Download MIMS+Pharmacist+December+2020+MY

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts
no text concepts found
Transcript
YYO
OU
UR
R TTR
RU
US
STTEED
DS
SO
OU
UR
RC
CEE O
OFF P
PH
HA
AR
RM
MA
AC
CYY IIN
NFFO
OR
RM
MAT
ATIIO
ON
N
MPS: Recognize
pharmacists in
transformative
global health role
MALAYSIA
MALAYSIA •• NOVEMBER/DECEMBER
NOVEMBER/DECEMBER 2020
2020
Malaysian pain
undertreated
compared to
other countries
Antibiotics may
raise risk of
appendicitis in
children, teens
BRACE CORONA
advocates continuing
ACEis/ARBs in
mild-to-moderate COVID-19
IN COLLABORATION WITH MPS
MEDICAL
MEDICAL PROFESSIONAL
PROFESSIONAL COPY
COPY •• NOT
NOT FOR
FOR SALE
SALE
| YO U R T R U ST E D S O U R C E O F P H A R M A CY I N F O R M AT I O N
CONTENTS
NOVEMBER/DECEMBER ISSUE
Publisher
Yasunobu Sakai
Country Vice President
(Marketing Platform & Medcomms)
Aundrey Yeoh
Contributing Editors
Malaysia: Saras Ramiya, Pank Jit Sin,
Rachel Soon
Singapore: Elvira Manzano, Roshini Claire
Anthony, Pearl Toh, Audrey Abella
Hong Kong: Christina Lau,
Dr Joseph Delano Fule Robles
Philippines: Stephen Padilla, Jairia Dela
Cruz, Elaine Soliven
4
NATIONAL NEWS
MPS: Recognize pharmacists in transformative global health role
5
Peripheral artery disease a disability risk for Malaysians
6
New kid on the block reduces influenza symptoms, severity
8
New endometriosis patient support website launched
9
Malaysian pain undertreated compared to other countries
10
More advocacy needed for regular BP monitoring
Circulation Executive
Pauline Hoe
12
FRONT PAGE
BRACE CORONA advocates continuing ACEis/ARBs in mild-to-moderate
COVID-19
Accounting Manager
Christine Goh
6
Business Managers
Kam Zhi Yan,
Rathika Nagarajan, Sugalia Santhira,
Xavier Wee, Krystle Lim
Designer
Razli Rahman
Published by
MIMS Medica Sdn Bhd
2nd Floor, West Wing, Quattro West,
No.4, Lorong Persiaran Barat
46200 Petaling Jaya
Selangor, Malaysia
Email: [email protected]
Tel: (603) 7623 8000
10
What ifi cofiofiavifiufi
What
ifi 2019
cofiofiavifiufi
dififiafifi
(COVID-19)?
What
ifi 2019
cofiofiavifiufi
dififiafifi
(COVID-19)?
fififififififififififi fififififififi 2019 (fiOVID-19) fifi fi
dififiafifi
2019
(COVID-19)?
fififififififififififi
fififififififi
2019
fi
fififipfifififififiy
fillfifififi
fifififi
cfifi(fiOVID-19)
fipfifififi ffifimfifi
fifi pfifififififi
fififififififififififi fififififififi 2019
(fiOVID-19)
fifipfififififi
fi
fififipfifififififiy
fillfifififi
fifififi
cfifi
fipfifififi
fifi
Tfifi fififififi fifififi
cfififififi
fiOVID-19
fifi fiffifim
fifififil
fifififi
fififififififififififi
fififififififi
2019
fifipfififififi
fi cfifififififififififi
fififipfifififififiy
fillfifififi
fifififi
cfifi(fiOVID-19)
fipfifififi
ffifim
pfififififi
fifi pfifififififi
pfifififififi
Tfifi
fifififi
cfififififi
fifi
fifififil
cfifififififififififi
fifififi
wfifi fififififi
fifififififififififififififififififififififififififififififififififififififififififififififififififififififififififi
fififipfifififififiy
fillfifififi
fififififiOVID-19
cfifi fipfifififi
pfififififi
fifi pfifififififi
Tfifi
fififififi
fifififi
cfififififi
fiOVID-19
fifi fi
fiffifim
fifififil
cfifififififififififi
fifififi
wfifi
fifififififififififififififififififififififififififififififififififififififififififififififififififififififififififi
fififififififififififififi
Tfifi
fififififi
fifififi cfififififi fiOVID-19 fifi fi fifififil cfifififififififififi fifififi
wfifi
fifififififififififififififififififififififififififififififififififififififififififififififififififififififififififi
fififififififififififififi
wfifi
fifififififififififififififififififififififififififififififififififififififififififififififififififififififififififi
fififififififififififififi
fififififififififififififi
Tfiafifimififiiofi
Tfiafifimififiiofi
Tfiafifimififiiofi
Dfioplfitfi
Dfioplfitfi
fi.fi. Coufih
& Sfififizfi
Dfioplfitfi
fi.fi.
&
Dfioplfitfi
fi.fi. Coufih
Coufih
& Sfififizfi
Sfififizfi
fi.fi. Coufih & Sfififizfi
Hfiadachfi
Hfiadachfi
Hfiadachfi
Hfiadachfi
Fatifiufi
Fatifiufi
Fatifiufi
Fatifiufi
Clofifi cofitact
Clofifi
Clofifi cofitact
cofitact
Clofifi cofitact
Symptomfi
Symptomfi
Symptomfi
Ffivfifi
Ffivfifi
Ffivfifi
Ffivfifi
Dfiy Coufih
Dfiy
Dfiy Coufih
Coufih
Dfiy Coufih
Shofitfifififi
Shofitfifififi
Bfifiath
Shofitfifififi
Bfifiath
Shofitfifififi
Bfifiath
Bfifiath
of
of
of
of
Pfifivfifitiofi
Pfifivfifitiofi
Pfifivfifitiofi
HOW TO CONTACT US
Wafih hafid fififiulafily
with watfifi & fioap ofi
Wafih
hafid
fififiulafily
Wafih
hafid
fififiulafily
hafid
fiafiitizfifi
with
with watfifi
watfifi &
& fioap
fioap ofi
ofi
Wafih
hafid
fififiulafily
hafid
fiafiitizfifi
hafid
fiafiitizfifi
with watfifi & fioap ofi
hafid fiafiitizfifi
Wfiafi a mafik
if you afifi ufiwfill
Wfiafi
Wfiafi a
a mafik
mafik
if
if you
you afifi
afifi ufiwfill
ufiwfill
Wfiafi a mafik
if you afifi ufiwfill
Covfifi youfi mouth with
tififiufi whilfi fifififizififi
Covfifi
youfi
mouth
Covfifiofi
youfi
mouth with
with
coufihififi
tififiufi
tififiufi whilfi
whilfi fifififizififi
fifififizififi
Covfifiofi
youfi
mouth with
coufihififi
ofi
coufihififi
tififiufi whilfi fifififizififi
ofi coufihififi
Avoid touchififi youfi
fiyfifi, fiofifi, afid mouth
Avoid
touchififi
youfi
Avoid
touchififihafidfi
youfi
with
ufiwafihfid
fiyfifi,
fiyfifi, fiofifi,
fiofifi, afid
afid mouth
mouth
Avoid
touchififihafidfi
youfi
with
ufiwafihfid
with
ufiwafihfid
hafidfi
fiyfifi, fiofifi, afid mouth
with ufiwafihfid hafidfi
Eat ofily thofioufihly
cookfid food
Eat
Eat ofily
ofily thofioufihly
thofioufihly
cookfid
cookfid food
food
Eat ofily thofioufihly
cookfid food
Stay at homfi,
avoid cofitact with
Stay
at
Stay
at homfi,
homfi,
cfiowdfi
avoid
avoid cofitact
cofitact with
with
Stay
at homfi,
cfiowdfi
cfiowdfi
avoid cofitact with
cfiowdfi
To subscribe:
[email protected]
To contact the editor:
[email protected]
To submit an article:
[email protected]
7 Stfipfi of Hafid Hyfiifififi Tfichfiiqufi
7 Stfipfi of Hafid Hyfiifififi Tfichfiiqufi
7 Stfipfi of Hafid Hyfiifififi Tfichfiiqufi
Palmfi
Back of hafidfi
Bfitwfififi fifififififi
Back of fifififififi
Palmfi
Palmfi
Back
Back of
of hafidfi
hafidfi
Bfitwfififi
Bfitwfififi fifififififi
fifififififi
Back
Back of
of fifififififi
fifififififi
Palmfi
Back of hafidfi
Bfitwfififi fifififififi
Back of fifififififi
Thumbfi
Fififififi tipfi
Wfiifitfi
Thumbfi
Thumbfi
Fififififi
Fififififi tipfi
tipfi
Wfiifitfi
Wfiifitfi
Thumbfi
Fififififi tipfi
Wfiifitfi
Mfilfiyfifififi Pfififimficfififificfil Sficfififiy
Mfilfiyfifififi Pfififimficfififificfil
Mfilfiyfifififi
Pfififimficfififificfil Sficfififiy
Sficfififiy
Mfilfiyfifififi Pfififimficfififificfil Sficfififiy
1
AUSTRALIA • MALAYSIA • HONG KONG
INDIA • INDONESIA • CHINA • MYANMAR
NEW ZEALAND • PHILIPPINES • VIETNAM
SINGAPORE • SOUTH KOREA • THAILAND
NOVEMBER/DECEMBER ISSUE
| YO U R T R U ST E D S O U R C E O F P H A R M A CY I N F O R M AT I O N
CONTENTS
NOVEMBER/DECEMBER ISSUE
14
FROM ABROAD [COVID-19 Updates]
Remdesivir improves recovery, reduces mortality of COVID-19 patients
15
Sofosbuvir-daclatasvir: a role in COVID-19 management?
16
Corticosteroids do not avert mortality in severe, critical COVID-19 patients
18
COVID-19 in hospitals: Toilets, staff, public areas show contamination
19
Viral shedding from asymptomatic COVID-19 patients may be prolonged
15
19
20
FROM ABROAD
Pharmacist-led audit/feedback intervention improves medication safety
21
Antibiotics may raise risk of appendicitis in children, teens
22
Rheuma drug shows disease-modifying potential for T1D
24
Cranberry juice a potential treatment for H pylori infection?
25
Turmeric extract may help relieve pain in knee OA
26
New evidence backs safety of low-dose aspirin in women attempting
pregnancy
21
28
MIMS Pharmacist is published 6 times a
year by MIMS Medica. MIMS Pharmacist
is a controlled circulation publication to
pharmacists and members of allied professions in Malaysia. Editorial matter published herein has been prepared by professional editorial staff. Views expressed are
not necessarily those of MIMS Medica.
