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Round Up Email May 2025

In this month's Round Up highlights include an update of the herpes zoster vaccine section, evidence relating to the use of semaglutide in MASH, and a section relating to the use of azathioprine in pregnancy.

Question 1
Lyme disease – Is Lyme disease more common in the Summer or the Winter? The infection is spread through the bite of an infected tick of the genus Ixodes but for approximately how long does the tick need to be attached to transmit the Lyme disease bacterium? Antibiotic treatment is highly effective, but approximately what proportion of patients have persistent symptoms despite antibiotic treatment?: Lyme disease
With respect to Lyme disease, which statement is false?
- Lyme borreliosis is more commonly diagnosed during the summer season
- in most cases, the tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted
- antibiotic treatment is highly effective, but approximately 1% of treated patients experience persistent symptoms
Question 2
Scabies section on GPnotebook – this section has been updated.: Scabies
With respect to scabies, which statement is false
- female scabies mites live for 1-2 weeks; they lay 1-3 eggs per day and burrow at a rate of 2-3 mm per day
- in classic scabies 5 to 15 mites live in an infected host but in crusted scabies the number of mites can be as high as hundreds or even millions
- UK guidance states that ivermectin 3 mg tablets are licensed for the treatment for scabies once diagnosis has been confirmed clinically or by parasitological examination
Question 3
Herpes Zoster vaccination – this section summarises new evidence of protective effects of HZ vaccination with respect to dementia and cardiovascular disease.: Herpes zoster (shingles) vaccine
With respect to the herpes zoster vaccination, which statement is false?
- herpes zoster (HZ) is an often painful neurocutaneous syndrome resulting from reactivation of varicella-zoster virus (VZV) that has remained latent in sensory ganglia after primary VZV infection (varicella, chickenpox)
- with respect to protective effects of zoster vaccine with respect to shingles, evidence suggests that the risk is reduced by 90%
- with respect to reduction in risk of cardiovascular disease associated with the use of zoster vaccine, the protective association persisted up to 8 years, with the greatest reduction observed 2–3 years post-vaccination
Question 4
Relugolix-estradiol-norethisterone acetate for treating moderate to severe symptoms of uterine fibroids – this section describes this recently NICE approved therapy option for the management of uterine fibroids.: Relugolix–estradiol–norethisterone for treating symptoms of endometriosis
With respect to relugolix-estradiol-norethisterone acetate for treating moderate to severe symptoms of uterine fibroids, which statement is false?
- relugolix is s an orally active nonpeptide GnRH-receptor antagonist that is suitable for daily use
- evidence shows that once-daily relugolix-estradiol-norethisterone acetate resulted in a significant reduction in menstrual bleeding, as compared with placebo, but increased the risk of osteoporosis
- evidence shows that once daily relugolix-estradiol-norethisterone acetate significantly reduced moderate-to-severe uterine leiomyoma-associated pain with a more pronounced effect on menstrual pain
Question 5
Azathioprine in pregnancy – this section of Gpnotebook has been updated.: Azathioprine during pregnancy
With respect to the use of azathioprine during pregnancy, which statement is false?
- intrahepatic cholestasis of pregnancy (ICP) has been rarely reported in patients treated with azathioprine products and but is not believed to be a risk applicable to other drugs in the thiopurine class (mercaptopurine and tioguanine)
- is evidence suggestive of an increased risk of congenital abnormalilty and spontaneous abortion if the father has received treatment with a thiopurine within 3 months of the baby being conceived
- cholestasis of pregnancy associated with azathioprine tends to occur earlier in pregnancy than non drug-induced cholestasis of pregnancy, and elevated bile acid levels may not reduce with ursodeoxycholic acid
Question 6
Semaglutide in metabolic dysfunction–associated steatohepatitis (MASH) – this trial evidence has been summarised on Gpnotebook.: Semaglutide in metabolic dysfunction–associated steatohepatitis (MASH)
With respect to the use of semaglutide in metabolic dysfunction–associated steatohepatitis (MASH), which statement is false?
- steatohepatitis promotes liver fibrosis, progression to cirrhosis, and hepatocellular carcinoma
- in an analysis of ESSENCE study, semaglutide associated with higher steatohepatitis resolution without worsening of liver fibrosis when compared to placebo
- the presence of advanced fibrosis (stage 1 or higher) significantly increases liver-related and all-cause mortality

Round Up Email May 2025

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6