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1.
Rev. esp. enferm. dig ; 115(4): 168-174, 2023. tab, graf
Artigo em Inglês | IBECS | ID: ibc-218575

RESUMO

Background: Vonoprazan is a potassium competitive acid blocker (P-CAB) approved in Japan in 2014 to treat endoscopic submucosal dissection (ESD)-induced ulcers and bleeding or perforation. Therefore, this meta-analysis aimed to determine whether Vonoprazan is more effective than Lansoprazole in the treatment of ESD-induced ulcers which include ulcer healing and shrinking rate, among others. Methods: Randomized controlled trials (RCT) and retrospective studies were collected from the PubMed (Medline), Embase, Web of science and Cochrane Library databases. Meanwhile, studies were selected according to predetermined qualification criteria and data were extracted by two researchers. The quality of the methods for published papers was evaluated using the modified Jadad scale. Results: Five studies were included in this meta-analysis, the ulcer healing rate effect was not significantly higher in the intervention groups than in the control groups at 4 weeks, [OR:1.07 (0.51, 2.22), 95% CI, I2=2%, Z=0.18, P=0.86]. There was no significant difference in the ulcer shrinkage rate at 4 weeks [MD:0.20 (-1.51, 1.92), 95% CI, I2=0%, P=0.82] and 8 weeks [MD: -0.09 (-0.30, 0.12), 95% CI, I2=0%, P=0.39]. Conclusion: There was no significant difference between Vonoprazan and Lansoprazole in the ulcers induced by treatment after 4 weeks and 8 weeks of treatment with ESD (AU)


Assuntos
Humanos , Pirróis/uso terapêutico , Sulfonamidas/uso terapêutico , Úlcera Gástrica/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Rev. esp. enferm. dig ; 115(6): 294-300, 2023. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-221705

RESUMO

Background and aims: vonoprazan, a novel potassium-competitive acid blocking agent, has better clinical outcomes in the treatment of acid-related diseases. However, some adverse events have been associated with vonoprazan for the treatment of acid-associated diseases. Therefore, this systematic review and meta-analysis aimed to explore the safety and tolerability of vonoprazan for acid-associated diseases. Methods: electronic databases were retrieved to determine randomized controlled trials (RCTs) of vonoprazan for acid-associated diseases with any adverse effects and discontinuation. Results: this systematic review and meta-analysis conforming to the selection criteria included 18 RCTs with a total of 7,932 participants. Compared with proton pump inhibitors, oral vonoprazan treatment showed no significant increase in the incidence of adverse effects (95 % CI = 0.987-1.095, p = 0.141). Diarrhea or loose stools analysis showed that there was a statistically significant difference between vonoprazan and proton pump inhibitors (PPIs) treatment (95 % CI = 0.661-0.966, p = 0.021). However, there was no significant difference in constipation, rash or eruption, nausea or vomiting, bloating or abdominal pain, dysgeusia, nasopharyngitis, neurological disorders, upper respiratory tract infection and abnormal investigations between vonoprazan and PPIs treatment. Conclusion: vonoprazan, which has better tolerability and safety, may significantly decrease diarrhea and loose stools in acid-related patients compared with PPIs. Our meta-analysis led to safer strategies for treating acid-related diseases. More high-quality studies with larger sample sizes are needed to further elucidate its efficacy and safety (AU)


Assuntos
Humanos , Pirróis/efeitos adversos , Sulfonamidas/efeitos adversos , Inibidores da Bomba de Prótons/efeitos adversos , Pirróis/uso terapêutico , Sulfonamidas/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
An. R. Acad. Farm ; 82(3): 317-323, jul.-sept. 2016. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-158074

RESUMO

La leishmaniasis se encuentra entre las seis enfermedades más importantes en el Programa Especial de Investigación y Adiestramiento en Enfermedades Tropicales (TDR) de la OMS. Los fármacos disponibles actualmente presentan altas toxicidades o se han desarrollado resistencias para los mismos, de modo que buscar nuevos compuestos que posean actividad anti-leishmánica es una opción quimioterapéutica atractiva. En el presente estudio hemos utilizado la topología molecular y el análisis de regresión multilineal para el desarrollo de un modelo QSAR capaz de predecir la actividad frente a L. major y L. donovani de un grupo de compuestos derivados del pirrol [1,2-alfa] quinoxalina. Validados los modelos topológicos seleccionados, se ha realizado un cribado molecular y se han seleccionado nuevos derivados de la quinoxalina con potencial actividad anti-leishmánica


