scholarly journals Low-dose corticosteroid and mycophenolate for primary treatment of minimal change disease

QJM ◽  
2019 ◽  
Vol 113 (6) ◽  
pp. 399-403
Author(s):  
M K M Ma ◽  
D Y H Yap ◽  
C L Li ◽  
M M Y Mok ◽  
G C W Chan ◽  
...  
Keyword(s):  
Minimal Change Disease ◽  
Low Dose ◽  
Standard Dose ◽  
Minimal Change ◽  
Adult Onset ◽  
First Line ◽  
Group 2 ◽  
Enteric Coated ◽  
Dose Corticosteroid ◽  
Group 1

Abstract Background Mycophenolate has been shown to be effective in glomerular disease. However, the role of mycophenolate in the first-line treatment of adult-onset idiopathic minimal change disease (MCD) has not been systematically studied in a randomized fashion. Aim To evaluate the therapeutic efficacy of enteric-coated mycophenolate sodium combined with low-dose corticosteroid as first-line treatment for MCNS. Design A prospective, open-label, randomized clinical trial. Methods Twenty adult patients with biopsy proven MCD were recruited and randomly assigned to receive either enteric-coated Mycophenolate Sodium (EC-MPS) plus low-dose prednisolone (Group 1: Prednisolone 0.25 mg/kg/day, n = 10) or standard-dose prednisolone (Group 2: Prednisolone 1 mg/kg/day, n = 10). Results After 24 weeks of therapy, eight patients in Group 1 vs. seven of patients in Group 2 achieved complete remission (P = 0.606). Both groups showed a significant reduction of urine protein excretion (P < 0.05) and increased serum albumin (P < 0.001) vs. baseline levels. However, no significant between-group differences were demonstrated. The relapse rate was also similar in both groups. Both treatment regimens were well tolerated but there were more patient reported adverse effects in the standard-dose prednisolone group. Conclusion EC-MPS plus low-dose prednisolone is non-inferior to standard-dose prednisolone therapy in inducing clinical remission and preventing relapse in adult-onset idiopathic MCD and is associated with better tolerability and less adverse effects. This trial is registered with the ClinicalTrials.gov number NCT01185197.

scholarly journals Does dose modification affect efficacy of first-line pazopanib in metastatic renal cell carcinoma?

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 512-512 ◽  
Author(s):  
Paolo Grassi ◽  
Giuseppe Procopio ◽  
Raffaele Ratta ◽  
Luca Porcu ◽  
Antonia Martinetti ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Standard Dose ◽  
First Line ◽  
Starting Dose ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

512 Background: Pazopanib is a standard treatment for metastatic renal cell carcinoma (mRCC) and 800 mg/day is considered the optimal dose for mRCC patients (pts). However, some pts require a dose reduction due to toxicity. It remains unclear whether reduced-dose pazopanib is as effective as the standard dose in achieving a response. Methods: We retrospectively evaluated treatment duration, objective response rate (ORR), progression-free survival (PFS), and discontinuation rate in consecutive pts with mRCC treated with first-line pazopanib between 2011 and 2016 at the Istituto Nazionale Tumori of Milano, Italy. Three patient groups were compared: group 1 received the standard starting dose of 800 mg/day continously, group 2 received a dose reduced to 400 or 600 mg/day after starting with 800 mg/day, and group 3 received a reduced starting dose of 400 or 600 mg/day because of ECOG performance status = 2-3 and/or comorbidities. Results: We included 69 pts, with 34 in group 1, 19 in group 2, and 16 in group 3. Median age at diagnosis was 62 years, and 64% were male. Overall 13% and 87% of pts were classified as Heng good and intermediate-risk respectively. In 10 and 9 pts of the group 2, the dose was reduced to 600 and 400 mg/day respectively while 12 and 4 pts in the group 3 received a reduced initial dose of 400 and 600 mg/day respectively. After a median follow-up of 13.9 months (range 0.3-43.8), 27 (39.1%) pts showed progressive disease (PD) and 3 (4.3%) pts were dead. Incidence rate of PD or death was 2.5 (95% CI: 0.6-4.4; Hazard ratio [HR]:1) per 100 person-months in group 1; 4.0 (95% CI: 0-11.4; HR: 1.45) per 100 person-months in group 2 and 3.3 (95% CI: 0-6.8; HR: 1.19) per 100 person-months in group 3. Rates of discontinuation due to PD were 28% in group 1, 42% in group 2, and 44% in group 3. ORR was 44%, 11% and 19% in group 1, group 2, and group 3 respectively. Conclusions: Our results suggest that mRCC pts receiving a lower dose of first-line pazopanib might not have a meaningful PFS advantage compared with those receiving standard dose. These data highlight the importance of management of the treatment-related side effects that may eventually lead to optimal drug exposure.

