#235 Spooky Cakes: Dapa-CKD, Turmeric, Honey

October 5, 2020 | By Matthew Watto, MD

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

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

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Credits

• Producer: Sarah Phoebe Roberts
• 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

Sponsor

National Internal Medicine Day

Help ACP celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD20 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtags #NationalInternalMedicineDay, #IMProud, and #IMEssential.

VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

How to Claim VCU CME Credit

Time Stamps

• 00:00 Sponsor – National Internal Medicine Day, The American College of Physicians
• 00:25 Sponsor – VCU Health Continuing Education
• 00:40 Intro, disclaimer, Picks of the Week
• 07:38 Sponsor – National Internal Medicine Day, The American College of Physicians
• 08:40 Dapa-CKD
• 20:00 Turmeric for Knee Osteoarthritis
• 32:10 Honey for URTI and Cough
• 46:32 Shout out to @votehealth2020 and PatientVoting.com 
• 48:25 Outro
• Sponsor – VCU Health Continuing Education

Spooky Cakes

1. 1. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine 2020.
      • 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. 
   2. Wang Z, Jones G, Winzenberg T, et al. Effectiveness of Curcuma longa Extract for the Treatment of Symptoms and Effusion–Synovitis of Knee Osteoarthritis. Annals of Internal Medicine 2020.
      • 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!
   3. Abuelgasim H, Albury C, Lee J. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis. BMJ Evidence-Based Medicine 2020:bmjebm-2020-111336.
      • 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. 
   4. Raeessi MA, Aslani J, Raeessi N, Gharaie H, Karimi Zarchi AA, Raeessi F. Honey plus coffee versus systemic steroid in the treatment of persistent post-infectious cough: a randomised controlled trial. Prim Care Respir J. 2013 Sep;22(3):325-30. doi: 10.4104/pcrj.2013.00072. PMID: 23966217; PMCID: PMC6442828.
      • 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.

Links*

1. Candy Corn (autumn mix) and (classic)
2. Paul’s Halloween movie marathon: Cabin in the Woods, The Descent, The Witch, Ghostbusters

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will review and perform critical appraisal of recent articles with the potential to change internal medicine practice

Learning objectives

After listening to this episode listeners will…  

1. Review the potential benefits of dapagliflozin for prevent of CKD progression and death
2. Evaluate the utility of turmeric for osteoarthritis with inflammatory synovitis
3. Discuss the efficacy of honey for the treatment of acute upper respiratory tract infection and persistent post-infectious cough

Disclosures

The Curbsiders report no relevant financial disclosures. 

Citation

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.