Botulinum toxin (BT) therapy is a complex and highly individualised therapy defined by treatment algorithms and injection schemes describing its target muscles and their dosing. Various consensus guidelines have tried to standardise and to improve BT therapy. We wanted to update and improve consensus guidelines by: (1) Acknowledging recent advances of treatment algorithms. (2) Basing dosing tables on statistical analyses of real-life treatment data of 1831 BT injections in 36 different target muscles in 420 dystonia patients and 1593 BT injections in 31 different target muscles in 240 spasticity patients. (3) Providing more detailed dosing data including typical doses, dose variabilities, and dosing limits. (4) Including total doses and target muscle selections for typical clinical entities thus adapting dosing to different aetiologies and pathophysiologies. (5) In addition, providing a brief and concise review of the clinical entity treated together with general principles of its BT therapy. For this, we collaborated with IAB-Interdisciplinary Working Group for Movement Disorders which invited an international panel of experts for the support.
- Keywords
- Botulinum toxin, Consensus guidelines, Dose limits, Dose variability, Dosing tables, Dystonia, Spasticity, Target muscles, Therapy, Total dose, Treatment algorithms, Typical dose,
- MeSH
- Algorithms MeSH
- Botulinum Toxins, Type A * MeSH
- Botulinum Toxins * MeSH
- Dystonic Disorders * drug therapy MeSH
- Dystonia * drug therapy MeSH
- Humans MeSH
- Muscle Spasticity drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Botulinum Toxins, Type A * MeSH
- Botulinum Toxins * MeSH
The selection of pharmacotherapy for patients with allergic rhinitis aims to control the disease and depends on many factors. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines have considerably improved the treatment of allergic rhinitis. However, there is an increasing trend toward use of real-world evidence to inform clinical practice, especially because randomized controlled trials are often limited with regard to the applicability of results. The Contre les Maladies Chroniques pour un Vieillissement Actif (MACVIA) algorithm has proposed an allergic rhinitis treatment by a consensus group. This simple algorithm can be used to step up or step down allergic rhinitis treatment. Next-generation guidelines for the pharmacologic treatment of allergic rhinitis were developed by using existing GRADE-based guidelines for the disease, real-world evidence provided by mobile technology, and additive studies (allergen chamber studies) to refine the MACVIA algorithm.
- Keywords
- Allergic Rhinitis and Its Impact on Asthma, Allergic rhinitis, Development and Evaluation, Grading of Recommendations Assessment, guidelines, real-world evidence,
- MeSH
- Rhinitis, Allergic * diagnosis immunology therapy MeSH
- Algorithms * MeSH
- Asthma * diagnosis immunology therapy MeSH
- Evidence-Based Practice * MeSH
- Humans MeSH
- Practice Guidelines as Topic MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Since the publication in 2021 of the European Hematology Association (EHA) Clinical Practice Guidelines for the treatment of patients with smouldering multiple myeloma (SMM) and multiple myeloma (MM), developed in collaboration with the European Society for Medical Oncology, a novel international staging system (R2-ISS) has been developed, several prognostic factors are entering clinical practice (such as minimal residual disease, circulating plasma cells and monoclonal protein assessed by mass spectrometry) and, at the time of writing, 14 novel regimens have been approved by the EMA and/or the FDA for the treatment of patients with MM. A multidisciplinary group of experts from the EHA and European Myeloma Network, based in various institutions mostly located in Europe, have updated the previous guidelines and produced algorithms for everyday clinical practice that incorporate levels of evidence and grades of recommendation based on the aforementioned new data. In these Evidence-Based Guidelines, we provide key treatment recommendations for both patients with newly diagnosed MM and those with relapsed and/or refractory MM, including guidance for the use of established drugs as well as contemporary immunotherapies. Novel approaches for the management of patients with SMM focus on those who might require early intervention. Finally, we provide recommendations for myeloma-related complications and adverse events, such as bone disease, renal impairment and infections, as well as for those associated with T cell-mobilizing therapies, such as cytokine-release syndrome and immune effector cell-associated neurotoxicity syndrome.
