AIM To determine the scope of acute hypoglycemic effects for certain anti-rheumatic medications in a large retrospective observational study. METHODS Patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VAR...AIM To determine the scope of acute hypoglycemic effects for certain anti-rheumatic medications in a large retrospective observational study. METHODS Patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were selected who, during follow-up, initiated treatment with tumor necrosis factor inhibitors (TNFi's, including etanercept, adalimumab, infliximab, golimumab, or certolizumab), prednisone, or conventional disease-modifying anti-rheumatic drugs(DMARDs), and for whom proximate random blood glucose (RBG) measurements were available within a window 2-wk prior to, and 6 mo following, medication initiation. Similar data were obtained for patients with proximate values available for glycosylated hemoglobin A1C values within a window 2 mo preceding, and 12 mo following, medication initiation. RBG and A1C measurements were compared before and after initiation events using paired t-tests, and multivariate regression analysis was performed including established comorbidities and demographics.RESULTS Two thousands one hundred and eleven patients contributed at least one proximate measurement surrounding the initiation of any examined medication. A significant decrease in RBG was noted surrounding 653 individual hydroxychloroquine-initiation events(-3.68 mg/dL, P = 0.04), while an increase was noted for RBG surrounding 665 prednisone-initiation events(+5.85 mg/d L, P < 0.01). A statistically significant decrease in A1C was noted for sulfasalazine initiation, as measured by 49 individual initiation events(-0.70%, P < 0.01). Multivariate regression analyses, using methotrexate as the referent, suggest sulfasalazine (β =-0.58, P = 0.01) and hydroxychloroquine(β =-5.78, P = 0.01) use as predictors of lower post-medicationinitiation RBG and A1C values, respectively. Analysis by drug class suggested prednisone (or glucocorticoids) as predictive of higher medication-initiation event RBG among all start events as compared to DMARDs, while this analysis did not show any drug class-level effect for TNFi. A diagnosis of congestive heart failure(β = 4.69, P = 0.03) was predictive for higher post-initiation RBG values among all medication-initiation events.CONCLUSION No statistically significant hypoglycemic effects surrounding TNFi initiation were observed in this large cohort. Sulfasalazine and hydroxychloroquine may have epidemiologically significant acute hypoglycemic effects.展开更多
Biologic agents have ushered a new era in the treatment of inflammatory rheumatic diseases.In recent years,several biologic agents have been approved by food and drug administration and have significantly improved out...Biologic agents have ushered a new era in the treatment of inflammatory rheumatic diseases.In recent years,several biologic agents have been approved by food and drug administration and have significantly improved outcomes for patients with immune mediatedinflammatory disorders including rheumatic and inflammatory bowel diseases.The most common used biologic therapeutic agents are tumor necrosis factor inhibitors(etanercept,infliximab,adalimumab,certolizumab pegol,and golimumab),an interleukin(IL)-6 inhibitor(tocilizumab),an IL-1 receptor antagonist(anakinra),an anti-CD-20 antibody(rituximab),and a T cell costimulation modulator(abatacept).Their use during pregnancy has been controversial because of absence of controlled studies which have enrolled pregnant women.This brief overview provides published data on use of biologic agents for the treatment of rheumatic diseases in pregnancy.展开更多
