Once-weekly insulins: a promising approach to reduce the treatment burden in people with diabetes

Despite the availability of new classes of glucose-lowering drugs that improve glycaemic levels and minimise long-term complications, at least 20-25% of people with type 2 diabetes require insulin therapy. Moreover, a substantial proportion of these individuals do not achieve adequate metabolic control following insulin initiation. This is due to several factors: therapeutic inertia, fear of hypoglycaemia and/or weight gain, poor communication, complexity of insulin titration, and the number of injections needed, with the associated reduced adherence to insulin therapy. Once-weekly insulins provide a unique opportunity to simplify basal insulin therapy and to allow good glycaemic control with a low risk of hypoglycaemia. Several approaches to developing a stable and effective once-weekly insulin have been proposed, but, to date, insulin icodec and basal insulin Fc (insulin efsitora alfa) are the only two formulations for which clinical studies have been reported. The results of Phase I and II studies emphasise both efficacy (in term of glucose levels) and potential risks and adverse events. Phase III studies involving insulin icodec are reassuring regarding the risk of hypoglycaemia compared with daily basal insulin analogues. Despite some concerns raised in ongoing clinical trials, the available data suggest that weekly insulins may also be an option for individuals with type 1 diabetes, especially when adherence is suboptimal. For the first time there is an opportunity to make an important breakthrough in basal insulin therapy, particularly in people with type 2 diabetes, and to improve not only the quality of life of people with diabetes, but also the practice of diabetologists.

Twice or thrice weekly levothyroxine provides similar rates of adherence and post-Ramadan euthyroidism compared to daily levothyroxine during Ramadan fasting

BACKGROUND

Having to take levothyroxine (L-T4) on a daily basis, on an empty stomach is burdensome and may impair adherence, especially during Ramadan fasting. A long half-life and autoregulation of thyroid hormone levels allows for twice or thrice weekly administration of L-T4. This study aims to establish twice or thrice weekly L-T4 dosing as a convenient and effective practice during Ramadan fasting.

METHODS

The study included 2 groups; twice or thrice weekly (TTW) group included patients assigned to take L-T4 twice or thrice a week, and standard daily dosing (SDT) group included patients assigned to take L-T4 daily. Patients freely chose between three L-T4 regimens: before Iftar, before Suhor, or before the next fast. Thyroid status was assessed before and within 6 weeks after Ramadan. Only euthyroid patients were included.

RESULTS

TTW group included 57 patients, while SDT group included 91 patients. Pre-Ramadan TSH in TTW group (1.80 ± 0.88 µIU/L) was higher compared to SDT group (1.39 ± 0.72 µIU/L) [P = 0.003]. Similar adherence rates were observed in both groups, 96.5% in TTW group versus 89% in SDT group, [P = 0.13]. similar rates of post-Ramadan euthyroidism were also found in both groups, 91.2% in TTW group versus 94.5% in SDT group, [P = 0.509]. TTW group preferred regimen 1 (64.9%) significantly more than SDT group (35.2%) [P = 0.001].

CONCLUSION

Twice or thrice weekly levothyroxine results in similarly high rates of adherence (96.5%) and post-Ramadan euthyroidism (91.2%) compared to daily levothyroxine during Ramadan fasting.

Association of weekly or biweekly use of 50.000 IU vitamin D3 with hypervitaminosis D

Since the beginning of COVID-19 pandemic, many Iranian people are taking 50.000 IU of vitamin D3 on the weekly or biweekly bases in order to enhance their immune system function. This cross-sectional study was conducted on the patients of endocrinology clinic to compare 25(OH)D levels of weekly or biweekly consumption with the monthly users of vitamin D3 50,000 IU. The level above 100ng/ml of 25(OH)D was defined as hypervitaminosis D. Totally, 211 patients (108 and 103 patients in monthly and weekly/biweekly groups, respectively) were studied. In the subgroups of weekly and biweekly users, the rates of hypervitaminosis were 18.9% and 4.5%, respectively. In contrast, only 0.9% of monthly users had hypervitaminosis D. The highest vitamin D value of 185 ng/ml was detected in a patient who consumed 50,000 IU vitamin D3 weekly for 6 years. No hypercalcemia was detected in the patients with hypervitaminosis D.

