Dysport Addresses Spasticity in CP, Poststroke Patients
For patients afflicted with cerebral palsy (CP) or who have suffered a stroke, muscle spasms seriously affect their daily lives. Spasticity, the condition that causes them to suffer from stiff, often painful muscle contractures in the arms or legs, makes it difficult for these individuals to grasp objects, walk, or even maintain normal posture.
A new treatment approach addresses this debilitating condition for these patients. Recent studies show that Dysport, a potent neurotoxin that acts at the neuronal junction as a chemodenervating agent, cleaves to receptors at the neuromuscular presynaptic area to inhibit release of the potent neurotransmitter acetylcholine, effectively reducing muscle contractions.
Dysport is a class of clostridium botulinum toxin type A (Bt-A) designed to address spasticity and other conditions borne by similar etiology such as blepharospasm, hemifacial spasm, spasmodic torticollis, and other movement disorders. Recent studies show its promise in the treatment of myofascial pain, migraine, and low back pain.
Beaufour Ipsen, which manufactures Dysport, says that "when correctly administered by a medical professional and supplemented with a good rehabilitation program, Dysport effectively reduces spastic muscles and may help children with cerebral palsy learn how to walk, use their hands, and maintain proper gait, or stroke patients to recover and resume many of their normal activities more impressively, than if they were to undergo physical therapy alone."
Reduction of excessive muscular contraction with retention of natural function is the goal of Dysport treatment, according to a recent clinical review by consultant neurologist Ho King Hee of the Gleneagles Medical Center in Singapore.
On the local scene, a group of rehabilitation medicine specialists, neurologists, and pediatric neurologists recently organized the Neurological Rehabilitation Special Interest Group of the Philippines (NeuroRehab SIG) for two reasons: to address parallel treatment concerns, among them spasticity both in CP and poststroke patients, and study new management approaches, including Dysport, that may dramatically improve outcomes for their patients.
During its first learning session dubbed "Workshop One" on the applications of Dysport held last March 31 at the Makati Medical Center, the NeuroRehab SIG provided participating doctors with scientific and clinical information on Dysport, as well as training on its preparation and administration for, among other conditions, spasticity in the lower and upper extremities of both adult (poststroke) and pediatric (cerebral palsy) patients.
Dr. Raymond Rosales, consultant neurologist at the University of Santo Tomas and Metropolitan Hospitals and an authority in botulinum therapy, spoke about the basic science and use of Bt-A in spasticity, dystonia, and hyperhidrosis. He said it is remarkably effective for hyperhidrosis, citing his experience with patients who were successfully relieved of their condition with Dysport injections ranging from 100 units to 500 units per hand for severe cases. However for spasticity and dystonia, Rosales, who also heads the Asian Botulinum (Dysport) Study Group, stressed that Dysport (Bt-A) treatment should be supported with adequate rehabilitation care to achieve optimal benefits.
According to Rosales, his extensive personal experience shows that patients managed with Dysport alongside rehabilitation therapy may experience up to six months of relief from the symptoms of spasticity, enabling them to lead a normal life.
Treatment spacing and proper dosage are also important because the body's immune system reacts to the toxin and may cause the formation of antibodies that may render the treatment ineffective. He stressed that booster doses are a no-no, even if the dose appears inadequate, and any dose modification should be made during succeeding injections, which should be at least three months apart.
Singapore's Ho also advises keeping the dose "low initially and then [raising it] accordingly during subsequent injections," usually after four to six months, "to maintain clinical improvement."
Dr. Leonardo Fugoso, chief of the movement disorders center of Saint Luke's Medical Center, said that Bt-A injection is the "treatment of choice for dystonia," although for "generalized and secretal dystonia, we use oral medication." He said that Dysport treatment "benefits the most number of patients in the shortest period of time" and that its "efficacy and safety have been demonstrated in many open and controlled trials."
