What's New
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Family Medicine - Adult Endocrinology and Diabetes
Diabetes drugs and cardiovascular outcomes in at-risk adults (November 2021)
In a meta-analysis of trials comparing a GLP-1 receptor agonist (eg, liraglutide, semaglutide), SGLT2 inhibitor (eg, dapagliflozin, empagliflozin), or DPP-4 inhibitor (eg, linagliptin, sitagliptin) with placebo in people with type 2 diabetes and established cardiovascular disease (CVD), GLP-1 receptor agonists and SGLT2 inhibitors reduced the risk of all-cause and cardiovascular mortality.2 GLP-1 receptor agonists also reduced the risk of fatal or non-fatal stroke, whereas SGLT2 inhibitors reduced the risk of heart failure hospitalizations. DPP-4 inhibitors did not reduce or increase any CVD outcomes. For patients with type 2 diabetes who are not achieving glycemic goals with metformin and in whom atherosclerotic CVD predominates, we typically add a GLP-1 receptor agonist to metformin. For similar patients in whom heart failure predominates, we typically add an SGLT2 inhibitor.
Dermatology - Psoriasis and other Papulosquamous Disorders
Topical tapinarof for psoriasis (December 2021)
Topical therapies play an important role in the treatment of psoriasis. In two identical phase 3 trials of tapinarof, an investigational topical aryl hydrocarbon receptor-modulating agent, a total of 1025 adults with chronic plaque psoriasis involving 3 to 20 percent of the total body surface area were randomly assigned to either tapinarof 1% cream or vehicle.3 At week 12, patients treated with tapinarof were more likely to achieve the specified level of response (clear or almost clear by the Physician Global Assessment with pre-specified improvement parameters) than patients in the vehicle groups (35 versus 6 percent in trial 1 and 40 versus 6 percent in trial 2). Adverse events of folliculitis, contact dermatitis, and headache occurred more frequently in the tapinarof groups. These findings support efficacy of tapinarof; however, additional study is necessary to confirm long-term efficacy and safety.
Allergy and Immunology - Drug Hypersensitivity
Identifying patients at high risk for true beta-lactam allergy (November 2021)
Allergy to penicillin is the most common drug allergy, but the majority of patients with this label are not actually allergic. In a retrospective study of 410 adults referred to drug allergy centers specifically for urticarial eruptions occurring in association with a beta-lactam antibiotic, three questions proved useful for identifying patients at high risk for true allergy:1
* Did the urticaria develop after the first dose (ie, dose 1) (versus after subsequent doses)?
* Did the urticaria develop within 1 hour of the inciting dose?
* Did the urticaria resolve within 1 day of stopping the beta-lactam in question?
Patients answering yes to all three questions (named the 1-1-1 criterion by the investigators) had a high risk of a positive allergy evaluation (PPV = 90 percent). Such patients should not be re-exposed to beta-lactams and should be referred to an allergy specialist if future beta-lactam use is deemed medically important.
1. Sabato V, Gaeta F, Valluzzi RL, et al Urticaria: The 1-1-1 Criterion for Optimized Risk Stratification in [beta] -Lactam Allergy Delabeling. J Allergy Clin Immunol Pract 2021; 9:3697. [Context Link]
2. Kanie T, Mizuno A, Takaoka Y, et al Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis. Cochrane Database Syst Rev 2021; 10:CD013650. [Context Link]
3. Lebwohl MG, Stein Gold L, Strober B, et al Phase 3 Trials of Tapinarof Cream for Plaque Psoriasis. N Engl J Med 2021; 385:2219. [Context Link]
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