摘要:

Executive SummaryDaily medications required for the moderate-to-severe, persistent categories of asthma are the long-acting inhaled beta2-agonists as well as inhaled corticosteroids. Theophylline (a methylxanthine) is an accepted, but not preferred, alternative to the beta2-agonists in the more severe categories. For mild asthma, if daily medication (i.e., long-term control, or “maintenance”) is needed, nedocromil (or cromolyn) or inhaled corticosteroids, or anti-inflammatory drugs, are usually prescribed.Recent therapeutic guidelines call for early and aggressive intervention to prevent the airway-remodeling process that can develop over the length of the disease state. A chronic state of inflammation can induce long-term changes in the composition and function of the smooth muscle and underlying tissue structural matrix in the lungs, and an increase in fibroblast proliferation. The resulting mechanical alteration severely restricts airflow, and may be responsible for the treatment-refractory state observed in severe asthma cases.The beta-adrenergic (beta2-agonist) class of agents, such as albuterol, act as bronchodilators, and have been the mainstay of asthma therapy for several decades. The ongoing development of this class has resulted in agents that can be inhaled for amelioration of acute asthmatic attacks to provide rapid restoration of breathing function in these emergency and potentially life-threatening crises.Inhaled glucocorticoids are viewed as the gold standard for anti-inflammatory therapy. Compared to other classes, their impact on the inflammatory process is wider, as they exert their effects on a larger number of pathways and at an earlier phase of the inflammatory cascade compared to the LTRAs and beta-adrenergic agents, which act at more specific targets in the allergic response.The leukotriene receptor antagonists (LTRAs) prevent increase in vascular permeability, reduce the recruitment of leukocytes, and increase airway mucus secretion elicited by the leukotrienes. As they have displayed the desired antiinflammatory effect with increased patient exposure, they are being viewed as the agent of choice for the mild episodic, pediatric, and potentially for the mild persistent cases, with the inhaled glucocorticoids being reserved as a secondline option in these patient subtypes.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Executive SummaryUnderlying atherosclerotic disease results in partial blockage of large and medium-sized arteries in the heart. In some patients, this results in myocardial ischemia that produces an imbalance between myocardial oxygen supply and oxygen demand. The pain of angina is believed to result from this imbalance.The American Heart Association estimated that 6.4 million Americans had angina in 1998. This is based on the NHANES III Survey data. However, only about 3.5 million of these people are actually diagnosed with angina, while the remainder generally have silent ischemia, and are therefore rarely diagnosed. Latest estimates suggest that 550,000 new cases of angina are diagnosed every year in the US.Stable angina and post-myocardial infarction (post- MI) therapies are considered together because both are chronic conditions and require ongoing therapies. Similarly, patients hospitalized for unstable angina may be managed with many of the same agents. However, patients with a history of MI are at much greater risk of experiencing a second major adverse cardiac event than individuals with stable angina.Gene therapy provides a new possibility to treat patients with stable angina that is refractory to standard therapies. Introducing angiogenic growth factors is hoped to induce the growth of new collateral blood vessels, and provide a blood supply to formerly ischemic tissue. This mechanism occurs naturally in some individuals, who remain asymptomatic in spite of atherosclerosis of the coronary arteries.Technologies that alter the metabolism of heart cells, enabling them to use oxygen more efficiently, represent a novel strategy for treatment of angina. Clinical trials have shown positive results, particularly when used in addition to standard therapies. In addition, these agents do not affect heart rate or blood pressure. Interest in this technology revived in the late 1990's.Calcium channel antagonists are the dominant therapy today accounting for over 50% of the market. While their sales will continue to be dominant throughout the decade, it is expected that other platforms will be perceived as displacing them beginning in 2005.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Executive SummaryThere are estimated to be more than 100 types of HPV with 60 types identified so far. Of these 60, 30 can infect the genital areas – vulva, vagina, cervix, rectum, anus, scrotum and penis. Most types of HPV do not seem to cause any harm. However, some types certainly cause genital warts and others may cause cell changes that increase the risk of cervical and certain other cancers.HPV is also the leading cause of abnormal PAP smears and precancerous changes for the cervix. At present, there is no known cure for HPV. More than 24 million people in North America are infected with HPV. More than 1 million new cases are diagnosed each year.A number of vaccine programs are being pursued for HPV, including a couple of genetic vaccines. Unfortunately, the existence of over 100 HPV strains, or types, make the designing of a general vaccine difficult. Most programs concentrate on one or more of four types: the two most commonly associated with cervical dysplasia (HPV-16 and HPV-18) and the two most commonly associated with condyloma acuminata (HPV-6 and HPV-11).The major therapeutic treatment for condyloma acuminata involves the use of potent topicals containing an acid (trichloroacetic acid) as a keratolytic agent or podophyllotoxin (Podocon-25, Condylox) as an antimitotic agent. These topicals treat the condition by killing the cells in which the virus resides. They have the advantage of being relatively inexpensive and patient-administered; therefore, they will continue to be a major treatment modality.In 2000, market sales for HPV agents were $165 million, up 27% over $130 million in 1999. This growth is attributed primarily to expanded use of drug therapy.