scholarly journals Prognostic value of serum erythropoietin in the correction of anemia using recombinant erythropoietin drugs in patients with lymphoproliferative diseases

2012 ◽  
Vol 93 (4) ◽  
pp. 584-590 ◽  
Author(s):  
N A Romanenko ◽  
M V Berkos ◽  
S S Bessmeltsev ◽  
N A Potikhonova ◽  
K M Abdulkadyrov
Keyword(s):  
Positive Response ◽  
Hemoglobin Level ◽  
Response To Treatment ◽  
Control Group ◽  
Recombinant Erythropoietin ◽  
Epoetin Alfa ◽  
Lymphoproliferative Diseases ◽  
Endogenous Erythropoietin ◽  
Serum Erythropoietin ◽  
Erythropoietin Level

Aim. To evaluate the prognostic significance of the baseline content of endogenous erythropoietin in the blood serum of patients with lymphoproliferative diseases while using recombinant erythropoietin drugs to correct the anemia. Methods. 69 patients with lymphoproliferative disorders (chronic lymphocytic leukemia, indolent forms of non-Hodgkins lymphoma and multiple myeloma) in combination with anemia, ages from 24 to 81 years, were under our observation. Treatment with recombinant erythropoietin was performed in the first group (48 patients), the second (control) group consisted of 21 patients without treatment with recombinant erythropoietin. In all patients the hemoglobin concentration was reduced to 37-100 g/l. Results. A positive response to treatment with recombinant erythropoietin for 6-16 weeks was noted in 30 out of 48 patients treated with epoetin alfa (62.5%, p 0.05). The monthly increase in hemoglobin level was 19.1±14.4 g/l, while in patients who were not responding to therapy - 2.1±4.3 g/l. In the control group of patients not receiving recombinant erythropoietin drugs the monthly increase in hemoglobin level was 2.0±4.4 g/l, which is the same as in the group who did not respond to recombinant erythropoietin and is significantly lower (p 0.01), than in patients with a positive response. In the control group, the increase in hemoglobin level 20 g/l during 20 weeks was observed only in 5 of 21 (23.4%) patients. A reduced level of endogenous erythropoietin was detected in 28 (58.3%) patients, while increased and correlating with the severity of anemia was detected in 20 (41.7%) patients. An inverse correlation was established between the positive response to treatment with recombinant erythropoietin and the baseline endogenous erythropoietin (r=-0.36, n=48, p 0,05). The positive effect of epoetin alfa was observed more frequently in patients with low serum erythropoietin level [22 of 28 (78.6%) patients responded, p 0.01], than in patients with high erythropoietin level [only 8 out of 20 (40%) patients responded to treatment, p 0.05]. Conclusion. Low concentration of endogenous erythropoietin suggests a positive response to recombinant erythropoietin products and can therefore be used as one of the predictors of response; in cases of high (above 500 mIU/ml) levels of endogenous erythropoietin the response occurs very rarely; an intermediate level of erythropoietin (130-500 mIU/ml) may also be justified for the administration of recombinant erythropoietin.

Erythroid response (ER) rates in myelodysplastic syndromes (MDS) patients treated with epoetin alfa (EPO): A meta-analysis using the International Working Group criteria (IWGc) for MDS response

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6572-6572
Author(s):  
V. Moyo ◽  
P. Lefebvre ◽  
M. S. Duh ◽  
A. Bourezak ◽  
B. Yektashenas ◽  
...  
Keyword(s):  
Data Extraction ◽  
Meta Analysis ◽  
Refractory Anemia ◽  
Regression Analyses ◽  
Epoetin Alfa ◽  
Erythroid Response ◽  
Serum Erythropoietin Level ◽  
Study Characteristics ◽  
Serum Erythropoietin ◽  
Erythropoietin Level

