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Round Up Email February 2021

Highlights in this month's Round Up include a summary about the use of monoclonal antibodies in asthma, more evidence about the effectiveness of colchicine in myocardial infarction, and more data about use of SGLT2 inhibitors in CKD.

Question 1
Monoclonal antibodies in asthma – how do they work, when are they indicated, what do NICE suggest?: Monoclonal antibodies in severe eosinophilic asthma
1) Which statement regarding monoclonal antibodies in severe eosinophilic asthma is false
- a subgroup of asthma patients show eosinophilia in the absence of an allergic aetiology to their asthma
- IL-5 is a critical regulator of blood and tissue eosinophilia in severe eosinophilic asthma
- Atopic asthma represents about 20% of asthmatic patients and probably a higher proportion in patients with severe asthma
Question 2
More evidence about use of colchicine post-MI. Is it high or low dose colchicine that is used? If it is given, then is their benefit if in giving in the immediate post-MI period?: COLchicine Cardiovascular Outcomes Trial (COLCOT) - Efficacy and Safety of low-dose colchicine after myocardial infarction
2) Which statement regarding Efficacy and Safety of low-dose colchicine after myocardial infarction is false
- The COLCOT data shows benefit of high dose colchicine early initiation after an MI
- early initiation (day 0-3) of colchicine after MI greatly reduced the risk of ischaemic CV events compared with placebo
- low-dose colchicine (0.5 mg once daily) reduced the risk of the primary composite endpoint (CV death, MI, ischemic stroke, or ischemia-driven coronary revascularization) and key secondary endpoints in patients with chronic coronary disease
Question 3
CREDENCE was the trial of SGLT2 inhibitors in diabetes which evidenced the use of the 100mg dose in preventing progression of CKD. However, a recent study has data about using canagliflozin 100mg per day in eGFR < 30 ml/min/1.73m². This is summarised on GPnotebook.: CREDENCE - renal benefit with SGLT2i in patients with eGFR <30 ml/min/1.73m²
3) Which statement regarding the use of canagliflozin in CREDENCE is false
- data suggests that canagliflozin reduced albuminuria and slowed the rate of eGFR decline in patients with eGFR <30 ml/min/1.73m², compared to placebo
- effects of canagliflozin on kidney, CV and mortality outcomes in patients with an eGFR of <30 ml/min/1.73m² were similar to those with an eGFR of >=30 ml/min/1.73m^2
- the dose of canagliflozin in CREDENCE was 300mg per day; but reduced to 100mg per day when eGFR was < 30 ml/min/1.73m^2
Question 4
The long-term survival benefits of use of ACE inhibitors in heart failure have been shown in a follow-up of the AIRE study. This is summarised on GPnotebook: Long-term survival benefit of ramipril in patients with acute myocardial infarction complicated by heart failure
4) Which statement regarding use of ACE inhibitors and data from the AIRE trial is false
- ramipril increased life expectancy more for patients with diabetes than any other condition compared to placebo
- ramipril increased life expectancy more for patients with heart failure than any other condition compared to placebo
- based on 13.5 months of ramipril the extension of life between ramipril and placebo groups was an average of 14.5 months
Question 5
Use of inhaled corticosteroids in COPD – an update on GPnotebook: Inhaled corticosteroids in COPD
5) Which statement regarding the use of inhaled corticosteroids in COPD is false
- the threshold of a blood eosinophil count > 400 cells/muL identifies the top of the continuous relationship between eosinophils and ICS, and can be used to identify patients with the greatest likelihood of treatment benefit with ICS
- in vitro evidence suggests that COPD-associated inflammation has limited responsiveness to corticosteroids
- most evidence of ICS (alone) in COPD found that regular treatment with ICS alone does not modify the long-term decline of FEV1 nor mortality in patients with COPD
Question 6
More evidence of the effectiveness of LDL lowering in patients post MI. Another GPnotebook "key facts" update.: LDL and cardiovascular (CV) risk
6) Which statement regarding LDL lowering in patients post MI is false
- clinical trial data suggest that acquired relative CV risk reduction per unit LDL-c reduction is consistent, regardless of baseline LDL-c
- a meta-analysis concluded that statin therapy can safely reduce the 5-year incidence of major coronary events, coronary revascularisation, and stroke by about one tenth per mmol/L reduction in LDL cholesterol, largely irrespective of the initial lipid profile or other presenting characteristics
- patients with higher baseline LDL-c benefit most from LDL-c lowering therapy with a larger absolute LDL-c lowering and greatest reduction in mortality

Round Up Email February 2021

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6