SGLT2 inhibitors for CKD, Turmeric for knee pain and Honey for URTI.
Time for spooky cakes with a side of candy corn. We discuss Dapagliflozin (SGLT2i) for CKD, Turmeric for knee pain and Honey for URTI (cough) on this halloween themed hotcakes with Rahul Ganatra MD, MPH @rbganatra
Written by: Rahul Ganatra MD, MPH, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Sarah Phoebe Roberts MPH
Cover Art: Matthew Watto MD, FACP
Hosts: Rahul Ganatra MD, MPH, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Sarah Phoebe Roberts MPH
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
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Bottom Line: Dapagliflozin prevented decline in the composite outcome of major adverse kidney events and death from renal or cardiovascular events. This was driven mainly by less patients having a decline in eGFR by 50%. Very few deaths occurred. This trial was stopped early after just 2.4 years, which might lead us to overestimate the benefit of this treatment and Stuart has major concerns about the cost-effectiveness of SGLT2 inhibitors at this time. That said, we gave it 2-3 hotcakes since we’re excited that SGLT2i’s seem to provide benefit even on top of optimal medical therapy.
Bottom Line: Patients who received turmeric had a 9mm larger decline in pain than placebo on a 0 to 100mm visual analogue pain scale at 12 weeks. Unfortunately, this did not meet the prespecified “minimum clinically important difference” of 18mm. There was a potential for bias since this study was funded by a company that makes turmeric supplements aka “BIG TURMERIC”. Paul gave this 2.5 hotcakes since the treatment was safe and at least somewhat effective. Of note: Acetaminophen (paracetamol) was included in previous guidelines with a difference of only 3.7mm vs placebo!
Bottom Line: The studies included used variable forms of honey across many different age ranges…and one of the primary authors was a beekeeper! The authors concluded that honey seems to be more effective than “usual care” (e.g. diphenhydramine, acetaminophen, naproxen, etc) for controlling upper respiratory tract symptoms, specifically cough frequency and severity. Of note: Honey was not clearly better than placebo.
Bottom Line: A paste of 1 tablespoon of honey and small amount of instant coffee taken with warm water 3 times daily for a week was effective for resolution of persistent post-infectious cough (defined as a cough lasting >3 weeks after respiratory tract infection) compared to a paste containing prednisolone 40 mg daily or guaifenesin (control). This was a positive trial, but the authors performed a per protocol analysis, which introduces the potential for bias. We gave this one 3 spooky cakes with a side of autumn candy corn.
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Listeners will review and perform critical appraisal of recent articles with the potential to change internal medicine practice
After listening to this episode listeners will…
Review the potential benefits of dapagliflozin for prevent of CKD progression and death
Evaluate the utility of turmeric for osteoarthritis with inflammatory synovitis
Discuss the efficacy of honey for the treatment of acute upper respiratory tract infection and persistent post-infectious cough
The Curbsiders report no relevant financial disclosures.
Watto M, Ganatra R, Williams PN, Brigham SK, Roberts SP. “235 Spooky Cakes”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list Final publishing date October 5, 2020.