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Executive SummaryThe lifetime risk for a 50-year-old man to develop clinical prostate cancer is 9.5%. Symptoms include difficulty in urination, weak or interrupted flow, frequent urination, pain or burning during urination, continuous pain in the lower back or upper thighs. Progression is unpredictable. It progresses very slowly in some men, who do well for years without any treatment. In others, the disease is highly invasive and leads to early death.Progress in prostate cancer research has been slow, partially due to the lack of suitable animal models. Compared with all other cancers, the incidence of prostate carcinoma increases most rapidly with age. Despite the increasing prevalence of the disease, the underlying mechanisms of prostate cancer growth are basically unknown. Recent molecular studies have suggested roles for activated ras oncogenes in prostate carcinogenesis.Hormonal therapy is the first-line treatment for metastatic prostate cancer, and a number of ablative therapies have been developed based upon blocking the actions of androgens.Signal transduction and apoptosis agonists remain the areas of most intense development effort, although an approved product is still off in the future. Hormone therapy, although there are approved products in the market is still a very active area of development.Surgery and radiation therapy will continue to play major roles in the treatment of prostate cancer at least through 2010. Hormone therapies (antiandrogens, LHRH/GnRH modulators) are expected to remain the mainstay for prostate cancer therapy throughout the forecast horizon. No substantial change in the management of this condition is expected to occur in the near term. Toward the middle of the decade, signal transduction and angiogenesis inhibitors are expected to also play a moderate role in treatment, especially in hormone refractory cases of prostate cancer.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Executive SummaryThe most important advance toward understanding the disease came in 1817 with the publication of “Essay on the Shaking Palsy” by James Parkinson, a London surgeon. He was the first to identify the group of symptoms characteristic of Parkinson's disease.As the disease progresses, impairment worsens and eventually the patient is unable to get out of bed without assistance and is confined to a wheelchair. The mean age of onset is 58 years, and while the rate of disease progression varies from patient-topatient, the average interval from the initial signs of Parkinson's disease to late-stage disease is about 15 years.Although there have not been any absolute epidemiologic studies on Parkinson's disease, medical experts believe that up to 1 million Americans have Parkinson's disease; another 50,000 cases are diagnosed each year.A number of Parkinsonian symptoms are common enough to be known as the cardinal signs of the condition. All are primarily physical in nature, at least in the early stages of the disease, and include a resting tremor, rigidity, slowed movement and postural instability. One or more of these symptoms is always present in Parkinson's disease.Dementia is also associated with Parkinson's disease. Approximately 20% of the patient population suffers from some form of dementia, and most often this occurs in the later stages of the disease. It is important to keep in mind cognitive abnormalities are usually present in the Parkinson's disease patients, and the manifestation of these abnormalities can often be misdiagnosed as dementia.Levodopa and its combinations remain the most effective medication to relieve symptoms. As the disease progresses, rational polypharmacy (combination therapy) increasingly becomes necessary.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Executive SummaryCMV can be life-threatening for immunocompromised patients, including those with AIDS and those undergoing organ transplants or chemotherapy. In the bone marrow and solid organ transplant population, CMV can cause life-threatening pneumonia. In the AIDS patient population, retinitis caused by CMV is the primary cause of blindness.CMV is generally a very common viral infection. It is the most common viral infection known to be transmitted to the fetus during pregnancy and is the leading infectious cause of birth defects in the United States.CMV infections afflict the greatest number of AIDS patients after Pneumocystis carinii. The incidence for this infection in the US is estimated at approximately 18,000. There is a great deal of evidence that transmission of the virus is primarily cell to cell. Sexual transmission and perinatal transmission appear to be of epidemiological importance, as incidence rates are higher in young infants and young adults than they are in other age groups.The use of interferon in transplant recipients has reduced shedding of the virus and apparently improved the associated clinical conditions. The use of specific intravenous immunoglobulins with and without DHPG is associated with reduced CMV-associated symptoms in BMT.The FDA's approval of Varivax vaccine for varicella (chicken pox) in 1995 marked a milestone in the fight against herpes viral diseases. For the first time a vaccine had been shown to be effective in preventing a herpes virus infection, giving hope that vaccines could be developed for HSV, CMV, and other herpes viruses as well.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS