Effect of initial combination therapy with sitagliptin, a dipeptidyl peptidase-4 inhibitor, and pioglitazone on glycemic control and measures of β-cell function in patients with type 2 diabetes

AIM/HYPOTHESIS

To assess the safety and efficacy of initial combination therapy with sitagliptin and pioglitazone compared with pioglitazone monotherapy in drug-naïve patients with type 2 diabetes.

METHODS

A total of 520 patients were randomised to initial combination therapy with sitagliptin 100 mg q.d. and pioglitazone 30 mg q.d. or pioglitazone 30 mg q.d. monotherapy for 24 weeks.

RESULTS

Initial combination therapy with sitagliptin and pioglitazone led to a mean reduction from baseline in A1C of -2.4% compared with -1.5% for pioglitazone monotherapy (p<0.001). Mean reductions from baseline were greater in patients with a baseline A1C≥10% (-3.0% with combination therapy vs. -2.1% with pioglitazone monotherapy) compared with patients with a baseline A1C<10% (-2.0% with combination therapy vs. -1.1% with pioglitazone monotherapy). Sixty percent of patients in the combination therapy group vs. 28% in the pioglitazone monotherapy group had an A1C of <7% at week 24 (p<0.001). Fasting plasma glucose decreased by -63.0 mg/dl (-3.5 mmol/l) in the combination therapy group compared with -40.2 mg/dl (-2.2 mmol/l) for pioglitazone monotherapy (p<0.001), and 2-h post meal glucose decreased by -113.6 mg/dl (-6.3 mmol/l) with combination therapy compared with -68.9 mg/dl (-3.8 mmol/l) for pioglitazone monotherapy (p<0.001). Measures related to β-cell function also improved significantly with combination therapy compared with pioglitazone monotherapy. Combination therapy was generally well-tolerated compared with pioglitazone monotherapy, with similar incidences of hypoglycemia (1.1% and 0.8%, respectively), gastrointestinal adverse events (5.7% and 6.9%, respectively), and oedema (2.7% and 3.5%, respectively).

CONCLUSION/INTERPRETATION

Initial combination therapy with sitagliptin and pioglitazone substantially improved glycemic control and was generally well-tolerated compared with pioglitazone monotherapy.

[The concept of "vegetative depression" (1949) by Rudolf Lemke--an obsolete concept?]

OBJECTIVE

In 1949 East German psychiatrist Rudolf Lemke presented his concept of a vegetative, i. e., anxious depression due to a vegetative dysfunction, in which the mental symptoms are dominated and oppressed by somatic complaints.

METHODS

The strengths and weaknesses of Lemke's concept will be analysed with particular reference to earlier, similar theories, such as those by Cimbal, Hempel, and Rosenfeld.

RESULTS/CONCLUSIONS

The fact that, due to the dominance of physical symptoms, many patients suffering from this disease consult a general practitioner even today proves that Lemke dealt with a problem most significant both for psychiatry and general medicine.

[The German-Jewish psychiatrist James Lewin. A twice forgotten victim]

This study focuses on the life and psychiatric publications of James Lewin (1887-1937) who is a classic example of a person who has been forgotten in both the political and historical realms. His works are based on original and philosophical ideas of which this study investigates two in detail. On the one hand it examines Lewin's call for a psychopathology which describes the phenomenological basis and psychological structure of pathological states and experience regardless of the clinical evaluation of these states. On the other hand it explores his theory of situational psychoses as laid out in his MD thesis. For him this group of psychoses was to include prison psychoses and other psychogenic reactive psychoses that had been described shortly before. After World War I, Lewin worked for a long period as a neuropsychiatrist in his own practice in Berlin. However, as a Jew in Germany he faced increasing fascist oppression and emigrated to Soviet Russia in 1936. Yet, as archival sources show, he was put to death 1 year later within the framework of Stalin's purges, having been accused of conducting espionage on behalf of the Gestapo.

[The homosexual as a "molesting personality". Nikolaus Jensch and his psychiatric-genetic studies]

For the first time ever, this study presents facts on the biography of Nikolaus Jensch (1913 - 1964), who worked in Wroclav, Leipzig, Strasbourg and Bremen, and on his psychiatric-genetic studies on homosexuality during the Nazi regime. Jensch tried, under methodologically rather doubtful presuppositions, to separate "genuine" from so-called "pseudo-homosexuals", who for him were receptive to psychotherapeutic and educational intervention. Ultimately he aimed to establish an empiric prediction as to the heredity of homosexuality, although even that would not exculpate homosexuals from prosecution. In a different study he analysed the curing effects of castration for homosexuality and other sexual deviances. Although acknowledging the mutilating character of castration and its due to high recrudescence rates rather poor therapeutic outcome, he never pleaded to refrain from this intervention.

