{"http:\/\/dx.doi.org\/10.14288\/1.0433701":{"http:\/\/vivoweb.org\/ontology\/core#departmentOrSchool":[{"value":"Medicine, Faculty of","type":"literal","lang":"en"},{"value":"Anesthesiology, Pharmacology and Therapeutics, Department of","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider":[{"value":"DSpace","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/alternative":[{"value":"Therapeutics Letter 122","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/creator":[{"value":"Therapeutics Initiative (University of British Columbia)","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/issued":[{"value":"2023-06-20T22:16:36Z","type":"literal","lang":"en"},{"value":"2019-08","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/description":[{"value":"Therapeutics Letter 122 is the second  of two issues celebrating 25 years of The Therapeutics Initiative by highlighting key conclusions from the 120 issues of the Therapeutics Letter that have been published to date.","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO":[{"value":"https:\/\/circle.library.ubc.ca\/rest\/handle\/2429\/85111?expand=metadata","type":"literal","lang":"en"}],"http:\/\/www.w3.org\/2009\/08\/skos-reference\/skos.html#note":[{"value":"Twenty-Five Pearlsfrom 25 years (part 2)August 2019Mailing Address: Therapeutics InitiativeThe University of British ColumbiaDepartment of Anesthesiology, Pharmacology & Therapeutics 2176 Health Sciences MallVancouver, BC Canada V6T 1Z3Tel.: 604 822 0700 Fax: 604 822 0701 E-mail: info@ti.ubc.cawww.ti.ubc.ca122In this Letter, the second in a 2-part anniversary series, we present the remaining 12 \u201cclinical pearls\u201d found in Therapeutics Letters published between 2006 and 2018. The Therapeutics Initiative is celebrating its 25th anniversary this year, in part by highlighting some key conclusions from the 120 issues of the Therapeutics Letter published so far.14The majority of new drugs do NOT represent a major advan-tage when compared to avail-able alternativesIncreasing drug costs: Are we getting good value? [Apr-Jul 2006, issue 59]. This Letter estimated that \u201cif the increased use of \u2018me-too\u2019 drugs in Canada could be stopped for just one year, we could save more than one billion dollars \u2026\u201d Thus, prescribers, administrators, and government bodies collectively have the power to pre-vent this waste and free up money for other sectors of the healthcare system.15Risk assessment tools need to be studied in RCTsUsing Framingham for primary prevention cardiovascular risk assessment [Mar-Apr 2007, issue 63]. This Letter reported on a systematic review of 17 epi-demiologic studies assessing the accuracy of the Fram-ingham risk scores, which concluded that scores were inaccurate, tending to underestimate risk in high risk pop-ulations and overestimate risk in low risk populations.16Health care professionals must know how to critique and verify drug information in news storiesEvaluating the media as a source of drug therapy in-formation [Nov-Dec 2007, issue 67]. This Letter pro-vides examples of how media stories can be misleading and concluded that \u201cFrequently therapeutic effects are neither as spectacular nor as disastrous as media headlines suggest.\u201d17Better benefit and harm evidence is needed before long-term CNS stimulants can be recommended for treatment of ADHD in childrenWhat is the evidence for using CNS stimulants to treat ADHD in children? [Mar-May 2008, issue 69]. Short-term CNS stimulants improve teacher and parent ratings of hyperactive\/impul-sive disruptive behavior but do not improve chil-dren\u2019s ratings of anxiety or measures of academic achievement. Later, Stimulants for ADHD in children - Revisited [Jan-Feb 2018, issue 110] concluded that \u201cthere is convincing evidence that a proportion of boys and girls treated with stimulants in BC and around the world are simply the youngest in their class, and at a dif-ferent developmental stage than earlier-born classmates.\u201d This \u201cbirth month effect\u201d has been confirmed in BC research and around the world.18Statins do NOT have a proven net health benefit in primary prevention and their role in this setting should be reconsideredDo statins have a role in primary prevention? An Update [Mar-Apr 2010, issue 77]. The re-duction in major CHD serious adverse events with statins compared to placebo is not reflected in a reduction in total numbers of people with at least one serious adverse event.\u00a9ISSN 2369-8683 (Print)ISSN 2369-8691 (Online)The Therapeutics Initiative is funded by the BC Ministry of Health through a grant to the University of BC. The Therapeutics Initiative provides evidence-based advice about drug therapy, and is not responsible for formulating or adjudicating provincial drug policies.August 201923Independent analysis of Study 329 demonstrated serious harms and a lack of efficacy for acute and longer-term use of paroxetine and imipra-mine for adolescents with major depressionStudy 329 Why is it so important? [Jul-Aug 2016, issue 101]. This Letter concluded that \u201cPublished conclusions about efficacy and safety of drugs without independent analysis cannot be accepted as trustworthy.\u201d 24Growing evidence that the \u2018gluco-centric\u2019 drug management approach for type 2 diabetes is misguidedIs the current \u2018glucocentric\u2019 approach to management of type 2 diabetes misguided? [Nov-Dec 2016, issue 103]. This Letter concluded that \u201cLarge long-term randomized controlled trials measuring outcomes important to patients are needed urgently to test different approaches and drugs for the man-agement of type 2 diabetes.