and other
serious neuropsychiatric...
The FDA is requiring stronger warnings in the labeling of
the leukotriene receptor antagonist montelukast (Singulair,
and generics) about the risk of suicidal behavior and other
serious neuropsychiatric events associated with its use.
Drugs for Osteoarthritis
The Medical Letter on Drugs and Therapeutics • April 20, 2020; (Issue 1596)
Many different drugs are used for treatment of
osteoarthritis pain, but none of them prevent
progression of the disease. Nonpharmacologic
approaches including weight management, exercise,
tai chi, physical...
Many different drugs are used for treatment of
osteoarthritis pain, but none of them prevent
progression of the disease. Nonpharmacologic
approaches including weight management, exercise,
tai chi, physical therapy, assistive devices, and total
joint arthroplasty can also be used. The American
College of Rheumatology (ACR) has published new
guidelines for the management of osteoarthritis of the
hip, hand, and knee.
Some Drugs for COVID-19
The Medical Letter on Drugs and Therapeutics • April 6, 2020; (Issue 1595)
The severity and rapid spread of COVID-19 (caused by SARS-CoV-2) have raised questions about the use of some drugs in patients with the disease and whether currently available drugs could be effective in...
The severity and rapid spread of COVID-19 (caused by SARS-CoV-2) have raised questions about the use of some drugs in patients with the disease and whether currently available drugs could be effective in treating it. Definitive answers are lacking, but some recommendations can be made. For additional information on specific drugs, see our table Some Drugs Being Considered for Treatment of COVID-19.
Table: Treatments Considered for COVID-19 (Archived) (online only)
The Medical Letter on Drugs and Therapeutics • April 6, 2020; (Issue 1595)
...
View the Table: Treatments Considered for COVID-19
Some Drugs for COVID-19
The Medical Letter on Drugs and Therapeutics • April 6, 2020; (Issue 1919)
The severity and rapid spread of COVID-19 (caused by SARS-CoV-2) have raised questions about the use of some drugs in patients with the disease and whether currently available drugs could be effective in...
The severity and rapid spread of COVID-19 (caused by SARS-CoV-2) have raised questions about the use of some drugs in patients with the disease and whether currently available drugs could be effective in treating it. Definitive answers are lacking, but some recommendations can be made. For additional information on specific drugs, see our table Some Drugs Being Considered for Treatment of COVID-19.
Corticosteroids in Community-Acquired Pneumonia
The Medical Letter on Drugs and Therapeutics • January 13, 2020; (Issue 1589)
Recently updated guidelines from the American
Thoracic Society (ATS) and the Infectious Diseases
Society of America (IDSA) address the use of
corticosteroids as an adjunct to antimicrobials for
treatment of...
Recently updated guidelines from the American
Thoracic Society (ATS) and the Infectious Diseases
Society of America (IDSA) address the use of
corticosteroids as an adjunct to antimicrobials for
treatment of community-acquired pneumonia (CAP).
Drugs for Psoriatic Arthritis
The Medical Letter on Drugs and Therapeutics • December 30, 2019; (Issue 1588)
Psoriatic arthritis is a chronic inflammatory
arthropathy associated with psoriasis. A recent review
found that about 20% of patients with psoriasis have
psoriatic arthritis. Updated guidelines for...
Psoriatic arthritis is a chronic inflammatory
arthropathy associated with psoriasis. A recent review
found that about 20% of patients with psoriasis have
psoriatic arthritis. Updated guidelines for treatment
of psoriatic arthritis have recently been published.
Risankizumab (Skyrizi) for Psoriasis
The Medical Letter on Drugs and Therapeutics • June 3, 2019; (Issue 1573)
The FDA has approved the interleukin (IL)-23
antagonist risankizumab-rzaa (Skyrizi – Abbvie) for
treatment of moderate to severe plaque psoriasis in
adults. Risankizumab is the third IL-23 antagonist...
The FDA has approved the interleukin (IL)-23
antagonist risankizumab-rzaa (Skyrizi – Abbvie) for
treatment of moderate to severe plaque psoriasis in
adults. Risankizumab is the third IL-23 antagonist to
be approved for this indication; guselkumab (Tremfya)
and tildrakizumab (Ilumya) were approved earlier.
Drugs for Gout
The Medical Letter on Drugs and Therapeutics • March 11, 2019; (Issue 1567)
Drugs for gout reduce the pain and inflammation of
acute flares and lower serum urate levels in order to
prevent recurrent flares, development of tophi, and
joint...
Drugs for gout reduce the pain and inflammation of
acute flares and lower serum urate levels in order to
prevent recurrent flares, development of tophi, and
joint damage.
Tildrakizumab (Ilumya) - Another IL-23 Antagonist for Psoriasis
The Medical Letter on Drugs and Therapeutics • January 14, 2019; (Issue 1563)
Tildrakizumab-asmn (Ilumya – Sun), an interleukin
(IL)-23 antagonist, has been approved by the FDA for
treatment of adults with moderate to severe plaque
psoriasis who are candidates for systemic therapy...
Tildrakizumab-asmn (Ilumya – Sun), an interleukin
(IL)-23 antagonist, has been approved by the FDA for
treatment of adults with moderate to severe plaque
psoriasis who are candidates for systemic therapy or
phototherapy. Tildrakizumab is the second selective
IL-23 antagonist to be approved for this indication;
guselkumab (Tremfya) was the first.
Dupilumab (Dupixent) for Asthma
The Medical Letter on Drugs and Therapeutics • January 14, 2019; (Issue 1563)
The FDA has approved the subcutaneously injected
monoclonal antibody dupilumab (Dupixent – Sanofi/Regeneron) for add-on maintenance treatment of
patients ≥12 years old with moderate to severe
asthma...
The FDA has approved the subcutaneously injected
monoclonal antibody dupilumab (Dupixent – Sanofi/Regeneron) for add-on maintenance treatment of
patients ≥12 years old with moderate to severe
asthma with an eosinophilic phenotype or with oral
corticosteroid-dependent asthma. Dupilumab was
approved earlier to treat adults with moderate to
severe atopic dermatitis inadequately controlled with
topical therapies.
Drugs for Cough
The Medical Letter on Drugs and Therapeutics • December 17, 2018; (Issue 1562)
Acute cough (<3 weeks in duration) generally does
not require pharmacologic treatment, especially in
children. Suppression of productive cough may be
harmful. Management of patients with cough...
Acute cough (<3 weeks in duration) generally does
not require pharmacologic treatment, especially in
children. Suppression of productive cough may be
harmful. Management of patients with cough should
include elimination of any precipitating factor (e.g.,
cigarette smoking) and treatment of any underlying
cause such as upper airway cough syndrome,
gastroesophageal reflux disease, asthma, or other
pulmonary disease.
Two New Intra-Articular Injections for Knee Osteoarthritis
The Medical Letter on Drugs and Therapeutics • August 27, 2018; (Issue 1554)
The FDA has approved a single-injection hyaluronic
acid gel (Durolane – Bioventus) and an extended-release
(ER) formulation of the synthetic corticosteroid
triamcinolone acetonide (Zilretta – Flexion)...
The FDA has approved a single-injection hyaluronic
acid gel (Durolane – Bioventus) and an extended-release
(ER) formulation of the synthetic corticosteroid
triamcinolone acetonide (Zilretta – Flexion) for intra-articular
(IA) treatment of osteoarthritic knee pain.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • July 30, 2018; (Issue 1552)
Disease-modifying antirheumatic drugs (DMARDs)
are used for initial treatment of rheumatoid arthritis
(RA) to achieve clinical remission and prevent
irreversible joint damage (see Table 1). DMARDs
generally...
Disease-modifying antirheumatic drugs (DMARDs)
are used for initial treatment of rheumatoid arthritis
(RA) to achieve clinical remission and prevent
irreversible joint damage (see Table 1). DMARDs
generally do not have an immediate analgesic effect,
but over time they can control symptoms and have
been shown to delay and possibly stop progression
of the disease. Methotrexate (Trexall, and others)
is generally the drug of choice; it can be used for
patients with low, moderate, or high disease activity.
For mild disease, some clinicians prefer to start with
hydroxychloroquine (Plaquenil, and generics) and/or
sulfasalazine (Azulfidine, and others).
Baricitinib (Olumiant) for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • July 16, 2018; (Issue 1551)
The FDA has approved the Janus kinase (JAK) inhibitor
baricitinib (Olumiant – Lilly) for oral treatment of adults
with moderately to severely active rheumatoid arthritis
(RA) that has not responded...
The FDA has approved the Janus kinase (JAK) inhibitor
baricitinib (Olumiant – Lilly) for oral treatment of adults
with moderately to severely active rheumatoid arthritis
(RA) that has not responded adequately to one or more
tumor necrosis factor (TNF) inhibitors. Baricitinib is
the second JAK inhibitor to be approved for treatment
of RA; tofacitinib (Xeljanz, Xeljanz XR) was the first.
Axicabtagene Ciloleucel (Yescarta) for B-Cell Lymphoma (online only)
The Medical Letter on Drugs and Therapeutics • July 16, 2018; (Issue 1551)
The FDA has approved axicabtagene ciloleucel
(Yescarta – Kite) for treatment of adults with relapsed
or refractory CD19+ large B-cell lymphoma after ≥2
lines of systemic therapy. Yescarta is an...
The FDA has approved axicabtagene ciloleucel
(Yescarta – Kite) for treatment of adults with relapsed
or refractory CD19+ large B-cell lymphoma after ≥2
lines of systemic therapy. Yescarta is an individualized
cellular product prepared from the patient's own T cells,
which are genetically modified to express chimeric
antigen receptors (CAR) and then infused back into
the patient. It is the second CAR T-cell immunotherapy
to become available in the US. Tisagenlecleucel
(Kymriah), a CAR T-cell product previously approved
for treatment of relapsed or refractory B-cell precursor
acute lymphoblastic leukemia (ALL) in patients ≤25
years old, was recently also approved for relapsed or
refractory CD19+ large B-cell lymphoma after ≥2 lines
of systemic therapy.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • July 2, 2018; (Issue 1550)
Management of both ulcerative colitis (UC) and Crohn's
disease (CD) is based on disease severity. Disease
location (proctitis, left-sided colitis, or extensive
colitis) also plays a role in drug selection....
Management of both ulcerative colitis (UC) and Crohn's
disease (CD) is based on disease severity. Disease
location (proctitis, left-sided colitis, or extensive
colitis) also plays a role in drug selection. Some
drugs for induction and maintenance of remission of
inflammatory bowel disease (IBD) are listed in Table 1.
