Combined therapies long-term follow

Seymour JF, Pro B, Fuller LM, et al. Long-term follow-up of a prospective study of combined modality therapy for stage 1-11 indolent non-Hodgkin s lymphoma. J Clin Oncol 2003 21 2115-2122. 

Pharmacological intervention is often recommended as an adjunct to dietary modification and physical activity when other approaches have failed for patients with overweight and obesity. Currently only three medications are suitable for long-term therapy - orhstat, sibutramine, and rimonabant. These medications should only be prescribed in combination with lifestyle modifications and a structured long-term follow-up. Clinical practice... 

Administration of levodopa plus carbidopa (or benserazide) remains the most effective treatment, but does not provide benefit beyond 3-5 y and is followed by gradual loss of symptom control, on-off fluctuations, and development of orobuccofacial and limb dyskinesias. These long-term drawbacks of levodopa therapy may be delayed by early monotherapy with dopamine receptor agonists. Treatment of advanced disease requires the combined administration of antiparkinsonian agents. 

Hodgkin s disease accounts for 1% of all new cancers diagnosed in Western countries and for 15% of all malignant lymphomas. In patients with early stage lA-IIA disease without B-symptoms or bulky adenopathy, therapy consists of either extended field radiotherapy or limited duration chemotherapy, e.g. ABVD (anthracycline, bleomycin, vinblastine, dacarbazine) for 3-4 cycles followed by involved field radiotherapy. Radiation alone results in a 10-year relapse free survival of 70-75% and, because of the efficacy of salvage chemotherapy for those who relapse, an overall survival of 80-85%. The combined modality approach results in fewer relapses but overall survival is similar. In order to reduce the long term morbidity of radiation current trials are exploring combined modality treatment with lower radiation doses versus chemotherapy alone. 

Management of the motor fluctuations has largely been concentrated on attempts to prolong the duration of action of the drug, either by the use of controlled release preparations to obtain "smooth" concentration-time curves or by combining dopa with deprenyl or bromocriptine. Long-term (about 16 years) follow-up studies of patients have shown that the mean "functional" status of the patient approaches pretreatment levels after 5 years, and by 16 years all surviving patients were functionally less well than at the initiation of therapy. From such studies it may be concluded that... 

The beneficial effect of ACE inhibitors on mortality has been documented conclusively, with numerous trials showing a 20% to 30% relative reduction in mortality with ACE inhibitor therapy compared with placebo. A long-term (12-year) follow-up of the Studies of Left Ventricular Dysfunction (SOLVD) prevention and treatment trials demonstrated sustained survival benefits in patients treated with enalapril. In addition to improving survival, ACE inhibitors also reduce the combined risk of death or hospitalization, slow the progression of heart failure, and reduce the rates of reinfarction.The benefits of ACE inhibitor therapy are independent of the etiology of heart failure (ischemic versus nonischemic) and are observed in patients with mild, moderate, or severe symptoms. ACE inhibitors clearly are superior to vasodilator therapy with hydralazine-isosorbide dinitrate. ... 

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