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At least 19 recordsLinked to original sources
PubMed1994

HIV therapy advances. Early antiretroviral therapy.

AIM: To review evidence suggesting that antiretroviral therapy should be initiated at an early stage in HIV infection. METHOD: Review of published data. CONCLUSIONS: There are arguments both for and against early antiretroviral therapy. Although the reasons against are undoubtedly valid, evidence of greater efficacy, less toxicity and a delay in the development of resistance outweigh the possible disadvantages. Moreover, for some patients, early therapy may provide a chance of future benefits from more useful but currently untried treatments.

Antiviral Agents↗
PubMed2006

Advanced therapy may delay the need for transplantation in patients with the Eisenmenger syndrome.

AIMS: Advanced therapies (prostacyclin analogues, endothelin receptor antagonists) are successfully used in the treatment of idiopathic pulmonary arterial hypertension. In addition, patients with the Eisenmenger syndrome (ES) seem to benefit from these news drugs regarding symptoms, but there is still no evidence for changes in outcome. METHODS AND RESULTS: The clinical course of 43 patients (M/F 13/30, age 34.0 +/- 12.7 years), registered with unstable ES in our database, was retrospectively analysed. These patients were divided into two groups: those treated with and those treated without advanced therapy. The primary endpoint was defined as death from any cause. Death or inscription on the active waiting list of heart-lung transplantation was considered as secondary endpoint. Kaplan-Meier survival and log rank testing were performed to determine differences in outcome between the two groups. The total cohort was followed for a median period of 4.9 (range 0.2-14.9) years. Mean survival time for patients treated with (n = 26) and without (n = 17) advanced therapy therapies were 8.5 +/- 1.5 and 8.5 +/- 0.9 years, respectively (log rank testing, P = 0.31). However, the mean time to death or inscription on the active waiting list was significantly longer for patients treated with advanced therapy when compared with those without (7.8 +/- 1.0 vs. 3.4 +/- 0.9 years, P = 0.006). CONCLUSION: For the given follow-up period, no improvement in survival time could be documented in adult patients with unstable ES treated with advanced therapy. However, we might suggest with these data that the need for heart-lung transplantation can be substantially delayed with new drugs.

Adult↗
PubMed2025

Efficacy of Advanced Therapies in Achieving Remission by Disease Location in Crohn's Disease: A Systematic Review and Meta-analysis.

BACKGROUND & AIMS: We compared the efficacy of different advanced therapies by disease location in patients with Crohn's disease (CD) through a systematic review and meta-analysis. METHODS: Through a systematic review, we identified 14 randomized controlled trials in 3139 patients with moderate-to-severe CD who were treated with different advanced therapies vs placebo, and reported efficacy in inducing clinical remission, stratified by disease location (isolated colonic vs ileal disease, excluding ileocolonic disease). We grouped advanced therapies based on the primary mechanism of action: anti-interleukins, Janus kinase inhibitors (JAK inhibitors), anti-integrins, and tumor necrosis factor (TNF) antagonists. We calculated treatment efficacy (drug vs placebo), overall and by drug class, for colonic vs ileal disease. RESULTS: Overall treatment efficacy of advanced therapies vs placebo was higher in patients with colonic (odds ratio [OR], 4.09; 95% confidence interval [CI], 3.02-5.54) vs ileal CD (OR, 1.80; 95% CI, 1.23-2.63; P < .001). By drug class, anti-interleukins demonstrated a higher efficacy in colonic disease (OR, 4.29; 95% CI, 2.77-6.64) vs ileal disease (OR, 2.31; 95% CI, 1.44-3.70; P = .059), whereas no difference in efficacy was observed with anti-integrins (colonic vs ileal: OR, 1.79; 95% CI, 0.55-5.87 vs 2.10; 95% CI, 0.80-5.53; P = .84). For JAK inhibitors, efficacy was observed only in patients with isolated colonic disease (OR, 4.37; 95% CI, 2.67-7.15), but not in ileal disease (OR, 1.01; 95% CI, 0.54-1.89; P < .001). All analyses had minimal to moderate heterogeneity. CONCLUSIONS: The magnitude of efficacy of advanced therapies for ileal CD is generally lower compared with isolated colonic CD, with JAK inhibitors showing particularly limited efficacy for ileal disease. These results may help inform treatment selection.

