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Costigan C, O'Sullivan AM, O'Connell J, Sengupta S, Butler T, Molloy S, O'Hara FJ, Ryan B, Breslin N, O'Donnell S, O'Connor A, Smith S, McNamara D. Helicobacter pylori: High dose amoxicillin does not improve primary or secondary eradication rates in an Irish cohort. World J Clin Cases 2024; 12:2773-2779. [DOI: 10.12998/wjcc.v12.i16.2773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) eradication rates have fallen globally, likely in large part due to increasing antibiotic resistance to traditional therapy. In areas of high clarithromycin and metronidazole resistance such as ours, Maastricht VI guidelines suggest high dose amoxicillin dual therapy (HDADT) can be considered, subject to evidence for local efficacy. In this study we assess efficacy of HDADT therapy for H. pylori eradication in an Irish cohort.
AIM To assess the efficacy of HDADT therapy for H. pylori eradication in an Irish cohort as both first line, and subsequent therapy for patients diagnosed with H. pylori.
METHODS All patients testing positive for H. pylori in a tertiary centre were treated prospectively with HDADT (amoxicillin 1 g tid and esomeprazole 40 mg bid × 14 d) over a period of 8 months. Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy. A delta-over-baseline > 4% was considered positive. Patient demographics and treatment outcomes were recorded, analysed and controlled for basic demographics and prior H. pylori treatment.
RESULTS One hundred and ninety-eight patients were identified with H. pylori infection, 10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing. In all 139 were included in the analysis, 55% (n = 76) were female, mean age was 46.6 years. Overall, 93 (67%) of patients were treatment-naïve and 46 (33%) had received at least one previous course of treatment. The groups were statistically similar. Self-reported compliance with HDADT was 97%, mild side-effects occurred in 7%. There were no serious adverse drug reactions. Overall the eradication rate for our cohort was 56% (78/139). Eradication rates were worse for those with previous treatment [43% (20/46) vs 62% (58/93), P = 0.0458, odds ratio = 2.15]. Age and Gender had no effect on eradication status.
CONCLUSION Overall eradication rates with HDADT were disappointing. Despite being a simple and possibly better tolerated regime, these results do not support its routine use in a high dual resistance country. Further investigation of other regimens to achieve the > 90% eradication target is needed.
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Affiliation(s)
- Conor Costigan
- Trinity Academic Gastroenterology Group, School of Medicine-Trinity College Dublin, Dublin D2, Ireland
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - Aoife M O'Sullivan
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - Jim O'Connell
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - Shreyashee Sengupta
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - Thomas Butler
- Trinity Academic Gastroenterology Group, School of Medicine-Trinity College Dublin, Dublin D2, Ireland
| | - Stephen Molloy
- Trinity Academic Gastroenterology Group, School of Medicine-Trinity College Dublin, Dublin D2, Ireland
| | - Fintan John O'Hara
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - Barbara Ryan
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - Niall Breslin
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - Sarah O'Donnell
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - Anthony O'Connor
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - Sinead Smith
- Trinity Academic Gastroenterology Group, School of Medicine-Trinity College Dublin, Dublin D2, Ireland
| | - Deirdre McNamara
- Trinity Academic Gastroenterology Group, School of Medicine-Trinity College Dublin, Dublin D2, Ireland
- Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland
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2
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Jariyapamornkoon N, Boonkam P, Suanpairintr N. Assessment of the gradient diffusion method for fosfomycin susceptibility testing in Staphylococcus spp. and Enterococcus spp. isolated from the urine of companion dogs in Thailand. Vet World 2023; 16:2497-2503. [PMID: 38328370 PMCID: PMC10844777 DOI: 10.14202/vetworld.2023.2497-2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024] Open
