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1.
Biomed Chromatogr ; 15(8): 525-33, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11748688

RESUMO

Atrasentan is an endothelin antagonist selective for the ET(A) receptor in development at Abbott Laboratories for the treatment of cardiovascular disease and cell proliferation disorders. A simple and sensitive chromatographic method for the determination of atrasentan in human plasma has been developed and validated. The analytical method involves acidification of the plasma samples with 0.3 N HCl prior to extraction with 1:1 (v:v) hexane/tert-butylmethylether. The organic extract was evaporated to dryness, reconstituted with 20:80 (v:v) acetonitrile/0.05 M K(2)HPO(4) and washed with 75:25 (v:v) hexane/tert-butylmethylether. The organic layer was discarded and the aqueous layer was injected into the HPLC. Atrasentan and internal standard (ABT-790) were separated from interference using a 250 x 4.6 mm, 5 microm, 120 A Phenomenex Spherisorb C(8) analytical column with a 50 x 4.6 mm, Alltech Absorbosphere 5 microm CN guard cartridge using a mobile phase consisting of 25:15:5:55 (v:v:v:v) acetonitrile/isopropanol/methanol/0.05 M K(2)HPO(4), pH 7.0, at a flow rate of 1.0 mL/min. Fluorescence detection was achieved using lambda(ex) 278 nm and lambda(em) 322 nm. For a 1.0 mL plasma sample volume, the limit of quantitation was approximately 200 pg/mL. The method was linear from 0.2 to 1300 ng/mL (r(2) = 0.9986). Inter- and intra-day assay RSD (n = 6) were less than 10%. Mean accuracy determinations showed the quality control samples to range between 94 and 99% of the theoretical concentration.


Assuntos
Antineoplásicos/análise , Cromatografia Líquida de Alta Pressão/métodos , Endotelina-1/antagonistas & inibidores , Pirrolidinas , Antineoplásicos/sangue , Antineoplásicos/farmacocinética , Atrasentana , Calibragem , Estabilidade de Medicamentos , Fluorescência , Humanos , Estrutura Molecular , Controle de Qualidade , Padrões de Referência , Sensibilidade e Especificidade , Temperatura
2.
Urology ; 58(5): 717-22, 2001 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11711348

RESUMO

OBJECTIVES: To determine the effectiveness of the long-acting alpha(1)-adrenergic receptor blocking agent terazosin compared with placebo on lower urinary tract symptoms and peak urinary flow rate in men with clinical benign prostatic hyperplasia. METHODS: A formal meta-analysis of all nine randomized trials of terazosin using both an Empirical Bayes and a fully Bayesian approach was conducted. A pooled analysis was conducted on those studies in which patients had a baseline assessment of prostate volume by transrectal ultrasonography. RESULTS: No evidence of heterogeneity was found in the estimated effects of terazosin on the change in peak flow rates in the studies. Terazosin treatment was associated with an increase in the peak flow rate of 1.4 mL/s (95% confidence interval [1.0, 1.7]) compared with placebo. Terazosin resulted in an average reduction of 2.2 points over placebo (95% confidence interval [1.6, 3.0]) regarding the common symptom score (range 0 to 36 points). A mild heterogeneity was found across the studies, with the decrease in symptom score slightly greater with longer treatment duration. No evidence was found that the baseline prostate volume influenced the effect of terazosin. CONCLUSIONS: Terazosin was effective and superior to placebo in reducing symptoms and increasing the peak urinary flow rate. The effect of terazosin on the peak urinary flow rate was apparent in studies as short as 8 weeks. Most importantly, the effect of terazosin on symptoms and peak urinary flow rate was independent of the baseline prostate size for the range of prostate volumes reported.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Prazosina/análogos & derivados , Prazosina/uso terapêutico , Hiperplasia Prostática/complicações , Transtornos Urinários/tratamento farmacológico , Idoso , Teorema de Bayes , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Urinários/etiologia
3.
J Clin Pharmacol ; 41(4): 397-403, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11304896

RESUMO

The pharmacokinetics of 1, 10, 23.25, and 139.5 mg doses of atrasentan was assessed in a placebo-controlled, double-blind, single oral dose study in 24 healthy male subjects. Atrasentan was well tolerated. Atrasentan pharmacokinetics was linear in the 1 to 23.25 mg dose range, with some dose dependency in the highest dose group. Harmonic mean terminal half-life was similar across all dose groups (20-25 h). Apparent oral clearance was low (12 L/h) for the highest dose group compared with the other three dose groups (21-27 L/h). The apparent volume of distribution was large (approximately 6 L/kg), consistent with extensive tissue distribution.


