scholarly journals Tiotropium Respimat® add-on therapy to inhaled corticosteroids in patients with symptomatic asthma improves clinical outcomes regardless of baseline characteristics

2019 ◽  
Vol 158 ◽  
pp. 97-109 ◽  
Author(s):  
Thomas B. Casale ◽  
René Aalbers ◽  
Eugene R. Bleecker ◽  
Eli O. Meltzer ◽  
Liliana Zaremba-Pechmann ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Inhaled Corticosteroids ◽  
Symptomatic Asthma ◽  
Baseline Characteristics

scholarly journals Adverse clinical outcomes associated with RAAS inhibitor discontinuation: analysis of over 400 000 patients from the UK Clinical Practice Research Datalink (CPRD)

2021 ◽  
Author(s):  
Toby J L Humphrey ◽  
Glen James ◽  
Eric T Wittbrodt ◽  
Donna Zarzuela ◽  
Thomas F Hiemstra
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Clinical Practice ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Ckd Stage ◽  
First Occurrence ◽  
Baseline Characteristics

Abstract Background Users of guideline-recommended renin–angiotensin–aldosterone system (RAAS) inhibitors may experience disruptions to their treatment, e.g. due to hyperkalaemia, hypotension or acute kidney injury. The risks associated with treatment disruption have not been comprehensively assessed; therefore, we evaluated the risk of adverse clinical outcomes in RAAS inhibitor users experiencing treatment disruptions in a large population-wide database. Methods This exploratory, retrospective analysis utilized data from the UK’s Clinical Practice Research Datalink, linked to Hospital Episodes Statistics and the Office for National Statistics databases. Adults (≥18 years) with first RAAS inhibitor use (defined as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) between 1 January 2009 and 31 December 2014 were eligible for inclusion. Time to the first occurrence of adverse clinical outcomes [all-cause mortality, all-cause hospitalization, cardiac arrhythmia, heart failure hospitalization, cardiac arrest, advancement in chronic kidney disease (CKD) stage and acute kidney injury] was compared between RAAS inhibitor users with and without interruptions or cessations to treatment during follow-up. Associations between baseline characteristics and adverse clinical outcomes were also assessed. Results Among 434 027 RAAS inhibitor users, the risk of the first occurrence of all clinical outcomes, except advancement in CKD stage, was 8–75% lower in patients without interruptions or cessations versus patients with interruptions/cessations. Baseline characteristics independently associated with increased risk of clinical outcomes included increasing age, smoking, CKD, diabetes and heart failure. Conclusions These findings highlight the need for effective management of factors associated with RAAS inhibitor interruptions or cessations in patients for whom guideline-recommended RAAS inhibitor treatment is indicated.

scholarly journals Low Back Pain in Adolescents: A Comparison of Clinical Outcomes in Sports Participants and Nonparticipants

2010 ◽  
Vol 45 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Julie M. Fritz ◽  
Shannon N. Clifford
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Treatment Outcomes ◽  
Clinical Outcomes ◽  
Sports Participation ◽  
Mean Difference ◽  
Analysis Of Covariance ◽  
Low Back ◽  
Baseline Characteristics

