Effectiveness of Long-Term Treatment of Multiple Myeloma in Regular Care: Comparison of a Longitudinal and a Cross-Sectional Analysis Approach

2021 ◽  
pp. 1-8
Author(s):  
Tilman Steinmetz ◽  
Angela Ernst ◽  
Martin Hellmich ◽  
Melanie Heinz ◽  
Uwe Totzke
Keyword(s):  
Multiple Myeloma ◽  
Treatment Guidelines ◽  
Term Treatment ◽  
Subsequent Treatment ◽  
New Drugs ◽  
Event Analysis ◽  
Cross Sectional ◽  
Regular Care ◽  
Long Term Treatment ◽  
Cross Sectional Studies

<b><i>Introduction:</i></b> New drugs for multiple myeloma have considerably increased the options for consecutive treatment lines in regular care. Official treatment guidelines still discuss several regimens per line, and therefore, current practice is of topical interest. Large cross-sectional studies revealed a greater than linear loss of patients reaching consecutive treatment lines of ever decreasing effectiveness. <b><i>Methods:</i></b> In a longitudinal approach, we analyzed data of all 145 multiple myeloma patients treated in our outpatient clinic in Germany between January 1, 2012, and December 31, 2019, using a time-to-event analysis with death as competitive risk. <b><i>Results:</i></b> The estimated incidences of reaching the 2nd, 3rd, 4th, and 5th lines of therapy were 88, 66, 44, and 30%, respectively. Median times to subsequent treatment lines were 34, 18, 14, 13, and 15 months, respectively. <b><i>Discussion:</i></b> Percentages of patients reaching later therapy lines were considerably greater than predicted by cross-sectional studies and median times after the 1st line did not suggest a further decrease in effectiveness, while use of new drug regimens was similar to that reported in cross-sectional studies. <b><i>Conclusion:</i></b> Effectiveness of later therapy lines appears to be underestimated by cross-sectional analyses, and the conveyed focus on 1st-line treatment for multiple myeloma needs to be scrutinized.

A longitudinal study of psychotropic drug prescription

1982 ◽  
Vol 12 (1) ◽  
pp. 201-206 ◽  
Author(s):  
P. Williams ◽  
J. Murray ◽  
A. Clare
Keyword(s):  
Longitudinal Study ◽  
Psychotropic Drug ◽  
Drug Prescription ◽  
Term Treatment ◽  
Psychological Morbidity ◽  
Prolonged Treatment ◽  
Cross Sectional ◽  
Long Term Treatment ◽  
Cross Sectional Studies

SynopsisWhile many of the characteristics of psychotropic drug consumers have been established by means of cross-sectional studies, little is known about new consumers and the factors which predispose to long-term treatment. We report on a longitudinal study of 153 general practice patients beginning a new course of psychotropic drug treatment and characterized by extensive physical and psychological morbidity. About 1 in 5 were still receiving psychotropic drugs 6 months later and this prolonged treatment was associated with increased age, previous psychotropic drug-use, higher levels of psychological morbidity at the inception of treatment and, for the women only, social problems as perceived by the general practitioners.

scholarly journals Single-Oocyte Gene Expression Suggests That Curcumin Can Protect the Ovarian Reserve by Regulating the PTEN-AKT-FOXO3a Pathway

2021 ◽  
Vol 22 (12) ◽  
pp. 6570
Author(s):  
Yue Lv ◽  
Rui-Can Cao ◽  
Hong-Bin Liu ◽  
Xian-Wei Su ◽  
Gang Lu ◽  
...  
Keyword(s):  
Gene Expression ◽  
Ovarian Reserve ◽  
Primordial Follicle ◽  
Term Treatment ◽  
New Drugs ◽  
Gene Profiling ◽  
Primordial Follicles ◽  
Long Term Treatment ◽  
Follicle Activation

A better understanding of the mechanism of primordial follicle activation will help us better understand the causes of premature ovarian insufficiency (POI), and will help us identify new drugs that can be applied to the clinical treatment of infertility. In this study, single oocytes were isolated from primordial and primary follicles, and were used for gene profiling with TaqMan array cards. Bioinformatics analysis was performed on the gene expression data, and Ingenuity Pathway Analysis was used to analyze and predict drugs that affect follicle activation. An ovarian in vitro culture system was used to verify the function of the drug candidates, and we found that curcumin maintains the ovarian reserve. Long-term treatment with 100 mg/kg curcumin improved the ovarian reserve indicators of AMH, FSH, and estradiol in aging mice. Mechanistic studies show that curcumin can affect the translocation of FOXO3, thereby inhibiting the PTEN-AKT-FOXO3a pathway and protecting primordial follicles from overactivation. These results suggest that curcumin is a potential drug for the treatment of POI patients and for fertility preservation.

scholarly journals What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report

2021 ◽  
Vol 18 (4) ◽  
pp. 1425
Author(s):  
Morgane Guillou-Landreat ◽  
Antoine Dany ◽  
Gaëlle Challet-Bouju ◽  
Edouard Laforgue ◽  
Juliette Leboucher ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Pharmacological Therapy ◽  
Daily Clinical Practice ◽  
Short Report ◽  
Opioid Use ◽  
Cross Sectional ◽  
Long Term Treatment ◽  
Social Profiles

