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NIHR Signal 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...
NIHR Signal 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 ...
NIHR Signal 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,...
NIHR Signal 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...
NIHR Signal 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...
NIHR Signal 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...
NIHR Signal Aspirin did not prevent deaths or disability in healthy older adults
In the ASPREE trial, older adults with no apparent cardiovascular disease who took daily aspirin saw no benefit in terms of reducing the chance of dying or having dementia or disability. Instead, it slightly increased their mortality and bleeding risk - aspirin was associated with an excess of 1.6 deaths per 1,000 people per year. Half of these deaths were due to cancer. Aspirin is an established ‘secondary’ preventative treatment for people who have known cardiovascular disease. Ho...
NIHR Signal Benzodiazepines may increase length of stay and chance of delirium in intensive care
Benzodiazepines given during mechanical ventilation in intensive care could increase the risk of a longer hospital stay and delirium compared to other sedatives. A range of sedatives are used to reduce psychological distress in critically ill patients, but prior to this study, it was not clear which drugs are most effective. This systematic review looked at all the evidence from randomised controlled trials for the effectiveness of six different types of sedative used in people given mechanical...
NIHR Signal 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...
NIHR Signal People with COPD exacerbations prefer early discharge then treatment at home
People with flare-ups of COPD (chronic obstructive pulmonary disease) prefer to be managed at home rather than in hospital. Hospital stay was on average four days shorter when people were discharged early to the hospital at home scheme, and there was no noticeable increase in readmissions in this group. This NIHR-funded trial aimed to establish the costs and outcomes of hospital at home compared with staying in hospital for treatment. The findings support current guidance that hospital at home...
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