Hello! I hope that, as usual, you are doing well and I thank you for your loyalty and your positive feedback. Here are the selected articles for this week, have a good reading!
1/ COVID-19
Of course, we are going to start by talking about the withdrawal of the Lancet article that we spoke about few weeks ago. I did not talk too much about the study methods simply because the week prior, 3 other studies already had shown the uselessness of the chloroquine. So this Lancet article, whether approved or withdrawn, was not changing anything.
By the way, the results of the British Recovery study were presented. It was a study randomizing hospitalized COVID patients in 5 arms: standard of care, lopinavir-ritonavir, dexamethasone, hydroxychloroquine or azithromycin. With 1,500 patients in the hydroxychloroquine arm and 3,000 in the standard of care arm, there was no difference in mortality at day 28 between the 2 groups (respectively 25.7% vs 23.5%). One can still persist with hydroxychloroquine, but at some stage, it becomes unreasonable.
A study in Lancet Public Health looked at the non-hospital cardiac arrest events in the Paris region during COVID epidemic. So, the figure speaks by itself, and mortality followed the same trend. It is probably the collateral effects of COVID, associated with the inaccessibility of some healthcare services and with the renouncement to healthcare during that time.
2/ Cardiovascular medicine
A randomized controlled trial in the JAMA evaluated deprescribing antihypertensive medication for patients over 80 y.o. with a SBP < 150 mmHg vs. control group. Respectively, in each group, there were 86% and 89% of patients with a SBP < 150 mmHg at week 12 ; medication reduction was maintained in 66% of the patients from the intervention group. I hope that the authors will soon provide data with a longer follow-up and on cardiovascular or mortality clinical outcomes.
3/ Repsiratory medicine
The European Respiratory Society provides guidelines on withdrawal of inhaled corticosteroids for COPD patients. The American society suggested this option of medication reduction as well (see here). ERS recommends deprescribing ICS for patients with no recent exacerbation and having an eosinophil count under 300 / µL. In case of medication reduction, a long-acting bronchodilatator (LABA or LAMA) should be kept as a preventer.
4/ Gynaecology
Following a Lancet article about the risks of hormone replacement therapy, the European Medicines Agency was asked to start an inquiry about the risk increase of breast cancer with HRT up to 10 years after its discontinuation (except for low dose vaginal estrogens which seemed to be safe). These suspicions were validated by the EMA and from now on, they should figure in the corresponding medicines' safety information sheets.
A randomized controlled trial evaluated the impact of a shared-decision making tool regarding the choice between vaginal birth and C-section among patients with a past history of C-section, hoping reducing the rate of unnecessary surgical procedures. The study included over 1,400 patients and the tool only managed to decrease the number of C-sections by 3% (43% vs 46%). There was no significant difference between the 2 groups regarding maternal and neonatal consequences. Overall, this tool does not work, but remains interesting (see the study appendix ; too long to be copied here unfortunately).
5/ Endocrinology and nutrition
A new article discusses the overdiagnosis of thyroid cancer (see previous discussed article here). In France, the overdiagnosis of thyroid cancers is estimated at 83% between 2008 and 2012. The estimated mortality of this cancer is less than 1 per 100,000 patients.
A randomized controlled trial evaluated the efficacy of liraglutide for weight reduction in non diabetic obese teenagers. The authors conclude that the treatment is efficient, with a significant BMI decrease of 0.37 SD (standard deviation) after 56 weeks: that equals to a BMI decrease of around 5 points for patients with an initial average BMI of 35. However, as soon as liraglutide was stopped, weight was going back almost up to the initial value 6 months after cessation. For the control group, after stopping the placebo, BMI also increased so there was still a difference between the 2 groups, but the result on the weight by itself remains unsatisfactory anyway...
@Dr_Agibus (free translation by @carttom).
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