Impact of the number of changes of therapeutic strategy on improvement in depressed patients. dria study

2011 ◽  
Vol 26 (S2) ◽  
pp. 700-700
Author(s):  
M. Garcia-Toro ◽  
E. Valmisa ◽  
J. Galan ◽  
S. Ros
Keyword(s):  
Therapeutic Strategy ◽  
Clinical Symptoms ◽  
Remission Rate ◽  
Major Depressive ◽  
Pragmatic Clinical Trial ◽  
Remission Rates ◽  
Image Position ◽  
Antidepressant Combination ◽  
Strategy Switch

IntroductionThe STAR*D is a pragmatic clinical trial that showed lower remission rate and higher relapse rate when more strategies were used.[1]Objectives and aimsAssess clinical improvement in symptoms related to depression, anxiety and sleep, based on the number of strategies used.MethodsDescriptive, non-interventional, prospective study including outpatients diagnosed with Major Depressive Disorder (MDD) with sub-optimal response to standard antidepressants. In those patients a change on the therapeutic strategy (switch of antidepressant, combination of antidepressants, augmentation or a combination of previous strategies) had to be considered necessary. Follow-up period was 22–26 weeks.Results364 patients were included by 58 psychiatrists, 336 were analyzed (92.3%) and 315 (86.5%) completed the follow-up.[Difference last visit vs. basal]p < 0.0001 in all measuresConclusionsThe more changes on strategies used the less improvement on clinical symptoms and remission rates.This study has been sponsored by AstraZeneca Farmaceutica Spain, SA.

Therapeutic strategies used on treatment of depression. Dria study

2011 ◽  
Vol 26 (S2) ◽  
pp. 629-629
Author(s):  
R. Salvador ◽  
J. Galan ◽  
M. Garcia-Toro
Keyword(s):  
Real Life ◽  
Treatment Strategies ◽  
Therapeutic Strategies ◽  
Major Depressive ◽  
Multiple Strategies ◽  
The Past ◽  
Treatment Of Depression ◽  
Image Position ◽  
Antidepressant Combination

IntroductionThere are few clinical studies about strategies used in depression in clinical practice.ObjectivesDescribe therapeutic strategies used in psychiatric care in patients with depression who had a suboptimal response to standard antidepressants under real-life conditions.MethodsNon-interventional study that included a prospective cohort of outpatients diagnosed with Major Depressive Disorder (MDD) who needed a change on the treatment. Strategies were group as: switch of antidepressant, combination of antidepressants, augmentation or a combination of previous strategies. Follow-up period was 22-26 weeks.Results364 patients were included by 58 psychiatrists, 336 were analyzed (92.3%) and 315 (86.5%) completed the follow-up.[Strategies selected in each change][Relationship between no. changes and no. strategie]ConclusionsStrategies more used were: switch to another antidepressant, combination of antidepressant, augmentation and multiple strategies.Although a change of treatment was decided, frequently it was selected a strategy used in the past.This study has been sponsored by AstraZeneca Farmaceutica Spain, SA.

scholarly journals Outcomes of endoscopic transsphenoidal surgery for Cushing's disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zarina Brady ◽  
Aoife Garrahy ◽  
Claire Carthy ◽  
Michael W. O’Reilly ◽  
Christopher J. Thompson ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Remission Rate ◽  
Cushing's Disease ◽  
Endoscopic Transsphenoidal Surgery ◽  
Endocrine Society ◽  
Csf Leakage ◽  
Remission Rates

Abstract Background Transsphenoidal surgery (TSS) to resect an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the first-line treatment for Cushing’s disease (CD), with increasing usage of endoscopic transsphenoidal (ETSS) technique. The aim of this study was to assess remission rates and postoperative complications following ETSS for CD. Methods A retrospective analysis of a prospective single-surgeon database of consecutive patients with CD who underwent ETSS between January 2012–February 2020. Post-operative remission was defined, according to Endocrine Society Guidelines, as a morning serum cortisol < 138 nmol/L within 7 days of surgery, with improvement in clinical features of hypercortisolism. A strict cut-off of < 50 nmol/L at day 3 post-op was also applied, to allow early identification of remission. Results A single surgeon (MJ) performed 43 ETSS in 39 patients. Pre-operative MRI localised an adenoma in 22 (56%) patients; 18 microadenoma and 4 macroadenoma (2 with cavernous sinus invasion). IPSS was carried out in 33 (85%) patients. The remission rates for initial surgery were 87% using standard criteria, 58% using the strict criteria (day 3 cortisol < 50 nmol/L). Three patients had an early repeat ETSS for persistent disease (day 3 cortisol 306-555 nmol/L). When the outcome of repeat early ETSS was included, the remission rate was 92% (36/39) overall. Remission rate was 94% (33/35) when patients with macroadenomas were excluded. There were no cases of CSF leakage, meningitis, vascular injury or visual deterioration. Transient and permanent diabetes insipidus occurred in 33 and 23% following first ETSS, respectively. There was one case of recurrence of CD during the follow-up period of 24 (4–79) months. Conclusion Endoscopic transsphenoidal surgery produces satisfactory remission rates for the primary treatment of CD, with higher remission rates for microadenomas. A longer follow-up period is required to assess recurrence rates. Patients should be counselled regarding risk of postoperative diabetes insipidus.