(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed (3) Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids (4) Conclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.

scholarly journals Hypomagnesemia Induced by Long-Term Treatment with Proton-Pump Inhibitors

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Simone Janett ◽  
Pietro Camozzi ◽  
Gabriëlla G. A. M. Peeters ◽  
Sebastiano A. G. Lava ◽  
Giacomo D. Simonetti ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Term Treatment ◽  
Cross Sectional ◽  
Magnesium Metabolism ◽  
Poor Renal Function ◽  
Long Term Treatment

In 2006, hypomagnesemia was first described as a complication of proton-pump inhibitors. To address this issue, we systematically reviewed the literature. Hypomagnesemia, mostly associated with hypocalcemic hypoparathyroidism and hypokalemia, was reported in 64 individuals on long-term proton-pump inhibitors. Hypomagnesemia recurred following replacement of one proton-pump inhibitor with another but not with a histamine type-2 receptor antagonist. The association between proton-pump inhibitors and magnesium metabolism was addressed in 14 case-control, cross-sectional studies. An association was found in 11 of them: 6 reports found that the use of proton-pump inhibitors is associated per se with a tendency towards hypomagnesemia, 2 found that this tendency is more pronounced in patients concurrently treated with diuretics, carboplatin, or cisplatin, and 2 found a relevant tendency to hypomagnesemia in patients with poor renal function. Finally, findings likely reflecting decreased intestinal magnesium uptake were observed on treatment with proton-pump inhibitors. Three studies did not disclose any relationship between magnesium metabolism and treatment with histamine type-2 receptor antagonists. In conclusion, proton-pump inhibitors may cause hypomagnesemia. In these cases, switching to a histamine type-2 receptor antagonist is advised.

CLINICALAND MYCOLOGICAL PROFILE OF ONYCHOMYCOSIS IN A HILLY STATE OF NORTH - EAST INDIA .

2021 ◽  
pp. 41-43
Author(s):  
Subrata kumar Das ◽  
Saptadipa Das
Keyword(s):  
Epidemiological Data ◽  
Common Species ◽  
Term Treatment ◽  
Predisposing Factor ◽  
Cross Sectional ◽  
Diagnostic Strategies ◽  
North East India ◽  
North East ◽  
Number Of Patients ◽  
Long Term Treatment

Background: Onychomycosis is a chronic fungal infection of nger nails and toe nails. It is a non life threatening condition and requires long-term treatment. Mostly patients seek medical care for cosmetic purpose unless it gets secondarily infected and produce pain. Aims: The aim of this study was to determine the prevalence of various causative agents of onychomycosis and to study the clinical and mycological patterns of onychomycosis . Material and Methods: This was a cross sectional observational study which was carried over a period of one year , from December 2019 to November 2020 . A total of 47 patients were included in the study , who visited Dermatology OPD of SMIMS , Sikkim, India. After clinical evaluation , nail samples were subjected for KOH mount and culture. Results:This study included 47 patients of clinically diagnosed onychomycosis , 30 males and 17 males . In the present study maximum number of patients belonged to the age group 30-40 years with 28 patients . Most of the study subjects , 22 were agricultural worker . We found that trauma to the nails was the commonest predisposing factor 17. Out of 47 patients 33 patients were KOH positive and 21 patients were culture positive. Most common type of onychomycosis was Distal lateral subungual onychomycosis with 2 cases . Most common species identied in our study was T.rubram with 5 patients , followed by T. mentagrophytes with 3 patients. Conclusion: Along dermatophytes , NDM and yeasts were also common aetiological agents of onychomycosis. Since onychomycosis can cause physical , psychological and occupational problems, the clinico-epidemiological data can be helpful in development of preventive and diagnostic strategies.

Lenalidomide in relapsed and refractory multiple myeloma disease: feasibility and benefits of long-term treatment

2014 ◽  
Vol 93 (12) ◽  
pp. 1993-1999 ◽  
Author(s):  
Manola Zago ◽  
Katharina Oehrlein ◽  
Corinna Rendl ◽  
Corinna Hahn-Ast ◽  
Lothar Kanz ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Term Treatment ◽  
Refractory Multiple Myeloma ◽  
Long Term Treatment

Abstract 419: Human ApoB100/CETP Transgenic Mouse is a Useful Animal Model for Evaluation of HDL-C Elevation and Suppression of Atherosclerosis by Peroxisome Proliferator-Activated Receptor Delta Agonist

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Noriyuki Naya ◽  
Keita Fukao ◽  
Akemi Nakamura ◽  
Kohji Nomura ◽  
Seijiro Hara ◽  
...  
Keyword(s):  
Term Treatment ◽  
Serum Lipoprotein ◽  
Peroxisome Proliferator ◽  
Cross Sectional ◽  
Peroxisome Proliferator Activated Receptor ◽  
New Class ◽  
Promising Target ◽  
Long Term Treatment ◽  
Apoe Ko Mice ◽  
Lipoprotein Profiles

