Drastic or even life-threatening events can have lingering effects, like an echo. This is referred to as post-traumatic stress disorder (PTSD). The brain is unable to process these overwhelming experiences and stores the memories in such a way that they cannot be consciously controlled. They resurface again and again. Also at night, when people with PTSD relive the trauma over and over again until they wake up – usually in a state of panic. Antidepressants or blood pressure-lowering medications are commonly used to provide relief, among other treatments, but these are only partially effective and usually do not help relieving the nightmares. A medication specifically for treating trauma-related nightmares has not yet been approved in Germany.

Prof. Stefan Röpke conducts research on trauma-related disorders at the Department of Psychiatry and Neurosciences on the Benjamin Franklin Campus of Charité. In their search for new treatment approaches and avenues, he and his team, along with other partners, focused on the principal psychoactive compound of the cannabis plant: tetrahydrocannabinol, or THC for short. This active ingredient, also known for its psychoactive effects, interacts with the body’s endocannabinoid system, which is involved in regulating sleep, stress, and the processing of emotional memories. Stefan Röpke explains: “There is evidence suggesting that during REM sleep – the intense dream phases in which the brain processes experiences and regulates emotions – THC reduces dream activity and thereby alleviates nocturnal stress responses.”

A cannabinoid specifically targeting nightmares

Cannabis-based medications are already finding use in pain management, typically when standard treatments prove insufficient or patients cannot tolerate them. In Germany, this has been possible since the so-called “Cannabis for medical purposes” law took effect in 2017. Since then, it has become easier to use plant-derived or synthetically produced cannabinoids for medical and medical-scientific purposes. For their current study the researchers selected a form of THC derived directly from the cannabis plant in the form of drops – the prescription medication Dronabinol. The aim was to determine whether this approach could alleviate nightmares associated with PTSD and whether its use is safe in this context.

More than 170 patients with post-traumatic stress disorder and frequent, intense nightmares participated in the study. For a ten week period, they received either the medication or an identical-looking, cannabis-flavored placebo every evening before bedtime. Neither the healthcare providers nor the participants knew who was receiving which treatment – the gold standard of medical research, a so-called double-blind, placebo-controlled study.

By the end of the study period, nightmares had decreased to a significantly greater extent in the Dronabinol group than in the placebo group. On a scale of zero to eight points, the nightmare burden decreased by an average of 3.7 points, compared to only 2.2 points in the placebo group – a difference that is clearly noticeable to those affected. “More than a third of the patients treated with Dronabinol reported that they no longer experienced any nightmares after ten weeks. Another 21 percent reported that their nightmare burden had been at least halved,” as Stefan Röpke stated. “And about five out of six patients in the dronabinol group felt their health had markedly improved.”

No dependence or severe side effects

According to the studies, the cannabinoid had a specific effect on nightmares and sleep, but not on all PTSD symptoms. Moreover, the severity of the post-traumatic stress disorder and any accompanying depression did not change conclusively. Nevertheless, the majority of participants experienced significant relief, as the tormenting nightly re-experiencing of the traumatic event was interrupted, allowing for restful sleep. Taking the medication did not cause any severe side effects; however, the researchers observed moderate and mild side effects such as dizziness, headache, or increased appetite more frequently. The study team did not observe any withdrawal symptoms after the end of the study period and the discontinuation of the evening doses. In the next steps going forward, the researchers now aim to determine whether taking the cannabinoid is also effective and safe over the long term, or whether a tolerance effect develops over time.

*Roepke S et al. Dronabinol for nightmares in post-traumatic stress disorder: a randomized controlled trial. Nat Med 2026 Aug 05. doi: 10.1038/s41591-026-04546-9

About the study
The research was initiated and led by Charité; researchers from the Psychiatric University Clinic of the Charité at St. Hedwig Hospital, the University Medical Center Hamburg-Eppendorf, and the Central Institute for Mental Health in Mannheim were also involved. The work was supported by the company Bionorica SE

The post THC, the cannabis active ingredient, can put an end to trauma-related nightmares appeared first on Pharmacy Update Online.

A new study led by the University of Technology Sydney (UTS) found that Australia’s Pharmaceutical Benefits Scheme (PBS) is failing to meet the therapeutic needs of pregnant patients, driving widespread off-label prescribing and perpetuating structural health inequities.

Nausea and vomiting in pregnancy (NVP) affects up to 80 percent of pregnant women, yet only 10 to 20 percent of women who suffer from it use conventional medications.

Lead author Dr Hannah Jackson, a recent PhD graduate from the UTS Faculty of Health, said treatment of NVP has a complex history due to the thalidomide tragedy, which has resulted in conservative pharmaceutical regulations and limited therapeutic innovation.

