Alan Lenox-smith - Academia.edu (original) (raw)

Papers by Alan Lenox-smith

Research paper thumbnail of A double-blind, randomised, placebo controlled study of venlafaxine XL in patients with generalised anxiety disorder in primary care

PubMed, Oct 1, 2003

Background: Generalised anxiety disorder (GAD) is one of the commonest anxiety disorders and is t... more Background: Generalised anxiety disorder (GAD) is one of the commonest anxiety disorders and is treated almost entirely in primary care. Most recent studies performed in GAD have excluded depression for regulatory reasons. As GAD is usually a co-morbid disease, often co-existing with depression, the results from recent studies have only limited relevance to the naturalistic population. This study was set up to investigate venlafaxine XL in a more naturalistic population of patients with GAD. Aim: To assess the efficacy of venlafaxine XL in patients with generalised anxiety disorder with and without co-morbid depression. Design of study: Double-blind, randomised, placebo controlled, parallel-group, 24-week study. Setting: Primary care in the UK. Methods: Patients enrolled in the study were over 18 years old, met DSM-IV criteria for GAD, and had a score of 20 or more on the Hamilton Anxiety Scale (HAM-A). A score of more than 23 on the Montgomery Asberg Depression Rating Scale (MADRS) excluded patients. Eligible patients were randomised to receive 75 mg of venlafaxine or a matching placebo. After 2 weeks the dose could be doubled if the physician considered the response to be poor. The study duration was 24 weeks. Results: 244 patients were enrolled, with 122 randomised to the placebo and 122 to venlafaxine. Baseline characteristics were similar for both groups, each having a mean total HAM-A score at baseline of 28. The difference from the placebo group at 24 weeks on the total HAM-A score was 2.1 points (95% 0 to 4.2), which was statistically significant (P = 0.05). Remission rates at week 24 were 27.9% for the venlafaxine XL group and 18.9% for placebo group (P = 0.11). Conclusion: Venlafaxine was efficacious in the treatment of patients with GAD with and without depression over a 24-week period.

Research paper thumbnail of Excess Costs Associated with Possible Misdiagnosis of Alzheimer’s Disease Among Patients with Vascular Dementia in a UK CPRD Population

Journal of Alzheimer's Disease, Jun 22, 2016

Background: Prior diagnosis of Alzheimer's disease (AD) among patients later diagnosed with vascu... more Background: Prior diagnosis of Alzheimer's disease (AD) among patients later diagnosed with vascular dementia (VaD) has been associated with excess costs, suggesting potential benefits of earlier rule-out of AD diagnosis. Objective: To investigate whether prior diagnosis with AD among patients with VaD is associated with excess costs in the UK. Methods: Patients with a final VaD diagnosis, continuous data visibility for ≥6 months prior to index date, and linkage to Hospital Episode Statistics data were retrospectively selected from de-identified Clinical Practice Research Datalink data. Patients with AD diagnosis before a final VaD diagnosis were matched to similar patients with no prior AD diagnosis using propensity score methods. Annual excess healthcare costs were calculated for 5 years post-index, stratified by time to final diagnosis. Results: Of 9,311 patients with VaD, 508 (6%) had prior AD diagnosis with a median time to VaD diagnosis exceeding 2 years from index date. Over the entire follow-up period, patients with prior AD diagnosis had accumulated healthcare costs that were approximately GBP2,000 higher than those for matched counterparts (mostly due to higher hospitalization costs). Cost differentials peaked particularly in the period including the final VaD diagnosis, with excess costs quickly declining thereafter. Conclusion: Potential misdiagnosis of AD among UK patients with VaD resulted in substantial excess costs. The decline in excess costs following a final VaD diagnosis suggests potential benefits from earlier rule-out of AD.

Research paper thumbnail of Are there different predictors of analgesic response between antidepressants and anticonvulsants in painful diabetic neuropathy?

European Journal of Pain, 2015

To investigate baseline demographics and disease characteristics as predictors of the analgesic e... more To investigate baseline demographics and disease characteristics as predictors of the analgesic effect of duloxetine and pregabalin on diabetic peripheral neuropathic pain (DPNP).

