Cyclophosphamide dose adjustment based on body weight and albuminemia in elderly patients treated with R-mini-CHOP

2019 ◽  
Vol 83 (4) ◽  
pp. 775-785 ◽  
Author(s):  
E. Baudry ◽  
S. Huguet ◽  
A. L. Couderc ◽  
P. Chaibi ◽  
F. Bret ◽  
...  
Keyword(s):  
Body Weight ◽  
Elderly Patients ◽  
Dose Adjustment ◽  
Cyclophosphamide Dose

scholarly journals Long-term efficacy and safety of oral semaglutide and the effect of switching from sitagliptin to oral semaglutide in patients with type 2 diabetes: a 52-week, randomized, open-label extension of the PIONEER 7 trial

2020 ◽  
Vol 8 (2) ◽  
pp. e001649
Author(s):  
John B Buse ◽  
Bruce W Bode ◽  
Ann Mertens ◽  
Young Min Cho ◽  
Erik Christiansen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Dose Adjustment ◽  
Main Phase ◽  
Open Label ◽  
Open Label Extension ◽  
Registration Number ◽  
Flexible Dose

IntroductionThe PIONEER 7 trial demonstrated superior glycemic control and weight loss with once-daily oral semaglutide with flexible dose adjustment versus sitagliptin 100 mg in type 2 diabetes. This 52-week extension evaluated long-term oral semaglutide treatment and switching from sitagliptin to oral semaglutide.Research design and methodsA 52-week, open-label extension commenced after the 52-week main phase. Patients on oral semaglutide in the main phase continued treatment (n=184; durability part); those on sitagliptin were rerandomized to continued sitagliptin (n=98) or oral semaglutide (n=100; initiated at 3 mg) (switch part). Oral semaglutide was dose-adjusted (3, 7, or 14 mg) every 8 weeks based on glycated hemoglobin (HbA1c) (target <7.0% (<53 mmol/mol)) and tolerability. Secondary endpoints (no primary) included changes in HbA1c and body weight.ResultsIn the durability part, mean (SD) changes in HbA1c and body weight from week 0 were –1.5% (0.8) and –1.3% (1.0) and –2.8 kg (3.8) and –3.7 kg (5.2) at weeks 52 and 104, respectively. In the switch part, mean changes in HbA1c from week 52 to week 104 were –0.2% for oral semaglutide and 0.1% for sitagliptin (difference –0.3% (95% CI –0.6 to 0.0); p=0.0791 (superiority not confirmed)). More patients achieved HbA1c <7.0% with oral semaglutide (52.6%) than sitagliptin (28.6%; p=0.0011) and fewer received rescue medication (9% vs 23.5%). Respective mean changes in body weight were –2.4 kg and –0.9 kg (difference –1.5 kg (95% CI –2.8 to –0.1); p=0.0321). Gastrointestinal adverse events were the most commonly reported with oral semaglutide.ConclusionsLong-term oral semaglutide with flexible dose adjustment maintained HbA1c reductions, with additional body weight reductions, and was well tolerated. Switching from sitagliptin to flexibly dosed oral semaglutide maintained HbA1c reductions, helped more patients achieve HbA1c targets with less use of additional glucose-lowering medication, and offers the potential for additional reductions in body weight.Trial registration numberNCT02849080.

PP030 BODY WEIGHT INCREASES AFTER TRANSMURAL NUTRITIONAL SUPPORT IN MALNOURISHED ELDERLY PATIENTS

2010 ◽  
Vol 5 (2) ◽  
pp. 34-35
Author(s):  
F. Neelemaat ◽  
J.E. Bosmans ◽  
A. Thijs ◽  
J.C. Seidell ◽  
M.A. van Bokhorst-de van der Schueren
Keyword(s):  
Body Weight ◽  
Elderly Patients ◽  
Nutritional Support

Tinzaparin and enoxaparin given at prophylactic dose for eight days in medical elderly patients with impaired renal function

