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Results for “long-acting regimen”

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At least 19 recordsLinked to original sources

PubMed2026

Willingness to switch to long-acting regimens among people with HIV: a systematic review and meta-analysis.

OBJECTIVES: Long-acting regimens (LARs) offer promising alternatives for people with HIV, enhancing autonomy and convenience. Understanding preferences for LAR is essential to guide policy and implementation. DESIGN: This systematic review and meta-analysis examined willingness among adults with HIV to switch from daily oral antiretroviral therapy (ART) to LAR. METHODS: Following PRISMA guidelines, we included studies of adults with HIV using daily oral ART reporting willingness to switch to existing or hypothetical LAR. The primary outcome was the proportion willing to switch. Articles were searched in PubMed and Embase up to October 2024. Risk of bias was assessed using the RoB-PrevMH tool. A random-effects meta-analysis with a generalized linear mixed model synthesized willingness for LAR. Subgroup analyses explored heterogeneity. Alternative LAR were summarized descriptively. RESULTS: Searches identified 2038 records, of which 22 studies were included. Most studies were conducted in Europe or North America (96%). Willingness to switch to any LAR was 70% [95% confidence interval (95% CI): 59-79; I2  = 97.9%]. Furthermore, two-monthly intramuscular injections were the most frequently investigated LAR, with a pooled willingness of 60% (95%CI: 42-76; I2  = 97.5%). No study-level characteristics explained heterogeneity. Limited studies investigated willingness for alternative LAR. CONCLUSION: The majority of people with HIV expressed willingness to switch to LAR, with two-monthly intramuscular injections being the most commonly investigated formulation. Substantial heterogeneity persisted, suggesting that LAR preferences are highly context dependent. Evidence on alternative LAR, including tablets, implants and intravenous infusions, is limited. Low and middle-income countries were underrepresented, highlighting the need for geographically diverse research to better understand context-specific preferences and thereby inform treatment policy.

Humans↗

PubMed1992

Change in glycemia in a four-year interval in younger-onset insulin-dependent diabetes.

Hyperglycemia is an important risk factor for the development of retinopathy and nephropathy in people with diabetes mellitus. There are few population-based data on changes in glycemia over time. The purpose of this study was to examine changes in glycemia, as measured by glycosylated hemoglobin in 1980 to 1982 and in 1984 to 1986, in a large population-based study of people who were diagnosed to have diabetes before the age of 30 years and who used insulin (n = 697). Glycosylated hemoglobin was measured by a microcolumn technique at both examinations. There was a significant (P < .001) fall in the mean glycosylated hemoglobin from 10.8 to 10.1% over the 4-year interval of the study. In contrast, there was no change in the glycosylated hemoglobin (6.2%) in a similarly aged nondiabetic comparison group over the same period. The decrease in mean glycosylated hemoglobin over the 4-year period in the diabetic group was associated with several characteristics of diabetes management. These include changes in the insulin regimen (going from intermediate- or long-acting insulin only to combinations with short-acting insulin), an increase in the number of doses of insulin per day, and a higher frequency of self-monitoring of blood glucose level. It was also associated with an increased number of reported insulin reactions. These data suggest that recent changes in treatment and management of diabetes may be related to a significant decrease in glycemia.

Adult↗

PubMed2025

Antifungal treatment strategies and their impact on resistance development in clinical settings.

Invasive fungal diseases, particularly among immunocompromised patients, represent a growing clinical challenge due to limited therapeutic options, diagnostic delays and escalating antifungal resistance. Fungal pathogens employ diverse resistance mechanisms, including genetic mutations of antifungal target enzymes, biofilm formation, efflux pump overexpression and reduced drug penetration, which compromise the efficacy of clinically available antifungal classes. This review explores antifungal treatment modalities and evaluates approaches to mitigate resistance development. Advanced diagnostics and therapeutic drug monitoring are pivotal for enabling timely, targeted therapies and personalizing treatment plans, thus minimizing reliance on broad-spectrum agents. New antifungal agents, such as rezafungin, olorofim and fosmanogepix, along with long-acting and advanced formulations plus combination regimens, show substantial promise for managing resistance and improving treatment outcomes. Additionally, the development of immunotherapies and antifungal vaccines offers new avenues for bolstering host defences against fungal pathogens. Addressing antifungal resistance demands a multifaceted 'One Health' approach that integrates robust diagnostics, antifungal stewardship (AFS), precision medicine and collaborative global efforts. By advancing drug formulations, enhancing diagnostic tools and implementing forward-thinking AFS practices, the healthcare community can better tackle the escalating burden of fungal infections and deliver improved patient outcomes.

