Clinical therapeutics最新文献

{"title":"Combination of High-Dose Daptomycin and Ceftriaxone for Cardiac Implantable Electronic Device Infections: A 10-Year Experience","authors":"Giacomo Ponta ,&nbsp;Martina Ranzenigo ,&nbsp;Alessandra Marzi ,&nbsp;Chiara Oltolini ,&nbsp;Chiara Tassan Din ,&nbsp;Caterina Uberti-Foppa ,&nbsp;Vincenzo Spagnuolo ,&nbsp;Patrizio Mazzone ,&nbsp;Paolo Della Bella ,&nbsp;Paolo Scarpellini ,&nbsp;Antonella Castagna ,&nbsp;Marco Ripa","doi":"10.1016/j.clinthera.2024.07.012","DOIUrl":"10.1016/j.clinthera.2024.07.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Cardiac implantable electronic device (CIED) infections are increasingly common. Gram-positive bacteria such as coagulase negative staphylococci and <em>Staphylococcus aureus</em> are the most commonly involved pathogens. The aim of this study was to describe the characteristics and outcome of patients with CIED infections who underwent device removal and were empirically treated with high dose (8–12 mg/kg daily) daptomycin (DAP) in combination with ceftriaxone (CRO).</div></div><div><h3>Methods</h3><div>Retrospective, single center study including patients admitted at IRCCS San Raffaele Hospital (Milan, Italy), from June 2011 to June 2021, who underwent device removal for CIED infection and were empirically treated with DAP/CRO.</div></div><div><h3>Findings</h3><div>Overall, 147 patients were included in this study. Median duration of therapy was 16 days (IQR 14–26). Empirical treatment with DAP/CRO was confirmed as definitive treatment in 140 patients (95.2%). In 7 (4.8%) patients DAP/CRO were discontinued according to the definite microbiological isolates: Corynebacterium spp. (4), Pseudomonas aeruginosa (2), Enterobacter cloacae (1). Ten patients (6.8%) underwent treatment simplification to narrow-spectrum antibiotics. One patient (0.6%) interrupted DAP-CRO due to pancytopenia.</div><div>6-month follow-up was available for 123/147 patients (83.7%): 9 patients recurred with a CIED infection (7.3%), and 9 died (7.3%).</div></div><div><h3>Implications</h3><div>In our 10-year experience, high-dose DAP in combination with CRO represented a good option for empirical therapy of CIED infections. DAP-CRO combination was safe and effective, showing no significant drug-related adverse events and low rates of 6-month recurrence and mortality.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 10","pages":"Pages 819-821"},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Compatibility of Reduced Glutathione for Injection With 44 Intravenous Drugs During Simulated Y-site Administration","authors":"Rui Wu MS ,&nbsp;Gaochao Zhu BS ,&nbsp;Yinghui Ju MS ,&nbsp;Yue Zhu MS ,&nbsp;Menglin Wang MS ,&nbsp;Yangyu Zhao MS ,&nbsp;Sheng Liu BS","doi":"10.1016/j.clinthera.2024.08.002","DOIUrl":"10.1016/j.clinthera.2024.08.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Reduced glutathione (GSH) is extensively used in clinical therapeutics due to its antioxidative and cytoprotective properties. It is essential in the management of various chronic and acute conditions and serves as an adjunct therapy in oncology. Despite its widespread use, the physical compatibility of GSH with other intravenous drugs during Y-site administration has not been thoroughly investigated, posing risks such as reduced efficacy and adverse reactions. This study fills this critical gap by examining the physical compatibility of GSH with 44 commonly used intravenous drugs in simulated Y-site administration with 0.9% sodium chloride injection (NS) and 5% dextrose injection, aiming to enhance patient safety and clinical outcomes.</div></div><div><h3>Methods</h3><div>Simulated Y-site administration was conducted <em>in vitro</em> by mixing 24 mg/mL of GSH with equal volumes of 44 diluted intravenous drugs. Physical compatibility was assessed by observing visual changes, checking for the Tyndall effect, measuring turbidity, and monitoring pH levels at 0, 0.5, 1, 2, and 4 hours post-mixing. Physical compatibility was defined as the absence of color changes, gas evolution, particulate formation, and the Tyndall effect within 4 hours, with turbidity changes of less than 0.5 nephelometric turbidity units from baseline and pH variations of less than 10% from initial values.</div></div><div><h3>Findings</h3><div>GSH exhibited physical incompatibility with 11 of the 44 intravenous drugs evaluated, while it remained compatible with 33 drugs over 4 hours.</div></div><div><h3>Implications</h3><div>This study reveals that while GSH is physically compatible with the majority of tested intravenous drugs, incompatibilities with 11 drugs under simulated Y-site conditions necessitate rigorous compatibility testing prior to co-administration in clinical settings. These findings emphasize the importance of such testing to prevent potential treatment failures and adverse effects. Further research is needed to explore chemical stability and therapeutic efficacy in clinical settings, ensuring the safe and effective use of GSH in medical treatments.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 10","pages":"Pages 785-790"},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Potential Drug Interactions With Direct-Acting Antivirals for COVID-19 Among Hospitalized Patients","authors":"Essy Mozaffari PharmD, MPH, MBA ,&nbsp;Aastha Chandak PhD ,&nbsp;Andrew Ustianowski MD, PhD ,&nbsp;Christina G. Rivera PharmD, RPh ,&nbsp;Neera Ahuja MD, FACP ,&nbsp;Heng Jiang MPH ,&nbsp;Mark Berry PhD ,&nbsp;Jason F. Okulicz MD ,&nbsp;Alpesh N. Amin MD","doi":"10.1016/j.clinthera.2024.08.004","DOIUrl":"10.1016/j.clinthera.2024.08.004","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Clinicians consider polypharmacy, comorbidities, and other factors including the potential for drug-drug interactions (DDIs) when evaluating therapeutic options for specific clinical diagnoses. Contemporary treatment for coronavirus disease 2019 (COVID-19) includes direct-acting antivirals (DAAs). We sought to characterize patients’ characteristics, comorbidities, and medications received during their hospitalization for COVID-19 and quantify potential DDIs that clinicians consider in selecting appropriate DAAs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients hospitalized with a primary diagnosis of COVID-19 between May 2020 and December 2022 from the PINC AI Healthcare Database were identified. Medications administered during the hospitalization with the potential to cause DDIs with nirmatrelvir/ritonavir, remdesivir, or molnupiravir (per the Emergency Use Authorization factsheet or package insert) were assessed. For DDIs with nirmatrelvir/ritonavir, medications are categorized as “Contraindicated,” “Avoid Concomitant Use,” or “Other DDIs” (includes recommendation for dose modification or clinical and laboratory monitoring). For remdesivir, coadministration with chloroquine phosphate and hydroxychloroquine sulfate was not recommended. For molnupiravir, no drugs are listed as having potential DDIs. In a subset of patients, a multivariable logistic regression model was used to examine the association between documented patient/hospital characteristics and the likelihood of being “Contraindicated” to receive nirmatrelvir/ritonavir.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Of the 788,238 patients hospitalized for COVID-19 in 920 hospitals, 53% were ≥ 65 years old, and 31% had Charlson Comorbidity Index (CCI) ≥ 3. During the study period, about half of the patients received medications categorized as “Contraindicated” (11%) and/or “Avoid Concomitant Use” (41%) with nirmatrelvir/ritonavir. The frequency of administered drugs was higher in those aged ≥ 65 years (68%), CCI ≥ 3 (78%), with high-risk underlying conditions (55%). About 1% of patients received medications that were not recommended to be coadmistered with remdesivir. Among a subset of patients hospitalized for COVID-19 in 2022, those who were older, had higher CCI, high-risk underlying conditions, severe hepatic impairment, Medicare insurance, and hospitalized in larger hospitals were significantly more likely to be categorized as “Contraindicated” when considering nirmatrelvir/ritonavir as a therapeutic option to manage COVID-19.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Implications&lt;/h3&gt;&lt;div&gt;A significant proportion of patients hospitalized for COVID-19 receive medications for other conditions that have the potential to result in DDIs with DAAs; most predominantly with nirmatrelvir/ritonavir, a strong CYP3A enzyme inhibitor, fewer with remdesivir, and none with molnupiravir. Higher age and comorbidity burden were significantly associated with a higher likelihood of receiving medications tha","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 10","pages":"Pages 778-784"},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hard Work of Developing New Therapies for Pediatric Populations","authors":"Paul Beninger MD, MBA","doi":"10.1016/j.clinthera.2024.09.015","DOIUrl":"10.1016/j.clinthera.2024.09.015","url":null,"abstract":"","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 