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1.
Hepatol Res ; 53(5): 409-416, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36601972

RESUMO

AIM: Cabozantinib showed a favorable benefit-risk profile in Japanese patients with advanced hepatocellular carcinoma (HCC) in an open-label, phase II study (NCT03586973). This analysis presents cumulative data to final database lock. METHODS: Patients with previously treated, advanced HCC received cabozantinib 60 mg/day. Progression-free survival (PFS) and tumor response rates in prior-sorafenib and sorafenib-naïve cohorts were assessed by independent radiology committee (IRC) and an investigator. Liver function was evaluated by albumin-bilirubin (ALBI) score. RESULTS: Median cabozantinib exposure was 5.6 months. In the prior-sorafenib cohort (n = 20), median PFS was 7.4 months per IRC assessment and 5.6 months per investigator assessment. In the sorafenib-naïve cohort (n = 14), median PFS was 3.6 and 4.4 months per IRC and investigator assessment, respectively. Six-month PFS rate per IRC and investigator assessment in the prior-sorafenib cohort was 59.8% and 49.5%, respectively, and in the sorafenib-naïve cohort was 16.7% and 35.7%, respectively. Disease control rate by both IRC and investigator assessment was 85.0% in the prior-sorafenib cohort and 64.3% in the sorafenib-naïve cohort. Median overall survival (Kaplan-Meier estimate) was 19.3 and 9.9 months in the prior-sorafenib and sorafenib-naïve cohort, respectively. Mean ALBI score remained relatively constant in patients able to continue treatment. The most frequent adverse events were palmar-plantar erythrodysesthesia syndrome, diarrhea, hypertension, and decreased appetite. No new safety concerns were identified. CONCLUSIONS: Cabozantinib showed efficacy and a manageable safety profile in Japanese patients with advanced HCC.

2.
Int J Clin Oncol ; 28(3): 416-426, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36595123

RESUMO

BACKGROUND: Cabozantinib was established as the standard of care for the treatment of patients with renal cell carcinoma (RCC) whose disease had progressed after vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) therapy in the global randomized trial METEOR. A phase 2 study was conducted to bridge the findings in METEOR to Japanese patients. Here, we report a biomarker analysis and update the efficacy and safety results of cabozantinib treatment. METHODS: Japanese patients with RCC who received at least one prior VEGFR-TKI were enrolled and received cabozantinib 60 mg orally once daily. The primary endpoint was objective response rate. Secondary endpoints included progression-free survival, overall survival, and safety. Exploratory analyses included the relationship between plasma protein hepatocyte growth factor (HGF) levels and treatment responses. RESULTS: In total, 35 patients were enrolled. The median treatment duration was 58.3 (range 5.1-131.4) weeks. The objective response rate was 25.7% (90% confidence interval [CI] 14.1-40.6). Kaplan-Meier estimate of median progression-free survival was 11.1 months (95% CI 7.4-18.4). The estimated progression-free survival proportion was 73.1% (95% CI 54.6-85.0) at 6 months. Median overall survival was not reached. Adverse events were consistent with those in METEOR and the safety profile was acceptable. Nonresponders to cabozantinib showed relatively higher HGF levels than responders at baseline. CONCLUSIONS: Updated analyses demonstrate the long-term efficacy and safety of cabozantinib in Japanese patients with advanced RCC after at least one VEGFR-TKI therapy. Responders tended to show lower baseline HGF levels ClinicalTrials.gov Identifier: NCT03339219.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Inibidores de Proteínas Quinases , Humanos , Biomarcadores , Carcinoma de Células Renais/tratamento farmacológico , População do Leste Asiático , Neoplasias Renais/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores
3.
Clin Transl Sci ; 14(3): 1069-1081, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33503305

