Résumé
ABSTRACT Objectives: To evaluate the effectiveness of adding dapagliflozin as an intensification strategy for the treatment of patients with uncontrolled type 2 diabetes mellitus (T2DM). Materials and methods: A historical cohort study was conducted in 123 adult patients over 18 years old who were diagnosed with uncontrolled T2DM, who received dapagliflozin add-on to their dual base treatment: metformin plus glibenclamide (n = 32), metformin plus saxagliptin (n = 29), metformin plus exenatide (n = 28), or metformin plus insulin (n = 34). The endpoints were evaluated using analysis of variance. Results: All the patients completed a 52-week follow-up. Overall, 52.85% of patients were female, the Hispanic population represented the largest proportion of patients in all groups (60.98%), and the mean ± SD patient age and body weight were 55.05 ± 7.58 years and 83.55 ± 9.65 kg, respectively. The mean ± SD duration of T2DM, glycated hemoglobin (HbA1c), and fasting plasma glucose (FPG) were 5.93 ± 2.98 years, 8.1 ± 0.53%, and 166.03 ± 26.80 mg/dL, respectively. The grand mean changes of HbA1c, FPG, body weight and blood pressure showed a decreasing trend during the study period and it was statistically significant in all groups (p-value = <0.001). The proportion of patients achieving HbA1c target (<7%) was highest in the group that used a dapagliflozin add-on to metformin plus saxagliptin. Conclusion: The addition of dapagliflozin as an alternative for intensification of dual therapy consistently improved, not only FPG and HbA1c, but also body weight and blood pressure, with statistically significant results.
Sujets)
Humains , Femelle , Adulte , Composés benzhydryliques/usage thérapeutique , Diabète de type 2 , Diabète de type 2/traitement médicamenteux , Glucosides/usage thérapeutique , Hypoglycémiants , Hypoglycémiants/usage thérapeutique , Glycémie , Hémoglobine glyquée , Études de cohortes , Résultat thérapeutique , Colombie , Association de médicaments , Insuline/usage thérapeutique , Metformine/usage thérapeutiqueSujets)
Humains , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Composés benzhydryliques/usage thérapeutique , Maladies cardiovasculaires/prévention et contrôle , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Glucosides/usage thérapeutique , Défaillance cardiaque/traitement médicamenteux , Composés benzhydryliques/effets indésirables , Maladies cardiovasculaires/mortalité , Essais contrôlés randomisés comme sujet , Études multicentriques comme sujet , Évolution de la maladie , Diabète de type 2/complications , Inhibiteurs du cotransporteur sodium-glucose de type 2/effets indésirables , Glucosides/effets indésirables , Défaillance cardiaque/complications , Défaillance cardiaque/physiopathologie , Hospitalisation/statistiques et données numériquesSujets)
Humains , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Composés benzhydryliques/usage thérapeutique , Diabète de type 2/traitement médicamenteux , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Glucosides/usage thérapeutique , Défaillance cardiaque/traitement médicamenteux , Débit systolique/effets des médicaments et des substances chimiques , Composés benzhydryliques/effets indésirables , Hémoglobine glyquée/analyse , Agents cardiovasculaires/usage thérapeutique , Maladies cardiovasculaires/mortalité , Essais contrôlés randomisés comme sujet , Études multicentriques comme sujet , Association thérapeutique , Dysfonction ventriculaire gauche/complications , Dysfonction ventriculaire gauche/traitement médicamenteux , Diabète de type 2/complications , Inhibiteurs du cotransporteur sodium-glucose de type 2/effets indésirables , Glucosides/effets indésirables , Défaillance cardiaque/complicationsRésumé
SUMMARY Type 2 diabetes mellitus is an important public health problem, with a significant impact on cardiovascular morbidity and mortality and an important risk factor for chronic kidney disease. Various hypoglycemic therapies have proved to be beneficial to clinical outcomes, while others have failed to provide an improvement in cardiovascular and renal failure, only reducing blood glucose levels. Recently, sodium-glucose cotransporter-2 (SGLT2) inhibitors, represented by the empagliflozin, dapagliflozin, and canagliflozin, have been showing satisfactory and strong results in several clinical trials, especially regarding the reduction of cardiovascular mortality, reduction of hospitalization due to heart failure, reduction of albuminuria, and long-term maintenance of the glomerular filtration rate. The benefit from SGLT2 inhibitors stems from its main mechanism of action, which occurs in the proximal tubule of the nephron, causing glycosuria, and a consequent increase in natriuresis. This leads to increased sodium intake by the juxtaglomerular apparatus, activating the tubule glomerular-feedback and, finally, reducing intraglomerular hypertension, a frequent physiopathological condition in kidney disease caused by diabetes. In addition, this class of medication presents an appropriate safety profile, and its most frequently reported complication is an increase in the incidence of genital infections. Thus, these hypoglycemic agents gained space in practical recommendations for the management of type 2 diabetes mellitus and should be part of the initial therapeutic approach to provide, in addition to glycemic control, cardiovascular outcomes, and the renoprotection in the long term.
