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Long-term Users (long-term + user)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Clinical trial: long-term use of proton pump inhibitors in primary care patients , a cross sectional analysis of 901 patients

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009
C. REIMER
Summary Background, The use of proton pump inhibitors (PPIs) is extensive. While the incidence of new treatments remains stable, the prevalence of long-term treatment is rising. Studies have shown that up to 70% of patients on chronic acid suppression lack a verified indication for treatment. Aims, To investigate primary care patient characteristics associated with long-term use of PPIs. Methods, A cross-sectional analysis of 42 634 patients registered with 22 general practitioners was performed. Patients with prescriptions of ,120 tablets/year were defined as long-term users. A survey of a subgroup of patients without verified indication was performed. Results, In all, 901 (2.1%) patients were long-term treated. Verified indications for treatment were identified for 247/901 (27%). An upper GI endoscopy had been performed in 418 patients (46%). Of the 194/654 without verified indication who participated in the survey, 71% reported heartburn/acid regurgitation as the reason for therapy. On-demand therapy was reported by 43/194 (22%) and previous attempts to withdraw by 119/194 (61%). Conclusions, The prevalence of PPI long-term treatment among primary care patients is 2.1%. The main reason for treatment is reflux symptoms or verified GERD. Rationalization of use of PPIs is possible as daily treatment without attempts to discontinue is frequently observed. [source]

Octreotide therapy in dumping syndrome: analysis of long-term results

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2006
P. DIDDEN
Summary Background Octreotide therapy is effective in controlling severe dumping symptoms during short-term follow-up but little is known about long-term results. Aim To report on the long-term results of patients with severe dumping syndrome treated at the Leiden University Medical Center with subcutaneous or depot intramuscular (long-acting release) octreotide. Methods Follow-up of 34 patients with severe dumping syndrome refractory to other therapeutic measures treated between 1987 and 2005 with octreotide subcutaneous/long-acting release. At regular intervals symptoms, quality of life, weight, faecal fat excretion and gallstone formation were evaluated. Results All patients had excellent initial relief of symptoms during octreotide subcutaneous therapy. However, during follow-up 16 patients stopped therapy because of side effects (n = 9) or loss of efficacy (n = 7). Four patients died. Fourteen patients (41%) remain using octreotide (follow-up 93 ± 15 months), seven are on octreotide subcutaneous and seven on octreotide long-acting release. Patients with severe dumping (both early and late) do better on subcutaneous than long-acting release despite the inconvenience of frequent injections. Dumping symptoms are reduced by 50% even in long-term users. Body weight continues to increase during therapy despite more pronounced steatorrhoea. Conclusion The long-term the efficacy of octreotide is much less favourable compared with short-term treatment. [source]

Diclofenac and acute myocardial infarction in patients with no major risk factors

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 5 2007
Susan S. Jick
What is already known about this subject ,,We recently published the results of a study on the risk of acute myocardial infarction (AMI) in users of five nonsteroidal anti-inflammatory drugs during the years 2001 to 2005. ,,The results demonstrated, as has been reported in randomized trials, that rofecoxib and celecoxib increase the risk of AMI when taken for at least 10 months. ,,As expected, ibuprofen and naproxen did not materially increase the risk. ,,However, long-term users of diclofenac were at an increased risk of AMI similar to that of users of rofecoxib and celecoxib. What this study adds ,,Extensive use of diclofenac, similarly to rofecoxib and celecoxib, substantially increases the risk of AMI. ,,There is little suggestion of such an effect in users of ibuprofen and naproxen. Aims To explore further a recent finding that long-term users of diclofenac are at increased risk of acute myocardial infarction (AMI) similar to users of rofecoxib and celecoxib. Methods Using the General Practice Research Database, we conducted three separate nested case,control studies of three nonsteroidal anti-inflammatory drugs (NSAIDs) where use started after 1 January 1993 , diclofenac, ibuprofen and naproxen. Cases of AMI were identified between 1 January 1993 and 31 December 2000. Relative risk (RR) estimates for AMI in patients with no major clinical risk factors were determined for each NSAID according to number of prescriptions received compared with one prescription. Results were adjusted for variables possibly related to risk of AMI. Results There was no material elevation of AMI risk according to the number of prescriptions for ibuprofen [RRs and 95% confidence intervals (CIs) 1.0 (0.6, 1.6) and 1.7 (0.9, 3.1) for use of 10,19 and 20+ prescriptions, respectively, compared with one prescription] or naproxen [RRs 1.0 (0.5, 2.2) and 2.0 (0.9, 4.5) for use of 10,19 and 20+ prescriptions, respectively]. However, a substantial increased risk similar to that obtained in our prior study was found in patients who received ,10 prescriptions for diclofenac [RRs 1.9 (1.3, 2.7) and 2.0 (1.3, 3.0) for use of 10,19 and 20+ prescriptions, respectively]. Conclusions Extensive use of diclofenac substantially increases the risk of AMI. There is little suggestion of such an effect in users of ibuprofen and naproxen. [source]

Detection of Overexpressed COX-2 in Precancerous Lesions of Hamster Pancreas and Lungs by Molecular Imaging: Implications for Early Diagnosis and Prevention

CHEMMEDCHEM, Issue 6 2006
Hildegard
Abstract The enzyme cyclooxygenase-2 (COX-2) is overexpressed in many cancers, cardiovascular disease, neurodegenerative disorders, and arthritis. Selective inhibitors of COX-2 have been developed as therapeutics or preventive agents for these diseases. However, recent reports have revealed a significant increase in cardiovascular mortality in long-term users of the COX-2 inhibitors Vioxx and Celebrex, emphasizing the need for noninvasive tests that allow the identification of individuals whose COX-2 levels are overexpressed prior to assignment to treatment with these drugs. In this study, we have prepared a radioiodinated analogue of the selective COX-2 inhibitor celecoxib, and verified its binding to the COX-2 enzyme in,vitro. Biodistribution studies in hamsters demonstrated significantly higher levels of radiotracer in animals treated with the tobacco carcinogen NNK in lung, pancreas, and liver. Assessment of COX-2 levels by whole-body planar nuclear imaging two hours after injection of the radiotracer was suggestive of a distinct increase in COX-2 in the pancreas and liver of a hamster treated for 10 weeks with NNK, in the lungs and liver of a second animal, and in the liver only, in two additional animals from the same treatment group. Immunostains showed selective overexpression of COX-2 in pre-neoplastic lesions of the pancreas and lungs in only those animals that showed tracer accumulation in these organs and in the livers of all NNK-treated hamsters. Immunostains for COX-1 yielded detectable reactions in the intestinal epithelium but not in pancreas, lungs, or liver, supporting the specificity of the tracer for COX-2. Our data provide proof of principle for the hypothesis that molecular imaging with radiolabeled COX-2 inhibitors can be used for the noninvasive monitoring of overexpressed COX-2 levels. [source]