RESUMO

The investigational NEDD8-activating enzyme inhibitor pevonedistat is being evaluated in combination with azacitidine versus single-agent azacitidine in patients with higher-risk myelodysplastic syndrome (higher-risk MDS), higher-risk chronic myelomonocytic leukemia (higher-risk CMML), or low-blast acute myeloid leukemia (AML) in a Phase 3 trial PANTHER. To support Asia-inclusive global development, we applied multiregional clinical trial (MRCT) principles of the International Conference on Harmonisation E17 guidelines by evaluating similarity in drug-related and disease-related intrinsic and extrinsic factors. A PubMed literature review (January 2000-November 2019) supported similarity in epidemiology of higher-risk MDS, AML, and CMML in Western and East Asian populations. Furthermore, the treatment of MDS/AML was similar in both East Asian and Western regions, with the same dose of azacitidine being the standard of care. Median overall survival in MDS following azacitidine treatment was generally comparable across regions, and the types and frequencies of molecular alterations in AML and MDS were comparable. Dose-escalation studies established the same maximum tolerated dose of pevonedistat in combination with azacitidine in Western and East Asian populations. Pevonedistat clearance was similar across races. Taken together, conservation of drug-related and disease-related intrinsic and extrinsic factors supported design of an Asia-inclusive Phase 3 trial and a pooled East Asian region. A sample size of ~ 30 East Asian patients (of ~ 450 randomized) was estimated as needed to demonstrate consistency in efficacy relative to the global population. This analysis is presented as an exemplar to illustrate application of clinical pharmacology and translational science principles in designing Asia-inclusive MRCTs. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? Azacitidine is the standard of care for myelodysplastic syndromes/low-blast acute myeloid leukemia (AML) across Western and East Asian patients. The first-in-class small-molecule inhibitor of NEDD8-activating enzyme, pevonedistat, has been investigated as a single agent in multiple studies of hematologic and nonhematologic malignancies and in combination with azacitidine in elderly patients with untreated AML. WHAT QUESTION DID THIS STUDY ADDRESS? By applying clinical pharmacology and translational science and International Conference on Harmonisation E17 principles, this study designed an East Asian-inclusive global pivotal Phase 3 trial of pevonedistat, taking into consideration drug-related and disease-related intrinsic and extrinsic factors. WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? These analyses provide scientific rationale for Asia-inclusive globalization of the pivotal, Phase 3 PANTHER trial and for pooling clinical data across the East Asian region for assessing consistency in efficacy. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? We developed a framework to facilitate efficient global clinical development of investigational therapies for rare cancers and orphan diseases in Asia-inclusive multiregional clinical trials.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Ciclopentanos/farmacologia , Drogas em Investigação/farmacologia , Farmacologia Clínica/organização & administração , Pirimidinas/farmacologia , Pesquisa Translacional Biomédica/organização & administração , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ásia/epidemiologia , Azacitidina/farmacologia , Azacitidina/uso terapêutico , Ciclopentanos/uso terapêutico , Drogas em Investigação/uso terapêutico , Carga Global da Doença , Humanos , Incidência , Cooperação Internacional , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/epidemiologia , Leucemia Mielomonocítica Crônica/tratamento farmacológico , Leucemia Mielomonocítica Crônica/epidemiologia , Dose Máxima Tolerável , Síndromes Mielodisplásicas/tratamento farmacológico , Síndromes Mielodisplásicas/epidemiologia , Pirimidinas/uso terapêutico , Enzimas Ativadoras de Ubiquitina/antagonistas & inibidores , Estados Unidos/epidemiologia
4.
J Gastroenterol ; 56(2): 181-190, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33392749

RESUMO

BACKGROUND: To evaluate the efficacy and safety of cabozantinib in Japanese patients with advanced hepatocellular carcinoma (HCC) who had progressed following one or two lines of systemic therapy including sorafenib. An exploratory evaluation in sorafenib-naïve patients was performed. METHODS: In this open-label, single-arm, phase 2 trial, patients received oral cabozantinib 60 mg once daily. The primary endpoint was progression-free survival (PFS) rate at Week 24. Secondary endpoints included PFS, overall survival (OS), objective response rate (ORR, best response of complete/partial response), disease control rate (DCR, objective response or stable disease) and safety. RESULTS: Thirty-four patients received cabozantinib across 17 centers (prior sorafenib cohort, n = 20; sorafenib-naïve cohort, n = 14). PFS rate at 24 weeks was 59.8% [90% confidence interval (CI) 36.1-77.2%] in the prior sorafenib cohort, 16.7% (90% CI 4.0-36.8%) in the sorafenib-naïve cohort and 40.1% (90% CI 24.8-55.0%) overall. Median PFS was 7.4 months for the prior sorafenib cohort, 3.6 months for the sorafenib-naïve cohort, and 5.6 months overall. OS rate at 6 months was 100.0%, 78.6% and 91.1%, respectively; DCR was 85.0%, 64.3% and 76.5%, respectively. The ORR was 0.0% for both cohorts. All patients required dose modifications due to adverse events, the most common of these were palmar-plantar erythrodysesthesia syndrome and diarrhea. Three patients (8.8%) discontinued due to adverse events other than disease progression. CONCLUSIONS: Cabozantinib 60 mg/day has a favorable benefit/risk profile for Japanese patients with advanced HCC who have previously received one or two lines of systemic anticancer therapy including sorafenib. (Clinical trial registration: NCT03586973).


