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2-year clinical outcomes after implantation of sirolimus-eluting, paclitaxel-eluting, and bare-metal coronary stents: results from the WDHR (Western Denmark Heart Registry).

https://arctichealth.org/en/permalink/ahliterature89935
Source
J Am Coll Cardiol. 2009 Feb 24;53(8):658-64
Publication Type
Article
Date
Feb-24-2009
Author
Kaltoft Anne
Jensen Lisette Okkels
Maeng Michael
Tilsted Hans Henrik
Thayssen Per
Bøttcher Morten
Lassen Jens Flensted
Krusell Lars Romer
Rasmussen Klaus
Hansen Knud Nørregaard
Pedersen Lars
Johnsen Søren Paaske
Sørensen Henrik Toft
Thuesen Leif
Author Affiliation
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. annekaltoft@stofanet.dk
Source
J Am Coll Cardiol. 2009 Feb 24;53(8):658-64
Date
Feb-24-2009
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Disease - mortality - therapy
Drug-Eluting Stents - adverse effects
Female
Humans
Immunosuppressive Agents
Male
Middle Aged
Myocardial Infarction - etiology
Paclitaxel
Sirolimus
Stents - adverse effects
Thrombosis - etiology
Abstract
OBJECTIVES: This registry study assessed the safety and efficacy of the 2 types of drug-eluting stents (DES), sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES), compared with bare-metal stents (BMS). BACKGROUND: Drug-eluting stents may increase the risk of stent thrombosis (ST), myocardial infarction (MI), and death. METHODS: A total of 12,395 consecutive patients with coronary intervention and stent implantation recorded in the Western Denmark Heart Registry from January 2002 through June 2005 were followed up for 2 years. Data on death and MI were ascertained from national medical databases. We used Cox regression analysis to control for confounding. RESULTS: The 2-year incidence of definite ST was 0.64% in BMS patients, 0.79% in DES patients (adjusted relative risk [RR]: 1.09; 95% confidence interval [CI]: 0.72 to 1.65), 0.50% in SES patients (adjusted RR: 0.63, 95% CI: 0.35 to 1.15), and 1.30% in PES patients (adjusted RR: 1.82, 95% CI: 1.13 to 2.94). The incidence of MI was 3.8% in BMS-treated patients, 4.5% in DES-treated patients (adjusted RR: 1.24, 95% CI: 1.02 to 1.51), 4.1% in SES-treated patients (adjusted RR: 1.15, 95% CI: 0.91 to 1.47), and 5.3% in PES-treated patients (adjusted RR: 1.38, 95% CI: 1.06 to 1.81). Whereas overall 2-year adjusted mortality was similar in the BMS and the 2 DES stent groups, 12- to 24-month mortality was higher in patients treated with PES (RR 1.46, 95% CI: 1.02 to 2.09). Target lesion revascularization was reduced in both DES groups. CONCLUSIONS: During 2 years of follow-up, patients treated with PES had an increased risk of ST and MI compared with those treated with BMS and SES. Mortality after 12 months was also increased in PES patients.
Notes
Comment In: J Am Coll Cardiol. 2009 Feb 24;53(8):665-619232898
PubMed ID
19232897 View in PubMed
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Avermectins inhibit multidrug resistance of tumor cells.

