You might be interested in…Therapeutics

Migraine affects more than one billion people worldwide and is a leading cause of disability. The acute management of migraine episodes consists of drug interventions aimed at providing rapid and sustained pain relief, and, ideally, freedom from pain. Several drugs with different mechanisms of action are available.

The aim of this systematic review and network meta-analysis1was to compare all licensed drug interventions as oral monotherapy for the acute treatment of migraine episodes in adults. Inclusion criteria were for double blind randomised trials of adults (≥18 years) with a diagnosis of migraine according to the International Classification of Headache Disorders.

The results included 137 randomised controlled trials comprising 89,445 participants allocated to one of 17 active interventions or placebo. The conclusion was that, considering both efficacy and tolerability, eletriptan, rizatriptan, sumatriptan, and zolmitriptan showed the best overall performance for the acute treatment of migraine.

Also, eletriptan, rizatriptan, sumatriptan, and zolmitriptan were more efficacious than the recently marketed and more expensive drugs lasmiditan, rimegepant, and ubrogepant, which showed efficacy comparable to paracetamol and most nonsteroidal anti-inflammatory drugs. Finally, the authors suggested that triptans are currently widely underused, and access to the most effective triptans should be promoted globally and international guidelines updated accordingly.

Persons living with Parkinson’s Disease (PD) may face limitations with respect to daily activities of self-care, productivity, and leisure, leading to reduced indepen­dence and restricted participation in meaningful daily occupations and social activities, which in turn affects their quality of life. Recent years have witnessed an increasing interest in performing arts such as dance as a therapeutic medium for PD.

Dance classes for people with PD are offered worldwide. The purpose of this qualitative study2 was to explore how Dance for Parkinson (Dance for PD) is experienced, and how it contributes to the well-being and health of participants in Sweden.

The authors collected data from four focus groups. Participants were asked how dance classes impacted their well-being, and their ability to perform activities of daily life. The findings were that Dance for PD provided a multifaceted experience related to social relationships, aesthetic context, feelings of wellbeing and the physical experience of dancing. The main theme contained four sub-themes: Connectedness, Pleasure and glamour, Well-being in mind and body and Customized movements.

The authors concluded that Dance for PD is an enjoyable activity that meets the specific needs of persons living with the consequences of PD and should therefore be promoted by occupational therapists.

Reduced appendicular muscle mass is a key criterion for diagnosing sarcopenia. Studies have shown that the appendicular lean muscle mass index (ALMI) decreases annually by 0.7% in women and 0.8% in men among healthy older adults. The prevalence of sarcopenia in this population ranges from 9.9% to 40.4%, depending on the diagnostic criteria used. Sarcopenia in older adults is linked to adverse outcomes, including increased falls, functional decline, and higher rates of hospitalizations. This paper is a is a secondary endpoint analysis of a three-year randomized, double-blind, placebo-controlled trial called DO-HEALTH.3

There were 1,495 participants aged 70 years and older. The mean age was 74.9; 63.3% were women; 80.5% were at least moderately physically active at baseline. At the time of the study participants were healthy and physically active and were randomized to receive 2000 IU/d vitamin D and/or 1 g/d marine omega-3s and/or exercise. Change in ALMI over three years was calculated in all participants. The findings were that none of the treatments individually or in combination reduced the odds of incident sarcopenia compared with placebo.

Antidepressants are among the most commonly prescribed medications in the United States. In 2017 to 2018, 14% of U.S. adults reported using an antidepressant. Weight gain is a commonly reported side effect of antidepressant use that may affect patients’ long-term metabolic health.

The objective of this observational cohort study over 24 months4was to compare weight change across common first-line antidepressant treatments. The study looked at electronic health record (EHR) data from 2010 to 2019 across eight U.S. health systems, looking at data from 183,118 patients.

The eight drugs studied were sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine. Compared with that for sertraline, estimated 6-month weight gain was higher for escitalopram (difference, 0.41 kg), paroxetine (difference, 0.37 kg), duloxetine (difference, 0.34 kg), venlafaxine (difference, 0.17 kg), and citalopram (difference, 0.12 kg); similar for fluoxetine (difference, -0.07 kg); and lower for bupropion (difference, -0.22 kg). Six-month adherence ranged from 28% (duloxetine) to 41% (bupropion). Clinicians could consider potential weight gain and adherence to medication when initiating antidepressant treatment.

Finally in brief, data from DAYLIGHT5 support the clinical value of fezolinetant as a non-hormonal option for management of moderate-to-severe vasomotor symptoms of the menopause. The trial was funded by Astellas pharma which makes the drug so the usual caveats must apply.

References:

1. Karlsson W et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis. BMJ 2024;386:e080107. http://dx.doi.org/10.1136/bmj-2024‑080107
2. Andresson I et al. Dance for Parkinson, multifaceted experiences of persons living with Parkinson’s Disease. Scandinavian Journal of Occupational Therapy 2024, VOL. 31, NO. 1, 2411206. https://doi.org/10.1080/11038128.2024.2411206
3. Eggimann A et al. Effect of vitamin D, omega-3 supplementation, or a home exercise program on muscle mass and sarcopenia: DO-HEALTH trial. J Am Geriatr Soc. 2024;1–11. doi: 10.1111/jgs.19266
4. Petimar J et al. Medication-Induced Weight Change Across Common Antidepressant Treatments. A Target Trial Emulation Study. Ann Intern Med. doi:10.7326/M23-2742 (Published July 2024).
5. Schaudig K, et al. Efficacy and safety of fezolinetant for moderate-severe vasomotor symptoms during menopause in individuals unsuitable for hormone therapy: phase 3b randomised controlled trial. BMJ 2024;387:e079525 . doi: https://doi.org/10.1136/bmj-2024-079525