Assuntos
Antagonistas dos Receptores de Endotelina , Administração Oral , Adolescente , Adulto , Análise de Variância , Pressão Sanguínea/efeitos dos fármacos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Endotelina-1/efeitos dos fármacos , Meia-Vida , Humanos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Placebos
4.
Urology ; 57(4 Suppl 1): 73-6, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11295599

RESUMO

The very fact that apoptosis and nonsteroidal anti-inflammatory drugs (NSAIDs) can be linked in the same title should tell you that something unusual is happening. The image of NSAIDs among physicians is certainly discordant with that associated with cancer treatment, which usually involves administration of drugs with serious or even life-threatening toxicity. In contrast, the drugs discussed in this review, including selective cyclooxygenase-2 inhibitors, lipoxygenase inhibitors, and novel NSAID derivatives (eg, sulindac sulfone and R-flurbiprofen), offer the promise of oral, nontoxic agents able to control the progression of established prostate cancer and possibly to prevent the development of prostate cancer de novo. NSAIDs were initially developed to suppress inflammation and pain by inhibiting the production of prostaglandin E2 and its metabolites. At first glance, the fact that NSAIDs are active against prostate cancer in laboratory and clinical studies might suggest that prostaglandins play a pivotal role in prostate cancer biology. However, the story is much more complex than that. Although cyclooxygenase-mediated production of prostaglandins appears to play an important role in the biology of prostate cancer, the NSAIDs and derivatives with promising activity against prostate cancer manifest several mechanisms of action that can include direct inhibition of eicosanoid formation, indirect inhibition of eicosanoid formation by inhibiting expression of enzymes involved in eicosanoid synthesis, or by interfering with the function of cyclic guanosine monophosphate.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antineoplásicos/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Isoenzimas/antagonistas & inibidores , Inibidores da Angiogênese/uso terapêutico , Animais , Celecoxib , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/enzimologia , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2 , Flurbiprofeno/uso terapêutico , Humanos , Masculino , Proteínas de Membrana , Prostaglandina-Endoperóxido Sintases , Pirazóis , Ratos , Sulfonamidas/uso terapêutico , Sulindaco/análogos & derivados , Sulindaco/uso terapêutico
5.
Urology ; 57(4 Suppl 1): 86-9, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11295602

RESUMO

Several novel targets are currently being evaluated both preclinically and clinically for the prevention of prostate cancer. Four divergent and novel approaches were discussed at the National Cancer Institute-sponsored workshop entitled, "New Clinical Strategies in Prostate Cancer Prevention." These interventions are further categorized into soy protein-based serine-protease inhibitors that reduce superoxide-induced DNA damage, and molecularly targeted approaches that are directed toward endothelin-1 expression/overexpression, peroxisome proliferator-activated receptor ligands, and insulinlike growth factors. Understanding each of these approaches has offered insights into the process of malignant transformation of prostatic epithelium, and further illustrates the difficulties of developing new agents in the treatment and prevention of prostate cancer. Close scrutiny of the clinical data emerging with these approaches, including validation of biologic endpoints, is required before large-scale prevention studies with these novel agents and targets can be considered.


Assuntos
Anticarcinógenos/uso terapêutico , Neoplasias da Próstata/prevenção & controle , Tiazolidinedionas , Atrasentana , Cromanos/uso terapêutico , Humanos , Masculino , Pirrolidinas/uso terapêutico , Receptores de Endotelina/uso terapêutico , Somatomedinas/uso terapêutico , Tiazóis/uso terapêutico , Troglitazona , Inibidor da Tripsina de Soja de Bowman-Birk/uso terapêutico , Inibidores da Tripsina/uso terapêutico
6.
J Cardiovasc Pharmacol ; 36(5 Suppl 1): S292-6, 2000 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11078402

