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This paper presents a cost analysis of the utilisation of infliximab for the treatment of Crohn's disease. The indication for infliximab for Dutch Crohn patients is an active disease with insufficient improvement on adequate therapy with corticosteroids and/or immunosuppressive therapy. We compared direct health-care costs (hospital and community pharmacy) before and after first infliximab treatment for 21 Crohn patients in the University Hospital Groningen who started infliximab during 1 January 2000 to 15 march 2001. Our study design was observational and patients served as their own controls with similar periods before and after infliximab per patient considered (minimally 3 months before and 3 months after infliximab). Drug costs for infliximab (including administration) were estimated at € 5800,- per patient-year. Excluding infliximab costs, costs per patient-year were € 6400,- and € 8600,-before and after first infliximab treatment, respectively. In both periods, the majority of the other costs was related to hospitalization. Also, drug costs in the community pharmacy were estimated to contribute relevant shares. Other researchers have found decreases in medical costs after the start of infliximab treatment. We found the opposite development. More experience and routine with infliximab treatment may lower costs in the future.

This paper presents a cost analysis of the utilisation of infliximab for the treatment of Crohn's disease. The indication for infliximab for Dutch Crohn patients is an active disease with insufficient improvement on adequate therapy with corticosteroids and/or immunosuppressive therapy. We compared direct health-care costs (hospital and community pharmacy) before and after first infliximab treatment for 21 Crohn patients in the University Hospital Groningen who started infliximab during 1 January 2000 to 15 march 2001. Our study design was observational and patients served as their own controls with similar periods before and after infliximab per patient considered (minimally 3 months before and 3 months after infliximab). Drug costs for infliximab (including administration) were estimated at € 5800,- per patient-year. Excluding infliximab costs, costs per patient-year were € 6400,- and € 8600,-before and after first infliximab treatment, respectively. In both periods, the majority of the other costs was related to hospitalization. Also, drug costs in the community pharmacy were estimated to contribute relevant shares. Other researchers have found decreases in medical costs after the start of infliximab treatment. We found the opposite development. More experience and routine with infliximab treatment may lower costs in the future.

Drug therapy in cystic fibrosis is focused on pulmonary infection and inflammation, intestinal obstruction and the substitution of pancreas enzymes. Most morbidity and mortality arises from the pulmonary infection and subsequent tissue destruction and deterioration of lung function. Antibiotic treatment is the mainstay of therapy. Nebulised antibiotics improve lung function and the incidence of acute exacerbations is reduced in patients chronically infected with Pseudomonas. Macrolides play a special role probably due to an antiinflammatory effect. Inhalation of rhDNAse improves lung function and decreases deterioration of lung function. New therapeutics directed at the CFTR defect are not yet available. Pharmacokinetics in CF patients may differ from those in healthy volunteers, probably due to differences in body composition.

Drug therapy in cystic fibrosis is focused on pulmonary infection and inflammation, intestinal obstruction and the substitution of pancreas enzymes. Most morbidity and mortality arises from the pulmonary infection and subsequent tissue destruction and deterioration of lung function. Antibiotic treatment is the mainstay of therapy. Nebulised antibiotics improve lung function and the incidence of acute exacerbations is reduced in patients chronically infected with Pseudomonas. Macrolides play a special role probably due to an antiinflammatory effect. Inhalation of rhDNAse improves lung function and decreases deterioration of lung function. New therapeutics directed at the CFTR defect are not yet available. Pharmacokinetics in CF patients may differ from those in healthy volunteers, probably due to differences in body composition.

BACKGROUND: In chronic inpatients polypharmacy is common and sometimes the combinations of psychotropics are irrational from a theoretical point of view. AIMS Registration of polypharmacy and irrational combinations in clinical practice. METHODS: In this descriptive study of 127 longstay patients in a psychiatric hospital we registrated the frequency of polypharmacy, the number of irrational combinations of psycho tropics and the reasons to describe these combinations. We tried to find a relation with the type of housing (an indirect measure for the intensity of care) and to the DSM-IV diagnosis. RESULTS: We found the use of four or five psychotropics in 24% of the population, in these cases we found irrational combinations in 89%. This group mainly consisted of patients with (partial) therapy-resistant schizophrenia of the undifferentiated and disorganised subtype and with schizo-affective disorder. In the total group of users of four and five psychotropics we found relatively more premorbid personality disorders and mild mental retardation. The percentage of users of four and five psychotropics increased with the intensity of care. Irrational combinations were mainly the result of long-lasting treatment of complex symptomatology. Following literature, a list of possible treatments in case of therapy resistance and conduct disorders is given. The authors give recommendations for further research on addition with a second high-potency antipsychotic drug in the case of therapy resistance for clozapine, and for fostering the quality of prescribing low-potency antipsychotic drugs and benzodiazepines for addition in the case of conduct disorders. CONCLUSIONS: Polypharmacy and irrational combinations occur frequently in chronic inpatients and seem inevitable.