Leishmaniasis is present among the six greatest diseases reported in the WHO's Special Programme for Research and Training in Tropical Diseases (TDR). Nowadays, the available drugs show high toxicities or resistance has been developed. Therefore the search of new compounds that possess anti-leishmania activity is an attractive chemotherapeutic option. In the present study we have applied molecular topology and multilineal regression analysis to develop a QSAR model able to predict the activity of a series of pyrrolo [1,2-alfa] quinoxaline derived compounds against L. major and L. donovani. Once validated the selected topological models, a molecular screening has been performed and new quinoxaline derivatives with potential anti-leishmania activity have been selected


Assuntos
Humanos , Pirróis/toxicidade , Quinoxalinas/toxicidade , Leishmaniose/tratamento farmacológico , Antiprotozoários/farmacologia , Leishmania donovani/patogenicidade , Leishmania major/patogenicidade
5.
Clin. transl. oncol. (Print) ; 13(12): 869-877, dic. 2011. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-125995

RESUMO

INTRODUCTION Sunitinib, an oral, multitargeted receptor tyrosine kinase inhibitor, delays disease progression, with a median overall survival (OS) of more than 2 years, improves quality of life and is becoming the first-line standard of care for metastatic renal carcinoma (mRCC). PURPOSE To assess the economic value of sunitinib as fi rst-line therapy in mRCC within the Spanish healthcare system. METHODS An adapted Markov model with a 10-year time horizon was used to analyse the cost effectiveness of sunitinib vs. sorafenib (SFN) and bevacizumab/interferon-α (BEV/IFN) as first-line mRCC therapy from the Spanish third-party payer perspective. Progression-free survival (PFS) and OS data from sunitinib, SFN and BEV/IFN pivotal trials were extrapolated to project survival and costs in 6-week cycles. Results, in progression-free life-years (PFLY), life years (LY) and quality-adjusted life-years (QALY) gained, expressed as incremental cost-effectiveness ratios (ICER) with costs and benefits discounted annually at 3%, were obtained using deterministic and probabilistic analyses. RESULTS Sunitinib was more effective and less costly than both SFN (gains of 0.52 PFLY, 0.16 LY, 0.17 QALY) and BEV/IFN (gains of 0.19 PFLY, 0.23 LY, 0.16 QALY) with average cost savings/patients of €1,124 and €23,218, respectively. Using a willingness-to-pay (WTP) threshold of €50,000/QALY, sunitinib achieved an incremental net benefit (INB) of €9,717 and €31,211 compared with SFN and BEV/IFN, respectively. At this WTP, the probability of sunitinib providing the highest INB was 75%. CONCLUSION Our analysis suggests that sunitinib is a costeffective alternative to other targeted therapies as first-line mRCC therapy in the Spanish healthcare setting (AU)


Assuntos
Humanos , Masculino , Feminino , Inibidores da Angiogênese/economia , Carcinoma de Células Renais/economia , Ensaios Clínicos como Assunto/métodos , Indóis/economia , Indóis/uso terapêutico , Interferon-alfa/economia , Neoplasias Renais/economia , Neoplasias Renais/patologia , Modelos Econômicos , Pirróis/economia , Inibidores da Angiogênese/uso terapêutico , Antivirais/economia , Pirróis/uso terapêutico , Antivirais/uso terapêutico , Benzenossulfonatos/economia , Benzenossulfonatos/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/secundário , Custos e Análise de Custo
6.
Farm. hosp ; 34(4): 170-180, jul.-ago. 2010. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-106731

