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Continued Therapy (continued + therapy)

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Medical Sciences	100%

Selected Abstracts

Exenatide: a review from pharmacology to clinical practice

DIABETES OBESITY & METABOLISM, Issue 6 2009
R. Gentilella
Background:, Exenatide is an incretin mimetic that activates glucagon-like-peptide-1 receptors. It blunts the postprandial rise of plasma glucose by increasing glucose-dependent insulin secretion, suppressing inappropriately high glucagon secretion and delaying gastric emptying. Methods:, In seven clinical trials performed in 2845 adult patients with type 2 diabetes mellitus who were inadequately controlled by a sulphonylurea and/or metformin (glycosylated haemoglobin, HbA1c ,11%), or by thiazolidinediones (with or without metformin) and treated for periods from 16 weeks to 3 years, exenatide (5 ,g b.i.d. s.c. for the first 4 weeks of treatment and 10 ,g b.i.d. s.c. thereafter) reduced HbA1c, fasting and postprandial glucose, and body weight dose dependently, and was similar to insulin glargine and biphasic insulin aspart in reducing HbA1c. Body weight diminished with exenatide, whereas it increased with both insulin preparations. Positive effects on the lipid profile and a reduction in C-reactive protein were also recorded with exenatide. Treatment extensions up to 3 years showed that benefits were maintained in the long term. Adverse events were usually mild to moderate in intensity, and generally the frequency decreased with continued therapy. The most common was nausea (whose incidence may be reduced by gradual dose escalation from 5 ,g b.i.d. to 10 ,g b.i.d.), vomiting, diarrhoea, headache and hypoglycaemia (almost exclusively in patients treated with a sulphonylurea). Results and conclusions:, Exenatide is a new, promising therapeutic option for type 2 diabetic patients inadequately controlled by oral agents, before insulin therapy, offering the added benefits of body weight reduction and tight postprandial glucose control. [source]

Time Course of Adverse Events in Patients with Localization-related Epilepsy Receiving Topiramate Added to Carbamazepine

EPILEPSIA, Issue 5 2005
Jerzy Majkowski
Summary:,Purpose: To explore the time course of treatment-emergent adverse events (AEs) during topiramate (TPM) adjunctive therapy. Methods: Post hoc analyses were performed by using data from a large (264 subjects) multicenter, double-blind, placebo-controlled trial in which 200 mg/day TPM was added to carbamazepine (CBZ) with or without another antiepileptic drug (AED) in adults with treatment-resistant partial-onset seizures. The daily incidence and mean duration of the most common (,5% incidence) AEs were calculated for patients completing the 12-week study. Results: The daily incidence of somnolence, headache, loss of appetite, nervousness, fatigue, dizziness, upper respiratory tract infection, and vertigo peaked during titration and declined to rates similar to that of placebo after the target TPM dose had been reached. In contrast, the daily incidence of paresthesia increased during titration and was maintained for the study duration. Relatively few patients had cognitive symptoms (9% with TPM, 5% with placebo), but these were the most common AEs associated with treatment discontinuation. Patient/investigator reports of weight loss increased gradually over the course of the trial, corresponding with the pattern of change in weight measured at study visits. Conclusions: This study demonstrates that most of the more common AEs with TPM adjunctive therapy are transient. Patients can be counseled that most AEs emerging when TPM is initially added to CBZ can be expected to diminish with continued therapy. [source]

Visual Function is Stable in Patients Who Continue Long-Term Vigabatrin Therapy: Implications for Clinical Decision Making

EPILEPSIA, Issue 4 2001
Scott R. Paul
Summary: ,Purpose: Vigabatrin (VGB) has been shown to cause visual field constriction and other forms of mild visual dysfunction. We determined the safety of continuing VGB therapy in patients who had received prolonged treatment (>2 years) with the drug by serially monitoring changes in visual function over a 1-year period of continued therapy. We also followed up patients who discontinued VGB to see whether alternative therapies are effective. Methods: Fifteen of 17 patients who continued VGB therapy had visual-function testing (visual acuity, color vision, kinetic and static perimetry) every 3 months for 1 year. Eighteen patients who discontinued VGB were given alternative antiepileptic drugs (AEDs); their seizure responses were measured after ,3 months of treatment. Results: Patients continuing VGB showed no worsening of visual acuity, color vision, or visual-field constriction beyond that measured in the initial test. Many patients who discontinued VGB had good seizure control with either newer or previously unsuccessful AEDs. Conclusions: For patients who have an excellent response to VGB and only mild visual changes, continued therapy may be safe with close visual monitoring. Patients who do not have a significant reduction in seizures or who experience considerable visual dysfunction with VGB may respond well to alternative therapies. [source]