Although great effort has been made in
compiling and checking the information
given in this publication to ensure that
it is accurate, the authors, the publisher
and their servants or agents shall not be
responsible or in any way liable for the
continued currency of the information or
for any errors, omissions or inaccuracies in
this publication whether arising from negligence or otherwise howsoever, or for any
consequences arising therefrom; the publisher bears no responsibility or liability for
patent ownership or patent legality of any
medical product mentioned or featured,
nor is it responsible for verifying the ownership or originality of the product which,
therein infringes upon the intellectual property rights or other rights of any third party.
The inclusion or exclusion of any product
does not mean that the publisher advocates or rejects its use either generally or
in any particular field or fields. The information contained within should not be relied
upon solely for final treatment decisions.
©2020 MIMS Medica. All rights reserved.
No part of this publication may be reproduced in any language, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic,
mechanical, photocopying, recording or
otherwise), without the written consent of
the copyright owner. Permission to reprint
must be obtained from the publisher. Advertisements are subject to editorial acceptance and have no influence on editorial content or presentation. MIMS Medica
does not guarantee, directly or indirectly,
the quality or efficacy of any product or service described in the advertisements or other material which is commercial in nature.
25
CALENDAR
PP17931/12/2013(033147) ISSN 2076-5738
2
NOVEMBER/DECEMBER ISSUE
MESSAGE FROM THE MIMS PHARMACIST TEAM
FACING THE THIRD WAVE
O
Dear readers,
ctober 2020 has seen the largest
surge of COVID-19 cases in Malaysia so far, with over 800 new
cases a day emergent throughout the
country, primarily in Sabah. Healthcare
workers from the Peninsula are being
flown east to support their colleagues,
who have been struggling with shortages
in the wake of this third wave.
Meanwhile, multiple districts in Selangor, Kedah, Penang, and Perak have
been declared red zones. Conditional
movement control orders (CMCOs) in
the affected districts appear to be slowing down the rate of community infection, although once again the restrictions
involved have negatively impacted many
livelihoods.
We appreciate that pharmacists like
you continue to serve communities in
this time despite the personal risks involved, and hope that once again the
collective efforts of all Malaysians will
help stem the tide.
To keep you updated on ongoing developments in COVID-19 and other areas
of research, the MIMS Pharmacist team
continues to publish news and reviews
both online and as a monthly digital
magazine at the MIMS Specialty News
– Pharmacy website. (https://specialty.
mims.com/pharmacy)
If you would like to receive monthly email updates whenever new MIMS
Pharmacist issues are out, you can register an account for free at www.mims.
com and select “Pharmacy” as your
specialty of interest to do so.
We also welcome your contributions
in the form of news, stories and opinions
at [email protected] If you or
your organization would be interested in
business opportunities with MIMS Pharmacist, do contact our business team at
[email protected]
Sincerely,
The MIMS Pharmacist team
Are you a frontliner feeling the effects of stress and burnout?
Useful resources for
pharmacists:
Ministry of Health (MOH)
Malaysia Facebook
https://www.facebook.com/
kementeriankesihatanmalaysia
World Health Organization
COVID-19 Technical Guidance
Hub
https://www.who.int/emergencies/
diseases/novel-coronavirus-2019/
technical-guidance
International Pharmaceutical
Federation COVID-19
Information Hub
https://www.fip.org/coronavirus
Malaysian Pharmaceutical
Society (MPS) COVID-19
Resources and Initiatives
https://www.mps.org.my/newsmaster.
cfm?&menuid=37&action=view&
retrieveid=7819
You can dial in to a dedicated psychosocial support hotline run jointly by the MOH, Mercy Malaysia,
and the Women’s Aid Organization at these numbers from 8 am to 5 pm daily:
3
• 011-6399 6482
• 011-6399 4236
• 03-2935 9935
NOVEMBER/DECEMBER ISSUE
NATIONAL NEWS
MPS: Recognize pharmacists in transformative
global health role
Rachel Soon
P
harmacists are key healthcare
frontliners at the community level
as well as part of the final line of
defence against COVID-19 at hospitals,
says Malaysian Pharmaceutical Society
(MPS) president Amrahi Buang.
“In Malaysia, the importance of pharmacists cannot be understated,” said
Amrahi, in an MPS press statement
marking World Pharmacists Day 2020.
“Ever since the Movement Control Order
(MCO) was enforced on 18 March, pharmacy services have been classified as an
essential service … [since then,] pharmacists everywhere have been working
hard to contain the coronavirus.”
To commemorate the role of pharmacists in the COVID-19 pandemic, ‘Transforming Global Health’ was the theme
selected by the International Pharmaceutical Federation (FIP) for this year’s
World Pharmacists Day; the tenth annual
celebration thereof.
“This theme is very appropriate in the
present scenario with all the challenges
caused by the COVID-19 pandemic ever
since it was first discovered in Wuhan,
China at the end of December 2019,”
said Amrahi. “Whether in the private or
public sector, we have seen many innovative value-added pharmaceutical services for the rakyat.”
Amrahi added that the pandemic had
opened windows of opportunities for
pharmacists to serve in new innovative
ways, such as via digital platforms and
telepharmacy, with the aid of innovative
equipment and applications. He highlighted their active involvement in medical
research, clinical trials, healthcare logistics, as well as the development of new,
safe, and effective drugs and vaccines.
“Academic pharmacists also play an
important [role] in health transformation
by producing quality pharmacy graduates and competent scientists [of] high
calibre to fill the needs of the country and
community,” said Amrahi.
In an online message to the pharmacy community, FIP president Dominique Jordan said that the day was
an opportunity to communicate how
pharmacists are collaboratively “transforming the health in their communities
through a variety of professional services
such as advising on healthy living, vaccinating to prevent disease, and ensuring that medicines are used optimally.”
[https://www.fip.org/news?news=newsitem&newsitem=343]
We have seen many
innovative valueadded pharmaceutical
services for the
rakyat.
World Pharmacists Day is also a
chance to let people know how “pharmaceutical scientists are transforming
and prolonging lives by developing safe
and effective medicines and vaccines,
and pharmacy educators are transforming healthcare by ensuring that
there are enough qualified and competent pharmacists and scientists to meet
the growing needs of our societies,”
Jordan added.
Commenting on the FIP president’s
statement, Amrahi added that pharmacists are also among the HCPs recognized as key players in achieving Sustainable Development Goals (SDGs) set
by the United Nations. He emphasized
the contributions of pharmacists in ensuring access to affordable and effective
medications internationally, as well as expanding the use of technology as a care
delivery medium.
“Last but not least, to all 19,792 registered pharmacists in Malaysia, we wish
all of you a happy World Pharmacists
Day 2020,” said Amrahi in closing.
4
NOVEMBER/DECEMBER ISSUE
NATIONAL NEWS
Peripheral artery disease a disability risk
for Malaysians
number of lower limb amputees experience psychological adjustment problems.”
“There is an urgent need to address
the unmet needs and disease burden for
patients suffering from PAD,” said Datuk
Dr Zanariah Hussein, consultant endocrinologist at Hospital Putrajaya and Malaysian Endocrine and Metabolic Society
(MEMS) president. “Early diagnosis is
advisable, and this can be easily done
using basic clinical examination and administered by general practitioners or
nurses.”
L-R: Dr Mhark Vincent Bautista, associate medical director, Bayer Malaysia; Prof Dato’ Dr Hanafiah
Harunarashid; Prof Dr Wan Azman Wan Ahmad; and Datuk Dr Zanariah Hussein, during a panel
discussion on peripheral artery disease in Malaysia.
Rachel Soon
M
ore timely diagnosis and
treatment for peripheral artery disease (PAD) can significantly reduce the need for late-stage
amputations, say experts.
According to Prof Dato’ Dr Hanafiah Harunarashid, managing director
and consultant vascular surgeon, Hospital Canselor Tuanku Muhriz UKM, the
increasing prevalence of PAD risk factors among Malaysians—eg, obesity,
diabetes, smoking, high saturated fat
intake, sedentary living, as well as ageing—could lead to increasing PAD rates
among the general population.
“More than 70% of the world’s new
PAD cases between 2010 and 2015
came from Asia-Pacific countries,” said
Hanafiah, adding that Asians seemed to
be prone to PAD at a younger age, due to
their artery size being narrower on average. [Lancet Glob Health 2019;7:e1020–
e1030]
Speaking at a recent media event in
Kuala Lumpur on the development of
rivaroxaban for PAD treatment, Hanafiah
noted that PAD is commonly due to the
development of atherosclerotic plaque in
the legs, arms, neck or kidneys, causing
the slow narrowing of blood flow in the
area. This can eventually lead to complete blockage, resulting in critical limb
ischaemia and gangrene.
While lifestyle changes and pharmacological treatment can prevent or slow
the onset of severe PAD by maintaining
healthy arterial blood flow, many patients
are initially asymptomatic, creating challenges for early intervention, said Hanafiah. He added that overlooking PAD has
led to ‘avoidable problems’ in patients
receiving treatment for gangrene but not
for underlying PAD, often resulting in further upper limb atrophy during the patient’s recovery period.
“It is not uncommon that patients
with PAD need to undergo a lower limb
amputation, with or without previous revascularization attempts,” said Hanafiah.
“The impact of the amputation and disease goes beyond physical disability and
financial burden for treatment … clinical
reports have indicated that a significant
5
According to Prof Dr Wan Azman
Wan Ahmad, senior consultant cardiologist at UM Specialist Centre (UMSC) and
president of the National Heart Association of Malaysia (NHAM), the development of antithrombotic drugs such as
rivaroxaban has improved the prognosis
for patients with PAD.
“Previously, our only options were
anticoagulants such as warfarin which
came with several logistics issues, such
as a small therapeutic window, food interactions, and the need for frequent monitoring,” said Wan Azman. “Antiplatelets
such as aspirin also showed only modest reductions as they did not affect fibrin production in the clotting process
… however, dual-pathway inhibition with
aspirin and rivaroxaban has shown effectiveness in improving PAD outcomes.”
[N Engl J Med 2017;377:1319–1330;
2020;382:1994–2004]
“On top of available treatments for
PAD, patients are advised to adopt a
healthy lifestyle and consult their HCPs
for proper screening and diagnosis for
prevention and early detection,” Wan
Azman added.
Hanafiah, Zanariah, and Wan Azman
were speaking at a media event organized by Bayer Malaysia.
NOVEMBER/DECEMBER ISSUE
NATIONAL NEWS
New kid on the block reduces influenza
symptoms, severity
Pank Jit Sin
A
new first-in-class therapeutic
agent indicated for the treatment of acute, uncomplicated
influenza in persons aged 12 years and
above is now available in Malaysia.