Assuntos
Anilidas/farmacologia , Carcinoma Hepatocelular/tratamento farmacológico , Piridinas/farmacologia , Idoso , Anilidas/uso terapêutico , Carcinoma Hepatocelular/fisiopatologia , Feminino , Humanos , Japão , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Piridinas/uso terapêutico , Sorafenibe/farmacologia , Sorafenibe/uso terapêutico
5.
Int J Urol ; 27(11): 952-959, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32789967

RESUMO

OBJECTIVES: To evaluate the efficacy and safety of cabozantinib, through a bridging study to METEOR, in Japanese patients with advanced renal cell carcinoma who had progressed after prior tyrosine kinase inhibitor therapy. METHODS: This phase II, open-label, single-arm study (ClinicalTrials.gov registration number: NCT03339219) included adult Japanese patients with advanced renal cell carcinoma and measurable disease who had received one or more tyrosine kinase inhibitors. Patients received cabozantinib 60 mg orally once daily while there was clinical benefit, or until unacceptable toxicity or disease progression. The primary end-point was objective response rate per Response Evaluation Criteria in Solid Tumors Version 1.1. Secondary end-points included clinical benefit rate (complete or partial response, or ≥8-week stable disease), progression-free survival, overall survival and safety. RESULTS: Of the 35 patients enrolled, 68.6%, 22.9% and 8.6% had previously received one, two and three prior tyrosine kinase inhibitors, respectively. The median duration of cabozantinib exposure was 27.0 weeks (range 5.1-43.0 weeks). The objective response rate was 20.0% (90% confidence interval 9.8-34.3%), and the clinical benefit rate was 85.7% (95% confidence interval 69.7-95.2%). The 6-month estimated progression-free survival was 72.3% (95% confidence interval 53.3-84.6%); the median progression-free survival and overall survival were not reached. All patients reported adverse events, which were manageable by supportive treatment or dose modification; two patients (5.7%) discontinued therapy due to adverse events. CONCLUSIONS: The results showed that findings from METEOR can be extrapolated, and that cabozantinib 60 mg/day is a viable treatment option in Japanese patients with advanced renal cell carcinoma who had progressed after prior tyrosine kinase inhibitor therapy.


Assuntos
Antineoplásicos , Carcinoma de Células Renais , Neoplasias Renais , Adulto , Anilidas/efeitos adversos , Antineoplásicos/efeitos adversos , Carcinoma de Células Renais/tratamento farmacológico , Humanos , Japão , Neoplasias Renais/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Piridinas
6.
Clin J Am Soc Nephrol ; 14(3): 354-363, 2019 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-30755452

RESUMO

BACKGROUND AND OBJECTIVES: Imarikiren is a novel, potent, and selective direct renin inhibitor that has shown high oral availability during clinical development for the treatment of diabetic nephropathy. We evaluated the efficacy and safety of imarikiren in patients with type 2 diabetes mellitus and microalbuminuria. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a randomized, multicenter, placebo-controlled, double-blind, phase 2, dose-finding trial. A total of 415 patients were randomized to imarikiren 5, 20, 40, or 80 mg; placebo; or candesartan cilexetil 8 mg treatment for 12 weeks. The primary end point was change in log-transformed urine albumin-to-creatinine ratio from baseline to the end of treatment analyzed using analysis of covariance and a fixed sequence testing procedure. Secondary efficacy end points included urine albumin-to-creatinine ratio at each assessment point and remission and progression rates. Exploratory efficacy end points included eGFR and sitting BP before dosing. RESULTS: Changes in the urine albumin-to-creatinine ratio from baseline to the end of treatment were 16% (placebo), -16% (imarikiren 5 mg), -27% (imarikiren 20 mg), -38% (imarikiren 40 mg), -39% (imarikiren 80 mg), and -31% (candesartan cilexetil 8 mg). Urine albumin-to-creatinine ratio reductions from baseline were statistically significant in all imarikiren groups versus placebo (P<0.001 each) as well as for candesartan cilexetil 8 mg versus placebo (P<0.001). Remission rates (urine albumin-to-creatinine ratio <30 mg/g creatinine and decreased ≥30% from baseline) were higher in all imarikiren groups versus the placebo group. Incidence of adverse events was higher in the imarikiren 80-mg group (52%) versus placebo (42%) and candesartan cilexetil (43%) groups. Incidence of adverse events for the other imarikiren groups ranged from 33% to 42%. Adverse events were mild or moderate in severity. All imarikiren doses were well tolerated. CONCLUSIONS: Imarikiren resulted in a dose-dependent improvement in albuminuria compared with placebo, and it was well tolerated in patients with type 2 diabetes mellitus and microalbuminuria.


