We bring you the latest news from the healthcare about the health care in the United Kingdom.

zondag 15 april 2018

DTB: High-dose antihistamines for chronic spontaneous urticaria in adults

High-dose antihistamines for chronic spontaneous urticaria in adults

Chronic spontaneous urticaria (CSU) is a common skin disease characterised by intermittent weals (hives), angioedema or both lasting for at least 6 weeks.1-3 Second-generation antihistamines are widely used to manage symptoms but are not completely effective in many patients at licensed doses.4 Some guidelines recommend off-label use of high-dose antihistamines as the next therapeutic step.2,3 Here, we review the evidence supporting this recommendation.

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Once-daily triple therapy inhaler for COPD

Trelegy Ellipta (GSK) is a dry powder inhaler containing fluticasone furoate (inhaled corticosteroid [ICS]), vilanterol trifenatate (long-acting beta2 agonist [LABA]) and umeclidinium bromide (long-acting muscarinic antagonist [LAMA]).1 It is licensed for once-daily use as maintenance treatment for adults with moderate to severe chronic obstructive pulmonary disease (COPD) who are not adequately treated by a combination of an ICS and a LABA. Here, we consider the evidence for this combination product and discuss how it fits with current management strategies.

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Evidence for mosquito repellents in preventing malaria

Despite some successes in malaria prevention in recent years, mainly through the use of long-lasting insecticide-treated nets, there remains the need to protect against mosquito bites when outdoors. The other main interventions that help prevent mosquito bites involve applying topical repellents directly to the skin, wearing insecticide-treated clothing and using spatial repellents. A Cochrane systematic review has attempted to assess the effect of repellents on malaria transmission.1

The review included eight cluster randomised controlled trials (cRCTs) and two randomised controlled trials conducted in various malaria-endemic areas and among populations, including residents, military personnel and people living in refugee camps.1 Six trials investigated topical repellents, two investigated insecticide-treated clothing and two investigated spatial repellents. The evidence for all interventions was rated as low or very low quality. Primary outcomes included cases of clinical malaria (confirmed through blood smears or rapid diagnostic tests) and malaria parasitaemia.

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Opioid overdose and misuse in post-surgical opioid-naive {-}patients

Opioid misuse and overdose have become major problems in recent years, particularly in relation to chronic pain.1 In 2015, an estimated 2 million people in the USA suffered from substance use disorders related to prescription opioid analgesics.2 A retrospective cohort study has sought to quantify the effects on dependence, overdose or abuse of varying opioid prescribing patterns after surgery in an opioid-naive population.3

The study used data from one USA managed healthcare company with more than 37 million members with medical and pharmacy insurance coverage between 2008 and early 2016.3 The sample consisted of members who underwent surgery and had at least 6 months of medical insurance and 3 months of pharmacy insurance before surgery, as well as 90 days of pharmacy coverage and 1 year of medical coverage after surgery. The study assessed use of oral opioids after discharge, as...

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Retinoids: EMA updated warnings

The European Medicines Agency (EMA) has reviewed the safety of retinoids (e.g. acitretin, alitretinoin and isotretinoin) and has recommended updating pregnancy prevention programmes and publishing warnings on the possible risk of neuropsychiatric disorders.1

The review was initiated in 2016 and was performed by the EMA's Pharmacovigilance Risk Assessment Committee (PRAC) at the request of the UK government.1 The PRAC concluded that all oral retinoids can harm the unborn child and must not be used during pregnancy. In addition, acitretin, alitretinoin and isotretinoin must not be taken by girls and women of childbearing potential unless the conditions of a pregnancy prevention programme (PPP) are met. These programmes should support the discussion between clinician and patient on the risks of these medicines. The PPP should also include:

  • assessment of patients for the likelihood of becoming pregnant;

  • requirements for pregnancy testing and effective contraception before, during...

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    More recommendations to minimise exposure to {blacktriangledown} valproate in pregnancy

    The European Medicines Agency's (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) has recommended new measures to prevent exposure of babies to valproate medicines in the womb.1 An earlier initiative had been aimed at helping women to become better informed about the risks in order to reduce use of valproate medicines during pregnancy, and not starting treatment unless other options were ineffective or could not be used because of adverse effects. The latest review of safety measures comes after concerns were raised that the previous initiative had not been been not sufficiently effective.

