Triple Therapy In Treatment Research Articles

Clinical observation of Wumeiwan combined with triple therapy for treatment of chronic atrophic gastritis

Objective To explore clinical efficacy and safety of Wumeiwan combined with triple therapy for treatment of chronic atrophic gastritis (CAG). Methods According to the random indicator method, 113 patients with CAG were divided into control group (n=56) and treatment group (n=57). Patients of control group were treated with triple therapy, while treatment groupwere treated Wumeiwan combined with triple therapy. The two groups were treated for 3 months. Clinical effect was evaluated after treatment. The helicobacter pylori (Hp) conversion to negative of the two groups was compared and recorded. The Hp overcast conditions of the two groups were compared. The serum TNF-α, IL-6, IL-8 and peripheral blood CD3+, CD4+, CD8+, CD4+/CD8+ of the two groups before and after treatment were compared. The adverse reactions of the two groups during the treatment were compared. Results Total effective rate of treatment group was 94.7% (54/57), which was significantly higher than the control group 82.14% (46/56), and the difference was statistically significant (χ2=4.401, P=0.036). Hp overcast rate of treatment group was 88.2% (45/51), which was significantly higher than the control group 48.0%(24/50), and the difference was statistically significant (χ2=18.883, P=0.000). After treatment, the serum TNF-α (1.43 ± 0.17 mg/L vs. 1.97 ± 0.22 mg/L, t=14.615), IL-6 (30.79 ± 3.65 ng/L vs. 41.13 ± 4.10 ng/L, t=14.166), IL-8 (7.52 ± 1.32 ng/L vs. 9.60 ± 1.77 ng/L, t=7.090) in the treatment group were lower than those in the control group (P<0.05). After treatment, the peripheral blood CD3+ (75.12% ± 16.44% vs. 67.33% ± 14.37%, t=2.680), CD4+ (39.02% ± 11.41% vs. 33.49% ± 10.61%, t=2.667), CD4+/CD8+ (1.58 ± 0.35 vs. 1.19 ± 0.32, t=6.179) in the treatment group were higher than those in the control group (P<0.05), the peripheral blood CD8+ (24.75% ± 9.69% vs. 28.12% ± 11.29%, t=1.704) in the treatment group were higher than those in the control group (P<0.05). There was no significantly difference of the adverse reaction rates of the two groups during treatment (χ2=0.134, P=0.714). Conclusions The Wumeiwan combined with triple therapy for treatment of CAG has a good efficacy and low adverse reactions, has serious anti-inflammatory effects, can improve the body immunity, and it was worthy clinical application. Key words: Gastritis, atrophic; Wu Mei Wan; Triple therapy; Efficacy; Safety

Marzulene-S combined with standard triple therapy for treatment of children with Helicobacter pylori positive peptic ulcer: Efficacy and influence on serum pepsinogen and gastrointestinal hormones

Marzulene-S combined with standard triple therapy for treatment of children with <i>Helicobacter pylori</i> positive peptic ulcer: Efficacy and influence on serum pepsinogen and gastrointestinal hormones

Effectiveness of triple therapy with direct-acting antivirals for hepatitis C genotype 1 infection: application of propensity score matching in a national HCV treatment registry

BackgroundObservational studies are used to measure the effectiveness of an intervention in non-experimental, real world scenarios at the population level and are recognised as an important component of the evidence pyramid. Such data can be accrued through prospective cohort studies and a patient registry is a proven method for this type of study. The national hepatitis C (HCV) registry was established in Ireland in 2012 with the aim of monitoring the clinical and economic outcomes from new, high cost regimens for the treatment of HCV infection. A sustained virological response (SVR) 24 weeks following completion of therapy with interferon-containing regimens is considered a cure. Non-randomisation in these studies can result in confounding or selection bias. Propensity score (PS) matching is one of a number of statistical tools that can be used to mitigate the effects of confounding in observational studies.MethodsWe analysed the data of 309 patients who underwent triple therapy treatment with telaprevir (TPV) in combination with pegylated-interferon and ribavirin (PR) or boceprevir (BOC)/PR between June 2012 and December 2014. The decision to initiate treatment and the selection of the treatment regimen was at the discretion of the physician. To adjust for confounding, three approaches to propensity score matching were assessed Adjusted sustained-virological response rates (SVR), odds ratios, p-values and 95% confidence intervals were calculated from the three PS matched dataset.ResultsPrior to matching, the unadjusted sustained virological response rates 24 weeks after treatment complete (SVR24) were 74% (n = 158/215) and 61% (n = 57/94) for telaprevir/PR and boceprevir/PR, respectively. After matching, adjusted SVR24 rates were between 73–74% and 60–61% for telaprevir/PR and boceprevir/PR, respectively.ConclusionEfficacy rates were comparable with those reported in pivotal clinical trials and real world studies. After adjusting for confounding, we conclude that there was no difference in treatment effect after PS matching. The small sample size limits the conclusions that can be made about the effect of PS matching. Propensity score adjustment remains a tool that can be applied to future analysis, however, we suggest, where possible, using a larger sample size in order to reduce the uncertainty around the outcomes.

