Sacubitril/valsartan in heart failure: latest evidence and place in therapy
Despite significant therapeutic advances, patients with chronic heart failure (HF) remain at high risk for HF progression and death. Sacubitril/valsartan (previously known as LCZ696) is a first-in-class medicine that contains a neprilysin (NEP) inhibitor (sacubitril) and an angiotensin II (Ang-II) receptor blocker (valsartan). NEP is an endopeptidase that metabolizes different vasoactive peptides including natriuretic peptides, bradykinin and Ang-II. In consequence, its inhibition increases mainly the levels of both, natriuretic peptides (promoting diuresis, natriuresis and vasodilatation) and Ang-II whose effects are bloc...
Source: Therapeutic Advances in Chronic Disease - October 18, 2016 Category: Internal Medicine Authors: Kaplinsky, E. Tags: Reviews Source Type: research

Mepolizumab for severe refractory eosinophilic asthma: evidence to date and clinical potential
Severe asthma is characterized by major impairment of quality of life, poor symptom control and frequent exacerbations. Inflammatory, clinical and causative factors identify different phenotypes and endotypes of asthma. In the last few years, new treatment options have allowed for targeted treatments according to the different phenotypes of the disease. To accurately select a specific treatment for each asthmatic variant, the identification of appropriate biomarkers is required. Eosinophilic asthma is a distinct phenotype characterized by thickening of the basement membrane and corticosteroid responsiveness. This review re...
Source: Therapeutic Advances in Chronic Disease - October 18, 2016 Category: Internal Medicine Authors: Menzella, F., Lusuardi, M., Galeone, C., Taddei, S., Facciolongo, N., Zucchi, L. Tags: Reviews Source Type: research

The relationship of management modality in Saudi patients with type 2 diabetes to components of metabolic syndrome, {gamma} glutamyl transferase and highly sensitive C-reactive protein
Background: The aim of this study was to investigate the relationship among management modality, glycemic control, components of metabolic syndrome (MS) and serum levels of glutamyl transferase (GGT) and C-reactive protein (CRP) in patients with type 2 diabetes (T2DM). Methods: Patients with T2DM, not suffering from diabetes complications, were recruited from outpatients clinics at two hospitals in Jeddah. Anthropometric measurements and blood pressure (BP) were taken. A treatment plan was recorded. Fasting blood samples were obtained to measure glucose, glycated hemoglobin (HbA1c), lipids profile, highly sensitive (hs)-C...
Source: Therapeutic Advances in Chronic Disease - August 15, 2016 Category: Internal Medicine Authors: Bahijri, S. M., Ahmed, M., Al-Shali, K., Bokhari, S., Alhozali, A., Borai, A., Gusti, A., Ajabnoor, G., Alghamdi, A., Asiri, M., Tuomilehto, J. Tags: Original Research Source Type: research

Antipsychotic use in dementia: a systematic review of benefits and risks from meta-analyses
Conclusions: Antipsychotics have demonstrated modest efficacy in treating psychosis, aggression and agitation in individuals with dementia. Their use in individuals with dementia is often limited by their adverse effect profile. The use of antipsychotics should be reserved for severe symptoms that have failed to respond adequately to nonpharmacological management strategies. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - August 15, 2016 Category: Internal Medicine Authors: Tampi, R. R., Tampi, D. J., Balachandran, S., Srinivasan, S. Tags: Original Research Source Type: research

Prescribing attitudes, behaviors and opinions regarding metformin for patients with diabetes: a focus group study
Conclusions: Provider attitudes, behaviors and opinions regarding the use of metformin for T2DM reveals the need for further education to improve appropriate use of metformin. Educational interventions should target prescribing behaviors and opinions identified to be inconsistent with the evidence. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - August 15, 2016 Category: Internal Medicine Authors: Trinkley, K. E., Malone, D. C., Nelson, J. A., Saseen, J. J. Tags: Original Research Source Type: research

