DOCSLIB.ORG

Metformin Does Not Affect Cancer Risk: a Cohort Study in the U.K

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Metformin Does Not Affect Cancer Risk: a Cohort Study in the U.K 2522 Diabetes Care Volume 37, September 2014 Metformin Does Not Affect Cancer Konstantinos K. Tsilidis,1,2 Despoina Capothanassi,1 Naomi E. Allen,3 Risk: A Cohort Study in the U.K. Evangelos C. Rizos,4 David S. Lopez,5 Karin van Veldhoven,6–8 Clinical Practice Research Carlotta Sacerdote,7 Deborah Ashby,9 Paolo Vineis,6,7 Ioanna Tzoulaki,1,6 and Datalink Analyzed Like an John P.A. Ioannidis10 Intention-to-Treat Trial Diabetes Care 2014;37:2522–2532 | DOI: 10.2337/dc14-0584 OBJECTIVE Meta-analyses of epidemiologic studies have suggested that metformin may re- 1Department of Hygiene and Epidemiology, Uni- duce cancer incidence, but randomized controlled trials did not support this versity of Ioannina School of Medicine, Ioannina, hypothesis. Greece 2Cancer Epidemiology Unit, University of Oxford, EPIDEMIOLOGY/HEALTH SERVICES RESEARCH RESEARCH DESIGN AND METHODS Oxford, U.K. 3 A retrospective cohort study, Clinical Practice Research Datalink, was designed to Clinical Trial Service Unit, University of Oxford, Oxford, U.K. investigate the association between use of metformin compared with other anti- 4Lipid Disorders Clinic, Department of Internal diabetes medications and cancer risk by emulating an intention-to-treat analysis Medicine, University Hospital of Ioannina, Ioan- as in a trial. A total of 95,820 participants with type 2 diabetes who started taking nina, Greece 5 metformin and other oral antidiabetes medications within 12 months of their Division of Epidemiology, University of Texas School of Public Health, Houston, TX diagnosis (initiators) were followed up for first incident cancer diagnosis without 6Department of Epidemiology and Biostatistics, regard to any subsequent changes in pharmacotherapy. Cox proportional hazards School of Public Health, Imperial College London, models were used to estimate multivariable-adjusted hazard ratios (HR) and St Mary’s Campus, London, U.K. 7 95% CI. Human Genetics Foundation (HuGeF), Turin, Italy 8University College London Institute of Child RESULTS Health, Centre for Paediatric Epidemiology and A total of 51,484 individuals (54%) were metformin initiators and 18,264 (19%) Biostatistics, London, U.K. were sulfonylurea initiators, and 3,805 firstincidentcancerswerediagnosed 9Imperial Clinical Trials Unit, School of Public ’ during a median follow-up time of 5.1 years. Compared with initiators of sulfo- Health, Imperial College London, St Mary s Hos- pital, London, U.K. nylurea, initiators of metformin had a similar incidence of total cancer (HR 0.96; 10Stanford Prevention Research Center, Depart- 95% CI 0.89–1.04) and colorectal (HR 0.92; 95% CI 0.76–1.13), prostate (HR 1.02; ment of Medicine; Department of Health Re- 95% CI 0.83–1.25), lung (HR 0.85; 95% CI 0.68–1.07), or postmenopausal breast (HR search and Policy, Stanford University School of – Medicine; and Department of Statistics, Stanford 1.03; 95% CI 0.82 1.31) cancer or any other cancer. University School of Humanities and Sciences, Stanford, CA CONCLUSIONS Corresponding author: Konstantinos K. Tsilidis, In this large study, individuals with diabetes who used metformin had a similar risk [email protected], [email protected]. of developing cancer compared with those who used sulfonylureas. Received 6 March 2014 and accepted 24 April 2014. The effects of antidiabetes medications on cancer risk have recently attracted This article contains Supplementary Data online significant public interest. In particular, meta-analyses of observational studies at http://care.diabetesjournals.org/lookup/ suppl/doi:10.2337/dc14-0584/-/DC1. have found that the biguanide metformin, which is an insulin sensitizer and the fi © 2014 by the American Diabetes Association. most commonly used rst-line therapy for type 2 diabetes, may reduce cancer Readers may use this article as long as the work incidence (1,2). However, a meta-analysis of randomized controlled trials did not is properly cited, the use is educational and not support this hypothesis (3). for profit, and the work is not altered. care.diabetesjournals.org Tsilidis and Associates 2523 Many of the published pharmacoepi- medical records, with 95% of neoplasms (acarbose), meglitinide analogs demiologic studies are difficult to inter- and 88% of endocrine and metabolic dis- (nateglinide, repaglinide), GLP-1 pret, however, because they may be orders identified in the CRPD confirmed receptor antagonists (exenatide), subject to