The Latest News in Rheumatology
11/27/2002
Efficacy of Infliximab in Refractory Ankylosing
Spondylitis: Results of a Six-Month Open-Label Study
Mail-Order Drugs Get High Marks, Some Glitches
This study shows Remicade® showed remarkable efficiacy in a large group of
severely affected axial-AS patients who did not respond well to conventional
therapy. M. Breban, MD and colleagues published their results in the recent
issue of Rheumatology.
Results: 50 patients (76% male, 87% HLA-B27 positive, median age 35
years, median disease duration 13 years) with active AS took part in the study.
Patients received three infusions of Remicade® (5mg/kg) at weeks 0, 2, and 6,
and were monitored until week 24. Methotrexate was not administered in
combination with Remicade (as recommended in RA and used by some rheumatologists
for AS).
The majority of the patients reached "partial remisision", and 86%
of the patients had reached their maximal improvement by week 12.
75% of the patients experienced clear relapse during the study period.
Researchers believe this implies that Remicade® generally had a "transient
effect on disease evolution", and that repeated infusions are likely to be
required to maintain the efficacy of the drug.
The researchers found that relapse usually occurred after discontinuation of
the drug, but almost one-third of completers were still free of relapse four
months after the last infusion.
They say that it cannot be ruled out that the addition of methotrexate could
improve the extent or duration of efficacy of Remicade®--further studies must
be completed before conclusions can be drawn.
This study found no serious infection (such as tuberculosis) which have
recently been reported to occur at low but presumably increased frequency in
patients treated with Remicade®. The researchers relate this to the low number
of patients included in this study.
New York (Reuters Health)-- A new survey found that an overwhelming
percentage of patients using mail-order pharmacies to fill prescriptions say
that on the whole, they are highly satisfied with the option. However, the
report shows far less enthusiasm about the timeliness of the prescription
deliveries, the ability of customer service to answer questions, and all aspects
of mail-service pharmacies Internet services.
This survey underscores what pharmacy benefit managers (PMB's) claim are
advantages of mail service--that it's often more convenient and less costly for
patients, and delivers a high quality of care. PMB's are companies that
negotiate on behalf of clients to get drug discounts.
Many health plan sponsors see home delivery as part of the solution to rising
healthcare costs. Patients often pay the same co-payment for a 90-day supply of
medication by mail as they do for a 30-day supply filled at their local
pharmacy, which could reduce patients' out-of-pocket expenses.
The Pharmacy Benefit Management Institute, an independent organization that
conducts research for the PMB industry) surveyed 13,000 people nationwide who
use mail-service pharmacies as part of a managed prescription drug benefit
program.
- 88% said they were pleased with overall performance of their male-service
pharmacy.
- 70% were very satisfied.
- 95% claimed that they use mail-service because they pay less than they
would at a retail pharmacy.
- 82% use mail-service because it is more convenient than a retail pharmacy.
- Half of all respondents said they use mail-service because their benefit
provider requires them to do so (meaning mandate also appears to be a
significant driving factor in mail-service).
- 65% were highly satisfied with the timeliness of their prescription
delivery. (This area of performance showed the greatest gap in satisfaction)
- 62% were highly satisfied with the ease of reaching a pharmacist.
Crystal Wright, a spokeswoman for the National Association of Chain Drug
Stores, says that most Americans live within 5 miles of a drugstore where they
can get help from a pharmacist if they need it. "Consumers should ask
themselves, 'If I have a very serious problem or question about a medication,
how easy is it for me to get in touch with a real, live pharmacist rather than a
customer service representative?" asks Wright. She says that for very ill
patients or those taking multiple medications, it can be a problem when they're
forced to use mail-order for financial reasons, and "taken out of the
retail setting where they have access to a pharmacist."
Mail service accounted for 15.7% of all retail sales in 2001 in the U.S.,
making it a booming business.