We bring you the latest news from the healthcare about the health care in the United Kingdom.

donderdag 2 november 2017

The Lancet: [Comment] Targeting Crohn's disease

[Comment] Targeting Crohn's disease
There are many similarities between Crohn's disease and rheumatoid arthritis, such as in pathogenesis; in disconnect between symptoms, biological inflammatory activity, and structural damage; and in effective therapies (such as corticosteroids, conventional immunomodulators, and inhibitors of tumour necrosis factor). However, one area of divergence is the concept of disease modification in rheumatoid arthritis by cessation or stabilisation of structural damage to joints, which is assessed by simple x-rays of hands and calculation of joint space narrowing and erosions as a so-called "sharp score".
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[Articles] Effect of tight control management on Crohn's disease (CALM): a multicentre, randomised, controlled phase 3 trial
CALM is the first study to show that timely escalation with an anti-tumour necrosis factor therapy on the basis of clinical symptoms combined with biomarkers in patients with early Crohn's disease results in better clinical and endoscopic outcomes than symptom-driven decisions alone. Future studies should assess the effects of such a strategy on long-term outcomes such as bowel damage, surgeries, hospital admissions, and disability.
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[Articles] Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial
Among elderly patients who have PCI, a DES and a short duration of DAPT are better than BMS and a similar duration of DAPT with respect to the occurrence of all-cause mortality, myocardial infarction, stroke, and ischaemia-driven target lesion revascularisation. A strategy of combination of a DES to reduce the risk of subsequent repeat revascularisations with a short BMS-like DAPT regimen to reduce the risk of bleeding event is an attractive option for elderly patients who have PCI.
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[Comment] A SENIOR moment? Bare-metal stents in elderly patients
The WHO International Day of Older Persons1 was on Oct 1, 2017, and saw the release of guidelines on integrated care and equality of care for older people. Now, 40 years since the first percutaneous coronary intervention (PCI),2 we still do not know the optimal revascularisation strategy in elderly patients. Interventionalists face two important questions when considering PCI in elderly patients. First, should drug-eluting stents (DES) be mandated in elderly patients since they tend to have greater numbers of complex coronary lesions with calcification, tortuosity, and bifurcations than do younger patients3 and DES have been shown to be better than bare-metal stents (BMS), particularly in complex lesions?4 Second, since DES require a longer duration of dual antiplatelet therapy (6–12 months) than do BMS (1 month), does the benefit of DES outweigh the risk associated with extended DAPT (dual antiplatelet therapy; risk of life-threatening bleeding) or should patients have shortened DAPT with its attendant risk of myocardial infarction and stent thrombosis?5
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[Articles] Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial
In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time by more than the effect of a placebo procedure. The efficacy of invasive procedures can be assessed with a placebo control, as is standard for pharmacotherapy.
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