Expanded Table: Some Drugs for Inflammatory Bowel Disease (online only)
The Medical Letter on Drugs and Therapeutics • July 2, 2018; (Issue 1550)
...
View Expanded Table: Some Drugs for Inflammatory Bowel Disease
Table: Drugs for Ulcerative Colitis (online only)
The Medical Letter on Drugs and Therapeutics • July 2, 2018; (Issue 1550)
...
View Table: Drugs for Ulcerative Colitis
Table: Drugs for Crohn's Disease (online only)
The Medical Letter on Drugs and Therapeutics • July 2, 2018; (Issue 1550)
...
View Table: Drugs for Crohn's Disease
Table: Safety of Drugs for IBD in Pregnancy (online only)
The Medical Letter on Drugs and Therapeutics • July 2, 2018; (Issue 1550)
...
View Table: Safety of Drugs for IBD in Pregnancy
Benralizumab (Fasenra) for Severe Eosinophilic Asthma
The Medical Letter on Drugs and Therapeutics • February 26, 2018; (Issue 1541)
The FDA has approved benralizumab (Fasenra –
AstraZeneca), a humanized monoclonal antibody
selective for the interleukin-5 (IL-5) receptor, for
add-on maintenance treatment of severe asthma in
patients...
The FDA has approved benralizumab (Fasenra –
AstraZeneca), a humanized monoclonal antibody
selective for the interleukin-5 (IL-5) receptor, for
add-on maintenance treatment of severe asthma in
patients ≥12 years old with an eosinophilic phenotype.
Benralizumab is the third anti-IL-5 antibody to be
approved for treatment of severe eosinophilic asthma;
mepolizumab (Nucala) and reslizumab (Cinqair), which
target IL-5 itself, were approved earlier.
Nonopioid Drugs for Pain
The Medical Letter on Drugs and Therapeutics • February 12, 2018; (Issue 1540)
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future...
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future issue.
Tocilizumab (Actemra) for Giant Cell Arteritis
The Medical Letter on Drugs and Therapeutics • September 25, 2017; (Issue 1530)
The FDA has approved the interleukin-6 (IL-6) receptor
antagonist tocilizumab (Actemra – Genentech) for
subcutaneous (SC) treatment of giant cell arteritis
in adults. It is the first drug to be approved in...
The FDA has approved the interleukin-6 (IL-6) receptor
antagonist tocilizumab (Actemra – Genentech) for
subcutaneous (SC) treatment of giant cell arteritis
in adults. It is the first drug to be approved in the US
for this indication. Tocilizumab is also approved for
treatment of rheumatoid arthritis, polyarticular or
systemic juvenile idiopathic arthritis, and cytokine
release syndrome.
Drugs for Asthma
The Medical Letter on Drugs and Therapeutics • August 28, 2017; (Issue 1528)
The goal of asthma treatment is to control symptoms
and prevent exacerbations. Management of acute
exacerbations of asthma is not discussed...
The goal of asthma treatment is to control symptoms
and prevent exacerbations. Management of acute
exacerbations of asthma is not discussed here.
Brodalumab (Siliq) - Another IL-17A Antagonist for Psoriasis
The Medical Letter on Drugs and Therapeutics • July 17, 2017; (Issue 1525)
The FDA has approved brodalumab (Siliq – Valeant),
an injectable human interleukin (IL)-17A receptor
antagonist, for treatment of adults with moderate to
severe plaque psoriasis who have failed to...
The FDA has approved brodalumab (Siliq – Valeant),
an injectable human interleukin (IL)-17A receptor
antagonist, for treatment of adults with moderate to
severe plaque psoriasis who have failed to respond
to other systemic therapies. Brodalumab is the third
IL-17A antagonist to be approved in the US for this
indication; secukinumab (Cosentyx) and ixekizumab
(Taltz) were approved earlier.
Drugs for Allergic Disorders
The Medical Letter on Drugs and Therapeutics • May 8, 2017; (Issue 1520)
Allergic rhinitis can be classified as seasonal,
perennial, or episodic. It is often associated with
allergic conjunctivitis, rhinosinusitis, and asthma. H1-ANTIHISTAMINES — Oral – Oral...
Allergic rhinitis can be classified as seasonal,
perennial, or episodic. It is often associated with
allergic conjunctivitis, rhinosinusitis, and asthma.
H1-ANTIHISTAMINES — Oral – Oral second-generation H1-antihistamines are the preferred first-line treatment for relief of the itching, sneezing, and rhinorrhea that characterize mild-to-moderate allergic rhinitis. They are less effective for nasal congestion.
H1-ANTIHISTAMINES — Oral – Oral second-generation H1-antihistamines are the preferred first-line treatment for relief of the itching, sneezing, and rhinorrhea that characterize mild-to-moderate allergic rhinitis. They are less effective for nasal congestion.
Dupilumab (Dupixent) for Moderate to Severe Atopic Dermatitis
The Medical Letter on Drugs and Therapeutics • April 24, 2017; (Issue 1519)
The FDA has approved dupilumab (Dupixent – Sanofi/Regeneron), a subcutaneously-injected fully human
monoclonal antibody, for treatment of adults with
moderate to severe atopic dermatitis (eczema) that
has...
The FDA has approved dupilumab (Dupixent – Sanofi/Regeneron), a subcutaneously-injected fully human
monoclonal antibody, for treatment of adults with
moderate to severe atopic dermatitis (eczema) that
has not responded to topical therapies. It can be used
with or without topical corticosteroids.
OTC Fluticasone Furoate Nasal Spray (Flonase Sensimist) for Allergic Rhinitis (online only)
The Medical Letter on Drugs and Therapeutics • April 24, 2017; (Issue 1519)
The nasal spray formulation of the corticosteroid
fluticasone furoate is now available over the
counter (OTC) as Flonase Sensimist Allergy Relief
(GSK) in the same strength as the prescription
product...
The nasal spray formulation of the corticosteroid
fluticasone furoate is now available over the
counter (OTC) as Flonase Sensimist Allergy Relief
(GSK) in the same strength as the prescription
product (Veramyst) for treatment of seasonal or
perennial allergic rhinitis. It is the fourth intranasal
corticosteroid to become available OTC.
Crisaborole (Eucrisa) for Atopic Dermatitis
The Medical Letter on Drugs and Therapeutics • February 27, 2017; (Issue 1515)
The FDA has approved crisaborole 2% ointment
(Eucrisa – Pfizer) for topical treatment of mild to
moderate atopic dermatitis in patients ≥2 years old. It
is the first phosphodiesterase type-4 (PDE4)...
The FDA has approved crisaborole 2% ointment
(Eucrisa – Pfizer) for topical treatment of mild to
moderate atopic dermatitis in patients ≥2 years old. It
is the first phosphodiesterase type-4 (PDE4) inhibitor
to be approved in the US for this indication.
Ustekinumab (Stelara) for Crohn's Disease
The Medical Letter on Drugs and Therapeutics • January 2, 2017; (Issue 1511)
The FDA has approved the human interleukin (IL)-12
and -23 antagonist ustekinumab (Stelara – Janssen
Biotech) for treatment of moderately to severely active
Crohn's disease in adults who were intolerant of...
The FDA has approved the human interleukin (IL)-12
and -23 antagonist ustekinumab (Stelara – Janssen
Biotech) for treatment of moderately to severely active
Crohn's disease in adults who were intolerant of or
whose disease was unresponsive to treatment with immunomodulators
or corticosteroids, or a tumor necrosis
factor (TNF) inhibitor. Ustekinumab was approved earlier
for treatment of psoriasis and psoriatic arthritis.
Ixekizumab (Taltz) - A Second IL-17A Inhibitor for Psoriasis
The Medical Letter on Drugs and Therapeutics • May 9, 2016; (Issue 1494)
The FDA has approved ixekizumab (Taltz – Lilly), an
injectable humanized interleukin (IL)-17A antagonist,
for treatment of adults with moderate to severe plaque
psoriasis who are candidates for systemic...
The FDA has approved ixekizumab (Taltz – Lilly), an
injectable humanized interleukin (IL)-17A antagonist,
for treatment of adults with moderate to severe plaque
psoriasis who are candidates for systemic therapy
or phototherapy. Ixekizumab is the second IL-17A
antagonist to be approved for this indication in the US;
secukinumab (Cosentyx – Novartis) was the first.
Calcipotriene/Betamethasone Foam (Enstilar) for Psoriasis
The Medical Letter on Drugs and Therapeutics • April 11, 2016; (Issue 1492)
The FDA has approved Enstilar (Leo), an aerosol
foam formulation of the synthetic vitamin D3 analog
calcipotriene and the high-potency corticosteroid
betamethasone dipropionate, for topical treatment
of...
The FDA has approved Enstilar (Leo), an aerosol
foam formulation of the synthetic vitamin D3 analog
calcipotriene and the high-potency corticosteroid
betamethasone dipropionate, for topical treatment
of plaque psoriasis in adults. Topical ointment and
suspension formulations of the same combination
have been available for many years.
ColciGel - A Homeopathic Colchicine Gel for Gout
The Medical Letter on Drugs and Therapeutics • January 4, 2016; (Issue 1485)
Homeopathic drugs characteristically consist of very
large dilutions of "proven" substances. Serial dilutions
of 1:10 are designated by the Roman numeral X.
ColciGel (Gensco), a prescription homeopathic
gel...
Homeopathic drugs characteristically consist of very
large dilutions of "proven" substances. Serial dilutions
of 1:10 are designated by the Roman numeral X.
ColciGel (Gensco), a prescription homeopathic
gel containing a 10,000-fold dilution of colchicine
(colchicinum 4X), is now being marketed for topical
treatment and prophylaxis of gout.
Budesonide Rectal Foam (Uceris) for Ulcerative Colitis
The Medical Letter on Drugs and Therapeutics • November 9, 2015; (Issue 1481)
The FDA has approved a rectal foam formulation of
the corticosteroid budesonide (Uceris - Salix/Valeant)
for induction of remission in patients with active mild
to moderate distal ulcerative colitis (UC)...
The FDA has approved a rectal foam formulation of
the corticosteroid budesonide (Uceris - Salix/Valeant)
for induction of remission in patients with active mild
to moderate distal ulcerative colitis (UC) extending
up to 40 cm from the anal verge. Budesonide is also
available as oral extended-release tablets (also
branded as Uceris) for use in patients with UC and as
oral enteric-coated tablets (Entocort EC, and generics)
for treatment of Crohn's disease.
Drugs for Psoriasis
The Medical Letter on Drugs and Therapeutics • June 8, 2015; (Issue 1470)
Mild to moderate psoriasis is generally treated with
topical corticosteroids. Vitamin D analogs and tazarotene
are topical alternatives that can be used in combination
with topical corticosteroids....
