Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 5 Articles
Background: In many countries worldwide, the long-acting anticholinergic drug tiotropium is available as a dry\npowder formulation delivered by means of the HandiHalerÃ?® inhalation device and as an aqueous solution delivered\nvia the RespimatÃ?® Soft Mistââ??¢ Inhaler. Tiotropium HandiHalerÃ?® is a single-dose, dry powder, breath-actuated inhaler\nthat provides delivered doses and lung deposition of tiotropium that are, over a wide range, not influenced by the\nseverity of chronic obstructive pulmonary disease (COPD). Tiotropium RespimatÃ?® is a propellant-free, multi-dose\ninhaler that delivers a metered dose of medication as a fine, slow-moving, long-lasting soft mist, independently of\npatient inspiratory effort. The high fine-particle fraction of droplets produced by the RespimatÃ?® inhaler optimizes\nthe efficiency of drug delivery to the lungs.\nMethods: To help inform the choice of tiotropium inhaler for prescribers and patients, this systematic review\nsummarizes the available pharmacokinetic, efficacy and safety data from comparative studies of tiotropium\nRespimatÃ?® and tiotropium HandiHalerÃ?® in COPD, focusing on the licensed once-daily doses of 5 and 18 Ã?¼g,\nrespectively. Data sources reviewed include publications and abstracts identified from database searches.\nResults: Published evidence from comparative studies suggests that tiotropium RespimatÃ?® 5 Ã?¼g and tiotropium\nHandiHalerÃ?® 18 Ã?¼g provide similar clinical outcomes in patients with COPD.\nConclusions: The findings indicate that physicians can base their decision about an inhaler for tiotropium on\nfactors other than efficacy or safety. These could be patient preference for a particular inhaler, ease of use and the\nefficiency of drug delivery, with the aim of optimizing adherence and clinical outcomes with long-term tiotropium\nmaintenance therapy....
Background: Asthma is a common problem in children and, if inadequately controlled, may seriously diminish\ntheir quality of life. Inhaled short-acting beta2 agonists such as salbutamol are usually prescribed as ââ?¬Ë?relieverââ?¬â?¢\nmedication to help control day-to-day symptoms such as wheeze. As with many medications currently\nprescribed for younger children (defined as those aged 2 years 6 months to 6 years 11 months), there has\nbeen no pre-licensing age-specific pharmacological testing; consequently, the doses currently prescribed\n(200ââ?¬â??1000 Ã?¼g) may be ineffective or likely to induce unnecessary side effects. We plan to use the interrupter\ntechnique to measure airway resistance in this age group, allowing us for the first time to correlate inhaled\nsalbutamol dose with changes in clinical response. We will measure urinary salbutamol levels 30 min after\ndosing as an estimate of salbutamol doses in the lungs, and also look for genetic polymorphisms linked to\npoor responses to inhaled salbutamol.\nMethods: This is a phase IV, randomised, controlled, observer-blinded, single-centre trial with four parallel\ngroups (based on a sparse sampling approach) and a primary endpoint of the immediate bronchodilator\nresponse to salbutamol so that we can determine the most appropriate dose for an individual younger child.\nSimple randomisation will be used with a 1:1:1:1 allocation.\nDiscussion: The proposed research will exploit simple, non-invasive and inexpensive tests that can mostly be\nperformed in an outpatient setting in order to help develop the evidence for the correct dose of salbutamol\nin younger children with recurrent wheeze who have been prescribed salbutamol by their doctor....
