Geropharmacology for the rheumatologist

One step derivatization and dispersive liquid-liquid microextraction of hydroxychloroquine sulfate for its sensitive and accurate determination using GC-MS

In the present study, a novel analytical method for the determination of hydroxychloroquine sulfate in human serum and urine samples was established. One step derivatization and dispersive liquid-liquid microextraction (DLLME) was developed for quantitative determination of hydroxychloroquine sulfate in aqueous samples. Hydroxychloroquine sulfate was first hydrolyzed and converted to its benzoate derivative by adding benzoyl chloride in chloroform which also served as extraction solvent. Significant parameters such as type/volume of extraction and dispersive solvents, concentration/volume of sodium hydroxide, type/period of mixing and concentration of derivatizing agent were carefully optimized by one variable at a time approach. Under the optimum DLLME conditions, limit of detection (LOD), quantitation (LOQ) and dynamic range were calculated as 35.2, 117.2 and 96-1980 μg/kg (ppb), respectively. Recovery studies were conducted by spiked human serum and urine samples and the results were ranged between 93 and 107% with low standard deviations. Developed method can be easily used in hydroxychloroquine sulfate based SARS-CoV-2 and malaria treatment studies.

Cyclodextrin-mediated gold nanoparticles as multisensing probe for the selective detection of hydroxychloroquine drug

β-Cyclodextrin (β-CD) modified gold nanoparticles (AuNP) were rapidly synthesized using microwave assisted procedure. Parameters, such as time, pH and concentrations of β-CD and gold, were optimized for the synthesis of β-CD-AuNP. The addition of enantiomers and racemic mixture of hydroxychloroquine (R-HCQ, S-HCQ and RS-HCQ) drugs and their interaction with β-CD led to a red shift in the surface plasmon resonance of β-CD-AuNP. The changes associated with the introduction of HCQ in β-CD-AuNP were studied using various characterization techniques such as UV-vis, FT-IR, XRD, dynamic light scattering, zeta potential, transmission electron microscopy, fluorescence spectroscopy and electrochemical techniques. The host-guest interaction of β-cyclodextrin with S-HCQ, R-HCQ and RS-HCQ resulted in the aggregation of gold nanoparticles. The surface plasmon resonance at 521 nm for β-CD-AuNP was shifted to 600, 620 and 670 nm on the addition of S-HCQ, R-HCQ and RS-HCQ, respectively, with a color change from pink to blue. The selectivity and sensitivity of the developed system for RS-HCQ were investigated and the limit of detection (LOD=3 s/m) was found to be 2.61, 0.15, and 0.85 nM for optical, fluorescence and electrochemical methods, respectively. The successful monitoring of RS-HCQ drug in pharmaceutical samples is possible with these techniques.

Electronic Supplementary Material

Supplementary material is available for this article at 10.1007/s11814-020-0719-7 and is accessible for authorized users.

Study of the structural, chemical descriptors and optoelectronic properties of the drugs Hydroxychloroquine and Azithromycin

Density functional theory (DFT) was performed in order to predict the structural, chemical descriptors and optoelectronic properties of the drugs Hydroxychloroquine and Azithromycin using the wB97XD, O3LYP and B3LYP functional with 6-31+G(d,p) basis set. It is observed from our studies that most of the descriptors presented show association with some processes, including absorption, blood-brain barrier transport, binding and even toxicity. Hence, the treatment of COVID-19 using Hydroxychloroquine and Azithromycin in some patients as single dose and their combination in patients with Corona virus resistance can be more effective. Our results show that these therapeutic molecules may also have good nonlinear optical applications, may have semiconductor character with wide band gap and can also be promising materials in the production of optoelectronic devices. The density of states and thermodynamic properties were equally determined.

Disease-Modifying Antirheumatic Drug Use in the Elderly Rheumatoid Arthritis Patient

During the 10-year period since the last review was done by Gardner and Furst, studies have furthered the knowledge of the use of disease-modifying antirheumatic drugs (DMARDs) in the elderly rheumatoid arthritis (RA) patient. This article briefly reviews the clinical pharmacology of humans as they age, and details the effects of aging on the specific pharmacokinetics and responses to commonly used DMARDs. There has been some progress in understanding the elderly RA patient; however, data are insufficient to provide much confidence in DMARDs effects in the elderly.