scholarly journals The Appalachia Mind Health Initiative (AMHI): A pragmatic clinical trial of adjunctive internet-based Cognitive Behavior Therapy for treating major depressive disorder among primary care patients

2021 ◽  
Author(s):  
Robert M. Bossarte ◽  
Ronald C. Kessler ◽  
Andrew A. Nierenberg ◽  
Pim Cuijpers ◽  
Angel Enrique ◽  
...  
Keyword(s):  
Treatment Effects ◽  
Remission Rate ◽  
Self Report ◽  
Cognitive Behavior ◽  
Major Depressive ◽  
Treatment Providers ◽  
Health Initiative ◽  
Heterogeneity Of Treatment Effects ◽  
Comparative Treatment

Abstract Background: Major Depressive Disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM-only. But 77% of US MDD patients are nonetheless treated with ADM-only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based Cognitive Behavior Therapy (i-CBT) addresses all of these problems. Methods: Enrolled patients (n=3,360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM-only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms; and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size. Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE.Discussion: The study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM-only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT. Trial registration: The Appalachian Mind Health Initiative (AMHI; registry name) was prospectively registered on 10/9/19 (ClinicalTrials.gov Identifier: NCT04120285).

Methimazole-Induced Remission Rates in Pediatric Graves’ Disease: a Systematic Review

2021 ◽  
Author(s):  
Jelmer M van Lieshout ◽  
Christiaan F Mooij ◽  
A. S Paul van Trotsenburg ◽  
Nitash Zwaveling-Soonawala
Keyword(s):  
Systematic Review ◽  
Treatment Duration ◽  
Remission Rate ◽  
Graves Disease ◽  
Treatment Protocols ◽  
Intention To Treat ◽  
Remission Rates ◽  
One Year ◽  
Treat Analysis

Objective: Comparison of studies on remission rates in pediatric Graves’ disease is complicated by lack of uniformity in treatment protocols, remission definition, and follow-up duration. We performed a systematic review on remission rates in pediatric Graves’ disease and attempted to create uniformity by recalculating remission rates based on an intention-to-treat analysis. Methods: PubMed and Embase were searched in August 2020 for studies on patients with Graves’ disease (i) 2 to 18 years of age, (ii) initially treated with methimazole or carbimazole for at least 18 months, (iii) with a follow-up duration of at least one year after cessation of methimazole or carbimazole. All reported remission rates were recalculated using an intention-to-treat analysis. Results: Of 1,890 articles, 29 articles consisting of 24 patient cohorts, were included with a total of 3,057 patients (82.6% female). Methimazole or carbimazole was initially prescribed in 2,864 patients (93.7%). Recalculation based on intention-to-treat analysis resulted in an overall remission rate of 28.8% (829/2,880). Pooled remission rates based on treatment duration were 23.7%, 31.0%, 43.7%, and 75% after respectively 1.5-2.5 years, 2.5-5 years, 5-6 years (two studies), and 9 years (single study) treatment duration. Occurrence of adverse events was 419 in 2,377 patients (17.6%), with major side effects in 25 patients (1.1%). Conclusions: Using a standardized calculation the overall remission rate in methimazole treated pediatric GD is 28.8%. A few small studies indicate that longer treatment increases the remission rate. However, evidence is limited and further research is necessary to investigate the efficacy of longer treatment durations.