RESUMO

Endothelin (ET) receptor antagonists may be beneficial for treating several medical conditions. Human trials with various ET receptor antagonists show that these antagonists elevate the plasma immunoreactive endothelin-1 (irET-1) level, and different classes of antagonists seem to affect the plasma ET-1 level differently. In this report, we study effects of ETA-selective, ETB-selective, and nonselective receptor antagonists on the plasma irET-1 level in the rat, and also compare available clinical data. The plasma irET-1 level was increased by five- and ten-fold after rats were treated with A-192621, an ETB-selective antagonist with Ki values for ETA and ETB at 5600 and 8.8 nM, for 3 days at 30 and 100 mg/kg/day via food. The plasma irET-1 level was increased by 1.8 and 2.4-fold when rats were treated with A-216546, an antagonist with Ki values for ETA and ETB at 0.46 and 13 000 nM, at 10 and 50 mg/kg/day via food for 7 days. As a comparison, the plasma irET-1 level was increased by > 24-fold when rats were treated with A-182086, a nonselective antagonist with Ki values for ETA and ETB at 0.2 and 1.2 nM, at 100 mg/kg/day via food for 9 days. In humans, blockade of ETA by ABT-627 did not result in an elevation in irET-1 until after 7 days of treatment. The results are consistent with the hypothesis that the ETB-receptor is the clearance receptor for ET-1. Our data also suggest that the modest effect of ETA antagonists on the plasma irET-1 level is probably a result of the upregulation of the ET-1 gene via a feedback mechanism.


Assuntos
Antagonistas dos Receptores de Endotelina , Endotelina-1/sangue , Pirrolidinas/farmacologia , Animais , Atrasentana , Endotelina-1/imunologia , Ensaio de Imunoadsorção Enzimática , Masculino , Ratos , Ratos Sprague-Dawley , Receptor de Endotelina A , Receptor de Endotelina B
7.
J Cardiovasc Pharmacol ; 35(6): 838-44, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10836715

RESUMO

Endothelin-1 (ET-1), a potent vasoactive and mitogenic peptide, has been implicated in a number of cardiovascular diseases, including congestive heart failure, neointimal hyperplasia associated with restenosis, and hypertension. The vasoconstriction induced by ET-1 is thought to be mediated mainly by its action on ET(A) receptors on vascular smooth muscle cells. Recent studies have indicated that vasoconstriction also may be mediated by stimulation of an ET(B)-receptor subtype. Increased use of the pig as a cardiovascular model prompted us to examine the receptor profile in this species using ABT-627, a potent, nonpeptide antagonist of the ET(A) receptor. The precursor to ET-1, big ET-1 (0.02 nmol/kg/min), was infused intravenously in domestic swine, resulting in a sustained increase in mean blood pressure of 38 +/- 3 mm Hg. After stabilization of the pressor response, ABT-627 (0.1-10 microg/kg/min) or vehicle was infused for 30 min. Whereas vehicle infusion had no appreciable effect, a dose-related reversal of the pressor response to big ET-1 (11-100%) was observed by the end of the ABT-627 infusion. Blood samples were assayed for plasma concentrations of ABT-627; peak levels ranged from 9 +/- 2 to 937 +/- 168 ng/ml. In a separate group of pigs, the highest dose of ABT-627 produced only a modest reversal of the hypertensive response to an infusion of angiotensin II (300 ng/kg/min). Additional results indicate that the vasoconstrictor effects produced by sarafotoxin 6C (0.03 and 0.3 nmol/kg), an agonist of the ET(B) receptor, are not blocked by treatment with ABT-627 (10 microg/kg/min). However, complete blockade of the S6C response could be achieved using the ET(B) antagonist, A-192621 (0.33 mg/kg/min). Our results define the dose-response relation for the ET(A)-receptor antagonist ABT-627 in the vasculature of the domestic pig and suggest the presence of an ET(B)-receptor subtype that mediates vasoconstriction in this species.


Assuntos
Receptores de Endotelina/fisiologia , Vasoconstrição/fisiologia , Angiotensina II/farmacologia , Animais , Animais Domésticos , Atrasentana , Pressão Sanguínea/efeitos dos fármacos , Relação Dose-Resposta a Droga , Antagonistas dos Receptores de Endotelina , Endotelina-1 , Endotelinas/sangue , Endotelinas/farmacologia , Feminino , Artéria Femoral/efeitos dos fármacos , Artéria Femoral/fisiologia , Precursores de Proteínas/sangue , Precursores de Proteínas/farmacologia , Pirrolidinas/sangue , Pirrolidinas/farmacologia , Receptor de Endotelina A , Receptor de Endotelina B , Suínos , Fatores de Tempo , Vasoconstritores/farmacologia , Venenos de Víboras/farmacologia
8.
Br J Clin Pharmacol ; 49(6): 562-73, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10848720

