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Iresjö BM, Blomström S, Engström C, Johnsson E, Lundholm K. Acute appendicitis: A block-randomized study on active observation with or without antibiotic treatment. Surgery 2024; 175:929-935. [PMID: 38218686 DOI: 10.1016/j.surg.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Antibiotic treatment of unselected patients with acute appendicitis is safe and effective. However, it is unknown to what extent early provision of antibiotic treatment may represent overtreatment due to spontaneous healing of appendix inflammation. The aim of the present study was to evaluate the role of antibiotic treatment versus active in-hospital observation on spontaneous regression of acute appendicitis. METHOD Patients who sought acute medical care at Sahlgrenska University Hospital were block-randomized according to age (18-60 years) and systemic inflammation (C-reactive protein <60 mg/L, white blood cell <13,000/μL), in combination with clinical and abdominal characteristics of acute appendicitis. Study patients received antibiotic treatment and active observation, while control patients were allocated to classic active "wait and see observation" for either disease regression or the need for surgical exploration. According to our standard surgical care, certified surgeons in charge decided whether and when appendectomy was necessary. In total, 1,019 patients were screened for eligibility; 203 patients met inclusion criteria, 126 were accepted to participate, 29 declined, and 48 were missed for inclusion. RESULTS The antibiotic group (n = 69) and the control group (n = 57) were comparable at inclusion. Appendectomy at first hospital stay was 28% and 53% for study and control patients (χ2, P < .004). Life table analysis indicated a time-dependent difference in the need for appendectomy during follow-up (P < .03). Antibiotics prevented surgical exploration and appendectomy by 72% to 50% compared to 47% to 37% in the control group across the time course follow-ups between 5 and 1,200 days. CONCLUSION Early antibiotic treatment is superior to traditional "wait and see observation" to avoid surgical exploration and appendectomy.
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Affiliation(s)
- Britt-Marie Iresjö
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Sara Blomström
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Cecilia Engström
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Erik Johnsson
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Kent Lundholm
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Tsekrekos A, Vossen LE, Lundell L, Jeremiasen M, Johnsson E, Hedberg J, Edholm D, Klevebro F, Nilsson M, Rouvelas I. Improved survival after laparoscopic compared to open gastrectomy for advanced gastric cancer: a Swedish population-based cohort study. Gastric Cancer 2023; 26:467-477. [PMID: 36808262 PMCID: PMC10115725 DOI: 10.1007/s10120-023-01371-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy is increasingly used for the treatment of locally advanced gastric cancer but concerns remain whether similar results can be obtained compared to open gastrectomy, especially in Western populations. This study compared the short-term postoperative, oncological and survival outcomes following laparoscopic versus open gastrectomy based on data from the Swedish National Register for Esophageal and Gastric Cancer. METHODS Patients who underwent surgery with curative intent for adenocarcinoma of the stomach or gastroesophageal junction Siewert type III from 2015 to 2020 were identified, and 622 patients with cT2-4aN0-3M0 tumors were included. The impact of surgical approach on short-term outcomes was assessed using multivariable logistic regression. Long-term survival was compared using multivariable Cox regression. RESULTS In total, 350 patients underwent open and 272 laparoscopic gastrectomy, of which 12.9% were converted to open surgery. The groups were similar regarding distribution of clinical disease stage (27.6% stage I, 46.0% stage II, and 26.4% stage III). Neoadjuvant chemotherapy was administered to 52.7% of the patients. There was no difference in the rate of postoperative complications, but laparoscopic approach was associated with lower 90 day mortality (1.8 vs 4.9%, p = 0.043). The median number of resected lymph nodes was higher after laparoscopic surgery (32 vs 26, p < 0.001), while no difference was found in the rate of tumor-free resection margins. Better overall survival was observed after laparoscopic gastrectomy (HR 0.63, p < 0.001). CONCLUSIONS Laparoscopic gastrectomy can be safely preformed for advanced gastric cancer and is associated with improved overall survival compared to open surgery.
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Affiliation(s)
- Andrianos Tsekrekos
- Department of Upper Abdominal Surgery, Karolinska University Hospital, C1:77, Stockholm, Sweden. .,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden.
| | - Laura E Vossen
- Department of Upper Abdominal Surgery, Karolinska University Hospital, C1:77, Stockholm, Sweden.,Centre for Bioinformatics and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Lundell
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden.,Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Martin Jeremiasen
- Department of Surgery, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Erik Johnsson
- Department of Surgery, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jakob Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - David Edholm
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Klevebro
- Department of Upper Abdominal Surgery, Karolinska University Hospital, C1:77, Stockholm, Sweden.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden
| | - Magnus Nilsson
- Department of Upper Abdominal Surgery, Karolinska University Hospital, C1:77, Stockholm, Sweden.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden
| | - Ioannis Rouvelas
- Department of Upper Abdominal Surgery, Karolinska University Hospital, C1:77, Stockholm, Sweden.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden
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Sediqi E, Tsoposidis A, Wallenius V, Axelsson H, Persson J, Johnsson E, Lundell L, Kostic S. Laparoscopic Heller myotomy or pneumatic dilatation in achalasia: results of a prospective, randomized study with at least a decade of follow-up. Surg Endosc 2020; 35:1618-1625. [DOI: 10.1007/s00464-020-07541-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
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Persson J, Engström C, Bergquist H, Johnsson E, Smedh U. Validation of instruments for the assessment of dysphagia due to malignancy of the esophagus. Dis Esophagus 2019; 32:5267100. [PMID: 30596966 DOI: 10.1093/dote/doy125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022]
Abstract
The aim of the study was to validate the Watson scale, the Ogilvie scale, and the Goldschmid scale for assessment of dysphagia due to malignancy of the esophagus. After translation of the scales to Swedish, 35 patients with dysphagia due to esophageal malignancy were asked to participate. On day 1, patients were asked to fill in the questionnaires. The patients also kept a food diary for 4 consecutive days, for assessment of actual swallowing ability. On day 10, the patients were asked to fill in the scales again, to control for individual variability. As an external control group, 29 healthy volunteers were asked to fill in the questionnaires once. External validation was done against actual swallowing ability, and against the European Organization for Research and Treatment of Cancer scales QLQ-C30 and QLQ-OG25, which are already validated quality of life scales for malignancy. Reliability in the categorical variables (Ogilvie and Goldschmid) showed weighted kappa values of 0.52 and 0.54, respectively. For the Watson scale and the Dysphagia module of QLQ-OG25, the intraclass correlation coefficients were 0.68 and 0.80, respectively. Correlations between all scales were good to excellent with values of correlation coefficients (rs) between 0.69 and 0.88, with the strongest correlations between the Ogilvie score and the dysphagia module in QLQ-OG25. These latter two scales had the strongest correlation to the food diary (rs = 0.72). Although the Ogilvie scale was superior, all the three scales showed good reliability and are thus judged to have good validity for assessment of dysphagia due to esophageal malignancy.
