BLOOD GLUCOSE MONITORING SUPPLIES Standard Coverage: TrueTrack meter and blood glucose test strips are formulary Not requiring insulin therapy: o 100 strips and lancets every 3 months Requiring insulin therapy: o 100 strips and lancets every month Exception Criteria: Meter o An alternative meter to TrueTrack may be considered in children 3 years of age or less Not requiring insulin therapy: o During adjustment of medications, may receive up to 100 strips and lancets per month for 2 months only o If experiencing frequent episodes of hypoglycemia 5 times weekly ; despite education and regimen adjustment, may receive up to 200 strips and lancets every 3 months Requiring insulin therapy: o During adjustment of intensive insulin therapy 3 injections per day of short-acting and long-acting insulin ; or initiation of an insulin pump, may receive up to 200 strips and lancets per month for 2 months only o If receiving intensive insulin therapy 3 injections per day of short-acting and long-acting insulin ; or on an insulin pump, may receive 150 strips and lancet per month. Managing physician must submit plan and instructions for patient. Alternative amounts of blood glucose testing supplies may be requested by provider based on medical necessity. 11 02; Approved by the Pharmacy and Therapeutics Committee 11 12 02; Revised 12 03; Reviewed 12 05, 6 THIAZOLIDINEDIONES PIOGLITAZONE - ACTOS, ROSIGLITAZONE - AVANDIA ; Indications: Management of type 2 diabetes alone or in combination with sulfonylureas, metformin, or insulin Dosage: Pioglitazone: 1545 mg po qd Rosiglitazone 48 mg daily divided qd- bid Contraindications Precautions: Hepatic dysfunction Congestive heart failure NYHA class III and IV ; Fluid retention can occur which may lead to, or exacerbate, congestive heart failure when either drug is used as monotherapy or in combination with insulin. Monitoring: LFT's before initiating therapy and every 2 months for the first 12 months of therapy then periodically thereafter. If ALT increases 1-2.5 times the upper limit of normal, close clinical and laboratory monitoring is indicated. If ALT increases to 3 times the upper limit of normal, reevaluate and discontinue therapy if the ALT remains elevated. A1C every 3-6 months Criteria for Use: Baseline A1C 7% obtained within the previous 2 months prior to request Failure to achieve an A1C 7% on maximal doses of combination therapy including a sulfonylurea e.g., glyburide 10 mg daily ; and metformin 2000 mg daily ; for at least 4 months. If there is a contraindication to the use of either a sulfonylurea or metformin, the patient must be on a maximal dose of the alternative agent. OR Failure to achieve an A1C 7% on an insulin dose of 50 units daily. In addition, must have failed a combination of insulin with a maximal dose of Page 48 of 51.
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The results of the Diabetes Control and Complications Trial DCCT ; and UK Prospective Diabetes Study trials in type 1 and type 2 diabetes, respectively, have proved the importance of intensive glucose management in the prevention of microvascular complications retinopathy, nephropathy, and neuropathy ; . Both trials showed encouraging trends for a decrease in macrovascular complications, and this is being pursued in new studies. These findings have led to more strict goals for glucose control. As glucose levels are aimed to be closer to the normal range, the risk for hypoglycemia also increases dramatically. The choice of the agent therefore is more influenced currently by the risk for hypoglycemia. There are presently four classes of oral antihyperglycemic agents. These agents differ greatly in terms of mechanisms of action, efficacy, side effect profiles, and cost. Except for Acarbose, all classes decrease the glycosylated hemoglobin by a similar magnitude: 1.0 to 1.5%. In chronic renal failure, the oral agents that can be used therefore include the insulin secretagogues repaglinide and nateglinide and the thiazolidinediones rosiglitazone and pioglitazone ; with caution. Insulin also can be used safely in renal failure. J Soc Nephrol 16: S7S10, 2005. doi: 10.1681 ASN.2004110974.
