The Efficacy of Reboxetine as an Antidepressant, a Meta-analysis of Both Continuous (Mean HAM-D Score) and Dichotomous (Response Rate) Outcomes

Reboxetine is the first selective Norepinephrine Reuptake Inhibitor (NRI). Thereare limited numbers of quantitative synthesis studies of the efficacy of this drug intreating depressive disorders. We have meta-analyzed the efficacy of the reboxetineusing both continuous and dichotomous outcome measures. Data was collected from thePubmed search of English-language studies published from 1997 to 2007 and manualsearch of retrieved articles. We have searched for controlled clinical trials of reboxetinewith any other antidepressant comparator or placebo in adults with depressivedisorders using HAM-D scale for the outcome measure. After 11 studies were selected,separate meta-analyses for the active drug and for the placebo were performed usingrandom effect model. The overall effect size compared with the other antidepressantswas -0.06 (95%CI: -0.19; 0.08), with placebo -1.54 (95%CI: -2.23; -0.85). It wascalculated using the final mean HAM-D score (continuous outcome). The pooled SDwas used when the variance was not available. Pooled odds ratios for the response rates(dichotomous outcome) were 1.04 (95%CI: 0.75; 1.46) and 2.85 (95%CI: 1.88; 4.31) forthe active drug and placebo comparisons accordingly. These results suggest that theefficacy of the reboxetine and the other antidepressants (SSRI, TCA and SNRI) on bothmeasures does not differ while it is significantly superior to placebo

Intensity-Modulated Radiotherapy with Regional Hyperthermia for High-Risk Localized Prostate Carcinoma

Background: The purpose of this study was to evaluate the efficacy and toxicity of adding regional hyperthermia to intensity-modulated radiotherapy (IMRT) plus neoadjuvant androgen deprivation therapy (ADT) for high-risk localized prostate carcinoma. Methods: Data from 121 consecutive patients with high-risk prostate carcinoma who were treated with IMRT were retrospectively analyzed. The total planned dose of IMRT was 76 Gy in 38 fractions for all patients; hyperthermia was used in 70 of 121 patients. Intra-rectal temperatures at the prostate level were measured to evaluate thermal dose. Results: Median number of heating sessions was five and the median total thermal dose of CEM43T90 was 7.5 min. Median follow-up duration was 64 months. Addition of hyperthermia to IMRT predicted better clinical relapse-free survival. Higher thermal dose with CEM43T90 (>7 min) predicted improved biochemical disease-free survival. The occurrence of acute and delayed toxicity ≥Grade 2 was not significantly different between patients with or without hyperthermia. Conclusions: IMRT plus regional hyperthermia represents a promising approach with acceptable toxicity for high-risk localized prostate carcinoma. Further studies are needed to verify the efficacy of this combined treatment

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo