Newer drugs

Most of the drugs such as epinephrine and albuterol used to treat asthma attacks are bronchodilators—substances that expand the bronchial passages Newer drugs are designed to either inhibit the enzyme 5 lipoxygenase which acts on arachidomc acid m the first stage of leukotriene biosynthesis or to block leukotriene receptors... 

Mirapex), and ropinirole (Requip) are newer drugs used in the treatment of Parkinson s disease Drag-induced parkinsonism is treated with the anticholinergics benz-tropine (Cogentin) and trihexyphenidyl (Artane). 

Newer drugs ME (and 2) too slow to explain initial anticonvulsant effect. Increasing use in ME, PM, GM (5-15)... 

QUESTION What are the criteria that you used for these newer compounds in order to classify these newer drugs as either sympathomimetic or... 

There is no cure for AMD and the efficacy of most treatments is low. Newer drug developments show promise but no treatment can reverse damage that has already occurred.23 Early diagnosis is critical. High-risk patients need periodic eye examinations because some patients do not notice any changes, even when neovascularization has occurred.20... 

In many clinical trials a positive control of a clinically established drug is often used for comparison purposes for example, a novel selective serotonin reuptake inhibitor (SSRI), may be compared with a more established tricyclic antidepressant, such as imipramine. The aim is to see whether the new SSRI is more efficacious or has fewer adverse side effects than the more established tricyclic (Chapter 12). In many such comparisons the new and older treatments are equally efficacious at relieving depression, but the newer drugs display fewer side effects this means that they are better tolerated by patients, so that they are more willing to continue taking the tablets. The high rates of compliance also mean that, in overall terms, newer drugs with fewer side effects tend to be more efficacious. 

Lichtenberg, F.R., "Are the Benefits of Newer Drugs Worth Their Cost Evidence From the MEPS," Hlth. Affairs, 20 (5), 241-251 (2001). 

With the advent of computer-aided-drug modeling (CADM) the critical, scientific and faster approach to newer drug entities based on the biologically active prototypes, combinatorial chemistry, chiral chemistry and biotechnology has paved the way towards more specific, potent and above all less toxic drugs to improve the ultimate quality of life in humans. 

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Cimetidine contains an imidazole ring comparable to histamine, a sulfur atom (thioether group) in the side-chain, and a terminal functional group based upon a guanidine (see Section 4.5.4). Ranitidine bears considerable similarity to cimetidine, but there are some important differences. The heterocycle is now furan rather than imidazole, and the guanidine has been modified to an amidine (see Section 4.5.4). A newer drug, nizatidine, is a variant on ranitidine with a thiazole heterocyclic ring system. 

Bisphosphonates structurally mimic endogenous pyrophosphate, which inhibits precipitation and dissolution of bone minerals. They retard bone resorption by osteoclasts and, in part, also decrease bone mineralizatioa Indications include tumor osteolysis, hypercalcemia, and Paget s disease. Qinical trials with etidronate, administered as an intermittent regimen, have yielded favorable results in osteoporosis. With the newer drugs clodronate, pamidronate, and alendronate, inhibition of osteoclasts predominates a continuous regimen would thus appear to be feasible. 

The use of estimates of treatment effect based on indirect comparisons when there is a common comparator has recently been shown on many occasions to agree with the results of head-to-head clinical trials (Song et al. 2003). Clearly a more challenging situation exists where there is not a common parameter, for example, in a recent study of the relative cost effectiveness of newer drugs for treatment of epilepsy (Wilby et al. 2003). In this study, Bayesian Markov chain Monte Carlo models for multiparameter synthesis were used (Ades 2003). Here, complex models were used to analyze a set of clinical studies involving a series of clinical alternatives, including the two alternatives of interest. 

A common issue in these aggregated studies is howto measure innovation in pharmaceuticals. Three different types of measures have been used (1) the cumulative number of drugs approved with NMEs, (2) newer drugs as a proportion of total physician prescriptions, (3) and the average vintage of drugs. 

WUby, J., A. Kainth, N. Hawkins, D. Epstein, C. McDaid, et al. 2003. A Rapid and Systematic Review of the Clinical Effectiveness, Tolerability and Cost-Effectiveness of Newer Drugs for Epilepsy in Adults. Report to the National Institute for Clinical Excellence, forthcoming. 

Finally, bisphosphonates have an important place in treatment of osteoporosis of all causes, including steroid-induced osteoporosis. Disodium etidronate, alendronate and clodronate all have potent effects to restore bone mass, and this effect persists for several years of therapy. Newer drugs such as zoledronic acid can be administered by infrequent (once-yearly) infusion, which can help compliance and reduce side effects. 

Case JP. Old and new drugs used in rheumatoid arthritis A historical perspective. Part 2 The newer drugs and drug strategies. Am J Ther 2001 8 163-179. 

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