目的:观察还脑益聪方复方组分早期干预对阿尔茨海默病(Alzhei mer disease,AD)模型β淀粉样前体蛋白(β-amyloid precursor protein,APP)转基因小鼠行为学及脑胆碱能系统的影响。方法:将60只3月龄APP695V717I转基因小鼠随机分为4组:模...目的:观察还脑益聪方复方组分早期干预对阿尔茨海默病(Alzhei mer disease,AD)模型β淀粉样前体蛋白(β-amyloid precursor protein,APP)转基因小鼠行为学及脑胆碱能系统的影响。方法:将60只3月龄APP695V717I转基因小鼠随机分为4组:模型组、大剂量还脑益聪方组[2.80g/(kg.d)]、小剂量还脑益聪方组[1.40g/(kg.d)]及盐酸多奈哌齐阳性对照组[0.65mg/(kg.d)],每组15只。15只遗传背景相同的非转基因C57BL/6J小鼠作为正常对照组。所试药物稀释至相同体积灌胃给药,正常组和模型组给以等体积蒸馏水灌胃,连续灌胃6个月。采用Morris水迷宫实验和避暗实验进行小鼠行为学测试,采用酶联免疫吸附测定法分别检测小鼠大脑皮层和海马组织的乙酰胆碱(acetylcholine,ACh)、乙酰胆碱酯酶(acetylcholinesterase,AChE)含量及胆碱乙酰转移酶(choline acetyltransferase,ChAT)的活性,采用考马斯亮蓝法测定脑组织中蛋白的含量。结果:与正常对照组比较,模型组小鼠学习记忆成绩均显著下降(P<0.05,P<0.01),海马和皮层组织的ACh含量和ChAT活性显著降低,AChE含量显著增加(P<0.01,P<0.05)。与模型组比较,盐酸多奈哌齐组、还脑益聪方组小鼠的学习记忆能力均有明显提高(P<0.05);盐酸多奈哌齐组、还脑益聪方大剂量组小鼠海马ACh含量明显提高(P<0.05),盐酸多奈哌齐组、还脑益聪方组小鼠海马AChE含量显著降低,ChAT活性显著升高(P<0.01,P<0.05);盐酸多奈哌齐组和还脑益聪方两组小鼠皮层ACh含量均明显提高(P<0.05),AChE含量有不同程度的降低,还脑益聪方两组小鼠皮层ChAT活性均明显提高(P<0.05)。结论:还脑益聪方能明显改善APP转基因小鼠的学习记忆能力,其作用机制可能与调控小鼠海马与皮层胆碱能系统相关酶的含量有关。展开更多
基金Supported by VA HSR&D MERIT Award IIR,No.14-048-3 for Dr Caplansupported by a VA GME Enhancement Award
文摘AIM To determine the scope of acute hypoglycemic effects for certain anti-rheumatic medications in a large retrospective observational study. METHODS Patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were selected who, during follow-up, initiated treatment with tumor necrosis factor inhibitors (TNFi's, including etanercept, adalimumab, infliximab, golimumab, or certolizumab), prednisone, or conventional disease-modifying anti-rheumatic drugs(DMARDs), and for whom proximate random blood glucose (RBG) measurements were available within a window 2-wk prior to, and 6 mo following, medication initiation. Similar data were obtained for patients with proximate values available for glycosylated hemoglobin A1C values within a window 2 mo preceding, and 12 mo following, medication initiation. RBG and A1C measurements were compared before and after initiation events using paired t-tests, and multivariate regression analysis was performed including established comorbidities and demographics.RESULTS Two thousands one hundred and eleven patients contributed at least one proximate measurement surrounding the initiation of any examined medication. A significant decrease in RBG was noted surrounding 653 individual hydroxychloroquine-initiation events(-3.68 mg/dL, P = 0.04), while an increase was noted for RBG surrounding 665 prednisone-initiation events(+5.85 mg/d L, P < 0.01). A statistically significant decrease in A1C was noted for sulfasalazine initiation, as measured by 49 individual initiation events(-0.70%, P < 0.01). Multivariate regression analyses, using methotrexate as the referent, suggest sulfasalazine (β =-0.58, P = 0.01) and hydroxychloroquine(β =-5.78, P = 0.01) use as predictors of lower post-medicationinitiation RBG and A1C values, respectively. Analysis by drug class suggested prednisone (or glucocorticoids) as predictive of higher medication-initiation event RBG among all start events as compared to DMARDs, while this analysis did not show any drug class-level effect for TNFi. A diagnosis of congestive heart failure(β = 4.69, P = 0.03) was predictive for higher post-initiation RBG values among all medication-initiation events.CONCLUSION No statistically significant hypoglycemic effects surrounding TNFi initiation were observed in this large cohort. Sulfasalazine and hydroxychloroquine may have epidemiologically significant acute hypoglycemic effects.
文摘Biologic agents have ushered a new era in the treatment of inflammatory rheumatic diseases.In recent years,several biologic agents have been approved by food and drug administration and have significantly improved outcomes for patients with immune mediatedinflammatory disorders including rheumatic and inflammatory bowel diseases.The most common used biologic therapeutic agents are tumor necrosis factor inhibitors(etanercept,infliximab,adalimumab,certolizumab pegol,and golimumab),an interleukin(IL)-6 inhibitor(tocilizumab),an IL-1 receptor antagonist(anakinra),an anti-CD-20 antibody(rituximab),and a T cell costimulation modulator(abatacept).Their use during pregnancy has been controversial because of absence of controlled studies which have enrolled pregnant women.This brief overview provides published data on use of biologic agents for the treatment of rheumatic diseases in pregnancy.
