Early Treatment of a Migraine Attack while Pain is Still Mild Increases the Efficacy of Sumatriptan

Cephalalgia ◽  
2004 ◽  
Vol 24 (11) ◽  
pp. 925-933 ◽  
Author(s):  
J Scholpp ◽  
R Schellenberg ◽  
B Moeckesch ◽  
N Banik
Keyword(s):  
Treatment Group ◽  
Migraine Attack ◽  
Early Treatment ◽  
International Headache Society ◽  
Open Label ◽  
Open Label Study ◽  
Label Study ◽  
Delayed Treatment ◽  
Early Treatment Group ◽  
Late Treatment

To investigate the hypothesis that early treatment of a migraine attack with sumatriptan, while pain is still mild, results in higher pain free rates in comparison to delayed treatment, when pain is at least moderate, we performed a prospective, controlled and open label study. Migraineurs with or without aura who fulfilled the diagnostic criteria recommended by the International Headache Society were enrolled in the study and randomly assigned to either ‘early’ or ‘late’ treatment with sumatriptan 100 mg tablets. In the early treatment group significantly more patients were pain free at all times measured during two hours after dosing than in the late treatment group. Furthermore, patients in the early treatment group became pain free significantly sooner after dosing than patients who delayed treatment. It is concluded that migraineurs, who are able to differentiate between a migraine attack and other forms of headache, benefit from early intervention with sumatriptan 100 mg tablets.

scholarly journals Sorafenib Inhibits Tumor Growth and Improves Survival in a Transgenic Mouse Model of Pancreatic Islet Cell Tumors

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Volker Fendrich ◽  
Katja Maschuw ◽  
Johannes Rehm ◽  
Malte Buchholz ◽  
Julia P. Holler ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Treatment Group ◽  
Tumor Progression ◽  
Early Treatment ◽  
Islet Cell ◽  
Control Group ◽  
Islet Cell Tumors ◽  
Pancreatic Islet Cell ◽  
Early Treatment Group ◽  
Late Treatment

Background. The purpose of the study was to evaluate Sorafenib (BAY 43-9006) derived receptor tyrosine kinase inhibition on tumor progression in murine islet cell tumors. Sorafenib is considered to be a potent inhibitor of tumor angiogenesis and neovascularization in various solid tumors. Rip1Tag2 mice were treated in two different groups according to the model of tumor progression: the early treatment group received vehicle or Sorafenib from 10 to 14 weeks of age and the late treatment group from week 12 until death. Tumor surface, tumor cell proliferation, and apoptosis were measured in both treatment groups to assess the in vivo effects of Sorafenib. Survival was recorded for the late treatment group. In the early treatment group Sorafenib led to a dramatic decrease in tumor volume compared to the control group. Apoptosis was significantly augmented and cell proliferation was inhibited. As a single therapy Sorafenib significantly improved survival in the late treatment group.Conclusion. Sorafenib may provide a new paradigm for the therapy of islet cell tumors.

Comparison of Skeletal Complications and Treatment Patterns Associated with Early Versus Delayed Zoledronic Acid Therapy In Multiple Myeloma

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1956-1956
Author(s):  
Andrew Peng Yu ◽  
Arielle G Bensimon ◽  
Maryna Marynchenko ◽  
Eric Qiong Wu ◽  
Madhav Namjoshi ◽  
...  
Keyword(s):  
Treatment Group ◽  
Early Treatment ◽  
Chart Review ◽  
Employment Equity ◽  
Delayed Treatment ◽  
Kaplan Meier ◽  
Early Treatment Group ◽  
Equity Ownership ◽  
Baseline Characteristics ◽  
Diagnosis Date

