Prescrire international
-
In a trial involving patients with advanced-stage liver cancer but unimpaired hepatic function, sorafenib increased the median survival time by about 3 months in half of patients, but provoked frequent adverse effects.
-
(1) For patients with chronic symptomatic hyperuricaemia who fail to respond to a low purine diet, allopurinol is the standard drug used to prevent complications. This xanthine oxidase inhibitor can, in rare instances, cause severe skin reactions. Probenecid, a uricosuric agent, with which there is also long experience, is a second-line option; (2) Febuxostat, another xanthine oxidase inhibitor, is now authorized for the treatment of hyperuricaemia; (3) Two randomised double-blind trials in 762 and 1072 patients tested various doses of febuxostat compared with a standard dose of allopurinol (33 mg/day). ⋯ In the short term, severe cardiac disorders, based on a composite endpoint, were 4 to 5 times more frequent with febuxostat than with allopurinol. Treatment withdrawals due to hepatic disorders were more frequent with febuxostat than with allopurinol (2.8% versus 0.4%). The relative frequency of severe cutaneous disorders with febuxostat and allopurinol is not known; (6) Clinical evaluation does not include any head-to-head trials of febuxostat versus probenecid; (7) In practice, patients with hyperuricaemia should continue to receive allopurinol as first-line treatment, and probenecid as second-line treatment if allopurinol is ineffective.
-
Prescrire international · Feb 2009
Sitagliptin combined with sulphonylureas: new indication. Other treatments are preferable.
In type 2 diabetes, sitagliptin, in combination with a sulphonylurea, only provides modest efficacy in terms of HbA1c levels and increases the risk of hypoglycaemia.