Pharmacology/Pharmaceutical Industry
RCT | No significant fracture reduction from monthly 60,000 IU vitamin D3 supplementation
4 Apr, 2023 | 13:58h | UTCThe effect of monthly vitamin D supplementation on fractures: a tertiary outcome from the population-based, double-blind, randomised, placebo-controlled D-Health trial – The Lancet Diabetes & Endocrinology (link to abstract – $ for full-text)
Related:
RCT | Supplemental Vitamin D does not reduce incident fractures in midlife and older adults.
RCT | Vitamin D supplementation shows no significant impact on psoriasis severity
4 Apr, 2023 | 13:51h | UTCSummary: In a randomized, double-blind, placebo-controlled clinical trial involving 122 participants with plaque psoriasis, researchers investigated the effects of vitamin D supplementation on psoriasis severity during winter. Participants received either vitamin D (cholecalciferol, 100,000 IU loading dose followed by 20,000 IU/week) or a placebo for four months. The primary outcome was Psoriasis Area Severity Index (PASI) scores, with secondary outcomes including Physician Global Assessment, self-administered PASI, and Dermatology Life Quality Index scores.
The study found no significant difference in PASI scores or secondary outcomes between the two groups. The results suggest that vitamin D supplementation does not affect psoriasis severity. However, low baseline severity scores and a lower than expected increase in 25-hydroxyvitamin D levels in the intervention group may have influenced the findings, indicating that further research may be needed to account for these factors.
Article: Effect of Vitamin D Supplementation on Psoriasis Severity in Patients With Lower-Range Serum 25-Hydroxyvitamin D Levels: A Randomized Clinical Trial – JAMA Dermatology (free for a limited period)
Commentary on Twitter
This RCT, performed in North-Norway, found no measurable effect of vitamin D supplementation on psoriasis severity during winter. Low baseline severity, & lower-than-expected rise in 25(OH)D levels in intervention group, may have affected the results. https://t.co/ip17uFQsgM
— JAMA Dermatology (@JAMADerm) March 29, 2023
ICU Delirium | Bayesian analysis suggests high probabilities of benefits and low probabilities of harm with the use of haloperidol
3 Apr, 2023 | 13:43h | UTCHaloperidol vs. placebo for the treatment of delirium in ICU patients: a pre-planned, secondary Bayesian analysis of the AID–ICU trial – Intensive Care Medicine (free for a limited period)
Original article: RCT | Haloperidol for the treatment of delirium in ICU patients did not significantly improve outcomes.
Commentary on Twitter
Haloperidol vs placebo in acutely admitted, adult #ICU pts with #delirium? With IV haloperidol 2.5 mg × 3 daily & as needed doses up to max 20 mg daily:
➡️ high probabilities of benefits
➡️ low probabilities of harm for primary & most secondary outcomes
?️ https://t.co/iNRVVozlRJ pic.twitter.com/NJbhvxxdYx— Intensive Care Medicine (@yourICM) March 27, 2023
Study suggests no heightened death risk in young people with mRNA vaccines, but ChAdOx1 nCoV-19 vaccine linked to female cardiac deaths
30 Mar, 2023 | 14:28h | UTC
Commentary from the author on Twitter (thread – click for more)
Our latest @NatureComms research: Risk of death following COVID-19 vaccination or positive SARS-CoV-2 test in young people in England. Led by @Vnafilyan @kamleshkhunti @IsobelLWard et al. https://t.co/oxNdgEAflQ (1/3)
— Prof Amitava Banerjee? (@amibanerjee1) March 28, 2023
M-A | Limited evidence for analgesic effectiveness in acute low back pain treatment
29 Mar, 2023 | 13:32h | UTCSummary: The objective of this systematic review and network meta-analysis was to assess the effectiveness and safety of various analgesic medicines for treating acute non-specific low back pain. After examining 98 randomized controlled trials with over 15,000 participants, the study found that the quality of evidence for the effectiveness and safety of these medications is low or very low.
Some analgesic medicines showed potential in reducing pain intensity, but the evidence was limited due to trial risk of bias and imprecision in effect estimates. Furthermore, certain medications might increase the risk of adverse events during treatment, with evidence ranging from moderate to very low confidence.
