Pharmacoeconomic analysis of the neuroprotective medicines in the treatment of ischemic stroke

This article is in "Library" section.

Author:

R.I. YAGUDINA1, A.YU. KULIKOV1, V.A. KRYLOV1, E.YU. SOLOVIEVA2, A.I. FEDIN2

1 Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia;
2 Pirogov Russian National Research Medical University N.I.Pirogov Russian National Research Medical University of the Ministry of Health
of Russia, Moscow, Russia

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Pharmacoeconomic analysis of the neuroprotective medicines in the treatment of ischemic stroke

Author:
R.I. YAGUDINA1, A.YU. KULIKOV1, V.A. KRYLOV1, E.YU. SOLOVIEVA2, A.I. FEDIN2

1Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia;
2Pirogov Russian National Research Medical University N.I.Pirogov Russian National Research Medical University of the Ministry of Health
of Russia, Moscow, Russia

Summary:
Objective. To perform a pharmacoeconomic analysis of the most frequently prescribed neuroprotective medicines for treating patients with mild ischemic stroke in the acute and early rehabilitation periods in the Russian Federation. Material and methods. Three medical technologies were compared: ethylmethylhydroxypyridine succinate (mexidol), inosine + nicotinamide + riboflavin + succinic acid (cytoflavin) and a deproteinized hemoderivate of the blood of calves (actovegin). Cost minimization analysis, budget impact analysis and sensitivity analysis were performed based on the indirect comparison results. Results. Efficacy analysis shows that mentioned above medicines have the same efficacy: mean difference mexidol is 0,2 (CI min 0,25; max 0,65), cytoflavin — 0,61 (CI min 0,23; max 0,99), actovegin 0,2 (CI min 0,18; max 0,22). The cost minimization analysis for the Russian Federation shows that mexidol therapy is associated with the lowest costs, while savings are observed both in the evaluation of total costs and separate components: intravenous ampoules and tablet forms. The savings in comparison with cytoflavin and actovegin are 231 RUB and 12,872 RUB, respectively. These savings will be enough to treat five patients with ischemic stroke (IS) with mexidol. Moreover, oral mexidol therapy is cheaper than the same dosage forms of cytoflavin and actovegin by 481 RUB and 3,164 RUB, respectively. This is an advantage for the treatment of population at the outpatient stage. Budget impact analysis has shown that the budget for the medicines for treating IS at the current distribution between treatment regimens, is estimated at 1.99 BN RUB. The increase in the proportion of patients receiving mexidol by 10% reduces total costs to 1.75 BN RUB, which is 240 M RUB less than current costs. With these savings 85 thousand patients with IS could be treated. The sensitivity analysis reveals that the result of the cost minimization analysis and the budget impact analysis remain stable when both the amount of the population and the cost of 1 mg of mexidol vary from –10% to + 10%. Conclusions. Mexidol has the same efficacy as alternatives. However mexidol is superior to cytoflavin and actovegin in terms of cost minimization analysis. The savings from one course of alternatives will cover costs of treatment of five patients with IS using mexidol. The increase in the proportion of patients receiving mexidol is associated with savings, which allows us to consider mexidol therapy of mild IS as budget-saving in the Russian Federation. Keywords: pharmacoeconomics, indirect comparison, cost minimization analysis, budget impact analysis, neuroprotectors, ischemic stroke.


Evaluation of blood rheology by patients with acute ischemic stroke with Mexidol administration

Author:
D.M. PLOTNIKOV1, M.N. STEGMEIER1, O.I. ALIEV2

1 Department of Neurology and Neurosurgery, Siberian State Medical University, Tomsk, Russia;
2 Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia

Summary:
Objective. To study rheological properties of blood in patients with acute ischemic stroke treated with mexidol. Material and methods. Sixty patients with acute stroke, including 32 patients who received mexidol (500 mg/IV/20 days) and 28 people who received magnesium sulfate (2000 mg/IV/20 days) were examined. The control group included 20 people without a cardiovascular pathology. Blood rheology (viscosity of whole blood, plasma viscosity, hematocrit, aggregation and deformability of erythrocytes, fibrinogen level) was evaluated in patients three times: for the first 12 hours, 3—5 days and 18—20 days after hospitalization. Results. Hyperviscosity syndrome was observed in all patients with stroke. A significant decrease in blood viscosity was found in patients treated with mexidol: in the 3–5th day at low shear rates and in the 18—20th day at 3—100 s–1 shear rates. Significant differences in hematocrit (p=0.026) and fibrinogen levels (p=0.017) in patients treated with different drugs were found in the 18—20th day of the disease. Higher erythrocyte deformability index was recorded in patients treated with mexidol in the 3—5th day at shear rates of 90 and 890 s–1, in the 18—20th day at shear rates of 90—360 s–1. Conclusion. The study confirms the impact of mexidol on the fluidity of blood during the acute cerebral ischemia and shows its efficacy in reducing blood viscosity, decreasing the level of hematocrit and fibrinogen, increasing the deformability of erythrocytes.
Keywords: acute ischemic stroke, rheological parameters of blood, blood viscosity, erythrocytes deformability, mexidol (ethylmethylhydroxypyridine succinate), treatment of stroke.