https://arctichealth.org/en/permalink/ahliterature179753
Source
Eur J Pharmacol. 2004 Jun 16;493(1-3):57-64
Publication Type
Article
Date
Jun-16-2004
Author
Yuri N Korystov
Natalia V Ermakova
Ludmila N Kublik
Maria Kh Levitman
Vera V Shaposhnikova
Vladimir A Mosin
Viktor A Drinyaev
Elena B Kruglyak
Tamara S Novik
Tatiana S Sterlina
Author Affiliation
Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Moscow region 142290, Russian Federation. ykorystov@rambler.ru
Source
Eur J Pharmacol. 2004 Jun 16;493(1-3):57-64
Date
Jun-16-2004
Language
English
Publication Type
Article
Keywords
Animals
Cell Division - drug effects
Cell Line, Tumor
Cell Survival - drug effects
Cyclosporine - pharmacology
Dose-Response Relationship, Drug
Drug Combinations
Drug Evaluation, Preclinical - methods
Drug Resistance, Multiple - drug effects - physiology
Drug Synergism
Fluoresceins - diagnostic use - metabolism
Fluorescence
Humans
Ivermectin - analogs & derivatives - chemistry - pharmacology
Leukemia P388 - pathology
Male
Mice
Paclitaxel - pharmacology
Rhodamine 123 - diagnostic use - metabolism - pharmacology
Russia
Vincristine - pharmacology
Abstract
The modification of the sensitivity of Hep-2 and P388 tumor cells to taxol and vincristine, substrates of multidrug resistance proteins, by naturally occurring avermectins and the effect of avermectins on the accumulation of calcein in cells and the efflux of rhodamine 123 were studied. While avermectins did not affect the sensitivity of tumor cells to hydrogen peroxide and cisplatin, they significantly enhanced the sensitivity of cells of both wild-type and resistant strains to taxol and vincristine. The coefficients of modification for resistant strains were substantially higher. Avermectins suppressed the efflux of rhodamine 123 from cells and increased the accumulation of calcein in cells. The relative inhibitory activity of avermectins depended on the cell type and on the substrate of multidrug resistance proteins whose transport they suppressed (vincristine, taxol, rhodamine 123, calcein acetoxymethyl ester). The least active was avermectin B1 or ivermectin; the most active avermectins varied depending on the substrate and the cell type. In the case of vincristine transport, the most active avermectin was almost by one order of magnitude more effective than the traditional inhibitor of multidrug resistance cyclosporin A. This property of avermectins can be used in tumor therapy by combining application of avermectins with antitumor preparations, the substrates of multidrug resistance proteins.
PubMed ID
15189764 View in PubMed
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Cancer Care Ontario's New Drug Funding Program: controlled introduction of expensive anticancer drugs.

https://arctichealth.org/en/permalink/ahliterature187097
Source
Chronic Dis Can. 2002;23(4):152-6
Publication Type
Article
Date
2002
Author
William K Evans
Marilyn Nefsky
Joseph Pater
George Browman
Donald H Cowan
Author Affiliation
Cancer Care Ontario, 620 University Avenue, Toronto, Ontario, Canada M5G 2L7. bill.evans@cancercare.on.ca
Source
Chronic Dis Can. 2002;23(4):152-6
Date
2002
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents - economics - supply & distribution - therapeutic use
Drug Costs
Drug Therapy - economics
Health Services Accessibility - economics
Humans
Neoplasms - drug therapy - economics
Ontario
Paclitaxel - economics - therapeutic use
Pharmaceutical Services - economics - organization & administration
Program Development
Regional Medical Programs
State Government
Abstract
In the mid 1990s, the high cost and increasing number of new anticancer and supportive care drugs began to result in an inequality of access to promising new treatment approaches in the Province of Ontario. Starting with a single drug, paclitaxel, in 1995, the New Drug Funding Program has evolved to a provincial program that enables cancer patients in Canada's most populous province to equitably access new and expensive, intravenously administered drugs. This article describes the development of the program, including the evolution of the administrative mechanisms necessary to manage the program and the decisions of the Policy Advisory Committee that shape provincial funding policies. In fiscal year 2000/2001, the Program made 14 drugs available for 24 indications for a total provincial expenditure of approximately $37.7 million. These intravenous drugs can now be accessed through nine Regional Cancer Centres, the province's only cancer hospital (Princess Margaret Hospital) and 80 community hospitals and will directly benefit more than 8,700 patients.
PubMed ID
12517323 View in PubMed
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Cancer treatment in Sweden--costs of drugs, inpatient and outpatient care from 1985 to 1996 and cost effectiveness of new drugs.

