Update in New Medications for Primary Care

Abstract

Each year, the FDA approves dozens of new drugs for use in clinical practice. Clinicians must wade through a staggering amount of evidence to determine which drugs will be important new additions to their practice. Many of the new drugs relate to specialty practices, such as chemotherapeutic agents and immune-based therapies. A fraction of the newly approved drugs are potentially relevant for primary care clinicians. Most of these drugs are “me too” drugs that are a new drug within an existing class of medications. For example, the FDA may approve a new beta-blocker or a new proton-pump inhibitor. When these types of new drugs are as effective and safe as existing drugs, they are welcome primarily when their cost to patients and health plans is lower than that of currently available drugs. However, a small number of drugs each year are novel and relevant for primary care practice. These are drugs that work through a completely new mechanism compared to existing therapies and have the potential to represent an addition to our pharmacologic armamentarium. It is challenging for busy clinicians to determine which new drugs meet this requirement and to receive balanced information regarding efficacy, safety, side effects, and cost of these new medications. In addition, each year, new practice guidelines and systematic reviews provide guidance regarding optimal use and sequence of existing medications for common clinical problems in primary care. In this paper, we provide a balanced presentation of some of the most important new drugs in primary care, followed by important updates in pharmacologic management of common conditions seen in primary care. In preparation of the New Drugs section of this paper, we reviewed the FDA database of new drugs1 approved from January 1, 2006 through March 1, 2008. We excluded drugs that were (1) used exclusively in inpatient settings, (2) parenteral agents, (3) prescribed only by subspecialty providers, or (4) new formulations or combinations of existing medications. From the remaining drugs, we identified those that work by a novel mechanism and represent the first drug in a new class of medications. From this list, we selected those drugs that, in our opinion, had the most relevance and potential to change primary care practice. For the update in Management of Common Conditions section of this paper, we reviewed the following medical journals from January 1, 2006 through April 7, 2008: New England Journal of Medicine, Annals of Internal Medicine, ACP Journal Club, JAMA, Journal Watch, and Hypertension. We identified new practice guidelines and systemic reviews on the pharmacologic management of common and important medical problems managed in the office by general internists and offer our own recommendations for pharmacologic management of these conditions.