2016

2016

Intravenous alpha-1 antitrypsin augmentation therapy for treating patients with alpha-1 antitrypsin deficiency and lung disease

Summary of review:

Alpha-1 antitrypsin deficiency is an inherited disorder that can cause lung disease. It affects about 1 in 1600 to 5000 people. Those with lung disease suffer from shortness of breath, reduced ability to exercise and wheezing. People who smoke are more seriously affected and have a greater risk of dying from the disease.

We reviewed the benefits and harms of treating patients who have the form of the disease that affects the lungs with alpha-1 antitrypsin extracted from human plasma. We found two randomised trials (total 140 patients) comparing this treatment with placebo for two to three years. All patients were ex-smokers or had never smoked but had the genetic problem that carried a high risk of developing lung problems. Neither trial reported on the number of lung infections, hospital admissions or death from the disease.

The studies found no difference between the two groups in quality of life or in number of exacerbations of the disease. The lung function deteriorated slightly less measured by CT scan, but slightly more measured by forced expiratory volume in one second. Therapy with alpha-1 antitrypsin cannot be recommended, in view of the lack of evidence of clinical benefit and the high cost of treatment.


Routine vitamin A supplementation for the prevention of blindness due to measles infection in children

Summary of review:

Annually 500,000 children become blind worldwide, 75% of them living in low-income countries. The major causes of blindness in children vary widely from region to region and are related to the standard of living of the community. Corneal scarring from measles, vitamin A deficiency, use of harmful traditional eye remedies and ophthalmia neonatorium are the major causes in low-income countries. Vitamin A is an important nutrient in the body and is required for the normal functioning of the eye. Its deficiency results in poor vision.

Measles infection in children has been associated with vitamin A deficiency and blindness.The control of blindness in children is considered a high priority within the World Health Organization's VISION 2020 The Right to Sight Program. Studies have reported the beneficial effect of vitamin A in reducing morbidity and mortality in children with measles. This review examined vitamin A use in preventing blindness in children infected with measles without features of vitamin A deficiency. We included two randomised controlled trials of 260 children with measles comparing vitamin A with placebo. Two doses of vitamin A given on two consecutive days to hospitalised children with measles significantly increased the blood concentration of vitamin A after one week.

However, there is a limitation in that we did not find any study that examined the efficacy of vitamin A in preventing blindness (which is the primary outcome of interest in this review) in children infected with measles. The sample size of the included studies was also relatively small which could affect the precision of the estimates given. Also, no adverse event was reported in the included studies. We do not have sufficient evidence to demonstrate the benefit or otherwise of vitamin A in the prevention of blindness in children infected with measles.


Medication review in hospitalised patients to reduce morbidity and mortality

Summary of review:

This updated Cochrane systematic review studies the evidence for performing in-hospital medication review (defined as a systematic reassessment by a healthcare professional of an individual patients' medication with suggestions for improvement). We aimed to assess whether medication review may improve the health of adult patients.

Elderly patients are often prescribed several drugs despite a generally higher risk of adverse events and sometimes lesser treatment effectiveness in this population.

To find relevant trials, we searched electronic medical literature databases up to May 2015. We included 10 randomised controlled trials with a total of 3575 participants.

We found that medication review does not seem to prevent death and hospital readmissions, but that it might reduce emergency department contacts.

Our confidence in results across studies ranged from low to high. We found no evidence that medication review in hospitalised patients makes a difference towards preventing mortality (low-certainty evidence) or hospital readmissions (high-certainty evidence), but we found that medication review may have a preventive effect on reducing the number of emergency department contacts (low-certainty evidence). In the included trials, participants were followed for a short time (ranging from 30 days to one year). Therefore, important long-term treatment effects may have been overlooked. We suggest that further research with long-term patient follow-up and examination of specific methods of medication review should be undertaken before this intervention is implemented in clinical practice.


Screening for reducing morbidity and mortality in malignant melanoma (Protocol)