Abstract
Background and Aim The agar dilution method is the approved method for determining the minimum inhibitory concentration (MIC) in fosfomycin susceptibility testing, whereas the broth dilution method is not recommended. This study aimed to investigate the potential of the gradient diffusion method as a more convenient alternative to agar dilution method for MIC evaluation, particularly for the susceptibility testing of Staphylococcus spp. and Enterococcus spp. to fosfomycin. Materials and Methods A total of 194 isolates of Staphylococcus spp. and Enterococcus spp. were collected from urine samples of dogs diagnosed with bacterial cystitis. Bacterial identification and susceptibility to multiple antibiotics were tested using the Vitek 2 automated system. The susceptibility to fosfomycin was compared between agar dilution (reference method) and the gradient diffusion method. We assessed the agreement rates and errors between the two approaches by analyzing the MIC data. Results Staphylococcus pseudintermedius (98.7%) and Enterococcus faecalis (80.0%) exhibited high fosfomycin susceptibility rates, whereas Enterococcus faecium exhibited a lower susceptibility rate (38.5%). The gradient diffusion method demonstrated unacceptably low essential agreement (EA) rates (>90%) but acceptable categorical agreement (CA) rates (≥ 90%) for S. pseudintermedius (83.54% EA and 97.47% CA) and coagulase-negative staphylococci (CoNS) such as Staphylococcus chromogenes, Staphylococcus hominis, and Staphylococcus simulans (85.00% EA and 95.00% CA). Enterococcus spp. had an acceptable EA of 93.75%, but an unacceptably low CA rate of 82.81%, with a minor error rate of 17.19%. No significant errors were observed for Staphylococcus and Enterococcus spp. Conclusion The gradient diffusion method reliably determines MICs and interpretative breakpoints (S, I, R) for S. pseudintermedius. However, its applicability to CoNS and enterococci may be limited due to unacceptable errors.
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Affiliation(s)
- Nattha Jariyapamornkoon
- Department of Agricultural Technology, Faculty of Science and Technology, Thammasat University, Pathum Thani, Thailand
| | - Pongthai Boonkam
- Veterinary Diagnostic Laboratory, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nipattra Suanpairintr
- Department of Pharmacology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Food and Water Risk Analysis (FAWRA), Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
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Grynko L, Chornyi H, Kostenko M. SALE OF FALSIFIED MEDICINES VIA THE INTERNET IN UKRAINE: PROBLEMS OF DETECTION AND COUNTERACTION. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1106-1112. [PMID: 37326096 DOI: 10.36740/wlek202305132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: The purpose of the article is to identify and analyze problematic theoretical and practical aspects related to the sale of counterfeit medicines via the Internet and measures to counteract the spread of their counterfeit products, as well as to search for evidence-based ways to improve the regulatory and legal mechanism that regulates the activities of the pharmaceutical business in Ukraine. PATIENTS AND METHODS Materials and methods: The research based by the analysis of international acts, conventions and national legislation of Ukraine in the sphere of trade medi¬cines via the Internet, scientific achievements in this area. Methodologically, this work is based on the system of methods, scientific approaches, techniques and principles with the help of which the realization of the research aim is carried out. There have been applied universal, general scientific and special legal methods. CONCLUSION Conclusions: Analyzed the legal regulation of online sales of medicines. Made the conclusion about necessity implementation of projects to create forensic records which have shown their effectiveness in the fight against counterfeit medicines in European countries.
