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Branford, D; Webster, A, Gill, D, Randon, T, Peebles, K. Pages: 114 - 114 Abstract: The prescribing of psychotropic medications for children and young people is increasing. In the UK, antipsychotic prescriptions increased by an average of 3.3% per year between 2000 and 2019 with a trend towards longer treatments.1 A study involving more than 1500 general practices across the UK showed antidepressant prescribing incidence rates more than doubled in those aged 12 to 17 years old between 2005 and 2017 to 9.7 (females) and 4.2 (males) per 1000 person years.2 An analysis of NHS data by The Pharmaceutical Journal showed 56 002 patients aged 17 years or under were prescribed melatonin in April 2022, an increase of 168% since April 2015.3 In the USA, there has been widespread concern about the growth in prescribing of psychotropic medication and the potential harm to children in foster care. In addition, a large household survey showed the number of US youths... PubDate: 2024-07-29T15:30:13-07:00 DOI: 10.1136/dtb.2024.000022 Issue No:Vol. 62, No. 8 (2024)
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Pages: 115 - 115 Abstract: Key messages Guidelines recommend considering switching adults with atrial fibrillation (AF) on vitamin K anticoagulant (VKA) therapy to a direct oral anticoagulant (DOAC). A randomised trial assessed the safety and efficacy of switching to a DOAC in older frail patients with AF. There was an increased risk of bleeding complications in patients switched to a DOAC relative to those who remained on VKAs. The authors of an open-label randomised trial found that switching from international normalised ratio (INR)-guided vitamin K anticoagulant (VKA) treatment to a direct oral anticoagulant (DOAC) in frail older patients with atrial fibrillation (AF) was associated with more bleeding complications than continuing VKA treatment.1 Overview The FRAIL-AF trial was a multicentre, pragmatic, open-label, randomised superiority trial conducted in the Netherlands that recruited patients aged ≥75 years with AF managed by INR-guided VKA treatment and who scored ≥3... Keywords:
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PubDate: 2024-07-29T15:30:13-07:00 DOI: 10.1136/dtb.2024.000037 Issue No:Vol. 62, No. 8 (2024)
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Pages: 116 - 116 Abstract: Key points Dupilumab, a monoclonal antibody that inhibits interleukin-4 and interleukin-13 signalling, is licensed in the UK for a range of conditions including atopic dermatitis and asthma. A placebo-controlled trial assessed the effect of dupilumab in people with chronic obstructive pulmonary disease who had an eosinophil count ≥300 per microlitre and were at an increased risk of an exacerbation. The annualised rate of moderate or severe exacerbations was 0.78 with dupilumab and 1.1 with placebo. An injection of dupilumab given every 2 weeks for 52 weeks in addition to triple inhaler therapy to people with chronic obstructive pulmonary disease (COPD) who had an eosinophil count ≥300 per microlitre and who were at an increased risk of an exacerbation reduced the annualised rate of moderate or severe exacerbations by 0.32 compared with placebo.1 Overview An international multicentre phase 3 double-blind randomised... Keywords:
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PubDate: 2024-07-29T15:30:13-07:00 DOI: 10.1136/dtb.2024.000039 Issue No:Vol. 62, No. 8 (2024)
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Pages: 117 - 117 Abstract: Key learning points Topical steroids are safe and effective in the management of inflammatory skin conditions. Serious adverse reactions may occur after stopping a topical steroid following long-term use. The risk of a severe adverse reaction increases with the potency as well as the amount and duration of topical steroid use. In the May issue of its Drug Safety Update, the Medicines and Healthcare products Regulatory Agency (MHRA) announced that topical steroids will be labelled with their potency and reminds healthcare professionals of the risk of severe adverse effects including withdrawal reactions.1 Overview Topical steroids are effective in the management of inflammatory skin conditions including eczema, contact dermatitis and psoriasis, and work by suppressing the inflammatory reaction.1 2 They are classified according to their potency as mild (eg, hydrocortisone), moderate (eg, clobetasone), potent (eg, betamethasone) or... Keywords:
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PubDate: 2024-07-29T15:30:13-07:00 DOI: 10.1136/dtb.2024.000040 Issue No:Vol. 62, No. 8 (2024)
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Pages: 118 - 124 Abstract: What you need to know A fall in oestrogen during menopause can lead to unopposed neurokinin B activity in the brain’s temperature control centre, which can cause vasomotor symptoms (VMS). Hormone replacement therapy containing oestrogen is effective in reducing menopausal VMS. Fezolinetant, a neurokinin 3-receptor antagonist, is licensed for the treatment of moderate to severe menopausal VMS. In two studies used for regulatory approval, fezolinetant reduced VMS more than placebo at 12 weeks but changes in quality-of-life measures may not be clinically meaningful. Potential adverse effects of fezolinetant include diarrhoea, insomnia, abdominal pain and an increase in alanine transaminase. Fezolinetant is contraindicated with concomitant moderate or strong CYP1A2 inhibitors. Vasomotor symptoms (VMS) in the menopause The thermoregulatory centre of the hypothalamus is innervated by kisspeptin/neurokinin B/dynorphin (KNDy) neurones that are normally inhibited by oestrogen and stimulated by a protein... PubDate: 2024-07-29T15:30:13-07:00 DOI: 10.1136/dtb.2024.000025 Issue No:Vol. 62, No. 8 (2024)
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Lee, M; McCarron, J, Balinski, A, Bower, R. Pages: 125 - 127 Abstract: In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. Summary A woman in her mid-60s, without known liver disease, was admitted to the hospital with a partial malignant colonic obstruction. Over a 6-day course, she received a total of 13 g of intravenous acetaminophen not exceeding 4 g over a 24-hour period. She developed encephalopathy and an international normalised ratio of 6.1 meeting criteria for acute liver failure (ALF). She was treated with intravenous N-acetyl cysteine and other causes of liver failure were excluded. The patient was discharged with subsequent resolution of encephalopathy and improvement of her liver chemistries. Though ALF... PubDate: 2024-07-29T15:30:13-07:00 DOI: 10.1136/dtb.2024.251305rep Issue No:Vol. 62, No. 8 (2024)
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