6572 Background: Refractory anemia is a clinical hallmark of MDS. The most consistently used therapy for this anemia is EPO. Prior to the introduction of IWGc in 1997, ER rates varied substantially between studies. The present meta-analysis was undertaken to compare ER rates in studies of EPO-treated patients in MDS when defined by either IWGc or non-IWGc. Methods: A systematic review and data extraction of studies published from 1990–2005 in MDS patients treated with EPO was performed and yielded 21 studies evaluating a total of 895 patients. Pooled estimates of ER rates, stratified by IWGc, were calculated using random-effects meta-analysis methods, which incorporated both between- and within-study variations. Univariate meta-regression analyses were conducted to identify study characteristics that were significant determinants of ER rate. Results: Ten studies (604 patients) used the IWGc to define ER (overall, major, minor), while 11 studies (291 patients) used other definitions. Mean age for all patients was 70.6 years; 45% women. Mean baseline (BL) serum erythropoietin level and proportion of patients with refractory anemia or refractory anemia with ringed sideroblasts were comparable between studies; however, the proportion of transfusion-dependent patients at BL was lower in the IWG studies vs the non-IWG studies (36% vs. 84%, respectively, p<.001). The pooled estimate of ER rate was significantly higher for the IWG studies compared to the non-IWG studies (50.5%, 95% CI: 38.6%-62.3% vs. 27.8%, 95% CI: 22.7%-32.8% respectively, p=.002). Among patients in the IWG studies who achieved an ER, 62% (188/305) achieved a major ER. Studies reporting mean BL serum erythropoietin level <400mU/mL, <65% of patients transfusion-dependent at BL and use of subcutaneous EPO were found to be associated with higher ER rates. Conclusions: This meta-analysis of MDS patients treated with EPO demonstrates significantly higher ER rates in studies utilizing IWGc. These findings may be due to more refined definitions of ER and MDS diagnostic criteria as well as improvement in the management of anemia. [Table: see text]

scholarly journals Efficacy of erythropoiesis-stimulating agents and their effect on quality of life in anemic patients with lymphoproliferative diseases

2013 ◽  
Vol 94 (4) ◽  
pp. 468-473
Author(s):  
N A Romanenko ◽  
S S Bessmeltsev ◽  
I I Karmatskaya ◽  
N A Potikhonova ◽  
K M Abdulkadyrov
Keyword(s):  
Quality Of Life ◽  
Hemoglobin Level ◽  
Lymphocytic Leukemia ◽  
Control Group ◽  
Lymphoproliferative Diseases ◽  
Erythropoiesis Stimulating Agents ◽  
Number Of Patients ◽  
Positive Treatment ◽  
Assess Quality

Aim. To study the effect of different erythropoiesis-stimulating agents and to assess their influence on quality of life in anemic patients with lymphoproliferative diseases. Methods. The study included 137 patients with lymphoproliferative diseases (Burkitt’s lymphoma, B-cell chronic lymphocytic leukemia, multiple myeloma) and anemia, who were distributed to 2 groups. The first group consisted of 90 patients who received chemotherapy and erythropoiesis-stimulating agents [epoetinum alpha 40 000 IU once a week (n=41) or epoetinum beta 30 000 IU once a week (n=27) or darbaepoetinum alpha 500 μg once every third week (n=22)]. The treatment duration varied from 4 to 20 weeks (mean 9.3±4.1 weeks). The second (control) group included 47 patients with comparable baseline clinical and hematological characteristics receiving only chemotherapy. Patients were estimated as treatment responders if there was an increase of hemoglobin level by 20 g/L or hemoglobin level reached at least 110 g/L. All patients were administered FACT-An (Functional Assessment of Cancer Therapy, Anemia scale) questionnaire to assess quality of life. Results. In patients receiving erythropoiesis-stimulating agents the positive treatment response was more frequent compared to the control group (68.9 и 29.8% correspondingly). The number of patients requiring erythrocytes transfusion decreased from 29 to 10 (34.5%) in the first group and from 14 to 8 (57.1%) in the control group. There was no significant differences found in comparing different erythropoiesis-stimulating agents. The positive response was observed in 68.3% of patients treated with epoetinum alpha, 70.1% - epoetinum beta, 68.2% - darbaepoetinum alpha. The significant increase in quality of life measured by FACT-An was observed in erythropoiesis-stimulating agents responders. Conclusion. The administration of erythropoiesis-stimulating agents in patients with lymphoproliferative diseases and anemia is an effective way of controlling anemia, significantly reducing the need for erythrocytes transfusion and improving quality of life.

