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A review on modafinil: the characteristics, function, and use in critical care. 莫达非尼的特点、功能及在重症监护中的应用综述。
IF 2.4 Pub Date : 2020-04-04 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2020.1745209
Seyed MohammadReza Hashemian, Tayebeh Farhadi

In critically ill patients, sleep is generally interrupted. Some factors that lead to such sleep interruption include the intensive care unit (ICU) circumstance, primary medical disease itself, mental stress, and impacts of many drugs and other managements utilized to treat ICU patients. Another illness that may cause profound daytime somnolence is narcolepsy. Modafinil, methylphenidate and amphetamines are used as stimulants to treat symptoms, such as extreme daytime sleepiness, cataplexy and nocturnal sleep disruption. Such stimulants can increase awareness, improve perception and thinking, as well as assist in keeping people awake. The exact mechanism of action of modafinil is unclear. In vitro studies have demonstrated that binding of modafinil to the dopamine reuptake pump can prevent the reuptake of dopamine, resulting in a boost in extracellular dopamine. Modafinil is a racemic compound containing l and d isomers. Peak plasma concentrations of the drug occur at 2-4 h after administration; therefore, the absorption of modafinil is considered fast. Modafinil is properly distributed in tissues by binding to plasma proteins moderately. Despite the likely role of modafinil in improving cognition and arousal in critically ill patients, the available data on the use of modafinil in the ICU setting is limited. The aim of the study was to review the novel usage of modafinil for alleviation of fatigue, excessive daytime somnolence (EDS), and/or depression in critically ill patients.

危重病人的睡眠通常会中断。导致这种睡眠中断的一些因素包括重症监护病房(ICU)环境、原发医学疾病本身、精神压力、许多药物的影响以及用于治疗ICU患者的其他管理方法。另一种可能导致白天嗜睡的疾病是嗜睡症。莫达非尼、哌醋甲酯和安非他明被用作兴奋剂,用于治疗症状,如白天极度嗜睡、猝倒和夜间睡眠中断。这类兴奋剂可以增强意识,改善知觉和思维,并帮助人们保持清醒。莫达非尼的确切作用机制尚不清楚。体外研究表明,莫达非尼与多巴胺再摄取泵结合可以阻止多巴胺的再摄取,从而导致细胞外多巴胺的增加。莫达非尼是一种外消旋化合物,含有l和d异构体。给药后2-4小时血药浓度达到峰值;因此,莫达非尼的吸收被认为是快速的。莫达非尼与血浆蛋白适度结合,在组织中分布合理。尽管莫达非尼可能在改善危重患者的认知和觉醒方面发挥作用,但关于在ICU环境中使用莫达非尼的现有数据有限。本研究的目的是回顾莫达非尼在缓解危重病人疲劳、白天嗜睡(EDS)和/或抑郁方面的新用法。
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引用次数: 14
A comparative study of aceclofenac versus etoricoxib in the management of acute low back pain in a tertiary care hospital. 乙酰氯芬酸与依托昔布在三级护理医院治疗急性腰痛的比较研究
IF 2.4 Pub Date : 2020-03-31 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2020.1734008
Hema Jagannathan, Amulya Thota, Ashok Kumar B Kumarappa, Githa Kishore

Background: The aim of management of acute low back pain is to alleviate the pain quickly and improve functional ability. Non-steroidal anti-inflammatory drugs are the first line of treatment. The challenge lies in deciding which NSAIDs will provide greater symptomatic relief, while also being cost-effective. Objective: To compare the effectiveness of aceclofenac and etoricoxib in the management of acute low back pain. Methods: This prospective, open label, observational study was conducted at a tertiary care hospital. Patients over 18 years of age and presenting with low back pain of less than 6 weeks duration were enrolled in the study. Fifty patients with non-specific low back pain were randomized into two groups: Group A received aceclofenac (2 mg/kg) twice a day and Group B received etoricoxib (1 mg/kg) twice a day for 1 week. The Numerical Rating Scale (NRS) and Oswestry Low Back Disability Index (ODI) determined the clinically meaningful outcomes. Results: The decrease in pain intensity in Group A was 52.27%, while in Group B it was 62.53%. However, the decrease in pain scores between the groups was not statistically significant (p = .3795). Improvement in functional ability in Group A and Group B was 57.01% and 61.48%, respectively. However, this improvement between the groups was not statistically significant (p > .999) at the end of 1 week. The average cost-effectiveness ratio indicated that etoricoxib was the dominant treatment over aceclofenac. Therefore, etoricoxib was found to be the cost-effective option for short-term pain relief in acute low back pain for 1 week. Conclusion: Both aceclofenac and etoricoxib were clinically effective in reducing the pain intensity and in improving functional ability. However, etoricoxib was found to be the cost-effective intervention.