The study explored the significant challenges some women face when trying to treat one of pregnancy’s most common conditions.

“We found that in some cases prescribers were finding alternative ways to get women the medication they need in a community-based setting, which can reduce health system costs by keeping them out of hospital,” Dr Jackson said.

The historical cohort study analysed PBS dispensing records from nearly 300,000 pregnancies over a five-year period to assess how public resources for anti-nausea medications were distributed across different socioeconomic regions.

The findings show that while the PBS successfully performs its intended role of progressively providing affordable access to necessary medications, the narrow range of approved drugs for NVP can create significant disparities in treatment type and cost.

Despite lacking official approval or a specific listing for pregnancy under the PBS framework, the findings show that the drug ondansetron accounted for 54 percent of total PBS expenditure on anti-nausea medications in pregnancy.

“Because official subsidised options are so limited, doctors frequently rely on system workarounds to ensure patients on low incomes can afford necessary treatment,” said Dr Jackson.

Total PBS-funded expenditure across all anti-nausea medications for pregnancy was concentrated most among disadvantaged women, with the rate of ondansetron use rising faster in low-income areas.

Co-author on the paper, Associate Professor Luke Grzeskowiak from Flinders University, said “the observed system workarounds create a kind of ‘Robin Hood’ scenario, where providing medicines outside of PBS restrictions is seen as an acceptable workaround, because it’s helping vulnerable women get necessary treatment they would otherwise not be able to afford.”

“With fewer medications subsidised on the PBS, pregnant women with lower financial capacity must rely on a narrow selection of older therapies, while those with more means can pay out-of-pocket for non-PBS medications which may be more suitable,” said Associate Professor Grzeskowiak.

The authors argue that limited access to anti-nausea medications through the PBS can actually drive inequalities in medication access by seeing disadvantaged women access the limited subsidised medications, while affluent women can self-fund the full suite of guideline-recommended options.

With maternal health designated a national priority, the researchers urge policymakers to update Australia’s medication funding structures by expanding the range of pregnancy relevant medications approved and subsidised under the PBS.

“Without reform, the current policy framework will continue to perpetuate socioeconomic inequalities, incentivise prescribing outside of standard regulatory safeguards, and lead to potential inefficiencies in public spending,” said Dr Jackson.

“Ultimately, expanding PBS access to both new and repurposed existing medications will create a more dynamic, evidence-based health policy system that is truly responsive to pregnant women’s health needs.”

The post Systemic gap in drug subsidies leaves low-income pregnant women with fewer treatment options appeared first on Pharmacy Update Online.

Adults with type 2 diabetes and obesity have a high risk of fragility fractures, which are caused by low-energy trauma such as falling from standing height and are often the result of underlying bone weakness.

While GLP-1 receptor agonists can significantly reduce weight in users, there has been debate on whether rapid weight reduction could further weaken bones and make them more prone to fractures.

The new UCLA study, published in JAMA Network Open, used electronic health records of nearly 134,000 U.S. adults, ages 50-90, with type 2 diabetes to compare fracture risk of new users of GLP-1s to new users of another common diabetes medication, DPP-4 inhibitors.

Researchers found that GLP-1 receptor agonist use was associated with a 21% lower risk of fragility fracture over the 3-year study period compared to DPP-4 users, with the largest reductions occurring in fractures of the hip, femur and spine. A separate analysis found that the reduced risk was only associated with type 2 diabetes participants compared to a matching cohort of non-diabetic participants.

“Fractures are relatively uncommon, so very large studies are needed to detect a meaningful difference,” said Dr. Christopher Hamad. “Most previous studies were too small or were not designed to answer this question, and having data from more than 133,000 patients allowed us to better understand how GLP-1 medications may affect fracture risk and bone health.”

The authors noted that the findings come from a retrospective observational study and do not prove GLP-1s reduce fracture risk.  Prospective and translational studies are needed to confirm their mechanistic impacts and long-term effects on bone health.

Article: Hamad CD, Wiener J, Golzar A, et al. Glucagon-Like Peptide-1 Receptor Agonists and Fragility Fracture Risk in Type 2 Diabetes. JAMA Netw Open. 2026;9(7):e2625141. doi:10.1001/jamanetworkopen.2026.25141

The post GLP-1 drugs linked to lower fracture risk in adults with type 2 diabetes appeared first on Pharmacy Update Online.

Their readability is mostly college level, the analysis—the first of its kind–shows. This isn’t recommended for content designed to be read by patients, say the researchers, who add that while communication quality may influence clinical outcomes, the dual purpose clinical letters serve makes improvement challenging.