RESUMO

Objetivo Realizar un análisis de impacto presupuestario (AIP) de la introducción en la prestación sanitaria del sistema nacional de salud (SNS) de la combinación fija (CF) de amlodipino 5 o 10mg y atorvastatina 10mg en la indicación aprobada. Material y métodos El AIP se ha realizado desde la perspectiva del SNS para un periodo de 3 años (2009–2011). Se ha diseñado un modelo de decisión tipo árbol (árbol de pacientes) construido a partir de datos epidemiológicos y la literatura científica para estimar la población hipertensa susceptible de tratamiento con la CF. El AIP, por año y en total, se ha calculado imputando el coste a PVP-IVA de la CF al número de pacientes a tratar, del que se sustrae el coste del tratamiento antihipertensivo que se sustituye y el coste por paciente promedio actualizado de los eventos cardiovasculares prevenidos para el SNS por el uso de la CF en el periodo de referencia. Resultados La población susceptible de tratamiento con la CF es de 51.104 pacientes (1.er año), con una tasa de crecimiento entre 1–2% en los sucesivos años, lo que supone un coste (€) anual de 15,9M (2009), 19,9M (2010) y 24,1M (2011), totalizando 60,0M. El AIP se ve compensado mostrando valores de impacto negativo para el SNS cuando se descuentan los costes del tratamiento antihipertensivo sustituido y eventos cardiovasculares prevenidos, mostrando un ahorro de 69,9M € en 3 años. Conclusión El AIP de la CF de atorvastatina y amlodipino muestra que su uso en la indicación aprobada podría generar ahorros netos para el SNS en el periodo 2009–2011 de 9,9M (AU)


Objective To carry out a Budget Impact Analysis (BIA) of the inclusion of the administration, within the Spanish National Health System (SNS), of the fixed combination (FC) of amlodipine 5 or 10mg and atorvastatin 10mg for approved indications. Materials and Methods A BIA was carried out from the SNS perspective for a 3 year period (2009–2011). A tree type decision model was designed (tree of patients), based on epidemiological data and scientific literature, to estimate the hypertensive population that could be treated with a FC. The total per annum BIA was calculated by attributing the retail price- VAT of the FC to the number of patients to be treated, and deducting the cost of the treatment for hypertension that was replaced and the updated average cost per patient of cardiovascular events (CVEs) prevented by the use of the FC by the SNS during the period of study. Results The patient population susceptible to treatment with the FC was 51,104 patients (1st year), with a growth rate of between 1–2% over the following years, which means an annual cost (€) of 15.9M (2009), 19.9M (2010) and 24.1M (2011), with a total of 60.0M. The BIA was compensated showing negative impact values for the SNS when the cost of replaced antihypertensive treatment and prevented CVEs was deducted, with savings of €69.9M over 3 years. Conclusion The BIA of a FC of atorvastatin and amlodipine shows that the use of this medication for approved indications could generate net savings for the SNS of €9.9M for the period 2009–2011 (AU)


Assuntos
Humanos , Anlodipino/economia , Custos de Medicamentos , Ácidos Heptanoicos/economia , Programas Nacionais de Saúde/economia , Pirróis/economia , Anlodipino/administração & dosagem , Orçamentos , Doenças Cardiovasculares/prevenção & controle , Árvores de Decisões , Hipertensão/tratamento farmacológico , Hipertensão/economia , Modelos Teóricos , Pirróis/uso terapêutico , Espanha
7.
Clin. transl. oncol. (Print) ; 12(7): 468-472, jul. 2010.
Artigo em Inglês | IBECS | ID: ibc-124100

RESUMO

Sarcomas are uncommon malignancies that represent more than 50 different tumor types. Surgery remains the mainstay of treating localised disease. Anthracycline and ifosfamide-based chemotherapy is an option for advanced disease; however, effective treatment of advanced soft tissue sarcoma remains a challenge. Advances in understanding the genetic nature of cancer have led to the development of new treatment options for sarcoma. Sunitinib malate is an oral multitargeted tyrosine kinase inhibitor with antiangiogenic properties and promising activity in the treatment of GIST refractory to imatinib, however in either soft tissue sarcoma, experience with sunitinib is under development in different clinical trials. In this review we offer the experience with this small molecular target in non-GIST sarcomas (AU)