2007 ◽  
Vol 97 (04) ◽  
pp. 581-586 ◽  
Author(s):  
Manvel Aghassarian ◽  
Ludovic Drouet ◽  
Claire dit-Sollier ◽  
Karine Lacut ◽  
Jean-Jacques Heilmann ◽  
...  
Keyword(s):  
Renal Function ◽  
Body Weight ◽  
Elderly Patients ◽  
Creatinine Clearance ◽  
Impaired Renal Function ◽  
The Body ◽  
Accumulation Factor ◽  
Renal Elimination ◽  
Prophylactic Dose ◽  
Accumulation Effect

SummaryLow-molecular-weight heparins (LMWHs) accumulate in patients with impaired renal function. As this accumulation depends on heparin chain length and subsequent reticulo-endothelial/renal elimination, LMWHs might have different pharmacodynamic profiles. The primary objective was to examine if any accumulation effect of two LMWHs, enoxaparin and tinzaparin, occurred after repeated administration of a prophylactic dose over eight days in elderly patients (age >75 years) with creatinine clearance between 20 and 50 ml/min and body weight <65Kg. Patients were openly randomized to two groups (enoxaparin 4,000 IU or tinzaparin 4,500 IU once daily). Anti-Xa was measured on day 1 and day 8. Blood samples were taken at 0, 2, 4, 5, 6, 9, 12, 16 and 24 hours. The primary end point was the accumulation factor calculated as a ratio between the maximal anti-Xa activity on day 1and day 8. Fifty-five patients were included (mean age 87.9 ± 5.5 ).The creatinine clearance was 34.7 ± 11.4 ml/min; the body weight was 52.3 ± 8.6 kg. The accumulation factor defined was not significant for tinzaparin (1.05, p=0.29) while it was significantly enhanced for enoxaparin (1.22, p <0.0001). In this pharmacodynamic study performed in elderly patients with impaired renal function, a statistically significant accumulation effect was observed after eight days of prophylactic treatment with enoxaparin but not with tinzaparin, which are two LMWHs with different chain lengths. Trials based on clinical end points should be conducted to evaluate the clinical relevance of these observations.

Evidence for rituximab (R) underdosing in subpopulations of elderly patients with DLBC: Results of the RICOVER-60 study of the DSHNHL.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8024-8024
Author(s):  
Michael Pfreundschuh ◽  
Carsten Mueller ◽  
Samira Zeynalova ◽  
Gerhard Held ◽  
Viola Poeschel ◽  
...  
Keyword(s):  
Body Weight ◽  
Elderly Patients ◽  
Half Life ◽  
Serum Levels ◽  
Lower Quartile ◽  
Elderly Male ◽  
Elimination Half ◽  
Outcome Improvement ◽  
The Difference ◽  
To Receive

8024 Background: Gender and weight independently influence R clearance and R serum elimination half life (Mueller et al., Blood 2012). To investigate whether the differences in R pharmacokinetics translate into different outcomes, we analyzed elderly patients (pts) with different R pharmacokinetics treated in the RICOVER-60 study. Methods: 1222 elderly pts. (61-80 y) were randomized to receive 6 or 8 cycles of CHOP-14 with or without R given on days 1, 15, 29, 43, 57, 71, 85, and 99. For this study, subgroup analyses were performed for pts with faster R clearance: elderly male (vs. female) pts and elderly weighty (upper quartile: >77kg) vs. slim (lower quartile: ≤60 kg) female pts. Results: Elderly females had a slower R clearance (8.21 ml/h vs. 12.68 ml/h; p=0.003) and a prolonged R half life compared to men (t1/2ß=30.7 vs. t1/2ß=24.7 d; p=0.003). Female pts had a higher 3-year PFS (68% vs. 61%; p=0.062) and OS (74% vs. 68% p=0.086). The differences in outcome were due to a greater outcome improvement by the addition of R in females: the difference in 3-year PFS between female and male pts was 5.1% (p=0.448) in pts. receiving CHOP-14 only and 7.7% (p=0.053) when R was added. In a multivariate analysis the relative risk for progression in male compared to female patients was not significantly elevated after CHOP-14 (1.1; p=0.348), but was significantly higher after R-CHOP-14 (1.6; p=0.004). With respect to weight, addition of R resulted in a significantly improved 3-year PFS (74% vs. 49%; p=0.006) in female pts with a body weight within the lower quartile (≤60 kg) who have an R serum half life of >38.1 days, while there was no improvement by the addition of R (72% vs. 71%; p=0.816) in female pts. with a body weight within the upper quartile (>77kg), who have a serum half life of <29.3 days. Conclusions: The reduced benefit of adding R to CHOP in elderly DLBCL pts. with a shorter rituximab serum half life (and hence lower serum levels) suggests that the respective subpopulations (males and weighty females) are underdosed when R is dosed based on body surface area at 375 mg/m2. Ongoing studies of the DSHNHL investigate whether higher R doses for pts with a shorter R serum half life can improve the outcome of the respective pts.