Unlike many other health systems, there is a well established practice in the UK of sending letters to patients following an outpatient clinic appointment. These letters used to be copies of those sent to the patient’s family doctor (GP), but the emphasis has shifted to making them clearer and more patient centred, note the researchers.

Academy of Medical Royal Colleges (AoMRC) guidance in 2018 encouraged clinicians to write directly to patients rather than about them, and NHS England has since reinforced the importance of clear and timely communication with patients as essential for efficient and effective outpatient services, they add.

But it’s not clear to what extent clinical letters meet recommended readability standards. To find out and set a quality benchmark, the researchers focused on the highest volume outpatient specialty in UK healthcare—-ophthalmology.

They measured the readability and linguistic complexity of over 4.6 million outpatient clinic letters sent to 804,986 patients between 2013 and 2025 attending 17 subspecialty services at a UK hospital trust, specialising in various aspects of eye health.

Their analysis shows that the average readability score (Flesch Reading Ease) of the letters was 51.1, indicating college-level understanding. This means the correspondence was more complex and less accessible than recommended for content designed to be read by patients. Overall, 95% of the letters were less readable than recommended.

Readability varied across the 17 subspecialties, however, suggesting that communication quality may reflect service-level culture and documentation requirements, say the researchers.

The highest readability was observed for letters from paediatrics, optometry, and orthoptics services.

In children’s eye services, correspondence was often directed to parents or caregivers, which may encourage use of simpler language, suggest the researchers. And in optometry and orthoptics structured templates were often used, likely facilitating more consistent readability, they add.

There was a slight upward trend over the study period in the likelihood of letters being addressed directly to patients over the study period, but the proportion doing so remained very low, overall, at just over 2%, while use of the personal pronoun ‘you’ was also very low.

The researchers highlight several limitations to their findings, including the inability to assess variations in the readability of individual clinicians’ letters. The analysis also focused on readability and linguistic complexity rather than measuring which aspects of communication matter most to patients or had the greatest impact on healthcare outcomes.

The methods used to classify the intended audience may not fully reflect how correspondence is ultimately used or interpreted, while shifts in clinical practice, record keeping, or institutional policies may also have introduced effects not accounted for in the analysis, the researchers add.

But the study is the first long term population-scale evaluation of outpatient clinic letter readability over more than a decade, and exposes a gap between policy recommendations and routine practice, they point out.

“It demonstrates that poor readability is pervasive, has worsened over time, and varies
substantially between services, revealing system-level patterns that were previously unquantified,” they write.

Clinician letters must simultaneously work as a medical record and provide key information for other healthcare professionals as well as for patients, making it hard to simplify the linguistic content—a challenge that is further compounded by time pressures—they explain.

But they conclude: “These findings highlight a persistent gap between national recommendations and real-world practice, which underscores the need for targeted interventions and innovative approaches to support clear and patient-centred communication.”

The post Patient letters from UK hospital eye health services likely too difficult to understand appeared first on Pharmacy Update Online.

This figure increases for teenagers, with half of those attending CAMHS as teens going on to access adult mental health services by their early 30s – far more than previous research has suggested.

The findings shed light on the often severe mental health burden experienced by children who come to CAMHS and highlight the need for a better understanding of the long-term impact of childhood treatments, experts say.

CAMHS are a cornerstone of public mental health strategies, providing vital opportunities for early intervention. Studies on CAMHS treatments, however, have focused on short-term outcomes. Little is known about the long-term effects of treatments delivered, which can include medication and psychological therapies.

The study marks the longest follow-up to date of young people attending mental health services in the UK.

Researchers at the University of Edinburgh studied every child born in Scotland between 1991 and 1998 until 2023 – almost half a million people. They found that eight per cent attended CAMHS before the age of 18.

This small group went on to account for 46 per cent of all adult psychiatric inpatient bed days and 41 per cent of all NHS adult mental health outpatient appointments by the age of 32.

Former CAMHS patients account for large proportions of all severe mental illness diagnoses in adult psychiatric hospitals, including personality disorders (49 per cent), eating disorders (50 per cent), schizophrenia (39 per cent) and opioid use disorders (39 per cent).

Long-term treatment outcomes are routinely tracked across other conditions, such as cancer care, where the effects of interventions can be monitored for years after treatment, experts say.

The research team is calling for the Scottish Government to bring mental health in line with other areas of the NHS by establishing a Mental Health Observatory, routinely linking childhood and adulthood mental health records to evaluate the impact of services and policy changes.

Professor Ian Kelleher, Chair of Child and Adolescent Psychiatry at the University of Edinburgh, who led the study, said: “We know about long-term outcomes for 27 types of cancer in Scotland, but we’ve known very little about long-term outcomes for children who attend our CAMHS services because there is no equivalent monitoring system for mental health. This is more important now than ever, given the rising number of children and young people presenting with mental health problems.

