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Collier DJ, Taylor M, Godec T, Shiel J, James R, Chowdury Y, Ebano P, Monk V, Patel M, Pheby J, Pheby R, Foubister A, David C, Saxena M, Richardson L, Siddle J, Timlin G, Goldsmith P, Deeming N, Poulter NR, Gabe R, McManus RJ, Caulfield MJ. Personalized Antihypertensive Treatment Optimization With Smartphone-Enabled Remote Precision Dosing of Amlodipine During the COVID-19 Pandemic (PERSONAL-CovidBP Trial). J Am Heart Assoc 2024; 13:e030749. [PMID: 38323513 PMCID: PMC11010092 DOI: 10.1161/jaha.123.030749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/30/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The objective of the PERSONAL-CovidBP (Personalised Electronic Record Supported Optimisation When Alone for Patients With Hypertension: Pilot Study for Remote Medical Management of Hypertension During the COVID-19 Pandemic) trial was to assess the efficacy and safety of smartphone-enabled remote precision dosing of amlodipine to control blood pressure (BP) in participants with primary hypertension during the COVID-19 pandemic. METHODS AND RESULTS This was an open-label, remote, dose titration trial using daily home self-monitoring of BP, drug dose, and side effects with linked smartphone app and telemonitoring. Participants aged ≥18 years with uncontrolled hypertension (5-7 day baseline mean ≥135 mm Hg systolic BP or ≥85 mm Hg diastolic BP) received personalized amlodipine dose titration using novel (1, 2, 3, 4, 6, 7, 8, 9 mg) and standard (5 and 10 mg) doses daily over 14 weeks. The primary outcome of the trial was mean change in systolic BP from baseline to end of treatment. A total of 205 participants were enrolled and mean BP fell from 142/87 (systolic BP/diastolic BP) to 131/81 mm Hg (a reduction of 11 (95% CI, 10-12)/7 (95% CI, 6-7) mm Hg, P<0.001). The majority of participants achieved BP control on novel doses (84%); of those participants, 35% were controlled by 1 mg daily. The majority (88%) controlled on novel doses had no peripheral edema. Adherence to BP recording and reported adherence to medication was 84% and 94%, respectively. Patient retention was 96% (196/205). Treatment was well tolerated with no withdrawals from adverse events. CONCLUSIONS Personalized dose titration with amlodipine was safe, well tolerated, and efficacious in treating primary hypertension. The majority of participants achieved BP control on novel doses, and with personalization of dose there were no trial discontinuations due to drug intolerance. App-assisted remote clinician dose titration may better balance BP control and adverse effects and help optimize long-term care. REGISTRATION URL: clinicaltrials.gov. Identifier: NCT04559074.
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Affiliation(s)
- David J. Collier
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | | | - Thomas Godec
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Julian Shiel
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Rebecca James
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Yasmin Chowdury
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Patrizia Ebano
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Vivienne Monk
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Mital Patel
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Jane Pheby
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Ruby Pheby
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Amanda Foubister
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Clovel David
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Manish Saxena
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | | | | | | | | | | | - Neil R. Poulter
- Imperial College Clinical Trials Unit, School of Public Health, Imperial College LondonLondonUK
| | - Rhian Gabe
- Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Mark J. Caulfield
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
