Adherence Challenges and Long-Acting Injectable Antipsychotic Treatment in Patients With Schizophrenia.

Adherence challenges and long-acting injectable antipsychotic treatment in patients with schizophrenia.

J Psychosoc Nurs Ment Health Serv. 2013 Mar; 51(3): 13-8
Kirk Morton N, Zubek D

Medication nonadherence has been associated with persistence of psychotic symptoms, relapse, and hospitalization in patients with schizophrenia. Patients with untreated psychosis are significantly less likely to achieve remission, whereas antipsychotic drug adherence has been associated with recovery. As such, adherence to antipsychotic drug treatment is a key issue for nurses and treatment team members caring for patients who typically are on chronic, progressive disease course. Long-acting injectable (LAI) anti-psychotic drugs, developed to improve adherence and provide and alternative antipsychotic drug treatment fro schizophrenia, have been associated with improved treatment outcomes including reduction of relapse rates approximately 30% and reduction in hospitalizations. However, LAI antipsychotic drugs remain underutilized in the United States despite a growing body of literature supporting positive outcomes of LAI versus oral antipsychotic drugs. Mental health nurses are in a key position to support improved adherence inpatients with schizophrenia through use of practical educational strategies that help patients, family members, and health care providers better understand and manage treatment. HubMed – drug

Squeezers and leaf-cutters: differential diversification and degeneration of the venom system in toxicoferan reptiles.

Mol Cell Proteomics. 2013 Apr 1;
Fry BG, Undheim EA, Ali SA, Debono J, Scheib H, Ruder T, Jackson TN, Morgenstern D, Cadwallader L, Whitehead D, Nabuurs R, van der Weerd L, Vidal N, Roelants K, Hendrikx I, Gonzalez SP, Jones A, King GF, Antunes A, Sunagar K

While it has been established that all toxicoferan squamates share a common venomous ancestor, it has remained unclear whether the maxillary and mandibular venom glands are evolving on separate gene expression trajectories or if they remain under shared genetic control. We show that identical transcripts are simultaneously expressed not only in the mandibular and maxillary glands, but also in the enigmatic snake rictal gland. Toxin molecular frameworks recovered in this study were three-finger toxin (3FTx), CRiSP, crotamine (beta-defensin), cobra venom factor, cystatin, epididymal secretory protein, kunitz, L-amino-acid oxidase, lectin, renin aspartate protease, veficolin, and vespryn. We also discovered a novel low-molecular weight disulphide bridged peptide class in pythonid glands. In the iguanian lizards, the most highly expressed are potentially antimicrobial in nature [crotamine (beta-defensin) and cystatin], with crotamine (beta-defensin) also the most diverse. However, a number of proteins characterised from anguimorph lizards and caenophidian snakes with hemotoxic or neurotoxic activities were also recruited basally and remain expressed, albeit in low levels, even in the iguanian lizards. In contrast, the basal snakes express 3FTx and lectin toxins as the dominant transcripts. Even in the constricting pythonid and boid snakes, where the glands are predominantly mucous-secreting, low-levels of toxin transcripts can be detected. Venom thus appears to play little role in feeding behaviour of most iguanian lizards or the powerful constricting snakes, and the low levels of expression argue against a defensive role. However, clearly the incipient or secondarily atrophied venom systems of these taxa may be a source of novel compounds useful in drug design and discovery. HubMed – drug

Etanercept Improves Lipid Profile and Oxidative Stress Measures in Patients with Juvenile Idiopathic Arthritis.

J Rheumatol. 2013 Apr 1;
De Sanctis S, Marcovecchio ML, Gaspari S, Del Torto M, Mohn A, Chiarelli F, Breda L

OBJECTIVE: To investigate the effect of 1-year treatment with the anti-tumor necrosis factor-? (TNF-?) drug etanercept on lipid profile and oxidative stress in children and adolescents with juvenile idiopathic arthritis (JIA). METHODS: Thirty children with JIA (22 females; mean age 12.3 ± SD 5.7 yrs), all eligible for anti-TNF-? treatment, were assessed at baseline and after 6- and 12-month treatment with etanercept. Disease activity was determined using the Juvenile Arthritis Disease Activity Score (JADAS). Blood samples were drawn to measure the acute-phase reactants C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), lipids, and the proinflammatory cytokines TNF-?, interleukin-1? (IL-1?), IL-6 and interferon-?. To measure the oxidative stress marker 8-iso-prostaglandin F2?, 24-h urine samples were collected. RESULTS: Inflammatory indicators (CRP and ESR) and JADAS scores improved significantly after 1 year of etanercept treatment (all p < 0.001). Proinflammatory cytokines showed significant reduction during the study period (all p < 0.001). Similar reductions were detected in total cholesterol (p < 0.001), low-density lipoprotein cholesterol (p = 0.04), and triglycerides (p < 0.001), whereas no significant change was found in high-density lipoprotein cholesterol. No side effects were observed during the treatment period. CONCLUSION: This study shows for the first time that anti-TNF-? therapy for JIA is associated not only with a beneficial effect on clinical disease activity and inflammatory indexes, but also with improved lipid profile and oxidative stress. These findings suggest that TNF-? blockers might reduce atherosclerotic risk in children with JIA. HubMed – drug

Efficacy and Safety of Belimumab in Patients with Rheumatoid Arthritis: A Phase II, Randomized, Double-blind, Placebo-controlled, Dose-ranging Study.

J Rheumatol. 2013 Apr 1;
Stohl W, Merrill JT, McKay JD, Lisse JR, Zhong ZJ, Freimuth WW, Genovese MC

OBJECTIVE: To evaluate the efficacy/safety of belimumab in patients with rheumatoid arthritis (RA). METHODS: Patients fulfilling American College of Rheumatology (ACR) criteria for RA for ? 1 year who had at least moderate disease activity while receiving stable disease-modifying antirheumatic drug (DMARD) therapy and failed ? 1 DMARD were randomly assigned to placebo or belimumab 1, 4, or 10 mg/kg, administered intravenously on Days 1, 14, and 28, and then every 4 weeks for 24 weeks (n = 283). This was followed by an optional 24-week extension (n = 237) in which all patients received belimumab. Primary efficacy endpoint was the Week 24 ACR20 response. RESULTS: Week 24 ACR20 responses with placebo and belimumab 1, 4, and 10 mg/kg were 15.9%, 34.7% (p = 0.010), 25.4% (p = 0.168), and 28.2% (p = 0.080), respectively. Patients taking any belimumab dose who continued with belimumab in the open-label extension had an ACR20 response of 41% at 48 weeks. A similar ACR20 response (42%) at 48 weeks was seen in patients taking placebo who switched in the extension to belimumab 10 mg/kg. Greater response rates were observed in patients who at baseline were rheumatoid factor-positive, anticitrullinated protein antibody-positive, or tumor necrosis factor inhibitor-naive, or had elevated C-reactive protein levels, Disease Activity Score 28 > 5.1, or low B lymphocyte stimulator levels (< 0.858 ng/ml). Adverse event rates were similar across treatment groups. CONCLUSION: In this phase II trial, belimumab demonstrated efficacy and was generally well tolerated in patients with RA who had failed previous therapies. [ClinicalTrials.gov identifier NCT00071812]. HubMed – drug