Research paper thumbnail of Noradrenergic function in generalised anxiety disorder (GAD): A single photon emission tomography (SPET) study

Research paper thumbnail of Oligosymptomatic Hypocalcaemia in a Patient with Impaired Parathyroid Hormone Activity

Journal of the Royal Society of Medicine, 1988

Research paper thumbnail of Bisoprolol Alone and in Combination with Amlodipine or Nifedipine in the Treatment of Chronic Stable Angina

International Journal of Clinical Practice

Beta-blockers and calcium antagonists are both effective monotherapy for stable angina. When symp... more Beta-blockers and calcium antagonists are both effective monotherapy for stable angina. When symptoms persist, these two agents are commonly co-prescribed in the hope that this combination has added benefit compared with monotherapy alone. We investigated the additional efficacy of the calcium antagonists amlodipine and nifedipine when added to bisoprolol in patients with stable angina. Patients were randomised in a multicentre, single-blind study, with crossover of three treatments consisting of bisoprolol 10 mg once daily, bisoprolol plus nifedipine 20 mg twice daily, and bisoprolol plus amlodipine 5 mg once daily. Exercise tests were performed at the end of each four-week study period and the exercise time to onset of angina was assessed. A total of 198 patients from 17 centres were recruited of whom 147 were evaluable for efficacy. There were no statistically significant differences in exercise duration to onset of angina between any of the groups. The combination of bisoprolol plus nifedipine was least well tolerated. In summary, this study suggests there is little benefit in adding a calcium antagonist to bisoprolol in treating patients with stable angina.

Research paper thumbnail of Kingdom General Practice Research Database

which permits unrestricted noncommercial use, provided the original work is properly cited.

Research paper thumbnail of Potential cost savings to be made by slowing cognitive decline in mild Alzheimer's disease dementia using a model derived from the UK GERAS observational study

BMC geriatrics, Feb 23, 2018

Given the high costs associated with the care of those with Alzheimer's disease (AD) dementia... more Given the high costs associated with the care of those with Alzheimer's disease (AD) dementia, we examined the likely impact of a reduction in the rate of cognitive decline upon cost outcomes associated with this disease. Using the group of patients with mild AD dementia from the GERAS study, generalised linear modelling (GLM) was used to explore the relationship between change in cognition as measured using the Mini-Mental State Examination (MMSE) and UK overall costs (health care and social care costs, and total societal costs) associated with AD dementia. A total of 200 patients with mild AD dementia were identified. Least squares mean (LSM) ± standard error (SE) reduction in MMSE score was 3.6 ± 0.4 points over 18 months. Using GLM it was possible to calculate that this worsening in cognition was associated with an 8.7% increase in total societal costs, equating to an increase of approximately £2200 per patient over an 18-month period. If the rate of decline in cognition was...

Research paper thumbnail of Reliability of coded data to identify earliest indications of cognitive decline, cognitive evaluation and Alzheimer's disease diagnosis: a pilot study in England

BMJ open, Mar 22, 2018

Evaluate the reliability of using diagnosis codes and prescription data to identify the timing of... more Evaluate the reliability of using diagnosis codes and prescription data to identify the timing of symptomatic onset, cognitive assessment and diagnosis of Alzheimer's disease (AD) among patients diagnosed with AD. This was a retrospective cohort study using the UK Clinical Practice Research Datalink (CPRD). The study cohort consisted of a random sample of 50 patients with first AD diagnosis in 2010-2013. Additionally, patients were required to have a valid text-field code and a hospital episode or a referral in the 3 years before the first AD diagnosis. The earliest indications of cognitive impairment, cognitive assessment and AD diagnosis were identified using two approaches: (1) using an algorithm based on diagnostic codes and prescription drug information and (2) using information compiled from manual review of both text-based and coded data. The reliability of the code-based algorithm for identifying the earliest dates of the three measures described earlier was evaluated re...