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Affiliation(s)
- J Persson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital
| | - C Engström
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital
| | - H Bergquist
- Department of ENT, Head and Neck Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - E Johnsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital
| | - Ulrika Smedh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital
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Lundkvist P, Amini S, Lau Börjesson J, Pereira MJ, Kamble P, Sjöström D, Johnsson E, Eriksson JW, Klisch C. Metabolische Effekte einer Kombination von Dapagliflozin und wöchentlichem Exenatide bei adipösen Erwachsenen ohne Diabetes: 24-wöchige, randomisierte, placebokontrollierte Phase-2-Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - S Amini
- Universität Uppsala, Uppsala, Sweden
| | | | | | - P Kamble
- Universität Uppsala, Uppsala, Sweden
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Eriksson JW, Lundkvist P, Sjöström D, Katsogiannos P, Pereira MJ, Johnsson E, Stürzenhofecker B. Einjährige Behandlung adipöser Erwachsenen ohne Diabetes mit einer Kombination von Dapagliflozin und wöchentlichem Exenatide: Ergebnisse einer offenen Verlängerungsstudie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Matthaei S, Aggarwal N, Garcia-Hernandez P, Iqbal N, Chen H, Johnsson E, Chin A, Hansen L. One-year efficacy and safety of saxagliptin add-on in patients receiving dapagliflozin and metformin. Diabetes Obes Metab 2016; 18:1128-1133. [PMID: 27403645 DOI: 10.1111/dom.12741] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 11/28/2022]
Abstract
AIMS Greater reductions in glycated haemoglobin (HbA1c) with saxagliptin, a dipeptidyl peptidase-4 inhibitor, versus placebo add-on in patients with type 2 diabetes who had inadequate glycaemic control with dapagliflozin 10 mg/d plus metformin were demonstrated after 24 weeks of treatment. Results over 52 weeks of treatment were assessed in this analysis. MATERIALS AND METHODS Patients (mean baseline HbA1c 7.9%) receiving open-label dapagliflozin 10 mg/d plus metformin were randomized to double-blind saxagliptin 5 mg/d or placebo add-on. RESULTS The adjusted mean change from baseline to week 52 in HbA1c was greater with saxagliptin than with placebo add-on -0.38% vs 0.05%; difference -0.42% (95% confidence interval -0.64, -0.20)]. More patients achieved the HbA1c target of <7% with saxagliptin than with placebo add-on (29% vs 13%), and fewer patients were rescued or discontinued the study for lack of glycaemic control with saxagliptin than with placebo add-on (19% vs 28%). Reductions from baseline in body weight (≤1.5 kg) occurred in both groups. Similar proportions of patients reported ≥1 adverse event with saxagliptin (58.2%) and placebo add-on (58.0%); no new safety signals were detected. Hypoglycaemia was infrequent in both treatment groups (≤2.5%), with no major episodes. The rate of urinary tract infections was similar in the saxagliptin and placebo add-on groups (7.8% vs 7.4%). The incidence of genital infections was 3.3% with saxagliptin versus 6.2% with placebo add-on. CONCLUSIONS Triple therapy with saxagliptin add-on to dapagliflozin plus metformin for 52 weeks resulted in sustained improvements in glycaemic control without an increase in body weight or increased risk of hypoglycaemia.
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Affiliation(s)
- S Matthaei
- Diabetes-Zentrum, Quakenbrück Hospital, Quakenbrück, Germany
| | - N Aggarwal
- Aggarwal and Associates, Ltd, Brampton, Ontario, Canada
| | - P Garcia-Hernandez
- Servicio de Endocrinologia, Hospital Universitario Dr. José Eleuterio Gonzalez, Monterrey, Nuevo Leon, Mexico
| | - N Iqbal
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA.
| | - H Chen
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - E Johnsson
- Global Medicines Development, AstraZeneca, Gothenburg, Sweden
| | - A Chin
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - L Hansen
- Global Clinical Research Metabolics, Bristol-Myers Squibb, Princeton, New Jersey, USA
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Mathieu C, Herrera Marmolejo M, González González JG, Hansen L, Chen H, Johnsson E, Garcia-Sanchez R, Iqbal N. Efficacy and safety of triple therapy with dapagliflozin add-on to saxagliptin plus metformin over 52 weeks in patients with type 2 diabetes. Diabetes Obes Metab 2016; 18:1134-1137. [PMID: 27385192 DOI: 10.1111/dom.12737] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 01/10/2023]
Abstract
We previously reported that dapagliflozin versus placebo as add-on to saxagliptin plus metformin resulted in greater reductions in glycated haemoglobin (A1C), fasting plasma glucose (FPG) and body weight (BW) after 24 weeks of treatment in patients with type 2 diabetes (T2D). Here we report results after 52 weeks of treatment. Patients stabilized on open-label metformin and saxagliptin 5 mg/day for 8-16 weeks were randomized to placebo or dapagliflozin 10 mg/day plus open-label saxagliptin plus metformin for 52 weeks. Changes from baseline to week 52 were greater with dapagliflozin versus placebo in A1C (-0.74% vs. 0.07%), FPG (-27 vs. 10 mg/dL) and BW (-2.1 vs. -0.4 kg). More patients achieved A1C <7% with dapagliflozin (29.4%) versus placebo (12.6%). Adverse events were similar with dapagliflozin (66%) and placebo (71%), and hypoglycaemia was rare (≤2%). Genital infections occurred more often with dapagliflozin (6%) than with placebo (1%); frequency of urinary tract infections was similar between the two groups (9% vs. 10%). Triple therapy with dapagliflozin add-on to saxagliptin plus metformin is a durable, effective and well-tolerated intervention for the treatment of T2D.
