New drugs that treat stubborn illness seen often in primary care lead this group of Top 5 Papers for 2014. Type 2 diabetes, cryptogenic stroke, and hep-C are key targets.
Sofosbuvir, one of the new interferon-free antiâhepatitis C antivirals costs $1000/pill, totaling $84,000 for a 12-week course. Nonetheless, 2014 was the first time we talked about cure for this infection that leads to cirrhosis, liver cancer, and often to liver transplant. The topic will receive heavy attention in 2015.Details here.
It may turn out the SGLT2 drugs are “niche” agents because of their side effects and recommended adjustments for renal disease. GFRs of 30 to 45 cc/min contraindicate canagliflozin, the first FDA-approved SGLT2 inhibitor. Empagliflozin and dapagliflozin are the others approved in the US. Details here.
The combination of a GLP-1 agonist with basal insulin can produce a long-sought trifecta in treatment of type 2 diabetes: robust glycemic control with no increase in hypoglycemia and no weight gain. Details here.
Long-term use of sleep aid zolpidem was associated with a significantly greater risk of head injury or fracture requiring hospitalization than no use of sedative-hypnotic agents (P
Thirty-day noninvasive ambulatory ECG monitoring significantly improved the detection of atrial fibrillation by a factor of more than 5. The rate of anticoagulant treatment was nearly doubled compared with standard practice of short-duration ECG monitoring.Details here.
The NOACs have a number of practical advantages of over warfarin: fixed once- or twice-daily oral dosing without the need for coagulation monitoring, and few known or defined drug or food interactions. Drawbacks include bleeding risk that may be increased in patients older than 75 years and risk of major gastrointestinal bleeding (high dose) and increased dyspepsia with dabigatran. Also there is no routine laboratory test to reliably measure anticoagulant effect. Antidote for reversal is now being studied. Dabigatran/Pradaxa is a direct thrombin inhibitor and apixaban/Eliquis and rivaroxaban/Xarelto are factor XA inhibitors). Details here.
The best publications in a given year may be chosen because they are cited frequently, possibly because they warrant erudite editorials or because they are the most scientifically respected manuscripts. The road I’ve taken, however, is to select papers with results and/or conclusions that affect primary care practice-right now and for the immediate future.The references encompass situations and diseases that have frequently challenged me and are seen frequently in primary care:Â - Hepatitis CÂ - Type 2 diabetesÂ - InsomniaÂ - StrokeÂ - AnticoagulationÂ