Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Oct 2006
ReviewManagement of sepsis in the critically ill patient: key aspects.
Severe sepsis is a major cause of morbidity and mortality in the critically ill patient. Management involves identification and treatment of the underlying causative infection, with antimicrobial agents and surgery where necessary, haemodynamic resuscitation with fluids and vasoactive agents, steroids (for septic shock) and immunomodulation with drotrecogin-alpha (activated), where not contraindicated. Every effort must be made to identify sepsis early so as to optimise the patient's chances of a good outcome.
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Expert Opin Pharmacother · Oct 2006
ReviewEconomic evaluation of sustained sedation/analgesia in the intensive care unit.
Lorazepam, midazolam, propofol and opioids are the primary agents that are used for sustained sedation and analgesia of critically ill patients. The choice of agent depends on safety profiles, expected outcomes, cost, patient characteristics and clinical experience. ⋯ Many factors, aside from drug costs, influence the total cost of sedation in the intensive care unit. This article reviews the cost parameters of intensive care unit sedation that are specific to the characteristics of commonly used sedatives and analgesics, evaluates economic studies and cost models, summarises alternative methods of sedation and analgesia, and provides practical recommendations for methods of cost containment, including daily sedation interruption, sedation monitoring and protocol implementation.
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Expert Opin Pharmacother · Oct 2006
ReviewPregabalin for the treatment of generalised anxiety disorder.
Pregabalin is a new anxiolytic that has been recently licensed for the treatment of generalised anxiety disorder (GAD) in Europe. Short-term efficacy is based on six positive placebo-controlled studies, all of which showed a significant early separation from placebo in all of the doses used (150-600 mg) at the first week, and the efficacy at the end of the treatment was comparable with the comparators used in four of these studies. ⋯ The effect on cognitive function was minimal and notably less than that observed with benzodiazepines. The discontinuation symptoms following abrupt treatment cessation were similar to the rates with serotonin-noradrenaline re-uptake inhibitors and lower than with benzodiazepines with no signals of tolerance or dependence.
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Expert Opin Pharmacother · Aug 2006
Meta Analysis Comparative StudyThe cost-effectiveness issue of adjuvant trastuzumab in early breast cancer.
Trastuzumab has shown activity in patients with early breast cancer that overexpresses HER-2, and this drug has been employed in the adjuvant setting. Significant resources have been allocated to finance this new therapy. ⋯ This survey focuses on studies exploring adjuvant trastuzumab therapy in early-stage breast cancer that have been published since 2003, which report on efficacy, benefit and/or cost data in this setting. The paper summarises the results, focuses on the level of evidence of these studies, compares the calculated cost-effectiveness ratios and makes recommendations for future cost-effectiveness analyses.
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Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in the Western world. Historically, CLL patients have received prednisone- or chlorambucil-containing regimens, resulting in modest responses and a slim chance of long-term survival. ⋯ Single-agent fludarabine therapy has expanded into a combination regimen containing cyclophosphamide and has further evolved to incorporate monoclonal antibodies. A review of the fludarabine literature shows that these advancements in fludarabine-containing therapy have enhanced the overall patient response with a potential increase in survival time, thus representing progress towards a superior treatment for CLL.