https://arctichealth.org/en/permalink/ahliterature21357
Source
Acta Oncol. 1998;37(5):447-53
Publication Type
Article
Date
1998
Author
G. Ragnarson Tennvall
G. Karlsson
Author Affiliation
IHE, The Swedish Institute for Health Economics, Lund. grt@ihe.se
Source
Acta Oncol. 1998;37(5):447-53
Date
1998
Language
English
Publication Type
Article
Keywords
Ambulatory Care - economics
Androgen Antagonists - economics - therapeutic use
Antineoplastic Agents - economics - therapeutic use
Cost-Benefit Analysis
Deoxycytidine - analogs & derivatives - economics - therapeutic use
Drug Costs
Filgrastim - economics - therapeutic use
Gonadorelin - economics - therapeutic use
Humans
Neoplasms - drug therapy - economics
Paclitaxel - economics - therapeutic use
Receptors, Serotonin - drug effects
Receptors, Serotonin, 5-HT3
Research Support, Non-U.S. Gov't
Sweden
Abstract
This study was carried out to investigate the direct costs for treatment of patients with cancer from 1985 to 1996 in Sweden, and to examine health economic effects of changes in treatment pattern. Material for the study was collected from official statistics and from published health economic evaluations of cancer treatment. Costs for inpatient care decreased during the period, while costs for outpatient care and drugs increased. In total, the direct health care costs for cancer treatment decreased from 1985 to 1996. New drugs registered on the market are often more expensive than the drugs they replace. From a health economic perspective it is not clear, however, that higher drug costs necessarily increase total costs. Further health economic research is needed because many treatment alternatives have not yet been evaluated, and furthermore, because a treatment option can be cost effective in one specific indication but not in another.
PubMed ID
9831373 View in PubMed
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Chemotherapy: Current drugs still have potential in advanced ovarian cancer.

https://arctichealth.org/en/permalink/ahliterature144564
Source
Nat Rev Clin Oncol. 2010 Apr;7(4):191-3
Publication Type
Article
Date
Apr-2010
Author
Thomas Hogberg
Author Affiliation
Department of Cancer Epidemiology and South Swedish Regional Tumour Registry, Lund University and Lund University Hospital, SE-221 85 Lund, Sweden. thomas.hogberg@med.lu.se
Source
Nat Rev Clin Oncol. 2010 Apr;7(4):191-3
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Antibiotics, Antineoplastic - administration & dosage - therapeutic use
Antineoplastic Agents - administration & dosage - therapeutic use
Antineoplastic Agents, Phytogenic - administration & dosage - therapeutic use
Area Under Curve
Carboplatin - administration & dosage - therapeutic use
Cisplatin - administration & dosage - therapeutic use
Confidence Intervals
Disease Progression
Doxorubicin - administration & dosage - therapeutic use
Female
Humans
Ovarian Neoplasms - drug therapy - mortality - pathology
Paclitaxel - administration & dosage - therapeutic use
Sweden
Abstract
Dose-dense administration of paclitaxel as well as intraperitoneal administration of platinum and paclitaxel as first-line treatments provide similar advantages compared with standard treatment in advanced ovarian cancer. Both approaches, however, need to be confirmed by additional studies. a low dose of pegylated liposomal doxorubicin combined with carboplatin is superior to standard paclitaxel and carboplatin in relapsed platinum-sensitive ovarian cancer.
PubMed ID
20354543 View in PubMed
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Choice of stent and outcomes after treatment of drug-eluting stent restenosis in highly complex lesions.

https://arctichealth.org/en/permalink/ahliterature125152
Source
Catheter Cardiovasc Interv. 2013 Jan 1;81(1):E16-22
Publication Type
Article
Date
Jan-1-2013
Author
Xavier Freixa
Ali S Almasood
Sohail Q Khan
Karen Mackie
Mark Osten
Douglas Ing
Christopher B Overgaard
Eric M Horlick
Peter H Seidelin
Vladimír D┼żavík
Author Affiliation
Peter Munk Cardiac Centre, University Health Network, Interventional Cardiology Program, Division of Cardiology, Toronto, Ontario, Canada.