Ustekinumab in Crohns disease: evidence to date and place in therapy
Crohn’s disease (CD) is an inflammatory bowel disease (IBD) with uncertain etiology. Biologic agents have revolutionized the treatment of CD but nonresponders remain a challenge. Ustekinumab is an interleukin 12/23p40 inhibitor that was recently found effective in treating CD. We reviewed the current literature regarding the efficacy of ustekinumab in treating CD and concluded that ustekinumab is a novel, promising and relatively safe agent for the treatment of moderate to severe CD. Additional data from randomized controlled studies and real-life cohorts are pending. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - July 5, 2016 Category: Internal Medicine Authors: Engel, T., Kopylov, U. Tags: Reviews Source Type: research

Dimethyl fumarate in multiple sclerosis: latest developments, evidence and place in therapy
Dimethyl fumarate (DMF) is one of the newer additions to the armamentarium of potent immunomodulators for the treatment of relapsing-remitting multiple sclerosis (RRMS). After more than 2 years of real-world experience and more than 190,000 patients currently treated with DMF worldwide, it is a good timepoint to review the experience gathered so far and to re-evaluate the potential of this first-line oral multiple sclerosis (MS) drug. Post-hoc analyses of clinical and magnetic resonance imaging (MRI) data, some comprising more than 6 years of drug exposure including patients from the clinical trials, and the overall notion...
Source: Therapeutic Advances in Chronic Disease - July 5, 2016 Category: Internal Medicine Authors: Linker, R. A., Haghikia, A. Tags: Reviews Source Type: research

H.P. Acthar Gel (repository corticotropin injection) treatment of patients with multiple sclerosis and diabetes
Conclusion: The majority of patients experienced a timely resolution of their MS relapse with few hyperglycemic adverse events. Although more studies are necessary, these data suggest that Acthar Gel may be a well-tolerated and effective treatment option for patients with diabetes experiencing an MS relapse. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - July 5, 2016 Category: Internal Medicine Authors: Kutz, C. Tags: Original Research Source Type: research

Corrigendum
Nicolas D. Iadarola et al. (2015) Ketamine and other N-methyl-D-aspartate receptor antagonists in the treatment of depression: a perspective review. Ther Adv Chronic Dis 6(3) 97-114. In the legend of Figure 1 (two colours were reversed). The figure is correct but the legend is incorrect and has been corrected below: (Black circles: glutamate; grey circles: glutamine; blue circles: BDNF; blue channel: NMDA receptor complex; maroon channel: AMPA receptor complex; red channel: glial transporter-1/excitatory amino acid transporter 2 (GLT-1/EAAT2); olive channel: system xC-; peach channel: vesicular glutamate transporter; maroo...
Source: Therapeutic Advances in Chronic Disease - May 16, 2016 Category: Internal Medicine Tags: Corrigendum Source Type: research

Current and future treatment options for cystic fibrosis lung disease: latest evidence and clinical implications
Treatment for cystic fibrosis (CF) has conventionally targeted downstream consequences of the defect such as mucus plugging and infection. More recently, significant advances have been made in treating the root cause of the disease, namely a defective CF transmembrane conductance regulator (CFTR) gene. This review summarizes current pulmonary treatment options and highlights advances in research and development of new therapies. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - May 16, 2016 Category: Internal Medicine Authors: Edmondson, C., Davies, J. C. Tags: Review Source Type: research

Patient-reported functioning in major depressive disorder
This study examines the impact of MDD and its treatment on functioning. Methods: From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, we analyzed complete data of 2280 adult outpatients with MDD at entry and exit points of each level of antidepressant treatment and again 12 months post treatment. Functioning was measured using the Work and Social Adjustment Scale (WSAS). Results: The results show that only 7% of patients with MDD reported within-normal functioning before treatment. The proportion of patients achieving within-normal functioning (WSAS) scores significantly increased after treatme...
Source: Therapeutic Advances in Chronic Disease - May 16, 2016 Category: Internal Medicine Authors: IsHak, W. W., James, D. M., Mirocha, J., Youssef, H., Tobia, G., Pi, S., Collison, K. L., Cohen, R. M. Tags: Original Research Source Type: research

The prevalence and clinical characteristics associated with Diagnostic and Statistical Manual Version-5-defined anxious distress specifier in adults with major depressive disorder: results from the International Mood Disorders Collaborative Project
Conclusions: Our findings underscore the importance of evaluating ADS in adults with MDD as its presence identifies a subpopulation with greater illness-associated burden and hazards. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - May 16, 2016 Category: Internal Medicine Authors: McIntyre, R. S., Woldeyohannes, H. O., Soczynska, J. K., Vinberg, M., Cha, D. S., Lee, Y., Gallaugher, L. A., Dale, R. S., Alsuwaidan, M. T., Mansur, R. B., Muzina, D. J., Carvalho, A., Kennedy, S. Tags: Original Research Source Type: research

