-
1.
Characterization of Creatine Kinase Levels in Tofacitinib-Treated Patients with Ulcerative Colitis: Results from Clinical Trials.
Panaccione, R, Isaacs, JD, Chen, LA, Wang, W, Marren, A, Kwok, K, Wang, L, Chan, G, Su, C
Digestive diseases and sciences. 2021;(8):2732-2743
-
-
Free full text
-
Abstract
BACKGROUND Tofacitinib is an oral, small-molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Creatine kinase (CK) levels and CK-related adverse events (AEs) in tofacitinib-treated patients with UC were evaluated. METHODS Data were analyzed for three UC cohorts: Induction (phase 2 and 3 induction studies); Maintenance (phase 3 maintenance study); Overall [patients who received tofacitinib 5 or 10 mg twice daily (b.d.) in phase 2, phase 3, or open-label, long-term extension studies; data at November 2017]. Clinical trial data for tofacitinib-treated patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis are presented for contextualization. RESULTS Week 8 mean change from baseline CK with tofacitinib 10 mg b.d. induction therapy was 91.1 U/L (95% CI, 48.1-134.1) versus 19.2 U/L (8.5-29.9) with placebo. Among patients completing induction with 10 mg b.d. and re-randomized to 52 weeks of maintenance therapy, mean increases from induction baseline to the end of maintenance were 35.9 (8.1-63.7), 90.3 (51.9-128.7), and 115.6 U/L (91.6-139.7), with placebo, 5 and 10 mg b.d., respectively. The incidence rate (unique patients with events per 100 patient-years) for AEs of CK elevation in the tofacitinib-treated UC Overall cohort was 6.6 versus 2.2, 6.5, and 3.7 for tofacitinib-treated patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis, respectively. No serious AEs of CK elevation or AEs of myopathy occurred in UC studies. CONCLUSIONS In patients with UC, CK elevations with tofacitinib appeared reversible and not associated with clinically significant AEs. UC findings were consistent with tofacitinib use in other inflammatory diseases. TRIAL REGISTRATION NCT00787202; NCT01465763; NCT01458951; NCT01458574; NCT01470612; NCT01262118; NCT01484561; NCT00147498; NCT00413660; NCT00550446; NCT00603512; NCT00687193; NCT01059864; NCT01164579; NCT00976599; NCT01359150; NCT02147587; NCT00960440; NCT00847613; NCT00814307; NCT00856544; NCT00853385; NCT01039688; NCT02187055; NCT00413699; NCT00661661; NCT01710046; NCT00678210; NCT01276639; NCT01309737; NCT01241591; NCT01186744; NCT01163253; NCT01877668; NCT01882439; NCT01976364.
-
2.
Moderate volume of sprint bouts does not induce muscle damage in well-trained athletes.
Grazioli, R, Lopez, P, Machado, CLF, Farinha, JB, Fagundes, AO, Voser, R, Reischak-Oliveira, Á, Setuain, I, Izquierdo, M, Pinto, RS, et al
Journal of bodywork and movement therapies. 2020;(1):206-211
Abstract
INTRODUCTION Understanding the recovery in response to different sprint protocols is important for optimizing neuromuscular gains and organizing training sessions in sports. The current study aimed to investigate acute neuromuscular changes following a moderate volume of sprint protocols with and without change-of-direction. METHODS 26 well-trained male collegiate athletes from different sports were randomly allocated into straight-line group (SLG) or change-of-direction group (CODG). The protocols were 1 × 15 repetitions of 20-meter sprints in line (SLG) or with two changes in each repetition (CODG). Knee extension maximal and explosive strength, jump performance, serum creatine kinase, and quadriceps and hamstrings echo intensity were collected pre-, post- 0, 24, 48, and 72 h post-exercise. RESULTS There were no significant changes in any of the variables at any time point after the exercise protocols in comparison with pre-exercise values (p > 0.05). CONCLUSIONS The present study suggests that sprint training with moderate volume with or without change of direction does not induce neuromuscular or physiological changes during 72 h post-exercise. This information is especially important for sports staff in order to optimize training prescription and frequency.
-
3.
Creatine kinase during non-ST-segment elevation acute coronary syndromes is associated with major bleeding.
