Effectiveness and Safety of Prochlorperazine in Indian Patients with Acute Vertigo: Results from a Large, Prospective, Post-marketing Observational Study.

Aim: To assess the efficacy and safety of prochlorperazine in Indian patients with acute vertigo. Methods: In this prospective, multicenter, open-label, post-marketing observational study, patients with acute peripheral vertigo of different etiologies received 5 mg prochlorperazine thrice a day for 5 days. The primary endpoints were percentage of patients with improvement in (1) vertigo symptoms and (2) clinical response as per scale for vestibular vertigo severity level and clinical response evaluation (SVVSLCRE) from baseline to end of treatment (Day 6). The key secondary endpoints were (1) improvement in nystagmus grading, and (2) safety and tolerability Efficacy of prochlorperazine by route of administration of first prochlorperazine dose (oral or intramuscular) was also assessed. Results: Of 1716 enrolled patients (mean [standard deviation, SD]) age (42.0 [12.95] years; 53.6% men), 57.4% were diagnosed with Meniere's disease, followed by vestibular neuritis (17.4%), labyrinthitis (16.7%), or ear surgery (8.5%). In the overall population, 91.1% of patients showed improvement in clinical response per SVVSLCRE grading at Day 6 (p < 0.0001 vs. non-responders). Nystagmus grading was improved in 99.7% (of patients. No adverse drug reactions events were reported. Tolerability of prochlorperazine was rated as good, very good, and excellent by 43.6%, 32.9% and 20.7% of patients, respectively. Among patients with postoperative vertigo, 80.1% showed improvement in clinical response. In the intramuscular and oral subsets, 85.5% and 92.1% of patients showed improved clinical response, respectively. Conclusion: Prochlorperazine showed improvement in severity of symptoms and clinical response in all subsets of vertigo patients, with a good safety and tolerability profile. Trial Registration Number: CTRI/2022/01/039287. Date of Registration: 10 January 2022.

An Assessment of Knowledge, Attitude, and Practices of Physicians in the Management of Hyperuricemia in India: A Questionnaire-Based Study.

BACKGROUND: Hyperuricemia is found to be associated with the development and progression of gout, chronic kidney disease, cardiovascular diseases and several others. However, consistent recommendation in the management of hyperuricemia among physicians in India is absent. This study was done to assess the knowledge, attitude, practice (KAP) and barriers in the management of hyperuricemia among physicians in India. METHODS: A cross-sectional study using a telephonically-administered questionnaire was distributed to 350 physicians treating hyperuricemia patients with co-morbidities like hypertension, diabetes mellitus, metabolic syndrome etc. The questionnaire included 25 questions on qualitative and quantitative aspects. Descriptive statistics were used for demographic characteristics. Inferential statistics (binary logistic regression) was used to identify the relationship between knowledge scores across different physician factors. RESULTS: A total of 350 responses were obtained with a response rate of 100%. Majority of the physicians (90%) were male and 10% were female with median age of 45.5 ± 12.2 years. Mean scores for knowledge and attitude were 7.4 ± 2.35 and 12.1 ± 1.6, respectively. 66.1% (230) of physicians had adequate knowledge score, while the remaining 33.9% (118) had inadequate score. Irrespective of comorbidity status, no change in the attitude of physicians towards management of hyperuricemia was found. CONCLUSION: This study demonstrated that the majority of physicians demonstrated adequate level of knowledge, positive/favourable attitude and reported optimal treatment practices for the management of hyperuricemia while exhibiting a few perceived barriers. Nevertheless, facilitating widespread physician awareness about the benefits of optimal management of hyperuricemia is warranted.

Physicians' Perception on Allergic Rhinitis and Its Management: A Questionnaire Based Survey.

Despite high prevalence and impact on quality of life, Allergic Rhinitis (AR) is undertreated. Furthermore, existence of a relationship between AR and upper respiratory tract infection (URTI) is less explored. This Pan-India survey intended to assess physicians' perception about AR and URTI, and management practices in Indian setting. This questionnaire-based survey was conducted by telephonically interviewing 300 physicians [Consultant Physicians (CP): 33%; General Physicians (GP): 32%; ENT surgeons: 16%; pediatricians: 11%; allergy specialists: 8%] across India. CPs (33%) and GPs (32%) treated more AR patients in a month, versus other specialties. According to physicians, about 29.6% of patients with AR develop URTI in a month. Majority of the physicians (98%) believed that recurrent URTI can be considered as an indicator of undiagnosed AR. Majority of the physicians (98%) also considered AR to be a predisposing factor for increased risk of URTI. About 62% agreed that prompt diagnosis and treatment of AR can reduce the risk of complications such as URTI. Most preferred first- and second-line of treatment (alone or in combination) in AR management were oral antihistamines (41%) and intranasal corticosteroids (40%), respectively. Similar treatment preferences were observed irrespective of physicians' specialization and years of experience. This survey sheds light on the need to implement clear guidelines for the diagnosis and management of AR.

Efficacy and Safety of Levocloperastine in the Treatment of Dry Cough: A Prospective Observational Study.

Purpose/Aim: To evaluate effectiveness and safety of Levocloperastine in the treatment of dry cough in adult Indian patients. Methods: In this prospective, observational study, patients aged 18-60 years, presenting with dry cough and prescribed with Levocloperastine at baseline or a day prior to enrolment, as per standard clinical practice, were recruited from 3 centers in India. The scores of cough severity (100 mm VAS), cough frequency since last 24 h (7-point Likert scale), sleep disruption due to night-time awakenings (10 cm VAS), quality of life (QoL) (Leicester Cough Questionnaire [LCQ]), and number of days for achieving minimal important difference (MID) in cough severity (17 mm improvement on VAS) were assessed from baseline to Day 14. In addition, physicians' assessment of effectiveness of Levocloperastine at Day 14, adverse drug reactions (ADRs) and proportion of patients reporting sedation and other central nervous system side effects were also reported during the study. Descriptive statistics was used to summarize the data. Results: A total of 100 patients were enrolled in the study. The mean scores of cough severity, cough frequency and sleep disruption due to night-time awakening were significantly reduced from baseline to Day 14 (p<0.0001). A significant improvement in QoL scores (total and by domain) was noted from baseline to Day 14 (p<0.0001). Post treatment with Levocloperastine, the mean time for achieving MID was 5.3±0.26 days. Disappearance of cough was reported in 44% of patients; 54% patients reported improvement of cough by Day 14. No ADRs, cases of sedation or other side-effects were reported in the study. Conclusion: Levocloperastine was found to be effective and safe in the management of dry cough. A significant reduction in severity scores, frequency of cough and sleep disruption was reported, with an overall improvement in patient's QoL.