Prescrire international
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Prescrire international · Dec 2007
Levonorgestrel-releasing intrauterine device and uterine perforations.
Cases of uterine perforation have been reported with levonorgestrel-releasing intrauterine devices, possibly linked to their large size; the incidence seems to be similar to that observed with non-drug intrauterine devices.
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(1) Paracetamol is the first-choice analgesic for joint pain. Nonsteroidal antiinflammatory drugs (NSAIDs), especially ibuprofen, are second-line options. Cox-2 inhibitors are no more effective than traditional NSAIDs and have no tangible advantages in terms of gastrointestinal tolerability. ⋯ Serious skin reactions were reported both during clinical trials and after marketing, but their precise incidence is not known. Etoricoxib is partly metabolised by the cytochrome P450 isoenzyme CYP 3A4 and increases the bioavailability of ethinylestradiol. (7) When a NSAID is considered, drugs with which we have the most experience should be chosen, such as ibuprofen, and used at the lowest acceptable dose regimen (daily dose and length of treatment). Etoricoxib should be avoided.
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Prescrire international · Dec 2007
Leuprorelin, triptorelin: new indications. Locally advanced prostate cancer: minimally assessed me-toos.
Unlike goserelin, leuprorelin and triptorelin have not been assessed for their impact on survival in patients with locally advanced prostate cancer. The main adverse effects of these two drugs are similar, but convenience of use differs.
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Prescrire international · Aug 2007
Obesity: weight loss without drugs: a balanced diet avoiding high-calorie foods, plus exercise.
(1) Weight loss in obese patients can reduce some of the complications of obesity. (2) To determine which interventions have the greatest and most durable impact on weight, without a risk of serious adverse effects, we conducted a systematic review of the available evidence, based on standardised Prescrire methodology. (3) Clinical trials of treatments for obesity have not taken into account the social, environmental or psychological factors that contribute to obesity, nor the individual's history of obesity and previous treatments, nor the possible impact of dieting on quality of life. These flaws limit the conclusions drawn from these trials. (4) A meta-analysis of 32 randomised controlled trials involving obese patients showed that moderate and well-balanced calorie restriction is more effective than any other diet, resulting in an average weight loss of about 5 kg after one year. (5) A meta-analysis of 35 randomised controlled trials involving obese patients showed that a combination of dieting and increased exercise is more effective than either measure alone. ⋯ However, they only lead to modest enduring weight loss, and their limited impact on prevention of complications means they should not be pushed too insistently on patients. When patients want assistance with weight loss, their individual body weight history should be carefully analysed before embarking on a weight loss programme.