several biases (4). The pro- with alternate data sources (8,9). dipeptidyl peptidase 4 inhibitors gressive nature of type 2 diabetes re- (sitagliptin, vildagliptin); quires changes in pharmacotherapy Study Population 5. monotherapy with insulin; We extracted data on all participants over time and makes very difficult the 6. combination therapies with metfor- with type 2 diabetes aged 35 to 90 years assessment of the independent associa- min if the participants were simulta- who were prescribed at least one anti- tion of a specific medication and cancer neously exposed to two or more diabetes agent between 1 January 1987 risk. The lack of randomization makes OHAs including metformin during and 31 December 2010, provided that observational effect estimates vulnera- the initial 12-month treatment the first prescription was dated at least ble to confounding by indication due to period; 6 months after the CPRD registration the different prognoses of individuals 7. combination therapies with insulin; date of the participant. This was to en- between treatment groups. Moreover, and sure that most of the included partici- most randomized clinical trials are not 8. other combination therapies. pants with diabetes would be new users designed or sufficiently powered to ex- of antidiabetes drugs and to exclude amine cancer outcomes due to short The main analysis was based on a com- prevalent users with unknown type follow-up periods and very few cancer parison of those who started using met- and duration of treatment. In addition, events. formin compared with those who used eligible participants had never a history To overcome these limitations, we sulfonylureas because these two medi- of cancer. We also excluded the initial emulated the design and analysis of a cations were the most common and be- 12 months of follow-up after the first trial in a large retrospective cohort study cause sulfonylureas had similar clinical antidiabetes prescription, because any within the U.K. Clinical Practice Re- indications to metformin. cancer diagnoses occurring within that search Datalink (CPRD), one of the time are unlikely to be attributable to Outcome Assessment world’s largest electronic medical re- the medications. Of the initial 113,301 First incident cancer cases were defined cord databases, to investigate asso- participants with type 2 diabetes identi- by the presence of National Health Ser- ciations of cancer risk among users fied, 95,820 were available for statistical vice Read codes in the CPRD. The Read ofmetformincomparedwithusersof analysis (Fig. 1). code dictionary was first searched to sulfonylurea or other first-line oral hy- identify malignant neoplasms, excluding poglycemic agents (OHAs) among indi- Exposure Assessment nonmelanoma skin cancers, using sev- viduals with newly diagnosed diabetes. Exposure to antidiabetes medications eral sensitive and specific algorithms This “incident diabetes drug” cohort de- was assessed by the presence of antidia- and code lists. Two researchers (K.K.T. sign and intention-to-treat (ITT) analysis betes prescription records in the CPRD and D.C.) manually reviewed and con- can be regarded as the equivalent of a using British National Formulary codes. firmed the codes identified by the initial nonrandomized “trial” that avoids many Treatment-naive participants with dia- searches and excluded codes for border- of the biases of traditional observational betes at CPRD enrollment who first line, in situ, or suspected malignancies. studies (5). started using metformin (metformin ini- A similar process was followed to define tiators) were compared with initiators type 2 diabetes. RESEARCH DESIGN AND METHODS of other OHAs. Exposure to certain anti- Data Source diabetes drugs was classified based on Covariate Assessment This study was conducted using the U.K. the initial 12-month treatment period, Information on sociodemographic data, CPRD, previously known as General and an individual’s treatment pattern lifestyle characteristics, anthropometric Practice Research Database (6), and was categorized into one of the follow- variables, medical conditions, and treat- was approved by the Medicines and ing mutually exclusive groups: ments was extracted from the CPRD at Healthcare Products Regulatory Agency approximately the time of the first anti- Independent Scientific Advisory Com- 1. monotherapy with metformin, if diabetes prescription (index date). Age mittee. The CPRD was established in they were only exposed to metfor- and sex were recorded at the time of 1987 and currently encompasses more min during their initial 12-month the first prescription. BMI measure- than 5 million people enrolled from over treatment period; ments and smoking status (never, for- 600 general practitioners nationwide. 2. monotherapy with sulfonylureas, mer, current) were retrieved for the The people enrolled in the CPRD are rep- either first generation (tolbuta- 1 year before the index date. Alcohol resentative of the U.K. population with mide, chlorpropamide, tolazamide, consumption (never, former, current) regard to age, sex, and geographical dis- acetohexamide) or second genera- was defined from