Humans↗
PubMed2026

Major cardiovascular event risk of advanced therapies in inflammatory bowel diseases: systematic review and meta-analysis.

BACKGROUND: Patients with chronic immune-mediated disorders (IMIDs), including inflammatory bowel disease (IBD), are at increased risk of cardiovascular disease. While advanced therapies show cardioprotective effects in other IMIDs, their impact on major adverse cardiovascular events (MACE) in IBD remains unclear. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating MACE risk with advanced therapies in IBD. METHODS: Systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials identified 43 studies (36 RCTs, including 9 long-term follow-up (LTF) studies, and 7 observational studies) published between 2002 and 2024. Primary analyses estimated odds ratios (OR) for MACE comparing advanced therapy to placebo, with secondary analyses stratifying studies by drug class and length of follow-up. Sensitivity analyses were conducted using alternative methods to account for zero-event data. RESULTS: Placebo-controlled RCTs showed a nonsignificant trend toward reduced MACE risk (OR 0.60; 95% CI 0.24-1.51), with similar findings across sensitivity analyses accounting for sparse and zero-event data. Class-specific trends suggested lower MACE risk with IL-12/IL-23 inhibitors (OR 0.35; 95% CI 0.05-2.21), JAK inhibitors (OR 0.57; 95% CI 0.16-2.06), and a potential increase with Anti-TNF agents (OR: 3.04; 95% CI 0.31-29.47), though none reached statistical significance. LTF studies showed consistent findings. Observational studies suggested lower MACE risk with Anti-TNF therapies (OR 0.29; 95% CI 0.21-0.40), but not with IL-12/IL-23 (OR 4.41; 95% CI 0.49-39.28) or JAK inhibitors (OR 1.57; 95% CI 0.86-2.84). CONCLUSION: Advanced therapies did not demonstrate a clear increase or decrease in cardiovascular risk in IBD. The discrepancies between RCTs and observational studies underscore the urgent need for rigorous-designed observational research with long-term follow-up to evaluate the real-world impact of advanced therapies on MACE risk.

Humans↗
PubMed2004

Liver gene therapy: advances and hurdles.

Liver gene therapy is being developed as an alternative to orthotopic liver transplantation, which is the only effective therapy for many liver diseases. The liver has unique features that make it attractive for in vivo and ex vivo gene transfer. In vivo approach is far less invasive than ex vivo approach, although in most cases, host immune response directed against the transgene product and/or vector particles severely impairs the efficiency of gene transfer, and precludes long-term transgene expression after in vivo gene delivery. Ex vivo approach allows for an elective targeting of the hepatocytes, avoiding that the transgene be expressed in professional antigen-presenting, but is faced with the low in vitro proliferative ability of hepatocytes, and to the low in vivo liver repopulating ability of transplanted cells. In some specific situations where immune response was controlled or transplanted cells had a strong growth advantage over host hepatocytes, gene transfer resulted in long-term and complete correction of a liver genetic defect. In this review, we will outline the liver diseases that may benefit from gene therapy, the vector technology under investigation, the advances and the problems to be overcome.

Animals↗
PubMed1999

Long-term oxygen therapy: advances and perspectives in technical devices.

