Research roundup


Debbie Rigby examines the latest research news

Faecal microbiota transplantation for recurrent Clostridum difficile infection

Faecal microbiota transplantation (FMT) has become routine in managing recurrent C. difficile infection (CDI) refractory to antibiotics. This study of 72 people with 3 or more recurrent bouts of CDI confirms frozen and freeze-dried faecal matter is nearly as effective as the fresh product for treating patients with Clostridium difficile. Overall resolution of CDI was 87% during 2 months of follow-up after FMT.

Aliment Pharmacol Ther 2017; 45: 899–908

 

Environmental triggers and avoidance in the management of asthma

Many triggers, both allergenic and nonallergenic, and their interactions influence the natural history of asthma. Allergenic triggers include indoor allergens, such as house dust mites, molds, pets, cockroaches, and rodents, and outdoor allergens, such as pollens and molds. Nonallergenic triggers include viral infections, active and passive smoking, meteorological changes, and occupational exposures.

Journal of Asthma and Allergy 2017:10 47–56.

 

Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism

In this randomized, double-blind, phase 3 study, 3396 patients with venous thromboembolism received either once-daily rivaroxaban (at doses of 20 mg or 10 mg) or 100 mg of aspirin. The risk of a recurrent event was significantly lower with rivaroxaban at either a treatment dose (20 mg) or a prophylactic dose (10 mg) than with aspirin, without a significant increase in bleeding rates.

New England Journal of Medicine 2017 DOI: 10.1056/NEJMoa1700518
Editorial

Summary

 

Clinically significant bleeding with low-dose rivaroxaban versus aspirin, in addition to P2Y12 inhibition, in acute coronary syndromes

In this double-blind, multicentre, randomised trial (GEMINI-ACS-1) dual pathway antithrombotic therapy approach combining low-dose rivaroxaban with a P2Y12 inhibitor for the treatment of patients with acute coronary syndromes had similar risk of clinically significant bleeding as aspirin and a P2Y12 inhibitor. Patients were assigned rivaroxaban 2·5 mg twice daily or aspirin 100 mg daily, in addition to clopidogrel or ticagrelor within 10 days after presentation and continued for 6–12 months.

The Lancet, Published: 18 March 2017

 

 

 

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1 Comment

  1. Frederick Shellingford
    26/04/2017

    I think it should be clarified that in the EINSTEIN-CHOICE study published in NEJM the population studied had already completed a 6-12 month course of anti-coagulation for acute VTE with uncertain indication for extended treatment. Aspirin of course has no role in the acute treatment of VTE.

    My feeling is that the motive behind the study (as opposed to the stated aim) was not so much to prove the superiority of rivaroxaban over aspirin, but rather the non-inferiority of rivaroxaban 10mg to rivaroxaban 20mg (already proven efficacious in this setting in the EINSTEIN-EXTENSION study). The signal is there but unfortunately the study is underpowered to make this conclusion, not surprising given the small effect size (primary event rate < 5% in all groups) and in fact the target sample size had to be revised up to meet the statistical requirements of the existing protocol.

    In today's regulatory environment that is probably more than enough – just look to the similar albeit placebo-controlled AMPLIFY-EXT, which was enough to get apixaban 2.5mg approved and PBS listed for continuing prevention of VTE recurrence.

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