Olopatadine ophthalmic solution adjunctive to loratadine compared with loratadine alone in patients with active seasonal allergic conjunctivitis symptoms.

BACKGROUND: Olopatadine ophthalmic solution 0.1% (Patanol, Alcon Laboratories, Fort Woth, TX) is approved for the treatment of the signs and symptoms of allergic conjunctivitis. Loratadine 10 mg (Claritin, Schering-Plough, Madison, NJ) is a nonsedating oral antihistamine approved for the treatment of the signs and symptoms of allergic rhinitis. OBJECTIVE: To compare the efficacy of olopatadine used adjunctively with loratadine versus loratadine alone in patients with seasonal allergic conjunctivitis. METHODS: This three-center, observer-masked, treatment-controlled, randomized, parallel-group study involved patients aged 7 to 74 years with seasonal allergic conjunctivitis. Patients were treated for 7 days with either olopatadine twice daily adjunctive to loratadine once daily or only loratadine once daily. Efficacy variables (ocular itching and redness, physician's impression, patient's impression, patient diary ratings of ocular redness and itching), and safety parameters were evaluated during the screening visit and on days 0, 3, and 7. Patients completed the rhinoconjunctivitis quality of life questionnaire on days 0 and 7. RESULTS: Ninety-four patients received study drug. Patients receiving olopatadine twice daily in addition to loratadine once daily exhibited less ocular itching (P = 0.0436) and rated their ocular condition as more improved compared with those receiving loratadine alone (P < 0.0022). Twenty minutes after initial dosing, olopatadine plus loratadine relieved ocular itching and redness significantly better than loratadine alone (P = 0.001). Both treatment groups showed clinically meaningful improvements in overall quality of life in all but one of the rhinoconjunctivitis quality of life questionnaire domains. Overall, and in most domains, olopatadine plus loratadine also provided significantly better (P < 0.05) quality of life than loratadine alone at day 7. CONCLUSIONS: Compared with loratadine alone, olopatadine adjunctive to loratadine provides greater relief of ocular itching and redness, a better quality of life, and is well tolerated in patients with seasonal allergic conjunctivitis.

Pterygium in Australia: a cost of illness study.

PURPOSE: The aim of this report was to describe the number of Australians affected by pterygium in recent years, treatment options, number of treatment encounters and costs of treatment. METHOD: A review of published literature was conducted to identify the prevalence of pterygium in Australian populations. Costs of primary care were based on national general practitioner (GP) survey data. Costs of surgical intervention were based on Health Insurance Commission claims data and Australian Institute of Health and Welfare National Hospital Morbidity Data. RESULTS: Pterygium occurs in 1.1% of Australians. It is more prevalent in populations with higher exposure to ultraviolet radiation, and older men (occurring in 12% of males over 60 years). The estimated annual number of GP contacts was 58,900. Forty per cent of primary care contacts for pterygium were referred to an ophthalmologist and topical medication was prescribed by GPs in 32% of contacts. The estimated annual cost of GP visits, specialist visits and topical medication was AUD$3.2 m. There were 6997 claims for pterygium removal in 1999/2000 with 3192 conjunctival autografts. Rates of pterygium removal were highest in Queensland with 56 per 100,000 population. The annual costs of surgical intervention were estimated at AUD$4.8 m. CONCLUSIONS: The direct medical costs of pterygium in Australia are AUD$8.3 m annually. This is likely to be an underestimate of total cost because indirect costs such as loss of work time could not be measured. More data are needed on the long-term benefits of pterygium intervention.

A critical review of published economic modelling studies in depression.

Depression is a very costly chronic disease. An important cost driver is treatment failure caused by patient noncompliance due, in part, to the adverse effects of medications. Additionally, inadequate duration of therapy and inappropriate medication switching contribute to the high cost of treatment. With the epidemiological data for depression demonstrating a rise in both incidence and prevalence over the last 20 years, and the fact that many of the newer antidepressants will see patent expiry in the near future, previous antidepressant cost-effectiveness scenarios are likely to change. As economic models play an increasingly important role in therapeutic decision-making, clinicians are encouraged to understand the strategies and methods involved in modelling antidepressant therapy. The aim of this review of the literature and synthesis of the various techniques important to the modelling of antidepressant therapies is for the practitioner to gain an increased understanding of the modelling methods previously utilised and be in a position to better evaluate future health economic models for the treatment of depression.

A pharmacoeconomic analysis of patients with symptoms of benign prostatic hyperplasia.