Pre-exposure prophylaxis as HIV prevention in the UK
(Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - May 16, 2016 Category: Internal Medicine Authors: Brady, M. Tags: Editorial Source Type: research

Gout: optimizing treatment to achieve a disease cure
Gout is one of the most common inflammatory arthritides. The disease is due to the deposition of monosodium urate crystals. These deposits are reversible with proper treatment, suggesting that gout is a curable disease. The main aim in gout is to lower serum uric acid levels to a pre-established target; there are different urate-lowering drugs (xanthine oxidase inhibitors, uricosurics and uricases) through which this can be achieved. Proper treatment of gout also involves correct management of acute flares and their prevention. To ensure treatment adherence it is necessary to explain to the patient what the objectives are....
Source: Therapeutic Advances in Chronic Disease - February 26, 2016 Category: Internal Medicine Authors: Bernal, J. A., Quilis, N., Andres, M., Sivera, F., Pascual, E. Tags: Reviews Source Type: research

Opioid-induced constipation: advances and clinical guidance
Currently opioids are the most frequently used medications for chronic noncancer pain. Opioid-induced constipation is the most common adverse effect associated with prolonged use of opioids, having a major impact on quality of life. There is an increasing need to treat opioid-induced constipation. With the recent approval of medications for the treatment of opioid-induced constipation, there are several therapeutic approaches. This review addresses the clinical presentation and diagnosis of opioid-induced constipation, barriers to its diagnosis, effects of opioids in the gastrointestinal tract, differential tolerance to op...
Source: Therapeutic Advances in Chronic Disease - February 26, 2016 Category: Internal Medicine Authors: Nelson, A. D., Camilleri, M. Tags: Reviews Source Type: research

New perspectives on management of idiopathic pulmonary fibrosis
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive parenchymal lung disease characterized by a median survival of 3–5 years following diagnosis. The diagnosis is based on clinical, radiological and histopathological evaluation. Therefore, a multidisciplinary team is needed to reach the correct diagnosis. For a long time, supportive care and lung transplantation in selected cases, have been considered the only possible treatments for IPF. In the last decade many studies have investigated IPF pathogenesis, leading to an improved knowledge of the mechanisms underlying the disease and to the approval of two ne...
Source: Therapeutic Advances in Chronic Disease - February 26, 2016 Category: Internal Medicine Authors: Puglisi, S., Torrisi, S. E., Vindigni, V., Giuliano, R., Palmucci, S., Mule, M., Vancheri, C. Tags: Reviews Source Type: research

The GLP-1 agonist, liraglutide, as a pharmacotherapy for obesity
This article briefly reviews the history of pharmacotherapy for obesity before focusing on the clinical trial evidence for the use of the GLP-1 agonist liraglutide as a weight loss agent and comparing its efficacy with other emerging drug therapies for obesity. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - February 26, 2016 Category: Internal Medicine Authors: Crane, J., McGowan, B. Tags: Reviews Source Type: research

A review of the medical treatment of primary sclerosing cholangitis in the 21st century
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease that progresses to end-stage liver disease and cirrhosis. Recurrent biliary inflammation is thought to lead to dysplasia, and as such PSC confers a high risk of cholangiocarcinoma. PSC accounts for 10% of all UK liver transplants, although transplantation does not guarantee a cure with 20% recurrence in the graft. At present there are no effective medical treatment options for PSC, and trials of novel therapeutic agents are limited by the time taken to reach clinically significant endpoints with no well defined early surrogate markers for disease o...
Source: Therapeutic Advances in Chronic Disease - January 5, 2016 Category: Internal Medicine Authors: Goode, E. C., Rushbrook, S. M. Tags: Reviews Source Type: research

Ocular itch associated with allergic conjunctivitis: latest evidence and clinical management
This article presents the evolution of ocular allergy treatments, from vasoconstrictors, to antihistamines and mast-cell stabilizers, to the dual-acting agents, as well as corticosteroid and immunomodulatory options. Future targets for allergy treatment are also discussed. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - January 5, 2016 Category: Internal Medicine Authors: Ackerman, S., Smith, L. M., Gomes, P. J. Tags: Reviews Source Type: research