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Oh H, Kim KY, Yoo DW, Yoon IM. Blood Pressure-Lowering Effect of Fimasartan Versus Comparators: A Cross-Inference With a Systematic Review and Meta-Analysis Through a Quality Management System. Clin Ther 2023:S0149-2918(23)00025-5. [PMID: 36925383 DOI: 10.1016/j.clinthera.2023.01.005] [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: 08/08/2022] [Revised: 12/09/2022] [Accepted: 01/05/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Fimasartan, one of the newest angiotensin receptor blockers (ARBs) available worldwide, has been investigated extensively since its initial development. Our study group conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating fimasartan and comparators for their blood pressure (BP)-lowering effect. Moreover, we employed a cross-inference (frequentist and Bayesian inference) system, which has never been used in the medical field, to confirm the results of our study. In addition, a quality management system was integrated throughout the study for data quality. METHODS PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalKey, and ClinicalTrial.gov were searched for RCT studies from March 1998 to March 2022. In each study, the mean differences (MDs) and 95% CIs were identified for reductions in clinic sitting systolic and diastolic BP (SiSBP/SiDBP) or 24-hour mean systolic BP and diastolic BP by ambulatory BP monitoring (ASBP/ADBP) from baseline between the fimasartan and comparator groups, followed by meta-analysis. A subsequent meta-analysis was performed with frequentist and Bayesian inference as a tool in the cross-checking system. FINDINGS Eleven RCTs with a total of 2459 subjects were included in the study. The clinic SiSBP/SiDBP-lowering effect of fimasartan was significantly greater relative to those of comparators (MD for clinic SiSBP, -2.58 mm Hg [95% CI, -4.35 to -0.81; P = 0.004]; MD for clinic SiDBP, -2.13 mm Hg [95% CI, -2.96 to -1.30; P = 0.00001]). The ASBP/ADBP-lowering effect of fimasartan was also significantly greater relative to those of comparators (MD for ASBP, -3.58 mm Hg [95% CI, -5.74 to -1.43; P = 0.001]; MD for ADBP, -1.99 mm Hg [95% CI, -3.34 to -0.63; P = 0.004]). IMPLICATIONS Fimasartan seems to be more effective in lowering BP than its comparators, including other ARBs. Although there is a limited amount of data and a minuscule number of study subjects available, the results of cross-inference (frequentist + Bayesian) were fairly consistent with the meta-analysis results through our quality management system.
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Affiliation(s)
- Hojin Oh
- Oh Medicine and Methodology Research Institute, Seoryeong-ro, Seosan, Chungcheongnam-do, Republic of Korea; Chung-Ang Herb Dental Clinic, Seosan, Chungcheongnam-do, Republic of Korea.
| | - Kang-Yeon Kim
- Yonsei Da-on Family Medicine Clinic, Seosan, Chungcheongnam-do, Republic of Korea
| | - Duk-Woo Yoo
- Chung-Ang Herb Dental Clinic, Seosan, Chungcheongnam-do, Republic of Korea
| | - In Mo Yoon
- Unimedi Plastic Surgery Clinic, Gangnam-gu, Seoul, Republic of Korea
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Jeon ES, Lim SW, Kim SY, Yang HM, Kim MH, Rhee MY, Han SH, Shin J, Kim KI, Jeong JO, Sung KC, Hong GR, Kim HS, Kwon K, Kang TS, Lee HY, Han SE. A randomized, double-blind, multicenter, phase III study on the efficacy and safety of a combination treatment involving fimasartan, amlodipine, rosuvastatin in patients with essential hypertension and dyslipidemia who fail to respond adequately to fimasartan monotherapy. Clin Hypertens 2022; 28:40. [DOI: 10.1186/s40885-022-00223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Abstract
Background
To assess the efficacy and safety of a combination therapy involving fimasartan, amlodipine, and rosuvastatin in patients with essential hypertension and dyslipidemia who fail to respond to fimasartan monotherapy.
Methods
This phase III, randomized, double-blind, multicenter study was conducted in adults aged 19–70 years. Patients who voluntarily consented were screened for eligibility to enroll in the study. Patients who failed to respond to 4 weeks of fimasartan monotherapy were randomized with a 1:1:1 ratio to the fimasartan 60 mg/amlodipine 10 mg + rosuvastatin 20 mg (FMS/ALD + RSV) as study group, fimasartan 60 mg/amlodipine 10 mg (FMS/ALD) as control 1 group, and fimasartan 60 mg + rosuvastatin 20 mg (FMS + RSV) as control 2 group. The primary efficacy endpoints were the change in the sitting systolic blood pressure and the rate of change in the low-density lipoprotein cholesterol (LDL-C) level from baseline to 8 weeks. The adverse events, adverse drug reactions, physical examination findings, laboratory test results, electrocardiograms, and vital signs were evaluated to assess safety in the study.
