Prescrire international
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Prescrire international · Jun 2011
ReviewAcute heart failure with dyspnoea: initial treatment. Furosemide and trinitrine, despite the lack of a proven survival benefit.
For patients with acute heart failure and dyspnoea due to pulmonary congestion, the risk of death in the short term is high. To determine how best to manage these patients, we reviewed the relevant literature using the standard Prescrire methodology. There are few reliable clinical trial data. ⋯ Treatment is mainly based on loop diuretics, nitrate derivatives (when blood pressure is not too low) and non-invasive ventilation. It should be emphasised that these patients are highly unstable and that there is a narrow margin between beneficial and harmful effects of available treatments. Patients receiving treatment should always be closely monitored.
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Prescrire international · Jun 2011
Comparative StudyDenosumab. Limited efficacy in fracture prevention, too many adverse effects.
The standard drug for postmenopausal osteoporotic women with a high risk of fracture is alendronic acid, used in conjunction with non-drug measures. There are no drugs with demonstrated efficacy on the risk of fracture in castrated men with prostate cancer. Denosumab, a monoclonal antibody that inhibits a cytokine acting mainly on bone cells and lymphocytes, has been authorised in the European Union for use in both these settings. ⋯ In placebo-controlled trials, this monoclonal antibody was associated with a higher incidence of deep-seated infections such as endocarditis, cancer, and skin rash. More data are needed on the risk of pancreatitis, long-term bone disorders (atypical fractures, delayed fracture healing, osteonecrosis of the jaw), hypocalcaemia and cataracts, all of which were reported in clinical trials. In practice, denosumab is not sufficiently effective to outweigh its established and potential risks in postmenopausal osteoporotic women or in castrated men with prostate cancer.
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Lambert-Eaton myasthenic syndrome is a rare neurological syndrome of autoimmune origin. It is usually associated with small-cell lung cancer but may be idiopathic. The main clinical feature is potentially disabling limb muscle weakness. ⋯ Management is generally based on treatment of the underlying malignancy. Immunosuppressants are used in severe disease and in cases not associated with cancer, but they have limited efficacy. Symptomatic treatments are available but their efficacy is poorly documented.
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Constipation is a frequent complaint, especially in women and the elderly. It is sometimes drug-induced, and is only occasionally secondary to a functional or organic disorder. The risks associated with constipation are often overestimated. ⋯ In addition, all women of child-bearing age should use effective contraception while taking prucalopride. In practice, prucalopride should be avoided. It is better to focus on lifestyle and behavioural changes, and rational use of laxatives.
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Prescrire international · May 2011
Autologous chondrocytes. Autologous chondrocyte implantation: more data needed.
There is no standard surgical treatment for young adults with persistent, incapacitating symptoms of knee cartilage damage. ChondroCelect is the first cell therapy product to be authorised in the European Union. It contains a dense suspension of chondrocytes cultured from a biopsy of the patient's knee cartilage for 4 weeks before being reimplanted. ⋯ Autologous chondrocyte implantation is more complex than microfracture. During routine use, there is a risk that one patient will inadvertently receive chondrocytes collected from another patient, leading to a risk of rejection. In practice, this autologous chondrocyte product should only be used by highly specialised teams, and its assessment must continue.