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Instructions: We often gain a greater appreciation of the work epidemiologists do by analyzing a major disease outbreak or epidemic such as TB, food poisoning, influenza, the spread of HIV, cholera, Lyme disease, mad cow disease, or SARS from a local, state, national or global level. Small groups of 6-8 trainees will each analyze and report on a specific disease outbreak. The emergence of infectious disease may be from manmade or natural changes in the environment e.g., Lyme disease ; , demographic shifts in populations e.g., HIV ; , international travel e.g., cholera ; , technological and industrial changes e.g., hemolytic uremic syndrome in the Northwest in 1993 ; , adaptation of microbes e.g., antibiotic resistant organisms ; , or from lapses in the public health system e.g., food-borne infections ; . The analysis may involve an historical or current situation and should demonstrate the use of descriptive and inferential statistics. Qualitative data from diaries e.g., diaries of victims the 14th century bubonic plague in Europe ; or first-person accounts e.g., interviews with local public health officials ; regarding the disease outbreak could also be used to appreciate the importance of studying the distribution and determinants of diseases in human populations.
Daily for 16 weeks and found a reduction in fasting glucose from 185 to 139 mg dl, in A1C from 8.5 to 7.1%, and in FFA from 789 to 656 Eq l, with increases in adiponectin from 6.2 to 18.2 g ml and a 33% increase in insulin-mediated total body glucose disposal; this correlated with both improved insulin-stimulated insulin receptor substrate-1 tyrosine phosphorylation and with adiponectin. Krzyzanowska et al. abstract 508 ; treated eight healthy men with 8 mg rosiglitazone daily versus placebo for 21 days, with adiponectin increasing from 5.9 to 14.3 g ml and FFAs decreasing from 377 to 188 mol l, while no effect on either parameter was seen in eight men given placebo. With infusion of heparin and a lipid emulsion on day 21, FFA levels increased to a lesser extent and adiponectin further increased to 18.1 g ml with rosiglitazone. Insulin sensitivity decreased similarly in both groups, however, suggesting that the TZD-induced increase in adiponectin may not explain the insulin sensitizing effects of these agents. TZDs may allow more sustained glycemic control than seen with sulfonylureas. Spanheimer et al. abstract 320 ; treated 2, 120 individuals with pioglitazone versus glyburide with metformin if needed ; for 3 years, with insulin added for A1C levels 7.5%. Baseline A1C was 9.5%, and glycemic control was comparable in the two groups for the 1st year of study, but a significantly greater decline was seen in A1C in the pioglitazone group from 72 to 156 weeks by 22.5 versus 1.52% in those randomized to glyburide. Markolf et al. abstract 604 ; randomized 500 metformin-treated type 2 diabetic individuals to 30 mg pioglitazone versus 3.5 mg glyburide daily, finding that A1C decreased from a baseline of 8.5% by 1% vs. 0.6%, with 22 vs. 55% requiring insulin over the subsequent 3.5 years for annual progression rates to insulin of 7 vs. 16%. Oerter et al. abstract 539 ; reported a 96-week study of pioglitazone versus glyburide in 173 versus 206 metformin-treated individuals in 58 "routine care" outpatient clinics. A1C decreased from a baseline of 7.8% by 0.8 vs. 0.6%, and fasting glucose from a baseline of 164 mg dl by 18 versus 9 mg dl, with medication costs of 1, 436 versus 687 , but total treatment costs of 2, 448 versus 2, 163 , as the thiazolidinedione was associated with lower admission rates. The potency of TZDs is not, however, sufficient for all individuals with poor glycemic control. Davidson et al. abstract 569 and piracetam.
