Pharmacy & Therapeutics - June 2008 - (Page 319)

EDITORIAL LETTER TO THE EDITOR continued from page 314 “brand” themselves for the future. They advise obtaining the appropriate educational background as well as developing the leadership skills necessary to succeed, such as being a good listener and gaining an understanding of various corporate cultures. Applicants are also advised that they might need to move from firm to firm and from one geographic location to another. Young people are urged to build networks and to routinely take calls from executive recruitment firms in order to gain a more realistic sense of the global marketplace. I could not agree more with this solid advice. I have written extensively about career advice for young physicians, but I believe that most medical schools still fall far short in this arena. This report, on the contrary, is an effective summary that should serve young persons in the industry very well. I concur with its recommendations, especially because, as it says, “the pharmaceutical industry is entering a new business cycle that will force it to rationalize its operations and be more cost-efficient at creating and marketing new treatments.”1 Out of this turmoil will come opportunities, especially for students and others who are well prepared to grasp them. Reports like this, coupled with appropriate mentoring and training, will enable our young people to assume leadership positions in the future. After all, I assume that you agree with the important business maxim that one key attribute of good leadership means preparing the leaders of tomorrow. As always, I am interested in your views. You can reach me at my e-mail address, david.nash@jefferson.edu. Also, be sure to visit my new blog at http://departmentofhealthpolicy. blogspot.com. Aliskiren Reduces Plasma Renin Activity I read with great interest the Drug Forecast article by Drs. Cromer and Peker in the February 2008 issue of P&T, entitled “Aliskiren (Tekturna), A Novel Antihypertensive Approach to Inhibition of the Renin–Angiotensin– Aldosterone System.” However, I noted an inaccuracy in the Pharmacology section that needs to be addressed (page 93). The authors state: “When Ang II levels are inhibited, the feedback loop is suppressed, resulting in further reductions in plasma renin concentration.” Actually, the opposite is true. All agents that inhibit the renin–angiotensin–aldosterone system (RAAS), angiotensin-converting enzyme inhibitors (ACEIs), angiotensinreceptor blockers (ARBs), as well as aliskiren, interfere with the negative feedback loop of the RAAS, thus increasing plasma renin concentration. The key point of differentiation of aliskiren is that the ACEIs and ARBs increase plasma renin activity, whereas aliskiren (a direct renin inhibitor) reduces plasma renin activity despite the increase in plasma renin concentration, both as monotherapy and when administered with other antihypertensive agents, including ACEIs and ARBs.1 For example, a single 300-mg dose of aliskiren inhibits plasma renin activity more than 99% at 5 hours post dose, more than 95% at 24 hours, and greater than 85% at 48 hours.2 Although high plasma renin activity is associated with cardiovascular events,3 the clinical significance of reduced plasma renin activity by aliskiren is not yet clear. REFERENCE 1. Steiner M, Bugen D, Kazanchy B. The continuing evolution of the pharmaceutical industry: Career challenges and opportunities. RegentAtlantic Capital, LLC/ Fiduciary Network, December 2007. Available at: www.pharmawealthmanager.com. Accessed May 5, 2008. I REFERENCES 1. Gradman AH, Traub, D. The efficacy of aliskiren, a direct renin inhibitor, in the treatment of hypertension. Rev Cardiovascular Med 2007;8:S22–S30. 2. Danser AHJ, Charney A, Feldman DL, et al. The renin rise with aliskiren: It’s simply stoichiometry. Hypertension 2008; 51(4):e27–e28. 3. Alderman MH, Ooi WL, Cohen H, et al. Plasma renin activity: A risk factor for myocardial infarction in hypertensive patients. Am J Hypertens 1997;10(1):1–8. Sincerely, Marjorie Gatlin, MD Vice President and Head Cardiovascular and Metabolism Medical Franchise Novartis Pharmaceuticals Corporation East Hanover, New Jersey If you would like to submit a letter to the editor, please contact Sonja Sherritze at ssherritze@medimedia.com. Vol. 33 No. 6 • June 2008 • P&T® 319 http://departmentofhealthpolicyblogspot.com http://departmentofhealthpolicyblogspot.com http://www.pharmawealthmanager.com

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - June 2008

Editorial Aliskiren Reduces Plasma Renin Activity Medication Errors Prescription: Washington New Drugs/Drug News/ New Medical Devices Drug Forecast Challenges in Evaluating and Standardizing Medical Devices in Health Care Facilities California e-Pedigree Rules Pose Challenges For Pharmacies Pharmaceutical Approval Update American Psychiatric Association At a Glance: Dermatology Trends in Managed Care

Pharmacy & Therapeutics - June 2008

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