Consider step-up’ drugs for elderly patients

Formularies should give providers range of options

Small, incremental improvements to existing drugs can provide important benefits to patients, especially the elderly, a Temple University study has shown.

"People look down their noses at little changes in existing drugs in favor of blockbuster drugs and new chemical families. But new drugs in a therapeutic class often have fewer side effects, improved safety and effectiveness, and are used more easily," says Albert Wertheimer, PhD, director of the Center for Pharmaceutical Health Services Research at Temple University in Philadelphia and lead researcher on the study.

Wertheimer urges provider and insurers not to dismiss such drugs because they may have a whole new series of benefits.

"By nature of human genetic components, not all drugs work for all people," he says.

Incrementally innovative medicines have a molecular structure or method of action similar to the first drug that is approved. However, the drugs typically provide improved benefits, such as fewer side effects, improved safety, greater ease of use, or product alternatives that permit treatment to be better tailored to the individual.

"These improvements are especially important for optimal treatment of elderly patients because their diverse response to medications requires individualized care," he says.

There are many plusses to including such drugs in the formulary and not too much downside, he says. "It’s penny-wise and pound foolish not to have at least one alternative. Providers owe it to themselves to see if it has a clinical advantage or a price advantage," he says.