Current medical research and opinion
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Comparative Study Clinical Trial
Post-thymectomy combined treatment of prednisone and tacrolimus versus prednisone alone for consolidation of complete stable remission in patients with myasthenia gravis: a non-randomized, non-controlled study.
Thymectomy is a standard treatment of myasthenia gravis (MG). Immunomodulating agents are frequently given during the post-thymectomy latency period until complete remission is fully consolidated. ⋯ Post-thymectomy administration of tacrolimus combined with prednisone was more effective than prednisone alone for the consolidation of CSR in a substantially shorter period of time in patients with MG.
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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.
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Duloxetine is a serotonergic noradrenergic reuptake inhibitor with demonstrated efficacy in each of three independent studies for treatment of adults with generalized anxiety disorder (GAD). A pooled dataset from all completed trials is provided here to show the most likely clinical outcomes associated with duloxetine treatment for GAD. ⋯ In this sample of more than 1100 patients, duloxetine was efficacious for reducing anxiety severity and for increasing patients' overall role functioning in GAD.
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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 examine whether nebulized budesonide inhalation suspension treatment reduces asthma-related emergency department visit/hospitalization recurrence risk in children compared with other asthma medications, particularly non-nebulized inhaled corticosteroids. ⋯ For children aged < or = 8 years, budesonide inhalation suspension treatment after an asthma-related emergency department visit/hospitalization was associated with a significantly reduced risk of recurrence compared with other asthma medications and with non-nebulized inhaled corticosteroids. Because this was an observational study, results should be interpreted cautiously. However, this study allowed evaluation of treatment in real-world practice settings not often included in clinical trials.