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Primary Care

Anticoagulation for the prevention of stroke in non-valvular AF in general practice: room for improvement

Authors: Adam Ioannou, Sofia Metaxa, George Kassianos, Constantinos G Missouris

The aim of this study was to assess whether the recommendations and guidelines for thromboprophylaxis in patients with atrial fibrillation (AF) have been adopted in general practice (GP) in the UK. The authors concluded that one in four patients with non-valvular AF, at risk of a stroke, is not being adequately treated with an oral anticoagulant in primary care and suggest that a review of GP practice databases should be considered to identify patients with non-valvular AF, at risk of a disabling or fatal event, and measures taken to initiate anticoagulant therapy.

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Effectiveness, tolerability and practical application of the newer generation anti-obesity medications

Authors: Jeffrey S MacDaniels, Thomas L Schwartz

In this paper, the authors compare the efficacy and tolerability of five newer anti-obesity medications to guide clinical decision making, examining bupropion–naltrexone combination, liraglutide, lorcaserin, orlistat, and phentermine–topiramate combination.

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Combination therapy in type 2 diabetes mellitus: adding empagliflozin to basal insulin

Authors: Andrew Ahmann

Type 2 diabetes mellitus (T2DM) management is complex, with few patients successfully achieving recommended glycemic targets with monotherapy, most progressing to combination therapy, and many eventually requiring insulin. Sodium glucose cotransporter 2 (SGLT2) inhibitors are an emerging class of antidiabetes agents with an insulin-independent mechanism of action, making them suitable for use in combination with any other class of antidiabetes agents, including insulin. In this review the evaluates a 78-week, randomized, double-blind, placebo controlled trial investigating the impact of empagliflozin, an SGLT2 inhibitor, as add-on to basal insulin in patients with inadequate glycemic control on basal insulin, with or without metformin and/or a sulfonylurea.

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Metastatic squamous cell non-small-cell lung cancer (NSCLC): disrupting the drug treatment paradigm with immunotherapies

Authors: Sarah L Scarpace

Lung cancer is the third most commonly diagnosed cancer and the leading cause of cancer-related death in the United States. This paper provides an overview of drug therapy options for squamous cell NSCLC with a focus on the evidence and clinical application of the anti-PD1 therapies. A comparison of the dosing, administration, indications, and differences in the measurement of PD-L1 expression in the clinical trials of nivolumab and pembrolizumab is also provided.

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Antidepressant efficacy and side-effect burden: a quick guide for clinicians

Authors: Daniel Santarsieri, Thomas L Schwartz

Prescribing of antidepressant treatment (ADT) for major depressive disorder (MDD) has increased substantially over the last two decades. In this paper, the authors discuss the evidence that supports the use of ADT based on FDA approvals, data from randomized controlled trials or meta-analyses and where these are not available, the authors discuss and apply theoretical pharmacodynamic principles to help guide treatment choice in MDD.

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