Debbie Rigby takes a look at the latest in research news

Second-generation antipsychotics in children

Second generation antipsychotics such as clozapine, risperidone, olanzapine and quetiapine pose a serious risk to children, resulting in weight gain, dyslipidemia, and development of diabetes mellitus and metabolic syndrome. Children who are prescribed second generation antipsychotics are at risk of developing metabolic side effects with a potential effect on their future cardiovascular health. Medical management of weight gain and glucose intolerance with metformin has also been proposed.

Canadian Family Physician 2018;64(9):660-662.

 

Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome

An updated systematic review and meta-analysis concludes antidepressants are efficacious in reducing symptoms in IBS patients. The RR of IBS symptoms not improving with antidepressants versus placebo was 0.66 (95% CI 0.57–0.76), with similar treatment effects for both tricyclic antidepressants and SSRIs. Psychological therapies (cognitive behavioral therapy, relaxation therapy, multi-component psychological therapy, hypnotherapy, and dynamic psychotherapy) also appear to be effective treatments for IBS, although there are limitations in the quality of the evidence, and treatment effects may be overestimated as a result.

The American Journal of Gastroenterology (2018)

 

Pharmacotherapy for gestational diabetes

Lifestyle management is of paramount importance for the treatment of GDM. In pharmacotherapy, insulin remains the long-established mainstay of treatment. NPH (Neutral Protamine Hagedorn) and soluble human insulin have long been established for use, but favorable experience has now also accumulated with the newer insulins (aspart, lispro, detemir). Alternatively, metformin and glyburide have been used in GDM, but they have never gained wide acceptance. Nutritional supplements based on micronutrients and bioactives (probiotics and myoinositol) have shown promising results as well. Further experience with incretin agents (DPP-4 inhibitors and GLP-1 receptor agonists) is awaited.

Expert Opinion on Pharmacotherapy 2018;19(13):1407-14.

 

Nonsteroidal anti-inflammatory drugs in chronic pain

The decision about whether to use an NSAID for chronic pain and which one should be based on a patient’s risk of developing adverse GI and CV events. Lower- and upper-GI-tract events need to be considered. Celecoxib has a better lower-GI-tract tolerability profile than ns-NSAIDs plus a proton-pump inhibitor. In addition, the latest data suggest that long-term use of celecoxib 200 mg/day may be appropriate for patients at increased CV risk.

Journal of Pain Research 2018;11:1937–1948.