A Simple Model for Evaluating Medical Treatment Options

The approval or clinical evaluation of several new agents – cabazitaxel, enzalutamide, sipuleucel-T, radium-223 and abiraterone acetate – has significantly changed the management of patients with metastatic castration-resistant prostate cancer (mCRPC) prior to or after docetaxelbased chemotherapy. All of these agents have resulted in a significant survival benefit compared with their control group. However, treatment responses might differ depending on the associated comorbidities and the extent and the biological aggressiveness of the disease. Furthermore, treatment-associated side effects differ between the various drugs. As new drugs are approved, new treatment strategies and markers to best select which patients will best respond to which drug are needed. It is the aim of this article to (1) summarise the data of established treatment options in mCRPC, (2) highlight new developments of medical treatment, (3) provide clinically useful algorithms for the daily routine and to (4) point out future developments of medical treatment.

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Should medical treatment options be exhausted before splenectomy is performed in adult ITP patients? A debate

Annals of Hematology ◽

10.1007/s00277-010-1066-2 ◽

2010 ◽

Vol 89 (12) ◽

pp. 1185-1195 ◽

Cited By ~ 18

Author(s):

Roberto Stasi ◽

Adrian Newland ◽

Patrick Thornton ◽

Ingrid Pabinger

Keyword(s):

Medical Treatment ◽

Treatment Options

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Clinical classification and medical treatment options in childhood glaucoma

Archivos de la Sociedad Española de Oftalmología (English Edition) ◽

10.1016/j.oftale.2015.07.016 ◽

2015 ◽

Vol 90 (12) ◽

pp. 557-561

Author(s):

C. Mendez-Hernandez ◽

G. Arcos-Villegas ◽

J. Garcia-Sanchez ◽

J. Garcia-Feijoo

Keyword(s):

Medical Treatment ◽

Treatment Options ◽

Clinical Classification

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New developments in the medical treatment of Cushing's syndrome

Endocrine Related Cancer ◽

10.1530/erc-12-0191 ◽

2012 ◽

Vol 19 (6) ◽

pp. R205-R223 ◽

Cited By ~ 28

Author(s):

R van der Pas ◽

W W de Herder ◽

L J Hofland ◽

R A Feelders

Keyword(s):

Medical Treatment ◽

Medical Therapy ◽

Cushing’S Syndrome ◽

Treatment Options ◽

Cushing's Syndrome ◽

Treatment Modalities ◽

Primary Therapy ◽

Ectopic Acth ◽

Considerable Morbidity ◽

Acth Secreting

Cushing's syndrome (CS) is a severe endocrine disorder characterized by chronic cortisol excess due to an ACTH-secreting pituitary adenoma, ectopic ACTH production, or a cortisol-producing adrenal neoplasia. Regardless of the underlying cause, untreated CS is associated with considerable morbidity and mortality. Surgery is the primary therapy for all causes of CS, but surgical failure and ineligibility of the patient to undergo surgery necessitate alternative treatment modalities. The role of medical therapy in CS has been limited because of lack of efficacy or intolerability. In recent years, however, new targets for medical therapy have been identified, both at the level of the pituitary gland (e.g. somatostatin, dopamine, and epidermal growth factor receptors) and the adrenal gland (ectopically expressed receptors in ACTH-independent macronodular adrenal hyperplasia). In this review, results of preclinical and clinical studies with drugs that exert their action through these molecular targets, as well as already established medical treatment options, will be discussed.

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THERAPY OF ENDOCRINE DISEASE: Medical treatment of primary aldosteronism

Acta Endocrinologica ◽

10.1530/eje-19-0215 ◽

2019 ◽

Vol 181 (4) ◽

pp. R147-R153 ◽

Cited By ~ 2

Author(s):

Benjamin Lechner ◽

Katharina Lechner ◽

Daniel Heinrich ◽

Christian Adolf ◽

Finn Holler ◽

...

Keyword(s):

Medical Treatment ◽

Primary Aldosteronism ◽

Treatment Options ◽

Specific Treatment ◽

Adequate Treatment ◽

Mortality And Morbidity ◽

Drug Dosing ◽

Unilateral Disease ◽

Bilateral Adrenal Hyperplasia ◽

Causal Approach

In patients with primary aldosteronism, specific treatment provides prognostic benefit over optimal antihypertensive therapy and is therefore crucial to reduce mortality and morbidity in this subgroup of patients with hypertension. Prognostic relevance has been shown for adrenalectomy in unilateral disease and for medical treatment with mineralocorticoid receptor antagonists in bilateral adrenal hyperplasia. Collectively, evidence points to the superiority of surgical treatment compared to medical treatment. The causal approach of removing the mineralocorticoid excess, as well as the often-accompanying glucocorticoid excess, might provide one biologically plausible explanation for the observation of slightly better outcomes with surgical therapy. However, in patients living with primary aldosteronism, medical treatment is often insufficient for three major reasons. First and foremost, no marker of sufficient aldosterone blockade has yet been established and therefore adequate treatment of the aldosterone excess is often dismissed as a treatment goal. Second, side effects often limit patient compliance. Third, as recommendations differ from other indications like heart failure, drug dosing is often inadequate. The aim of this review is first to provide an overview over medical treatment options and second to review potential markers for treatment surveillance in patients with primary aldosteronism.