Assuntos
Humanos , Masculino , Feminino , Antineoplásicos/uso terapêutico , Indóis/uso terapêutico , Pirróis/uso terapêutico , Sarcoma/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Tirosina Quinases/antagonistas & inibidores , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Sarcoma/patologia
8.
Rev. neurol. (Ed. impr.) ; 51(1): 1-11, 1 jul., 2010. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-86693

RESUMO

Aim. To estimate the cost-effectiveness of atorvastatin at high doses (80 mg/day) for the reduction of the risk of fatal and nonfatal stroke in patients with recent cerebrovascular accident or transient ischemic attack (TIA) and without coronary heart disease in Spain using data from the SPARCL study. Patients and methods. A discrete event simulation was developed to represent the natural evolution of a cohort of 1000 patients following a stroke or TIA. The risk for fatal and non fatal cardiovascular events was calculated from the clinical characteristic of patients in the SPARCL study for both treatment arms (atorvastatin 80 mg/day and placebo). Survival time, quality-adjusted-life-years (QALY), clinical events, and medical direct costs for a period of 5 years with a 3% per year discount were calculated for the two alternatives. A probabilistic sensitivity analysis was made running 1000 simulations. esults. Compared to placebo, atorvastatin 80 mg/day prevented 22 strokes (14 nonfatal and 8 fatal), 22 myocardial infarctions (19 nonfatal and 3 fatal), 33 TIAs, 8 unstable angina episodes and 37 re-vascularisations per 1000 patients over5 years. The incremental cost eff ectiveness ratio after 1000 simulations was 9914 € (95% CI = 5717 to 26 082) per QALY. The acceptability curve showed 99% of the simulations falling below an acceptability threshold of 30 000€/QALY.Conclusions. Compared with placebo, use of high dose atorvastatin (80 mg/day) for secondary stroke prevention is not only of signifi cant clinical benefi t but can also be considered cost eff ective in Spain. It produces important benefi ts in health with an incremental cost within reasonable limits (AU)


Objetivos. Estimar los costes y la relación coste-efectividad de dosis altas de atorvastatina (80 mg/día) en la reducción del riesgo de recurrencia del ictus en pacientes con ataque isquémico transitorio (AIT) o ictus reciente y sin antecedentes de cardiopatía isquémica conocida, a partir de los resultados del estudio Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL). Pacientes y métodos. Se utilizó un modelo de simulación de eventos discretos que representa la historia natural de una cohorte de pacientes con ictus/AIT después del evento agudo. El modelo predijo sus riesgos de ictus, otras enfermedades cardiovasculares y muerte para atorvastatina y placebo. Se calcularon la supervivencia, los años de vida ajustados por calidad (AVAC), eventos clínicos y los costes médicos directos con un horizonte de cinco años (descuento, 3%). Se realizó un análisis de sensibilidad probabilístico mediante 1.000 simulaciones. Resultados. Comparada con placebo, la atorvastatina previno 22 ictus (14 no fatales y 8 fatales), 22 infartos de miocardio (19 no fatales y 3 fatales), 33 AIT, 8 anginas inestables y 37 revascularizaciones por 1.000 pacientes en cinco años. La razón coste-efectividad incremental media de las 1.000 simulaciones fue de 9.914 €/AVAC (IC 95% = 5.717-26.082). En la curva de aceptabilidad, el 99% estuvo por debajo de 30.000 €/AVAC. Conclusiones. Comparado con placebo, el uso de dosis altas de atorvastatina en la prevención secundaria del ictus es coste-efectivo, ya que produce benefi cios en salud importantes a un coste incremental razonable, en el que el 99% de las simulaciones cae por debajo del umbral de efi ciencia de 30.000 €/AVAC (AU)


Assuntos
Humanos , Ácidos Heptanoicos/economia , Acidente Vascular Cerebral/prevenção & controle , /economia , Ácidos Heptanoicos/uso terapêutico , /uso terapêutico , Ataque Isquêmico Transitório/prevenção & controle , Análise Custo-Benefício/economia , Placebos/uso terapêutico , Pirróis/economia , Pirróis/uso terapêutico , Prevenção Secundária , Infarto do Miocárdio/prevenção & controle
10.
Clin. transl. oncol. (Print) ; 10(12): 831-839, dic. 2008.
Artigo em Inglês | IBECS | ID: ibc-123563