Predictive Performance of Equations to Estimate Creatinine Clearance in Hospitalized Elderly Patients

1992 ◽  
Vol 26 (5) ◽  
pp. 627-635 ◽  
Author(s):  
Mary Beth O'Connell ◽  
Andrea M. Dwinell ◽  
Susan D. Bannick-Mohrland
Keyword(s):  
Body Weight ◽  
Elderly Patients ◽  
Creatinine Clearance ◽  
Drug Dose ◽  
The Other ◽  
Lean Body Weight ◽  
Hospitalized Elderly ◽  
Estimate Creatinine Clearance ◽  
Drug Doses ◽  
Hospitalized Elderly Patients

OBJECTIVE: To ascertain the clinical accuracy of equations that estimate creatinine clearance to predict the correct drug doses in hospitalized elderly patients DESIGN: Single 24-hour creatinine clearance measurement compared with estimated creatinine clearances derived from eight equations using total and modified ideal body weight SETTING: Nonintensive care medical and surgical units at a county hospital PATIENTS: 15 patients with urethral catheters were enrolled in each of three age groups: 65–75, 76–85, and ≥86 years MAIN OUTCOME MEASUREMENTS: Drug–dose predictions, bias, precision, and absolute errors RESULTS: The bias for all equations was −4.0−42.0 mL/min (–0.07–0.70 mL/s) and the precision was 10.8−47.4 mL/min (0.18–0.88 mL/s). The Jelliffe 1973, Hull et al., and Mawer et al. equations were the least biased and the Jelliffe 1973 was the most precise, followed by the Mawer et al., Hull et al., and Cockcroft-Gault equations. The percent of patients with absolute percent errors >20 percent were 38 percent for Jelliffe 1973, 36 percent for Mawer et al., 40 percent for Hull et al., and >50 percent for the other equations. The percent of patients receiving correct drug doses was 67 percent for Jelliffe 1973, 58 percent for Gates, 51 percent for Mawer et al. and Hull et al., and <50 percent for the other equations. Within various age, renal function, serum creatinine, and albumin subgroups, the Jelliffe 1973 estimates were least biased and most precise, followed by the Cockcroft-Gault estimates. Generally, estimates using modified lean body weight performed better than did those using total body weight. CONCLUSIONS: The Jelliffe 1973 equation with modified lean body weight was the best equation, followed by the Cockcroft-Gault equation. Even with the best equation, 33 percent of the patients would have received an incorrect drug dose. Therefore, some elderly patients may still require a measured creatinine clearance.

scholarly journals PO-221 Effects of different motor functional therapies on cognitive impairment in type 2 diabetes mellitus

2018 ◽  
Vol 1 (5) ◽  
Author(s):  
Yu Zhou
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Cognitive Impairment ◽  
Oxygen Uptake ◽  
Elderly Patients ◽  
Resistance Exercise ◽  
Aerobic Exercise ◽  
Exercise Group ◽  
Control Group