Research paper thumbnail of Resource utilisation, costs and clinical outcomes in non-institutionalised patients with Alzheimer's disease: 18-month UK results from the GERAS observational study

BMC geriatrics, Nov 25, 2016

Alzheimer's disease (AD), the commonest cause of dementia, represents a significant cost to U... more Alzheimer's disease (AD), the commonest cause of dementia, represents a significant cost to UK society. This analysis describes resource utilisation, costs and clinical outcomes in non-institutionalised patients with AD in the UK. The GERAS prospective observational study assessed societal costs associated with AD for patients and caregivers over 18 months, stratified according to baseline disease severity (mild, moderate, or moderately severe/severe [MS/S]). All patients enrolled had an informal caregiver willing to participate in the study. Healthcare resource utilisation was measured using the Resource Utilization in Dementia instrument, and 18-month costs estimated by applying unit costs of services and products (2010 values). Total societal costs were calculated using an opportunity cost approach. Overall, 526 patients (200 mild, 180 moderate and 146 MS/S at baseline) were recruited from 24 UK centres. Mini-Mental State Examination (MMSE) scores deteriorated most markedly i...

Research paper thumbnail of 51 * Cost and Resource Use in Non-Institutionalised Alzheimer's Patients - Results from an Observational Study in the Uk Over 18 Months

Age and Ageing, 2015

Introduction: Observational studies are important for collecting real life data to complement cli... more Introduction: Observational studies are important for collecting real life data to complement clinical trial results. The GERAS study has assessed the societal costs associated with Alzheimer's disease (AD) for patients and caregivers over 18 months, stratified by severity of patients' AD at baseline. Methods: The GERAS study is a prospective, multi-centre, non-interventional cohort study in the UK (with studies also conducted in Germany and France). Patients presenting

Research paper thumbnail of P4‐339: Excess Costs Associated with Possible Misdiagnosis of Alzheimer's Disease Among Patients with Vascular Dementia in a Uk CPRD Population

Alzheimer's & Dementia, 2014

Background: Prior diagnosis of Alzheimer's disease (AD) among patients later diagnosed with vascu... more Background: Prior diagnosis of Alzheimer's disease (AD) among patients later diagnosed with vascular dementia (VaD) has been associated with excess costs, suggesting potential benefits of earlier rule-out of AD diagnosis. Objective: To investigate whether prior diagnosis with AD among patients with VaD is associated with excess costs in the UK. Methods: Patients with a final VaD diagnosis, continuous data visibility for ≥6 months prior to index date, and linkage to Hospital Episode Statistics data were retrospectively selected from de-identified Clinical Practice Research Datalink data. Patients with AD diagnosis before a final VaD diagnosis were matched to similar patients with no prior AD diagnosis using propensity score methods. Annual excess healthcare costs were calculated for 5 years post-index, stratified by time to final diagnosis. Results: Of 9,311 patients with VaD, 508 (6%) had prior AD diagnosis with a median time to VaD diagnosis exceeding 2 years from index date. Over the entire follow-up period, patients with prior AD diagnosis had accumulated healthcare costs that were approximately GBP2,000 higher than those for matched counterparts (mostly due to higher hospitalization costs). Cost differentials peaked particularly in the period including the final VaD diagnosis, with excess costs quickly declining thereafter. Conclusion: Potential misdiagnosis of AD among UK patients with VaD resulted in substantial excess costs. The decline in excess costs following a final VaD diagnosis suggests potential benefits from earlier rule-out of AD.