Clinical effect of probiotics combined with triple therapy in the treatment of helicobacter pylori infection in children

Objective To discuss the application of combined probiotics pretreatment and late triple therapy with helicobacter pylori infection in children. Methods 300 children with helicobacter pylori infection were randomly divided into three groups according to the way of random table.Group A was treated with standard triple therapy, omeprazole, amoxicillin and clarithromycin treatment, and 10 d was 1 treatment course.B group was given probiotic pretreatment, prior to the triple therapy using compound lactobacillus acidophilus piece 1 piece/time, cold water to take after meals, taking 2 weeks, follow-up treatment with triple therapy for 10d.In group C, triple therapy before using compound lactobacillus acidophilus piece 1 piece/time, cold water to take after meals, taking 2 weeks, follow-up treatment with triple therapy for 10d.To take one week after the completion of compound lactobacillus acidophilus piece 1 piece/time, cold water after meals.The clinical therapeutic effects were recorded. Results The helicobacter pylori clearance rate of group A was 55.00%, that of group B was 86.00%, that in group C was 89.00%, the helicobacter pylori clearance rate of group B and group C was significantly higher than that in group A, the difference was statistically significant (χ2=23.103 7, 28.670 6, all P 0.05). In A group, nausea and vomiting occurred in 5 cases, 2 cases of diarrhea, abdominal distension abdominal pain in 4 cases, skin rash in 5 cases.In group B, nausea and vomiting occurred in 2 cases, 0 cases of diarrhea, abdominal distension abdominal pain in 1 case, skin rash in 1 case.In group C, nausea and vomiting occurred in 1 case, 0 cases of diarrhea, abdominal distension abdominal pain 0 cases, skin rashes in 1 case.The incidence rate of adverse reactions in group B and group C was lower than that in group A, the difference was statistically significant (χ2=11.965 8, 8.000 0, all P 0.05). Conclusion Joint probiotics pretreatment and late triple therapy application in helicobacter pylori in children can promote helicobacter pylori clearance, reduce the triple therapy drug adverse reactions, it is worthy of popularization and application in clinic. Key words: Probiotics; Triple therapy; Children; Helicobacter pylori infection

Cost analysis of residual viremia detected by two real-time PCR assays for response-guided (dual or triple) therapy of HCV genotype 1 infection

Introduction The duration of interferon-based dual and triple therapies for HCV-G1 is determined by assessment of early viral kinetics. We conducted a cost analysis to determine the mean cost of dual or triple therapy treatment for a patient with HCV-G1, where the therapy duration (24 or 48 weeks) is guided by HCV-RNA assay. Methods HCV-RNA was assessed by two widely used real-time PCR-based assays, Cobas Ampliprep/Cobas TaqMan (CAP-CTM) and Real-Time HCV (ART). As far as the dual therapy (PegINFα-2b and RBV) is concerned, at week 12 of treatment 16.0% of patients (27/169) were eligible to receive a shorter duration of therapy (24 weeks) according to CAP-CTM and 8.9% (15/169) according to ART: 26 patients achieved SVR (15.4%) with CAP-CTM and 15 with ART (8.9%). With regard to triple therapy (TPV, PegINFα-2a and RBV), at week 12 of treatment 59.6% of patients (31/52) were eligible to receive a shorter duration of therapy (24 weeks) according to CAP-CTM and 28.8% (15/52) according to ART: 30 patients achieved SVR (57.7%) with CAP-CTM and 13 with ART (25.0%). The cost analysis was conducted from the perspective of the Italian National Health Service (NHS). Only drug (TPV, PegINFα-2a, PegINFα-2b and RBV) and test (CAP-CTM and ART) costs were taken into account. Ex-factory prices (included all discounts) and national tariffs were used to calculate drug consumptions and tests, respectively. Costs were assessed in Euros 2015. Results With regard to dual therapy, the overall mean treatment cost per patient with CAP-CTM (€9,572.77) was lower than with ART (€9,876.19). With regard to triple therapy, the overall mean treatment cost per patient was lower with CAP-CTM (€31,354.40) than with ART (€33,155.26). Conclusions CAP-CTM HCV-RNA assay was cost-saving from the Italian NHS perspective compared with ART HCV-RNA assay in the dual (-€303.42 per patient) and triple (-€1,800.96 per patient) HCV therapy.