Assuntos
Albuminúria/tratamento farmacológico , Benzimidazóis/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/tratamento farmacológico , Morfolinas/uso terapêutico , Piperidinas/uso terapêutico , Inibidores de Proteases/uso terapêutico , Renina/antagonistas & inibidores , Adulto , Idoso , Albuminúria/diagnóstico , Albuminúria/etiologia , Benzimidazóis/efeitos adversos , Diabetes Mellitus Tipo 2/diagnóstico , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/etiologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Morfolinas/efeitos adversos , Piperidinas/efeitos adversos , Inibidores de Proteases/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
J Am Dent Assoc ; 150(1): 58-68, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30470390

RESUMO

BACKGROUND: The demand for orthognathic surgery has increased worldwide. Women with jaw deformity tend to have a worse quality of life than men owing to the deformity's negative effects on body image, low self-esteem, lack of self-confidence, and dissatisfaction with life. Therefore, they wish for more reliable treatment options. CASE DESCRIPTION: A woman aged 25 years and 9 months sought treatment for a convex profile and excessive gingival display caused by a skeletal Class II jaw-base relationship. Gingival exposure was up to 6.5 millimeters at full smile. She chose orthognathic surgery, and the authors performed a 2-piece segmental Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. After active orthodontic treatment, the protrusive profile was improved, and an acceptable occlusion and an attractive smile were achieved. PRACTICAL IMPLICATIONS: It is hoped that 2-piece segmental Le Fort I osteotomy becomes a common treatment option for patients with protrusive profiles and excessive gingival displays.


Assuntos
Osteotomia de Le Fort , Qualidade de Vida , Adulto , Cefalometria , Ossos Faciais , Feminino , Gengiva , Humanos , Masculino , Maxila , Osteotomia Sagital do Ramo Mandibular
8.
Clin Drug Investig ; 38(11): 1041-1051, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30194585

RESUMO

BACKGROUND AND OBJECTIVE: Imarikiren hydrochloride (TAK-272; SCO-272) is a novel direct renin inhibitor. The objective of this study was to determine the effects of renal impairment (RI) or hepatic impairment (HI) on the pharmacokinetics and safety of imarikiren. METHODS: This phase I, open-label, parallel-group comparative study evaluated the pharmacokinetics and safety of a single 40 mg oral dose of imarikiren in RI [mild, moderate, severe, or end-stage renal disease (ESRD), and on hemodialysis] or HI (mild or moderate) subjects compared with subjects with normal renal or hepatic function. RESULTS: Following administration of a single 40 mg oral imarikiren dose, the geometric mean imarikiren area under the plasma concentration-time curve from time zero to infinity (AUC∞) and maximum observed plasma concentration (Cmax) in subjects with mild, moderate, and severe RI (including non-hemodialysis and ESRD), and hemodialysis subjects compared with normal renal function subjects were approximately 0.5-, 1.2-, 2.7-, and 1.8-fold, respectively, for AUC∞; and approximately 0.6-, 0.8-, 2.1-, and 1.4-fold, respectively, for Cmax. The mean fraction of excretion of imarikiren in dialysate was ~ 3% during the 4 h dialysis period. The geometric mean imarikiren AUC∞ and Cmax in mild and moderate HI subjects compared with normal hepatic function subjects were approximately 1.0- and 1.4-fold, respectively, for AUC∞, and approximately 0.9- and 1.3-fold, respectively, for Cmax. No deaths or serious adverse events were observed; all adverse events were mild or moderate in intensity. CONCLUSIONS: RI and HI are associated with limited changes in imarikiren pharmacokinetics. Imarikiren was safe and well-tolerated, regardless of the severity of RI or HI. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02367872.


Assuntos
Benzimidazóis/administração & dosagem , Benzimidazóis/farmacocinética , Falência Renal Crônica/metabolismo , Hepatopatias/metabolismo , Morfolinas/administração & dosagem , Morfolinas/farmacocinética , Piperidinas/administração & dosagem , Piperidinas/farmacocinética , Adulto , Idoso , Área Sob a Curva , Benzimidazóis/efeitos adversos , Fármacos Cardiovasculares/administração & dosagem , Fármacos Cardiovasculares/efeitos adversos , Fármacos Cardiovasculares/farmacocinética , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/efeitos adversos , Inibidores Enzimáticos/farmacocinética , Feminino , Humanos , Rim/efeitos dos fármacos , Rim/metabolismo , Falência Renal Crônica/tratamento farmacológico , Hepatopatias/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Morfolinas/efeitos adversos , Piperidinas/efeitos adversos , Diálise Renal/tendências
9.
Diabetes Obes Metab ; 20(10): 2490-2493, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29862617