RESUMO

INTRODUCTION: Sunitinib is a multiselective oral inhibitor of several tyrosine-kinase receptors that has demonstrated its efficacy in patients with metastatic and/or unresectable gastrointestinal stroma tumours (GIST) who were resistant to or intolerant to previous treatment with imatinib. The purpose of this study is to assess the cost-effectiveness of sunitinib vs. best supportive care (BSC) in GIST as a second- line treatment, from the perspective of the Spanish National Health System. MATERIALS AND METHODS: A Markov model was used to assess the cost effectiveness of sunitinib (50 mg/day, 4 weeks "on" and 2 weeks "off") vs. BSC in GIST as a second-line treatment. Transition probabilities between the three health states considered in the model (progression-free survival (PFS), progression and death) were obtained from a clinical trial [Demetri et al. (2006) Lancet 368:1329-1338]. Health resource data (drugs, medical visits, laboratory and radiology tests, palliative care and adverse events) were obtained from an expert panel. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Projected PFS years, life years (LY) and quality of life adjusted years (QALYs) were higher for sunitinib compared with BSC: 0.50 vs. 0.24, 1.59 vs. 0.88 and 1.00 vs. 0.55. Mean costs per patient were 23,259 euros with sunitinib and 1,622 euros with BSC. The incremental cost-effectiveness ratios (ICERs) obtained were: 4,090 euros/month PFS, 30,242 euros/LY and 49,090 euros/QALY gained. The most influential variables for the results were the efficacy and unit cost of sunitinib. CONCLUSIONS: According to the efficiency thresholds for oncology patients in developed countries, sunitinib is considered cost-effective vs. BSC with acceptable costs per LY and QALY gained (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Quimioterapia Adjuvante/economia , Antineoplásicos/economia , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/economia , Indóis/economia , Indóis/uso terapêutico , Cadeias de Markov , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Pirróis/uso terapêutico , Algoritmos , Benzamidas , Análise Custo-Benefício , Progressão da Doença , Método Duplo-Cego , Resistencia a Medicamentos Antineoplásicos , Tumores do Estroma Gastrointestinal/mortalidade , Tumores do Estroma Gastrointestinal/patologia , Recursos em Saúde
11.
An. med. interna (Madr., 1983) ; 25(7): 366-369, jul. 2008. tab
Artigo em Es | IBECS | ID: ibc-69759

RESUMO

La angiogenésis neoplásica es un proceso esencial en el crecimiento progresivo de las neoplasias, y en la producción de metástasis. La angiogénesis consiste en una serie de complejos pasos consecutivos que conducen en último término al desarrollo de neovasos que aportan sangre a la masa tumoral. El VEGF tiene un papel primordial en la angiogénesis neoplásica, y por tanto es una importante diana en el tratamiento de las neoplasias. Bevacizumab, un anticuerpo monoclonal humano, inhibe el VEGF, y podría mejorar el transporte de la quimioterapia a las masas tumorales. Los inhibidores multi-kinasas (sorafenib y sunitinib) son pequeñas moléculas de administración oral, que inhiben diferentes receptores (esenciales en la angiogénesis neoplásica), como VEGFR o PDGFR. Estos agentes son útiles en el tratamiento del carcinoma de células renales avanzado, y están en investigación en muchos otros tumores


Neoplastic angiogenesis is an essential process in the progressive growth of neoplasms and the production of metastasis. Angiogenesis consists of a series of linked and sequential steps that ultimately leads to the development of a neovascular blood supply to the tumor mass. VEGF has got an essential role in neoplastic angiogenesis, there fore it is an important target in the treatment of neoplasms. Bevacizumab, a humanized monoclonal antibody, inhibits VEGF, and may also improve the delivery of chemotherapy to the tumor mass. Multi-kinase ihibitors (sorafenib and sunitinib) are orally administered small-molecules, that inhibit different receptors (essentials in the neoplastic angiogenesis), such as the VEGFR or PDGFR. These agents are useful in the treatment of advanced renal-cell carcinoma, and are under investigation in several tumors


