Cost Effectiveness of Once-Weekly Semaglutide Versus Once-Weekly Dulaglutide in the Treatment of Type 2 Diabetes in Canada

OBJECTIVE

The aim of this study was to assess the cost effectiveness of semaglutide versus dulaglutide, as an add-on to metformin monotherapy, for the treatment of type 2 diabetes (T2D), from a Canadian societal perspective.

METHODS

The Swedish Institute for Health Economics Cohort Model of T2D was used to assess the cost effectiveness of once-weekly semaglutide (0.5 or 1.0 mg) versus once-weekly dulaglutide (0.75 or 1.5 mg) over a 40-year time horizon. Using data from the SUSTAIN 7 trial, which demonstrated comparatively greater reductions in glycated hemoglobin (HbA1c), body mass index and systolic blood pressure with semaglutide, compared with dulaglutide, a deterministic base-case and scenario simulation were conducted. The robustness of the results was evaluated with probabilistic sensitivity analyses and 15 deterministic sensitivity analyses.

RESULTS

The base-case analysis indicated that semaglutide is a dominant treatment option, compared with dulaglutide. Semaglutide was associated with lower total costs (Canadian dollars [CAN$]) versus dulaglutide for both low-dose (CAN$113,287 vs. CAN$113,690; cost-saving: CAN$403) and high-dose (CAN$112,983 vs. CAN$113,695; cost-saving: CAN$711) comparisons. Semaglutide resulted in increased quality-adjusted life-years (QALYs) and QALY gains, compared with dulaglutide, for both low-dose (11.10 vs. 11.07 QALYs; + 0.04 QALYs) and high-dose (11.12 vs. 11.07 QALYs; + 0.05 QALYs) comparisons. The probabilistic sensitivity analysis showed that for 66-73% of iterations, semaglutide was either dominant or was considered cost effective at a willingness-to-pay threshold of CAN$50,000.

CONCLUSIONS

From a Canadian societal perspective, semaglutide may be a cost-effective treatment option versus dulaglutide in patients with T2D who are inadequately controlled on metformin monotherapy.

A matched case-control study to assess the association between non-steroidal anti-inflammatory drug use and thrombotic microangiopathy

Several case reports suggest that non-steroidal anti-inflammatory drug (NSAID) use is associated with development of thrombotic microangiopathy (TMA). We conducted a matched population-based case-control study using linked administrative healthcare data in Ontario, Canada to assess the relationship between TMA hospitalization and recent exposure to prescription NSAIDs versus acetaminophen (acetaminophen was chosen as the referent drug because it has no known association with TMA). Cases and controls were drawn from a source population of adults who filled a prescription for either NSAIDs or acetaminophen between 1991 and 2015 (restricted to adults with prescription drug benefits [n = 3.6 million]). We identified 44 eligible cases with a hospital admission for incident TMA and a recent prescription for NSAIDs or acetaminophen. We successfully matched 38 cases (1:4) to 152 controls without TMA on demographics, risk factors for TMA, and indications for NSAID use. Cases and controls were similar with respect to age (71 years) and sex (63% women); however, on average, cases had more comorbidities than controls (12 vs. 14; p<0.05) and more primary care visits in the year before the index date (19 vs. 12; p<0.05). Cases were significantly less likely than controls to have received a recent prescription for NSAIDs (19/38 [50%] vs. 115/152 [76%], respectively; adjusted odds ratio 0.37, 95% confidence interval: 0.16 to 0.84). Results were similar in several sensitivity analyses. Overall, the results of this study do not support a harmful association between NSAID use and the development of TMA.

Complications of the Arteriovenous Fistula: A Systematic Review

The implementation of patient-centered care requires an individualized approach to hemodialysis vascular access, on the basis of each patient's unique balance of risks and benefits. This systematic review aimed to summarize current literature on fistula risks, including rates of complications, to assist with patient-centered decision making. We searched Medline from 2000 to 2014 for English-language studies with prospectively captured data on ≥100 fistulas. We assessed study quality and extracted data on study design, patient characteristics, and outcomes. After screening 2292 citations, 43 articles met our inclusion criteria (61 unique cohorts; n>11,374 fistulas). Median complication rates per 1000 patient days were as follows: 0.04 aneurysms (14 unique cohorts; n=1827 fistulas), 0.11 infections (16 cohorts; n>6439 fistulas), 0.05 steal events (15 cohorts; n>2543 fistulas), 0.24 thrombotic events (26 cohorts; n=4232 fistulas), and 0.03 venous hypertensive events (1 cohort; n=350 fistulas). Risk of bias was high in many studies and event rates were variable, thus we could not present pooled results. Studies generally did not report variables associated with fistula complications, patient comorbidities, vessel characteristics, surgeon experience, or nursing cannulation skill. Overall, we found marked variability in complication rates, partly due to poor quality studies, significant heterogeneity of study populations, and inconsistent definitions. There is an urgent need to standardize reporting of methods and definitions of vascular access complications in future clinical studies to better inform patient and provider decision making.