Abstract Context: Back pain is common in adolescents. Participation in sports has been identified as a risk factor for the development of back pain in adolescents, but the influence of sports participation on treatment outcomes in adolescents has not been adequately examined. Objective: To examine the clinical outcomes of rehabilitation for adolescents with low back pain (LBP) and to evaluate the influence of sports participation on outcomes. Design: Observational study. Setting: Outpatient physical therapy clinics. Patients or Other Participants: Fifty-eight adolescents (age  =  15.40 ± 1.44 years; 56.90% female) with LBP referred for treatment. Twenty-three patients (39.66%) had developed back pain from sports participation. Intervention(s): Patients completed the Modified Oswestry Disability Questionnaire and numeric pain rating before and after treatment. Treatment duration and content were at the clinician's discretion. Adolescents were categorized as sports participants if the onset of back pain was linked to organized sports. Additional data collected included diagnostic imaging before referral, clinical characteristics, and medical diagnosis. Main Outcome Measure(s): Baseline characteristics were compared based on sports participation. The influence of sports participation on outcomes was examined using a repeated-measures analysis of covariance with the Oswestry and pain scores as dependent variables. The number of sessions and duration of care were compared using t tests. Results: Many adolescents with LBP receiving outpatient physical therapy treatment were involved in sports and cited sports participation as a causative factor for their LBP. Some differences in baseline characteristics and clinical treatment outcomes were noted between sports participants and nonparticipants. Sports participants were more likely to undergo magnetic resonance imaging before referral (P  =  .013), attended more sessions (mean difference  =  1.40, 95% confidence interval [CI]  =  0.21, 2.59, P  =  .022) over a longer duration (mean difference  =  12.44 days, 95% CI  =  1.28, 23.10, P  =  .024), and experienced less improvement in disability (mean Oswestry difference  =  6.66, 95% CI  =  0.53, 12.78, P  =  .048) than nonparticipants. Overall, the pattern of clinical outcomes in this sample of adolescents with LBP was similar to that of adults with LBP. Conclusions: Adolescents with LBP due to sports participation received more treatment but experienced less improvement in disability than nonparticipants. This may indicate a worse prognosis for sports participants. Further research is required.

Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

2021 ◽  
pp. neurintsurg-2021-017940
Author(s):  
Zeguang Ren ◽  
Gaoting Ma ◽  
Maxim Mokin ◽  
Ashutosh P Jadhav ◽  
Baixue Jia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Ct Perfusion ◽  
Non Invasive ◽  
Vessel Imaging ◽  
Baseline Characteristics ◽  
Procedural Outcomes ◽  
Head Computed Tomography

BackgroudThe goal of this study was to determine if the choice of imaging paradigm performed in the emergency department influences the procedural or clinical outcomes after mechanical thrombectomy (MT).MethodsThis is a retrospective comparative outcome study which was conducted from the ANGEL-ACT registry. Comparisons were made between baseline characteristics and clinical outcomes of patients with acute ischemic stroke undergoing MT with non-contrast head computed tomography (NCHCT) alone versus patients undergoing NCHCT plus non-invasive vessel imaging (NVI) (including CT angiography (with or without CT perfusion) and magnetic resonance angiography). The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included change in mRS score from baseline to 90 days, the proportions of mRS 0–1, 0–2, and 0–3, and dramatic clinical improvement at 24 hours. The safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH, and mortality within 90 days.ResultsA total of 894 patients met the inclusion criteria; 476 (53%) underwent NCHCT alone and 418 (47%) underwent NCHCT + NVI. In the NCHCT alone group, the door-to-reperfusion time was shorter by 47 min compared with the NCHCT + NVI group (219 vs 266 min, P<0.001). Patients in the NCHCT alone group showed a smaller increase in baseline mRS score at 90 days (median 3 vs 2 points; P=0.004) after adjustment. There were no significant differences between groups in the remaining clinical outcomes.ConclusionsIn patients selected for MT using NCHCT alone versus NCHCT + NVI, there were improved procedural outcomes and smaller increases in baseline mRS scores at 90 days.

scholarly journals Inhaled Corticosteroids and the Pneumonia Risk in Patients With Chronic Obstructive Pulmonary Disease: A Meta-analysis of Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Hong Chen ◽  
Jian Sun ◽  
Qiang Huang ◽  
Yongqi Liu ◽  
Mengxin Yuan ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Controlled Trials ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled ◽  
Copd Patients ◽  
Baseline Characteristics