RESUMO

AIMS: Endothelins (ETs) may play a role in the pathogenesis of a variety of cardiovascular diseases. The present study was designed to investigate the pharmacokinetic and pharmacodynamic effects of the orally active ETA selective receptor antagonist ABT-627 in healthy humans. METHODS: Healthy volunteers were included in two studies with cross-over design. Subjects received single or multiple dose (an 8 day period) administration of oralABT-627 or matched placebo, in a dose range of 0.2-40 mg. The pharmacokinetics of ABT-627 were described and its effects on systemic haemodynamics under resting conditions and on forearm vasoconstriction in response to ET-1 were assessed. RESULTS: ABT-627 was generally well tolerated in both studies, with transient headache being the most reported adverse event (in 62% vs 4% during placebo, P < 0.05, for Study 1 and in 42% vs 60%, P = 0.2, for Study 2). ABT-627 was rapidly absorbed, reaching maximum plasma levels at approximately 1 h post dose. Single dose ABT-627, at a dose of 20 and 40 mg, inhibited ET-1 induced forearm vasoconstriction at 8 h post dose. Eight days ABT-627 treatment, at a dose level of 5 mg and above, also effectively blocked forearm vasoconstriction to ET-1. ABT-627 caused a significant reduction in peripheral resistance as compared with placebo (16 +/- 1 vs 19 +/- 1, 18 +/- 2 vs 23 +/- 3, 15 +/- 1 vs 17 +/- 1 AU at 1, 5, 20 mg in Study 2) with only a mild decrease in blood pressure (79 +/- 2 vs 84 +/- 3, 80 +/- 4 vs 90 +/- 5, 75 +/- 3 vs 79 +/- 1 at 1, 5, 20 mg in Study 2). ABT-627 caused a moderate dose-dependent increase in circulating immunoreactive ET levels (a maximal increase of 50% over baseline at the 20 mg dose level). CONCLUSIONS: The oral ETA receptor blocker ABT-627 is well tolerated, rapidly absorbed, effectively blocks ET-1 induced vasoconstriction and causes a decrease in total peripheral resistance and mean arterial pressure. Our data suggest that ABT-627 may be a valuable tool in treatment of cardiovascular disease.


Assuntos
Antagonistas dos Receptores de Endotelina , Pirrolidinas/farmacologia , Pirrolidinas/farmacocinética , Adulto , Idoso , Área Sob a Curva , Atrasentana , Disponibilidade Biológica , Endotelinas/antagonistas & inibidores , Endotelinas/metabolismo , Antebraço/irrigação sanguínea , Meia-Vida , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Receptor de Endotelina A , Fluxo Sanguíneo Regional/fisiologia , Vasoconstrição/efeitos dos fármacos
9.
Eur J Pharmacol ; 388(1): 29-35, 2000 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-10657544

RESUMO

Tactile allodynia, the enhanced perception of pain in response to normally non-painful stimulation, represents a common complication of diabetic neuropathy. The activation of endothelin ET(A) receptors has been implicated in diabetes-induced reductions in peripheral neurovascularization and concomitant endoneurial hypoxia. Endothelin receptor activation has also been shown to alter the peripheral and central processing of nociceptive information. The present study was conducted to evaluate the antinociceptive effects of the novel endothelin ET(A) receptor-selective antagonist, 2R-(4-methoxyphenyl)-4S-(1,3-benzodioxol-5-yl)-1-(N, N-di(n-butyl)aminocarbonyl-methyl)-pyrrolidine-3R-carboxylic acid (ABT-627), in the streptozotocin-induced diabetic rat model of neuropathic pain. Rats were injected with 75 mg/kg streptozotocin (i. p.), and drug effects were assessed 8-12 weeks following streptozotocin treatment to allow for stabilization of blood glucose levels (>/=240 mg/dl) and tactile allodynia thresholds (