Long-term outcomes of thrombotic microangiopathy treated with plasma exchange: A systematic review

With the adoption of plasma exchange as standard treatment for thrombotic microangiopathy (TMA), more patients are surviving and long-term outcomes have greater relevance. We conducted a systematic review to synthesize and evaluate the quality of evidence on long-term outcomes of TMA among adults treated with plasma exchange and to identify factors that may be associated with a worse long-term prognosis. We searched databases from 1980 to 2013 for eligible articles published in any language. We included studies that reported outcomes in at least ten adults with a history of TMA treated with plasma exchange and at least 6 months of follow-up. We abstracted data in duplicate and assessed the methodological quality of each study using an assessment tool developed based on recommended validity criteria. We screened 6672 articles, reviewed 213, and included 34 studies totaling 1182 patients (study median [range], 24 [10-118]). The mean (or median) follow-up ranged from 6 months to 13 years. The cumulative incidence of relapse and mortality was highly variable and ranged from 3 to 84 and 0 to 61%, respectively. The incidence of other outcomes across 10 studies also varied (outcomes included hypertension, kidney disease, preeclampsia, stroke, seizure, severe cognitive impairment, and depression); in three other studies, long-term neurocognitive function and health-related quality of life were significantly lower than in the general population. Patients who survive an episode of TMA may be susceptible to long-term vascular complications, but the magnitude of this risk and how to mitigate it remains unclear. Am. J. Hematol. 91:623-630, 2016. © 2016 Wiley Periodicals, Inc.

Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women

BACKGROUND

The antibiotic nitrofurantoin is commonly used to treat uncomplicated urinary tract infections. However, when this drug is used by patients with reduced kidney function, its urine concentration may be subtherapeutic.

METHODS

We conducted a population-based study of older women (mean age 79 years) in Ontario, Canada, whose estimated glomerular filtration rate was relatively low (median 38 mL/min per 1.73 m(2)) and for whom 1 of 4 antibiotics had been prescribed for urinary tract infection: nitrofurantoin, ciprofloxacin, norfloxacin or trimethoprim-sulfamethoxazole. We assessed 2 measures of treatment failure in the subsequent 14 days: receipt of a second antibiotic indicated for urinary tract infection and hospital encounter (emergency department visit or hospital admission) with a urinary tract infection. We repeated the analysis for older women with relatively high estimated glomerular filtration rate (median 69 mL/min per 1.73 m(2)).

RESULTS

The baseline characteristics of the 4 antibiotic groups were similar. Relative to nitrofurantoin, the other antibiotics (including ciprofloxacin) were associated with a lower rate of treatment failure among women with relatively low estimated glomerular filtration rate (for ciprofloxacin v. nitrofurantoin: second antibiotic prescription, 130/1989 [6.5%] v. 516/3739 [13.8%], odds ratio [OR] 0.44, 95% confidence interval [CI] 0.36-0.53; hospital encounter, 21/1989 [1.1%] v. 95/3739 [2.5%], OR 0.41, 95% CI 0.25-0.66). However, a similar risk of treatment failure with nitrofurantoin was also observed among women with relatively high estimated glomerular filtration rate. The results were consistent in multiple additional analyses.

INTERPRETATION

In this study, the presence of mild or moderate reductions in estimated glomerular filtration rate did not justify avoidance of nitrofurantoin.

[The synergistic action of guanghuoxiang volatile oil and sodium artesunate against Plasmodium berghei and reversal of SA-resistant Plasmodium berghei]

OBJECTIVE

To study the synergistic action of a combination of guanghuoxiang volatile oil (B) and sodium artesunate (SA) against Plasmodium berghei (P. b) and the resistance-reversal activity against SA-resistant P. b (P. b SA-R).

METHODS

Mice infected with P. b N or P. b R were treated with a combination of B and SA respectively by 4-day suppressive test method and linear regression to calculate the SD50 of B and SA for each drug alone and in combination (equally effective dose compatibility).