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It is well accepted that TZDs may cause volume expansion and peripheral edema. The edema that sometimes accompanies the use of a TZD can be worrisome, because it may be a harbinger of congestive heart failure CHF ; .31 There is a growing concern that the use of TZDs is associated with CHF, 27 although this relationship is unclear. The American Heart Association and the American Diabetes Association have issued an official statement on the use of TZDs and have developed guidelines to minimize the risk of heart failure. The possible association of TZDs with the risk of CHF has been documented in several studies, although no prospective controlled clinical trials have been completed.32, 33 Tang et al., at the Cleveland Clinic, 31 reported that despite the association of TZDs with an increased risk of edema, the additional risk of cardiovascular disease attributable to TZDs is relatively small. On the other hand, a published longitudinal observational study by Delea et al.34 reported that the initiation of TZDs was associated with an increased risk of incident CHF hazard ratio 1.7; P .001 ; . If TZDs do confer an increased risk for CHF, one might expect a doseresponse effect; however, no such evidence was reported in the Delea study. Researchers are conducting a long-term study, funded by the American Diabetes Association, of TZD use and CHF in the Kaiser Permanente Northern California Diabetes Registry. Preliminary analyses have noted a substantially elevated prevalence of several markers of disease severity, including poor glycemic control HbA1c above 9.5% ; , among patients initiating new diabetes medications compared with patients who were not starting new therapies. Moreover, compared with those initiating other therapies, the TZD initiators had more CHF risk factors, including the greatest prevalence of ischemic heart disease, hypertension, elevated urinary albumin excretion, elevated serum creatinine, microalbuminuria, and obesity; the poorest glycemic control; and the lowest mean HDL-C levels. These patients were also those most likely to need medications for dyslipidemia and hypertension, and they had the highest utilization of outpatient and inpatient services. In an observational study by Masoudi et al., 35 the use of a TZD combined with metformin was not associated with increased mortality in older patients with diabetes and heart failure. The authors also noted that patients in their study sample might have better outcomes with the use of either TZDs or metformin. Thus, TZDs were initiated more frequently in diabetic patients with more advanced disease. Because there are no generic TZDs at present, these expensive therapies will probably be reserved for more severe or advanced cases of diabetes. with sensitivity to this product or any of its components.4 Pioglitazone is contraindicated for patients with diabetic ketoacidosis, hypersensitivity to pioglitazone products, or New York Heart Association class III or IV CHF.5 and piroxicam.
Reflexology treatment is not always advisable during pregnancy, and all complementary medicines should be taken under supervision of a qualified practitioner. Feverfew should not be used during pregnancy. Non-drug treatments certainly can be helpful, and massage, cranial-sacral therapy, Bowen, acupuncture, relaxation, and biofeedback are just some found to be useful by many. Some women also find applications of heat or cold to the head can be useful. Conclusion The best advice is to take as few drugs as is practically and realistically possible for you, and at.
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10A NCAC 13F .1212 REPORTING OF ACCIDENTS AND INCIDENTS a ; An adult care home shall notify the county department of social services of any accident or incident resulting in resident death or any accident or incident resulting in injury to a resident requiring referral for emergency medical evaluation, hospitalization, or medical treatment other than first aid. b ; Notification as required in Paragraph a ; of this Rule shall be by a copy of the death report completed according to Rule .1208 of this Subchapter or a written report that shall provide the following information: 1 ; resident's name; 2 ; name of staff who discovered the accident or incident; 3 ; name of the person preparing the report; 4 ; how, when and where the accident or incident occurred; 5 ; nature of the injury; 6 ; what was done for the resident, including any follow-up care; 7 ; time of notification or attempts at notification of the resident's responsible person or contact person as required in Paragraph e ; of this Rule; and 8 ; signature of the administrator or administrator-in-charge. c ; The report as required in Paragraph b ; of this Rule shall be submitted to the county department of social services by mail, telefacsimile, electronic mail, or in person within 48 hours of the initial discovery or knowledge by staff of the accident or incident. d ; The facility shall immediately notify the county department of social services in accordance with G.S. 108A-102 and the local law enforcement authority as required by law of any mental or physical abuse, neglect or exploitation of a resident. e ; The facility shall assure the notification of a resident's responsible person or contact person, as indicated on the Resident Register, of the following, unless the resident or his responsible person or contact person objects to such notification: 1 ; any injury to or illness of the resident requiring medical treatment or referral for emergency medical evaluation, with notification to be as soon as possible but no later than 24 hours from the time of the initial discovery or knowledge of the injury or illness by staff and documented in the resident's file; and 2 ; any incident of the resident falling or elopement which does not result in injury requiring medical treatment or referral for emergency medical evaluation, with notification to be as soon as possible but not later than 48 hours from the time of initial discovery or knowledge of the incident by staff and documented in the resident's file, except for elopement requiring immediate notification according to Rule .0906 f ; 4 ; of this Subchapter. f ; When a resident is at risk that death or physical harm will occur as a result of physical violence by another person, the facility shall immediately report the situation to the local law enforcement authority. g ; In the case of physical assault by a resident or whenever there is a risk that death or physical harm will occur due to the actions or behavior of a resident, the facility shall immediately: 1 ; seek the assistance of the local law enforcement authority; 2 ; provide additional supervision of the threatening resident to protect others from harm; 3 ; seek any needed emergency medical treatment; 4 ; make a referral to the Local Management Entity for Mental Health Services or mental health provider for emergency treatment of the threatening resident; and 5 ; cooperate with assessment personnel assigned to the case by the Local Management Entity for Mental Health Services or mental health provider to enable them to provide their earliest possible assessment. h ; The facility shall immediately report any assault resulting in harm to a resident or other person in the facility to the local law enforcement authority. History Note: Authority G.S. 131D-2; 143B-165; Eff. July 1, 2005. AVAILABILITY OF CORRECTIVE ACTION AND SURVEY REPORTS and pletal.
