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NEWS - Pharmacists / Pharmacology / Drugs

Do Antidepressants Work? – The New York Times (10 articles per month are free)

“The most comprehensive study on them has recently been published, showing mostly modest effects”.

See related meta-analysis and commentaries in our February 23rd issue (see #3)


#ACC18 – The ODYSSEY Trial Ends Well— But Will It Be Enough? – Cardiobrief (free) AND Ten Quick Thoughts on ODYSSEY – John Mandrola, via Medscape (free registration required)

“An absolute risk reduction of 1.6% in the primary endpoint translates to a number needed to treat of 64. Using the current price of $14,500 per year, Kaul calculated that preventing one event over the trial period of almost 3 years would cost about $2.6 million” (via John Mandrola). This study was presented at #ACC18 and has not been published yet. Among the many commentaries, these two were selected for a balanced point of view.


Authors of premier medical textbook didn’t disclose $11 million in industry payments – STAT (free)

“’The most recognized book in all of medicine’ is also rife with hidden financial conflicts. Should Harrison’s authors be disclosing $11 million in payments from drug and device makers?” (via @caseymross see Tweet)


Opioid Wisely – Choosing Wisely Canada (free)

Related Guideline: Guideline for opioid therapy and chronic noncancer pain – Canadian Medical Association Journal (free)

See complete lists from Choosing Wisely U.S. / Choosing Wisely UKChoosing Wisely Australia AND Choosing Wisely Canada

This campaign encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing, with recommendations relevant to different specialties.


Balanced Crystalloids versus Saline in Critically Ill Adults – New England Journal of Medicine (free)

Related article: Balanced Crystalloids versus Saline in Noncritically Ill Adults – New England Journal of Medicine (free)

Commentary: Balanced Crystalloids May Be Better Than Saline for Critically Ill Patients – NEJM Physician’s First Watch (free)

“Balanced crystalloids may be superior to saline in critically ill patients — but not in patients hospitalized outside an ICU” (from Physician’s First Watch)


Comparative Effectiveness and Safety of Cognitive Enhancers for Treating Alzheimer’s Disease: Systematic Review and Network Meta-analysis – Journal of the American Geriatrics Society (free)

Source: Medscape (free registration required)

“Cognitive enhancers in general have minimal effects on cognition according to minimal clinically important difference and global ratings. The drugs appear safe, but this must be interpreted cautiously because trial participants may have less comorbidity and fewer adverse effects than those treated with these drugs in clinical practice”.


Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty – New England Journal of Medicine (link to abstract – $ for full-text)

Quick Take Video Summary: Preventing VTE after Hip or Knee Arthroplasty (free)

“Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism”.


Opinion: Stories about tragic flu deaths wrongly portray Tamiflu as a panacea – HealthNewsReview (free)

Related: Tamiflu and Relenza: getting the full evidence picture – Cochrane Library (free)

“The review confirms small benefits on symptom relief, namely shortening duration of symptoms by half a day on average. However, there is little evidence to support any belief that use of NIs reduces hospital admission or the risk of developing confirmed pneumonia”. (from Cochrane)


Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries: No benefit of sodium bicarbonate or acetylcysteine for prevention of complications after angiography: The PRESERVE trial – 2 Minute Medicine (free) AND Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – NEJM Resident 360 (free)

“Among patients at high risk for renal complications who were undergoing angiography, there was no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over placebo for the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days or for the prevention of contrast-associated acute kidney injury”.


Immunogenicity of Fractional-Dose Vaccine during a Yellow Fever Outbreak — Preliminary Report – The New England Journal of Medicine (free)

A fractional dose containing one fifth of the standard dose was effective at inducing seroconversion, supporting the use of fractional-dose vaccination for outbreak control.


Apalutamide Treatment and Metastasis-free Survival in Prostate Cancer – New England Journal of Medicine (free)

“Apalutamide improves castration resistant prostate CA survival compared with… placebo. Why wasn’t it compared w bicalutamide?” (via @RichardLehman1 see Tweet). See Richard Lehman’s point of view


Trimethoprim use for urinary tract infection and risk of adverse outcomes in older patients: cohort study – The BMJ (free)

“Trimethoprim is associated with a greater risk of acute kidney injury and hyperkalaemia compared with other antibiotics used to treat UTIs, but not a greater risk of death”


Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial – The Lancet (link to abstract – $ for full-text)

“Steroid-containing fine-mist triple inhaler comp with dry powder double inhaler resulting in 0.09 fewer exacerbations per year. Yup.” (via @RichardLehman1 see Tweet) See Richard Lehman’s point of view


Atypical antipsychotics, insulin resistance and weight; a meta-analysis of healthy volunteer studies – Progress in Neuro-Psychopharmacology and Biological Psychiatry (link to abstract – $ for full-text) (via @psychopharmacol see Tweet)

“These findings provide preliminary evidence that atypical antipsychotics cause insulin resistance and weight gain directly, independent of psychiatric disease and may be associated with length of treatment”.


Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals – JAMA Cardiology (free)

Commentary: Omega-3 Supplements Don’t Protect Against Heart Disease – The New York Times (10 articles per month are free)

Omega-3 fatty acids did not prevent fatal or nonfatal coronary heart disease or any major vascular events.