Eosinophilic airway inflammation: role in asthma and chronic obstructive pulmonary disease
The chronic lung diseases, asthma and chronic obstructive pulmonary disease (COPD), are common affecting over 500 million people worldwide and causing substantial morbidity and mortality. Asthma is typically associated with Th2-mediated eosinophilic airway inflammation, in contrast to neutrophilic inflammation observed commonly in COPD. However, there is increasing evidence that the eosinophil might play an important role in 10–40% of patients with COPD. Consistently in both asthma and COPD a sputum eosinophilia is associated with a good response to corticosteroid therapy and tailored strategies aimed to normalize sp...
Source: Therapeutic Advances in Chronic Disease - January 5, 2016 Category: Internal Medicine Authors: George, L., Brightling, C. E. Tags: Reviews Source Type: research

Ponesimod, a selective S1P1 receptor modulator: a potential treatment for multiple sclerosis and other immune-mediated diseases
The first oral treatment for relapsing multiple sclerosis, the nonselective sphingosine-1-phosphate receptor (S1PR) modulator fingolimod, led to identification of a pivotal role of sphingosine-1-phosphate and one of its five known receptors, S1P1R, in regulation of lymphocyte trafficking in multiple sclerosis. Modulation of S1P3R, initially thought to cause some of fingolimod’s side effects, prompted the search for novel compounds with high selectivity for S1P1R. Ponesimod is an orally active, selective S1P1R modulator that causes dose-dependent sequestration of lymphocytes in lymphoid organs. In contrast to the long...
Source: Therapeutic Advances in Chronic Disease - January 5, 2016 Category: Internal Medicine Authors: DAmbrosio, D., Freedman, M. S., Prinz, J. Tags: Reviews Source Type: research

Lixisenatide in type 2 diabetes: latest evidence and clinical usefulness
Type 2 diabetes (T2D) is a highly prevalent disorder that affects millions of people worldwide. The hallmark of T2D is hyperglycemia and, while many treatment modalities exist, achieving and maintaining glycemic control can be challenging. Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are an appealing treatment option as they improve glycemic control, reduce weight, and limit the risk of hypoglycemia. Lixisenatide is a once-daily GLP-1 RA that has been evaluated in the GetGoal clinical trial program and has demonstrated efficacy and tolerability across a spectrum of patients. The feature that most distinguishes l...
Source: Therapeutic Advances in Chronic Disease - January 5, 2016 Category: Internal Medicine Authors: Anderson, S. L., Trujillo, J. M. Tags: Reviews Source Type: research

The diagnosis and treatment of chronic migraine: the case for daily scheduled opioid treatment in chronic headache
(Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - October 13, 2015 Category: Internal Medicine Authors: Derakhshan, I. Tags: Letter to the Editor Source Type: research

Insulin degludec and insulin aspart: novel insulins for the management of diabetes mellitus
Patients with type 2 diabetes mellitus require insulin as disease progresses to attain or maintain glycaemic targets. Basal insulin is commonly prescribed initially, alone or with one or more rapid-acting prandial insulin doses, to limit mealtime glucose excursions (a basal–bolus regimen). Both patients and physicians must balance the advantages of improved glycaemic control with the risk of hypoglycaemia and increasing regimen complexity. The rapid-acting insulin analogues (insulin aspart, insulin lispro and insulin glulisine) all have similar pharmacokinetic and pharmacodynamic characteristics and clinical efficacy...
Source: Therapeutic Advances in Chronic Disease - October 13, 2015 Category: Internal Medicine Authors: Atkin, S., Javed, Z., Fulcher, G. Tags: Reviews Source Type: research

Cardiovascular disease and type 1 diabetes: prevalence, prediction and management in an ageing population
Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1D). However, evidence of its risks and management is often extrapolated from studies in type 2 diabetic (T2D) patients or the general population. This approach is unsatisfactory given that the underlying pathology, demographics and natural history of the disease differ between T1D and T2D. Furthermore, with a rising life expectancy, a greater number of T1D patients are exposed to the cardiovascular (CV) risk factors associated with an ageing population. The aim of this review is to examine the existing literature around CVD in T1D. We...
Source: Therapeutic Advances in Chronic Disease - October 13, 2015 Category: Internal Medicine Authors: Lee, S. I., Patel, M., Jones, C. M., Narendran, P. Tags: Reviews Source Type: research