RESUMO

We aimed to explore the efficacy and safety of once-weekly trelagliptin 100 mg as an add-on therapy to insulin in Japanese patients with type 2 diabetes mellitus with inadequate glycaemic control. Patients with haemoglobin A1c (HbA1c) 7.5% to 10.0% who were receiving 8 to 40 units of insulin per day were randomized to receive, with insulin, trelagliptin 100 mg (A/A, n = 116) or placebo (P/A, n = 124) for a 12-week double-blind (DB) phase, after which all received trelagliptin for a 40-week open-label phase. Primary endpoints were HbA1c change from baseline to the end of the DB phase and adverse events (AEs). HbA1c significantly decreased in the A/A group vs the P/A group at the end of the DB phase (least square mean difference, -0.63% [95% CI, -0.83 to -0.44]: P < .0001). The frequency of treatment-emergent AEs during the DB phase was 44.0% in the A/A group and 47.6% in the P/A group. No patient experienced severe hypoglycaemia during trelagliptin treatment. Once-weekly trelagliptin 100 mg therapy with insulin demonstrated a significant reduction in HbA1c. Long-term treatment was well-tolerated, with no clinically significant hypoglycaemia, suggesting that trelagliptin with insulin is a meaningful treatment option in this patient population.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Insulina/administração & dosagem , Uracila/análogos & derivados , Adulto , Idoso , Povo Asiático , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Hemoglobinas Glicadas/efeitos dos fármacos , Hemoglobinas Glicadas/metabolismo , Humanos , Insulina/efeitos adversos , Japão , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uracila/administração & dosagem , Uracila/efeitos adversos
10.
Basic Clin Pharmacol Toxicol ; 123(5): 607-614, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29845723

RESUMO

Imarikiren hydrochloride (TAK-272/SCO-272) is a novel direct renin inhibitor with potential indications for cardiovascular and renal diseases. This phase I study evaluated the pharmacokinetics, pharmacodynamics and safety of a single oral administration of imarikiren in healthy Japanese male subjects. The Dose-Ascending part (double-blind, placebo-controlled, parallel-group design; n = 60) comprised six steps from 5 to 200 mg (n = 8 for imarikiren and n = 2 for placebo per step). The Food Effect part (n = 12) was an open-label, 2 × 2 crossover design with a dose of 50 mg to evaluate the effect of food on the pharmacokinetics and safety of imarikiren. There was a generally linear relationship between dose and area under the plasma concentration-time curve (0 to infinity) or maximum plasma concentration of imarikiren. Food had no clinically significant effect on the exposure of imarikiren. Inhibition of plasma renin activity was rapid and lasted up to 24 hr at all doses. Plasma active renin concentration increased, reaching a maximum at approximately 6 hr, in a nearly dose-dependent manner. Across both study parts, the number of subjects with treatment-emergent adverse events ranged from 0 to 3 per group with no dependency on dose. All treatment-emergent adverse events except two were mild in intensity; there were no serious adverse events or deaths. Single oral administration of imarikiren from 5 to 200 mg was safe and well tolerated. These findings suggest that further clinical development of a once-daily imarikiren regimen is warranted.


Assuntos
Benzimidazóis , Morfolinas , Piperidinas , Renina/antagonistas & inibidores , Administração Oral , Adulto , Área Sob a Curva , Benzimidazóis/administração & dosagem , Benzimidazóis/efeitos adversos , Benzimidazóis/farmacocinética , Fármacos Cardiovasculares/administração & dosagem , Fármacos Cardiovasculares/efeitos adversos , Fármacos Cardiovasculares/farmacocinética , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Monitoramento de Medicamentos/métodos , Interações Alimento-Droga , Meia-Vida , Voluntários Saudáveis , Humanos , Masculino , Morfolinas/administração & dosagem , Morfolinas/efeitos adversos , Morfolinas/farmacocinética , Piperidinas/administração & dosagem , Piperidinas/efeitos adversos , Piperidinas/farmacocinética
11.
Angle Orthod ; 88(5): 602-610, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29799272