Objective The clinical manifestations of diabetic cognitive dysfunction are decreased visual spatial ability, executive dysfunction, mental activity speed and attention, and decreased abstract logical reasoning. Cognitive dysfunction is irreversible. Timely and accurate assessment and diagnosis, early detection and intervention to delay disease progression are particularly critical. The Cognitive Assessment Scale plays an important role in screening for cognitive dysfunction in diabetes. To observe the effects of motor functional therapy on cognitive impairment and blood glucose, blood lipids, body weight, body composition, and maximal oxygen uptake in patients with type 2 diabetes. Methods A total of 63 elderly patients with type 2 diabetes mellitus in Chengdu community aged ≥65 years and educated for ≥12 years were enrolled in the motor function therapy group according to the simple mental state examination (MMSE) score (diabetes cognitive impairment, MMSE total score) ≥ 20 points, aerobic exercise group, n = 21) and functional function therapy group (diabetes cognitive impairment, MMSE total score ≥ 20 points, resistance exercise group, n = 21). The adult community of diabetes in Chengdu (normal cognitive function) with age ≥ 65 years, education time ≥ 12 years, and MMSE total score ≥ 24 points was used as the control group (n=21). Montreal Cognitive Assessment Scale (MOCA): MOCA is an assessment tool developed by Nasreddine and clinically proven to be used for rapid screening of MCI. There were no statistical differences in baseline data (age, gender, and hypertension incidence) among the 3 groups of patients. The LOTCA scale was used to evaluate the cognitive function of the subjects and to compare between groups. Sixty-three patients with type 2 diabetes were randomly divided into aerobic exercise intensity group (50% VO2max) (n=21), resistance exercise intensity group and control group (n=21). Both the aerobic exercise group and the resistance exercise group underwent a 12-week moderate-intensity exercise three times a week. The resistance middle strength group was trained 2 groups each time, each group was 25 minutes, the group rested for 5 minutes, 55 minutes in total, and the aerobic medium intensity group continued to exercise for 55 minutes. All patients underwent fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), body weight, and fat weight (FW) before and after training. , lean body mass (LBM), maximal oxygen uptake (VO2max) determination; measure the energy expenditure of word movement and the total energy expenditure of the entire exercise process. Results There were no significant differences among the three groups before the test (P>0.05). All the indexes of the medium-intensity resistance exercise group and the medium-intensity aerobic exercise group were significantly different from the control group (P<0.05). After the MOCA score test There was an improvement in the score before the trial, and the total score of LOTCA was significantly different among the three groups. In addition to perceptual sub-items (item identification), the aerobic exercise group and the resistance exercise group LOTCA scale in perceptual sub-projects (incomplete object recognition), visual motion organization and its sub-projects (copying two-dimensional graphics, building blocks) The design and puzzle) project scores were higher than before the test, close to the control group score. The scores of the two groups of exercise therapy in the thinking operation and its sub-projects (Riska organized shape classification, picture arrangement B and geometric reasoning) and attention-focused items were lower than the control group. Compared with the resistance exercise, there was a significant difference in the maximum oxygen uptake between aerobic exercise and resistance exercise (P<0.05). Compared with the total exercise energy consumption in the first 6 weeks, the aerobic exercise group was superior to the resistance exercise group. The total exercise energy expenditure was compared in the last 6 weeks, and the resistance exercise group was superior to the aerobic exercise group. Conclusions Elderly patients with type 2 diabetes may have cognitive impairment earlier. In the absence of differences in exercise, the aerobic exercise group and the resistance exercise group improve cognitive impairment, blood sugar, blood fat, body weight, and body composition in patients with type 2 diabetes. There is no significant difference. Compared with MMSE, LOTCA has the advantage of identifying early cognitive impairment in elderly patients with type 2 diabetes and distinguishing the severity of the damage.  

scholarly journals In Elderly Patients with Newly Diagnosed Aggressive B-Cell Lymphoma, the Rate of Change in Body Weight after the First Course R-CHOP (-like) Chemo Therapy Has Effect on Their Survival

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4238-4238 ◽  
Author(s):  
Muramatsu Ayako ◽  
Nagata Hiroaki ◽  
Kuriyama Kodai ◽  
Hirakawa Yoshiko ◽  
Oshiro Muneo ◽  
...  
Keyword(s):  
Body Weight ◽  
Elderly Patients ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Rate Of Change ◽  
Newly Diagnosed ◽  
Clinical Records ◽  
The Impact ◽  
Aggressive B Cell Lymphoma