Source
Catheter Cardiovasc Interv. 2013 Jan 1;81(1):E16-22
Date
Jan-1-2013
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary - adverse effects - instrumentation
Confidence Intervals
Coronary Angiography - methods
Coronary Restenosis - mortality - radiography - therapy
Coronary Stenosis - mortality - radiography - therapy
Drug-Eluting Stents - utilization
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Ontario
Paclitaxel - administration & dosage
Patient Selection
Prosthesis Failure
Registries
Retreatment
Retrospective Studies
Risk assessment
Severity of Illness Index
Sirolimus - administration & dosage
Survival Analysis
Treatment Outcome
Abstract
Our aim was to compare the outcomes of a same versus different drug-eluting stent (DES) implantation strategy for the treatment of DES instent restenosis (ISR).
The absence of clear data renders the treatment of DES ISR one of the most challenging situations in interventional cardiology.
We identified all cases of DES ISR treated with a second DES between January 2004 and January 2009. The lesions were divided into those treated with the same DES as the initial one that restenosed and those treated with a different DES. The main end-point was repeat target lesion revascularization (TLR).
We included 116 patients with a total of 132 lesions. The patient population was highly complex: 55.5% with diabetes, 56% with type-C lesions, 15.9% with lesions previously stented with BMS and 18.2% with fluoroscopic evidence of stent fracture. A same and different stent strategy was conducted in 41 lesions (31%) and 91 lesions (69%), respectively. Overall TLR was 31.1% and occurred in 46.3% of patients treated with the same stent and 24.4% of those with a different stent (P = 0.012). Multivariable analysis found same stent strategy (OR 2.84, 95%CI 1.23-6.57;P = 0.014) and occurrence of stent fracture (OR 4.03, 95%CI 1.33-12.01;P = 0.012) to be the only independent predictors of TLR after a median follow-up of 20.4 [12.1-30.2] months.
In highly complex lesions, DES implantation for DES ISR is linked to a high need of future revascularization. An association between implanting a DES type other than the original and lower rate of TLR is suggested.
PubMed ID
22511403 View in PubMed
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Clinical impact of second-generation everolimus-eluting stent compared with first-generation drug-eluting stents in diabetes mellitus patients: insights from a nationwide coronary intervention register.

https://arctichealth.org/en/permalink/ahliterature118728
Source
JACC Cardiovasc Interv. 2012 Nov;5(11):1141-9
Publication Type
Article
Date
Nov-2012
Author
Elvin Kedhi
Marc E Gomes
Bo Lagerqvist
J Gustav Smith
Elmir Omerovic
Stefan James
Jan Harnek
Göran K Olivecrona
Author Affiliation
Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands. kedhie@maasstadziekenhuis.nl
Source
JACC Cardiovasc Interv. 2012 Nov;5(11):1141-9
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Aged
Coronary Artery Disease - surgery
Diabetic Angiopathies - surgery
Drug-Eluting Stents
Female
Humans
Immunosuppressive Agents - administration & dosage
Male
Paclitaxel - administration & dosage
Percutaneous Coronary Intervention
Prosthesis Design
Registries
Retrospective Studies
Sirolimus - administration & dosage - analogs & derivatives
Sweden
Abstract
This study sought to study the second-generation everolimus-eluting stent (EES) as compared with first-generation sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) in diabetes mellitus (DM) patients.
There are limited data available comparing clinical outcomes in this setting with EES and SES, whereas studies comparing EES with PES are not powered for low-frequency endpoints.
All DM patients treated with EES, PES, or SES from January 18, 2007, to July 29, 2011, from the SCAAR (Swedish Coronary Angiography and Angioplasty Registery) were included. The EES was compared with SES or PES for the primary composite endpoint of clinically driven detected restenosis, definite stent thrombosis (ST), and all-cause mortality.