Brewster, LM, Fernand, J
Open heart. 2020;(2)
Abstract
BACKGROUND It was recently reported that highly elevated plasma activity of the ADP-scavenging enzyme creatine kinase (CK), to >10 times the upper reference limit (URL), is independently associated with fatal or non-fatal bleeding during treatment for ST-segment elevation myocardial infarction (OR 2.6 (95% CI, 1.8 to 2.7)/log CK increase). Evidence indicates that CK attenuates ADP-dependent platelet aggregation. This study investigates whether moderately elevated CK in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is associated with major bleeding. METHODS The Thrombolysis In Myocardial Ischemia (TIMI) 3B trial compared recombinant tissue-type plasminogen activator (rt-PA) (35-80 mg) with placebo and early catheterisation with conservative management in patients with NSTE-ACS. Main outcomes of the current study are the independent association of peak plasma CK (CKmax) with adjudicated fatal or non-fatal major bleeding (primary) and with combined major bleeding, stroke and hospital death (secondary), with covariables including age, sex, body mass index, systolic blood pressure, creatinine and assignment to add-on rt-PA versus placebo. Discrimination was assessed with C-statistics. RESULTS The study included 1473 patients (66% men, 80% white, mean age 59 years, SE 0.3). CKmax ranged between 15 and 19 045 IU/L (mean (SE), 450 (24) IU/L; two times URL). Major bleeding occurred in 2.0% (mean age 65 (1.3) years; mean CKmax 1015 (319) IU/L; six times URL), and the combined outcome in 4.3% of the patients, adjusted OR per log CK increase, respectively, 3.1 (1.6 to 5.9) for major bleeding and 3.9 (2.5 to 6.1) for the combined outcome; C-index 0.8 for both outcomes. The association between CK and bleeding was independent of the use of thrombolytic therapy. DISCUSSION The presented data add to the existing evidence that proportionate to its plasma activity, the ADP-binding enzyme CK is strongly and independently associated with non-fatal and fatal major bleeding during treatment for NSTE-ACS. CK might increase the accuracy of prediction models for major bleeding in patients with NSTE-ACS. TRIAL REGISTRATION NUMBER NCT00000472.
-
4.
Effects of mechanical bed massage on biochemical markers of exercise-induced back muscle fatigue in athletes: A randomized controlled trial.
Zhong, H, Eungpinichpong, W, Wang, X, Chatchawan, U, Wanpen, S, Buranruk, O, Wang, C
Journal of back and musculoskeletal rehabilitation. 2020;(5):793-800
Abstract
BACKGROUND Many previous studies have explored the effects of manual massage on back muscle fatigue, and most of the mechanical massage techniques imitate manual massage. However, it is unknown whether mechanical and manual massage have the same functions for exercise-induced back muscle fatigue. OBJECTIVE To investigate the effects of mechanical bed massage on the biochemical markers of exercise-induced back muscle fatigue in male collegiate athletes. METHODS Twenty-eight male collegiate athletes who met the experimental criteria were recruited in this randomized controlled trial, and randomly assigned to a mechanical bed massage group (experimental group) or resting group (control group). The subjects performed eight bouts of reverse sit-up in the prone position and received 20 minutes of the intervention. Creatine kinase, blood lactate, and serum cortisol levels were measured at baseline, after fatigue, after intervention, and after 24 hours. RESULTS The level of serum cortisol of the control group was significantly higher than that of the experimental group after the intervention (p< 0.05). The comparison of the two groups for blood lactate levels showed no significant differences at any of the measurement time-points (p> 0.05). There was no significant difference in creatine kinase levels immediately after the intervention (p> 0.05), but a significant difference in creatine kinase level was observed between the two groups 24 hours later (p< 0.05). CONCLUSIONS Significant differences were observed between mechanical bed massage and rest condition on serum cortisol and creatine kinase for exercise-induced muscle fatigue. Therefore, mechanical bed massage may reduce stress and muscle damage for the athlete after training or competition.
-
5.
Effects of lymphatic drainage and cryotherapy on indirect markers of muscle damage.
Behringer, M, Jedlicka, D, Mester, J
The Journal of sports medicine and physical fitness. 2018;(6):903-909
Abstract
BACKGROUND Muscle enzymes are cleared from the extracellular space by the lymphatic system, while smaller proteins enter the bloodstream directly. We investigated if manual lymphatic drainage (MLD), local cryotherapy (CRY), and rest (RST) differently affect the time course of creatine kinase (CK, 84 kDa) and heart-type fatty acid binding protein (h-FABP, 15 kDa) in the blood. METHODS Randomized controlled trial. After 4x20 unilateral, eccentric accentuated knee extensions (with one-third of the maximal isometric force) 30 sports students randomly received either a 30 min MLD, CRY or they rested (RST) for the same amount of time. CK, h-FABP, neutrophil granulocytes, and the perceived muscle soreness were assessed before, immediately after, and 1 hour, 4 hours, and 24 hours after the exercise. RESULTS All measures increased significantly (P<0.001) after the protocol indicating that muscle damage was induced. However, the responses did not differ between the treatments. CONCLUSIONS Large and small damage markers were not affected differently by MLD, CRY, or RST, when applied for 30 min and no beneficial effects on inflammation or muscle soreness could be found for MLD and CRY when compared to RST. This information is particularly important for those sports physicians and conditioning specialists who use biochemical muscle damage markers to adjust the training load and volume of athletes.