Assuntos
Humanos , Masculino , Feminino , Inibidores da Angiogênese/uso terapêutico , Indóis/uso terapêutico , Pirróis/uso terapêutico , Anticorpos Monoclonais/administração & dosagem , Linfangiogênese , Linfangiogênese/fisiologia , Inibidores da Angiogênese/imunologia , Inibidores da Angiogênese/metabolismo , Inibidores da Angiogênese/farmacocinética , Neovascularização Patológica/complicações , Proteínas Quinases/uso terapêutico , Imunoterapia/métodos , Mitose , Mitose/fisiologia
12.
Rev. esp. quimioter ; 19(4): 376-377, dic. 2006.
Artigo em Es | IBECS | ID: ibc-053440
13.
Clin. transl. oncol. (Print) ; 8(10): 706-710, oct. 2006. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-125317

RESUMO

Recent developments in molecular biology have lead to an increased understanding of the events involved in renal cell carcinoma (RCC) carcinogenesis. In this field, basic molecular pathways important to oncogenic transformation secondary to Von Hippel-Lindau (VHL) tumor suppression gene inactivation, associated to clear-cell RCC, have been elucidated. Loss of function of VHL results in the high-expression of pro-angiogenic growth factors, such as vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF). New therapies against specific targets in RCC have demonstrated significant clinical activity in patients. These therapeutic approaches are based on the VEGF inhibition by using anti-VEGF monoclonal antibodies (bevacizumab) or multi-kinase inhibitors, that also target PDGF and c-kit tyrosine kinases (sorafenib, sunitinib); or by the inhibition of the mammalian target of rapamycin (mTOR) pathway (temsirolimus). This article reviews current knowledge of molecular pathogenesis of inherited and sporadic RCC (AU)


Assuntos
Humanos , Anticorpos Monoclonais Humanizados , Anticorpos Monoclonais/uso terapêutico , Inibidores da Angiogênese/uso terapêutico , Antineoplásicos/uso terapêutico , Benzenossulfonatos/uso terapêutico , Carcinoma de Células Renais/terapia , Carcinoma de Células Renais/genética , Neoplasias Renais/genética , Neoplasias Renais/terapia , Transdução de Sinais/genética , Indóis/uso terapêutico , Biologia Molecular , Mutação , Niacinamida/análogos & derivados , Compostos de Fenilureia , Piridinas/uso terapêutico , Pirróis/uso terapêutico , /uso terapêutico , Doença de von Hippel-Lindau/genética , Sirolimo/análogos & derivados , Sirolimo/uso terapêutico
14.
Gastroenterol. hepatol. (Ed. impr.) ; 29(1): 21-24, ene. 2006. ilus, tab
Artigo em Es | IBECS | ID: ibc-042942

RESUMO

El consumo de los inhibidores de la 3-hidroxi-3-metilglutaril-coenzima A (HMG-CoA) reductasa, conocidos como estatinas, se ha asociado a la elevación de transaminasas y, menos frecuentemente, con cuadros de hepatotoxicidad. Recientemente se han comunicado varios casos de toxicidad hepática aguda por atorvastatina. Presentamos el caso de un varón de 72 años que desarrolló una hepatitis colestásica aguda tras la reintroducción de atorvastatina a una dosis superior a la previamente prescrita. La suspensión del fármaco permitió una total recuperación clínica y analítica


Consumption of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA) inhibitors, known as statins, has been associated with elevated transaminase levels but rarely with acute hepatitis. Recently, several cases of acute hepatitis secondary to atorvastatin therapy have been published. We report the case of a 72-year-old man who developed acute cholestatic hepatitis after reinitiating treatment with atorvastatin at a higher dose than that previously prescribed. After treatment discontinuation, the patient made a full recovery, with normalization of clinical and laboratory findings