Abstract Abstract 1956 Introduction: Zoledronic acid (ZOL) is currently the standard of care to reduce/delay progressive skeletal-related events (SREs) in multiple myeloma (MM). However, limited evidence is available on the relationship between the timing of ZOL initiation and patient outcomes in this indication. This study retrospectively compared the risks of SREs and ZOL treatment discontinuation associated with early versus delayed ZOL therapy for patients with symptomatic MM. Methods: Data were collected from a physician-administered medical chart review among patients with a confirmed diagnosis of symptomatic MM treated after 01/01/2002. Participating hematologists and oncologists were asked to provide detailed information for patients meeting the inclusion criteria, including demographics, comorbidity profiles, disease severity and bone health at diagnosis, bisphosphonate treatment patterns, and timing of SREs. Analyses were conducted among patients who received early or delayed ZOL therapy, defined respectively as initiating ZOL ≤60 days versus >60 days after the first symptomatic MM diagnosis. Kaplan-Meier analysis with a log-rank test was performed to compare the risk of SREs between the study cohorts. Patients were followed from their diagnosis date until the first subsequent SRE, or until loss of follow-up. SREs included pathologic fractures (vertebral or non-vertebral), spinal cord compression, radiation to relieve bone pain, hypercalcemia, and prophylactic surgery to treat impending fractures. Cox proportional hazard modeling was used to compare the risk of SREs associated with early versus delayed ZOL treatment, controlling for demographic factors, stage of MM, bone health status, and presence of major comorbidities at diagnosis. To evaluate the implications of early treatment on persistence, risk of ZOL discontinuation was compared between the cohorts in a survival analysis framework. Time to discontinuation for any reason was evaluated using the Kaplan-Meier method, which followed patients from the date of ZOL initiation; as a sensitivity analysis, time to discontinuation for reasons other than stable or remitted MM was also assessed. Results: A total of 312 patients met the study inclusion criteria. Median time to ZOL initiation from symptomatic MM diagnosis was 25 days in the early treatment cohort (N=126) and 242 days in the delayed treatment cohort (N=186). Baseline characteristics assessed at the time of diagnosis were generally well-balanced between the study groups; however, patients with early ZOL therapy were older on average (62.3±10.0 vs. 60.1±10.6 years; p=.022), were more likely to have Durie-Salmon stage III MM (57.9% vs. 44.1%; p=.034), and had a higher average number of lytic lesions (7.1±7.8 vs. 4.8±7.0; p<.001) than those with delayed therapy. Following the diagnosis date, time to the first SRE was significantly longer for patients who received early treatment with ZOL (p=.005). At 2 years post-diagnosis, the SRE-free rate was 74.6% in the early treatment group compared to 56.5% in the delayed treatment group. Adjusting for baseline characteristics, Cox regression analysis confirmed that early ZOL therapy was associated with a significantly lower risk of any SRE (hazard ratio=.625 vs. delayed ZOL therapy; p=.029). The risk of ZOL treatment discontinuation over time was also significantly lower in the early treatment group. At 2 years from ZOL initiation, rates of discontinuation for any reason were 9.6% versus 16.4% among patients with early versus delayed therapy, respectively (p=.032). Rates of discontinuation for reasons other than stable or remitted MM showed a similar pattern in the early versus delayed treatment groups (6.5% vs. 12.0% at 2 years; p=.044). Conclusion: This retrospective chart review among patients with symptomatic MM found that early treatment with ZOL was significantly associated with reduced risks of SREs and with better persistence compared to delayed treatment. Results indicate that early initiation of ZOL therapy may have important clinical implications in MM. Disclosures: Yu: Novartis Pharmaceuticals Corporation: Consultancy. Bensimon:Novartis Pharmaceuticals Corporation: Consultancy. Marynchenko:Novartis Pharmaceuticals Corporation: Consultancy. Wu:Novartis Pharmaceuticals Corporation: Consultancy. Namjoshi:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Guo:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Ericson:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Raje:Novartis Pharmaceuticals Corporation: Consultancy.

The premonitory phase of migraine and migraine management

Cephalalgia ◽  
2012 ◽  
Vol 33 (13) ◽  
pp. 1117-1121 ◽  
Author(s):  
Werner J Becker
Keyword(s):  
Literature Review ◽  
Migraine Attack ◽  
Management Strategy ◽  
Controlled Study ◽  
Open Label ◽  
Double Blind ◽  
Open Label Study ◽  
Label Study ◽  
Medication Treatment ◽  
Premonitory Symptoms

Objective: The objective was to determine, through a literature review, whether treatment during the premonitory phase of migraine is a potentially useful migraine management strategy. Methods: A general literature review was done with regard to the nature of migraine premonitory symptoms, their frequency, their reliability in predicting migraine attacks, and the effectiveness of medication treatment when given during the premonitory phase. Results: Many different symptoms have been reported as premonitory symptoms that occur before migraine attacks. Up to 87% of patients with migraine may experience premonitory symptoms, although some studies have provided estimates as low as 33%. In selected patients, premonitory symptoms may be relatively reliable predictors of a migraine attack to follow. Both naratriptan (open-label study) and domperidone (double-blind, randomized, placebo-controlled study) have been reported to be effective when given during the premonitory phase. Conclusions: More research is needed, but there is some evidence that medication treatment during the premonitory phase has the potential to be helpful in selected patients with migraine.