Sujets)
Humains , Maladies cardiovasculaires/prévention et contrôle , Diabète de type 2/traitement médicamenteux , Transporteur-2 sodium-glucose/pharmacologie , Inhibiteurs du cotransporteur sodium-glucose de type 2/pharmacologie , Hypoglycémiants/pharmacologie , Maladies du rein/prévention et contrôle , Composés benzhydryliques/usage thérapeutique , Maladies cardiovasculaires/étiologie , Maladies cardiovasculaires/mortalité , Diabète de type 2/complications , Néphropathies diabétiques/étiologie , Néphropathies diabétiques/métabolisme , Néphropathies diabétiques/prévention et contrôle , Transporteur-2 sodium-glucose/usage thérapeutique , Canagliflozine/usage thérapeutique , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Débit de filtration glomérulaire , Glucose/métabolisme , Glucosides/usage thérapeutique , Hypoglycémiants/usage thérapeutique , Rein/effets des médicaments et des substances chimiques , Rein/physiopathologie , Rein/métabolisme , Maladies du rein/étiologie , Maladies du rein/métabolismeRésumé
SUMMARY Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are drugs that act by maintaining glycosuria. Recent studies have shown promising effects of these in the treatment of type 2 diabetes mellitus (DM2). However, there may be an increased risk of developing urinary tract infections (UTIs) in patients treated with these. Our study aims to analyze the association between the risk of UTI in patients treated with SGLT2i. A systematic review of the literature was carried out by randomized clinical trials, totalizing at the end of the selection 23 articles that were statistically evaluated. The incidence of UTI was generally demonstrated in articles and in different subgroups: patients on SGLT2i monotherapy or on combination therapy; according to specific comorbidities of each sample or according to the drug used. They noticed an increase in the chance of UTI in the SGLT2i groups compared to the control groups on placebo or other oral antidiabetic agents. This increased chance was found predominantly with the use of Dapagliflozin, Canagliflozin, and Tofogliflozin, regardless of the dosing. Lastly, stands out that the dimension of UTI chances for DM2 patients who use SGLT2i remains to be more strictly determined.
RESUMO Os inibidores do cotransportador de sódio-glicose do tipo 2 (SGLT2i) são medicamentos que atuam mantendo a glicosúria. Estudos recentes têm demonstrado efeitos promissores desses no tratamento de diabetes mellitus tipo 2 (DM2). No entanto, pode haver um risco aumentado de desenvolver infecções do trato urinário (UTI) em pacientes tratados com essa classe de medicação. Nosso estudo tem como objetivo analisar a associação entre o risco de desenvolver UTI em pacientes tratados com SGLT2i. Uma revisão sistemática da literatura foi realizada por ensaios clínicos randomizados, totalizando, ao final da seleção, 23 artigos que foram avaliados estatisticamente. A incidência de UTI foi demonstrada genericamente de acordo com os dados dos artigos e em diferentes subgrupos: pacientes em monoterapia com SGLT2i ou em terapia combinada, de acordo com as comorbidades específicas de cada amostra ou de acordo com a droga utilizada. Verificou-se um aumento na chance de UTI nos grupos SGLT2i em comparação com os grupos de controle em placebo ou outros agentes antidiabéticos orais. Essa chance aumentada foi encontrada predominantemente com uso de Dapagliflozina, Canagliflozina e Tofoglifozina, independentemente da dosagem. Por fim, ressaltou-se que as chances de UTI em pacientes com DM2 em uso de SGLT2i ainda precisam ser mais bem determinadas.
