Alan Ehrlich, MD, Author at Clinical Advisor - Page 3

Alan Ehrlich, MD

All articles by Alan Ehrlich, MD

Dalfampridine approved for multiple sclerosis

Level 3: Lacking direct evidence Dalfampridine (Ampyra) extended release tablets, previously called Fampridine-SR, have been approved by the FDA to improve walking in patients with multiple sclerosis. In two clinical trials with 507 patients, the drug was associated with consistent improvement in walking speed on a 25-foot walk when compared with placebo (NNT 4). However,…

Cladribine and fingolimod each reduce relapse in adults with relapsing-remitting MS

Level 1: Likely reliable evidence Relapsing-remitting multiple sclerosis (MS) is commonly treated with parenteral drugs that can lead to adverse events and poor adherence. Three phase 3 randomized trials evaluated the efficacy and safety of two oral drugs, cladribine (Mylinax) and fingolimod, for patients with MS. The CLARITY trial compared cladribine vs. placebo in 1,326…

Prediction rule identifies children at low risk after suffering minor head trauma

Level 1: Likely reliable evidence CT is often performed on children with head trauma to diagnose clinically important traumatic brain injuries. Attempts have been made to develop criteria that might safely avoid unnecessary procedures. The Pediatric Emergency Care Applied Research Network (PECARN) study has now developed a prediction rule that identifies children who are at…

IM vaccine may be more effective than intranasal vaccine for seasonal flu in healthy adults

Level 2: Mid-level evidence IM and intranasal seasonal influenza vaccines were compared with each other and with placebo in a randomized trial involving 1,952 healthy adults during the 2007-2008 influenza season (N Engl J Med. 2009;361:1260-1267; available at content.nejm.org/cgi/content/full/361/13/1260, accessed November 9, 2009). The rate of laboratory-confirmed symptomatic influenza was 6.1% overall, with lowest incidence…

The immune response to vaccine against Hemophilus influenzae may be blunted

Vaccine response in infants may be lower with use of prophylactic acetaminopehn

Level 3: Lacking direct evidence Prophylactic acetaminophen, or paracetamol, has been advocated to reduce the frequency and severity of fever and other adverse reactions associated with pediatric immunization. Because fever is a natural part of the immune response, a new study investigated the effects of postvaccination prophylactic acetaminophen use on both fever reduction and antibody…

BNP-guided treatment reduces mortality in chronic heart failure

Level 1: Likely reliable evidence B-type natriuretic peptide (BNP) as well as its N-terminal fragment (NT-proBNP) can provide useful diagnostic and prognostic information in patients with acute dyspnea and chronic heart failure. Prognosis tends to be better in patients whose BNP levels decrease in response to treatment. A recent systematic review offers evidence that medical…

Insulin therapy associated with dose-dependent increase in risk for cancer

Level 2: Mid-level evidence A recent observational study evaluated the malignancy rates associated with human insulin and insulin analog in 127,031 adults with diabetes receiving first-time insulin monotherapy (Diabetologia. 2009;52:1732-1744). All participants were without known malignant disease at baseline; 75% were treated with human insulin and 19% with insulin glargine exclusively. Others received either insulin…

Preoperative medical testing prior to removal of a cataract (shown) had no effect on adverse events

Routine preoperative testing not beneficial prior to cataract surgery

Level 1: Likely reliable evidence A recent Cochrane review of three randomized trials evaluated the addition of routine medical testing to standard preoperative history and physical exams prior to age-related cataract surgery. Routine preoperative testing included ECG; complete blood count; electrolyte, blood urea nitrogen, creatinine, and blood glucose determinations, regardless of indications. In 21,531 operations,…

Dabigatran superior to warfarin in patients with atrial fibrillation

Level 1: Likely reliable evidence The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial compared the efficacy and safety of dabigatran (Pradax in Canada and Pradaxa in Europe), a new oral direct thrombin inhibitor that does not require blood test monitoring, with warfarin (Coumadin) in 18,113 patients who had atrial fibrillation and additional risk factors…

UFH for thromboprophylaxis may have higher risk of major bleeding than LMWH

Level 2: Mid-level evidence The American College of Chest Physicians (ACCP) recommends thromboprophylaxis using unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), or fondaparinux (Arixtra) in selected general medical patients. The results of a recent Cochrane review of 13 randomized trials suggest that while LMWH and UFH are similarly effective, LMWH may be safer (Cochrane Database Syst…

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