Prescription Trend in Antihypertensive Drugs in Mumbai And Suburbs: A Survey

A872

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8

Objectives: There is variety of causes of having a disease and hub cause leading to having multiple diseases. By eliminating the cause, the risk of having multiple diseases could be reduced. In this study, I developed the network structure, disease structural model, to analyze the cause and effect of history of diseases.  Methods: To develop the disease structural model, National Health and Nutrition Examination Survey (NHANES) 2011-2012 which assess the health and nutritional status of 5,389 people in the United States was used. The following fields in NHANES were chosen; demographic data (age, male, human race, citizen of US), social status (educational level, marital status, annual house hold income, health insurance covered), lifestyle habit (smoking, had at least 12 alcohol drink per year, hours watch TV or videos past), laboratory data (glycohemoglobin, HDL cholesterol, total cholesterol, systolic blood pressure, body mass index), health status, history of disease (mild cognitive impairment, gout, heart disease, cerebral vascular disorder, heart attack, asthma, anemia, angina, chronic bronchitis, cancer). The model was analyzed by calculating dimension.  Results: Using NHANES public data, I developed the disease structural model. AIC was . The highest in degree, 5, was HDL and smoking. The highest out degree, 10, was high blood pressure (systolic blood pressure > = 140 mmHg). The high blood pressure had the highest degree, 13 and it was the central node. No cause and effect was found between annual income and history of disease.  Conclusions: I developed the disease structural model and found that high blood pressure could be hub of history of disease such as cerebral vascular disease and heart disease and no cause and effect between annual income and history of disease. PCV56 Prescription Trend in Antihypertensive Drugs in Mumbai And Suburbs: A Survey Desai GV, Desai NS, D’souza DM, Kumar MS, Ningoo MS, Shah RS, Majumdar AS Bombay College of Pharmacy, Mumbai, India

Objectives: There is a myriad of generic brands of antihypertensive drugs found in the Indian pharmaceutical market. These brands contain a single drug or a combination of drugs that are prescribed by physicians. This survey was designed to study the prescription trend in antihypertensives in Mumbai and suburbs.  Methods: The survey was questionnaire based and was conducted in retail pharmacies as well as hospital pharmacies. The response received was then evaluated and statistical comparisons were performed. The survey comprised of the following questions: a) The average number of prescriptions received per week for antihypertensives. b) The drugs which are highly prescribed and their number of prescriptions per week. c) Is combination therapy commonly prescribed? If yes, what are the most prescribed combinations and what are their numbers per week?  Results: The survey in retail pharmacies revealed that as monotherapy, the major prescribed generic brands contain the actives telmisartan (32%) and amlodipine (26%). While in hospital pharmacies, the major prescriptions were for telmisartan (45%) and amlodipine (40%). With respect to generic brands featuring fixed dose combinations in retail pharmacy prescriptions, 20% were for amlodipine-atenolol and 20% for amlodipine-telmisartan. Whereas in hospital pharmacies, 35% were for amlodipine-telmisartan and 18% were for amlodipine-metoprolol.  Conclusions: Thus mapping the prescription trends, it was concluded that branded generics containing the actives telmisartan and those containing amlodipine were majorly prescribed as per retail and hospital pharmacy records which was captured by the questionnaire for monotherapy in hypertension. With respect to combination therapy, varied combinations of drugs were seen to be prescribed, no particular drug combination being predominant in retail pharmacies. In hospital pharmacies, the combination amlodipine-telmisartan was being relatively prescribed more. PCV57 Identification of Statin Intolerance: Results From A Survey of South Korean Clinicians McKendrick J1, Gandra SR2, Cheng L3, Hovingh GK4, Dent R3, Wieffer H1, Catapano AL5, Oh P6, Rosenson RS7, Stroes ES4 1PRMA Consulting Ltd, Fleet, UK, 2Amgen Inc., Thousand Oaks, CA, USA, 3Amgen, Inc., Thousand Oaks, CA, USA, 4Academic Medical Center, Amsterdam, The Netherlands, 5University of Milano and IRCCS Multimedica, Milano, Italy, 6Toronto Rehabilitation Institute, Toronto, ON, Canada, 7Mount Sinai Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA

Objectives: To understand how clinicians in South Korea identify patients with statin intolerance (SI).  Methods: A web-based survey was conducted in South Korea between November-December 2015. The survey asked participants to report on how they identify patients with SI. Specialists and general/family physicians (GPs) participated; they were required to have treated ≥ 75 and 50 patients with hypercholesterolemia, respectively, in the previous 12 months, and ≥ 5 patients presenting with SI symptoms. All participants provided informed consent.  Results: Thirty specialists and 30 GPs participated. Around 4% of patients treated with statins present with signs/symptoms of potential SI and 0.3% of patients have SI confirmed. Both specialists and GPs reported similar symptoms in patients with potential SI. Persistent elevation in transaminases was identified as the most common sign of SI at presentation (44%); 27% of patients had muscle-related symptoms (MRS) and 24% had elevated creatine kinase (CK) without MRS. Other symptoms (5%) included alopecia and gastric symptoms, and CNS effects (1%). Minimum criteria used by 63% of specialists and 77% of GPs to establish SI in patients with persistent elevation of transaminase were re-challenge and trying treatment with ≥ 2 statins. For patients with muscle-related symptoms, 50% of specialists and 80% of GPs would also require both rechallenge and trying treatment with ≥ 2 statins; in addition, 83% of both specialists and GPs would require a decrease in CK upon statin treatment modification or discontinuation of the statin regimen, and 70% of specialists and 90% of GPs would require other potential causes of signs/symptoms to be excluded.  Conclusions: Based on a survey and consistent with recent global guidance regarding management of SI, the majority of clinicians in South Korea required rechallenge and treatment with ≥ 2 statins to confirm SI in a patient with persistent elevation of transaminase or MRS.

PCV58 Management of Patients with Statin Intolerance in Japan, South Korea and Taiwan: Comparison of Results From A Clinician Survey Kajinami K1, McKendrick J2, Gandra SR3, Cheng L4, Hovingh G5, Dent R4, Wieffer H2, Catapano AL6, Oh P7, Rosenson RS8, Stroes ES5 1Kanazawa Medical University, Uchinada, Japan, 2PRMA Consulting Ltd, Fleet, UK, 3Amgen Inc., Thousand Oaks, CA, USA, 4Amgen, Inc., Thousand Oaks, CA, USA, 5Academic Medical Center, Amsterdam, The Netherlands, 6University of Milano and IRCCS Multimedica, Milano, Italy, 7Toronto Rehabilitation Institute, Toronto, ON, Canada, 8Mount Sinai Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA

Objectives: To compare how clinicians manage patients with statin intolerance (SI) in Japan, South Korea and Taiwan.  Methods: A web-based survey was conducted in Japan between January-February 2014, and in South Korea and Taiwan between November-December 2015. In total, 180 specialists and general/family physicians (GPs) participated; they were required to have treated ≥ 75 and 50 patients with hypercholesterolemia, respectively, in the previous year, and ≥ 5 patients presenting with SI symptoms. Informed consent was provided.  Results: Clinicians estimated a low prevalence of SI (Japan, 2%; South Korea, 0.3%; Taiwan, 2%). Clinicians in Japan were less likely to prescribe a low-dose statin to SI patients than in South Korea and Taiwan (mean proportion of case load: 29%, 61% and 56% respectively); 14% (Japan), 23% (South Korea) and 28% (Taiwan) of patients did not receive a concomitant nonstatin lipid-lowering therapy (LLT). Clinicians used non-statin LLT either as monotherapy or with a low-dose statin (Japan: 55%, 15%; South Korea, 23%, 38%; Taiwan, 37%, 28% respectively). A small proportion of SI patients received no therapy (Japan, 16%; South Korea, 16%; Taiwan, 7%). Within Japan and Taiwan, similar patterns were reported for specialists and GPs for use of low-dose statin and non-statin LLT treatment. However, a non-statin LLT was used by 70% of specialists and 53% of GPs in South Korea. Ezetimibe was the first choice non-statin LLT selected by clinicians as a monotherapy (Japan, 72%; South Korea, 47%; Taiwan, 80%) or in combination with a low-dose statin (Japan, 38%; South Korea, 50%; Taiwan, 82%), although GPs in South Korea preferred fish oil.  Conclusions: The estimated prevalence of SI was low across countries. Low-dose statins are used more frequently for SI patients in South Korea and Taiwan than Japan. Non-statin LLT was commonly prescribed with concomitant low-dose statin in South Korea and without in Japan and Taiwan. PCV59 Identification of Statin Intolerance: Results From A Survey of Clinicians in Taiwan Kajinami K1, McKendrick J2, Gandra SR3, Cheng L4, Hovingh GK5, Dent R4, Wieffer H2, Catapano AL6, Oh P7, Rosenson RS8, Stroes ES5 1Kanazawa Medical University, Uchinada, Japan, 2PRMA Consulting Ltd, Fleet, UK, 3Amgen Inc., Thousand Oaks, CA, USA, 4Amgen, Inc., Thousand Oaks, CA, USA, 5Academic Medical Center, Amsterdam, The Netherlands, 6University of Milano and IRCCS Multimedica, Milano, Italy, 7Toronto Rehabilitation Institute, Toronto, ON, Canada, 8Mount Sinai Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA

Objectives: To understand how clinicians based in Taiwan identify patients with statin intolerance (SI).  Methods: A web-based survey was conducted in Taiwan between November-December 2015. The survey asked participants to report on how they identify patients with SI. Specialists and general/family physicians (GPs) participated; they were required to have treated ≥ 75 and 50 patients with hypercholesterolemia, respectively, in the previous 12 months, and ≥ 5 patients presenting with SI symptoms. All participants provided informed consent.  Results: Thirty specialists and 30 GPs participated in the survey. Clinicians reported an average of 46% of patients with potential SI presented with muscle-related symptoms (MRS). Other common signs of potential SI reported by clinicians were persistent elevation in transaminases (25%) and elevated creatine kinase (CK) without MRS (11%). On average, 9% of patients presented with other symptoms, such as gastric symptoms and alopecia, and 1% presented with CNS effects. Approximately 93% of GPs and 80% of specialists would use rechallenge to confirm SI. The remainder would see if symptoms improved or resolved when the statin was discontinued or lowered. Almost all GPs (90%) and specialists (83%) would try ≥ 2 statins before they considered a patient as SI. Rechallenge and trying ≥ 2 statins was reported as the minimum criteria to confirm SI by 63% clinicians; the majority of clinicians (95%) would also recheck known elevated CK levels after modifying or stopping a statin. It was estimated by clinicians that 10% of all patients treated with statins presented with signs/symptoms of SI and 2% of all patients had their SI confirmed.  Conclusions: Based on a survey conducted in Taiwan and in accordance with recent global guidance regarding management of SI, the majority of clinicians used rechallenge and alternative statins before confirming that a patient with MRS was SI. PCV60 Identification of Statin Intolerance: Results From a Survey of Clinicians in Japan McKendrick J1, Gandra SR2, Hovingh GK3, Dent R4, Wieffer H1, Catapano AL5, Oh P6, Rosenson RS7, Stroes ES3 1PRMA Consulting Ltd, Fleet, UK, 2Amgen Inc., Thousand Oaks, CA, USA, 3Academic Medical Center, Amsterdam, The Netherlands, 4Amgen, Inc., Thousand Oaks, CA, USA, 5University of Milano and IRCCS Multimedica, Milano, Italy, 6Toronto Rehabilitation Institute, Toronto, ON, Canada, 7Mount Sinai Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA

Objectives: To understand how Japanese clinicians identify patients with statin intolerance (SI).  Methods: A web-based survey was conducted in Japan between January-February 2014. The survey asked participants to report on how they identify patients with SI. Specialists and general/family physicians (GPs) participated; they were required to have treated ≥ 75 and 50 patients with hypercholesterolemia, respectively, in the previous 12 months, and ≥ 5 patients presenting with SI symptoms. Participants provided informed consent.  Results: Forty specialists and 20 GPs completed the survey. Overall, an estimated 13% of patients treated with statins have potential SI; 2% of these have their SI confirmed. All symptoms of potential SI