10","pages":"Pages 727-729"},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xolremdi—Mavorixafor","authors":"Paul Beninger MD, MBA","doi":"10.1016/j.clinthera.2024.09.007","DOIUrl":"10.1016/j.clinthera.2024.09.007","url":null,"abstract":"","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 10","pages":"Pages 822-823"},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Pain in Cirrhosis: Advice to Caregivers of Those with Rock Livers","authors":"Randolph E. Regal PharmD","doi":"10.1016/j.clinthera.2024.08.001","DOIUrl":"10.1016/j.clinthera.2024.08.001","url":null,"abstract":"<div><h3>Purpose</h3><div>When one considers the significant role of the liver in medication absorption and metabolism, clinicians must appreciate the important ramifications for medication dosing and monitoring in patients with cirrhosis. For many medications, dose adjustments may be necessary to minimize toxicities or avoid adverse effects from drug accumulation. Clinicians could be well served if they can understand in some detail how pharmacokinetic properties are altered in cirrhosis.</div></div><div><h3>Methods</h3><div>A PubMed search of the English medical literature starting with 1980 using keywords cirrhosis, pain management, and analgesics was performed, and additional papers were found using references from the first round of papers.</div></div><div><h3>Findings</h3><div>Patients with cirrhosis often have significant reductions in first-pass metabolism, altered volumes of distribution, and marked reductions in both renal and hepatic elimination of drugs. These factors may contribute to much higher levels of drug exposure compared to the general population. In terms of drug dosing, FDA labeling is often ambiguous and even incongruous with observed pharmacokinetic changes.</div></div><div><h3>Implications</h3><div>This article may provide guidance for clinicians to optimize pain management in people living with cirrhosis.</div></div><div><h3>Key Message</h3><div>Current FDA labeling for dosing analgesic drugs in patients with cirrhosis is either vague or not consistent with findings from newer pharmacokinetic research. With this review, we hope to provide insight and guidance to clinicians on how to dose-adjust medications commonly utilized in pain management in these patients.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 10","pages":"Pages 812-818"},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Predictive Potential of C-Peptide in Differentiating Type 1 Diabetes From Type 2 Diabetes in an Outpatient Population in Abu Dhabi","authors":"Sajid Iqbal MPhil, MSc ,&nbsp;Abdulrahim Abu Jayyab MSc, PhD ,&nbsp;Ayah Mohammad Alrashdi BSc ,&nbsp;Syed Shujauddin MSc, MBA ,&nbsp;Josep Lluis Clua-Espuny MD, PhD ,&nbsp;Silvia Reverté-Villarroya MSc, PhD","doi":"10.1016/j.clinthera.2024.07.002","DOIUrl":"10.1016/j.clinthera.2024.07.002","url":null,"abstract":"<div><h3>Purpose</h3><p>We aimed to investigate the predictive potential of plasma connecting peptide (C-peptide) in differentiating type 1 diabetes (T1D) from type 2 diabetes (T2D) and to inform evidence-based diabetes classification criteria.</p></div><div><h3>Methods</h3><p>A retrospective review was performed of all the patients with diabetes visiting an outpatient diabetology, endocrinology, general practice and family medicine tertiary health care center between January 2016 and December 2021.</p></div><div><h3>Findings</h3><p>Two hundred twelve individuals with diabetes were included, 85 (44.8%) with T1D and 127 (55.2%) with T2D. Mean (SD) age at diagnosis was 35.9 (15.1) years, and 112 (52.8%) men. Median (interquartile range [IQR]) duration of diabetes was 3.8 (3.0–4.5) years (T1D, 3.9 [3.5–4.6]; T2D, 3.4 [2.4–4.4]; <em>P</em> = 0.001). Body mass index was &lt;18.5 kg/m² in 5 (2.5%) individuals (T1D, 5; T2D, none), 18.5 to &lt;25 kg/m² in 57 (28.5%) (T1D, 32; T2D, 25), 25 to &lt;30 kg/m² in 58 (29%) (T1D, 28; T2D, 30), and &gt;30 kg/m² in 80 (40.0%) (T1D, 20; T2D, 60). Median (IQR) glycosylated hemoglobin was 7.4% (6.7%–8.5%) (T1D, 8.3% [7.2%–9.9%]; T2D, 7% [6.3%–7.6%]; <em>P</em> = 0.0001). Median (IQR) C-peptide concentration was 0.59 nmol/L (0.01–1.14 nmol/L) (T1D, 0.01 nmol/L [0.003–0.05 nmol/L]; T2D, 1.03 nmol/L [0.70–1.44 nmol/L]; <em>P</em> = 0.0001). C-peptide concentration of ≤0.16 nmol/L showed 92.9% sensitivity, 1-specificity of 2.4%, and AUC of 97.2% (CI, 94.7%–99.6%; <em>P</em> = 0.0001) in differentiating T1D from T2D.