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Affiliation(s)
- Larysa Grynko
- POLTAVA LAW INSTITUTE YAROSLAV MUDRYI NATIONAL LAW UNIVERSITY, POLTAVA, UKRAINE
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Prculovska M, Acevska J, Poceva Panovska A, Nakov N, Dimtirovska A, Brezovska K. Root causes for presence of nitrosamine impurities in active pharmaceutical substances and finished pharmaceutical products. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Milena Prculovska
- REPLEK FARM Ltd., Quality Control Department, Kozle No. 188, 1000 Skopje, R.N. Macedonia
| | - Jelena Acevska
- Institute of Applied Chemistry and Pharmaceutical Analysis, Faculty of Pharmacy, University Ss. Cyril and Methodius, Majka Tereza 47, 1000 Skopje, R.N. Macedonia
| | - Ana Poceva Panovska
- Institute of Applied Chemistry and Pharmaceutical Analysis, Faculty of Pharmacy, University Ss. Cyril and Methodius, Majka Tereza 47, 1000 Skopje, R.N. Macedonia
| | - Natalija Nakov
- Institute of Applied Chemistry and Pharmaceutical Analysis, Faculty of Pharmacy, University Ss. Cyril and Methodius, Majka Tereza 47, 1000 Skopje, R.N. Macedonia
| | - Aneta Dimtirovska
- Institute of Applied Chemistry and Pharmaceutical Analysis, Faculty of Pharmacy, University Ss. Cyril and Methodius, Majka Tereza 47, 1000 Skopje, R.N. Macedonia
| | - Katerina Brezovska
- Institute of Applied Chemistry and Pharmaceutical Analysis, Faculty of Pharmacy, University Ss. Cyril and Methodius, Majka Tereza 47, 1000 Skopje, R.N. Macedonia
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Smileva A, Dimovska N, Keleshovska B, Dimova D, Makraduli L. Challenges of possible replacement for titanium dioxide in Dapoxetine film coating tablets. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ana Smileva
- Replek, Kozle 188, 1000 Skopje, North Macedonia
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Adamova Abrasheva E, Atanasoski D, Kronevska N, Ivcheska A, Karadzinska E, Paneva O. Cleaning validation concept for introduction of product with new active pharmaceutical ingredient in pharmaceutical production. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Elisaveta Adamova Abrasheva
- ALKALOID AD Skopje, Pharmaceutical, Chemical and Cosmetics Company, Aleksandar Makedonski 12, 1000 Skopje, Republic of North Macedonia
| | - Darko Atanasoski
- ALKALOID AD Skopje, Pharmaceutical, Chemical and Cosmetics Company, Aleksandar Makedonski 12, 1000 Skopje, Republic of North Macedonia
| | - Natasha Kronevska
- ALKALOID AD Skopje, Pharmaceutical, Chemical and Cosmetics Company, Aleksandar Makedonski 12, 1000 Skopje, Republic of North Macedonia
| | - Ana Ivcheska
- ALKALOID AD Skopje, Pharmaceutical, Chemical and Cosmetics Company, Aleksandar Makedonski 12, 1000 Skopje, Republic of North Macedonia
| | - Elizabeta Karadzinska
- ALKALOID AD Skopje, Pharmaceutical, Chemical and Cosmetics Company, Aleksandar Makedonski 12, 1000 Skopje, Republic of North Macedonia
| | - Olivera Paneva
- ALKALOID AD Skopje, Pharmaceutical, Chemical and Cosmetics Company, Aleksandar Makedonski 12, 1000 Skopje, Republic of North Macedonia
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Gini R, Sturkenboom MCJ, Sultana J, Cave A, Landi A, Pacurariu A, Roberto G, Schink T, Candore G, Slattery J, Trifirò G. Different Strategies to Execute Multi-Database Studies for Medicines Surveillance in Real-World Setting: A Reflection on the European Model. Clin Pharmacol Ther 2020; 108:228-235. [PMID: 32243569 PMCID: PMC7484985 DOI: 10.1002/cpt.1833] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/13/2020] [Indexed: 12/18/2022]
Abstract
Although postmarketing studies conducted in population‐based databases often contain information on patients in the order of millions, they can still be underpowered if outcomes or exposure of interest is rare, or the interest is in subgroup effects. Combining several databases might provide the statistical power needed. A multi‐database study (MDS) uses at least two healthcare databases, which are not linked with each other at an individual person level, with analyses carried out in parallel across each database applying a common study protocol. Although many MDSs have been performed in Europe in the past 10 years, there is a lack of clarity on the peculiarities and implications of the existing strategies to conduct them. In this review, we identify four strategies to execute MDSs, classified according to specific choices in the execution: (A) local analyses, where data are extracted and analyzed locally, with programs developed by each site; (B) sharing of raw data, where raw data are locally extracted and transferred without analysis to a central partner, where all the data are pooled and analyzed; (C) use of a common data model with study‐specific data, where study‐specific data are locally extracted, loaded into a common data model, and processed locally with centrally developed programs; and (D) use of general common data model, where all local data are extracted and loaded into a common data model, prior to and independent of any study protocol, and protocols are incorporated in centrally developed programs that run locally. We illustrate differences between strategies and analyze potential implications.