The new drug, baloxavir marboxil
(Xofluza™, Roche), is taken as a single
dose within 48 hours after the onset of
influenza symptoms. When compared to
placebo, baloxavir has been shown to
significantly reduce the median time to
alleviation of symptoms and median time
to resolution of fever (p<0.001 for both).
When compared to placebo and oseltamivir, baloxavir significantly reduced
infectious viral load within a shorter duration. Furthermore, it has a favourable
safety profile with side effects comparable to oseltamivir. [N Engl J Med
2018;379:913–923]
Speaking at the virtual launch of the
new drug, Dr Petrick @ Ramesh K. Periyasamy, head of infectious diseases unit,
Hospital Canselor Tuanku Muhriz UKM,
said one main challenge of physicians
when diagnosing influenza is how it can
be easily confused with other respiratory illnesses, such as the common cold,
as they share similar milder symptoms
such as cough, nasal discharge and sore
throat.
However, influenza is characterized
by more severe systemic symptoms
such as fever, muscle pain and general unwellness. It can cause a variety of
complications ranging from sinus or ear
infections to more severe complications
such as pneumonia.
Petrick said: “Symptoms of influenza include sudden onset of fever, cough
(usually dry), headache, muscle and joint
pain, sore throat and a runny nose. The
symptoms usually start 24 to 48 hours
L-R: Dr Petrick @ Ramesh K. Periyasamy and Dr Charles Li.
after infection and lasts up to 8 days.
Most adults are contagious 1 day before
their symptoms start and remain contagious up to 7 days after becoming sick.”
Dr Charles Li, medical and regulatory
director, Roche Malaysia, said the new
drug represents a new chapter in influenza treatment with it being convenient
(thereby improving patient compliance)
and efficacious. At the same time, Roche
Malaysia has launched the ‘Axe The
Flu’ campaign, targeting the public to
increase awareness of influenza symptoms and severity.
Li said: “Recognizing influenza symptoms early is key to effective treatment
and prevention of the virus spreading. If
patients see their doctors within 48 hours
of symptom onset, one dose of baloxavir
marboxil can significantly reduce the duration of influenza symptoms.”
The treatment could be covered by
medical insurance depending on the policy; patients are advised to check with
their provider for confirmation of coverage. It is already available at hospitals,
GP clinics and pharmacies. However, Li
said patients may find it easier to access
the treatment in the hospital setting for
the time being. The expected price for
a dose of baloxavir marboxil is around
RM250.
6
About baloxavir marboxil
The new therapeutic agent is a first-inclass antiviral with a novel mechanism of
action. Unlike previous antiviral agents,
baloxavir marboxil inhibits a subunit of viral polymerase and stops viral replication
early in the disease cycle. This mechanism works on both A and B strains of
influenza.
The evidence for baloxavir marboxil came from the CAPSTONE-1* trial, a
phase III multicentre, randomized, placebo-controlled study which looked at
1,436 participants aged 12 to 64 years
who were diagnosed with symptomatic,
uncomplicated influenza. Participants
were randomly assigned to receive a
single oral administration of 40 mg or
80 mg (40 mg if they weighed less than
80 kg and 80 mg if more than 80 kg) of
baloxavir marboxil; placebo or 75 mg of
oseltamivir twice daily for 5 days.
Baloxavir marboxil met its primary
endpoint of significantly reduced duration of influenza symptoms compared to
placebo. It further demonstrated similar
efficacy to oseltamivir in symptom duration and adverse events.
*
CAPSTONE-1: A Study of S-033188 (Baloxavir
Marboxil) Compared With Placebo or Oseltamivir in
Otherwise Healthy Patients With Influenza
NOVEMBER/DECEMBER ISSUE
INTRODUCING A NEW ONLINE MODULE ON GERD
Stay safe and keep earning your CPD points online
W
NE
Earn
Your CPD
Points
Here
Improving Blood Pressure Control with
Combination Therapy
Evidence shows that combination therapy is more effective
at lowering blood pressure (BP) compared with increasing
the dose of monotherapy. Single-pill fixed dose combinations
provide better BP control by simplifying patients’ drug regimen,
thereby improving treatment adherence. This module aims
to educate healthcare providers on the use of combination
therapy towards achieving BP goals in patients currently taking
antihypertensive medication.
MPS code: 0569
n to access
S ca
GERD is a condition wherein stomach acid rises and enters the
oesophagus, often resulting in either manageable symptoms
or long-term complications if left untreated. Epidemiological
studies in Asia have shown an increasing prevalence of
symptom-based GERD year after year. This module aims to
educate healthcare providers on the use of proton pump
inhibitors (PPIs) as an effective treatment in suppressing
gastric acid secretion in patients with GERD. Compared to
other methods of treatment, PPIs exhibit faster onset of
action with tolerable safety profiles.
n to access
S ca
Gastric acid control: The role of proton
pump inhibitors in the treatment of
gastroesophageal reflux disease (GERD)
MPS code: 0136
an to registe
Sc
r
The global prevalence of Alzheimer’s disease (AD) and its
treatment costs are projected to increase tremendously, thus
placing increasing pressure on developing countries’ healthcare
systems. Pharmacists are well-positioned to assist clinicians in
the provision of various care services to individuals living with
AD. This module aims to provide an overview of the epidemiology
and burden of disease, as well as the risk factors and prevention
strategies for AD. In addition, it also discusses the role of
pharmacists in AD management, while simultaneously reviewing
current approaches to AD management.
MY-CPD-140_MP_NOV2020
n to access
S ca
Alzheimer’s disease: Pharmacists’ role in
the era of expanding scopes of practice
MPS code: 0206
Start earning CPD points at
Log in to
register now
www.mims-cpd.com.my
www.mims-cpd.com.my
For your convenience, you can
monitor your CPD points earned via the
website at anytime.
Your personal My CPD Log can be printed
or emailed.
Enquiries:
MIMS Medica Sdn Bhd (891450-U)
2nd Floor, West Wing, Quattro West
No. 4, Lorong Persiaran Barat
46200 Petaling Jaya, Selangor, Malaysia.
Tel: +603 7623 8000 Fax: +603 7623 8188
Email: [email protected]
Website: www.mims.com
NATIONAL NEWS
New endometriosis patient support website
launched
Rachel Soon
A
new patient-centred website
for Malaysians with endometriosis has been launched by the
Endometriosis Association of Malaysia
(MyEndosis).
Developed with the support of Bayer Co. (Malaysia) Sdn Bhd, the website
(http://myendosis.org) provides information on disease symptoms, diagnosis,
and treatment options, as well as patient testimonials and connection to peer
support.
“A lack of awareness of endometriosis and social taboos surrounding the
disease are common factors associated
with the delay in seeking treatment,” said
MyEndosis founder and president Surita
Mogan. “Many women live in silence and
pain because they don’t know what is
normal and what isn’t when it comes to
menstrual health.”
Speaking at its official launch, Surita
said that the website was the first to be
managed purely by patients and caregivers. Currently accessible in Bahasa Malaysia and English, the association aims
to add Chinese and Vietnamese translations of site content in future.
Imelda. “Although symptoms may vary in
type and severity, the pain can be both
physically and mentally exhausting, leaving patients feeling helpless and overwhelmed.”
“The website will also be a catalyst
for us to launch our MyEndosis National Survey in October 2020,” said Surita.
“This survey will give us statistics from all
states in Malaysia in order for us to push
for acknowledgement from government
ministries and agencies so we have a
better healthcare plan to help patients
financially and emotionally.”
While there are no official statistics
or large-scale studies on prevalence
or the delays in diagnosis experienced
in Malaysia, at least 2,500 individuals
have joined MyEndosis’ Facebook support group since its inception in March
2014. Through a preliminary study of 30
women conducted in August 2020, MyEndosis also reported that a third of respondents endured symptoms for over 9
years before seeking treatment.
Breaking the silence
At the same event, consultant obstetrician and gynaecologist Dr Imelda Balchin
highlighted that it can take up to 11 years
for patients with pelvic pain to receive an
endometriosis diagnosis. [Am J Obstet
Gynecol 2019;220(4):354.e1–354.e12]
“Endometriosis affects one-in-ten
women during their reproductive years,
yet not many are aware of what [it] entails and how it can be managed,” said
Closing the treatment gap
When asked about how GPs could support patients, consultant obstetrician and
gynaecologist Dr Patricia Lim Su-Lyn
said that it was important to listen to their
history, particularly descriptions of debilitating period symptoms, and focus on
their impact on quality of life.
“Even if [gynaecologists] do not find
any signs of endometriosis on ultrasound
[scan] or raised CA-125* levels [in the
patient], we may still empirically opt to
treat the patient’s case as endometriosis to see if they benefit from any treatment,” said Lim. She added that GPs
with the means to do so could conduct
ultrasound scans to detect ovarian cysts
or blood tests to check the patient’s CA125 levels.
On the same topic, Imelda emphasized the use of accessible language and
local culture in conversations about the
disease, noting that while scientific terms
such as ‘endometriosis’ itself could
be obtuse for most people, colloquial
names such as ‘senggugut’ were often
more quickly understood by patients and
their families.
L-R: Dr Patricia Lim Su-Lyn, Dr Imelda Balchin and Surita Mogan, at the official launch of the
MyEndosis website.
*
8
CA-125: Cancer Antigen 125
NOVEMBER/DECEMBER ISSUE
NATIONAL NEWS
Malaysian pain undertreated compared to
other countries
Rachel Soon
M
any Malaysians choose to
delay seeking treatment for
pain and are less likely to
do so than residents of other countries,
according to a recent international consumer study.
In a report from the Global Pain Index
(GPI) 2020 study, over 85% of Malaysian
respondents said they had experienced
some form of pain in the last year, with
the top five most common being headache (89%), tension headache (80%),
muscle ache (77%), period pain (71%),
and joint pain (70%).
However, only 38% of respondents
said they chose to seek treatment immediately for pain, with 56% preferring to
wait hours (38%) or days to weeks (18%)
before treating it. Six percent said they
never treated their pain.
Malaysian respondents were also
less likely to medicate for pain compared
to the global average in the study, with
only 48% of respondents reported taking pain medication (vs 65% globally). In
contrast, 74% reported preferring to rest
or sleep to deal with pain issues.
Thirty-one percent of Malaysian respondents said they avoided taking
pain medication in general, with the
commonest reasons cited including
possible dependency (29%) and adverse
effects (25%).
The GPI 2020 study was conducted
by Edelman Intelligence UK and commissioned by GlaxoSmithKline (GSK)
Consumer Healthcare, with its results
being announced at a virtual press event
in September. Consisting of a 25-minute online survey, the study examined
19 countries with a representative sample of 1,000 respondents (across age,
gender, and region) interviewed from
each country.