Depressive symptoms in patients with schizofrenia or schizoaffective disorder, prevalence and importance in subjective evaluation. 4D study

2011 ◽  
Vol 26 (S2) ◽  
pp. 1482-1482 ◽  
Author(s):  
M. Bousoño ◽  
J. Galan ◽  
E. Prieto ◽  
J. Sanjuan
Keyword(s):  
Depressive Symptoms ◽  
Schizoaffective Disorder ◽  
Therapeutic Strategy ◽  
Subjective Evaluation ◽  
Depression Scale ◽  
Clinical Relapse ◽  
Patient Global Impression ◽  
Relapse Time ◽  
Image Position

IntroductionDepressive symptoms in patients with schizophrenia has been associated with overall worse outcomes.ObjectiveAssess the prevalence and evolution of depressive symptoms, measured with the Calgary Depression Scale for Schizophrenia (CDSS), and its importance in subjective evaluation.MethodsNon-interventional, prospective (6 moths of follow-up) study of a cohort of patients with schizophrenia of schizoaffective disorders who have had a clinical relapse that required a change in the therapeutic strategy.Results305 patients were included, 288 (94.4%) was the population analyzed and 272 (89.1%) completed the follow-up. 226 (78.5%) of patients have a diagnosis of schizophrenia, the rest were diagnosed of schizoaffective disorder.CDSS (unlike SWN-K, PANSS, DAI-10, ICG-G nor PSP) at baseline was correlated (r = −0.18497, p = 0.0016) with Patient Global Impression (PGI) in month_6.Depressive symptoms were the only ones at baseline with statistically significant association to positive response in SWN-K and PGI in the multivariate analysis.ConclusionsOver 50% of patients had depression in relapse time, with a good progress of those symptoms in the follow-up period.Depressive symptoms were the unique at baseline associated with a good subjective evaluation from the patient.

Long-term outcomes of transsphenoidal surgery for management of growth hormone–secreting adenomas: single-center results

2020 ◽  
Vol 133 (5) ◽  
pp. 1360-1370 ◽  
Author(s):  
Mohammed J. Asha ◽  
Hirokazu Takami ◽  
Carlos Velasquez ◽  
Selfy Oswari ◽  
Joao Paulo Almeida ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Recurrence Rate ◽  
Transsphenoidal Surgery ◽  
Remission Rate ◽  
Repeat Surgery ◽  
Significant Difference ◽  
Remission Rates ◽  
Biochemical Remission

OBJECTIVETranssphenoidal surgery is advocated as the first-line management of growth hormone (GH)–secreting adenomas. Although disease control is defined by strict criteria for biochemical remission, the length of follow-up needed is not well defined in literature. In this report, the authors present their long-term remission rate and identify various predictive factors that might influence the clinical outcome.METHODSThe authors conducted a single-institute retrospective analysis of all transsphenoidal procedures for GH-secreting adenomas performed from January 2000 to June 2016. The primary outcome was defined as biochemical remission according to the 2010 consensus criteria and measured at the 1-year postoperative mark as well as on the last recorded follow-up appointment.Secondary variables included recurrence rate, patterns of clinical presentation, and outcome of adjuvant therapy (including repeat surgery). Subgroup analysis was performed for patients who had biochemical or radiological “discordance”—patients who achieved biochemical remission but with incongruent insulin-like growth factor 1 (IGF-1)/GH or residual tumor on MRI. Recurrence-free survival analysis was conducted for patients who achieved remission at 1 year after surgery.RESULTSEighty-one patients (45 female and 36 male) with confirmed acromegaly treated with transsphenoidal surgery were included. In 62 cases the patients were treated with a pure endoscopic approach and in 19 cases an endoscopically assisted microscopic approach was used.Primary biochemical remission after surgery was achieved in 59 cases (73%) at 1 year after surgery. However, only 41 patients (51%) remained in primary surgical remission (without any adjuvant treatment) at their last follow-up appointment, indicating a recurrence rate of 31% (18 of 59 patients) over the duration of follow-up (mean 100 ± 61 months). Long-term remission rates for pure endoscopic and endoscopically assisted cases were not significantly different (48% vs 52%, p = 0.6). Similarly, no significant difference in long-term remission was detected between primary surgery and repeat surgery (54% vs 33%, p = 0.22).Long-term remission was significantly influenced by extent of resection, cavernous sinus invasion (radiologically as well as surgically reported), and preoperative and early postoperative GH and IGF-1 levels (within 24–48 hours after surgery) as well as by clinical grade, with lower remission rates in patients with dysmorphic features and/or medical comorbidities (grade 2–3) compared to minimally symptomatic or silent cases (grade 1).CONCLUSIONSThe long-term surgical remission rate appears to be significantly less than “early” remission rates and is highly dependent on the extent of tumor resection. The authors advocate a long-term follow-up regimen and propose a clinical grading system that may aid in predicting long-term outcome in addition to the previously reported anatomical factors. The role of repeat surgery is highlighted.

