You’ll find more of the latest studies relevant to primary care below. For a more comprehensive catalog of recent practice-changing trials, head over to Pathway!
📉 What is the role of ruxolitinib cream in patients with vitiligo?
The TRuE-V1 and TRuE-V2 trials (Oct 2022) compared ruxolitinib cream 1.5% BID to placebo for 24 weeks. These were two separate phase 3, double-blind, vehicle-controlled trials that included patients > 12 years of age with non-segmental vitiligo and depigmentation covering < 10% of total body surface area. The Vitiligo Area Scoring Index (VASI) was used to assess treatment response, with higher scores indicating greater areas of depigmentation.
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TRuE-V1 (n=330) showed a significantly greater proportion of patients achieving a decrease of > 75% in the facial VASI at 24 weeks (29.8% vs 7.4%; RR 4, 95% CI 1.9 to 8.4, NNT = 4) in the treatment group.
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TRuE-V2 (n=343) showed a significantly greater proportion of patients achieving decrease of > 75% in the facial VASI at 24 weeks (30.9% vs 11.4%; RR 2.7, 95% CI 1.5 to 4.9, NNT = 5) in the treatment group.
- Both trials also showed that treatment led to a significantly greater percentage of patients achieving a decrease of > 90% in the facial VASI and > 50% in total VASI at 24 weeks, with no significant difference in adverse events.
❤️ What is the long-term effect of intensive blood pressure control on mortality?
This secondary analysis of the SPRINT trial (Oct 2022, n=9361) compared intensive blood pressure control (goal systolic BP < 120 mmHg) to standard blood pressure control (goal systolic BP < 140 mmHg) in patients over age 50 with hypertension and increased cardiovascular risk. During the median intervention period of 3.3 years, there was a significant decrease in cardiovascular mortality (HR 0.66, 95% CI 0.49 to 0.89) and a borderline significant decrease in all-cause mortality (HR 0.83, 95% CI 0.68 to 1.01). This benefit disappeared after a median of 8.8 years of follow-up. Systolic blood pressure in the intensive treatment group increased from 133 mmHg at 5 years to 140 mmHg at 10 years.
🫁 What is the impact of morphine in patients with COPD and chronic breathlessness?
The BEAMS trial (Nov 2022, n=156) compared extended-release morphine (8 mg/day or 16 mg/day in week 1, followed by 8 mg/day in week 2) to placebo in adult patients with COPD and chronic breathlessness. There was no significant difference in the primary outcome of reduction in breathlessness score in the 8 mg/day group (0.8 vs. 0.7; AD 0.3, 95% CI -0.4 to 0.9) or in the 16 mg/day group (1.0 vs. 0.7, AD 0.3, 95% CI -0.4 to 1.0). There was also no significant difference in mean daily step counts between groups at 3 weeks.
💉 What is the impact of siRNA olpasiran on lipoprotein(a) levels?
The OCEAN(a)-DOSE trial (Nov 2022, n=281) was a randomized, dose-finding trial that compared different doses of olpasiran (10mg, 75mg or 225mg every 12 weeks or 225mg every 24 weeks) to placebo in adult patients with baseline lipoprotein(a) [Lp(a)] levels over 150 nmol/L. Most patients in the study were already taking a statin (88%) and/or ezetimibe (52%), and 23% were taking a PCSK-9 inhibitor.
There was a significant decrease in Lp(a) levels in patients treated with olpasiran compared to placebo (-70.5% for the 10 mg dose, -97.4% for the 75 mg dose, -101.1% for the 225 mg dose every 12 weeks, and -100.5% for the 225 mg dose every 24 weeks, p < 0.001 for all comparisons). There was no significant difference in adverse events across treatment groups, and the most common adverse event was injection site reaction.
🦠 What is the role of angiotensin receptor blockers in the treatment of COVID-19?
The CLARITY trial (Nov 2022, n=787) compared angiotensin receptor blockers (ARBs) to placebo in patients with severe COVID-19 requiring hospitalization. There was no significant difference on the WHO severity scale between groups at 14 days (OR 1.51, 95% CI 1.02 to 2.23). There was also no significant difference between groups at day 28. There was no significant difference in serious adverse events between groups.
