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Agilio: Diagnosis and Treatment Guidance February 2025 Update

This update contains 7 significant changes, 10 minor changes and 1 new topic.

Significant Changes:

  • Asthma — reviewed. A literature search was conducted in December 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has been updated in line with the joint BTS/NICE/SIGN guideline Asthma: diagnosis, monitoring and chronic asthma management NG245 BTS/NICE/SIGN, 2024 and the Global Initiative for Asthma (GINA) guideline Global strategy for asthma management and prevention GINA, 2024. The recommendations on diagnosis and management of asthma in all age-groups have been updated in line with the BTS/NICE/SIGN (2024) recommendations, including use of different objective tests to confirm the diagnosis depending on age-group, and prescribing initial treatment with anti-inflammatory reliever (AIR) therapy or maintenance and reliever therapy (MART) using an inhaled corticosteroid (ICS)/formoterol combination inhaler for people aged 12 years and over first-line, and to consider a MART regime with an ICS/formoterol combination inhaler for children aged 5 to 11 years (off-label indication in this age-group).
  • Hyperthyroidism — reviewed. A literature search was conducted in December 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommendations have been updated in line with the National Institute for Health and Care Excellence (NICE) clinical guideline Thyroid disease: assessment and management (2023) and other current evidence in the literature.
  • Hypothyroidism — reviewed. A literature search was conducted in November 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone minor restructuring. The recommendations have been updated in line with the National Institute for Health and Care Excellence (NICE) clinical guideline Thyroid disease: assessment and managementand other current evidence.
  • Incontinence – urinary, in women — reviewed. A literature search was conducted in September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The following changes have been made, vibegron has been added as an option for treating the symptoms of overactive bladder if antimuscarinic medicines are unsuitable, ineffective, or not tolerated, this is based on the National Institute for Health and Care Excellence (NICE) Technology appraisal guidance on Vibegron, and the topic has been restructured to improve navigation.
  • Plantar fasciitis— reviewed. A literature search was conducted in November 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The recommendations on when to arrange additional imaging have been expanded. The basis for recommendation sections have been updated in line with current evidence in the literature.
  • Renal or ureteric colic – acute— reviewed. A literature search was conducted in September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.
  • Undescended testes — reviewed. A literature search was conducted from November to December 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Recommendations have been updated in line with current evidence. Minor changes have been made with regards to referral in line with the latest NHS England guidance Newborn and infant physical examination (NIPE) screening programme handbook.

 

Minor Changes:

  • Antenatal care – uncomplicated pregnancy — minor update. Information that pregnant women with a BMI over 30 kg/m2 should be advised to take a higher daily dose (5 mg of folic acid a day) has been removed from this topic, and sections on dietary advice, and exercise have also been updated in line with the updated NICE guideline Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years.
  • Bipolar disorder — minor update. Severe cutaneous adverse reactions and hyperpigmentation added as adverse reactions for valproate, in line with the manufacturer’s updated SPC.
  • Chronic obstructive pulmonary disease — minor update. A link was added to the NICE HTA Digital technologies to support self-management of COPD: early value assessment, to the text on self-management.
  • HIV infection and AIDS — minor update. Wording change to the definition of advanced HIV disease.
  • Immunizations – pneumococcal — minor update. Information relating to people aged over 10 years who are unvaccinated or partially vaccinated vaccination has been updated in line with the updated UK Health Security Agency (UKHSA) publication Immunisation against infectious disease (The Green Book) Chapter 25: Pneumococcal.
  • Nausea/vomiting in pregnancy— minor update. The definition of hyperemesis gravidarum has been updated in line with RCOG, 2024 Guideline The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No.69). Information that growth differentiation factor 15 (GDF15) is a possible cause of hyperemesis gravidarum, and that hyperemesis gravidarum is associated with a higher risk of termination of pregnancy have also been added to this topic.
  • Osteoporosis – prevention of fragility fractures — minor update. Information about the use of risedronate in people with severe renal impairment has been clarified.
  • Palliative care – oral — minor update. A safety warning about the use of oral swabs with a foam head has been added to this topic.
  • Sciatica (lumbar radiculopathy) — minor update. Information that sudden onset bilateral radicular pain or unilateral radicular pain progressing to bilateral pain is not by itself a feature of cauda equina syndrome (CES) but can be a warning that CES may occur, and that people with bilateral sciatica but without CES symptoms should be urgently referred to a musculoskeletal triage service has been added to this topic.
  • Sickle cell disease — minor update. Information on which people with sickle cell crisis need immediate admission has been clarified.

 

New Topic:

  • Cushing’s syndrome — new topic. A literature search was conducted in August 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.