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In August 2003. the US Department of Veterans Affairs (VA) awarded a contract for prostagiandin ophthalmic agents with travoprost as the agent of choice, Although there was no national mandate to switch patients from existing therapy, many VA facilities had agreements from their iocai ophthalmology and optometry departments to conduct a therapeutic interchange of patients from existing prostagiandins (eg, iatanoprost) to travoprost- The primary purpose of this report is to describe the experience of conversion to travoprost after this contract. Medical records of converted patients were evaluated for change in intraocular pressure (lOP), change in visual field, adverse events, and whether or not a change back to the original therapy or alternative therapy was required. Of 578 patients evaluated, most (84%) had been using Iatanoprost before the conversion. After conversion, mean lOP was significantly reduced by 1,64 ± 4.95 mm Hg {P<.0001). Of 188 patients with documented visual field assessment. 89.9% had no change or improvement in visual field after conversion. Adverse events occurred in 44 (7.6%) patients, with hyperemia occurring in 13 (2.2%) patients. Discontinuation of travoprost was attributed to an adverse event in 29 (5.0%) patients and attributed to ineffectiveness in 17 (2.9%) patients. Adverse drug event rates were significantly less than those reported in the literature. Travoprost was effective and well tolerated in most patients after therapeutic interchange. This evaluation provides additional information regarding outcomes associated with the therapeutic interchange. [ABSTRACT FROM AUTHOR]

The development and approval of disease modifying treatments (nusinersen, onasemnogene abeparvovec-xioi, risdiplam) for spinal muscular atrophy (SMA) and expanding use of newborn screen has revolutionized our management of SMA patients. In Colorado and Wyoming, newborn screen for SMA was initiated in 2020, with diagnosis and treatment typically occurring in the first weeks of life. Early treatment is truly life-altering for infants with SMA. However, long-term outcomes for these children and durability of treatments such as onasemnogene abeparvovec-xioi are not well known so careful monitoring in a neuromuscular center remains critical. Neuromuscular centers and providers are adapting to this new era of SMA care by developing monitoring protocols to identify signs of disease progression or treatment failure that may require changes in clinical management. At Children's Hospital Colorado we implemented electrophysiologic monitoring with peroneal compound motor action potentials (CMAPs) every 6 months, starting at diagnosis, as an adjunctive monitoring tool alongside standardized physical therapy and clinical assessments. Here, we present our experience with CMAP monitoring in SMA patients identified by newborn screen, alongside standardized physical therapy assessment and functional data. In children with SMA with 2 copies of SMN 2 baseline CMAPs performed in the first few weeks of life were typically low, whereas baseline CMAPs in newborns with 4 or more copies of SMN2 were typically on the higher end of normal. CMAPs in patients with 2 or 3 copies of SMN2 tended to show a bigger increase over time compared to CMAPs in patients with 4 or more copies of SMN2. However, patients with an initial CMAP less than 2 mV continued to have lower CMAPs over time compared to patients with an initial CMAP over 2 mV. Patients with lower CMAPs also had signs of weakness on clinical and physical therapy assessments. As the neuromuscular community learns a new and evolving phenotype for SMA patients receiving disease-modifying therapy in the newborn period it is critical to continue to share information to develop and periodically re-evaluate monitoring programs that allow us to anticipate and respond to changing patient needs. [ABSTRACT FROM AUTHOR]

The market withdrawal of troglitazone forced the Department of Veterans Affairs (VA) to perform a systemwide switch from troglitazone to rosiglitazone or pioglitazone. The potency, dosing equivalents, and safety of these agents had not been specifically assessed in the complex VA patient base, which includes elderly patients. The VA Pharmacy Benefits Management Strategic Healthcare Group (VA PBM) performed a national drug utilization evaluation (DUE) of the conversion from troglitazone to rosiglitazone or pioglitazone. The objectives were to: 1) assess dosing potency and equivalence of con-version doses; 2) evaluate the effects of rosiglitazone and pioglitazone on HgbA1C, lipid panel, LFTs, and Hgb/Hct; and 3) monitor adverse drug events. Nine VA facilities participated in collecting a minimum of 4 months' data for analysis by the VA PBM. A standard dose conversion table was provided. The dosing equivalent appeared less potent for pioglitazone compared to rosiglitazone as demonstrated by more frequent dosage increases (28% vs 16%). The most common ADEs detected were weight gain (27%), mild LFT elevation (23%), and CHF symptoms (9.4%). The findings of this DUE warrant close monitoring of patients placed on thiazolidinedione therapy, particularly with regards to CHF exacerbation and potential hepatotoxicity, which prompted the initiation of a VA National Thiazolidinedione Registry. [ABSTRACT FROM AUTHOR]