Clinical therapeutics
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Clinical therapeutics · Feb 2008
ReviewManagement of mixed dyslipidemia in patients with or at risk for cardiovascular disease: a role for combination fibrate therapy.
Lowering low-density lipoprotein cholesterol (LDL-C) is the primary focus of the management of dyslipidemia in patients with or at risk for cardiovascular disease. However, use of a statin alone may be insufficient for the treatment of mixed dyslipidemia, which is characterized by low levels of high-density lipoprotein cholesterol and elevated levels of triglycerides, with or without elevated levels of LDL-C. ⋯ The addition of fenofibrate to statin therapy may be a useful strategy for the management of mixed dyslipidemia in patients with or at risk for cardiovascular disease.
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Clinical therapeutics · Feb 2008
Comparative StudyCost-effectiveness analysis of emtricitabine/tenofovir versus lamivudine/zidovudine, in combination with efavirenz, in antiretroviral-naive, HIV-1-infected patients.
The aim of this study was to compare the cost per unit of effectiveness (successful treatment episode) of 2 highly active antiretroviral therapy combinations-emtricitabine/tenofovir DF + efavirenz (TVD + EFV) and lamivudine/zidovudine + efavirenz (COMB + EFV)-in antiretroviral-naive, HIV-1-infected patients from the perspective of costs to society. ⋯ Based on the results of this analysis, patients who started treatment of HIV-1 infection with combination TVD + EFV had significantly lower health care resource utilization and overall treatment costs compared with the COMB + EFV combination.
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Clinical therapeutics · Feb 2008
Comparative StudyEconomic evaluation of sunitinib malate in second-line treatment of metastatic renal cell carcinoma in Finland.
Cytokine therapy is currently used as first-line treatment of metastatic renal cell carcinoma (mRCC). Until recently, treatments with proven efficacy after the failure of first-line cytokine therapy were not available. In recent clinical trials, sunitinib has been associated with good response rates in patients with mRCC. ⋯ Based on the results of this cost-effectiveness analysis, sunitinib is potentially cost-effective as a second-line treatment of mRCC compared with the treatment currently practiced in Finnish hospitals. The ICER (euro/QALY gained) obtained in the present study was less than the value considered suitable for novel oncology treatments.
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Clinical therapeutics · Jan 2008
Randomized Controlled TrialOpen-label, prospective, randomized comparison of propofol and sevoflurane for laryngeal mask anesthesia for magnetic resonance imaging in pediatric patients.
Magnetic resonance imaging (MRI) for pediatric patients often requires deep sedation or anesthesia because they must remain completely immobile for a relatively long period to obtain high-quality images. ⋯ This small study found that sevoflurane, at the doses used in this study, provided shorter induction and faster recovery times than i.v. propofol for LMA anesthesia in these selected children undergoing MRI. The percentage of MRI interruption in the propofol group was significantly higher than that in the sevoflurane group. Sevoflurane was associated with a significantly higher score on the PAED scale, indicating greater emergence delirium.
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Clinical therapeutics · Jan 2008
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of levalbuterol and racemic albuterol in hospitalized patients with acute asthma or COPD: a 2-week, multicenter, randomized, open-label study.
The National Heart, Lung, and Blood Institute guideline recommends that dosing racemic albuterol be administered every 1 to 4 hours for treating patients with asthma or chronic obstructive pulmonary disease (COPD) in the hospital. Previously published preliminary and retrospective studies suggested that levalbuterol can be administered every 8 hours for the treatment of bronchoconstriction in hospitalized patients. However, it is unclear how the different dosing regimens affect the total number of nebulizations (scheduled plus as-needed treatments) and the costs of treatment of bronchoconstriction in a hospital setting. Moreover, it is not clear how the different dosing regimens affect symptom outcomes and health status in hospitalized patients with asthma or COPD. ⋯ In these hospitalized patients with acute asthma or COPD treated with levalbuterol every 6 to 8 hours or racemic albuterol every 1 to 4 hours, significantly fewer total nebulizations were required with levalbuterol, without an increased need for rescue nebulizations during 14 days of hospitalization. Both treatments were associated with improvements from baseline in symptoms and health status. The costs of treating bronchoconstriction in hospitalized patients were similar between the levalbuterol and racemic albuterol groups.