RESUMO

OBJECTIVES: To determine the frictional force (FF) of the novel, elastic, bendable titanium-niobium (Ti-Nb) alloy orthodontic wire in stainless steel (SS) brackets and to compare it with those of titanium-nickel (Ti-Ni) and titanium-molybdenum (Ti-Mo) alloy wires. MATERIALS AND METHODS: Three sizes of Ti-Nb, Ti-Ni, and Ti-Mo alloy wires were ligated with elastic modules to 0.018-inch and 0.022-inch SS brackets. The dynamic FFs between the orthodontic wires and SS brackets were measured at three bracket-wire angles (0°, 5°, and 10°) with an Instron 5567 loading apparatus (Canton, Mass). RESULTS: FFs increased gradually with the angle and wire size. In the 0.018-inch-slot bracket, the dynamic FFs of Ti-Nb and Ti-Ni alloy wires were almost the same, and those of the Ti-Mo alloy wire were significantly greater ( P<0.05). FF values were 1.5-2 times greater in the 0.022-inch-slot bracket than in the 0.018-inch-slot bracket, regardless of alloy wire type, and the Ti-Mo alloy wire showed the greatest FF. Scanning electric microscopic images showed that the surface of the Ti-Mo alloy wire was much rougher than that of the Ti-Ni and Ti-Nb alloy wires. CONCLUSION: These findings demonstrate that the Ti-Nb alloy wire has almost the same frictional resistance as the Ti-Ni alloy wire, although it has a higher elastic modulus.


Assuntos
Fios Ortodônticos , Ligas , Elasticidade , Fricção , Técnicas In Vitro , Aço Inoxidável
12.
J Diabetes Investig ; 9(2): 354-359, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28836351

RESUMO

INTRODUCTION: Trelagliptin, a novel once-weekly oral dipeptidyl peptidase-4 (DPP-4) inhibitor, has shown favorable efficacy and safety in type 2 diabetes mellitus patients. Trelagliptin was launched in Japan, and is expected to be initially used for switchover from a daily DPP-4 inhibitor in the clinical setting. Thus, the present study was carried out to explore the efficacy and safety of trelagliptin after a daily DPP-4 inhibitor was switched to it. MATERIALS AND METHODS: This was an open-label, phase 3 exploratory study to evaluate the efficacy and safety of trelagliptin in Japanese type 2 diabetes mellitus patients who had stable glycemic control on once-daily sitagliptin therapy. Eligible patients received trelagliptin 100 mg orally before breakfast once a week for 12 weeks. The primary end-point was blood glucose by the meal tolerance test, and additional end-points were glycemic control (efficacy) and safety. RESULTS: Altogether, 14 patients received the study drug. The blood glucose did not markedly change from baseline at major assessment points in the meal tolerance test, and a decrease in blood glucose was observed at several other assessment points. Adverse events were reported in 42.9% (6/14) of patients, but all adverse events were mild or moderate in severity, and most were not related to the study drug. No cases of death, serious adverse events or hypoglycemia were reported. DISCUSSION: It is considered possible to switch a once-daily DPP-4 inhibitor to trelagliptin in type 2 diabetes mellitus patients with stable glycemic control in combination with diet and exercise therapy without any major influences on glycemic control or safety.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Uracila/análogos & derivados , Idoso , Glicemia/análise , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Feminino , Hemoglobinas Glicadas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uracila/efeitos adversos , Uracila/uso terapêutico
13.
Int J Oral Maxillofac Implants ; 32(2): 344­349, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27525519

RESUMO

PURPOSE: The purpose of this study was to evaluate the influence of placement angle and force direction on the initial stability of orthodontic miniscrews using a three-dimensional finite element model that approximates the real interface between the screw and surrounding bone. MATERIALS AND METHODS: Three-dimensional finite element models with 6-mm-long and 1.4-mm-diameter titanium miniscrews were used. Four insertion angles, ranging from 0 degrees (perpendicular to the bone surface) to 45 degrees, were examined. A load of 2 N was applied to the center of the screw head in four directions (upward, downward, and on the right and left sides). RESULTS: At the same insertion angle, the stresses on the miniscrews were highest in downward force applications, while they were the lowest in upward force applications. This means that with upward traction, stresses are more evenly distributed on the surface of the miniscrew. An analysis of the principal stress distribution in surrounding bone showed that compressive and tensile stresses increased with the angle of insertion up to 30 degrees. For larger insertion angles, the increase almost vanished. CONCLUSION: An obliquely inserted miniscrew and its surrounding tissues generally provide sufficient anchorage for 2 N of orthodontic loading, but care must be taken to avoid screw failure during placement and removal of obliquely placed miniscrews.

15.
J Orthod Sci ; 5(3): 104-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27556023

RESUMO

This article reports the orthodontic treatment of a 20-year-old patient with dental crowding and temporomandibular joint disorders (TMDs). The patient presented moderate anterior crowding with a Class I molar relationship and masticatory disturbance in the mandibular position induced by previous splint therapy. Orthodontic treatment with multi-bracket appliance was initiated to correct the anterior crowding in both dental arches, after the extraction of first premolars and third molars, and also to maintain the splint-induced position of the condyles. After 26 months of treatment, an acceptable occlusion was achieved without any TMD symptoms. After 18-month retention, flattening on the right condyle was observed, possibly as an adaptative remodeling. After 16-year retention period, the occlusion was maintained without recurrence of any TMD symptoms, indicating a long-term stability of occlusion and temporomandibular joint (TMJ) components. Our results suggest the possibility of compromised treatment in patients with TMD to achieve a long-term stability in occlusion and TMJ function.

