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Rachel Soon, 6 days ago

On 8 August, the first town hall held by the Ministry of Health (MOH) with members of the pharmacy profession took place in Putrajaya. Over 500 pharmacists from across the country and from different areas of practice—community and hospital, public and private, academy and industry—converged to fill the auditorium for the chance to engage in direct dialogue with MOH.

Jackey Suen, 08 Oct 2018

Adding pertuzumab to trastuzumab plus an aromatase inhibitor (AI) improves progression-free survival (PFS) in patients with HER2-positive metastatic or locally advanced breast cancer, the phase II PERTAIN study has shown.

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Use of alpha blockers in the treatment of hypertension in women is associated with an increased risk of hypotension and related events as compared with other blood pressure-lowering drugs, as reported in a recent study.
Dr. Bryan Li, Dr. Gerry Kwok, Dr. Thomas Yau, 07 Aug 2019

Case 1: A 59-year-old gentleman with advanced HCC was referred to our centre for management. He had a history of diabetes, hypertension and ischaemic heart disease. He was a nondrinker and not a carrier of hepatitis B or C.

Case 2: A 65-year-old man with a history of alcoholic cirrhosis and oesophageal varices was found to have rising AFP levels on routine follow-up. He also had a 3-year history of diabetes and was on diet control, with an HbA1c of 6.2 percent and fasting glucose of 6.8 mmol/L. He did not need any diabetic medications.

Febuxostat a promising urate-lowering treatment in patients with renal impairment

Jairia Dela Cruz
04 Sep 2018

Both the extended- and immediate-release formulations of febuxostat are effective and well tolerated in the treatment of gout patients with normal or impaired renal function, according to the results of a phase III trial.

“[F]ebuxostat XR [extended release] formulations were developed with the aim of providing comparable or superior urate-lowering efficacy vs their febuxostat IR [immediate release] counterparts, with reductions in treatment-initiated flares due to a more stable drug exposure profile,” the investigators said.

Based on the present data, equivalent doses of febuxostat XR and IR have similar treatment effects on serum urate (sUA) levels, showing the potential to manage hyperuricaemia in patients with renal impairment, for whom treatment options are limited, they added.

In the trial, 1,783 patients (mean age 55.1 years; 88.4 percent male) with a history of gout and normal or impaired (mild to severe) renal function were randomized to receive once-daily treatment with placebo (n=357), febuxostat IR 40 mg (n=357) or 80 mg (n=357), or XR 40 mg (n=355) or 80 mg (n=357) orally for 3 months. The overall mean serum urate (sUA) at baseline was 9.61 mg/dL, and 65.1 percent of patients had baseline sUA ≥9.0 mg/dL.

At month 3, the primary endpoint of sUA <5.0 mg/dL occurred with greater frequency across all febuxostat formulation and dose groups vs the placebo group (p<0.001 for all comparisons). The proportion of patients achieving this endpoint was greater in the XR vs IR 40-mg group (25.9 percent vs 15.7 percent; p=0.001) but did not differ significantly between the XR vs IR 80-mg group (50.1 percent vs 42.6 percent). [Arthritis Rheumatol 2018;doi:10.1002/art.40685]

Similar results were obtained for the secondary endpoint of sUA <6.0 mg/dL, with the study drug showing superiority over placebo (p<0.001 for all comparisons), whereas treatment effects were comparable between equivalent doses of XR and IR formulations (40 mg: 48.2 percent vs 40.3 percent; 80 mg: 61.1 percent vs 57.7 percent). On the other hand, the number of patients with ≥1 gout flare requiring treatment over 3 months was similar across treatment groups (range, 20.7–27.2 percent).

Of note, the superior urate-lowering effects of febuxostat vs placebo were seen across renal function subgroups, including patients with severe renal impairment.

The study drug was well tolerated. Commonly reported TEAEs—such as diarrhoea, hypertension, nasopharyngitis, arthralgia and upper respiratory tract infection—were evenly distributed across the renal function subgroups, with no apparent trends emerging between febuxostat doses or formulations.

“This trial represents the largest investigation of febuxostat in patients with renal impairment, including severe renal impairment, and the stratification of randomization by renal function (severe or not severe) helped to maintain a balanced distribution of patients with various degrees of renal impairment across treatment groups at baseline,” the investigators said.

Despite the presence of several limitations, the results add to the growing evidence supporting the use of febuxostat in the management of hyperuricaemia in patients with renal impairment, they added.

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Most Read Articles
Rachel Soon, 6 days ago

On 8 August, the first town hall held by the Ministry of Health (MOH) with members of the pharmacy profession took place in Putrajaya. Over 500 pharmacists from across the country and from different areas of practice—community and hospital, public and private, academy and industry—converged to fill the auditorium for the chance to engage in direct dialogue with MOH.

Jackey Suen, 08 Oct 2018

Adding pertuzumab to trastuzumab plus an aromatase inhibitor (AI) improves progression-free survival (PFS) in patients with HER2-positive metastatic or locally advanced breast cancer, the phase II PERTAIN study has shown.

05 Aug 2019
Use of alpha blockers in the treatment of hypertension in women is associated with an increased risk of hypotension and related events as compared with other blood pressure-lowering drugs, as reported in a recent study.
Dr. Bryan Li, Dr. Gerry Kwok, Dr. Thomas Yau, 07 Aug 2019

Case 1: A 59-year-old gentleman with advanced HCC was referred to our centre for management. He had a history of diabetes, hypertension and ischaemic heart disease. He was a nondrinker and not a carrier of hepatitis B or C.

Case 2: A 65-year-old man with a history of alcoholic cirrhosis and oesophageal varices was found to have rising AFP levels on routine follow-up. He also had a 3-year history of diabetes and was on diet control, with an HbA1c of 6.2 percent and fasting glucose of 6.8 mmol/L. He did not need any diabetic medications.