Assuntos
Analgésicos não Narcóticos/farmacologia , Neuropatias Diabéticas/complicações , Antagonistas dos Receptores de Endotelina , Dor/tratamento farmacológico , Pirrolidinas/farmacologia , Analgésicos não Narcóticos/sangue , Animais , Atrasentana , Diabetes Mellitus Experimental/fisiopatologia , Humanos , Masculino , Dor/etiologia , Medição da Dor/efeitos dos fármacos , Estimulação Física , Pirrolidinas/sangue , Ratos , Ratos Sprague-Dawley , Receptor de Endotelina A , Receptor de Endotelina B , Estereoisomerismo , Vasoconstritores/farmacologia
10.
Urology ; 54(1): 81-5, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10414731

RESUMO

OBJECTIVES: To review and assess the cardiovascular safety of the alpha1-blocker terazosin when used to treat symptomatic benign prostatic hyperplasia (BPH) in patients taking concurrent antihypertensive medications. METHODS: This retrospective analysis focused on blood pressure changes and blood pressure-related side effects in 555 of 2084 patients randomized to either terazosin or placebo in the Hytrin Community Assessment Trial (HYCAT) study who were following either single or combination antihypertensive regimens (treated patients). We also compared results in normotensive and hypertensive patients, whether treated or not. RESULTS: The addition of terazosin lowered mean systolic blood pressure by 5.3 mm Hg for untreated patients and 6.7 mm Hg for treated patients. For patients hypertensive on entry, mean reductions in systolic blood pressure in those untreated and treated were 12.1 and 11.1 mm Hg, respectively. The addition of terazosin to an existing antihypertensive regimen had its greatest impact (a mean reduction of 12.3 mm Hg) in those receiving diuretic therapy alone. Diastolic pressure changes followed a similar pattern. The incidences of blood pressure-related side effects in patients on terazosin were comparable between untreated (13.5%) and treated patients (14.3%), as were premature withdrawal rates, with 4.2% of untreated patients and 4.5% of treated patients withdrawing due to blood pressure-related side effects. CONCLUSIONS: Terazosin can be safely used to treat patients with symptomatic BPH regardless of their blood pressure status and antihypertensive regimen. Terazosin may be safely added to ongoing antihypertensive therapy.


Assuntos
Antagonistas Adrenérgicos alfa/farmacologia , Antagonistas Adrenérgicos alfa/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Prazosina/análogos & derivados , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Idoso , Humanos , Masculino , Prazosina/farmacologia , Prazosina/uso terapêutico , Estudos Retrospectivos
11.
Circulation ; 97(25): 2551-6, 1998 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-9657476

RESUMO

BACKGROUND: As endothelin binds to ET(A) receptors, it stimulates vascular smooth muscle cell proliferation and may thus be pivotally involved in the pathogenesis of restenosis. This study assessed the ability of a potent and selective ET(A) antagonist to reduce neointimal hyperplasia in a porcine coronary artery stented injury model. METHODS AND RESULTS: Fifty-five pigs were randomized to receive placebo or the oral ET(A)-selective antagonist ABT147627 twice daily for 28 days in one of three doses: 0.75 mg/kg (low), 3.75 mg/kg (mid), and 10.0 mg/kg (high). Each underwent oversized stent deployment in two randomly assigned major epicardial coronary arteries. Three animals (5.5%) died as a consequence of stent thrombosis within 24 hours of the procedure. The remaining 52 animals (13 pigs per group) survived without complication until predetermined euthanasia at 28 days. In the placebo group, mean injury score was 1.73+/-0.80, with a mean neointimal response of 0.45+/-0.24 mm. By comparison, the low-dose group had a similar mean injury score of 1.79+/-0.75 with reduced neointimal response, 0.36+/-0.22 mm (P<0.01). Mean injury score in the mid-dose animals was significantly greater than in the placebo group (1.94+/-0.92; P<0.05). The neointimal hyperplasia associated with this injury was less than with placebo, although the difference did not reach statistical significance (0.40+/-0.25 mm; P=0.05). In the high-dose pigs, mean injury score was also significantly greater than in the placebo arm (1.93+/-0.73; P<0.05). Despite this, neointimal response was also significantly less (0.37+/-0.37 mm; P<0.01). CONCLUSIONS: Oral, selective ET(A) receptor antagonism significantly reduced neointimal hyperplasia forming over porcine coronary stented injuries in the first 28 days. This strategy may have clinical potential for the limitation and treatment of coronary restenosis after percutaneous revascularization.