</p></div><div><h3>Implications</h3><p>To our knowledge, this is the first study in the Middle East and North Africa region highlighting the role of C-peptide in diabetes classification. The estimated cutoff point for C-peptide concentration (≤0.16 nmol/L) will certainly help in accurately classifying the T1D and will rule out the routine clinical judgmental approaches in the region, especially in those scenarios and periods where it is always difficult to diagnose the diabetes type. Quantifying the cutoff for C-peptide is among the vital strengths of this study that will provide a better treatment plan in diabetes care management. Also, we evaluated concomitant glucose levels to rule out the phenomenon of falsely low C-peptide values in the setting of hypoglycemia or severe glucose toxicity. Based on our findings, C-peptide testing could be included in postulating an evidence-based guideline that differentiates T1D from T2D. Despite this, our study has some limitations, including the selection bias due to the retrospective design and low C-peptide levels could be indicative of low pancreatic reserves due to other causes or long-standing T2D, and quantifying these reasons requires additional resources and time.</p></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 9","pages":"Pages 696-701"},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0149291824002030/pdfft?md5=4c7b2b00a75435f49dcf9c405758f60c&pid=1-s2.0-S0149291824002030-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Vasoactive Inotrope Score Trajectories and Their Prognostic Significance in Critically Ill Sepsis Patients: A Retrospective Cohort Analysis","authors":"Shiji Xiao ,&nbsp;Qiufeng Zhuang ,&nbsp;Yinling Li ,&nbsp;Zhibin Xue","doi":"10.1016/j.clinthera.2024.07.006","DOIUrl":"10.1016/j.clinthera.2024.07.006","url":null,"abstract":"<div><h3>Purpose</h3><p>Sepsis continues to be a critical issue in intensive care, characterized by significant morbidity and mortality. This study explores the association between Vasoactive Inotrope Score (VIS) trajectories and 28-day mortality in ICU patients with sepsis, employing VIS trajectories as a marker for assessing severity and guiding therapy.</p></div><div><h3>Methods</h3><p>We conducted a retrospective analysis of the MIMIC-IV database, which included sepsis patients admitted to the ICU between 2008 and 2019. VIS calculations were performed bi-hourly during the first 72 hours of ICU admission. Using latent growth mixture modeling, we identified distinct VIS trajectory patterns, and multivariate Cox proportional hazards models were employed to evaluate their association with 28-day mortality.</p></div><div><h3>Findings</h3><p>Among 6,802 sepsis patients who met the inclusion criteria, four distinct VIS trajectory patterns were identified: “Low-Decreasing” (52.1%), “Mild-Ascending” (13.2%), “Moderate-Decreasing” (23.0%), and “High-Stable” (11.6%). The 28-day survival analysis demonstrated that, compared to the “Low-Decreasing” group, the “Mild-Ascending” group had a hazard ratio (HR) for mortality of 2.55 (95% CI: 2.19–2.97, <em>P</em> &lt; 0.001), the “Moderate-Decreasing” group had an HR of 1.20 (95% CI: 1.03–1.41, <em>P</em> = 0.021), and the “High-Stable” group presented the highest risk with an HR of 4.19 (95% CI: 3.43–5.12, <em>P</em> &lt; 0.001).</p></div><div><h3>Implications</h3><p>This study offers significant insights into the prognostic value of VIS trajectories in sepsis patients. The identification of distinct trajectory patterns not only underscores the heterogeneity in sepsis but also emphasizes the importance of personalized management strategies. The findings underscore the potential of VIS trajectory monitoring in predicting 28-day outcomes and in guiding clinical decision-making in ICU settings.</p></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 9","pages":"Pages 711-716"},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-year Efficacy and Safety of Dulaglutide in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Retrospective Study of Asian Patients","authors":"Myung Jin Kim ,&nbsp;Hwi Seung Kim ,&nbsp;Yun Kyung Cho ,&nbsp;Chang Hee Jung ,&nbsp;Woo Je Lee","doi":"10.1016/j.clinthera.2024.06.024","DOIUrl":"10.1016/j.clinthera.2024.06.024","url":null,"abstract":"<div><h3>Purpose</h3><p>Dulaglutide is a long-acting glucagon-like peptide-1 receptor agonist that is not cleared by the kidneys and has proven efficacy and safety in patients with diabetic kidney disease. We aimed to evaluate the 1-year efficacy of dulaglutide in patients with diabetic kidney disease who have used the drug for more than 1 year.