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Affiliation(s)
- Rona Gini
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | | | | | - Alison Cave
- European Medicines Agency, Amsterdam, The Netherlands
| | - Annalisa Landi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, Italy.,Teddy European Network of Excellence for Paediatric Clinical Research, Pavia, Italy
| | | | | | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | | | - Jim Slattery
- European Medicines Agency, Amsterdam, The Netherlands
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Università di Messina, Messina, Italy
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8
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Berencsi K, Sami A, Ali MS, Marinier K, Deltour N, Perez-Gutthann S, Pedersen L, Rijnbeek P, Van der Lei J, Lapi F, Simonetti M, Reyes C, Sturkenboom MCJM, Prieto-Alhambra D. Impact of risk minimisation measures on the use of strontium ranelate in Europe: a multi-national cohort study in 5 EU countries by the EU-ADR Alliance. Osteoporos Int 2020; 31:721-755. [PMID: 31696274 DOI: 10.1007/s00198-019-05181-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In May 2013 and March 2014, the European Medicines Agency (EMA) issued two decisions restricting the use of strontium ranelate (SR). These risk minimisation measures (RMM) introduced new contraindications and limited the indications of SR therapy. The EMA required an assessment of the impact of RMMs on the use of SR in Europe. Methods design: multi-national, multi-database cohort Setting: electronic medical record databases based on hospital (Denmark) and primary care provenance (Italy, Spain, the Netherlands, UK). PARTICIPANTS the database source populations were included for population-based analyses, and SR users for patient-level analyses. INTERVENTION New RMMs included contraindications (ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, uncontrolled hypertension) and restricted SR indication to severe osteoporosis with initiation by experienced physician and not as first line anti-osteoporosis therapy. METHODS Prevalence and incidence rates of SR use in the population; prevalence of contraindications and restricted indications in SR users, plus 1-year therapy persistence. Drug use measures were calculated in three periods for comparison: reference (2004 to May 2013), transition (June 2013 to March 2014) and assessment (from April 2014 to end 2016). RESULTS The study population included 143 million person-years(PY) of follow-up and 76,141 incident episodes of SR treatment. Average monthly prevalence rates of SR use dropped by 86.4% from 62.6/10,000 PY (95 CI 62.4-62.9) in the reference to 8.5 (8.5-8.6) in the assessment period. Similarly, the incidence rate of SR use fell by 97.3% from 7.4/10,000 PY (7.4-7.4) to 0.2 (0.2-0.2) between the reference and assessment period. The prevalence of any contraindication decreased, whilst the prevalence of restricted indications increased in these periods. One-year persistence decreased in the assessment compared with reference period. CONCLUSIONS Our study demonstrates a substantial impact of the regulatory action to restrict use of SR in Europe: SR utilisation overall decreased strongly. The proportion of patients fulfilling the restricted indications, without contraindications, increased after the proposed RMMs.
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Affiliation(s)
- K Berencsi
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - A Sami
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M S Ali
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - K Marinier
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | - N Deltour
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | | | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - C Reyes
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | | | - D Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
- Botnar Research Centre, Windmill Road, Oxford, OX37LD, UK.
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Jiang HT, Ran CC, Liao YP, Zhu JH, Wang H, Deng R, Nie M, He BC, Deng ZL. IGF-1 reverses the osteogenic inhibitory effect of dexamethasone on BMP9-induced osteogenic differentiation in mouse embryonic fibroblasts via PI3K/AKT/COX-2 pathway. J Steroid Biochem Mol Biol 2019; 191:105363. [PMID: 31018166 DOI: 10.1016/j.jsbmb.2019.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/19/2019] [Accepted: 04/09/2019] [Indexed: 02/08/2023]
Abstract
Glucocorticoid-Induced Osteoporosis (GIOP) is a prevalent clinical complication caused by large dose administration of glucocorticoids, such as Dexamethasone (Dex) and Prednisone. GIOP may lead to fractures and even Osteonecrosis of the Femoral Head (ONFH). It has been reported that glucocorticoids inhibit osteogenesis via the suppression of osteogenic differentiation in Mesenchymal Stem Cells (MSCs), but the precise mechanism underlying this suppression awaits further investigation. Meanwhile, novel and efficacious therapies are recommended to cope with GIOP. In this study, we demonstrated that Dex had the inhibitory effect on Bone Morphogenetic Protein 9 (BMP9)-induced ALP activities and matrix mineralization in Mouse Embryonic Fibroblasts (MEFs). In addition, the study confirmed that Dex decreased the expression of osteogenic markers such as Runx2 and OPN. However, the inhibitory effect of Dex on these osteogenic markers can be reversed when combined with insulin-like growth factor 1 (IGF-1). Regarding the inhibitory mechanism, we found that the level of AKT and p-AKT can be decreased by Dex and that Ly294002, the PI3K inhibitor, can block the reversal effect of IGF-1. Moreover, the knockdown or inhibition of COX-2 produced similar results to those of Ly294002. Our findings indicated that IGF-1 may reverse the osteogenic inhibitory effect of Dex via PI3K/AKT pathway, which may be associated with the up-regulation of COX-2. This study may provide new clinical management strategy for GIOP cases.
