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- Manage chronic hand eczema with conventional treatments, but emerging
therapies show promise-
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Abstract: Chronic hand eczema is a complex inflammatory skin disease that persists for 3 or more months or relapses twice or more a year. Individuals with chronic hand eczema experience symptoms such as itch, pain and burning of the skin, which substantially impact the patient’s health-related quality of life and occupational performance. Management of hand eczema requires the identification and avoidance of causative factors, and the use of conventional treatments such as topical agents, phototherapy and systemic therapies. Additionally, dupilumab and delgocitinib are among the emerging therapies that show promise in the treatment of chronic hand eczema.
PubDate: 2025-04-06
- Comparing two-dose 1500 mg dalbavancin to standard of care in the
outpatient treatment of invasive infections-
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Abstract: Introduction Standard of care (SOC) treatments for invasive Gram-positive infections often involve prolonged intravenous (IV) antibiotic therapy, which can be cumbersome for patients and lead to complications such as thrombosis and line infections. Dalbavancin (DBV), an intravenous lipoglycopeptide antibiotic, offers a potential alternative due to its long terminal half-life, allowing for less frequent administrations and eliminating the need for outpatient parenteral lines. Objective This study aims to compare the efficacy of a two-dose regimen of dalbavancin (DBV; 1500 mg on day 1 and day 8) to the standard of care (SOC) in the outpatient treatment of invasive Gram-positive infections, including bacteremia, prosthetic joint infections (PJI), and osteomyelitis (OM). Methods A single-center, retrospective, observational cohort study was conducted at the East Alabama Medical Center. Adult patients diagnosed with bacteremia, OM, or PJI and discharged with outpatient antibiotic orders between July 2019 and December 2023 were included. Patients received either two-dose DBV or SOC. Clinical success, defined as the absence of infection recurrence and no additional antibiotic therapy within 90 days postdischarge, was the primary outcome. Secondary outcomes included infection recurrence, additional antibiotic use, readmissions, emergency department visits, and mortality. Results Out of 148 patients, 62 received DBV and 86 received SOC. Clinical success was achieved in 89% of the DBV group and 92% of the SOC group (p = 0.518). Infection-related readmissions were lower in the DBV group (5% versus 19%; p = 0.011). The DBV group had a shorter mean duration of inpatient antibiotics compared with the SOC group (6.5 days versus 10.1 days; p < 0.001). No mortality was observed in either group. Conclusions The two-dose DBV regimen demonstrated comparable clinical success to SOC. The DBV group had fewer readmissions and fewer ED visits, although the latter did not reach statistical significance. DBV may offer an alternative for outpatient treatment of invasive Gram-positive infections. Further research with larger sample sizes is recommended to validate these findings.
PubDate: 2025-04-02
- Iptacopan in paroxysmal nocturnal haemoglobinuria: a profile of its use
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Abstract: Iptacopan (Fabhalta®), a complement factor B inhibitor, is a valuable treatment option for adult patients with paroxysmal nocturnal haemoglobinuria (PNH). It is the first oral monotherapy available for treatment of PNH in the USA and the EU. As demonstrated in the phase III clinical trials APPLY-PNH and APPOINT-PNH, twice daily iptacopan provided clinically meaningful improvements in haemoglobin levels in both anti-complement component 5 (anti-C5) therapy-experienced and complement inhibitor-naïve patients with PNH and anaemia. In APPLY-PNH, iptacopan was superior to continuing anti-C5 therapy at improving haemoglobin levels without the need for red blood cell transfusions (RBCTs). In both trials, iptacopan also reduced the need for RBCTs and reduced patient-reported fatigue levels. Iptacopan was generally well tolerated, with the most common adverse events being acute mild-to-moderate headache and with no discontinuations due to adverse events recorded in either trial. Currently available data show iptacopan efficacy is durable over 48 weeks; longer term efficacy and safety data are awaited with interest.
PubDate: 2025-03-26
- Effective drug dosage rounding reduces healthcare expenses in the Japanese
healthcare system-
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Abstract: Introduction Anticancer drugs are administered near the maximum tolerated dose, and their therapeutic range is significantly narrower compared to conventional drugs. Even for expensive anticancer drugs, some of the drug in the vial is used, whereas the remainder is discarded. Objective Because body size impacts dosage and varies significantly among racial groups, in this study, we aimed to assess the impact of dose adjustment on healthcare expenses and bevacizumab dose fluctuations in Japan. Methods We investigated the effects of bevacizumab dosage variation and the degree of dose adjustment on medical costs based on annual bevacizumab use data from the National Database of Health (NDB) Open Data. Additionally, a multicentre, retrospective study was conducted at four national university hospitals to record bevacizumab consumption. We analysed the impact of dose adjustments in the ranges of 10%, 5%, and 2% on drug costs. Results Simulations based on this data estimated potential cost savings. The use of bevacizumab has been steadily increasing: 1.59 million vials were used in Japan in 2021, costing JPY 101.6 billion. Dose adjustments of 10%, 5%, and 2% could reduce costs by approximately JPY 4,619,699,806, 1,777,439,323, and 420,016,889 per year, respectively. Dose adjustments for bevacizumab could significantly reduce healthcare costs in Japan. Conclusion Numerous anticancer drugs exist beyond bevacizumab, and similar cost-reduction measures applied to these drugs could lead to further savings. Although prospective clinical trials are needed to assess the impact of dose adjustments on treatment effectiveness, significant healthcare cost reductions are anticipated if this approach proves effective.
