From staff reports

	Good Neighbor Pharmacy stores in 19 states are now providing immunization services to patients without doctor’s prescriptions, AmerisourceBergen Drug Corporation (ABDC) announced during its 

	“Patient access to vaccinations remains a challenge, but as America’s most accessible healthcare professionals, pharmacists are ideally positioned to address this public health need,” said Chuck Reed, ABDC’s group VP, pharmacy technology & solutions. “However, many independent community pharmacists have experienced difficulty finding a physician willing to engage in collaborative practices. Our collaborative practice coverage is designed to help these pharmacies attract and retain patients, increase their revenue, and remain competitive.”

	In the states where the immunizations without prescriptions are available, ABDC has collaborative practice agreements with physicians that allow pharmacists to determine the need for vaccines, eliminating the need for a doctor’s prescription. More than 100 pharmacies are enrolled in the program.

Articles

Good Neighbor Pharmacy stores in 19 states are now providing immunization services to patients without doctor’s prescriptions.

Immunizations without prescriptions available at some Good Neighbor pharmacies

Biologic response modifiers developed for the treatment of  rheumatoid arthritis do not appear to be associated with an increased risk of  cancer, according to a 

Journal of the American Medical Association.

Maria A. Lopez-Olivo, MD, PhD, of the University of Texas  M.D. Anderson Cancer Center in Houston and colleagues conducted a large  systematic review and meta-analysis to examine the risk of developing cancer.  They reviewed data for nearly 3,000 rheumatoid arthritis patients being treated  with biologic response modifiers (BRMs), such as tumor necrosis factor (TNF)  inhibitors, who were enrolled in 63 randomized controlled trials. 

Because these biologic agents interfere with the immune  system, concerns have been expressed about their safety, specifically with  respect to infections and malignancies. However, data linking these treatments  with potential cancer risks is not definitive.

  The authors found no statistically significant risk for  malignancies among patients taking BRMs when compared with patients using other  treatments. Of the 29,423 patients, 211 developed a malignancy during the  trial. The incidence rate for any malignancy during the first year of therapy  was very low in the BRM plus methotrexate group (0.77%; 95% CI, 0.65%–0.92%),  the BRM monotherapy group (0.64%; 95% CI, 0.42%–0.95%), and the controls  (0.66%; 95% CI, 0.52%–0.84%). Anakinra plus methotrexate showed lower odds  compared with methotrexate alone (Peto odds ratio, 0.11; 95% CI, 0.03–0.45),  according to the abstract.

“Patients are understandably concerned when treatments are  linked to cancer risk. With this knowledge, clinicians can effectively  demonstrate that the benefits of BRMs far outweigh the risk,” said Maria E.  Suarez-Almazor, MD, professor in the department of general internal medicine,  in an Anderson news release.

The authors concluded that further studies need to  look at long-term risk and risk of recurrence in patients with RA with history  of cancer or cancer risk factors, which remain unknown. 

Biologic response modifiers developed for the treatment of rheumatoid arthritis do not appear to be associated with an increased risk of cancer, according to a study published September 5 in the Journal of the American Medical Association.

Biologics for RA treatment don't increase cancer risk

Children with  asthma who use glucocorticoid inhalers may grow shorter on average than those  who do not use inhaled corticosteroids (ICS), according to a 

Previous  studies have shown that the use of these drugs decreases growth rate, but it  was believed that growth returned to normal after the first few years of  therapy, according to lead author H. William Kelly, PharmD, of the University  of New Mexico, Albuquerque, and colleagues. However, in this follow-up to the  earlier Childhood Asthma Management Program (CAMP) clinical trial, the authors  found that children who were given the glucocorticoid inhalers grew up to be on  average one-half inch shorter than those who used placebo.

Beginning at  aged 5 to 13 years, the researchers randomly assigned patients to receive 400  μg of budesonide, 16 mg of nedocromil, or placebo daily for 4 to 6 years.

At the mean  age of 25 years, 943 of the original 1,041 patients were measured for adult  height and weight. The authors found that patients who had taken budesonide during  the trial had a mean height 1.2 cm shorter than those assigned to a placebo  inhaler (171.1 cm vs 172.3 cm, 95% CI, -0.5 to -1.9 cm, 

=.001). In  addition, a larger daily dose was associated with a lower adult height (−0.1 cm  for each microgram per kilogram, 

=.007), and the deficit in adult  height was greater for women (−1.8 cm, 

=.10)  and for participants who were younger at trial entry than for those who were  older.

The mean  adult height in the nedocromil group (172.1 cm) was similar to that of the  placebo group (

"The  potential effect on adult height must be balanced against the large and  well-established benefit of these drugs in controlling persistent asthma,” the  authors cautioned. “It seems prudent to select inhaled glucocorticoids and  devices with higher therapeutic indexes and to use them in the lowest effective  doses in children with persistent asthma."

Children with asthma who use glucocorticoid inhalers may grow shorter on average than those who do not use inhaled corticosteroids (ICS), according to a study published September 6 in the New England Journal of Medicine.

Glucocorticoid inhalers may impact adult height

While beta-blocker use continues to be the standard of care for patients with coronary artery disease (CAD), especially for those patients who have had a myocardial infarction (MI), these drugs may not be effective long term, according to an online 

Sripal Bangalore, MD, MHA, of New York University School of Medicine, and colleagues conducted a longitudinal, observational study to determine the long-term efficacy of beta-blockers to prevent cardiovascular events in stable patients with a prior history of MI, in those with CAD but no history of MI, and in those with only risk factors for CAD. Patients from the Reduction of Atherothrombosis for Continued Health (REACH) registry were divided into three cohorts to match the categories above and followed prospectively for 4 years. Outcomes assessed included cardiovascular outcomes, hospitalization, and vascular interventions.