背景:急性腰痛治疗的目的是迅速减轻疼痛,提高患者的功能。非甾体抗炎药是治疗的第一线。挑战在于决定哪种非甾体抗炎药能更好地缓解症状,同时又具有成本效益。目的:比较乙酰氯芬酸与依托昔布治疗急性腰痛的疗效。方法:这项前瞻性、开放标签、观察性研究在一家三级保健医院进行。年龄超过18岁且腰痛持续时间少于6周的患者被纳入研究。50例非特异性腰痛患者随机分为两组:A组给予aceclofenac (2 mg/kg)每日2次,B组给予依托昔布(1 mg/kg)每日2次,连续1周。数值评定量表(NRS)和Oswestry腰背残疾指数(ODI)确定临床有意义的结果。结果:A组疼痛强度降低52.27%,B组疼痛强度降低62.53%。但两组间疼痛评分差异无统计学意义(p = 0.3795)。A组和B组功能能力改善率分别为57.01%和61.48%。然而,在1周结束时,组间的改善无统计学意义(p > .999)。平均成本-效果比表明,依托昔布优于乙酰氯芬酸。因此,我们发现依托昔布是短期缓解急性腰痛1周的经济有效的选择。结论:乙酰氯芬酸和依托瑞昔布在减轻疼痛强度和改善功能方面均有临床疗效。然而,我们发现依托妥昔布是一种具有成本效益的干预措施。
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引用次数: 2
Can the dexamethasone intravitreal implant Ozurdex be safely administered in an out-of-operating room setting? 地塞米松玻璃体内植入物Ozurdex可以安全地在手术室外使用吗?
IF 2.4 Pub Date : 2020-03-31 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2020.1742723
María Del Pino Cidad-Betegón, Félix Armadá-Maresca, Gloria Amorena-Santesteban, Javier Coca-Robinot, Oriana D'Anna-Mardero, Irene de la Rosa-Pérez, Beatriz Manzano-Muñoz, Jesús García-Martínez, Mónica Asencio-Durán, Gema Casado-Abad

Purpose: To describe a standardized protocol of the dexamethasone intravitreal (DEX) implant Ozurdex (Allergan, Dublin, Ireland) performed in a controlled environment surgical cabin (CESC). Methods: Retrospective and observational study conducted on patients who underwent a DEX implant between May 2011 and June 2019, in a third level University Hospital. The controlled environment surgical cabin (ArcSterile, Imex, Valencia, Spain) used in this study was the MB 20 (2 m width, 1.60 m depth, and 2 m height) with an uninterrupted power system (ARSSAI1) to keep the cabin working for 20 min. The cabin was used in the open mode. A standardized protocol of intravitreal injections in controlled environment surgical cabin was designed. Results: From May 2011 to February 2015, a total of 454 DEX implants were performed in the operating room, whereas from March 2015 to June 2019, 1054 DEX devices were implanted using the CESC. The mean number of DEX implants/per week was significantly lower in the operating room than in the CESC [2.3 (2.1 to 2.5) versus 3.8 (3.6 to 4.1), mean difference 1.5 (1.2 to 1.8), p < 0.0001]. The incidence of endophthalmitis was similar in the two populations, 0/454 (0.0%; 95% CI 0.0 to 0.81%) and 0/1054 (0.0%; 95% CI 0.0 to 0.35%) in the operating room and in the CESC, respectively. Conclusions: The CESC may be a good alternative to the conventional operating room for the administration of the intravitreal DEX implant.