RESULTS

B alone, N:SD50 = 87.64 +/- 19.58(GKD), R:SD50 = 43.24 +/- 7.71(GKD); SA alone, N:SD50 = 0.88 +/- 0.01(MGKD), R:SD50 = 27.69 +/- 0.93(MGKD). B and SA combination, N:B SD50 = 36.89 +/- 4.57(GKD), SA SD50 = 0.39 +/- 0.05 (MGKD); R:B SD50 = 7.40 +/- 1.30(GKD), SA SD50 = 4.21 +/- 0.74(MGKD). The synergistic indexes of B and SA in combination were 2.2 for N and 6.6 for R, respectivly. The multiple of resistance reversal of B vs SA was 6.6. The relative reversal rate was 87.6%.

CONCLUSION

A combination of B and SA may enhance the antimalarial effect against P. b and reverse the SA-resistance of P. b and delay the occurrence of resistance to SA in N.

Combination of EGFR, HER-2/neu, and HER-3 is a stronger predictor for the outcome of oral squamous cell carcinoma than any individual family members

In a series of 111 patients with squamous cell carcinoma (SCC), we used immunohistochemistry to examine the expression levels of four epidermal growth factor receptor (EGFR) family members (EGFR, HER-2/neu, HER-3, and HER-4). Expression of the EGFR members was not significantly associated with tumor size. However, their expressions (except for HER-4) were significantly associated with the presence of lymph node metastasis, and all of them were significantly associated with distant metastasis. We further examined the association between the expression levels of the EGFR members and the survival rates in 47 oral SCC patients whose detailed clinical follow-ups were available. The expression of all EGFR members was significantly associated with shortened patient survival, and the association was strongest for HER-2/neu. Furthermore, the combination of HER-2, HER-3, and EGFR but not HER-4 significantly improved the predicting power. The expression level of HER-2/neu was significantly correlated with that of EGFR or HER-3. Similar coexpression patterns were also observed in three oral SCC cell lines studied, but not in four other head and neck SCC cell lines. Taken together, these results indicated that expression levels of EGFR, HER-2/ neu, and HER-3 may help predict the outcome of patients with oral SCC.

Neoplastic odontogenic epithelial cells express bone sialoprotein

Bone sialoprotein (BSP) is synthesized and secreted by bone-, dentine- and cementum-forming cells and has been implicated in de novo bone formation and mineralization. In this study, we used histological sections of odontogenic neoplasms and performed immunohistochemical and in situ hybridization analyses. In ameloblastoma, BSP mRNA signals were seen in the neoplastic epithelial cells forming nests, strips and islands. BSP deposition was also seen in the stellate reticulum of the tumour masses revealed by immunohistochemistry using human BSP antibodies. In calcifying epithelial odontogenic tumour, the calcified masses demonstrated positive immunoreactivity to the human BSP antibodies, and the hybridization signals for BSP were located in the cells near the calcified particles. In the calcifying odontogenic cyst, strong BSP signals were seen in cells surrounding the characteristic nests of ghost cells, which often calcify subsequently. BSP protein was also found in these cells by immunohistochemistry. The active expression of BSP in the epithelial elements of the odontogenic tumours of adult patients suggests the activation of this matrix protein gene in the neoplastic process, and that BSP may play an important role in tumour formation and differentiation with respect to pathological calcification.

[HPLC determination of six flavonoid constituents in Ginkgo biloba leaves]

Six flavonoid constituents (quercetin, isorhamnetin, kaempferol, bilobetin, ginkgetin and sciadopitysin) were isolated from Ginkgo biloba leaves and determined by reversed phase HPLC using salvianolic acid B as internal standard. The column employed was Zorbax ODS (150 mm x 4 mm ID, 5 microns). The mobile phase consisted of solvent A (methanol) and solvent B [tetrahydrofuran--water--formic acid (34:65:1)] for gradient elution. The flow rate was 1 ml.min-1 and detection was effected at 350 nm. This method is accurate, rapid and reproducible. Analytical data for various samples were given.

[Study in the combining quantity of Con A-binding sites on membrane surface of artesunate-resistance strain of Plasmodium berghei]

OBJECTIVE

To study the production mechanism of plasmodium berghei (PB) in resisting artesunate.

