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Richard’s Reviews: Psoriasis, Breast Cancer and Infertility

Posted on 2nd September 2014 by

Evidence Reviews

In “Richard’s Reviews”, Richard Lehman writes a weekly review of published journals for the BMJ. He summarizes the findings of new research and shares what he thinks about each study. In this post I will be reviewing the studies that were published in the New England Journal of Medicine.

Journal: NEJM 10 July 2014 Vol 371

Study Title

Adjuvant Exemestane with Ovarian Suppression in Premenopausal Breast Cancer

What you need to know

This paper describes a trial comparing aromatase inhibitor Exemestane plus ovarian suppression Vs. Tamoxifen plus ovarian suppression for a period of 5 years to treat premenopausal women with hormone-receptor–positive early breast cancer. The trial reports a “significantly reduced recurrence” of breast cancer in the group that recieved the exemestane plus ovarian suppression. However, if you look at the numbers the rate of freedom from breast cancer at 5 years was 92.8% in the exemestane–ovarian suppression group, as compared with 88.8% in the tamoxifen–ovarian suppression group. Also, adverse effects were reported in 30.6% of the patients in the exemestane-ovarian suppression group while 29.4% were reported in those in the tamoxifen-ovarian suppression group. In conclusion, there isn’t a significant difference between the two groups, and either one can be used based on patient preference.

Study Title

Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome

What you need to know

In this trial, Letrozole was compared to Clomiphene for the treatment of infertility in women diagnosed with Polycystic Ovary Syndrome. Clomiphene is currently the first choice for the treatment of infertility in women, however, this trial found that aromatase inhibitors such as Letrozole might result in better pregnancy outcomes. To put this finding in numbers, 27.5% of women who recieved Letrozole gave live births Vs. 19.1% of those who recieved Clomiphene. Also, ovulation was induced more frequently with Letrozole where it occured ın 61.7% of the treatment cycles Vs. 48.3% of the Clomiphene treatment cycles. The side effects profile was quite similar except that Clomiphene was associated with more hot flashes while Letrozole was associated with more dizziness and fatigue. The one thing that would stand against Letrozole in this trial is that there were four major congenital anomalies reported in its group Vs. one major congenital anomaly in the Clomiphene group.

Study Title

Dupilumab Treatment in Adults with Moderate-to-Severe Atopic Dermatitis

What you need to know

This study was split into 3 trials; 4 week dupilumab monotherapy Vs. Placebo, 12 week dupilumab monotherapy Vs. Placebo, and 4 week dupilumab + topical Glucocorticoids Vs. Placebo + Glucocorticoids. The findings of this study are very exciting for patients with treatment-resistant Atopic Dermatitis (Eczema); 85% of patients in the dupilumab group had a 50% reduction in the severity of their eczema as compared with 35% of those in the placebo group. 40% of patients in the dupilumab group had a clearing or near-clearing of their skin lesions as compared with 7% in the placebo group. Pruritus scores decreased (indicating a reduction in itch) by 55.7% in the dupilumab group versus 15.1% in the placebo group. In the combination study, 100% of the patients in the dupilumab group had a reduction in the severity of their eczema, as compared with 50% of those who received topical glucocorticoids with placebo injection. The use of dupilumab plus glucocorticoids enabled the patients to use less than half the amount of topical glucocorticoids used by those who received placebo plus the topical medication. The most frequent adverse events with dupilumab were nasopharyngitis and headache.

Study Title

Secukinumab in Plaque Psoriasis.

What you need to know

Psoriasis is a condition of the skin that is the cause of crusty red patches of skin covered with silver skales.Secukinumab blocks Interleukin-17A which is considered to be central to the pathogenesis of psoriasis. In this study it was compared in two trials, one against placebo and the other against Etanercept. The results of the comparison with placebo were naturally very significant where the reduction of psoriasis severity was 81.6% with 300 mg of secukinumab, 71.6% with 150 mg of secukinumab, and 4.5% with placebo. On the other hand, the comparison with Etanercept yielded a reduction of psoriasis severity of 77.1% with 300 mg of secukinumab, 67.0% with 150 mg of secukinumab, 44.0% with etanercept, and 4.9% with placebo. Regarding side effects, Secukinumab naturally had a higher infection rate when compared to placebo, however the rates were similar to those with Etanercept.

Check out the original review at: http://blogs.bmj.com/bmj/2014/07/14/richard-lehmans-journal-review-14-july-2014/


Norah Essali

Hi! I'm a medical student from Syria. I hope you find my posts useful! View more posts from Norah

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