Assessment of Sequential and Standard Triple Therapy in Treatment of Helicobacter pylori Infection in Children Dependent on Bacteria Sensitivity to Antibiotics.

In the last decade a 10-day schema of sequential therapy of Helicobacter pylori infection based on proton pomp inhibitor (PPI), amoxicillin (AMO), clarithromycin (CLA) and metronidazole (MET) has been introduced. Many studies have emphasized greater efficacy of this therapy in comparison to the efficacy of the standard 7-day triple therapy (PPI + AMO + CLA or MET). The aim of the study was to assess the sequential and standard triple therapy. Sixty-nine children, aged 5 to 17 years, with symptoms of dyspepsia and gastric or duodenal ulcer were included in the study. The children were randomly divided into three groups. Group I - 23 children treated with PPI + AMO + CLA, group II - 23 children treated with PPI + AMO + MET, and group III - 23 children treated with sequential therapy. The diagnosis of Helicobacter pylori infection was based on histopathological evaluation of gastric mucosa sample and on culture. The sensitivity of bacterial strains to antibiotics was assessed based on E-tests. The efficacy of Helicobacter pylori eradication was assessed 6-8 weeks after the completion of the treatment. In children infected with Helicobacter pylori strains, which were sensitive to clarithromycin, the highest rate of eradication was obtained in the group treated with PPI + AMO + CLA (100%) and in the group treated with sequential therapy (90.48%), the lowest was in the group treated with PPI + AMO + MET. Efficiency of treatment of Helicobacter pylori infection in children depended on sensitivity of the strains to clarithromycin. Sensitivity to metronidazole did not influence significantly the eradication rate.

TAFRO Syndrome Associated with EBV and Successful Triple Therapy Treatment: Case Report and Review of the Literature.

TAFRO syndrome is a rare constellation of symptoms: thrombocytopenia, anasarca, reticulin fibrosis of the bone marrow, renal dysfunction, and organomegaly. Its pathogenesis involves an excessive and inappropriate cytokine storm, most notably from IL-6, causing multiorgan failure; however, its etiology is undetermined. Starting in 2012, TAFRO syndrome was first identified in Japan as an atypical variant of Castleman's disease. Previous reports include various different treatment protocols with inconsistent survival outcomes. Here we report the first known American, EBV positive but HIV and HHV-8 negative, male with TAFRO syndrome. He was successfully treated with an unusual three-drug regimen including tocilizumab, etoposide, and rituximab. We review the literature of TAFRO syndrome, discuss its possible viral etiology, and propose an original treatment regimen.

Cooperative effect of BI-69A11 and celecoxib enhances radiosensitization by modulating DNA damage repair in colon carcinoma.