The effect of angiotensin II receptor blockers on hyperuricemia
In conclusion, losartan is the only ARB that has consistently demonstrated a significant reduction in serum uric acid levels, although the significance of impacting clinical outcomes remains unknown. Losartan appears to be a safe and efficacious agent to lower serum uric acid levels in patients with hyperuricemia. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - October 13, 2015 Category: Internal Medicine Authors: Wolff, M. L., Cruz, J. L., Vanderman, A. J., Brown, J. N. Tags: Reviews Source Type: research

Pharmacological treatment of spondyloarthritis: exploring the effectiveness of nonsteroidal anti-inflammatory drugs, traditional disease-modifying antirheumatic drugs and biological therapies
Spondyloarthritis represents a heterogeneous group of articular inflammatory diseases that share common genetic, clinical and radiological features. The therapy target of spondyloarthritis relies mainly in improving patients’ quality of life, controlling articular inflammation, preventing the structural joints damage and preserving the functional abilities, autonomy and social participation of patients. Among these, traditional disease-modifying antirheumatic drugs have been demonstrated to be effective in the management of peripheral arthritis; moreover, in the last decade, biological therapies have improved the app...
Source: Therapeutic Advances in Chronic Disease - October 13, 2015 Category: Internal Medicine Authors: Caso, F., Costa, L., Del Puente, A., Di Minno, M. N. D., Lupoli, G., Scarpa, R., Peluso, R. Tags: Reviews Source Type: research

Strategies for treating chronic HCV infection in patients with cirrhosis: latest evidence and clinical outcomes
This article provides a review on the most up to date data on the use of DAA’s in patients with advanced fibrosis and cirrhosis. We are at a point where HCV could be truly eradicated, but to do so will require ensuring there are effective and safe treatments for those with advanced fibrosis and cirrhosis. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - October 13, 2015 Category: Internal Medicine Authors: Wilder, J. M., Muir, A. J. Tags: Reviews Source Type: research

Chronic spontaneous urticaria: latest developments in aetiology, diagnosis and therapy
Chronic urticaria is a debilitating disease characterized by itching and hives with or without angioedema lasting for more than 6 weeks. The disease carries a significant emotional and economic burden for the patient and often results in an odyssey between doctors of different specialities. Patients suffering from chronic urticaria are considered more difficult to satisfy, treat and to have a bigger emotional burden than the average patient in dermatology, paediatric and general practice settings. A joint initiative under the Dermatology section of the European Academy of Allergy and Clinical immunology (EAACI), the Global...
Source: Therapeutic Advances in Chronic Disease - October 13, 2015 Category: Internal Medicine Authors: Vestergaard, C., Deleuran, M. Tags: Reviews Source Type: research

Impact of air quality on lung health: myth or reality?
The respiratory system is a primary target of the harmful effects of key air pollutants of health concern. Several air pollutants have been implicated including particulate matter (PM), ozone (O3), nitrogen dioxide (NO2) polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs). It is well known that episodes of exposure to high concentrations of outdoor air pollutants can cause acute respiratory exacerbations. However, there is now increasing evidence suggesting that significant exposure to outdoor air pollutants may be also associated with development of lung cancer and with incident cases of chronic ...
Source: Therapeutic Advances in Chronic Disease - August 25, 2015 Category: Internal Medicine Authors: Marino, E., Caruso, M., Campagna, D., Polosa, R. Tags: Reviews Source Type: research

Obstructive sleep apnoea syndrome and its management
Obstructive sleep apnoea (OSA) is a common disorder characterized by repetitive episodes of nocturnal breathing cessation due to upper airway collapse. OSA causes severe symptoms, such as excessive daytime somnolence, and is associated with a significant cardiovascular morbidity and mortality. Different treatment options are now available for an effective management of this disease. After more than three decades from its first use, continuous positive airway pressure (CPAP) is still recognized as the gold standard treatment. Nasal CPAP (nCPAP) is highly effective in controlling symptoms, improving quality of life and reduc...
Source: Therapeutic Advances in Chronic Disease - August 25, 2015 Category: Internal Medicine Authors: Spicuzza, L., Caruso, D., Di Maria, G. Tags: Reviews Source Type: research