-
6.
Posterolateral vs Direct Anterior Approach in Total Hip Arthroplasty (POLADA Trial): A Randomized Controlled Trial to Assess Differences in Serum Markers.
Rykov, K, Reininga, IHF, Sietsma, MS, Knobben, BAS, Ten Have, BLEF
The Journal of arthroplasty. 2017;(12):3652-3658.e1
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty has claimed to be a true tissue-sparing minimally invasive approach that has less tissue damage and a faster recovery when compared to the posterolateral approach (PLA). The aim of this randomized controlled trial is to measure the differences in serum markers and functional outcomes between the DAA and PLA for total hip arthroplasty. METHODS Forty-six patients were prospectively included and randomized for either the DAA (n = 23) or PLA (n = 23). All surgical procedures were performed by 3 well-trained orthopedic surgeons. The degree of tissue damage was assessed by measuring creatine kinase (CK) and C-reactive protein levels (CRP) preoperatively and 2 hours, 1 day, 2 weeks, and 6 weeks postoperatively. Generalized linear mixed models analyses were used to assess differences between serum markers over time; correction for possible confounding factors was performed. The Hip disability and Osteoarthritis Outcome Score and the Harris Hip Score were assessed preoperatively and 6 weeks postoperatively. RESULTS There were no differences in patient demographics. The DAA had a longer operative time (P = .001). CK and CRP levels increased postoperatively, but no significant differences between the groups were found on any of the time points. Functional outcomes were also similar in both approaches. CONCLUSION No difference in tissue damage measured with serum markers CK and CRP were found between the DAA and PLA for total hip arthroplasty.
-
7.
Lean body mass and creatine kinase are associated with reduced inflammation in obesity.
Bekkelund, SI, Jorde, R
European journal of clinical investigation. 2017;(11):803-811
Abstract
BACKGROUND Obesity is associated with inflammation, but the role of lean mass and creatine kinase (CK) on the inflammatory process is less known. We investigated the associations between lean mass, CK and fat mass upon inflammatory parameters in an overweight and obese adult population. MATERIAL AND METHODS Body composition examined by dual-energy X-ray absorptiometry, high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), CK and supplementary clinical parameters were measured in 454 overweight and obese individuals. This is a secondary analysis from a cohort of obese individuals treated with Vitamin D. RESULTS Mean age was 47·6 ± 11·4 years and mean body mass index 34·6 ± 3·9 kg/m2 . Lean mass correlated negatively with hs-CRP (r = -0·127, P = 0·042) and ESR (r = -0·381, P < 0·001). Median lean mass in the lower ESR quartile was significantly higher than in the upper quartile (P < 0·001) but not between lower and upper hs-CRP quartiles (P = 0·114). CK was negatively correlated with hs-CRP (r = -0·151, P < 0·001) and ESR (r = -0·240, P < 0·001). Median CK in the lower hs-CRP and ESR quartiles were significantly higher than in the upper quartiles (P < 0·001 for both). Conversely, fat mass was positively associated with hs-CRP and ESR. CONCLUSIONS Inflammatory parameters were related to reduced lean mass and CK in an overweight and obese population. Hypothetically, lean mass has a favourable effect on obesity-related inflammation, and CK may play a role as an inhibitor of inflammation in obesity.
-
8.
The Effect of Remifentanil on Succinylcholine Induced Changes in Serum Potassium and Creatine Kinase: A Prospective Randomized Double blind Study.
