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Background: With states legalizing cannabis at a rapid pace, and the increasing popularity of edibles, it is important to document marketing practices to better understand how they might be appealing and misleading to consumers to guide state policymakers., Methods: A descriptive content analysis of 1229 cannabis edible packages advertised on a publicly available website between June and November 2022 and available for sale in licensed dispensaries was performed., Results: Healthy ingredient descriptors were the most common type of descriptor with 31 % of packages including words like "vegan", "gluten free" and "natural". Quality descriptors like "handcrafted" were on 28 % of packages. Other descriptors were focused on the consumer experience including expected effects (e.g., "relax") (27 %), taste or flavor (e.g., "sour") (21 %) and pharmacokinetics (e.g., "fast-acting") (19 %). Images of non-cannabis plants and outdoor nature settings were on half of packages. Images of the cannabis plant were on 33 % of packages. Flavor imagery including images of food were common (43 %). Other marketing appeals included images of people (15 %), animals (12 %) and space (10 %)., Conclusions: Package marketing used by other commercial industries was common on cannabis edible packages. Edibles marketing is distinct from other cannabis products in its ability to focus on the food ingredients which could mislead consumers into thinking the cannabis, rather than the food, is healthy or less harmful. Research examining the impact of cannabis edibles marketing strategies on appeal and harm perceptions is critically needed to guide policymakers as they establish packaging regulations to optimize public health and safety., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Guidelines recommend selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRI) as first-line treatments for major depressive disorder (MDD) and emphasize the importance of early pharmacological treatment as key factors to treatment success. Objectives: To compare the MDD-related healthcare resource utilization (HCRU) and cost among patients (1) with early vs late pharmacological treatment initiation and (2) achieving minimum therapeutic dose (MTD) early vs late. Methods: The MarketScan database (2010-2015) was used. Adults who were newly-treated with SSRI/SNRI within 12 months after the initial MDD diagnosis (index) were included. Patients who initiated SSRI/SNRI within 2 weeks of the index date were defined as early initiators; those who reached MTD within 4 weeks of index date were defined as early MTD achievers. MDD-related HCRU and costs per year after the index date were compared between early and late initiators and between early and late achievers using propensity score matching and generalized linear models. Results: Of the 55,539 patients, 60% were early initiators and 61% were early MTD achievers. The mean number of MDD-related outpatient visits per year were significantly higher for late initiator (6.7 vs 4.2, p  < .001) and late MTD achievers (6.5 vs 4.5, p  < .001) vs their early counterparts. Mean annual MDD-related outpatient, drug, and total cost were significantly higher for late initiators and MTD achievers vs the early groups. Conclusions: There is an opportunity to improve outcomes by treating MDD patients with SSRI/SNRI within 2 weeks and at or above the MTD within 4 weeks of diagnosis or less.

We carried out a secondary analysis of a double-blind, placebo-controlled trial of desvenlafaxine for major depressive disorder (MDD) to explore the associations between depressive symptoms and subtypes, and functional outcomes, including work functioning. Employed outpatients with MDD were assigned randomly in a 2 : 1 ratio to receive desvenlafaxine 50 mg/day or placebo for 12 weeks. Analyses were carried out post-hoc with the intent-to-treat (ITT) sample (N=427) and a prospectively defined modified ITT sample (N=310), composed of patients with baseline 17-item Hamilton Rating Scale for Depression score of at least 20. Functional outcomes at week 12 included items and factors from the Montgomery-Åsberg Depression Rating Scale, Sheehan Disability Scale, and the Work Productivity and Activity Impairment questionnaire. In the modified ITT sample, but not in the ITT sample, desvenlafaxine-treated patients showed significantly greater improvement in several functional outcomes in the responder, nonanxious, and normal-energy patient subgroups. Improvement in the 17-item Hamilton Rating Scale for Depression total score at week 2 predicted change at week 12 in several functional outcomes. Functional improvement at 12 weeks was greater in subgroups of patients and was also significantly predicted by early improvement in depressive symptoms in employed patients with MDD treated with desvenlafaxine.

Ximelagatran (Exanta (R) is the first oral anticoagulant in a new class of drugs called direct thrombin inhibitors. Two studies suggest that ximelagatran is at least as effective as warfarin in preventing stroke in high risk patients with atrial fibrillation. Ximelagatran may also reduce the rate of major cardiovascular events after a myocardial infarction, compared to placebo. Ximelagatran does not require dose adjustments or routine blood monitoring. As with warfarin, bleeding risks increase with higher doses of ximelagatran. There is, however, no specific antidote to help manage bleeding. The safety of ximelagatran will not be fully known without further evaluation and surveillance for potential liver toxicity and drug interactions.

Enfuvirtide is the first in a new class of drugs called fusion inhibitors. It was recently approved in Canada for the treatment of patients with evidence of HIV-1 replication despite ongoing antiretroviral therapy. Current evidence on safety and efficacy is limited to 48-week studies. Two phase III trials found that in treatment-experienced patients failing antiretroviral treatment, the addition of subcutanous enfuvirtide to an optimized oral background antiretroviral regimen significantly reduced viral load and increased CD4 cell counts. Potential high cost and limited supply may reduce access to this treatment.

Angiotensin II receptor blockers (ARBs) directly inhibit the angiotensin II type 1 receptors, which suppresses the renin-angiotensin-aldosterone system (RAAS). Six ARBs are approved in Canada for the treatment of hypertension, none are yet approved for the treatment of heart failure (HF). Evidence comparing ARBs to angiotensin converting enzyme inhibitors (ACEIs) in HF is still limited. A recent meta-analysis of 17 clinical trials could not confirm that ARBs are superior to ACEIs in reducing either mortality or hospitalization in HF patients. ARBs may be used as an alternative in HF patients intolerant of ACEIs. A meta-analysis indicates that, compared to using an ACEI alone, adding an ARB to an ACEI carries the potential for additional benefits in terms of reduced hospitalization, but not mortality. However, the FDA determined there is currently insufficient evidence of such additional benefit when valsartan is combined to an ACEI in patients with HF.

(1) Atopic dermatitis (AD) is a chronic dermatological condition characterized by pruritus (itchiness) and rash. Topical corticosteroids are the mainstay of pharmacotherapy. (2) Tacrolimus ointment is a new topical anti-inflammatory agent available in Canada through the Special Access Program. (3) It is approved as a second line agent for short or long term intermittent treatment of moderate to severe AD. (4) Clinical trials suggest it is both effective and safe, but comparative studies with corticosteroids and long-term information are limited.