“CAMHS is not just a childhood treatment service – it identifies a population that will go on to be high-intensity users of specialist adult mental health services. From a health, societal and economic perspective, we need to robustly evaluate whether existing CAMHS interventions are leading to long-term benefits.”

Dr Jane Morris, Chair of the Royal College of Psychiatrists in Scotland, said: “This important work underlines the importance of identifying mental health conditions as early as possible to prevent irreversible damage to people’s healthy development. It goes further by highlighting the need for further intensive supports in our adult services to maintain those benefits through life. We and our colleagues in the field of public mental health would support the establishment of a Mental Health Observatory to ensure delivery of the best possible care to people in Scotland.”

The study is published in the journal European Child and Adolescent Psychiatry: https://www.nature.com/articles/s42004-026-01942-7 [URL will become active after embargo lifts]. It was funded by the Academy of Medical Sciences, the UK Department for Science, Innovation and Technology, and Research Data Scotland.

The post Almost half of child mental health patients need adult care too appeared first on Pharmacy Update Online.

The retrospective cohort study linked deidentified electronic health records with administrative claims from the Optum Labs Data Warehouse, identifying 1,428 adults with commercial or Medicare Advantage cover who received a first buprenorphine prescription for opioid use disorder (OUD) between 1 January 2020 and 25 September 2024. Abandonment was defined as no dispensing record within 30 days of the prescribing date.

Overall, 369 patients (25.8%) abandoned their first prescription, with the annual proportion rising from 19% in 2020 to 37% in 2024 (*P* for trend = .02).

Patients whose prescriptions went unfilled were younger (mean 54.3 vs 57.4 years), more frequently Hispanic (10.6% vs 4.8%), more likely to hold commercial rather than Medicare Advantage cover (51.8% vs 29.4%), and faced higher pharmacy deductibles (mean $483.80 vs $296.40). Those who collected their medication were more likely to have a recorded diagnosis of OUD or overdose in the previous 180 days (54.4% vs 40.1%) or a mental health diagnosis (52.5% vs 38.5%).

The authors, led by Xinyi Jiang, PhD, MS, of the CDC’s Division of Overdose Prevention, suggest pharmacy plan deductibles may be an important factor in abandonment, and point to dispensing buprenorphine directly during clinical encounters, strengthening linkage to care, and improving pharmacy availability as ways to reduce barriers to treatment.

**Source:** Jiang X, Zhang K, Chen Y, et al. Abandonment of Prescribed Buprenorphine for Opioid Use Disorder, 2020-2024. *JAMA Netw Open.* 2026;9(8):e2627142. doi:10.1001/jamanetworkopen.2026.27142

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2026.27142?guestAccessKey=1db66b39-91d4-4a88-b5b1-334a938dd52d&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_term=080426

The post Abandonment of prescribed buprenorphine for opioid use disorder, 2020-2024 appeared first on Pharmacy Update Online.

Funded by the Medical Research Council, the research is the first of its kind in the UK, and the findings reveal families are falling into unmanageable debt, reluctantly adopting feeding practices they know could harm their babies, and even taking formula from shops without paying as a last resort.

Exploring the experiences of 281 struggling parents through surveys and interviews, the study found that financial strain has triggered a severe crisis of anxiety, guilt, and isolation among parents.

Nearly every parent surveyed reported damage to their mental health. For some, the distress is so severe it has led to feelings of regret over having a baby. One participant shared: “Sometimes I regret having this baby and I feel awful about having those thoughts because I love her so much but I’m not a good mum to her.”

Driven by the high cost of formula, parents reported a range of drastic coping strategies:

• Compromised infant safety: Almost 40% of parents resorted to unsafe feeding practices, including reusing leftover formula, watering down formula, and reducing sterilisation.
• Extreme personal sacrifices: More than a third of parents (37%) left their homes unheated, 43% fell behind on bills, and nearly half (47%) took on debts that are difficult to repay. For 21% of mothers, it meant cutting maternity leave short to return to work early.
• Cheaper alternatives: Nearly half of the families (48%) introduced solid foods before their baby was ready, or switched to cheaper milk intended for older babies (45%).
• Acts of last resort: Facing absolute desperation, 10% of parents reported taking formula from a shop without paying.

Amy Brown, a Professor of Public Health at Swansea University, who led the study, said: “Infant formula prices were high before the cost-of-living crisis, and rose up to 45% between 2021 and 2023. A recent report by the Competition and Markets Authority identified excessive price rises for infant formula and exceptionally high profit margins of between 50-75%.