Since the early beginnings of long-term oxygen therapy, by means of cylinders of compressed oxygen and their subsequent replacement with oxygen concentrators, most technical advances have been steadily focused on improving the facilities for continuous ambulatory oxygen therapy. Largely for this purpose, two different systems have been developed. 1) Oxygen concentrators in combination with portable cylinders for patients requiring oxygen at home and during short-term outdoor activities. If connected to an oxygen-conserving device, the duration of the ambulatory administration can be increased substantially. To improve mobility, a new generation of lightweight cylinders can nowadays be provided be several suppliers, thus; the weight of the portable systems can be reduced down to 2.1 kg. 2) Liquid oxygen is still the most convenient system for patients requiring continuous oxygen at home as well as during extensive daily outdoor activities. Liquid oxygen administration, however, is handicapped by its high costs, mainly due to logistical expenditure. Conserving devices are capable of lowering substantially the consumption and costs of gaseous and liquid oxygen. The following conserving techniques have proved to be efficient: reservoir cannulas, demand oxygen-pulse devices, and transtracheal catheters. The transtracheal route additionally improves physical ability and prolongs survival, suggested to be a consequence of unloading the work of breathing. Looking to future perspectives, there is ongoing progress in the technical improvement of concentrators. A very promising product is a new kind of concentrator which can be used to refill small portable cylinders at home. This system may be a real and probably less expensive alternative to liquid oxygen. In conclusion, all future efforts should be directed at improving the facilities for providing continuous ambulatory oxygen therapy, the superior concept for pulmonary rehabilitation in patients with chronic respiratory insufficiency.

Home Care Services↗
PubMed1994

HIV therapy advances. Update on a proteinase inhibitor.

HIV PROTEINASE INHIBITORS: The HIV proteinase enzyme has been identified as a potential target for antiretroviral therapy, as inhibition of this enzyme leads to the generation of immature, non-infectious virions. There are several proteinase inhibitors in development; the first to enter clinical trials was saquinavir. DEVELOPMENT OF SAQUINAVIR: Saquinavir, a transition-stage analogue of an HIV proteinase cleavage site, was developed using computer-led rational design techniques. It is a highly specific inhibitor of HIV-1 and -2 proteinases, with antiviral activity at concentrations 1000-fold less than those causing cytotoxicity. EUROPEAN CLINICAL EXPERIENCE WITH SAQUINAVIR: Three European clinical studies involving 202 patients have been conducted with saquinavir at doses of 25, 75, 200 and 600 mg three times a day. Two studies were dose-ranging monotherapy trials, one in asymptomatic or mildly symptomatic patients not previously treated with zidovudine, the other in patients with advanced HIV infection who had been treated with zidovudine. The third study was a combination therapy trial with zidovudine in previously untreated patients with advanced infection. Saquinavir was well tolerated either alone or in combination with zidovudine. In the monotherapy studies, CD4 cell counts and estimates of viral load showed the best results with the 600-mg dose. The combination of saquinavir and zidovudine resulted in higher and more sustained increases in CD4 cell counts than with either drug alone. The CD4 cell counts favoured saquinavir at 200 and 600 mg in combination with zidovudine, although plasma viraemia and the RNA polymerase chain reaction indicated that the 600-mg dose (in combination) produced better responses.

Aspartic Acid Endopeptidases↗
PubMedDate not supplied

Altered jaw posture and occlusal disruption patterns following mandibular advancement therapy for sleep apnea: a preliminary study of cephalometric predictors.

PURPOSE: Reports of irreversible alteration in jaw posture and destructive occlusal contact relationships in individuals using mandibular advancement devices for obstructive sleep apnea are beginning to appear. This study sought cephalometric means of identifying such individuals before commencing therapy. MATERIALS AND METHODS: Cephalograms of 34 obstructive sleep apnea sufferers who had worn mandibular advancement devices for 2 years were compared retrospectively with baseline films taken at commencement of therapy and analyzed for signs of morphologic changes in jaw position and occlusal relationship. In affected patients, two distinct morphologic species of mandibular reposturing became evident: (1) bilateral posterior open bite with destructive incisal attrition; and (2) less destructive intermediate open bite over the premolar and first molar regions. From the observed morphology patterns, gonial angle and maxillary-mandibular plane angle were analyzed as possible vertical cephalometric risk predictors, with newly defined pterygoid advancement proportion (PtAP) as a horizontal predictor. RESULTS: Three patients displayed the posterior open bite pattern and had gonial angles < or = 119 degrees and maxillary-mandibular plane angles < or = 16 degrees, with PtAP values > or = 0.48. Prediction intervals for the five intermediate open bite cases were 118 degrees < or = gonial angle < or = 128 degrees, and 23 degrees < or = maxillary-mandibular plane angle < or = 32 degrees. PtAP values were > or = 0.52. CONCLUSION: Cephalometric analysis can help practitioners identify which apnea patients might be likely to develop irreversible mandibular postural changes from wearing a jaw-repositioning device.

