Advances in therapy
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Dual antiplatelet therapy with aspirin and clopidogrel is a cornerstone of the management of patients with acute coronary syndromes and following percutaneous coronary intervention. Despite the proven benefits, clear limitations of clopidogrel exist. ⋯ The promising results seen with prasugrel in large, randomized trials led to its recent approval by the US Food and Drug Administration for reducing thrombotic cardiovascular events in patients with acute coronary syndromes managed with percutaneous coronary intervention. This article will review the limitations of standard antiplatelet therapy and discuss the clinical application of prasugrel.
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Advances in therapy · Nov 2009
Nebulized formoterol provides added benefits to tiotropium treatment in chronic obstructive pulmonary disease.
The use of one or more long-acting bronchodilators is key in the maintenance therapy of chronic obstructive pulmonary disease (COPD). This analysis pooled the results of two double-blind studies evaluating the efficacy and safety of adding nebulized formoterol fumarate inhalation solution (FFIS) to maintenance tiotropium (TIO) treatment. ⋯ The addition of FFIS to maintenance TIO treatment for moderate to severe COPD results in significantly improved FEV(1) and dyspnea, decreased rescue medication use, and a lower incidence of AEs and COPD exacerbations. The addition of FFIS to TIO yields clinically and statistically significant benefits for COPD patients and might be of long-term benefit.
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Advances in therapy · Sep 2009
ReviewPhosphodiesterase type 5 inhibitors in pulmonary arterial hypertension.
Pulmonary arterial hypertension (PAH) is a rare disease characterized by vascular proliferation and remodeling, resulting in a progressive increase in pulmonary arterial resistance, right heart failure, and death. The pathogenesis of PAH is multifactorial, with endothelial cell dysfunction playing an integral role. This endothelial dysfunction is characterized by an overproduction of vasoconstrictors and proliferative factors, such as endothelin-1, and a reduction of vasodilators and antiproliferative factors, such prostacyclin and nitric oxide. ⋯ Side effects are usually mild and transient and include headache, flushing, nasal congestion, digestive disorders, and myalgia. Mild and moderate renal or hepatic failure does not significantly affect the metabolism of PDE-5 inhibitors, whereas coadministration of bosentan decreases sildenafil and tadalafil plasma levels. Due to their clinical effectiveness, tolerance profile, and their oral administration, sildenafil and tadalafil are two of the recommended first-line therapies for PAH patients in World Health Organization functional classes II or III.
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Advances in therapy · Jul 2009
ReviewCardiotoxicity associated with trastuzumab treatment of HER2+ breast cancer.
Although having high clinical efficacy in the treatment of human epidermal growth factor receptor-2 (HER2+) metastatic breast cancer, trastuzumab has been associated with cardiotoxicity, and the etiology and pathogenesis of this condition is currently under investigation. ⋯ The risk of cardiac dysfunction associated with trastuzumab can be justified given the increase in overall survival. This risk is lower when trastuzumab is given as monotherapy. The paradigm for cardiologists remains the same: treat the cancer effectively whilst preventing cardiotoxicity.
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Advances in therapy · Jul 2009
Comparative StudyComparing hydrocortisone and methylprednisolone in patients with septic shock.
Intravenous hydrocortisone of 200-300 mg/day for 7 days is suggested for patients with septic shock who require vasopressors to maintain mean artery pressure >or=65 mmHg, despite adequate fluid resuscitation. No study to date has compared the effects between physiologic doses of hydrocortisone and methylprednisolone in patients with septic shock. ⋯ Low-dose methylprednisolone and hydrocortisone might have a similar effect for the treatment of patients with septic shock.