Load more

Recommended publications
  • (Trulicity) Pen and the Semaglutide (Ozempic) Pen
    Protocol H9X-MC-B021(b) Crossover Study Comparing Dulaglutide (Trulicity) Pen and the Semaglutide (Ozempic) Pen NCT03724981 Approval Date: 30-Nov-2018 H9X-MC-B021(b) Clinical Protocol Page 1 Protocol H9X-MC-B021(b): Crossover Study Comparing the Dulaglutide (Trulicity) Pen and the Semaglutide (Ozempic) Pen Confidential Information The information contained in this document is confidential and is intended for the use of clinical investigators. It is the property of Eli Lilly and Company or its subsidiaries and should not be copied by or distributed to persons not involved in the clinical investigation of dulaglutide (LY2189265), unless such persons are bound by a confidentiality agreement with Eli Lilly and Company or its subsidiaries. Note to Regulatory Authorities: This document may contain protected personal data and/or commercially confidential information exempt from public disclosure. Eli Lilly and Company requests consultation regarding release/redaction prior to any public release. In the United States, this document is subject to Freedom of Information Act (FOIA) Exemption 4 and may not be reproduced or otherwise disseminated without the written approval of Eli Lilly and Company or its subsidiaries. Dulaglutide (LY2189265) Eli Lilly and Company Indianapolis, Indiana USA 46285 Protocol Electronically Signed and Approved by Lilly on 07 Aug 2018 Amendment (a) Electronically Signed and Approved by Lilly on 11 Sep 2018 Amendment (b) Electronically Signed and Approved by Lilly on date below Approval Date: 30-Nov-2018 GMT LY2189265 H9X-MC-B021(b) Clinical Protocol Page 2 Table of Contents Section Page Protocol H9X-MC-B021(b): Crossover Study Comparing the Dulaglutide (Trulicity) Pen and the Semaglutide (Ozempic) Pen ............................................................1 Table of Contents........................................................................................................................2 1.
    [Show full text]
  • Rigorous Clinical Trial Design in Public Health Emergencies Is Essential
    1 Rigorous Clinical Trial Design in Public Health Emergencies Is Essential Susan S. Ellenberg (Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania); Gerald T. Keusch (Departments of Medicine and Global Health, Boston University Schools of Medicine and Public Health); Abdel G. Babiker (Medical Research Council Clinical Trials Unit, University College London); Kathryn M. Edwards (Department of Pediatrics, Vanderbilt University School of Medicine); Roger J. Lewis (Department of Emergency Medicine, Harbor-UCLA Medical Center); Jens D. Lundgren( Department of Infectious Diseases, University of Copenhagen); Charles D. Wells (Infectious Diseases Unit, Sanofi-U.S.); Fred Wabwire-Mangen (Department of Epidemiology, Makerere University School of Public Health); Keith P.W.J. McAdam (Department of Clinical and Tropical Medicine, London School of Hygiene and Tropical Medicine) Keywords: randomized clinical trial; Ebola; ethics Running title: Research in public health emergencies Key Points: To obtain definitive information about the effects of treatments and vaccines, even in public health emergencies, randomized clinical trials are essential. Such trials are ethical and feasible with efforts to engage and collaborate with the affected communities. Contact information, corresponding author: Susan S. Ellenberg, Ph.D. University of Pennsylvania 423 Guardian Drive, Room 611 Philadelphia, PA 19104 [email protected]; 215-573-3904 Contact information, alternate corresponding author: Gerald T. Keusch, MD Boston University School of Medicine 620 Albany St Boston, MA 02118 [email protected]; 617-414-8960 2 ABSTRACT Randomized clinical trials are the most reliable approaches to evaluating the effects of new treatments and vaccines. During the 2014-15 West African Ebola epidemic, many argued that such trials were neither ethical nor feasible in an environment of limited health infrastructure and severe disease with a high fatality rate.
