geoffrey modest medical blogs

Another industry-sponsored study found benefit for a GLP-1 agonist on renal and cardiovascular outcomes, this time with dulaglutide in the REWIND study. RENAL BENEFITS : (see  dm dulaglutide dec renal events lancet2019 in dropbox, or doi.org/10.1016/S0140-6736(19)31150-X Details: -- 9901 participants from 371 sites in 24 countries in this randomized double-blind trial, comparing dulaglutide injections of 1.5 mg vs placebo -- mean age 66, 46% women, 76% white, duration of diabetes 11 years, median A1c 7.2%, BMI 32, blood pressure 137/78, -- meds: metformin 81%, sulfonylureas 46%, insulin 24%, ACE inhibitors 50%, ARB’s 34%, ACE-I or ARB 81% -- baseline: 8% had macroalbuminuria, 27% microalbuminuria, mean urinary albumin/creatinine ratio UACR, 2 mg/g, mean eGFR 77 (22% had eGFR <60), creatinine 0.95 mg/dL -- primary composite outcome: 1 st occurrence of nonfatal MI, nonfatal stroke, or death from cardiovascular causes -- secondary outcome composite of microvascu

The drug company sponsored PIONEER 4 study found that oral semaglutide seems to be at least as good as subcutaneous liraglutide in decreasing hemoglobin A1c and body weight (see  dm oral semaglut vs liraglut lancet2019  in dropbox, or doi.org/10.1016/ S0140-6736(19)31271-1). Details: -- 711 patients with type 2 diabetes, randomized to once daily oral semaglultide (dose escalated to 14 mg), once daily subcutaneous liraglutide (dose escalated to 1.8 mg), vs placebo and followed for 52 weeks, in 2016-2017 -- patients were from 100 sites in 12 countries, were at least 18 years old, A1c of 7.0-9.5%, and on a stable dose of metformin (at least 1500 mg, or maximally tolerated), with or without an SGLT-2 inhibitor -- 48% female, mean age 56, A1c=8.0%, duration of DM 7.6 yrs, fasting glucose 167 mg/dL, BMI 33, 73% white/4% black or African-American/13% Asian/6% Latino, eGFR 96, 26% on SGLT-2 at baseline  -- those with persistent hyperglycemia (basically >200 mg/dL) or A1c >

There was a recent Am Heart Assn scientific statement on the prevention/management of cardiovascular disease in people living with HIV (PLWH), see  cad hiv controlled AHA statement circ2019  in dropbox, or DOI: 10.1161/CIR.0000000000000695). Overview:  -- those with HIV infection are at increased risk for a variety of non-infectious cardiovascular complications, including myocardial infarction, heart failure, stroke, and coronary artery disease, as well as pulmonary hypertension and sudden cardiac death. -- This increase in cardiovascular diseases continues even in those with HIV viral suppression and high CD4 counts, controlling for the standard cardiovascular risk factors; however there is more cardiovascular disease in those with lower CD4 counts or unsuppressed HIV viral loads -- the clinical issue here is that PLWH are living longer as HIV has become a chronic disease, but even though the incidence of cardiovascular complications is lower in PLWH who have suppressed v

A recent article reinforced the efficacy and safety of the combination pill  bictegravir ,  emtricitabine , and  tenofovir   alafenamide  (BIC/TAF/FTC), finding it to be equal to the combination of dolutegravir ,  emtricitabine , and  tenofovir   alafenamide  (DTG/TAF/FTC). This current study provides 96 week results, after the prior 48 week results that led to BIC/TAF/FTC approval (see  hiv doluteg vs bicteg lancethiv2019 in dropbox, or  doi.org/10.1016/ S2352-3018(19)30080-3) Details: -- randomized, double-blind, noninferiority study done in 26 outpatient centers in 10 countries, beginning in 2015-16 -- treatment naïve adults over 18 yo with HIV-1 infection, eGFR >30, and virus sensitive to FTC and tenofovir -- 657 patients were enrolled, 645 completed the 96 weeks -- 96 week secondary outcome: proportion of participants with plasma HIV viral load <50 copies/ml comparing these 2 medications, with prespecified noninferiority margin of -12% Results: -- at