Factors and Outcomes Associated With Early and Delayed Aneurysm Treatment in Subarachnoid Hemorrhage Patients in the United States

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 670-678 ◽  
Author(s):  
Farhan Siddiq ◽  
Saqib A. Chaudhry ◽  
Ramachandra P. Tummala ◽  
M. Fareed K. Suri ◽  
Adnan I. Qureshi
Keyword(s):  
United States ◽  
Subarachnoid Hemorrhage ◽  
Treatment Group ◽  
Early Treatment ◽  
The United States ◽  
Delayed Treatment ◽  
Aneurysm Treatment ◽  
Surgical Clip ◽  
Early Treatment Group ◽  
Ruptured Intracranial Aneurysm

Abstract BACKGROUND: Recent studies from selected centers have shown that early surgical treatment of aneurysms in subarachnoid hemorrhage (SAH) patients can improve outcomes. These results have not been validated in clinical practice at large. OBJECTIVE: To identify factors and outcomes associated with timing of ruptured intracranial aneurysm obliteration treatment in patients with SAH after hospitalization in the United States. METHODS: We analyzed the data from the Nationwide Inpatient Sample (2005–2008) for all patients presenting with primary diagnosis of SAH, receiving aneurysm treatment (endovascular coil embolization or surgical clip placement). Early treatment was defined as aneurysm treatment performed within 48 hours and delayed treatment if treatment was performed after 48 hours of admission. RESULTS: Of 32 048 patients with SAH who underwent aneurysm treatment, 24 085 (75.2%) underwent early treatment and 7963 (24.8%) underwent delayed treatment. Female sex (P = .002), endovascular embolization (P &lt; .001), and weekday admission (P &lt; .001) were independent predictors of early treatment. In the early treatment group, patients were more likely discharged with none to minimal disability (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14-1.47) and less likely to be discharged with moderate to severe disability (OR 0.77, 95%CI 0.67-0.87) compared with those in the delayed treatment group. The in-hospital mortality was higher in the early treatment group compared with the delayed treatment group (OR 1.36 95%CI 1.12-1.66). CONCLUSION: Patients with SAH who undergo aneurysm treatment within 48 hours of hospital admission are more likely to be discharged with none to minimal disability. Early treatment is more likely to occur in those undergoing endovascular treatment and in patients admitted on weekdays.

scholarly journals Early corticosteroid treatment for postoperative acute lung injury after lung cancer surgery

2019 ◽  
Vol 13 ◽  
pp. 175346661984025 ◽  
Author(s):  
Hayoung Choi ◽  
Beomsu Shin ◽  
Hongseok Yoo ◽  
Gee Young Suh ◽  
Jong Ho Cho ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Acute Lung Injury ◽  
Treatment Group ◽  
Lung Injury ◽  
Early Treatment ◽  
Lung Resection ◽  
Lung Cancer Surgery ◽  
Corticosteroid Treatment ◽  
Early Treatment Group ◽  
Late Treatment

Background: Acute lung injury (ALI) is the most serious pulmonary complication after lung resection. Although the beneficial effects of low-dose corticosteroids have been demonstrated in patients with postoperative ALI, there are limited data on optimal corticosteroid treatment. Methods: We retrospectively analyzed 58 patients who were diagnosed with ALI among 7593 patients who underwent lung cancer surgery between January 2009 and December 2016. Results: Of the 58 patients, 42 (72%) received corticosteroid treatment within 72 h (early treatment group) and 16 (28%) received corticosteroid treatment more than 72 h after ALI occurred (late treatment group). The early treatment group demonstrated a higher response to corticosteroid treatment compared with the late treatment group (95% versus 69%, respectively, p = 0.014), had an improved lung injury score (86% versus 63%, p = 0.072), and were more likely to be successfully weaned from the ventilator within 7 days (57% versus 39%, p = 0.332). During corticosteroid treatment, the early treatment group had a lower rate of delirium (24% versus 63%, p = 0.012) compared with the late treatment group. No significant differences in length of stay (30 versus 37 days, p = 0.254) or in-hospital mortality (43% versus 38%, p = 0.773) were observed; however, the early treatment group tended to have a higher rate of successful weaning than the late treatment group ( p = 0.098, log-rank test). Conclusions: Early initiation of corticosteroid treatment improved lung injury and promoted ventilator weaning in patients with ALI following lung resection for lung cancer.

scholarly journals Delayed Initiation of Supplemental Pain Management is Associated with Postherpetic Neuralgia: A Retrospective Study