Low Dose and Standard Dose of Imatinib Therapy for Patients with Chronic Myeloid Leukemia in Akita Prefecture, Japan.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4575-4575
Author(s):  
Naoto Takahashi ◽  
Yoshihiro Kameoka ◽  
Hirofumi Saitoh ◽  
Naohito Fujishima ◽  
Makoto Hirokawa ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Characteristics ◽  
Low Dose ◽  
Standard Dose ◽  
Point Mutations ◽  
Imatinib Therapy ◽  
Group I ◽  
Akita Prefecture ◽  
Group 2 ◽  
Group 1

Abstract The IRIS study for CML patients demonstrated the excellent clinical and cytogenetic/molecular effects of imatinib. Patients participating in the IRIS trial were selected according to strict eligibility criteria. The clinical features of patients are usually much more heterogeneous in practical situations than in clinical trials. Sometimes, patients cannot be treated with the standard dose of imatinib because of severe toxicity, especially older patients or patients who had already been treated with the other drugs. In this study, we analyzed whether patients could still be effectively treated using lower doses. Our study analyzed 86 CML patients from 17 hospitals in Akita prefecture. 80 patients were in CP, one patient was in AP, 4 patients were in BC, and one patient had cytogenetic relapse after allo-SCT. All patients were treated with imatinib between December 2001 and July 2007. Initially a dose of 400mg/day was given to almost all patients. Later the dose was decreased in a subset of patients experiencing imatinib-induced side effects. We classified patients into two groups according to the imatinib dosage and analyzed their clinical characteristics [Table 1] and the accumulation of CCR/MMR [Figure 1, 2]. In Group 1, we analyzed 55 patients received 300mg or more of imantiib per day. In Group 2, we analyzed 31 patients received less than 300mg of imatinib per day. Patients in Group 2 were older and had more histories of pretreatment and showed a higher frequency of adverse effects of imatinib than in Group 1. There were no significant differences of CCR/MMR rate between Group 1 and Group 2. This study reproduces the imatinib efficacy results described in the IRIS study, not only for patients treated with standard dose imatinib and for patients who could not take 400mg/day because of imatinib toxicity or other complications. We did not observe an increase in frequency of BCR-ABL point mutations in patients receiving a lower dose of imatinib, suggesting that the low dose imatinib treatment analyzed in our study does not enhance imatinib resistance by increasing BCR-ABL point mutations. In conclusion, we provide data supporting the use of lower doses of imatinib for CML patients that cannot be given sufficient dosage of imatinib for reasons such as severe hematological or non-hematological side effects or other complication. Clinical Characteristics of Patients in Group I and II Group 1(n=55) Group 2(n=31) P Average doseage 380 mg/day 185 mg/day Average age (% of over 70 yrs) 57.7 yrs (22 %) 68.0 yrs (58 %) .001 (.007) History of treatment with IFN/HU before imatinib therapy 16% 55%. 002 Adverse effect (Grade3/4) 16% 42% .009 PFS to AP/BC at 60 Mo 97.8% 89.6% .28 CCR /MMR rate 78% / 51% 61% / 39% .09 / .27 Point mutation of bcr-abl in patients without MMR 4/17 2/13 .99 Figure Figure Figure Figure

scholarly journals Tacrolimus as the first-line agent in adult-onset minimal change disease: A randomized controlled study

