Key Message

Evidence from 1 retrospective cohort study (identified in 1 systematic review) suggested that anakinra may reduce 28-day mortality and the risk for death in adults diagnosed with hemophagocytic lymphohistiocytosis (HLH).

Due to the very low certainty of evidence from the single cohort study included in the systematic review, there is insufficient information to draw reliable conclusions regarding the clinical effectiveness of anakinra compared to standard treatments for patients diagnosed with HLH.

No evidence on the safety or cost-effectiveness of anakinra compared to current standard treatments or to placebo was identified.

Key Message

Two systematic reviews (1 with a network meta-analysis and 1 with a meta-analysis),1 randomized controlled trial, and 7 non-randomized studies were identified about the comparative clinical effectiveness of normothermia versus hypothermia in adult patients after cardiac arrest.

Normothermia was found to be similar to hypothermia for several clinical- and patient related outcomes, such as survival, hospital mortality, and quality of life. There was limited evidence to suggest that either type of targeted temperature management was more efficacious, with findings suggesting that normothermia may be associated with greater protocol adherence and decreased prescription medication use coming from low-quality non-randomized studies.

Four evidence-based guidelines were identified regarding targeted temperature management (normothermia or hypothermia) in adult patients after cardiac arrest. All guidelines strongly recommend targeted temperature management for eligible patients, particularly for patients resuscitated following out-of-hospital cardiac arrest. Identified guidelines from the Canadian Cardiovascular Society and American Academy of Neurology present strong recommendations for hypothermic targeted temperature management.

Key Message

During surgery, wounds can be washed out, or irrigated, using antibiotic, antiseptic, or saline solutions to prevent infections; the evidence in this report found over 20 different antibiotic solutions used across trials.Most studies showed that antibiotic irrigation solutions were better or no different compared to using antiseptic, saline, or no irrigation; however, a small number of studies indicated otherwise. One study reported in a systematic review showed fewer infections and complications for antiseptic compared to a triple antibiotic solution, while another study included in the same systematic review found a higher percentage of implant loss when a triple antibiotic solution was compared to antiseptic; data were poorly reported in these studies.Bacitracin-specific evidence was found in 2 studies; 1 study reported in 1 systematic review showed a higher percentage of infection when bacitracin irrigation was compared to cefazolin and saline irrigation; however, this was not statistically significant. Another study showed no differences in infections requiring surgical intervention or in hospitalization when bacitracin irrigation was compared to no irrigation.One guideline recommends that wound irrigation and intracavity lavage should not be conducted during surgery, and that applying antibiotics before wound closure should only be done as part of a research trial.Due to the mixed findings across studies, high-quality research is needed to clarify the role of antibiotic irrigation during surgery. Because guideline recommendations about wound irrigation, specifically, are based on research published before 2008, updated guidelines to include research from more current studies are needed to reflect current practice.

Key Message

Four systematic reviews (SRs) and 1 economic evaluation were identified regarding the clinical effectiveness (including safety) and cost-effectiveness of adalimumab in adults with non-infectious uveitis.

In adults with active non-infectious uveitis (VISUAL I), adalimumab significantly lowered the risk of treatment failure and significantly improved changes in best-corrected visual acuity, anterior chamber cell grade, and vitreous haze grade. Additionally, the number and rate of adverse events and serious adverse events were greater in the adalimumab group compared to the placebo group. Clinical effectiveness and safety findings from the Japanese sub study (VISUAL I Japan) and data from a randomized controlled trial of a younger adult population (ADUR) demonstrated that adalimumab may have no treatment effect.

In adults with inactive non-infectious uveitis (VISUAL II), adalimumab significantly lowered risk of treatment failure; however, adalimumab may have no treatment effect on changes in best-corrected visual acuity, anterior chamber cell grade, and vitreous haze grade. Additionally, the number and rate of adverse events and serious adverse events were variable in the adalimumab versus placebo groups (e.g., number of adverse events was greater in the adalimumab group but the rate of adverse events was higher in the placebo groups). Clinical effectiveness and safety findings from the Japanese substudy (VISUAL II Japan) demonstrated that adalimumab may have no treatment effect.

Considering both active and inactive non-infectious uveitis (VISUAL I, VISUAL I [Japan], VISUAL II, VISUAL II [Japan], and ADUR), change in vitreous haze grade improved significantly more in the adalimumab group than the control group.

In the perspective of the health care system in the UK, adalimumab (plus systemic corticosteroid and immunosuppressant therapy) is not more cost-effective than systemic corticosteroid and immunosuppressant use alone (modelled by placebo data) in adults with active and inactive non-infectious uveitis influencing the posterior segment (i.e., back of the eye).

