An update on diagnosis and treatment of adult growth hormone deficiency

Orsalia Alexopoulou, Dominique Maiter Published in the journal : March 2018 Category : Endocrinology

Adult growth hormone deficiency (AGHD) is nowadays recognized as a distinct clinical entity and replacement therapy has become a standard practice. The benefits of GH treatment seem to outweigh its potential risks but issues concerning long term efficacy and safety are still a subject of debate. More research is needed in some key areas and it remains essential to monitor patients by means of longitudinal surveillance studies.

Key Words

Growth Hormone Deficiency, Hypopituitarism, GH deficient adults

Read more

Glycemic self-monitoring: benefit-cost ratio

Vanessa Preumont, Stéphanie Rouhard Published in the journal : March 2018 Category : Diabétologie

The FreeStyle Libre® and Guardian Connect® glucose monitors are currently available in Belgium for patients with Type 1 diabetes and for subjects without residual insulin secretion. The FreeStyle Libre® device was designed to replace the recommended finger-stick glucose monitoring, without any need of calibration. Accuracy is comparable to that pertaining to currently available real-time continuous glucose monitoring. The system can be used in adults, children, and during pregnancy. In randomized trials, its use was reported associated with a reduction in hypoglycemia and, in observational studies, with an improvement in glycated hemoglobin levels. User satisfaction was proven high, with relatively few adverse events. Glucose data can be summarized as ambulatory profile in order to facilitate insulin dose adjustments. Further trials are needed in order to assess the long-term impact on both glycated hemoglobin and quality of life.

Read more

Innovations in nephrology: what to remember from 2017?

Johann Morelle, Nathalie Demoulin, Michel Jadoul, Hubert Piessevaux Published in the journal : February 2018 Category : Nephrology

In 2017, the treatment of severe forms (proteinuric and/or with impaired kidney function) of IgA nephropathy, the most common primary chronic glomerulonephritis, proved to be of particular interest. Several studies highlighted that the risks associated with conventional immunosuppressive therapy, still mainly based on corticosteroids outweighs the potential benefits. A Targeted (enteric)-release corticosteroids constitutes a new therapeutic agent will soon be tested in a Phase 3 study, following encouraging results from Phase 2. Furthermore, several observational studies, conducted in 2017, suggested that the nephrotoxicity due to proton pump inhibitors be more common than hitherto appreciated, though the causal relationship between both must still be firmly demonstrated. In this paper, we discuss the implications from these studies concerning the use of this widely prescribed family drug.

Read more

Hemostasis and thrombosis in 2017, a year full of innovations

Cédric Hermans, Catherine Lambert Published in the journal : February 2018 Category : Hémostase – Thrombose

The year 2017 was particularly rich in new developments in the field pertaining to coagulation disorders, be they thrombotic or hemorrhagic. Several studies further confirmed the role of direct oral anticoagulants (DOACs) at reduced dose levels for the secondary prevention of venous thromboembolic disease. These same agents will likely replace low molecular weight heparins (LMWHs) in cancer patients with antecedents of venous thromboembolism. A specific and extensively validated antidote is already available for dabigatran (idarucizumab). While awaiting the validation of specific antidotes for factor Xa anticoagulants, prothrombin complex concentrates (PCCs) have been shown to be effective, even at reduced dose levels, in patients requiring rapid reversibility of anticoagulation induced by an anti-Xa agent. In the hemophilia setting, the development of a bispecific antibody mimicking the action of FVIII (emicizumab), along with the first successes of gene therapy for hemophilia A open revolutionary perspectives as to the management of this rare disease.

Read more

Immunotherapy and targeted therapies are standard of care in oncology

Jean-François Baurain, François Duhoux, Astrid De Cuyper, Frank Cornélis, Jean-Pascal Machiels, Thierry Pieters Published in the journal : February 2018 Category : Oncologie

2017 was again a great year for oncologists, as the efficacy of new promising drugs and treatment modalities could be confirmed, thus improving the prognosis of our patients. Since we cannot describe all highlights here, we decided to focus on some major advances. Immunotherapy with anti-PD-1/PD-L1 antibodies has become a standard of care in many metastatic patients, with a long-term survival benefit reported for some of them (yet it is too early to talk about cure). However, the administration of these antibodies is associated with a very specific auto-immune toxicity that may have serious or even fatal consequences if not recognized and treated early. Moreover, the range of available targeted therapies is continuously growing, with the advent of new therapeutic classes, such as the CDK 4/6 and PARP inhibitors. Thanks to our better understanding of the mechanisms underlying resistance to targeted therapies, news drugs have been developed (e.g. osimertinib) and have proved able to overcome the resistance observed with the first-generation tyrosine kinase inhibitors in lung cancer. There is also a trend toward decreasing the aggressiveness of chemotherapeutic regimens. All these treatments are available at the King Albert II Cancer Institute, along with new treatments that are currently being investigated and might become the standard of care of tomorrow.

Read more

Innovations in onco-haematology : What to remember from 2017 ?