目的:描述在受控环境手术舱(CESC)中进行地塞米松玻璃体内(DEX)植入Ozurdex (Allergan, Dublin, Ireland)的标准化方案。方法:对2011年5月至2019年6月在某三级大学医院行DEX植入的患者进行回顾性观察研究。本研究使用的受控环境手术舱(ArcSterile, Imex, Valencia, Spain)为MB 20(宽2 m,深1.60 m,高2 m),采用不间断动力系统(ARSSAI1)使手术舱工作20分钟。舱室是在开放式模式下使用的。设计了一套规范的受控环境手术舱内玻璃体内注射方案。结果:2011年5月至2015年2月,共在手术室植入了454个DEX植入物,2015年3月至2019年6月,使用CESC植入了1054个DEX植入物。手术室内DEX植入物平均数量/每周明显低于CESC[2.3(2.1至2.5)vs 3.8(3.6至4.1),平均差异1.5(1.2至1.8),p结论:CESC可能是传统手术室玻璃体内DEX植入物的良好替代方案。
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引用次数: 3
Inbuilt novel bioretardant feature of biopolymer isolated from cucumis sativa for designing drug loaded bionanosuspension. 利用从黄瓜中分离的生物聚合物设计载药生物纳米悬浮液的新型生物阻聚特性。
IF 2.4 Pub Date : 2020-03-31 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2020.1745210
Yogita Tyagi, Nv Satheesh Madhav

Objectives: The current research work has potential for delivery of fluvoxamine moiety in bio-nanosuspension mode for the effective treatment of depression. Depression is a mood disorder characterized by persistently low mood and a feeling of sadness and loss of interest. Methods: The fluvoxamine loaded bio-nanosuspension was prepared using novel bio-retardant isolated from fruit pulp of Cucumis sativa by a novel method with different ratios (1:1, 1:2, 1:3, 1:4, 1:5) and the same ratios with standard polymer eudragit L-100. The bio-nanosuspensions were evaluated for pH stability studies, percentage entrapment efficacy, in vitro drug release, particle size, polydispersity index, zeta potential, and stability studies. Results: The bio-nanosuspension was subjected to the best formulation based on comparison of above mentioned evaluation parameters, and the Fc1 (1:1) formulation was found to be the best formulation. Cucumis sativa provided excellent stability for the formulation, and the resulting particle size was found to be 194 nm. The bio-nanosuspension had a Polydispersity Index (PDI) of 0.13 with zeta potential of -17.9 mV. Conclusion: The fluvoxamine loaded bio-nanosuspension using Cucumis sativa was found to be nontoxic and compatible with drug delivery systems for treatment of depression. This was the first report in which Cucumis sativa as a bioretardant demonstrated greater retardability over the standard polymer eudragit-100.

目的:本研究为氟伏沙明部分以生物纳米混悬液的方式有效治疗抑郁症提供了可能。抑郁症是一种情绪障碍,其特征是情绪持续低落,感到悲伤和失去兴趣。方法:以黄瓜果肉为原料,采用不同配比(1:1、1:2、1:3、1:4、1:5),与标准聚合物乌达木酯L-100配比的新型阻燃剂制备负载氟伏沙明的生物纳米混悬液。对生物纳米混悬液进行pH稳定性研究、包封率、体外药物释放、粒径、多分散指数、zeta电位和稳定性研究。结果:通过对上述评价参数的比较,确定了生物纳米混悬液的最佳配方,Fc1(1:1)为最佳配方。黄瓜为该配方提供了良好的稳定性,得到的颗粒尺寸为194 nm。该生物纳米悬浮液的多分散指数(PDI)为0.13,zeta电位为-17.9 mV。结论:以黄瓜为原料制备的氟伏沙明生物纳米混悬液无毒,且与药物传递系统兼容,可用于抑郁症的治疗。这是首次报道黄瓜作为生物阻垢剂比标准聚合物eudragit-100表现出更大的阻垢性。
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引用次数: 3
Autologous conditioned serum: clinical and functional results using a novel disease modifying agent for the management of knee osteoarthritis. 自体条件血清:一种新型疾病调节剂治疗膝骨关节炎的临床和功能结果。
IF 2.4 Pub Date : 2020-03-25 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2020.1734009
Matteo Vitali, Marco Ometti, Andreas Drossinos, Pierluigi Pironti, Luca Santoleri, Vincenzo Salini