Sujets)
Humains , Infections urinaires/étiologie , Diabète de type 2/traitement médicamenteux , Inhibiteurs du cotransporteur sodium-glucose de type 2/effets indésirables , Composés benzhydryliques/effets indésirables , Composés benzhydryliques/usage thérapeutique , Essais contrôlés randomisés comme sujet , Facteurs de risque , Diabète de type 2/complications , Canagliflozine/effets indésirables , Canagliflozine/usage thérapeutique , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Glucosides/effets indésirables , Glucosides/usage thérapeutiqueRésumé
ABSTRACT Objective: This analysis compared the efficacy and safety of the sodium-glucose cotransporter-2 (SGLT2) inhibitor, dapagliflozin, and the dipeptidyl peptidase-4 (DPP4) inhibitor, saxagliptin, both added on to metformin. Materials and methods: This was a post-hoc analysis from a double-blind, randomized, 24-week clinical trial (NCT01606007) of patients with type 2 diabetes (T2D) inadequately controlled with metformin. We compared the dapagliflozin 10 mg (n = 179) and saxagliptin 5 mg (n = 176) treatment arms. Results: Dapagliflozin showed significantly greater mean reductions versus saxagliptin in HbA1c (difference versus saxagliptin [95% CI]: −0.32% [-0.54, −0.10]; p < 0.005), fasting plasma glucose (-0.98 [-1.42, −0.54] mmol/L; p < 0.0001), body weight (-2.39 [-3.08, −1.71] kg; p < 0.0001) and systolic blood pressure (SBP) (-3.89 [-6.15, −1.63] mmHg; p < 0.001). More dapagliflozintreated than saxagliptin-treated patients achieved the composite endpoint of HbA1c reduction ≥ 0.5%, weight loss ≥ 2 kg, SBP reduction ≥ 2 mmHg and no major/minor hypoglycemia (24% versus 7%). No major events of hypoglycemia were reported. More patients on dapagliflozin (6%) versus saxagliptin (0.6%) experienced genital infections. Conclusion: Dapagliflozin demonstrated greater glycemic efficacy than saxagliptin with additional benefits on weight and SBP, and the safety profile was consistent with previous studies.
Sujets)
Humains , Mâle , Femelle , Adulte d'âge moyen , Composés benzhydryliques/usage thérapeutique , Adamantane/analogues et dérivés , Diabète de type 2/traitement médicamenteux , Dipeptides/usage thérapeutique , Inhibiteurs de la dipeptidyl-peptidase IV/usage thérapeutique , Glucosides/usage thérapeutique , Composés benzhydryliques/effets indésirables , Glycémie/effets des médicaments et des substances chimiques , Pression sanguine/effets des médicaments et des substances chimiques , Poids/effets des médicaments et des substances chimiques , Adamantane/effets indésirables , Adamantane/usage thérapeutique , Méthode en double aveugle , Diabète de type 2/sang , Dipeptides/effets indésirables , Transporteur-2 sodium-glucose/usage thérapeutique , Inhibiteurs de la dipeptidyl-peptidase IV/effets indésirables , Hypoglycémiants/usage thérapeutique , Metformine/usage thérapeutiqueRésumé
Summary Introduction: Diabetes mellitus is one of the most common chronic diseases in the world, with high morbidity and mortality rates, resulting in a greatly negative socioeconomic impact. Although there are several classes of oral antidiabetic agents, most of the patients are outside the therapeutic goal range. Objective: To review the use of SGLT-2 inhibitors in the treatment of type 2 diabetes mellitus, focusing on their favorable and unfavorable effects, as well as on cardiovascular profile. Method: A literature search on Pubmed database was performed using the following keywords: "SGLT-2 inhibitors," "dapagliflozin," "empagliflozin," "canagliflozin." Results: SGLT-2 inhibitors are a class of oral antidiabetic drugs directed to the kidney. Their mechanism of action is to reduce blood glucose by inducing glycosuria. Extra-glycemic benefits have been described, such as weight loss, decline in blood pressure and levels of triglycerides and uric acid, and they can slow the progression of kidney disease. Genitourinary infections are the main side effects. There is a low risk of hypotension and hypoglycemia. Diabetic ketoacidosis is a serious adverse effect, although rare. Empagliflozin has already had its cardiovascular benefit demonstrated and studies with other drugs are currently being performed. Conclusion: SGLT-2 inhibitors are a new treatment option for type 2 diabetes mellitus, acting independently of insulin. They have potential benefits other than the reduction of blood glucose, but also carry a risk for adverse effects.