Antifungal Agents↗

PubMed1978

The use of continuous insulin infusion for the peripartum management of pregnant diabetic women.

Sixteen pregnant diabetic patients near term were maintained on a regimen of continuous insulin infusion during the peripartum period. Blood glucose remained in the range of 75 to 150 mg. per deciliter, with insulin infusion rates between 0.25 and 2.00 U. per hour. Following delivery the infusion was continued through the first postpartum day or until oral intake was tolerated and subcutaneous long-acting insulin could be given. Sliding scale regimens were unnecessary; insulin dosage for discharge was easily determined; and the metabolic care of these patients was greatly simplified. Neonatal hypoglycemia in the 17 infants delivered of these diabetic patients was not entirely eliminated despite euglycemia in the mothers.

Apgar Score↗

PubMedDate not supplied

Comparison of one daily injection of NPH and crystalline PZI insulins on urinary glucose in diabetic children.

Two one-injection insulin regimens--a combination of intermediate-action NPH insulin with regular insulin and a combination of long-acting PZI insulin with regular insulin, all of porcine origin and manufactured by Nordisk Insulin Laboratories--were compared to a group of 10 juvenile diabetics, each child serving as his own control. The results of thrice daily urine tests were recorded for periods of 3 months during each regimen and the incidence of glucosuria of less than 1% constituted the index used for metabolic control. Although the total insulin dose was almost the same with both schemes, it was found that less glucose was excreted during the night and early morning with the PZI regimen than the NPH regimen, indicating that a single injection of NPH is insufficient for good diabetic control.

Adolescent↗

PubMed1977

Fundamental differences in the action of estrogens and antiestrogens on the uterus: comparison between compounds with similar duration of action.

In order to understand differences in the mechanism of action of estrogens and antiestrogens, it is essential to make comparisons between compounds with similar duration of action. Hence, in these studies, we compare the action of a long-acting estrogen (17alpha-ethinyl estriol-3-cyclopentyl ether, EE3CPE) and a long-acting antiestrogen (U-11,100AUA) on the immature rat uterus and analyze different dosage regimens (single and multiple injections) in studying the effects of these compounds on the uterine estrogen receptor and on uterine growth and sensitivity to estradiol. During the first 24 h, UA (50 microng) and EE3CPE (5 microng) evoke remarkably similar receptor distribution patterns and uterine wet weight increase; however, pronounced differences are seen with long-term, multiple injection regimens (every 12 or 24 h for 72 h). Such treatment with UA results in maintenance of high nuclear receptor levels and very low cytoplasmic receptor levels (ca. 10% of total), but no further increase in uterine weight, DNA or protein content, or total receptor content beyond 24-48 h. In contrast, multiple injections of EE3CPE produce not only a prolonged nuclear retention of receptor, but a progressive increase in total receptor content in the tissue and 35-50% of total receptor is cytoplasmic; uterine weight and DNA and protein content also continue to increase markedly above the 24 h level, and responsiveness to estradiol is maintained. However, regardless of whether the uterus continues to grow (as the EE3CPE) or stops growing after 24-48 h (as with UA), the receptor content on a cell basis is similar. Hence, uterine responsiveness to estradiol and continued uterine growth appear not to be related to the total content of receptor per cell, but rather are correlated with the cytoplasmic receptor level within the cell. As there is a continuous translocation of cytoplasmic receptor to the necleus in the growing uterus, the antagonistic action of antiestrogens appears to derive from their ability to effect a marked perturbation in the subcellular distribution of receptor, whereby very little of receptor (ca. 10%) is cytoplasmic, and further estrogen receptor accumulation (most likely synthesis) is blocked.