\u201d Also about treatment of type 2 di-abetes, EMPA-REG OUTCOME Trial: What does it mean? [Jul-Aug 2017, issue 107] concluded: \u201cIt is uncertain whether the reduction in mortality and serious adverse events in the EMPA-REG OUTCOME trial is attributable to empagli-flozin or to less use of other glucose-lowering therapies.\u201d25Compared to placebo the Shingrix vaccine reduced the incidence of herpes zosterShingrix: A New Vaccine for Shingles [Sep-Oct 2018, issue 114]. The vaccine reduced the incidence of shingles over 3.5 years by 3.26% (NNV = 31) in all age groups and reduced the incidence of post-herpetic neuralgia by 0.28% (NNV \u2248 350).  Compared to placebo, Shingrix increased grade 3 systemic reactions (which prevented normal daily activities for about 1-3 days) by 4 to 9% (NNH 11 to 25). When considering this vaccine, the physician and patient must consider the balance of baseline herpes zoster risk, harms, benefits and costs.The draft of this Therapeutics Letter was submitted for review to 130 experts and primary care physicians in order to correct any inaccuracies and to ensure that the information is concise and relevant to clinicians.12219There are no clinically mean-ingful benefits of bisphos-phonates in postmenopaus-al women with NO prior fracture or vertebral compressionA systematic review of the efficacy of bisphospho-nates [Sep-Oct 2011, issue 83]. Because of the small magnitude of effect and the high risk of bias in the included trials, this Letter concluded that in wom-en with a prior fracture or vertebral compression, \u201cit is unclear whether bisphosphonates cause a clinically meaningful reduction of hip fractures.\u201d 20Seven steps to become adept at deprescribingReducing Polypharmacy. A logical approach [Jun-Jul 2014, issue 90]. Treatments for symptoms or prevention should be re-evalu-ated regularly and should meet a test of common sense: \u201cin this patient, do the medicine\u2019s bene-fits meaningfully outweigh its harms?\u201d21Most commonly used surro-gate markers have not been proven to be consistently predictive of morbidity and mortalityThe limitations and potential hazards of using surrogate markers [Oct-Dec 2014, issue 92]. This Letter provided examples of where relying on sur-rogate markers to assess effectiveness of drug ther-apy proved to be harmful. The Letter recommends avoiding \u201cchasing surrogate targets (e.g. LDL cholesterol) that have not been proven to have a net health benefit.\u201d22Lower blood pressure tar-gets have not been shown to have a net health benefitDoes SPRINT change our approach to blood pressure targets? [Jan-Feb 2016, issue 98] and Using best evidence for the management of hy-pertension [May-Jun 2017, issue 106]. An updat-ed analysis of 11 RCTs (including SPRINT) with over 38,000 participants showed that lower tar-gets did not reduce total mortality, or total serious adverse events. Blood pressure treatment tar-gets should be the same as those used in RCTs, i.e.below 140-160\/90-100 mmHg, for preven-tion of cardiovascular events and death.BRINGING BEST EVIDENCE TO CLINICIANS8am to 5pm, Saturday October 5th, 2019 Vancouver General Hospital, 899 West 12th AveAccreditation: 6.5 MAINPRO+ MOC SECTION1Brochure: https:\/\/ti.ubc.ca\/BestEvidence19Registration: https:\/\/events.eply.com\/BestEvidence19","type":"literal","lang":"en"},{"value":"The UBC TI is funded by the BC Ministry of Health to provide evidence-based information about drug therapy. We neither formulate nor adjudicate provincial drug policies.","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/hasType":[{"value":"Other","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/isShownAt":[{"value":"10.14288\/1.0433701","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/language":[{"value":"eng","type":"literal","lang":"en"}],"https:\/\/open.library.ubc.ca\/terms#peerReviewStatus":[{"value":"Reviewed","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/provider":[{"value":"Vancouver : University of British Columbia Library","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/rights":[{"value":"Attribution-NonCommercial-NoDerivatives 4.0 International","type":"literal","lang":"en"}],"https:\/\/open.library.ubc.ca\/terms#rightsURI":[{"value":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/","type":"literal","lang":"en"}],"https:\/\/open.library.ubc.ca\/terms#scholarLevel":[{"value":"Faculty","type":"literal","lang":"en"},{"value":"Researcher","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/subject":[{"value":"Antidepressive Agents","type":"literal","lang":"en"},{"value":"Antihypertensive Agents","type":"literal","lang":"en"},{"value":"Attention Deficit Disorder with Hyperactivity","type":"literal","lang":"en"},{"value":"Biomarkers","type":"literal","lang":"en"},{"value":"Diphosphonates","type":"literal","lang":"en"},{"value":"Central Nervous System Stimulants","type":"literal","lang":"en"},{"value":"Deprescriptions","type":"literal","lang":"en"},{"value":"Diabetes Mellitus, Type 2","type":"literal","lang":"en"},{"value":"Herpes Zoster Vaccine","type":"literal","lang":"en"},{"value":"Hydroxymethylglutaryl-CoA Reductase Inhibitors","type":"literal","lang":"en"},{"value":"Journalism","type":"literal","lang":"en"},{"value":"Mass Media","type":"literal","lang":"en"},{"value":"Postmenopause","type":"literal","lang":"en"},{"value":"Primary Prevention","type":"literal","lang":"en"},{"value":"Risk Assessment","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/title":[{"value":"Twenty-Five Pearls from 25 years (part 2)","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/type":[{"value":"Text","type":"literal","lang":"en"}],"https:\/\/open.library.ubc.ca\/terms#identifierURI":[{"value":"http:\/\/hdl.handle.net\/2429\/85111","type":"literal","lang":"en"}]}}