Prelimenary results of a phase I/II of a combination of cetuximab and taxane for triple negative breast cancer patients

e12018

Background: The triple negative subtype of breast cancer is currently only treated with chemotherapeutic agents. It has been demonstrated that over 50% of this kind of tumors express EGFR (HER-1). Cetuximab is a humanized antiEGFR IgG1 antibody. In colon cancer there are also high percentage of EGFR expression and addition of Cetuximab to chemotherapy results in renewed sensitivity to treatments. We therefore hypothesized that in a similar manner addition of Cetuximab to taxanes which are among the most potent anti breast cancer drugs will result in increased effectiveness in this subset of breast cancer patients. Methods: From January 2007 to January 2009, we treated 12 breast cancer patients with either paclitaxel 80 mg/m2, (10 patients) or docetaxel (30 mg mg/m2) (2 patients), with cetuximab weekly. Patients had a pathology sample of breast cancer with triple negative components, metastatic disease and up to two prior chemotherapy lines in the metastatic settings. Results: Patient characteristics (median): age 60 (31–69) years, prior taxane therapy 9/12 pts. Toxicity: Dermatologic grade 2 9/12 grade 3 3/12, nail disease grade 2 10/12 evaluable patients. One patient developed severe swallowing difficulties after 19 month of therapy which may or may not be linked to the treatment. Response is evaluable for 11/12 patients. Response which includes clinical response, tumor marker decrease, and a metastasis size decrease was noted in 9/11 patients. Including tumor marker normalization and nearly a roentgoenolgic CR in a young patient previously treated with several chemeotherapietic lines. Three patients developed brain metastasis during treatments. Molecular pathology is now performed. We continue accrual. Conclusions: Administration of taxane-cetuximab weekly therapy for triple negative breast cancer patients is possible. Toxicity is the cumulated expected toxicity of each of the agents — special care should be taken for nail disease which occurred in most of the patients. Some impressive clinical responses were obtained even in taxane pretreated patients.

[Table: see text]

[Oswald Bumke in Leipzig. Beyond Kraepelin, Freud and Rüdin's Entartungslehre]

Oswald Bumke is a central figure in twentieth-century German psychiatry, having had a considerable influence on its development as one of its best-known representatives. His time in Leipzig from 1921 to 1924 and subsequently in Munich up to the mid-1930s saw the second major phase in his scientific work, during which he laid the basis for the renown he still enjoys as a result of his specialist encyclopaedic textbooks and manuals summarising the current knowledge of his time. At the beginning of the 1920s he made his stand on the burning issues of the day and thus influenced the conceptional history of the subject. For instance, he proposed his own philosophical psychology, rejecting the experimental psychological approach of Emil Kraepelin. By challenging the libido theory and the dynamic unconscious he weakened the impact of Sigmund Freud and psychoanalysis on German scientific psychiatry. Moreover, Bumke strongly opposed the prevailing concept of degeneration and its main protagonist Ernst Rüdin. Owing to the political and social developments at the time, however, he was not able to raise much support among his colleagues.

[Cenesthetic schizophrenia by Huber: 50 years of a concept]

50 years after the first description of cenesthetic schizophrenia as a concept by Gerd Huber, it can be valued as a starting point of fundamental insights into the course of schizophrenia and also for the development of the concept of basic symptoms assessment. Because patients suffering from cenesthetic schizophrenia are often misdiagnosed, it is still relevant for diagnostic and therapeutic purposes in practise today. Cenesthetic symptoms can be considered as substrate-close because they can be part of idiopathic psychosyndromes and also of organic brain lesions. Therefore they could be allocated as a typical example of the possible phenomenological identity or overlap of neurological and psychopathological symptomatology. The historical, psychopathological methodological and clinical foundations of the concept of cenesthetic schizophrenia will be demonstrated and the importance of this work for today will be emphasized.

[Hans Steinert: 100 years of myotonic dystrophy]

This study includes for the first time detailed biographical facts about Hans Steinert (1875-1911), who in 1909 first described myotonic dystrophy (Steinert's disease) as an independent syndrome. Of utmost importance are Steinert's years at the medical hospital of Leipzig University, where in 1901 he became the assistant of his mentor Heinrich Curschmann (1846-1910). Shortly after being appointed Extraordinary Professor there, Steinert died at the age of 36. As early as 1912 Hans Curschmann (1875-1950) fully recognized the importance of Steinert's pioneering work. Referring to key passages in his 1909 investigation, this study demonstrates how, on the basis of precise observation, subtle neurologic examination, and great clinical experience, Steinert succeeded in identifying a syndrome that to this day plays an important role in neurologic practice.