Remission rate

Pentostatin is effective in the treatment of hairy cell leukemia, producing 80-90% remissions (with a complete remission rate of more than 50%). The common side effects of pentostatin include myelosuppression, nausea, and skin rashes. Renal failure,... 

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

Azathioprine and 6-MP in oral doses up to 2.5 mg/kg per day have been shown to maintain remission in 45% of patients for up to 5 years.2,25,26 These drugs may be used to prevent disease recurrence after surgically-induced remission. Methotrexate in doses ranging from 12.5 to 25 mg per week given orally, intramuscularly, or subcutaneously has resulted in remission rates of up to 52% at 3 years.26,27... 

Anxiety disorders are characterized as chronic in nature with low rates of spontaneous symptom remission and high rates of relapse. Research illustrates that symptoms of anxiety disorders tend to wax and wane, with less than a third of patients remitting spontaneously.7 In a 12-year follow-up study of anxiety disorder patients, recurrence rates were similar between PD with and without agoraphobia (56% and 58%, respectively) despite great differences seen in reported rates of remission (48% and 82% with treatment, respectively).8 Fifty-eight percent of treated GAD patients experienced symptom remission, with 55% experiencing recurrence during the follow-up period. While individuals with SAD had the lowest remission rate with treatment (37%), those who did respond had the lowest rate of recurrence (39%) compared with patients with other anxiety disorders. 

The proportion of ALL in patients older than age 60 years constitutes between 16% and 31% of all adult leukemias. Treatment of adults largely has followed the conventional chemotherapeutic regimes used in childhood ALL. However, the intensification regimens common in childhood are not suitable for this population because of their associated toxic-ities in older patients. The adverse prognostic factor, the Philadelphia chromosome, occurs in 15% to 30% of adults and thus is more common in the over 60 age group.17 Based on the experience achieved in CML, the use of imatinib, a potent inhibitor of the Ph+-associated BCR-ABL tyrosine kinase, is becoming a common practice for these older adults. Results show that the combination of imatinib with conventional chemotherapy has improved remission rates compared with the use of conventional chemotherapy alone,... 

Switching non-responsive patients from an SSRI to an SNRI led 25 per cent of them to get better. Change from an SSRI to bupropion produced virtually the same remission rate (26 per cent). But what of the patients who were not switched to a different class of antidepressant, but instead were simply given another SSRI Twenty-seven per cent of these patients also got better - a remission rate that is virtually identical to that produced by changing to a different type of medication. In other words, the rate of improvement did not depend on the kind of drug to which the patient had been switched. Simply changing from one SSRI to another was as effective as changing to a completely... 

Venlafaxine extended release, duloxetine, paroxetine, and escitalopram are FDA approved for treatment of GAD. Sertraline is also effective. Acute response and remission rates are approximately 65% and 30%, respectively. Imipramine may be used when patients fail to respond to selective serotonin reuptake inhibitors (SSRIs). In one trial, diazepam, trazodone, and imipramine had greater anxiolytic activity than placebo. 

The field of antidepressant research was revolutionized in the late 1980s by the introduction of selective serotonin reuptake inhibitors (SSRIs), exemplified by fluoxetine (9). In addition to their antidepressant action, SSRIs have also proven effective for a broad range of psychiatric illnesses, and, more importantly, they demonstrated an improved tolerability profile as compared to TCAs and MAOIs due to their increased selectivity. On the other hand, SSRIs proved inferior to TCAs and MAOIs in their reduced antidepressant effects, slower onset of action, lower remission rates, and decreased ability to control the physical symptoms associated with depression. 

Sulfasalazine treatment results in an 85% remission rate in mild to moderate ulcerative colitis. Termination of therapy leads to an 80% relapse within the next year. In Crohn s disease, sulfasalazine acts primarily on involved colonic mucosa, although remission of ileal disease also has been reported. The National Cooperative Crohn s Disease Study found sulfasalazine to be better in the treatment of colonic disease, while corticosteroids were judged better in the treatment of small bowel disease. Since sulfasalazine does not prevent relapse of Crohn s disease once remission is achieved, maintenance therapy is not characteristically used. 

Carmustine and lomustine can produce remissions that last from 3 to 6 months in 40 to 50% of patients with primary brain tumors. Both drugs also are used as secondary treatment of Hodgkin s disease and in experimental combination chemotherapy for various types of lung cancer. Other tumors in which remission rates of 10 to 30% have been obtained are non-Hodgkin s lymphomas, multiple myeloma, melanoma, renal cell carcinoma, and colorectal cancer. 

Dacarbazine is the most active agent used in metastatic melanoma, producing a 20% remission rate. It is also combined with doxorubicin and other agents in the treatment of various sarcomas and Hodgkin s disease. 

