Research in brief

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In the first of a pair of randomised, double-blind, placebo-controlled trials published in The Lancet, investigators of the TESLA Part B study assessed the efficacy of the PCSK9 antibody, evolocumab, for homozygous familial hypercholesterolaemia. Patients received monthly evolocumab (n=33) or placebo (n=16) for 12 weeks. The percentage change in ultracentrifugation LDL cholesterol from baseline to week 12 was −23·1% (95% CI −30·7 to −15·4) in the intervention group compared with 7·9% (−2·7 to 18·5) in the placebo group (treatment difference −30·9%, −43·9 to −18·0; adjusted p<0·0001). In the second study, the RUTHERFORD-2 trialists allocated patients with heterozygous familial hypercholesterolaemia to evolocumab (n=110) or placebo (n=54) once every 2 weeks, or monthly evolocumab (n=110) or placebo (n=55), for 12 weeks. Both doses of the study drug led to reductions in LDL cholesterol from baseline to week 12 compared with placebo (treatment difference for once every 2 weeks dose −59·2% [95% CI −65·1 to −53·4] and for the monthly dose −61·3% [–69·0 to −53·6]; p<0·0001 for both). Treatment was generally well tolerated. The CALORIES trial investigators have attempted to resolve the uncertainty regarding the delivery route for early nutritional support in critical care. Their pragmatic, open, multicentre, randomised trial included patients with an unplanned admission to ICU who required early nutritional support. Parenteral or enteral nutrition was administered for up to 5 days. 30 day mortality was 33% (393/1188) in patients allocated to parenteral nutrition and 34% (409/1195) in patients allocated to enteral nutrition; the difference between the groups was not statistically significant (absolute difference between groups 1·15, 95% CI −2·65 to 4·94). Incidence of hypoglycaemia and vomiting was lower in the parenteral group than in the enteral group. A phase 2 randomised dose-ranging trial of mirogabalin has yielded some promising results for people with diabetes and painful peripheral neuropathy. Investigators allocated 452 patients with type 1 or type 2 diabetes and painful peripheral neuropathy to placebo, five different doses of mirogabalin, or pregabalin (active comparator) for 5 weeks. Higher mirogabalin doses (15 mg/day, 20 mg/day, and 30 mg/day) were associated with significantly greater reductions in mean daily pain score from baseline to week 5 compared with placebo (least squares mean difference −0·94, −0·88, and −1·01, respectively; p<0·05). The most common adverse events associated with mirogabalin treatment were dizziness and somnolence. The ADVANCE-ON collaborators report the post-trial observational follow-up of 8494 patients with type 2 diabetes who had participated in the ADVANCE factorial trial. In the ADVANCE trial, although the combination of perindopril and indapamide for blood pressure lowering over 4·5 years was associated with a reduction in mortality, intensive glycaemic control over 5 years was not. In ADVANCE-ON, after 5·9 years post-trial follow-up, reductions in cardiovascular mortality (hazard ratio 0·88, 95% CI 0·77 to 0·99) and all-cause mortality (0·91, 0·84 to 0·99) persisted for the active blood pressure lowering treatment group. There were no differences in cardiovascular mortality or all-cause mortality between the intensive glycaemic control or standard care cohorts after 5·4 years of post-trial follow-up. Liraglutide treatment could have effects beyond glycaemic control alone, suggest the investigators of the LIBRA placebo-controlled trial. Researchers randomly assigned patients with type 2 diabetes to 48 weeks of daily placebo injection (n=25) or subcutaneous liraglutide (n=26). In advance of receiving treatment, all patients had 4 weeks of short-term intensive insulin treatment to improve glucotoxicity caused by diabetes. At 48 weeks, patients in the liraglutide cohort had better pancreatic β-cell function than those in the placebo group, as assessed by the Insulin Secretion-Sensitivity Index-2 (mean [SE] baseline adjusted values: 339·8 [27·8] and 229·3 [28·4], respectively; p=0·008). However, the beneficial effect on β cells was not maintained following termination of liraglutide treatment. Results from a single-centre randomised controlled trial cast the spotlight on the role of vitamin D in intensive care. Investigators for the VITdAL-ICU trial allocated critically ill patients with vitamin D deficiency to receive a loading dose of vitamin D3 (540 000 IU) or placebo, and then five, monthly, maintenance doses. The primary outcome did not differ between groups assigned to vitamin D3 (n=237) or placebo (n=238), with patients receiving vitamin D3 staying in hospital for a median of 20·1 days (IQR 11·1–33·3), and placebo patients for 19·3 days (11·1–34·9; p=0·98). Length of ICU stay, in-hospital death, and death at 6 months did not significantly differ between the two groups.