PubDate: 2025-03-24
- Dose rounding: a cost-savings fix or the new standard'
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PubDate: 2025-03-24
- Therapeutic effect of adding magnesium sulfate in treatment of
organophosphorus poisoning: a systematic review and meta-analysis-
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Abstract: Introduction Acute organophosphorus insecticide poisoning is a significant cause of self-poisoning suicides and deaths due to unintentional exposure. Although atropine combined with pralidoxime is the standard treatment foracute organophosphorus poisoning, its effectiveness in reducing mortality remains uncertain. Objective This study aimed to conduct a meta-analysis on the therapeutic effects of addingmagnesium sulphate to the standard treatment for acute organophosphorus poisoning. Methods We systematically searched clinical studies on PubMed, MEDLINE, Embase and Cochrane databases from their inceptionuntil June 2024. Additionally, we performed citation analysis to identify both published and unpublished studies on the therapeutic effect of addingmagnesium sulphate to the standard treatment for acute organophosphorus poisoning, focusing on mortality and the need for intubation. We utilized RevMan Web 2023 to conduct the meta-analysis using Mantel-Haenszel method. For randomized controlled trials (RCTs), outcomes were pooled as risk ratios (RR) with 95% confidence intervals (CI), while for observational studies, outcomes were pooled as odds ratios (OR) with 95% CI. Statistical heterogeneity was assessed using the I2 statistic. A random effects model was employed if the I2 value was 50% or higher; otherwise, a fixed effects model was used. The confidence in effect estimates was evaluated based on the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The protocol for this systematic review is registered in PROSPERO (registration number: CRD42022310934). Results Our meta-analysis included seven randomized controlled trials with sample sizes ranging from 40 to 100 patients, and five observational studies with sample sizes ranging from 15 to 133 patients. Most of the studies exhibited significant methodological biases. For RCT studies, the mean (SD) age of 247 patients who received add-on magnesium sulfate with standard treatment for acute organophosphorus poisoning was 31.9(8.4) years, while the mean (SD) age of 217 patients who received only the standard treatment was 34.7(12.8) years. Patients receiving add-on magnesium sulfate had 63% significantly lower mortality rate compared to the standard treatment group [RR (95% CI) = 0.37 (0.21-0.65), I2 =12%] and a 27% significantly lower intubation rate compared to the standard treatment group [RR (95% CI) = 0.73 (0.59-0.91), I2 = 0%]. For observational studies, patients receiving an additional 4g of magnesium sulfate did not reduce mortality rate compared to the standard treatment group [OR (95% CI) = 0.49 (0.23-1.01), I2 = 0%]. Conclusion Magnesium sulfate when used as an add-on treatment to atropine and pralidoxime can significantly reduce mortality and intubation rates in patients with acute organophosphate poisoning. The limitation of this meta-analysis is the poor quality and small sample sizes of the included studies, highlighting the need for larger, high-quality multicenter randomized trials to better understand the role of magnesium sulfate in treating organophosphorus poisoning.
PubDate: 2025-03-14
- First reports of adverse drug reactions
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PubDate: 2025-03-13
- Take a personalised approach when treating older adults with rosacea
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Abstract: Rosacea is a chronic inflammatory skin condition characterized by erythema, telangiectasia and inflammatory lesions on the face. Rosacea, and the adverse events occurring during its treatment, are commonly more severe in older versus younger adults (adults aged > 65 years). Treatment personalisation is especially relevant for older adults. Personalising treatment by basing it on an individual’s presenting features aids in improving treatment versatility and patient-centred care in this population. Potential adverse events, comorbidities and drug-drug interactions should be considered when prescribing treatment. Therapeutic options include topical and oral pharmacological agents, light-based therapies and minimally invasive surgeries.