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To 6 mg day ; , titrated for optimal glycemic control. Inclusion criteria included an age of 40 to years, HbA1c: 6.6% to 9.9%, absence of significant hepatic or renal disease, absence of congestive heart failure New York Heart Association functional class II to IV ; , cigarette smoking, and no known carotid artery disease. All study measurements were obtained at study entry and after 26 2 weeks. In order to improve metabolic control, individual medical advice was given to every patient throughout the study. In the pioglitazone group, other additional oral antidiabetic therapy was permitted except for metformin, while only TZDs were excluded for additional treatment in the glimepiride group. All blood draws and measurements were performed in the morning after fasting of the patients from midnight onward. Biochemical parameters. HbA1c was determined by means of high-pressure liquid chromatography Adams TMA1c, Menarini Diagnostics, Florence, Italy ; . Therapy response was defined as an absolute decrease in HbA1c from baseline by at least 0.6% normal reference range: 4.2% to 6.0% ; . Glucose was assessed using a standard glucose oxidase reference method Ruhrtal Labortechnik, Mhnesee-Delecke, Germany ; , and lipids total cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], triglycerides ; were measured by means of standard dry chemistry methods OSR, Olympus Diagnostica, Hamburg, Germany ; . Insulin was measured using a chemiluminescence method Sciema, Mainz, Germany ; , PAI-I by ELISA American Diagnostica, Pfungstadt, Germany ; , endothelin by ELISA Biomedica, Vienna, Austria ; , and adiponectin by radioimmunoassay Linco, St. Charles, Missouri ELISAs from R&D Systems Wiesbaden, Germany ; were used for the determination of the following parameters: ICAM, VCAM, vascular endothelial growth factor [VEGF], MMP-9, MCP-1. The sCD40L determinations were also performed by ELISA Bender Medsystems, Vienna, Austria ; . Turbimetric methods were used for the following parameters: high-sensitivity C-reactive protein hsCRP ; Olympus, Hamburg, Germany ; , fibrinogen Dade Behring, Schwalbach, Germany ; , and vonWillebrand factor Instrumentation Laboratory GmbH, Kirchheim, Germany ; . High-sensitive C-reactive protein changes 15 mg l during the observation period were attributed to other inflammatory processes flu, cold, and so on ; and were eliminated before analysis. Carotid intima-media thickness IMT ; . Carotid IMT was evaluated at all time points by a single operator with high-resolution B-mode ultrasound on a single machine Caris Plus, Esaote SpA, Genoa, Italy ; with a 10-MHz linear array transducer LA 523 ; . All recordings were performed in a standardized way, and readings were analyzed by a physician blinded to patient profile and treatment assignment as described previously 20, 21 ; . Statistical analysis. The analysis of efficacy is based on the intention-to-treat population, which consists of all patients and premphase.
5 pharmacological and surgical intervention for the prevention of diabetes.
Redondo S, Ruiz E, Santos-Gallego CG, Padilla E, Tejerina T 2005 ; Pioglitazone induces vascular smooth muscle cell apoptosis through a peroxisome proliferatoractivated receptor-gamma, transforming growth factor-beta1, and a Smad2dependent mechanism. Diabetes 54: 811-817 and propranolol.