Abstract Background The incidence of B-cell lymphoma increases with age, and over 40% occurs in patients at age of 70 years old or more. Aggressive B-cell lymphoma was often treated with R-CHOP (-like) regimen. However, in elderly B-cell lymphoma patients, treatment intensification often must be lowered due to the risks of comorbidities and organ function deterioration, and treatment outcomes are worse compared to younger patients. The optimal dose of R-CHOP (-like) therapy is necessary to improve the outcome of the elderly patients with B-cell lymphoma. We conducted a retrospective cohort study examining the influence of the rate of change in body weight after the first chemo therapy on their outcomes and survival. Methods Clinical records of 111 patients who had received R-CHOP (-like) regimen were retrospectively analyzed. They were all over 73 years old, and newly diagnosed with aggressive B-cell lymphoma by WHO 2008 criteria. They were treated at Japanese Red Cross Kyoto Daiichi Hospital between January 1st 2008 and December 31st 2017. Data on clinical characteristics and treatment modalities were obtained through the review of medical charts. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The impact of variables on PFS and OS was evaluated by univariate log-rank tests and by multivariate analysis using the Cox proportional hazards model. Results Median age at diagnosis was 78 years old (73-94). The 2-year OS rate was 77.5% (95%Cl: 68.3-84.3%), PFS rate was 77.4% (95%Cl: 68.2-84.3%) in all patients. The 5-year OS rate was 62.3% (95%Cl: 50.2-72.2%), PFS rate was 55.5% (95%Cl: 43.4-66%) in all patients. The average rate of change in body weight after the first therapy was 4.59%. Large changes in body weight ( >9.3%) after the first therapy had worse clinical outcomes with shorter median OS (1.43 years vs. NA, P <0.001 HR 4.39, 95% CI 2.14 to 8.99, see figure 1) and median PFS (1.43 years vs. 6.9 years, P<0.001, HR 3.65, 95%CI 1.82to 7.29, see figure 2). Conclusion Large changes in body weight ( >9.3%) after the first therapy were associated with poor outcomes in elderly people with newly diagnosed aggressive B-cell lymphoma. This suggests that adjusting drug dosage on and after the second therapy in those patients has possible to be improve their survival. Disclosures No relevant conflicts of interest to declare.

scholarly journals Anti-Xa Activity of Enoxaparin for Prevention of Venous Thromboembolism in Severe Nephrotic Syndrome—A Single Center Prospective Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5709
Author(s):  
Anna Matyjek ◽  
Aleksandra Rymarz ◽  
Zuzanna Nowicka ◽  
Slawomir Literacki ◽  
Tomasz Rozmyslowicz ◽  
...  
Keyword(s):  
Body Weight ◽  
Nephrotic Syndrome ◽  
Dose Adjustment ◽  
Ideal Body Weight ◽  
Optimal Dose ◽  
Fixed Dose ◽  
Bivariate Model ◽  
Risk Threshold ◽  
Venous Thromboembolic Events ◽  
Ideal Body

Severe nephrotic syndrome (NS) is associated with high risk of venous thromboembolic events (VTE), as well as presumably altered heparin pharmacokinetics and pharmacodynamics. Although prophylactic anticoagulation is recommended, the optimal dose is not established. The aim of the study was to test two co-primary hypotheses: of reduced enoxaparin effectiveness and of the need for dose-adjustment in NS. Forty two nephrotic patients with serum albumin ≤2.5 g/dL were alternately assigned to a standard fixed-dose of enoxaparin (NS-FD: 40 mg/day) or ideal body weight (IBW)-based adjusted-dose (NS-AD: 1 mg/kg/day). Twenty one matched non-proteinuric individuals (C-FD) also received fixed-dose. Co-primary outcomes were: the achievement of low- and high-VTE risk threshold of antifactor-Xa activity (anti-FXa) defined as 0.2 IU/mL and 0.3 IU/mL, respectively. Low-VTE-risk threshold was achieved less often in NS-FD than C-FD group (91 vs. 62%, p = 0.024), while the high-VTE-risk threshold more often in NS-AD than in NS-FD group (90 vs. 38%, p < 0.001). Two VTE were observed in NS during 12 months of follow-up (incidence: 5.88%/year). In both cases anti-FXa were 0.3 IU/mL implying the use of anti-FXa >0.3 IU/mL as a target for dose-adjustment logistic regression models. We determined the optimal dose/IBW cut-off value at 0.8 mg/kg and further developed bivariate model (termed the DoAT model) including dose/IBW and antithrombin activity that improved the diagnostic accuracy (AUC 0.85 ± 0.06 vs. AUC 0.75 ± 0.08). Enoxaparin efficacy is reduced in severe NS and the dose should be adjusted to ideal body weight to achieve target anti-FXa activity.

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