Prevention of Cirrhosis Complications: Looking for Potential Disease Modifying Agents

The current therapeutic strategies for the management of patients with cirrhosis rely on the prevention or treatment of specific complications. The removal of the causative agents (i.e., viruses or alcohol) prevents decompensation in the vast majority of patients with compensated cirrhosis. In contrast, even when etiological treatment has been effective, a significant proportion of patients with decompensated cirrhosis remains at risk of further disease progression. Therefore, therapies targeting specific key points in the complex pathophysiological cascade of decompensated cirrhosis could represent a new approach for the management of these severely ill patients. Some of the interventions currently employed for treating or preventing specific complications of cirrhosis or used in other diseases (i.e., poorly absorbable oral antibiotics, statins, albumin) have been proposed as potential disease-modifying agents in cirrhosis (DMAC) since clinical studies have shown their capacity of improving survival. Additional multicenter, large randomized clinical trials are awaited to confirm these promising results. Finally, new drugs able to antagonize key pathophysiological mechanisms are under pre-clinical development or at the initial stages of clinical assessment.

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Management of Optic Neuritis in Canada: Survey of Ophthalmologists and Neurologists

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s031716710000860x ◽

2008 ◽

Vol 35 (2) ◽

pp. 179-184 ◽

Cited By ~ 7

Author(s):

Edward J. Atkins ◽

Carolyn D. Drews-Botsch ◽

Nancy J. Newman ◽

Olivier Calvetti ◽

Seegar Swanson ◽

...

Keyword(s):

Clinical Trials ◽

Optic Neuritis ◽

Randomized Clinical Trials ◽

Mail Survey ◽

Standard Of Care ◽

High Dose ◽

Acute Optic Neuritis ◽

Disease Modifying ◽

Disease Modifying Agents ◽

The Impact

ABSTRACTBackground:Acute isolated optic neuritis is often the first manifestation of multiple sclerosis (MS), and its management remains controversial. Over the past decade, with the advent of new disease-modifying agents, management of isolated optic neuritis has become more complicated.Objectives:To evaluate the current practice patterns of Canadian ophthalmologists and neurologists in the management of acute optic neuritis, and to evaluate the impact of recently published randomized clinical trials.Design:Mail survey.Methods:All practicing ophthalmologists and neurologists in Canada were mailed a survey evaluating the management of isolated acute optic neuritis and familiarity with recent clinical trials. Surveys for 1158 were mailed, and completed surveys were collected anonymously through a datafax system. Second and third mailings were sent to non-respondents 6 and 12 weeks later.Results:The final response rate was 34.5%. Although many acute optic neuritis patients initially present to ophthalmologists, neurologists are the physicians primarily managing these patients. Ordering magnetic resonance imaging, and treating with high dose intravenous steroids has become the standard of care. However, 15% of physicians (14% of ophthalmologists and 16% of neurologists) continue to prescribe low dose oral steroids, and steroids are being given for reasons other than to shorten the duration of visual symptoms by 73% of ophthalmologists and 50% of neurologists. More neurologists than ophthalmologists are familiar with recent clinical trials involving disease-modifying agents.Conclusion:Although the management of acute optic neuritis has been evaluated in large clinical trials that were published in major international journals, some ophthalmologists and neurologists are not following evidence-based recommendations.

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The use of antimalarials in combination with other disease modifying agents in rheumatoid arthritis–the French Experience

Lupus ◽

10.1177/0961203396005001111 ◽

1996 ◽

Vol 5 (1_suppl) ◽

pp. 45-49 ◽

Cited By ~ 1

Author(s):

A Kahan ◽

C-J Menkès

Keyword(s):

Rheumatoid Arthritis ◽

Combination Therapy ◽

Excess Mortality ◽

Severe Disease ◽

Significant Proportion ◽

Triple Combination ◽

Triple Combination Therapy ◽

French Experience ◽

Disease Modifying ◽

Disease Modifying Agents

A significant proportion of patients with rheumatoid arthritis have an aggressive, severe disease that may contribute to excess mortality. It has been suggested that early, aggressive therapy might improve the prognosis of these patients with active, severe rheumatoid arthritis. Combinations of disease modifying anti-rheumatic drugs including antimalarials are increasingly used in patients with active disease. While several open trials showed encouraging results, some controlled studies gave less support for the use of combination therapy. Ongoing controlled trials of double or triple combination therapy, such as hydroxychloroquine, methotrexate and sulphasalazine, should help define its place in treating patients with rheumatoid arthritis.

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