Adding low dose theophylline to inhaled corticosteroids does not reduce COPD exacerbations
Taking low-dose theophylline tablets in addition to inhaled corticosteroids did not significantly reduce chronic obstructive pulmonary disease flare-ups (exacerbations). This NIHR funded study found that people taking the combination and those taking an inhaled steroid had the same number of exacerbations - just over two per year.
People who experience frequent exacerbations are often prescribed steroid inhalers to reduce inflammation of the airways. Theophylline also helps open up the airways,...
The benefits of commonly used blood pressure and cholesterol lowering treatment can last 16 years
Fewer deaths from stroke had occurred in people who had high blood pressure treated with amlodipine, a calcium-channel blocker, compared to atenolol, 10 years after the end of a large trial. People with high blood pressure who took statins were less likely to die from cardiovascular diseases, such as heart disease or stroke than those taking a placebo.
This study followed over 7,000 UK patients who had taken part in a clinical trial of blood pressure and cholesterol-lowering treatments between ...
Combining mirtazapine with other antidepressants is not effective for treatment-resistant depression
Adding mirtazapine to first-line antidepressants for adults with treatment-resistant depression does not improve symptoms when compared with placebo (dummy pills). People taking mirtazapine are more likely to experience side effects, and stop taking their treatment.
This NIHR-funded trial took place in 106 general practices in England, recruiting 480 adults with mild to severe depression. All participants had been taking selective serotonin reuptake inhibitor (SSRI) or serotonin-noradrenaline r...
Antidepressants do not help treat depression in people living with dementia
Antidepressants do not reduce symptoms of depression in people with dementia compared with placebo (dummy pills). Measured 6 to 13 weeks after starting the treatment, there is little or no difference in participants’ symptoms, but an increased chance of unwanted side effects. The review did not identify enough data to determine if antidepressants have an effect in the longer-term.
This Cochrane review included randomised controlled trials of any antidepressant drugs compared to placebo. P...
Home-based cardiac rehabilitation for heart failure has high rates of participation
Home-based cardiac rehabilitation for people with heart failure improves quality of life at 12 months compared with usual care. Among those allocated to rehabilitation, 90% remained in the programme – more than double average attendance rate for hospital-based rehabilitation. The average cost was estimated at £418 per participant which is within the National Health Service tariff for cardiac rehabilitation in England of £477 per patient.
This NIHR-funded trial included 216 par...
Thyroid hormone treatment does not help adults with mildly abnormal thyroid tests
There appears to be no benefit from treating adults with subclinical hypothyroidism. Treatment has no effect on quality of life or symptoms compared with placebo or no treatment.
Thyroid function tests are commonly performed in general practice for patients who present with a range of symptoms, including fatigue or tiredness. When subclinical hypothyroidism is detected, there is uncertainty whether treatment is worthwhile or how to best monitor success. A recent large study found that hormone l...
People leaving hospital after medical illness do not benefit from extended clot reducing treatment
Taking rivaroxaban after discharge from hospital does not significantly reduce the risk of venous thromboembolism, either blood clots in large veins or of dying from clots travelling to the lungs.
People who are hospitalised with conditions such as heart failure and stroke are at an increased risk of blood clots. This risk is further increased by factors such as age, lack of mobility and previous illness or clots. These patients will usually be given anticoagulant treatment to reduce blood clot...
Pelvic floor muscle training can improve symptoms of urinary incontinence
Two-thirds of women with any type of urinary incontinence who have pelvic floor muscle training see improvement or cure compared with only a third of women who receive no treatment or inactive treatments. It is even more effective for women with stress incontinence, with three-quarters of women reporting improvement or resolution of symptoms, such as episodes of leakage.
This systematic review included 31 trials and 1,817 women with any type of incontinence; stress, urgency or mixed urinary inc...
Repeat thyroid function tests for healthy older people are not needed
Older adults with normal thyroid function or subclinical thyroid dysfunction show notable long-term stability of their thyroid hormone levels. This suggests that it is safe for GPs not to routinely retest older adults unless they have risk factors or develop clinical symptoms of overt thyroid dysfunction.
Over five years, about 0.2% older adults with normal thyroid function will develop overt hypothyroidism and about 3.5% will develop subclinical hypothyroidism. Amongst those with subclinical h...
The best dose of aspirin for cardiovascular protection may depend on body weight
Low dose aspirin only appears to be effective at preventing stroke or heart attack for people weighing less than 70kg, while higher doses are better for people who weigh over 70kg.
Researchers analysed data from 13 trials of aspirin for primary or secondary prevention of cardiovascular events, totalling over 115,000 participants. They found that 75 to 100mg aspirin only benefitted people who weighed less than 70kg, while only those who weighed 70kg or more benefited from doses of 325mg or above...