Animals↗

PubMed1975

A review of obesity and its management in 263 cases.

Obesity is defined with reference to hte probable cellular differences in adolescent and maturity-onset obesity. The aetiology and pathogenesis of obesity are briefly discussed. A multifactorial approach was used to treat 263 patients for obesity. This regimen included strict diet, programmed exercise, psychotherapy and medication. D-Phendimetrazine bitartrate in the long-acting form proved an excellent anorexiant for routine use. Fenfluramine was a valuable adjuvant drug for refractory cases. A detailed analysis of the results shows an over-all classified mean weight loss of 14,3%. Interrelationships between degree of overweight, age, degree of weight loss, etc., are critically examined. The most important conclusion was the need for close medical supervision and encouragement both during and after the formal weight loss programme.

Adolescent↗

PubMedDate not supplied

Reassessment of the role of theophylline in the current therapy for nocturnal asthma.

BACKGROUND: Symptoms of asthma commonly increase at night for a variety of reasons. While different options are available for the management of nocturnal asthma, theophylline has maintained a prominent role in treating this problem, and it is widely promoted as a first-line agent. Very recent reports stress the use of anti-inflammatory agents as the drugs of choice for the long-term treatment of asthma. METHODS: Using the key words "asthma," "theophylline," "bronchodilators," "adrenal cortex hormones," "beclomethasone," "triamcinolone acetonide," and "disodium cromoglycate," the MEDLINE files were searched from 1982 to the present. Articles dating before 1982 were accessed from cross-reference of the more recent articles. RESULTS: Sustained-release theophylline preparations are effective in decreasing the rate of exacerbations of nocturnal asthma symptoms, but theophylline has risks of major toxicity and serum concentrations must be monitored. Inhaled corticosteroids are also useful in controlling nocturnal asthma, and they reduce inflammation, which is the basic problem in asthmatics. Inhaled anticholinergics and oral controlled-release albuterol are also helpful in reducing symptoms of nocturnal asthma. CONCLUSIONS: A suggested approach to managing nocturnal asthma includes corticosteroids inhaled through a spacer device at optimum doses, adding inhaled albuterol or oral sustained-release albuterol and then ipratropium with a spacer. If control is not maintained with this regimen, sustained-release theophylline may add benefit to inhaled steroid therapy in reducing nighttime asthma symptoms. Long-acting inhaled beta 2 agonists show promise and could be the adjunctive treatment of choice when they become available in the United States.

Adrenal Cortex Hormones↗

PubMed1979

Pharmacokinetics of bromocriptine during continuous oral treatment of Parkinson's disease.

The plasma kinetics of bromocriptine (BCT), a long-acting dopamine agonist, was studied in twelve patients with Parkinson's disease, using a newly developed gas chromatographic method of analysis. Each patient received BCT for at least three weeks in a constant but different dose regimen. Concomitant treatment with 1-DOPA was not allowed. During a 6-day hospitalization period, a blood sample was taken immediately before the afternoon dose at 14.00 h (Cmin) to determine the steady-state level. On the 6th day blood samples were collected every hour during two 8 h dose intervals. The results showed a significant correlation between the mean values of the AUC and the Cmin. First order elimination kinetics appeared to be followed by BCT, at least for the plasma concentrations commonly found. Considerable inter-individual variation was demonstrated both for the dose/plasma concentration ratio and for calculated plasma clearances. No serious side-effects were observed during the investigation.

Aged↗

PubMed1979

Control of blood glucose levels in the streptozotocin diabetic rat using a long-acting heat-treated insulin.