- MeSH
- Humans MeSH
- Evidence-Based Medicine MeSH
- Multiple Myeloma * diagnosis therapy MeSH
- Practice Guidelines as Topic * MeSH
- Neoplasm Staging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
BACKGROUND AND OBJECTIVE: The European Association of Urology urolithiasis guidelines provide evidence-based recommendations for the diagnosis and treatment of urinary stone disease. Given the complexity and variability of stone formation, individualised patient management is emphasised. METHODS: The guidelines incorporate evidence from the latest research and focus on risk assessment, imaging techniques, pharmacological management, and surgical interventions. A research librarian conducted literature searches for urolithiasis in the Cochrane Library, Medline, and Embase databases via Dialog-Datastar. The strength of recommendations is also rated. KEY FINDINGS AND LIMITATIONS: Diagnosis relies on a combination of clinical history, biochemical evaluation, and imaging, with ultrasound as the first-line modality and low-dose computed tomography as the gold standard for precise stone assessment. Stone composition and burden influence treatment decisions with algorithms primarily based on stone size, location, and composition. Nonsteroidal anti-inflammatory drugs are recommended for first-line pain management, with opioids reserved as a secondary option. Medical expulsive therapy with α-blockers may be considered for selected patients with ureteral stones. Extracorporeal shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy remain the primary intervention modalities, with selection based on stone characteristics and patient factors. Advances in multiplanar imaging have improved assessment of the stone burden, although further research is needed to refine predictive models. Genetic testing is recommended for high-risk patients to guide personalised treatment. CONCLUSIONS AND CLINICAL IMPLICATIONS: The guidelines provide a framework for clinical decision-making while acknowledging the need for continued advances in urolithiasis.
- Keywords
- Intervention, Treatment, Urolithiasis,
- MeSH
- Risk Assessment MeSH
- Humans MeSH
- Lithotripsy standards MeSH
- Societies, Medical MeSH
- Ureteroscopy standards MeSH
- Urolithiasis * therapy diagnosis MeSH
- Urology * standards MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Practice Guideline MeSH
- Geographicals
- Europe MeSH
BACKGROUND AND OBJECTIVE: The aim of this review was to define patients who are at high risk of recurrence of urolithiasis, to delineate diagnostic and therapeutic algorithms for each type of stone, and to clarify general guidelines and recommendations for prevention of recurrence. METHODS: A professional research librarian carried out literature searches for all sections of the urolithiasis guidelines, covering the timeframe between 1976 and June 2023. KEY FINDINGS AND LIMITATIONS: For every patient with urolithiasis, an attempt should be made to analyse the stone. Patients should be given general instructions on how to prevent recurrence, including adequate fluid and calcium intake, and low consumption of sodium and protein. Identifying and correcting the causative factors is a cornerstone in preventing the recurrence of urolithiasis. Diagnostic and therapeutic algorithms by stone composition are available. Every patient should undergo baseline metabolic screening, while patients with calcium stones, who are at high risk of relapse and complications, should undergo extensive metabolic screening with two 24-h urine collections and should receive targeted therapy. Patients with uric acid, infection, or cystine stones are at high risk of relapse. All patients at high risk of recurrence should be closely monitored, especially those not complying with therapy in the long term. CONCLUSIONS AND CLINICAL IMPLICATIONS: Metabolic stone evaluation and patient follow-up are highly recommended to prevent urolithiasis recurrence.
- Keywords
- Follow-up, Metabolic evaluation, Prevention, Treatment, Urolithiasis,
- MeSH
- Risk Assessment MeSH
- Humans MeSH
- Urinary Calculi * prevention & control therapy MeSH
- Recurrence * MeSH
- Risk Factors MeSH
- Secondary Prevention * methods MeSH
- Practice Guidelines as Topic MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Practice Guideline MeSH
• This update provides recommendations for perioperative treatment of locally advanced oesophageal and OGJ adenocarcinoma. • Recent phase III data have demonstrated that perioperative ChT should be the preferred approach for most patients. • Updated recommendations are also provided for the use of immune checkpoint inhibitors in advanced squamous-cell carcinoma. • Algorithms for the management of locoregional oesophageal cancer and advanced squamous-cell carcinoma are provided. • Recommendations are based on available scientific data and the authors’ collective expert opinion.
