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Three new trials of novel headache drugs

…l. N Engl J Med 2019;381:142-149). The proportion of patients who were pain-free two hours after dosing was 19.6% with rimegepant versus 12.0% with placebo. In addition, 37.6% of rimegepant-treated patients reported they were free from their most bothersome symptom compared to 25.2% receiving placebo. The 7.6% treatment difference reported in the trial would appear to be less than what is seen with subcutaneous or oral sumatriptan (Derry et al. Co…

Ponesimod – phase III results in MS

…reliminary announcement. Ponesimod is the latest in a series of sphingosine-1-phosphate receptor drugs, a group that includes fingolimod, siponimod and ozanimod. Somewhat unique is that ponesimod is selective to S1PR-1 and acts as an agonist rather than an antagonist (or functional agonist). Ponesimod has a short half-life (30 hours) and is eliminated in about 1 week (Dash et al. Xenobiotica 2018;48:442-451). The drug was developed by Actelion and…

MS highlights from EAN 2019

…and 5. Trial of fingolimod vs. glatiramer acetate: ASSESS is the first head-to-head study to compare fingolimod with glatiramer acetate. RRMS patients were randomized to fingolimod 0.5 mg/day or glatiramer acetate 20 mg/day for one year (Cree et al. EAN 2019; abstract EPR1084). At 12 months, there was a significant 40.7% reduction in annualized relapse rate with fingolimod compared to glatiramer acetate, and significant reductions in the number of…

HSCT vs. drug in RRMS: head-to-head study

…noablation followed by autologous HSCT in 24 MS patients reported a disease-free survival rate at three years of 69.6% (Atkins et al. Lancet 2016;388:576-585). One-third of patients had a sustained improvement in EDSS score. There was one death. In the phase II HALT-MS trial, which also used high-dose immunosuppression followed by aHSCT, the rate of progression-free survival was 91.3% after a median follow-up of 62 months (range 12-72 months) (Nas…

FDA approves migraine drug for cluster headaches

…or the duration of the episode. Among the CGRP class of agents, the longest-term safety data are available for erenumab. After a median exposure of three years, there was a low rate of serious adverse events (4.2/100 patient-years) (Ashina et al. Cephalalgia; epublished May 2019). The most common adverse effects were viral upper respiratory tract infection, sinusitis, influenza and back pain. CGRP-targeted therapies have grown rapidly since their…