Objective: The purpose of this study was to investigate the potential ability of autologous conditioned serum (ACS) to decrease pain and improve joint functionality in patients affected by knee osteoarthritis (OA). Methods: Fifteen patients with clinical and radiological signs of OA of the knee were recruited for this study. Each patient received 4 injections of ACS (Orthokine; orthogen, Dusseldorf, Germany) at the site of OA once per week for 4 weeks. Clinical and functional evaluation was performed using the VAS scale for pain, WOMAC scale and KSS functional and clinical scores before the first injection, at one week, at two weeks, at three weeks, at one month and at six months. Statistical analysis was done with the Wilcoxon Signed-Rank Test. Results: Our results show an improvement of all the evaluation scales at 6 months follow-up. Particularly, VAS scales among all patients decreased by 35.8% (p = .00148), KSS functional scores improved by 38.2% (p = .00148), KSS clinical scores improved by 28.9% (p = .00236) and WOMAC scores were reduced by 19.8% (p = .00188). Few adverse effects were observed in our sample. The most common complaint was pain and swelling in the subsequent days after performing the intra-articular injection. Only one patient reported rigidity following the injection of the ACS. Conclusion: Our results, in conjunction with preexisting studies in the medical literature regarding ACS, demonstrate the viability of this therapy for the treatment of knee OA, showing positive influence on pain and joint function without significant adverse effects.

目的:本研究的目的是探讨自体条件血清(ACS)减轻膝关节骨关节炎(OA)患者疼痛和改善关节功能的潜在能力。方法:选取15例有临床及影像学征象的膝关节OA患者作为研究对象。每位患者接受4次ACS (Orthokine;orthogen,杜塞尔多夫,德国)在OA现场每周一次,持续4周。采用首次注射前、第1周、第2周、第3周、第1个月和第6个月的疼痛VAS评分、WOMAC评分和KSS功能和临床评分进行临床和功能评价。统计学分析采用Wilcoxon sign - rank检验。结果:随访6个月,各项评价指标均有改善。其中,VAS评分下降35.8% (p = 0.00148), KSS功能评分提高38.2% (p = 0.00148), KSS临床评分提高28.9% (p = 0.00236), WOMAC评分降低19.8% (p = 0.00188)。在我们的样本中几乎没有观察到不良反应。最常见的主诉是关节内注射后数日的疼痛和肿胀。只有一名患者报告在注射ACS后出现僵硬。结论:我们的研究结果,结合已有的关于ACS的医学文献研究,证明了这种治疗膝关节OA的可行性,对疼痛和关节功能有积极的影响,没有明显的不良反应。
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引用次数: 14
Virtual screening for potential inhibitors of β(1,3)-D-glucan synthase as drug candidates against fungal cell wall. β(1,3)- d -葡聚糖合成酶抑制剂作为真菌细胞壁候选药物的虚拟筛选
IF 2.4 Pub Date : 2020-03-11 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2020.1734010
Zinat Farhadi, Tayebeh Farhadi, Seyed MohammadReza Hashemian

Background: To enhance the outcome in patients with invasive candidiasis, initiation of an efficient antifungal treatment in a suitable dosage is necessary. Echinocandins (e.g. caspofungin) inhibit the enzyme β(1,3)-D-glucan synthase of the fungal cell wall. Compared to azoles and other antifungal agents, echinocandins have lower adverse effects and toxicity in humans. Echinocandins are available in injectable (intravenous) form. Methods: In this study, to identify the novel oral drug-like compounds that affect the fungal cell wall, downloaded oral drug-like compounds from the ZINC database were processed with a virtual screening procedure. The docking free energies were calculated and compared with the known inhibitor caspofungin. Four molecules were selected as the most potent ligands and subjected to hydrogen bonds analysis. Results: Considering the hydrogen bond analysis, two compounds (ZINC71336662 and ZINC40910772) were predicted to better interact with the active site of β(1,3)-D-glucan synthase compared with caspofungin. Conclusion: The introduced compound in this study may be valuable to analyze experimentally as a novel oral drug candidate targeting fungal cell walls.