2019 ◽  
Vol 30 (1) ◽  
pp. 129
Author(s):  
SmitaSubhash Divyaveer ◽  
MalagoudaR Patil ◽  
Arpita Raychaudhary ◽  
Mayuri Trivedi ◽  
Chetan Mahajan ◽  
...  
Keyword(s):  
Minimal Change Disease ◽  
Minimal Change ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Adult Onset ◽  
First Line ◽  
Randomized Controlled

Immediate and long-term results of the first line chemotherapy in patients with metastatic triple negative breast cancer. Final analysis of randomized study

2020 ◽  
pp. 75-80
Author(s):  
S.A. Lyalkin ◽  
◽  
L.A. Syvak ◽  
N.O. Verevkina ◽  
◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Randomized Study ◽  
Progression Free Survival ◽  
First Line ◽  
Free Survival ◽  
Group 2 ◽  
Line Chemotherapy ◽  
Group 1

The objective: was to evaluate the efficacy of the first line chemotherapy in patients with metastatic triple negative breast cancer (TNBC). Materials and methods. Open randomized study was performed including 122 patients with metastatic TNBC. The efficacy and safety of the first line chemotherapy of regimens АТ (n=59) – group 1, patients received doxorubicine 60 мг/м2 and paclitaxel 175 мг/м2 and ТР (n=63) – group 2, patients received paclitaxel 175 мг/м2 and carboplatin AUC 5 were evaluated. Results. The median duration of response was 9.5 months (4.5–13.25 months) in patients received AT regimen and 8.5 months (4.7–12.25 months), in TP regimen; no statistically significant differences were observed, р=0.836. The median progression free survival was 7 months (95% CI 5–26 months) in group 1 and 7.5 months (95% CI 6–35 months) in group 2, p=0.85. Both chemotherapy regimens (AT and TP) had mild or moderate toxicity profiles (grade 1 or 2 in most patients). No significant difference in gastrointestinal toxicity was observed. The incidence of grade 3–4 neutropenia was higher in patients of group 2 (TP regimen): 42.8% versus 27% (р<0.05). Conclusions. Both regimens of chemotherapy (AT and TP) are appropriate to use in the first line setting in patients with metastatic TNBC. Key words: metastatic triple negative breast cancer, chemotherapy, progression free survival, chemotherapy toxicity.

scholarly journals Clinical Characteristics and Outcomes of Adults with Nephrotic Syndrome Due to Minimal Change Disease

2021 ◽  
Vol 10 (16) ◽  
pp. 3632
Author(s):  
Sophia Lionaki ◽  
Evangelos Mantios ◽  
Ioanna Tsoumbou ◽  
Smaragdi Marinaki ◽  
George Makris ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Nephrotic Syndrome ◽  
Minimal Change Disease ◽  
Kidney Injury ◽  
Spontaneous Remission ◽  
Minimal Change ◽  
Adult Onset ◽  
Potential Risk Factors ◽  
The Mean ◽  
End Stage

Purpose: Minimal change disease (MCD) is considered a relatively benign glomerulopathy, as it rarely progresses to end-stage kidney disease. The aim of this study was to describe the characteristics and outcomes of adults with MCD and identify potential risk factors for relapse. Patients & Methods: We retrospectively studied a cohort of adults with biopsy-proven MCD in terms of clinical features and treatment outcomes. Baseline characteristics and outcomes were recorded and predictors of relapse were analyzed using logistic regression multivariate analysis. Results: 59 patients with adult-onset primary MCD with nephrotic syndrome were included. Mean serum creatinine at diagnosis was 0.8 mg/dL (±2.5) and estimated GFR (eGFR) was 87 mL/min/1.73 m2 (±29.5). Mean serum albumin was 2.5 g/dL (±0.8) and 24 h proteinuria 6.8 g (±3.7). Microscopic hematuria was detected in 35 (58.5%) patients. 42 patients received prednisone alone, six patients received prednisone plus cyclophosphamide, five patients received prednisone plus cyclosporine, one patient received prednisone plus rituximab and five patients did not receive immunosuppression at all since they achieved spontaneous remission. During a mean follow up time of 34.7(22.1) months, 46.1% of patients experienced at least one episode of relapse. The mean age of patients who did not experience a relapse was significantly higher than that of patients who relapsed while relapsers had a significantly longer duration of 24 h proteinuria prior to biopsy compared to non-relapsers. Overall, 10% of patients experienced acute kidney injury while the mean eGFR at the end was 82 mL/min/1.73 m2 (±29.1) and one patient ended up in chronic dialysis. Overall, the proportion of non-relapsers, who experienced acute kidney injury (17%) was significantly higher than the one recorded among relapsers (0%).Conclusion: In this series of patients, almost 46% of adult-onset nephrotic MCD patients experienced a relapse, although their renal progression was rare. Younger onset age was an independent risk factor for relapse in adult-onset MCD patients.