16.
Orthod Fr ; 87(2): 229-43, 2016 Jun.
Artigo em Francês | MEDLINE | ID: mdl-27358007

RESUMO

Vertical dentoalveolar discrepancies are a common problem in orthodontic patients but are often difficult to treat with traditional mechanics. This case report illustrates the successful treatment of overerupted mandibular incisors via the indirect use of miniscrew anchorage. A woman (age, 22 years 9 months) had chief complaints of maxillary incisor protrusion and crooked teeth. An excessive curve of Spee caused by elongation of the mandibular incisors was also found. The patient was diagnosed with a severe Class II Division 1 malocclusion and a deep overbite. After extraction of the mandibular first premolars and the subsequent leveling phase, the elongated incisors were intruded with a novel method, which involved the combined use of sectional archwires and miniscrews placed in the premolar areas. After the procedure, the mandibular incisors had been intruded by 6.5 mm with no undesirable side effects. The total active treatment period was 42 months. The resultant occlusion and satisfactory facial profile were maintained after 30 months of retention. Our novel intrusion approach shows potential for correcting a deep overbite.


Assuntos
Parafusos Ósseos , Incisivo/patologia , Má Oclusão Classe II de Angle/terapia , Procedimentos de Ancoragem Ortodôntica/instrumentação , Sobremordida/terapia , Técnicas de Movimentação Dentária/instrumentação , Dente Pré-Molar/cirurgia , Cefalometria/métodos , Feminino , Seguimentos , Humanos , Miniaturização , Contenções Ortodônticas , Fios Ortodônticos , Planejamento de Assistência ao Paciente , Radiografia Panorâmica , Extração Dentária/métodos , Resultado do Tratamento , Adulto Jovem
17.
Am J Orthod Dentofacial Orthop ; 149(6): 912-22, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27242002

RESUMO

We successfully treated a Class II Division 2 patient with maxillary group distalization using interradicular miniscrews. A woman, aged 28 years 11 months, had a convex profile and an excessive overjet caused by a skeletal Class II jaw-base relationship. After leveling and alignment, titanium miniscrews were obliquely implanted between the maxillary second premolar and first molar. To distalize the maxillary dentition, nickel-titanium closing coil springs with a 2-N load were placed between the screws and the hooks on the archwire. After 28 months of active orthodontic treatment, a proper facial profile and an acceptable occlusion were achieved with a 4-mm distalization of the maxillary dentition. The resultant occlusion was stable throughout a 5-year retention period. Interradicular miniscrews were useful to distalize the maxillary dentition for correcting a Class II malocclusion. This new strategy, group distalization with miniscrews, can make the treatment simpler with greater predictability.


Assuntos
Má Oclusão Classe II de Angle/terapia , Técnicas de Movimentação Dentária/instrumentação , Adulto , Parafusos Ósseos , Feminino , Humanos , Maxila , Fatores de Tempo , Resultado do Tratamento
18.
Am J Orthod Dentofacial Orthop ; 149(5): 740-50, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27131256

RESUMO

We successfully treated a 32-year-old woman who had facial asymmetry and unilateral mandibular condylar osteochondroma using ipsilateral mandibular condylectomy and contralateral ramus osteotomy. Mirror image analysis with a noncontact 3-dimensional image scanner showed that the soft tissue on the deviated side was protruded more than 5.50 mm compared with the nondeviated side. The patient was diagnosed as having facial asymmetry with a skeletal Class III jaw-base relationship caused by unilateral mandibular condylar osteochondroma. After 18 months of preoperative orthodontic treatment, an ipsilateral condylectomy and a contralateral sagittal split ramus osteotomy were performed. As the result of postoperative orthodontic treatment for 20 months, an ideal occlusion with a Class I molar relationship and an adequate interincisal relationship was achieved. Facial asymmetry and mandibular protrusion were dramatically improved, and the total differences between the deviated and nondeviated sides were decreased to less than 1.11 mm. The acceptable occlusion and the symmetric face were maintained throughout the 1-year retention period. Our results indicated stability after condylectomy without condylar reconstruction in a patient with unilateral condylar osteochondroma.