Diurnal plasma glucose levels have been studied two hourly in streptozotocin diabetic rats during insulin treatment. Protamine Zinc Insulin induced a very steep fall in plasma glucose level from 359 +/- 100 (SD) mg/100 ml to 91 +/- 49 mg/100 ml within two hours. Plasma glucose was then low (13-60 mg/100 ml) until after 18 hours when an equally steep rise in glucose concentration ocurred. Six other insulin preparations and several insulin treatment regimens were tested with the aim of normalising the 24 hour plasma glucose profile of streptozotocin diabetic rats. One preparation, a non-commercial, very long acting Ultralente NOVO (Mc, ox pH 5.5) yielded a diurnal plasma glucose profile reasonably close to normal when it was administered once a day and when the dose was based on daily blood glucose measurements. Mean plasma glucose was 122 +/- 55 mg/100 ml with a nadir of 55 +/- 15 and a maximal of 187 +/- 99 mg/100 ml.

Animals↗

PubMed1975

Attempts to programme ovulation with exogenous oestrogens and LH-RH analogue.

An attempt was made to programme ovulation in women on a predetermined day of the menstrual cycle by treatment used to induce ovulation in anovulatory sterility. At laparotomy for elective sterilization the ovaries were observed to assess the occurrence of ruptured follicles and ovulation. Histological analysis of ovaries and endometrium was performed, and ova were recovered from some women. Several regimens were tested but ovulation seldom occurred as planned. Clomiphene citrate, human chorionic gonadotrophin (HCG), synthetic luteinizing hormone releasing hormone (LH-RH), and ethinyloestradiol were ineffective. Human menopausal gonadotrophin followed by HCG was more effective, but multiple ovulations occurred. When one single injection of a potent long-acting LH-RH analogue was given on day 13 of the cycle to 10 women pretreated with ethinyloestradiol signs of recent ovulation were observed on day 15 in seven and on day 16 in two.

Administration, Intranasal↗

PubMed1976

The possible mode of action of prostaglandins: X. Antagonism between prostaglandin F2a and prolactin or human chorionic gonadotropin: a comparative study.

A comparative assessment of the efficacy of prolactin or HCG in reversing the luteolytic property of a single dose (2.0 mg/kg) of PGF2a was conducted in pregnant (day 10) rats. It was found that prolactin maintained pregnancy in 90% of the test animals. HCG though found to maintain pregnancy in 70% of the PGF2a-treated pregnants, the fetal survival rate was, however, recorded to be 62% against the control value of 98%. Conversely, prolactin replacement maintained the fetal survival rate as high as 93.4%. Moreover, the growth of the fetuses, placentae and corpus luteum in the pregnants having prolactin in conjunction with PGF2a was also found to be greater compared to the animals which had a combined regimen of PGF2a and HCG, but identical to controls. On the other hand, similar combined regimen when applied to hysterectomized pregnant rats, it was observed that though the vaginal diestrus was maintained by the prolactin or HCG in the presence of PGF2a, the prolactin regimen was found to be superb compared to HCG in the maintenance of luteal weight and functional activity. It was concluded that the antifertility effect of PGF2a in the rat is primarily the consequence of luteolysis and prolactin seems to be a much more appropriate hormonal replacement compared to HCG, a long-acting LH, in antagonizing the luteolytic property of PGF2a.

Animals↗

PubMed1992

Double-blind, randomized trial for the control of delayed emesis in patients receiving cisplatin: comparison of placebo vs. adrenocorticotropic hormone (ACTH).

Delayed nausea and vomiting is a significant problem for the majority of patients receiving cisplatin. We designed a double-blind randomized study comparing the effects of ACTH and placebo on delayed emesis. Sixty-four adult cancer patients entered this trial; all received a chemotherapy regimen containing cisplatin (greater than or equal to 60 mg/m2) and a combination of metoclopramide and dexamethasone for the control of acute emesis during the period from 0 to 24 h after cisplatin (day 1). Twenty-four hours after cisplatin (day 2) they were randomized to receive 1 mg of ACTH i.m. in its long-acting form, or placebo in an identical vial. All patients were asked to keep a daily record of the incidence and severity of delayed vomiting and nausea for each of the five consecutive 24-h periods after cisplatin administration. Sixty patients were evaluable. The percentages of patients experiencing vomiting in the ACTH and placebo arms were, respectively, 17% vs. 43% on day 2 (24-48 h after cisplatin) (P = 0.04), 13% vs. 40% on day 3 (48-72 h) (P = 0.04), 20% vs. 34% on day 4 (72-96 h), and 20% vs. 30% on day 5 (96-120 h). During the entire 5-day study period, 33% of the patients in the ACTH group experienced delayed vomiting as opposed to 57% in the placebo arm (P = 0.11).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗

PubMed1978

Relieving pain with nerve blocks.

