Critical Appraisal of Ranibizumab in the Treatment of Diabetic Macular Edema.

Critical appraisal of ranibizumab in the treatment of diabetic macular edema.

Clin Ophthalmol. 2013; 7: 1257-67
Stewart MW

Diabetic retinopathy is the leading cause of blindness among individuals of working age in industrialized nations, with most of the vision loss resulting from diabetic macular edema (DME). The formation of DME depends on the action of several growth factors and inflammatory mediators, but vascular endothelial growth factor (VEGF) appears to be critical for breaking down the blood-retinal barrier and promoting the accumulation of macular edema. Laser photocoagulation has been the standard-of-care for three decades, and although it stabilizes vision, significant gains in visual acuity after treatment are unusual. Several VEGF inhibitors (pegaptanib, aflibercept, and ranibizumab) have been initially developed and tested for the treatment of age-related macular degeneration and subsequently for DME. In Phase I, II, and III trials for DME, ranibizumab has been shown to be superior to macular laser photocoagulation and intraocular triamcinolone acetonide injections for improving visual acuity and drying the macula. As a result, ranibizumab is the only anti-VEGF drug that has been approved by the United States Food and Drug Administration for the treatment of DME. Most experts now consider intravitreal anti-VEGF therapy to be standard-of-care for DME involving the fovea. HubMed – drug



J Clin Endocrinol Metab. 2013 Jul 8;
Pinzani P, Scatena C, Salvianti F, Corsini E, Canu L, Poli G, Paglierani M, Piccini V, Pazzagli M, Nesi G, Mannelli M, Luconi M

Context:Adrenocortical carcinoma (ACC) is a rare malignancy, the prognosis of which is mainly dependent on stage at diagnosis. The identification of disease-associated markers for early diagnosis and drug monitoring is mandatory. Circulating tumor cells (CTC) are released into the bloodstream from primary tumor/metastasis. CTC detection in blood samples may have enormous potential for assisting diagnosis of malignancy, estimating prognosis and monitoring the disease.Objective:To investigate the presence of CTC in blood samples of patients with ACC or benign adrenocortical adenoma (ACA).Setting:University Hospital.Patients:14 ACC and 10 ACA.Intervention:CTC analysis performed in blood samples from 14 ACC and 10 ACA patients. CTC isolated on the basis of cell size by filtration through ScreenCell® devices, followed by identification according to validated morphometric criteria and immunocytochemistry.Main outcome measure:Difference in CTC detection between ACC and ACA.Results:CTC were detected in all ACC but not in ACA samples. Immunocytochemistry confirmed the adrenocortical origin. When ACC patients were stratified according to the median value of tumor diameter and metastatic condition, a statistically significant difference was found in the number of CTC detected after surgery. A significant correlation between the number of CTC in post-surgical samples and clinical parameters was found for tumor diameter alone.Conclusions:Our findings provide the first evidence for adrenocortical tumors that CTC may represent a useful marker to support differential diagnosis between ACC and ACA. The correlation with some clinical parameters suggests a possible relevance of CTC analysis for prognosis and non-invasive monitoring of disease progression and drug response. HubMed – drug