Improving health literacy
around pain
Speaking at the press event, Dr Gopinathan Raju, consultant anaesthetist
and pain management specialist, noted
that it was important for healthcare professionals to help educate patients and
dispel myths regarding common overthe-counter pharmacological treatments
for pain, such as those surrounding tolerance, adverse effects, drug-drug interactions, and special demographic groups.
“Research has shown that long periods of unrelieved pain can lead to adverse psychological and physical complications,” added Shawn Roy, GSK
Consumer Insight Lead, South East
Asia and Taiwan. “In fact, the GPI 2020
showed 67% of Malaysians believed that
pain decreases their quality of life.”
Roy highlighted that delayed or untreated pain had negative impacts not
only on individuals, but on broader socioeconomic areas. He noted that the
Malaysian Employers Federation (MEF)
Man-Days Lost and Absenteeism Survey 2019 estimated productivity losses
of over 10.7 million man-days due to
sick leave taken by workers between
June 2018 and May 2019. [https://www.
nst.com.my/news/nation/2019/11/
542802/mef-107-million-man-days-lostsick-leave]
According to Bryan Wong, general manager, GSK Consumer Healthcare Malaysia, the GPI 2020 results
also showed a low level of health literacy among respondents comparable
with the findings of the 2019 National
Health and Morbidity Survey (NHMS
2019), which reported low health literacy
among 35.1% of adults aged 18 years
and above.
“Given the data … it is very important
to provide accessible and easy-to-digest
health information with verified sources
on the right channels to empower and
improve the community’s health literacy,”
said Wong.
At the same event, GSK Consumer
Healthcare Malaysia announced a collaboration with Watsons Malaysia on a
health literacy campaign called ‘Know
Your Medicine, Find the Right Relief’ to
be conducted on social media, digital
and broadcast platforms, and physical stores nationally. According to GSK
representatives, it aims “to educate and
increase Malaysians’ access to medicine knowledge which will help in [the]
pain management journey and enable
enhancement of the quality of life of the
overall population.”
9
NOVEMBER/DECEMBER ISSUE
NATIONAL NEWS
More advocacy needed for regular
BP monitoring
Rachel Soon
W
ith rising rates of hypertension among younger
populations, regular blood
pressure (BP) monitoring should be encouraged in adults 18 years and older,
says an expert.
According to Dr Mohd Arifin Mohd
Ali, president of the Malaysian Society of
Hypertension (MSH), a lack of awareness
on one’s BP status as well as the potential complications of uncontrolled hypertension could contribute to increased
rates of stroke, heart attack, and kidney
disease, particularly in those with a family
history of hypertension.
A recent consumer survey conducted by OMRON Healthcare found that
42% of 504 respondents felt that their
BP was not serious or in need of regular
monitoring, while 34% felt that checking
their BP whenever they visited their doctor was sufficient. However, at least 85%
had checked their BP at least once in the
preceding year.
In addition, the latest National Health
and Morbidity Survey (NHMS) 2019 reported a 30.0% overall hypertension rate
among Malaysian adults 18 years and
older; a prevalence comparable to those
reported in the NHMS 2015 (30.3%) and
2011 (32.6%). Of the 30.0%, 15.9% had
known hypertension, while the remaining
14.1% had elevated BP not yet diagnosed as hypertension.
being a contributing factor to hypertension. Previous NHMS data has tracked a
concerning rise in the proportion of Malaysians considered obese, ranging from
a mere 4.4% in 1996 to 14.0% in 2006,
17.7% in 2015, and 19.7% as of 2019.
... a lack of awareness
on one’s BP status as
well as the potential
complications
of uncontrolled
hypertension
could contribute to
increased rates of
stroke, heart attack,
and kidney disease.
Asked about the role of community
healthcare workers (HCWs) such as general practitioners (GPs) and pharmacists
in tackling hypertension—particularly
patients with unknown hypertension—
Arifin stressed public awareness first
and foremost, pointing to the MSH’s
efforts in providing up-to-date training on the topic for HCWs as well as in
public forums.
“This is where the media, GPs, and
pharmacists must also be updated to
current levels of knowledge about hypertension; they have a role to play in
educating and explaining [the same] to
their patients,” said Arifin. “Knowledge
about obesity and weight control, fattening foods, control of blood sugar,
diet, reducing salt intake, need for exercise and so on—must all be part of
[this].
He added that in his own practice,
he advised patients to be compliant and
to ‘know their numbers’ (BP readings).
He also advocated for the use of home
BP monitoring devices by patients,
with regular clinical follow-ups at 3-to-4
month intervals.
As a public service to help identify
those with at increased risk of developing hypertension, OMRON Healthcare
has announced the release of an online
self-checklist (https://hypertensionrisk.
questionpro.com/) developed in collaboration with MSH to encourage the public to monitor their BP as well as seek
medical advice on prevention and treatment of hypertension.
“In my opinion, … we may consider
[the NHMS 2019 findings] to be rather
good as the [prevalence] rate has not increased, though the total [of people with
hypertension] has increased,” said Arifin.
However, he added that the growing prevalence of obesity among adults
18 years and above as reported in the
NHMS was also concerning due to it
10
NOVEMBER/DECEMBER ISSUE
KEEP UP WITH YOUR MEDICAL EDUCATION NEEDS
Complete these online modules successfully and earn a total of
3 CPD points
Earn
Your CPD
Points
Here
The prevalence of allergic rhinitis (AR) is on the rise; it
affects approximately 40% of the population globally, with
the highest rates observed in the Asia Pacific region. This
module focuses on current practices in AR management
among primary care practitioners and their familiarity with
current guidelines. Additionally, it also explores the patient
perspective of AR management.
The Allergic Rhinitis Boot Camp | Part 2
Using patient profiles to guide
antihistamine choice: An expert
consensus
an to registe
Sc
r
Antihistamines are the mainstay of treatment for allergic
rhinitis (AR), particularly in the primary care setting.
However, selecting appropriate antihistamines may be
a challenge owing to the wide range of antihistamines
available. This module highlights the use of patient
profiles to guide the choice of antihistamines in primary
care based on expert consensus and recommendations.
MY-CPD-143_MP_DEC2020
n to access
S ca
The Allergic Rhinitis Boot Camp | Part 1
Allergic rhinitis management and patient
journey: Understanding the disease and
current guidelines
MPS code: 0181
MPS code: 0369
n to access
S ca
Hypertension (HTN) remains a challenging medical
problem, affecting over 1 billion individuals worldwide. HTN
is often called the “silent killer” because it typically has
no symptoms. Suboptimal BP control puts a tremendous
burden on the health and welfare of individuals and the
population. This online CPD video provides an update
on the evidence for managing HTN, while simultaneously
highlighting the role of single-pill fixed-dose combination
in promoting adherence to HTN treatment.
n to access
S ca
Hypertension: Understanding the
silent killer
MPS code: 0436
Start earning CPD points at
Log in to
register now
www.mims-cpd.com.my
www.mims-cpd.com.my
For your convenience, you can
monitor your CPD points earned via the
website at anytime.
Your personal My CPD Log can be printed
or emailed.
Enquiries:
MIMS Medica Sdn Bhd (891450-U)
2nd Floor, West Wing, Quattro West
No. 4, Lorong Persiaran Barat
46200 Petaling Jaya, Selangor, Malaysia.
Tel: +603 7623 8000 Fax: +603 7623 8188
Email: [email protected]
Website: www.mims.com
FRONT PAGE
BRACE CORONA
advocates continuing ACEis/ARBs
in mild-to-moderate COVID-19
Roshini Claire Anthony
P
atients
hospitalized
with
mild-to-moderate
COVID-19
who are on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for
hypertension should continue these
medications, according to primary results of the BRACE CORONA trial presented at ESC 2020.
“In patients hospitalized with
COVID-19, suspending ACE inhibitor/
ARB therapy for 30 days did not impact
the number of days alive and out of hospital,” presented principal investigator
Professor Renato Lopes from the Duke
Clinical Research Institute, Durham,
North Carolina, US.
“Because these data indicate that
there is no clinical benefit from routinely
suspending these medications in hos-
pitalized patients with mild-to-moderate
COVID-19, they should be generally continued for those with an indication,” said
Lopes.
Participants in this multicentre, phase
IV Brazil-based trial were 659 adults
(mean age 55.7 years, 40.4% female,
mean BMI 31.0 kg/m2) hospitalized with
a confirmed diagnosis of COVID-19 and
who were chronic users of ACE inhibitors/ARBs. They were randomized to
either temporarily suspend their use of
ACE inhibitors/ARBs for 30 days (n=334)
or continue with their medications
(n=325).
Patients hospitalized for decompensated heart failure in the past year, those
on sacubitril/valsartan or >3 antihypertensive medications, and those with haemodynamic instability in the first 24 hours
until confirmation of COVID-19 diagnosis
were excluded.
12
NOVEMBER/DECEMBER ISSUE
FRONT PAGE
About half the patient population was
obese (52.2%) and 31.9% had diabetes, while few patients had heart failure
or kidney disease (1.4% each). At hospital admission, patients were primarily
on ARBs (83.3%) and 16.7% were on
ACE inhibitors. Patients had a median
5-year duration of use of these drugs.
Other medications included beta blockers (14.6%), calcium channel blockers
(18.2%), and diuretics (31.1%).
The most common presenting symptoms of COVID-19 were cough (70.3%),
fever (69.5%), and dyspnoea (53.7%),
with patients experiencing symptoms
a median 6 days prior to admission. In
the first 24 hours of admission, most patients had either mild (57.1%) or moderate (42.9%) COVID-19, with no incidence
of severe COVID-19 (due to exclusion
criteria).
At 30 days, number of days alive
and out of hospital was comparable between patients who suspended and continued ACE inhibitors/ARBs (mean 21.9
vs 22.9 days; mean difference -1.1 days;
mean ratio, 0.95; p=0.09). [ESC 2020,
Hot Line session]
A similar proportion of patients who
suspended or continued ACE inhibitors/
ARBs were alive and out of hospital at
day 30 (91.8% vs 95.0%). The median
number of days alive and out of hospital
at 30 days was 25 days in both groups.
Gianfranco Parati from the University of
Milan-Bicocca and San Luca Hospital,
Milan, Italy. [https://www.youtube.com/
watch?v=NqtjzX7iWZs, accessed 3
September 2020]
“There has been conflicting observational evidence about the potential impact of ACE inhibitors/ARBs on patients
with COVID-19,” noted Lopes.
There has been
conflicting
observational
evidence about the
potential impact of
ACE inhibitors/ARBs
on patients with
COVID-19.
