Randomised trial of verubecestat for prodromal Alzheimer’s disease

It has been noted in a previous abstract (NZMJ, 5/10/18) that lanabecestat, atabecestat and verubecestat have not been successful in ameliorating the progression of dementia in Alzheimer’s disease.

These researchers speculate that commencing the use of verubecestat in patients with memory loss and elevated brain amyloid levels but not flagrant dementia might prevent the development of dementia. Hence this trial which compares treatment of such patients with verubecestat or placebo.

It was concluded that treatment with verubecestat did not improve clinical ratings of dementia among patients with prodromal Alzheimer’s disease.

NEJM 2019; 380:1408–20

Operative treatment versus nonoperative treatment of Achilles tendon ruptures

The objectives of this study were to compare re-rupture rate, complication rate and functional outcome after operative versus nonoperative treatment of Achilles tendon ruptures.

Data was extracted from 29 studies—10 randomised trials including 944 patients and 19 observational studies including 14,918 patients. A significant reduction in re-ruptures was seen after operative treatment (risk ratio 0.43). A significantly higher complication rate was seen after operative treatment (risk ratio 2.76). This difference was attributed to the incidence of infection (2.8%) in the operative group.

Although the risk of re-rupture was less in the operative group it was noted that re-rupture rates are low and the difference between the two groups was low at 1.6%.

BMJ 2019; 364:k5120

How long does a knee replacement last?

Knee replacement surgery is the mainstay of treatment for end-stage osteoarthritis. In this study the researchers seek to establish how long a knee replacement lasts.

Information was obtained from case series reports and pooled registry results from Australia and Finland. The researchers considered the latter to be more accurate. Over 300,000 cases were studied in the pooled registry data.

The pooled registry data showed that approximately 82% of total knee replacements last 25 years, and 70% of unicondylar knee replacements last 25 years.

Lancet 2019; 393:655–63

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