By Q. Bozep. University of Texas at Tyler. 2018.
There was no statistically significant difference in the ability of the niacin extended-release and simvastatin fixed-dose combination compared to simvastatin alone in achieving the National Cholesterol Education Program Adult Treatment Panel III low-density lipoprotein cholesterol 110 goals based on 1 study sildenafil 100mg low cost. Achievement of National Cholesterol Education Program low-density lipoprotein cholesterol goals of fixed-dose combination products Fixed-dose combination LDL-C < 100 mg/dL or LDL-C < 70 mg/dL or product 2 buy sildenafil 75 mg on line. A comparative effectiveness review and meta-analysis was recently conducted by the Agency for Healthcare Research and Quality. Its conclusions regarding combination lipid- 115 lowering products are consistent with the results of this review. How do statins and fixed-dose combination products containing a statin and another lipid-lowering drug compare in their ability to increase high- density lipoprotein cholesterol? Summary of findings • When statins are provided in doses that reduce low-density lipoprotein cholesterol by equivalent amounts, a similar percent increase in high-density lipoprotein cholesterol can be achieved. Statins Page 31 of 128 Final Report Update 5 Drug Effectiveness Review Project • Some studies found greater increases in high-density lipoprotein cholesterol with low- dose rosuvastatin compared with atorvastatin, while other studies found no difference. Are there doses for each statin or fixed-dose combination product containing a statin and another lipid-lowering drug that produce similar percent increase in high-density lipoprotein cholesterol between statins? Statins A previous meta-analysis of placebo-controlled trials estimated that, on average, statins increased high-density lipoprotein cholesterol by 3 mg/dL (0. In our review of 77 head-to-head trials, statins raised high-density lipoprotein cholesterol levels from 0% to 19%, with the great majority between 5% and 9% (Evidence Table 1). While most found no significant difference in high- density lipoprotein cholesterol-raising among the statins, there were some exceptions. In 6 head-to-head studies of low-density lipoprotein cholesterol lowering, simvastatin 38, 41, 52, 55, 58, 68 increased high-density lipoprotein cholesterol more than atorvastatin 10 to 80 mg, 26, 29, 30, 39, 42, 48, but in 14 others, there was no significant difference between the 2 on this measure. Patients were then randomized to simvastatin 40 mg or atorvastatin 40 mg for 8 weeks, when the atorvastatin dose was increased to 80 mg while the simvastatin dose remained the same. The non-equivalent dosing and patient inclusion criteria limited the utility of this finding. There was 1 meta-analysis of randomized controlled trials of atorvastatin and simvastatin which demonstrated that simvastatin was generally associated with greater increases in high-density lipoprotein cholesterol than atorvastatin, with the greatest significance at the 12 higher doses of atorvastatin. Two studies that compared atorvastatin to simvastatin were designed to measure high- 33, 59 density lipoprotein cholesterol raising as a primary outcome. A 24-week study of 917 patients randomized to atorvastatin 80 mg or simvastatin 80 mg reported only an average of the 33 increase at weeks 18 and 24, separately, by baseline high-density lipoprotein cholesterol level. The average increase was the same in patients with baseline high-density lipoprotein cholesterol above and below 40 mg/dL: 2. These differences were not statistically significant. In the other study Statins Page 32 of 128 Final Report Update 5 Drug Effectiveness Review Project 59 reporting high-density lipoprotein cholesterol as a primary outcome, 826 patients were randomized to atorvastatin (20 mg daily for 6 weeks, then 40 mg daily) or simvastatin (40 mg daily for 6 weeks, then 80 mg daily) for 36 weeks. The primary endpoint was the average of results from weeks 6 and 12. The mean percent increase in high-density lipoprotein cholesterol was greater in the simvastatin group (9. High-density lipoprotein cholesterol increased by 9. At lower doses, the difference was not significant (percent change not reported). Nine head-to-head trials (in 11 publications) reported high-density lipoprotein cholesterol 14, 17, 20, 36, 43, 56, 69, 92-94, 98 increases with rosuvastatin compared with atorvastatin. Five studies reported greater increases in high-density lipoprotein cholesterol with rosuvastatin 5 or 10 mg 20, 36, 43, 93, 94 than with atorvastatin 10 mg. A sixth study of fair quality reported no difference 69 between the 2 drugs at the same doses. Two studies reported greater increases with rosuvastatin 10 mg than with atorvastatin 20 mg (with one showing a decrease in high-density lipoprotein 17, 98 cholesterol). Two studies reported greater increases with rosuvastatin 40 mg compared with 14, 20 atorvastatin 80 mg. Six head-to-head studies comparing low-dose rosuvastatin (5 or 10 mg) to low-dose atorvastatin (10 or 20 mg) reported no significant difference in change in high- 16, 21-24, 28, 91 density lipoprotein cholesterol.