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Affiliation(s)
- Hai-Tao Jiang
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China; Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Cheng-Cheng Ran
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China; Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Yun-Peng Liao
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China; Department of Pharmacology, School of Pharmacy, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Jia-Hui Zhu
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China; Department of Pharmacology, School of Pharmacy, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Han Wang
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China; Department of Pharmacology, School of Pharmacy, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Rui Deng
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China
| | - Mao Nie
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China
| | - Bai-Cheng He
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China; Department of Pharmacology, School of Pharmacy, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Zhong-Liang Deng
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China.
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Kirchmayer U, Sorge C, Sultana J, Lapi F, Onder G, Agabiti N, Cascini S, Roberto G, Corrao G, Vitale C, Lucenteforte E, Mugelli A, Davoli M. Bisphosphonates and cardiovascular risk in elderly patients with previous cardiovascular disease: a population-based nested case-control study in Italy. Ther Adv Drug Saf 2019; 10:2042098619838138. [PMID: 31057787 PMCID: PMC6452576 DOI: 10.1177/2042098619838138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/18/2019] [Indexed: 01/05/2023] Open
Abstract
Background: In a globally aging population, chronic conditions with a high impact on healthcare costs and quality of life, such as osteoporosis and associated fractures, are a matter of concern. For osteoporosis, several drug treatments are available, but evidence on adverse cardiovascular and cerebrovascular (CCV) events, and in particular the risk of atrial fibrillation (AF), related to anti-osteoporotic drug use is inconclusive. The objective of this study was to evaluate the association between the use of bisphosphonates (BPs), strontium ranelate (SR), and other anti-osteoporosis drugs and the risk of AF and CCV events in a large cohort of patients affected by CCV diseases. Methods: Based on a cohort of patients aged 65 years and over, discharged from the hospitals of five large Italian areas after a CCV event between 2008 and 2011, two nested case-control studies were conducted. Cases were patients with a subsequent hospital admission for AF or CCV; four controls for each case were randomly selected and matched by age group, sex and follow-up time. A total of three exposure measures were tested: ever use, adherence and recency of use. In the conditional logistic regression models, patients not treated with any anti-osteoporotic medication were considered as the reference category. Results: The initial cohort accounted for 657,246 patients. Neither BPs nor SR use was associated with an increased risk of AF regardless of the adherence and recency of use. Overall BP and SR use was associated with a slightly increased risk of CCV; however, results reversed when considering higher adherence: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.71–0.92 for BPs and OR 0.71, 95% CI 0.52–0.97 for SR. Conclusions: BPs do not increase cardiovascular risk and can be prescribed to elderly patients for osteoporosis treatment. However, patients with pre-existing cerebrovascular/cardiovascular conditions should be carefully monitored.
