1.
Meta-analysis of biochemical and patient-level effects of calcimimetic therapy.
Strippoli, GF, Palmer, S, Tong, A, Elder, G, Messa, P, Craig, JC
American journal of kidney diseases : the official journal of the National Kidney Foundation. 2006;(5):715-26
Abstract
BACKGROUND Many randomized trials have now evaluated the effects of calcimimetics in patients with chronic kidney disease and secondary hyperparathyroidism (SHPT) on standard therapy with vitamin D and/or phosphate binders. We conducted a meta-analysis to evaluate outcomes of therapy with these novel agents. METHODS MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and conference proceedings were searched for randomized controlled trials evaluating any calcimimetic against placebo or another agent in predialysis or dialysis patients with chronic kidney disease. Data were extracted for all relevant patient-centered and surrogate outcomes. Analysis was by means of a random-effects model, and results are expressed as relative risk or weighted mean difference (WMD) with 95% confidence intervals (CIs). RESULTS Eight trials (1,429 patients) were identified that compared a calcimimetic agent plus standard therapy with placebo plus standard therapy. End-of-treatment values for parathyroid hormone (4 trials; 1,278 patients; WMD, -290.49 pg/mL; 95% CI, -359.91 to -221.07), serum calcium (3 trials; 1,201 patients; WMD, -0.85 mg/dL; 95% CI, -1.14 to -0.56), serum phosphorus (3 trials; 1,195 patients; WMD, -0.29 mg/dL; 95% CI, -0.50 to -0.08), and calcium x phosphorus product (3 trials; 1,194 patients; WMD, -7.90 mg2/dL2; 95% CI, -10.25 to -5.54) were significantly lower with calcimimetic therapy compared with placebo. No significant effects on patient-based end points were shown. CONCLUSION Calcimimetic treatment of patients with SHPT leads to significant improvements in biochemical parameters that observational studies have associated with increased mortality, cardiovascular risk, and osteitis fibrosa, but patient-based benefits have not yet been shown. For patients with SHPT, the benefits of calcimimetics over standard therapy remain uncertain until additional randomized trials become available.
2.
[Systematic treatment of tinea pedis--evidence for treatment? A result of a Cochrane review].
Haedersdal, M, Svejgaard, EL
Ugeskrift for laeger. 2003;(14):1436-8
Abstract
BACKGROUND About 15% of the population have fungal infections of the feet (tinea pedis or athlete's foot). Whilst there are many clinical presentations of tinea pedis the most common are between the toes (interdigital) and on the soles, heels and sides of the foot (plantar) which is known as moccasin foot. Once acquired the infection can spread to other sites including the nails, which can be a source of reinfection. Oral therapy is usually used for chronic conditions or when topical treatment has failed. OBJECTIVES To assess the effects and costs of oral treatments for fungal infections of the skin of the foot (tinea pedis). SEARCH STRATEGY Randomised controlled trials were identified from MEDLINE, EMBASE and CINAHL from the beginning of these databases to January 2000. We also searched the Cochrane Controlled trials Register (Cochrane Library issue 1, 2000) the Science Citation Index, BIOSIS, CAB-Health, Health star and Economic databases. Bibliographies were searched, podiatry journals hand searched and the pharmaceutical industry and schools of podiatry contacted. SELECTION CRITERIA Randomised controlled trials including participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes in culture. DATA COLLECTION AND ANALYSIS Study selection was done by two independent reviewers. Methodological quality assessment and data collection was also assessed by two independent reviewers. MAIN RESULTS Twelve trials, involving 700 participants, were included. The two trials comparing terbinafine and griseofulvin produced a pooled risk difference of 52% (95% confidence intervals 33% to 71%) in favour of terbinafine's ability to cure infection. No significant difference was detected between terbinafine and itraconazole; fluconazole and either itraconazole and ketoconazole; or between griseofulvin and ketoconazole, although the trials were generally small. Two trials showed that terbinafine and itraconazole were effective compared with placebo. Adverse effects were reported for all drugs, with gastrointestinal effects most commonly reported. REVIEWERS' CONCLUSIONS The evidence suggests that terbinafine is more effective than griseofulvin and that terbinafine and itraconazole are more effective than no treatment.
3.
Efficacy and cutaneous safety of adapalene in black patients versus white patients with acne vulgaris.
Czernielewski, J, Poncet, M, Mizzi, F
Cutis. 2002;(4):243-8
Abstract
Acne vulgaris is the most common dermatologic disorder seen in American black patients (ie, African Americans and African Caribbeans, Fitzgerald skin types IV through VI). Despite its prevalence, there is a lack of data on the effects of treatments, such as the use of topical retinoids and retinoid analogs, in this patient population. Adapalene is a topical retinoid analog that has demonstrated efficacy in the reduction of noninflammatory and inflammatory lesions, along with excellent cutaneous tolerability. Most clinical studies of this agent have involved predominantly white patient populations. This meta-analysis of 5 randomized US and European studies was designed to evaluate the efficacy and safety of adapalene in black versus white patients. The percentage reduction in the number of inflammatory lesions was significantly greater among black patients compared with white patients (P=.012). The percentage reductions in total inflammatory and noninflammatory lesion counts were similar in the 2 groups (P>.3). There were significantly less erythema and scaling in black patients compared with white patients (P<.001 and P=.026 for worst scores for erythema and scaling, respectively). Although the incidence of dryness was similar in both groups, a smaller percentage of black than white patients had moderate or severe scores for dryness (7% vs 18%, respectively). In summary, adapalene appears to be a viable treatment for black patients with acne vulgaris.