Background: Whether all types of inhaled corticosteroids (ICSs) would increase the pneumonia risk in patients with chronic obstructive pulmonary disease (COPD) remains controversial. We aimed to assess the association between ICSs treatment and pneumonia risk in COPD patients, and the impact of medication details and baseline characteristics of patients on the association.Methods: Four databases (PubMed, Embase, Cochrane Library, and Clinical Trials.gov) were searched to identify eligible randomized controlled trials (RCTs) comparing ICSs treatment with non-ICSs treatment on the pneumonia risk in COPD patients. Pooled results were calculated using Peto odds ratios (Peto ORs) with corresponding 95% confidence intervals (CIs).Results: A total of 59 RCTs enrolling 103,477 patients were analyzed. All types of ICSs significantly increased the pneumonia risk (Peto OR, 1.43; 95% CI, 1.34–1.53). Subgroup analysis showed that there was a dose-response relationship between ICSs treatment and pneumonia risk (low-dose: Peto OR, 1.33; 95% CI, 1.22–1.45; medium-dose: Peto OR, 1.50; 95% CI, 1.28–1.76; and high-dose: Peto OR, 1.64; 95% CI, 1.45–1.85). Subgroup analyses based on treatment durations and baseline characteristics (severity, age, and body mass index) of patients were consistant with the above results. Subgroup analysis based on severity of pneumonia showed that fluticasone (Peto OR, 1.75; 95% CI, 1.44–2.14) increased the risk of serious pneumonia, while budesonide and beclomethasone did not.Conclusions: ICSs treatment significantly increased the risk of pneumonia in COPD patients. There was a dose-response relationship between ICSs treatment and pneumonia risk. The pneumonia risk was related with COPD severity.

scholarly journals Adherence to corticosteroids and clinical outcomes in mepolizumab therapy for severe asthma

2020 ◽  
Vol 55 (5) ◽  
pp. 1902259 ◽  
Author(s):  
Gráinne d'Ancona ◽  
Joanne Kavanagh ◽  
Cris Roxas ◽  
Linda Green ◽  
Mariana Fernandes ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Biologic Therapy ◽  
Inhaled Corticosteroids ◽  
Final Analysis ◽  
Good Adherence ◽  
Eosinophilic Asthma ◽  
Exacerbation Rate ◽  
Asthmatic Patients ◽  
Severe Eosinophilic Asthma ◽  
Asthma Patients

IntroductionInhaled corticosteroids (ICS) achieve disease control in the majority of asthmatic patients, although adherence to prescribed ICS is often poor. Patients with severe eosinophilic asthma may require treatment with oral corticosteroids (OCS) and/or biologic agents such as mepolizumab. It is unknown if ICS adherence changes on, or alters clinical response to, biologic therapy.MethodsWe examined ICS adherence and clinical outcomes in OCS-dependent severe eosinophilic asthma patients who completed 1 year of mepolizumab therapy. The ICS medicines possession ratio (MPR) was calculated (the number of doses of ICS issued on prescription/expected number) for the year before and the year after biologic initiation. Good adherence was defined as MPR >0.75, intermediate 0.74–0.51 and poor <0.5. We examined outcomes after 12 months of biologic therapy, including OCS reduction and annualised exacerbation rate (AER), stratified by adherence to ICS on mepolizumab.ResultsOut of 109 patients commencing mepolizumab, 91 who had completed 12 months of treatment were included in the final analysis. While receiving mepolizumab, 68% had good ICS adherence, with 16 (18%) having poor ICS adherence. ICS use within the cohort remained similar before (MPR 0.81±0.32) and during mepolizumab treatment (0.82±0.32; p=0.78). Patients with good adherence had greater reductions in OCS dose (median (interquartile range) OCS reduction 100 (74–100)% versus 60 (27–100)%; p=0.031) and exacerbations (AER change −2.1±3.1 versus 0.3±2.5; p=0.011) than those with poor adherence. Good ICS adherence predicted the likelihood of stopping maintenance OCS (adjusted OR 3.19, 95% CI 1.02–9.94; p=0.045).ConclusionICS nonadherence is common in severe eosinophilic asthma patients receiving mepolizumab, and is associated with a lesser reduction in OCS requirements and AER.

scholarly journals Impact of baseline anti-cyclic citrullinated peptide-2 antibody concentration on efficacy outcomes following treatment with subcutaneous abatacept or adalimumab: 2-year results from the AMPLE trial

2015 ◽  
Vol 75 (4) ◽  
pp. 709-714 ◽  
Author(s):  
Jeremy Sokolove ◽  
Michael Schiff ◽  
Roy Fleischmann ◽  
Michael E Weinblatt ◽  
Sean E Connolly ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Clinical Outcomes ◽  
Antibody Concentration ◽  
Treatment Groups ◽  
Cyclic Citrullinated Peptide ◽  
Remission Rates ◽  
Registration Number ◽  
Baseline Characteristics ◽  
Citrullinated Peptide