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Affiliation(s)
- Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Chiara Sorge
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo 112, Rome, 00147, Italy
| | - Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Graziano Onder
- Department of Geriatrics, Catholic University of Rome, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Silvia Cascini
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Giuseppe Roberto
- Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, Florence, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Cristiana Vitale
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Ersilia Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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da Silva RE, Amato AA, Andrade DDBC, Leite e Silva AV, de Carvalho MR, Novaes MRCG. Research Priorities and Resource Allocation in the Investigation of New Drugs for Cancer in Least Developed Countries. JOURNAL OF ONCOLOGY 2018; 2018:8092702. [PMID: 30057606 PMCID: PMC6051037 DOI: 10.1155/2018/8092702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/03/2018] [Accepted: 05/27/2018] [Indexed: 12/14/2022]
Abstract
Cancer incidence has increased significantly in low- and middle-income countries. The priorities of international health research are not always aligned with the global burden of cancer. This study aims to analyze global tendencies in clinical trials in oncology and discuss research priorities and resource allocation in the investigation of new drugs for cancers that significantly affect the least developed countries. This was a retrospective and analytical study that included data collected from the World Health Organization's International Clinical Trials Registry Platform (ICTRP) in 2014. According to our results, there was a tendency for clinical trials involving breast and lung cancer to be conducted in countries with a lower level of economic development. On the other hand, cervical, stomach, and liver cancer, despite the significant burden that these place on middle- and low-income countries, were studied little among the countries selected. In conclusion, the organizations that most fund research to develop new drugs for cancer treatment continue to show little interest in prioritizing resources to fund research for certain types of cancer such as those of the cervix, stomach, and liver, which have a significant impact in low- and middle-income countries.
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Affiliation(s)
- Ricardo Eccard da Silva
- Office of Clinical Trials, Brazilian Health Regulatory Agency (ANVISA), Setor de Indústria Trecho 5, Área Especial 57, 71205-050, Brasília, Brazil
- Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, Brazil
| | - Angélica Amorim Amato
- Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, Brazil
| | | | - Alessandra Vanessa Leite e Silva
- Hospital de Base, Secretary of Health, Government of the Federal District, SMHS, Quadra 101, Área Especial, s/n, Asa Sul, 70330-150, Brasília, Brazil
| | - Marta Rodrigues de Carvalho
- School of Medicine, Health Science Education and Research Foundation (FEPECS), SMHN Quadra 03, Conjunto A, Bloco 1, Edifício FEPECS, 70.710-907 Brasília, Brazil
| | - Maria Rita Carvalho Garbi Novaes
- Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, Brazil
- School of Medicine, Health Science Education and Research Foundation (FEPECS), SMHN Quadra 03, Conjunto A, Bloco 1, Edifício FEPECS, 70.710-907 Brasília, Brazil
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Miller E. Targeting Mucosal Healing: Optimising Results with Early Appropriate Therapy in Crohn’s Disease. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10312992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Given the progressive nature of Crohn’s disease (CD), Prof Panés made a case for timely intervention in at-risk patients to achieve the ultimate goal of slowing disease progression. Prof Peyrin-Biroulet looked at the more recent treatment target of endoscopic healing and reviewed the positives and negatives of the current endoscopic indices to measure disease activity. Prof Lees then provided an overview of the clinical trial programme and real-world data of vedolizumab, a gut-selective α4β7 integrin inhibitor.
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Yee K. Management of Multiply Relapsed Aggressive Non-Hodgkin Lymphoma: New Perspectives. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10313871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Patients with refractory/relapsed (R/R) non-Hodgkin lymphoma (NHL) make up a very heterogeneous population with a poor life expectancy. The objective of this symposium was to provide an overview of the current treatment landscape for aggressive NHL, as well as the future research on new treatments. Transplant-eligible patients receive salvage chemotherapy, followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT). Patients who fail transplant or are transplant-ineligible generally receive palliative treatment or enter clinical trials; there is no standard of care and thus there is a high unmet clinical need. Pixantrone is currently indicated for adult patients with multiply R/R aggressive B-cell NHL, thereby filling the unmet clinical need in this field. The symposium started with a brief overview of the meeting objectives. This was followed by an overview of the current and future treatment landscape for aggressive NHL, including a case study of a patient with diffuse large B-cell lymphoma (DLBCL) with multiple relapses receiving pixantrone as monotherapy. The results and post hoc analysis of the CORAL and the SCHOLAR1 studies were reviewed, including the relative merits of combination therapy versus monotherapy for patients with relapsed DLBCL who had failed second-line salvage therapy. The symposium ended with an outline of the profile and mechanism of action of pixantrone, and evidence from the PIX301 study that provided the basis for regulatory approval for the use of pixantrone in third and fourth-line treatment of R/R aggressive B-cell NHL. The clinical efficacy and safety of pixantrone were reviewed, together with a future perspective on the ongoing PIX306 trial. The symposium concluded with the presentation of two clinical cases of patients treated with pixantrone, a ‘Question and Answer’ session, and a panel discussion.
