MedPage Today Roundup

Trying out a new post type. I keep track of a few days of interesting links from MedPage Today emails (they have great summaries!) in a draft post and jot down a few notes for each. Then, when there’s a reasonable number of links, I’ll publish the post.

FDA Okays Antioxidant Drug for ALS

• edaravone (Radicava) approved in the US, works to relieve oxidative stress caused by ALS
  • reduces blood vessel and neuron injury
  • leads to reduced decline of daily functioning
  • may only work for mildly symptomatic patients
• has been approved (for brain damage prevention post stroke) since 2002 in Japan
• IV infusion only, risk for allergic reaction, complicated dosing schedule.

Most Docs Make Wrong Choices in Stopping PPIs

• Simulation-based survey found that docs would continue PPIs in low risk (bleed) patients but discontinue in high risk patients
• We should be discontinuing PPIs in more low risk patients given that they are not nearly as innocuous as we once thought
• This makes sense to what I’ve seen in practice - trying to stop PPIs in patients at risk of c diff recurrence. The hardest part is figuring out why they were on the PPI in the first place!

AACE: Iron Indices Tied to HbA1c in Poorly Controlled T2D

• Not much data yet. Elevated iron indicies (e.g., serum iron & ferritin) are associated to poorly controlled type two diabetes.

AACE: GLP-1 Receptor Agonist Successful Tx for T1D

• Liraglutide reduced HbA1c by 0.29% vs placebo in type 1 diabetes patients, based on a systemic review and meta-analysis
• Also found reduction in insulin dose requirements
• Surpringly fast effect (within 3 months)

  “The group suggested these findings may be attributed to the reduction in post-prandial glucagon surge following appetite suppression induced by liraglutide, due to the lack of functioning beta cells in those with type 1 diabetes.”

Eating Raw Meat Tied to Toxoplasmosis in Japan

• Found that raw meat had a much higher association with toxo in pregnancy than did scooping cat litter
  • Unfortunately for guys with cats and pregnant wives, the guy should still definitely be scooping the cat litter. But the risk is probably far less than what most people think
• People in the region studies routinely eat raw horse meat and raw chicken meat. UGH

One in Three Newly Approved Drugs Has Safety Issues

• Looked at drugs approved between 2001 and 2010, and found 32% had post-market safety issues
• Lead to 3 market removals and 61 black box warnings
• Only so much you can do with the number of participants in clinical trials
• Very important to fill out those Health Canada Vigilance Reports!

Quinine for Leg Cramps Tied to Increased Death Risk

• Quinine for muscle cramps or restless legs can lead to 3-fold increase in risk of death… in patients under age 50
  • less risk in older adults
  • higher doses increased risk
• Not that effective to begin with
• Were unable to factor out unmeasured confounders, so it might not be because of the quinine
• They are also worried about daily consumption of Gin and Tonic. Thankfully no evidence against it though. (one would imagine the alcohol would be the more concerning part!)