Amplification of PI3K-Akt pathway promotes radioresistance in various cancers including colorectal carcinoma. Local recurrence in colon cancer causes poor prognosis affecting overall survival of cancer-affected patient population. To avoid local recurrence, pre-operative or post-operative additional radiotherapy is given. However, main concern regarding radiotherapy is to increase the radiosensitivity of malignant cell without hampering the activities of normal cells. In this context, addition of two or more than two chemotherapeutic drugs as a radiosensitizer is a common practice in radiation biology. BI-69A11 earlier showed potential apoptosis-inducing effect in melanoma and colon carcinoma. Celecoxib showed anti-cancer effects in both COX-2 dependent and independent pathways and used to act as a radiosensitizing enhancer. Here, we suggest that the combination of BI-69A11 and celecoxib inhibits the phosphorylation of ataxia telangiectasia mutated (ATM) kinase and DNA-PK responsible for ionizing radiation (IR)-induced double-strand break (DSB) repair. Moreover, the combinatorial effect of BI-69A11 and celecoxib attenuates the IR-induced G2/M cell cycle arrest. Furthermore, this combination also impairs IR-induced activation of Akt and downstream targets of ATM. This might lead to induced activation of apoptotic pathway after triple therapy treatment modulating pro-apoptotic and anti-apoptotic proteins. This activation of apoptotic pathway also showed the interdependence of PUMA and BAD in triple combination-treated colon cancer cells in a p53 independent manner. This study reveals the therapeutic potential of the triple combination therapy in prevention of radioresistance. Besides, it also demonstrates the cytotoxic effects of triple combination therapy in colon cancer. This study shows utility and potential implication on safety of the patients undergoing radiation therapy.

KIR and Human Leukocyte Antigen Genotype Associated Risk of Cytomegalovirus Disease in Renal Transplant Patients.

Cytomegalovirus(CMV) infections have a significant effect on morbidity and mortality in kidney transplants. We conducted a study to ascertain the association of natural killer cell killer immunoglobulin-like receptors and human leukocyte antigen (HLA) genotype with risk of CMV disease. The 90 CMV-negative patients receiving a first renal transplantation from a CMV-positive donor in this study received triple immunosuppressive therapy and prophylactic CMV treatment for up to 3 months after transplantation. We observed a 43.3% incidence rate of CMV disease within the first year after transplantation. Twenty-seven recipients experienced a rejection episode, 14 of which had CMV disease, mostly after rejection, suggesting that in this group, CMV disease is not a risk factor for rejection. KIR gene or genotype distribution were similar between the CMV diseased and CMV disease-free group. Twenty-seven recipients (30%) carried KIR-AA genotype, of which nine (33%) had CMV disease. Of the remaining 63 (70%) recipients with KIR-BX genotype, 30 (48%) had CMV disease. There was no significant difference between the two genotype groups with regard to occurrence of CMV disease, although there was a trend toward a lower incidence of CMV disease in recipients carrying the KIR-AA genotype. For CMV disease, we found no significant risk associated with the number of activating or inhibitory KIRs. Neither was missing KIR ligands for the inhibitory KIRs (HLA-C1/C2/Bw4) in recipients associated with lower rates of CMV disease. In CMV-negative recipients, genotypic analysis of KIR repertoire and HLA ligands does not provide risk factors for primary CMV disease after renal transplantation.

Severe COPD Exacerbation Risk and Long-Acting Bronchodilator Treatments: Comparison of Three Observational Data Analysis Methods.

ObjectiveResults from three observational methods for assessing effectiveness of long-acting bronchodilator therapies for reducing severe exacerbations of chronic obstructive pulmonary disease (COPD) were compared: intent-to-treat (ITT), as protocol (AP), and an as-treated analysis that utilized a marginal structural model (MSM) incorporating time-varying covariates related to treatment adherence and moderate exacerbations.Study Design and SettingSevere exacerbation risk was assessed over a 2-year period using claims data for patients aged ≥40 years who initiated long-acting muscarinic antagonist (LAMA), inhaled corticosteroid/long-acting beta-agonist (ICS/LABA), or triple therapy (LAMA + ICS/LABA).ResultsA total of 5475 COPD patients met inclusion criteria. Six months post-initiation, 53.5 % of patients discontinued using any therapy. The ITT analysis found an increased severe exacerbation risk for triple therapy treatment (hazard ratio [HR] 1.24; 95 % confidence interval [CI] 1.00–1.53). No increased risk was found in the AP (HR 1.00; 95 % CI 0.73–1.36), or MSM analyses (HR 1.11; 95 % CI 0.68–1.81). The MSM highlighted important associations among post-index events.ConclusionNeglecting to adjust for treatment discontinuation may produce biased risk estimates. The MSM approach is a promising tool to compare chronic disease management by illuminating relationships between treatment decisions, adherence, patient choices, and outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s40801-015-0025-6) contains supplementary material, which is available to authorized users.

