Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jun 2020
[Recurrent Therapy of Multiple Myeloma - Individualized Concepts from The Arsenal of Diverse Options].
The prognosis of patients with multiple myeloma has improved significantly over the past 20 years. However, the patient population in the relapse situation is very heterogeneous due to increasing age and the previous course of the disease and therapy. In particular, the approval of new targeted substances offers numerous treatment options that can be adapted to the individual situation. ⋯ In frail patients, a combination of two can also be used. The new substances also offer very good therapeutic options for high-risk cytogenetics or renal insufficiency. The monoclonal antibodies Daratumumab and Elotuzumab are well tolerated except for infusion reactions and are highly effective in various combinations, even in high-risk cytogenetics.
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Dtsch. Med. Wochenschr. · Jun 2020
[From a trail to an official path: new recommendations for the treatment of mild asthma].
Accumulating evidence suggests that a symptom-driven therapy with fixed combinations of inhaled corticosteroids (ICS) and formoterol is safer and more feasible in patients with mild asthma than a treatment with short-acting beta-2-agonists (SABA) alone. Therefore, the new international GINA asthma guideline (2019) recommends, for the first time, as needed low dose ICS-formoterol as the preferred controller in treatment step 1. This radical paradigm shift will have a major impact on asthma care in the future.
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Dtsch. Med. Wochenschr. · Jun 2020
[What is new in the diagnosis and therapy of renal cell carcinoma?]
Renal cell carcinomas (RCC) include different tumor entities, of which clear cell RCC is the most common tumor with approx. 75 % followed by the papillary RCC with 10-15 %. RCC are increasingly being diagnosed incidental in the context of abdominal diagnostics from other indications using sonography or cross-sectional imaging. ⋯ The combinations lead to a higher response rate and longer survival. In the second line and subsequent lines, there is no evidence-based data after combination therapies, but drugs can be used that were not yet part of the first-line therapy.
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Dtsch. Med. Wochenschr. · Jun 2020
[Prevention of stroke and dementia in general practice: evaluation of the project INVADE].
Stroke and dementia have several modifiable risk factors in common. In the primary care prevention project INVADE (INtervention project on VAscular brain diseases and Dementia in the district of Ebersberg), these vascular risk factors were recorded systematically and treated according to evidence-based guidelines. ⋯ clinicaltrials.gov, NCT1107548, registration date: 21.04.2010, drks.de, DRKS00011348, registration date: 29.12.2016.
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Dtsch. Med. Wochenschr. · Jun 2020
[Antidiabetic SGLT-2 inhibitors prevent progression of chronic kidney disease].
Several interventional trials that studied cardiovascular safety of antidiabetic drugs in patients with diabetes mellitus and elevated risk of cardiovascular disease suggested potential nephroprotective effects of SGLT-2 inhibitors. Subsequently, the CREDENCE study confirmed reduced progression of chronic kidney disease (CKD) towards dialysis-dependency in diabetic patients with mildly or moderately impaired glomerular filtration rate and high albuminuria. ⋯ The final publication of DAPA-CKD is expected in late 2020. Parallelly, new treatment guidelines from the Kidney-Disease:-Improving-Global-Outcomes (KDIGO)-Initiative will recommend SGLT-2 inhibitors as standard treatment for CKD patients with diabetes mellitus, even though these drugs are not yet licensed for patients with moderately-to-severely reduced renal function.