ObjectivesTo examine whether baseline anti-cyclic citrullinated peptide-2 (CCP2) antibody status and concentration correlated with clinical outcomes in patients treated with abatacept or adalimumab on background methotrexate (MTX) in the 2-year AMPLE (Abatacept versus adaliMumab comParison in bioLogic-naïvE rheumatoid arthritis subjects with background MTX) study.MethodsIn this exploratory analysis, anti-CCP2 antibody concentration was measured at baseline, and antibody-positive patients were divided into equal quartiles, Q1–Q4, representing increasing antibody concentrations. Clinical outcomes analysed by baseline anti-CCP2 status and quartile included change from baseline in disease activity and disability and remission rates.ResultsBaseline characteristics were generally comparable across quartiles and treatment groups. In both treatment groups, anti-CCP2 antibody-negative patients responded less well than antibody-positive patients. At year 2, improvements in disease activity and disability and remission rates were similar across Q1–Q3, but were numerically higher in Q4 in the abatacept group; in contrast, treatment effects were similar across all quartiles in the adalimumab group.ConclusionsIn AMPLE, baseline anti-CCP2 positivity was associated with a better response for abatacept and adalimumab. Patients with the highest baseline anti-CCP2 antibody concentrations had better clinical response with abatacept than patients with lower concentrations, an association that was not observed with adalimumab.Trial registration numberNCT00929864.

scholarly journals P1374 Clinical outcomes of patients with solid left atrial appendage thrombi. Predictors of thrombus resolution and impact of anticoagulation regimens

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Nelles ◽  
M Lambers ◽  
M Schafigh ◽  
R Schueler ◽  
V Vij ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
International Normalized Ratio ◽  
Individual Risk ◽  
Old Patients ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
The Individual ◽  
Direct Acting ◽  
Current Guidelines

Abstract OBJECTIVE Current guidelines recommend vitamin k antagonist (VKA) therapy with a therapeutic international normalized ratio of 2.0 to 3.0 for at least 3 weeks upon detection of an LA/LAA thrombus in patients with atrial fibrillation (AF). Reported thrombus resolution rates with VKAs vary between approximately 50% and 90%. Data on thrombus resolution after a therapy with a direct-acting oral anticoagulant (DOAC) are scarce but efficacy data on DOAC indicate on potential favorable outcomes. METHODS We analyzed 78 patients diagnosed with a solid LA thrombus by transesophageal echocardiography and compared baseline characteristics, the anticoagulatory regime and the clinical outcomes of patients with and without thrombus resolution. RESULTS Mean age of the population was 76 ±8 years old. Patients were male in 61.5% and presented with a high risk for thromboembolism (CHA2DS2-VASc 4.3 ± 1.1). At the time of thrombus diagnosis 44,9% (35/78) patients were treated with a DOAC, 47,4% (37/78) were under therapy with a VKA and only 14,1% (11/78) of the patients had no prior DOAC or VKA treatment. Mean thrombus size was 1,63 ± 0,61cm x 0,98 ± 0,31cm. Complete thrombus resolution was achieved after a mean 116 ± 79 days in a total of 48,2% (40/78) of patients. There was no statistically significant difference in the rate of LAA thrombus resolution between VKA and DOACs (41,2% vs. 57,1%), but in cases in which therapy with a DOAC led to a complete thrombus resolution, the time needed for the resolution was significantly shorter than with VKA (81 ± 38 days vs. 129 ± 46 days, p = 0,03). CONCLUSIONS There was difference in the rate of LAA thrombus resolution between VKA and DOACs, the resolution time was shorter in patients prescribed a DOAC. In clinical practice the individual risk for thrombus persistence can not be predicted. 80,1% of patients were prescribed, what would be considered, an appropriate anticoagulant regimen, but only 48,2% had thrombus resolution at any point of follow up documented via TEE. Switching to DOAC after prior VKA therapy is an effective and valid alternative to patients presenting with LAA thrombi.

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