METHODS

The combining quantity of Con A-binding sites on membrane surface of PB trophozoite labelled with fluorescein isothiocyanate (FITC) of Con A was determined by fluoromicrospectrophotometer.

RESULTS

The combining quantity of PB artesunate-resistance strain (PBAR) was reduced significantly than that of PB normal strain (P < 0.01).

CONCLUSIONS

The type of glucose in surface membrane of PBAR has changed and the changes of membrane fluidity could be one of the causes of the change in the combining quantity of Con A-binding sites on membrane of PBAR.

[The influences of lanthanum,cerium and fluorine ions to the activity of collagenase degrading cemental collagens]

The influences of trace elements lanthanum,cerium and fluorine to the activity of clostridium histolyticum collagenase(CHC) during the period of CHC degrading the cemental root collagen in vitro is studied.The results reveal that La(3+) can significantly inhibit the activity of the CHC than Ce(3+) and F(-). Therefore it suggests that lanthanum may be used as a new kind of element in preventing root caries.The mechanisms of above functions are also discussed.

Strong correlation between c-erbB-2 overexpression and overall survival of patients with oral squamous cell carcinoma

Overexpression of c-erbB-2 (also known as HER-2/neu) has been found in many human cancers, including head and neck squamous cell carcinoma (SCC). We therefore examined expression of the oncoprotein in oral SCC primary tumor samples and compared its relationship with clinical stages and survival rate. Out of 80 cases of oral SCC, high expression level (++ or +++) of c-erbB-2 was found in 41 cases. Of the 80 cases with follow-up information, 39 were further investigated for the correlation of expression level of c-erbB-2 and survival rate. Overexpression of the oncoprotein was significantly correlated with shorter overall survival, and the patients with low and no expression of c-erbB-2 had much higher survival rates. Overexpression of c-erbB-2 was also significantly correlated with nodal stage and metastasis. We found that high expression level of c-erbB-2 was frequently detected in oral cancer cell lines but not in the other head and neck SCC cell lines. Thus, we conclude that overexpression of c-erbB-2 is a frequent event in oral SCC and is correlated with poor survival and may be used as a poor prognostic factor.

[The effects of LTA and plaque on the periodontal tissue of the Guinea pig]

40 Guinea pigs were divided into 4 groups.The gingival sulcus of 2 mandibular incisors were irrigated with LPS(Lipopolysaccharide),LTA (Lipoteichoicacid),PL(Subgingival plaque) and NS(Normal saline solution) respectively.2 animals were sacrificed in group of 5 successively at 1,2,3,6,8 week after irrigation.Microscopic examination demonstrated:Only a few penetration of inflammatory cells lay in the gingival tissue in NS control group.Significant infiltrate associated with evident crystal resorption were noted at 1st week and active remodeling took place at 4th,5th week in LPS group.Enhancing accumulations of plaque calculus with weak inflammation could be seen in LTA group.Not only accumulations of plaque and calculus but also penetration of inflammation with resorption of bone were seen in PL group.Their effects on the periodontal tissue of Guinea pig showed evident different.These findings served further expression the possible mechanisms of periodontal diseases.

[Recurrent fetal cellular rhabdomyoma:histopathological and ultrastructural observations]

A mass of the neck in an 8-year-old boy diagnosed with recurrent fetal cellular rhabdomyoma was reported.The recurrent tumor consisted of undifferentiated round and short spindle cells and immature striated muscle cells,which was similar to the primary tumor occured in five years ago.However,there were more large round myoblasts which mainly located at the periphery of the tumor and osteoid stroma in the recurrent case immuno-histochemistry stain and ultrstructure observation suggested that these were undifferntiated mesenchymal cell and myoblasts.The differential diagnosis from fibrosarcoma,highly differentiated rhabdomyosarcoma,and hemangiopericytoma were dicussed.Author considered FRMs has a recurrent and malignant change tendency though it belongs to benign tumor.

[Malignant pleomorphic adenoma of salivary glands:A clinicopathologic study of 83 cases]

This paper presented the clinicopathologic features of 83 cases of malignant pleomorphic adenomas(MPA) of the salivary glands.The average age of the patients was 53 years old.The ratio from male to female was 1.24 to 1.Thirty nine tumors located in parotid glands,twenty in submandibular glands and seventeen in palate.Histopathologically,the malignant component of 76 tumors was identified as carcinoma and 7 tumours as carcinosarcoma both in various types.The statistic analysis showed the factors which influenced the prognosis(P>0.05) included 1. location,2. histologic subtype of malignant component,3.differentiation grade,4.infiltration status,and 5.with or without lymph node metastasis in the initial operation.The prognosis of MPA was more ominous than that of/the conventional types of carcinoma,with only 52.7% of year survival rate.The authors concluded that the pleomorphic adenoma was the pre-cancerous lesion of MPA.Therefore,it is necessary to resect the pleomorphic adenoma as early as possible in order to prevent the occurence of the MPA.