背景:为了提高侵袭性念珠菌病患者的预后,有必要开始适当剂量的有效抗真菌治疗。棘白菌素(如caspofungin)抑制真菌细胞壁的β(1,3)- d -葡聚糖合成酶。与唑类和其他抗真菌药物相比,棘白菌素对人体的不良反应和毒性较低。棘白菌素有注射(静脉注射)形式。方法:为了鉴定影响真菌细胞壁的新型口服药物样化合物,本研究采用虚拟筛选程序对锌数据库中下载的口服药物样化合物进行处理。计算了对接自由能,并与已知抑制剂caspofungin进行了比较。选择四个分子作为最有效的配体并进行氢键分析。结果:结合氢键分析,预测ZINC71336662和ZINC40910772两种化合物与β(1,3)- d -葡聚糖合成酶活性位点的相互作用优于caspofungin。结论:该化合物可作为一种靶向真菌细胞壁的新型口服药物进行实验分析。
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引用次数: 7
Levonorgestrel emergency contraception and bodyweight: are current recommendations consistent with historic data? 左炔诺孕酮紧急避孕与体重:目前的建议与历史数据一致吗?
IF 2.4 Pub Date : 2020-02-10 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2020.1725524
László Kardos

Objective: To assess the consistency between current recommendations that women of body weight (BW) or body mass index (BMI) above a defined threshold should use a double dose of levonorgestrel (LNG) for emergency contraception (EC) and observed frequency of pregnancy in historic studies of single-dose LNG for EC. Methods: We applied double dose recommendation criteria to individual participant level data from three historic studies of the WHO's Human Reproductive Program to categorize subjects into single dose-recommended (SDR) and double dose-recommended (DDR) groups and compared the latter to the former using pregnancy risk ratios (RR). Results: A total of 5859 subjects with 59 pregnancies made up the full dataset. Depending on the recommendation source (USA or UK) and inclusion or exclusion of heavy outlier data, DDR criteria were satisfied by 3.7% to 18.9% of subjects. Pregnancy proportions were mostly lower in DDR than in SDR subjects, with risk ratio estimates ranging from zero to 1.17, exceeding unity only when the USA criterion was used with outliers included. DDR subjects had a significantly lower relative frequency of pregnancy than SDR subjects when the UK criteria were used and outliers excluded (RR = 0.17 [95% CI: 0.04; 0.70], p = .0024). Conclusions: Our findings are consistent with the notion that there is no real loss of pregnancy control with single-dose LNG-EC in high-BMI and/or high-BW users, and today's double dose recommendations were prematurely issued and remain questionable.

目的:评估目前关于体重(BW)或体重指数(BMI)高于规定阈值的女性应使用双剂量左炔诺孕酮(LNG)进行紧急避孕(EC)的建议与单剂量LNG用于EC的历史研究中观察到的妊娠频率之间的一致性。方法:我们对来自世界卫生组织人类生殖规划的三个历史研究的个体参与者水平数据应用双剂量推荐标准,将受试者分为单剂量推荐(SDR)组和双剂量推荐(DDR)组,并使用妊娠风险比(RR)将后者与前者进行比较。结果:5859名怀孕的受试者组成了完整的数据集。根据推荐来源(美国或英国)和纳入或排除大量异常数据,3.7%至18.9%的受试者满足DDR标准。与SDR受试者相比,DDR受试者的怀孕比例大多较低,风险比估计值在0到1.17之间,只有在使用美国标准并包含异常值时才超过统一。当使用英国标准并排除异常值时,DDR受试者的妊娠相对频率显著低于SDR受试者(RR = 0.17 [95% CI: 0.04;0.70], p = .0024)。结论:我们的研究结果与单剂量LNG-EC在高bmi和/或高体重用户中没有真正失去妊娠控制的观点是一致的,今天的双剂量建议过早发布,仍然值得怀疑。
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引用次数: 3
Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations. 多发性硬化症女性患者的妊娠相关问题:循证综述与实用建议。
IF 2.4 Pub Date : 2020-01-23 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2020.1721507
Beatriz Canibaño, Dirk Deleu, Boulenouar Mesraoua, Gayane Melikyan, Faiza Ibrahim, Yolande Hanssens

