Clinical trials symptomatic treatment

Clinical trials and meta-analyses have demonstrated that early carotid endarterectomy (CEA) is the preferred treatment for most patients with severe symptomatic internal carotid artery (ICA) stenosis and selected patients with moderate disease.However, CEA is often delayed in chnical practice, or may not be appropriate in some patients due to an unfavorable risk-benefit profile. In these settings, it is reasonable to consider acute antithrombotic treatment to prevent early recurrent stroke. 

In clinical practice, nitrates are used on a large scale in the treatment of ischaemic heart disease, in particular stable angina. Although very effective as a symptomatic measure, it remains unclear so far whether the prognosis of patients with stable angina is improved by nitrate treatment. Clinical trials addressing this question are ungoing. 

SR003 Boyle, P., C. Robertson, F. Lowe, and C. Roehrbom. Updated meta-analysis of clinical trials of Serenoa repens extract in the treatment of symptomatic... 

Boyle, P. et al., Meta-analysis of clinical trials of permixon in the treatment of symptomatic benign prostatic hyperplasia, Urology, 55, 533-539, 2000. 

Alternatively, risk tables allow a relatively small number of important variables to be considered and have the major advantage that they do not require the calculation of any score by the clinician or patient. Fig. 27.8 shows a risk table for the five-year risk of ipsilateral ischemic stroke in patients with recently symptomatic carotid stenosis on medical treatment, derived from the ECST model. The table is based on the five variables that were both significant predictors of risk in the ECST model (Table 27.3) and yielded clinically important subgroup-treatment effect interactions in the analysis of pooled data from the relevant trials (sex, age, time since last symptomatic event, type of presenting event(s) and carotid plaque surface morphology). 

Only clozapine has shown superiority over other antipsychotics in randomized clinical trials for the management of treatment-resistant schizophrenia. Symptomatic improvement with clozapine often occurs slowly in resistant patients, and as many as 60% of patients may improve if clozapine is used for up to 6 months. 

Even though neurodegenerative diseases still have no cure, specific symptoms may be amenable to medical treatment (Table 39.3). While few randomized clinical trials of symptomatic therapy have been performed in individual neurodegenerative... 

The cascade of apoptosis may be promoted by mitogen activated protein (MAP) kinase activation. CEP1347, a small molecule MAP kinase inhibitor that crosses the blood brain barrier is protective in MPTP-treated mice (Saporito et al., 1999). A clinical trial showed good tolerability, no interference with L-dopa pharmacokinetics, and no symptomatic effects of treatment over a 4-week period (Parkinson Study Group, 2004). A larger phase II trial has commenced. 

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