2020 ◽  
Vol 1;23 (1;1) ◽  
pp. 65-72
Author(s):  
Min Yan
Keyword(s):  
Retrospective Study ◽  
Pain Management ◽  
Treatment Group ◽  
Postherpetic Neuralgia ◽  
Early Treatment ◽  
Initial Time ◽  
Early Treatment Group ◽  
Delayed Initiation ◽  
Late Treatment ◽  
Risk Patients

Background: Acute pain is a risk factor for developing postherpetic neuralgia (PHN), the most common complication of herpes zoster (HZ). Supplemental analgesics are frequently used in the treatment of acute herpetic pain. However, there are insufficient data regarding when to begin supplemental analgesics, and it is unknown whether the delayed use of supplemental analgesics increases the risk of PHN in high-risk patients. Objectives: This study aimed to evaluate the association between initial time of supplemental pain management and the risk of PHN in high-risk patients. Study Design: Retrospective study. Setting: The Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine. Methods: We performed a retrospective study between May 13, 2017 and August 8, 2018 in our clinic. Multivariable logistic regression analysis was conducted to examine the independent factors associated with PHN. Supplemental pain management was defined as any use of opioids, tricyclic antidepressants, or nerve blocks. A subgroup analysis was conducted in patients who received supplemental pain management within the first 30 days of onset. According to the initial time of supplemental pain management, patients were divided into 2 groups: the early treatment group (≤ 14 days), and the late treatment group (> 14 days). The clinical outcomes in these 2 groups was compared for propensity score (PS) matching. Results: A total of 134 patients with HZ aged 50 years or older with moderate to severe pain were enrolled in this study. The delayed initiation of supplemental pain management (> 14 days) (odds ratio, 4.11; 95% confidence interval, 1.69-9.92; P = 0.002) and severity of rash (odds ratio, 2.93; 95% confidence interval, 1.22-7.01; P = 0.016) were independent factors associated with PHN. In the subgroup analysis, after PS matching, there were no significant differences in the baseline clinical parameters between the early and late treatment groups. The incidence of PHN was significantly lower in the early treatment group than the late treatment group (36. 4% vs. 72.7%; P = 0.015). Reduction in pain was also greater in the early treatment group. Limitations: The findings identified in the present study are specific to the patients who were relatively older and with moderate to severe pain. It is impossible to determine from our study whether younger individuals and individuals with mild acute pain will benefit from early supplemental treatments. Furthermore, because of the retrospective nature of the study, there may be some confounders that could not be controlled. Further prospective studies with larger sample sizes and longer follow-up periods are needed. Conclusions: The early use of supplemental pain management may decrease the risk of PHN. It might therefore be beneficial to consider administering supplemental pain management earlier in older patients with moderate to severe acute herpetic pain. Key words: Herpes zoster, postherpetic neuralgia, analgesia, opioid, nerve block, tricyclic antidepressant

scholarly journals Therapy of visceral leishmaniasis due to Leishmania infantum: experimental assessment of efficacy of AmBisome.

1996 ◽  
Vol 40 (5) ◽  
pp. 1214-1218 ◽  
Author(s):  
J P Gangneux ◽  
A Sulahian ◽  
Y J Garin ◽  
R Farinotti ◽  
F Derouin
Keyword(s):  
Treatment Group ◽  
Visceral Leishmaniasis ◽  
Early Treatment ◽  
Leishmania Infantum ◽  
Dose Range ◽  
Control Groups ◽  
Experimental Assessment ◽  
Delayed Treatment ◽  
Early Treatment Group ◽  
Range Study

The tolerance and efficacy of amphotericin B (AmB) deoxycholate (Fungizone) were compared with those of liposomal AmB (AmBisome) in a murine model of visceral leishmaniasis induced by Leishmania infantum. Control groups consisted of untreated mice and mice treated with a pentavalent antimonial (Glucantime). BALB/c mice were infected intravenously on day 0 with 10(7) promastigotes of L. infantum and then treated from day 7 to 17 (early treatment group) or from day 60 to 70 (delayed treatment group). The pentavalent antimonial was administered daily by intraperitoneal injection, whereas AmB formulations were administered intravenously on alternate days. On days 20, 60, and 120 (early treatment group) and on days 72 and 125 (delayed treatment group), parasite burdens in the liver, spleen, and lungs were determined by subculturings using a microtitration method. A dose range study showed that administration of AmBisome at the well-tolerated doses of 5 or 50 mg/kg of body weight completely eradicated the parasites from the tissues. At 0.8 mg/kg, AmBisome proved more efficacious than AmB deoxycholate administered at the same dose. We also compared the levels of AmB deoxycholate and AmBisome in plasma and tissue. Mice treated with AmBisome had levels of AmB in tissue much higher than did AmB deoxycholate-treated mice with persistent detectable levels 14 weeks after treatment. These results seem to account for the remarkable efficacy of the liposomal formulation of AmB in the treatment of visceral leishmaniasis due to L. infantum.