    [Show full text]
  • Transcriptional Biomarkers for Predicting Development of TB: Progress and Clinical Considerations
    Early View ERJ Methods Transcriptional biomarkers for predicting development of TB: progress and clinical considerations Hanif Esmail, Frank Cobelens, Delia Goletti Please cite this article as: Esmail H, Cobelens F, Goletti D. Transcriptional biomarkers for predicting development of TB: progress and clinical considerations. Eur Respir J 2020; in press (https://doi.org/10.1183/13993003.01957-2019). This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Copyright ©ERS 2020 Transcriptional biomarkers for predicting development of TB: progress and clinical considerations Hanif Esmail1,2,3, Frank Cobelens4, Delia Goletti5* 1. Medical Research Council Clinical Trials Unit at University College London, London, UK 2. Institute for Global Health, University College London, London, UK 3. Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa 4. Dept of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 5. Translational Research Unit, Department of Epidemiology and Preclinical Research, “L. Spallanzani” National Institute for Infectious Diseases (INMI), IRCCS, Via Portuense 292, 00149 Rome, Italy * Corresponding author Key words: Transcriptional biomarkers, incipient tuberculosis, latent tuberculosis Introduction Achieving the ambitious targets for global tuberculosis (TB) control, will require an increased emphasis on preventing development of active disease in those with latent TB infection (LTBI) by preventative treatment or vaccination[1].
    [Show full text]
  • List of Union Reference Dates A
    Active substance name (INN) EU DLP BfArM / BAH DLP yearly PSUR 6-month-PSUR yearly PSUR bis DLP (List of Union PSUR Submission Reference Dates and Frequency (List of Union Frequency of Reference Dates and submission of Periodic Frequency of submission of Safety Update Reports, Periodic Safety Update 30 Nov. 2012) Reports, 30 Nov.
    [Show full text]
  • Sulfonylurea Review
    Human Journals Review Article February 2018 Vol.:11, Issue:3 © All rights are reserved by Farah Yousef et al. Sulfonylurea Review Keywords: Type II diabetes, Sulfonylurea, Glimipiride, Glybu- ride, Structure Activity Relationship. ABSTRACT Farah Yousef*1, Oussama Mansour2, Jehad Herbali3 Diabetes Mellitus is a chronic disease represented with high 1 Ph.D. candidate in pharmaceutical sciences, Damas- glucose blood levels. Although sulfonylurea compounds are the cus University, Damascus, Syria. second preferred drug to treat Type II Diabetes (TYIID), they are still the most used agents due to their lower cost and as a 2 Assistant Professor in pharmaceutical chimestry, Ti- mono-dosing. Literature divides these compounds according to st nd rd shreen University, Lattakia, Syria their discovery into 1 , 2 , 3 generations. However, only six sulfonylurea compounds are now available for use in the United 3 Assistant Professor in pharmaceutical chimestry, Da- States: Chlorpropamide, Glimepiride, Glipizide, Glyburide, mascus University, Damascus, Syria. Tolazamide, and Tolbutamide. They function by increasing Submission: 24 January 2018 insulin secretion from pancreatic beta cells. Their main active site is ATP sensitive potassium ion channels; Kir 6.2\SUR1; Accepted: 29 January 2018 Published: 28 February 2018 Potassium Inward Rectifier ion channel 6.2\ Sulfonylurea re- ceptor 1. They are sulfonamide derivatives. However, research- ers have declared that sulfonylurea moiety is not the only one responsible for this group efficacy. It has been known that sud- den and acute hypoglycemia incidences and weight gain are the www.ijppr.humanjournals.com two most common adverse effects TYIID the patient might face during treatment with sulfonylurea agents. This review indi- cates the historical development of sulfonylurea and the differ- ences among this group members.