Resumo Introdução: O diabetes mellitus é uma das doenças crônicas mais frequentes no mundo, com altas taxas de morbimortalidade, resultando em um grande impacto negativo socioeconômico. Apesar de existirem diversas classes de antidiabéticos orais, a maioria dos pacientes acometidos está fora da meta terapêutica. Objetivo: Revisar o uso dos inibidores da SGLT-2 no tratamento do diabetes mellitus tipo 2, com enfoque nos efeitos favoráveis, desfavoráveis e no perfil cardiovascular. Método: Foi realizada uma pesquisa bibliográfica transversal com artigos científicos obtidos da base de dados Pubmed, utilizando os descritores: "SGLT-2 inhibitors", "dapagliflozin", "empagliflozin", "canagliflozin". Resultados: Os inibidores da SGLT-2 são uma classe de antidiabéticos orais com atuação no rim. O mecanismo de ação é reduzir a glicemia induzindo glicosúria. Benefícios extraglicêmicos já foram descritos, como redução de peso, pressão arterial, triglicerídeos e ácido úrico, além de retardar a progressão da doença renal. O principal efeito colateral é a infecção geniturinária, com baixo risco de hipotensão e hipoglicemia. Cetoacidose diabética é um efeito adverso grave, mas infrequente. A empagliflozina já teve seu benefício cardiovascular demonstrado, e estudos com outras drogas estão em andamento. Conclusão: Os inibidores da SGLT-2 são uma nova opção de tratamento do diabetes mellitus tipo 2, que atua de forma insulino-independente e com potenciais benefícios adicionais, além da redução da glicemia, mas também com risco de efeitos adversos.
Sujets)
Humains , Diabète de type 2/traitement médicamenteux , Inhibiteurs du cotransporteur sodium-glucose de type 2 , Hypoglycémiants/usage thérapeutique , Composés benzhydryliques/usage thérapeutique , Glycémie/effets des médicaments et des substances chimiques , Transporteur-2 sodium-glucose , Canagliflozine/usage thérapeutique , Glucosides/usage thérapeutique , Hypoglycémiants/effets indésirables , Rein/effets des médicaments et des substances chimiquesRésumé
Dapaglifozina, un inhibidor del cotransportador de sodio-glucosa 2 (I-SGLT2) induce glucosuria y reduce la glicemia en adultos con diabetes tipo 2. Objetivo: Presentar una cetosis diabética normoglicémica en una adolescente con diabetes tipo 1 (DM1) que recibía dapaglifozina y alertar sobre el riesgo del uso I-SGLT2 que parece promisorio, pero no está aprobado en niños ni en DM1. Caso clínico: Paciente de 17 años sin cetosis durante 9 años con DM1, inició dapaglifozina 10 mg/día para reducir la insulina y el peso. Durante 11 meses de tratamiento tuvo cetonas capilares indetectables, redujo el índice de masa corporal 23,9 a 21,1 kg/m², la insulina basal 40 a 17 U, la hemoglobina glicosilada 8,3 a 7,5%, la glicemia capilar 175 a 161 mg/dl y la variabilidad de la glucosa (desvío estándar 85 a 77). Inesperadamente aparecieron náuseas y vómitos. La paciente portaba bomba de insulina con monitorización continua de glucosa, bien calibrada (glucosas intersticiales concordantes con glicemias), que mostraba glucosa estable bajo 200 mg/dl. Recibió insulina pero los vómitos persistieron; en tres horas, aparecieron deshidratación y desmayos, con cetonas 4,6 nmol/l y glicemia 224 mg/dl. Recibió suero fisiológico, ondansetrón, carbohidratos y varias dosis de insulina con pronta recuperación del estado general e hidratación, sin embargo, la cetosis continuó durante 24 horas. Cabe destacar que la bomba estaba funcionando bien y no se cambió la cánula. Al superar la cetosis, continuó con la misma cánula con buen control metabólico. Conclusión: Es importante sospechar la cetosis diabética normoglicémica por ser de riesgo vital.
