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  Issue 1 (2006)

Book Review
Ulrich Schwabe, Dieter Paffrath (Ed.)

Arzneiverordnungs-Report 2005 (Drug Prescription Report), Current Data, Costs, Trends, and Comments

Springer publishing house, Berlin 2005. 1218 pages. Bound. 34,95 Euro. ISBN 3-540-21359-7

"The drug prescription report 2005 is marked by drastic changes caused by the GKV Modernisierungsgesetz (GMG) (modernization law) at the statutory medicinal drug prescriptions". In this issue one can only agree to the publishers of the report. Related to drugs (co-) prescribed by dermatologists the trend has further increased in the sense of a decrease of the prescription frequency to the debit of GKV in the reporting period. This applies even to a higher degree for "anti-mycotics" which are dealt with in a separate chapter compared to "dermatics and wound treatment products".

The Encyclopedia is divided in two parts. The first part consists of an alphabetical listing in tables as per the brand names of the considered substances on more than 1300 pages. Given are the chemical structure, different substance characteristic, the designation according to INCI (International Nomenclature for Cosmetic Ingredients), the effect claimed, areas of application as well as producers and suppliers.

The first sentence in the anti-mycotics chapter reads as follows: "the decline of prescriptions for anti-mycotics in 2004 amounts to altogether almost 50 percent compared to the previous year". This is in particular caused by the decline of the prescription for topical mono-preparations! The statement given is here reproduced non-commented: "the drastical cutback of prescriptions in this market segment is thus politically intended and therefore comprehensible".

Surprisingly, the discontinuation of the refundability of most topical anti-mycotics has not entailed a prescription increase of products which remain reimbursable. Thus for example the prescription frequency of Ciclopirox-containing original provider preparations has decreased by 27.3 percent whereas this does not concern the refundable solution of the treatment of onychomycosis. It is informed, furthermore, that a dispensing augmentation of adequate preparations in the OTC sector has been observed in the magnitude of 10 to 15 percent.

A part of the previously topical anti-mycotics of the type mono-preparations prescribed in the GKV has possibly been replaced by "corticosteroid-containing combinations". If one considers the defined employed daily doses (DDD), this attracts attention to the fact that the glucocorticoid combinations with 30.5 million DDD meanwhile rank distinctively before the mono-preparations with 20.7 million DDD. It is rightly pointed out in the book that the employment of such agents is not reflected by dermato-mycological guidelines.

As concerns application frequency, "corticosteroids" are still in front position. However, they are also declining with 237 million DDD in 2004 compared to 267 million in the previous year. Drastically fallen back have equally the so-called wound treatment agents: here only 47 have been prescribed compared to 129 million daily doses. A rise of the prescription frequency is not the case in any group, at least psoriasis preparations have proven stable with 27 million DDD.

Significant changes have also occurred in the sector of acne therapeutics as here benzyl peroxide-containing agents are no longer refundable. At the preparations for external application Adapalen with 6.6 million DDD ranks in top position. Regarding verrucae preparations, probably the ceased refundabilty of salicylic acid containing mono-preparations has caused a prescription increment of 3.9 percent for a combination preparation based on salicylic acid and fluorouracil has come about. The comparably highest increase in prescription frequency has been observed in the sector calcineurin-inhibitors classified as immune suppressants. The prescription frequency of the three ready-to-use drugs of the group was by 46 percent higher than in the preceding year. Pimecrolimus ranks with altogether 4.6 million DDD distinctly before Tacrolimus with 2.7 millions.

The still by far most often prescribed preparation for external application has no essential reference to dermatology, that is topically applicable Diclofenac with 2.84 million prescriptions. But also in this case a decrease by 30.1 percent occurred which may be basically associated with the omission of the refundability of non-prescription Diclofenac-preparations for external application.

In the list of the "leading drugs 2004 compliant with prescriptions" ranks the first topical dermatic on position 89 (973,000 prescriptions at 15.7 percent decrease compared to the previous year) with the Prednicarbate original preparation in its different presentation forms. On second position of dermatics follow Ciclopirox-containing original provider preparations on position 141.

Within a synopsis it can be ascertained that the drug prescription report 2005 presents a wide range of highly interesting insights to the dermopharmaceutically interested circle of persons. Also if one may be disposed to not always follow the interpretation of facts, the compilation per se can meanwhile be classified as indispensable.

Prof. Dr. med. H. C. Korting, München



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