Mild to moderate psoriasis is generally treated with
topical corticosteroids. Vitamin D analogs and tazarotene
are topical alternatives that can be used in combination
with topical corticosteroids. Phototherapy and systemic
therapy, including biologic agents, are recommended for
patients with moderate to severe disease.
Drugs for Psoriatic Arthritis (online only)
The Medical Letter on Drugs and Therapeutics • June 8, 2015; (Issue 1470)
Psoriatic arthritis is a chronic inflammatory arthropathy
that develops in up to 40% of patients with
psoriasis. Several guidelines for treatment of psoriatic
arthritis have been...
Psoriatic arthritis is a chronic inflammatory arthropathy
that develops in up to 40% of patients with
psoriasis. Several guidelines for treatment of psoriatic
arthritis have been published.
Fluticasone Furoate (Arnuity Ellipta) for Asthma
The Medical Letter on Drugs and Therapeutics • May 25, 2015; (Issue 1469)
The FDA has approved Arnuity Ellipta (GSK), a single-agent
inhaler containing the corticosteroid fluticasone
furoate, for once-daily maintenance treatment of
asthma in patients ≥12 years old. Fluticasone...
The FDA has approved Arnuity Ellipta (GSK), a single-agent
inhaler containing the corticosteroid fluticasone
furoate, for once-daily maintenance treatment of
asthma in patients ≥12 years old. Fluticasone furoate
is also available in combination with the long-acting
beta2-agonist vilanterol as Breo Ellipta for treatment
of asthma and COPD.
Secukinumab (Cosentyx) for Psoriasis
The Medical Letter on Drugs and Therapeutics • March 30, 2015; (Issue 1465)
Secukinumab (Cosentyx – Novartis), an injectable
human interleukin (IL)-17A antagonist, has been
approved by the FDA for treatment of moderate to
severe plaque psoriasis in adult patients who...
Secukinumab (Cosentyx – Novartis), an injectable
human interleukin (IL)-17A antagonist, has been
approved by the FDA for treatment of moderate to
severe plaque psoriasis in adult patients who are
candidates for systemic therapy or phototherapy.
It is the first IL-17 inhibitor to be approved for any
indication in the US.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • December 22, 2014; (Issue 1458)
For initial treatment of rheumatoid arthritis, most expert clinicians prescribe a disease-modifying antirheumatic drug (DMARD) and add a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid to...
For initial treatment of rheumatoid arthritis, most expert clinicians prescribe a disease-modifying antirheumatic drug (DMARD) and add a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid to control symptoms. Methotrexate is generally the DMARD of choice...
DMARDs
Disease-modifying antirheumatic drugs (DMARDs) are used early in the treatment of rheumatoid arthritis (RA) to achieve clinical remission, prevent irreversible damage to joints, and minimize toxicity associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. DMARDs generally do not have an immediate analgesic effect, but over time can control symptoms and have been shown to delay and possibly stop progression of the disease. Methotrexate (Rheumatrex, and others) is generally the first DMARD prescribed; it can be used to treat mild, moderate, or severe RA. For mild disease, some clinicians prefer to start with hydroxychloroquine (Plaquenil, and generics) and/or sulfasalazine (Azulfidine, and others).
DMARDs
Disease-modifying antirheumatic drugs (DMARDs) are used early in the treatment of rheumatoid arthritis (RA) to achieve clinical remission, prevent irreversible damage to joints, and minimize toxicity associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. DMARDs generally do not have an immediate analgesic effect, but over time can control symptoms and have been shown to delay and possibly stop progression of the disease. Methotrexate (Rheumatrex, and others) is generally the first DMARD prescribed; it can be used to treat mild, moderate, or severe RA. For mild disease, some clinicians prefer to start with hydroxychloroquine (Plaquenil, and generics) and/or sulfasalazine (Azulfidine, and others).
Vedolizumab (Entyvio) for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • September 15, 2014; (Issue 1451)
The FDA has approved vedolizumab (Entyvio - Takeda),
an intravenous integrin receptor antagonist, for treatment
of moderate to severe ulcerative colitis or Crohn's
disease in adults who have not responded...
The FDA has approved vedolizumab (Entyvio - Takeda),
an intravenous integrin receptor antagonist, for treatment
of moderate to severe ulcerative colitis or Crohn's
disease in adults who have not responded to, lost
response to, or cannot tolerate standard treatment.
Natalizumab (Tysabri), another integrin receptor antagonist,
has been available for several years for treatment
of Crohn's disease and multiple sclerosis.
Drugs for Osteoarthritis
The Medical Letter on Drugs and Therapeutics • September 1, 2014; (Issue 1450)
Many different drugs are used for treatment of osteoarthritis
pain, but none of them prevent progression
of the disease. Many nonpharmacologic approaches
are available as well, including weight...
Many different drugs are used for treatment of osteoarthritis
pain, but none of them prevent progression
of the disease. Many nonpharmacologic approaches
are available as well, including weight management,
exercise, physical therapy, assistive devices, and total
joint arthroplasty. New guidelines for the management
of osteoarthritis have recently been published.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • August 4, 2014; (Issue 1448)
Aminosalicylates are effective for induction and maintenance
of remission in mild to moderate ulcerative
colitis. They are not recommended for treatment of
Crohn's disease.
FORMULATIONS — Oral mesalamine...
Aminosalicylates are effective for induction and maintenance
of remission in mild to moderate ulcerative
colitis. They are not recommended for treatment of
Crohn's disease.
FORMULATIONS — Oral mesalamine is rapidly absorbed in the small intestine and most of the drug does not reach the colon. Pentasa releases mesalamine gradually throughout the gastrointestinal tract. Delzicol, Asacol HD, Lialda, and Apriso delay the release of the drug until it reaches the distal ileum and colon. Sulfasalazine (Azulfidine, and generics), balsalazide (Colazal, and others), and olsalazine (Dipentum) are prodrugs; mesalamine is azo-bonded to a second moiety and released in the colon following bacterial cleavage of the bond. Mesalamine is also available as an enema (Rowasa, and generics) and as a rectal suppository (Canasa).
FORMULATIONS — Oral mesalamine is rapidly absorbed in the small intestine and most of the drug does not reach the colon. Pentasa releases mesalamine gradually throughout the gastrointestinal tract. Delzicol, Asacol HD, Lialda, and Apriso delay the release of the drug until it reaches the distal ileum and colon. Sulfasalazine (Azulfidine, and generics), balsalazide (Colazal, and others), and olsalazine (Dipentum) are prodrugs; mesalamine is azo-bonded to a second moiety and released in the colon following bacterial cleavage of the bond. Mesalamine is also available as an enema (Rowasa, and generics) and as a rectal suppository (Canasa).
Golimumab (Simponi) for Ulcerative Colitis
The Medical Letter on Drugs and Therapeutics • March 31, 2014; (Issue 1439)
The FDA has approved golimumab (Simponi – Janssen),
a fully human monoclonal antibody specific for tumor necrosis
factor (TNF) alpha, for induction and maintenance
of remission in patients with moderate to...
The FDA has approved golimumab (Simponi – Janssen),
a fully human monoclonal antibody specific for tumor necrosis
factor (TNF) alpha, for induction and maintenance
of remission in patients with moderate to severe ulcerative
colitis who do not respond to or cannot tolerate other
therapies or who require continuous treatment with corticosteroids.
Golimumab was approved earlier for treatment
of rheumatoid arthritis, psoriatic arthritis, and ankylosing
spondylitis. It is the third TNF inhibitor to be approved for
use in ulcerative colitis.
Drugs for Gout
The Medical Letter on Drugs and Therapeutics • March 17, 2014; (Issue 1438)
The goals of gout treatment are threefold: treating
acute inflammation, preventing flares, and lowering serum
urate...
The goals of gout treatment are threefold: treating
acute inflammation, preventing flares, and lowering serum
urate levels.
An OTC Corticosteroid Nasal Spray for Allergic Rhinitis
The Medical Letter on Drugs and Therapeutics • November 11, 2013; (Issue 1429)
The FDA has approved the over-the-counter (OTC)
sale of Nasacort Allergy 24HR (Sanofi), a triamcinolone
acetonide nasal spray previously available only
by prescription as Nasacort AQ. The OTC product,
which...
The FDA has approved the over-the-counter (OTC)
sale of Nasacort Allergy 24HR (Sanofi), a triamcinolone
acetonide nasal spray previously available only
by prescription as Nasacort AQ. The OTC product,
which is scheduled to be marketed in the spring of
2014, will be the first corticosteroid nasal spray that
can be purchased without a prescription in the US.
Nasacort Allergy 24HR is approved for use in patients
≥2 years old with nasal allergy symptoms.
Canakinumab (Ilaris) for Systemic Juvenile Idiopathic Arthritis
The Medical Letter on Drugs and Therapeutics • August 19, 2013; (Issue 1423)
The FDA has approved the interleukin-1 (IL-1) beta
inhibitor canakinumab (Ilaris – Novartis) for treatment of
systemic juvenile idiopathic arthritis (sJIA; formerly
called juvenile rheumatoid arthritis or...
The FDA has approved the interleukin-1 (IL-1) beta
inhibitor canakinumab (Ilaris – Novartis) for treatment of
systemic juvenile idiopathic arthritis (sJIA; formerly
called juvenile rheumatoid arthritis or Still’s disease) in
children ≥2 years old. Canakinumab was approved earlier
for treatment of cryopyrin-associated periodic syndromes
(CAPS). Tocilizumab (Actemra), an interleukin-6
(IL-6) inhibitor that has been available since 2010 for
treatment of rheumatoid arthritis in adults, was also
recently approved by the FDA for sJIA. Canakinumab is
the only IL-1 inhibitor approved for this indication.
Drugs for Allergic Disorders
The Medical Letter on Drugs and Therapeutics • May 1, 2013; (Issue 129)
The use of drugs to prevent and control symptoms of
allergic disorders can be optimized when patients
avoid exposure to specific allergens and/or environmental
conditions that trigger or worsen their...
The use of drugs to prevent and control symptoms of
allergic disorders can be optimized when patients
avoid exposure to specific allergens and/or environmental
conditions that trigger or worsen their symptoms.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2013; (Issue 128)
Pain can be acute or chronic. The two major types of
chronic pain are nociceptive pain and neuropathic
pain. Nociceptive pain can be treated with nonopioid
analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. The two major types of
chronic pain are nociceptive pain and neuropathic
pain. Nociceptive pain can be treated with nonopioid
analgesics or opioids. Neuropathic pain is less responsive
to opioids and is often treated with adjuvant drugs
such as antidepressants and antiepileptics. Combining
different types of analgesics may provide an additive
analgesic effect without increasing adverse effects.
