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Current Opinion in Pulmonary Medicine Sep 2009Several studies have investigated fatigue among sarcoidosis patients. The purpose of this review is to analyze published data on the assessment, prevalence, etiology,... (Review)
Review
PURPOSE OF REVIEW
Several studies have investigated fatigue among sarcoidosis patients. The purpose of this review is to analyze published data on the assessment, prevalence, etiology, and treatment of sarcoidosis-associated fatigue.
RECENT FINDINGS
Fatigue was identified as a prominent problem in sarcoidosis, and its presence was frequently associated with impaired quality of life, compared with patients without fatigue. Although the studies with good methodological fatigue assessment found no relationship between clinical parameters and fatigue in sarcoidosis patients, the remaining studies reported associations between fatigue and clinical and psychological parameters. No studies were designed to analyze the etiology of fatigue, but some studies showed that prednisone-treated patients reported more fatigue compared with untreated patients. In addition, only one study focused on a treatment for fatigue, dexmethylphenidate hydrochloride. Several instruments to measure fatigue were used, with the Fatigue Assessment Scale most frequently utilized.
SUMMARY
This review illustrates the importance of fatigue as an under-recognized complication of sarcoidosis. It further emphasizes the need for longitudinal prospective studies to better define sarcoidosis fatigue, explore its impact on quality of life, define aggravating or alleviating factors and evaluate new potential treatment strategies.
Topics: Fatigue; Glucocorticoids; Humans; Prognosis; Quality of Life; Sarcoidosis
PubMed: 19458531
DOI: 10.1097/MCP.0b013e32832d0403 -
European Journal of Clinical... Mar 2013Attention deficit hyperactivity disorder (ADHD) in adulthood is increasingly diagnosed and treated. Methylphenidate is frequently advocated as a first-line... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Attention deficit hyperactivity disorder (ADHD) in adulthood is increasingly diagnosed and treated. Methylphenidate is frequently advocated as a first-line pharmacological treatment.
PURPOSE
The aim of our study was to compare all-cause discontinuation rate of methylphenidate and its pharmaceutical presentations with placebo in adults with ADHD.
METHODS
This was a systematic review and meta-analysis of randomized controlled trials comparing methylphenidate with placebo in adults with ADHD. All-cause treatment discontinuation was the primary endpoint. The efficacy in reducing ADHD symptoms and safety were the secondary endpoints.
RESULTS
Twelve studies (2,496 patients) met the inclusion criteria. Four racemic methylphenidate and one dexmethylphenidate presentations were investigated. The rate of all-cause treatment discontinuation was greater with methylphenidate than with placebo, but this difference was not statistically significant [odds ratio (OR) 1.19, 95 % confidence interval (95 % CI) 0.82-1.74, P = 0.37, I(2) = 64 %] This finding reached the conventional threshold of statistical significance after one outlier study was excluded (OR 1.44, 95 % CI 1.14-1.82, P = 0.002, I(2) = 0). Methylphenidate was more efficacious than placebo for reducing ADHD symptoms and it was associated with a higher proportion of patients dropping out due to adverse effects.
CONCLUSIONS
Despite reducing ADHD symptoms, methylphenidate showed no advantage over placebo in terms of treatment discontinuation. More attention should be given in the future to the endpoint "all-cause treatment discontinuation" when making regulatory decisions and developing clinical guidelines involving the treatment of ADHD in adulthood.
Topics: Adult; Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Chi-Square Distribution; Dexmethylphenidate Hydrochloride; Drug Administration Schedule; Endpoint Determination; Female; Humans; Male; Methylphenidate; Odds Ratio; Patient Dropouts; Randomized Controlled Trials as Topic; Research Design; Treatment Outcome
PubMed: 22983311
DOI: 10.1007/s00228-012-1390-7 -
Psychiatria Hungarica : a Magyar... 2007Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent psychiatric disorders of childhood, which persists into adulthood in 10-60% of the cases. A... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent psychiatric disorders of childhood, which persists into adulthood in 10-60% of the cases. A growing body of data suggests that pharmacotherapy of the disorder is efficacious but a comprehensive summary of available evidence from clinical trials is lacking. The aim of the article was to provide a systematic review of therapeutic efficacy observed in the pharmacological treatment of ADHD based on data from controlled clinical trials.
METHODS
We used the search engines PubMed and Medline to identify relevant clinical trials. Studies with short term, double-blind and parallel design were selected for the review.
RESULTS
Altogether, 11 trials were included in the review. Our systematic review indicated that adult ADHD is treated with the same medications as the childhood form of the disorder, including psychostimulants as the first line of treatment, antidepressants as the second line, and more recently atomoxetine as well. In view of the fact that only relatively few investigations were available within the individual drug classes, no statistically significant differences could be demonstrated among the classes; thus, our data with regard to effect size should only be considered as descriptive. Most of the investigations focused on psychostimulants, which produced a strong effect size vs. placebo. With regard to atomoxetine, only a few studies were found, in which, however, a large number of subjects were enrolled, representing the largest studies in the literature. The effect size of atomoxetine in these studies was in the medium range. This result is noteworthy since the average age of the subjects in these studies was the highest among the selected studies (more than 40 years, in contrast to less than 40 years in all other studies); this (considering the chronicity of the illness) is viewed as a predictor of poor therapeutic response. Among antidepressants, most clinical trials tested bupropion; based on these trials, this compound is expected to produce an effect size in the medium range.
CONCLUSIONS
Pharmacologic agents affecting the dopamine and norepinephrine system have been found to be effective in reducing the symptoms of adult ADHD. In half of the trials, the tested drug was a psychostimulant. The effect sizes of the studies with amphetamine, methylphenidate and dexmethylphenidate were in the high effect size range, and owing to the small number of investigations, we could not discriminate between these drugs. Based on the data available from the literature, non-stimulant medications are indicated when substance dependence or abuse is in the history, or when the side effects of psychostimulants are not tolerated by the patient.
Topics: Adrenergic Uptake Inhibitors; Adult; Antidepressive Agents, Second-Generation; Atomoxetine Hydrochloride; Attention Deficit Disorder with Hyperactivity; Bupropion; Controlled Clinical Trials as Topic; Dopamine Uptake Inhibitors; Double-Blind Method; Female; Humans; Male; Propylamines
PubMed: 18167421
DOI: No ID Found