Tolerance and effectiveness of anti–tumor necrosis factor α therapies in elderly patients with rheumatoid arthritis: A population-based cohort study

OBJECTIVE

Limited data have been published on tolerance to and efficacy of classic or biologic disease-modifying antirheumatic drugs in elderly patients with rheumatoid arthritis (RA). The goal of the present study was to evaluate the tolerance to and effectiveness of anti-tumor necrosis factor (anti-TNF) agents in elderly patients (> or =65 years old) with RA (ERA) in comparison with younger patients (YRA).

METHODS

The Swiss Clinical Quality Management program for RA is a longitudinal population-based cohort. All patients who had received at least 1 dose of anti-TNF agents between January 1997 and November 2005 were included and categorized according to their age. Tolerance was assessed by analyzing discontinuation rates of anti-TNF agents. Effectiveness of these agents was assessed by analyzing RA disease activity (Disease Activity Score in 28 joints [DAS28]) and functional disability (Health Assessment Questionnaire [HAQ]) after anti-TNF initiation.

RESULTS

Among 1,571 patients with RA treated with anti-TNF agents, 344 were > or =65 years of age at treatment initiation. Drug discontinuation rates (median time 3 years) and mean change in DAS28 scores at 2 years (-0.65 versus -0.58) were identical in ERA and YRA. However, HAQ score improved significantly less in ERA (-0.02) than in YRA (-0.1) and a subsequent analysis revealed that this finding was essentially due to patients >75 years of age.

CONCLUSION

Age in itself should not interfere with the decision to treat elderly patients with RA with anti-TNF agents. In a subset of patients ages >75 years, no functional improvement according to HAQ should be expected despite improvements in disease activity.

Disease-modifying antirheumatic drug use in the elderly rheumatoid arthritis patient

During the 10-year period since the last review was done by Gardner and Furst, studies have furthered our knowledge of use of disease-modifying antirheumatic drugs (DMARDs) in the elderly rheumatoid arthritis (RA) patient. This article will briefly review the clinical pharmacology of human as they age, and detail the effects of aging on the specific pharmacokinetics and responses to commonly used DMARDs. There has been some progress in understanding the elderly RA patient, however, there is insufficient data for much confidence in DMARDs effects in the elderly.

Management Issues with Elderly-Onset Rheumatoid Arthritis

Elderly-onset rheumatoid arthritis (EORA) is defined as rheumatoid arthritis (RA) starting at >60 years of age. EORA is characterised by a lower female/male ratio compared with RA in younger patients and it more frequently has an acute onset accompanied by constitutional symptoms. Two incompletely overlapping subsets of RA have been recognised: one exhibits the classical RA clinical picture while the other has a polymyalgia rheumatica-like appearance, characterised by shoulder involvement, absence of rheumatoid factor and, usually, by a nonerosive course. Identification of anti-cyclic citrullinated peptide antibodies is useful for distinguishing the latter subset from true polymyalgia rheumatica. Elderly-onset spondyloarthritis, crystal-related arthritis, remitting seronegative symmetrical synovitis with pitting oedema syndrome and hepatitis C virus-related arthritis must also be considered in the differential diagnosis. EORA treatment requires prudence because of the increase in age-related risks pertaining principally to the renal, cardiovascular and gastrointestinal systems. No groups of molecules usually employed for RA therapy in younger subjects (analgesics, NSAIDs, corticosteroids, disease-modifying antirheumatic drugs, anticytokine drugs) can be excluded a priori from the treatment of EORA patients. Nevertheless, the risk/benefit ratio relating to their use must be accurately evaluated for every single patient. Recently marketed compounds such as leflunomide and tumour necrosis factor-alpha antagonists have also increased the therapeutic opportunities for aged RA patients.

Inflammatory rheumatologic disorders in the elderly. Unusual presentations, altered outlooks

Comorbidities, metabolic alterations, immunosenescence, and use of drugs may affect the manifestation, clinical course, immunopathogenesis, and prognosis of inflammatory rheumatologic disease in older persons. These factors need to be considered in evaluation and treatment in the geriatric population. In this article, Drs Belostocki and Paget discuss rheumatologic disorders that typically occur in advanced age, as well as those that characteristically occur in younger patients but may present de novo in the elderly.