Assuntos
Doença das Coronárias/patologia , Vasos Coronários/patologia , Antagonistas dos Receptores de Endotelina , Stents , Túnica Íntima/patologia , Administração Oral , Animais , Pressão Sanguínea/efeitos dos fármacos , Doença das Coronárias/cirurgia , Modelos Animais de Doenças , Hiperplasia/etiologia , Hiperplasia/prevenção & controle , Distribuição Aleatória , Análise de Regressão , Suínos
12.
Urology ; 50(4): 556-61, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9338731

RESUMO

OBJECTIVES: To prospectively analyze whether the treatment of men with clinically benign prostatic hyperplasia (BPH) with alpha blocking agents affects the serum prostate-specific antigen (PSA) levels, and to determine the magnitude of such effect. METHODS: Serial PSA measurements were performed using the Abbott IMx assay over 1 year in 134 men over the age of 55 years participating in the Hytrin Community Assessment Trial (HYCAT). HYCAT is a 1-year, randomized, placebo-controlled, double-blinded study of the alpha1-adrenergic antagonist terazosin. All men had lower urinary tract symptoms and a clinical diagnosis of BPH with an American Urological Association (AUA) symptom index of 13 points or more, an AUA bother score of 8 points or more, and a peak urinary flow rate of less than 15 mL/s. PSA was measured at baseline and at 8, 26, 39, and 52 (end of study) weeks. RESULTS: Baseline serum PSA levels weakly correlated with patients' age at study entry, and modestly with residual urine (positive correlation) and peak flow rate (negative correlation), although none of the levels were statistically significant. Changes of serum PSA during the course of the study did not correlate with either one of the symptom severity or bother assessment tools, residual urine, or peak flow rate. Mean PSA increased from a baseline of 2.5+/-0.22 ng/mL (mean+/-SE) by 0.5+/-0.11 ng/mL in the placebo-, and from 2.7+/-0.23 ng/mL by 0.3+/-0.11 ng/mL in the terazosin-treated patients (P = 0.36 by ANOVA). There were no differences in the changes in serum PSA when patients were stratified by decade of life according to the age-specific PSA reference ranges, or by the final dose of terazosin (2, 5, or 10 mg daily). CONCLUSIONS: The treatment of men with lower urinary tract symptoms and clinical BPH with the alpha1-adrenergic antagonist terazosin does not affect serum PSA concentration, and thus does not confound longitudinal monitoring of serum PSA levels in patients at risk for prostate carcinoma.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Prazosina/análogos & derivados , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/sangue , Hiperplasia Prostática/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prazosina/uso terapêutico , Fatores de Tempo
13.
N Engl J Med ; 335(8): 533-9, 1996 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-8684407

RESUMO

BACKGROUND: Men with benign prostatic hyperplasia can be treated with alpha 1-adrenergic-antagonist drugs that relax prostatic smooth muscle or with drugs that inhibit 5 alpha-reductase and therefore reduce tissue androgen concentrations. However, the effects of the two types of drugs have not been compared. METHODS: We compared the safety and efficacy of placebo, terazosin (10 mg daily), finasteride (5 mg daily), and the combination of both drugs in 1229 men with benign prostatic hyperplasia. American Urological Association symptom scores and peak urinary-flow rates were determined at base line and periodically for one year. RESULTS: The mean changes from base line in the symptom scores in the placebo, finasteride, terazosin, and combination-therapy groups at one year were decreases of 2.6, 3.2, 6.1, and 6.2 points, respectively (P<0.001 for the comparisons of both terazosin and combination therapy with finasteride and with placebo). The mean changes at one year in the peak urinary-flow rates were increases of 1.4, 1.6, 2.7, and 3.2 ml per second, respectively (P<0.001 for the comparisons of both terazosin and combination therapy with finasteride and with placebo). Finasteride had no more effect on either measure than placebo. In the placebo group, 1.6 percent of the men discontinued the study because of adverse effects, as did 4.8 to 7.8 percent of the men in the other three groups. CONCLUSIONS: In men with benign prostatic hyperplasia, terazosin was effective therapy, whereas finasteride was not, and the combination of terazosin and finasteride was no more effective than terazosin alone.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Finasterida/uso terapêutico , Oxirredutases/antagonistas & inibidores , Prazosina/análogos & derivados , Hiperplasia Prostática/tratamento farmacológico , Antagonistas Adrenérgicos alfa/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Quimioterapia Combinada , Inibidores Enzimáticos/efeitos adversos , Finasterida/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Prazosina/efeitos adversos , Prazosina/uso terapêutico , Resultado do Tratamento , Urodinâmica/efeitos dos fármacos
14.
Urology ; 47(2): 159-68, 1996 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8607227