Dapagliflozin, an insulin-independent sodium-glucose cotransporter 2 inhibitor (SGLT2-I) induces glycosuria and reduces hyperglycemia in adults with type 2 diabetes. Objective: To present an euglycemic diabetic ketosis in an adolescent with type 1 diabetes (T1D) receiving dapagliflozin, to alert about the risk of a drug not approved in children nor in T1D. Case report: A 17 years old adolescent with T1D during 9 years, was started on dapagliflozin 10 mg / day to reduce insulin dose and weight. During 11 months on treatment, capillaries ketones were undetectable and she exhibited a reduction in body mass index 23.9 to 21.1 kg/m2, basal insulin 40 to 17 U, glycated hemoglobin 8.3 to 7.5%, capillary glucose 175 to 161 mg/dl and glucose variability (standard deviation) 85 to 77. Suddenly nausea and vomits appeared. The patient was on an insulin pump and well calibrated continuous glucose monitoring, showing stable glucose levels under 200 mg/dl, and an insulin bolus was delivered. Vomiting without hyperglycemia persisted; three hours later, she was severely dehydrated and fainting, with ketones 4.6 nmol/l and glucose 224 mg/dl. She received IV saline fluids, ondansetron, carbohydrates and several insulin boluses. Hydration and general condition improved soon, however despite several insulin doses, ketosis continued for 24 hours. It is remarkable that the pump was working well and the cannula was not changed. After the ketosis was resolved, she continued using the same cannula with good metabolic control. Conclusion: Euglycemic ketosis is a life-threatening condition that must be suspected.
Sujets)
Humains , Femelle , Adolescent , Composés benzhydryliques/effets indésirables , Acidocétose diabétique/induit chimiquement , Diabète de type 1/traitement médicamenteux , Glucosides/effets indésirables , Hypoglycémiants/effets indésirables , Insuline/usage thérapeutique , Composés benzhydryliques/usage thérapeutique , Glycémie/métabolisme , Marqueurs biologiques/sang , Acidocétose diabétique/diagnostic , Acidocétose diabétique/sang , Diabète de type 1/complications , Diabète de type 1/sang , Association de médicaments , Glucosides/usage thérapeutique , Hypoglycémiants/usage thérapeutiqueRésumé
Objective: To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years). Methods: From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador). The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. Results: The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012); "Have you been absent from school/work in the last 12 months?" (p < 0.001); "Have you discontinued your asthma relief or control medication in the last 12 months?" (p = 0.008). In addition, 30.2% of the patients in the 12- to 17-year age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups), whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups). Conclusions: In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance. .
Objetivo: Avaliar o impacto da asma em pacientes segundo as faixas etárias de 12-17 anos, 18-40 anos e ≥ 41 anos no Brasil. Métodos: Os dados de 400 pacientes com asma diagnosticada por um médico e residentes de quatro capitais estaduais brasileiras (São Paulo, Rio de Janeiro, Curitiba e Salvador) foram obtidos em um inquérito realizado em países da América Latina em 2011. Os dados foram coletados por meio de um questionário padronizado em entrevista presencial com os pacientes ou com os pais/responsáveis daqueles < 18 anos. As questões abordavam controle da asma, número de hospitalizações, número de consultas de urgência, absenteísmo na escola/trabalho e impactos da asma na qualidade de vida, sono e lazer. Os dados foram estratificados pelas faixas etárias selecionadas. Resultados: Em comparação com os grupos de pacientes adultos, houve uma proporção significativamente maior no grupo 12-17 anos em relação a ter ao menos um episódio de asma grave que impediu o paciente a continuar a jogar ou a se exercitar nos últimos 12 meses (p = 0,012), absenteísmo escolar/trabalho nos últimos 12 meses (p < 0,001), e interrupção de medicação para controle ou prevenção da asma nos últimos 12 meses (p = 0,008). Além disso, 30,2% dos pacientes na faixa etária 12-17 anos relataram que esforços físicos normais eram atividades muito limitantes (p = 0,010 vs. outros grupos), enquanto 14% dos pacientes do grupo ≥ 41 anos descreveram as atividades sociais como muito limitantes (p = 0,011 vs. outros grupos). Conclusões: Nessa amostra, o impacto da asma foi maior nos pacientes com idade entre 12 e 17 anos do que nos adultos, e isso pode ser atribuído à baixa aderência ao tratamento. .
