Author: Kaye

The Disease Burden Esketamine (Spravato) by Johnson and Johnson, received local market authorization in October 2021 for use ‘with an oral antidepressant (SSRI or SNRI) in treatment-resistant depression (TRD)’, which is defined as major depressive disorder (MDD) in adults who have not responded adequately to at least 2 different antidepressants of an adequate dose and duration to treat the current depressive episode.  MDD is estimated to affect over 300 million people globally and has significant clinical, humanistic and economic burden. Approximately one-third of patients with MDD do not respond to available antidepressants, which translates into an increased risk of subsequent…

Disease Burden and Current Treatment Landscape In June 2020, upadacitinib hemihydrate (Rinvoq; AbbVie), an oral reversible JAK1 selective inhibitor received local regulatory approval for use in ‘moderate to severe active rheumatoid arthritis (RA) in adult patients who have responded inadequately to, or who are intolerant to one or more disease-modifying anti-rheumatic drugs (DMARDs).’ RA is a chronic systemic inflammatory autoimmune disease that causes significant pain, disability, and progressive joint destruction. Overtime, if inadequately treated, irreversible joint damage and loss of function can result in disability, impaired quality of life and premature death. In Singapore, RA affects up to 1% of…

Disease burden and current treatment landscape Atopic dermatitis (AD) or atopic eczema is a common inflammatory skin condition that affects 20.8% of children aged 7 to 16 years in Singapore. While many children (about 70%) improve as they grow older, a significant proportion of patients in Singapore experience later onset (13.6%) after the age of 21 years. Further, it is estimated that up to a quarter of these adult cases manifest in the moderate to severe form which poses significant debilitating challenges for sufferers. Symptoms that include incessant itching, dry skin, excoriations and pain, can severely limit every day activities, psychological…

The Burden of Diabetic Kidney Disease Diabetes is the leading cause of kidney failure in Singapore, accounting for 66% of newly diagnosed ESRD in 2015. There are 400,000 diabetics in Singapore today and the country ranks top globally for diabetic nephropathy, with 2 in 3 new cases of kidney failure attributed to it. To date, despite best available guidelines-directed therapies, many individuals with chronic kidney disease (CKD) associated with diabetes mellitus (DM) remain at high risk for CKD progression and cardiovascular (CV) events. The economic burden from CKD and ESRD in DM is consequently remarkably heavy due to the complexities…

Psoriasis is an inflammatory immune-mediated chronic disease with significant impact on the individual’s physical, emotional and psychosocial wellbeing. The complex and heterogenous molecular genetic basis of psoriasis underlies the difficulty in disease management. Trial-and-error, frustrating treatment responses, relapses and drug-related adverse events (AE) are par for the course in a patient’s journey. In 2000, it was estimated that over 40,000 persons were affected by psoriasis in Singapore. While the local economic impact has not been formally evaluated, the annual cost from medical expenses and lost wages due to psoriasis in the U.S. was estimated at US$11.25 billion in 2008. Current…

Psoriasis is a common skin disease with a global prevalence of 2-3%, and affects over 40,000 people in Singapore. The chronic inflammatory condition with predominant skin, nail and joint involvement is an immune-mediated disease characterised by red, thickened plaques with a silvery scale. It has far-reaching systemic complications, with up to 40% of individuals at risk of developing psoriatic arthritis within 5-10 years of cutaneous disease onset, alongside other cardiovascular co-morbidities. Current therapies Patients with moderate to severe chronic plaque psoriasis refractory to conventional therapies (topical treatment, phototherapy and oral therapy) are likely to require biologic treatment escalation. Local expert…

Background Heart failure (HF) is a significant health problem with a prevalence of 4.5% in Singapore, and over 26 million globally. More than half of HF patients are categorised as HF with reduced left ventricular ejection fraction (LVEF ≤ 45%) i.e., HFrEF. Low LVEF in systolic HF as well as hospitalisation for worsening or symptomatic HF are powerful predictors of mortality, with few therapies to date designed to attenuate this risk. Vericiguat (Verquvo), an oral soluble guanylate cyclase (sGC) stimulator, enhances the cyclic guanosine monophosphate (cGMP) pathway and restores nitric oxide (NO) sensitivity within the dysregulated HF state. This translates…

The Burden of Insomnia Insomnia is a highly prevalent and debilitating disorder associated with significant functional impairment. A Singapore study conducted by Yeo et al in 1996 places sleep disorder estimates among Singaporeans at 15.3%, a number matched globally across industrialised countries with prevalence rates ranging between 10-50%. The diagnosis of insomnia is broadly defined by sleep disturbances for at least three nights per week, with consequent daytime impairment arising from sleep difficulty. Chronic insomnia in particular has been shown to be associated with substantial societal costs that result from reduced work productivity, daytime dysfunction and poor health-related quality of…

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory lung disease characterised by irreversible airflow limitation and associated with significant morbidity and mortality. In 2014, COPD was ranked the 10th leading cause of death in Singapore. The 2020 GOLD COPD guidelines define inhaled bronchodilator therapy as the mainstay of stable COPD management, with no distinction between choice of agent. Most commonly, β2-agonists and muscarinic antagonists are used, with longer-acting bronchodilators conferring more convenient and effective symptom relief compared to short-acting agents. Revefenacin is a potent lung-selective long-acting muscarinic antagonist (LAMA) labelled for the maintenance treatment of patients with COPD. It…

Glaucoma is a prominent cause of irreversible blindness, with a global prevalence of 3.45% among individuals between 40-80 years of age. The disease pathophysiology is multifactorial, but intraocular pressure (IOP) remains the singular modifiable risk factor across all clinical phenotypes. IOP control continues to be the mainstay of glaucoma treatment, involving either topically instilled IOP-lowering agents or surgery. A plethora of pharmacological options are available for reducing IOP and vary in cost, dosing schedule, IOP-lowering potential and adverse event (AE) profile. The American Academy of Ophthalmology (AAO) and European Glaucoma Society (EGS), recommend an initial mono-therapy approach, with a preference…