Perbandingan Efek Suplementasi Tablet Tambah Darah Dengan Dan Tanpa Vitamin C Terhadap Kadar Hemoglobin Pada Ibu Hamil Dengan Usiakehamilan 16-32 Minggu Di Desa Keniten Kecamatan Mojo Kabupaten Kediri

2017 ◽  
Vol 3 (1) ◽  
pp. 76
Author(s):  
Siti Asiyah ◽  
Dwi Estuning Rahayu ◽  
Wiranti Dwi Novita Isnaeni
Keyword(s):  
Treatment Group ◽  
Vitamin C ◽  
Gestational Age ◽  
Group Treatment ◽  
Sampling Technique ◽  
Hemoglobin Level ◽  
The Body ◽  
Control Group ◽  
Fetal Organ ◽  
And Control

The needed of Iron Tablet in pregnancy was increase than mother who not pregnant.  That  cause of  high metabolism at the pregnancy for formed of  fetal organ and energy. One of effort for prevent anemia in mother pregnant with giving the Iron tablet and vitamin c. The reason of  this research in 4 June – 11 July 2014 is for compare the effect of  iron tablet suplementation with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks In Desa Keniten Kecamatan Mojo Kabupaten Kediri. This research method using comparative analytical.  Research design type of Quasy Eksperiment that have treatment group and control group. Treatment group will giving by Iron tablet and 100 mg vitamin C, and control group just giving by iron tablet during 21 days. Population in this research are all of mother pregnant with Gestational Age Of 16-32 Weeks with Sampling technique is  cluster random sampling is 29 mother pregnant. Comparison analysis of  iron tablet suplementation effect with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks, data analysis using Mann Whitney U-test and the calculated U value (44,5) less than U-table (51). So there was difference of iron tablet suplementation effect with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks Therefore, the addition of vitamin C on iron intake is needed to increase the uptake of iron tablets. When the amount of iron uptake increases, the reserves of iron in the body will also increase, so as to prevent anemia in pregnant women; Keywords : Iron Tablet (Fe), Vitamin C, Hemoglobin level, Mother Pregnant

scholarly journals Effects of Dietary Inclusion of Dry Hydrastis canadensis on Laying Performance, Egg Quality, Serum Biochemical Parameters and Cecal Microbiota in Laying Hens

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1381
Author(s):  
Tzuen-Rong J Tzeng ◽  
Tzu-Yu Liu ◽  
Chiao-Wei Lin ◽  
Pei-En Chang ◽  
Pei-Xin Liao ◽  
...  
Keyword(s):  
Biochemical Parameters ◽  
Egg Production ◽  
Laying Hens ◽  
Basal Diet ◽  
Response To Treatment ◽  
Control Group ◽  
Hydrastis Canadensis ◽  
Laying Performance ◽  
Cecal Microbiota ◽  
Dietary Treatments