Given the lack of high-quality evidence, clinicians and patients are advised to be cautious when using analgesic medicines for acute non-specific low back pain. More robust head-to-head comparison trials are needed to provide clearer guidance on the best course of treatment.
News Release: Study finds “considerable uncertainty” around effectiveness and safety of analgesics for low back pain – BMJ Newsroom
Commentary from the author on Twitter (thread – click for more)
Out today in @bmj_latest.
We found “considerable uncertainty” around the effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain.
Available at https://t.co/PeOmEOeJyJ
Thread ? pic.twitter.com/T8YDNGhhME
— Michael Wewege (@mawewege) March 22, 2023
Consensus Paper | Diagnosis and treatment of anticancer drug-induced interstitial lung disease
29 Mar, 2023 | 13:04h | UTC
Cohort Study | Leukotriene-receptor antagonist use during pregnancy not linked to neuropsychiatric events in offspring
17 Mar, 2023 | 12:56h | UTCCommentary: In utero exposure to asthma medication not tied to risks of neurodevelopmental disorders – MDedge
Deprescribing strategies for opioids and benzodiazepines with emphasis on concurrent use: a scoping review
15 Mar, 2023 | 15:06h | UTCRelated:
RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports
Deprescribing in Palliative Cancer Care – Life
Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360
Polypharmacy Management in Older Patients – Mayo Clinic Proceedings
Eliminating Medication Overload: A National Action Plan – Lown Institute
Common ED Medication Errors: Polypharmacy – emDocs
Current and future perspectives on the management of polypharmacy – BMC Family Practice
Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international
Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety
ISCCM Consensus Statement | Prevention of venous thromboembolism in the critical care unit
13 Mar, 2023 | 14:53h | UTC
Decrease in hospitalizations and liver failure after FDA mandate limiting paracetamol dosage in prescription opioid combinations.
13 Mar, 2023 | 14:45h | UTCAssociation of FDA Mandate Limiting Acetaminophen (Paracetamol) in Prescription Combination Opioid Products and Subsequent Hospitalizations and Acute Liver Failure – JAMA (free for a limited period)
Editorial: Moving the Needle to Reduce Acetaminophen (Paracetamol) Hepatotoxicity – JAMA (free for a limited period)
Author Interview: Limiting Acetaminophen in Prescription Combination Opioid Products – JAMA
Video Summary: Acetaminophen (Paracetamol) and Acute Liver Failure – JAMA
Commentary on Twitter
The @US_FDA mandate to limit acetaminophen to 325 mg/tablet in prescription combination acetaminophen and opioid medications was associated with a decline in hospitalizations involving acetaminophen and opioid toxicity. https://t.co/6tdqFAI4hG
— JAMA (@JAMA_current) March 7, 2023
Review | How to use nebulized antibiotics in severe respiratory infections
10 Mar, 2023 | 14:31h | UTCHow to Use Nebulized Antibiotics in Severe Respiratory Infections – Antibiotics
M-A | Opioids for breathlessness in heart failure have no significant benefits and increase adverse effects
9 Mar, 2023 | 14:11h | UTCSummary: The study aimed to assess the effectiveness of opioids in treating breathlessness in patients with heart failure and to evaluate their adverse effects. The authors conducted a systematic review of randomized controlled trials (RCTs) and included eight studies with 271 patients.
The results showed that opioids did not provide significant benefits in managing breathlessness in advanced HF and significantly increased the risk of adverse events such as nausea, vomiting, and constipation.
The authors suggest that opioids should be considered only as a last resort when other interventions have failed or in emergency situations.
Article: Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis – Heart
FDA panel endorses 2 RSV vaccines for older adults, but flag at potential increased risk of Guillain-Barre
8 Mar, 2023 | 14:27h | UTCPfizer vaccine:
In close vote, FDA advisers recommend Pfizer RSV vaccine for those 60 and older – CIDRAP
GSK’s vaccine:
FDA panel recommends GSK’s RSV vaccine for ages 60 and up – CIDRAP
FDA advisors recommend GSK’s RSV vaccine for older adults, but flag potential safety risks – CNBC
See also: Rare neurological condition is ‘important potential risk’ of Pfizer’s RSV vaccine, FDA says – CNN
M-A | Comparison of a short vs. long-course antibiotic therapy for ventilator-associated pneumonia
7 Mar, 2023 | 13:18h | UTCSummary:
This systematic review and meta-analysis of randomized controlled trials aimed to compare the rates of recurrence and relapse of ventilator-associated pneumonia (VAP) between short-course (≤8 days) and long-course (≥10-15 days) antibiotic therapy strategies. Five relevant studies involving 1069 patients were identified.