Results
Of 138 randomized patients, 131 were conducted efficacy analysis, and 125 completed the study. For the change in LDL-C and sitting SBP (SiSBP) as primary efficacy assessments, the change in LDL-C at week 8 was significantly reduce in the FMS/ALD + RSV group than in the control 1 group (P < 0.001). The change in SiSBP at week 8 were greater reduce in the FMS/ALD + RSV group than in the FMS + RSV group (both P < 0.001). For the safety evaluation, there were no differences among the treatment groups in the incidence of adverse drug reactions.
Conclusions
The fimasartan/amlodipine + rosuvastatin combination therapy can effectively and safely lower blood pressure and improve lipid levels in patients with essential hypertension and dyslipidemia who fail to respond adequately to fimasartan monotherapy.
Trial registration
NCT03156842, Registered 17 May 2017
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Systematic Review with Network Meta-Analysis: Comparative Efficacy and Safety of Combination Therapy with Angiotensin II Receptor Blockers and Amlodipine in Asian Hypertensive Patients. Int J Hypertens 2019; 2019:9516279. [PMID: 31827918 PMCID: PMC6885253 DOI: 10.1155/2019/9516279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/24/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background Hypertension (HTN) is the leading risk factor for cardiovascular mortality globally. The WHO estimates a 60% increase in Asian HTN patients between 2000 and 2025. Numerous studies have compared safety and efficacy between antihypertensive classes, but in-class comparisons of angiotensin II receptor blockers (ARBs) in combination therapy (CT) (fixed-dose combination or dual combination) with a calcium channel blocker (CCB) are lacking in Asia. Objective To compare the efficacy and safety of the various ARB-amlodipine CTs and amlodipine (AML) monotherapy for treatment of HTN in Asian population. Methods A systematic literature review sourced Asian randomized controlled trials (RCTs) from PubMed and Cochrane Libraries to inform a network meta-analysis (NMA). We considered the ARB-AML CT. The primary efficacy and safety endpoints were short-term (8–12 weeks) treatment response and treatment-emergent adverse events (TEAEs), respectively. AML monotherapy was used as a comparator to allow for indirect treatment effect estimation in the absence of direct RCTs evidence comparing the different ARB-AML CTs. Results The analysis included 1198 Asian HTN patients from seven studies involving six ARB-AML CTs: azilsartan (AZL), candesartan (CAN), fimasartan (FIM), losartan (LOS), olmesartan (OLM), and telmisartan (TEL). Compared to AML monotherapy, CT of AZL-AML had five times greater odds of prompting a treatment response (OR 5.2, 95% CI: 2.5, 11.2), while CAN-AML had 3.9 (95% CI: 2.5, 6.4), FIM-AML had 3.4 (95% CI: 1.4, 8.5), TEL-AML had 3.3 (95% CI: 1.6, 7.1), OLM-AML had 2.7 (95% CI: 1.6, 5.0), and LOS-AML had 2.0 (95% CI: 0.6, 7.3). All ARB-AML CTs had safety profiles comparable to AML monotherapy except TEL-AML, which had significantly lower odds of TEAEs (0.26 (95% CI: 0.087, 0.70)). Conclusion This study suggests that all ARB-AML CTs compared favorably to AML monotherapy regarding short-term treatment response in uncomplicated HTN patients of Asian origin. AZL-AML prompted the most favorable treatment response. Safety profiles among the ARB-AML CTs were largely comparable. Due to the limited study size and small number of trials (direct evidence), our findings should best be interpreted as an exploratory effort importance to inform future research direction.
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Abstract
Purpose of Review The purpose of this review is to summarize the most recent data available on advances in development of novel medical treatments for hypertension and related comorbidities. Recent Findings Approximately half of all hypertensive patients have not achieved goal blood pressure with current available antihypertensive medications. Recent landmark studies and new hypertension guidelines have called for stricter blood pressure control, creating a need for better strategies for lowering blood pressure. This has led to a shift in focus, in recent years, to the development of combination pills as a means of achieving improved blood pressure control by increasing adherence to prescribed medications along with further research and development of promising novel drugs based on discovery of new molecular targets such as the counter-regulatory renin-angiotensin system. Summary Fixed-dose combination pills and novel treatments based on recently discovered pathogenic mechanisms of hypertension that have demonstrated promising results as treatments for hypertension and related comorbidities will be discussed in this review.
