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Hemodialysis --- Technology assessment --- Evaluation.

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Folic acid supplements have been considered as safe. A combined analysis from 2009 of two Norwegian randomized controlled clinical trials, with extended post-trial follow-up, demonstrated however, an increased incidence of cancer among patients taking folic acid for homocysteine reduction as secondary prevention of cardiovascular events. In Norway folic acid is among the 10 most sold non-prescription drugs with 17.5 defined daily doses per 1000 inhabitants/day. Norwegian guidelines have since 1998 recommended supplements of folic acid 0.4 mg daily to women periconceptionally in order to reduce the risk of neural tube defects. The present systematic review explores whether there is an increased cancer risk associated with folic acid supplements given orally. This is done in a systematic review and meta-analysis including controlled studies (randomised and observational) of folic acid supplementation. Key messages1. Meta-analysis of ten RCTs with mainly elderly men with cardiovascular disease showed a borderline significant increase in incidence of cancer in the folic acid group compared to controls. Overall cancer incidence was not studied in the seven observational studies.When analysing site-specific cancers, prostate cancer was the only cancer type where increased risk was shown for folic acid supplements. No increased incidence of cancer was found in the seven observational studies.2. This review found insufficient documentation to conclude about cancer risk for fertile women that are recommended folic acid periconceptionally in order to reduce the risk of neural tube defects.

Neoplasms. --- Folic acid. --- Cancer.

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Background The Norwegian Medicines Agency asked the Norwegian Knowledge Centre for the Health Services to review the documentation for antipsychotic drugs in order to evaluate differences in efficacy and safety between the various drugs used for schizophrenia in adults. Methods We searched systematically for literature in the Cochrane Library, Medline, Embase and PsychInfo. We evaluated all identified reviews according to predefined inclusion criteria and appraised the methodological quality of the included systematic reviews. Results We included six systematic reviews. We extracted and analyzed results on the efficacy or safety of first generation antipsychotics (typical antipsychotics) versus second generation antipsychotics (atypical antipsychotics) and among the various second generation antipsychotics. Of 99 possible comparisions, data were available on only 30. We found few differences in efficacy. However, haloperidole showed less efficacy than amisulpride and clozapine, and olanzapine led to greater improvement in functional capacity than quetiapine and ziprasidone. With respect to efficacy measured as symptom response among the second generation antipsychotics there were no differences. For adverse events, metabolic adverse events were most obvious for the second-generation antipsychotic drug olanzapine followed by clozapine and quetiapine, and extrapyramidal adverse events were most obvious for the first- generation antipsychotic drugs haloperidole and perfenazine. There were no differences in extrapyramidal symptoms among the second generation antipsychotics, except that quetiapin caused extrapyramidal symptoms in a greater proportion of patients than risperidon. There were no or few differences between the groups regarding cardiovascular, anticholinergic and hormonal adverse events as well as for discontinuation. Conclusion We found few differences in efficacy between first- and second- generation antipsychotic drugs, and among the second generation antipsychotics. For adverse events there were reported differences for at least one type of adverse event for the majority of the comparisons.

Antipsychotic drugs.