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Expert Opinion on Pharmacotherapy

Olivier Bruyère
Chondroitin Sulfate (CS) is a drug which is available as pharmaceutical-grade and nutriceutical-grade products, with important variations in preparation, composition, purity and therapeutic effects. Previous studies using pharmaceutical-grade CS suggested that the compound improves pain and function and delays structural progression in knee osteoarthritis (OA), whereas discrepant results were observed when lower grade preparations were investigated. The recently published chondroitin versus celecoxib versus Placebo Trial (CONCEPT) assessed the symptomatic effect of pharmaceutical-grade CS 800 mg/day in symptomatic knee OA...
February 16, 2018: Expert Opinion on Pharmacotherapy
Kaoru Okuizumi, Teruyoshi Kamata, Daiju Matsui, Kengo Saito, Takuyuki Matsumoto, Yoshikazu Fukuchi
BACKGROUND: Responder analyses assessing clinical worsening have attempted to clarify clinically meaningful drug efficacy enhancements in patients with Alzheimer's disease (AD). RESEARCH DESIGN AND METHODS: This was a meta-analysis of two multicenter, randomized, double-blind, parallel-group, 24-week studies of 633 Japanese patients with moderate to severe AD receiving memantine 20 mg/day (n = 318) or placebo (n = 315). The clinical trial registration number is UMIN000026013...
February 16, 2018: Expert Opinion on Pharmacotherapy
Timothy L Comstock, John D Sheppard
Topical corticosteroids are an important pharmacotherapy for the management of various inflammatory conditions affecting the anterior segment of the eye. However, medications in this class are associated with well-known risks including increased intraocular pressure (IOP) and development of cataracts. The topical corticosteroid loteprednol etabonate (LE) was developed with the specific intention of minimizing these side effects. Areas Covered: The focus of this review is to examine published efficacy and safety data for LE, a drug engineered to undergo rapid metabolism to inactive metabolites with the goal of improved safety...
February 10, 2018: Expert Opinion on Pharmacotherapy
Sanghamitra Mohanty, Chintan Trivedi, Carola Gianni, Andrea Natale
Distinct differences in clinical presentation, utilization of therapy and outcome of atrial fibrillation (AF) management are observed in men vs women. This review focuses on our current knowledge on these sex-specific variations and how those impact the detection of AF and therapeutic decisions. Areas covered: The current article reviews reports illustrating gender-related differences in the incidence, prevalence, clinical presentations, different risk factors, pathophysiology, therapeutic strategies, procedural parameters in catheter ablation for AF and complications and long-term outcome of ablative therapy including arrhythmia recurrence and quality of life...
February 9, 2018: Expert Opinion on Pharmacotherapy
James M Kidd, Joseph L Kuti, David P Nicolau
Introduction Hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP) are among the most prevalent infections in hospitalized patients, particularly those in the intensive care unit. Importantly, the frequency of multidrug resistant (MDR) Gram-negative (GN) bacteria as the bacteriologic cause of HABP/VABP is increasing. These include MDR Pseudomonas aeruginosa, Acinetobacter baumannii, and carbapenem resistant Enterobactericeae (CRE). Few antibiotics are currently available when such MDR Gram-negatives are encountered and older agents such as polymyxin B, colistin (polymyxin E), and tigecycline have typically performed poorly in HABP/VABP...
February 7, 2018: Expert Opinion on Pharmacotherapy
Marco Pitteri, Roberta Magliozzi, Albulena Bajrami, Valentina Camera, Massimiliano Calabrese
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating disease of the central nervous system affecting both white matter and grey matter in the earliest phases of its course. The crucial role of neurodegeneration in disability progression in MS, regardless of white matter damage, has been confirmed by several imaging and neuropathological studies. Fingolimod is an effective immunomodulator of the sphingosine 1-phosphate receptor, approved in relapsing remitting MS and able to cross the blood-brain barrier and to slow disability progression and brain volume loss...
February 3, 2018: Expert Opinion on Pharmacotherapy
Hiroshi Maegawa, Kazuyuki Tobe, Hiromi Tabuchi, Ichiro Nakamura, Satoshi Uno
BACKGROUND: This subgroup analysis of STELLA-LONG TERM interim data explored the long-term safety and efficacy of ipragliflozin in non-elderly vs elderly Japanese type 2 diabetes mellitus (T2DM) patients. RESEARCH DESIGN AND METHODS: STELLA-LONG TERM is an ongoing 3-year prospective surveillance study of Japanese T2DM patients receiving ipragliflozin 50 mg once daily. In this subgroup analysis, patient characteristics, laboratory variables, and adverse drug reactions (ADRs) were compared between non-elderly (<65 years) and elderly (≥65 years) patients...
