Insulin Aspart for Improved Glycemic Control

Posted April 10th, 2011. Filed under Drugs News

Insulin Aspart

At the annual meeting of the American Diabetes Association (ADA), many studies presented data indicating that insulin aspart (rDNA origin) injection (Novolog, Eli Lily and Company) maintains adequate control of blood sugar levels for people with type 1 diabetes if the injection is administered right before or just after a meal. Human insulin has to be injected 30 minutes before a meal, which is problematic for many people with type 1 diabetes, because they need to calculate their insulin dose based on the amount of carbohydrates to be consumed in a meal.

The mealtime dosing study compared the use of insulin aspart before and after a meal. Results showed that postprandial glycemic control was adequate regardless of when the drug was administered, but glycemic response was 25% lower when insulin aspart was administered before a meal rather than after it.
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Two other studies presented at the ADA showed that insulin aspart provided better glycemic control than regular human insulin (RHI). In one study, insulin aspart given just before a meal was compared with RHI given 30 minutes before the meal. Peak glucose levels were 25 minutes shorter, postprandial glucose surges were 20°% lower (P=0.034), and peak insulin levels were reached 27 minutes earlier with insulin aspart than with RHI. The other study compared treatment with insulin aspart with or without bedtime insulin, RHI with or without NPH insulin, and human premixed insulin. Insulin aspart had greater reductions in HbA1c than the RHI group or the insulin premix group. Postprandial glucose levels decreased the most with insulin aspart.

Another study on insulin aspart focused on gestational diabetes. It included 15 women who were 18 to 28 weeks pregnant and unable to achieve adequate glycemic control through diet alone. The women underwent a series of tests on three different days in random order. In one test, no insulin was administered; in the other two tests, they received either insulin aspart or RHI. The study showed that insulin aspart was more effective than RHI in blunting the postprandial glucose peak 60 minutes after the meal and reducing the overall amount of glucose in the bloodstream (to which the fetus is exposed) following the meal.

Etanercept for Ankylosing Spondylitis

Posted April 8th, 2011. Filed under Drugs News

The FDA has approved the expanded use of etanercept (Enbrel®, Amgen/ Wyeth) for patients with ankylosing spondylitis, a chronic inflammatory disease that primarily affects the lower back and joints. Approximately 350,000 patients in the U.S. have this condition.

In the 277-patient trial, the drug benefited 70% of patients younger than age 42 and 48% of patients older than age 42. The women had a lower response rate (45%) than the men did (65%). Of the patients receiving the drug, 58% showed significant improvement of measured pain, function, and inflammation after six months of twice-weekly treatments, compared with 23% of patients receiving placebo.
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Etanercept patients who carried the HLAB27 genetic marker had a higher rate of response (65%) than patients who were HLAB27-negative (38%).

Etanercept was approved to treat rheumatoid arthritis in 1998, juvenile rheumatoid arthritis in 1999, and psori-atic arthritis in 2002.

Inhaled Corticosteroids and Chronic Lung Disease

Posted April 5th, 2011. Filed under Drugs News

The jury is still out on whether inhaled corticosteroids slow the decline in lung function for patients with chronic obstructive pulmonary disease (COPD). COPD, which is characterized by limited airflow, is the fourth leading cause of death in the U.S.
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Researchers from the Medical University of South Carolina say that the tradeoff of long-term improvement might not be worth the persistent effects of the drugs, and they support inhaled cortico-steroids for symptomatic patients who have a spirometric response to them or who have frequent COPD exacerbations that require the use of oral cortico-steroids or antibiotics.

The “Polypill” for Heart Disease and Stroke

Posted April 2nd, 2011. Filed under Drugs News

single pill might be able to reduce heart attacks and strokes by more than 80%, concludes a study from England. Heart attacks, stroke, and other pre­ventable cardiovascular diseases kill or seriously affect 50% of people in Britain.

Professor Nicholas Wald and Malcolm Law propose a “polypill” that would contain six active components—aspirin, a cholesterol-lowering drug, three blood pressure-lowering drugs at half the standard dose, and folic acid. The pill would be taken daily by all people aged 55 and over and is expected to have a huge effect on preventing disease in the Western world.
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Their radical strategy is based on evidence from more than 750 trials involving 400,000 participants.

These medications are well tolerated, and new problems are unlikely because they have been studied extensively and have often been used in combination.

Interferons and Psychosis

Posted March 28th, 2011. Filed under Drugs News

Interferons

Interferon alfa (IFN-a) therapy can have adverse psychiatric effects. Although symptoms, such as hallucinations, usually improve shortly after the drug is stopped, they may occasionally persist. Turkish researchers who treated a man with chronic hepatitis B advise monitoring the mental status of patients receiving IFN-a during all stages of therapy.
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Laronidase for Genetic Disease

Posted March 25th, 2011. Filed under Drugs News

Genetic Disease

The FDA has approved laronidase (Aldurazyme®, BioMarin), the first treatment for certain forms of a rare genetic disease called mucopolysaccharidosis I (MPS I), which includes Hurler’s syndrome. This disease results from the absence or malfunctioning of an enzyme that breaks down molecules called glycosaminoglycans (GAG) in the cells. The buildup of GAG results in progressive cellular damage that affects appearance, physical abilities, organ function, and, in some cases, mental development.
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In one study, treated patients showed improved lung and walking capacity in a six-minute walking test after 26 weeks.

The most serious adverse drug event was an anaphylactic (allergic) reaction approximately three hours after infusion. Safety concerns related to infusion reactions included flushing, fever, headache, and rash.

Don’t Drop the Droperidol

Posted March 24th, 2011. Filed under Drugs News

The recent “black-box” warning about life-threatening prolongation of the QT interval caused by droperidol (Inapsine®, Akorn/Taylor) use has probably come as a surprise to emergency-department physicians and their staffs who have been using the drug for years. In fact, it so alarmed researchers from Indiana University School of Medicine and the University of Virginia School of Medicine that they decided to investigate the basis for the warning.

Droperidol is widely used as a tran-quilizer for agitated patients, as a pre-surgical medication before the administration of anesthesia, and as an emetic agent to prevent nausea after surgery. A black-box warning is the most serious type of warning for an FDA-approved drug.
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After reviewing data from several sources, the investigators noted a shortlived and dose-dependent association between droperidol and QT prolongation but not between droperidol and torsades de pointes.

Although the FDA recommended the warning to advise caution and ongoing cardiac monitoring, the researchers are concerned that this warning might have the effect of halting the use of a “time-tested” therapy that is still often a safe and appropriate choice.

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