RESUMO

OBJECTIVES: To determine the clinical effectiveness and safety of alpha(1)-blockade therapy versus placebo in the treatment of men with moderate to severe symptoms of prostatism in a community-based population under usual care conditions. METHODS: The Hytrin Community Assessment Trial is a prospective, placebo-controlled, randomized, double-blinded, 1-year clinical trial, conducted at 15 academic medical centers (regional sites) and 141 private urology practices (satellite sites). A total of 2084 men at least 55 years old with moderate to severe symptoms of benign prostatic hyperplasia (BPH) as determined by an American Urological Association (AUA) Symptom Score (AUA-SS) of 13 or more points and a bother score (AUA-BS) of 8 or more were enrolled. Randomized patients at regional sites were required to have a peak urinary flow rate less that 15 mL/s with voided volume of at least 150 mL. Treatment with terazosin was initiated with 1 mg daily for 3 days, followed by 2 mg daily for 25 days. Thereafter, patients were titrated stepwise to 5 or 10 mg if they failed to achieve a 35% or greater improvement in the AUA-SS. Primary outcome measures were AUA-SS, AUA-BS, BPH Impact Index (BII), disease-specific quality of life (QQL) score, and treatment failure as defined as discontinuation due to persistent or worsening symptoms or need for surgical intervention for BPH. Secondary outcome measures were peak urinary flow rate and postvoid residual urine volume. RESULTS: AUA-SS (0 to 35 point scale) improved from a baseline mean of 20.1 points by 37.8% during terazosin (n=976) and by 18.4% during placebo (n=973) treatment (P<0.001). Similarly, statistically superior improvements were observed in regard to the AUA-BS, BII, and the QQL score in the terazosin-treated patients. Peak urinary flow rate improved from a baseline of 9.6 mL/s (both regional treatment groups) by 2.2 mL/s in the terazosin group (n=137) and by 0.7 mL/s in the placebo group (n=140) (P< or = 0.05). Treatment failure occurred in 11.2% of terazosin- and 25.4% of placebo-treated patients (P<0.001; Kaplan-Meier adjusted withdrawal rates of 365 days). Withdrawal from study drug treatment due to adverse events occurred in 19.7% of terazosin- and 15.2% of placebo-treated patients (P<0.001). CONCLUSIONS: Terazosin given once daily in a dose ranging from 2 to 10 mg in community-based urology practices under conditions simulating usual care is effective in reducing the symptoms, perception of bother, and the impairment of QQL due to urinary symptoms in men with moderate to severe symptoms of prostatism. This effect is superior to placebo and maintained over 12 months of follow-up. Clinical research outcome studies in BPH can be conducted in community-based practices, thus simulating as closely as possible "usual care" conditions.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Prazosina/análogos & derivados , Hiperplasia Prostática/tratamento farmacológico , Antagonistas Adrenérgicos alfa/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Humanos , Masculino , Pessoa de Meia-Idade , Prazosina/efeitos adversos , Prazosina/uso terapêutico , Estudos Prospectivos , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Análise de Sobrevida , Fatores de Tempo , Falha de Tratamento , Estados Unidos , Urodinâmica/efeitos dos fármacos
15.
Urology ; 47(2): 169-78, 1996 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8607228

