Updates to Post-Myocardial Infarction and Osteoporosis

All TreatGx users now have access to the updated treatment algorithms for Post-Myocardial Infarction and Osteoporosis. As always, these updates include the TreatGx standard of providing personalized dosing based on pharmacogenetics, kidney function, liver function, and drug interactions. 

Post-Myocardial Infarction

This update includes recommendations from the 2013 ACCF/AHA Guidelines for the management of ST-Elevation Myocardial infarction[1], the 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes [2], and the 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease[3].   

The medication options were reviewed and updated based on guideline, monograph and specific trial data for use in those with previous myocardial infarction.  Dosing details and recommendations have been updated based on relevant kidney, liver, drug interaction and pharmacogenetic factors as indicated by monographs and guidelines.

Osteoporosis  

This update implemented recommendations from the newest clinical guidelines including the American Association of Clinical Endocrinologists (AACE) /American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis 2020 Update [4], Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update 2020 [5], and the Scottish Intercollegiate Guidelines Network Management of osteoporosis and the prevention of fragility fractures 2021 [6]. 

Additional medication options for osteoporosis were added: abaloparatide, ibandronate, calcitonin nasal spray (available in the US only), and romosozumab. All medications will be provided with an updated profile and information which includes: evidence of efficacy for reduction of vertebral/nonvertebral/hip fractures, whether off-label use in specific populations, duration of treatment and/or drug holidays, and sequential treatment. 

References

1. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr., Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA et al: 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology 2013, 61(4):e78-140.
2. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Jr., Ganiats TG, Holmes DR, Jr., Jaffe AS, Jneid H, Kelly RF, Kontos MCet al:2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014, 130(25):2354-2394.
3. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri Let al:2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation 2016, 134(10):e123-155.
4. Watts NB, Camacho PM, Lewiecki EM, Petak SM:American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update.Endocr Pract 2021, 27(4):379-380.
5. Shoback D, Rosen CJ, Black DM, Cheung AM, Murad MH, Eastell R:Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update.J Clin Endocrinol Metab 2020, 105(3).
6. Scottish Intercollegiate Guidelines Network:Management of osteoporosis and the prevention of fragility fractures [SIGN 142]. In:SIGN UK. Edinburgh; 2021.