Background: Fluticasone furoate is a once-daily inhaled corticosteroid. This report provides an overview of safety\nand efficacy data that support the use of once-daily fluticasone furoate 100 �¼g or 200 �¼g in adult and adolescent\nasthma patients.\nMethods: Fourteen clinical studies (six Phase II and eight Phase III) were conducted as part of the fluticasone furoate\nglobal clinical development programme in asthma. Safety data from 10 parallel-group, randomised, double-blind Phase\nII and III studies (including 3345 patients who received at least one dose of fluticasone furoate) were integrated to\nprovide information on adverse events, withdrawals, laboratory assessments, vital signs and hypothalamic-pituitaryadrenal\naxis function. The efficacy of once-daily fluticasone furoate was evaluated in all included studies.\nResults: Once-daily fluticasone furoate 100 �¼g and 200 �¼g safety profiles were consistent with those reported for other\ninhaled corticosteroids, and both doses consistently demonstrated efficacy versus placebo. In the integrated analysis,\nno dose-response relationship was observed for the overall incidence of adverse events and there were no significant\neffects of fluticasone furoate on hypothalamic-pituitary-adrenal axis function.\nConclusion: Once-daily fluticasone furoate 100 �¼g and 200 �¼g had acceptable safety profiles and was efficacious in\nadult and adolescent patients with asthma. There was no evidence of cortisol suppression at studied doses....
Background: In carbon ion radiotherapy (CIR) for esophageal cancer, organ and target motion is a major challenge\nfor treatment planning due to potential range deviations. This study intends to analyze the impact of intrafractional\nvariations on dosimetric parameters and to identify favourable settings for robust treatment plans.\nMethods: We contoured esophageal boost volumes in different organ localizations for four patients and calculated\nCIR-plans with 13 different beam geometries on a free-breathing CT. Forward calculation of these plans was\nperformed on 4D-CT datasets representing seven different phases of the breathing cycle. Plan quality was assessed\nfor each patient and beam configuration.\nResults: Target volume coverage was adequate for all settings in the baseline CIR-plans (V95 > 98% for two-beam\ngeometries, > 94% for one-beam geometries), but reduced on 4D-CT plans (V95 range 50ââ?¬â??95%). Sparing of the\norgans at risk (OAR) was adequate, but range deviations during the breathing cycle partly caused critical, maximum\ndoses to spinal cord up to 3.5x higher than expected. There was at least one beam configuration for each patient\nwith appropriate plan quality.\nConclusions: Despite intrafractional motion, CIR for esophageal cancer is possible with robust treatment plans\nwhen an individually optimized beam setup is selected depending on tumor size and localization....
Background: Liraglutide 3 mg was recently approved as an anti-obesity drug. Metformin is weight neutral, yet it\ncould enhance the therapeutic index of GLP-1 agonist. We compared weight-lowering potential of liraglutide 1.\n2 mg in combination with metformin to liraglutide 3 mg monotherapy in obese PCOS.\nMethods: Thirty obese women with PCOS (aged 33.1 Ã?± 6.1 years, BMI 38.3 Ã?± 5.4 kg/m2) were randomized to\ncombination (COMBO) of metformin (MET) 1000 mg BID and liraglutide 1.2 mg QD (N= 15) or liraglutide 3 mg\n(LIRA3) QD alone (N= 15) for 12 weeks. The primary outcome was change in anthropometric measures of obesity.\nResults: Both treatments led to significant weight loss (âË?â??3.6 Ã?± 2.5 kg, p = 0.002 in COMBO vs âË?â??6.3 Ã?± 3.7 kg, p = 0.001\nin LIRA3). BMI and waist circumference reduction in LIRA3 was greater than in COMBO (âË?â??2.2 Ã?± 1.3 vs âË?â??1.3 Ã?± 0.9 kg/\nm2,\np = 0.05 and âË?â??4.2 Ã?± 3.4 vs âË?â??2.2 Ã?± 6.2 cm, p = 0.014, respectively). Both interventions resulted in a significant\ndecrease of post-OGTT glucose levels. COMBO significantly reduced total testosterone and was associated with less\nnausea.\nConclusions: Short-term interventions with COMBO and LIRA3 both led to significant improvement of measures of\nobesity in obese PCOS, LIRA3 being superior to COMBO. However, COMBO further improved androgen profile\nbeyond weight reduction and was associated with better tolerability....
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