Although corticosteroids have been used as adjunctive therapy for septic shock for more than 50 years, uncertainty persists about the effects of these medications on mortality. Previous trials and study-level meta-analyses have failed to resolve the questions regarding the role of corticosteroids in the management of patients with septic shock.
A recent patient-level meta-analysis published on May 22, 2023, in NEJM Evidence assessed the effect of hydrocortisone versus usual care on 90-day mortality, secondary clinical outcomes, and adverse effects and compared the effects of hydrocortisone across prespecified patient subgroups.
The researchers pooled individual patient data from septic shock trials that investigated the adjunctive use of I.V. hydrocortisone.
The primary outcome was 90-day all-cause mortality across predefined subgroups. Secondary outcomes included mortality at ICU and hospital discharge at 28 and 180 days, and the number of vasopressor-, ventilator-, and organ failure–free days. Adverse events included superinfection, muscle weakness, hyperglycemia, hypernatremia, and gastroduodenal bleeding.
Of 24 eligible trials, 17 trials provided individual patient data, and 7 trials (with a total of 5,929 patients) provided 90-day mortality data. The patient-level meta-analysis of hydrocortisone for patients with septic shock found that hydrocortisone was not associated with reduced risk of 90-day all-cause mortality. Further, the effects of hydrocortisone on 90-day all-cause mortality did not differ significantly between continuous versus bolus administration, a fixed-duration versus vasopressor dependency–guided administration, or between discontinuation with tapering versus without tapering.
Hydrocortisone may be associated with a decreased risk of ICU mortality and with increased vasopressor-free days but may not be associated with reduced mortality at 28 days, 180 days, and hospital discharge. Hydrocortisone may be associated with an increased risk of muscle weakness. ■
Risk associated with the use of amiodarone with anticoagulants in patients with AFib
Amiodarone, the most effective antiarrhythmic drug prescribed to patients with AFib, is known to inhibit elimination of apixaban and rivaroxaban, thus possibly increasing anticoagulant-related risk for bleeding. Researchers at the Vanderbilt University School of Medicine conducted a retrospective cohort study to compare risk for bleeding-related hospitalizations during treatment with amiodarone versus flecainide or sotalol, antiarrhythmic drugs that do not inhibit these anticoagulants’ elimination.
The study, published in the June 2023 issue of Annals of Internal Medicine, included over 90,000 Medicare beneficiaries aged 65 or older with AFib who began apixaban or rivaroxaban anticoagulant use between January 1, 2012, and November 30, 2018, and were subsequently treated with either amiodarone or with flecainide or sotalol. The primary outcome was time to event for bleeding-related hospitalizations and ischemic stroke.
Results of the study indicated that risk for bleeding-related hospitalizations increased significantly with amiodarone use compared with use of flecainide or sotalol (57 vs. 39 events per 1,000 person-years). There was no significant association with stroke or systemic embolism. ■
Low-dose colchicine may reduce need for knee and hip replacements in patients with osteoporosis
Colchicine, an anti-inflammatory medication that is commonly prescribed to treat gout and pericarditis, may reduce the need for knee and hip replacements in patients with osteoporosis according to a recent study published in the June 2023 issue of Annals of Internal Medicine. A group of researchers in the Netherlands and Australia examined data from a 2020 trial conducted to investigate the efficacy of low-dose colchicine in patients with chronic coronary artery disease and found that colchicine reduces the need for total knee or hip replacements.
Although the study was not designed to investigate the effect of colchicine in patients with osteoporosis, the researchers postulated that because inflammation plays an important role in the development of osteoarthritis, anti-inflammatory drugs such as colchicine may slow disease progression.
The researchers used data from a randomized, controlled, double-blind trial of more than 5,000 patients in 43 medical centers in Australia and the Netherlands who received 0.5 mg daily of colchicine or placebo. The authors found that during a median follow-up period of 28.6 months, 2.5% of patients in the colchicine group received a total knee or hip replacement compared with 3.5% of patients in the placebo group.
The authors concluded that further research specifically studying colchicine therapy as a means to slow disease progression in osteoarthritis is warranted. Until then, colchicine cannot be recommended as a treatment for osteoarthritis. ■
Low-dose colchicine may reduce need for knee and hip replacements in patients with osteoporosis
Colchicine, an anti-inflammatory medication that is commonly prescribed to treat gout and pericarditis, may reduce the need for knee and hip replacements in patients with osteoporosis according to a recent study published in the June 2023 issue of Annals of Internal Medicine. A group of researchers in the Netherlands and Australia examined data from a 2020 trial conducted to investigate the efficacy of low-dose colchicine in patients with chronic coronary artery disease and found that colchicine reduces the need for total knee or hip replacements.
Although the study was not designed to investigate the effect of colchicine in patients with osteoporosis, the researchers postulated that because inflammation plays an important role in the development of osteoarthritis, anti-inflammatory drugs such as colchicine may slow disease progression.
The researchers used data from a randomized, controlled, double-blind trial of more than 5,000 patients in 43 medical centers in Australia and the Netherlands who received 0.5 mg daily of colchicine or placebo. The authors found that during a median follow-up period of 28.6 months, 2.5% of patients in the colchicine group received a total knee or hip replacement compared with 3.5% of patients in the placebo group.
The authors concluded that further research specifically studying colchicine therapy as a means to slow disease progression in osteoarthritis is warranted. Until then, colchicine cannot be recommended as a treatment for osteoarthritis. ■