Assuntos
Côndilo Mandibular/cirurgia , Neoplasias Mandibulares/cirurgia , Osteocondroma/cirurgia , Osteotomia Sagital do Ramo Mandibular , Adulto , Feminino , Humanos , Neoplasias Mandibulares/patologia , Osteocondroma/patologia
19.
J Diabetes Investig ; 7(5): 718-26, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27181699

RESUMO

AIMS/INTRODUCTION: Trelagliptin is a novel once-weekly oral dipeptidyl peptidase-4 inhibitor for type 2 diabetes mellitus that was first approved in Japan. We evaluated long-term safety and efficacy of trelagliptin in Japanese patients with type 2 diabetes mellitus. MATERIALS AND METHODS: This was a phase 3, multicenter, open-label study to evaluate long-term safety and efficacy of trelagliptin. Patients with type 2 diabetes mellitus inadequately controlled despite diet/exercise or treatment with one of the existing oral antidiabetic drugs along with diet/exercise received trelagliptin 100 mg orally once weekly for 52 weeks as monotherapy or combination therapies. The primary end-points were the safety variables, and the secondary end-points were glycosylated hemoglobin and fasting plasma glucose. RESULTS: A total of 680 patients received the following antidiabetic therapies: trelagliptin monotherapy (n = 248), combination with a sulfonylurea (n = 158), a glinide (n = 67), an α-glucosidase inhibitor (n = 65), a biguanide (n = 70), or a thiazolidinedione (n = 72). During the study, 79.8% of the patients experienced at least one adverse event for monotherapy, 87.3% for combination with a sulfonylurea, 77.6% for a glinide, 81.5% for an α-glucosidase inhibitor, 64.3% for a biguanide, and 84.7% for a thiazolidinedione, respectively. Most of the adverse events were mild or moderate. The change in glycosylated hemoglobin from baseline at the end of the treatment period was -0.74 to -0.25% for each therapy. CONCLUSIONS: Once-weekly oral trelagliptin provides well-tolerated long-term safety and efficacy in both monotherapy and combination therapies in Japanese patients with type 2 diabetes mellitus.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Uracila/análogos & derivados , Administração Oral , Idoso , Diabetes Mellitus Tipo 2/sangue , Dipeptidil Peptidase 4/metabolismo , Inibidores da Dipeptidil Peptidase IV/administração & dosagem , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Quimioterapia Combinada/efeitos adversos , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uracila/administração & dosagem , Uracila/efeitos adversos , Uracila/uso terapêutico
20.
Ann Biomed Eng ; 44(8): 2480-2488, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26795976

RESUMO

Osteoporotic fracture has become a major public health problem, and until today, the treatments available are not satisfactory. While there is growing evidence to support the individual treatment of parathyroid hormone (PTH) administration and low-intensity pulsed ultrasound (LIPUS) exposure as respectively systemic and local therapies during osteoporotic fracture healing, their effects have not yet been investigated when introduced concurrently. This study aimed to evaluate the effects of combined treatment with PTH (1-34) and LIPUS on fracture healing in ovariectomized (OVX) rats. Thirty-two, 12-week-old female Sprague-Dawley rats were OVX to induce osteoporosis. After 12 weeks, the rats underwent surgery to create bilateral mid-diaphyseal fractures of proximal tibiae. All animals were randomly divided into 4 groups (n = 8 for each): control group as placebo, PTH group, LIPUS group, and combined group. PTH group had PTH administration at a dose of 30 µg/kg/day for 3 days/week for 6 weeks. LIPUS group received ultrasound 5 days/week for 20 min/day for 6 weeks and combined group had both PTH administration and LIPUS exposure for 6 weeks. Fracture healing was observed weekly by anteroposterior radiography and micro-CT. Five weeks after the fracture, the tibia were harvested to permit histological assessments and at week 6, for mechanical property of the fracture callus. Micro-CT showed that the PTH and combined groups exhibited significantly higher BMD and trabecular bone integrity than control group at weeks 4-6. Radiography, fracture healing score and mean callus area indicated that the combined group revealed better healing processes than the individual groups. Mechanically, bending moment to failure was significantly higher in LIPUS, PTH and combined groups than in control group. These data suggest that the combined treatment of PTH and LIPUS have been shown to accelerate fracture bone healing and enhance bone properties rather than single agent therapy, and may be considered as a treatment remedy for fracture healing in postmenopausal osteoporosis.


Assuntos
Consolidação da Fratura/efeitos dos fármacos , Fraturas por Osteoporose/terapia , Teriparatida/farmacologia , Fraturas da Tíbia/terapia , Ondas Ultrassônicas , Animais , Modelos Animais de Doenças , Feminino , Humanos , Fraturas por Osteoporose/metabolismo , Ovariectomia , Ratos , Ratos Sprague-Dawley , Teriparatida/farmacocinética , Fraturas da Tíbia/metabolismo
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