Transsphenoidal Surgery for Cushing's Disease: Endocrinological Follow-up Monitoring of 82 Patients

Neurosurgery ◽  
2002 ◽  
Vol 51 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Ilan Shimon ◽  
Zvi Ram ◽  
Zvi R. Cohen ◽  
Moshe Hadani
Keyword(s):  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Adrenocorticotropic Hormone ◽  
Remission Rate ◽  
The United States ◽  
Cushing's Disease ◽  
Free Cortisol ◽  
Remission Rates ◽  
Surgical Failure

Abstract OBJECTIVE Transsphenoidal surgery is the preferred treatment modality for adrenocorticotropic hormone-secreting pituitary adenomas. In the past 2 decades, several institutions in the United States and Europe have reported remission rates of 70 to 85% after transsphenoidal surgery for treatment of Cushing's disease. We analyzed our postoperative results for a large cohort of patients with Cushing's disease. METHODS Eighty-two patients with adrenocorticotropic hormone-secreting adenomas (79 microadenomas and 3 macroadenomas) underwent transsphenoidal surgery between 1990 and 2000. Seventy-seven patients were surgically treated for the first time, and 13 patients underwent reoperations (5 had undergone the first operation elsewhere) because of previous surgical failure (10 patients) or recurrence (3 patients). The mean postoperative follow-up period was 4.2 ± 2.8 years. Biochemical remission was defined as postoperative normalization of elevated 24-hour urinary free cortisol secretion and suppression of morning cortisol levels with 1 mg of dexamethasone. RESULTS Remission was achieved for 78% of all patients after one operation and for 62% of patients who underwent a second operation. The recurrence rate was 5%. Ten patients did not exhibit a visible tumor on magnetic resonance imaging scans, and the other patients were divided according to adenoma size (2–5 or 6–10 mm). Remission rates were similar for the three groups of patients (78–80%). Pituitary tumor stained for adrenocorticotropic hormone was detected in 78% of resected pituitary tissue specimens obtained from patients who achieved remission, compared with 53% from patients who experienced surgical failure (P = 0.06). CONCLUSION Our series demonstrates the efficacy of transsphenoidal surgery for Cushing's disease resulting from pituitary microadenomas. Microadenoma size had no effect on the remission rate. Reoperations are indicated after initial surgical failures.

scholarly journals Surgical outcomes and multidisciplinary management strategy of Cushing’s disease: a single-center experience in China

2020 ◽  
Vol 48 (6) ◽  
pp. E7 ◽  
Author(s):  
Keyi Zhang ◽  
Ming Shen ◽  
Nidan Qiao ◽  
Zhengyuan Chen ◽  
Wenqiang He ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Surgical Outcomes ◽  
Management Strategy ◽  
Remission Rate ◽  
Pituitary Surgery ◽  
Multivariate Regression Analysis ◽  
Cushing's Disease ◽  
Endoscopic Endonasal ◽  
Remission Rates

OBJECTIVEThe primary aim of this study was to investigate the value of multidisciplinary team (MDT) management in treating patients with Cushing’s disease (CD). The secondary aim was to assess the concordance of bilateral inferior petrosal sinus sampling (BIPSS) lateralization with intraoperative observations.METHODSThe authors recruited 124 consecutive patients (128 procedures) who had undergone endoscopic endonasal resection of adrenocorticotropic hormone–secreting pituitary adenomas from May 2014 to April 2018 and assessed their clinical characteristics, surgical outcomes, and adjuvant therapies. The criteria for surgical remission were normalized serum and urinary cortisol levels, which could be suppressed by a low-dose dexamethasone suppression test at 3-months’ follow-up without adjuvant treatment.RESULTSThe remission rates of the 113 patients with long-term follow-up (20.3 ± 12.2 months) were 83.2% after surgery alone and 91.2% after adjuvant therapy. The surgical remission rates of macroadenomas, MRI-visible microadenomas, and MRI-negative tumors were 66.7% (12/18), 89.3% (67/75), and 75% (15/20), respectively (p = 0.039). The surgical remission rates had a trend of improvement during the study period (87.5% in 2017–2018 vs 76.5% in 2014, p = 0.517). Multivariate regression analysis showed that a history of previous pituitary surgery (OR 0.300, 95% CI 0.100–0.903; p = 0.032) and MRI-visible microadenoma (OR 3.048, 95% CI 1.030–9.019; p = 0.044) were independent factors influencing surgical remission. The recurrence rate was 3.2% after a mean of 18 months after surgery. The remission rate of postoperative MDT management in patients with persistent disease was higher than non-MDT management (66.7% vs 0%, p = 0.033). In cases with preoperative BIPSS lateralization, 84.6% (44/52) were concordant with intraoperative findings.CONCLUSIONSMRI-visible microadenoma and primary surgery were independent predictors of surgical remission in CD. The MDT management strategy helps to achieve a better overall outcome. BIPSS may help to lateralize the tumor in MRI-negative/equivocal microadenomas.

