Therapeutics Letter

This is a bi-monthly publication targeting identified problematic therapeutic issues (brief, simple, practical messages). The process involves a literature review and development of the message by different working groups of the Therapeutics Initiative. A draft of the Letter is reviewed by specialists who are expert in the particular therapeutic area and all members and associates of the Therapeutics Initiative before the Letter is disseminated. The Therapeutics Initiative is a full member of the International Society of Drug Bulletins.

ISSN: 2369-8691 (Online)
ISSN: 2369-8683 (Print)

[103] Is the current ‘glucocentric’ approach to management of type 2 diabetes misguided?

March 15, 2017 Therapeutics Letter 8 Comments

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A recent Alberta modeling study suggests that lifetime risk of diabetes is now 50% for non-indigenous Canadians and 80% for First Nations Canadians.1 If true, type 2 diabetes (DM2) will become the most common primary care diagnosis. Costs including medical visits, capillary blood glucose (CBG) testing, laboratory tests, and drug therapies will threaten other social priorities. In 2013, British … [Read more...]

[102] Indacaterol for chronic obstructive pulmonary disease

January 26, 2017 Therapeutics Letter Leave a Comment

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Chronic obstructive pulmonary disease (COPD) is an inflammatory condition characterized by irreversible airflow obstruction. It is caused by exposure to noxious particles or gases, with exposure to cigarette smoke the most common cause. Several classes of drugs can be prescribed: short and long-acting beta2 (β2) agonist, short and long-acting antimuscarinic, inhaled corticosteroids and … [Read more...]

[101] Study 329: Why is it so important?

November 22, 2016 Therapeutics Letter 2 Comments

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Study 329 is a GlaxoSmithKline (GSK) sponsored trial with 22 academic authors that compared paroxetine, imipramine, and placebo for adolescent depression. In this trial 275 adolescents with major depression were randomized in a double-blind fashion to paroxetine (93), imipramine (95) or placebo (87) for 8 weeks. Those who completed 8 weeks were studied in a 6-month continuation phase. Published … [Read more...]

[100] Questioning the basis of approval for non-insulin glucose lowering drugs

September 16, 2016 Therapeutics Letter 10 Comments

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Glucose lowering drugs are commonly prescribed in British Columbia, and 44% of adults with type 2 diabetes are receiving more than one drug (see Table). Annual spending on non-insulin glucose lowering drugs in Canada was $748 million in 2013.1 When these drugs are taken, the underlying unproven assumption is that by lowering glucose they will prevent the complications of diabetes: premature … [Read more...]

[99] Comparative effectiveness of proton pump inhibitors

June 28, 2016 Therapeutics Letter 9 Comments

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Six previous Therapeutics Letters reported information about the benefits and harms of different proton pump inhibitors (PPIs).1-6 These drugs work by irreversibly inhibiting gastric H+K+ ATPase (the proton pump) in the stomach. They inhibit both basal and stimulated acid secretion and are used in a number of clinical settings: gastroesophageal reflux disease (GERD), reflux esophagitis, peptic … [Read more...]

[98] Does SPRINT change our approach to blood pressure targets?

April 7, 2016 Therapeutics Letter 3 Comments

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Therapeutics Letter #821 summarized evidence from the Cochrane systematic review, Treatment blood pressure targets for hypertension.2 The Cochrane review was based on the 7 randomized controlled trials (RCTs) designed to test treatment targets that were available as of October 2008. The conclusion was that “Treating patients to lower than standard blood pressure (BP) targets (≤ 140-160/90-100 … [Read more...]

[97] Intravenous (IV) iron for severe iron deficiency

February 24, 2016 Therapeutics Letter 4 Comments

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Anemia affects about one-third of humans; iron (Fe) deficiency is the most common cause.1 In Canada (2009-11), deficiency defined as serum ferritin < 15 mcg/L was estimated to affect 13% of females aged 12-19, and 9% of females aged 20-49.2 This estimate is probably low, as the ferritin cutoff is arbitrary and it excludes residents of First Nation reserves, where nutrition is often inferior to … [Read more...]

[96] Benefits and harms of drugs for “neuropathic” pain

January 19, 2016 Therapeutics Letter 8 Comments

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Chronic pain (at times presumed to be “neuropathic” in origin) is a common problem in clinical practice. It is now well recognized that the results of drug treatment are more often disappointing than not.1 Despite this, from 2005-2014 the number of British Columbians prescribed gabapentin increased 1.8 fold, pregabalin 17 fold, and duloxetine 3.6 fold (from 2008). Use of venlafaxine (mostly for … [Read more...]

[95] Antipsychotics should not be used for non-psychotic depression

September 30, 2015 Therapeutics Letter Leave a Comment

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This Letter reviews clinical evidence for use of antipsychotics for depression. In Canada, two antipsychotic drugs are approved to treat major depressive disorder (MDD) that is not responsive to other treatment. Quetiapine (Seroquel XR) is approved as monotherapy or in combination with conventional antidepressants for symptomatic relief of MDD “when currently available approved antidepressant … [Read more...]

[94] Dual antiplatelet therapy: net health benefit or harm?

July 31, 2015 Therapeutics Letter Leave a Comment

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The antiplatelet drugs acetylsalicylic acid (ASA), clopidogrel (Plavix) and ticlopidine (Ticlid) were reviewed in TL #37.1 Ticlopidine is no longer available in Canada. ASA has a unique action, irreversibly inhibiting platelet cyclooxygenase. Clopidogrel and two new drugs, prasugrel (Effient) and ticagrelor (Brilinta), reduce platelet activation and aggregation by inhibiting P2Y12 adenosine … [Read more...]

Therapeutics Letter

[103] Is the current ‘glucocentric’ approach to management of type 2 diabetes misguided?

[102] Indacaterol for chronic obstructive pulmonary disease

[101] Study 329: Why is it so important?

[100] Questioning the basis of approval for non-insulin glucose lowering drugs

[99] Comparative effectiveness of proton pump inhibitors

[98] Does SPRINT change our approach to blood pressure targets?

[97] Intravenous (IV) iron for severe iron deficiency

[96] Benefits and harms of drugs for “neuropathic” pain

[95] Antipsychotics should not be used for non-psychotic depression

[94] Dual antiplatelet therapy: net health benefit or harm?

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