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Affiliation(s)
- Jared Davis
- Department of Medicine, University of Alabama at Birmingham, BDB 327, 1720 2nd Ave S, Birmingham, AL, 35294, USA.
| | - Suzanne Oparil
- UAB Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham, ZRB 1034, 703 19th St S, Birmingham, AL, 35233, USA
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Angeli F, Verdecchia P, Trapasso M, Pane M, Signorotti S, Reboldi G. PK/PD evaluation of fimasartan for the treatment of hypertension Current evidences and future perspectives. Expert Opin Drug Metab Toxicol 2018; 14:533-541. [PMID: 29676941 DOI: 10.1080/17425255.2018.1468435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Fimasartan is the ninth and latest Angiotensin Receptor Blockers for the treatment of hypertension. Fimasartan is a derivative of losartan in which the imidazole ring has been replaced. It provides a selective type 1 angiotensin II receptor antagonist effect with noncompetitive, in surmountable binding. Fimasartan is rapidly absorbed following oral administration with an oral bioavailability of 18.6 ± 7.2%. Fimasartan is relatively stable in terms of metabolism and more than 90% of circulating fimasartan moieties in the plasma are in the parent form; fecal elimination and biliary excretion are the predominant elimination pathways of fimasartan. Areas covered: We reviewed data from clinical trials that investigated safety and efficacy of fimasartan in hypertension. Expert opinion: Fimasartan proved good efficacy in blood pressure reduction. In large clinical studies,fimasartan showed an excellent safety profile and when combined with hydrochlorothiazide oram lodipine, it showed a better effect on controlling blood pressure than monotherapy. Fimasartan 60-120 mg once daily has also shown an antihypertensive effect over 24-h. Moreover, preclinical studies demonstrated organ-protecting effects of fimasartan. These results make fimasartan an attractive candidate for the treatment of hypertension. However, it remains to test the benefit of using fimasartan on clinical outcomes.
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Affiliation(s)
- Fabio Angeli
- a Department of Cardiology and Cardiovascular Pathophysiology , Hospital and University of Perugia , Perugia , Italy
| | - Paolo Verdecchia
- b Department of Internal Medicine , Hospital of Assisi , Assisi , Italy
| | - Monica Trapasso
- c Department of Medicine , University of Perugia , Perugia , Italy
| | - Marina Pane
- c Department of Medicine , University of Perugia , Perugia , Italy
| | - Sara Signorotti
- c Department of Medicine , University of Perugia , Perugia , Italy
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Lee HY, Kim SY, Choi KJ, Yoo BS, Cha DH, Jung HO, Ryu DR, Choi JH, Lee KJ, Park TH, Oh JH, Kim SM, Choi JY, Kim KH, Shim J, Kim WS, Choi SW, Park DG, Song PS, Hong TJ, Rhee MY, Rha SW, Park SW. A Randomized, Multicenter, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and the Tolerability of a Triple Combination of Amlodipine/Losartan/Rosuvastatin in Patients With Comorbid Essential Hypertension and Hyperlipidemia. Clin Ther 2017; 39:2366-2379. [DOI: 10.1016/j.clinthera.2017.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/06/2017] [Accepted: 10/14/2017] [Indexed: 01/01/2023]
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Zhai Y, Su J, Ran W, Zhang P, Yin Q, Zhang Z, Yu H, Li Y. Preparation and Application of Cell Membrane-Camouflaged Nanoparticles for Cancer Therapy. Theranostics 2017; 7:2575-2592. [PMID: 28819448 PMCID: PMC5558554 DOI: 10.7150/thno.20118] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/23/2017] [Indexed: 02/07/2023] Open
Abstract
Cancer is one of the leading causes of death worldwide. Many treatments have been developed so far, although effective, suffer from severe side effects due to low selectivity. Nanoparticles can improve the therapeutic index of their delivered drugs by specifically transporting them to tumors. However, their exogenous nature usually leads to fast clearance by mononuclear phagocytic system. Recently, cell membrane-camouflaged nanoparticles have been investigated for cancer therapy, taking advantages of excellent biocompatibility and versatile functionality of cell membranes. In this review, we summarized source materials and procedures that have been used for constructing and characterizing biomimetic nanoparticles with a focus on their application in cancer therapy.
