Comparative Durability of Nevirapine Versus Efavirenz in First-Line Regimens During the First Year of Initiating Antiretroviral Therapy Among Swaziland HIV-Infected Adults.

Comparative durability of nevirapine versus efavirenz in first-line regimens during the first year of initiating antiretroviral therapy among Swaziland HIV-infected adults.

Pan Afr Med J. 2013; 15: 5
Takuva S, Evans D, Zuma K, Okello V, Louwagie G

Nevirapine (NVP) and Efavirenz (EFV) have generally comparable clinical and virologic efficacy. However, data comparing NVP durability to EFV are imprecise. We analyzed cohort data to compare durability of NVP to EFV among patients initiating ART in Mbabane, Swaziland. The primary outcome was poor regimen durability defined as any modification of NVP or EFV to the ART regimen. Multivariate Cox proportional hazards models were employed to estimate the risk of poor regimen durability (all-cause) for the two regimens and also separately to estimate risk of drug-related toxicity. We analyzed records for 769 patients initiating ART in Mbabane, Swaziland from March 2006 to December 2007. 30 patients (3.9%) changed their NVP or EFV-based regimen during follow up. Cumulative incidence for poor regimen durability was 5.3% and 2.7% for NVP and EFV, respectively. Cumulative incidence for drug-related toxicity was 1.9% and 2.7% for NVP and EFV, respectively. Burden of TB was high and 14 (46.7%) modifications were due to patients substituting NVP due to beginning TB treatment. Though the estimates were imprecise, use of NVP – based regimens seemed to be associated with higher risk of modifications compared to use of EFV – based regimens (HR 2.03 95%CI 0.58 – 7.05) and NVP – based regimens had a small advantage over EFV – based regimens with regard to toxicity – related modifications (HR 0.87 95%CI 0.26 – 2.90). Due to the high burden of TB and a significant proportion of patients changing their ART regimen after starting TB treatment, use of EFV as the preferred NNRTI over NVP in high TB endemic settings may result in improved first-line regimen tolerance. Further studies comparing the cost-effectiveness of delivering these two NNRTIs in light of their different limitations are required. HubMed – drug

Diltiazem-induced Transient Complete Atrioventricular Block in an Elderly Patient with Acute on Chronic Renal Failure.

Open Cardiovasc Med J. 2013; 7: 23-26
Brenes JA, Cha YM

Diltiazem is a calcium channel blocker commonly used in the treatment of various cardiovascular disorders such as hypertension, angina and supraventricular tachycardias. Metabolism occurs mainly in the liver, but a small percentage of unchanged drug and metabolites are excreted in the urine. Toxicity from this medication usually presents in the form of dysrrhytmias and heart block. Hence, we present a case of complete atrioventricular AV block in a patient receiving sustained- release diltiazem on a chronic basis. Risk factors such as advanced age and impaired renal function are dis-cussed. HubMed – drug

Asthma: beyond corticosteroid treatment.

Arch Med Sci. 2013 Jun 20; 9(3): 521-526
Marandi Y, Farahi N, Hashjin GS

Asthma is one of the most common chronic diseases in the world, affecting over 300 million people. It is an inflammatory disorder characterized by bronchoconstriction and airway hyperresponsiveness, followed by inflammatory manifestations in the respiratory system. The prevalence of asthma is rising and there is a clinical need to develop more effective treatments. While corticosteroids (glucocorticosteroids) remain the mainstay of asthma therapy, they have limitations because of their potentially severe side-effects and the presence of corticosteroid resistance in some patients. This review discusses current strategies in the treatment of asthma and considers new therapeutic regimens of asthma in the drug development pipeline. HubMed – drug

Persistence with statin therapy in Hungary.

Arch Med Sci. 2013 Jun 20; 9(3): 409-417
Kiss Z, Nagy L, Reiber I, Paragh G, Molnar MP, Rokszin G, Abonyi-Toth Z, Mark L

Persistence with lipid-lowering drug therapy by cardiovascular patients in Hungary has not been studied previously. This study was designed to determine the rate with which Hungarian patients with hyperlipidemia persist in taking lipid-lowering agents, and to compare this with rates reported from other countries.This was a retrospective study that utilized data from the Institutional Database of the National Health Insurance Fund to analyze persistence rates with statins and ezetimibe. The study included data for patients who started lipid-lowering therapy between January 1, 2007, and March 31, 2009. Variables included type of lipid-lowering therapy, year of therapy start, and patient age. Main outcome measures were medians of persistence in months, percentages of patients persisting in therapy for 6 and 12 months, and Kaplan-Meier persistence plots.The percentage of patients who persisted with overall statin therapy was 46% after 1 month, 40.3% after 2 months, 27% after 6 months, and 20.1% after 12 months. Persistence was slightly greater for statin therapy started during 2008 than during 2007. Older patients were more persistent with therapy than younger patients. Persistence with the combination of ezetimibe-statin therapy was greater than with statin or ezetimibe monotherapy.Persistence with statin therapy by patients in Hungary was low compared with other countries. Low persistence may have negated potential clinical benefits of long-term statin therapy. HubMed – drug

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