Tools for Practice

Tools for Practice #363 Making a difference in indifference? Medications for apathy in dementia

In patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy?

Methylphenidate may improve apathy scores by a small but potentially clinically meaningful amount compared to placebo (example: 5 points more on a 72-point scale) at ~12 weeks. Methylphenidate does not impact cognition in randomized, controlled trials (RCTs). Antipsychotics and antidepressants do not improve apathy compared to placebo. Read More

Tools for Practice #362 – Facing the Evidence in Acne, Part I: Oral contraceptives and spironolactone in females

How effective are combined oral contraceptives (COC) and spironolactone for treating acne of at least mild-moderate severity in females?

At ~24 weeks, ~80-90% of females report improvement in their acne with COCs, compared to 50-80% placebo, and 30-50% will have clear-almost clear skin versus 10-40% on placebo. Efficacy appears similar between individual COCs. Spironolactone, typically added to topical agents, has similar outcomes. Discontinuations due to adverse events appear comparable to placebo. Read More

Tools for Practice #361 Preventing RSV Infections in Infants

How safe and effective are monoclonal antibodies to prevent respiratory syncytial virus (RSV) infections in infants?

In high-risk infants (premature and/or congenital heart or lung conditions), palivizumab (4-5 doses monthly during RSV season) reduces RSV hospitalization (4.5% versus 10% placebo). Nirsevimab (one dose) reduces RSV hospitalizations in healthy premature infants (0.8% versus 4%) and term infants (0.3-0.4% versus 1.5-2.0%). Side effects are similar to placebo. Read More

Tools for Practice #360 Ketamine for Depression

What are the benefits and harms of ketamine/esketamine for depression?

Ketamine/esketamine appears effective for moderate-severe depression (helping 10-20% more people respond over placebo at 1-4 weeks). However, biases are very common and large effects are likely exaggerated. Adverse events are common (example: 20% more nausea/vomiting). Considerable uncertainty remains (treating mid/long-term, misuse risk, and long-term harms) and treatment is costly. Read More

Tools for Practice #359 Topical corticosteroids for atopic dermatitis – More than skin deep

What are the benefits/harms of topical corticosteroids for atopic dermatitis in adults/children?

Evidence is somewhat limited but topical corticosteroids are effective for atopic dermatitis and efficacy likely increases with potency. Once daily seems similarly effective to twice daily. If frequent flares, ‘weekend therapy’ (treatment 2-days/week to areas with recurrent flares) will help ~60% avoid a flare versus ~30% using placebo-cream over 16-weeks. Topical corticosteroids are well-tolerated for ≤6 weeks. Long-term harms are not available. Read More