Research paper thumbnail of Treatment and outcomes for patients with depression who are partial responders to SSRI treatment: post-hoc analysis findings from the FINDER European observational study

Journal of affective disorders, 2014

Remission is the goal in depression, but in practice many patients only experience a partial resp... more Remission is the goal in depression, but in practice many patients only experience a partial response to treatment. We sought to determine the prevalence, management and subsequent outcomes of partial responder patients. Patients enrolled in the naturalistic Factors Influencing Depression Endpoints Research (FINDER) study with the Hospital Anxiety and Depression Scale depression subscale (HADS-D) score >10 at baseline who received only SSRI(s) between 0 and 3 months comprised the study cohort (n=1147). Patients were categorized as remitters, partial responders or non-responders at 3 months and then followed up at 6 months. At 3 months, 29.4% of the study population were considered non-responders, 27.6% were partial responders, and 39.3% were remitters. Most partial responders at 3 months remained on the same SSRI for the next 3 months. Of the 247 partial responders at 3 months and remained on the same SSRI(s) between 3 and 6 months, 10.9% met criteria for non-response at 6 months...

Research paper thumbnail of Value in venlafaxine study

The British journal of general practice : the journal of the Royal College of General Practitioners, 2004

Research paper thumbnail of Response to 'Wishful pharmaceutical thinking

The British journal of general practice : the journal of the Royal College of General Practitioners, 2004

Response to 'Wishful pharmaceutical thinking' A Lenox-Smith 57 'Just a GP' E Purv... more Response to 'Wishful pharmaceutical thinking' A Lenox-Smith 57 'Just a GP' E Purves and CGunstone 57 Delayed prescriptions—not a good option for infants R Damoiseaux 58 A clinical indication on every repeat prescription N Masters 58 Accuracy of electronic ...

Research paper thumbnail of A 12-week nursing support programme for carers of children and adolescents in the UK with attention deficit hyperactivity disorder prescribed atomoxetine

Therapeutic Advances in Psychopharmacology, 2012

Introduction: Patient support programmes are assuming greater importance in the UK in many therap... more Introduction: Patient support programmes are assuming greater importance in the UK in many therapeutic areas, mostly with the aim of improving adherence to medication and many being provided by the pharmaceutical industry. Atomoxetine is a noradrenaline reuptake inhibitor for the treatment of attention deficit hyperactivity disorder that has recently demonstrated incremental efficacy for at least 12 weeks. Issues of adherence may be predicted over this initial period particularly if adverse events are reported. The Strattera Support Service was initiated in 2006 ( funded by Eli Lilly) to provide advice, initially through telephone contact, by trained nurses during the first 12 weeks of atomoxetine therapy and is offered to carers of patients diagnosed with ADHD after atomoxetine has been prescribed. The aim of this pilot service evaluation is to assess discontinuation rates and compare them with historical control data. Methods: Data from patients in the service who initiated atomox...

Research paper thumbnail of A single photon emission tomography (SPET) study of noradrenergic function in generalised anxiety disorder (GAD)

Research paper thumbnail of Noradrenergic dysfunction in generalised anxiety disorder (GAD: a SPET study using a clonidine challenge

Research paper thumbnail of A Review of the Serotonin-Norepinephrine Reuptake Inhibitors: Pharmacologic Aspects and Clinical Implications for Treatment of Major Depressive Disorder and Associated Painful Physical Symptoms

Open Journal of Depression, 2013

Research paper thumbnail of A review of the suitability of duloxetine and venlafaxine for use in patients with depression in primary care with a focus on cardiovascular safety, suicide and mortality due to antidepressant overdose

Therapeutic advances in psychopharmacology, 2013

Depression and anxiety disorders are among the most common disorders treated by general practitio... more Depression and anxiety disorders are among the most common disorders treated by general practitioners (GPs) in the UK. Since both disorders are associated with a significantly increased risk of suicide, including with antidepressant overdose, the safety of antidepressants in overdose is of paramount importance. Numerous updates relating to antidepressant safety have been issued by regulators in the UK which may have eroded GP confidence in antidepressants. Venlafaxine, a serotonin nor adrenaline reuptake inhibitor (SNRI) had primary care prescribing restrictions placed on it in 2004 due to concerns about cardiotoxicity and mortality in overdose. Although a review of the evidence led to a reversal of the majority of restrictions in 2006, evidence suggests GPs may still be cautious in their prescribing of venlafaxine and possibly other SNRI antidepressants for patients with depression and anxiety disorders. This paper reviews the evidence pertaining to the safety of SNRI antidepressan...