Drugs for Acne, Rosacea and Psoriasis
The Medical Letter on Drugs and Therapeutics • January 1, 2013; (Issue 125)
The pathogenesis of acne is multifactorial: follicular
hyperkeratinization, bacteria, sebum production,
androgens, and inflammation all play a role. The gram-positive
microaerophilic bacteria...
The pathogenesis of acne is multifactorial: follicular
hyperkeratinization, bacteria, sebum production,
androgens, and inflammation all play a role. The gram-positive
microaerophilic bacteria Propionibacterium
acnes promote development of acne lesions by secreting
chemotactic factors that attract leukocytes to the
follicle, causing inflammation.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • May 1, 2012; (Issue 117)
Disease-modifying anti-rheumatic drugs (DMARDs)
are now used early in the treatment of rheumatoid
arthritis (RA) to achieve clinical remission, prevent
irreversible damage to joints, and minimize...
Disease-modifying anti-rheumatic drugs (DMARDs)
are now used early in the treatment of rheumatoid
arthritis (RA) to achieve clinical remission, prevent
irreversible damage to joints, and minimize toxicity
associated with nonsteroidal anti-inflammatory drugs
(NSAIDs) and corticosteroids. DMARDs (Table 1)
generally do not have an immediate analgesic effect,
but over time can control symptoms and have been
shown to delay and possibly stop progression of the
disease. NSAIDs have immediate analgesic and antiinflammatory
effects, but may not affect the disease
process. Oral corticosteroids can relieve joint symptoms
and control systemic manifestations, but their
chronic use can cause many complications. Judicious
use of intra-articular corticosteroids can rapidly
decrease inflammation in acute joints with few, if any,
adverse effects.
Indacaterol (Arcapta Neohaler) for COPD
The Medical Letter on Drugs and Therapeutics • April 30, 2012; (Issue 1389)
The FDA has approved indacaterol (in´´ da ka´ ter ol; Arcapta Neohaler – Novartis), an inhaled long-acting beta2-agonist, for once-daily maintenance treatment of airflow obstruction in patients with...
The FDA has approved indacaterol (in´´ da ka´ ter ol; Arcapta Neohaler – Novartis), an inhaled long-acting beta2-agonist, for once-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD). Indacaterol is not approved for treatment of exacerbations of COPD or for treatment of asthma. It has been available in Europe as Onbrez Breezhaler since 2009.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • March 1, 2012; (Issue 115)
Inflammatory bowel disease (IBD) is generally classified
as either Crohn’s disease (CD) or ulcerative
colitis (UC). More detailed guidelines on their treatment
are available from the American College...
Inflammatory bowel disease (IBD) is generally classified
as either Crohn’s disease (CD) or ulcerative
colitis (UC). More detailed guidelines on their treatment
are available from the American College of
Gastroenterology.
Drugs for Asthma
The Medical Letter on Drugs and Therapeutics • February 1, 2012; (Issue 114)
Inhalation is the preferred route of delivery for most
asthma drugs. Chlorofluorocarbons (CFCs), which
have ozone-depleting properties, are being phased out
as propellants in metered-dose inhalers....
Inhalation is the preferred route of delivery for most
asthma drugs. Chlorofluorocarbons (CFCs), which
have ozone-depleting properties, are being phased out
as propellants in metered-dose inhalers. Non-chlorinated
hydrofluoroalkane (HFA) propellants, which do
not deplete the ozone layer, are being used instead.
A Fixed-Dose Combination of Ibuprofen and Famotidine (Duexis)
The Medical Letter on Drugs and Therapeutics • October 31, 2011; (Issue 1376)
The FDA has approved Duexis (Horizon), a fixed-dose
combination of the nonsteroidal anti-inflammatory drug
(NSAID) ibuprofen and the H2-receptor antagonist
(H2RA) famotidine, for symptomatic relief of...
The FDA has approved Duexis (Horizon), a fixed-dose
combination of the nonsteroidal anti-inflammatory drug
(NSAID) ibuprofen and the H2-receptor antagonist
(H2RA) famotidine, for symptomatic relief of osteoarthritis
and rheumatoid arthritis and to decrease the risk of
developing gastric and duodenal ulcers in patients at
risk for NSAID-associated ulcers. Vimovo, a combination
of the NSAID naproxen and the proton pump
inhibitor (PPI) esomeprazole, is also approved by the
FDA for prevention of NSAID-associated gastric ulcers.
Roflumilast (Daliresp) for COPD
The Medical Letter on Drugs and Therapeutics • July 25, 2011; (Issue 1369)
Roflumilast (Daliresp – Forest), an oral phosphodiesterase
4 (PDE4) inhibitor, was approved by the FDA to reduce the risk of exacerbations in adult patients
with severe chronic obstructive pulmonary...
Roflumilast (Daliresp – Forest), an oral phosphodiesterase
4 (PDE4) inhibitor, was approved by the FDA to reduce the risk of exacerbations in adult patients
with severe chronic obstructive pulmonary disease
(COPD) associated with chronic bronchitis and a history
of exacerbations.
Drugs for Chronic Obstructive Pulmonary Disease
The Medical Letter on Drugs and Therapeutics • November 1, 2010; (Issue 99)
The goals of drug therapy for chronic obstructive pulmonary
disease (COPD) are to reduce symptoms such
as dyspnea, improve exercise tolerance and quality of
life, and decrease complications of the disease...
The goals of drug therapy for chronic obstructive pulmonary
disease (COPD) are to reduce symptoms such
as dyspnea, improve exercise tolerance and quality of
life, and decrease complications of the disease such as
acute exacerbations. Other guidelines for treatment of
this condition have been published or updated in
recent years.
Mometasone/Formoterol (Dulera) for Asthma
The Medical Letter on Drugs and Therapeutics • October 18, 2010; (Issue 1349)
A combination of the corticosteroid mometasone furoate (Asmanex) and the long-acting beta2-agonist
(LABA) formoterol (Foradil) has become available in a
single metered-dose inhaler (Dulera – Schering)...
A combination of the corticosteroid mometasone furoate (Asmanex) and the long-acting beta2-agonist
(LABA) formoterol (Foradil) has become available in a
single metered-dose inhaler (Dulera – Schering) for
treatment of asthma in patients ≥12 years old. It is the
third corticosteroid/LABA combination inhaler to
become available for this indication in the US. None of
these combinations should be used for initial treatment
of asthma or for acute treatment of asthma symptoms.
Drugs for Bacterial Infections
The Medical Letter on Drugs and Therapeutics • June 1, 2010; (Issue 94)
The text below reviews some common bacterial infections and their treatment. The recommendations made
here are based on the results of susceptibility studies, clinical trials and the opinions of Medical Letter...
The text below reviews some common bacterial infections and their treatment. The recommendations made
here are based on the results of susceptibility studies, clinical trials and the opinions of Medical Letter consultants.
Safety of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease (COPD)
The Medical Letter on Drugs and Therapeutics • May 31, 2010; (Issue 1339)
Two combinations of an inhaled corticosteroid with an inhaled long-acting beta2-agonist are approved by the
FDA for use in patients with COPD: fluticasone/salmeterol (Advair Diskus) and...
Two combinations of an inhaled corticosteroid with an inhaled long-acting beta2-agonist are approved by the
FDA for use in patients with COPD: fluticasone/salmeterol (Advair Diskus) and budesonide/formoterol
(Symbicort). A Medical Letter reader has questioned the safety of using corticosteroid inhalers in patients
with this disorder. No single-agent inhaled corticosteroid inhaler is approved for this indication.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2010; (Issue 92)
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less responsive to opioids; adjuvant medicines such as antidepressants and anticonvulsants are often used to treat neuropathic pain. Combining different types of analgesics may provide an additive analgesic effect without increasing adverse effects.
In Brief: Stopping Long-Acting Beta-2 Agonists
The Medical Letter on Drugs and Therapeutics • March 22, 2010; (Issue 1334)
A little more than a year ago, The Medical Letter reported the results of an FDA meta-analysis which found that use of a long-acting beta-2 agonist (LABA) such as salmeterol (Severent) or formoterol (Foradil)...
A little more than a year ago, The Medical Letter reported the results of an FDA meta-analysis which found that use of a long-acting beta-2 agonist (LABA) such as salmeterol (Severent) or formoterol (Foradil) in patients with asthma was associated with an increased risk of a composite endpoint of asthma-related death, intubation or hospitalization; the highest risk was in children 4-11 years old.There was no significant increase in risk when a long-acting beta-2 agonist was used with an inhaled corticosteroid.The Medical Letter recommended that long-acting beta-2 agonists should not be used as monotherapy for asthma, especially in children, and that long-acting beta-2 agonists should be used for asthma only in combination with an inhaled corticosteroid, preferably in a fixed-dose combination in the same inhaler.1
Now the FDA has issued new Safe Use Requirements2 and labeling requirements for long-acting beta-2 agonists that include the following: “Stop use of the LABA, if possible, once asthma control is achieved and maintain the use of an asthma-controller medication such as an inhaled corticosteroid.”3
It has not been determined that patients taking a longacting beta-2 agonist in a fixed-dose combination with an inhaled corticosteroid have an increased risk of death or that stopping long-acting beta-2 agonists in such patients will improve long-term outcomes. A controlled clinical trial of these new requirements would be welcome.
1. Long-acting beta-2 agonists in asthma. Med Lett Drugs Ther 2009; 51:1.
2. www.fda.gov/safety/medwatch/default.htm
3. BA Chowdhury and G Dal Pan. The FDA and safe use of long-acting beta-agonists in the treatment of asthma. N Engl J Med 2010; Feb 24 (epub).
Download: U.S. English
Now the FDA has issued new Safe Use Requirements2 and labeling requirements for long-acting beta-2 agonists that include the following: “Stop use of the LABA, if possible, once asthma control is achieved and maintain the use of an asthma-controller medication such as an inhaled corticosteroid.”3
It has not been determined that patients taking a longacting beta-2 agonist in a fixed-dose combination with an inhaled corticosteroid have an increased risk of death or that stopping long-acting beta-2 agonists in such patients will improve long-term outcomes. A controlled clinical trial of these new requirements would be welcome.
1. Long-acting beta-2 agonists in asthma. Med Lett Drugs Ther 2009; 51:1.
2. www.fda.gov/safety/medwatch/default.htm
3. BA Chowdhury and G Dal Pan. The FDA and safe use of long-acting beta-agonists in the treatment of asthma. N Engl J Med 2010; Feb 24 (epub).
