Current medical research and opinion
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Meta Analysis Comparative Study
The development of new-onset type 2 diabetes associated with choosing a calcium channel blocker compared to a diuretic or beta-blocker.
It has been acknowledged that patients who receive a beta-blocker or diuretic based regimen are at increased risk of developing new-onset diabetes. Recently, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to decrease patients' odds of developing new-onset type 2 diabetes. A number of large placebo-controlled multi-center trials in post-myocardial infarction and heart failure patients have shown the ability of renin-angiotensin-aldosterone system medications to reduce the onset of type 2 diabetes. Pharmacologic data has shown improved insulin sensitivity with ACEIs and ARBs. Controversy persists regarding the influence of calcium channel blockers on the development of new-onset diabetes. ⋯ Calcium channel blockers may be associated with reduced odds of developing new-onset type 2 diabetes compared to diuretics and beta-blockers.
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Randomized Controlled Trial Multicenter Study
Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder.
Duloxetine and escitalopram were compared in an 8-month, randomized, double-blind, placebo-controlled trial in adult outpatients meeting DSM-IV criteria for major depressive disorder (MDD). The results regarding the primary objective of the study (onset of antidepressant action) have been previously published. The current paper focuses on the longer-term (8-month) comparisons of efficacy and safety between duloxetine and escitalopram. ⋯ Throughout the 8-month study, similar improvement was observed for both duloxetine and escitalopram on most efficacy measures with the exception of the sleep subscale of the HAMD(17). Drug differences were identified in safety/tolerability measures.
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Randomized Controlled Trial Multicenter Study
Once-daily sitagliptin, a dipeptidyl peptidase-4 inhibitor, for the treatment of patients with type 2 diabetes.
Sitagliptin, an oral, potent, and selective dipeptidyl peptidase-4 (DPP-4) inhibitor was evaluated as once-daily monotherapy in a 12-week randomized, double-blind, placebo-controlled, parallel group, dose-ranging study. Additionally, the glycemic response to sitagliptin 100 mg daily was evaluated as a once-daily (100 mg once-daily) or twice-daily (50 mg twice-daily) dosing regimen. ⋯ Sitagliptin monotherapy improved indices of glycemic control compared to placebo and was generally well-tolerated in patients with type 2 diabetes. The glycemic response to treatment with sitagliptin 100 mg/day was similar between the sitagliptin 100-mg once-daily and 50-mg twice-daily dose regimens.
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Multiple sclerosis (MS) is a complex, heterogeneous disease. Standard treatment of relapsing MS includes interferon beta (IFNbeta) and glatiramer acetate. These agents reduce relapse rates, and IFNbeta-1a is associated with a slowing of disease progression. Despite treatment, many patients experience disease progression, prompting neurologists to use combination therapies to delay this progression. Agents that may be considered for combination therapy are those with unique mechanisms of action that exert additive or synergistic efficacy. This article reviews combination treatment with immunosuppressive therapies and new agents for the management of MS. ⋯ Combination of standard therapies with immunosuppressive agents or with new therapies may provide synergistic effects that will likely benefit patients with MS. Larger, well-controlled trials need to be conducted.
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To evaluate the effect of triamcinolone acetonide (ITA) on intraocular pressure (IOP) following intravitreal injection, and, in those patients who experience post-injection elevation of IOP, to determine the time course, effect of multiple injections, and risk factors for the pressure rise. ⋯ ITA is frequently associated with a significant elevation in IOP, typically within the first 2-months after injection. Most patients who do not have an elevated IOP after an initial injection will not experience a pressure rise after an additional one. About one-third will require topical glaucoma therapy for IOP control. Patients with OAG may be more difficult to control and require a longer duration of therapy. The inconsistent post-injection follow-up visit intervals among patients in this retrospective review may have affected our results, as some patients with maximum IOP changes may have been missed between office visits. In addition, practice patterns among treating physicians typically differ as to thresholds for the treatment of elevated IOP. A randomized, prospective, controlled trial could better address these issues.