Activism / treatment / standard of care
From: doe (ironjustice_at_aol.comdoe)
Date: 06/23/04
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Date: 23 Jun 2004 11:08:37 GMT
With over forty percent of diabetics now being recommended for iron reduction
therapy and with studies showing regression of vision loss one might / could ?
.. expect this treatment to become .. standard of care?
With a little bit of .. pressure .. it could .. ?
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The “accelerated approval” program. In this scenario, the treatment gets
approval on the basis of “surrogate markers,” such as regression of a
tumor, rather than demonstrated clinical benefit, such as increased survival.
Treatments can go into a “priority review” if a treatment would be a
significant improvement over drugs already on the market. And they can “fast
track” a treatment by submitting data on a rolling timetable, as the research
marches along, not just at the end of the process.
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The article states that among type II insulin-resistant diabetic patients,
40% have elevated ferritin and should be considered for phlebotomy therapy.
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Diabetes Metab 2002 Sep;28(4 Pt 1):335-9
[Do the insulin resistance associated hepatic iron overload must be
researched during diabetes mellitus type II?]
[Article in French]
Roblin X, Chevassus P, Boudemaghe T, Palayodan A
Departement de Medecine Interne et Hepato-gastro-enterologie, Centre
hospitalier de Gap, 05007 Gap Cedex.
[Medline record in process]
The insulin resistance-associated hepatic iron overload is the first
aetiology of iron overload disorders in France. If we do not know its
mechanism, the prevalence among type II diabetic patients is around 40%.
Hyperferritinaemia is present in all cases, but is not specific of the
diagnosis. This pathology features liver fibrosis among 10% of the patients
and some cases of primary liver cancer have been described. Moreover, a large
body of evidence favors the direct involvement of iron in the development of
extra hepatic neoplasia, while therapeutic phlebotomy to maintain low to
normal body iron stores can prevent all known complications of insulin
resistance-associated hepatic iron overload. In addition, treatment of type
II diabetes mellitus and other features of insulin resistance syndrome is
essential. In conclusion, it is important to detect this syndrome during type
II diabetes mellitus.
PMID: 12442073, UI: 22328961
http://www.biospace.com/news_story.cfm?StoryID=16417520&full=1
These data suggest the key to minimizing vision loss is earlier detection
through increased screenings and treatments that inhibit progression of
diabetic macular edema toward the center of the macula.
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Graefes Arch Clin Exp Ophthalmol. 2001 Dec;239(12):909-14. Related Articles,
Links
Effect of isovolemic hemodilution in central retinal vein occlusion.
Glacet-Bernard A, Zourdani A, Milhoub M, Maraqua N, Coscas G, Soubrane G.
University Eye Clinic of Creteil, Intercommunal and Henri Mondor (Assistance
Publique des Hjpitaux de Paris) Hospitals, University of Paris XII, France.
agnes.glacet@chicreteil.fr
BACKGROUND: Hemorheologic abnormalities have recently been shown to play a role
in the pathogenesis of retinal vein occlusion (RVO), and several studies have
demonstrated the efficacy of isovolemic hemodilution in these eyes. This study
was designed to investigate further the effects of hemodilution, with regard to
the duration of symptoms before the treatment. METHODS: In a prospective study,
142 eyes with central or hemicentral RVO were treated by isovolemic
hemodilution. The target hematocrit value was 35%. Mean duration of follow-up
was 10 months. A subgroup of 50 patients treated within 2 weeks of the onset of
symptoms was compared first with patients treated later by hemodilution, and
then retrospectively with controls with central RVO and without hemodilution.
RESULTS: Hemodilution therapy resulted in a decrease in hematocrit level from
42% to 32% on average, with no major side effect. After treatment, a
significant decrease was observed in hemorheologic parameters (fibrinogen,
erythrocyte aggregation), except in plasma viscosity. Retinal circulation times
were significantly shortened. Visual acuity (VA) improvement immediately after
treatment (in 43% of eyes) was correlated with better final visual outcome
(P<0.05). At the end of follow-up, VA was better in patients treated within the
first 2 weeks than in those treated later and in controls (41% had VA of 20/40
or more in the early-treatment group versus 23% in the late-treatment group,
P<0.01). Final retinal ischemia was also greater in the late-treatment group
and in controls. Hemodilution in 12 patients with long-standing RVO and macular
edema was ineffective. CONCLUSION: Our study is consistent with previous
investigations that confirmed the efficacy of isovolemic hemodilution in RVO on
hemorheologic parameters, retinal circulation times and final VA. It also
underlined strongly the benefit of early treatment within the first 2 weeks of
the RVO. Further studies are required to confirm these results.
PMID: 11820695 [PubMed - indexed for MEDLINE]
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Tom
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