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Affiliation(s)
- C Mathieu
- Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | | - L Hansen
- Global Clinical Research Metabolics, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - H Chen
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - E Johnsson
- Global Medicines Development, AstraZenca, Gothenburg, Sweden
| | - R Garcia-Sanchez
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - N Iqbal
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
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Leiter LA, Cefalu WT, de Bruin TWA, Xu J, Parikh S, Johnsson E, Gause-Nilsson I. Long-term maintenance of efficacy of dapagliflozin in patients with type 2 diabetes mellitus and cardiovascular disease. Diabetes Obes Metab 2016; 18:766-74. [PMID: 27009868 DOI: 10.1111/dom.12666] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/15/2016] [Accepted: 03/20/2016] [Indexed: 01/10/2023]
Abstract
AIM To evaluate the long-term efficacy, safety and tolerability of dapagliflozin versus placebo added to usual care in patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). METHODS Data were pooled from two phase III studies (NCT01031680 and NCT01042977) in high-risk patients (N = 1887) with T2DM and CVD treated with dapagliflozin (10 mg/day) or placebo. Patients completing the double-blind treatment studies (24 weeks) entered one or two sequential double-blind, long-term (LT) extensions of 28 (LT1; n = 1649) and 52 (LT2; n = 568) weeks. RESULTS Baseline and CVD characteristics were similar in the two groups. Patients entering LT1 and LT2 on dapagliflozin maintained a greater mean reduction in glycated haemoglobin (HbA1c) versus placebo at 52 weeks [LT1, -0.58% (95% confidence interval -0.68, -0.49)] and 104 weeks [LT2, -0.35% (95% confidence interval -0.59, -0.12)]. Mean body weight and systolic blood pressure (SBP) reductions versus placebo were maintained in patients entering LT1 (52 weeks; -2.23 kg and -3.25 mmHg, respectively) and LT2 (104 weeks; -3.16 kg and -2.03 mmHg, respectively). Patients on dapagliflozin had a better three-item composite endpoint of clinical benefit (glycaemia, weight and SBP) compared with placebo at week 24 (LT1, 10.1% vs. 1.1%) and week 104 (LT2, 6.7% vs. 1.4%). Genital and urinary tract infections were more frequent with dapagliflozin than with placebo. Events of hypoglycaemia, renal impairment/failure and volume depletion were similar between groups. CONCLUSIONS The long-term efficacy of dapagliflozin to maintain reductions in HbA1c, SBP and body weight over 2 years, together with its tolerability profile, make dapagliflozin an appropriate option in high-risk patients with T2DM and CVD.
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Affiliation(s)
- L A Leiter
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - W T Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - T W A de Bruin
- Research & Development, AstraZeneca, Gaithersburg, MD, USA
| | - J Xu
- Biometrics and Informatics, AstraZeneca, Gaithersburg, MD, USA
| | - S Parikh
- Global Medical Affairs-CV and Metabolism, AstraZeneca, Gaithersburg, MD, USA
| | - E Johnsson
- Research & Development, AstraZeneca Gothenburg, Mölndal, Sweden
| | - I Gause-Nilsson
- Research & Development, AstraZeneca Gothenburg, Mölndal, Sweden
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Heerspink HJL, Johnsson E, Gause-Nilsson I, Cain VA, Sjöström CD. Dapagliflozin reduces albuminuria in patients with diabetes and hypertension receiving renin-angiotensin blockers. Diabetes Obes Metab 2016; 18:590-7. [PMID: 26936519 PMCID: PMC4850750 DOI: 10.1111/dom.12654] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 01/23/2016] [Accepted: 02/27/2016] [Indexed: 01/10/2023]
Abstract
AIMS To characterize the effect of dapagliflozin on albuminuria and estimated glomerular filtration rate (eGFR) and to determine whether effects on albuminuria were mediated through changes in glycated haemoblogin (HbA1c), systolic blood pressure (SBP), body weight or eGFR. METHODS We conducted a post hoc analysis of data pooled from two phase III clinical trials in hypertensive patients with type 2 diabetes (T2DM) on stable angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, randomly assigned to dapagliflozin 10 mg/day or matched placebo. This analysis included only patients with microalbuminuria or macroalbuminuria at baseline. RESULTS Patients were randomized to receive dapagliflozin 10 mg (n = 167) or placebo (n = 189). Dapagliflozin resulted in greater 12-week reductions in albuminuria compared with placebo: -33.2% [95% confidence interval (CI) -45.4, -18.2]. The reduction in albuminuria was also present after adjusting for age, sex and changes in HbA1c, SBP, body weight and eGFR: -23.5% (95% CI -37.6, -6.3). There was a decrease in eGFR with dapagliflozin versus placebo that was readily reversed 1 week after last dose. No serious renal-related adverse events were observed in any group. CONCLUSIONS Dapagliflozin was effective in lowering albuminuria in patients with T2DM and hypertension using renin-angiotensin system blockade therapy. Reductions in albuminuria were still present after adjusting for changes in HbA1c, SBP, body weight and eGFR. Dapagliflozin-induced improvements in glycaemic control and reductions in SBP, coupled with other potentially beneficial renal effects, may lead to a reduced long-term renal and cardiovascular risk.