Weekly Carboplatin and Paclitaxel: A Retrospective Comparison with the Three-Weekly Schedule in First-Line Treatment of Ovarian Cancer

BACKGROUND

Conventional first-line combination therapy for ovarian cancer comprises 6 cycles of adjuvant or neoadjuvant carboplatin (AUC5-6) with paclitaxel (175 mg/m² ) every 3 weeks (PC-3W). Weekly scheduling of paclitaxel may maximize its antiangiogenic effect and reduce adverse effects. We compared the efficacy and safety of PC-3W with a modified protocol of weekly paclitaxel 80 mg/m² and weekly carboplatin AUC2 administered on days 1, 8, and 15 in a 28-day cycle (i.e., with 1 week off-treatment [PC-W]).

MATERIALS AND METHODS

Medical records of consecutive patients treated between 2000 and 2018 were reviewed; 707 patients were analyzed for demographic and clinical characteristics, effectiveness and toxicity.

RESULTS

PC-3W was administered to 402 patients (median age, 60.5 years) and PC-W to 305 patients (median age, 62.5 years). Most patients (91.4%) were diagnosed at stage III-IV. Notwithstanding a higher proportion of residual disease and older patients in the PC-W group, median progression-free survival was 21.4 months and 13.2 months for PC-W and PC-3W, respectively; median overall survival was 75.2 and 54.0 months for PC-W and PC-3W, respectively. Cox proportional hazards model indicated improved survival for patients treated with PC-W (hazard ratio, 0.54). Similar results were observed for older patients diagnosed at ≥75 years. PC-W demonstrated a better safety profile, with lower incidence of neuropathy, neutropenia, and alopecia.

CONCLUSION

PC-W is as active and better tolerated than the standard PC-3W regimen. PC-W may serve as an alternative option for elderly or frail patients.

IMPLICATIONS FOR PRACTICE

Weekly scheduling of paclitaxel 80 mg/m² and carboplatin AUC2, administered on days 1, 8, and 15 in a 28-day cycle (PC-W) for first-line therapy for advanced ovarian cancer, is as active and better tolerated than the standard regimen of carboplatin and paclitaxel (175 mg/m² ) every 3 weeks (PC-3W). It is possible that the weekly holiday on day 21 in the PC-W regimen may ensure better completion rates (which may result in treatment delays for toxicity in PC-3W). The results of this retrospective analysis highlight the weekly regimen as a valid treatment option, especially for elderly patients and those with significant comorbidities.

Factors affecting continuation of weekly teriparatide administration in rural areas

INTRODUCTION

Although teriparatide plays an important role in the treatment of patients with severe osteoporosis, it is meaningless if patients cannot continue. There have been few reports of studies evaluating factors affecting the continuation rate of weekly teriparatide; moreover, no study has investigated the relationship between the distance to travel to the hospital and continuation rate. Therefore, we examined the continuation rate of weekly teriparatide and factors that affect this rate.

MATERIALS AND METHODS

This retrospective study included 73 patients who were administered weekly teriparatide in a rural hospital. Patient information, including the age, sex, distance between the hospital and home, family structure, place of introduction, reason for the start of teriparatide administration, past osteoporosis treatment and fracture, side effects, and period of teriparatide continuation, was collected. We examined factors influencing weekly teriparatide continuation.

RESULTS

The continuation rate of weekly teriparatide was 22.7%. The Kaplan-Meier curves for the two groups regarding the place of introduction and side effects showed significant differences (P = 0.0158 and P = 0.0309, respectively). In the multivariate analyses to investigate factors associated with teriparatide continuation, an older age, starting administration while hospitalized, and side effects were identified as risk factors negatively influencing continuation (P = 0.0280, P = 0.0222, and P = 0.0095, respectively). On the other hand, the number of family members and distance between our hospital and home did not affect teriparatide continuation.

CONCLUSION

An older age, starting administration while hospitalized, and side effects were identified as risk factors negatively influencing teriparatide continuation.

A comparative effectiveness pilot study of teriparatide for medication-related osteonecrosis of the jaw: daily versus weekly administration

We studied the effectiveness of teriparatide (TPTD) for treating medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis and examined differences in the clinical outcomes following daily versus weekly TPTD. The outcomes were significantly improved in the entire patient series and the daily group.

PURPOSE

Teriparatide (TPTD) treatment for Stage II-III medication-related osteonecrosis of the jaw (MRONJ) in osteoporotic patients has yielded promising results in uncontrolled studies. The daily administration and the weekly administration of TPTD have been reported to improve outcomes in MRONJ. Herein, we sought to identify differences in the clinical outcomes of MRONJ patients treated with daily TPTD versus weekly TPTD.

