Tools for Practice #380 Is the secret to treating depression hidden in your genes?
Can genetic testing improve the efficacy and safety of antidepressants?
Pharmacogenomics testing to guide treatment in patients with depression might increase response and remission rates at 8 weeks by about 5% (example response rate 29% with pharmacogenomics versus 25% usual care), with no clear effects on tolerability. Studies have significant limitations. Cost (up to > $2000) and genes tested vary widely. Read More
3 January 2025
Tools for Practice #379 Bumpin’ Up the Protection? RSV Vaccine in Pregnancy
How effective and safe is the respiratory syncytial virus (RSV) vaccine (AbrysvoTM) when given during pregnancy?
The RSV vaccine (AbrysvoTM), approved by Health Canada in pregnancy, reduces severe RSV infections (0.5% infection rate versus 1.8% placebo) and RSV hospitalizations (0.5% versus 1.3%) at 180 days in infants. Preterm births were numerically, but not statistically, higher with this vaccine versus placebo. Administration is limited to 32-36 weeks’ gestation to mitigate this potential risk. Guidelines recommend nirsevimab for infants over prenatal vaccine where indicated. Read More
9 December 2024
Tools for Practice #378 Tony Romo-sozumab: Winning touchdown in osteoporosis or interception for the loss?
What is the efficacy and safety of romosozumab in postmenopausal women with osteoporosis?
In a single randomized, controlled trial (RCT) of postmenopausal women with fracture history, romosozumab was more effective than alendronate at reducing major osteoporotic fractures (7% versus 10%) including hip fractures (2% versus 3%) but increased cardiovascular events (0.8% versus 0.3%) at 2.7 years. High cost and potential cardiovascular harm may limit use.
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22 November 2024
Tools for Practice #377 – How to slow the flow IV: Combined oral contraceptives
In premenopausal heavy menstrual bleeding due to benign etiology, do combined oral contraceptives (COC) improve patient outcomes?
About 80% of women on COC will see improvement in mean blood loss, compared to 40% on placebo. Additionally, their use of sanitary items is reduced by approximately half (compared to 20% for placebo), and hemoglobin improves. Levonorgestrel-containing intrauterine systems, however, are more effective. Read More
8 November 2024
Tools for Practice #376 Testosterone supplementation for men: Let’s (andro-)pause for a moment (Update)
What are the benefits and harms of testosterone supplementation in healthy men or those with age-related low testosterone?
Compared to placebo, testosterone may increase lean body mass by ~1.6kg in older men but has no consistent, meaningful impact on sexual function, strength, fatigue, or cognition. Testosterone does not increase prostate events, myocardial infarction or stroke, but pulmonary embolism (0.9% versus 0.5% placebo) and atrial fibrillation (3.5% versus 2.4% placebo) may be increased. Read More
25 October 2024