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Affiliation(s)
- H J L Heerspink
- University of Groningen, University Medical Center, Groningen, The Netherlands
| | - E Johnsson
- AstraZeneca, Gothenburg, Mölndal, Sweden
| | | | - V A Cain
- AstraZeneca, Wilmington, DE, USA
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Tang W, Bouw R, Johnsson E, Boulton D, Leil T, LaCreta F, Scheerer M. Vergleich der Pharmakodynamik von Dapagliflozin bei Patienten mit Typ-1- oder Typ-2-Diabetes. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rohwedder K, Johnsson E. Der Nüchternplamaglukosewert zu Therapiebeginn könnte prädiktiv für das Ansprechen auf Dapagliflozin als Add-on zu Metformin sein. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Forst T, Rohwedder K, Sugg J, Johnsson E. Dapagliflozin senkt den postprandialen Blutzucker ohne Anstieg von C-Peptid oder Insulin. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Heerspink HL, Johnsson E, Gause-Nilsson I, Sjöström D, Pieperhoff S. Dapagliflozin reduziert Albuminurie als Zusatz zu Inhibitoren des Renin-Angiotensin-Systems bei hypersensitiven Diabetespatienten. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rudosfky G, Rohwedder K, Balycheva I, Johnsson E. Genitalinfektionen und Zusammenhang mit dem Body-Mass-Index bei Patienten mit Typ-2-Diabetes-mellitus unter Dapagliflozin. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gause-Nilsson I, Sonesson C, Johansson P, Johnsson E, Müller D. Kein erhöhtes Risiko kardiovaskulärer Ereignisse bei älteren Patienten mit Typ 2 Diabetes mellitus, kardiovaskulärer Erkrankung und Hypertonie unter Dapagliflozin. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hansen L, Sonesson C, Thoren F, Ptaszynska A, Iqbal N, Xu J, Johnsson E, Scheerer M. Insulin:Kohlenhydrat-Quotient und renale Glukoseausscheidung über 24 Stunden zur Bestimmung von Insulindosisanpassungen bei mit Dapagliflozin behandelten Patienten mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kosiborod M, Gause-Nilsson I, Sugg J, Sonesson C, Johnsson E, Marbach S. Wirksamkeit und Verträglichkeit von Dapagliflozin bei Patienten mit Typ-2-Diabetes und begleitender Herzinsuffizienz. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tang W, Leil TA, Johnsson E, Boulton DW, LaCreta F. Comparison of the pharmacokinetics and pharmacodynamics of dapagliflozin in patients with type 1 versus type 2 diabetes mellitus. Diabetes Obes Metab 2016; 18:236-40. [PMID: 26510924 DOI: 10.1111/dom.12594] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/15/2015] [Accepted: 10/23/2015] [Indexed: 01/08/2023]
Abstract
AIMS To compare the pharmacokinetics and pharmacodynamics of dapagliflozin in patients with type 1 diabetes mellitus (T1DM) versus type 2 diabetes mellitus (T2DM) in order to explore the potential of dapagliflozin as add-on therapy to insulin in patients with T1DM. METHODS Steady-state pharmacokinetics and pharmacodynamics of dapagliflozin (1-100 mg) were evaluated in a meta-analysis of patients with T1DM or T2DM. A model was constructed of the relationship between dapagliflozin systemic exposure and urinary glucose excretion (UGE) in patients with T1DM versus those with T2DM. RESULTS Data were analysed from 160 patients (T1DM, n = 70; T2DM, n = 90). Dapagliflozin systemic exposure (maximum concentration and area under the curve) increased similarly in a dose-related manner in both patient populations. Dose-dependent increases in 24-h UGE were observed with dapagliflozin in both populations. Unadjusted results showed that with regard to UGE response, dapagliflozin was more potent in patients with T1DM {mean half-maximum effective concentration [EC50 ] = 2.72 ng/ml [95% confidence interval (CI) 1.14, 5.08]} than in patients with T2DM [EC50 = 12.2 ng/ml (95% CI 4.91, 21.1)]. After normalization for baseline fasting plasma glucose, estimated glomerular filtration rate and UGE, however, the UGE potency of dapagliflozin was similar between the two populations [T1DM: mean EC50 , 8.12 ng/ml (95% CI 2.95, 14.6); T2DM: mean EC50 , 7.75 ng/ml (95% CI 1.35, 18.1)]. CONCLUSIONS Dapagliflozin pharmacokinetics and the predicted UGE dose exposure response to dapagliflozin were similar in patients with T1DM and those with T2DM and suggest that the dapagliflozin dosages currently used for the treatment of T2DM may provide benefit as add-on therapy to insulin in patients with T1DM.
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Affiliation(s)
- W Tang
- AstraZeneca, Gaithersburg, MD, USA
| | - T A Leil
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | | | - F LaCreta
- Bristol-Myers Squibb, Princeton, NJ, USA
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Lambers Heerspink HJ, Johnsson E, Gause-Nilsson I, Sjöström C. Erratum to: Abstracts of the 51st Annual Meeting of the EASD, Stockholm 2015. 'Dapagliflozin reduces albuminuria on top of renin-angiotensin system blockade in hypertensive patients with diabetes'. Diabetologia 2015; 58:2901. [PMID: 26404064 DOI: 10.1007/s00125-015-3765-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- H J Lambers Heerspink
- Dept of Clinical Pharmacology, University Medical Center Groningen, Groningen, Netherlands
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Matthaei S, Bowering K, Rohwedder K, Sugg J, Parikh S, Johnsson E. Durability and tolerability of dapagliflozin over 52 weeks as add-on to metformin and sulphonylurea in type 2 diabetes. Diabetes Obes Metab 2015. [PMID: 26212528 DOI: 10.1111/dom.12543] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS To evaluate the safety and efficacy of dapagliflozin as add-on therapy to metformin plus sulphonylurea over 52 weeks. METHODS Patients with type 2 diabetes mellitus (T2DM) using sulphonylurea and metformin received dapagliflozin 10 mg/day or placebo added to therapy for 52 weeks (24-week randomized, double-blind period plus 28-week double-blind extension). RESULTS A total of 219 patients were randomized 1 : 1 to dapagliflozin or placebo. Over 52 weeks, glycated haemoglobin (HbA1c) and fasting plasma glucose levels showed greater improvement from baseline with dapagliflozin (-0.8% and -1.5 mmol/l) than with placebo (-0.1% and 0.6 mmol/l). More patients achieved HbA1c <7.0% with dapagliflozin (27.3%) than with placebo (11.3%) at 52 weeks. Dapagliflozin was associated with greater reductions in body weight and systolic blood pressure (-2.9 kg and -1.0 mmHg) compared with placebo (-1.0 kg and 1.1 mmHg). Greater increases in total, LDL and HDL cholesterol and decreases in triglycerides were observed with dapagliflozin (3.4, 4.8, 6.9 and -8.0%, respectively) versus placebo (1.4, 0.9, 0.6 and 2.9%, respectively). Fewer patients were rescued for failing to reach glycaemic targets with dapagliflozin (9.3%) than with placebo (44.4%). Adverse events and serious adverse events were similar between groups (dapagliflozin: 69.7 and 6.4%; placebo: 73.4 and 7.3%). More hypoglycaemic events were observed with dapagliflozin (15.6%) than with placebo (8.3%). Genital infections were reported in more patients in the dapagliflozin (10.1%) than in the placebo group (0.9%) and urinary tract infection frequency was similar in the two groups (10.1 and 11.0%). CONCLUSION Dapagliflozin as add-on to metformin plus a sulphonylurea was well tolerated and improvement in glycaemic control was maintained over 52 weeks.