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Microvascular Decompression for Trigeminal Neuralgia: Our Experiences at Bir Hospital

Nepal Journal of Neuroscience ◽

10.3126/njn.v14i2.19697 ◽

2017 ◽

Vol 14 (2) ◽

pp. 3-7

Author(s):

Gopal R Sharma ◽

Rajiv Jha ◽

Prakash Poudel ◽

Dhrub R Adhikari ◽

Prakash Bista

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Medical Treatment ◽

Treatment Options ◽

Superior Cerebellar Artery ◽

Anterior Inferior Cerebellar Artery ◽

Recurrent Pain ◽

Cerebellar Artery

Trigeminal neuralgia (TGN) is a very peculiar disease, mostly characterized by unilateral paroxysmal facial pain, often described by patient as ‘one of the worst pain in my life’. This condition is also known as ‘Tic Douloureus’. The annual incidence of TN is about 4.7/100000 population, male and female are equally affected. The diagnosis is usually made by history, clinical fi ndings and cranial imaging is required to rule out compressing vascular loop, organic lesions and Multiple Sclerosis (MS) at Trigeminal nerve (TN). Treatment of TGN ranged from medical to surgical intervention. Between September 2007 and April 2015, 20 patients underwent micro vascular decompression (MVD) of TN for TGN who were refractory to medical treatment at department of Neurosurgery, Bir Hospital. All decompressions were performed using operating microscope. Follow up period ranged from 22 months to 8 years.There were 9 males and 11 females and age ranged from 30-70 years. The neuralgic pain was localized on right side in 13 patients and left on 7 patients. Pain distribution was on V3 (mandibular branch) dermatome in 11, V2( Maxillary branch ) in 4, V2-3 in 2 and V1- 2-3 in 3 patients respectively. On intraoperative fi ndings TN was compressed by superior cerebellar artery ( SCA ) in 8, tumors in 4, unidentifi ed vessels in 3, veins in 2, anterior inferior cerebellar artery ( AICA ) in 1 and no cause was found in 2 patients. 7 patients suffered postoperative complications which included hyposthesia in 3, pseudomeningocele in 3 and meningitis in 1. There was no mortality in this series. 20 patients felt pain relief immediately after procedure and 1 patients came after 3 years with recurrent pain requiring second surgery. In conclusion, MVD for TGN in younger patients who are refractory to medical treatment is one of the best treatment options which is safe and long term pain relief is achieved in majority of cases.Nepal Journal of Neuroscience, Vol. 14, No. 2, 2017 Page:11-15

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Symposium: Medical treatment options for diabetic retinopathy

Acta Ophthalmologica Scandinavica ◽

10.1111/j.1600-0420.2006.00712_45.x ◽

2006 ◽

Vol 84 ◽

pp. 102-103

Keyword(s):

Diabetic Retinopathy ◽

Medical Treatment ◽

Treatment Options

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Highlights on Medical Treatment of Uterine Fibroids

Current Pharmaceutical Design ◽

10.2174/1381612826666210101152820 ◽

2021 ◽

Vol 26 ◽

Author(s):

Stefano Angioni ◽

Maurizio N. D’Alterio ◽

Angelos Daniilidis

Keyword(s):

Medical Treatment ◽

Treatment Effectiveness ◽

Treatment Options ◽

Uterine Fibroids ◽

European Medicines Agency ◽

Benign Tumors ◽

Medical Treatments ◽

Advantages And Disadvantages ◽

Receptor Modulators ◽

Progesterone Receptor Modulators

: Uterine fibroids (leiomyomas or myomas) are the most frequent benign tumors in women. Heavy menstrual bleeding with resultant anemia, dysmenorrhea, chronic pelvic pain, infertility urinary symptoms and constipation are generally associated with uterine fibroids (UFs). Although strategies mainly resort to surgical intervention, medical treatments are considered the first-line treatment to preserve fertility and avoid surgery. The aim of this review is to offer available and newest medical treatment options for symptomatic UFs. Various medical therapies are now available for women with uterine fibroids, although each therapy has its own advantages and disadvantages. Our topic specifically explores gonadotropin-releasing hormone (GnRH) analogs and selective progesterone receptor modulators (SPRMs), but also provides the reader with useful advice on the therapies for fibroids available after the recent European Medicines Agency (EMA) warning (EMA/160220/2020). The treatment options depend on the personal treatment objectives of the patients, in addition to treatment effectiveness and necessity for recurrent interventions.

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