Acute External Laryngeal Trauma: Experience with 112 Patients

2005 ◽  
Vol 114 (5) ◽  
pp. 361-368 ◽  
Author(s):  
Allen P. Butler ◽  
Ashli K. O'Rourke ◽  
Brennan P. Wood ◽  
Edward S. Porubsky
Keyword(s):  
Treatment Group ◽  
Clinical Outcomes ◽  
Early Treatment ◽  
Tertiary Care ◽  
Treatment Protocol ◽  
Care Hospital ◽  
Delayed Treatment ◽  
Laryngeal Trauma ◽  
Airway Function ◽  
Early Treatment Group

The purpose of this report is to promote early recognition, expeditious evaluation, and judicious management of acute external laryngeal trauma. A retrospective chart review was performed of 112 cases that were managed at a Medical College of Georgia tertiary care hospital by the senior author (E.S.P.). Patients were classified by the time of their presentation, the severity of their injury, and the treatment protocol followed. The clinical outcomes of airway, voice quality, and deglutition were retrospectively reviewed. For voice outcomes, in the delayed treatment group, only 27.7% of patients had a good result, as compared to a 78.3% good result in the early treatment group. Similar differences were demonstrated regarding the airway. In the delayed treatment group, only 73.3% had good airway function, as compared to 93.3% who had good airway function in the early treatment group. Ninety-nine percent of all patients had a good result for deglutition. We conclude that expeditious diagnosis and intervention reduce the incidence of suboptimal clinical outcomes, and with timely and appropriate application of diagnostic and management protocols, the majority of patients will be successfully decannulated (97%) with functional speech (100%) and normal deglutition (99%).

46 Impact of early versus late medical treatment of a hemodynamically significant patent ductus arteriosus on time to reach full feeds in preterm neonates

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e32-e34
Author(s):  
Krishan Yadav ◽  
Joseph Ting ◽  
Michael Castaldo ◽  
Gurpreet Grewal ◽  
Mimi Kuan
Keyword(s):  
Treatment Group ◽  
Patent Ductus Arteriosus ◽  
Medical Treatment ◽  
Preterm Infants ◽  
Early Treatment ◽  
Prolonged Exposure ◽  
Ductus Arteriosus ◽  
Early Treatment Group ◽  
Late Treatment ◽  
Patent Ductus

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Prolonged exposure to a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants has been associated with an increase in neonatal morbidities. Objectives To examine the effect of timing of medical treatment (within first 7 days of life versus after 7 days of life) for a hsPDA on the duration to achieve full feeds in infants born at &lt;30 weeks of gestation. Design/Methods This was a retrospective cohort study in a quaternary neonatal intensive care unit (NICU) with a targeted neonatal echocardiography service. Infants admitted between July 2015 – June 2019 who received medical treatment for an hsPDA were included and grouped based on those who received first medical therapy within 7 days of life (early treatment) and after 7 days of life (late treatment). An hsPDA was defined using both clinical (worsening ventilation, pulmonary hemorrhage/edema, or hypotension requiring inotrope or hydrocortisone) and echocardiographic findings (LA/Ao ratio &gt;1.4; LVO &gt;350 mL/kg/min, PDA &gt;1.4 mm, IVRT &lt; 35 ms). Duration to reach full feeds was calculated based on number of days to reach a total enteral feed ≥ 120 mL/kg/day with no parenteral source of nutrition. Results Forty-six infants met the inclusion criteria. Of the 46 infants, 24 were identified as receiving early treatment and 22 received late treatment. Infants in the early treatment group had lower median birth weight than the late treatment group (802 g vs. 1016 g, p=0.022). All other clinical characteristics were not significantly different. No significant difference was found in the use of indomethacin, ibuprofen, or acetaminophen as the initial medical treatment (Table 1). The late treatment group had elevated left ventricular output (median: 286 vs. 369 mL/kg/min, p=0.013) and tricuspid annular plane systolic excursion (median: 6 vs. 8 mm, p=0.002) (Table 2). Infants in the early treatment group reached full feeds earlier than those in the late treatment group (19 vs. 30 days, p=0.042) (Table 1). Conclusion Early medical treatment of hsPDA was associated with shorter duration to reach full feeds in our cohort of preterm infants. Further larger scale study is needed to understand the association between the timing of medical therapy and prolonged exposure of splanchnic circulation to hemodynamically significant ductus.

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