PubDate: 2025-03-12
- Consider topical superpotent corticosteroids for oral lichen planus;
reserve systemic therapy for severe disease-
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Abstract: Oral lichen planus (OLP) is a potentially very painful immune-mediated inflammatory disease for which there is no cure. Treatment options consist of immunosuppressive, immunomodulatory and anti-inflammatory drugs. Treatment is usually topical. Topical superpotent corticosteroids are the mainstay of treatment, and topical calcineurin inhibitors are suggested for OLP refractory to topical corticosteroids. Beyond these, there is a wide range of additional treatment options. It is necessary to follow-up regularly and monitor for malignancy associated with the disease.
PubDate: 2025-03-04
- Continue to treat sarcopenia with exercise and diet while potential
pharmacotherapies are under investigation-
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Abstract: Sarcopenia is an age-associated muscle disease characterised by a loss of skeletal muscle function and mass, and resulting in an increased risk of falls and fractures. It is treated with resistance exercises and diet optimisation; however, these interventions are not suitable for all patients. Currently, no pharmacotherapies are approved for the treatment of sarcopenia. Both hormonal and non-hormonal drugs have been considered; testosterone and BIO101 each have growing bodies of evidence as potential therapies for sarcopenia, but they require further studies, particularly in sarcopenic patients. The clinical evidence supporting the use of other drugs is varied and sometimes conflicting.
PubDate: 2025-02-28
- Regulatory and clinical aspects in biosimilar medicines: comparability,
extrapolation, interchangeability, and safety-
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Abstract: Biological medicines have transformed modern therapeutics, enabling effective treatment for various chronic and severe conditions such as diabetes, cancer, and rheumatoid arthritis. Since their introduction in the 1980s, these innovative treatments have significantly improved patient outcomes and life expectancy. With the expiration of exclusivity rights for many biological drugs, biosimilars have emerged as cost-effective alternatives. Biosimilars are biologically derived medicines that demonstrate high similarity to their reference products, with no clinically meaningful differences in quality, safety, or efficacy, as confirmed through rigorous comparability studies. The development of biosimilars has enhanced access to biological therapies by reducing treatment costs, thus alleviating financial burdens on healthcare systems. Since the first biosimilar approval in 2006, over 80 biosimilars have been authorized in Europe, facilitating broader adoption. Real-world clinical data support their equivalence to originator biologics in therapeutic performance, reaffirming the reliability of pre-approval comparability assessments. Biosimilars are now integral to modern healthcare, offering effective, safe, and affordable treatment options for patients globally. Three distinct categories of biological substances and their respective biosimilars—growth hormone, monoclonal antibodies, and insulin analogs and insulin—were analyzed to integrate the discussed concepts and comprehensively evaluate their impact on the healthcare market. These substances represent different stages of regulatory approval by the European Commission: one approved over a decade ago, one recently approved, and one currently under development and regulatory evaluation.
PubDate: 2025-02-27
- Consider patient characteristics when treating compulsive sexual behaviour
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Abstract: Compulsive sexual behaviour (CSB) describes out-of-control problematic sexual behaviour. Recently compulsive sexual behaviour disorder was recognised as an impulse control disorder by the WHO. Patient evaluation, including diagnosis of co-occurring disorders, is essential to inform selection of psychological and pharmacological treatment options for CSB. First-line therapy for CSB is psychotherapy, while pharmacological treatments may be used to support psychotherapy. Studies of compulsive sexual behavior disorder (CSBD) therapies are limited by population size and diversity. Study of larger and diverse populations with CSB is needed. Future research will aid selection of treatment options.
PubDate: 2025-02-24
- Diagnose childhood interstitial lung disease in a stepwise manner and
treat according to the aetiology of the associated condition-
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Abstract: Childhood interstitial lung disease (chILD) comprises a large and heterogeneous group of disorders that affect the lungs. It is associated with high morbidity and mortality, has no cure and no approved pharmacological treatment. Most management options are empirical because of the paucity of research in this field. Patients with suspected chILD should be examined in a timely manner, with diagnosis involving a stepwise approach and the aetiology of the diagnosed condition guiding treatment. Supportive care should be given to all patients with chILD.
PubDate: 2025-02-12
- Adis summary of research: Lebrikizumab improves quality of life and
patient-reported symptoms of anxiety and depression in patients with
moderate-to-severe atopic dermatitis-
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Abstract: Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by pruritus and skin lesions. These symptoms can have a negative impact on quality of life (QOL) and mental health. This Adis Summary of Research reports the effects of lebrikizumab on QOL and patient-reported symptoms of anxiety and depression in adults and adolescents with moderate to severe AD.
PubDate: 2025-02-11
- Look for glaucoma, especially in elderly, and match therapies to patients
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Abstract: Glaucoma is a major cause of blindness. The most common type, primary open-angle glaucoma (POAG) often goes untreated due to its asymptomatic nature. Treatment aims to lower intraocular pressure (IOP), which slows POAG progression. Topical therapies, notably prostaglandin analogues (PGAs) and beta blockers are effective, but dry eyes, conjunctivitis and other issues contribute to treatment discontinuation and poor adherence. New sustained-release PGA implants may be better tolerated. Additionally, Rho kinase inhibitors are an emerging class of drugs with multiple IOP-lowering mechanisms and includes the approved therapies netarsudil (available in the USA) and ripasudil (available in Asia).