Pain syndromes in elderly patients are seldom psychogenic or due merely to "old age." Careful differential diagnosis is important, as judicious use of nerve blocks as adjunctive therapy often can relieve pain and restore activity. In the acute phase of shoulder pain, intrabursal injection of local anesthetic and steroid inhibits the inflammatory process. In the later stages, suprascapular nerve block relieves pain and interrupts afferent pain pathways. The occipital pain and headache of cervical arthritis also often respond to injection of 2 to 3 ml of long-acting anesthetic into the greater and lesser occipital nerves at the sites where they pierce the trapezius. Minor causalgia, shoulder-arm syndrome, or chronic traumatic edema may follow either forearm fracture or inflammation around the shoulder joint. Five stellate ganglion blocks with 1% lidocaine on alternate days, followed by 3 to 4 months of active and passive exercise, is the most effective treatment. This regimen usually produces a fully functional extremity. In degenerative disk disease, osteoarthritis, and metastatic disease, the cause of back pain is essentially the same--edema and inflammation of nerve roots at the intervertebral foramina. Injection of local anesthetic and steroid into the epidural space usually reduces swelling and inflammation. Patients are evaluated in 2 weeks and reblocked if improvement has plateaued. Pain relief most often is prompt and persists for an indefinite period.

Acute Disease↗

PubMed2026

Liposomal bupivacaine versus ropivacaine for surgical site infiltration in lumbar fusion: a prospective randomized controlled trial.

INTRODUCTION: Effective postoperative pain control after lumbar spine surgery remains challenging, and excessive opioid use is associated with adverse outcomes. Evidence comparing liposomal bupivacaine (LB) with conventional long-acting local anesthetics in spine surgery is limited. PATIENTS AND METHODS: In this single-center, prospective, randomized, patient- and outcome assessor-blinded trial, adult undergoing one- or two-level posterior lumbar decompression and fusion were assigned (1:1) to surgical site infiltration with either LB (266 mg) plus 25 mg plain bupivacaine (LB group) or ropivacaine (R group). The primary outcome was 72 h cumulative opioid consumption (morphine milligram equivalents, MME). Secondary outcomes included time-profile opioid consumption, pain scores, rescue analgesia, safety, and functional recovery. RESULTS: A total of 202 patients were included in the modified intention-to-treat analysis. Cumulative MME within 72 h was significantly lower in the LB group compared with the R group [43.0 (37.0, 58.0) mg vs. 58.0 (46.0, 73.0) mg], corresponding to a 22% relative reduction (GMR 0.78, 95% CI 0.71-0.85; p < 0.001). The reduction was most pronounced during 8-24 h and 24-48 h postoperatively. Overall pain scores at rest and with movement, as well as 72-h pain AUC, were lower in the LB group. No significant between-group differences were observed in rescue analgesia, adverse events and functional recovery. CONCLUSION: In patients undergoing one- or two-level posterior lumbar decompression and fusion, surgical site infiltration with an LB-based combined regimen, compared with ropivacaine monotherapy, reduced 72-h opioid consumption and cumulative postoperative pain burden without an observed increase in adverse events or impairment of early functional recovery.

Humans↗

PubMed1992

Amlodipine combined with beta blockade for chronic angina: results of a multicenter, placebo-controlled, randomized double-blind study.