Objective: To review the current evidence regarding pregnancy-related issues in multiple sclerosis (MS) and to provide recommendations specific for each of them. Research design and methods: A systematic review was performed based on a comprehensive literature search. Results: MS has no effect on fertility, pregnancy or fetal outcomes, and pregnancies do not affect the long-term disease course and accumulation of disability. There is a potential risk for relapse after use of gonadotropin-releasing hormone agonists during assisted reproduction techniques. At short-term, pregnancy leads to a reduction of relapses during the third trimester, followed by an increased risk of relapses during the first three months postpartum. Pregnancies in MS are not per se high risk pregnancies, and MS does not influence the mode of delivery or anesthesia unless in the presence of significant disability. MRI is not contraindicated during pregnancy; however, gadolinium contrast media should be avoided whenever possible. It is safe to use pulse dose methylprednisolone infusions to manage acute disabling relapses during pregnancy and breastfeeding. However, its use during the first trimester of pregnancy is still controversial. Women with MS should be encouraged to breastfeed with a possible favorable effect of exclusive breastfeeding. Disease-modifying drugs can be classified according to their potential for pregnancy-associated risk and impact on fetal outcome. Interferon beta (IFNβ) and glatiramer acetate (GA) may be continued until pregnancy is confirmed and, after consideration of the individual risk-benefit if continued, during pregnancy. The benefit of continuing natalizumab during the entire pregnancy may outweigh the risk of recurring disease activity, particularly in women with highly active MS. GA and IFNβ are considered safe during breastfeeding. The use of natalizumab during pregnancy or lactation requires monitoring of the newborn. Conclusions: This review provides current evidence and recommendations for counseling and management of women with MS preconception, during pregnancy and postpartum.

目的:回顾与多发性硬化症(MS)妊娠相关问题的现有证据,并针对每个问题提出具体建议。研究设计与方法:在全面文献检索的基础上进行系统综述。研究结果多发性硬化症对生育、妊娠或胎儿结局没有影响,妊娠也不会影响长期病程和残疾的累积。在辅助生殖技术中使用促性腺激素释放激素激动剂后有复发的潜在风险。在短期内,妊娠会导致妊娠三个月内复发率降低,但在产后头三个月内复发的风险会增加。多发性硬化症患者的妊娠本身并不是高风险妊娠,而且多发性硬化症不会影响分娩方式或麻醉,除非存在严重残疾。孕期并不禁忌磁共振成像,但应尽可能避免使用钆造影剂。在孕期和哺乳期使用脉冲剂量的甲基强的松龙输液来控制急性致残性复发是安全的。然而,在妊娠头三个月使用甲基强的松龙仍存在争议。应鼓励患有多发性硬化症的妇女进行母乳喂养,纯母乳喂养可能会产生有利影响。疾病修饰药物可根据其潜在的妊娠相关风险和对胎儿结局的影响进行分类。β干扰素(IFNβ)和醋酸格拉替雷(GA)可以继续使用,直到确认妊娠为止;如果继续使用,在考虑了个体风险-获益之后,可以在妊娠期间继续使用。在整个妊娠期间继续使用纳他珠单抗的益处可能大于疾病活动复发的风险,尤其是对于患有高度活动性多发性硬化症的妇女。GA和IFNβ在哺乳期被认为是安全的。在妊娠期或哺乳期使用纳他珠单抗需要对新生儿进行监测。结论:本综述为患有多发性硬化症的妇女在孕前、孕期和产后的咨询和管理提供了当前的证据和建议。
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引用次数: 0
Efficacy of lofexidine for mitigating opioid withdrawal symptoms: results from two randomized, placebo-controlled trials. 洛非西定缓解阿片类药物戒断症状的疗效:两项随机安慰剂对照试验的结果。
IF 2.4 Pub Date : 2020-01-08 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2019.1704416
Danesh Alam, Carlos Tirado, Mark Pirner, Thomas Clinch