Evaluation of the prognostic value of liver stiffness in patients with hepatitis C virus treated with triple or dual antiviral therapy: A prospective pilot study.

To evaluate the association between liver stiffness (LS) prior to the initiation of dual/triple therapy and viral response. LS was measured in all patients before treatment was administered. The therapeutic approach was based on hepatic, virological, and immunological evaluations and considered the fact that patients with severe fibrosis (F3) or compensated cirrhosis (F4) in Child-Pugh class A are the primary candidates for triple therapy. In total, 65 hepatitis C virus (HCV) patients were treated with Peg-interferon/ribavirin (Peg-IFN/RBV); 24 patients were classified as genotypes 1/4 (36.92%), and 41 patients were classified as genotypes 2/3 (63.08%) (dual therapy). In addition, 20 HCV treatment-experienced genotype 1 patients were treated with PegIFN-RBV and boceprevir (triple therapy). Wilcoxon rank-sum tests were used to compare the groups. LS significantly differed between dual therapy and triple therapy (P = 0.002). The mean LS value before dual therapy treatment was 8.61 ± 5.79 kPa and was significantly different between patients achieving a sustained virologic response (SVR) 24 weeks after therapy and those who did not (7.23 ± 5.18 kPa vs 11.72 ± 5.99 kPa, respectively, P = 0.0003). The relative risk of non-response to therapy was 4.45 (95%CI: 2.32-8.55). The attributable risk of non-response to therapy was 49%. The mean LS value before triple therapy treatment was 13.29 ± 8.57 kPa and was significantly different between patients achieving and not achieving SVR24 (9.41 ± 5.05 vs 19.11 ± 9.74, respectively; P = 0.008). The relative risk of non-response to therapy was 5.57% (95%CI: 1.50-20.65). The attributable risk of non-response to therapy (70%) was increased compared with dual therapy patients. Pre-treatment stiffness > 12 kPa was significantly associated with non-SVR (P < 0.025) in both groups. Pre-treatment liver stiffness may be useful for predicting the response to treatment in patients treated with either dual or triple anti-HCV therapy.

Cost-effectiveness model for hepatitis C screening and treatment: Implications for Egypt and other countries with high prevalence

Hepatitis C virus (HCV) infection is a major cause of cirrhosis and liver cancer, and many developing countries report intermediate-to-high prevalence. However, the economic impact of screening and treatment for HCV in high prevalence countries has not been well studied. Thus, we examined the cost-effectiveness of screening and treatment for HCV infection for asymptomatic, average-risk adults using a Markov decision analytic model. In our model, we collected age-specific prevalence, disease progression rates for Egyptians and local cost estimates in Egypt, which has the highest prevalence of HCV infection (~15%) in the world. We estimated the incremental cost-effectiveness ratio and conducted sensitivity analyses to determine how cost-effective HCV screening and treatment might be in other developing countries with high and intermediate prevalence. In Egypt, implementing a screening programme using triple-therapy treatment (sofosbuvir with pegylated interferon and ribavirin) was dominant compared with no screening because it would have lower total costs and improve health outcomes. HCV screening and treatment would also be cost-effective in global settings with intermediate costs of drug treatment (~$8000) and a higher sustained viral response rate (70–80%).

Desafíos de lopinavir/ritonavir en la cronicidad de la infección por virus de la inmunodeficiencia humana

Combination antiretroviral therapy (ART) has increased patient survival, which is currently similar to that of the general population in western countries. However, ART is unable to completely restore normal health, given the persistence of chronic immune activation. Human immunodeficiency virus (HIV) infection has become a chronic disease and 50% of patients will soon be older than 50 years. Currently, there is a debate on the possibility of accelerated aging in the HIV-infected population. An overlap has been observed between chronic inflammation, age-related comorbidities, lifestyle, and the long-term toxicity of ART. ART-related toxicity can encourage the development of comorbidities, especially cardiovascular and renal complications, while toxicity-especially that of thymidine analogs-can also contribute to inflammation and aging. Evidence is available on simplification strategies with boosted protease inhibitor monotherapy aiming to avoid or reduce potential or demonstrated toxicity. Currently, studies are underway of dual therapy strategies with lopinavir/ritonavir (LPV/r) with distinct antiretroviral agents. The studies with the largest samples are those with raltegravir and lamivudine. The GARDEL trial has demonstrated that dual therapy with LPV/r plus a generic drug such as lamivudine is non-inferior to triple therapy in treatment- naïve patients. All of the above indicates the response to the challenge posed to LPV/r by the chronic phase of the disease and by the need to reduce costs.