Download: U.S. English
Addendum: Cost of Ustekinumab (Stelara)
The Medical Letter on Drugs and Therapeutics • March 8, 2010; (Issue 1333)
In the Medical Letter article on ustekinumab (Stelara) for psoriasis (2010; 52:7), footnote 2 in table 2 should have included a second sentence: $5595.60 is the cost of one 45-mg...
In the Medical Letter article on ustekinumab (Stelara) for psoriasis (2010; 52:7), footnote 2 in table 2 should have included a second sentence: $5595.60 is the cost of one 45-mg syringe.
Drugs for Allergic Disorders
The Medical Letter on Drugs and Therapeutics • February 1, 2010; (Issue 90)
Allergic rhinitis, allergic conjunctivitis, atopic dermatitis, urticaria, anaphylaxis and asthma (not included here; reviewed in Treatment Guidelines 2008; 6:83) are prevalent worldwide, especially in...
Allergic rhinitis, allergic conjunctivitis, atopic dermatitis, urticaria, anaphylaxis and asthma (not included here; reviewed in Treatment Guidelines 2008; 6:83) are prevalent worldwide, especially in industrialized countries. Pharmacologic treatment of these disorders continues to improve in efficacy and safety. In addition to using drugs to prevent and control these allergic diseases, patients should be instructed to avoid, if possible, specific allergens and/or environmental conditions that trigger or worsen their symptoms. Allergen-specific immunotherapy may be useful for treatment of allergic rhinitis and allergic conjunctivitis, and in preventing severe insect venom-triggered reactions.
Ustekinumab (Stelara) for Psoriasis
The Medical Letter on Drugs and Therapeutics • January 25, 2010; (Issue 1330)
The FDA has approved the use of ustekinumab (Stelara - Centocor Ortho Biotech), an interleukin antagonist given by subcutaneous (SC) injection for treatment of adults with moderate to severe plaque psoriasis....
The FDA has approved the use of ustekinumab (Stelara - Centocor Ortho Biotech), an interleukin antagonist given by subcutaneous (SC) injection for treatment of adults with moderate to severe plaque psoriasis. It is the first agent in its class for this indication; the other biologic agents for psoriasis are Tcell or tumor necrosis factor (TNF) inhibitors.
Colchicine and Other Drugs for Gout
The Medical Letter on Drugs and Therapeutics • November 30, 2009; (Issue 1326)
Until the recent introduction of febuxostat (Uloric), no new drugs had been marketed for treatment of gout in the past 40 years. Colchicine, which has been available for decades as an unapproved drug, has now...
Until the recent introduction of febuxostat (Uloric), no new drugs had been marketed for treatment of gout in the past 40 years. Colchicine, which has been available for decades as an unapproved drug, has now been approved by the FDA (Colcrys) for treatment and prophylaxis of gout flares. It was approved earlier only in combination with probenecid (Colbenemid, and others). The goals of gout treatment are three-fold: treating acute disease, preventing flares and reducing uric acid stores.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • September 1, 2009; (Issue 85)
Inflammatory bowel disease (IBD) is either Crohn's disease or ulcerative colitis. Drug selection is guided by disease type (Crohn's versus ulcerative colitis), severity and location and whether the goal is...
Inflammatory bowel disease (IBD) is either Crohn's disease or ulcerative colitis. Drug selection is guided by disease type (Crohn's versus ulcerative colitis), severity and location and whether the goal is induction or maintenance of remission. Table 1 on page 66 lists the drugs used to treat IBD with their formulations and cost. Table 2 on page 68 lists the drugs of choice and their doses for different indications. Table 3 on page 71 lists the drugs' adverse effects and recommendations for monitoring. More detailed guidelines are available from the American College of Gastroenterology.
Drugs for Thyroid Disorders
The Medical Letter on Drugs and Therapeutics • August 1, 2009; (Issue 84)
Primary hypothyroidism is usually the result of Hashimoto's thyroiditis, thyroidectomy for hyperthyroidism, goiter or cancer, or radioactive iodine therapy for...
Primary hypothyroidism is usually the result of Hashimoto's thyroiditis, thyroidectomy for hyperthyroidism, goiter or cancer, or radioactive iodine therapy for hyperthyroidism.
Febuxostat (Uloric) for Chronic Treatment of Gout
The Medical Letter on Drugs and Therapeutics • May 18, 2009; (Issue 1312)
Febuxostat (Uloric - Takeda), a xanthine oxidase inhibitor, has been approved by the FDA for chronic management of hyperuricemia in patients with gout. It is the first drug marketed for treatment of gout in 40...
Febuxostat (Uloric - Takeda), a xanthine oxidase inhibitor, has been approved by the FDA for chronic management of hyperuricemia in patients with gout. It is the first drug marketed for treatment of gout in 40 years. Febuxostat is structurally unrelated to allopurinol, the only other commercially available inhibitor of xanthine oxidase. Xanthine oxidase inhibitors decrease serum urate concentrations by decreasing urate synthesis.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • May 1, 2009; (Issue 81)
Disease-modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA) to prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal...
Disease-modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA) to prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
Two New Drugs for Chronic ITP
The Medical Letter on Drugs and Therapeutics • February 9, 2009; (Issue 1305)
Romiplostim (Nplate - Amgen), a recombinant fusion protein injected subcutaneously, and eltrombopag (Promacta - GlaxoSmithKline), a non-peptide taken orally, have been approved by the FDA for treatment of...
Romiplostim (Nplate - Amgen), a recombinant fusion protein injected subcutaneously, and eltrombopag (Promacta - GlaxoSmithKline), a non-peptide taken orally, have been approved by the FDA for treatment of chronic immune thrombocytopenic purpura (ITP) refractory to corticosteroids, immunoglobulins and/or splenectomy.
Long-Acting Beta-2 Agonists in Asthma
The Medical Letter on Drugs and Therapeutics • January 12, 2009; (Issue 1303)
Continued use of a long-acting beta-2 agonist for treatment of asthma may cause down-regulation of the beta-2 receptor with loss of the bronchoprotective effect from rescue therapy with a short-acting beta-2...
Continued use of a long-acting beta-2 agonist for treatment of asthma may cause down-regulation of the beta-2 receptor with loss of the bronchoprotective effect from rescue therapy with a short-acting beta-2 agonist. After a large study (SMART) found an increased risk of asthma-related deaths in patients receiving the long-acting beta-2 agonist salmeterol, a boxed warning was added to the labeling of all medications containing a long-acting beta-2 agonist. Now the FDA has completed a meta-analysis of 110 asthma treatment studies in 60,954 patients taking any of the long-acting beta-2 agonist formulations listed in the table.
Drugs That May Cause Psychiatric Symptoms
The Medical Letter on Drugs and Therapeutics • December 15, 2008; (Issue 1301)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously...
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.
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A Granisetron Patch (Sancuso)
The Medical Letter on Drugs and Therapeutics • December 15, 2008; (Issue 1301)
The treatment of choice to prevent emesis due to highand moderate-risk emetogenic drugs used in cancer chemotherapy is aprepitant plus a serotonin receptor antagonist plus dexamethasone. Four serotonin receptor...
The treatment of choice to prevent emesis due to highand moderate-risk emetogenic drugs used in cancer chemotherapy is aprepitant plus a serotonin receptor antagonist plus dexamethasone. Four serotonin receptor antagonists are available in the US in intravenous (IV) formulations for prevention of nausea and vomiting due to cancer chemotherapy, and 3 of these are also available for oral use. Now the FDA has approved one of these, granisetron, in a transdermal formulation (Sancuso - ProStrakan).
Drugs for Asthma
The Medical Letter on Drugs and Therapeutics • December 1, 2008; (Issue 76)
No truly new drugs have been approved for treatment of asthma since omalizumab (Xolair) in 2003, but some randomized controlled trials of older drugs have been published, and new guidelines have become...
No truly new drugs have been approved for treatment of asthma since omalizumab (Xolair) in 2003, but some randomized controlled trials of older drugs have been published, and new guidelines have become available.
Drugs for Acne, Rosacea and Psoriasis
The Medical Letter on Drugs and Therapeutics • November 1, 2008; (Issue 75)
The pathogenesis of acne is multifactorial: follicular hyperkeratinization, bacteria, sebum production, androgens and inflammation all play a role. The gram-positive microaerophilic bacteria Propionibacterium...
The pathogenesis of acne is multifactorial: follicular hyperkeratinization, bacteria, sebum production, androgens and inflammation all play a role. The gram-positive microaerophilic bacteria Propionibacterium acnes promote development of acne lesions by secreting chemotactic factors that attract leukocytes to the follicle, causing inflammation.
Olopatadine (Patanase) Nasal Spray
The Medical Letter on Drugs and Therapeutics • June 30, 2008; (Issue 1289)
Olopatadine 0.6% nasal spray (Patanase - Alcon) has been approved by the FDA for treatment of seasonal allergic rhinitis in patients ≥ 12 years old. An H1-antihistamine with mast-cell stabilizing activity,...
Olopatadine 0.6% nasal spray (Patanase - Alcon) has been approved by the FDA for treatment of seasonal allergic rhinitis in patients ≥ 12 years old. An H1-antihistamine with mast-cell stabilizing activity, olopatadine is already marketed for treatment of allergic conjunctivitis in a 0.1% solution as Patanol and in a 0.2% solution as Pataday. Azelastine (Astelin), another H1-antihistamine with mast-cell stabilizing activity, has been available for intranasal treatment of allergic rhinitis since 1997.
Fluticasone Furoate (Veramyst) for Allergic Rhinitis
The Medical Letter on Drugs and Therapeutics • November 5, 2007; (Issue 1273)
Fluticasone furoate nasal spray (Veramyst - GSK) is now available for once-daily treatment of seasonal and perennial allergic rhinitis in adults and children ≥2 years old. It is similar to fluticasone...
Fluticasone furoate nasal spray (Veramyst - GSK) is now available for once-daily treatment of seasonal and perennial allergic rhinitis in adults and children ≥2 years old. It is similar to fluticasone propionate nasal spray (Flonase, and others), which is now available generically.
Drugs for Chronic Obstructive Pulmonary Disease
The Medical Letter on Drugs and Therapeutics • November 1, 2007; (Issue 63)
The goals of drug therapy for chronic obstructive pulmonary disease (COPD) are to reduce symptoms such as dyspnea, improve exercise tolerance and quality of life, and minimize complications of the disease such...