Research paper thumbnail of A double-blind, randomised, placebo controlled study of venlafaxine XL in patients with generalised anxiety disorder in primary care

PubMed, Oct 1, 2003

Background: Generalised anxiety disorder (GAD) is one of the commonest anxiety disorders and is t... more Background: Generalised anxiety disorder (GAD) is one of the commonest anxiety disorders and is treated almost entirely in primary care. Most recent studies performed in GAD have excluded depression for regulatory reasons. As GAD is usually a co-morbid disease, often co-existing with depression, the results from recent studies have only limited relevance to the naturalistic population. This study was set up to investigate venlafaxine XL in a more naturalistic population of patients with GAD. Aim: To assess the efficacy of venlafaxine XL in patients with generalised anxiety disorder with and without co-morbid depression. Design of study: Double-blind, randomised, placebo controlled, parallel-group, 24-week study. Setting: Primary care in the UK. Methods: Patients enrolled in the study were over 18 years old, met DSM-IV criteria for GAD, and had a score of 20 or more on the Hamilton Anxiety Scale (HAM-A). A score of more than 23 on the Montgomery Asberg Depression Rating Scale (MADRS) excluded patients. Eligible patients were randomised to receive 75 mg of venlafaxine or a matching placebo. After 2 weeks the dose could be doubled if the physician considered the response to be poor. The study duration was 24 weeks. Results: 244 patients were enrolled, with 122 randomised to the placebo and 122 to venlafaxine. Baseline characteristics were similar for both groups, each having a mean total HAM-A score at baseline of 28. The difference from the placebo group at 24 weeks on the total HAM-A score was 2.1 points (95% 0 to 4.2), which was statistically significant (P = 0.05). Remission rates at week 24 were 27.9% for the venlafaxine XL group and 18.9% for placebo group (P = 0.11). Conclusion: Venlafaxine was efficacious in the treatment of patients with GAD with and without depression over a 24-week period.

Research paper thumbnail of Excess Costs Associated with Possible Misdiagnosis of Alzheimer’s Disease Among Patients with Vascular Dementia in a UK CPRD Population

Journal of Alzheimer's Disease, Jun 22, 2016

Background: Prior diagnosis of Alzheimer's disease (AD) among patients later diagnosed with vascu... more Background: Prior diagnosis of Alzheimer's disease (AD) among patients later diagnosed with vascular dementia (VaD) has been associated with excess costs, suggesting potential benefits of earlier rule-out of AD diagnosis. Objective: To investigate whether prior diagnosis with AD among patients with VaD is associated with excess costs in the UK. Methods: Patients with a final VaD diagnosis, continuous data visibility for ≥6 months prior to index date, and linkage to Hospital Episode Statistics data were retrospectively selected from de-identified Clinical Practice Research Datalink data. Patients with AD diagnosis before a final VaD diagnosis were matched to similar patients with no prior AD diagnosis using propensity score methods. Annual excess healthcare costs were calculated for 5 years post-index, stratified by time to final diagnosis. Results: Of 9,311 patients with VaD, 508 (6%) had prior AD diagnosis with a median time to VaD diagnosis exceeding 2 years from index date. Over the entire follow-up period, patients with prior AD diagnosis had accumulated healthcare costs that were approximately GBP2,000 higher than those for matched counterparts (mostly due to higher hospitalization costs). Cost differentials peaked particularly in the period including the final VaD diagnosis, with excess costs quickly declining thereafter. Conclusion: Potential misdiagnosis of AD among UK patients with VaD resulted in substantial excess costs. The decline in excess costs following a final VaD diagnosis suggests potential benefits from earlier rule-out of AD.

Research paper thumbnail of Are there different predictors of analgesic response between antidepressants and anticonvulsants in painful diabetic neuropathy?

European Journal of Pain, 2015

To investigate baseline demographics and disease characteristics as predictors of the analgesic e... more To investigate baseline demographics and disease characteristics as predictors of the analgesic effect of duloxetine and pregabalin on diabetic peripheral neuropathic pain (DPNP).

