EHC Program Update: Management of Asthma, Management of Uterine Fibroids, Skin Cancer, Risk of Bias in Systematic Reviews; Final Reports; Effects of Sodium Intake on Chronic Disease Outcomes Draft Report

Effectiveness and Safety of Bronchial Thermoplasty in Management of Asthma
(Systematic Review, released 12/14/2017)
Selected key findings:

• Bronchial Thermoplasty (BT) along with standard medical management, compared to medical management alone, may improve asthma control and quality of life, but evidence is insufficient to determine impact on asthma exacerbations.
• BT along with standard medical management, compared to a similar procedure without the heat (sham procedure), does not improve asthma control or hospitalizations but may reduce severe exacerbations and emergency room visits.
• BT causes more adverse events (such as worsening of asthma symptoms, respiratory infections, and coughing up blood) during the treatment period than standard treatment. Based on the available literature, there is still uncertainty about the balance of benefits and harms, and about which patients are most likely to benefit from the procedure.
• For more, see https://effectivehealthcare.ahrq.gov/topics/asthma-nonpharmacologic-treatment/thermoplasty-systematic-review

Management of Uterine Fibroids
(Systematic Review, released 12/14/2017)
Selected key findings:

• Gonadotropin-releasing hormone (GnRH) agonists, mifepristone, ulipristal, and uterine artery embolism (UAE) reduce fibroid size, and improve symptoms and quality of life. High intensity focused ultrasound reduces fibroid size, but impact on quality of life was not measured. Myomectomy and hysterectomy also improve quality of life. Direct comparisons of interventions provide little evidence.
• For women in their 30s, the chance of needing retreatment for fibroids within the next 2 years was 6–7 percent after medical treatment or myomectomy and 44 percent after UAE. For older women, the chance was 9–19 percent after medical treatment or UAE and 0 percent after myomectomy.
• Using data from160 studies, risk of unexpected leiomyosarcoma ranged from less than 1 to 13 of 10,000 surgeries.
• Survival time appears shorter with power morcellation; however, confidence intervals are wide and overlap with other surgical approaches.
• For more, see https://effectivehealthcare.ahrq.gov/topics/uterine-fibroids/research-2017 

Treatments for Basal Cell and Squamous Cell Carcinoma of the Skin
(Systematic Review, released 12/8/2017)
Selected key findings:

• Comparative evidence on treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) is limited. Many comparisons were evaluated in one or two randomized controlled trials only.
• Surgery and radiotherapy have lower recurrence rates for BCC than interventions that destroy lesions with heat or cold, photodynamic therapy (PDT), or curettage.
• There is moderate confidence that PDT for BCC is associated with better cosmetic outcomes than surgery.
• Serious adverse events, events leading to treatment discontinuation, and treatment site infections were uncommon with all treatments for BCC.
• Recurrence rates for SCC in situ were lower with PDT and cryotherapy than with drugs. Evidence was insufficient to draw conclusions for other treatments.
• For more, see https://effectivehealthcare.ahrq.gov/topics/skin-cancer/research

Methods Report Available 

Assessing the Risk of Bias in Systematic Reviews of Health Care Interventions
(Methods Guide Chapter, released 12/13/2017)

Opportunity to Comment on Draft Report

We encourage the public to participate in the development of our research projects. Comments can be submitted for:

Effects of Dietary Sodium and Potassium Intake on Chronic Disease Outcomes and Related Risk Factors 
Available for comment until January 8, 2018