[Histopathological and ultrastructural studies of melanomatic neuroectodermal tumor of infancy]

Three cases of melanomatic neuroectodermal tumor of infancy(MNTI) were studied.The tumor mainly consisted of small neuroblastic-like cells and pigmented large cuboidal cell,and infiltrated adjacent tissues.The main ultrastructural charactristics were the presence of some membranebound dense-core secretory granules,numerous free ribosomes and polysomes aggregaed in rosettes,occasional mitoses in the small cells;and four types of membranebound pigment granules corresponding to melanosomes at different stages of maturation in the pigment cell.immunohistochemical results indicated that both of main cells were positive reaction for NSE,negative for S-100.These facts suggested they are immature in and malignancy.Further,the isogenesis of the tumor cells and embryo optic cup cells were discussed.

[Effects of demineral-resistant of Lanthanum,Cerium and Fluoride on human root surface:A comparative study in vitro]

An in vitro acid-resistant and remineralized study on human root surface with 500ppm lanthanum,Cerium and Fluoride accidulate buffer was carried out in a pH-cy-cling system.The results of quantitative chemical and energy spectrometry analyses showed that all these three elements had the demineral-resistant effects,although fluoride showed a better effect,Furthermore,the mechanisms of lanthanum,Cerium and Fluoride on demineral-resistant were discussed from the viewpoint of crystal physicochemistry.

[Primary non-Hodgkin's lymphoma on parotid gland clinicopathologic and immunohistochemical study.]

A clinico-pathologic and immunohistochemical study of 20 cases of primary non-Hodgkin's lymphoma on the parotid gland was made.The result showed 45% of the cases originated from B cells,white 40% from T cells,the rest 15% from the small lymphocytes.Immunohistochemical study was made on 11 cases,the result of immunophenotype was in concordance with the histopathologic diagnosis in 10 cases,except in one case which was initially diagnosed as plasmocytoid lymphocytic lymphoma,but the immunmophenotype suggested that it was T cell type of malignant lymphoma(ML).Follow-up data can be collected in 16 cases(80%).Three of the 16 cases(18.75%) died of the tumor within one year,they were diagnosed initially as B cleaved cell,lymphoplastic cell and polymorphic T cell type of ML,each in 1 case.Other cases survived from 15 months to 9.25 years,among them 2 were diagnosed as low-grade ML(both of small lymphocyte type),7 cases as middle-grade ML(5 of B cleaved cell,2 of B mixed type),and 4 cases as high-grade ML (2 of clear T cell,2 of polymorphic T cell type).They were treated by surgical removal and combined western and traditional Chinese medicine,their prognosis was quite good.

Nucleolar organizer regions (NORs) in lymphoproliferative disorders of the human salivary gland

The relationship between the silver-stained proteins of the nucleolar organizer regions (AgNORs) and proliferative activity was studied in 30 patients with lymphoproliferative disorders of the major salivary gland. The salivary gland lesions were microscopically and immunohistochemically differentiated into myoepithelial sialadenitis (MESA, n = 6), low-grade B-cell lymphoma (n = 16), high-grade B-cell lymphoma (n = 5), and T-cell lymphoma (n = 3). The mean AgNOR count per nucleus for MESA was 2.48; for low-grade B-cell lymphoma, 2.19; for high-grade B-cell lymphoma, 6.37; and for T-cell lymphoma, 5.46. There was no significant difference in AgNOR counts per nucleus between the MESA and low-grade B-cell lymphoma, whereas the high-grade B-cell lymphomas exhibited significantly increased mean AgNOR number. Furthermore, the mean numbers of AgNOR were compared with cellular types of lymphoproliferative disorders. A statistically significant difference did exist among AgNOR counts of centroblasts, centrocytes and mantle zone lymphocytes or interfollicular lymphocytes in MESA. There was no significant difference in AgNOR counts per nucleus among the centroblasts of MESA, neoplastic centroblasts of centroblastic/centrocytic lymphoma, and centroblastic lymphoma. It was shown that AgNOR enumeration of tumor cells in mucosa-associated lymphoid tissue (MALT) lymphoma was similar to those seen in mantle zone and interfollicular lymphocytes of MESA. Therefore, we propose that MALT lymphoma may represent a mucosal counterpart of mantle zone lymphocyte- or interfollicular lymphocyte-related low-grade B-cell lymphomas.

