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NEWS - Pharmacists / Pharmacology

Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: A Pharmacoepidemiological Study – Journal of Clinical Psychopharmacology (link to abstract – $ for full-text)

Commentaries: Incidence of Extrapyramidal Symptoms Higher With Certain Antidepressants – MPR (free) AND Antidepressants tied to Parkinson’s-like symptoms – Univadis (free registration required)

“Observational study: Incidence of EPSs with antidepressants. RRs: duloxetine, 5.68; mirtazapine, 3.78; citalopram, 3.47; escitalopram, 3.23; paroxetine, 3.07; sertraline, 2.57; venlafaxine, 2.37; bupropion, 2.31; and fluoxetine, 2.03 (all significant)” (via @psychopharmacol see Tweet)

 


Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs – American Academy of Neurology and the American Epilepsy Society

Part I: Treatment of new-onset epilepsy (free PDF)

Part II: Treatment-resistant epilepsy (free PDF)

Commentary: New Epilepsy Guidelines Shed Light on Explosion of New Drugs – MedPage Today (free registration required)

 


A Placebo-Controlled Trial of Bezafibrate in Primary Biliary Cholangitis – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries: A Trial of Bezafibrate in Primary Biliary Cholangitis – NEJM Resident 360 (free) AND Bezafibrate Normalizes Liver Enzymes in PBC – MedPage Today (free registration required)

“In a randomized trial of patients with primary biliary cholangitis, bezafibrate and ursodeoxycholic acid resulted in a higher rate of complete biochemical response than ursodeoxycholic acid alone” (via @NEJM see Tweet with visual abstract)

 


Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT – Health Technology Assessment (free)

“The results of this large randomised trial, conducted in accordance with best practice, demonstrate clear benefit for antibiotic prophylaxis in terms of reducing the frequency of UTI for people carrying out CISC”.

 


Stimulants for ADHD in children: Revisited – Therapeutics Initiative (via @AllenFrancesMD)

“There is convincing evidence that a proportion of boys and girls treated with stimulants in BC and around the world are simply the youngest in their class”

 


Effect of Fremanezumab Compared With Placebo for Prevention of Episodic Migraine: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentary: Fremanezumab effective in preventing episodic migraine – 2 Minute Medicine (free)

“Among patients with episodic migraine in whom multiple medication classes had not previously failed, subcutaneous fremanezumab, compared with placebo, resulted in a statistically significant 1.3- to 1.5-day reduction in the mean number of monthly migraine days over a 12-week period”. (from JAMA)

“The small effect size in terms of reduction in number of days with migraine dampens enthusiasm for this medication, though without head-to-head comparison against other prophylactics, this is hard to assess” (from 2 Minute Medicine)

 


Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis – JAMA Internal Medicine (free for a limited period)

Invited Commentary: Mineralocorticoid Receptor Antagonists in ST-Segment Elevation Myocardial Infarction – JAMA Internal Medicine (free for a limited period)

Aldosterone antagonists are beneficial for patients with STEMI and reduced ejection fraction. This meta-analysis suggests that patients with STEMI and LVEF greater than 40% or without heart failure also have improved outcomes with aldosterone antagonists.

 


Dose Increase Versus Unchanged Continuation of Antidepressants After Initial Antidepressant Treatment Failure in Patients With Major Depressive Disorder: A Systematic Review and Meta-Analysis of Randomized, Double-Blind Trials – The Journal of Clinical Psychiatry (link to abstract – $ for full-text)

Commentary: Depression: boosting SSRIs doesn’t work – Univadis (free registration required)

“Meta-analysis: there is evidence from RCTs against increasing the dose of SSRIs (with the possible exception of citalopram) in adult patients with major depression and antidepressant treatment failure” (via @psychopharmacol see Tweet)

 


ASCO 2018: Shortening Adjuvant Trastuzumab to 6 Months in Patients With HER2-Positive Early Breast Cancer Is Effective and Reduces Cardiac Toxicities – The ASCO Post (free)

Commentaries: Test of Herceptin Finds Briefer Treatment Can Work, With Fewer Side Effects – NPR (free) AND Shorter drug treatment OK for many breast cancer patients – Associated Press (free) AND For Women With Early Breast Cancer, Herceptin Treatment Can Be Much Shorter – The New York Times (10 articles per month are free)

““For women with early-stage breast cancer who needed the drug Herceptin, 6 months of treatment were as good as 12, a major study found. Less risk of side effects, less cost, less time “being a patient.”” (via @NYTHealth see Tweet)

 


Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of adverse events in non-randomised studies – Cochrane Library (link to abstract – $ for full-text)

Summary: Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of harmful effects – Cochrane Library (free)

“Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children and adolescents, which often lead to withdrawal of methylphenidate”.

 



Anticholinergic drugs and risk of dementia: case-control study – The BMJ (free)

Editorial: Anticholinergic drugs and dementia in older adults (free)

Commentaries: Expert reaction to study investigating the association between different types of anticholinergic drugs and risk of dementia – Science Media Centre (free) AND Anticholinergic drugs may be linked to increased risk of dementia – OnMedica (free)

“The effect of anticholinergic therapy is relatively small (odds ratio 1.1 – 1.2) and establishing an association does not prove a causal link. Nevertheless, the paper may act as a useful guide for future research and clinical practice”. (by Prof Les Iversen, in Science Media Centre)

 


First-line drugs for hypertension – Cochrane Library (free)

Summary: Thiazides best first choice for hypertension – Cochrane Library (free)

“First-line low-dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension. First-line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality”.

 


Acid‐suppressive drugs and risk of kidney disease: A systematic review and meta‐analysis – Journal of Gastroenterology and Hepatology (link to abstract – $ for full-text)

Source: Hospital Medicine Virtual Journal Club

Proton pump inhibitors were associated with higher risks of acute interstitial nephritis (HR, 2.78; 95% CI, 1.25‐6.17), acute kidney injury (HR, 1.85; 95% CI, 1.33‐2.59), chronic kidney disease (HR, 1.47; 95% CI, 1.03‐2.09), and end‐stage renal disease (HR, 1.61; 95% CI, 1.26‐2.04) than non‐PPI therapy. Similar risks were not identified for H2RA therapy.

 


When antibiotics turn toxic – Nature News (free)

“Commonly prescribed drugs called fluoroquinolones cause rare, disabling side effects. Researchers are struggling to work out why”.

 


A Quiet Drug Problem Among the Elderly – The New York Times (free)

Related: Our Other Prescription Drug Problem – New England Journal of Medicine (free) AND Benzodiazepines: our other prescription drug epidemic – STAT (free)

“Despite warnings from experts, older people are using more anti-anxiety and sleep medications, putting them at risk of serious side effects and even overdoses”.

 


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)

 


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