No convincing evidence for Grazax in hay fever
Use of Grazax (grass pollen extract) to treat hay fever is not, on current evidence, recommended by the Drug and Therapeutics Bulletin.
Grazax is reviewed in the February issue of DTB, which concludes that published clinical trials offer no convincing evidence of a worthwhile benefit from the drug. It highlights that no published trials have compared Grazax with subcutaneous immunotherapy or standard symptomatic therapies for allergic rhinitis.
Moreover, it says, it could find no published trials that have specifically assessed the effect of Grazax in patients who remain symptomatic despite optimal use of standard therapies. The bulletin also points out that Grazax is expensive (£821 per year) compared with immunotherapy injections (£320) and symptomatic treatment (£6 for loratadine and £29 for beclometasone) and its long-term safety and efficacy are not known.
The use of Versatis (lidocaine 5 per cent plasters) to treat postherpetic neuralgia is similarly rejected by the DTB. The bulletin does not recommend the product, which was licensed last year, because evidence of its efficacy compared with placebo comes from small, short-term studies. “Importantly, lidocaine plasters have not been compared with established, and less costly, treatments for postherpetic neuralgia,” it says.
The February DTB also reviews the treatment of depression in patients who misuse alcohol. It recommends that abstinence from alcohol should be the first aim since depressive symptoms often remit within two weeks of quitting. Any residual depression should then be treated with antidepressants (often along with psychological therapy). However, tricyclic antidepressants are best avoided because of their potential toxicity in combination with alcohol and in overdose.
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