“This is a significant issue because infant formula is not a discretionary product. When infants are not breastfed or not fully breastfed, infant formula is needed to support growth and development. The worrying and rapid changes in the formula market coincide with the broader cost-of-living crisis, with many families already struggling to get by.”

More than half of babies in the UK receive formula during their first week, with 88% receiving some formula milk by six months of age. Low-income households are far more likely to use formula to feed their babies. Globally, fewer than half of infants are exclusively breastfed for the first six months of life.

Many mothers featured in the study had wanted to breastfeed their baby but had been unable to get the support to do so. This left them feeling particularly guilty, anxious and let down twice when they then struggled to afford the formula their baby needed.

Professor Brown added: “We expected our research to reflect some of the experiences we had been seeing in the media but were shocked at how many families it was affecting and how deeply.

“Mothers described how the lack of support and action on the issue had left them feeling heartbroken and feeling like they had failed. Some attributed it to causing postnatal depression, especially when they really wanted to breastfeed and felt as if they had let their baby down twice.

“Our research shows that we urgently need more holistic support across infant feeding that both ensures more women who want to breastfeed can do so, and those who are using formula have reliable access to affordable products that put babies and parents first. This would help to ensure greater infant food security, protecting both infant health and nutrition but wider development and family wellbeing.”

Published in Maternal and Child Nutrition, the study ‘Infant formula affordability negatively impacts parental wellbeing, financial security and safe feeding practices in the UK’v was carried out in collaboration with Cardiff Metropolitan University, University of Hertfordshire, First Steps Nutrition Trust, Leicester Mammas, the Independent Food Aid Network, and the Newcastle upon Tyne Hospitals NHS Foundation Trust.

The post New study shows the devastating impact high infant formula milk prices are having on families in the UK appeared first on Pharmacy Update Online.

Researchers found that rates of gestational diabetes – a condition that develops during pregnancy and can cause serious complications for both mother and baby – increased from around eight per cent of pregnancies in 2018 to more than 12 per cent in 2022.

The sharpest rises were seen among some ethnic minority groups and women living in deprived areas.

Experts say the findings highlight an urgent need to strengthen maternity services and improve support for women at highest risk.

Gestational diabetes mellitus (GDM) is the most common complication arising during pregnancy. The condition occurs when the body cannot produce enough insulin to regulate blood sugar levels during pregnancy.

GDM is associated with an increased risk of complications including preterm birth, emergency Caesarean section and babies being born either larger or smaller than expected for their gestational age. It is also linked to long-term health risks for both mothers and their children.

Researchers analysed routinely collected NHS maternity data covering over 2.3 million mothers and around 2.8 million births across 184 hospitals in England between 2018 and 2022.

The highest increases in gestational diabetes were seen among Asian women, where rates reached around 23 per cent, and among women living in the most deprived areas, where they reached around 14 per cent.

The study also found marked inequalities in pregnancy outcomes across ethnic and socioeconomic groups. Black mothers were more likely to experience an emergency Caesarean birth, women living in deprived areas were more likely to give birth preterm, and Asian mothers were more likely to have babies born small for gestational age.

Among these higher-risk groups, a diagnosis of gestational diabetes was associated with a further increase in the risk of preterm birth.

Researchers say rising maternal age, increasing rates of obesity and improvements in data capture are likely contributors to the growing prevalence of gestational diabetes.

The study also found that changes to gestational diabetes screening introduced during the COVID-19 pandemic did not meaningfully affect overall trends in diagnosis. Experts say the rise in cases reflects broader underlying changes rather than changes in testing practice.

Rebecca Reynolds, Professor of Metabolic Medicine at the University of Edinburgh, said: “This the first time we have managed to estimate the number of women with gestational diabetes in the UK. The rising number of women being diagnosed is concerning and impacts on maternity services delivery which are already challenged. Importantly, gestational diabetes also increases risk of future type 2 diabetes and cardiovascular disease, so better preventative measures are needed to help support these women post partum.”

Dr Sonya Babu-Narayan, Clinical Director at the British Heart Foundation, said: “Big data research studies like this, which can now analyse millions of healthcare records, are uncovering a concerning rise in conditions which raise people’s chances of having a future heart attack or stroke. Gestational diabetes often goes away after pregnancy, but it can increase women’s risk of future cardiovascular disease. Healthcare professionals who want to fully understand people’s risk of heart attack and stroke should routinely ask women about risk factors unique to them, such as diabetes or high blood pressure in pregnancy – even if that pregnancy was decades earlier. If you are a woman who has had diabetes or high blood pressure during pregnancy, it is especially important to attend health checks when invited.”