Among the rehabilitation medicine specialists who shared their expertise during the workshop were: Dr. Jeanne Flordelis of the Chong Hua and Perpetual Succor Hospitals in Cebu City, who talked about the mechanisms of spasticity; and Dr. Joy Evangelista of the University of the Philippines-Philippine General Hospital, who presented objective measures and supportive therapeutic approaches in spasticity.
The NeuroRehab SIG conducts regular workshops for doctors who want to take advantage of the various applications of Dysport for their patients. Information programs may also be arranged for patients and their caretakers. More information may be obtained from Dr. O. Darvin (executive assistant of the SIG) or Ms. Richie Zabat (telephones +63-2-5324253 and +63-2-5331971, e-mail odarvin@compass.com.ph).
Antifungal Market to Grow 70%
in the Next 10 Years
LONDON
The global systemic antifungal market will be worth almost US$6 billion by 2014, its growth primarily driven by the novel echino-candin class, which is expected to grow at a compounded annual rate of 11.2 percent over the decade.
London-based independent market analyst Datamonitor makes this forecast in a recent survey examining the impact of key events in the systemic antifungal market.
The report, however, warns that the increasing competitiveness of the systemic antifungals market necessitates a larger commitment of prelaunch resources, with a lengthening payback period.
The global systemic antifungal market has experienced strong growth since 1999, increasing in value from US$2.1 billion to US$3.3 billion in 2003. The introduction of the echino-candin class has been a key driver of this growth, and has boosted the value of the echinocandin sector by US$312 million in 2003. Datamonitor forecasts the systemic antifungal market to be worth US$5.7 billion by 2014, representing a growth of 73 percent over the period.
Novel antifungals, such as Cancidas (caspofungin), experienced relatively slow initial uptake, as physicians have been reluctant to use it without detailed, peer-reviewed data. However, 2003 sales were significantly stronger than 2002, demonstrating an acceptance of its role in antifungal therapy. Datamonitor expects the value of the echinocandin class to triple, from US$429 million in 2004 to US$1.2 billion in 2014. This class will account for 22 percent of the total systemic antifungal market compared to just nine percent in 2003. While the azoles class will continue to dominate the antifungal market in 2014, their growth will be much lower.
Growing physician antifungal choices are leading to more selectivity in prescription choice. Consequently, the new azoles' product characteristics like oral bioavailability and ease of dosing are becoming key factors in new product uptake. Also like the novel azoles, Vfend (voriconazole) and posaconazole are expected to show rapid growth at the expense of older products such as Diflucan (fluconazole).
The launch of Vfend and Cancidas has created increased competition within a sector traditionally dominated by a limited number of products. As patent expiries and new product launches heighten competition, market penetration and product success will increasingly depend on effective positioning strategies and appropriate targeting of niche patient groups and pathogen types.
Pfizer is actively positioning Vfend as a successor, obtaining approvals for the treatment of Candida infections in addition to the original aspergillosis labeling. Pfizer is also well-positioned to take advantage of the potential offered by the Japanese market, with Vfend submitted for approval in June 2003, and a strong sales and marketing network in place through the promotion of Diflucan.
Fujisawa, through its marketing of AmBisome in the United States, should also reap the benefits of copromotion and possible combination therapy with the programmed US launch of micafungin in 2005. Although Merck & Co. currently markets only one antifungal product (Cancidas), the strong uptake expected over the next decade-as the product becomes firmly established in the treatment of severe and disseminated infections-will maintain the company's market share and antifungal sales revenue. Datamonitor
MSD Connects Cardiologists in Virtual Grand Rounds
Familial hypercholestero-lemia among Filipinos was the subject of the first virtual cardiology grand rounds held recently at the PGH-MSD Communication and Information Networking Center (CONNECT).
Senior cardiology fellow Ronald Santos of the University of the Philippines-Philippine General Hospital (UP-PGH) made the presentation, noting that although the prevalence of familial hypercholesterolemia among Filipinos is not very high, it exists and remains unknown to many.
Santos said the prevalence rate of familial hypercholesterolemia is 1:500 in the United States, Europe, and Japan and 1:100 in Lebanon and Saudi Arabia. It is a distinct condition that has a great impact on premature atherosclerosis. Santos said once a family member is diagnosed with hypercholeste-rolemia, all other members of the family must be tested.