Develop an international network of opinion leaders in the medical field to assist in the development of new products, for example, pioglitazone with metformin.
American heart association's scientific sessions 200 2 mazzone t, et al effects of pioglitazone and glimepiride on carotid intima-media thickness in type 2 diabetes ' results of the chicago study and proscar.
Phenylephrine HCl Hydrocodone Bit Chlorpheniramine.73 Phenylephrine HCl Promethazine HCl .75 Phenytoin.25 Phos-Flur.44 Phospholine Iodide.66 Phrenilin .20, 23 Phytonadione .33, 82 Pilocarpine HCl .66, 85 Pilopine HS.66 Pimecrolimus .42 Pindolol.34 Pioglitazone HCl.48 Piroxicam .56 Plaquenil .15, 58 Plavix .33, 82 Plendil.35 Podofilox .42 Polaramine, Repetab.71 Poly-Vi-Flor .81 Polycitra .80 Polycitra-K .80 Polymyxin B Sulfate Trimethoprim .68 Polysporin .68 Polytrim .68 Potassium Bicarbonate Citric Acid .84 Potassium Chloride .53, 84 Potassium Chloride Potassium Bicarbonate Citric Acid.84 Potassium Citrate .80 Potassium Gluconate .84 Potassium Iodide .45 Pramipexole.24 Pravachol.37 Pravastatin Sodium.37 Prazosin HCl.36 Pred Forte.69 Prednisolone Acetate .69-70 Prednisolone Sodium Phosphate .45, 57, 69-70, Prednisolone.45, 57, 72 Prednisone.45, 57, 72 Prelone .45, 57, 72 Premarin.59, 63.
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12.1 Oral Agents 12.1.1 Biguanides Fasting glucose results may be requested if prescribed as a single agent 729159 Metformin Glucophage 815225 Metformin 719285 Metformin 729167 Metformin 815233 Metformin 719293 Metformin 703909 Metformin 12.1.2 Sulphonylureas 894502 Glibenclamide 781258 Glibenclamide 868906 Gliclazide 834599 Gliclazide 838209 Gliclazide 700717 Gliclazide 700639 Gliclazide 834866 Gliclazide 12.1.4 Thiazolidinediones: Motivation Required 707974 Pioglitazone 707981 Pioglitazone 899496 Rosiglitazone 899499 Rosiglitazone 12.2.1 Biphasic 733512 Insulin 793876 Insulin 816213 Insulin 853437 Insulin 861782 Insulin 853461 Insulin 783811 Insulin 863572 Insulin 825794 Insulin 702086 Insulin 702089 Insulin 12.2.2 Intermediate Acting 733458 Insulin 863556 Insulin 853453 Insulin Actraphane Actraphane Actraphane Humalog Mix 25 Humalog Mix 25 Humalog Mix 25 Humulin 30 70 Humulin 30 70 Humulin 30 70 Novomix Novomix Humulin N Humulin N Humulin N 10ml 3ml VIAL PENFILL PENSET VIAL CARTRIDGE DISP PEN VIAL CARTRIDGE DISP PEN FLEXPEN CARTRIDGE VIAL CARTRIDGE DISP PEN Sandoz Metformin FCT 500 Sandoz Metformin Glucophage Sandoz Metformin FCT 850 Sandoz Metformin Glucophage Diacare Sandoz-glibenclamide Diaglucide Glucomed Glycron Glygard Merck-gliclazide Sandoz gliclazide Cipla pioglitazone Cipla pioglitazone Avandia Avandia 500mg TAB FCT TAB TAB FCT TAB TAB TAB TAB TAB TAB TAB TAB TAB TAB TAB TAB TAB TAB Only for patients intolerant of pioglitazone Only for patients intolerant of pioglitazone and provera.
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There has been no substantiated evidence of liver toxicity with rosiglitazone and pioglitazone and rabeprazole.
New england journal of medicine 1996; 334 : 1380-1388 type ii evidence - summary of randomised controlled trials ii.
