The medical letter on drugs and therapeutics october 13 2014

The Medical Letter ® on Drugs and Therapeutics Objective Drug Reviews Since 1959 Volume 56 ISSUE ISSUE No 1433 1453 Volume 56 October 13, 2014 IN THIS ISSUE Influenza Vaccine for 2014-2015 p 97 Empagliflozin (Jardiance) for Diabetes p 99 A Stool DNA Test (Cologuard) for Colorectal Cancer Screening p 100 Rescheduling of Hydrocodone Combination Products p 101 In Brief: PCV13 for Adults >65 Years Old p 102 Important Copyright Message FORWARDING OR COPYING IS A VIOLATION OF U.S AND INTERNATIONAL COPYRIGHT LAWS The Medical Letter, Inc publications are protected by U.S and international copyright laws Forwarding, copying or any distribution of this material is prohibited Sharing a password with a non-subscriber or otherwise making the contents of this site available to third parties is strictly prohibited By accessing and reading the attached content I agree to comply with U.S and international copyright laws and these terms and conditions of The Medical Letter, Inc For further information click: Subscriptions, Site Licenses, Reprints or call customer service at: 800-211-2769 Published by The Medical Letter, Inc • A Nonprofit Organization Revised 11/5/2014: See Tables and for new age indication for FluBlock (now >18 years) The Medical Letter publications are protected by US and international copyright laws Forwarding, copying or any other distribution of this material is strictly prohibited For further information call: 800-211-2769 The Medical Letter ® on Drugs and Therapeutics Objective Drug Reviews Since 1959 Volume 56 ISSUE ISSUE No 1433 1453 Volume 56 ▶ October 13, 2014 Take CME Exams ALSO IN THIS ISSUE Empagliflozin (Jardiance) for Diabetes p 99 A Stool DNA Test (Cologuard) for Colorectal Cancer Screening p 100 Rescheduling of Hydrocodone Combination Products p 101 In Brief: PCV13 for Adults ≥65 Years Old p 102 Influenza Vaccine for 2014-2015 Table 2014-2015 Seasonal Influenza Vaccine1 Composition Annual vaccination against influenza A and B viruses has been shown to decrease influenza illness and its complications.1 Trivalent Vaccine (Inactivated) A/California/7/2009 H1N1-like A/Texas/50/2012 H3N2-like B/Massachusetts/2/2012-like (Yamagata lineage) EFFECTIVENESS — The effectiveness of the seasonal vaccine in preventing influenza in healthy adults depends on the match between the vaccine and circulating strains Vaccine effectiveness is highest (50-80% in young adults; lower in the elderly) when the match is close, but even when the match is poor, vaccination has been shown to reduce the risk of death from influenza.2 In addition, vaccination of children and adolescents can protect unvaccinated residents of the same community.3 Quadrivalent Vaccine (Live-Attenuated and Inactivated) A/California/7/2009 H1N1-like A/Texas/50/2012 H3N2-like B/Massachusetts/2/2012-like (Yamagata lineage) B/Brisbane/60/2008-like (Victoria lineage) Live vs Inactivated – The intranasal live-attenuated influenza vaccine, FluMist Quadrivalent, is only recommended for healthy, non-pregnant persons 2-49 years old It appears to be more effective than the inactivated vaccine in children ≤6 years old.4 In adults, the inactivated influenza vaccine has been more effective than the intranasal live vaccine.5 High-Dose Inactivated Vaccine – Older adults may have a lower antibody response to influenza vaccination than younger adults.6 Fluzone High-Dose, which contains 60 mcg of hemagglutinin antigen from each strain compared to 15 mcg in the conventional vaccine, induced significantly higher antibody responses than the standard-dose inactivated influenza vaccine in a study in 31,989 adults ≥65 years old, with no increase in serious adverse effects It was more effective than the standarddose vaccine in preventing influenza; laboratoryconfirmed influenza illness occurred in 1.4% of adults who received the high-dose vaccine compared to 1.9% of those who received the standard-dose vaccine.7 Who Should Be Vaccinated Everyone ≥6 months old without a specific contraindication, including pregnant women Timing Now through the end of the influenza season (about May 2015) Choice of Vaccine2 Pregnant women Inactivated standard-dose vaccine Healthy children 2-8 years old Preferred: intranasal live-attenuated vaccine (FluMist Quadrivalent) Alternative: inactivated vaccine3 if FluMist is contraindicated or unavailable Healthy adults 18 years >18 years >3 years >4 years >4 years >3 years >6 months7 >65 years 18-64 years $11.30 10.55 15.90 32.755 19.13 7.65 14.81 13.63 12.49 10.69 29.405 15.625 0.5 mL syringe2 mL multidose vial 0.5 mL syringe2 0.5 mL syringe2 0.5 mL vial2 mL multidose vial none 3 years >3 years >3 years >3 years >3 years >6 months7 15.90 14.90 15.905 17.15 17.97 16.15 0.2 mL sprayer10 none 2-49 years11 22.70 Inactivated Influenza Vaccines (IIV) Trivalent (IIV3) Afluria (bioCSL) Fluarix (GSK) FluBlok (Protein Sciences)4 Flucelvax (Novartis)6 FluLaval (GSK) Fluvirin (Novartis) Fluzone (Sanofi Pasteur) Fluzone High-Dose 8 Fluzone Intradermal 9 Quadrivalent (IIV4) Fluarix Quadrivalent (GSK) FluLaval Quadrivalent (GSK) Fluzone Quadrivalent (Sanofi Pasteur) Live-Attenuated Influenza Vaccine (LAIV) FluMist Quadrivalent (Medimmune) Private sector cost (including excise tax) per dose as of August 1, 2014 according to the CDC Vaccine Price List Available at www.cdc.gov/vaccines/ programs/vfc/awardees/vaccine-management/price-list/index.html Accessed October 2, 2014 Sold in boxes of 10 FDA-approved for use in persons ≥5 years of age For 2014-2015, the ACIP recommends that Afluria not be administered to children