Compared to long-course therapy, short-course therapy increased the number of antibiotic-free days without any impact on recurrence and relapses of VAP, 28 days mortality, mechanical ventilation duration, number of extra-pulmonary infections, and length of ICU stay.
However, the study’s limitations, such as the small sample size and the lack of standardized definitions of the assessed outcomes, should be considered when interpreting the results.
Commentary: Study finds benefits in short-course antibiotics for ventilator-associated pneumonia – CIDRAP
Cohort Study | Early pregnancy exposure to NSAIDs is associated with slightly higher risks of neonatal and maternal adverse outcomes
7 Mar, 2023 | 12:56h | UTCSummary:
A nationwide cohort study in South Korea, including 1.8 million pregnancies, investigated the association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during early pregnancy and neonatal and maternal adverse outcomes.
The study revealed that pregnant women exposed to NSAIDs during early pregnancy were at increased risk of oligohydramnios and had a slightly higher likelihood of having an infant with major congenital malformations and low birth weight. These risks remained elevated when comparing NSAIDs against acetaminophen or past users.
The study suggests that clinicians should weigh the need to prescribe NSAIDs in early pregnancy against the modest but possible risk of neonatal and maternal outcomes and consider prescribing nonselective NSAIDs for <10 days, with continued careful monitoring for any safety signals.
M-A | Oral iron supplementation and anemia in children according to schedule, duration, dose and cosupplementation
7 Mar, 2023 | 12:53h | UTCSummary:
The article is a systematic review and meta-analysis of 129 randomized trials on iron supplementation and anemia in children. The study aimed to identify the optimal schedule, duration, dose, and cosupplementation regimen for iron supplementation in children and adolescents aged under 20 years.
The results showed that frequent (3-7 times/week) and intermittent (1-2 times/week) iron supplementation could be equally effective at increasing hemoglobin and decreasing anemia, iron deficiency, and iron deficiency anemia.
The study supports WHO recommendations regarding the frequency, duration, and dose of iron supplementation, including 3 months annually of daily oral iron supplementation for children aged 6 months to 12 years living in regions with a high burden of anemia. However, it also suggests that weekly iron supplementation might be considered an alternative to the recommended daily regimen in some contexts, given evidence of similar efficacy.
Review | Analysis of deprescription strategies of proton pump inhibitors in primary care
7 Mar, 2023 | 12:42h | UTCRelated:
Deprescribing proton pump inhibitors – Australian Journal of General Practice
An overview of systematic reviews and meta-analyses on the effect of medication interventions targeting polypharmacy for frail older adults
3 Mar, 2023 | 14:07h | UTCSummary: This overview of published systematic reviews examined the effectiveness of medication reviews on managing polypharmacy in frail older adults. The overview identified 10 systematic reviews, which included 154 studies. Medication reviews were the most common intervention, and the evidence suggests that they help reduce inappropriate medication use in frail older adults, but their impact on frailty scores and hospital admission is unclear. Pharmacist-led medication interventions were the most common, reducing inappropriate prescriptions in various settings. Tools, such as clinical decision-making computer support tools, were also found to be effective. The evidence quality ranged from moderate to critically low, highlighting the need for further research to establish if interventions directed at polypharmacy could have an impact on frailty syndromes.