Cephalometry↗
PubMed1996

Advances in Therapy for Advanced Breast Cancer.

Breast cancer is a major public health problem in the US, with 46,000 women dying annually from the disease. However, innovative therapies are rapidly attempting to change the natural history of advanced disease. These therapies include such new drugs as taxanes and innovative modalities like gene therapy, immunotherapy, therapy with monoclonal antibodies, and higher doses of established agents in high-dose chemotherapy with stem cell support. Clinical trials are currently exploring all of these modalities.

Journal Article↗
PubMed2001

[Medical and coordination aspects of workers' health care improvement and occupational therapy advances in present economic situation].

Medical and social aspects of workers' health care in present economic situation should be based on a Federal Law? 125 "On mandatory social insurance covering occupational accidents and occupational diseases" accepted in 2000. Medical care for workers could promote further improvement of occupational therapy service, foundation of industrial medicine centers similar to "AutoVAZ" Health Center, specification of new periodic documents on practice of periodic medical examinations, criteria determining disability degree. These measures could improve medical management of workers.

Accidents, Occupational↗
PubMed2002

Iron therapy, advanced oxidation protein products, and carotid artery intima-media thickness in end-stage renal disease.

BACKGROUND: Increased common carotid artery intima-media thickness (CCA-IMT) is a marker of early atherosclerosis. Low-grade inflammation is associated with the pathogenesis of atherosclerosis. Low-grade inflammation and increased CCA-IMT are observed in end-stage renal disease (ESRD). Oxidative stress is involved in uremia-related inflammation. Advanced oxidation protein products (AOPP) are markers of oxidant-mediated protein damage in ESRD. Intravenous iron given to patients on hemodialysis (HD) might induce oxidative stress. We investigated the relationships between AOPP, iron therapy, and CCA-IMT in stable HD patients. METHODS AND RESULTS: Plasma AOPP and blood chemistry, including iron status, were analyzed in a cohort of 79 ESRD patients on HD. Measurements of CCA-IMT and CCA diameter, as assessed by B-mode ultrasonography, were obtained in 60 patients. AOPP levels were elevated in ESRD patients, and in univariate (r=0.42, P<0.0001) and multivariate analyses (r=0.38, P<0.001), they correlated with serum ferritin and with the intravenous iron dose received during the 12 months preceding the study (ferritin, P<0001; AOPP, P<0.01). Univariate and multivariate analyses identified the AOPP concentration as being significantly associated with CCA-IMT (P=0.0197) and CCA wall-to-lumen ratio (r=0.560, P<0.0001). Independently of AOPP concentration, cumulative iron dose was positively related to CCA-IMT (P=0.015) in patients <60 years. CONCLUSION: In ESRD patients, CCA-IMT and CCA wall-to-lumen ratio were associated with plasma AOPP, serum ferritin, and the annual intravenous iron dose administered. These findings support the concept of a role of oxidative stress in the early atherosclerosis of ESRD patients, which may be increased by the usually recommended doses of intravenous iron.

Biomarkers↗
PubMed2005

Psoriatic arthritis therapy advances.

PURPOSE OF REVIEW: This paper will review the data published in 2004 on the treatment of psoriatic arthritis, which arthritis affects 6 to 39% of all patients with psoriasis. RECENT FINDINGS: New data from placebo-controlled trials of anti-tumor necrosis factor agents, etanercept, infliximab, and adalimumab continue to show sustained effectiveness of these therapies in their ability to control the symptoms and signs of both arthritis and psoriasis, improve quality of life and function, and inhibit disease progression as measured by radiologic changes. Medications that inhibit T cells have been approved for the treatment of psoriasis and have been studied in psoriatic arthritis. The effectiveness of one of these agents, efalizumab, did not achieve statistical significance in the treatment of psoriatic arthritis. The results of a trial with a second agent, alefacept are pending public review. SUMMARY: There has been a persistent increased focus on the diagnosis and treatment of psoriatic arthritis as newer and more effective drugs than traditional disease-modifying agents have become available.

Antirheumatic Agents↗