Children and adolescents with Crohn's disease (CD) present often with a more complicated disease course compared to adult patients. In addition, the potential impact of CD on growth, pubertal and emotional development of patients underlines the need for a specific management strategy of pediatric-onset CD. To develop the first evidenced based and consensus driven guidelines for pediatric-onset CD an expert panel of 33 IBD specialists was formed after an open call within the European Crohn's and Colitis Organisation and the European Society of Pediatric Gastroenterolog, Hepatology and Nutrition. The aim was to base on a thorough review of existing evidence a state of the art guidance on the medical treatment and long term management of children and adolescents with CD, with individualized treatment algorithms based on a benefit-risk analysis according to different clinical scenarios. In children and adolescents who did not have finished their growth, exclusive enteral nutrition (EEN) is the induction therapy of first choice due to its excellent safety profile, preferable over corticosteroids, which are equipotential to induce remission. The majority of patients with pediatric-onset CD require immunomodulator based maintenance therapy. The experts discuss several factors potentially predictive for poor disease outcome (such as severe perianal fistulizing disease, severe stricturing/penetrating disease, severe growth retardation, panenteric disease, persistent severe disease despite adequate induction therapy), which may incite to an anti-TNF-based top down approach. These guidelines are intended to give practical (whenever possible evidence-based) answers to (pediatric) gastroenterologists who take care of children and adolescents with CD; they are not meant to be a rule or legal standard, since many different clinical scenario exist requiring treatment strategies not covered by or different from these guidelines.
- Keywords
- Crohn's disease, Guidelines, Medical therapy, Pediatric,
- MeSH
- Adalimumab MeSH
- Algorithms MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Anti-Inflammatory Agents, Non-Steroidal therapeutic use MeSH
- Azathioprine therapeutic use MeSH
- Crohn Disease therapy MeSH
- Child MeSH
- Enteral Nutrition * MeSH
- Adrenal Cortex Hormones adverse effects therapeutic use MeSH
- Antibodies, Monoclonal, Humanized therapeutic use MeSH
- Immunosuppressive Agents therapeutic use MeSH
- Remission Induction methods MeSH
- Infliximab MeSH
- Aminosalicylic Acids therapeutic use MeSH
- Humans MeSH
- Mercaptopurine therapeutic use MeSH
- Methotrexate therapeutic use MeSH
- Adolescent MeSH
- Antibodies, Monoclonal therapeutic use MeSH
- Thalidomide therapeutic use MeSH
- Tumor Necrosis Factor-alpha antagonists & inhibitors MeSH
- Maintenance Chemotherapy methods MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Publication type
- Journal Article MeSH
- Practice Guideline MeSH
- Names of Substances
- Adalimumab MeSH
- Anti-Bacterial Agents MeSH
- Anti-Inflammatory Agents, Non-Steroidal MeSH
- Azathioprine MeSH
- Adrenal Cortex Hormones MeSH
- Antibodies, Monoclonal, Humanized MeSH
- Immunosuppressive Agents MeSH
- Infliximab MeSH
- Aminosalicylic Acids MeSH
- Mercaptopurine MeSH
- Methotrexate MeSH
- Antibodies, Monoclonal MeSH
- Thalidomide MeSH
- Tumor Necrosis Factor-alpha MeSH
CONTEXT: An optimum metabolic evaluation strategy for urinary stone patients has not been clearly defined. OBJECTIVE: To evaluate the optimum strategy for metabolic stone evaluation and management to prevent recurrent urinary stones. EVIDENCE ACQUISITION: Several databases were searched to identify studies on the metabolic evaluation and prevention of stone recurrence in urolithiasis patients. Special interest was given to the level of evidence in the existing literature. EVIDENCE SYNTHESIS: Reliable stone analysis and basic metabolic evaluation are highly recommended in all patients after stone passage (grade A). Every patient should be assigned to a low- or high-risk group for stone formation. It is highly recommended that low-risk stone formers follow general fluid and nutritional intake guidelines, as well as lifestyle-related preventative measures to reduce stone recurrences (grade A). High-risk stone formers should undergo specific metabolic evaluation with 24-h urine collection (grade A). More specifically, there is strong evidence to recommend pharmacological treatment of calcium oxalate stones in patients with specific abnormalities in urine composition (grades A and B). Treatment of calcium phosphate stones using thiazides is only highly recommended when hypercalciuria is present (grade A). In the presence of renal tubular acidosis (RTA), potassium citrate and/or thiazide are highly recommended based on the relative urinary risk factor (grade A or B). Recommendations for therapeutic measures for the remaining stone types are based on low evidence (grade C or B following panel consensus). Diagnostic and therapeutic algorithms are presented for all stone types based on the best level of existing evidence. CONCLUSION: Metabolic stone evaluation is highly recommended to prevent stone recurrences. PATIENT SUMMARY: In this report, we looked at how patients with urolithiasis should be evaluated and treated in order to prevent new stone formation. Stone type determination and specific blood and urine analysis are needed to guide patient treatment.
