Use of Liraglutide 3.0 mg for Weight Management in a Real-World Setting in Switzerland.

INTRODUCTION: Data from randomized controlled trials show that liraglutide 3.0 mg, in combination with diet and exercise, is associated with greater weight loss than diet and exercise alone in patients with obesity. In practice, the utilization of weight loss drugs is influenced by various factors, including the cost of treatment. We conducted a retrospective, observational study to assess the effectiveness of liraglutide 3.0 mg and patients' persistence on treatment, in a real-world setting. METHODS: Data were extracted from de-identified electronic medical records from an obesity management clinic in Switzerland. Changes in body weight and blood pressure were evaluated in the full cohort (N = 277, 19% of whom had undergone bariatric surgery) and subgroups who were persistent on liraglutide 3.0 mg for at least 4 months (n = 236), 7 months (n = 159), or 12 months (n = 71). RESULTS: Median persistence on liraglutide was 6.8 months. Median maximum dose received was 1.5 mg, and 13.7% of patients reached the maintenance dose of 3.0 mg. Mean 7-month weight change from baseline in the full cohort was -4.1 kg (95% confidence interval: -5.0, -3.2; p < 0.001; -4.2%). Weight change was -4.4 kg (-4.7%) in the ≥4-month persistence subgroup at 4 months, -5.1 kg (-5.3%) in the ≥7-month persistence subgroup at 7 months, and -7.5 kg (-7.1%) in the ≥12-month persistence subgroup at 12 months (all p < 0.001). In the full cohort, 40% and 14% of patients lost ≥5% and >10% of body weight at 7 months, respectively. Weight loss did not differ significantly according to history of bariatric surgery (p = 0.94). Diastolic blood pressure decreased (from 87.0 to 83.9 mm Hg at 7 months; p = 0.018), with no significant changes in systolic blood pressure. Approximately two-thirds of patients did not have health insurance that could cover the cost of liraglutide. CONCLUSION: In a real-world setting with low insurance coverage and with most patients not reaching the recommended maintenance dose of 3.0 mg, the use of liraglutide, in combination with diet and exercise, was associated with clinically meaningful weight loss.

[Evidence based check-up: the general medical point of view]. / Evidenz-basierter Check-up aus allgemeininternistischer Sicht.

Check-up is a frequent motivation for patients to see their general practitioner. The challenge lies in the choice of screening tools to accomplish an efficient, individual and age-adapted approach. In this article we review evidence-based screening methods, whose efficacy has been demonstrated by randomized clinical trials, as well as their application in clinical practice. While cardiovascular check-up has a high grade of evidence for nearly all patients, counselling to lifestyle change except for smoking cessation has been proved with lower evidence. In contrast, relatively new is the fact that ultrasound to screen for an abdominal aortic aneurysm is useful among men smokers or past smokers between 65 and 75 years old.

Le check-up est une raison fréquente pour les patients de consulter leur médecin de famille. Le défi réside dans le choix des examens de dépistage qui permettent d'accomplir une approche raisonnable, individuelle et adaptée à l'âge. Dans cet article, nous passons en revue les examens de dépistage dont l'utilité a été prouvée par des études randomisées, ainsi que leur utilisation pratique. Cet article propose une mise à jour des recommandations actuelles pour le dépistage ainsi que leur rationnel. Alors que par exemple le dépistage cardio-vasculaire pour la majorité des patients a un haut degré de preuves, les conseils pour le changement de style de vie ont moins de preuves d'efficacité, à l'exception de l'arrêt du tabac. Un dépistage relativement récemment démontré efficace est le dépistage d'un anévrisme de l'aorte abdominale par ultrason, ce qui est utile chez les hommes fumeurs ou ex-fumeurs entre 65 et 75 ans.

[Aftercare following bariatric surgery]. / Nachsorge nach bariatrischen operationen.

With the increase of patients after bariatric and metabolic surgery the long-term follow-up of this population will become a challenge. Bariatric patients require regular and life-long follow-up in order to affect the long-term achievements of this therapy in a positive way. For that reason bariatric patients should be followed in the first phase by a multidisciplinary team of the bariatric centre. Taking into account some fundamental considerations general practinioner should be involved in the care of these patients when a stable situation occured.

Human bronchial epithelium controls TH2 responses by TH1-induced, nitric oxide-mediated STAT5 dephosphorylation: implications for the pathogenesis of asthma.

Increased levels of NO in exhaled air in association with increased NO synthetase (NOS)2 expression in bronchial epithelial are hallmark features of asthma. It has been suggested that NO contributes to asthma pathogenesis by selective down-regulation of TH1 responses. We demonstrate, however, that NO can reversibly limit in vitro expansion of both human TH1 and TH2 CD4+ T cells. Mechanistically, NO induces cGMP-mediated reversible STAT5 dephosphorylation and therefore interferes with the IL-2R activation cascade. Human bronchial epithelial cells (HBEC) up-regulate NOS2 after stimulation with IFN-gamma secreted by TH1 CD4+ T cells and release NO, which inhibits both TH1 and TH2 cell proliferation. This reversible T cell growth arrest depends on NO because T cell proliferation is completely restored after in vitro blocking of NOS2 on HBEC. HBEC thus drive the effector end of a TH1-controlled feedback loop, which protects airway mucosal tissues at the potential lesional site in asthma from overwhelming CD4+ TH2 (and potentially TH1) responses following allergen exposure. Variations in the efficiency of this feedback loop provides a plausible mechanism to explain why only a subset of atopics sensitized to ubiquitous aeroallergens progress to expression of clinically relevant levels of airways inflammation.