February 1, 2018: Expert Opinion on Pharmacotherapy
Eric Chung
Nocturia is a common urinary condition experienced by both men and women. While desmopressin has historically been utilized to treat conditions such as central diabetes insipidus and primary nocturnal enuresis, there is an increased interest in the use of desmopressin in the management of adult nocturia. Areas covered: This article provides a review on the pathophysiology of nocturia and the clinical outcomes and safety profile of desmopressin in the management of adult nocturnal voiding dysfunction. Expert opinion: To date, desmopressin is the only anti-diuretic hormone that is approved for nocturia...
January 29, 2018: Expert Opinion on Pharmacotherapy
Tariq Chukir, Alpana P Shukla, Katherine H Saunders, Louis J Aronne
Type 2 diabetes (T2DM) is associated with significant morbidity and mortality. Obesity is one of the main risk factors for T2DM and its management requires a multidisciplinary approach, which may include pharmacotherapy. Areas covered: In this paper, data on efficacy, tolerability and safety of FDA-approved pharmacotherapies for obesity (orlistat, phentermine/topiramate extended-release, lorcaserin, bupropion sustained release/naltrexone sustained release and liraglutide) are reviewed, focusing on individuals with type 2 diabetes...
January 29, 2018: Expert Opinion on Pharmacotherapy
Philip B Miner
Uroguanylin interacting with intestinal Guanylate Cyclase C (GC-C) receptors plays an important role in gastrointestinal fluid and electrolyte homeostasis. Plecanatide is the first uroguanylin analog that stimulates GC-C receptors on gastrointestinal mucosa with pH-sensitive receptor binding. Binding to the GC-C receptor activates intracellular conversion of GTP to cGMP resulting in the stimulation of intestinal fluid secretion. Areas covered: Herein, all published research regarding the development of and clinical experience with plecanatide is reviewed...
January 29, 2018: Expert Opinion on Pharmacotherapy
Taylor Edwards, Nupur U Patel, Amy Blake, Samantha Prabakaran, Danielle Reimer, Steven R Feldman, Lindsay C Strowd
Atopic Dermatitis (AD) is a common chronic inflammatory skin disorder with a constellation of symptoms. Currently, there are numerous therapies in various phases of drug development that target the pathogenesis of AD. Areas covered: Our paper aims to examine small molecule therapies and other novel agents registered for clinical trial in the phase II and mainly phase III stages of development. A literature search using PubMed as well as was conducted. Clinical trial evidence of these novel agents was compiled and assessed...
January 29, 2018: Expert Opinion on Pharmacotherapy
Anne Michal Morsel, Manuel Morrens, Bernard Sabbe
Bipolar I disorder (BD I) is complex with a chronic course that significantly impacts a sufferer's quality of life. As of right now, there are many available treatments that aim to rapidly treat manic or depressive episodes and stabilize mood. The purpose of this report is to provide an up-to-date comprehensive review of the available evidence-based trials of pharmacotherapy for the treatment of BD I. Areas covered: This paper reviews randomized active comparator-controlled or placebo-controlled trials evaluating the use of current pharmacotherapy in adults with BD I from phase III to clinical practice...
January 23, 2018: Expert Opinion on Pharmacotherapy
Milen Minkov
Langerhans cell histiocytosis (LCH) is a rare myeloid neoplasia driven by activation mutations alongside the MAPK pathway. Its broad spectrum of clinical manifestations and diverse course and clinical outcome, make interpretation of trial data difficult. Use of different stratification systems further complicates comparison among trials. Areas covered: This review summarizes the published data derived from prospective clinical trials from Phase II onwards. PubMed was searched using combinations of the keywords 'Langerhans cell histiocytosis', 'histiocytosis X', 'pediatric', 'children', 'treatment', and 'therapy'...
January 22, 2018: Expert Opinion on Pharmacotherapy
Bruno Achutti Duso, Dario Trapani, Giulia Viale, Carmen Criscitiello, Paolo D'Amico, Carmen Belli, Luca Mazzarella, Marzia Locatelli, Ida Minchella, Giuseppe Curigliano
Breast cancer (BC) remains the most frequently diagnosed cancer and the most common cause of cancer death among women of all races worldwide. Over 80% of BC cases are hormone receptor (HR)-positive, comprised of luminal A and luminal B per molecular subtypes, imposing an urgent need to fully understand the mechanisms behind progression. Ribociclib is a selective cycline-dependent kinase 4 and 6 inhibitor. A phase 1 and a phase 3 trial have established a definitive role of ribociclib as frontline in the treatment of endocrine-sensitive advanced BC...