The study is published in the journal BMJ Medicine: https://bmjmedicine.bmj.com/lookup/doi/10.1136/bmjmed-2025-002412 [URL will become active after embargo lifts]. It involved researchers from King’s College London, University of Glasgow, University of Warwick and researchers within the HDRUK Diabetes Data Catalyst, a partnership between British Heart Foundation Data Science Centre, Diabetes UK and Health Data Research UK. It was funded by the British Heart Foundation.

The post Gestational diabetes diagnoses rise sharply in England appeared first on Pharmacy Update Online.

New research from the USC Schaeffer Center for Health Policy & Economics published in Health Affairs finds that drug spending has become increasingly focused on highly novel drugs in the last decade. This shift appears to be driven by increased prescribing of more innovative medicines rather than high prices for a small number of drugs.

“Market forces and government policies appear to be evolving in ways that better reward pharmaceutical innovation. As policymakers continue to scrutinize drug spending, our findings suggest this spending is increasingly on treatments more likely to represent true scientific advances,” said lead author Darius Lakdawalla, Schaeffer’s chief scientific officer and USC university professor of pharmaceutical economics and public policy.

How researchers determined drug novelty
USC researchers examined 20 years of data on about 600 newly approved small-molecule drugs, such as prescription pills, while developing a framework to assess their novelty.

Researchers matched records from a public database of drug characteristics—which includes information such as molecular structure, biological targets, and therapeutic class—with FDA files of approved drugs. They then linked data on drug spending from the Medical Expenditure Panel Survey, a nationally representative source of U.S. healthcare use and spending, to a database of drug pricing and rebate information to estimate both gross revenues and net revenues after accounting for manufacturer discounts.

To determine novelty, researchers developed measures to assess how similar a new drug’s molecular structure was to other previously approved drugs in its class, how many drugs shared the same biological target, and the uniqueness of how the drug is delivered and absorbed. Drugs were categorized as low, medium or high novelty for each of the three measures.

Key findings

• From 2000 through the early 2010s, the market for less biochemically novel drugs was growing while the market share for less novel drugs had been declining.
• Around 2013, revenues for high-novelty drugs started growing substantially faster than less innovative products. For instance, average gross revenues for drugs with highly unique therapeutic targets quadrupled from $400 million to $1.6 billion by the end of the decade, far outpacing growth for less novel products in this category.
• The widening revenue gap between highly novel and less novel drugs largely persisted after accounting for estimated rebates drug manufacturers provided to health plans and pharmacy benefit managers (PBMs).
• During this time, prescriptions for highly innovative drugs surged while prescriptions for less novel drugs declined. This suggests increased spending on more innovative drugs was largely driven by greater use rather than higher prices.

[See the data: https://www.datawrapper.de/_/hdcKp/?v=4]

Policy implications
The increase in drug spending beginning in 2013 has often been attributed to the introduction of a few innovative high-cost therapies, including highly effective hepatitis C treatments. However, while USC researchers found highly novel drugs were major contributors to revenue growth after 2013, they also observed increasing revenue among innovative drugs introduced before 2013.

The shift to greater spending on innovative drugs could be explained by PBMs’ growing use of restrictive formularies around this time, the researchers suggested.

PBMs, which negotiate drug coverage on behalf of health plans, find it easier to exclude drugs with multiple, similarly effective therapeutic alternatives. As a result, more novel treatments may have been more widely covered, which in turn could be incentivizing manufacturers to focus development on meaningful advances.

“Our research shows that the market rewards different forms of pharmaceutical innovation and highlights how reimbursement and formulary decisions can shape whether novel medicines succeed in the marketplace,” said co-author Boshen Jiao, a Schaeffer scholar and assistant professor at the USC Mann School of Pharmacy and Pharmaceutical Sciences.

About the study
Ian Haworth of the USC Mann School is also an author. Please see the study for author disclosures.

The post Pharmaceutical spending is shifting away from ‘me-too’ drugs appeared first on Pharmacy Update Online.

In a new review published in The Journal of Clinical Endocrinology & Metabolism, researchers from LSU’s Pennington Biomedical Research Center examine the concept of “metabolically healthy obesity” and argue that a newer framework distinguishing preclinical obesity from clinical obesity provides a more biologically grounded and clinically actionable approach.

The review, “Does Metabolically Healthy Obesity Really Exist: Going Toward New Definitions,” was authored by Dr. Christian Rodriguez, postdoctoral researcher, and LSU Boyd Professor Dr. Eric Ravussin. The paper examines how the traditional classification of metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) has influenced treatment decisions and why the newer outline developed by the Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity may offer a better path forward.

The traditional MHO/MUO framework generally classifies people with obesity based on the presence or absence of metabolic abnormalities. Under that approach, individuals with metabolically unhealthy obesity may be candidates for more intensive lifestyle interventions and pharmacotherapy, while those classified as having metabolically healthy obesity may initially receive structured lifestyle support, with more intensive treatment considered if their metabolic health worsens or other risk factors emerge.