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Affiliation(s)
- S Matthaei
- Diabetes-Zentrum Quakenbrück, Quakenbrück, Germany
| | - K Bowering
- University of Alberta, Department of Medicine, Alberta, Canada
| | | | - J Sugg
- Formerly AstraZeneca, Wilmington, DE, USA
| | - S Parikh
- AstraZeneca, Gaithersburg, MD, USA
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Persson J, Johnsson E, Kostic S, Lundell L, Smedh U. Treatment of achalasia with laparoscopic myotomy or pneumatic dilatation: long-term results of a prospective, randomized study. World J Surg 2015; 39:713-20. [PMID: 25409838 DOI: 10.1007/s00268-014-2869-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study compares the long-term results of pneumatic dilatations versus laparoscopic myotomy using treatment failure as the primary outcome. The frequency and degree of dysphagia, the effects on quality of life (QoL), and health economy were also examined. METHODS Fifty-three patients with achalasia were randomized to laparoscopic myotomy with a posterior partial fundoplication [laparoscopic myotomy (LM) n = 25] or repetitive pneumatic dilatation [pneumatic dilatation (PD) n = 28]. The median observation period was 81.5 months (range 12-131). RESULTS At the minimal follow-up of 5 years, ten patients (36%) in the dilatation group and two patients (8%) in the myotomy group, including two patients lost to follow-up (one in each arm), were classified as failures (p = 0.016). The cumulative incidence of treatment failures was analyzed by survival statistics. Taking the entire follow-up period into account, a significant difference was observed in favor of the LM strategy (p = 0.02). Although both treatments resulted in significant improvements in dysphagia scores, LM was significantly favored over PD after 1 and 3 years, but not after 5 years. Health-related QoL assessed by the personal general well being score was higher in the LM group after 3 years, but the difference was not fully statistically significant at 5 years. Direct medical costs during the entire follow-up period were in median $13,421 for LM as compared to $5,558 for PD (p = 0.001). CONCLUSIONS This long-term follow-up of a randomized clinical study shows that LM is superior to repetitive PD treatment of newly diagnosed achalasia, albeit that this surgical strategy is burdened by high initial direct medical costs. www.ClinicalTrials.gov NCT 02086669.
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Affiliation(s)
- Jan Persson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, 41345, Gothenburg, Sweden,
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Sjöström CD, Hashemi M, Sugg J, Ptaszynska A, Johnsson E. Dapagliflozin-induced weight loss affects 24-week glycated haemoglobin and blood pressure levels. Diabetes Obes Metab 2015; 17:809-12. [PMID: 25997813 DOI: 10.1111/dom.12500] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/12/2015] [Accepted: 05/18/2015] [Indexed: 12/20/2022]
Abstract
The aim of this study was to investigate the associations between dapagliflozin-mediated reductions in body weight and reductions in glycated haemoglobin (HbA1c) and blood pressure. Data were pooled from seven studies evaluating dapagliflozin 10 mg as monotherapy or combination therapy over 24 weeks. Using linear regression to estimate the contribution of weight loss to HbA1c and blood pressure reductions, the β-value estimate for HbA1c (%)/kg was 0.028 (p < 0.0001). Weight loss of 2 kg with dapagliflozin contributed to 6% of the total HbA1c reduction. For systolic (SBP) and diastolic blood pressure (DBP), the β-value (mmHg/kg) estimates were 0.606 (p < 0.0001) and 0.253 (p < 0.0001), respectively. Weight loss of 2 kg contributed to 28% of the overall SBP reduction, and 24% of the overall DBP reduction. In conclusion, dapagliflozin-mediated weight loss may contribute to overall reductions in HbA1c and blood pressure.
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Affiliation(s)
| | | | - J Sugg
- Formerly AstraZeneca, Wilmington, DE, USA
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Rohwedder K, Johnsson E, Parikh SJ. Verringertes Hypoglykämierisiko mit Dapagliflozin gegenüber Glipizid als Add-on-Therapie bei Typ 2 Diabetes mellitus: 4-Jahresdaten einer Phase-3-Studie. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sjöström D, Johansson P, Ptaszynska A, List JF, Johnsson E, Stürzenhofecker B. Dapagliflozin verringert den Blutdruck bei hypertensiven und nicht-hypertensiven Patienten mit Typ 2 Diabetes. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rohwedder K, Matthaei S, Bowering K, Grohl A, Johnsson E. Verbesserung der glykämischen Kontrolle und Verringerung des Körpergewichtes innerhalb von 52 Wochen mit Dapagliflozin als Add-on-Therapie zu Metformin und Sulfonylharnstoff. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yavin Y, Mansfield TA, Ptaszynska A, Apanovitch AM, Johnsson KM, Johnsson E, Parikh SJ, List JF, Marbach S. Keine erhöhte Hyperkaliämie-Inzidenz bei Therapie mit dem SGLT-2 Inhibitor Dapagliflozin. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Johnsson E, Johnsson KM, Mansfield TA, Apanovitch A, Yavin Y, Ptaszynska A, Parikh SJ, List JF, Rist R. Sicherheit und Verträglichkeit von Dapagliflozin hinsichtlich Diurese zur Behandlung des Typ 2 Diabetes mellitus über 24 Wochen. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ptaszynska A, Mansfield TA, Johnsson E, Parikh SJ, Yavin Y, List JF, Pieperhoff S. Langfristige renale Verträglichkeit der Dapagliflozin-Behandlung. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Johnsson KM, Ptaszynska A, Mansfield TA, Apanovitch A, Johnsson E, Parikh SJ, List JF, Job S. Der selektive SGLT-2 Inhibitor Dapagliflozin ist nicht mit einem erhöhten Frakturrisiko assoziiert. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gause-Nilsson I, de Bruin TWA, Sugg J, Parikh SJ, Johnsson E, Leiter LA, Pieperhoff S. Wirksamkeit und Verträglichkeit von Dapagliflozin über 2 Jahre bei T2DM-Patienten mit kardiovaskulärer Vorerkrankung. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cefalu WT, Gause-Nilsson I, de Bruin TWA, Sugg JE, Parikh SJ, Johnsson E, Hein UK. Langfristige Wirksamkeit und Verträglichkeit von Dapagliflozin bei Patienten mit Typ 2 Diabetes, kardiovaskulärer Erkrankung und Hypertonie. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mansfield TA, Fioretto P, Ptaszynska A, Yavin Y, Apanovitch A, Johnsson E, Parikh SJ, List JF, Kuske M. Dapagliflozin ist sicher und gut verträglich bei älteren Patienten mit Typ 2 Diabetes mellitus. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rohwedder K, Del Prato S, Nauck M, Johnsson E, Parikh SJ. Bessere Beständigkeit der glykämischen Kontrolle mit Dapagliflozin im Vergleich zu Glipizid als Add-on-Therapie bei unter Metformin unzureichend kontrolliertem Typ 2 Diabetes: 4-Jahres Daten. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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de Bruin TWA, Fioretto P, Johnsson E, Ptasynska A, Parikh SJ, List J, Rohwedder K. Sicherheit und Wirksamkeit des SGLT-2-Hemmers Dapagliflozin bei älteren Patienten mit Typ-2-Diabetes. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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de Bruin TWA, Leiter LA, Cefalu WT, Gause-Nilsson I, Johnsson E, Parikh SJ, Rohwedder K. Dapagliflozin bei Patienten mit Typ-2-Diabetes und bestehender kardiovaskulärer Erkrankung: Hypotonie und Verträglichkeit in Bezug auf Volumenverlust. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Langkilde AM, Johansson P, Ptasynska A, Johnsson E, Rohwedder K. Kardiovaskuläre Sicherheit des SGLT-2-Hemmers Dapagliflozin: Metaanalyse einer Exposition von mehr als 6000 Patientenjahren. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sjöström D, Hashemi M, Sugg J, Ptasynska A, Johnsson E, Rohwedder K. Gewichtsverlust durch Dapagliflozin beeinflusst HbA1c-Spiegel und Blutdruckwerte nach 24 Wochen. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Matthaei S, Rohwedder K, Grohl A, Johnsson E. Verbesserung der Blutzuckerkontrolle und Verringerung des Körpergewichts unter Dapagliflozin als Zusatztherapie zu Metformin und Sulfonylharnstoff. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hardy E, Ptasynska A, de Bruin TWA, Johnsson E, Parikh SJ, List J, Rohwedder K. Veränderungen des Lipidprofils bei Patienten mit Typ-2-Diabetes mellitus unter einer Behandlung mit Dapagliflozin. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rohwedder K, Ptasynska A, Henry RR, Murray AV, Nauck M, Johnsson E, List J, Parikh SJ. Direkter Vergleich zeigt ähnliche Wirksamkeit von Dapagliflozin im Vergleich zu Metformin oder Sulfonylharnstoffen in verschiedenen Ausgangs-HbA1c-Gruppen. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kiyosue A, Hayashi N, Komori H, Leonsson-Zachrisson M, Johnsson E. Dose-ranging study with the glucokinase activator AZD1656 as monotherapy in Japanese patients with type 2 diabetes mellitus. Diabetes Obes Metab 2013; 15:923-30. [PMID: 23522182 DOI: 10.1111/dom.12100] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/10/2012] [Accepted: 03/10/2013] [Indexed: 12/22/2022]
Abstract
AIM To assess the glucose-lowering effects of monotherapy with the glucokinase activator AZD1656 in Japanese patients with type 2 diabetes mellitus. METHODS This was a randomized, double-blind, placebo-controlled study performed in Japan (NCT01152385). Patients (n = 224) were randomized to AZD1656 (40-200, 20-140 or 10-80 mg titrated doses) or placebo. The primary variable was the placebo-corrected change from baseline to 4 months in glycated haemoglobin (HbA1c). Effects on fasting plasma glucose (FPG) and safety were also assessed. RESULTS HbA1c was reduced numerically from baseline by 0.3-0.8% with AZD1656 and by 0.1% with placebo over the first 2 months of treatment, after which effects of AZD1656 started to decline. The changes from baseline to 4 months in HbA1c were not significant for the AZD1656 40-200 mg group versus placebo [mean (95% CI) placebo-corrected change: -0.22 (-0.65, 0.20)%; p = 0.30]. Formal significance testing was not carried out for the other two AZD1656 dose groups. A higher percentage of patients on AZD1656 achieved HbA1c ≤ 7% after 4 months versus placebo, but responder rates were low. Results for FPG reflected those for HbA1c. Cases of hypoglycaemia were rare with AZD1656 (one patient) and no safety concerns were raised. CONCLUSIONS Although initially favourable plasma glucose reductions were observed, there was a loss of effect over time with sustained AZD1656 treatment. The study design did not allow an evaluation of the reasons for this lack of long-term efficacy.
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Affiliation(s)
- A Kiyosue
- Department of Internal Medicine, Tokyo-Eki Center-Building Clinic, Tokyo, Japan
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Wilding JPH, Leonsson-Zachrisson M, Wessman C, Johnsson E. Dose-ranging study with the glucokinase activator AZD1656 in patients with type 2 diabetes mellitus on metformin. Diabetes Obes Metab 2013; 15:750-9. [PMID: 23464532 DOI: 10.1111/dom.12088] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/03/2012] [Accepted: 02/19/2013] [Indexed: 01/10/2023]
Abstract
AIM To investigate the effect of glucokinase activator AZD1656 on glycated haemoglobin (HbA1c) as an add-on to metformin in patients with type 2 diabetes. METHODS This randomized, double-blind, placebo-controlled study (NCT01020123) was conducted over 4 months with an optional 2-month extension. Patients (n = 458) with HbA1c 7.5-10% were randomized to AZD1656 20 mg (n = 40) or 40 mg (n = 52) fixed doses or 10-140 mg (n = 91) or 20-200 mg (n = 93) titrated doses, placebo (n = 88) or glipizide 5-20 mg titrated (n = 94). Patients (n = 72) with HbA1c >10 and ≤12% received open-label AZD1656 (20-200 mg titrated). Primary outcome was placebo-corrected change in HbA1c from baseline to 4 months of treatment. RESULTS Significant reductions in HbA1c from baseline to 4 months were observed with blinded AZD1656 10-140 and 20-200 mg versus placebo [mean (95% CI) changes: -0.80 (-1.14; -0.46) and -0.81 (-1.14; -0.47) %, respectively), with similar reductions observed with glipizide. A higher percentage of patients on AZD1656 than on placebo achieved HbA1c ≤7.0 or ≤6.5 % after 4 months. Mean (s.d.) change in HbA1c for open-label AZD1656 (20-200 mg) was -2.8 (1.19) % after 4 months. AZD1656 was well tolerated, with less hypoglycaemia than glipizide. In the extension population, HbA1c was still reduced with AZD1656 versus placebo after 6 months, but the effect of AZD1656 on glucose control was not sustained over time. CONCLUSION Addition of AZD1656 (individually titrated) to metformin gave significant improvements in glycaemic control up to 4 months, although efficacy diminished over time.