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Patients had albumin excretion rates AERs ; determined by measurement of albumin and creatinine in random morning urine specimens. AER is defined as the albuminkreatinine ratio. sGeometric mean; "p 0.001. [Data from Lebovitz, H.E., Dole, J.F., Pahwrdhan, R., Rappaport, E.B., and Freed, M.I. J. Clin. Endocrinol. Metab. 85, in press.] common to all PPARy agonists. Hepatotoxicity appears to be specific to troglitazone, while random, unexplained, transient elevations of serum creatine phosphokinase CPK ; activity have been reported only with pioglitazone. Weight gain, increase in plasma volume, edema, and increased plasma LDL cholesterol concentration appear to be class effects of PPARr agonists.
Department of Internal Medicine I R.H.S., K.-D.P., B.L., J.S. ; , Department of Internal Medicine II B.K.K. ; , Department of Laboratory Medicine R.E. ; , University of Regensburg Medical Center Regensburg, Germany; Institute for Surgical Research C.H. ; , Rikshospitalet, University of Oslo, Oslo, Norway.
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None of the models considered included the potential impact of weight gain on mortality. As discussed in the review of the clinical effectiveness of pioglitazone, pioglitazone has been shown to have a marked and progressive effect in increasing body weight. Although the effect of obesity on mortality independent of the effect of lipid concentrations is controversial, there remains the possibility that the increase in body weight due to pioglitazone usage may have an adverse impact on long-term mortality. It is a key shortcoming that these effects are not included in the models.
Pregnancy and lactation safety in pregnancy and lactation has not been established see contra-indications, for instance, actos pioglitazone hydrochloride.
ET-01. COMBINED TREATMENT WITH FOTEMUSTINE ENHANCES EFFECTS OF LOW RADIATION DOSES ON GLIOMA XENOGRAFT IN NUDE MICE P. Beauchesne, C. Lucas, R. Pedeux, S. Bertrand, R. Branche, R. Revel, J.F. Dore; Unite INSERM U590, Centre L. Berard, Lyon; Institut de Recherches Internationales SERVIER, Courbevoie; NeuroOncologieNeurologie, CHU de Nancy, Nancy; France Purpose: Malignant gliomas display aggressive local behaviour and are not cured by existing therapies. Glioma cells are considered to be radioresistant; however, we previously showed that they can be sensitive to low-dose irradiations both in vitro and in vivo Beauchesne et al., 2003 ; . So far, no chemotherapeutic drug used alone has demonstrated dramatic short-term benefits for glioblastoma. The aim of the present study was to evaluate the antitumour activity of fotemustine administered alone or in combination with fractionated low radiation doses on a subcutaneous human malignant glioma xenograft. Materials and Methods: G152 glioma cells, an established malignant glioma cell line, were inoculated under sterile conditions by subcutaneous route in the interscapular area of nude mice 1 tumour per animal ; . Two different administration schedules of a same total dose of fotemustine i.p. were evaluated: 40 mg kg day on days 1, 8 or 8 mg kg day daily for 5 consecutive days per week for 2 weeks. First, tolerance was evaluated in healthy mice. Then fotemustine efficiency was studied in tumour-bearing mice, either alone or in combination with fractionated radiation. Results: A total of 42 animals were distributed in 6 groups as follows: Control group solvent only, days 15 and 812 ; , fotemustine i.p. alone dose 1 D1 ; 40 mg kg day on days 1 and 8 ; or D2 mg kg day on days 15 and 812 ; , irradiation alone 0.8 3 Gy ; , and fotemustine i.p. D1 or D2, combined with irradiation. The tolerance was excellent in healthy mice for both groups of treatment with fotemustine alone. In grafted animals, the weekly dose of fotemustine administered alone or with radiation therapy was not tolerated, with the death of all but one animal. Conversely, the daily administration of fotemustine alone was safe, and the concurrent administration with radiation therapy was more effective than ultrafractionated regimen alone. Conclusions: The continuous administration of low doses of fotemustine by i.p. route with radiation therapy was safe and enhanced the effect of ultrafractionated low radiation doses. These results warrant further studies to validate their clinical implications and piracetam.
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