HCV Triple Therapy is Equally effective in African-Americans and Non-African-Americans

Real-world experience with HCV medications differs from original the index studies. African-Americans (AA) are commonly underrepresented in clinical trials. Therefore, we hypothesized that postmarketing experience with the first generation HCV protease inhibitors (PI) (telaprevir and boceprevir) differs from premarket reports in clinically meaningful ways regarding patient race. We conducted a single-center, retrospective, observational analysis to evaluate the efficacy of HCV triple therapy in a nontrial setting. Clinical response and quantitative laboratory values were compared between AA and non-AA patients throughout the duration of treatment. Patients were included if they started triple therapy treatment after July 2011 and are not a part of any other clinical/pharmaceutical trials. Thirty-five patients with HCV genotype 1 were included in this study—22 non-AA and 13 AAs. AAs had a higher BMI compared to non-AA (33.6 vs 28.8, p = 0.046). “High” baseline HCV RNA values (above 800,000 copies) were more prevalent in AA (69.2 %) vs non-AA (63.6 %). AA had less favorable IL28B genotypes; only 7.7 % had type CC compared to 40.9 % of non-AA. SVR12 was achieved 82 % of the time with each PI but there was no significance in type of PI used (p = 1.00). Patients with cirrhosis were less likely to achieve SVR12 (40 %) compared to those without cirrhosis (88 %, p = 0.013). Thirty-three percent of the patients who received blood transfusions did not achieve SVR12 while every patient who did not require transfusion achieved SVR12 (p = 0.001). All patients with IL28B genotype CC achieved SVR12 (p = 0.007). SVR12 did not differ among AA (77 %) and non-AA (86.4 %) (p = 0.528).

Effect of Methotrexate Use and Erythrocyte Methotrexate Polyglutamate on Glycosylated Hemoglobin in Rheumatoid Arthritis

To investigate whether methotrexate (MTX) use, as compared to other therapies, and erythrocyte methotrexate polyglutamate (MTXGlu) concentrations are associated with changes in glycosylated hemoglobin (HbA1c ) levels in rheumatoid arthritis (RA) patients. The derivation cohort consisted of patients selected from the Treatment in the Rotterdam Early Arthritis Cohort who fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA. Patients were randomized to 6 treatment arms: triple disease-modifying antirheumatic drug (DMARD) therapy (consisting of MTX, sulfasalazine, and hydroxychloroquine [HCQ]) + intramuscular (IM) glucocorticoids, triple DMARD therapy + oral glucocorticoids, MTX + oral glucocorticoid therapy, MTX therapy, oral glucocorticoid therapy, and HCQ therapy. HbA1c levels were determined at baseline and at 3 months. Concentrations of erythrocyte MTXGlu1-5 were measured after 3 months of treatment. Within treatment arms, changes in the level of HbA1c were compared by paired t-test. Associations of MTXGlu concentrations with changes in the level of HbA1c were tested using multiple linear regression analysis, adjusted for age, sex, body mass index, and comedication. Significant associations were validated using data on RA patients taking MTX who were enrolled in the Methotrexate in Rotterdam cohort. In the derivation cohort, the mean change in HbA1c level after 3 months of treatment was -1.9 mmoles/mole (-0.18%) (P = 0.001). Levels of HbA1c decreased in 4 of the individual treatment groups, as follows: for the triple DMARD therapy + IM glucocorticoids treatment arm, -5.5 mmoles/mole (-0.50%) (P < 0.001), for the triple DMARD therapy + oral glucocorticoids treatment arm, -3.7 mmoles/mole (-0.34%) (P < 0.001), for the MTX treatment arm, -0.8 mmoles/mole (-0.08%) (P = 0.018), and for the HCQ treatment arm, -2.0 mmoles/mole (-0.19%) (P = 0.175). Increased levels of MTXGlu2 (β = -0.20, P = 0.005), MTXGlu3 (β = -0.31, P < 0.001), MTXGlu4 (β = -0.33, P < 0.001) after treatment, MTXGlu5 (β = -0.39, P < 0.001), and total MTXGlu (β = -0.29, P < 0.001) were associated with decreased levels of HBA1c . In the validation cohort, levels of HbA1c were decreased by 2.6 mmoles/mole (0.23%) (P < 0.001) after treatment, and MTXGlu3 was associated with decreased levels of HbA1c (β = -0.26, P = 0.018). MTX use and higher concentrations of erythrocyte MTXGlu are associated with decreased levels of HbA1c in RA patients. Triple DMARD therapy and HCQ treatment resulted in reduced HbA1c levels, and glucocorticoid treatment resulted in increased levels of HbA1c .