Objectives: Fear of opioid withdrawal syndrome (OWS) often dissuades opioid discontinuation. Lofexidine is an FDA-approved, alpha2-adrenergic receptor agonist for treatment of OWS. Pivotal trial results from the per-protocol statistical analyses have been published. However, the FDA prescribing information presents these efficacy results using a different, standardized statistical approach that does not transform data or impute missing values. This analysis is easier to interpret and allows comparison across studies. This reanalysis is presented here. Methods: Studies were double-blind, placebo-controlled for 7 days in Study 1 and 5 days in Study 2. Opioid-dependent adults received placebo or lofexidine; efficacy was assessed using the Short Opioid Withdrawal Scale of Gossop (SOWS-G) daily. Results: Study 1 (N = 602) mean SOWS-G scores were 6.1 (SE: 0.35), 6.5 (SE: 0.34), and 8.8 (SE: 0.47) over Days 1-7 for lofexidine 2.88 mg/day, 2.16 mg/day, and placebo, respectively (for 2.88, p < .0001; for 2.16 mg, p < .0001). Study 2 (N = 264) mean SOWS-G scores were 7.0 (SE: 0.44) and 8.9 (SE: 0.48) over Days 1-5 for lofexidine 2.16 mg/day and placebo, respectively (p = .0037). Median time to treatment discontinuation was approximately 2 days later with lofexidine treatment than with placebo and significantly more lofexidine-treated subjects completed the studies. Hypotension and bradycardia were more common with lofexidine. More placebo subjects withdrew prematurely for lack of efficacy. Conclusion: This simplified analysis confirmed previous per-protocol results, that lofexidine better reduces OWS severity and increases retention compared with placebo in opioid-dependent adults. These results are robust and comparable across studies using various methods of analysis. ClinicalTrials.gov identifier: Study 1, NCT01863186; Study 2 NCT00235729. URL: https://clinicaltrials.gov/.

目的:对阿片类药物戒断综合征(OWS)的恐惧往往会阻碍阿片类药物的停用。洛非西定是一种经美国食品及药物管理局批准的α2-肾上腺素能受体激动剂,可用于治疗OWS。按协议统计分析的关键试验结果已经公布。不过,美国食品及药物管理局的处方信息采用了一种不同的标准化统计方法来介绍这些疗效结果,这种方法不转换数据或计算缺失值。这种分析方法更易于解释,并可对不同研究进行比较。本文介绍了这种重新分析方法。研究方法研究 1 和研究 2 分别进行了为期 7 天和 5 天的双盲安慰剂对照研究。阿片类药物依赖成人接受安慰剂或洛非西定治疗;每天使用戈索普阿片类药物戒断简易量表(SOWS-G)评估疗效。研究结果研究 1(N = 602)中,洛非西定 2.88 毫克/天、2.16 毫克/天和安慰剂在第 1-7 天的平均 SOWS-G 评分分别为 6.1(SE:0.35)、6.5(SE:0.34)和 8.8(SE:0.47)(对于洛非西定 2.88 毫克/天、2.16 毫克/天和 2.88 毫克/天,P = 264)。88, p p N = 264),洛非西定 2.16 毫克/天和安慰剂在第 1-5 天的平均 SOWS-G 评分分别为 7.0(SE:0.44)和 8.9(SE:0.48)(p = .0037)。洛非西定治疗的中位停药时间比安慰剂晚约2天,而且完成研究的洛非西定治疗受试者明显更多。低血压和心动过缓在使用洛非西定时更为常见。因疗效不佳而提前退出研究的安慰剂受试者更多。结论:这项简化分析证实了之前的按方案治疗结果,即与安慰剂相比,洛非西定能更好地减轻阿片类药物依赖成人的OWS严重程度,并提高保留率。这些结果是可靠的,在采用不同分析方法的研究中具有可比性。ClinicalTrials.gov 标识符:研究 1 NCT01863186;研究 2 NCT00235729。网址:https://clinicaltrials.gov/。
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引用次数: 0
Clinical characteristics and patient treatment satisfaction with Humalog U-200 in patients with type 2 diabetes mellitus: an observational study. Humalog U-200治疗2型糖尿病患者的临床特点及患者治疗满意度:一项观察性研究。
IF 2.4 Pub Date : 2019-12-11 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2019.1704415
Jil Mamza, Uchena Anyanwagu, Mohammed Alkharaiji, Iskandar Idris