PubDate: 2025-02-10
- Efficiently Reducing Medical Costs through Drug Vial Optimization and
Multidose Vials for the Utilization of Cancer Drug Compounding Robots-
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Abstract: Introduction The development of automated robots for anticancer drug compounding is progressing, with anticipated improvements in operational efficiency. This study aimed to evaluate the potential of drug vial optimization (DVO) and the development multidose vials to safely and efficiently reduce medical costs through robotic compounding. Methods We conducted a survey of six anticancer drugs across four hospitals in Japan where robots are used. Results By implementing DVO, we estimated that the costs associated with wasted residual anticancer drug liquid could be reduced from ¥128.47 million [US$833,301, €787,293] (for original medicines equivalent) and ¥46.22 million [US$299,832, €283,278] (for generic medicines equivalent) to ¥30.75 million [US$199,460, €188,447] and ¥12.04 million [US$78,101, €73,789], respectively. This reduces waste costs by 75.8% for original medicine and 73.8% for generics. Furthermore, we estimated the potential preparation time savings associated with the development of multidose vials. A 5000-mg multidose vial of fluorouracil (5-FU) reduced the average robotic compounding time per day across the four hospitals by approximately 21 minutes. Additional time savings included approximately 16 minutes for a 260-mg paclitaxel vial, 13 minutes for a 3000-mg gemcitabine vial, 11 minutes for a 1000-mg bevacizumab vial, 6 minutes for a 3000-mg oxaliplatin vial, and 2 minutes for a 1200-mg rituximab vial. For 5-FU, which requires frequent preparation, there were days when the robotic compounding time was reduced by more than an hour. Conclusions The findings suggest that the development of multidose vials could improve operational efficiency and significantly reduce medical costs.
PubDate: 2025-02-01
- Manage acne in pregnancy with limited choices and extra considerations
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Abstract: Acne vulgaris is a common complaint in pregnancy and has typically been treated with topical antibiotics and anti-inflammatories, with systemic therapies usually reserved for refractory or more severe acne. Choice of therapy is mainly dependent on minimising maternal and foetal risk. Other options can include oral supplements, acid peels, intralesional injections, cosmetics or skincare products, and sunscreen, but caution is required due to a lack of regulation and evidence. Additional care is also required if the pregnancy was unplanned, potentially necessitating a change in treatment choice due to safety concerns.
PubDate: 2025-01-29
- Correction: Lotilaner ophthalmic solution 0.25% in Demodex
blepharitis: a profile of its use-
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PubDate: 2025-01-27
- Initiate treatment with inflammatory modulators early in adult-onset
Still’s disease-
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Abstract: Autoinflammatory, adult-onset Still’s disease (AOSD) is, if not the same disease, along the same spectrum as systemic juvenile idiopathic arthritis, presenting with arthralgia, fever and rash. Key therapies are corticosteroid-sparing interleukin (IL)-1 and IL-6 blockers. NSAIDs and short-term, high-dose corticosteroids are still recommended, with the latter mandatory in severe AOSD, and/or when complications such as macrophage activation syndrome (MAS) occur. Emerging therapies based on small trials in patients with refractory-AOSD include Janus kinase inhibitors and tadekinig alpha. Interferon-γ antagonist emapalumab is effective in patients with Still’s disease and MAS.
PubDate: 2025-01-24
- Nedosiran in primary hyperoxaluria type 1: a profile of its use
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Abstract: Nedosiran (Rivfloza®), a lactate dehydrogenase A-directed small interfering RNA (siRNA), is a valuable addition to the treatment options available for patients with primary hyperoxaluria type 1 (PH1). It is the second siRNA therapy approved for use in PH1 (following lumasiran) in the USA. Nedosiran is administered once monthly via subcutaneous injection by a healthcare professional, caregiver or patient aged ≥ 12 years. Results from PHYOX2, a 6-month, multinational, randomized, double-blind, placebo-controlled, pivotal phase 2 trial, show that nedosiran produces significantly greater reductions in urinary oxalate excretion than placebo in patients with PH1, with approximately two-thirds of patients achieving normal or near-normal levels of urinary oxalate excretion. In the ongoing phase 3 PHYOX3 trial, the efficacy of nedosiran was sustained for ≥ 30 months. Nedosiran is generally well tolerated, with adverse events typically being mild to moderate in severity. The most common treatment-related adverse events are injection site reactions.
PubDate: 2025-01-21
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