Valor de la genética en la era de la terapia triple frente al virus de la hepatitis C

Despite the introduction of protease inhibitors (PI) in the treatment of hepatitis C, the sensitivity of interferon continues to be essential to achieve a sustained virological response (SVR) and to eradicate the viral infection. Currently, pegylated interferon (PEG-IFN) and ribavirin (RBV) are required to avoid selection of PI-resistance mutations. The likelihood of obtaining an SVR with dual therapy in treatment-naïve patients with genotype 1 infection varies from 40% to 50%. That is, almost half of these patients would not require a PI, thus avoiding their adverse effects and considerably reducing the cost of the treatment. Identifying which patients could potentially respond to dual therapy is one of the main challenges in clinical practice. The genetic variability of the host is one of the main factors affecting the sensitivity of PEG-IFN and therefore in the response to current treatment. Other baseline factors related to the host, the virus and, especially, to intratreatment factors such as rapid virological response (RVR) are strongly associated with the probability of achieving an SVR. The evidence on the decision to prescribe dual or triple therapy according to the factors predictive of response is based on retrospective studies or post-hoc analyses of pivotal studies on PI. Study of the polymorphisms of the IFNL3 gene (IL28B), ITPA, IFN-stimulated genes (ISGs), TT/ΔG (ss469415590; IFNL4)) and RBV transporters could help in the decision to prescribe dual or triple therapy in treatment naïve patients.

Clarithromycin-based triple therapy for treatment of peptic ulcer in Helicobacter pylori-positive children

Clarithromycin-based triple therapy for treatment of peptic ulcer in <i>Helicobacter pylori</i>-positive children

Triple Therapy Treatment Outcomes in Patients with Chronic Hepatitis C at a Referral Center in South Florida

Purpose: The goal of this study is to evaluate the efficacy and safety of triple therapy antiviral treatment for individuals with hepatitis C in a retrospective study at a South Florida referral center. Methods: Sixty genotype 1 (GT 1) individuals were included in this study (33 males, 27 females). Mean age was 52 years, with a range of 21 to 73, including 37% over the age of 60. Peginterferon alpha-2a/2b (PEG-IFN), ribavirin (RBV) and telaprevir/boceprevir were administered to each patient. Dosage was tailored to patient response. Total treatment duration ranged from 24 weeks to 48 weeks. Patients were monitored during treatment and up to six months post treatment. Results: Among 60 subjects, 47 (78%) achieved SVR (sustained virological response) 24 weeks after treatment completion. There is a strong correlation between lower BMI and early virological response. Relapse rate was 10%, and the overall discontinuation rate was 12%. Sixty-eight percent suffered from major depression, and 5% suffered from extreme psychiatric conditions. Fourteen percentexperienced retinopathy and ocular deficiencies, which subsided post treatment. Males were more susceptible to thrombocytopenia, while females were more susceptible to lymphocytopenia. One case resulted in idiopathic thrombocytopenic purpura, which prevented further treatment. Six (10%) patients had dermatological symptoms, including one case of cutaneous sarcoidosis. Overall, 11 (18%) patients were hospitalized through the course of triple therapy treatment, a majority of whom required blood transfusions. Conclusion: The side effects of triple therapy are substantial, and a decision to begin treatment must effectively weigh the risks versus the benefits. Lower BMI and early virological response are factors associated with improved treatment outcome. Proposed decrease of ribavirin dose due to anemia may cause relapse after ETR (end of treatment response). Despite improvements over PEG-IFN/RBV therapy, a more efficient and safer treatment option is urgently needed. Disclosure - Dr. Sornmayura - Speaking and Teaching: Merck Dr. Schiff - Consultant: Gilead, Merck; Scientific Advisory Board: Bristol Myers Squibb, Gilead, Vertex Pharmaceuticals; Grant/Research Support: Abbott, Anadys, Bristol Myers Squibb, Gilead, Merck, Medtronics, Novelos Therapetics, Orasure Technologies, Roche Molecular, Vertex Pharmaceuticals, Discovery Life Sciences, Beckman Coulter.Figure