Assuntos
Masculino , Idoso , Humanos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Pirróis/efeitos adversos , Ácidos Heptanoicos/efeitos adversos , Doença Aguda , Colestase/induzido quimicamente , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Pirróis/administração & dosagem , Ácidos Heptanoicos/administração & dosagem
15.
Gastroenterol. hepatol. (Ed. impr.) ; 29(1): 21-24, ene. 2006. ilus, tab
Artigo em Es | IBECS | ID: ibc-042960

RESUMO

El consumo de los inhibidores de la 3-hidroxi-3-metilglutaril-coenzima A (HMG-CoA) reductasa, conocidos como estatinas, se ha asociado a la elevación de transaminasas y, menos frecuentemente, con cuadros de hepatotoxicidad. Recientemente se han comunicado varios casos de toxicidad hepática aguda por atorvastatina. Presentamos el caso de un varón de 72 años que desarrolló una hepatitis colestásica aguda tras la reintroducción de atorvastatina a una dosis superior a la previamente prescrita. La suspensión del fármaco permitió una total recuperación clínica y analítica


Consumption of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA) inhibitors, known as statins, has been associated with elevated transaminase levels but rarely with acute hepatitis. Recently, several cases of acute hepatitis secondary to atorvastatin therapy have been published. We report the case of a 72-year-old man who developed acute cholestatic hepatitis after reinitiating treatment with atorvastatin at a higher dose than that previously prescribed. After treatment discontinuation, the patient made a full recovery, with normalization of clinical and laboratory findings


Assuntos
Masculino , Idoso , Humanos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Pirróis/efeitos adversos , Ácidos Heptanoicos/efeitos adversos , Doença Aguda , Colestase/induzido quimicamente , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Pirróis/administração & dosagem , Ácidos Heptanoicos/administração & dosagem
16.
Rev. esp. cardiol. (Ed. impr.) ; 57(10): 909-915, oct. 2004.
Artigo em Es | IBECS | ID: ibc-35507

RESUMO

Introducción y objetivos. La monitorización del efecto de las estatinas se ha estudiado fundamentalmente en el ámbito arterial periférico. Es posible estudiar la microcirculación coronaria mediante la evaluación de la reserva coronaria (RC) con ecocardiografía transtorácica. El objetivo del estudio fue evaluar, de forma no invasiva, el efecto de atorvastatina en la función endotelial periférica y la microvasculatura coronaria en pacientes dislipémicos. Pacientes y método. Se incluyó a 21 pacientes dislipémicos sin antecedentes de aterosclerosis clínica (edad, 64,9 ñ 11 años; mujeres, 61,9 por ciento). Se valoraron, basalmente y a los 3 meses de tratamiento con 20 mg/día de atorvastatina, el perfil lipídico, el grosor mediointimal (GMI) carotídeo, la vasodilatación dependiente del endotelio (VDE) y la reserva coronaria (RC) de la arteria descendente anterior (DA). Los estudios se realizaron con ecocardiografía. Resultados. Simultáneamente con la mejoría del perfil lipídico se apreció un incremento del 43 por ciento de la VDE (el 4,3 ñ 4,4 por ciento frente al 6,2 ñ 3,8 por ciento; p = 0,07) y un 25 por ciento de mejoría de la RC (2,5 ñ 0,6 frente a 3,1 ñ 0,8; p = 0,002). El incremento de la VDE se correlacionaba con la edad (r = -0,60; p = 0,004), el GMI carotídeo (r = -0,47; p = 0,029), el colesterol unido a lipoproteínas de baja densidad (cLDL) basal (r = -0,43; p = 0,05) y con la VDE basal (r = -0,63; p = 0,002). El incremento de la RC se correlacionaba con el cLDL final (r = -0,51; p = 0,04). Conclusiones. El tratamiento a corto plazo con atorvastatina mejora no sólo el perfil lipídico, sino también la función microvascular coronaria y la vasodilatación periférica dependiente del endotelio. Es posible su monitorización de manera no invasiva con ecocardiografía (AU)


