Nonbranded or branded direct-to-consumer prescription drug advertising-which is more effective?

Recently, pharmaceutical manufacturers have increased the amount of nonbranded, disease-education focused, direct-to-consumer advertisements. A comparison to branded, product-specific, ads was examined through a series of survey questions measuring consumer attitudes and the role of involvement. Nonbranded ads compared favorably to branded ads and should remain a viable part of the marketing mix. Consumers' level of disease state involvement was the strongest determinant of attitudes overall and within the two ad groupings, as highly involved consumers had significantly more positives attitudes regarding the nonbranded ads. Regardless of involvement level, however, nonbranded ads maintained positive attitude levels.     

Blood Pressure Control Provides Less Cardiovascular Protection in Adults With Than Without Apparent Treatment‐Resistant Hypertension

Hypertension control may offer less protection from incident cardiovascular disease (CVD_i) in adults with than without apparent treatment‐resistant hypertension (aTRH), ie, blood pressure uncontrolled while taking three or more antihypertensive medications or controlled to <140/<90 mm Hg while taking four or more antihypertensive medications. Electronic health data were matched to health claims for 2006–2012. Patients with CVD_i in 2006–2007 or with untreated hypertension were excluded, leaving 118,356 treated hypertensives, including 40,690 with aTRH, and 460,599 observation years. Blood pressure and medication number were determined by all clinic visit means from 2008 to CVD_i or end of study. Primary outcome was first CVD_i (stroke, coronary heart disease, heart failure) from hospital and emergency department claims. Controlling for age, race, sex, diabetes, chronic kidney disease, and statin use, hypertension control afforded less CVD_i protection in patients with aTRH (hazard ratio, 0.87; 95% confidence interval, 0.82–0.93) than without aTRH (hazard ratio, 0.69; 95% confidence interval, 0.65–0.74; P<.001). Strategies beyond hypertension control may prevent more CVD_i in patients with aTRH.     

Future Treatments of NASH

NASH is a complex metabolic disease best understood by recognizing the sources and fates of major metabolic substrates (carbohydrates and fatty acids) and how their excess can lead to lipotoxic liver injury with a histological phenotype of NASH. With this perspective, targets of therapy can be predicted. This review summarizes recent clinical trial data and where these trials fit into the substrate overload lipotoxic liver injury paradigm of NASH pathogenesis. Because NASH is likely the result of diverse environmental, genetic, and epigenetic factors that differ among patients, no single therapy is likely to be effective in all patients. Ultimately, rationally designed personalized therapy will be achieved for patients with NASH, but this will require substantial new knowledge on why patients respond to specific therapies, a goal that remains elusive. Hopefully, this gap in knowledge will be addressed by analysis of responders and non-responders in current and future clinical trials.