Medical treatment update on pulmonary arterial hypertension
Pulmonary arterial hypertension is a chronic, progressive disease of the pulmonary vasculature resulting in poor outcomes if left untreated. The management of group 1 pulmonary arterial hypertension has included the use of prostanoids, phosphodiesterase-5 inhibitors, and endothelin receptor antagonists targeting the prostacyclin, endothelin-1, and nitric oxide pathways. Three new medications have been approved by the US Food and Drug Administration over the past couple of years. Macitentan is the newest endothelin receptor antagonist, riociguat is a soluble guanylate cyclase stimulator, and treprostinil diolamine is the fi...
Source: Therapeutic Advances in Chronic Disease - August 25, 2015 Category: Internal Medicine Authors: Enderby, C. Y., Burger, C. Tags: Reviews Source Type: research

Managing hyperphosphatemia in patients with chronic kidney disease on dialysis with ferric citrate: latest evidence and clinical usefulness
Ferric citrate is a novel phosphate binder that allows the simultaneous treatment of hyperphosphatemia and iron deficiency in patients being treated for end-stage renal disease with hemodialysis (HD). Multiple clinical trials in HD patients have uniformly and consistently demonstrated the efficacy of the drug in controlling hyperphosphatemia with a good safety profile, leading the US Food and Drug Administration in 2014 to approve its use for that indication. A concurrent beneficial effect, while using ferric citrate as a phosphate binder, is its salutary effect in HD patients with iron deficiency being treated with an ery...
Source: Therapeutic Advances in Chronic Disease - August 25, 2015 Category: Internal Medicine Authors: Yagil, Y., Fadem, S. Z., Kant, K. S., Bhatt, U., Sika, M., Lewis, J. B., Negoi, D., for the Collaborative Study Group Tags: Reviews Source Type: research

Statin use in prediabetic patients: rationale and results to date
Prediabetes increases the risk for new-onset diabetes mellitus in patients receiving statins and this risk is dose- and time- dependent. Explanations for the conversion of a predisposed individual to diabetes are ambiguous including reductions in ubiquinone and adiponectin levels. However, the risk of new-onset diabetes mellitus is far outweighed by the statin-induced considerable decrease in cardiovascular events. Thus, prediabetic patients at high cardiovascular risk should not be denied high-dose statin therapy due to the small increase in the risk of developing diabetes since statins, especially at higher doses, cause ...
Source: Therapeutic Advances in Chronic Disease - August 25, 2015 Category: Internal Medicine Authors: Kei, A., Rizos, E. C., Elisaf, M. Tags: Reviews Source Type: research

Perspective on the role of Ozurdex (dexamethasone intravitreal implant) in the management of diabetic macular oedema
Diabetic macular oedema (DMO) is the most common cause of visual loss in the working age population. Intravitreal therapy has superseded macular laser as the first-line treatment for the management of centre-involving DMO in most patients. As well as the proven efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents, phase II and III clinical trials of Ozurdex intravitreal dexamethasone implants for DMO have also demonstrated a mean increase in visual acuity and corresponding mean reduction in central macular thickness, particularly in pseudophakic eyes. Because of the risk of visual loss from c...
Source: Therapeutic Advances in Chronic Disease - August 25, 2015 Category: Internal Medicine Authors: Mehta, H., Gillies, M., Fraser-Bell, S. Tags: Reviews Source Type: research

Vedolizumab: an {alpha}4{beta}7 integrin antagonist for ulcerative colitis and Crohn's disease
Ulcerative colitis (UC) and Crohn’s disease (CD) are chronic, relapsing inflammatory bowel diseases associated with significant morbidity. Conventional therapies for these diseases include corticosteroids, aminosalicylates, immunomodulators, and monoclonal antibodies. Over the years tumor necrosis factor (TNF)-α antagonists alone or in combination with other therapies have emerged as the cornerstone of treatment for induction and maintenance of remission of moderate to severe UC and CD. Unfortunately, some patients with moderate to severe UC and CD are unable to attain or maintain remission with TNF-α ant...
Source: Therapeutic Advances in Chronic Disease - August 25, 2015 Category: Internal Medicine Authors: Cherry, L. N., Yunker, N. S., Lambert, E. R., Vaughan, D., Lowe, D. K. Tags: Reviews Source Type: research