Amlodipine, a potent long-acting dihydropyridine calcium antagonist, was compared with placebo in a parallel, randomized, double-blind study in 134 patients with chronic stable angina pectoris maintained on beta-adrenergic blocking agents. After a single-blind, two-week placebo period, patients were randomized to receive either amlodipine (2.5, 5, and 10 mg) or placebo once daily for four weeks. The effects of amlodipine on maximal exercise time, work, time to angina onset, and subjective indices including angina frequency, nitroglycerin tablet consumption, and patient and investigator ratings were assessed. Each dose of amlodipine produced increases in exercise time and calculated total work accomplished compared to baseline. Improvements at 5 and 10 mg were significantly greater than placebo which produced no significant change (p less than 0.05). Qualitative improvements in the severity of angina were produced by amlodipine at 5 and 10 mg daily assessed by patient-rating questionnaires (p less than 0.05). Reductions in angina frequency attacks per week and weekly nitroglycerin tablet consumption occurred but were not statistically significant when compared with placebo. Adverse effects observed during amlodipine treatment prompted discontinuation of treatment in only 2 out of 100 patients. Three patients discontinued treatment for reported lack of efficacy. No laboratory abnormalities prompted treatment discontinuation and minor side effects of dizziness, nausea, headache, and fatigue were observed infrequently. The results of this controlled, large-scale multicenter trial suggest that amlodipine significantly increased exercise capacity and was well tolerated when added to the antianginal regimen of patients remaining symptomatic while receiving beta-blocking agents.

Adolescent↗

PubMed1978

The episodic nature of anxiety and its treatment with oxazepam.

The presentation of anxiety in clinical practice is examined, and it is concluded that many patients, perhaps a majority, experience fluctuating levels of anxiety. It is therefore suggested that therapy should be intermittent, according to this waxing and waning of symptoms. Most benzodiazepines are long-acting, and are therefore unsuitable for this type of therapy, but oxazepam, which is short-acting and has no active metabolites, is ideal for this purpose. It is proposed that such a regimen would minimize the problems of over-sedation, psychological habituation, and a reluctance, due to a permanently tranquillized state, to deal with the root causes of the anxiety.

Anxiety↗

PubMed1992

Formoterol, a new long-acting beta 2 agonist, inhaled twice daily, in stable asthmatic subjects.

STUDY OBJECTIVE: To determine whether formoterol, a new beta 2 agonist with experimentally documented long duration, is clinically more effective than salbutamol in the maintenance treatment of chronic asthma. DESIGN: Randomized double-blind between-patient comparison between treatment with formoterol and with salbutamol during four weeks. SETTING: Asthma/allergy department in a university hospital. PATIENTS: Thirty-seven patients with chronic stable asthma, who during a two-week run-in period with inhaled salbutamol, 4 x 100 micrograms twice a day, used at least four additional doses (100 micrograms each) daily, were randomly assigned to use either formoterol or salbutamol. Thirty-five patients were evaluated for efficacy. One early withdrawal and one dropout were found in the salbutamol group. The groups were similar with respect to demographic data and baseline lung function. INTERVENTIONS: During the four-week study period, the patients used either formoterol (4 x 6 micrograms twice a day and as necessary, n = 19) or salbutamol (4 x 100 micrograms twice a day and as necessary, n = 16). Inhaled steroids and orally administered theophylline were allowed if doses were kept constant. MEASUREMENTS AND MAIN RESULTS: The median number of additional doses per 24 h (median of two weeks) of the test aerosols was 0 (range, 0 to 6) for formoterol and 4 (range, 0 to 14) for salbutamol (p less than 0.01). Morning and evening PEFRs were 422 (SEM = 31) and 443 (SEM = 30), respectively, for formoterol, and 335 (SEM = 30) and 360 (SEM = 26), respectively, for salbutamol (p = 0.05 for both). Formoterol was superior (p less than 0.05) to salbutamol with respect to control of asthma symptoms, estimated duration of action and patient preference. Side effects did not differ. CONCLUSIONS: Inhaled formoterol administered twice a day and as necessary was clinically more effective than the same regimen of salbutamol.

Administration, Inhalation↗