Alternative growth promoters are able to not only effectively replace the traditional use of antibiotics but also provide additional health benefits for livestock and reduce food safety concerns. This study investigated the effects of dry Hydrastis canadensis on the laying performance and fecal microbial community of laying hens. Twenty-four Lohmann (LSL, white layer strain) hens were reared from 40 to 48 weeks of age and randomly allotted to four dietary treatments (six birds/treatment). The dietary treatments comprised a basal diet with no treatment as control, a basal diet plus 0.6% powder of dry Hydrastis canadensis roots (R) or leaves (L), and a basal diet plus 0.6% powder of a mixture of dry Hydrastis canadensis roots and leaves (1:1, LR). No mortality was observed in the whole experimental period. The results indicated that albumen height in the LR group was significantly greater than that in the control group. The diet supplemented with Hydrastis canadensis had no significant effects on egg production rate, egg weight, eggshell strength, eggshell thickness, Haugh unit, or yolk height during the whole experimental phase. However, principal coordinate analysis, comparative heat map analysis, and cluster dendrogram analysis of cecal microbiota showed distinct clusters among the groups treated with Hydrastis canadensis and the control group. Regarding blood biochemical parameters, serum cholesterol levels were significantly lower in all Hydrastis canadensis-treated groups compared with those in the control group. Moreover, serum low-density lipoprotein levels were lower in hens supplemented with the leaf of Hydrastis canadensis. The abundances of the phyla Fusobacteria and Kiritimatiellaeota were increased (p < 0.05) in laying hens fed with 0.6% Hydrastis canadensis leaves, whereas the abundance of the phylum Firmicutes in cecum digesta decreased in response to treatment with Hydrastis canadensis roots and leaves. The relative abundance of the Fusobacterium genus was higher in the LR group compared with that in the control. On the contrary, we found a different trend in the Synergistes genus. The potential influences of these microbiota on the performance of laying hens were discussed. The results demonstrate that Hydrastis canadensis can improve the egg albumen height and modulate the cecum digesta microbiota composition of laying hens.

scholarly journals PIM2 and NF-κβ gene expression in a sample of AML and ALL Egyptian patients and its relevance to response to treatment

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shymaa Kamal El Din Abed El Rahman ◽  
Sanaa Sayed Abd Elshafy ◽  
Mohamed Samra ◽  
Hala Mohammed Ali ◽  
Rabab Afifi Mohamed
Keyword(s):  
Overall Survival ◽  
Acute Leukemia ◽  
De Novo ◽  
Lymphoblastic Leukemia ◽  
Expression Level ◽  
Response To Treatment ◽  
Control Group ◽  
Poor Overall Survival ◽  
Healthy Control ◽  
Complete Blood Counts

Abstract Background The relation between PIM2 and the transcriptional factor NF κβ have been controversial in literature. The significance of PIM2 and NF-κβ genes expression on the incidence of acute leukemia (AML and ALL) and its relevance to the response rate was evaluated. Sixty de novo acute leukemia patients were stratified in 2 groups: 30 acute myeloid leukemia (AML) and 30 acute lymphoblastic leukemia (ALL) patients and compared to 30 sex- and age-matched controls. The expression level of PIM2 and NF κβ genes was measured using quantitative real-time polymerase chain reaction (QRT-PCR). The patients were followed with clinical examination and complete blood counts. Results The expression level of PIM2 gene was significantly higher in AML patients (P<0.001) compared to the control group. The mean expression level of NF κβ gene was significantly high in AML and ALL patients compared to the healthy control group (P=0.037 and P<0.001; respectively). The overall survival in AML patients was higher in NF κβ gene low expressers compared to high expressers (P=0.047). The number of AML patients who achieved complete remission was significantly higher in PIM2 gene low expressers in comparison to PIM2 gene high expressers (P=0.042). Conclusion PIM2 and NF κβ genes might have a role in the pathogenesis of acute leukemia, poor overall survival, and failure of response to induction therapy.

A NEW APPROACH FOR INVESTIGATING HYPOTHALAMO-PITUITARY-GONADAL AND ADRENAL FEEDBACK CONTROL MECHANISMS: ACTIVE IMMUNIZATION WITH STEROIDS

1974 ◽  
Vol 76 (3) ◽  
pp. 556-569 ◽  
Author(s):  
E. Nieschlag ◽  
K. H. Usadel ◽  
H. K. Kley ◽  
U. Schwedes ◽  
K. Schöffling ◽  
...  
Keyword(s):  
Feedback Control ◽  
Leydig Cells ◽  
Positive Response ◽  
Active Immunization ◽  
Biologically Active ◽  
Control Group ◽  
Control Mechanisms ◽  
New Approach ◽  
Biological Neutralization ◽  
Group Serum