Cutaneous cryptococcosis associated with lepromatous leprosy

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2001
Rubem David Azulay MD
A 65-year-old Brazilian man presented with an erythematous nodular lesion on the left forearm (Fig. 1). The patient had been treated with multidrug therapy for 8 months for lepromatous leprosy. During therapy, he developed recurrent episodes of reactions which were treated with high doses of prednisone and thalidomide. The histopathology of the cutaneous nodular lesion showed a granulomatous inflammatory infiltrate; some histiocytes contained vacuolations and others demonstrated oval-like or coma-like structures (Fig. 2). The specimen was cultivated in Sabouraud agar at room temperature. The colonies were transferred to Petri dishes containing Niger Seed Agar (NSA) (Fig. 3). The confirmed diagnosis was Cryptococcus neoformans var. neoformans based on microscopy and physiology, including the canavanine,glycine,bromothymol blue (CGB) medium (Lazéra MS, Pires FDA, Camillo-Coura L et al. Natural habitat of Cryptococcus neoformans var. neoformans in decaying wood forming hollows in living trees. J Med Vet Mycol 1996; 34: 127,131). The liquor culture was negative. Hemoculture and urine culture were also negative. Latex agglutination test was blood positive and liquor negative. Figure 1. Erythematous nodular lesion on the left forearm measuring 9 cm in diameter Figure 2. Granulomatous infiltrate presenting oval-like or coma-like structures inside the histiocytes (mucicarmine stain, ×,100) Figure 3. Petri dishes with Niger Seed Agar containing numerous colonies of Cryptococcus neoformans var. neoformans The patient's hemogram revealed normocytic anemia and normal total and differential white blood count. The CD4 count was 189/m3 and the CD8 count was 141/m3. Serology for anti-human immunodeficiency virus-I (anti-HIV-I) antibodies was negative. The X-ray of the lungs showed an areolar image in the superior lobe of the right lung. Therapy with prednisone was suspended and fluconazole (300 mg/day) was prescribed. The nodular cutaneous lesion regressed completely after 90 days. The patient was submitted to a second skin biopsy for treatment control. The culture of the specimen taken was still positive and the histopathology showed the same picture as before treatment. After 5 months of continued therapy with fluconazole, another biopsy was performed but no fungus was recovered from the specimen. [source]

Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: A randomized, double-blind, placebo-controlled, multicenter clinical trial,

ARTHRITIS & RHEUMATISM, Issue 1 2009
I. Jon Russell
Objective To evaluate the safety and efficacy of sodium oxybate for management of the symptoms of fibromyalgia syndrome (FMS). Methods Patients with FMS (according to the American College of Rheumatology 1990 criteria) were randomized, after discontinuing their prestudy medications for FMS, to receive 4.5 gm or 6 gm of sodium oxybate or matching placebo once per night for 8 weeks. The primary outcome variable (POV) was a composite score for changes from baseline in 3 coprimary self-report measures: patient's pain rating (in daily electronic diaries) on a visual analog scale (PVAS), the Fibromyalgia Impact Questionnaire (FIQ) score, and the Patient Global Impression of Change (PGI-C). A beneficial response rate for the POV composite score was defined as ,20% improvement in the PVAS and FIQ scores plus a rating of "much better" or "very much better" on the PGI-C. Secondary measures included subjective sleep outcomes (on the Jenkins Scale for Sleep) and quality-of-life measures. The analyses were based on an intent-to-treat (ITT) population. Results The ITT population included 188 patients with FMS, 78% of whom completed the trial. Significant benefit was observed with both dosages of sodium oxybate, according to changes in the POV and subjective sleep quality. Improvements in the PVAS score were significantly correlated with sleep outcomes. Sodium oxybate was well tolerated overall; dose-related nausea (,28% of patients) and dizziness (,18% of patients) tended to resolve with continued therapy. Conclusion Sodium oxybate therapy was well tolerated and significantly improved the symptoms of FMS. Further study of sodium oxybate as a novel therapeutic option for FMS is warranted. [source]