Marie-Christiane Vekemans, Eric Van Den Neste, Sarah Bailly Published in the journal : February 2018 Category : Onco-Hématologie

The landscape of Multiple Myeloma treatments is rapidly evolving, with more and more potent therapeutic options. The most exciting news are probably those regarding a new class of therapies targeting the B-cell maturation antigen (BCMA) via different mechanisms. CAR T-cells as well as antibody-drug conjugates targeting this antigen have yielded very promising results. This next-generation MM treatments will probably lead to a paradigm shift from purely “survival-focused” to “quality of-life-focused”. Biomarkers of minimal residual disease (MRD) and molecular/cytogenetic techniques will undoubtedly be of great help in redefining treatment goals and selecting appropriate treatments. Treating MM in earlier stages will also impact the way we consider this disease today. The management of chronic lymphocytic leukemia has evolved tremendously over the past years, notably due to the efficacy of new oral therapies and the increased consideration of prognostic factors.

Read more

Glioblastoma with prolonged survival despite poor prognosticators

Emmanuel Costa, Tevi Morel Lawson, Julie Lelotte, Edward Fomekong, Geraldo Vaz, Nicolas Whenham, Laurette Renard, Christian Raftopoulos Published in the journal : February 2018 Category : Neurochirurgie

Glioblastoma (GBM) is the most aggressive primary tumor of the central nervous system (CNS), and our study sought to identify the characteristics of patients with prolonged overall survival (OS). To this end, we reviewed the records of 127 patients who underwent surgery in our center for GBM between January 2002 and November 2011. We then identified those patients with prolonged survival (>3years). The characteristics of all these patients and their tumors were analyzed, and the anatomic pathological diagnosis was reviewed by a second anatomical pathologist. Of these 127 patients, 101 (79.6%) underwent excisional surgery, with 12 of these surviving longer than 36 months. The GBM diagnosis was confirmed in 11 (11%) patients (F/M: 4.5; mean age: 50 years (31-68); mean Karnofsky preoperative: 82%). The average survival of these 11 patients was 74 months (36-150); seven patients (63.6%) underwent complete resection, three (27.3%) almost complete resection, and the last one (9.1%) partial resection. Only two (18.8%) patients exhibited an IDH1 mutation. Seven (63.6%) patients benefited from a complete Stupp protocol. Eight of these patients had poor prognostic factors regarding prolonged survival (age, low Karnofsky score, or unmutated IDH). In conclusion, for any patient who develops a GBM, there is some hope that survival may be prolonged, even in the presence of poor prognosticators.

Read more

Faster-acting insulin aspart FIASP® : advancement in the management of diabetes

Mirela Morisca-Gavriliu, Michel P. Hermans, Dominique Maiter, Vanessa Preumont Published in the journal : February 2018 Category : Diabétologie

Insulin FIASP (for “fast-acting insulin aspart”) is a new original insulin formulation that combines insulin aspart and two excipients, namely a vitamin (niacinamide) and an aminoacid (L-arginine), designed to increase the initial insulin absorption rate following subcutaneous injection, thereby promoting an earlier anti-hyperglycemic effect after meals. Its efficacy and safety profiles have been studied in the Onset clinical trial program. These first clinical studies have shown that using FIASP is associated with improved early post-prandial glycemic control compared to aspart alone in Type 1 and Type 2 diabetic subjects. It is expected that insulin FIASP will soon be available in Belgium.

Read more

Innovations in dermatology: What to remember from 2017?

Marie Baeck, Caroline Colmant, Laurence de Montjoye, Pierre-Dominique Ghislain, Anne Herman, Bernard Leroy, Chloé Algoet, Alison Coster, Liliane Marot, Isabelle Tromme Published in the journal : February 2018 Category : Dermatology

The world of biologicals continues to rapidly evolve, whilst diversifying in terms of therapeutic targets, available molecules, and indications. Notably, the way to manage severe atopic dermatitis will substantially change in 2018 following the introduction of dupilumab, an anti-IL-4 and IL-13, with considerable efficacy in Phase III clinical studies. In addition, rituximab was demonstrated to be associated with clinical remission in many patients with pemphigus.

Read more

Optimal Recovery and bilateral total hip prosthesis

Maïté Van Cauter, Jean-Emile Dubuc, Jean-Cyr Yombi, Olivier Cornu Published in the journal : February 2018 Category : Chirurgie orthopédique et traumatologie

The first total hip prostheses were implanted more than 40 years ago. Over the past 10 years, so-called "mini-invasive" surgeries have emerged, enabling patient's muscle mass to be preserved. This type of surgery is associated with a faster functional recovery and shorter hospital stay. Five years ago, we implemented a clinical course on arthroplasty, titled "Optimal Recovery", at the Cliniques Universitaires Saint-Luc. This protocol seeks to optimize the care of patients throughout their care journey, ensuring that standardized procedures be applied as much as possible. Patients benefit from two information sessions, one individual and one group session, and receive an information leaflet, in order to be actively included in the care process, which reduces their stress. Minimally-invasive surgical techniques, along with the adaptation of pre-, intra- and postoperative protocols, including postoperative analgesia and rehabilitation techniques, have likewise been developed in this setting. Implementing this type of care strategy has been associated with a reduction in both hospital stay and postoperative transfusion rates. The good results thereby observed enable bilateral arthroplasty to be performed at the same time, without any significant impact on either duration of the operation or functional recovery.

Read more