Key messages

• Telepharmacy may help people take their medicines as prescribed, and may reduce both systolic blood pressure (the pressure in your arteries when your heart beats) and diastolic blood pressure (the pressure between heartbeats). It probably makes little or no difference to blood sugar control (HbA1c).

• We are very uncertain about its effects on patients’ satisfaction with care. Telepharmacy may affect medicine‐related problems (such as side effects or interactions), but findings varied because some interventions aimed to detect more problems while others aimed to reduce harms from medicines. No studies reported the number of deaths or unwanted effects from telepharmacy, so potential harms remain uncertain.

• Studies did not show consistent effects on quality of life, hospital admissions, hospital emergency department visits, or healthcare costs. Most studies involved only a few people or had limitations, and the studies varied in delivery and content.

What is telepharmacy?

Telepharmacy is the use of phone calls, video calls, mobile apps, or other electronic communication to provide pharmacy services without meeting in person. It can include advice about medicines, help with taking medicines as prescribed, and monitoring of health. Telepharmacy can make it easier for people to get support from a pharmacist, especially if they live far from a clinic or have difficulty travelling. It may also help pharmacists detect medicine‐related problems and adjust treatments when needed.

What are long-term health conditions?

Long-term health conditions, sometimes called chronic conditions, are health problems that can usually be controlled but not cured. They last for three months or longer, and may get worse over time. People with long-term conditions often require ongoing care. Examples include diabetes, high blood pressure, asthma, and heart disease. These conditions can affect a person’s quality of life and may lead to serious complications if not well managed. People with long‐term conditions often need regular check‐ups, tests, and support to take their medicines correctly.

What did we want to find out?

We wanted to find out whether telepharmacy, compared with usual care, helps people take their medicines as prescribed, and improves patients’ satisfaction with care, medicine‐related problems, asthma control, blood pressure, and blood sugar control (measured using the HbA1c test) in people with long‐term conditions in outpatient settings. We also looked at other possible effects, such as quality of life, admissions to hospital, emergency department visits, and healthcare costs.

What did we do?

We searched for studies that compared pharmacist‐led telepharmacy with usual care for people with long-term conditions in outpatient settings. We included high-quality studies, known as randomised controlled trials. We summarised the results and rated our confidence in the evidence, considering factors such as study design, number of participants, and consistency of results.

What did we find?

We found 21 trials including 5440 people, which were performed in different countries and settings (e.g. pharmacy, hospital). Most trials compared telepharmacy with usual face-to-face care for people with long‐term conditions in outpatient settings. In the included studies, usual care generally referred to standard face-to-face care without additional telepharmacy support. Most studies lasted 12 months or less.

In people with long-term conditions in outpatient settings, compared with usual care:

• telepharmacy may improve how well people take their medicines as prescribed (10 studies, 2978 people), that is, as instructed by their healthcare providers;

• the evidence is very uncertain about whether telepharmacy improves patients’ satisfaction with their care (3 studies, 422 people);

• telepharmacy may affect problems such as medicine side effects or interactions (5 studies, 547 people), but findings varied because some studies aimed to detect more problems while other studies aimed to reduce harms;

• telepharmacy may reduce systolic blood pressure (the pressure in your arteries when your heart beats) and diastolic blood pressure (the pressure between heartbeats) (5 studies, 1254 people); but

• telepharmacy probably makes little or no difference to blood sugar control (HbA1c levels) (5 studies, 1771 people).

No studies reported the number of deaths or unwanted effects from telepharmacy, so potential harms remain uncertain. We have more confidence in some findings (such as blood sugar control) than in others (such as patients' satisfaction with their care). For some outcomes, future research could change what we know.

What are the limitations of the evidence?

Our confidence in the findings was reduced because many studies involved only a few people, had problems with how they were carried out, or produced results that did not always agree. Evidence about problems caused by medicines came only from descriptions given by patients, as we were unable to group and analyse data from different studies. The studies used telepharmacy interventions that varied in their content, and how or how often they were given, which may have influenced the results.

How up to date is this evidence?

The evidence is up to date to December 2025.

Key messages

• Current evidence does not allow firm conclusions regarding the safety of treatment with insulin-like growth factor-1, a protein that helps blood vessels in the retina of the eye grow normally, in premature babies born before term and weighing less than 1500 grams.

• Current evidence does not allow firm conclusions regarding the effect of insulin-like growth factor-1 treatment for prevention of retinopathy of prematurity, a disease in premature babies where blood vessels in the back of the eye do not grow normally.

• So far, studies of insulin-like growth factor-1 in preterm infants may not detect important benefits or side effects.

What are retinopathy of prematurity and insulin-like growth factor-1?

Retinopathy of prematurity is a common disease in babies born prematurely with a birth weight less than 1500 grams. It is caused when blood vessels in the back of the eye do not grow normally. Retinopathy of prematurity can cause vision problems or blindness.