    [Show full text]
  • The PRISMA-IPD Statement
    Clinical Review & Education Special Communication Preferred Reporting Items for a Systematic Review and Meta-analysis of Individual Participant Data The PRISMA-IPD Statement Lesley A. Stewart, PhD; Mike Clarke, DPhil; Maroeska Rovers, PhD; Richard D. Riley, PhD; Mark Simmonds, PhD; Gavin Stewart, PhD; Jayne F. Tierney, PhD; for the PRISMA-IPD Development Group Editorial page 1625 IMPORTANCE Systematic reviews and meta-analyses of individual participant data (IPD) aim Supplemental content at to collect, check, and reanalyze individual-level data from all studies addressing a particular jama.com research question and are therefore considered a gold standard approach to evidence synthesis. They are likely to be used with increasing frequency as current initiatives to share clinical trial data gain momentum and may be particularly important in reviewing controversial therapeutic areas. OBJECTIVE To develop PRISMA-IPD as a stand-alone extension to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement, tailored to the specific requirements of reporting systematic reviews and meta-analyses of IPD. Although developed primarily for reviews of randomized trials, many items will apply in other contexts, including reviews of diagnosis and prognosis. DESIGN Development of PRISMA-IPD followed the EQUATOR Network framework guidance and used the existing standard PRISMA Statement as a starting point to draft additional relevant material. A web-based survey informed discussion at an international workshop that included researchers, clinicians, methodologists experienced in conducting systematic reviews and meta-analyses of IPD, and journal editors. The statement was drafted and iterative refinements were made by the project, advisory, and development groups. The PRISMA-IPD Development Group reached agreement on the PRISMA-IPD checklist and flow diagram by consensus.
    [Show full text]
  • Diagnostic Accuracy of a Host Response Point-Of-Care Test In
    medRxiv preprint doi: https://doi.org/10.1101/2020.05.27.20114512; this version posted June 2, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Diagnostic accuracy of a host response point-of-care test in patients with suspected COVID-19 Tristan W Clark1,2,3,4*, Nathan J Brendish1, 2, Stephen Poole1,2,3, Vasanth V Naidu2, Christopher Mansbridge2, Nicholas Norton2, Helen Wheeler3, Laura Presland3 and Sean Ewings5 1. School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK 2. Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 3. NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK 4. NIHR Post Doctoral Fellowship Programme, UK 5. Southampton Clinical Trials Unit, University of Southampton, UK *Corresponding author Dr Tristan William Clark, Associate Professor and Consultant in Infectious Diseases. NIHR Post Doctoral Fellow. Address: LF101, South Academic block, Southampton General Hospital, Southampton, SO16 6YD. Tel: 0044(0)23818410 E-mail address: [email protected] 1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.05.27.20114512; this version posted June 2, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
    [Show full text]
  • Download and Use
    Shenkin et al. BMC Medicine (2019) 17:138 https://doi.org/10.1186/s12916-019-1367-9 RESEARCHARTICLE Open Access Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method Susan D. Shenkin1, Christopher Fox2, Mary Godfrey3, Najma Siddiqi4, Steve Goodacre5, John Young6, Atul Anand7, Alasdair Gray8, Janet Hanley9, Allan MacRaild8, Jill Steven8, Polly L. Black8, Zoë Tieges1, Julia Boyd10, Jacqueline Stephen10, Christopher J. Weir10 and Alasdair M. J. MacLullich1* Abstract Background: Delirium affects > 15% of hospitalised patients but is grossly underdetected, contributing to poor care. The 4 ‘A’s Test (4AT, www.the4AT.com) is a short delirium assessment tool designed for routine use without special training. Theprimaryobjectivewastoassesstheaccuracyofthe4ATfor delirium detection. The secondary objective was to compare the 4AT with another commonly used delirium assessment tool, the Confusion Assessment Method (CAM). Methods: This was a prospective diagnostic test accuracy study set in emergency departments or acute medical wards involving acute medical patients aged ≥ 70. All those without acutely life-threatening illness or coma were eligible. Patients underwent (1) reference standard delirium assessment based on DSM-IV criteria and (2) were randomised to either the index test (4AT, scores 0–12; prespecified score of > 3 considered positive) or the comparator (CAM; scored positive or negative), in a random order, using computer-generated pseudo-random numbers, stratified by study site, with block allocation. Reference standard and 4AT or CAM assessments were performed by pairs of independent raters blinded to the results of the other assessment. Results: Eight hundred forty-three individuals were randomised: 21 withdrew, 3 lost contact, 32 indeterminate diagnosis, 2 missing outcome, and 785 were included in the analysis.