[Clinicopathological analysis of 20 cases of giant cell granuloma of the jaw]

The pathological features of 20 cases of giant cell granuloma and 12 cases of giant cell tumor of the jaw were compared. Specimens of 8 cases of giant cell granuloma and 5 cases of giant cell tumor were stained with Wilder's reticular fiber stain and trichromic stain. The results showed that reticular fibers and collagenous fibers were more abundant and more focal in distribution in giant cell granulomas than in those of giant cell tumors. It is concluded that the two staining methods adopted are helpful in the differential diagnosis between these two kinds of diseases.

Primary malignant lymphoma of the salivary gland: a tumor of mucosa-associated lymphoid tissue

The clinical, morphologic and immunohistochemical features of 10 cases of the low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of salivary glands are described. Although the initial histologic diagnosis in nine of these cases was myoepithelial sialadenitis, the diagnosis of primary salivary gland MALT lymphoma was based on the demonstration of light chain restriction and on morphologic characteristics. Histologic study showed a characteristic cytology, which included centrocytoid cells (composed of small centrocytes and monocytoid B cells) and a varying degree of plasma cell differentiation; the occurrence of epithelial or acinar invasion by neoplastic centrocytoid cells; and the presence of reactive lymph follicles among the neoplastic cells. Furthermore, multinucleate giant cells resembling Warthin-Finkeldey cells were detected in seven cases. In the light of these findings, cases previously diagnosed as myoepithelial sialadenitis require careful assessment and nine out of 32 cases are, in reality, examples of primary salivary gland MALT lymphomas. Immunohistochemical analysis of paraffin sections revealed the following characteristic immunophenotype of MALT lymphoma: L26, KiB3 and LN2 positive, and a monotypic immunoglobulin pattern (predominantly IgM/kappa). It was of interest that salivary gland parenchyma, infiltrated by neoplastic centrocytoid cells, reacted with LN3 for cells expressing human leukocyte antigen-DR (HLA-DR) antigens. Whereas salivary gland epithelia devoid of a neoplastic invasion were invariably negative for LN3. This suggests a lymphocyte-mediated role in salivary epithelial HLA-DR expression. It appears that HLA-DR expression is an inducible phenomenon in MALT lymphomas of salivary gland.

[Effects of low level fluoride on the resolutive behavior of dental enamel]

The purpose of this investigation was to study the low level fluoride on the resolutive behavior of dental enamel in vitro.Twelve enamel slabs were used to treat with acidulated phosphate fluoride solutions containing different F concentration and then with acidic artificial carious gel.Chemical analysis were carried out with atomic absorption spectrophotometer,fluoride ion-selective electrode and electron microprobe.Results indicate that different F concentration in environmental solutions make different physicochemical ways on effects to enamel demineralization,they are specific and non-specific absorption of fluoride ions or dissolution and reprecipitation of fluoridated apatite and CaF(2).

Metabolic changes in women using a long-acting monthly oral contraceptive and return of ovulation on discontinuation

Metabolic changes were investigated in two groups of women using oral contraceptives for 5 to 16 years. Blood samples were taken during the last cycle of oral contraceptive use and three months post-treatment. One group had used a monthly oral contraceptive (MOC, 3mg quinestrol and 10mg 16-methylene chlormadinone acetate) and the second group a daily oral contraceptive (DOC, 35 micrograms ethynylestradiol and 0.625 mg norethisterone). During treatment there were increases in serum total cholesterol and triglycerides but not HDL-C, in plasma total cortisol but not in renin activity, angiotensin II or urinary free cortisol excretion, in hemoglobin and some coagulation factors but not Factor X or antithrombin III, platelet function or fibrinolysis. The area under the blood glucose concentration-time curve, but not that for serum insulin, was slightly increased and there was no change in fasting blood sugar concentrations. All metabolic parameters, except plasma cortisol, which had shown an increase on treatment, had decreased to control levels within 3 months. Ovulation returned promptly in all women, the mean time being 70 days for Group MOC and 44 days for Group DOC. Thus, in spite of the long duration of use of the oral contraceptives, metabolic changes were minor.