Insulin-like growth factor-1 is a protein that helps blood vessels in the retina of the eye grow normally during pregnancy. When babies are born too early, they may not have enough insulin-like growth factor-1 in their bodies and this may cause blood vessels in the retina to grow abnormally, leading to the development of retinopathy of prematurity.

How is retinopathy of prematurity treated?

Currently, retinopathy of prematurity is treated with lasers that burn the retina in the back of the baby's eye to stop stimulation of the abnormal blood vessels that may damage vision, or with medications that are injected into the eye to temporarily stop the abnormal blood vessels from continuing to grow and damage vision.

What did we want to find out?

We wanted to find out if giving insulin-like growth factor-1 to premature babies prevents or treats retinopathy of prematurity. We also wanted to find out if giving insulin-like growth factor-1 to premature babies causes any serious side effects or problems, or had an effect on any other medical issues caused by prematurity, like brain bleeding or lung disease of prematurity.

What did we do?

We searched for research studies that compared treatment with insulin-like growth factor-1 either to a placebo (a ‘dummy’ or sham treatment) or to standard care, which is usual neonatal intensive care unit (NICU) care that does not normally include giving insulin-like growth factor-1, in premature babies who were at risk of developing retinopathy of prematurity. We compared and summarized the results of the studies and rated our confidence in the evidence based on study methods and size.

What did we find?

We included two studies with a total of 140 premature babies. The included studies tested insulin-like growth factor-1 treatment in premature babies and followed their outcomes through five to six years of age.

We found that the results of current studies do not allow for a definite conclusion regarding its efficacy for preventing or treating retinopathy of prematurity. The results of current studies also do not allow for a definite conclusion regarding the safety of insulin-like growth factor-1 treatment in premature babies, including harmful effects or death.

What are the limitations of the evidence?

Our confidence in the evidence is very low, and the results of further research could differ from the results of this review. Two main factors reduced our confidence in the evidence. First, we only identified two studies of insulin-like growth factor-1 treatment in premature infants and not many infants participated in them. This means there may not have been enough participants who received treatment to determine whether it actually made a difference. Second, the studies we found had problems with their design or the way they were conducted, which may affect the accuracy of their results.

How up to date is this evidence?

The evidence is up-to-date to March 2025.

Key messages

• In people with mild memory and thinking problems (mild cognitive impairment (MCI)) or mild dementia due to Alzheimer's disease, laboratory-produced medicines (anti-amyloid monoclonal antibodies) that target and remove potentially damaging build-ups of amyloid proteins in the brain, probably result in little to no difference in the decline in memory functioning and thinking ability, or in how severe dementia symptoms are, compared with placebo (sham treatment) 18 months after the start of treatment.

• Anti-amyloid monoclonal antibodies probably cause more brain swelling and tiny (micro) bleeds than placebo. They do not increase other serious unwanted effects or deaths compared with placebo.

• Successful removal of amyloid proteins from the brain does not seem to be associated with clinically meaningful improvements in people with MCI or mild dementia due to Alzheimer’s disease. Future research on disease-modifying treatments for Alzheimer’s disease should focus on other treatments.

What is Alzheimer’s disease?

In Alzheimer’s disease, brain cells die following the build-up of proteins (called amyloid plaques). Alzheimer’s disease affects people’s memory and thinking abilities. Symptoms are usually mild to begin with and do not interfere with everyday life. This is called ‘mild cognitive impairment’ (MCI). Over time, it can progress to mild dementia, where memory and thinking difficulties are serious enough to interfere with everyday activities. About 15% of people with MCI will develop dementia due to Alzheimer’s disease within two years. It is the most common form of dementia among older people.

What are anti-amyloid monoclonal antibodies?

Antibodies are made by the body as a defence against disease. They can also be produced in a laboratory for use as a medical treatment. Anti-amyloid antibodies are designed to target the amyloid proteins that cause plaques due to Alzheimer’s disease, and remove them from the brain. They are ‘monoclonal’ because they only target amyloid proteins. Removing amyloid proteins from the brain may slow the progression of Alzheimer’s disease.

What did we want to find out?

We wanted to know if anti-amyloid monoclonal antibodies are an effective medicine for people with MCI or mild dementia due to Alzheimer’s disease. We evaluated whether they slowed down:

• the decline in memory and thinking;

• the decline in ability to manage everyday activities; and

• the worsening of dementia symptoms.

We also wanted to know if they caused any unwanted effects.

What did we do?

We searched for studies that investigated one or more anti-amyloid monoclonal antibodies to treat people with MCI or mild dementia due to Alzheimer’s disease, compared with placebo (sham treatment that does not contain any medicine but looks identical to the medicine being tested and is delivered in the same way).

We summarised the results of the studies, and rated our confidence in the evidence, considering aspects such as study sizes and methods.

What did we find?