PPARδ is one of the transcription factors that regulate lipid metabolism. Recently, PPARδ agonists have been reported to induce the elevation of plasma HDL-C levels in obese mice, rhesus monkeys as well as humans, indicating their potentials as a new class of HDL-C raising agent. In addition, anti-atherosclerotic effects of PPARδ agonists were reported in LDLR-KO and ApoE-KO mice. In these mice, however, the lipoprotein profiles are greatly different from those in humans in terms of the deficiency in CETP and ApoB100, and thus the anti-inflammatory effects were regarded as a main anti-atherosclerotic mechanism of PPARδ agonists. It has been reported that human ApoB100/CETP transgenic (hApoB100/CETP-Tg) mice have similar lipoprotein profiles with humans. In this study, we used hApoB100/CETP-Tg mice placed under a western diet for evaluation of GW501516, one of the most potent and selective PPARδ agonists, in order to investigate the linkage between HDL-C elevation and anti-atherosclerotic potency. For evaluation of plasma HDL-C levels, the hApoB100/CETP-Tg mice were orally treated with GW501516 for 1 week and its potency was compared with fenofibrate, a PPARα agonist used in the clinic. For evaluation of the anti-atherosclerotic effect, the mice were orally treated with GW501516 for 18 weeks and atherosclerosis at the aortic valves was determined by cross-sectional lesion analysis. Serum lipoprotein parameters were periodically monitored and lipoprotein profiles were analyzed by FPLC method. Treatment with GW501516 resulted in significant elevation of plasma HDL-C levels with more potency compared to fenofibrate (24% and 15% elevation at 10mg/kg, respectively). Serum apoA-I was also increased by the similar ratio as HDL-C, and the particle size of HDL was not changed, suggesting that the numbers of HDL particle are increased by GW501516. Long term treatment of GW501516 (3 and 10 mg/kg) resulted in dose-dependent suppression of atherosclerosis (42 and 57% inhibition, respectively) with a strong correlation with HDL-C elevation (p<0.001). By using hApoB100/CETP-Tg mice, PPARδ was confirmed as a promising target of anti-atherosclerotic therapy as a new class of HDL-C raising agent.

scholarly journals Fixed duration vs continuous therapy in multiple myeloma

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 212-222 ◽  
Author(s):  
Heinz Ludwig ◽  
Niklas Zojer
Keyword(s):  
Young Patients ◽  
Progression Free Survival ◽  
Term Treatment ◽  
New Drugs ◽  
Prolonged Treatment ◽  
Severe Toxicity ◽  
Fixed Duration ◽  
Continuous Therapy ◽  
Long Term Treatment ◽  
Risk Patients

Abstract The introduction of new drugs with less severe toxicity profiles than those of conventional antimyeloma agents allowed the evaluation of continuous therapy compared with fixed duration therapy. In transplant-eligible patients, consolidation therapy with bortezomib or bortezomib-based regimens showed significant progression-free survival (PFS) benefit in cytogenetic standard-risk patients and to a lesser extent, high-risk patients. Continuous therapy with lenalidomide maintenance treatment after autologous stem cell transplantation resulted in a significant survival gain. In transplant noneligible patients, continuous lenalidomide-dexamethasone therapy improved survival over fixed duration melphalan-prednisone-thalidomide. The concept of prolonged treatment in elderly patients is supported by some other studies, but most of them revealed a gain in PFS only. Young patients with unfavorable prognosis show a greater willingness to accept long-term treatment, whereas the readiness to undergo such treatments and the benefits therefrom decline with increasing age and decreasing fitness, rendering fixed duration therapy a suitable option in elderly frail patients.

The role of cross-sectional echocardiography in Kawasaki disease

1991 ◽  
Vol 1 (3) ◽  
pp. 221-224 ◽  
Author(s):  
José A. Ettedgui ◽  
William H. Neches ◽  
Elfriede Pahl
Keyword(s):  
Kawasaki Disease ◽  
Coronary Arteriography ◽  
Term Treatment ◽  
Left Ventricular ◽  
Arterial Stenosis ◽  
Cross Sectional ◽  
Coronary Aneurysms ◽  
Long Term Treatment ◽  
Clear Delineation

SummaryCross-sectional echocardiography is an essential tool in the evaluation ofchildren with Kawasaki disease, both in the acute and chronic stages. In the acute phase of the illness, it is valuable for diagnosis and management of pancarditis and for the long-term monitoring of pericardial effusions, left ventricular function, and the rare cases of chronic valvar dysfunction. When coronary arterial abnormalities are detected, echocardiography can serially evaluate long-term treatment with drugs which prevent the aggregation of platelets and monitor the resolution of coronary aneurysms. The value of cross-sectional echocardiography, nonetheless, is very limited in the detection of coronary arterial stenosis. Coronary arteriography is still important for the diagnosis of obstructive lesions in the coronary arteries and should be used in conjunction with cross-sectional echocardiography for the appropriate long- term management of children with Kawasaki disease at high risk of developing coronary arterial stenosis. Perhaps, in the future, high resolution transesophageal echocardiography will allow clear delineation of coronary arterial anatomy and specifically stenosis, but its role in the evaluation and management of children with Kawasaki disease remains to be explored.

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