Sujets)
Femelle , Humains , Mâle , Adulte d'âge moyen , Composés benzhydryliques/usage thérapeutique , Glycémie/métabolisme , /traitement médicamenteux , Glucosides/usage thérapeutique , Hypoglycémiants/usage thérapeutique , Metformine/usage thérapeutique , Pression sanguine , Poids , Essai clinique , Études de cohortes , Relation dose-effet des médicaments , Méthode en double aveugle , Association de médicaments , /sang , Études de suivi , Hémoglobine glyquée/analyse , Facteurs tempsRésumé
Objective To evaluate the effects of terazosin and tolterodine on ureteral stent discomfort. Materials and Methods Of 163 patients assessed for eligibility, 104 patients were randomly assigned to receive placebo, 2 mg of terazosin twice daily, 2 mg of tolterodine daily, or both terazosin plus tolterodine during the stenting period. Prior to stenting and at stent removal, the International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) subscore and the Visual Analog Scale for Pain were determined. The patients also reported their analgesic use during the stenting period. Results Ninety-four patients completed the study. We noted significant decreases in the total IPSS scores (p = 0.002), irritative subscore (p = 0.039), QoL (p = 0.001), flank pain (p = 0.013), voiding pain (p = 0.01) and amount of analgesics used (p = 0.02) in the groups. However, neither the obstructive subscore nor the suprapubic pain improved significantly (p = 0.251 and p = 0.522, respectively). The patients receiving terazosin plus tolterodine experienced significant reductions in the total IPSS, irritative symptoms, QoL, flank pain, voiding pain and decreased analgesics use compared with those patients receiving placebo. However, compared with placebo, terazosin monotherapy did not affect pain levels, and tolterodine monotherapy did not improve QoL, flank pain or analgesics use. Conclusions Terazosin plus tolterodine improves ureteral stent-related complications, including irritative symptoms, the amount of analgesics used, QoL, flank pain and voiding pain but does not decrease obstructive symptoms or suprapubic pain. This trial was registered at www.clinicaltrials.gov as NCT01530243. .
Sujets)
Adolescent , Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Composés benzhydryliques/usage thérapeutique , Crésols/usage thérapeutique , Phénylpropanolamine/usage thérapeutique , Prazosine/analogues et dérivés , Endoprothèses/effets indésirables , Uretère/effets des médicaments et des substances chimiques , Agents urologiques/usage thérapeutique , Méthode en double aveugle , Ablation de dispositif/effets indésirables , Douleur du flanc/traitement médicamenteux , Études prospectives , Prazosine/usage thérapeutique , Qualité de vie , Enquêtes et questionnaires , Facteurs temps , Résultat thérapeutique , Échelle visuelle analogiqueRésumé
Modafinil has been used as a pharmaceutical associated whit antidepressives in depressions which have relevant symptoms of fatigue, hypersomnia, or alterations in attention during the acute episode or in the residual symptoms when a total regression in not possible. Due to the specific characteristics of these symptoms, it has been postulated for the treatment of atypical and winter depressions, because of the prevalence somnolence in these groups. The clinical studies show that modafinil has a lower risk in turning to mania in the treatment of depressive groups.
El modafinilo e ha empleado como fármaco asociado a antidepresivos en depresiones que poseen como síntomas relevantes fatiga, hipersomnia o alteraciones de la atención durante el episodio agudo o en los síntomas residuales al no lograrse la remisión completa. Debido a sus características específicas sobre estos síntomas, ha sido postulado para el tratamiento de depresiones atípicas y depresiones invernales, por el predominio de la somnolencia en estos cuadros. Los estudios clínicos señalan que el modafinilo tendría un menor riesgo de viraje a manía en el tratamiento de los cuadros depresivos.
Sujets)
Humains , Composés benzhydryliques/usage thérapeutique , Dépression/traitement médicamenteux , Troubles de l'humeur/traitement médicamenteux , Troubles du sommeil par somnolence excessive , Stimulants du système nerveux central/usage thérapeutiqueRésumé
We compared the effects of bladder training and/or tolterodine as first line treatment in female patients with overactive bladder (OAB). One hundred and thirty-nine female patients with OAB were randomized to treatment with bladder training (BT), tolterodine (To, 2 mg twice daily) or both (Co) for 12 weeks. Treatment efficacy was measured by micturition diary, urgency scores and patients' subjective assessment of their bladder condition. Mean frequency and nocturia significantly decreased in all treatment groups, declining 25.9% and 56.1%, respectively, in the BT group; 30.2% and 65.4%, respectively, in the To group; and 33.5% and 66.3%, respectively in the Co group (p<0.05 for each). The decrease in frequency was significantly greater in the Co group than in the BT group (p<0.05). Mean urgency score decreased by 44.8%, 62.2% and 60.2% in the BT, To, and Co groups, respectively, and the improvement was significantly greater in the To and Co groups than in the BT group (p<0.05 for each). Although BT, To and their combination were all effective in controlling OAB symptoms, combination therapy was more effective than either method alone. Tolterodine alone may be instituted as a first-line therapy, but may be more effective when combined with bladder training.
