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Ropinirole, bromocriptine, and piribedil are associated with the highest incidence rates of adverse effects in Parkinson's disease, according to a review published online Sept. 4 in CNS Neuroscience & Therapeutics. Bao-Dong Li, from the Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine in China, and colleagues conducted a systematic review to compare the adverse effects of 11 drugs used to treat Parkinson's disease. Data were included from 24 randomized controlled trials. The researchers found that, compared with placebo, the incidence of adverse reactions of ropinirole, rotigotine, entacapone, and sumanirole were higher in terms of nausea. The incidence rates of dyskinesia side effects were highest with ropinirole, while in terms of patients' hallucination, pramipexole was significantly higher. The surface under the cumulative ranking curve values of all drugs showed that the incidence of adverse reaction of pergolide was relatively high (nausea, 83.5 percent; hallucination, 79.8 percent); the incidence of dyskinesia and somnolence was higher with ropinirole (80.5 and 69.4 percent); in terms of dizziness, the incidence of adverse reaction of piribedil was higher (67.0 percent), and in terms of constipation, the incidence of bromocriptine was relatively high (62.3 percent). "In addition to current forms of treatment, we hope that our results can produce useful information for further development of new drugs to treat Parkinson's disease based on the natures of each drug," the authors write.

For patients with stage 4 or 5 chronic kidney disease and hepatitis C virus (HCV) infection, 12 weeks of treatment with glecaprevir and pibrentasvir results in a high rate of sustained virologic response, according to a study published online Oct. 11 in the New England Journal of Medicine. Edward Gane, M.D., from Auckland City Hospital in New Zealand, and colleagues conducted a multicenter trial to examine the efficacy and safety of combination treatment with the NS3/4A protease inhibitor glecaprevir and the NS5A inhibitor pibrentasvir for 12 weeks in adults with HCV infection and compensated liver disease with severe renal impairment, dependence on dialysis, or both. Participants had stage 4 or 5 chronic kidney disease. One hundred four patients were enrolled in the trial. The researchers found that the sustained virologic response rate was 98 percent. During treatment, none of the patients had virologic failure, and none had a virologic relapse after the end of treatment. Pruritus, fatigue, and nausea were reported in at least 10 percent of the patients. Twenty-four percent of the patients reported serious adverse events. Because of adverse events, four patients discontinued the trial treatment prematurely; three of these had sustained virologic response

For patients with acute coronary syndromes (ACS), diabetes mellitus (DM), but not pre-DM, is associated with an increased risk of major adverse cardiac events (MACE), according to a study published online Oct. 18 in the Journal of the American College of Cardiology. Serdar Farhan, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined the impact of pre-DM on coronary plaque characteristics and ischemic outcome in patients with ACS. Participants underwent quantitative coronary angiography, grayscale intravascular ultrasound (IVUS), and radiofrequency IVUS after successful percutaneous coronary intervention. Patients were categorized based on their glucometabolic status as normal glucose metabolism (NGM; 162 patients), pre-DM (202 patients), and DM (183 patients). The researchers found that there were no significant between-group differences with respect to IVUS findings indicative of vulnerable plaques. Compared to patients with pre-DM or NGM, patients with DM had a higher crude rate of MACE (25.9 versus 16.3 and 16.1 percent; P = 0.03 and 0.02, respectively). Using NGM as the reference group, DM, but not pre-DM, was correlated with increased risk of MACE in an adjusted model (hazard ratios, 2.2 [95 percent confidence interval, 1.25 to 3.86; P = 0.006] and 1.29 [95 percent confidence interval, 0.71 to 2.33; P = 0.41]).

Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online Oct. 23 in the Annals of Internal Medicine. Paul R. Conlin, M.D., from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus. The authors provided updates on management within seven areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice," the authors write.