May 20th, 2013

Selections from Richard Lehman’s Literature Review: May 20th

CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

BMJ  18 May 2013  Vol 346

Comparative Safety and Effectiveness of Sitagliptin in Patients with Type 2 Diabetes: You’ll be tired by now of me banging on about the need for long term proof of safety and a reduction in patient important adverse events before awarding a licence for sugar lowering drugs in type 2 diabetes. Sitagliptin is one of a group of drugs (DPP 4 inhibitors) which is coming under close scrutiny for possible harms to the pancreas; following short-term trials, it was licensed in 2006 under the brand name of Januvia. Here is a survey of a large US provider database looking at outcomes over 2.5 years. They detect no increase in acute pancreatitis and a neutral effect on all cause hospital admission and mortality. But that is not the end of the matter, as the editorial explains. It’s a well-conducted study, but in a drug that may be taken for decades, insufficient to allay all concerns.

JAMA Intern Med  13 May 2013  Vol 173

Use of Glucocorticoids and Risk of VTE (pg. 743): People who are given corticosteroids often have conditions that increase the risk of venous thromboembolism (VTE), so how can you tell if the corticosteroids themselves cause VTE, or whether it’s all confounding by indication, to use the EBM jargon? It’s something the authors of this Denmark-wide case-control study have considered carefully. Filling in a prescription for steroids in Denmark is associated with a doubling in the risk of VTE. Confronting the confounding issue, they respond, “we consider a biological mechanism likely because the association followed a clear temporal gradient, persisted after adjustment for indicators of severity of underlying disease, and existed also for noninflammatory conditions.”

Forced Smoking Abstinence – Not Enough for Smoking Cessation (pg. 789): Lock ‘em up and stop them having any cigs: that’ll cure them. But in fact the fascist method of smoking cessation is almost uniformly unsuccessful. Prisoners released from American jails where they were forced to give up smoking are back smoking regularly at 3 months in 98% of cases, male and female. Those offered the WISE intervention, described in this study, sustained a quit rate of 12% at 3 months. It’s a sad, mad world.


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