The challenge is that the definition of MHO varies considerably across studies and is often not a stable condition. Individuals classified as having MHO may develop metabolic abnormalities over time, complicating treatment plans based on the assumption that their obesity is currently “healthy.”

“Metabolically healthy obesity helped researchers recognize that obesity does not affect every person in exactly the same way,” Dr. Ravussin said. “But the classification is difficult to use as a foundation for long-term treatment because the definitions vary and metabolic health can change. A person who is considered metabolically healthy today may not be metabolically healthy tomorrow.”

The preclinical/clinical obesity framework proposed by the Lancet Commission takes a different approach. Rather than defining obesity primarily by the presence or absence of a specific cluster of metabolic risk factors, it considers whether excess adiposity is causing dysfunction in organs or tissues or limiting a person’s ability to perform daily activities.

This means that preclinical obesity describes individuals with confirmed excess adiposity who do not currently have evidence of obesity-related organ or tissue dysfunction. These individuals may benefit from structured lifestyle interventions, regular monitoring of cardiometabolic health and shared decision-making about pharmacotherapy when individual risk is elevated.

On the other hand, clinical obesity is defined by excess adiposity accompanied by obesity-related organ or tissue dysfunction or significant limitations in daily activities. For these individuals, evidence-based pharmacotherapy and, when appropriate, metabolic or bariatric surgery may be considered alongside treatment of the specific health problems associated with obesity.

Importantly, the framework also changes how treatment success may be evaluated. Rather than measuring success solely by the amount of weight lost, the goal is to improve or resolve the organ or tissue dysfunction that defines a person’s clinical obesity.

“Moving from the question ‘Is this person metabolically healthy or unhealthy?’ to ‘Is excess adiposity affecting the function of the body?’ gives us a more clinically meaningful way to think about obesity,” Dr. Rodriguez said. “The framework allows us to identify people who may benefit from prevention and monitoring while also recognizing when obesity has progressed to a disease state requiring more intensive treatment.”

The new approach builds on the work of the Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity. Three Pennington Biomedical researchers – Dr. Ravussin, Dr. Philip Schauer and Dr. John Kirwan – served on the 56-member international Commission that developed the new method for defining and diagnosing obesity.

The authors note that it is still evolving and will require additional research to validate its diagnostic criteria and develop tools for consistent implementation in clinical practice and public health. The review concludes that the concept of metabolically healthy obesity has helped advance understanding of the biological diversity of obesity but is limited by inconsistent definitions, its potentially temporary nature and its focus on a relatively narrow set of metabolic risk factors.

About the Pennington Biomedical Research Center

The Pennington Biomedical Research Center is at the forefront of medical discovery as it relates to understanding the triggers of obesity, diabetes, cardiovascular disease, cancer and dementia. Pennington Biomedical has the vision to lead the world in promoting nutrition and metabolic health and eliminating metabolic disease through scientific discoveries that create solutions from cells to society. The Center conducts basic, clinical and population research, and is a campus in the LSU System.

The research enterprise at Pennington Biomedical includes over 600 employees within a network of 44 clinics and research laboratories, and 16 highly specialized core service facilities. Its scientists and physician-scientists are supported by research trainees, lab technicians, nurses, dietitians and other support personnel. Pennington Biomedical is a globally recognized state-of-the-art research institution in Baton Rouge, Louisiana. For more information, see www.pbrc.edu.

The post New approach to obesity classification could better guide treatment decisions appeared first on Pharmacy Update Online.

The committee recommended granting marketing authorisations for three medicines to treat adults with primary hypercholesterolaemia or mixed dyslipidaemia, conditions that cause high cholesterol levels in the blood: Lyrokaul (lerodalcibep) is an injection that patients can self-administer monthly; Evlarco (obicetrapib / ezetimibe) and Ubeslo (obicetrapib) are both oral formulations to be taken daily.

The other nine products to get the green light were:

• Susvimo (rabinizumab) to treat adults with neovascular (wet) age-related macular degeneration.
• Icotyde (icotrokinra) for the treatment of moderate-to-severe plaque psoriasis in adults and adolescents from 12 years of age.
• Lynavoy (linerixibat) for the treatment of adults with cholestatic pruritus.
• Nezglyal (leriglitazone) for the treatment of cerebral adrenoleukodystrophy, a rare genetic disorder which affects the brain, typically during childhood.
• Zokovea (ensitrelvir), an antiviral medicine, for the post-exposure prophylaxis of COVID-19.
• Cavoley (pegfilgrastim) for the treatment of neutropenia (low levels of neutrophils, a type of white blood cell).
• Riociguat Accord (riociguat) for the treatment of chronic thromboembolic pulmonary hypertension in adults and treatment of pulmonary arterial hypertension in adults and children from 6 years of age.
• Ruxolitinib Viatris (ruxolitinib hemifumarate) for the treatment of myelofibrosis, polycythaemia vera and graft-versus-host disease.
• Tafamidis Accord (tafamidis) for the treatment of hereditary transthyretin amyloidosis in adult patients with cardiomyopathy.