Assuntos
Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Idoso , Vasodilatação , Interpretação Estatística de Dados , Endotélio Vascular , Pirróis , Modelos Teóricos , Microcirculação , Triglicerídeos , Ecocardiografia , Circulação Coronária , Colesterol , Fatores de Tempo , LDL-Colesterol , Hiperlipidemias , Ácidos Heptanoicos , HDL-Colesterol
18.
Med. clín (Ed. impr.) ; 123(14): 535-537, oct. 2004.
Artigo em Es | IBECS | ID: ibc-35691

RESUMO

FUNDAMENTO Y OBJETIVO: La diabetes mellitus tipo 2 se asocia con un aumento de riesgo cardiovascular. Los valores basales de proteína C reactiva (PCR), marcador prototipo de inflamación, se relacionan con un mayor riesgo de acontecimientos cardiovasculares. Las estatinas tienen efectos antiinflamatorios directos. Por este motivo, hemos examinado el efecto de la atorvastatina sobre los valores de PCR en pacientes con diabetes mellitus tipo 2. PACIENTES Y MÉTODO: Se ha evaluado la PCR basal y tras 6 meses de tratamiento con 20 mg/día de atorvastatina en 30 pacientes con diabetes mellitus tipo 2, no fumadores y con hiperlipemia. RESULTADOS: Los valores de PCR disminuyeron significativamente tras el tratamiento con atorvastatina (media de --4,99 mg/l; p < 0,001). Observamos una correlación entre la PCR basal y el índice de masa corporal (r = 0,429; p = 0,018), el fibrinógeno (r = 0,607; p = 0,001) y la microalbuminuria (r = 0,470; p = 0,01). No hubo correlación significativa entre la PCR basal y el colesterol unido a lipoproteínas de baja densidad. La reducción de la PCR se correlacionó significativamente con la glucemia basal (r = --0,457; p = 0,019) y la hemoglobina glucosilada a los 6 meses (r = --0,421; p = 0,03). CONCLUSIONES: Estos resultados confirman los hallazgos de estudios previos, al comprobarse una disminución de los valores de PCR tras tratamiento con atorvastatina, independiente de la reducción de los valores de colesterol unido a lipoproteínas de baja densidad (AU)


Assuntos
Idoso , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Humanos , Doença Pulmonar Obstrutiva Crônica , Hipolipemiantes , Proteína C-Reativa , Músculos Respiratórios , Debilidade Muscular , Pirróis , Inibidores de Hidroximetilglutaril-CoA Redutases , Ácidos Heptanoicos , Diabetes Mellitus Tipo 2 , Hiperlipidemias
19.
Rev. clín. esp. (Ed. impr.) ; 204(10): 554-560, oct. 2004.
Artigo em Es | IBECS | ID: ibc-36213

RESUMO

Se revisan los mecanismos de absorción de colesterol biliar y de la dieta y se comentan las características de un nuevo inhibidor específico de la absorción del colesterol en el intestino: la ezetimiba. La variablidad de la capacidad absortiva en distintos individuos hace que la eficacia de las estatinas se vea limitada. La ezetimiba se absorbe bien por víal oral, se glucuroniza en el hígado y entra en la circulación enterohepática, por ello su vida media es larga, alrededor de 22 horas. La dosis más efectiva es 10 mg administrados una vez al día. Actuando sobre las dos fuentes: la producción de colesterol hepatocitario y la absorción en el enterocito, se obtiene efecto sinérgico. La dosis más baja de estatina acompañada de 10 mg de ezetimiba equivale a dar la dosis más alta de estatina. En pacientes que toman estatinas al añadir ezetimiba el porcentaje de los que alcanzan el objetivo se incrementa de un 27 por ciento a un 75 por ciento. Además de aumentar la eficacia también se evitan efectos secundarios, ya que la tolerancia de ezetimiba es similar al placebo. La reducción máxima promedio de la cifra de colesterol plasmático con 10 mg de ezetimiba y 80 mg de simvastatina o atorvastatina oscila entre el 60 por ciento-65 por ciento (AU)


Assuntos
Humanos , Colesterol , Obstrução Intestinal , Hipercolesterolemia , Azetidinas , Anticolesterolemiantes , Pirróis , Ácidos Heptanoicos
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