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Affiliation(s)
- J P H Wilding
- Department of Obesity and Endocrinology, University Hospital Aintree, Liverpool, UK.
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Ung KA, Stotzer PO, Nilsson A, Gustavsson ML, Johnsson E. Covered and uncovered self-expandable metallic Hanarostents are equally efficacious in the drainage of extrahepatic malignant strictures. Results of a double-blind randomized study. Scand J Gastroenterol 2013; 48:459-65. [PMID: 23373541 DOI: 10.3109/00365521.2012.758766] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Self-expandable metallic stents (SEMS) placement is a standard treatment for inoperable malignant bile duct strictures. Covered SEMS have been introduced to avoid stent occlusion by tumor ingrowth. The aims were to compare covered and uncovered stents in terms of patency, efficacy and complication rate. MATERIAL AND METHODS Consecutive patients with inoperable malignant distal biliary strictures were included in the study and randomized to receive a covered (n = 34) or uncovered (n = 34) Hanaro SEMS. Follow-up was performed by nurses after 18 h, 48 h, 2 weeks and thereafter every month until stent dysfunction or the patient died. Outcomes were measured as follows: the patients reported urine and stool color, presence of fever and abdominal pain. Liver function tests and CRP were analyzed each time. The procedure time and complications were monitored. The follow-up was blinded to stent type. RESULTS The median patient age was 79 years (IQR: 66-83, R: 54-92), 59% were female and 85% had the gallbladder in situ. There was no difference between covered and uncovered stents in terms of procedure time (median: 30 min (20-38, R: 12-90) vs. 30 min (IQR: 20-42, R: 12-70)), stent patency (median: 153 days (IQR: 65-217; R: 20-609) vs. median of 127 days (IQR: 70-196; R: 18-486)) or patient survival (median: 154 days (IQR: 65-217; R: 21-609) vs 157 days (IQR: 70-273, R: 20-690)). Eighty-seven percent died with a patent covered and 83% with an uncovered stent (n.s.). Two early complications occurred (sepsis; pancreatitis), both with covered stents. CONCLUSION There is no clinical difference between covered and uncovered biliary Hanaro SEMS. Both types are easily inserted with low complication rate and have long-term patency.
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Affiliation(s)
- Kjell-Arne Ung
- Deparment of Internal Medicine, Gastroenterology Section, Kärnsjukhuset, Skövde, Sweden.
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Hansson J, Körner U, Ludwigs K, Johnsson E, Jönsson C, Lundholm K. Antibiotics as first-line therapy for acute appendicitis: evidence for a change in clinical practice. World J Surg 2012; 36:2028-36. [PMID: 22569747 DOI: 10.1007/s00268-012-1641-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Randomized studies have indicated that acute appendicitis may be treated by antibiotics without the need of surgery. However, concerns have been raised about selection bias of patients in such studies. Therefore, the present study was aimed to validate previous findings in randomized studies by a full-scale population-based application. METHODS All patients with acute appendicitis at Sahlgrenska University Hospital (May 2009 and February 2010) were offered intravenous piperacillin plus tazobactam according to our previous experience, followed by 9 days out-hospital oral ciprofloxacin plus metronidazole. Endpoints were treatment efficacy and complications. Efficient antibiotic treatment was defined as recovery without the need of surgery beyond 1 year of follow-up. RESULTS A total of 558 consecutive patients were hospitalized and treated due to acute appendicitis. Seventy-nine percent (n = 442) received antibiotics as first-line therapy and 20 % (n = 111) had primary surgery as the second-line therapy. Seventy-seven percent of patients on primary antibiotics recovered while 23 % (n = 100) had subsequent appendectomy due to failed initial treatment on antibiotics. Thirty-eight patients (11 %) of the 342 had experienced recurrent appendicitis at 1-year follow-up. Primary antibiotic treatment had fewer complications compared to primary surgery. CONCLUSIONS This population-based study confirms previous results of randomized studies. Antibiotic treatment can be offered as the first-line therapy to a majority of unselected patients with acute appendicitis without medical drawbacks other than the unknown risk for long-term relapse, which must be weighed against the unpredicted but well-known risk for serious major complications following surgical intervention.
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Affiliation(s)
- Jeanette Hansson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, 416 85 Goteborg, Sweden
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Hesser H, Gustafsson T, Lundén C, Henrikson O, Fattahi K, Johnsson E, Westin VZ, Carlbring P, Mäki-Torkko E, Kaldo V, Andersson G. A randomized controlled trial of internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus. J Consult Clin Psychol 2012; 80:649-61. [DOI: 10.1037/a0027021] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bergquist H, Johnsson E, Nyman J, Rylander H, Hammerlid E, Friesland S, Ejnell H, Lundell L, Ruth M. Combined stent insertion and single high-dose brachytherapy in patients with advanced esophageal cancer--results of a prospective safety study. Dis Esophagus 2012; 25:410-5. [PMID: 21899654 DOI: 10.1111/j.1442-2050.2011.01248.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Previous randomized studies comparing the two commonly used palliative treatments for incurable esophageal cancer, i.e. stent insertion and intraluminal brachytherapy, have revealed the pros and cons of each therapy. While stent treatment offers a more prompt effect, brachytherapy results in more long-lasting relief of dysphagia and a better health-related quality of life (HRQL) in those living longer. This prospective pilot study aimed to explore the feasibility and safety of combining these two regimes and incorporating a single high dose of internal radiation. Patients with newly diagnosed, incurable cancer of the esophagus and dysphagia were eligible for inclusion, and stent insertion followed by a single dose (12 Gy) of brachytherapy was performed as a two-stage procedure. Clinical parameters including HRQL and adverse events were registered at inclusion, and 1, 2, 3, 6, and 12 months later. Twelve patients (nine males) with a median age of 73 years (range 54-85) were included. Stent insertion followed by a single dose of brachytherapy was successfully performed in all but one patient who was treated with stent only. Relief of dysphagia was achieved in the majority of cases (10/11, P < 0.05), but HRQL did not improve except for dysphagia-related items. Only minor adverse events, including chest pain, reflux, and restenosis, were reported. The median survival time after inclusion was 6.6 months. Our conclusion is that the combination of stent insertion and single high-dose brachytherapy seems to be a feasible and safe palliative regime in patients with advanced esophageal cancer. Randomized trials comparing the efficacy of this strategy to stent insertion or brachytherapy alone are warranted.
