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Archive for June, 2013

Statin treatment and risk of developing diabetes

27 Jun, 13 | by kuppell

A study looking into whether there is an association between statin use and new onset diabetes found that patients treated with atorvastatin, rosuvastatin, or simvastatin were at an increased risk of new onset diabetes compared with those treated with pravastatin.

Researchers conducted a population-based retrospective cohort study in patients aged 66 years and older in Ontario, Canada who started treatment with a statin from 1 August 1997 to 31 March 2010. They examined the healthcare records of more than 1.5 million older people. The analysis was restricted to new users who had not been prescribed a statin in at least the preceding year and patients with established diabetes before the start of treatment were excluded. The primary outcome was incident diabetes. Over the 14 year study period, the researchers identified 471,250 patients with no history of diabetes who were newly treated with a statin. Of these patients, 227,994 (48.3%) received a statin for primary prevention, while 243,256 (51.7%) received a statin for secondary prevention.

Reporting their findings in the British Medical Journal the researchers say that, compared with pravastatin, there was an increased risk of incident diabetes with atorvastatin (adjusted HR 1.22, 95% CI 1.15 to 1.29), rosuvastatin (1.18, 1.10 to 1.26) and simvastatin (1.10, 1.04 to 1.17). There was no significantly increased risk among patients who received fluvastatin or lovastatin and the risk of incident diabetes was similar whether statins were used for primary or secondary prevention. BMJ 2013;346:f2610.

Short-term course of glucocorticoids for COPD

18 Jun, 13 | by kuppell

A short-term 5-day, rather than 14-day, course of glucocorticoid treatment should be used for acute exacerbations of chronic obstructive pulmonary disease (COPD) according to a study published in JAMA. The Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) study was a randomised, non-inferiority Swiss trial which enrolled 314 patients (from March 2006 to February 2011) presenting to the emergency departments of five hospitals with acute COPD exacerbations. Patients were past or present smokers (≥20 pack-years) without a history of asthma.

Patients received 40mg of prednisone daily for either 5 or 14 days in a placebo-controlled double-blind manner. The main outcome was time to next COPD exacerbation during a follow-up of 6 months.

Of the 314 patients, 311 were included in the intention-to-treat analysis and 296 in the per-protocol analysis. Hazard ratios (HRs) for the short-term versus 14-day treatment group were 0.95 (90% CI, 0.70 to 1.29; p=0.006 for non-inferiority) in the intention-to-treat analysis and 0.93 (90% CI, 0.68 to 1.26; p=0.005 for non-inferiority) in the per-protocol analysis, meeting the researchers non-inferiority criterion. In the 5-day treatment group, 56 patients (35.9%) reached the primary end point and 57 (36.8%) in the 14-day group. Estimates of reexacerbation rates within 6 months were 37.2% (95% CI, 29.5% to 44.9%) in the short-term group with median time to event being 43.5 days and were 38.4% (95% CI, 30.6% to 46.3%) in the 14-day treatment group with median time to event of 29 days.

The authors conclude that: ‘In patients presenting to the emergency department with acute exacerbations of COPD, 5-day treatment with systemic glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up but significantly reduced glucocorticoid exposure. These findings support the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD.’ JAMA 2013;309:2223-31.

Continuous infliximab treatment rather than intermittent for plaque psoriasis

11 Jun, 13 | by kuppell

Continuous therapy with infliximab is more effective than intermittent therapy and is associated with fewer side effects in patients with moderate to severe plaque-type psoriasis according to a study published in the British Journal of Dermatology.

Eligible patients for inclusion in the extension study, RESTORE2, had received infliximab for 26 weeks and achieved Psoriasis Area and Severity Index (PASI) score of 75 in the initial RESTORE1 study. Of these, 222 patients were randomised to receive continuous infliximab treatment (5mg/kg every 8 weeks) and 219 received intermittent treatment (no infliximab until >50% loss of PASI improvement). The researchers say that more serious infusion-related reactions occurred with intermittent treatment (8/219 patients, 4%) than with continuous treatment (1/222 patients, <1%) which lead to termination of the study.  Although no formal efficacy analyses were conducted, continuous therapy led to greater PASI 75 at week 52 in the continuous group (81/101, 80%) than in the intermittent group (39/83, 47%).

‘For patients with moderate-to-severe plaque-type psoriasis, continuous therapy with infliximab may be more effective than intermittent therapy. The incidence of serious infusion-related reactions in the intermittent group suggests that clinicians should avoid intermittent therapy in this population,’ advise the researchers. Br J of Dermatol 2013;168:1325-34.

Latest from European Journal of Hospital Pharmacy

Latest from European Journal of Hospital Pharmacy