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Expert Opinion on Pharmacotherapy

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December 11, 2018: Expert Opinion on Pharmacotherapy
Johnathon Seth Parham, Anne Carol Goldberg
Familial Hypercholesterolemia (FH) is an inherited disorder characterized by a defect in the binding and internalization of low-density lipoprotein (LDL) particles, resulting in markedly elevated LDL levels and premature atherosclerosis. It is one of the most common inherited disorders of lipid metabolism. Many FH patients, especially those with homozygous FH do not reach LDL goals with traditional LDL therapies and may require additional, less often used, therapies. Areas covered: Mipomersen is an anti-sense oligonucleotide that prevents production of apolipoprotein B leading to decreased levels of very low-density lipoprotein (VLDL) and LDL...
December 10, 2018: Expert Opinion on Pharmacotherapy
Anna Whelehan, Norman Delanty
Counseling for women with epilepsy of childbearing potential surrounding pregnancy issues is of the utmost importance and should be done when antiepileptic medications are prescribed and reviewed regularly at clinic visits. Physicians must be familiar with risks associated with antiepileptic medication, and endeavor to minimize risks to a fetus while selecting best medications for epilepsy type. Areas covered: The authors discuss the role of folic acid, updated evidence relating to the occurrence of major congenital malformations and neurocognitive risks associated with antiepileptic medication...
December 10, 2018: Expert Opinion on Pharmacotherapy
P Barbanti, L Grazzi, G Egeo
Migraine is increasingly recognized as an extremely burdensome and disabling disorder in both children and adolescents. A proper treatment plan is needed to improve the quality of life of both children and families as well as to minimize the risk of disease progression. Areas covered: This review focuses on the current pharmacotherapy for acute migraine in pediatric populations, taking into account specific considerations for those drugs tested in randomized, placebo-controlled trials (RCTs). Expert opinion: A large number of RCTs have documented the efficacy, tolerability, and safety of different compounds...
December 7, 2018: Expert Opinion on Pharmacotherapy
Samuel Lee, Deirdre J Cohen
Esophageal cancer is a heterogeneous cancer comprised of differing cells of origin, molecular changes, and immune microenvironments. To date, most advances have been made in chemotherapy regimens where a one-size-fits-all approach is used. As a result, there remains a lack of tailored treatment options for such a heterogeneous cancer. This paper highlights the current standard of care treatment options as well as active areas of clinical research. Areas covered: The authors review the key trials that have led to current standard of care treatment including pivotal chemotherapy and targeted therapy trials...
December 7, 2018: Expert Opinion on Pharmacotherapy
Abdalla Ibrahim, Leon G Walsh, Mohamed Algaali, Zahir Satti, Thomas J Kiernan, Bryan P Yan
Direct oral anticoagulants (DOACs) have gained momentum in recent years in patients requiring anticoagulation for the prevention and management of venous thromboembolism and thromboembolic events caused by atrial fibrillation. The use of these agents involves potential bleeding complications, particularly during invasive procedures. With increasing use of DOACs, adequate knowledge regarding the perioperative management of patients on DOACs has become indispensable. Areas covered: This review covers the indications, mechanism of action, and pharmacokinetics of DOACs and their management in different perioperative settings based on various current guidelines and practices...
December 6, 2018: Expert Opinion on Pharmacotherapy
Dragana Nikolic, Andreea Corina, Peter P Toth, Lubna Hammad, Manfredi Rizzo
No abstract text is available yet for this article.
December 6, 2018: Expert Opinion on Pharmacotherapy
Michael R Hamblin
The prognosis for severe burns has improved significantly over the past 50 years. Meanwhile, burns have become an affliction mainly affecting the less well-developed regions of the world. Early excision and skin grafting has led to major improvements in therapeutic outcomes. Areas covered: The purpose of this article is to survey the use of pharmacotherapy to treat different pathophysiological complications of burn injury. The author, herein, discusses the use of drug treatments for a number of systemic metabolic disturbances including hyperglycemia, elevated catabolism, and gluconeogenesis...
December 5, 2018: Expert Opinion on Pharmacotherapy
Laura Dumitrescu, Cris S Constantinescu, Radu Tanasescu
Multiple sclerosis (MS) is a chronic central nervous system immune-mediated disease with an important inflammatory component associated with focal demyelination and widespread neurodegeneration. In most cases, the clinical presentation is relapsing-remitting, followed by a secondary progressive phase, characterized by disability accrual unrelated to relapses. In a minority, the phenotype is progressive from the beginning. Major therapeutic achievements have been made concerning the relapsing phase but modifying the evolution of progressive MS remains an unmet need...
December 5, 2018: Expert Opinion on Pharmacotherapy
Marc Laine, Lemesle Gilles, Thibaut Dabry, Vassili Panagides, Peyrol Michael, Franck Paganelli, Laurent Bonello
Anticoagulant therapy is critical to prevent ischemic recurrences and complications in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Unfractionated heparin (UFH), an injectable anticoagulant has several limitations: lack of predictability of its biological efficacy, platelets activation, heparin-induced thrombopenia and bleedings. Bivalirudin, a synthetic direct thrombin inhibitor has biological properties that promised better clinical outcome in ACS patients undergoing PCI...
December 4, 2018: Expert Opinion on Pharmacotherapy
Giulio Perugi, Alessandro Pallucchini, Salvatore Rizzato, Pietro De Rossi, Gabriele Sani, Angelo Maremmani, Vito Pinzone, Icro Maremmani
Substance use disorder (SUD) is very common amongst patients with attention deficit hyperactivity disorder (ADHD). The two disorders share partially overlapping features and SUD in ADHD is characterized by an early age of onset, high likelihood of poly-substance use, increased risk of suicide attempts, more hospitalizations, and scarce treatment adherence. Areas covered: This paper reviews randomized active comparator-controlled or placebo-controlled trials evaluating the use of pharmacotherapy in patients with ADHD and SUD...
