In the treatment of type 2 diabetes not controlled by metformin and a sulfonylurea, no add-on drug has an obvious advantage over another, according to an Annals of Internal Medicine network meta-analysis.
Researchers examined 18 trials comprising 4500 participants with uncontrolled diabetes. (The add-on treatments were thiazolidinediones, glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors, insulins, and acarbose.) The following effects were noted:
No drug class had an advantage in controlling glycated hemoglobin levels.
Insulins and thiazolidinediones were associated with weight gain.
Glucagon-like peptide-1 agonists were associated with weight loss.
Insulins were associated with a doubled frequency of hypoglycemic episodes.
The authors acknowledge the limitations of network meta-analysis, in which some treatments are compared indirectly. They conclude that, in choosing a third drug, an individual patient's clinical features such as weight and hypoglycemia need to be considered.
Thursday, June 23, 2011
3-Month Treatment for Latent TB Infection as Effective as 9-Month Treatment
In patients with latent tuberculosis, a shorter treatment regimen may be as safe and effective as a longer course in preventing active disease, according to a CDC study presented on Monday at the American Thoracic Society conference.
Researchers studied some 8000 patients with latent TB who lived in countries with low to medium incidence of TB — mostly from the U.S. and Canada. Patients were randomized to either the standard treatment (9 months of self-administered daily isoniazid) or a shorter regimen (3 months of supervised weekly rifapentine and isoniazid). Over roughly 3 years' follow-up, seven patients on the shorter regimen developed TB disease, compared with 15 on standard treatment. The shortened-therapy group had a significantly higher rate of treatment completion (82% vs. 69%).
CDC Director Dr. Thomas Frieden called the findings "one of the biggest developments in TB treatment in decades." The CDC stresses that the results are only applicable to countries with low to moderate levels of latent infection
Researchers studied some 8000 patients with latent TB who lived in countries with low to medium incidence of TB — mostly from the U.S. and Canada. Patients were randomized to either the standard treatment (9 months of self-administered daily isoniazid) or a shorter regimen (3 months of supervised weekly rifapentine and isoniazid). Over roughly 3 years' follow-up, seven patients on the shorter regimen developed TB disease, compared with 15 on standard treatment. The shortened-therapy group had a significantly higher rate of treatment completion (82% vs. 69%).
CDC Director Dr. Thomas Frieden called the findings "one of the biggest developments in TB treatment in decades." The CDC stresses that the results are only applicable to countries with low to moderate levels of latent infection
lower dose asa appears to lower gi bleeds
Long-term use of aspirin and the risk of gastrointestinal bleeding.
Am J Med. 2011; 124(5):426-33 (ISSN: 1555-7162)
Huang ES; Strate LL; Ho WW; Lee SS; Chan AT
Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
BACKGROUND: In short-term trials, aspirin is associated with gastrointestinal bleeding. However, the effect of dose and duration of aspirin use on risk remains unclear.
METHODS: We conducted a prospective study of 87,680 women enrolled in the Nurses' Health Study in 1990 who provided biennial data on aspirin use. We examined the relative risk (RR) of major gastrointestinal bleeding requiring hospitalization or blood transfusion.
RESULTS: During a 24-year follow-up, 1537 women reported a major gastrointestinal bleeding. Among women who used aspirin regularly (≥2 standard [325 mg] tablets/week), the multivariate RR of gastrointestinal bleeding was 1.43 (95% confidence interval [CI], 1.29-1.59) when compared with nonregular users. Compared with women who denied any aspirin use, the multivariate RRs of gastrointestinal bleeding were 1.03 (95% CI, 0.85-1.24) for women who used 0.5 to 1.5 standard aspirin tablets/week, 1.30 (95% CI, 1.07-1.58) for women who used 2 to 5 tablets/week, 1.77 (95% CI, 1.44-2.18) for women who used 6 to 14 tablets/week, and 2.24 (95% CI, 1.66-3.03) for women who used more than 14 tablets/week (P(trend)<.001). Similar dose-response relationships were observed among short-term users (≤5 years; P(trend)<.001) and long-term users (>5 years; P(trend)<.001). In contrast, after adjustments were made for dose, increasing duration of use did not confer a greater risk of bleeding (P(trend) = .28).