Research paper thumbnail of Noradrenergic function in generalised anxiety disorder (GAD): A single photon emission tomography (SPET) study

Research paper thumbnail of Oligosymptomatic Hypocalcaemia in a Patient with Impaired Parathyroid Hormone Activity

Journal of the Royal Society of Medicine, 1988

Research paper thumbnail of Bisoprolol Alone and in Combination with Amlodipine or Nifedipine in the Treatment of Chronic Stable Angina

International Journal of Clinical Practice

Beta-blockers and calcium antagonists are both effective monotherapy for stable angina. When symp... more Beta-blockers and calcium antagonists are both effective monotherapy for stable angina. When symptoms persist, these two agents are commonly co-prescribed in the hope that this combination has added benefit compared with monotherapy alone. We investigated the additional efficacy of the calcium antagonists amlodipine and nifedipine when added to bisoprolol in patients with stable angina. Patients were randomised in a multicentre, single-blind study, with crossover of three treatments consisting of bisoprolol 10 mg once daily, bisoprolol plus nifedipine 20 mg twice daily, and bisoprolol plus amlodipine 5 mg once daily. Exercise tests were performed at the end of each four-week study period and the exercise time to onset of angina was assessed. A total of 198 patients from 17 centres were recruited of whom 147 were evaluable for efficacy. There were no statistically significant differences in exercise duration to onset of angina between any of the groups. The combination of bisoprolol plus nifedipine was least well tolerated. In summary, this study suggests there is little benefit in adding a calcium antagonist to bisoprolol in treating patients with stable angina.

Research paper thumbnail of Kingdom General Practice Research Database

which permits unrestricted noncommercial use, provided the original work is properly cited.

Research paper thumbnail of Potential cost savings to be made by slowing cognitive decline in mild Alzheimer's disease dementia using a model derived from the UK GERAS observational study

BMC geriatrics, Feb 23, 2018

Given the high costs associated with the care of those with Alzheimer's disease (AD) dementia... more Given the high costs associated with the care of those with Alzheimer's disease (AD) dementia, we examined the likely impact of a reduction in the rate of cognitive decline upon cost outcomes associated with this disease. Using the group of patients with mild AD dementia from the GERAS study, generalised linear modelling (GLM) was used to explore the relationship between change in cognition as measured using the Mini-Mental State Examination (MMSE) and UK overall costs (health care and social care costs, and total societal costs) associated with AD dementia. A total of 200 patients with mild AD dementia were identified. Least squares mean (LSM) ± standard error (SE) reduction in MMSE score was 3.6 ± 0.4 points over 18 months. Using GLM it was possible to calculate that this worsening in cognition was associated with an 8.7% increase in total societal costs, equating to an increase of approximately £2200 per patient over an 18-month period. If the rate of decline in cognition was...

Research paper thumbnail of Reliability of coded data to identify earliest indications of cognitive decline, cognitive evaluation and Alzheimer's disease diagnosis: a pilot study in England

BMJ open, Mar 22, 2018

Evaluate the reliability of using diagnosis codes and prescription data to identify the timing of... more Evaluate the reliability of using diagnosis codes and prescription data to identify the timing of symptomatic onset, cognitive assessment and diagnosis of Alzheimer's disease (AD) among patients diagnosed with AD. This was a retrospective cohort study using the UK Clinical Practice Research Datalink (CPRD). The study cohort consisted of a random sample of 50 patients with first AD diagnosis in 2010-2013. Additionally, patients were required to have a valid text-field code and a hospital episode or a referral in the 3 years before the first AD diagnosis. The earliest indications of cognitive impairment, cognitive assessment and AD diagnosis were identified using two approaches: (1) using an algorithm based on diagnostic codes and prescription drug information and (2) using information compiled from manual review of both text-based and coded data. The reliability of the code-based algorithm for identifying the earliest dates of the three measures described earlier was evaluated re...