scholarly journals Low Dose X-Ray Sources and High Quantum Efficiency Sensors: The Next Challenge in Dental Digital Imaging?

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Arnav R. Mistry ◽  
Daniel Uzbelger Feldman ◽  
Jie Yang ◽  
Eric Ryterski
Keyword(s):  
Low Dose ◽  
Image Resolution ◽  
X Ray ◽  
Imaging Technologies ◽  
Group 4 ◽  
X Ray Imaging ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Objective(s). The major challenge encountered to decrease the milliamperes (mA) level in X-ray imaging systems is the quantum noise phenomena. This investigation evaluated dose exposure and image resolution of a low dose X-ray imaging (LDXI) prototype comprising a low mA X-ray source and a novel microlens-based sensor relative to current imaging technologies.Study Design. A LDXI in static (group 1) and dynamic (group 2) modes was compared to medical fluoroscopy (group 3), digital intraoral radiography (group 4), and CBCT scan (group 5) using a dental phantom.Results. The Mann-Whitney test showed no statistical significance(α=0.01)in dose exposure between groups 1 and 3 and 1 and 4 and timing exposure (seconds) between groups 1 and 5 and 2 and 3. Image resolution test showed group 1 > group 4 > group 2 > group 3 > group 5.Conclusions. The LDXI proved the concept for obtaining a high definition image resolution for static and dynamic radiography at lower or similar dose exposure and smaller pixel size, respectively, when compared to current imaging technologies. Lower mA at the X-ray source and high QE at the detector level principles with microlens could be applied to current imaging technologies to considerably reduce dose exposure without compromising image resolution in the near future.

scholarly journals Comparative Study of Propofol Versus Thiopental Sodium with Succinylcholine for Laryngeal Mask Airway (LMA) Insertion

2018 ◽  
Vol 10 (1) ◽  
pp. 11-15
Author(s):  
Chandra Shekhar Karmakar ◽  
Md Afzalur Rahman ◽  
Mohammad Rezaul Karim ◽  
Monirul Islam ◽  
Md Shahidul Islam ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Low Dose ◽  
Upper Airway ◽  
Laryngeal Mask ◽  
Airway Reflex ◽  
Haemodynamic Changes ◽  
Thiopental Sodium ◽  
Group 2 ◽  
Insertion Condition ◽  
Group 1

