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Cardiovascular Medicine - Arrhythmias

Midodrine for recurrent vasovagal syncope (November 2021)


Vasovagal syncope, the most common type of syncope, can be recurrent in some individuals; no therapy has been found to be consistently effective. In a recent trial that randomly assigned over 130 patients with recurrent vasovagal syncope to the vasoconstrictor midodrine or placebo, midodrine reduced the risk of recurrent syncope at one year, and adverse effects were similar between the groups.2 For patients with recurrent vasovagal syncope despite general preventive measures who do not have an indication for permanent cardiac pacing, we suggest treatment with either midodrine or fludrocortisone.


Dermatology - Atopic Dermatitis and Other Dermatitis

Topical ruxolitinib for atopic dermatitis (October 2021)


Topical ruxolitinib, a Janus kinase (JAK) inhibitor, is a new short-term therapy for atopic dermatitis (AD). In two randomized trials that enrolled over 1200 adolescents and adults with mild to moderate AD (<20 percent of body surface area affected) not controlled by topical prescription medications, more individuals assigned to ruxolitinib cream (0.75% or 1.5%) achieved clear or almost clear skin and reduced pruritis with no increase in adverse effects compared with vehicle.3 Based on these findings, topical ruxolitinib has been approved by the US Food and Drug Administration for the short-term treatment of mild to moderate AD in immunocompetent individuals with the characteristics of the study participants. Although topical ruxolitinib appears promising, more data are needed regarding its systemic absorption and long-term safety before its use becomes routine.


Family Medicine - Adult General Internal Medicine

Cannabis edible product ingestion in US children (October 2021)


Concentrated edible cannabis (marijuana) products are popular for recreational use. Exploratory ingestions of these products in young children can cause severe toxicity including seizures, apnea, and coma. In a report from the United States National Poison Data System, cannabis edible product ingestions have significantly increased in children <5 years old, with over twice the rate of exposures from states where adult cannabis use is legal.4 These findings indicate an urgent need for education of adult cannabis users regarding the dangers that edible cannabis products pose to young children and for legislative efforts to prohibit cannabis product packaging and advertising that target children.


Allergy and Immunology - Asthma and COPD

Dupilumab for children >= 6 years old with moderate-to-severe asthma (November 2021)


Dupilumab, a monoclonal antibody that blocks interleukin (IL)-4 and IL-13 signaling, is now approved by the US Food and Drug Administration (FDA) for children 6 years of age and older with moderate-to-severe persistent asthma and eosinophilia or dependency on oral glucocorticoids. Approval is based upon trials in adolescents and adults and a single randomized trial in 408 children 6 to 11 years of age with moderate-to-severe asthma that showed a significant reduction in the annual rate of severe exacerbations requiring treatment with systemic glucocorticoids in children treated with dupilumab compared with placebo (rate ratio 0.35, 95% CI 0.22-0.56).1 Because dupilumab is also approved for use in selected children with moderate-to-severe atopic dermatitis (AD), it may be particularly useful in children with comorbid refractory asthma and AD.


1. Dupilumab [Context Link]


2. Sheldon R, Faris P, Tang A, et al Midodrine for the Prevention of Vasovagal Syncope: A Randomized Clinical Trial. Ann Intern Med 2021; 174:1349. [Context Link]


3. Papp K, Szepietowski JC, Kircik L, et al Efficacy and safety of ruxolitinib cream for the treatment of atopic dermatitis: Results from 2 phase 3, randomized, double-blind studies. J Am Acad Dermatol 2021; 85:863. [Context Link]


4. Whitehill JM, Dilley JA, Brooks-Russell A, et al Edible Cannabis Exposures Among Children: 2017-2019. Pediatrics 2021; 147. [Context Link]


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