2 Minute Medicine Rewind April 14, 2025
Yoga or Strengthening Exercise for Knee Osteoarthritis
1. In patients with knee osteoarthritis (OA), yoga did not significantly reduce knee pain compared to those performing strengthening exercises.
Yoga was non-inferior compared to strengthening exercises for patients with knee osteoarthritis with similar knee symptoms, quality of life and depression observed in both groups.
Evidence Rating Level: 1 (Excellent)
Exercise therapy is currently recommended as first-line therapy for OA by several international guidelines. However, differences in the effectiveness of different forms of exercise have not been well explored in the management of knee OA. This study therefore sought to compare the effectiveness of yoga and strengthening exercises in patients with OA. Between June 2021 and June 2022, 117 participants (mean[SD] age, 62.5[8.3] years; 72.6% female) with knee OA from Australia were randomized to either a yoga program (n = 58) or a strengthening program (n = 59). Both programs took place across 24 weeks and involved 3 sessions per week of each respective exercise type. Participants were assessed at 4 week intervals for visual analog scale (VAS) knee pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Over 12 weeks, there was no significant between-group differences in mean VAS knee pain (between-group difference, −1.1 mm [95% CI, −7.8 to 5.7 mm]; P = .76; Cohen d, −0.2 [95% CI, −1.6 to 1.2]). A similar trend was observed over 24 weeks with no significant between-group differences in mean VAS knee pain (between-group difference: −5.8 mm [95% CI, −12.9 to 1.2 mm]; P = .11; Cohen d, −1.1 [95% CI, −2.5 to 0.3]). Over 24 weeks, there was a modest difference between groups in favour of yoga for WOMAC pain (between-group difference, −44.5 mm [95% CI, −70.7 to −18.3 mm]). Overall, this study found that yoga was similar in effectiveness to strengthening exercises for patients with knee OA.
Epinephrine vs Norepinephrine as Initial Treatment in Children With Septic Shock
1. Epinephrine was associated with greater 30-day mortality compared to norepinephrine in the management of septic shock in pediatric patients.
Evidence Rating Level: 2 (Good)
Vasoactive agents remain the therapeutic option of choice in the management of septic shock in children who have not adequately responded to intravenous fluid resuscitation alone. In adults, norepinephrine remains the clear first line vasoactive agent of choice. However, there are few studies comparing the effectiveness of epinephrine and norepinephrine in children with septic shock. This study therefore sought to investigate outcomes in children with septic shock who were treated with either agent. 231 children (median[IQR] age, 11.4[5.6-15.4] years); 54.6% female) from the Boston Children’s Hospital with septic shock who were treated with epinephrine (n = 147) or norepinephrine (n = 84) were included in the analysis. The primary outcome of the study was MAKE30 which was a composite outcome including death or renal function-related outcomes such as persistent kidney dysfunction by 30 days of hospital discharge, whichever occurred first. Secondary outcomes included 30 day in-hospital mortality. There was no statistically significant difference in the number of children who met MAKE30 between children who received epinephrine or norepinephrine (6.1% vs 3.6% respectively). Epinephrine was associated with greater 30-day mortality compared to norepinephrine (3.7 vs 0%; risk difference: 3.7%; 95% CI, 0.2% to 7.2%). Overall, this study found that among children with septic shock requiring vasoactive agents, epinephrine was associated with greater 30-day mortality compared to norepinephrine.
1. In patients admitted to the intensive care unit (ICU) with at least one risk factor for clinically significant gastrointestinal bleeding (GIB), the impact of stress ulcer prophylaxis (SUP) on 28-day mortality was greatest in those who were younger, had chronic liver disease, coagulopathy or malignancy.
Evidence Rating Level: 2 (Good)
While GIB can contribute to critical illness or death, SUP may also increase the rate of adverse events such that it is difficult to delineate whether benefits of SUP justify its application in such patients. A previous clinical trial has shown benefits for SUP in ICU patients with risk factors for GIB. However, significant heterogeneity in treatment effect was observed depending on patient characteristics. This retrospective cohort study therefore sought to identify which patients would benefit most from SUP. Records of 25,475 patients (median[IQR] age, 66[55-77] years) with at least 1 risk factor for GIB were obtained from a comprehensive database from the Beth Israel Deaconess Medical Centre, Boston and analyzed for 28-day mortality after ICU entry. When analyzed based on subgroups, the impact of SUP on 28-day mortality was markedly different in patients older than 77 compared to other age groups (posterior probability of difference in OR, 99.3%), in patients with liver disease compared to those without (median OR, 0.87 vs 1.07; posterior probability of difference in OR, 99.9%), in patients with coagulopathy compared to those without (median OR, 0.95 vs 1.09; posterior probability of difference in OR, 92.1%) and in those with malignancy compared to those without (median OR 0.57 vs 1.20, posterior probability of difference in OR, 100%). Overall, this study found that among patients admitted to ICU with at least one risk factor for clinically significant GIB, the impact of SUB on 28-day mortality was greatest in younger patients and patients who had chronic liver disease, coagulopathy or malignancy.
