Reducing risks of osteoporosis fractures in Crohn’s disease with impact and resistance training

Cr. John Arano

Source from MIMS.com

A recent study shows that combined impact and resistance training exercises helps raise bone mineral density (BMD) and muscle function, which benefits patients with Crohn’s disease (CD) who has a high risk in developing osteoporosis and related fractures.

Researchers selected adults with stable CD (n=47, mean age=49.3 years) and were assigned to undergo an exercise intervention (n=23) or receive usual care alone (n=24) for 6 months. Usual care plus a combined impact and resistance training programme were given to the exercise group while patients underwent three 60-minutes sessions per week, with a gradual tapering of supervision to self-management.

Most of the patients had quiescent disease and none of the patients smoked. 216 months median time since the CD diagnosis and according to baseline BMD measurements, 12 patients had evidence of osteopaenia or osteoporosis at the lumbar spine and 20 at the left hip. The most common medications used for CD were immunosuppressants and biologics; none were on corticosteroids.

The bone mineral density (BMD) values were better in the exercise vs the control group at 6 months, with the difference significant at lumbar spine, but not at femoral neck nor at greater trochanter.

Even though there were three exercise-related adverse events (for instance light-headedness and nausea) the intervention yielded improvements in all muscle function outcomes and fatigue severity.

The findings highlight the intervention as a suitable model of exercise for reducing the future risk of osteoporotic fractures and physical disability in this high‐risk population, according to researchers.

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No adverse CV outcomes and excess risks of death from Febuxostat

Cr. Halacious

Source from MIMS.com

According to the results of a meta-analysis, the use of febuxostat does not appear to come with an increased hazard of mortality or adverse cardiovascular (CV) outcomes, for the treatment of patients with gout and hyperuricemia.

Data from 15 randomized controlled trials were collected by researchers and contributed to a total of 16,070 participants. The proportion of patients with hypertension varied between 27.7 percent and 100.0 percent, while those with diabetes ranged from 6.9 percent to 100.0 percent.

A median follow-up of 6.4 months were used across the trials, and the use of febuxostat vs control (allopurinol or placebo) did not result in a significant increase in the risk of CV mortality and all-cause mortality.

The same was true for adverse CV outcomes, as follows: major adverse CV events (risk difference [RD] 1.40 percent), myocardial infarction (RD, -0.06 percent), stroke (RD, 0.10 percent), or new-onset hypertension (RD, 1.58 percent).

Among patients with existing CV disease, the findings were consistent and the test (Egger’s regression test) did not detect significant publication bias.

The evidence were limited by the presence of low to moderate certainty, the researchers said. Recommendations of evaluating CV events and mortality as an outcome were stated by the researchers, as well as defining major adverse CV events, and comparing the outcomes among different doses of febuxostat over a longer follow-up duration in future trials.

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Therapeutic potential in COVID-19 with colchicine

Cr. Fusion Medical Animation

Source from MIMS.com

Based on a study, survival rate in patients with COVID-19 was improved with the use of colchicine, which are usually used for the treatment of gout and other inflammatory disorders as compared with standard of care (SoC).

The well-recognised anti-inflammatory effects and potential antiviral properties made it as one of the drugs that was considered for the treatment of COVID-19.  140 hospitalized patients who contracted COVID-19 had their outcomes evaluated as they were treated with SoC (hydroxychloroquine and/or intravenous dexamethasone; and/or lopinavir/ritonavir) and in 122 patients treated with colchicine and SoC.

The SoC group, have lower serum concentrations of C-reactive prottein and ferritin, as well as neutrophil count but higher PaO2/FiO2 ratio at baseline.

Survival when being compared over 21 days of follow-up, it was more favourable in the colchicine than the SoC group. A lower risk of death was strongly associated with colchicine, on Cox proprortional hazards regression (hazard ratio, 0.151).

At entry, there were a higher serum levels of ferritin, worse Pa02/Fi02 and poor survival at older age for the risk factors. 

With no treatment discontinuation due to severe adverse events, colchicine had a good safety profile. In nine patients, dosing was reduced from 1 to 0.5 mg/day due to diarrhoea.

With the aim of preventing the patient’s autoinflammatory response, the current study provides proof-of-concept data supporting the possible use of colchicine in the treatment of the early phase of COVID-19.

To determine the efficacy and safety of colchicine, properly designed trials are needed with the best protocol in terms of dosage and timing of administartion in patients with COVID-19, said the researchers.

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