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Affiliation(s)
- Yihui Zhai
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jinghan Su
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wei Ran
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Pengcheng Zhang
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Qi Yin
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Zhiwen Zhang
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Haijun Yu
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Yaping Li
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
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Rhee MY, Ahn T, Chang K, Chae SC, Yang TH, Shim WJ, Kang TS, Ryu JK, Nah DY, Park TH, Chae IH, Park SW, Lee HY, Tahk SJ, Yoon YW, Shim CY, Shin DG, Seo HS, Lee SY, Kim DI, Kwan J, Joo SJ, Jeong MH, Jeong JO, Sung KC, Kim SY, Kim SH, Chun KJ, Oh DJ. The efficacy and safety of co-administration of fimasartan and rosuvastatin to patients with hypertension and dyslipidemia. BMC Pharmacol Toxicol 2017; 18:2. [PMID: 28057081 PMCID: PMC5217661 DOI: 10.1186/s40360-016-0112-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/13/2016] [Indexed: 12/15/2022] Open
Abstract
Background Hypertension and dyslipidemia are major risk factors of cardiovascular disease (CVD) events. The objective of this study was to evaluate the efficacy and safety of the co-administration of fimasartan and rosuvastatin in patients with hypertension and hypercholesterolemia. Methods We conducted a randomized double-blind and parallel-group trial. Patients who met eligible criteria after 4 weeks of therapeutic life change were randomly assigned to the following groups. 1) co-administration of fimasartan 120 mg/rosuvastatin 20 mg (FMS/RSV), 2) fimasartan 120 mg (FMS) alone 3) rosuvastatin 20 mg (RSV) alone. Drugs were administered once daily for 8 weeks. Results Of 140 randomized patients, 135 for whom efficacy data were available were analyzed. After 8 weeks of treatment, the FMS/RSV treatment group showed greater reductions in sitting systolic (siSBP) and diastolic (siDBP) blood pressures than those in the group receiving RSV alone (both p < 0.001). Reductions in siSBP and siDBP were not significantly different between the FMS/RSV and FMS alone groups (p = 0.500 and p = 0.734, respectively). After 8 weeks of treatment, FMS/RSV treatment showed greater efficacy in percentage reduction of low-density lipoprotein cholesterol (LDL-C) level from baseline than that shown by FMS alone treatment (p < 0.001). The response rates of siSBP with FMS/RSV, FMS alone, and RSV alone treatments were 65.22, 55.56, and 34.09%, respectively (FMS/RSV vs. RSV, p = 0.006). The LDL-C goal attainment rates with FMS/RSV, RSV alone, and FMS alone treatments were 80.43%, 81.82%, and 15.56%, respectively (FMS/RSV vs. FMS, p < 0.001). Incidence of adverse drug reactions with FMS/RSV treatment was 8.33%, which was similar to those associated with FMS and RSV alone treatments. Conclusion This study demonstrated that the co-administration of fimasartan and rosuvastatin to patients with both hypertension and hypercholesterolemia was efficacious and safe. Trial registration ClinicalTrials.gov Identifier: NCT02166814. 16 June 2014 Electronic supplementary material The online version of this article (doi:10.1186/s40360-016-0112-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Taehoon Ahn
- Division of Cardiology, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Tae-Hyun Yang
- Division of Cardiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Wan Joo Shim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Tae Soo Kang
- Department of Cardiology, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jae-Kean Ryu
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Deuk-Young Nah
- Division of Cardiology, Dongguk University Gyeongju Hospital, Gyeongju, Republic of Korea
| | - Tae-Ho Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Woo Park
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University Hospital, Suwon, Republic of Korea
| | - Young Won Yoon
- Division of Cardiology, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Dong-Gu Shin