Nasseri, K, Shami, S, Shirmohammadi, M, Sarshivi, F, Ghadami, N
Acta bio-medica : Atenei Parmensis. 2017;(3):276-280
Abstract
BACKGROUND AND AIM OF THE WORK Succinylcholine is still included as drugs favored by anesthetists because of its rapid onset and short duration of action. However, it can bring about complications such as hyperkalemia and increased serum creatine phosphokinase (CPK). This study aims at evaluating the effects of remifentanil on succinylcholine-induced postoperative changes in serum potassium and CPK. METHODS In this study, 59 patients with short term lower abdominal surgery were randomly divided into two groups. In the first group (control group), 2 ml normal saline was used before injecting anesthetic drugs while in the second group (study group), 1 mcg/kg of remifentanil was injected. The patients were anesthetized with a combination of fentanyl (1 mg/kg) and propofol (2 mg/kg). Besides, succinylcholine (1.5 mg/kg) was used for muscle relaxation and tracheal intubation. Serum potassium (before and 5 min after tracheal intubation), CPK (before anesthetic injection and 24 h after surgery) and hemodynamic parameters (including systolic, diastolic and mean arterial blood pressure and heart rate) were recorded. RESULTS Serum levels of potassium and CPK before and after induction of anesthesia showed no significant difference in both groups. Systolic, diastolic, and mean arterial blood pressure and heart rate in both groups after induction significantly changed. Compared to saline, remifentanil significantly stabilized hemodynamic changes after intubation. CONCLUSIONS The results suggest that remifentanil has no prophylactic effect on succinylcholine-induced CPK and potassium levels. However, it improves stability of hemodynamic variables.
-
9.
Post-exercise recovery of biological, clinical and metabolic variables after different temperatures and durations of cold water immersion: a randomized clinical trial.
Vanderlei, FM, de Albuquerque, MC, de Almeida, AC, Machado, AF, Netto, J, Pastre, CM
The Journal of sports medicine and physical fitness. 2017;(10):1267-1275
Abstract
BACKGROUND Cold water immersion (CWI) is a commonly used recuperative strategy. However there is a lack of standardization of protocols considering the duration and temperature of application of the technique and the stress model. Therefore it is important to study the issue of dose response in a specific stress model. Thus the objective was to analyze and compare the effects of CWI during intense post-exercise recovery using different durations and temperatures of immersion. METHODS One hundred and five male individuals were divided into five groups: one control group (CG) and four recovery groups (G1: 5' at 9±1 °C; G2: 5' at 14±1 °C; G3: 15' at 9±1 °C; G4: 15' at 14±1 °C). The volunteers were submitted to an exhaustion protocol that consisted of a jump program and the Wingate Test. Immediately after the exhaustion protocol, the volunteers were directed to a tank with water and ice, where they were immersed for the recovery procedure, during which blood samples were collected for later lactate and creatine kinase (CK) analysis. Variables were collected prior to the exercise and 24, 48, 72, and 96 hours after its completion. RESULTS For the CK concentration, 15 minutes at 14 °C was the best intervention option, considering the values at 72 hours after exercise, while for the moment of peak lactate an advantage was observed for immersion for 5 minutes at 14 °C. Regarding the perception of recovery, CWI for 5 minutes at 14 °C performed better long-term, from the time of the intervention to 96 hours post-exercise. For pain, no form of immersion responded better than the CG at the immediately post-intervention moment. CONCLUSIONS There were no differences in behavior between the CWI intervention groups for the outcomes studied.
-
10.
Effects of combined β-hydroxy-β-methylbutyrate (HMB) and whey protein ingestion on symptoms of eccentric exercise-induced muscle damage.
Shirato, M, Tsuchiya, Y, Sato, T, Hamano, S, Gushiken, T, Kimura, N, Ochi, E
Journal of the International Society of Sports Nutrition. 2016;:7
Abstract
BACKGROUND The purpose of this study was to examine the effects of combined β-hydroxy-β-methylbutyrate (HMB) and whey protein ingestion on muscle strength and damage following a single bout of eccentric exercise. METHODS Eighteen untrained male subjects were assigned to HMB and Whey protein (HMB + Whey; 3 g/day HMB and 36.6 g/day whey protein, n = 6), HMB (3 g/day, n = 6), or whey protein (36.6 g/day, n = 6) groups. Ingestion commenced 7 days before non-dominant elbow flexor eccentric exercise (30 deg/sec, 6 reps × 7 sets) and continued until 4 days post-exercise. The maximal isometric strength, muscle soreness, plasma creatine kinase (CK), lactate dehydrogenase (LDH) were assessed pre-exercise, and at 1, 2, 3, and 5 days after exercise. RESULTS The change scores of maximal isometric strength significantly decreased at day 1, 2, and 5 in the whey protein group compared to pre value and that in HMB + Whey protein and HMB groups decreased at day 1 and 5. The muscle soreness significantly increased in the whey and HMB + Whey protein groups at day 3 compared to pre value (p < 0.05). CK and LDH significantly increased (time effect: p < 0.05) after exercise. However, all data were not significant difference among the groups. CONCLUSIONS These results suggest that ingestion of combined HMB and whey protein does not have a role to inhibit muscle strength loss and soreness, and decrease in muscle damage markers after eccentric exercise in comparison with HMB and whey protein alone.