    PRAC reviewed the evidence and consulted with healthcare professionals and with patients, including women and their children who have been affected by valproate use during pregnancy.1 It was noted that women were still not always receiving the right information in a timely manner and that further measures were needed to help avoid valproate use during...

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    Omega-3 fatty acid supplements and cardiovascular disease

    A meta-analysis of large randomised trials has assessed the association of omega-3 fatty acid (eicosapentaenoic acid [EPA] and docosahexanoic acid [DHA]) supplement use with the risk of fatal and non-fatal cardiovascular heart disease (CHD) and major vascular events.1 The meta-analysis (10 trials; 77,917 high-risk people) included studies that involved at least 500 participants and ran for at least 1 year (mean duration 4.4 years).1 The main outcomes included fatal CHD, non-fatal myocardial infarction (MI), stroke, major vascular events and all-cause mortality, as well as major vascular events in study population subgroups.

    Of the 77,917 participants, 61% were men and the mean age at entry was 64 years.1 About 66% of participants had a history of CHD, 28% had previously had a stroke and 37% had diabetes. The association of treatment with outcomes was assessed for 6,273 CHD events (2,695 CHD deaths and 2,276...

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    Co-dydramol - specify the strength

    The Medicines and Healthcare Products Regulatory Agency (MHRA) has stressed the importance of specifying the strength of co-dydramol products when they are generically prescribed to minimise dispensing errors and the risk of accidental opioid overdose.1 The MHRA notes that the ratio of dihydrocodeine to paracetamol in co-dydramol was previously fixed at 1:50 (dihydrocodeine 10mg and paracetamol 500mg). However, more co-dydramol products are available with higher doses of dihydrocodeine:2,3

  • dihydrocodeine 20mg and paracetamol 500mg (co-dydramol 20mg/500mg); and

  • dihydrocodeine 30mg and paracetamol 500mg (co-dydramol 30mg/500mg).

    Healthcare professionals are advised that when prescribing co-dydramol, they should clearly indicate tablet strength and dose.1 Although the packaging for different co-dydramol products has reportedly been designed to clearly differentiate between the strengths, the MHRA urges vigilance when prescribing and dispensing. When dispensing co-dydramol, pharmacists should check that the strength has been specified, and if in...

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    {blacktriangledown} Daclizumab withdrawn from the market worldwide

    Biogen and AbbVie have announced the voluntary worldwide withdrawal of marketing authorisations for daclizumab (Zinbryta) for the treatment of relapsing multiple sclerosis (MS) as a result of the "complex and evolving benefit/risk profile" of the drug.1 Following seven reported cases of inflammatory brain disorders (encephalitis and meningoencephalitis) associated with daclizumab, the European Medicines Agency (EMA) has undertaken an urgent review of the safety of the drug.2

    Clinicians will be contacted directly with further information about the withdrawal of daclizumab. Until then, the EMA advises that:2

  • doctors should not start new patients on daclizumab;

  • doctors should review patients currently treated with daclizumab and initiate alternative therapy, as soon as possible;

  • patients must not stop their medication without discussing with their doctor; and

  • patients who have any questions should talk to their doctor.

    The company has also decided to stop...

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    STOMP - time to make more noise

    Learning disability or intellectual disability (ID) is characterised by significant impairment of both cognitive functioning and adaptive behaviours, and an onset in early childhood. Complex mental and physical health problems as well as social issues are common and are associated with communication and cognitive difficulties that result in maladaptive behaviour patterns (often referred to as 'behaviour that challenges'). Ideally, all people presenting with behavioural concerns would be assessed by a specialist health and social care team to develop a behaviour support plan with tailored treatment strategies and appropriate specialist follow-up.

    A report of events at Winterbourne View private hospital highlighted "deep concerns about the over-use of antipsychotic and antidepressant medicines" in people with ID,1 and led to further analysis and discussion on the use of such drugs.2–4 A review of the safe and appropriate use of psychotropic drugs was highlighted as...

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