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La Gamba F, Corrao G, Romio S, Sturkenboom M, Trifirò G, Schink T, de Ridder M. Combining evidence from multiple electronic health care databases: performances of one-stage and two-stage meta-analysis in matched case-control studies. Pharmacoepidemiol Drug Saf 2017; 26:1213-1219. [PMID: 28799196 DOI: 10.1002/pds.4280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 04/11/2017] [Accepted: 07/04/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Clustering of patients in databases is usually ignored in one-stage meta-analysis of multi-database studies using matched case-control data. The aim of this study was to compare bias and efficiency of such a one-stage meta-analysis with a two-stage meta-analysis. METHODS First, we compared the approaches by generating matched case-control data under 5 simulated scenarios, built by varying: (1) the exposure-outcome association; (2) its variability among databases; (3) the confounding strength of one covariate on this association; (4) its variability; and (5) the (heterogeneous) confounding strength of two covariates. Second, we made the same comparison using empirical data from the ARITMO project, a multiple database study investigating the risk of ventricular arrhythmia following the use of medications with arrhythmogenic potential. In our study, we specifically investigated the effect of current use of promethazine. RESULTS Bias increased for one-stage meta-analysis with increasing (1) between-database variance of exposure effect and (2) heterogeneous confounding generated by two covariates. The efficiency of one-stage meta-analysis was slightly lower than that of two-stage meta-analysis for the majority of investigated scenarios. Based on ARITMO data, there were no evident differences between one-stage (OR = 1.50, CI = [1.08; 2.08]) and two-stage (OR = 1.55, CI = [1.12; 2.16]) approaches. CONCLUSIONS When the effect of interest is heterogeneous, a one-stage meta-analysis ignoring clustering gives biased estimates. Two-stage meta-analysis generates estimates at least as accurate and precise as one-stage meta-analysis. However, in a study using small databases and rare exposures and/or outcomes, a correct one-stage meta-analysis becomes essential.
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Affiliation(s)
- Fabiola La Gamba
- Janssen Pharmaceutica NV, Beerse, Belgium.,Center for Statistics, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Campus Diepenbeek, Diepenbeek, Belgium
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, and Centre of Public Health, University of Milano-Bicocca, Milan, Italy
| | - Silvana Romio
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, and Centre of Public Health, University of Milano-Bicocca, Milan, Italy.,Department of Medical Informatics, Erasmus University Medical School, Rotterdam, The Netherlands
| | - Miriam Sturkenboom
- Department of Medical Informatics, Erasmus University Medical School, Rotterdam, The Netherlands
| | - Gianluca Trifirò
- Department of Medical Informatics, Erasmus University Medical School, Rotterdam, The Netherlands.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Maria de Ridder
- Department of Medical Informatics, Erasmus University Medical School, Rotterdam, The Netherlands
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Nicha V, Simonoska Crcarevska M, Glavas Dodov M, Slaveska Raichki R. Quality use of an unlicensed medicine and off label use of a medicine. MAKEDONSKO FARMACEVTSKI BILTEN 2014. [DOI: 10.33320/maced.pharm.bull.2014.60.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This paper gives an overview of the concept and process of quality use of unlicensed medicines and off label use of medicines, with special attention on the professional roles and responsibilities of prescribers and pharmacists. It also focuses on the policy requirements, sets of guidelines, recommendations, best practices, and other aspects addressed under this topic that represent the state of update knowledge. As a complex and specific issue, the use of an unlicensed medicine and off label prescribed medicine in different health care levels is of particular importance for the healthcare settings in the Republic of Macedonia since, the existing regulatory structure requires adoption and development of a comprehensive strategy relating to this topic in the near future with an aim of encouraging and supporting the development and maintenance of a sound health system with high standards of medication-use policies.
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