Patients enrolled in the REACH registry were age 45 years and older, had established CAD, cerebrovascular disease, or peripheral arterial disease, or had at least three atherothrombotic risk factors. Patients were followed from August 2004 to April 2009. In the registry 14,043 patients (31%) had prior MI, 12,012 (27%) had documented CAD but without MI, and 18,653 (42%) had CAD risk factors only. Among these patients, 21,860 were included in the propensity score-matched analysis, so that the three cohorts were well balanced across comparator groups.

In the prior MI group, the events rates were not significantly different for patients using beta-blockers and those not using beta-blockers for the primary outcome (a composite of cardiovascular death, nonfatal MI, or nonfatal stroke) with a HR=0.90 (95% CI, 0.79-1.03; 

=.14), the secondary outcome (hospitalization for atherothrombotic events or a revascularization procedure) with OR=0.91 (95% CI, 0.82-1.00), or any of the tertiary outcomes, including cardiovascular death, MI, and stroke.

In the CAD without MI group, the event rates were similar in those taking beta-blockers compared with those not taking beta-blockers for the primary outcome, for cardiovascular death, for stroke, and for MI. Those taking beta-blockers had higher rates for the secondary outcome and for hospitalization compared with patients not taking beta-blockers.

In the third cohort of patients with risk factors only, the event rates were higher in the patients on beta-blocker therapy compared to those not taking beta-blockers for the primary outcome, the secondary outcome, but not for MI and stroke.

"In this analysis…, beta-blocker use was not associated with a lower incidence of cardiovascular events among individuals with a prior history of MI, among individuals with CAD but no MI history, or among individuals with risk factors only for atherosclerotic disease," the authors commented. "Available evidence suggests that beta-blocker use is associated with benefit in patients with acute MI (without impending shock or heart block), and may be efficacious in the short-to-intermediate term duration for patients after MI and in those with chronic heart failure."

While beta-blocker use continues to be the standard of care for patients with coronary artery disease (CAD), especially for those patients who have had a myocardial infarction (MI), these drugs may not be effective long term, according to an online report published Oct. 3 in JAMA.

How long should beta-blockers be used in CAD patients?

Apixaban (Eliquis), an investigational anticoagulant developed by Bristol-Myers Squibb and Pfizer, has lower rates of stroke, systemic embolism, and bleeding than warfarin in patients with atrial fibrillation, regardless of level of risk for these events, according a recent online 

Researchers from Duke University Medical Center and other institutions analyzed the ARISTOTLE trial results that were previously published, to assess how the outcomes differed for patients according to three risk scores that are used to predict the risk of stroke and bleeding (CHADS

Patients who were assigned to apixaban (n=9120) had significantly lower rates of stroke or system embolism, mortality, and bleeding than those treated with warfarin (n=9081) in the ARISTOTLE trial, regardless of CHADS

 score. Stroke or systemic embolism occurred in 44 patients (0.74%) with a CHADS

 score of 1 who were assigned to apixaban and 51 patients (0.87%) who received warfarin. Those with a CHADS

 score of 2 had a higher rate of stroke and systemic embolism (74 [1.24%] taking apixaban and 82 [1.37%] taking warfarin. Those with a CHADS

 score of 3 or higher had the highest rate of stroke or systemic embolism (94 [1.95%] on apixaban and 132 [2.80%] on warfarin. Similar trends were evident in terms of mortality and bleeding rates, the authors noted.

VASc, and HAS-BLED score, patients who received apixaban had less net clinical events, with lower rates of the composite of stroke, systemic embolism, ISTH major bleeding, and all-cause mortality, than did patients who received warfarin. These results were driven mainly by reductions in bleeding,"the authors wrote.

The researchers suggested that because the benefits of apixaban do not differ in patients according to the risk scores, the risk scoring systems being used might not be as relevant when tailoring apixaban treatment to individual patients than for patients receiving warfarin.

"Further improvement in the methods for risk stratification of both stroke and bleeding should help to advance personalised treatment with novel oral anticoagulants in patients with atrial fibrillation, particularly those at low risk," the authors concluded.

The analysis was funded by Bristol-Myers Squibb and Pfizer.

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Apixaban (Eliquis), an investigational anticoagulant developed by Bristol-Myers Squibb and Pfizer, has lower rates of stroke, systemic embolism, and bleeding than warfarin in patients with atrial fibrillation, regardless of level of risk for these events, according a recent online analysis published October 2 in The Lancet.

Lower rates of stroke, bleeding seen with apixaban compared to warfarin in Afib patients, regardless of risk profile

 to better serve patient with cystic fibrosis (CF).

Walgreens will have “significant ownership stake” in CFF’s specialty pharmacy, 

"By working with a pharmacy chain the size and stature of Walgreens, we will be better able to offer people with CF greater access to high-quality, customer-friendly pharmacy services,” said Robert J. Beall, PhD, president and CEO of the CFF.

 and 180 hospital pharmacies will be able to offer enhanced services to CF patients to help them manage their treatment regimens.

"Walgreens has a long-standing relationship with the CF community, and we understand the unique needs and challenges that CF patients and their families face," said Mike Ellis, vice president of Walgreens specialty pharmacy and infusion. "By working with the CFF, we are both committed to CF patients continuing to have access to the medications and services they need to stay healthy and getting the greatest benefit from their relationship with their pharmacist."

The Cystic Fibrosis Foundation (CFF) is teaming up with Walgreens to better serve patient with cystic fibrosis (CF).