Comparative trials, history

Two small comparative trials in HP-negative patients with histories of NSAID-related ulcer complications suggested that a standard dosage of a PPI and a nonselective NSAID have a GI safety profile similar to that observed with a selective COX-2 inhibitor. However, the comparative benefits and cost effectiveness of these regimens remain controversial. Cotherapy with a PPI and a selective COX-2 inhibitor should be considered in patients with multiple or life-threatening risk factors. ... 

Nortriptyline. Nortriptyhne, a tricychc antidepressant, has been shown in double-blind, placebo-controlled randomized trials to be superior to placebo for smoking cessation (Prochazka et al. 1998). Nortriptyline appears to have efficacy comparable to that of bupropion for smoking cessation (Hall et al. 2002). The efficacy of this agent may be improved with more intensive behavioral therapies (Hall et al. 1998). Nortriptyline s mechanism of action is thought to relate to its noradrenergic and serotonergic reuptake blockade, because these two neurotransmitters have been implicated in the neurobiology of nicotine dependence. Side effects of nortiptyline are typical of tricyclic antidepressants and include dry mouth, blurred vision, constipation, and orthostatic hypotension. Nortriptyline appears to have some utility for smokers with a past history of major depression, and it can be recommended as a second-... 

Because the above trials showed a >50% relative reduction in total mortality with ICD therapy, MADIT II used broader entry criteria for primary prevention of SCD, removing the criteria for NSVT and EPS 1,232 patients with a history of MI > 30 days prior and an EF < 30% were randomized to conventional therapy or ICD implantation [10]. Conventional therapy was comparable in both arms and included a high rate of use of beta blockers, angiotensin-converting enzyme inhibitors, and statins (over two thirds for all medications in both arms). The trial was stopped early at 20 months because the relative reduction in total mortality... 

The largest juvenile, controlled trial of a TCA reported favorable results with DMI in 62 clinically referred children with ADHD (Biederman et al., 1989). Many of these children had previously failed to respond to psychostimulant treatment. Sixty-eight percent of DMI-treated patients were considered very much or much improved, compared with only 10% of placebo patients (p < 0.001), at an average daily dose of 5 mg/kg. In a further analysis, neither comorbidity with conduct disorder, depression, or anxiety, nor a family history of ADHD yielded differential responses to DMI treatment (Biederman et al., 1993b). In addition, DMI-treated ADHD patients showed a substantial reduction in depressive symptoms compared with placebo-treated patients. 

Serious life-threatening infections, including sepsis and pneumonia, have been reported with the use of TNF inhibitors. Patients should be evaluated for tuberculosisrisk factors and tested for latent tuberculosis infection prior to starting therapy. Concurrent use with other immunosuppressive therapy should be avoided. In clinical trials of all TNF-blocking agents more cases of lymphoma were observed compared with control patients. Patients with a prior history of prolonged phototherapy treatment should be monitored for nonmelanoma skin cancers. 

There are no studies comparing the efficacy of SLIT and drugs. Such trials would be of interest to answer the question of how IT compares with pharmacotherapy. It is important, however, to reinforce the concept that both therapies are complementary and that very likely the combination of both strategies will provide the patient with better options for both symptom control and possibly for modification of the natural history of the disease [36]. 

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