HCV Triple Therapy, The Non-study Experience: A Single Center Analysis Comparing African American to White Americans

Purpose: To evaluate qualitative and quantitative differences between African Americans and White Americans in the treatment of HCV in a non-study based setting; the real world experience. Methods: A retrospective case study analysis at a single center that evaluated the efficacy of triple HCV therapy in non study setting. Clinical response and quantitative laboratory values were compared between African-American and non African-American patients throughout the duration of treatment. Patients were included if they started triple therapy treatment after July 2011 and are not a part of any other clinical/pharmaceutical trials. Results: African-Americans were found to have significantly higher BMI and HCV RNA quantitative viral loads at initiation of treatment with triple therapy (either boceprevir or telaprevir; Table 1). Throughout the course of treatment, African Americans had a greater percentage decrease in their baseline hemoglobin and platelet count, and a corresponding reduction in their baseline ribavirin dose. However, treatment outcomes (defined as virus negative at the conclusion of treatment) were not found to be statistically significant between African American and White Americans. A subset analysis (Table 2) revealed that patients who were virus negative at the end of treatment (either telaprevir or boceprevir) were less likely to have received blood transfusions throughout the duration of treatment.Table: Table. HCV triple therapy—African vs white AmericansTable: Table. Treatment outcomesConclusion: Treatment dosages of ribavirin are based upon a patients weight, which corresponds with BMI. Higher doses of ribavirin are more likely to cause cytopenia compared to smaller doses of ribavirin. As a result, patients with higher BMI are more likely to have decreased hemoglobin and platelet counts. In the event a patient develops severe cytopenia, blood transfusion may be necessary. As evidenced in this study, blood transfusion was statistically significant in treatment outcomes - if a patient requires blood transfusions, they are less likely to complete treatment and achieve virus negativity. Larger studies, with greater power, are needed in order to explore other prognostic indicators in the treatment of chronic HCV.

The efficacy of moxifloxacin-based triple therapy in treatment of Helicobacter pylori infection: a systematic review and meta-analysis of randomized clinical trials

Recent evidence shows that moxifloxacin could exert an antimicrobial effect against Helicobacter pylori in both in vitro and in vivo models. To systematically evaluate whether moxifloxacin-containing triple therapy could improve eradication rates and reduce side effects in first-line or second-line anti-H. pylori treatment, eligible articles were identified by searches of electronic databases. We included all randomized trials comparing moxifloxacin-based triple therapy with standard triple or quadruple therapy during H. pylori eradication treatment. Statistical analysis was performed with Review Manager 5.0.10. Subanalysis/sensitivity analysis was also performed. We identified seven randomized trials (n=1263). Pooled H. pylori eradication rates were 79.03% (95%CI: 75.73-82.07) and 68.33% (95%CI: 64.44-72.04) for patients with moxifloxacin-based triple therapy or with standard triple or quadruple therapy, respectively (intention-to-treat analysis). The odds ratio (OR) was 1.82 (95%CI: 1.17-2.81), the occurrence of total side effects was 15.23% (95%CI: 12.58-18.20) and 27.17% (95%CI: 23.64-30.92) for groups with or without moxifloxacin, and the summary OR was 0.45 (95%CI: 0.26-0.77). In subgroup analyses, we noted that the second-line eradication rate in the moxifloxacin group was significantly higher than that in the quadruple therapy group (73.33 vs 60.17%, OR: 1.78, 95%CI: 1.16-2.73, P<0.001). However, there was no difference in first-line eradication treatment. Findings from this meta-analysis suggest that moxifloxacin-based triple therapy is more effective and better tolerated than standard triple or quadruple therapy. Therefore, a moxifloxacin-based triple regimen should be used in the second-line treatment of H. pylori infection.