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Reinders MK et al. – Treatment–failure gout (TFG) affects approximately 50,000 patients or about 1% of the overall population of patients with gout in the United States of America. The severity of TFG is manifested by frequent acute attacks of disabling arthritis, chronic deforming joint disease, destructive masses of urate crystals (tophi), progressive physical disability, and poor health–related quality of life. Pegloticase, a novel PEGylated urate oxidase (uricase) enzyme, has been resubmitted for US Food and Drug Administration approval. In a 6–month, placebo–controlled clinical trial, 8 mg of pegloticase for every 2 weeks induced a lytic decrease of serum urate concentrations, leading to dissolution of tophi in 40% of patients at final visit. Although long–term data are awaited, an anti–inflammatory strategy, eg, based on glucocorticosteroids, is needed to prevent pegloticase antibody formation leading to IRs and diminished or shortened efficacy, and might also prevent gout flares. According to the current clinical data, pegloticase might have an important role as a (bridging) treatment in sUr–responsive patients for tophi clearance in severe chronic refractory gout.



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Although the efficacy of clopidogrel plus aspirin for treating acute coronary syndromes (ACS) is well established, considerable uncertainty remains about dosing. Investigators for the manufacturer-sponsored CURRENT–OASIS 7 trial employed a 2×2 factorial design to examine the effects of doubling the standard loading dose and first-week maintenance dose of clopidogrel (from 300 to 600 mg and from 75 to 150 mg, respectively), and compared the effects of high-dose (300–325 mg/day) versus low-dose (75–100 mg/day) aspirin. All 25,086 patients (mean age, 61; 27% women) had ACS and were scheduled for coronary angiography with percutaneous coronary intervention (PCI) as indicated within 72 hours after randomization, and all received a loading aspirin dose of >300 mg. The primary 30-day outcome was a composite of cardiovascular death, myocardial infarction (MI), and stroke. The study had 80% power to detect a 16% reduction in risk.





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Raymond A. Lorenz, Pharm.D.; Cherry W. Jackson, Pharm.D.; FASHP, Marianne Saitz, D.O., M.P.H.

Posted: 11/08/2010; Pharmacotherapy. 2010;30(9):942-951. © 2010 Pharmacotherapy Publication



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Therapeutic Goals in Major Depressive Disorder (MDD)
In a survey published in JAMA in 2003, <22% of respondents who received MDD treatment in the past 12 months considered their treatment adequate.
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Abstract and Introduction


Generalized anxiety disorder (GAD) is a common, chronic mental illness that has a significant burden on the patient's quality of life. Treatment for GAD routinely consists of monotherapy with a proven anxiolytic such as an antidepressant or benzodiazepine, but many patients do not respond fully to these drugs, and additional treatment may be needed. Therefore, we reviewed the safety and efficacy of atypical antipsychotics as adjunct therapy to standard GAD pharmacotherapy in patients deemed treatment resistant. We performed a literature search of the MEDLINE database for English-language articles published from January 1966–May 2009. Identified articles were evaluated, and only open-label trials and randomized controlled trials (RCTs) were included in the review. Relevant references from the articles were also evaluated. Only a few reports of large-scale RCTs that assessed an atypical antipsychotic for treatment-resistant GAD have been published. Articles were found for five of the eight currently available atypical antipsychotics, but not for asenapine, clozapine, and paliperidone. Several open-label trials and smaller RCTs support the need for further evaluation of aripiprazole and quetiapine for treatment-refractory GAD, although one quetiapine trial demonstrated negative results. There is disparate data for risperidone, with one open-label trial and one small RCT showing positive results and one large RCT showing negative results. One open-label trial of ziprasidone and one RCT of olanzapine both showed beneficial effects of the drugs. Adverse effects were specific to each agent, with weight gain being the most common, but many studies did not monitor systematically for lipid level, weight, or glucose level changes. Although data suggest efficacy regarding the use of atypical antipsychotics for augmentation of treatment-refractory GAD, more rigorous studies (large, double-blind, placebo-controlled trials) on the safety and efficacy of these agents are needed in order to recommend their use in patients with GAD.



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The FDA approved a dose of dabigatran of 150 mg twice a day for use in patients with nonvalvular AF. In the pivotal RE-LY (Randomized Evaluation of Long-term Anticoagulant Therapy) study, this dose was found to be superior to warfarin for the prevention of stroke and systemic emboli



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The researchers found a 22% increased risk for hemorrhagic stroke and a 10% decreased risk for ischemic stroke with vitamin E supplementation, although the absolute effects are small



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November 5, 2010 (Hyattsville, Maryland) — New data indicate there has finally been progress in improving awareness, treatment, and control of hypertension in the US, although much work still remains to be done [1].



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November 11, 2010 — Postmenopausal women who use hormone replacement therapy face a 29% increased risk of ovarian cancer, according to a study .

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