The side effects of conventional drug treatments for IBS/C cheap 100 mg sildenafil. Stephenson JJ generic sildenafil 100mg otc, Barghout V, Kahler KH, Fernandes J, Beaulieu JF, Joo S, et al. Effectiveness of tegaserod therapy on GI-related resource utilization in a managed care population. Long-term follow-up of medically treated childhood constipation. Tarpila S, Tarpila A, Grohn P, Silvennoinen T, Lindberg L. Efficacy of ground flaxseed on constipation in patients with irritable bowel syndrome. Current Topics in Nutraceuticals Research 2004;2(2):119-25. Thompson WG, Creed F, Drossman DA, Heaton KW, Mazzacca G. Functional bowel disease and functional abdominal pain. Tomas-Ridocci M, Anon R, Minguez M, Zaragoza A, Ballester J, Benages A. What is the most effective way for relieving constipation in children aged >1 year? Tytgat GN, Heading RC, Muller-Lissner S, Kamm MA, Scholmerich J, Berstad A, et al. Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting. A comparative study: the efficacy of liquid paraffin and lactulose in management of chronic functional constipation. Biofeedback training in treatment of childhood constipation: a randomised controlled study. Constipation Drugs Page 90 of 141 Final Report Drug Effectiveness Review Project 109. Constipation and solitary encopresis; diagnostic work-up and therapy]. Management of constipation in residents with dementia: sorbitol effectiveness and cost. Management of constipation in residents with dementia: sorbitol effectiveness and cost. Macrogol 4000 in treatment of chronic functional constipation of aged patients. Chinese Journal of New Drugs and Clinical Remedies (China) 2004;23:101-03. Constipation Drugs Page 91 of 141 Final Report Drug Effectiveness Review Project EVIDENCE TABLES Constipation Drugs Page 92 of 141 Final Report Drug Effectiveness Review Project C h ronicC onstipationandIB S-C 32 ST U DY : A uth ors,article#: A ndorskyand G oldner Y ear: 1990 C ountry:U SA F U N DIN G : N R R ESEA R C H O B JEC T IV E: Com pareclinicalefficacyandsafetyof PE G 3350vs. Y ear: 1995 C ountry:U S F U N DIN G : Proctor& G am bleCo. N /A Duration: 8weeks 8weeks Samplesize: 11 11 IN C L U SIO N C R IT ER IA : Subjectivechronic constipation:definedaspassageof <= 3stools/weekforatleast6m onths;subjects entered4-wkbaselinephase,andonlythosewhowereconfirm edonbasisof stooldiariestodem onstrate constipationwererandom ized;fullym obile& healthyonbasisof m edicalhistory& physicalex am ;19- 85yrs. Y ear:1995 PO PU L A T IO N G roupssimilar atbaseline:N o,theydifferinsex anddurationof constipation C H A R A C T ER IST IC S: psyllium placebo M eanage(years): 52. Y ear:1995 R ESU L T S: H ealth O utcomeM easures: • Stoolfrequencyincreasedsignificantlyafter8wkspsyllium treatm ent(3. A dh erence/C ompliance: N R Constipation Drugs Page 98 of 141 Final Report Drug Effectiveness Review Project A N A L Y SIS: IT T :Y es Postrandomizationexclusions:N o A DEQ U A T ER A N DO M IZ A T IO N : N R A DEQ U A T EA L L O C A T IO N N R C O N C EA L M EN T : B L IN DIN G O F O U T C O M E yes A SSESSO R S: A T T R IT IO N (overall): O verallattrition: 0 Differentialattritionh igh : N o A T T R IT IO N (treatmentspecific): psyllium placebo T otalattrition: 0 0 W ith drawalsdueto adverseevents: 0 0 Q U A L IT Y R A T IN G : F air Constipation Drugs Page 99 of 141 Final Report Drug Effectiveness Review Project C h ronicC onstipationandIB S-C 43 ST U DY : A uth ors,article#:A ttar etal. F U N DIN G : N R R ESEA R C H O B JEC T IV E: Tocom paretheefficacyof PE G andlactuloseinchronic constipation DESIG N : Studydesign:singleblindR CT— asthetreatm entsdifferedinappearanceandtaste,patientsm ayknow whichtheyreceived Setting:M ulti-center, m ulticenter,10centersinF ranceandScotland,patientsrecruitedfrom outpatient gastroenterologyandgeriatric institutions Samplesize:115 IN T ER V EN T IO N : PEG 3350 (with electrolytes) lactulose Dose: 13. Y ear:2004 PO PU L A T IO N G roupssimilar atbaseline: Y es C H A R A C T ER IST IC S: PEG 3350 lactulose M eanage(years): 55 55 Patientsaged 65 yearsor older (% ): 41. Y ear:1999 A DV ER SEEV EN T S: PEG 3350 lactulose O veralladverseeffectsreported: N R N R M ediandailyepisodesof: • diarrhea 0. A dh erence/C ompliance: N R A N A L Y SIS: IT T :no Postrandomizationexclusions:N R A DEQ U A T ER A N DO M IZ A T IO N : yes A DEQ U A T EA L L O C A T IO N N R C O N C EA L M EN T : B L IN DIN G O F O U T C O M E D efacto“no”becausepatientsm ayhaveknownthedrug duetotaste/appearance,theoutcom eassessors A SSESSO R S: andprovidersm ayhavelearnedthataswell A T T R IT IO N (overall): O verallattrition: 13% Differentialattritionh igh :no A T T R IT IO N (treatmentspecific): PEG 3350 lactulose T otalattrition: 10 6 W ith drawalsdueto adverseevents: 2 1 Q U A L IT Y R A T IN G : Poor Constipation Drugs Page 102 of 141 Final Report Drug Effectiveness Review Project C h ronicC onstipationandIB S-C 33 ST U DY : A uth ors,article#: C leveland etal.
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