A pharmacoeconomic analysis of therapies for patients with benign prostatic hyperplasia (BPH) was conducted. The therapies compared were androgenic hormone inhibition (finasteride) and alpha-blockade (doxazosin, prazosin and terazosin). This was a cost-effectiveness analysis from the perspective of the US military. The 36-month decision-tree model considered the aforementioned drugs as initial therapy for BPH following an unsuccessful period of watchful waiting. Therapy was continued toward a successful response. All patients who did not respond to therapy received secondary interventions, including transurethral resection of the prostate (TURP). The main outcome measures were clinical effectiveness and incurred costs. A Monte Carlo sensitivity analysis was performed on all cost-effectiveness ratios. The model and sensitivity analysis supported prazosin as the most cost effective alpha-blocker over finasteride: the mean difference was $US381.65 (1994 values) per successfully treated patient, with a range of $US57.83 to $US675.53, in favour of prazosin. If prazosin was used as initial drug therapy after watchful waiting for a man over 50 years of age with classical symptoms of prostatism and no other severe or confounding comorbid conditions, a cost of $US578.15 per treatment could be expected, with clinical effectiveness of 70.3%. Patients who cannot tolerate prazosin should be considered for terazosin therapy before moving on from alpha-blockers. Subsequent treatment with finasteride would cost $US1426.53, with an additional clinical effectiveness of 9.9%. For the small number of patients who fail both therapies, the cost effectiveness of a first TURP as 'third-line' intervention [$US4321.36 for an additional effectiveness of 8.62% and a repeat TURP as 'fourth-line' ($US7650.54 for 0.59%) interventional] was calculated in a similar manner. Costs were cumulative, and effectiveness was derived from the total number of patients who started prazosin therapy. Pharmacological therapy was more cost effective than surgical intervention, and alpha-blockers were more cost effective than finasteride. Among the alpha-blockers, prazosin was by far the most cost effective followed by terazosin, then doxazosin.

Isolation of a group of glycolipid toxins from seedheads of annual ryegrass Lolium rigidum Gaud.) infected by Corynebacterium rathayi.

A group of highly toxic compounds was isolated from galled seedheads of annual ryegrass (Lolium rigidum Gaud.) containing Corynebacterium rathayi. Purified extracts were resolved by reverse-phase high-performance liquid chromatography into eight main fractions which have been partially characterised and shown to be toxic to nursling rats. A mixture of the toxins also produced clinical signs and brain lesions in lambs consistent with annual ryegrass toxicity. The name 'corynetoxin' is tentatively proposed for the series, individual members being designated according to their order of elution from the high performance liquid chromatography column as corynetoxins 1 to 8. The two main fractions are corynetoxins 3 and 4 of which the former has been crystallised. They appear to be of glycolipid character, 3-hydroxyheptadecanoic acid and a C6 amino sugar being identified among the hydrolysis products of corynetoxin 3, and heptadec-2-enoic acid and a C6 amino sugar from corynetoxin 4.

Production of tremorgenic toxins by Penicillium janthinellum Biourge: a possible aetiological factor in ryegrass staggers.

Topsoil, herbage and faeces collected during an outbreak of ryegrass staggers in sheep were examined for tremorgenic penicillia. No such fungi were recovered from the plant material, but they were found among the predominant fungi in the soil and faecal samples. The commonest species of Penicillium, and almost the only tremorgenic species encountered, was Penicillium janthinellum Biourge. When fed to sheep, the mycelium of this fungus evoked a number of the clinical signs seen in field cases of ryegrass staggers. Two tremorgenic toxins were isolated from the mycelial felts and available evidence indicates that they are verruculogen and fumitremorgin A. P. janthinellum also produced these tremorgens when cultured in moist, autoclaved soil, but not in unheated soil. The results obtained from this study are in accord with the hypothesis that ryegrass staggers is caused by tremorgenic mycotoxins.

Isolation of toxic metabolites of Phomopsis leptostromiformis responsible for lupinosis.

Two metabolites of P. leptostromiformis (phomopsins A and B) have been isolated as a crystalline mixture from a culture of the fungus on lupin seed. The mixture has been shown to be capable of inducing lupinosis in sheep and in young rats. Key steps in the isolation were the transfer of the phomopsins from crude aqueous solution to tetrahydrofuran and chromatography on macroreticular polystyrene resin. The bioassays used in monitoring fractions were based on inhibition of cell cultures and the mitosis-arresting effect of the metabolites on liver cells in vivo.