    [Show full text]
  • Clinical Trial Design and Clinical Trials Unit
    Clinical trial design and Clinical Trials Unit Nina L. Jebsen, MD, PhD Centre for Cancer Biomarkers, University of Bergen Centre for Bone- and Soft Tissue Tumours, Haukeland University Hospital Outline • Why clinical studies? • Preconditions • Principles • Types of clinical trials • Different phases in clinical trials • Design of clinical trials – Basket design – Enrichment design – Umbrella design – Marker-based strategy design – Adaptive design • Clinical Trials Unit • CTU, Haukeland University Hospital Why clinical studies? • Control/optimize an experimental process to – reduce errors/bias = internal validity/credibility – reduce variability = external validity/reproducibility – QA data collection settings = model validity/design • Understand the biological chain of events that lead to disease progression and response to intervention • Simplify and validate statistical data analysis • Generate evidence for effect of a specific treatment . in a specific population • Results extrapolated for standard clinical use . • Necessary (Phase III) for drug approval • Take into account ethical issues Preconditions • Access to patients (be realistic) • Approvals by legal authorities • Accept from local hospital department • Adequate resources/financial support • Infrastructure • Necessary equipment • Experienced personnel • Well-functioning routines • Study-team with mutual understanding of all implications Study population vs clinical practice • Age – study patients often younger • Performance status – study patients better performance status
    [Show full text]
  • Ehealth DSI [Ehdsi V2.2.2-OR] Ehealth DSI – Master Value Set
    MTC eHealth DSI [eHDSI v2.2.2-OR] eHealth DSI – Master Value Set Catalogue Responsible : eHDSI Solution Provider PublishDate : Wed Nov 08 16:16:10 CET 2017 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 1 of 490 MTC Table of Contents epSOSActiveIngredient 4 epSOSAdministrativeGender 148 epSOSAdverseEventType 149 epSOSAllergenNoDrugs 150 epSOSBloodGroup 155 epSOSBloodPressure 156 epSOSCodeNoMedication 157 epSOSCodeProb 158 epSOSConfidentiality 159 epSOSCountry 160 epSOSDisplayLabel 167 epSOSDocumentCode 170 epSOSDoseForm 171 epSOSHealthcareProfessionalRoles 184 epSOSIllnessesandDisorders 186 epSOSLanguage 448 epSOSMedicalDevices 458 epSOSNullFavor 461 epSOSPackage 462 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 2 of 490 MTC epSOSPersonalRelationship 464 epSOSPregnancyInformation 466 epSOSProcedures 467 epSOSReactionAllergy 470 epSOSResolutionOutcome 472 epSOSRoleClass 473 epSOSRouteofAdministration 474 epSOSSections 477 epSOSSeverity 478 epSOSSocialHistory 479 epSOSStatusCode 480 epSOSSubstitutionCode 481 epSOSTelecomAddress 482 epSOSTimingEvent 483 epSOSUnits 484 epSOSUnknownInformation 487 epSOSVaccine 488 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 3 of 490 MTC epSOSActiveIngredient epSOSActiveIngredient Value Set ID 1.3.6.1.4.1.12559.11.10.1.3.1.42.24 TRANSLATIONS Code System ID Code System Version Concept Code Description (FSN) 2.16.840.1.113883.6.73 2017-01 A ALIMENTARY TRACT AND METABOLISM 2.16.840.1.113883.6.73 2017-01
    [Show full text]
  • In Silico Target Based Computational Drug Repositioning of Tolazamide with Canagliflozin
