Urgent Updates - December 10, 2021

EVALUATION OF PHARMACOLOGIC TREATMENTS FOR H1 ANTIHISTAMINE–REFRACTORY CHRONIC SPONTANEOUS URTICARIAA SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
In this network meta-analysis of 23 randomized clinical trials including 2480 participants, the biologic agents ligelizumab, 72 or 240 mg (large beneficial effect), and omalizumab, 300 or 600 mg (moderate beneficial effect), appeared to be effective treatments for H1antihistamine–refractory chronic spontaneous urticaria. With respect to the magnitude of effect size and evidence certainty, dapsone; hydroxychloroquine; cyclosporine; ligelizumab, 24 mg; omalizumab, 150 mg; and zafirlukast seem to have a small beneficial effect.
Full Access: JAMA

AAP UPDATES COVID-19 GUIDANCE FOR TESTING, FACE MASKS, MIS-C
This guidance is intended to assist pediatricians in understanding indications for SARS-CoV-2 testing as well as test selection and interpretation. The document also provides algorithms for common testing scenarios and information about practical considerations for in-office testing for SARS-CoV-2. Some of the recommendations include that patient treated for MIS-C wait at least 90 days after the diagnosis to receive a COVID-19 vaccine.
Full Access: AAP

ACG CLINICAL GUIDELINE FOR THE DIAGNOSIS AND MANAGEMENT OF GASTROESOPHAGEAL REFLUX DISEASE
ACG updates guidelines for GERD diagnosis, pharmacologic, lifestyle, surgical and endoscopic management. Some of the recommendations include: for patients with classic GERD symptoms of heartburn and regurgitation who have no alarm symptoms, we recommend an 8-wk trial of empiric PPIs once daily before a meal; we recommend attempting to discontinue the PPIs in patients whose classic GERD symptoms respond to an 8-wk empiric trial of PPIs; we recommend PPI administration 30–60 min before a meal rather than at bedtime for GERD symptom control; we do not recommend sucralfate for GERD therapy except during pregnancy.
Full Access: The American Journal of Gastroenterology

NON-SURGICAL TREATMENT OF LATERAL EPICONDYLITIS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS
There are multiple randomized controlled trials for non-surgical management of lateral epicondylitis, but the existing literature does not provide conclusive evidence that there is one preferred method of non-surgical treatment for this condition. Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment.
A 2014 systematic review of RCTs of nonsurgical treatments for lateral epicondylitis identified 4 studies comparing corticosteroid injections to saline or anesthetic injections. Neither corticosteroid, platelet-rich plasma, botulinum toxin, prolotherapy, hyaluronic acid, or autologous blood injections have proven superior to saline or anesthetic injections. However, all injections that contained “placebo” significantly improved lateral epicondylitis.
Full Access: Pubmed

SUCCESS OF COVID ANTIVIRAL PILLS HINGES ON SPEEDY, ACCURATE TESTS
U.S. could have access to a new antiviral pill from Merck expected to alter the deadly trajectory of the covid-19 pandemic — with a second option from Pfizer to follow shortly after. In clinical trials, molnupiravir was given to non-hospitalized, unvaccinated, high-risk adult patients within five days of their first covid symptoms. Pfizer’s product, Paxlovid, was tested in similar patients as early as three days — just 72 hours — after symptoms emerged. Results from the Merck trial showed the drug reduced the risk of hospitalizations by about 50% and prevented deaths entirely.
Full Access: Medscape