Enhancing Outcomes from Major Depression: Using Antidepressant Combination Therapies with Multifunctional Pharmacologic Mechanisms from the Initiation of Treatment

CNS Spectrums ◽  
2010 ◽  
Vol 15 (2) ◽  
pp. 79-94 ◽  
Author(s):  
Stephen M. Stahl
Keyword(s):  
Major Depression ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Antidepressant Treatment ◽  
Symptomatic Improvement ◽  
Good News ◽  
Sustained Remission ◽  
Major Depressive ◽  
Remission Rates ◽  
Antidepressant Combination

Traditional guidelines call for treatment of major depression with a sequence of single antidepressants. Augmentation with a second agent generally only occurs when the first agent is well tolerated and when it also provides at least some symptomatic improvement on its own. Since this standard approach leads to low rates of attaining and sustaining remission by the first agent, with diminishing returns for each subsequent agent, there is growing dissatisfaction with this approach to the treatment of major depression. One new trend is to attempt to enhance the rates of sustained remission from a major depressive episode by combining two therapeutic agents from the very initiation of treatment of a major depressive episode.Traditional treatment of major depression begins with a single “first line” antidepressant, and if it does not work or is not tolerated, trying another and then another. Unfortunately, this strategy results in disappointing remission rates for the first antidepressant (Figure 1), and disappointing rates of maintaining any improvement that is attained by this first agent because of high relapse rates over the next year despite continuing treatment with the first antidepressant (Figure 2A). And that is the good news. The bad news is that with each subsequent antidepressant treatment administered remission rates are progressively reduced (Figure 1). For those patients who do improve, they are progressively less likely to sustain their therapeutic gains despite continuing to take the drug that led to their initial improvement (Figure 2).

scholarly journals Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases

2011 ◽  
Vol 164 (4) ◽  
pp. 499-504 ◽  
Author(s):  
Xin Qu ◽  
Min Wang ◽  
Guodong Wang ◽  
Tao Han ◽  
Chengzhi Mou ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Tumor Invasion ◽  
Transsphenoidal Surgery ◽  
Remission Rate ◽  
Academic Medical Center ◽  
Entire Group ◽  
Initial Surgery ◽  
Remission Rates ◽  
Male Patients

ContextLittle systematic data on male prolactinomas treated with surgery are available.ObjectiveTo clarify the clinical features and confirm the efficacy of transsphenoidal surgery for male prolactinomas and predictive factors after initial surgery.Patients and methodsThis retrospective study included 87 male patients with prolactinoma treated by transsphenoidal surgery at an academic medical center. Hormonal and visual status, remission rates, and the rate of tumor relapse, as well as predictive factors, were evaluated.ResultsPostoperative initial remission was achieved in 52.9% of patients. The remission rate was markedly higher in microadenomas (83.3%) than in macroadenomas (44.9%). Logistic regression analysis showed that the predictive factors of the early negative outcomes were high preoperative prolactin (PRL) levels and tumor invasion. After a median follow-up of 45 months, the long-term remission rate was 42.5%, and relapse of hyperprolactinemia occurred in 19.6% of the cured patients. The 5-year recurrence-free survival was 78.2% (95% confidence interval, 62.3–88.1%). When surgery was followed by adjuvant treatment in uncured and recurrent patients, 78.8% of patients in the entire group in the absence of dopamine agonists obtained biochemical remission at the end of follow-up.ConclusionTranssphenoidal surgery is a viable treatment alternative for male prolactinomas. The remission rates of male patients with microadenomas and/or intrasellar macroprolactinomas by surgery alone remain excellent, and surgery followed by adjuvant therapy as necessary is required for optimizing management of male prolactinomas, especially for extrasellar macroprolactinomas. The early negative results are associated with preoperative PRL levels and tumor invasion.

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