1. In postmenopausal patients with ulcerative colitis (UC) or Crohn’s disease (CD), approximately one-third had osteoporosis while approximately 40% had osteopenia.
2. In men aged over 50 years with UC or CD, approximately 13% had osteoporosis while approximately 50% had osteopenia.
Evidence Rating Level: 2 (Good)
Osteopenia and osteoporosis are diseases that are well-known to occur commonly in those with inflammatory bowel disease (IBD). However, the prevalence of osteopenia and osteoporosis at IBD diagnosis has not been well characterized, and bone mineral density (BMD) testing remains underutilized in these patients. This prospective cohort study therefore sought to determine the incidence of osteopenia and osteoporosis at IBD diagnosis. 209 and 141 patients with a new diagnosis of UC (median[IQR] age, 44[28-57]; 53.1% female) and CD (median age[IQR], 36[25-54]; 46.1% female) from Copenhagen were included and assessed for osteopenia and osteoporosis via BMD testing using dual-energy X-ray absorptiometry (DEXA). Among postmenopausal women with a new diagnosis of UC and CD, 35.7% (15/42) and 28.6% (6/21) were diagnosed with osteoporosis respectively. Among males aged above 50 years with a new diagnosis of UC and CD, 13.2% (5/38) and 12.5% (3/24) were diagnosed with osteoporosis respectively. The incidence of osteopenia in postmenopausal women with newly diagnosed UC and CD was 40.5% (17/4) and 38.1% (8/21) respectively, while in men aged above 50 with newly diagnosed UC and CD it was 44.7% (17/38) and 50.0% (12/24) respectively. Overall, this study showed that postmenopausal women and men aged over 50 with a new diagnosis of UC and CD experience much higher rates of osteopenia and osteoporosis compared to those without UC and CD.
1. While not statistically significant, the use of sotorasib plus panitumumab may have a 30% relative risk reduction in the risk of death compared to the investigator’s choice of chemotherapy in the management of Kirsten rat sarcoma viral oncogene homologue (KRAS) glycine-to-cysteine mutation at codon 12 (KRAS G12C) colorectal cancer.
Evidence Rating Level: 1 (Excellent)
Currently, the management of KRAS-mutated colorectal cancer remains limited to chemotherapy with a lack of targeted therapeutic options available. CodeBreak 300 was a randomized, phase III clinical trial which evaluated the efficacy of sotorasib, an irreversible KRAS G12C inhibitor, in combination with panatimumab compared to the investigator’s choice of standard-care trifluridine/tipiracil or regorafinib. This study presents the final analysis of overall survival (OS) of CodeBreak 300. 160 patients with KRAS G12C chemorefractory metastatic colorectal cancer (mCRC) were randomly assigned to receive either sotorasib 960 mg-panatimumab (n = 53), sotorasib 240 mg-panatimumab (n = 53) or investigator’s choice (n = 54). The estimated hazard ratio (HR) for OS was 0.83 (95% CI, 0.49 to 1.39; descriptive two-sided P = .50) with sotorasib 240 mg-panatimumab and 0.70 (95% CI, 0.41 to 1.18; two-sided P = .20 v statistically significance threshold 0.01875) with sotorasib 960 mg-panatimumab. The overall response rates (ORR) across the sotorasib 960 mg-panatimumab, sotorasib 240 mg-panatimumab, and investigator’s choice groups were 30.2% (95% CI, 18.3 to 44.3), 7.5% (95% CI, 2.1 to 18.2), and 1.9% (95% CI, 0.0 to 9.9). Overall, this study found that while there was no statistically significant difference in OS between each of the groups, the use of sotorasib 960 mg plus panitumumab may have a 30% relative risk reduction in the risk of death compared to the use of trifluridine/tipiracil or regorafinib.
Image: PD
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