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Tailoring treatments and emphasising prevention to be key in 2014

What advances in medicine can pharmacy expect to see in 2014 and how will they help with an increasingly elderly population and lifestyle-related health problems? Steve Titmarsh investigates

Clinical predictions for the year ahead

New medicines and guidance

The increasing age of the population brings with it a rise in the number of people with degenerative diseases such as dementia and cancer. Our lifestyles – taking less exercise and eating more processed and calorie-laden foods – compound the burden on the NHS with increasing rates of obesity, diabetes, and cardiovascular disease. Medicines expected to be licensed over the next 12 months reflect some of these trends (see Table 1, below).


Prevention through public health initiatives will be a growing theme next year. Nice is developing public health guidance on ‘Exercise referral schemes and 'Overweight' (an update of its 2006 guidance) and Obese adults - lifestyle weight management', due to be published in 2014.2



Table 1. Some of the medicines expected to be licensed during 2014

Drug

Indication

Apaziquone    

Bladder cancer

Cangrelor       

Acute coronary syndrome – thrombosis prevention

Carfilzomib     

Multiple myeloma

Chlormethine  

Cutaneous T cell lymphoma

Dasiprotimut-T

Non Hodgkin's lymphoma

Enobosarm     

Non-small cell cancer

Insulin degludec/insulin aspart           

Type 1 and 2 diabetes

Ipilimumab       

Prostate cancer

Ipilimumab, trametinib  

Malignant melanoma

Liraglutide       

Obesity

Obinutuzumab, ofatumumab  

Chronic lymphocytic leukaemia

Pazopanib, bevacizumab, vintafolide, paclitaxel

Ovarian cancer

Sorafenib       

Thyroid cancer, renal cell carcinoma

Trastuzumab emtansine, bevacizumab, everolimus

Breast cancer

Vorapaxar

Secondary prevention of cardiovascular events


Source: UKMi. Prescribing Outlook - New Medicines. September 2013


 

Efficiency versus cost

However, there are tensions that could slow the rate of progress. For example, NHS organisations are mandated to make funding available for new medicines that Nice deems cost effective.3 But these new medicines can be significantly more expensive than currently used drugs and, while the NHS is under pressure to improve the quality and delivery of care, it has also been tasked with making efficiency savings of £20 billion by 2014-15.4 It will take significant cultural and organisational change to fully embrace new ways of working to take advantage of any benefits newer therapies have to offer. That process has begun but the changes will not be fully realised for some time, perhaps not even before the next NHS reorganisation.



Personalised medicines

Developments in genetics are really starting to bear fruit in the use and development of new medicines, particularly in oncology. Biomarkers are being identified that help identify patients who will benefit most from specific medicines. For example, the EGFR-TK mutation test can be used to identify patients with non-small cell lung cancer (NSCLC) who have a specific mutation in their EGFR gene. This mutation is found in 10 to 15 per cent of NSCLC patients and is important because those patients without the mutation will respond better to standard chemotherapy.5


Personalisation of medication is a theme that will continue to develop in medicine. And pharmacists can play their part through medicines optimisation, helping to ensure that each individual obtains the best outcomes. Optimising the use of medicines is particularly important for patients with long-term conditions and community pharmacists are seen as having a key role in more integrated health services.6 This is supported by the Nice scoping document on medicines optimisation, which says: ‘Medicines are the most common intervention in healthcare. Over one billion prescription items were dispensed in the community in England in 2012, at a cost of £8.5bn.'7


The challenges of funding and delivery, coupled with pharmacy's position as an easily accessible point of contact for patients, presents the sector with a real opportunity to demonstrate its contribution to health and wellbeing and make the case to be an equal partner in the ‘renewed' NHS in 2014.



References

1. kingsfund.org.uk/projects/new-nhs (accessed December 2013).

2. guidance.nice.org.uk/PHG/InDevelopment (accessed December 2013).

3. Nice, Good practice guidance: Developing and updating local formularies (2013). nice.org.uk/mpc/goodpracticeguidance/GPG1.jsp (accessed December 2013).

4. improvement.nhs.uk/Default.aspx?alias=www.improvement.nhs.uk/qipp (accessed December 2013).

5.  Parliamentary Office of Science and Technology. Personal cancer treatments. Post Note 406;March 2012.

6.  pjonline.com/news/nhs_issues_call_to_action_over_community_pharmacy%E2%80%99s_place_in_primary_care (accessed December 2013).

7. nice.org.uk/nicemedia/live/14175/65802/65802.pdf (accessed December 2013).

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