The goals of drug therapy for chronic obstructive pulmonary disease (COPD) are to reduce symptoms such as dyspnea, improve exercise tolerance and quality of life, and minimize complications of the disease such as acute exacerbations and cor pulmonale. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines developed by the World Health Organization and the National Heart, Lung and Blood Institute were updated in 2006. The American Thoracic Society and the European Respiratory Society jointly developed guidelines for COPD in 2004.
Choice of Antibacterial Drugs
The Medical Letter on Drugs and Therapeutics • May 1, 2007; (Issue 57)
Information about empirical treatment of bacterial infections, emerging trends in antimicrobial resistance, new drugs and new data about older drugs continue to become available. Usual pathogens and empiric...
Information about empirical treatment of bacterial infections, emerging trends in antimicrobial resistance, new drugs and new data about older drugs continue to become available. Usual pathogens and empiric treatment for some common types of infections are summarized in the text and a table listing the drugs of choice and alternatives for each pathogen begins on page 40. The recommendations made here are based on the results of susceptibility studies, clinical trials and the opinions of Medical Letter consultants.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2007; (Issue 56)
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain is generally treated with nonopioid analgesics and opioids. Antidepressants...
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain is generally treated with nonopioid analgesics and opioids. Antidepressants and anticonvulsants have been used to treat neuropathic pain. Combining two different types of analgesics may nprovide an additive analgesic effect without increasing adverse effects.
A Betamethasone-Calcipotriene Combination for Psoriasis
The Medical Letter on Drugs and Therapeutics • July 3, 2006; (Issue 1238)
Taclonex ointment (Warner Chilcott/LEO Pharma), a combination of the vitamin D3 analog calcipotriene 0.005% (Dovonex) and the high-potency corticosteroid betamethasone dipropionate 0.064%, was recently approved...
Taclonex ointment (Warner Chilcott/LEO Pharma), a combination of the vitamin D3 analog calcipotriene 0.005% (Dovonex) and the high-potency corticosteroid betamethasone dipropionate 0.064%, was recently approved by the FDA for treatment of psoriasis vulgaris in patients ≥ 18 years old.
Intra-Articular Injections for Osteoarthritis of the Knee
The Medical Letter on Drugs and Therapeutics • March 27, 2006; (Issue 1231)
Now that glucosamine and chondroitin, 2 favorite over-the-counter remedies for painful osteoarthritis (OA) of the knee, have been at least somewhat discredited, some patients will be asking about alternatives....
Now that glucosamine and chondroitin, 2 favorite over-the-counter remedies for painful osteoarthritis (OA) of the knee, have been at least somewhat discredited, some patients will be asking about alternatives. One of these is periodic intra-articular injection of a corticosteroid or hyaluronic acid preparation.
Clobetasol Propionate (Clobex) Spray for Psoriasis
The Medical Letter on Drugs and Therapeutics • March 27, 2006; (Issue 1231)
The FDA has approved a new spray formulation of the super-high-potency corticosteroid clobetasol propionate 0.05% (Clobex - Galderma) for treatment of moderate to severe plaque psoriasis in adults. Clobetasol...
The FDA has approved a new spray formulation of the super-high-potency corticosteroid clobetasol propionate 0.05% (Clobex - Galderma) for treatment of moderate to severe plaque psoriasis in adults. Clobetasol propionate is also available as a cream, ointment, gel, solution, foam, lotion and shampoo.
Mometasone (Asmanex Twisthaler) for Asthma
The Medical Letter on Drugs and Therapeutics • December 5, 2005; (Issue 1223)
The FDA has approved marketing of the corticosteroid mometasone furoate in an orally inhaled dry powder formulation (Asmanex Twisthaler - Schering-Plough) for maintenance treatment of asthma in patients at...
The FDA has approved marketing of the corticosteroid mometasone furoate in an orally inhaled dry powder formulation (Asmanex Twisthaler - Schering-Plough) for maintenance treatment of asthma in patients at least 12 years old. Mometasone is also available as a mid-potency topical corticosteroid cream (Elocon) and as an intranasal spray (Nasonex) for treatment of allergic rhinitis.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • December 1, 2005; (Issue 40)
To prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, disease modifying anti-rheumatic drugs (DMARDs) are now used...
To prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, disease modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA). The DMARDs listed in the table on page 84 have no immediate analgesic effects, but can control symptoms and have been shown to delay and possibly stop progression of the disease. The NSAIDs listed in the table on page 88 have analgesic and anti-inflammatory effects, but may not affect the disease process. Oral corticosteroids can rapidly relieve joint symptoms and control systemic manifestations, but their chronic use is associated with many complications.
Drugs for Acne, Rosacea and Psoriasis
The Medical Letter on Drugs and Therapeutics • July 1, 2005; (Issue 35)
The pathogenesis of acne is multifactorial: follicular hyperkeratinization, Propionibacterium acnes bacteria, sebum production, androgens and inflammation have all been implicated. P. acnes, a gram-positive...
The pathogenesis of acne is multifactorial: follicular hyperkeratinization, Propionibacterium acnes bacteria, sebum production, androgens and inflammation have all been implicated. P. acnes, a gram-positive microaerophilic bacterium, plays an important role in the development of acne lesions by secreting chemotactic factors that attract leukocytes to the follicle, causing inflammation.
Drugs for Asthma
The Medical Letter on Drugs and Therapeutics • May 1, 2005; (Issue 33)
Patients with mild, infrequent asthma symptoms may require only intermittent, asneeded use of an inhaled short-acting beta2-adrenergic agonist. Use of a short-acting beta2-agonist more than twice weekly, other...
Patients with mild, infrequent asthma symptoms may require only intermittent, asneeded use of an inhaled short-acting beta2-adrenergic agonist. Use of a short-acting beta2-agonist more than twice weekly, other than for exercise-induced bronchospasm, indicates a need for anti-inflammatory treatment. Inhaled corticosteroids are the most effective anti-inflammatory medication; leukotriene modifiers are less effective alternatives. If regular use of an inhaled corticosteroid in a low dose does not prevent symptoms, a long-acting beta2-agonist should be added; addition of a second drug is more effective than raising the dose of the inhaled steroid. A leukotriene modifier can also be used as the second drug. Omalizumab may be considered as adjunctive therapy for patients more than 12 years old who have allergic asthma not controlled by other drugs. A short course of oral corticosteroids may be useful for acute exacerbations. Treatment of acute severe asthma as a medical emergency is not included here; it has been reviewed elsewhere (ER McFadden Jr, Am J Respir Crit Care Med 2003; 168:740).
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • July 1, 2004; (Issue 23)
Three types of analgesic drugs are available: non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; opioids; and adjuvant drugs that are not usually thought of...
Three types of analgesic drugs are available: non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; opioids; and adjuvant drugs that are not usually thought of as analgesics, such as antidepressants, which can act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. Combining two different types of analgesics may provide an additive analgesic effect without necessarily increasing adverse effects.
Prevention and Treatment of Sunburn
The Medical Letter on Drugs and Therapeutics • June 7, 2004; (Issue 1184)
Solar ultraviolet (UV) light capable of injuring the skin is classified by wavelength into UVA I (340-400 nm), UVA II (320-340 nm) and UVB (290-320 nm). UVB is responsible for most of the erythema of sunburn....
Solar ultraviolet (UV) light capable of injuring the skin is classified by wavelength into UVA I (340-400 nm), UVA II (320-340 nm) and UVB (290-320 nm). UVB is responsible for most of the erythema of sunburn. UVA has been implicated in the development of phototoxicity and photoaging. The FDA permits sunscreen manufacturers to claim broad-spectrum protection if their products block at least part of UVA II in addition to UVB.
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Choice of Antibacterial Drugs
The Medical Letter on Drugs and Therapeutics • March 1, 2004; (Issue 19)
New drugs for bacterial infections and new information about older drugs continue to become available. Empirical treatment of some common bacterial infections is discussed in this article. A table listing the...
New drugs for bacterial infections and new information about older drugs continue to become available. Empirical treatment of some common bacterial infections is discussed in this article. A table listing the drugs of choice and alternatives for each pathogen begins on page 18. These recommendations are based on results of susceptibility studies, clinical trials and the opinions of Medical Letter consultants. Local resistance patterns should be taken into account. Trade names are listed on page 24.
Omalizumab (Xolair): An Anti-IgE Antibody For Asthma
The Medical Letter on Drugs and Therapeutics • August 19, 2003; (Issue 1163)
The FDA has approved release of omalizumab (oh mah lye zoo mab; Xolair - Genentech, Novartis), a humanized monoclonal antibody given subcutaneously that binds to immunoglobulin E (IgE). The drug is labeled for...
The FDA has approved release of omalizumab (oh mah lye zoo mab; Xolair - Genentech, Novartis), a humanized monoclonal antibody given subcutaneously that binds to immunoglobulin E (IgE). The drug is labeled for patients at least 12 years old with moderate to severe persistent asthma who have shown reactivity to an allergen and whose symptoms are inadequately controlled by an inhaled corticosteroid. The manufacturer claims the drug can help stop allergic reactions before they begin.
Aprepitant (Emend) for Prevention of Nausea and Vomiting Due to Cancer Chemotherapy
The Medical Letter on Drugs and Therapeutics • August 4, 2003; (Issue 1162)
Aprepitant (Emend - Merck), the first substance P/neurokinin 1 (NK1) receptor antagonist to be approved by the FDA, is now available for oral use with corticosteroids and selective serotonin (5-HT3) receptor...
Aprepitant (Emend - Merck), the first substance P/neurokinin 1 (NK1) receptor antagonist to be approved by the FDA, is now available for oral use with corticosteroids and selective serotonin (5-HT3) receptor antagonists to prevent nausea and vomiting caused by highly emetogenic anticancer drugs such as cisplatin.
Alefacept (Amevive) For Treatment of Psoriasis
The Medical Letter on Drugs and Therapeutics • April 14, 2003; (Issue 1154)
Alefacept (a le' fa sept; Amevive - Biogen) has been approved by the FDA for parenteral treatment of adults with moderate to severe chronic plaque...
Alefacept (a le' fa sept; Amevive - Biogen) has been approved by the FDA for parenteral treatment of adults with moderate to severe chronic plaque psoriasis.
Montelukast (Singulair) for Allergic Rhinitis
The Medical Letter on Drugs and Therapeutics • March 17, 2003; (Issue 1152)
Montelukast (Singulair - Merck), a leukotriene receptor antagonist already marketed for asthma (Treatment Guidelines from The Medical Letter 2002; 1:11), has been approved by the FDA for treatment of seasonal...
Montelukast (Singulair - Merck), a leukotriene receptor antagonist already marketed for asthma (Treatment Guidelines from The Medical Letter 2002; 1:11), has been approved by the FDA for treatment of seasonal allergic rhinitis in adults and children more than 2 years old.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • January 1, 2003; (Issue 5)
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs), listed in the table on page 26, have analgesic and anti-inflammatory effects, but may not affect...