Sujets)
Adulte d'âge moyen , Humains , Femelle , Vessie hyperactive/thérapie , Résultat thérapeutique , Apprentissage de la propreté , Phénylpropanolamine/usage thérapeutique , , Antagonistes muscariniques/usage thérapeutique , Crésols/usage thérapeutique , Association thérapeutique , Composés benzhydryliques/usage thérapeutique , Thérapie comportementale/méthodesRésumé
OBJECTIVES: To study the urinary symptoms and quality of life changes in Thai women with overactive bladder (OAB) after tolterodine treatment. MATERIAL AND METHOD: Thirty women (aged 30-77 years) diagnosed as having OAB at the Gynecology Clinic, King Chulalongkorn Memorial Hospital from January to April 2004 were included in the present study. Tolterodine 2 mg, twice daily was given. After 8 weeks treatment, changes in micturition diary variables and tolerability were determined. Short form 36 (SF36) questionaires (Thai version) were given before and after 8 weeks of treatment. RESULTS: At 8 weeks, all micturition per day decreased from 16. 7 +/- 5. 3 to 6. 7 +/- 2.4 times per day. The number of nocturia episodes decreased from 5.4 +/- 4.2 to 1.1 +/- 1.0 times per night. The most common side effect was dry month in 5 cases (16.7%) with 2 cases reporting a moderate degree and 1 case with severe degree. Only one case (3.3%) withdrew from the present study due to a severe dry mouth. The SF-36 scores changed significantly in the domains of physical functioning, role function emotional, social function and mental heath. CONCLUSION: Tolterodine was well tolerated and its effects improved the quality of life in Thai women with OAB.
Sujets)
Adulte , Sujet âgé , Composés benzhydryliques/usage thérapeutique , Crésols/usage thérapeutique , Femelle , Humains , Adulte d'âge moyen , Antagonistes muscariniques/usage thérapeutique , Phénylpropanolamine/usage thérapeutique , Études prospectives , Qualité de vie , Enquêtes et questionnaires , Thaïlande , Résultat thérapeutique , Incontinence urinaire/traitement médicamenteuxRésumé
Trinta e dois pacientes portadores de Urticária Crônica Idiopática foram submetidos a um estudo duplo-cego, comparativo, de mais de 6 semanas de tratamento com a dose diária oral de 10mg de cetirizina e 60mg, duas vezes ao dia, de terfenadina. A eficácia dos dois medicamentos mostrou-se equivalente com relaçäo à regressäo das pápulas, eritema e prurido. A terfenadina apresentou uma incidência menor de sonolência enquanto a cetirizina mostrou-se mais eficaz em diminuir a reatividade da pele à histamina
Sujets)
Humains , Adolescent , Adulte , Adulte d'âge moyen , Mâle , Femelle , Composés benzhydryliques/usage thérapeutique , Hydroxyzine/usage thérapeutique , Urticaire/traitement médicamenteux , Méthode en double aveugle , Association de médicaments , Tolérance aux médicamentsRésumé
Em um estudo duplo-cego, foi comparada a eficácia do regime posológico tradicional de terfenadina, de 60mg a cada 12 horas, com o regime de 120mg em dose única diária pela manhä, no tratamento da rinite alérgica perene. Dois grupos semelhantes de 15 pacientes cada, com rinite alérgica perene, receberam alterantivamente um dos dois regimes posológicos. A intensidade dos sintomas foi avaliada tanto pelo pesquisador, antes e ao final de um período de 7 dias de tratamento, como diariamente pelo paciente, através de uma escala de 4 pontos. Na avaliaçäo do médico e dos pacientes, ambos os regimes foram eficazes em reduzir os sintomas da rinite, embora os espirros, isoladamente, tenham melhorado mais com o regime de 60mg BID do que com o tratamento em dose única diária. Entretanto, considerando-se a evoluçäo global dos pacientes e a eficácia clínica do tratamento, näo houve diferenças estatisticamente significantes entre os dois regimes posológicos. A terfenadina, na dose única matinal de 120mg, além de eficaz, é bem tolerada e odferece uma alternativa mais conveniente para o tratamento da rinite perene
Sujets)
Humains , Enfant , Adolescent , Adulte , Adulte d'âge moyen , Mâle , Femelle , Composés benzhydryliques/usage thérapeutique , Rhinite spasmodique apériodique/traitement médicamenteuxRésumé