METHODS

We enrolled 13 patients and randomly assigned them to receive either of two treatments: 1×/week 56.5-μg TPTD injection for 6 months (weekly group; n = 6 patients after 1 dropout), or 20-μg TPTD injection daily for 6 months (daily group; n = 6 patients). Patients in both groups received conventional therapy plus intensive antibiotic therapy as necessary. We compared the changes in the patients' clinical stage of MRONJ, bone metabolism, percentage of bone formation, and bone turnover markers between the weekly and daily groups.

RESULTS

TPTD treatment with MRONJ led to partial remission or complete remission in 5 daily-group patients and 3 weekly-group patients. The MRONJ stage was significantly improved from baseline to 6 months of treatment in the entire series of 12 patients (p = 0.008); the weekly group did not show significant improvement, but the daily group did (p = 0.01).

CONCLUSIONS

This study provides the first comparison of clinical outcomes between MRONJ patients who received daily or weekly TPTD injections. Six months of treatment with TPTD realized a significant improvement of MRONJ stage in both the entire patient series and the daily group.

The effects of teriparatide on acceleration of bone healing following atypical femoral fracture: comparison between daily and weekly administration

We compared the effectiveness of promoting bone healing between two teriparatide preparations for atypical femoral fracture (AFF). A total of 45 AFFs were included in this study, and we compared the duration of bone union. Teriparatide administered by daily injection enhanced bone union more than weekly administration in complete AFFs.

INTRODUCTION

The efficacy of teriparatide for atypical femoral fracture (AFF) has been recently reported. Although two different teriparatide preparations can be used to treat osteoporosis in Japan, daily or weekly injection, all previous reports on the effectiveness of teriparatide for AFF only examined daily injection formulations. Therefore, we compared the promotion of bone healing between the two teriparatide preparations for AFF.

METHODS

A total of 45 consecutive AFFs in 43 Japanese patients were included in this study. They received either a daily 20-μg teriparatide injection (daily group; n = 32) or a once-a-week 56.5-μg teriparatide injection (weekly group; n = 13). We compared the clinical background and duration of bone union between these two groups.

RESULTS

When all patents were included, the fracture healing time was not significantly different between the two groups. Only patients with complete AFFs had significantly fewer daily bisphosphonate or denosumab injections than the weekly group (P < 0.05). The fracture healing time in the daily group (6.1 ± 4.1 months) was significantly shorter than that in the weekly group (10.1 ± 4.2 months) (P < 0.05). Even if the influence of bisphosphonate or denosumab usage was excluded, a similar significant difference was observed in the fracture healing time (P < 0.05). There was no significant difference between the two groups among patients with incomplete AFFs.

CONCLUSIONS

Daily teriparatide injections enhance bone union more than weekly injections in complete AFF patients.

The weekly associations between climatic factors and Plasmodium vivax and Plasmodium falciparum malaria in China, 2005-2014

Background

Meteorological factors play a crucial role in malaria transmission, but limited evidence is available from China. This study aimed to estimate the weekly associations between meteorological factors and Plasmodium vivax and Plasmodium falciparum malaria in China.

Methods

The Distributed Lag Non-Linear Model was used to examine non-linearity and delayed effects of average temperature, rainfall, relative humidity, sunshine hours, wind speed and atmospheric pressure on malaria.

Results

Average temperature was associated with P. vivax and P. falciparum cases over long ranges of lags. The effect was more immediate on P. vivax (0-6 weeks) than on P. falciparum (1-9 weeks). Relative humidity was associated with P. vivax and P. falciparum over 8-10 weeks and 5-8 weeks lag, respectively. A significant effect of wind speed on P. vivax was observed at 0-2 weeks lag, but no association was found with P. falciparum. Rainfall had a decreasing effect on P. vivax, but no association was found with P. falciparum. Sunshine hours were negatively associated with P. falciparum, but the association was unclear for P. vixax. However, the effects of atmospheric pressure on both malaria types were not significant at any lag.

Conclusions

Our study highlights a substantial effect of weekly climatic factors on P. vivax and P. falciparum malaria transmission in China, with different lags. This provides an evidence base for health authorities in developing a malaria early-warning system.

Dose-dense weekly chemotherapy in advanced ovarian cancer: An updated meta-analysis of randomized controlled trials

OBJECTIVE

The use of dose-dense weekly chemotherapy in the management of advanced ovarian cancer (OC) remains controversial. The aim of this meta-analysis was to evaluate the efficacy of dose-dense regimen to improve clinical outcomes in OC patients with the inclusion of new trials.

