RESUMEN
BACKGROUND: Epoetin alfa (EPO) and darbepoetin alfa (DPO) are erythropoiesis-stimulating agents that are widely and interchangeably used for the treatment of anemia in patients with advanced chronic kidney disease and end-stage renal disease. No study has specifically compared the risks of hard study outcomes between EPO and DPO, including mortality. STUDY DESIGN: Systematic review of the literature and meta-analysis. SETTING & POPULATION: Patients enrolled in randomized trials comparing EPO versus DPO for the treatment of anemia in adults with chronic kidney disease, including those requiring dialysis. SELECTION CRITERIA FOR STUDIES: We conducted a systematic search of the literature (PubMed, CENTRAL, SCOPUS, and EMBASE, all years) and industry resources, using predefined search terms and data abstraction tools. We then summarized key characteristics and findings of these trials and performed a random-effects meta-analysis of trials with at least 3 months' duration to identify the summary OR of mortality between patients randomly assigned to DPO versus EPO. INTERVENTION: DPO versus EPO. OUTCOME: All-cause mortality. RESULTS: We identified 9 trials that met the stated inclusion criteria. Overall, 2,024 patients were included in the meta-analysis, of whom 126 died during follow-up, which ranged from 20 to 52 weeks. We found no significant difference in mortality between patients randomly assigned to DPO versus EPO (OR, 1.33; 95% CI, 0.88-2.01). No treatment heterogeneity across studies was detected (Q statistic=4.60; P=0.8). LIMITATIONS: Generalizability to nontrial populations is uncertain. CONCLUSIONS: Few trials directly comparing DPO and EPO have been conducted and follow-up was limited. In aggregate, no effect of specific erythropoiesis-stimulating agent on mortality was identified, but the confidence limits were wide and remained compatible with considerable harm from DPO. Absent adequately powered randomized trials, observational postmarketing comparative effectiveness studies comparing these erythropoiesis-stimulating agents are required to better characterize the long-term safety profiles of these agents.
Asunto(s)
Eritropoyetina/análogos & derivados , Hematínicos/uso terapéutico , Insuficiencia Renal Crónica/mortalidad , Anemia/tratamiento farmacológico , Anemia/etiología , Causas de Muerte , Darbepoetina alfa , Método Doble Ciego , Epoetina alfa , Eritropoyetina/efectos adversos , Eritropoyetina/farmacocinética , Eritropoyetina/uso terapéutico , Semivida , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Proteínas Recombinantes/uso terapéutico , Diálisis Renal , Insuficiencia Renal Crónica/complicacionesRESUMEN
Gum arabic is widely used in the food industry as an additive, both as a thickener and an emulsifier. This study has compared the emulsification properties of two types of gums, KLTA (Acacia senegal) and GCA (Acacia seyal), both in their native/untreated forms and after exposure to high pressure (800 MPa). Further studies were undertaken to chemically modify the disulphide linkages present and to investigate the effects of their reduction on the diffusion of the carbohydrate materials. The emulsification properties of the gum samples were examined by determining the droplet size distribution in a "model" oil-in-water system. Results showed that high pressure treatment and chemical reduction of gums changed the emulsification properties of both gums. The high molecular weight component in arabinogalactan-proteins (AGP/GP), and more "branched" carbohydrates present in gum arabic, may be responsible for the emulsification properties of GCA gum, indicating that the emulsification mechanisms for KLTA and GCA were different.
Asunto(s)
Emulsionantes/química , Goma Arábiga/química , Acacia/química , Disulfuros/química , Presión Hidrostática , Peso Molecular , Mucoproteínas/química , Proteínas de Plantas/químicaRESUMEN
The study describes the synthesis of new geminally disubstituted C-linked carbo-ß(2,2)-amino acids (ß(2,2)-Caas) with different carbohydrate side chains, and their use in the synthesis of ß(2,2)-peptides. The study infers that the side chain has an influence on the synthesis of peptides and their conformational behaviour.