Vinte pacientes adultos, com rinite alérgica perene, foram tratados com terfenadina, 60 mg, duas vezes ao dia, durante 20 semanas. Avaliaram-se a eficácia e a tolerabilidade da droga. Em 90% dos casos um alívio sintomático completo ou moderado foi obtido. Com outros antagonistas H1, a terfenadina näo foi completamente eficaz no alívio da congestäo nadsal. A ocorrência de sonolência e outros efeitos colaterais foi insignificante. Näo foi observado nenhum resultado laboratorial anormal após o tratamento. O eletrocardiograma e o exame oftalmológicos também permaneceram normais. Estes resultados permitem ao autor recomendar o uso da terfenadina como droga de primeira escolha no tratamento a longo prazo da rinite alérgica perene
Sujets)
Humains , Enfant , Adolescent , Adulte , Adulte d'âge moyen , Mâle , Femelle , Composés benzhydryliques/usage thérapeutique , Techniques in vitro , Rhinite spasmodique apériodique/traitement médicamenteux , Méthode en double aveugle , Tolérance aux médicaments , Études de suivi , Tests cutanés , Facteurs tempsRésumé
Em estudo aberto, näo comparativo, 20 pacientes com urticária foram avaliados após 14 dias de tratamento com Terfenadine. Houve regressäo do porcentual de superfície corpórea afetada tanto no 7§ como no 14§ dias de avaliaçäo, assim como da intensidade dos sintomas. Reaçöes adversas de leve intensidade foram relatadas por 3 (15%) dos 20 pacientes
Sujets)
Enfant , Adolescent , Adulte , Adulte d'âge moyen , Humains , Mâle , Femelle , Composés benzhydryliques/usage thérapeutique , Urticaire/traitement médicamenteuxRésumé
Tras un análisis un tanto extensivo de los conceptos antiguos y modernos sobre utilización de antihistamínicos como complementos terapéuticos en el tratamiento sintomático del asma, describimos dos series de investigaciones clínicas. Hemos comparado, en pacientes asmáticos, el efecto broncodilatador o preventivo de la bronco-obstrucción producido por el ejercicio físico de un derivado xántico, la oxitrifilina, administrada sola o en asociación a la terfenadina, uno de los antihistamínicos recientemente introducidos en la terapéutica y que no provoca efectos depresivos sobre el sistema nerviosos central. Para comparación se han utilizado los correspondientes grupos testigos a los que se les administró placebo. Los resultados demuestran que cuando la terfenadina se administra con antelación a la oxitrifilina aumenta el efecto broncodilatador de esta substancia y también potencializa el efecto preventivo de la bronco-obstrucción que se produce en los asmáticos sometidos a ejercicio físico. La terfenadina no produjo efectos depresivos ni anticolinérgicos
Sujets)
Humains , Asthme/traitement médicamenteux , Antihistaminiques des récepteurs H1/usage thérapeutique , Composés benzhydryliques/usage thérapeutique , Choline/analyse , Antihistaminiques des récepteurs H1/pharmacologie , Théophylline/analyseRésumé
La terfenadina es un nuevo bloqueador específico de los receptores H1 periféricos. Diversos estudios clínicos realizados en los Estados Unidos y Europa han demostrado su eficacia en el tratamiento de la urticaria y la rinitis alérgica, así como la ausencia de efecto sedante, incluso cuando se administra conjuntamente con tranquilizantes o alcohol. El objetivo de nuestro estudio fue una evaluación comparativa de la tolerancia y eficacia de terfenadina y placebo, en el tratamiento de urticaria crónica, en pacientes latinoamericanos
Sujets)
Humains , Composés benzhydryliques/usage thérapeutique , Urticaire/traitement médicamenteux , Essais cliniques comme sujet , Composés benzhydryliques/effets indésirables , PlaceboRésumé
Se analizan los resultados de un estudio abierto controlado no comparativo para valorar la eficacia y tolerancia de la terfenadina en el tratamiento de la rinitis alérgica. Se incluyeron 40 casos de niños de ambos sexos con edades comprendidos entre dos y doce años. Se catalogó la gravedad de la afección como severa en 22.5%, moderada en 75% y leve en 2.5%. El 40% de los casos tenían su padecimiento asociado con asma y la mayoría de los pacientes estudiados habían sido tratados con otros medicamentos in que se hubiese logrado resultados satisfactorios. Se administró terfenadina por vía bucal en forma de suspensión: la dosis empleada fue de 30 mg cada 12h (una cucharadina de 5ml) para los niños menores de 5 años y 60 mg también cada 12h (2 cucharaditas de 5 ml) para niños entre seis y 12 años. Se consideró que el tratamiento fue eficaz en 69% de los casos, con un alto índice de seguridad