Fluticasone in mild to moderate atopic dermatitis relapse: a randomized controlled trial

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p = 0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD

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Explorando el contexto del tratamiento antihipertensivo en Atención Primaria. Estudio SIMPLITENS / Exploring the context of antihypertensive treatment in primary care. The SIMPLITENS study

A pesar de la existencia de diferentes guías sobre el manejo de la hipertensión arterial y de los numerosos fármacos antihipertensivos disponibles, el grado de control de la hipertensión dista de ser óptimo, siendo muchas las razones que pueden explicar esta circunstancia. El objetivo del estudio SIMPLITENS fue describir la situación del tratamiento antihipertensivo en Atención Primaria en España con los objetivos secundarios de hacer un retrato de la actitud terapéutica de los médicos, identificar el papel de factores circunstanciales (administración, guías) sobre las decisiones terapéuticas y validar un modelo de simplificación del tratamiento. Se utilizó el método Delphi para investigaciones clínicas de RAND/UCLA. Participaron 140 médicos de Atención Primaria que manifestaron su grado de acuerdo o desacuerdo con 28 afirmaciones (13 sobre la actitud terapéutica frente a la hipertensión arterial, 9 sobre el impacto de los factores circunstanciales y 6 sobre un modelo simplificado de tratamiento) mediante una escala de cinco categorías. Se realizaron dos rondas y se consideró que había consenso cuando un 75% de los votos eran coincidentes. Hubo consenso sobre 12 cuestiones, 4 en primera y 8 en segunda ronda. Cuatro de las afirmaciones con consenso eran sobre la actitud terapéutica, 4 sobre los factores circunstanciales y 4 sobre la validación del modelo simplificado. A la vista de los resultados obtenidos, parece aconsejable diseñar acciones formativas sobre el tratamiento antihipertensivo, especialmente sobre las evidencias de eficacia de los distintos fármacos en monoterapia y combinación, sobre el contenido de las guías y sobre los criterios de selección del tratamiento en distintos grupos de pacientes

Despite the existence of several guidelines on the management of hypertension and the numerous antihypertensive agents available, hypertension control is far from optimal, for multiple reasons. The aim of the SIMPLITENS trial was to describe the situation of antihypertensive treatment in primary care in Spain. Secondary objectives were to describe the therapeutic approach in primary care physicians, identify the role of circumstantial factors (administration, guidelines) on therapeutic decisions, and to validate a treatment simplification model. We used the RAND-UCLA Delphi method for clinical research. Participants consisted of 140 primary care physicians who expressed their degree of agreement or disagreement with 28 statements (13 on the therapeutic approach to hypertension, 9 on the impact of circumstantial factors, and 6 on the treatment simplification model) through a 5-point scale. Two rounds were held and consensus was considered to be reached when 75% of the votes were in agreement. Consensus was reached on 12 statements, 4 in the first round and 8 in the second. Four of the statements achieving consensus were related to the therapeutic approach, 4 were related to circumstantial factors and 4 were related to the simplification model. The results obtained suggest that training strategies on antihypertensive treatment should be designed, especially on evidence of the effectiveness of the distinct agents, both as monotherapy and combination therapy, on the contents of guidelines, and on the criteria for treatment selection in distinct patient groups

¿Se ha modificado el uso de antitérmicos tras la introducción de ibuprofeno a diferentes concentraciones? / Has the use of antipyretics been modified after the introduction of different concentrations of ibuprofen into the market?

INTRODUCCIÓN: Se analiza la utilización de antitérmicos en pediatría extrahospitalaria en España después de la aparición de medicamentos con 40 mg/ml de ibuprofeno. PACIENTES Y MÉTODOS: Estudio transversal, observacional y descriptivo en pacientes menores de 14 años con síndrome febril ya tratado, atendidos en Urgencias del Servicio de Pediatría del Consorcio Hospital General Universitario de Valencia entre noviembre del 2012 y enero del 2013. RESULTADOS: De 217 niños, 144 estaban tratados con paracetamol o ibuprofeno, 69 recibían ambos fármacos, y uno paracetamol y metamizol. Hubo un 58,7% de exposiciones a paracetamol y un 40,9% a ibuprofeno. En el 63,2% de los casos el uso de antitérmicos fue decidido por los padres. En 98 exposiciones la dosis fue diferente de la autorizada en la ficha técnica (uso «off-label»). El 40,2% de las exposiciones a ibuprofeno fue «off-label», en su mayoría por infradosificación (35,9%). Paracetamol se usó «off-label» en el 29,8% de los casos, predominando la sobredosificación (26,8%), diferencia estadísticamente significativa. No hubo diferencias significativas en el uso «off-label» combinado o en monoterapia. CONCLUSIONES: La mayoría de los niños con síndrome febril que llegan a urgencias con tratamiento antitérmico reciben este por decisión de sus padres. El paracetamol es el fármaco más usado, uno de cada 3 niños lo reciben simultáneamente con ibuprofeno. En un tercio de las ocasiones, los antitérmicos son utilizados al margen de la ficha técnica con una tendencia creciente que, en el caso del ibuprofeno, puede estar relacionada con la existencia de presentaciones farmacéuticas con distintas concentraciones

INTRODUCTION: Due to the emergence of new pharmaceutical presentations of ibuprofen (40 mg/ml), an analysis was made on the use of antipyretics in pediatric outpatient in Spain. PATIENTS AND METHODS: A cross-sectional, observational, descriptive study was carried out on a sample of children under 14 years old with treated febrile syndrome, seen in the Emergency Room of the Hospital General Universitario de Valencia from November 2012 to January 2013. RESULTS: Of the 217 children included, 144 were treated with paracetamol or ibuprofen, 69 received both drugs, and one received paracetamol and metamizol. There were 58.7% of exposures to paracetamol and 40.9% to ibuprofen. The parents decided the use of antipyretics in 63.2% of cases. In 98 exposures the dose was different from that authorized in the labeling of the drug (off-label use). Ibuprofen was used off-label in 40.2% of cases, mostly by underdosing (35.9%). Paracetamol was used off-label in 29.8% of cases, predominantly overdose (26.8%), with the difference being statistically significant. No significant differences were observed in the off-label use in either monotherapy or combined use. There were also no differences when antipyretics prescribed by doctors or given directly by parents were evaluated separately. CONCLUSIONS: The majority of children with treated febrile syndrome seen in the Emergency Room were receiving antipyretic drugs after a parental decision. Paracetamol is the most commonly used drug and one in three children received it simultaneously with ibuprofen. The antipyretics were used off label in one-third of the cases. Off label use of ibuprofen is increasing, and is probably due to the existence of different pharmaceutical presentations

Mejores medicamentos para los niños: La iniciativa pediátrica europea cumple 5 años / Better medicines for children: The european paediatric initiative is five years old

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Diferencias y similitudes entre diuréticos / Differences and similarities among diuretics

Los diuréticos tiazídicos son los fármacos más recomendados para el tratamiento inicial de la hipertensión arterial, por su bajo coste, pero también por su eficacia y tolerabilidad tanto en monoterapia como en combinación. Aunque el fármaco más utilizado es la hidroclorotiazida existen argumentos a favor de su sustitución por clortalidona. El uso de tiazidas reduce la incidencia de ictus y de enfermedad coronaria, como han demostrado numerosos ensayos clínicos. La combinación de tiazidas con otros antihipertensivos aumenta su eficacia. El efecto adverso más común es la hipopotasemia, por lo que deben vigilarse los valores plasmáticos de potasio. Dado que muchos pacientes no alcanzan el objetivo terapéutico con un solo fármaco, si no existen contraindicaciones, debería incluirse un diurético en cualquier pauta terapéutica que asocie fármacos antihipertensivos (AU)

Thiazides are the most commonly recommended treatment for hypertension because of their low cost, tolerability and efficacy both as monotherapy and in combination with other agents. Although the most commonly used drug is hydrochlorothiazide, there are arguments in favor of its replacement with chlorthalidone. Numerous clinical trials have shown that a diuretic-based strategy is effective in preventing stroke and cardiac disease. Some combinations of thiazide diuretics with an antihypertensive drug of a different class increase antihypertensive efficacy. The most common adverse effect is hypokalemia and consequently plasma potassium levels must be monitored. Because many patients require more than one drug to control their blood pressure, a diuretic should be included in the therapeutic regimen unless contraindicated (AU)

Investigación en envejecimiento. Aspectos relacionados con el uso de medicamentos / Investigation in aging. Features related with the use of drugs

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