    Bulletin of Environment, Pharmacology and Life Sciences Bull. Env. Pharmacol. Life Sci., Vol 8 [8] July 2019 : 34-44 ©2019 Academy for Environment and Life Sciences, India Online ISSN 2277-1808 Journal’s URL:http://www.bepls.com CODEN: BEPLAD Global Impact Factor 0.876 Universal Impact Factor 0.9804 NAAS Rating 4.95 ORIGINAL ARTICLE OPEN ACCESS In silico Target Based Computational Drug Repositioning of Tolazamide with Canagliflozin Hajra Jadoon, Simra Jadoon, Madiha Jadoon, Sajid Khan, Azhar Mehmood, Muhammad Rizwan1, Anum Munir. 1-Department of Bioinformatics Government Post Graduate College Mandian Abbottabad 22010, Pakistan. E-mail: [email protected] ABSTRACT Diabetes mellitus is a collection of metabolic infection described by high glucose level that comes out from imperfections in insulin emission. The commonness rate of sort 2 diabetes mellitus in Pakistan is 11.77%. It is the fourth driving reason for death because of its connection with different illnesses i-e cardiovascular and renal disappointment. Currently Tolazamide medicine is used to control diabetes. This research work is aimed to reposition a drug Tolazamide with Canaglaflozin which is used against heart attack but target the same genes as Tolazamide that decreases the side effect of drugs used against diabetes. Drug repositioning was carried out in an off-target profile in which drug information was retrieved, its interactions with already known targeted genes and new target genes are determined, side effects, toxicity class are compared, its associated pathways are identified and docking is done with the interacting targets. It was found that Tolazamide showed strong interaction with KCNJ11 and ABCC8, CACNA1A, CACNA1B, and CACNA1C all these are also the target of Canagliflozin.
    [Show full text]
  • Understanding Clinical Trials and Research a Guide for People Affected by Cancer
    Understanding Clinical Trials and Research A guide for people affected by cancer Practical and support information For information & support, call Understanding Clinical Trials and Research A guide for people affected by cancer First published April 2012. This edition July 2018. © Cancer Council Australia 2018. ISBN 978 1 925651 28 7 Understanding Clinical Trials and Research is reviewed approximately every 3 years. Check the publication date above to ensure this copy is up to date. Editor: Ruth Sheard. Designer: Paula Marchant. Printer: SOS Print + Media Group. Acknowledgements This edition has been developed by Cancer Council NSW on behalf of all other state and territory Cancer Councils as part of a National Cancer Information Working Group initiative. We thank the reviewers of this booklet: A/Prof Andrew Redfern, Consultant Medical Oncologist, Fiona Stanley Hospital, Clinical Academic Oncologist, The University of Western Australia, and Lead Clinician, State Breast Cancer Collaborative, WA; Christie Allan, Program Coordinator – Clinical Trials, Cancer Council Victoria; Bronwyn Chalmers, Clinical Trial Coordinator, Westmead Breast Cancer Institute, NSW; Sarah Coulson, Coordinator, Oncology Clinical Trials, Projects and Research, Tasmanian Health Service, TAS; Kate Cox, 13 11 20 Consultant, Cancer Council SA; Annette Cubitt, Clinical Trials Manager, Department of Medical Oncology, Cancer Care Services, Royal Brisbane and Women’s Hospital, QLD; Pete Currie, Consumer; Amy Ives, Clinical Trials Coordinator, Department of Medical Oncology,
    [Show full text]