METHODS

For this updated meta-analysis, PubMed Medline and Scopus databases and meeting proceedings were searched for eligible studies with the limitation of randomized controlled trials, comparing dose-dense chemotherapy versus standard treatment. Trials were grouped in two types of dose-dense chemotherapy: weekly dose-dense (both paclitaxel and carboplatin weekly administration) and semi-weekly dose-dense (weekly paclitaxel and three weekly carboplatin administration). Data were extracted independently and were analyzed using RevMan statistical software version 5.3 (http://www.cochrane.org). Primary end-point was progression-free survival (PFS).

RESULTS

Four randomized controlled trials comprising 3698 patients were identified as eligible. Dose-dense chemotherapy had not a significant benefit on PFS (HR 0.92, 95% CI 0.81-1.04, p = 0.20). When the analysis was restricted to both weekly and semi-weekly dose-dense data, a no significant interaction between dose-dense and standard regimen was confirmed (HR 1.01, 95% CI 0.93-1.10 and HR 0.82, 95% CI 0.63-1.08, respectively).

CONCLUSIONS

In the absence of PFS superiority of dose-dense schedule, three weekly schedule should remain the standard of care for advanced OC.

Alcohol consumption and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: Baseline data from the Dogo Study

Diabetes mellitus and heavy alcohol consumption are both associated with vascular disease, a category that includes erectile dysfunction (ED). However, the association between alcohol consumption and ED among patients with type 2 diabetes mellitus remains unclear. The aim of the present multicenter cross-sectional study was to investigate the relationship between drinking frequency, weekly alcohol consumption, daily alcohol consumption, and ED among Japanese patients with type 2 diabetes mellitus. Study subjects were 340 male Japanese patients with type 2 diabetes mellitus, aged 19-70 years, who had undergone blood tests at our institutions. A self-administered questionnaire was used to collect information on the variables under study. ED was defined as present when a subject had a Sexual Health Inventory for Men score <8. Adjustment was made for age, body mass index, duration of type 2 diabetes mellitus, current smoking, hypertension, dyslipidemia, glycated hemoglobin, stroke, coronary artery disease, diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. The prevalence of ED was 43.2% (147/340). The frequency of alcohol consumption and weekly alcohol consumption were independently inversely associated with ED (p for trend p = 0.001 and 0.004, respectively). The relationship between daily alcohol consumption and ED was an inverted J-shaped curve: alcohol consumption of less than 60 g, but not 60 g or more, per day was independently related to a lower prevalence of ED (p for quadratic trend = 0.003). In Japanese men with type 2 diabetes mellitus, an inverted J-shaped relationship between daily alcohol consumption and ED was observed, while frequency of alcohol consumption and weekly alcohol consumption were significantly inversely associated with ED.

Dose-Dense Chemotherapy in Metastatic Breast Cancer: Shortening the Time Interval for a Better Therapeutic Index

Despite the advancement of targeted therapies in metastatic breast cancer, chemotherapy is still of pivotal importance. The concept of dose density is known to increase the efficacy of chemotherapy. In metastatic disease, preservation of the quality of life is equally important. Because of this, weekly regimens are a cornerstone in metastatic disease. Taxanes like paclitaxel or nab-paclitaxel as well as antracyclines are often used in palliative treatment. Further advances to increase dose density have led to the concept of daily metronomic schedules with oral chemotherapeutic drugs like cyclophosphamide, capecitabine, or vinorelbine. Metronomic chemotherapy affects tumor angiogenesis and also weakens immunosuppressive regulatory T cells, promoting better control of tumor progression. Weekly or daily dose-dense regimens are a reasonable compromise between efficacy and toxicity to improve the therapeutic index. This is most important for the treatment of chronic disease where palliation and preservation of quality of life are vital.

Weekly carboplatin in combination with weekly paclitaxel in the treatment of metastatic non-small cell lung cancer: a single center 10-year experience

PURPOSE

The primary objective of this retrospective analysis is to assess efficacy and toxicity of a chemotherapeutic regimen using weekly carboplatin in combination with weekly paclitaxel as first-line therapy for advanced/metastatic non-small cell lung cancer (NSCLC).

METHODS

All patients with stage IIIB/IV NSCLC treated with weekly carboplatin AUC (area under the curve) 3 days 1, 8, 15, q4w in combination with weekly paclitaxel 75 mg/m(2) days 1, 8, 15, q4w as first-line therapy at the Kantonsspital Graubuenden between August 2004 and May 2014 were retrospectively analyzed by medical record review.