We found 17 studies that were carried out in different countries and involved 20,342 people. The average age across studies was from 70 to 74 years. All studies were funded by companies that produced the anti-amyloid monoclonal antibodies.

Main results

After 18 months of treatment, anti-amyloid monoclonal antibodies:

• may make little to no difference to how bad people’s dementia symptoms are (9 studies, 8053 people);

• probably make little to no difference in the decline in memory and thinking ability (13 studies, 9895 people) or the ability to manage everyday activities (3 studies, 3478 people);

• may result in a small improvement in more complex everyday tasks, such as shopping, managing finances, taking medication, and using transportation (1 study, 1252 people);

• probably result in a small increase in the occurrence of brain swelling. For every 1000 people using monoclonal antibodies, 119 developed brain swelling compared with only 12 of 1000 people using placebo (11 studies, 13,595 people);

• may result in a small increase in microbleeds in the brain (3 studies, 4308 people);

• do not increase other serious unwanted effects as defined by the study authors (9 studies, 11,904 people); and

• do not increase deaths from any cause (7 studies, 9733 people).

What are the limitations of the evidence?

Our confidence in the evidence is limited for two reasons. Firstly, people who received monoclonal antibodies had more brain swelling and microbleeds than people receiving placebo. However, most studies did not separate people with symptoms of brain swelling and microbleeds from those in whom these effects were only visible with a scan. This reporting gap leaves patients without the information they need to understand the seriousness of potential unwanted effects. Secondly, the results came from studies that did not last very long. These are important limitations in the evidence for people with Alzheimer’s disease, who need to know the longer-term benefits and unwanted effects of medicines.

We found six ongoing studies. The review's conclusions may change as new results become available.

How up to date is this evidence?

The evidence is current to 7 August 2025.

Key messages

• Children with low language proficiency (LLP) (difficulties) may meet problems with speaking, understanding language, and literacy (ability to read) as they grow older. They also have psychological and social difficulties later in life, but the evidence is less certain for these outcomes than for learning outcomes.

• It is unclear whether early language skills affect later independence and participation in everyday life, as the evidence is very limited and uncertain.

• We need more long-term, high-quality studies with large samples and comparison groups to understand which children are most affected and how early language difficulties affect later outcomes, particularly independence and participation in daily life, where current evidence is limited.

Low language proficiency in children

Children with LLP have difficulties with speaking, understanding, or using language in early childhood. These difficulties can affect how children learn to read, communicate with others, and take part in everyday activities at school and at home. For some children, early language difficulties improve over time. For others, they continue as children grow older and may affect later learning, social relationships, and independence.

What did we want to find out?
We wanted to see whether children with low language skills at ages four to eight years old continue to have problems with language, reading, and quality of life as they grow up.

What did we do?
We searched for studies of children between the ages of four and eight years who were identified as having LLP. These children either scored below average on language tests or had a clinical diagnosis. We analysed outcomes related to language and reading, as well as five areas of quality of life:

• psychological well-being (mental health)

• physical health

• independence

• social relationships (making friends)

• participation in everyday life such as work and community life

We combined the results of the studies using statistical methods (meta-analysis) and took into account that some outcomes were related to each other.

What did we find?

We found 80 studies (that took place in North America or Europe) which followed children with LLP into adolescence or adulthood and reported outcomes from 15 different groups of children (cohorts), with about 28,800 children in total.

Children with LLP are likely to continue:

• having difficulties with language and reading into adolescence and adulthood.

These difficulties were noticeable and consistent across studies. Children with LLP may also be at higher risk of:

• mental health problems, such as depression or anxiety

• difficulties with making friends

• less independence in daily life

We do not have enough evidence to know whether they have problems with physical health.

What are the limitations of the evidence?

Some studies in this review had limitations that affect how confident we can be in the results.

• We are highly confident that children with LLP have difficulties with literacy (ability to read) when growing up.

• We are moderately confident that children with LLP have difficulties with language when growing up, because some of the children in the studies dropped out. However, our results were generally consistent.

• We are moderately confident that children with LLP experience more mental health problems (e.g. problems with making friends) and a lack of participation in everyday life when growing up. Our confidence is only moderate because of small studies (for participation) or variation between studies. Generally, patterns were consistent but further evidence may change our results.

• We have low confidence that children with LLP have difficulties with becoming independent when growing up, because of very few studies. Further evidence is likely to change our results.

• We are not confident that children with LLP have difficulties with physical health when growing up. The evidence is very uncertain.

The way low language proficiency was described and measured sometimes varied between studies. Some outcomes — especially physical health, independence, and participation in daily life — were only reported in a few studies. Some studies were small or included only certain groups of children. Important factors, such as non-verbal IQ or other health conditions, were not always reported. The results also varied between studies, which means that not all children with LLP are affected in the same way. Overall patterns are consistent, but some findings should be interpreted carefully.

How up to date is this evidence?

The evidence is up-to-date to March 2025.

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