1. The Impact of Pharmacy Safety Alerts on Thiazolidinedione Use Lee YY 1, Chiang YC 1, Kuo LN 1, Chen HY 1,2 Department of Pharmacy, Taipei Medical University -Wanfang Hospital 1 School of Pharmacy, Taipei Medical University 2 BACKGROUND METHODS REFERENCES CONCLUSIONS RESULTS  After Pharmacy directly communicated with main prescribers and published Hospital Internal Safety Alerts regarding rosiglitazone between May to November 2007, the usage of thiazolidinediones reduced from around 30,000 tablets per month to 25,000 tablets per month. (Figure 1)  The average monthly amount of thiazolidinediones used changed from 30,449±2,278 tables to 24,024 ±955 tables for February 2007 to May 2007 and December 2007 to March 2008, respectively (p=0.002).  Pharmacy safety alert plays an important role in improving medication safety.  This study indicated that prompt medication safety alerts issued by Pharmacy may result in a positive impact on prescribers.  With proper communications between pharmacists and physicians, the prescribing pattern can be affected even without restricted hospital prescribing regulation.  The limitations of the study include retrospective follow up and the drug usage can be affected by total patient number and patient’s morbidity conditions. Further study is needed in the future. Figure 1. Monthly Usage of Thiazolidinediones 1. Nissen Se, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. NEJM 2007; 356: 2451-71. 2. U.S. Food and Drug Administration.Information for Healthcare Professionals: Rosiglitazone maleate. Avaliable at http://www.fda.gov/cder/drug/InfoSheets/HCP/rosiglitazone200707HCP.htm. Accessed 5/6/2008. http://www.fda.gov/cder/drug/InfoSheets/HCP/rosiglitazone200707HCP.htm 3. Home PD, Pocock SJ, Beck-Nielsen H, et al. Rosiglitazone evaluated for cardiovascualr outcomes-an interim analysis. NEJM 2007;357: 28-38. Figure 2. Usage Patterns of Pioglitazone and Rosiglitazone In May 2007,a meta-analysis of 42 clinical studies revealed rosiglitazone (Avandia ® ) may cause an increased risk of myocardial ischemic events. A following interim analysis from RECORD study, a 6-year, open-label, noninferiority trial, addressed the use of rosiglitazone was associated with a higher danger of heart failure. As a result, the U.S. Food and Drug Administration (FDA) issued safety alerts on the potential cardiovascualr risk of rosiglitazone on May 21, 2007 and August 14, 2007. Later on, FDA added a new boxed warning about the risk of myocardial ischemia for the label of rosiglitazone on November 19, 2007. In order to ensure medication safety, Pharmacy and Endocrinology Department held an interdisciplinary journal club with presentations and discussions regarding the safety use of rosiglitazone in June 2007. Between May to November 2007, Pharmacy also issued several Internal Hospital Memos on the potential risks of rosiglitazone.  This was a retrospective, observational study.  We compared the monthly usage of thiazolidinediones on the formulary, including rosiglitazone and pioglitazone, before and after pharmacy interventions such as interdisciplinary journal club discussions and hospital internal medication safety alerts.  Data were collected from February 2007 to March 2008 and analyzed by Student’s t-test and chi-square test. 30,449 ±2,278 1st Pharmacy Safety Alert 24,024 ±955 Interdisciplinary Journal Club Last Pharmacy Safety Alert Interdisciplinary Journal Club 1st Pharmacy Safety Alert OBJECTIVE  The objective of the study was to evaluate the impact of pharmacist interventions regarding rosiglitazone on physician’s prescribing pattern. OBJECTIVE To evaluate the impact of pharmacy’s medication safety alerts regarding rosiglitazone on physician’s prescribing pattern. METHODS We compared the monthly usage of thiazolidinediones on the formulary, including rosiglitazone and pioglitazone, before and after pharmacy interventions regarding U.S. Food and Drug Administration’s warnings on rosiglitazone. Data were collected from February 2007 to March 2008. RESULTS After interventions done between May to November 2007, the usage of thiazolidinediones has reduced. The average monthly amount of thiazolidinediones used changed from 30,449 ± 2,278 tables to 24,024 ± 955 tables (p=0.002). Within the same therapeutic class, the percentage of total monthly usage changed from 66% vs. 34% to 46% vs. 54% for rosiglitazone and pioglitazone, respectively (p<0.001). CONCLUSIONS Pharmacy safety alert plays an important role in improving medication safety. This study indicated that prompt medication safety alerts issued by Pharmacy may result in a positive impact on prescribers. With proper communications between pharmacists and physicians, the prescribing pattern can be affected even without restricted hospital prescribing regulation.  Within the same therapeutic class, the proportion of rosiglitazone use gradually decreased while the use of pioglitazone gradually increased.  The percentage of total monthly usage changed from 67% vs. 33% to 44% vs. 56% for rosiglitazone and pioglitazone, respectively(p<0.001). (Figure 2) ABSTRACT