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Every month, the subjects in Prescrire’s Spotlight.
2008 : 1 | 30 | 60
Reporting of adverse effects by patients helps build an improved understanding of drugs.
1 July 2008
Defining the protocols for clinical trials in publicly accessible registers prior to commencement of the trials would help identify drugs’ real risk-benefit balance.
This quinine-based drug used to treat nocturnal leg cramps has a distinctly unfavourable risk-benefit balance. Its packaging and presentation are unsafe, making it look like a sweet, which poses a real danger to children.
FREE DOWNLOAD The papillomavirus 16, 18 vaccine, like the papillomavirus 6, 11, 16, 18 vaccine, reduces the risk of high-grade cervical dysplasia due to all viral genotypes by about 40% in young women who are not yet infected at the time of vaccination. The vaccine does not seem to provoke any serious adverse effects, but there is no proof that it reduces the risk of cancer. Full text available for free download.
1 June 2008
FEATURED REVIEW Reliable evidence supports the use of thiazide diuretics as first-line treatment for uncomplicated arterial hypertension. When patients fail to reach blood pressure targets, or this treatment is poorly tolerated, what are the best second-line options? We reviewed the available evidence, based on our standard in-house methodology. Full review (4p) in English available for download by subscribers.
In people over 50 presenting moderate memory loss, cholinesterase inhibitors, marketed as a treatment for Alzheimer’s disease, offer no proven benefit in preventing dementia, and cause numerous adverse effects.
In the absence of an obvious deficiency, antioxydants (vitamin E, carotene, etc.) have no proven health benefits, and some are probably harmful.
Treatment of depressive patients should start with non-drug measures. Antidepressants should be reserved for incapacitating disorders that are resistant to these measures, and patients should be closely monitored.
Treatment of children and adolescents considered to be depressive should rely first and foremost on non-drug treatments. Currently there is no antidepressant that has a favourable risk-benefit balance in children.
It is vital to be aware of a disease’s natural outcome in order to make pertinent treatment decisions, in particular to define the aim of treatment.
FEATURED REVIEW Aliskiren is the first renin inhibitor to reach the market for management of arterial hypertension. The adverse effect profile does not seem to be any better than that of other antihypertensive drugs, and better-assessed drugs with longer followup are available. Full review (4p) in English available for download by subscribers.
1 May 2008
In spring 2007, following massive protests, the French Health Minister was forced to withdraw draft legislation allowing the pharmaceutical firms' "compliance support" programmes. The proposed law permitted staff on the firms' payroll to ensure that patients were following their treatment for chronic conditions.
Trimetazidine has an unfavourable risk-benefit balance. Contrary to the information provided to health professionals, the patient information leaflet does not inform patients of the need to review the prescription after three months' treatment.
Some drugs are described as "freely available" to patients in pharmacies. But where will patients find reliable information enable them to make informed choices?
Brand name extensions known as "umbrella" brands, created to bring several drugs under one name, reduce drugs to a mass-market product and patients to consumers who are unaware of what they are taking.
Bisphosphonate treatment for postmenopausal women with severe osteoporosis provides limited efficacy for the first 5 years, but can cause sometimes severe adverse effects. Beyond this period, the benefit is minimal given the adverse effects.
FREE DOWNLOAD The budesonide + formoterol combination should not be recommended for "on demand" use to control asthma attacks. It exposes patients to an added risk of adverse effects, and undermines the clear distinction between maintenance treatment and control of attacks that has been found to help patients manage their asthma. Full text available for free download.
1 April 2008
FEATURED REVIEW Osteodensitometry is the standard method for measuring bone mineral density. To determine whether measurement of bone mineral density is useful in the prevention of fractures in postmenopausal women, we reviewed the relevant literature using our established in-house methodology. Full review (4p) in English available for download by subscribers.
Medical guidelines are a good thing if doctors are failing to provide optimum patient care. But they should not be allowed to hinder doctors seeking to identify the best care for each individual patient.
More and more cases of gastrointestinal, neuropsychiatric and cardiovascular adverse effects linked to varenicline are being reported.
Although Cox-2 inhibitors present no demonstrable therapeutic advantages, they have been shown to cause serious adverse effects. Drug regulatory agencies have settled for half-measures that favour the interests of the pharmaceuticals industry.
Some cosmetics and drugs used to treat benign disorders in children can expose them to potentially severe adverse effects.
The use of colchicine is controversial due to its severe, sometimes fatal adverse effects. It is best only to prescribe it for gout attacks if analgesics and antiinflammatory treatments prove ineffective.
In addition to the risk of teratogenic effects, oral isotretinoin can cause adverse effects to the mucous membranes, especially in the stomach.
New evidence confirms that sibutramine has an unfavourable risk-benefit balance, with sometimes severe, even fatal, adverse effects.
FEATURED REVIEW Oral mucositis is a frequent adverse effect of cancer chemotherapy and radiotherapy, and can keep patients from drinking and eating normally. Prevention is based on orodental care and ice. Other treatments are no more effective and carry a risk of known or poorly documented adverse effects. Full review (3p) in English available for download by subscribers.
1 March 2008
For smokers wishing to quit, if medical treatment is necessary, nicotine is the best option as it has a more favourable risk-benefit balance.
Numerous drugs can cause taste disorders, which can lead to anorexia and a deterioration in a patient’s general condition.
Some drugs, particularly those used to treat Parkinson’s disease, cause pathological behaviour such as gambling or hypersexuality, which can affect a person’s family and social life and even have legal consequences.
It is now a fact that passive smoking is damaging.