Background: There are limited data on the real-world evidence of Humalog 200 units/ml KwikPen (U-200) insulin. We assessed the use of U-200 insulin in UK routine clinical practice to provide information on clinical characteristics, treatment satisfaction and short-term clinical outcomes. Methods: Nine patients with type 2 diabetes who initiated U-200 in secondary care and a further 12 identified from primary care electronic database were enrolled. A treatment satisfaction questionnaire was administered to the 19 secondary care patients. Follow-up data on clinical parameters were collected at 3 and 6 months following initial U-200 insulin administration and the data were used to assess changes in clinical outcomes from baseline. Results: Secondary care patients had a mean age 60 ± 11 years, mean HbA1c of 8.6% ± 1.3% and a mean BMI of 39.7 ± 5.3 kg/m2 at baseline. Primary care database patients had a mean age 57 ± 13 years, mean HbA1c 10.3% ± 1.7 and a mean BMI 42.3 ± 3.8 kg/m2. The nine participants' responses to the questionnaire suggested a high preference for U-200 over a previous mealtime insulin pen (PMIP). On average, the patients agreed that U-200 was quicker to inject, had a better controlled home blood glucose reading and less discomfort at the injection site compared to a PMIP. Patients were willing to continue with their U-200 treatment. No significant HbA1c reduction was observed at 3 months in the secondary care group (-0.5%), but marked significant reduction in HbA1c was seen at 3 months in the primary care dataset to (-2.8%; p < .0004). There was also some suggestion of weight loss in both the secondary and primary care groups. Conclusion: Humalog U-200 insulin users were comprised mainly of older patients with diabetes complications and high HbA1c levels at the time of U-200 initiation. Overall, U-200 improved patients' satisfaction with diabetes treatment and short-term metabolic outcomes.

背景:Humalog 200单位/毫升KwikPen (U-200)胰岛素的实际证据数据有限。我们评估了U-200胰岛素在英国常规临床实践中的使用,以提供有关临床特征、治疗满意度和短期临床结果的信息。方法:9例2型糖尿病患者在二级保健中开始使用U-200,另外12例从初级保健电子数据库中确定。对19例二级护理患者进行治疗满意度问卷调查。在首次使用U-200胰岛素后的3个月和6个月收集临床参数的随访数据,并使用这些数据评估从基线到临床结果的变化。结果:二级护理患者的平均年龄为60±11岁,基线时平均HbA1c为8.6%±1.3%,平均BMI为39.7±5.3 kg/m2。初级保健数据库患者的平均年龄为57±13岁,平均HbA1c为10.3%±1.7,平均BMI为42.3±3.8 kg/m2。九名参与者对问卷的回答表明,他们对U-200的偏好高于之前的餐时胰岛素笔(PMIP)。平均而言,患者同意U-200注射速度更快,与pip相比,家庭血糖读数控制得更好,注射部位的不适也更少。患者愿意继续他们的U-200治疗。二级护理组在3个月时未观察到明显的HbA1c降低(-0.5%),但在初级护理组3个月时HbA1c显著降低(-2.8%;p结论:U-200胰岛素的使用者主要是年龄较大且开始使用U-200时HbA1c水平较高的糖尿病并发症患者。总体而言,U-200提高了患者对糖尿病治疗和短期代谢结局的满意度。
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引用次数: 1
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Journal of Drug Assessment
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