Experience with a third generation recombinant factor VIII concentrate (Advate ® ) for immune tolerance induction in patients with haemophilia A

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73338/1/j.1365-2516.2008.01960.x.pd

Subcutaneous injection of hyaluronidase with recombinant human insulin compared with insulin lispro in type 1 diabetes

Aims Prandial treatment with human regular insulin for diabetes may result in early postprandial hyperglycaemia and late hypoglycaemia due to its slow onset and long duration of action. This study compared injections of recombinant human insulin (rHI) formulated with recombinant human hyaluronidase [rHuPH20] (INSULIN‐PH20) to insulin lispro for prandial treatment in subjects with type 1 diabetes (T1D). Methods After a 1‐month run‐in period using twice‐daily insulin glargine (or usual basal insulin therapy for pump users) with prandial lispro, 46 subjects with T1D (42 ± 13 years; body mass index: 26 ± 4 kg/m2; A1c: 6.8 ± 0.5%) were assigned to INSULIN‐PH20 or lispro in a random sequence for two consecutive, 12‐week periods as the prandial insulin in an intensive treatment regimen. Results The mean glycaemic excursion for INSULIN‐PH20 (0.96 ± 2.00 mmol/l) was comparable (p = 0.322) to lispro (0.80 ± 1.95 mmol/l). The 8‐point self‐monitored blood glucose profiles were also comparable in the two groups. Good glycaemic control (A1c) was maintained for both treatments at 12 weeks (INSULIN‐PH20: 7.0 ± 0.5%; lispro: 6.9 ± 0.6%). Overall rates of hypoglycaemia (≤3.9 mmol/l) were 24 events per patient per 4 weeks for INSULIN‐PH20 and 22 events for lispro. There were no significant differences in adverse events or immunogenicity between treatments and both treatments were well tolerated. Conclusions Unlike commercially available formulations of regular human insulin, a formulation of rHI with rHuPH20 was comparable to lispro for postprandial glucose excursions in a basal‐bolus treatment regimen for T1D patients. Glycaemic control, safety and tolerability profiles were comparable for both treatments

Dialysis in public and private hospitals in Queensland

Background: Clinical outcomes for patients treated in public and private hospitals may be different. Aim: The aim of the study was to compare the characteristics and outcomes of patients receiving dialysis at public and private hospitals in Queensland. Methods: Incident adult dialysis patients in Queensland registered with the Australia and New Zealand Dialysis and Transplant Registry between 1999 and 2009 were classified by dialysis modality at either a public or private hospital. Outcomes were dialysis patient characteristics and survival. Results: Three thousand, three hundred and ten patients commenced dialysis in public hospitals, 1939 haemodialysis (HD) and 1371 peritoneal dialysis (PD). Seven hundred and ninety-three patients commenced dialysis in private hospitals, 757 HD and 36 PD. Compared with public HD, private HD patients were older, had more coronary artery disease and less diabetes, and were more likely to live in an urban area. Public HD patients were more likely to be obese and referred late to a nephrologist. Nearly all indigenous patients were managed in public hospitals. Private patients were more likely to have an arteriovenous fistula or graft at first HD (P < 0.001) but not after excluding late referrals (P = 0.09). Public hospitals provided longer HD sessions and more HD hours per week for all age groups except 75+ years. Compared with public hospital HD, patient survival adjusted for multiple variables was comparable for private hospital HD (hazard ratio 1.20 (95% confidence interval 0.98-1.46, P = 0.07)) but worse for public PD (hazard ratio 1.14 (95% confidence interval 1.05-1.24, P = 0.002)). Conclusion: Private HD patients are older and less likely to be diabetic than public patients. Patient survival is worse for public PD than public HD. © 2012 The Authors. Internal Medicine Journa