"The key is primary prevention. Once you have diagnosed hypercholesterolemia in a family and treat it early, you really lower the risk of premature atherosclerosis and prevent early cardiac events. As we prevent other members of the family from having hypercholesterolemia, then the risk of having premature atherosclerosis is lowered," Santos explained.
The virtual cardiology grand rounds, a joint project of UP-PGH and Merck Sharp & Dohme (MSD), is a NetMeeting-enabled facility provided in nine MSD Resource Centers nationwide where medical symposia an conferences are telecast live. Doctors in different locations in the country interact on-line.
Kid-Friendly Medicines from Unilab
Parents often find it hard to make their kids take medication because of taste. A market study commissioned by United Laboratories showed that 77 percent of Filipino mothers point to bad taste of medicine as the major cause of noncompliance with treatment. It does not matter how effective a medicine is: if it looks, smells, and tastes bad, the child won't take it.
But Filipino ingenuity and creativity is changing children's attitudes toward taking medicine. PediaTech, the research and development arm of United Laboratories Inc., has introduced TasteRite, a technology that significantly masks the bitter taste of medicine.
The novel taste-masking system proves that Filipinos can be at par with their counterparts in multinational companies that have far greater resources to develop breakthrough technologies. "What really matters are good ideas," Jojo Santos, Unilab assistant vice president for research and development, said.
Unilab has filed international patent for the technology.
PediaTech developed the taste-masking system by combining two commonly used pharmaceutical polymers that temporarily bind the dissolved drug responsible for the bitter taste, preventing the tongue's taste receptors from detecting bitterness. When it reaches the stomach, the polymer system rapidly releases the bound drug, rendering it ready for absorption.
Unilab R and D director Joyce Santos said PediaTech is committed to make a difference in the lives of parents and children by developing breakthrough technologies and products that better satisfy patients' needs. "We have one strategy-make compliance simple and easy."
Launched in February 2003, the TasteRite technology can be applied to many bad-tasting drugs like paracetamol. It makes medicines for children more palatable, in the process enhancing compliance with medication.
Unilab assures the medicines manufactured with TasteRite technology are therapeutically equivalent to traditional bad-tasting medicines, having passed bioequivalence and clinical studies. Orendain and Associates
Pfizer, Aventis Seek Euro OK for Inhaled Insulin
Pfizer Inc. and Aventis are seeking permit from the European Medicines Evaluation Agency (EMEA) to market inhaled insulin in Europe for adult type 1 and type 2 diabetic patients.
The dry powder form of insulin inhaled into the lungs before eating closely mimics the normal physiological insulin response to meals by quickly being absorbed into the bloodstream to reduce meal-related spikes in glucose levels, Pfizer said.
The two firms have entered into a global agreement to collaborate in developing, manufacturing, and promoting inhaled insulin. Pfizer is also collaborating with Nektar Therapeutics, which developed the inhalation device and formulation.
Pfizer and Aventis are also eyeing to market inhaled insulin in the United States and are holding talks with the US Food and Drug Administration for the timing of the submission of their application for drug approval.
Breast Center Offers Multidisciplinary Approach
St. Luke's Medical Center (SLMC) has made a commitment to fighting breast cancer with the establishment of a dedicated Breast Center.
"We are providing women with the finest medical expertise for breast health along with a comfortable and supportive setting where all services can be found in one convenient location," says Dr. Alejandro C. Dizon, head of the center.
The center has a multidisciplinary team of specialists-surgical oncologists, medical oncologists, radiation oncologists, gynecologists, pathologists, plastic and reconstructive surgeons, physiatrists, psychiatrists, pain and palliative care specialists-to facilitate prompt evaluation, immediate results, and coordinated treatment and follow-up.
A new technology that offers accurate diagnosis of breast lesions, the Mammotome is an innovative, minimally invasive, vacuum-assisted biopsy system with minimal tissue trauma and patient discomfort.
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