The CHMP recommended extensions of indication for eight medicines that are already authorised in the EU: Enhertu, Jivi, Piqray, Repatha, Riltrava Aerosphere, Rinvoq, Trixeo Aerosphere, and Trodelvy.

The committee also approved an update of the composition of the vaccines Bimervax, Comirnaty, Nuvaxovid and Spikevax to target the new XFG variant of the virus that causes COVID-19.

The post Green light for twelve new medicines in the EU appeared first on Pharmacy Update Online.

Why discharge summaries matter

A discharge summary is the primary method of communicating what happened during a hospital stay to GPs, community teams, community pharmacists, and sometimes patients’ carers. When this transfer of information is delayed or incomplete, the consequences can be serious: GPs may fail to follow up appropriately, or may unknowingly re-prescribe medication that caused harm in the first place. Patients themselves are often unclear about their own medication changes, increasing the risk of errors after discharge. The project’s goal, says Mr Chan, was to “improve both the quality and the timeliness of discharge information while reducing the administrative burden on clinicians.”

A process under strain

Before the redesign, the discharge process was slow and highly variable. Clinicians often had to review hundreds of pages of notes before compiling a summary — a particular challenge on mental health wards, where admissions can range from 30 to 120 days. Completion rates within 24 hours of discharge varied considerably between wards, from around 70% down to just 30%. Ownership of the task was also unclear, with doctors and pharmacists sometimes each assuming the other was responsible, while junior doctors juggled competing priorities. The result was delay, and community clinicians left without timely information on diagnosis, treatment, and medication changes.

Redesigning the pathway before adding AI

Recognising that the problem could not be solved by one professional group alone, the trust convened a multidisciplinary co-production group, chaired by a consultant psychiatrist. The team used performance data and direct feedback from GPs to clarify responsibilities and standardise workflows before considering any technology. This groundwork alone raised the overall proportion of discharge summaries reaching GPs within 24 hours to around 60% — but progress then plateaued.

Introducing AI

The trust had already been using an AI platform, Anathem, for about two years to support ambient voice transcription of outpatient consultations. Extending this technology to discharge summaries was, “a natural progression” says Mr Chan. The AI reviews up to 300 pages of clinical notes and drafts the two-part discharge document: a clinical summary and a medication summary, including the reason for admission, diagnosis, interventions, medication changes and reasons for stopping drugs, and follow-up requirements. Feedback from GPs showed they rarely read beyond two pages, so the AI-generated document was deliberately condensed to that length.

The impact on efficiency has been substantial. Producing a discharge summary manually took a junior doctor 45 minutes to an hour; with AI support, this has fallen to around 20 minutes. Timeliness has also improved sharply, with 24-hour completion rates rising from 60% to around 90%.

Safeguards and accountability

Crucially, the AI does not send documents automatically. The resident doctor must review, edit, and formally sign off the summary using a smart card before it is transmitted electronically to the GP, retaining full professional accountability. This reflects lessons learned from early problems, including “hallucinations or confabulations”; in one case, the AI mistakenly recorded a patient’s suicidal ideation as an intent toward strangulation. Such incidents reinforced the trust’s view that AI can support clinicians but cannot replace their judgement.

Access to the tool is similarly staged. Foundation-level doctors (F1 and F2) are excluded. Specialty Trainee (ST) level doctors must first demonstrate they can produce a discharge summary manually before AI access is granted — an approach Mr Chan compares to a pilot needing to be able to fly a plane manually before using autopilot.

What’s next

Having piloted the approach on three wards, the trust now plans to scale it across the wider hospital and into community services, while continuing to gather feedback from clinicians, GPs, and patients. Mr Chan believes the model is transferable across the NHS, since safe information transfer between care settings is a universal challenge, even if local workflows differ.

Looking ahead, he is clear that AI will not replace healthcare professionals. “The future is not about replacing healthcare professionals with machines,” he says. “It is about augmenting them… The combination of human judgment, compassion and professional accountability, supported by well-governed technology, will deliver the safest care to the patient.”

Poster presented at the Clinical Pharmacy Congress. London 8-9th May 2026

The post Smarter, faster, safer: automating discharge summaries with Anathem AI appeared first on Pharmacy Update Online.