No evidence-based guidelines regarding the use of adalimumab for the treatment of adults with non-infectious uveitis were identified.

Key Message

In adults with rheumatoid arthritis, prefabricated orthopedic footwear may reduce foot pain and improve physical functioning, but not affect health-related quality of life. However, this is based on evidence of variable quality from within-group designs, comparing outcomes pre- and postintervention.

Due to conflicting results, evidence of variable quality from comparatives studies regarding the effectiveness of prefabricated orthopedic footwear for foot pain and foot function in people with inflammation of the soles of the feet (plantar fasciitis) or gout was inconclusive.

Evidence of variable quality from 2 systematic reviews suggested that prefabricated orthopedic footwear after a healed diabetic foot ulcer (DFU) may prevent the recurrence of the condition better than conventional shoes at 1 year but not at 2 years.

No economic evaluations were identified that evaluated the cost-effectiveness of prefabricated orthopedic footwear for treating people with lower-limb conditions.

Two evidence-based guidelines recommended against using orthopedic footwear for treatment in patients with DFUs and 2 recommended using orthopedic footwears for adults with healed DFUs to prevent a recurrence. One guideline recommended using orthopedic footwear by adults with rheumatoid arthritis.

Key Message

An update to a 2020 Canada's Drug Agency Rapid Review was conducted to capture new literature published since 2019 examining the effectiveness of drug treatment informed by genetic testing compared to usual care for adults with depression. Eleven studies were identified: 1 systematic review, 1 health technology assessment, 4 randomized controlled trials reported in 5 publications, 1 non-randomized study, 1 cohort study with historical control, and 2 uncontrolled before-and-after studies. Similar to the conclusions of the 2020 Canada's Drug Agency report, the effectiveness of gene testing for treating depression was unclear. In patients with depression, some studies showed that there were improvements in the clinical effectiveness outcomes in those who received gene testing and other studies showed that there was no difference in outcomes between those who received gene testing and those who did not. No studies showed that gene testing resulted in worse outcomes compared to those who did not receive gene testing. In the current report, the were several limitations across studies such as poor design, inclusion of subjectively measured outcomes, small sample sizes, and a focus on hospital settings all of which may not be generalizable to other populations.

Key Message

One relevant systematic review and network meta-analysis (which included 1 relevant randomized controlled trial), 4 non-randomized studies, and 6 evidence-based guideline reports, representing 5 evidence-based guidelines were identified in this report.The clinical effectiveness regarding response, relapse, progression-free survival, and overall survival broadly favoured bortezomib-lenalidomide-dexamethasone (RVd) over bortezomib-cyclophosphamide-dexamethasone (CyBorD), although the magnitude and direction of association was not always consistent, and few estimates were statistically significant.Limited evidence on the safety of RVd relative to CyBorD was found.No evidence on the cost-effectiveness of RVd as induction therapy before autologous stem cell transplant for multiple myeloma was found.Among the 5 included guidelines, 3 specifically recommend RVd as a first option for induction therapy among transplant-eligible newly diagnosed multiple myeloma patients, and 2 recommend more broadly defined 3-drug induction regimens that include RVd.

Key Message

A preponderance of evidence identified in this review indicates a relative benefit in the clinical effectiveness of heroin-assisted treatment, injectable hydromorphone, or diacetylmorphine compared to methadone in patients with opioid use disorder. Most of the evidence in this review describing sustained-release oral morphine versus methadone shows no significant difference in measures of clinical effectiveness for patients with opioid use disorder. There is a lack of evidence reported in systematic reviews and randomized controlled trials describing the clinical effectiveness of oral hydromorphone, fentanyl patches, and fentanyl buccal tablets. Most of the evidence in this review, describing various forms of opioid substitution treatments, has been characterized as low quality and draws from the same several trials.

Key Message

The clinical effectiveness of floatation therapy for the treatment of physical conditions remains uncertain. One randomized controlled trial was identified that evaluated floatation-restricted environmental stimulation therapy (REST) compared with placebo and waitlist control groups for the treatment of patients with chronic pain. The trial reported no significant differences between the 3 treatment groups on any of the outcomes measured including those related to pain, medication use, quality of life, sleep impairment, anxiety, or depression. One guideline was identified that states that there is insufficient evidence to recommend for or against the use of sensory deprivation tanks in patients with symptoms attributed to mild traumatic brain injury. The cost-effectiveness of floatation therapy for the treatment of physical condition is unknown as no relevant economic evaluations were identified.