In 4,751 percutaneous coronary intervention-treated DM patients, 8,134 stents were implanted (EES = 3,928, PES = 2,836, SES = 1,370). The EES was associated with significantly lower event rates compared with SES (SES vs. EES hazard ratio [HR]: 1.99; 95% confidence interval (CI): 1.19 to 3.08). The same was observed when compared with PES (PES vs. EES HR: 1.33; 95% CI: 0.93 to 1.91) but did not reach statistical significance. These results were mainly driven by lower incidence of ST (SES vs. EES HR: 2.87; 95% CI: 1.08 to 7.61; PES vs. EES HR: 1.74, 95% CI: 0.82 to 3.71) and mortality (SES vs. EES HR: 2.02; 95% CI: 1.03 to 3.98; PES vs. EES HR: 1.69; 95% CI: 1.06 to 2.72). No significant differences in restenosis rates were observed between EES and SES or PES (SES vs. EES HR: 1.26; 95% CI: 0.77 to 2.08; PES vs. EES HR: 1.05; 95% CI: 0.71 to 1.55).
In all-comer DM patients the use of EES was associated with improved outcomes compared with SES and PES mainly driven by lower rates of ST and mortality. These results suggest better safety rather than efficacy with EES when compared with SES or PES.
PubMed ID
23174638 View in PubMed
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Comparison of a polymer-free rapamycin-eluting stent (YUKON) with a polymer-based paclitaxel-eluting stent (TAXUS) in real-world coronary artery lesions.

https://arctichealth.org/en/permalink/ahliterature87343
Source
Catheter Cardiovasc Interv. 2008 Feb 15;71(3):333-9
Publication Type
Article
Date
Feb-15-2008
Author
Ruef Johannes
Störger Hans
Schwarz Franz
Haase Jürgen
Author Affiliation
Red Cross Hospital Cardiology Center, Frankfurt, Germany. j.ruef@kardiocentrum-ffm.de
Source
Catheter Cardiovasc Interv. 2008 Feb 15;71(3):333-9
Date
Feb-15-2008
Language
English
Publication Type
Article
Keywords
Aged
Analysis of Variance
Angioplasty, Transluminal, Percutaneous Coronary - methods
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Aspirin - therapeutic use
Cohort Studies
Coronary Angiography - methods
Coronary Restenosis - epidemiology - radiography
Coronary Stenosis - mortality - radiography - therapy
Drug-Eluting Stents
Female
Humans
Male
Middle Aged
Paclitaxel - therapeutic use
Polymers
Probability
Prognosis
Reference Values
Risk assessment
Severity of Illness Index
Sirolimus - therapeutic use
Survival Analysis
Treatment Outcome
Vascular Patency - physiology
Vasodilator Agents - therapeutic use
Abstract
BACKGROUND: In selected patient cohorts the polymer-free rapamycin-eluting YUKON stent (A) has demonstrated noninferiority compared with the polymer-based paclitaxel-eluting TAXUS stent (B). To test for equivalency in unselected real-world patients with coronary lesions of various complexities, we retrospectively compared both stent designs. METHODS: A total of 410 patients with symptomatic CAD were successfully treated with A (n = 205) or with B (n = 205). Baseline clinical characteristics, coronary lesion location, lesion length, and the number of stents implanted per lesion were equally distributed between the treatment groups. All patients underwent QCA-analysis at baseline. Clinical follow-up with assessment of MACE and noncardiac deaths was obtained at 30 days and 6 months. RESULTS: Nominal stent diameter was 2.96 +/- 0.38 mm in Group A vs. 3.05 +/- 0.42 mm in Group B (P = 0.2); nominal length of stented segmentwas 22.97 +/-13.0 mm vs. 23.63 +/- 10.0 (P = 0.56). Analysis of MACE after 6 months resulted in one angiographically documented stent thrombosis causing MI in B (0.2%) vs. none in A. No other MI or cardiac deaths occurred in either group, while two noncardiac deaths in A (1.0%) were reported. Fifteen target lesion revascularizations (7.3%) were performed in A vs. 7 (3.4%) in B. Differences in study endpoints at 6 months did not reach statistical significance (P > 0.05). CONCLUSIONS: Up to 6 months after PCI of real-world coronary lesions, there were no statistically significant differences in MACE between patients treated with the polymer-free rapamycin-eluting YUKON stent and the polymer-based paclitaxel-eluting TAXUS stent.
Notes
Comment In: Catheter Cardiovasc Interv. 2008 Feb 15;71(3):340-118288754
PubMed ID
18288747 View in PubMed
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80 records – page 1 of 8.