Prescrire international
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Prescrire international · Jun 2015
ReviewRituximab (MABTHERA) and severe polyangiitis. An option for patients informed of the uncertainties.
Granulomatosis with polyangiitis (Wegener's granulomatosis) and microscopic polyangiitis are two types of rapidly fatal necrotizing vasculitis. The standard induction therapy consists of cyclophosphamide (an immunosuppressant) plus a corticosteroid. This treatment significantly prolongs survival but has burdensome adverse effects. ⋯ Its effects on fertility are poorly documented. In practice, in patients with severe granulomatosis with polyangiitis or microscopic polyangiitis, rituximab is as effective at 18 months as cyclophosphamide followed by azathioprine; in addition, it has different and less frequent adverse effects. Rituximab is therefore an alternative when the standard treatment is likely to be problematic, but patients should be informed that longer-term efficacy is uncertain and that the optimal dose remains to be established.
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Prescrire international · Jun 2015
Dabigatran (Pradaxa): deep vein thrombosis and pulmonary embolism. Warfarin remains the standard drug.
Not more effective than warfarin in three "non-inferiority" trials. Less bleeding but more acute coronary events with dabigatran, and still no antidote.
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Prescrire international · Jun 2015
How INNs are created. Making drug names safer by contributing to INN selection.
The international nonproprietary names (INNs) of drugs proposed by the World Health Organization (WHO) are released for public consultation. These consultations provide an opportunity to identify any risks associated with INNs that could lead to confusion. Prescrire has submitted numerous comments since it began participating in the WHO's public consultations on proposed INNs in 2007. ⋯ The lack of an identifiable common stem in certain INNs, sometimes perceived as an obstacle to INN comprehensibility, is a consequence of the procedure for assigning INNs, because the INN programme wants to ensure that new common stems are not created prematurely. Critical analysis of proposed INNs during WHO public consultations offers an insight into the challenges involved in devising common stems. This analysis is useful for improving the quality and safety of INNs.