RESUMO

OBJECTIVES: To evaluate the cost-effectiveness and functional status effects of terazosin, an alpha(1)-adrenoceptor antagonist, compared with placebo in the treatment of men with moderate to severe, symptomatic, benign prostatic hyperplasia (BPH). METHODS: Prospective, randomized, double-blind, placebo-controlled multicenter trial of 2084 patients was conducted at 15 academic regional centers and 141 community-based satellite centers. Information about the use of health care resources and non-disease-specific functional status measures was collected by a standardized telephone interview of patients at baseline and every month thereafter for 12 months. Other information, such as American Urologic Association (AUA) disease-specific functional status scores, was obtained from the patient study records. Patients had a mean age of 65.7 years (range, 46 to 94), with a clinical diagnosis of BPH. At baseline men had at least moderate BPH symptoms by AUA Symptom score (13 or more) and Bother Score (8 or more). On entry, patients at regional sites had peak urinary flow rates 15 mL/s or less and total voided urine volumes 150 mL or greater. A total of 1053 patients were randomized to terazosin and 1031 to placebo treatment. Primary outcome measures included payments for all direct medical resource consumption (inpatient care, emergency department care, outpatient care, and medications); changes in three AUA disease-specific functional status indicators, (Symptom, Bother, and Quality of Life scores), and non-disease-specific functional status measures (days of work loss, days of customary activity loss, and days of bed rest). RESULTS: Total payments for health care resource (including study drug medication), adjusted to reflect 1000 patients per treatment group, were $3,781,803 and $3,568,263 in the placebo and terazosin groups, respectively. All three AUA disease-specific functional status scores improved significantly more in the terazosin group than in the placebo group. We found no difference between terazosin and placebo in all three nonspecific functional status measures. CONCLUSIONS: Compared with placebo, terazosin therapy for moderate to severe symptomatic BPH results in approximately equivalent payments for direct medical care, better disease-specific functional status improvement, and comparable change in non-disease-specific functional status measures.


Assuntos
Antagonistas Adrenérgicos alfa/economia , Prazosina/análogos & derivados , Hiperplasia Prostática/economia , Antagonistas Adrenérgicos alfa/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Análise Custo-Benefício , Grupos Diagnósticos Relacionados/economia , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prazosina/economia , Prazosina/uso terapêutico , Estudos Prospectivos , Hiperplasia Prostática/tratamento farmacológico , Análise de Regressão , Resultado do Tratamento , Estados Unidos
16.
J Lipid Res ; 28(2): 207-15, 1987 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3572248

RESUMO

The synthesis of apoB-100 and apoB-48 by rat liver was investigated by studying the apoB complement of very low density lipoproteins (VLDL) from hepatic perfusates and Golgi fractions. The relative amounts of apoB-100 and apoB-48 in perfusate and Golgi VLDL as determined by sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis were similar to those in serum VLDL. To investigate the relative rates of synthesis of the VLDL B proteins, rats were injected intraportally with tritiated amino acid, and hepatic Golgi and serum VLDL were isolated from 7.5 to 120 min later. In hepatic Golgi VLDL, apoB-100 and apoE were maximally labeled at 15 min after the tritiated amino acid pulse. In contrast, VLDL apoB-48 attained maximum radioactivity at 30 min after isotope injection. In serum VLDL, apoB-100 and apoE were maximally labeled at 30 min post-isotope injection, while activity in apoB-48 peaked at 60 min. The data suggest that the synthesis of the B proteins and incorporation into rat liver nascent VLDL are independently regulated. The differential labeling patterns of the VLDL B proteins may be explained by an intracellular pool of apoB-48 that is larger than that of apoB-100. An alternative explanation of the results is that apoB-100 is a precursor to apoB-48.


Assuntos
Apolipoproteínas B/biossíntese , Lipoproteínas VLDL/metabolismo , Fígado/metabolismo , Animais , Apolipoproteína B-100 , Apolipoproteína B-48 , Apolipoproteínas B/sangue , Complexo de Golgi/metabolismo , Técnicas In Vitro , Cinética , Lipoproteínas VLDL/sangue , Masculino , Perfusão , Ratos , Ratos Endogâmicos
17.
Biochem J ; 204(2): 609-12, 1982 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-7115352

RESUMO

Rat lymph chylomicrons were treated with Pronase resulting in particles completely devoid of surface apoproteins. On re-incubation with serum, the Pronase-treated chylomicrons re-acquired, by transfer from other lipoproteins, all apoproteins except apoprotein B, which is water-insoluble and non-transferable. When two groups of rats were injected with [3H]cholesterol-labelled control or Pronase-treated chylomicrons, radioactivity was incorporated into the liver of both groups at similar rates. It is concluded that the remnants of the control and Pronase-treated chylomicrons formed in the vascular space were recognized and taken up by liver cells by a process that does not require apoprotein B.


Assuntos
Apolipoproteínas/farmacologia , Quilomícrons/metabolismo , Fígado/metabolismo , Animais , Apolipoproteínas B , Eletroforese em Gel de Poliacrilamida , Fígado/efeitos dos fármacos , Masculino , Pronase/farmacologia , Ratos , Ratos Endogâmicos
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