Current medical research and opinion
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To evaluate the efficacy and safety of the dipeptidyl peptidase (DPP)-4 inhibitor linagliptin in Asian patients with type 2 diabetes mellitus (T2DM), a rapidly increasing population. ⋯ This study was limited by the post hoc nature of the analysis, and because the pooling did not differentiate between geographically distant Asian regions. Nonetheless, this analysis provides evidence that linagliptin was efficacious and well tolerated as monotherapy or added to other oral antidiabetes therapies in Asian patients with T2DM.
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Comparative Study
Comparing two tyrosine kinase inhibitors for treatment of advanced renal cell carcinoma in Medicare and commercially insured patients.
The objective of this study was to compare treatment characteristics, survival and costs for sunitinib and pazopanib for advanced renal cell carcinoma (RCC) in a real-world setting. ⋯ Mortality data and proxy variables for treatment effectiveness indicate comparable clinical value for both medications. Sunitinib treatment trended towards higher index medication and total healthcare costs despite higher pre-index total costs and worse health status indicators at baseline with pazopanib. Non-adherence with sunitinib was associated with significantly higher total healthcare costs, which may indicate differences in tolerability between the two agents and requires further investigation.
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To evaluate the healthcare utilization, treatments, and costs incurred by women with uterine fibroids (UF), compared to those without UF, for 5 years before and 5 years after diagnosis. ⋯ Patients with UF incurred significantly higher healthcare utilization and costs than those without UF, both pre- and post-diagnosis.
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Editorial Comment
Sepsis and beta-blockade: a look into diastolic function.
There is growing interest on the modulation of the overwhelming sympathetic response of septic patients. Beta-blockers appear promising in this respect and, although we are at early stage, one large trial and a smaller one have demonstrated major beneficial effects. ⋯ It should be also considered that septic patients are at higher risk of cardiac arrhythmias and beta-blocker may have a protective effect in this regard. We are still at a preliminary stage and more research is needed it seems reasonable that beta-blockade will become an option for the treatment of septic patients over the next few years.
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Treatment of hypertension remains challenging in clinical practice. One major problem is incorrect utilization of the principal drug classes. Drugs from each class are currently used in accordance with an assumption that the blood pressure (BP) lowering effect is dose dependent. While this is true for most drugs, it is not appropriate for all drugs that block the renin-angiotensin system (RAS). ⋯ In hypertensive patients, a strategy based on ACE inhibitors with dose-dependent efficacy such as perindopril as optimal treatment should lead both to improved BP control and to a better protection from target organ damage, thereby reducing the incidence of cardiovascular events.