RESULTS

A total of 90 patients were treated. Median age was 66 years (range 39-88). A total of 229 chemotherapy cycles were administered. Hematological and non-hematological toxicity were acceptable allowing for a median relative dose intensity for all planned treatment cycles of 76 %. Overall response rate was 34 %. Median overall and progression free survival was 6.3 (95 % CI, 4.9-8.7) and 3.4 (95 % CI, 2.3-5.1) months, respectively. Patients with an ECOG performance score (PS) of 0 or 1 had a significantly better OS compared to patients with a PS of ≥2. No statistically significant difference was observed in patients younger or older than 70 years of age.

CONCLUSIONS

Weekly carboplatin in combination with weekly paclitaxel results in good response rates and acceptable toxicity in patients with advanced and metastatic NSCLC including patients with poor risk features (brain metastases, older age, and impaired PS). Nonetheless, selecting the right patient for a platinum-based combination treatment remains an important task in clinical practice.

Long-term results of a randomised phase III trial of weekly versus three-weekly paclitaxel/platinum induction therapy followed by standard or extended three-weekly paclitaxel/platinum in European patients with advanced epithelial ovarian cancer

BACKGROUND

Weekly paclitaxel/carboplatin might improve survival in platinum-resistant epithelial ovarian cancer (EOC). We compared efficacy of first-line weekly to three-weekly paclitaxel/cis- or carboplatin (PCw and PC3w) induction therapy, followed by either three or six PC3w cycles.

PATIENTS AND METHODS

In this multicentre, randomised phase III trial with 2×2 design, patients with FIGO stage IIb-IV EOC were randomised to six cycles PCw (paclitaxel 90mg/m(2), cisplatin 70mg/m(2) or carboplatin AUC 4) or three cycles PC3w (paclitaxel 175mg/m(2), cisplatin 75mg/m(2) or carboplatin AUC 6), followed by either three or six cycles PC3w. Primary endpoints were progression free survival (PFS) and overall survival (OS). Secondary endpoints were response rate (RR) and toxicity.

RESULTS

Of 267 eligible patients, 133 received PCw and 134 PC3w. The first 105 patients received cisplatin, after protocol amendment the subsequent 162 patients received carboplatin. Weekly cisplatin was less well tolerated than weekly carboplatin. All PC3w cycles were well tolerated. At the end of all treatments, RR was 90.8% with no differences between the treatment arms. After a follow-up of median 10.3years (range 7.1-14.8), median PFS was 18.5 (95% confidence interval (CI) 15.9-21.0) months for PCw and 16.4 (95% CI 13.5-19.2) months for PC3w (p=0.78). Median OS was 44.8 (95% CI 33.1-56.5) months for PCw and 41.1 (95% CI 34.4-47.7) months for PC3w (p=0.98).

CONCLUSIONS

There was no benefit in terms of OS, PFS or RR for a weekly regimen nor for extended chemotherapy as first-line treatment for EOC in European patients.

Weekly gemcitabine and docetaxel in refractory soft tissue sarcoma: a retrospective analysis

PURPOSE

The combination of gemcitabine and docetaxel (GD) is used to effectively treat patients with soft tissue sarcoma (STS). It is widely considered that the conventional doses used are too high for long term use and many patients must discontinue GD treatment due to its toxicity. Therefore, to determine the appropriate dose meeting acceptable efficacy results, while minimizing toxic side effects, we treated patients with a weekly infusion of GD (weekly GD).

MATERIALS AND METHODS

A total of 22 patients presenting a variety of STSs were treated at Yonsei Cancer Center. All patients had metastatic or recurrent cancer and had previously received doxorubicin and ifosfamide combination chemotherapy. In all cases, gemcitabine (1,000 mg/m(2)) and docetaxel (35 mg/m(2)) were administered intravenously on days 1 and 8 of a 21-day cycle. We retrospectively reviewed the medical records of these patients.

RESULTS

The response rate was 4.5%, with one patient diagnosed with leiomyosarcoma having a partial response, and the disease control rate was 40.9%. The median progression-free survival (PFS) duration was 2.7 months and the PFS was correlated with the treatment response to a weekly GD. The median overall survival (OS) duration was 7.8 months and the OS was correlated with histology. There was no significant difference in OS between patients who received weekly GD as a 2nd line chemotherapy and those who received 3rd line or more. Treatment was generally well tolerated.

CONCLUSION

Weekly GD was well tolerated and showed moderate efficacy, indicating that this could be a reasonable option as a salvage treatment for metastatic STS.