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Every month, the subjects in Prescrire’s Spotlight.
2008 : 1 | 30 | 60
FREE DOWNLOAD There is widespread use of progestagen-only products before menopause, in spite of the lack of robust evidence concerning their risk-benefit balance. A recent French study showed an increase in breast cancer among women using an oral progestagen. It is advisable to evaluate drugs before their use provokes adverse reactions in patients. Full text available for free download.
1 December 2008
FEATURED REVIEW Dental amalgam is one of the main sources of exposure to mercury in industrialised countries. Evaluation of risk-benefit balances of alternatives to dental amalgam does not provide sufficient data to base an informed choice between available options. Full review (5p) in English available for download by subscribers.
When a smoking cessation drug seems advisable, nicotine is the drug with the best risk-benefit balance.
Many pregnant women self-medicate, but few are aware of the dangers some ordinary drugs can pose to the unborn baby.
Although it offers no benefits to diabetic patients and can have sometimes severe adverse effects, pioglitazone is still on the market, and at a high price.
In the care of newborns, pain and discomfort caused by some nursing procedures could be better prevented.
To relieve sore throats, no topical drug offers any tangible benefit over a sweet.
FEATURED REVIEW Ziconotide is not an opiate and is not related to the usual classes of analgesic drugs. The efficacy of ziconotide in relieving neurogenic pain remains to be established. In cancer pain, the available evidence showing that ziconotide is effective after opiate failure is too weak in view of the potential risks. Full review (4p) in English available for download by subscribers.
1 November 2008
In countries where the water is subject to strict bacteriological controls, wounds may be cleaned with tap water.
In some common situations, drugs are unnecessary. Prescrire’s information sheets outline these situations to help determine when it is necessary to seek the advice of a professional, which drugs should be avoided and which ones may be helpful.
Pergolide offers no benefits and exposes to numerous risks, especially cardiac.
New evidence confirms that benfluorex can cause severe adverse effects. Its unfavourable risk-benefit balance justifies its withdrawal from the market.
Despite its unfavourable risk-benefit balance, duloxetine is marketed for a range of indications.
It is deplorable that vaccine advertising via the powerful media of TV and radio is allowed to contain abridged health information.
Complaints by patients who have suffered adverse effects are investigated case by case in France, unlike in other countries where victims can bring class actions.
FREE DOWNLOAD There are still no data conclusively demonstrating that glitazones prevent clinical complications of diabetes. An increased risk of adverse effects has been confirmed in patients treated with pioglitazone. There is no justification for adding a glitazone to insulin in the treatment of type 2 diabetes. Full text available for free download.
1 October 2008
FEATURED REVIEW How can patients who complain of poor-quality sleep be helped, without resorting to treatments that can have adverse effects? Misconceptions and worrying over the lack of sleep and its consequences can contribute to reinforcing these disorders. We conducted a systematic review of the literature based on the standard Prescrire procedure. Full review (7p) in English available for download by subscribers.
Bisphosphonates can cause incapacitating musculoskeletal pain.
Prescrire assesses the quality and consistency of the guidelines published by France’s main health authority, the Haute autorité de santé (HAS), applying an explicit marking system based on internationally recognised assessment criteria.
Any form of nonsteroidal anti-inflammatories (NSAIDs) taken in pregnancy expose the foetus to the risk of potentially severe disorders.
Further to a request by Prescrire, the European Medicines Agency has published a list of sometimes severe adverse effects caused by exenatide. The benefits of this drug seem to be increasingly slender.
Marketing approval exemption procedures are fast-tracking some drugs to market, to the detriment of the evaluation quality.
Prescrire suggests that pharmacists who do want to make drugs available over the counter draw up a strict list.
Drugs offering no proven therapeutic benefits are being approved thanks to so-called "non-inferiority" clinical trials.
FEATURED REVIEW A transdermal system for fentanyl, an opiate analgesic, will soon be marketed in France for patient-controlled relief of acute postoperative pain by iontophoresis, a needle-free technique. This system not particularly convenient and there is a risk of misuse and overdose. Full review (4p) in English available for download by subscribers.
1 September 2008
FREE DOWNLOAD Tadalafil (Cialis°, Lilly) was first marketed in France in 2003. In 2007, Lilly added two lower dose strengths and promoted them for once-daily use. The lack of long-term safety data on daily use of tadalafil calls for caution. It is better to continue using tadalafil "on demand". Full text available for free download.
1 August 2008
FEATURED REVIEW Plasmodium falciparum malaria can be fatal, especially in young children and non-immune persons. Several drugs are effective but emergence of parasite resistance limits the choice. We conducted a review of the literature, based on Prescrire’s standard methodology. Full review (7p) in English available for download by subscribers.
FEATURED REVIEW Many diabetic patients, like the rest of the population, enjoy alcoholic drinks. We conducted a review of the literature for information on the possible risks of alcohol consumption for diabetic patients, based on Prescrire's standard in-house methodology. Drinking one standard unit a day seems to be an acceptable amount. Full review (3p) in English available for download by subscribers.
1 July 2008
In 2005 in France, around 2.5 million workers are reported to have been exposed to some 5 million tonnes of toxic chemical agents, with inadequate preventive measures or information.
Plant-based products, often mistakenly considered as harmless alternative remedies, are sometimes the cause of severe adverse effects and can interfere with a number of drugs. Health professionals must be informed of the use of these products before prescribing or giving other medicinal treatments.