</p></div><div><h3>Methods</h3><p>This retrospective, observational study comprised 131 patients with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m² who had received dulaglutide for more than one year between June 2016 and May 2023. The primary outcome measures were changes in glycosylated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and body weight from baseline to the 12-month follow-up, with assessments performed at six-month intervals. Subgroup analyses were conducted based on age, sex, baseline body mass index, FPG, and HbA1c, and insulin administration at baseline and last follow-up.</p></div><div><h3>Findings</h3><p>The mean age was 60.0 ± 10.2 years, and 61.1% of the participants were males. Baseline HbA1c, FPG, and body weight were 9.1% (76.0 mmol/mol), 186.8 mg/dL, and 79.3 kg, respectively. Dulaglutide significantly reduced HbA1c, FPG, and body weight from baseline to the 12-month follow-up (mean ± standard error: –1.2 ± 0.1%, –34.8 ± 6.9 mg/dL, and –2.3 ± 0.5 kg, respectively; <em>P</em> &lt; 0.001). Subgroup analysis revealed significant differences in HbA1c reduction based on baseline HbA1c.</p></div><div><h3>Implications</h3><p>Dulaglutide exhibited sustained glucose-lowering and weight-reduction effects during the initial 1 year of treatment in patients with diabetic kidney disease. Altogether, dulaglutide could serve as a favorable long-term therapeutic option for patients with diabetic kidney disease in real-world clinical settings.</p></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 9","pages":"Pages 683-688"},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0149291824001991/pdfft?md5=1b57d901e8f076c7a69335f164773cda&pid=1-s2.0-S0149291824001991-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Propolis Consumption on Glycemic Indices and Liver Enzymes in Adults: A Grading of Recommendations Assessment, Development, and Valuation-assessed Systematic Review and Dose-Response Meta-analysis","authors":"Shaghayegh Adeli MSc ,&nbsp;Mahsa Maroofi MSc ,&nbsp;Fatemeh Pourteymour Fard Tabrizi Ph.D ,&nbsp;Beitullah Alipour Ph.D ,&nbsp;Marzieh Heidari MSc ,&nbsp;Mahdi Vajdi Ph.D ,&nbsp;Mahdieh Abbasalizad-Farhangi Ph.D","doi":"10.1016/j.clinthera.2024.06.022","DOIUrl":"10.1016/j.clinthera.2024.06.022","url":null,"abstract":"<div><h3>Purpose</h3><p>Even though various randomized controlled trials (RCTs) have assessed the effect of propolis on glycemic indices and liver enzyme concentrations in adults, results have been inconsistent, without conclusive evidence. This systematic review and meta-analysis of RCTs sought to evaluate the effects of propolis consumption on glycemic indices and liver enzymes, fasting blood glucose, insulin, homeostatic model assessment of insulin resistance, glycosylated hemoglobin, alanine transaminase, aspartate aminotransferase, and gamma-glutamyl transferase in adults.</p></div><div><h3>Methods</h3><p>Two independent researchers systematically searched PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library for English-language RCTs published up to April 2024. The results were generated through a random-effects model and presented as the weighted mean difference (WMD) with a 95% CI. The Cochrane Risk of Bias Tool for RCTs and Grading of Recommendations Assessment, Development, and Evaluation assessment were used to evaluate quality assessment and certainty of evidence.</p></div><div><h3>Findings</h3><p>A total of 21 RCTs were included. A pooled analysis of 24 trials reported that propolis consumption led to a significant reduction in fasting blood glucose (WMD, −9.75 mg/dL; 95% CI, −16.14 to −3.35), insulin (WMD, −1.64 µU/mL; 95% CI, −2.61 to −0.68), glycosylated hemoglobin (WMD, −0.46%; 95% CI, −0.71 to −0.21), homeostatic model assessment of insulin resistance (WMD, −0.54; 95% CI, −0.98 to −0.09), alanine transaminase (WMD, −2.60 IU/L; 95% CI, −4.58 to −0.61), and aspartate aminotransferase (WMD, −2.07 IU/L; 95% CI, −3.05 to −1.09). However, there were no significant effects on gamma-glutamyl transferase in comparison with the control group.</p></div><div><h3>Implications</h3><p>This meta-analysis has shown that propolis supplementation may have beneficial effects on glycemic indices and liver enzymes. Future high-quality, long-term RCTs are needed to confirm our results. ClinicalTrials.gov identifiers: CRD42024524763. (<em>Clin Ther</em>. 2024;46:XXX–XXX) © 2024 Elsevier HS Journals, Inc.</p></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 9","pages":"Pages e6-e14"},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}