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Abstract

AbstractOsteoporosis guidelineA new guideline on the management of osteoporosis in men over 50 and post‐menopausal women has been published by the National Osteoporosis Guideline Group (www.shef.ac.uk/NOGG), a group of organisations representing health professionals and patients, with funding from several pharmaceutical companies.The guideline recommends using the FRAX tool (www.shef.ac.uk/FRAX) to assess the 10‐year fracture risk in individuals with risk factors to facilitate targeting DXA scans to measure bone mineral density. Patients who have already sustained a fragility fracture should be treated without risk assessment. Treatment recommendations are similar to those published in draft NICE guidance on primary and secondary prevention, selecting alendronate as the drug of first choice for most patients.Efalizumab efficacyA multicentred postapproval trial has demonstrated long‐term efficacy and a favourable safety profile for efalizumab (Raptiva) in moderate to severe chronic plaque psoriasis.The CONTROL II study, presented in September at the 17th EADV congress in Paris, was conducted at 170 sites in 18 European countries and involved 1255 patients who had failed to respond to traditional systemic therapies. In this non‐blinded study, 68 per cent of participants achieved the primary efficacy end‐point and showed improvement within the first 12 weeks; control was maintained in responding patients who continued treatment.Adverse effects were graded as mild or moderate and similar to those reported in earlier studies. There was no evidence of an increase in malignancies or infections.New oral anticoagulantRivaroxaban (Xarelto), an oral factor Xa inhibitor, has been introduced for the prevention of venous thrombo‐embolism in patients undergoing elective hip or knee replacement surgery. Compared with the low molecular weight heparin enoxaparin (Clexane), rivaroxaban has been shown to reduce the risk of venous thrombosis by 70 per cent after hip replacement and by 49 per cent after knee replacement; the risk of bleeding was similar.At the recommended dose of 10mg once daily, prophylaxis after hip surgery lasts five weeks and costs £157; prophylaxis after knee surgery lasts two weeks and costs £63.New productsUCB Pharma has introduced lacosamide (Vimpat) as adjunctive treatment of partial‐onset epilepsy with or without secondary generalisation in patients aged 16 and over. A month's treatment at the recommended maintenance dose of 100‐200mg twice daily costs approximately £73‐£140.A new non‐nucleoside reverse transcriptase inhibitor (NNRI) is available for the treatment of HIV‐1 infection in combination with a boosted protease inhibitor (PI) and other antiretrovirals in treatment‐experienced adults. Etravirine (Intelence) costs approximately £320 for one month's treatment at the recommended dose of 200mg twice daily.Voltarol Pain‐Eze (diclofenac) 12.5mg tablets are now available without prescription; a pack of 18 tablets costs £5.99.Atypicals and EPS riskAtypical antipsychotics are not associated with a significantly lower risk of extra‐pyramidal symptoms than first‐generation agents such as perphenazine (Fentazin), a new analysis of the CATIE study has shown (Br J Psychiatry 2008;193:279–88).CATIE was a large trial comparing the efficacy and safety of antipsychotics in the treatment of schizophrenia in which perphenazine was a representative first‐generation agent (Am J Psychiatry 2006;163:611–22). This analysis found no differences in the risk of parkinsonism, dystonia, akathisia or tardive dyskinesia between perphenazine and the newer antipsychotics; use of antiparkinsonian medication was higher with risperidone and lower with quetiapine (Seroquel).Mental health websiteA new website offering information about mental illnesses and drug treatment has been launched by the United Kingdom Psychiatric Pharmacy Group (UKPPG), the College of Mental Health Pharmacists (CMHP), the Pharmaceutical Schizo‐phrenia Initiative (PSI) and the National Institute for Mental Health in England (NIMHE).www.choiceandmedication.org.uk includes information about 17 mental illnesses and a large number of drug treatments. It offers links to other sites offering information and downloadable leaflets, help to identify the local mental health trust and downloadable charts comparing treatments for each indication.