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs), listed in the table on page 26, have analgesic and anti-inflammatory effects, but may not affect the disease process. Corticosteroids can provide rapid relief of joint symptoms and control of systemic manifestations, but chronic use is associated with many complications. The "disease-modifying" anti-rheumatic drugs (DMARDs), listed on page 29, have no immediate analgesic effects, but can control symptoms and may delay progression of the disease (American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines, Arthritis Rheum 2002; 46:328). Interactions of anti-rheumatic drugs with other drugs are listed in The Medical Letter Handbook of Adverse Drug Interactions, 2003.
Drugs for Asthma
The Medical Letter on Drugs and Therapeutics • October 1, 2002; (Issue 2)
New drug formulations continue to be introduced for the treatment of asthma, and new studies on older drugs continue to change our perspectives on the management of this chronic inflammatory disease. Treatment...
New drug formulations continue to be introduced for the treatment of asthma, and new studies on older drugs continue to change our perspectives on the management of this chronic inflammatory disease. Treatment of asthma in the emergency department or hospital is not addressed here. More information on the diagnosis and treatment of asthma is available from Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma (Bethesda:NIH, 1997 and 2002 update; www.nhlbi.nih.gov).
Drugs That May Cause Psychiatric Symptoms
The Medical Letter on Drugs and Therapeutics • July 8, 2002; (Issue 1134)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously...
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.
Topical Pimecrolimus (Elidel) for treatment of atopic dermatitis
The Medical Letter on Drugs and Therapeutics • May 27, 2002; (Issue 1131)
Pimecrolimus 1% cream (pim e kroe' limus; SDZ ASM 981; Elidel - Novartis) has been approved by the FDA for short-term and intermittent long-term treatment of mild to moderate atopic dermatitis in...
Pimecrolimus 1% cream (pim e kroe' limus; SDZ ASM 981; Elidel - Novartis) has been approved by the FDA for short-term and intermittent long-term treatment of mild to moderate atopic dermatitis in non-immunocompromised patients at least 2 years old.
Budesonide (Entocort EC) For Crohn's Disease
The Medical Letter on Drugs and Therapeutics • January 21, 2002; (Issue 1122)
Budesonide (Entocort EC — AstraZeneca), a locally active glucocorticosteriod widely used for inhalation treatment of allergic rhinitis and asthma (Medical Letter 2000; 42:19), has been approved for oral...
Budesonide (Entocort EC — AstraZeneca), a locally active glucocorticosteriod widely used for inhalation treatment of allergic rhinitis and asthma (Medical Letter 2000; 42:19), has been approved for oral treatment of mild to moderate active Crohn's disease involving the ileum and/or ascending colon. Both oral budesonide and budesonide enemas have been available for years in Europe and Canada for treatment of inflammatory bowel disease.
A Combination of Fluticasone and Salmeterol For Asthma
The Medical Letter on Drugs and Therapeutics • April 16, 2001; (Issue 1102)
Fluticasone propionate, an inhaled corticosteroid, and salmeterol xinafoate, a long-acting beta2-adrenergic agonist, are now available together in a dry-powder inhaler for maintenance treatment of patients with...
Fluticasone propionate, an inhaled corticosteroid, and salmeterol xinafoate, a long-acting beta2-adrenergic agonist, are now available together in a dry-powder inhaler for maintenance treatment of patients with asthma. The new combination is not recommended for treatment of acute bronchospasm or for treatment of children less than 12 years old.
Topical Tacrolimus For Treatment of Atopic Dermatitis
The Medical Letter on Drugs and Therapeutics • April 16, 2001; (Issue 1102)
Tacrolimus ointment (Protopic) has been approved by the FDA in 0.03% and 0.1% formulations for treatment of atopic dermatitis. Tacrolimus is used systemically (Prograf) to prevent rejection of organ...
Tacrolimus ointment (Protopic) has been approved by the FDA in 0.03% and 0.1% formulations for treatment of atopic dermatitis. Tacrolimus is used systemically (Prograf) to prevent rejection of organ transplants.
Drugs that may cause Cognitive Disorders in the Elderly
The Medical Letter on Drugs and Therapeutics • November 27, 2000; (Issue 1093)
Older patients are especially susceptible to drug-induced cognitive impairment. They are more likely to be taking multiple drugs, to have higher blood levels of those drugs because of renal or hepatic...
Older patients are especially susceptible to drug-induced cognitive impairment. They are more likely to be taking multiple drugs, to have higher blood levels of those drugs because of renal or hepatic dysfunction, and to have pre-existing cognitive problems that make it difficult to detect the role of drugs causing new symptoms or making old ones worse.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • August 21, 2000; (Issue 1085)
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought...
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. Non-opioids can be given concurrently with opioids for an additive analgesic effect.
Drugs For Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • July 10, 2000; (Issue 1082)
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic and anti-inflammatory effects, but may not affect the disease process. The...
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic and anti-inflammatory effects, but may not affect the disease process. The "disease-modifying anti-rheumatic"drugs (DMARDs) have no immediate analgesic effects, but can control symptoms and may delay progression of the disease.
Bexarotene (Targretin) For Cutaneous T-cell Lymphoma
The Medical Letter on Drugs and Therapeutics • April 3, 2000; (Issue 1075)
Bexarotene, a retinoid analog, has been approved by the US Food and Drug Administration for oral treatment of dermatologic manifestations of refractory cutaneous T-cell...
Bexarotene, a retinoid analog, has been approved by the US Food and Drug Administration for oral treatment of dermatologic manifestations of refractory cutaneous T-cell lymphoma.
Drugs for Asthma
The Medical Letter on Drugs and Therapeutics • March 6, 2000; (Issue 1073)
Asthma is a chronic inflammatory disorder of the airways; inflammation caused by allergens, viral respiratory infections or other stimuli leads to bronchial hyperresponsiveness and obstruction of airflow....
Asthma is a chronic inflammatory disorder of the airways; inflammation caused by allergens, viral respiratory infections or other stimuli leads to bronchial hyperresponsiveness and obstruction of airflow. Anti-inflammatory drugs, particularly inhaled corticosteroids, are central to its management.
Mycophenolate Mofetil - A New Immunosuppressant for Organ Transplantation
The Medical Letter on Drugs and Therapeutics • September 29, 1995; (Issue 958)
Mycophenolate mofetil (CellCept - Roche) has been approved by the US Food and Drug Administration for oral use in preventing organ rejection in patients receiving allogeneic renal transplants. It is being...
Mycophenolate mofetil (CellCept - Roche) has been approved by the US Food and Drug Administration for oral use in preventing organ rejection in patients receiving allogeneic renal transplants. It is being promoted as an improvement over azathioprine (Imuran) for concurrent use with cyclosporine (Sandimmune; Neoral) and corticosteroids.
Drugs For Tuberculosis
The Medical Letter on Drugs and Therapeutics • August 4, 1995; (Issue 954)
Tuberculosis (TB) continues to be a major problem in the United States, particularly in areas where drug resistance is common (Morbid Mortal Weekly Rep, 44:387, May 26, 1995). Since poor compliance is the...
Tuberculosis (TB) continues to be a major problem in the United States, particularly in areas where drug resistance is common (Morbid Mortal Weekly Rep, 44:387, May 26, 1995). Since poor compliance is the most important cause of treatment failure and is associated with emergence of drug resistence, some experts now recommend that all patients take drugs for TB under direct observation (SE Weis et al, N Engl J Med, 330:1179, 1994; R Bayer and D Wilkinson, Lancet, 345:1545, June 17, 1995).
Fluticasone Propionate Nasal Spray for Allergic Rhinitis
The Medical Letter on Drugs and Therapeutics • January 20, 1995; (Issue 940)
An intranasal spray formulation of the corticosteroid fluticasone propionate (floo tik a sone; Flonase - Allen & Hanburys) has been approved by the US Food and Drug Administration for treatment of seasonal...
An intranasal spray formulation of the corticosteroid fluticasone propionate (floo tik a sone; Flonase - Allen & Hanburys) has been approved by the US Food and Drug Administration for treatment of seasonal and perennial allergic rhinitis in adults and children more than 12 years old.
Doxepin Cream for Pruritus
The Medical Letter on Drugs and Therapeutics • October 28, 1994; (Issue 934)
The US Food and Drug Administration has approved the marketing of 5% doxepin hydrochloride cream (Zonalon - GenDerm) for treatment of pruritus due to eczematous dermatoses. Oral doxepin is used as a tricyclic...
The US Food and Drug Administration has approved the marketing of 5% doxepin hydrochloride cream (Zonalon - GenDerm) for treatment of pruritus due to eczematous dermatoses. Oral doxepin is used as a tricyclic antidepressant (Sinequan, and others).
Calcipotriene for Psoriasis
The Medical Letter on Drugs and Therapeutics • August 5, 1994; (Issue 928)
Calcipotriene ointment 0.005% (calcipotriol; Dovonex - Westwood Squibb), a synthetic vitamin D 3 analog previously available in Europe and Canada, has now been approved by the US Food and Drug Administration...
Calcipotriene ointment 0.005% (calcipotriol; Dovonex - Westwood Squibb), a synthetic vitamin D 3 analog previously available in Europe and Canada, has now been approved by the US Food and Drug Administration (FDA) for treatment of moderate plaque psoriasis, the most common form of the disease.
Granisetron to Prevent Vomiting After Cancer Chemotherapy
The Medical Letter on Drugs and Therapeutics • July 8, 1994; (Issue 926)
Granisetron, a serotonin (5-HT) antagonist similar to ondansetron, was recently approved by the US Food and Drug Administration for prevention of nausea and vomiting due to cancer chemotherapy. Although...
Granisetron, a serotonin (5-HT) antagonist similar to ondansetron, was recently approved by the US Food and Drug Administration for prevention of nausea and vomiting due to cancer chemotherapy. Although available in an oral formulation in other countries, granisetron is available here only for intravenous (IV) use.
Intranasa Budesonide for Allergic Rhinitis
The Medical Letter on Drugs and Therapeutics • July 8, 1994; (Issue 926)
An intranasal formulation of the corticosteroid budesonide (Rhinocort Nasal Inhaler - Astra) was recently approved by the US Food and Drug Administration for treatment of seasonal or perennial allergic...
An intranasal formulation of the corticosteroid budesonide (Rhinocort Nasal Inhaler - Astra) was recently approved by the US Food and Drug Administration for treatment of seasonal or perennial allergic rhinitis in adults and children and nonallergic perennial rhinitis in adults. Budesonide has been available in Canada and Europe for several years for inhalation treatment of both allergic rhinitis and asthma.