ABSTRACT A new method for the investigation of hypothalamo-pituitary-gonadal and adrenal feedback control mechanisms based on the biological neutralization of gonadal and adrenal steroids by active immunization is proposed. The regulatory influence of a given steroid in the feedback control is proved when reduction of the free, biologically active fraction of this steroid caused by antibody binding induces a positive response of the pituitary, thus effecting gonadal or adrenal hypertrophy and hyperfunction. The advantages and limitations of the new model are demonstrated by the effects of active immunization of rabbits with cortisol (F), aldosterone (Aldo), dehydroepiandrosterone (DHA), androstenedione (Δ4-A), testosterone (T), 5α-dihydrotestosterone (5α-DHT), 5β-DHT and oestradiol (E2). In the immunized animals and in a control group serum concentrations of total corticosteroids (TC), DHA, T, Δ4-A, E1, E2, LH and FSH, the percentage of binding of steroids in serum and the specificity of the antisera are determined. The testes are evaluated by histometry and the nuclear volume of the adrenocortical and Leydig cells is measured.

Efficacy of gefitinib combined with bevacizumab versus gefitinib in advanced EGFR L858R NSCLC.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21185-e21185
Author(s):  
Xinmin Zhao ◽  
Xianghua Wu ◽  
Huijie Wang ◽  
Hui Yu ◽  
Si Sun ◽  
...  
Keyword(s):  
Liquid Biopsy ◽  
Therapeutic Option ◽  
Objective Response ◽  
Acquired Resistance ◽  
Response To Treatment ◽  
Control Group ◽  
Special Cases ◽  
Significant Difference ◽  
Experimental Group ◽  
Egfr Tkis

e21185 Background: 60-80% of EGFR+ NSCLC could benefit from the treatment of EGFR TKIs. However, as a result of acquired resistance, median progression-free survival (PFS) associated with EGFR-TKIs monotherapy was rarely longer than 11 months. Vascular endothelial growth factor (VEGF) and its receptor (VEGFR) play an important role in the angiogenesis and progression of NSCLC. The combination of EGFR-TKIs and anti-vascular drugs that inhibit the EGFR and VEGF/VEGFR pathways may be a potential therapeutic option for EGFR-mutant NSCLC. The purpose of our study was to evaluate whether gefitinib combined with bevacizumab is associated with an increased PFS benefit compared with gefitinib alone. Methods: This study is a randomized, open-controlled, single-center study. A total of 43 advanced non-squamous NSCLC patients with EGFR L858R mutations were enrolled, including 24 in the experimental group and 19 in the control group. The experimental group received gefitinib combined with bevacizumab (gefitinib 250 mg, QD+bevacizumab 7.5 mg/kg, Q3W), and the control group received gefitinib monotherapy (250 mg, QD). Response to treatment was evaluated after one month of the treatment, followed by once every two months, and adverse events were graded. The primary endpoint was PFS, and secondary endpoints included objective response rate (ORR), disease control rate (DCR), duration of response (DOR), overall survival (OS), and safety and tolerability evaluation. Samples at baseline (tissue or liquid biopsy), 43 days after treatment (liquid biopsy), and disease progression were subjected to genomic (139-gene NGS panel) profiling. Results: As of December 31, 2020, 22 patients were evaluable (12 for experimental group, 10 for control group). The ORR of the experimental group and the control group were 42% vs 60%, respectively, with no significant difference (experimental group: CR = 0, PR = 5, SD = 7, PD = 0; control group: CR = 0, PR = 6, SD = 4, PD = 0). Main adverse reactions included skin rash (n = 16), diarrhea (n = 24), hypertension (n = 2), proteinuria (n = 1). Other special cases developed fever, nausea and vomiting, elevated platelets, conjunctivitis, back pain, which were manageable. 36 patients with baseline liquid biopsy samples can be evaluated (33 plasma and 3 pleural fluid samples). Of these, EGFR L858R were detectable in 86% (n = 31) of patients. The most common co-mutated gene was TP53 (57%), followed by DNMT3A (49%) and TET2 (17%). Mutation profiles were comparable between the two groups. Conclusions: Compared to gefitinib monotherapy, gefitinib combined with bevacizumab in the treatment of non-squamous NSCLC with EGFR L858R showed similar efficacy and safety profiles.