January 22, 2018: Expert Opinion on Pharmacotherapy
Luigi Gennari, John P Bilezikian
Osteoporosis represents a major health and societal burden in men, as well as in women. However, only a minority of men are screened and treated for osteoporosis and fracture prevention, even after first fracture. Areas covered: This article provides a comprehensive summary of the currently available drugs for osteoporosis in men as well as insights into new and developing pharmacotherapy. Expert opinion: To date, therapeutic approaches to osteoporosis in men remain not as well defined as in women, since antifracture efficacy data are lacking for most approved pharmaceuticals...
January 19, 2018: Expert Opinion on Pharmacotherapy
Niki Katsiki, Željko Reiner, Eugenia Tedeschi Reiner, Khalid Al-Rasadi, Matteo Pirro, Dimitri P Mikhailidis, Amirhossein Sahebkar
OBJECTIVE: Dyslipidemia is commonly associated with endothelial dysfunction and increased cardiovascular risk. Pitavastatin has been shown to reduce total and low-density lipoprotein cholesterol, to increase high-density lipoprotein (HDL)-cholesterol and improve HDL function. Furthermore, several trials explored its effects on flow-mediated dilation (FMD), as an index of endothelial function. The authors evaluated the effect of pitavastatin therapy on FMD. METHODS: The authors performed a systematic review and meta-analysis of all clinical trials exploring the impact of pitavastatin on FMD...
January 15, 2018: Expert Opinion on Pharmacotherapy
Dorota Danielak, Marta Karaźniewicz-Łada, Franciszek Główka
Ticagrelor is a first drug of a new chemical class cyclopentyltriazolopyrimidines. It is an antiplatelet agent with a unique mechanism of action, allowing a direct and reversible competitive inhibition of P2Y12 receptor. According to newest guidelines, it is recommended for prevention of thrombotic events in patients with acute coronary syndromes. Moreover, it is preferred over clopidogrel, an older generation antiplatelet drug, and therefore gains more interest in modern cardiology and vascular medicine. Areas covered: This review is a comprehensive and thorough summary of the most important findings on ticagrelor...
December 27, 2017: Expert Opinion on Pharmacotherapy
Ileana Antohe, Sabina A Antoniu, Cristina Gavrilovici
Inhaled therapies are the therapeutic mainstay in stable chronic obstructive pulmonary disease (COPD). They are represented by long-acting bronchodilators (anticholinergics or beta2-agonists) and by inhaled corticosteroids, currently available as a monotherapy or as combination therapies in one inhaler. Combinations of anticholinergics and beta2 agonists or beta2 agonists and inhaled corticosteroids are widely used per the prescription guidelines. The advantage of them are related with higher adherence and better acceptability by the patients as compared to both components dosed with individual inhalers...
December 22, 2017: Expert Opinion on Pharmacotherapy
J Y Reginster, Nasser Al Daghri, Jean-Marc Kaufman, Olivier Bruyère
The recently published results of the sequential treatment of postmenopausal osteoporotic women with subcutaneous abaloparatide (80 µg/day) (ABL) for 18 months followed by 6 months of oral alendronate (70 mg/week) (ALN) support the administration of an anti-resorptive agent after completion of a treatment course with an osteoanabolic agent. The ABL/ALN sequence resulted in greater bone mineral density gains at all skeletal sites and in a reduction of vertebral, non-vertebral, major and clinical fractures compared to what is observed after 18 months of placebo followed by 6 months of ALN...
December 22, 2017: Expert Opinion on Pharmacotherapy
Sheila Doggrell
Sodium-glucose cotransporter 2 (SGLT2) inhibitors (the 'gliflozins') promote the excretion of glucose from the kidney to lower HbA1c. Empagliflozin was the first gliflozin shown to improve cardiovascular and renal outcomes in subjects with type 2 diabetes and cardiovascular disease. Areas covered: In the Canagliflozin Cardiovascular Assessment Study (CANVAS) Program, there were improvements in the primary cardiovascular and exploratory renal outcomes with canagliflozin, compared to placebo. The safety outcome finding, which was of most interest, was that there was a higher risk of amputation of toes, feet, or legs with canagliflozin than in the placebo group...
December 18, 2017: Expert Opinion on Pharmacotherapy
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