CONCLUSION: Regular aspirin use is associated with gastrointestinal bleeding. Risk seems more strongly related to dose than duration of aspirin use. Efforts to minimize adverse effects of aspirin therapy should emphasize using the lowest effective dose among both short- and long-term users.
Am J Med. 2011; 124(5):426-33 (ISSN: 1555-7162)
Huang ES; Strate LL; Ho WW; Lee SS; Chan AT
Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
BACKGROUND: In short-term trials, aspirin is associated with gastrointestinal bleeding. However, the effect of dose and duration of aspirin use on risk remains unclear.
METHODS: We conducted a prospective study of 87,680 women enrolled in the Nurses' Health Study in 1990 who provided biennial data on aspirin use. We examined the relative risk (RR) of major gastrointestinal bleeding requiring hospitalization or blood transfusion.
RESULTS: During a 24-year follow-up, 1537 women reported a major gastrointestinal bleeding. Among women who used aspirin regularly (≥2 standard [325 mg] tablets/week), the multivariate RR of gastrointestinal bleeding was 1.43 (95% confidence interval [CI], 1.29-1.59) when compared with nonregular users. Compared with women who denied any aspirin use, the multivariate RRs of gastrointestinal bleeding were 1.03 (95% CI, 0.85-1.24) for women who used 0.5 to 1.5 standard aspirin tablets/week, 1.30 (95% CI, 1.07-1.58) for women who used 2 to 5 tablets/week, 1.77 (95% CI, 1.44-2.18) for women who used 6 to 14 tablets/week, and 2.24 (95% CI, 1.66-3.03) for women who used more than 14 tablets/week (P(trend)<.001). Similar dose-response relationships were observed among short-term users (≤5 years; P(trend)<.001) and long-term users (>5 years; P(trend)<.001). In contrast, after adjustments were made for dose, increasing duration of use did not confer a greater risk of bleeding (P(trend) = .28).
CONCLUSION: Regular aspirin use is associated with gastrointestinal bleeding. Risk seems more strongly related to dose than duration of aspirin use. Efforts to minimize adverse effects of aspirin therapy should emphasize using the lowest effective dose among both short- and long-term users.
FDA: 5-Alpha Reductase Inhibitors Associated with Increased Risk for High-Grade Prostate Cancer Diagnosis
The labels of 5-alpha reductase inhibitors (5-ARIs) are being changed to note an increased risk for being diagnosed with high-grade prostate cancer, the FDA announced on Thursday. The drugs (finasteride and dutasteride) are approved to treat benign prostatic hyperplasia and male pattern hair loss.
The announcement came after the FDA reviewed data from two prostate cancer prevention trials. In one, finasteride (given daily for 7 years) was associated with a higher frequency of prostate cancers with Gleason scores between 8 and 10, compared with placebo (1.8% vs. 1.1%). In the other, dutasteride (given daily for 4 years) was also associated with more high-grade cancers relative to placebo (1% vs. 0.5%).
The FDA recommends that physicians rule out prostate cancer before prescribing 5-ARIs for benign prostatic hyperplasia. Also, because these drugs lower prostate-specific antigen values, clinicians should be aware that if PSA increases while a patient is taking a 5-ARI — even if it is within the normal range — it may indicate the presence of prostate cancer
The announcement came after the FDA reviewed data from two prostate cancer prevention trials. In one, finasteride (given daily for 7 years) was associated with a higher frequency of prostate cancers with Gleason scores between 8 and 10, compared with placebo (1.8% vs. 1.1%). In the other, dutasteride (given daily for 4 years) was also associated with more high-grade cancers relative to placebo (1% vs. 0.5%).
The FDA recommends that physicians rule out prostate cancer before prescribing 5-ARIs for benign prostatic hyperplasia. Also, because these drugs lower prostate-specific antigen values, clinicians should be aware that if PSA increases while a patient is taking a 5-ARI — even if it is within the normal range — it may indicate the presence of prostate cancer
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