170. Semaglutide, NEW Gonorrhea Guidelines, Cost of Diabetic Drugs, Mask and Children

Semaglutide works for weight loss but at what co$t?

BOARD CHANGER- New gonorrhea guidelines

Diabetes drugs are expensive for our patients and we can't forget that.

Children find it hard to tell what facial expression you are giving when you have a mask on!


https://www.nejm.org/doi/10.1056/NEJMoa2032183

industry-conducted trial published in the New England Journal of Medicine.
Researchers randomized nearly 2000 participants without diabetes who were either overweight with at least one weight-related comorbidity or obese to receive All2.4 mg subcutaneous semaglutide or placebo weekly for 68 weeks.
mean bmi 38. weighing at 105 lbs.

Mean weight loss was significantly greater with semaglutide than placebo (15% vs. 2%), as was the percentage of patients losing >5% of body weight (86% vs. 32%).

difference is 31lbs-- over 68weeks or 16 months.. the drug cost 734$ per month. that is 11,744 for treatment or 379 per pound. not worth it to me

twitter and say shouldnt you have the conversation?!?





BOARD CHANGER



The CDC now recommends treating uncomplicated gonorrhea with a single 500-mg intramuscular dose of ceftriaxone, according to updated guidelines in MMWR. The recommendation applies to urogenital, anorectal, and pharyngeal infections.
Previously, the CDC recommended ceftriaxone plus oral azithromycin. The authors note that azithromycin resistance is "an increasing concern." Nationwide, the percentage of N. gonorrhoeae isolates with reduced susceptibility to azithromycin increased from 0.6% in 2013 to 4.6% in 2018.
Among the recommendations:
People weighing ≥150 kg should be given a single 1-g dose of ceftriaxone.
In patients for whom a chlamydial infection has not been ruled out, doxycycline 100 mg orally twice a day for 7 days is also recommended.
For patients with cephalosporin allergy, an intramuscular dose of gentamicin (240 mg) plus an oral dose of azithromycin (2 g) may be considered.
In cases where intramuscular ceftriaxone can't be given, an oral dose of cefixime (800 mg) is an option, but the authors note it may not be as effective.
For pharyngeal gonorrhea, there are no reliable alternative therapies and test-of-cure is recommended.


Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 | MMWR
BOARD ANSWER CHANGER
https://news.wisc.edu/can-blocking-a-frown-keep-bad-feelings-at-bay/


remember that article back in 2010 which basically showed those people to get botox had decrease ability to defer emotions or facial expressions of others??

It was out of the university of wisconin and not they are back at it with this article----


https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0243708

Children’s emotion inferences from masked faces: Implications for social interactions during COVID-19


Plos one


This study took 81 7-13yr old child to see how children perceived others’ emotions as partial information about the face was presented

pictures of stereotypical facial configurations associated with sadness, anger, and fear posed by male and female models.

Pictures were presented in unaltered format (i.e., with no covering) or digitally altered to be (a) covered with a surgical face mask that obscured the mouth and nose, or (b) covered with sunglasses that obscured the eyes and eyebrows

The primary question addressed by this study is whether masks meaningfully degraded children’s ability to infer others’ emotions

“Accuracy between the faces that wore masks and shades did not differ”

And that was the others conclsuions

“These data suggest that while there may be some challenges for children incurred by others wearing masks, in combination with other contextual cues, masks are unlikely to dramatically impair children’s social interactions in their everyday lives”

But that doesn’t tell the whole story


Because when you look at the results you see that both sunglasses and mask did present a challenge for kids compared to no mask or no sunglasses. About a 10% absolute difference or a 33% realtive difference and althought you cant really use NNT in this type of trial if you were that would be a NNH of 10.

For every 10 kids, 1 kid has a dramatic impairment in their ability to infer others emotions with the use of mask or sunglasses

This is not me being antimask. This is not me saying that mask are the devil. This is me saying there are real effects to what we are doing and we have to be prepared for them and one of them might be children that are not able to infer emotions as well.




Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020

new guidelines regarding treatment of gonorrhea-
Prior recommendations had included treating a patient for both gonorrhea and chlamydia when there was a positive gonorrhea test regardless of chlamydia results. These updated guidelines recommend not treating a patient for chlamydia if the patient is diagnosed with gonorrhea if testing shows no chlamydia infection. Treatment for both is still recommended if chlamydia status is unknown. Dosing for gonorrhea treatment was also increased from ceftriaxone 250mg IM to 500mg IM, and treatment for coinfection with chlamydia was changed from azithromycin to doxycycline with a longer course of 7 days.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.
2922?guestAccessKey=3ed2a6bb-bc67-4b5e-955c-
08cc5b7bedf6&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-
jamainternalmedicine&utm_content=etoc&utm_term=120720

ben franklin is linked to the famous saying “a penny saved is a penny earned” well I wonder
what he would say about our next and last paper titled-
Out-of-Pocket Costs for Novel Guideline-Directed Diabetes Therapies Under Medicare Part D

Which did exactly as the article suggests and looked at the cost of novel diabetic agents under Medicare
part D which covers almost 45,000,000 people.
They reviewed 6 drug classes and projected annual out-of-pocket costs
Across near 3000 Part D plans commonly covered GLP-1RAs, SGLT2is, and DPP-4is had
monthly list prices between $434 to $935
compared with $3 to $11 for metformin, sulfonylureas, and TZDs.
What does that mean for your patient, how does that translate into real world information??
Well,
annual costs for common novel agents were $5202 to $11 225
with only $31 to $136 for traditional drugs
And the Projected annual out-of-pocket cost for novel drug regimen were $1231 to $1981,
compared with $250 to $355 for traditional regimens.

Considering at best these new agents have a NNT of 20 the variability to prevent one nonfatal
event that approaches 100K needs to be seriously looked at.