Evaluation of blood rheology by patients with acute ischemic stroke with Mexidol administration

This article is in "Library" section.

Author:

D.M. PLOTNIKOV1, M.N. STEGMEIER1, O.I. ALIEV2

1 Department of Neurology and Neurosurgery, Siberian State Medical University, Tomsk, Russia;
2 Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk National Research Medical Center, Russian Academy of
Sciences, Tomsk, Russia

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New Packaging: Mexidol® 5 ml #10 and Mexidol® 2 ml #20

The new packages are designed for the minimum recommended therapeutic course and have been released to meet the needs of patients who have been prescribed Mexidol®.

The new packages will improve patients' adherence (compliance) to the prescribed therapy in order to increase its effectiveness.

Important! In order to maximize the therapeutic potential of Mexidol®, it is necessary to prescribe adequate therapeutic doses and follow the therapy sequence - to start treatment with injection form and then continue the treatment with tablets (Mexidol® film-coated tablets, 125 mg, and Mexidol® Forte 250 film-coated tablets, 250 mg).


Combined administration of mexidol with known medicines

Author:
T.A. VORONINA, E.A. IVANOVA

Research Zakusov Institute of Pharmacology, Moscow, Russia

Summary:
This review summarizes the available data on the combined administration of mexidol with medicines of different pharmacotherapeutic groups. Mexidol has a multifaceted mechanism of action and exhibits a wide range of pharmacological effects. It enhances therapeutic effects of a variety of drugs in research and clinical settings, boosts the effectiveness of therapy prescribed in accordance with the applicable federal standards and contributes to reducing the severity of complications. Effectiveness data and pathogenetic considerations underpinning combination therapy with mexidol and other drugs suggest that this is a viable approach for treating cerebrovascular and cardiovascular diseases, diseases of the nervous system, open-angle glaucoma and alcohol intoxication as well as a number of other diseases.

Keywords: mexidol, combination therapy, free radicals, lipid peroxidation, ischemic stroke, myocardial infarction, ischemic heart disease, epilepsy, alcohol intoxication.


Effect of mexidol on physical working efficiency and level of lactat in blood rats in conditions of light desynhronizes

Author:
T.A. ZAMOSHCHINA, A.A. GOSTYUKHINA, K.V. ZAITSEV, M.V. SVETLIK, O.B. ZHUKOVA

Federal state budgetary institution «Siberian Federal science-clinical center of Federal medicobio-logical agency», Seversk, Russia; Siberian
State Medical University SSMU, Tomsk, Russia

Summary:
Objective. To study an effect of mexidol on the performance of rats after light or dark deprivations in the swimming test with a load and to evaluate the state of glycolytic processes under these conditions. Material and methods. The experiment was carried out in the spring on 70 Wistar male rats. Three groups (30 animals) were in natural light conditions. One of them was not affected. The other two groups were subjected to exercise and 30 minutes before it either saline or mexidol was administered intramuscularly. Four other groups (40 animals) for 10 days were under conditions of dark or light deprivation prior to the presentation of physical activity and received either saline or mexidol before the test after deprivation was canceled. A forced swimming test with an additional load, which was presented to animals every day at 10—11 am for five days in a row, was used as a model of physical activity. The level of lactate was determined by colorimetric method. Results and conclusion. Mexidol increased the performance of rats in the swimming test, both under natural lighting conditions and with light desynchronization, contributed to the formation of cross adaptation to physical activity under natural lighting conditions and prolonged this state under conditions of light deprivation, did not change the content of lactate in the blood of rats after exercise in natural lighting conditions and dark deprivation and prevented its rise after light deprivation.

Keywords: mexidol, light and dark deprivation, working capacity, lactate.


