Tolerability Of Drug Treatments Research Articles

The use of recently approved antiepileptic drugs: use with caution, use in refractory patients or use as first-line indications?

Approximately 50% of patients with newly diagnosed epilepsy achieve immediate remission, and up to 50% enter terminal remission with first-generation antiepileptic drugs. However, 20–30% of cases are still refractory to current treatments. This population is the target of newer antiepileptic drugs and other compounds in development. The licensing of newer antiepileptic drugs represents an advance in the development of more manageable products and the control of several disturbing adverse drug reactions of the older compounds. However, despite the development of several new antiepileptic drugs, the efficacy and tolerability of drug treatment of epilepsy has not substantially improved in terms of effectiveness and risk–benefit and cost–benefit profiles. Newer antiepileptic drugs are, at best, equivalent in efficacy to their predecessors, but some of them are more manageable and better tolerated. However, the use of a first-generation compound at low doses in newly diagnosed patients is still preferable because the disease can be as well-controlled and the incidence of intolerable side effects is minimized. Newer generation compounds should be used as alternative treatments in patients who are nonresponding to first-generation drugs and in those for whom these drugs are contraindicated or poorly tolerated. As an exception, some new-generation drugs are a valuable option in the presence of comorbidities known to respond to these products or in patients with selected epilepsy syndromes. In light of the heterogeneity and the complexity of the mechanisms underlying epileptic seizures, the future of drug development will be the discovery of drugs efficacious for the treatment of selected epilepsy syndromes or, more specifically, targeting genetic defects leading to molecular abnormalities.

Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis

Objective To appraise the evidence for comparative efficacy and tolerability of drug treatments in patients with generalised anxiety disorder.Design Systematic review of randomised controlled trials. Primary Bayesian probabilistic mixed treatment...

Health-related quality-of-life measurement in hypertension. A review of randomised controlled drug trials.

In hypertension, tolerability of drug treatment is important because individuals may see the use of antihypertensive medications as more troubling than their seemingly symptomless disease. This may result in noncompliance and ineffectual long term treatment. In the past 15 years, new antihypertensive medications have been marketed on the basis of the advantages they offer with regard to adverse effects and the unavoidable impact of such adverse effects on a person's quality of life. When related to health, quality of life refers to the physical, psychological and social dimensions of health that are influenced by a person's experiences, beliefs, expectations and perceptions. To measure this concept, many instruments, either generic or specific, may be used. The purpose of this study is to describe, by way of a critical review of the literature, the instruments that are most often used in the measurement of health-related quality of life (HR-QOL) in people using antihypertensive drug treatments. We carried out a search of the literature published in English in the period January 1966 to July 2000, looking for randomised controlled trials of antihypertensive drugs. Using the Medline database, we included 77 papers in our review. Our main finding suggests that HR-QOL changes associated with antihypertensive treatment are measured with many different instruments. In almost all studies, at least 1 instrument specific to a health dimension was used, whereas not many used a generic instrument only. The most commonly measured HR-QOL dimensions were cognitive function, symptomatic well-being, sexual function, psychological well-being, sleep dysfunction, social participation and general health perception. Since the choice of dimensions to measure depends not only on the disease but also on the drug, this review adds further evidence that a generic instrument as well as a preference measurement should be added to a specific instrument.

Comparison of the Clinical Success Rates and Quality of Life Effects of Brimonidine Tartrate 0.2% and Betaxolol 0.25% Suspension in Patients With Open-Angle Glaucoma and Ocular Hypertension

To compare the clinical effectiveness and the impact on quality of life of twice-daily brimonidine 0.2% with those of twice-daily betaxolol 0.25% in patients with glaucoma or ocular hypertension. A prospective, double-masked, randomized, comparative, multicenter, 4-month "real-life" clinical trial involving 188 patients. Medications were instilled twice daily. Efficacy was determined through measurement of intraocular pressure; safety and tolerability were measured using reports of adverse events, a quality of life survey (Glaucoma Disability Index), heart rate, and blood pressure. Patients with an inadequate response in intraocular pressure after 1 month or those who experienced significant adverse events in the first month were switched to the alternative study arm and remained taking the alternative medication for a total of 4 months or left the study. The main outcome measure was clinical success, as determined by evaluation of the efficacy, safety, and tolerability of drug treatment, and was achieved when the investigator recommended that the patient continue the treatment after completion of the study. As initial therapy, clinical success was achieved in 74% of patients treated with brimonidine, as compared with 57% of patients treated with betaxolol (P = 0.027). The overall mean decrease in intraocular pressure from baseline was 5.9 mm Hg with brimonidine and 3.8 mm Hg with betaxolol. Both treatments were well tolerated, and there were no significant between-group differences in the incidence of adverse events or in the quality of life summary scores. Twice-daily brimonidine 0.2% and betaxolol 0.25% suspension were safe and effective as first-line therapy for glaucoma and ocular hypertension. In this study, brimonidine showed clinical effectiveness superior to that of betaxolol.