Research paper thumbnail of Resource utilisation, costs and clinical outcomes in non-institutionalised patients with Alzheimer's disease: 18-month UK results from the GERAS observational study

BMC geriatrics, Nov 25, 2016

Alzheimer's disease (AD), the commonest cause of dementia, represents a significant cost to U... more Alzheimer's disease (AD), the commonest cause of dementia, represents a significant cost to UK society. This analysis describes resource utilisation, costs and clinical outcomes in non-institutionalised patients with AD in the UK. The GERAS prospective observational study assessed societal costs associated with AD for patients and caregivers over 18 months, stratified according to baseline disease severity (mild, moderate, or moderately severe/severe [MS/S]). All patients enrolled had an informal caregiver willing to participate in the study. Healthcare resource utilisation was measured using the Resource Utilization in Dementia instrument, and 18-month costs estimated by applying unit costs of services and products (2010 values). Total societal costs were calculated using an opportunity cost approach. Overall, 526 patients (200 mild, 180 moderate and 146 MS/S at baseline) were recruited from 24 UK centres. Mini-Mental State Examination (MMSE) scores deteriorated most markedly i...

Research paper thumbnail of 51 * Cost and Resource Use in Non-Institutionalised Alzheimer's Patients - Results from an Observational Study in the Uk Over 18 Months

Age and Ageing, 2015

Introduction: Observational studies are important for collecting real life data to complement cli... more Introduction: Observational studies are important for collecting real life data to complement clinical trial results. The GERAS study has assessed the societal costs associated with Alzheimer's disease (AD) for patients and caregivers over 18 months, stratified by severity of patients' AD at baseline. Methods: The GERAS study is a prospective, multi-centre, non-interventional cohort study in the UK (with studies also conducted in Germany and France). Patients presenting

Research paper thumbnail of P4‐339: Excess Costs Associated with Possible Misdiagnosis of Alzheimer's Disease Among Patients with Vascular Dementia in a Uk CPRD Population

Alzheimer's & Dementia, 2014

Background: Prior diagnosis of Alzheimer's disease (AD) among patients later diagnosed with vascu... more Background: Prior diagnosis of Alzheimer's disease (AD) among patients later diagnosed with vascular dementia (VaD) has been associated with excess costs, suggesting potential benefits of earlier rule-out of AD diagnosis. Objective: To investigate whether prior diagnosis with AD among patients with VaD is associated with excess costs in the UK. Methods: Patients with a final VaD diagnosis, continuous data visibility for ≥6 months prior to index date, and linkage to Hospital Episode Statistics data were retrospectively selected from de-identified Clinical Practice Research Datalink data. Patients with AD diagnosis before a final VaD diagnosis were matched to similar patients with no prior AD diagnosis using propensity score methods. Annual excess healthcare costs were calculated for 5 years post-index, stratified by time to final diagnosis. Results: Of 9,311 patients with VaD, 508 (6%) had prior AD diagnosis with a median time to VaD diagnosis exceeding 2 years from index date. Over the entire follow-up period, patients with prior AD diagnosis had accumulated healthcare costs that were approximately GBP2,000 higher than those for matched counterparts (mostly due to higher hospitalization costs). Cost differentials peaked particularly in the period including the final VaD diagnosis, with excess costs quickly declining thereafter. Conclusion: Potential misdiagnosis of AD among UK patients with VaD resulted in substantial excess costs. The decline in excess costs following a final VaD diagnosis suggests potential benefits from earlier rule-out of AD.

Research paper thumbnail of Treatment and outcomes for patients with depression who are partial responders to SSRI treatment: post-hoc analysis findings from the FINDER European observational study

Journal of affective disorders, 2014

Remission is the goal in depression, but in practice many patients only experience a partial resp... more Remission is the goal in depression, but in practice many patients only experience a partial response to treatment. We sought to determine the prevalence, management and subsequent outcomes of partial responder patients. Patients enrolled in the naturalistic Factors Influencing Depression Endpoints Research (FINDER) study with the Hospital Anxiety and Depression Scale depression subscale (HADS-D) score >10 at baseline who received only SSRI(s) between 0 and 3 months comprised the study cohort (n=1147). Patients were categorized as remitters, partial responders or non-responders at 3 months and then followed up at 6 months. At 3 months, 29.4% of the study population were considered non-responders, 27.6% were partial responders, and 39.3% were remitters. Most partial responders at 3 months remained on the same SSRI for the next 3 months. Of the 247 partial responders at 3 months and remained on the same SSRI(s) between 3 and 6 months, 10.9% met criteria for non-response at 6 months...