Effect of mexidol on the efficiency of intravenous thrombolytic therapy for ischemic stroke during the therapeutic window

Author:
Knni K.S., Dyomin T.V., Adeeva L.B.
Interregional Clinical and Diagnostic Center, Kazan, Russia 12A, Karbyshev St., Kazan, Republic of Tatarstan 420101

Summary:
Objective: to evaluate the effect of intravenous mexidol on the efficiency of intravenous thrombolytic therapy (TLT) during the therapeutic window. Patients and methods. The retrospective study enrolled 123 patients with ischemic stroke (IS) who had undergone intravenous TLT in the vascular centers of the Republic of Tatarstan. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the time course of changes in their neurological status. According to the baseline severity of a neurological deficit, all the patients were divided into three subgroups: 1) mild IS (<8 NIHSS scores at admission); 2) moderate IS (>8 scores); and 3) severe IS (<16 scores). All the patients underwent X-ray computed tomography at admission, at 24 hours after TLT, and in case of worsening of their health status. Results. The prehospital use of mexidol followed by TLT in patients with IS had a positive effect on the regression of neurological deficit regardless of the severity of the disease. There were significant differences in the degree of regression of neurological deficit according to NIHSS at 24 hours and 10 days after hospital admission in patients with severe IS, who received intravenous mexidol at the prehospital stage and who did not take this drug before TLT. The pre-TLT use of mexidol contributed to higher regression of neurological deficit. There was a lower frequency of hemorrhagic transformations in the patients who used mexidol at the prehospital stage versus those who did not. Conclusion. The findings demonstrate the positive effect of mexidol on the efficiency and safety of TLT in patients with IS.

Keywords: ethylmethylhydroxypyridine succinate; intravenous thrombolytic therapy; ischemic stroke; neuroprotective therapy.


Experience with mexidol in neurological practice

Author:
O.A. GROMOVA, I.YU. TORSHIN, L.V. STAKHOVSKAYA, E.G. PEPELYAEV, V.A. SEMENOV, A.G. NAZARENKO

Federal Research Center «Informatics and Management», Institute of Pharmacoinformatics, RAS, Moscow, Russia; Research Institute of
Central Research Hospital of the Russian National Research Medical University. N.I. Pirogova, Moscow, Russia; FGBOU VO «Kemerovo
State Medical University» MH RF, Kemerovo, Russia; Federal State Autonomous Institution «National Medical Research Center for
Neurosurgery named after Academician N.N. Burdenko» of the Ministry of Health of the Russian Federation, Moscow, Russia

Summary:
Antihypoxic, antioxidant and nootropic effects of mexidol contribute to the improvement of patients with cerebrovascular pathology. The results of clinical studies show that the sequential scheme of using mexidol (first i.v. or i.m., then per os) is effective in the complex therapy of ischemic diseases of the brain, vascular surgery, therapy and rehabilitation of patients with degenerativedystrophic changes of the spine, treatment of neurodegenerative pathology (including multiple sclerosis, Parkinson’s disease and diabetic polyneuropathy), infectious neuropathies (ARVI, herpes, tick-borne encephalitis), neuropsychological and autonomic disorders.

Keywords: neurotransmission, GABA, acetylcholine, antihypoxants, nootropics, data mining, mexidol.


The efficacy of mexidol for transient ischemic attacks in the vertebrobasilar system in elderly patients with chronic cerebral ischemia

Author:
YU.V. ABRAMENKO
Tver State Medical University, Tver, Russia

Summary:
Objective. To evaluate the clinical efficacy, metabolic and membrane protective effects of mexidol for transient ischemic attacks (TIA) in the vertebrobasilar system in elderly patients with chronic cerebral ischemia (CCI). Material and methods. Fifty-three patients, aged from 60 to 74 years, with the first episode of TIA in the vertebrobasilar system and CCI were examined. Patients of the main group (n=33) received mexidol in the dose of 500 mg for 10 days along with standard therapy, patients of the comparison group (n=20) received only standard therapy. The clinical implications of TIA, laboratory indices of the state of oxidant and antioxidant systems and percentage absorption of lipid-phospholipid complexes in the infrared spectrum of blood serum were studied. The control group consisted of 20 healthy people. Results and сonclusion. The use of mexidol was associated with more rapid regression of the focal neurological deficit. Mexidol significantly reduced the intensity of lipid peroxidation and had a positive impact on the level of neuronal membrane phospholipids. Metabolic and membrane protective effects of mexidol and it’s positive impact on the regression of focal neurological deficit justify its inclusion into complex therapy of TIA in the vertebrobasilar system developed in patients with CCI, especially in elderly patients.

Keywords: transient ischemic attack, vertebrobasilar system, chronic cerebral ischemia, mexidol, lipid peroxidation, phospholipids.