The major indication for L-asparaginase is in the treatment of acute lymphoblastic leukemia complete remission rates of 50 to 60% are possible. Lack of crossresistance and bone marrow toxicity make the enzyme particularly useful in combination chemotherapy, l-Asparaginase also can be used in the treatment of certain types of lymphoma. It has no role in the treatment of nonlymphocytic leukemias or other types of cancer. 

The pharmacologic treatment of enuresis in children and adults with MR is a subject that has been more extensively studied than most other diagnoses. Enuresis causes significant anxiety for those experiencing it as well as for those who care for them. Approximately 20% of 5-year-old children wet the bed at least monthly, while by age 6 only 10% wet the bed. There is a 15% remission rate each year after age 6. 

Inadequate treatment duration is a rarely considered cause of TRD [Keller et al. 1982a, 1982b, 1982c]. In the context of TRD, a 4-to 6-week trial is inadequate to determine potential treatment efficacy. Most outcome studies have found only a 25%-30% remission rate by week 6 of treatment. Georgotas et... 

Thase ME, Entsuah AR, Rudolph RL Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry 178 234-241,2001... 

An efficacy outcome measure (e.g. change from baseline in a symptom assessment instrument, response rate according to a predefined response criterion, remission rate, time to response, time to relapse according to predefined relapse criteria, etc.). For Phase III trials the primary endpoint should be a clinical event (such as full recovery) or clinical improvement relevant to the patient (e.g. disappearance of specific symptoms). 

Bioequivalence (e.g. equivalence of efficacy) of two different galenical formulations of the same compound as measured by maintained remission rates in schizophrenic patients after an oral or depot antipsychotic formulation. 

Throughout the rest of this chapter, response and remission rates are used. Therefore, these concepts are briefly discussed here. Response is most often defined as a 50% or greater reduction in symptom severity as measured by a standardized rating assessment such as the Hamilton Depression Rating Scale (HDRS). The drawback to this approach is that response does not differentiate between partial and complete response, particularly when the initial symptom severity is high. Thus, a patient could be classified as a responder and still be quite symptomatic. In some instances, a patient could be classified as responder and still meet entry requirements for an antidepressant clinical trial based on their persistent symptom severity. 

As mentioned earlier, for certain patients there may be no class of antidepressants with better efficacy than the TCAs. For this reason alone, these medications remain a valuable part of the antidepressant armamentarium. When the dose of a TCA is adjusted based on clinic assessment of response, a TCA will produce at least a partial response in 60% to 70% of depressed patients and a full remission in 20% to 40%. When the dose is adjusted using therapeutic drug monitoring (TDM), the full remission rate may be higher. 

The optimal therapeutic range for antidepressant response with this secondary amine TCA is 110 to 160 ng/mL. The studies have found a remission rate of 59% within versus 20% outside this range. 

The results for this tertiary amine tricyclic are less convincing in terms of efficacy but quite robust with regard to toxicity. The optimal range for this medication in terms of antidepressant efficacy is approximately 80 to 150 ng/mL (amitriptyline plus nortriptyline). Studies generally found a nonsignificant trend with a remission rate of 48% within versus 29% outside this range. 

Thus, the upper limit to the therapeutic range is a function of toxicity rather than reduced efficacy in contrast to the other TCAs. Perry et al. ( 326) proposed a minimal threshold for this tertiary amine TCA of 265 ng/mL (imipramine plus desimipramine) with a remission rate of 42% above this threshold versus 15% below it. Of note, this threshold for optimal antidepressant response is closer to the threshold for CNS and cardiac toxicity than for any other TCA. Preskorn and colleagues ( 327) found a lower optimal threshold for imipramine plus desimipramine (125 ng/mL) when it was used to treat clinical depression in children and adolescents than when used in adults. 

Remission rates are higher with antidepressants or with combinations of antidepressants having dual serotonin and norepinephrine actions, as compared with those having serotonin selective actions. 

Indications that there may be antidepressant synergy from dual 5HT-NE actions that correspond with these theoretical molecular events comes from studies in which venlafaxine has produced increased remission rates in major depressive disorders as compared with SSRIs. Increased remission rates with the TCAs over the SSRIs have also been reported and support the concept of dual action being more efficacious than SSRI action alone for remission of depression in some patients. 

Solomon BL, Evaul JE, Burman KD, Wartofsky L. Remission rates with antithyroid drug therapy continuing influence of iodine intake Ann Intern Med 1987 107(4) 510-2. 

This case raises an important question regarding the dopamine-blocking effect of melatonin. Like dopamine receptor antagonists, melatonin should be used with care, because of the risk of tardive dyskinesia, which has serious morbidity and a low remission rate. Melatonin should be used with special caution in patients with organic brain damage. 

Thase ME. Effectiveness of antidepressants comparative remission rates. J Clin Psychiatry. 2003 64(suppl 2) 3-7. 

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