BACKGROUND: In chronic inpatients polypharmacy is common and sometimes the combinations of psychotropics are irrational from a theoretical point of view. AIMS Registration of polypharmacy and irrational combinations in clinical practice. METHODS: In this descriptive study of 127 longstay patients in a psychiatric hospital we registrated the frequency of polypharmacy, the number of irrational combinations of psycho tropics and the reasons to describe these combinations. We tried to find a relation with the type of housing (an indirect measure for the intensity of care) and to the DSM-IV diagnosis. RESULTS: We found the use of four or five psychotropics in 24% of the population, in these cases we found irrational combinations in 89%. This group mainly consisted of patients with (partial) therapy-resistant schizophrenia of the undifferentiated and disorganised subtype and with schizo-affective disorder. In the total group of users of four and five psychotropics we found relatively more premorbid personality disorders and mild mental retardation. The percentage of users of four and five psychotropics increased with the intensity of care. Irrational combinations were mainly the result of long-lasting treatment of complex symptomatology. Following literature, a list of possible treatments in case of therapy resistance and conduct disorders is given. The authors give recommendations for further research on addition with a second high-potency antipsychotic drug in the case of therapy resistance for clozapine, and for fostering the quality of prescribing low-potency antipsychotic drugs and benzodiazepines for addition in the case of conduct disorders. CONCLUSIONS: Polypharmacy and irrational combinations occur frequently in chronic inpatients and seem inevitable.

On the Dutch market soon the first COX-2-selective NSAID's will become available. Because these agents selective inhibit the isoenzyme that is involved in inflammation, these drugs will show a better effectiveness/safety ratio, compared to classic NSAID's. In this article we present the current insights on COX-2-NSAID's.

On the Dutch market soon the first COX-2-selective NSAID's will become available. Because these agents selective inhibit the isoenzyme that is involved in inflammation, these drugs will show a better effectiveness/safety ratio, compared to classic NSAID's. In this article we present the current insights on COX-2-NSAID's.

De prevalentie van overgewicht en obesitas bij kinderen neemt snel toe. Deze toename zal gepaard gaan met meer vóórkomen van diabetes mellitus type 2 bij jeugdigen. De belangrijkste beïnvloedbare risicofactor voor het ontstaan van insulineresistentie bij jongeren is overgewicht. De diagnostische criteria voor ‘diabetes mellitus’ bij jeugdigen zijn: (a) symptomen van diabetes mellitus en een willekeurige plasmaglucoseconcentratie ≥ 11,1 mmol/l, of (b) nuchtere plasmaglucoseconcentratie ≥ 7,0 mmol/l, of (c) 2-uursplasmaglucosewaarde na een glucosebelasting (in een tolerantietest) ≥ 11,1 mmol/l. Behandeling bestaat uit het verlagen van de glucoseconcentratie door veranderingen in leefstijl, zoals meer lichamelijke beweging en een dieet. In de VS is metformine geregistreerd voor gebruik bij jeugdigen. Bij ernstige hyperglykemie of diabetische ketoacidose is insuline geïndiceerd. Vroege opsporing is nuttig bij kinderen met obesitas en 2 additionele risicofactoren: diabetes type 2 bij eerste- of tweedegraadsfamilieleden, behorend tot een bepaalde etnische minderheid, of aanwijzingen voor insulineresistentie.

De prevalentie van overgewicht en obesitas bij kinderen neemt snel toe. Deze toename zal gepaard gaan met meer vóórkomen van diabetes mellitus type 2 bij jeugdigen. De belangrijkste beïnvloedbare risicofactor voor het ontstaan van insulineresistentie bij jongeren is overgewicht. De diagnostische criteria voor ‘diabetes mellitus’ bij jeugdigen zijn: (a) symptomen van diabetes mellitus en een willekeurige plasmaglucoseconcentratie ≥ 11,1 mmol/l, of (b) nuchtere plasmaglucoseconcentratie ≥ 7,0 mmol/l, of (c) 2-uursplasmaglucosewaarde na een glucosebelasting (in een tolerantietest) ≥ 11,1 mmol/l. Behandeling bestaat uit het verlagen van de glucoseconcentratie door veranderingen in leefstijl, zoals meer lichamelijke beweging en een dieet. In de VS is metformine geregistreerd voor gebruik bij jeugdigen. Bij ernstige hyperglykemie of diabetische ketoacidose is insuline geïndiceerd. Vroege opsporing is nuttig bij kinderen met obesitas en 2 additionele risicofactoren: diabetes type 2 bij eerste- of tweedegraadsfamilieleden, behorend tot een bepaalde etnische minderheid, of aanwijzingen voor insulineresistentie.

On the Dutch market soon the first COX-2-selective NSAID's will become available. Because these agents selective inhibit the isoenzyme that is involved in inflammation, these drugs will show a better effectiveness/safety ratio, compared to classic NSAID's. In this article we present the current insights on COX-2-NSAID's.