“On one hand, renin-angiotensin-aldosterone system (RAAS) inhibition is
harmful. ACE inhibitors and ARBs could
increase ACE-2 receptor expression
and thus, enhance viral entry and binding leading to outcomes in patients with
COVID-19,” said Lopes. [https://www.
youtube.com/watch?v=z9GxFTBFdPQ,
accessed 3 September 2020]
“On the other hand, preliminary
data hypothesize that RAAS inhibitors
could benefit patients with COVID-19 by
decreasing acute lung damage and
preventing angiotensin-II-mediated pulmonary inflammation,” he said.
“This is the first randomized data assessing the role of continuing vs stopping
ACE inhibitors and ARBs in patients with
COVID-19. Our findings constitute contemporary and high-quality randomized
evidence to guide the care of patients
with COVID-19,” Lopes said.
Not the whole story
Despite the positive results, issues remain, and analysing them may help clarify some of the findings, Parati pointed
out.
The trial included a relatively young
population of patients with mild or
moderate COVID-19. “By selecting [patients with] relatively mild or moderate
[COVID-19], with such a low mortality
rate, in my opinion, the [researchers]
could not really solve the issue,” he said.
There might also be differences in the
outcomes between ACE inhibitors and
ARBs. While the results are important
because they were obtained from a randomized trial, they might “not be telling
us the last words.”
“It might be nice to consider the interaction between age, comorbidities,
and these treatments. That might tell us
more,” concluded Parati.
There were nine deaths in each
group during the trial. All-cause mortality
at 30 days did not significantly differ between patients who suspended or continued their ACE inhibitors/ARBs (2.7%
vs 2.8%; hazard ratio, 0.97, 95% confidence interval, 0.38–2.52; p=0.95).
Implications of BRACE
CORONA
“COVID-19 has really changed our lives
… and one of the issues raised is what
to do with ARBs and ACE inhibitors because most patients are taking these
[medications] because of cardiovascular disease,” said discussant Professor
13
NOVEMBER/DECEMBER ISSUE
FROM ABROAD [COVID-19 UPDATES]
Remdesivir improves recovery, reduces
mortality of COVID-19 patients
symptom duration, or disease severity.
“However, among patients whose
symptoms worsen and who require mechanical ventilation or ECMO on day 5 of
the remdesivir course, continuing treatment through 10 days may be beneficial
versus discontinuing it on day 5,” the researchers noted.
For those with moderate COVID-19,
a 5-day course compared with standard of care was associated with small
reductions in mortality and serious AEs
and a greater number of patients having
clinical improvement at day 11. Notably,
a 10-day course was not more effective
than 5 days or standard of care. [JAMA
2020;324:1048–1057]
Stephen Padilla
A
systematic review of randomized controlled trials (RCTs)
has confirmed the potential of
remdesivir in improving recovery and
reducing serious adverse events (AEs),
as well as mortality and time to clinical
improvement, but not hospital length of
stay, in coronavirus disease (COVID-19)
patients.
“For adults not receiving mechanical
ventilation or extracorporeal membrane
oxygenation (ECMO), a 5-day course
of remdesivir may provide similar benefits to and fewer harms than a 10-day
course,” the researchers said.
English-language RCTs of remdesivir
treatments for adults with suspected
or confirmed COVID-19 were searched
from several databases, tables of contents of journals, and US Food and Drug
Administration and company websites
from 1 January through 31 August 2020.
A single reviewer abstracted data
and assessed risk of bias, which were
verified by a second reviewer. Certain-
ty of evidence was evaluated using
Grading of Recommendations Assessments, Development and Evaluation
(GRADE) methods.
Four RCTs met the eligibility criteria. Compared with placebo, remdesivir significantly improved recovery in
adults with severe COVID-19 (absolute
risk difference [ARD] range, 7–10%)
and was associated with a small reduction in mortality (ARD range, –4% to
1%) and a shorter time to recovery or
clinical improvement. [Ann Intern Med
2020;doi:10.7326/M20-5752]
Remdesivir, however, showed little to
no effect on hospital length of stay. The
antiviral agent also reduced serious AEs
by a moderate amount (ARD range,–6%
to –8%).
Among hospitalized patients not requiring mechanical ventilation, a 5-day
remdesivir course, compared with a 10day course, reduced mortality, increased
recovery or clinical improvement by
small to moderate amounts, shortened
time to recovery, and lessened serious
AEs. Recovery did not vary by age, sex,
14
“Our findings are generally in line
with prior reviews, although none included the trial of remdesivir in patients with moderate COVID-19, and
outcomes reported in prior reviews
were limited,” the researchers said.
[J Med Virol 2020;doi:10.1002/jmv.
26443; Eur J Clin Invest 2020:e13383;
Virus Res 2020;288:198137; BMJ 2020;
370:m2980;
www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management]
“Our living review uses methods
specifically derived for continual updating and is intended, in part, to inform the
work of the American College of Physicians Scientific Medical Policy Committee,” they added.
This systematic review was limited by low-certainty evidence with few
published trials, including one preliminary report and two open-label trials.
Trials also excluded pregnant women
and adults with severe kidney or liver
disease. “New evidence will be incorporated using living review methods
and may alter these conclusions,” the
researchers said.
NOVEMBER/DECEMBER ISSUE
FROM ABROAD [COVID-19 UPDATES]
Sofosbuvir-daclatasvir: a role in COVID-19
management?
Roshini Claire Anthony
A
small study conducted in Iran
suggests a role for sofosbuvir-daclatasvir in the treatment
of moderate-to-severe COVID-19.
This open-label trial included 66
adult patients with moderate or severe
COVID-19 who were admitted at one of
four hospitals in Tehran, Iran. They were
randomized 1:1 to receive the standardof-care (SoC)* regimen of hydroxychloroquine (200 mg twice/day) ± lopinavir/
ritonavir (250 mg twice/day) with or without a once-daily regimen of sofosbuvir
(400 mg) plus daclatasvir (60 mg) for 14
days.
Patient characteristics were as follows: sofosbuvir-daclatasvir group: median age 58 years, 61% male; SoC-only
group: median age 62 years, 42% male.
Fifty-two and 33% of patients in the sofosbuvir-daclatasvir and SoC groups, respectively, had diabetes, 36% and 33%,
respectively, had hypertension, and 23%
and 33%, respectively, were obese.
A greater proportion of sofosbuvir-daclatasvir compared with SoC-only
recipients achieved clinical recovery**
within 14 days of treatment, though
this was not significant (88% vs 67%;
p=0.076). Time to clinical recovery was
significantly shorter in the sofosbuvir-daclatasvir compared with the SoC-only
group (median 6 vs 11 days; p=0.041).
Duration of hospitalization was significantly shorter among patients who
received sofosbuvir-daclatasvir compared with SoC only (mean 6 vs 8 days;
p=0.029).
The need for mechanical ventilation
did not significantly differ between the
sofosbuvir-daclatasvir and SoC-only
groups (9% vs 21%; p=0.303).
More patients in the SoC-only than
sofosbuvir-daclatasvir group received
lopinavir/ritonavir (64% vs 33%; p=0.026).
“However, the outcomes in the
treatment group were balanced across
lopinavir/ritonavir administration,” said
Hannah Wentzel, a public health student
at Imperial College London, UK, who
presented the results at the COVID-19
conference organized by the International AIDS Society. In addition, corticosteroid administration (36% and 24%
of sofosbuvir-daclatasvir and SoC-only
recipients, respectively) did not predict
clinical recovery outcomes, she said.
No adverse events were reported.
There were three deaths in the sofos-
buvir-daclatasvir group and five in the
SoC-only group.
The researchers also conducted a
meta-analysis combining this trial and
two others in Abadan and Sari, Iran,
with a total of 176 patients. The trial in
Abadan was not randomized and consecutive patients received hydroxychloroquine with either sofosbuvir-daclatasvir
or lopinavir/ritonavir plus ribavirin***. In
the Sari study, patients received either
sofosbuvir-daclatasvir plus ribavirin or
hydroxychloroquine ± lopinavir/ritonavir.
In the pooled analysis, median age
of patients was 57 and 61 years in
the sofosbuvir-daclatasvir and control
arms, respectively, and 52% and 42%,
respectively, were male. Time to discharge from hospital was improved in
the sofosbuvir-daclatasvir compared
with the control arm (subhazard ratio, 2.03; p<0.001). Meta-analysis
showed a reduction in mortality risk with
sofosbuvir-daclatasvir vs SoC.
“Other viral families share similar replication mechanisms to SARS-CoV-2.
Therefore, existing nucleotide and nucleoside analogues are being investigated as potential COVID-19 therapies,”
said Wentzel.
“Sofosbuvir-daclatasvir is associated
with faster discharge from hospital and
improved survival in this combined analysis of three trials,” she added. However,
limitations include the small sample size
and lack of viral load data. The results will
be confirmed in the larger, double-blind,
placebo-controlled, randomized DISCOVER trial, results of which are anticipated in September, she said.
*
**
SoC at time of trial
normalization of fever (<37.2°C [oral]), respiratory
rate ≤24 per minute on room air, oxygen saturation
≥94% on room air for ≥24 hours
*** change in SoC following change in national
treatment guidelines
15
NOVEMBER/DECEMBER ISSUE
FROM ABROAD [COVID-19 UPDATES]
Corticosteroids do not avert mortality in
severe, critical COVID-19 patients
Stephen Padilla
U
se of systemic corticosteroids
does not reduce in-hospital mortality for patients with
severe or critical coronavirus disease
(COVID-19), in stark contrast to observations from the RECOVERY clinical trial,
according to a study in Wuhan, China.
“Absence of the beneficial effect in
our study in contrast to that was observed in the clinical trial may be due to
biases in observational data, in particular
confounding by indication bias, differences in clinical characteristics of patients,
choice of corticosteroid used, or timing
of initiation of treatment and duration of
treatment,” the researchers said.
A total of 1,514 severe and 249 critical
hospitalized COVID-19 patients from two
medical centres in Wuhan were included
in this study. The researchers assessed
the association of corticosteroid use with
the risk of in-hospital mortality in severe
and critical cases using multivariable Cox
models, Cox model with time-varying
exposure and propensity score analysis
(inverse-probability-of-treatment-weighting [IPTW] and propensity score matching [PSM]).
Among hospitalized patients, 531
(35.1%) with severe and 159 (63.9%) with
critical COVID-19 received corticosteroids. Compared to nonuse, use of systemic corticosteroid was not associated
with reductions in in-hospital mortality
in either severe (hazard ratio [HR], 1.77,
95% confidence interval [CI], 1.08–2.89;
p=0.023) or critical cases (HR, 2.07,
95% CI, 1.08–3.98; p=0.028). [J Clin Endocrinol Metab 2020;105:dgaa627]
Time-varying Cox analysis showed
similar results. Furthermore, corticosteroid use in patients with severe COVID-19
at admission resulted in neither improved
nor harmful outcome in either PSM or
IPTW analysis. Findings for critical patients at admission were consistent in
multivariable Cox model analysis.