- Department of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Hong Seog Seo
- Division of Cardiology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Sung Yun Lee
- Cardiac and Vascular Center, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Doo Il Kim
- Department of Cardiology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jun Kwan
- Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Seung-Jae Joo
- Division of Cardiology, Jeju National University Hospital, Jeju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiovascular, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ki Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Seoul Metropolitan Government Seoul National University Hospital Boramae Medical Center, Seoul, Republic of Korea
| | - Kook-Jin Chun
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong Joo Oh
- Division of Cardiology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Formulations of Amlodipine: A Review. JOURNAL OF PHARMACEUTICS 2016; 2016:8961621. [PMID: 27822402 PMCID: PMC5086392 DOI: 10.1155/2016/8961621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/20/2016] [Indexed: 12/11/2022]
Abstract
Amlodipine (AD) is a calcium channel blocker that is mainly used in the treatment of hypertension and angina. However, latest findings have revealed that its efficacy is not only limited to the treatment of cardiovascular diseases as it has shown to possess antioxidant activity and plays an important role in apoptosis. Therefore, it is also employed in the treatment of cerebrovascular stroke, neurodegenerative diseases, leukemia, breast cancer, and so forth either alone or in combination with other drugs. AD is a photosensitive drug and requires protection from light. A number of workers have tried to formulate various conventional and nonconventional dosage forms of AD. This review highlights all the formulations that have been developed to achieve maximum stability with the desired therapeutic action for the delivery of AD such as fast dissolving tablets, floating tablets, layered tablets, single-pill combinations, capsules, oral and transdermal films, suspensions, emulsions, mucoadhesive microspheres, gels, transdermal patches, and liposomal formulations.
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He T, Liu X, Li Y, Liu XY, Wu QY, Liu ML, Yuan H. High-dose calcium channel blocker (CCB) monotherapy vs combination therapy of standard-dose CCBs and angiotensin receptor blockers for hypertension: a meta-analysis. J Hum Hypertens 2016; 31:79-88. [PMID: 27511478 DOI: 10.1038/jhh.2016.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/05/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022]
Abstract
In this study, we evaluated the efficacy and safety of high-dose calcium channel blocker (CCB) monotherapy and standard-dose CCBs combined with angiotensin receptor blockers (ARBs) for patients with hypertension. A comprehensive search of PubMed, Embase and the Cochrane Central Register of Controlled Trials was performed in December 2015. Randomized controlled trials designed to identify the above goal were included. Thirteen trials including 2371 patients were identified. The standard-dose CCB/ARB combination resulted in a greater reduction of systolic blood pressure (WMD -2.52, 95% confidence interval (CI): -3.76 to -1.28) and diastolic blood pressure (weighted mean difference (WMD) -2.07, 95% CI: -3.73 to -0.42) compared to high-dose CCB monotherapy. The overall hypertension control rate for the CCB/ARB combination was higher than that for CCB monotherapy (relative risk (RR): 1.17, 95% CI: 1.08-1.26). Furthermore, the CCB/ARB combination treatment yielded significantly fewer overall adverse events (RR: 0.84, 95% CI: 0.74-0.95), oedema (RR: 0.31; 95% CI: 0.18-0.52) and rash (RR: 0.27, 95% CI: 0.08-0.96, P=0.04) than did CCB monotherapy. The standard-dose CCB/ARB combination is superior to high-dose CCB monotherapy for lowering blood pressure and reducing adverse events in hypertensive patients. Future research should focus on the cost-effectiveness and long-term effects of these two treatment strategies for patients with hypertension.