Research paper thumbnail of Value in venlafaxine study

The British journal of general practice : the journal of the Royal College of General Practitioners, 2004

Research paper thumbnail of Response to 'Wishful pharmaceutical thinking

The British journal of general practice : the journal of the Royal College of General Practitioners, 2004

Response to 'Wishful pharmaceutical thinking' A Lenox-Smith 57 'Just a GP' E Purv... more Response to 'Wishful pharmaceutical thinking' A Lenox-Smith 57 'Just a GP' E Purves and CGunstone 57 Delayed prescriptions—not a good option for infants R Damoiseaux 58 A clinical indication on every repeat prescription N Masters 58 Accuracy of electronic ...

Research paper thumbnail of A 12-week nursing support programme for carers of children and adolescents in the UK with attention deficit hyperactivity disorder prescribed atomoxetine

Therapeutic Advances in Psychopharmacology, 2012

Introduction: Patient support programmes are assuming greater importance in the UK in many therap... more Introduction: Patient support programmes are assuming greater importance in the UK in many therapeutic areas, mostly with the aim of improving adherence to medication and many being provided by the pharmaceutical industry. Atomoxetine is a noradrenaline reuptake inhibitor for the treatment of attention deficit hyperactivity disorder that has recently demonstrated incremental efficacy for at least 12 weeks. Issues of adherence may be predicted over this initial period particularly if adverse events are reported. The Strattera Support Service was initiated in 2006 ( funded by Eli Lilly) to provide advice, initially through telephone contact, by trained nurses during the first 12 weeks of atomoxetine therapy and is offered to carers of patients diagnosed with ADHD after atomoxetine has been prescribed. The aim of this pilot service evaluation is to assess discontinuation rates and compare them with historical control data. Methods: Data from patients in the service who initiated atomox...

Research paper thumbnail of A single photon emission tomography (SPET) study of noradrenergic function in generalised anxiety disorder (GAD)

Research paper thumbnail of Noradrenergic dysfunction in generalised anxiety disorder (GAD: a SPET study using a clonidine challenge

Research paper thumbnail of A Review of the Serotonin-Norepinephrine Reuptake Inhibitors: Pharmacologic Aspects and Clinical Implications for Treatment of Major Depressive Disorder and Associated Painful Physical Symptoms

Open Journal of Depression, 2013

Research paper thumbnail of A review of the suitability of duloxetine and venlafaxine for use in patients with depression in primary care with a focus on cardiovascular safety, suicide and mortality due to antidepressant overdose

Therapeutic advances in psychopharmacology, 2013

Depression and anxiety disorders are among the most common disorders treated by general practitio... more Depression and anxiety disorders are among the most common disorders treated by general practitioners (GPs) in the UK. Since both disorders are associated with a significantly increased risk of suicide, including with antidepressant overdose, the safety of antidepressants in overdose is of paramount importance. Numerous updates relating to antidepressant safety have been issued by regulators in the UK which may have eroded GP confidence in antidepressants. Venlafaxine, a serotonin nor adrenaline reuptake inhibitor (SNRI) had primary care prescribing restrictions placed on it in 2004 due to concerns about cardiotoxicity and mortality in overdose. Although a review of the evidence led to a reversal of the majority of restrictions in 2006, evidence suggests GPs may still be cautious in their prescribing of venlafaxine and possibly other SNRI antidepressants for patients with depression and anxiety disorders. This paper reviews the evidence pertaining to the safety of SNRI antidepressan...