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Affiliation(s)
- H Bergquist
- Department of ENT/H&N Surgery Surgery Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Johansson R, Sjöberg E, Sjögren M, Johnsson E, Carlbring P, Andersson T, Rousseau A, Andersson G. Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: a randomized controlled trial. PLoS One 2012; 7:e36905. [PMID: 22615841 PMCID: PMC3352859 DOI: 10.1371/journal.pone.0036905] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 04/05/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Major depression can be treated by means of cognitive behavior therapy, delivered via the Internet as guided self-help. Individually tailored guided self-help treatments have shown promising results in the treatment of anxiety disorders. This randomized controlled trial tested the efficacy of an Internet-based individually tailored guided self-help treatment which specifically targeted depression with comorbid symptoms. The treatment was compared both to standardized (non-tailored) Internet-based treatment and to an active control group in the form of a monitored online discussion group. Both guided self-help treatments were based on cognitive behavior therapy and lasted for 10 weeks. The discussion group consisted of weekly discussion themes related to depression and the treatment of depression. METHODS A total of 121 participants with diagnosed major depressive disorder and with a range of comorbid symptoms were randomized to three groups. The tailored treatment consisted of a prescribed set of modules targeting depression as well as comorbid problems. The standardized treatment was a previously tested guided self-help program for depression. RESULTS From pre-treatment to post-treatment, both treatment groups improved on measures of depression, anxiety and quality of life. The results were maintained at a 6-month follow-up. Subgroup analyses showed that the tailored treatment was more effective than the standardized treatment among participants with higher levels of depression at baseline and more comorbidity, both in terms of reduction of depressive symptoms and on recovery rates. In the subgroup with lower baseline scores of depression, few differences were seen between treatments and the discussion group. CONCLUSIONS This study shows that tailored Internet-based treatment for depression is effective and that addressing comorbidity by tailoring may be one way of making guided self-help treatments more effective than standardized approaches in the treatment of more severe depression. TRIAL REGISTRATION Clinicaltrials.gov NCT01181583.
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Affiliation(s)
- Robert Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
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Costamagna G, Tringali A, Spicak J, Mutignani M, Shaw J, Roy A, Johnsson E, De Moura EGH, Cheng S, Ponchon T, Bittinger M, Messmann H, Neuhaus H, Schumacher B, Laugier R, Saarnio J, Ariqueta FI. Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry. Dig Liver Dis 2012; 44:37-43. [PMID: 21937292 DOI: 10.1016/j.dld.2011.08.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 07/30/2011] [Accepted: 08/16/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Duodenal stenting has become a broadly accepted first line of treatment for patients with advanced malignant gastroduodenal obstruction as these patients are difficult to treat and are poor surgical candidates. AIMS To document duodenal stent performance for palliative management of malignant gastroduodenal obstruction. METHODS Multicentre, single arm, prospective registry documenting peroral endoscopic duodenal stenting procedures in 202 patients. RESULTS Technical success achieved in 98% (CI, 95%, 99%) of stent placements. Increase of Gastric Outlet Obstruction Score by at least 1 point compared to baseline was achieved in 91% (CI, 86%, 95%) of patients persisting for a median of 184 days (CI, 109, 266). By day 5 (CI, 4, 6) after stent placement, 50% of patients experienced a score increase of at least 1 point. Improvement from 14% of patients at baseline tolerating soft solids or low residue/normal diet to 84% at 15 days, 86% at 30 days, 81% at 90 days, 79% at 180 days, and 70% at 270 days. Complications included stent ingrowth and/or overgrowth (12.4%), transient periprocedural symptoms (3%), bleeding (3%), stent migration (1.5%), and perforation (0.5%). CONCLUSIONS Safety and effectiveness of duodenal stenting for palliation of malignant gastroduodenal obstruction was confirmed in the largest international prospective series to date.
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Blomberg J, Wenger U, Lagergren J, Arnelo U, Agustsson T, Johnsson E, Toth E, Lagergren P. Antireflux stent versus conventional stent in the palliation of distal esophageal cancer. A randomized, multicenter clinical trial. Scand J Gastroenterol 2010; 45:208-16. [PMID: 19968614 DOI: 10.3109/00365520903443860] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Patients with incurable distal esophageal or cardia cancer often need palliative stenting to relieve their dysphagia but stents passing through the cardia can cause reflux and aspiration, leading to a reduced health-related quality of life (HRQL). This study addressed the hypothesis that antireflux stenting improves HRQL compared to conventional stenting. MATERIAL AND METHODS In a single-blind, multicenter, randomized trial in patients with inoperable esophageal or cardia cancer requiring palliative stenting passing through the cardia, 65 patients were stented. Patients received either an antireflux stent (Esophageal Z-Stent with Dua antireflux valve; n = 28) or a conventional stent (Esophageal Z-stent, Ultraflex or Wallstent; n = 37). Validated questionnaires (European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-OES18) were used to collect information on HRQL at baseline and 1 and 3 months after stenting. Main outcome measurements were differences in HRQL scores between baseline and 1 and 3 months after stenting. RESULTS Scores for most aspects of HRQL were similar in the two groups, and no statistically significant differences were found. Some general symptoms however showed clinically relevant improvement in the antireflux stent group, while esophageal-specific symptoms such as dysphagia seemed clinically better, and symptoms of reflux were clinically reduced in the conventional stent group but not in the antireflux stent group. CONCLUSION This study, although limited in size, provided no obvious support for using the antireflux stent in preference to the conventional stent in the palliation of distal esophageal or cardia cancer from an HRQL perspective.
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Affiliation(s)
- John Blomberg
- Upper GastroIntestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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