P2Y12 antagonists in non-ST-segment elevation acute coronary syndromes: latest evidence and optimal use
Dual antiplatelet therapy (DAPT), which includes the combination of aspirin and a P2Y12 platelet receptor inhibitor, is a well-established antiplatelet regimen in the treatment of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Three P2Y12 inhibitor options (clopidogrel, prasugrel and ticagrelor) are currently available, all having different efficacy and safety profiles along with contrasting contraindications, special warnings and precautions for use. This review compares and contrasts the unique P2Y12 antagonists in the NSTE-ACS setting, covering the latest evidence and their optimal use. (Sour...
Source: Therapeutic Advances in Chronic Disease - June 8, 2015 Category: Internal Medicine Authors: Norgard, N. B., DiNicolantonio, J. J. Tags: Reviews Source Type: research

Psoriatic arthritis: latest treatments and their place in therapy
Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory disease that may affect peripheral and axial joints, entheses, skin and nails, and other organs. Treatment with nonsteroidal anti-inflammatory drugs, steroid and disease-modifying antirheumatic drugs had been the backbone of traditional management of PsA for many years. However, improvement in our understanding of immunopathogenesis of PsA has led to new immunomodulatory therapies. Introduction of novel agents has raised the bar for treatment and helped drive research into additional therapeutic options. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - June 8, 2015 Category: Internal Medicine Authors: Kang, E. J., Kavanaugh, A. Tags: Reviews Source Type: research

Atypical femoral fractures and bisphosphonate use: current evidence and clinical implications
Osteoporosis is a disease characterized by a low bone volume and deterioration of the bone quality, which increases the risk of low-energy fractures. Bisphosphonate (BP) treatment increases the bone mass and reduces the risk of fractures in patients with osteoporosis by suppressing bone resorption. In spite of its clinical benefits, the long-term use of BPs has been linked to the occurrence of atypical femoral fractures (AFFs). Although the evidence had been controversial regarding the association between the occurrence of AFFs and BP use, more recent studies with radiographic adjudication have indicated the significant as...
Source: Therapeutic Advances in Chronic Disease - June 8, 2015 Category: Internal Medicine Authors: Saita, Y., Ishijima, M., Kaneko, K. Tags: Reviews Source Type: research

Bedaquiline for the treatment of multidrug-resistant tuberculosis: great promise or disappointment?
This report examines the available data on this novel drug for the treatment of MDR-TB. PubMed searches, last updated 18 February 2015, using the terms bedaquiline, TMC 207 and R207910 identified pertinent English citations. Citation reference lists were reviewed to identify other relevant reports. Pertinent MDR-TB treatment reports on the US Food and Drug Administration, Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and Cochrane websites were also evaluated. Bedaquiline is an adenosine triphosphate (ATP) synthase inhibitor specific for MTB and some nontuberculous mycobacteria. The early...
Source: Therapeutic Advances in Chronic Disease - June 8, 2015 Category: Internal Medicine Authors: Field, S. K. Tags: Reviews Source Type: research

Potential for specific dihydropyridine calcium channel blockers to have a positive impact on cognitive function in humans: a systematic review
Conclusion: At present there is limited evidence to suggest that nitrendipine may be associated with reduction in incident dementia. This association comes from a single trial and needs to be replicated. Furthermore, there is no high-quality evidence for any of the other potential candidate CCBs. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - June 8, 2015 Category: Internal Medicine Authors: Peters, J., Booth, A., Peters, R. Tags: Original Research Source Type: research

Optimizing the use of anti-tumor necrosis factor in the management of patients with Crohn's disease
Since the approval of the first anti-tumor necrosis factor (anti-TNF) therapy in late 1998, the treatment for Crohn’s disease (CD) has been revolutionized. Anti-TNF therapy has been consistently shown in numerous clinical trials to be effective for patients with more aggressive perianal, internal penetrating, and fistulizing CD. However, the loss of clinical remission is frequent and only one-third of patients remain in clinical remission at 1 year. The pharmacokinetics of anti-TNF is highly variable among patients and could be influenced by many factors including serum albumin, gender, body weight, systemic inflamma...
Source: Therapeutic Advances in Chronic Disease - May 1, 2015 Category: Internal Medicine Authors: Nguyen, D. L., Flores, S., Sassi, K., Bechtold, M. L., Nguyen, E. T., Parekh, N. K. Tags: Reviews Source Type: research