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Affiliation(s)
- T He
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - X Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Y Li
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - X Y Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Q Y Wu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - M L Liu
- Department of Gerontology, The First Hospital of Beijing University, Beijing, People's Republic of China
| | - H Yuan
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
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Kim KI, Shin MS, Ihm SH, Youn HJ, Sung KC, Chae SC, Nam CW, Seo HS, Park SM, Rhee MY, Kim MH, Cha KS, Kim YJ, Kim JJ, Chun KJ, Yoo BS, Park S, Shin ES, Kim DS, Il Kim D, Kim KH, Joo SJ, Jeong JO, Shin J, Kim CH. A Randomized, Double-blind, Multicenter, Phase III Study to Evaluate the Efficacy and Safety of Fimasartan/Amlodipine Combined Therapy Versus Fimasartan Monotherapy in Patients With Essential Hypertension Unresponsive to Fimasartan Monotherapy. Clin Ther 2016; 38:2159-2170. [PMID: 27502326 DOI: 10.1016/j.clinthera.2016.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/28/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The goal of this study was to evaluate whether the blood pressure-lowering efficacy of fimasartan/amlodipine combination therapy was superior to that of fimasartan monotherapy after 8 weeks of treatment in patients with hypertension who had failed to respond adequately to fimasartan monotherapy. METHODS This trial was a randomized, double-blind, multicenter, Phase III clinical study. Patients who failed to respond after 4 weeks of treatment with 60 mg daily of fimasartan (sitting systolic blood pressure [SiSBP]) ≥140 mm Hg) were randomized to receive either daily fimasartan 60 mg or fimasartan/amlodipine 60 mg/10 mg. The primary efficacy end point was the change in SiSBP from baseline to week 8. Secondary end points included the change in SiSBP from baseline to week 4, the changes in sitting diastolic blood pressure from baseline to weeks 4 and 8, and the response rate (SiSBP <140 mm Hg or decrease in SiSBP ≥20 mm Hg) or control rate (SiSBP <140 mm Hg) at week 8. Treatment-emergent adverse events were also assessed. FINDINGS Of 143 patients randomized to treatment, 137 patients who had available efficacy data were analyzed. The mean age of patients was 59.1 (8.9) years, and 100 (73.0%) were male. Baseline SiSBP and sitting diastolic blood pressure were 150.6 (9.2) mm Hg and 91.7 (8.6) mm Hg, respectively. In the fimasartan/amlodipine combination group, a greater reduction in SiSBP from baseline to week 8 was observed compared with the fimasartan group (7.8 [13.3] mm Hg in the fimasartan group vs 20.5 [14.6] mm Hg in the fimasartan/amlodipine group; P < 0.0001). This reduction was observed after 4 weeks. The mean SiSBP changes from baseline to week 4 were 8.1 (15.8) mm Hg in the fimasartan group and 20.1 (14.7) mm Hg in the fimasartan/amlodipine group (P < 0.0001). At week 8, the response rate was significantly higher in the fimasartan/amlodipine (82.1%) group than in the fimasartan (32.9%) group (P < 0.0001). The control rate at week 8 was also higher in the fimasartan/amlodipine (79.1%) group than in the fimasartan (31.4%) group (P < 0.0001). Adverse drug reactions were observed in 9 patients (6.3%), with no significant differences between treatment groups. There were no serious adverse events associated with the study drugs. IMPLICATIONS Fimasartan/amlodipine combination therapy exhibited superior efficacy in reducing blood pressure, with no increase in adverse drug reactions, compared with fimasartan monotherapy. ClinicalTrials.gov identifier: NCT02152306.
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Affiliation(s)
- Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Mi-Seung Shin
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sang-Hyun Ihm
- Department of Internal Medicine, Bucheon St. Mary׳s Hospital, College of Medicine, The Catholic University of Koreau, Bucheon, Republic of Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chang-Wook Nam
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Republic of Korea
| | - Hong Seog Seo
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Joong Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Kook Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Byung-Su Yoo
- Division of Cardiology, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei Health System, Seoul, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine,Ulsan, Republic of Korea
| | - Dong-Soo Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Doo Il Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Jin-Ok Jeong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Cheol Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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