scholarly journals Saphenous Vein Graft Disease Is Associated with a Low Serum Erythropoietin Level

2015 ◽  
Vol 24 (6) ◽  
pp. 544-547 ◽  
Author(s):  
Ibrahim Kocaoglu ◽  
Ugur Arslan ◽  
Yavuzer Koza ◽  
Mustafa M�cahit Balci ◽  
Gizem �elik ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Vein Graft Disease ◽  
Serum Erythropoietin Level ◽  
Graft Disease ◽  
Serum Erythropoietin ◽  
Saphenous Vein Graft Disease ◽  
Erythropoietin Level ◽  
Low Serum

scholarly journals A Prognostic Marker in Idiopathic Sudden Sensorineural Hearing Loss: Serum Calprotectin

2020 ◽  
Vol 13 (1) ◽  
pp. 36-40
Author(s):  
İhsan Kuzucu ◽  
Tuba Çandar ◽  
Deniz Baklacı ◽  
İsmail Güler ◽  
Rauf Oğuzhan Kum ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Response To Treatment ◽  
Control Group ◽  
Study Group ◽  
Cross Sectional ◽  
Historical Cohort ◽  
The Relationship

Objectives. Calprotectin, a protein released by neutrophils, has been used in many studies as a biomarker showing the presence of inflammation. In this study, it was aimed to investigate the relationship between serum calprotectin level and response to the treatment of idiopathic sudden sensorineural hearing loss (ISSHL).Methods. The present study is a prospective, cross-sectional historical cohort study. The study group consisted of 44 patients with ISSHL, and the control group consisted of 41 healthy volunteers without ear pathology. At the same time, patients in the study group were divided into three groups according to the response to ISSHL treatment (recovered, partially recovered, unrecovered). The relationship between the groups was statistically evaluated in terms of serum calprotectin levels.Results. The mean serum calprotectin value was 75.67±19.48 ng/mL in the study group and 50.24±29.14 ng/mL in the control group (<i>P</i>=0.001). Serum calprotectin value according to the severity of hearing loss in the mild, moderate and severe was 66.20±8.82, 70.35±16.77, and 91.23±19.73 ng/mL, respectively. Serum calprotectin value in the severe group was significantly higher compared to the moderate and mild groups (<i>P</i>=0.004, <i>P</i>=0.001, respectively). Serum calprotectin value according to the treatment response in the recovered, partially recovered and unrecovered groups was 63.36±11.54, 80.17±12.06, and 85.33±22.33 ng/mL, respectively. Serum calprotectin value in the recovered group was significantly lower compared to the partially recovered and unrecovered groups (<i>P</i>=0.002, <i>P</i>=0.001, respectively).Conclusion. Serum calprotectin value informs the clinician about both the severity of hearing loss and the response to treatment. Hence, serum calprotectin can be used as an important biomarker in ISSHL patients for the determination of the prognosis of disease.

scholarly journals An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

2017 ◽  
Vol 5 (1) ◽  
pp. 1-468 ◽  
Author(s):  
Chris Salisbury ◽  
Alicia O’Cathain ◽  
Clare Thomas ◽  
Louisa Edwards ◽  
Alan A Montgomery ◽  
...  
Keyword(s):  
Retention Rate ◽  
Intervention Group ◽  
Research Programme ◽  
Response To Treatment ◽  
Self Management ◽  
Control Group ◽  
Controlled Trials ◽  
Cvd Risk ◽  
Access To Health ◽  
Satisfaction With Treatment

BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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