Related:
RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports
Deprescribing in Palliative Cancer Care – Life
Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360
Polypharmacy Management in Older Patients – Mayo Clinic Proceedings
Eliminating Medication Overload: A National Action Plan – Lown Institute
Common ED Medication Errors: Polypharmacy – emDocs
Current and future perspectives on the management of polypharmacy – BMC Family Practice
Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international
Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety
RCT | Physician-led medication reviews in polypharmacy patients with Type 2 DM treated with at least 12 medications
1 Mar, 2023 | 13:36h | UTC
M-A | Which adverse events and which drugs are implicated in drug-related hospital admissions
28 Feb, 2023 | 13:59h | UTCSummary: This systematic review and meta-analysis aimed to provide an updated estimation of drug-related hospital admissions, the types and frequency of drug-induced harm, and the drugs involved. The review included 17 studies that examined acute admissions to emergency departments or inpatient wards resulting from drug-induced harm in the general population. These studies were published between January 2012 and December 2021. The estimated rates of admissions resulting from adverse drug reactions* (ADRs) and adverse drug events* (ADEs) were 8.3% and 13.9%, respectively. Almost half of the admissions related to ADRs and over two-thirds of those related to ADEs were possibly preventable. Gastrointestinal disorders, electrolyte disturbances, bleeding events, and renal and urinary disorders were the most frequently involved categories of drug-induced harm. The most frequently involved drug groups were nervous system drugs, followed by cardiovascular and antithrombotic agents.
*Adverse drug events (ADEs) and adverse drug reactions (ADRs) are two terms that are often used interchangeably, but they actually have different meanings. Adverse drug events (ADEs) refer to any negative effect that results from medication exposure and can be caused by a variety of factors, including medication errors, overdose, drug interactions, or allergic reactions. In contrast, adverse drug reactions (ADRs) are a specific type of ADE that occur as unintended effects of medication at normal therapeutic doses.
Cluster RCT | Effect of an antibiotic stewardship intervention to improve antibiotic prescribing for suspected UTI in older adults
24 Feb, 2023 | 13:58h | UTCSummary: The study evaluated the effectiveness of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections (UTI) in frail older adults. The study was a pragmatic, parallel, cluster-randomized controlled trial conducted in four European countries and included 1041 frail older adults aged 70 or older. The intervention involved a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. The control group provided care as usual. The primary outcome was the number of antibiotic prescriptions for suspected UTI per person year, and secondary outcomes included incidence of complications, hospital referrals, admissions, and mortality. The results showed that the intervention group had a lower rate of receiving an antibiotic prescription for a suspected UTI (0.27 per person year) compared to the control group (0.58 per person year), with no increase in complications or adverse events.
Commentary: Trial: Stewardship intervention cuts antibiotic prescribing for suspected urinary infections – CIDRAP
Related:
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Acute pain management pearls: a focused review for the hospital clinician
23 Feb, 2023 | 13:15h | UTCAcute Pain Management Pearls: A Focused Review for the Hospital Clinician – Healthcare
Antibiotic allergy de-labeling: a pathway against antibiotic resistance
23 Feb, 2023 | 13:12h | UTCAntibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance – Antibiotics
Related:
M-A: Most patients with allergy to Penicillin can be given Cefazolin
Podcast: A Clinical Pharmacologist’s Perspective on Penicillin Allergy
Study: Development and Validation of a Penicillin Allergy Clinical Decision Rule
NICE: Double Check Patients with ‘Penicillin Allergy’ to Avoid Increased MRSA Risk
Perspective | Application of Bayesian approaches in drug development: starting a virtuous cycle
22 Feb, 2023 | 12:32h | UTC
Commentary on Twitter
Application of Bayesian approaches in drug development: starting a virtuous cycle https://t.co/GxPFRA3J6u
A new Perspective that highlights the value of Bayesian methods in drug development, discusses barriers to their application and recommends approaches to address them pic.twitter.com/JTgo02aPdI
— Nature Reviews Drug Discovery (@NatRevDrugDisc) February 16, 2023
Analysis | High drug prices are not justified by industry’s spending on research and development
21 Feb, 2023 | 11:41h | UTCHigh drug prices are not justified by industry’s spending on research and development – The BMJ
News Release: Drug prices not justified by industry’s research and development spending – BMJ Newsroom
Commentary from the author on Twitter (thread – click for more)
New @bmj_latest paper?
High drug prices do not seem justified by pharma industry’s R&D spending & new drugs' added benefits ??
How can companies develop more innovative & affordable medicines?Read the thread ?https://t.co/YYznD4Tvwq@ojwouters @ElsTorreele @martinmckee
— Aris Angelis (@Aris_Angelis) February 16, 2023