Optimizing the use of thiopurines in inflammatory bowel disease
Immunomodulator drugs, of which thiopurines can be considered the backbone, are widely used in the treatment of inflammatory bowel disease. They have been shown to be highly effective and safe; however, a significant proportion of patients are deemed to have a poor response or suffer adverse reactions. Knowing how to monitor and optimize thiopurine therapy in these scenarios is crucial to effective management. We discuss the metabolism of thiopurines, the use of enzyme/metabolite testing to guide treatment, as well as strategies to circumvent toxicity and side effects, such as allopurinol coprescription. The indications, u...
Source: Therapeutic Advances in Chronic Disease - May 1, 2015 Category: Internal Medicine Authors: Goel, R. M., Blaker, P., Mentzer, A., Fong, S. C. M., Marinaki, A. M., Sanderson, J. D. Tags: Reviews Source Type: research

Management of cirrhotic ascites
The most common complication to chronic liver failure is ascites. The formation of ascites in the cirrhotic patient is caused by a complex chain of pathophysiological events involving portal hypertension and progressive vascular dysfunction. Since ascites formation represents a hallmark in the natural history of chronic liver failure it predicts a poor outcome with a 50% mortality rate within 3 years. Patients with ascites are at high risk of developing complications such as spontaneous bacterial peritonitis, hyponatremia and progressive renal impairment. Adequate management of cirrhotic ascites and its complications bette...
Source: Therapeutic Advances in Chronic Disease - May 1, 2015 Category: Internal Medicine Authors: Pedersen, J. S., Bendtsen, F., Moller, S. Tags: Reviews Source Type: research

The diagnosis and treatment of chronic migraine
This article discusses the current state of management of chronic migraine. (Source: Therapeutic Advances in Chronic Disease)
Source: Therapeutic Advances in Chronic Disease - May 1, 2015 Category: Internal Medicine Authors: Weatherall, M. W. Tags: Reviews Source Type: research

Ketamine and other N-methyl-D-aspartate receptor antagonists in the treatment of depression: a perspective review
Current pharmacotherapies for major depressive disorder (MDD) and bipolar depression (BDep) have a distinct lag of onset that can generate great distress and impairment in patients. Furthermore, as demonstrated by several real-world effectiveness trials, their efficacy is limited. All approved antidepressant medications for MDD primarily act through monoaminergic mechanisms, agonists or antagonists with varying affinities for serotonin, norepinephrine and dopamine. The glutamate system has received much attention in recent years as an avenue for developing novel therapeutics. A single subanesthetic dose infusion of the non...
Source: Therapeutic Advances in Chronic Disease - May 1, 2015 Category: Internal Medicine Authors: Iadarola, N. D., Niciu, M. J., Richards, E. M., Vande Voort, J. L., Ballard, E. D., Lundin, N. B., Nugent, A. C., Machado-Vieira, R., Zarate, C. A. Tags: Reviews Source Type: research

The prevalence of vascular calcification in patients with end-stage renal disease on hemodialysis: a cross-sectional observational study
Background: This multicenter international cross-sectional observational study characterized vascular and valvular calcification burden and correlations with pulse pressure, diabetes, hypertension, and cardiovascular diseases in prevalent hemodialysis patients. Methods: We enrolled 275 consecutive adults with end-stage renal disease on maintenance hemodialysis for>=3 months. Coprimary endpoints were prevalences of: (1) echocardiographic calcification in mitral valve, aortic valve or mitral annulus; (2) aortoiliac tree vascular calcifications by plain lateral lumbar X-ray. Correlations among calcification sites and with...
Source: Therapeutic Advances in Chronic Disease - May 1, 2015 Category: Internal Medicine Authors: Kraus, M. A., Kalra, P. A., Hunter, J., Menoyo, J., Stankus, N. Tags: Original Research Source Type: research