Salmeterol
The Medical Letter on Drugs and Therapeutics • April 29, 1994; (Issue 921)
Salmeterol xinafoate (Serevent - Allen & Hanburys), a long-acting β 2 -selective adrenergic agonist for inhalation, has been approved by the US Food and Drug Administration for maintenance treatment of...
Salmeterol xinafoate (Serevent - Allen & Hanburys), a long-acting β 2 -selective adrenergic agonist for inhalation, has been approved by the US Food and Drug Administration for maintenance treatment of asthma, with or without concurrent use of inhaled corticosteroids. Salmeterol is not recommended for acute treatment of bronchospasm.
Ophthalmic Levocabastine for Allergic Conjunctivitis
The Medical Letter on Drugs and Therapeutics • April 15, 1994; (Issue 920)
A 0.05% ophthalmic solution of levocabastine hydrochloride (Livostin - Iolab), a histamine H 1 -receptor antagonist, has been approved by the US Food and Drug Administration for treatment of seasonal allergic...
A 0.05% ophthalmic solution of levocabastine hydrochloride (Livostin - Iolab), a histamine H 1 -receptor antagonist, has been approved by the US Food and Drug Administration for treatment of seasonal allergic conjunctivitis. The new drug is a cyclohexylpiperidine derivative with no structural relationship to any other antihistamine.
Drugs for Tuberculosis
The Medical Letter on Drugs and Therapeutics • October 29, 1993; (Issue 908)
The rising incidence of tuberculosis (TB) has been accompanied by a dramatic increase in drug resistance in some areas of the USA (TR Frieden et al, N Engl J Med, 328:521, 1993). Since poor compliance is the...
The rising incidence of tuberculosis (TB) has been accompanied by a dramatic increase in drug resistance in some areas of the USA (TR Frieden et al, N Engl J Med, 328:521, 1993). Since poor compliance is the most important cause of treatment failure and associated with emergence of drug resistance, some experts now recommend that patients with TB take their drugs under direct obeservation (MD Iseman et al, N Engl J Med, 329:576, 1993).
Ketorolac for Seasonal Allergic Conjunctivitis
The Medical Letter on Drugs and Therapeutics • September 17, 1993; (Issue 905)
Ketorolac (kee' toe role ak) tromethamine 0.5%, a nonsteroidal anti-inflammatory drug (NSAID) previously available for parenteral and oral administration (Toradol - Medical Letter, 32:79, 1990), has now been...
Ketorolac (kee' toe role ak) tromethamine 0.5%, a nonsteroidal anti-inflammatory drug (NSAID) previously available for parenteral and oral administration (Toradol - Medical Letter, 32:79, 1990), has now been approved for ophthalmic use (Acular - Allergan, Fisons) to relieve itching in seasonal allergic conjunctivitis. NSAIDs decrease prostaglandin concentrations in the eye, which theoretically might contribute to a decrease in itching. Several other NSAIDs are available for ophthalmic use in the USA, but none is marketed for this indication. Flurbiprofen (Ocufen) and suprofen (Profenal) are promoted for use in ophthalmic surgery to prevent miosis. Diclofenac (Voltaren) is available in an ophthalmic solution for treatment of post-operative inflammation after cataract extraction.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • January 8, 1993; (Issue 887)
Three types of analgesic drugs are available in the USA: first, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as...
Three types of analgesic drugs are available in the USA: first, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. (American Pain Society, Principles of analgesic Use, 3rd ed, Skokie, illinois: American pain society, 1992).
Oral Mesalamine for Ulcerative Colitis
The Medical Letter on Drugs and Therapeutics • August 21, 1992; (Issue 877)
An oral formulation of mesalamine (5-aminosalicylic acid, 5-ASA, Asacol - Proctor & Gamble), was recently approved by the US Food and Drug Administration (FDA) for treatment of mildly to moderately active...
An oral formulation of mesalamine (5-aminosalicylic acid, 5-ASA, Asacol - Proctor & Gamble), was recently approved by the US Food and Drug Administration (FDA) for treatment of mildly to moderately active ulcerative colitis; it has not been approved for maintenance of remissions. Olsalazine (Dipentum), a similar drug (Medical Letter, 32:105, 1990), is approved for maintenance of remissions but not for treatment.
Intranasal Triamcinolone For Allergic Rhinitis
The Medical Letter on Drugs and Therapeutics • December 13, 1991; (Issue 859)
An intranasal formulation of the corticosteroid triamcinolone (Nasacort - Rh ne- Poulenc Rorer) was recently approved by the US Food and Drug Administration for once-daily treatment of seasonal and perennial...
An intranasal formulation of the corticosteroid triamcinolone (Nasacort - Rh ne- Poulenc Rorer) was recently approved by the US Food and Drug Administration for once-daily treatment of seasonal and perennial allergic rhinitis.
Topical Corticosteroids
The Medical Letter on Drugs and Therapeutics • November 15, 1991; (Issue 857)
Two new topical corticosteroids - fluticasone (Cutivate - Glaxo), a mediumpotency product, and halobetasol propionate (Ultravate - Westwood-Squibb), a superhigh- potency drug- were recently approved for...
Two new topical corticosteroids - fluticasone (Cutivate - Glaxo), a mediumpotency product, and halobetasol propionate (Ultravate - Westwood-Squibb), a superhigh- potency drug- were recently approved for marketing by the US Food and Drug Administration.
Drugs For AIDS And Associated Infections
The Medical Letter on Drugs and Therapeutics • October 18, 1991; (Issue 855)
A growing number of clinical trials now permits some consensus on the treatment of human immunodeficiency virus (HIV) and other infections associated with acquired immune deficiency syndrome (AIDS) in...
A growing number of clinical trials now permits some consensus on the treatment of human immunodeficiency virus (HIV) and other infections associated with acquired immune deficiency syndrome (AIDS) in adults.
Ondansentron To Prevent Vomiting After Cancer Chemotherapy
The Medical Letter on Drugs and Therapeutics • June 28, 1991; (Issue 847)
Ondansetron (on dan' se tron; Zofran - Glaxo), a serotonin (5-hydroxytryptamine) antagonist, was recently marketed in the USA for intravenous use to prevent nausea and vomiting due to cancer chemotherapy. An...
Ondansetron (on dan' se tron; Zofran - Glaxo), a serotonin (5-hydroxytryptamine) antagonist, was recently marketed in the USA for intravenous use to prevent nausea and vomiting due to cancer chemotherapy. An oral formulation is available in many other countries.
Olsalazine
The Medical Letter on Drugs and Therapeutics • November 16, 1990; (Issue 831)
Olsalazine sodium (Dipentum - Pharmacia), a dimer (two molecules linked by an azo bond) of 5-aminosalicylic acid, was recently approved by the US Food and Drug Administration for oral use to maintain...
Olsalazine sodium (Dipentum - Pharmacia), a dimer (two molecules linked by an azo bond) of 5-aminosalicylic acid, was recently approved by the US Food and Drug Administration for oral use to maintain remission of ulcerative colitis in adult patients who cannot tolerate sulfasalazine (Azulfidine; and others).
Drugs for Treatment of Fungal Infections
The Medical Letter on Drugs and Therapeutics • June 15, 1990; (Issue 820)
...
Dexamethasone Bacterial Meningitis In Children
The Medical Letter on Drugs and Therapeutics • January 27, 1989; (Issue 784)
A recent report in the New England Journal of Medicine suggested that in children with bacterial meningitis, adding the corticosteroid dexamethasone (Decadron; and others) to antibiotic treatment could...
A recent report in the New England Journal of Medicine suggested that in children with bacterial meningitis, adding the corticosteroid dexamethasone (Decadron; and others) to antibiotic treatment could decrease the incidence of moderate or severe hearing loss.
Mesalamine For Ulcerative Colitis
The Medical Letter on Drugs and Therapeutics • May 20, 1988; (Issue 766)
Mesalamine (Rowasa - Reid-Rowell), probably better known as 5-aminosalicylic acid (5-ASA) and also called mesalazine in some other countries, was recently marketed in the USA as an enema for treatment of mild...
Mesalamine (Rowasa - Reid-Rowell), probably better known as 5-aminosalicylic acid (5-ASA) and also called mesalazine in some other countries, was recently marketed in the USA as an enema for treatment of mild to moderate distal ulcerative colitis, including ulcerative proctosigmoiditis and ulcerative proctitis.
Generic Topical Corticosteroids
The Medical Letter on Drugs and Therapeutics • May 6, 1988; (Issue 765)
Since the last Medical Letter review of generic drugs (Volume 28, page 1, 1986), the prediction that generic drugs newly approved in the USA under more relaxed federal regulations will probably be as reliable...
Since the last Medical Letter review of generic drugs (Volume 28, page 1, 1986), the prediction that generic drugs newly approved in the USA under more relaxed federal regulations will probably be as reliable as brand-name drugs has generally been accurate. Few well-documented generic product failures have been reported. Recently, however, the equivalence of generic topical corticosteroids has been questioned.
Drugs For Treatment of Deep Fungal Infections
The Medical Letter on Drugs and Therapeutics • March 11, 1988; (Issue 761)
The incidence of opportunistic deep fungal infections continues to increase, particularly among patients who have AIDS, are taking immunosuppressive drugs, or are in intensive care...
The incidence of opportunistic deep fungal infections continues to increase, particularly among patients who have AIDS, are taking immunosuppressive drugs, or are in intensive care units.
Nabilone And Other Antiemetic For Cancer Patients
The Medical Letter on Drugs and Therapeutics • January 1, 1988; (Issue 756)
Nabilone (Cesamet - Lilly), a synthetic cannabinoid chemically related to tetrahydrocannabinol (THC), the main active ingredient in marijuana, was recently marketed in the USA for oral treatment of nausea and...
Nabilone (Cesamet - Lilly), a synthetic cannabinoid chemically related to tetrahydrocannabinol (THC), the main active ingredient in marijuana, was recently marketed in the USA for oral treatment of nausea and vomiting associated with cancer chemotherapy. Oral THC itself, known generically as dronabinol (Marinol), is also commercially available as an antiemetic for cancer patients (Medical Letter, 27:97, 1985). Other drugs used for this purpose include metoclopramide (Reglan - Medical Letter, 24:67, 1982), prochlorperazine (Compazine; and others), haloperidol (Haldol; and others), and corticosteroids. Benzodiazepines, such as lorazepam (Ativan; and others), are used to treat anticipatory nausea and vomiting that occurs before chemotherapy begins.