Safety of hydroxyanthracene derivatives for use in food – EFSA Journal (free)

Press release: EFSA confirms health concerns for hydroxyanthracene derivatives in food – European Food Safety Agency (free)

Commentary: Europe’s safety watchdog says laxatives may increase cancer risk – Reuters (free)

“This group of substances naturally occurs in plants such as aloe or senna species. Extracts containing them are used in food supplements for their laxative effect”. (from Press Release)


Adjunctive Glucocorticoid Therapy in Patients with Septic Shock – New England Journal of Medicine (free)

Commentaries: The Definitive Word on Steroids in Septic Shock – Emergency Medicine Literature of Note (free) AND Adrenal – The Bottom Line (free)

“For the primary outcome, there was no statistically significance difference in mortality at 90 days – 27.9% in the hydrocortisone cohort, and 28.8% with placebo. Looking at secondary outcomes, the results here tended to favor hydrocortisone – a slightly faster resolution of shock, shorter ICU stays, and, oddly, decreased transfusion requirements”. (from Emergency Medicine Literature of Note Blog)


Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study – The BMJ (free)

“The duration of treatment rather than dose is more strongly associated with opioid misuse after surgery, concludes this study” (via @bmj_latest see Tweet)


Meta-analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults – Journal of the American Geriatrics Society (link to abstract – $ for full-text)

“Interventions designed to optimize medication use reduced the risk of any and serious ADRs in older adults. Implementation of these successful interventions in healthcare systems may improve medication safety in older adults”.


Chemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis – Journal of Neurosurgery (link to abstract – $ for full-text)

Chemical venous thromboembolism prophylaxis seems to be effective and safe in neurosurgical patients.

Source: EvidenceAlerts


The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder – Therapeutic Advances in Psychotherapy (free PDF)

“Review: The relapse risk during 1 year in adults with MDD was lower when SSRIs were combined with psychotherapy. Results comparing SSRIs and SNRIs were inconclusive. TCAs may be equally as effective as SSRIs” (via @psychopharmacol see Tweet)


Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial – The Lancet (free)

Commentaries: Learning from TARDIS: time for more focused trials in stroke prevention – The Lancet (free) AND Triple Antiplatelets for Reducing Dependency After Ischaemic Stroke – TARDIS – American College of Cardiology, Latest in Cardiology (free)

“Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice”.


Prescribing Cascade in a Cardiology Practice – American College of Cardiology, Latest in Cardiology (free)

“Before starting a medication to treat a new medical condition, consider whether this condition could be a drug-related adverse event. Specifically, consider whether this could represent a prescribing cascade”.


Effect of PCSK9 Inhibitors on Clinical Outcomes in Patients With Hypercholesterolemia: A Meta‐Analysis of 35 Randomized Controlled Trials – Journal of the American Heart Association (free)

PCSK9 inhibitors were associated with reduced incidence of myocardial infarction (2.3% vs 3,6%), stroke (1.0% vs 1.4%) and coronary revascularization (4,2% vs 5,8%). Overall, no significant change was observed in cardiovascular or all-cause mortality.


Practice guideline update summary: Mild cognitive impairment – American Academy of Neurology (free PDF)

Commentary: Mild cognitive impairment: a practice guideline update – Clinical Advisor (free)

“For patients diagnosed with MCI, clinicians may choose NOT to offer cholinesterase inhibitors”.

“If clinicians choose to offer cholinesterase inhibitors, they must first discuss with patients the fact that this is an off-label prescription not currently backed by empirical evidence”.


The use of probiotics to prevent Clostridium difficile diarrhea associated with antibiotic use – Cochrane Library (free)

See related meta-analysis: Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection

“Based on this systematic review and meta-analysis of 31 randomized controlled trials including 8672 patients, moderate certainty evidence suggests that probiotics are effective for preventing C. difficile-associated diarrhea”


The struggle to do no harm in clinical trials – Nature (free)

“The struggle to do no harm: the unexplained deaths in #cancer immunotherapy trials” (via @EricTopol see Tweet)


Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study – Journal of the American Heart Association (free)

“Composite rates of recurrence and major bleeding were 12.4% in patients who initiated NOACs within 2 days after acute stroke, 2.1% in those who initiated NOACs between 3 and 14 days, and 9.1% in patients who initiated NOACs >14 days after acute stroke. Future randomized studies to assess timing of initiation and choice of agent in patients with acute stroke and AF are warranted”.


Is treatment with corticosteroids beneficial and safe for people with pneumonia? – The Cochrane Library (free)

Related: Corticosteroids for Pneumonia: Ready for Primetime? – emDocs (free)

“Corticosteroid therapy reduced mortality and morbidity in adults with severe CAP; the number needed to treat for an additional beneficial outcome was 18 patients (95% CI 12 to 49) to prevent one death. Corticosteroid therapy reduced morbidity, but not mortality, for adults and children with non-severe CAP”


People Don’t Take Their Pills. Only One Thing Seems to Help. – The New York Times (10 articles per month are free)

“High-tech approaches and “reminder” packaging don’t work well. Reducing prices does”.


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