Alex Rae-Grant, MD, Deputy Editor of Neurology, says his pick for clinical study of the year was a trial in NEJM that provided clarity on medications for benzodiazepine-resistant status epilepticus. Previously, it was unclear if any second-phase drug (fosphenytoin, valproate, or levetiracetam) was superior in its ability to control seizures in patients who did not respond to benzodiazepines, leading to confusion and treatment delay. With similar efficacy of each drug demonstrated in this high-quality trial, clinicians can now safely choose whichever drug makes the most sense for their patient considering their underlying condition, labs, and comorbidities — potentially saving lives and brain tissue. View the Status Epilepticus in Adults topic in DynaMed to read more.
Vito Iacoviello, MD, Deputy Editor of Infectious Disease (ID), didn’t have a “favorite” clinical study in 2019, but he did remark that there were a few negative ID-related stories this year. Most noteworthy and concerning were surges in vaccine-preventable diseases worldwide including hepatitis A, measles, and cholera. These outbreaks prompted the World Health Organization (WHO) to add vaccination hesitancy to the 10 Threats to Global Health list this year. Keep up with Infectious Disease epidemiology in DynaMed.
Terence Trow, MD, Deputy Editor of Pulmonary Medicine, noted two trials on a new triple combination gene-based therapy for cystic fibrosis. Most patients with cystic fibrosis have a delta F508 mutation and these patients do not respond to ivacaftor monotherapy. In first trial, published in NEJM, elexacaftor/texacaftor/ivacaftor (Trikafta) triple therapy was effective compared to placebo. The second trial in Lancet showed that triple therapy was more effective than double texacaftor/ivacaftor therapy. The data from these trials led to FDA approval of the triple regimen, providing a new option for most patients with cystic fibrosis. Read about Cystic Fibrosis in DynaMed.
Additional Top stories for 2019:
A mysterious and severe pulmonary condition associated with vaping made headlines this year, and the DynaMed editors were quick to add a brand-new topic — Vaping. Stay current as we continue to learn more about e-cigarette or vaping product use associated lung injury (EVALI).
Deaths from drug overdoses continued to rise in 2019, and opioids are a leading cause. Naloxone is an antidote that can be given via IV or intramuscular injection and can also be administered as an intranasal spray. To curb future opioid use, medication-based withdrawal (in combination with psychosocial services) is recommended over abrupt cessation. In order to help your patients with addiction, read about Opioid Overdose and Opioid Withdrawal in DynaMed.
Many organs otherwise suitable for transplantation are not ultimately used because of hepatitis C virus (HCV) infection of the donor. This situation contributes to a shortage of available organs for transplantation and longer wait times for patients in need of an organ. More effective antiviral drugs for HCV are available, and a study published in NEJM this year showed that treatment of HCV-uninfected recipients after transplantation of an HCV-infected lung or heart prevented the establishment of HCV infection. More studies are needed to understand the long-term safety of this strategy, but it is a promising approach to expand the pool of available organs for transplantation. Read about treatment of HCV in DynaMed.