- Keywords
- European Association of Urology, Guidelines, Lithiasis, Medical treatment, Metabolic evaluation, Recurrence and conservative treatment, Stone, Urinary,
- MeSH
- Adult MeSH
- Calcium Phosphates urine MeSH
- Middle Aged MeSH
- Humans MeSH
- Urinary Calculi etiology metabolism prevention & control therapy urine MeSH
- Drinking MeSH
- Recurrence MeSH
- Acidosis, Renal Tubular complications MeSH
- Risk Factors MeSH
- Aged MeSH
- Calcium Compounds metabolism urine MeSH
- Calcium Oxalate urine MeSH
- Calcium urine MeSH
- Life Style MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Names of Substances
- Calcium Phosphates MeSH
- Calcium Compounds MeSH
- Calcium Oxalate MeSH
- Calcium MeSH
At two meetings of a Central European board of multiple sclerosis (MS) experts in 2018 and 2019 factors influencing daily treatment choices in MS, especially practice guidelines, biomarkers and burden of disease, were discussed. The heterogeneity of MS and the complexity of the available treatment options call for informed treatment choices. However, evidence from clinical trials is generally lacking, particularly regarding sequencing, switches and escalation of drugs. Also, there is a need to identify patients who require highly efficacious treatment from the onset of their disease to prevent deterioration. The recently published European Committee for the Treatment and Research in Multiple Sclerosis/European Academy of Neurology clinical practice guidelines on pharmacological management of MS cover aspects such as treatment efficacy, response criteria, strategies to address suboptimal response and safety concerns and are based on expert consensus statements. However, the recommendations constitute an excellent framework that should be adapted to local regulations, MS center capacities and infrastructure. Further, available and emerging biomarkers for treatment guidance were discussed. Magnetic resonance imaging parameters are deemed most reliable at present, even though complex assessment including clinical evaluation and laboratory parameters besides imaging is necessary in clinical routine. Neurofilament-light chain levels appear to represent the current most promising non-imaging biomarker. Other immunological data, including issues of immunosenescence, will play an increasingly important role for future treatment algorithms. Cognitive impairment has been recognized as a major contribution to MS disease burden. Regular evaluation of cognitive function is recommended in MS patients, although no specific disease-modifying treatment has been defined to date. Finally, systematic documentation of real-life data is recognized as a great opportunity to tackle unresolved daily routine challenges, such as use of sequential therapies, but requires joint efforts across clinics, governments and pharmaceutical companies.
- Keywords
- biomarkers, burden of disease, cognitive dysfunction, magnetic resonance imaging, multiple sclerosis, neurofilament,
- Publication type
- Journal Article MeSH
- Review MeSH
As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynecological Oncology (ESGO) organized 3 international consensus meetings with leading experts in the field to define protocols and to provide guidance for pregnant patients and healthcare providers on the management of gynecological cancers in pregnancy. Following the third consensus meeting, the guidelines published in 2019 were updated by incorporating new evidence on this field and covering new topics to provide comprehensive evidence-based guidelines on all relevant issues within a multidisciplinary setting. ESGO appointed 21 experts from relevant disciplines and 2 cancer survivors to serve on the international development group. Members of the International Network on Cancer, Infertility and Pregnancy involved in the 3 international consensus meetings were included. To ensure that the guidelines were evidence-based, data identified from a systematic search were reviewed and critically appraised. In the absence of robust scientific evidence, the guidelines were based on the consensus of the international development group. Prior to publication, the guidelines were reviewed by 100 independent international practitioners in cancer care delivery from Asia, Europe, Africa, and North and South Americas, and 3 patient representatives to ensure a global perspective. These ESGO/International Network on Cancer, Infertility and Pregnancy guidelines address all relevant aspects of imaging, pathology, surgery, medical oncology, obstetrics, radiation therapy, psychology, patient perspectives and pediatric follow-up in a multidisciplinary setting for patients with tubo-ovarian, cervical, and vulvar cancers during pregnancy. Treatment algorithms for each tumor type are also defined.
- Keywords
- Cervical Cancer, Guidelines, Pregnancy, Tubo-Ovarian Cancer, Vulvar Cancer,
- Publication type
- Journal Article MeSH
- Review MeSH
