Comparable efficacy and tolerability between twice daily and three times daily betahistine for Ménière's disease

Conclusion. Betahistine at oral doses of 16 mg tid and 24 mg bid provides similar efficacy and tolerability in the treatment of vertigo in patients with Ménière's disease. Objective. To compare the efficacy and tolerability of betahistine 16 mg tid and 24 mg bid in the treatment of vertigo in patients with Ménière's disease. Patients and methods. This was a randomized, open-label study of 120 consecutive patients with well-established Ménière's disease treated with betahistine 16 mg tid or 24 mg bid for 24 weeks. Treatment efficacy, assessed by clinical outcome level in terms of severity, frequency and duration of vertigo spells, was evaluated at baseline and at weeks 4, 12 and 24. Between-group comparisons of outcome data (Wilcoxon, Mann-Whitney U test) and adverse events (chi-squared test) were made. Results. Betahistine 16 mg tid or 24 mg bid showed a significant improvement in clinical outcome level from baseline to week 24 (p<0.01). There was no significant difference between dosage groups regarding improvement in vertigo at any time point during the study. There was no significant difference between groups in the incidence of adverse events, which was low (maximum: headache, 16 mg tid, 16.7% of patients at week 4; 6.7% at week 24). The number of patients reporting adverse events diminished with time.     

Pharmacological treatment of geriatric cachexia: evidence and safety in perspective

Anticachexic or antisarcopenic medications are prescribed worldwide for geriatric patients with poor appetite and associated weight loss. They represent a valuable treatment option for managing cachexia. However, the well-publicized adverse reports about these medications in acquired immunodeficiency syndrome (AIDS) and in the cancer population has led to some concern and much subsequent discussion over the safety of these medications being used in geriatric population. This review looks at the evidence in relation to the benefits and risks of these medications and discusses what we know about their use in the geriatric population.     

Rimonabant for treating tobacco dependence

Tobacco use continues to cause 5 million preventable deaths worldwide each year. Despite effective treatments being available, these are underutilized and cessation rates remain low. As tobacco use has complex physiological effects, there are multiple opportunities for novel pharmacological agents to play a role in a comprehensive treatment plan. The endocannabinoid system has been linked to the nicotine reward pathways in animal models. Rimonabant, a selective cannabinoid receptor (type 1) blocker, has been shown in some early clinical trials to have some positive effects in increasing abstinence rates of smokers attempting to stop. In addition, smokers who stop smoking with the assistance of rimonabant may gain less weight than those using placebo. However, the results from these few trials have not been entirely consistent and so its role as an aid to smoking cessation remains to be determined.     

Nocturia

Nocturia is a poorly understood symptom complex. It is seldom the result of obstructive lower urinary tract symptoms alone. Its association with multiple medical comorbidities and nocturnal polyuria explains the generally poor response to interventions aimed at improving outflow obstruction or lessening the impact of bladder instability. Nocturia is increasingly recognized as a surrogate marker for poor health and one that carries with it an increased risk of mortality. The management of nocturia needs to address not only the underlying medical conditions, but also the impact of nocturnal polyuria – the latter through anti-diuretic pharmacology or by manipulating the timing of an individual’s diuresis to avoid periods of sleep. Those interventions which increase the time before the first wake to void in an individual with several episodes of nocturia should be deemed of greater clinical significance than those that simply reduce the total number of voided episodes. In this respect an understanding of the restorative function of deep slow-wave sleep should not be underestimated. A failure to understand the fundamental causes of nocturia frequently results in an ineffective polypharmacy which further impacts on the quality of life in a predominantly senescent population.     

Morphological stabilization and regression of carotid plaque following therapy with evolocumab in a high-risk patient

Lipid-lowering therapy is a mainstay for the management of coronary and carotid disease. Actually, progression of atherosclerosis and adverse events are reduced in proportion to the achieved levels of LDL cholesterol (LDL-C). A 67-year-old patient underwent two hospitalizations 6 months apart due to acute coronary syndromes. In the first, PCI with drug-eluting stents (DES) was performed to treat ulcerated stenoses in the left anterior descending artery. In the second, lipid-rich critical disease was found on the right coronary artery and treated with PCI + DES. Later, carotid duplex ultra-sonography (DU) was done due to some episodes of dizziness. It showed an 80% critical stenosis (peak systolic velocity, PSV 239 cm/s) of the left internal carotid artery (LICA) with high-risk features (hypoechogenic and irregular plaque with “fluffy” components). In consideration of the plaque morphology and the unmet LDL-C targets, evolocumab was added to the ongoing statin therapy. In the following months, we observed a parallel trend between carotid plaque regression and LDL-C lowering. Initial plaque remodeling was seen after 5 months: the atheroma appeared fibrotic, with no more fluffy components. At 10 months, in conjunction with the achievement of LDL-C goal (23 mg/dl), a fibrocalcific atheroma was observed; PSV, after an initial rise, fell to 229 cm/s. No further cardiovascular event occurred at 46 months. Last DUS showed a 60% fibrocalcific mid LICA stenosis with PSV of 180 cm/s. Our experience highlights the important role of proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors in promoting remodeling and hopefully regression of atherosclerotic plaques.     

Pharmacological treatment response according to the severity of symptoms in patients with chronic obstructive pulmonary disease

Background

Pharmacological management of chronic obstructive pulmonary disease (COPD) is recommended according to the individualized assessment of symptoms and exacerbation risks. The aim of this study was to determine the relationship between the baseline Modified British Medical Research Council (mMRC) dyspnea scale and the COPD Assessment Test (CAT) score and pharmacological treatment response in patients with COPD.

Methods

A total of 102 stable COPD patients who were enrolled in prospective cohort studies were analyzed. Pharmacological treatment responses after a 3-month treatment were assessed by changes on the mMRC dyspnea scale, CAT scores, and spirometric pulmonary functions.

Results

Sixty-two patients with a mMRC dyspnea scale ≤1 were classified as having “less dyspnea” and 40 patients with a mMRC dyspnea scale ≥2 as having “more dyspnea”. After a 3-month treatment, the mean mMRC dyspnea scale in the “more dyspnea” group was significantly decreased versus the “less dyspnea” group; however, there were no significant differences in CAT score changes or spirometric pulmonary function changes between the two groups. Baseline mMRC scales (Spearman’s rho =−0.591, P<0.001) and baseline CAT scores (Pearson’s r =−0.337, P=0.001) were significantly correlated with their changes after a 3-month treatment. Multiple logistic regression analysis demonstrated that baseline mMRC scale and CAT score were the only independent predictors of improvement greater than a minimal clinically significant difference after treatment.

Conclusions

The severity of COPD symptoms is associated with their response to pharmacotherapy. COPD patients with a higher baseline mMRC dyspnea scale and CAT score experience greater symptom reduction by pharmacotherapy.