RESUMEN
BACKGROUND: Even though treatment guidelines recommend botulinum neurotoxin A (BoNT-A) as first line treatment for primary cervical dystonia (CD), there are only limited data on how BoNT-A-injections are administered in routine clinical practice. OBJECTIVE: This subgroup analysis evaluated patient satisfaction and symptom control under consideration of BoNTA treatment modalities in German and Austrian CD patients (DE/AT, nâ¯= 79) compared to the full international cohort (nâ¯= 995). MATERIAL AND METHODS: The INTEREST-IN-CD2 was a prospective, multicenter, longitudinal observational study. Course of treatment in adult primary CD patients under BoNTA treatment was assessed over a time period of 3 years. Primary outcome measure was the long-term satisfaction of patients with treatment, measured as maximum satisfaction between two consecutive injections as well as satisfaction at the time of reinjection. RESULTS: Treatment satisfaction at the maximum effect was stable and comparably good in both populations during the study (82.3-92.7% and 85.0-89.9%). Satisfaction decreased with decreasing BoNTA effect at the end of the treatment interval: it was comparable at the start of the study in both groups (54.2% vs. 51.4%), decreased numerically in the DE/AT group to 32.7% but remained stable in the total population. Analysis of Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Tsui scores did not reveal any substantial differences between the DE/AT subgroup and total cohort. CONCLUSION: Overall, the study confirmed good clinical symptom control by BoNTA. The numerical differences in the current satisfaction seen in the comparison of DE/AT to the total cohort are possibly due to different proportions of BoNTA naïve patients in both groups, as they expressed different levels of satisfaction than previously treated patients.
Asunto(s)
Toxinas Botulínicas Tipo A , Satisfacción del Paciente , Tortícolis , Adulto , Austria , Toxinas Botulínicas Tipo A/uso terapéutico , Alemania , Humanos , Estudios Longitudinales , Estudios Prospectivos , Tortícolis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Arteriovenous fistula (AVF) is the common vascular access type for a hemodialysis patient. Its failure is due to neointimal hyperplasia. Vitamin K antagonists are given to lower thrombosis tendency, but have side effects that enhance arterial calcifications. Here, we investigated the effects of vitamin K antagonists and vitamin K2 (K2) treatment on neointimal hyperplasia development and calcification in rats and in arterialized human veins. AVF was generated in female rats while chronic kidney disease (CKD) was induced using an adenine-enriched diet. Arterialization, CKD, and vitamin K antagonists all significantly enhanced venous neointimal hyperplasia. K2 treatment, additional to vitamin K antagonists, significantly reduced neointimal hyperplasia in arterialized veins in healthy rats but not in rats with CKD. Arterialization, CKD, and vitamin K antagonism all significantly increased, whereas K2 supplementation attenuated calcification in healthy rats and rats with CKD. K2 significantly enhanced matrix Gla protein carboxylation in control rats and rats with CKD. Arterialized human vein samples contained inactive matrix Gla protein at calcification and neointimal hyperplasia sites, indicating local vitamin K deficiency. Thus, vitamin K antagonists have detrimental effects on AVF remodeling, whereas K2 reduced neointimal hyperplasia and calcification indicating vasoprotective effects. Hence, K2 administration may be useful to prevent neointimal hyperplasia and calcification in arterialized veins