Discontinuation of antihyperlipidemic drugs - do rates reported in clinical trials reflect rates in primary care settings?

Article Abstract:

Primary care patients taking antihyperlipidemic drugs may discontinue treatment at higher rates than have been reported by clinical trials. Antihyperlipidemic medications are used to lower the level of fat in the blood. Researchers compared the discontinuation rates of primary care patients in two health maintenance organizations (HMOs) with those of people enrolled in clinical trials. Forty-one percent of the HMO patients stopped taking bile acid sequestrants, compared to 31% of those enrolled in trials. Almost half the HMO patients stopped taking niacin, compared to 4% of the trial patients. Thirty-seven percent of the HMO patients stopped taking gemfibrozil, compared to 15% of the trial patients. Patients in clinical trials have access to more services than are available to the general public. It may be misleading to use data from clinical trials to evaluate the effectiveness of antihyperlipidemic drugs.

Usage, Statistics, Drug utilization, Drug monitoring, Antilipemic agents

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Low power and striking results - a surprise but not a paradox

Article Abstract:

The editors of the New England Journal of Medicine in 1995 published a research report that would not ordinarily be published for statistical reasons. The authors studied the use of bone marrow transplantation in patients with non-Hodgkin's disease who did not respond completely to chemotherapy. Only 69 patients were allocated to one of two treatment groups: continued chemotherapy or bone marrow transplant. The small size of the treatment groups means that the study had little statistical power to detect a definite difference in the treatment groups. Yet the confidence intervals for survival rates reported by the authors still indicate that whatever small advantage bone marrow transplantation confers, its expense and risks do not justify its use in these patients.

Editorial, Analysis, Medical publishing, Medical statistics

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Hepatitis B vaccination and the risk of multiple sclerosis

Article Abstract:

There appears to be no link between hepatitis B vaccination and multiple sclerosis, according to a study of 192 women with multiple sclerosis and 534 healthy women. There was also no increased risk of multiple sclerosis in women who received more than one dose of the vaccine.

Complications and side effects, Risk factors, Multiple sclerosis, Hepatitis B vaccine, Hepatitis B vaccines

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