December 4, 2018: Expert Opinion on Pharmacotherapy
Amanda C Nascimento-Carvalho, Cristiana M Nascimento-Carvalho
Community-acquired pneumonia (CAP) is the leading cause of mortality among children under 5 years worldwide. However, the choices of chemical therapy for the empirical treatment of CAP are frequently debated. Areas covered: The authors provide an update on the chemical management recommendations for childhood CAP. The authors have performed a MEDLINE literature search, using the keywords 'guidelines,' 'community-acquired pneumonia,' AND 'children.' Articles published in English, providing consensual recommendations on management of children >2 months and <5 years with CAP but without HIV infection, were included...
December 3, 2018: Expert Opinion on Pharmacotherapy
Maka S Hedrington, Stephen N Davis
Glucagon-like peptide-1 (GLP-1) receptor agonists are highly potent antihyperglycemic drugs that impose low risk of hypoglycemia and also result in body weight reduction. Currently, all approved members of the class require administration by injection. Areas covered: This manuscript reviews oral semaglutide-an experimental GLP-1 receptor agonist in phase-3 clinical development. Available pharmacological and clinical data of the drug are reviewed, and important end-points described. Expert opinion: Oral peptide delivery has become possible with the discovery of absorption enhancers...
November 30, 2018: Expert Opinion on Pharmacotherapy
Lidiane Torres, Nicola Conran
Sickle cell disease (SCD) is an inherited disease with lifelong morbidity, whose complications include frequent acute painful vaso-occlusive episodes (VOEs) that often require hospitalization. The only pharmacotherapy currently in regular use for SCD management is hydroxyurea (hydroxycarbamide). Areas covered: We review recent advances in pharmacotherapy for SCD and summarize promising synthetic agents that are in late-stage development (phase 3) for SCD. Expert opinion: Emerging SCD therapies have been developed to target specific pathophysiological mechanisms of the disease, as either preventative or abortive approaches to VOEs...
November 30, 2018: Expert Opinion on Pharmacotherapy
Michele Fornaro
No abstract text is available yet for this article.
November 29, 2018: Expert Opinion on Pharmacotherapy
Marc Bardou, Kyle J Fortinsky, Nicolas Chapelle, Maxime Luu, Alan Barkun
Gastroesophageal reflux (GER), and its complicated form gastroesophageal reflux disease (GERD) is a common condition in infants and children. As GERD is often considered to cause extra-oesophageal symptoms in children and in the absence of standardized diagnostic and treatment algorithm, many children are inappropriately exposed to empirical anti-reflux treatments, with Acid-Suppressive Medications (ASM); mostly proton pump inhibitors (PPIs). Areas covered: The authors summarize the pharmacological management of pediatric GERD and discuss the efficacy of PPIs as randomized controlled trials have failed to demonstrate their clinical efficacy in the pediatric population...
November 29, 2018: Expert Opinion on Pharmacotherapy
Seetal Dodd, Lauren Arancini, Nieves Gómez-Coronado, Rudi Gasser, Dan I Lubman, Olivia M Dean, Michael Berk
No abstract text is available yet for this article.
November 29, 2018: Expert Opinion on Pharmacotherapy
Violaine Planté-Bordeneuve, Hollis Lin, Jared Gollob, Sonalee Agarwal, Marissa Betts, Kyle Fahrbach, Madhura Chitnis, Michael Polydefkis
BACKGROUND: Hereditary transthyretin-mediated amyloidosis (hATTR amyloidosis) is a progressive, life-threatening disease. Until recently, tafamidis was the only approved pharmacotherapy. Patisiran significantly improved polyneuropathy and Quality of life (QoL) in the phase III APOLLO study. In the absence of direct comparisons, this analysis aims to evaluate the comparative efficacy of tafamidis and patisiran in hATTR amyloidosis with polyneuropathy. RESEARCH DESIGN AND METHODS: Randomized controlled trial evidence for tafamidis was identified by systematic literature review...
November 29, 2018: Expert Opinion on Pharmacotherapy
Paul Chan, Li Shao, Brian Tomlinson, Yuzhen Zhang, Zhong-Min Liu
Statins are the first line of therapy to reduce low-density lipoprotein cholesterol (LDL-C) in order to decrease cardiovascular events. Pitavastatin is the latest statin to be introduced to the market. Areas covered: In this article, the authors review the efficacy, safety, and tolerability of pitavastatin. The authors also review a recent cardiovascular outcome study. Expert opinion: Pitavastatin produces dose-dependent reductions in LDL-C at lower doses than other statins. The maximum approved dose of 4 mg reduces LDL-C by about 40-49% in different patient groups and is equivalent to atorvastatin 20 mg in this effect...
November 27, 2018: Expert Opinion on Pharmacotherapy
Monika Banach, Barbara Miziak, Kinga K Borowicz-Reutt, Stanisław J Czuczwar
As a matter of course, elderly people are more sensitive to both the pharmacological and toxicological effects of pharmacotherapy. A senior's treatment, therefore, requires more attention compared to younger adults. Extended release (ER) formulations of anti-epileptic drugs (AEDs) have been developed to improve safety, efficacy and long-term adherence. In senior patients, ER AEDs are used to treat epilepsy, psychiatric conditions, and neuropathic pain. However, very limited clinical evidence is available on the use of these ER AEDs in these populations...
November 27, 2018: Expert Opinion on Pharmacotherapy
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