Several reasons explain why these
results conflict with those from the RECOVERY trial, according to the researchers. First, the baseline conditions of
patients were different between treated
and untreated cases due to the retrospective and nonrandomized nature of
the current study.
Second, prednisone was used by
most patients in this study as opposed to
dexamethasone. Although both agents
are glucocorticoids, dexamethasone is
four to five times more potent than prednisone and >20 times more potent than
naturally occurring hormone cortisol. [N
Engl J Med 2005;353:1711–1723]
Finally, durations and doses of corticosteroid therapy were different between
the two studies. In the current analysis,
dexamethasone 7.5 mg was initiated
at the onset of severe illness for a median of 5 days. In the RECOVERY trial,
dexamethasone 6 mg was administered
for 7 days.
“The rationale for corticosteroid use
includes its potential role in suppressing
inflammatory storm, reducing inflammatory exudation, and preventing multiple
16
organ injuries in acute respiratory failure,”
the researchers said. “However, its multifaceted negative impacts on prognosis
should not be overlooked.”
In other recent studies, the viral load
of SARS-CoV-2, the causative agent of
COVID-19, significantly exacerbated the
severity of the disease. Corticosteroids
may suppress immunity and promote
virus replication, further worsening prognosis. [Sci China Life Sci 2020;63:364374; BMJ 2014;348:g1721]
“Our results showed that median lymphocyte count remained low during the
use of systemic corticosteroids, which
might lead to a higher risk of superinfections,” the researchers said. “Systemic
corticosteroids could also induce hyperglycaemia, which was shown to be an independent risk factor for the prognosis of
infection and critically ill patients.” [J Clin
Endocrinol Metab 2015;100:4490–4497;
Crit Care Med 2020;48:e115–e122; Diabetes Metab J 2013;37:385–390]
Use of corticosteroids was also associated with complications in the elderly population. In the present cohort,
the median age of severe and critical
COVID-19 patients was 61.0 and 68.0
years, respectively. [Gastroenterology
2014;147:784–792.e9; Ann Intern Med
2004;141:764–770]
NOVEMBER/DECEMBER ISSUE
EMPOWERING
HEALTHCARE
COMMUNITIES
FROM ABROAD [COVID-19 UPDATES]
COVID-19 in hospitals: Toilets, staff, public areas
show contamination
Pearl Toh
W
ith much remains controversial regarding the possible
transmission route of the
SARS-CoV-2 virus, a study reveals yet
another surprise worthy of caution in the
hospital setting.
The review presented during the ESCMID* Conference on Coronavirus Disease (ECCVID) showed high level of viral
load in the air surrounding COVID-19 patients, toilets, as well as staff and public
areas in hospitals. [ECCVID 2020, abstract 00757]
Based on 17 papers included in the
review, more than a quarter (27.5%) of
the air sampled from enclosed hospital
environment around COVID-19 patients
tested positive for SARS-CoV-2 RNA, regardless of whether it was in the intense
care unit (ICU; 27/97, 27.8%) or non-ICU
settings (41/150, 27.3%).
Of the 67 air samples collected less
than 1 metre away from the patient, only
one (1.5%) turned out positive SARSCoV-2. For air sampled at a distance of
1–5 metres away from the cases, 6%
(4/67) were positive for SARS-CoV-2.
This implies few infectivity of the air
surrounding patients with COVID-19, according to Dr Gabriel Birgand, University
Hospital Centre Nantes, France.
However, in other areas within the
hospitals such as patient toilets, the
rate of positivity for SARS-CoV-2 was
23.8% of the 21 toilets tested, and hit as
high as 34.1% (14/41) in public areas in
hospital settings.
Of note, the median SARS-CoV-2
RNA concentration in patient toilets was
10 times higher than the samples collected from the patients’ rooms.
For staff areas and clinical sites,
SARS-CoV-2 contamination was found
in 15 of 121 samples (12.4%) and 20 of
221 samples (9.5%), respectively.
As detection of SARS-CoV-2 RNA
does not necessarily mean the virus is
viable, the researchers also compared
results of viral cultures from these areas.
Among the 78 viral cultures performed, three showed viable SARSCoV-2 virus (4%)—with all of these
sourced from enclosed patient environments in non-ICU settings (3/39, 7.7%).
“In hospital, the air near COVID-19
patients is frequently contaminated
with SARS-CoV-2 RNA, with however,
poor proof of its infectivity—meaning we
detected the viral RNA, but when trying
to culture these samples, there was little evidence of viable virus,” pointed out
Birgand.
“High viral loads found in toilet/bathrooms, staff and public hallways means
these areas require strong compliance
with cleaning measures and personal
protective equipment [PPE],” he added.
As Birgand explained, these findings
support the current recommendations
18
for PPE—that surgical facemask is efficient for preventing transmission from
patient to healthcare workers in most
settings, except in aerosol generating
procedures whereby protection class
respirators FFP2 are required.
For the review study, Birgand and
team identified 2,034 published literature
on air contamination by COVID-19 in
the hospital settings—of which, 17 met
the eligibility criteria for inclusion. The
contamination rate indicated by SARSCoV-2 viral RNA was compared across
different hospital settings, clinical context, distance from patient, and air ventilation system.
The study also corroborates what
was observed previously in environmental sampling from three hospital rooms
of COVID-19 patients in National Centre for Infectious Diseases, Singapore,
which showed contamination in toilet
bowls and air exhaust outlets. Samples
taken after disinfection measures turned
out negative, which highlights the importance of routine cleaning. [JAMA
2020;323:1610–1612]
*
ESCMID: European Society of Clinical Microbiology
and Infectious Diseases
NOVEMBER/DECEMBER ISSUE
FROM ABROAD [COVID-19 UPDATES]
Viral shedding from asymptomatic COVID-19
patients may be prolonged
Pearl Toh
N
ot only do asymptomatic
COVID-19 carriers have viral
loads that are similar to symptomatic patients, they could remain asymptomatic for a prolonged period of
median 24 days from diagnosis, reveals
a study.
Hence, viral shedding could also be
prolonged in asymptomatic people—
sparking concerns on potential transmissibility of asymptomatic infections.
Among 303 patients (median age
25 years, 66.3% women) who tested positive for SARS-CoV-2 by RTPCR, about one-third (36.3%) were
asymptomatic at diagnosis. [JAMA
Intern Med 2020;doi:10.1001/jamainternmed.2020.3862]
Of note, 84.6% of the asymptomatic
patients remained so for a median of 24
days from diagnosis.
Despite being asymptomatic, these
patients carried similar viral loads as
those who were symptomatic, as indicated by Ct values of RT-PCR tests.
respectively, showed negative conversion at day 14. The corresponding negative conversion rates at day 21 were
75.2% and 69.9%, respectively.
However, viral loads of asymptomatic
patients tended to decline more slowly
than symptomatic patients, with respect
to the envelope (env) gene of SARSCoV-2 detected from lower respiratory
tract specimens (β=−0.065; p=0.005 for
time interaction).
“It is important to note that detection
of viral RNA does not equate infectious
virus being present and transmissible,”
cautioned the researchers.
Meanwhile, the drop in other genetic
segments encoding for viral nucleocapsid protein and RNA-dependent RNA
polymerase were not significantly different between asymptomatic and symptomatic patients.
The median time to negative conversion among asymptomatic patients
was 17 days compared with 19.5 days
in symptomatic patients (p=0.07). At
14 days, 33.7% and 29.6% of asymptomatic and symptomatic patients,
Viral loads of
asymptomatic
patients tended to
decline more slowly
than symptomatic
patients.
Even so, the results do not support
the notion that infected individuals without symptoms are less likely to spread
or be cleared of the virus sooner than
symptomatic patients.
“An important implication of our
findings is that there may be substantial
under-reporting of infected patients using the current symptom-based surveillance and screening,” the researchers
highlighted.
“Many individuals with SARS-CoV-2
infection remained asymptomatic for
a prolonged period ... [and thus,] viral
molecular shedding was prolonged,”
they noted. “Because transmission by
asymptomatic patients with SARSCoV-2 may be a key factor in community
spread, population-based surveillance
and isolation of asymptomatic patients
may be required.”
As the study cohort involved young,
healthy patients, the researchers said the
findings should not be generalized to the
whole population at large. Another limitation was that the role of molecular viral
shedding in transmission from asymptomatic patients is also unknown.
19
NOVEMBER/DECEMBER ISSUE
FROM ABROAD
Pharmacist-led audit/feedback intervention
improves medication safety
Stephen Padilla
T
he pharmacist-led Safety Medication dASHboard (SMASH)
intervention has resulted in reduced rates of potentially hazardous
prescribing and inadequate blood-test
monitoring in general practices during
the first 24 weeks after initiation, a study
has shown. The reduction is sustained
at 12 months for prescribing but not for
monitoring.
“There were substantial differences in
rates of potentially hazardous prescribing
between practices prior to the intervention, and there was a marked reduction
in the variation between practices over
the 12-month follow-up period,” the researchers said.
SMASH was implemented in 43 general practices covering a population of
235,595 people in Salford, UK, and included the following components: training of clinical pharmacists to deliver the
intervention; a web-based dashboard
providing actionable, patient-level feedback; and pharmacists reviewing individual at-risk patients and initiating remedial
actions or advising general practitioners
on doing so.
The intervention was initiated between 18 April 2016 and 26 September 2017. The researchers used an interrupted time series analysis of rates
(prevalence) of potentially hazardous
prescribing and inadequate blood-test
monitoring to compare observed postintervention rates to extrapolations from a
24-month preintervention trend.
A total of 47,413 (mean age, 60
years; 48.7% males) individuals were
registered to participating practices and
had one or more risk factors for being exposed to hazardous prescribing or inadequate blood-test monitoring at the start
of the intervention.
Ninety-five percent of practices at
baseline had rates of potentially hazardous prescribing (composite of 10
indicators) between 0.88% and 6.19%.
The prevalence of potentially hazardous prescribing decreased by 27.9%
(95% confidence interval [CI], 20.3%–
36.8%; p<0.001) and by 40.7% (95%
CI, 29.1%–54.2%; p<0.001) at 24
weeks and at 12 months after intervention initiation, respectively. [PLoS Med
2020;17:e1003286]
For inadequate blood-test monitoring
(composite of two indicators), the rate
reduction was 22.0% (95% CI, 0.2%–
50.7%; p=0.046) at 24 weeks and nonsignificant at 12 months (23.5%, 95% CI,
–4.5% to 61.6%; p=0.127).
The rates of potentially hazardous prescribing stood between 0.74%
and 3.02% for 95% of practices after
12 months.
