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So far ADARRC has created 12 blog entries.

Convalescent plasma does not improve outcomes in patients hospitalized with severe COVID-19 pneumonia (PlasmAr)

2021-05-22T15:36:37+04:00

Does convalescent plasma improve outcomes in patients hospitalized with severe pneumonia due to SARS-CoV-2? In this study, convalescent plasma did not improve outcomes in patients hospitalized with severe COVID-19 pneumonia. Simonovich VA, Burgos Pratx LD, Scibona P, et al, for the PlasmAr Study Group. A randomized trial of convalescent plasma in Covid-19 severe pneumonia. N Engl J Med 2021;384(7):619-629.

Convalescent plasma does not improve outcomes in patients hospitalized with severe COVID-19 pneumonia (PlasmAr)2021-05-22T15:36:37+04:00

Tofacitinib Does Not Increase Risk of Venous Thromboembolism in Patients With RA

2021-05-22T15:33:58+04:00

Does Tofacitinib Increase the Risk of Venous Thromboembolism in Patients with RA? Recently, a link between venous thromboembolism (VTE) and Janus Kinase (JAK) inhibitors has emerged, causing the FDA to recommend a black box label for tofacitinib in 2019. New research, however, suggests that tofacitinib had similarly infrequent cases of VTE (<1 per 100) when compared with tumor necrosis factor inhibitors (TNFIs). Desai RJ, Pawar A, Khosrow-Khavar F, Weinblatt ME, Kim SC. Risk of venous thromboembolism associated with tofacitinib in patients with rheumatoid arthritis: a population-based cohort study [published online ahead of print, 2021 Mar 22]. Rheumatology (Oxford). 2021;keab294. [...]

Tofacitinib Does Not Increase Risk of Venous Thromboembolism in Patients With RA2021-05-22T15:33:58+04:00

Tocilizumab and sarilumab are effective for critically ill patients with COVID-19 who require organ support

2021-05-22T15:30:37+04:00

Are monoclonal antibodies against the interleukin-6 receptor effective in patients who are critically ill with COVID-19? In patients who are critically ill with COVID-19 and require respiratory or cardiovascular organ support, the monocloncal antibodies tocilizumab and sarilumab reduce mortality (number needed to treat [NNT] = 12) and decrease the need for organ support during the 3 weeks following the initiation of therapy. As we have seen with other studies of COVID-19 therapies, benefit is often restricted to specific groups, and this result should not be generalized to less ill patients for whom the benefit has not been demonstrated. The [...]

Tocilizumab and sarilumab are effective for critically ill patients with COVID-19 who require organ support2021-05-22T15:30:37+04:00

Single-dose opioid analgesics offer no benefit over non-narcotic analgesia for musculoskeletal pain

2021-05-22T15:26:42+04:00

For acute muscle pain, what oral analgesic provides the best immediate relief? A single dose of opioid analgesics provides similar acute pain relief to a single dose of a combination of acetaminophen and ibuprofen in patients with acute musculoskeletal pain in the emergency department. Opioids increase the likelihood of nausea or vomiting. There was no added benefit of 800 mg of ibuprofen as compared with 400 mg. Unfortunately, the study did not investigate the further effect, possibly because of the placebo effect, of an injectable analgesic. These results are similar to those of previous studies of opioids and different doses [...]

Single-dose opioid analgesics offer no benefit over non-narcotic analgesia for musculoskeletal pain2021-05-22T15:26:42+04:00

SR: Exercise is the only intervention to provide long-term improvement in patients with chronic low back pain

2021-05-22T15:23:38+04:00

What interventions are effective in managing patients with chronic low back pain? The interventions that are better than control in achieving at least a 30% reduction in pain are exercise, oral nonsteroidal anti-inflammatory drugs (NSAIDs), duloxetine, and opioids, but discontinuations of the latter 2 treatments were common. Lower-quality data suggest that manipulation and topical capsaicin are also effective. Finally, it is possible the authors' inclusion criteria missed important studies. Kolber MR, Ton J, Thomas B, et al. PEER systematic review of randomized controlled trials: Management of chronic low back pain in primary care. Can Fam Physician 2021;67(1):e20-e30. [...]

SR: Exercise is the only intervention to provide long-term improvement in patients with chronic low back pain2021-05-22T15:23:38+04:00

Uncertain benefit of electroacupuncture for chronic low back pain Clinical question

2021-05-22T12:37:15+04:00

Is electroacupuncture safe and effective in the treatment of adults with chronic low back pain? This study found mixed results on the benefits of electroacupuncture in treating adults with chronic low back pain. Although no significant difference occurred between active and sham therapy for the primary outcome of reduced pain, a secondary outcome of reduced disability was significantly improved with active versus sham therapy. In addition, eliminating one single significant outlier from the overall analysis resulted in a significant benefit of active electroacupuncture versus sham therapy in both reducing pain and disability. Kong JT, Puetz C, Tian [...]

Uncertain benefit of electroacupuncture for chronic low back pain Clinical question2021-05-22T12:37:15+04:00

Colchicine reduces myocardial infarction and revascularization in patients with established coronary disease (LoDoCo2)

2021-05-22T12:38:14+04:00

In patients with chronic coronary artery disease, does colchicine reduce the risk of cardiovascular events? Colchicine 0.5 mg daily significantly reduces the risk of myocardial infarction (MI) and ischemia-driven revascularization. For the compositive outcome of cardiovascular death, MI, or ischemic stroke, the number needed to treat (NNT) was 67 over 29 months. The cost is $8 per month in Canada and $65 per month in the United States. There was a worrisome signal of increased noncardiovascular mortality, but no clear pattern with regard to cause of death. Nidorf SM, Fiolet AT, Mosterd A, et al, for the [...]

Colchicine reduces myocardial infarction and revascularization in patients with established coronary disease (LoDoCo2)2021-05-22T12:38:14+04:00

Combination of baricitinib and remdesivir reduces recovery time in patients hospitalized with COVID-19 pneumonia

2021-05-22T12:38:35+04:00

Does the combination of baricitinib and remdesivir improve outcomes in patients hospitalized with COVID-19? For hospitalized patients with COVID-19 and evidence of lower respiratory tract infection, the combination of baracitinib plus remdesivir results in faster time to recovery, especially in patients who require noninvasive mechanical ventilation or high-flow oxygen. No survival benefit is seen with this combination. Kalil AC, Patterson TF, Mehta AK, et al. Baricitinib plus remdesivir for hospitalized adults with Covid-19. N Engl J Med. Published online December 11, 2020. doi: 10.1056/NEJMoa2031994.

Combination of baricitinib and remdesivir reduces recovery time in patients hospitalized with COVID-19 pneumonia2021-05-22T12:38:35+04:00

BMD testing: one and done

2021-05-22T15:18:01+04:00

Are repeat bone mineral density tests necessary to identify women who are susceptible to fracture? Rechecking bone mineral density (BMD) after 3 years does not add additional prognostic information. In other words, not much changes in 3 years with regard to estimating fracture risk and, presumably, need for treatment, so serial testing is not useful. Another study found similar results in older patients, and, similarly, a third study found that BMD monitoring is not necessary after starting treatment with a bisphosphonate. Crandall CJ, Larson J, Wright NC, et al. Serial bone density measurement and incident fracture risk [...]

BMD testing: one and done2021-05-22T15:18:01+04:00

Musculoskeletal surgery for nontraumatic pain: not a great analgesic

2021-03-21T11:23:19+04:00

Do common musculoskeletal surgical procedures produce better pain relief than no surgery? Sure, musculoskeletal surgery is invaluable for unintentional injury. But for conditions associated with chronic pain — such as knee, shoulder, wrist, neck, or back pain — even patients with objective changes on imaging that scream out for intervention, will not, on average, have better long-term pain relief with surgery as compared with no surgery. Most of the studies were not masked and there should have been a placebo effect to bolster a difference in pain relief between surgery and no surgery. As with any intervention, some [...]

Musculoskeletal surgery for nontraumatic pain: not a great analgesic2021-03-21T11:23:19+04:00
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