Background: The increasing emphasis on day case anaesthesia has lead to the greater use of the laryngeal mask airway (LMA) as an alternative to intubation. Laryngoscopy and tracheal intubation are noxious stimuli, which cause a reflex increase in both sympathetic and sympathoadrenal activity that may result in tachycardia, hypertension and dysarrhythmias. Insertion of Laryngeal mask airway (LMA) is associated with less haemodynamic changes, minimal increase in intraocular and intracranial pressure and lower incidence of sore throat. Still its insertion requires sufficient depth of anesthesia to prevent airway reflex (gagging, coughing nd spasms). To insert LMA successfully propofol is the most frequently administered medication. But most of all recommend not using propofol singly for LMA insertion. Thiopental can’t suppress the upper airway reflexes as propofol but with low dose succinylcholine upper airway reflexes are attenuated so combination of thiopental sodium with succinylcholine may be another choice of drug.Objectives: This Prospective study was conducted to evaluate the effectiveness of Thiopental sodium and Succinylcholine for insertion of the LMA in comparison with Propofol.Methods: This interventional study was carried out in Sixty patients, aged 3-45 years who were scheduled for elective surgical procedure under general anaesthesia in ShSMCH. Patients were randomly assigned to two groups by odd and even number basis. In Group-1 (N1=30), LMA was inserted after induction with Thiopental sodium (5 mg/kg body weight i.v.) and Succinylcholine (0.5mg/kg i.v); in Group-2 (N2 = 30), the LMA was inserted with Propofol (2.5mg/kg i.v). Jaw relaxation, incidence of coughing- gagging , overall insertion condition and haemodynamic changes were observed.Results: Grade of jaw relaxation in Group-1 was Good in 93.3%, incomplete in 6.7% and 0% poor but in Group-2, 86.7% was good 10% incomplete and 3.3% was poor. Coughing occurred in 33.3% of patients in the Group-2 and there was only 10% in succinyl group (P=0.028) which is significantly higher in Group-2. Overall insertion condition in Group -1 was excellent in 86.7%, Good in 10% cases and poor in only 3.3% cases on the other hand in Group-2 excellent in 53.3%, Good in 33.3% cases and poor in only 13.3% cases (P=0.019).Conclusion: There was statistically significant difference in jaw relaxation in two groups and incidence of Gagging or Coughing is higher in Group-2. Overall insertion condition was significantly better in Group-1. We concluded that Thiopental sodium with low dose Suxamethonium is an effective alternative of Propofol.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 11-15

scholarly journals Internal endoscopic drainage as first line or second line treatment in case of postsleeve gastrectomy fistulas

2018 ◽  
Vol 06 (06) ◽  
pp. E745-E750 ◽  
Author(s):  
J. Gonzalez ◽  
D. Lorenzo ◽  
T. Guilbaud ◽  
T. Bège ◽  
M. Barthet
Keyword(s):  
Demographic Data ◽  
Median Number ◽  
Endoscopic Management ◽  
Endoscopic Drainage ◽  
Efficacy Rate ◽  
Second Line ◽  
First Line ◽  
Tertiary Center ◽  
Group 2 ◽  
Group 1

Abstract Background and study aims Management of post-sleeve gastrectomy fistulas (PSGF) recently has evolved, resulting in prioritization of internal endoscopic drainage (IED). We report our experience with the technique in a tertiary center. Patients and methods This was a single-center, retrospective study of 44 patients whose PSGF was managed with IED, comparing two periods: after 2013 (Group 1; n = 22) when IED was used in first line and before 2013 (Group 2; n = 22) when IED was applied in second line. Demographic data, pre-endoscopic management, characteristics of fistulas, therapeutic modalities and outcomes were recorded and compared between the two groups. The primary endpoint was IED efficacy; the secondary endpoint was a comparison of outcomes depending on the timing of IED in the management strategy. Results The groups were matched in gender (16 female, 16 male), mean age (43 years old), severity of fistula, delay before treatment, and exposure to previous endoscopic or surgical treatments. The overall efficacy rate was 84 % (37/44): 86 % in Group 1 and 82 % in Group 2 (NS). There was one death and one patient who underwent surgery. The median time to healing was 226 ± 750 days (Group 1) vs. 305 ± 300 days (Group 2) (NS), with a median number of endoscopies of 3 ± 6 vs. 4.5 ± 2.4 (NS). There were no differences in number of nasocavity drains and double pigtail stents (DPS), but significantly more metallic stents, complications, and secondary strictures were seen in Group 2. Conclusion IED for management of PSGF is effective in more than 80 % of cases whenever it is used during the therapeutic strategy. This approach should be favored when possible.

scholarly journals FP073PROGNOSTIC SIGNIFICANCE OF RENAL BIOPSY IN ADULT ONSET MINIMAL CHANGE DISEASE

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i73-i73
Author(s):  
Simona Stancu ◽  
Gabriel Stefan ◽  
Madalina Hoinoiu ◽  
Ioana Dicu ◽  
Cosmin Florescu ◽  
...  
Keyword(s):  
Renal Biopsy ◽  
Minimal Change Disease ◽  
Minimal Change ◽  
Adult Onset
Sign in / Sign up

Export Citation Format

Share Document