Previous studies showed how general practice-based pharmacists improved
integrated patient care and how they
could deliver clinical interventions efficiently and in high volume. [Int J Pharm
Pract 2018;26:501–506; Res Social
20
Adm Pharm 2018;14:228–240]
“Our study demonstrates how these
pharmacists can also play a key role in
sustainably improving medication safety
in general practice and reducing variation
in potentially hazardous prescribing between practices,” the researchers said.
“However, for this to be effective, it
is imperative to have an underpinning
‘learning health systems’ capability
for continuous data-driven self-study
that promotes change and improvement,” they added. [Yearb Med Inform
2017;26:16–23]
Such capability requires a digital infrastructure for continuous, patient-level feedback that allows practitioners
to identify high-risk patients, access
educational materials, and compare
rates of high-risk prescribing and monitoring both between practices and within
their practice over time, according to the
researchers.
The current study was limited by the
nonrandomization of practices, leading
to potential unmeasured confounding of
the findings, they noted.
NOVEMBER/DECEMBER ISSUE
FROM ABROAD
Antibiotics may raise risk of appendicitis in
children, teens
Jairia Dela Cruz
K
ids and teens exposed to antibiotics risk developing appendicitis, and this risk is dictated
by the frequency of exposure, a study
has shown.
“At first sight, we observed a higher
risk of appendicitis among children exposed to antibiotics early in life, but after
adjustment for the number of antibiotic
courses, this apparent association disappeared,” according to investigators.
“Therefore, our results suggest that it
is not early exposure but rather repeated
exposure that is important. To our knowledge, no previous study has examined
antibiotic exposure and subsequent risk
of developing appendicitis,” they added.
Accordingly, a potential
underlying mechanism
explaining our results
is reverse causality:
some children might
have been prescribed
antibiotics to treat
an undiagnosed
appendicitis.
The analysis included a paediatric cohort of 1,385,707 children aged
0–19 years, with 7,406,397 antibiotic
prescriptions dispensed over a mean
follow-up of 10.1 years. Most of the children (84.1%) received at least one prescription (mean, 4), with penicillin being
the most prescribed antibiotic (80.0%).
There were 11,861 cases of appendicitis documented, occurring at
a mean age of 9.8 years. Poisson and
logistic regression models showed that
compared with nonexposure, receipt of
at least one course of antibiotics conferred about a 70% increase in the risk of
developing appendicitis (adjusted rate
ratio [RR], 1.72, 95% confidence interval [CI], 1.61–1.85). [Aliment Pharmacol
Ther 2020;doi:10.1111/apt.16084]
Notably, the risk increased by 1.04fold (95% CI, 1.04–1.04) per antibiotic course, with the highest risk seen in
children who had received at least seven
courses of antibiotics (RR, 2.02, 95% CI,
1.87–2.18).
“Antibiotics have extensive effects
on the composition, diversity, and function of the gut microbiota, and some
studies have shown bacterial dysbiosis
in the appendix to be a potential risk
factor in development of appendicitis,”
the investigators noted. [Microbiology
2010;156:3216–3223; Nat Microbiol 2018;3:1255–1265; Nat Commun
2016;7:10410]
However, they acknowledged that
despite the dose-dependent associa-
21
tion between antibiotics and appendicitis
risk, suggesting that the drugs may be
causally involved, causality cannot be
inferred from the current observational
study.
“Accordingly, a potential underlying mechanism explaining our results is
reverse causality: some children might
have been prescribed antibiotics to treat
an undiagnosed appendicitis,” the investigators claimed.
It is also possible that the use of antibiotics may have been overestimated
because of the possibility of filled but unused prescriptions, they added.
The investigators called for further
research to establish the causal involvement of antibiotics in developing appendicitis or whether some children are
more susceptible to bacterial infections,
including appendicitis, and therefore
have a high exposure to antibiotics.
NOVEMBER/DECEMBER ISSUE
FROM ABROAD
Rheuma drug shows disease-modifying
potential for T1D
Audrey Abella
F
indings from the phase IIa T1GER
study revealed the therapeutic
potential of the monoclonal antibody golimumab for children and young
adults with type 1 diabetes (T1D).
“There are no approved disease-modifying therapies for T1D,” said
Dr Teresa Quattrin from the Jacobs
School of Medicine and Biomedical Sciences, University of Buffalo in New York,
US, during her presentation of the initial
results. “[As such,] there is a significant
need for therapies that slow the progression of T1D autoimmunity and disease,”
noted Dr Eric Felner from the Emory
University School of Medicine in Atlanta,
Georgia, US, in his poster presentation of
the subgroup findings.
Golimumab
specifically
targets
TNFα*, a pro-inflammatory cytokine influencing T1D initiation and progression,
and is approved for the treatment of
rheumatic diseases**.
The team sought to determine the
role of golimumab in T1D. Eighty-four
participants (mean age 14 years, 60%
male) were randomized 2:1 to receive SC
golimumab*** or placebo for 52 weeks.
[EASD 2020, abstract 53]
function and prevent
possible complications in individuals
with T1D.
Although HbA1c
was
numerically
lower with golimumab vs placebo, the difference
was not significant
(p=0.80). “As often
observed in clinical
trials, an initial decline in HbA1c was
observed in both groups over the first 4
weeks. But over time, HbA1c appeared
to be lower with golimumab vs placebo,”
noted Quattrin.
Increase in daily insulin use was
lower with golimumab vs placebo (0.07
vs 0.24 U/kg; p=0.001), as was the
absolute amount of insulin used (0.51 vs
0.69 U/kg).
Also, more golimumab vs placebo
recipients were using a daily insulin dose
of <0.5 U/kg (n=21 vs 3) and ≤0.25 U/kg
(n=7 vs 0). “[These suggest] that golimumab provides optimal glycaemic control
with low insulin dose,” said Quattrin.
At week 52, C-peptide area under the
curve (AUC) after a 4h MMTT# was higher with golimumab vs placebo (mean,
0.64 vs 0.43 pmol/mL; p<0.001). “[The]
C-peptide change … started at week 12
and persisted throughout the study,” said
Quattrin.
There were also more golimumab vs
placebo recipients who had C-peptide
increase or minimal loss (41% vs 11%),
who were in partial remission (IDAA1c##
remission score <9; 43% vs 7%), or both
(29% vs 4%). “These suggest that golimumab may be arresting disease progression for a large subset of patients,” noted
Quattrin.
C-peptide is a widely used measure
of pancreatic β cell function, with low
levels suggesting diabetes-related complications. [Diabetes Ther 2017;8:475–
487; Diabetes Med 2015;32:1346–1353]
Therefore, this finding underscores the
potential of golimumab to preserve β cell
The rates of serious adverse events
(AEs; 2% vs 4%) and drug-related AEs
(43% in each arm) were similar between
the golimumab and the placebo arms.
Treatment discontinuation rate owing to
AEs was higher with golimumab vs placebo (4% vs 0%), as was the incidence
22
of hypoglycaemia reported at investigator’s discretion (23% vs 7%).
In a subgroup of participants aged
6–17 years (n=68), golimumab use led
to a significantly less change in C-peptide AUC (mean, 0.11 vs 0.55 pmol/mL;
pnominal<0.0001), less increase in insulin use (0.06 vs 0.27 U/kg/day; pnominal =0.0004), lower absolute insulin use
(0.53 vs 0.74 U/kg/day), and numerically
lower hypoglycaemic event rates (42%
vs 48%) vs placebo. [EASD 2020, abstract 631]
“[Taken together, the findings]
demonstrate the ability [of golimumab] to
preserve endogenous insulin production,
reduce exogenous insulin requirements,
and improve clinical and metabolic parameters in children and young adults
with newly diagnosed stage 3 T1D …
These results support golimumab as a
potential disease-modifying therapy for
T1D,” said Quattrin. Further evaluation is
warranted to validate the findings.
* TNFα: tumour necrosis factor alpha
** Rheumatoid arthritis, nonradiographic axial
spondyloarthritis, polyarticular juvenile idiopathic
arthritis
*** Induction doses (weeks 0 and 2): 60 and 100 mg/
m2 for participants weighing <45 kg and ≥45 kg,
respectively; maintenance doses (week 4 and every
2 weeks thereafter): 30 and 50 mg/m2, respectively
# 4h MMTT: 4-hour mixed-meal tolerance test
## IDAA1c: insulin dose-adjusted A1c
NOVEMBER/DECEMBER ISSUE
EMPOWERING
HEALTHCARE
COMMUNITIES
Bringing your
trusted source of
pharmacy news
into the future.
Keep up with the latest in local and
international news and views in our
bi-monthly online magazine for the
pharmacy community.
Sign up for free at www.mims.com/malaysia
for email updates, or download our digital issues at
https://specialty.mims.com/pharmacy
FROM ABROAD
Cranberry juice a potential treatment
for H pylori infection?
Pearl Toh
C
onsuming cranberry juice twice
daily for 8 weeks can help suppress Helicobacter pylori infection among Chinese adults, suggests
a randomized study—thus opening
the door to using cranberry juice as a
complementary approach to H. pylori
management.
Despite the availability of effective
treatment with triple or quadruple antibiotics, treatment failure still occurred in
10–30% of patients and increasing antibiotic resistance may pose a challenge.
"The study findings reveal that cranberry juice may be a useful aid in H. pylori management in adults in a high-risk
region of China with an endemic infection rate of over 50%,” said principal investigator Professor Pan Kai-Feng from
Peking University Cancer Hospital & Institute, Beijing, China.
“While not alternatives to antibiotics,
effective complementary strategies, like
cranberry, that can contribute to managing H. pylori infections without negative side effects are highly desirable,”
he added.
while 93.15% of the patients receiving
placebo remained positive for H. pyloriinfection in the intention-to-treat population (p=0.021).
Similar results were seen in the
per-protocol analysis, whereby the infection rate was significantly lower in the
high-dose group compared with the placebo group (80.0% vs 92.65%; p=0.012).
On the other hand, lower doses of
proanthocyanidin-containing cranberry
juice did not have an effect on H. pyloriinfection. The proportion of patients who
remained positive for H. pylori infection
in the low- and medium-dose groups
were similar as the placebo group
(~92%–95%).
Among the participants who were
tested negative at 8 weeks, 75% of
them remained free of infection when
they were retested 45 days after the end
of intervention.
The beneficial effect of cranberry juice may be attributed to the active
phenolic compound proanthocyanidin, which can prevent bacteria from
adhering to the stomach lining, according to the researchers.
“Cranberry proanthocyanidins do
not appreciably degrade under the highly acidic conditions in the stomach, allowing them to maintain bioactivity,” explained Pan and co-authors.
After 8 weeks,
the high-dose
intervention led to an
almost 20% drop in H.
pylori infection rate.
In addition, the effects of powder formulation of proanthocyanidin were also
tested. However, the powder form did
not have significant effect on H. pylorisuppression.
“In situations where antibiotic treatment of H. pylori is warranted but resistance to antibiotics is reducing H. pylori
eradication rates, concurrent administration of cranberry might help improve
treatment outcomes,” the researchers
suggested.
The double-blind trial randomized
522 adults (mean age 47.24 years,
44.40% male) who were tested positive for H. pylori to receive any one of
three doses (low, medium, high) of
proanthocyanidin-standardized
cranberry juice or placebo for 8 weeks.
Proanthocyanidin is the active phenolic
compound found in cranberry. H. pylori infection was tested using 13C-urea
breath testing. [J Gastroenterol Hepatol
2020;doi:10.1111/jgh.15212]
After 8 weeks, the high-dose intervention (juice containing 88 mg proanthocyanidin) led to an almost 20% drop
in H. pylori infection rate to 82.43%,
24
NOVEMBER/DECEMBER ISSUE
FROM ABROAD
Turmeric extract may help relieve pain
in knee OA
Pearl Toh
T
urmeric extract supplements
can help reduce knee pain associated with knee osteoarthritis, although there are no changes in
knee effusion-synovitis or cartilage composition, a study suggests.
“[So far, there is] no approved disease-modifying drugs currently are available to treat osteoarthritis,” said the researchers.
The current treatment strategies such
as NSAID and acetaminophen not only
produce low to moderate effect on easing pain and do not slow structural progression, they are also associated with
multiple side effects, they pointed out.
Multicentre trials
with larger sample
sizes are needed to
assess the clinical
significance of these
findings.
In the double-blind, single-centre
study, 70 participants (mean age 62
years) with symptomatic knee osteoarthritis and effusion-synovitis on ultrasonography were randomized 1:1 to receive two capsules containing turmeric
extract 1,000 mg daily or a matching
placebo for 12 weeks. [Ann Intern Med
2020;doi:10.7326/M20-0990]
After 12 weeks, turmeric extract led
to significant improvement in the primary outcome of knee pain assessed on a
visual analogue scale (VAS) compared
with placebo (mean, -23.8 vs -14.6 mm;
difference, -9.1 mm; p=0.039).
Knee pain assessed by WOMAC*
was also significantly improved in the
turmeric group vs the placebo group
(mean -84.2 mm vs -37.0 mm; difference, -47.2 mm; p=0.006).
However, there were no significant
changes in the coprimary outcome of effusion-synovitis volume between the two
groups (difference, 3.2 mL; p=0.075).
T2 relaxation time of the lateral femoral cartilage on MRI was also comparable
among patients who received turmeric
extract vs placebo (difference, -0.4 ms;
p=0.30).
“The effect on pain was only moderate; however, it was achieved without any effect on knee structural measures assessed by MRI,” observed the
researchers.
Post hoc analyses revealed that pain
reductions were reported in patients
who had a lower effusion-synovitis volume at baseline but not in those with a
higher volume.
“[This] is an important hypothesis-generating finding. A possible explanation is that participants with a higher
effusion-synovitis volume may have more
severe disease,” said the researchers.
*
“[In addition,] we did not find any
difference in the number of reported
adverse events between groups, indicating that [turmeric extract] was safe
and modestly effective in treating osteoarthritis in this short-term study,” they
added.
Adverse events (AEs) occurred at
comparable rates in the two groups,
with 39% of patients receiving turmeric extract and 53% of those on placebo experiencing at least one AE of any
grade (p=0.16). Two of the AEs in the
turmeric group and five in the placebo
group were considered to be possibly
related to treatment.
One limitation of the study was the
relatively short duration spanning just 12
weeks, which might not be sufficient to
detect structural changes. As the treatment effect on pain had yet to plateau
at the end of the study, the researchers
believed that treatment effect may be
greater with longer duration.
“Multicentre trials with larger sample
sizes are needed to assess the clinical significance of these findings,” they
suggested.
WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index
25
NOVEMBER/DECEMBER ISSUE
FROM ABROAD
New evidence backs safety of low-dose
aspirin in women attempting pregnancy
Jairia Dela Cruz
D
aily use of low-dose aspirin
(LDA) among women of reproductive age appears to have no
harmful effect on menstrual cycle length
and hormone patterns, as shown in a
study.
Given the potential uses of daily LDA
in women—including reducing the risks
of stroke and cardiovascular disease,
colon cancer, and obstetrical complications such as pre-eclampsia, foetal
growth restriction, pregnancy loss, and
preterm birth—the present data reassure
those wanting to get pregnant that “LDA
is unlikely to adversely affect their menstrual cycles,” according to investigators.
“LDA may have further benefits in
human reproduction by improving uterine and ovarian blood flow, enhancing
embryo implantation and placental invasion, and sustaining early pregnancy. Indeed, we previously observed in
the Effects of Aspirin in Gestation and
Reproduction (EAGeR) trial that preconception LDA [use] in women with a
single recent pregnancy loss was associated with higher rate of live birth
compared with placebo,” they added.
[J Clin Endocrinol Metab 2017;102:86–
92; Lancet 2014;384:29–36]
In the current study, the investigators
performed a secondary analysis of the
EAGeR trial, which included 915 women
(mean age, 29 years; mean body mass
index, 26 kg/m2) with regular periods
who had been randomized to receive 81mg aspirin (n=452) or placebo (n=463)
daily in addition to 400 mg folic acid. Participants were followed for six menstrual
cycles or through pregnancy.
There were no significant between-group differences observed in
menstrual cycle length and follicular
and luteal phases. LDA did not confer a
greater risk of having a short (relative risk
[RR], 1.02) or long follicular phase length
(RR, 1.01), short (RR, 1.02) or long cycle
length (RR, 0.97), and short (RR, 1.23)
or long luteal phase length (RR, 1.03).
[Fertil Steril 2020;doi:10.1016/j.fertnstert.2020.06.022]
Furthermore, hormone levels during
the first two cycles were similar in the
LDA and placebo groups.
“Our results are consistent with one
study evaluating serum hormone concentrations that also found no association between over-the-counter aspirin
taken for one or two menstrual cycles
and E2, luteal progesterone, follicle-stimulating hormone, and luteinizing hormone,” the investigators noted. [Gynecol
Obstet Invest 1985;19:32–37; Hum Reprod 2015;30:1714–1723]
Meanwhile, the discrepancies in
menstrual cycle length seen in several other studies are likely related to differences in aspirin dose and duration
of use, they added. [Contraception
1984;29:181–188; J Clin Endocrinol Metab 2017;102:86–92; Gynecol Obstet
Invest 1985;19:32–37]
In an editorial piece, Dr Jennifer Eaton, of the Women and Infants
26
Hospital and Warren Alpert Medical
School of Brown University, Rhode
Island, US, said that the study is
strengthened by its randomized, placebo-controlled design and its large
study population, and the findings may
be used to counsel women on the use
of LDA. [Fertil Steril 2020;doi:10.1016/j.
fertnstert.2020.08.018]
Eaton emphasized that normal cycle
parameters and hormone levels do not
necessarily mean normal fertility. Therefore, couples who fail to conceive based
on the duration of unprotected intercourse should still undergo the standard
fertility evaluation.
“Finally, women who present with cycle irregularity while taking LDA should be
evaluated to determine the aetiology. Despite biologic plausibility, the hypothetical
impact of LDA on menstrual cyclicity is
not supported by the data presented in
this well-designed study,” she added.
Eaton also pointed out some important limitations to the study. Among these
are the inclusion of only normally cycling
women, which limits data extrapolation
to women with short or long cycles, and
the use of urinary samples rather than
serum samples, which could have influenced the results.
NOVEMBER/DECEMBER ISSUE
EVENT CALENDAR
NOVEMBER
APRIL 2021
APRIL 2021
FRIDAY–SUNDAY
FRIDAY–SUNDAY
SUNDAY–TUESDAY
27-29
Malaysian Society of
Gastroenterology and
Hepatology Annual Scientific
Meeting (Virtual GUT 2020)
Location: Virtual Conference
Tel: 03 8996 0700 / 1700 / 2700
Fax: 03 8996 4700
Email: [email protected]
Website: www.msgh.org.my
2-4
National Heart Association of
Malaysia Congress 2021 (NHAM
Congress 2021)
Location: Kuala Lumpur Convention Centre
Info: NHAM Congress Secretariat
Tel: 03 7931 2131
Website: www.nham-conference.com
4-6
Asia-Oceania Conference
on Obesity and Malaysian
Association for the Study of
Obesity Scientific Conference
(AOCO-MASO 2021)
Location: Hotel Istana, Kuala Lumpur
Info: Conference Secretariat
Tel: 03 9769 2471
Email: [email protected]
Website: www.aocomaso2021.com
APRIL 2021
JULY–AUGUST 2021
AUGUST 2021
TUESDAY–SATURDAY
THURSDAY–SUNDAY
TUESDAY–THURSDAY
6-10
Federation of Asian
Pharmaceutical Associations
(FAPA) Congress 2020
Location: KL Convention Centre
Info: FAPA Secretariat
URL: www.facebook.com/FAPA2020
AUGUST 2021
19-22
THURSDAY–SUNDAY
Asia Pacific Digestive Week
(APDW) 2021
Location: Kuala Lumpur Convention Centre
Info: Malaysian Society of Gastroenterology
& Hepatology (MSGH)
Email: [email protected]
URL: www.apdwkl2021.org
29-1
11th Malaysian Endocrine &
Metabolic Society (MEMS)
Annual Congress (MAC 11)
Location: TBC
Info: Congress Secretariat
Tel: (03) 7931 2856
Email: [email protected]
URL: www.memsmac.org
TBC
MPS Northern Region
Pharmacists Convention (NRPC)
2020 & MPSKP Annual General
Meeting
Location: AIMST University, Kedah
Info: Malaysian Pharmaceutical Society
Kedah/Perlis Area (MPSKP)
URL: facebook.com/MPSKPArea
17-19
Asian Symposium on Medicinal
Plants and Spices (ASOMPS) XVII
Location: Zenith Hotel, Putrajaya
Info: Malaysian Natural Products Society
(Prof Dr Faridah Abas)
Email: [email protected]
URL: asompsxvii.org
TBC
11th National Pharmacy R&D
Conference 2020
Location: TBC
Info: Pharmaceutical Research &
Development Branch, Pharmacy Policy
& Strategic Planning Division, Ministry of
Health (MOH)
URL: research.pharmacy.gov.my/
rndconf2020
To notify us of any events of interest to pharmacists, please submit details to [email protected]
28
NOVEMBER/DECEMBER ISSUE